Agenda Document Pack - Midlothian Integration Joint Board - 24/10/2024
Midlothian Council · 24 October 2024
Back to Midlothian Integration Joint Board — 24 October 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
Notice of Meeting and Agenda Midlothian Integration Joint Board Venue: Council Chambers/Hybrid, Midlothian House, Dalkeith, EH22 1DN Date: Thursday, 24 October 2024 Time: 14:00 Morag Barrow Chief Officer Contact: Clerk Name: Democratic Services Clerk Telephone: 0131 271 3160 Clerk Email: democratic.services@midlothian.gov.uk Further Information: This is a meeting which is open to members of the public. Page 1 of 286
Page 2
1 Welcome, Introductions and Apologies 2 Order of Business Including notice of new business submitted as urgent for consideration at the end of the meeting. 3 Declaration of Interest Members should declare any financial and non-financial interests they have in the items of business for consideration, identifying the relevant agenda item and the nature of their interest. 4 Minute of Previous Meeting 4.1 Minutes of previous Midlothian IJB Board Meeting held on 22nd August 2024 5 - 20 4.2 Minutes of Strategic Planning Group on 29th August 2024 21 - 30 4.3 Minutes of the Audit and Risk Committee Meeting held on 6th June 2024 31 - 40 5 Public Reports 5.1 Chair’s Update – Councillor McManus, Chair 5.2 Chief Officers Report – Morag Barrow, Chief Officer 41 - 48 5.3 Strategic Planning Group Update – Andrew Fleming, SPG Chair 5.4 Audit and Risk Committee Update – Val de Souza, Audit and Risk Chair For Decision 5.5 MIJB Membership Recommendations - Paper presented by Democratic Services 49 - 52 5.6 Annual Performance Report Review for Publication - Paper presented by Gill Main, Integration Manager and Elouise Johnstone, Performance Manager 53 - 142 5.7 Report on Commissioned Scoping Exercise on Employability & Opportunities for Better Partnership Workforce Planning - Paper presented by Jim Sherval, Public Health Consultant 143 - 150 For Discussion Page 2 of 286
Page 3
5.8 MIJB Performance Report - Paper presented by Elouise Johnstone, Performance Manager 151 - 176 5.9 Midlothian Drug Misuse and Alcohol Specific Deaths 2023 - Paper presented by Nick Clater, Head of Adult Services 177 - 182 5.10 Public Health Update - Paper by Jim Sherval, Public Health Consultant, and Ruth Flynn, Public Health Practitioner 183 - 190 5.11 Integrated Assurance Report Paper presented by Claire Ross, Chief AHP 191 - 242 5.12 Darzi Report Discussion - Paper prepared by Gill Main, Integration Manager 243 - 250 5.13 MIJB Finance Update - Paper prepared by David King, Interim Chief Financial Officer 251 - 264 For Noting 5.14 Community Payback Orders Justice Report - Paper presented by Fiona Kennedy, Group Service Manager 265 - 270 5.15 Review of Risk Register Policy - Paper presented by David King, Interim Chief Financial Officer 271 - 286 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board will be held on: • Thursday 21st November 2024, 14:00 – 16:00, development session for board members only. • Thursday 19th December 2024, 14:00 – 16:00. Midlothian Integration Joint Board full board meeting Page 3 of 286
Page 4
Page 4 of 286
Page 5
Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday, 22 August 2024 2.00pm Council Chambers, Midlothian House and Virtual Meeting held using Microsoft Teams. Present (voting members): Connor McManus (Chair) Councillor Winchester (attended virtually) Councillor Parry (attended virtually) Councillor Milligan (attended virtually) Andrew Fleming (NHS Lothian Kirsty MacDonald (NHS Lothian Dr Amjad Khan (NHS Lothian) Present (non-voting members): Morag Barrow (Chief Officer) David King (Interim Chief Finance Officer) Joan Tranent (Chief Social Work Officer) Fiona Stratton (Chief Nurse) Claire Ross (Chief AHP) Rebecca Green (Clinical Director) Wanda Fairgrieve (Partnership Representative NHS) Magda Clark (Third Sector Representative) (attended virtually) Keith Chapman (Lived Experience Representative) Jordan Miller (Partnership Representative NHS) In attendance: Councillor McKenzie (attended virtually) Gill Main (Integration Manager) Nick Clater (Head of Adult Services & Social Care) Grace Cowan (Head of Primary Care and Older Peoples Services) Jim Sherval (Consultant in Public Health) (attended virtually) Fiona Kennedy (Group Service Manager Elouise Johnstone (Performance Manager) (attended virtually Ashley Goodfellow (Deputy Director of Public Health and Health Policy) (attended virtually) Hannah Forbes (Democratic Services Officer Midlothian Integration Joint Board Thursday, 24 October 2024 Item No 4.1 Page 5 of 286
Page 6
2 Midlothian Integration Joint Board Thursday 18 April 2024 1. Welcome and Introductions The Chair welcomed everyone to this Meeting of the Midlothian Integration Joint Board (MIJB). Apologies were received from Roxanne King, (Executive Business Manager) 2. Order of Business The order of business was confirmed as outlined in the agenda that had been previously circulated. 3. Declarations of Interest No declarations of interest were received. 4. Minute of Previous Meetings 4.1 The Minute of previous Midlothian IJB Board Meeting held on 20th June 2024 was approved as an accurate record. 4.2 The Minute of the meeting of the MIJB – Strategic Planning Group held on 23 May 2024 was approved as an accurate record. 4.3 The Minute of the meeting of the MIJB - Audit and Risk Committee held on 7 March 2024 approved as an accurate record. 5. Public Reports Apologies: Roxanne King (Executive Business Manager) Val de Souza (Vice Chair NHS) Page 6 of 286
Page 7
3 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments 5.1 MIJB Board Membership Nominations paper presented by The Chief Officer of Corporate Solutions. The Chief Officer of Corporate Solutions detailed that this report provides the MIJB with information on the nomination of two new voting members and the re-appointment of one non- voting member as proposed by NHS Lothian Board. The report seeks the MIJB’s endorsement of the two voting members. The MIJB is asked to: • Note the resignation of Nadin Atka and Angus McCann from MIJB • Endorse the nomination of Kirsty MacDonald as a voting member of the MIJB with effect from 31 August 2024 on the resignation of Angus McCann • Endorse the nomination of Dr Amjad Khan as a voting member of the MIJB with effect from 26 June 2024 • Note the re-appointment of Fiona Stratton as a non-voting member of the MIJB with effect from 23 June 2024. • Welcome new colleagues to the MIJB This was proposed by Andrew Fleming and seconded by Wanda Fairgrieve. Nominations endorsed by Board. 5.2 Chair’s Update - Presented by Councillor McManus The Chair highlighted the upcoming Strategic Plan consultation townhall meetings, hoping to see members there. It was also highlighted that today will be Joan Tranent, Chief Social Work Officer, last meeting with the IJB. Chair thanked Joan for coming along today and for all the work that she has done, noting she will be very much missed. Page 7 of 286
Page 8
4 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments There was an introduction from both new voting members, Dr Amjad Khan and Kirsty MacDonald. It was highlighted that Tracy Ann Miller would be standing in for Val De Souza, Vice Chair. It was mentioned the Strategic planning Group will be held on Thursday 26th September 2024 and all Board members will be invited to attend and participate in the planned Equalities and Children’s Right’s Impact Assessment on the draft Strategic Plan. 5.3 Chief Officers Report – Morag Barrow, Chief Officer Morag Barrow, Chief Officer, presented the report and advised the paper sets out the key strategic updates for the Board. The Chief Officer highlighted items for the attention of the Board detailing the achievement of the Midlothian Team delivering on the medication assisted treatment standard. It has been updated to the Board over the last couple of years, noting acknowledgement from Scottish Government that we are in green on these. It was also noted the significant improvement in terms of our A11 target, currently at 100%. The Chief Officer praised the operational teams for their work. The Annual Performance Report will come back in October due to the late publication of data. It was also noted the Health and Social Care Partnership team are working with the NHS Lothian team around the agenda for change reform and the implications of reducing working hours as per Scottish Government directive and detailed the impact of that. It was mentioned the improvement of the HACE survey, it was expressed the challenges faced with the HACE and we will continue to update on that as we move forward. The Chief Officer provided an update on the NRS drug deaths.. Midlothian have reported 20 drugs deaths this year. Disappointment was expressed relating to that Page 8 of 286
Page 9
5 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments figure, it was mentioned that every death is a tragedy and we extend our condolences to the families. It was stated there is nothing to be concerned around the service delivery as we propose to do the same as last year, bringing a detailed paper to the Board. It was highlighted that David King, Interim Chief Financial Officer, has provided a submission to the pre-budgetary scrutiny consolation on behalf of the Board. Due to timing, this could not be formally presented here first however, if members wish we can share the Interim Chief Financial Officer’s response for information. Discussions highlighting concerns relating to the National Care Service (NCS) bill arose, stating that it is such a significant piece of documentation, the Board need to discuss that, rather than it going through consultation correspondence. However, it was expressed this may not be possible. It was posed what can we be doing around the NRS drug deaths to address that. In relation to delayed discharges in the paper, it references the additional capacity and is the additional capacity going to be enough to help us. Additionally, another area was around the HACE survey what do we think was the basis of the improvement. It was also asked for more information regarding weight management services and how we are going to identify the correct people for that service. The Head of Adult Services and Social Care advised in relation to the question asked regarding the NRS drug deaths, they are currently still analysing the data as there is a significant amount that is provided. Stating there will be a briefing for IJB and elected members in the next week or so, to provide a more detailed report regarding that for the next IJB. It was explained looking at the 3–5- year average this is what was we had expected to see. It was stated that there is more work that Page 9 of 286
Page 10
6 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments needs to be done around responsiveness of services and some of that may require reallocation of funding. The Chief Officer explained in relation to the question regarding the reduction in delayed discharges, with the financial challenges our performance will slow down. The majority of the delays are due to not having enough care home placements that are accessible to teams. The Head of Primary Care and Older Peoples Services advised that improved flow is seen within the system daily, and this is a benefit as we have recently not seen any flow. The aim is to get this back to pre-pandemic levels. The Clinical Director spoke to the increases to HACE survey and detailed that in the report it is only the statically significant ones. The Chief AHP spoke to the question regarding weight management and advised that there are 2 things that would be beneficial to share, firstly the development of a new post within Public Health, seeking to support the challenges around weight stigma. In terms of the service itself, it is currently underway with a range of recovery actions to try and improve the position. The process work should significantly improve the current status. The Integration Manager advised in terms on the NCS there are challenges in relation to the sophistication of the survey that it doesn’t allow us to do a free text responses. This consultation does not give us the option to not publish, all must be published it is important to note the political sensitivity around that. The Chair stated that if all Board members contribute and send to the Integration Manager to formulate a response. Page 10 of 286
Page 11
7 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments 5.4 Strategic Commissioning Plan First Draft for Public Consideration - Paper presented by Gill Main, Integration Manager Gill Main, Integration Manager, and Elouise Johnstone, Performance Manager, presented the report. This report sets out the actions and progress to date in relation to the development of Midlothian Integration Joint Boards new Strategic Plan for 2025 – 35 and presents a draft plan (appendix 1) for Board approval to commence public consultation in line with the Strategic Plan Statutory Guidance. Chair thanked the Integration Manager for the report and opened up for any questions. A question was asked asking for assurance that this has been engaged with the main partners NHS Lothian and the council itself and that the integration Manger is confident that they are happy it has been built into that, and to check engagement with the main partner the council itself, confident they are well built into that. The second question that was asked was in relation to Strategic aim number 1 that it accompanies people looking at palliative care. The Integration Manager advised the team has attempted to reach out to everybody so anyone can see themselves at any point of this plan, with people moving through the system at different points of their life. It was highlighted the 3rd strategic aim relates to get access to swift change and it covers them across all of those. The whole centre of this plan is for what people need. The Chair asked for a Proposer to move the paper into Consultation, Jordan Miller stated that he would Propose the paper and a seconder would be Andrew Fleming. The chair also thanked The Integration Manger and the team for all the hard work that has gone into this. Page 11 of 286
Page 12
8 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments 5.5 Audit and Risk Committee, and Strategic Planning Group Terms of Reference - Paper presented by David King, Interim Chief Finical Officer and Gill Main, Integration Manager The Interim Chief Financial Officer advised that this report presents for the Board’s consideration the reviewed Terms of Reference for both the Midlothian IJB Strategic Planning Group (SPG) and the Audit and Risk Committee (ARC) The Integration Manger spoke to the statutory element of the SPG, as a statutory committee and currently isn’t noted as such in our standing orders, suggesting the Board may wish to consider this. Statutory guidance states that we must have a partner that is not as an officer from NHS Lothian and from the council, we may want to consider how we formalise the agreement with Midlothian council. That ensures there is that involvement throughout any key issues to note. There is also another key issue that the Chair of that committee should be a voting member of the Board and not an officer of the HSPC. Chair noted that Val De Souza is currently the Chair of Audit and Risk Committee and expressed gratitude for Andrew Fleming taking on the role of Chair of SPG. . Chair also highlighted the importance of attending these sessions and who needs to attend as a reminder to all. The Proposer for this was Andrew Fleming and the seconder was Jordan Miller. Page 12 of 286
Page 13
9 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments 5.6 Digital in Midlothian - Paper presented by Claire Ross, Chief AHP The purpose of this report is to update Midlothian Integration Joint Board (IJB) on progress relating to the Midlothian Health and Social Care (HSCP) Digital Implementation and Delivery Plan (2022- 2025.) As this plan enters its final year, this update set out achievements to date and proposed priorities going forwards in the context of the current financial challenges. Aligned to the IJB Strategic Plan, which describes Digital Technology as an enabler, the Digital Implementation and Delivery Plan has four primary functions aligned to the Digital, Data and Technology Enabled Care vision to: 1. provide a clear vision, agreed governance route and dedicated resource 2. build on the accelerated pace of, and focus on, digital technology created by the COVID-19 pandemic, and see digital technology as a key pillar in the delivery of long-term sustainability for health and social care services. 3. outline a change programme to build on current and ongoing work to implement, co-ordinate and deliver to a series of fundamental priorities to enable digital transformation in the longer term. 4. outline context against which coordinated effort is required for Midlothian HSCP to deliver against national strategies and local ambitions. The Chair thanked the Chief AHP for the report and opened to any questions. It was stated that there is a positive position around consolidation rather than expansion, in recognition of limited resources to move this forward. Queries as to how long consolidation can continue, and what opportunities for sharing resources across other bodies to support help us were posed. Page 13 of 286
Page 14
10 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments The Chief AHP advised there would be two elements which could be brought back for consideration, firstly looking at the priorities stated in Appendix 1. An area I think we have really achieved well in the last two years refers to the digital infrastructure which has a well-established implementation and programme board. Reference was made to the connection to the other health and social partnerships, which could grows upwards. It feels there is a greater opportunity for sharing across the system and that is applicable within the National Arena. The Chair thanked the Chief AHP again for the report, the report was proposed by Andrew Fleming and seconded by Wanda Fairgrieve. For Discussion 5.7 MIJB Finance Update Quarter 1 & Revised Medium-Term Financial Strategy - Paper prepared by David King, Interim Chief Financial Officer The Interim Chief Financial Officer spoke to the report and advised the purpose of this report sets out: • The results of the partners’ quarter one financial reviews in so far as these relate to the IJB’s budget for 2024/25, the quarter one financial review providing a forecast out-turn for 2024/25. • Further mitigations and work underway to manage the financial pressures identified in the quarter one review. • A review of the Medium-Term Financial Strategy (formally the Five-Year Financial Plan) The Interim Chief Financial Officer highlighted what has been set out for this financial year. Referring to table 1 in the paper, noting it is the plan that we started with, stating the budget was set at £158 million.. However, after a lot of examination of the financial pressures sitting in the system, we are Page 14 of 286
Page 15
11 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments looking at trying to source recovery actions of around £10 million. There was an in-depth conversation that took place, and we agreed a plan to put into motion. Noting quarter 1 is where our partners look at the first 3 months of the financial year and cast forward their projections. Table 3 details the output of this projection, it states the IJB will be overspent by £9.1 million in the current financial year. Concerns around the social care position and the health position regarding overspend were highlighted. It was emphasised that Social care is running over each month. This is a demand driven service and there is a huge demand for that service. It was stated that there are currently two actions that are underway, firstly there is a lot of ongoing work regarding the previously agreed recovery actions. Secondly, operational teams are currently working on further recovery plans. These will be presented to the IJB. It was stated that the IJB make the decision if these recovery plans impact the strategic plan and are affecting what we have set out to deliver in the current financial year. The Chair thanked the Interim Chief Financial Officer for the report and opened to questions. It was asked for some more depth on why we are currently struggling to recover and the difficulties around what we are doing. It was stated that any recovery towards the end of the finical year will prove to be even more difficult. The Interim Chief Financial Officer advised that looking at the plan, due to the additional allocation from Midlothian Council of £3.3 million pounds, largely covered the new pressures. Stressing the recovery programme is concerned with the large overspend in 2023/2024, this position has deteriorated towards the end of the year and is not improving. What is now being looked at is the Page 15 of 286
Page 16
12 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments fundamental pressure in the system. It was stated that he was eager to bring this back to the September IJB. 5.8 IJB Performance Report - Paper presented by Elouise Johnstone, Performance Manager Elouise Johnstone, Performance Manager, presented the report. The report sets out the update on progress towards the IJB performance goals set for the financial year 2023/24. Due to the processes required to validate these data, the full reporting year is almost complete for all indicators. Noting the Performance Assurance and Governance Group met on the 11th of July 2024, having the first scrutiny session looking at the Integration indicators that require to be published in the Annual Performance Report. The Group were due to meet again on the 8th of August 2024, but this meeting did take place. There had been a detailed look at the visuals designed to represent the Integration indicators. The Performance Manager thanked all to attended the session, stating feedback that was given was very thoughtful and incredibly constructive and has led to another round of improvements in terms of how we present the data, how we describe our progress and how we talk about our position in relation to Scotland as a whole. The OutNav strategic governance outcomes map was discussed, noting that the progress has been rated as great and the confidence is in relation to the data that provides the evidence of that progresses. The service maps are aggregated to create the strategic overview of progress. There will be assurance if services are continued to be onboarded, the depth of the evidence base will increase therefore the confidence in the evidence will also increase. Page 16 of 286
Page 17
13 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments The Chair thanked the Performance Manager for the report. 5.9 Public Health Update - Paper by Jim Sherval, Public Health Consultant, and Jac Kirkland, Public Health Practitioner The Public Health Consultant introduced Jac Kirkland, Public Health Practitioner, to present the report. Its purpose setting out an update on the progress of the Health Inclusion Team. It was highlighted that the Health Inclusion Team is unique to Midlothian, as no other Health and Social Care Partnership has a team similar to it. This conveying the commitment to early intervention and prevention strategies in Midlothian. The work of the team was described, noting they are situated at Number 11 with this seen as an asset enabling opportunities to do partnership work. It was reported, besides one year due to vacancy, the target of seeing 145 people a year was met. The team work mainly with 35–44-year-old males, and around 84% of the work over the last 4 years has been conducted via outreach as a service. This is due to the nature of the clients the service is trying to engage and support, although appointments are offered. The volume of returning clients within HIT was discussed, to ascertain the nature of the client base and showing the trust they have within out service. Chair thanked the Public Health Practitioner for the report. 5.10 Midlothian IJB Health and Care (Staffing) (Scotland) Duties Benchmarking Report - Paper presented by Gill Main, Integration Manager Recommendation s approved Page 17 of 286
Page 18
14 Midlothian Integration Joint Board Thursday 18 April 2024 Decision Action Owner Date to be Completed/ Comments The Integration Manager spoke to the purpose of the report and advised that it sets out a benchmarking position in relation to Midlothian Integration Joint Boards current position on the duties of the Health and Care (Staffing) (Scotland) Act, 2019 relating to the planning or securing of the provision of care services from third party providers. As result of this report Members are asked to: • note the report and current benchmarking position and proposed recommendations for action in 2024/25, • provide feedback, and suggest any amendments to recommended action during the 2024/25 reporting period, • note that 2024/25 report will be presented to the board in April 2025 for approval before forwarding to Scottish Government. It was highlighted at this point in time we are not as far forward as our NHS colleagues who have been given a template to be able to fully understand their reporting duties are. We only have the legislation to work with, awaiting what a reporting template will look like. There were no questions in relation to the report, Chair thanked the Integration Manager for speaking to this report. For Noting 5.11 Governance Review - Paper presented by Gill Main, Integration Manager, Alan Turpie, Standards Officer, and Duncan Stainbank Page 18 of 286
Page 19
15 Midlothian Integration Joint Board Thursday 18 April 2024 5 Private Reports No items for discussion. 6 Any Other Business No items for discussion. 7 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board (Special) will be held on 21 September 2024 The meeting terminated at 15:17pm. Decision Action Owner Date to be Completed/ Comments The Integration Manager spoke to the purpose of the report, setting out key action required to ensure the statutory governance requirements of Midlothian Integration Joint Board are fulfilled. A number of statutory governance requirements activities in 2024 have progressed. Chair thanked the Integration Manager for the report, and no questions were raised. Chair closed the meeting advising the next meeting will be the Special MIJB that will be discussing finance. Page 19 of 286
Page 20
Page 20 of 286
Page 21
Midlothian Integration Joint Board Meeting Date Time Venue Strategic Planning Group Thursday, 27 June 2024 14:00pm Virtual via MS Teams Chair: Gill Main (Integration Manager) Vice Chair: Vacant Present (MIJB members): Morag Barrow (Chief Officer) Keith Chapman (Lived Experience Member) Andrew Fleming (NHS Lothian) Magda Clark (Third Sector Member) Present (SPG Members): Gill Main (Integration Manager) (Chair) Elouise Johnstone (Programme Manager) Jim Sherval (Consultant in Public Health) Rebecca Green (Clinical Director) Grace Cowan (Head of Primary Care & Older People) Roxanne King (Executive Business Manager) James Hill (Midlothian Council Representative) In Attendance: Emma-Jane Gunda (Assistant Strategic Programme Manager) Gary Leadbetter (Democratic Services) Midlothian Integration Joint Board Thursday, 24 October 2024 Item 4.2 Page 21 of 286
Page 22
2 Strategic Planning Group Thursday, 23 May 2024 Apologies: David King (Interim Chief Financial Officer) Rachael Honeyman (Head of Volunteering NHS) Laura Hutchison (NHS Equality, Diversity & Human Rights Lead) Wanda Fairgrieve (Partnership Rep) 1. Welcome and Introductions The Chair welcomed everyone to the meeting of the Midlothian Integration Joint Board (MIJB) – Strategic Planning Group (SPG). Apologies were noted. The Chair noted that there were no representatives in this meeting from either Midlothian Council or NHS Lothian. 2. Order of Business The order of business was as set out in the agenda. 3. Minutes of Meeting 3.1 The Minute of the Strategic Planning Group meeting held on 23 May 2024 was submitted and approved as a correct record. 3.2 Action Log. Emma-Jane Gunda, Assistant Strategic Programme Manager, presented the Action Log and updates were noted. 3.3 Risk Register. The Chair noted that there are currently no risks on the risk register and advised that they expect as thing moves forward with the review of the ToR that risks will be raised more regularly and escalated as appropriate. 4. Updates Page 22 of 286
Page 23
3 Strategic Planning Group Thursday, 23 May 2024 Report Title/Summary Decision Action Owner Date to be Completed/ Comments 4.1 Chairs Update (verbal) - Gill Main, Integration Manager The Chair provided the following updates: • Since the last meeting there has been work undertaken to look at the Strategic Commissioning Plan for 2025-40. This involved a significant redesign and summary following IJB input at the May Development Session. It was advised that this would be reviewed in July by a Working Group of IJB Members and Officers. • Notice of an internal audit on Directions had been received and it was noted that most of the information had been provided, with there being one or two outstanding queries from the internal auditors, in relation to the provision of information. • A revised ToR has been proposed for SPG which was reviewed at the Audit and Risk Committee in June. The A&R Committee were happy to recommend the revised ToRs to the IJB for consideration and, as such, it will be presented to the IJB in August. • Andrew Fleming, NHS Lothian, will be taking over as Chair of the SPG from August 2024. 4.2 Finance Update (verbal) – David King, Interim Chief Financial Officer The Chair provided an update in the absence of David King, Interim Chief Financial Officer. The Chair advised that at the last IJB meeting a paper was circulated which laid out the revised financial reporting and planning process. An indication of the financial position will be presented to every IJB or an actual financial position, if the partners have made this available. Further revisions to the current five-year financial plan will be made over the next few months, with a view to republishing the revised plan in December 2024. The challenge will be ensuring this reflects the IJB’s strategic aims and goals and that it is not just a financial reaction to a financial challenge. The indication for month 2 2024 provided by the partners show that the IJB is overspend by several hundred thousand pounds and work continues to identify the drivers behind this pressure. The HSCP is continuing to review the impact of the Page 23 of 286
Page 24
4 Strategic Planning Group Thursday, 23 May 2024 Report Title/Summary Decision Action Owner Date to be Completed/ Comments recovery programmes agreed by the IJB in its 2024/25 budget setting and, as part of that process, how much of the current financial position is driven by the actual delivery of the recovery programmes over the financial year. The IJB continues to engage with NHS Lothian to understand any pressures more fully resulting from the set aside budget allocation. Discussions are underway to ensure that the IJB and SPG are fully engaged in this work, with the possibility of further finance workshops later in the year. However, it is very likely that further financial recovery actions will be needed in the current financial year and the financial challenges in 2025/26, and beyond, are also significant. Any recovery actions for 2025/26 need to be properly mapped onto the IJB Strategic Plan It was noted that any questions regarding this update could be directed to Democratic Services and a response would be sought from David King. 4.3 PAGG Update (verbal) – Elouise Johnstone, Programme Manager Elouise Johnstone, Programme Manager, provided a verbal update, explaining that at the recent meeting of the PAGG there was a presentation on the Joint Strategic Needs Assessment and the processes that sit behind it. Elouise Johnstone further spoke to the need to take decision that are grounded in evidence, rather than assumptions, and highlighted the quality of the team’s work in relation to this. Elouise Johnstone explained that supplementary indicators to sit within the Annual Performance Report were also identified, which will be included in the next iteration of the report. 4.4 HSCP Integrated Workforce Governance Board (verbal) – Morag Barrow, Joint Director Health and Social Care As Grace Cowan, Head of Primary Care and Older People’s Services, chaired the last HSCP Integrated Workforce Governance Board, they provided the update. They advised that, at the meeting, the reduced working week had been discussed, noting that it was agreed that this would be overseen through the ELT and the Workforce Board, with updates at the SMT Page 24 of 286
