Agenda Pack
North Lanarkshire Council · 14 February 2023
Back to IJB Performance, Finance and Audit Committee — 14 February 2023 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 Tuesday 14th February at 3.00pm 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 (16.11.22) 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. Maintaining a Positive Balance of Care For Noting Attachment M Dendy FINANCE & AUDIT 7. Financial Monitoring For Noting Attachment A Kilburn 8. Financial Regulations For Noting Attachment A Kilburn PERFORMANCE 9. Covid-19 Update / Resilience Response For Noting Attachment R McGuffie 10. Annual Performance Report 2021-22 For Approval Attachment R McGuffie 11. Performance Report Q2 For Noting Attachment M Dendy
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12. MAT Standards For Noting Attachment M Dendy 13. Mental Health Strategy Update For Noting Attachment M Thomson 14. NSS Screening For Approval Attachment R McGuffie 15. Cancer Inequalities For Noting Attachment R McGuffie 16. 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 17. Date of Next Meeting: 19th April 2023 9.30am-12pm
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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
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ITEM 4 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 Reserve strategy coming to March 23 IJB alongside SCP and Financial Plan 2. Feb/March 2020 Comments received from circulated papers Internal Audit Plan 19/20 Progress Report A Kilburn 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 Owner changed to AK
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ITEM 4 2. Service Level Agreement to be drafted around disaggregation of Children’s & Families & Justice Social Work Budgets. Revised timescale – September 2022 Action currently on hold due to National Care Service exercise underway 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 Ongoing Complete Complete 4. 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 5. 16.2.22 Item 6 Finance A Kilburn 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 6. 16.2.22 Item 6 Comms M Dell Update requested on development of H&SC NL website August 2022 Ongoing
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ITEM 4 7. 16.2.22 Item 6 Finance A Kilburn/CFO Longer term SLA to be developed for Hosted service arrangements. February 2023 Ongoing Owner changed to AK 8. 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 9. 16.2.22 Item 9 Financial Plan A Kilburn Update to be provided within Financial Plan on 10% budget being committed to frontline MH staffing February 2023 Ongoing Owner changed to AK c£66m is spent on staffing which equates to 90% of the MH budget. This is 25.18% of current staffing establishment. Staffing establishment figures are updated and reported in the financial monitoring reports. Complete 10. 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 On agenda
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ITEM 4 11. 31.8.22 Item 6 IJB Self-Assessment Report R McGuffie Consider hosting a development session to further explore the self-evaluation work Ongoing – future Liaison session topic
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1 REPORT Item No: 5 1. PURPOSE OF REPORT This paper is coming to the IJB Performance, Finance and Audit Sub- Committee ; 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 IJB PFA SUB COMMITTEE This paper has been: Prepared Reviewed Endorsed By: The Senior Leadership Team 3. RECOMMENDATIONS 3.1 The Sub-Committee 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 Sub Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer North HSCP DATE: 14th February 2023 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 16th November 2022. No changes to the risk rating were recommended at that meeting however the actions associated with each risk have been updated. The register was also reviewed at the IJB on 30th November 2022. 5.3 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 5.4 These risks were reviewed on 17th January 2023 and will be subject to further review with the new Chief Finance Officer as part of the financial planning exercise for 2023/24. 5.5 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 5.6 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 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 High NHSL Corporate
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3 complexities of opportunity lost due to the current reprioritising of services in response to COVID-19. 2039 Staff Fatigue, Resilience, Wellbeing & Safety – Effects of prolonged Covid response is adversely impacting on staff, increasing staff absence and consequently reducing workforce capacity. High NHSL Corporate 2124 Sustaining a Safe Workforce – unable to sustain necessary safe workforce to meet changing priorities and service demands Very High NHSL Corporate 2126 Sustaining Out of Hours Primary Care Service Very High NHSL Corporate 2086 Sustaining GP Services 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 NLC RIA0000460 Performance & planning – increasing expectations and High NLC – Social Work/Social care
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4 changing performance demands will result in a failure to provide performance information internal, external and including S Govt, 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 7.6 STAKEHOLDER ENGAGEMENT
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5 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 28.02.23 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 28.02.23 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 30.06.23 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 30.06.22 Previously IJB11. Previously IJB20.M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.23 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 31.12.23 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 28.02.23 Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 28.02.23 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 30.06.23 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 31.12.23 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 28.02.23 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. M edium medium Ross M cGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 30.06.23 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 High medium Ross M cGuffie M orag Dendy IJB,PF&A, SLT 28.02.23 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 28.02.23 SLT, IJB 28.02.23 SLT, IJB PFA, IJB 28.02.23 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 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 8. Whole system 'firebreak' and associated improvement cycle in development for Feb/Mar 23 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 30.06.23 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: Maintaining a Positive Balance of Care TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author of Report: Graeme Cowan, Senior Manager, Strategy & Performance DATE: 14th February 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Committee: For approval For endorsement To note 1.2 The Health and Social Care Partnership is fully committed to ensuring that people are supported to live full and active lives in their own homes and localities, minimising the use of hospital and other care settings. This report is to advise Committee of a range of key metric which compare the performance in North Lanarkshire across other Scottish councils which demonstrate the sustained efforts to maintain a positive balance of care. 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Senior Manager, Strategy & Performance Reviewed By: Head of Planning, Performance & Quality Assurance Endorsed By: 3. RECOMMENDATIONS 3.1 The Committee is asked to: i) Endorse and support the balance of care within North Lanarkshire; and ii) Note the contents of the report 4. BACKGROUND/SUMMARY OF KEY ISSUES 4.1 The Health and Social Care Partnership is fully committed to ensuring that people are supported to live full and active lives in their own homes and localities, minimising the use of hospital settings. This purpose of this report is to update Committee on the positive balance of care within North Lanarkshire, in comparison with other partnerships across Scotland, and to provide committee with an overview of the supports and services in place to help people live as independently as possible in their own homes for as long as possible.
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2 5. BALANCE OF CARE 5.1 The provision of social care and support in North Lanarkshire is spread across a range of organisations and settings and much of it is co-designed to meet a diverse and complex range of individuals’ needs across North Lanarkshire’s communities. 5.2 The balance of care is a term commonly used to refer to the balance of support and care available within community-based settings (e.g. home care, self directed support, day services, voluntary sector supports, support for carers), when compared with the support and care available within residential settings (e.g. care homes, NHS continuing care provision, etc.). 5.3 North Lanarkshire has, for many years, had a positive balance of care, which means that the considerable investment in community-based supports over time has resulted in a high proportion of individuals with long-term and complex needs being able to continue to live as independently as possible within their own homes. 5.4 In order to allow comparison across different partnership areas, there is a standard performance metric which looks at the proportion of individuals aged 18 and over who have long term needs and who receive personal care at home. This metric has been used for benchmarking purposes through Health & Social Care Partnerships’ Annual Performance Reports (APRs) and is key metric within the National Indicator Set designed to measure the overall impact of health and social care integration. This particular metric reflects very positively the long-term efforts in North Lanarkshire to create and sustain the range of supports outlined above. As the chart below illustrates, North Lanarkshire has the second highest proportion of individuals aged 18 and over with long terms needs who receive personal care at home in Scotland. This has remained consistent over recent years with approximately 75% of people aged 18 and over with long term care needs receiving personal care at home. Chart 1: Percentage of people aged 18+ with long term needs receiving personal care at home (2021)
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3 Source: Insights in social care: statistics for Scotland 2020/21 5.5 It is also helpful to consider an additional metric for benchmarking with other partnership areas, namely the percentage of individuals over the age of 65 who have long term care needs and receive 10 or more hours of home care per week. This again reflects positively on the balance of care within North Lanarkshire, with over 50% of individuals over the age of 65 with long term needs receiving 10 or more hours of home care per week. This is the second highest percentage in Scotland. Chart 2: Percentage of people aged 65 and over with long term care needs receiving 10+ hours of home care
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4 Source: Insights in social care: statistics for Scotland 2020/21 6. CARE HOME STAYS 6.1 As outlined in the previous section, the balance of care in North Lanarkshire tips favourably towards community-based supports compared with most other Health & Social Care Partnerships. Perhaps it is therefore unsurprising to note that the overall number of registered places in care homes within North Lanarkshire is lower than the Scottish average and lower than the majority of other partnership areas relative to its overall size of population. The chart below illustrates the number of registered places in care homes for older people (aged 65 and over). Chart 3: Rate of registered places in care homes for older people per 1,000 population aged 65 and over (2022) Source: Care home census for adults in Scotland, Statistics on Care Homes and Residents for Years 2011 to 2022
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5 7. SOCIAL WORK EXPENDITURE 7.1 The overall balance of care within North Lanarkshire should also be seen within a financial context, and in terms of the overall resources available to the service and its partners. The importance we have placed in ensuring individuals, particularly those with complex and long term needs, are supported to live independently within their own home and within their own communities is reflected in the profile of the service’s expenditure. Also, when comparing overall gross social work spend on those aged 18 and over, North Lanarkshire’s overall spend per capita is lower than the Scottish average and lower than the vast majority of other partnership areas which is perhaps even more noteworthy given the pattern of social and economic deprivation across North Lanarkshire. Chart 4: Gross social work spend per head of population (aged 18+) Source: Local Government Benchmarking Framework 2020/21 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES Maintaining a positive balance of care impacts on all National Health & Wellbeing Outcomes, and specifically relates to: National Outcome 2: People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 8.2 ASSOCIATED MEASURE(S) The partnership continues to monitor progress across all service areas through its performance framework and quarterly Chief Executive Performance Reviews and balance of care metrics are included within the National Indicator set, reported via Annual Performance Reports. 8.3 FINANCIAL None 8.4 PEOPLE None 8.5 INEQUALITIES
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6 EQIA Completed: Yes No N/A 9. BACKGROUND PAPERS None 10. APPENDICES None ............................................................................. HEAD OF PLANNING, PERFORMANCE AND QUALITY ASSURANCE Members seeking further information about any aspect of this report, please contact Graeme Cowan on telephone number 07946702861.
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1 REPORT Item No: 7 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 9 December 2022. 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; (2) Note the financial position is a year-to-date underspend of £10.467m and: (3) Note the updated position regarding the return of unallocated Covid-19 ring- fenced reserves in sections 8.5 and 8.6. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND 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 As detailed in the following table, the IJB year to date position is an underspend of £10.467m and the projected outturn for 2022/23 is an underspend of £14.325m, assuming the current trajectory of spend continues throughout this financial year. Service Year to Date Position £m Projected Year End Outturn £m Health Care Services 4.601 5.902 Social Care Services 5.866 8.423 Total North Lanarkshire HSCP 10.467 14.325 SUBJECT: Financial Monitoring Report 2022/2023 TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Amanda Kilburn, Chief Financial Officer DATE: 14th February 2023 Yes No N/A
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2 6.2 Subject to IJB approval, this estimated 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. 6.3 The following provides a high-level summary of the key pressures and the main reasons why the IJB is currently projecting an underspend against its budget this year: Employee Costs net underspend of £10.291m: as previously highlighted there are ongoing challenges in terms of recruitment and retention issues across all service areas. For a wide range of posts recruitment has been unsuccessful due to the availability of the skills mix required or the competition being offered by other private and public sectors. These are issues that are being faced by IJBs across Scotland. Home Support net overspend of £0.377m: within Home Support Services, employee costs have increased as the service continues to support delayed discharges and demand however, this additional cost is being part funded from an earmarked reserve and the current number of vacant posts throughout other parts of the partnership. Payments to Other Bodies net underspend of £2.636m: 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. There is also an underspend in package costs due to slippage in Self-Directed Support (SDS) start dates. It is anticipated these are in-year underspends only and the full budget will be required in future years. Independent Care Homes net overspend of £0.425m: there are currently 1,487 care packages within this service however when the budget was set for this financial year, it was based on 1,361 care packages. This has resulted in the service experiencing a pressure on the current allocated budget. Admin Costs net underspend of £1.862m: within the carers funding there is currently an unallocated budget of £1.8m. 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. Prescribing breakeven: Though prescribing is currently projecting a breakeven position, activity is 4% higher compared to the same period last year, however the cost per item is lower due to a reduction in the tariff price. Due to the uncertainty around costs and prescribing activity, the volatility experienced within prescribing is likely to continue for the foreseeable future. 6.4 Throughout the financial year, adjustments are made to the original budget due to additional funding allocations and budget transfers. Appendix 4 provides a reconciliation of the main budget adjustments applied this financial year.
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3 7. RESERVES 7.1 It is important 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 statue and is part of a range of measures in place to ensure that s106 public bodies do not over-commit themselves financially. 7.2 The current IJB reserves position for 2022/23 is a revised balance of £93.954m and is summarised in the table below. A detailed analysis of these reserves is at Appendix 5: LEAD SUMMARY Opening Balance at 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance at 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 44.999 (0.065) (9.617) 35.317 NHSL & NLC Earmarked Reserves 30.573 4.787 (6.235) 29.125 NHSL & NLC Risk-Based Reserves 18.894 0.405 (0.796) 18.503 NHSL Contingency Reserves 4.167 6.842 - 11.009 NHSL & NLC Closed Reserves 20.819 (11.969) (8.850) - Total 119.452 0.000 (25.498) 93.954 7.3 The IJB Reserves Strategy 2022/2023 will be presented to the IJB in March 2023. This updated strategy will include the revised structure of the reserves which will continue to enable the IJB to meet its agreed strategic objectives, and Scottish Government policy requirements. 8. COVID-19 8.1 Each month Covid-19 costs are being reported to the Scottish Government through the Lanarkshire Finance Performance Return (FPR). The costs incurred to date of £5.375m are included within the financial position reported and will be met by an existing IJB Covid-19 Reserve. 8.2 Whilst the scale of Covid-19 costs has reduced significantly in 2022/23 and are projected to reduce further in 2023/24, Scottish Government recognises that there are specific legacy costs that will require additional funding support in the new financial year. This includes funding for: Vaccinations staffing and delivery; Test and protect activities; Additional PPE requirements; and Some specific public health measures.
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4 8.3 Beyond the above, IJBs have been advised to expect to meet remaining costs from baseline funding. 8.4 The following table summarises the main areas of expenditure incurred to date and the projected cost to year end: 8.5 Scottish Government have confirmed the balance of £24.051m is to be returned from North Lanarkshire in respect of IJB Covid-19 reserves. This will be carried out by Scottish Government reducing the allocation given to NHSL pending a local arrangement between IJB and NHSL to off-set this reduction. 8.6 The table below shows the current position before and after this transfer: 9. CURRENT VACANCY POSITION 9.1 As highlighted throughout this report, employee costs are projecting a significant underspend within all services. Recruitment continues to be progressed for vacant posts in all areas. 9.2 The table below shows the current full time equivalent (FTE) vacancy numbers within each service against the budgeted establishment: Costs Incurred to Date Projected Full Year Costs Costs Incurred to Date Projected Full Year Costs £m £m £m £m £m Provider Sustainability Payments 1.638 2.106 - - 2.106 Additional Staff Costs - - 0.120 0.140 0.140 Primary Care Remobilisation Costs - - 1.408 2.177 2.177 Mental Health Assessment Hub - Hospital at Home & Unscheduled Care - - 2.209 3.147 3.147 TOTAL 1.638 2.106 3.737 5.464 7.570 Description of Cost TOTAL Covid-19 Total Estimated Cost 2022/23 Social Care Health Opening Balance As At 1 April 2022 Pending Drawdown from Reserves Return of Covid-19 Reserves to Scottish Government Revised Balance As At 31 March 2023 £m £m £m £m Covid-19 Funding 29.677 (5.626) (24.051) 0.000 Covid-19 Funding - Unscheduled Care 1.944 (1.944) 0.000 TOTAL 31.621 (7.570) (24.051) 0.000 Ring-Fenced Covid-19 Reserve
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5 9.3 To help cover the current vacant posts, agency staff, bankaide, overtime and excess part time hours are used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at Appendix 6. 10. DELEGATED SERVICES 10.1 The following table shows the costs of other North Lanarkshire Council services delegated to the IJB. The IJB remain accountable for these services, however, they continue to be delivered by North Lanarkshire Council. North Lanarkshire HSCP monitors the delivery of these services on behalf of the IJB. 10.2 The projected outturn position to 31 March 2023 is a breakeven position for both services. Service Annual Budget £m Projection to Year End £m Variance £m Housing 1.870 1.870 - Breakeven Transport 0.551 0.551 - Breakeven Total 2.421 2.421 - Breakeven 11. IMPLICATIONS 11.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. SERVICE ESTABLISHMENT (FTE) ACTUAL (FTE) VACANCIES (FTE) VACANCIES (%) North West Locality 384.98 344.63 40.35 10.5% North East Locality 323.53 300.25 23.28 7.2% Adult Services 273.56 249.25 24.31 8.9% Children Services 551.69 470.08 81.61 14.8% Mental Health 1,160.08 1,090.82 69.26 6.0% Social Care Services 834.20 666.10 168.10 20.2% Home Support 1,000.07 995.99 4.08 0.4% Other 123.57 215.16 -91.59 -74.1% TOTAL 4,651.68 4,332.28 319.40 6.9% SERVICE Overtime Year to Date Cost £ Excess Part Time Year to Date Cost £ Bankaide Year to Date Cost £ Agency Year to Date Cost £ North West Locality 109,382 29,493 386,000 28,505 North East Locality 59,213 34,183 257,000 - Adult Services 42,115 57,623 144,000 44,585 Children Services 119,456 70,769 297,000 11,948 Mental Health & Learning Disabilities 368,491 67,014 1,655,000 2,001,234 Social Care Services 713,752 - - 20,540 Home Support 2,897,656 - - - Other 22,645 12,987 33,000 - TOTAL 4,332,710 272,069 2,772,000 2,106,812
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6 11.2 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. 11.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 11.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. 11.5 PEOPLE None 11.6 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. 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 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 North Lanarkshire IJB Reserves Appendix 5 Analysis of Additional Employee Costs Appendix 6 ........................................... 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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7 North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Expenditure Annual Year To Date Variance Budget Budget Actual Total 2022/2023 November 2022 November 2022 November 2022 £m £m £m £m Health Care Services Locality and Other Services 51.639 32.624 30.731 1.893 Addiction Services 5.272 2.075 1.548 0.527 Medical and Nursing Directorate 4.940 3.038 3.078 (0.040) Prescribing 69.582 46.388 46.388 0.000 Out of Area Services 4.571 3.047 3.216 (0.168) Area Wide Services 10.579 6.317 6.245 0.072 Hosted Services 163.003 103.430 101.116 2.314 Family Health Services 109.438 75.307 75.307 0.000 Set-Aside Budget 66.858 44.572 44.572 0.000 Covid-19 2.462 2.446 2.441 0.004 Total Expenditure - NHSL 488.344 319.245 314.643 4.601 Social Care Services Social Care Services Gross Expenditure 241.738 157.670 151.980 5.690 Social Care Services Gross Income (Including Covid-19 Income) (2.877) 3.926 3.750 0.175 Social Care Services Net Expenditure 238.861 161.596 155.730 5.866 Housing Revenue Account Expenditure 1.870 1.325 1.325 0.000 Transport Services Expenditure 0.551 0.169 0.169 0.000 Social Care, Housing and Transport Services Net Expenditure 241.282 163.090 157.225 5.866 Total Expenditure - NHSL and NLC 729.626 482.335 471.868 10.467 Funded By: Annual Budget 2022/2023 £m NHS Lanarkshire Funding (467.705) Social Care Funding (22.964) Resource Transfer (23.421) Commissioned Services (6.718) Scottish Government Funding - Covid-19 and Remobilisation (2.670) Transfer from Reserves (Approved) (17.969) Total Funding - NHSL (541.446) 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 (729.626) 2022/2023 Year To Date
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8 Hosted Services Appendix 2 November 2022 November 2022 November 2022 November 2022 November 2022 November 2022 November 2022 November 2022 November 2022 Budget Actual Variance Budget Actual Variance Budget Actual Variance 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 2.984 1.993 1.880 0.113 1.522 1.017 0.904 0.113 1.462 0.977 0.977 0.000 Continence Services 2.361 1.574 1.585 (0.012) 1.204 0.803 0.814 (0.012) 1.157 0.771 0.771 0.000 Immunisation Services 1.898 1.071 1.782 (0.711) 0.968 0.546 1.257 (0.711) 0.930 0.525 0.525 0.000 Speech and Language Therapy Services 6.114 4.081 3.501 0.580 3.118 2.081 1.502 0.580 2.996 2.000 2.000 0.000 Children and Adolescents Mental Health Services 16.419 7.393 6.657 0.736 8.374 3.770 3.035 0.736 8.045 3.623 3.623 0.000 Childrens Services 12.437 8.023 7.787 0.236 6.343 4.092 3.855 0.236 6.094 3.931 3.931 0.000 Integrated Equipment and Adaptations Store 0.567 0.378 0.367 0.012 0.289 0.193 0.181 0.012 0.278 0.185 0.185 0.000 Dietetics Services 3.854 2.560 2.370 0.190 1.966 1.306 1.116 0.190 1.889 1.254 1.254 0.000 Podiatry Services 4.357 2.902 2.810 0.092 2.222 1.480 1.388 0.092 2.135 1.422 1.422 0.000 Prisoner Healthcare Services 1.707 1.138 1.105 0.033 0.870 0.581 0.547 0.033 0.836 0.558 0.558 0.000 Blood Borne Viruses Services 1.529 1.019 0.962 0.057 0.780 0.520 0.463 0.057 0.749 0.499 0.499 0.000 Hospital at Home 2.502 1.499 1.350 0.149 1.276 0.764 0.615 0.149 1.226 0.734 0.734 0.000 Mental Health and Learning Disability Services 73.916 49.728 48.889 0.839 37.697 25.361 24.522 0.839 36.219 24.367 24.367 0.000 TOTAL 130.644 83.359 81.045 2.314 66.628 42.513 40.199 2.314 64.015 40.846 40.846 0.000 Led by the North Partnership South Lanarkshire IJB - 49% Share Year to Date Annual Budget 2022/2023 Annual Budget 2022/2023 Year to Date North Lanarkshire IJB - 51% ShareYear to DateAnnual Budget 2022/2023 Hosted Services Appendix 3 November 2022 November 2022 November 2022 November 2022 November 2022 November 2022 November 2022 November 2022 November 2022 Budget Actual Variance Budget Actual Variance Budget Actual Variance 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 7.488 4.874 4.473 0.401 3.819 2.486 2.486 0.000 3.669 2.388 1.987 0.401 Brain Injury Unit 2.365 1.081 1.212 (0.131) 1.206 0.551 0.551 0.000 1.159 0.530 0.660 (0.131) Out of Hours Services 8.919 5.874 5.856 0.017 4.548 2.996 2.996 0.000 4.370 2.878 2.861 0.017 Palliative Care Services 7.218 4.845 4.732 0.114 3.681 2.471 2.471 0.000 3.537 2.374 2.260 0.114 Physiotherapy Services 10.204 6.816 6.469 0.347 5.204 3.476 3.476 0.000 5.000 3.340 2.993 0.347 Primary Care Services 0.801 0.527 0.490 0.037 0.409 0.269 0.269 0.000 0.393 0.258 0.221 0.037 Occupational Therapy Services 7.975 5.346 4.921 0.425 4.067 2.727 2.727 0.000 3.908 2.620 2.195 0.425 Diabetic Services 4.945 3.690 3.634 0.056 2.522 1.882 1.882 0.000 2.423 1.808 1.752 0.056 Telehealth 0.660 0.340 0.209 0.132 0.336 0.174 0.174 0.000 0.323 0.167 0.035 0.132 Sub Total 50.576 33.394 31.995 1.398 25.794 17.031 17.031 0.000 24.782 16.363 14.965 1.398 Ring Fenced Funding Primary Care Improvement Fund 12.874 5.961 5.961 0.000 6.566 3.040 3.040 0.000 6.308 2.921 2.921 0.000 Primary Care Transformation Fund 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Sub Total 12.874 5.961 5.961 0.000 6.566 3.040 3.040 0.000 6.308 2.921 2.921 0.000 TOTAL 63.449 39.354 37.956 1.398 32.359 20.071 20.071 0.000 31.090 19.284 17.885 1.398 Annual Budget 2022/2023 Year to Date South Lanarkshire IJB - 49% Share Led by the South Partnership Annual Budget 2022/2023 Year to Date Annual Budget 2022/2023 Year to Date North Lanarkshire IJB - 51% Share
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9 North Lanarkshire IJB Appendix 4 Movement on Reserves Audit Trail NHSL & NCL 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 44.999 (0.065) (9.617) 35.317 NHSL & NLC Earmarked Reserves 30.573 4.787 (6.235) 29.125 NHSL & NLC Risk-Based Reserves 18.894 0.405 (0.796) 18.503 NHSL Contingency Reserves 4.167 6.842 11.009 NHSL & NLC Closed Reserves 20.819 (11.969) (8.850) 0.000 119.452 0.000 (25.498) 93.954 LEAD SUMMARY Total 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 NLC Financial & Strategic Planning 2023/2026 5.416 1.017 6.433 NLC Long Covid Contingency 3.000 (0.727) 2.273 NHSL Prescribing Fund 4.361 4.361 NLC Social Care Demand 6.117 (0.612) (0.069) 5.436 18.894 0.405 (0.796) 18.503 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 6.842 11.009 4.167 6.842 0.000 11.009 RISK-BASED RESERVES TOTAL RISK-BASED RESERVES LEAD CONTINGENCY FUND RESERVES TOTAL CONTINGENCY FUND RESERVES LEAD 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 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 Blood-Borne Viruses Services 0.146 0.146 NHSL Children and Adolescent Mental Health Services 5.283 (3.865) 1.418 NHSL Community Living Change Fund 1.298 1.298 NHSL Covid-19 Funding 29.742 (0.065) (2.670) 27.007 NHSL Covid-19 Funding - Unscheduled Care 1.944 1.944 NHSL Mental Health and Learning Disability Services - Veteran's First Point 0.026 (0.003) 0.023 NHSL Mental Health Improvement Fund - Psychology 0.084 (0.031) 0.053 NHSL Mental Health Infant - NES Funding 0.013 (0.004) 0.009 NHSL Mental Health Innovation Funding 0.120 0.120 NHSL Mental Health Recovery Renewal - Facilities Projects 1.840 (0.948) 0.892 NHSL Mental Health Support for Those Hospitalised with Covid-19 0.172 (0.134) 0.038 NHSL Mental Health Wellbeing in Primary Care Services 0.148 0.148 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 44.999 (0.065) (9.617) 35.317 LEAD RING-FENCED RESERVES TOTAL RING-FENCED RESERVES
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10 Appendix 4 (cont.) 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 Adult Social Care Winter Preparedness Fund 1.941 1.941 NLC Adaptations Fund 0.289 (0.200) 0.089 NLC Adult Protection (share with C&F and NHSL) 0.050 (0.017) 0.033 NLC Advocacy Services 0.123 0.061 (0.045) 0.139 NHSL Area Wide Services - Health Promotion - North Lanarkshire Leisure agreement 0.123 0.123 NHSL Area Wide Services - Pre School Vision Screening 0.075 0.075 NHSL Area Wide Services - Primary Care Corporate (iHUB Project - NES funding) 0.034 (0.021) 0.013 NHSL Area Wide Services - Refugees and Displaced Persons 0.400 (0.125) 0.275 NLC Assistive Technology Contract x 12 months (ATC) 0.000 0.090 (0.062) 0.028 NHSL Business Case - Health Care Support Workers, Multi-Disciplinary Teams 1.794 (1.481) 0.313 NLC Business Case - Non-Recurring NLC Costs 5.380 0.537 (1.941) 3.976 NHSL Care Homes Allocation 0.318 0.318 NLC Carers Act 2018 - Support 0.852 0.852 NHSL Champions Board Funding 0.045 0.153 0.198 NHSL Dietetics Services - Double Running Costs 0.110 (0.098) 0.012 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.694 (0.064) 0.630 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 (0.173) 0.527 NHSL Discharge Support Workers Band 4 x 2 WTE 0.107 0.107 NHSL Distinction Awards 0.036 0.036 NLC Financial Strategy - Changes to LA Services Muirpark 2.973 (1.242) 1.731 NHSL Forensic Band 3 x 5 WTE 0.147 0.147 NHSL GPIT Reprovisioning Gap 0.181 0.181 NHSL Health Inequalities - Screening 0.098 (0.004) 0.094 NHSL Health Visiting Students/Trainees 0.840 0.840 NHSL High Resource User Posts 0.025 0.027 (0.025) 0.027 NHSL Hospital at Home Services - Support Development 0.414 (0.288) 0.126 NHSL Integrated Authority Support 6.076 6.076 NHSL Kylepark Works 1.000 1.000 NHSL Long Acting Buprenorphine 0.255 0.255 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.107 (0.074) 0.033 NHSL Minor Capital Works 1.387 (0.100) 1.287 NHSL Organisational Development Fund 0.000 0.260 0.260 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.908 0.908 NLC Planned Date of Discharge - Discharge To Assess 0.200 0.241 (0.074) 0.367 NLC Planned Date of Discharge - Locality Social Work Manager Post 0.055 0.096 (0.051) 0.100 NHSL Podiatry Services - Foot Screening 0.459 (0.019) 0.440 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.070 0.070 NHSL Regrading of Posts Including Backpay 0.125 0.125 0.250 NHSL Scottish Clinical Leadership Fellowship 0.045 0.045 NHSL Sexual Health Services - Forensic Medical 0.222 0.222 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.109 0.393 (0.011) 0.491 NLC Social Care Contracting Staff within Quality Assurance Services 0.047 0.028 (0.052) 0.023 NHSL Supervisor Training 0.077 0.077 NLC Unmet Saving 21/22 - IDS/LSS (merging building Coatbridge & Cumbernauld) 0.086 (0.068) 0.018 NLC Violence Against Women (Joint Initiative with SLC and C&F) 0.030 0.030 30.573 4.787 (6.235) 29.125 LEAD EARMARKED RESERVES TOTAL EARMARKED RESERVES
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11 Appendix 4 (Cont.)
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12 Opening Balance As At 1 April 2022 Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Administration Support Services 0.240 (0.239) (0.001) 0.000 NHSL Area Wide Services - Admin 0.080 (0.080) 0.000 NHSL Area Wide Services - Audiology Equipment 0.011 (0.011) 0.000 NHSL Area Wide Services - Locality Funding 0.432 (0.432) 0.000 NHSL Area Wide Services - Mental Health Pharmacy, PCIP and NES SLA with GPs 1.048 (1.048) 0.000 NHSL Area Wide Services - NES Training 0.132 (0.132) 0.000 NHSL Area Wide Services - Update Consolidated Health Information (CHI) 0.015 (0.015) 0.000 NHSL Assistant Support Worker - Promise 0.026 (0.026) 0.000 NLC Carers Act 2018 - Waving of Charges 0.580 (0.580) 0.000 NHSL Children and Adolescent Mental Health Services - Choice and Partnership Approach (CAPA) Team 0.717 (0.717) 0.000 NHSL Children and Adolescent Mental Health Services - Service Improvement Post (Band 7 - 18 months) 0.088 (0.088) 0.000 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.346 (0.346) 0.000 NHSL Children and Adolescent Mental Health Services - Waiting List Co-ordinator (Band 5) 0.038 (0.038) 0.000 NHSL Childrens Services - Childrens Inspection Senior Nurse (3 months) 0.017 (0.017) 0.000 NHSL Childrens Services - Manager Post (1WTE) 0.040 (0.040) 0.000 NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.645 (0.645) 0.000 NHSL CLAN Cancer Support Funding 0.095 (0.095) 0.000 NHSL Clinical Fellow Funding 0.080 (0.080) 0.000 NHSL Clinical Guidelines Post 0.023 (0.023) 0.000 NHSL Clinical Pharmacist - Additions 0.035 (0.035) 0.000 NHSL Community Assessment and Rehabilitation Service - Rehabilitation Pilot 0.023 (0.023) (0.000) NHSL Community WIFI 0.342 (0.342) 0.000 NHSL Development of Health Promoting Culture 0.141 (0.141) 0.000 NHSL Diagnostic Support Service - Dementia Post 0.429 (0.429) 0.000 NHSL Dietetics Services 0.046 (0.046) 0.000 NHSL Dietetics Services - Band 6 0.114 (0.114) 0.000 NHSL Dietetics Services - Diabetes Type 2 and Adult Weight Management 0.024 (0.024) 0.000 NHSL Dietetics Services - Oral Nutrition 0.038 -0.038 0.000 NHSL Dietetics Services - Weight Management 0.049 (0.049) 0.000 NHSL Eating Disorders Funding 0.111 0.065 (0.176) 0.000 NHSL Health Inequalities - Health Promotion Posts 0.006 (0.006) 0.000 NHSL Health Inequalities Funding 0.024 (0.024) 0.000 NLC Home Support Development 0.217 (0.217) 0.000 NHSL Hospital at Home Services - Shortfall 0.110 (0.110) 0.000 NLC IJB Financial Plan Contingency - Allocated to NLC 3.000 (3.000) 0.000 NLC Impact of Covid-19 Pandemic Review 0.100 (0.100) 0.000 NHSL Integrated Support Worker 0.153 (0.153) 0.000 NHSL IT Federated Trust Environment Strategy 0.214 (0.214) 0.000 NHSL Joint Equipment Store 0.554 (0.554) 0.000 NHSL Kings Fund Organisational Development 0.014 (0.014) 0.000 NHSL LD Band 3 x 4 WTE 0.118 (0.118) 0.000 NHSL Long Term Conditions (LTC) Lead Clinician 0.010 (0.010) 0.000 NHSL Maternity and Neonatal Psychological Interventions 0.044 (0.044) 0.000 NHSL Medical Director - Associate Medical Director (MR) 0.074 (0.074) 0.000 NHSL Medical Director - Child Death Review Funding 0.021 (0.021) 0.000 NHSL Mental Health and Learning Disability Services - Action 15 3.019 (3.019) 0.000 NHSL Mental Health and Learning Disability Services - Distress Brief Intervention 1.552 (1.552) 0.000 NHSL Mental Health and Learning Disability Services - Mental Health Improvement Fund 0.254 (0.254) 0.000 NHSL Mental Health PDN 0.2wte for 20/21 spend previously approved 0.011 (0.011) 0.000 NLC Mental Health Practice Assessor 0.006 (0.006) 0.000 NHSL Mental Health Perinatal and Infant 0.532 (0.532) 0.000 NHSL Mental Health Practice Development (HF) 0.047 (0.047) 0.000 NHSL Motherwell Rehabilitation Team Leadership 0.058 (0.058) 0.000 NHSL Neurodevelopmental Pathway OT 0.095 (0.095) 0.000 NHSL Nursing Appointments 0.119 (0.119) 0.000 NHSL Nursing Services 0.125 (0.125) 0.000 NHSL Nursing Services - District Nurse 0.292 (0.292) 0.000 NHSL Nursing Services - Extend Health Improvement Unit posts to March 2020 0.075 (0.075) 0.000 NHSL Nursing Services - Family Nurse Partnership 0.033 (0.033) (0.000) NHSL Nursing Services - Nursing Assoicate Post Band 7 x 0.2 WTE 0.011 (0.011) 0.000 NHSL Nursing Services - Queens Nursing Institute Grants 0.004 (0.004) 0.000 NHSL Nursing Services - Quest Patient Safety Posts 0.003 (0.003) 0.000 NHSL Nursing Services - School Nursing 0.162 (0.162) 0.000 NHSL Nursing Services - Solihull Training 0.018 (0.018) 0.000 NLC Payment to Voluntary Org - Glenboig 0.006 (0.006) 0.000 NHSL Pre School Screening Exclusion Incident Audit 0.025 (0.025) 0.000 NHSL Project Manager - Adverse Events 0.036 (0.036) 0.000 NHSL Promise Funding (2 years) 0.052 (0.052) 0.000 NHSL Psychology Services- Capacity Building 0.117 (0.117) 0.000 NHSL Psychology Services - Improving Access 0.095 (0.095) 0.000 NHSL Psychology Services - Recovery and Renewal Phase 1 & 2 0.614 (0.614) 0.000 NHSL Public Health Intelligence Data Analysts 0.061 (0.061) 0.000 NHSL Public Projection Joint Resourcing 0.075 (0.075) 0.000 NHSL Return to Nursing Students 0.107 (0.107) 0.000 NLC SDS Transformational Team 0.025 (0.025) 0.000 NHSL Sexual Health Services - Health & Homeless Post 0.004 (0.004) 0.000 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) (2 clinics for 2 years) 0.386 (0.382) (0.004) 0.000 NHSL Sexual Health Services - Sexually Transmitted Infections 0.122 (0.011) (0.111) 0.000 NHSL Speech, Language and Therapy Services 0.807 (0.807) 0.000 NHSL Speech, Language and Therapy Services - Contract 0.250 (0.250) 0.000 NHSL Test of Change - High Intensity Service Users 0.027 (0.027) (0.000) NHSL Third Sector Initiatives To Improve Health 0.306 (0.306) 0.000 NHSL Training Fund 0.246 (0.246) 0.000 NHSL Vulnerable Population Post - Health Improvement Funding 0.068 (0.068) (0.000) NLC Winter Plan 0.300 (0.300) 0.000 NHSL Winter Plan - Discharge To Assess 0.010 (0.010) (0.000) 20.819 (11.969) (8.850) 0.000 LEAD CLOSED RESERVES TOTAL CLOSED RESERVES
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13 North Lanarkshire IJB Budget Reconciliation 2022/2023 Appendix 5 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 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 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 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 Draw Down from Reserves 1.740 Junior Doctor Income 2.274 Adustment to Commissioned Services 0.082 Increase to Hosted Services Led by South 0.433 Other Budget Adjustments 0.002 NHSL Financial Allocation at 30 September 2022 532.079 Draw Down from Reserves 1.039 Scottish Government Funding Health Care Support Workers 1.743 Scottish Government Funding for Band 2-4 (North Allocation) 0.933 Increase to Hosted Services Led by South 0.634 Other Budget Adjustments 0.160 NHSL Financial Allocation at 30 October 2022 536.588 Draw Down from Reserves 1.275 Medical Pay Award 4.5% 0.979 Junior Medical 0.132 Increase to Hosted Services Led by South 2.450 Other Budget Adjustments 0.022 NHSL Financial Allocation at 30 November 2022 541.446 Budget Adjustments Posted in Month 8 Budget Adjustments Posted in Month 6 Budget Adjustments Posted in Month 3 Budget Adjustments Posted in Month 4 Budget Adjustments Posted in Month 5 Budget Adjustments Posted in Month 7
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14 Analysis of Additional Employee Costs Appendix 6 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 44,000 32,000 17,500 35,500 209,500 2,000 340,500 2 44,000 32,000 17,500 35,500 209,500 2,000 340,500 3 53,000 34,000 22,000 30,000 205,000 3,000 347,000 4 54,000 30,000 17,000 38,000 216,000 5,000 360,000 5 49,000 33,000 17,000 41,000 212,000 4,000 356,000 6 43,000 31,000 12,000 34,000 196,000 4,000 320,000 7 53,000 32,000 17,000 43,000 221,000 6,000 372,000 8 46,000 33,000 24,000 40,000 186,000 7,000 336,000 TOTAL 386,000 257,000 144,000 297,000 1,655,000 33,000 2,772,000 North West Locality £ Adult Services £ Children Services £ Learning Disabilities £ Mental Health £ Social Care Services £ TOTAL £ 1 1,396 6,804 9,018 19,329 72,766 109,313 2 406 6,804 1,303 37,927 338,077 384,517 3 2,527 6,804 42,413 184,579 236,323 4 4,348 4,796 37,915 199,682 246,741 5 5,698 4,988 38,211 212,758 261,655 6 759 4,797 1,627 49,939 193,626 250,748 7 2,817 4,796 59,821 234,119 7,204 308,757 8 10,554 4,796 97,273 182,799 13,336 308,758 TOTAL 28,505 44,585 11,948 382,828 1,618,406 20,540 2,106,812 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 13,187 8,071 10,569 12,294 49,952 8,427 109,798 4,808 217,106 2 12,032 8,789 3,582 9,091 42,880 73,558 285,090 1,096 436,118 3 21,425 6,426 4,508 7,572 29,605 76,713 277,793 2,558 426,600 4 12,482 4,153 2,223 16,873 30,022 74,719 290,873 2,923 434,268 5 17,069 10,685 3,218 9,750 53,447 87,187 321,181 1,541 504,078 6 10,687 7,575 4,373 14,542 48,147 76,800 326,698 2,629 491,451 7 13,149 4,503 6,412 21,905 55,807 84,165 362,809 4,290 553,040 8 9,351 9,011 7,230 27,429 58,631 113,755 503,326 2,800 731,533 9 118,428 420,088 538,516 TOTAL 109,382 59,213 42,115 119,456 368,491 713,752 2,897,656 22,645 4,332,710 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 6,869 5,164 12,800 6,579 10,496 889 42,797 2 3,401 4,223 7,228 5,775 8,002 796 29,425 3 4,231 6,891 8,791 6,755 9,229 656 36,553 4 3,007 4,827 5,230 8,288 7,947 2,269 31,568 5 3,801 3,348 5,450 7,051 9,240 4,532 33,422 6 3,660 3,937 5,002 11,180 7,207 649 31,635 7 2,077 1,879 6,954 12,542 8,465 1,605 33,522 8 2,447 3,914 6,168 12,599 6,428 1,591 33,147 TOTAL 29,493 34,183 57,623 70,769 67,014 12,987 272,069 Period Period Period Period BANKAIDE COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE AGENCY COSTS YEAR TO DATE EXCESS PART TIME COSTS YEAR TO DATE
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1 REPORT Item No: 8 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 requests that the amendments to the Financial Regulations are noted. 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 Financial Regulations attached as an appendix to this report are noted. 4. VARIATIONS TO DIRECTIONS 5. CONCLUSIONS 5.1 Two minor amendments were recommended by Audit Scotland in their North Lanarkshire IJB 2021/22 Annual Audit Report November 2022 to reflect the budget disaggregation of Children, Families and Justice Services and to note the arrangements for the management of hosted services. These amendments have been made as follows: Section Original Revised Introduction North Lanarkshire Council and NHS Lanarkshire have delegated responsibility to the Board for planning and resourcing service provision for adult and older people health and social care services. North Lanarkshire Council and NHS Lanarkshire have delegated responsibility to the Board for planning and resourcing service provision for the following adult and older people health and social care services: (List Social Care and Health Services) SUBJECT: Financial Regulations TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Amanda Kilburn, Chief Financial Officer DATE: 14th February 2023 Yes No N/A
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2 Section Insert 7 7.1 HOSTED SERVICES In line with the Scottish Government’s Integrated Resources Advisory Group Finance Guidance (section 4.3.1.10), it is agreed that the host partnership requires to manage any in-year overspends or underspends within a hosted service. Financial outturns will be reviewed as part of the annual review of all hosted services, bringing potential for budgetary changes for future years. 6. IMPLICATIONS 6.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 6.2 ASSOCIATED MEASURE(S) None 6.3 FINANCIAL The Financial Regulations will be revised annually. 6.4 RISK ASSESSMENT/RISK MANAGEMENT None 6.5 PEOPLE None 6.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 6.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 7. BACKGROUND PAPERS None. 8. APPENDICES North Lanarkshire HSCP Financial Regulations Appendix 1 ........................................... 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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3 Appendix 1 NORTH LANARKSHIRE HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD FINANCIAL REGULATIONS January 2023 INTRODUCTION These Financial Regulations of the North Lanarkshire Joint Integration Board (the Board) apply from 1 April 2016 and set out the arrangements for the proper administration of the financial affairs of the Board.
