Winter Planning and Enhanced Supports - Business Case for North Lanarkshire
North Lanarkshire Council · 6 September 2022
Back to Adult Social Work, Care and Wellbeing Committee — 6 September 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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North Lanarkshire Council Report Does this report require to be approved? ☒ Yes ☐ No Ref MD/AH Date 06/09/22 From Morag Dendy, Head of Planning, Performance and Quality Assurance E-mail dendym@northlan.gov.uk Telephone 01698 332075 Executive Summary The current and projected demand for health and social care services is significant. To meet this demand, the Scottish Government allocated additional funding in 2021/2022 and has committed to further recurring investment from 2022/2023 to increase capacity across health and social care services with immediate effect. In February 2022, the Integration Joint Board approved a business case for the commitment of the additional funding, while also taking the opportunity to target non- recurring reserves to implement a series of proposals, including the development of a Home First model in North Lanarkshire, additional community nursing capacity, enhanced care at home capacity, and additional infrastructure supports. This report provides an update on the progress made with implementing these proposals, relating to: PO49 Prevention and early intervention PO50.1 Do the right thing, first time PO50 Focus on what matters to people (Outcomes) PO52 Supporting people to live well connected lives PO54 Technology and sustainable solutions PO82 Work, volunteer, and care Recommendations It is recommended that the Adult Social Work, Care and Wellbeing Committee: 1. Endorse and support the approach to reporting on the delivery of change through the business case. 2. Note the contents of the report Adult Social Work, Care and Wellbeing Committee Winter Planning and Enhanced Supports – Business Case for North Lanarkshire
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The Plan for North Lanarkshire Priority Improve the health and wellbeing of our communities Ambition statement (12) Ensure our residents are able to achieve, maintain, and recover their independence through appropriate supports at home and in their communities 1. Background 1.1 There is a long history in North Lanarkshire of focusing on people being at home for as long as possible, or as quickly as possible following a hospital admission, including but not limited to the development of Integrated Rehab Teams, Discharge to Assess and Planned Date of Discharge to support the mainstream of effective locality, area wide and hospital-based services. Prevention, early intervention and anticipatory care planning, which promotes wellbeing and reduce inequalities, has also had priority focus, in particular through the Community Solutions Programme, building communities where people can have full, independent and connected lives. Overarching the whole system is the work to ensure that when people make contact with health or social work services that the response is quick and effective, with a focus on helping people to help themselves first. The importance of getting things right first time and focusing on what matters most to people has never been more important. The development of First Point of Contact incorporating good conversations across the Health and Social Care Partnership (HSCP) and embedding the approach with a whole system focus will support getting it right first time. 1.2 In the above context, the North Lanarkshire HSCP must continue to meet people’s current care needs and plan future services while managing the current extraordinary pressures on existing services because of demographic growth, the impact of the Covid-19 pandemic and underlying financial challenges. Recognising that more of the same will not sustain robust services and supports into the future, a Strategic Commissioning Plan Programme Board (SCP PB) has been established to ensure a whole system approach is adopted to support transformational change which capitalises on the availability and use of short-term, recovery orientated resourcing and reshapes the use of core funding. 1.3 The SCP PB is maintaining oversight of these developments. The early focus is on creating additional capacity, but the SCP PB will ensure the alignment and joining of developments to create clearer pathways and avoid confusion and cross-over in teams and roles avoiding unnecessarily duplication. 1.4 Action taken now must have a lasting and sustainable impact and build resilience in the whole system supporting health and social care in North Lanarkshire. Recurring and non-recurring investment must strengthen services and supports through this winter and other periods of pressure, build on the approach to recovery and renewal set out in the NHS Recovery Plan, and support continued efforts to improve social care support. 1.5 In September 2021 the IJB approved the establishment of a Change Fund (Ring-fenced Reserve No 28: Integrated Authority Support - £6.076m) to support the remobilisation and redesign of services post Covid, to enable the delivery of the Programme of Work for the North Lanarkshire HSCP, and to achieve the ambitions set out in the Partnership’s Strategic Commissioning Plan: 1. Do the right thing first time 2. Provide a range of community services and supports to people to live well in connected communities 3. Focus on what matters to people 4. Be at the forefront of technical and sustainable solutions