Page 25
5 Strategic Planning Group Thursday, 23 May 2024 Report Title/Summary Decision Action Owner Date to be Completed/ Comments and the SPG. Grace Cowan advised the health and care staffing benchmarking was also discussed, with it being agreed that this would first sit with the Clinical Care Governance Group and Social Work Assurance Group and then into SMT. It was also noted that collaborative reporting was also discussed at the meeting, with the proposed route of travel being agreed. Further, the Turas review was also discussed with the need to get the system to function properly to pull through accurate information, with it being noted that there needs to be a good deal of work in the background and front line to allow for this. Finally, it was noted that there was a briefing around this year’s Speak Up week, with it being advised that Morag Barrow, Grace Cowan and Nick Clater and the extended leadership team would be interviewed in relation to this. The Chair further advised that the health and care staffing benchmarking report was largely to determine what the IJBs responsibility is, noting that this would be presented to the IJB in draft form for review. The Chair explained that there are three parts to the legislation: the part that asks for the reporting on health, the part that asks for reporting on local authority and the part that asks for reporting on IJB. The Chair then spoke to each of these parts, explaining that there was clarity in relation to the reporting on health. They noted that there was less clarity around the reporting on local authority until the Scottish Government explains what the reporting will be. The Chair further advised that the Scottish Government had not advised on what the IJB reporting template would look like, but the legislation was a little clearer on this. The Chair explained that the IJBs role is around reporting on the duties as the pertain to the planning, procuring, and securing of the provision of care through third parties. The Chair explained that this is the purpose of that report. 5. Updates Page 25 of 286
Page 26
6 Strategic Planning Group Thursday, 23 May 2024 Report Title/Summary Decision Action Owner Date to be Completed/ Comments Topics in Focus 5.1 Strategic Commissioning Plan Update – Gill Main, Integration Manager The Chair presented the report. The report sets out the actions and progress to date in relation to the development of Midlothian Integration Joint Boards new Strategic Commissioning Plan for 2025-40. Members were asked to: • Note activity and progress made to date. • Note the Board feedback. • Review and discuss the Midlothian Citizen Panel data presented. • Note the action still to be taken to develop the first draft of the Midlothian IJB Strategic Commissioning Plan 2025-40 for consultation. The Chair shared and spoke to a presentation on the Midlothian IJB’s Strategic Commissioning Plan 2025-40, speaking to the various actions and activities that have taken place in relation to this and further those actions and activities that are planned. Elouise Johnstone, Performance Manager, shared and spoke to a presentation on the Midlothian Citizen Panel data, with it being noted that the Midlothian Citizens Panel includes 1000 people which is demographically representative, as far as possible, of the whole population of Midlothian. There were 573 responses to the questionnaire which is a 57% response rate, which is a reasonable response rate in comparison to other comparable surveys. Page 26 of 286
Page 27
7 Strategic Planning Group Thursday, 23 May 2024 Report Title/Summary Decision Action Owner Date to be Completed/ Comments Keith Chapman, Lived Experience Member, raised a query as to whether there was longitudinal data. Elouise Johnstone explained that the Citizens Panel allowed for surveys to be completed every year or on a once off. They explained that this survey was a once off and so there was no longitudinal data. Andrew Fleming, NHS Lothian, queried whether the people surveyed were those with experience of services and whether there was any analysis below the headline results. The Chair explained that the members of the citizens panel are not known as they are selected by the organisation that run the Citizens Panel, with a distribution across the SIMD profiles of Midlothian. Further, Elouise Johnstone explained that the raw data is not shared so a deeper analysis cannot be undertaken, meaning only assumptions could be made in terms of taking the responses as a cohort. Items for Decision 5.2 Annual Performance Report Draft Review – Elouise Johnstone, Performance Manager Elouise Johnstone, Performance Manager, presented the report. The report presented an updated draft of the 2023-24 Midlothian Integration Joint Board (IJB) Annual Performance Report (APR) and provides an overview of the proposed format and content, with the addition of the qualitative data as provided by HSCP services. Members were asked to: • Consider the updated draft of the Midlothian IJB APR, provide feedback, suggest areas for review, and agree a plan for gathering additional content on service activity. • Note that Public Health Scotland (PHS) have released limited management data (which cannot be published) on 10th May 2024 meaning the full draft of the Midlothian IJB APR will be presented to this group on 26th September 2024. • Note that Public Health Scotland (PHS) will release validated data on 2nd July 2024 meaning Midlothian IJB will be asked to approve this report publication on 17th Include the reasons for publication in October in the foreword. Discussion to take place out with the meeting on which heads of service and professional leads would share additional information and by when. Page 27 of 286
Page 28
8 Strategic Planning Group Thursday, 23 May 2024 Report Title/Summary Decision Action Owner Date to be Completed/ Comments October. This will not meet the current Scottish Government deadline for publication of 31st July 2024. The Chair noted that there needs to be more input from the heads of services and professional leads around challenges, looking ahead and impact stories. The Chair stated that it would be useful to have agreement about who could help gather this information and when this could be shared. It was noted that the late publication date was not out of alignment with other HSCPs and that there would be not penalties in relation not this. It was agreed that the reasons for it being published 6 months into the new financial year should be included in the foreword. Morag Barrow, Chief Officer, also noted that there needs to be honesty and transparency in the report around the challenges that are being faced. It was agreed that the Heads of Service and professional leads would send additional information to Elouise Johnstone for the report, with the who and when to be agreed out with the meeting. Keith Chapman, Lived Experience Member, stated that workforce and financial challenges need to be explicitly included in the report. The Chair advised that this is not a finished report and that there are edits that need to be made. The Chair stated that there is some repetition in the stories that needs to be tidied up, that the bit around inspection is not an impact story, that there needs to be information around workforce included, and finally that there also needs to be information included about communications and engagement. Items for Discussion 5.3 Terms of Reference Update – Gill Main, Integration Manager Page 28 of 286
Page 29
9 Strategic Planning Group Thursday, 23 May 2024 Report Title/Summary Decision Action Owner Date to be Completed/ Comments The Chair presented the report. The report sets out the action taken to date to review the Midlothian IJB Strategic Planning Group Terms of Reference (ToR) in line with the Public Bodies (Joint Working) (Scotland) Act 2014 and the revised Strategic Plans Statutory Guidance. Members were asked to review the revised Midlothian IJB Strategic Planning Group Terms of Reference (ToR) and note the proposed changes. 6. AOCB Morag Barrow noted that the lack of representation from NHS Lothian and Midlothian Council needs to be addressed, following which some discussion took place on when this should be addressed and by whom. It was noted that it might be worthwhile addressing this properly after and if the IJB approves the revised ToR, although something could be done in the interim on this by Morag Barrow and, if needed, by Andrew Fleming afterwards as the new Chair of SPG. There was some discussion on who would be best placed to be the representative from Midlothian Council. 7. Date of next meeting The next meeting of the Midlothian Integration Joint Board – Strategic Planning Group will be held on Thursday, 29 August 2024 at 14:00pm. (Action: All Members to Note) The meeting terminated at 15:37pm. Page 29 of 286
Page 30
Page 30 of 286
Page 31
Midlothian Integration Joint Board Meeting Date Time Venue Audit and Risk Committee Thursday, 6 June 2024 2.00pm Virtual Meeting held using MS Teams Present (voting members): Angus McCann (Chair) Councillor McManus Councillor Milligan Councillor Parry Present (non-voting members): Morag Barrow (Chief Officer) David King (Chief Finance Officer (Interim)) Duncan Stainbank (Chief Internal Auditor) Gill Main (Integration Manager) Patricia Fraser (External Auditor) Roxanne King (Executive Business Manager) In attendance: Gary Leadbetter (Democratic Services Officer) Apologies: Val de Souza Midlothian Integration Joint Board Thursday, 24 October 2024 Item No 4.3 Page 31 of 286
Page 32
2 MIJB - Audit and Risk Committee Thursday 6 June 2024 1. Welcome and Introductions Angus McCann noted that they were stepping in as the Chair in the absence of Val de Souza, whose apologies were provided. The Chair welcomed everyone to the meeting of the Midlothian Integration Joint Board (MIJB) – Audit and Risk Committee. 2. Order of Business The Order of Business was as detailed in the agenda. 3. Declarations of interest No declarations of interest were received. 4. Minutes of Meeting 4.1 The Minute of Meeting of the Audit and Risk Committee held on 7 March 2024 was submitted and approved as a correct record. David King, Interim Chief Financial Officer, explained that there was a comment in the previous minute in relation to setting up training for Datix. They advised that this is addressed in the paper for Item 5.3 and so would be picked up when that Item is discussed. 5. Public Reports 5.1 Scottish Audit Report on Mental Health – Head of Adult Services and Social Care Nick Clater, Head of Adult Services and Social Care presented the report. Audit Scotland published an audit report in September 2023 on the access to adult mental health services in Scotland. This report noted that: • Funding for adult mental health services in Scotland has increased significantly since 2017; however, the impact remains unclear due to a lack of data. • Access to these services remains challenging. • The mental health workforce faces high vacancy rates, and progress in expanding primary care mental health support is delayed. Page 32 of 286
Page 33
3 MIJB - Audit and Risk Committee Thursday 6 June 2024 • Disparities persist, particularly affecting ethnic minorities, rural residents, and those in poverty. • The government lacks sufficient oversight and focuses primarily on waiting times for psychological therapies. • The Scottish Government's progress on mental health commitments is mixed, with further goals not on track for achievement. The Committee were asked to note the report. The Chair thanked Nick Clater for the report and opened it up for questions. Morag Barrow, Chief Officer, stated that it would be useful to see a progress update on this particularly in terms of how the Midlothian perspective is benchmarked against the recommendations. The Chair queried whether Midlothian offered the full choice in relation to face-to-face and virtual. Nick Clater advised that the offer a choice is being rolled out, starting with old age mental health. Nick Clater explained that the default had been face-to-face and that if people were to ask for something else then the alternative would be offered. The Chair stated that when this is brought back it would be useful to bring facts and evidence around data quality and the offer of choice. 5.2 Appointment of an Independent Member to the Audit and Risk Committee – Chief Financial Officer (Interim) David King, Chief Financial Officer (Interim), presented the report. The IJB Audit and Risk committee’s terms of reference lay out the membership of the committee. That is four members from the voting members of the IJB (two from NHSiL and two from Midlothian Council) and an independent member. The latter being an individual who is not a member of the IJB (nor a member of the NHS Lothian Board nor a Midlothian Councillor) and is therefore literally independent from the IJB and its partners. Such an individual will bring their previous experience to the committee, provide an additional input into the work of the committee and support the committee’s role in assuring proper governance. This role is considered best practice in the development of an audit committee and such a member has sat on the IJB’s audit and Risk committee in previous years although currently this role is vacant. The Committee were asked to support the appointment of an independent member to the Committee. Page 33 of 286
Page 34
4 MIJB - Audit and Risk Committee Thursday 6 June 2024 The Chair thanked David King for the report and opened it up for questions. Councillor Milligan noted that the Community Planning Partnership (CPP) could be asked to nominate a member. Duncan Stainbank, Chief Internal Auditor, noted that it would be useful to bring on a member with a background in financial accountancy. In relation to the quorum, Duncan Stainbank advised that this might mean that a meeting quorum would be made up of two NHS representatives and an independent or two councillors and an independent. Duncan Stainbank queried whether the Committee would be comfortable with this. It was agreed that the CPP should be asked to nominate a member, but that every route should be explored. It was also agreed that the quorum should be made up of one representative from each of the voting constituents, i.e. one independent, one NHS representative and one councillor. Gill Main, Integration Manager, explained that both they and David King had been liaising with a candidate who had expressed interest, although more on this could not be shared currently. 5.3 Review of Risk Management Policy – Chief Financial Officer (Interim) David King, Chief Financial Officer (Interim), presented the report. The IJB approved its risk management policy at its meeting in February 2016. At its meeting in December 2017, the IJB’s Audit and Risk Committee recognised that ‘the IJB’s risk register (and risk management process) recognises the risk to the IJB’s own business – that is the preparation and delivery of the Strategic Plan. The IJB’s does not consider ‘operational’ risks, being the risks managed by the partners unless these risks are so significant that they would impact on the IJB’s Strategic plan. That said, it should be remembered that IJB is not in a position to manage such operational risks and would, in any event, depend on the management actions of the partners.’ Best practice would require that the IJB now reviews its Risk Management Policy and the paper lays out that review. The Committee were asked to: • Consider the revision and amendments to the current policy. • Recommend these amendments to the IJB. • Recommend that the IJB adopts the revised Risk Management Policy. Page 34 of 286
Page 35
5 MIJB - Audit and Risk Committee Thursday 6 June 2024 The Chair thanked David King for the report and opened it up for questions. Gill Main advised that there was a typographical error in the report under 9.3, where it states “aucit” instead of “audit.” Gill Main further queried whether, in 1.5 of the report, the wording should be “treat, tolerate and mitigate risk” instead of “terminate, transfer or treat risk.” They further asked whether something should be noted about tying in the Strategic Planning Group and their role. David King confirmed that they were happy with these suggestions. The Chair queried how Gill Main would envisage taking the SPG risks and conveying them into Risk Management Policy. Gill Main explained that the SPG would still hold the SPG risk register and that anything they felt they were unable to treat or tolerate would be escalated to the Board’s risk register. It was agreed that the changes would be made, that the report would be tidied up and checked for any errors, which would be amended, and that the report would then be shared again with the Committee via email before it is shared with the IJB. 5.4 Risk Register – Chief Financial Officer (Interim) David King, Chief Financial Officer (Interim), presented the report. The report presented the IJB’s Q4 risk register for discussion by the Committee. The Committee were asked to: • Note the Q4 risk register. • Consider if any further additions or changes should be made to the risk register. • Agree to the proposal that, at a future meeting, a presentation on the use of Datix is provided to the Committee along with a further more detailed consideration of the risk register. David King queried whether there should be a slot in the September meeting for the Datix presentation and the consideration of the risk register. Page 35 of 286
Page 36
6 MIJB - Audit and Risk Committee Thursday 6 June 2024 Following a short discussion, it was agreed that at the September meeting Roxanne King, Executive Business Manager, would deliver a Datix presentation for Members and that there would be a deep dive into the risk register. The Chair stated that the wording on the first risk on the risk register seems quite general and wide. Duncan Stainback stated the risks in the register are for the IJB, rather than from the partners, and the expectation would be that the partners would manage the risks around disruption to operational service delivery. Duncan Stainbank noted that this is why the risk would be at a high level for the IJB. Roxanne King explained that they and David King would be doing some work around this risk between this meeting and September. There was a discussion around some work needing to be undertaken on the risk register and that how the risks were put on have perhaps not translated well on the Datix system, so it was noted that work would be undertaken on this. 5.5 Best Value Framework – Chief Financial Officer (Interim) David King, Chief Financial Officer (Interim), presented the report. The paper updates the Committee on the duty of Best Value, on how that applies to the IJB and how the IJB can ensure that this duty is delivered. The Committee were asked to request that the IJB develop a best value framework which can then be used to assess the delivery of best value. The Chair thanked David King for the report and opened it up for questions. The Chair asked that David King explain what they envisage a best value framework would look like and how it would be used on an ongoing basis. David King explained that it would lay out all of the discussion that has been had, the duties and the seven broad themes and it would state that every year an officer, presumably the Chief Financial Officer, would look at how the themes have been dealt with, which would be turned into a report for the IJB. This report would ask the Committee whether they feel the IJB has met these themes and, if the IJB felt they have not, then this would allow recommendations to be laid out on how they can be achieved. Patricia Fraser, External Auditor, stated that this was a point that was raised in the External Auditor’s Annual Audit report the previous year. Patricia Fraser stated that their judgment was that the IJB does demonstrate continuous improvement and that this was just about having the Page 36 of 286
Page 37
7 MIJB - Audit and Risk Committee Thursday 6 June 2024 framework in place. Patricia Fraser advised that, if it was deemed to be helpful, then good practice examples could be provided. The Chair confirmed that this would be helpful. 5.6 Revision of Terms of Reference – Audit and Risk and Strategic Planning Group – Chief Financial Officer (Interim) David King, Chief Financial Officer (Interim), presented the report. The report presents, for comment only, revised Terms of Reference for the IJB’s Audit and Risk Committee and the IJB’s Strategic Planning Group. The Committee are asked to consider these revised Terms of Reference and reflect on any suggested amendments. The Chair thanked David King for the report and opened it up for questions. The Chair stated that, on page 2 of the SPG’s ToRs, under 3.3 the wording around “Where the Integration Authority is an Integration Joint Board” can be tweaked as the MIJB is an integrated joint board. Also under 3.3, the Chair noted that the wording under the second bullet point “where one local authority is a constituent authority” is not required. The Chair also stated, under 4.1, that it should be eight not ten. 5.7 Review of the Annual Governance Statement – Chief Internal Auditor Duncan Stainbank, Chief Internal Auditor, presented the report. The purpose of the report is to present the draft Annual Governance Statement 2023/24 for the Midlothian Health and Social Care Integration Joint Board (MIJB) which explains the MIJB’s governance arrangements and system of internal control and reports on their effectiveness for the year ended 31 March 2024. The Committee are asked to consider the Midlothian Health and Social Care Integration Joint Board draft Annual Governance Statement 2023/24 (Appendix 1 to the report), which explained the MIJB’s governance arrangements and system of internal control and reports on their effectiveness for the year ended 31 March 2024, and provide any commentary thereon and approve for inclusion in the draft ,Annual Accounts 2023/24. The Chair thanked Duncan Stainbank for the report and opened it up for questions. Morag Barrow stated that where the paper talked about recovery actions that it should be 2024/25, not 2023/24, which Duncan Stainbank agreed with. Page 37 of 286
Page 38
8 MIJB - Audit and Risk Committee Thursday 6 June 2024 The Chair noted that there are three corrections to be made to the paper, firstly that the CIPFA/SOLACE Framework does not need to be referenced to as new, that it should be noted that the code of conduct should also be adhered to and that it should also include that board papers are published. 5.8 Internal Audit Reports – Chief Internal Auditor Duncan Stainbank, Chief Internal Auditor, presented the report. The purpose of the report is to present the Internal Audit Annual Assurance Report 2023/24 for the Midlothian Health and Social Care Integration Joint Board (MIJB) which includes the Chief Internal Auditor’s independent assurance opinion on the adequacy of the arrangements for governance, risk management and internal control by the MIJB of the delegated resources. The Committee are asked to consider the MIJB Internal Audit Assurance Report 2023/24 (Appendix 1 to the report), which sets out the findings and conclusions arising from all Internal Audit work carried out for the year to 31 March 2024, consider the assurances contained therein, and provide any commentary thereon. The Chair thanked Duncan Stainbank for the report and opened it up for questions. Gill Main stated that some of the timescales around the recommendations are not achievable against the timelines stated, due to the delay in receiving the report, noting that they are looking for support to extend the timescales so that they are more manageable. Duncan Stainbank stated that they did not think anything needed to be changed in terms of the report, as it is looking back at the previous year, but that they were happy to extend the dates of the recommendations to meet the requirements of Gill Main’s team. Morag Barrow asked the Committee to approve writing to the Council to ask for support around publication, which the Committee agreed with. 5.9 MIJB Internal Audit Report: Publication Scheme – Chief Internal Auditor Duncan Stainbank, Chief Internal Auditor, presented the report. The purpose of the report is to present the findings and recommendations from the recently completed Internal Audit review of the Publication Scheme, completed in partnership between the Midlothian Council and NHS Lothian Internal Audit teams. Page 38 of 286
Page 39
9 MIJB - Audit and Risk Committee Thursday 6 June 2024 The Committee are asked to consider the findings and recommendations from the recently completed Internal Audit review of the Publication Scheme. The Chair thanked Duncan Stainbank for the report and opened it up for questions, of which there were none. 6. Private Reports No private business discussed at this meeting. 7. Date of next meeting The next meeting will be held on Thursday, 5 September 2024 at 2.00pm. (Action: All Members to Note) The meeting terminated at 15:19pm. Page 39 of 286
Page 40
Page 40 of 286
Page 41
Midlothian Integration Joint Board Thursday 24th October 2024, 14:00-16:00 Chief Officer’s Report Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting October 2024. Board members are asked to: • Note the content of the report. # Item number: 5.2 Page 41 of 286
Page 42
Midlothian Integration Joint Board Midlothian Integration Joint Board Chief Officer’s Report 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting October 2024. 2 Recommendations 2.1 As a result of this report Members are asked to: • Note the content of the report. 3 Background and main report 3.1 Chief Finance Officer for Midlothian IJB Discussion with partners remain underway to find a solution to recruit to a permanent Chief Finance Officer (CFO) for the IJB. Recruitment for a shared post with East Lothian, and a part time CFO for Midlothian have failed to produce any employable candidates. The Chief Officer has requested that NHS Lothian and Midlothian Council discuss options and provide the IJB with a suitable and timely plan. Midlothian IJB Partners meeting The Chief Officer and Chair of Midlothian IJB hosted a partners meeting on 3 October. This was attended by Caroline Hiscox (NHS Lothian CEO), Grace Vickers (Midlothian Council CEO), Craig Marriott (Director of Finance, NHS Lothian), David Gladwin (Chief Officer for Finance, Midlothian Council), David King (Interim CFO, Midlothian IJB), and Gill Main (Integration manager, Midlothian HSCP). The group discussed the current challenges experienced by the IJB and noted the positive working relationships in place. A further meeting is arranged for early November following Quarter 2 financial out-turn. Morag Barrow, Chief Officer – morag.barrow@nhs.scot 3.2 Review of Social Work Governance by the Care Inspectorate In July 2024, the Care Inspectorate announced that they intended to undertake a review of HSCP Social Work governance and assurance arrangements. The Review commenced in July 2024 and will conclude in December 2024 with a Report anticipated in early 2025. This is a national Review of Social Work Governance and Assurance. It is not specific to Midlothian. Nick Clater, as incoming Chief Social Work Officer (CSWO), is the named link with the Care Inspectorate for both the HSCP and Midlothian Council. The work involved covers all aspects of professional Social Work, HSCP services, and Children’s Services. Page 42 of 286
Page 43
Midlothian Integration Joint Board Relevant documentation ws provided to the Care Inspectorate by 27 August. The Care Inspectorate opened a staff survey on 19 August 2024, and this closed on 4 October 2024. The survey was for all frontline staff delivering social work duties on a day-to- day basis and their first line managers across children’s, adults and justice social work services. The Care Inspectorate held an interview with social work leads on 7 October and there were also wider focus groups arranged with HSCP management. The Review is generally viewed by Social Work Scotland and the profession, as having positive potential in relation to ensuring Social Work as a profession is better understood within an integration space, and that clear lines of accountability and governance are in evidence across HSCPs. Midlothian HSCP Resource Panels Significant work has been undertaken to ensure a robust process is in place to provide further scrutiny to the Adult Social Care spend. The three existing Resource Panels, Hospital Discharge, Older Adults and the Adults Panel have been revised, with new processes implemented to provide additional governance and assurance. A new Terms of Reference has been devised with the chairing of all three Panels under the leadership of the HSCP Group Service Manager. New and existing packages of care requests presenting to the Panel process have a greater level of oversight from various tiers of management prior to Panel consideration. All relevant Service Managers attend Panel to provide the expertise and rigour required to challenge, critique and support the applications in order to keep residents safe. Panel members apply a consistent approach to considering the application for a package of care against the national Eligibility Criteria. In line with other HSCPs, Midlothian HSCP is currently applying the ‘Critical’ and ‘Substantial’ criteria. A methodology around the rationale for supporting (or not) an application for a new package of care is clearly articulated to the Social Worker who can then communicate with the individual and their family. The Resource Panel meets weekly with 2-5 hours of work required to consider all assessments and applications. On average there are 45 applications to consider each week, with both new requests and changes (increases and decreases) to existing care packages. It should be noted that this is considerable time set aside by Service Managers and the Group Service Manager and highlights the application and rigour being provided. Notable trends include an older population of individuals (85-95 years) requiring long term nursing care after remaining at home with a carer, complexity around the care needs of individuals with dementia, a significant need for companionship for people so carers can have some respite and large packages of care with transport requirements for individuals with learning disabilities. King’s Counsel opinion was recently commissioned by the HSCP to provide a considered legal opinion to some of the more complex areas of the decision-making processes that the Panel take. This legal summary will be used to further develop the HSCP understanding and agenda around the fair and equitable distribution of care. Midlothian Post Diagnostic Support In 2022 Midlothian HSCP had the opportunity to invest into the Dementia service to enable and develop 4 dedicated Post diagnostic support workers (PDSW) to provide robust Post Diagnostic Support to individuals newly diagnosed with dementia. An allocated named PDSW provides support for a minimum of one year following diagnosis, offering advice, information, emotional and practical support to the individual and their family/carers who are in the process of, or have been diagnosed with dementia, using the 5 Pillar Model of Post Diagnostic Support. Page 43 of 286
Page 44
