Agenda Pack
North Lanarkshire Council · 19 April 2023
Back to IJB Performance, Finance and Audit Committee — 19 April 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 A meeting of the Performance Finance & Audit Committee will be held on Wednesday 19th April at 9.30am-12pm 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 IJB PFA-14.2.23 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 FINANCE & AUDIT 6. Financial Monitoring report For Noting Attachment A Kilburn 7. Progress Report For Endorsement Attachment A Kilburn PERFORMANCE 8. Resilience Update For Noting Attachment R McGuffie 9. Q3 Performance Report 2022/2023 For Noting Attachment M Dendy 10. Speech and Language Therapy Update For Noting Attachment M Thomson 11. OT Paediatrics Update For Noting Attachment M Thomson 12. Digital Alarms For Approval Attachment D Fraser
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2 13. Community Solutions Annual Report For Approval Attachment M Halliday 14. 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 15. Date of Next Meeting: 21st June 2023 10.30am-12pm
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1 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on 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
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 4. 9.12.20 Item 6 & Item 11 Addictions services M Dendy 1. An update on accommodation issues affecting the delivery of the addiction services was requested. 21.9.21 – verbal update given – work ongoing to resolve accommodation issues. 2. Update requested on funding commitments. ADP strategy presented and approved at IJB on 21.9.21. Request for detail on commissioning of services, evidence of benefits and achievements and timelines for implementation of funding commitments to be brought back to IJB. 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 August 2022 Complete Ongoing updates on progress scheduled into forward plan for PFA MAT standards update given to Feb IJB PFA
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2 6. 22.6.21 Item 6 Whistleblowing R McGuffie An agreement with NLC was to be developed to ensure a clear process for all H&SC NL staff. An annual report to be provided to the IJB March 2022 – draft guidance shared with NLC and awaiting comment December 2021 December 2022 Ongoing –update planned for May 23 IJB Complete 11. 22.6.22 Item 8 Financial Plan - Provision of smoke alarms R McGuffie Agreed that H&SC NL funding towards provision of smoke alarms to meet new standards would be included within future Digital Strategy report. March 2023 Update to be provide after year- end figures 14. 22.6.22 Item 9 Equalities Mainstreaming Report M Dendy Progress updates on delivery of equality outcomes to be presented via Performance, Finance & Audit Committee May 2023 18. 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 19. 16.11.22 Item 5 Risk Management Strategy R McGuffie 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 and also review current risk register Update planned for March 2023 IJB 20 16.11.22 Item 6 Analogue to digital R McGuffie Share progress report on the work On April 2023 agenda 21. 14.2.23 Item 11 Performance Report R McGuffie Bring more information on OT paediatrics and speech and language On April 2023 agenda 22. 14.2.23 Item 13 MH Strategy R McGuffie Consider dedicating liaison session for a more in-depth discussion Discuss wider thematic work with Brian Moore and Cllr Ayeshah Khan
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3 ACTION LOG – ITEMS DEFERRED DUE TO COVID NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS
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4 CLOSED ACTIONS 1. NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 7. 21.9.21 Item 7 Primary Care Implementation Plan Dr L Munro 2. An update on planned engagement events with local people on the primary care implementation plan was requested. Update provided and noted at March 2022 IJB 21.6.22 – verbal update on progress noted 3. Memorandum of Understanding to be shared December 2021 Complete – update report to 16th Nov PFA Remove Complete 9. 21.9.21 Item 16 Best Value Audit M Dendy An update on the Self Evaluation exercise is to be presented to the PF&A committee. February 2022 – deferred to August 2022 as engagement event took place after PF&A meeting Complete Complete 10. 8.12.21 Item 14 Integration review - Chief Financial Officer R McGuffie Following approval to proceed from the IJB, reports were to be presented to NLC and NHSL Board to seek support for preferred option. 16.2.22 Update on progress provided at PF&A meeting. HR process being progressed 21.6.22 – Update on recruitment of CFO provided 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. March 2022 June 2022 Complete
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5 12. 22.6.22 Item 5 Unaudited Accounts R McG/NL Content of report to be amended to include more details around reason for significant underspend June 2022 Report updated accordingly. Complete 13. 22.6.22 Item 8 & Item 9 Equalities Mainstreaming Report & Risk Register R McG/CJ IJB members suggested additions to the IJB risk Register on following highlighted risks; Cost of Living Pressures Urgent/Unscheduled care Community Alarms (Analogue to digital) National Care Service September 2022 Complete 1. 30/10/18 Item 11 Reserves Strategy A Kilburn To develop a reserves strategy on receipt of national guidance on setting minimum levels of reserves. In the interim period a local reserves strategy will be progressed. Update September 2021: The IJB Reserves Strategy 2021/2022 was approved by the IJB on 22 June 2021. This 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. Update on Exit strategies to be presented to PF& A in November 2021 8.12.22 Update provided within report Medium to Long Term Financial Planning. Further work being undertaken to confirm exit plans and ongoing areas of work. 23.3.22 – Update on Financial plan for 2022/23 presented that included update on reserves strategy June 2021 November 2021 – deferred to IJB December 2021 deferred to March 2023. Complete Reserve strategy presented to IJB PFA on 16th Nov. Final version to March IJB alongside updated SCP Added to March 23 agenda- complete
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6 but agreed at meeting to provide further more detailed update to include exit strategy for short term initiatives funded from reserves and conclusion of all other areas of reserve funding 2. 26.5.20 Item 10 Internal Audit Report – Due Diligence Review A Kilburn Further update on the disaggregation of the children, families and justice social work services budget to be presented to the IJB. Update September 2021: The progress in respect of this action is regularly reported to the IJB (Performance, Finance and Audit) Committee. The updated report to the IJB (Performance, Finance and Audit) Committee on 24 August 2021 advised that the budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Work is continuing to progress in respect of the hosting arrangements for cross-cutting and support services. The original timeline of March 2021 has therefore been extended to the revised timeline of September 2021. The Service Level Agreement for the future hosting arrangements and associated budgets will be presented to the IJB following consultation and endorsement by the NLC Adult Health and Social Care Committee and Education and Families Committee. A further report will therefore be presented to the next meeting of the IJB (Performance, Finance and Audit) Committee on 9 November 2021. September/December 2020 Deferred to March 2021 – deferred to September 2021 – deferred to November 2021 Update March 2022 - Further work required to conclude agreements around hosting arrangements. Original Action complete with further update on hosting arrangements presented to PF&A in November 2021. Complete – presented to IJB PFA on 16th Nov
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7 3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. 21.9.21 – Report presented setting out proposed use of a Change Fund. Progress reports on each element of the proposed plan to be presented to the PF&A February 2022 – update on progress noted with further updates to be presented March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action. Ongoing Complete 5. 9.12.20 Item 7 Category One Responders M Dendy An update on this issue was to be provided at the next meeting of the IJB following the completion of the consultation exercise and any further feedback from S Government. Update provided on 23.3.21 and a further update will be provided following completion of the engagement events with Chief Officers and IJB Chairs 21.9.21 – Update provided highlighting confirmation of named officers with lead responsibility. Further updates to be provided following anticipated national workshops. March 2021 September 2021 December 2021 Self assessment completed and feedback from West of Scotland Regional Resilience Partnership received. Update report to next IJB in March 23- Complete 8. 22.9.20 Item 5 Mental Health Continuing Care Contracted Beds R McGuffie Issue not progressed as planned during 2020 as engagement process postponed due to lockdown impact on visits to care homes. 21.9.21 Business Case to be developed and presented to IJB, South Lanarkshire IJB and NHSL Board. June 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS
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8 22.3.22 – Update provided on progress on engagement and development of business case September 2022 around engagement standards. Final business case to Dec IJB. Approved at NL IJB, SL IJB and NHS Board in December 2023. Complete. 15. 22.6.22 Item 12 Strategic Commissioning Plan M Dendy/T Marshall Detailed report on community nursing to be brought back to future meeting and included within SCP On March 23 IJb agenda –IJB approved plan 16. 22.6.22 Item 4 Community Alarms R McG Provide the committee with an update on community alarms switching from analogue to digital and risk to service users Complete Update provided at 16th Nov PFA 17. 22.6.22 Item 14 Audited Accounts R McG Bring audited accounts to Sept committee Complete
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1 REPORT Item No: 5 SUBJECT: Risk Management: IJB Risk Register TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie, Chief Officer NHSCP Author(s) of Report Stacey Anderson, Support Services / Project Manager DATE: 19th April 2023 1. PURPOSE OF REPORT This paper is coming to the IJB Performance, Finance and Audit Sub- Committee; For approval For endorsement To note The purpose of this report is to provide a summary to the Integration Joint Board on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE PERFROMANCE,FINANCE AND AUDIT COMMITTEE This paper has been: Prepared Reviewed Endorsed By: The Operational & Business Manager and Chief Officer for H& SC NL. 3. RECOMMENDATIONS 3.1 The IJB PFA is asked to note the contents of the report which includes the latest version of the IJB PFA 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. Yes No N/A
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2 BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.2 The PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board and the PFA committee considered the finance and performance risks at its last minute on 14th February 2023. The register was also reviewed at the IJB on 22nd March 2023. 5.3 A full review of the risk management reporting within the IJB is currently in progress as part of the risk strategy review and in line with the dynamic developments and changes the new NHS Lanarkshire Risk Manager is implementing within the board. These developments will include review of how risk reporting is managed and presented at IJB and a further evaluation of the improvement methodology aligned with the risk actions. In order to provide a robust overview of these developments, a risk management session has been scheduled for the next IJB Liaison Session and a full report of changes/ developments will be provided to the IJB PFA and IJB at the next meeting. 5.4 Following discussions at the last meeting of PFA on 14th February 2023, there has been a number of changes in the risk register: 3 risks closed: o IJB 03/21 – EU withdrawal o IJB 08/21 – Financial Implications of Covid o IJB 09/21 – Impact of pandemic on implementation of the strategic plan 1 risk increased: o IJB 06/21 – Prescribing – increased due to the projected increased costs facing the partnership in 2023/24 2 new risks identified: o IJB 19/23 – Service sustainability – a broader risk on sustainability challenges, replacing previous risks on EU withdrawal and Covid o IJB 20/23 – Workforce sustainability – a broader risk on sustainability challenges, replacing previous risks on EU withdrawal and Covid 5.5 There are currently two risks rated as Very High on the IJB risk register. IJB 06/21 – Prescribing Activity and Costs IJB 17/22 – Unscheduled Care 5.6 There are eight high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 12/21 - Staff Health & wellbeing IJB 14/22 – CAMHS IJB 15/22 – Cost of Living IJB 16/22 – National Care Service IJB 19/23 – Service sustainability IJB 20/23 – Workforce sustainability
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3 5.7 There are a number of high/very high rated operational risks that have been identified as having or potentially having an impact on IJB objectives and/or delivery of services and these are highlighted below. No Risk Risk Rating Lead Organisation/Area 1882 Acute Sector Bed Capacity - availability of acute beds due to delays experienced for onwards movement of patients 'fit for transfer' to care homes, those requiring care at home, exacerbated by rising cases of Covid and high demand Very High NHSL Corporate 2085 Capacity within NHSL to respond to ongoing challenges due to Covid 19 and associated variants Very High NHSL Corporate 1379 Delayed Discharge Performance and Impact High NHSL Corporate 1984 Impact From Stepping Down Non- Urgent Services High NHSL Corporate 1832 Compliance with the Health & Care (Staffing) (Scotland) Bill: Clinical Workforce due to issues of availability, recruitment and retention. 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 complexities of opportunity lost due to the current reprioritising of services in response to COVID-19. High NHSL Corporate 659 Failure to deal effectively with major emergency Very High NHSL Corporate 2039 Staff Fatigue, Resilience, Wellbeing & Safety – Effects of prolonged Covid response is adversely impacting on staff, increasing staff absence and consequently reducing workforce capacity. Very High NHSL Corporate 1992 Continuous Covid Response & impact on routine PH Screening & surveillance programmes High NHSL Corporate 1587 Sustainability of the two-site model for the Out-of-Hours Service Very High NHSL Corporate 2004 Potential Impact on patients resulting from disruption of day to day clinical care in response to Covid pandemic Very High NHSL Corporate 1989 Ability to maintain a workforce Very NHSL Corporate
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4 commensurate with the need to suppress Covid, deliver Vaccination Programme, Recover & Remobilise High 2014 Recovery of Performance 2021/22 Very High NHSL Corporate 2086 Sustaining GP Services 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 changing performance demands will result in a failure to provide performance information internal, external and including S Govt, High NLC – Social Work/Social care 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
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5 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 17 risks identified on its IJB risk register with 10 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 Stakeholders are represented at the IJB and the IJB PFA Committee and can contribute to approval and amendments to the IJB risk register. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPER None
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6 9. APPENDICES IJB Risk Register Appendix 1 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Stacey Anderson on telephone number 07976801913.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) 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. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. . The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website. ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Annual planned Procurement and Standing Financial Instructions presentations. 3. Annual review of Code of Conduct 4. Review of how Members' Decleration of Interests are collated and reviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.03.24 Previously IJB6. Reviewed and updated on 15 May 21. Reviewed and updated on March 2023. Previously IJB2, IJB7, IJB10 and IJB12. HIGH M EDIUM M arie M oy M arie M oy SLT, IJB PFA, IJB 31.05.23 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. 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 2022/2023 has been agreed and is being reviewed regularly. 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 31 March 2023 to support external social care providers. 16. The Scottish Government announced on 5 October 2021 an additional £300m for winter health and social care pressures. 18. Work is ongoing with both partner organisations to confirm the final 2023/24 budget. Once complete, a new risk will be created to reflect the final 2023/24 financial plan. ACTIONS 1. Annual budget setting processes within each of the partners. 2. The development of the IJB Reserves Strategy 2023/2024 is being presented to March 23 IJB. 3. The review and update of the IJB Medium Term Financial Plan is being presented to March 23 IJB. HIGH Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 1 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) 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 2022/23 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 31.05.23 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. M EDIUM M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.23 08.03.23 CLOSED 08.03.23M 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 Stacey Anderson on behalf of the Chief Officer Page 2 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) 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 IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal 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 and 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. 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. 6. Regular HSCP monitoring. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 7. 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. 8. 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. 9. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in 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. VERY HIGH LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.03.23 Previously IJB11. 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 is being discussed to meet the additional costs of responding to and recovering from the Covid‐19 pandemic however the total amount for 2021/2022 has not yet been confirmed by the Scottish Government. There is therefore a risk that the HSCP may not be fully reimbursed in respect of the additional costs of responding to and recovering from the Covid‐19 pandemic in 2021/2022. The IJB projected outurn 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. The 2021/2022 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 operat+D12ional, 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. VERY HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.21 08.03.23 CLOSED 08.03.23 ‐ included in Risk IJB01.21 and will be further updated as part of new risk for financial outturn in 2023/24 Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 3 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) 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 Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 31.12.21 08.03.23 CLOSED 08.02.23 ‐ new risk to be formed around implementation of new 2023‐26 SCP 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 was placed on the Social Care Sustainability Payments by External Social Care Providers up to 31 October 2021. 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. 5. Additional funding for 2021/2022 and 2022/2023 has been announced by the Scottish Government. Further Covid‐19 funding is expected to be confirmed in February 2022 following the submission of the quarter 3 Lanarkshire Mobilisation Plan 2021/2022. 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. VERY HIGH M EDIUM Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 4 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) 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.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 abscence 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 recieved by Scottish Government specificaly 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. Audits of adherence to sickness absence policy being undertaken HIGH low Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 31.05.23 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 31 October 2021. 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. medium medium Ross M cGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 31.12.21 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 31.05.23 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 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 SLT, IJB 31.05.23 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 31.05.23 Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 5 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) 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.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 SLT, IJB PFA, IJB 28.02.23 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 5. Operation Flow Firebreak 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 6. Operation Flow whole system improvement plans being developed, with further learning sessions in April 23 M edium Low Diane Fraser Ross M cGuffie SLT, IJB PFA, IJB, ASW C&W B 30.06.23 IJB.19. 2023 Performance 27/02/2023 Service Sustanability Due to competing service priorties and workforce/ operational and finacial challenges there is a risk that the IJB will be unable to implement the strategic plan/commision plan . Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety High 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 is regulary reviewed and agreed. 7. Capacity plans in place to maximise efficiency. 8. Consultation and involvement with key stakeholders including service users and carers. 9. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 10. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 11. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Actions 1. Sustainability plans to be reviewed regulalry 2. Re‐introduction of scruity panels 3. Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. 4. Review of reporting process into IJB to ensure contionus review of services/ service developments. High Low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 31.05.23 Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 6 of 7
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 22nd March 2023) 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.20. 2023 Workforce Sustanability It is becoming increasingly difficult to recruit to particular roles across Health and Social Care. Gaps in the workforce can result in reduction of service provsion, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawl 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. 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. High CONTROLS 1. 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. 2. 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. 3. Development of the Care Academy 4. Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support ACTIONS 1. Annual workforce plan being prepared 2. NHSL programme underway to support international recruitment 3. On the day recruitment events being trialled in Home Support 4. Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 31.05.23 Report Prepared by Stacey Anderson on behalf of the Chief Officer Page 7 of 7
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1 REPORT Item No: 6 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 3 February 2023. 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; and (2) Note the financial position is a year-to-date underspend of £15.332m. 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 £15.332m and the projected outturn for 2022/23 is an underspend of £17.264m, 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 7.846 8.416 Social Care Services 7.486 8.848 SUBJECT: Financial Monitoring Report 2022/2023 TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NHSCP Author(s) of Report Amanda Kilburn, Chief Financial Officer DATE: 19th April 2023 Yes No N/A
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2 Total North Lanarkshire HSCP 15.332 17.264 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 £12.323m: 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 £0.541m: within Home Support Services, employee costs have increased as the service continues to support delayed discharges and demand however, this additional cost is being funded from the current number of vacant posts throughout other parts of the partnership. Payments to Other Bodies net underspend of £2.840m: 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 £0.788m: there are currently 1,461 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 £1.884m: 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 net overspend of £0.500m: activity and cost per item within prescribing is 2.69% higher compared to the same period last year. Due to the uncertainty around costs and prescribing activity and the three-month time lag in receiving the data, 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. The table