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4 The Public Bodies (Joint Working) (Scotland) Act 2014 received Royal Assent on 1 April 2014. It puts in place the framework for integrating health and social care in Scotland. North Lanarkshire Council and NHS Lanarkshire have delegated responsibility to the Board for planning and resourcing service provision for the following adult and older people health and social care services: Social Care Services Adult Social Care Health Care Services Locality Services Addiction Services Medical and Nursing Directorate Prescribing Out of Area Services Area Wide Services Family Health Services Hosted Services o Sexual Health Services o Continence Services o Immunisation Services o Speech and Language Therapy Services o Children and Adolescents Mental Health Services o Children Services o Integrated Equipment and Adaptations Store o Dietetics Services o Podiatry Services o Prisoner Healthcare Services o Blood Borne Viruses Services o Hospital at Home o Mental Health and Learning Disability Services
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5 1. STATUTORY RESPONSIBILITY AND APPLICATION 1.1 The legislation requires that the Board is subject to the audit and accounts provisions of a body under Section 106 of the Local Government (Scotland) Act 1973 (Section 13). This will require audited annual accounts to be prepared with the reporting requirements specified in the relevant legislation and regulations (Section 12 of the Local Government in Scotland Act 2003 and regulations under section 105 of the Local Government (Scotland) Act 1973). 1.2 The Board is responsible for ensuring that its business is conducted in accordance with the law and appropriate standards and that public money is safeguarded, properly accounted for and used economically, efficiently, effectively, equitably and ethically. The Board's activities are furthermore guided by the Scheme of Delegation which sets out the underlying principles and responsibilities on openness, integrity and accountability. 1.3 In discharging these responsibilities, Board members and senior officers are responsible for implementing effective arrangements for governing the Board's affairs and facilitating the effective exercising of its functions including arrangements for managing risk. 1.4 As a consequence of these responsibilities, the Board must regulate the actions taken on its behalf that carry financial implications to provide assurance of their propriety and consistency. It is furthermore a requirement of these regulations that all financial transactions instructed by the Board are within the legal powers of the Board. These Financial Regulations thus form a key element of the maintenance of a robust, clear and accountable governance framework for the Board. 1.5 The Board has designated the Chief Officer (CO) as having responsibility for the preparation, implementation and reporting of the Board's Strategic Plan and the delivery of all delegated services. 1.6 The Board's Chief Financial Officer (CFO) will be responsible for the administration of the financial affairs of the Board and will support the CO in this respect. 1.7 The financial statements of the Board will be prepared according to the Code of Practice in Local Authority Accounting in the UK. The CFO will be responsible for signing the financial statements. 1.8 Any significant or material breach or non−compliance with these regulations or the associated finance rules, procedures or policies issued under their authority must be reported immediately to the CFO, who may consult others as appropriate to determine the proper action. 1.9 The financial regulations will be reviewed at least annually by the CFO, in consultation with the partners, and presented to the Board for approval if required.
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6 2. RESPONSIBILITIES 2.1 Chief Officer (CO) 2. 1.1 The Board's Scheme of Delegation sets out the powers delegated to officers pursuant to the Public Bodies (Joint Working) (Scotland) Act 2014 2.1.2 Under the Board's Scheme of Delegation, the CO is responsible for establishing sound arrangements for implementing the Board's strategic direction, ensuring that the planned outcomes of the Strategic Plan are achieved whilst giving due regard to sustainability and equality considerations, continuous improvement and economy, efficiency and effectiveness in the use of resources. 2.1.3 As noted in the Scheme of delegation, the CO has authority over the officers of the Board, not withstanding the legal responsibilities of the Board's CFO. 2.1.4 The Scheme of Delegation will provide for a situation where the CO is unavailable and will detail how urgent decisions are made in his/her absence. 2.2 Chief Finance Officer (CFO) 2.2.1 The Board's CFO has been designated responsible for the administration of the Board's financial affairs. 2.2.2 The CFO is responsible for advising the Board on all financial matters and for monitoring and reporting on the Board's financial performance and position. 2.2.3 This officer will also oversee the development and implementation of appropriate strategies to manage risk, control the delegated resources and comply with governance standards. 2.2.4 With the exception of urgent decisions, which must be taken in accordance with the Board's Scheme of Delegation to Officers, authority to discharge financially−related responsibilities must be delegated formally in writing by the CFO. 2.3 NHS Lanarkshire and North Lanarkshire Council Partners 2.3.1 NHS Lanarkshire and North Lanarkshire Council remain fully accountable for the financial performance of their service area against the budget allocated. They may incur revenue expenditure in furtherance of agreed Board policies only to the extent that budgetary provision has been made. 2.3.2 The Health Board and North Lanarkshire Council will formally report major financial issues to the CO and the CFO, who will instruct appropriate action. Section 5 provides further details. 2.3.3 It will remain the duty of the Council Section 95 Officer and the NHS Accountable Officer to monitor and regulate the financial performance of their respective share of the resources available to the Board during each reporting period, throughout the financial year. On a day to day basis the financial responsibilities of the NHS Accountable officer are delegated to the Director of Finance.
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7 2. RESPONSIBILITIES (Cont.) 2.4 Board Members 2.4.1 Board members' responsibilities with regard to financial matters are: (a) Approving the Board's financial strategy, including the partnership priorities and budget−setting; (b) Approving the Board's strategic direction and overseeing arrangements for securing and demonstrating best value; (c) Ensuring proper control is exercised over the Board's delegated resources through scrutiny of periodic financial reports comparing expenditure with the level of budgetary provision; (d) Ensuring the development of service targets and performance measurements of a financial and non−financial nature to monitor service achievements. 2.4.2 In this regard, the respective remits and key functions of the Board, including audit matters, are set out in the Board's Terms of Reference and Delegated Functions. 2.5 Following the Public Pound 2.5.1 The Board's CFO will establish arrangements to maintain control and clear public accountability over the use of resources identified as in the scope of the Board for use as directed and set out in the Strategic Plan. 2.6 Internal and External Audit 2.6.1 The Board will make appropriate and proportionate arrangements, to review and consider all key matters and outputs relating to internal and external audit provision in line with relevant good governance standards in the public sector. 2.6.2 The Board will arrange for the establishment of adequate and proportionate internal arrangements in line with Public Sector Internal Audit Standards. Detailed arrangements for the production, delivery and reporting on the outcome of Internal Audit Plan shall be submitted to the Board annually for approval 2.6.3 The Board will approve unsigned and audited accounts by the 30 June and 30 September respectively. The Accounts Commission will appoint the external auditors to the Board who will undertake their duties in accordance with relevant auditing standards and the Audit Scotland Code of Audit Practice. All significant External Audit outputs will be reported to the next subsequent meeting of the Board. 2.7 Risk Management 2.7.1 The Health Board and North Lanarkshire Council are responsible for the delivery of effective implementation of risk management arrangements in relation to their respective service areas and for ensuring its effectiveness and review on an ongoing basis. 2.7.2 The CO is responsible for establishing the Board's risk strategy and profile and ensuring effective risk management arrangements are in place. 2.7.3 There will be regular, bi−annual reporting on risk management to the Board.
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8 2.7.4 The CO will make appropriate provision for insurance according to the risk management strategy.
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9 3. THE STRATEGIC PLAN 3.1 The Strategic Plan will be underpinned by a financial plan that sets out the expected resource consequences of planned changes in capacity. 3.2 The Board will approve the Strategic Plan after consultation with its stakeholders, in line with the principles and duties set out in the legislation. The resources in the Strategic Plan will comprise: (a) The budget allocation made to the Board by North Lanarkshire Council for delegated adult social care services; (b) The budget allocation made to the Board by the Health Board for delegated healthcare services; and (c) The amount set aside by the Health Board for any delegated services provided in large hospitals for the population of the Board. 3.3 The Strategic Plan will incorporate a medium term financial planning framework (3 years) for the resources within scope of the Strategic Plan. 4. FINANCIAL PLANNING AND BUDGETING 4.1 The Board will publish an annual budget setting out the total resources included in the Strategic Plan for that year. 4.2 The first year will be based on the existing budget contributions from the Health Board and North Lanarkshire Council. 4.3 The resources in the first year of the Board should be based on the due diligence carried out during the shadow year. The due diligence process should be based on the existing financial plans and actual spend of the Health Board and North Lanarkshire Council including planned savings, and other agreed adjustments, on the performance during the shadow period and on past financial performance in recent years. 4.4 The CO and the CFO will develop a resource plan and budget for its resources in line with the method set out in the Integration Scheme. 4.5 The legislation requires that in order to determine payments from the Board to the North Lanarkshire Council and the Health Board, a direction will be given. The direction should be in writing and must include information on the integrated functions that are being directed and how they are to be delivered along with the amount of and method of determining the payment to carry out the delegated functions. 4.6 A direction from the Board will take the form of a letter from the CO to the Health Board or North Lanarkshire Council referring to the arrangements for the delivery set out in the Strategic Plan and/or other documentation. Once issued, they can be amended or varied by a subsequent direction. 4.7 Following receipt of a direction, if circumstances change, the Local Authority Section 95 Officer and the Health Board Accountable Officer will consult with the CO and CFO about any required action that has significant financial implications for the Board. Following this consultation and, as appropriate, a request to
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10 approve a revised direction will be submitted to the Board for approval. Thereafter, the partner will submit any revised direction to their respective Committees for noting. 4. FINANCIAL PLANNING AND BUDGETING (Cont.) 4.8 All reports to the Board shall contain a paragraph in respect of the main risks associated with the financial information contained within the report. 4.9 The Board will allocate the resources identified as in scope by the Health Board and North Lanarkshire Council in line with the Strategic Plan as part of the annual budget setting process. 4.10 The annual budget will be built up from a base budget and will consider inflation, demand and other known pressures. This will then be adjusted as appropriate to take account of efficiency saving requirements. 4.11 It is accepted that in year there may be cause for variation in individual budget lines and virements of resources from one heading to another may be required to make best use of the overall resource. In−year virement of budgets after the financial plan has been set will require to be specified in the scheme of delegation for each of the partners. Authorisation for in year virements will be required from the Board for any proposed transfer in excess of £0.250m. 4.12 The Chief Officer must discuss any in year virement proposal with the partner holding the funding to determine whether the proposal is sound. This will include determining that the funding is free for virement, that no funding conditions, regulations or tax requirements would be breached by its proposed use and that there are no other unmanageable risks. 4.13 Having determined the proposed virement is feasible the following delegated authorities exist: (i) Where the proposal for virement exceeds £0.250m, the Chief Officer requires the Board approval to proceed. In taking the proposal to the Board any concerns raised by the partner holding the funding, (or in the event of a transfer between partners or a potential impact on the either partner) must be reflected in the virement request to the Board. (ii) For virements below £0.250m between lines within the same partner's budget which have no likely service impact on the other partner, the Chief Officer may proceed providing they have agreement from the relevant accountable officer for that body that the virement is feasible. This would be the Chief Accountable Officer of the Health Board and the Section 95 Officer in the case of North Lanarkshire Council. (iii) It would be for the partners scheme of delegation to determine a proportionate and reasonable mechanism for seeking this agreement for virement under £0.250m. In the event of a difference of opinion between the Chief Officer and the relevant partner's accountable officer as to whether the virement is feasible, the proposed virement should be referred to the Board for a decision. The Board cannot compel the partner to execute a virement that would lead it to be a breach of regulations, funding
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11 requirements, its overall budget limits or other duties. In other circumstances the Board may direct the partner to execute the virement but in doing so would also have to agree how the Board would manage the consequences of any residual risk flagged by the partner. 4. FINANCIAL PLANNING AND BUDGETING (Cont.) 4.13 (iv) For virements below £0.250m which are likely to have a service impact on the other partner or which are between partners' budgets the above applies but is widened to take account of both partners' views. (v) If the virement has revenue implications for future years, the virement will firstly be approved by the appropriate partner's Committee and thereafter approved by the Board. 5. MANAGING FINANCIAL PERFORMANCE AND FINANCIAL MONITORING 5.1 The Health Board and North Lanarkshire Council Directors of Finance and the CFO will establish a process of regular in−year reporting and forecasting to provide the CO with management accounts for both arms of the operational budget and for the Board as a whole. 5.2 The detailed procedures for, and the form of, the financial reporting arrangements for the Board will be determined by the CFO in accordance with the general directions of the Local Authority Section 95 Officer and the Health Board Accountable Officer. 5.3 It will remain the duty of the Local Authority Section 95 Officer and the Health Board Accountable Officer to monitor or regulate the financial performance of their respective share of the resources available to the Board during each reporting period throughout the financial year. Budgetary control information will be provided to the CFO on a 4 weekly I monthly basis. The CFO will have the ultimate responsibility to report the financial performance to the IJB for their scrutiny and review as detailed at section 5.5. 5.4 It will be the responsibility of the Local Authority Section 95 Officer and the Health Board Accountable Officer to comply with the agreed reporting timetable and to make available to the CFO timeously the relevant financial information required for the financial reporting arrangements. This will include such details as may be required for the purpose of reporting to the Integrated Joint Board on the financial planning of revenue expenditure including data on levels of existing services and the development of the strategic commissioning plan and the annual report. 5.5 Quarterly management reports will be prepared and presented to the Board for scrutiny and review. The format and details of the report will be agreed by the Board. The existing budgetary control frameworks adopted by each partner will form the basis of generating the required financial and performance monitoring information. 5.6 Each partner will synchronise the formal budget setting timelines and reporting periods to provide regular information to the CFO. The reporting timetable for information being presented to the Board is detailed in the table below. The
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12 reporting timetable reflects the presentation to the Board within 2 months of the period end date: 5. MANAGING FINANCIAL PERFORMANCE AND FINANCIAL MONITORING (Cont.) Period Under Review Period End Reports Submitted to the Board by April − June 30 June * 31 August ** July − September 30 September * 30 November ** October − December 31 December * 28 February ** January − March 31 March * 31 May ** * or nearest complete accounting period end. ** or nearest meeting of the Board 5.7 The CFO will review the financial performance in line with agreed planned outcomes as set out in the Strategic Plan and ensure respective financial plans are updated to support this. 5.8 The Budget for the Board will be set as a balanced budget. 5.9 The Local Authority Section 95 Officer and the Health Board Accountable Officer will not incur, nor will they cause or allow to be incurred, additional expenditure chargeable to the Board which has not been included in the total resources available to the Board without discussion with the CFO. 5.10 Any item of expenditure of an 'emergency' nature will be dealt with by the partner for that service in line with their arrangements for emergency expenditure. 5.11 The Board will approve a Reserve Policy to enable the Board to use its power to hold reserves. The reserves policy and reserves strategy will detail the level of reserves required and their purpose. 5.12 In order to allow a valid comparison of actual results with the estimated income and expenditure of the service, it shall be the responsibility of the Local Authority Section 95 Officer and the Health Board Accountable Officer to provide such information as may be required for this purpose to the CFO. 5.13 Where it appears that the amount of income received or expenditure made has or may significantly deviate from that included in the total resources included in the Strategic Plan, resulting in a significant change to the Board's overall financial position, or impacting upon the policy of the Board, or revenue implications for future years, it will be the responsibility of the Local Authority Section 95 Officer and the Health Board Accountable Officer to consult with the CFO timeously and identify and advise of solutions to remedy the variance. The responsibility and management of these variances remain with the partner incurring the additional spend. Should an overspend be as a result of action taken by the other partner, then the partners should agree a remedial plan.
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13 5.14 If the Board's CFO is advised that a significant change is likely to the Board's overall financial position, and that the deviation involves a change of policy of the Board, or results in revenue implications for future years, a report will be provided for the Board in good time detailing the financial consequences to enable appropriate action to be taken timeously. 5. MANAGING FINANCIAL PERFORMANCE AND FINANCIAL MONITORING (Cont.) 5.15 If an overspend is forecast on either partner's in scope budget, the CO and the Board's CFO will agree a recovery plan with the relevant partner to balance the overspending budget to determine the actions required to be taken to deliver the recovery plan. If the overspend arises from the assumptions in the Board's strategic plan on the impact of service changes that are not realised as anticipated this should be subject to a report and corrective action. This corrective action may include a recovery plan which should consider revisions to the commissioning of services and / or financial plans to account for the changed circumstances and the use of any available reserves. 5.16 The CO will determine the actions required to be taken to deliver the recovery plan in conjunction with parties. These actions should be approved by the Board as advised by the CFO. 5.17 In exceptional circumstances, should the North Lanarkshire Council or the Health Board require the Board to identify resources to offset an in−year overspend, they (i.e. the partner) must do this by amending their contributions to the Board. 5.18 Subject to discussion and consultation with the Health Board and North Lanarkshire Council, the Board may increase the payment to the affected body by utilising any balance on the general fund, if available in line with the reserves policy. This may require adjustments to the allocations from the Board to these bodies to reflect the recovery plan agreed. 5.19 If the recovery plan is unsuccessful and there are insufficient general fund reserves to fund a year end overspend, then the overspending partner has the option to: (a) Make additional one−off adjustment to the resources it is making available to the Board, or (b) Provide additional resources to the Board which are then recovered in future years from subsequent underspends in that Partners contribution, (subject to scrutiny of the reasons for the overspend and assurance that there is a plan in place to address this). 5.20 Unplanned underspends effectively represent overfunding by the North Lanarkshire Council or the Health Board with respect to planned outcomes and could be returned to the Local Authority or Health Board in−year through adjustments to their respective contributions to the Board and recurrently through the process for subsequent year adjustments or maintained by the Board to be carried forward through the General Fund Balance. 6. NOTIONAL SET−ASIDE BUDGET FOR DIRECTED HOSPITAL SERVICES
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14 6.1 In respect of resources for delegated functions that are provided in large hospitals the NHS Lanarkshire Health Board has determined that these resources will be excluded from the aligned budget of the Board and instead retained and set−aside for direction by the Board through the Strategic Plan. These will be termed Set−Aside budgets. 6. NOTIONAL SET−ASIDE BUDGET FOR DIRECTED HOSPITAL SERVICES (Cont.) 6.2 The method for determining the amount of notional set−aside budgets for NHS Lanarkshire hospital services follows guidance issued by the Integrated Resources Advisory Group (IRAG) and is detailed in section 10.5 of the Integration Scheme. The set−aside budget includes the resources for the in scope hospital services used by the partnership population in the Health Board. 6.3 It is noted that overheads will not be included in directed hospital services. 6.4 Any proposal to transfer resources between the set−aside budget and the directly managed Budget for directed hospital services will require to have been modelled by the Health Board and agreed by the Board. The financial implications must be set out in the Strategic Plan of the Board. It must also be demonstrated by the Health Board that the planned capacity change has actually been delivered. 6.5 This applies to both reductions and increases in hospital capacity. Transfers from the set−aside budget to the directly managed budget will require an increase in the allocation from the Health Board to the Board; conversely, transfers from the directly managed budget to the set-aside budget will require an increase in the allocation from the Board to the Health Board. 6.6 It is not anticipated there would be in-year virements between the Board’s directly managed budget and the notional set-aside budget outwith the directions made by the Board pursuant to the Strategic Plan. Should the Board wish to issue new directions in-year, section 6.4 of these Financial Regulations will apply. 7. HOSTED SERVICES 7.1 In line with the Scottish Government’s Integrated Resources Advisory Group Finance Guidance (section 4.3.1.10), it is agreed that the host partnership requires to manage any in-year overspends or underspends within a hosted service. Financial outturns will be reviewed as part of the annual review of all hosted services, bringing potential for budgetary changes for future years. 8. ACCOUNTING SYSTEMS AND RECORDS 8.1 It is the responsibility of the CFO to determine the appropriate accounting policies for the Board. The Accounting Standards as adapted for the public sector will apply to the Board. The Code of Practice on Local Authority Accounting in the UK will be the applicable guidance for their interpretation. Accounting records are required to be kept in line with Best Practice. 8.2 The Board financial statements will be completed to meet the audit and publication timetable specified in regulations (Local Authority Accounts (Scotland) Regulations
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15 2014). The IRAG guidance states that there should be agreement of in-year transactions and year end balances with North Lanarkshire Council and the Health Board by 30 April. 8. ACCOUNTING SYSTEMS AND RECORDS (Cont.) 8.3 The CFO must provide any relevant information required by the Health Board and North Lanarkshire Council to enable their statements to be prepared within the statutory timetable for the preparation and publication of the financial statements. 8.4 Where there is an in−year variance in the Board annual accounts, either an overspend or underspend on service expenditure, the Health Board and the North Lanarkshire Council should agree the creditor/debtor with the Board as part of the year end close down procedures. 8.5 Initially, recording of financial information in respect of the Board will be processed via the local authority ledger. This will be reviewed periodically to ensure this remains an appropriate solution. 8.6 The financial ledger transactions relating the Board will be carried out prior to the end of the financial year with post year−end adjustments for material information only. Year−end balances and transactions will be agreed timeously in order to allow completion of the accounts in line with the required timescales. This date will agreed annually by the Board, the North Lanarkshire Council and the Health Board. 9. CAPITAL 9.1 In the short term, the Board will not be empowered to own capital assets and the VAT regimes of North Lanarkshire Council and the Health Board will apply to capital assets used to provide the delegated services. 9.2 Ownership of assets and associated liabilities will remain with each of the partners. 9.3 In preparing the Strategic Plan, the CO will consider all of the resources which are required to deliver the integration outcomes including the relevant non-current assets owned by the Health Board and North Lanarkshire Council. 9.4 The CO of the Board will consult with the North Lanarkshire Council and the Health Board to make best use of existing resources. 9.5 The Board, or partners, should identify the asset requirements to support the Strategic Plan. This will enable the CO to identify capital investment projects or business cases to submit to North Lanarkshire Council and the Health Board for consideration as part of their capital planning processes, recognising that partnership discussion would be required at an early stage if a project was to be jointly funded. 9.6 If a partner proposes capital investment, relative to the Board's activities, a process of consultation with the Board should be undertaken.
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16 9.7 The Board's budget may include payments from the North Lanarkshire Council and Health Board to cover the revenue costs of assets e.g. rents, repairs and maintenance, rates, cleaning, property insurance etc. This should be agreed as part of the budget negotiations. 10. TAXATION 10.1 HMRC have confirmed that the Board is not a taxable person under the VAT Act 1994 as it will not provide services directly. This is on the basis that the Board is not delivering any supplies that fall within the scope of VAT. 10.2 Although the Board will be responsible for producing the Strategic Plan for the delivery of services by North Lanarkshire Council and the Health Board, the Board will not be responsible for the actual delivery of delegated services and as there is no consideration received by the Board for the production of the plan this will not alter the VAT registration position. 11. HOUSING REVENUE ACCOUNT 11.1 The Board's budget for delegated services includes services that are currently funded by the Housing Revenue Account (HRA). This relates to expenditure on adaptations and also care of gardens. While this budget is to form part of the budget for delegated services, it is part of North Lanarkshire Council's ring-fenced HRA. 11.2 Guidance prepared by the Scottish Government details that the local authority will identify and delegate the budget from the HRA to the Board equal to the amount of money required to pay for council tenants. 11.3 The Guidance clearly states that the HRA ring−fence will continue and that local authorities must ensure that HRA funds are not used for adaptations across other tenures or for different purposes. The checks and safeguards to ensure the integrity of the HRA will be detailed in the Strategic Plan. 11.4 An annual financial statement will be prepared to provide the required level of transparency and accountability.
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1 REPORT Item No: 9 SUBJECT: Covid-19 Update / Resilience Response TO: IJB Performance, Finance and Audit Subcommittee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie ,Chief Officer North HSCP DATE: 14th February 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board: 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 INTEGRATION JOINT BOARD 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 is asked to: (1) Note that NHS Lanarkshire stood down its Covid Live Incident down in January 2023, though command structures have been adapted to continue to focus on ongoing wider resilience challenges, specifically around service pressures (2) Note the whole-system response to ongoing health and social care pressures, as outlined in appendix 1. 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. Yes No N/A
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2 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. 5.1.3 NHS Lanarkshire stood down its Live Covid Incident in January 2023, so this will be the final Covid update report unless a new live incident is established. Further updates will continue around wider system resilience. 5.2 Update on Numbers 5.2.1 As at 26th January, the seven-day case rate within North Lanarkshire is 23.4 per 100k population, which is a further decrease to the figures last presented to the IJB from 18th November when it was 35.2 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 January, there are 66 covid positive inpatients and a further 1 in offsite facilities, which in total is a slight increase from the 59 reported on 18th November. 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 As at 31st January, there are 5 outbreaks in care homes covering 29 residents and 18 members of staff cumulatively. 5.4 Delayed Discharge/System Pressures/Home Support 5.4.1 For the majority of 2022, North Lanarkshire maintained delays around the 70s and below, reaching a low under 50 delays during June. However, over December and January, delays have hovered around the 100 mark, which while significantly beyond where we wish to be, is still around the Scottish average in rate terms. 5.4.2 During peak winter pressures in 2019/20, North Lanarkshire had the highest rate of referrals for supported discharge in Scotland, averaging 77 per week. Two weeks in January 2023 have totalled 145 and 158 referrals, with the average weekly referral rate over 22/23 being in excess of 120 per week. 5.4.3 As at 30th January, the delayed discharge position is 93 delays with 41 discharges taking place. Recent data requested by Scottish Government has identified that the turnover of delays is approaching 50% per week, with many of the longer delays associated with AWI and Mental Health cases. 5.4.4 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
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3 5.4.5 Home Assessment Team roll out continues, with capacity continuing to increase in Cumbernauld and Wishaw teams. Over 600 patients have now been supported home much earlier than would normally be possible, with 60% requiring no ongoing Home Support package after 2 weeks of wrap around support. 5.5 Covid Vaccination 5.5.1 The Covid vaccination programme has been very successful in Lanarkshire, with the current position noted below, following the autumn/winter programme roll out: Total doses administered 1,835,182 Individuals with at least 1 dose 560,175 Partially vaccinated 26,294 Fully vaccinated 92,277 Boosters 441,604 5.6 Ongoing Resilience Response 5.6.1 There remains significant ongoing pressure in all health and social care systems across Scotland. High demand and patient acuity, coupled with increased flu and covid numbers in recent months has placed even greater demand on the system. 5.6.2 In Lanarkshire, there is a genuine whole-system focus to our resilience response. Following a number of requests and directives from Scottish Government, a whole system letter was issued to Caroline Lamb, Director-General Health & Social Care and Chief Executive NHS Scotland and Sally Loudon, Chief Executive, COSLA to outline the positive work underway. This letter has formed the basis of a whole- system briefing prepared by the three Chief Executives and two Chief Officers (see appendix one). 5.6.3 Further resilience updates will continue to be issued to the IJB and the IJB subcommittee until balance is restored in the system. 6. CONCLUSIONS 6.1 There has been a tremendous effort across the whole system (including third and independent sectors, communities and public partners) in response to the pandemic and more recent system pressures. 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 A whole-system approach has been taken to respond to the current system pressures, with key actions in response to recent Scottish Government outlined in appendix 1. 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.
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4 7.3 FINANCIAL This paper has been reviewed by Finance: 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 Appendix 1: Whole system response to system pressures ............................................................................. 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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5 Appendix 1: Summary Briefing: Lanarkshire Whole System Response to System Pressures Date: 31.01.23 Prepared by: Jann Gardner - Chief Executive, NHSL Cleland Sneddon – Chief Executive, South Lanarkshire Council Des Murray - Chief Executive, North Lanarkshire Council Soumen Sengupta – Chief Officer, South Lanarkshire Integration Joint Board Ross McGuffie – Chief Officer, North Lanarkshire Integration Joint Board 1. Purpose of briefing 1.1. To provide an update on the whole Lanarkshire response to the ongoing health and social care challenges prevalent across Scotland, particularly in respect of those actions being taken in support of pressures within University Hospitals Hairmyres, Monklands and Wishaw. 2. Background 2.1. Whole system working is a defining feature of the Lanarkshire approach to the sustained and unprecedented pressures facing our health and social care system. This is manifested by both collaborative working at operational levels, and by ongoing collaborative direction and oversight at Chief Executive and Chief Officer level. The three Chief Executives work together on, are routinely sighted on and are fully engaged in addressing the significant challenges faced by our services and staff in Lanarkshire – within our hospitals, across our community health care and social care services and amongst our partners in primary care. Both Chief Officers are Executive Directors of both NHS Lanarkshire and the respective Councils – so as well as being integral members of Corporate Management Teams also provide an essential leadership bridge for the strategic collaboration that we are committed to Lanarkshire-wide. 2.2 Our staff – with the support of our partners – continue to work diligently and tirelessly. This includes the significant contribution of our leadership teams. We are hugely appreciative of everything that they all have delivered and their continuing commitment to our communities and to the difficult work ahead. 2.3. The Lanarkshire Winter Plan 2022/23 was presented to the NHS Lanarkshire Board in October 2022 and subsequently both Integration Joint Boards (IJBs) and appropriate forums of both Councils. Additionally, briefing sessions on the challenges that our communities, our staff and our system were facing and then the mitigating actions that were being taken as part of that Winter Plan were provided for members of the NHS Lanarkshire Board, both IJBs, local elected members, MPs and MSPs. 2.4 This briefing provides a high-level summary of the range of work that our teams have been progressing and developing through the festive period to now. It incorporates continuing work in relation to the above extant Winter Plan and our wider approach to unscheduled care. The contents have formed the basis of a joint letter sent to Caroline Lamb, Director-General Health & Social Care and Chief Executive NHS Scotland and Sally Loudon, Chief Executive, COSLA.
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6 3. Plan of Action 3.1. In Lanarkshire, no hospital delay is acceptable and in general, it is recognised that hospital discharges need to increase to safely and appropriately enhance the “flow” of patients through hospitals. To support this philosophy, Discharge Without Delay (DWD) has been endorsed through all management and governance routes, acknowledging that fully embedding such a significant change programme is an ongoing process. Our commitment to DWD includes our reinforcing the importance of the Home First principles and Planned Date of Discharge (PDD) across our services. It also acknowledged that circa 95% of all patients are ‘discharged without delay’ - and accordingly, ensuring effective processes internal to the hospital setting is crucial to the management of patients whose discharge is delayed for any reason so as to appropriately and safely minimise the length of stay for all patients, the vast majority of whom who do not require packages of care or care placements and whose discharges are not classed as a “delay”. Role of Professional Leads in Response to Service Pressures 3.2 Lanarkshire has a well-established Care Home Assurance Tactical Group, whose membership includes professional leads from across health care disciplines and from social work in both HSCPs. In turn, there is a dedicated Nurse-led Care Home Liaison Team that works closely with all care homes such that they can respond as flexibly as possible - recognising statutory responsibilities – and continue to provide support to the wider system pressures across Lanarkshire. 3.3 A similar multi-professional oversight group is well-established in respect of Lanarkshire care at home services under the co-chairing of both Chief Officers. As well as ensuring consistent practice, this mechanism has seen the approval of a move to retain care packages for 72 hours for anyone with a care package who is admitted to the hospital - which contributes to both our DWD programme and ‘Operation Flow’ (described in sub-sections 13 and 14 below) to maximise discharge capability. 3.4 Both Chief Social Work Officers for South and North Lanarkshire also provide close professional oversight of “in-house” HSCP care at home and residential care services so that again, those teams can be as responsive as possible whilst recognising the statutory responsibilities associated with being registered services employing registered staff. Interim Care Home Beds 3.5 Both HSCPs have commissioned interim care home beds in seeking to reduce the number of patients who remain in hospital pending the availability of their care home of choice or the necessary care at home package to support their safe discharge home. Across both HSCPs, there are approximately 80 interim/intermediate care beds being commissioned to provide additional capacity. Both HSCPs have instigated systems to promote “flow” through these placements such that the capacity can be maximised whilst ensuring patients are not “stuck” in an inappropriate setting. 3.6 We recognise that many providers have had and continue to have reservations about providing interim placements. We have also identified that that there is frequently a reporting disparity between the headline empty beds vacancy position and the actual available for use position across the care home sector, and that is a limiting factor for providers.