Midlothian Integration Joint Board Currently, the PDSWs support 194 individuals in various stages of their 12-month post diagnosis support. The current waiting list of newly diagnosed individuals is 24, with the longest wait ibeing11 weeks. Waiting times can vary, as there is an element of individual choice as not all individuals wish to begin straight away with their post diagnostic support, meaning the service continues to provide a person-centred approach to delivering support and intervention. Feedback is routinely sought from individuals and carers which to date has been extremely positive. The "excellent" and "very good" with only the occasional "good" demonstrates the positive impact Midlothian’s delivery of post diagnostic support has on our residents. Justice Work is underway to support the reduction of pressures in the custodial estate through early intervention and prevention. In July 2024, information was provided with regard to the Emergency Release of Prisoners which was processed under relevant legislation, Section 11 of the Bail and Release (Scotland) Act 2023. At the time the Government set out intention to use the powers, the prison population was 8348. Under the legislation 477 prisoners were released early. The powers provided respite and time for other measures to be put in place. However, the population in set to increase and on current modelling it is estimated that the prison population will be at approximately 8500. Current SPS figures show that on 13th September the number of people in custody stood at 8227. Of that figure 28% are being held on remand (either awaiting trial or being held post- conviction but awaiting sentence). Of most concern is the use of remand for women, although the number of women in prison is 4% of the total population, 39% of women are being held on remand. The significant pressures being faced by SPS has required measures being implemented which negatively impact the health and wellbeing of individuals and impacts on their ability to engage in rehabilitation measures. This includes increase in doubling up within single rooms through use of bunk beds, reduction in the time that individuals are able to access work, education and recreation to ensure that everyone has the opportunity to participate. However, those held on remand are unable to access employment or education or to participate in offence focused work. Local Authorities are working collaboratively to consider how to more effectively support people at risk of remand and to ensure that the use of remand into custody is for those who pose a risk of harm to others. Foundation Apprenticeships The HSCP Learning and Development team have been working in close partnership with a range of colleagues and organisations across Education, including Communities and Lifelong Learning and Employability, Skills Development Scotland, local colleges, Universities, NHS Education Scotland, and NHS Lothian to develop the programme of Foundation Apprenticeships. Foundation Apprenticeships (FA) support young people (predominantly in S5 and S6) to undertake an apprenticeship in their chosen areas of learning from a practice based and class-based approach. Each FA will attend a weekly placement from September to May in the academic year learning about the roles within that placement. They also receive a weekly teaching element which is delivered by our SVQ assessors from the learning and development team. This year, following some promotional work with Education the HSCP have an increase in the of number of young people taking up FAs in Health and Social Care and Children and Young People programmes. This year there are 21 young people undertaking an FA in Health and Social Care, with placements across a range of services in Page 44 of 286
Page 45
Midlothian Integration Joint Board Midlothian. In addition, there are 37 in the Children and Young people programme, again across a range of services within Midlothian. This is good news in terms of encouraging young people to commence in a career in these areas and support our workforce development plan to recruit and retain people into careers in these areas. The HSCP will be building on this for future years to continue to build this number in these specific areas. Nick Clater, Head of Adult Services - nick.clater@midlothian.gov.uk 3.3 Older People & Primary Care Delayed Discharge: National planning updated position Reducing the number of delayed discharges across Board areas to pre-pandemic levels before winter 2024/25, is a priority for Scottish Government. As a result, a Collaborative Response and Assurance Group (CRAG) was formed in June 2024, led by the Cabinet Secretary for Health and Social Care, and co-chaired with Councillor Paul Kelly. As of week 22/06/24, total delays across Scotland were recorded as 1986, with the target reduction set to 1410 delays by October 2024. For HSCPs this equates to 34.7 delays maximum per 100 000 population. For Midlothian HSCP this equates to 27 delays. There is no account for demographic representation that would account for differential performance. If achieved, this will reduce national hospital occupancy levels to 85% and provide the required capacity to maintain system flow over the winter months. HSCPs are graded as High, Moderate or Low risk dependent on their recorded performance. Midlothian HSCP did move into the lower category for a few weeks towards the end of September achieving the target of 27 delays. However, as we progress towards winter, Midlothian are in the moderate category, with an increase in 4 delays to take us to 31 delays (as at 09/09/24). Of these 31 people there are 13 currently awaiting Care home placement. Midlothian consistently feature as the lowest, or one of the lowest, mainland Boards for lack of available care home beds. The HSCP continue to focus on improved performance relating to patient flow. District Nursing (DN) Review The HSCP DN review is progressing, with the support of NHS Lothian Nursing Directorate, using the Health and Social Care staffing act principles to ascertain workflow across our community nursing service, which will support a new workforce model moving into 2025/26. for the future. This work will be completed late October 2024 and submitted to NHS Lothian Nursing and Midwifery Workforce Programme Board in November 2024. Grace Cowan, Head of Primary Care & Older People - grace.cowan@nhs.scot Page 45 of 286
Page 46
Midlothian Integration Joint Board 3.4 Planning, Performance and Programme Service Review Following Midlothian Integration Joint Board’s June meeting and an instruction to the HSCP Integration Manager to progress with IJB Financial recovery Action No 5 (Planning, Performance and Programme), the service review has concluded and successfully achieved a saving target of £364.5k in a recurring capacity. The service has reduced its analyst capacity, no longer benefits from programme or project support, and no longer has specialist posts in Workforce Planning, or Equalities and Human Rights. The new Service name ‘Planning, Performance, and Improvement’ reflects this change and will now focus on working together in new ways. A Q2 update on Midlothian IJB Financial Recovery Action No.5 has been submitted to the Chief Officer and Chief Finance Officer for their review and consideration. Agenda for Change Reform and Reduced Working Week Work continues to support changes for all staff employed under Agenda for Change. The service is supporting the HSCP to take a coordinated approach to transitioning from 37.5 hours to 37 hours in tranches to minimise disruption and allow community facing services time to plan and mitigate the loss of capacity across the team. This work in now in its final stages and will conclude by 30 November 2024. Gill Main, Integration Manager – gill.main3@nhs.scot 3.4 General Practice All 11 practices currently still have open lists for registration and patient access to core general medical services (GMS) with additional list extension (LEGUP) support arrangements in place for practices with the highest rate of population growth. However, several practices are currently disputing their revised and uplifted NHS Lothian facilities management costs, and access to some enhanced medical services may be affected. Pharmacy The Midlothian Primary Care Pharmacy Team won the Innovation and Productivity award category in NHS Lothian’s 2024 Celebrating Success Awards on 26th September, after their success in implementing a novel medicines reconciliation Hub and delivering huge efficiency savings over the last year. Older People and Frailty Work continues to progress the HSCP’s commitment to transforming its approach to preventing and managing Frailty in our community. The vision is for the universal use of a functional frailty scale which will facilitate a new common language, which can be understood and applied by all professionals and services, as well as older people themselves, as the key intervention to unlocking access to a sliding scale/spectrum of integrated resources depending on a person’s stage of frailty, allowing them to more seamlessly move across traditional service boundaries and silos without repeated referrals and re-assessments. This will also help move balance of frailty resource and supported intervention back to prevention and early intervention. Over time, a programme of community engagement and the development of digital solutions (including a Frailty passport) will underpin and support this approach. The next stakeholder engagement event, which will incorporate training in the use of the frailty scale, will take place on 14th November. Page 46 of 286
Page 47
Midlothian Integration Joint Board Medical Staffing Despite the current challenges in medical recruitment and retention, the HSCP are pleased to have recruited a replacement Consultant in General Adult Psychiatry, enabling our local Mental Health services to remain resilient with capacity for the diagnosis and treatment of significant mental illness when needed. Rebecca Green, Clinical Director – rebecca.green@nhs.scot 3.5 Chief Nurse Midlothian HSCP is a member of the Midlothian Palliative Care Managed Clinical Network. The network invited Dr Kirsty Boyd, the National Clinical Lead for Palliative Care to attend its most recent meeting ahead of the launch of the consultation on the new National Palliative Care Strategy. Dr Boyd highlighted the plans for the national Palliative Care Strategy to align with the themes of Realistic Medicine and Getting it Right for Everyone (GIRFE), and a shift in focus from life expectancy to quality of life. There are clear ambitions to utilise digital platforms to deliver the ambitions of the strategy, and for there to be a significant emphasis on Future Care Planning rooted in a workforce with increased capability to lead (often difficult) conversations about planning ahead for when things change. The Scottish Government has now published the draft palliative care strategy for consultation. • Palliative Care Strategy: Palliative Care Matters for all The consultation is open until 10 January 2025. Additional papers have also been produced which Board members may find to be of interest: • Palliative Care Strategy: Service Mapping Survey: Additional Paper • Palliative Care Strategy: Lived Experiences and Public Views: Additional Paper • Palliative Care Strategy: Population Data and Research: Additional Paper • Palliative Care Strategy: HIS Gatherings Views Report Fiona Stratton, Chief Nurse – Fiona.stratton@nhs.scot 4 Policy Implications 4.1 The issues outlined in this report relate to the integration of health and social care services and the delivery of policy objectives within the IJBs Strategic Plan. 5 Directions 5.1 The report reflects the ongoing work in support of the delivery of the current Directions issued by Midlothian IJB. 6 Equalities Implications 6.1 There are no specific equalities issues arising from this update report. Page 47 of 286
Page 48
Midlothian Integration Joint Board 7 Resource Implications 7.1 There are no direct resource implications arising from this report. 8 Risk 8.1 The key risks associated with the delivery of services and programmes of work are articulated and monitored by managers and, where appropriate, reflected in the risk register. 9 Involving people 9.1 There continues to be ongoing engagement and involvement with key stakeholders across the Partnership to support development and delivery of services. 10 Background Papers AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO 0131 271 3402 DATE October 2024 Page 48 of 286
Page 49
Midlothian Integration Joint Board Thursday, 24th October 2024, 14:00-16:00 Midlothian IJB Membership Recommendations Executive summary This report provides information about changes to non-voting membership of the Midlothian Integration Joint Board (IJB) and seeks the Board’s formal endorsement of them. Members are asked to: • Endorse the nomination of Nick Clater as a non-voting member of the Midlothian Integration Joint Board • Note the formal resignation of Johanne Simpson from the role as Medical Practitioner to the Midlothian Integration Joint Board # Item number: 5.5 Page 49 of 286
Page 50
Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian IJB Membership Recommendations 1 Purpose 1.1 This report notes and seeks the Board’s endorsement of nominations for non-voting members on the Midlothian Integration Joint Board, for membership, and to agree the appointment of the 2 Recommendations 2.1 As a result of this report, Members are asked to: • Endorse the nomination of Nick Clater as a non-voting member of the Midlothian Integration Joint Board • Note the formal resignation of Johanne Simpson from the role as Medical Practitioner to the Midlothian Integration Joint Board 3 Background and main report 3.1 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 determines the membership of Integration Joint Boards. This details the requirement to ensure members are representative of service users in the local authority, staff engaged in the provision of services, and third sector bodies carrying out activities related to health and social care in the local authority. 3.2 Following the resignation of Joan Tranent as Professional Advisor for Social Work and Social Care to the IJB on the 10th of October 2024, a vacancy in membership has arisen. Nick Clater has been nominated to take up the post of Professional Advisor for Social Work and Social Care, given his new position as Chief Social Work Officer for Midlothian which began on the 10th of October 2024. The Board is requested to endorse the nomination of Nick Clater as a new non- voting member of Midlothian IJB fulfilling the role of Professional Advisor for Social Work and Social Care. 3.3 Confirmation from NHS Lothian was received in September 2024 that Johanne Simpson will no longer be acting as Medical Practitioner representative to the IJB. The IJB are asked to note her formal resignation. 3.4 The post of Medical Practitioner to the IJB will remain vacant as NHS Lothian seek a replacement. Notification of this replacement will be presented to the IJB once received. Page 50 of 286
Page 51
Midlothian Integration Joint Board 4 Policy Implications 4.1 There are no policy implications arising from this report. 5 Directions 5.1 There are no implications for Directions arising from this report. 6 Equalities Implications 6.1 There is no direct impact on inequalities arising from this report. 7 Resource Implications 7.1 There are no resource implications arising from this report. 8 Risk 8.1 Failure to appoint Integration Joint Board members would result in the Integration Joint Board being unable to meet the requirements of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Act 2014 and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. 9 Involving people 9.1 The regulations and guidance accompanying the Public Bodies (Joint Working) Act (2014) requires the IJB membership to be reflective of those working in the delivery of health and social care in the community and should include representation from all key stakeholders. This includes staff, service users, voluntary bodies and independent organisations related to health and social care in the local authority. 10 Background Papers 10.1 N/A AUTHOR’S NAME AND DELEGATION Iina Jaara, Democratic Services Team Leader, Democratic Services AUTHOR’S CONTACT DETAILS democratic.services@midlothian.gov.uk DATE 1st of October 2024 Page 51 of 286
Page 52
Page 52 of 286
Page 53
Midlothian Integration Joint Board Thursday 24th October 2024, 14:00-16:00 Annual Performance Report 2023/24 Executive summary The IJB is required by Scottish Government and the Public Bodies (Joint Working) (Scotland) Act 2014 to publish an Annual Performance Report. The Midlothian Annual Performance Report (appendix 1) provides information on the health and wellbeing of the people of Midlothian and assesses performance towards meeting the 9 National Health and Wellbeing Outcomes. It also describes the financial performance of the Partnership and the quality of health and care services delivered during 2023/24. The data was scrutinised at the Performance, Assurance, and Governance Group (PAGG) on 11th July 2024 and 8th August 2024, following the receipt of validated data from Public Health Scotland (PHS) Local Intelligence Support Team (LIST), and several amendments were suggested to ensure the data were represented in the context of local experience. Results for some indicators are not directly comparable to previous years due to changes in survey wording. Midlothian’s performance improved for ten indicators, remained the same for four indicators, and deteriorated for five indicators. Following review, scrutiny, and amendment, the Midlothian IJB Annual Performance Report 2023/24 is now presented to the Board for approval and the delegated authority for Morag Barrow, Chief Officer, to publish this report before 31st October 2024. Board Members are asked to: • Note the content of the Annual Performance Report, • Approve this report, and • Subject to any amendments, grant delegated authority to the Chief Officer, Morag Barrow, to publish this report before 31st October 2024. Item number: 5.6 Page 53 of 286
Page 54
Midlothian Integration Joint Board Midlothian Integration Joint Board Annual Performance Report 2023/24 1 Purpose 1.1 The Midlothian Annual Performance Report (appendix 1) provides information on the health and wellbeing of the people of Midlothian and an assessment of our performance towards achieving the 9 National Health and Wellbeing Outcomes. It also describes the financial performance of the IJB, and the quality of health and care services delivered during 2023/24. 2 Recommendations 2.1 As a result of this report what are Members are asked to: • Note the content of the Annual Performance Report, • Approve this report, and • Subject to any amendments, grant delegated authority to the Chief Officer, Morag Barrow, to publish this report before 31st October 2024. 3 Background and main report 3.1 The IJB are required by Scottish Government and the Public Bodies (Joint Working) (Scotland) Act 2014 to publish an annual report detailing key achievements of the previous financial year and an assessment of performance against the national core suite of integration indicators and in meeting the 9 National Health and Wellbeing Outcomes. 3.2 The purpose of the Annual Performance Report is to provide an overview of performance of the IJB in planning and carrying out integrated functions and is produced for the benefit of the IJB, Partnerships and their communities. It must be made publicly available, written using plain English, and make good use of graphics and case studies to bring performance data to life. All published reports must also meet legal accessibility standards. 3.3 The non-validated management data for the National Core Suite of Integration Indicators were received from Public Health Scotland on 10th May 2024. As 2023/24 is a reporting year for the Health and Care Experience survey, all indicators have an update for this report. 3.4 The data was scrutinised at the Performance, Assurance, and Governance Group (PAGG) on 11th July 2024 following the receipt of validated data from Public Health Scotland (PHS) Local Intelligence Support Team (LIST), and several amendments Page 54 of 286
Page 55
Midlothian Integration Joint Board were suggested to ensure the data were represented in the context of local experience. 3.5 The updated data visualisations were reviewed, discussed and recommended for inclusion at the Performance, Assurance, and Governance Group (PAGG) on 8th August 2024. 3.6 It should be noted that changes were made to the questions for some indicators. This means that direct comparison with previous years cannot be made. This applies to the following indicators: 2, 3, 4, 5, 7 and 9 2. Adults supported at home agreed that they are supported to live as independently as possible. 3. Adults supported at home agreed they had a say in how their help, care or support was provided. 4. Adults supported at home agreed that their health and social care services seemed to be well coordinated. 5. Adults receiving care or support rated it as excellent or good. 7. Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life. 9. Adults supported at home agreed they felt safe. 3.7 Midlothian’s performance improved for ten indicators, remained the same for four indicators, and deteriorated for five indicators. 3.8 This report presents the final draft of the APR. It is therefore requested that Midlothian IJB agree delegated authority for Morag Barrow, Chief Officer, to publish the Annual Report by 31st October 2024. 4 Policy Implications 4.1 IJBs have a legal obligation to produce an annual performance report in line with The Public Bodies (Joint Working) (Content of Performance Reports) (Scotland) Regulations 2014 and the Scottish Government Guidance: Health and Social Care Integration Partnerships: reporting guidance. 4.2 This includes reporting on the national Core Suite of Integration Indicators provided by Public Health Scotland, using these to support reporting on how well we are progressing the 9 National Health and Wellbeing Outcomes which apply to integrated health and social care. 4.2 This Midlothian Annual Performance Report complies with all the requirements with the exception of a breakdown of spend per locality. Systems to facilitate a robust report on this are not yet in place. 5 Directions 5.1 This report does not relate to any specific Directions. Page 55 of 286
Page 56
Midlothian Integration Joint Board 6 Equalities Implications 6.1 There are no equalities implications arising directly from this report. However, the report itself has been written with accessibility in mind. This includes being structured and written in a way that is easily followed and understood by those in our communities who may wish to read the report. This report meets the legal requirements for accessibility standards. 7 Resource Implications 7.1 There are no resource implications arising from this report. 8 Risk 8.1 IJBs have a legal obligation to produce an annual performance report which meets the requirements set by Scottish Government. Not complying will pose legislative risks and it will be more difficult for the IJB to undertake its duties related to accountability and good governance. 9 Involving people 9.1 The report highlights the involvement of users of people and communities in the development and recommissioning of services. 10 Background Papers 10.1 No background papers. AUTHOR’S NAME & DESIGNATION Gill Main, Integration Manager Elouise Johnstone, Programme Manager (Performance) CONTACT INFO Via email or MS Teams DATE 03/10/2024 Appendices: Appendix 1: Midlothian Annual Performance Report 2023/24 Page 56 of 286
Page 57
1 Midlothian Integration Joint Board Annual Performance Report 2023/24 Page 57 of 286
Page 58
2 Contents Executive Summary ..................................................................................... 3 Foreword ..................................................................................................... 7 Introduction ................................................................................................ 8 Who we are .............................................................................................. 8 What we are trying to achieve .................................................................. 9 How do we know if we are achieving this? ............................................. 11 How did we do? ......................................................................................... 12 How we are reporting our data .............................................................. 12 The National Indicators ........................................................................... 13 Working with local communities ............................................................... 42 Looking forward ........................................................................................ 44 Inspections ................................................................................................ 47 Business and governance .......................................................................... 63 Data Appendix ........................................................................................... 67 Ministerial Steering Group Targets ............................................................ 86 Page 58 of 286
Page 59
3 Executive Summary The Midlothian Integration Joint Board (IJB) plans and directs health and social care services for the people of Midlothian. We are a planning and decision-making body responsible for the integrated budget from Midlothian Council and NHS Lothian. We are responsible for monitoring progress towards the National Health and Wellbeing Outcomes and the objectives in our Strategic Plan 2022 to 2025. We provide services and supports to ensure people have access to the right advice, care, and support in the right place, at the right time to be able to lead long and healthy lives. We focus on prevention, recovery, independence, choice and control, equalities, supporting the person not just their condition, and high quality and coordinated care that is evidence based and provided locally. Like all of Scotland’s public services, we have faced a very challenging financial position in 2023/24 that is likely to continue for many years to come. We have more work to do but have been well prepared with transformation initiatives to help us assess, and adapt, to change. Despite this financial shortfall, the services we plan and direct must, by law, aim to improve outcomes for people who use our services, their carers, and families. Considering the impact of all our services is a complex exercise and involves a wide range of data. The Scottish Government measure our performance towards nine Health and Wellbeing Outcomes using data collected from Scottish Health and Care Experience (HACE) Survey and Scottish Government’s Ministerial Strategic Group targets for hospital admissions. We have continued to develop our use of outcome mapping to better understand how services contribute to progress towards our strategic aims and outcomes that matter to people. Our progress We used a range of feedback to inform the content of this report including feedback from people who use our services, their families and carers, the Midlothian Citizens’ Panel, the Scottish Government’s Ministerial Strategic Group (MSG) targets, and The National Performance Indicators. The National Indicators 1-9 are taken from the Health and Care Experience Survey (HACE) which is conducted every 2 years. Premature mortality is defined as deaths occurring before the age of 75. During 2023, the premature mortality rate in Midlothian decreased to 399.5 (from 423 in 2022). This is a reduction of 5% in deaths occurring before the age of 75 in Midlothian. The national rate of premature mortality increased by 0.2%. The responses to the Health and Care Experience Survey tell us that more than 90% of the Midlothian residents who were asked, agreed that they are able to look after their health very well or quite well. More than three-quarters of respondents who live at home agreed that they are supported to live as independently as possible. Just over half of all Citizens’ Panel respondents (58%) stated that they were happy with most or all aspects of their physical health and just over two thirds (68%) stated they were happy with most or Page 59 of 286
Page 60
4 all aspects of their mental health. Almost two thirds of all respondents (64%) stated that they were happy with most or all aspects of their general wellbeing. GP Practices are often the first place most people go to get support with their health and wellbeing. NHS Lothian data tell us that the 11 GP Practices across Midlothian consistently undertake more ‘patient contacts’ than the other Lothian Health and Social Care Partnership areas. The national data shows that GP practices maintained their performance in most of the areas, including improvements in the quality of information provided by receptionists, access to speak to a doctor, and the overall rating of care provided by GP. These improvements were made despite a large increase in our population, the temporary closure of Bonnyrigg Health Centre, and the new management and staffing arrangements at Danderhall. The number of days people spent in hospital when they were admitted in an emergency reduced. However, more people were urgently admitted to hospital in 2023/24, compared to 2022/23. The number of people who were readmitted to hospital within 28 days of going home was lower in 2023/24 than in 2022/23. This is a positive indicator that discharges are being planned well, and that the support required for someone to return home from hospital safely is in place. The number of adults with intensive care needs who receive care at home in Midlothian increased by 5.8%. This was the largest increase in Lothian. Edinburgh City had an increase of 1.9%, while East Lothian and West Lothian both increased by less than 1%. The number of Health and Care Experience survey respondents receiving care or support who rated it as excellent or good reduced by 13% from 2022/23. We also saw a small drop in the number of people who agreed that services and support had an impact on improving or maintaining their quality of life. As part of our Citizens’ Panel survey, we asked people about their experiences of health and care services. More than half of respondents (51%) agreed that the services they use improve their quality of life, but only 20% agreed that the services they use are always improving. The national indicator relating to how well carers feel that they are supported to continue in their caring role has improved from the Health and Care Experience survey 2 years ago, but it is still very low. The national picture is equally challenging, with all Health and Social Care Partnerships in Scotland having a rating below 50%. During 2023/24, the Care Inspectorate completed 24 inspections in Midlothian. More than three- quarters of care services inspected were given a rating of Good or Better. A summary of the key findings can be found later in this report. We received 1027 Adult Support and Protection referrals in 2023/24, compared to 929 the year before. This is an increase of 98 referrals (10.55%) and an 52.37% increase over two years. The main type of harm investigated was psychological/emotional harm. In 2023/24, the iMatter is an annual survey sent to all employees across health and social care in the Lothians that askes about their work and wellbeing including ‘effective team working’, ‘health and wellbeing’, and ‘being involved in decisions’ was completed by 65% of the workforce in Page 60 of 286
Page 61
5 Midlothian Health and Social Care Partnership. This is a significant increase compared with 2022/23 (48% completion rate). In 2022/23 Midlothian Health and Social Care Partnership published its first Integrated Workforce Plan for 2022/25 alongside a staff Communication, Engagement and Experience Delivery Plan. Work continued in 2023/24 to put in place a workforce governance and assurance structure to help plan, develop, and constantly improve how we support our workforce. A new Integrated Workforce Governance Board was established in 2023 to support quality planning between our services, NHS Lothian, Midlothian Council, Midlothian Community Planning Partnership, the Third Sector, and other partners. The Board oversees and directs the work of two SubGroups: Workforce Planning and Workforce Engagement. Midlothian Health and Social Care Partnership continued to support a Wellbeing Lead post. While we recognise the positive impact of this support, there is more we need to do to keep people working in health and social care well, and at work. How we spent our money We are funded by our partners, Midlothian Council and NHS Lothian, and are responsible for the integrated budget we receive. The funding is to support the delivery of the health and social care in Midlothian. Midlothian Health and Social Care Partnership uses the money allocated to its services to plan, deliver, monitor, and evaluate the services it provides and commissions. The actions services take, and how they use the resources allocated to them will determine how much progress we make, and how quickly. We monitored these plans and asked Midlothian Health and Social Care Partnership to do things differently when we thought there was a need to do so. During the financial year 2023/24 we spent more money than we were allocated in both health and social care. In health services, this was mostly due to pressures within GP prescribing services as a result of increased demand, and the cost of services within Acute Hospitals (The Royal Infirmary of Edinburgh and the Western General hospital). In social care services, increased demand, and higher costs to delivery of both social care were significant challenges. There has not been any additional funding to support these pressures. To ensure good financial management, we should have some financial reserves. In 2023/24 we had to spend all of our general reserve (c. £6.2m) to pay for services. Although this was planned, it has meant we no longer have any reserves to support recovery plans or to investment in service transformation. Looking forward We are currently developing our next Strategic Plan. This will set out our ten-year vision for integrated health and social care services and how we will use our resources to improve the health and wellbeing of people and communities in Midlothian. In 2024, the Strategic Planning Group will work alongside our partners and communities to develop key themes and build on the overall ambitions of the plan and priority areas for actions across the short, medium, and longer term. It is Page 61 of 286
