Item 11 - Performance Report Quarter 2 2022-23
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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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.