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7 3.7 Both South and North Lanarkshire Councils have already introduced a short term enhanced rate at 25% supplement on National Care Home Contract rates for nursing rates in support of such placements. This enhanced rate is to cover additional costs attributable to hospital discharge placements and to ensure that care homes can respond quickly to each referral. We were happy to share our work in this regard and for the methodology adopted by both Councils to have helped shape the recently announced national approach to commissioning interim care. 3.8 More fundamentally we understand that moving into a care home is a very personal decision for a person and their family, and so appreciate the importance of supporting our staff in what can be very sensitive conversations. Recognising that there is no legal framework for social workers to compel individuals to take up an interim placement, our Care Home Assurance Tactical Group guidance was developed to support staff to apply the National Choice Guidance to Patients within wards who have had their full assessment completed; have been allocated finance; and have appropriate legal framework confirmed to support moves (noting that it should not be used to support moves of any individual who is progressing through the Adults With Incapacity pathway – see 3.9). We were very happy to share this with Scottish Government colleagues to inform the national guidance subsequently circulated. Support for Carers 3.9 Extensive support for carers has been made available throughout the year as part of the respective Strategic Commissioning Plans of both IJBs and this has been enhanced in the winter period. Primarily, direct support is provided via the Lanarkshire Carer’s Centre and respective outreach services, and this is being enhanced by dedicated carers staff who support the hospital discharge processes, working with carers to seek to ensure all possible supports are in place to ensure effective and safe discharges. This includes each individual having a named worker, dates agreed for planned discharge and identified rehabilitation input to ensure an enablement focus. In January 2023, the North Lanarkshire HSCP started the offer of up to £1000 to support families and carers to support discharge, covering costs such as additional heating/food or new items required such as a bed to support downstairs living during recovery. Adults with Incapacity 3.10 The Chief Social Work Officers for South and North Lanarkshire are both committed and engaged in the whole system efforts to the significant system pressures that are being contended with. Their advice and guidance is crucial to ensure actions taken by social workers are in accordance with their powers and duties as prescribed within the legislative framework, enabling them to preserve the human rights of the individuals requiring intervention through them. This is especially important in respect to individuals made vulnerable through mental incapacity, and we are all clear about the importance of supporting the social workers involved in discharging this delicate role. 3.11 There are a variety of reasons for delay in relation to progressing guardianship application, e.g. identification of local solicitors to carry forward private applications. We understand that this might be alleviated via Scottish Government engagement with the Law Society of Scotland to consider the means by which particular concerns regarding applications can be highlighted, to encourage promotion of services at a local level. Discussion may also usefully be undertaken
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8 with the Scottish Legal Aid Board, to consider the possibility of them expediting the process of determining applications for legal aid to support families pursuing applications in the Sheriff Court. It may also be of assistance for nationally there to be discussion with the Scottish Courts Tribunal Service in an effort to identify opportunities for the prioritisation, and expeditious processing of guardianship applications to limit any delays in securing their determination and guardian appointments. 3.12 Both HSCPs utilise best practice methodology in seeking to ensure the discharge process associated with the management of AWI patients is undertaken as timeously as possible whilst still complying with legislative requirements. There is dedicated Mental Health Officer (MHO) support for these patients. Utilisation of 13za is actively pursued when appropriate and there is weekly scrutiny of the patients’ pathways. It should also be noted that both HSCPs have undertaken publicity campaigns seeking to maximise the number of people with Power of Attorney in place such that it reduces the potential number of AWI patients in the system. Confirming Arrangements for COVID-19 testing before care home discharge and follow-up communication with services and families on seasonal respiratory infections 3.13 As described above, there is a very effective Care Home Assurance Tactical Group and associated systems in place in Lanarkshire. Through the offices of this group, up to date guidance is issued upon receipt together with offer of support to any care home where they may wish some additional assistance to understand implications of same. This includes all information in relation to testing both at time of admission and discharge. It also ensures appropriate infection control advice is available for both staff and residents such that any disruption to normal working is minimised and safety maintained. Delivering a different model of care for a short period e.g. moving to critical/life saving care only 3.14 Throughout the winter, a ‘command’ meeting structure has been in operation. This has involved a three times weekly meeting supported by three (or more) times daily position statement calls. The Command Meetings are attended by NHSL Corporate Management Teams - which include both HSCP Chief Officers - and senior clinical Acute and HSCP representatives. The daily position calls are similarly attended by senior operational representatives of all parts of the system, including local social work teams and the Scottish Ambulance Service (SAS). 3.15 During the course of December and through January, the Command Meeting has agreed prioritisation of work such that, for instance, planned elective work has on occasion been stood down and priority given to unscheduled care. Similarly, there has been prioritisation of additional trauma sessions to clear backlogs/manage increased trauma during recent inclement weather. 3.16 As part of this prioritisation, it was also agreed that community nursing in both HSCPs would be moved onto a ‘red’ pathway, thereby meaning that only essential care was undertaken and releasing some staff to undertake other work to maximise hospital discharges/avoid admission.
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9 3.17 The Command Meeting has also recognised the significant pressure on primary care and is minded that in cancelling elective care and/or standing down outpatient clinics then so this increases the pressure on primary care as the patients then re-present to their GP seeking additional assistance pending access to secondary care. As such, it is only those clinics where there is real scope for the capacity released to significantly improve unscheduled care flow that have been stood down. 3.18 Work is ongoing with Scottish Government colleagues in understanding the impact of standing down some unscheduled care and the respective recovery trajectory to get services back to the original forecast for waiting times. Opening/procuring additional capacity 3.19 The ability to open additional capacity has been limited as a result of a lack of available staffing. Even where staff have been released, this primarily has been utilised to support existing staff shortfalls in mainstream areas where they are having to manage additional beds in existing wards, e.g. through the use of a ‘fifth’ bed in four-bedded bay, using day rooms, and caring for patients in beds in ‘non- bedded areas’ in A&E whilst awaiting transfer to a ward. 3.20 All efforts have been made to secure additional capacity via external providers and the Golden Jubilee National Hospital, however this has had limited impact in practice. 3.21 In addition, both HSCPs had already invested in recruiting additional health care support staff into Integrated Care and Support Teams (South Lanarkshire HSCP) and District Nurse Teams (North Lanarkshire HSCP) to support rapid response for patients who wish to be discharged from hospital to die at home. This ‘End of Life’ Care pathway work meant that patients who would otherwise be awaiting high resource care at home packages could be discharged early and means that yet another cohort of patients who may otherwise be delayed in hospital were now being managed in their own homes. These teams work closely with specialist palliative care medical and nursing staff as well as hospices if required. Typically, these teams are routinely managing around forty people who would otherwise be in hospital. Moving Staff to Areas of Pressure 3.22 As described in sub-section 7 above, appropriate staff from a number of areas were re-directed such that they could support ‘flow’ through the system in recent weeks. 3.23 Sixty-four staff from the NHSL Vaccination Service were moved to support wider hospital pressures at end of December whilst a further twenty have been moved in the last week. This follows on from the completion of the vaccination programme which also played a key role in minimising the numbers of people who may otherwise have had to be admitted to hospital either as a result of Covid-19 or flu. 3.24 In Lanarkshire, we also recognised the likely pressure on the system in winter when starting our winter planning process in July 2022. In light of this, we offered an extended LES for our GPs whereby we were asking them if they would be prepared to open on the fourth day of the four-day Public Holiday weekends, i.e. 27th December and 3rd January. Thereafter, we also asked if they would be prepared to open on each of the remaining Saturdays in January. Accordingly,
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10 around 50% of the population of Lanarkshire have been able to access their own GP as opposed to relying on A&E, Primary Care Out of Hours or NHS24. 3.25 A key part of our Winter Plan was to have additional physiotherapy and occupational therapy presence at the ‘front door’ to assist in recognising people who could be supported to rehabilitate in their own home without the need for admission. Similarly, additional allied health professional (AHP) staff were available at weekends to support ongoing assessment for weekend admissions such that the scope to maximise discharges on the Monday was achieved. 3.26 There has also been ongoing review of AHP services to recognise where any additional input could be provided to both support discharges and through additional community input, avoid admission. It is important to acknowledge that, reasonable mitigations notwithstanding, such necessary re-prioritisation of staff have inevitable implications for other areas of service delivery and performance recovery. Increased Engagement with Third Sector providers 3.27 Both HSCPs have commissioned a range of services from the third sector which support the ability of people to remain independent in their own homes as well as specifically providing ‘non-statutory’ support to those people recently discharged from hospital such that there is early warning of any issues which may otherwise result in re-admission. Additional Funding for Care Home Beds 3.28 Independent providers of social care in Scotland have highlighted the extremely difficult operating environment. Coupled to the cost-of-living-crisis and the impact of the pandemic, vacancy pressures are a significant concern for many providers in terms of service viability. 3.29 We have also identified that there is frequently a reporting disparity between the headline empty care home beds vacancy position for providers and the actual available for use position. A local review of care home information submissions identified a variety of explanations for this, including: • Care homes operating waiting lists • Care homes reserving vacancies for planned pending admissions • New admissions available but specific eligibility criteria i.e. a religious order • Fee paying private admissions • Room being used for respite • Specific bed availability e.g. frail elderly • Redecoration of rooms • Beds closed due to outbreaks • Moratoriums 3.30 As highlighted at sub-section 3 above, both Councils have already instituted a mechanism to spot purchase interim/intermediate care beds at a short term enhanced rate at 25% supplement on National Care Home Contract rates for nursing rates. Currently, there is scope to be purchasing circa eighty such beds at any time across both HSCPs, thereby moving eighty people who would otherwise be in hospital categorised as a ‘delayed discharge’. All patients requiring supported discharge with a planned date in place and those who are delayed are reviewed on a daily basis, with an individualised approach taken to explore all
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11 options to move the patients to their end destination as quickly as possible, or using an intermediate step where required. Discharge Intervention Required - Phase One 3.31 As will be appreciated from the above, there has been a huge amount of work undertaken to support the acute care sector over recent months and the associated work to try and create additional flow through the whole system. 3.32 Up to now, there has been a concerted approach to seeking to embed DWD and maximise the concept of PDD. Linked to this is work to enhance morning and weekend discharges. This is in addition to hospital transition teams (home first/home assessment teams), and investment in discharge teams A&E departments. There is a robust organisational structure where DWD improvement projects are monitored and scrutinised through a dedicated DWD Lead and DWD steering group. This group then reports to the unscheduled care board for NHS Lanarkshire. 3.33 Notable successes have been the introduction of the Home First philosophy, introduction of PDD, development and implementation of a discharge policy. In addition, there is the development of home first/ home assessment teams which are expanding across Lanarkshire and are intended to be fully embedded by March 2023. a. Home First Home First has been adopted across Lanarkshire and the message has been reinforced recently across all staff groups. Patients and families are encouraged to return and be assessed at home from hospital on the package of care they were currently on or be assessed in a care home of their choice as an alternative to a hospital bed. The Lanarkshire DWD action plan is closely aligned to the Realistic Medicine/ Health Improvement work across Lanarkshire hospitals. This work is delivered by staff on each acute site who provide a holistic approach to care and encourage the Home First principles. b) Planned Date of Discharge (PDD) PDD has been getting phased in across Lanarkshire since 2020. The approach has allowed targeted care to be delivered, reduction in referrals for care, and a multiagency approach which includes robust assessment and care management. Lanarkshire has a DWD management information dashboard which can be drilled down to hospital, HSCP, locality and ward levels. This allows for improvements to owned at the most appropriate operational level. The current percentage of PDDs recorded on the dashboard is 54% for Lanarkshire, with work ongoing to ensure this is fully embedded and being reported accurately across the system. Referrals of those without a planned date of discharge account for a high percentage of those patients whose discharge is delayed. Conversely, 90% of the patients who have a planned date leave hospital on their PDD. DWD performance is reported monthly through the NHS Corporate Management Team, and North and South Lanarkshire HSCP Senior Management Teams. A whole system gap analysis is underway in relation to DWD and PDD to understand where to focus improvements. This analysis is being developed into a
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12 heat map for Lanarkshire. Once this is complete training and tools will be put in place to ensure continuous and sustained improvements. c) Criteria Led Discharge (CLD) Criteria led discharge is a priority development within all of the Lanarkshire hospitals under the leadership of their respective site triumvirates with a clear alignment to PDD. The risk appetite for CLD across medical and nursing teams has been a component of the gap analysis and will feature in the above heat map. We have identified and sites teams within each hospital are working towards improvement in overall, pre-noon and weekend discharges. CLD has been implemented successfully in surgical areas, supporting improvements in length of stay and work is planned to expand the methodology across other areas of the system. d) Home First/ Home Assessment Teams Our Home First (South Lanarkshire) and Home Assessment (North Lanarkshire) Teams are hospital transition teams developed by South and North Lanarkshire HSCPs respectively. They are supporting ‘discharge to assess’ through an integrated approach across social work/care, allied health professional and home care staff. These teams implement PDD once the patient is admitted into the service allowing for the mainstream home care service to plan care after a period of rehabilitation and assessment. These team have prevented patients from becoming delayed, allowed for targeted care and have subsequently better patient outcomes. We have also had some early success by deploying these teams at the front door to prevent admission. Early indications suggest that around 60% of individuals supported home in this way require no ongoing home care package after two weeks of wrap around support. We are actively expanding this provision within what continues to be an extremely challenging workforce supply environment, particularly in respect of home care. e) Discharge Support in Emergency Depts. We have established discharge facilitators who support A&E departments across our Lanarkshire hospitals. These arrangements have been strengthened through collaboration with the Lanarkshire Flow Navigation Centre who will be screening patients with social care needs overnight to allow for a rapid response by social work/ care in the morning, thus allowing for more rapid restarts of care and patients to be discharged to be assessed in a care home, should long term care be indicated. In “day” hours, a combination of senior care manager, acute care of the elderly nursing, a discharge facilitator and occupational therapy staff will provide admission avoidance and rapid discharge capability. This is currently being piloted in University Hospital Hairmyres. Outcomes will be reviewed with a view of rapidly scaling up across all of our Lanarkshire hospitals. f) Hospital at Home (H@H) There is an established H@H service which covers eight of the ten localities across Lanarkshire. The service is currently expanding into the Clydesdale locality and this should be in place by March 2023. Work is currently underway to review the whole H@H service to establish how support could also be extended to the Cambuslang/Rutherglen locality.
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13 Discharge Intervention Required – Phase Two 3.34 Notwithstanding the various areas of work set out at sub-section 12 above - all of which is recognised as requiring to continue and become embedded as ‘good practice’ in supporting hospital flow – we have recognised that there is a need for an additional concerted approach to ‘de-compress’ our three acute hospitals in particular. There is also recognition that there is an imperative to consider how best to enable a similar whole system effort to “de-compress” our community health and social care services, and to work with our colleagues in general practice to do similar within primary care. 3.35 Operation FLOW was launched on 20th January 2022. This is a rapid improvement plan that will provide a focus for the work of our teams from now into spring, its key components being: • Service improvement and recovery plans that are current being enacted as part of the Winter Plan as well as the escalated measures agreed before Christmas. • A concentrated and coordinated whole-system effort – a “firebreak” - will take place from Thursday 23 February to Friday 3 March 2023, including a weekend period, to stabilise and decompress our hospital sites. • Following this “firebreak”, we will enact further measures to sustain an improved position across the whole system as we move through late winter and early spring. 3.36 In order to be successful, we are taking steps to identify for additional capacity during the firebreak period as well as working differently and flexibly over the coming weeks. It is likely that additional shifts/hours will be offered to staff in health and social care over the nine-day firebreak period to allow the necessary focus on patient assessment, treatment and discharge. Communication will be critical to the success of the “firebreak” and we are committed to ensuring we providing our staff with the information they need to carry out local briefings and discussions with staff. 3.37 This “firebreak” should release the time and energy amongst our hospital teams in particular so that they and we better progress the other elements of our overall Operation FLOW improvement plan. Active planning continues with acute site and locality teams. Each week, as we proceed with Operation FLOW, we will publish an action plan update on the NHS Lanarkshire website, including a Q&A section to provide more detail as it is confirmed. 3.38 Operation FLOW marks a different approach to addressing the pressures we are facing, but it is crucial to recognise the vast amount effort that has been and continues to be made by our staff. Additional Developments to improve flow/ release capacity Acute Front Door Model 3.39 We know that the infrastructure of A&E and Front Door Assessment Areas are limited and overcrowding persists across all acute sites. This has a substantial impact on achieving safe patient flow and ensuring staff well-being across the Acute Sites. University Hospital Wishaw is significantly vulnerable in relation to these challenges and as a consequence a priority project is underway to increase front door assessment capacity on that site. The A&E department requires to remain fully operational whilst the works progress, so an internal decant option
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14 has been identified and preparation work is underway to support a phased approach to this development. If the internal decant option can be supported, then A&E accommodation will increase by 15 bays in total once work is completed. 3.40 We know that the front door accommodation within University Hospitals Hairmyres and Monklands are also challenged, and we also acknowledge that the work outlined above to enhance the footprint of University Hospital Wishaw is a short- term solution. Therefore, we have commissioned Healthcare Planners to: • Undertake a whole system review of emergency and urgent care across acute, primary and community services. • Develop a strategy for the delivery of emergency and urgent care for Lanarkshire to inform the development of the new NHS Lanarkshire healthcare strategy, Our Health Together. • Inform NHS Lanarkshire’s infrastructure requirements for urgent and emergency care now and into the future which will influence the details of the Health Board’s Property Strategy. 3.41 We also recognise that current systems and processes within Lanarkshire A&Es may have an impact on performance and so have undertaken a gap-analysis diagnostic across all three sites. A key finding of this analysis has been the need to standardise streaming processes across the three acute sites and determine how best to ring-fence minor flow. This work is being progressed through Operation FLOW. Urgent Community Care 24/7 3.42 Urgent care in the community is that which requires a response before the next routine care service (or appointment). The over-riding principle is “right care, in the right place, at the right time”. 3.43 We know that there is increasing demand on general practice - where it is estimated 90% of urgent care is delivered – alongside workforce and sustainability challenges across general practice. The NHS Board and both IJBs have endorsed the need to look to radically change urgent care delivery to ensure sustainable services in Lanarkshire. There is significant support for a model which brings together a number of existing services together. 3.44 The current system challenges also highlight the need to consider a way to deliver urgent care during the in-hours period. Consequently, we are progressing a whole system approach to agree how we will develop a co-ordinated, sustainable in- hours community care service. We are aiming to have an outline model for this by early Spring 2023. Expansion of Flow Navigation Centre (FNC) 3.45 We also know the importance of signposting and direction of patients in terms of “right care, in the right place, at the right time”. It is a better process if this is done prior to patients presenting to A&E or Assessment Areas - the Lanarkshire FNC has an important role in this. Work has commenced with the Scottish Ambulance Service (SAS) to implement a non-conveyancing pathway for patients with chronic obstructive pulmonary disease (COPD). We are keen to expand this approach to include other conditions such as patients with frailty or those who have a non- injury fall.
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15 3.46 Given that a Senior Clinical Decision Maker (SCDM) is not always available in the FNC. we have implemented a model where the FNC teams can seek support from a SCDM in A&E via Consultant Connect (see below). 3.47 There is social work support within the FNC which is working really well in preventing presentations or admissions to the “front doors” of each of the hospitals. We are scoping the other roles that could potentially add further value to the FNC, e.g. pharmacists and other allied health professionals. We are also learning from colleagues across the wider NHS system around the form-and- functionality of their FNCs to determine opportunities for Lanarkshire. This work will also continue via Operation FLOW. Consultant Connect 3.48 Consultant Connect is a method of professional-to-professional telehealth communication which provides an opportunity for clinicians to receive specialty guidance or advice pre-referral to specialist secondary care. We anticipate that this could reduce the number of patients presenting or being referred to A&E and Assessment Areas, with project management support allocated to co-ordinate wide-scale implementation across our system. Reprioritising routine care 3.49 We recognise that the throughout the pandemic, there has been reduced capacity to provide routine care in both primary and secondary care to routine care. This has resulted in extended outpatient and diagnostic waits and impaired management of chronic illnesses. This is contributing to dysfunction within the acute care system as patient seek alternative pathways for help with their clinical conditions, and have less well controlled comorbidities which may contribute to increased length of stay. 3.50 We are exploring a Population Health Management approach to prioritising available resource, using both primary and secondary care data and following a Triple Helix model, working closely with academic and eHealth industry partners. Interface Care 3.51 The Interface Care Programme Team from the Scottish Government utilised the data from Public Health Scotland to generate relevant analysis for Ambulatory care sensitive conditions (ACSCs) codes. This analysis provided an understanding of the high volume conditions by NHS Board, both in terms of admissions and occupied beds days; and provided details of the potential reductions on occupied beds days that Interface Care aims to achieve. Respiratory conditions, and in particular COPD, was deemed as a high priority condition for NHS Lanarkshire. 3.52 In order to support the implementation of new pathways for the conditions identified, a number of enabling services were highlighted. These services were identified for further development to support the delivery of the Interface Care Programme’s aim to deliver a 20% reduction in length of stay, and provide high quality and safe care for our target population. The two enabling services identified for NHS Lanarkshire were Outpatient Parenteral Antibiotic Therapy (OPAT) and H@H (as above). A summary of the work as part of the Lanarkshire Interface Care Programme is described below. Review of COPD services
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16 3.53 We know that many of our staff have been working differently in response to the pandemic and consequently the time is now right to re-focus our service delivery approaches and models. There are three distinct areas of focus of work underway to develop a whole system respiratory pathway: COPD prevention plan – focuses on prevention and early intervention of COPD. Proactive Care – to increase the use of telehealth for symptom monitoring and management and undertaking an audit to understand the detail of patient journeys. Admission Avoidance and Supported Discharge – focuses on the implementation of the SAS non-conveyancing pathway for COPD patients; formalising the H@H response for patients with COPD; and implementation of Consultant Connect 3.54 We have established a whole system Respiratory Speciality Improvement Group and plan to use the development of the respiratory pathway as a blueprint for pathway development across Lanarkshire; and implement and embed new models or care and new ways of working as previously described. Outpatient Parenteral Antimicrobial Therapy (OPAT) Service Extension 3.55 OPAT services can release bed capacity by avoiding the need to admit patients with infections requiring daily intravenous (IV) antibiotics who are otherwise well enough not to need to be in hospital; and identifying patients who can be discharged and therefore have a shorter length of stay once they are well enough to return home and continue their daily IV treatment at home or at clinic. 3.56 The NHS Lanarkshire OPAT Service currently delivers a Lanarkshire-wide service, based at University Hospital Monklands, integrated with a community model delivered by district nurses in the East Kilbride locality. The service has capacity for 10 active patients, with flexibility to go up to 15. Additionally, an average of two patients are treated at home through the East Kilbride locality service. The number of bed days the Service saved in 2021 was 3,567, which equates to 9.8 beds at 100% occupancy. 3.57 There is an opportunity to increase the capacity of the OPAT service to treat the additional significant demand from patients currently in hospital beds unnecessarily. Nationally collected data shows that if Bed Days Saved by the current OPAT service is calculated as a rate per 100,000 of population, NHS Lanarkshire currently has the lowest rate in Scotland. If we were able to compare with the best performing Board in Scotland, this has the potential to save 19,152 bed days a year which equates to 52.5 beds. 3.58 Following consideration of a robust business case developed by staff drawn from across our system, a recruitment process is underway to develop the University Hospital Monklands OPAT Service and then develop the community based model. The scope for optimising this is limited by the non-recurrent funding available through the Interface Care Programme, and further consideration of this nationally is needed. 4. Conclusion 4.1 This has been and continues to be the most challenging period that our health and social care services have ever experienced. We recognise the impact, the distress and the frustrations that this has for patients, service users, carers and
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17 communities right across Lanarkshire – just as is the case right across Scotland. We also understand how much we continue to ask of all staff right across our services and across our partners. We are hugely grateful for their patience, resilience and adaptability, and look forward to the continuing support of Board Members, local elected members, local MSPs and local MPs – alongside Scottish Government, COSLA and other national agencies - as we collectively progress the important work ahead.
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REPORT Item No: 10 SUBJECT: Annual Performance Report 2021‐22 TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie Chief Officer Author of Report: Graeme Cowan, Senior Manager, Strategy & Performance DATE: 14th February 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Committee: For approval For endorsement To note 1.2 The purpose of the report is to provide the Committee with the draft Annual Performance Report 2021/22. 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Senior Manager, Strategy & Performance Reviewed By: Endorsed By: 3. RECOMMENDATIONS 3.1 The Committee is asked to note the contents of the report and approve publication of the Annual Performance Report (attached as appendix) on the partnership’s website, following graphic design input. 4. BACKGROUND/SUMMARY OF KEY ISSUES 4.1 The Public Bodies (Joint Working) (Scotland) Act 2014 requires the Integration Joint Board to publish an Annual Performance Report, setting out an assessment of performance in planning and carrying out those functions for which it is responsible. 4.2 Guidance on these Annual Performance Reports was produced by the Scottish Government in March 2016. 4.3 The draft Annual Performance Report 2021/22 is attached as an Appendix and is a summary of the Health & Social Care Partnership’s performance over the last year, setting out what’s been achieved and what we need to focus on in the future. 5. IMPLICATIONS
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5.1 NATIONAL OUTCOMES The Annual Performance Report contains content relevant to all national outcomes. 5.2 ASSOCIATED MEASURE(S) None 5.3 FINANCIAL None 5.4 PEOPLE None 5.5 INEQUALITIES EQIA Completed: Yes No N/A 6. BACKGROUND PAPERS None 7. APPENDICES ............................................................................. CHIEF ACCOUNTABLE OFFICER Members seeking further information about any aspect of this report, please contact Graeme Cowan on telephone number 07946702861.
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Annual Performance Report 2021/22 Health & Social Care North Lanarkshire
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2 Contents 1. Introduction 3 2. Measuring Performance Under Integration 4 3. Our Progress Against the National Health & Wellbeing Outcomes 13 National Outcome 1 & 5 13 National Outcome 2 17 National Outcome 3 20 National Outcome 4 24 National Outcome 6 28 National Outcome 7 30 National Outcome 8 33 National Outcome 9 34 4. Looking Forward – Next Steps 40 Appendices Appendix 1 – Summary of Performance Against Core Suite of Integration Indicators 41 Appendix 2 – HSCP Performance Dashboard 43 Appendix 3 – Actual Expenditure Profile 47 Appendix 4 – Analysis of 2021/22 Expenditure 48 Appendix 5 – Inspection of Services 49 Appendix 6 – Glossary of Terms 52
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3 1. Introduction Welcome to North Lanarkshire Health and Care Partnership’s (HSCP) Annual Performance Report, which covers the period April 2021 to March 2022. Using a range of qualitative and quantitative information, this report evidences how we have performed against the National Health & Wellbeing Outcomes, National Core Integration Indicators, the Ministerial Strategic Group indicators and local performance measures. The Integration Joint Board receives regular progress reports and these reports, along with previous Annual Performance Reports can be found on our website https://www.hscnorthlan.scot/. The Annual Performance Report is an opportunity to reflect on the past year and to celebrate the work and achievements of our services, employees and partners and the work we continue to deliver with service users, carers, families and communities. It also allows us to reflect on and acknowledge the current and future challenges facing the partnership, many of which reflect the lasting wider impacts of the COVID-19 pandemic. The following report outlines our performance and key developments of 2021/22. The first section of the report looks at the performance information we are required to report, showing trend information and a comparison with the Scottish position. Unfortunately, due to issues outwith the control of the partnership we are unable to report a full effect position for some indicators. The reason for this is detailed within the relevant section of the report. The remainder of the report takes each of the National Outcomes in turn and provides a range of developments and achievements from across 2021/22.
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4 2. Measuring Performance Under Integration Since 2016/17, Integration Authorities have been required by legislation to report on the Core Suite of Integration Indicators within their Annual Performance Reports. The indicators were developed in consultation with a wide range of stakeholders and are intended for consideration within the wider context of health and social care and to help identify areas for improvement to aid with strategic planning. Indicator values are derived from national data sources to enable comparability between local areas and with Scotland. There are 23 indicators in total. The indicators reported comprise of nine indicators based on the Health and Care Experience Survey and ten other measures mainly using health activity, community and deaths information. The remaining four indicators cannot be reported as national data is not available or there is not yet a nationally agreed definition. Scottish Health and Care Experience Survey Indicator Title NL 2015/16 NL 2017/18 NL 2019/20 NL 2021/22 Scotland 2021/22 HSCNL Trend from Previous Survey Scotland Trend from Previous Survey NI -1 Percentage of adults able to look after their health very well or quite well 91.7% 90.3% 90.5% 87.5% 90.9% NI - 2 Percentage of adults supported at home who agreed that they are supported to live as independently as possible 77.6% 79.8% 78.8% NI - 3 Percentage of adults supported at home who agreed that they had a say in how their help, care, or support was provided 71.2% 67.1% 70.6% NI - 4 Percentage of adults supported at home who agreed that their health and social care services seemed to be well co-ordinated 70.2% 66.6% 66.4% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 77.8% 74.0% 75.3%
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5 NI - 6 Percentage of people with positive experience of care at their GP practice 79.3% 75.5% 68.3% 51.8% 66.5% NI - 7 Percentage of adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 75.7% 77.0% 78.1% NI - 8 Percentage of carers who feel supported to continue in their caring role 41.2% 33.2% 32.6% 25.1% 29.7% NI - 9 Percentage of adults supported at home who agreed they felt safe 80.0% 79.8% 79.7% Performance is better than previous reporting period Performance is worse than previous reporting period
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6 National Outcome Indicators – Benchmarking – 2021/22 Scotland North Lanarkshire East Ayrshire Eilean Siar Dundee City North Ayrshire Inverclyde West Dunbartonshire Glasgow City Percentage of adults able to look after their health very well or quite well 90.9% 87.5% 89.5% 93.4% 88.6% 88.8% 90.1% 89.9% 88.1% Percentage of adults supported at home who agree that they are supported to live as independently as possible 78.8% 79.8% 76.1% 82.5% 84.0% 81.3% 82.9% 83.2% 80.3% Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided 70.6% 67.1% 71.0% 72.4% 75.0% 73.5% 66.7% 75.1% 71.1% Percentage of adults supported at home who agree that their health and social care services seemed to be well co-ordinated 66.4% 66.6% 60.0% 70.8% 77.5% 64.4% 68.6% 77.2% 70.1% Percentage of adults receiving any care or support who rate it as excellent or good 75.3% 74.0% 79.6% 82.6% 84.1% 75.8% 81.3% 77.5% 74.9% Percentage of people with positive experience of care at their GP practice 66.5% 51.8% 56.9% 80.2% 66.6% 61.2% 58.7% 64.6% 71.4% Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life 78.1% 77.0% 75.7% 84.2% 71.5% 77.6% 79.6% 85.7% 79.6% Percentage of carers who feel supported to continue in their caring role 29.7% 25.1% 27.6% 41.2% 31.0% 30.8% 28.7% 31.7% 33.7% Percentage of adults supported at home who agree they felt safe 79.7% 79.8% 73.0% 88.0% 77.1% 83.0% 81.9% 87.9% 81.0% The table above provides a comparison across the National Outcome Indicators (sourced from the 2021/22 Health and Care Experience Survey), within North Lanarkshire’s ‘Family Group’ of comparators. For the most part, the figures highlight areas that we can improve on across a range of areas - supporting people to live as independently as possible, health and social care services being well co-ordinated, improving or maintaining quality of life, people having a positive experience of care at their GP practice and carers feeling supported to continue in their caring role.
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7 Use of 2021 calendar year data instead of 2021/22 financial year data for indicators 12, 13, 14, 15 and 16 The primary source of data for these indicators are Scottish Morbidity Records (SMRs) which are nationally collected discharge-based hospital records. Following recommendations made by Public Health Scotland (PHS) and communicated to all Health and Social Care Partnerships, the most recent reporting period available is calendar year 2021; this ensures that these indicators are based on the most complete and robust data currently available. Figures presented may not fully reflect activity during 2021/22 due to the varying impact of COVID-19 at different points of the pandemic. Indicator 20 NHS Boards were not able to provide detailed cost information for 2020/21 due to changes in service delivery during the pandemic. As a result, PHS have not provided information for indicator 20 beyond 2019/20. PHS previously published information to calendar year 2020 using costs from 2019/20 as a proxy but, given the impact of the COVID-19 pandemic on activity and expenditure, PHS no longer consider this appropriate. Indicator Title NL 2017 NL 2018 NL 2019 NL 2020 NL 2021 Scotland 2021 HSCNL Trend Scotland Trend NI -11 Premature mortality rate per 100,000 persons 482 517 515 581 580 466 Indicator Title NL 2017/18 NL 2018/19 NL 2019/20 NL 2020/21 NL 2021 Scotland 2021 HSCNL Trend Scotland Trend NI -12 Emergence admission rate (per 100,000 population) 15,663 15,826 16,281 13,824 15,093 11,656 NI – 13 Emergency bed day rate (per 100,000 population) 121,395 117,292 119,574 103,720 115,108 110,718 NI – 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 99 101 106 123 117 110
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8 NI - 15 Proportion of last 6 months of life spent at home or in a community setting 89.0% 88.9% 88.9%% 90.2% 90.0% 89.9% NI – 16 Falls rate per 1,000 population aged 65+ 22.6 22.6 21.3 19.2 21.4 23.1 NL 2017/18 NL 2018/19 NL 2019/20 NL 2020/21 NL 2021/22 Scotland 2021/22 HSCNL Trend Scotland Trend NI -17 Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections 79.1% 76.4% 83.3% 80.7% 78.1% 75.8% NL 2017 NL 2018 NL 2019 NL 2020 NL 2021 Scotland 2021 HSCNL Trend Scotland Trend NI – 18 Percentage of adults with intensive care needs receiving care at home 72.2% 74.6% 74.4% 75.1% 75.0% 64.9% NL 2017/18 NL 2018/19 NL 2019/20 NL 2020/21 NL 2021/22 Scotland 2021/22 HSCNL Trend Scotland Trend NI – 19 Number of days people spend in hospital when they are ready to be discharge (per 1,000 population) 1,009 996 1,109 781 831 761 NL 2017/18 NL 2018/19 NL 2019/20 NL 2020/21 NL 2021/22 Scotland 2021/22 HSCNL Trend Scotland Trend NI – 20 Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency 20.7% 21.1% 21.6% N/A N/A N/A Performance is better than previous reporting period Performance is worse than previous reporting period
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9 National Integration Indicators – Benchmarking – 2021 Scotland North Lanarkshire East Ayrshire Eilean Siar Dundee City North Ayrshire Inverclyde West Dunbartonshire Glasgow City Premature mortality rate per 100,000 466 580 (2021) 556 428 599 568 509 627 661 Emergency admission rate per 100,000 11,656 15,093 (2021) 14,565 13,856 12,326 14,401 13,181 13,170 11,842 Emergency bed day rate for adults per 100,000 110,718 115,108 (2021) 123,759 125,228 106,084 150,139 143,454 134,010 125,313 Emergency readmission to hospital within 28 days of discharge (per 1,000 discharges) 110 117 (2021) 123 106 139 116 93 96 104 Proportion of last 6 months of life spent at home or in the community 89.9% 90.0% (2021) 90.1% 90.6% 91.5% 88.7% 88.6% 89.8% 89.2% Falls rate per population aged 65+ 23.1 21.4 (2021) 18.9 24.8 31.8 20.7 21.6 22.7 28.5 Proportion of care services graded ‘Good’ (4) / better in Care Inspectorate Inspections 75.8% 78.1% (2021/22) 71.3% 87.7% 74.0% 78.8% 85.1% 87.7% 83.7% Percentage of adults with intensive care needs receiving care at home 64.9% 75.0% (2021) 67.6% 62.5% 63.2% 76.8% 68.1% 72.1% 60.8% Number of days people aged 75+ spend in hospital when ready to be discharged, per 1,000 population 761 831 (2021/22) 399 1,305 799 819 296 972 828 The table above provides a comparison across the National Integration Indicators, within North Lanarkshire’s ‘Family Group’ of comparators. Our comparative position is fairly positive on areas such as emergency bed day rate (reflecting the lower average length of stay in hospital) proportion of people spending the last six months of their life in a community setting, falls rate, and the proportion of people with intensive needs supported at home. However, the figures also highlight areas that we can improve on across a range of areas - unplanned admissions, readmissions rate, the proportion of care services graded 4 (Good) or better and the occupied bed day rate for those whose discharge from hospital is delayed.
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10 Measuring Performance Under Integration (MPUI) Emergency Admissions Based on agreed trajectories, our objective for 2021/22 was to manage the anticipated increase in admissions following the restrictions that had been in place during 2020. The actual position for 2021/22 was 45,240 emergency admissions which represents an increase of 15.2% from 2020/21. Unscheduled Bed Days Based on agreed trajectories, our objective for 2020/21 was to achieve a reduction in the number of unscheduled bed days across all specialties from 325,051 in 2019/20 to 309,703 in 2020/21, a reduction of just over 4%. The actual position for 2020/21 was 279,170 bed days which represents a reduction of 14.1% from 2019/20. The impact of the first Covid-19 lockdown is fairly obvious from the chart below and the challenge is to ensure the number of unscheduled bed days remains below pre-pandemic levels. A&E Attendances Based on agreed trajectories, our objective for 2021/22 was to absorb the anticipated increase in A&E attendances following the reduced number of attendances in 2020.The actual position for 2021/22 was 122,371 A&E attendances which was 1.8% lower than our planned trajectory.
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11 Delayed Discharge Based on agreed trajectories, our objective for 2020/21 was to achieve a reduction in the number of occupied bed days due to standard delays, from 24,948 in 2020/21 to 23,725 in 2021/22. The actual position for 2021/22 was 26,744 occupied bed days which represents an increase of 7.2% from 2020/21. Due to increased demand during the summer months and also with the increased pressure during winter 2021/22, the overall number of bed days dure to standard delays remained outside our planned trajectory. End of Life Care The percentage of the last six months of life spent at home or in community settings has gradually increased since 2015/16, however 2021/22 witnessed a very small reduction. Balance of Care The percentage of people aged 65+ who live at home in North Lanarkshire remains high, and increased in 2020/21 to 97.1% Using benchmarked data from the Local Benchmarking Framework for 202/21, approximately 68% of older people with long term needs are supported at home. This compares well with the Scottish average and other similar Health & Social Care Partnerships. North Lanarkshire has the fifth highest percentage of all mainland council areas in Scotland.
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12 Performance Dashboard The Health & Social Care Partnership also has in place a corporate performance dashboard which is monitored and reported on a quarterly basis and is attached as Appendix 2. This comprises a range of performance metrics and Key Performance Indicators that are used to give the Strategic Leadership Team and Integration Joint Board an assurance of progress against key performance targets.