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3 below shows the current year to date allocations received from Scottish Government: Scottish Government Allocations 2022/23 £m Outcomes Framework – Effective Prevention (Bloodborne Virus) 0.569 Outcomes Framework – Effective Prevention (Hep C) 1.111 Outcomes Framework – Rotavirus, Seasonal Flu and Childhood Flu 0.731 Outcomes Framework - Shingles 0.362 Mental Health Outcomes Framework 1.046 Mental Health Innovation Fund 0.487 Capacity Building for Psychological Therapies & CAMHS 0.845 Distress Brief Intervention 0.869 Hospital at Home 0.250 Multi-Disciplinary Teams 2.676 Family Nurse Practitioner Funding 1.215 District Nursing 0.608 Long Covid Support Funding 0.320 Learning Disability Health Checks 0.123 Alcohol and Drug Partnership – Tranche 1 2.179 Delivery of Veteran Specific Mental Health Support 0.126 Child Death Review 0.024 ICU Baseline Bed Capacity Uplift 0.044 TOTAL 13.585 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 £69.237m and is summarised in the table below. A detailed analysis of these reserves is at Appendix 5: 7.3 The IJB Reserves Strategy 2022/2023 has been updated to 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. Opening Balance After Review Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 49.903 (24.116) (14.353) 11.434 NHSL & NLC Earmarked Reserves 31.661 17.186 (6.494) 42.353 NHSL & NLC Risk-Based Reserves 13.478 (2.130) (0.796) 10.552 NHSL Contingency Reserves 4.167 1.032 (0.301) 4.898 NHSL & NLC Closed Reserves 20.244 (15.916) (4.327) - 119.453 (23.944) (26.271) 69.237 LEAD SUMMARY Total
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4 8. CURRENT VACANCY POSITION 8.1 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. 8.2 The table below shows the current full time equivalent (FTE) vacancy numbers within each service against the budgeted establishment: 8.3 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. 9. DELEGATED SERVICES 9.1 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. 9.2 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 Establishment Actual FTE FTE FTE % North West Locality 384.98 344.99 39.99 10.4% North East Locality 323.53 296.98 26.55 8.2% Adult Services 273.94 247.79 26.15 9.5% Children Services 566.39 477.44 88.95 15.7% Mental Health 1,142.60 1,094.16 48.44 4.2% Social Care Services 834.20 660.40 173.80 20.8% Home Support 1,000.07 991.89 8.18 0.8% Other 179.99 255.45 -75.46 -41.9% TOTAL 4,705.70 4,369.10 336.60 7.2% Service Vacancies Overtime Excess Part Time Bankaide Agency £m £m £m £m North West Locality 0.118 0.033 0.437 0.051 North East Locality 0.072 0.041 0.199 - Adult Services 0.048 0.066 0.153 0.073 Children Services 0.148 0.085 0.304 0.017 Mental Health & Learning Disabilities 0.403 0.072 1.840 2.576 Social Care Services 0.879 - - 0.099 Home Support 3.529 - - - Other 0.025 0.015 0.019 - TOTAL 5.223 0.312 2.952 2.816 SERVICE Year to Date Cost
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5 Housing 1.870 1.870 - Breakeven Transport 0.551 0.551 - Breakeven Total 2.421 2.421 - Breakeven 10. IMPLICATIONS 10.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 10.2 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. 10.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 10.4 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. 10.5 PEOPLE None 10.6 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. 10.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 10.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 11. BACKGROUND PAPERS None. 12. 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
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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 January 2023 January 2023 January 2023 £m £m £m £m Health Care Services Locality and Other Services 52.336 41.134 38.644 2.489 Addiction Services 6.112 3.424 2.767 0.657 Medical and Nursing Directorate 5.419 4.492 3.822 0.670 Prescribing 69.582 57.985 58.485 (0.500) Out of Area Services 4.571 3.809 4.634 (0.825) Area Wide Services 11.221 8.568 8.316 0.253 Hosted Services 161.848 131.745 126.642 5.103 Family Health Services 114.043 95.812 95.812 0.000 Set-Aside Budget 66.858 55.715 55.715 0.000 Covid-19 4.578 4.578 4.578 0.000 Total Expenditure - NHSL 496.568 407.262 399.415 7.846 Social Care Services Social Care Services Gross Expenditure 241.758 187.698 180.617 7.081 Social Care Services Gross Income (Including Covid-19 Income) (2.896) (0.619) (1.025) 0.406 Social Care Services Net Expenditure 238.862 187.078 179.592 7.486 Housing Revenue Account Expenditure 1.870 1.667 1.667 0.000 Transport Services Expenditure 0.551 0.169 0.169 0.000 Social Care, Housing and Transport Services Net Expenditure 241.283 188.915 181.428 7.486 Total Expenditure - NHSL and NLC 737.851 596.176 580.844 15.333 Funded By: Annual Budget 2022/2023 £m NHS Lanarkshire Funding (475.156) Social Care Funding (22.964) Resource Transfer (23.421) Commissioned Services (6.718) Scottish Government Funding - Covid-19 and Remobilisation (4.578) Transfer from Reserves (Approved) (16.834) Total Funding - NHSL (549.671) 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 (737.851) 2022/2023 Year To Date
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8 Hosted Services Appendix 2 January 2023 January 2023 January 2023 January 2023 January 2023 January 2023 January 2023 January 2023 January 2023 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 3.043 2.548 2.420 0.128 1.552 1.300 1.172 0.128 1.491 1.249 1.249 0.000 Continence Services 2.364 1.971 1.973 (0.002) 1.206 1.005 1.007 (0.002) 1.159 0.966 0.966 0.000 Immunisation Services 1.902 1.586 2.015 (0.429) 0.970 0.809 1.237 (0.429) 0.932 0.777 0.777 0.000 Speech and Language Therapy Services 6.148 5.132 4.449 0.682 3.136 2.617 1.935 0.682 3.013 2.514 2.514 0.000 Children and Adolescents Mental Health Services 12.513 9.632 8.494 1.138 6.381 4.912 3.775 1.138 6.131 4.720 4.720 0.000 Childrens Services 12.067 10.063 9.744 0.319 6.154 5.132 4.813 0.319 5.913 4.931 4.931 0.000 Integrated Equipment and Adaptations Store 0.567 0.473 0.575 (0.102) 0.289 0.241 0.343 (0.102) 0.278 0.232 0.232 0.000 Dietetics Services 3.873 3.234 2.958 0.276 1.975 1.649 1.374 0.276 1.898 1.584 1.584 0.000 Podiatry Services 4.380 3.652 3.516 0.136 2.234 1.862 1.727 0.136 2.146 1.789 1.789 0.000 Prisoner Healthcare Services 1.714 1.429 1.379 0.050 0.874 0.729 0.679 0.050 0.840 0.700 0.700 0.000 Blood Borne Viruses Services 1.529 1.274 1.228 0.046 0.780 0.650 0.604 0.046 0.749 0.624 0.624 0.000 Hospital at Home 2.511 1.989 1.689 0.300 1.281 1.014 0.715 0.300 1.231 0.975 0.975 0.000 Mental Health and Learning Disability Services 76.747 63.320 60.759 2.562 39.141 32.293 29.732 2.562 37.606 31.027 31.027 0.000 TOTAL 129.359 106.303 101.200 5.103 65.973 54.214 49.111 5.103 63.386 52.088 52.088 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 January 2023 January 2023 January 2023 January 2023 January 2023 January 2023 January 2023 January 2023 January 2023 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 7.517 6.228 5.588 0.640 3.834 3.176 3.176 0.000 3.683 3.052 2.412 0.640 Brain Injury Unit 2.367 1.733 1.475 0.258 1.207 0.884 0.884 0.000 1.160 0.849 0.591 0.258 Out of Hours Services 8.941 7.399 7.392 0.007 4.560 3.773 3.773 0.000 4.381 3.626 3.618 0.007 Palliative Care Services 7.249 6.060 5.887 0.173 3.697 3.091 3.091 0.000 3.552 2.969 2.797 0.173 Physiotherapy Services 10.266 8.572 8.183 0.390 5.236 4.372 4.372 0.000 5.030 4.201 3.811 0.390 Primary Care Services 0.811 0.673 0.625 0.048 0.413 0.343 0.343 0.000 0.397 0.330 0.282 0.048 Occupational Therapy Services 8.046 6.732 6.178 0.554 4.103 3.433 3.433 0.000 3.943 3.299 2.744 0.554 Diabetic Services 4.964 4.336 4.259 0.078 2.531 2.211 2.211 0.000 2.432 2.125 2.047 0.078 Telehealth 0.671 0.507 0.246 0.261 0.342 0.259 0.259 0.000 0.329 0.248 (0.012) 0.261 Sub Total 50.832 42.242 39.832 2.410 25.924 21.543 21.543 0.000 24.908 20.698 18.289 2.410 Ring Fenced Funding Primary Care Improvement Fund 12.874 7.646 7.646 (0.000) 6.566 3.899 3.899 0.000 6.308 3.746 3.746 (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 7.646 7.646 (0.000) 6.566 3.899 3.899 0.000 6.308 3.746 3.746 (0.000) TOTAL 63.705 49.887 47.478 2.410 32.490 25.443 25.443 0.000 31.216 24.445 22.035 2.410 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 Budget Reconciliation 2022/2023 Appendix 4 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 Adjustment to Reserves -2.321 Junior Medical & Trainee Income 0.073 Learning Disabilities Health Checks 0.123 Increase to Hosted Services Led by South 4.085 Other Budget Adjustments 0.015 NHSL Financial Allocation at 31 December 2022 543.421 Draw Down from Reserves 2.169 Increase to Area Wide Services 0.122 Mental Health Funding 2.571 AFC Pay Award 0.660 Increase to Hosted Services Led by South 0.651 Other Budget Adjustments 0.077 NHSL Financial Allocation at 31 January 2023 549.671 Budget Adjustments Posted in Month 10 Budget Adjustments Posted in Month 9 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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10 North Lanarkshire IJB APPENDIX 5 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 49.903 (24.116) (14.353) 11.434 NHSL & NLC Earmarked Reserves 31.661 17.186 (6.494) 42.353 NHSL & NLC Risk-Based Reserves 13.478 (2.130) (0.796) 10.552 NHSL Contingency Reserves 4.167 1.032 (0.301) 4.898 NHSL & NLC Closed Reserves 20.244 (15.916) (4.327) (0.000) 119.453 (23.944) (26.271) 69.237 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 Long Covid Contingency 3.000 0.000 (0.727) 2.273 NHSL Prescribing Fund 4.361 0.000 0.000 4.361 NLC Social Care Demand 6.117 (2.130) (0.069) 3.918 13.478 (2.130) (0.796) 10.552 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 1.032 (0.301) 4.898 4.167 1.032 (0.301) 4.898 20.244 (15.916) (4.327) (0.000) LEAD CONTINGENCY FUND RESERVES TOTAL RISK-BASED RESERVES LEAD RISK-BASED RESERVES TOTAL CONTINGENCY FUND RESERVES TOTAL CLOSED RESERVES 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 0.000 (2.800) 0.354 NHSL Alcohol and Drug Partnership - Local Implementation Plan 0.167 0.000 0.000 0.167 NHSL Alcohol and Drug Partnership - Long Acting Buprenorphine 0.255 0.000 0.000 0.255 NHSL Blood-Borne Viruses Services 0.146 0.000 0.000 0.146 NHSL Children and Adolescent Mental Health Services 5.333 0.000 (3.082) 2.251 NHSL Community Living Change Fund 1.298 0.000 0.000 1.298 NHSL Covid-19 Funding 29.742 (24.116) (2.957) 2.669 NHSL Covid-19 Funding - Unscheduled Care 1.944 0.000 (1.620) 0.324 NHSL Mental Health and Learning Disability Services - Action 15 3.019 0.000 (3.016) 0.003 NHSL Mental Health and Learning Disability Services - Veteran's First Point 0.026 0.000 0.000 0.026 NHSL Mental Health - Diagnostic Support Service Dementia Post 0.429 0.000 0.000 0.429 NHSL Mental Health Improvement Fund - Psychology 0.553 0.000 (0.448) 0.105 NHSL Mental Health Psychology Services Capacity Building 0.117 0.000 0.000 0.117 NHSL Mental Health Psychology Services - Recovery and Renewal Phase 1 & 2 0.614 0.000 (0.430) 0.184 NHSL Mental Health Recovery Renewal - Facilities Projects 1.840 0.000 0.000 1.840 NHSL Mental Health Wellbeing in Primary Care Services 0.148 0.000 0.000 0.148 NHSL Shielding - Social Care Support Fund 0.038 0.000 0.000 0.038 NHSL Staff Wellbeing 0.254 0.000 0.000 0.254 NHSL Test and Protect Funding 0.520 0.000 0.000 0.520 NHSL Third Sector Initiatives To Improve Health 0.306 0.000 0.000 0.306 49.903 (24.116) (14.353) 11.434TOTAL RING-FENCED RESERVES LEAD RING-FENCED RESERVES
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11 Appendix 5 (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 0.000 (0.001) 1.940 NLC Adaptations Fund 0.289 0.000 (0.200) 0.089 NLC Adult Protection (share with C&F and NHSL) 0.050 0.000 (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 0.000 0.000 0.123 NHSL Area Wide Services - NES Training 0.132 0.000 0.000 0.132 NHSL Area Wide Services - Pre School Vision Screening 0.075 0.000 0.000 0.075 NHSL Area Wide Services - Primary Care Corporate (iHUB Project - NES funding) 0.034 0.000 0.000 0.034 NHSL Area Wide Services - Refugees and Displaced Persons 0.400 0.000 (0.132) 0.268 NLC Assistive Technology Contract x 12 months (ATC) 0.000 0.090 (0.062) 0.028 NHSL Breast Feeding Team (2 year funding) 0.000 0.828 0.000 0.828 NHSL Business Case - Health Care Support Workers, Multi-Disciplinary Teams 1.794 0.000 (1.213) 0.581 NLC Business Case - Non-Recurring NLC Costs 5.380 0.537 (1.941) 3.976 NHSL Care Homes Allocation 0.318 0.000 0.000 0.318 NLC Carers Act 2018 - Support 0.852 0.000 0.000 0.852 NHSL Champions Board Funding 0.172 0.000 0.000 0.172 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.346 0.000 0.000 0.346 NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.645 0.000 (0.231) 0.414 NHSL Development of Chryston Community Health Clinic 0.000 0.212 0.000 0.212 NHSL Dietetics Services - Double Running Costs 0.110 0.000 0.000 0.110 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.694 0.000 (0.064) 0.630 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 1.000 2.776 0.000 3.776 NLC Digital and IT Strategy Technology Improvements - Other 0.566 0.000 0.000 0.566 NLC Digital and IT Strategy Technology Improvements - SWIS 0.700 0.000 (0.173) 0.527 NHSL Discharge Support Workers Band 4 x 2 WTE 0.107 0.000 0.000 0.107 NHSL Distinction Awards 0.036 0.000 0.000 0.036 NLC Financial Strategy - Changes to LA Services Muirpark 2.973 0.000 (1.242) 1.731 NHSL Forensic Band 3 x 5 WTE 0.147 0.000 0.000 0.147 NHSL GPIT Reprovisioning Gap 0.181 0.000 0.000 0.181 NHSL Health Inequalities - Screening 0.098 0.000 (0.024) 0.074 NHSL Health Visiting Students/Trainees 0.840 0.000 (0.356) 0.484 NLC Home Support Resilience (2 year funding) 0.000 3.498 0.000 3.498 NHSL Hospital at Home Services - Support Development 0.414 0.000 (0.043) 0.371 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.000 0.187 0.000 0.187 NLC IJB Helpline (2 years funding) 0.000 0.600 0.000 0.600 NHSL Integrated Authority Support 6.076 (1.150) 0.000 4.926 NHSL Kylepark Works 1.000 0.608 0.000 1.608 NHSL Learning Disabilities Band 3 x 4 FTE 0.118 0.000 0.000 0.118 NLC Local Government Pay Award 23/24 0.000 2.653 0.000 2.653 NHSL Long Covid Pathways 0.000 0.444 0.000 0.444 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.107 0.000 (0.074) 0.033 NHSL Minor Capital Works 1.387 0.000 (0.209) 1.178 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.000 0.550 0.000 0.550 NHSL Organisational Development Fund 0.000 0.260 0.000 0.260 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.908 0.000 (0.027) 0.881 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 0.000 (0.033) 0.426 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.070 0.000 0.000 0.070 NHSL Psychology Posts 2 x Band 6 0.000 0.098 0.000 0.098 NHSL Regrading of Posts Including Backpay 0.125 0.125 0.000 0.250 NHSL Scottish Clinical Leadership Fellowship 0.045 0.000 (0.011) 0.034 NHSL Sexual Health Services - Forensic Medical 0.222 0.000 (0.047) 0.175 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.109 0.386 (0.004) 0.491 NLC Social Care Contracting Staff within Quality Assurance Services 0.047 0.028 (0.052) 0.023 NLC/NHSL Staff Training Academy 0.000 2.400 0.000 2.400 NHSL Stigma Free Lanarkshire (3 year funding) 0.000 0.450 0.000 0.450 NHSL Supervisor Training 0.077 0.000 (0.012) 0.065 NLC Unmet Saving 21/22 - IDS/LSS (merging building Coatbridge & Cumbernauld) 0.086 0.000 (0.068) 0.018 NLC Violence Against Women (Joint Initiative with SLC and C&F) 0.030 0.000 0.000 0.030 NHSL Vulnerable and Complex Cases - Test of Change 0.000 1.208 (0.088) 1.120 31.661 17.186 (6.494) 42.353 LEAD EARMARKED RESERVES TOTAL EARMARKED RESERVES 119.453 (23.944) (26.271) 69.237TOTAL RESERVES
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12 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 9 51,000 -58,000 9,000 7,000 185,000 -14,000 180,000 TOTAL 437,000 199,000 153,000 304,000 1,840,000 19,000 2,952,000 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 59,821 234,119 301,553 8 10,554 4,796 97,273 182,799 7,204 302,626 9 11,584 12,168 754 63,042 232,980 13,336 333,864 10 11,285 16,710 4,141 57,024 221,263 20,796 331,219 11 57,701 57,701 TOTAL 51,374 73,463 16,843 502,894 2,072,649 99,037 2,816,260 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 8,914 12,937 5,770 28,958 34,450 118,428 420,088 2,046 631,591 10 86,099 254,737 340,836 11 79,279 377,024 456,303 TOTAL 118,296 72,150 47,885 148,414 402,941 879,130 3,529,417 24,691 5,222,924 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 9 3,517 6,460 8,221 14,474 5,392 1,790 39,854 TOTAL 33,010 40,643 65,844 85,243 72,406 14,777 311,923 BANKAIDE COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE AGENCY COSTS YEAR TO DATE EXCESS PART TIME COSTS YEAR TO DATE Period Period Period Period
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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 an outline of the actions agreed with the External Auditor, Internal Audit, and the Senior Management Team to further develop the IJB governance framework. 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 content of the report is noted; and (2) That further progress reports will be presented to future meetings of the PFA Committee in respect of any ongoing actions. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Recommendations to further strengthen the IJB governance framework were made by both External and Internal Audit. The Senior Management Team (SMT) have also identified improvement opportunities which will further contribute to the IJB’s annual assessment of their governance arrangements. 5.2 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. Further details are attached at appendices 1 to 3. 5.3 Any actions which are reported as complete will be removed from the next progress report to the PFA Committee. SUBJECT: Progress Report on Agreed Actions TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NHSCP Author(s) of Report Amanda Kilburn, Chief Financial Officer DATE: 19th April 2023 Yes No N/A
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2 6. CONCLUSIONS 6.1 An update on the progress made to date was reported to the PFA Committee on 16 November 2022. A summary of the current position statement is shown in the table below: Source Total Actions Completed Actions Ongoing Actions External Audit 5 4 1 Internal Audit 5 4 1 Senior Management 6 5 1 Total 16 13 3 81% 19% 6.1 The ongoing actions are measured against the revised timeline set out at appendices 1 to 3. 7. PROGRESS ON NORTH LANARKSHIRE IJB SELF-EVALUATION 7.1 The results of the self-evaluation exercise were presented to the PFA Committee on 31 August 2022 with the main improvement actions being identified as follows: Evidence how Health and Social Care spending contributes to prevention and early intervention; Embed learning and new ways of working in the IJB from the response to the pandemic to ensure plans and governance are fit for purpose; and Review how performance information is used by the IJB to ensure it is timely, relevant and provides a good measure of progress towards agreed outcomes. 7.2 Continuous self-evaluation and embedded learning will become the essence of ensuring the main improvement actions identified above become part of normal business. To date the progress and work undertaken have included the following: In March 2023 the Medium-Term Financial Plan 2023-2026, the Reserves Strategy 2022-2023 and the Strategic Commissioning Plan 2023-2026 will be presented to the IJB for approval. These three strands of work align to strengthen the IJB’s outcomes against available resources by embedding good practise and lessons learned and by ensuring future funding and reserves link to outcomes around prevention and early intervention. During 2022, discussions at staff roadshows considered and reviewed the areas of work which were effective during the pandemic and those which presented more of a challenge. These discussions were informed by key inputs from members of the Strategic Leadership Team. Lessons learned have been shared with a wider audience as part of engagement events and have been further expanded and built upon during discussions with stakeholders across our communities and localities. These insights are reflected in the new Strategic Commissioning Plan 2023-2026 and its associated Programme of Work.
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3 In August 2022, the PFA Committee endorsed the development of a revised whole system performance framework for the partnership. The Strategic Commissioning Plan 2023-2026 has endorsed this framework by focussing on the participation and engagement of key partners and drawing together and building upon the richness of their contributions. A whole system working group has been established to support the performance framework allowing committee members to exercise effective oversight, scrutiny, and challenge. 7.3 The self-evaluation exercise has recognised the extent to which the assessment team considered the current arrangements for the North Lanarkshire IJB to be effective and has identified how well the Board is meeting its intended outcomes. To ensure continuous improvement will be ongoing, the next steps include: To continue to update and refresh the Medium-Term Financial Plan, the Reserves Strategy, and the Strategic Commissioning Plan to reflect the changing financial environment and outcomes and priorities of the Board; Ongoing monitoring of progress by the IJB in terms of delivery of the actions in the Improvement Plan and realisation of the intended outcomes set out therein; Consideration of the need for a further follow up self-evaluation exercise (where appropriate within the context of developments around the future of the National Care Service for Scotland) to provide ongoing assurance on the extent to which the IJB is meeting its statutory best values duty; and Preparing for future Best Value audits led by Audit Scotland following confirmation that the audits of IJBs will recommence in 2023/24. 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES This report relates to all national outcomes as effective governance arrangements will ensure the IJB can fulfil its statutory duties. Good governance enables the IJB to pursue its vision effectively as well as underpinning that vision with mechanisms for control and management of risk. 8.2 ASSOCIATED MEASURE(S) The implementation of agreed actions will contribute to the ongoing development of the internal control framework and will also inform the Annual Governance Statement for 2022/2023. 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT When reviewing the current position and achievable timescales, the risks associated with this have been considered. 8.5 PEOPLE None 8.6 INEQUALITIES & FAIRER SCOTLAND DUTY
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4 Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 9. BACKGROUND PAPERS None. 10. APPENDICES External Audit Actions Appendix 1 Internal Audit Actions Appendix 2 Senior Management Actions Appendix 3 ........................................... 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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5 Update on External Audit Actions Appendix 1 Ref Finding Recommendation Management Response Current Position 1 Accounts inspection advert The notice of inspection should state the objection end date and the advert should be posted on the IJB website in addition to the North Lanarkshire Council website. Original The IJB should ensure it has procedures in place to ensure the accounts inspection advert is published in line with criteria set out in the Local Authority Accounts (Scotland) Regulations 2014. Agreed The IJB will ensure future adverts are posted on the IJB website in addition to the North Lanarkshire Council website. IJB Chief Financial Officer Original Timeline: June 2023 2 2022/23 Reserves Strategy There are significant reserves held at 31 March 2022. A reserves strategy for 2022/23 which sets out how and when monies will be spent, has not yet been developed. Original The IJB should develop a reserves strategy for 2022/23 which sets out how and when monies will be spent. The IJB 2022/23 Reserves Strategy will be presented to the PFA Committee on 16th November and to the IJB on 30th November 2022. The reserves strategy will continue to be updated in line with the new Strategic Commissioning Plan 2023- 2026 and the new Medium Term Financial Plan 2023-2026. IJB Chief Financial Officer Original Timeline: November 2022 COMPLETE – 2022/23 Reserves Strategy was approved at the IJB on 22 March 2023. 3 Review of Financial Regulations The financial regulations were approved on 8 March 2016. They require to be updated to reflect the budget disaggregation of Children, Families and Justice Services and to also note the arrangements for the management of financial resources for hosted services. Original The financial regulations should be reviewed to ensure they remain up- to-date and fit for purpose. Agreed The services currently delegated by each partner to the IJB will be specified in the IJB Financial Regulations. The principal method of accounting for Hosted Services will also be included. IJB Chief Financial Officer Original Timeline: 31 March 2023 COMPLETE – Revised regulations went to PF&A Committee on 15 Feb 2023. b/f 4 Website Refresh Recommendation It should be clear who has ownership of the IJB website and responsibility for maintaining it. The website should be refreshed to reflect the IJB’s current operating model. Ongoing HSCP working group is currently completing the development of the website. IJB Chief Officer Revised Timeline: 31 March 2023 Complete – Website launched end of February 2023 with paper celebrating the launch endorsed by the IJB Committee on 22 March 2023.
