Agenda Document Pack - Clinical and Care Governance Committee - 28/11/2024
Moray Council · 28 November 2024
Back to Clinical and Care Governance Committee — 28 November 2024 and its agenda
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Clinical and Care Governance Committee Thursday, 28 November 2024 Council Chambers NOTICE IS HEREBY GIVEN that a Meeting of the Clinical and Care Governance Committee, Council Chambers, Council Office, High Street, Elgin, IV30 1BX on Thursday, 28 November 2024 at 13:30 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Minutes of meeting of 29 August 2024 5 - 8 4. Action Log - 29 August 2024 9 - 10 Effective Communication and Information 5. Complaints Report for Quarter 2 2024-25 11 - 26 6. Drug Related Deaths in Moray 27 - 30 Safe and Effective Practice 7. Health and Social Care Moray Clinical and Care Governance Group Escalation Report 31 - 42 8. Joint Inspection of Adult Support and Protection - Progress Review Summary and Findings 43 - 62 9. Adult Support and Protection Multi Agency Improvement Plan 63 - 76 Page 1
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10. Learning Disability Services Dynamic Support Register - Update 77 - 84 Accessible, Flexible and Responsive Services 11. End of Life Care Home Beds 85 - 88 12. Items for Escalation to MIJB Page 2
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MORAY INTEGRATION JOINT BOARD SEDERUNT Mr Derick Murray (Chair) Councillor Peter Bloomfield (Voting Member) Councillor Scott Lawrence (Voting Member) Mr Alex Stephen (Voting Member) Mr Ivan Augustus (Non-Voting Member) Professor Duff Bruce (Non-Voting Member) Mrs Sheila Brumby (Non-Voting Member) Ms Helen Chisholm (Non-Voting Member) Mr Sean Coady (Non-Voting Member) Dr Robert Lockhart (Non-Voting Member) Mr Jim Lyon (Non-Voting Member) Ms Deborah O'Shea (Non-Voting Member) Ms Judith Proctor (Non-Voting Member) Ms Elizabeth Robinson (Non-Voting Member) Dr Malcolm Simmons (Non-Voting Member) Mr Kevin Todd (Non-Voting Member) Ms Janette Topp (Non-Voting Member) Clerk Name: Caroline O'Connor Clerk Telephone: 07779 999296 Clerk Email: committee.services@moray.gov.uk Page 3
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MINUTE OF MEETING OF THE CLINICAL AND CARE GOVERNANCE COMMITTEE Thursday, 29 August 2024 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Councillor Peter Bloomfield, Mrs Sheila Brumby, Mr Sean Coady, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Jim Lyon, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Ms Elizabeth Robinson, Ms Janette Topp APOLOGIES Mr Ivan Augustus, Professor Duff Bruce, Ms Helen Chisholm, Dr Malcolm Simmons, Mr Alex Stephen, Mr Kevin Todd IN ATTENDANCE Corporate Manager; Self-Directed Support and Carers Lead Officer; Allied Health Professional, Sector Lead Moray; Donna Forbes, Social Work Service Manager and Caroline O'Connor, Committee Services Officer SUBSTITUTES Mr Sandy Riddell (for Mr Alex Stephen) 1. Chair The meeting was chaired by Mr Derick Murray. 2. Welcome and Apologies The Committee joined the Chair in welcoming Judith Proctor, Interim Chief Officer, Health and Social Care Moray to her first meeting of the Committee. 3. Declaration of Member's Interests There were no declarations of Member's interests in respect of any item on the agenda. Item 3. Page 5
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4. Minute of meeting of 30 May 2024 The minute of the meeting of 30 May 2024 was submitted and approved. 5. Action Log - 30 May 2024 The Action Log of the meeting of 30 May 2024 was discussed and updated accordingly. 6. Strategic Risk Register - June 2024 The meeting had before it a report by the Interim Chief Officer providing an overview of the current strategic risks, along with a summary of actions which are in place to mitigate those risks, updated June 2024. Following consideration the Committee unanimously agreed to:- i. note the updated Strategic Risk Register included in Appendix 1; and ii. endorse the new format applied to the whole Strategic Risk Register and updated content therein. 7. Complaints Report for Quarter 1 2024-25 The meeting had before it a report by the Allied Health Professional - Sector Lead, Moray informing the Committee of complaints report and closed during Quarter 1 (1 April 2024 - 30 June 2024). Following consideration the Committee unanimously agreed to note the totals, lessons learned, response times and action taken for complaints completed within the last quarter. 8. Draft Health and Social Care Moray Annual Complaints Report 2023-24 The meeting had before it a report by the Chief Nurse, Moray providing the Committee with the Draft Health and Social Care Moray (HSCM) Annual Complaints Report for 2023/24. In response to a question from Councillor Bloomfield relating to the reasons for the spike in GMED and Adult Mental Health complaints, the Depute Chief Officer advised the GMED figures relate to Grampian wide rather than only Moray and do tend to be complex as they cover a wide range of services and confirmed figures will be broken down to relate to Moray in future reports. In relation to the Adult Mental Health complaints, the Depute Chief Officer confirmed few related to Ward 4 but he would provide a more detailed response for the next committee. In response to question from Councillor Lawrence relating to whether comparator figures were available for Children's Social Work and Justice services which had previously not been the responsibility of the Moray Integration Joint Board, the Interim Chief Officer confirmed historical figures would be accessed and included in future reports. Following consideration the Committee unanimously agreed to:- Page 6
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i. note the contents of the annual report; and ii. request the annual report be submitted to Moray Integration Joint Board in September for approval prior to publication. 9. Inspection of the Moray Supported Lodgings Project in May 2024 The meeting had before it a report by the Head of Service and Chief Social Work Officer updating the Committee on the outcome of the recent full inspection of the Moray Supported Lodgings Project by the Care Inspectorate in May 2024. Councillor Bloomfield, noting the reason for the weak rating for Quality Indicator 3.2 related to lack of staff training, asked what assurances could be given that the issue would not happen again. In response the Interim Chief Social Work Officer and Head of Service advised training and development was part of the Improvement Plan to be progressed. In response to a question from Mr Riddell as to what leadership oversight there is of the improvement activities and seeking assurance that the activities are being progress, the Interim Chief Social Work Officer and Head of Service advised there was a direct link between the service manager with overall responsibility for the service and him. Following consideration the Committee unanimously agreed to note the outcome of the full inspection of the Moray Supported Lodgings Project by the Care Inspectorate in May 2024. 10. Health and Social Care Moray Clinical and Care Governance Group Escalation Report The meeting had before it a report by the Allied Health Professional - Sector Lead, Moray informing the Committee of progress and exceptions reported to the Clinical and Care Governance Group since the last report to Committee in May 2024. Following consideration the Committee unanimously agreed to note the contents of the report. 11. Progress Report on Moray Unpaid Carers Strategy The meeting had before it a report by the Service Manager, Provider Services providing an update on the progress in delivering on the objections within the Carer Strategy. The Carers (Scotland) Act 2016 requires the Moray Integration Joint Board to prepare and review a local carer strategy. Following consideration the Committee unanimously agreed to:- i. note the progress made in meeting the objectives within the strategy; ii. note the challenges in delivering the key objectives for Year 1 of the strategy; and iii. instruct the Lead Officer for Unpaid Carers to report back to Clinical and Care Governance Committee on a quarterly basis, as a minimum, to monitor the progress of the actions within the strategy. Page 7
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12. Items for Escalation to MIJB The Committee noted there were no items for escalation to the Moray Integration Joint Board. Page 8
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MEETING OF MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE THURSDAY 29 AUGUST 2024 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE NOVEMBER 2024 1. Strategic Risk Register Update to be provided detailing the impacts of recruitment of dentists on dental services. Discussion to take place between Chief Officer and Unpaid Carer Officer on whether specific mention of Unpaid Carers Strategy should be included in controls section. November 2024 November 2024 Corporate Manager Chief Officer MIJB Development Session took place 31 October 2024 to review and update current Strategic Risk Register. To be presented to MIJB early 2025. 2. Draft HSCM Annual Complaints Report 2023-24 Future reporting of Primary Care Out of Hours (GMED) complaints to broken down into Moray figures. Detailed response relating to Adult Mental Health figures to be provided to next Committee. Historical figures for Children’s Social Work and Justice services to be added to future reports August 2025 November 2024 August 2025 Depute Chief Officer Depute Chief Officer CSWO/Corporate Business Support Manager Quarter 2 Complaints report includes information about GMED service. 2023/24 Annual Complaints report was updated to include this information Item 4. Page 9
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Ensure graphs in future reports are legible. August 2025 Corporate Business Support Manager On Schedule Page 10
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 28 NOVEMBER 2024 SUBJECT: COMPLAINTS REPORT FOR QUARTER 2, 2024/2025 BY: CHIEF NURSE - MORAY 1. REASON FOR REPORT 1.1 To inform the Committee of complaints reported and closed during Quarter 2 (1 July 2024 – 30 September 2024). 2. RECOMMENDATION 2.1 It is recommended that the Committee considers and notes the totals, lessons learned, response times and action taken for complaints completed within the last quarter. 3. BACKGROUND 3.1 Within Health and Social Care Moray (HSCM), complaints received by NHS Grampian (NHSG) and Moray Council are recorded on 2 separate systems, in accordance with the appropriate policy and procedure of these organisations. 3.2 At the meeting on 27 February 2020 (para 7 of the minute refers), it was agreed that a combined report from NHSG and Council complaints systems be submitted to future meetings of the Committee. At the Committee meeting on 27 August 2020 (para 14 of the minute refers) it was requested that the procedures be explained to demonstrate the similarities and differences, if any. 3.3 NHS and Local Authority (LA) Complaint Handling Procedure/Policy requires all staff to deal with feedback and complaints in a person/client-centred way. The procedure has been developed working closely with the Scottish Public Services Ombudsman (SPSO). There is a standard approach to handling complaints across the NHS and Local Authority, which complies with the SPSO's guidance on a model complaints handling procedure and meets all of the requirements of the Patient Rights (Scotland) Act 2011, and accords with the Healthcare Principles introduced by the Act. 3.4 The complaints process followed by both NHSG and Moray Council have the same target response timescales. Early resolution, or front line, complaints will be responded to within 5 working days and complaints handled at the Item 5. Page 11
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investigation stage have a response time of 20 working days. Where it is not possible to complete the investigation within 20 working days an interim response should be provided with an indication of when the final response should be provided. 3.5 The decision as to whether the complaint is upheld or not will be made by the manager or Head of Service. If the person raising the complaint is not satisfied with the outcome, then they may contact the Scottish Public Services Ombudsman (SPSO) for an independent review and assessment, however prior to this, every effort is made to engage with the complainant to resolve the matter to their satisfaction. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The CCG Committee is presented with quarterly complaints performance information using the mandatory Key Performance Indicators (KPIs), published by SPSO in March 2022. These are: Indicator One The total number of complaints received The sum of the number of complaints received at Stage 1 (this includes escalated complaints as they were first received at Stage 1), and the number of complaints received directly at Stage 2. Indicator Two The number and percentage of complaints at each stage which were closed in full within the set timescales of five and 20 working days The number of complaints closed in full at stage 1, stage 2 and after escalation within MCHP timescales as % of all stage 1, stage 2 and escalated complaints responded to in full Indicator Three The average time in working days for a full response to complaints at each stage The average time in working days to respond at stage 1, stage 2 and after escalation Indicator Four The outcome of complaints at each stage The number of complaints upheld, partially upheld, not upheld and resolved at stage 1, stage 2 and after escalation as % of all complaints closed at stage 1, stage 2 and after escalation 4.2 The qualitative indicator on learning from complaints has been removed. However, Part 4 of the SPSO Model Complaints Handling Procedure on Governance stresses the importance of learning from complaints, and the requirements to record and publicise learning. Therefore learning from complaints will continue to be included in quarterly complaints performance reports and annual complaints reports. 4.3 HSCM Complaints performance data for Quarter 2 is attached at Appendix 1. Page 12
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4.4 Information about complaints referred to the Ombudsman are also included along with any complaints relating to the actions and processes of Moray Integration Joint Board (MIJB). 4.5 Figures reported do not include complaints raised regarding the vaccination appointments or processes as these are being dealt with through a dedicated team covering the Grampian area. Any complaints or comments regarding the Moray Vaccination Centre in Elgin are included in reported figures. 4.6 Out of Hours Primary Care Service (known as GMED) is hosted by the Moray Integration Joint Board for the whole of Grampian. GMED service cares for patients who have urgent care needs and cannot wait until their GP Practice is open. GMED operates 18:00 until 08:00 each weekday, all weekends and each public holiday including the festive period. Therefore figures presented for GMED are for a Grampian wide service that on average sees around 90,000 contacts annually (1/6 of the Grampian population). 4.7 Following ministerial approval, Children and Families and Justice Social Work Services were formally delegated by the Local Authority to MIJB on 16 March 2023. All complaints and enquiries received regarding these services and recorded on Lagan are captured in Appendix 1 and the figures below. Complaints 4.8 Overall, a total of 35 complaints were received during Quarter 2. Total Rec’d Q2 23/24 Total Closed Q2 23/24 Total Rec’d Q3 23/24 Total Closed Q3 23/24 Total Rec’d Q4 23/24 Total Closed Q4 23/24 Total Rec’d Q1 24/25 Total Closed Q1 24/25 Total Rec’d Q2 24/25 Total Closed Q2 24/25 LA 16 9 26 20 22 16 13 12 18 10 NH S 21 25 16 17 15 22 15 10 17 15 37 34 42 37 37 38 28 22 35 25 4.9 The table below sets out HSCM complaints received and closed by Quarter. Children and Families and Justice Social Work services figures are included from Q1 2023/24 onwards: Page 13