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13 3. Our Progress Against the National Health & Wellbeing Outcomes National Health and Wellbeing Outcome 1 People are able to look after their own health and wellbeing and live in good health for longer National Health and Wellbeing Outcome 5 Health and Social Care Services contribute to reducing health inequalities Prevention and Early Intervention The HSCP delivers a broad range of prevention and early intervention programmes with a focus on reducing inequalities. Some highlights from 2021/22 are included below: Healthy Schools NHS Lanarkshire partnered with education services in North Lanarkshire Council to equip schools with an updated health and wellbeing resource for all pupils. The Healthy Schools resource is designed to give the future generation of Lanarkshire the healthiest start possible. The covid-19 pandemic disrupted the life of every child and had consequences for their wellbeing, further highlighting the importance of Healthy Schools which supports children and young people from nursery throughout Primary and Secondary school with their health and wellbeing. This interactive website is used by teaching staff to empower children and young people to make positive choices, and it’s available to be accessed by all members of the public, meaning parents and carers can use it too. Originally created in 2014 with input from children and young people, it provides a safe space for pupils to learn about various topics that can support them as they grow such as nutrition, mental and physical health, substance misuse, planning for change and more. It was successfully relaunched in 2021 with a new look and design, updated materials for all levels and now has new resources specifically aimed at S5 and S6 pupils. Breastfeeding During 2021/22, the partnership continued to support efforts within North Lanarkshire Council and NHS Lanarkshire in delivering a breastfeeding action plan, designed to make North Lanarkshire a supportive and welcoming place where new mums breastfeeding feel comfortable and where people across the area can look forward to a healthy future. This has included: taking breastfeeding message into schools and designing new community buildings to include breastfeeding facilities; and encouraging more businesses to seek accreditation and carry the
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14 Breastfeeding Friendly Scotland sign and supporting new mums who wish to continue to breastfeed on their return to work from maternity leave. Bowel Screening As one of two test sites in Scotland, the partnership continued to develop its approach to improving bowel screening uptake rates in North Lanarkshire. Working with NHS National Services Scotland (NSS), this project is seeking to use data insights, artificial intelligence and predictive analytics to improve uptake rates across the whole of North Lanarkshire, but specifically amongst individuals who live in North Lanarkshire’s more deprived communities. High Resource Users The High Resource Users project has been in place since 2018, working with individuals with particularly complex needs who attend our emergency departments and make significant use of our services. The project has focused on working with existing services to adapt to meet the needs of individuals in a more holistic, person-centred way. The programme of work was paused during 2020, as staff were redeployed to assist with operational responses to the pandemic. From April 2021, the third phase of the programme commenced with a focus on embedding a model of care to: • Improve the health and wellbeing outcomes of vulnerable individuals who are making frequent use of services using a case management approach; • Reduce the frequency of attendances at emergency departments. Progress during 2021/22 includes: • Re-establishment of the steering group and project charter; • Agreed criteria for cohort of patients; • Wok alongside services across the partnership to manage individuals identified needs, e.g. Mental Health, Social Work, Addictions, Housing Services and Social Inclusion & Wealth; • Raise awareness of third sector and voluntary organisations to improve social prescribing; Chryston Community Health Clinic North Lanarkshire Council’s ‘The Plan for North Lanarkshire’ sets out an ambitious estates strategy that looks to develop Community Hubs / Campuses. Further to consideration of this approach, NHS Lanarkshire working in partnership with North Lanarkshire Council, invited hub South West Scotland to deliver a single campus for the replacement of Muirhead Community Health Clinic and Chryston Primary School. Since 14th May 2020 all parties have been involved with site identification, stakeholder engagement and design development of the new facility. In keeping with North Lanarkshire Council’s hub programme guiding principles, there will be two discreet facilities under one roof with the benefits of shared arrangements for car parking, amenities including waste yards, a suite of bookable rooms, staff accommodation that includes touchdown space for community based staff and outdoor space that can be enjoyed by the local community. The site identified was that of Lanrig Park, located in the Chryston area of North Lanarkshire. The Chryston area provides an ideal location for the facility, as it is central and provides the best public transport links to all areas of the Northern Corridor. There has been extensive engagement to date with all stakeholders including North Lanarkshire Council (NLC) and NHS Lanarkshire project teams which has resulted in the optimum design being
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15 developed to the satisfaction of all the stakeholders. The agreed design has been through a wide- ranging number of engagement sessions with the NHS Lanarkshire staff, Health & Social Care Partnership staff, teachers, support staff and pupils at Chryston Primary School together with representatives of the Parent Council and elected members, culminating in an online public consultation to inform residents of the design outcome. The business case for the development of Chryston Community Health Clinic was considered by the NHS Lanarkshire Board in December 2021 at a cost of £3.65M and signed off with all legal agreements completed in January 2022. The build programme began on Monday 14 February 2022 with a completion date of early August 2023. Engagement & Participation There is a long and established track record of engagement and participation within health and social care in North Lanarkshire. Our approach facilitates the involvement and engagement of people, carers and families, community and voluntary sector organisations and the independent sector in the development of services and support for people across our communities. During 2021/22, we initiated a review of our engagement and participation structures which resulted in recommendations to support our overarching intentions to facilitate active participation, that demonstrates shared accountability, is place based and addresses inequality. To implement the recommendations from the review, a programme of work to create a true co- produced approach, building on the successful partnerships already established across our networks and with third sector providers already delivering services across our communities, is underway. It is intended to: • be community led • help embed our Engagement & Participation Strategy into practice • align with the revised operational structure of the H&SCP • establish robust links with Community Boards • consider the lasting impact of COVID-19 and recovery of services A review of the funding currently provided directly to several providers supporting our engagement activity is also underway, as we recognise that organisations important to our structures require financial commitment to ensure stability and security to support meaningful engagement and participation. A review of the investment needed to support our strategic direction and offer some certainty to organisations to allow work to develop and positive practice to be fully incorporated across all our engagement and participation networks, will strengthen our approach. Work continues to establish robust links with Community Boards and support improved engagement and participation across all care groups by:15 • strengthening the voices of supported people and their families including unpaid carers • embedding participation that goes beyond listening/sharing information • further developing sector and area wide engagement and participation forums • incorporating learning from Covid regarding engagement and participation • identifying strengths and opportunities in terms of local resources/ communities Community boards are the foundation of the community planning process in North Lanarkshire as agreed by all partners of the North Lanarkshire Partnership including HSCNL. Multi-agency Local Partnership teams have been launched recently to support the development of the community
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16 planning agenda within community partnership areas. Managers from each of the localities within the Health & Social Care Partnership are key members of these forums, and this developing piece of work offers opportunities to co-ordinate our locality improvement activities across the wider Community Planning Partnership. There are several forums operational in North Lanarkshire that present a good opportunity for working together with staff from statutory services, community/ voluntary and independent sector. A place-based focus is important in the delivery, development and improvement of effective services that support local people. However, these structures add complexity to the engagement and participation landscape, which is cluttered resulting in forums being used mainly as a vehicle to share information. The chairs of Locality Planning Groups have been considering the future remit and responsibilities of their groups within the context of the wider sector in which they exist and in light of the findings of the recent review. The current engagement activities for the Strategic Commissioning Plan has presented a further opportunity to progress this agenda
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17 National Health and Wellbeing Outcome 2 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community Support at Home North Lanarkshire has, for many years, had a positive balance of care, which means that the considerable investment in community-based supports over time has resulted in a high proportion of people with long-term and complex needs being able to continue to live in their own homes. The metric used for benchmarking across Scottish Health & Social Care Partnerships and reported in the Annual Performance Reports (APRs) reflects very positively the long-term efforts in North Lanarkshire to create and sustain the range of supports which minimise long term residential, nursing or hospital care. Focusing on adult services, support at home is offered through internal home support, independent sector provision and direct payment. Home support has a budget of £57 million to support up to 3,000 people at home in any one day (over 5,500 people over the year). 74% of home support service is provided by in house services, the remainder provided by the independent sector. However, maintaining responsive, high-quality support at home for those who require this has presented as substantial challenge over the past year due to significant workforce pressures within the sector. The national and local drive to relieve pressure on acute health services is significant and resource has focussed on supporting discharge. The HSCP have continued to focus on early intervention and prevention and the deliver of person centred care through self-directed support. There has been considerable work to implement a new structure within Home Support Service to ensure that assessment and planning through Reablement is re-introduced and that the wider options for independent living can be developed. A Home Support Redesign programme has been established to progress the implementation to improve pathways and service user experience, and address workforce challenges to maximise capacity and responsiveness. Home Support Service The home support service in North Lanarkshire provides over 35,000 hours of support each week to around 3,500 services users. Both the in-house service and the local independent sector have faced huge challenges through both the pandemic and recovery period with significant workforce and demand pressures, a pattern which has been common across the country. Immediately prior to the pandemic, plans were put in place for a redesign of the service with the centralisation of some functions and new roles to maximise the capacity and quality of the service, to embed reablement and to support a move away from a time and task model to more personalised self-directed support for those with more stable longer-term needs. The pandemic, wider demand and system changes have required plans to be adapted and additional resource to be invested in the service supported through partnership and new Scottish Government funding, with additional management and administrative support put in place, alongside the additionlal recruitment of 140 frontline home support workers based in Home Assessment Team and Home Support Service. The service now employs approx 950 FTE Home Support Workers.
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18 The Home Support Service implemented the first stage of the planned redesign which included the centralisation of the management and administration of the service. A reassessment of the implementation of further stages is in place to allow the service to reflect and review changes to the original plan to meet current and new priorities. This includes our Out of Hours Service to address call waiting times for both staff and service users. To ensure the delivery of a safe and high-quality service to support positive outcomes, consultation with staff, service users and their carers’ and stakeholders will inform the continued redesign of the service. The key areas that will be addressed to have a responsive, adapatable service include; 1. Recruitment and retention of Home Support Workers, administration and Management 2. Training, to ensure staff are competent and confident across all aspects of Home Support provision 3. Roles: evaluating the hard-to-recruit posts 4. Quality of care and support being provided 5. Efficiency/ scheduling 6. Increased demand needs to be managed through efficient pathways Recruitment and retention to posts at all grades has been challenging and there has been a higher than usual turnover. Particularly Home Support Worker, Support Officer and Service Delivery Coordinators are difficult to recruit and retain. These new roles were introduced just prior to the pandemic, and it was not possible to establish them fully due to changes in working arrangements and the difficulties of delivering training. The feedback from staff is that the roles are challenging and therefore it has not been possible to sustain staff in post. 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 A further key element of the redesign of Home Support was the development of a dynamic scheduling tool to support the field workforce and introduce key benefits of mobile working. Dynamic scheduling will have benefits for the home support workforce in the field and for those who schedule and plan work. It is an essential tool to maximise the availability and skills of the workforce. The Service has been working closely with colleagues from the Care Inspectorate, both strategically in relation to service improvement as well as operationally at service level. During 2021/22: • The service received 4,579 referrals for support; • 3,345 (73%) of these were to support individuals’ hospital discharge; • 1,170 individuals were supported through our reablement service; • The service (both in-house and commissioned providers) delivered in excess of 2.8 million visits to service users’ homes. • The service (both in-house and commissioned providers) delivered in excess of 1.8 million hours of service. Discharge Without Delay (DWD) Discharge Without Delay is a whole system approach which supports people to be cared for at home (or as close to home as possible), prevents avoidable admissions to hospital and, where hospital admission is necessary, supports timely discharge. This programme was introduced towards the end of 2021/22 and continues as a priority for the partnership.
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19 The Home Assessment Team (HAT) was developed as a new team within North Lanarkshire and was launched in early 2022. The team works collaboratively with hospital discharge hubs and clinical teams to support timely discharge from hospital to enable an assessment of each person’s immediate and longer-term needs in their own home. This can include anything from signposting to support from a statutory service and community care assessment. The Home Assessment Team take a multi-disciplinary approach to person centred care and consists of Home Support staff, AHP’s, Clinical Responders and Social Work staff to embed Home First principles to enable people to be supported to return home for a period of assessment. The initial implementation stage has demonstrated multiple benefits in supporting early intervention, reducing deconditioning and has resulted in positive outcomes for people as well as North Lanarkshire services by reducing the level of statutory support required following discharge and crucially, supporting maintained and increased levels of independence for people of North Lanarkshire.
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20 National Health and Wellbeing Outcome 3 People use health and social care services have positive experiences of those services and have their dignity respected Community Solutions Community Solutions is a successful, HSCNL cross-sector health and social care investment and improvement programme for North Lanarkshire, established in 2012, which is improving people’s health, wellbeing, quality of life and equality by investing in community-led initiatives which build community, family and individual strengths and resources - with a focus on prevention and early intervention. The Community Solutions Programme involves all HSCNL partners and also links to the North Lanarkshire community planning partnership – North Lanarkshire Partnership (NLP) and the Children’s Services Partnership. Community Solutions invests in a wide range of community and voluntary sector (CVS) organisations to achieve positive personal outcomes for local people and build CVS capacity. The programme is governed by a HSCNL Community Solutions Governance Sub-Group, with regular reports to HSCNL Core Management and wider Strategic Leadership Team; PFA and IJB. HSCNL provides £1.1 million in annual recurrent funding for the programme plus additional funding for specific projects, including an additional £1.2 million during 2022-24 agreed at the special February 2022 IJB meeting, as part of wider investment in Winter Planning and Enhanced Supports. VANL also receives additional custodian funding for the CVS directly from the Scottish Government and North Lanarkshire Council which are invested through the Community Solutions Programme. Evaluation of funded projects to date shows that the Community Solutions is highly cost-effective, helping local people improve their health and wellbeing and strengthening CVS capacity to provide such support. The new Community Solutions Strategy and Investment Plan for 2022-25 sets out how the Community Solutions Programme invests the funding it receives from its funders to contribute to improved health, wellbeing, quality of life and equality of the people of North Lanarkshire by strengthening community capacity and resilience and delivering person-centred, community-based support and services to priority groups. The Strategy and Investment Plan was developed collaboratively with key stakeholders and is informed by: • evidence of local needs • experience of delivering Community Solutions and evaluation of Community Solutions funded projects to date • priorities and commitments as set out in the Plan for North Lanarkshire, Health and Social Care NL Commissioning Plan and related strategies and plans on issues such as the Tackling Poverty Strategy, with reference to relevant national commitments. The Strategy and Investment Plan sets out the Community Solutions Programme’s • Vision and Mission • Approach and Values • Priorities for Investment
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21 • Funding and Investment Approach • Evaluating Impact and Supporting Learning and Improvement Self-Directed Support - Transformational SDS Agenda Our transformational Self Directed Supporrt agenda has an emphasis on building greater community capacity to support earlier preventative approaches and proactive planning. Key priorities include ensuring that opportunities around partnership working across the spectrum of community solutions, universal services, third and voluntary sectors as well as statutory services, assistive technology are enhanced, and maximised so that people can be supported at home as independently as possible, for as long as is appropriate, whilst minimising risk and reducing reliance on statutory services. This will involve nurturing and implementing different ways of working, earlier positive interventions, and exploring what organisations might be able to do differently to support transformation and ultimately lead to a more sustainable social care system locally. The number of people receiving an individual budget within the 21/22 year was 1,520. The graph below shows the number of individual budgets per locality. This numbers reflect all people receiving funding via an SDS budget across children, adults, and carers. There are currently 148 individuals who have an individual budget to provide 24-hour support. Part of the transformational work going forward will be around robust reviews of these support arrangements considering the potential use of technology enabled care solutions. In the year 21/22 year we had a total of 317 Direct Payments (Option 1) and as with SDS budgets overall these figures include all children, adults and carers. To support the increase in people choosing a Direct Payment arrangement, and the anticipated need going forward a new DP support service was specified and procured. Community Living Change Fund/Coming Home Report In line with Scottish Government recommendations made within the Coming Home Implementation Report, and more recently the allocation to North Lanarkshire Health and Social Care Partnership of £1,298,332 from the Community Living Change fund, over a three-year period (2021-2024), a programme of work is being undertaken to support the strategic objectives of:
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22 • Reducing delayed discharges of people with complex needs. • Repatriate those people inappropriately placed outside of Scotland. • Redesign the way services are provided for people with complex needs. The aim is to establish a multi-agency team lead by Health and Social Care, who will identify individuals with Complex Care Needs whose discharge is delayed and to develop protocols to address this. A key outcome is to establish a new register of individual affected and the introduction of an appropriate assessment tool which will facilitate review of all cases. From this individual outcome plans will be developed to assist each person back home addressing and resolving the key obstacles faced such as housing, funding, care equipment etc. For those individuals identified as being repatriated and following appropriate assessment including risk assessments, planning will facilitate appropriate interventions to ensure individuals can come home safely. Additional protocols will be developed to support interactions with other authorities which may be involved in such areas. North Lanarkshire are fully committed to Self-Directed Support and people’s rights to be involved as much as possible in decisions made about their support and care were they are able, and the plan for this work will continue to reflect SDS principles and values. Technology in Health and Social Care North Lanarkshire Health and Social Care Partnership continues to invest in the implementation of technology enable care. This is now evident with the formation of a dedicated Technology Team within Health and Social Care. The requirement for the technology team was identified when looking at the need for new and innovative ways to provide support. Technology has also become a national focus on support provision as identified through the Digital Health and Care Strategy 2021. The technology team will look to provide support and guidance on technology with a renewed focus on embedding technology into the assessment, planning and implementation of care to provide service users further choice in how care can be provided. The Technology Team will coordinate standards, processes, training and innovation on the use of technology across the health and social care partnership. The tech flat within North Lanarkshire continues to be a well-used resource within the technology team where around 60 visitors per month attend the flat. The flat has allowed for the consideration of technology in assessment and planning and why technology can enhance support to an individual. The flat continues to be upgraded with new and innovative technology and this is something that the team will be looking to further evolve. Work has been carried out alongside our NHS partners in developing guidance around the use of technology within rehabilitation and how we can better support out communities. Further on to this piece of work we continue to be involved in shaping the NHS Lanarkshire Digital Strategy to ensure a person centred focus on the use of technology is considered. The technology team has had continual involvement in shaping and directing national policy and strategy around TEC, telecare and the analogue to digital transition through partnerships with the Digital Office for Local Government, NSS TEC and the Scottish Government.
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23 The analogue to digital telecare transition continues to be progressed through the technology team and this will look to conclude with a fully digital community alarm and telecare service by the end of 2025. First Point of Contact A major focus for the Health and Social care Partnership is to ensure that when people make contact with health or social work services the response is rapid and appropriate. There should be a focus on assisting people to be independent and getting things right first time. The core of which is a strength-based approach, transferring the balance of care to prevention, early intervention and self- management. In order to explore a whole system change a pilot project was undertaken in Motherwell in 2021 using the three conversation model. Partners 4 Change who led on the delivery of the model have worked with 75 council areas in the UK in relation to reform, redesign, financial sustainability, and personalisation. Of the 75 councils, 35 councils delivered whole system change through the 3- conversation approach. The evaluation of the Motherwell Innovation Site in 2022 deemed it to be a success with much learning. The emphasis was an introduction to a whole system, multi-disciplinary team approach embodying coordination, collaboration focusing on communities and person-centred approaches. The different way of working reduced barriers and the basic recording system met legislative needs. It was found that voluntary sector links were better as early as possible for quality outcomes and supporting people with better lives. The focus on outcomes led to the success of the innovation site and ultimately success for people in our communities. The engagement with people was meaningful and there was limited access to services for longer term supports. There is ongoing development of further innovation work with voluntary sector partners. The First Point of Contact Group are addressing how to bridge the gap between the voluntary and statutory services, creating trusted pathways. There will be further emphasis on prevention and early intervention.
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24 National Health and Wellbeing Outcome 4 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services Lanarkshire Mental Health & Wellbeing Strategy The delivery of the Mental Health & Wellbeing Strategy has continued to progress. Over the course of 2021, we looked forward and took advantage of the opportunities and experiences of working in different ways rather than, by default, returning services to the way they were delivered pre-COVID. All workstreams reviewed their delivery plans to ensure that they: • Take account of the impact of COVID-19; • Build on our recovery plans and the new ways of working that have developed over the course of the pandemic; • Retain a focus on the vision and objectives set out in the Mental Health & Wellbeing Strategy Good Mental Health for All Progress during 2021/22 • Well Connected (social prescribing) and Suicide Prevention apps launched • Training in Challenging Mental Health Stigma and Discrimination developed • Co-ordinated communications approach for future campaigns and awareness days. Primary Care Mental Health & Wellbeing Teams The Primary Care Mental Health and Wellbeing Service (PCMHW) model for Lanarkshire has been developed with 61 GP practices now able to access the service. It is anticipated that all 101 GP Practices will have access to the Primary Care Mental Health and Wellbeing Service by 2022, with a continued phased approach to roll-out in the remainder of 2021, and into 2022. Over 40 additional clinical posts will be recruited in this time frame, which will include 3rd Sector Mental Health & Wellbeing Workers. Since March 2018, 12,000 referrals have been managed by the service with less than 3% of patients seen requiring onward referral to secondary care mental health services. The Service provides clinical triage and assessment, and both clinical and non-clinical brief interventions and/or support(s) to people experiencing mild to moderate mental health problems of a short-term nature accessed via their GP practice. Feedback from key stakeholders thus far has been very positive. Emergency Departments Additional nursing support has also been put in place within the three Emergency Departments across Lanarkshire to carry out mental health assessments for patients presenting within the department and ensure they are given access to the right support and services to meet their needs. An unscheduled care sub-group established to look at the professional interface and strengthen pathways between Psychiatric Liaison Nurses (PLNs) and Mental Health specialities. This will ensure more defined and robust processes linked to the patient journey and experience of accessing services within localities.
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25 The Flow Navigation Centre (FNC) is now fully established in hours and offers an alternative route for a mental health assessment than ED triage. Direct links with PLNS for Community Police Triage (CPT) and Scottish Ambulance Service (SAS) triage is fully established for both in hours via FNC and Out of Hours (OOH) at Douglas Street. The OOH service at Douglas Street has expanded and is now fully embedded with a SOP in situ for patients to be triaged and assessed via telephone, virtual platform, or face-to-face appointment. Mental Health ANP’s now form part of OOH unscheduled care service based at Douglas Street, and have developed good links with primary care services to support overall senior decision making. Regular communication with senior staff within ED departments, police and SAS links are established and progressing well. Established links with NHS24 and work ongoing in relation to understanding the infrastructure between pathways and systems. A robust governance framework that spans across mental health unscheduled care service has been established. Lanarkshire Custody Suites Two Advanced Nurse Practitioners ANPs recruited through Action 15 funding in place and providing a valuable mental health assessment resource to support people who present with mental health needs when detained for any period of time. Feedback has been positive. Prisoner Healthcare A staffing model for the mental health within Shotts Prison has been developed to ensure the level of care for prisoners reflects the services offered to the rest of the population. Psychological Therapies Service posts and the Health Improvement Practitioner post have been recruited to, though there remain challenges around filling some of the other posts. The staffing model has been amended to address this with agreement that the Band 7 ANP post will be replaced by a Band 5 plus a Band 3. All clinical documents reviewed by team and agreed. Policies and protocols have been developed and incorporated into Standard Operating Procedures. Advocacy services now actively involved The main risks relate to difficulties in recruiting staff and a lack of fit for purpose accommodation to enable new multi-disciplinary team within HMP Shotts. Digital Solutions Digital solutions are being explored to help provide services in new ways that make them more accessible and enhance patients’ experience. The Digital Safety Plan project was short-listed for the Holyrood Connect Awards. Near Me is being well-used with CAMHS, Psychology, and Psychiatry the top 3 users of the system. Work is underway and progressing very successfully to move Mental Health staff from Midis over to Morse, in a phased approach. Digital champions have been identified and regular meetings are in place which are very well attended with good practice being shared. Child & Adolescent Mental Health Services (CAMHS) A significant change to the current CAMHS model has been developed to meet the national service specification. Plans have been implemented during 2021/22 focusing on the needs of children and families affected by more complex mental health problems, moving early intervention support to the Schools Counselling Model, School Nursing service and the Community Wellbeing Framework.
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26 Phase 1 of the review has focused on the implementation of the Choices and Partnership Approach (CAPA) model with the deployment of nursing workforce into CAMHS in addition to the establishment of the team with responsibility for delivering the Neurodevelopmental Pathway across Lanarkshire. Phase 2 will focus on the requirement to implement national recommendations in relation to eating disorders and extension of all CAMHS services to age 18. Progress to date: • Udston Hospital confirmed as the site for the CAMHS South Lanarkshire base and is now fully operational. • Refurbishment work across Coathill and Airbles Road accommodation. • Digital Solutions • Appointment Text reminder service was launched • Clinical information sharing on Clinical Portal completed • Introduction of GP electronic referral system • Introduction of digital case record • Development of engagement plan to work with children and young people in the redesign of the service. Community Mental Health & Wellbeing (Children & Young People) Delivering improvements for children and young people’s mental health and wellbeing is embedded in North Lanarkshire Children’s Services Plans and associated workstreams, led by the children’s services partnership boards. Since the launch of the Lanarkshire Strategy, the focus has been on continuing to deliver priorities through already existing structures and workstreams with a focus on prevention/early intervention and promoting positive mental health and resilience. North Lanarkshire’s Children’s Services Plans for 2021-2023 have now been published. North Lanarkshire will continue to have a dedicated workstream led by the Children and Young People’s Mental Health, Wellbeing and Resilience Steering Group. Funding from the National Children and Young People’s Mental Health and Wellbeing Programme has been agreed for the delivery of community mental health and wellbeing supports and services for children and young people. This will allow the provision of bespoke services that are right for each local authority and direct support for children and young people. The Scottish Government is clear that funding is to be used for new or enhanced services. Gap analysis, benchmarking and co- production of services is underway with a project officer recruited by both local authorities. Specialist Services Perinatal and Infant Mental Health A successful funding bid was made (in Sept 2020) to the National Perinatal and Infant Mental Health Programme for the development of a whole-system model for perinatal mental health care that enables women, their partners and families to be supported in their own communities; the establishment of a multi-disciplinary Community Perinatal Mental Health Service; and the establishment of a designated multi-disciplinary NHSL maternity and neonatal psychological intervention service. Separate funding has also been granted to enable the development of shared strategic goals and agreed pathways for indicated high risk infants and their parents who are not currently accessing clinical services; the development of a model of infant mental health provision; and the establishment of a designated multi-disciplinary and multi-agency Infant Mental Health Service.
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27 Alcohol & Drugs Partnership (ADP) North Lanarkshire Alcohol and Drug Partnership is hosted within HSCNL and has been considerably strengthened over the last two years, co-developing its 2021-2024 strategy around the themes of rights/respect/recovery through engagement with a broad range of stakeholders : https://mars.northlanarkshire.gov.uk/egenda/images/att99221.pdf Five ADP sub-groups have been established to develop actions covering: Prevention, Early Intervention and Education; Treatment Care and Recovery; Whole Family Approach; Public Health Approach in Justice and Reducing Alcohol Harms. In line with the cross-cutting elements within these key areas the interface between the ADP, CSP and CJP has also been strengthened and whilst the the lead senior officer for the ADP is the Head of Performance and Planning both the CSWO and Head of Adult Social Work Services have a role in the wider ADP structure.
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28 National Health and Wellbeing Outcome 6 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 Support to Unpaid Carers We work in partnership with both commissioned services and funded organisations, all of whom offer a range of supports to Adult Carers and Young Carers. Overall approximately 11,000 carers are known to the carer support organisations in North Lanarkshire and are in receipt of some form of support. During 2021/22 1040 Adult Carer Support Plans have been progressed by Lanarkshire Carers where assessed need was deemed to be low or moderate. In the situations where carer need has been identified as being significant or critical and unable to be met through the range of carer support options described above and below, approximately 50 individual Carer budgets have been agreed. In many instances individual budgets to supported people are also scoped to reflect individual carer circumstances, such as complex care related needs, caring responsibility for more than one person, or the carer’s own health related needs. In addition over 1,000 carers benefited from small grants distributed through Lanarkshire Carers. Young Carers have been supported through Young Carer Statements, a wide range of Carer support and activity groups, training opportunities, resilience aid and support, respite breaks, creative short breaks, carer awareness training and legal advice. A pan Lanarkshire Steering Group focussing on the needs of Young Adult Carers was also established last year. A key ambition is to ensure the needs of carers are integral to wider service planning, an example being that following the success of a Community Link Worker initiative, focussed on support, advice, guidance, and signposting to families whose child may have a neuro developmental condition, there are plans to extend this in 2022/23. This has been funded through community mental health and wellbeing framework budget for children and young people and is now hosted through North Lanarkshire Carers Together and in line with our wider approach focusses on early, whole family support and community connections, There is a well-established short break service, operated by Lanarkshire Carers and this continues to play an important role in supporting unpaid carers in enjoying a break from their caring role. Feedback from carers however has also pointed to the need for more regular, flexible ‘time out’ accessible within their local community. This has informed a range of new initiatives including a ‘Carer Breather’ programme, facilitated through NLCT and delivered by a range of local organisations and the piloting of a ‘Sitter Service’. These initiatives offer unpaid carers regular and flexible breaks from caring. Positive feedback from unpaid carers regarding this approach will result in an expanded programme in the coming year. Work is also ongoing to meet the requirements of the Carers Act to ensure that unpaid carers are as involved as they want to be in hospital discharge arrangements. This includes involvement in decision making, as well as support at the point of discharge and beyond. Whilst this approach has been welcomed, we are aware through feedback from Carer support organisations, Advocacy, and individual carers that further work is required in this area, to ensure that no involved unpaid carers are missed from discharge planning as a result of pressures to work at pace in this area.
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29 We remain aware also of the diversity and fluidity of the carer population and that despite our efforts some carers remail less visible to services and supports. We continue to innovate and use a range of methods ensure information support is accessible from the more traditional information packs to the launch of a new podcast for carers and support for digital inclusion.
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30 National Health and Wellbeing Outcome 7 People using health and social care services are safe from harm Adult Support and Protection (ASP) During 2021/22 North Lanarkshire Social Work Services, as part of Health and Social Care North Lanarkshire, received 2434 ASP referrals, an increase of less than 1% compared to 2020/21 (from 2,426 to 2,434). This is the third consecutive year that an annual increase has been measured. Police Scotland remain one of the highest referring agencies, submitting 16% (380) of all ASP referrals received; this measures a 39% decrease from last year (from 598 to 380). In addition to the 380 ASP referrals made by Police Scotland, there were a total of 4,004 Police ‘Adult Concern’ Reports received. Since the same reporting period last year there has been a 13% increase in police ‘Adult Concern’ reports (from 3,552 to 4,004). This is the third year running when significant increases have occurred; this work continues to generate significant resource pressures. For the fourth year running, there was an increase in the number of referrals received from NHS L personnel (from 426 to 473, up 11%). Referrals from Social Work Services staff decreased by 10% (from 411 to 371). For this period, ASP referrals from Care Homes demonstrated a 9% increase (from 416 to 455). Information from Inquiry and Investigation processes suggest possible causes of this include, the increasing complexity of people placed in care homes, many of whom have significant levels of cognitive impairment and/or dementia, and behaviour which requires intensive support. Monitoring and support in this area is provided by colleagues in Quality Assurance in addition to thorough ASP Multi agency training and, in line with the increased focus on Care Homes during the pandemic this area of activity has more recently also been monitored through weekly review of ASP referrals for care homes and multi-professional Care Home Oversight arrangements e.g. Care Home Assurance Team (CHAT) . Adults with mental health issues were represented in 35% (858) of the total ASP referrals received, being the main primary user group referred. Referrals for this group have decreased since the same time last year but remain high in overall percentage terms (from 939 to 858). This only reinforces the importance of key service developments such as Distress Brief Intervention (DBI) and social work investment in delivering ASP training for those organisations who deliver services at home to our most vulnerable service users.
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31 ASP Investigations /Case Conferences and Statutory Orders/Functions During 2021-22 there were 434 ASP Investigations carried out, a 18% conversion rate from inquiry to investigation and a 16% increase from the previous year. There were 111 ASP Initial Case Conferences held; this measures a 29% decrease from last year. Anecdotal information from localities suggest that some cases have moved from investigation to case conference sooner in the process. For the period 2021/22, North Lanarkshire Council, as part of Health and Social Care North Lanarkshire also sought and implemented thirteen ASP Protection orders, broken down as; six Removal Orders, three Banning Orders and four temporary Banning Orders, all with power of arrest. Social Work Adult Protection Case File Review The ongoing monitoring and review of adult protection operational activity remains a key feature for Social Work Services. A multi-agency inspection readiness group was formed with senior representatives across the public bodies and led by a Senior Social Work Manager. This group has met regularly to support the pre inspection agenda, as well as planning multi-agency case file reading across localities during April and May 2021; this activity identified areas for policy and practice improvement and, provided organisational learning in virtual file reading methods to help prepare the partnership for future formal inspection activity. Training ASP Council Officer Training (Day 2) and Investigative Interviewing Training (Day 3) materials were reviewed and redesigned to support remote/virtual training delivery and were delivered during April to May 2021 for 30 employees who are required to undertake investigations under Adult Support and Protection (Scotland) Act 2007. The Post Graduate Certificate in ASP is presented each academic year (University of Stirling). For the year 2021-22, the Council supported two experienced employees to successfully complete this professional learning programme; both employees will complete this course in December 2022. This is very positive as it provides further evidence of the Councils’ commitment to invest in employee development and to build upon staff resources that supports the continuous improvement of ASP practice. 2183 2230 2426 2434 510 400 374 43494 100 156 111 2018/19 2019/20 2020/21 2021/22 ASP Referrals, Investigations and Case Conferences No. of ASP referrals No. of Investigations No. of initial case conferences
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32 Appropriate Adults Services In January 2020, Appropriate Adults (AA) Services across Scotland became a statutory function via part implementation of the Criminal Justice (Scotland) Act 2016. This now means that a statutory duty is placed upon Police Scotland to request an Appropriate Adult, while the Council have a statutory duty to provide Appropriate Adult Services, and the training of AA’s. The Care Inspectorate have the duty to assess the quality of AA Services. During 2021-22, national developments have continued to take place to assist with the ongoing implementation of the national statutory framework e.g. Scottish Government AA Oversight Group, national training group, and the requirement to complete a service based questionnaire on North Lanarkshire AA Services, for the Care Inspectorate. The Council is currently working in partnership with the Care Inspectorate and other partners to design a self-evaluation model for ongoing quality assurance purposes for AA Services. Appropriate Adult Services in North Lanarkshire are currently fully operated, funded and delivered through Social Work Services with 12 employees trained to perform AA roles during business hours and SWES (Social Work Emergency Services) staff providing support out of hours. In line with statutory guidance produced by Scottish Government, work is underway to develop a local Appropriate Adult Oversight Group. This multi-agency group will have responsibilities for policy and practice development in this area e.g. recruitment, training, confidentiality, health and safety and service complaints. Appropriate Adult referrals decreased by 23% (from 92 to 71) from the same time last year. North Lanarkshire is similar to other local authority areas who have also experienced reductions in referral rates; this is being monitored by the national Oversight group, Scottish Appropriate Adult Network and Police Scotland. While there was a decrease, there were increases in the number of times AA’s are being asked to attend police stations (for the same offence) and are spending an increased amount of time supporting vulnerable adults whilst there. As Council employees perform the AA role in addition to professional social work roles, this continues to contribute to resource pressures. An Appropriate Adult Development Officer post has been agreed and funded through new monies following statutory implementation; this post remains vacant.
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33 National Health and Wellbeing Outcome 8 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 Staff Health & Wellbeing Work has continued in 2021/22 with the further development of the Health & Social Care North Lanarkshire Health & Wellbeing Group, bringing together leaders from across the partnership to better co-ordinated resources and initiatives across NHS Lanarkshire, North Lanarkshire Council and other partner organisations. Two health and wellbeing posts have been created within NHS Lanarkshire and North Lanarkshire Council and will be progressed in 2022/23. These posts will lead and embed the co-ordinated approach to staff health and wellbeing across the partnership. Care Academy The Health & Social Care Academy workstream has been a much longer standing piece of work, with a more mature partnership model and based on a key joint venture with NHS Lanarkshire. Recently, the workstream has deepened the existing work by establishing 3 priority sub- groups focused on 1) the young workforce, with further development of the in school vocational offering for Health and Social Care; 2) adult recruitment and employability, with a focus on both short- and longer-term workforce demands in the sector, 3) building capacity and resilience by supporting wellbeing, training, and development across the existing workforce. A clear plan of action has been developed for each of the subgroups who will take forward this work forward in the next 6 to 12 months with regular reporting to the Workforce for the Future Steering Group. Work will also be taken forward in the next phase to develop a framework of outcome measures which can be used to track the overall progress of the programme and its impact.
