Agenda Document Pack - Moray Integration Joint Board - 30/01/2025
Moray Council · 30 January 2025
Back to Moray Integration Joint Board — 30 January 2025 and its agenda
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Moray Integration Joint Board Thursday, 30 January 2025 Council Chambers NOTICE IS HEREBY GIVEN that a Meeting of the Moray Integration Joint Board, Council Chambers, Council Office, High Street, Elgin, IV30 1BX on Thursday, 30 January 2025 at 09:30 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Minute of meeting of 28 November 2024 5 - 8 4. Action Log of 28 November 2024 9 - 10 5. Minute of Special Meeting of 20 November 2024 11 - 12 6. Minutes - for noting 6a Minute of meeting Clinical and Care Governance Committee of 29 August 2024 13 - 16 7. Chief Officer Report 17 - 22 8. Revenue Budget Monitoring Quarter 3 for 2024-25 9. North East Route Map for Strategic Change 23 - 36 10. General Practice Vision and Objectives Update 37 - 50 11. Grampian Vaccination and Immunisation Annual Report 2024 51 - 106 Page 1
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12. Charging for Services 107 - 112 13. Childrens Services Plan 2023-2026 - Annual Report for 2023-2024 113 - 172 14. Carefirst Replacement - Update 173 - 222 15. Getting it Right for Everyone 223 - 228 16. Chair of Moray Integration Joint Board 229 - 232 17. Code of Conduct Update 233 - 256 Watching the Meeting You can watch the webcast live by going to: http://www.moray.gov.uk/moray_standard/page_43661.html Webcasts are available to view for 1 year following the meeting. You can also attend the meeting in person, if you wish to do so, please come to the High Street entrance door and a member of staff will be let into the building. Page 2
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MORAY INTEGRATION JOINT BOARD SEDERUNT Mr Dennis Robertson (Vice-Chair) Councillor Peter Bloomfield (Voting Member) Councillor Elaine Kirby (Voting Member) Councillor Scott Lawrence (Voting Member) Mr Derick Murray (Voting Member) Mr Sandy Riddell (Voting Member) Mr Alex Stephen (Voting Member) Councillor Ben Williams (Voting Member) Dr Adam Coldwells (Ex-Officio) Mr John Mundell (Ex-Officio) Mr Ivan Augustus (Non-Voting Member) Professor Duff Bruce (Non-Voting Member) Mrs Sheila Brumby (Non-Voting Member) Mr Sean Coady (Non-Voting Member) Ms Sonya Duncan (Non-Voting Member) Ms Jane Ewen (Non-Voting Member) Dr Robert Lockhart (Non-Voting Member) Mr Jim Lyon (Non-Voting Member) Ms Deirdre McIntyre (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) 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 MORAY INTEGRATION JOINT BOARD Thursday, 28 November 2024 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Ivan Augustus, Councillor Peter Bloomfield, Mrs Sheila Brumby, Mr Sean Coady, Ms Jane Ewen, Councillor Elaine Kirby, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Jim Lyon, Ms Deirdre McIntyre, Mr Derick Murray, Mrs Jeanette Netherwood, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Mr Dennis Robertson, Ms Elizabeth Robinson, Dr Malcolm Simmons, Mr Kevin Todd, Councillor Ben Williams APOLOGIES Professor Duff Bruce, Dr Adam Coldwells, Mr John Mundell, Mr Alex Stephen, Ms Janette Topp IN ATTENDANCE Corporate Manager; Consultant Practitioner, Adult Support and Protection Lead Officer; Corporate Business Support Manager and Caroline O'Connor, Committee Services Officer. 1. Chair The meeting was chaired by Mr Dennis Robertson. 2. Welcome The Board joined the Chair in welcoming Councillor Elaine Kirby to her first meeting of the Board. 3. Declaration of Member's Interests Mr Riddell stated for transparency that he was Chair of the Mental Welfare Commission Scotland. The Board noted there were no other declarations of member's interests. Item 3. Page 5
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4. Minute of meeting of 26 September 2024 The minute of the meeting of 26 September 2024 was submitted and approved. 5. Action Log of 26 September 2024 The Action Log of the meeting of 26 September 2024 was discussed and updated accordingly. During discussion, it was noted in respect of the mental health inpatient bed base review collaborative working was ongoing linking with the strategic delivery plan and a progress update report on the strategic delivery plan was due to come back to the Board in 6 months time. The Chief Officer suggested a development session be scheduled to be held before the progress update comes back to the Board, to engage with Board members and provide more details on progress. This was agreed. 6. Minutes of meeting Audit, Performance and Risk Committee of 27 June 2024 The Board noted the minute of the meeting of the Audit, Performance and Risk Committee of 27 June 2024. 7. Congratulations The Board joined the Chair in congratulating Ms Judith Proctor, Interim Chief Officer on her permanent appointment to the post of Chief Officer. 8. Chief Officer Report The meeting had before it a report by the Chief Officer informing the Board of the Chief Officer activities that support the delivery against the Moray Integration Joint Board's (MIJB's) strategic priorities articulated in the Strategic Plan, and the delivery against the 9 Health and Wellbeing outcomes. Following consideration the Board unanimously agreed:- (i) to note the content of the report; and (ii) that transforming services to meet the aspirations of the MIJB's Strategic Plan remains a priority. 9. Revenue Budget Monitoring Quarter 2 for 2024-25 The meeting had before it a report by the Chief Financial Officer updating the Moray Integration Joint Board (MIJB) of the current Revenue Budget reporting position as at 30 September 2024 for the MIJB budget. Mr Murray asked if it would be possible to hold a session for members of the Board to explain the terminology used in the report and provide better understanding for members of the Board of the details and how it all links together. In response, the Chief Officer confirmed it was proposed to hold a development session in January to provide further understanding relating to how the budget is constructed along with the forecast for the following year's savings. Following consideration the Board unanimously agreed to:- Page 6
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(i) note the financial position of the Board as at 30 September 2024 is showing an overspend of £4,795,686 on core services; (ii) note the provisional forecast position for 2024/25 of an overspend of £9,530,074 on total budget for core services; (iii) note the progress against the approved savings plan in paragraph 6, and Appendix 4; (iv) note the budget pressures and emerging budget pressure as detailed in paragraph 7; and (v) note the revisions to staffing arrangements dealt with under delegated powers and in accordance with financial regulations within the Council (MC) and NHS Grampian (NHSG) for the period 1 June to 30 September 2024 as show in Appendix 3. 10. Public Sector Climate Change Duties Reporting Submission 2023-24 The meeting had before it a report by the Chief Officer presenting the Moray Integration Joint Board (MIJB) Climate Change Duties Report submission for 2023/24. Following consideration the Board unanimously agreed to approve the draft Public Sector Climate Change submission to Sustainable Scotland Network (Appendix 1) for the reporting year 2023/24. 11. Carefirst Replacement - Update The meeting had before it a report by the Interim Head of Service and Chief Social Work Officer informing the Board of the progress of the replacement Social Work and social care case management system and the outline business case. Following consideration the Board unanimously agreed to:- (i) note the update on progress; and (ii) approve the amended timescale for the outline business case to be reported to the Board in January 2025. 12. Adult Support and Protection Biennial Report 2022-2024 The meeting had before it a report by the Consultant Practitioner, Adult Support and Protection Lead Officer providing the Board the Adult Support and Protection Biennial Report for the period from 2022-2024. The Board joined the Chair in commending the work of the team in response to the recent Adult and Support Protection Progress Review which highlighted significant improvement within the service, reflected in the Biennial Report. Following consideration the Board unanimously agreed to:- Page 7
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(i) note the publication of the Moray's Adult Support and Protection Biennial Report 2022-2024; (ii) acknowledge from the Biennial Report, the work of the Adult Protection Committee (APC) and practitioners across the Partnership to ensure adults in need of support and protection are appropriately supported; and (iii) recognised, as detailed in the Biennial Report, the success of the APC over the reporting period in making significant progress in relation to the findings of the 2022 Joint Inspection. 13. Moray Integration Joint Board Meetings 2025-26 The meeting had before it a report by the Corporate Manager asking the Board to agree the meeting dates for 2025/26. Following consideration the Board unanimously agreed to endorse the schedule of meetings for the Moray Integration Joint Board (MIJB), the Audit, Performance and Risk (APR) Committee and the Clinical and Care Governance (CCG) Committee for 2025/26. 14. Financial Recovery Plan - Confidential The meeting had before it a report by the Chief Financial Officer providing the Board with an update on the financial recovery action plan that addressed the 2024/25 budget gap between income and forecast expenditure. Following consideration the Board unanimously agreed to:- (i) note the expected financial position at the end of the current financial year and the implications for 2025/26; (ii) note the updated recovery action plan highlighted at Appendix 1 and in paragraph 6; and (iii) approve the amendments to the savings proposals detailed at para 6.11 to 6.17. Page 8
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MEETING OF MORAY INTEGRATION JOINT BOARD Thursday 28 November 2024 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 30 JANUARY 2025 1. Options for Ward 4 Inpatient Unit for Patients with Mental Illness Further development work to be undertaken in order to prepare a full detailed report which would be brought back to the Board for consideration in approximately 3 months. Update 28/11/24: Development session to be scheduled to be held before the strategic delivery plan progress update comes back to the Board in 6 months, to provide more details on progress and engage with members of the Board. TBC TBC SC/KK JP There will be a Grampian wide mental health inpatient bed base review and any recommendations in relation to Ward 4 will be included within this Item 4. Page 9
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 30 JANUARY 2025 2. Chief Officer Report • Interim Chief Officer provide an update in relation to progress made resulting from the external inspection of Children's Services in relation to children and young people at risk of harm, through the governance structures of the MIJB; • Interim Chief Officer would provide a report in relation to how the rights and supported needs of unpaid carers are met in Moray; • Interim Chief Officer would arrange a development day for a demonstration in relation to Digital Health and Care TBC JP In Progress 3. Moray Mental Health and Wellbeing System Delivery Plan and Proposed Governance Structure Further consideration to be given to the quorum for the Moray Good Mental Health for All Strategic Group Jan 2025 IM In Progress – action closed Update report scheduled for MIJB May 2025 4. Carefirst Replacement Outline business case to be reported to the Board in January 2025. 30 Jan 2025 JL On today’s agenda 5. Revenue Budget Monitoring Quarter 2 for 2024-25 Development session to be scheduled for January 2025 to provide further understanding relating to how the budget is constructed (including terminology used) along with the forecast for the following years savings Jan 2025 JP Development session took place on 8 January 2025 Page 10
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MINUTE OF SPECIAL MEETING OF THE MORAY INTEGRATION JOINT BOARD Wednesday, 20 November 2024 Committee Room, Council Office, High Street, Elgin, IV30 1BX PRESENT Councillor Peter Bloomfield, Dr Adam Coldwells, Councillor Scott Lawrence, Mr John Mundell, Mr Derick Murray, Mr Sandy Riddell, Mr Dennis Robertson, Mr Alex Stephen, Councillor Ben Williams IN ATTENDANCE Head of Human Resources, ICT and Organisational Development and Caroline O'Connor, Committee Services Officer. 1. Chair The meeting was chaired by Mr Dennis Robertson. 2. Declaration of Member's Interests In terms of Standing Order 3.2, there were no declarations of member's interests. 3. Recruitment for Chief Officer Moray Integration Joint Board [Para 6.2.3] The meeting had before it a report by the Head of Human Resources, ICT and Organisational Development, Moray Council asking the Board to consider the candidate report and candidate summary report in line with the agreed Recruitment and Selection interim process for the Chief Officer, Moray Integration Joint Board. Following discussion the Board unanimously agreed to:- (i) note the summary candidate report; and (ii) accept the recommendation of the report to appoint Judith Proctor to the post. Item 5. Page 11
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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 6a Page 13
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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 14
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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 progressed, 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 objectives 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 15
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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 16
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: CHIEF OFFICER REPORT BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To inform the Board of the Chief Officer activities that support the delivery against the Moray Integration Joint Board’s (MIJB’s) strategic priorities articulated in the Strategic Plan, and the delivery against the 9 Health and Wellbeing outcomes. 1.2 Strategic planning needs to maintain a focus on transformational change to deliver services to our community within the resources we have available. 2024/25 is a very challenging year for delivering within the budget, with our two funding partners, Moray Council and NHS Grampian, under considerable financial pressure as well. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider and note the content of the report; and ii) agree that transforming services to meet the aspirations of the MIJB’s Strategic Plan remains a priority. 3. BACKGROUND Home First 3.1 The numbers of patients whose discharge is delayed remains challenging, but they have reduced, and the position is better than at this time last year. Our current position at time of report is 32 patients delayed, with the target being 26. The Discharge to Assess Team (D2A) have joined forces with the START team (care at home enablement team) and early indications of this test of change are positive. 3.2 Ongoing work around identifying those whose care needs are critical continues. Weekly meetings take place to ensure that the Moray Multi- Disciplinary Team (MDT) are sighted on each case and are able to pull together to ensure care packages are secured as quickly as possible. Item 7. Page 17
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3.3 Health and Social Care Moray (HSCM) continue with daily strategic MDT which has now become business as usual and is now recognised as the place that MDT members can get support with any challenges or risks. 3.4 HSCM are working on ensuring that the Dr Gray’s Hospital (DGH) MDT meetings can liaise with the patient's own practice MDT in order to maximise early discharges. Vaccination Programme 3.5 It was requested that the Annual Vaccination Report be added as a separate item on today’s agenda . The same report will be shared with the Aberdeen City and Aberdeenshire IJBs in early February. Ward 4 3.6 Two workshops set up by the Mental Health and Learning Disability (MHLD) Portfolio Board took place in November 2024 as part of the Mental Health Bed Base Review for Grampian. Representatives from Moray participated in these events. 3.7 Following the workshops each Health and Social Care Partnership (HSCP) submitted a storyboard which outlined: people, places and pathways. Moray submitted their response on 20 December 2024. 3.8 A small Moray working group will continue to participate in the overall Bed Base Review and coordinate wider Moray responses as required. The working group will report to the Moray Mental Health Strategic Group. 3.9 It is anticipated that the MHLD Programme Board will reach its conclusions on the way forward within the current financial year. 3.10 The Moray Mental Health Strategic Group will report back to MIJB on 29 May 2025. Aberlour Medical Centre Update 3.11 The General Medical Services (GMS) contract process has been completed. News release circulated to patients of the practice and staff all aware. The process to transfer Aberlour Medical Practice to Speyside Medical Group is now in progress. The transfer date of 1 April 2025 has been agreed, and the practice will remain under the running of HSCM until that date. Lossiemouth Locality Update 3.12 The Lossiemouth Locality Planning Group met on 8 November 2024 to evaluate progress to date and to set priorities for the following two years. 3.13 The Head of Service and Deputy Head of Service, HSCM met with the SOS group on 10 December 2024 to continue to explore opportunities to progress Recommendation 2 within the Scottish Government report titled ‘Independent Report on the Moray Coast Branch Surgeries Closure’. At this meeting the Head of Service confirmed that there is no additional funding available to pilot a nurse led project within the coastal village area. This position has also been confirmed by Scottish Government in regard to any new SG funding in a Parliamentary Question to the Cabinet Secretary on 18 December 2024. Page 18
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3.14 The primary structure for service planning will continue to be progressed through the Lossiemouth Locality Planning Group to ensure a 'whole system' approach is taken to service delivery. Management capacity 3.15 The Programme Management Office (PMO) has been established to co- ordinate and support progress of savings projects and the delivery of agreed savings plans for 2024/25 with the re-deployment of a service manager and part time support manager. Management capacity to progress actions to release savings remains a challenge, and opportunities for development have been identified for circulation with wider staff groups, that are intended to provide additional capacity in key project areas. The Mental Welfare Commission (MWC) 3.16 The Mental Welfare Commission (MWC) announced visit to Ward 4, DGH took place on 16 October 2024. The report is due to be published on 15 January 2025 and an action plan will require to be completed to take forward the recommendations. The action plan will go to SMT on 19 March 2025 for approval before being submitted to the MWC by the deadline of 2 April 2025 Festive Working 3.17 HSCM Teams were at times under significant pressures during the Festive Period. Everyone worked together to ensure a continuation with patient flow in DGH and Community Hospitals. DGH had significant challenges with capacity. All parts of the system are holding debriefs to learn from this period for future planning. GMED 3.18 The GMED service continues to observe recurring difficulties in staffing shifts across its centres. It is not always possible to secure staff through the bank system to cover unplanned absences and staff may decline requests to redeploy to other areas which are short-staffed. 3.19 Contingency protocols activated by GMED in October have included:- • Fraserburgh operations: Clinician and driver relocated to Peterhead. • Huntly operations: Following a review of protocols, Huntly remains in full operations. • Introduction of a HCSW on overnight shifts when MIUs are not operational to manage lone working risks. • There is no change to the way patients access the GMED service across the Grampian region. 3.20 HSCM continue to engage with Aberdeenshire HSCP to review the GMED Service’s position and remit across the urgent and unscheduled care system following the closures of their MIUs in the overnight period. 3.21 Early in 2024, Chief Officers for Moray, Aberdeen City and Aberdeenshire HSCPs requested a review of the GMED model. The review, led by a programme board, aims to enhance the quality, safety and efficiency of the service while ensuring sustainable workforce levels and promoting staff wellbeing. Page 19
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3.22 The review will be completed by the end of January 2025 with review findings due to be presented to the three IJBs in March 2025. A programme of engagement and consultation will be included as informed by the national Planning with People guidance. Review of Social Work Governance & Assurance Arrangements across Scotland 3.23 The Scottish Government has undertaken a review on social work governance and assurance in Scotland between July to December 2024, carried out by the Care Inspectorate on their behalf under Section 53 of the Public Services Reform (Scotland) Act 2010. The review seeks to address, nationally, how well social work governance and assurance arrangements support leaders to: • Ensure statutory duties are carried out safely and effectively:- • Enable social work staff to be supported, accountable and effective in their practice • Assist social work staff to uphold core social work values • Highlight areas of influence for CSWOs and key social work leaders • Identify challenges, improvements and what is working well 3.24 The review was conducted on a regional basis using the European Framework for Quality Management (EFQM) model and a National Report is expected on the Care Inspectorate website in March 2025 notwithstanding slippage. The findings will be reported back to MIJB following publication of the report. Reserves Policy 3.25 The Reserves Policy was approved at MIJB on 25 January 2024 when it was agreed that the policy would be reviewed annually with the next review being due no later than March 2025 (para 16 of minute refers). The policy has been reviewed and as there are no amendments recommended this year; the current policy will remain valid. With the financial climate this financial year there will be no reserves by the end of 2024/25. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 To support the acceleration of the MIJB ambitions set out in the Strategic Plan the Delivery plan is currently being refreshed to support next steps 4.2 The challenge of finance persists and there remains the need to address the underlying deficit in core services. The development of a Programme Management Office is in progress to support our financial savings. 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” Working with our partners to support people so they can cope with, and where possible, overcome the health and wellbeing challenges they may face. Page 20
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Ensuring that the right care is provided at the right place at the right time when people are in need. Ensuring that our systems are as simple and efficient as possible. (b) Policy and Legal The Chief Officer continues to operate within the appropriate level of delegated authority, ensuring that the MIJB is sighted on key issues at the earliest opportunity, and continues to influence and agree the strategic direction. (c) Financial implications There are no financial implications arising directly from this report. The Chief Finance Officer continues to report regularly. There is an ongoing requirement to find efficiencies and to demonstrate best value for money. (d) Risk Implications and Mitigation The risk of not redesigning services will mean that HSCM and the Moray Portfolio cannot respond adequately to future demands. (e) Staffing Implications Staff remain the organisation’s greatest asset, and engagement with all sectors must continue to ensure full involvement, which will create the best solutions to the challenges faced. HSCM staff are facing continued pressures on a daily basis, and effort into ensuring staff well-being must continue. (f) Property There are no issues arising directly from this report. (g) Equalities/Socio Economic Impact Any proposed permanent change to service delivery will need to be impact assessed to ensure that HSCM are not disadvantaging any section of our community. HSCM will continue to work closely with all our partners to ensure that we contribute to the health and well-being of the community and support the recovery phase of the Covid-19 pandemic. (h) Climate Change and Biodiversity Impacts Care closer to and at home, delivered by teams working on a locality basis, will reduce HSCM’s reliance on centralised fixed assets and their associated use of utilities. (i) Directions There are no directions arising from this report. (j) Consultations The Moray Portfolio Senior Management Team, the Legal Services Manager and Caroline O’Connor, Committee Services Officer have been consulted in the drafting of this report and are in agreement with the contents of this report as regards their respective responsibilities 6. CONCLUSION Page 21
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6.1 The MIJB are asked to acknowledge the significant efforts of staff, across in-house providers, externally commissioned services, the Independent and Third Sector, who are supporting the response to the recovery, and the drive to create resilience and sustainability through positive change. 6.2 The size of the financial challenge facing the MIJB, and also its two funding partners, means that redesign and transformation is not an option but a necessity. HSCM’s approach will be to prioritise quality, safety and good outcomes in all service redesigns. Author of Report: Judith Proctor, Chief Officer, Moray Portfolio Page 22
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: NORTH EAST ROUTE MAP FOR STRATEGIC CHANGE BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 The purpose of this report is to provide a brief overview of the North East Route Map for Strategic Change. It aims to offer assurance and seek approval from the Moray Integration Joint Board (MIJB). The report outlines the strategic priorities for the future of health and care across the North East and the practical steps required to create a sustainable health and care system. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) provide comment on the Grampian Strategic Change Board terms of reference at Appendix 1; ii) endorse the establishment of the Grampian Strategic Change Board; iii) endorse the collaborative approach proposed to develop a Route Map for Strategic Change; and iv) agree that the IJB Chief Officers should actively participate in the development and implementation of the Route Map for Strategic Change and work collaboratively with other partners to ensure the success of this crucial transformation program. 3. BACKGROUND 3.1 The health and care system across Scotland is facing a period of unprecedented challenge. This is also reflected in the Grampian and North of Scotland system. Demographic shifts, including an aging population and increasing multi-morbidity, are placing growing pressure on maintaining existing services. This, coupled with rising demand for care and persistent financial constraints in the post-pandemic world, necessitates a period of significant transformation to ensure the health and care system's long-term sustainability and ability to deliver high-quality care for future generations. Item 9. Page 23
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4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 In North East Scotland there is an opportunity to build on existing positive relationships which currently facilitate co-operation between partners and seek to extend this to explore and establish the close collaboration necessary to meet current challenges by transforming our integrated health and care system for the benefit of our citizens. 4.2 The North East is not alone in facing these challenges. Health and care systems across the developed world are currently struggling with the question of how to adapt their services to deal with continuously rising and changing patterns of demand. It is also widely recognised that simply adding more money and resources is insufficient to improve the quality and sustainability of services, particularly given the challenges in maintaining existing service quality due to changing demographics and increasing need. Radical transformation is required. This is not an easy thing to do; change and transformation are always difficult; they create uncertainty and require us to give up what we have in exchange for something new. This is particularly difficult when it involves something that is very important to us, such as the health and care services that colleagues and our families will all need to call on at some point in our lives. Nor is there certainty and consensus on what radical transformation looks like. 4.3 It is therefore vital that all partners and citizens work collaboratively to achieve the broader scale of change required to meet the challenges collectively faced to transform ways of working to get the most out of the money available. 4.4 In recognition of the urgent need to move at pace, a Grampian Health and Care Strategic Change Board (SCB) was established in November 2024 by the NHS Grampian Chief Executive Team, including Health and Social Care Partnership (HSCP) Chief Officers, to provide strategic oversight, coordination, and leadership for transformation programs across the North East. 4.5 As it develops the SCB will be responsible for developing and implementing the NHS Grampian’s Route Map for Strategic Change in collaboration with IJBs, a key document outlining our shared strategic priorities for the future of health and care across the North East coupled with the practical steps required to create a sustainable health and care system. 4.6 Following endorsement of the development of the Route Map for Strategic Change by the NHS Grampian Board in December 2024, SCB now seek formal agreement from the three North East IJBs in early 2025 to collaborate on areas of common interest in the development of the Route Map for Strategic Change, acknowledging the shared governance responsibilities of NHS Grampian and IJBs in Grampian. 4.7 Subject to the decisions of the three IJBs the Route Map for Strategic Change will be developed in collaboration with Integration Joint Boards and reflect IJB’s Strategic Plans, as critical joint partners in this transformation journey. The IJBs’ deep understanding of local needs, priorities, and resources is essential for shaping and influencing the strategic direction of the change programme. Page 24
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4.8 Route Map High Level Framework 4.9 The Chief Officers of HSCPs/IJBs are members of the SCB (one is a co-chair) and so the SCB will pursue areas of shared interest and ensure coherence across NHS Grampian and IJBs’ strategic priorities. This collaborative approach acknowledges that the success of health and care in the North East depends on a shared commitment to working together respectfully and effectively. It is acknowledged that HSCPs are also integral to transformation work with their respective Councils and the SCB will explore how best to ensure coherence with that work through IJB Strategic Plans. 4.10 Accordingly, the SCB (co-chaired by the NHS Grampian Deputy CEO and a HSCP CO) is tasked with: • Providing the necessary oversight and steer of the development of the Route Map for Strategic Change prior to submitting this to NHS Grampian Chief Executive Team (CET) – which includes HSCP Chief Officers - and to the NHS Grampian Board, 3 IJBs and Scottish Government. The North East Partnership Steering Group can provide an opportunity for IJB Chairs and Vice Chairs to discuss matters and give any steer prior to formal reporting. • Commission, co-ordinate and seek assurance on agreed cross-system programmes of change to deliver on agreed outcomes as per the agreed Route Map for Strategic Change and fundamentally the ambitions set out in organisational strategies; and • Enable delivery of change in both the short and medium term by prioritising the necessary capacity and expertise (internally and externally), creating the environment for change pertaining to strategic change as set out in the agreed Route Map, and where required, escalation to NHS Grampian CET – which includes HSCP Chief Officers – and / or IJBs for their consideration. 4.11 The principle of subsidiarity will be maintained which recognises the complex governance ecosystem NHS Grampian and HSCPs operate within. The Page 25
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statutory decision-making process and reporting routes in each of the partner public bodies will be respected within this principle and with a clear aim of collaboration and reducing duplication wherever possible. 4.12 The work of the SCB will necessarily be iterative, acknowledging the complex and dynamic nature of the health and care landscape. In the first 12 months of the SCB there will be a need for flexibility and a willingness to learn and adapt as there is a transition from a model of cooperation to one of true collaboration. The role and remit of the SCB recognises and respects the complex governance landscapes partners operate within, whilst acknowledging that collective action must be taken to transform our health and care system to ensure its future sustainability. 4.13 The role of Chief Officers as members of the SCB is important in providing leadership and direction but not a substitute for the active engagement and participation of the IJBs and there will be frequent engagement with IJBs in the development of the Route Map for Strategic Change. Formal support from the IJBs is therefore requested for the establishment of the Grampian Strategic Change Board. The IJB is asked to direct each Chief Officer to actively participate in the development and implementation of the Route Map for Strategic Change and work collaboratively with other partners to ensure the success of this crucial transformation program. 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 report on the North East Route Map for Strategic Change is linked to the current Moray Integration Joint Board Strategic Plan by emphasising the need for significant transformation to ensure the sustainability and quality of the health and care system in the North East of Scotland. It highlights the importance of collaboration between partners and citizens to achieve the necessary change. The IJBs are critical partners in this transformation journey, with their deep understanding of local needs, priorities, and resources essential for shaping the strategic direction of the change programme. Implementing the report recommendations, will create a sustainable and high-quality health and care system that meets the needs of the people of the North East. (b) Policy and Legal There are no direct policy and legal implications rising from the recommendations of this report. (c) Financial implications There are no direct financial implications arising from the recommendations of the report. (d) Risk Implications and Mitigation There are no identified risks related to this report. (e) Staffing Implications Page 26
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There are no direct staffing implications arising from the recommendations of this report. (f) Property There are no direct property implications arising from the recommendations of this report. (g) Equalities/Socio Economic Impact There are no direct implications arising from the recommendations of this report. (h) Climate Change and Biodiversity Impacts There are no direct impacts arising from the recommendations of this report. (i) Directions None. (j) Consultations Consultations have been undertaken with the following, who are in agreement with the content of this report where it relates to their area of responsibility: • MIJB Chief Officer • Corporate Manager • Caroline O’Connor, Committee Services Officer 6. CONCLUSION 6.1 By working together in a spirit of partnership and shared purpose, and building on the positive working relationships already established across partners in North East Scotland, a sustainable and high-quality health and care system can be created that meets the needs of the people of the North East for generations to come. Author of Report: Alan Cooper, Planning, Innovation and Programmes. Background Papers: Appendix 1 Ref: Page 27
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APPENDIX 1 Grampian Strategic Change Board Terms of Reference Date Published: N/A Version: v2.0 FINAL December 2024 Document Type: Governance Item 9. Page 29
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V2.0 Final – January 2024 Page 2 of 8 1. Purpose The Strategic Change Oversight Board aims to ensure whole system co-ordination, leadership and oversight of programmes of work within its remit by creating the necessary governance, conditions for change and capacity to support the delivery of strategic change priorities set out in the Route Map for Strategic Change. This can only be achieved by working in collaboration with system partners on shared priorities across the health and care system at a local, regional and national level. It is widely recognised that radical transformation is not an easy thing to do; change and transformation are always difficult, they create uncertainty, and they require us to give up what we have in exchange for something new. This is particularly difficult when it involves something that is very important to us, such as the health and care services that we and our families will all need to call on at some point in our lives. Change will not happen overnight and the first year of the Strategic Change Board will allow us to learn together in the shared aim of providing health and care services that will best meet the needs of future generations and deliver high quality health and care to the people of Grampian. The Strategic Change Board on behalf of the Chief Executive Team (CET) - which includes HSCP Chief Officers - will be tasked to: • Provide the necessary oversight and steer of the development of the Route Map for Strategic Change prior to submitting this to CET – which includes HSCP Chief Officers - and to the NHS Grampian Board and as required to the 3 IJBs and Scottish Government. To mark a deliberate step change towards greater system working the North East Partnership Steering Group will also provide an opportunity for IJB Chairs and Vice Chairs to discuss matters and give any steer prior to formal reporting. • Commission, co-ordinate and seek assurance on both the NHS Grampian and agreed cross- system programmes of change to deliver on agreed outcomes as per the agreed Route Map for Strategic Change and fundamentally the ambitions set out in organisational strategies; and • Enable delivery of change in both the short and medium term by prioritising the necessary capacity and expertise (internally and externally), creating the environment for change, and where required, escalation to CET – which includes HSCP Chief Officers - and/or IJBs for their consideration pertaining to strategic change as set out in the agreed Route Map. The above will be done in the context of the NHS Grampian Plan for the Future and the 3 IJB strategic plans. 2. Role and Function The specific objectives of the Strategic Change Board are: a. Oversee the collaborative system development and seek agreement on the Route Map for Strategic Change. It is envisaged this will be in two stages – 1) overarching framework for enabling strategic change in December 2024 and 2) detailed phasing of key priorities for change over the period initially up to 2028 agreed as part of the Medium Term Delivery Plan. A review point will be built in towards later in 2028 in line with the Plan for the Future timeline of 2032. b. Identify key areas of focus for transformation and strategic change against agreed outcomes, ensuring cohesion across NHS Grampian and the 3 IJB strategic plans, aligned to our shared strategic intent. Page 30
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V2.0 Final – January 2024 Page 3 of 8 c. Commission, provide oversight and seek assurance on key activities to support implementation of required change and de-commissioning and that these deliver against the agreed objectives and outcomes as set out in the Route Map for Strategic Change. d. Oversee and track the individual and whole impact (intended/unintended consequences) of the collective programmes of change through robust approach to system modelling, monitoring and learning. e. Oversee the prioritisation/re-prioritisation of change activities (linked to d) and the required capacity to ensure the objective prioritisation of change capacity across the system. f. Ensure delivery of the transformation and strategic change objectives set out within the Route Map for change which enables ‘finding balance’ as an agile and continuous process of risk/impact assessing, adjusting, prioritising and adapting based on a set of agreed parameters across the 4 domains of prevention and clinical, financial and staff governance. g. On behalf of the NHS Grampian CET, review and oversee the mitigation and management of strategic risk 3006 in relation to Insufficient change and innovation to create a system which can meet demand and deliver on our strategic intent. 3. Duties and Responsibilities The Strategic Change Board will oversee the delivery of (and, where appropriate, make recommendations on) transformation and strategic change priorities. Specifically: i. Provide leadership to, and oversight of, agreed transformation and strategic change workstreams including associated KPIs, timelines, deliverables and milestones. ii. Ensure robust engagement and meaningful involvement with the public, staff and partners is at the heart of the delivery of our strategy, underpinning plans and the delivery of transformation itself. iii. Build relationships and actively engage with senior stakeholders in the delivery of agreed transformation and strategic change workstreams. iv. Promote alignment with local, regional, and national strategies, including NHS Scotland’s emerging national arrangements, as detailed in the Scottish Government's 2025/26 Planning Guidance and DL(2024)31 ‘A renewed approach to population based planning across NHS Scotland’. This includes ensuring effective engagement with the North of Scotland Executive to maximise collaboration and avoid duplication of effort. v. Ensuring that all areas of transformation respond and seek to maximise opportunities for prevention, reduce health inequalities and improve health for all. vi. Commissioning areas of work which have a clear set of objectives, timescales and measures for success, with clear commitment of support and governance in response to priority areas enabling delivery of effective redesign which supports sustainability, performance and improved health outcomes. vii. Co-ordinating and prioritising deployment of implementation support/resources and expertise across priority areas on a short and medium term, based on agreed deliverables/outcomes and mitigation/management of risk. viii. Provide recommendations for realigning governance arrangements to ensure the delivery of transformation and strategic change priorities. ix. Consider and provide advice on the strategic implications of new and emerging policy (with a specific focus on the emerging Scottish Government Reform agenda) within the context of the provision of health and care delivery in Grampian. Page 31
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V2.0 Final – January 2024 Page 4 of 8 x. Establishment of a risk register to identify potential risks related to the delivery (and non- delivery) of transformation and strategic change priorities, mitigation strategies for identified risks, and monitoring and review of identified risks and mitigation strategies. xi. Provide collective leadership on the prioritisation and alignment of resources to support the transformation of the health and care system in line with the commitments of shared strategic aims. The Strategic Change Board will also provide assurance to the Chief Executive’s Team – which includes HSCP Chief Officers – on: i. The management of dependencies between Scottish Government / NHS Scotland, Integration Joint Boards, Health and Social Care Partnerships and other associated organisations regarding implementation and operationalisation of transformation initiatives such as business change, workforce and planning. ii. The operating model and governance of transformation and strategic change implementation within the remit of NHS Grampian iii. For the purposes of the review and oversight of the mitigation and management of NHS Grampian’s Strategic Risk 3006 'Insufficient change and innovation to create a system which can meet demand and deliver on our strategic intent', PAFIC holds the primary oversight, which encompasses scrutiny regarding the management of this risk, including associated controls, mitigations and governance arrangements. The Population Health Committee also holds an overseeing role and will specifically take into account the causation and impact of the risk to delivering on our strategic intent from a population health perspective. 4. Authority The Strategic Change Board is authorised to: • Oversee the achievement of agreed priorities and associated powers of decision making. The views of all representatives will form an essential element of this within an open and transparent culture. • Receive information and assurance of status of agreed priorities and be assured any risks are recorded, monitored and that mitigation plans are in place. Each member of the Strategic Change Board will comply with existing accountability arrangements and will make decisions which are permitted under the appropriate organisational Scheme of Delegation. Recognising that some decisions may not be of obvious benefit to, or impact directly upon, all component parts of represented organisations, members shall seek to pay due regard to the best interests of the population of Grampian in delivering a sustainable system of healthcare. 5. Composition Members of the Strategic Change Board are appointed by the Chief Executive’s Team and IJB’s. Supplementary members will be included for specific discussions to keep the Strategic Change Board an effective forum. Core Membership Core members hold collective responsibility for the Strategic Change Board's outcomes and strategic alignment. They are expected to actively participate in decision-making, contribute expertise, and Page 32
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V2.0 Final – January 2024 Page 5 of 8 ensure that the Strategic Change Board’s activities reflect and address the priorities of NHS Grampian, the Integration Joint Boards (IJBs), and wider system partners. Core members are accountable for: • Advocating for the delivery of the agreed Route Map for Strategic Change. • Engaging with their respective areas to provide insights and feedback for the Strategic Change Board. • Where appropriate, ensuring the implementation of Strategic Change Board decisions within their operational domains. Advisory Membership Advisory members support the Strategic Change Board by offering subject-matter expertise and insights to guide discussions and decisions. While they do not hold voting rights, their input is critical in: • Highlighting emerging opportunities and risks related to their specialist areas. • Providing expert guidance on operationalising strategic priorities. • Ensuring that their contributions reflect regional, national, and local policy contexts. The membership is as follows: Name Role Core Members June Brown (Co-Chair) Deputy CEO / Executive Nurse Director/ Route Map Exec Lead Judith Proctor (Co-Chair) Chief Officer, Health and Social Care Moray Alex Stephen Director of Finance Susan Webb Director of Public Health / Population Health Portfolio Steven Lyndsay Employee Director Stuart Humphreys Director of Marketing & Corporate Communications Nick Fluck Executive Medical Director Geraldine Fraser Portfolio Executive Lead – IFP and MUSC Tom Power Director of People & Culture/CET Lead for Prioritisation Pamela Milliken Chief Officer, Aberdeenshire Health and Social Care Partnership Fiona Mitchelhill Chief Officer, Aberdeen City Health and Social Care Partnership Kevin Sim Consultant in Critical Care, ISCP Representative Lorraine Scott Head of Planning and Programmes Alan Cooper Programme Lead for Route Map for Strategic Change Mark Burrell Chair, Area Clinical Forum Robert Lockhart Clinical Lead for Primary Care, Moray & Chair Grampian Area Medical Committee Advisory Members Martin Innes Chief Digital Officer Gary Kidd Assistant Director of Infrastructure & Sustainability Sarah Irvine Deputy Director of Finance June Barnard Acute Director of Nursing and Midwifery Andy Keen Clinical Lead for Innovation James Cannon Director of Regional Planning - North Alan Bell Head of Information Governance David Pfleger Director of Pharmacy Lynn Morrison Director of AHPs Linda Downie Vice-Chair GP Sub-Committee Page 33
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V2.0 Final – January 2024 Page 6 of 8 Strategic Change Board Chair The Board will be co-chaired by the Deputy Chief Executive and nominated Chief Officer. The Chief Officer co-chair will rotate between the Chief Officer cohort on an annual basis. In the absence of the Deputy Chief Executive a nominated member of the core group will co-chair the meeting. Support Function for Strategic Change Board Secretarial support will be provided by the Executive Business Unit (EBU) specifically in relation to arrangement of meetings and action notes. The PIP Directorate will provide the necessary support to the Co-Chairs in relation to agenda setting, decision log, updating action trackers, facilitating assurance reports and development of commissions for the agreement by the Strategic Chance Board. Attendance Members are expected to attend meetings wherever possible. In exceptional circumstances, and subject to prior approval of a Co-Chair, a deputy can attend. At the invitation of a Co-Chair, other persons may also attend meetings for specific agenda items. 6. Meeting Arrangements Meetings will initially be 2-3 weekly until the Route Map for Strategic Change is agreed, thereafter the Board will meet monthly, or as determined by the Chair. Any member of the collaborative can ask for a meeting to be convened, or for a matter to be considered in correspondence. At the start of each meeting, all members and attendees will be asked to declare any interests related to the agenda items. A register of interests will be maintained by the secretariat, updated regularly, and reviewed at the start of each meeting to ensure transparency and compliance with governance standards. The quorum for the meeting is 75% of core members. A duly convened meeting of the Strategic Change Board at which quorum is present shall be considered competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by members in accordance with the appropriate organisational Scheme of Delegation. Unless otherwise agreed, notice of each meeting confirming venue, time, and date with an agenda of any items to be discussed shall be circulated to each member of the collaborative, and any other person required to attend, no later than 5 working days before the date of the meeting. Supporting papers shall be sent to members, and to other attendees as appropriate, no later than 5 working days before the date of the meeting. Draft minutes shall be sent to the Chair within 4 business days of the meeting and submitted for formal agreement at the next meeting. Page 34
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V2.0 Final – January 2024 Page 7 of 8 7. Reporting The Co-Chairs shall report formally to the Chief Executive’s Team – which includes HSCP Chief Officers – on its proceedings after each meeting. This aims to ensure strategic alignment wherever possible across NHS Grampian, IJBs, North of Scotland Executive and the emerging national reform agenda as outline in Scottish Government 2025/26 planning guidance and DL(2024)31 ‘A renewed approach to population based planning across NHS Scotland’. The Strategic Change Board will make whatever recommendations to the Chief Executive’s Team – which includes HSCP Chief Officers – that it deems appropriate in any area within its remit where action or improvement is needed. Recommendations requiring action or approval by IJBs will be made on a case-by-case basis and in accordance with IJB governance arrangements. The Strategic Change Board will provide relevant assurance to the CET – which includes HSCP Chief Officers, NHS Grampian Board (via PAFIC) and 3 IJBs as appropriate. The governance arrangements (including sub-groups) are outlined in the organogram below. Sub-groups will be established according to the agreed strategic change priorities. Strategic Change Board Sub-Groups In line with our commitment to effective governance and continuous improvement, several sub- groups will report directly to the Strategic Change Board. These sub-groups will play a crucial role in supporting our shared strategic objectives and ensuring comprehensive oversight across various initiatives. The sub-groups will report to the Strategic Change Board on matters that fall within the Board's competence, role, and remit. This ensures that all relevant issues are addressed appropriately and in alignment with strategic priorities. To ensure clarity and alignment with strategic goals, the reporting relationships and terms of reference for these sub-groups will undergo a comprehensive review within the first 6 months of the Strategic Change Board’s first meeting. This review will help us refine their roles, responsibilities, and reporting structures to better serve our shared needs and enhance overall effectiveness. Page 35
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V2.0 Final – January 2024 Page 8 of 8 Governance Chart Page 36
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: GENERAL PRACTICE VISION AND OBJECTIVES UPDATE BY: PROGRAMME MANAGER, GP VISION PROGRAMME 1. REASON FOR REPORT 1.1 To update the Board on the outcomes and recommendations of the NHS Grampian General Practice (GP) Vision programme, and seek endorsement of the vision and SMART objectives related to this programme. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) notes the content of the report as an update on current progress on the GP Vision Programme; and ii) requests a report is brought back to the Board with a further annual update in spring 2026. 3. BACKGROUND GP Vision and Objectives 3.1 In response to current sustainability challenges and evolving needs within the NHS Grampian area, a programme of work was commissioned in July 2023 to articulate a new vision statement and strategic objectives that capture the changes required to move towards a more sustainable general practice sector within the area. 3.2 In March 2024 the output of this programme of work was presented to the three Integrated Joint Boards (IJB’s). The Vision Statement, ‘A sustainable General Practice across Grampian which enables people in their communities to stay well through the prevention and treatment of ill health’, was approved which encapsulates a commitment to fostering health and well-being within our communities. It signifies a commitment to providing comprehensive and Item 10. Page 37
