Minute
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 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Tuesday 14th February 2023 3pm-5.25pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Phillip Couser NHS Lanarkshire Nominated Non Exec Director Councillor Gerry Brennan North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Councillor Paul Kelly (left 3.30pm) 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 Cathy McGinty Unison Staff Side Rep (NHSL) John Watson Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager Paul Carey Audit Scotland Stacey Connor (Minutes) Minute Secretary Graeme Cowan Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Maddy Halliday Chief Exec, VANL Third Sector Rep 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 Maggs Thomson Head of Health NHSCP Apologies Trudi Marshall Nurse Director North HSCP James Muir NHS Lanarkshire Nominated Non Exec Director
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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. Special welcome was extended to Phillip Couser and Stacey Anderson who have joined both the IJB and IJB PFA committees. 2. Declaration of Interests There were no declarations of interest raised. 3. Minutes 16th November 2022 The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log Brian Moore drew attention to the previous minutes regarding reference to the risk strategy and requested update on procurement of community alarms. Ross McGuffie advised risk strategy is almost complete awaiting some details from the council strategy to finalise the paper but it is planned to be tabled at 22nd March 2023. New alarms have been purchased which are digital ready, update reports will be available at the end of the financial year so can bring a formal update to a future committee; this will be added to action log. Brian Moore requested update on development of the work plan, Stacey Anderson has been working on this and it will be shared soon. Ross McGuffie shared an updated action log to reflect the progression of work since the last committee. Item 1- Reserve Strategy- Amanda Kilburn is progressing this and an update will come to March IJB. Item 5- Finance- Need to wait and see financial implications of Feeley Report going forward. Item 16- Fairer Scotland Duty- There is work on going across all partner bodies on EQIA and fairer Scotland duty, Mark Dell is working up an EQIA section for the HSCP website to tie in with this work also. RMcG
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3 5. PF & A Risk Register 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. 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 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. 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 advised he will undertake risk register reviews to ensure risks have the correct rating scores and includes any mitigations in place. The risk strategy will include risk sharing arrangement across NHS and Council partners so can flag any changes which impact on both partners. Phillip Couser noted a number of actions for some risks have been completed but the risk stayed at the same rating. He also noted the EU risk which is noted as a single risk and should be reviewed and updated. Ross McGuffie will consider closing the risk and in future will review and aim to reduce risks but this is challenging in some instances due to long term nature of some elements. Cllr Bob Burgess queried the GP sustainability risk and asked if the Saturday clinics currently being offered by GPs be a mitigation. Ross McGuffie noted can predict demand over long weekend periods, although this is not something which will be long term but it will be part of the winter plan to RMcG
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4 create extra system capacity in future. Dr Lucy Munro noted due to capacity not possible to continue throughout the year. Ally Boyle noted the risk relating to impact of covid requires an update. Ross McGuffie acknowledged that in future need to ensure use the risk register to drive reports coming to the committee particularly for high and very high risks. Brian Moore advised external audit had sent a communication related to fraud; this is rated as low on the register risk but due to the current situation, cost of living crisis and threat of cyber-attacks requested a review of current rating. Ross McGuffie advised the risk will mainly sit with parent organisations but will consider this as part of risk strategy review. The IJB PFA committee agreed the following recommendation: Noted the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 6. Maintaining a Positive Balance of Care 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. The report shared today 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. 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. 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.). Ally Boyle noted it would be interesting to see cost implications of this work on other areas. Morag Dendy noted this is a baseline report and work on some more of the details will be undertaken going forward; current focus in mainly on local authority work. Ross McGuffie advised key part of the model is to focus on community support to make this work; need to look at patient’s quality of life as part of reablement process. Maddy Halliday noted from April plan to strengthen community solutions evaluation work.