Page 62
6 anticipated that we will be able to review a first draft of this plan by May, and a revised draft for public consultation from September to November 2024. A Public Engagement Plan is also underway including online discussion, face to face 'townhall' sessions, questionnaires, surveys, and a citizens panel. The Health and Care (Staffing) (Scotland) Act had implications for both our health and social care workforce will require us to work closely with our NHS Lothian and Midlothian Council partners who employ the staff who work within the Health and Social Care Partnership. The Act also requires us to ensuring the services we commission to provide care on our behalf are meeting the duties of the Act when we are planning or securing contracts. The new National Care Service legislation begins to set out the future of social care in Scotland. This could significantly change the way we are asked to work. Although it is not clear what the future will mean for integrated health and social care, we will continue to work closely with Scottish Government development teams and share our views on proposals. In 2024/25 we will submit a new Integrated Workforce Plan 2025-28 to Scottish Government. Of course, we don’t employ any staff as the health and social care workforce are employees of our NHS Lothian and Midlothian Council partners. However, we will continue to work with all our colleagues and Scottish Government to ensure we are meeting all our requirements. In 2023/24, a Bed Based Review was carried out to consider the available options and opportunities to review how we provide inpatient and residential care and support. As the work progressed, we identified important issues that were relevant across both health and social care and have taken action to make changes and improvements. This work now forms a significant part of our transformation programme which will continue to develop across 2024/25. Page 62 of 286
Page 63
7 Foreword Welcome to our 9th Annual Performance Report which reflects on our progress and performance from 1st April 2023 to 31st March 2024. This report describes the progress Midlothian Integration Joint Board (IJB) has made in providing the right care, at the right time, in the right place and reviewing the progress we have made towards the 9 National Health and Wellbeing Outcomes. It has been my pleasure to continue to serve as Chief Officer in 2023/24 and oversee the delivery of services that have improved outcomes for people and communities. I would like to sincerely thank every single member of staff, all of our partners and every member of our community who has contributed to improving outcomes for people over the past year. As I look back on 2023/24 , I am proud of the way we have worked with Midlothian Health and Social Care Partnership and all our partners to support positive change for people. The timing of this report is always welcomed as it provides an opportunity look back on the previous year, take stock of where we are now, and use this information to develop our plans for next year. This is particularly important as we develop our next Strategic Plan and consider our contribution to seeing people and communities thrive. For 2022/23, the national data showed we made great progress towards people in communities living good lives. Taking time to understand local communities, what makes people healthy, and how we support good health and wellbeing has supported more people to live the lives they choose. The work of our community teams has had a huge impact on more people being at home, less people being in hospital when they no longer need to be, and less people being readmitted to hospital after going home. We know we still have much to do, but it is important to celebrate where we have had success and remember how important it is to work together, be willing to do things differently, and share skills across the whole system. However, the future is uncertain. The financial outlook remains challenging and plans for a new National Care Service have not progressed enough to be able to understand the impact this will have on integrated health and social care. We may not know what the next chapter in health and social care will be in Scotland, but we can choose how we will respond. We will continue to plan and deliver care and support with a partnership approach and shape a new future together. Morag Barrow Chief Officer, Midlothian IJB Page 63 of 286
Page 64
8 Introduction Who we are The Midlothian Integration Joint Board (IJB) plan and direct health and social care services for the people of Midlothian. We are a planning and decision-making body created by Midlothian Council and NHS Lothian. We are responsible for the integrated budget (received from Midlothian Council and NHS Lothian) and allocate this in line with our objectives in the Strategic Plan. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act (2014). We meet regularly and include members from NHS Lothian and Midlothian Council, the Third Sector, staff, and people who represent the interests of people and communities, people who experience our services, their families, and carers. Midlothian Health and Social Care Partnership oversees more than 60 services on our behalf. This includes two hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region for the four Health and Social Care Partnerships - Midlothian, East Lothian, West Lothian, and City of Edinburgh. Page 64 of 286
Page 65
9 What we are trying to achieve The Scottish Government measure our performance based on Health and Wellbeing Outcomes. National Health & Wellbeing Outcome 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. 5 Health Inequalities Health & social care services contribute to reducing health inequalities. 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. 7 Safe from Harm People using health & social care services are safe from harm. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide. 9 Use of Resources Resources are used effectively and efficiently. Page 65 of 286
Page 66
10 Our Strategic Plan 2022-2025 We also measure our performance against our objectives in our Strategic Plan. This directs the Midlothian Health and Social Care Partnership to transform services, with the resources available, so that people in Midlothian live longer and healthier lives. We want to work with people as partners in their own health and social care and we want to provide more support, treatment, and care for people in their homes and communities. We have asked the Midlothian Health and Social Care Partnership to ensure they offer services in a timely way at every stage of someone’s care and treatment: • Preventing ill health and providing support early, • Ongoing support and treatment, • In times of crisis and emergency. Our Strategic Aims Our Strategic Plan has six main aims: 1. Increase people’s support and opportunities to stay well, prevent ill or worsening health, and plan ahead. 2. Enable more people to get support, treatment and care in community and home-based settings. 3. Increase people’s choice and control over their support and services. 4. Support more people with rehabilitation and recovery. 5. Improve our ability to promote and protect people's human rights, including social and economic rights and meet our duties under human rights law through our services and support. 6. Expand our joint working, integration of services, and partnership work with primary care, Third Sector organisations, providers, unpaid carers, and communities to better meet people’s needs. Our Values We aim to provide the right support in the right place at the right time. We think about how we work, and how we can improve, in three ways: • Integration is about how we work with all our partners to ensure everyone gets the right care, at the right time, and in the right setting. • Quality is about 6 key areas of services – are they safe, effective, efficient, timely, person-centred, equitable. • Best Value is about ensuring resources are well managed improving services that deliver the best possible outcomes for people and communities. Page 66 of 286
Page 67
11 How do we know if we are achieving this? Understanding how we contribute to people’s outcomes The services we plan and direct must, by law, aim to improve outcomes for people who use our services, their carers, and families. It is hard to evaluate how the work we do contributes to improvements in the health and wellbeing of people and communities. This is because so many factors influence peoples’ lives, what difference each factor makes, and the impact it has in their life. We use Outcome Mapping as a way to understand how our services contribute to our strategic aims and the outcomes that matter to people. This approach allows us to describe what we do, who with, what people learn and gain as a result, how this makes them feel and the difference this makes in their lives. This helps us make more targeted, locally informed decisions about how to commission services. The feedback and information we use We used a range of feedback to inform the content of this report • Feedback from people who use our services, their families, and carers • Scottish Government’s Ministerial Strategic Group (MSG) targets • Scottish Government Data - The National Performance Indicators The National Indicators 1-9 are taken from the Health and Care Experience Survey (HACE) which is conducted every 2 years, and 2023/24 is a reporting year. In November 2023 the HACE survey was posted to a random sample of 5,739 people living in Midlothian and registered with a GP in Scotland. People were asked about their experiences during the previous 12 months - accessing and using their GP practice and Out of Hours services; aspects of care and support provided by local authorities and other organisations; and caring responsibilities and related support. 1,408 people responded from Midlothian which is only 1.5% of Midlothian’s population. The response rate this year was 25%. The response rate was highest in the 65-74 age group at 25%. This is compared to the lowest response rate of 3% for those aged 17-24. In 2023 the Scottish Government updated the survey, some questions were added, some were amended, and some were removed (the full list of these changes is in the Scottish Government Technical Report). These changes mean it is difficult to compare our performance with previous years and, in some cases, we only have data from 2020. Results for indicators 2, 3, 4, 5, 7 and 9 are not directly comparable to previous years due to changes in survey wording. We also gather information on a more local basis, using the Citizens' Panel, which is designed to record and reflect the views of people living in a specific area. It brings together the views of around 1,000 residents of Midlothian and asks their views about health and social care issues. Citizens' Panel membership reflects the diversity of the Midlothian population better than the Health and Care Experience Survey. This is because there are similar proportions of people on the citizens panel to the Midlothian population, for example in relation to sex, age, and deprivation. This helps ensure that we are hearing the views of more people living in Midlothian and be more confident in the data we use to help us make good decisions for local people. You can see the details of our performance in the Data Appendix at the end of this report. Page 67 of 286
Page 68
12 How did we do? How we are reporting our data The information we use to measure our progress comes from several sources and shows where we have done well and where we have room to improve. We have designed the report to look at each of the Health and Wellbeing Outcomes alongside the National Performance Indicators used to measure each one. All National Performance Indicator data for Midlothian against the national average is in the Data Appendix. In the Data Appendix we have provided more information about our progress over time and our position in comparison to the rest of Scotland. We have summarised our progress using coloured boxes: - Our performance has improved compared to last year. - There hasn’t been a significant change in performance compared to last year. - Our performance has worsened compared to last year. For some National Indicators, the number of responses from each locality were too small to be published. We have also included our locally collected Citizens’ Panel data, which is helpful for our understanding, but it is not included in how the Integration Indicators are calculated. We want people who live in Midlothian to take action to stay well, prevent ill or worsening health, plan ahead, and live healthier, longer lives. We think about how we do this in three ways: early intervention and prevention; support and treatment; and crisis and emergency. For each Health and Wellbeing Outcome we have described the impact of what we do for the people who live in Midlothian. We have used icons to show good examples of Early Intervention and Prevention, Support and Treatment and Crisis and Emergency. Page 68 of 286
Page 69
13 The National Indicators - Our performance has improved compared to last year. - There hasn’t been a significant change in performance compared to last year. - Our performance has worsened compared to last year. The National Indicators 1-9 are taken from the Health and Care Experience Survey (HACE) which is conducted every 2 years. This means that Indicators 1-9 are compared with the results from two years ago. Indicators 11 to 19 are compared with the results from last year. *Results for indicators 2, 3, 4, 5, 7 and 9 are not directly comparable to previous years due to changes in survey wording. National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. 92.5% Adults supported at home agreed that they are supported to live as independently as possible*. 76.5% Adults supported at home agreed they had a say in how their help, care or support was provided*. 61.9% Adults supported at home agreed that their health and social care services seemed to be well coordinated*. 74.4% Adults receiving care or support rated it as excellent or good*. 65.6% Adults had a positive experience of the care provided by their GP practice. 67.9% Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life*. 76.0% Carers feel supported to continue in their caring role. 34.6% Adults supported at home agreed they felt safe*. 79.9% Page 69 of 286
Page 70
14 . National Indicator Our result Our Progress Premature Mortality Rate (People under 75) 399 per 100,000 Emergency Admission Rate 10,438 per 100,000 Emergency Bed Day Rate. 105,962 per 100,000 Readmission to hospital within 28 days. 95 per 1,000 Proportion of the last 6 months of life spent at home or a community setting. 87.9% Falls Rate (People over 65 who were admitted to hospital). 24% Care services graded Good or better in Care Inspectorate Inspections. 76.4% Adults with intensive care needs are receiving care at home. 70.3% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 639 per 1,000 Health and Care resource spent on hospital stays where the person was admitted as an emergency. 23% Page 70 of 286
Page 71
15 National Indicators used to measure this outcome. The responses to the Health and Care Experience Survey tell us that more than 90% of the Midlothian residents who were asked, agreed that they are able to look after their health very well or quite well. Responses to the Midlothian Citizen’s panel about ‘what makes a good life’ included: • Family • Financial stability/security • Friends • Good health • Good housing • Safety and security • Opportunities. Just over half of all respondents (58%) stated that they were happy with most or all aspects of their physical health and just over two thirds (68%) stated they were happy with most or all aspects of their mental health. Almost two thirds of all respondents (64%) stated that they were happy with most or all aspects of their general wellbeing. People told us how many health and social care professionals they saw in the last month. General Practice and Pharmacy were most frequently seen, with over half to two thirds of respondents stating that they had used these in the past month. Of the 1,000 panel members we asked, 573 returned completed surveys. This means the response rate was 57%, which is the same as other Citizens’ Panel surveys, and higher than the Midlothian response rate to the national Health and Care Experience Survey. Social work, social care, and primary care services provide a range of supports that help people look after their health and wellbeing. GP Practices are often the first place most people go to get support with their health and wellbeing. NHS Lothian data tell us that the 11 GP Practices across Midlothian consistently undertake more ‘patient contacts’ than the other Lothian Health and Social Care Partnership areas. National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. 92.5% Premature Mortality Rate (People under 75) 399 per 100,000 Emergency Admission Rate 10,438 per 100,000 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. Page 71 of 286
Page 72
16 Premature mortality is defined as deaths occurring before the age of 75. This indicator is measured using the European Age-Standardised mortality rate for people aged under 75. The methodology was updated in 2013, allowing for comparisons over time. Since 1997, the rate of premature mortality decreased every year until 2015 when there was an increase. It then remained relatively stable until 2020 where there was a further increase, largely due to COVID-19 deaths. During 2023, the premature mortality rate in Midlothian decreased to 399.5 (from 423 in 2022). This is a reduction of 5% in deaths occurring before the age of 75 in Midlothian. The national rate of premature mortality increased by 0.2%. Reducing the wait to see a GP One Midlothian GP Practice wanted to reduce the time people waited to discuss non-urgent results. The practice team introduced protected appointment slots for these appointments, and waiting times reduced from 17.3 days to 8 days. Patients can now discuss their results quickly with their GP, address any concerns and ensure any treatment needed is not delayed. Page 72 of 286
Page 73
17 National Indicators used to measure this outcome. The results for indicators 2, 3, 4, 5, 7 and 9 are not directly comparable to previous years due to changes in survey wording. National Indicator Our result Our Progress Adults supported at home agreed that they are supported to live as independently as possible. 76.5% Adults supported at home agreed they had a say in how their help, care or support was provided. 61.9% Emergency Admission Rate. 10,438 per 100,000 Emergency Bed Day Rate. 105,962 per 100,000 Readmission to hospital within 28 days. 95 per 1,000 Proportion of the last 6 months of life spent at home or a community setting. 87.9% Falls Rate (People over 65 admitted to hospital as an emergency). 24% Adults with intensive care needs are receiving care at home. 70.3% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 639 per 1,000 Health and Care resource spent on hospital stays where the person was admitted as an emergency. 23% 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. Page 73 of 286
Page 74
18 There have been improvements to how well people feel they are able to live independently and at home, or in a homely setting in their community. More than three-quarters of respondents who live at home agreed that they are supported to live as independently as possible. As part of our Citizens’ Panel survey, we asked people about who supports them to live independently at home or in a homely setting in their community. 89% of respondents agreed that they were able to ask for practical help from family, friends, and neighbours. This included support like putting their bins out, picking up shopping or medication, and small jobs around the home. 88% of respondents stated that they were able to ask for emotional support from family, friends, and neighbours and had somebody or a support group to talk through difficult decisions or if they feel lonely, sad, or anxious. Whilst the majority of survey responses we received had support from family, friends, and neighbours, this isn’t always the case. Circumstances can change and people can find themselves in need of additional support, which can be provided by community-based services. The number of people who were readmitted to hospital within 28 days of going home was lower in 2023/24 than in 2022/23. We know that people have better outcomes when they go home from hospital at the right time with the right support in place. This is a positive indicator that discharges are being planned well, and that support required for someone to come home from hospital safely is in place. The number of days people spent in hospital when they were admitted in an emergency reduced. However, more people were urgently admitted to hospital in 2023/24, compared to 2022/23. The number of adults with intensive care needs who receive care at home in Midlothian increased by 5.8%. This was the largest increase in Lothian. Edinburgh City had an increase of 1.9%, while East Lothian and West Lothian both increased by less than 1%. Increased mental health support Mental Health and Resilience Service The team recognised that Distress Brief Intervention played a key role in equipping people with skills to manage their own mental health and prevent future crisis. One year funding made it possible to increase the workforce to extend the service operating hours. Page 74 of 286
Page 75
19 Reducing time spent in intensive care Adults with Complex and Exceptional Needs Team The team improved support for people who needed invasive ventilation in a crisis by developing alternatives to intensive care for patients with Duchenne Muscular Dystrophy. In the past, patients would have been admitted to hospital when non-invasive ventilation treatment was not enough to remain safe at home. As a result of the team’s work, care can now be delivered at home for longer. By adopting this proactive approach, the time people typically spent in intensive care reduced from an average of 9 months down to 11 days. The team were chosen as finalists in the NHS Lothian Celebrating Success awards to recognise this work. Dietetic support to reduce hospital admissions Dietetic service The multidisciplinary team providing care to gynaecology patients identified an opportunity to add specialist dietetic input and reduce the number of people who needed to go to hospital. The Dietetics service undertook a one-year pilot project to improve outcomes for people affected by endometriosis and pelvic pain across all 4 NHS Lothian Health and Social Care Partnership areas. A dietitian was introduced to the endometriosis service and clinics began in October. In the 5 years before the dietetics input was introduced, there were 62 ward admissions for endometriosis and pelvic pain (from all four Health and Social Care Partnership areas combined). Following specialist dietetic input, the number of admissions had reduced to 3. Page 75 of 286
Page 76
20 Reducing reoffending Justice Social Work Team The Justice Social Work service supported people to complete Community Payback Orders. 227 Community Payback Orders were imposed: 154 with a supervision requirement, and 149 with an Unpaid Work requirement. The team developed individual plans and opportunities for each person they supported to help them change their behaviour and reduce the risk they would re-offend or cause harm to themselves or others. The Unpaid Work team completed 309 projects. In addition to providing opportunities for people who had offended to support their local community, the team supported people to achieve 110 qualifications through a range of training opportunities to increase their chances of employment and promote rehabilitation. A member of staff qualified as an SVQ Assessor and supported the first 2 participants to complete an SVQ in Work Skills. One of these individuals has used this qualification to apply to College and is due to start a full-time course in August 2024. Page 76 of 286
Page 77
21 National Indicators used to measure this outcome. GPs are independent contractors, and we continued to work closely together. The Health and Care Experience survey covers elements of services that are delivered by GP independent contractors, and elements that are delivered by the Health and Social Care Partnership. There are now more specialist services located in practices than ever before. People do not usually need to see a GP first to access the care they need from Physiotherapists, Primary Care Mental Health Nurses, and Wellbeing Practitioners. Pharmacists, Advanced Nurse Practitioners for minor illness, Phlebotomists and Community Treatment & Assessment Clinics are also available at GP practices. Community Councils fed back that GP services are valued, and the challenging environment they work in is recognised. GP practices fed back comments they received directly from their patients, to help identify areas for improvement, and to highlight when people have reported a positive experience of their care. National Indicator Our result Our Progress Adults supported at home agreed they had a say in how their help, care or support was provided. 61.9% Adults supported at home agreed that their health and social care services seemed to be well coordinated. 74.4% Adults receiving care or support rated it as excellent or good. 65.6% Adults had a positive experience of the care provided by their GP practice. 67.9% Readmission to hospital within 28 days. 95 per 1,000 Proportion of the last 6 months of life spent at home or a community setting. 87.9% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 639 per 1,000 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected Page 77 of 286
Page 78
22 The Health and Care Experience survey show that GP practices maintained their performance in most of the areas included in the survey. There were also improvements in: • The quality of information provided by receptionists, • Access arrangements for speaking to a doctor, • Overall rating of care provided by GP. These improvements were made in challenging circumstances, including increases in population and demand, the temporary closure of Bonnyrigg Health Centre, and the new management and staffing arrangements at Danderhall. “I would like to thank the Medical Practice for their fantastic service today. The receptionist was extremely helpful and kind. A prescription I requested on Wednesday which I didn't expect to be ready was, which was amazing.” “Really helpful and reassuring GP who thoroughly addressed my concerns. eConsult system was easy for me to use and I had an appointment by the next day. The reception staff were very nice too.” Reducing the need for multiple appointments GP One GP practice noticed that people with more than one long term condition were being invited for several appointments over the course of a year. The engagement rate for these appointments was 52%. The practice team introduced an optional ‘annual health check’. Invitations were sent by text or letter and the practice team phoned people who didn’t reply. People are now only asked to attend their GP practice for a single annual health check, avoiding the need for multiple appointments for different conditions. This has reduced additional travel, tests, and time. It also created an opportunity for people to be given information about lifestyle improvements that can improve their health. The engagement rate has increased to 75%. Page 78 of 286
Page 79
23 Supporting people to lose weight Weight Management Service Second Nature is an app that supports people to focus on creating new habits that results in weight loss that lasts longer. The weight management team use Second Nature to help people think about how they eat, exercise, sleep, think about themselves, and manage stress. Across Lothian, over 900 people have been referred to Second Nature with 88% of people taking up this opportunity. On average, people lost 4.8kg at the end of the first 3 months. Over 400 members of our staff were referred. Over 93% of people used the app and lost an average of 5.7kg in the first 3 months. 72% of people said it helped then make a positive change to their lifestyle and 85% of people increased physical activity levels, improved mental health, and higher confidence levels. People who have used this approach described Second Nature as a “game changer” in weight management. This approach has also been highly successful people who are receiving support from the Fertility Wellbeing and Weight Management Service. Patients reported a positive impact on their health and lives, with seven spontaneous pregnancies, one pregnancy after fertility treatment and three people progressing onto the fertility treatment list. Improving Information Midlothian Community Hospital Staff at Midlothian Community Hospital wanted to improve the information available to people in hospital, their families, friends, and carers. The team developed a range of leaflets about the admission process, what to expect during their stay, and about planning for leaving hospital. Each ward has its own leaflet that gives an overview of the type of care delivered along with an explanation of commonly used words and phrases that people might hear. To ensure each ward can provide the right information feedback can be collected using a QR code on the leaflets. The team are using feedback to better understand the experience of people who have been admitted to Midlothian Community Hospital or supported somebody during this time. Page 79 of 286
Page 80
24 Safer social media Midlothian Appropriate Adult & Adult Support and Protection The Midlothian Appropriate Adult and Adult Support and Protection Service supported young neurodiverse adults navigate social media and maintain healthy relationships. Making Choices, Keeping Safe Midlothian is a programme of 5 workshops developed and designed around the different perspectives of the young adults taking part and the issues most important to them. The Social Work Learning Disability Team, Police Scotland, the Enable Local Area Coordination Service, the Community Learning Disability Team, and Third Sector partners worked alongside the group, their families, and carers to explore choices for young adults living full and healthy lives that can also keep them safe. This project has been so popular that another set of workshops is already underway. Page 80 of 286
Page 81
25 National Indicators used to measure this outcome. The number of Health and Care Experience survey respondents receiving care or support who rated it as excellent or good reduced by 13% from 2022/23. We also saw a small drop in the number of people who agreed that services and support had an impact on improving or maintaining their quality of life. However, the nationally provided data we receive doesn’t tell us which, if any, services or suports people have experienced. This means it is difficult for us to draw any specific conclusions about how or where we need to improve. To help address this we have used other methods to ask the people who live in Midlothian for feedback. As part of our Citizens’ Panel survey, we asked people about their experiences of health and care services. More than half of respondents (51%) agreed that the services they use improve their quality of life, but only 20% agreed that the services they use are always improving. National Indicator Our result Our Progress Adults receiving care or support rated it as excellent or good. 65.6% Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life. 76.0% Emergency Bed Day Rate 105,962 per 100,000 Readmission to hospital within 28 days 95 per 1,000 Falls Rate (People over 65) 24% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 639 per 1,000 Health and Care resource spent on hospital stays where the person was admitted as an emergency. 23% 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. Page 81 of 286
