Minute
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 ITEM 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 19th April 2023 9.30am-12pm Present: Voting Members: Councillor Claire Barclay Proxy for Councillor Gerry Brennan North Lanarkshire Council Nominated Councillor Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Phillip Couser (left 10.25am) NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly (Left 10.15am) North Lanarkshire Council Nominated Councillor Councillor Ayeshah Khan North Lanarkshire Council Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director James Muir 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 John Watson Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager Stacey Connor (Minutes) Minute Secretary Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Maddy Halliday Chief Exec, VANL Third Sector Rep Dr Lucy Munro Medical Director North HSCP Elizabeth Seaton Partnership for Change User Rep Maggs Thomson Head of Health NHSCP Apologies: Paul Carey Audit Scotland Diane Fraser Head of Adult Social Work Services Cathy McGinty Unison Staff Side Rep (NHSL) Trudi Marshall Nurse Director North HSCP
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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. 2. Declaration of Interests It was noted for Item 13 Brian Moore and other non-executive directors are part of the NHS Lanarkshire endowment committee which allocates funding for the social prescribing initiative. This was noted. 3. Minutes The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log Under matters arising Brian Moore queried if a summary report for the annual report will be available. Ross McGuffie advised required reports will be published on the new HSCP website. Morag Dendy added the summary report is not finalised but it will be soon. Ross McGuffie advised Stacey Anderson is undertaking a review of action logs for both committees to streamline reports and update the action logs. The Liaison Sessions were first established to bring voting members together as an organisational development session but this has now moved towards more of a workshop session. Membership for liaison session will be extended to all members of the IJB. Item 18- IJB Self-Assessment Report- The work has identified a number of actions which are included as part of the progress report. Best value audits were previously stood down due to National Care Service work but are now expected to be reinstated. Item 22 MH Strategy- Will come back to liaison session and this is the final year of the current strategy so this will be reviewed in due course. Ross McGuffie also advised there is a new date for a liaison session in May, the main agenda item being human learning systems. Morag Dendy advised she have been able to secure a range of events through NES which commence this week to develop the process. Maddy Halliday advised that the community solutions programme has learning and improvement work across the programme which could feed through to HSCP going forward. This was noted.
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3 5. PF & A Risk Register The purpose of the 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. 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 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 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. Ross McGuffie advised Stacey Anderson and Maggs Thomson have been working with Charlotte Hope (Corporate risk manager at NHS Lanarkshire ) to develop a new reporting template for risk reporting to the committee. This will also be looked at in more detail as part of the risk workshop at a future liaison session. Cllr Ayeshah Khan reminded the committee to be mindful of not using jargon within the risk reports; this was noted. Philip Couser referenced risk 20/23 (workforce sustainability) and queried what is the background to this risk to offer the committee assurance. Ross McGuffie acknowledged there are areas of pressure across a number of service areas due to recruitment challenges but this is a national issue.
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4 Trudi Marshall added that during covid the professional governance structure were redeployed to firstly support pandemic and then to support the firebreak and vaccination programme, which means there are gaps in the governance process due to this; have tried to mitigate the risk where possible. The IJB PFA agreed the following recommendations: Noted 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. 6. Financial Monitoring Report The financial monitoring 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. 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. The key reasons why the IJB is currently projecting an underspend against its budget this year are as below: • 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.
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5 • 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. The current IJB reserves position for 2022/23 is a revised balance of £69.237m. James Muir asked is the vacancy trend rate increasing or decreasing, can more data be included to offer assurance. Amanda Kilburn replied the challenge is when recruiting when someone starts the likelihood is someone else will leave due to a number of reasons. More data will be included in the year-end report to offer some assurance. Ross McGuffie added trend rate is dependent on each services, although overall the 7% is reasonably static. When the organisation receives new funding sources staff move around the system to more attractive posts which creates vacancy issues in other services. Trudi Marshall acknowledged nursing is the largest workforce to add to the figure and advised that not all university places were filled last year which will impact on future recruitment. There is work being undertaken to look at new roles at band 4 level to sit under registrants, placements and careers fayres are also being planned. Ross McGuffie added that we produce an annual workforce plan which can be brought to the committee to offer a deeper dive; this was noted. Ally Boyle asked that for services with higher agency spend are there processes in place to manage and reduce this. Dr Lucy Munro noted agency spend in Mental Health is mainly on medical cover and all mitigations are considered before agency usage. Brian Moore noted the existing reserve under digital and IT strategy for home support scheduling tool and asked if we have a timeline or plan in relation to committing the funding. Ross McGuffie advised have now completed procurement process for SWISS programme which will take 12-18 months to fully implement. Brian Moore also queried, with regarding to in year allocations, if alcohol and drug funding is new . Ross McGuffie confirmed this is not new money and it is as expected.