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5. Promote prevention and early intervention 6. Ensure North Lanarkshire is the best place to work, volunteer and care 1.6 Priorities for the use of the Change Fund were identified as: • Prevention and early intervention, targeting spending on helping people to live healthier and safer lives and maintaining their independence at home or in the community. This will mean less spending is required on hospital or specialist care later on. • Empower individuals and communities, involving them in service design and delivery. This should result in services that match what people need and want. • Improve efficiency by adopting a whole system approach to improve and deliver services 1.7 In October 2021, the Scottish Government announced funding to help protect health and social care services over the winter period and to support longer term improvement in service capacity. This announcement was supported by new investment funding of more than £300 million nationally. The Scottish Government also announced the 2022/2023 Budget in December 2021. 1.8 The Scottish Government winter planning preparations are predicated on the following four key principles: 1. Maximising capacity through investment in new staffing, resources, facilities and services. 2. Ensuring staff wellbeing and supporting them to continue to work safely and effectively with appropriate guidance and line-management and access to timely physical, practical and emotional wellbeing support. 3. Ensuring system flow through taking specific interventions now to improve planned discharge from hospital, social work assessment, provide intermediary care and increase access to care in a range of community settings to ensure that people are cared for as close to home as possible. 4. Improving outcomes through our collective investment in people, capacity and systems to deliver the right care in the right setting. 1.9 Subject to confirmation of the 2022/2023 Scottish Government Budget, the full year effect of the 2021/2022 funding allocations in 2022/2023 is estimated as follows: Fund Funding 2021/2022 2022/2023 Care at Home Recurring £3.597m £7.194m Multi-Disciplinary Teams Recurring £1.160m £2.320m Health Care Support Workers (Band 3) Recurring £0.638m £1.276m Sub-Total Recurring £5.395m £10.790m Interim Care Non-recurring £2.320m £1.160m Total £7.715m £11.950m 1.10 In addition to the proposed funding allocation detailed in the table above, £200m nationally was announced to fund the increase in the cost of the externally commissioned pay uplift from £10.02 per hour to £10.50 per hour effective from 1 April 2022. The Scottish Government indicated that if part of the funding was not required
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to meet the cost of the pay uplift the remainder be retained by the HSCP and was not ring-fenced. Incorporated into the business case funding is capacity to recognise the range of additional cost pressures experienced by independent sector providers. 1.11 Whilst the increase in the hourly rate for direct care staff was welcomed, it covered a proportion of the hourly rate and only for staff providing direct care. Independent sector providers are understandably impacted by the range of cost pressures, challenges in recruitment and retention and whilst all staff are experiencing the cost-of-living challenges, there are particular issues now emerging for staff within some of our key frontline service areas. Many staff of independent sector providers for example are required to use their own vehicles to deliver services, and although they are re- imbursed for this, the rapidly rising cost of fuel and other related service costs mean that our mileage rates may not always be sufficient to cover their actual costs. The Council recognised the impact of this for NLC staff in a committee paper to full Council in June 2022. 1.12 A 3% uplift in individual budgets is being implemented to ensure that the people can maintain choice and control in how they achieve outcomes across all 4 of the Self-Directed Support options: receiving support through a direct payment (1), through individual service agreement (2), organised by the council (3) or a combination of these options (4). 1.13 In summary, in respect of the financial year 2022/2023, the anticipated funding can be aligned to the indicative costs in 2022/2023 as follows: 1.14 The indicative recurring costs in 2022/2023 of £14.019m exceed the indicative recurring funding available of £11.278m by £2.741m. Whilst this funding gap will be addressed by non-recurring funding in 2022/2023, a recurring funding solution will require to be identified effective from 1 April 2023. This is being progressed as part of the development of the IJB Medium To Long Term Financial Plan. 1.15 As highlighted at paragraph 1.10, the totality of the recurring financial envelope is still to be confirmed. Part of the £200m national funding may be available to contribute to the above costs, subject to consultation with the NHSL Director of Finance and the NLC Head of Financial Solutions. 1.16 It is also anticipated that the impact of our efforts in enhancing upstream service models to support individuals to live as independently as possible in their own homes will allow us to realign our current care home funding model. It is our intention that these
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enhancements will prevent and reduce the number of people who, under current arrangements, may be assessed as requiring long-term residential care. The financial impact of these efforts will be monitored during 2022/2023. 2. Report 2.1 BUSINESS CASE PROPOSALS 2.2 Proposals to secure additional capacity, supports and activity across a range of disciplines and sectors, including our partners in the third and independent sectors, were developed and progressed in consultation with NLC and NHSL partners. These proposals, which were approved by the IJB in February 2022, are set out in Sections 7, 8 and 9. They support the wider programme of creating additional capacity across our health and care system as well as targeting our efforts to transform and redesign our services and supports to ensure people can access the right support from the right person at the right time. The business case is structured to ensure the partnership optimises the additional new Scottish Government funding, the IJB Change Fund and the use of ear-marked reserves. 2.3 The proposed developments within the business case are targeted at the following areas: 1. Assessment and planning capacity (including Home First) Proposals 1 and 2 2. Direct provision of services and supports Proposals 3, 4, 5, 6 and 7 3. Infrastructure capacity Proposals 8, 9 and 10 2.4 A 4-minute animation was created to describe the detail of the business case, making information accessible to staff and partners. The animation (available through the link below) was widely circulated for use within teams meeting and was used in staff roadshows with positive feedback. https://www.youtube.com/watch?v=kKIG51Pd67s 2.5 The original implementation assumptions were as follows: • Phase 1: 1 December 2021 to 31 December 2021 • Phase 2: 1 January 2022 to 31 March 2022 • Phase 3: 1 April 2022 to 31 March 2023 • Phase 4: 1 April 2023 to 31 March 2024 While much of the recruitment activity planned for Phases 1 and 2 has taken place, it was necessary to reschedule some planned recruitment due to the ongoing response to the Covid-19 pandemic. 2.6 This is a complex change agenda that needs a whole system approach to achieving the right things, but it also needs a fluid approach in how they are achieved. Building a confident, resilient workforce is unquestionably a priority. Permanent arrangements are clearly preferred but will not be possible across the scale of the change agenda. Robust analysis of performance and business intelligence will inform decision-making within workstreams and at the SCP PB. 2.7 Given the significant amount of recruitment activity required to support these proposals, it is important to ensure the business case aligns with the priorities and opportunities