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accessible healthcare services that not only address illness but also promote preventive care and empower individuals to lead healthier lives in their communities. 3.3 The Vision is underpinned by problem statements highlighted during the stakeholder engagement programme and subsequently grouped against 10 Key themes: • Data • Multi-Disciplinary Team • Models of Contract • Premises • Digital • Mental Health & Wellbeing • Recruitment & Retention • Continuity • Pathways • Keeping the Population well 4. KEY MATTERS RELEVANT TO RECOMMENDATION GP Vision Implementation 4.1 Following approval at the meeting of the Board on 28 March 2024 (para 11 of minute refers), an implementation board was set up, which includes key stakeholders from across the system, including primary care, acute, Local Medical Committee (LMC) and a patient representative. 4.2 An implementation plan was developed to deliver the set objectives within existing resources. The initial step involved assessing all 10 objectives to determine prioritisation within available resource. During the prioritisation process, regard was had to factors such as the IJBs’ respective strategic plans, risk, impact, and dependencies on other initiatives. Based on the prioritisation, five objectives have been prioritised:- • Data • Multi-Disciplinary Team • Models of Contract • Premises • Digital 4.3 A Senior Responsible Officer (SRO), deputy SRO and project lead has been identified for each of the priority areas and project groups have been set up for each of the workstreams. The implementation board oversees the progress of the priority objectives where a programme management approach has been used. This includes the use of highlight reports to track the progress of initiatives, addressing key milestones, risks, and actions. These reports are shared during board meetings to ensure transparency and prompt corrective actions when necessary. To further enhance communication and engagement, a newsletter is produced after each board meeting, summarising decisions made, ongoing challenges, and next steps. This newsletter is distributed to all relevant stakeholders, including general practitioners, keeping them informed Page 38
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and fostering a sense of accountability and continuous progress throughout the program's lifecycle. 4.4 Regular meetings with the Scottish Government are established and ongoing to ensure consistent progress reporting and maintain alignment with national objectives. These meetings serve as a platform not only to update the government on key milestones and developments but also to test and validate critical assumptions underlying the implementation plan. By engaging in open dialogue, the meetings explore what actions can be effectively delivered at a local level, fostering collaboration and identifying areas where local flexibility could enhance outcomes. Additionally, these sessions provide an opportunity to discuss potential funding opportunities, with the Scottish Government offering insights into available resources or new initiatives that could support the delivery of the remaining objectives. This proactive approach helps to ensure that the project remains responsive to both national priorities and local needs, creating a dynamic partnership for continued progress. Workstream Updates Data Workstream 4.5 The rationale for this was that there is currently no standardisation in the way data is coded and collected across General Practices and shared with relevant partners to inform resource allocation to help deliver better outcomes for our communities. 4.6 The primary goal of the data workstream is to explore how data can effectively support the various other workstreams within the GP Vision Programme. There were also the key objectives to:- • identify and define necessary data sets; • create data gathering processes which enables consistent and consolidated data to be collected across General Practice in a standardised way; and • develop data sharing arrangements with relevant partners where necessary. 4.7 The focus has been on offering assistance to the groups in terms of data collection, data analysis, and identifying what data is already available and how it can be leveraged for better decision-making. By evaluating current data sources, the workstream aims to ensure that the right information is accessible to drive improvements in service delivery, resource allocation, and overall strategic planning. Key Progress Points: 4.8 Identification of Existing Data Sets: the group has successfully identified key data sets that are currently available across different workstreams. These data sets are valuable in supporting evidence-based decision-making and informing strategy development. 4.9 Demand Measurement through GP Phone Systems: the group has initiated discussions to explore how demand can be better measured through GP phone systems. This will allow us to track patient inquiries, appointment requests, and Page 39
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other relevant data that can provide insights into service demand and resource allocation needs. 4.10 Create data gathering processes which enables consistent and consolidated data to be collected across General Practice in a standardised way; Updating and Standardising Data Entry Templates: the group have opened discussions about the need to update and standardise data entry templates across GP clinical systems. This is aimed at ensuring consistency, improving data quality, and facilitating easier analysis across the board. 4.11 Investigation of Artificial Intelligence (AI) and Data Collation Tools: The team is investigating the potential of using AI and other advanced tools to help automate and streamline the process of collecting and aggregating data from GP practices. This could enhance the efficiency of data management, reduce administrative burden, and provide more timely insights. 4.12 Data Protection Impact Assessment (DPIA) Challenges: The team has identified and escalated challenges related to the DPIA process to the Scottish Government for further resolution. These challenges relate to ensuring compliance with data privacy regulations while enabling data sharing and utilisation across workstreams. 4.13 The data workstream does not have a fixed timeline for completion but will continue to support other workstreams on an ongoing basis. The approach is to respond to data-related requests from other teams as needed, ensuring that they have the necessary data to meet their objectives. Given the cross over with other workstreams, it is anticipated that the role of the data workstream will evolve as other workstreams identify new data requirements, risks, and opportunities. 4.14 Compilation of Available Data Sets: A list of current data sets has been compiled and is now available for review. This will serve as a valuable resource for workstreams looking to tap into existing data to support their initiatives. This list will be regularly updated as more data sets are identified and as new data becomes available. Key Risks and Issues - Data 4.15 Data Availability and Consistency: One of the significant challenges faced is that data is predominantly held by individual GP practices. This makes it difficult to obtain consistent and standardised data across the board. Variations in how data is collected, stored, and shared by practices create barriers to ensuring the accuracy and completeness of data for decision-making. Next Steps for 2025/26 – Data 4.16 Evaluation of Feasibility: The next steps involve deeper discussions around what is feasible from the current data sets. The group will explore which data can be effectively used to support upcoming initiatives and identify any gaps in data that need to be addressed. A proposal will be developed to scope and investigate a General Practice Data Dashboard. This work will determine what the data would benefit GPs, what this can display and determine if the dashboard is feasible. The anticipated benefits of a data dashboard in general practice include improved patient care, enhanced operational efficiency, data- driven decision-making, and better compliance with clinical standards. This will Page 40
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help to address the objective set for data by ensuring consistent and consolidated data to be collected across General Practice. 4.17 Engagement with Practices: Further engagement with GP practices will be necessary to establish data-sharing protocols, address data quality issues, and explore solutions to the challenges of inconsistent data management. 4.18 Advanced Analytics and AI Integration: The group will continue to investigate opportunities for integrating advanced analytics tools, such as AI, to provide deeper insights into the data and improve decision-making processes. 4.19 Collaboration with Other Workstreams: The group will maintain close collaboration with other workstreams to ensure that data collection and usage are aligned with their objectives, and that timely and actionable insights to support their activities are provided. Multi-Disciplinary Team (MDT) (Primary Care Improvement Plan (PCIP) Review workstream) 4.20 The objective of the PCIP Review workstream was to initiate and complete an evaluation and review of PCIP services that are in place across NHS Grampian. Where best practice is identified, learn from this, and facilitate its rollout to other areas if appropriate. 4.21 The rationale for this was that there have been recruitment challenges within Grampian. This has led to MDTs often being understaffed and unable to achieve the full breadth or services that they could deliver on. This has a knock on impact on General Practice and the ability to deliver proactive health care. 4.22 A period of consultation was undertaken in terms of how the project would be supported and taken forward with key stakeholders across the three Health and Social Care Partnerships (HSCPs) in Grampian being identified. The project has representation from the Public Health Scotland (PHS), the Local Intelligence Support Team (LIST), HSCP leads, NHS Grampian Finance colleagues, as well as primary care clinical and management representation. • Quality - How well is PCIP being delivered in terms of services to patients? • Quantity - What is the overall PCIP resource? • Efficiency - What does PCIP do to support practices, patients and staff? 4.23 The working group will present the wider PCIP review group with the data collection work when complete and available for the formal review process to commence. This work is anticipated to be complete by spring 2025. PCIP Review Methodology 4.24 The review of PCIPs across Grampian in the context of the GP Vision is based on the PDSA (Plan Do Study Act) methodology to progress this work as follows: 4.25 An Evaluation Framework has been agreed to provide a structure and systematic tool to assess whether PCIP has achieved its intended results. Page 41
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4.26 The working group has gathered budget data for Moray, Aberdeen City and Aberdeenshire to compare the budget breakdown of each service and discussions will take place in terms of how each budget is utilised to provide the services required in each. 4.27 The review group has identified 6 workstreams: • Pharmacotherapy, • Community Treatment and Care (CTAC), • Physiotherapy Musculoskeletal; First Contact Practitioners, • Vaccination Transformation Programme, • Urgent Care and Link Workers - Under Urgent Care sits the City Visiting workstream for the Aberdeen City HSCP and Occupational Therapy for the Moray HSCP. 4.28 The project group will be gathering information on all workstreams and have started with the MSK FCP (Musculoskeletal First Contact Practitioner) workstream. The MSK FCP workstream is a less convoluted pathway in terms of service delivery and easier to follow and was a good place to start in comparison to other more complicated workstreams. This was agreed with the wider group and has been a test for any anomalies and variances that arise when gathering the data from the HSCPs. The process will assist when the group moves on to the review of other workstreams. The benefit of this work will be the ability to compare how the service is delivered across Grampian and identify examples of good practice that may be transferable to HSCP’s. 4.29 A plan for public engagement is being considered so that it dovetails with the detailed information when it becomes available. Taking this approach will determine the most valuable feedback requested and take cognisance of any variance & differences highlighted during the data gathering. The PCIP consultation element is about the users and staff of the workstreams that we have to contractually deliver via the MoU (Memorandum of Understanding) for example what they think of the services and how they are delivered. PCIP is also part of a communications group that is working on a public engagement communications strategy (see 4.53). Progress for 2025/26 4.30 The project continues through the discovery phase to provide the wealth of detail and information to move to a process of evaluation. There are no preconceived notions as to what a change might look like, and this has been the understanding since the outset for the project. A challenge throughout the process has been access to the required data and this is crucial to the success of the project. It is anticipated that the completion of the stages of the project will be completed during this period: • Quantity – completed spring 2025 • Quality and Efficiency will be completed following the PCIP engagement programme that will include patients and staffing groups 4.31 The outcome will be a final report for each workstream incorporating all three HSCP’s where appropriate and for the workstreams that are not provided across all partnerships. The PCIP Review project group will provide an overarching report that will provide the information from the findings to the Page 42
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Visioning Board and enable consideration for any recommendations for change and this will include sharing good practice opportunities. Models of Contract workstream 4.32 The objective of the Models of Contract workstream was to develop a flexible approach to the delivery of the existing General Medical Services (GMS) contract, using currently available levers, following consultation with relevant stakeholders. 4.33 The rationale for this was that there is growing evidence that the current 2018 GMS contract is not best placed to meet patients’ needs in an efficient and effective manner in Grampian. There are significant ongoing difficulties with recruitment and retention and therefore sustainability across General Practice in the northeast of Scotland. There is evidence that the ambitions of the Primary Care Improvement Programme are yet to be fully realised. 4.34 The aim of the Models of Contract Workstream is to identify and assess new approaches that could potentially offer greater flexibility, efficiency, and alignment with the evolving needs of General Practice. This process includes looking beyond traditional contractual frameworks to explore models that could drive better outcomes, especially in the context of current challenges and future objectives. 4.35 To inform this exploration, a comprehensive review of the existing NHS Grampian (NHSG) contractual landscape has been conducted. This review involved benchmarking the current contracts against those used by other health boards across Scotland. By analysing these comparisons, the team has been able to identify potential gaps, best practices, and areas for improvement, which will help guide the development of a more innovative and effective contractual approach moving forward. 4.36 An additional component of this work involves investigating the possibility of transferring certain elements of Memoranda of Understanding (MoU) back to local practices, should both parties agree. This could involve revisiting existing agreements to allow for greater local autonomy and control, ensuring that the terms of the MoUs are more closely aligned with the specific needs and priorities of individual practices. 4.37 A key risk associated with this third component is the potential lack of sufficient support from stakeholders. If local practices or other involved parties are not fully aligned or do not support the proposed changes, it could delay or hinder the successful implementation of the new model. Therefore, the next steps will involve continuing discussions with key stakeholders to address concerns, build consensus, and ensure that the necessary buy-in is secured to move forward with the proposed changes. These ongoing conversations will be crucial for the success of the initiative and for ensuring that all parties are on board with the new approach. This element also intrinsically links with the output of the PCIP review. Progress for 2025/26 4.38 The workstream has identified opportunities to explore alternative models of CTAC delivery using a customised version of the options appraisal framework- Page 43
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we have been working closely with Scottish Government on this with a view to drafting an options appraisal in January 2025. Premises Workstream 4.39 The objective of the premises workstream was to via the Primary Care Premises Group, each HSCP, in consultation with practices and relevant partners, will develop an estate plan to meet the needs of our communities. Regard will be had to buildings (where required) being well-equipped, accessible, patient-centred, conducive to partnership working, integrated with advanced and standardised technologies, and in the right place to meet the needs of the communities. 4.40 The rationale for this was that there is pressure on the sustainability of General Practice which is linked to liabilities arising from GP contractors’ premises. Within the current infrastructure there is insufficient space and the internal structure of premises impedes alternative ways of working which can best meet the needs of the communities. 4.41 The Premises workstream has been integrated into the broader NHS Grampian Premises Group, ensuring that the work aligns with the group's objectives and strategic direction. This integration allows for a coordinated approach to managing and optimising healthcare infrastructure across the region, with a focus on aligning local needs with broader organizational goals. By being part of this group, the workstream can leverage insights and resources from across NHS Grampian, ensuring that premises-related challenges and opportunities are addressed collaboratively and comprehensively. 4.42 A key focus of this workstream is to identify and establish a baseline for NHS Grampian's infrastructure. This involves conducting a thorough assessment of existing premises, including their condition, functionality, capacity, and alignment with current and future healthcare service delivery needs. This baseline assessment is critical for understanding where improvements or investments are needed, as well as providing a foundation for making data- driven decisions about future infrastructure developments. The information gathered will also help inform long-term planning and prioritisation of resources to ensure that NHS Grampian's premises are fit for purpose and financially stability. This work is progressing with the baseline data expected to be available January 2025. 4.43 The workstream is also linking closely with each HSCP Premises Strategy and the Scottish Government's Programme Initiation Agreement (PIA). By aligning with these strategies, the workstream ensures that the premises work is consistent with both local priorities and national policy objectives. This integration helps create a unified approach to premises management, ensuring that all relevant stakeholders are aligned and that any gaps or overlaps are identified early in the process. 4.44 However, a potential risk that has been identified in this workstream is ensuring that all premises — whether NHS Grampian-owned or not — are adequately considered in the planning and decision-making process. There may be challenges in capturing the full scope of premises across the region, particularly when some facilities are managed by other organizations or independent providers. If these non-NHSG-owned estates are not properly included in the Page 44
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assessment and planning process, it could lead to gaps in service provision or missed opportunities for collaboration and resource-sharing. Therefore, mitigating this risk will require close coordination with external stakeholders and a comprehensive mapping of all relevant premises, regardless of ownership. This will be assessed and reviewed in line with national timelines. Progress for 2025/26 4.45 Key progress area will be the baseline assessment of premises which is anticipated being complete in early 2025. In addition there is ongoing work to learn lessons from past lease assignations, although this is not expected until completion of the current round of leases. Digital workstream 4.46 The objective of the digital workstream was to support the development of a regional Grampian Digital plan, which includes General Practice. This will help to develop a coherent approach to the development of a prioritised set of digital solutions to ensure the wider system is best placed to meet the needs of communities within available resource. 4.47 The rationale for this was because the digital programme is not meeting the requirements of General Practice or our communities. This including: inadequate resource for service design and business analysis; no uniform approach to citizen-facing digital services. There is no clear plan to integrate patient data across health and social care and there is insufficient focus on automation. There are delays in implementing agreed solutions and capacity issues in relation to data protection compliance. 4.48 A digital plan will aim to address these challenges by setting out a set of prioritised digital interventions for general practice at national, regional and local levels. Key Progress points 4.49 At the outset, it is important to have regard to activity currently underway that is relevant to General Practice. An audit of such activity across local authorities, NHS Grampian and at a national level has been carried out. This is to ensure that additional activity to improve digital capability does not duplicate or conflict with existing priorities. It has also enabled regard to be had to whether there is opportunity to expand existing capability into general practice in Grampian. 4.50 A workshop to consider a radical redesign of GP service provision has also taken place with relevant stakeholders. This, together with the audit above, and having due regard to the problem statements arising from the GP Visioning work, will allow for the development of a prioritised set of objectives for General Practice. Progress for 2025/26 4.51 It is anticipated that a Digital Plan for General Practice will be completed in 2025/2026. This will set out all existing and additional priorities for the development of digital capability for General Practice in Grampian. It will be aligned to all other priority workstreams across the GP Vision Programme and seek to build on relevant existing digital initiatives such as the Aberdeen Digital Innovation Programme. It is anticipated that the Digital Sub-Group will lead on the development of appropriate business cases for new capability. Page 45
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Other workstreams 4.52 Two additional workstreams will commence in early 2025. These are: • Recruitment & Retention • Mental Health & Wellbeing Stakeholder engagement 4.53 To ensure the successful execution of the GP Vision Programme, a communication sub-group has been formed to develop stakeholder engagement, a patient representative is included in this group. This sub-group will oversee the creation and coordination of the communications, working closely with GP practices to gather relevant content and ensure that the messages are effectively delivered to both the public and patients. The sub- group will also collaborate with practices to highlight their best practices and patient engagement successes, ensuring the intended outcomes are achieved. 4.54 The planned stakeholder engagement consists of two key communication strategies aimed at fostering understanding and collaboration around changes in general practice. 4.55 First, a strategic communication campaign will be launched to the general public, highlighting the challenges faced by general practices today, such as increasing patient demand, staff shortages, and evolving service delivery models. This communication will also inform the public about the ongoing changes in how general practices now operate, emphasising the adaptations made to improve patient care despite these challenges. 4.56 The second component involves a targeted communication initiative for GP practices to share with their patients. Using a "Did You Know?" approach, this will highlight best practices from Inverbervie Medial practice, showcasing their successful communications campaign. 4.57 Further to this a case study in relation to Inverbervie medical Practice detailing how the GP practice has leveraged its Patient Participation Group (PPG) to strengthen relationships with its patient population, demonstrating the value of patient involvement in shaping practice improvements and enhancing care delivery. Next Steps 4.58 A workshop will be held early 2025 to ensure that the current priorities remain aligned with the goals of the organisation, this will provide an opportunity for the programme board to review and refine these priorities as needed. The allocation of resources will be carefully reviewed to ensure that sufficient support is directed towards the most impactful areas, allowing for the successful implementation of the key objectives. 4.59 In Year 2 of the GP vision programme of work, the focus will be on building upon the progress made in Year 1, where 5 of the original 10 objectives were successfully initiated. These objectives, cover critical areas of development, and will continue to be a key priority. 4.60 In 2025/26 the programme seeks to expand its reach, refine strategies, and address any emerging challenges to ensure that all objectives are met by the Page 46
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end of Year 2. This will involve a mix of continuing with established projects, enhancing stakeholder engagement, and commencing further objectives that align with the overarching goals. 4.61 The programme board and workstream leads will continue to liaise with the Scottish Government to ensure consistent progress reporting and maintain alignment with national objectives. Tests of change and other opportunities will be determined by SRO’s and Workstream leads and presented to the Scottish Government to move the programme forward. 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 HSCP vision is: ‘We come together as equal and valued partners in care to achieve the best health and wellbeing possible for everyone in Moray throughout their lives’ This is underpinned by three strategic priorities, the vision and objectives will support the delivery of these as shown in the below table. Moray HSCP Strategic Priorities Moray council LOIP NHSG GP Vision Objectives Improve the health and wellbeing of the population (Better Health) Building a better future for our children and young people in Moray. Improving wellbeing of our population ✓ Data ✓ Pathways ✓ Keeping the Population well ✓ Models of Contract ✓ MDT ✓ Mental Health & Wellbeing ✓ Continuity of Care ✓ Digital Improve the quality of care people receive (better Care Empowering and connecting communities ✓ Data ✓ Digital ✓ Models of Contract ✓ MDT ✓ Mental Health & Wellbeing ✓ Continuity of Care ✓ Premises Improve the efficient of health and social care services to ensure we spend public money on services that get good outcomes for people (better value) Developing a diverse, inclusive and sustainable economy ✓ Data ✓ Models of Contract ✓ MDT ✓ Mental health and Wellbeing ✓ Continuity of care ✓ Premises ✓ Digital (b) Policy and Legal There are no direct policy or legal implications arising from the recommendations of this report. (c) Financial implications Page 47
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There are no direct financial implications arising from the recommendations of this report. (d) Risk Implications and Mitigation Category Description Mitigation RAG Status Sustainability There is a risk that if the project is not delivered, General Practice within Grampian will continue on an unsustainable basis. This will further exacerbate the challenges outlined above. As the first point of access to healthcare for 90% of the population General Practice delivers early intervention and preventative measures for the whole system and therefore the consequences will not be limited to GP services. Failure to deliver the project will increase the prospect of further increasing demand on secondary care services, unscheduled and urgent care (including PC & OOH), a reduction in NHS performance and poorer outcomes for Grampian’s residents across the health and social care system. The development of a project to deliver a shared vision and strategic objectives for General Practice in Grampian. Adequate funding support from the Scottish Government to build the necessary capacity to deliver this project (which is preventative in nature) to March 2024 and anticipated support to deliver the implementation plan beyond March 2024. Working with public health colleagues to ensure preventative focus of workstreams and focus interventions on need. Sustainability Resource The programme is required to be delivered within existing resources, therefore there is a risk that the programme is not delivered due to the financial pressures across Grampian and other competing priorities. Continued highlighting of concerns and engagement with all stakeholders to understand the importance and risks of not undertaking this project Consideration of current priorities and workforce that could be realigned to deliver some or all of the programme. As well as phasing of timelines to make Resource Page 48
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workloads manageable. Engagement – Public Reputational risk due to the potential service changes being disliked by the public Potential increased complaint due to changes to services There are also risks if changes are not made around patient expectations and experience – waiting times etc. A Patient representative is part of the Programme governance structure moving forward for co-design and engagement Patient stakeholder engagement – working with communications teams, partner agencies, and social media to make sure messages made on an ongoing basis. In 2024/25 this will focus on the PCIP workstream Working with Local Empowerment Groups (LEGS) and working with elected members and community councils to increase understanding for the case to change. Engagement – Public Engagement – Workforce Risk that key stakeholder do not have the capacity and therefore loose interest in implementation of priorities No dedicated resource to release General Practice to implement within an already pressured system Reputational risks with General Practice if programme not implemented Continued highlighting of concerns and engagement with all stakeholders to understand the importance and risks of not undertaking this programme. Consideration of current priorities and workforce that could be realigned to deliver some or all of the programme. As well as phasing of timelines to make workloads manageable. Engagement – Workforce Page 49
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(e) Staffing Implications There are no direct staffing implications arising from the recommendations of this report. (f) Property There are no direct property implications arising from the recommendations of this report. (g) Equalities/Socio Economic Impact There are no direct implications arising from the recommendations of this report (h) Climate Change and Biodiversity Impacts There are no direct climate change or biodiversity implications arising from the recommendations of this report. (i) Directions None arising from this report (j) Consultations Consultations have been undertaken with the following who are in agreement with the content of this report where it relates to their area of responsibility: • MIJB Chief Officer • Head of Service / Deputy Chief Officer • Caroline O’Connor, Committee Services Officer 6. CONCLUSION 6.1 The Board are recommended to note the content of the report as an update on current progress on the GP Vision Programme and instruct the Chief Officers to report back with a further annual update in 2026 Author of Report: Ali Chapman, Programme Manager (NHSG General Practice Vision Programme) Page 50
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: GRAMPIAN VACCINATION AND IMMUNISATION ANNUAL REPORT 2024 BY: VACCINATION PLANNING MANAGER AND CONSULTANT IN PUBLIC HEALTH MEDICINE/IMMUNISATION COORDINATOR 1. REASON FOR REPORT 1.1 To update the Board with an annual monitoring report of vaccine preventable disease surveillance data, along with uptake data for each vaccine delivered within Grampian to provide assurance. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) scrutinise and note the findings of the Vaccination and Immunisation Annual Report 2024 attached as Appendix 1; and ii) request annual monitoring reporting continues to the Board. 3. BACKGROUND 3.1 The World Health Organisation (WHO) describes vaccines as one of the two public health interventions that have the greatest impact on the world’s health, the other being clean water. Vaccination can prevent or reduce the severity of disease, minimise disability and save lives, often in many of the most disadvantaged people in society. It offers excellent value for money by reducing current and future public expenditure on health and social care provision. 3.2 Effective control of vaccine preventable disease requires action across the whole health and care system, and this aligns with the drive to improve outcomes and reduce inequalities. 3.3 The first Grampian Vaccination and Immunisation Annual Report 2023 was reported to the Board on 30 November 2023 (para 8 of minute refers). The second report is attached as Appendix 1. Item 11. Page 51
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3.4 Teams continue to transition from the mass vaccination hub model of delivery created at the height of the Covid pandemic to a smaller service, more fitted to “business as usual” activity whilst retaining the ability to flex as needed. 3.5 The delivery of vaccination programmes has not yet reached a stable state nationally or locally. A number of changes have been implemented since the previous report including the introduction of a new Respiratory Syncytial Virus (RSV) vaccine to protect infants and older adults. A change in the vaccine for Pertussis in pregnancy programmes, changes to eligibility for spring and Autumn COVID-19 programmes, changes to eligibility for flu programme and the rolling programme changes to Shingles continue to roll out. In addition to this the service has moved from separate call centres within health and social care partnership areas to a Once for Grampian single call centre to utilise economies of scale with resultant financial savings. Next year there will be changes to the preschool programme to introduce an 18 months visit to support an additional dose of hib c and the introduction of a vaccine against varicella (chickenpox). The service will also see the eligible for severely weakened immune system for the shingles programme reduce from age 50 to 18 years and based on Joint Committee on Vaccination and Immunisation (JCVI) advice that Boards should begin to plan for more stable eligible cohorts for covid-19 programmes based on cost effectiveness analysis. 3.6 As part of the new Scottish Vaccination and Immunisation Programme’s (SVIP) Strategic Framework Boards are asked to focus on improving equity across our programmes. NHS Grampian are responding with an equity plan and a Grampian Strategic Framework which is realistic within current resources and will build on the successes seen within Grampian, including those in Moray. In addition, we are expecting the launch of national standards for vaccination teams to work to which are included in NHS Grampian’s Annual Delivery Plan reporting to Scottish Government. 3.7 These competing priorities will all have an impact on the work done in Moray over the next 3-5 years. Outreach work for small populations cannot deliver as many vaccinations as in a hub in the same timeframe. As programmes expand and the resources to deliver funded via SVIP and Primary Care Improvement Plan (PCIP) remain static at some point there will be a trade-off between putting resources into reducing inequity and maintaining the offer to other parts of the population. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Scotland, like many countries close to home and worldwide, is seeing declines in vaccinations. In Scotland uptake has largely held or shown modest decline for many routine vaccinations with sharper declines in seasonal vaccinations. Grampian is seeing the same trend, almost exactly mirroring the national picture. 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” Page 52
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Working with our partners to support people so they can cope with, and where possible, overcome the health and wellbeing challenges they may face. Ensuring that the right care is provided at the right place at the right time when people are in need. Ensuring that our systems are as simple and efficient as possible. The approach set out in this report is consistent with the ambitions of the MIJB strategic plan. (b) Policy and Legal None directly associated with this report (c) Financial implications None directly associated with this report (d) Risk Implications and Mitigation None directly associated with this report (e) Staffing Implications None directly associated with this report (f) Property None directly associated with this report (g) Equalities/Socio Economic Impact An Equality Impact Assessment is not required as there are no changes to policy arising from this report and therefore there will be no differential impact on people with protected characteristics. However, individual strategies will comply with the need for an Equalities Impact Assessment and is considered as part of our service planning process. (h) Climate Change and Biodiversity Impacts None directly associated with this report (i) Directions None directly associated with this report (j) Consultations Chief Officer; Heads of Services; Chief Financial Officer and the Caroline O’Connor, Committee Services Officer, have been consulted in the writing of this report. 6. CONCLUSION 6.1 The Grampian Vaccination and Immunisation annual report (Appendix 1) is an opportunity to reflect on the delivery of the programme and the varied activities and improvements that have been achieved over the year. Page 53
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Author of Report: Jo Hall, Vaccination Planning Manager, Public Health, NHS Grampian Dr Clare- Louise Walker, Consultant in Public Health Medicine/Immunisation Coordinator, Public Health, NHS Grampian Background Papers: Appendix 1 Grampian Vaccination and Immunisation Annual Report 2024 Page 54
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1 APPENDIX 1 Item 11. Page 55
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1 Contents Abbreviations 2 Executive Summary 3 Introduction 5 Why vaccination is Important as Part of Population Health 7 National and Local Context of vaccination 8 Vaccine Preventable disease 10 Vaccination Uptake 21 Equity In Grampian 35 Quality improvement 40 Horizon Scanning 45 Conclusions 47 Acknowledgements 47 References 47 Appendix 1. Routine childhood and adult immunisation schedule 49 Page 56
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2 Abbreviations ADP Annual Delivery Plan AMR Antimicrobial resistance CMO Chief Medical Officer (for Scotland) DPH Director of Public Health FVCV Flu Vaccine and Covid-19 Vaccine GBMSM Gay, Bisexual and Men who have sex with Men GREC Grampian Regional Equality Council GVIP Grampian Vaccination and Immunisation Programme HSCP Health and Social Care Partnership HV Health Visitor IJB Integrated Joint Board JCVI Joint Committee on Vaccinations and Immunisation MSM Men who have Sex with Men NHSG NHS Grampian PAG Preliminary Assessment Group PHS Public Health Scotland SG Scottish Government SIMD Scottish Index of Multiple Deprivation SIRS Scottish Immunisation & Recall System SLWG Short Life Working Group SVIP Scottish Vaccination and Immunisation Programme VMT Vaccination Management Tool VTP Vaccination Transformation Programme WHO World Health Organisation Vaccine and disease abbreviations BCG Bacillus Calmette-Guerin DTP Diphtheria, tetanus, polio FVCV Influenza vaccine (Flu) and COVID-19 Vaccine Hep A Hepatitis A Hep B Hepatitis B Hib Haemophilus influenzae type B HPV Human Papilloma Virus IPD Invasive pneumococcal disease IPV Inactivated Polio Virus MenACWY Meningococcal groups A, C, W and Y MenC Meningitis C MMR Measles, Mumps and Rubella MMRV Measles, Mumps, Rubella and Varicella Mpox Mpox (Previously Monkeypox) PPV Pneumococcal Polysaccharide Vaccine RSV Respiratory Syncytial Virus TB Tuberculosis Td Tetanus and Diphtheria vaccine Page 57
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3 1. EXECUTIVE SUMMARY 1.1. This is the second Annual Vaccination and Immunisation Report for NHS Grampian. The purpose of the report is to provide an annual monitoring report of vaccine preventable disease surveillance data, along with uptake data for each vaccine. A commentary is provided to give context for greater understanding of the data and the challenges and quality improvement measures associated with the programme. A section on horizon scanning is also included. 1.2. Vaccination offers excellent value for money. It provides protection against a range of infections across the life course, enabling our population to live longer, healthier lives, reducing inequalities, and releasing health service capacity. It also makes a vital contribution to reducing unnecessary antibiotic usage and antimicrobial resistance. Vaccination can prevent or reduce the severity of disease, minimise disability and save lives, often in many of the most disadvantaged people in society. The European Region of WHO recommend coverage of 95% in a population is required to control or eliminate disease. 1.3. Since 2022, operational delivery of vaccination has been the responsibility of our three Health and Social Care Partnerships (HSCPs) in Aberdeen City, Aberdeenshire, and Moray. Programme coordination lies with NHS Grampian and the Director of Public Health is the Senior Responsible Officer for vaccinations. 1.4. Although we are post pandemic, the vaccination services have still not reached a stable state nationally or locally with national changes to programmes, local delivery evolution and a national vaccination strategy and standards to implement with a focus on health inequity. 1.5. 2023-24 have seen the vaccination service respond to outbreaks of whooping cough, measles and Mpox as partners in outbreak response. 1.6. Grampian continues to offer a good vaccination service which outperforms the Scottish average for most programmes. However, the national picture is one of modest declines in vaccination uptake across programmes with more sharp declines in seasonal vaccinations. 1.7. The one area where Grampian consistently underperforms against national comparators is health equity. Those in the most socio-economically deprived quintiles and some ethnic minorities have consistently lower vaccination uptakes compared with the Scottish average. This will be tackled as part of our quality improvement work next year as we finalise and implement our equity plan. 1.8. Grampian has maintained uptake for childhood vaccinations at close to the WHO recommended 95% except for rotavirus, meningitis B- and the second dose of MMR. There are geographical variations to tackle. 1.9. Uptake for school aged vaccinations is varied. HPV uptake is broadly similar to last year with a welcome increase in uptake for boys after S2. Teenage boosters show a fall of 3-5% from last year for both Grampian and Scotland. 1.10. The change to a 2 dose Shingles programme has generally had a good uptake, with almost 80% of those taking a first dose going on to complete the course with a second. Grampian outperforms the Scottish average for all cohorts and by 12.6% overall. 1.11. Young children, the elderly and people in a clinical risk group are most at risk of severe pneumococcal disease, and so all these groups are currently offered a pneumococcal immunisation. Trend data showed Grampian’s uptake was consistently under the Scottish average, however since 2020-21 there has been a sharp and consistent increase in uptake so for 2023-24 we now exceed the Scottish average for most cohorts. Page 58
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4 1.12. Uptake of seasonal flu and COVID-19 vaccinations in Winter 2023/24 was similar in Grampian to the Scotland average and highest in the oldest age groups. Uptake shows a socioeconomic gradient with highest uptake amongst least deprived. Overall uptake for these seasonal vaccinations has decreased significantly in all cohorts except for older age groups since the last report. 1.13. Non routine vaccinations cover a range of situations where citizens require vaccination out with the usual population vaccination schedules. We have developed digital processes to assist clinicians to refer a citizen for vaccinations that are required out with normal vaccination schedules. 1.14. Travel risk assessments, advice, and vaccinations (if required) are provided to reduce the risk of transmission of diseases amongst patients travelling to countries where these diseases are still prevalent. The travel health service in Grampian has been delivered by community pharmacy since October 2021. A new “Once for Grampian” integrated model will commence in early 2025 in response to budgetary requirements. 1.15. Priorities for improvement will be brought together under the GVIP Strategic Framework mirroring the national document. Some of the areas which will feature in our local plan are included for reference. 1.16. Conclusion: We continue to deliver the vaccination programme and seek to maximise vaccination uptake within a sustainable vaccination system. Page 59
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5 2. INTRODUCTION 2.1. This is the second Annual Vaccination and Immunisation Report for NHS Grampian. The purpose of the report is to provide an annual monitoring report of vaccine preventable disease surveillance data, along with uptake data for each vaccine. A commentary is provided to give context for greater understanding of the data and the challenges and quality improvement measures associated with the programme. 2.2. Although we are post pandemic, the vaccination services have still not reached a stable state nationally or locally. Changes we have implemented since the previous report include a move from separate call centres into a Once for Grampian single call centre to utilise economies of scale with resultant financial savings, establishment of a new RSV programme to protect infants, establishment of a new RSV programme to protect older people, a change in vaccine for the Pertussis in Pregnancy programme, changes to eligibility for Spring and Autumn COVID programmes, changes to eligibility for flu programme and the rolling programme changes to Shingles discussed in our previous report continue to roll out. We continue to transition from the large vaccination hub model of delivery to a smaller service, more fitted to “business as usual” activity whilst retaining the ability to flex as needed. At the time of writing in November 2024, we are developing a Once for Grampian Travel Health Service to replace the existing service – a change forced by financial circumstances. Next year will see changes to the preschool programme to bring in earlier MMR vaccination with the addition of a vaccine against varicella (chickenpox) 2.3. Since the last report we have also seen vaccination services respond to a resurgence of whooping cough in Grampian, community transmission of measles in several parts of England and preparations made for Mpox cases in the wake of Clade 1b spread across Africa. Tuberculosis notifications have increased and there have been reports of bird flu in dairy cattle in the US- the consequences of which are under national and international review. Vaccine preventable diseases are in the news again. 2.4. Local vaccination services have worked across the Grampian system on wider health improvement initiatives such as a pilot project for stroke prevention through atrial fibrillation and high blood pressure detection in Aberdeenshire as well as a number of events through the health hub at Bon Accord Vaccination and Wellbeing Hub described in Aberdeen City’s spotlight section. 2.5. Scottish Vaccination and Immunisation Programme (SVIP) have developed a 5- year strategic framework. This requires equity to be a priority throughout our programmes. However, as this work has to be absorbed in current budgets at a time of financial pressure for NHS Grampian, careful consideration has to be given to what work will result in the best outcomes. National standards are also in development and have been incorporated into the Annual Delivery Plan (ADP) which we submit to the Scottish Government. We await the details of the performance indicators to guide future work. 2.6. In response to the SVIP Strategic Framework, we have developed our own GVIP Strategic Framework to bring together ongoing work, work we are already committed to and the opportunity to look at gaps and over the next 5 years to scope out what work can be done to fill some of those gaps. Page 60
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6 2.7. Work is ongoing to finalise an equity plan for vaccination which will intersect with work in the Public Health Directorate, especially screening, the SVIP1 and GVIP Strategic frameworks and local outcome and improvement plans. 2.8. Data systems remain an issue, and we are playing our part in national work to develop a single system which will manage cohorts, appointments, reporting and allow for seamless communication with current systems such as the VMT and GPIT systems. Although such digital developments are in the 5-year SVIP Strategic Framework as enabling functions, it will be some years before we see the benefit of change. In the meantime, we work locally on quality improvements to modify the risks caused by our reliance on resource hungry workarounds such as manual manipulation of Excel spreadsheets to keep the programmes moving. 2.9. In the summer of 2025, we expect the new electronic Child Health Record to come online. This is a replacement for the SIRS system through which childhood vaccinations are managed. Our vaccination needs assessment for children under 6 identified how inflexible the current system for appointing is through SIRS. We look forward to any changes in the new system. 2.10. In addition, we are at the start of the process of “greening” vaccination services and what can be done to make our services more sustainable. NHSG staff are working nationally and locally on this. 2.11. Finances remain a risk. All areas of NHSG have been asked to identify efficiencies. For vaccination this is complex as funding for the programme comes from different budgets and there continues to be an introduction of new programmes. The vast majority of funding comes from Scottish Government (SG) via SVIP with other funding coming from the Primary care improvement fund (PCIF) to cover the functions transferred from primary care as part of the implementation of the vaccination transformation programme which is now complete. 2.12. Local teams have the chance to highlight their achievements in the report this year. 2.13. The most recently published data has been used throughout the report. Variation in data release timings and reporting intervals mean that the period covered in this report varies by programme. 2.14. The routine childhood and adult schedules in the UK (appendix 1) are based on advice from the independent Joint Committee on Vaccination and Immunisation (JCVI) and provides protection against the following vaccine preventable infections: COVID-19 Pertussis (whooping cough) Diphtheria Pneumococcal disease Haemophilus influenza type b (Hib) Polio Hepatitis B Respiratory syncytial virus Human Papilloma Virus (HPV) Rotavirus Influenza Rubella Measles Shingles Meningococcal disease Tetanus Mumps Tuberculosis 1 Scotland's 5-year Vaccination and Immunisation Framework and Delivery Plan - Publications - Public Health Scotland Page 61
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7 3. WHY VACCINATION IS IMPORTANT AS PART OF POPULATION HEALTH 3.1. The World Health Organisation (WHO) describes vaccines as one of the two public health interventions that have the greatest impact on the world’s health, the other being clean water. It is also considered as one of the most impactful and cost- effective public health interventions available to communities and populations across the world. Vaccination can prevent or reduce the severity of disease, minimise disability and save lives, often in many of the most disadvantaged people in society. It offers excellent value for money by reducing current and future public expenditure on health and social care provision. The European Region of WHO recommend coverage of 95% in a population is required to control or eliminate disease. 3.2. Effective control of vaccine preventable disease requires action across the whole health and care system, and this aligns with the drive to improve outcomes and reduce inequalities. Vaccination has for the first time become included in the annual delivery plan (ADP) process for health boards. 3.3. Surveillance data demonstrate low incidence rates of vaccine preventable disease during 2022 in Grampian. Many of the vaccine preventable diseases are also notifiable diseases because of their potential to cause harm to public health. The information in Table 1 was taken from disease notifications to Public Health Protection Team in 2023. 3.4. Antimicrobial resistance (AMR) has been highlighted as a global threat to health as pathogens evolve and become more successful at evading antibiotics causing morbidity and mortality. As vaccines are used prophylactically, they decrease the number of infectious disease cases and reduce antibiotic use and the emergence and spread of AMR.2It is expected that the new RSV programme will have a significant effect on antibiotic prescribing. Table 1: Notifiable organism/ disease controllable by vaccination in Grampian 2023 Source: HP Zone – 04/10/24 Micoli, F., Bagnoli, F., Rappuoli, R. et al. The role of vaccines in combatting antimicrobial resistance. Nat Rev Microbiol 19, 287–302 (2021). https://doi.org/10.1038/s41579-020-00506-3 2 The role of vaccines in combatting antimicrobial resistance | Nature Reviews Microbiology accessed 15/10/2024 Page 62