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6 Update on External Audit Actions (Cont.) Appendix 1 (Cont.) Ref Finding Recommendation Management Response Current Position b/f 7 Medium to long term financial plan Recommendation The IJB’s medium to long term financial plan should be reviewed due to the impact of Covid-19 and EU withdrawal. Ongoing The new Medium Term Financial Plan 2023-2026 reflects the impact of recovering from Covid-19 and other challenging factors facing the IJB. It has been condensed to a three-year plan due to the pending formation of the National Care Service (NCS) and the continuing uncertainty around future funding. The MTFP will align to the Strategic Commissioning Plan 2023-2026 and the current IJB Reserves Strategy. IJB Chief Financial Officer Revised Timeline: 31 March 2023 COMPLETE – Medium Term Financial Plan 2023 – 2026 was approved at the IJB on 22 March 2023.
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7 Update on Internal Audit Actions Appendix 2 Ref Risk Management Maturity Audit Report Adequate Assurance (Audit Ref: NL04/18) Recommendations / Management Response Current Position 1 The PFA Committee does not receive an annual assurance report on risk management and there are no defined KPIs or performance measures for risk management. There is a risk that the PFA Committee may not be able to conclude on the overall adequacy and effectiveness of Risk Management arrangements. (Priority: Amber) Agreed An appropriate methodology for assessing the adequacy and effectiveness of risk management arrangements will be developed. This will include suitable KPIs and performance measures. Performance Manager Original Timeline: March 2020 Revised Timeline: March 2022 Revised Timeline: March 2023 Complete As previously advised, the annual review of the current suite of indicators and targets has been completed. An appropriate methodology for assessing the adequacy and effectiveness of risk management arrangements will be developed. This will include consideration of suitable key performance indicators and performance measures as part of the current review of the HSCP’s performance framework. Annual performance report submitted to the PFA Committee on 14 Feb 23 along with a performance update report which included key performance indicators and measures. 2 Improvements are needed to the way in which performance information is reported to better enable Committee members to exercise effective oversight, scrutiny, and challenge. It is considered there is scope for significant improvement in what and how this information is presented. There is a risk that the IJB may not provide adequate performance information to key stakeholders to enable them to make informed decisions and recommend remedial actions to address concerns arising. The IJB Performance, Finance and Audit Committee may not therefore be in a position to fulfil its remit which includes the requirement to ‘Review quarterly performance and recommend remedial action to address concerns’ and to ‘Ensure effective arrangements are in place to register all performance and operational risks’. (Priority: Amber) Agreed Management will undertake a formal review of the current arrangements for monitoring and reporting performance to reflect on whether reports are fit for purpose and contain relevant, comprehensive information useful to stakeholders. This could include comparison with other IJB published reports. Particular consideration should be given to the following areas: an overview of all indicators on the performance scorecard including a mechanism to provide an update on indicators previously reported but now considered satisfactory; proposed actions with timescales, progress with these and how effective they are; greater use of benchmarking with other IJBs and trend information; and incorporating reporting by locality. Performance Manager Original Timeline: January 2020 Revised Timeline: March 2022 Revised timeline: March 2023 Complete As previously advised, the annual review of the current suite of indicators and targets has been completed. In August 2022, the IJB’s Performance, Audit and Finance Committee endorsed the development of a revised whole system performance framework for the partnership. The current engagement and participation activity taking place in relation to the development of the new Strategic Commissioning Plan will draw together and build upon the richness of contribution across key partners. A whole system working group will be established to support the performance framework for the emerging Strategic Commissioning Plan. The richness of information that will comprise whole system performance reports will allow Committee members to exercise effective oversight, scrutiny, and challenge. As per update given above, the new Strategic Commissioning Plan 2023-2026 was approved at the IJB on 22 March 2023. Annual performance report submitted to the PFA Committee on 14 Feb 23 along with a performance update report which included key performance indicators and measures.
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8 Update on Internal Audit Actions (Cont.) Appendix 2 (Cont.) Ref Risk Management Maturity Audit Report Adequate Assurance (Audit Ref: 0600/2019/004) Recommendations / Management Response Current Position 3 There is no formal record of the setting and approval of targets and trajectories for indicators on the performance scorecard. Internal Audit noted that targets and trajectories for underlying performance measures are discussed and agreed at the Chief Executives’ Performance Review meetings but no formal record of this is retained. There is therefore no formal documented record or clear rationale for the targets and trajectories set. (Priority: Amber) Agreed Management should ensure that a formal record is retained detailing the rationale for and approval of the targets and trajectories set for the indicators on the performance scorecard and this information should be shared with the Performance, Finance and Audit Committee. Performance Manager Original Timeline: October 2019 Revised Timeline: March 2022 Revised Timeline: December 2022 Complete The annual review of the current reporting arrangements was rescheduled as a result of the Covid-19 pandemic. This work however is now being progressed in line with the revised timeline. The annual review of the current reporting arrangements will be reported to the IJB in December 2022 and will set out the agreement for future years. From 23/24 onwards, this will be presented to the board each year in line with quarter one performance cycle. Annual performance report submitted to the PFA Committee on 14 Feb 23 along with a performance update report which included key performance indicators and measures.
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9 Update on Internal Audit Actions (Cont.) Appendix 2 (Cont.) Ref Financial Due Diligence Audit Report Adequate Assurance (Audit Ref: 0700/2020/003 Recommendations / Management Response Current Position 4 Management needs to formalise and agree the proposed arrangements for those services with a ‘cross cutting function’, to be hosted by either Health and Social Care or Education and Families, and following the approval of the IJB and NLC, to finalise and process the agreed transfer of the remaining cost centres, in relation to the disaggregation of Children, Families and Justice Social Work Services, and their resultant budget. (Priority: Amber) Agreed. IJB management will: (1) liaise with relevant Council officers to ensure that the transfer of the remaining cost centres, and the resultant resources transferred, are agreed/completed as a matter of urgency; (2) in conjunction with Education and Families, determine, agree, and fully document the proposed arrangements for those functions to be ‘hosted’ by Education and Families and accessed by Adult Health and Social Work Services and vice versa, including giving consideration as to whether there should be a recharge system; (3) in conjunction with relevant Council officers, ensure that both the IJB and NLC approve the proposed ‘hosting’ arrangements for the budgets in respect of the cross-cutting services; and (4) liaise with the Council to resolve any other outstanding issues with regards to the disaggregation of Children, Families and Justice Services’ budgets and the treatment thereof. Internal Audit Comment Management should ensure that: (1) the hosting arrangements for the budgets in respect of cross-cutting services are finalised; (2) the hosting arrangements and detail of the disaggregated budgets which have been agreed are submitted to the IJB and to the relevant Council committees (Adult Health and Social Care and Education and Families). Original Responsible Officer: Chief Officer Original Timeline: October 2020 Revised Responsible Officer: Chief Financial Officer Revised Timeline: September 2021 Revised Responsible Officer: Head of Adult Social Work and Head of Planning, Performance and Quality Assurance Revised Timeline: TBC Complete The budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Within the Financial Monitoring Report to the IJB on 9 December 2020, the IJB approved the revised direction to North Lanarkshire Council to reflect the conclusion of the budget disaggregation exercise in line with the Revised Integration Scheme – Transfer of Functions. This included the budget transfer of ‘direct’ Children, Families and Justice budgets and the transferring of budgets for the cross-cutting and support services. Ongoing The finalisation of the Service Level Agreement is overdue as per the original timeline of March 2021 which was initially revised to September 2021 but has been extended again to June 2022. Once finalised, the Service Level Agreement will be presented to a future meeting of the NLC Adult Health and Social Care Committee, the NLC Education and Families Committee and the IJB for approval. The Service Level Agreement between Children, Families and Justice Services will be revisited once further clarity has been obtained around what services will be part of the new National Care Service. 5 There is a need for a more formal record of the methodology adopted for disaggregation/the resultant figures/cost centres being transferred from Health and Social Care to Education and Families and the associated risks as a result of changes to the Integration Scheme to be formally reported to key stakeholders (i.e. the IJB and relevant Council Committee). (Priority: Amber) Agreed IJB management should, in conjunction with relevant Council officers, ensure that a report is submitted to the IJB setting out the methodology for the disaggregation of cost centres and budgets associated with Children, Families and Justice Social Work Services, detailing the implications of the full disaggregation. Internal Audit Comment Management should ensure that: (1) the hosting arrangements for the budgets in respect of cross-cutting services are finalised. (2) the hosting arrangements and detail of the disaggregated budgets which have been agreed are submitted to the IJB and to the relevant Council committees (Adult Health and Social Care and Education and Families). Original Responsible Officer: Chief Officer Original Timeline: October 2020 Revised Responsible Officer: Chief Financial Officer Revised Timeline: September 2021 Revised Timeline: June 2022 Revised Responsible Officer: Head of Adult Social Work and Head of Planning, Performance and Quality Assurance Complete The budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Within the Financial Monitoring Report to the IJB on 9 December 2020, the IJB approved the revised direction to North Lanarkshire Council to reflect the conclusion of the budget disaggregation exercise in line with the Revised Integration Scheme – Transfer of Functions. This included the budget transfer of ‘direct’ Children, Families and Justice budgets and the transferring of budgets for the cross-cutting and support services.
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10 Revised Timeline: TBC Update on Senior Management Actions Appendix 3 Ref Annual Governance Statement Continuous Improvement Actions Current Position 1 Further consideration of the Ministerial Strategic Group (MSG) proposals. Original Responsible Officer: Chief Officer Original Timeline: March 2021 Revised Responsible Officer: Chief Officer Revised Timeline: March 2022 Complete A range of actions were agreed across the partnership to take forward the MSG proposals. These actions were included as part of the overall North Lanarkshire Integration Review and Self-Assessment. An update report on the total of 38 actions was presented to the IJB PFA Committee on 24 August 2021. 35 actions have been completed and 3 actions remain outstanding. Complete Two of the outstanding actions relate to the finance workstream. This includes a review of the support arrangements for the Chief Financial Officer and the link between strategic and operational finance. On 8 December 2021, the North Lanarkshire IJB agreed to create a full-time Chief Financial Officer for each IJB. On 25 January 2022, the South Lanarkshire IJB also agreed to this approach. This option is now being progressed. Complete The third outstanding action relates to the development of systems to support integrated IT arrangements. The Lanarkshire Data Sharing Partnership Board was reviewed, and new structures have been agreed. The role out of Microsoft 365 across all partners is the current priority. Complete The MSG had previously indicated that a second self-evaluation will be undertaken in 12 months to assess progress. The follow up was rescheduled due to the Covid-19 pandemic. The second self-evaluation is currently being progressed in February 2022. Work is also progressing nationally in respect of the development of the National Care Service. Complete The Improvement Service is carrying out a self-evaluation of the function of the IJB as part of a national best value audit. Effective from February 2022, a review of current participation and engagement structures is also being progressed. Complete 2 Review the IJB governance arrangements This will include the review of the following: IJB joint internal audit arrangements IJB Code of Corporate Governance Complete The outcome of the overall North Lanarkshire Integration Review and Self-Assessment was reported to the IJB PFA Committee on 24 August 2021. The review of the North Lanarkshire Integration Scheme included consideration of governance arrangements. The governance structure moving forward proposed key interfaces around clinical and care governance.
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11 IJB emergency response arrangements and the further development of the IJB website. Original Responsible Officer: Chief Financial Officer Original Timeline: March 2021 Revised Responsible Officer: Chief Financial Officer Revised Timeline: March 2022 Revised Timeline: March 2023 The understanding of the governance requirements underpinning health and social care integration continues to develop and includes an increased awareness of decision-making responsibilities. The further development of collaborative leadership and building relationships with key stakeholders continue to be key improvement actions. The outcome of the National Care Service Consultation will also influence future governance arrangements for the IJB and both partners. The External Audit of the North Lanarkshire IJB Annual Accounts 2020/2021 has now been completed. The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2020/2021 give a true and fair view of the state of affairs and of its net expenditure for the year and have therefore issued an unqualified independent auditor’s report. The findings of the audit process have also been reported to the IJB and an action plan approved as set out in the External Auditor’s Annual Audit Report. Current process will remain however further work may be required due to the introduction of the National Care Service. Complete The working group continue to develop the IJB website which will be complete by March 2023. Website launched end of February 2023 with paper celebrating the launch endorsed by the IJB Committee on 22 March 2023.
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12 Update on Senior Management Actions (Cont.) Appendix 3 (Cont.) Ref Annual Governance Statement Continuous Improvement Actions Current Position 3 Finalise the budget transfer from the IJB to NLC, in line with the revised Integration Scheme This will include the following: the conclusion of the budget disaggregation exercise for the transfer of the remaining cost centres and their resultant budgets the finalisation of the Service Level Agreement including the arrangements for those services with a ‘cross cutting function’ the issue of a revised direction to reflect the 2020/2021 financial allocations Original Responsible Officer: Chief Officer Original Timeline: September 2020 Revised Responsible Officer: Chief Financial Officer Revised Timeline: September 2021 Revised Responsible Officer: Head of Adult Social Work and Head of Planning, Performance and Quality Assurance Revised Timeline: TBC Internal Audit Comment Management should ensure that: (1) the hosting arrangements for the budgets in respect of cross-cutting services are finalised; (2) the hosting arrangements and detail of the disaggregated budgets which have been agreed are submitted to the IJB and to the relevant Council committees (Adult Health and Social Care and Education and Families). Complete The budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Within the Financial Monitoring Report to the IJB on 9 December 2020, the IJB approved the revised direction to North Lanarkshire Council to reflect the conclusion of the budget disaggregation exercise in line with the Revised Integration Scheme – Transfer of Functions. This included the budget transfer of ‘direct’ Children, Families and Justice budgets and the transferring of budgets for the cross-cutting and support services. Update Once finalised, the Service Level Agreement will be presented to a future meeting of the NLC Adult Health and Social Care Committee, the NLC Education and Families Committee and the IJB for approval. The Service Level Agreement between Children, Families and Justice Services will be revisited once further clarity has been obtained around what services will be part of the new National Care Service. The outstanding Service Level Agreement will be incorporated into the same outstanding action highlighted by Internal Audit under ‘Financial Due Diligence Audit Report’ 0700/2020/003 action note 4 above. 4 National Care Service To develop a sound understanding of the impact for the NLHSCP of the outputs of the National Care Service legislation. Ongoing Due to the uncertainty and lack of detail currently available, this will be revisited once further clarity has been obtained. 5 Category 1 Responder Review the IJB’s progress in becoming a Category 1 Responder as set out within the Civil Contingencies Act. In conjunction with the Local Resilience Partnership undertake a self- assessment review against the seven duties, reporting progress to the West of Scotland Regional Resilience Partnership. Original Responsible Officer: Chief Officer Original Timeline: March 2023 Complete IJB Category 1 Responders in Civil Contingencies Act 2004 was presented to the IJB on 22 March 2023.
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13 Update on Senior Management Actions (Cont.) Appendix 3 (Cont.) Ref Self-Evaluation of the North Lanarkshire Health and Social Care Integration Joint Board (IJB) Current Position 6 Evidence how Health and Social Care spending contributes to prevention and early intervention This will include the following: review of the Strategic Commissioning Plan to strengthen outcome 5 around inequalities review of opportunities against resources include a question in all board papers regarding how it impacts upon prevention and early intervention undertake a review of good practice from across Scotland ring-fence funding for prevention and early intervention as part of the Reserves Strategy engage with Academia to establish how we measure success evidence how existing work links to prevention and early intervention and how this aligns to outcomes Original Responsible Officer: Head of Planning, Performance and Quality Assurance and Chief Finance Officer Original Timeline: February 2023 Complete Both the Strategic Commissioning Plan 2023-2026 and Medium-Term Financial Plan 2023-2026 are currently underway and will align to strengthen outcomes against resources. By ensuring good practise and lessons learned, both plans will review future funding and reserves to link with outcomes around prevention and early intervention. Medium Term Financial Plan 2023 – 2026 was approved at the IJB on 22 March 2023. Strategic Commissioning Plan 2023-2026 was approved at the IJB on 22 March 2023. IJB Reserves Strategy 2022-2023 was approved at the IJB on 22 March 2023.
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1 REPORT Item No: 8 SUBJECT: Resilience Response TO: IJB Performance, Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer North HSCP Author(s) of Report Ross McGuffie ,Chief Officer North HSCP DATE: 19th April 2023 1. PURPOSE OF REPORT 1.1 This paper is coming to the IJB Performance, Finance and Audit Committee: 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 IJB PERFORMANCE, FINANCE AND AUDIT COMMITTEE 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 PFA 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 that NHS Lanarkshire was able to move from black to red status on 6th March 2023, following a successful ‘firebreak’ as part of Operation Flow 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 NHS Lanarkshire stood down its Live Covid Incident in January 2023, however, the operational pressures emanating from the pandemic recovery have been pronounced, with NHS Lanarkshire in Black status since 27th July 2022. Yes No N/A
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2 5.1.2 Operation Flow was developed to create a ‘firebreak’ to rapidly reduce hospital inpatient capacity, then creating the staff capacity to work on service redesign to bring the system as a whole back into equilibrium. 5.1.3 Following the 9-day firebreak, hospital inpatient capacity reduced by around 15% across Lanarkshire, supporting the system to move from black to red status on 6th March 2023. 5.2 Operation Flow 5.2.1 The IJB received an update on Operation Flow at its meeting on 22nd March 2023. Operation Flow is the whole system strategic planning approach in Lanarkshire aimed at supporting a sustained recovery of the entire health and social care system. 5.2.2 The planning exercise commenced with senior leaders from the three acute sites and two HSCPs coming together face to face to discuss the key areas of challenge and potential areas of gain for the system as a whole. This engagement approach set a positive tone of collective responsibility and whole system working, and it is positive that following the Firebreak, further whole system learning sessions have been arranged for 6th and 27th April to collectively develop the next phases of Operation Flow. 5.2.3 In preparation for these sessions, the North HSCP has held a feedback session based on the Firebreak activity and dedicated time at the Strategic Leadership Team to further review the learning so far. A number of key themes have emerged, including: Significant gains in whole system partnership working from the Firebreak The ever increasing role of Home Assessment Teams in supporting discharge and also controlling future demand into mainstream Home Support services The need to better steward referrals for equipment Hospital at Home’s extended hours (to 8pm) led to the safe management of a larger caseload of patients, with significant increases in referrals received Interim Care needs to continue as part of the Choices Protocol for Care Home admission and also to support any Localities struggling with Care at Home capacity The discharge process is complex, bureaucratic and time consuming and needs to be streamlined across the system We use multiple (largely paper based) systems to record the discharge journey, that means there is never one version of the truth and makes joined up working more challenging Trakcare isn’t updated frequently enough, with the example of 238 delayed discharge bed days being recorded on the system despite the patients already being discharged Further work required to consistently implement the Flow Bundle, including developments such as Planned Date of Discharge and Criteria Led Discharge 5.2.4 Staff directly involved in the operational delivery of the Firebreak will be in attendance at the learning sessions in April to ensure that we are able to get into the detail of the kind of issues noted above.
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3 5.3 Delayed Discharge 5.3.1 One of the key aims of the Firebreak was to utilise multi-agency teams to review all inpatients on a daily basis, with the aim of improving the flow of the 95% of patients who don’t need supported discharge, but also supporting earlier identification of the 5% who will require support. 5.3.2 Consequently, one of the anticipated outcomes of the firebreak was the identification of a significant number of referrals for Social Work/Social Care support. Over the nine-day firebreak, 180 referrals for supported discharge were received in North Lanarkshire, with a further 81 in the three days running up to the start. To put this into context, during peak winter pressures in 2019/20, North Lanarkshire averaged 77 referrals per week for supported discharge, which was the highest rate in Scotland. 5.6.3 However, despite the spike in demand, the recently improved performance in delayed discharge has been maintained. At the start of the firebreak, there were 84 delays in the system, with 40 of these on the acute sites, and at 31st March, this has reduced to 69 delays, with 26 on the acute sites. On 20th March, the HSCP had its lowest recorded number of delays since November 2021 at 59. 5.6.4 While delay numbers will continue to fluctuate day by day, overall performance since the Firebreak has been much improved with considerable efforts ongoing to ensure the changes made through the Firebreak activity can become sustainable across the system as a whole. 6. CONCLUSIONS 6.1 There has been a tremendous whole system effort to plan Operation Flow and to enact the firebreak at scale and pace. 6.2 The reduction in occupancy levels across all three sites has allowed NHS Lanarkshire to move from black to red status on 6th March 2022, following over 6 months in black status. 6.3 Attention has now moved to make the most of the system decompression to move forwards with the ambitious change programme identified to ensure the positive performance improvements can be sustained and indeed further improved over time. 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. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT
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4 Risk IJB 17/22 sets out the unscheduled care challenges currently being faced in the Lanarkshire system. 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 ............................................................................. 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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1 REPORT Item No: 9 SUBJECT: Performance Update – Quarter 3 (October – December 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: 19th April 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 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 October to 31 December 2022 (Quarter 3). 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.