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21.00 25.00 18.00 15.0015.0014.00 23.00 19.00 32.00 24.00 18.00 22.00 17.00 22.00 26.00 21.00 32.00 21.00 24.00 35.00 25.00 29.0031.00 34.00 37.00 34.00 42.00 37.0037.0038.00 28.00 22.00 35.00 25.00 Q2 20/21 Q3 20/21 Q4 20/21 Q1 21/22 Q2 21/22 Q3 21/22 Q4 21/22 Q1 22/23 Q2 22/23 Q3 22/23 Q4 22/23 Q1 23/24 Q2 23/24 Q3 23/24 Q4 23/24 Q1 24/25 Q2 24/25 45 40 35 30 25 20 15 10 5 0 Received Closed MP/MSP Enquiries 4.10 There were 11 MP/MSP enquiries received regarding council services, under HSCM (including Children and Families and Justice), and recorded on the Council system, Lagan. These were allocated as follows: Service Number of Enquiries Access Team 2 Care at Home 7 Children and Families Area Teams 1 Fostering and Adoption and Supported Lodgings 1 4.11 One of these enquiries was closed as it was out of jurisdiction, 2 enquiries were cancelled, 7 were resolved and 1 is still being investigated. 4.12 As of 1 April 2024, all general MP/MSP enquiries received by NHS Grampian Chief Executive Office, regarding health services, and specific to Moray, are forwarded direct to Service Managers in Moray to handle, in their entirety. To support this change HSCM have streamlined their operational procedures for handling enquiries which has improved efficiency, management oversight, consistency in responses, time management and data collection. 4.13 There were 2 MP/MSP enquiries received regarding health services, under HSCM, during this reporting period. One was in relation to Ward 4, Dr Gray’s Hospital and the other was regarding availability of adult Attention Deficit Hyperactivity Disorder (ADHD) assessments in Grampian. 4.14 Any patient specific MP/MSP enquiries continue to be logged on Datix, and processed by NHS Grampian, either as a complaint or a concern, and captured in figures presented today. 4.15 No concerns were received during Quarter 2 and recorded on Datix. 5. SUMMARY OF IMPLICATIONS Page 14
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(a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” As set out within Annex C of the Health and Social Care Integration Public Bodies (Joint Working) (Scotland) Act 2014 Clinical and Care Governance Framework. Effective handling of complaints is used to ensure the efficient and sustainable delivery of services to meet priorities. (b) Policy and Legal Clinical and Care Governance requirements are set out within the Moray Health and Social Care Integration Scheme. Appropriate arrangements must be in place to ensure and evidence good governance in meeting duties under the Public Bodies (Joint Working) (Scotland) Act 2014. (c) Financial implications None directly associated with this report. (d) Risk Implications and Mitigation There are systems and processes in place across service areas to support clinical governance, providing assurance to the HSCM Senior Leadership Team and to the Clinical and Care Governance Committee. There are platforms within Health and Social Care to discuss and share good practice, learning and challenges. MIJB, Moray Council and NHS Grampian could find themselves exposed to significant risks if good governance is not in place. The purpose of this report is to oversee the processes to ensure that appropriate action is taken in response to adverse events, scrutiny reports/action plans, safety action notices, feedback, complaints and litigation, and those examples of good practice and lessons learned are disseminated widely. (e) Staffing Implications This activity is core to all practitioners in the front line both in terms of their professional competence and assurances in care delivery. (f) Property None directly arising from this report. (g) Equalities/Socio Economic Impact Not required as there are no changes to policy. (h) Climate Change and Biodiversity Impacts None directly arising from this report. (i) Directions None directly arising from this report. (j) Consultations Consultations have been undertaken with the following staff who are in agreement with the content of this report where it relates to their area of responsibility: Page 15
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Corporate Manager Caroline O’Connor, Committee Services Officer, Moray Council Clinical and Care Governance Group 6. CONCLUSION 6.1 This report provides a summary of HSCM complaints received and closed during Quarter 2 (1 July – 30 September 2024). The governance and monitoring of complaints forms part of core business for teams and services and the provision of a good quality, effective and safe service is a key priority for all. Author of Report: Isla Whyte, Corporate Business Support Manager Background Papers: with author Ref: Page 16
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APPENDIX 1 Complaints Data (by closed complaints) Quarter 2 (01/07/24 – 30/09/2024) Learning from complaints Teams and services actively review all forms of feedback to see where improvements can be made and share any learning. The tables 1, 2, 3, 4, 5 and 6 below set out the outcomes of closed complaints, what service received the complaint and any actions taken /learning. Table 1 Complaints Information Extracted from Datix – 15 complaints were closed during Quarter 2, 2024/25. Actions Taken/Outcome of complaints closed during Quarter 2, 2024/25: Fully upheld: Complaint is accepted Partially upheld: Complaint is partly accepted Not upheld: Complaint is not accepted Consent not received: Consent form not received from patient Total Access - Improvements made to service access 1 0 0 0 1 Communication - Improvements in communication staff- staff or staff-patient 5 2 0 0 7 Education/training of staff 4 2 0 0 6 Share lessons with staff/patient/public 1 1 0 0 2 Waiting - Review of waiting times 2 0 0 0 2 No action required 0 0 4 1 5 Total 13 5 4 1 23* *this figure does not represent number of complaints closed as complaints may have more than one action Item 5. Page 17
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Table 2 Complaints Information Extracted from Lagan: 10 complaints were closed during Quarter 2, 2024/25 Directorate Department Service Upheld Partially Upheld Not Upheld Resolution Grand Total Access Team 0 1 1 1 3 Cala 0 0 1 0 1 Children and Families Area Teams 0 0 2 0 2 Children and Families and Criminal Justice Criminal Justice 1 0 0 0 1 Access Team 0 0 1 0 1 Care at Home 0 1 0 0 1 Health and Social Care Moray Health and Social Care Moray Learning Disability 1 0 0 0 1 Table 3 Complaints Information Extracted from Datix: 15 complaints were closed during Quarter 2, 2024/25 Fully upheld: Complaint is accepted Partially upheld: Complaint is partly accepted Not upheld: Complaint is not accepted Consent not received: Consent form not received from patient Total Allied Health Professionals 2 0 0 0 2 Community Nursing 2 0 0 0 2 Community Pharmacy 0 0 1 0 1 General Practice 0 2 0 0 2 GMED 3 1 1 1 6 Mental Health - Adult Mental Health 0 0 1 0 1 Mental Health - Specialisms 0 0 1 0 1 Total 7 3 4 1 15 Page 18
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Table 4 Complaints Information Extracted from Datix – Action Taken by Service (complaints closed during Quarter 2, 2024/25) Allied Health Professionals Community Nursing Community Pharmacy General Practice GMED Mental Health - Adult Mental Health Mental Health - Specialisms Total Waiting - Review of waiting times 1 0 0 0 1 0 0 2 Access - Improvements made to service access 0 1 0 0 0 0 0 1 Communication - Improvements in communication staff-staff or staff-patient 1 2 0 2 2 0 0 7 Education/training of staff 0 2 0 1 3 0 0 6 Share lessons with staff/patient/public 0 1 0 1 0 0 0 2 No action required 0 0 1 0 2 1 1 5 Total 2 6 1 4 8 1 1 23* *this figure does not represent number of complaints closed as complaints may have more than one action. Page 19
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Active review of complaints through reporting and investigation is a useful tool to identify learning and improve services. Below are some of the actions and learning from complaints closed in Quarter 2, 2024/25. Information provided is kept brief to ensure no patient identifiable information is shared. Table 5 Actions and Lessons Learned (Datix) Staff fully briefed on pertussis Education/ training Staff reminded to wear correct PPE Continue to ensure all contacts / telephone calls etc are recorded in case notes by clinicians and admin Reminder to be sent to all clinicians to ensure they communicate clearly with patients Staff reminded to signpost patients to website / up to date information and not rely on printed information which could be out of date Communication Staff reminded to be clear on timescales when communicating with patients A thematic analysis shows, Communication Improvements (staff to staff or staff to patient) continues to be the most common theme arising from complaints. There is no trend in the data showing repeat complaints – from same people or the same complaint. Table 6 Learning Outcomes (Lagan) Process / Procedure To ensure contact between young person and family is considered in care planning Complaint Against Staff Increased vigilance by task supervisor Communication and following procedure continue to be the main themes arising from complaints, again there is no evidence of repeat complaints. Page 20
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Indicator 1 – The total number of complaints received The sum of the number of complaints received at Stage 1 (this includes escalated complaints as they were first received at Stage 1), and the number of complaints received directly at Stage 2. Table 7 – Total number of complaints received in Quarter 2, 2024/25 System recorded Early Resolution / Frontline Investigation Not Marked Total NHS – Datix 9 marked early resolution 8 marked investigative 0 17 Moray Council - Lagan 6 marked frontline 7 marked investigative 5 not yet marked 18 Total 15 15 5 35 Table 8 – Allocation of complaints received in Quarter 2, 2024/25 NHS Service - Datix Allied Health Professionals 2 GMED 3 Community Nursing 1 Mental Health - Adult Mental Health 7 Mental Health – Old Age Psychiatry 1 General Practice 1 Community Pharmacy 1 Vaccination Transformation Programme 1 Total 17 Page 21
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Table 9 – Allocation of complaints received in Quarter 2, 2024/25 MC Service - Lagan Children and Families and Criminal Justice Children and Families Area Teams 2 Cala 1 Criminal Justice 1 Fostering and Adoption and Supported Lodgings 1 Access Team 6 Health and Social Care Moray Moray East 1 Access Team 4 Community Care Finance 2 Total 18 Page 22
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Indicator 2 - The number and percentage of complaints at each stage which were closed in full within the set timescales of five and 20 working days The number of complaints closed in full at stage 1, stage 2 and after escalation within MCHP timescales as % of all stage 1, stage 2 and escalated complaints responded to in full. There were 15 Complaints closed on the NHS system Datix during Quarter 2, 2024/25 – breakdown as follows: Early Resolution/Stage 1 2 Investigation/Stage 2 4 Escalated Stage 2 7 No consent received 1 SPSO 1 There were 10 Complaints closed on the MC system Lagan during Quarter 2, 2024/25 – breakdown as follows: Early Resolution/Stage 1 5 Investigation/Stage 2 3 Escalated Stage 2 2 Table 10 – number and percentage of complaints at each stage closed within timescales (based on complaints closed during Quarter 2, 2024/25) Frontline/Early Resolution within timescale Investigation within timescale Escalated Investigation NHS - Datix 2 out of 2 (100%) 1 out of 4 (25%) 2 out of 7 (29%) Moray Council - Lagan 2 out of 5 (40%) 0 out of 3 (0%) 2 out of 2 (100%) Whilst HSCM aim to respond to complaints within timescales this is not always achievable. Complaints received are often multi-faceted and include more than one service and other sectors, which can impact on response times due to the level of investigation and coordination required. Page 23
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Indicator 3 - The average time in working days for a full response to complaints at each stage Table 11 – average time in working days to respond at stage 1, stage 2 and after escalation (based on complaints closed during Quarter 2, 2024/25) ** one particularly complicated investigation (involved 3 services and external partners) has impacted response time here – the complaint was also reopened 4 months after response was issued which is included in the total response time. Frontline Investigative Escalated Investigative NHS - Datix 3 days 113 days ** 38 days Moray Council - Lagan 13 days 54 days 8 days Page 24
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Indicator 4 - The outcome of complaints at each stage The number of complaints upheld, partially upheld, not upheld and resolved at stage 1, stage 2 and after escalation as % of all complaints closed at stage 1, stage 2 and after escalation. Graph 2 below shows the number of complaints fully upheld, partially upheld and not upheld as recorded in Datix during Quarter 2, 2024/25. 15 complaints were closed during Quarter 2: 1 was closed as no consent was received. From the remaining 14: 50% were upheld, 21% were partially upheld and 29% were not upheld. Early Resolution Investigation Escalated Investigation SPSO 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 Fully Upheld Partially Upheld Not Upheld Complaints Outcome (Datix) Page 25
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Complaints Information Extracted from Lagan: 10 complaints were closed during Quarter 2, 2024/25: 20% were fully upheld, 20% partially upheld, 50% were not upheld and 10% were resolved. 2 were closed as they were duplicates. Graph 3 below shows the number of complaints upheld, partially upheld and not upheld as recorded in Lagan from the 10 closed complaints during Quarter 2, 2024/25. Frontline Investigation Escalated Investigative 2.5 2 1.5 1 0.5 0 Fully Upheld: Complaint is accepted Partially Upheld: Complaint is partly accepted Not Upheld: Complaint is not accepted Resolution Complaints Outcome (lagan) Page 26
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 28 NOVEMBER 2024 SUBJECT: DRUG RELATED DEATHS IN MORAY BY: BUSINESS MANAGER, MENTAL HEALTH AND DRUG AND ALCOHOL SERVICES 1. REASON FOR REPORT 1.1 To update the Committee about drug-related deaths in Moray. 2. RECOMMENDATION 2.1 It is recommended that the Committee consider and note: i) the drug related death figures for Moray; ii) the ongoing work of the service in relation to the Multi Agency Risk System (MARS) process; iii) the National Benchmarking report on the implementation of the Medication Assisted Treatment (MAT) Standards: Scotland 2023/24; iv) the work being done on the Moray residential rehabilitation pathway; and v) the development of a strategic group and lived experience panel to align the Moray strategy and the National Mission 3. BACKGROUND 3.1 The National Records of Scotland (NRS) publish, annually, the Drug-related Deaths in Scotland figures. The report on the 2023 figures is now available, published in August 2024 and can be accessed online: Drug misuse deaths increase | National Records of Scotland (nrscotland.gov.uk) Item 6. Page 27
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4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 National Records of Scotland confirmed that Moray had 10 confirmed drug related deaths in 2023, an increase from 9 in 2022. Only 50% of these were known to secondary care services. 4.2 The MARS meetings continue to take place on a regular basis for people known to be high-risk, currently there are 5 people in the process – a decrease from 9 in the previous report. This is partially due to the required support being put in place for people which has meant that their risk is lessened, however it is important to acknowledge that some individuals have been removed from the process as a result of non-engagement with all support offered over a significant period of time. These individuals remain at considerable risk and services continue to try to attempt to engage with them. . 4.3 Good progress has been made towards achieving the MAT standards. Moray was rated green for MAT 1 – 5 and provisional green for MAT 6 -10. Public Health Scotland have recently issued Reporting and Improvement Guidance for 2024/25 which will be considered and implemented locally. 4.4 Drug Related Death Meetings are chaired and meeting notes held confidentially. The frequency of meetings are demand led, there have been less of these recently as the number of drug related deaths reduce. 4.5 Moray Integrated Drug and Alcohol Service follow a review process of all the cases open in service for shared learning and debrief. 4.6 Clinical governance will be assured to Moray Health and Social Care Clinical and Care Governance Group by completing and submitting the Quality Assurance Reporting Template on a biannual basis. This includes reporting of risks; adverse events; learning outcomes from adverse events reviews (drug related deaths); good practice; external reviews of service; people’s experience of the service – complaints / care experience. 4.7 A local implementation group continues to meet fortnightly to support delivery of MAT standards in Moray. 4.8 The Moray residential rehab pathway has now been published, following improvement work undertaken in conjunction with HIS. The pathway has now been actioned and people have access to residential rehab. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” Moray Drug and Alcohol Partnership Delivery Plan 2021 - 2024 (reviewed and revised November 2022). (b) Policy and Legal Improved governance – review and reporting of all drug and alcohol related deaths. Page 28