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8 3.5. Hepatitis B and Tuberculosis (TB) have numerically the highest number of notified cases and there has been a slight increase in reported cases in 2023.Tuberculosis vaccination is a targeted, risk-based programme, not a population-based vaccination programme. Infection rates are low regionally in comparison to international incidence. Hepatitis B became a population-based programme in October 2017 as part of the childhood programme and we would predict these numbers to fall as the children grow to adulthood. More information on both programmes is given below. 4. NATIONAL AND LOCAL CONTEXT - Immunisation Programmes National 4.1. Immunisation policy in Scotland is set by the Scottish Government Health Directorate who take advice from the UK Joint Committee on Vaccinations and Immunisation (JCVI). JCVI provide advice on immunisations for the prevention of infections and/or disease following consideration of evidence on the burden of disease, vaccine safety and efficacy and on the impact and cost effectiveness of immunisation strategies3 . The UK immunisation schedule is continually reviewed and updated4 Immunisation against infectious disease (commonly known as the Green Book)5 reflects the current policies and procedures as advised by the JCVI and provides essential guidance on vaccines and vaccination procedures for all vaccine preventable diseases that may occur in the UK. 4.2. The Vaccination Transformation Programme (VTP) is complete. VTP was created following the 2018 Scottish General Medical Services (GMS) Contract6. The Contract aims to improve access for patients in General Practice (GP) with the expansion of multi-disciplinary teams to share the delivery of care and ease workload pressures. 4.3. Two CMO letters in 2024 state the ongoing important role of General Practice staff in promoting and advising on vaccinations; responding to vaccination status enquiries; and signposting and referring to Immunisation Teams in Health Boards for vaccine delivery.7 8 Local 4.4. The Director for Public Health has the accountability and governance oversight for vaccination and immunisation at NHS Grampian Board Level and undertakes the role of executive lead. 3 Joint Committee on Vaccination and Immunisation Code of Practice, June 4 Complete schedule (children & adults) available here: https://www.gov.uk/government/publications/the- complete-routine-immunisation-schedule 5 Immunisation Against Infectious Disease, Immunisation against infectious disease - GOV.UK (www.gov.uk) 6 GMS contract: 2018 - gov.scot (www.gov.scot) 7 Non-routine vaccination update SGHD/CMO(2024)13 4th July 2024 Non-routine vaccination update 8 Averting the resurgence of measles in Scotland SGHD/CMO(2023)13 , 2023 16th August 2023 Averting the resurgence of measles in Scotland 2023 Page 63
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9 4.5. Since 2022, NHS Grampian has been responsible for coordination of vaccination programmes with operational delivery being the responsibility of our three Health and Social Care Partnerships (HSCPs) in Aberdeen City, Aberdeenshire, and Moray. This has meant local changes in how members of the public access services. In Grampian, vaccinations are administered in a range of settings. 4.6. The operational delivery of vaccination is through the 3 HSCPs with the Chief Officers being accountable to their respective Integrated Joint Boards (IJBs). 4.7. The Grampian Vaccination and Immunisation (GVIP) Programme Board is chaired by the Director of Public Health with the 3 HSCP Chief Officers, Finance, Primary Care, Nursing, Pharmacy and property and asset colleagues as members. The Programme Board has oversight of the whole vaccination programme, oversees progress, and ensures the nationally agreed outcomes are delivered within Grampian, taking decisions on a Grampian wide basis on complex issues that are common to Grampian or issues which are escalated. 4.8. Reporting into the GVIP Programme Board, the GVIP Clinical and Care Governance Group meets monthly to be assured that all appropriate governance arrangements are in place, to identify actions where required and to provide support and advice and share learning across NHS Grampian. This group reviews quality of service delivery, complaints and feedback, adverse events along with the review of the vaccination programme risk register. 4.9. It is recognised that some functions are better organised once on the bigger NHSG footprint rather than three times on the smaller HSCP footprints. This Once for Grampian approach can be seen in the successful move to a single call centre model. 4.10. Alongside local governance structures we are also a partner in the Scottish Vaccination and Immunisation Programme (SVIP) structure. SVIP incorporates a public health and clinically led, person-centred approach to the programme based on strong collaboration across the system. SVIP builds on the learning and experience developed from the previous PHS-led Scottish Immunisation Programme (SIP), the previous SG-led Flu and Covid-19 (FVCV Programme) and the Vaccination Transformation Programme (VTP). Finance 4.11. The funding arrangements for service delivery and vaccine supply are complex. The funding to support the delivery currently comes from a number of sources including PCIF, SVIP and board baseline budgets. The programme has had to absorb a number of programme changes over the past year within current SVIP funding. The SVIP allocation is the only current source of dedicated funding to support the introduction of any programme changes. 4.12. Scottish Government is undertaking an extensive review process of current funding arrangements with the aim of future streamlining the funding approach across immunisation programmes. It is anticipated that this move will help facilitate the flexibilities available and will ease the reporting burden across funding streams. It will consider any opportunities to baseline funding as part of a wider review exercise and will continue to engage with Boards via Directors of Finance, Directors of Public Health and Immunisation Coordinators over the course of this financial year to support the transition to greater baselining of funding. Page 64
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10 5. VACCINE PREVENTABLE DISEASES 5.1. Data for vaccine preventable diseases are summarised at both a national and Grampian level where data are available. 5.2. The following section contains background information about the agents, diseases, and vaccinations for reference. 5.3. Graphs showing Scottish data aim to illustrate the effect of vaccination on vaccine preventable diseases COVID-19 5.4. COVID-19 is an acute respiratory viral infection caused by SARS-Cov-2 and spread primarily through respiratory droplets and aerosol. The 2020 COVID-19 pandemic resulted in a significant increase in mortality both worldwide and in the United Kingdom, particularly in people aged over 75, and led to several lockdowns and accelerated vaccine development. Mortality has subsequently fallen, believed to be due to increased natural and vaccine-mediated immunity, but rapid emergence of new strains has led to concerns regarding immune escape and adaptations to vaccines by their manufacturers. 5.5. Initial national programmes in the UK aimed to offer primary vaccination prioritised by risk category as capacity allowed. The lowest risk group, children aged 5 to 11 years, were offered vaccination by late 2021. As COVID moves to more of a business-as-usual state and more becomes known about the disease and the protection that the vaccines give, previously eligible groups are reassessed and removed from the programme as cost and clinical effectiveness evidence indicates the benefits of vaccination (especially in preventing transmission) are reduced. For the 2024 autumn winter period, seasonal booster programmes are now only offered to certain groups including those aged over 65; clinically at-risk individuals; residents and staff of care homes for older adults, and frontline healthcare staff. 5.6. For 2024 JCVI does not advise COVID 19 vaccination for health and social care workers or care home staff, however they suggested an occupational offer for these groups, which the Scottish Government accepted9. Diphtheria 5.7. Diphtheria is caused by Corynebacterium diphtheriae and closely related bacteria and classically presents with swollen neck glands and a pseudo membrane in the throat which obstructs the airways or sore throat or pharyngitis in unimmunised or partially immunised individuals. It is now rare in Scotland following the vaccination programme which began in 1941/2. In 1940 there were nearly 16,000 cases in Scotland with 675 deaths. Haemophilus influenza type b (Hib) 5.8. Haemophilus influenzae can cause serious invasive disease, especially in young children. There are six subtypes but prior to vaccination Type B was the dominant subtype. The usual presentation of invasive disease was meningitis with around 10% of children having long term complications of the disease. Cases from Hib 9 JCVI statement on the COVID-19 vaccination programme for autumn 2024, 8 April 2024 - GOV.UK Page 65
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11 have fallen dramatically since the introduction of vaccination. Protection is achieved from 4 doses given in multivalent preparations as part of the childhood programme. (A multivalent preparation is one which provides protection against multiple strains of a disease, or protection against multiple diseases in the same vaccine preparation.) Figure 1: Laboratory reports of invasive Haemophilus influenzae type b disease in Scotland, 1988 to 2023 (week 13) - Source: PHS Hepatitis A 5.9. Hepatitis A is caused by the Hepatitis A virus and spread through the faecal-oral route. Hepatitis A infection tends to be mild and does not result in chronic infection or liver impairment, though can lead to significant morbidity or mortality in older people and those with hepatic co-morbidities. Given its faecal-oral spread, Hepatitis A is comparatively rare in high-income countries with adequate standards of sanitation and vaccination. At-risk categories include individuals travelling to Hepatitis A-endemic areas; patients with chronic liver disease; patients with haemophilia; men who have sex with men (MSM); people who inject drugs, and individuals with occupational exposure. Several Hepatitis A vaccinations are available – both monovalent and combined with Hepatitis B or Typhoid vaccinations – and these are given either IM or subcutaneously (in the case of haemophilic patients) in two or three doses. Hepatitis B 5.10. Hepatitis B is caused by the Hepatitis B virus and spread through exposure to infected blood or bodily fluids. Hepatitis B causes an acute flu-like illness with jaundice and may sometimes lead to complete liver failure. While infection resolves in most patients following the acute illness, chronic infection persists in a proportion of cases. Risk of chronic infection is increased in young people and immunocompromised individuals, and chronic infection can lead to cirrhosis and hepatocellular carcinoma. 5.11. Hepatitis B vaccination is included in the routine childhood immunisation programme - 3 doses in 1st year (with extra doses at 4 weeks and 1 year to babies at risk) as well as selective pre- and post-exposure vaccination programmes for at- risk individuals. At risk categories include neonates with maternal Hepatitis B exposure; travellers to endemic countries; people who inject drugs; MSM; sex Page 66
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12 workers; close family contacts of individuals with chronic Hepatitis B infection; individuals living in custodial institutions or residential accommodation; individuals with certain renal or hepatic comorbidities, and those at risk of occupational exposure. Table 2: Hepatitis B cases in Grampian 2011-2023 Source: HP Zone 2023 Human Papilloma Virus (HPV) 5.12. Vaccination against HPV is part of WHO’s global Cervical Cancer Elimination Initiative. There is a causal pathway from infection with particular high risk HPV subtypes and development of squamous cell carcinomas of the cervix, anus, vulva, vagina, penis and head and neck cancers. By vaccinating young people and older people at higher risk, this pathway can be disrupted. 5.13. A joint paper10 from PHS and the Universities of Strathclyde and Edinburgh published online in January 2024 showed that following vaccination, reductions in incidence of cervical cancer are seen for those aged under 18 at the time of vaccination. A great success is that no cervical cancer cases have been detected in fully vaccinated women following HPV immunisation at age 12 and 13 since the programme started in Scotland in 2008. 5.14. From 1 January 2023, following a review of evidence by JCVI showing one dose conferred similar levels of immunity to two doses, the HPV vaccine moved to a one-dose schedule for immunocompetent individuals before their 25th birthday. 2 doses are required for citizens aged 25 – 45 years in the MSM programme and 3 doses for those who are immunosuppressed or known to be HIV positive. Influenza 5.15. Influenza is an acute viral respiratory infection caused by influenza A, B or C – symptoms include fever, myalgia, malaise, headache and coryzal (common cold) symptoms. Influenza is normally self-limiting in otherwise healthy patients but can lead to significant morbidity in young children, older people, immunocompromised individuals, those with respiratory or cardiac co-morbidities and pregnant women. Influenza is highly seasonal, and a vaccination programme has been in place in the United Kingdom since the late 1960s. Periodic antigenic drift in the virus means that individuals frequently lose immunity between influenza seasons, necessitating at-risk individuals being re-vaccinated each year against likely dominant strains. 5.16. The nasal flu vaccine is used in the children’s programme because of its superior effectiveness in children leading to reduced cases in children and the community when compared to injectable vaccines. 5.17. Bird flu or Avian Influenza is an infectious type of influenza that spreads between birds and occasionally infects humans who have directly handled infected birds alive or dead. It isn’t spread easily from human to human. There is a risk that a new strain of flu could be created if an individual is infected with both a strain of bird flu and human flu at the same time and elements from each combine to produce a new strain. If this resulted in a new, more infectious and harmful type of flu there 10 Invasive cervical cancer incidence following bivalent human papillomavirus vaccination: a population-based observational study of age at immunization, dose, and deprivation - PubMed Page 67
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13 could be an increase in morbidity and mortality. For this reason, poultry workers are advised to be vaccinated against human flu as they are the most likely to be at risk in this circumstance. In a further development, evidence of infection with avian influenza has been found in dairy cattle in the US. The impact of this on bovine (cattle) and human health is under investigation nationally and internationally. Measles 5.18. Measles is one of the most transmissible infectious diseases. It can lead to serious and potentially life-threatening complications even years after the original infection. Catching measles when pregnant can result in complications for baby. However, the MMR vaccine, which also provides protection against mumps and rubella, is highly effective - after two doses around 99% of people will be protected against measles. 5.19. In 2023, WHO estimates there were 10.3 million cases of measles worldwide and 107,500 people died.11 5.20. There is a current measles outbreak in England related to areas with lower MMR uptake rates centred on London and Birmingham. In the year to 30th September 2024 there have been 2563 cases of laboratory confirmed measles cases in England. 48% of these have been in London, 22% have been in the West Midlands and 7% in the East of England. This outbreak appears to be subsiding at the time of writing. 5.21. Nearly 12 % of cases are in the under 1s who are not eligible for vaccination in the UK schedules. Approximately 25% are in the 1-4 years group and the 5-10 years group. Figure 3: Laboratory-confirmed cases of measles in England in 2024 to end of September 2024 – Source: UKHSA Measles dashboard 11 Measles Page 68
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14 Figure 4: Number of laboratory-confirmed cases of measles in Scotland by year, 1988 to end of June 2024 – source PHS quarterly report 5.22. In the first half of the year to end of Jun 2024 there have been 14 cases of measles in Scotland – none in Grampian. Of the 14 cases, 10 were thought to be imported from outside the UK and a further 2 were cases possibly linked to imported cases. Two had no travel history or known links to imported cases, perhaps representing community transmission. 5.23. The resurgence of measles is also seen across Europe. In the most recent 12 months to May 2024 there were a total of 6,742 cases of measles reported to the European Centre for Disease Prevention and Control. The EU/EEA countries with highest reported rates of cases for this time period were Romania, Liechtenstein, Austria and Belgium. 5.24. Measles is therefore a travel related disease in Scotland. The protection conferred on unvaccinated people because of our high uptake rates for MMR cannot be relied upon in other countries Meningococcal disease (Men B) 5.25. Men B vaccination is given as 3 doses in the first year of life with Men C also currently given at 1 year as part of the childhood programme. The Meningococcal groups A,C,W and Y (Men ACWY) vaccine protects against meningococcal disease caused by four groups of meningococcal bacteria A, C,W and Y. The Men ACWY vaccine is offered to all young people in S3 at school. Young people in S4 to S6 who missed the opportunity to be immunised the previous year are offered vaccination at subsequent visits. 5.26. Due to the success of the adolescent MenACWY vaccination programme in controlling meningococcal disease across the population, from 2025 a dose of meningococcal C containing vaccine will no longer be recommended at 12 months. (This would have been delivered via the Hib/MenC vaccination at this time.) 5.27. The number of notifiable cases of meningococcal disease in Grampian over the past ten years is detailed below: Page 69
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15 Table 3: Meningococcal cases in Grampian 2011 – 2023 Source: HPZone Figure 5: Meningococcal disease cases reported to MIDAS by serogroup, 2003 to 2022 (week 13) - Source: PHS Mpox 5.28. Mpox (previously known as Monkeypox) is a rare viral infection related to Smallpox. It is usually associated with travel to West Africa and has only, until recently, rarely been reported out with this region. Two forms of Mpox are found Clade I (Central African) and Clade II (West African). Clade I is currently considered a more serious infection than Clade II and is treated as a High Consequence Infectious Disease. 5.29. The Mpox virus is similar to the smallpox virus and the smallpox vaccine gives effective protection against Mpox. The vaccine is given in two doses a minimum of 28 days apart. 5.30. The 2022–2023 Mpox outbreak represents the first incidence of widespread community transmission outside of Africa. Clade II was responsible. This was initially identified in the United Kingdom in May 2022, with subsequent cases confirmed in 111 countries as of May 2023. During this outbreak, all those in NHS Grampian (NHSG) who were considered at high risk of Mpox were offered vaccination in line with national guidance via sexual health clinics. 5.31. In 2024 cases related to Clade I have begun to be seen in countries outside its traditional boundaries and England has seen a cluster of 4 cases at the beginning of November 2024. 5.32. Grampian has continued to offer opportunistic Mpox vaccination to eligible individuals as part of a holistic approach for those attending sexual health services. Eligible healthcare workers have been offered vaccination. Mumps 5.33. Mumps, caused by paramyxovirus, is spread by airborne or droplet transmission and classically causes bilateral parotid swelling, fever, and myalgia. In addition, mumps can cause a variety of significant complications such as meningitis, encephalitis, orchiditis, oophoritis and pancreatitis. These complications, if developed, may be associated with sensorineural hearing loss and subfertility. Vaccination against mumps in the United Kingdom commenced with the introduction of the MMR vaccine in 1988, leading to a significant decrease in the Page 70
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16 prevalence of mumps in the years following due to high levels of uptake. Subsequent decreases in uptake, as well as supply issues with the MMR in certain years, have led to increasing cases since the late 1990s. Pertussis (Whooping cough) 5.34. Pertussis, or whooping cough, is a highly, infectious bacterial disease affecting the respiratory system. Infants and young children are particularly at risk of severe disease and/or death. The number of notifiable cases in Grampian over the past 10 years is detailed below: Table 4: Pertussis cases in Grampian 2011- 23 Source: HPZone 5.35. In 2024 there has been a huge surge in pertussis cases in Grampian, Scotland and the UK as a whole. Grampian has seen 1052 cases notified in 2024 in the year to the 1st October. 5.36. Protection against disease is conferred via vaccination in childhood. From October 2012, pregnant women in Scotland have been offered a pertussis vaccine typically between 16- and 32-weeks’ gestation. This is to protect infants in their first eight weeks of life who are too young to receive their routine immunisations and are most at risk of complications from the infection. 5.37. In addition, the existing occupational health offer which was largely paused because of vaccine supply issues was restarted. A booster is offered to workers whose main focus of work is with pregnant women and young infants. Pneumococcal disease 5.38. Pneumococcal disease can present as non-invasive or invasive infections caused by the bacterium Streptococcus pneumoniae (also called pneumococcus). Non- invasive disease includes middle ear infections (otitis media), sinusitis and bronchitis, whilst invasive pneumococcal disease includes septicaemia, pneumonia, and meningitis. 5.39. Young children, the elderly and people in a clinical risk group are most at risk of severe pneumococcal disease, and so all these groups are currently offered a pneumococcal immunisation. 5.40. People aged 65 or over only need a single dose of the vaccine. However, those with certain underlying health conditions require additional doses every 5 years. Children with health conditions may require additional doses. Polio 5.41. Poliomyelitis is now rare in the UK following national vaccination programmes. It is an acute illness caused by the poliovirus entering the body through the gut and giving rise to a range of symptoms from gastrointestinal disturbance, fever and paralysis. During UK epidemics in the 1950s up to 8000 notifications of paralytic polio were received in a year. 4 doses via the 6 in 1 vaccine are offered during the childhood programme, with a booster dose delivered at age 14 (S3). Page 71
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17 Respiratory Syncytial Virus (RSV) 5.42. RSV is a common cause of respiratory tract infections in the autumn into winter. For most, symptoms are mild but infants aged under 6 months and elderly people are at greater risk of pneumonia and bronchiolitis leading to hospitalisation and death in some cases. In August 2024 a new national vaccination programme was introduced in Grampian with two aims: to give passive immunity to infants via a maternal vaccination from 28 weeks’ gestation and to protect older people as they turn 75. There is a catch up vaccination programme for those 75-80 years of age. Currently there are no plans for boosters. The maternal vaccination will be offered in each pregnancy to protect each infant. Rotavirus 5.43. Rotavirus is an extremely infectious cause of gastroenteritis through both the faecal-oral and occasionally respiratory route and can require hospitalisation in severe cases due to dehydration. Incidence follows a seasonal pattern, with the majority of cases in winter and early spring, and most symptomatic cases are in young children. A national infant rotavirus vaccination programme was commenced in Scotland in 2013, leading to a significant reduction in both overall cases and peak incidence in winter. Rotarix, the licensed vaccine for rotavirus, is given orally in two doses at 8 and 12 weeks. Figure 9: Laboratory reports of rotavirus in Scotland from 2011 to end of March 2023 – Source: PHS Rubella 5.44. Rubella is a viral illness caused by togavirus and spread by droplet transmission. The symptoms of acute rubella infection tend to be mild and include fever, coryzal symptoms, malaise and rash – though it may be associated with more serious complications such as post-infectious encephalitis and thrombocytopenia. The primary concern regarding rubella is the potential for foetal loss and birth defects in cases of maternal infection in pregnancy. Up to 90% of infants exposed to rubella at 8 to 10 weeks' gestation will develop congenital rubella syndrome. As such, the Page 72
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18 primary aim of vaccination programmes is to reduce exposure of pregnant women to rubella. Targeted vaccination began in the UK in 1970, and universal vaccination began in 1988 with the introduction of MMR leading to significant decreases in rates of rubella. This is delivered during the childhood programme via the MMR vaccine. Figure 10: Number of laboratory-confirmed cases of rubella in Scotland by year, 1988 to end of March 2023 – Source: PHS Shingles 5.45. Shingles (Herpes zoster) is caused by the reactivation of a latent varicella zoster virus infection, sometimes decades after initial infection. Shingles can occur at any age, with the highest incidence seen in older people. The severity of shingles generally increases with age and can lead to Post Herpetic Neuralgia that may require hospitalisation. 5.46. The shingles vaccine programme for older adults was introduced in Scotland in September 2013 following recommendation by JCVI in 2009 and SG policy. The JCVI recently recommended changes to the shingles programme and these were implemented from 1st September 2023. The vaccine offered has changed from Zostavax to the non-live vaccine Shingrix requiring a switch from a 1-dose to a 2- dose schedule. 5.47. The eligible age for immunocompetent individuals will change from 70 to 60 years of age for the routine cohort in a phased implementation over a 10-year period. In addition, from 1st September 2023, eligibility expanded to all those who are severely immunosuppressed aged 50 years and over, with no upper age limit. Tetanus 5.48. Tetanus is caused by the release of tetanus toxin during infection with Clostridium tetani. It causes symptoms such as fever, muscle spasms, lockjaw, difficulty breathing and swallowing problems. Bacterial spores are commonly present in the environment, including soil. This vaccine is given at 8, 12 and 16 weeks via the 6- 1 vaccine and at 3 years 4 months via the 4-1 vaccine. Page 73
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19 Tuberculosis 5.49. BCG immunisation programme was introduced into the UK in 1953 to protect against Tuberculosis (TB), a serious bacterial disease which affects the lungs and other parts of the body including brain, bones, kidneys, and joints. The programme has undergone changes in response to changing trends in TB epidemiology. Following a continued decline in TB incidence in the UK-born population, the universal school-based programme for adolescents was stopped in 2005. The BCG immunisation programme is now risk-based; the key part being a neonatal programme targeted at those children most at risk of exposure to TB, to protect them from the more serious childhood forms of the disease. Babies are offered the vaccine if they or their parents or others close to the baby have lived in an area with high levels of tuberculosis. 5.50. In 2023 increases in TB notifications were seen in most boards. Grampian saw 28 TB notifications in 2023 which was an increase from the relatively stable mean of 18 seen since throughout 2019-2022. Figure 11: Tuberculosis incidence per 100,000 population and case numbers by NHS board, 2023 – Source: PHS Page 74
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20 Figure 12: Number of tuberculosis notifications in Scotland by NHS board by quarter, January 2019 to quarter 1, 2024 (PHS12 ) Typhoid 5.51. Typhoid fever is caused by Salmonella enterica typhi and is spread through the faecal-oral route. Typhoid fever varies significantly in severity from isolated gastrointestinal symptoms and fever to multi-organ failure and has a mortality rate of up to 20% if untreated. Given its faecal-oral spread, typhoid fever is comparatively rare in high-income countries with adequate standards of sanitation - the United Kingdom averaged 393 cases of typhoid fever a year between 2008 and 2017 and 93% of cases were determined to have been contracted abroad. As such, vaccination against typhoid fever is typically only carried out on individuals travelling to endemic areas. Increasing antibiotic resistance noted in typhoid- endemic countries increases the importance of vaccination of at-risk travellers. There are currently two typhoid vaccines licensed in the United Kingdom - a polysaccharide vaccine given in one oral dose, and a live attenuated vaccine given in three oral doses. 12 National quarterly report of tuberculosis in Scotland: quarter 1, 2024 - National quarterly report of tuberculosis in Scotland - Publications - Public Health Scotland Page 75
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21 6. VACCINE UPTAKE 6.1. Vaccination coverage is the percentage of people from the target population who have received a specific vaccine. The risk to public health increases if immunisation rates fall below herd immunity levels as this makes the possibility of communicable disease transmission more likely. 6.2. The Grampian Vaccination and Immunisation Programme is organised into the following work streams, largely mirroring the structure in figure 13 below. Reporting in this chapter follows the order below in Table 5. Table 5: Reporting Periods Figure 13: Vaccination and Immunisation Work streams Page 76
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22 Pregnancy Pertussis 6.3. Across Grampian the pertussis vaccine in pregnancy programme is delivered from 16 weeks’ gestation. Midwives have an important role in promoting the vaccine, ensuring pregnant women are informed and administering the vaccine. 6.4. During 2023/24, coverage in Grampian from locally held data was 73.3% shown in Table 6. The data is reported according to NHS Board of delivery and therefore excludes those who choose to receive their maternity care in other Board areas. 6.5. Because of different approaches to recording data across Scotland it is difficult to make a direct comparison with the rest of Scotland. Table 6: Whooping Cough in Pregnancy Uptake Rates in NHS Grampian between April 2023 – March 2024 Source: Badgernet - 20th May 2024 Flu and COVID-19 Programme 6.6. Pregnant women are eligible for Flu and COVID-19 vaccinations, but uptake remains low. In 2023/24, 606 (13%) COVID-19 vaccinations were administered which represents a slight reduction in uptake of 1.8% compared to 2022/23. This decrease occurred despite the number of pregnant women decreasing by 745 during 2023/24. It is not possible to calculate an accurate uptake rate for Flu (2023/24) because the vaccination records are stored in multiple systems (VMT, BadgerNet, and TRAK) with restricted access which has limited data availability. 6.7. In NHS Grampian, flu and COVID-19 vaccines in pregnancy are given by the vaccination service, not by community midwives as part of antenatal care. These vaccines are part of a seasonal programme and there is insufficient capacity to deliver in maternity services. Pregnant women are given a fast-track pass to drop in to vaccination services as a priority for flu and COVID-19 vaccination 6.8. During the summer of 2023, a study was undertaken in Grampian to understand vaccine hesitancy in pregnant women. A number of recommendations were identified and implemented including better access to vaccination information for both patients and staff and a fast-track pass to vaccination hubs. Feedback shows midwives feel more supported in their vaccination roles and some barriers to vaccination were reduced. Feedback about the fast track pass has resulted in changes to the pass itself to make it look more “official”. 6.9. In 2024, we are working with midwifery colleagues and a behavioural scientist from University of Aberdeen to try to boost autumn and winter vaccination rates among maternity staff and pregnant women. More information can be seen in the Spotlight. Page 77
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23 Childhood Routine Immunisations 6.10. Over the past 10 years, there has been a gradual decline in the uptake of childhood immunisations across the UK and globally. While Scotland’s uptake has continued to perform well by comparison with the other UK nations, this trend is observed in Grampian also. Figure 14: Scotland’s Immunisation uptake rates by 5 years of age 2014-2023 Source: Childhood Immunisations (child_imms_scot_qtr224.xlsx) - 20th November 2024 6.11. The reporting ages for childhood vaccine completion rates in the UK are 12 months, 24 months, five years and six years of age. The data presented is based on the published data from PHS and relates to year end to March 2024. 6.12. There are time lags between when a vaccination is first offered within the routine childhood schedule and when uptake is evaluated, for example MMR2 appointments are scheduled from 3 years 4 months but uptake is evaluated based on the cohort of children who reach 5 years. Therefore, uptake data in a particular reporting year reflect delivery practices over a longer period. Vaccinations up to 12 Months of Age 6.13. The 95% target is met on a Grampian basis for all vaccinations up to 12 months of age except Rotavirus and Men B as seen in Table 7. The Rotavirus course requires two vaccinations in a narrow time window (8 and 12 weeks) and must be completed before 24 weeks. The consequence of this schedule is if the first dose is missed or delayed for some reason it may not be possible to have the second dose within this time window. Page 78
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24 6.14. Although Aberdeen City coverage remains under the 95% threshold for all vaccinations, rates have increased in each completed primary course with Rotavirus and Men B improved to above 90%. Table 7: Completed Primary Immunisations by 12 Months of Age, Local Authority, NHS Grampian and Scotland between April 2023 – March 2024 Source: SIRS - 13th May 2024 Immunisations up to 24 Months of Age 6.15. The second year of life introduces the vaccines for Men C, Hib, Men B booster and MMR. In common with Scotland as a whole NHS Grampian achieves the 95% mark for 6 in 1 only (Table 8). Aberdeenshire exceeds the target for all these vaccines. Again, there are improvements for Aberdeen City which has increased uptake for all vaccines except for 6 in 1. This is in contrast to generally static or slight falls in rates for Grampian and Scottish averages. Table 8: Completed Primary Immunisations by 24 Months of Age, Local Authority, NHS Grampian and Scotland between April 2023 – March 2024 Source: SIRS - 13th May 2024 Immunisations up to Five Years of Age 6.16. Grampian’s uptake of vaccinations up to five years of age are all below 95% except for the 6 in 1 and are all slightly below those seen for the Scotland average (Table 9). There is variation in uptake across the HSCPs which lead to quality improvement work discussed in later sections. Table 9: Completed Primary Immunisations and Boosters by 5 Years of Age, Local Authority, NHS Grampian and Scotland between April 2023 – March 2024 Source: SIRS - 13th May 2024 Page 79
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25 Immunisations up to Six Years of Age 6.17. By the age of 6, first MMR, MMR2 and 4 in 1 remain lower than the Scottish average and below the 95% coverage mark. (Table 10). Despite a few initiatives uptake is similar to last year. This is of concern as MMR requires two doses for protection and 95% coverage for population protection. Measles is a particular concern because it is highly infectious, and the disease can have significant short- and long-term health complications. 6.18. We would expect to see improved rates in Aberdeen City over time as the younger cohorts showing increased uptakes begin to move through the programme. Table 10: Completed Primary Immunisations and Boosters by 6 Years of Age, Local Authority, NHS Grampian and Scotland between April 2023 – March 2024 Source: SIRS - 13th May 2024 Uptake and Coverage of School-based Immunisation Programmes Human Papilloma Virus (HPV) 6.19. Uptake has decreased across S1 and S2 in Grampian and in Scotland. 6.20. Coverage remains higher in girls than boys (Table 11). This may be a legacy of the programme starting as a female only programme. 6.21. Coverage consistently improves with each school year showing the importance of offering vaccination catch up opportunities each year. 6.22. A process has been developed to ensure any child who has left school without the opportunity to receive routine vaccinations is contacted with the offer of vaccination. Table 11: HPV Immunisation Uptake Rates of Dose 1, the End of the School Year 2022/23 at S1 and S2 by Local Authority Area, NHS Grampian and Scotland Source: CHSP School/SIRS - 28th November 2023 Page 80
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26 Vaccination with Td, IPV and Men ACWY 6.23. Grampian’s uptake is lower than last year, however, still exceeds the Scottish average. Rates continue to improve in S4 compared to S3 (Table 12). Table 12: Td/IPV and MenACWY Uptake Rates, the End of the School Year 2022/23 at S3 and S4 by Local Authority Area, NHS Grampian and Scotland Source: CHSP School/SIRS - 1st September 2024 6.24. When coverage is analysed by Scottish Index of Multiple Deprivation (SIMD) there is a disparity between those in the most deprived and least deprived quintiles. Coverage among the least deprived is as much as 30% higher (Figure 15). Where increases in uptake from last year are seen, they are mostly from the least deprived groups. Grampian’s uptake for those in the most deprived groups are consistently lower than the Scottish average. Figure 15: Td/IPV and MenACWY Uptake Rates, the End of the School Year 2022/23 at S3 and S4 by SIMD, NHS Grampian and Scotland Source: CHSP School/SIRS - 1st September 2024 Page 81
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27 Uptake and Coverage in Adult Immunisation Programmes Shingles 6.25. During 2023/24 the shingles programme moved to the 2-dose Shingrix schedule, and an offer was made to the eligible groups at the start of 2024. The new eligible routine groups were those who are aged 50 years old and over with a severely weakened immune system and individuals aged 65 and 70 (predefined age eligibility cut offs). A catch-up offer was also made to individuals aged between 71-79 years. 6.26. In 2023/24, 24,096 shingles vaccines were administered covering the routine and catch-up cohorts as displayed in Table 14. This led to an uptake rate of 53.9% which is 12.6% higher than the Scottish average of 41.3%. The highest uptake was observed within the new cohorts (Age 65 and Age 70). 6.27. There was a 19.3% difference between dose 2 uptake and dose 1 (Figure 16). This suggests that individuals who start the vaccine course are likely to finish it. 6.28. Uptake of adult vaccination programmes experience seasonal fluctuations as a result of the alignment in delivery models. Table 14: Shingles Shingrix Vaccination Coverage amongst Eligible Routine and Catch-Up Cohorts by NHS Grampian and Scotland between 1 September 2023 to 31 May 2024 Source: PHS vaccination surveillance dashboard - 25th June 2024 Figure 16: Shingles Shingrix Dose 1 & 2 Comparison between 2023/24 Source: PHS vaccination surveillance dashboard - 25th June 2024 Page 82
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28 Pneumococcal 6.29. Pneumococcal is a one-off vaccine for those aged 65 years and over and those under 65 with underlying conditions, that protects against 23 serotypes of pneumococcal disease. A small cohort require repeat vaccination every 5 years. 6.30. During 2023/24, 7,265 pneumococcal vaccines were administered to citizens turning 65 as well as those in the 2 – 64 at risk cohort and good progress has been made to offer the vaccine to eligible groups. 6.31. There are a number of codes used to record pneumococcal vaccinations in historical GP records which sometimes makes it difficult to identify those who require additional vaccinations. Work is ongoing to mitigate these data issues. 6.32. According to trend data available from PHS we can see that Grampian used to be consistently under the Scotland average however, during 2023/24 Grampian has surpassed the national average for uptake Table 15 & Figure 17 Please note that data from 2021-2022 is missing because of COVID-19 and work is currently ongoing by PHS to acquire trend data for 2022-2023. Table 15: Annual Pneumococcal Vaccination Coverage amongst Individuals Aged 65+ and 2-64 at Risk for Grampian and Scotland between 1 April 2017 – 31st March 2024 Source: PHS vaccination surveillance dashboard - 25th June 2024 Figure 17: Pneumococcal Uptake Trend for Grampian and Scotland Between 2017-2024 Source: PHS vaccination surveillance dashboard - 25th June 2024 Page 83
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29 Uptake and Coverage in Seasonal Immunisation Programmes Influenza 6.33. For the 2023/24 flu season adults aged 50 and over, health and social care workers and individuals at risk aged 18 years or over were eligible to receive the flu vaccine. The programme ran from the 5th of September 2023 until the 31st of March 2024 and there were 308,731 eligible citizens. Citizens were invited to attend clinics with most vaccines being co-administered with the COVID-19 winter booster vaccine. 6.34. Grampian delivered 168,954 flu vaccines and outperformed the Scottish average for total flu vaccinations as seen in Table 16 where Grampian is approximately 1% higher than the Scottish average. 6.35. Uptake of flu vaccinations for 18-64 at risk and 50-64 years were lower for both Scotland and Grampian (consistently 16% and 20% lower respectively for these age groups) than the previous year. Uptake remained strong in the 65 and over age group. Table 16: % Uptake Seasonal Flu Vaccine adults 2023/24 Source: PHS Discovery Dashboard – 7th April 2024 Figure 18: Cold Spot Map of Influenza Autumn Winter ‘23 Vaccination Uptake for All Cohorts Source: PHS Discovery Dashboard – 7th April 2024 Page 84
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30 COVID-19 6.36. As with the seasonal flu vaccine the COVID-19 winter booster programme ran from the 5th of September 2023 to the 31st of March 2024. Eligible groups for the 2023/24 COVID-19 winter booster programme included adults aged 65 years or over, frontline health and social care workers, and at-risk individuals aged 6 months and over. 6.37. A total of 113,334 vaccines were administered during the programme, 58.5% uptake among the total eligible cohort, which is around 2% higher than the uptake reported for the rest of Scotland (Table 17). Uptake for the total cohort was reduced by approximately 15% compared with the previous year for both Grampian and Scotland. 6.38. During the 2023/24 season overall the uptake rates in Grampian were higher than for the rest of Scotland for all cohorts. 6.39. Uptake is lower in areas which are most deprived (Table 18). Uptake is also lower in some ethnic minority groups, specifically the Polish and African communities. Table 17: % Uptake COVID-19 Booster Vaccine 2023-24 Source: PHS Discovery Dashboard – 7th April 2024 Figure 19: Cold Spot Map of COVID-19 Autumn Winter ‘23 Vaccination Uptake for All Cohorts Source: PHS Discovery Dashboard – 7th April 2024 Page 85
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31 Table 18: Uptake of COVID-19 Winter Booster Vaccine by SIMD Quintile for Eligible Groups 2023/24 Programme Source: PHS Discovery Dashboard – 7th April 2024 Uptake and delivery of other selective and non- routine vaccines 6.40. Non routine vaccinations cover a range of situations where citizens require vaccination out with the usual population vaccination schedules. These include those identified as at clinical risk under the Green Book, individuals recently treated for cancer or who have had a stem cell transplant and require their full course of vaccinations again; bat handlers or travellers who have been scratched or bitten by rabid animals; new residents in Scotland requiring catch up vaccinations 6.41. Non routine does not include occupational, sexual health risk-based vaccinations or travel vaccinations. 6.42. With no national scheduling, call or recall system for non-routine vaccinations, Boards have been working to put in place processes which support the delivery of these vaccines. NHSG has processes by which services may refer a citizen for vaccinations that are required out with normal vaccination schedules. There remain outstanding operational and clinical questions to be worked through and we are collaborating with specialist services on a local and national level to achieve clarity and strong clinical governance in this most flexible of programmes. A local working group has been established to improve and further develop a system- wide approach to non-routine vaccinations in NHSG with the aim to protect the health of the local population and reduce inequalities. 6.43. A CMO letter clarifying the place of non-routine vaccinations was issued in July 2024. 6.44. A digital referral pathway has successfully been established in NHS Grampian for primary care using SCI gateway and a second for secondary care is awaiting implementation. Post Exposure treatment of infectious disease 6.45. Health protection investigations regularly identify persons who have been exposed to infectious disease. Post-exposure treatment with vaccines is recommended in some cases including Diphtheria, Hepatitis A and B, Measles, Meningococcus, MPox and Pertussis. Immunoglobulin may also be indicated for some infections. Health and Social Care Partnerships (HSCP) arrange and administer vaccinations, with referrals made in line with the non-routine vaccine pathway. Out of hours arrangements are under local discussion as vaccination is not funded for an out of hours service. This service gap has come under national discussion in response to discussions about MPox preparedness. Page 86
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32 Babies born to mothers with Hepatitis B 6.46. The risk of developing chronic hepatitis B (Hep B) infection depends on the age at which infection is acquired. Chronic infection occurs in 90% of those infected perinatally but is less frequent in those infected as children (e.g. 20 to 50% in children between one and five years of age). Post-exposure immunisation is provided to infants born to Hep B infected mothers, identified through antenatal screening, to prevent mother to child transmission at or around the time of birth. 6.47. Immunisation of the infant starts as soon as possible after birth, and no later than 24 hours, and is followed by additional doses at four weeks and one year. These doses are in addition to the routine schedule at 8, 12 and 16 weeks. 6.48. During 2023/24, a total of <10 babies were born to mothers' resident in Grampian infected with Hep B (Table 19). Because of the small numbers involved the breakdown of these data is not given. 6.49. Ongoing audit and analysis of vaccinations is discussed at the appropriate Grampian Newborn Screening overview meetings. Table 19: Hepatitis B Screening Status of All Mothers Delivering in Grampian during the Period April 2023 – March 2024 Source: Badgernet – 17th October 2024 BCG for Newborns at Risk of Tuberculosis 6.50. In 2023, 887 babies in Grampian were identified as meeting the national eligibility criteria for BCG vaccination. Of these 766 (86.4%) received the vaccine within the first 12 months of life. 6.51. The BCG uptake levels in at risk infants in Grampian exceeds the 2018 Scottish TB Framework Key Performance Indicator level (set at 85% uptake level) [3] Table 20: Uptake Levels of BCG for Eligible Infants During the Period 2017 – 2023 Source: PHS - August 2024 Page 87
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33 Vaccinations delivered in Sexual Health Clinics 6.52. A small number of vaccinations are carried out in sexual health clinics as part of their specialist assessment and treatment. 6.53. Since the Mpox outbreak in 2022/23 NHS Grampian sexual health clinics vaccinated 631 individuals, with all those eligible having been offered an appointment to attend for 1st and 2nd doses. Opportunistic vaccination continues. 6.54. A further breakdown is detailed below in Table 21. Table 21: Vaccinations Delivered Within Sexual Health Clinics Source: NaSH – 22nd October 2024 Vaccinations delivered in Occupational Health Services 6.55. Occupational Health Services (OHS) provides professional, confidential and impartial specialist advice to support employees in the workplace about their health. 6.56. The OHS runs clinics for staff in the Aberdeen and Elgin sites offering Hep A, Hep B, DTP, DtaP, Typhoid, MMR, Pertussis and Varicella vaccines. The team also offer Mantoux testing and Mpox vaccine to eligible staff. External clinics at RGU support the student cohorts as well as maternity staff. The staff Immunisation Policy is currently under review. 6.57. Between April 2023 and March 2024, a total of 6,863 vaccinations were administered within the occupational health services. 5,184 (75.5%) of these vaccines were Hep B vaccinations. A breakdown of the remaining 1,679 vaccinations is displayed in the below Figure 18. Figure 20: Vaccinations Delivered Within Occupational Health Services Between April 2023 – March 2024 (Excluding Hep B) Source: NHSG OHS – November 2024 Page 88
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34 Travel health 6.58. At the time of writing in December 2024, the travel health service is undergoing redevelopment. The travel health service in Grampian has been delivered by community pharmacy since October 2021. However, static budgets and rising costs mean that the service will be taken in house from February 2025. 6.59. Residents will commence their assessment by visiting the Travel Health Pro website and using the information to decide what they need to travel safely. Residents may need to check routine vaccinations are up to date, or may require non-NHS vaccinations, travel medication, NHS vaccination, and travel advice for an existing long-term condition where their regular clinician may not be able to offer advice. 6.60. Assessments will be offered on-line and vaccination appointments will be available at 2-3 sites in Grampian. 6.61. Materials to support school groups travelling abroad are under development. 6.62. Only the following four travel vaccines are part of the NHS travel service: Hepatitis A (Hep A), Typhoid, Cholera, and polio / diphtheria / tetanus. All other travel vaccination or medication are not available via this service and as under current arrangements, residents will need to consult a private travel health clinic for these. Table 22: Number of NHS travel vaccines administered by Local authority and Health board. September 2023 - August 2024 Source: Seer vaccination dashboard – 22nd October 2024 Page 89
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35 7. Equity in Grampian 7.1. “Health inequalities are the unjust and avoidable differences in people’s health across the population and between specific population groups. Health inequalities go against the principles of social justice because they are avoidable. They do not occur randomly or by chance. They are socially determined by circumstances largely beyond an individual’s control. These circumstances disadvantage people and limit their chance to live longer, healthier and fulfilled lives. The existence of health inequalities in Scotland means that the right of everyone to the highest attainable standard of physical and mental health is not being enjoyed equally across the population.” 7.2. The above statement is taken from the NHS Grampian Health Inequalities Action Plan. We know from the information we have that those suffering socioeconomic deprivation, and some ethnic groups are less likely to come forward for preventative healthcare. SVIP have created a 5-year strategic framework for vaccination with inequalities one of the main priorities. To complement this, PHS are developing more data products for vaccination which include SIMD and ethnicity. 7.3. As part of our work, GVIP have held an inequalities workshop where our data was presented ((Figure 19 and Figure 20), and our priorities agreed as those in SIMD areas 1 and 2 as well as populations from Poland, Africa and parts of Asia due to the lower uptake demonstrated in Table 23. Currently, uptake rates for these populations are one of the few areas Grampian perform less well than the Scottish average. 7.4. These figures demonstrate Grampian’s uptake is lower than that of Scotland in many ethnic groups. The difference is under 5% for most groups, apart from Other Caribbean or Black and Other African populations and less well-defined groups such as “White other”. The first two are relatively small cohorts of just over 200 combined and targeted small-scale work may be successful. The White Other is a larger group of 5,000 and may be more difficult to specifically identify and target and may need to be included in a more general approach. 7.5. Last year we undertook a Needs Assessment focussing on families with children under six years of age. Amongst other work to collate what engagement activities are ongoing, we asked about families’ concerns and beliefs about vaccination and the practical barriers to accessing vaccination. As part of this work, we reached ethnic communities through the support of HSCP and GREC (Grampian Regional Equality Council). (See Needs Assessment Spotlight). 7.6. Although many respondents reported that vaccines were important and staff were a trusted source of information, reports of concerns around vaccine side effects, safety and post-COVID lack of confidence were also seen. There were reports of barriers including inflexibility in appointments and transport. 7.7. Table 18 (Covid-19 Winter booster) and Figure 14 (Teenage boosters) show breakdown in uptake by SIMD. There is a 25%-30% difference in uptake between those from areas with most socio-economic deprivation in Grampian and the least. 7.8. Using all this information we are creating an equity plan for to sit as part of the NHS Grampian Health Inequalities plan. 7.9. Pathways for vaccination have been created for the asylum seeker population. 7.10. Further information about outreach work is available in the HSCP Spotlight. Page 90