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presented through the North Lanarkshire Care Academy and also links with local employability programmes, where appropriate. Attracting staff to benefit from the opportunities of working in North Lanarkshire will also link with any national or local recruitment campaigns. 2.8 Within each phase of the implementation process, the business plan proposals continue to be re-evaluated both within workstreams and at the SCP PB. The forward plans will be changed to reflect the reality of recruitment, the impact of development, the impact of Covid-19, the ongoing confirmation of funding available and the outcomes achieved through the preceding phases. 2.9 ASSESSMENT AND PLANNING 2.10 What We Are Aiming to Achieve • Increased assessment capacity to support the level of demand and complexity • Increased capacity to support recovery, rehabilitation and reablement • Improved the engagement with people with lived experiences and family members • Direct support to inform assessment and planning roles and facilitate quick and effective transfers of care • Assessment and planning over 7 days 2.11 Home First & Integrated Rehabilitation Capacity Description Establishment of Home Assessment Teams, incorporating time limited support at home and wider services, working alongside Allied Health Professional (AHP) colleagues, will allow us to increase the number of people assessed in their own home and to facilitate a timely discharge from hospital or prevent unnecessary admission. Whilst it is proposed these teams will work closely with integrated rehabilitation teams to manage transitions, ensuring these team are separate, ring-fenced teams will allow protection of this capacity to focus solely on facilitating discharged and flexibility of workforce across the sector. The capacity of the integrated rehabilitation teams (IRTs) will also be enhanced. These ring-fenced teams will enable: • A designated workforce whose focus is enabling discharge and maximising function in the home environment by increasing the number of timely post- discharge assessments and providing a rapid community response to prevent hospital admission • A robust discharge pathway for those who require home assessment following discharge from both front door and downstream wards • Flexibility to deploy the workforce across the sectors • Home first conversation to become the norm at every stage of the person’s journey (Why not home? Why not now?) • Clear leadership within discharge services • The approach to avoiding admission will be developed with the IRT and locality teams • Wide-ranging strong links with discharge facilitators within the hospital discharge hub • Close links with hospital Planned Date of Discharge (PDD) teams to identify appropriate patients for the pathway.
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• Close working relationship with IRTs, District Nurses, Acute AHP staff, Hospital at Home and Hospital Discharge Support Programme (3rd sector) with access to equipment stores. • Current IRTs to reduce waits for planned AHP input. The teams provide: • Up to a 3-day assessment period followed by a maximum of 2 weeks of input from the appropriate team members. People will be referred / signposted to the appropriate teams and services at the earliest opportunity if a clear ongoing need is identified. However, there are ambitions that a proportion of people would not require ongoing input. • Home support from ring-fenced staff whilst under the care of the team. Decisions regarding ongoing home support will be made as soon as possible. A minimum of 72 hours’ notice will be provided prior to transfer to long-term home care services (during which time the team will continue support). • Referral and signposting to appropriate ongoing support and interventions e.g. Reablement; IRT; promotion of self-management through use of North Lanarkshire leisure; use of assistive technology • Work towards providing a 7-day service as recruitment allows. • Investment Phase 1 2021/22 £m Phase 2 2021/22 £m Phase 3 2022/23 £m Total £m Recurring Cost 3.283 2.032 1.840 7.155 Non-recurring costs 0 0 0.820 0.820 Total 3.283 2.032 2.660 7.975 Progress Home First Recruitment Social Work posts: • In post: 2 Senior social workers, 1 Social Worker & 1 Social Work Assistant Home Support posts: • Service Delivery Manager in place • Bulk of Service Delivery Coordinators in place; some out-of-hours posts being re- advertised externally • 2 Support Officers in place with remaining posts being re0-advertised • Home Support Workers in place to support soft launch in Wishaw and roll-out to Cumbernauld; short-leeting for remaining posts taking place w/c 18th July AHPs: • Discharge Without Delay Manager and Discharge to Assess Co-ordinators in post • One Community OT in post. Recruitment underway for remaining 5 posts. • Remaining Home First AHP recruitment to be phased as Home Assessment rolled out • Home Assessment Teams Roll-Out • ‘Soft launch’ of HAT team on 25 April 2022. Since then, we have worked closely with 29 patients (as at 5th July). • As a result of HAT input, a number of patients/service users have been turned around at the hospital front door preventing admission. This turn-around provides a positive outcome, whereby assessment can take place within a patient’s/service user’s own home environment, as opposed to an unfamiliar, busy, hospital environment. • A plan is underway within UHW for accommodation to include the HAT team when working from UHW. The team will be based with the hospital social work team and discharge coordinators.