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Delivery in line with Rights, Respect and Recovery 2018 – Scotland’s strategy to improve health by preventing and reducing alcohol and drug use, harm and related deaths, the aim of the National Mission on Drug Deaths Plan 2022-2026 to reduce drug deaths and improve lives and the Scottish Government Phase One Report: Good Practice Guide for Pathways into, Through and Out of Residential Rehabilitation Scotland. (c) Financial implications There are no financial implications. The Adverse Event Review Process and Multi Agency Risk System approach are undertaken by existing staff and multi-agency partners. (d) Risk Implications and Mitigation As detailed above at Section 4. (e) Staffing Implications Additional staff have already been appointed to support delivery of MAT standards, as well as meet increased demand on services. However, there are ongoing difficulties in recruiting to vacant clinical posts within the service which may impact on the ability to deliver care in a timely manner. (f) Property Current accommodation remains not fit for purpose, and does not allow service to comply with all of the MAT standards. In addition, colocation with the Justice Service can be seen as a barrier to people accessing treatment. Work continues to secure alternative premises for the service, however, to date this has been unsuccessful. (g) Equalities/Socio Economic Impact None arising directly from this report as there is no change to policy. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions None arising from this report. (j) Consultations Public Protection Lead, Moray Alcohol and Drug Partnership Manager, Alcohol and Drug Partnership Co-ordinator, Clinical Team Lead, Moray Integrated Drug and Alcohol Service and Caroline O’Connor, Committee Services Officer, Moray Council. Comments have been incorporated in this report. 6. CONCLUSION 6.1 Moray's strategy to reduce drug-related deaths is supported by regular reviews, the Multi Agency Risk System (MARS), and the Medication Assisted Treatment (MAT) standards. The combination of daily high-risk event and MAT multi-disciplinary meetings ensures timely responses to individuals at greatest risk. These collaborative efforts help manage risk and reduce harm for vulnerable individuals in service. Page 29
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Author of Report: Lynne Clark, Business Manager Background Papers: Ref: Page 30
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 28 NOVEMBER 2024 SUBJECT: HEALTH AND SOCIAL CARE MORAY (HSCM) CLINICAL AND CARE GOVERNANCE GROUP ESCALATION REPORT BY: CHIEF NURSE - MORAY 1. REASON FOR REPORT 1.1 To inform the Committee of progress and exceptions reported to the Clinical and Care Governance Group since the last report to Committee in August 2024. 2. RECOMMENDATION 2.1 It is recommended that the Committee consider and note the contents of the report. 3. BACKGROUND 3.1 HSCM Clinical Governance Group was established as described in a report to this Committee on 28 February 2019 (para 7 of the minute refers). 3.2 The assurance framework for clinical governance was further developed with the establishment of the Clinical Risk Management Group (CRM) as described in a report to this Committee on 30 May 2019 (para 7 of the minute refers). 3.3 As reported to this Committee on 29 October 2020 (para 5 of the minute refers) Social Care representatives attend the Clinical Governance Group, so the group was renamed HSCM Clinical and Care Governance (CCG) Group. 3.4 A refresh of the Terms of Reference for the HSCM CCG Group was undertaken in 2023 and reported to this Committee on 30 November 2023 (para 6 of the minute refers). 3.5 This report contains information reported to HSCM CCG Group from Clinical Service Groups / departments. This report also contains further information relating to incidents / adverse events reported via Datix and areas of concern / risk and good practice shared during the reporting period. 3.6 The reporting schedule of the CCG Group does not always align to quarterly reporting to the committee. It has been agreed that the Escalation Report should include the CCG Group meetings between committee scheduling; this may not always be quarterly. 3.7 The CCG Group have met 3 times during this reporting period. Item 7. Page 31
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4. KEY MATTERS RELEVANT TO RECOMMENDATION Audit, Guidelines Reviews and Reports 4.1 Relevant Audits, Guidelines Reviews and Reports are presented and discussed. These include local and national information that is relevant to HSCM, for example, recommendations from Health Improvement Scotland (HIS) reports from other areas which require to be discussed, and assurance given that services in Moray are aware of these and have processes in place to meet / mitigate the report recommendations. Overview of items discussed during this reporting period are listed below: CRM Minutes External Reports Service Updates Adverse Events and Duty of Candour HSCM Risk Register Complaints / Feedback Update from Practice Governance Group Areas of achievement / Good Practice Community Appointment Day 4.2 In response to the increasing number of referrals and the complexity surrounding patient presentations, it was agreed that the Moray Community Appointment Day (CAD) would focus on Musculoskeletal (MSK) Conditions (conditions affecting bones, joints, muscles, and connective tissues). 4.3 140 MSK Physio and 60 MSK Podiatry patients on the waiting lists were invited to attend the CAD on 11 September 2024 at the Moray Sports Centre in Elgin. The CAD was an opt in invitation format and patients were screened to ensure they were suitable for this intervention. 11 appointment slots were available every 15 minutes. 19 community groups and partner services were in attendance. 162 patients opted in with 120 attending on the day. On checking in, patients were invited to scan a QR code linking them to their own online Personal Health Passport, which was completed by them as they moved around the zones, promoting self-management and ownership. Patients were encouraged to have meaningful conversations about what matters most to them and by bringing health and community organisations together under one roof, allowed people’s health and wellbeing to be viewed holistically. 4.4 Preliminary feedback was largely positive, indicating that patients felt the day had been ‘enlightening’, benefited greatly from having services available in one place and found out about what is available in communities. Further analysis showed that patients particularly valued the focused time given to them, being listened to what matters to them, having access to a one-stop-shop, patient centred care and feeling informed. Included in the patient evaluation was the Page 32
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Collaborate tool; 78% reported that every effort was made to help them understand their health issue, 74% reported that every effort was made to include what mattered to them in choosing what they do next, 79% reported that every effort was made to listen to things that mattered to them most about their health issues. Overall, patients rated the experience 4.5 out of 5. 4.5 60% of patients were either recommended a Patient Initiated Review (PIR) within 6 months or fully discharged from the service. 4.6 Full evaluation is in progress and a further update will follow in due course. Children and Families Health Service 4.7 Both the Health Visiting and School Nursing teams are fully staffed at present. The service has now moved to electronic records which is a very positive step. Challenges continue as the School Nurse service adapts in order to fulfil the 10 priorities set out by the Scottish Government. More detail on these priorities can be found here The School Nursing Role in Integrated Community Nursing Teams - School Nursing Priority Areas and Pathways Family Fest – September 2024 4.8 An event took place in Elgin Town Hall on 19 September 2024. This event was as the result of a successful partnership between the Children’s Services Network and Moray Pathways Local Employability Partnership with the aim of showcasing developments in the first year of the Children’s Services Plan (CSP). This event highlighted ways in which families can maximise their household income alongside identifying the variety of supports available to help with this and other aspects of family life such as positive mental health and wellbeing. Over 330 people attended the event, an increase of 110 attendees from the previous year. 4.9 Social Work Recruitment remains a challenge with some teams carrying significant vacancies. However, a Social Worker in Training (SWiT) model is now being progressed to help alleviate some of the recruitment pressure. Work is also ongoing to develop and build on links with educational establishments to promote social work career opportunities. Adult Support and Protection Multi-Agency Joint Inspection – Progress Review 4.10 The CCG Group acknowledged the significant amount of work undertaken by staff as part of the recent progress review. A separate report is on today’s agenda providing the findings from the review and an updated Multi-Agency Improvement Plan. Clinical Risk Management (CRM) 4.11 The CRM group continues to meet every 2 weeks to discuss issues highlighted on the HSCM Datix dashboard. This includes Level 1 and Level 2 investigations, Complaints, Duty of Candour and Risks. Page 33
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4.12 The group is attended by members of the Senior Management Team, Clinical Leads, Chief Nurse and relevant Service Managers. The purpose is to ensure that senior managers are assured of the standards of services and that where necessary investigations are carried out appropriately, and learning opportunities identified and shared following adverse events and complaints. 4.13 Any learning identified is presented and discussed at all relevant operational meetings. Complaints and Feedback 4.14 HSCM complaints information for Quarter 2, 2024/25 is included in a separate report on today’s agenda. Adverse Events (AE) 4.15 Information about AE reported on Datix during Quarter 2, 2024/25 is available at Appendix 1. 4.16 There was a significant rise in AE recorded on Datix during Q3 of 2023/24. The increase can be attributed to our mental health inpatient areas. Some inpatients can display higher levels of distress, violence and aggression, and this results in more recorded incidents. Findings and Lessons Learned from incidents and reviews 4.17 A Level 1 review consists of a full review team who have been commissioned to carry out a significant event analysis and review, reporting findings and learning via the division/service governance structures. 4.18 There are currently 3 Level 1 reviews in progress (at the time of reporting). HSCM Risk Register 4.19 Each Clinical Service Group/Department highlights risks associated with their service, which are then discussed at CRM. The risk register is routinely reviewed with leads with guidance and support provided regarding updates. Work is ongoing to review and improve this process and this will be discussed at OMT every month. 4.20 New risks identified on Datix are discussed at CRM. There is an ongoing review of the operational risk registers. At the time of reporting, there are 48 risks on the risk register. These are monitored and reviewed as appropriate, by the service managers. Duty of Candour 4.21 At the time of reporting there are no ongoing Duty of Candour incidents. Items for escalation to the Clinical and Care Governance Committee 4.22 There are no items to escalate to Committee. Page 34
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5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” As set out within Annex C of the Health and Social Care Integration Public Bodies (Joint Working) (Scotland) Act 2014 Clinical and Care Governance Framework. (b) Policy and Legal Clinical and Care Governance requirements are set out within the Moray Health and Social Care Integration Scheme. Appropriate arrangements must be in place to ensure and evidence good governance in meeting duties under the Public Bodies (Joint Working) (Scotland) Act 2014. (c) Financial implications None directly associated with this report. (d) Risk Implications and Mitigation There are systems and processes in place across service areas to support clinical governance, providing assurance to the HSCM Senior Leadership Team and to the CCG Committee. There are platforms within Health and Social Care to discuss and share good practice, learning and challenges. Moray Integration Joint Board (MIJB), Moray Council and NHS Grampian could find themselves exposed to significant risks if good governance is not in place. The purpose of this report is to oversee the processes to ensure that appropriate action is taken in response to adverse events, scrutiny reports/action plans, safety action notices, feedback, complaints and litigation, and those examples of good practice and lessons learned are disseminated widely. Adverse events and complaints provide significant information on trends relating to risk and an encouraging opportunity for learning across the system. Regular monitoring of this is critical to ensure continuous improvement and the ambition of achieving excellence in our delivery of high quality care and treatment. The local CRM group reviews all events logged on Datix, ensuring risk is identified and managed. (e) Staffing Implications This activity is core to all practitioners in the front line both in terms of their professional competence and assurances in care delivery. (f) Property None directly arising from this report. Page 35
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(g) Equalities/Socio Economic Impact There is no requirement for an equality impact assessment because there is no change to policy required as a result of this report. (h) Climate Change and Biodiversity Impacts None directly arising from this report. (i) Directions None directly arising from this report. (j) Consultations Consultations have been undertaken with the following staff who are in agreement with the content of this report where it relates to their area of responsibility: HSCM Clinical and Care Governance Group members Sonya Duncan, Corporate Manager Caroline O’Connor, Committee Services Officer, Moray Council Health Improvement Team Lead, Public Health Moray Service Manager – Children and Families 6. CONCLUSION 6.1 The HSCM CCG Group are assured that issues and risks identified from complaints, clinical risk management, internal and external reporting, are identified and escalated appropriately. The group continues to develop lines of communication to support the dissemination of information for action and sharing of good practice throughout the whole clinical system in Moray. This report aims to provide assurance to this Committee that there are effective systems in place to reassure, challenge and share learning. Author of Report: Isla Whyte, Corporate Business Support Manager, HSCM Background Papers: with author Ref: Page 36