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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 3, October – December 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 3, October - December 2022) 1. Cervical Screening Target 2022/23 2022/23 Q2 2022/23 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening Uptake 80% 73.3% 72.9% ê ê Narrative & Corrective Action Data analysed from Milan for the time period 1st Jan 2022 to 31st Dec 2022 Airdrie - no practices achieved the 80% uptake target. Bellshill - no practices achieved the 80% uptake target. Coatbridge - 1 practice achieved 80.1% uptake in Quarter 1. Motherwell - 1 practice achieved above 80% uptake for the full year. 1 further practice achieved above 80% uptake in Quarter 1 and 2. North - 2 practices achieved above 80% uptake for the full year. 1 further practice achieved above 80% in quarter 3. Wishaw - no practices achieved the 80% uptake target Work being carried out by health improvement and public health: 1. Generic: Information Provision/Communications to the wider population to support awareness raising and informed choices such as National Cervical Cancer Awareness Prevention Week January 2023 & Cervical Cancer Screening Awareness Week June 2022. Delivery of training in partnership with all sectors (NHSL/Locality Level) to promote cancer 70.5 71.8 72.3 74 76.3 73.4 65 70 75 80 Airdrie Bellshill Coatbridge Motherwell North Wishaw Average Uptake % Area Average Cervical Screening Uptake 2022
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4 screening programmes, including messages around detecting cancer early and signs/symptoms (Breast, Bowel and Cervical programmes). 2. Population Specific: Targeted work to increase screening awareness and uptake/reduce defaulting through awareness raising campaigns for cervical screening and HPV- Bellshill and Airdrie (the lowest uptake for cervical screening). Women’s health events in December 2022 & February 2023 (targeted at 25-39 age group & mother & toddler group) delivered by Lanarkshire Health Improvement staff at Mossend Mosque. There was some misunderstanding about the HPV vaccine and the need for a smear in the future too. Cancer Screening Workshops carried out with Lanarkshire Carers BAME group Jan 22-May 22. 3. Programme Specific: Targeted work to increase screening awareness and uptake/reduce defaulting by linking with specific populations in the community to raise awareness of screening programmes and increase rates in; areas of low uptake, SIMD 1&2: Jo’s Trust training circulated via localities. Reported Barriers: Access to GP practice appointment times at a suitable time around caring responsibilities. Many practices do not offer evening appointments with the practice nurse. Some would prefer it to be like the Breast Screening programme in that it is a mobile unit, as in smaller villages they may know the practice nurse so this can add to the embarrassment that some report to feel going for smear. Staff resource: Josephine Reilly, Public Health Quality Improvement Facilitator has an addition 1 day per week to support GP practices with quality improvement work to address cervical screening uptake. This will not fully cover the gap left by the CRUK programme but will help. 2. Immunisations Target 2022/23 2022/23 Q2 2022/23 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 2 year olds 90% 95.6% 95.0% ê ê Immunisations – %s of 5 year olds 93.8% 92.7% ê ê Narrative & Corrective Action The uptake rates for both 2 year olds and 5 year olds has shown a consistent and small drop off over consecutive quarters. While uptake rates remain high, there is improvement work in place across all localities offering additional clinics at weekends.
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5 3. Delayed Discharge / Home Support / Reablement Target 2022/23 2022/23 Q2 2022/23 Q3 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 7,409 8,309 ê ê Reablement - Number Of People Completing Reablement Process 2,000 (500 per quarter) 678 (cumulative) 1049 é é Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 60.6% 55.0% ê ê Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 50.2% 50.3% é ê Narrative & Corrective Action One of the key aims of the Firebreak was to utilise multi-agency teams to review all inpatients on a daily basis, with the aim of improving the flow of the 95% of patients who don’t need supported discharge, but also supporting earlier identification of the 5% who will require support. Consequently, one of the anticipated outcomes of the firebreak was the identification of a significant number of referrals for Social Work/Social Care support, though it is hoped that once the backlog of newly identified patients is cleared, the more proactive identification of patients will help to reduce delays in future. Over the nine-day firebreak, 180 referrals for supported discharge were received in North Lanarkshire, with a further 81 in the three days running up to the start. To put this into context, during peak winter pressures in 2019/20, North Lanarkshire averaged 77 referrals per week for supported discharge, which was the highest rate in Scotland. However, despite the spike in demand, the recently improved performance in delayed discharge has been maintained. At the start of the firebreak, there were 84 delays in the system, with 40 of these on the acute sites, and at 7th March, this has reduced to 70 delays, with 27 on the acute sites. There remains a risk of short-term increases in delays due to the very high number of referrals for complex assessment (14 referrals in a single day for complex assessments on one site alone in the middle of the firebreak). While additional Social Work
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6 capacity has been identified to support these cases through the assessment process, there is a risk that a number will become delays before complete. Home Support i) Waiting List position All teams are currently working towards waiting lists being reduced with care permanently placed where it can, significant work has been completed in partnership with quality assurance regarding community capacity building with colleagues form the independent sector. Once we see the bulk of this work transfer over this should create much needed capacity within locality teams which will allow reablement teams to function and progress as normal. It is anticipated that most of this work will be completely transferred across by the end of April. Once complete teams will have a clearer picture of capacity issues. ii) Service Users awaiting a Home Support Service: All teams have been undertaking significant work to reduce the number of service users waiting on support commencing, however despite best efforts the following number of people are awaiting a package of support: Cumbernauld has the added difficulty of Glasgow Hospital Discharges and referral rates have increased significantly over the last few months. Teams continue to prioritise referrals; however, the focus has continued to be on supporting hospital discharge due to the ongoing pressures that hospital sites have in terms of capacity. iii) Absence Issues All Home Support Teams meet regularly with their respective ER advisor and a monthly meeting now takes place between Service Managers, Senior Manager Older Adults and the HR business Partners where monthly absence performance is reviewed within the respective locality teams. There are several Home Support staff who are off long term due to a variety of serious health issues, however it is the short-term absence that is having the greatest impact across all teams. The monthly meetings that are taking place ensures SDC’s are progressing absence management and support in line with the services managing attendance policy. iv) Recruitment
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7 Home Support Worker recruitment has continued with 21 awaiting start dates and a further 23 appointed this week following interview. The main concern for the service is the delay in advertisements going out for Support Officers and Service Delivery Coordinators which has been raised with HR. A focussed recruitment advert for Home Support Workers for Cumbernauld and Wishaw has been ran with the closing date of the 24.03.23. Given the pressures in both teams it is essential that capacity is created to meet the demands of community and hospital referrals while increasing reablement capacity to meet service demands. Reablement 354 people commenced with the reablement service during quarter 3, which is lower than the same quarter of last year (385), and lower than previous quarters of 2022/23. 374 people completed the reablement during quarter 2, which is higher than the same quarter of last year (223) and higher than previous quarters of 2022/23. This reflects the efforts to work with individuals who have not been able to progress through the reablement service for a variety of reasons, and identify more appropriate, long-term supports. This has also impacted the proportion of people who require no or reduced level of support at the end of the reablement process. 4. Integrated Equipment & Adaptation Service Target 2022/23 2022/23 Q2 2022/23 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status IEAS - % Deliveries Achieved Within 7 Working Days 80% 75.1% 63.4% ê ê Narrative & Corrective Action 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. The service has had significant challenges in relation to the recruitment of staff to vacancies across the entire service. 5. CAMHS Target 2022/23 2022/23 Q2 2022/23 Q3 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% 25.4% 19.1% ê ê
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8 Narrative & Corrective Action The Waiting List Initiative continues with a steady downward trajectory in children and young people who are waiting to be seen (see figure 14 below). It is planned to continue in collaboration with implementation of Choice and Partnership approach (CAPA) and modelling indicates monthly incremental improvements in waiting times as a result. From 22nd August 2022 – 12th March 2023, the out of hours clinics have offered an additional 1379 appointments, with 1010 attendances, 358 not brought, 7 patients transferred and 144 patients meaningfully redirected to other more appropriate supports. The team have also been delivering a Centralised Duty approach. This has improved flexibility of response as well as reducing interruption to planned clinical activity. The team are working closely with our Communications colleagues to promote the positive messaging around what is being delivered and plans to develop to meet future demand and need. CAMHS Overall WL 6th March 2022 Performance for February shows 39.21% with 890 patients waiting over 18 weeks. Longest wait is 143 weeks.
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9 Neurodevelopmental Service Unfortunately the Neurodevelopmental waiting list was created before the service was fully staffed and this has resulted in the current performance. A waiting list cleanse is currently being undertaken to ensure there is an accurate record of the children waiting. It is anticipated that effective use of Trakcare will allow better monitoring of demand and capacity within the service. There has been a significant increase in staff over the past few months which has already had an impact on the longest waits. The service are also in the final stages of a commissioning process to secure neurodevelopmental assessments from an independent company, it is anticipated that this will have a positive impact on the longest waits. Performance for February shows 17.8% with 5314 patients waiting over 18 weeks. Longest wait is 193 weeks. 6. Psychological Therapies Target 2022/23 2022/23 Q2 2022/23 Q3 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% 82.8% 85.1% é é Narrative and Corrective Action During February 85.21% of patients commenced psychological therapy within 18 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. The complexity of referrals in adult PTT is being noted – work is starting to investigate the increase in severity of
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10 presentation (and subsequent effect on functioning). The number of referrals has increased noticeably over time however many variables exist such as addition of cCBT Self-Referral data. 584 patients are waiting over 18 weeks and the longest wait is 49 weeks. 7. Adult Mental Health Target 2022/23 2022/23 Q2 2022/23 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 68.8% 63.8% ê ê Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 91.1% 80.2% ê ê Narrative & Corrective Action Waiting times are discussed at every monthly senior medical staff meeting; Data collection methods are currently under review, as there had been issues with the collection methods not always having been consistent; There had been teams in the North struggling with lower numbers of nursing staff, who do also work within the memory clinics, and this may have resulted in knock-on effects on medical waiting times; Recruitment has occurred, including for an additional consultant psychiatrist who started in January 2023, and this will hopefully help with waiting times; Additional clinics have been arranged; Further medical staff recruitment is also planned, after changes in posts within the service which may also have affected the waiting times figures recently.
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11 8. Waiting Times Performance - Medical Children & Young People (Consultant Led) Target 2022/23 2022/23 Q2 2022/23 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90% 44.9% 46.4% é ê Narrative & Corrective Action Acute Paediatrics were under significant clinical pressure in December 2022 and early January 2023. A pause in community paediatric clinics had to be implemented as clinical risk within the ward due to level of clinical acuity and gaps in rota. A Paediatric Consultant post was successfully recruited in March. This will provide additional capacity to support increase in delivery against target. The Paediatric Programme Board is in process of being re-established. It will be chaired by Dr Adam Daly and will focus on building a sustainable model for Paediatric services going forward and will include addressing the challenges around community paediatric waiting times. Performance for February shows 43.9% with 1056 children waiting over 12 weeks. Longest wait is 52 weeks. 9. Waiting Times Performance – AHP and Community Services Target 2022/23 2022/23 Q2 2022/23 Q3 Performance Compared to Performance Compared to RAG Status
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12 Previous Quarter Same Quarter Previous Year SLT - Paediatrics - 12wks (NORTH HOSTED) 50% 20.0% 27.1% é ê Narrative & Corrective Action Speech and Language therapy interventions have still to recover from impact on waiting times secondary to stand down of services during early stages of Covid 19. This has been compounded by sideways movement of experienced staff into other prioritised areas of work (Neurological Developmental Service). The management team and professional lead for SLT have been working together to address this challenging long standing position. The team have identified the need to progress Trakcare roll out to provide assurance on delivery of service across the system and assurance of standardised processes being followed by individuals and Teams. Only 1 area currently uses Trakcare. Service Improvement input and admin support will be key to facilitating delivery of this first step in our improvement plan. A Service Improvement group has been convened with support from a project manager and service improvement manager within Specialist Children’s Health Service Unit. There will be workshops for wider stakeholder engagement (including a cross section of SLTs, eHealth, communications and information management). The first workshop is planned for May 2023. 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. 10. Waiting Times Performance – AHP and Community Services Target 2022/23 2022/23 Q2 2022/23 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status
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13 Occupational Therapy - Paediatric - 12wks (SOUTH HOSTED) 50% 35.3% 42.3% é ê Narrative & Corrective Action An additional 4.0 WTE Children & Young People (CYP) Occupational Therapists transferred to the new NHSL Neurodisability Team in January 2023. All open caseloads have been transferred to remaining staff within the CYP OT team, impacting on the ability of staff to take new patients from the waiting list. Recruitment has been ongoing in this specialty for the last 4 months, but there is a national shortage of skilled CYP OT, and vacancies exist across the service. To help manage the volume of referrals the service has developed a wide range of universal and targeted video and educational resources to support parents and CYP at this time. A CYP OT helpline was also launched in early Feb 2023 to enhance early access to advice and guidance and manage the waiting list. Work has commenced to re-design the pathways between CYP OT, CAMHS & Neurodevelopmental services. 11. Stop Smoking Service Target 2022/23 2022/23 Q1 2022/23 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sustain and embed successful smoking quits, at 12 weeks post quit, in 40% of SIMD areas. 902 82 304 é ê Narrative & Corrective Action The service has a robust recovery plan in place, focusing on the challenges in getting referrals back up across acute services and improved performance in pharmacy. For the 6-month period (April 2022 to September 2022): We achieved 67% of our overall target (304 quits against a target of 451). Community achieved 83% against target Pharmacies achieved 54% against target Our three acute sites (combined) achieved 96% against target Pregnancy achieved 115% against target (30 quits) Mental Health achieved 59% against target (5 quits) No Localities achieved 100% or above GREEN
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14 Localities achieving 82% to 99% AMBER = CamGlen, Motherwell Localities achieving below 82% RED = Airdrie, Coatbridge, North, Bellshill, Wishaw, East Kilbride, Clydesdale, Hamilton Ratios of 12 week quit success by service area – the table below shows the ratios in quarters 1 to 2 of clients by service area who set a quit date and were not smoking after 12 weeks: Service area Ratio Community 1 in 2 Mental Health 1 in 3 Acute 2 in 3 Pregnancy 1 in 3 Pharmacy 1 in 4 Some other points to note for quarter 1 to 2: 1. Our annual target hasn’t changed for 2022/23 (902 quits). 2. There has been a 30% decrease in quit attempts in Quarter 1 to 2 2022/23 compared with the same period last year. The pharmacy decreased by 38% and specialist decreased by 7%. 3. Following on from the point above even though there has been an overall decrease in quit attempts we have seen a 21% increase in quit attempts from Acute compared to the same period last year. 4. The overall 12 week quit rate for Quarter 1 to 2 2022/23 was 34% (pharmacy 24% and specialist 53%) compared with 33% for the same period last year (pharmacy 28% and specialist 49%). 12. Sickness Absence Target 2022/23 2022/23 Q2 2022/23 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 6.47% 8.31% ê ê Sickness Absence (NLC) - days lost per person 11.32 5.15 8.56 ê é 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.
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15 In NLC, monthly meetings are taking place between Senior Managers, Service Managers, and HR Business Partners where monthly absence performance is reviewed within the respective teams.
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1 REPORT Item No: 10 SUBJECT: Speech and Language Therapy Update TO: Integration Joint Board Performance, Finance and Audit Lead Officer for Report: Maggs Thomson, Head of Health NHSCP Author(s) of Report Pauline Downie, Professional Lead for Speech and Language Therapy DATE: 19 April 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Pauline Downie, Professional Lead Speech and Language Therapist
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2 3. RECOMMENDATIONS 1. The IJB approves that mobilisation funding is extended to 2023-24 financial year to enable appointment of SLTs over-establishment of up to 6 WTE band 6 posts 2. The IJB endorses the formation of a SLT Service Improvement Group with wider stakeholder engagement and support from Project Management and Service Improvement manager within the SCHSU. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Purpose Update to Integrated Joint Board Performance, Finance and Audit Committee on Speech and Language Therapy (SLT) Children and Young Peoples Service including performance against waiting times, service improvement plans to date and future plans Background Pre-Covid performance against the waiting times target of 90% of children seen within 12 weeks for specialist intervention was 67% In March 2020 all routine SLT CYP services were paused and schools and nurseries closed. In June 2020 all routine clients/families were contacted, further risk assessment was carried out and families offered support. Waiting times performance in July 2020 was 4%. The service in clinics schools and nurseries recommenced from June to October 2020. Waiting times performance in February 2023 is 24%. The SLT CYP service have had temporary funding to March 2023 to recruit a further 12 posts in community SLT teams. Staff have been recruited to these posts, however due to staff turnover the SLT CYP service has at no time been over- establishment for the past 2 years. A recent Public Health report highlighted the impact of the pandemic on children’s speech development and the role of SLTs and the wider workforce in supporting children with speech, language and communication needs. The SLT CYP service works within a Balanced System of Universal, Targeted and Specialist support for children with communication and eating, drinking, swallowing problems. This has been described in a recent paper Equity for All. Universal and targeted support Yes ☐ No ☐ N/A ☐
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3 includes working with the wider early years workforce and therefore this is a core element of SLT CYP service. The current waiting times reflect specialist intervention only. Performance SLT CYP Staffing capacity The funded establishment for SLT CYP is 92.64 WTE (this includes leadership and admin posts and staff working in the neurodevelopmental service) Current WTE in post is 77.36 WTE + 9.55 WTE on SLT mobilisation funding = 86.91 WTE The actual number of staff working in community clinics with children on the waiting list for specialist intervention is less than above as some of the SLT CYP staffing is funded by Education departments in North and South Lanarkshire. Actual SLT staff working in community clinics 86.91 WTE – 13.74 WTE (NLC) – 18.37 WTE (NLC) – 4.5 WTE (NDS) = 50.3 WTE Turnover in CYP service for 2021-22 8 staff left and 8 staff were appointed Turnover in CYP service for 2021-22 16 staff left (5 to other integrated teams within NHSL) and 9 were appointed. This is due to supply of SLTs. Staff turnover has a significant impact on caseload management and therefore waiting times as children on the caseload have to be re-allocated to other SLTs and also there is a period of vacancy while recruitment is ongoing. Mobilisation funding While this has been welcomed and utilised, as can be seen from the underspend in the SLT budget, it has not been possible to appoint over-establishment.
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4 Please note figures from finance below reflect the whole SLT budget: 2021-22 £264,056 - average wte 6.06wte 2022-23 – to M11 - £639,880 – average wte 12.87wte The current underspend within SLT at M11 is £794,487 Split Pays £723,045 / Non Pays £71,762 The underspend in pays is £723,045 and the spend on mobilisation is £639,880 so effectively the underspend without mobilisation funding would have been £83,165 Current Clinical Service Improvement Plan SLT CYP The SLT CYP service has focused on the following areas Aim Desired Outcome Aim 1 The SLT CYP vision and service model has been developed based on national guidance for universal, targeted and specialist service delivery, including the balanced systems approach. The vision and service model will be documented in accessible formats and communicated with staff and stakeholders. Outcome: The SLT CYP Service will have a communication plan to share the service delivery vision and model with staff and stakeholders. This will ensure staff and stakeholders have a clear and shared understanding of the SLT role with children and young people across Lanarkshire. Aim 2: The CYP service will use the principles of Realistic Medicine, Effective Decision Making and Who’s Concerned/Bothered/Worried (Kate Malcomess, Care Aims) to provide evidence- based support for CYP at Universal, Targeted and Specialist levels. Outcome: The CYP data will evidence a decrease in the variation of support for CYP across the service at Universal, Targeted and Specialist levels. The SLT performance data will show reduced: Waiting times Variation in waiting times Variation in new to return ratio numbers Variation in vetting outcomes Aim 3: The vetting process following receipt of a RfA will be evaluated to determine if the current method allows consistent and effective management across the CYP service in line with the service model. Outcomes: Discussions will take place with staff and parents/guardians to identify what works well in our current vetting practice and any improvements that can be made. Any identified improvements will inform recommendations for future management of *Request for Assistance) RfAs when they are received in our service. Aim 4: To develop and pilot a vetting pathway which gives CYP access to Universal/Targeted advice, Outcome: Two localities will be identified to trial the vetting pilot with CYP once an RfA has been received. The data for these localities will demonstrate:
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5 strategies and resources within 6-12 weeks of an RfA being received. The person who is worried/bothered/concerned will be able to access resources/advice and will be supported to implement this with the CYP, through telephone calls, Near Me and/or face to face appointments. Contact being made following an RfA within 6-12 weeks with families and professionals to undertake vetting. An increase in the number of cases managed at Universal/Targeted. A decrease in the number of cases progressing for Specialist Assessment. Families will be consulted following participation in the waiting well project and feedback will highlight an increase in: Families reporting access to resources and implementation of advice/strategies with CYP. Stakeholders, including families and professionals understanding the value of their role as the people closest to CYP providing input with Universal/Targeted support from SLT. Aim 5: The admin team supporting the enquiry service will increase their confidence levels and efficiency in this area of the service. Outcome: Helpline admin staff confidence levels will increase for managing calls and we will establish standardised processes in the team Aim 6: To improve outcomes for CYP who are not brought to appointments Outcome: CYP who are not brought to appointments, or are not consistently brought to appointments will be supported to achieve the best possible outcome. Some of the above aims are underpinned by the need to have access to mainstream systems such as Trakcare. The implementation of Trakcare and improvement of activity data gathering systems are included in our SLT service work plan. We are making progress with the above aims however there have been many stumbling blocks such as access to Trakcare, waiting for targeted information to be added to website, lack of clarity about Data protection impact assessments. Assessment Despite a continued focus on service improvement and recruitment, the waiting times for specialist assessment have not improved. This can partially be attributed to workforce capacity but also as seen above, there is still variation in vetting outcomes and also access to systems which could improve consistency of data collection. Many children and families have already had speech, language and communication support at universal and targeted levels before being placed on a waiting list for specialist assessment. Current data collection does not reflect the service model as it focuses on only one tier of the service model.