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• Roll-out underway in Cumbernauld and currently reviewing timeline for roll-out to other localities • Training ongoing • Evaluation of service to continue on a 3-monthly basis • Satellite stores for small stock of aids/adaptations to be set up for equipment • Comms required to ensure the public and staff awareness of the team and their role • Challenges: o Lack of admin support o Pharmacy input – currently under discussion. o Joined up working with H&SC/SLC o Access to pool cars o Accommodation within UHW & UHW o Newly appointed workers to HAT continuing to carry cases from previous post o Delay in recruitment of AHP staff o Communication channels between professions/teams need to be clarified. Integrated Rehab Team Expansion Recruitment • NLC Team Leads in post; advert closed for NHSL Team Lead posts • OT Professional Leads: NHSL Professional Lead in place; NLC Professional Lead – advert closed • Permanent OT posts advertised • Advanced Practitioner OT posts largely filled; 2 part-time posts going back out to advert • Advanced Practitioner Physio posts filled; closing date extended for Band 5 post • Admin posts largely fille
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2.12 Enhanced Community Nursing Capacity Description Scottish Government funding allocated 123 Health Care Support Workers (HCSWs) to NHS Lanarkshire. The North Lanarkshire share of this is 40 WTE. These HCSWs will be used to support a refresh of our existing care management approach. Care Management is where we use early warning indicator tools such as SPARRA (Scottish Patients at Risk of Readmission and Admission) to identify those people in our communities who are at highest risk of admission to hospital. These individuals are allocated a district nurse to undertake focused work with them to care plan and minimise the risk but their social care needs are provided separately. The testing of a new approach involves the additional HCSW being placed in existing community nursing teams supporting them to meet all care needs whilst they are being care managed. This will support a very person-centred approach focusing on what matters most to these people and their families but also on stabilising their conditions and reducing their risk of admission. Some of this funding has also been skill-mixed to ensure that we have enough of a registrant workforce to supervise the HCSW. The home first approach will ensure that people can return to their own home whilst assessment of future needs is undertaken. Any nursing needs during this time would have previously been provided within Acute services. This new resource will enable these needs to be met in the community. Additional registered nurses will enable new developments such as administration of IV antibiotics whilst we undertake a full community nursing review. Investment Phase 1 2021/22 £m Phase 2 2021/22 £m Phase 3 2022/23 £m Total £m Recurring Cost 1.492 0.079 0.316 1.887 Non-recurring costs 0 0.235 0.185 0.420 Total 1.492 0.314 0.501 2.308 Progress • 27.4 WTE of 40 WTE Band 3 Healthcare Support Worker posts filled • 5 Band 5 nurse posts filled plus 2 Band 6 nurse on a temporary basis due to difficulties in filling Band 5 posts. • Senior nurse and practice assessor posts currently being recruited to. 2.13 DIRECT PROVISION OF SERVICES AND SUPPORTS 2.14 What we are aiming to achieve • Robust management of direct support – forward placing • Increased quality of support • Support to frontline staff • Quality assurance / outcomes focus with people who use services and families • Increased capacity within Community Alarm, Equipment and Adaptations and Assisted Technology • Increased capacity out of hours
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2.15 Increased Capacity Across Home Support Service, Equipment and Adaptations Service, Community Alarms Service & Assistive Technology Description The expansion of current direct provision of support will include: • Home support expansion, making permanent some temporary measures which are required longer term to facilitate improved capacity and quality of service. Both frontline practitioners as well as logistics and operational management posts are included in the immediate requirements. • Increased capacity within the Equipment and Adaptation Service • Development of a dedicated Technology Team to support the use of technology within the HSCP to support individuals within their homes and communities. This team will focus on embedding technology into assessment and planning processes; providing training to all staff groups on technology and its use in care and support; supporting with risk assessments; ensuring technology support advice is embedded in SDS; and providing high level data on the technology being used within our communities. Investment Phase 1 2021/22 £m Phase 2 2021/22 £m Phase 3 2022/23 £m Total £m Recurring costs 3.932 0.144 0 4.076 Non-recurring costs 0 2.644 0 2.644 Total 3.932 2.789 0 6.720 Progress Home Support Expansion • 71.89 WTE permanent posts funded by the Business case allocated across localities; process commencing to match existing temporary staff into these posts within each team. • Continuing to identify key training that all staff must undertake (e.g. for Home Support Workers: adult support and protection, medication, moving and assisting, dementia awareness, long term conditions, and specific roles including reablement, intensive and longer term). • As well as agreeing key training, methods, frequencies including refresher training, venues and facilitators must also be identified. • Challenges: o A high number of staff require moving and assisting refresher training following the pandemic, creating risk for the service and individuals receiving care and support. o Number of staff applying for Home Assessment Team posts o Insufficient dedicated training resource Community Alarms, Equipment Store and Assistive Tech • Recruitment to new posts on track. • Test Assistive Tech training for Adult Health & Social Care staff completed in Cumbernauld. • Rolling out training to Adult Health & Social Care staff over the course of 2022/23.