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APPENDIX 1 Adverse Events by Category and Level of Review Reported on Datix (Quarter 2, 2024/25) Table 1 Level 3 - local review by line manager in discussion with staff Level 2 - local management team review Total Abusive, violent, disruptive or self-harming behaviour 66 0 66 Access, Appointment, Admission, Transfer, Discharge (Including Absconders) 10 0 10 Accident (Including Falls, Exposure to Blood/Body Fluids, Asbestos, Heat, Radiation, Needlesticks or other hazards) 84 1 85 Clinical Assessment (Investigations, Images and Lab Tests) 2 0 2 Consent, Confidentiality or Communication 3 1 4 Diagnosis, failed or delayed 1 0 1 Financial loss 2 0 2 Fire 3 0 3 Implementation of care or ongoing monitoring/review (inc. pressure ulcers) 14 0 14 Infrastructure or resources (Staffing, Facilities, Environment, Lifts) 21 0 21 Medical device/equipment 4 0 4 Medication 51 0 51 Other - please specify in description 35 2 36 Patient Information (Records, Documents, Test Results, Scans) 9 0 9 Security (no longer contains fire) 3 0 3 Treatment, Procedure (Incl. Operations or Blood Transfusions etc.) 6 0 6 Total 314 4 318 Item 7. Page 37
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Adverse Events by Type and Result Reported on Datix (Quarter 2, 2024/25) Graph 1 Breach of Information / IT Security Patient / Client / Resident Staff (including Volunteers) Student or Trainee Visitors, Relatives or member of the... Provision of Service Audit Property / Equipment 160 140 120 100 80 60 40 20 0 Near Miss (event prevented) Event resulted in NO injury, harm or ill-health Event resulted in injury, harm or ill-health Adverse Events by Type and Result Page 38
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Adverse Events by Service and Level of Review Reported on Datix (Quarter 2, 2024/25) Table 2 Level 3 - local review by line manager in discussion with staff Level 2 - local management team review Total Allied Health Professionals 14 0 14 Community Hospital Nursing 81 1 82 Community Nursing 28 1 29 Community Pharmacy 2 0 2 Continence Service 1 0 1 General Practice 3 0 3 GMED 23 0 23 Mental Health - Adult Mental Health 64 2 66 Mental Health - Learning Disabilities 1 0 1 Mental Health - Old Age Psychiatry 44 0 44 Mental Health - Psychology 1 0 1 Mental Health - Specialisms 4 0 4 Out of Hours Community Nursing 2 0 2 Primary Care 5 0 5 Public Dental Service 4 0 4 Public Health 1 0 1 Vaccination Transformation Programme 36 0 36 Total 314 4 318 Page 39
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Adverse Events by Type and Severity Reported on Datix (Quarter 2, 2024/25) Table 3 NEGLIGIBLE: Negligible/no injury or illness, negligible/no disruption to service, negligible/no financial loss MINOR: Minor injury or illness, short term disruption to service, minor financial loss MODERATE: Significant injury, externally reportable e.g. RIDDOR, some disruption to service, significant financial loss MAJOR: Major injury, sustained loss of services, major financial loss Total Breach of Information / IT Security 5 0 0 0 5 Patient / Client / Resident 177 33 2 1 213 Staff (including Volunteers) 18 5 1 0 24 Student or Trainee 1 0 0 0 1 Visitors, Relatives or member of the Public 9 1 0 0 10 Provision of Service 33 3 0 0 36 Audit 1 0 0 0 1 Property / Equipment 34 1 0 0 35 Total 278 43 3 1 325 Page 40
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Table 4: All adverse events by result by Quarter on Datix 2021/22 Quarter 4 2022.23 Quarter 1 2022/23 Quarter 2 2022/23 Quarter 3 2022/23 Quarter 4 2023/24 Quarter 1 2023/24 Quarter 2 2023/24 Quarter 3 2023/24 Quarter 4 2024/25 Quarter 1 2024/25 Quarter 2 Occurrence with NO injury, harm or ill-health 189 218 214 283 200 210 270 327 235 217 225 Occurrence resulting in injury, harm or ill-health 79 89 98 78 60 73 76 71 70 69 59 Near Miss (occurrence prevented) 31 29 40 38 20 22 26 50 31 27 41 Property damage or loss 0 0 0 0 0 0 0 0 0 0 0 Death 0 0 0 0 0 0 0 0 0 0 0 Total 299 336 352 349 280 305 372 448 336 313 325 Table 5: Adverse Events by Severity Reported by Quarter on Datix 2021/22 Quarter 4 2022/23 Quarter 1 2022/23 Quarter 2 2022/23 Quarter 3 2022/23 Quarter 4 2023/24 Quarter 1 2023/24 Quarter 2 2023/24 Quarter 3 2023/24 Quarter 4 2024/25 Quarter 1 2024/25 Quarter 2 Negligible 231 259 264 283 226 240 305 388 274 256 278 Minor 64 70 78 60 48 58 61 52 53 50 43 Moderate 2 4 8 5 6 5 6 8 9 6 3 Major 2 1 2 0 0 1 0 0 0 1 1 Extreme 0 2 0 1 0 1 0 0 0 0 0 Total 299 336 352 349 280 305 372 448 336 313 325 Page 41
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 28 NOVEMBER 2024 SUBJECT: JOINT INSPECTION OF ADULT SUPPORT AND PROTECTION – PROGRESS REVIEW SUMMARY AND FINDINGS BY: CONSULTANT PRACTITIONER, ADULT SUPPORT AND PROTECTION LEAD OFFICER 1. REASON FOR REPORT 1.1 This report provides a summary and overview of the findings of the Moray Joint Inspection of Adult Support and Protection – Progress Review that took place between August – October 2024. 2. RECOMMENDATION 2.1 It is recommended the Committee: i) considers and notes the Joint Inspection of Adult Support and Protection – Progress Review Report; and ii) acknowledges the hard work and commitment demonstrated by the Moray Adult Protection Committee, Leaders, and Front-Line Practitioners throughout the Partnership in supporting people at risk in the Moray community. 3. BACKGROUND 3.1 The Progress Review of the Moray partnership took place between August and October 2024. This was a review of the progress following previous Joint Inspection in 2022 where a number of recommendations were made. These recommendations are outlined below. The partnership should ensure the application and delivery of key processes for all adults at risk of harm is consistent and in line with the Moray Health and Social Care Partnership (HSCP) and Grampian interagency procedures. The partnership should ensure that full adult support and protection investigations are carried out for all adults at risk of harm who require them. Item 8. Page 43
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The partnership should seek to improve the quality of chronologies, risk assessments, and protection plans. This will impact positively on the management of risk for adults at risk of harm. Case conferences and review case conferences should be clearly defined, involve the adult at risk of harm and unpaid carer where appropriate and should be convened for all adults at risk of harm who require them. The partnership should prioritise the full implementation of the improvement plan. Strategic leaders should ensure that the appropriate resources are made available. Strategic leaders should strengthen governance of adult support and protection practice. There should be robust measures in place to identify concerns early and promptly implement remedial action. Strategic leaders should continue to develop multi-agency self-evaluation activities. Frontline staff should be fully involved in the design, implementation, and consequent improvement work. 3.2 The Progress Review methodology compromised of The analysis of supporting documentary evidence and a focussed position statement Case File Reading of health, police and social work records of adults at risk of harm. The Joint Inspection Team read 20 adults at risk of harm files, whose adult support and protection journey progressed to an inquiry with investigative powers and beyond. Focus Group discussions with multi-agency frontline staff, middle managers and strategic managers from across the Partnership. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Care Inspectorate has commended the Partnership in the findings of the Progress Review where significant progress was found in all 7 of the recommended areas (above) for improvement in the 2022 Joint Inspection. The full report from the Care Inspectorate was published on 29 October 2024 and can be found here and attached as Appendix 1. Key findings include: Consistent application and delivery of key processes. Practitioners were noted to be confident and highly professional and followed the multi- agency adult support and protection procedures meticulously Investigations were carried out for all adults at risk who required them. Almost all Investigations were rated good or better (85%). Adults at risk of harm had in place a Chronology. 80% of Chronologies were rated good or better, which is a significant improvement from 39% in 2022. The Quality of Risk Assessments and Protection Plans had improvement significantly Case Conferences were found to be carried out effectively. The right people from partner agencies prioritised attendance. Almost all Case Conferences were rated good or better for quality. Initial Referral Discussions (IRDs) were found to be of an exemplar for the sector The Adult Protection Committee (APC) and Chief Officers Group (COG) exercised sound and effective multi-agency governance over the delivery of improvements to adult support and protection Page 44
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The partnership had a cohesive programme of multi-agency audits and quality assurance activities. These included involvement from front line practitioners. 4.2 The below table evidences the significant progress Moray has made in relation to key processes comparing the findings of the 2022 Joint Inspection to the Progress Review 2024. 4.3 The Progress Review highlighted areas in which require further improvement. These areas are highlighted below. Assessment of risk during Investigation stage to be explicit. Recording of health information pertinent to adult support and protection requires improvement 4.4 Actions have already commenced in relation to the highlighted areas for further improvement, and these have been highlighted within our Multi-Agency Improvement Plan. 4.5 The Care inspectorate’s link inspector will continue to engage with the Partnership and attends the Adult Protection Committee. 4.6 The Partnership will continue to have in place a Multi-Agency Improvement Plan and this will continue to be utilised as a tool to track progress and further improvement moving forward. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Moray Partners in Care 2022-2032” This report supports the Moray Strategic Plan in relation to Partners in Care, making choices and taking control over decisions affecting our care and supporting the outcome that people are safe. (b) Policy and Legal The Adult Support and Protection (Scotland) Act 2007 is the main legal reference points for this project for which the MIJB are legally responsible. Page 45
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(c) Financial implications No financial implications as a direct result of this report. (d) Risk Implications and Mitigation The Partnership working together in relation to adult support and Protection have specific legal duties outlined in the 2007 Legislation. The effective and ongoing collaborative work lead by the Adult Protection Committee will continue to ensure we are discharging these duties effectively. (e) Staffing Implications None as a direct result of this report. (f) Property None as a direct result of this report. (g) Equalities/Socio Economic Impact Not required as there are no changes to policy as a result of this report. (h) Climate Change and Biodiversity Impacts None as a direct result of this report. (i) Directions None as a direct result of this report. (j) Consultations ASP Planning and Improvement Subgroup. 6. CONCLUSION 6.1 The report aims to provide assurance to Committee that there are effective processes in place to monitor and progress actions in the plan. Author of Report: Vicki Low, Consultant Practitioner, Adult Support and Protection Lead Officer – HSCM Background Papers: with author Ref: Page 46
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OFFICIAL in the Moray partnership area Published October 2024 APPENDIX 1 Item 8. Page 47
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P a g e | 2 o f 1 5 Table of Contents Background 3 Overview of progress made in Moray partnership 6 Progress on priority areas for improvement 7 Summary of progress 14 Next steps 15 Page 48
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P a g e | 3 o f 1 5 Background Joint inspection partners In June 2023 Scottish Ministers requested that the Care Inspectorate lead the progress reviews of adult support and protection in collaboration with Healthcare Improvement Scotland and His Majesty’s Inspectorate of Constabulary in Scotland. These relate to six partnerships across Scotland where important areas of weakness outweighed strengths in our phase 1 inspection programme between 2020 and 2023. Joint inspection focus The purpose of these six joint inspection team progress reviews is to provide assurance about the extent to which improvement has progressed in each of these partnership1 areas. Updated code of practice The updated code of practice for the Adult Support and Protection (Scotland) Act 2007 was published in July 2022. Partnerships should have implemented the new code of practice guidance for the cases scrutinised in this progress review. Joint review methodology The methodology for these six progress reviews includes: The analysis of supporting documentary evidence and a focussed position statement submitted by each partnership. This evidence relates specifically to areas for improvement identified in the phase 1 inspection reports. Reading a sample of health, police, and social work records of adults at risk of harm. We read the records of 20 adults at risk of harm whose adult support and protection journey progressed to an inquiry with investigative powers and beyond. Staff focus groups – We met with 39 members of staff from the Moray partnership to discuss improvements they have made to the delivery of key process, and strategic leadership for adult support and protection. Staff included multi-agency frontline staff, middle managers and strategic managers. 1https://www.careinspectorate.com/images/Adult_Support_and_Protection/New_links/1.__Definition_of_a dult_protection_partnership.pdf Page 49
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P a g e | 4 o f 1 5 Quality indicators Our quality indicators for these joint reviews are on the Care Inspectorate’s website.2 We have used the same quality indicators that were used in the phase 1 inspection. Standard terms applied to the sample of records we read. All – 100% Almost all – 80% - 99% Most – 60% - 79% Just over half – 51% - 59% Half – 50% Just under half – 40% - 49% Some – 20% - 39% Few – 1% - 19% Progress Priority areas for improvement were identified in the phase 1 inspection. To indicate progress, we have used RAG rated arrow indicators. In our determinations we have included the principles of a RADAR model (Results, Approach, Deployment, Assessment and Refinement) that helped us to identify how effectively and efficiently partnerships approached their improvement work. What we mean by these is set out in the key below. 2https://www.careinspectorate.com/images/Adult_Support_and_Protection/4.__Adult_support_and_protec tion_-_quality_indicator_framework.pdf Page 50
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P a g e | 5 o f 1 5 Minimal progress Improvement is minimal. The partnership’s overall approach to improvement is not comprehensive or put into practice. It’s deployment and implementation are limited. It has not embedded improvements or they are still at the planning stage. It does not communicate improvements effectively and they are not well understood by staff. It does not assess and review the effectiveness of its improvement progress. Some progress Evidence of some improvement. The partnership’s approach to improvement is moderate. Its implementation and deployment of improvements are structured. It is beginning to embed improvements in practice. It communicates improvements partially and staff understand them reasonably well. It has limited measures to evaluate and review impact and outcomes for adults at risk of harm. It periodically assesses and reviews its improvement methodology. Significant progress Significant improvement. The partnership’s approach to improvement is comprehensive and embedded. Its deployment of improvements is well structured, implemented and effective. It communicates improvements purposefully, and staff understand them fully. It has effective measures to evaluate and review impact and outcomes for adults at risk of harm. It continually assesses and refines its improvement methodology. Page 51