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34 National Health and Wellbeing Outcome 9 Resources are used effectively and efficiently in the provision of health and social care services Financial Year 2021/2022 Financial information is part of our performance management framework with regular reporting of financial performance to the IJB. National Health and Wellbeing Outcome 9 also requires resources to be used effectively and efficiently in the provision of health and social care services. The resources available to the IJB to deliver the delegated functions set out in the Integration Scheme and the Strategic Commissioning Plan are comprised of the financial contributions from North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL). The financial position for public services continues to be challenging, particularly in response to the Covid-19 pandemic, the inflationary cost pressures and the potential outcome of future nationally agreed pay awards. Notwithstanding these pressures, in March 2021 the IJB agreed a financial plan for 2021/2022 to ensure a balanced budget was achieved by 31 March 2022. The detail of this plan is available at IJB Financial Plan 2021/20221. Partner Contributions 2021/2022 The delegated funds for the IJB come from NLC and NHSL. The level of funding available to the IJB is therefore heavily influenced by these organisations’ grant settlements from the Scottish Government. The total funding for the IJB in 2021/2022 was £752m. The comparison of funding contributions from the partners between 2019/2020 and 2021/2022 is graphically illustrated in the table and chart as follows: 1 https://mars.northlanarkshire.gov.uk/egenda/images/att95939.pdf Actual Funding 2019/2020 2020/2021 2021/2022 £m £m £m NLC Funding 161.112 150.938 168.587 NHSL Funding 477.550 542.167 582.943 Total Funding 638.662 693.105 751.531 Annual Increase 8.578 54.443 58.426
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35 The IJB’s Financial Position at 31 March 2022 The IJB Financial Plan 2021/2022 was approved by the IJB on 23 March 2021. Included within the funding available is a “notional set-aside budget” totalling £65.2m in respect of functions delegated by the Health Board which are carried out in a hospital within the Health Board area and provided for two or more local authority areas. Partner Expenditure 2021/2022 The total expenditure for the IJB in 2021/2022 was £685m. The comparison of actual expenditure between 2019/2020 and 2021/2022 is summarised in the table and graph below and further detailed at appendix 3. 0.000 100.000 200.000 300.000 400.000 500.000 600.000 700.000 800.000 2019/2020 2020/2021 2021/2022 Actual Funding Profile 2019/2020 to 2021/2022 (£m) NLC Funding NHSL Funding Total Actual Expenditure 2019/2020 2020/2021 2021/2022 £m £m £m Expenditure - NLC 212.044 205.709 213.065 Expenditure - NHSL 426.187 450.693 472.132 Transfer To / (From) IJB Reserves 0.431 36.703 66.334 Total Funding 638.662 693.105 751.531 Annual Increase 8.578 54.443 58.426
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36 As far as possible, the health and social care expenditure is also analysed by geographical area at appendix 4 and is summarised in the chart below. Further work will be progressed to develop more detailed locality financial monitoring reports. 2021/2022 Financial Outturn A financial surplus totalling £74.7m was reported at 31 March 2022. This is mainly due to the additional funding received from the Scottish Government to address Covid-19 expenditure and to take forward national and local priorities and essential and necessary changes within HSCP service delivery. The total underspend represents approximately 10% of the total financial envelope available of £752m. It is critical to note that this underspend is non-recurring. The significant variances across health and social care services are highlighted in the table below. 0.000 100.000 200.000 300.000 400.000 500.000 2019/2020 2020/2021 2021/2022 Actual Total Expenditure 2019/2020 to 2021/2022 Expenditure - NLC Expenditure - NHSL Transfer To / (From) IJB Reserves Health Localities (£32m - 5%) Social Work Services (£206m - 31%) North Lanarkshire-Wide (£364m - 56%) Lanarkshire Hosted Services (£54m - 8%) 2021/2022 Expenditure Analysis
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37 % of Total Underspend of £74.7m Main Factors 42% Funding received from the Scottish Government during 2021/2022 to address the cost of the response to the Covid-19 pandemic totalled £45.1m. The actual costs incurred in respect of the Covid-19 pandemic totalled £13.4m. The uncommitted funding of £31.7m was therefore transferred to a ring-fenced IJB Covid-19 reserve at 31 March 2022. The use of this reserve in 2022/2023 to address the significant changes to the Public Health policies in relation to Covid-19 pandemic is being discussed and agreed with the Scottish Government. It is expected that part of this IJB Covid-19 reserve may be returned to the Scottish Government to be redistributed across the health and social care sector to meet current Covid priorities. 20% The underspend across the Hosted Services led by the North Lanarkshire IJB totalled £15.3m. 20% There is an underspend totalling £8.0m across the Care At Home Service. This is predominantly due to staff shortages. A balance of the funding received in 2021/2022 to support winter planning remained uncommitted at 31 March 2022 and totalled £6.4m. Funding totalling £0.8m to support Carers also remained uncommitted at the year-end. These underspends total £15.2m. 8% The underspend across Locality and Other services totalled £5.9m. This is mainly due to vacancies across the six localities. 10% The balance of the underspend totalling £6.6m relates to Addiction Services, Area- wide Services, Prescribing and the Medical and Nursing Directorate. The balance on the IJB reserves at 1 April 2021 was £53.118m. The year-end surplus at 31 March 2022 was £74.7m. A total of £8.3m was drawdown from reserves during 2021/2022 to fund approved commitments. The net movement on reserves in 2021/2022 is summarised in the table below. Movement on Reserves NHSL NLC Total Balance as at 1 April 2021 £36.400m £16.718m £53.118m Year-end Surplus £58.697m £15.973m £74.670m Transfers From Reserves (£7.564m) (£0.772m) (£8.336m) Balance as at 31 March 2022 £87.533m £31.919m £119.452m The balance on the IJB reserves at 31 March 2022 is £119.5m (Ring-fenced - £45.7m; Earmarked - £70.1m and Contingency - £3.7m). The contingency reserve represents 0.5% of the total IJB financial envelope.
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38 Further details of the ring-fenced, ear-marked and general fund reserves totalling £119.5m is available at Note 11 of the Unaudited IJB Annual Accounts 2021/20222. Strategic Risk Assessment The IJB Risk Management Strategy complements the existing risk management processes within each partner. All three risk registers are reviewed regularly by the management team. Throughout the year, the financial monitoring reports provided updates on the management of the key financial risks. Best Value Assessment The IJB has a duty of Best Value, by striving to secure continuous improvements in performance, while maintaining an appropriate balance between quality and cost. In making those arrangements and securing that balance, the IJB has a duty to have regard to economy, efficiency and effectiveness, equal opportunities requirements and to contribute to the achievement of sustainable development. To provide an overall mechanism to review the best value arrangements for the IJB, a best value framework has been developed. Internal Audit Opinion 2021/2022 The Joint Internal Audit opinion was provided by the NLC Audit and Risk Manager and the Chief Auditor of NHS Lanarkshire. The conclusion is reasonable assurance can be placed upon the adequacy and effectiveness of the North Lanarkshire Health and Social Care IJB’s framework of governance, risk management and internal control for the year ended 31 March 2022. No issues or weaknesses were identified. Emergency Response to the Covid-19 Pandemic Covid-19 has affected each member of our society and a robust response was implemented. Available resources have, to date, been refocussed on the critical areas affected by the Covid-19 pandemic. Whilst these priorities are also continuing into 2022/2023, every effort is being made to progress the Response, Recovery and Remobilisation Plans. Remobilising the full range of HSCP services is challenging and maintaining innovation and learning from the pandemic will be essential. Although the current operational and financial challenges will inevitably drive the pace of change, improving outcomes for individuals will continue to underpin the IJB’s strategic commissioning intentions and the ongoing re-design and integration of health and social care services. As a result of the Covid-19 pandemic, there is a high degree of uncertainty in respect of additional costs particularly as we approach the winter period. The immediate challenge continues to be in respect of staff recruitment and staff turnover for both partners and external health and social care providers. The additional health and social care costs which are being incurred in response to the Covid-19 pandemic are being reported to the Scottish Government through the 2022/2023 Lanarkshire Remobilisation Plan. Financial Outlook for 2022/2023 and Beyond The IJB continue to operate in an increasingly challenging environment. Extensive consultation and engagement with a wide range of key stakeholders was previously undertaken to develop the Strategic Commissioning Plan 2020-20233. Locality plans have also been developed which localise the ambitions detailed in the Strategic Commissioning Plan. 2 https://mars.northlanarkshire.gov.uk/egenda/images/att98264.pdf 3 https://mars.northlanarkshire.gov.uk/egenda/images/att93862.pdf
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39 The IJB Directions4 which were issued to each of the partners to achieve safer, healthier, independent lives for the residents of North Lanarkshire are in alignment with the 9 National Health and Wellbeing Outcomes and the 6 Health and Social Care Delivery Plan Priorities. In respect of demographic growth and demand for services, research indicates that expenditure on healthcare would require to increase in real terms by an average of 3.3% per annum over the next 15 years to 2033 to maintain NHS provision at current levels. Social care funding would also require increasing by 3.9% per annum to meet the needs of the population living longer and an increasing number of younger adults living with disabilities. These projections do not consider the impact of the Covid-19 pandemic including long-Covid, the financial cost of which continues to be uncertain but is expected to be significant. Future Financial Sustainability The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the current significant challenges for both partners. Efficient, effective and affordable services fit for the future will need to be developed as part of the integration and transformational change activities. The IJB Medium to Long Term Financial Plan was prepared in March 2020 and underpins strong financial planning and management, the achievement of best value and the allocation of resources to support sustainable models of service delivery from a whole system perspective, ensuring our limited resources are targeted to achieve our outcomes. This plan however was prepared before the impact of the emergency response to the Covid-19 pandemic was known. As part of the recovery plan to the Covid-19 pandemic, the IJB Medium to Long Term Financial Plan is being reviewed to reflect the operational and financial challenges. The IJB Chief Finance Officer will continue to consult with both partners about the options available to address all 2022/2023 recurring and non-recurring health and social care cost pressures. Cost reduction options will be explored however this is not expected to release sufficient funding to meet the total increase in all health and social care cost pressures going forward. Reliance will therefore require to be placed on non-recurring funding and reserves. Our joint focus with all our partners and stakeholders will continue to be ensuring that all resources in scope are maximised, health and social care services are remobilised and a whole system approach across North Lanarkshire is adopted which is sustainable and operates efficiently and effectively. 4 https://mars.northlanarkshire.gov.uk/egenda/images/att95940.pdf
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40 4. Looking Forward – Our Next Steps We will continue to focus on delivering and implementing our Programme of Work for 2022/23, while managing the current extraordinary pressures on existing services as a result of demographic growth, the lasting implications of the Covid-19 pandemic and wider financial challenges. 2022/23 will be the final year of our Strategic Commissioning Plan 2020 – 23 and we will continue to deliver against our 6 key ambitions, 27 ambition statements, and 41 Programmes of Work. 1. Do the right thing first time 2. Provide a range of community services and supports to people to live well in connected communities 3. Focus on what matters to people 4. Be at the forefront of technical and sustainable solutions 5. Promote prevention and early intervention 6. Ensure North Lanarkshire is the best place to work, volunteer and care Looking ahead to 2022/23, we will commence engagement with stakeholders, service users, carers and families on the development of our new Strategic Commissioning Plan for the period 2023-26. To support this, we will develop a new Programme of Work for 2023-36 incorporating the transformational change priorities for the partnership, and their related workstreams. A whole system approach to delivery of the SCP’s Programme of Work will be further developed to equip leaders and managers to work with interconnections and co-dependencies, as well as give clarity and structure to wider partners and stakeholders.
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41 Appendix 1 – Summary of Performance against Core Suite of Integration Indicators Indicator Title NL 2015/16 NL 2017/18 NL 2019/20 NL 2021/22 NI -1 Percentage of adults able to look after their health very well or quite well 91.7% 90.3% 90.5% 87.5% NI - 2 Percentage of adults supported at home who agreed that they are supported to live as independently as possible 77.6% 79.8% NI - 3 Percentage of adults supported at home who agreed that they had a say in how their help, care, or support was provided 71.2% 67.1% NI - 4 Percentage of adults supported at home who agreed that their health and social care services seemed to be well co-ordinated 70.2% 66.6% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 77.8% 74.0% NI - 6 Percentage of people with positive experience of care at their GP practice 79.3% 75.5% 68.3% 51.8% NI - 7 Percentage of adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 75.7% 77.0% NI - 8 Percentage of carers who feel supported to continue in their caring role 41.2% 33.2% 32.6% 25.1% NI - 9 Percentage of adults supported at home who agreed they felt safe 80.0% 79.8% Indicator Title NL 2017 NL 2018 NL 2019 NL 2020 NL 2021 NI -11 Premature mortality rate per 100,000 persons 482 517 515 581 580 Indicator Title NL 2017/18 NL 2018/19 NL 2019/20 NL 2020/21 NL 2021 NI -12 Emergence admission rate (per 100,000 population) 15,663 15,826 16,281 13,824 15,093 NI – 13 Emergency bed day rate (per 100,000 population) 121,395 117,292 119,574 103,720 115,108
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42 NI – 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 99 101 106 123 117 NI - 15 Proportion of last 6 months of life spent at home or in a community setting 89.0% 88.9% 88.9%% 90.2% 90.0% NI – 16 Falls rate per 1,000 population aged 65+ 22.6 22.6 21.3 19.2 21.4 NL 2017/18 NL 2018/19 NL 2019/20 NL 2020/21 NL 2021/22 NI -17 Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections 79.1% 76.4% 83.3% 80.7% 78.1% NL 2017 NL 2018 NL 2019 NL 2020 NL 2021 NI – 18 Percentage of adults with intensive care needs receiving care at home 72.2% 74.6% 74.4% 75.1% 75.0% NL 2017/18 NL 2018/19 NL 2019/20 NL 2020/21 NL 2021/22 NI – 19 Number of days people spend in hospital when they are ready to be discharge (per 1,000 population) 1,009 996 1,109 781 831 NL 2017/18 NL 2018/19 NL 2019/20 NL 2020/21 NL 2021/22 NI – 20 Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency 20.7% 21.1% 21.6% N/A N/A
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43 Appendix 2 – HSCP Performance Dashboard Outcome (National Health & Wellbeing) KPI Target 2021/22 2021/22 Q1 2021/22 Q2 2022/22 Q3 2021/22 Q4 2021/22 Performance 1. People are able to look after and improve their own health and wellbeing and live in good health longer Alcohol Brief Interventions North 2039 947 1954 2,755 3,457 Alcohol Brief Interventions NHSL 5499 1460 3145 4383 5392 Cervical Screening 80% 75.0% 75.0% 74.6% 74.0% Immunisations – %s of 2 year olds 95% 96.0% 96.4% 96.6% 96.5% Immunisations – %s of 5 year olds 95% 95.0% 94.8% 94.9% 94.3% Addictions – Completed Waits 90% 95.8% Data issues Data issues Data issues Addictions – Ongoing Waits 90% 86.7% Data issues Data issues Data issues Addictions – Ongoing Waits NHSL 90% 90.9% Data issues Data issues Data issues Percentage of people who have completed 6-8 week review 90% 77.0% 77.1% 76.3% 77.7% 2. People, including those with disabilities and long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community Delayed discharge bed days - standard delays 23725 5,608 7,631 6,381 7,124 A&E Attendances - NL Residents 116456 32,688 32,910 28,547 28,226 Emergency Admissions - NL Residents 44001 11,701 11,707 11,298 10,535 Unscheduled Bed Days - all specialties, NL Residents 294999 79,698 82,091 83,834 80,517 Inpatient Activity – Readmissions 7 days 8 6.38 6.01 6.70 5.35 Percentage of patients waiting less than 12 months to begin PDS (waiting less than 12 months/total number waiting) 65% 82.4% 80.5% 83.6% 82.0% 'Mental Health - bed occupancy rate 85.9% 81.2% 94.7% 88.7% Assistive Technology - Number Of People With Technology (0-17 yrs) 1,452 2000 (500 per quarter) 42 39 38 36
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44 Assistive Technology - Number Of People With Technology (18-64yrs) 633 645 634 631 Assistive Technology - Number Of People With Technology (65+) 889 880 873 866 Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 373 706 916 1170 Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 68.2% 59.9% 67.7% 63.1% Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 61.4% 65.5% 53.2% 52.2% Balance Of Care - % Of People (Age 65+) 45% 47.6% 45.7% 44.3% 45.3% IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 74.8% 70.0% 66.3% 61.7% 3. People who use health and social care services have positive experiences of those services, and have their dignity respected 18 Week RTT Performance – CAMHS NHSL (NORTH HOSTED) 90% 57.3% 68.3% 69.5% 80.0% 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 81.0% 85.8% 81.5% 85.5% Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90%* 93.7% 86.6% 78.8% 73.4% Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90%* 87.4% 86.2% 85.8% 85.5% Consultant Outpatient WT - Learning Disability - 12wks (NHSL) (NORTH HOSTED) 90%* 100.0% 100.0% 100% 100% Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90%* 99.4% 96.6% 92.6% 72.5% Admission to MH Wards: Proportion NHSL Patients >=95% 97.4% 97.8% 98.0% 96.6% MSK Podiatry - 12wks (NORTH HOSTED) 90%* 96.0% 58.1% 73.6% 93.0% Podiatry - 12wks (NORTH HOSTED) 90%* 37.0% 28.5% 27.8% 90.5% Podiatry - domiciliary visits - 12wks (NORTH HOSTED) 90%* 37.8% 41.3% 50.0% 100% SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 33.7% 24.0% 30.1% 25.8% SLT - Adult - 12wks (NORTH HOSTED) 90%* 92.1% 85.2% 75.0% 83.2%
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45 Dietetics - 12wks (NORTH HOSTED) 90%* 68.9% 57.8% 60.7% 65.8% 4. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services Care Home Placements At End Of Quarter - Per 1000 Popn 65+ 24 21.4 21.4 21.0 21.3 Care Home Placements At End Of Quarter - Per 1000 Popn 75+ 50 43.7 43.7 43.0 44.0 Care Home - Average Length of Stay 865 851 852 831 819 Number Of People With Self Directed Support 1,000 1127 1127 1200 1256 Number Of People With A Direct Payment 240 282 298 308 321 5. Health and social care services contribute to reducing health inequalities Sustain and embed successful smoking quits, at 12 weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 127 241 313 412 6. People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact on their caring role on their own health and wellbeing Community Alarm Service Users 75 Years And Over Per 1000 Population Under Review 189.0 190.4 187.8 186.8 7. People who use health and social care services are safe from harm Manual Handling Awareness Training 90% 95.5% Data not available 95.2% 91.4% PAMOVA Training 90% 91.0% Data not available 96.4% 92.4% Adult Basic Life Support Training 90% 95.4% Data not available 89.8% 88.4% Paediatric Basic Life Support Training 90% 95.0% Data not available 94.6% 92.6% Fire Safety Training 90% 96.7% Data not available 96.8% 92.1% Hand Hygiene Training 90% 86.8% Data not available 96.1% 92.6% Safe information Handling Training 90% 81.5% Data not available 96.9% 92.0% Child Protection Awareness Training 90% 99.3% Data not available 96.0% 92.1% Health and Safety Awareness Training 90% 94.2% Data not available 97.3% 93.9% Occupational Health Service Awareness Training 90% 88.3% Data not available 97.9% 93.2%
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46 Adult Support and Protection Awareness Training 90% 78.8% Data not available 96.1% 92.5% % Of Adult Protection Referrals Passed To Care Team For Investigation 17.7% 17.9%* 20.3% 18.9% % Of Adult Protection Investigations Going To Initial Case Conference 18.9% 16.9%* 41.0% 23.9% Adult Protection - % Of Referrals With Decision Within 5 Days 60% 79.5% 76.5% 74.1% 79.3% % of Adult Protection Referrals Which Did Not Go On To Investigation Or Other Service 69.9% 65.7% 62.7% 66.3% 8. 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 TURAS compliance (NHSL, North) >80% 66% 64% 56% 58% 9. Resources are used effectively and efficiently in the provision of health and social care services Breakeven Position - YTD Variance Including Prescribing (NHSL) >=0 0.823m 0 £4432k £58.697m Breakeven Position - YTD Variance Excluding Prescribing (NHSL) >=0 0.823m 2046K £4432k £57.197m Sickness Absence (NHSL, North) 6.95% 6.61% 6.29% 5.28% Sickness Absence (NLC) - days lost per person 11.32 3.18 6.59 10.66 14
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47 Appendix 3 Actual Expenditure Profile 2019/2020 to 2021/2022 Appendix 3 0.000 25.000 50.000 75.000 100.000 125.000 150.000 175.000 200.000 225.000 Social Care Services Housing Services Family Health Services Prescribing Hosted Services - Led by the North IJB Hosted Services - Led by the South IJB Health Care Services - Localities Health Care Services - Area Wide Health Care Services - Out-of Area Hospital Acute Services (Notional Set Aside Budget) Corporate Services 2019/2022 2020/2021 2021/2022
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48 North Lanarkshire IJB Appendix 4 Analysis of 2021/2022 Expenditure Airdrie Locality Bellshill Locality Coatbridge Locality Cumbernauld Locality Motherwell Locality Wishaw Locality North Lanarkshire Lanarkshire Wide £m £m £m £m £m £m £m £m £m % Health Care Services 4.827 4.483 5.069 7.316 4.374 5.449 23.608 55.126 8% Social Care Services (Localities, Housing, Self Directed Support, Care Homes and Out-of-Hours) 212.882 212.882 31% Area Wide Health Care 11.010 11.010 2% Out of Area Health Care 4.990 4.990 1% Medical and Nursing 3.949 3.949 1% Addiction 4.345 4.345 1% Corporate 0.214 0.214 0% Family Health 109.651 109.651 16% Prescribing 68.739 68.739 10% Set-Aside Budget 65.164 65.164 10% Hosted Services Led By South Lanarkshire IJB 34.554 34.554 5% Hosted Services Led By North Lanarkshire IJB 50.718 63.855 114.573 17% Total 4.827 4.483 5.069 7.316 4.374 5.449 589.824 63.855 685.197 100% Percentage of Total 1% 1% 1% 1% 1% 1% 86% 9% 100% Health and Social Care Services TOTAL
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49 Appendix 5 – Inspection Findings 2021/22 Further information on 2021/22 inspection activity can be found in the Quality Assurance Annual Report. Service Resource Name Service Group Date Last Inspected How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? How good is our care and support during the COVID-19 pandemic? Lanarkshire Care Partners Self Directed Support 26/04/2021 Weak Weak Weak Not Assessed Weak Adequate Good Shepherd Secure Services 06/05/2021 Good Good Good Not Assessed Good Woodside Care Home Care Home (NLC) 20/05/2021 Adequate Deanston Care Home Care Home (NLC) 21/05/2021 Adequate Love Learning Scotland Self Directed Support 27/05/2021 Adequate Good Good Not Assessed Adequate Good LOVE@CARE Non Traditional Respite 27/05/2021 Adequate Good Good NA Adequate Good Summerlee House Care Home Care Home (NLC) 08/06/2021 Good Cumbernauld - NLC Home Support 09/06/2021 Not Inspected Weak Weak Not Inspected Weak Weak Highgate Care Home Care Home (NLC) 24/06/2021 Adequate The National Fostering Agency Scotland Fostering & Continuing Care 24/06/2021 Good Good Good Not Assessed Good Ochil Tower School Residential Schools 25/06/2021 Good Good Adequate Very Good Very Good Rawyards House Care Home Care Home (NLC) 29/06/2021 Not Assessed Not Assessed Not Assessed Not Assessed Adequate Adequate SCRT – [City & County] Self Directed Support 30/07/2021 Weak Constance Care Self Directed Support 13/08/2021 Good Adequate Adequate Not Assessed Adequate Good
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50 Hillend View Care Home (NLC) 18/08/2021 Unsatisfactory Weak Unsatisfactory Not Assessed Weak Weak Care No1 Ltd T/A The No1 Care Agency Non Traditional Respite 20/08/2021 Very Good NA NA NA NA Good HK - Care Consulting Self Directed Support 26/08/2021 Very Good Not Assessed Not Assessed Not Assessed Not Assessed Very Good JKL Care Services Self Directed Support 06/09/2021 Good Not Assessed Not Assessed Not Assessed Not Assessed Good Lochside Manor Care Home (NLC) 20/09/2021 Adequate Not Assessed Not Assessed Not Assessed Not Assessed Adequate Beechwood Care Home Care Home (NLC) 23/09/2021 Good Not Assessed Not Assessed Not Assessed Not Assessed Good Netherton Court Care Home Care Home (NLC) 23/09/2021 Not Assessed Adequate Not Assessed Not Assessed Not Assessed Adequate Lifeways Community Care - Glasgow Self Directed Support 01/10/2021 Good Adequate Adequate Not Assessed Adequate Adequate Craig En Goyne Care Home Care Home (NLC) 05/10/2021 Adequate Not Assessed Not Assessed Not Assessed Not Assessed Adequate Rosepark Nursing Home Care Home (NLC) 12/10/2021 Adequate Not Assessed Not Assessed Not Assessed Not Assessed Adequate Centenary House Care Home Care Home (NLC) 02/11/2021 Adequate Adequate Adequate Not Assessed Adequate Adequate Jon Fleming Group Self Directed Support 03/11/2021 Good Not Assessed Not Assessed Not Assessed Not Assessed Good Invercare Services Self Directed Support 24/11/2021 Adequate Not Assessed Not Assessed Not Assessed Not Assessed Adequate SRS Care Solutions Self Directed Support 24/11/2021 Good Not Assessed Not Assessed Not Assessed Not Assessed Good Darroch Nursing Home Care Home (NLC) 01/12/2021 Adequate Not Assessed Not Assessed Not Assessed Not Assessed Good Active Care & Support Services Self Directed Support 08/12/2021 Adequate
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51 Murdostoun Care Home (NLC) 09/12/2021 Weak Adequate Adequate Not Assessed Adequate Adequate Carrickstone House Nursing Home Care Home (NLC) 13/12/2021 Adequate Not Assessed Not Assessed Not Assessed Not Assessed Adequate Kibble Secure Unit Secure Services 17/12/2021 Very Good Very Good Very Good Very Good Good Stanmore Residential Schools 21/12/2021 Weak Weak Weak Adequate Weak The Village Care Home Care Home (NLC) 23/12/2021 Adequate Millbrae Care Home Care Home (NLC) 10/01/2022 Adequate Not Assessed Not Assessed Not Assessed Not Assessed Adequate Carnbroe Care Centre Care Home (NLC) 18/01/2022 Adequate Not Assessed Not Assessed Not Assessed Not Assessed Crossreach Children's Services Residential Schools 09/02/2022 Very Good Not Assessed Not Assessed Not Assessed Very Good Thornhill House Residential Home Care Home (NLC) 10/02/2022 Good Not Assessed Not Assessed Not Assessed Not Assessed Good Kirknowe Nursing Home Care Home (NLC) 11/02/2022 Good Not Assessed Not Assessed Not Assessed Not Assessed Good Bellshill - NLC Home Support 14/03/2022 Weak Weak Weak Weak Weak Weak
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52 Glossary of Terms A&E Attendance An A&E attendance is when a patient attends an Accident & Emergency department. ADP The Alcohol and Drug Partnership (ADP) is responsible for commissioning and developing local strategies for tackling problem alcohol and drug use and promoting recovery based on an assessment of local needs. Adult Protection Committee The Adult Protection Committee is a multi- agency committee which monitors and reviews what is happening locally to safeguard adults. It is made up of senior staff from many of the agencies involved in protecting adults who may be at risk. Adult Support & Protection (ASP) Adult Support and Protection relates to the protection of adults at risk of harm and the measures and duties within the Adult Support and Protection (Scotland) Act 2007. CAMHS The NHS Lanarkshire Child & Adolescent Mental Health Service (CAMHS) is a specialist service for infants, children and young people. Delayed Discharge A delayed discharge occurs when a patient is ready to leave a hospital or similar care provider but is still occupying a bed. Emergency Admission An emergency admission is one where a patient is admitted to hospital urgently and unexpectedly (ie the admission is unplanned). First Point of Contact (FPOC) First Point of Contact (FPOC) is an approach which aims to support people in our communities to receive the right support, from the right person, at the right time. T Good Mental Health For ALL (GMHFA) Good Mental Health for All sets out a vision for Scotland and a rationale for why it is important for local strategic partnerships to continue to focus on improving mental health, equitably, across the population. Health & Care Experience Survey The Health and Care Experience Survey is a national survey which asks about people’s experiences of accessing and using their GP practice and Out of Hours services • aspects of care and support provided by local authorities and other organisations • caring responsibilities and related support Integration Authority Integration Authorities are responsible for planning, designing and commissioning health and social care services in an integrated way from a single budget in order to take a joined
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53 up approach, more easily shifting resources to best meet need. Integration Joint Board (IJB) Health Boards and Local Authorities delegate a significant number of functions and resource to the Integration Joint Board, which is responsible for the planning of integrated arrangements and onward service delivery. Measuring Performance Under Integration (MPUI) A small set of indicators was developed as a way of measuring performance of Health & Social Care Partnerships. Mental Health Action 15 Mental Health Action 15 is an action from the Scottish Government’s Mental Health Strategy and relates to the investment in additional workforce across A&Es, GP practices, police station custody suites and prisons. Ministerial Strategic Group for Health and Community Care (MSG) a key strategic decision taking group in relation to transformational change in health and community care in Scotland. The group is chaired by the Cabinet Secretary for Health and Sport and the COSLA Spokesperson for Health and Social Care. National Core Integration Indicators A core suite of indicators that Integration Authorities use to measure progress towards the National Health and Wellbeing Outcomes. National Health & Wellbeing Outcomes There are nine national health and wellbeing outcomes which apply to integrated health and social care. Health Boards, Local Authorities and Integration Authorities work together to ensure that these outcomes are meaningful to people in their area. Personal Protective Equipment (PPE) Personal Protective Equipment is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. PSSST Lanarkshire’s Psychological Services Staff Support Team SHAPE Recovery SHAPE is a programme of support for front line health and care workers which can help reduce rates of post-traumatic stress disorder (PTSD) and depression. Social Work Scotland (SWS) Social Work Scotland is the professional body for social work and social care leaders. SALUS Salus is a provider of Occupational Health and other services to NHS Lanarkshire. Trauma informed Practice (TiP)_ Trauma-informed practice is designed to raise awareness among all staff about the wide impact of trauma and to prevent the re- traumatisation of patients and services users in service settings that are meant to support and assist healing
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54 Unscheduled Bed Day A bed-day is a day during which a person stays overnight in a hospital. An unscheduled bed day is where the patient’s admission was unplanned. VANL Voluntary Action North Lanarkshire is a charitable organisation which provides support to community and voluntary organisations across the whole of North Lanarkshire.
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1 REPORT Item No: 11 1. PURPOSE OF REPORT 1.1 This paper is coming to the Committee: For approval For endorsement To note 1.2 The purpose of the report is to provide an update to the Committee on the areas for improvement which have been identified as part of the Quarterly Performance Review for the period 1 July to 30 September 2022 (Quarter 2). 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Senior Manager, Strategy & Performance Reviewed By: Head of Planning, Performance & Quality Assurance Endorsed By: 3. RECOMMENDATIONS 3.1 The Committee is asked to note the contents of the report and its appendix. 4. BACKGROUND/SUMMARY OF KEY ISSUES 4.1 The Chief Officer has joint quarterly performance review meetings with the Chief Executive of NHS Lanarkshire and the Chief Executive of North Lanarkshire Council. These meetings are supported by a Chief Executive Performance Framework comprising a range of performance measures from across both health and social work systems, including relevant targets and trajectories. 4.2 Based on a traffic-light system there are areas for improvement identified within the performance framework each quarter for those that are flagged as Red or Amber. The performance review meetings are used as a means for jointly agreeing corrective actions. SUBJECT: Performance Update – Quarter 2 (July – September 2022) TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author of Report: Graeme Cowan, Senior Manager, Strategy & Performance DATE: 14th February 2023
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2 5. AREAS FOR IMPROVEMENT 5.1 The areas for improvement and corrective actions are attached as Appendix 1. 6. CONCLUSIONS 6.1 The areas for improvement identified in Appendix 1 are being progressed as a matter of priority, and progress updates will be reported at future meetings of the Board and the Performance, Finance & Audit Committee. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES The Chief Executive Performance Review process is structured in a way to allow performance levels to be assessed against each of the 9 national outcomes. 7.2 ASSOCIATED MEASURE(S) None 7.3 FINANCIAL None 7.4 PEOPLE None 7.5 INEQUALITIES EQIA Completed: Yes No N/A 8. BACKGROUND PAPERS None 9. APPENDICES Appendix One - Areas for Improvement (Quarter 2, July - September 2022) ............................................................................. HEAD OF PLANNING, PERFORMANCE AND QUALITY ASSURANCE Members seeking further information about any aspect of this report, please contact Graeme Cowan on telephone number 07946702861.
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3 Appendix 1 – Areas for Improvement (Quarter 2, July - September 2022) 1. Delayed Discharge / Home Support / Reablement Target 2022/23 2022/23 Q1 2022/23 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Delayed discharge bed days - standard delays 31,796 Q1 – 7184 Q2 – 8966 Q3 – 8166 Q4 – 7531 6,680 7,409 Reablement - Number Of People Completing Reablement Process 2,000 (500 per quarter) 354 678 (cumulative) Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 67.1% 60.6% Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 56.2% 50.2% Narrative & Corrective Action Delayed Discharge April – September 2022/23 HSCP North Lanarkshire delayed discharge performance was 16,706 standard bed days against a target of 18,931, 2225 bed days below target. Performance improved during June, however bed days have increased from July through to October. Management information suggests that this trend has continued through November and December.
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4 Performance at the last Scottish Government data release showed North below the Scottish average in terms of rates of delay. The number of patients discharged with no delay was above 95% by the end of October (target 98%). A wide range of activity is underway, both locally and nationally, to drive further improvement in performance, these include: 1. Whole system improvement work on the PDD process, including development of PDD metrics for inclusion in future reports 2. Lanarkshire is a demonstrator site for Home First/Discharge without delay. 3. Home Assessment Team is now operational and has supported over 280 people home since May 2022. Further work is ongoing to accelerate the implementation of Home Assessment Teams across all localities. 4. Expanding Hospital at Home service and expanding to under 65s.
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5 5. Additional CSWs have been recruited to enhance the care offering to those on District Nursing caseloads, freeing up further Home Support capacity to concentrate on other cases. 6. New approach to interim care home placements introduced in December 2022. 7. Participation in national Rapid Action Group for Care at Home. Home Support / Reablement NLC in-house Home Support provision has increased over the last 28 months with pressures in the system caused by a number of factors including reduced availability of alternatives to in-house home support, pressures from hospital referrals/ discharges, staff absence, skills, training, increased acuity and complexity. Recruitment and retention to posts at all grades has been challenging and there has been a higher than usual turnover. In particular Home Support Worker, Support Officer and Service Delivery Coordinators are difficult to recruit and retain. These new roles were introduced just prior to the pandemic, and it was not possible to establish them fully due to changes in working arrangements and the difficulties of delivering training. The feedback from staff is that the roles are challenging and therefore it has not been possible to sustain staff in post. 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. The current Home Support operational model needs to be reviewed to embed Home Support provision, assessment and planning and longer-term care and support provision for North Lanarkshire. To facilitate this, it will be necessary to ensure that the model reflects the pathway which will ensure that: All individuals will have an opportunity to be assessed at home when they are being discharged from hospital, or when their health is deteriorating to the point that they may need hospital Community supports will be considered and individuals will be signposted Reablement and rehabilitation will be 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. The Home Support element of the Reablement provision will have dedicated management team. During the period of assessment, a lead worker will be allocated to identify personal outcomes and develop a support plan to meet those outcomes. Capacity within the reablement service has reduced significantly since the onset of the C-19 pandemic, as a result of the pressures and demands outlined above. Efforts continue to ensure reablement capacity within the service is protected with reablement and rehabilitation key priorities for the future of the operating model. 324 people completed the reablement process in quarter 2, which was 31 fewer thane the previous quarter and significantly below the target of 500 people per quarter. It is crucial that the Reablement Service is supported to fully recover to ensure consistent practice across all 6 localities in supporting people’s
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6 rehabilitation or reablement needs. 258 people have completed the reablement process in October and November 2022, suggesting an increase in flow through the service. 2. Integrated Equipment & Adaptation Service Target 2022/23 2022/23 Q1 2022/23 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status IEAS - % Deliveries Achieved Within 7 Working Days 80% 66.6% 75.1% Narrative & Corrective Action Overall performance for equipment deliveries within seven working days was 75.1% for Quarter 2, an improvement from 66.6% for Quarter 1. The service continues to prioritise work for supporting hospital discharges and admission prevention, which can often affect its ability to deliver other equipment requests within agreed timescales. 3. CAMHS Target 2022/23 2022/23 Q1 2022/23 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of patients commencing treatment within 18 weeks of referral 90% 67.7% 25.4% Narrative & Corrective Action The CAMHS RTT showed 19.58% of patients commenced intervention within 18 weeks of referral in October 2022. Although this is a reduction in RTT performance, this was anticipated as waiting list initiative clinics are now in place to reduce the longest waits from the waiting list. As previously noted to the Board, successful recruitment of our new Nursing Teams has allowed us to create new waiting list initiative clinics. From 22nd August – 20th November, these out of hours clinics have seen 665 additional appointments offered, with 512 attendances, 153 DNAs, 5 patients transferred and 76 patients positively redirected to other more appropriate supports. As anticipated, our compliance against the Referral to Treatment Time target has reduced markedly due to the waiting list initiative clinics now being in place and new capacity being focused on seeing individuals who have already breached the 18wk target.
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7 Positively, this has seen our total number of waits start to reduce and we will see this trend continue in the November and December data once released. The new Nursing teams have created a significant improvement in capacity as demonstrated in recent data and this will continue to grow in line with recent recruitment success. Waiting List Initiative Progress A waiting list initiative (WLI) commenced on 22nd August, with the aim of increasing capacity by Christmas to around 70 new patient appointments per week. To date, we have been able to offer just short of 800 appointments (to 4th December) and are on track to deliver the capacity sought ahead of Christmas. A pause has been put on WLI during festive period. This has been informed by family and carer feedback and reduced availability of staff. The WLI will recommence on January 9th.
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8 Projecting Recovery Based on the new increased capacity of the service and a continued average of 288 new referrals per month, we have worked with analysts to project how long it will take to clear the existing waiting lists: The starting point of waiting list patients offered will be completed by June and anticipated to conclude by August to ensure children who are not brought at first appointment are offered appropriate further opportunity to engage.