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2.16 Hospital at Home Description Extension of Working Hours • Introduction of (Band 7) to allow service hours and to continue until 10pm. • Increased Band 7 Advanced Nurse Practitioners (ANP) capacity to enable patient admission to service 7 days a week, 8am-10pm. • HIS have allocated £212k non-recurring one-year funding towards this. • There is a current national shortfall in the availability of qualified Advanced Practitioners, therefore a training programme would need to be offered and supported, this requires up to 2 years to complete (although some potential internal H@H candidates have already been supported through the advanced clinical care and Non-Medical Prescribing programmes, so may require less support before becoming fully qualified). Permanent funding of Step down Pathway • During the Covid pandemic a “step down” hub was created to ring fence staff to assist with anticipated hospital flow and create a designated pathway for Acute inpatients to be discharged into the Hospital @ Home (H@H) service. • This service improvement contributed to increased referral activity and admitted an average of 38 patients per month in 2021. Due to the clinical presentation of the patients at admission to H@H the model has been slightly adapted to allow the patients to be managed by a junior doctor (with Consultant in-reach when necessary) and Band 5 nurses • Junior doctors have been difficult to recruit on a continuing basis; however, an ANP band 7 nurse can provide clinical management to these patients. Investment Phase 1 2021/22 £m Phase 2 2021/22 £m Phase 3 2022/23 £m Total £m Recurring Cost 0.437 0 0 0.437 Non-recurring costs 0 0 0 0 Total 0.437 0 0 0.437 Progress • Step Down posts already recruited using Covid monies - staff have been made substantive • One vacancy out to advert. • Next steps: o Identify training requirement of Acute staff as part of establishment of Home Assessment/Discharge without Delay o Build Assistive Tech training into Reablement & Intensive Services workstream plan o Ongoing awareness raising across all localities
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2.17 Bed Modelling Description Building on a well-established direction of travel, continued development of a model of community response that focuses on reablement and rehabilitation with a view to shortening hospital stays and supporting people home earlier, reducing the risk of deterioration and maximising the chance of independent living. This approach affects the demands placed on, and the offer available through off-site facilities. We will seek to continue to provide greater consistency between sites and continuity of care between inpatient facilities and the community. Progress Since January 2022, 18 individuals have been supported via interim placements. These individuals have had a wide range of needs with many moving on to their preferred choice of care home, and a small number returning home with a package of support. 2.18 Support to the Independent Sector self-directed support providers including support at home Description The scale of investment in direct provision of supports is both welcome and a challenge. The additional resourcing of hourly rates of pay for frontline staff to £10.02 is also welcome but again presents challenge. The ability of the independent sector to attract and retain direct support staff will be increasingly challenging. The ability if the independent sector to recruit and retain first line managers will also be challenged by a competitive market as will lower differentials between organisational levels. It was agreed that a local provider sustainability fund is established to facilitate an individualised approach to: • Supporting recruitment and retention • Supporting staff wellbeing • Supporting cross sector support to SVQ2 • Increase to Scottish Care support to the sector It was also agreed that a Programme of Work is established to strengthen the support across the sector and to facilitate allocation of local supports to evidence direct benefit and a longer-term exit plan, led by quality assurance. Investment Non-recurring funding of £0.5m each year for 2 years totalling £1m (2021/2022 - £0.5m; 2022/2023 - £0.5m). Progress Following an internal planning session to agree parameter, information was then shared with relevant providers re the focus/purpose of the ‘Building Capacity’ funding. We adapted our Proposal for Funding process to enable applications to be submitted and tracked. The closing date for applications was Friday 12th August. 21 applications have been received, at a total request of £153,261. Evaluations are
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taking place, with intention to notify successful applicants by Friday 2nd Sept. Successful awards will be granted from 5th Sept. We have indicated the requirement for a 6-month interim update on how awards have impacted capacity, with a final report to confirm how objectives have been met. This will inform phase 2. 