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6 Recommendations The SCHSU will support SLT with further service improvement ideas with dedicated time from project management and service improvement manager. This will include wider stakeholders from eHealth, communications and information services as well as representation from SLT CYP staff across a range of bands and specialisms. The initial focus will be on process mapping. This is planned for April 25th. Going forward the service improvement plan will be supported and underpinned by a focussed review of current position, current improvement plan and wider organisational support that can enhance delivery of aspiration. Work Stream Challenge Action E Health The service recognises that the need for robust data to report and manage performance is being hampered by lack of implementation of a service wide electronic system (Trakcare). The service recognises the lack of an electronic documentation recording system. This is complicating communication and robust supervision within the service and externally with other children’s services. Service improvement and project management colleagues will work collaboratively with professional leadership, wider team and ehealth colleagues to expand scope and span of Trakcare across SLT system. This will provide assurance of capacity and demand. Service improvement and project management colleagues will work collaboratively with professional leadership, wider team and ehealth colleagues to progress delivery of MORSE. Service improvement and project management colleagues will work with team and ehealth colleagues to develop systems that accurately represent universal and targeted aspects of SLT service as well as waiting times for specialist intervention Workforce Recruitment and retention of staff to CYP service has been a long term challenge. Service improvement and project management colleagues will work collaboratively with professional leadership, wider team and HR colleagues to progress delivery of
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7 focussed recruitment plans for the service. Opportunities will be explored that will encourage positive relationships to develop between service and further education. Opportunities will be explored that will support development of non- registered colleagues to expand competence and if wanted to support progression to professional learning. Environment Service is provided over multiple sites and in multiple ways. Service improvement and project management leads will use opportunity of Process Mapping day to engage with staff to consider environment and challenges that it presents in provision of care planning. This will inform: - Capacity and demand of buildings across whole system Economies of scale that can enhance flexibility of team over all. Flexibility of service delivery times.
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8 Communication Significant work has already been undertaken to address unmet needs of CYP who are waiting to be seen. Team recognise that there is limited awareness of this beyond specialist service Support required from Service Improvement and Project Management colleagues in collaboration with Communication colleagues to ensure:- CYP and families are appropriately informed of what they can do to help themselves or support their child whilst waiting. Professional colleagues inclusive of Education and other health professionals need to know how to support families whilst waiting. Increase awareness of the range of tools that can be directed to that will encourage self-directed support. 6. CONCLUSIONS In conclusion we ask that the committee: 1. Note the difficulties in recruitment, retention and national supply of SLTs 2. Approve the extension of mobilisation funding to appoint over- establishment in SLT CYP service up to 6 WTE band 6 staff at an annual cost £313,914 3. Endorse the formation of a Speech and Language Service Improvement group with wider representation from support services and including support from Project Management within the SCHSU
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9 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing 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 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 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 ☒ 7.2 ASSOCIATED MEASURE(S) The Speech and Language Therapy (SLT) Service are a hosted service within the SCHSU within the Health and Social Care North and subject to their operational governance arrangements. The SLT service also have professional governance arrangements through the AHP Director/ NMAHP Director 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. Yes ☐ No ☐ N/A ☐
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10 7.5 PEOPLE This affects children and young people with speech, language and communication support needs and their parents/carers. Also staff working within the Speech and Language Therapy service. We have received feedback from parents and families on certain elements of the work plan such as their experience of the vetting process. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS Relevant documents Gascoigne, M (2021) Equity for All: Children’s Speech and Language Therapy Services in Scotland, Better Communication CIC URL https://www.bettercommunication.org.uk/downloads/2022%20Equity%20for%2 0All%20Final%20for%20Publication.pdf (Accessed 15/03/2023) Public Health Scotland (2023) Speech and communication development among children in Scotland during the COVID-19 pandemic. URL https://publichealthscotland.scot/our-areas-of-work/conditions-and- diseases/covid-19/covid-19-data-and-intelligence/speech-and-communication- development-among-children-in-scotland-during-the-covid-19-pandemic/ (Accessed 15/3/2023) 9. APPENDICES None. Please include a glossary of terms if not already included. Yes ☐ No ☐ N/A ☒ Yes ☐ No ☐ N/A ☒
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11 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Pauline.Downie@lanarkshire.scot.nhs.uk Professional Lead SLT
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1 REPORT Item No: 11 SUBJECT: Children & Young People’s (CYP) Occupational Therapy Waiting Times Performance TO: North HSCP Integration Joint Board Performance Lead Officer for Report: Maggs Thomson, Head of Health, North HSCP Author(s) of Report Janice McClymont, Head of Occupational Therapy Profession, NHS Lanarkshire DATE: 19 April 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ Prepared by: Janice McClymont, Head of Occupational Therapy Profession, NHSL
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2 Reviewed by: Claire Rae, Head of Health & Social Care, South Health & Social Care Partnership 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) recognise the current demands on NHSL Children & Young People’s Occupational Therapy Services (2) approve the enclosed mitigating actions to manage service demand and work towards the achievement of the agreed waiting times performance target 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES Current performance against local AHP Waiting Times performance: at 28th February 2023: Total Number waiting: 664 Number of people waiting beyond target: 517 Longest patient wait: 39 weeks Performance within 12week target: 32.2% Performance Commentary The CYP OT Team have seen a 24% increase in demand post pandemic Throughout the pandemic the team developed a wide variety of universal and targeted video resources and information packs to support children and families to access early therapy information and advice. This supported the service to absorb the increased demand and remain within the 12week target until April 2022. National developments within CAMHS and Neurodevelopmental Services in 2022 resulted in a migration of experienced CYP OT staff to these new services. A total of 9 staff at B6 – B8a moved on from the service (7.0 wte to the NHSL Neurodevelopmental Assessment & Diagnostic Service; and 1.2 wte to NHSL CAMHS) There is currently a 28% vacancy factor within the CYP OT Team at Feb 2023. Yes ☒ No ☐ N/A ☐
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3 This picture is replicated across many Board areas, and there is currently a national challenge in the recruitment of experienced CYP OT. Locally, recruitment to Band 5 CYP OTs has been successful, but the staff require support to build their skills in this specialist area as OT practice based learning placement have been reduced across children’s services. All open cases have been transferred to the remaining CYP OT staff, reducing the ability to address new patient assessments, and impacting negatively on waiting times performance. Performance Recovery Plan The following actions are being undertaken to address the current waiting list position: Monthly caseload review of all open caseloads to maximise potential for discharge Continued signposting to universal and targeted resources where applicable. Additional funding agreed to support excess hours/overtime. Monthly Waiting List Validation Exercise in line with CYP OT Priority Framework. Review of CYP OT Workshops and Group Programmes completed Dec 2022 Re-introduction of AHP Baby Group for babies with complex neuro rehab needs in April 2023. An additional number of group programmes scheduled for April & May 2023 to increase capacity. Launch of CYP Advice Line – 7th February 2023. Teams measuring impact of new workshops and advice line via QI Projects. Generic email address introduced to support any professional making a request for assistance. Introduction of Activity Profiles for every child in ASN Schools. On target to have this exercise complete by 31st March 23. This will reduce the time spent on clinical report writing and increase capacity and communication in ASN schools. A seating surveillance system will be commenced when additional staffing secured to increase the efficiency and co-ordination for children with postural management and seating needs. Early developments have commenced with Neurodevelopmental and CAMHS services to redesign pathways for CYP, and avoid duplication across teams. 6. CONCLUSIONS It is predicted that the NHSL CYP OT Service will breach the locally agreed waiting times performance target over the next 6 months due to the national recruitment challenges of specialist and experienced CYP occupational therapy staff. However, the application of the performance recovery plan
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4 noted above, and progression of recruitment opportunities will be progressed to optimise performance and progress towards the 12 week waiting times target. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing 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 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 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 ☒ 7.2 ASSOCIATED MEASURE(S) Monthly reporting of performance via the Lanarkshire Primary Care & Waiting Times Performance Group. Monthly re- assessment of risk via the CYP OT Waiting Times Performance on South HSCP Risk Register 7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☐ N/A ☒
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5 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 PEOPLE The CYP OT Team are being supported by the CYP OT Care Group Lead, and the Head of Occupational Therapy Profession. The Spiritual Care Team are supporting staff health and wellbeing. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS None. 9. APPENDICES None. Please include a glossary of terms if not already included. Yes ☐ No ☐ N/A ☒ Yes ☐ No ☐ N/A ☒
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6 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Janice McClymont, Janice.Mcclymont@lanarkshire.scot.nhs.uk
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1 REPORT Item No: 12 SUBJECT: Community Alarm Analogue to Digital Transition and Service Review Update TO: Integration Joint Board Performance, Finance and Audit Committee Lead Officer for Report: Diane Fraser, Head of Adult Social Work Services Author(s) of Report Karen Workman, Manager Adult Social Work Margaret Flavell, Manager Adult Social Work DATE: 19th April 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval For endorsement To note 1.1 This report informs Committee of the current position in relation to the Community Alarm Service, particularly describing the drivers for undertaking a review of the service and anticipated outcomes; and the Service’s transition from an Analogue to Digital infrastructure. 2. ROUTE TO THE BOARD This paper has been: Prepared Margaret Flavell and Karen Workman both Senior Managers Adult Social Work Reviewed Home Support Programme Board Endorsed Health and Social Care Partnership CORE team
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2 3. RECOMMENDATIONS It is recommended that the Integration Joint Board Performance, Finance and Audit Committee: 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Community Alarm Service supports people in North Lanarkshire live safely in their own home by providing a range of responses depending on the individual circumstances of calls made through the button and box in each person’s home. The responses include: • Providing reassurance • Contacting a friend or family member to visit • Arranging a home support worker to attend • Contacting GP or Emergency Services 5.2 The service operates 24 hours per day, 7 days a week, 365 days per year. When the individual activates the alarm, a signal is sent via the telephone line to the alarm receiving centre in North Lanarkshire which is staffed 24 hours a day, 365 days a year. A Response Advisor (call handler) speaks directly to the person to find out what kind of assistance is required. 5.3 The service provides 7,500 people in North Lanarkshire with the confidence that they can call for help at any time of the day or night, every day of the year and is an essential service when people experience particular difficulties such as a fall or sudden illness. 5.4 The majority of people live in their own home however the service also provides cover to all tenants living within NLC Sheltered Housing Complexes during out of hours and variously to registered social landlords. (1) Acknowledge the contents of this Community Alarm Service Report. (2) Acknowledge the work being undertaken to ensure a seamless transition from analogue to digital and the work to date. (3) Acknowledge the progress to date and work ongoing regarding the Community Alarm Service review including the review of co-dependent services, particularly Home Support Out of Hours provision, Social Work Emergency Services and Registered Social Landlords. (4) Acknowledge that recommendations will come back to the committee for endorsement from the review. Yes No N/A
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3 5.5 The Community Alarm Service currently provides a telecare service to around 6,500 service users using dispersed analogue community alarms and to around 1,000 users within sheltered accommodation. 5.6 The service receives on average 1,000 alarm activations per day. Approximately 20% of these daily activations result in a Home Support Worker responding to support the person in their own home, to support with either personal care or in the event of a fall. Most alarm calls are for reassurance, essential to maintaining people in their own homes. 5.7 In addition to the basic button and box which people generally associate with Community Alarms, there are over 1,000 pieces of assistive technology programmed through to the alarm receiving centre. This ranges from door contacts to hard wired smoke detectors for individuals with cognitive impairment. 5.8 In 2020, as part of the centralisation of Care at Home, the service was relocated to the Dalziel Building to sit alongside the centralised Home Support Service, strengthening links and connections. Because of the responsive nature of the support offered through Community Alarms, as well as providing core service it also provides resource to support the Home Support Service, particularly out of hours, as well as significant support to the Social Work Emergency Service. The reach and stretch of the service requires a review of the operating model. 5.9 By 2025 all analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology. Telecommunication suppliers are well on the way to making this switch to IP networks. Scotland’s telecare service providers including health and social care partnerships, housing associations and many other organisations who use analogue connectivity to deliver their services, need to upgrade. 5.10 North Lanarkshire Health and Social Care Partnership (NL H&SCP) and North Lanarkshire Council (NLC) have invested significantly in early intervention and supported self-management for over a decade, with support for change and investment across all sectors which focus on wellbeing. The Community Alarm Service is a key part of supporting self-management with technological advancements creating the opportunity to move from being a crisis response service to being more proactive and preventative. 5.11 The above circumstances summarises the importance of the Community Alarms Service, the changes to the digital infrastructure and need to review the operating model for the service. A review of the Community Alarms Service will develop options for the future service model that capitalise on new ways of working using digital technology, to establish community alarm and telecare services that are person-centred, and outcome focused, and support the achievement of the priorities and ambitions of the North Lanarkshire Health and Social Care Strategic Commissioning Plan 2023-26.
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4 Community Alarm Service Review 5.12 In line with the Digital Health and Care Strategy, a joint initiative between the Scottish Government and COSLA published in October 2021, we aim to improve the health and wellbeing in our communities. We must examine the current community alarm service and identify areas for development or changes required to the service to facilitate a more positive outcome for our citizens. Digital transformation must encompass the full range of health, social care and wellbeing services commissioned and provided by Health Boards, by Integration Authorities and by Local Authorities and their third and independent sector partners. Importantly, it extends as well to informal care, self-care, prevention, and public health. 5.13 This community alarm review will ensure that we are providing a person-centred and outcome focused approach to our community alarm and telecare service delivery that puts the citizen at the centre to ensure that new ways of working and technology will meet the long-term needs of the people of North Lanarkshire (Independent Review of Adult Social Care Scotland). 5.14 The review will consider the current service delivery model and involve communities, service users, families, carers, staff, and other key stakeholders to have their say in development options for the future service model that will deliver the best outcomes for users. 5.15 Focus groups will be a key aspect of this review to allow the views and wishes of our communities and services who have input to our Community Alarm Service to have their voices heard. These focus groups will ensure that we are building towards a person centre service that will meet the ongoing and future needs of the people who require to use the service and those who may require to use the service in the future. In addition, surveys will be sent to key stakeholders including for example GP services across North Lanarkshire for their feedback on the existing service and future needs. 5.16 Focus Groups will include but will not be limited to: Community Alarm Service Home Support Social Work Services (Social Work/Integrated Rehab Teams/Addictions/Integrated Day Service/Locality Support Service/Mental Health) Health Care (Acute/District Nurses/GP’s/Falls Team/Pharmacy) 3rd Sector (VANL/Getting Better Together Shotts) Carers (Carers Together/MacMillan) Housing Services including Registered Social Landlords 5.17 A range of data sources across a variety of systems in use in North Lanarkshire will provide essential information regarding the current community alarm usage and will allow us to detail how and who we support in our communities. This data will also help us determine how we currently use the resources within the Community Alarm Service.
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5 5.18 Using one of our third sector partners we will interview around one hundred individuals living in North Lanarkshire who have had a Community Alarm Service recently, currently use the service or a carer of a family member of someone using the service. 5.19 We will analyse and interpret the range of feedback that has been gathered by the service from the public, from families and wider stakeholders contacting the service. 5.20 We also have Care Inspectorate Inspection Reports of the service and will use the information provided to enhance our learning of the service overall. The review will consider the recommendation to review the registration of the service. 5.21 The move from an Analogue ARC to a Digital ARC will require additional ongoing resources within the Community Alarm Service team to implement and manage the new operational environment. There will be various Device Management Platforms (DMP) that will need to be utilised to monitor, configure and setup new alarms onto the new Digital ARC, and this additional requirement needs to be included in the resource review of the service. 5.22 The service has not been included in any of the recent service reviews of the linked services it supports. It is therefore important that all areas of support the Community Alarm Service provides are included to ensure that proper management and governance structures are in place to support the transition to a new digital platform. Analogue to Digital 5.23 Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started. The rollout is scheduled to be completed by 2025, when analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology. 5.24 Telecommunication suppliers are well on their journey to making this switch to ‘IP networks’. Any systems relying on analogue lines, such as telecare, will be affected by this change. Individuals who have been provided with Analogue telecare equipment from North Lanarkshire Council must have their equipment updated to Digital ready devices to continue to receive a safe and reliable service. 5.25 North Lanarkshire is being supported in this transition by the Digital Office for Scottish Local Government. Across Scotland, most current solutions use analogue dial-up protocols to carry status and alarm signalling between the alarms devices in users’ homes and the Alarm Receiving Centres (ARC) - North Lanarkshire’s ARC is based in the Dalziel Building in Motherwell. Digital IP telephone lines are not designed to support these analogue protocols meaning that there is a risk that telecare alarm signalling will not operate reliably. This
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6 may result in a higher number of failed calls and redials being seen by the Community Alarm responders on the ARC system. 5.26 Current telecare equipment is connected to an individual’s home phone telephone line. The new digital solutions being installed connect to a home’s Broadband Router and from there connect to the IP telephone network. These require mains power to operate, but if there is a mains failure in the house the digital connection (and therefore the Community Alarm) would not work. Backup connection for community alarms is provided via the mobile telephone network using a SIM card in the digital alarm. The currently installed analogue alarms do not have a SIM and therefor have no resilience in the event of a power outage. 5.27 This transition to digital will require reviewing all the alarm devices that are in place within homes in the community and sheltered house residencies and replace these current analogue devices with digital ready alarm devices. There will also be a requirement for digitally enabled peripherals such as falls detectors, door contacts etc, to be thoroughly tested to ensure that they are compatible with any new digital alarm receiving centre and alarm device. The ability to connect existing interconnected fire/smoke detectors via the digital alarm is currently not available. Some manufacturers are working on solutions and have indicated there may soon be an ability to connect with some specific mainstream supplier products. 5.28 We have already changed over 1900 analogue alarms, with a further 600 scheduled to be exchanged by June 2023 to meet the planned change over dates advised by the Telephony providers. 5.29 There will be a requirement for the implementation of a digital ARC in North Lanarkshire to replace our current Analogue ARC to safely allow for calls to be transmitted through the digital network. The requirement of a new digital ARC to support this transition has allowed North Lanarkshire to work with the Digital Office for Local Government to create a tender for a national shared digital ARC. This will allow the Partnership to adopt a new Digital Solution that will meet future requirements and can be customised to our specific operational requirements. This work has included 13 other local authorities to ensure that a robust and secure solution can be found. The tender for this solution was published in March 2023, with a planned award date of June 2023. 5.30 North Lanarkshire currently runs PNC 8.1 an analogue ARC provided by Tunstall Healthcare (UK) Ltd. The current contract runs until the 31st of March 2023 and is being extended for 1 year. 5.31 North Lanarkshire Council have committed to be part of a Nationally Procured Digital Alarm Receiving Centre, led by the Digital Office. This procurement is now live, and the anticipated award date is the end of June 2023. North Lanarkshire will be one of the first adopters.
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7 5.32 Funding was secured from Technology Enabled Care (TEC) Scotland to the sum of £15k to support us to carry out a telecare service review in anticipation of Analogue to Digital transition. 6. CONCLUSIONS The review will consider the current service delivery model and involve communities, service users, families, carers, staff, and other key stakeholders to have their say in development options for the future service model that will deliver the best outcomes for users. The review will also ensure that the service is digitally ready to continue to provide a safe and reliable service. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES The Community Alarm Service impacts across the range of national health and wellbeing indicators. 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT The risk register will be updated in line with the findings and outcome of the review of the service. 7.5 PEOPLE The review of Community Alarms will be built heavily on undertaking focus groups and survey work to ensure that all stakeholders participate and engage in the design of future operating models. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A An EQIA and Fairer Scotland Impact Assessment will be undertaken as part of the review process.
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8 8. BACKGROUND PAPERS None 9. APPENDICES None CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Diane Fraser on telephone number 01698 332001.
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1 REPORT Item No: 13 SUBJECT: Community Solutions Annual Report 2021-22 TO: Integrated Joint Board PFA Lead Officer for Report: Maddy Halliday, CEO Voluntary Action North Lanarkshire Author(s) of Report Maddy Halliday, CEO Voluntary Action North Lanarkshire DATE: 19 April 2023 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Maddy Halliday ☒ Reviewed By: ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS The North IJB PFA Committee comment and note on the Community Solutions Programme’s 2021-22 Annual Report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Community Solutions Annual Report 2021-22 is presented to North IJB PFA for information and comment and, if appropriate, approval and/or referral to the IJB. The Report provides the following information. 5.1.1 Background to the programme with reference to the new Community Solutions Strategy and Investment Plan 2022-25. 5.1.2 A summary of performance and impact during 2021-22 with further detail provided in Appendices. The report provides high level summaries of: overall investment through the programme for 2021-22 - £3.6million key programme developments and most importantly the performance and impact of funded projects including: o reach in term of unique individuals o number of activities/services provided with examples o personal outcomes (with a few exceptions where it was not possible for funded projects to capture this information – e.g. Community Transport.) 5.1.3 An overview of priorities for 2022-23 and progress as of March 2023, which are very positive and significant. Highlights include: development and agreement of the exciting, new Community Solutions “Improving Lives Initiative” successful recommissioning of the Community Solutions Locality Hosts Yes ☐ No ☐ N/A ☒
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3 development of a new Community Solutions Performance Management, Evaluation, Learning and Improvement Framework for implementation from April 2023, which will improve the quality of information captured and shared through the programme. 5.2 Community Solutions Annual Reports are prepared by VANL staff, supported by analysis of performance and evaluation data provided to VANL by funded projects and complementary information captured by VANL directly. 5.3 Programme Annual Reports cover a given financial year April-March and are usually ready in the autumn following the end of the financial year. The 2021-22 Annual Report is late due to the following. 5.3.1 Significant staffing challenges during 2021-22 due to combination of staff leaving; difficulty filling vacancies; and sickness absence. These issues are now mostly resolved, except for new recruitment, which continues to be challenging. 5.3.2 Trebling of custodian funds managed by VANL on behalf of the programme – due to additional investment from HSCNL through the programme and £1.6 million in custodian funding from the Scottish Government to increase community-based support for mental health. This meant staff had to prioritise management of new funding to ensure timely distribution over preparation of reports. 5.4 From spring 2023, Community Solutions Annual Reports will be complemented by Fund Impact and Learning Reports for separate funds due to the increasing number and diversity of the funds managed through the programme. 5.4.1 These Impact and Learning reports will provide more detail on the collective performance, impact and learning of all funded projects for a given fund. VANL will also organise stakeholder events for each Fund at key intervals to support discussion of the learning with a view to informing future health and social care policy, practice and investment 5.4.2 Fund Impact and Learning Reports will be published at different intervals depending on the duration of the fund. For example: For a pilot funds – usually within four months of the end of the pilot For a fund that operate for a year or less – usually within four months of funded projects completing delivery For a fund that operates for more than a year – annually and then within usually within four months of the funded projects completing delivery.