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6 Brian Moored note if we haven’t committed money in reserves it will impact on future Scottish Government future funding allocations, he asked is this the case. Ross McGuffie advised looking at maximising funding already available where possible. The IJB PFA Committee agreed 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. 7. Progress Report The progress 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. An update on the progress made to date was reported to the PFA Committee on16 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% The results of the self-evaluation exercise were presented to the PFA Committee on 31st 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. Ally Boyle suggested to include more narrative to advise the delays in actions is due to other factors; this was noted. Brian Moore referred internal audit actions relating to risk processes and requested further assurance regarding the actions.. Amanda Kilburn will review actions and provide more assurance where possible. The IJB PFA Committee note the following recommendations: (1) That the content of the report is noted; and
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7 (2) That further progress reports will be presented to future meetings of the PFA Committee in respect of any ongoing actions. 8. Resilience Update 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. 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. 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. 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
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8 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. 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. There has been agreement to establish SLWG working groups in the first phase to look at learning. Before phase 2 commences to review the winter plan with a focus to take learning from operation flow and discharge events to develop the plan. Phase 3 will be the longer term work. Brian Moore asked how significant are the equipment delays to the discharge process. Ross McGuffie replied it is sometimes due to over ordering of equipment. Lanarkshire has more hospital beds in the community than across the acute sites. This comes down to education of staff to consider what they are ordering and requirements. There is a whole system review being undertaken of the equipment sources to identify any actions required. The IJB PFA: (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 9. Q3 Performance Report 2022/2023 This 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). Report covers the following performance areas: Cervical Screening Immunisations Delayed discharges/home support and reablement Integrated equipment and adaption services CAMHS Psychological therapies
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9 Adult mental health Waiting times performance- medical children and young people Waiting times performance AHP and community services Stop smoking service Sickness absence Cllr Ayeshah Khan asked are we on target to clear CAMHS waiting lists backlog in summer time and is there any proposals to have mobile units for cervical screening appointments. Dr Lucy Munro advised by autumn time at the latest the waiting lists will be significantly reduced, need to consider who would use this capacity and also monitor if there is an increase in referrals to the services due to this additional capacity. Cllr Ayeshah Khan drew attention to 3rd sector involvement as an earlier engager with patients for prevention. Maddy Halliday agreed with this point and noted concerns with funding if not available in 3rd sector difficult to manage and asked where do strategic discussions take place. Dr Lucy Munro stated there are other supports available outside of CAMHS that patients can use. Morag Dendy advised that a new performance manager is in post and a key part of their role will be to align performance reporting work undertaken in a collective way. Maggs also noted that the programme board was established to bring RTT back into line and has a specific directive to achieve this. She also added CAMHS is also part of the MH strategy work so strategic discussion will occur as part of the MH workstreams. Ally Boyle asked are we starting to get intelligence on DNA reasons which is nearly 25% in CAMHS. Dr Lucy Munro advised some do not attend appointments as they no longer require the service. She advised that this is emerging data but needs to be looked at in more detail and that we require processes to follow up with those who DNA appointments. Maggs Thomson acknowledged that there is an issue around the data with Scottish Government which is being worked on. The IJB PFA Committee noted the contents of the report and its appendix. 10. Speech and Language Therapy Update 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%.
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10 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. Maggs Thomson advised met with Strathclyde University to improve undergraduate programme to help attract some additional staff to the service. Cllr Bob Burgess noted concerns for maternity leavers do they eventually come back to the services or do we lose the skilled staff. Maggs Thomson noted this is a nationally funded programme, starting to see less applicants leading to posts going to clearing positions. She also confirmed that staff do come back to the service after maternity leave. Brian Moore noted it would useful in the next year to get another dedicated report; this was noted. He also noted issues around track care access. Ross McGuffie advised he has been discussing with IT the need to prioritise access for community services to track care. The IJB PFA agreed the following 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. 11. OT Paediatrics Update Performance Background: 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 12 week 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. This picture is replicated across many Board areas, and there is currently a national
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11 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. 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 noted in the report, and progression of recruitment opportunities will be progressed to optimise performance and progress towards the 12 week waiting times target. Brian Moore noted it would be useful to get a yearly update on how the service is progressing; this was noted. 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 12. Digital Alarms 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. 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. 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.
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12 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. The above circumstances summarise 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. Cllr Claire Barclay noted for 20% of alarm activations it results in someone requiring to attend a patient so for 80% they are activating for other reasons, is there some data on why they are being activated and if there are other routes which can be used. Morag Dendy acknowledged that the service is looking into this data in more detail currently. Cllr Bob Burgess asked will the new technology cost more money to patients, are there any issues with complexity of technology for the 7500 people listed and does this include partners. Morag Dendy advised previously had 10000 listed in reports as using the services previously but the figure is actually 7500, this is for the unit rather than the number of people supported. The expectation is the technology should be much easier and responsive for users. There will be an increased cost going forward but it is not decided who will cover these costs. Ally Boyle noted the new technology is not able to interface with smoke alarms which the old system previously did, so we need assurance going forward for those that require assistance they will receive this. It was noted that we need a solution as part of the transition process which is clearly communicated. Morag Dendy noted this has been flagged at a national level and we are considering if community alarms are the right response to assist those in this situation or if something else is required. Morag will ensure transition arrangements are communicated clearly and add update to action list to ensure work comes back when ready. Recommendations noted by the IJB PFA committee are as follows: (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
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13 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. 13. Community Solutions Annual Report 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: Background to the programme with reference to the new Community Solutions Strategy and Investment Plan 2022-25. 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 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.) 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 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. Maddy Halliday will share summary document with the committee after the meeting. Cllr Ayeshah Khan noted figure missing in locally activity fund. Maddy Halliday noted this has not been fully agreed yet as part of an SLA but should be confirmed soon this is why it was not included. Brian Moore asked for some consideration to include financial information as an appendix in more detail in future. He asked where are we in relation to recruitment challenges. Maddy Halliday advised do report to governance group with more details around the budget which can be shared going forward. There are 2 critical posts which are on temporary contracts awaiting SLA to be able to fill permanently.
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14 The IJB PFA Committee comment and note on the Community Solutions Programme’s 2021-22 Annual Report. 14. Risk There was no new risk identified by the committee. 15. Date of Next Meeting 21st June 2023 10.30am-12pm