Page 82
26 Listening to people’s views Thistle Wellbeing Service People with neurological conditions were invited to share their views about the support they received from the Thistle Wellbeing Service. The key message was that people want to keep their autonomy and be listened to. People described how problems can be caused by decisions being made and actions (on their behalf) being taken that are totally outside of their control. Examples were things like changes to medications, or an assumption that a driving licence needs to be removed following a diagnosis. People described how important it was to get back to doing the things they previously enjoyed, for example caring for pets, enjoying the outdoors, going fishing, driving, or trying something new such as becoming a peer volunteer. All the people surveyed provided positive feedback about the support they received, and people described how the support they received had changed their life. People described being supported to come to terms with a diagnosis, managing long term conditions in new ways, and feeling able to return to activities and hobbies. People had found a new sense of hope, it helped them to enjoy life, and to think more positively about the future. Supporting women to make changes Spring Service The Midlothian Spring service supported 43 women who may have experienced past or current trauma, may be struggling with their mental health and/or substance misuse and may be in contact with the Justice system. One participant, who was subject to a Community Payback Order commented that the service had supported her to complete beauty courses – something she couldn't have imagined that she would have been able to do at the start of her support. She has also completed Health in Mind peer- support training and commented that “I can’t believe that someone like me could help someone like me”. Whist she experiences ongoing difficulties her mental health, she is more positive about managing this and said that, for the first time in 13 years, she is confident that she won't be back in contact with the justice system again. Page 82 of 286
Page 83
27 National Indicators used to measure this outcome. The Scottish Index of Multiple Deprivation (SIMD) is how the Scottish Government identifies areas of deprivation in Scotland. SIMD data is organised into data zones, from the most to the least deprived. There are 10 data zones in Midlothian within the most deprived 20% data zones in Scotland. Every week 10 people living in Midlothian are diagnosed with cancer. Taking time off work and having to travel to appointments can have a negative impact on peoples’ incomes. The Improving the Cancer Journey team are there for people following a diagnosis and provided support to 130 people. More than three quarters of the people they supported live in areas of higher economic deprivation, and their top concerns were money and finance. The team work closely with the Welfare Benefits team and the Supported Employment service. In 2023/24, Welfare Rights Team helped put £191,343 into the pockets of the people referred. National Indicator Our result Our Progress Premature Mortality Rate (People under 75) 428 per 100,000 Emergency Admission Rate 10,438 per 100,000 5 Health Inequalities Health & social care services contribute to reducing health inequalities Putting money in people’s pockets Welfare Rights Team The Welfare Rights Team provide advice and support to ensure people can access what they need and receive the right benefits and help reduce levels of poverty. 722 referrals were made to the Welfare Rights team. As a result, £4,394,375 in benefit income was paid to people. This is an average increase of just over £6,000 for each individual supported. The team work with a number of partners and more than half of referrals are from Adult Services, GPs, and other Health Care Professionals. Page 83 of 286
Page 84
28 National Indicators used to measure this outcome. The national indicator relating to how well carers feel that they are supported to continue in their caring role has improved from the Health and Care Experience survey 2 years ago, but it is still very low. The national picture is equally challenging, with all Health and Social Care Partnerships in Scotland having a rating below 50%. During 2023/24, further Carers Act funding was used to expand early intervention and prevention services within Midlothian Council and Midlothian Third Sector services. Our partners, VOCAL, used this to increase carer awareness training, work with grass-roots community organisations, and exploring a Community Carer Cooperative. Funding also supported a new Dementia Carer Support Worker in the British Red Cross. Understanding the experience of Midlothian carers is vital to ensure we design and deliver services and support carers need. In 2023, the VOCAL Carer Survey expanded and became the ‘Midlothian Carer Survey’. Survey responses were higher than in previous years and the feedback and information will help shape our next Carers Strategy and the services we provide. National Indicator Our result Our Progress Carers feel supported to continue in their caring role. 34.6% 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Young Adult Carer Transition Service Communities and Lifelong Learning Team and VOCAL Young carers don’t always access the support they need as they grow older. Working in partnership we supported the development of Young Carer and Young Adult Carer support. The Communities and Lifelong Learning Team and VOCAL worked to ensure there are supports in place for carers of all ages. Young people are helping shape what the service offers to help them plan their futures alongside their caring role. Page 84 of 286
Page 85
29 Respite We have successfully reestablished residential respite services following the disruption caused by COVID. An extra-care housing flat within Cowan Court has been transformed to offer respite for one or two people. For carers of people with higher physical and cognitive care needs, two rooms are being re- established for respite care in Highbank Intermediate Care facility. Social Workers have been able to plan and pre-book respite breaks via the Lothian Hospital Flow Hub. Respite Cowan Court Families said they felt comfortable using Cowan Court for respite as they knew it was safe with one- to-one care. People who stayed there could go out, supported by a member of staff e.g. to a local café. Carers said that people enjoyed the activities and outings. The staff were described as “friendly and helpful”, with people noting that the flat was “lovely and well equipped”. Respite Highbank To help people and their carers prepare for respite, people can visit before their stay. This provides an opportunity to see the service and often puts minds at ease. Families have said this helped them feel happy and confident that the person they care for is being well looked after and found the flexibility in length of respite stay supportive and helpful. “It is the staff that have made the transitions easy for both the family and the cared for person.” “The place has a very homely feel.” “It has made a difference being able to get a break from the caring role.” Page 85 of 286
Page 86
30 Information for Carers Midlothian Community Hospital It is important for families and carers to be included in all aspects of care planning during an admission to Midlothian Community Hospital. It is also important to provide carers and relatives with clear and helpful information about how they can support the person they care for to return home from hospital. Launched on ‘What Matters to You Day’, the hospital created a ‘Carers Matters’ space in the reception area with posters, information, and leaflets. Page 86 of 286
Page 87
31 National Indicators used to measure this outcome. During 2023/24, the Care Inspectorate completed 24 inspections in Midlothian. More than three-quarters of care services inspected were given a rating of Good or Better. A summary of the key findings can be found later in this report. We received 1027 Adult Support and Protection referrals in 2023/24, compared to 929 the year before. This is an increase of 98 referrals (10.55%) and an 52.37% increase over two years. The main type of harm investigated was psychological/emotional harm. National Indicator Our result Our Progress Adults supported at home agreed they felt safe. 79.9% Emergency Admission Rate 10,438 per 100,000 Emergency Bed Day Rate 105,962 per 100,000 Readmission to hospital within 28 days. 95 per 1,000 Falls Rate (People over 65) 24% Care services graded Good or better in Care Inspectorate Inspections. 76.4% Health and Care resource spent on hospital stays where the person was admitted as an emergency. 23% 7 Safe from Harm People using health & social care services are safe from harm. Page 87 of 286
Page 88
32 Issues with medication are a common cause of harm, it is important we support people to use their medications safely. The World Health Organisation set out three priority areas for action, to protect patients from harm and to help them get the maximum benefit from medication. These are: • medication safety in high-risk situations • medication safety in polypharmacy (taking more than one medicine) • medication safety in transitions of care (for example when being discharged from hospital). Some medicines are prescribed to reduce the risk of developing a long-term condition, and these can have side effects. It is important that we can monitor the effectiveness of medications to reduce the risk of harm. Improving Safe Use of Medicines GP Bisphosphonate medication is used to prevent or treat osteoporosis (where bones become brittle or fragile). People who have been prescribed it should have 5 yearly treatment reviews and scans to check bone density. A team of GPs identified 43 patients who were overdue a scan/review. • 17 people (39%) were referred for a bone scan • 3 people (7%) were able to stop their prescriptions • 13 people (30%) were added to recall for future review. Safety has improved as patients are either more reliably referred for a scan to review their condition, or they can have their treatment stopped when appropriate. This reduces the risk of medication-related harm and side-effects. Improved safety of substance-user reviews GP Delays to medicines can increase the risk of illicit substance use or overdose for people that use substances. Ensuring up to date toxicology results that guide safe prescribing can reduce this risk. A team of GPs found that only 38% of people known to use substances had recent toxicology results. They introduced a system to encourage booking the next appointment at each review. They also made sure people were able to see the same GP and build up a relationship of trust. Attendance for medication review increased to 93% and 86% had up-to-date toxicology reports. Reception staff received fewer requests for short notice prescriptions from people who use substances, helping to ensure that prescriptions are issued in good time. Page 88 of 286
Page 89
33 National Indicators used to measure this outcome. These are no National Indicators to measure our progress towards this outcome, so we use staff surveys and other local information to evaluate our performance. Staff experience iMatter is an annual survey sent to all employees across health and social care in the Lothians. In 2023/24, 65% of the workforce in Midlothian Health and Social Care Partnership completed the survey. This is a significant increase compared with 2022/23 (48% completion rate). Staff are asked about their work and their wellbeing including ‘effective team working’, ‘health and wellbeing’, and ‘being involved in decisions’. The Employee Engagement Index is the overall score given to the organisation. The five key areas of this measure how well staff feel they are: • Informed, • Appropriately trained & developed, • Involved in decisions, • Treated fairly and consistently, with dignity and respect, in an environment where diversity is valued, and • Provided with a continuously improving and safe working environment, promoting the health and wellbeing of staff, patients, and the wider community. In 2023/24 Midlothian Health and Social Care Partnership Employee Engagement Index was 78 (the maximum score is 100). The Index score did not change between 2022/23 and 2023/24, but significant more people took part in the imatter survey. This means that we can have much greater confidence in what the survey tells us. Our Workforce We do not directly employ any staff. The health and social care workforce are employed through Midlothian Council, NHS Lothian, and organisations in the Independent and Third sector alongside our unpaid carers and volunteers. However, we know that this combined workforce is the single biggest asset available to us. The needs of our workforce are changing and dependent on many new factors. In 2022 Midlothian Health and Social Care Partnership published its first Integrated Workforce Plan for 2022/25 alongside a staff Communication, Engagement and Experience Delivery Plan. Our Integrated Workforce Plan focuses on the 5 pillars of workforce planning set by Scottish Government to support recovery, growth and transformation of health and social care. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide Page 89 of 286
Page 90
34 Workforce Governance In 2023/24 we asked Midlothian Health and Social Care Partnership to put in place a workforce governance and assurance structure to help plan, develop, and constantly improve how we support our workforce. This included supporting new Workforce Lead post within the Health and Social Care Partnership. A new Integrated Workforce Governance Board was established in 2023 to support quality planning between our services, NHS Lothian, Midlothian Council, Midlothian Community Planning Partnership, the Third Sector, and other partners. The Board oversees and directs the work of two SubGroups: Workforce Planning and Workforce Engagement. The Workforce Planning SubGroup was tasked with the development, delivery, monitoring and reporting of the Integrated Workforce Plan 2022-25 and supported the Health and Social Care Partnership to increase its skills and capacity in relation to workforce planning. The Workforce Planning Subgroup also supported our understanding of the duties of the Health and Care (Staffing) (Scotland) Act. The Workforce Engagement Subgroup was tasked with the development, delivery, monitoring and reporting of workforce engagement activity, and staff governance and development. This SubGroup was also responsible for the development and delivery of Midlothian Health and Social Care Partnership’s Staff Communication Engagement and Experience Plan, and the measurement and evaluation of the 12 months action plan. Unfortunately, due to the financial challenges we face, we have been unable to continue to afford a Workforce Lead and work in this area has slowed down as a result. The Integrated Workforce Governance Board continues to oversee workforce planning and support activity, but the two SubGroup have paused. Staff Wellbeing Staff who work within Midlothian Health and Social Care Partnership tell us that delivering quality, person centred care is both rewarding and demanding. We must ensure that everyone who works for the partnership, regardless of their role, has the support they need to thrive. Midlothian Health and Social Care Partnership and the Wellbeing Lead have led a programme of support for staff wellbeing including 2 workshops exploring the emotional demands of working in the community, coping strategies, and managing emotional risk. 27 people attended with 80% stating that they were likely to use their new knowledge and skills. While we recognise the positive impact of wellbeing support, there is more we need to do to keep people working in health and social care well, and at work. “I often think about the wellbeing workshop when I am at work and am very grateful for being given the opportunity and a safe space to express how emotionally draining I find my job. I think just being able to express this and it being acknowledged has been huge to me as a person and as an employee ……I feel that we need to understand the importance of wellbeing in employees to make a strong and resilient work force.” Page 90 of 286
Page 91
35 “I have recommended the wellbeing course to all my colleagues, and I believe that all employees, including management should be encouraged to go on it to ensure the right tools and coping strategies are in place to ensure a healthy, productive workplace.” Improving staff wellbeing Midlothian Community Hospital Midlothian Community Hospital proactively supported wellbeing for all. In partnership with the NHS Lothian Charity, local businesses and charities, a staff wellbeing garden was designed with staff. The garden aims to be a little sanctuary from the busy hospital environment, and somewhere for staff to take a break, in a calm and inspiring area. This will be an area where staff can easily access to fresh air and sunlight, and due to open later this year. The monthly Soup Stop is an opportunity for staff to have lunch together. The number of staff attending from across Midlothian has grown over 50% in the past year with 30-40 staff enjoying time together at each event. To support rising numbers, the Soup Stop has invested in equipment and increased the selection on offer. Staff value the opportunity to connect, share ideas and experiences, and “take a breather”. The Soup Stop has been so successful that similar events are now being offered at other Health and Social Care Partnership locations. Page 91 of 286
Page 92
36 National Indicators used to measure this outcome. Our Strategic Plan sets out how we will support people, and how we allocate the integrated budget we receive from Midlothian Council and NHS Lothian. Midlothian Health and Social Care Partnership uses the money allocated to its services to plan, deliver, monitor, and evaluate the services it provides and commissions. All services have a duty to ensure we deliver Best Value. This means we ensure resources are well managed, to improve services, and deliver the best possible outcomes for people and communities. The actions services take, and how they use the resources allocated to them will determine how much progress we make, and how quickly. We monitored these plans and asked Midlothian Health and Social Care Partnership to do things differently when we thought there was a need to do so. In 2023/24 our resources were stretched due to salary increases for our staff and the staff of commissioned services, and the increasing cost of providing services to a larger population with more complex needs. To meet this challenge, our services have continued to keep a focus on quality, innovation, and improvement. National Indicator Our result Our Progress Adults supported at home agreed that their health and social care services seemed to be well coordinated. 74.4% Emergency Admission Rate 10,438 per 100,000 Proportion of the last 6 months of life spent at home or a community setting. 87.9% Falls Rate (People over 65) 24% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 639 per 1,000 Health and Care resource spent on hospital stays where the person was admitted as an emergency. 23% 9 Use of Resources Resources are used effectively and efficiently. Page 92 of 286
Page 93
37 Improving prescribing in General Practice Pharmacy Team Pharmacy Teams collaborated with GPs in all 11 practices to establish an agreed ‘Permissible Repeats Policy’ for priority medication groups. This aimed to reduce the workload generated by ad hoc ‘Acute’ prescriptions requests from patients. As a result, Ad hoc ‘Acute’ prescriptions reduced by 3%, equating to 2,800 less Acute prescriptions and 93 hours of combined GP & admin time saved every month. The Midlothian Pharmacy service developed a Pharmacy Hub to complete the prompt medicines reconciliation of hospital immediate discharge letters. As well as improving patient safety, the Hub has improved the efficiency of medication provision and timely communication with patients. 98% of hospital immediate discharge letters were reconciled within 48 hrs of the Pharmacy Hub receiving them. In February 2024, 83% of letters were completed within 24 hrs. This work was recognised at the NHS Lothian Celebrating Success Awards. Making it easier to see a GP Pathhead GP The Pathhead GP practice team improved the number of people who attended appointments – especially for longer timeslots. The practice sent text-reminders, and this reduced the number of missed appointments to 1.5% of all appointments. The text system also allows people to rebook at a more convenient time if needed. As a result, more appointments are available, including some at short notice. Page 93 of 286
Page 94
38 How we spent our money (2023/24) We are funded by our partners, Midlothian Council and NHS Lothian, and are responsible for the integrated budget we receive. The funding is to support the delivery of the health and social care in Midlothian. We work closely with our partners and receive a budget offer from them both every year. However, we often don’t know exactly what this will be until February or March each year. This is because of how our partners receive funding from Scottish Government. At our meeting on the 16th March 2023, we accepted the budget offer from NHS Lothian, but did not accept the budget offer from Midlothian Council because it did not meet the criteria in the Scottish Government guidance. After further discussions, we accepted this offer but had to deliver further savings plans to address the shortfall. You can read more about how we spent our money in our Annual Accounts. Financial challenges during 2023/24 During the financial year 2023/24 we spent more money than we were allocated in both health and social care. In health services, this was mostly due to pressures within GP prescribing services as a result of increased demand, and the cost of services within Acute Hospitals (The Royal Infirmary of Edinburgh and the Western General hospital). In social care services, increased demand, and higher costs to delivery of both social care were significant challenges. There has not been any additional funding to support these pressures. To ensure good financial management, we should have some financial reserves. In 2023/24 we had to spend all of our general reserve (c. £6.2m) to pay for services. Although this was planned, it has meant we no longer have any reserves to support recovery plans or to investment in service transformation. Our Hosted and Set Aside services continued to experience a number of pressures. Mental Health Inpatient services required additional capacity to meet high demand. There was also increased demand for equipment provided by the Community Equipment Store. Page 94 of 286
Page 95
39 How we spent our money in 2023/24 Budget Spend Variance Note Direct Midlothian Services Community AHPS £3,504 £3,437 £67 Community Hospitals £7,967 £7,933 £34 District Nursing £8,649 £8,700 -£51 General Medical Services £17,956 £18,040 -£84 Health Visiting £2,623 £2,683 -£60 Mental Health £3,039 £3,379 -£340 Other £5,201 £8,013 -£2,812 1 Prescribing £21,195 £21,917 -£722 Resource Transfer £6,928 £6,928 £0 2 Older People £25,451 £30,816 £5,365 Learning Disabilities £19,166 £22,424 -£3,258 Mental Health £1,205 £1,049 £156 Physical Disabilities £3,917 £4,224 -£307 Assessment and Care Management £3,972 £3,902 £70 Other £3,705 £3,621 £84 3 Midlothian Share of pan-Lothian Set Aside £22,784 £24,328 -£1,544 4 Mental Health £3,249 £3,379 -£130 Learning Disabilities £1,430 £1,419 £11 GP Out of Hours £1,358 £1,358 £0 Rehabilitation £1,011 £879 £132 Sexual Health £824 £815 £9 Psychology £1,681 £1,515 £166 Substance Misuse £592 £574 £18 Allied Health Professions £1,740 £1,682 £58 Oral Health £963 £862 £101 Other £4,143 £4,070 £73 Dental £6,198 £6,198 £0 5 Ophthalmology £1,964 £1,964 £0 5 Pharmacy £4,169 £4,169 £0 5 Sub Totals Health Budget Social Care Budget £129,168 £134,242 £57,416 £66,036 -£13,694 NHS reserves adjustment -£1,366 £1,366 6 Per Annual Accounts Health Social Care £129,168 £132,906 £57,416 £66,036 -£12,358 Page 95 of 286
Page 96
40 Notes 1. Other includes £4.816m for the Social Care Fund which is held in the Health Budget but expended in the social care services. It also includes £1.336m of funds held by NHS Lothian on behalf of Midlothian Council. There is more information about this in note 6 below. 2. ‘Resource Transfer’ describes funds for specific purposes which are transferred from health to social care. However, these remain part of the health budget. 3. ‘Social Care Other’ includes care for non-specific groups, substance use services and other management costs. 4. ‘Set Aside’ describes the budgets for functions delegated to us but managed by the Acute Services management teams within NHS Lothian. These services are: • Accident and Emergency • Cardiology • Diabetes • Endocrinology • Gastroenterology • General Medicine • Geriatric Medicine • Rehabilitation Medicine • Respiratory Medicine • Various ancillary support services for the above These services are delivered at the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital. 5. In the Health system, expenditure to support the delivery of community dentistry, community opticians and community pharmacists is termed as ‘non-cash limited’ (NCL) and part of the delivery of primary care functions delegated to us. However, there is no budget allocated to us and costs are supported by the Scottish Government. 6. NHS Lothian is not able to hold reserves. However, at the end of the financial year, £1.336m of funds were held by NHS Lothian on our behalf. These funds were transferred to Midlothian Council to support the social care position. Thus, although these are shown as expenditure, these funds are not expenditure and have therefore been removed. The charges (shown as expenditure above) made by Midlothian Council to us are the net costs of delivering social care services in Midlothian. The charges from NHS Lothian are based on the health budget setting model that we agree together. Charges for the core services delivered by Midlothian Health and Social Care Partnership are based on the net direct actual costs. Charges for hosted and set aside services delivered across all of Lothian are based on the total actual costs for these services shared by the four Lothian IJBs. Our share of the total actual costs incurred in 2023/24 for hosted services, the Lothian set aside budget, and the non-cash limited budgets is 10% . Page 96 of 286
Page 97
41 Main Areas of Spend (2018/19-2023/24) The graph below compares our spend trends for the past 6 years. We are unable to report on spend by locality as we do not hold data in this form. 32261 21917 18040 14366 0 20000 40000 60000 80000 100000 Community Hospital Prescribing GMS Other £ 000's Main areas of spend 2018/19-2023/24 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 112358 Page 97 of 286
Page 98
42 Working with local communities Community Planning is a way of organisations working together, and with local communities, to use resources to improve people’s lives. There are 32 Community Planning Partnerships across Scotland - one for each council area. These Partnerships bring together key organisations, both statutory and Third Sector, to plan services that will deliver better outcomes for people. We are part of the Midlothian Community Planning Partnership and by working together we want to see people leading healthy, safe, and successful lives. This involves including the people who use our services, their families, and carers in developing and improving the care and support we provide. In 2023/24 we led the 'Midlothian will be Healthier' thematic area of the ‘Single Midlothian Plan’ with 4 multi-sector projects: • Midlothian Care and Support Community Co-operative • Falls prevention and support • Digital self-management platform • Early identification and support for people living with frailty. We worked closely with the Midlothian Community Planning Partnership to develop the contribution from health and social care. The work to develop a new plan for 2023/27 was based on the wishes of people and communities and explored opportunities to work more closely with the partners in our Community Planning Partnership. Page 98 of 286
Page 99
43 Communication and Engagement Working with people and communities is the only way to ensure we are planning for what people need. To understand what is already working well, where we can improve, and how we can do better, we commissioned the Strategic Planning Group to review how we are working with and listening to people and communities. In November 2023, we started a 5-step evaluation process using the Healthcare Improvement Scotland Quality Framework for Community Engagement. This has helped us to work more closely with our communities and community partners, involve more people in our decisions, and help make what people care about most a reality. This process is still underway and will conclude in 2024/25. We will then publish our Community Engagement Plan and refresh our Public Engagement Statement. Page 99 of 286
Page 100
44 Looking forward Strategic Plan We are currently developing our next Strategic Plan. This will set out our ten-year vision for integrated health and social care services and how we will use our resources to improve the health and wellbeing of people and communities in Midlothian. On 24th August 2023, Midlothian IJB approved the timeline for this work with an anticipated publication date before the end of April 2025. Following an initial consultation between September and December 2023, the Board developed a set of propositions in January 2024 for the Strategic Planning Group to develop into a first draft of the next strategic plan. As we develop this plan, we will focus on what matters to people, how they want things to change, and ask for feedback. We will also listen to our third-party services, providers, and partner organisations to better understand what is already working well and where they are opportunities to improve, so we can focus our contribution to see progress towards people in Midlothian living good lives. Like all Integration Authorities in Scotland, our role is to plan and deliver the services that support better health and wellbeing in our communities. We are asked by the Scottish Government to work with our partners to plan across the whole system using the National Health and Wellbeing Outcomes Framework and ensure the Principles for Planning and Delivering Integrated Health and Social Care are the driving force behind our planned activity to successfully and improve outcomes. These national ambitions are the same for every Integration Authority in Scotland and they will be our ultimate aim for as long as we are asked to work in this way. The action we choose to take, and the pace at which we are able to make progress, is unique to Midlothian. In 2024, the Strategic Planning Group will work alongside our partners and communities to develop key themes and build on the overall ambitions of the plan and priority areas for actions across the short, medium, and longer term. It is anticipated that we will be able to review a first draft of this plan by May, and a second draft for public consultation from September to November 2024. A Public Engagement Plan is also underway including online discussion, face to face 'townhall' sessions, questionnaires, surveys, and a citizens panel. We are also aware we have to adapt and change in response to the world around us. In 2023/24 this has meant some difficult decisions about our future, how we plan financially, and what this means for our services. This also gives us an opportunity to revise our plans, make changes quickly, and transform our services. New Legislation In 2023/24 several new pieces of legislation required us to take action. The Health and Care (Staffing) (Scotland) Act had implications for both our health and social care workforce and required us to work closely with both of our partners NHS Lothian and Midlothian Council who employ the staff who work within the Health and Social Care Partnership. The requirement to provide detailed Page 100 of 286
Page 101