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36 Figure 19: Autumn Winter 2023/24 COVID-19 Vaccination Uptake Rates by Ethnicity Source: PHS Discovery Dashboard – 7th April 2024 Figure 20: Autumn Winter 2023/24 Influenza Vaccination Uptake Rates by Ethnicity Source: PHS Discovery Dashboard – 7th April 2024 Page 91
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37 Table 23: Autumn Winter 2023/24 Vaccination Uptake by Ethnicity Source: PHS Discovery Dashboard – 7th April 2024 Page 92
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40 8. Quality improvement and Safety in Vaccination 8.1. The overall aim of the GVIP is to provide high-quality care to individuals and support the health of our population. Quality Improvement supports making healthcare safe, effective, patient-centred, efficient and equitable for those receiving and delivering care. In NHS Grampian we take a coordinated approach to reviewing processes and delivery mechanism to ensure we can provide the best possible care. 8.2. Issues and learning are identified through adverse event reporting, feedback, Problem Assessment Groups (PAG) and quality improvement activity. This is discussed at the GVIP Clinical and Care Governance Group, where programmes, adverse events, feedback and risks are discussed and reviewed. Staff participate in shared learning events across the programme at least 2 times per year, along with relevant short life working groups convened to develop improved processes. The Clinical and Care Governance Group reports into Programme Board under standing agenda items. 8.3. In addition, we are required to report incidents to PHS under the Vaccination Adverse Event Management Protocol. We are asked to report audit and quality improvement initiatives to the SVIP Clinical Governance Group. PHS reports twice yearly to SG as part of their assurance processes. 8.4. The updated Measles Elimination Plan for Grampian was implemented. We reviewed current MMR status of citizens aged 3 years 8 months to 17 years and contacted all those with no or one vaccine dose administered. Citizens with incomplete status were invited to attend. Work is ongoing to ensure the available data in electronic systems are updated and interrogated to provide accurate information to target messaging and resources to maximise uptake 8.5. Design and implementation of digital referral process utilising SCI gateway and trak to support primary and secondary care colleagues and improve our reporting. Priorities for improvement We will implement the Vaccination and Immunisation Strategic Framework for Grampian to draw together work on areas of improvement and facilitate planned work on priorities and a reduction in reactive activities. Alongside this work and as part of the strategy we will finalise and implement the equity plan for vaccination. The Strategic Framework, with underlying action plan, will go to a GVIP Programme Board workshop in January 2025, and the equity plan has already been outlined at GVIP Programme Board in October 2024 and will be finalised in early 2025. A selection of current quality improvement and development activities that will sit under the Strategic Framework are: o Finalising post-exposure prophylaxis pathway o Implementation of digital improvements to non-routine vaccination pathway o Detailed risk assessment and mitigations of local manual appointing systems o Finalise vaccination pathway for home schooled children o Work with e-health colleagues to scope digital consent o Focus on improving uptake of school age vaccinations o Implementation of a new Travel Health Service for Grampian o Behavioural science approach to improving uptake for COVID and flu vaccination in maternity services. Page 95
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41 9. Spotlight on the HSCPs 9.1. Spotlight on Aberdeen City 2024 Page 96
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45 10. Planned changes and Horizon Scanning for Programme 10.1. Implementation of SVIP Strategic Framework and GVIP Strategic Framework 10.2. Development of national business case for new digital system to handle vaccination business from appointing to reporting. 10.3. The below table provides a summary of forthcoming planned and proposed schedule changes which will require teams to adapt delivery models. Programme Changes (proposed/approved) Childhood The JCVI advised that the following changes should come into effect nationally once the current supply of the Hib/MenC vaccine has been used: a. An additional dose of Hib-containing multivalent vaccine such as the 6in1 will be given at 18 months (to replace the Hib dose at 12-13 months). The 18-month appointment will be an additional vaccination appointment in the national schedule. b. From 2025, JCVI are recommending the second dose of MMR vaccine be brought forward from 3 years 4 months to 18 months of age. The rationale for delivering the vaccine earlier is to complete the course at an earlier age and therefore further reduce the likelihood of measles outbreaks. c. In addition, the JCVI issued a statement recommending the introduction of a universal varicella vaccination to the routine schedule. It is advised this will be a 2-dose programme offered at 12 and 18 moths of age using the combined MMRV (measles, mumps, rubella and varicella) vaccine. A catch-up programme will also be initiated to prevent a gap in immunity. d. Due to the success of the adolescent MenACWY programme in controlling meningococcal C disease across the population a dose of meningococcal C containing vaccine is no longer recommended at 12 months. A SLWG has been established to inform effective planning, and timely delivery of the schedule changes within the childhood programme. Implementation date for the new Child Health System to replace Scottish Immunisation Recall Systems (SIRS) is now June 2025. Adult JCVI advice is that the Shingrix programme for Shingles should be expanded further to include all severely immunosuppressed adults over the age of 18 and to older people 80 and over. They also advise this would be offered to people who have already been eligible for of completed vaccination with Zostavax Seasonal COVID 19 programmes for Summer and Winter are reaching a steady state. We await final JCVI advice for Autumn Winter 2025 and Spring 2026. It is anticipated that the eligible groups will be reduced, however, this is dependent on cost effectiveness analysis once the current vaccine supply arrangements have ceased. Page 100
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46 Pregnant women are not included in JCVI advice for future population covid-19 vaccine programmes from Autumn Winter 2025 nor are health and social care workers Poultry workers are again eligible for influenza vaccination in the Autumn Winter programme for 2024/25 as a response to Avian Influenza. This offer will likely be greater than last year as SGs new register for kept birds will be used to identify poultry workers at risk. Asylum seekers are included in the flu offer for the first time in 2024. RSV is our new programme for 2024. Currently it is a once only dose for adults and is repeated in every pregnancy to give passive immunity to infants. Once this programme has been evaluated for effectiveness and safety, it is possible that changes will be made to the schedule and eligibility groups. Epidemic planning 2023/4 has seen an uptick in Whooping Cough, tuberculosis, measles and MPox. Vaccination services need to be able to flex in the event of an unexpected large outbreak or epidemic. Page 101
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47 11. Conclusions 11.1. This report has highlighted the findings from the surveillance data on vaccine preventable disease in Grampian, as well as vaccine uptakes across childhood, school age and adult programmes in Grampian. The data within the report demonstrates low incidence rates of most vaccine preventable diseases in Scotland and Grampian. 11.2. We continue to achieve good coverage in our vaccination programmes, however there is a growing concern in relation to a decline in uptake trends. 11.3. We will work on maximising uptake especially among populations facing health inequalities. 11.4. We will implement the new Strategic Frameworks, Standards and Equity plan over the next 12 months. 12. Acknowledgements The NHS Grampian public health directorate would like to thank everyone who works so hard across the Grampian system to ensure that the population is protected against vaccine preventable diseases by working to ensure that we maintain a high vaccine coverage. 13. Feedback As this is our second annual report, we would welcome feedback on the content of this report so that we can make improvements for future reporting. Please contact us directly with any feedback at: gram.vaccineenquiries@nhs.scot 14. References 1. Scotland's 5-year Vaccination and Immunisation Framework and Delivery Plan - Publications - Public Health Scotland 2. https://doi.org/10.1038/s41579-020-00506-3 The role of vaccines in combatting antimicrobial resistance | Nature Reviews Microbiology accessed 15/10/2024 3. Joint Committee on Vaccination and Immunisation Code of Practice, June 2013 4. Complete schedule (children & adults) available here: https://www.gov.uk/government/publications/the-complete-routine-immunisation- schedule 5. Immunisation Against Infectious Disease, https://www.gov.uk/government/collections/immunisation-against-infectious-disease- the-green-book 6. GMS contract: 2018 - gov.scot (www.gov.scot) 7. Non-routine vaccination update SGHD/CMO(2024)13 4th July 2024 Non-routine vaccination update 8. Averting the resurgence of measles in Scotland SGHD/CMO(2023)13 , 2023 16th August 2023 Averting the resurgence of measles in Scotland 2023 9. JCVI statement on the COVID-19 vaccination programme for autumn 2024, 8 April 2024 - GOV.UK Page 102
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48 10. Invasive cervical cancer incidence following bivalent human papillomavirus vaccination: a population-based observational study of age at immunization, dose, and deprivation - PubMed 11. Measles https://www.who.int/news-room/fact-sheets/detail/measles 12. National quarterly report of tuberculosis in Scotland: quarter 1, 2024 - National quarterly report of tuberculosis in Scotland - Publications - Public Health Scotland Page 103
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49 15. Appendices 15.1 Appendix 1: Routine childhood and adult immunisation schedule Source: The complete routine immunisation schedule from September 2023 (publishing.service.gov.uk) Page 104
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DRAFT REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: CHARGING FOR SERVICES BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To ask the Moray Integration Joint Board (MIJB) to consider the charges for services for the 2025/26 financial year. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) adhere to the request of the Moray Council that the MIJB recommend to them, the charges for the services delivered within the delegated functions; ii) consider and approve the charges set out at Appendix 1 for recommendation to Moray Council for approval and inclusion into their budget setting processes; and iii) note the recommended charges will be subject to assessment for the socio-economic impact and reported back to the MIJB where there is significant impact and no mitigation. 3. BACKGROUND 3.1 Integration Authorities do not currently have statutory powers to set charges for the services aligned to delegated functions. Moray Council, therefore, has the legal responsibility to set social care charges on behalf of the MIJB. 3.2 Moray Council has in place a Charging for Services policy that was updated and approved by the Policy & Resources Committee on 24 October 2017 (para 8 of the minute refers). The policy states that a review of charges should be undertaken annually as an integral part of the budget process. 3.3 During 2017, discussions took place between the MIJB Chief Financial Officer and the Chief Financial Officer, Moray Council, where it was considered appropriate for the MIJB to be involved in the setting of charges for the services it has commissioning responsibility for. Whilst Moray Council retains Item 12. Page 107
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the statutory responsibility for this duty, the recommendation made to the Moray Council Policy and Resources Committee at its meeting of 24 October 2017 was that the MIJB should be requested to recommend the charges for services delivered. A report was presented to this Board on 14 December 2017 where it was agreed that the MIJB would take responsibility for recommending charges for services to Moray Council (para 6 of the minute refers). 3.4 MIJB have continued to consider the charges it will recommend to Moray Council on an annual basis, ahead of Moray Council setting its charges as part of its budget setting process. The recommendations of the MIJB will be considered at a meeting of the Moray Council on 19 February 2025. 4. KEY MATTERS RELEVANT TO RECOMMENDATION Charging Overview 4.1 The net funding provided to the MIJB from Moray Council considers the impact of social care income generation from charging for services. On this basis, the MIJB Chief Officer, Chief Financial Officer and the Chief Financial Officer, Moray Council have together considered an equitable approach reflecting this position. 4.2 Not all charges are within the control of the Moray Council. Some charges levied by the Council are set by statute, some are limited by statute, and some have the method of calculation prescribed by statute. 4.3 In prior years, Moray Councils’ methodology for proposing charges has been in-line with the Consumer Price Index (CPI) + 1%. The CPI 12 month rate released in September 2024 was 2.6%, including the +1% = 3.6%. Charging for Care Services (means tested) 4.4 It is necessary that the MIJB considers its approach to income maximisation within the context of its existing policies and the broader context of social care. The introduction of Self-Directed Support through the Self Directed Support (SDS) (Scotland) Act 2013 led the Moray Council to review its charging policy for non-residential services to ensure a fair, effective, consistent and transparent system. This led to the introduction of the Contributions Policy. Under SDS, individuals are informed of their entitlement to support as part of their overall personal budget designed to meet their needs and achieve their outcomes. It also determines how much they will have to contribute (based on their ability to pay) for the care and support they choose. With the introduction of the Contributions Policy, the number of services for which charges were being made were reduced. It is important to understand that charges still require to be determined to enable personal budgets to be calculated and any associated contributions to be applied to overall budgets. The Contributions Policy was last reviewed and approved at a meeting of the Moray Council on 10 November 2021 (para 12 of the minute refers). Following on from the Feeley report published in February 2021 relating to the Independent Review of Adult Social Care (https://www.gov.scot/publications/independent-review-adult-social-care- scotland/documents), the Convention of Scottish Local Authorities (COSLA) have produced an annual Non-residential care charging guidance. This is however only guidance and not statutory. It should be noted that the thinking Page 108
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behind the report extends to what is believed to be right and fair for people receiving social care supports in their own homes. It is recommended that people should no longer be charged for non-residential social care support such as care and, support at home, and day care as it is believed that it does not make sense for people to have access to health care free at the point of need but, in circumstances that are equally related to their health and wellbeing, to be charged for support. Charges for Care Services (non-means tested) 4.5 In addition to services charged against an individual’s financial assessment, a small number of services are charged at a flat rate. 4.6 Following work undertaken by the finance section of Moray Council to look at these flat rate charges in comparison to other authorities, the increases proposed are detailed in Appendix 1. 4.7 Local Authorities administer the Blue Badge Scheme on behalf of the Scottish Government, which has set the maximum administration fee at £20. Badge validity lasts for 3 years. It is proposed that this charge is maintained at this level. 4.8 In April 2018, The Fairer Scotland Duty, part 1 of the Equality Act 2010 came into force placing legal responsibility on public bodies in Scotland to consider how they can reduce inequalities of outcome caused by socio-economic disadvantage when making strategic decisions. In this respect, the setting of charges would fall within this section of the duty and as a result due consideration is being given to the consequent impacts and mitigation. 4.9 Health and Social Care Moray Community Care Finance Team will continue to work with service users and in collaboration with Moray Council’s Income Maximisation Team to ensure all individuals are getting the benefits assistance they are entitled to so no one who really needs a service has to give it up. Other Charges 4.10 Whilst there is still a requirement to be mindful of income maximisation, it is also important to consider that often these additional supports, whilst difficult to quantify, have the ability to provide essential support around social inclusion etc. and therefore prevent individuals requiring additional, more intensive care supports. With the current pressures being experienced in social care, it is important to ensure we continue to drive the remobilisation of these supporting services with the aim of alleviating this pressure where possible and safe to do so. With this in mind, and the current financial position, as part of the savings proposal agreed in May 2024, charges and contributions policy are currently being considered and reviewed and will be brought back to a future meeting of the MIJB. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan 2022-2032, ‘Partners in Care’ Page 109
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The levying of charges for social care services is an essential component of delivering priorities on a sustainable basis. (b) Policy and Legal The Public Bodies (Joint Working) (Scotland) Act 2014 dictates that the setting of social care charges will not be able to be delegated by a local authority to an integration authority as part of the joint working arrangements prepared under the Act. (c) Financial implications Charging for services provides a consistent approach to the levying of charges where appropriate, however the net financial benefit is limited and constrained by the Contributions Policy. (d) Risk Implications and Mitigation There are no risks arising directly from this report. There remains a risk in that any increase or introduction of charges could have a detrimental effect on service uptake. (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact Full assessment of the socio-economic impact of the Social Care charges on the protected groups as outlined in the Fairer Scotland Duties legislation will be carried out prior to Moray Council setting its charges for the 2025/26 financial year. (h) Consultations The Chief Financial Officer, Moray Council and the Head of Service – Strategy and Commissioning have been consulted and their comments have been incorporated within this report. 6. CONCLUSION 6.1 Moray Council by way of their statutory duty for setting charges for services has requested the MIJB recommends the charges for services to be delivered for the 2025/26 financial year, ensuring a strategic role is maintained. Author of Report: Deborah O’Shea – Chief Financial Officer Background Papers: with author Ref: Page 110
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APPENDIX 1 SECTION B: SOCIAL CARE – MIJB REF SERVICE CODE S/M/SD BUDGET 2024/25 CHARGE 2024/25 CHARGE 2025/26 DATE OF LAST CHANGE %age increase B1. Moray Lifeline / Telecare per quarter including VAT £108,000 £44.18 £48 April 2024 8.65% B4. Blue Badge – Badge valid for 3 years M £33,000 £20 £20 April 2021 0 B6. Meals at Day Care Centres (Older People) and Shared Lives: £82,826 B6a. Meal – per meal £5.50 £6 April 2024 9.09% B6b. Tea & Biscuits – per cup £0.85 £1 April 2024 17.65% B6c. Light meal (Shared Lives Service only) Per Shared Lives carer Per Shared Lives carer April 2021 B6d. Packed lunches (Murray Street) TO BE REMOVED £5.50 £5.50 April 2023 B10. Stair lift maintenance per quarter including VAT – No VAT if registered disabled £13,500 £18.20 £19.00 April 2024 4.40% B11. Occupational Therapy Aids and Equipment None (per CoSLA recommendation) None (per CoSLA recommendation) October 2005 B12. Hire of Day Centre rooms TO BE REMOVED £5.71 per hour £6.00 per hour April 2023 B14. Speyside Lunch Club TO BE REMOVED £6.50 inc VAT £6.87 inc VAT April 2023 B16 Case review carried out on behalf of another local authority £110.38 £114 April 2024 3.28% Item 12. Page 111
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: CHILDREN’S SERVICES PLAN 2023-2026 - ANNUAL REPORT FOR YEAR 2023-2024 BY: INTERIM CHIEF SOCIAL WORK OFFICER 1. REASON FOR REPORT 1.1 To present the draft Children’s Services Plan 2023-24 Annual Report to the Moray Integration Joint Board. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) scrutinise and approve the Children’s Services Plan 2023-2024 Annual report attached as Appendix 1; and ii) note when both the Corporate Planning Board and the Moray Integrated Joint Board have approved the report, a finalised version will be submitted to the Scottish Government and published on the Community Planning Board website. 3. BACKGROUND 3.1 Part 3 of the Children and Young People (Scotland) Act 2014 places a statutory duty on the local authority and its relevant health board to prepare a Children’s Services Plan for the area of the local authority, in respect of each three-year period. It is expected that they will work collaboratively with other members of the Community Planning Partnership (CPP), as well as with children, young people, and their families at various stages of the plan’s development and review. There is a statutory duty to provide an annual update report on progress of the plan. 3.2 The Children’s Services Plan 2023-26 (Appendix 1) was developed based on a Children and Families Joint Strategic Needs Assessment and approved at the Community Planning Board on 17 May 2023 (para 6 of minute refers). Item 13. Page 113
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3.3 The Scottish Government reviews all Children’s Services Plans within 6 months of submission. Moray’s plan fully met 14/15 criteria within the review and no alterations were required. 3.4 Moray Children’s Services Plan 2023-26 incorporates the following statutory plans into one plan: • Child Poverty Plan • Corporate Parenting Plan • Children’s Right and Participation Plan Although not a statutory requirement it was additionally agreed to incorporate Moray’s Promise and Child Protection Improvement Plan within the Children’s Services Plan. Following the Children’s Services Partnership Inspection, an additional improvement plan relating to the inspection outcomes has been produced separately and out of the scope of this report. 3.5 The annual report for the Whole Family Wellbeing Fund is included within the Children Services Plan Annual report. 3.6 The format of the annual report is taken from the Children’s Services Plan, with progress updates divided into the 8 priority areas. More detail is provided within priorities where there is a statutory plan incorporated. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Progress within the first year of delivery has included the reshaping and establishment of new strategic groups in line with the 8 priority areas and the associated governance and reporting arrangements. This report is the first to explore how to complete the combined reporting approach and therefore a learning process for all involved. 4.2 The key areas of progress made across the priorities are: I. An increase in young people’s inclusion in the design and implementation of commissioned services and a total of £310,000 of funding has been distributed by the partnership using participatory budgeting which young people have led. II. A Moray Child Poverty Dataset has been established which going forward will direct improvement work and the targeting of resources. There has been an increase in the frequency of financial enquiries made directly with families with early years children to promote access to support early. III. A new parent support service has been designed and implemented to assist parents to understand and support their children’s mental and emotional health and wellbeing. Work has been established focusing on smoothing transitions between services with the next steps being to look at child to adult transition. Page 114
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IV. Child protection processes have been updated in line with new guidance and assessment-based training delivered. A year long partnership-based internet safety campaign reached 2389 children and young people. V. Improved access for children with disability and neurodiversity to sport opportunities including the introduction of bespoke sessions where appropriate. Widened the opportunities available to schools to develop alternative education curriculums in response to needs and undertaken the Education Additional Support Needs (ASN) review and began implementing changes. VI. Progressed work to update the child planning documentation and guidance used and provided refreshed solution orientated training for staff. Community hub-based approaches to family support and a joint adult/child family support service focused on families with challenges relating to substance use were piloted during the year. VII. Created a virtual headteacher role to focus on improving the education attainment of looked after and care experienced children and young people and introduced the Education Scotland Promise Award to Moray. Through commissioning we have introduced a new Children’s Right Service and two new evidenced based approaches to family support have been commissioned to increase the ways families at risk of breakdown can be supported. The number and range of placements available for children in need of care has increased. VIII. Developed a multi-agency learning and development strategy to support our workforce and recruited a Learning & Development Co-ordinator to develop a multiagency training programme IX. Working within partnership additional funding has been secured; examples include funding to develop and implement a maintaining relationship policy to support looked after and care experienced children and young people and funding for work to explore in detail the financial needs of families where a member/s have disabilities. 4.3 In year 2, progress will focus on the continued delivery of the plan and self- evaluation activity to see if the actions are making a difference to the outcomes of Moray’s children and young people. The Children and Young People Health and Wellbeing survey will be repeated and the findings incorporated to help evidence the progress being made. 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” Several of the actions within the Children’s Services Plan contribute to the delivery of the Corporate Plan and will be reported appropriately. (b) Policy and Legal Policy based work is being undertaken in line with the appropriate processes and governance. There are no legal implications currently. Page 115
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(c) Financial implications There are no financial implications from this report however work is required within the actions agreed to develop and resource joint commissioning process in the future. (d) Risk Implications and Mitigation No implications arising from the report. (e) Staffing Implications Capacity to deliver the plan is a challenge, work is ongoing to explore if prioritisation of actions is required in the second part of the delivery period. (f) Property No implications arising from the report. (g) Equalities/Socio Economic Impact None arising directly from this report. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions None arising from this report. (j) Consultations Each children services strategic group have provided the information included in this report. 6. CONCLUSION 6.1 Progress has been made in the first year of the plan, during a turbulent period of workforce and recruitment challenges, leadership change and a service inspection. 6.2 Feedback has been very positive regarding the Children Services Plan 2023-2026 however consideration requires to be given as to how to manage the feedback of the Children Inspectors that the plan is ambitious. Author of Report: Lindsay Nelson (Improvement Officer Wellbeing) Background Papers: Appendix 1- Children Services Plan Annual Report Ref: Page 116
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APPENDIX 1 Item 13. Page 117
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APPENDIX 1 Table of Content Introduction……………………………………………………………………………………………………………………….2 Strategic Outcomes…………………………………………………………………………………………………………….5 Voice…………………………………………………………………………………………………………………………………9 Family……………………………………………………………………………………………………………………………….12 Tackling Child Poverty 12 Improving the mental and emotional well-being of children young people and their families 20 Keeping children and young people safe 26 Supporting children and families who experience challenges due to disability or neurodiversity 28 Strengthening family support 31 Care………………………………………………………………………………………………………………………………… 37 People………………………………………………………………………………………………………………………………43 Scaffolding………………………………………………………………………………………………………………………..44 Measuring Progress…………………………………………………………………………………………………………….47 Appendix 1 Whole Family Wellbeing Report …………………………………………………………………………………48 Appendix 2 photo Gallery………………………………………………………………………………………………………….53 Page 118
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3 Introduction Welcome to Moray’s Children's Services Plan, Our Promise to the Children of Moray, annual report for 2023 -2024. Moray’s Children Services Plan and reporting also incorporates the other key partnership plans that have an exclusive focus on children, young people and their families. They are: • Child Poverty Plan • Children's Rights and Participation Plan • Corporate Parenting Plan • Child Protection Improvement Plan Moray formally launched our Promise to the Children of Moray in October 2023, showcasing the various priorities to an audience of 220 people, accompanied by a marketplace of 25+ local organisations who work within the area of family support. Our plan was introduced by the NHS Grampians’ s Children’s Commissioner accompanied by parents from the Our Lines, Oor Anne Project, supported by Children 1st Moray. The parents highlighted the importance of working with respect for parents, ensure that they feel heard, are taken seriously and that support is to be available at all stages, including if their children are no longer living with them. The plan was warmly received, described as comprehensive, clear and easy to read. There was an agreement that the priorities reflected the areas they wished to see improve. Attendees fed back they wanted to hear the progress, therefore we have made the event an annual occasion to share progress and hear if together we are making a difference. The first year of our plan coincides with some key challenges felt both locally and nationally that families are facing: • Reduced school attendance • Increased violence and aggression both within and outside the school community. • Ongoing impact of COVID, especially evident in specific age groups • The struggles of neurodiverse parents and children • Rise in both poverty and child poverty and the cost-of-living crisis Page 119
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4 Our action plans are structured around the five foundations of The Promise with children’s rights underpinning every foundation. Voice Explains how we will seek out and act on the voice of children, young people and their families Family Details the actions we will take to; tackle child poverty, improve the mental wellbeing of children, young people and families, keep children and young people safe from harm, strengthen support for families and meet the challenges children, young people and families face due to disability and neurodiversity Care Outlines how we will support our looked after and care experienced children and young people to reach their full potential People Describes how we will support the workforce to listen and be compassionate in their decision making, develop trusting relationships with our children, young people and families and deliver the services and supports they need Scaffolding Outlines the key actions strategic leaders will take together to ensure that the ‘system’ supports the delivery of improvements outlined within this plan. Our strategic outcomes are outlined below, followed by individual progress reports for each of the 9 priority areas. Page 120
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5 PRIORITY AREAS Voice Hearing children’s voice • The voice of children and young people is evident in all things that impact on them. • Adults successfully seek out and hear the voices of children and young people of all levels of ability. • Engagement activities are more coordinated, minimising the risk of children and young people being over consulted. Family Tackling Child Poverty • Parents claim all of the welfare benefits they are entitled to and do not feel stigmatised when seeking support. • The impact of poverty on children, young people and their families is minimised. • Young adults and parents experience no poverty related barriers to entering and sustaining training and employment Improving Mental Wellbeing of Families • Parents are confident and able to support their child(ren) to sustain good mental wellbeing. • The right mental health and wellbeing support is available to children, young people and their parents as soon as they need it. • Community based mental wellbeing support is strengthened. • Children, young people and their parents experience a smooth transition between support services, including transition to adult services Keeping Children Safe • Workers are confident and supported to identify and understand risk. • Children, young people and families are empowered to participate in child protection processes. • Children and young people develop healthy relationships with peers, online and in the community. • Children and young people are safer because risks have been identified early and responded to effectively. • Children and young people at risk of or who come into conflict with the law are supported with compassion and care. • Children and young people are supported through recovery and do not experience further trauma. Page 121
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6 Overcoming Challenges Experienced by Children with Disability or Neurodiversity • Children and young people’s education and care needs are met, regardless of need. • Parents and young people with neurodiversity challenges can access early help and support. • Children, young people and families with additional support needs have improved access to support, leisure and community-based activities. • Families can access a neurodiversity diagnosis in a timely way. • Children with additional support needs experience a smooth transition to adult services. Strengthening Family Support • Children’s and families’ needs are addressed early through implementation of effective child’s planning processes. • There is a clear pathway of non-stigmatised support available to parents throughout Moray. • Children’s transition into Nursery is consistently good. • Parents are supported and enabled to be the best parents they can be. Care Improving Outcomes for Care Experienced Young People • The gap in educational outcomes of looked after and care experienced young people is reduced. • Looked after and care experienced young people enter and sustain education, training or employment after leaving school. • The health needs of looked after children and young people are met. • Looked after and care experienced young people, and their parents/carer feel their voice has been heard through the provision of independent advocacy. • The number of range of placements available meets the needs of children and young people in need of care. • Transitions feel and are experienced as integrated, with maintaining relationships being paramount. • Siblings are supported to maintain positive relationships with one another. • Children and young people seeking asylum are fully integrated into school and community life. • Looked after and care experienced young people are not overrepresented in the criminal justice system. • Our improvement activity is shaped by the voice of our looked after and care experienced young people. People Page 122
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7 Supporting our Workforce • Integrated working practice is enhanced through joint development opportunities that support our shared vision, core principles and values. • Staff facilitate and enable the relationships, networks and connections that support our children, young people and families Scaffolding Working in Partnership • As a partnership, we are aware of the changing needs of children, young people and their families. • As a partnership, we maximise all opportunities to lever in additional funding and work together to ensure it supports the delivery of our shared priorities. • The risk of silo working across children and adult services minimised. • We more consistently and effectively measure the impact of the actions we are taking to improve outcomes for children, young people and families. • The co-ordination of continuous improvement activity improves Page 123
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8 The voice of the child is more than seeking their views, it is about enabling children and young people to take as active role as possible in making decisions about things which affect them Voice: Hearing children and young people’s voices Our focus for improvement Our actions and progress The voice of children and young people is evident in all things that impact on them. “When we went to the meeting, the school listened to you, it made a huge difference and the improvements to my grandson’s timetable and how we are treated has totally changed. Thank you so much.” Parent (Nov 2023) “First time in 2 years we feel we have been listened to and progress was made at the CPM for our daughter thanks to your services input.” Parent (Jan 2024) All strategic groups report on how they are engaging with children and young people. At the beginning of this reporting period, they jointly contributed to the Children’s Rights statutory report 2020-2203 Moray Children's Rights Report 2020-2023 Below is a range of examples of some of the ways young people’s voice has had an impact in 2023/24: Impacted service design & development including commissioning • 8 Young people were part of commissioning the new Children’s Rights Service • Young people shaped the school counselling service’s new digital platform, looking at language and content and suggesting new themes. A survey by the provider of young people showed being listened to by adults with the time and space to do so was the support they wanted most for their mental wellbeing • Approaches of family mediation and functional family therapy have been introduced within new services, both approaches hold the child/young person’s voice at the centre of support and assessing impact Influencing policy • Children living in the CALA children house were part of the process of refreshing the service delivery plan along with their families • Supported the policy team to look at the language used in child protection processes and procedures and designing information leaflets Sharing their views: • A single point of contact was developed in housing in response to care experienced young people expressing they felt housing officers didn’t understand their challenges • 6 care experienced young adults shared their views on receiving mental health support Page 124
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9 Voice: Hearing children and young people’s voices Our focus for improvement Our actions and progress • Young people produced a film on the positive/negatives of living in Burghead from their perspective and suggested improvements - https://vimeo.com/903878755/a9ee8f143e?share=copy • Champion Board members made a video introducing Moray and met with Care Inspectorate inspectors when they visited • Young people influenced the development of a petition policy to be able to have their views presented • Young people co-produced the guides for practitioners to experience better meetings, its success in hearing meetings has led to plans to expand the work to cover all types of meeting going forward Decision Making and Funding Participatory budgeting (PB) approaches are enabling young people to share their views and be decision makers on issues that impact them, examples this year include: • Deciding Pupil Equity Funding spending, outcomes include creating new sensory areas in classrooms and installing water fountains • Developing more inclusive community provision to include those struggling with their mental wellbeing (10K of community mental health funding distributed across 8 projects) • £240K of funding to develop children’s play activities and youth activities improved 4 play areas, including a skate park. Communities working together additional raised £25K to upscale these projects • Allocating £33K of Just transition funding to children and youth focused projects to support the ambition of net zero across 14 projects We continue to promote children’s rights with 48 out of 52 schools in Moray being registered for UNICEF Rights Respecting School Award and 85% having now achieved an award. We have a lead teacher for UNCRC with pupil participation groups and children rights groups supported by youth work in place. More schools are evidencing how children and families are part of developing school improvement plans. Engagement activities are more co-ordinated, minimising the risk of There is a delay to this work, a proposal has been outlined and options explored. However, in the current financial situation it has been decided to halt this work. All strategic groups are reporting on their engagement work regularly to the oversight group so there remains opportunities to explore what we can achieve during this period. Page 125
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10 Voice: Hearing children and young people’s voices Our focus for improvement Our actions and progress children and young people being over consulted Adults successfully seek out and hear the voices of children and young people of all levels of ability. Aberlour Options Voice.pdf During the recent Children Services inspection, responses by children and young people to the care inspectorates survey showed that: • 78% of children reported that their worker had listened to them • 76% of children reported their rights had been explained to them • 78% of children reported they had someone who could help them express their views The records audit undertaken showed that 56% of records were rated as good or better with regard how the professionals had listened, heard and involved the child with 78% of records stating the child contributed to initial meetings. We have a range of work in development: • Expanding the use of the “Better Meetings” guides to all practitioners and meetings • A toolkit of resources for hearing voice is to be launched with new child planning guidance in September 2024. • Introduced active listening training alongside mental wellbeing training and beginning to introduce an emotional distress assessment tool with pastoral staff to help staff feel more confident in conversations with young people about their mental wellbeing • Continuing to develop child friendly complaints, (aligned to the Scottish Public Service Ombudsmen model) and Child Protection Procedures by co-designing more child friendly materials • Highlighting good practice- Aberlour Options have presented to a wide range of professionals this year on how they are successfully capturing the voice of those with disabilities or are non-verbal. • Moray will introduce the voice of the infant toolkit developed in Aberdeenshire in Autumn 2024 with the aim to increase the evidence of the voice of babies in records and reports by 80%. Page 126
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11 Poverty impacts on the health and wellbeing of the whole family and for children it can have long term effects on outcomes in adulthood. Family: Tackling Poverty Our focus for improvement Our actions and progress What poverty look like in Moray is understood by all Moray has made significant progress through the development of a localised dataset in enhancing our understanding of child poverty. The national Scottish Index of Multiple Deprivation (SIMD) measures have been combined with local analysis to provide an accurate internal picture of Moray, using mainly 2021-2023 data (latest SIMD data available is from 2020). The national picture shows Moray having a child poverty rate of 24.1% in comparison to the national rate of 24.5%. This is a rise of 2.8% on the data included in our Children Services Plan. Moray’s poverty ranking (based on the Child Poverty After Housing Costs data) has seen significant change. Since 2014 Moray’s position was static at 20thout of the 32 local authorities. However over last few years’ Moray rose to 11th and has varied since between 14th and 16th. When placed next to the 8 comparative areas to Moray, we are rated second highest. Our internal picture shows the complexity of child poverty in Moray: • More people in Moray (41.3%) live in rural areas compared to the national average of 17%. • 26% of children living in urban areas are in poverty, in contrast to 21% who live rurally • 48% of the 66% of the children experiencing poverty are living in urban areas and living in just 30% of the most deprived areas (as opposed to the 14.5% identified if we use the SIMD ranking system only). 85.5% of children in Moray live out with the most deprived areas. • the level of poverty experienced ranges from 0% to 64.8% in different areas of Moray. The scale of child poverty in Moray: • There are 3, 849 children experiencing relative poverty, this is a rise of 470 children (14%) since 2020 • The largest increase seen in an area was 12.1% (equates to 88 children) • The highest and lowest ranked intermediate zones are both in Elgin Page 127
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12 Family: Tackling Poverty Our focus for improvement Our actions and progress What poverty look like in Moray is understood by all (cont.) We now have all 126 zoned areas (with populations between 500-1000) rated using poverty/financial vulnerability factors from highest to lowest, when focusing on the areas rated the highest, 20/25 areas show increase in child poverty and 5 areas a decrease Factors impacting poverty in Moray: Recent evidence shows good levels of employment. However, the Moray average working week is longer than the national one and the average full time weekly wage is lower (£647.20 compared to £702.80), showing Moray primarily has a low-income economy. Other factors include: • Increased public transport costs and access challenges • Increased food prices in more rural areas • Access to mains gas and cost of alternative fuel • A higher proportion of rural properties are less well insulated Our next steps are to use the dataset to set accurate baselines and performance indicators and to continue to develop to incorporate other types of poverty including digital poverty, food security and hygiene poverty. Parents claim all the welfare benefits they are entitled to and do not feel stigmatised when seeking support. Moray Council provided all households with a copy of the ‘Worrying About Money’ leaflet, which was co-developed in partnership with the Independent Food Aid Network (IFAN), alongside their council tax bill in April 2023. The leaflet focuses on promoting cash-first support options in Moray. The leaflet incorporated the content of the previous Locality Network developed poverty conversation toolkit, which included additional community based supports. Three training events on the cash first options were delivered in partnership with IFAN this year, with 1 focused on school-based staff. The before and after training surveys showed an average increase in ratings around knowledge and confidence from 1.56 to 4.1 on a 5-point scale. Hits on the online version of the worrying about Money site increased following training dates, with a 33% increase evident after the first training session. Page 128
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13 Family: Tackling Poverty Our focus for improvement Our actions and progress Parents claim all the welfare benefits they are entitled to and do not feel stigmatised when seeking support (cont.) We continue to use the Grampian developed Financial Inclusion Pathway and the newer Infant Feeding Crisis Pathway. Additional training has focused on health visitors and midwifes with a recent test for change looking at 2 areas teams showing that 94% of families were asked about financial supports. The support available across Moray has expanded this year. • The Moray Baby Bank charity has combined with a new pre-loved charity to expand the range of items available free for families • The Infant Formulae in a Crisis Pathway have been expanded to consider food insecurity and includes income maximisation. • Moray Community Foundation, launched in April 2023, to address personal emergencies which have been compounded by the cost-of-living crisis. • A financial wellbeing worker is part of the support included in the newly commissioned intensive family support service, Families Together (Children 1st) • Increased family learning opportunities that offer support on budgeting and numeracy-based skills has been coordinated through Community Learning Development (CLD) • The Fairer Moray Forum Action Group has undertaken a mapping exercise to identify the variety of supports on offer throughout Moray to improve the awareness of supports which are available. • Moray continues to contribute to the annual Challenge Poverty week to raise awareness of support The impact of poverty on children, young people and their families is minimised, whilst opportunities for wellbeing and attainment are maximised Pupil and Strategic Equity funding (SEF) is used in a range of ways across our school estate with a common theme being the employment of Home School Link Workers and youth workers to support family engagement. • 38 of the 43 PEF plans available focused on health and wellbeing, examples included breakfast clubs, nurture-based support and outdoor learning • 15 schools focused on families and communities, examples being developing hub spaces for families to access, family learning, developing clothes and swop shops, book and cooking sessions • 4 larger scale school projects were funded using SEF, 3 in areas meeting SIMD (5-6) criteria and a third in an area where low income and pockets of poverty are an issue Page 129
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14 Family: Tackling Poverty Our focus for improvement Our actions and progress The impact of poverty on children, young people and their families is minimised, whilst opportunities for wellbeing and attainment are maximised (cont.) Examples of good practice developed using the funding Elgin High School managed to combine elements of its PEF funding with over £1700 of funding successfully acquired from community sources to run a Breakfast Club. They received a further £1000 Kellogg’s grant who they partnered with to share good practice and are a current test school for their new secondary school welcome pack. 20-25 pupils attend daily, with 64% of pupils fitting PEF criteria. Provision includes monthly cooked breakfast and hot chocolate Fridays. The school also ran a whole school “Scottish Big Breakfast” in support of STV children’s Appeal which included fruit tasting, making fruit smoothies using pedal power and a school band providing music. Due to the success, they now run the whole school breakfast once every school term. Buckie Associated School Group received £275,855 to focus on children between P5-S1 from across the schools in the ASG areas identifying pupils through a data analysis looking at attendance, poverty related attainment, social and emotional based concerns and those achieving lower than their potential attainment. A hub and spoke model were adopted with a range of support provided including additional literacy and numeracy support, working on alternative awards to build confidence, developing safe spaces within school, weekly parent contact and whole family activities. Outcomes have included: • increases in attendance, (rising 7.5% to 85.1% and 5.7% to 86.2% in the second cohort) • All pupils had increased scores on the Glasgow Mental Wellbeing Profile and were evidenced seeking less support from other school staff by the end of the first term. • A target of 20% improvement was set for those identified as not working at their age/stage, results post support showed 44% had reached the expected writing level, 55% their reading level and 33% their numeracy level.12 of the lowest attaining pupils also completed Hi5 Awards Summer holiday support Page 130