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P a g e | 6 o f 1 5 Overview of progress made in Moray partnership Priority areas for improvement from Phase 1 in June 2022 Progress Progress review findings in September 2024 1 The partnership should ensure the application and delivery of key processes for all adults at risk of harm is consistent and in line with the Moray Health and Social Care Partnership (HSCP) and Grampian interagency procedures. Significant progress made. 2 The partnership should ensure that full adult support and protection investigations are carried out for all adults at risk of harm who require them. Significant progress made. 3 The partnership should seek to improve the quality of chronologies, risk assessments, and protection plans. This will impact positively on the management of risk for adults at risk of harm. Significant progress made. 4 Case conferences and review case conferences should be clearly defined, involve the adult at risk of harm and unpaid carer where appropriate and should be convened for all adults at risk of harm who require them. Significant progress made. 5 The partnership should prioritise the full implementation of the improvement plan. Strategic leaders should ensure that the appropriate resources are made available. Significant progress made. 6 Strategic leaders should strengthen governance of adult support and protection practice. There should be robust measures in place to identify concerns early and promptly implement remedial action. Significant progress made. 7 Strategic leaders should continue to develop multi-agency self-evaluation activities. Frontline staff should be fully involved in the design, implementation and consequent improvement work. Significant progress made. Significant progress Some progress Minimal progress Page 52
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P a g e | 7 o f 1 5 Progress on priority areas for improvement Key processes priority area for improvement 1 The partnership should ensure the application and delivery of key processes for all adults at risk of harm is consistent and in line with the Moray Health and Social Care Partnership (HSCP) and Grampian interagency procedures. The recently reviewed Grampian interagency adult support and protection procedures were comprehensive, and well-designed. It referenced the Scottish Government’s revised code of practice (2022) well. There was a helpful multi-agency Moray adult support and protection procedure specifically for Moray staff. It reflected the adult support and protection context in Moray. There was training for council officers and other staff to support implementation of the revised code of practice. The positive results of our reading the records of adults at risk of harm showed staff followed the partnership’s adult support and protection procedures meticulously. Frontline staff at our focus group were confident and highly professional about adult support and protection. They found the partnership’s adult support and procedures helpful. The adult protection committee exercised due governance over the revising and updating of the adult protection procedures. The partnership made significant progress. The partnership overall followed its comprehensive multi-agency adult support and protection procedures rigorously. Key processes priority area for improvement 2 The partnership should ensure that full adult support and protection investigations are carried out for all adults at risk of harm who require them. Inquiries with investigative powers were much improved. The partnership rectified the issue of sometimes not carrying out investigations when necessary. It successfully put in place the quality assurance measure of double reading inquiry reports. Advanced social work practitioners reviewed all inquiry reports. They gave insightful feedback to the council officer. This system worked well. The partnership redesigned its template for inquiry reports, which improved their quality. Page 53
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P a g e | 8 o f 1 5 In 2024, the partnership carried out an inquiry with investigative powers when required for all adults at risk of harm in our sample. This compared favourably to just over half of the time in 2022 – a significant improvement. Quality of inquiries was similarly improved, from just over half being good or better in 2022, to almost all good or better in 2024 – another impressive improvement. All inquiries with investigative powers were timely, effectively determined if the adult was at risk of harm, involved a council officer, and deployed a second worker when necessary. Council officers were very positive about the quality assurance and improvement measures in place. They said the standard template for inquiries was helpful, as was the double reading process. Partnership staff collaborated effectively for inquiries. Speech and language therapists purposefully supported council officers and other staff when the adult at risk of harm had difficulties with communication. The partnership made significant progress. The partnership conducted inquiries with investigative powers when required. Key processes priority area for improvement 3 The partnership should seek to improve the quality of chronologies, risk assessments, and protection plans. This will impact positively on the management of risk for adults at risk of harm. Chronologies The partnership developed a simple and effective template for the preparation of chronologies for adults at risk of harm. It was a multi-agency tool. Case conference delegates always discussed the adult at risk of harm’s chronology. As did core groups (multi-agency meetings to discuss progress with the adult at risk of harm’s protection plan) when they reviewed progress with protection planning for the adult at risk of harm. Chronologies was a topic at the partnership’s multi-agency learning events. The partnership planned a programme of multi-agency training on chronologies. The partnership’s view was that “they were on a journey with chronologies”, with further improvements required. Our record reading results suggested there was more improvement than they thought. Page 54
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P a g e | 9 o f 1 5 Chronologies were much improved. In 2024, all adults at risk of harm in our sample who required a chronology had one, and almost all chronologies were good or better for quality. This compared very favourably to only some adults at risk of harm had a chronology in 2022, and some good or better for quality. Staff shared the chronology with the adult at risk of harm when appropriate. This was an inclusive approach. Risk assessment The partnership undertook a range of multi-agency quality assurance and improvements for risk assessment. They included development of a well-designed multi-agency complex risk assessment template, staff training, and dynamic updates to risk assessments via core groups. There was a Grampian multi-agency risk assessment training workshop. In 2024, most adults at risk of harm in our sample had a risk assessment – a modest improvement from just over half in 2022. But in 2024 some had no risk assessment. The reason for this, acknowledged by the partnership, was staff did not prepare risk assessments when the episode did not proceed to an adult protection case conference. There were exceptions. The otherwise comprehensive and well-designed inquiry template did not have appropriate fields for the explicit assessment of risk. The partnership considered the risks for the adult but did not explicitly assess and record them. Given the sound improvements the partnership achieved for all our priority areas for improvement, we are confident it can quickly rectify the risk assessment issue. Positively, almost all completed risk assessments were good or better for quality. Staff inclusively shared risk assessments with the adult at risk of harm when appropriate. Protection plans The partnership developed a well-crafted electronic protection plan template. This was clearly effective. Commendably, in 2024 almost all adults at risk of harm in our sample who required a protection plan had one, and quality was good or better for almost all of them. This compared favourably to most adults at risk of harm had a protection plan in 2022, most of which were good or better for quality. Again, a notable improvement. Staff shared protection plans with the adult at risk of harm. This showed an ethos of involving the adult at risk of harm throughout their adult support and protection journey. The partnership made significant progress. It significantly improved the three elements of management of risk for adults at risk of harm – chronology, risk assessment, and protection plans. Presence of risk assessments required further improvement so that all adults at risk of harm have one. Page 55
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P a g e | 1 0 o f 1 5 Key processes priority area for improvement 4 Case conferences and review case conferences should be clearly defined, involve the adult at risk of harm and unpaid carer where appropriate and should be convened for all adults at risk of harm who require them. The partnership undertook substantial multi-agency improvement work for adult protection case conferences. This included a multi-agency audit of 27 case conferences in 2023. It focused on effective participation of the adult at risk of harm, and redesigned case conference processes, as well as the template for recording them. It purposefully identified additional police officers for training, to make sure the police always attended adult protection case conferences when invited. Our 2024 record reading results clearly showed this was successful. In 2024, the partnership convened an adult protection case conference for all adults at risk of harm in our sample who required one. This was an improvement from 2022, when it convened a case conference for just over half of the adults at risk of harm who required one. This was compelling evidence the partnership rectified the issue we identified with case conferences in 2022. Case conference quality was improved too, with almost all good or better for quality in 2024. Police officers and health professionals attended all case conferences when invited. And all case conferences effectively determined what needed to be done to keep the adult risk of harm safe, supported and protected. Only some adults at risk of harm attended and participated in their case conference when invited. This was despite the partnership’s strenuous efforts to support adults at risk of harm to participate. The partnership worked with a third sector independent advocacy organisation to support participation and also linked with a university which was carrying out a study of participation of adults at risk of harm in their case conference. The partnership also changed the process to make it easier for the adult at risk of harm to participate; prior to the case conference the adult at risk of harm could speak with the chair if they wished. It provided an accessible information pack to adults at risk of harm and their families to help them understand the process. Review adult protection conferences were much improved in 2024, with almost all in our sample convened when required. This compared to just under half convened when required in 2022. Effectiveness of review case conference improved too. In 2024, all review case conferences determined required actions to keep the adult at risk of harm safe. In 2022, the equivalent figure was almost all. The partnership made significant progress. It convened competent, well-executed case conferences when required for adults at risk of harm. Page 56
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P a g e | 1 1 o f 1 5 Strategic leadership priority area for improvement 5 The partnership should prioritise the full implementation of the improvement plan. Strategic leaders should ensure that the appropriate resources are made available. Following our joint inspection of adult support and protection in 2022, the partnership determined the improvement actions needed to implement our seven priority areas for improvement. And how it would measure progress. It established the governance arrangements for oversight of improvement activity. The favourable results of our reading the records of adults at risk of harm in 2024 are convincing evidence the partnership implemented its improvement plan effectively. The partnership had an electronic application to support its improvement work. The partnership instigated a range of notable improvement focused activities. It successfully assigned the role of adult support and protection champion to some health professionals. It established a post of adult protection specialist nurse and set up professional practice forums for adult support and protection. Since 2022, the consultant practitioner team was reconfigured to better support adult support and protection activities. It had four consultant practitioners supporting specific business areas, including adult support and protection. All consultants managed the operational delivery of adult support and protection. This enabled the lead officer for adult support and protection to better support strategic developments and the delivery of the improvement plan for adult support and protection. Policing capacity to effectively carry out adult support and protection work was enhanced with the appointment of a coordinator for interagency referral discussions for the divisional concern hub. NHS Grampian’s appointment of a specialist adult protection nurse, and adult protection champions enhanced its capacity to carry out adult support and protection work. The partnership made significant progress. It created additional capacity to support improvements for adult support and protection and successfully delivered the improvements our 2022 joint inspection identified. Page 57
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P a g e | 1 2 o f 1 5 Strategic leadership priority area for improvement 6 Strategic leaders should strengthen governance of adult support and protection practice. There should be robust measures in place to identify concerns early and promptly implement remedial action The substantial progress evidenced by our 2024 progress review data showed the overall effectiveness of the audits and quality assurance activities the Moray partnership did. This was evidence of real improvement. It strongly verified the partnership’s assertions they have made good progress with improvements. The Moray adult protection committee and the chief officer group had a regular flow of audit and other data submitted for them to appraise. The adult protection committee had a risk register, which logged risks associated with our priority areas for improvement. These, among other things, enabled these groups to exercise sound muti-agency governance over the delivery of improvements to adult support and protection. Operational managers with responsibility for adult support and protection systematically worked diligently and effectively to bring about necessary improvements to adult support and protection. This was a key factor for the partnership’s successful delivery of improvements to adult support and protection. The partnership strengthened the role of first-line managers for operational oversight and governance of adult support and protection. There were regular purposeful team meetings to discuss adult support and protection quality assurance issues. The quality assurance tool “the adult’s journey” was a promising development. The consultant practitioner team used it to quality assure adult support and protection practice. They completed two templates per month. They communicated the results to the practitioners involved and updated the tool to reflect learning from practice. The partnership made significant progress. It exercised sound, effective multi-agency governance for adult support and protection. Page 58