45 assurances on the steps we have taken to ensure appropriate numbers of staff to provide safe and effective care required us to develop new processes and ways of reporting. While we have undertaken a number of tasks to provide assurance that we are meeting our duties and obligations in relation to safe staffing, there is still more we could do. In 2024/25 we will continue to work with both our partners to ensure service are aware of the duty to comply with the guiding principles of the Health and Care (Staffing) (Scotland) Act, 2019. The Act also requires us to report on how we are ensuring we have considered the duties of the Act when we are planning or securing contracts for care that is provided by others on our behalf. In Midlothian, we commission over £45 million in services provided by third parties. We will continue to work alongside our partners to ensure that we have met our duties in relation to the services that we commission from third parties. In 2024/25 we this will include • Ensuring our Market Facilitation Plan supports a local market that promotes the guiding principles of the Act. • Reviewing and updating the register of contracts to note when one of the services managed by Midlothian Health and Social Care Partnership plans or secures the provision of ‘social care’ from a third party under a contract, agreement, or other arrangements. • Issuing a contract variation with a clause detailing the requirements of all third-party providers in relation to hourly rate and minimum pay. • Asking Midlothian Health and Social Care Partnership to ensure all third-party providers are aware of the duty to comply with the guiding principles of the Act by overseeing a review of contract terms and conditions. • Ensuring due diligence check before contracting services that include questions on staffing and delivery. Workforce Of course, this also impacts on how we think about wider workforce planning. In 2024/25 we will be asked to submit a new Integrated Workforce Plan 2025-28 to Scottish Government. Of course, we don’t employ any staff as the health and social care workforce are employees of our NHS and local authority partners. However, we will continue to work with all our colleagues and Scottish Government to ensure we are meeting all our requirements. We know that higher unemployment rates are associated with poorer health outcomes a cause of health inequality, social exclusion, and poverty. Low employment rates are associated with a lower life expectancy and people who live in areas with high employment rates are more likely to live longer and in better health. In 2023/24 we began work alongside our partners and the Local Employability Partnership to commit to ways we can support local people into work. We have identified a number of focused actions to support fair work in Midlothian and will be able to report on the outcome of this next year. National Care Service The new National Care Service legislation begins to set out the future of social care in Scotland. This could significantly change the way we are asked to work. Although it is not clear what the future will mean for integrated health and social care, we will continue to work closely with Scottish Government development teams and share our views on proposals. Page 101 of 286
Page 102
46 Operational Transformation In 2023/24, a Bed Based Review was carried out to consider the available options and opportunities to review how we provide inpatient and residential care and support. As the work progressed, we identified important issues that were relevant across both health and social care and have taken action to make changes and improvements. Page 102 of 286
Page 103
47 Inspections The Care Inspectorate inspect care homes and care at home services to check the quality of care. The majority of care homes in Midlothian are not managed by the Health and Social Care Partnership. Read the full reports at the Care Inspectorate website. Care at Home – Support Services Name Date People's wellbeing Leadership Staff team Setting Care & support planning Baal-Perazim 11/05/2023 4 5 5 Not assessed 4 Call In Homecare 22/02/2024 4 4 4 Not assessed 4 Cera Care - Midlothian 20/03/2024 5 5 Not assessed Not assessed Not assessed McSence 16/05/2023 4 3 Not assessed Not assessed Not assessed Midlothian Council - Domiciliary Care 15/11/2023 4 4 4 Not assessed 3 6 Excellent 5 Very Good 4 Good 3 Adequate 2 Weak 1 Poor Page 103 of 286
Page 104
48 Recommendations and Areas for Improvement (if any) Name Recommended Improvement Baal-Perazim People should be confident their medication regime is being managed safely. Therefore, the provider should ensure: a. Staff administering medication have clear information as to the name of the medication, what the medication is used for, the dosage and the impact taking the medication has on the person; b. Protocols for “as required” medication are in place. People should experience high quality care and support that is right for them. Therefore, the provider should ensure: a. Risk assessments are completed, monitored, and reviewed where there is an identified risk to the supported person and/or others; b. Support plans include clear guidance as to how staff sensitively manage situations where a person is significantly distressed and anxious to achieve planned outcomes. Call In Homecare To ensure people and their relatives are provided with clear information about the service, in particular the arrangements for staff delivering their care and any changes in staffing, the provider should ensure good communication between staff, people, and the management team. The implementation of communication agreements with people would support this area for improvement. Midlothian Council - Domiciliary Care To ensure people experience high quality care, the manager should ensure that records are fully maintained, along with relevant guidance (including body maps) when supporting people with their medication. To ensure that people are confident that the care they receive is well led and managed, the manager should ensure any actions identified from audits completed are carried through to completion and this is clearly evidenced and tracked. To ensure people that staff know how to care and support them should they become unwell, anticipatory care plans should be developed for each person. To ensure that people are confident that the care they receive is person centred and well led, the manager should ensure Personal plans record all risk, health, welfare, and safety needs in a coherent manner which identifies how needs are met. This should also incorporate risk enablement where appropriate and agreed. Page 104 of 286
Page 105
49 Care Homes for Older People Name Date People's wellbeing Leadership Staff team Setting Care & support planning Aaron House 19/03/2024 4 4 5 4 4 Drummond Grange 16/08/2023 4 5 Not assessed 4 Not assessed Nazareth House 24/08/2023 3 3 2 Not assessed 3 Nazareth House 02/11/2023 Not assessed Not assessed 2 Not assessed Not assessed Newbyres Village 05/05/2023 2 2 2 4 2 Newbyres Village 04/08/2023 3 3 3 Not assessed 3 Pine Villa 20/06/2023 5 5 4 3 4 Pittendreich 28/09/2023 3 3 3 3 3 Springfield Bank 12/04/2023 4 4 4 4 4 Springfield Bank 24/07/2023 3 3 3 Not assessed 3 Page 105 of 286
Page 106
50 Recommendations and Areas for Improvement Name Recommended Improvement Drummond Grange To improve the environment of the home the provider should continue to develop a comprehensive refurbishment plan. This should include, but not be restricted to, improving bedrooms and corridors, ensuring timely repairs and replacement of items. The plan should detail the timescales for refurbishment and repairs/maintenance to take place and be reviewed on a regular basis. Each unit should have its own full plan, specific to that environment. Nazareth House Requirements 1. By 27 October 2023, personal plans must accurately reflect the care provided and ensure that service users’ health, safety and wellbeing needs are being accurately assessed, documented, met, and are effectively communicated between all relevant staff. To do this the provider must at a minimum ensure: • Personal plans are reviewed and updated accordingly to reflect all assessed care needs. • Personal plans are fully audited to ensure all the information held within them can be cross referenced as being accurate. This includes the effective use of assessment tools used to determine risk. • The effectiveness of the care provided to service users is measured through observation of their care, quality audits and feedback from them and those important to them. All observations must be documented. • Ensuring that each service user’s health and wellbeing is consistently monitored and evaluated to inform the level of care required. This should include the accurate recording of residents’ food and fluid intake and the maintaining of other relevant records. People should have choice about getting involved with activities and interests important to them, both in the care home and their community. The provider should continue to develop opportunities for people to participate in meaningful activities. This is to enable people to get the most out of life and options to maintain and develop their interests, activities, and what matters to them. This includes opportunities to connect with family friends and the local community, in different ways. People with specific communication needs or cognitive impairment should also be supported to participate in a meaningful way and those important to them involved in planning activities and evaluating how meaningful they were. The recording and monitoring of this should help to promote positive outcomes for all. Page 106 of 286
Page 107
51 Name Recommended Improvement To support people's health and wellbeing, the manager must implement care and support plans for people who are at risk of becoming constipated. This should include, but is not limited to, ensuring records detail preventative actions to be taken, how this will be monitored and managed, and ensure there is effective clinical oversight of people's elimination records. To ensure people experience safe care and support where management have a good oversight and monitoring of the service, internal quality assurance should be improved. This would include providing clear evidence of the audit carried out, the information sampled and the outcomes with identified actions to be followed up. Where any accident or incident reported to management, results in unexplained or unexpected injury this should be fully investigated and recorded and notified to the care inspectorate. To ensure people are actively encouraged to be involved in improving the service, family, friends, and people supported should be given feedback on how quality assurance processes have led to improvements based on their feedback and suggestions. Requirements 1. By 27 October 2023, people experiencing care must have responsive care from staff with the right knowledge and competence. The provider must at a minimum ensure: • There is a management overview of the quality of care provided, which is evidenced based and recorded. • Records of the overview of the quality of care includes an action plan with end dates for any improvements required and further review as needed. • Observations of staff practice are carried out and recorded. This would include, ensuring training is put into practice, and that staff practice reflects the health and social care standards. • Where practice is identified as needing improvement there is support through training and one to one meetings. By 27 October 2023, in order to protect service users and staff, the provider must ensure that it is always suitably competent persons who carry out safe and effective moving and assisting techniques. The provider must at a minimum ensure: All staff must receive appropriate training and updates in line with good practice guidance in order to carry out safe and Page 107 of 286
Page 108
52 Name Recommended Improvement effective practices. This includes observed practice for staff, feedback, and any identified actions, all of which must be documented. By 27 October 2023, staff must be able to support people to receive care that meets their health, safety and wellbeing needs and enables them to experience respectful, personalised, and compassionate care. The provider must at a minimum ensure: • There are enough staff on each shift who are appropriately trained, skilled, and competent in the role they are to perform at all times. • The numbers and skill mix of staff deployed is based on an accurate assessment of each service users’ needs, including needs arising from living with other service users in a group, taking the layout of the building into account. • Make certain there are enough staff to ensure that service users experience meaningful engagement and occupation. A full management overview of training should be undertaken, this would include: • Training to reflect the promoting excellence framework for people with dementia, at a minimum of skilled level. • Training which specifically reflected people's health needs living in the home. • Training being linked into one to one supervision, be reflective of residents needs and staff be given the opportunity to reflect on their learning though observed competency checks. • All staff undertaking training on the health and social care standards as part of their induction, including meaningful engagement. Six monthly reviews of support, as good practice, should give detail on discussions and reflect all aspects of care, including outcomes and activities. Outcomes of what people want from their life in the home (including relatives views) should be reflected in the review of care. Nazareth House To ensure people experience high quality care, the provider should continue to ensure that all staff have regular opportunities to develop their skills and reflect on their practice. This should include but not be limited to, planned observations of staff practice and regular one to one supervision. Requirement 1 Page 108 of 286
Page 109
53 Name Recommended Improvement By 27 October 2023, personal plans must accurately reflect the care provided and ensure that service users’ health, safety and wellbeing needs are being accurately assessed, documented, met, and are effectively communicated between all relevant staff. To do this the provider must at a minimum ensure: • Personal plans are reviewed and updated accordingly to reflect all assessed care needs. • Personal plans are fully audited, to ensure all the information held within them can be cross referenced as being accurate. This includes the effective use of assessment tools used to determine risk. • The effectiveness of the care provided to service users is measured through observation of their care, quality audits and feedback from them and those important to them. All observations must be documented. • Ensuring that each service user’s health and wellbeing is consistently monitored and evaluated, to inform the level of care required. This should include the accurate recording of residents’ food and fluid intake and the maintaining of other relevant records. Requirement 2 By 27 October 2023, people experiencing care must have responsive care from staff with the right knowledge and competence. The provider must at a minimum ensure: • There is a management overview of the quality of care provided, which is evidenced based and recorded. • Records of the overview of the quality of care includes an action plan, with end dates for any improvements required and further review as needed. • Observations of staff practice are carried out and recorded. This would include, ensuring training is put into practice and that staff practice reflects the Health and Social Care Standards (HSCS). • Where practice is identified as needing improvement, there is support through training and one to one meetings. Requirement 3 By 27 October 2023, in order to protect service users and staff, the provider must ensure that it is always suitably competent persons who carry out safe and effective moving and assisting techniques. The provider must at a minimum ensure: All staff must receive appropriate training and updates in line with good practice guidance in order to carry out safe and effective practices. This includes observed practice for staff, feedback, and any identified actions, all of which must be Page 109 of 286
Page 110
54 Name Recommended Improvement documented. Requirement 4 By 27 October 2023, staff must be able to support people to receive care that meets their health, safety and wellbeing needs and enables them to experience respectful, personalised, and compassionate care. The provider must at a minimum ensure: • There are enough staff on each shift who are appropriately trained, skilled and competent in the role they are to perform at all times. • The numbers and skill mix of staff deployed is based on an accurate assessment of each service users’ needs, including needs arising from living with other service users in a group, taking the layout of the building into account. • Make certain there are enough staff, to ensure that service users experience meaningful engagement and occupation. Newbyres Care Village Requirements 1. By 14 July 2023 the provider must ensure that care records reflect accurately care given to ensure people can be confident that their health is monitored appropriately. (a) care documentation and records (including health charts) are accurate, sufficiently detailed and reflect the care planned or provided (b) staff have the appropriate knowledge through training so are aware of their responsibility in maintaining accurate records, retaining records and follow best practice including Scottish Social Services (SSSC guidance) (c) staff have the appropriate knowledge through training about the use of healthcare assessment tools including MUST, challenging behaviour, and pressure risk assessments. (d) ensure that staff know policy and best practice. To ensure people have positive experiences, the provider should ensure care and support is tailored to the needs, wishes and choices of people and delivered in a dignified way. Requirements 1. By 14 July 2023 and to ensure people experience safe care and support the provider must make improvements to their quality assurance oversight. To do this, the provider must at a minimum ensure: (a) the system effectively enables areas for improvement to be promptly and accurately identified Page 110 of 286
Page 111
55 Name Recommended Improvement (b) that the outcomes because of any audit are clearly recorded - where areas for improvement are identified, that an action plan is developed detailing timescales and the person responsible (c) all current quality assurance arrangements are reviewed and developed to ensure that these are systematic, effective, and integral to service provision - people’s views about the care and support they receive is sought to inform quality assurance (d) quality insurance (including audits and oversight) have appropriate systems and processes in place to review the effectiveness of, undertaken by the management structure which may include the senior management team. By 14 July 2023 to ensure people have confidence that the service they use is led well and managed effectively. The provider must improve management arrangements and oversight. To do this, the provider must at a minimum ……. (a) the management have effective oversight of the day-to-day delivery of care to service users to ensure their care needs are fully met. (b) the management have a visible presence within the service and engage with residents, relatives, and staff to support the development of management oversight required (c) the management engage with service users and staff about the quality of the service and take action to address improvements identified to ensure improved outcomes for service users (d) monitor staff competence through training, supervision, and on-site observations of staff practice and take action to improve or reduce poor or unsafe practice. (e) introduce staff individual learning and development plans to ensure staff continue to have the knowledge and skill to meet people’s needs (f) ensure staff feel supported through regular support and supervision, including competencies of practice (g) to hold regular team meetings and reflect on practice through team meetings, identifying areas to improve. Requirements 1. By 14 July 2023 to ensure people are confident that staff are responsive to their needs. The provider must ensure that there are enough staff working in the care home to ensure person centred and responsive care (including nursing input) can be delivered. To do this, the provider must at a minimum ensure that Page 111 of 286
Page 112
56 Name Recommended Improvement (a) there are appropriate assessments and review of people's (service users’) needs and wishes (b) at all times, suitably qualified and competent staff are working in the care service (c) there are enough staff to support service users' health, welfare, and safety (iv) temporary staff are given opportunity to reflect on their practice (d) provided at the agreed times, and in such a way that meets the identified needs (including nursing input) of the service user as recorded in their agreed support plan (e) the physical layout of the building is considered when reviewing staffing levels (f) dependency tools used to assess the staffing levels required to meet people’s care needs incorporate time to be involved in training, observations of practice, team meetings and supervision meetings. Requirements 1. By 14 July 2023 to ensure that personal planning reflects people’s outcomes and wishes, the provider must ensure personal plans contain current, clear, and meaningful information. To do this, the provider must at a minimum ensure ……. (a) personal plans record all risk, health, welfare, and safety needs in a coherent manner which identifies how needs are met (b) care plans are reviewed on a regular basis to ensure they are accurate and consistent to the identified care needs assessed (c) the auditing of care plans by the provider includes a follow through of actions to ensure any areas identified for improvement are actioned upon and any learning is recorded Newbyres Care Village To ensure people continue to experience safe care and support the manager should continue to make improvements to their quality assurance oversight, through regular auditing of personal plans and other related documentation. Pine Villa The provider should ensure appropriate fire safety systems are in place to safeguard the health, safety and wellbeing of residents and staff. This should include: • an up-to-date fire evacuation plan • suitably detailed personal emergency evacuation plans for all residents, including people on respite placements • nighttime fire evacuation drills, to inform staffing and risk during the night. Where any risk is identified through the drills/evacuation, staffing must be increased to ensure the safety of people living in the home. Page 112 of 286
Page 113
57 Name Recommended Improvement To make sure people have privacy, dignity, safety, and a bedroom of their own, double rooms should only be used when: i) Two people are in a pre-existing relationship before moving into the care home and choose to share, or ii) Two people form a relationship while living in the home and specifically request to live together in a double room. iii) If isolation of a person sharing a room is needed there should be appropriate contingencies and agreements in place that help keep people safe, this might include the two people agreeing to be isolated together. Pittendreich All people supported should have an opportunity to engage in regular meaningful activities. Activities and interests recorded in their personal plan should be evaluated against what they want to achieve or would like to do. To ensure that people's needs are fully met as agreed in their personal plan, the manager should ensure: • all documentation relating to care is accurately recorded. This includes but is not limited to, oral care, continence, personal care, skin integrity and repositioning. • information within the personal plan is accurate and reflects changing individual care needs • staff practice fully reflects the care as written in the personal plan. Where people had been prescribed ‘as required’ medication, there should be detailed protocols as to when to give this, at what point at the escalation of pain, anxiety or stress and distress to administer and if the medication was successful in alleviating the symptoms. To ensure people experience safe care and support where management have a good oversight and monitoring of the service, internal quality assurance should be improved. This would include: • detailing observations as part of the audit • giving feedback to residents, relatives, and staff where improvements have been agreed • recording actions taken as a result of feedback and audits and linking this into the overarching improvement plan •recording the views of relatives, residents, and staff as part of the quality assurance process. To ensure people experience high quality care, the provider should enable opportunities for staff to reflect on their practice Page 113 of 286
Page 114
58 Name Recommended Improvement through discussions at team meetings and through regular supervision with their manager. Staff supervision should include discussion on training and development as well as feedback on observed practice. To improve the environment of the home the provider should continue to develop a refurbishment plan. This should include, but not be restricted to timely repairs and replacement of items. The plan should detail the timescales for refurbishment and repairs/maintenance to take place and be reviewed on a regular basis. To ensure that evaluation of care leads to improved outcomes, clear actions should be identified where changes to care or deficits in care are highlighted. The actions should be reflected in an updated personal plan and should be monitored effectively. Six monthly reviews of support, as good practice, should give detail on discussions and reflect all aspects of care, including outcomes and activities. Outcomes of what people want from their life in the home (including relatives views) should be reflected in the review of care. Springfield Bank All staff should receive training on meaningful engagement with people living in a care home. This would give staff the knowledge, skills, and confidence to initiate meaningful interactions with residents out with direct care tasks. To improve the environment of the home the provider should develop a full refurbishment plan. This should include a full inventory of any, furniture, fittings or equipment which is need of replacement. The plan should detail the timescales for refurbishment to take place and be reviewed on a regular basis. People should have choice about getting involved with activities and interests important to them, both in the care home and their community. The provider should continue to develop opportunities for people to participate in meaningful activities. People with specific communication needs or cognitive impairment should also be supported to participate in a meaningful way and those important to them involved in planning activities and evaluating how meaningful they were. The recording and monitoring of this should help to promote positive outcomes for all. An assessment of the number of health and wellbeing workers should be undertaken to ensure each person has the Page 114 of 286
Page 115
59 Name Recommended Improvement opportunity to engage in activities meaningful to them. Springfield Bank To support people's health and wellbeing, the manager should ensure that food and fluid intake records are completed appropriately. This should include, but is not limited to, ensuring there is an effective system in place to regularly monitor and evaluate intake records to ensure appropriate action is taken. Intermediate Care Homes Name Date People's wellbeing Leadership Staff team Setting Care & support planning Highbank 16/01/2024 4 5 Not assessed Not assessed 4 Care Homes for Adults with a Learning Disability Name Date People's wellbeing Leadership Staff team Setting Care & support planning Dougall Court 09/10/2023 4 4 4 4 4 Recommendations and Areas for Improvement Name Recommended Improvement Dougall Court To ensure people experience high quality care, the provider should ensure the premises where support is delivered is suitable to meet the care needs of people. This is especially relevant as people become older and their health and care needs may change. Page 115 of 286
Page 116
60 Care Homes for Adults with a Learning Disability and Autism Name Date People's wellbeing Leadership Staff team Setting Care & support planning Parkside Court 10/10/2023 4 4 4 4 4 Recommendations and Areas for Improvement Name Recommended Improvement Parkside Court To support positive outcomes for people, the provider should ensure the environment is suitable to fully meet peoples’ assessed care and support needs and potential future care needs including people’s mobility being a key focus area. To do this, the provider should, as a minimum: 1. Develop and implement an action plan which has specific, measurable, achievable, relative and timebound (SMART) objectives to ensure the accommodation is fit for purpose to meet people’s care needs in the medium to long term. This includes adaptions to the current registered building. 2. Engaging in meaningful discussions with people, their relatives, welfare guardians and other relevant agencies and professionals. 3. If from the above action plan, it was identified that the current environment would not meet people’s care needs in the medium to long term, then alternative accommodation opportunities that can meet people’s outcomes should be explored. Page 116 of 286
Page 117
61 Housing Support Service Name Date People's wellbeing Leadership Staff team Setting Care & support planning Cowan Court 12/10/2023 5 5 Not assessed Not assessed Not assessed The Redwoods Caring Foundation 05/09/2023 5 5 Not assessed Not assessed Not assessed Thera (Scotland) 09/02/2024 5 5 5 Not assessed 5 Support Service Name Date People's wellbeing Leadership Staff team Setting Care & support planning CAT Team 09/08/2023 5 3 4 Not assessed 4 Garvald House 13/09/2023 5 5 Not assessed Not assessed 5 Midlothian Park Cottage 05/06/2023 5 5 5 Not assessed 5 Page 117 of 286
Page 118
62 Recommendations and Areas for Improvement Name Recommended Improvement CAT Team The Provider should consult with and determine key stakeholder’s views on engagement with quality assurance processes in the service. Consideration should be given to developing a forum or forums which allow people to share their views and contribute to service development and improvement plans. The Provider should provide notifications of accidents and incidents to the Care Inspectorate in line with regulatory guidance (see Records that all registered services (except childminding). The Provider should develop competency-based observations of staff practice, clarifying that they have the requisite skills and that they put them into practice during support. Observations should include feedback from people who experienced care and inform discussion, supervision and professional development for the staff concerned. The Provider should develop a training matrix which allows management overview of learning undertaken and insight into when refresher training updates are needed. In order to ensure that personal plans are relevant and adequately guide staff response to any presenting risk, the Provider should: - Ensure that personal plans identify all risk, health, welfare, and safety issues in a manner which documents how needs are met. - Ensure that personal plans are shared with people who experience care and their representatives. In order to ensure that people can contribute to their personal planning and evaluate outcomes arising from support, the Provider should ensure that: -Reviews are carried out a minimum of six-monthly intervals -Review capture and fully record people's evaluations of the outcomes derived from their support. Page 118 of 286
Page 119