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4 6. CONCLUSIONS 6.1 The Community Solutions 2021-22 Annual Report Reach demonstrates the continued positive impact of the Community Solutions which has been achieved with relatively modest investment. 6.2 The planned increased investment through the programme from April 2023 will enable us to build on and improve reach and impact further. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing 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 reasonably 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 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 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 ☒ 7.2 ASSOCIATED MEASURE(S) See performance and outcome measures presented in the 2021-22 Annual Report.
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5 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Insufficient resources for the North Lanarkshire Community and Voluntary Sector. (To effectively and sustainably deliver its contribution to HSCNL Commissioning Plan.) Very High Ross McGuffie 7.5 PEOPLE 7.5.1 VANL has two staff in critical support roles for the Community Solutions programme who are on temporary contracts which are scheduled to be confirmed as permanent once the HSCNL/VANL Service Level Agreement for the Community Solutions Programme is signed. 7.5.2 The scheduled start date for the SLA is 1st April 2023. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: Yes ☐ No ☒ N/A ☐ Yes ☐ No ☒ N/A ☐ Yes ☐ No ☒ N/A ☐
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6 8. BACKGROUND PAPERS None 9. APPENDICES The Community Solutions Annual Report 2021-22 CHIEF ACCOUNTABLE OFFICER (or Depute): Members seeking further information about any aspect of this report, please contact the following: Maddy Halliday, CEO, Voluntary Action North Lanarkshire: Maddy.halliday@vanl.co.uk
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7 Annual Report 2021-2022 To be considered by HSCNL spring/summer 2023 – after which the report will be designed prior to publication in spring 2023)
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8 Contents 1. Introduction 2. Background to Community Solutions 3. Community Solutions Achievements 2021-22 4. Community Solutions Priorities for 2022-23 5. Appendices
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9 1. Introduction The Community Solutions (CS) Programme is a North Lanarkshire partnership initiative involving: Health and Social Care North Lanarkshire’s (HSCNL) public sector partner organisations – North Lanarkshire Council (NLC) and NHS Lanarkshire Voluntary Action North Lanarkshire (VANL) - the programme’s host organisation Community and Voluntary Sector (CVS) funded organisations and projects This report provides an overview of the work and achievements of Health and Social Care North Lanarkshire’s Community Solutions Programme and its funded projects during 2021-22, with a focus on activity, reach and, where possible, outcomes and learning. This report is formally presented to HSCNL’s Integrated Joint Board (IJB) and also shared with all stakeholders to provide accountability for the programme and support understanding, learning, and improvement within the programme and more widely across health and social care and community planning. This report is complemented by: progress reports and in-depth Impact and Learning Reports for each fund at appropriate intervals information on each funded project on the new, Community Solutions website (launched in spring 2023). This Annual Report for 2021-22 was published late in March 2023 due to capacity issues within VANL caused by the rapid and significant increase in the amount of custodian funds being managed through the programme. The 2022-23 and future Annual Reports will be published in the autumn following the end of the financial year in March Many thanks to the funded projects which provided information and to the VANL staff who prepared this report.
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10 2. Background to Community Solutions Community Solutions is a successful, cross-sector health and social care investment and improvement programme for North Lanarkshire. The programme - which was established in 2012 - aims to improve 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 programme invests strategically in the Community and Voluntary Sector (CVS) through several complementary strands of work. Local partnership-working between the CVS and public sector through six Community Solutions Locality Consortia, to identify and respond to local needs, including development of a Local Partnership Plan and management of a Local Activity Fund which makes small funding awards to CVS organisations. Development and delivery of direct support and services by CVS organisations on priority, thematic issues including anticipatory care; befriending; carers’ support; community transport; hospital discharge support and more. Capacity-building for carers’ and the CVS. The programme is an innovative, effective, and respected partnership and collaborative initiative between statutory and community and voluntary organisations and the public, including: Health and Social Care Partnership North Lanarkshire which is responsible for planning, commissioning, and overseeing the delivery of community health and social care services across North Lanarkshire. HSCNL provides core and project funding for the Community Solutions Programme, as well as governance and delivery support for the programme. The North Lanarkshire Children’s Services Partnership which is responsible for planning, commissioning, and overseeing children and young people’s services across North Lanarkshire. The Children’s Services Partnership provides funding for the Community and Voluntary sector to support children and young people’s mental health and wellbeing, which is managed through the Community Solutions Programme. Voluntary Action North Lanarkshire, the local Third Sector Interface (TSI), which hosts and manages the programme on behalf of HSCNL and the Children’s Services Partnership. The diverse, large and vibrant Community and Voluntary Sector operating in North Lanarkshire, which receives funding through the programme and other sources to provide information, support, and care to individuals, families, and groups and work with local people to strengthen community capacity, resources, and resilience.
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11 Local people who support programme planning, delivery, and evaluation as service users, carers, volunteers and residents. 2.1 Vision and Mission 2.1.1 Vision The Community Solutions vision is for a North Lanarkshire where: the community and voluntary sector have greater capacity to strengthen communities, improve lives, and advance equality and human rights priority groups are helped to “live their best life” with access to person- centered, timely, effective community-based preventative and early intervention support, provided by community and voluntary organisations, complemented by timely access to public sector services communities are stronger, more resilient and inclusive, with improved health, wellbeing and quality of life, with reduced inequality and protection of human rights 2.1.2 Mission The Community Solutions mission is to provide strategic investment and support to the CVS, so the sector is able to work with local people and public sector colleagues to achieve its vision. 2.2 Approach and Values Community Solution’s values and approach underpin our mission and provide the foundation upon which the Programme is built. 2.2.1 Holistic and Integrated Approach The Community Solutions Programme takes a holistic and integrated approach to health, wellbeing, quality of life and equality encompassing: mental and physical health and wellbeing and their connection the social, economic, and environmental influences on health, wellbeing, and equality and the actions needed to tackle these. 2.2.2 Strategic Investment Approach Community Solutions takes a strategic investment approach which prioritises the following in line with HSCNL’s ambitions: investment in health improvement, prevention, and early intervention activities, which reduce inequalities and protect human rights investment in crisis and ongoing support, with a focus on recovery and re- enablement, self-directed support, and self-management. cost-effective, community-based support and services provided by CVS organisations.
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12 capacity building within the CVS and wider community by supporting key CVS ‘anchor’ organisations and volunteering to build the community infrastructure and capacity to support provision of good community-based support over time 2.2.3 Values Community Solutions also takes a value-based approach. The Community Solutions Programme values are: Person-centered and empowering, placing the person at the centre of the service, helping them to live their best life and supporting their human rights by: actively listening and understanding their needs supporting people to develop their personal resources and capabilities helping them to develop and sustain supportive relationships and social connections Collaborative working and co-production, to achieve goals and improvements where we develop equal relationships between people who use services and people who provide services – with support provided ‘with people’ rather than ‘to them’. This means involving local people - including those receiving support - and service providers in the CVS and statutory sectors to facilitate a positive and participatory cycle of planning, delivery, evaluation, learning and continuous improvement. This approach is informed by the Ladder of Participation and National Community Engagement Standards. 2.3 Programme Governance Community Solutions is governed through a “triple-lock” approach and supported and managed locally and across North Lanarkshire. Six local CVS organisations receive funding to act as “locality hosts” for the Community Solutions Programme in their area and convene locality Community Solutions consortia meetings involving CVS funded organisations; HSCNL locality and VANL staff. These consortia review local needs and priorities; agree a Locality Development Plan and manage a Local Activity Fund (LAF) for their area. The six locality host organisations also meet regularly with key VANL staff to share information and discuss key issues to inform locality and North Lanarkshire-wide developments VANL convenes and supports the Community Solutions Governance Group, which meets at least quarterly with representatives from HSCNL, VANL and the CVS to support strategic planning, review, improvements and reporting HSCNL’s senior management and its Integrated Joint Board agree the programme’s strategy and funding and review progress reports.
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13 2.4 Programme Delivery and Evaluation Support VANL hosts and manages the Community Solutions programme on behalf of HSCNL and the Children’s Services Partnership and receives funding to cover the costs of this work, which includes the following: programme governance support facilitating collective planning and development of the programme overall and specific funds programme communications and liaison with key stakeholders management of funding awards evaluation, learning and improvement support for each custodian fund and funded projects overall co-ordination of programme performance management, evaluation and reporting. In addition, VANL is commissioned by HSCNL and others to provide capacity- building support – currently on the following three, key issues: CVS support for children, young people and families CVS and localities Volunteering. VANL staff also provide wider capacity-building support for the CVS and support links between the Community Solutions Programme, health and social care, children’s services and community planning. Much of this work is resourced by VANL’s complementary, core funding from the Scottish Government and North Lanarkshire Council (NLC). VANL’s support for the Community Solutions Programme is monitored through the Programme’s “triple-lock” governance arrangements. 2.5 Programme Performance Management and Evaluation Preparation of this report was supported by information captured by funded projects and VANL, supported by the Programme’s Evaluation Framework. This information includes: reach - including number, type and location of funded projects; number of unique individuals supported activity – type of support and services provided personal outcomes for people receiving support through funded projects The Community Solutions Programme has a range of aspirational personal outcomes for people receiving support through funded projects as set out below. Funded projects invite services users to provide feedback on their views about whether the support provided has helped them achieve these outcomes. For adults o People to have improved health and wellbeing o People to feel more connected, included and safe o People to feel more informed and aware
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14 For unpaid carers o Carers to feel more informed and aware o Carers health and wellbeing to be improved o Carers to be more able to have a life outside of caring For children, young people and families: o Improved health and wellbeing o Family relationships strengthened o Increased resilience As indicated in Section 4 below, VANL worked with partners to develop and strengthen the programme’s approach to performance management and evaluation during 2022. Our updated approach will improve performance management, evaluation, reporting for each funded project and fund and the programme overall from April 2023 and will be reflected in reports from autumn 2023 onwards. 3. Community Solutions Achievements 2021-22 3.1 Development of the New Programme Strategy and Investment Plan During 2021-22 VANL staff facilitated consultation, drafting and agreement of a new Community Solutions Strategy and Investment Plan 2022-25. The plan, which was approved by HSCNL IJB in March 2022, sets out how the Community Solutions Programme will invest the funding it receives from its funders in the years ahead 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-centered, community-based support and services to priority groups.’’ The Strategy and Investment Plan is published on the new Community Solutions website, launched in spring 2023.
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15 3.2 Custodian Funds and Funding Management 3.2.1 During 2021-22, over £3.6 million of funding was managed through the Community Solutions Programme by VANL on behalf of several funders including: Health and Social Care North Lanarkshire Scottish Government North Lanarkshire Council (linked to Children’s Services Partnership) Funding awards were made to a total of 225 projects delivered by 95 community and voluntary sector (CVS) organisations. In addition, VANL received £168,000 in funding to support CVS capacity building as outlined above and, in the table, below and funding to support delivery and evaluation of the Community Solutions programme, as set out in section 2.4. The £3.6 million of funding managed by VANL through the Community Solutions programme during 2021-22 was a trebling of funding managed in previous years and required significant staffing development within VANL to increase our capacity. Summary of Community Solutions Programme Funding 2021-22 Funding Source and Fund Funding Amount (£) 1. Health and Social Care North Lanarkshire 1.1 Locality Funding (6 HSCNL Localities) Locality Hosts Funding 240,000 Locality Activity Funding 180,000 1.2 Thematic Funding Anticipatory Care 71,620 Carer Breather 100,000 Carer Strategy Implementation Support (via North Lanarkshire Council) (Carers Together North Lanarkshire) 40,000 Community Food 40,000
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16 Community Transport 72,000 Home Visiting and Befriending 189,514 Funding Source and Fund Funding Amount (£) Hospital Discharge 77,500 Physical Activities 40,000 ShopMobility 32,058 1.3 CVS Capacity Building Support Carers’ Network (Carers Together North Lanarkshire) 40,000 Children, Young People and Families (VANL) 30,000 CVS and locality support (VANL) 60,000 Volunteering (VANL) 38,000 1.4 VANL Programme Delivery and Evaluation Support 80,000 1.5 Unallocated funding c/f to 2022-23 6,871 1.6 Sub-total: HSCNL Funding 2021- 22 1,342,678 2. Scottish Government Funding – direct to VANL or via third party 2.1 Community Children and Young People Mental Health and Wellbeing Fund (phase Two) (via North Lanarkshire Council) 2.1.1 Custodian Funding managed by VANL with North Lanarkshire Council colleagues on behalf of Scottish Government and awarded to CVS organisations. 439,432
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17 Please see the Appendices for a full break-down of the distribution of all Community Solutions funding for 2021-22. 3.3 Localities The Community Solutions programme is rooted in our local communities to support effective partnership working between the CVS, public sector and engagement of service users and carers and wider public. This partnership working and engagement is supported through six Community Solutions: CVS locality host organisations Consortia Locality Activity Funds. 3.3.1 Locality Hosts The Community Solutions programme is supported at locality level by six CVS “anchor” organisations that as act as “locality hosts” for the programme. The locality hosts provide the following support: 2.1.2 VANL Delivery Costs 40,186 Funding Source and Fund Funding Amount (£) 2.2 Community Mental Health and Wellbeing Fund (to support people over 18) (direct to VANL) 2.2.1 Custodian Fund managed by VANL on behalf of Scottish Government and awarded to CVS organisations. 2.2.2 VANL Delivery Costs 1,671,372 71,358 2.3 Support in the Right Direction (Custodian fund via Inspiring Scotland managed by VANL through Community Solutions programme with funding for two CVS organisations. No delivery costs for VANL.) 88,241 2. 4 Sub-total: Scottish Government Funding 2021-22 2,310,589 3. TOTAL Programme Funding 2021-22 3,653,267
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18 convene and support the six, Community Solutions Locality Consortia support the development and delivery of Locality Partnership Development Plans with members of the consortia, other CVS organisations, service users and unpaid carers work with the consortia and VANL to manage the Locality Activity Fund (LAF) for their locality work with VANL to support wider CVS and volunteer capacity building and links with community planning The Community Solutions’ locality hosts for 2021-22 are listed below, each of which received £40,000 funding to deliver their role. Locality Locality Hosts 3.3.2 Locality Consortia The Community Solutions Locality Consortia comprise representatives from the local CVS and health and social care staff from the council and NHS who meet at least quarterly to discuss key local issues and support development and delivery of their Local Development Plan and LAF. 3.3.3 Locality Activity Fund There are six Community Solutions Locality Activity Funds (which provide small grants to CVS organisations in each locality to help them deliver a new or improved activity to support residents. Each consortia decides on how to allocate their LAF in line with their Locality Development Plan. LAF awards are then managed by locality hosts and VANL. During 2021-22 each locality had a £30k LAF to allocate – a total of £180,000, which was distributed to a total of 82 projects. (See diagram below and Appendix B.) Because each LAF award is relatively small, funded projects are not required to undertake a full evaluation, however, funded projects capture and share key data with Locality Hosts/VANL for reporting purposes. Also, checks are made by Locality Hosts and VANL to ensure funded work is delivered.
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19 LAF Awards 2021-2022 – Reach and Activities In 2021-22, Locality Activity Fund awards have… Funded 82 projects Supported 1818 individuals, including 996 carers Supported the delivery of 489 activities (excluding daily/monthly activities) Including community development projects, outdoor projects, post-Covid recovery, cooking, food and nutrition, physical activity, and arts projects See Appendix B for a full list of funded projects by locality. LAF Awards 2021-2022 – Impact In 2021-22, as a result of Locality Activity Fund projects… 1259 people felt more connected, included and safe 810 people have improved health and wellbeing 550 people felt more informed and aware 207 carers felt more informed and aware Carers Children, Young People and Families Adults 134 carers health and wellbeing was improved 230 carers were more able to have a life outside of caring 1067 children, young people or families’ health and wellbeing was improved 125 families relationships were strengthened 164 children, young people and families have become more resilient
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20 3.4 Thematic Funding Community Solutions funding is awarded to a range of CVS organisations to provide services and support to residents on selected, priority “thematic” issues, which are outlined below, with details of funding, reach and outcomes for 2021-22. 3.4.1 Anticipatory Care Background The Community Solutions Anticipatory Care funding award is provided to the North Lanarkshire CVS organisation Equals Advocacy, which uses this funding to employ advocacy workers to support anticipatory care for older, frail adults in liaison with health and social care staff. This funding has been in place since 2012. Anticipatory Care in North Lanarkshire aims to help connect older, frail adults to services and support at an early stage, supported by a Primary Care Frailty Multidisciplinary Team (MDT) and an independent advocacy worker employed by Equals Advocacy. GPs support this service and approach by identifying an older person with increasing frailty. The person is then referred to Equals Advocacy which helps the person complete one or more assessments at home supported by an advocacy worker. This information is shared with the MDT which develops and agrees an Anticipatory Care Plan in liaison with the service user. During 2021-22, Equals Advocacy received a funding award of £71,312 through the Community Solutions Programme to support their role in this service.
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21 Achievements 2021-22 Equals Advocacy support evaluation of their advocacy service by asking service users to complete feedback questionnaires at the start and end of their engagement with advocacy support and provide VANL with summary, anonymous information to support reporting. In 2021-22, Community Solutions funding has supported Equals Advocacy to… Support 369 individuals through the Anticipatory Care project Deliver 240 activities Support 305 of the 369 total individuals to meet Community Solutions personal outcomes such as.. 103 people felt more connected, included and safe 62 people had improved health and wellbeing, and felt more informed and aware 26 carers… felt more informed and aware health and wellbeing was improved were more able to have a life outside of caring 3.4.2 Befriending 5 Background Befriending provides support to people who are lonely and isolated to increase their social support and inclusion and improve their quality of life and wellbeing. Community Solutions provides funding to the following CVS organisations to recruit and support trained, befriending volunteers. This funding has been provided since 2012: Befriend Motherwell CACE Elim Christian Centre Getting Better Together Glenboig Development Trust HomeStart Orbiston Neighbourhood Centre Volunteering Matters YMCA Bellshill
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22 Funding Awards 2021-2022 Total number of projects funded: 9 Total amount awarded: £189,514 Achievements 2021-22 In 2021-22, Community Solutions funded Befriending projects… Supported 1510 individuals through 2995 activities Including telephone befriending, home visits, group and 1-1 befriending, and volunteer recruitment Supported 2145 unique individuals to meet Community Solutions personal outcomes Secured an additional £158,398 of funding from other sources Been supported by 116 o volunteers, who dedicated 1942.5 volunteering hours For children, young people and families... • 168 had improved health and wellbeing • 15 family relationships were strengthened • 138 had increased resilience For example, • 638 people’s mental health and wellbeing improved • 1182 people felt more connected, included and safe • 455 people felt more informed and aware *The number of people who met Community Solutions personal outcomes is higher than the total individuals supported as it is the number of unique individuals who reported on each outcome 3.4.3 Carers’ Breather Background The Community Solutions Carers’ Breather fund was established in 2020, informed by review of previous Community Solutions funding for unpaid carers. The purpose of the Fund is as follows. To enable CVS organisations to enhance and extend regular and locally based support for unpaid carers, including carers who do not necessarily wish to identify as a carer and/or are unknown to formal services For carers to be supported to: o enjoy the benefits of regular and ongoing breaks in their neighbourhood o access support without having to formally link up with carers’ support organisation
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23 Funding Awards 2021-2022 Total number of projects funded: 9 Total amount awarded: £89,981 Achievements 2021-22 In 2021-22, Community Solutions funded Carer Breather projects… Delivered 684 activities Supported 215 cared for people and 363 carers and their wider families Been supported by 22 volunteers, who devoted 354 hours. Supported 712 individuals to achieve carer-specific community solutions personal outcomes For example, • 244 carers’ felt more informed and aware • 246 carers’ health and wellbeing was improved • 222 carer’s were more able to have of a life outside of caring Including therapeutic arts workshops, craft activities, garden projects, drop in sessions *The number of people who met Community Solutions personal outcomes is higher than the total individuals supported as it is the number of unique individuals who reported on each outcome 3.4.4 Children and Young People’s Community Mental Health and Wellbeing Fund Background The purpose of this fund is to improve the mental health and wellbeing of children and young people in North Lanarkshire by increasing support provided by local CVS organisations in liaison with schools. The Fund was developed in 2020 with an initial pilot (Phase One) involving schools, staff in the council’s Education and Families team, VANL staff and CVS organisations. Decisions regarding funding awards are led by schools, informed by local needs and priorities and learning from the previous phase. The fund is managed and supported by School Cluster Improvement and Integration Leads (CILLs) and VANL staff, working closely together.
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24 The Fund supports delivery of the Scottish Government Children and Young People’s Mental Health and Wellbeing framework, and the North Lanarkshire Children’s Services Plan and is part of a suite of mental health and wellbeing initiatives for children and young people in North Lanarkshire, managed through our Children’s Services Partnership. Funding is provided by the Scottish Government through North Lanarkshire Council to VANL for distribution the North Lanarkshire CVS. Funding Awards 2021-2022 Total number of CVS projects funded: 53 Total amount awarded: £434,700 Achievements 2021-22 In 2021-22, the Children and Young People’s Community Mental Health and Wellbeing Fund… Supported 1263 primary school children, 548 secondary school children, and 654 wider family members* (*parents, siblings, carers) Awarded funding to 53 projects across 21 CVS organisations Delivered projects to 40 primary schools, and 12 secondary schools involving 11 clusters Delivered the following activities • Art, play and drama therapy • Additional support needs tailored supports • Counselling, trauma and bereavement • Digital activities • Equine therapy • Healthy eating and nutrition • Mindfulness and selfcare workshops • Parental supports • Physical and outdoor activities
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25 The outcomes for children and young people supported by the above funded projects are assessed using “The SHANARRI Wellbeing indicators for children and young people. Outcomes for 2021-22 are summarised below. Healthy 1452 Safe 1656 1309 Achieving 1320 1463 Nurtured Active 1429 1301 Respected Responsible 1001 Included children and young people feel… The Impact and Learning reports for Phase One and Two of the Children and Young People’s Mental Health and Wellbeing Fund are available on the new Community Solutions website launched in spring 2023.