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15 Family: Tackling Poverty Our focus for improvement Our actions and progress The impact of poverty on children, young people and their families is minimised, whilst opportunities for wellbeing and attainment are maximised (cont.) School holidays are a challenge for families experiencing poverty or with low income, last summer we were able to distribute £67, 935K between 21 providers to provide additional childcare and activities, targeting those on low incomes. Provision included holiday playschemes, sport camps, enhancement to planned provision to involve meals and to organisations working with vulnerable families, for example our drugs & alcohol service and women’s aid. We also worked to increase the number of free access family activities available through the summer, examples being coding sessions and Lego build sessions. Improving home efficiency and minimising fuel poverty • To date the Moray Energy Efficiency scheme has supported 228 council and privately own properties to increase home efficiency • a new Eco 4 flex scheme is due to be launch in May 2024 focused on those living in private housing occupied by low income, vulnerable and fuel poor households. • Additional support to families continues to be provided through cash first options and through vouchers provided by our 3rd sector partners, an example being Aberlour Childcare Trust urgent assist fund to manage fuel costs. In this coming year we plan to audit the cost of the school day approach across schools, including assessing more closely the uptake of free school meals, travel and the education maintenance allowance Young adults and parents experience no poverty related barriers to entering and sustaining training and employment. Young adults and parents experience no poverty related barriers to entering Our Local Employment Pathway is named Moray Pathways, • It is comprised of over 50 support organisations and local employers with the aim of supporting local people into fair and sustainable employment. • The pathway utilises No One Left Behind and Child Poverty Employability funding to provide a key worker support service for young people and for parents. • In total, 763 people were referred to the Moray Pathway partners this year, including 185 young adults and 60 parents, of which 45 have been care experienced. Page 131
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16 Family: Tackling Poverty Our focus for improvement Our actions and progress and sustaining training and employment (cont.) Young adults and parents experience no poverty related barriers to entering Outcomes of Moray Pathways A total 326 Outcomes were recorded with young people achieved the following: • 27 moved on to employment, with 17/27 securing 6 month paid placements with the pathway funded Moray Employer Recruitment Incentive (MERI) (10 parents also used this scheme) • 40 completed vocational based activity • 30 entered further/higher education • 61 worked on barriers to employment, these included personal development, their health & wellbeing, and creative and life skills (includes mentoring) • 15 are at the engagement phase (newest referrals) Examples of young people’s support provided are the annual summer programme for those leaving school where there may be a risk of not progressing to their identified positive destination (24 young people took part this summer) Mentoring Young Talent matches care experienced young people and young people 16+ that are not in employment, education and training to a volunteer mentor for a year. 34 young people were supported this year. Progress for Parents The Progress for Parents service within Moray Pathways (parent employability scheme) focuses on the 6 identified priority family groupings by, • Partnering with organisations to provide place-based support in areas identified with most need through working together with the family nursing partnership, the resettlement team, schools and the justice team amongst other partners. • Joining family sessions and attending community-based activities like community lunches and schools to raise awareness of service Page 132
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17 Family: Tackling Poverty Our focus for improvement Our actions and progress and sustaining training and employment (cont.) Young adults and parents experience no poverty related barriers to entering • 1-1 key workers support parents with personal development, barrier removal and skills development to create opportunities to enter the workforce or secure improved career options • project officers focusing on school age childcare and families with disabilities. Outcomes of Progress for Parents In total 60 new parents were referred in 23/24, with 76 parents continuing to be supported from the previous year. All parents are offered a referral to the Money Advice Team as part of an initial financial health check. Of the 60 referrals this year: • 13 parents continue to work 1:1 with a keyworker to address barriers to employment and on personal development, • 1 parent has been supported to start volunteering, • 2 have gone into education, • 25 have entered employment, • 6 have progressed into training, • 13 have disengaged for various reasons. Barriers to employment for parents School Age Childcare 2 parent focused surveys identified that the cost and availability of childcare for school age children is a major barrier to parents entering the workforce. Both a local working group and a Highland and Islands Regional Economic Subgroup are jointly looking at the issue with a range of stakeholders, including Scottish Government representation. A Project Officer started in post in January 2024, initially focusing on establishing relationships with local childcare providers, both mapping current provision and exploring barriers to expanding local provision. Page 133
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18 Family: Tackling Poverty Our focus for improvement Our actions and progress and sustaining training and employment (cont.) An example of good practice in this area locally has been a partnership between Moray Business Gateway, Moray Council’s Childminder Development Officer, Moray UHI and Moray Pathways. Funding and support were provided to create a free bespoke two-week childminding training course for six participants. Two of the attendees have gone on to be registered childminders with places available. Families with disabilities Moray made a successful application to the Child Poverty Accelerator fund to work with families with disabilities to improve income maximisation and develop a local group to continue to support families. Engagement events with families have taken place, with feedback being used to develop the project to meet need. Page 134
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19 Positive mental wellbeing greatly improves the experience of growing up and provides a solid foundation upon which a person’s lifelong health and wellbeing outcomes Family: Improving the mental and emotional wellbeing of children, young people and their families Our focus for improvement Our actions and progress Parents are confident and able to support their children to sustain good mental wellbeing “The practical tips in the sessions give me more optimism that there is something that I can do” “Comparing what makes me stressed to what makes my son stressed help me realise that I can dismiss him at times” I'll notice myself doing it from now on and try to do better” “I want to understand self- harm more and how I can help him” We identified a gap in local support or training for parents to access themselves (without their child) to learn more about supporting their child’s mental wellbeing. A parent pilot was developed and tested in partnership with Therapeutic Counselling Services offering parents the following choices: • online or face-to-face workshops covering anxiety, stress, self-esteem and self-harm designed around psychoeducation, personal development and skills and resources • 1-hour wellbeing consultations for the parent or carer to assess their resilience, identify the child struggles and create a plan of action together including providing resources • 1-2-1 support, focusing on listening and validating concerns, facilitating parents to develop insight, identifying strengths, offering tools, discussions of boundaries, demonstrations of resources and activities provided and psychoeducation about teenage development Key successes of the pilot included: • 98% parent self-referral rate • 85% measured increase in self- confidence to support their child mental wellbeing • 98% reported increased knowledge of mental wellbeing related issues and understanding of young people’s needs • Parents reported a 70% sustained improvement and application of their knowledge 8 weeks after receiving support. • Parents willingness to open up about other concerns. For example, 29 parents shared they were experiencing financial struggles and 19% of parents shared their own mental wellbeing struggles Page 135
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20 Family: Improving the mental and emotional wellbeing of children, young people and their families Our focus for improvement Our actions and progress Moray Parent Project Report.pdf The pilot has been so successful and popular with parents we have committed to its continuation with increased focus on attracting Dad’s and kinship carers and developing an open-door handover for parents into Mental Health & wellbeing services to support their needs. The pilot will be incorporated into the support available through the community/family hubs being developed through our Strategic Equity and Whole Family Wellbeing Funding. The right support is available at the right time A Mental Health & Wellbeing Services (MHWB) Development Group has been established, consisting of the 4 main MHWB services so far. The group is focused on: • Working to improve coordinated support plans, • Smoothing transitions between services, • Increasing early intervention uptake and reducing redirected referral numbers. Progress to date includes: • Development of case discussion meetings. 19 children & young people have benefitted to date with the following impacts seen of the approach: - Improved collaborative working that ensures the right amount of support is available from the most appropriate service - Joint risk management discussions in relation to suicide and self-harm concerns. - Some cases have been escalated to CAMHS - Staff are reporting their practice is developing through increased knowledge through engagement with more highly trained Mental Health specialists. - Next step is to consider how to support those waiting for more specialist support and to those leaving CAMHS to support transition into community provision Page 136
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21 Family: Improving the mental and emotional wellbeing of children, young people and their families Our focus for improvement Our actions and progress The right support is available at the right time (cont.) • Smoothing transitions between the services, all the commissioned MHWB services are now agreed referrers to CAMHS, making the case discussions more effective and increasing the quality of information in referrals • Jointly developed a service information leaflet shared to all schools and the wider Children Services sector as part of work to promote early intervention provision and reduce redirected referral levels The Improvement Officer (Mental Wellbeing) works closely with the services to improve data collection, evidencing the impact of support and service development, this has led to: • the development of a mental wellbeing dataset to help inform service development, identify gaps in provision and emerging trends • addressed an emerging trend of an increase in redirected referrals to school counselling, leading to training for guidance pastoral teams on assessing emotional distress • supporting our community MHWB service to measure impact more consistently and work together to reduce the waiting time which has reduced from 12 weeks to 5-6 weeks Young people have: • co-developed with the counselling service their digital platform, shaping content and testing its usability • tested new ways of experiencing support, trying out mind movement taster sessions within two high schools We have explored different support and capacity building opportunities by: • piloting attaching a young person’s community mental wellbeing practitioner to 2 of our children houses. Initial results show an increased uptake of 1-1 support in comparison to the children’s house not in the trail (control) • waiting well through phone check-ins when on waiting list for community MHWB services • a trial of an under-10s counselling offer has been running in 3 primary schools with 34 spaces, this is currently being evaluated Page 137
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22 Family: Improving the mental and emotional wellbeing of children, young people and their families Our focus for improvement Our actions and progress The right support is available at the right time (cont.) • identified gaps in peer-based support within the peri-natal parent stage, a series of recommendations are currently being considered to explore in the upcoming year Developed and resourced 2 suicide prevention pilots planned in response to an identified training gap. The pilot is designed to explore how we create suicide safe schools and includes partners of SAMH, CAMHS and CRUSE bereavement service. Outcomes • There has been a 39% increase in referrals to community-based MH services, a 9% rise to school counselling services and a 7% fall seen in CAMHS referrals during this year. We hope to maintain this shift towards early intervention going forward. • Through additional support provided, our community mental wellbeing service average improvement rate has increased from lows of 48% to consistently being between 80-90%. • The average confidence rate of parents in relation to supporting their child’s mental wellbeing who received 1-1 support within our parent pilot rose from 50% to 88%. Community based mental wellbeing support is strengthened “I didn’t want change, I was quite happy the way my life was, I never went anywhere without my mum except school, I’m proud of myself for all the changes I’ve made, I'm happier now and my mum trusts me too” Young person 13 yrs A social-prescribing based pilot was undertaken to understand why young people were engaging less in community provision which was impacting the outcome of the work of our mental health support services Young people were supported to identify and address barriers to accessing provision available. The insights gained were used to work with community providers to increase inclusion for young people struggling with their mental wellbeing. A social prescribing model was developed outlining the level of support young people needed to use this approach successfully A Participatory Budgeting (PB) opportunity was developed by the young people who had taken part in the project based on their shared experiences to design and run a funding process which they themed around inclusivity • 26 referrals were received for young people 12 years and over who had been receiving mental wellbeing- based support. Page 138
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23 Family: Improving the mental and emotional wellbeing of children, young people and their families Our focus for improvement Our actions and progress “Having a fit life card has opened up my daughter’s world, she loves going to the gym, becoming more confident with every visit” – Parent Insert small pic of poster here • 17 young people went on to achieve their community-based goals, examples included joining gym classes, joining a local youth club, getting a part time job and joining school-based clubs. • 3 young people who were not attending school returned to school • all participants showed an increase in school attendance. • the social prescribing model developed will now be evaluated alongside our adult models to identify how to develop a social prescribing approach in Moray fit for all “I wanted friends, I struggle cos I don’t understand people, they say one thing and it means something completely different. It’s much better at school I can say hi to or smile to people as we pass each other going to our classes and have someone to hang out with who thinks like me” Young Person 14 yrs feedback on what they gained from the pilot £10K of our Children & Young People’s Community Mental Wellbeing Funding was used to run the process across two areas. A total of 23 applications were received with 494 votes cast by young people across the 2 school ASG areas with 8 projects successful. The successful projects ranged from providing lunch time sports activities, equipment for scout groups, increase access to outdoor learning opportunities, supporting military children, funding to support a diversity & inclusion group to gain the LGBT Educational Charter and support to enable a new role-playing games club developed by parents for neurodiverse children to afford premises during a pilot phase. Example of young person’s feedback “Designing everything took time, it was good to hear what others on the panel had to say about everything, and we could agree on most things. I liked how everyone’s voices were heard; everyone got our activity and idea on our poster.” Young Person Page 139
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24 To be safe means growing up in an environment where a child or young person feels secure, nurtured, listened to and enabled to develop to their full potential Family: Keeping Children and young people safe Our focus for improvement Our actions and progress Workers are supported to identify and understand risk (This work is linked to the People priority within our CSP) A new Multi-agency Learning Development Strategy and training program has been developed, informed by a training needs assessment completed by 145 staff members. New roles have been created of a Partnership Learning and Development Co-ordinator and a Trauma Informed Development officer who is already in post. http://www.moray.gov.uk/downloads/file153710.pdf During the reporting period: • 85 multiagency staff completed Child Protection Basic Awareness training • 34 staff completed Understanding Neglect training. • staff attended a series of briefings to share the new Child Protection National Guidance, and all training materials have been updated to reflect the guidance • Participation and trauma informed practice themes have been incorporated into our training and development. • A review and refresh have taken place of multi-agency chronologies and child protection procedures across the partnership within the last year 404 frontline staff completed the Care Inspectorate survey in August 2023 as part of our inspection. • 90% agreed that the learning and training they participated in has increased their confidence and skills when working with children and young people at risk of harm • 97% reported they were confident to recognise and report signs of child abuse, neglect and exploitation. Staff who have undertaken recent training reported: • 96% Knew the standards of practice expected of them • 89% agreeing that they had the guidance and supervision in place to meet those expectations. Page 140
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25 Family: Keeping Children and young people safe Our focus for improvement Our actions and progress Moray also launched its Moray Protects website, which provides a public platform for engagement and awareness raising initiatives, alongside information and guidance for practitioners on public protection. Children and Families are empowered to participate in Child Protection Processes “I felt listened to because some of the outcomes I asked for were upheld and (the professional named here) listened to me and took my thoughts into account” (young person”, 12 years old). A solution orientated approach to Child Protection Planning Meetings has been implemented with evidence of the approach evident in 100% of the meeting that were examined in recent quality assurance reviews. Parents attended child protection meeting in 95% of cases. 107 staff having attended solution orientated training in the last year. Feedback since these changes were introduced include that professionals and families feel that risks are fully explored but in a more positive way with a clearer focus applied. 98 parents completing the care inspectorate survey confirmed that children, young people, parents and carers felt their views were considered during decision making. We are working to ensure children understand the child protection processes by: • introducing a children’s section with child friendly advice on the processes on the recently launched Moray Protects website. • testing how child friendly our complaints process through a new child feedback form introduced Our focus going forward is: • the continued roll out of solution-oriented core group meetings • continued use of the complaints child feedback form to identify areas of learning • to quality assure the changes made to the child protection processes to see how well the child voice is being heard • develop a young person support and protection procedure outlining the approach practitioners should follow when working alongside individuals aged 16-18 (or to 26 if care experienced). Children and young people develop healthy relationships with peers, Moray’s Child Protection Committee and NSPCC Scotland worked together to develop the ‘Let’s Chat Online Safety’ campaign beginning in 2023. The aim of the campaign has been to raise awareness of online harm and offer solutions and guidance to tackle risks early. The campaign to date has included: Page 141
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26 Family: Keeping Children and young people safe Our focus for improvement Our actions and progress online and in the community. Children and young people develop healthy relationships with peers, online and in the community (cont.) “Good focus on solutions and what we can start doing to help kids today” “Interesting, informative and fun” • 18 parent sessions attended by 256 parent/carers, • 4506 online safety leaflets being distributed • 359 families engaged at a range of community events • Workshops delivered in schools to 2389 young people The focus of content was designed in response to parents and frontline staff requests, covering topics including, gaming, grooming, mental health and wellbeing, online bullying, friendship, pornography, parental controls, persuasive design, sharing nudes and social media. All the FAQs responses across all the topics have been shared on the Moray Protects website. The Safer Schools Scotland app has also been re-launched locally to promote access to up-to-date advice and jointly promoted with the campaign. Children and young people are safer because risks have been identified early and responded to effectively. Those who come into conflict with the law are supported with compassion and care and children are supported through recover and do not experience further trauma. Moray continues to invest in the assessment tools used and the development of our child protection processes. • 138 staff received Graded Care Profile 2 training • 154 staff have received Safe and Together training via the violence against women and social work partnership. Safe and Together language related changes are now being evidenced in report and file audits. We continue to regularly quality assure the components of our process, our recent inspection highlighting the quality of our IRDs and SCIMs processes as a strength. 92% of Joint Interviews are carried out using the SCIM method far exceeding our initial target of 60%. Moray has increased the availability of intensive family support interventions to support where risk is identified that may impact the stability of the family including when children in conflict with the law. Family functioning therapy and family group decision making form the approaches being used. Moray’s Protection from Serious Harm Protocol was developed within this reporting period with a view to managing the risk of harm posed to a young person and/or to other people Page 142
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27 Children with disability and neurodiversity and their families will receive the support they need to enable the children to reach their potential Family: Supporting children and families who experience challenges due to disability and neurodiversity Our focus for improvement Our actions and progress Children and young people’s education and care needs are met, regardless of need. A large-scale Additional Support Needs (ASN) Education Review is underway looking at alternative curriculums, resource allocation, policy guidance and review, training and development and the ASN provision arrangements across Moray. This work incorporates reviewing options to extend nursery provision for children with complex needs. The process involves significant staff and parent consultation, and staff change management processes. The progress to date has been: • A new procurement framework designed to make it easier for voluntary and third sector organisations to support the delivery of alternative education curriculums • Moderation completed across all schools in Moray to understand need and a new formula agreed to allocate resources • Staff change management and new provision planning underway • New induction training programme planned for School Pupil Support Assistants to better meet the needs of children with ASN Work outlined in the strengthening family priority regarding nursery transition is also contributing to meeting early children with more complex ASN related needs. Work looking at the use of part-time timetables in education has begun with new procedures introduced prior to a part time timetable being introduced and tracking their use has been improved. Next year we will be investigating how this approach is working for children with neurodiversity-based needs. Parents and young people with neurodiversity challenges can access early help and support Parents and young people with neurodiversity Access to peer support Several projects have developed in this area, • parents and carers have developed a social media community group which has 848 members • ICON (Informing & Connecting Our Neurodivergent families in Moray) is a group for both parents and professionals meeting to share experiences, services or skills and access to advice • The locality networks are exploring the option of developing a physical drop-in hub for parents regarding any support need this will be developed in partnership with numerous services. Page 143
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28 Family: Supporting children and families who experience challenges due to disability and neurodiversity Our focus for improvement Our actions and progress challenges can access early help and support (cont.) Access to support Funding has been secured from the Scottish Government Accelerator Fund to run a pilot over the next year exploring the effectiveness of the current financial system of support for families with disabled children. We will be designing and testing improvements to these systems to maximise the income of those families. A social work led disability pod for children with complex needs was established in response to consultation with parents and workers which evidenced a need to feel support was more connected. Work is ongoing to outline a clear pathway of support from universal services through to social work. A total of 89 children/young people were open to the pod at the end of March 2024, including 27 care experienced/looked after young people. The pod is enabling workers to share skills as well as knowledge of scarce resources and ensuring greater equity and consistency so that children and young people can receive the appropriate resources and services Access to sport Active Schools and the Sports Development Team are leading on developing ASN and disability sport friendly provision across Moray. When comparing the same term in 2022/23 to 2023/2024 they’re has been: • 70% increase in disabled access • 26% increase of children with ASN accessing the Active Schools sport-based sessions. • The team have introduced ASN specific extra-curricular clubs in two schools this year. A targeted ASN cycling programme was developed with funding acquired from Scottish Cycling, • providing 32 sessions across 8 schools with 104 young people taking part. • 65 disabled adults included. New ASN friendly sessions have been introduced at the Moray Leisure Centre and within libraries both during term and holiday times for activities like ice skating, swimming and learning based activities. Page 144
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29 Family: Supporting children and families who experience challenges due to disability and neurodiversity Our focus for improvement Our actions and progress A Disability Sport Hub is being developed with the purpose of supporting sports clubs across Moray to respond and meet the needs of young people with disabilities and ASN. The Hub aims to develop a community of shared practice, support, training and education and in-turn improve access to the clubs through inclusion of self- directed support opportunities. Key partners from the start of this proposal have included Scottish Disability Sport and the Moray ASN Parent Action Group. Families can access a neurodiversity diagnosis in a timely way Progress on the development of the Grampian neurodevelopmental pathway stalled in 2022/2023. Moray decided to reinstate the ADAPT process previously used for diagnosing autism spectrum disorder while awaiting progress of the pathway. A Fast-track option has been developed and prioritisation agreed for those due to leave school. Processes have been developed in consultation with the Moray ASN Parent Action Group. 32 diagnoses have been made, of which 21 were fast tracked. This is a temporary reinstatement of ADAPT as the pathway work is now underway. Children with additional support needs experience a smooth transition to adult services. 3 areas of work are developing: • A multidisciplinary transition group focused on young people who will require a high care package when they transition to adult services. This groups work connects to that of the disability pod that has been developing • A pan-Grampian transition group has been formed to look at pathways from a health perspective, the focus is specifically on children with complex needs or multiple diagnoses. The aim is to develop transition frameworks in relation to young people’s health needs as they become adults. • A local Task and Finish group has been established to explore the various transitions young people are experiencing and outlined within our children services plan. The group are focusing on identifying where young people’s needs were not as complex and may not have met thresholds for adult services however within a short period have seen their needs increase when children-based services and approaches are no longer available. Page 145
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30 We want to make sure families can access the help they need, where and when they need it. Family: Strengthening family support Our focus for improvement Our actions and progress Children and their family’s needs are addressed early through implementation of effective child’s planning processes We are enhancing the Child Planning Process in Moray to improve families’ access to support. We are doing this by: • updating the Child Plan documentation and guidance for practitioners with test pilot areas planned • increased the availability of solution orientated meeting training with 107 practitioners trained over the last year • developing a toolkit of resources for hearing and gathering the voices of children and young people that will accompany the guidance when fully introduced • a GIRFEC website including a central repository drawn from the ALISS platform has been financed, the aim is to have one place that will support both the named person and families directly to understand processes they may be experiencing e.g. child planning and the support available to them • Wellbeing Coordinators role development has included coaching and supporting the Named Person and Team Around the Child, including attending 228 child planning meetings (including 52 review meetings) this year. • going forward we will redesign the role of both the Multi-Agency Support Hub and Multi-Agency Performance Hub to lead on developing a self-evaluation calendar for child planning to ensure the process is meeting the needs of families. There is a clear pathway of non-stigmatised support available to parents throughout Moray and parents are supported to be the best parents they can. Work is ongoing to develop the local family support pathway. We have continued to deepen our understanding of families’ needs, enhancing current support and developing new intensive family support provision. Work undertaken includes: • completing families journey mapping work in partnership with Children 1st and Quarriers Arrows (Drugs and Alcohol support service) alongside considering the recommendations of the research of Children 1st Moray (part funded locally) which focused on supporting birth parents who no longer have care of their children Our Lives, Oor Ane Summary Report Page 146
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31 Family: Strengthening family support Our focus for improvement Our actions and progress There is a clear pathway of non-stigmatised support available to parents throughout Moray and parents are supported to be the best parents they can (cont.) Feedback from parents on what they like about PEEP: “My children have become a lot more confident” “Learnt something new about your child development at every session and the time with other mums” “Catching up with other mums and socialising my wee one” • utilising CORRA funding to contract Aberlour Trust to complete an assessment of Moray’s current family support provision. Through engagement that included 24 families and 80+ professionals’ recommendations were formed. Key themes are to improve the accessibility of support available and the co-ordination of support when families need assistance from multiple agencies. • key learning is being taken forward in the continue development of the wellbeing coordinator’s role, (part of our locality planning model) The following new intensive support provision and enhancements of current provision on the pathway have taken place: Developing prevention/early intervention family support for early years families PEEP is a family learning programme designed to help parents understand their child’s development and how as a parent then can create everyday opportunities to support their development. We are developing a universal PEEP pathway for families with children 0-5 years. Work to date has included: • increasing PEEP activity by growing the number of groups running from 6 to 12 over the year • introduced ante-natal PEEP groups in Moray through partnership working between health and early years • introduced targeted individual family PEEP sessions delivered by our Scottish Government funded Equality & Excellent Leads within our Early Years Intervention Team • our partnership model has developed to include 8 member organisations • we have been confirmed as 1 of 10 local authorities taking part in the Scottish Government Whole Family Wellbeing Funding (WFWF) family Learning Together programme with PEEPLE (training planned for next year) AB56 (a targeted family support service for families with at least one child under 5 years) has continued to develop using both parenting and cognitive behaviour therapy-based approaches to support the wider wellbeing of Page 147
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32 Family: Strengthening family support Our focus for improvement Our actions and progress There is a clear pathway of non-stigmatised support available to parents throughout Moray and parents are supported to be the best parents they can (cont.) “ Emma has changed my life, from a parent struggling to cope with his behaviour that happened nearly daily to maybe one, twice a week!” Parent Parent feedback to Locality Networks reference increases activities in area: 'Great to see organised activities to for me and me 2- year-old as travelling to access these is not an option for me. 'Regular weekly opportunity to get out with my child and meet other parents in Buckie is great. families. They continue to work with 30 families at a time, with 50 families supported over the last year. (Funded through Moray Council Early Years team) Increasing early intervention support available and at the right time by: Wellbeing Co-ordinators (key roles central to the development of our family support pathway) have worked alongside social work and the named person to develop family support packages through the child planning process. The co-ordinators are identifying families where we feel an enhanced support provision could prevent social work-based intervention. Family/community hubs have been developing within schools in 4 school areas (utilising both PEF/SEF funding). Using a hub and spoke model they are developing to reflect the uniqueness of the locality and the families within those areas. The next step is to introduce a further 3 community hubs and extend the support available through the 4 hubs, utilising components of our Whole Family Wellbeing Fund An example of a hub is outlined within the poverty priority Our children & families locality networks have continued to develop, highlights this year include: • the introduction of paid 3rd sector chairs, • engagement shaped around the priority areas of our CSP, collating the lived experiences of families and front-line professionals to further inform how the plan is delivered and consider the impact of work as its undertaken. This ensures all the children’s workforce, but especially the 3rd sector, is central to the progress of the CSP • Attendance is continuing to increase, bringing in a more diverse range of services/organisations ensuring effective communication and reach • supported the develop of solutions to emerging community-based issues, for example the rise of anti- social behaviour by both bringing together evidence of the issue and supporting partnership working. An example in practice was facilitating a multi-agency response in one locality led to a temporary youth Page 148
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33 Family: Strengthening family support Our focus for improvement Our actions and progress There is a clear pathway of non-stigmatised support available to parents throughout Moray and parents are supported to be the best parents they can (cont.) “Having the family meeting was really helpful. It gave other people in the family an opportunity to talk about their concerns.” Family Aug 2023 “It has been good to hear the kids views and to be able to talk to them about what they had said” Parent October 2023 “I feel like finally our family is on the path to a place we want to be” July 2023 space being developed and 55 young people were engaged with, forming part of the actions that lead to a decrease in anti-social behaviour in that specific area • Bringing in £1,8000 of funding to support the continuation of early years provisions like Active Start • Gathering Feedback from parents attending the activities to share to wider forums Locality Networks remain key to ensuring we are identifying emerging issues, often prior to data and wider intelligence being available so we can response swiftly through early intervention and prevention to limit them escalating. We also have key areas of focus outlined in the CSP for the networks to explore partnership-based solutions to address at the earlier stages, examples being addressing anxiety while it is low and looking for gaps or locality specific issues requiring family support. Developed intensive family support offers through: the commissioning of two intensive family support services and trial extension of a drugs & alcoholic based family recovery • Families Together provided by Children 1st includes whole family support and a financial wellbeing provision, in operation since May 2023 they have worked with 44 families. Families have gained by a total of £103K through debt management, income maximisation and help with energy bills. 72% of the families receiving family support reported feeling safer, with 75% reported improved wellbeing. • Family Functioning Therapy provided by Action for Children, is support for families with children over 11 years where a risk has been identified to the stability of family life. The aim is to prevent care placements, improve school attendance, reduce offending and improve family dynamics by working with families in their home. 14 families have been working with the service since its launch, with reports available outlining how the families are doing better on a range of factors covering family dynamics, level of family conflict and parenting capacity. Page 149
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34 Family: Strengthening family support Our focus for improvement Our actions and progress There is a clear pathway of non-stigmatised support available to parents throughout Moray and parents are supported to be the best parents they can (cont.) • Arrows Drug & Alcohol Service Children & Families Recovery Team An intensive whole family approach was trialled during this year using Whole Family Wellbeing Funding to work with families with a member receiving support for drugs & alcohol use. Support was provided to other adults impacted, to children & young people through intensive family support, 1-1 work and group work. Holiday based activities were also provided to the families. 86 families were supported over the year and 60 new referrals were received Additionally, we have looked to introduce resource to develop practice across our children’s workforce, developing three additional roles, • a trauma informed practice workforce development role (filled at the end of this period) • a multi-agency learning & development co-ordinator to ensure a workforce wide approach is taken to training (recruited post this reporting period) • Family Wellbeing Manager role is to manage and continue to develop the family support pathway and to address any barriers to access to services in communities (still to be recruited) Children’s transition into Nursery is consistently good I personally feel it has had a significant impact; it gives us a much greater insight into the family’s background.” A Moray Nursery Manager Work was needed to improve the planning for and meeting of children’s needs when transitioning to nurseries, especially when there was early evidence of developmental delays, possible neurodiversity or those with disability. A protocol for information sharing between Health Visitors and Early Years settings has been developed and tested in one associated school group (ASG) area. A second test of change is planned at the next nursery entry point. “We have a child whose parents had behavioural concerns and had approached the HV…….. once he started with us we began to pick up on areas, where he required further support, largely emotional regulation. The information sharing has supported us to implement support strategies including Zones of Regulation and Emotion Coaching…….. The child has responded positively in nursery, knowing that ELC and Family are sharing information and working together.” A Moray Nursery Manager Page 150
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35 Case Study from the Arrows Family Recovery Team When R initially began attending the parent support group facilitated by Arrows children and family’s team, she admitted that she was only attending because she had to, to get social work off her back. However, she remained coming to the group and through this R has developed more confidence in her parenting skills and has a greater awareness of the affect her own and her partners substance use had on her ability to parent her children. She is developing strategies to help her children deal with their emotions and she is more interested the work I do 1-1 with her children to explore their emotions following a traumatic period. Through the group, R has also offered peer support to other s and built new connections and friendships with people who have had similar experiences as her. It is noticeable at child planning meetings now that R is confident in her ability to advocate her children’s needs and opinions, and she has more awareness of her children’s developmental successes Page 151
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36 As Corporate Parents we are committed to working together in partnership to ensure our children and young people with experience of care receive the right support to reach their full potential and can be all they want to be Care: Improving Outcomes for looked After and Care Experienced Children and Young People Our focus for improvement Our actions and progress The gap in educational outcomes of looked after and care experienced young people is reduced. Scottish Attainment Challenge Funding has been used to recruit a Virtual School Head Teacher to drive forward improvements. Moray’s Virtual School Head Teacher took up the post in August 2023. Key improvements include the: • development of a robust data set to identify and track all care experienced children and young people • corporate Parenting Leads identified in all Moray schools • development of a self-evaluation toolkit for Corporate Parenting Leads to quality assure all aspects of education for care experienced children and young people. This includes attendance, attainment, exclusions and child planning processes • development of a trauma informed support plan for children and young people • introduction of Education Scotland Promise Award. Our local data continues to evidence gaps between care experienced children and young people and their non- care experienced peers. The data shows that we are not yet closing the attainment gap. More focused work and commitment is needed to ensure we get it right for our care experienced children & young people. Looked after and care experienced young people enter and sustain education, training, or employment after leaving school. The Moray Pathways (local employment partnership) received 45 referrals for care experienced young people to support employability and positive post school destinations to ensure our care experienced young people have the same lifelong opportunities as their non cared for peers. Over the last year our Mentoring Young Talent Programme re-launched across schools supported by our Virtual Head Teacher to target care experience young people who would benefit from the programme. Outcomes include: • 100% of the school leavers involved with the programme have moved into a positive destination. • a total of 16 school leavers are still maintaining a supportive relationship with their mentor. Page 152
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37 Care: Improving Outcomes for looked After and Care Experienced Children and Young People Our focus for improvement Our actions and progress • in total 28 care experienced young people who have participated in the mentoring programme voiced that this support has improved their wellbeing and helped them gain valuable skills needed to for their future. • data evidences an increase in attendance for care experienced young people matched with a mentor Examples of young people’s feedback on receiving mentoring: “She has been great; she listens and gives me the best advice & she also enjoys baking. She has helped me through college during the lows. She helped me job search for a little Saturday job and I now work in a kitchen which has been really great for my confidence and giving me experience in catering”. (Young Person) “He has made me feel more confident & independent & I realise that I can achieve my goals. He supports me and is helping me put a business plan together, he believes in me.” (Young Person) The health needs of looked after children and young people are met. Every child and young person who becomes looked after receives an Initial Health Assessment. An audit of those Initial Health Assessments which have not been completed within national agreed timescales has led to the following improvements being introduced: • School Nurse teams introduced a single point of contact for all Initial Health Assessment Referrals. • Strengths and Difficulties assessment tool training has been delivered to all staff. • annual Information sessions in relation to Health Assessments for Looked After Children has been delivered to teams. This has resulted in an increase in the number of children receiving their Health Assessment within 4 weeks from 47% to 56% and within 8 weeks from 75% to 88%. Looked after and care experienced young people, and their parents/carer feel their voice has been heard through the provision of independent advocacy. Care experienced young people were involved in the commissioning of a new single service advocacy provider in Moray for children and families. As part of the commissioning process young people from Moray Champions Board: • evaluated the applications and provided feedback • were involved in shaping the service design, method of delivery and created a logo for the service Page 153
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38 Care: Improving Outcomes for looked After and Care Experienced Children and Young People Our focus for improvement Our actions and progress • participated in the recruitment process of Children’s Rights Workers. Moray Children’s Rights Service launched in October 2023. Since launch 62 Care Experienced Young People and 14 members of their family have been referred to the service. Looked after and care experienced young people, and their parents/carer feel their voice has been heard through the provision of independent advocacy (cont.) The Better Meetings Practitioners Guides have been implemented across Social Work as a tool to support children and young people to fully participate in their meetings and hearings, the guides have now formed part of the Social Work Induction for all new social workers. “The Better Meetings Guides supports the meeting to remain child centred and allows the child to voice who they want at their meeting, it’s a great tool”. (Social Worker) “Great reminder that you don’t need to be formal”. (Panel Member) “My meeting was easier because there wasn’t so many issues to talk about and they were talking to me more and I spoke more than I usually do”. (Young Person) The number and range of placements available meets the needs of children and young people in need of care The carers recruitment campaign has been active over the last year. We have worked with current foster carers to co-design an online social media campaign and ran targeted information sessions focused on the positive experiences of fostering. • During the last year we have increased the number of fostering households from 34 to 37 (8.87%) households. • The carer recruitment campaign for foster carers and supported lodgings has continued to broaden placement options and reduced the need for agency/out of area placements. • In Kinship Care the number of kinship households has increased from 28 to 30 (7%) • In supported lodgings the number of households has increased from 4 to 7 • In continuing care, the number of placements has increased from 7 to 9 a rise of (28%) providing young people with stability and continuity as they transitioned into adulthood. Page 154
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39 Care: Improving Outcomes for looked After and Care Experienced Children and Young People Our focus for improvement Our actions and progress Transitions feel and are experienced as integrated, with maintaining relationships being paramount. We successfully gained funding from the Corra Foundation following engagement work with young people to explore how we can better support them to sustain relationships with the people who are important to them. • Our care experienced young people identified this as their top priority area for improvement. • They shaped the funding bid and will lead this improvement project going into 2024-2025, being fully involved in the development of a local Maintaining Relationships policy. Our Through Care and After Care team have recently introduced a new pathway planning tool, ‘My Future, My Plan,’ which looks holistically at young people’s needs throughout their journey and into adulthood. Young people have shaped the development of a new ‘Care Leavers Housing Protocol’ and the introduction of 2 new (CEYP) Housing Support Officers to help young people with the transition from care and be a single point of contact for young people living in their own tenancy. Action For Children have introduced the role of ‘Transition Worker’ to support care experienced children and young people and those on the edge of care overcome barriers and experience successful transitions. During the last year 21 young people have been supported. • 9 young people living in a residential children’s house have been supported with their transition both into and from care. • 12 young people have been supported in the community. Support includes transitioning from school into training and employment and transitioning into their own tenancy. Siblings are supported to maintain positive relationships with one another. The rolling out and embedding of the Together or Apart Assessment for siblings within Social Work has led to improved practice and recording. Keeping brother and sister groups together safely is a priority and recent reporting has evidenced that in foster care placements 9 out of 10 (90%) brother and sister groups are kept together, which is an improvement from the previous year of (68%). Page 155