63 Business and governance IJB Membership Date Change in membership 18th August 2023 Hannah Cairns resigned her position as Midlothian Health and Social Care Partnership Chief AHP and therefore also her position on Midlothian IJB as the AHP Professional Advisor and non-voting member. 24th August 2023 Val De Souza stood down as Midlothian Integration Joint Board Chair from, taking on the role of Vice Chair. 24th August 2023 Councillor Connor McManus accepted the role as Midlothian Integration Joint Board Chair. Councillor Connor McManus stood down from the Audit and Risk Committee. 21st December 2023 Councillor Derek Milligan was nominated and accepted to Audit and Risk Committee. 14th September 2023 Miriam Leighton, Volunteering Development Manager, Volunteer Midlothian resigned her position on Midlothian IJB as Third Sector Representative and non-voting member. 21st December 2023 Claire Flanagan resigned her position as on Midlothian IJB Chief Finance Officer. 21st September 2023 Nadin Akta resumed her position NHS Lothian Non-Executive Director and therefore also her position on Midlothian IJB as a voting member. 21st December 2023 Magda Clark, was nominated and accepted the position on Midlothian IJB as Third Sector Representative and non-voting member 21st December 2023 Claire Ross was appointed to the position of Midlothian Health and Social Care Partnership Chief AHP and was nominated and accepted to as the Midlothian IJB AHP Professional Advisor and non-voting member. 21st December 2024 David King was appointed as on Midlothian IJB Interim Chief Finance Officer from 1st April 2024 • The Midlothian IJB Carer representative position remains vacant. Page 119 of 286
Page 120
64 Key Decisions Finance • 13th April 2023: Budget offers reviewed. NHS Lothian offer accepted. Midlothian Council offer not accepted • 22nd June 2023: Financial Recovery Plans 2023/24 reviewed, and recommendations accepted • 21st December 2023: Medium-term Financial Plan 2024/25 – 2028/29 reviewed and agreed • 21st March 2024: Midlothian Council offer accepted • 21st March 2024: IJB Outturn Projection 2023/24 reviewed • 21st March 2024: 2024/25 Budget Position reviewed • 21st March 2024: 5 Financial Recovery Actions agreed for 2024/25 • 20th September 2024: Annual accounts agreed Governance and Audit • 22nd June 2023: Midlothian IJB Integrated Impact Assurance process reviewed and agreed. • 24th August 2023: Midlothian IJB Governance Plan reviewed and agreed • 21st December 2023: Midlothian IJB Scheme of Publication reviewed and approved • 8th February 2024: Midlothian IJB Self-Improvement Development Plan Approved Strategy, Planning, and Performance • April 2023: Midlothian IJB Mainstreaming Equalities Report and Action Plan 2023-25 Approved. • 24th August 2023: Midlothian IJB Annual Performance Report Approved • 24th August 2023: Midlothian IJB Performance Framework Update 2023/24 reviewed and agreed • 30th August 2023: Annual Performance Report published • 8th February 2024: Strategic Plan 2025/35 proposals agreed for development and consultation. Other Activity • The Health and Social Care Partnership Integrated Assurance Report Reviewed 13th April 2023 and 21st December 2023 • October 2023: Consultation on the Scottish Government Strategic Plan and Annual Performance Report Statutory Guidance response agreed and submitted. Copies of the relevant reports can be found in the committee reports on the Midlothian Integration Joint Board pages of the Midlothian Council website. Equality in Midlothian Everyone should be treated equally. No-one should have worse opportunities because of where they were born, how they identify, what they believe or whether they have a disability. We take steps to ensure equality is at the heart of what we do and the work of our partners. This includes the way we make decisions, the way we and people who work alongside us behave, how we decide how we spend money, and how we improve our services. Page 120 of 286
Page 121
65 By law, we must report on the progress towards mainstreaming equality by publishing a Mainstreaming Equality Report every 4 years and provide a progress update midway through the plan. Midlothian Health and Social Care Partnership is the organisation delivering services to the community, and working to further equality in its work, but the IJB must publish the report on its actions. In Midlothian, we complete Integrated Impact Assessments (IIAs) to consider how our work might impact equality issues, health inequalities, socio-economic inequalities, needs assessments for care experienced people, human rights, and the environment. Completing an IIA should highlight how we can avoid discrimination against groups of people and to remove or minimise disadvantage where possible. In 2023/24, we completed 2 IIAs for the following new or revised strategies, policies and plans, provisions, practices, and activities: • Chest, Heart & Stroke Scotland (CHSS) Long COVID Service - Midlothian Health and Social Care Partnership Long COVID Pathway Implementation Project • Assessing and devising options for change to the Deaf Action contract covering Midlothian Health and Social Care Partnership. Directions Directions were reviewed at a part-year performance update on 21st September 2023. The end of year review and Direction setting for 2024/25 was postponed due to the rapidly changing financial position and an inability to make meaningful decisions. This was rescheduled to June 2024. Outcome mapping and the OutNav software We know good conversations are vital in understanding how to support someone to achieve their personal outcomes, but this can be difficult to measure. It is often a combination of factors that make a positive difference in people lives. To ensure that services can describe their contribution, we use an approach called Outcome Mapping, which is a way to understand how our services contribute to people achieving the outcomes that matter to them and can help services make more targeted, locally informed decisions about how to design, deliver or commission services. This approach allows us to describe what we do, who with, what people learn and gain as a result, how this makes them feel and the difference this makes in their lives. The Outcome Mapping approach was developed by Matter of Focus and is informed by Contribution Analysis, evidence to action and participatory approaches. Outcome mapping is a process of continual improvement and supports services to develop meaningful action plans for change and is central to the approach to measurement developed by Midlothian HSPC, based on the triangulation of three types of data: service data (activity), system data (population experience), and what matters to people (outcome mapping). Our Strategic Governance Outcome Map helps us better understand the contributes we are making to personal outcomes for people. We are using this unique approach to provide a real time picture of the progress we are making towards our strategic aims and the nine National Health and Wellbeing Outcomes across the whole system. We do this by linking to service outcome maps and other national data. Page 121 of 286
Page 122
66 Outcome maps are a way to understand how services contribute to people achieving the outcomes that matter to them. Working this way means Midlothian Health and Social Care Partnership services can quickly learn from what has worked well and what needs to improve and use this information to make more targeted, locally informed decisions about how to design, deliver or commission services. This approach allows services to describe what they do, who with, what people learn and gain as a result, how this makes them feel and the difference this makes in their lives. We have designed these maps to have ‘stepping-stones’ that include a set of success criteria aligned to the Care Inspectorate Joint Inspection Framework. Each outcome map is colour-coded to show an evaluation of how much progress a service is making progress towards personal outcomes and the strength of evidence is to support that progress rating. This results in a two-factor rating system for each stepping- stone in the outcome map. This approach is now central to our performance measurement and strategic planning. The information collected from each of these three areas together provides objective, whole system evidence that supports services to develop meaningful action plans for change. Page 122 of 286
Page 123
67 Data Appendix In 2023-24, Midlothian’s performance stayed the same compared to 2021-2022. Overall performance across Scotland decreased by 0.2 percentage points. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance, and ranked 9th out of 31 Integration Authorities. 92% 94% 93% 91% East Locality West Locality Midlothian Scotland Percentage of adults able to look after their health very well or quite well National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. 92.5% 92% 93% 91% 91% 50% 60% 70% 80% 90% 100% 2021/22 2023/24 Percentage of adults able to look after their health well or very well Midlothian Scotland Page 123 of 286
Page 124
68 In 2023-24, Midlothian’s performance improved compared to 2020-2021. Overall performance across Scotland got worse by 6.4 percentage points. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance, ranked 12th out of 31 Integration Authorities. 81% 72% 76% 72% East Locality West Locality Midlothian Scotland Percentage of adults supported at home who agreed that they are supported to live as independently as possible 73% 76% 78% 72% 50% 60% 70% 80% 90% 100% 2021/22 2023/24 Percentage of adults supported at home who agreed that they are supported to live as independently as possible Midlothian Scotland National Indicator Our result Our Progress Adults supported at home agreed that they are supported to live as independently as possible*. 76.5% Page 124 of 286
Page 125
69 In 2023-24, Midlothian’s performance was worse compared to 2020-2021. Overall performance across Scotland got worse by 11 percentage points. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance, ranked 14th out of 31 Integration Authorities. 61% 65% 62% 60% East Locality West Locality Midlothian Scotland Percentage of adults supported at home who agreed that they had a say in how their help, care or support was provided 71% 62% 71% 60% 50% 60% 70% 80% 90% 100% 2021/22 2023/24 Percentage of adults supported at home who agreed that they had a say in how their help, care or support was provided Midlothian Scotland National Indicator Our result Our Progress Adults supported at home agreed they had a say in how their help, care or support was provided. 61.9% Page 125 of 286
Page 126
70 In 2023-24, Midlothian’s performance was better compared to 2020-2021. Overall performance across Scotland got worse by 5 percentage points. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance, ranked 1st out of 31 Integration Authorities. 80% 71% 74% 61% East Locality West Locality Midlothian Scotland Percentage of adults supported at home who agreed that their health and social care services seemed to be well coordinated 65% 74%66% 61% 50% 60% 70% 80% 90% 100% 2021/22 2023/24 Percentage of adults supported at home who agreed that their health and social care services seemed to be well coordinated Midlothian Scotland National Indicator Our result Our Progress Adults supported at home agreed that their health and social care services seemed to be well coordinated. 74.4% Page 126 of 286
Page 127
71 In 2023-24, Midlothian’s performance was worse compared to 2020-2021. Overall performance across Scotland got worse by 5 percentage points. Midlothian’s performance was worse than across Scotland. We have work to do in relation to national performance, ranked 27th out of 31 Integration Authorities. 68% 65% 66% 70% East Locality West Locality Midlothian Scotland Percentage of adults receiving any care or support who rated it as excellent or good 79% 66% 75% 70% 50% 60% 70% 80% 90% 100% 2021/22 2023/24 Percentage of adults receiving any care or support who rated it as excellent or good Midlothian Scotland National Indicator Our result Our Progress Adults receiving care or support rated it as excellent or good. 65.6% Page 127 of 286
Page 128
72 In 2023-24, Midlothian’s performance improved compared to 2020-2021. Overall performance across Scotland improved by 2 percentage points. Midlothian’s performance was worse than across Scotland. We have work to do in relation to national performance, ranked 19th out of 31 Integration Authorities. 70% 68% 67% 69% East Locality West Locality Midlothian Scotland Percentage of people with positive experience of the care provided by their GP practice 62% 67% 68% 69% 50% 60% 70% 80% 90% 100% 2021/22 2023/24 Percentage of people with positive experience of the care provided by their GP practice Midlothian Scotland National Indicator Our result Our Progress Adults had a positive experience of the care provided by their GP practice. 67.9% Page 128 of 286
Page 129
73 In 2023-24, Midlothian’s performance was worse compared to 2020-2021. Overall performance across Scotland got worse by 8 percentage points. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance. 78% 74% 76% 70% East Locality West Locality Midlothian Scotland Percentage of adults supported at home who agreed that their services and support had an impact on improving or maintaining their quality of life 81% 76%78% 70% 50% 60% 70% 80% 90% 100% 2021/22 2023/24 Percentage of adults supported at home agreed services and support had an impact on improving or maintaining their quality of life Midlothian Scotland National Indicator Our result Our Progress Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life. 76% Page 129 of 286
Page 130
74 In 2023-24, Midlothian’s performance improved compared to 2020-2021. Overall performance across Scotland improved by 1.5 percentage points. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance, ranked 6th out of 31 Integration Authorities. 35% 33% 35% 31% East Locality West Locality Midlothian Scotland Percentage of carers who feel supported to continue in their caring role 27% 35%30% 31% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2021/22 2023/24 Percentage of carers who feel supported to continue in their caring role Midlothian Scotland National Indicator Our result Our Progress Carers feel supported to continue in their caring role. 34.6% Page 130 of 286
Page 131
75 In 2023-24, Midlothian’s performance stayed the same compared to 2020-2021. Overall performance across Scotland got worse by 7 percentage points. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance, ranked 4th out of 31 Integration Authorities. 81% 85% 80% 73% East Locality West Locality Midlothian Scotland Percentage of adults supported at home who agreed they felt safe 79% 80%80% 73% 50% 60% 70% 80% 90% 100% 2021/22 2023/24 Percentage of adults supported at home who agreed they felt safe Midlothian Scotland National Indicator Our result Our Progress Adults supported at home agreed they felt safe. 79.9% Page 131 of 286
Page 132
76 In 2023-24, Midlothian’s premature mortality rate improved. Overall premature mortality rate across Scotland got worse by 0.2%. Midlothian’s rate was better than across Scotland. We have work to do in relation to national performance, ranked 15th out of 31 Integration Authorities. Midlothian Scotland 375 400 425 450 475 2017 2018 2019 2020 2021 2022 2023 Rate (per 100,000) Premature mortality rate (per 100,000 population) National Indicator Our result Our Progress Premature Mortality Rate (People under 75) 399.5 per 100,000 Page 132 of 286
Page 133
77 In 2023-24, Midlothian’s emergency admission rate increased compared to 2022-2023 by 6.6%. Overall emergency admission rate across Scotland increased by 3.8%. Midlothian’s rate was lower than across Scotland. We are doing well in relation to national performance, ranked 11th out of 31 Integration Authorities. *Where noted the calendar year 2023 is used as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance from Public Health Scotland. 10,845 10,069 10,438 11,707 East Locality West Locality Midlothian Scotland Rate (per 100,000) Rate of emergency admissions for adults (per 100,000) Midlothian Scotland 9,000 9,500 10,000 10,500 11,000 11,500 12,000 12,500 13,000 2017/18 2018/19 2019/20 2020/21 2121/22 2022/23 2023 Rate (per 100,000) Rate of emergency admissions for adults (per 100,000) National Indicator Our result Our Progress Emergency Admission Rate 10,438 per 100,000 Page 133 of 286
Page 134
78 In 2023-24, Midlothian’s emergency bed day rate reduced compared to 2022-2023 by 5.8%. Overall emergency bed day rate across Scotland reduced by 5.8%. Midlothian’s rate was lower than across Scotland. We are doing well in relation to national performance, ranked 12th out of 31 Integration Authorities. *Where noted the calendar year 2023 is used as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance from Public Health Scotland. 107,856 103,911 105,962 112,883 East Locality West Locality Midlothian Scotland Rate (per 100,000) Rate of emergency bed days for adults (per 100,000) Midlothian Scotland 40,000 60,000 80,000 100,000 120,000 140,000 2017/18 2018/19 2019/20 2020/21 2020/21 2022/23 2023 Rate (per 100,000) Rate of emergency bed days for adults (per 100,000) National Indicator Our result Our Progress Emergency Bed Day Rate 105,962 per 100,000 Page 134 of 286
Page 135
79 In 2023-24, Midlothian’s readmission to hospital within 28 days rate reduced compared to 2022-2023 by 4%. Overall readmission to hospital within 28 days rate across Scotland increased by 2%. Midlothian’s rate was lower than across Scotland. We are doing well in relation to national performance, ranked 12th out of 31 Integration Authorities. *Where noted the calendar year 2023 is used as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance from Public Health Scotland. 98 92 95 104 East Locality West Locality Midlothian Scotland Rate (per 1,000) Readmissions to hospital within 28 days of discharge (per 1,000 admissions) Midlothian Scotland 40 60 80 100 120 140 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023 Rate (per 1,000) Readmissions to hospital within 28 days of discharge (per 1,000 admissions) National Indicator Our result Our Progress Readmission to hospital within 28 days. 95 per 1,000 Page 135 of 286
Page 136
80 In 2023-24, Midlothian’s proportion of the last 6 months of life spent at home or a community setting stayed the same compared to 2022-2023. Overall proportion of the last 6 months of life spent at home or a community setting across Scotland stayed the same. Midlothian’s rate was lower than across Scotland. We have work to do in relation to national performance, ranked 28th out of 31 Integration Authorities. *Where noted the calendar year 2023 is used as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance from Public Health Scotland. Midlothian Scotland 80% 83% 85% 88% 90% 93% 95% 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023 Proportion of last 6 months of life spent at home or in a community setting National Indicator Our result Our Progress Proportion of the last 6 months of life spent at home or a community setting. 87.9% 87% 89% 88% 89% East Locality West Locality Midlothian Scotland Proportion of last 6 months of life spent at home or in a community setting, 2023* Page 136 of 286
Page 137
81 In 2023-24, Midlothian’s falls rate for people aged over 65 who were admitted to hospital increased compared to 2022-2023 by 5.1 percentage points. Overall falls rate across Scotland increased by less than 1 percentage point. Midlothian’s rate was higher than across Scotland. We are doing well in relation to national performance, ranked 13th out of 31 Integration Authorities. *Where noted the calendar year 2023 is used as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance from Public Health Scotland. 26.0 22.0 24.0 23.0 East Locality West Locality Midlothian Scotland Rate (per 1,000) Falls rate per 1,000 population aged 65% (admitted to hospital) Midlothian Scotland 14 16 18 20 22 24 26 28 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023 Rate (per 1,000) Falls rate per 1,000 population aged 65+ National Indicator Our result Our Progress Falls Rate (People over 65 who were admitted to hospital) 24% Page 137 of 286
Page 138
82 In 2023-24, Midlothian’s performance improved compared to 2022-2023 by 4.2 percentage points. Overall performance across Scotland improved by 1.8 percentage points. Midlothian’s performance was the same as across Scotland. We have work to do in relation to national performance, ranked 21st out of 31 Integration Authorities. Midlothian Scotland 70% 75% 80% 85% 90% 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 Proportion of care services graded 'good' or better in Care Inspectorate inspections National Indicator Our result Our Progress Care services graded Good or better in Care Inspectorate Inspections. 76.4% Page 138 of 286
Page 139
83 In 2023-24, Midlothian’s performance increased compared to 2022-2023 by 10.3 percentage points. Overall performance across Scotland stayed the same. Midlothian’s performance was higher than across Scotland. We are doing well in relation to national performance, ranked 6th out of 31 Integration Authorities. *Where noted the calendar year 2023 is used as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance from Public Health Scotland. Midlothian Scotland 50% 55% 60% 65% 70% 75% 80% 2017 2018 2019 2020 2021 2022 2023 Percentage of adults with intensive needs receiving care at home National Indicator Our result Our Progress Adults with intensive care needs are receiving care at home. 70.3% Page 139 of 286
Page 140
84 In 2023-24, Midlothian’s performance improved compared to 2022-2023 by 18.5%. Overall performance across Scotland improved by 1.8%. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance, ranked 10th out of 31 Integration Authorities. *Where noted the calendar year 2023 is used as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance from Public Health Scotland. Midlothian Scotland 200 400 600 800 1,000 1,200 1,400 1,600 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 Number of days (per 1,000) Number of days people aged 75+ spend in hospital when they are ready to be discharged (per 1,000 population) National Indicator Our result Our Progress The number of days people aged over 75 spend in hospital when they are ready to be discharged. 639 per 1,000 Page 140 of 286
Page 141
85 This data is no longer collated and not current. NHS Boards have not been able to provide detailed cost information since 2019/20 due to changes in service delivery during the COVID-19 pandemic. As a result, PHS have not provided information for indicator 20 beyond 2019/20. PHS previously published information to calendar year 2020 using costs from 2019/20 as a proxy but, given the impact of the COVID-19 pandemic on activity and expenditure, PHS no longer consider this appropriate. 23% 24% 0% 10% 20% 30% 2015/16 2016/17 2017/18 2018/19 2019/20 Percentage of total health and social care spend on hospital stays where the patient was admitted in an emergency Midlothian Scotland National Indicator Our result Our Progress Health and Care resource spent on hospital stays where the person was admitted as an emergency. 23% Page 141 of 286
Page 142
86 Ministerial Steering Group Targets Updated targets for 2022/23 were developed by the Health and Social Care Partnership, agreed by the IJB, and submitted to Scottish Government in June 2022. Our targets were set to prioritise an increase in system stability. MEASURE 2019- 20 2020- 21 2021- 22 2022- 23 2023- 24 STATUS Maintain emergency admissions into hospital from Midlothian at or below 767 / month. 10,966 9,207 9,606 8,458 8,263 Maintain number of unscheduled hospital bed days: acute specialties at or below 5,074 / month 59,798 57,459 57,394 60,452 58,123 Maintain the use of unscheduled: • geriatric long-stay beds (all ages) • mental health beds (all ages) at or below 2021/22 levels 12,806 13,708 12,802 12,511 16,638 11,934 16,747 12,345 14,099P 8,997P Maintain Emergency Department Attendance (all ages) at or below (2,629 / month) 33,319 26,390 33,155 33,233 32,453 Maintain Delayed Discharge Occupied Bed Days at or below 820 / month. 10,412 7,150 6,135 12,608 9,627 Reduce the percentage of time people spend in a large hospital in their last six months of life. 9.1% 7.5% 8% 8.1% No data N/A Maintain the proportion of people over the age of 65 who are living in the community at 97% or higher. 96.7% 97% 96.9% 96.9% No data N/A SOURCE: Public Health Scotland Integration Performance Indicators 2024 *Where noted the calendar year 2023 is used as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance from Public Health Scotland. PWhere noted this data is provisional. Page 142 of 286
Page 143
Midlothian Integration Joint Board Thursday, 24th October, 14:00-16:00 MIJB Commission: Scoping Exercise in relation to Local Employability and other Fair Work for Pay Options Item number: 5.7 Executive summary In response to the Annual Report of NHS Lothian’s Director of Public Health, Midlothian Integration Joint Board (IJB) agreed to ask the Strategic Planning Group (SPG) to take forward work on employability to identify ways in which it could support the ambitions of fair work in Midlothian. The Strategic Planning Group (SPG) agreed that Midlothian Health and Social Care Partnership’s Integrated Workforce Governance Board should commission operational actions to complete a scoping exercise alongside key stakeholders. This scoping exercise was to establish the current landscape in relation to employability and employment support for local people entering Health and Social Care employment. The outcome of this work was brought back to the SPG to provide a ‘strategic view and support’. SPG then asked the working group responsible for the scoping exercise to ‘consider the priority of each recommendation and identify capacity from existing resource for any options being considered for discussion and agreement at the Workforce Governance Board’. This report sets out the result of that exercise and presents the actions recommended by the Workforce Governance Board. Members are asked to: • Note the outcome of the commission and the actions being taken forward by the Workforce Governance Board Page 143 of 286
Page 144
Midlothian Integration Joint Board 1 Purpose 1.1 This report sets out the recommended actions from the scoping exercise which are considered priority and achievable within existing resources. This scoping exercise was commissioned by the Midlothian’s Strategic Planning Group’s to establish the current landscape in relation to employability and employment support for local people entering Health and Social Care employment within Midlothian Health and Social Care Partnership (HSCP). 1.2 The principle aim of this piece of work is to help: • match labour market supply and demand • provide meaningful work and career success • support local employment to support the ambitions of fair work in Midlothian. 2 Recommendations 2.1 As result of this report Members are asked to: • Note the outcome of the commission and the actions being taken forward by the Workforce Governance Board 3 Background and main report A scoping exercise was carried out by members of the Workforce Engagement Subgroup on the request of the SPG to fulfil the IJB’s ask to identify ways in which it could support the ambitions of fair work in Midlothian. This scoping exercise was completed in partnership with key stakeholders and was presented to the Strategic Planning Group (23rd May 2024). It is available on request. It highlighted work already in place in the HSCP to support employability and employment support for local people entering Health and Social Care employment. It set this within the local employability landscape and made recommendations on further actions which could be taken to support the IJB’s ambitions of fair work in Midlothian. At the SPG meeting dated 23rd May 2024, it was requested that further work be done on the scoping exercise to: • consider the priority of each action • consider which of these actions were an operational ask of the HSCP Page 144 of 286
Page 145
Midlothian Integration Joint Board • identify capacity from existing resources to take actions identified as priority and operational forward • present these for discussion and agreement at the Workforce Governance Board Please see Local Employability Scoping Exercise Prioritised Actions (appendix 1) for the results of this further work that has recently been adopted by the Workforce Governance Board. The work has focused on identifying a limited number of focused actions which are believed to be realistic, achievable and impactful within current capacity, alongside a number of ‘lighter touch’ and one-off actions to support the IJB’s ambitions of fair work in Midlothian. 4 Policy Implications 4.1 This report aims to develop realistic actions which could be taken to support the IJB’s ambitions of fair work in Midlothian. 4.2 Midlothian Council is committed to developing and implementing Community Wealth Building (CWB) and the NHS Lothian Strategic Development Framework (LSDF) includes Anchors within one of its 6 pillars. This work supports both policies. 5 Directions 5.1 This report does not directly impact upon Midlothian HSCPs ability to deliver any existing Directions or raise the need to highlight the potential requirement for a new Direction to the Midlothian Integration Joint Board via its Strategic Planning Group (SPG). 6 Equalities Implications 6.1 This report highlights actions which should achieve positive equality outcomes for members of groups that are socially or economically disadvantaged or excluded. 6.2 If there is agreement for the work to progress an IIA should be completed. 7 Resource Implications 7.1 This report aims to deliver best value by identifying actions which can be taken forward using capacity from existing resources and by embedding it within existing Midlothian Employability Structures (The Local Employability Partnership). Page 145 of 286
Page 146
Midlothian Integration Joint Board 7.2 It advances the principles of integration by proposing actions which have taken into account opportunities under both employers in the HSCP. 8 Risk 8.1 There is the risk that, if this work is not progressed the co-ordination and development of approaches to strengthen employability and employment support for local people entering Health and Social Care employment within Midlothian HSCP will be negatively impacted. 9 Involving people 9.1 The contents of this report were created through the involvement of key stakeholders including members of Workforce Staff Engagement Subgroup, NHS Lothian, and the Local Employability Partnership. It draws on engagement work with people seeking employability opportunities undertaken by the Midlothian Local Employability Partnership. 10 Background Papers AUTHOR’S NAME Becky Hilton DESIGNATION Population Health Strategic Programme Manager CONTACT INFO rebecca.hilton@nhslothian.scot.nhs.uk DATE 01/10/2024 Appendices: Appendix 1: Local Employability Scoping Exercise Prioritised Actions Page 146 of 286
Page 147
Appendix 1: 1st October 2024 HSCP Employability Scoping Exercise Prioritised Actions Consideration has been given to the prioritisation of recommendations from the scoping exercise and the resources available to take them forward. These are the final proposed actions. New actions to be driven forward. Actions Agreed next step Responsible Timescale Governance 1. Co-ordination of HSCP employability work 2. HSCP representation on the Local Employability Partnership Co-ordination of HSCP Employability actions will move to the LEP. Pilot HSCP actions as a standing item on every agenda (monthly). Anthea will be the HSCP rep and will be the link between the LEP and the HSCP Workforce Governance Board. Through attendance Anthea will assess the right additional HSCP representation/ will nominate a deputy for when she cannot attend. Annette Laing – LEP agenda setting. Anthea Fraser - HSCP representation 1. From 30th Sept 2. From 26th Aug LEP (working overview) Workforce Governance Board to be updated. 3. Explore what vacancy information/data can be shared with the LEP to allow employability partners time and information to prepare /support people to apply for health & social care jobs. 4. Establish a process to do this. Becky to set up an initial meeting with relevant stakeholders to explore this. This will consider broader NHS Lothian roles alongside Midllothian HSCP NHS Lothian roles. Anthea to establish if there is capacity within Midlothian Council HR for this work to also involve HSCP Midlothian Council roles. Becky (NHS Lothian) Anthea (HSCP) January 2025 LEP (working overview) Workforce Governance Board to be updated. NHS Lothian Anchors Page 147 of 286
Page 148