2.19 Investment in Communities Description To make prevention and early intervention a reality, additional investment is required to add to the community capacity building work already well embedded through the Community Solutions Programme through VANL. Further investment will see development across a number of key priorities for the Partnership, in particular: • First Point of Contact and 3 conversations • Develop the response to frailty • Promoting active health • Further developing social prescribing • Increasing the response to wellbeing • Address digital exclusion The range of achievements through Community Solutions Programme Approach has seen significant development through anchor organisations of Support in the Right Direction Community Connectors, Improving Cancer Journey and Social Prescribing. Early findings from the innovation test site introducing 3 conversations to improve First Point of Contact has indicated that there is a need to invest more significantly in a robust response through the sector which would facilitate a further focus on prevention and wellbeing through connectedness and valued activity with a combination of paid roles and community investment funding. The funding proposals were based on the appointment of 9 Community Connectors across key anchor organisations to support 3 Conversations with Older Adults, Younger Adults and Carers. An umbrella approach through Community Solutions will ensure a co-ordinated approach throughout North Lanarkshire and link clearly to the Community Consortia in promoting local opportunities for and with people, avoiding the need for more formal services for longer. The Community Connectors will also play an important role in the transitional arrangements for people at the point they may need more formal responses from the HSCP. A core investment of £1.1m supports the current programme activity but an additional £1.2 over a two-year period will enable the considerable expansion of the offer. A Programme of Work led jointly by Quality Assurance and Health Improvement, has been established to strengthen the support cross sector and facilitate allocation to support local volunteering, evidence direct benefit. Investment Phase 1 2021/22 £m Phase 2 2021/22 £m Phase 3 2022/23 £m Total £m Recurring Cost 0 0 0 0 Non-recurring costs 0.618 0.618 0 1.236 Total 0.618 0.618 0 1.236
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Progress • Outline proposal developed for Community Connector posts hosted within host organisations in each of the 6 localities. • This comes with challenges due to each organisation having different terms and conditions, e.g., Voluntary Action North Lanarkshire (VANL) cannot recruit to posts. The posts need to be nested within ‘anchor’ organisations. Further work to be done to develop the proposal to achieve the intended outcomes. • Scottish Government has confirmed another 12 months of Community Mental Health and Wellbeing monies. 2.20 INFRASTRUCTURE SUPPORT COSTS 2.21 What we are aiming to achieve All of the transformational change required and described above cannot be achieved, sustained and evidenced without additional infrastructure growth, required on a recurring and non-recurring basis. The infrastructure developments to support all of the above include: • Programme management resource and capacity • Additional social work management capacity • Increased focus on Technology Enabled Care including: community alarms, Making Life Easier, assistive technology • HSCP approach to technology in business, including: SWIS, Midas, Morse, trakcare, dynamic scheduling, GP system upgrade • Business functions including HR, Finance, and IT • Quality Assurance, commissioning, and procurement capacity • Performance and data intelligence capacity • Staff health and wellbeing, in particular the infrastructure to support the use and monitoring the impact of the additional funding to support staff health and wellbeing across the partnership.
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2.22 Social Work Management posts Description Additional resource is required to enable the Service to implement the necessary service design and improvements in Adult Social Work Services. There is a need for additional support to deliver on the key priorities and ensure that there is professional leadership and advice throughout the redesign of services. Mental Health and Addiction Services The national and local focus on addiction services is both welcomed and necessary to address the unacceptable impact of drug and alcohol harm. The strategic and operational capacity to support this work is placing considerable strain on existing resources. Whilst the preferred position may be the appointment of temporary Service Manager capacity, a more pragmatic approach may need to be taken to release capacity in staff who hold the expertise required. Access to services and assessment and planning The work on improving access to services, including Three Conversations, Assessment and planning as well as providing professional oversight to the recovery of direct services including IDS, LSS and Integrated Equipment and Adaptation Service. The work of Health and Wellbeing, Trauma Informed Practice and Rapid Transition Housing has developed over the past few months but now needs to be fully implemented. Therefore, there is a need for temporary support to provide the necessary capacity. Whilst the preferred position may be the appointment of temporary Service Manager capacity a more pragmatic approach may need to be taken to release capacity in staff who hold the expertise required. Complex care in older adults Additional capacity for 23 months to advance key strategic areas such as unscheduled care, discharge without delay, support and care for people who live with dementia or have palliative care needs, housing, review of ASG and oversight of Care Homes. Whilst the preferred position is the appointment of temporary Service Manager capacity a more pragmatic approach may need to be taken to release capacity in staff who hold the expertise required. Resource Worker capacity In addition to the above, there is a need for additional Resource Worker capacity to support the professional leadership required and support the delivery of mental, addictions and complex care strategies. Investment Phase 1 2021/22 £m Phase 2 2021/22 £m Phase 3 2022/23 £m Total £m Recurring Cost 0 0 0 0 Non-recurring costs 0 0 0.303 0.303 Total 0 0 0.303 0.303 Progress • Two Service Managers have been appointed to support the ‘Access to services and assessment and planning’ and ‘Complex care in older adults’ workstreams with start dates to be agreed. • Plans are in place to reconfigure the resource worker posts to one senior officer post.