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P a g e | 1 3 o f 1 5 Strategic leadership priority area for improvement 7 Strategic leaders should continue to develop multi-agency self-evaluation activities. Frontline staff should be fully involved in the design, implementation and consequent improvement work. There was evidence of regular, multi-agency quality assurance and audit activities. For example, audits of adult protection case conferences, interagency referral discussions, and double reading of adult support and protection investigation reports. The partnership created the required capacity to carry out these activities rigorously and effectively. Frontline staff (council officers) were involved in the double reading of investigation reports. They considered this was effective. Advanced practitioners, who are frontline staff, participated in multi-agency audits of adult support and protection activities. There was a recent multi-agency audit of interagency referral discussions in which frontline staff participated. We did not generate any statistical data on this, but from our record reading and the focus groups their interagency referral discussion system was highly effective. The partnership made significant progress. Its cohesive programme of multi-agency audits and quality assurance activities was successful. Frontline staff were suitably involved. Page 59
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P a g e | 1 4 o f 1 5 Summary of progress Key processes progress including findings out with priority areas for improvement. The Moray partnership’s interagency referral discussions for adults at risk of harm were highly constructive. Their approach to interagency referral discussions was Grampian wide. Social work, police, and health staff purposefully and consistently attended these virtual forums, as did other partners, such as care providers. The meetings were timely, focused, and well recorded. Staff at all levels attested to the significant benefits derived from them. Interagency referral discussions contributed effectively to keeping adults at risk of harm safe, supported and protected, with enhanced health and wellbeing. Moray’s approach to interagency referral discussions was an exemplar for the sector. Our joint inspection in 2022 identified that recording of adult support and protection matters in the health records of adults at risk of harm warranted improvement. The partnership initiated several improvement actions for this. There was helpful guidance and multi-disciplinary training for health professionals about adult support and protection recording. The partnership issued an advice note on adult support and protection recording to all health professionals. This was accompanied by an online training video. In 2024, adult support and protection recording in health records remained an area for improvement. In 2024 and 2022 just over half of adult support and protection recording in health records was good or better. There was no repository in the NHS electronic recording system for adult support and protection materials such as inquiry reports and minutes of case conferences. Health staff said it would be helpful if one was created. Health staff also said the electronic recording system could be difficult to use. The Moray partnership instituted its interagency vulnerable adults process (MIVA). It afforded partnership representatives the opportunity to explore interventions for individuals repeatedly intimated to social work in police concern reports (iVPDs). An advanced practitioner chaired the meetings. And NHS staff, the police harm reduction unit, and community safety participated. There was a reduction in police reports for individuals discussed at MIVA. Overall, Moray’s key processes for adult support and protection were much improved. Risk assessment presence for adults at risk of harm needed further improvement. Key process improvements ensured adults at risk of harm were safer, included and had improved wellbeing. Page 60
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P a g e | 1 5 o f 1 5 Strategic leadership progress including findings out with priority areas for improvement Overall, Moray’s strategic leadership for adult support and protection was further improved. There was significant progress for the three priority areas for improvement for strategic leadership. The partnership’s operational and strategic governance for adult support and protection was well-established and effective. Moray’s adult protection committee and the chief officer group exercised sound, rigorous governance over adult support and protection. Next steps The Care Inspectorate’s link inspector will continue to engage with the partnership. We have shared the full record reading results with the partnership to inform future improvement work. A multi-agency adult support and protection quality improvement framework is about to be published that the partnership should consider. This has the potential to positively inform their self-evaluation approach. The partnership should also keep track of the National Implementation Group’s work relating to inquiries and investigations. National discussions will help them to determine at what stage risk assessments are needed and inform any future review of key processes. Page 61
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Headquarters Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY Tel: 01382 207100 Fax: 01382 207289 Website: www.careinspectorate.com Email: enquiries@careinspectorate.gov.scot Care Inspectorate Enquiries: 0345 600 9527 © Care Inspectorate 2024 I Published by: Communications I COMMS-1024-525 @careinspect careinspectorate #KeepThePromise Page 62
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 28 NOVEMBER 2024 SUBJECT: ADULT SUPPORT AND PROTECTION MULTI-AGENCY IMPROVEMENT PLAN BY: CONSULTANT PRACTITIONER, ADULT SUPPORT AND PROTECTION LEAD OFFICER 1. REASON FOR REPORT 1.1 To update the Committee on progress against the Adult Support and Protection Multi-agency Improvement Plan since the last update provided in March 2024. 2. RECOMMENDATION 2.1 It is recommended the Committee considers and notes: i) the Multi-agency Improvement Plan and progress to date; and ii) the systems in place to monitor and progress actions within the plan. 3. BACKGROUND 3.1 The joint inspection of the Moray partnership took place between March and May 2022. The Care Inspectorate asked the Moray partnership to develop an Improvement Plan to address the priority areas for improvement. 3.2 The Multi-agency Improvement Plan (Appendix 1) builds upon Moray’s original improvement action plan formulated in 2019 following a series of engagement and consultation events and multi-agency workshops with the purpose of giving a clear foundation and oversight to Adult Support and Protection activities in Moray. 3.3 This multi-agency plan is the tool used within the Moray Adult Protection Committee to provide assurance to all partners of progression and development in the work carried out. 3.4 A recent Joint Inspection of Adult Support and Protection – Progress Review concluded in October 2024. This Progress Review concluded that Moray has Item 9. Page 63
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made significant progress in all areas of improvement identified in the 2022 Inspection. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The 2024 Progress Review undertaken concluded that Moray has made significant progress in each area highlighted for improvement from the 2022 Joint Inspection. A link to the published report can be found here. 4.2 Moray Adult Protection Committee has demonstrated a strong, collaborative, and effective improvement work ethic since 2022, and will continue to strengthen its approach to supporting people at risk of harm within our community. This could not have been achieved without the hard work and commitment from the front-line practitioners across the Partnership. 4.3 As highlighted within the Progress Review Report Moray still has areas to improve. These have been incorporated into the Multi-Agency Improvement Plan (Appendix 1) as well as a full review of all actions and refresh for 2024- 2026 period. 4.4 NHS Grampian (NHSG) will also be progressing further Adult Support and Protection (ASP) improvements via a NHSG specific ASP Improvement Plan. This plan is coordinated and led by the NHSG Public Protection team and include some of the actions from the Moray multi-agency plan, but also encompasses wider ‘Grampian wide’ initiatives – where a one for Grampian approach is thought to be beneficial on grounds of resource use and consistency. 4.5 This NHSG ASP Improvement Plan is regularly reviewed by the NHSG Adult Protection Group and overseen by the NHSG Public Protection Committee. There are direct lines of communication and updates between the NHSG Adult Public Protection lead and the Moray ASP Consultant Practitioner – ensuring that both the local Moray Multi-Agency Improvement Plan and the NHSG wide plan remain synchronised. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Moray Partners in Care 2022-2032” This report supports the Moray Strategic Plan in relation to Partners in Care, making choices and taking control over decisions affecting our care and supporting the outcome that people are safe. (b) Policy and Legal The Adult Support and Protection (Scotland) Act 2007 is the main legal reference points for this project for which the MIJB are legally responsible. (c) Financial implications No financial implications as a direct result of this report. (d) Risk Implications and Mitigation Page 64
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The Improvement Plan will implement robust systems and processes in response to the Care Inspectorate’s findings, with a multi-agency approach. Regular monitoring and reviewing of new processes are critical to ensure continuous improvement and to ensure inspection readiness. (e) Staffing Implications None as a direct result of this report. (f) Property None as a direct result of this report. (g) Equalities/Socio Economic Impact Not required as there are no changes to policy as a result of this report. (h) Climate Change and Biodiversity Impacts None as a direct result of this report. (i) Directions None as a direct result of this report. (j) Consultations ASP Planning and Improvement Subgroup. 6. CONCLUSION 6.1 The report aims to provide assurance to Committee that there are effective processes in place to monitor and progress actions in the plan. Author of Report: Vicki Low, Consultant Practitioner, Adult Support and Protection Lead Officer – HSCM Background Papers: with author Ref: Page 65
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1 APPENDIX 1 MORAY ADULT SUPPORT AND PROTECTION SELF EVALUATION IMPROVEMENT ACTION PLAN 2024-2026 Report Type: Actions Report Action Status Cancelled Overdue; Neglected Unassigned; Check Progress Not Started; In Progress; Assigned Completed 1. Lived Experience (PRIORITY) Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To ASP SIP Cat1.1 Review commissioned advocacy service to ensure formal advocacy services are as accessible as possible for people involved in ASP process AGENCY: Local Authority July 2024 Tender process completed. 100% Marie Burnell ASP SIP Cat 1.2 Report to be provided to APC on a regular basis evidencing engagement with lived experience AGENCY: Multi-Agency July 2024 Communication and Feedback Questionnaire in place. Reporting taking place 100% Elaine MacDonald, CP, Advocacy ASP SIP Cat 1.3 Review of Communication and Engagement Plan for ASP AGENCY: Multi-Agency October 2024 In progress 50% Elaine MacDonald, ASP AP, Advocacy Partners ASP SIP Cat1.4 Listen to People - Agree and implement a systematic approach to capturing the lived experience AGENCY: Local Authority 31-Mar- 2023 Despite many attempts to hold conversations cafes etc this action has not fully been achieved and is now past 75% Item 9. Page 67
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2 APPENDIX 1 (qualitative) of people who have been in contact with the ASP process overdue. Please see actions below to support capturing the voice of lived experience - to be removed ASP SIP Cat 1.5 Consideration to be given to Public Protection lived experience panel – to support the reviewing and consultation of improvements and development work AGENCY: Local Authority April 2025 Initial discussions have taken place with the ADP to build on this idea. Representatives to work together to build a public Protection panel. This action will replace ASP SIP Cat 1.4 5% Elaine MacDonald, Justin Jansen, Emma Johnston, Ainya Taylor, Emma Plant, Angela More ASP SIP Cat 1.6 Update reports of lived experience feedback to be presented to ASP on a regular basis AGENCY: Multi-Agency April 2025 First Report to be presented August APC – completed 0% Elaine MacDonald ASP AP Advocacy partners 2. Quality Assurance and Audit (PRIORITY) Code Action Title Agency Due Date Latest Status Update Status Progres s Status Icon Assigned To ASP SIP Cat2.1 Design of ASP audit to undertake case file QA for x1 adult. This will encompass from point of referral to IASPCC findings shared with PGB and reported to APC with aim to inform practice improvement and highlight elements of good practice. AGENCY: Local Authority January 2024 Journey Audit Tool complete and agreed by APC and PGB 100% Vicki Low ASP SIP 2.2 Monthly audits to take place using the Journey Audit Tool from April 2024. Report back to APC with 6 monthly reports AGENCY: Local Authority February 2024 Audits being undertaken by ASP lead officer with view to widen auditors to include multi-agency. First report to APC due November 2024 Please note change to deadline date due to recent Progress review (no capacity to progress) 25% Vicki Low Page 68
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3 APPENDIX 1 ASP SIP Cat2.3 Multi-Agency Audit Calendar to be written and implemented AGENCY: Multi-Agency Novemb er 2024 Not commenced – however, discussions taking place 0% Vicki Low; Kenneth O’Brien; Kerry McCombie ASP SIP Cat2.4 Report to APC on a regular basis regarding outcomes and recommendations of single agency screening tool audit AGENCY: Local Authority Novemb er 2024 Presently single agency audits for screening activities are undertaken – findings of which are reported verbally back to Social Work Advanced Practitioner Forum. To enhance feedback and to ensure that this is written and recorded to be presented to APC via report 0% ASP AP ASP SIP Cat2.5 Multi-Agency Audit findings report to be presented to APC on a regular basis (6monthly) AGENCY: Multi Agency Jan 2025 Multi-Agency Audits are taking place (IRD and Case Conference audit) However, this needs to be more regularly – and reflected within Audit Calendar 25% Vicki Low, Kenneth O’Brien, Kerry McCombie 3. ICT and Recording (PRIORITY) Code Action Title Agency Due Date Latest Status Update Status Progres s Status Icon Assigned To ASP SIP Cat3.1 ASP recording guidance training video to be implemented and part of core training AGENCY: Multi-Agency February 2025 NHSG have progressed this action Lead Agency to progress. Note this is delayed due to Inspection activities – amended due date 50% Vicki Low ASP SIP Cat3.2 Devise way of Carefirst recording systems to evidence ASP referral discussions clearly AGENCY: Local Authority Septemb er 2024 ASP consultation form and process to be brought to APC November 2024 for approval – thereafter PGB. 100% Vicki Low; Vicki Logan ASP SIP Cat3.6 Discussion to take place regarding proposal for possible Data set from AGENCY: Police October 2024 Police Scotland to join Data Subgroup - commencing September 2024 – to be 50% Vicki Low Page 69