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40 Care: Improving Outcomes for looked After and Care Experienced Children and Young People Our focus for improvement Our actions and progress We have seen a rise in the number of care experienced children and young people accessing independent advocacy in relation to their sibling rights, this evidence children becoming increasingly aware of their rights to sibling relationships. Children and young people seeking asylum are fully integrated into school and community life. Moray is part of The National Transfer Scheme and during the last year has supported 15 unaccompanied asylum- seeking young people who have arrived in Moray without their parents/carers. All children and young people who have come to stay in Moray are living in dual occupancy accommodation or supported lodgings and where appropriate are accessing education. We have developed new processes to ensure all children and young people arriving in Moray have timely access to Health and Wellbeing support and transition into Education and training. Looked after and care experienced young people are not overrepresented in the criminal justice system We have continued to embed a whole systems approach to reduce the number of care experienced young people entering the criminal justice system. Over the last year we have: • continued to deliver Scottish Fire and Rescue Youth Scheme for young people in Moray, • Police Scotland Youth Volunteers Programme - targeting care experienced young people. • our Youth Justice Team have delivered a range of early and preventative approaches, interventions and used an open-door relational approach for young people at risk of re-offending. • Police Scotland Harm and Reduction Officer continues to provide a single point of contact for our local children’s houses including bespoke development sessions with foster and kinship carers. • currently (8%) of open cases within justice social work and youth justice care experienced young people, this is a slight decrease from (10.4%) the previous year. As we continue to uphold children’s rights and strive towards a reduction in the use of restraint and seclusion we have continued to roll out and embed trauma informed practice alongside robust monitoring on its use. Over the last year our local children’s home has seen a 100% reduction in the use of restraint. Next steps include the roll out of a new Safer Working Policy across the Health and Social Care Partnership. Our improvement activity is shaped by the voice of our Moray Champions Board continues to thrive and during the last year has been the driving force behind events which have enabled young people to connect with their peers, develop new and valuable skills, and be involved in the co-production and decision making of services. Key achievements include: Page 156
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41 Care: Improving Outcomes for looked After and Care Experienced Children and Young People Our focus for improvement Our actions and progress looked after and care experienced young people. • Care Leavers Event supported by 15 Corporate Parents from across the partnership. • Care Day Celebrations hosted by 10 care experienced young people and attended by 50 Corporate Parents. • Participation in Moray Council Recruitment Process. • 8 young people hosted a Summer BBQ which provided peer support opportunities for young care experienced children. • Co-produced a new Care Leavers Housing Protocol and introduction of two Housing Needs Support Officers as single points of contact for care experienced young people. • 3 young people created and launched a video addressing stigma in Education. • 8 young people supported the joint inspection of children’s services by developing a welcome video for inspections and hosting an engagement event with young inspectors from the Care Inspectorate. • Moray Champions Board took a lead role in the commissioning including service design and delivery of the new advocacy provider for Moray. • 5 young people worked with Morays Promise Team to co-produce and submit a successful funding bid to Corra, to develop a local maintaining relationships project. We have developed a network of 45 Promise Keepers from across the partnership, including Health, Education, Social Work, Police and 3rd sector organisations. The Promise Keeper’s role is to support and report on Promise improvement activity within their department or organisation and coordinate the involvement of children and families in improvements to service design and delivery. The Promise Keepers network has supported a wide range of improvement projects including: • Looked after children and young people involved in the service delivery plan for our local Children’s home. • Recruitment of staff. • Development of tools to gather the voice of care experienced young people. • The use of stigmatising language across the care system. Page 157
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42 Care: Improving Outcomes for looked After and Care Experienced Children and Young People Our focus for improvement Our actions and progress • The creation of a Promise wall in our short breaks service to strengthen our communication with children and young people who are non-verbal We have strengthened the voice of care experienced children and young people within our Corporate Parenting Strategic Group with the development of our Corporate Parenting and Promise Communication Plan and participation model. Page 158
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43 Our workforce includes all volunteers, carers and employees who have a role in improving the wellbeing of children, young people and their families People: Supporting Our Workforce Our focus for improvement Our actions and progress Integrated working practice is enhanced through joint development opportunities that supports our shared vision, core principles and values. A multi-agency learning and development strategy has been produced along with a training needs analysis undertaken with staff from across the workforce. A Learning & Development Coordinator job description was finalised, and the role has been recruited with a start date beyond this reporting period. Staff facilitate and enable the relationships, networks and connections that support our children, young people and families A Trauma Informed Development Officer role has been developed and recruited, starting in the next reporting year. All our multi-agency training has been evaluated to ensure it is strength based and relational Page 159
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44 We will strive to ensure that our governance, culture, systems and processed empower our paid and voluntary workforce and local communities to deliver the improvements children and young people have told us matter most to them Scaffolding: Working in Partnership Our focus for improvement Our actions and progress As a partnership, we are aware of the changing needs of children, young people and their families. This year we have produced our adult Joint Strategic Needs Assessment (JSNA) and began the process of updating the children’s JSNA. We have identified a resource to do this and have published the 2023 version alongside our CSP 2023-2026 plan. We have a wider insight into the needs of our families and have used learning reviews to sharpen that understanding where we have identified a need for deeper insight. Examples of our responses to changes identified have included the introduction of Sudden Infant death awareness and safe sleep training across our workforce and we are currently joint working to develop an all-age Suicide Prevention Action Plan which includes new work to develop suicide safe school communities. We have established the strategic structure and governance to oversee the delivery of the various priorities within our Children Services Plan. There is work underway in most areas to develop datasets that will sit under our JSNA and ensure we are able to demonstrate the outcomes and differences being made. As part of keeping the voice of children and young people at the centre of our approach and ensuring we are continuing our understanding of the impact of change on Moray’s children we have committed to repeat the Children’s Health & Wellbeing Survey every 2 years. This will also provide a valuable insight into if the work we are progressing is making the intended difference to the experiences of our children and families As a partnership, we maximise all opportunities to lever in additional funding and work together to ensure it supports the delivery of our shared priorities. The partnership is making progress leveraging in additional funding to deliver our shared priorities. Examples during this year include: • A successful bid to the Child Poverty Accelerator fund (£43,000) to explore the effectiveness of the current system of support for those affected by financial hardship, and maximise the number of families in receipt of Income Maximisation support Page 160
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45 Scaffolding: Working in Partnership Our focus for improvement Our actions and progress • Successful Corra Foundation bid (£150K) to explore better support to care experienced young people to sustain the relationships that are important to them. This includes the development of a local Maintaining Relationships Policy. • Our 3rd sector partners have been securing funding to increase the capacity of children’s mental health services in response to demand through the Willamson Grant Foundation and in peri-natal mental health through Inspiring Scotland funding • The locality networks have worked with smaller providers to secure £2300 of funding focused on community based early years activities to address locality-based gaps in provision outlined by parents in that area • The YPZONE is a young people’s drugs & alcohol service within Moray, this is currently in its 3rd year of funding, this has been developed through our locality networks and is funded though match funding from a range of local sectors e.g. Education, Health, ADP, Social Work and matched by Corra. A review of all Scottish Government funding streams issues to single agencies and partnerships groups has been completed. We are committed to align our spending to the CSP priorities. Moray is successful at acquiring funding in but continues to experience recruitment issues in securing suitably skilled staff and to have the capacity to coordinate and report on these additional sources efficiently. The risk of silo working across children and adult services minimised. We have in place a clear governance structure devolved from the Community Planning Partnership to produce and deliver the CSP with the GIRFEC Leadership Group in place. The group is made up of senior decision makers from both the public and 3rd sector. Members of the strategic groups are from across our partnership, and we have clear terms of reference for each strategic group which are aligned to the various priorities. The GIRFEC Leadership Group has scheduled regular developments session to focus on the progress of the delivery of the Children Services Plan and there are quarterly Chairs Partnership meetings to ensure connection and to minimise silo working. Improvement Officers resourced from across the Children Services Partnership work across the priorities to reduce silo working and support the pace of progress. We more consistently and effectively measure impact of the actions we are taking Within our CSP we have considered how we will know if we have made a difference by delivering the outcomes. Work is ongoing to establish datasets across the priorities to ensure we can evidence that difference and establish performance measures. Page 161
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46 Scaffolding: Working in Partnership Our focus for improvement Our actions and progress to improve outcomes for children, young people and families. We have a series of surveys and engagement work outlined in the plan to progress in year 2 and 3 to see if children and families feel we are having an impact in specific areas. Following our successful CSP launch we have committed to providing a public progress engagement event each year with both the workforce and families invited together to share their views. The next one is planned for September 2024. The co-ordination of continuous improvement activity improves Due to staff capacity and absences, we have only managed to complete a high-level performance framework in this first year, although we have identified a performance and self-evaluation framework to develop and embed. As outlined above in this first year we have: • established a new governance structure with strategic groups focused on each of the priority area • developed progress reporting processes in consultation with the chairs of the strategic groups • established Partnership Chairs Meeting to ensure the intersectionality across our thematic priorities is well evidenced and work is co-ordinated. Page 162
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47 Measuring Progress The progress made this year has been the following: • Agreed that the Children and families Joint Strategic Needs Assessment (JSNA) will be updated annually, secured a resource with this work ongoing • The adult JSNA has been completed. There is now a holistic picture available of needs within Moray. This will help the identification of key areas where joint working between adult & children services will have the most impact • Identified a performance management and self-evaluation framework we plan to embed across the partnership • Our new governance structure is established with the different strategic groups developing priority-based datasets. These strands of work will come together to form a robust process for the collection and analysis of useful data and provide a set of data that will help inform the JSNA going forward • a source of data has been identified for all the wellbeing indicators which includes a commitment to run the Health & Wellbeing survey across Moray schools every 2 years. The survey is scheduled to run again in the autumn/winter term this year. We aim to increase the percentage of young people completing the surveys, especially within our senior phase school population. • Identified specific measures that demonstrate the 8 SHANARRI wellbeing indicators we will track. See http://www.moray.gov.uk/downloads/file150784.pdf Page 163
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48 Appendix I Moray’s Whole Family Wellbeing Fund Update Question 1. Activity Title and description Question 2: During this year, how has this activity contributed (or expected to contribute) toward one or more short term, intermediate or long term WFWF logic model outcome(s) identified in your WFWF initial plan. Question 3. Estimate of percentage of WFWF funding spent on this activity to date and estimate of percentage of this activity out of total WFWF budget Activities Undertaken Activity 1: build on the successes of the locality planning model as highlighted through the external evaluation of the pilot model Extension of the wellbeing co-ordinator’s post and further develop remit Roles have been extended for 2 years and the work has been developed to include more coaching and supporting of the named person and the Team Around the Child (TAC). This includes focusing on hearing and understanding children and family’s needs and voice and co- ordinating support packages and managing access to the early year’s based whole family support provision. Working with the social work access team to identify families not needing statutory intervention to coordinate support plans to meet their needs. These specific roles are: • Contributing to removing barriers to existing support, • Improving access to specific parts of our developing system which is resulting in increasing the number of families receiving support. • The role is focused on ensuring the right support is identified and accessed. • A total of 228 child planning meetings were attended in this reporting year compared to 40 in the previous year (470% increase) and there was a 4% increase in referrals received from social work Costs: £115,780 Year 23/24 (22% of annual funding) Activity 2: build on the successes of the locality planning model as highlighted Investment in 3rd sector to lead the locality networks. The networks are made-up of community organisations and frontline practitioners who have a remit to improve outcomes for children and families within the individual communities which make up Moray. Costs: £13,265 Yr 23/24, (2.4% of funding, expected to rise to 8.8% of next year’s funding) Page 164
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49 through the external evaluation of the pilot model The work of the locality networks is outlined in the strengthening families update. This has been positively impacted by the availability of 3rd sector chairs now that paid contracts have been established. The paid roles have been confirmed for a further year. There has been an increase in third sector and community group membership of the networks. Next steps of the networks are to focus on finding partnership-based solutions to low level needs identified within the CSP or to any emerging need coming through. Outcomes: 3rd sector partners are leading the networks, having a key role in the development of support at early stages. The increase in membership of the locality networks evidence more collaborative working developing Activity 3: Build capacity in the system to design and deliver holistic family support Recruit a senior manager to coordinate system design/re-design and implementation We have continued to experience challenges in capacity to move this forward, with some of our mitigating actions also impacted by staff absence. Work was outsourced to Aberlour Trust to continue progress looking at current provision and systems in place and to development the intensive support elements of our pathway. (Combined CORRA funding, community MHWB funding to complete this). We are still to recruit to this role which will be part of considering the sustainability of our progress going forward and post the funding period. Outcomes: Built on earlier family engagement to understand need by the provider engaging with 24 families and 88 professionals working with families. This builds on the work by Arrows and Children 1st described in the strengthening family’s priority update. This work has been led by a 3rd sector organisation ensuring they have taken a lead role in the development of holistic family support. Our strengthening family strategic group is in place and has overseen the work to date in this area. Delays in recruitment to role, mitigated by funding the 3rd sector by CORRA funding to undertake work Page 165
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50 Activity 4: build capacity in the system to design and deliver holistic family support Recruit a learning and development coordinator A coordinator has been recruited and is due to start post in the next reporting period. A Multi- agency Learning and Development Strategy including a training programme has been developed to support the coordination of training. The multi-agency learning and development group is established. Financial costs of this role will be within 24/25 years onwards (10.9%) Activity 5: development of intensive family support provision Investment in design and delivery of intensive holistic family support testing with families affected by substance use Quarriers Arrows drugs and alcohol service have piloted a whole family support service as part of their recovery service. Highlights of the services are outlined in the family priority update. Evaluation continues of the test of an intensive support offer for families affected by substance abuse provided by through an adult focused service. Outcomes: we should establish through evaluation of impact how we can combine adult /child focus services together, in turn informing both adult and children service delivery going forward. This represents 25% of the WFWF annual budget. £135K in Yr 2023/24 Activity 6: NEW development of prevention/early intervention family support Investment in 3rd sector to expand the provision of PEEP and contribute to development of universal pathway Within the reporting period we have committed to this and began the procurement process. Since the reporting period we have agreed a contract with Action for Children Outcomes: Parent surveys have evidenced how strongly parents value PEEP opportunities. Through the work we will be increasing access until we reach a universal offer for all families with children up to 5 years delivered within their communities. We have plans to work with the 3rd sector provider to sustain the provision through accessing other external funding sources going forward. Financial commitment has been made in this financial year will costs accruing from next financial year. Cost n/a in 23/24, 90K for 24/25, 17% 90K for 25/26, 17% Page 166
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51 Activity 7: NEW development of early intervention support relating to family mental wellbeing Procurement of provision to support parents to understand and best support their child’s mental wellbeing including exploring their own mental wellbeing resilience Working with one of our MHWB providers we have developed an approach that enables parents to directly access support and advice on mental wellbeing issues which are impacting their family. The work includes supporting parents to self-evaluate their own mental wellbeing and resilience as part of the support provided. A pilot of this work was undertaken this year and is outlined in the mental wellbeing priority section, including a link to the report. In total 235 parents were involved in the pilot. The pilot is being extended for up to 2 years and will develop to include more rural based families, kinship parents and fathers in the support and developing links into adult MHWB services so we can establish an open door approach to accessing support. Outcomes: parents are shaping this provision to direct where the focus is and to develop this new type of support that incorporates the parent and child needs through the parents’ perspective and experience. Next steps include integrating this into the community hubs to widen access routes. Costs n/a for 23/24, forecast 60K for 24/25 11%, 60K for 25/26 11% Question 4: Overview of progress to date Progress remains slower than anticipated due to local capacity issues, recruitment challenges as well as significant leadership change. Recommendations from the external evaluation of the locality planning model have been taken forward. Tendering process have been planned to invite the 3rd sector to lead on the development and coordination of Moray’s universal offer of PEEP to all families as part of our prevention and early intervention offer and a successful pilot looking MHWB through a holistic family lens has been so successful other areas are approaching our provider to work with them. We have a family support pathway emerging from our exploratory work and pilot activity (PEEP test for change work, Drugs and alcohol-based family support, 3rd sector based system design project completed applying a system design approach) and have identified our next steps in that redesign. It’s important we take our time and pause where needed to collate our learning to ensure this remains a joint up partnership-based process. The flexibility in the WFWF funding criteria and Page 167
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52 timelines for spending are supporting this approach. We are utilising other funding streams alongside the WFWF in a bid to make changes more sustainable which results in our funding being allocated more progressively. Progress of our initial plans are detailed in question one and two above. The advancement on those activities includes the development of community hub and spoke models within 3 of our locality areas exploring using schools as the hub and reaching out into the community and other settings. We are now investing in family link workers to support the model to continue to develop further. Question 5. main successes to delivery and factors enabling nice successes Our successes to date have been our partnership commitment and working which includes several of our 3rd sector partners. The 3rd sector has been contracted to lead on parts of the designing/redesigning work to date. Th embedding of our revised governance structure including the multi-agency strengthening family’s strategic work. We have tried 3 variations on the hub and spoke model in different localities enabling three sources of intelligence to help shape our redesign further. The wellbeing coordinators roles continue to develop in response to the redesign and are central to ensuring our developing pathway feels connected. Question 6: main challenges to delivery and plans to mitigate Capacity to coordinate and recruit the right staff to undertake this work remains a key challenge. We have been experiencing and continue to experience: • Senior leadership change across our partnership which takes time to embed, being a small local authority we have fewer leadership positions making this extent of change highly significant • A lack of capacity in our current staff provision which is being further impacted by staff absences in key roles to lead this work but also in our day-to-day service delivery. Most senior staff hold a wide remit which leaves little capacity to cover absences • Our larger 3rd sector providers also experiencing substantial senior management change which impacts there readiest to undertake new work or approaches which has limited its mitigating impact Mitigating factors going forward are that our new leadership team is now fully in place (although temporary) and that leadership team is committed to our children services plan. Our close partnerships with our 3rd sector colleagues mean we should be able to move forward quickly when they have stabilised Page 168
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53 Despite the challenges we have managed to progress key projects due to our partnership approach which has provided further intelligence and insight into need and access to support which we can now integrate into the developing pathway. Question 7: how have the activities and outcomes in section 1 have been informed by different stakeholders Our 3rd sector partners have been key to our progress so far support journey mapping and engaging families directly and we now have 2 further providers now contracted to provide support through our WFWF. The Intensive family support offer within our emerging pathway has significantly grown in the last year, it is not reliant on this funding stream but has been informed by the work undertaken and through benchmarking models in other areas. Any other comments The flexibility to carry over funding is crucial in the current environment and enables time to fully utilise service design and quality improvement methodology to develop theory of changes and apply them. Page 169
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54 Appendix II Photo Gallery Care Day Celebration- raising the flag ceremony Employability post school summer programme Elgin high School- Big Breakfast with STV Children Appeal Engagement at Children’s Services Plan Launch Event Page 170
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: CAREFIRST REPLACEMENT - UPDATE BY: INTERIM HEAD OF SERVICE & CHIEF SOCIAL WORK OFFICER 1. REASON FOR REPORT 1.1 To inform the Board of the progress of the replacement Social Work and Social Care case management system and the outline business case. 2. RECOMMENDATION 2.1 The Board are requested to: i) consider and approve the outline business case at Appendix 1; ii) note the amended project timescales at Appendix 2; and iii) note approval for funding will be subject of a future report following the outcome of the tender process and further details are known. 3. BACKGROUND 3.1 CareFirst 5 was implemented in 1998 and upgraded to CareFirst 6 in 2010. The last upgrade took place in 2017. A report was submitted to Moray Council Audit and Scrutiny Committee on 23 November 2022 (para 7 of minute refers), and Moray Integration Joint Board (MIJB) Audit, Performance and Risk Committee on 24 November 2022 (para 7 of minute refers), providing an update on Internal Audit Completed Projects which included reference to a review of the CareFirst System undertaken and asked the Committee to note the recommendation to replace CareFirst. 3.2 A report was submitted to this Board on 25 January 2024 (para 12 of minute refers) where approval was given to initiate the process to begin scoping a replacement system and subsequently the current contract was extended for a further year to 31 March 2025. 3.3 A further report was submitted to this Board on 27 June 2024 (para 10 of minute refers) where it was noted that project resourcing would be from existing staff complement, that priorities for Moray Council procurement would be Item 14. Page 173
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realigned to create capacity to support the replacement Carefirst project, and approval was given to progress the outline business case (OBC) by September 2024. 3.4 A report was requested by and submitted to Moray Council Audit and Scrutiny Committee on 11 September 2024 regarding the progress in replacing the existing Carefirst system (para 11 of minute refers), following the paper submitted to that Committee on 14 February 2024 (para 6 of minute refers) in relation to a follow up review undertaken by Internal Audit. 3.5 A progress update report was submitted to the Board on 28 November 2024 (para 11 of the draft minute refers) outlining the governance process being followed and the amended timescale for submission of the OBC was approved for January 2025. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The OBC was presented to the Moray Council ICT Gateway meeting on 26 November and was accepted and supported. 4.2 The project has been classified as having a strategic impact so in accordance with Moray Council governance framework, the OBC was presented to the Moray Council Corporate and Senior Management Team meeting on 4 December 2024. Consideration was highlighted for the potential for progressing with a shared service in this regard, with the other Councils and health and social care partnerships in Grampian. Unfortunately, this is not possible as both Aberdeen City and Aberdeenshire have progressed to new systems and are already in the process of implementing and embedding these, however the option was added into the OBC as it had been considered and discounted. The discussions also highlighted opportunities for potential sharing of data, through the integrated system, with Education and Housing, and this will be included and progressed through the project working group. It was also highlighted that it would be beneficial to include automated records management as part of the specification going forward. The OBC, attached as Appendix 1,has been amended to incorporate the comments provided which will also ensure these aspects are included in the specification. 4.3 There was some discussion regarding funding for the system. The usual process followed would be to agree a budget prior to progressing to tender. However, due to the multitude of variables regarding whether to choose a Cloud based or locally hosted system and the associated implications regarding calculations for costs for licences, maintenance and support, which then has a direct impact on the consideration of how the system may be funded. In order to establish the cost of the system it is necessary to progress the specification and then tender process, that will deliver on the business case requirements. Subsequent discussions regarding how it is to be funded will need to be clarified once costs are known, so this is currently classified as a known budget pressure for MIJB as it is an essential system. 4.4 It has been recognised by all parties that there is an urgent need to progress the implementation of a fit for purpose primary recording database for the Social Work and Social Care records. Page 174
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Learning from Others 4.5 As reported previously, data cleansing and process mapping are key elements highlighted by other partnerships that have migrated to a new system. Progress has commenced on data cleansing with an initial focus on Adult Services social work and some initial pilots for process mapping using available software have been scheduled, which will inform the focus for the main plan. Project Timeline 4.6 A revised project schedule is shown at Appendix 2. The detail for the schedule for implementation will be completed once the tender process is completed and it is known what type of system and who the provider will be. Resources 4.7 Recruitment for the secondment for a dedicated senior project officer has progressed. Moray Council Procurement and ICT staff have been identified to support the project and the Board and working group have been established. 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” Providing staff with effective tools to provide the right support and the right time in the right place is essential for meeting people’s outcomes, the fundamental aim of the strategic plan. (b) Policy and Legal There are no legal implications arising from this report. (c) Financial implications The only budget currently allocated is the current revenue costs for support and as yet no additional provision has been made in MIJB or Council budgets, however as the budget setting process progresses a budget pressure will be included for this software. Further discussions will be held with Moray Council regarding funding once the preferred product and financial requirements are known. It is intended to utilise existing staff resource to be project officer. The amount of funding and resources required going forward will be brought back to this Board for consideration in the Full Business Case. (d) Risk Implications and Mitigation To continue with the existing system is a significant risk to service delivery. • Continuing to operate on a legacy system presents potential likely risks of non-compliance with changes to legislation and regulation and provides no opportunity to develop working practices to reflect improvements and good practice. • The recent failure of hardware is indicative of the increasing risk of disruption to services if there are other issues from operating on old hardware. • There is an increased risk of issues with data security as the system is not updated with protection against new cyber threats. Page 175
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• There are risks to efficient and effective working practices e.g. the system does not support uploading of documents, requiring records to be held in alternative storage solutions which impacts negatively on time to search for information. Without the system, service users would have to resort to use of paper based records. • The reporting solution of the existing system does not support provision of robust performance information on which to base decisions. There is a risk to the MIJB budget in that no funding is currently identified so costs will have to be incorporated, therefore requiring potential additional savings to be identified. If the project is not resourced sufficiently there is a risk that it will not deliver the anticipated efficiencies and will not improve staff morale. The proposed governance arrangements through identified resource requirements would enable assurance and oversight of delivery of the project. The audit work previously undertaken noted serious concerns regarding the limitations of the CareFirst system, with information regarding social care users needing to be retained on a Council server or in paper files. In addition, issues were also noted regarding access and information management controls within CareFirst. The Chief Internal Auditor of MIJB is very concerned about the current recording arrangements of very sensitive information, the risk of maintaining multiple databases, and the CareFirst System not being supported. He is of the view there is an urgent need to agree on a future direction of how social care information should be recorded that will allow officers to effectively manage the needs of social care users in accordance with policies/ regulations while still ensuring strong information management controls are maintained. (e) Staffing Implications It is intended a senior project officer be appointed from an internal secondment in Health and Social Care Moray (HSCM). There will also be significant input required from working group members and from other staff across services who will be involved in process mapping exercises to streamline ways of working before introduction of a new system. It is anticipated that additional ICT resource will be required which will be identified in the full business case. (f) Property There are no property implications arising from this report. (g) Equalities/Socio Economic Impact An equalities impact assessment is not required as there is no change to service delivery arising as a result of this report. (h) Climate Change and Biodiversity Impacts There are no climate change implications arising from this report. (i) Directions Page 176
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There are no directions arising from this report. (j) Consultations Chief Officer; Chief Financial Officer; Interim Head of Service/CSWO, Information Systems Officer, HSCM, Chief Financial Officer (Moray Council), Head of Human Resources, ICT & Organisational Development; Senior Auditor and Caroline O’Connor, Committee Services Officer, Moray Council have been consulted and their comments have been included in the body of the report. 6. CONCLUSION 6.1 This report contains the OBC and amended timescales for a replacement information and case management system for Social Work and Social Care services in HSCM. Author of Report: Jeanette Netherwood Background Papers: Carefirst Replacement, Moray Integration Joint Board 28 November 2024 Carefirst Replacement, Moray Integration Joint Board 27 June 2024 / Appendix 1 / Appendix 2 / Appendix 3 CareFirst Replacement, Moray Integration Joint Board 25 January 2024 Internal Audit Section – Completed Projects Report, 24 November 2022 Internal Audit Section Completed Projects Report – Appendix 1 Internal Audit Section Completed Projects Report – Appendix 2 Setting the Bar Social Work Scotland, May 2022 Ref: Page 177
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Outline Business Case for Strategic Projects Version Number: 1.1 Created: 21/01/2025 09:5818/11/2024 16:41 Saved: 21/01/2025 11:5020/01/2025 17:14 http://smi.moray.gov.uk/mpg/pro1/24-006 carems/01_project_information/20250127 final_outline_business_case_replacement_carefirst.docxhttp://smi.moray.gov.uk/mpg/pro1/24-006 carems/01_project_information/outline_business_case_replacement_carefirst.docx Page 1 of 37 Contents 1. Version History ......................................................................................... 2 2. Executive Summary .................................................................................. 2 3. The Strategic Case ................................................................................... 3 3.1 The Strategic Context ......................................................................... 3 3.2 Aim...................................................................................................... 4 3.3 Objectives ........................................................................................... 4 3.4 Existing Arrangements ........................................................................ 5 3.5 Business Needs – Current and Future ................................................ 6 3.6 Potential Business Scope and Key Service Requirements ................. 8 3.7 Main Benefits ...................................................................................... 9 3.8 Main Risks ........................................................................................ 12 3.9 Constraints ........................................................................................ 14 3.10 Dependencies ................................................................................ 15 4. The Economic Case ............................................................................... 15 4.1 Critical Success Factors ................................................................... 15 4.2 Short List Options ............................................................................. 17 4.3 Options Appraisals ............................................................................ 20 4.4 The Preferred Option ........................................................................ 25 5. Commercial Case ................................................................................... 25 5.1 Required Services ........................................................................ 2625 5.2 The Procurement Process ................................................................ 26 5.3 Procurement strategy and implementation timescales ..................... 26 5.3.1 Contract Lengths .................................................................... 2726 Name of Document: Outline Business Case Author: Jeanette Netherwood Description of Content: New Case Management System for Social Work and Social Care Status: Version 1.1 Approved by: HSCM Social Work and Social Care Information Management System Board Date of Approval: 20/1/25 APPENDIX 1 Item 14. Page 179
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Outline Business Case Page 2 of 37 5.3.2 Charging Mechanisms ............................................................ 2726 6. The Financial Case ............................................................................. 2726 6.1 Overall Affordability ....................................................................... 2726 6.2 Funding Source ............................................................................ 2726 6.3 Impact on the Income & Expenditure Account .............................. 2827 7. The Management Case ...................................................................... 2928 7.1 Resource Requirements ............................................................... 2928 7.2 Programme Management Arrangements .......................................... 30 7.3 Project Management Arrangements ................................................. 30 7.4 Project Reporting Structure ........................................................... 3231 7.5 Arrangements for Change Management ....................................... 3635 7.6 Arrangement for Benefits Realisation ........................................... 3635 7.7 Arrangements for Risk Management ............................................ 3736 7.8 Gateway Review Arrangements ................................................... 3736 Use of this document: The content of this document provides the outline sections for completion of an Intermediate Business case. The guidance and summary checklists under each section should be removed as the document is populated and before submission for approval. For further information please refer to a completed example of the Intermediate Business case. 1. Version History Version Date Details 0.1 10/5/24 Initial draft created by Jeanette Netherwood 0.2 15/11/24 Revised and updated by Jeanette Netherwood following feedback from OMT and SMT and colleagues in ICT, procurement, performance and systems 1.0 15/11/24 Final Version for ICT Gateway 27/11/24 “Approved to allow proceeding with procurement process which is required to ascertain detail on options and costs with full business case required thereafter.” 1.1 13/1/25 Updated to incorporate feedback from SMT/CMT meeting on 6/12/24 for submission to MIJB 30/1/25 2. Executive Summary As technology develops the council must look to explore new opportunities that become available to add efficiencies and improve service delivery. This outline business case considers the issues and options regarding replacement of the core case information system used by all Social Work and Social Care services within Health and Social Care Moray. The system is Page 180
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Outline Business Case Page 3 of 37 used to record needs and outcomes for individuals, the chosen delivery mechanism for provision of support, and progress in achieving the individuals’ outcomes. The current system, CareFirst, is now a legacy system, was implemented in 1998 with the last upgrade in 2017. It no longer supports any form of development, legislative updates or new reporting requirements. However, there are financial challenges for MIJB and Moray Council so procurement of a new system will present a significant budget pressure. 3. The Strategic Case 3.1 The Strategic Context The current financial situation for Local Government and National Health services is challenging. The UK and Scottish economy are forecasting low growth, and this means pressure will continue for the foreseeable future. However, with the backdrop of this economic challenge there are opportunities to review how we provide services and design more effective and efficient models. National Strategies 1 A changing nation: how Scotland will thrive in a digital world The Scottish Digital Strategy was refreshed in 2021 Part three of the strategy Digital Government and Services identifies the need to deliver and tailor services so they are responsive, matched to their needs and provide efficient and quality access to services. Setting the Bar report commissioned by Social Work Scotland in May 2022 highlights the challenges being faced by social work practitioners in Scotland, the increasing number and complexity of workloads and the dissatisfaction level of 78% (1,238 of 1,588 responders) highlighting issues relating to high administrative workloads as a main cause of dissatisfaction. Therefore, there is a need to streamline administrative processes to release capacity for practitioners to meet people and provide support. Local Strategies The Moray Integration Joint Board vision is :- Page 181
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Outline Business Case Page 4 of 37 “We come together as equal and valued partners in care to achieve the best health and wellbeing possible for everyone in Moray throughout their lives.” One of the strategic missions is to “Improve the efficiency of health and social care services to ensure we spend public money on services which achieve good outcomes for people (better value)”. The introduction of a modern system, for recording information about people who need support and monitoring how Health and Social Care Moray provides that support and successfully meets agreed outcomes, underpins the strategic vision and mission. Consistent, accurate and timely recording of data will facilitate the flow of information to the right people at the right time enabling evidence-based decisions to be made operationally and for trends to be analysed to inform Strategic Commissioning plans for future. 3.2 Aim Health and Social Care Moray aims to achieve good outcomes for people who receive our services and for them to have a good experience of the support provided. Implement a modern management information system, which holds one single source of truth for individuals’ in relation to social work and social care information management and has the platform to enable future developments. This system will assist the identification and recording of an individual and their support networks’ needs, defining outcomes, plotting progress and recording when they are achieved. The system will provide a better experience for the individual and for the staff involved. It will provide increased visibility of people’s requirements, which will inform strategic commissioning decisions for further development of sustainable services. 3.3 Objectives Reference SMART Objective Type Measure Objective 1 Achieve implementation of a single source of truth for case management records for social Efficiency System operational and in use by Adult, C&F and Justice services Page 182
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Outline Business Case Page 5 of 37 3.4 Existing Arrangements There are circa 450 users of CareFirst with the majority being frontline social workers and social care workers, the system supports the following functions. • Adult & Children’s Social Work and Social Care Services • Justice Services • Finance • Local Authority Occupational Therapy The system currently supports around 10,000 live cases. There is an interface between CareFirst Financials (CFF) module and the Financial Management System (FMS) for the payment of care homes, however this process is underpinned by two old in-house access data bases which are also end of life. Residential, foster and direct payments are also made via interfaces. There are separate systems for staff scheduling for care at home services and for the equipment loan (stores). There are also Housing colleagues who work and social care by March 2027, that will meet future service needs Compliance Improved assessment of GDPR compliance by Internal Audit by June 2027 Objective 2 Embed the quality assurance and performance monitoring framework for social work services by September 2027 Effectiveness Quarterly reporting embedded across services Feedback from people receiving services (outcomes achieved / Complaints / compliments) Objective 3 Increase staff satisfaction and confidence in use of the information management system by September 2027 Effectiveness Staff survey Training feedback Objective 4 Complete a review of core social work processes to streamline and identify efficiencies by September 2025 Efficiency Report to SMT on identified efficiencies Objective 5 Interfaces Seamless interface for payment to be processed directly to external providers by June 2027. Efficiency Reduction in manual data input Page 183
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Outline Business Case Page 6 of 37 access the system for people who receive a service from Social work or social care. The current CareFirst System is now a legacy system and cannot be upgraded as the supplier has developed a new platform and product. It is possible that the current provider will stop offering support and no further developments of the system may be possible. It is outdated and does not align with other programmes in order to create required performance reporting. Staff working in the field are not able to real-time access or uploading of information, photographs or voice notes which can lead to delays in information being received by those who are making decisions, a problem when dealing with people or families in crisis or Adult Support and Protection issues. There are no mechanisms to support self-evaluation or individuals service interface. The current legacy system is standalone and does not convert to support mobile access, nor access to offline information, a key element to support those working out in communities, particularly our Out of Hours provision. Reports for Statutory Returns, Freedom of Information and team performance are produced from a different system due to the restrictions of the CareFirst system. It currently is not possible to pull performance reports from the system and requires staff resource to achieve the required data. The need for interfaces between CareFirst and other systems has been considered but would be costly, would require a lot of time to build and there is also a possibility that the existing software will not support the process. Without automation of these interfaces there is a risk of increased human errors processing confidential information that, requires to be accurate. 3.5 Business Needs – Current and Future Due to the challenging economic climate, there is a need to ensure all processes and actions are undertaken as efficiently and effectively as possible. Improved User Experience There has been significant growth in Social Work and Social Care activity and related need to record information about individuals. The current system is time consuming and frustrating for staff to use and is not windows based, so is less intuitive to use. Exporting of word documents are of a Word 10 format, and chronologies can be exported but not in a format that can be merged with other agency chronologies. Page 184
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Outline Business Case Page 7 of 37 A more technologically advanced system would reduce frustrations, improve efficiencies and free up social work and social care time to allow more time to be spent with individuals and families coming into contact with services. These aspects have been highlighted in all staff surveys within the past 24 months where staff have raised the challenges of access and usability of the CareFirst platform. Uploading and storage of Documents There is a need for all forms of documents, photographs, feedback surveys etc to be able to be uploaded and attached to a person’s record to ensure that decisions are made with all the up to date information available. CareFirst does not allow documents to be uploaded meaning that documents are stored in various places including paper and electronic files. This causes inefficient searches for information and may result in information being missed. Collating information regarding cases can be very time consuming. A single system for all information would provide a more secure means of holding sensitive information and would allow for staff to access templates and completed documents in one secure place. Partner organisations are not able to upload any information. Reporting Existing reporting by users is limited, the processes adopted across teams is varied so reporting performance is challenging and time consuming. There is a requirement for team dashboards for smarter reporting, better governance and oversight, better financial monitoring in the system, with reports being able to be produced in real time. Statutory returns should be a standard report. GDPR Compliance The system needs to facilitate a single store for all information relating to the person and have appropriate audit trails and automatic application of data retention schedules. Currently there are limited security groupings and audit trails of who has access to information and this is an area of concern highlighted by internal audit. Automated records management inclusion would also be beneficial. Interfaces The interface with FMS is considered essential however there are other systems (Staff plan, ELMS, Address Gazetteer) that would be beneficial in terms of efficiency and effectiveness to either interface with or to have as a module. There is also a need to ensure future developments, such as the DHI living lab work around the personal data store and the ability to use AI for notes will be able to be incorporated. In addition, it has been highlighted that there is no interface between the Education system SEEMiS or the Housing system NEC (formerly iWorld) and Carefirst and potential opportunities for sharing data need further discussion. These discussions will also be taken Page 185
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Outline Business Case Page 8 of 37 forward to identify potential opportunities regarding sharing information with health colleagues. Online Authorisation This would save time for officers involved and would provide a robust audit trail. It would also facilitate improved budget monitoring which in turn would assist in improving forecasting of future financial requirements. Access on the move There is an operational need to have the functionality to access the case management system whilst in the community, especially where there are crisis situations and real-time sharing of information is essential to enable appropriate parties involved to be able to upload and access up to date information. Collaborative Working As we continue to work more closely with third parties there is a need to consider how key information is updated or uploaded, and by whom, to ensure up to date accurate information. (The current system is not cloud based which means users must be logged into the Council Network. This means that currently only users with a Moray Council log in and device can have access to CareFirst). Self-evaluation / Service user interface Moray is progressing a learning and development culture where understanding service user feedback is essential for supporting continuous improvement. Legislation has come into effect (UNCRC Scotland 2024) to require Local Authorities to gather the views of children and their parents / carers, ensuring they are centred within its recording and documents. As we progress there needs a system which can support interface to collate views and feedback which is accessible promoting greater efficiency for the workforce and accountability to those we support to be engaged in their services of support. 3.6 Potential Business Scope and Key Service Requirements CareFirst is used by all Social Work teams across Children and Families, Adult and Justice Services. Discussions have taken place since the project mandate and the following areas for potential inclusion in the project have been identified. a) Expand use of system to cover residential services, care at home and also potential for some housing services access. This again would improve efficiency and data protection(reduces duplication of data held in multiple sources and accessing via one system enhances data controls. Page 186