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26 3.4.5 Community Mental Health and Wellbeing Fund Background The Community Mental Health and Wellbeing (CMHWB) Fund is a national fund established by the Scottish government in late 2021 to help local CVS groups provide increased mental health and wellbeing support. The Scottish Government asked the 32 Third Sector Interfaces (TSIs) in Scotland – of which VANL is the interface for North Lanarkshire – to manage the funding on their behalf. VANL was required to manage the fund in partnership with HSCNL and because we already have the Community Solutions programme, it made sense to manage this fund through the programme to supporting synergy with other programme funding. In February of 2022, VANL was allocated an initial £995k from the Scottish government to distribute to organisations in North Lanarkshire’s CVS. VANL received 85 applications requesting a total of £2.1 million in funding. The initial funding allocation meant only the top 30 projects could be funded. VANL then secured an additional £720k of funding from the Scottish Government. Funding Awards 2021-22 Number of Projects: 52 (see Appendix A for full list) Total amount: £1.6 million Achievements 2021-22 In 2021-22, the Community Mental Health and Wellbeing Fund… Been supported by 237 volunteers who devoted 7902 hours Helped projects to secure an additional £258,105 of additional funding Supported 8139 individuals through 10,939 activities For example, activities include: • healthy eating education • arts projects • stress management • relaxation • bereavement support wellbeing classes • men’s groups • exercise • garden projects
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27 In 2021-22, the Community Mental Health and Wellbeing Fund … Supported 9183 individuals to meet Community Solutions personal outcomes Of the 8139 people supported, those that reported on outcomes met showed: • 3004 adults’ health and wellbeing improved (141 carers) • 1660 adults felt more connected, included and safe • 1540 adults felt more informed and aware (181 carers) • 1847 children and young people’s health and wellbeing improved • 463 family relationships improved • 438 have children & young people have increased resilience *The number of people who met Community Solutions personal outcomes is higher than the total individuals supported as it is the number of unique individuals who reported on each outcome 3.4.6 Community Transport Background The Community Solutions funding to support Community Transport has been provided to the North Lanarkshire CVS organisation, Getting Better Together (GBT) since 2016. Community Transport supports vulnerable residents to travel to essential appointments and key activities, supporting their health, wellbeing and inclusion. Community Transport services are demand-responsive and therefore determined by service users’ requirements. During 2021-22, GBT also supported NHS Lanarkshire and its staff with transport during the COVID pandemic. Getting Better Together (GBT) received a Community Solutions funding award of £72,000 during 2021-22, which, combined with funding from other sources, helped GBT deliver the following community transport services. Transport for community groups, schools, CVS and non-profit organisations using bookable, fully wheelchair accessible minibus and multi-purpose vehicles. A volunteer driver service, where volunteers use their own car to transport people to essential NHS appointments and are reimbursed for their expenses.
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28 A Community Transport HUB pilot partnership with NHS Lanarkshire and Community Transport Glasgow providing transport support for patients, staff, samples and supplies during the COVID pandemic.
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29 Achievements 2021-22 In 2021-22, with Community Solutions funding, Getting Better Together’s Community Transport project… Avoided estimated £77197 total probable cost for NHS Lanarkshire, of which £39,960 was due to the Volunteer Driver Service Been supported by five volunteer drivers who gave 1624 hours Provided 4312 passenger journeys, covering 58,325 miles. 1184 of the 4312 total journeys were provided by volunteer drivers, covering 23,343 of the total miles The Community Transport Hub pilot began on 1st April 2019; due to the COVID pandemic, GBT adapted its existing services to pilot the Community Transport Hub with NHS Lanarkshire. Through this pilot, GBT supplied the NHS with two drivers and vehicles, five days a week providing 1,409 journeys covering 33,342 miles. GBT also adapted their volunteer driver service during Covid, with GBT staff replacing volunteers. 3.4.7 Hospital Discharge Background The Community Solutions funding for Hospital Discharge Support Service (HDSS) has been provided to the CVS organisation Getting Better Together (GBT) since 2013. The aim of the HDSS is to help patients and carers to access additional community- based support following hospital discharge to: support rehabilitation and recovery, including physical activity support self-management reduce loneliness and isolation The service is available to all North Lanarkshire residents aged over 16. The HDSS has a base in the University Hospitals in Monklands and Wishaw. HDSS staff also liaise with University Hospital Hairmyres and other rehabilitation settings throughout Lanarkshire to support the discharge of North Lanarkshire-based patients.
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30 HDSS staff provide guidance and support to patients, carers and families through the discharge process. The service uses a person-centred approach - with staff discussing personal outcomes with patients, carers and families. Staff also signpost service users to sources of personal and community support – including support provided by CVS organisations - that they can access following discharge from hospital. The funding award to GBT to provide the HDSS 2021-22 during 2021-22 was £149,120. Achievements 2021-22 In 2021-22, with Community Solutions funding, the Hospital Discharge Support Service… Supported 629 individuals Supported 262 individuals to meet Community Solutions personal outcomes Delivered 179 activities Including hospital discharge transport, and referrals and signposting to appropriate services Of the 262 individuals that reported on Community Solutions personal outcomes, • 87 peoples’ health and wellbeing improved • 96 peoples felt more informed and aware • 42 carers felt more informed and aware • 37 carers’ health and wellbeing improved The service refers patients to other local community supports. In 2021-22, the most common supports requested were for: carer support – 35 referrals social opportunities such as befriending and community groups – 22 referrals financial inclusion – 9 referrals ex-armed forces support – 9 referrals In 2021-22, more referrals were made on behalf of patients/carers, than by patients/carers themselves.
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31 3.4.8 Physical Activities Background During 2021-22, Community Solutions provided the then, North Lanarkshire Leisure Trust with £60,000 to support provision of physical activities for people across North Lanarkshire with a range health conditions to enhance their physical and mental wellbeing. Referrals to the service were received from a health and social care staff. Achievements 2021-22 In 2021-22, with Community Solutions funding the Physical Activities project… Supported 2584 individuals across the service overall Supported 2584 individuals to meet the Community Solutions personal outcome: ‘Adults health and wellbeing is improved’ Including: • 1964 new referals to the general project • 620 new referals to specialist health classes 3.4.9 ShopMobility Background During 2021-221, Community Solutions provided a funding award of £32K to the Health and Wellness Hub (HWB) to support provision of a ShopMobility service in Motherwell and Coatbridge. The service supported people with mobility difficulties to access shopping and other community facilities by providing a range of easy-to-use portable scooters, wheelchairs and power chairs. Staff and volunteers involved also 1 The Community Solutions funding for this service was to provide interim support to the HWH while they endeavoured to secure longer term funding for the service. Unfortunately, HWH announced in September 2022 that they were closing their Mobility Hubs in both Motherwell and Coatbridge as they had not secured sufficient funding to sustain the service. VANL and others are exploring options regarding the future for a service of this kind.
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32 provided useful information to service users and signposted them to other sources of support provided by CVS and public sector organisations. Achievements 2021-22 In 2021-22, with Community Solutions funding, ShopMobility… Supported 318 individuals through 942 activities and interactions Including new registrations to the service, use of their community hub and classes Been supported by 3 volunteers, who have provided 229 hours Supported 170 individuals to meet Community Solutions personal outcomes 170 of the total 318 individuals supported reported on Community Solutions personal outcomes, including: • 35 people felt more connected, included and safe • 50 peoples’ health and wellbeing improved • 85 people felt more informed and aware 3.4.10 Support in the Right Direction Background The Scottish Government funds a national “Support in the Right Direction” (SiRD) programme which aims to empower people and carers receiving social care support and services to be equal partners in their care where they have real choice and control over their lives, including: decisions about where they live and the services they receive participation in fulfilling activities and their community employment if appropriate This is usually referred to as “self-directed support”. The national SIRD Fund is managed by Inspiring Scotland on behalf of the Scottish Government and VANL since 2017. VANL has distributed this funding through the Community Solutions Programme to two CVS organisations: Equals Advocacy North Lanarkshire Disability Forum
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33 Their Community Solutions funding helps these two organisations provide the following services: general and focussed in-depth self-directed support including 1-to-1 case work, online and Zoom conversations, information sessions community connectors, who work directly with people to find suitable supports like groups and activities Funding Awards 2021-22 Number of Projects: 2 Total amount: £88,241 Achievements 2021-22 In 2021-22, the Support in the Right Direction project has Supported 694 individuals Of the total 694 individuals, 87 were carers This includes: • 141 people provided focused support • 141 people supported through case work • 412 people supported with general independent support activities • 56 of those were carers living with a condition • 31 were carers accessing support for their own personal outcomes
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34 3.5 Capacity Building During 2021-22 Community Solutions invested in the following four areas of capacity-building. Carers Children, Young People and Families CVS (localities and North-Lanarkshire wide) Volunteering 3.5.1 Carers’ Capacity Building Background Community Solutions supports capacity building for Carers by funding North Lanarkshire Carers’ Together to support the Carers’ Network and a range of other carers’ support activities. Achievements 2021-22 During 2021-22, North Lanarkshire Carers Together received a grant of £40,000 with which it achieved the following. Supported the Carers Network, which brings carers together to share information; provide peer support; and develop collective views to inform improved policy and practice. Supported development and delivery of the the Carers’ Breather Fund outlined above, including development of a successful “Referral Guide”. Led on further development of a Carers’ Pathway Toolkit, to ensure that Carers’ needs are considered and supported when planning services for the people they care for. Influencing carers’ policy and services through participation in the North Lanarkshire Carers’ Strategy Group and other forums ‘It’s imperative we listen to the carers to help shape how the service is delivered. We know service design and redesign should have people who receive the service at the heart of the process and our carers are very much the same’ - Service provider ‘Today was my first time meeting with this amazing group. I had a back massage which I’ve never had before in my life. I feel relaxed and more able to complete my day. Meeting with other carers in my position has benefitted me greatly and I look forward to meeting again next week.’ - Carer
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35 3.5.2 CVS Capacity-Building Background VANL staff provide capacity building support to CVS organisations to help them strengthen their individual and collective ability to provide effective and sustainable support and services to residents. VANL supports: CVS organisations receiving new or re-current funding through the Community Solutions programme, including organisational reviews CVS organisations that do not currently receive funding through Community Solutions but provide support and services to residents and which may apply for Community Solutions funding in future. VANL staff support CVS capacity building in two ways. By providing organisational development support to CVS organisations on issues such as: o governance o income generation o finance, HR and ICT management o evaluation By supporting the sector to come together in different ways to share information; support learning and facilitate partnership working and influencing. We do this in several ways including: by convening and supporting meetings of the North Lanarkshire CVS Partnership Group and several thematic networks by organising regular CVS locality events and an annual conference
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36 Achievements 2021-22 VANL’s CVS capacity-building work was supported during 2021-22 with a £60,000 grant through Community Solutions, supplemented by core funding from the Scottish Government and North Lanarkshire Council. (Also see Children, Young People and Families section below.) VANL staff provided the following support to CVS organisations during 2021-22… 150 CVS organisations were provided with guidance on key issues to support their sustainability and effectiveness including income generation, governance, ICT, human resources. 64 organisations had their accounts independently examined by VANL’s qualified finance team. The new, North Lanarkshire Community Lottery was planned and launched to support the local CVS to raise more funding from the public. Training was provided to over 260 CVS staff and volunteers on a range of topics such as volunteer management, child protection and successful funding applications. . Nine CVS Funding e-bulletins and 24 funding e- alerts were prepared and distributed – in liaison with HSCNL and Council colleagues. The CVS were supported to network, collaborate and influence policy and practice through the following CVS networks: • Befriending • Children, Young People and Families • Community and Voluntary Sector Partnership Group (CVSPG) • Employability Network • Mental Health and Wellbeing Network 3.5.3 Children, Young People and Families VANL staff undertake capacity building with the CVS to strengthen the support they provide to local children, young people and families to improve their wellbeing. VANL does this in the following ways. Convene and support the North Lanarkshire CVS Children, Young People and Families Network to support information-sharing; peer support; and partnership working through the North Lanarkshire Children’s Services Partnership; HSCNL; North Lanarkshire (Community Planning) Partnership (NLP). Support the CVS to strengthen their contributions to: o helping mothers breastfeed successfully with bespoke training from the Infant Mental Health Team and links with community midwives. o child protection, through provision of training by VANL staff o tackling poverty, including supporting CVS organisations that support: employment money and welfare advice community food support o Children and young people’s mental health, including:
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37 a key role in developing arrangements for the Children and Young People’s Community Mental Health and Wellbeing Fund (see 3.4.4) CVS support for improving infant mental health with access to Infant Mental Health Training and The Infant Mental Health toolkit. Young people’s volunteering, including support for the Saltire Awards. Support CVS participation in the Children’s Services Partnership and facilitating links between this, Community Solutions, HSCNL and community planning. Achievements 2021-22 During 2021-2022, HSCNL provided VANL with a grant of £30,000 to support our children, young people and family's capacity-building work as outlined above. This funding was complemented by our core funding from the Scottish Government and North Lanarkshire Council. VANL staff supported the following work with this funding during 2021-22. During 2021-22, VANL staff supported the following children, young people and family's capacity- building work Convened 4 meetings of the Children, Young People and Families Network involving 30 CVS organisations which supported work on the following issues CVS peer support to parents in local community venues. Supported CVS organisations to help families affected by child and family poverty. Provided 4 Introduction to Child Protection training courses to 77 CVC staff. Helped CVS organisations to improve their support for child and young people's mental health and wellbeing through management of Phase 2 of the children and young people's community and mental health and wellbeing fund Supported young people's volunteering by issuing 557 Saltire Awards. Support CVS participation in the Children’s Services Partnership through representation on the Board and Officers Group. 3.5.4 Volunteering Background VANL staff support volunteer development across North Lanarkshire working with the CVS – which involves and relies on many thousands of volunteers to deliver their support and services
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38 public sector partners - including North Lanarkshire Council, NHS Lanarkshire, Police and Fire and Rescue - which also involve volunteers and support volunteering more widely the business sector, which assists through employer supported volunteering VANL staff support volunteering strategically and operationally including: setting up and convening the North Lanarkshire Volunteering Partnership to facilitate improved cross-sector support for volunteering promoting volunteering opportunities to the public and supporting matching to roles and Protection of Vulnerable Groups (PVG) checks supporting volunteer-involving organisations to improve their recruitment and support for volunteers, including accreditation through the Volunteer- Friendly award. Achievements 2021-22 During 2021-2022 HSCNL provided VANL with a grant of £38,000 to support our volunteering development work, which was complemented by our core funding from the Scottish Government and North Lanarkshire Council. During 2021-22, VANL staff supported the following Volunteer Development activities… Recruited and matched 96 volunteers with 30 organisations Trained 43 volunteers PVG checked 81 volunteers across 16 organisations Training included: • Befriending volunteer training • Introduction to volunteering • Training in use of online software such as Locator, Making Life Easier, and the Volunteering Scotland website
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39 4. Community Solutions Priorities 2022-23 This section provides an overview of development priorities for the Community Solutions Programme during 2022-2023. Because this 2021-22 Annual Report was published later than usual in April 2023, this 2022-23 section provides progress updates for these priorities, with full reporting provided in the 2022-23 Annual Report, which will be published in Autumn 2023. 4.1 Custodian Fund Developments 4.1.1 Carer Breather Fund Phase Two Funding for Phase Two of the Carer Breather Fund, covering the period April 2023 – March 2025, was approved by HSCNL in December 2022. Staff in VANL worked with North Lanarkshire Carers Together (NLCT) to promote the fund and support assessment and awards. Applications were assessed and award decisions made by a panel involving representatives from VANL, NCLT and carer representatives, with awards issued by end of March 2023. Learning from Phase One will support delivery of Phase Two, which will be supported by the updated Carer Pathway Toolkit, use of which will be mandatory for projects receiving funding in Phase Two. 4.1.2 Children and Young People’s Community Mental Health and Wellbeing Fund Phase Three Funding for Phase Three of this fund was agreed by North Lanarkshire Council and the Children’s Services Partnership in spring 2022 with a launch event in May 2022. As for Phases One and Two, funding awards for Phase Three were made to local CVS organisations to provide support to children and young people to improve their mental health and wellbeing. Funding decisions were made in late 2022-early 2023, informed by a Learning and Improvement event in Autumn of 2022. Also, communication and support for schools and funded projects has strengthened for Phase Three, including support sessions for funded CVS organisations. 4.1.3 Substance Misuse Fund Following discussions in 2022 between staff in VANL and the North Lanarkshire Alcohol and Drug Partnership (NLADP) £100k funding was made available by NLADP to pilot improved community-based approaches by the CVS to support prevention of substance misuse and people affected by substance misuse. Each Community Solutions Locality Consortia were allocated a proportion of the fund to manage, with applications open from December 2023. The funding will be awarded by spring 2023, with activities delivered thereafter. VANL staff will provided funded projects with evaluation support and prepare a report to support learning from the pilot with a view to securing further investment in effective approaches.
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40 4.1.4 Community Mental Health and Wellbeing Being Fund Phase Two Funding for Phase Two of the Community Mental Health and Wellbeing Fund was announced by the Scottish Government in Autumn 2022 with a total of £955K available to fund CVS organisations in North Lanarkshire. Learning from Phase One informed this second phase, including ring-fenced funding to support Black, Asian and Minority Ethnic (BAME) and LGBTiA+ groups. Applications were sought from CVS organisations during Nov/Dec 2022. A cross- sector Panel involving staff from VANL, NHS Lanarkshire and North Lanarkshire Council assessed all applications and made funding decisions by early March 2023. Awards were issued by the end of March 2023 for activity to be delivered from April. 4.1.5 Improving Lives Initiative Background Social Prescribing Social Prescribing is an approach which assists people to access non-clinical support in their community instead of or in addition to clinical support. The focus is on promoting people’s wellbeing and helping them manage health and other challenges more effectively. Social prescribing approaches have been supported in North Lanarkshire for many years but have tended to develop in a fragmented way developed by different parts of our health and social care system. Between 2019 and 2020, VANL undertook a scoping exercise on Social Prescribing in North Lanarkshire, commissioned by NHS Lanarkshire, with a report published in summer 2020. The intention was that this report would inform future development of a more co-ordinated, cross-sector approach to social prescribing across North Lanarkshire involving the CVS and public sectors. During 2020-21, NHS Lanarkshire and VANL worked together on a joint proposal to develop this work and secured funding to do so from NHS Charities Together. However, due to staffing recruitment challenges, delivery of this work was deferred until late 2022/2023. Improving Cancer Journey Between 2021 to early 2023, HSCNL and VANL staff liaised with MacMillan Cancer Support to agree an approach to investing £800K funding over four years to improve community support for people affected by cancer in North Lanarkshire.
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41 Strengthening CVS Contribution to Prevention and Early Intervention Support in the Community In Feb. 2022, HSCNL approved an additional £1.2 million to be invested through the Community Solutions Programme over two years to strengthen the CVS contribution to prevention and early intervention. A major focus of this funding was to establish a team of “Community Connectors” who would use the “Three Conversations” approach to support people to: Improve their health and wellbeing prevent problems arising and/or escalating and, where they arise, to respond and try to resolve these as quickly as possible support recovery and rehabilitation for people returning home from hospital or residential care help people remain independent in the community reduce the need for formal services. Improving Lives Initiative Plan Between May and December 2022, VANL staff worked closely with HSCNL staff to develop a plan to invest all the above additional funding strategically alongside recurrent Community Solutions Funding for locality hosts and the Locality Activity Fund (LAF) to maximise synergy and impact of these funding streams. ILI will link direct provision of support to individuals by the Community Connectors with investment in the CVS and its ability to provide support by: increasing the size of the generic Locality Activity Fund from £30,000 a year to £xx a year continuing to provide general CVS capacity-building support through Locality Hosts and VANL staff basing the Community Connectors in two Locality Host organisations and the North Lanarkshire Disability Forum linking ILI to North Lanarkshire-wide projects funded through Community Solutions Thematic Funding (see below). ILI will launch in April 2023. 4.1.6 Locality Hosts Re-commissioning In May 2022, the Community Solutions Governance Group agreed to recommission the Community Solutions Locality Hosts. VANL staff liaised with Governance Group members to agree the approach and criteria with further consultation with Community Solutions.