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9 The waiting list has delivered assessments to those who were identified at the starting point. Referrals have continued throughout the time period and success of being able to balance capacity and demand will require a blended approach of ongoing supplementary support whilst CAPA model embeds and we recruit staff to facilitate flex in numbers of choice appointments being offered. CAPA Implementation A significant level of work has been progressed over last 3 months to assure progress on being able to deliver CAPA by end of March 2023. Each team is progressing at variable paces due to different stages of recruitment within individual teams, however, we are tailoring plans accordingly to complete the process as soon as practicable. Skills matrix, job planning and CAPA away days have been delivered or are in process across all teams. All teams are being supported by our service improvement and project leads as well as our waiting list coordinators. A key to successful roll out of CAPA model will be the quality assurance work that precedes it. This includes caseload review with support and supervision from clinical coordinators and delivery of a Duty Team that can field and appropriately respond to unscheduled care requests and crisis. Recruitment Recruitment remains challenging within CAMHS. The reasons for this are multi factorial: - High competition to recruit colleagues with level of skill required into specialist posts. Staff who we have managed to retain have moved into promoted posts within CAMHS or NDS. Successful recruitment is not reflected within internal vacancy numbers. We are addressing this in different ways: - A dedicated recruitment team in place to support CAMHS management teams to ensure all vacancies are processed as quickly as possible and minimise the risk of any delays in the recruitment processes. A CAMHS specific recruitment landing page is being built to proactively support our position that Lanarkshire and specifically CAMHS is a good place to work. Reviewing all identified posts that have been difficult to recruit to and assessing whether these monies could be redirected to other types of posts and/or wider partnership short term funding streams that could support earlier intervention. CAMHS Nursing Teams: Band 5 x 4 (16%). The service is actively working with universities to promote CAMHS as a positive destination for newly qualified nurses. This will include increasing number of student nurse training places offered by team. Additionally, CAMHS is utilising opportunity of newly qualified nurse access to team so that we can grow and develop our own in years ahead. CAMHS AHPs: 5 vacancies (29.2%). Many of these vacancies have arisen due to staff being promoted within service which is a positive for our retention strategy which includes professional support and positive career pathways for AHP colleagues Neurodevelopmental Service
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10 Staffing within our Neurodevelopmental Service has increased by 135% over last 6 months. They now have a funded whole time equivalency (wte) of 44.25 across all staff groups. We anticipate that all but 2 of these posts will be filled by end of February. Prioritisation of work to support this growth within team has had to focus on team building and development, delivery of robust and consistent standardised operating procedures and delivery of an e-Health infra structure that is capable of responding to new ways of working. Our newly appointed clinical coordinator has driven forward these priorities and we are pleased to advise: - TrakCare is now implemented Waiting list is split into 6 localities for 5-14, plus Pre 5 and 15+ age groupings Commissioning Process underway to procure additional external capacity for our longest waits for a diagnosis of Autistic Spectrum Disorder, 2 tenders received, which have been rated, £500,000 budget agreed. Service Development & Team Building Day was delivered on December 7th and positively evaluated by staff. Operational Policy is being finalised. New locality model of service delivery will be in place in January 2023. Work continues to progress delivery of Morse. Other Developments Our South Lanarkshire site in Udston is now fully operational. It hosts south locality teams as well as our Neurodevelopmental Service. We have received positive comments from the experience of children, young people and their families who have been seen within the building. An official opening of the building is planned for early next year. Monies have been identified that will support refurbishment of our North Lanarkshire estate to bring them to same standard of Udston site. A virtual series of walk through experiences are being planned that will be able to be provided via electronic link when we offer appointments. This will help inform children, young people and their families of what they can expect when they attend appointments with us. 4. Psychological Therapies Target 2022/23 2022/23 Q1 2022/23 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of patients commencing treatment within 18 weeks of referral 90% 85.0% 82.8% Narrative and Corrective Action
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11 During November 83.57% of patients commenced psychological therapy within 18 weeks (target is 90% and this is a slight decrease from October which was 86.54%). The longest wait was in Motherwell PTT at 45 weeks. Work continues to focus on sharing longest waits across localities in PTT to balance workloads, with a new “virtual locality” adult PTT now in place to focus on longest waits. Focus on appointment outcomes (second table) continues to have a good impact – overall average of completed outcomes being 96.22%. HEAT Summary PT No. of Patients Waiting (Assessment) 1239 No. of Patients Waiting (Intervention) 898 No. of Patients Waiting (Overall) 2137 No. of Patients Waiting <= 18 weeks 1657 % Waiting <= 18 weeks (Overall) 77.54% Longest Wait Overall (Weeks) 45 PT Team with longest wait Motherwell No. of Completed Waits 1065 No. of Completed Waits <= 18 weeks 890 % Completed Waits <= 18 Weeks 83.57% Appointment Outcomes Completed for last month (Adult does not include CamGlen): Team All New C31Z1 Chronic Pain Psychology 87.50% 100.00% F3Z4 Obstetrics MNPI 91.20% 83.33% G1AZ2 Psychological Therapies Addictions 97.52% 100.00% G1BZ2 Psychological Therapy Eating Disorders 98.77% 100.00%
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12 G1Z2 Psychological Therapies 98.31% 96.31% G1Z21 PT V1P 100.00% 100.00% G1Z22 PTAccept-LTC 100.00% 100.00% G1Z25 Psychology Assessment Plus 78.38% 71.43% G1Z3 PT Clinical Health 98.28% 100.00% G1Z4 PT Neuropsychology 100.00% 100.00% G1Z6 Perinatal Psychology 98.11% 100.00% G1Z7 EP Psychology 97.06% 100.00% G1Z8 Psychology Staff Support 96.30% 100.00% G3Z2UN Psychological Therapies Forensic Unscheduled 100.00% 100.00% G4Z2 Psychological Therapies Older People 99.77% 100.00% G5Z2UN Psychological Therapies Learning Disability Unscheduled Clinic 96.52% 94.74% R3Z20 LWMS Adult Psychology 98.00% 100.00% Overall Average 96.22% 96.81% Patients who did not receive an intervention (i.e. have an appointment outcome such as “No Treatment Required”) are excluded. 5. Waiting Times Performance – AHP and Community Services Target 2022/23 2022/23 Q1 2022/23 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 50% 27.3% 20.0% Narrative & Corrective Action Performance prior to COVID-19 was 62.7%. The service has previously described the SLT covid-19 journey – suspension in OP appointments; staff redeployed to staff wellbeing and immunisation teams; and a gradual move to remote working. Pre-Covid the Service was unable to achieve the 90% 12 week target, partially linked to the roll out of the 12-15 month screening, which led to some double running for SLT. The first children who had gone through the 12-15 month assessment were reaching the 27-30 month assessment stage just before the pandemic hit, and the service expected to see a gradual improvement in demand profiles due to earlier intervention. However, performance deteriorated significantly from April 2020 due to the impact of the pandemic, dipping below the lower control limit.
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13 The service is struggling to sustain improvement. Performance for November improved slightly to 34.1% (the highest since February 2022) with 1158 children waiting over 12 weeks. The longest wait is 62 weeks. A range of work is underway within the Children’s Services team, learning from some of the progress made within other services (e.g. triage model introduced in Podiatry and group activity within Psychological Therapies). While some Locality areas still have some accommodation challenges, group activity recommenced in August 2022, which will support an increase in capacity, while further review is underway to explore what other group supports could be initiated. A Data Protection Impact Assessment has now been signed off to support the introduction of Hanen More Than Words Groups, and work continues on the DPIA to support the use of Microsoft Teams as a mechanism for further online group activity. Staffing levels remain a challenge, with absences at over 5%, though special leave has reduced in recent months and recruitment remains an issue across Scotland. 6. Waiting Times Performance – AHP and Community Services Target 2022/23 2022/23 Q1 2022/23 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status
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14 Occupational Therapy - Paediatric - 12wks (SOUTH HOSTED) 50% 59.2% 35.3% Narrative & Corrective Action Performance over recent months shows a downward trend (see fig 7 below) with recent outlier points below the lower control limit, performance in November shows improvement, 60%, with 248 people waiting beyond target. Increase in demand has seen sustained referral rate increase of 23% on pre-pandemic levels. Increase in complexity and variety of clinical presentations resulting in limited ability to utilise universal and targeted service resources that have previously been successful in managing demand. New Lanarkshire developments in CAMHS and Neurodevelopmental services has resulted in the migration of a number of senior and experienced CYP OTs to these new services. All open caseloads of the staff transferring have been distributed across the CYP OT teams, reducing capacity to address new referrals. Despite the development of Neurodevelopment (ND) and CAMHS OT posts, treatment and ongoing support for complex ND cases and wellbeing presentations remain with CYP OT. Work is required to re-design existing pathways to maximise patient outcomes and experience, and make best use of available resources. Reduced staffing capacity continues as a result of vacancies, turnover and maternity leave.
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15 7. Sickness Absence Target 2022/23 2022/23 Q1 2022/23 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 5.72% 6.47% Sickness Absence (NLC) - days lost per person 11.32 2.58 5.15 Narrative & Corrective Action All long term and short term sickness absence continues to be managed in accordance with the relevant policies across NHSL and NLC. A number of resources are remain in place to support staff who are experiencing sickness absence, including spiritual care, salus helpline and psychological support services. North Health and Social Care Partnership has a well-established Health and Wellbeing Group in place who work to identify resources and additional support services to help staff remain at work during the challenges they have experienced and the continued pressures on services to provide high quality care to patients and service users within the partnership, and beyond.
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1 REPORT Item No:12 SUBJECT: Alcohol and Drug Partnership (ADP) and Medication Assisted Treatment (MAT) Standards Update TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer Author of Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Head of Health DATE: 14th February 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the Committee: For approval For endorsement To note 1.2 The purpose of the report is to provide the Committee with update on work to implement the MAT Standards in North Lanarkshire and on progress in relation to ADP commissioning and investment in local services and supports. 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Head of Health Reviewed By: Head of Planning, Performance and Quality Assurance Endorsed By: 3. RECOMMENDATIONS 3.1 The Committee is asked to: note the contents of the report require continued reporting within the agreed timeframes 4. BACKGROUND/SUMMARY OF KEY ISSUES 4.1 The number of drug deaths and level of harm caused by alcohol and drugs both national and locally requires a continued and consistent focus on the actions needed to reduce deaths and improve lives impacted by drugs and alcohol. 4.2 Reports to the Integration Joint Board and Performance, Finance and Audit Committee in 2022 in February, September and November, demonstrate the strength of the foundation work required to achieve real change in the lives of people in North Lanarkshire.
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2 4.3 This report provides an update on the progress being made specifically in relation to implementing the Medication Assisted Treatment standards and in relation to the service commissioning work which supports the strategic direction of the Alcohol and Drug Partnership. The Medication Assisted Treatment (MAT) standards plan 4.4 The Medication Assisted Treatment (MAT) standards direct what is needed for the consistent delivery of safe and accessible drug treatment and support in Scotland. The MAT standards apply to all services and organisations responsible for the delivery of care in a recovery-oriented system of care and are prioritised in an attempt to prevent and reduce deaths. 4.5 Th North Lanarkshire MAT plan has been developed by partners and has taken account of the voices of lived and living experience. 4.6 The current MAT standards in North Lanarkshire are: 1. Same day access: All people accessing services have the option to start MAT from the same day of presentation. 2. Choice: All people are supported to make an informed choice on what medication to use for MAT and the appropriate dose 3. Assertive outreach: All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT. 4. Harm Reduction: All people are offered evidence-based harm reduction at the point of MAT delivery. 5. Retention: All people will receive support to remain in treatment for as long as requested. 6. Psychological Support: The system that provides MAT is psychologically informed (tier 1); routinely delivers evidence-based low intensity psychosocial interventions (tier 2); and supports individuals to grow social networks. 7. Primary Care: All people have the option of MAT shared with Primary Care. 8. Independent Advocacy: All people have access to independent advocacy and support for housing, welfare and income needs. 9. Mental Health: All people with co-occurring drug use and mental health difficulties can receive mental health care at the point of MAT delivery. 10. Trauma Informed Care: All people receive trauma informed care. 4.7 The MAT Standards Implementation Plan produced in September 2022 to set out actions being taken in North Lanarkshire was developed by partners and takes account of the voices of lived and living experience. 4.8 Focusing specifically on MAT standards 1 – 5 the current status in North Lanarkshire is noted below: 1 Same day access - All people accessing services have the option to start MAT from the same day of presentation RED Pan – Lanarkshire Oversight and Governance group has been established North Lanarkshire MAT Working Group has been established North Project Lead recruitment progressed
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3 Leads for each MAT standard in place Action plan to support MAT 1 in place Learning from the Urgent Care Support Team Test of Change initiated in South Standard Operating Procedure setting out prescribing guidelines, care pathways and identify key localities to initiate/test same day access being developed Clinical prescribing guidelines have been written by lead pharmacist and signed off by stakeholders to support same day prescribing for MAT A Standard Operating Procedure has been written in regards to the Test of Change which will influence MAT service development Pan Lan Workforce development plan progressing NLADP Supporting experiential / lived experience feedback to this process via commissioned services and existing structures 2 Choice - All people are supported to make an informed choice on what medication to use for MAT and the appropriate dose AMBER Workstream lead identified Current approaches, processes, and resources available have been reviewed Short Life Working Group established to update named patient SOP and key action required to implement across MAT2 Test of Change sites and wider localities Work continuing to establish a standardised approach to choices offered across all services with relevant supporting guidelines to be developed Leaflet/promotional content to being developed for individuals accessing treatment highlighting MAT 2 setting out choices Lived experience to continue to monitor progress and feedback on an ongoing basis – NLADP supporting 3 Assertive outreach - All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT AMBER Work stream lead identified Learning from LORT/Assertive Outreach services including Justice reviewed to develop an MAT 3 action plan Assertive outreach capacity reviewed with recommendation to NLADP treatment group – informing ADP commissioning Progress on the Urgent Care Response Team mobile capacity sourced and resourced Developing standard operating procedure, information sharing protocols and pathways for rapid access to opioid substitution therapy and supportive care 4 Harm Reduction - All people are offered evidence-based harm reduction at the point of MAT delivery AMBER Work stream lead identified Review of current arrangements/processes MAT 4 WAND action plan developed MAT 4 workforce development plan to move to more consistent HR screening at each opportunity/appointment Workforce briefing sessions/training and ‘local champions’ to be identified for ach locality
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4 Increase naloxone provision targeting to localities of concerns identifying key people who will respond in suspected overdose situations including community link and families Harm Reduction Team Standard Operating Procedure to be developed with Harm Reduction Team and Addiction Recovery Teams in conjunction with service manager. Improvement plan to be developed based on Standard Operating Procedure delivery. Home testing plan being developed to work alongside normal team-based testing Electronic system currently in development with IT services, which will consist of a harm reduction form on MORSE, reporting to Harm Reduction Team Harm reduction packs (IEP, Wound packs, BBV test kits, documentation, aide memoire) to be developed that will be individual workers responsibility to take to appointments 5 Retention - All people will receive support to remain in treatment for as long as requested RED MAT 5 Lead identified Review of current Standard Operating Procedures and information offered to individuals in relation to treatment and care Pathways and process review – planned/unplanned discharge rates reviewed to identify appropriate assertive outreach support/follow up opportunities Action plan and timeline for MAT 5 developed NLADP reviewing family inclusive practice across treatment and care services Further work is being undertaken to have structured and documented pathways in place to make best use of statutory and commissioned services Established shared care arrangements with GPs that includes proactive and supported transfer of people stable on MAT is a challenge North Lanarkshire ADP 4.9 NLADP has a strategic commitment and strong aspiration to create a whole system approach to holistic, person-centred and recovery focused services and supports, building on the many examples of innovative involvement of people with lived experience at individual, service and partnership levels to proactively consult, engage and seek feedback. 4.10 A significant review of services and analysis of performance has informed the commissioning and investment position captured in the table below. 4.11 There is a commitment to 3-year funding approach with quarterly reporting and annual reviews: NLC initiatives continuing NHS initiatives continuing Creative Faces Family Plus Project Older Person Advocacy support Addiction Psychology posts Occupational Therapy posts Harm Reduction posts ART – Integrated Team
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5 Drug Testing and Treatment Order – DTTO Housing Life Coaching Kickstart project Substance Misuse Liaison Team VAW Partnership Services for retender on a 3 + 1 year basis New Services on a 3 + 1 + 1 year basis Recovery Development Youth Information and learning Individual Placement Support Crisis/overdose response and assertive outreach service Adult Family Support Community and voluntary sector initiatives Test of Change Initiatives Medics Against Violence – Acute Navigators Phoenix Futures – T2 Treatment Service Barnardos – young person support Equal Say Independent Advocacy Phoenix - Prison Through Care support Scottish Drugs Forum – Addiction Worker Training Programme Youth Justice Contextual Safeguarding - Arrest Referral Solution Courts Lived & Living Experience Panels Substance Misuse Support Fund – VANL Extended Youth Work Provision & Diversionary Activities – CL&D Corra Funded initiatives Research, Development and Scoping Blue Triangle – Breakthrough Service Family learning centres support Barnardos/Phoenix – family support ToC SRC – Residential Rehab provision River Garden Circle – Families and Justice HIS Substance Use and Mental Health Scotland Excel – Residential Rehab Scottish Recovery Consortium - Rehab Training and events calendar to follow in 2023 building on learning from our first training needs analysis. 4.12 The intention is to seek performance reporting on a quarterly basis with regular engagement with the ADP support team through named contacts with all services. 4.13 Reflecting an increase focus on whole system responses, annual stakeholder engagement sessions in springtime of each year will give an opportunity for all stakeholders and people with lived and living experience to reflect on the impact on the loves of people in North Lanarkshire. 4.14 A full and detailed annual report will be brought to the PFA and will facilitate completion of the Self-Assessment required by the Scottish Government. A detailed performance report will therefore be brought to the Performance, Finance and Audit committee in Cycle 3 of each year August – September. 5. IMPLICATIONS 5.1 NATIONAL OUTCOMES The Annual Performance Report contains content relevant to all national outcomes.
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6 5.2 ASSOCIATED MEASURE(S) None 5.3 FINANCIAL None 5.4 PEOPLE None 5.5 INEQUALITIES EQIA Completed: Yes No N/A 6. BACKGROUND PAPERS None 7. APPENDICES ............................................................................. CHIEF ACCOUNTABLE OFFICER Members seeking further information about any aspect of this report, please contact John Holleran on telephone number 01698 753651.
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1 REPORT Item No: 13 SUBJECT: Lanarkshire Mental Health and Wellbeing Strategy TO: Performance, Finance & Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health NHSCP Author(s) of Report Ian Nicol, Programme Manager DATE: 14th February 2023 1 PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note 2 ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: The Lanarkshire Mental Health and Wellbeing Strategy Board 3 RECOMMENDATIONS The Performance, Finance and Audit Committee is asked to note that: 1) The delivery plans for all workstreams have been reviewed to ensure that they build on Covid-19 recovery plans and focus recovery efforts on the objectives set out in Getting it Right for Every Person. The refreshed Delivery Plan has been mapped onto the National Transition and Recovery Plan. 2) An Achievement Framework has been developed to link the improved capability delivered by projects and workstreams to improvements in key performance indicators and the achievement of short and long term outcomes and benefits. 3) A prototype performance report is currently being collated based on these. Once this has been achieved a process will be established to enable quarterly production of this report. 4) Planning is commencing for the development of a new Strategy to succeed the 2019-24 Strategy.
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2 4 VARIATIONS TO DIRECTIONS? 5 BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Getting it Right for Every Person, a Mental Health and Wellbeing Strategy for Lanarkshire was launched in October 2019 to provide a shared vision and to drive significant shifts in culture (how we see and treat mental health and physical health), focussing on earlier intervention and prevention as well as the redesign and reconfiguration of services and development of new services. 5.2 There are 4 main workstreams within the Programme: Good Mental Health for All Improving Access to Mental Health Support and Services Children and Young People Mental Health & Wellbeing – fully integrated in the North Lanarkshire and South Lanarkshire Children’s Services Plans Specialist Mental Health Services 5.3 The Mental Health and Wellbeing Strategy Board and the majority of project groups were stood down in March 2020 due to the COVID-19 pandemic. Whilst Strategy delivery was restarted in January 2021, there was a further disruption over the summer of 2021 when all non-essential meetings were stood down owing to the pressure on services. 5.4 Since the last update to this committee in November 2021, the delivery of the Strategy has continued to progress. Over the course of 2022, we have been looking forward, endeavouring to take advantage of the opportunities and experiences of working in different ways rather than necessarily, by default, return services to the way were delivered pre-COVID. All workstreams have reviewed their delivery plans to ensure that they: Take account of the impact of Covid-19; Build on our recovery plans and the new ways of working that have developed over the course of the pandemic; whilst Retaining a focus on the vision and objectives set out in the Lanarkshire Mental Health and Wellbeing Strategy; 5.5 The refreshed Implementation Plan for the Lanarkshire Strategy is attached at Appendix 1. This shows the progress that has been made across all Strategy workstreams and sets out plans for the final year of the current Strategy. 5.6 It also maps our plans in Lanarkshire onto the actions contained within the Coronavirus (COVID 19): Mental Health Transition and Recovery Plan, published by Scottish Government in October 2020, to ensure that they are consistent with current government priorities for mental health and wellbeing. Yes No N/A
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3 6 WORKSTREAMS 6.1 Good Mental Health for All 6.1.1 Challenging the stigma around mental health, promoting good mental health and addressing the barriers (social, environmental, financial or cultural) that make it more difficult for some people to take up opportunities to improve their wellbeing, are a priority across Lanarkshire. 6.1.2 The Covid 19 Pandemic was stressful for many and threw a spotlight on the relationship between mental and physical health. The impact was not experienced equitably. Those least able to draw on protective factors (good health; financial wellbeing; affordable housing; employment; being able to work from home; support home schooling) were less equipped to deal with the impact. It exacerbated long-standing inequalities in being able to thrive in the face of adversity. 6.1.3 The longer-term impact of the pandemic is likely to widen these inequalities further unless significant action is taken. This has taken on a new urgency with the emerging cost of living crisis, compounding the threat and further widening the gap. 6.1.4 Our approach to promoting good mental health and wellbeing and the collective actions/programmes of work undertaken by all community planning partners is distilled in our Good Mental Health for All North and South Lanarkshire Delivery Plans. 6.1.5 The GMHFA Delivery Plans cover 6 key areas: Mentally Healthy Infants, Children and Young People; Mentally Healthy Later Life; Mentally Health Environments and Communities; Mentally Healthy Employment; Reducing the Prevalence of Suicide, Self-Harm, Distress and Common Mental Health Problems. 6.1.6 The Key Highlights from 2021/2022 are set out below. Challenging Stigma and Discrimination 12 NHS Stigma Free Champions have been trained by Stigma Free Lanarkshire 14 Understanding Stigma Workshops have been delivered by champions 152 Participants attended The Leaders of North Lanarkshire Community Planning Partnership committed to ensuring their workplaces and communities are free from mental health stigma and discrimination by signing a pledge to action, creating social media videos with key messages and creating a podcast series 4 Leaders’ workshops delivered – attended by 76 Leaders from NHSL, Police Scotland; NLC; VANL; Fire and Rescue Launch of a Justice Services Pilot in South Lanarkshire (November 2022) focusing on workplace culture: delivering targeted workshops; leaders messaging video; champions programme; and a comprehensive evaluation programme to determine the impact of the SFL/SLC partnership Suicide Prevention Between March and August 2022, 650 people were trained in Suicide Alert across North and South Lanarkshire (90-minute awareness raising workshop)
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4 Between March and August 2022, 162 people were trained in the more intensive (2-day) Applied Suicide Intervention Skills Training (ASIST) Breathing Space benches aim to create welcoming spaces to sit and chat. 4 new benches were installed in 2022 A range of activities and awareness raising events took place during suicide prevention week (4th-10th Sept) including: themed walks; zumba; football tournaments; golf tournament; mindfulness sessions; ALERT training sessions; distribution of suicide prevention drinks coasters with key messaging Recovery “Mental Health is a destination, not a process. It’s about how you drive, not where you’re going” On 2nd November 2022,150 people came together to share stories and celebrate recovery. For many it was the first opportunity to connect with others face-to-face since before the pandemic. 100% of people said they enjoyed the event 100% of people said the event met (or exceeded) their expectations 95% said they’d learned something about recovery 89% said the event had helped with their own recovery “Inspiring and humbling to open up and release your feelings “It has sparked inspiration for helping others and making a positive difference in High Schools (Coatbridge High School) “Without a doubt, helped my recovery” Distress Brief Intervention Distress Brief Interventions (DBI) are an innovative way of supporting people in distress. DBI consists of two parts, with Level 1 seeing trained front-line health, police, paramedic and primary care staff help ease any individual. They then ask the person if they would like further support and, if they agree, they are referred to the DBI service with a promise of contact within the next 24 hours to start providing further face-to-face support. Level 2 is provided by commissioned and trained third sector staff who contact the person within 24-hours of referral and provide community- based problem solving support, wellness and distress management planning, supported connections and signposting. To date 9,316 people across Lanarkshire have accessed third sector (Level 2) support. Between Oct 2021 and Sept 2022 this averaged at 189 referrals per month. The most common source of referral were: A&E departments (40%); followed by Primary Care (21%); Psychiatric Liaison Service (18%); Police Scotland (13%); Scottish Ambulance Service (3%) 79% of appropriately concluded cases engaged in DBI support. Of those, 76% engaged in further support beyond the first supportive intervention The most common presenting problems included: Depressed/Low mood (65% of referrals), Stress/Anxiety (56% of referrals). Suicidal thoughts (40% of referrals) Priorities for Action Secure funding for the Stigma Free Lanarkshire Programme Team. Focus on embedding work to challenge mental health stigma and discrimination
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5 Promote a confident, confident and skilled workforce through delivering training and building capacity for delivering training in-line with the NHS Education Scotland Framework for Mental Health Improvement and Suicide Prevention Promote a compassionate response to people presenting in distress by embedding Distress Brief Interventions into mainstream services and supports Reduce the number of suicides across Lanarkshire through driving a programme of work in line with the new national suicide prevention plan, Creating Hope Together Improve access to a range of non-clinical supports to improve mental health and wellbeing via Well Connected and other social prescribing programmes and the Communities Mental Health and Wellbeing Fund Deliver an annual Recovery Event for Lanarkshire enabling people with lived experience to share stories of recovery and explore what recovery means to them Explore robust Health and Equality Impact Assessments by means of strengthening active consideration of mental health and wellbeing to support a ‘mental health in all policies’ approach. 6.2 Improving Access to Mental Health Support and Services (IAMHSS) 6.2.1 IAMHSS has been concentrating on specific areas to ensure the right support is available at the right time within Primary Care, Emergency Departments, Custody Suites and Prisoner Healthcare and through the development of digital solutions. This workstream has also been responsible for developing and implementing proposals for the use of funding for mental health posts made available through Action 15 of the Scottish Government’s Mental Health Strategy. 6.2.2 Primary Care Mental Health & Wellbeing Teams Primary Care Mental Health and Wellbeing Service (PCMHW) model for Lanarkshire developed with Mental Health Liaison Nurses now covering 91 GP practices supported by LAMH Mental Health and Wellbeing Workers providing a non-clinical role. The Service provides clinical triage and assessment, and both clinical and non-clinical brief interventions and/or support(s) to people experiencing mild to moderate mental health problems of a short-term nature accessed via their GP practice. The Assessment Plus Project is now providing guided self-help intervention in 3 localities. Assessment Plus is a Cognitive Behavioural Therapy (CBT) based guided self-help intervention. It is facilitated by assessment and formulation of individual patient needs by clinical psychologists to create a person centred plan of care based on guided self-help. Assistant Psychologists then work with the patient to deliver the agreed care plan over a time limited number of sessions. Between January and November 2022, a total of 11,155 referrals were received: 10,810 for the Mental Health Liaison Nurses & 345 for the Mental Wellbeing Workers. 6.6% of patients seen required onward referral to secondary care mental health or addiction services. Feedback from key stakeholders thus far has been very positive. There are risks attached to this expansion of the service particularly with regards to lack of accommodation for a staff base. This creates significant difficulties in staff ability to complete clinical administration tasks, provision
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6 of clinical supervision; development reviews; case management, and the delivery of in-house training. 6.2.3 Emergency Departments Staff recruitment process has been successful with a few posts again outstanding due to natural movement of staff. The Flow Navigation Centre (FNC) went live in December 2020 and is fully established in-hours providing an alternative to ED triage for a mental health assessment. Unscheduled care sub-group established to look at the professional interface and strengthen pathways between PLNS and Mental Health specialities. This will ensure more defined and robust processes linked to the patient journey and experience of accessing services within localities. Direct links with Psychiatric Liaison Nurse Service (PLNS) for Community Police Triage (CPT) and Scottish Ambulance Service (SAS) triage is fully established for both in hours via FNC and Out-of-Hours (OOH) at Douglas Street. Expanded in November 2021 to include British Transport Police. (OOH) service at Douglas Street has expanded and is now fully embedded with Standard Operating Procedure (SOP) in place for patients to be triaged and assessed via telephone, virtual platform, or face-to-face appointment. Mental Health Advanced Nurse Practitioners (ANPs) now form part of unscheduled care and liaison services and have developed good links with primary care services to support overall senior decision making. An additional ANP pilot commenced in February to support a triaged liaison approach across the 3 Acute sites. Feedback that it’s going well. Measures are being collated for evaluation. Systematic regular communication between senior staff in EDs, police and SAS established and progressing well. Links established with NHS24 and work ongoing to map pathways and systems. A robust governance framework has been established that spans across mental health unscheduled care service. Consistent weekly data is being reported across all work streams regarding FNC, OOH and source of referrals as well as ED assessments and missed opportunities where assessment could have taken place outwith ED. Annual reports compiled for 2020 and 2021 to identify benefits and challenges in the delivery of unscheduled care and to provide data to determine further areas for service improvement. Patient stories obtained to reflect experience of accessing unscheduled care services. Annual CPT data reviewed with positive progress evident, to date there has been an overall reduction of 68% in police attendance at ED. Work ongoing linking to National Redesign of Urgent Care (RUC) group. Pathway benchmarking against National roadmap completed for our service with no major gaps identified. Lanarkshire has been recognised through RUC as having made good progress and on track with implementation of National requirements. 6.2.4 Custody Suites 2 Advanced Nurse Practitioners ANPs recruited through Action 15 funding in place and providing a valuable mental health assessment resource to
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7 support people who present with mental health needs when detained for any period of time. Feedback has been positive. 6.2.5 Prisoner Mental Health Staffing model for the mental health within Shotts Prison developed to ensure the level of care for prisoners reflects the services offered to the rest of the population. Psychological Therapies Service posts and the Health Improvement Practitioner post have been recruited to, though there remain challenges around filling some of the other posts: o Unable to recruit to a Band 7 Advanced Nurse Practitioner post due to salary issues; however, agreement was reached to recruit 2 ‘whole-time equivalent’ Band 3 Support Workers instead. o An Administrator was recruited and has since left post. It has been difficult to recruit a replacement. o An Occupational Therapist was recruited and left post shortly after. Again, it has been difficult to recruit a replacement. Notwithstanding recruitment and accommodation challenges, the population of HMP Shotts now has improved access to a wider range of mental health services – in particular psychological therapies and health improvement – through a match-stepped model of care. An Multi-Disciplinary Team approach has been established with weekly MDT meetings incorporating all specialities. Referral pathways have been established, ensuring patient-centred care. Communication between specialties is improved with an increased focus on health improvement. The main risks relate to significant difficulties in recruiting and retaining staff and a lack of fit for purpose accommodation for the new multi- disciplinary team within HMP Shotts. 6.2.6 Digital Solutions Digital solutions are being explored to help provide services in new ways that make them more accessible and enhance patients’ experience. The Digital Safety Plan project was short-listed for the Holyrood Connect Awards. Near Me is being well-used with CAMHS, Psychology, and Psychiatry the top 3 users of the system. MORSE transition completed for all previous Midis users. Work remains underway for remaining services to migrate to MORSE system. Successful collaboration with Connecting Scotland to provide devices and support to service users. Increase in use of digital interventions for service users. Specific digital intervention training completed and MORSE training completed. Digital champions have been identified and regular meetings are in place which are very well attended with good practice being shared. 6.3 Children and Young People’s Mental Health and Wellbeing 6.3.1 CAMHS and Neurodevelopmental Services CAMHS In 2021, the Scottish Government Children and Young Peoples Mental Health and Wellbeing Taskforce published national specifications for Child and
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8 Adolescent Mental Health Services and Neurodevelopmental Services. Both Specifications aim to ensure that children and families receive the supports and access to services that meet their needs at the earliest opportunity, based on the GIRFEC approach. For many children and young people, such support is likely to be community based, and should be quickly and easily accessible. These services are required to be available for all children and young people who are aged 0-18 years, and young adults aged 18-24 (and up to age 26 for care experienced people). The Lanarkshire CAMHS Modernisation Programme 2021-23 has been established to implement the National CAMHS Service Specification – as well as associated Scottish Government directives – by March 2023. The purpose of this programme is to assess, evaluate and, where appropriate, redesign Child & Adolescent Mental Health services, ensuring a whole systems approach based on children and young people’s rights and relationships, to deliver safe, effective and child-centred care across Lanarkshire. In April 2021, North Lanarkshire HSCP received confirmation from Scottish Government of recurring funding specific to CAMHS of £3.3 million via the Recovery and Renewal Fund (RFF). The main areas of focus of the Programme are: Implementation of the Choices and Partnership Approach service transformation model for CAMHS by March 2023. Full implementation of the national CAMHS Specification to include extension of age range, requirements for eating disorder patients and planning for transition of care by March 2023. Numbers of children and young people in CAMHS already nearing the age of 18 requires to be gathered and numbers of patients who wish to remain under the care of CAMHS requires to be quantified in order to inform demand. Timelines for this activity are contained within the project plan. Full implementation of Children and Young People – national neurodevelopmental specification: principle and standards of care. Neurodevelopmental Service Nationally there is an expectation that Neurodevelopmental Service will deliver an assessment and diagnosis of neurodevelopmental disorders including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD) and Dyspraxia. This will be delivered locally via highly specialist multi-disciplinary staff. Recovery and Renewal funding (RRF) of £375,311 in 2021/22 and £643,917 in 2022/23 has been provided to support delivery of the national Neurodevelopmental Service Specification to include clearance of all waiting lists by March 2023. The main areas of focus of the Neurodevelopmental Services in Lanarkshire are: Consolidation of a dedicated NDS team with appropriate line management and professional support by January 2023 Progress of delivery towards full implementation of the national NDS specification by March 2023.
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9 Choices & Partnership Approach (CAPA) CAPA is a service transformation model that combines collaborative and participatory practice with service users to enhance effectiveness, leadership, skills modelling and demand and capacity management. Implementation of this model is wholly dependent on our ability to recruit workforce and secure accommodation, IT and supportive administrative infrastructure. A plan has been developed to expand CAMHS age range from 18-25 and to implement the transition care protocol. A series of workshops have been held, attended by representatives from the Directorate for Mental Health at the Scottish Government, and the outcomes of these cascaded to staff across the service and support services. These workshops included CAPA engagement sessions for the CAMHS management team, a CAPA Master Class for CAMHS clinicians and a separate information session for HSCP leaders. CAMHS in Lanarkshire visited CAMHS colleagues in NHS Grampian to establish a supportive network and learn lessons from their implementation of the CAPA model. CAMHS are currently in receipt of improvement support via the SG Mental Health Division Performance Unit Liaison Lead, Professional Advisor and Improvement Advisor. This support will continue for the duration of the Modernisation Programme. A series of workshops/away days for locality teams were held in late November and December 2022. All teams are being supported by service improvement, project leads and waiting list coordinators. A key to successful roll out of CAPA model will be the quality assurance work that precedes it. This includes caseload review with support and supervision from clinical coordinators and delivery of a Duty Team that can field and appropriately respond to unscheduled care requests and crisis. Workforce Work has been completed with the Scottish Government Improvement Advisor and Professional Advisor to analyse CAMHS capacity (based on current funded establishment) against demand (numbers of referrals per head of population). From the analysis, it is evident that in order to meet Referral to Treatment (RTT) trajectory, CAMHS requires 131 WTE of which 90 WTE must deliver services that contribute to the RTT. CAMHS recruitment continues and Recruitment Landing Page is in development. An exercise has taken place to review locality capacity in each CAMHS team with a view to building a capacity calculator to facilitate modelling and forward projections of the numbers of new/return CAPA appointments required to meet Waiting Lists and ongoing demand. Skill mix is being reviewed with the of produce job plan/clinic templates for beginning of roll out of CAPA towards the end of January 2023. An expected outcome of this is the design and implementation of a CAPA calculator/ timetable to provide an even spread appointments across teams, with regular review (every 12 weeks) of capacity against demand to allow enhanced/ sufficient capacity for new/return patient appointments, with the correct ratio for staff groups to ensure waiting time management. It is anticipated that this will be in place following the waiting list initiative described below to ensure seamless transition.