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Outline Business Case Page 9 of 37 b) future proofing – ensure the system is able to interface with a variety of systems and enables the incorporation of AI tools to increase efficiency in record keeping. c) Incorporate a staff scheduling module to reduce duplication of data held and rationalise the systems required. If this were possible the resources used for the current staff scheduling system could be utilised. This is not possible for the initial contract due to the timing however it should be considered as a future development. Scope Minimum Intermediate Maximum Outcomes Essential/core Desirable Optional Potential Business Scope Adding access to rest of social care services i.e. residential, Care at home Access by approved external parties Access to system/ sharing of information with appropriate housing & education services Staff scheduling system Updating information by approved external parties Key Service Requirements Streamlined processes with interfaces to enable efficient processing and reduction in manual/double entry input e.g. payment to external providers Mobile access to real time data Improved performance reporting and management oversight of budgets and workloads Ability to interface with DHI “Community Connections” Service user feedback captured in the system Ability to incorporate use of AI e.g. to assist note taking 3.7 Main Benefits Page 187
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Outline Business Case Page 10 of 37 Main outcomes and benefits of the potential scope are identified in the table below with Priority H- High, M-Medium or L-Low and Type i.e. Cash releasing (CR), Non-Cash releasing (NCR), Qualitative (QUAL) or Quantitative (QUAN) Objectives Main benefits Priority Type Objective 1 Achieve implementation of a single source of truth for case management records for social work and social care by March 2027, that will be fit to meet future service needs Increased data security from cyber attacks Increased automation of collation of statutory reporting information Increased automation of data retention schedules Removal of duplication of client records Improved oversight - provide ability to upload documents, photographs, drawings, charts etc directly Increase in the effectiveness and accuracy of chronologies (preferably multiagency) Improved access to client-based information for field-based staff by March 2027. Improved ability to share information with partner organisations Increase effectiveness of search facilities System will be supported and be updated for any legislative changes Increased oversight of workloads and performance enabling managers to identify trends and support and improvement mindset H H H H H H H M M H H NCR NCR QUAL QUAL NCR NCR CR NCR / QUAL NCR NCR NCR/Q UAL Page 188
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Outline Business Case Page 11 of 37 Objective 2 Embed the quality assurance and performance monitoring framework for social work services by September 2027 Improved visibility and knowledge of the social work standards Increased consistency in information available and improved accuracy Increase accessibility of standard performance reports for managers Increasing accuracy of information input via validation on data fields. H H M H QUAL NCR NCR NCR Objective 3 Increase staff satisfaction and confidence in use of the case management system by September 2027 Increased staff morale Training in new processes and application of standards provided for all Increase in staff retention H M M NCR QUAL NCR Objective 4 Complete a review of core social work processes to streamline and identify efficiencies by September 2025 Identification of opportunities to streamline processes and have tasks undertaken by most appropriate staff member Increased number and quality of assessments completed on time Increased number and quality of reviews undertaken Development of process maps to support training and consistency of approach H H H M QUAL/ CR QUAL / CR QUAL / CR QUAL Objective 5 Seamless interface for payment to be processed directly to external providers by June 2027 Reduction in staff time processing duplicate entries across different systems Reduction in keying errors Enable use of AI for notes H H M CR CR CR There is the potential for some dis-benefits of a new case management system: - • The cost of a new case management system is a significant pressure at a time when budgets are severely constrained. Page 189
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Outline Business Case Page 12 of 37 • There will remain some reliance on the existing SharePoint site until all records are transferred to the new system and this will take some considerable time. • There will be significant staff resource required from all teams to undertake preparatory work, involvement in testing and training on the new system which will further increase workloads unless additional capacity can be provided. 3.8 Main Risks A number of risks have been identified and will need to be managed throughout the project. A RADIC log has been created and can be found here Risk Description Mitigation 1. Failure to meet specified audit recommendations regarding information governance Ensure audit recommendations are addressed in the specification and award documentation 2. Failure to meet information governance standards and compliance with GDPR Information governance advisor appointed to the working group to ensure all requirements are addressed and system designed and implemented to ensure compliance 3. Inability to extract data to inform use of existing contracts to identify future trends and requirements for strategic commissioning purposes resulting in missed opportunities to negotiate competitive prices and a need to spot purchase at higher prices to meeting individual outcomes. Ensure finance and performance representation on the workgroup so requirements are incorporated into the system specification, design and implementation. 4. Failure to provide resources to preparation for and implement the new system will result in a system that does not meet the specified outcomes Meetings held with other authorities who have recently implemented a new case management system to learn any lessons from their experience and hear recommendations for adoption. 5. Lack of availability of specialist skills (e.g. ICT, procurement, record management, process mapping) to meet key milestones will result in delays to implementation. Initial requirements have been identified in the project mandate and are further expanded in this OBC. A detailed project plan is being developed which will be owned by the Programme Board. The project officer will chair the working group and ensure progress with milestones are monitored Page 190
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Outline Business Case Page 13 of 37 Risk Description Mitigation with any issues being escalated to the Board. 6. Without sufficient budget provision the project will not be able to progress and will not deliver the outcomes required, which would result in failure to meet statutory responsibilities Estimates for budget requirements have been sought using Scotland Excel framework and information from other authorities, however the framework is due for renewal in February 2025. The updated information will be provided to decision makers as soon as it is available. 7. Lack of effective budget and progress monitoring will result in delays to implementation and potential for outcomes not being delivered. The project officer will monitor progress and report through the governance framework, escalating any matters for concern to ensure remedial action can be taken to bring matters back on target. 8. Lack of management buy in to support the prioritisation and allocation of resources to progress the project resulting in the project not progressing effectively. HSCM SMT team and service managers have been consulted and fully support the requirement for a new system that is fit for purpose. It is recognised that there are limited resources but this project has been given priority status. 9. Lack of staff buy in for the need for change of system, to input to consultation and engagement for designing improved processes for use with the new system use and to undertake training in the new system. All staff using the system have been consulted and support the requirement for a new system. It is recognised that it will be additional workload in the short term but the benefits identified are very significant and through continued staff consultation and engagement and a change management plan any risks should be mitigated. 10. Budgetary pressures for Funding – because both funding partners are experiencing significant budgetary challenges there is a risk that agreement over financial support for the additional budget pressure will not be achieved NHSG and Moray Council have been made aware of the requirements through Chief Financial Officer discussions and project mandate has been through the Council governance process. This OBC will be taken through the governance process and Page 191
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Outline Business Case Page 14 of 37 Risk Description Mitigation discussions held between CFO’s to seek resolution. 11. Inability to take forward opportunities presented through the Growth Deal with the work being undertaken by DHI around personal data stores will result in the development being used by other authorities and significant costs in future to use the product developed. The requirements to ensure ability to interface with the DHI personal data store will be incorporated into the specification to future proof and ensure the product can be used by Moray. The support currently in place for CareFirst from OLM (the system provider) is significantly limited and will eventually cease, as OLM have rolled out a new product “Eclipse”. CareFirst is now considered a legacy system so it will not by updated for any changes to legislation or regulation with any associated reporting requiring manual data retrieval and report writing as OLM cannot create new reporting scripts. Every single case open to social work is recorded on CareFirst and staff rely on this to be able to pull together information pertaining to individuals open to services. It is also where managers have oversight of the work being undertaken by staff for prioritisation and performance monitoring purposes. To continue with CareFirst would increase the risk of problems developing that cannot be resolved. We are mitigating these risks by starting a procurement process. 3.9 Constraints Capacity – successful implementation is dependent on sufficient resources being made available from within Health and Social Care Moray and Moray council at the appropriate time to complete all project tasks. Budget – the current financial challenges facing all services may impact on this programme and the budget available to deliver the service in the future. There will be a need to pay for the existing system for at least a year to cover a transition period. Timescales – the system is legacy and an extension has been secured for an additional year to March 2025. This will not be sufficient time to procure and implement a new case management system. These risks have been included in the RADIC Log Page 192
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Outline Business Case Page 15 of 37 3.10 Dependencies Streamlined processes When implementing a new computer system, it is prudent to consider if processes are as efficient as they can be. There are some core processes that all teams use that should be reviewed and the outcome of this should inform implementation of the system. These tasks will be detailed in the project plan and progress monitored by the board. Data cleansing Information from other authorities who have changed systems recently advises early work to ensure data is as accurate and in correct formats to prevent delays in implementation. Input required from many teams This project will be dependent on timely support, engagement and consultation from a wide variety of specialist staff and teams, within HSCM and Moray Council in order to meet milestones on time. 4. The Economic Case 4.1 Critical Success Factors Strategic fit and business needs To provide a case management system that is the one source of information pertaining to an individual in receipt of social work and social care service. The system needs to facilitate recording and reporting of outcomes and monitoring of service delivery in progressing to delivery of outcomes. It needs to support future developments and interfaces with other systems to increase efficient and effective working practices. Potential VFM The system should reduce staff time spent recording, searching and reporting and will build capacity into social work and social care teams, which will allow for Page 193
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Outline Business Case Page 16 of 37 more timely client contact, carrying out and improved recording of reviews which will ensure that people’s outcomes are monitored, and support is appropriate. The data will then be reported more consistently and timeously resulting in confidence that funds are allocated appropriately and equitably. Interfaces with existing systems will reduce duplication of records and manual input. Potential achievability Similar solutions have been successfully delivered in other partnerships in Scotland. The ability to implement a system across all teams will require significant work from services migrating in testing to ensure configuration meets business needs and in undertaking training to ensure staff competence and confidence in the new system. There will be a need for appropriate resources from ICT to facilitate the change. Supply-side capacity and capability There are currently a number of suppliers successfully delivering solutions to other Health and Social care partnerships and local authorities, 5 of which are on the Scotland Excel framework. These suppliers have been assessed as being able to deliver. Through engagement with other authorities who have implemented systems recently their lessons learnt will be incorporated into implementation plans. There will be a requirement for sufficient appropriate staff resource to be released throughout the stages of this project to ensure successful implementation. Potential affordability Revenue costs of the existing system equate to £104k per annum currently which will be available for allocation once the new system is operational. Releasing staff time from bureaucratic administrative processes will improve productivity and create capacity so that tasks can be undertaken by less staff. It is anticipated that it will enable some difficult to fill vacancies to be released. This will be evidence by the process mapping review work to be undertaken. Page 194
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Outline Business Case Page 17 of 37 4.2 Short List Options A SWOT assessment was undertaken of the options for scope, service solution, service delivery, implementation and funding and is shown in Appendix 1 and this helped inform the options presented in the table below. Option 1 Option 2 Option 3 Option 4 Option 5 Case Management System (As is) Case Management System (Minimum) Case Management System (Extended) Case Management System (Extended) Case Management System (Maximum) Case management system and finance module Core Case Management System including finance and reporting modules and potential to interface to other systems and access to information in the field. As option 2 but also expanding access to system to supported accommodation, day services and social care services. Additional interfaces e.g. with stores and personal data store As option 3 but also incorporating approved partner access and update. It also incorporates feedback mechanisms from those who use the service As option 4 but also incorporating a staff scheduling module Interface with Payroll 4.2.1 Option 1 – status quo Retain the existing CareFirst system provided by OLM. Benefits: No changes for staff Risks: • This is a legacy system that is not fit for purpose any longer, does not support efficient ways of working. • Old hardware and technology – there was a server failure in July 2024 resulting in service outage of 5 hours. As the hardware is old it is more difficult to find parts and the likelihood of failure increases, which will impact on our ability to use the system. • Data Protection - is it does not allow uploads of core documents so requires storage of documents in a separate location which is not good Page 195
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Outline Business Case Page 18 of 37 practice, does not have good search facilities and so increases the potential risk of data breaches due to inconsistent naming conventions. • Product support – has essentially ceased now that the company has a new product. No updates to the core product are being made by the company, so there is a risk that if there were any changes in legislation, we would be non-compliant. • Finance module – the current finance module can only be partially used; due to the way it has been implemented and its reliance on two old databases to underpin the interface. Costs : The cost of the legacy system will increase each year by RPI for as long as the system is available. This is not considered a viable solution 4.2.2 Option 2 – the do minimum For services currently using CareFirst Benefits: a) provision of a system that holds the information for each person who uses the services and is the single source of truth. Information will be supplied in a variety of formats and document types. b) The system will be fully GDPR compliant and have good audit trails and security for access. c) It will have an integrated reporting tool that provides statutory reports and easily accessible management information. d) It will have a financial module and have the ability to interface with other systems to enable future developments and efficiencies. Risks:- • Capacity of core services to support implementation due to competing priorities • Services will need to respond to engagement and consultations timeously which may be challenging where there are competing priorities. Costs:- initial estimates are £1.254m over 5 years This option will cover the core requirements of a system to meet service needs and enable improvements to working practices that will deliver efficiencies. Page 196
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Outline Business Case Page 19 of 37 4.2.3 Option 3 – the do intermediate This option includes all the elements of option 2 but also includes expansion of the use of system to other social services, enabling of interfaces to other systems and accessing information on the move (mobile technology). Benefits:- • This option would reduce duplication of files and facilitate better sharing of information between services who work with individuals giving a more complete picture. • It would provide additional efficiencies in ways of working, reducing double entries which would save staff time. • Improved effectiveness and efficiency where social workers and other staff need access to real-time information when in the field especially during periods of crisis. Risks :- as for option 2 above Costs : - as for option 2 above however there maybe additional costs for interfaces that would need to be offset by identification of efficiencies in working practices. 4.2.4 Option 4 – the do intermediate extended This option includes all the elements of option 3 and incorporates ability to update and potentially access data held by other approved partners and to provide a mechanism for collating feedback from people using services. Benefits:- • As for option 3 • Allowing partner access would streamline processes and increase efficient working practices through information being updated more quickly and being used by partners supporting particular individuals. • There is a statutory need to collate feedback from people using services and the ability to do this via the core system would be beneficial. At present this need will be achieved via external mechanisms which will not be linked to the system directly. Risks:- • As for option 3 above • Uncertainty regarding specific requirements, access restrictions and data security implications Page 197
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Outline Business Case Page 20 of 37 • Uncertainty of availability of solution for collating feedback within core systems at this stage Cash :- likely to be additional costs for additional functionality 4.2.5 Option 5 – the do maximum This option includes all of option 4 and adds the interface or a module for staff scheduling that is compatible to the main system and will enable one record to be held for people using services. Also adds the ability to interface to payroll system. In the interim a procurement exercise will be carried out to secure a system but ultimately it would be preferable that the system functionality and core information for the individual were in one integrated system. Benefits:- • Amalgamation of other staff scheduling systems into one would ensure the single source of truth about people using services, with the most up to date information available. • Potential reduction in costs for additional systems • Efficiencies relating to removing need for paper timesheets Risks:- • Uncertainty regarding ability to deliver within the resources available for the project. • Uncertainty that a supplier will be able to provide an integrated solution Costs:- • costs will be more than option 3 as there is increased functionality. • There is potential for efficiencies in reduction paperwork and time for processing timesheets. • There would be the budget currently allocated to the existing staff scheduling solution (circa £64k) but contracts would need to be aligned to release these funds. 4.3 Options Appraisals The summary option appraisal was undertaken by the core delivery group and reviewed by Senior Management Team. Given the significant budgetary challenge HSCM has to address, delivering this project with additional spend controlled as tightly as possible has been identified as a key factor. Page 198
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Outline Business Case Page 21 of 37 Each option was fully considered in respect to the level of fit with the System replacement objectives and with the Critical Success Factors (CSFs), as set out above. This assessment was summarised in terms of the degree to which each option satisfied the objective or success factor on a scale of: • x – fails to meet some key aspects of CSFs / SROs • ? – possible satisfaction of CSFs / SROs • Y – meets most aspects of CSFs / SROs • YY - strong fit with CSFs / SROs Page 199
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Outline Business Case for Strategic Projects Version Number: 1.1 Created: 21/01/2025 09:5818/11/2024 16:41 Saved: 21/01/2025 11:5020/01/2025 17:14 http://smi.moray.gov.uk/mpg/pro1/24-006 carems/01_project_information/20250127 final_outline_business_case_replacement_carefirst.docxhttp://smi.moray.gov.uk/mpg/pro1/24-006 carems/01_project_information/outline_business_case_replacement_carefirst.docx Page 22 of 37 Reference to: Option 4.2.1 Option 4.2.2 Option 4.2.3 Option 4.2.4 Option 4.2.5 Description of Option: Do Nothing/ As is Case management system and finance module Minimum Core Case Management System including finance and reporting modules and potential to interface to other systems. Access to data on the move (mobile solution) Intermediate As option 2 but also expanding access to system to supported accommodation (Adult and C&F), day services and social care services. Additional interfaces with stores and personal data store Intermediate extended As option 3 but also incorporating approved partner access and update. It also incorporates feedback mechanisms from those who use the service Maximum As option 4 but also incorporating a staff scheduling module and payroll interface Objective 1 Achieve implementation of a single source of truth for case management records for social work and social care by March 2027, that will be fit to meet future service needs x Y YY YY YY Page 200
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Outline Business Case Page 23 of 37 Objective 2 Embed the quality assurance and performance monitoring framework for social work services by September 2027 x Y Y Y Y Objective 3 Increase staff satisfaction and confidence in use of the case management system by September 2027 x Y Y Y Y Objective 4 Complete a review of core social work processes to streamline and identify efficiencies by September 2025 Y Y Y Y Y Objective 5 Seamless interface for payment to be processed directly to external providers by June 2027 x ? Y Y Y CSF’S Strategic Fit / Business need X Y Y Y Y Potential VFM X Y Y ? Y Potential Achievability Y Y Y ? ? Supply side capacity ? Y Y ? ? Potential Affordability Y ? ? ? ? Page 201
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Outline Business Case Page 24 of 37 Costs Y Y Y Y Y Risks N Y Y Y Y Summary Discounted Possible Preferred Possible Possible Page 202
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Outline Business Case for Strategic Projects Version Number: 1.1 Created: 21/01/2025 09:5818/11/2024 16:41 Saved: 21/01/2025 11:5020/01/2025 17:14 http://smi.moray.gov.uk/mpg/pro1/24-006 carems/01_project_information/20250127 final_outline_business_case_replacement_carefirst.docxhttp://smi.moray.gov.uk/mpg/pro1/24-006 carems/01_project_information/outline_business_case_replacement_carefirst.docx Page 25 of 37 4.4 The Preferred Option The preferred option selected from the Options Appraisal is: Intermediate As option 2 but also expanding access to system to supported accommodation, day services and social care services. Additional interfaces with stores and personal data store Option 3 was selected as the preferred options as it will provide the security and additional functionality required but with least cost implications at this stage. There is the potential for development into options 4 and 5 over time if/when funds and project capacity are available. 5. Commercial Case Discussions have been held with a procurement officer to determine the best possible route to market. The following options were identified: a) Use of Scotland Excel framework a. The providers on the framework have already been assessed for compliance for a lot of the key aspects for data protection and cyber security so it would take less time to tender b. 5 Scottish Local Authorities are using the Scotland Excel contract, so it is tried and tested and we can learn from their experiences Given the limitations on timescales, and the fact that 5 suppliers on the Scotland Excel contract are used by other Scottish Local Authorities, it would seem a prudent and less risky approach. However, the case management framework on Scotland Excel is due to expire on 14 February 2025 so we are not able to confirm what the new framework will look like, nor which suppliers will be on the framework until it is live. Page 203
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Outline Business Case Page 26 of 37 b) Open Tender a. May provide a greater variety of providers to choose from b. Will be more time-consuming to prepare tender and score as more onus on us to check compliance and standards compared to using a framework c) Shared Service pan Grampian a. By combing with other partners across Grampian we could share the workload and seek economies of scale for a system. b. It would be extremely challenging to establish standard processes across all three authorities and the various functions within so would require significant up front work prior to going to tender. At this time this option is not viable because Aberdeen City have already progressed with a Microsoft product which they are tailoring to there own processes and Aberdeenshire are in year 3 of an implementation of the OLM product “Eclipse” and both parties are in contracts. The preferred option is to use the Scotland Excel Framework, however this approach will need to be reviewed once details of the new framework are available. 5.1 Required Services A detailed service specification document will be compiled to identify all the service requirements. Information shared by other authorities who have been through the process will be used for reference and their lessons learnt will be incorporated, to ensure the specification is as robust as possible. A working group of system users, system support, ICT representation, information governance and performance reporting will collate the requirements and wider engagement with a draft version will be completed prior to finalisation for the procurement process. 5.2 The Procurement Process A mini competition would be conducted using Scotland Excel framework and adhering to the Moray Councils Procurement Process. Page 204
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Outline Business Case Page 27 of 37 5.3 Procurement strategy and implementation timescales Please refer to The Moray Council Procurement Strategy document along with guidance from the procurement team when outlining the appropriate procurement strategy and timescales expected. As this contract is a high value, high risk contract a Procurement Strategy (PR08) will be completed with support and guidance from the procurement officer. Anticipated timescale is circa 6 months from specification drafting to award, with an estimated allowance of 18 months for implementation. 5.3.1 Contract Lengths A framework can only be for 4 years but a call off can be longer but it will not be possible to determine what options there are until there is sight of the documents on the framework. If the open tender route is selected it may take slightly longer to complete the procurement and tender process but it would enable a contract for a longer period. Advice will be sought from Procurement on the most appropriate route once approval to proceed is obtained and the new Scotland Excel Framework is available to review. 5.3.2 Charging Mechanisms N/A 6. The Financial Case 6.1 Overall Affordability The indicative costs of the project is estimated at £1.254m over 5 years. 6.2 Funding Source HSCM is being charged £104k for year to 31 March 2025 for the current system. This has increased from £94k the previous year. There is no contract in place. The supplier, OLM, provided indicative figures for continued provision of existing functionality in the table below, but there are no guarantees that the system will be available in future years. Year 1 2024/25 Year 2 2025/26 Year 3 2026/27 Year 4 2027/28 Year 5 2028/29 Page 205
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Outline Business Case Page 28 of 37 £104,532.33 £104,532.33 + Oct set RPI Year 2 cost + Oct set RPI Year 3 cost + Oct set RPI Year 4 cost + Oct set RPI There are currently no allowances in Capital (Moray Council) or revenue budgets (HSCM) for a new system. 6.3 Impact on the Income & Expenditure Account There are currently 443 registered users of CareFirst so indicative prices are shown for 500 users. (This aspect will require review during discussions with potential providers as some licences are for concurrent users and others are named users which makes a difference in number of licences required.) The table below shows indicative figures from the Scotland Excel Framework for the existing provider if hosted on site. Costs change significantly depending on type of provision (Locally hosted, hosted by third party or Software as a Supplier (cloud)) and there are impacts on options for funding. Hosted locally Year 1 2024/25 £k Year 2 2025/26 £k Year 3 2026/27 £k Year 4 2027/28 £k Year 5 2028/29 £k 5 year Total Capital Licences £144 Service Installation £178 Hardware £70 Consultancy / Training £70 Capital total £0 £462 £0 £0 £0 £462 Revenue Support and Helpdesk £216 £216 £216 £648 HSCM Project Staff costs :- Senior Officer (G10) Data cleansing (G4) Process mapping (G8) From existing workforce/ temporary opportunities From existing workforce / temporary opportunities From existing workforce/ temporary opportunities £0 Existing system costs £106 £114 £124 £344 Efficiencies in staffing (£100) (£100) (£200) Revenue Total £106 £114 £340 £116 £116 £792 Total Costs £106 £576 £340 £116 £116 £1,254 Funded by: Existing Revenue HSCM: £106 £114 £124 £116 £116 £576 Additional Capital required £462 £462 Additional Revenue required £216 £216 Total funding £106 £576 £340 £116 £116 Page 206
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Outline Business Case Page 29 of 37 £1254 Note 1 & 2 - The figure for hardware (1) and consultancy (2) are an indicative value and requires discussion with the potential suppliers and Council ICT officers to determine exact requirements. The efficiencies in staffing relate to funds for existing difficult to fill vacancies which could be released as processes become more efficient. These figures will be informed further following the process mapping exercises. These overall figures are indicative as there requires to be further discussion with ICT, procurement and potential providers to determine the most appropriate method provision of service i.e. hosted on site, hosted by 3rd party via the supplier or hosted on a cloud. (Note If cloud-based option is taken forward then none of the costs can be capitalised as there is no asset at the end of the contract.) As there is insufficient budget allowance this will be a budget pressure. Until the procurement process is progressed and discussions are held with potential suppliers it is not possible to ascertain whether it will be preferable to have a “Cloud” (hosted) product or one that is managed locally. ICT services are agnostic regarding the choice so the decision will be based on the product deliverables. The decision regarding Cloud or locally supported is significant from a funding perspective because Cloud based product will not be able to be capitalised whereas locally hosted will, which has an impact on the revenue budget requirements. Until discussions take place with suppliers to clarify queries regarding charging for licences (specific user or concurrent, annual or contract term etc) and content of migration and consultancy provision it is not possible to provide more accurate figures. 7. The Management Case 7.1 Resource Requirements Estimate of Resources required would be:- HSCM • Project officer (internal secondment) – Lead the working group in delivering system specification, procurement, migration and implementation Page 207
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Outline Business Case Page 30 of 37 • Process Improvement officer (internal secondment) – to lead the review and documentation of processes, and identification of efficiencies, in preparation for the transition to a new system. • Data Cleansing (internal secondment) – to assist with identification of common errors and action data cleansing identified to reduce the amount of delay in transferring data to a new system. incorporated in substantive roles:- • Programme lead • Theme lead – process improvement, quality assurance framework implementation • Theme lead – communication and engagement • Theme lead – procedure review and training • System support (including data cleansing), configuration and training • Project admin support - for organising meetings, recording actions and decisions and ensuring timely distribution of papers • Service champions during development, procurement, testing and implementation phases There will be additional requirements for support from across all services areas to support testing, identify process improvements, efficiencies and to assist with implementation. Council • Senior ICT officer - advice for specification, involved in procurement process and tender award, advice for data mapping and migration, system support. Support for interfaces to be set up, developed and implemented. Potential requirement for hardware configuration and support if option for a hosted system is selected. • Process Improvement – Team Leader – estimate 20 days to provide advice on process mapping and use of software. • Procurement – advice and support of procurement officer for tender process during November 2024 for OBC and then February to June 2025. • Information Governance – support and guidance for data sharing agreements, records management and data cleansing throughout the project. New system provider • External support as necessary from system supplier and where necessary other suppliers for interfaces. 7.2 Programme Management Arrangements The implementation of a modern system and review of processes is contained in the Strategic Delivery plan for HSCM, with progress reported to MIJB and Page 208
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Outline Business Case Page 31 of 37 will facilitate and underpin other financial savings identified in the Financial Delivery Plan, which is overseen by the Budget Savings Oversight Group. 7.3 Project Management Arrangements The project will be managed in accordance with HSCM and Moray Council procedures. A Service manager has been appointed by Health and Social Care Moray to progress the project to the business case. The progress of the project will then be dependent on approval by MIJB and Moray Council and identification of funding streams for the project staff resource and system procurement. If approval is obtained to progress with procurement and implementation the Head of service will progress the recruitment for a project manager who will then lead the project through to completion. A high-level outline project plan is in place and a more detailed plan is being developed. The timescales for implementation and phasing of adoption by services will be determined once it is known what type of system has been procured. Page 209
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Outline Business Case Page 32 of 37 7.4 Project Reporting Structure ➢ Project Management Support ➢ Communication and Engagement Plan Social Work and Social Care Information Management System Working Group Process & Procedures workstream Procurement workstream OD and Training workstream Early Adopters / Service User group Records Management workstream ICT & Digital Solutions workstream Social Work and Social Care Information Management System (SWIMS) Project Board OMT SMT HSCM Moray Integration Joint Board (IJB) Moray Council Social Work and Social Care Information Management SystemProject Governance Page 210
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Outline Business Case Page 33 of 37 Group Purpose Representing Member SMT Approve strategic objectives, scope, and principles of project Head of Service Project Sponsor To lead project for HSCM Member of Senior Management Team SMT Head of Service New Case Management System Board 1. Managing the delivery of a new Case Management System for HSCM 2. Own the project plan 3. Represent the future users and providers of the project – agree and establish the quality standards 4. Maintain strategic alignment of project with IJB strategy 5. Resolve conflict 6. Manage: Risks/Assumptions/Dependencies/ Issues / Changes 7. Sign off – new ways of working 8. Benefit realisation 9. Quality assurance 10. Compliance with TMC “Gateway Policy” Project Sponsor Corporate Programme Manager Children’s Services Service Man rep Adult Social Work Service Man rep Locality Man rep Justice Services Manager Finance ICT Applications Manager Internal Audit Rep Staff side/Union? (ask HR for advice) Senior Project Officer Project Administrator Head of Service Jeanette Netherwood Carl Campbell John Campbell Lesley Attridge Jillian Petrie Deb O’Shea Chris Leonard Tracey Laing Social Work and Social Care Information Management (SWIMS) Working Group 1. Develop and manage the project plan 2. Day to day management of the project 3. Ensure delivery of a new system that meets the identified objectives Core: Senior Project Officer ICT & Digital lead TBC Graeme Shanks Page 211
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Outline Business Case Page 34 of 37 4. Monitor Progress 5. Manage RADIC 6. Manage Service and Project Resources 7. Report to Project Board 8. Map Benefits System Support Team Rep (C&F, Adult, Justice, LD, MH, OT, SDS) Community Care Finance Process & Procedure lead Performance Communication and Engagement Project Administrator Advisors: Procurement Finance HR & OD Information Governance Commissioning Vicki Logan Emma Gormely Sean Brown Jillian Petrie Anna McLeod Louise Burgin Michelle Fleming Chris McLeod Catherine Quinn Tbd Aylsa Kennedy Fiona McPherson tbd Jay Campbell Tara Gaughan Tbd Alison Morris tbd Service Design and specification Representatives of services, and types of service, to help design the principles, standards and approach for implementation. To sign off agreed service specifications prior to procurement process. Appropriate representation of teams and roles to ensure full coverage. Liaisons nominated by Service Managers and approved by Head of Service New Case Management System - Workstreams Specific topic specialists will progress elements of the plan Digital Solutions workstream Progress the detailed options for specific tasks identified by the delivery group for this theme including. ICT applications and network team DHI link Graeme Shanks TBC Chaloner Chute (DHI) Page 212
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Outline Business Case Page 35 of 37 Service specification, assessment of tender, migration to new system and associated testing and security checks, support to end users, assessing mobile technology options Process & Procedures Workstream Progress the specific tasks identified by the working group in relation to process review, improvement and updating of procedures. Nominated leads / Service reps Procedure officer Process improvement lead tbc HSCM Policy officer HSCM officer / advice from Gregor McNicol tbc Procurement Workstream Progress the detailed work for the specification, tender documents, assessment of tender and award of contract processes. Senior Project Officer Procurement advisor Service reps ICT lead Records Man lead SDS team rep Tbd Jay Campbell Tbd Tbd Alison Morris OD and Training workstream Progress the detailed options for specific tasks identified by the working group for this theme Senior Project Officer OD team System supplier training team System support team Communications officer Records Management Workstream To identify areas for data cleansing and develop plan to address. To inform system security grouping requirements and settings Senior Project Officer Records Management lead Systems officer Data cleansing officer Alison Morris Vicky Logan Service implementation Early Adopters / Service Group To be determined once Page 213
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Outline Business Case Page 36 of 37 system is procured 1. Requirement for significant service input to identifying the needs, defining any the new processes required, managing the transition and deliver the benefits. 2. Service managers will be supported by specialist staff (i.e. ICT, OD team, Records Management, System Support) 3. Service managers will have responsibility for implementation of the agreed principles and standards within the Service 4. Assist in the identification of need, type and facilitate implementation of training 5. Identify other opportunities not included in the business case 6. Develop operational plans, policies and procedures and KPIs for their services. All types of service delivery Nominated Core Contact for co- ordination (by HoS) Service managers / Team Managers SWIMS Working Group 7.5 Arrangements for Change Management Engagement and consultation with services will inform the specification to meet service requirements and once implemented there may be changes or impacts for individual regarding the tasks they perform. Where this situation occurs existing Council process will be followed for any changes required for Council employed staff and NHSG process will be followed for any NHSG employed staff. 7.6 Arrangement for Benefits Realisation Benefit mapping exercise was undertaken 13 May 2024 utilising information supplied at the engagement sessions with CareFirst users in early May. The benefits identified will be owned by the Board and regular progress monitoring of the project plan and associated performance measures that will identify when benefits, outlined in section 3.7, have been realised. Progress on the project will be reported initially to Moray Integration Joint Board on a 6 monthly basis and once the project is complete an end of project Page 214
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Outline Business Case Page 37 of 37 report will be submitted outlining the progress and achievements and any outstanding matters for action. 7.7 Arrangements for Risk Management Risks to the overall project will be reported to and owned by the Project Board. Risks to the relevant work streams will be identified, recorded and reported to the work stream lead who will provide updates and identify mitigations where applicable to the working group (or project manager if urgent) and these will be escalated to the Project Board as necessary. 7.8 Gateway Review Arrangements This project will follow the Moray Council’s Project Governance Policy and project gateway review arrangements. It is based on the Prince2 Project management methodology, aligned with the Scottish Government Construction Procurement Manual and the Office of Government Commerce (OGC) Gateway framework. A copy of the Moray Gateway Process can be found here: PMG – Moray Gateway Process Page 215
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ID RAG (Prev) RAG (Cur) % Complete Task Name Duration Start Finish 1 4% CareFirst Replacement 823 days? Wed 03/01/24 Wed 24/03/27 2 98% Concept 273 days? Wed 03/01/24 Thu 30/01/25 3 100% Develop report for IJB 10 days Wed 03/01/24 Tue 16/01/24 4 100% Approval to proceed to scope - IJB Meeting 1 day Thu 25/01/24 Thu 25/01/24 5 100% 3MB to SMT for resource allocation 1 day? Wed 20/03/24 Wed 20/03/24 6 100% Survey and Initial engagement with teams 9 days Mon 06/05/24 Fri 17/05/24 7 100% Complete Project Mandate template 3 days? Mon 20/05/24 Wed 22/05/24 8 100% Approval 27 days? Wed 22/05/24 Thu 27/06/24 9 100% SMT approved in principle 1 day? Wed 22/05/24 Wed 22/05/24 10 100% Submit to ICT gateway for approval 1 day? Tue 28/05/24 Tue 28/05/24 11 100% Submit to AMWG for approval to proceed 1 day? Wed 12/06/24 Wed 12/06/24 12 100% Report to IJB - approve detailed scoping work 1 day? Thu 27/06/24 Thu 27/06/24 13 100% Concept Complete 0 days Thu 27/06/24 Thu 27/06/24 14 97% Develop Outline Business Case 148 days? Fri 28/06/24 Thu 30/01/25 15 100% Scoping exercise (Define goals, deadlines, project deliverables, boundaries, resources) 15 days Fri 28/06/24 Thu 18/07/24 16 100% Consulatation 10 days Fri 19/07/24 Thu 01/08/24 17 100% Define Resources 1 day? Fri 02/08/24 Fri 02/08/24 18 100% Draft Report 2 days Mon 05/08/24 Tue 06/08/24 19 75% Approval 50 days Wed 13/11/24 Thu 30/01/25 20 100% HSCM SMT approval 1 day Wed 13/11/24 Wed 13/11/24 21 100% ICT Gateway (AMWG Not required) 1 day Tue 26/11/24 Tue 26/11/24 22 100% SMT/CMT 1 day Wed 04/12/24 Wed 04/12/24 23 0% Outline Business case approval - IJB Meeting 1 day Thu 30/01/25 Thu 30/01/25 24 0% Develop Outline Business Case compeleted 0 days Thu 30/01/25 Thu 30/01/25 25 0% Definition 97 days? Mon 03/02/25 Thu 19/06/25 26 0% Develop Full Business Case 97 days? Mon 03/02/25 Thu 19/06/25 27 0% Update and confirm (goals, deadlines, project deliverables, boundaries, resources) 30 days Mon 03/02/25 Fri 14/03/25 28 0% Consulatation 10 days Mon 17/03/25 Fri 28/03/25 29 0% Define Resources 1 day? Mon 31/03/25 Mon 31/03/25 27/06 30/01 2023 2024 2025 2026 2027 2028 Task Milestone Summary Rolled Up Task Rolled Up Milestone Rolled Up Progress Split External Tasks Project Summary Group By Summary Inactive Task Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only Baseline Progress Deadline Page 1 Project: CareFirst Replacement Projec Date: Fri 17/01/25 APPENDIX 2 Item 14. Page 217
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ID RAG (Prev) RAG (Cur) % Complete Task Name Duration Start Finish 30 0% Draft Report 9 days Tue 01/04/25 Fri 11/04/25 31 0% Approval 3 days Mon 14/04/25 Wed 16/04/25 32 0% HSCM SMT approval 1 day Mon 14/04/25 Mon 14/04/25 33 0% ICT Gateway (AMWG Not required) 1 day Tue 15/04/25 Tue 15/04/25 34 0% SMT/CMT 1 day Wed 16/04/25 Wed 16/04/25 35 0% Business case and funding approval - IJB Meeting 1 day Thu 19/06/25 Thu 19/06/25 36 0% Definition Complete 0 days Thu 19/06/25 Thu 19/06/25 37 0% Initiation & Planning 11 days? Fri 20/06/25 Fri 04/07/25 38 0% Develop PID 10 days Fri 20/06/25 Thu 03/07/25 39 0% PID approval 1 day? Fri 04/07/25 Fri 04/07/25 40 0% Initiation & Planning complete 0 days Fri 04/07/25 Fri 04/07/25 41 1% Delivery 505 days? Mon 06/01/25 Thu 24/12/26 42 14% Project Mobilisation 16 days? Wed 08/01/25 Wed 29/01/25 43 15% Project governance 5 days Wed 08/01/25 Tue 14/01/25 44 15% Identify project team 10 days Wed 15/01/25 Tue 28/01/25 45 0% Kick off meeting 1 day? Wed 29/01/25 Wed 29/01/25 46 0% Project Strategy 487 days Thu 30/01/25 Thu 24/12/26 47 0% Communication Strategy 487 days Thu 30/01/25 Thu 24/12/26 48 0% Develop communication plan 5 days Thu 30/01/25 Wed 05/02/25 49 0% Comms 482 days Thu 06/02/25 Thu 24/12/26 50 0% Comms complete 0 days Thu 24/12/26 Thu 24/12/26 51 0% Quality Strategy 487 days Thu 30/01/25 Thu 24/12/26 52 0% Develop Quality Plan 5 days Thu 30/01/25 Wed 05/02/25 53 0% Quality monitoring 482 days Thu 06/02/25 Thu 24/12/26 54 0% Quality complete 0 days Thu 24/12/26 Thu 24/12/26 55 26% Specification of requirements 40 days Mon 06/01/25 Fri 28/02/25 56 30% Develop specification 35 days Mon 06/01/25 Fri 21/02/25 57 0% Confirm specification 5 days Mon 24/02/25 Fri 28/02/25 58 0% Specification signed off 0 days Fri 28/02/25 Fri 28/02/25 59 2% Data Cleansing (self defined preparation) 103 days Mon 06/01/25 Fri 30/05/25 19/06 04/07 24/12 24/12 28/02 2023 2024 2025 2026 2027 2028 Task Milestone Summary Rolled Up Task Rolled Up Milestone Rolled Up Progress Split External Tasks Project Summary Group By Summary Inactive Task Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only Baseline Progress Deadline Page 2 Project: CareFirst Replacement Projec Date: Fri 17/01/25 Page 218
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ID RAG (Prev) RAG (Cur) % Complete Task Name Duration Start Finish 60 5% Adult Services 34 days Mon 06/01/25 Thu 20/02/25 61 10% Data analysis - Adult services 17 days Mon 06/01/25 Tue 28/01/25 62 0% Data cleansing - Adult Services 17 days Wed 29/01/25 Thu 20/02/25 63 0% C&F Services 34 days Fri 21/02/25 Wed 09/04/25 64 0% Data anlaysing - Children and Families 17 days Fri 21/02/25 Mon 17/03/25 65 0% Data cleansing - Children and Families 17 days Tue 18/03/25 Wed 09/04/25 66 0% Justice Services 35 days Thu 10/04/25 Fri 30/05/25 67 0% Data anlaysing - Justice Services 17 days Thu 10/04/25 Tue 06/05/25 68 0% Data cleansing - Justice Services 18 days Wed 07/05/25 Fri 30/05/25 69 0% Data Cleansing signed off 0 days Fri 30/05/25 Fri 30/05/25 70 0% Process Mapping 175 days Mon 27/01/25 Tue 30/09/25 71 0% Adult Services - pilot 25 days Mon 27/01/25 Fri 28/02/25 72 0% Develop schedule for Adult Services 25 days Mon 03/03/25 Fri 04/04/25 73 0% Implement Adult Services process mapping 25 days Mon 07/04/25 Tue 13/05/25 74 0% Develop schedule for C&F Services 25 days Wed 14/05/25 Tue 17/06/25 75 0% Implement C&F schedule 25 days Wed 18/06/25 Tue 22/07/25 76 0% Develop schedule for Justice Services 25 days Wed 23/07/25 Tue 26/08/25 77 0% Implement Justic Services schedule 25 days Wed 27/08/25 Tue 30/09/25 78 0% Process Mapping signed off 0 days Tue 30/09/25 Tue 30/09/25 79 0% Procurement process 63 days Mon 03/03/25 Fri 30/05/25 80 0% PQQ (The Moray Council) 20 days Mon 03/03/25 Fri 28/03/25 81 0% Tender Action 20 days Mon 31/03/25 Mon 28/04/25 82 0% Tender Assessment 8 days Tue 29/04/25 Fri 09/05/25 83 0% Tender Acceptance 5 days Mon 12/05/25 Fri 16/05/25 84 0% Tender Standstill 10 days Mon 19/05/25 Fri 30/05/25 85 0% Procurement complete 0 days Fri 30/05/25 Fri 30/05/25 86 0% Installation - TBC 32 days? Thu 04/09/25 Fri 17/10/25 87 0% Dependent on type of system requirement i.e. cloud/server based) 30 days Thu 04/09/25 Wed 15/10/25 88 0% Test site 1 day? Thu 16/10/25 Thu 16/10/25 89 0% Live site 1 day? Fri 17/10/25 Fri 17/10/25 30/05 30/09 30/05 2023 2024 2025 2026 2027 2028 Task Milestone Summary Rolled Up Task Rolled Up Milestone Rolled Up Progress Split External Tasks Project Summary Group By Summary Inactive Task Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only Baseline Progress Deadline Page 3 Project: CareFirst Replacement Projec Date: Fri 17/01/25 Page 219
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ID RAG (Prev) RAG (Cur) % Complete Task Name Duration Start Finish 90 0% Installation Complete 0 days Fri 17/10/25 Fri 17/10/25 91 0% Configuration - TBC 47 days? Mon 20/10/25 Tue 23/12/25 92 0% Dependent on type of system requirement i.e. cloud/server based) 45 days Mon 20/10/25 Fri 19/12/25 93 0% Test site 1 day? Mon 22/12/25 Mon 22/12/25 94 0% Live site 1 day? Tue 23/12/25 Tue 23/12/25 95 0% Configuration completed 0 days Tue 23/12/25 Tue 23/12/25 96 0% Data Cleansing 75 days Mon 30/06/25 Fri 10/10/25 97 0% Data analysis 5 days Mon 30/06/25 Fri 04/07/25 98 0% Data cleansing 70 days Mon 07/07/25 Fri 10/10/25 99 0% Data Cleansing signed off 0 days Fri 10/10/25 Fri 10/10/25 100 0% Migration 30 days Mon 20/10/25 Fri 28/11/25 101 0% Test site 15 days Mon 20/10/25 Fri 07/11/25 102 0% Live site 15 days Mon 10/11/25 Fri 28/11/25 103 0% Migration completed 0 days Fri 28/11/25 Fri 28/11/25 104 0% User Acceptance Testing (in depth) 50 days Mon 01/12/25 Tue 17/02/26 105 0% Develop test plan 15 days Mon 01/12/25 Fri 19/12/25 106 0% Testing 35 days Mon 22/12/25 Tue 17/02/26 107 0% UAT sign off 0 days Tue 17/02/26 Tue 17/02/26 108 0% Integration of test and live systems 47 days Wed 18/02/26 Thu 23/04/26 109 0% tbc 47 days Wed 18/02/26 Thu 23/04/26 110 0% Integration of test and live systems completed 0 days Thu 23/04/26 Thu 23/04/26 111 0% Final Testing and Security Checks 30 days Fri 24/04/26 Thu 04/06/26 112 0% Develop Test plan 2 days Fri 24/04/26 Mon 27/04/26 113 0% Testing carried out 28 days Tue 28/04/26 Thu 04/06/26 114 0% Testing signed off 0 days Thu 04/06/26 Thu 04/06/26 115 0% Training 75 days? Fri 05/06/26 Thu 17/09/26 116 0% Develop Training plan 10 days? Fri 05/06/26 Thu 18/06/26 117 0% Phase 1 - Training carried out 15 days Fri 19/06/26 Thu 09/07/26 118 0% Phase 2 - Training carried out 15 days Fri 10/07/26 Thu 30/07/26 119 0% Phase 3 - Training carried out 35 days Fri 31/07/26 Thu 17/09/26 17/10 23/12 10/10 28/11 17/02 23/04 04/06 2023 2024 2025 2026 2027 2028 Task Milestone Summary Rolled Up Task Rolled Up Milestone Rolled Up Progress Split External Tasks Project Summary Group By Summary Inactive Task Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only Baseline Progress Deadline Page 4 Project: CareFirst Replacement Projec Date: Fri 17/01/25 Page 220