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4 APPENDIX 1 Police Scotland which would be added to the existing local date set to APC fully achieved once reporting is in place to reflect Police data within Quarterly reporting. Review of ASP recording in key health systems + creation of standardised SOP/guidance. AGENCY: NHSG June 2025 Moray Inspection findings being taken to NHSG Public Protection Committee in November 2024. To seek commission to launch new work on ASP recording across health board. 0% Kenneth O’Brien 4. Policy, Process and Procedures Code Action Title Agency Due Date Latest Status Update Status Progres s Status Icon Assigned To ASP SIP Cat4.1 Full Team Manager oversight of ASP activity within teams AGENCY: Local Authority 30-Nov- 2024 Update June 2024 – regular TM meetings in place to discuss and transfer up and coming reviews, Team Spreadsheets in place and reviewed by TMs, fortnightly ASP operational meetings in place. To monitor 75% CSWO Vicki Low ASP SIP Cat4.2 Full review of Operational Guidance for Lead Agency. This will include – consultation with front line practitioners AGENCY: Local Authority Decemb er 2024 Review of Operation Guidance underway 25% Vicki Low ASP SIP Cat4.4 Local Moray LSI Framework to be consulted upon and written – to include multi-agency as well as commissioning team AGENCY: Multi-Agency April 2025 National LSI Framework currently being updated. Work will commence following this LSI documents to support Local LSI activity in place 0% Vicki Low, Aimee Borzoni, Sarah Gordon, Kerry McCombie ASP SIP Cat4.5 Embedding of the Grampian Decision Specific Capacity Pathway. AGENCY: Multi-Agency October 2025 Pathway now live. Due date moved to October 2025 to allow for one year in operational use and evaluation to be 95% Kenneth Obrien Page 70
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5 APPENDIX 1 considered. ASP SIP Cat4.7 iVPD local process review to take place to identify opportunities for improvements in quality of information shared, and expectations of agencies receiving Adult Concern Reports from Police AGENCY: Multi Agency Nov 2024 iVPD local process written and out for consultation – currently with education. This action has taken much longer than anticipated as it has involved both Children and Adults. Revision to end date from Dec 2022 to reflect Final draft will be taken back to Grampian Group in November and once agreed, disseminated for further ratification thereafter. 75% Police Alexander Allan ASP SIP Cat 4.8 Full review of multi-agency attendance at Initial Referral Discussions (across Grampian) AGENCY: Multi-Agency Decemb er 2024 Work to be undertaken by Aberdeen City to review IRD attendance initially – awaiting feedback 5% Val Vertigans Kerry McCombie Vicki Low Ann-Marie Bruce ASP SIP Cat 4.9 Full review of multi-agency attendance at Initial and Review Case Conference AGENCY: Multi Agency Decemb er 2024 Initial meeting has taken place. To take forward to Grampian ASP Group for endorsement by all partners. To be removed and replaced with ASP SIP Cat 4.11 5% Kenneth O’Brien ASP SIP Cat 4.10 Review of ASP referrals and appropriateness – measured against eligibility criteria – to include all sources AGENCY: Lead Agency Novemb er 2024 Review of referrals from Care Homes undertaken (presented to APC and PGB) – recommendations to be taken forward by Learning and Development Subgroup Review of NHS referral source to be written 10% Vicki Low Elaine MacDonald ASP SIP Cat 4.11 Review of Multiagency ASP Case Conference processes and standards. AGENCY: Multi Agency April 2025 Grampian wide multiagency review of invitations, oversight, attendance and report provision to case conferences. Initial agreement to work via Grampian ASP Group. Full terms of reference now 0% Kenny O’Brien Page 71
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6 APPENDIX 1 signed off by Grampian ASP Group. GP Sub-committee on board to support alongside other multiagency partners. First meeting being scheduled. 5. Training and Development Code Action Title Agency Due Date Latest Status Update Status Progres s Status Icon Assigned To ASP SIP Cat5.1 Clear training calendar to be available for viewing on webpage AGENCY: Local Authority Septemb er 2024 All up and coming training displayed using Eventbrite and available to view – to update webpage 25% Suzy Gentle Natalie Spencer ASP SIP Cat5.2 Pan Grampian multi-Agency risk assessment training to be undertaken AGENCY: Multi-Agency Sep 2024 Training workshops pilot now completed. These sessions will now run as standard throughout the Partnership 100% Suzy Gentle Vicki Low ASP SIP Cat5.3 Review of Adult Support and Protection Training Plan AGENCY: Local Authority March 2025 Yet to be commenced 0% Vicki Low; Suzy Gentle; Elaine MacDonald ASP SIP Cat5.4 National Approach to Chronologies across the Lifespan AGENCY: Multi-Agency April 2025 National Implementation Chronologies Group has widened attendance to include all services supporting individuals from across the Lifespan. Toolkit developed and in draft – under review and consultation alongside Iriss who are supporting. Next step – to pilot toolkit to support Leaders in supporting practitioners 25% Vicki Low ASP SIP Cat5.5 Clear and up to date records of all Adult Support and Protection training undertaken - Module, 1, 2, 3 and 4 - AGENCY: Local Authority 31-Aug- 2024 Records in place for all Adult Social Workers – to implement an agreed way of highlighting training needs via 50% Suzy Gentle; Elaine MacDonald Page 72
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7 APPENDIX 1 including when Council Officer refresher training is required supervision alongside Team Managers Review of Training modules underway on a Grampian basis. Action now overdue, but progressing ASP SIP Cat5.6 Council Officer Handbook detailing tasks in relation to Adult Support and Protection duties and role AGENCY: Local Authority Dec 2024 delayed end date has been amended – this is due to delivery of Grampian wide training in risk assessments and chronologies – guide to reflect these changes. Consideration that the Local Operational Guidance will have practitioner guidance within Appendix information 50% Vicki Low ASP SIP Cat5.7 Multi-Agency SLWG on self-neglect and hoarding to raise awareness of subject and have clear practitioner toolkit/guidance in place AGENCY: Multi-Agency Novemb er 2024 SLWG in place. Practitioners Guide in draft to complement existing Clutter Image Rating Tool. Training workshops to be undertaken to support embedding of guidance. Chairing of this SLWG transferred to Public Protection Lead Officer 25% Emma Johnston ASP SIP Cat5.11 Learning and Development Subgroup – Moray to be commence. To identify and implement local training and awareness on a multi-agency basis AGENCY: Multi-Agency Septemb er 2024 Subgroup implementation agreed by APC. Initial Meeting to take place (August) to agree priorities locally 25% Suzy Gentle Elaine MacDonald ASP SIP Cat5.12 Training Needs Analysis (TNA) to be undertaken for Lead Agency in relation to ASP AGENCY: Lead Agency Novemb er 2024 TNA in draft – to be presented to Learning and Development Subgroup 75% Vicki Low ASP SIP Cat5.13 Mandatory online training for ASP rolled out and to be undertaken by all officers. AGENCY: Police Dec 2024 Online training embedded and work ongoing to increase compliance of mandatory completion across all relevant Policing departments. Extension to due date 75% Jackie Knight Page 73
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8 APPENDIX 1 ASP SIP Cat5.14 Senior Management Team to be invited to ASP specific training and expectations of role AGENCY: Lead Agency March 2025 Await completion of Local Operational Guidance developments 0% Vicki Low ASP SIP Cat5.15 Professional Curiosity Training to be undertaken across Grampian AGENCY: Multi Agency March 2025 Agreement at Grampian Learning and Development Group that this will take place. Training to be developed and cascaded 5% Suzy Gentle; ASP AP 6. Service Redesign and Review Code Action Title Agency Due Date Latest Status Update Status Progres s Status Icon Assigned To ASP SIP Cat6.1 Requirement for all Adult Social Workers to undergo Council Officer training as agreed previously on a Grampian basis – this is mandatory – awareness of this agreement to be sent to all teams AGENCY: Local Authority Oct 2024 Discussion with HR to ensure that ASP council officer training features on job description Awareness within all SW teams to take place 0% Vicki Low Marie Burnell 7. Professional Practice Code Action Title Agency Due Date Latest Status Update Status Progres s Status Icon Assigned To ASP SIP Cat7.1 Regular reports to committee in relation to Council Officer feedback to inform improvements AGENCY: Local Authority March 2025 CO feedback questionnaire available. Reports to be fed back into Committee every 6 months with recommendations. First Report due to APC October 2024 50% Elaine MacDonald ASP SIP Cat7.2 Trauma informed walk through for Adult Protection Service to take place to inform further developments in relation to trauma informed practice AGENCY: Local Authority October 2024 Meeting arranged with Moray Trauma Informed Practitioner to discuss Grampian Trauma Informed SLWG formed 75% ASP AP Vicki Low Yvonne Davidson (NHS) Page 74
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9 APPENDIX 1 Trauma Informed work through – focus group 1 took place across Grampian ASP SIP Cat 7.3 Finding a way to measure the impact of Core Group discussions in between ASP case conferences AGENCY: Local Authority March 2025 Initial discussions taking place 5% Vicki Low; Elaine MacDonald; ASP AP ASP AP Cat 7.4 Finding a way to measure the effectiveness of Protection and actions for individuals and professionals AGENCY: Local Authority March 2025 Initial discussions taking place 5% Vicki Low; Elaine MacDonald; ASP AP ASP AP Cat .7.5 Finding a way to measure the effectiveness of Multi-Agency Chronologies on professional practice AGENCY: Local Authority March 2025 Initial discussions taking place 5% Vicki Low; Elaine MacDonald; ASP AP ASP AP Cat. 7.6 Revision of Investigation Documentation to fully reflect risk assessment and mitigations in place AGENCY: Local Authority Dec 2024 This will coincide with Local Operational guidance review 0% Vicki Low Page 75
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 28 NOVEMBER 2024 SUBJECT: LEARNING DISABILITY SERVICE DYNAMIC SUPPORT REGISTER – UPDATE BY: INTEGRATED SERVICE MANAGER, COMMUNITY LEARNING DISABILITY SERVICE 1. REASON FOR REPORT 1.1 To inform Committee of the requirements of the Scottish Government directive relating to the Coming Home Report, and of the actions and progress made by the Learning Disability Service in response to the directive. Assurance is also given that planning and development continues which will address future anticipated needs associated to the directive. 2. RECOMMENDATION 2.1 It is recommended that the Committee: i) note the requirements of the Scottish Government in relation to the Coming Home Report and Dynamic Support Register and the actions taken by the Learning Disability Service to respond to the Scottish Government Directive as set out in paragraphs 4.1 – 4.6,And in doing so; ii) continue to support the housing projects that are to be utilised by adults with a Learning Disability which is integral to meeting the requirements of the register and which was previously agreed at the Moray Integration Joint Board on 30 March 2023 (para 12 of the minute refers). 3. BACKGROUND 3.1 The Scottish Government published the ‘Coming Home Implementation Report’ on 21 February 2022: https://www.gov.scot/publications/coming-home- implementation-report-working-group-complex-care-delayed-discharge. This report sets out a new framework for adults with Learning Disabilities and complex support needs who are placed in unsuitable out of area placements, or Item 10. Page 77
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who are inappropriately admitted to hospital, due to breakdown of their community-based support. 3.2 This framework aims to ensure that there is greater visibility for adults with a Learning Disability (LD) and expects that there will be development of specialist Multi Disciplinary Teams (MDTs) focused on tailoring the complex services required in the community. Furthermore, this should act as a driver for our local commissioning strategy and appropriate housing development. 3.3 On 15 May 2023, a memorandum of understanding was signed by both Maree Todd, Minister for Social Care and Paul Kelly, COSLA Health and Social Care Spokesperson, agreeing that all integration authorities will use a Dynamic Support Register to collate information about adults with a LD in hospital or inappropriately placed. This will act as a tool to improve local case management and to inform planning and provision. Each integration authority will report monitoring data from their Dynamic Support Registers using national reporting mechanisms. 3.4 The Dynamic Support Register has been provided by the Scottish Government as a standard template with the criteria for the red, amber and green categories clearly defined. 3.5 The Moray Integrated LD Team have collectively agreed which adults, in accordance with the criteria, should be entered on to the Dynamic Support Register, and a lead worker for each person has been identified. Each adult on the register has a detailed action plan outlining their support needs and identifies the MDT around them supporting the plan. It also indicates what is being done to find appropriate accommodation or bring individuals ‘home’ to Moray. 3.6 Action plans are reviewed 2 or 4 weekly depending upon red or amber category, and the Practice Consultant in Complex and Challenging Behaviour supports this process where appropriate. Governance of the plans takes place at the LD Resource Allocation Meetings, with wider discussions, planning and agreement taking place at the LD Transformation Board. Updates on the register are regularly provided to housing colleagues. 3.7 A local Integrated Complex Care Pathway setting out processes relating to the Dynamic Support register is currently under development and this will offer clear guidance, reinforcing the work that is already being done. A Complex Care Pathway for Moray will seek to achieve commitment from all professional health leads that allocation priority will be given to those people identified on the Dynamic Support Register as complex and high risk, where appropriate. 3.8 The need for suitable housing for people with a LD in Moray has been embedded in strategy and planning for many years. In 2013, The Moray Council adopted the then Moray LD Partnership Board, Commissioning and Delivery Plan 2013-2023 following approval by the Moray Council Health and Social Care Services Committee on 9 October 2013 (para 6 of the minute refers). This plan was updated and agreed by the Board on 28 January 2021 (para 8 of the minute refers) and again on 30 March 2023 (para 12 of the minute refers). Page 78
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3.9 The development of housing for adults with a LD remains a continuous process, with recent housing projects completed including the Highland Way development in Buckie which opened in August 2021 and the Greenfield Circle development in Elgin which opened in March 2022. 3.10 The Woodview 2 project planned for development in 2024/2025 which was to offer a further 8 - 10 bungalow style houses to individuals with complex and challenging needs, in partnership with Grampian Housing, has been delayed until at least 2027. 3.11 A further development at Elgin Western Village has provided the LD service with nomination rights to 4 bungalows and 13 flats. Construction has started with a view to the first tenants expecting to take residency in February 25. These will be suitable for individuals who do not exhibit extreme or challenging behaviour. 3.12 The Moray Council Housing Service currently continues to source and negotiate the planning of further housing developments. The local housing strategy is due to be renewed which considers the Moray Housing Need and Demand Assessment, local and national drivers and strategic priorities and housing for people with a LD must remain a strategic priority. 3.13 Where there is no new and appropriate housing available, Adults on the Dynamic Support register can be supported to make an application for entry onto the Moray Council Housing Register and with independent housing associations. This would not be the preferred route of rehousing as mainstream housing will not be designed with the required environmental specifications in line with individuals assessed needs. Standalone properties also cannot benefit from efficiencies that would otherwise be possible in core and cluster developments. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Moray supports over 450 people with a LD. There are many reasons why people with a LD could find themselves in hospital, in inappropriate care settings or at risk of breakdown of care. The service has identified 21 people who live with parents where those parents are past retirement age. These parents are unable to maintain their role indefinitely and inevitably, care can break down should their health decline or they are no longer able to provide the care. The service maintains a register of people in this situation so we can anticipate who will need future care and accommodation to try and avoid emergency scenarios. Other reasons can include an increase in frequency and severity of challenging behaviour or through not having the correct support in place. 4.2 The most recent data submission from the Dynamic Support Register to the Scottish Government was made on 7 October 2024. This data has not yet been published. The previous publication released on 3 September 2024, is available here, where figure 3 makes reference to Moray: https://publichealthscotland.scot/media/28819/dynamic-support-register-tables- final.xlsx Page 79