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2.23 Quality Assurance / Performance & Analytics / Financial Management Description With significant investment in direct service, comes the requirement for increased robustness in quality assurance, performance monitoring, HR support and financial advice. Historically the quality assurance role has focused on independent sector provision, in particular nursing homes. The positive balance of care and the focus on care and support at home requires that emphasis to spread across all areas of service provision. Contract arrangements have progressed with vigour over the last 18 months with clear specification and contract around social care services. With the increased rigour of contractual arrangements, the monitoring requirements also become clear, again requiring increased capacity to respond. The quality assurance team also leads on the communities, carer and advocacy provision. Additional capacity is required to effectively support monitoring and performance analysis across the sector. There will be additional implementation, reporting and analytical requirements. Additional resource is therefore required to support HR, finance, system developments and reporting infrastructures. Analytical information will be required timeously to inform future decision-making. It is anticipated that a reporting framework will be developed around the following Key Performance Indicators. 1. No of delays at census point 2. No of DD occupied bed days 3. No of people discharged into an interim care home 4. No of people who have moved on from interim placement by the agreed date for the placement to end 5. Average length of interim care placements 6. No of NHS staff recruited to band 3 and 4 posts 7. Increase in assessments carried out at home rather than hospital 8. Reduction in no of people waiting for an assessment 9. Reduction in length of time waiting for an assessment 10. Reduction in no of people waiting for a care at home service 11. Reduction in unmet hours of care 12. Evidence of the types of service and activity funded and the no of people supported 13. % increase in use of community equipment and tech 14. Evidence of resource to support the use of technology and digital resources 15. Investment Phase 1 2021/22 £m Phase 2 2021/22 £m Phase 3 2022/23 £m Total £m Recurring Cost 0 0 0.464 0.464 Non-recurring costs 0 0 0.157 0.157 Total 0 0 0.620 0.620 Progress • Two Senior Officers have been appointed in the Quality Assurance team and one Senior Officer, with start dates to be agreed. An additional Resource Worker has been appointed to the Quality Assurance team. • Recruitment continues for the remaining outstanding posts.
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2.24 Staff Health & Wellbeing Description On 5 October 2021, the Cabinet Secretary for Health and Social Care announced an additional package of support of £4 million for staff wellbeing focusing on people’s physical and emotional needs. An allocation of £245,302 (£126,859 North & £118,442 South) was notified to Chief Officers, with a stipulation that this funding was provided for the 2021/22 financial year. A small team of existing and additional staff, led by Health Promoting Health Services is working alongside colleagues in acute services to: • Support comms and provide continued focus on sharing good information, including how to identify what would help and how that can be actioned • Ensure wide uptake • Ensure underrepresented staff groups are encouraged to consider what works for them • Impact is monitored qualitatively as well as quantitively • Learning from the pandemic and responses required through recovery are taken forward to inform future design. • Investment Phase 1 2021/22 £m Phase 2 2021/22 £m Phase 3 2022/23 £m Total £m Recurring Cost 0 0 0 0 Non-recurring costs 0.087 0 0 0.087 Total 0.087 0 0 0.087 Progress Two posts will be recruited to with one hosted by each of the partner organisations (NHSL and NLC). 3. Measures of success 3.1 Progress continues to be made at pace to implement the business case and undertake the recruitment as approved in order to progress the necessary change activity in line with the Scottish Government funding allocations. 3.2 A governance structure has been established to oversee the implementation of the business case, with the SCP PB meeting 4-weekly to ensure the development of new operating models remains on track, is aligned with planned recruitment activities and is delivering the planned benefits. 4. Supporting documentation Appendix 1 – Summary of Costings Morag Dendy Head of Planning, Performance and Quality Assurance