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42 Eligible organisations were able to apply from December 2022 for three year’s funding, commencing in April 2023. Award decisions were made by a cross- sector panel during Feb-March 2023. All but one of the previous Locality Hosts were re-commissioned based on the quality of their applications. Announcements regarding the new Locality Hosts will be made in April. The Locality Hosts will be supported by VANL staff to strengthen their local consortia and links to Community Boards and other statutory partners in their locality. 4.1.7 Review of Community Solutions Thematic Funding In autumn 2022, the Community Solutions Governance Group agreed that Community Solutions Thematic funding should be reviewed as the funding awards had remained the same for over twelve years. VANL staff started to set up arrangements to support this review involving members of Community Solutions Locality Consortia and other HSCNL staff. Recommendations arising from this review will be considered by the Community Solutions Governance Group and senior HSCNL management with a view to reaching agreement on any changes by summer 2023 for implementation to a schedule also to be agreed. 4.1.7 Proactive Support for People in the Community At the request of HSCNL, VANL staff developed a proposal during early 2023 to build on several community-based pilot initiatives in North Lanarkshire over the last few years to strengthen proactive support for frail and vulnerable people in the community. In addition to facilitating improved wellbeing through better community support, the project also aims to reduce attendance at A&E and admission and re-admission to hospital. The proposed project learns from and seeks to build upon: a recent test of change project that assessed needs of frail patients referred by General Practitioners (GP) and facilitated access to improved support a pilot project that visited people with a Community Alarms in their homes to ensure that the information held on the Community Alarm System was accurate and also to review their support needs The project would also link to and complement the Community Connectors to be employed as part of the roll out of ILI and existing health and social care link workers. 4.2 Capacity Building 4.2.1 Carers
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43 North Lanarkshire Carers Together will continue to be commissioned to support the Carers’ Network; Carers’ Breather Fund; and other carers developments. 4.2.2 Children, Young People and Families During 2022-23, VANL staff will continue to develop and deliver capacity- building support to the CVS as set out above in section 3.4, so CVS organisations so they are more able to contribute to improve the wellbeing of our children, young people and families. 4.2.3 CVS Capacity Building During 2022-23, VANL staff will continue to develop and deliver capacity- building support to the CVS as set out above in section 3.4 so both Community Solutions funded organisations and the sector more widely is more able to contribute to improved wellbeing of residents and communities. 4.2.4 Volunteering Volunteering Support During 2022-2023, VANL staff continued to support volunteering across North Lanarkshire, working closely with public sector partners and the CVS in the ways set out in section 3.4. North Lanarkshire Volunteering Partnership and Strategy During 2022-23 VANL staff continued to convene and support The North Lanarkshire Volunteering Partnership with a focus on developing a new, North Lanarkshire Volunteering Strategy and Implementation Plan. The Strategy was approved by the North Lanarkshire Partnership Strategic Leadership Board in February 2023 and has been referred to HSCNL’s Integrated Joint Board (IJB) and North Lanarkshire Council for consideration with a view to approval by April 2023. Once the Strategy has been approved, VANL staff will work with partners to support implementation, evaluation and review. The Strategy will support delivery of commitments in the Plan for North Lanarkshire; HSCNL Commissioning Plan and the Community Solutions Strategy and Investment Plan with priorities to increase: the number and diversity of volunteers from all ages and backgrounds the range and type of volunteer roles employer-supported volunteering. 4.3 Programme Performance Management, Evaluation, Learning and Improvement 4.3.1 Development of Improved Approach
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44 During 2022-23 VANL staff reviewed the Community Solutions approach to performance management, evaluation, learning and improvement for funded projects; funds; and the programme as a whole. The following resources were developed during 2022-23: A new Community Solutions Performance Management, Evaluation, Learning and Improvement (PMELI) Framework A new Evaluation Guide for funded projects and wider CVS. The new Framework was approved by the Community Solutions Governance Group in November 2022. The Guide was launched in March 2023 for implementation from April 2023, supported by the Evaluation Guide, which will be published in April 2023 also. 4.3.2 CVS Contribution to Mental Health and Wellbeing During 2022-23, VANL staff developed - in liaison with NHS and CVS colleagues - a pilot initiative to support more in-depth assessment of CVS organisations’ contributions to mental health and wellbeing outcomes for the people they support. The pilot would support a small number of CVS organisations - including both Community Solution funded organisations – to use the Warwick-Edinburgh Mental Health and Wellbeing Scale (WEMWBS) to capture more robust evidence on the difference their support has made to their service users’ mental health. It is envisaged the pilot would commence during mid to late 2023, subject to some additional funding being secured. Learning from the pilot would deepen understanding of the CVS contributions to mental health and wellbeing with a view to informing future investment in community-based mental health support in North Lanarkshire. The approach may also be rolled out more widely across the CVS if the pilot demonstrates viability and usefulness. 4.4 Programme Communications and Liaison During 2022-23 VANL staff will continue to: communicate and liaise with all programme stakeholders including funded projects; locality hosts and consortia; and HSCNL colleagues represent the Community Solutions Programme and CVS on HSCNL’s Strategic Leadership Team and IJB Board and Performance, Finance and Audit Committee share key information about the programme online through Community Solutions e-bulletins. Development of a new Community Solutions website was planned for 2022 but due to staffing capacity issues has been deferred to spring-summer 2023.
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45 4.5 Programme Governance VANL staff will continue to convene and support the Community Solutions Governance Group during 2022-23 as outlined above in section 2.3 During 2022-23 membership of the Group was reviewed to strengthen representation and engagement of key stakeholders including: HSCNL staff Council staff from the Enterprise and Communities and Education and Families Departments Locality hosts and consortia (for implementation from spring 2023) Appendix A Community Solutions Locality Host Funding 2021-22: Total Awards £240K CVS Organisation Project Total Funding Amount (£) A.1 The Health and Wellness Hub (Airdrie) Locality Host 40,000 A.2 Orbiston Neighbourhood Centre (Bellshill) Locality Host 40,000 A.3 Glenboig Development Trust (Coatbridge) Locality Host 40,000 A.4 CACE (Cumbernauld) Locality Host 40,000 A.5 North Lanarkshire Carers Together (Motherwell) Locality Host 40,000 A.6 Getting Better Together (Wishaw and Shotts) Locality Host 40,000 Appendix B Locality Activity Fund Distribution 2021-22 Total number of projects funded in the six Community Solutions localities: 82 Total income for 2021-22: £180,000 Total spend: £179,978
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46 Plus, c/f underspend from 2020/21: 27,082 Airdrie Locality Organisation Project Total Funding Amount (£) B.1 Airdrie Citizen’s Advice Bureau Airdrie Action Partnership 3,874 B.2 Bear Necessities Local Support and Development Groups to Families 3,836 B.3 Calderbank Parish Church of Scotland Airdrie Foodbank Post Covid Recovery 2,620 B.4 Diamonds in the Community Community Christmas Dinner Community Noticeboard (noticeboard in main shopping centre) Transport Home Comforts 1,500 1,533 4,000 B.5 Hope for Autism Cooking project 5,048 B.6 Health and Wellness Hub Massage for people with cancer 1,750 B.7 Longriggend Village Association Longriggend Peoples Project (community improvement scheme) 2,230 B.8 Make and Create Arts Make and Create a Healthier Future (healthy food visual arts project) 2,593 B.9 Parkinson’s Self- Help Group Promotion of plant- based diet 1,216 B.10 Plains Community Futures Plains Outdoor Gym 3,000
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47 B.11 Whinnhall Allotments Beechbank Toddlers Outdoor Resilience Project 300 No. of projects 13 Total 33,500 (including c/f underspend from 2020/20
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48 Bellshill Locality Organisation Project Total Funding Amount (£) B.12 Bazooka Arts Covid-19 Response Creative Connections 3,000 4,715 B.13 Bellshill & Mossend YMCA FarmBot Urban Micro Garden (teaching about environmental issues through Agri-tech software) 4,200 B.14 Diamonds in the Community Sporting Memories Group 5,000 B.15 Dollywood Imagination Library 1,000 B.16 Fresh Start NL Digital Befriending / Bellshill BAME Befriending 2,550 B.17 Jack & Jill Relaxation Sessions 1,494 B.18 Lanarkshire Community Food and Health Partnership Community Food & Health Project - Training Family Barnardo's Health Cooking Course 750 360 B.19 Nurture Scotland KIN-etc.! 1,000 B.20 Salvation Army Community Café 4,776 B.21 Social Track Urban Sports Project 2,600 B.22 Orbiston Neighbourhood Centre Covid Recovery Support 4,520 B.23 Viewpark Conservation Group Our Space 615 B.24 VIP Arts and Sports Academy Insane Project Outdoors Together Pram to Primary 5,130 3,500 3,350
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49 Organisation Project Total Funding Amount (£) B.25 YMCA Befriending 1,600 No. of projects 18 Total 50,160 (using c/f underspend from 2020/21)
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50 Coatbridge Locality Organisation Project Total Funding Amount (£) B.26 Autumn Village group Rejuvenating Village (engagement with community through monthly events) 1,485 B.27 Bazooka Arts All Stars All Star recovery Bazooka Coatbridge 2,440 2,440 4,810 B.28 Cliftonville & Coatdyke Community Group Cliftonville Bowling 1,750 B.29 Coatbridge Consortium Partnership Group (group of Coatbridge consortia members) Hello World 2,309 B.30 Coatbridge Toddlers Coatbridge Toddlers 2,320 B.31 Glenboig Development Trust Boys – Men’s Shed Glenboig Walking Football Townhead Toddlers 3,620 3,620 5,200 B.32 Kirkshaws Neighbourhood House Angels and Aeroplanes, Flying Higher Jackie’s Craft Group Media project 1,060 940 1,000 B.33 Lanarkshire Community Food and Health Partnership Women’s Cook Club 2,136 B.34 Nurture Scotland Kinect 1,200 B.35 Parents for Safe Play 3,000 No. of projects 16 Total 23,845 Balance c/f to 2022-23
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51 Cumbernauld and the North Locality Organisation Project Total Funding Amount (£) B.36 CACE Befriending Development Afternoon 486 B.37 Strathcarron Hospice Community Loss and Bereavement Resource Boxes 1,610 B.38 Croy Community Hub Always Unique Club 1,500 Kids Enterprise Group 1,750 B.39 Fool On Anybody Can Cook 2,000 Cumbernauld Workshop 4,410 B.40 Friends of Kilsyth Saturday Gatherings 1,750 B.41 Gartcosh Activity Group Lunch Club 880 B.42 Kilsyth Civic Week Intergenerational Tea Dance 1,190 B.43 Kilsyth Storehouse Church Church Cafe 3,750 B.44 Lanarkshire Community Food and Health Partnership Big Chef, Little Chef Cumbernauld Academy 1,380 No. of projects 11 Total 20,706 Balance c/f to 2022-23
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52 Motherwell Locality Organisation Project Total Funding Amount (£) B.45 Befriend Motherwell Intergenerational Cookery Project 1,060 B.46 Fool On Fool On Community Outreach Events 4,200 B.47 Forgewood Housing Co-operative Food for Forgewood Supporting Community Groups 1,200 2,766 B.48 Lanarkshire Community Food & Health Partnership After School Club Big Chef Little Chef 1,080 840 B.49 Lanarkshire Deaf Club Café Project 1,200 B.50 Motherwell Maranatha Foodbank 276 B.51 Neighbourhood Networks Airbles Blooms 1,000 B.52 NLC Community Partnership Team (South) Craigneuk Health and Wellbeing Participatory Budgeting Project 2,000 B.53 North Lanarkshire Carers Together BAME Carers Information and Advice Project 5,000 B.54 Nurture Scotland KIN-ect 1,600 B.55 Senior Citizens Monday Club Muirhouse Recovery Project 1,200 B.56 Volunteering Matters Youth Befriending Project 5,000 B.57 YAMS (You Are My Sunshine) Mental Health Hub - Motherwell Drop In 5,000 No. of projects Total 33,422
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53 15 (using c/f underspend from 2020/21) Wishaw and Shotts Locality Organisation Project Total Funding Amount (£) B.58 Baby Bears Toddler Group Outdoor Play 1,995 B.59 Crochet and Chatter Group, Salsburgh Spooktacular in Salsburgh 600 B.60 Getting Better Together Christmas Light Switch on Fitness Classes and Fruity Friday Happy Smiles Project Youth Inclusion Project 1,000 1,545 940 4,900 B.61 NLC Community Partnership Team Participatory Budgeting Project 2,000 B.62 Overtown Parish Church Community Lunch 1,000 B.63 Rivals Gym Martial Arts Physical and Mental Fitness programme Supporting mental health through martial arts, boxing, and fitness 1,500 1,500 B.64 Salsburgh Community Council Salsburgh Christmas Event 1,930 B.65 Wishaw YMCA Camera Club YMCA Book Worms Contact Boxercise Souper Days 2,900 2,575 2,070 2,820 No. of projects 15 Total 29,275
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54 Appendix C Community Solutions Thematic Funding 2021-22: Total Awards £862K C.1 Anticipatory Care: Total Awards £71K CVS Organisation/Project Total Funding Amount (£) Equals Advocacy 71,312 C.2 Carer’s Breather: Total Awards £135K Bazooka Arts 22,848 Getting Better Together 22,240 Glenboig Development Trust 21,160 North Lanarkshire Carers Together 10,000 Parkinson’s Self Help Group North Lanarkshire 16,390 Parkinson’s Self Help Group Motherwell 30,000 The Haven (Carer Breather) 27,950 The Haven (Carer Sitter pilot) 7,069 The Health and Wellness Hub 23,476 Watch Us Grow 29,000 C.3 Carers’ Support Network: Total Awards £40K North Lanarkshire Carers Together 40,000
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55
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56 CVS Organisation/Project Total Funding Amount (£) C.4 Community Food: Total Awards £10K Lanarkshire Community Food and Health Partnership 10,000 C.5 Community Transport: Total Awards £72K Getting Better Together 72,000 C.6 Befriending: Total Awards £852K Befriend Motherwell 8,000 CACE 20,600 Elim Christian Centre 14,228 Getting Better Together 29,000 Glenboig Development Trust 20,000 HomeStart 33,000 Orbiston Neighbourhood Centre 20,000 Volunteering Matters 29,800 YMCA Bellshill 20,000 C.7 Hospital Discharge Support Programme: Total Award £149K Getting Better Together 149,120 C.8 Physical Activities: Total Award £60K North Lanarkshire Leisure Trust 60,000 C.9 ShopMobility: Total Award £32K The Health and Wellness Hub 32,058
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57 CVS Organisation/Project Total Funding Amount (£) C.10 Support in the Right Direction (Self Director Support) Fund 2021-22: Total Awards £88K Equals Advocacy Support in the Right Direction 14,054 North Lanarkshire Disability Forum Support in the Right Direction 74,187 Appendix D Community Solutions Children and Young People Fund 2021-22: Total Awards: £331K for 52 projects across 20 CVS organisations (See main body of this report and also separate Learning and Impact Report for this Fund) CVS Organisation Project Schools’ Cluster Total Funding Amount (£) D.1 A-Jab Fitness & Emotional Support A-jabs boxing for better mental health Bellshill 6,124 D.2 Bazooka Arts Therapeutic Transitions Project Bellshill 9,184 Creative Wellbeing - A Therapeutic Arts Transitions Support Project Chryston 6,859 D.3 Getting Better Together Community Transport Coltness 2,613 D.4 Glenboig Developme nt Trust Primary Transition Airdrie Academy 4,531 Secondary Transitions 4,511 Seniors year 4 – 6 5,221
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58 With Out Walls - Braidhurst High School Braidhurst 4,897 With Out Walls – Muir Street 1 2,290 CVS Organisation Project Schools’ Cluster Total Funding Amount (£) D.4 Glenboig Developme nt Trust With Out Walls – Muir Street 3 Braidhurst 2,290 With Out Walls - Unpaid Carers Respite Motherwell 4,897 With Out Walls – Dalziel High School Dalziel 2,290 With Out Walls - Glencairn PS Motherwell 2,518 Horizon Project St Ambrose 8,515 Primary Transition 4,531 Secondary Transitions 4,511 Seniors year 4 – 6 5,221 D.5 HomeStart Practical Steps Towards Change Bellshill 4,344 D.6 Hope for Autism Support for school Transitions Airdrie Academy 4,570 Supporting Parent Carers of Autistic Children and Young People Through a Peer Group Model St Margaret’s 3,406 D.7 Lanarkshire Community Food & Health Partnership Come Dine with Us Airdrie Academy 8,000
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59 Braidhurst 9,560 Dalziel 9,536 Dalziel Nutrition 3,100 Come Dine with Us Greenfaulds 7,185 St Ambrose 8,000 CVS Organisation Project Schools’ Cluster Total Funding Amount (£) D.7 Lanarkshire Community Food & Health Partnership Big Chef Little Chef St Margaret’s 3,600 D.8 Made4UinML2 Paths to life Coltness 1,685 D.9 Make and Create Arts Positive Creations, Airdrie and St Ambrose Clusters Airdrie Academy 3,160 Positive Creations at Portland High School St Margaret’s 3,000 D.10 One Parent Families Scotland Creating Connections: Forgewood Family Learning Centre Braidhurst 5,634 Creating Connections: Ailsa Family Learning Dalziel 5,584 Creating Connections: Ladywell 5,880 Creating Connections Greenfaulds 11,568
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60 Creating Connection s - Peer Led Approach St Margaret’s 15,820 D.11 Parent Action for Safe Play Active Play / Play Champion Programme Braidhurst 2,198 Greenfaulds 10,773 St Maurice 5,120 D.12 Ponies Help Children Mental Health and Wellbeing Support Coltness 898 Greenfaulds 1,632 D.13 Reeltime Music Portland Creative Video Project St Margaret’s 1,262 D.14 Rivals School of Martial Arts Reaching positive destinations through mental health and wellbeing sessions Coltness 1,500 CVS Organisation Project Schools’ Cluster Total Funding Amount (£) D.15 Social Track Wheely Good Fun Dalziel 2,000 D.16 The Health and Wellness Hub Emotional Wellbeing in Schools Airdrie Academy 2,145 Braidhurst 2,738 571 Dalziel 1,867 St Margaret’s 6,830
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61 D.17 The Miracle Foundation Secondary School Transition Support for Young People Airdrie Academy 3,600 Supporting children and young people’s mental health Braidhurst 1,800 Calderhead 7,200 Chryston 29,800 Dalziel 4,650 Bereavement and Trauma Support Greenfaulds 4,800 D.18 VIP Arts and Sports Academy Creative Transitions Project Bellshill 8,080 Musical theatre sessions Greenfaulds 1,620 D.19 Volunteering Matters North Lanarkshire Youth Befriending Project St Maurice 5,958 D.20 YMCA Bellshill & Mossend Y-Empower – 1:1 Support Airdrie Academy & St Ambrose 14,400 Digital Youth Programme Bellshill 5,990 Digital Wellness Coltness 5,541 CVS Organisation Project Schools’ Cluster Total Funding Amount (£) D.20 YMCA Bellshill & Mossend FarmBots (teaching about environmental issues through Agri- tech software) Coltness 3,468
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63 Appendix E Community Solutions Community Mental Health and Wellbeing Fund 2021-22: Total Awards £1.6 million across 42 CVS organisations and 53 projects CVS Organisation Project Total Funding Amount (£) E.1 Airdrie Citizen's Advice Action Beyond Courage 41,081 E.2 Bazooka Arts Connect Access 38,276 Connect Community 48,653 E.3 Bipolar Scotland Enabling Groups 10,106 E.4 CACE Groups 50,000 E.5 Cloudberry Communities Natural Connections 38,000 E.6 Community Action Newarthill Summer Programme 11,034 E.7 Conservation Volunteers Natural Connections Legacy 40,975 E.8 Cruse Bereavement Bereavement Support 10,654 E.9 Cumbernauld FM Living History 35,584 E.10 Deaf Services Lanarkshire Wellbeing Activities 23,452 E.11 Deafblind Scotland Don't Worry Be Happy 10,073 E.12 Drumpellier Christian Fellowship Townhead Community Hub 37,060 E.13 Fair Play Foundation Active8 20,530 E.14 FAMS Moving Forward 35,370 E.15 Forgewood Housing Coop Taking Steps 44,484
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64 CVS Organisation Project Total Funding Amount (£) E.16 Getting Better Together The Parent Journey 26,649 Active Lifestyles 15,000 E.17 Glenboig Development Trust Mentoring Futures 47,675 Garden Project 49,584 Stop the World 47,117 E.18 Health & Wellness Hub Transforming Lives 47,902 E.19 Hope Community Garden Project 10,880 E.20 Kirkshaws Neighbourhood Centre Health & Wellbeing Project 21,214 E.21 Lanarkshire Association for Mental Health Wishaw Wellbeing 32,020 E.22 LAMH Recycle Personalised Community Supports with Peer Mentoring 50,000 E.23 MADE4UINML2 Wellbeing in ML2: Adults and Older People 48,834 E.24 Maggie's Lanarkshire Wellbeing Sessions 18,848 E.25 Motherwell FC The Well Hub 18,000 E.26 Motherwell Foodbank Motherwell Foodbank @ Maranatha 31,304 E.27 New Opportunities New Opportunities Project 31,239 E.28 NL Recovery Communities Peace of Mind Therapies 10,300 Cumbernauld 37,684
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65 E.29 One Parent Families Scotland Airdrie 37,684 CVS Organisation Project Total Funding Amount (£) E.29 One Parent Families Scotland Motherwell and Bellshill 37,684 E.30 PAMIS (people with profound and multiple learning disabilities) Wellbeing Project 12,037 E.31 Parkinson’s Self- Help Group Nurture, Develop and Grow 11,045 E.32 Rivals Martial Arts Gym Food for thought 30,000 E.33 Scottish Huntington’s Association National HD Specialist 10,188 E.34 Social Track Active Travel for Mental Health 50,000 Free Your Inner Child 49,000 E.35 Street Soccer Scotland Positive Change Through Football 10,593 E.36 The Haven (Carers’ Support) Cumbernauld, Coatbridge, Airdrie 39,700 Wishaw & Shotts, Motherwell, Bellshill 39,700 E.37 The Miracle Foundation Encouraging Growth & Resilience Mental Health Workshops 46,835 E.38 Venture Scotland Challenge Yourself, Discover Yourself 49,931 E.39 Veterans Community Lanarkshire Veterans Community 17,500
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66 E.40 Viewpark Conservation Group Mental Health and Greenspace Project 46,100 E.41 Windmills connect@windmills 10,000 CVS Organisation Project Total Funding Amount (£) E.41 Windmills (Community Café supporting training and employment of people with Learning Disabilities) familycook- in@windmills 1 27,800 skills@windmills 1 48,400 E.42 YMCA Bellshill & Mossend Virtual Wellbeing Space 19,020 [Document Ends]