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5 The Committee: i) Endorsed and supported the balance of care within North Lanarkshire; and ii) Noted the contents of the report 7. Financial Monitoring This report provided 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. 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. 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. The report provided 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
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6 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. The current IJB reserves position for 2022/23 is a revised balance of £93.954m the time of writing the report, further details are provided within the report. 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. £5.37m cost to date for covid costs projection for year end is an increase to £7.5m. Maddy Halliday queried is there flexibility for the return of covid money to Scottish Government to be redirected to other areas; this has been confirmed there is no flexibility. Brian Moore questioned how did the slippage come about for self-directed support. Amanda Kilburn noted budget is allocated on a yearly basis but depends when the package start as this is not always on 1st April to tie in with financial year. So funding will be there but may not fully used until following year. The IJB PFA Committee agreed the following recommendations: (1) Noted the contents of the report; (2) Noted the financial position is a year-to-date underspend of £10.467m and: (3) Noted the updated position regarding the return of unallocated Covid- 19 ring-fenced reserves in sections 8.5 and 8.6. 8. Financial Regulations
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7 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) 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. Brian Moore stated this would be useful to bring review of financial regulations annually to the committee to reinforce roles and responsibilities of members; this was noted. The PFA Committee is asked to agree the following recommendations: (1) That the Financial Regulations attached as an appendix to this report are noted. 9. Covid 19 Update/ Resilience Response 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. As at 31st January, there are 5 outbreaks in care homes covering 29 residents and 18 members of staff cumulatively. 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:
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8 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 Ross McGuffie noted working on delayed discharges with other services relating to operational flow work. As currently for 40% of cases only notified when patient is ready to be discharged which is creating a delay as not enough time to arrange what is required for the patient. Currently have 32 individuals in interim care beds. Working at front door of the hospital with flow navigation system to get patients to right place first time, using care home pathways to get access to an ED consultant in first instance. Operation flow is a whole system piece of work; firebreak is due to start to get MDT senior teams to review patients on sites on a daily basis to get discharge dates agreed. The aim is to get acute sites under 100% occupancy. The second part is the improvement actions underway- looking at continuous flow model to spread risk through the hospital to manage flow away from ED to wards. Ally Boyle noted it would be good to have a record of work undertaken with covid as a whole system so that learning can be used going forward when needed; this was noted. Maddy Halliday noted carers together recently commissioned a survey around cost of living charges, she asked is there ways in which we can increase direct support to carers. Ross McGuffie advised will undertake a full evaluation exercise to consider what can be down to support carers going forward. Cllr Gerry Brennan asked do we know from current data available how bad system pressures have been. Ross McGuffie noted can see acute sites constantly running over capacity for a sustained period and those present at ED have higher levels of acuity than in the past. The aim of operation flow is to get back to business as usual and manage staff expectations too. Brian Moore asked how do we capture baseline data and progress against work programmes outlined if there will no longer be a covid report. Ross McGuffie confirmed will being resilience reports in place of covid report to include some of the key action areas particularly around operation flow. Cllr Ayeshah Khan commended the report and taking the lessons learned forward; this was echoed by other committee members. Ross McGuffie noted learning will feature in future winter plans.