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5. Impacts ( http://connect/report-template-guidance ) 5.1 Public Sector Equality Duty and Fairer Scotland Duty Does the report contain information that has an impact as a result of the Public Sector Equality Duty and/or Fairer Scotland Duty? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? If Yes, has an assessment been carried out and published on the council’s website? https://www.northlanarkshire.gov.uk/your-community/equalities/equality-and-fairer- scotland-duty-impact-assessments Yes ☐ No ☐ 5.2 Financial impact Does the report contain any financial impacts? Yes ☒ No ☐ If Yes, have all relevant financial impacts have been discussed and agreed with Financial Solutions? Yes ☒ No ☐ If Yes, please provide a brief summary of the impact? There are significant financial implications, both recurring and non-recurring detailed throughout the report and summarised in Appendix 1. The financial risks associated with each proposal outlined in this business case have been assessed. Action is being taken to mitigate the risks identified. The risks will continue to be closely monitored within each workstream and by the SCP PB. Progress updates will be reported to the North Lanarkshire IJB (Performance, Finance and Audit) Committee. 5.3 HR policy impact Does the report contain any HR policy or procedure impacts? Yes ☒ No ☐ If Yes, have all relevant HR impacts have been discussed and agreed with People and Organisational Development? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? The implications on the staffing establishments for the NLC and NHSL partners are outlined in each of the ten proposals as appropriate which are detailed in Sections 7, 8 and 9. 5.4 Legal impact Does the report contain any legal impacts (such as general legal matters, statutory considerations (including employment law considerations), or new legislation)? Yes ☐ No ☐ If Yes, have all relevant legal impacts have been discussed and agreed with Legal and Democratic Solutions? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.5 Data protection impact Does the report / project / practice contain or involve the processing of personal data? Yes ☐ No ☐ If Yes, is the processing of this personal data likely to result in a high risk to the data subject? Yes ☐ No ☐
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If Yes, has a Data Protection Impact Assessment (DPIA) been carried out and e- mailed to dataprotection@northlan.gov.uk Yes ☐ No ☐ 5.6 Technology / Digital impact Does the report contain information that has an impact on either technology, digital transformation, service redesign / business change processes, data management, or connectivity / broadband / Wi-Fi? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? Where the impact identifies a requirement for technology, has an assessment been carried out (or scheduled) by the Enterprise Architecture Governance Group (EAGG)? Yes ☐ No ☐ 5.7 Environmental / Carbon impact Does the report / project / practice contain information that has an impact on any environmental or carbon matters? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.8 Communications impact Does the report contain any information that has an impact on the council’s communications activities? Yes ☐ No ☐ If Yes, please provide a brief summary of the impact? 5.9 Risk impact Is there a risk impact? Yes ☒ No ☐ If Yes, please provide a brief summary of the key risks and potential impacts, highlighting where the risk(s) are assessed and recorded (e.g. Corporate or Service or Project Risk Registers), and how they are managed? Initial risks relate to the availability of the workforce, management capacity recruitment and being unable to demonstrate improvement in relation to the key outcomes. A risk and issues log is being created.
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Appendix 1 Summary of Costings FULL YEAR COSTS Assessment and Planning Direct Provision of Services and Supports Infrastructure Support Costs Total Home First & Integrated Rehab Teams Community Nursing Capacity Total HS expansion (incl Tech posts) Hospital @ Home Bed Modelling Indep Sector Investment in Communities Total SW Management Quality Assurance / Performance / Finance Staff Health & Wellbeing HR/ ESC/OD Total Total of 3 phases 7,974,576 2,307,816 10,282,392 6,720,245 436,885 - 1,000,000 618,406 8,775,536 302,930 550,061 86,525 - 939,517 19,997,445 Phase 1 3,282,545 1,492,112 4,774,657 3,931,613 436,885 - 500,000 - 4,868,498 550,061 86,525 - 636,587 10,279,742 Phase 2 2,032,220 314,232 2,346,452 2,788,632 - - 500,000 618,406 3,907,038 302,930 - - - 302,930 6,556,419 Phase 3 2,659,812 501,472 3,161,284 - - - - - - - - - - 3,161,284 check sum - - - - - - - - - - - - - RECURRING FULL YEAR COSTS Assessment and Planning Direct Provision of Services and Supports Infrastructure Support Costs Total Home First & Integrated Rehab Teams Community Nursing Capacity Total HS expansion (incl Tech posts) Hospital @ Home Bed Modelling Indep Sector Investment in Communities Total SW Management Quality Assurance / Performance / Finance Staff Health & Wellbeing HR/ ESC/OD Total Total of 3 phases 7,154,605 1,887,352 9,041,957 4,075,996 436,885 - - 4,512,881 463,536 - - 463,536 14,018,374 Phase 1 3,282,545 1,492,112 4,774,657 3,931,613 436,885 - - 4,368,498 463,536 - - 463,536 9,606,691 Phase 2 2,032,220 79,048 2,111,268 144,383 - - 144,383 - - - - 2,255,651 Phase 3 1,839,841 316,192 2,156,033 - - - - - - - - 2,156,033 check sum - - - - - - - - - - - - - NON RECURRING FULL YEAR COSTS Assessment and Planning Direct Provision of Services and Supports Infrastructure Support Costs Total Home First & Integrated Rehab Teams Community Nursing Capacity Total HS expansion (incl Tech posts) Hospital @ Home Bed Modelling Indep Sector Investment in Communities Total SW Management Quality Assurance / Performance / Finance Staff Health & Wellbeing HR/ ESC/OD Total Total of 3 phases 819,971 420,464 1,240,435 2,644,248 1,000,000 618,406 4,262,654 302,930 86,525 86,525 - 475,981 5,979,070 Phase 1 - - 86,525 86,525 - 173,051 173,051 Phase 2 235,184 235,184 2,644,248 500,000 618,406 3,762,654 302,930 - - - 302,930 4,300,768 Phase 3 819,971 185,280 1,005,251 - 500,000 500,000 - - - - 1,505,251