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10 Recruitment is also underway within the Neurodevelopmental Service to complement and expand the current workforce. All posts are live and interest was received. Waiting List Management and Initiative A Waiting List validation exercise has been completed which saw a reduction in the list of 15%. These patients either no longer wanted treatment or did not opt in to remain on the Waiting List as per NHS policy. Patients on the list were divided by age group: over 16’s were written to individually and under 16’s the parent/carer or guardian were contacted. A waiting list initiative commenced at the end of August 2022 to provide additional sessions to complete new patient assessments both in and out of current working hours. Since then more than 600 patients have been taken from the waiting lists. As anticipated, compliance against the Referral to Treatment target has reduced due to the waiting list initiative clinics now being in place and new capacity being focused on seeing individuals who have already breached the 18wk target. 15% of the children and young people seen are discharged and less than 1% transferred to other support. A greater understanding is needed of the circumstance of children and young people who are in this position. This has potential to inform wider thinking on how we could deliver a whole system response that is capable of diverting them earlier in care journey. Work is at an advanced stage with procurement colleagues to seek an external supplier to support a cohort of children and young people over the age of 12 with their neurodevelopmental assessment and diagnosis. Young people who are in the later stages of transition to further education or work will be prioritised. It is recognised that this will not suit all our families, children and young people, so the Service will continue to offer assessments from the Neurodevelopmental Service for children over 12 years of age. Accommodation The new South Lanarkshire CAMHS facility within Udston Hospital, supporting CAMHS, the Eating Disorders team and the Neurodevelopmental Service opened to patients on 5th September 2022 and is now fully operational. It hosts South locality teams as well as our Neurodevelopmental Service. We have received positive comments from the children, young people and their families who have been seen within the building. Work is ongoing to develop artwork that will complement the space. An official opening of the building is planned for early 2023. This facility is in addition to the remaining satellite clinics within South Lanarkshire health centres which ensure local access for those who are unable to travel. Monies have been identified that will support refurbishment of our North Lanarkshire estate to bring it to same standard of Udston site. eHealth A cleanse exercise has been undertaken of Trakcare, the NHSL patient management system. This includes a refresh of the options available for staff to book patients in different locations and under specific clinicians. Once completed, this will have a positive impact on the data being extracted which will be used to report 18-week RTT performance to Public
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11 Health Scotland. This will also allow the Service to understand capacity versus demand more robustly, which in turn will allow better planning and leaner pathways for children and young people. In addition to this, NHS Lanarkshire is working with GPs to enable electronic referrals to be sent to CAMHS using the national system. SCI Gateway for CAMHS went live on 1st November 2022 and the Service has been receiving approximately 8 electronic referrals per day (which is in line with referral rates). Those GPs who continue to refer by paper are being asked to use the SCI Gateway platform. The benefits of using this system means that information is available to referrers about the services CAMHS provides, as well as other support services, and accurate/robust information at the point of referral. This will ultimately allow CAMHS to make decisions at the point of vetting more timeously and which are more clinically appropriate. All our mental health inpatient estate has embedded ward Quality Groups which has supported development of local outcomes around meaningful activity for individuals within our acute admission areas. Current paper records have been moved to an electronic patient record (MORSE). This will release time for clinicians and administrative staff as well as enhance information governance security. Interfaces between systems are also key to allow a more streamlined approach to working with the necessary information between electronic referrals, appointments and record systems. Communication and Engagement Extensive staff engagement in conjunction with Human Resources and Partnership is ongoing in order to embed the Modernisation Strategy with particular reference to the CAPA transformation model. Stakeholder engagement events were organised in 2021 to include HSCP Core and Strategic Leadership Teams. A CAMHS Communication and Engagement Task Group has been established to develop a Communication and Engagement Plan for the delivery of the programme. The programme also has a dedicated engagement officer to support and lead on engagement activities and events. The engagement activities have included attendance at various children’s, young people’s and family forums and networks as well as organising stakeholder engagement events with the third sector groups and local communities. A brand new CAMHS logo is being designed by New Lanarkshire College students. This is planned to be completed and approved in January 2023. 6.3.2 Children and Young People’s Community Mental Health and Wellbeing Support and Services Delivering improvements for children and young people’s mental health and wellbeing is embedded in the North and South Lanarkshire Children’s Services Plans and associated workstreams, led by the children’s services partnership boards. Since the launch of the Lanarkshire Strategy, the focus has been on continuing to deliver priorities through existing children’s services planning structures and workstreams with a focus on prevention/early intervention and promoting positive mental health and resilience. Funding from the National Children and Young People’s Mental Health and Wellbeing Programme is being provided for the delivery of community mental
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12 health and wellbeing supports and services for children and young people. This is to support the development and provision of bespoke services that are right for each local authority and direct support for children and young people. The Scottish Government is clear that funding is to be used for new or enhanced services. Project officer have been recruited by both local authorities and gap analysis, benchmarking and co-production of services has been undertaken. Key developments in North Lanarkshire The GIRFEC in NL website is live and includes a section on supports and services which is under development. The website will include information on mental health and wellbeing resources, in addition to links to relevant NHS and other websites in line with target audience. Pan-Lanarkshire discussions have been taking place on a specific Mental Health and Wellbeing section for children and young people, parents/carers, and professionals and this will be procured by NHS as part of the Elament update. The intention is to co-design this site with target groups. Further to feedback from focus groups, we are hoping to organise events for young people, in both North and South Lanarkshire in February 2023 to celebrate Youth Mental Health. The idea is supported by Education, Community Learning and Development (CLD), NHS Health improvement, Stigma Free Lanarkshire and other partners as an opportunity for young people to both design an event and showcase the work that has been ongoing. In relation to Community Mental Health Framework funding, the below developments are ongoing: o Empowering cluster work through Community Solutions o Family support workers x 2 (Neurodevelopmental/ASN) o Family support workers x 1.5 – cluster-based (CAMHS referrals) o CLD Living Life to the Full programme with additionality in workforce. o Active and Creative communities – peer mentoring and diversionary mental health work. o Procurement of a digital platform for mental health and counselling support (underway) o Procurement of counselling support for care-experienced young people, as part of a co-production exercise with TNT (underway) School counselling continues to be accessed within each cluster, with increased promotion of self-referral for those who wish to access it this way. As the School nurse workforce grows, the emotional and wellbeing pathway will offer additional access to health support for children and young people. Let’s Introduce Anxiety Management (LIAM) training continues to be delivered across NLC and discussions are underway regarding expansion of training within education and other partners. Early discussions are underway to address the identified gap for 16-26 year-old care experienced young people to access Health services supported by a multi-agency sub-group. Suicide and Self Harm Prevention Training to support the implementation of the Lanarkshire Lifelines resource and Critical Incident procedures continues which will support with the emerging issue of self-harm.
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13 The Suicide Prevention Group will oversee resources and scope any gaps. Key developments in South Lanarkshire South Lanarkshire Children’s Services Planning Continue to engage with children, young people and families about mental health and wellbeing needs in the community. Implementation of Kooth (online mental health support). Engagement with workforce around Whole Family Wellbeing Fund. Family Support Hubs have been launched across the 4 localities of South Lanarkshire. The focus of the work is to provide earlier intervention and holistic support to families to prevent escalation to statutory social work. Between July and December 2022, 1,640 referrals were received from Police Scotland, Education Resources, NHS Lanarkshire, housing, community groups and families. Initial feedback has been very positive. Engagement with Young People on Mental Health Services In line with the increased focus on the UN Convention on the Rights of the Child (UNCRC), and recognition of the importance of including young people in planning and participating in service design, a large-scale survey was co-designed with young people. In addition, focus groups were completed with young people, including a number of at-risk groups. The views of 3,536 young people were sought and fed into a report with the following recommendations: o Increase capacity for mental health supports within primary schools o Exploration of peer support programmes o Easier access into services – clear pathway to access support o Look at more universal supports available within our communities o Focus on increased supports for families o Improved signposting / advertising of services o Ensure groups which are at higher risk of experiencing mental health difficulties are able to access appropriate mental health supports o Ensure teachers are aware of supports with regard to signposting o Review mental health curriculum and supports within schools, in line with the PSE review o Establish reference groups for parents/carers and young people moving forward Early Intervention Theraplay play therapy is being offered for 5-9-year-olds. Theraplay is a child-centred, resilience focused approach in which the practitioner works collaboratively with the school and family over eight weeks. Play therapy has been introduced as part of a broader set of supports for children under 10. Referrals are via primary schools. Action for Children programmes o Bouncing Back - 22 targeted schools are accessing two CBT-based workshops with a focus on resilience-building for primary 4 and 5 pupils. Approximately 1,000 children will take part. o The Blues Programme roll out in secondary schools is continuing, with 258 young people taking part from August-December 2022. SAMH o Plan to deliver peer support programmes for secondary schools is underway. Workshops for parent/carers and staff have been trailed and will to be rolled out soon.
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14 Suicide Prevention/Self Harm Briefings and Training Lifelines Lanarkshire - a training plan to support the roll out of Lifelines Lanarkshire multi-agency guidance for staff supporting children and young people who may be at risk of suicide and self-harm is underway. Thus far the following have been completed: o A range of briefings both at the strategic level and the practitioner level across SL Children’s Services has taken place, including all staff in Education Resources via the annual Child Protection Briefing in August 2021/August 2022. o Half day Skilled Level training for key staff: • 261 key staff from all mainstream secondary schools • 2 cohorts of Children’s Services social work staff • 2 cohorts of Youth, Family and Community Learning staff o Next steps: • Pilot training for key primary school staff and ASN staff • Develop an online module at Informed Level for all staff • Planning to develop a Training for Trainers manual/training for key Children’s Services staff Applied Suicide Intervention Skills Training (ASIST) has restarted. Thus far: o 42 staff trained in this period o Future courses running at full capacity Children’s Mental Health Week – Celebrating Mental Health Events taking place to coincide with Children’s Mental Health Week on 6 - 13 February 2023. Focus is to share good practice, signpost resources and link in third sector and other partners in conversations about supports. The South Lanarkshire Youth Council is has worked with partners to help us plan the week. Kevin Stewart, MSP, Minister for Mental Wellbeing and Social Care plans to speak at the conference on Wednesday 8th February, with young people representatives in attendance. Workforce Wellbeing – Supervision/Reflective Practice Plans There has been an increased awareness of and focus on staff wellbeing across Children’s Services. Thus far, Social Work Resources has trialled two reflective practice models, which were evaluated positively. Next steps for workforce wellbeing: o Piloting and evaluating Place to Think reflective groups for school Child Protection Coordinators o Piloting Counselling Skills training modules for education staff o The Education Resources Mental Health and Wellbeing Group are undertaking a needs analysis to consider further the supports that may benefit education staff when working with vulnerable children and young people. 6.4 Specialist Services 6.4.1 Older Adult Inpatient Provision Hospital Based Complex Clinical Care (HBCCC) Before the pandemic IJB approval was given to commence an engagement exercise with service users, next of kin, and care home with a view to consolidating contracted HBCCC beds onto a single care home
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15 site. The aim being to support new opportunities for multi-disciplinary team-based working and a range of services provided that will benefit the patients. Owing to the COVID-related risks associated with care home transfers, this proposal was put on hold. IJB approval was given in September 2021 to recommenced this work. In line with HIS ‘Planning with People’ guidance, an Engagement Planning Group was established, comprising key staff and stakeholder groups, to enable effective engagement with all those impacted by the planned service change. The Engagement Planning Group completed an options appraisal with the option of consolidating provision at Hatton Lea Care Home proposal scoring highest. EQIA completed for the planned service change. Business case subsequently approved by North Lanarkshire IJB and endorsed by NHS Lanarkshire and South Lanarkshire IJB. EQIA drafted for review by with Engagement Planning Group. Next tasks: o Review existing Cumbernauld patients’ on-going care requirements; confirm funding arrangements for each patient; and hold individual meetings with patients/carers/families to agree future care arrangements. o Agree Cumbernauld exit plan with Four Seasons. Camglen inpatient provision Letter received from Glasgow City HSCP giving 6 months’ notice of termination, effective from 23rd May 2022, of the agreement to provide access to NHSGGC Older People’s Mental Health in-patient beds for residents of the Camglen area. Admissions of Camglen patients to Udston commenced on w/c 17th Oct. It was agreed that no NHSGGC inpatients would transfer at this time. Solution implemented enabling Camglen CMHT Morse access to input admission information and access discharge information. No new medical staff have been recruited at this time to support the transfer of patients from Camglen; therefore, two designated medical staff from within Older Adults have been designated responsibility for in-patient care as an interim measure. Further discussion required with NHSGGC to clarify the final steps of the transfer of OPMH in-patient beds for residents of Camglen area. 6.4.2 Review of Adult Rehabilitation and Recovery The objectives of this workstream are to: Develop a single referral process and electronic referral form and agree the process for assessment of referrals Review discharge planning processes; establish a notional timeframe for discharge planning on admission; identify barriers to discharge; and establish a process to ensure that potential/actual delayed discharges are escalated. Review the current Community Rehabilitation Team model. Completed work: Mapping of Glencairn and Community Rehab referral and assessment processes completed. New referral form in place with a single point of referral.
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16 Pathway to community rehab now live Planned date of discharge is in place. Review of the Community Rehabilitation Team model has been completed. The new nursing model is now embedded in practice. Rehabilitation & Recovery Service Operational Policy is being finalised EQIA drafted 6.4.3 South Lanarkshire Integrated Community Mental Health Teams (CMHTs) Interim centralised operational management structure agreed. CMHT Service Manager in post. Clinical & Professional governance structure agreed by Mental Health & Learning Disabilities Clinical Governance Group & South Lanarkshire Support, Care & Clinical Governance Group. Principles agreed for disaggregating hosted services and transfer of funding to South Lanarkshire. Transfer approved by North Lanarkshire and South Lanarkshire IJBs. Funding and nursing staff transferred to South Lanarkshire HSCP. 6.4.4 Perinatal and Infant Mental Health A successful funding bid was made (in Sept 2020) to the National Perinatal and Infant Mental Health Programme for the development of a whole-system model for perinatal mental health care that enables women, their partners and families to be supported in their own communities; the establishment of a multi-disciplinary Community Perinatal Mental Health Service; and the establishment of a designated multi-disciplinary NHSL maternity and neonatal psychological intervention service. Separate funding has also been granted to enable the development of shared strategic goals and agreed pathways for indicated high risk infants and their parents who are not currently accessing clinical services; the development of a model of infant mental health provision; and the establishment of a designated multi-disciplinary and multi-agency Infant Mental Health Service. Perinatal Mental Health, Infant Mental Health and Maternal & Neonatal Psychological Interventions Service Development Groups were established, reporting into the PIMH Steering group. Engagement with lived experience activities planned out and underway NHSL Perinatal Mental Health Service: Dedicated specialised community perinatal mental health team established, incorporating psychiatry, community mental health nurse, clinical psychology, community nursery nurse, midwifery, occupational therapy and social work staffing. Recruitment to the expanded team completed. Education and training models rolled out. Clinical Quality Group set up. Clinical pathways established to ensure timely and equitable access for women to specialist perinatal mental health services. Systems in place to ensure that professionals working in universal services with women and their partners and families can access consultation, information and advice in a timely manner.
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17 Improved access to third sector support services. Information materials and webpage developed to provide access for women and their partners/families to timely information to help them to make informed choices. Systematic engagement with lived experience and third sector in place – ensuring feedback incorporated into service design Data collection in place to measure access to service and impact of service and development of a system of continuous quality improvement 6-monthly progress reporting against outcomes to the National Perinatal and Infant Mental Health Programme NHSL Infant Mental Health Service: Funding secured from the Scottish Government for a Lanarkshire Infant Mental Health Service Multi-agency, multi-disciplinary Infant Mental Health (IMH) team established Clinical model developed. Multi-disciplinary multi-agency IMH training programme in place for all agencies including third sector Infant Mental Health Easy Access Telephone Advice Line & Consultation System established for Health Visitors NHSL LearnPro Foundation level module on Infant Mental Health: When to be Concerned for all NHSL staff working with infants and their parents Development of a Pan-Lanarkshire Multi-Agency Infant Mental Health Observational Indicator Set [birth to 3rd birthday]. Systematic engagement with lived experience and third sector in place – ensuring feedback incorporated into service design. 6-monthly progress reporting against outcomes to the National Perinatal and Infant Mental Health Programme Study of Barriers to Access to Mental Health Service and Mental Health Support for Infants in Lanarkshire planned NHSL Maternity and Neonatal Psychological Interventions Service: Funding secured from the Scottish Government until 2023 for a Maternity and Neonatal Psychological Interventions (MPNI) Service. MNPI Team recruited. Induction and training programme for new staff developed with reference to the NHS Education for Scotland Perinatal Mental Health Curricular Framework, and ‘Essential Perinatal and Infant Mental Health’ e-learning resource. Clinical model and pathways developed to ensure timely equitable access. Systematic engagement with those with lived experience and third sector representatives to ensure feedback incorporated into service design, information leaflets and website. Website content developed in draft form and linking with communication department Experts by Experience consultation organised for Neonatal Parents. Continued links with Maternal mental health participation officers. Increased access to third sector services for service users Data collection in place to measure access to service and impact of service and development of a system of continuous quality improvement Evaluation and impact assessment – 6-monthly reporting of progress against outcomes
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18 6.4.5 Forensic Mental Health Forensic Mental Health Services did not stand down during the pandemic. Community Team and 2 wards continued to function with the Scottish Government framework with limited face-to-face contact. Two significant reports have been published: Independent Review into the Delivery of Forensic Mental Health Services: o 67 recommendations – some will have a fairly big impact if implemented, whilst others are ‘housekeeping’. o Scottish Government have had 2 option appraisal events. Initial 9 options were shortlisted to 4 although one option, status Quo would not be considered by Scottish Government as they had accepted that this was not acceptable following the Barron report o The first round of options had a new ‘national Board’ as the 1st ranked option. We await the report of the latest option appraisal held in June Pathways for Women Through Forensic Mental Health Services (The Forensic Network): o Options appraisal produced recommendations for high, medium and low secure provision o Work progressing on provision of beds for females at TSH. No report as yet There is significant concern nationally over a lack of secure accommodation across Scotland. Work is ongoing to create capacity but there are pressures in the short to medium term. A Bed Capacity Group organised by Forensic Network meets regularly to review capacity across the forensic estate. 6.4.6 Tier 3 Eating Disorder Specialist Service (TESS) NHS Lanarkshire was allocated £545,796 over financial year 2021/22 from the Scottish Government’s Mental Health Recovery & Renewal Fund in response to the National Review of Eating Disorder Services’ Recommendation 1 to support services to meet the urgent needs of eating disorder patients and services as a direct result of an increase in the number and severity of eating disorder presentations related to the Covid- 19 pandemic. Avoidant and Restrictive Food Intake Disorder (ARFID training) has now been completed. This has highlighted how wide the scope of ARFID presentations is. There is staff opinion that TESS may be best placed to treat people who are deemed high physical risk because of their Feeding Disorder (as per interim ARFID agreement); however, there is no additional resource attached to this. Our 8B Clinical Psychologist will undertake a needs assessment of this group. Eight CBT-ED (cognitive behavioural therapy for people with eating disorders) supervision groups have now been set up to support implementation of CBT-ED training and have been running monthly. Good uptake of B-EAT Eating Disorders training workshops for staff Work is ongoing to set up GP pilot for Momentum and Carers interventions Family-Based Treatment (FBT) supervision has been arranged and supervisors allocated. There have been difficulties recruiting to a number of posts (dietetic, OT and nursing)
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19 Physician session and recruitment of a GP outstanding. Half day team session took place on 6th September to review service criteria and implications of supporting patients who present with ARFID. Developing a dietetic pathway for local Eating Disorder inpatient admissions and the interface between Mental Health and TESS dietitians Linking in with providers and third sector organisations who will deliver implementation of additional clinical services and pilot projects. Short term funding impacts on ability to appropriately plan and take a strategic vision -2022-23 funding still to be confirmed. The inpatient test of change proposal was dependant on utilising SG monies to support significant additional recruitment – this is looking less feasible as the year progresses NHSL has no specialist Eating Disorder Admission route for males with eating disorders across Scotland – and more men considered very high risk are attending the service 6.4.7 Psychotherapy The objective for this workstream is to establish a single Lanarkshire-wide Psychotherapy Service to ensure consistency in: o Structure and roles/responsibilities o Service delivery o Treatment interventions offered pan-Lanarkshire. Full time consultants are now in post in North and South Lanarkshire with an additional part-time consultant working 3 sessions per week in North. The key areas for development are the establishment of a pan-Lanarkshire quality group and also the organisation of a series of development days to look at systems and processes, including a patient’s journey from start to finish which will inform the content of an operational policy. 6.4.8 Mental Health Pharmacy The lack of dedicated proactive clinical pharmacy input has been identified as a significant risk into the care and treatment of patients accessing specialist mental health services in NHS Lanarkshire: o compromising safe, effective and person-centred care o introducing unwarranted variation in care o increasing risks of patient harm associated with polypharmacy, high risk medicines and care of those with complex conditions and multi- morbidities by lack of access to medication reviews in line with national standards o lack of access to pharmaceutical advice including evidence-based treatment to patients within these services Following a joint submission from NES and the Mental Health Pharmacy Strategy Group, the Scottish Government, announced funding to NHS Boards for 2021/2022 for Mental Health Pharmacist and Technician recruitment as part of an overall investment to be made available over four years until 2024/25, subject to successful recruitment and delivery of outcomes. A short-life working group was set up to agree plans in response to the funding announcement and a proposal developed for the use of SG funding in 2021/22 and 2022/23. It is understood that the recovery funding from Scottish Government is no longer going to be forthcoming. We are still waiting on a formal letter from SG regarding what is happening, but in the meantime, everything is on
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20 hold (and Finance are looking into what the state of play will be regarding ongoing funding of posts that we have recruited to) Further key issues include: o Pharmacy recruitment remains a challenge both within NHS Lanarkshire and within specialist MH services. o the need to maximise and optimally use the skills of the entire pharmacy workforce o the need to address challenges associated with the changing workforce of pharmacy and the wider MHLD multidisciplinary team o with all Scottish health boards potentially looking to recruit to similar posts at the same time, we need to be able to attract talent o the need to ‘grow our own’ within the service, with training posts, rotational posts, development opportunities, etc. o shoring up specialist MHLD pharmacy services in order to be better placed to offer support/ training to generalist colleagues working within acute services and/or primary care. Discussions have taken place with Acute and Primary Care colleagues about the potential for split roles/secondments in an attempt to address unsuccessful recruitment. 7 COMMUNICATION AND ENGAGEMENT 7.1 During the development of the Lanarkshire MHWB Strategy, a Communications and Engagement group was established with membership from service users, carers, and community and voluntary sector organisations to act as a reference point and influence and inform all aspects of GIRFEP. 7.2 As the Lanarkshire Mental Health and Wellbeing Programme moved into its implementation phase, the Communication and Engagement Reference Group has reviewed the Communication and Engagement Strategy to ensure that: communication is coordinated across all partner organisations and that all messages are transparent and consistent there is ongoing meaningful involvement with the communities impacted by poor mental health and wellbeing, particularly those with lived experience the right systems and supports are in place to enable effective engagement and participation between all stakeholders involved in strategy implementation 7.3 Communication and Engagement Plans for all Strategy workstreams have been presented to the group. These were welcomed with a number of questions asked including how communication and engagement outcomes would be measured and how workstreams might incorporate service user feedback. It was noted that the reports were useful in highlighting emerging issues and could be used to escalate responses. 7.4 A workshop took place in October 2022 to review the role of the Group as we move into the final year of delivery of the current Strategy. The following was agreed at the workshop: A group is still required to support projects with communications and engagement ideas and identify channels through which activities can take place.
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21 A new Communications and Engagement Strategy and supporting plan is required. We need to follow up with projects on progress, challenges, etc. and be assured that communications plans are being acted upon. The format of meetings to be more flexible, allowing for workshop-type sessions and sharing of information and ideas. Equality Impact Assessments should help in identifying themes for these. Communications and Engagement group meetings can be used as a platform for identifying and sharing new groups for engagement, etc. The group needs a Chairperson from the Strategy Board who has a broad overview of all the activities/projects underneath. The Chairperson should either be, or be supported by, a communications professional. Communications and Engagement meetings/workshops to be opened up to any Strategy Board ‘Lead’, allowing them to drop in and ask questions request help/support. To ensure any future Strategy is aligned with existing NHS Lanarkshire and Health and Social Care Partnership engagement structures and other related strategies. Planning the development of the next Strategy needs to start now and we need to think who we need to engage with and how to create a Strategy that is co-produced and meaningful. 8 EVALUATING IMPACT 8.1 Achievement Framework An outcomes-focused Achievement Framework has been developed (Appendix 2) for the Mental Health and Wellbeing Strategy that links the contributions made by projects and workstreams to outputs and the achievement of short and long term outcomes This can only be used to evaluate and report on work that has reached the implementation stage. Evaluation findings will therefore become available at different times. As we start planning the development of the new Mental Health and Wellbeing Strategy, work is underway with Strategy leads to evaluate impact across all areas of the Strategy 8.2 Performance Framework A short-life working group has developed a performance framework, consisting of a set of output measures aligned with the Achievement Framework, to assist in monitoring service delivery and directing future planning and investment (Appendix 3). These will include KPIs that are currently in use for reporting at national and/or Board or Partnership level. A prototype performance report is currently being collated based on these. Once this has been achieved a process will be established to enable quarterly production of this report. 9 CONCLUSIONS 9.1 In the wake of the Covd-19 pandemic, we looked to move forward and take advantage of the opportunities and experiences of working in different ways rather than, by default, returning services to the way were delivered pre- COVID.
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22 9.2 To this end, we have reviewed the delivery plans for all workstreams to ensure that they build on our recovery plans and focus our recovery efforts on the objectives set out in the Getting it Right for Every Person. 9.3 In support of this, an Achievement Framework has been developed to and a Performance Report is being finalised that will link the improved capability delivered by projects and workstreams to improvements in key performance indicators and the achievement of short and long term outcomes and benefits. 10 IMPLICATIONS 10.1 NATIONAL 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 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 10.2 ASSOCIATED MEASURE(S) A Mental Health & Learning Disability Performance Review is currently produced 6-monthly which includes the following measures: Admissions and readmissions to Mental Health Wards Bed occupancy Psychiatry: numbers waiting more than 12 weeks (Adult/Older Adult/Learning Disability) Treatment Time Guarantee: % completed waits within 12 Weeks Psychological therapies: 18-weeks referral to treatment (Adult Psychological Services/CAMHS) Dementia: Number of patients diagnosed with dementia in the reporting quarter
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23 Percentage of patients on the waiting list for Dementia Post Diagnostic Support that have been waiting for less than 12 months The performance review includes other measures such as staff absence and training levels, DATIX incidents, complaints, out of area patients. 10.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A The landscape in relation to additional funding streams including Mental Health, released throughout the year by Scottish Government is complex with continued uncertainty around the scale and timing of future funding. The costs and funding available for 2023/24 will be closely monitored and reported. 10.4 RISK ASSESSMENT/RISK MANAGEMENT A Risk Management Strategy has been developed which aligns with the NHS Lanarkshire Risk Management Strategy. The risks currently on the Programme Risk Register are set out in Appendix 4. 10.5 PEOPLE The population and system approach adopted by the Strategy identifies the need to develop an integrated workforce plan, including training & developments plans and giving real consideration to the recruitment & retention of our workforce an essential component of its delivery. This recognises the importance and priority attached to developing a mental health and wellbeing workforce to meet the current and future needs of the population, including all staff (not just staff employed in mental health posts) is a challenge for the whole of the NHS and Partners in local government; education, social work and other public, voluntary and third sector organisations. The Strategy also highlights the need to improve current and future accommodation requirements, in order that we can ensure that the people who use and provide mental health services feel valued. 10.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A EQIAs have been completed for most Strategy workstreams with the remaining in progress. 11 BACKGROUND PAPERS Lanarkshire Mental Health and Wellbeing Strategy Lanarkshire Mental health and Wellbeing Strategy Summary Lanarkshire Mental Health and Wellbeing Strategy Communication and Engagement Report
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24 12 APPENDICES Appendix 1: Refreshed Implementation Plan Appendix 2: Achievement Framework Appendix 3: Output Measures Appendix 4: Programme Risks ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Maggs Thomson Head of Health on telephone number 01698 752591
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 25 Appendix 1: Refreshed Mental Health and Wellbeing Strategy Delivery Plan Good Mental Health for All Develop multiagency Good Mental Health for All Action Plans for North and South Lanarkshire that have the full buy-in of all partners. Support the shift in the balance of care from hospital to locally based community care increasingly being delivered through a blended model. Focus on Health Inequalities, the unfair and avoidable differences across social groups and between different population groups. Define the delivery, performance management and accountability structures for implementing and monitoring the action plan reflecting the prevention, promotion and support and recovery agenda. Support and influence partner organisations, strategies and plans that impact on mental health and wellbeing. Establish and participate in networks both within and outwith North and South Lanarkshire for the purposes of developing the evidence base and for sharing of good practice. Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Cross-Cutting Whole Population Mental Health 1.1 Clear Your Head 1.2 Measuring Population Mental Health 1.3 Physical Activity 1.4 Participation in Sport 1.5 Behaviour Change 1.6 Tackling Stigma Develop Performance ‘Dashboards’ across all 6 areas of GMHFA Develop a Comms plan incorporating a year- round, co-ordinated campaign strategy capitalising on national initiatives and awareness days and campaigns
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 26 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Mentally Healthy Infants, Children and Young People 6.1 Family Support. 6.2 Signposting to Help and Support. 6.3 Emotional Wellbeing 6.6 Training and Learning 6.7 Educational Psychology and School Counselling Services. 6.8 National Guidance. 6.9 Whole School Approach 6.10 Children and Families Workforce 6.12 Community Support 6.14 Emotional Distress. 6.15 The Promise Develop a repository of mental health resources for schools which encourage a whole school approach to mental health and reducing stigma and discrimination. Review, develop and support the roll-out of evidence-based parenting programmes in line with the Lanarkshire Parenting Pathway Establish working groups in both partnerships in the wake of the Covid-19 pandemic to prevent and mitigate child poverty, specifically working toward the ambitious income-based targets set out in the Child Poverty (Scotland) Act. Mentally Healthy Later Life Older People 9.1 Ensuring Mental Health Support & Build capacity within the third sector to address the needs of isolated and/or lonely older adults utilising the Community Mental Health & Wellbeing Fund
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 27 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Services for Older People 9.4 Loneliness Raise awareness and increase uptake of Carer’s Assessments and implement the 2018 Carer’s Act Promote active ageing, resilience and connectivity through asset based approaches, particularly for people diagnosed with dementia and other long term conditions. Mentally Healthy Environments and Communities Socio-Economic Inequalities 4.1 Tackling Poverty. 4.2 Mental Health Support for Those Living in Poverty 4.3 Benefits System Whole Population Mental Health 1.1 Clear Your Head 1.3 Physical Activity 1.4 Participation in Sport Improve engagement with communities Harness the Community Mental Health and Wellbeing Fund, to promote mental health and wellbeing Support a partnership approach to maximising our natural community assets through the Green Health Partnership Group Increase access to quality affordable and safe housing Prevent, reduce and mitigate the negative consequences of homelessness Work in partnership to address poverty across Lanarkshire Work with local sporting organisations, bodies and clubs to promote links between wellbeing, sport and inclusion
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 28 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Mentally Healthy Employment and Working Life Employment 2.1 Redundancy. (PACE) initiative. 2.2 Employability 2.3 Mentally Healthy Workplaces 2.4 Fair Working Practices 2.5 Home Working. 2.6 Support for Health and Social Care Workforce 2.7 Debt Challenge stigma and discrimination in the workplace through Stigma Free Lanarkshire Raise awareness of the importance of mental health and wellbeing and local supports with key agencies who support vulnerable clients back into employment Promote staff mental health and wellbeing following first-wave COVID 19 pandemic Staff Surveys to monitor mental health and wellbeing/inclusive cultures at work Training for Managers on Mentally Healthy Workplaces (including Home & hybrid Working) Collaborate with Community Planning Partners and Employability around the centrality of mental health and wellbeing, including the availability of training, stigma free workplaces, availability and inclusivity of supports Reducing the Prevalence of Common Mental Health Problems, Distress, Self- Harm and Suicide Relationships 5.1 Relationship Support 5.3 Relationship Trauma Continue to develop and extend accessible community assets and non-clinical sources of support to empower people to protect and improve their health and wellbeing
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 29 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 People Who Have Suffered Bereavement & Loss 10.1 Grief 10.2 Bereavement Support. 10.3 Compassionate Support 10.4 Bereavement by Suicide Distress Interventions 11.1 Distress Brief Intervention Suicide Prevention 12.1 Suicide Prevention Action Plan 12.2 Public Health Response 12.3 A Pandemic- Specific Response Maximise opportunities to promote mental health and wellbeing through technology Develop North and South Lanarkshire Suicide Prevention Action Plans which are informed by the Scottish Government’s Suicide Prevention Action Plan Review all suicides which take place in Lanarkshire including a focus on locations of concern (awaiting Scottish Government guidance) Review mental health awareness and suicide prevention training, identify gaps and develop a strategic approach to delivery
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 30 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 12.4 Future Long-Term Strategy 12.5 Suicide Reporting and Learning System 12.6 Veterans 12.7 Self-Harm Continue to develop and deliver the DBI programme across Lanarkshire Improving the Quality of Life of Those Experiencing Mental Health Problems Mental Health Services 16.4 Workforce 16.11 Clearer Pathways to Support and Treatment. Develop partnerships across workplaces , communities, schools and health and social care to create a Movement for Change in relation to challenging stigma in partnership with See Me and Lanarkshire Recovery Network Promote national and local campaigns to raise awareness and drive attitudinal change Build capacity through creating Stigma Free Champions across health and social care Service users and carers are involved in mental health services and service development Increase the strategic priority given to the physical health needs of people with Severe and Enduring Mental Health Problems Ensure patients and carers using mental health services are empowered to access the range of health improvement opportunities and
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 31 Workstreams Link to National Transition & Recovery Plan Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 supports available to aid recovery and promote wellbeing. Improving Access to Mental Health Support and Services Objectives Improve access to treatment and joined-up accessible services. Improve access to mental health services within a clinically appropriate timescale. Provide access to high quality, specialist mental health care for those who have higher levels of need, as well as general health care which can deal with an issue there and then for people with a mental health problem. Ensure that general health care also addresses the conditions that can contribute to people becoming unwell, with the ultimate aim of reducing the need for specialist services. Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Custody Suites 17.4 Criminal Justice System Approved access to Mental Health Care in Custody implemented Telephone / Audio Assessment Pilot completed Scope introduction of Third Sector support Digital Solutions 15.1 Computerised Cognitive Behavioural Therapy 15.2 Video Enabled Therapy 15.3 Rural Communities. Mental Health Services process maps produced Gap analysis completed and prioritised solution tests of change agreed Gather intelligence of digital solutions being incorporated within Lanarkshire’s Mental Health and Learning Disability services
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 32 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 15.4 Digital Inclusion 15.6 Evaluation 15.7 Innovation Hubs Move all Mental Health & Learning Disability services onto a safe electronic record keeping documentation system Identify, support and promote digital use by service users Identify digital skills gaps and identify appropriate learning for staff Establish a network of Mental health & learning Disability digital champions Transforming Mental Health in Emergency Departments Mental Health Services 16.3 Unscheduled Care 16.4 Workforce Recruitment of Psychiatric Liaison Nurses and Advanced Nurse Practitioners Pathways for face to face mental health assessment in Douglas Street introduced Pan Lanarkshire Community Police, Transport Police and Scottish Ambulance Service Triage model operating 24/7 Mental Health & Wellbeing in Primary Care 8.3 Access to Services – a specific pathway for those who have been shielding 9.1 Ensuring Mental Health Support & Services for Older People 16.4 Workforce 16.11 Clearer Pathways to Support and Treatment PCMH & Wellbeing Services providing sessional MH Liaison Nurse input to all GP practices Assessment Plus Service (psychological therapies) transitioning to be part of PCMH stepped/matched care model Mental Health & Wellbeing Worker service commissioned to provide non-clinical interventions within the stepped/matched care PCMH & Wellbeing Service model.
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 33 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Establish a Mental Health and Wellbeing in Primary Care (MHWPC) Service model as proposed in the national Mental Health in Primary Care Short-Life Working Group Report Prisoner Mental Healthcare 17.4 Criminal Justice System Develop Prison Stepped Match Care Model Develop proposal for additional working space in conjunction with Scottish Prison Service Complete recruitment process
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 34 Children and Young People’s Mental Health and Wellbeing Objectives To ensure an integrated whole-systems approach to the planning and delivery of support and services across the NHS, social work and education, the voluntary sector and other community planning partner agencies, underpinned by GIRFEC principles, and including children and young people. To invest in prevention and early intervention and to develop a menu of support that will improve communication, help providers understand where they fit in the continuum of mental wellbeing; and ensure that there is consistent support for the whole family across ages and stages of a young person’s life. To reconfigure CAMHS to improve capacity and coverage and provide economy of scale in relation to medical and admin cover. To establish a new Neurodevelopmental Service to reduce the number of young people, particularly with symptoms of Autistic Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (DHD), waiting on a variety of services’ waiting lists to be seen and engaging in a prolonged assessment with handovers. To be a centre of excellence for the mental health care and treatment of accommodated infants, children and young people where effective, informed assessment, formulation and treatment begins at the point of referral. To improve our ability to evidence the impact of support and services on the health and wellbeing of children and young people To develop a workforce strategy that will ensure a confident and competent workforce that will make best use of ability and resources across all sectors. Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Community Mental Health and Wellbeing 6.1 Family Support. 6.2 Signposting to Help and Support. 6.3 Emotional Wellbeing 6.6 Training and Learning 6.7 Educational Psychology and School Counselling Services. 6.8 National Guidance. North Lanarkshire Establish Children and Young People’s Mental Health, Wellbeing and Resilience Task Group Embed Children and Young People’s Mental Health and Wellbeing in North Lanarkshire Children’s Services Plan and ensure governance in place Identify priorities for North Lanarkshire’s Children’s Services Plan 2021/23 Complete initial mapping of mental health and wellbeing supports and services provided by
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 35 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 6.9 Whole School Approach 6.10 Children and Families Workforce 6.12 Community Support 6.14 Emotional Distress. 6.15 The Promise universal, 3rd sector and specialist services that can be accessed by parents, children and young people Maintain map to ensure that it consistently presents a complete and current picture of mental health and wellbeing supports and services that can be accessed by parents, children and young people Develop and implement plan to deliver the mental health and wellbeing elements of the North Lanarkshire Children’s Services Plan and implement the National Community Mental Health and Wellbeing Supports and Services Framework Evaluation of services currently in place for Community Mental Health for Scottish Government feedback South Lanarkshire Establish Children and Young People’s Mental Health and Wellbeing Sub Group as part of the Children’s Services Planning Structure Identify priorities for South Lanarkshire’s Children’s Services Plan 2021/23 Complete initial mapping of mental health and wellbeing supports and services provided by universal, third sector and specialist services that can be accessed by parents, children and young people.