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9 The IJB PFA noted the following points: (1) Noted 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) Noted the whole-system response to ongoing health and social care pressures, as outlined in appendix 1 of the report. 10. Annual Performance Report 2021-22 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. Guidance on these Annual Performance Reports was produced by the Scottish Government in March 2016. The draft Annual Performance Report 2021/22 is attached as an Appendix to the report tabled 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. Graeme Cowan shared a presentation with the committee. It advised the publication date of the report should be no later than 4 months of end of reporting year; Coronavirus (Scotland) Act 2020 allowed IJBs to extend their publication date. There are 23 core indicators which are broken down to 9 indicators. Cllr Gerry Brennan asked what has been undertaken to improve falls. Ross McGuffie advised that work is undertake for fall prevention across different service, staff training and other work across the whole system. Ally Boyle queried if thought has been given to having a summary document for the report content to make it easier for the public to understand. Phillip Couser added it would be useful to make the actions more explicit to show the progress. Maddy Halliday asked have we had data on number of respondents for the survey, and considered adjustments for areas of deprivations. Community solutions care share data from their report to be included in this report. Later in the meeting Graeme Cowan confirmed had 7327 responses for the survey. Cllr Ayeshah Khan questioned accessibility of the report and agreed with the proposal of a summary document. Graeme Cowan acknowledged can draft a summary document for this report. Although he did acknowledge
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10 restricted in what data can be published as this is not our data. Will also consider messaging for the wider public. The Committee noted the contents of the report and approved publication of the Annual Performance Report on the partnership’s website, following graphic design input. 11. Performance Report Q2 The report tabled today provides 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). 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. 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. Morag Dendy provided an update for the different services key areas within the report. Phillip Couser noted the board has discussed using unvalidated data to manage the time lag in data. Measuring against certain indicators is not always useful as doesn’t illustrate the full picture. Morag Dendy noted already linking closely with North Lanarkshire Council and South colleagues to consider consistent reporting arrangements and to ensure data is relevant. This will also link to the refresh for the strategic commissioning plan. Ross McGuffie advised have used CAMHS as an example to look at wider picture in more detail and will be looking to do the same with other services. Maddy Halliday noted if we had schedule when information is required could provide more current data, community solution produce reports at intervals. This was noted. Brian Moore noted low figures for OT services, proposed in future can have more detailed discussion around the reasons for these figures and understanding the particular issues. More detailed information to be brought back to a future meeting on OT paediatrics and Speech and language. RMcG
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11 The committed noted the report and appendix. 12. MAT Standards 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. 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. The test work undertaken in South Lanarkshire and local learning will fed into each MAT standard. Some actions may be completed but if the whole actions are not completed it will not change the RAG status rating for a standard; so may not provide whole picture. Reporting regularly to Scottish Government any updates. An annual report will be shared with committee to provide key updates. Cllr Bob Burgess queried are veterans included in the work. Morag Dendy advised veterans can access the service but it’s not a specialist service for just them. The Committee agreed the following recommendations: Noted the contents of the report Requested continued reporting within the agreed timeframes
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12 13. Mental Health Strategy Update 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. 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 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; 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. Brian Moore noted due to time constraints could consider a greater discussion as part of an IJB Liaison session. Ross McGuffie will consider this going forward. Maggs Thomson outlined some of the key work within the programme. Particular challenges of recruitment in HMP Shotts. There is a national view in how mental health services should be delivered in prison settings and there is some HIS involvement also. For CAMHS the unverified data is showing an improvement already. Big push for the strategy board is around engagement for recruitment due to some services inability to recruit. Accommodations is another area which is challenging for some services to be delivered. RMcG
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13 Maddy Halliday noted community sector work is not included within the report but plan to include in future. Mags Thomson will pick up with Maddy out with the meeting. Cllr Ayeshah Khan noted be useful to look at wider work as part of thematic work; Brian Moore, Ross McGuffie & Cllr Ayeshah Khan will pick up out with meeting. The IJB PFA Committee noted the following: 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. RMcG/BM/ AKh 14. NSS Screening 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. 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. 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.
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14 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. 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. The committee: Noted the contents of the report; Requested future updates from the Programme Board on the delivery phase of the project. 15. Cancer Inequalities 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. 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 Ross McGuffie noted taken to strategic leadership group, already been to NHSL population health committee and will go to relevant South governance groups. Concerns around screening uptake particularly for bowel cancer as survival rate reduces depending at which stage it is identified at. Maddy Halliday noted an initiative to support those affect by cancer linked to community solutions. It would be good to have a cross sector review of weight management work. Ross McGuffie noted this has been picked up at the strategic group already. The committee noted the following recommendations: Noted the contents of the report; Noted 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
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15 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. 16. Risk Brian Moore acknowledged the fraud risk discussed which will be considered in future. 17. Date of Next Meeting 19th April 2023 9.30am-12pm