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ID RAG (Prev) RAG (Cur) % Complete Task Name Duration Start Finish 120 0% Training signed off 0 days Thu 17/09/26 Thu 17/09/26 121 0% Change management 70 days Fri 24/04/26 Thu 30/07/26 122 0% Develop change mangement plan 10 days Fri 24/04/26 Thu 07/05/26 123 0% Change management approval 1 day Fri 08/05/26 Fri 08/05/26 124 0% Implement change management plan 30 days Fri 19/06/26 Thu 30/07/26 125 0% Change management signed off 0 days Thu 30/07/26 Thu 30/07/26 126 0% Implementation and Go live 91 days Fri 10/07/26 Fri 13/11/26 127 0% Implementation 51 days Fri 10/07/26 Fri 18/09/26 128 0% Phase 1 1 day Fri 10/07/26 Fri 10/07/26 129 0% Phase 2 1 day Fri 31/07/26 Fri 31/07/26 130 0% Phase 3 1 day Fri 18/09/26 Fri 18/09/26 131 0% Go Live 0 days Fri 18/09/26 Fri 18/09/26 132 0% Enhanced support 90 days Mon 13/07/26 Fri 13/11/26 133 0% Implementation sign off 0 days Fri 13/11/26 Fri 13/11/26 134 0% Delivery complete 0 days Thu 24/12/26 Thu 24/12/26 135 0% Project Closure 7 days? Mon 28/12/26 Tue 05/01/27 136 0% End of Project Report Prepared 5 days Mon 28/12/26 Fri 01/01/27 137 0% Project Board Approval 1 day? Mon 04/01/27 Mon 04/01/27 138 0% Council Committee Approval 1 day? Tue 05/01/27 Tue 05/01/27 139 0% End of Project Report signed off 0 days Tue 05/01/27 Tue 05/01/27 140 0% Post Project Review (dates tbc at project closure) 16 days? Wed 03/03/27 Wed 24/03/27 141 0% Carry out review 10 days Wed 03/03/27 Tue 16/03/27 142 0% Benefits Review Report produced 5 days Wed 17/03/27 Tue 23/03/27 143 0% Benefits Realisation Board (CMT) 1 day? Wed 24/03/27 Wed 24/03/27 144 0% Post project review completed 0 days Wed 24/03/27 Wed 24/03/27 17/09 30/07 18/09 13/11 24/12 05/01 24/03 2023 2024 2025 2026 2027 2028 Task Milestone Summary Rolled Up Task Rolled Up Milestone Rolled Up Progress Split External Tasks Project Summary Group By Summary Inactive Task Inactive Task Inactive Milestone Inactive Summary Manual Task Duration-only Manual Summary Rollup Manual Summary Start-only Finish-only Baseline Progress Deadline Page 5 Project: CareFirst Replacement Projec Date: Fri 17/01/25 Page 221
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: GETTING IT RIGHT FOR EVERYONE BY: DEPUTY HEAD OF SERVICE 1. REASON FOR REPORT 1.1 To inform the Board of progress of the national Getting it Right for Everyone (GIRFE) programme, the involvement of Health & Social Care Moray (HSCM) as a GIRFE partner, and the collaborative GIRFE approaches being taken by partners in Grampian. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider and note the content of the report; ii) endorse the collaborative whole system approach being taken in Moray and by partners across Grampian; and iii) agree to receive further reports detailing how GIRFE is being embedded in Moray. 3. BACKGROUND 3.1 Getting it Right for Every Child (GIRFEC) is the national commitment to provide all children, young people and their families with the right support at the right time, so that every child and young person in Scotland can reach their full potential. 3.2 Getting it Right For Everyone (GIRFE) will take a multi-agency approach to health and social care support and services from young adulthood to end of life. It is about providing a more personalised way to access help and support when it is needed and will place the person at the centre of all the decision making that affects them, with a joined-up consistent approach, regardless of the support needed at any stage of life. It is intended that GIRFE will form the future practice model of all health, social care and public sector professionals, and shape the design and delivery of services, ensuring that people’s needs are met. Item 15. Page 223
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3.3 In a strategic context, GIRFE builds on existing best practice and learning from GIRFEC. It is part of a programme to improve population health and wellbeing, reduce health inequalities, create sustainable health, and care services by enabling an earlier and more co-ordinated response to take place in a community setting maximising both formal and informal support systems. 3.4 The Scottish Government began the co-design of GIRFE in 2022 following a recommendation made in The Independent Review of Adult Social Care led by Derek Feeley. In 2023 Aberdeenshire and Aberdeen City Health and Social Care Partnerships (HSCP) were amongst the first six GIRFE place-based pathfinders. In January 2024, HSCM became one of three GIRFE partners joining the co- design process which involves HSCP teams, the Scottish Government, and people with lived experience across Scotland. 3.5 The objectives of the co-design journey were to: • co-design a set of principles for GIRFE • understand what a national practice model might look like • understand what might be needed for consistent implementation across Scotland 3.6 The specific themed areas explored within the GIRFE development work were: • people in prisons • people in Alcohol and Drug services • people registered at ‘deep end’ GP practices (‘deep end’ is a term used to describe work in general practices serving the 100 most deprived populations in Scotland) • families with multiple and/or complex needs; and young people in transition from child to adult services • older people and frailty 3.7 The five finalised GIRFE principles are: 1. I have the information I need to make decisions about my life, in a format that works for me, and I am supported to understand what options are available to me, and trusted to know what is right for me. * 2. The people who support me take the time to listen to and understand me as a person and communicate in a way that works for me. We consider my whole life when making decisions about my life. * 3. I know that I can be clear about what matters to me, and I trust that my choices will be respected and taken into account by the people who support me. 4. If I need to access services or support, I am treated with kindness, dignity and respect at all times. 5. The people I am involved with work together with me and each other to share relevant information, in a format that is accessible to me, and develop a clear understanding of how to support my wellbeing. * Page 224
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*Within this principle, ‘I’ or ‘Me’ can be substituted for / include the addition of ‘my guardian’ or ‘my power of attorney’ where relevant. 3.8 The ambition of GIRFE is to place the person at the centre of all decision making, with a joined up consistent approach, regardless of the support needed at each stage of their life. The work has culminated in the development of a national GIRFE ‘Team Around the Person’ toolkit. The toolkit has been collaboratively designed with people with lived experience who have actively helped to identify the barriers that prevent us Getting It Right For Everyone and have worked with their local pathfinder and partner teams to shape the tools. 3.9 Organisations across Scotland are now being assisted to embed GIRFE. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 HSCM’s work as a GIRFE Partner has been led by the GIRFE Delivery Group which will now take forward the actions required to embed the GIRFE toolkit and principles into the planning and delivery of services. 4.2 The following actions will form part of the Moray GIRFE delivery plan: 1. The promotion of GIRFE to key Moray stakeholder groups including; Moray Integration Joint Board (MIJB) members, senior managers, primary and secondary care services, HSCM partners, third Sector, unpaid carers, and community groups. A combination of presentations, paper briefs and social media posts as appropriate. 2. Locality Multi-Disciplinary Teams to benchmark ‘How good are we – at getting it right for everyone’. 3. GIRFE Principles to be embedded in all new or updated policies. 4. The GIRFE ethos and principles to be embedded into all new HSCM commissioned contracts. This will ensure that providers are aspiring to getting it right for everyone across Moray. Key Performance Indicators (KPIs) will be co-designed with providers. 5. The incorporation of GIRFE in the revised model for Discharge to Assess/START with a particular emphasis on My Plan, My Team, Community Connections and Coordinator. 6. The incorporation of GIRFE into the Hospital Discharge Team process with a particular emphasis on My Plan, My Team, Community Connections and Coordinator aspects of the GIRFE Toolkit. 7. The incorporation of GIRFE in to the Virtual Ward Model in localities with particular emphasis on My Plan, My Team, Community Connections and Coordinator. 8. The embedding of GIRFE into the digital transformation work being facilitated by the Digital Health & Care Innovation Centre (DHI). Page 225
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4.3 The Moray GIRFE Delivery Group will monitor, evaluate and report on progress via the HSCM Operational Management Team, Senior Management Team and MIJB. 4.4 HSCM are working closely with colleagues in Aberdeen City and Aberdeenshire to ensure consistency of implementation and maximisation of available resources. The work already taking place within Grampian has received accolades at a national level. 4.5 Following a period of embedding GIRFE in each of the three Grampian partnership areas, a learning event will be held, supported by the Scottish Government, to connect various work programmes and showcase good practice both locally and nationally. 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 approach set out in this report is consistent with the MIJB Strategic Plan. HSCM will seek to embed the approaches in the revised HSCM Strategic Delivery Plan in order to promote an approach across all services that is in line with person led and outcome focused care for the citizens of Moray. (b) Policy and Legal There are no implications for policy or legal. (c) Financial implications No additional funding has been made available by the Scottish Government for GIRFE. (d) Risk Implications and Mitigation None. (e) Staffing Implications None. (f) Property None. (g) Equalities/Socio Economic Impact None. (h) Climate Change and Biodiversity Impacts None. (i) Directions None (j) Consultations The following people were consulted during the writing of this report: Page 226
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Fiona Macpherson – Communications and Engagement Officer Marie Burnell – Service Manager Community Learning Disability Team Kay McInnes – Team Manager, Hospital Discharge Team Emma Gormley – Team Manager, Access Team James Brown – Senior Charge Nurse, Seafield Hospital Lisa Taylor – Team Manager, Health Improvement Team Dawn Duncan – Professional Lead, OT Tracie Wills – Senior Commissioning Officer Lizette Van Zyl – Service Manager, Policy Development and Commissioning John Campbell – Service Manager Laura Sutherland, Locality Manager Sean Coady, Head of Service, Health and Social Care Moray 6. CONCLUSION 6.1 The Board are recommended to note the content of the report. Author of Report: Iain Macdonald: Deputy Head of Service References: Getting it right for everyone (GIRFE) - gov.scot Page 227
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: CHAIR OF MORAY INTEGRATION JOINT BOARD BY: STANDARDS OFFICER 1. REASON FOR REPORT 1.1 To ask the Board to agree a temporary change to the arrangements for Chair of the Moray Integration Joint Board (MIJB), as set out in the Moray Integration Scheme. 2. RECOMMENDATION 2.1 It is recommended the Board agrees:- (i) to a temporary deviation from the Moray Integration Scheme allowing Mr Dennis Robertson to continue to undertake the role of Chair of the Board until 31 March 2025; and (ii) that Councillor Elaine Kirby take on the role of Chair of the Board from 1 April 2025 until 30 September 2025, following which the role of Chair will revert back to a Health Board Member in line with the Integration Scheme. 3. BACKGROUND 3.1 It is stated in the Moray Integration Scheme in para 3.7 that the Chair role rotates between the Council and NHS on an 18 month basis. 3.2 At the meeting of the Board on 25 January 2024 (para 9 of minute refers) the Board approved the rotation of Chair from a Health Board Member to a Council Member from 1 April 2024, for a period of 18 months. 3.3 Councillor Tracy Colyer took up the role of Chair from 1 April 2024. 4. KEY MATTERS RELEVANT TO RECOMMENDATIONS 4.1 Following the resignation of Councillor Tracy Colyer on 26 September 2024, Moray Council agreed at its meeting on 4 December 2024 that Councillor Item 16. Page 229
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Elaine Kirby be appointed as a Council Member on MIJB and Chair of the Board until 30 September 2025 (para 14 of draft minute refers). 4.2 Since the resignation of Councillor Colyer, the Chair role has been undertaken by Mr Dennis Robertson as Vice Chair. 4.3 As Councillor Elaine Kirby is a new Council Member on MIJB, it would be beneficial for her to have a period of familiarisation with the business of the Board prior to taking on the role of Chair. 4.4 As such a temporary deviation from the rotation set out in the Integration Scheme is proposed allowing Mr Dennis Robertson to continue to undertake the role of Chair until 31 March 2025. 4.5 It is proposed that Councillor Elaine Kirby take on the role of Chair from 1 April 2025 until 30 September 2025 following which the role of Chair will rotate back to a Health Board Member. 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” Effective governance arrangements support the development and delivery of priorities and plans. (b) Policy and Legal The Board, through its approved Standing Orders for Meetings, established under the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014, ensures that affairs are administered in accordance with the law, probity and proper standards. (c) Financial implications None arising from this report. (d) Risk Implications and Mitigation None arising from this report. (e) Staffing Implications None arising from this report. (f) Property None arising from this report. (g) Equalities/Socio Economic Impact None arising from this report. (h) Climate Change and Biodiversity Impacts None arising from this report. (i) Directions None arising from this report. Page 230
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(j) Consultations Consultations have been undertaken with the following who are in agreement with the content of this report where it relates to their area of responsibility: • MIJB Chief Officer • Corporate Manager 6. CONCLUSION 6.1 The Board is asked to agree a temporary change to the arrangements for Chair of the Board set out in the Moray Integration Scheme. Author of Report: Caroline O’Connor, Committee Services Officer Background Papers: Ref: Page 231
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 30 JANUARY 2025 SUBJECT: CODE OF CONDUCT UPDATE BY: STANDARDS OFFICER 1. REASON FOR REPORT 1.1 To ask the Board to adopt the Standards Commission’s Model Code of Conduct for Members of Devolved Bodies replacing the Code of Conduct previously agreed by the Board in June 2016. 2. RECOMMENDATION 2.1 It is recommended the Board agrees to adopt the Standards Commission’s Model Code of Conduct for Members of Devolved Bodies (Appendix 1) as the Code of Conduct for the Moray Integration Joint Board. 3. BACKGROUND 3.1 At its meeting on 25 February 2016 (para 7 of minute refers), the Board agreed to subscribe to and comply with the Standards in Public Life – Code of Conduct for Members of Devolved Public Bodies. At this time it was noted that the Scottish Government was working on a specific Code of Conduct for members of an Integration Joint Board (IJB) and when available this would replace the existing code and be the subject of a future report to the Board. 3.2 At its meeting on 30 June 2016 (para 4 of minute refers), the Board agreed the revised Code of Conduct specific to the Moray Integration Joint Board. 4. KEY MATTERS RELEVANT TO RECOMMENDATIONS 4.1 Since the Board approved the MIJB Code of Conduct June 2016, the Model Code of Conduct for Members of Devolved Public Bodies was updated by the Standards Commission in December 2021. A copy of the Model Code is attached at Appendix 1. 4.2 A training session for members of the Board held on 1 February 2024 included the Code of Conduct and was based on the revised Code. Item 17. Page 233
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4.3 The revised Code now requires to be adopted by the Board and it is recommended the link to the revised Code on the Standards Commission website, linked in paragraph 4.1 above, is added to the Health and Social Care Moray website. 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 Code of Conduct is a key component of ensuring good governance and a transparent, accountable decision making body. (b) Policy and Legal The IJB is a devolved public body for the purposes of the Ethical Standards in Public Life etc (Scotland) Act 200. (c) Financial implications None arising from this report. (d) Risk Implications and Mitigation Members are complying with the relevant legislation in agreeing the recommendation. The Code of Conduct offers clarify as to the standards of conduct that are expected of members in the important role that they play. (e) Staffing Implications None arising from this report. (f) Property None arising from this report. (g) Equalities/Socio Economic Impact None arising from this report. (h) Climate Change and Biodiversity Impacts None arising from this report. (i) Directions None arising from this report. (j) Consultations Consultations have been undertaken with the following who are in agreement with the content of this report where it relates to their area of responsibility: • MIJB Chief Officer • Corporate Manager 6. CONCLUSION Page 234
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6.1 The Board is asked to adopt the Standards Commission’s Model Code of Conduct for Members of Devolved Bodies replacing the Code of Conduct previously agreed by the Board in June 2016. Author of Report: Caroline O’Connor, Committee Services Officer Background Papers: MIJB on 30 June 2016 - Code of Conduct Report / Appendix 1 Ref: Page 235
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Model Code of Conduct for Members of Devolved Public Bodies December 2021 APPENDIX 1 Item 17. Page 237
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2 CONTENTS Section 1: Introduction to the Model Code of Conduct My Responsibilities Enforcement Section 2: Key Principles of the Model Code of Conduct Section 3: General Conduct Respect and Courtesy Remuneration, Allowances and Expenses Gifts and Hospitality Confidentiality Use of Public Body Resources Dealing with my Public Body and Preferential Treatment Appointments to Outside Organisations Section 4: Registration of Interests Category One: Remuneration Category Two: Other Roles Category Three: Contracts Category Four: Election Expenses Category Five: Houses, Land and Buildings Category Six: Interest in Shares and Securities Category Seven: Gifts and Hospitality Category Eight: Non–Financial Interests Category Nine: Close Family Members Section 5: Declaration of Interests Stage 1: Connection Stage 2: Interest Stage 3: Participation Section 6: Lobbying and Access ANNEXES Annex A Breaches of the Code Annex B Definitions Page 238
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3 Section 1: Introduction To The Model Code Of Conduct 1.1 This Code has been issued by the Scottish Ministers, with the approval of the Scottish Parliament, as required by the Ethical Standards in Public Life etc. (Scotland) Act 2000 (the “Act”). 1.2 The purpose of the Code is to set out the conduct expected of those who serve on the boards of public bodies in Scotland. 1.3 The Code has been developed in line with the nine key principles of public life in Scotland. The principles are listed in Section 2 and set out how the provisions of the Code should be interpreted and applied in practice. My Responsibilities 1.4 I understand that the public has a high expectation of those who serve on the boards of public bodies and the way in which they should conduct themselves in undertaking their duties. I will always seek to meet those expectations by ensuring that I conduct myself in accordance with the Code. 1.5 I will comply with the substantive provisions of this Code, being sections 3 to 6 inclusive, in all situations and at all times where I am acting as a board member of my public body, have referred to myself as a board member or could objectively be considered to be acting as a board member. 1.6 I will comply with the substantive provisions of this Code, being sections 3 to 6 inclusive, in all my dealings with the public, employees and fellow board members, whether formal or informal. 1.7 I understand that it is my personal responsibility to be familiar with the provisions of this Code and that I must also comply with the law and my public body’s rules, standing orders and regulations. I will also ensure that I am familiar with any guidance or advice notes issued by the Standards Commission for Scotland (“Standards Commission”) and my public body, and endeavour to take part in any training offered on the Code. 1.8 I will not, at any time, advocate or encourage any action contrary to this Code. 1.9 I understand that no written information, whether in the Code itself or the associated Guidance or Advice Notes issued by the Standards Commission, can provide for all circumstances. If I am uncertain about how the Code applies, I will seek advice from the Standards Officer of my public body, failing whom the Chair or Chief Executive of my public body. I note that I may also choose to seek external legal advice on how to interpret the provisions of the Code. Enforcement 1.10 Part 2 of the Act sets out the provisions for dealing with alleged breaches of the Code, including the sanctions that can be applied if the Standards Commission finds that there has been a breach of the Code. More information on how complaints are dealt with and the sanctions available can be found at Annex A. Page 239
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4 Section 2: Key Principles Of The Model Code Of Conduct 2.1 The Code has been based on the following key principles of public life. I will behave in accordance with these principles and understand that they should be used for guidance and interpreting the provisions in the Code. 2.2 I note that a breach of one or more of the key principles does not in itself amount to a breach of the Code. I note that, for a breach of the Code to be found, there must also be a contravention of one or more of the provisions in sections 3 to 6 inclusive of the Code. The key principles are: Duty I have a duty to uphold the law and act in accordance with the law and the public trust placed in me. I have a duty to act in the interests of the public body of which I am a member and in accordance with the core functions and duties of that body. Selflessness I have a duty to take decisions solely in terms of public interest. I must not act in order to gain financial or other material benefit for myself, family or friends. Integrity I must not place myself under any financial, or other, obligation to any individual or organisation that might reasonably be thought to influence me in the performance of my duties. Objectivity I must make decisions solely on merit and in a way that is consistent with the functions of my public body when carrying out public business including making appointments, awarding contracts or recommending individuals for rewards and benefits. Accountability and Stewardship I am accountable to the public for my decisions and actions. I have a duty to consider issues on their merits, taking account of the views of others and I must ensure that my public body uses its resources prudently and in accordance with the law. Openness I have a duty to be as open as possible about my decisions and actions, giving reasons for my decisions and restricting information only when the wider public interest clearly demands. Honesty I have a duty to act honestly. I must declare any private interests relating to my public duties and take steps to resolve any conflicts arising in a way that protects the public interest. Leadership I have a duty to promote and support these principles by leadership and example, and to maintain and strengthen the public’s trust and confidence in the integrity of my public body and its members in conducting public business. Page 240
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5 Respect I must respect all other board members and all employees of my public body and the role they play, treating them with courtesy at all times. Similarly, I must respect members of the public when performing my duties as a board member. Page 241
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6 Section 3: General Conduct Respect and Courtesy 3.1 I will treat everyone with courtesy and respect. This includes in person, in writing, at meetings, when I am online and when I am using social media. 3.2 I will not discriminate unlawfully on the basis of race, age, sex, sexual orientation, gender reassignment, disability, religion or belief, marital status or pregnancy/maternity; I will advance equality of opportunity and seek to foster good relations between different people. 3.3 I will not engage in any conduct that could amount to bullying or harassment (which includes sexual harassment). I accept that such conduct is completely unacceptable and will be considered to be a breach of this Code. 3.4 I accept that disrespect, bullying and harassment can be: a) a one-off incident, b) part of a cumulative course of conduct; or c) a pattern of behaviour. 3.5 I understand that how, and in what context, I exhibit certain behaviours can be as important as what I communicate, given that disrespect, bullying and harassment can be physical, verbal and non-verbal conduct. 3.6 I accept that it is my responsibility to understand what constitutes bullying and harassment and I will utilise resources, including the Standards Commission’s guidance and advice notes, my public body’s policies and training material (where appropriate) to ensure that my knowledge and understanding is up to date. 3.7 Except where it is written into my role as Board member, and / or at the invitation of the Chief Executive, I will not become involved in operational management of my public body. I acknowledge and understand that operational management is the responsibility of the Chief Executive and Executive Team. 3.8 I will not undermine any individual employee or group of employees, or raise concerns about their performance, conduct or capability in public. I will raise any concerns I have on such matters in private with senior management as appropriate. 3.9 I will not take, or seek to take, unfair advantage of my position in my dealings with employees of my public body or bring any undue influence to bear on employees to take a certain action. I will not ask or direct employees to do something which I know, or should reasonably know, could compromise them or prevent them from undertaking their duties properly and appropriately. 3.10 I will respect and comply with rulings from the Chair during meetings of: a) my public body, its committees; and b) any outside organisations that I have been appointed or nominated to by my public body or on which I represent my public body. Page 242
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7 3.11 I will respect the principle of collective decision-making and corporate responsibility. This means that once the Board has made a decision, I will support that decision, even if I did not agree with it or vote for it. Remuneration, Allowances and Expenses 3.12 I will comply with the rules, and the policies of my public body, on the payment of remuneration, allowances and expenses. Gifts and Hospitality 3.13 I understand that I may be offered gifts (including money raised via crowdfunding or sponsorship), hospitality, material benefits or services (“gift or hospitality”) that may be reasonably regarded by a member of the public with knowledge of the relevant facts as placing me under an improper obligation or being capable of influencing my judgement. 3.14 I will never ask for or seek any gift or hospitality. 3.15 I will refuse any gift or hospitality, unless it is: a) a minor item or token of modest intrinsic value offered on an infrequent basis; b) a gift being offered to my public body; c) hospitality which would reasonably be associated with my duties as a board member; or d) hospitality which has been approved in advance by my public body. 3.16 I will consider whether there could be a reasonable perception that any gift or hospitality received by a person or body connected to me could or would influence my judgement. 3.17 I will not allow the promise of money or other financial advantage to induce me to act improperly in my role as a board member. I accept that the money or advantage (including any gift or hospitality) does not have to be given to me directly. The offer of monies or advantages to others, including community groups, may amount to bribery, if the intention is to induce me to improperly perform a function. 3.18 I will never accept any gift or hospitality from any individual or applicant who is awaiting a decision from, or seeking to do business with, my public body. 3.19 If I consider that declining an offer of a gift would cause offence, I will accept it and hand it over to my public body at the earliest possible opportunity and ask for it to be registered. 3.20 I will promptly advise my public body’s Standards Officer if I am offered (but refuse) any gift or hospitality of any significant value and / or if I am offered any gift or hospitality from the same source on a repeated basis, so that my public body can monitor this. 3.21 I will familiarise myself with the terms of the Bribery Act 2010, which provides for offences of bribing another person and offences relating to being bribed. Page 243
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8 Confidentiality 3.22 I will not disclose confidential information or information which should reasonably be regarded as being of a confidential or private nature, without the express consent of a person or body authorised to give such consent, or unless required to do so by law. I note that if I cannot obtain such express consent, I should assume it is not given. 3.23 I accept that confidential information can include discussions, documents, and information which is not yet public or never intended to be public, and information deemed confidential by statute. 3.24 I will only use confidential information to undertake my duties as a board member. I will not use it in any way for personal advantage or to discredit my public body (even if my personal view is that the information should be publicly available). 3.25 I note that these confidentiality requirements do not apply to protected whistleblowing disclosures made to the prescribed persons and bodies as identified in statute. Use of Public Body Resources 3.26 I will only use my public body’s resources, including employee assistance, facilities, stationery and IT equipment, for carrying out duties on behalf of the public body, in accordance with its relevant policies. 3.27 I will not use, or in any way enable others to use, my public body’s resources: a) imprudently (without thinking about the implications or consequences); b) unlawfully; c) for any political activities or matters relating to these; or d) improperly. Dealing with my Public Body and Preferential Treatment 3.28 I will not use, or attempt to use, my position or influence as a board member to: a) improperly confer on or secure for myself, or others, an advantage; b) avoid a disadvantage for myself, or create a disadvantage for others or c) improperly seek preferential treatment or access for myself or others. 3.29 I will avoid any action which could lead members of the public to believe that preferential treatment or access is being sought. 3.30 I will advise employees of any connection, as defined at Section 5, I may have to a matter, when seeking information or advice or responding to a request for information or advice from them. Page 244
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9 Appointments to Outside Organisations 3.31 If I am appointed, or nominated by my public body, as a member of another body or organisation, I will abide by the rules of conduct and will act in the best interests of that body or organisation while acting as a member of it. I will also continue to observe the rules of this Code when carrying out the duties of that body or organisation. 3.32 I accept that if I am a director or trustee (or equivalent) of a company or a charity, I will be responsible for identifying, and taking advice on, any conflicts of interest that may arise between the company or charity and my public body. Page 245
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10 Section 4: Registration Of Interests 4.1 The following paragraphs set out what I have to register when I am appointed and whenever my circumstances change. The register covers my current term of appointment. 4.2 I understand that regulations made by the Scottish Ministers describe the detail and timescale for registering interests; including a requirement that a board member must register their registrable interests within one month of becoming a board member, and register any changes to those interests within one month of those changes having occurred. 4.3 The interests which I am required to register are those set out in the following paragraphs. Other than as required by paragraph 4.23, I understand it is not necessary to register the interests of my spouse or cohabitee. Category One: Remuneration 4.4 I will register any work for which I receive, or expect to receive, payment. I have a registrable interest where I receive remuneration by virtue of being: a) employed; b) self-employed; c) the holder of an office; d) a director of an undertaking; e) a partner in a firm; f) appointed or nominated by my public body to another body; or g) engaged in a trade, profession or vocation or any other work. 4.5 I understand that in relation to 4.4 above, the amount of remuneration does not require to be registered. I understand that any remuneration received as a board member of this specific public body does not have to be registered. 4.6 I understand that if a position is not remunerated it does not need to be registered under this category. However, unremunerated directorships may need to be registered under Category Two, “Other Roles”. 4.7 I must register any allowances I receive in relation to membership of any organisation under Category One. 4.8 When registering employment as an employee, I must give the full name of the employer, the nature of its business, and the nature of the post I hold in the organisation. 4.9 When registering remuneration from the categories listed in paragraph 4.4 (b) to (g) above, I must provide the full name and give details of the nature of the business, organisation, undertaking, partnership or other body, as appropriate. I recognise that some other employments may be incompatible with my role as board member of my public body in terms of paragraph 6.7 of this Code. Page 246
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11 4.10 Where I otherwise undertake a trade, profession or vocation, or any other work, the detail to be given is the nature of the work and how often it is undertaken. 4.11 When registering a directorship, it is necessary to provide the registered name and registered number of the undertaking in which the directorship is held and provide information about the nature of its business. 4.12 I understand that registration of a pension is not required as this falls outside the scope of the category. Category Two: Other Roles 4.13 I will register any unremunerated directorships where the body in question is a subsidiary or parent company of an undertaking in which I hold a remunerated directorship. 4.14 I will register the registered name and registered number of the subsidiary or parent company or other undertaking and the nature of its business, and its relationship to the company or other undertaking in which I am a director and from which I receive remuneration. Category Three: Contracts 4.15 I have a registerable interest where I (or a firm in which I am a partner, or an undertaking in which I am a director or in which I have shares of a value as described in paragraph 4.19 below) have made a contract with my public body: a) under which goods or services are to be provided, or works are to be executed; and b) which has not been fully discharged. 4.16 I will register a description of the contract, including its duration, but excluding the value. Category Four: Election Expenses 4.17 If I have been elected to my public body, then I will register a description of, and statement of, any assistance towards election expenses relating to election to my public body. Category Five: Houses, Land and Buildings 4.18 I have a registrable interest where I own or have any other right or interest in houses, land and buildings, which may be significant to, of relevance to, or bear upon, the work and operation of my public body. Page 247
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12 4.19 I accept that, when deciding whether or not I need to register any interest I have in houses, land or buildings, the test to be applied is whether a member of the public, with knowledge of the relevant facts, would reasonably regard the interest as being so significant that it could potentially affect my responsibilities to my public body and to the public, or could influence my actions, speeches or decision- making. Category Six: Interest in Shares and Securities 4.20 I have a registerable interest where: a) I own or have an interest in more than 1% of the issued share capital of the company or other body; or b) Where, at the relevant date, the market value of any shares and securities (in any one specific company or body) that I own or have an interest in is greater than £25,000. Category Seven: Gifts and Hospitality 4.21 I understand the requirements of paragraphs 3.13 to 3.21 regarding gifts and hospitality. As I will not accept any gifts or hospitality, other than under the limited circumstances allowed, I understand there is no longer the need to register any. Category Eight: Non–Financial Interests 4.22 I may also have other interests and I understand it is equally important that relevant interests such as membership or holding office in other public bodies, companies, clubs, societies and organisations such as trades unions and voluntary organisations, are registered and described. In this context, I understand non- financial interests are those which members of the public with knowledge of the relevant facts might reasonably think could influence my actions, speeches, votes or decision-making in my public body (this includes its Committees and memberships of other organisations to which I have been appointed or nominated by my public body). Category Nine: Close Family Members 4.23 I will register the interests of any close family member who has transactions with my public body or is likely to have transactions or do business with it. Page 248
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13 Section 5: Declaration Of Interests Stage 1: Connection 5.1 For each particular matter I am involved in as a board member, I will first consider whether I have a connection to that matter. 5.2 I understand that a connection is any link between the matter being considered and me, or a person or body I am associated with. This could be a family relationship or a social or professional contact. 5.3 A connection includes anything that I have registered as an interest. 5.4 A connection does not include being a member of a body to which I have been appointed or nominated by my public body as a representative of my public body, unless: a) The matter being considered by my public body is quasi-judicial or regulatory; or b) I have a personal conflict by reason of my actions, my connections or my legal obligations. Stage 2: Interest 5.5 I understand my connection is an interest that requires to be declared where the objective test is met – that is where a member of the public with knowledge of the relevant facts would reasonably regard my connection to a particular matter as being so significant that it would be considered as being likely to influence the discussion or decision-making. Stage 3: Participation 5.6 I will declare my interest as early as possible in meetings. I will not remain in the meeting nor participate in any way in those parts of meetings where I have declared an interest. 5.7 I will consider whether it is appropriate for transparency reasons to state publicly where I have a connection, which I do not consider amounts to an interest. 5.8 I note that I can apply to the Standards Commission and ask it to grant a dispensation to allow me to take part in the discussion and decision-making on a matter where I would otherwise have to declare an interest and withdraw (as a result of having a connection to the matter that would fall within the objective test). I note that such an application must be made in advance of any meetings where the dispensation is sought and that I cannot take part in any discussion or decision- making on the matter in question unless, and until, the application is granted. 5.9 I note that public confidence in a public body is damaged by the perception that decisions taken by that body are substantially influenced by factors other than the public interest. I will not accept a role or appointment if doing so means I will have to declare interests frequently at meetings in respect of my role as a board member. Similarly, if any appointment or nomination to another body would give rise to objective concern because of my existing personal involvement or affiliations, I will not accept the appointment or nomination. Page 249
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14 Section 6: Lobbying And Access 6.1 I understand that a wide range of people will seek access to me as a board member and will try to lobby me, including individuals, organisations and companies. I must distinguish between: a) any role I have in dealing with enquiries from the public; b) any community engagement where I am working with individuals and organisations to encourage their participation and involvement, and; c) lobbying, which is where I am approached by any individual or organisation who is seeking to influence me for financial gain or advantage, particularly those who are seeking to do business with my public body (for example contracts/procurement). 6.2 In deciding whether, and if so how, to respond to such lobbying, I will always have regard to the objective test, which is whether a member of the public, with knowledge of the relevant facts, would reasonably regard my conduct as being likely to influence my, or my public body’s, decision-making role. 6.3 I will not, in relation to contact with any person or organisation that lobbies, do anything which contravenes this Code or any other relevant rule of my public body or any statutory provision. 6.4 I will not, in relation to contact with any person or organisation that lobbies, act in any way which could bring discredit upon my public body. 6.5 If I have concerns about the approach or methods used by any person or organisation in their contacts with me, I will seek the guidance of the Chair, Chief Executive or Standards Officer of my public body. 6.6 The public must be assured that no person or organisation will gain better access to, or treatment by, me as a result of employing a company or individual to lobby on a fee basis on their behalf. I will not, therefore, offer or accord any preferential access or treatment to those lobbying on a fee basis on behalf of clients compared with that which I accord any other person or organisation who lobbies or approaches me. I will ensure that those lobbying on a fee basis on behalf of clients are not given to understand that preferential access or treatment, compared to that accorded to any other person or organisation, might be forthcoming. 6.7 Before taking any action as a result of being lobbied, I will seek to satisfy myself about the identity of the person or organisation that is lobbying and the motive for lobbying. I understand I may choose to act in response to a person or organisation lobbying on a fee basis on behalf of clients but it is important that I understand the basis on which I am being lobbied in order to ensure that any action taken in connection with the lobbyist complies with the standards set out in this Code and the Lobbying (Scotland) Act 2016. Page 250
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15 6.8 I will not accept any paid work: a) which would involve me lobbying on behalf of any person or organisation or any clients of a person or organisation. b) to provide services as a strategist, adviser or consultant, for example, advising on how to influence my public body and its members. This does not prohibit me from being remunerated for activity which may arise because of, or relate to, membership of my public body, such as journalism or broadcasting, or involvement in representative or presentational work, such as participation in delegations, conferences or other events. Page 251
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16 Annex A: Breaches Of The Code Introduction 1. The Ethical Standards in Public Life etc. (Scotland) Act 2000 (“the Act”) provided for a framework to encourage and, where necessary, enforce high ethical standards in public life. 2. The Act provided for the introduction of new codes of conduct for local authority councillors and members of relevant public bodies, imposing on councils and relevant public bodies a duty to help their members comply with the relevant code. 3. The Act and the subsequent Scottish Parliamentary Commissions and Commissioners etc. Act 2010 established the Standards Commission for Scotland (“Standards Commission”) and the post of Commissioner for Ethical Standards in Public Life in Scotland (“ESC”). 4. The Standards Commission and ESC are separate and independent, each with distinct functions. Complaints of breaches of a public body’s Code of Conduct are investigated by the ESC and adjudicated upon by the Standards Commission. 5. The first Model Code of Conduct came into force in 2002. The Code has since been reviewed and re-issued in 2014. The 2021 Code has been issued by the Scottish Ministers following consultation, and with the approval of the Scottish Parliament, as required by the Act. Investigation of Complaints 6. The ESC is responsible for investigating complaints about members of devolved public bodies. It is not, however, mandatory to report a complaint about a potential breach of the Code to the ESC. It may be more appropriate in some circumstances for attempts to be made to resolve the matter informally at a local level. 7. On conclusion of the investigation, the ESC will send a report to the Standards Commission. Hearings 8. On receipt of a report from the ESC, the Standards Commission can choose to: • Do nothing; • Direct the ESC to carry out further investigations; or • Hold a Hearing. 9. Hearings are held (usually in public) to determine whether the member concerned has breached their public body’s Code of Conduct. The Hearing Panel comprises of three members of the Standards Commission. The ESC will present evidence and/or make submissions at the Hearing about the investigation and any conclusions as to whether the member has contravened the Code. The member is entitled to attend or be represented at the Hearing and can also present evidence and make Page 252
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17 submissions. Both parties can call witnesses. Once it has heard all the evidence and submissions, the Hearing Panel will make a determination about whether or not it is satisfied, on the balance of probabilities, that there has been a contravention of the Code by the member. If the Hearing Panel decides that a member has breached their public body’s Code, it is obliged to impose a sanction. Sanctions 10. The sanctions that can be imposed following a finding of a breach of the Code are as follows: • Censure: A censure is a formal record of the Standards Commission’s severe and public disapproval of the member concerned. • Suspension: This can be a full or partial suspension (for up to one year). A full suspension means that the member is suspended from attending all meetings of the public body. Partial suspension means that the member is suspended from attending some of the meetings of the public body. The Commission can direct that any remuneration or allowance the member receives as a result of their membership of the public body be reduced or not paid during a period of suspension. • Disqualification: Disqualification means that the member is removed from membership of the body and disqualified (for a period not exceeding five years), from membership of the body. Where a member is also a member of another devolved public body (as defined in the Act), the Commission may also remove or disqualify that person in respect of that membership. Full details of the sanctions are set out in section 19 of the Act. Interim Suspensions 11. Section 21 of the Act provides the Standards Commission with the power to impose an interim suspension on a member on receipt of an interim report from the ESC about an ongoing investigation. In making a decision about whether or not to impose an interim suspension, a Panel comprising of three Members of the Standards Commission will review the interim report and any representations received from the member and will consider whether it is satisfied: • That the further conduct of the ESC’s investigation is likely to be prejudiced if such an action is not taken (for example if there are concerns that the member may try to interfere with evidence or witnesses); or • That it is otherwise in the public interest to take such a measure. A policy outlining how the Standards Commission makes any decision under Section 21 and the procedures it will follow in doing so, should any such a report be received from the ESC can be found here. 12. The decision to impose an interim suspension is not, and should not be seen as, a finding on the merits of any complaint or the validity of any allegations against a member of a devolved public body, nor should it be viewed as a disciplinary measure. Page 253
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18 Annex B: Definitions “Bullying” is inappropriate and unwelcome behaviour which is offensive and intimidating, and which makes an individual or group feel undermined, humiliated or insulted. "Chair" includes Board Convener or any other individual discharging a similar function to that of a Chair or Convener under alternative decision-making structures. “Code” is the code of conduct for members of your devolved public body, which is based on the Model Code of Conduct for members of devolved public bodies in Scotland. "Cohabitee" includes any person who is living with you in a relationship similar to that of a partner, civil partner, or spouse. “Confidential Information” includes: • any information passed on to the public body by a Government department (even if it is not clearly marked as confidential) which does not allow the disclosure of that information to the public; • information of which the law prohibits disclosure (under statute or by the order of a Court); • any legal advice provided to the public body; or • any other information which would reasonably be considered a breach of confidence should it be made public. "Election expenses" means expenses incurred, whether before, during or after the election, on account of, or in respect of, the conduct or management of the election. “Employee” includes individuals employed: • directly by the public body; • as contractors by the public body, or • by a contractor to work on the public body’s premises. “Gifts” a gift can include any item or service received free of charge, or which may be offered or promised at a discounted rate or on terms not available to the general public. Gifts include benefits such as relief from indebtedness, loan concessions, or provision of property, services or facilities at a cost below that generally charged to members of the public. It can also include gifts received directly or gifts received by any company in which the recipient holds a controlling interest in, or by a partnership of which the recipient is a partner. “Harassment” is any unwelcome behaviour or conduct which makes someone feel offended, humiliated, intimidated, frightened and / or uncomfortable. Harassment can be experienced directly or indirectly and can occur as an isolated incident or as a course of persistent behaviour. Page 254
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19 “Hospitality” includes the offer or promise of food, drink, accommodation, entertainment or the opportunity to attend any cultural or sporting event on terms not available to the general public. “Relevant Date” Where a board member had an interest in shares at the date on which the member was appointed as a member, the relevant date is – (a) that date; and (b) the 5th April immediately following that date and in each succeeding year, where the interest is retained on that 5th April. “Public body” means a devolved public body listed in Schedule 3 of the Ethical Standards in Public Life etc. (Scotland) Act 2000, as amended. “Remuneration" includes any salary, wage, share of profits, fee, other monetary benefit or benefit in kind. “Securities” a security is a certificate or other financial instrument that has monetary value and can be traded. Securities includes equity and debt securities, such as stocks bonds and debentures. “Undertaking” means: a) a body corporate or partnership; or b) an unincorporated association carrying on a trade or business, with or without a view to a profit. Page 255
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© Crown copyright 2021 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.scot Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew’s House Edinburgh EH1 3DG ISBN: 978-1-80201-741-0 (web only) Published by The Scottish Government, December 2021 Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 5NA PPDAS987066 (12/21) w w w . g o v . s c o tPage 256