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4.3 To give context to the report, Moray ranks relatively highly on the graph, considering its population size, which is an unfavourable place to be. There is an increase in the red category from the previous report submitted with 14 in total. There are some individuals that the team are seeking accommodation and care for as a matter of urgency. For all on the register, the team are already undertaking review and planning for identified individuals’ return to Moray, and for many this is in partnership with the provider services. Some of these people are prioritised for the ‘Elgin Western Village’ accommodation. It is anticipated that the next committee report will evidence a substantial reduction in number in the red category. 4.4 There are very few people who are in the amber category, and this is due to the requirement to review following discharge from hospital, or because people have moved from Red to Amber as risks of breakdown of care and accommodation have been reduced due to MDT working. 4.5 There are 11 people identified in the green category who are appropriately placed out of area who do not wish to return to Moray. This has reduced slightly due to a change of ordinary residence for some. 4.6 In planning for the future, the LD Service and the ‘Disability Pod’ under Childrens Services are working closely together to aid planning for transitions and to avoid making out of area placements for children, where there would be a responsibility to return them to Moray once they are 18 if placed out of area as a child. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The Dynamic Support register is a functional tool for the recording of high risk and complex individuals. The systems around the LD Service into which it feeds such as the Transformation Board, the Complex Care Pathway and the Housing Projects are consistent with the MIJB vision and values as set out in the strategic plan. (b) Policy and Legal The Scottish Government, ‘Coming Home Implementation Report, 21 February 2022. This report sets out measures to prevent delayed discharge of people with a LD, to repatriate those living out with their home authority, to avoid unnecessary hospital admissions and requires each partnership area to create and maintain a dynamic register of those people who are most at risk. Data from the register is required to be reported back to the Scottish Government. There can be legal implications relating to supporting adults to move out of hospital or into new accommodation. This is dependent on the adults’ capacity as they will be required to sign a tenancy agreement. Should the adult not have capacity to do this, there is a legal process to apply for Guardianship which may be held privately or by the local authority. Page 80
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Intervention orders must also be sought should a guardianship already be in place. (c) Financial implications The dynamic support register focuses on the individuals who generally have high levels of need and are particularly complex. These individuals can require 24 hour 1-1 or 2-1 support within their home and local community, which may also have to be delivered by specialist services. There will be increased expenditure for this type of care provision and costs will be variable depending upon the exact hours of support required and the individual service providers’ hourly rate. If care breaks down because of ageing parents who are no longer able to support their adult children, there will be increased expenditure to the package of support they are already receiving. This will be due to having to provide the care and support that the parents would once provide. Out of area placements are usually high cost, therefore we will likely see a reduction in costs to the support of those adults returning to Moray. To ensure that these higher cost services can be funded within the current financial climate, transformational change within the service Is planned, looking at alternative options for service delivery where we can take advantage of economies of scale and there’s an emphasis on shared day and night time care. (d) Risk Implications and Mitigation Addressing the needs of those on the dynamic support register relies upon: The responsiveness and capacity of the MDT to work together Houses in which to accommodate people Sourcing the right care provision. There are risks with all of the above. The team has faced challenges with recruitment over the past 18 months, particularly within Psychiatry, Psychology and Social Work. The mitigation here is that the dynamic support register is seen as a ‘priority’ and those individuals on the register should be allocated promptly to the relevant professionals and in line with a complex care pathway. Whilst the LD housing projects have been underway for some time, housing specific to adults with a LD where the team have nomination rights are few, and there is not enough housing to accommodate all those we know are on the register and are at risk of care breaking down. The Woodview 2 build has been delayed and other projects are still under negotiation. There is a risk that hospital discharges will be delayed, and we cannot support people to return to Moray in the foreseeable future. The only mitigation here would be the continued use of out of area placements, however this does not align with the Scottish Government instruction and would not be in the best interest for supported individuals. Page 81
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There is a national recruitment crisis in care provision which Moray has been impacted by. Neither in-house Provider Services nor independent organisations have care hours readily available and whole staff teams need to be recruited to support individuals with a LD. This is a lengthy process which can take 6 months or more. This may be acceptable where time is needed to undertake long term planning, or where the individual requires a slow transition however, the mitigating option when requiring care more quickly would be to fund a placement outside of Moray. There are rare occasions where a large care package may end, and advantage can be taken of a staff team that’s already available. Should this happen, the care should be redirected to those identified on the dynamic support register given their recognised priority and will be in keeping with the Scottish Government directive. (e) Staffing Implications There are no staffing implications associated directly with the upkeep and management of the dynamic support register. Individual staff teams will need to be recruited to support some of the individuals on the dynamic support register in accordance with their assessed needs. (f) Property There are no property implications. Housing will be owned by the Moray Council Housing or by a housing association. Individuals moving into those properties will be tenants. (g) Equalities/Socio Economic Impact There is no impact or change in Policy. Entry onto the dynamic support register is determined by set criteria and will be applicable to all adults with a LD. (h) Climate Change and Biodiversity Impacts There are no impacts directly related to the keeping of the Dynamic Support Register. Climate change and biodiversity impacts are considered and managed by the housing developers and builders as part of their own requirements. (i) Directions There are no directions associated with this report. (j) Consultations Judith Proctor, Chief Officer Jim Lyon, Head of Service John Campbell, Service Manager Fiona Geddes, Housing Strategy Development Manager Anna MacLeod, LD Team Manager (Social Work) Michelle Cordon, LD Team Manager (Health) Rob Outram, Practice Consultant for complex and challenging needs. Isla Whyte, Interim Support Manager Caroline O’Connor, Committee Services Officer 6. CONCLUSION Page 82
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6.1 The Dynamic Support Register is a practical tool to record and manage adults who are highly complex. Whilst the LD MDT are able to identify those who should be on the register, assess needs and provide Health and Social Work support, there is an inextricable link between the team, In – House Provider Services, Commissioning and Moray Council Housing Services and it is imperative that each service continues to work together to meet the needs of those individuals to achieve the desired outcomes set out by the Scottish Government. 6.2 The Housing model offered by the projects noted above offers the most sustainable and best value option for long term support. 6.3 HSCM Provider Services Staff Team based at Woodview is managed by Practice Consultant in Complex and Challenging Needs, and this team have in the past been successful in recruiting and maintaining appropriate staffing with skills specific to supporting those with complex and challenging behaviour. This provision, both at Woodview and via outreach, achieves successful outcomes for many on the dynamic support register. Author of Report: Marie Burnell, Service Manager Background Papers: There are no background papers. Ref: Page 83
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REPORT TO: MORAY INTEGRATION JOINT BOARD CLINICAL AND CARE GOVERNANCE COMMITTEE ON 28 NOVEMBER 2024 SUBJECT: END OF LIFE CARE HOME BEDS BY: LESLEY ATTRIDGE, LOCALITY MANAGER 1. REASON FOR REPORT 1.1 To inform the Committee of the termination of block funded End Of Life Beds within Moray. 2. RECOMMENDATION 2.1 It is recommended that the Committee: (i) homologate the termination of End Of Life (EOL) Care Bed block funded contract from March 2024; and (ii) agree new EOL Care Bed Provision Strategy; transitioning to a spot-purchase model through the Resource Allocation meeting (RAM) process, ensuring continued access to EOL care for Moray residents. 3. BACKGROUND 3.1 Health & Social Care Moray (HSCM) maintained a service level agreement (SLA) in place with Speyside Care Home from April 2019 to March 2024, providing palliative care beds for people of Moray who did not require to remain in hospital but could not or chose not to be at home for palliative care. HSCM also established a block funded contract with Spynie Care Home during the period of October 2022 – March 2024, through interim funding available at the time, to support people who were End Of Life (EOL). 3.2 The beds were commissioned to support EOL patients transitioning from acute hospital care who could not return home, also patients in the community who required a period of symptom management control and patients who chose not to remain at home/or support was not available to do so, for EOL care. A further driver for the Elgin/Lossiemouth locality, where there is no community hospital, was to have a commissioned service for EOL care in alignment with our Home First strategic approach, as set out in Partners in Care 2022-2032. Item 11. Page 85
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3.3 The beds in both facilities were underutilised, failing to deliver best value for money. The cessation of interim funding meant there was no funding to continue this arrangement. 3.4 The budget for core funded Social work provision in relation to this will be monitored, with any budgetary pressures and escalated to the Chief Finance Officer and Head of Service. 3.5 The demand for EOL beds will continue to be monitored through the Resource Allocation Meeting (RAM) and process. Any negative impact on Moray residents will be escalated to Senior Managers. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The EOL beds at Spynie Care Home cost £346,270 for the duration of the contract and ran at 70% occupancy. The occupancy of Speyside Care Home was lower than 70% occupancy also. 4.2 The beds were accessed through the District Nursing Teams for each respective locality with a defined criteria in place. At times this was not adhered to, to support system flow, and as a result caused blockages within the named facilities. 4.3 EOL beds are still required for people who require this level of support as detailed in 3.2 and therefore the RAM process has been amended (currently in draft) to include District Nursing colleagues. Through this process EOL beds will be able to be requested on a spot purchase basis that will be funded through core Social Work funding streams. The spot purchase of care home beds does happen at present but requires to be formalised within the RAM process as described above to ensure robust governance, equity in provision and monitoring purposes 4.4 The demand on care home beds remains very high within Moray and has competing demands for them which are inclusive of EOL, crisis in the community and hospital discharges. Therefore, managing the limited resource through the RAM is crucial in providing equity across all localities but also ensuring prioritisation of risk and need. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” In line with the Home First theme within the MIJB’s Strategic Plan, in particular Objective 3: We work together to give you the right care in the right place at the right time (b) Policy and Legal In accordance with Eligibility Criteria for Social Care. (c) Financial implications Page 86
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Budget pressure on core funded Social Work provision is noted in 4.3. Financial Implications will continue to be monitored as part of the RAM process. (d) Risk Implications and Mitigation Residents of Moray have limited access to EOL care beds when they choose not to remain at home for EOL Care. District Nursing Teams are to be integrated into the new RAM process to establish a formal tracking mechanism for EOL bed requests, identifying any service gaps. The budget continues to see an overspend in short term placements due to the demand. This will be mitigated through the Resource Allocation Meeting to ensure equity in provision and in meeting and monitoring demand for this provision. (e) Staffing Implications None directly arising from this report (f) Property None directly arising from this report. (g) Equalities/Socio Economic Impact There are no known impacts at this time. The monitoring process will keep this under review. Any potential impacts are identified through the monitoring process they will be (h) Climate Change and Biodiversity Impacts None directly arising from this report. (i) Directions There are no directions arising from this report. (j) Consultations Laura Holtham ,Clinical Lead Palliative Care Moray Robert Lockhart, GP Clinical Lead Moray Sean Coady, Head of Service Moray Judith Proctor, Chief Officer Moray Clinical and Care Governance Group 6. CONCLUSION 6.1 It is clear within the Palliative Care Strategic Board and framework that there is a need for the people of Moray to have access to EOL beds and a duty of care within the HSCM partnership to ensure this need it met. The proposed model will provide a balanced approach to maintaining high- quality EOL care whilst ensuring financial sustainability for MIJB. This approach demonstrates our commitment to responsive, efficient, and compassionate care for our most vulnerable residents. The Resource Allocation process will continue to monitor and evaluate this situation. Page 87
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Author of Report: Lesley Attridge Background Papers: Scottish Government Palliative Care Strategic Framework Moray Strategic Palliative Care Framework Ref: Page 88