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 36 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Carry out large scale school survey and collate findings Establish early intervention hub to take referrals from Police and Social Work to supporting families that do not meet the threshold for formal supports from Social Work Parent consultation Roll out Lifelines Lanarkshire training across South Lanarkshire secondary schools. Evaluation of services currently in place for Community Mental Health for Scottish Government feedback Specialist CAMHS 6.16 Demand for CAMHS 6.17 CAMHS Service Specification 6.18 CAMHS Access Improvement 16.1 An Immediate Focus on Services 16.2 Renewal 16.5 Setting High Standards Establish Programme Board to oversee the CAMHS Modernisation Strategy 2021-23 IT enablement review Waiting times management and clearance of waiting lists Investment of national Recovery and Renewal funding Demand, Capacity, Activity and Queue (DCAQ) planning in line with Choices and Partnership Approach (CAPA) Calculator Workforce recruitment Unscheduled care Accommodation review
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 37 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Children and Young People’s Neuro- developmental Pathway 6.19 Neurodevelopmental Services – National Specification 6.20 Neurodevelopmental Services – Digital Support Identify staff resource release from existing multi- disciplinary services Roll out of clinic Waiting times management Evaluation of outcomes Investment of national funding
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 38 Specialist Mental Health Services Objectives Review Older Adult inpatient provision to develop a more cost effective and flexible model that will better meet the expectations of patients and staff, whilst providing more control over the quality and safety of care provided. Adapt our clinical model to enable discharge and preventative readmission through enhanced community based services that offer flexibility, more control over the quality and safety of care provided. Review the models for Forensic Mental Health Services and Mental Health Rehabilitation and Recovery Services to replace the 12 beds previously available prior to the alignment of Gigha Ward, Beckford Lodge from Adult Rehabilitation to Forensic Services. Update the referral pathway for the Mental Health Rehabilitation and Recovery Service. Establish fully integrated Community Mental Health Services within locality services in South Lanarkshire. Establish a dedicated specialised community perinatal mental health team, including psychiatry, community mental health nurse, clinical psychology, community nursery nurse and social work staffing. Develop a model of infant mental health which integrates the approaches currently adopted in Health, Community and Voluntary Sector, Early Years and Social Work Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Older Adult Inpatient Provision 16.8 Bed Availability IJB approval to engage with patients and providers on consolidation of contracted HBCCC provision. Agree business case for the consolidation of contracted HBCCC bed provision on one central site and enable the establishment of a new MDT model of enhanced provision. . Engage with patients currently supported in contracted hospital-based complex clinical care beds in Cumbernauld Care Home and their families and carers to agree a plan for their continuing care Engage with care home providers Establish enhanced MDT model of care
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 39 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Ensure access to OPMH in-patient beds for residents of the Camglen area who would previously have been admitted to Glasgow hospitals Review of dementia and functional inpatient provision Rehabilitation and Recovery 16.8 Bed Availability 16.9 A Modern Understanding of Mental Illness 16.11 Clearer Pathways to Support and Treatment Map Glencairn referral and assessment process Review referral documentation Review Operational Policy and referral criteria Review the current Community Rehab model Develop new model of Community Rehabilitation mapped onto Royal College of Psychology Accreditation for Inpatient Mental Health Services (AIMS) standards Implement new Community Rehab Model Review role and function of mental health inpatient beds at Cleland hospital with a view to future-proofing in relation to population needs South Lanarkshire Community Mental Health Services Integration 16.10 A Joined-up Approach 16.11 Clearer Pathways to Support and Treatment Transfer nurses to South Lanarkshire HSCP: Agree operational management structure for community based mental health services in South Lanarkshire Develop Clinical and Care Governance Framework Transfer funding to South Lanarkshire HSCP Transfer nursing staff to South Lanarkshire HSCP
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 40 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Unscheduled Care 16.3 Unscheduled Care Establish Flow Navigation Centre (FNC) Develop in-hours and out-of-hours care pathways available for those referring in to the FNC Agree and recruit to staffing model Establish CMHT unscheduled care pathway Develop comms plan to increase awareness of new pathways across all referring agencies Evaluate impact of establishment of the FNC Eating Disorders 16.13 Eating Disorders Support development of TESS and other tiers of the NHSL Eating Disorders (ED) pathway in response to recommendations from the Mental Welfare Commission, National Eating Disorders review, and SIGN Eating Disorders guidelines Address gaps in ED services within NHSL particularly in relation to equipping and upskilling staff in all tiers of the NHSL pathway Mental Health Pharmacy Improve current level of pharmacy service to optimise safe, effective and person-centred care by utilising additional SG funding and maximising and making optimal use of the skills of the pharmacy workforce Forensic Mental Health Forensic Mental Health Services 17.1 Changes to Practices 17.2 Secure Mental Health Services Plan for implementation of Independent Review into the Delivery of Forensic Mental Health Services Plan for implementation of recommendations of The Forensic Network Report on Pathways for Women Through Forensic Mental Health Services
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 41 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 17.4 Criminal Justice System Psycho- therapy 16.1 An Immediate Focus on Services Establish a single Lanarkshire-wide Psychotherapy Service to ensure consistency in: Structure and roles/responsibilities Service delivery Treatment interventions offered pan-Lanarkshire Perinatal Mental Health 6.5 Access to Perinatal and Infant Mental Health Services 7.3 Perinatal Mental Health Design future staffing model for a Lanarkshire Perinatal Mental Health Service: Secure funding from Scottish Government Design achievement framework to identify final outcomes Establish a dedicated specialised community perinatal mental health team, including psychiatry, community mental health nurse, clinical psychology, community nursery nurse, midwifery, occupational therapy and social work staffing Develop clinical pathways and structures to ensure timely and quality of access, and equality of access, for women to specialist mental health services Put in place systems to ensure that professionals working in universal services with women and their partners and families can access consultation, information and advice in a timely manner Develop leaflets, webpage and third sector linkages to enable women and their partners/families have access
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 42 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 to timely information to help them to make informed choices Increase access to third sector support services for service users Data collection to measure access to service and impact of service and development of a system of continuous quality improvement Evaluation and Impact Assessment – 6-monthly progress reporting against outcomes Infant Mental Health 6.5 Access to Perinatal and Infant Mental Health Services Staffing model Secure funding from Scottish Government for a Lanarkshire Infant Mental Health Service Establish multi-agency, multi-disciplinary IMH team Develop clinical model Multi-disciplinary multi-agency IMH training programme for all agencies including third sector Infant Mental Health Easy Access Telephone Advice Line & Consultation System for Health Visitors NHSL LearnPro Foundation level module on Infant Mental Health: When to be Concerned for all NHSL staff working with infants and their parents Pan-Lanarkshire Multi-Agency Infant Mental Health Observational Indicator Set [birth to 3rd birthday] Systematic engagement with lived experience and third sector in place – ensuring feedback incorporated into service design
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 43 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Study of Barriers to Access to Mental Health Service and Mental Health Support for Infants in Lanarkshire Maternity and Neonatal Psychological Interventions 6.5 Access to Perinatal and Infant Mental Health Services Design future model for Maternity and Neonatal Psychological Interventions (MPNI) Service and secure Scottish Government funding until March 2023 Recruit MNPI Team Provide induction and training programme for new staff with reference to the NHS Education for Scotland Perinatal Mental Health Curricular Framework, and ‘Essential Perinatal and Infant Mental Health’ e- learning resource. Develop clinical model and pathways to ensure timely and quality of access, and equality of access. Systematic engagement with those with lived experience and third sector representatives to ensure feedback incorporated into service design: - MNPI experts by experience group - lived experience member on development group Women and their partners/families have access to timely information to enable them to make informed choices: service leaflets & webpage Data collection in place to measure access to service and impact of service and development of a system of continuous quality improvement Increase access to third sector services for service users
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 44 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 23 2023- 24 Evaluation and impact assessment – 6-monthly reporting of progress against outcomes Cross-Cutting Workstreams Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 2023 2023- 2024 Ensuring Equity and Equality 3.1 Causes of Inequality 3.3 Rural Isolation 3.4 Data Collection Complete Equality and Diversity Impact Assessment on the Mental Health and Wellbeing Strategy Carry out EQIAs of all workstreams to ensure that we are aware of systemic inequality faced by any part of the Lanarkshire population Identify common themes, refresh Strategy EQIA and develop an action plan to address mental health inequalities on an individual and structural level Workforce Development 2.6 Support for Health and Social Care Workforce 6.10 Children and Families Workforce 16.1 An Immediate Focus on Services 16.2 Renewal Define the required workforce plan: purpose, scope and ownership Identify proposed service changes that will impact on future workforce requirements Identify the skills required and the type and number of staff across all sectors to deliver new service models Description of the existing workforce across all sectors, its existing skills and deployment, including an assessment of any problem areas arising from e.g. supply of staff with particular skills, age profile, turnover, movement between sectors
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 45 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 2023 2023- 2024 Develop a plan to deliver the required workforce (new skills in new locations) and manage the change Implement the plan, measure progress and refresh the plan as required. Data, Evaluation, and Performance Reporting 1.2 Measuring Population Mental Health 3.4 Data Collection 16.6 Access and Quality Develop an Achievement Framework to define the fully define the outcomes and benefits to be delivered, understand contribution of projects and workstreams to the delivery of these and inform the development of appropriate measures of success Develop a Mental Health and Wellbeing Strategy Performance Framework and measurement plan and commence regular reporting Stakeholder Engagement 5.4 Carers 16.15 Delivery Role of the Third Sector 16.16 Strategic and Partnership Work with the Third Sector Develop a Stakeholder Engagement Strategy Establish a Communications and Engagement Reference Group Ensure that the 3rd Sector is represented on the Strategy Board, Communications and Engagement Reference Group and is involved as required in workstreams Develop and implement stakeholder engagement plans for each workstream Review Communication and Engagement Strategy and role of Communications and Engagement Reference Group Estates Assess accommodation requirements across all workstreams with a view to enabling more integrated team working and feed into wider estates/
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Blue Complete Green On track Amber Progressed but unlikely to be completed within the planned timescale Red Delayed Purple Planned 46 Workstreams National Transition & Recovery Plan Commitments Actions 2019- 2020 2020- 2021 2021- 2022 2022- 2023 2023- 2024 accommodation strategies of the health and social care partnerships and parent organisations
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47 Appendix 2: Achievement Framework What we start with: Time Funding Expertise Leadership Staffing Communicati on Governance Evidence base National policy What we will do: Consult with key stakeholders Create a Mental Health & Wellbeing (MH&WB) Strategy Implement the MH&WB Strategy. Actions will include: Increasing mental health service provision in community settings Ensuring all staff are trained in current practice Ensuring capacity to manage MH&WB issues meets demand Providing integrated services, including shared information Focusing on early What we will achieve in one to two years: People have access to the services that meet their needs People have access to the information they need Staff have the knowledge they need to deliver MH&WB services Lanarkshire people are aware of MH&WB issues Lanarkshire people are aware of the impact of MH&WB on their own and others’ lives What we will achieve in two to five years: People have enough resilience to manage life events and trauma People maintain their independence, avoiding hospital admission where possible, and achieving timely discharge following any admission People feel more connected to their local communities and have adequate social networks Having mental health issues is viewed no differently to having physical health issues Lanarkshire people are comfortable talking about mental health What we will achieve in the longer term: Lanarkshire people have good MH&WB Lanarkshire communities are compassionate Lanarkshire people have a good quality of life Inequalities in MH&WB are reduced or eliminated What outputs we will measure: No. complaints related to access to different parts of the service Waiting times/list size for different services No. Emergency Department mental health referrals Feedback from service users – possibly develop a generic survey (including access and information) No. people from SIMD 1 & 2 accessing mental health services No. people accessing mental health & wellbeing resources (including online, DBI, voluntary sector) No. staff achieving all mandatory training requirements No. people accessing income maximisation resources
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48 Appendix 3: Proposed Output Measures Output measure Definition - to be tested when first collated Source Baseline start date Reporting period Workstreams involved No. complaints related to access to different parts of the service Any complaint related to accessing any mental health, LD, addictions services Patient Affairs complaints, Care Opinion, Objective N/A Quarterly Children's Services, Specialist Services, IAMHSS Waiting times/list size for different services % patients started treatment within target time from referral TrakCare Mar-19 Quarterly Children's Services, IAMHSS % waiting within the target time TrakCare Mar-19 Quarterly Children's Services, IAMHSS No. Emergency Department mental health referrals No. patients referred to psychiatric assessment nurses directly from ED triage Service database 2020 Quarterly Specialist Services/IAMHSS Feedback from service users – possibly develop a generic survey (including access and information) Standard question examples: Did you feel the service met your needs? Did you have enough information in advance? How do you feel the staff responded to your needs today? Online survey, paper option for digitally excluded tbc Quarterly All workstreams No. people from SIMD 1 & 2 accessing mental health services Convert postcodes to SIMD quintiles for every new episode of care on TrakCare, SWIS, other systems TrakCare & SWIS to SIMD convertor Mar-19 Annually All workstreams No. people accessing mental health & wellbeing resources (including online, DBI, voluntary sector) No. people accessing Elament, Calm Distress, Well Connected, Silvercloud (MH-related) Online/App analytics Mar-20 Quarterly GMHFA No. people accessing Distress Brief Intervention DBI reports Mar-20 Quarterly GMHFA No. people benefiting from Community MHWB Fund VANL/VASLan reports tbc Quarterly GMHFA No. staff achieving all mandatory training requirements Mandatory modules relevant to each service Relevant learning platform tbc Quarterly All workstreams
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49 Output measure Definition - to be tested when first collated Source Baseline start date Reporting period Workstreams involved No. people accessing income maximisation resources No. people accessing income maximisation resources and total amount of money received NLC/SLC N/A tbc GMHFA No. reports of reduced isolation and loneliness No. reporting reduced isolation from Community MHWB Fund VANL/VASLan reports tbc Quarterly GMHFA No. people engaging with mental health & wellbeing events No. attending events organised during national & local campaigns and sessions Eventbrite, Service Leads tbc Annually All workstreams
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50 Appendix 4: Programme Risks Description Mitigation/Action Plan Likelihood Impact RAG There is a risk that the delivery and implementation of the Strategy is delayed or not completed as a result of the lack of continued specialist resources to lead, manage the programme and to provide dedicated programme and project management expertise. NSS Programme Team retained to support NL Strategic Commissioning Plan Programme of Work in the wake of the Covid-19 pandemic and develop HSCNL programme and project management - including continued support for Mental Health and Wellbeing Strategy implementation. No confirmation at this stage of programme support beyond 31/03/23. Likelihood of risk increased. 4 3 12 There is a risk that the Mental Health and Wellbeing Strategy workstreams cannot be progressed whilst NHSL, HSCNL, SL HSCP and other partners are on an emergency footing to respond to the COVD-19 pandemic resulting in delays to delivery of planned improvements and serious impact on services, patient care and the mental health and wellbeing of the population of Lanarkshire. Delivery plans for all workstreams reviewed in light of National Transition & Recovery Plan and Mental Health Recovery and Renewal Fund Covid is now receding; however, this remains a significant risk moving into the winter period. The response and management of Covid will continue to prove challenging. 2 4 8 There is a risk that a lack of a staff base to accommodate the expansion of the Primary Care Mental Health & Wellbeing Service will result in significant difficulties in provision of clinical supervision; development reviews; case management, the ability to deliver in house training, which have a serious impact on the delivery of the service and patient care. Raise risk to both North and South Property Strategy Meetings Identify suitable accommodation bases in North and South Lanarkshire 4 4 16 Through additional SG funding, Psychological Services has recruited recruit an additional 17 staff across localities. There is a risk that the existing shortage of suitable clinical space impacts on the ability of Psychological Services to increase staffing levels / offer trainee placements; and to see a significant proportion of patients Operate a hybrid of face-to-face and remote consultation, enabling clinicians to have the option to continue with home working for part of the week – where this is efficient and effective and safe. The Psychological Services Advisory Committee has established a SLWG to review of flexible/agile working with staff, to determine perspectives, 5 4 20
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51 Description Mitigation/Action Plan Likelihood Impact RAG resulting in a failure to meet the HEAT Standards set out by Scottish Government, inadequate patient care and poorer outcomes for patients. There is also the risk of detrimental impact on team functioning and staff wellbeing. attitudes, challenges, and opportunities around changes in working practices – including 0800-2000 working, and weekend working. There is a risk that we are unable to recruit suitably qualified staff for CAMHS resulting in an inability to provide a timely quality service due to a combination of rapid change (including but not exclusively the introduction of the CAPA model and move to Udston) and the high level of demand on the service. This is a particular risk for those children and young people with the most complex medical needs given the shortage of medical staff. Dedicated recruitment team Both AMDs for psychiatry and paediatrics will be involved in the workforce planning HR workstream with support from the comms and engagement workstream will ensure staff comms and involvement are appropriate and supportive of the needs of staff to be as efficient and effective as possible 4 4 16 There is a risk of over medicalisation of stress and distress due to lack of visibility of referral criteria and alternative options to referrers, particularly early interventions. This has an impact on CAMHS being able to provide a timely quality service. Provision of referral criteria information to referrers in the referrers preferred format Close linkage between the programme and LA provision, with comms, in order that the ‘no wrong door’ policy can be effected 2 5 10 There is a risk that the short term and long term outcomes for children with neurodevelopment disorders will be adversely affected by restricted access to services and support due to waits of several years for assessment and diagnosis. Short term: Commissioning of external service to provide diagnostic pathway; reappraisal of feasibility of NHS Lanarkshire provided pathway to avoid duplication of assessment; waiting list cleansing exercise. Long Term: Recruitment where possible to ceiling of current SG funding; appraisal of service model and resources required to deliver long term pathway flow and liaison with SG to secure same 4 4 16 There is a risk that we are unable to implement CAPA due to lack of IT infrastructure, specifically TrakCare. Development days with leadership team and local teams have been arranged/taken place to inform delivery of Trakcare. 3 4 12
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52 Description Mitigation/Action Plan Likelihood Impact RAG IT infrastructure is in place and awaiting job plans from CAMHS staff. Assurance provided from IT that Trakcare build will be reviewed and flexibility for adapting and developing templates.
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1 REPORT Item No: 14 SUBJECT: NSS Screening Data Intelligence Pilot 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: 14th February 2023 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 contents of the report; Request future updates from the Programme Board on the delivery phase of the project. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background Yes No N/A
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2 5.1.1 Through the nation Health and Social Care Scotland Chief Officers’ Group, an engagement forum has been developed with National Services Scotland to explore potential areas for collaboration. The group is supported by the Chief Officers for North Lanarkshire and West Lothian, with a range of inputs from National Services Scotland and Public Health Scotland. 5.1.2 The first area of potential collaboration was put forward by the North Lanarkshire partnership building on the work undertaken as part of the Joint Strategic Needs Assessment undertaken to support the development of the current Strategic Commissioning Plan. The needs assessment highlighted significant inequality in screening uptake across North Lanarkshire’s communities, with further work required to fully understand the impact. 5.1.3 In November 2018, the Scottish Screening Committee set out a range of objectives with the aim of making screening more accessible; breaking down barriers to participation; creating person centred approaches; and making better use of data and performance information to improve planning, operational performance and outcomes. 5.1.4 Data from this work highlighted that around 35% of the population do not attend screening appointments, with a high correlation between deprivation and non- attendance. 5.1.5 The reasons for non-attendance are multifaceted and complex, but by understanding the barriers to attendance better, it should be possible to focus resources and personalise services to facilitate participation. 5.1.6 A project team was established with lead officers from National Services Scotland, Public Health Scotland, North Lanarkshire Health and Social Care Partnership and West Lothian Health and Social Care Partnership, working on a five step approach to deliver the proof of concept: 1. Identify analysis objectives with the Health and Social Care Partnerships 2. Define areas of focus and use cases 3. Data analysis and modelling 4. Test insight with users and identify potential interventions 5. Define ongoing monitoring to track benefits and improve 5.1.7 The proof of concept was established with the broad aim to “reduce the barriers to participation through better use of screening data, advanced analytics and working with Health and Social Care Partnerships to identify opportunities to focus local resources and third sector partners more effectively to encourage and facilitate participation in screening.” 5.1.8 Four key outcomes were sought from the work, covering the geographical presentation of data; contextual outcome information to understand the impact of screening; investigation of factors underlying screening participation; and identified use cases to leverage data and existing resources to improve uptake of screening.
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3 5.1.9 Two pilots have since been identified, with the North Lanarkshire HSCP leading work with local communities on how best to understand the impact of screening and encourage uptake, while West Lothian HSCP is exploring the impact of personalised screening reminders. 5.2 Developing our approach Geographical Presentation of Data 5.2.1 The first focus of the programme was to get a better understanding of the data, moving away from the normal data presentation at Health Board level to smaller geographical areas. Uptake was able to be viewed at Health Board, Council, Locality and Electoral Ward geographical areas, with the potential to build this data flexibly to population areas that make most sense locally. 5.2.2 An example of the ward level uptake across North Lanarkshire for bowel screening uptake is as follows: 5.2.3 While overall North Lanarkshire is only slightly below the Scottish average for uptake, there is considerable difference in uptake between most affluent and most deprived areas, with only 50% uptake in our most deprived communities:
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4 Contextual Information to Understand Impact 5.2.4 Using nationally available data from England, the impact of early identification of cancers can be fully understood. Using bowel cancer as an example, early identification at stage 1 has a 5-year survival rate of over 90%, but later detection at stage 4 compares at 10%. 5.2.5 Using local data for the two Health and Social Care Partnership areas involved in this programme highlights the impact of poor screening uptake quite clearly, with North Lanarkshire showing around 10% lower levels of early detections than West Lothian. 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 I II III IV % net survival Stage of detection 5-year bowel cancer net survival (England)
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5 5.2.6 Through this area of the project, an intelligence platform has been created, connecting a range of different data sources and developing advanced analytics to build predictive models. Investigation Underlying Factors for Screening Participation 5.2.7 Through development of the intelligence platform, a number of areas have been explored to gain a better understanding of screening participation, looking at a range of underlying factors including ethnicity; homelessness; mental health; and linkages to those with frequent unscheduled care attendances. 5.2.8 An example of this output is the impact of ethnicity in uptake of bowel screening, with lower uptake in some ethnic groups strongly evident: 5.2.9 Linkages have also been made with the research undertaken around uptake of the Covid vaccination programme, and the learning from some of the initiatives developed to increase uptake, such as the use of different coloured envelopes and individualised support to attend appointments. Identified Use Cases to Improve Uptake 0% 10% 20% 30% 40% 50% 60% 70% North Lanarkshire West Lothian % detected at stage I-II HSCP Proportion of bowel cancers detected at stage I-II All cancers Screening-detected cancers
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6 5.2.10 A framework was developed to look at how to best frame the improvement cycles from the proof of concept. This includes gaining a better understanding of what drives non-participation; the system-based changes that could improve the screening pathway; local changes that could support more individualised approaches; and how we can make best use of community touchpoints and assets to support attendance. 5.2.11 Using this framework, the project team have been able to identify two key pilots as the next stage of the project. Pilot 1 (West Lothian) is looking at the impact of personalised screening reminders, which include localised content such as public transport routes. Pilot 2 (North Lanarkshire) aims to engage with local communities on how best to understand the impact of screening and encourage uptake. 5.3 Developing the North Lanarkshire Pilot 5.3.1 The development of the North Lanarkshire pilot has heavily focused on a broad engagement programme, through a series of structured interviews, focus groups and workshops, covering the following groups: Male ethnic minorities in deprived communities People without English as a first language in deprived communities Volunteers with sensory impairment via Deaf Blind Scotland Clinicians in deep end clinics Health improvement practitioners working on inequalities Pharmacists Key leads from across the North Lanarkshire HSCP/NHSL system 5.3.2 The Service Design Process was undertaken as follows:
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7 5.3.3 Through the engagement journey and broader supporting research we have been able to identify the top barriers to participation in bowel screening: Fear and denial around the test outcome A misconception that the test is not applicable if you don’t have any apparent symptoms of bowel cancer Concerns around the practicalities and cleanliness of the test Individual perceived risk being low or consideration of future consequences of bowel cancer The fact that it takes place away from the usual health care settings Low health literacy and numeracy Gender – on the whole males were less likely to participate in screening Lower socioeconomic group 5.3.4 The research undertaken in North Lanarkshire with those with lived experience led to a reframing of the screening journey: 5.3.5 The workshops have identified for ideas for piloting in North Lanarkshire: Texts to introduce the bowel screening process and track the stage in the process Communication and guidance to activate community touchpoints Local pharmacy encouragement and kit pick up for non-attenders Focused community workshops with specific low uptake groups
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8 5.3.6 The concept cards developed behind each of these four ideas are included in appendix one. 5.3.7 The aim is now to move into the delivery phase, using the Community Boards as the primary delivery vehicle. The aim from the outset of the North Lanarkshire projects is to develop community activity to support screening uptake and the Community Boards offer a unique opportunity to move this into the delivery phase. 5.3.8 A Project Board will commence in late January 2023 to coordinate this next phase of the project. Terms of Reference for the group are included in Appendix 2. 5.3.9 In November 2022, Cancer Research UK published its report Deprivation and Cancer Inequalities in Scotland, which highlights the extensive cancer inequalities currently faced. Those in the most deprived areas are 30% more likely to develop cancer and all cancer mortality a staggering 74% higher than those in the least deprived areas. 5.3.10 A key theme from the report is the need to have access to high-quality data, which was the starting point for this programme of work and collaboration between National Services Scotland, Public Health Scotland and the NL Health and Social Care Partnership. 5.3.11 The report also identifies the impact of lower screening uptake in more deprived communities, noting a 20% lower uptake for bowl and breast screening and 11% lower uptake for cervical screening in the most deprived communities, which is similar to the findings of our local research. 5.3.12 It is vital that this screening project is seen as part of a wider strategic focus on cancer inequalities, bringing together all partners across the Community Planning Partnerships to tackle the key thematic areas outlined: reducing preventable causes of cancer; taking bold action to diagnose cancers earlier; ensuring equitable access to optimal treatments; and improving the quality and availability of data. 5.3.13 NHS Lanarkshire’s Population Health Committee is coordinating some review activity around the main themes outlined in the report, to support a whole system approach to tackling this issue. 6. CONCLUSIONS 6.1 Progress around the bowel screening pilot programme continues, following an extensive programme of engagement and research. 6.2 A Programme Board will commence in late January 2023 to coordinate the next delivery phase of the programme, which will be focused through our local Community Boards. 6.3 It is vital that this is seen as one part of a wider strategic focus on cancer inequalities, forming a key strategic objective for our community planning partnerships in North and South Lanarkshire.
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9 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES 7.1.1 The programme 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 identified to date, though small budgets may be required to support action across the Community Boards as the programme develops. 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4.1 There are no associated risks on the risk register at present. 7.5 PEOPLE 7.5.1 An extensive engagement programme was undertaken to form the basis of the next phase of project delivery. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY 7.6.1 An EQIA is being developed to support the next phase of the programme, building on the information gleaned from our wider engagement and research. EQIA Completed: Yes No N/A 7.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. BACKGROUND PAPERS 9. APPENDICES Appendix 1: Opportunity Cards Appendix 2: Programme Board terms of Reference ............................................................................. 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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10 Appendix 1 – Opportunity Cards
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14 Appendix 2: NSS Screening Data Intelligence Pilot: North Lanarkshire HSCP Project Board ToR NHS Lanarkshire Screening Inequalities Project: Outline brief Background The provision of screening uptake data will enable Community Boards to plan and deliver local interventions to increase uptake, supporting the early intervention and prevention of bowel cancer within the population. Objectives and deliverables • Conduct a discovery of what data is available and how this is currently used. • To agree what data is needed and the frequency of data updates on a recurring, automatic basis to be of use to the Community Boards planning interventions. Duration TBC In-scope Bowel screening uptake data Out of scope Other screening services data Outline plan • To conduct a discovery of what data is available and how this is currently used. • To agree what data is needed and the frequency of data updates on a recurring, automatic basis to be of use to the Community Boards in planning interventions. Expected benefits Community Boards will be able to determine which regions to target with interventions Methodology Project team will create a plan for approval by the Project Board Stakeholders Community Boards, LIST Analysts, PHS Analysts, NHS Board Screening Co-ordinators, Screening Programme, National Screening Oversight, NHS Lanarkshire Health Improvement team. Constraints Availability of uptake data, information governance restrictions, availability of subject matter experts. Resource requirements Project Lead: TBC, PM Support: Sarah Adams, Data Analyst input: TBC Governance This project is governed by North Lanarkshire HSCP with Ross McGuffie, Chief Officer acting as Senior Responsible Officer
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15 Project Board Membership Name Organisation Project board role Responsibilities Ross McGuffie North Lanarkshire Health & Social Care Partnership Chair & HSCP Representative Chair project meetings Represent the interest of NL HSCP Lead the project, providing clear leadership and direction throughout its lifespan Ensure the project remains aligned to the strategic direction of the NSO with respect to tackling inequalities in access to screening. Accountable for the delivery of project objectives Julie Anderson/Garrick Wagner NHS National Services Scotland National Services Division (NSD) Representative To represent the interest of the Bowel Screening Programme and ensure the project is aligned to the strategic objectives of the Screening Programme. Celia Biffa-Watt NHS Lanarkshire Health Board Health Board Representative To represent the interest of the regional Health Board and ensure the project is aligned to the strategic objectives of the Health Board. Gavin Clark/Angus Morton Public Health Scotland Public Health Scotland Representative To represent the interest of Public Health Scotland. Provide advice and guidance about population needs with regards access to population screening services. Graeme Cowan North Lanarkshire HSCP Represent North Lanarkshire HSCP Provide advice and guidance around how data can be used to support activities led by the Community Boards. Leanne Pollock North Lanarkshire Council Community Board representative To represent the interests of the North Lanarkshire Community Boards. David Readhead North Lanarkshire Local Intelligence Support Team) LIST Represent LIST Analysts Provide advice and guidance around available data and information governance requirements for access. Helen Reed NHS National Services Scotland National Screening Oversight representative To represent the interest of the National Screening Oversight. To provide advice and guidance based on information gathered from other inequalities initiatives undertaken/planned by other Health Boards/organisations.
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16 Name Organisation Project board role Responsibilities Vicki Trim NHS Lanarkshire Health Improvement Lead Provide advice and guidance around selection and implementation of interventions to be led by the Community Boards.
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17 Project Governance Reporting Group Name Interests Lead contact Digital Modernisation Programme Board Progress updates David Proud Screening Programme Board Progress Updates Garrick Wagner National Screening Oversight Progress Updates David Proud Chief Officers Reference Group (CORG) Progress Updates Katherine Ross NHS Lanarkshire population health committee Progress Updates Ross McGuffie Adult social work and care committee Progress Updates Ross McGuffie IJB performance, finance and audit committee Progress Updates Ross McGuffie
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18 Meetings Chair: Ross McGuffie Deputy Chair TBC Frequency of meetings as and when required for the purpose of project decision making, but starting monthly Agenda The agenda and any supporting papers will be circulated one week in advance of each meeting by the project board secretariat. Requests for agenda items should be sent to the secretariat no later than 2 weeks before the next meeting. Decision Making The quorum for decision making and carrying out the business of the Board will be 50% of members, and decision making will be by majority. In circumstances where the group are unable to come to a consensus the Chair has the authority to make the final decision. Logging of decisions made All decisions will be recorded in the action log by the board secretariat. Minute of meetings An action log will be updated at each meeting. Lifespan The group will close when the project is completed. Review The terms of reference will be reviewed and updated on an annual basis. The next review date is January 2024.
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1 REPORT Item No: 15 SUBJECT: Cancer Research UK Screening Inequalities Report TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie, Chief Officer North HSCP DATE: 14th February 2023 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 Committee is asked to: Note the contents of the report; Note that NHS Lanarkshire’s Population Health Committee is coordinating an exercise to: o Form a baseline against all key themes outlined in this report o Research and understand the evidence around gold standard practice for each theme o Undertake a gap analysis to identify key actions for implementation through NHS Lanarkshire and wider partners. Request an update on the NHSL exercise once complete Embed cancer inequalities as a key theme in the 2023-26 Strategic Commissioning Plan. 4. VARIATIONS TO DIRECTIONS Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 In November 2022, Cancer Research UK published a report on Deprivation and Cancer Inequalities in Scotland. The report focuses on inequalities in relation to deprivation across the cancer pathway in Scotland, as it is one of the most influential factors in driving differences in cancer incidence, diagnosis and outcomes. 5.1.2 The report explores the levels of deprivation across Scotland and how this can impact on cancer incidence and outcomes, then focuses on three key areas of action: Prevention Early diagnosis Treatment 5.2 Deprivation in Scotland 5.2.1 Deprivation encompasses a wide range of different factors including income, employment, education, health, access to services, crime and housing. In Scotland, this is usually quantified using a relative measurement scale, the Scottish Index of Multiple Deprivation (SIMD). 5.2.2 Using the SIMD methodology, NHS Lanarkshire is the third most deprived Health Board in Scotland, with 28% of data zones in the most deprived quintile, behind NHS Ayrshire and Arran (31%) and NHS Greater Glasgow and Clyde (35%). 5.2.3 Cancer incidence is 33% higher in the most deprived populations in Scotland in comparison to the least deprived areas. It is estimated there are around 4,900 extra cancer cases every year in Scotland attributable to deprivation, with lung cancer contributing nearly half of these. 5.2.4 Cancer mortality is 74% higher in the most deprived population compared to the least deprived. This gap has narrowed slightly since the Covid-19 pandemic, which may relate to people from more deprived areas being more likely to die from Covid-19.
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3 5.2.5 Accordingly, cancer survival is lower in the most deprived groups – e.g. for bowel cancer, five year survival rates are 10% lower in the most deprived populations compared to the least deprived. 5.3 Prevention 5.3.1 Smoking remains the biggest cause of cancer in Scotland, responsible for 1 in 5 cases. While smoking prevalence continues to fall across Scotland, the rates in the most deprived population have consistently been much higher. In 2019, 32% of people in the most deprived quintile smoked, compared to 6% in the least deprived. 5.3.2 Overweight and obesity is the second highest risk factor for cancer in Scotland, causing nearly 7% of cancer cases each year. Unlike smoking, projections for adult obesity do not show a broad downward trajectory, with an increase from 36% in 2019 to 41% in 2040 projected for the most deprived and a modest decrease in the least deprived from 22% to 19% over the same timescale. Childhood obesity rates are twice as high in the most deprived areas compared to the least deprived. 5.4 Early Diagnosis 5.4.1 Cancer screening can help prevent cancers developing as well as detecting cancers at an early stage when treatment is more likely to be successful. Around 7% of all cancers in Scotland are detected through the breast, bowel and cervical
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4 screening programmes. For both breast and bowel screening, uptake is 20% lower in the most deprived populations compared to the least deprived and uptake is 11% lower for cervical screening. 5.4.2 Awareness of the signs and symptoms of cancer is lower in among more deprived populations. Health literacy is an important factor in inequalities, with identification of symptoms that could indicate cancer one of many factors that could support earlier diagnosis. People in the most deprived populations are between 50 and 75% less likely to recognise bruising, unspecified pain, changes in appearance of a mole, persistent cough or weight loss as potential symptoms of cancer. 5.4.3 Barriers to seeking help are more likely to exist for those living in more deprived communities. A range of difficulties such as getting access to an appointment, getting an appointment at a convenient time, being able to discuss health problems remotely, confidence to talk about symptoms or thinking symptoms were related to an existing condition are all significantly more prevalent in those from the most deprived communities (particularly around being able to access appointments with health professionals). 5.4.4 Consequently, those from more deprived areas are more likely to be diagnosed following an emergency referral and are more likely to be diagnosed at a later stage for some cancer sites. Data from other countries suggests that most deprived communities are 50% more likely to be diagnosed through an emergency presentation, with some evidence of this in Scotland, with 21% of patients in the West of Scotland diagnosed through emergency referral. Patients diagnosed at an early stage are more likely to survive their disease longer, with stage 1 and 2 diagnoses for breast and bowel cancer being around 5% lower in most deprived groups. 5.5 Treatment 5.5.1 NHS Scotland operates two targets for cancer waiting times: 62-day target from receipt of referral for an urgent suspected cancer to treatment 31-day target from decision to treat until first treatment begins for all cancers 5.5.2 There is no data available on cancer waiting times by deprivation level, however, the report does note declining Scottish performance against the 62-day target. NHS Lanarkshire currently sits above the Scottish average and 4th in Scotland for performance, but below target.
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5 5.6 Emergent themes 5.6.1 To conclude the report, Cancer Research UK sets out the importance of ensuring nobody is left behind in a shared mission to bear cancer. The following themes are noted: Need to roll out interventions that tackle the know drivers of inequalities, including smoking and obesity, which are cancer risk factors that disproportionately affect more deprived communities Need for bold action to diagnose cancers earlier and ensure everyone has equal access to the right treatment for them. Need to build a much stronger understanding of where inequalities exist and what is driving them through better data collection, infrastructure and access. The report calls for national agreement on data collection around patient characteristics, including age, gender, ethnicity, sexuality and deprivation. 5.7 Next steps 5.7.1 Given cancer is one of the leading causes of death in Scotland and NHS Lanarkshire’s significant deprivation profile, the contents of this report are highly concerning. 5.7.2 At the 18th January 2023 meeting of NHS Lanarkshire’s Population Health Committee, it was agreed: A scoping exercise be undertaken locally against all core elements outlined in this report, to provide a baseline for Lanarkshire. Research should be undertaken to better understand the evidence base and gold standard practice around each key element, to allow a gap analysis to be undertaken. Key actions be embedded within the Healthcare Strategy Our Health Together, but importantly embedded within partner plans, including IJB Strategic Commissioning Plans as well as those of the Community Planning Partnerships. 6. CONCLUSIONS
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6 6.1 The Cancer Research UK report Deprivation and Cancer Inequalities in Scotland highlights the significant impact of deprivation on cancer incidence, diagnosis and outcomes. With NHS Lanarkshire identified as the third most deprived Health Board in Scotland, the findings of the report are highly concerning. 6.2 It is recommended that cancer inequalities form a theme within the upcoming Strategic Commissioning Plan, 2023-26. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES 7.1.1 The programme 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 identified to date, though small budgets may be required to support action across the Community Boards as the programme develops. 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4.1 There are no associated risks on the risk register at present. 7.5 PEOPLE 7.5.1 Through the NSS screening pilot, an extensive engagement programme was undertaken around screening inequalities and similar methodology could be utilised for other elements. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY 7.6.1 An EQIA is being developed to around the NSS screening pilot, which could potentially be extended. EQIA Completed: Yes No N/A 7.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. BACKGROUND PAPERS 9. APPENDICES Appendix 1: Cancer Research UK – Deprivation and Cancer Inequalities in Scotland report
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7 Cancer in the UK - Deprivation and Cancer Inequalities in Scotland (003).pdf ............................................................................. 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