Appendix 1: 1st October 2024 Institution Workforce Subgroup (overview) 5. Explore opportunities to build closer working between HSCP patient/service user priority groups and the LEP/ No-one Left Behind Scottish Government funding (co- ordinated by the LEP) Take a focused approach to this work building on employability opportunities with the Justice service to establish pathways to employment. Justice to present those training and qualifications achieved to date at LEP and seek a strenghening of relationships with LEP members. Formal request to senior management to create work experience for Justice clients across the local authority. Share the learning with other service areas of the HSCP. Caroline Griffiths (HSCP Justice) Iain Pemble Caroline Griffiths Annette Laing (LEP) March 2025 August 2024 TBC LEP (working overview) Workforce Governance Board to be updated Actions already in motion to be nudged/nurtured. 6. External communication promoting work/gaining experience in Health and Social Care 6.1. Ensure local comms/promotional activities promote opportunities with both employers in the HSCP Continue annual HSCP attendance at career events across all secondary schools HSCP careers to be represented at biannual employability recruitment events for adults, co- ordinated by CLLE. Anthea Fraser (HSCP) Kirsty Jack (HSCP) Rachael Honeyman (NHS March 2025 LEP (working overview) Workforce Governance Board to be updated Page 148 of 286
Page 149
Appendix 1: 1st October 2024 6.2. Establish ways of working that ensure resources across teams are best utilised when promoting careers/volunteering in Health and Social Care in schools and at local careers events. Anthea, Pauline and Rachael to facilitate the cross-representation of heath and socia care volunteering, employability and careers. Lothian Volunteering) Pauline Macdonald (NHS Lothian) Sharon Armstrong (CLLE) 7. Recruitment paperwork 7.1. Explore what improvements can be made to Council employed HSCP job adverts and descriptions to make then more accessible. Anthea will pursue work with HR (Council) to ensure paper-based application forms are available and consistent with the content of online application forms. Anthea Fraser (HSCP) Pamela Brannan (Midlothian Council HR) March 2025 Workforce Governance Board 8. Learn from NHS Lothian/ LEP pilot to create paid work experience in NHS Lothian. Oversight of this is via the LEP. HSCP attendance at the LEP will provide opportunities for consideration of a 2025 No-one Left Behind funding application including strenghtening work experience in the HSCP. Annette Laing (LEP) Becky Hilton (NHS Lothian pilot) Anthea Fraser (HSCP)/ Fiona Kennedy (HSCP) March 2025 LEP Workforce Governance Board to be updated One off action to connect dots. Page 149 of 286
Page 150
Appendix 1: 1st October 2024 9. Recruitment paperwork 9.1. Understand and be prepared to embed work happening at a national NHS level to make the recruitment process more accessible. Brief the HSCP Workforce Governance Board on the National Anchors NHS recruitment process work. Becky Hilton (NHS Lothian) & Fiona (HSCP) 17th Sept 2024 (tbc) Workforce Governance Board (update) 10. HSCP to link in with Child Poverty action to review local childcare availability and increase provision. Anthea and her team to have an awareness of the work ongoing to increase local childcare provision in order that it can inform HSCP career development work. Anette to link Anthea with Jordan Thorstensen (CLLE) 26th Aug 2024 LEP (working overview) 11. Work with the Promise Lead and Voluntary Services Team to review volunteer recruitment process and applicability. Becky to introduce Rachael to Claire Brooks to see if links can be made between volunteering opportunities and keeping The Promise in Midlothian. Becky to link Rachael with Claire Brooks (Children’s Services) 26th Aug 2024 N/A Page 150 of 286
Page 151
Midlothian Integration Joint Board Thursday 24th October 2024, 14:00-16:00 IJB Performance Report Executive summary The purpose of this report is to update the IJB on progress towards the IJB performance goals set for the financial year 2023/24. Due to the processes required to validate these data, the full reporting year is almost complete for all indicators. A report describing progress against each improvement goal is attached in Appendix 1. There is an inbuilt reporting delay (noted above). More recent management data are available for a number of the improvement goals but as they have not been validated, they cannot be published. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided. Following a review of the Terms of Reference for the Committees of the IJB, it was recommended that the Performance Assurance and Governance Group be dissolved, and the data scrutiny function be added to Strategic Planning Group (SPG). After a discussion at the August 2024 Board meeting it was agreed that the OutNav Strategic Governance Map should be incorporated into the IJB Performance Report. Members are asked to: • Note the performance against the IJB Improvement Goals for 2023/24 (Appendix 1). • Note the inclusion of the OutNav Strategic Governance Map (Appendix 2). Item number: 5.8 Page 151 of 286
Page 152
Midlothian Integration Joint Board Midlothian Integration Joint Board Performance Report 1 Purpose 1.1 The purpose of this report is to update the IJB on progress towards the IJB performance goals set for the financial year 2023/24. Due to the processes required to validate these data, the full reporting year is almost complete for all indicators. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the performance against the IJB Improvement Goals for 2023/24 (Appendix 1). • Note the inclusion of the OutNav Strategic Governance Map (Appendix 2). 3 Background and main report 3.1 The IJB has previously identified improvement goals to monitor progress on reducing unscheduled hospital activity and use of institutional care. They are based on goals recommended by the Scottish Government Ministerial Strategic Group for Health and Community Care). 3.2 At the IJB meeting in June 2022 the Performance Assurance & Governance Group recommended that the improvement goals for 2022/23 were set to prioritise an increase in system stability, focussing on workforce recovery and wellbeing. 3.3 An updated report describing progress against each improvement goal is attached in Appendix 1. This report is produced by the Local Intelligence Support Team (LIST) on behalf of the Midlothian HSCP. Members are asked to note the information in Appendix 1, specifically regarding data completeness. Due to the processes required to validate these data for publication, there is an inbuilt reporting delay, and this information is not taken from a “live” system. This means that we are not yet able to calculate the full year performance for some measures. 3.4 Members are asked to note that Public Health Scotland (PHS) has moved to a schedule of quarterly, rather than monthly, updates. 3.5 More recent management data are available for a number of the improvement goals but as they have not been validated, they cannot be published. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided below. 3.6 A&E Attendances 2022/23 Target Rate per 100,000 people 2,629 / month 2023/24 Running Average 2,836 / month Page 152 of 286
Page 153
Midlothian Integration Joint Board The validated data are available up to June 2024. Based on this information, the target is not currently being met. The most recent non-validated management information data indicate an improved position, currently meeting the target. 3.7 Emergency Admissions 2022/23 Target Rate per 100,000 767 / month 2023/24 Running Average 789 / month The validated data are only available up to December 2023. Based on this information, the target is not currently being met. The most recent non-validated management information data indicate the target is not currently being met. Unplanned Bed Days (Acute) 2022/23 Target Rate per 100,000 5,074 / month 2022/23 Rate 4,691 / month The validated data are only available up to December 2023. Based on this information, the target is currently being met. The most recent non-validated management information data indicate the target is currently being met. 3.8 Delayed Discharge Occupied Bed Days 2022/23 Target Rate per 100,000 820 / month 2023/24 Running Average 1252 / month The validated data are only available up to March 2024. Based on this information, the target is currently being met. The most recent non-validated management information data indicate that the target is not currently being met. 3.9 End of Life – Percentage of Last Six Months Spent in Large Hospitals 2022/23 Target Rate <8.7% 2021/22 Rate 8% The validated data are only available on a provisional basis for 2022/23. Based on this information, the target is currently being met. It is not possible to refer to management information as these data are not held locally. 3.10 Balance of Care 2022/23 Target Rate >96.4% 2021/22 Rate 96.9% The validated data are only available on a provisional basis for 2022/23. Based on this information, the target is currently being met. It is not possible to refer to management information as these data are not held locally. 3.11 It had previously been agreed at the December 2023 Board meeting that non- validated management data would be examined in detail by the Performance Assurance and Governance Group each month. 3.12 Following a review of the Terms of Reference for the Committees of the IJB, it was recommended that the Performance Assurance and Governance Group be dissolved, and the data scrutiny function be added to Strategic Planning Group (SPG). Page 153 of 286
Page 154
Midlothian Integration Joint Board 3.13 The Performance Assurance and Governance group therefore met for the last time in August 2024, and completed the review of the Core Suite of Integration Indicators for inclusion in the Annual Performance Report. 3.14 After a discussion at the August 2024 Board meeting, it was agreed that the OutNav Strategic Governance Map should be incorporated into the IJB Performance Report. 3.15 At the September meeting of SPG, the Integration Manager and the Performance Manager delivered presentations to set out organisational reporting requirements and updates in relation to structures, processes and documents. This included a detailed description of the OutNav Strategic Governance Map, which is included at Appendix 2. 3.16 Future updates describing progress toward the IJB’s strategic aims will be provided in a scheduled programme, to align with Board meeting dates, key reporting timelines, and with scrutiny provided in advance by SPG. 3.17 For the October report each year, the focus will be on the content reported in the final column: “What Difference Does This Make?” This column is designed to show progress towards achieving the 9 National Health & Wellbeing Outcomes, which are: 1. People are able to look after and improve their own health and wellbeing and live in good health for longer. 2. People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 3. People who use health and social care services have positive experiences of those services, and have their dignity respected. 4. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. 5. Health and social care services contribute to reducing health inequalities. 6. People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and well-being 7. People who use health and social care services are safe from harm. 8. People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. 9. Resources are used effectively and efficiently in the provision of health and social care services. 3.18 The evidence used to assess progress against these outcomes is the Core Suite of Integration Indicators. These data are generated, validated and published each year by Public Health Scotland, and form part of the statutory requirement for inclusion in the IJB’s Annual Performance Report. 3.19 At the time of writing, the Annual Performance Report 2023/24 had not been submitted for IJB authority to publish, so the current OutNav Strategic Governance Map holds the evidence taken from the APR 2022/23. The data are visualised at Appendix 2, alongside the high-level overview of the OutNav Strategic Governance Map. Page 154 of 286
Page 155
Midlothian Integration Joint Board 3.20 The indicators for the reporting year 2023/24 have been scrutinised by the Performance Assurance and Governance Group. In future, this activity will be completed by SPG. 3.21 Following publication of the APR 2023/24, column 6 of the OutNav Strategic Governance Map will be updated. 3.22 In support of the OutNav Strategic Governance Map progress reports to the IJB, the Best Value framework updates will be presented at Audit and Risk. 4 Policy Implications 4.1 There are no policy implications arising from this report. 5 Directions 5.1 This report does not directly impact upon service ability to deliver existing Directions. 5.2 It is acknowledged that there will be a requirement for ongoing review and revision to the Performance Report, in alignment with any revisions to existing Directions / issue of new Directions at any stage in the reporting period. 6 Equalities Implications 6.1 There are no equality implications from focussing on these goals but there may be implications in the actions that result from work to achieve them. 6.2 The focus of most of the goals is on reducing hospital activity and hospitals are not used equally by the population. There are groups of people that make more use of hospitals than others – for example older people, people living in areas of deprivation or people who live alone. 7 Resource Implications 7.1 There will be resource implications resulting from further action to achieve these improvement goals. 8 Risk 8.1 The risk of not finding solutions to address complex performance measurement challenges is that we are underinformed in relation to increases in complexity, acuity and the resulting additional pressures these create for our workforce; and what this may mean for wellbeing, retention and recruitment. 9 Involving people 9.1 The Performance Assurance & Governance Group will no longer meet monthly to review and discuss these and other measures as part of wider data assurance. This role has been transferred to the Strategic Planning Group which has a wider Page 155 of 286
Page 156
Midlothian Integration Joint Board membership including representation of elected officials, the third sector and public health. 10 Background Papers 10.1 No background papers. AUTHOR’S NAME Elouise Johnstone DESIGNATION Strategic Programme Manager for Performance CONTACT INFO elouise.johnstone@nhslothian.scot.nhs.uk DATE 30th September 2024 Appendices: Appendix One: Local Intelligence Support Team (LIST) Report describing progress against the IJB improvement goals. Appendix Two: OutNav Strategic Governance Map Page 156 of 286
Page 157
Midlothian HSCP MSG Indicators Performance from April 2019 to June 2024, with 2020/21 MSG targets and trends Local Intelligence Support Team (LIST), September 2024 Page 157 of 286
Page 158
Data completeness Source: MSG data release Sep-24, PHS 2Page 158 of 286
Page 159
A&E Attendances Source: MSG data release Sep-24; data published up to Jun-24 3Page 159 of 286
Page 160
Emergency Admissions Source: MSG data release Sep-24; data published up to Dec-23 4 Page 160 of 286
Page 161
Unplanned Bed Days - Acute Source: MSG data release Sep-24; data published up to Dec-23 5Page 161 of 286
Page 162
Delayed Discharges Occupied Bed Days (18+) Source: MSG data release Sep-24; data published up to Jun-24 6Page 162 of 286
Page 163
End of Life - Percentage of Last Six Months Spent in Large Hospitals Source: MSG data release Sep-24; data published up to 2021/22 7 Year Annual 2020/21 Target <8.7% 2019/2020 9.1% 2020/2021 7.5% 2021/2022 8% 2022/2023 (provisional) 8.1% Page 163 of 286
Page 164
End of Life - Percentage of Last Six Months Spent in the Community – by calendar year Source: MSG data release Sep-24; data published up to 2022 8 Year Annual 2019 9.3% 2020 7.5% 2021 8.2% 2022 8.3% 2023 (provisional) 7.8% Page 164 of 286
Page 165
Midlothian IJB Strategic Governance Map 24th October 2024 Page 165 of 286
Page 166
IJB Strategic Governance Map - Overview Page 166 of 286
Page 167
Evidence Standards Page 167 of 286
Page 168
Health and Wellbeing Outcome 1 EvidenceWhat difference does this make? Page 168 of 286
Page 169
What difference does this make? Health and Wellbeing Outcome 2 Evidence Page 169 of 286
Page 170
EvidenceHealth and Wellbeing Outcome 3 What difference does this make? Page 170 of 286
Page 171
EvidenceHealth and Wellbeing Outcome 4 What difference does this make? Page 171 of 286
Page 172
EvidenceHealth and Wellbeing Outcome 5 What difference does this make? Page 172 of 286
Page 173
EvidenceHealth and Wellbeing Outcome 6 What difference does this make? Page 173 of 286
Page 174
EvidenceHealth and Wellbeing Outcome 7 What difference does this make? Page 174 of 286
Page 175
EvidenceHealth and Wellbeing Outcome 8 What difference does this make? Page 175 of 286
Page 176
EvidenceHealth and Wellbeing Outcome 9 What difference does this make? Page 176 of 286
Page 177
Midlothian Integration Joint Board Thursday, 24th October 2024, 14:00 – 16:00 Midlothian Drug Misuse and Alcohol Specific Deaths 2023 Executive summary Midlothian and East Lothian Drugs and Alcohol Partnership (MELDAP) is the local Alcohol and Drugs Partnership (ADP). MELDAP aims include: • Reduce the harm to individuals and promote recovery from substance use • Protect children and young people affected by parental substance use • Promote early intervention to prevent the harmful use of alcohol and drugs • Develop high quality services responsive to the changing needs of people who use and need our services. This report highlights pertinent areas relating to Drug Misuse and Alcohol Specific Deaths in Midlothian for 2023, to accompany a presentation for Board consideration. Board members are asked to: • Note the content of this report, • Note the actions taken by MELDAP and its services Item number: 5.9 Page 177 of 286
Page 178
Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian Drug Misuse and Alcohol Specific Deaths 2022 1 Purpose 1.1 This report is to brief the Integrated Joint Board (IJB) on Drug Misuse and Alcohol Specific Deaths in Midlothian covering the period of 2020 to 2023. 2 Recommendations 2.1 IJB Members are being asked to note the content of this report. 3 Background and main report 3.1 Drug Misuse Deaths 2023. In Midlothian there was an increase from 4 in 2022 to 20 in 2023. 3.2 Please see below the 2023 data for Scotland and the 4 Integrated Joint Board (IJB) areas against that of 2022: Drug Misuse Deaths Scotland Midlothian East Lothian West Lothian City of Edinburgh All 1172 + (121) 20 (+16) 20 (+3) 31 – (1) 111 – (2) Males 805 + (113) 12 (+10) 14 (+2) 23 + (1) 78 – (4) Females 367 + (8) 8 (+6) 6 (+1) 8 – (2) 33 + (2) 3.3 Nationally in 2023, people from areas of deprivation are 15 times more likely to die from a Drugs Misuse Death than those from the least deprived areas of Scotland. This gap has increased over the last 5 years. 3.4 High risk patterns of drug use, especially poly-drug/street drug use has increased and the combined toxicity of different drugs are amplifying the harm. E.G Bromazepam, Nitazine type drugs, Cocaine, Methadone, Diazepam and Pregabalin. The harm related to poly-drug use is compounded by the fact that this is an ageing cohort with co-occurring mental and physical health issues. 3.5 Highlighted Actions 3.5.1 The Midlothian Substance Use Service (MLSUS) and Mid and East Lothian Drugs [MELD] as part of MELDAP services are meeting the Medication Assisted Treatment (MAT) Standards 1 to 5 as required by the Scottish Government. These focus on providing same day start for people seeking Opiate Substitute Therapies Page 178 of 286
Page 179
Midlothian Integration Joint Board and ensuring an increased level of choice of medication within the service including delivering Buvidal (an injectable slow-release dose of the opiate Buprenorphine) and have implemented MAT standards 6-10 ahead of expectations. MAT Standards 6 to 10 focus on the delivery of trauma informed psychological support, advocacy, and provision of treatment in Primary Care settings. 3.5.2 Midlothian Substance Use services provided assertive outreach to people who have experienced non-fatal overdose with range of harm-reduction interventions including support into treatment offered. 3.5.3 MELDAP has increased the resourcing and coverage of Naloxone (A medication which temporarily reverses the effects of opiate overdose) 3.5.4 Recent changes in drugs available in Midlothian have shown increases in synthetic opioids (Nitazines). These opioids are much stronger and can result in drug poisoning with people often unaware of their presence in the drugs they use. MELDAP has requested a doubling up of Naloxone kits issued to individuals to try and counter this. 3.5.5 Funded by MELDAP, MELD in partnership with SUS has introduced the use of Home Drug Testing strips to alert people to the possible presence of Nitazines and Xylazine. The kit contains harm reduction advice, Contact service details and Naloxone kits. 3.5.6 MELDAP provided funding to MELD to deliver a Naloxone stall at the Tesco store in Dalkeith as part of Overdose Awareness Day on Saturday 31st August. 26 units of Naloxone and 26 Nyxoid kits were provided. 50 people were offered information and/or advice. There is a plan to carry these events out at different Supermarkets every six months. 3.5.7 MELDAP funds an independent advocacy response provided by CAPS. Additional advocacy support is provided by Access to Industry. 3.5.9 Midlothian services have consistently delivered above the 90% access standard for substance use services. The current performance for 2024/25 - Q1 is 98.44%. This standard requires that people wishing to access service are seen within 3 weeks [referral to treatment]. 3.5.10 MELDAP have established a working group, including people with lived experience to provide guidance on what type of services are needed to engage and support people who use cocaine and crack cocaine. The group will also examine the reasons people disengage with services and what can be done to help them back into treatment. 3.6 Alcohol Specific Deaths 2023 In Midlothian there was a slight reduction in the numbers of those who passed away, 17 in 2022 to 15 in 2023. 3.7 Please see below the 2023 data for Scotland and the 4 Integrated Joint Board (IJB) areas against that of 2022. Page 179 of 286
Page 180
Midlothian Integration Joint Board Scotland Midlothian East Lothian West Lothian City of Edinburgh 1277 (+1) 15 (-2) 16 (-3) 43 (+19) 89 (-4) 3.8 Nationally in 2023, people from areas of deprivation are 4.5 times more likely to die from an Alcohol Specific Death than those from the least deprived areas of Scotland. 3.9 Highlighted Actions 3.9.1 The Midlothian Substance Use Service (MLSUS) and Mid and East Lothian Drugs (MELD) provide direct access to treatment and support for those affected by their or others alcohol use. 3.9.2 Edinburgh and Lothian Council on Alcohol (ELCA) provide an alcohol counselling service in Midlothian. 3.9.3 There is now a low threshold café in Penicuik. The focus in this service is to encourage those not in alcohol and drug treatment to accept support in a café setting with the aim of supporting them to enter treatment and recovery services. 3.9.4 The MELDAP Recovery College provided by Access to Industry offers assistance into education, training, volunteering and employment. 3.9.5 In relation to prevention activities, MYPAS provide support to young people affected by their own alcohol and drug use. They offer one to one support/key working and group work opportunities. 4 Policy Implications 4.1 The actions noted above are delivered as part of our local response to meet elements of Scottish Government priorities and national drugs policy (Rights, Respect and Recovery and Strategies for Preventing Drug-Related Deaths in Scotland: Our Emergency Response) as well as the MELDAP Delivery Plan. 5 Directions 5.1 This report does not directly impact upon service ability to deliver existing Directions. 6 Equalities Implications 6.1 There are no direct equalities implications arising from this report. 7 Resource Implications 7.1 There are no resource implications as the work of services and the partnership is within financial resources. Page 180 of 286
Page 181
Midlothian Integration Joint Board 8 Risk 8.1 No risks identified. 9 Involving people 9.1 MELDAP have engaged with a number of partner organisations to deliver services and responses to engage people that use drugs and or alcohol into treatment and recovery. People and family members who have used treatment services have the opportunity to share their views (Experiential Evidence) linked to the delivery of the MAT standards. The views of staff are also collected as part of this process. 9.2 Access to Industry was commissioned to undertake research into the ways people would like to be involved have their voices heard about services including the design of new services. 10 Background Papers 10.1 Link to National Records of Scotland [NRS] publication below. https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital- events/deaths/drug-related-deaths-in-scotland/2023 AUTHOR’S NAME Nick Clater DESIGNATION Head of Adult Services CONTACT INFO Nick.Clater@midlothian.gov.uk DATE 07/10/2024 Appendices: None Page 181 of 286
Page 182
Page 182 of 286
Page 183
Midlothian Integration Joint Board Thursday, 24th October 2024, 14:00-16:00 Public Health Update - Homeless Prevention Duty Executive summary This report highlights the Homeless Prevention Duty which will form part of the forthcoming Housing Bill. The duty will result in a significant shift in how local authorities and other public bodies identify and respond when they believe a person or household is at risk of becoming homeless. The Scottish Government has confirmed its intention to include prevention of homelessness duties in its 2023-2024 legislative programme, however the details of guidance around this have yet to be confirmed. To prepare for the forthcoming Duty, a small team has been set up to help map out where Midlothian’s gaps are around prevention, any potential risks that could result from the prevention duty and some actions to mitigate the impact of those risks. Members are asked to: • Note this update on the homeless prevention duty and encourage staff to collaborate with homeless prevention duty planning as appropriate. # Item number: 5.10 Page 183 of 286
Page 184
Midlothian Integration Joint Board Midlothian Integration Joint Board Public Health Update 1 Purpose 1.1 This report sets out an update on the Homeless Prevention Duty which is due to be announced in 2024 as part of the Housing Bill. It also highlights plans for collaboration among staff to prepare for implementation. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note this update on the homeless prevention duty and encourage staff to engage with homeless prevention mapping sessions. 3 Background and main report 3.1 Homelessness is often a late marker of severe and complex disadvantage, which can be identified across the life course of individuals (Public Health Scotland, 2023). In 2018 the Scottish Government published its Ending Homelessness Together: High Level Action Plan, incorporating the recommendations of the Homelessness and Rough Sleeping Action Group. The plan sets out the Scottish Government’s vision that everyone has a home that meets their needs and homelessness is ended. The delivery of the plan has been overseen by the Homeless Prevention and Strategy Group, co-chaired by representatives of the Scottish Government and COSLA. 3.2 Throughout the delivery of the action plan the Strategy Group has been clear that there is a need for partners across all services including health, education, social work, community support and justice and the third sector to ask about the housing circumstances of people using their services, and, where a possible risk of homelessness is identified, act to prevent homelessness from occurring. A key part of the action plan was to develop a new duty on local authorities, wider public bodies and delivery partners to prevent homelessness. This led to the creation of the Scotland Homeless Prevention Review Group, led by Crisis at the request of the Scottish Government. They were tasked to identify legal duties needed for local authorities and public bodies to prevent homelessness. The Preventing Homelessness in Scotland report was published in 2023. Relevant key recommendations of the Prevention Review Group include: • The prevention of homelessness should be a shared public duty, and public bodies should identify a risk of homelessness and ‘act’ upon that information. Page 184 of 286
Page 185
Midlothian Integration Joint Board • A duty on HSCPs to identify the housing circumstances of service users and prevent homelessness, including social workers/social care workers to ‘ask and act’ about housing issues or the risk of homelessness. 3.2 Homelessness Prevention Task and Finish Group The Homelessness Prevention Task and Finish Group was asked by the Homelessness Prevention and Strategy Group to consider the groundwork needed to ensure the successful implementation of Scotland’s new homelessness prevention legislation. The group’s report and recommendations were published in August 2023. The Scottish Government responded in December 2023 stating that they ‘fully support the key messages coming out of the group’s report are that the measures could be transformative; that investment in prevention saves lives and money; and that, to be successful, the duties need to be backed by adequate resourcing and support’. Scottish Government also suggested that they may rename the Housing Bill to reflect the broad scope of the provision, for example the ‘Early Intervention and Housing Sustainability Bill’. They also have stated that key next steps would be: • Providing clarity as soon as possible on which public bodies the new duties will apply to, so that individuals and organisations working in those sectors can engage with the draft legislation. • Clarifying what is meant by ‘Ask’ and ‘Act,’ and introduce these as two separate duties. Carrying out in-depth consultation with frontline workers, managers and strategic leads in public bodies to ensure the ‘Ask’ and ‘Act’ duties are designed in a way that is appropriate for those sectors. 3.3 Homeless prevention duty planning Working with the Midlothian housing team, the public health team supported by the strategy team, are planning sessions to help map out Midlothian’s gaps around prevention, any potential risks that could result from the prevention duty, and actions that could be taken to mitigate the impact of these. Since publishing its Rapid Rehousing Transition Plan in 2018 Midlothian Council has made some significant steps in the transformation of its response to homelessness, including: • A reduction in the number of open homeless cases • A reduction in average time taken to discharge duties to those found to be homeless. • Ending the use of Bed and Breakfast type accommodation. • Developing a successful Housing First programme. • Introducing a homeless prevention fund • Creating a Homeless Prevention Forum • Developing partnership working through the Health and Homeless Steering Group • Reducing number of households in temporary accommodation • Reduced average time spent in temporary accommodation. • Breaches of the revised Unsuitable Accommodation Order. Initiatives such as these will hopefully result in a good foundation on which to implement any forthcoming prevention duty. Page 185 of 286
Page 186
Midlothian Integration Joint Board 3.4 Masters Research Public Health supervised a Masters student from Edinburgh University who carried out research in Midlothian looking at the homeless prevention duty. The qualitative study examined whether different professional groups are more or less likely to ask and act to prevent homelessness within a Health and Social Care Partnership. Eight participants took part in the research through semi-structured interviews. The study found that participants are envisioned to implement the policy, are keen to build on the care they provide for the homeless population and welcoming to the duty to ask and act that enables better collaboration with other services to provide holistic care for individuals. The findings from the study will help focus on the gaps in knowledge and understanding around the prevention duty and what it means for Midlothian. 3.5 Planning Group The Housing (Scotland) Bill was introduced to Parliament on 24 April 2024, Parliament agreed that consideration of Bill at Stage 1 be completed by 29 November 2024. A recent report published has stated that witnesses were widely supportive of the principle behind the Bill's 'ask and act' provisions. However, many felt more detail was needed about how the duty would work in practice. Responding to these concerns, a Scottish Government official stated that 'asking' is about "working very much within your own functions" and to 'act' is to do so "within your own powers". Those working in relevant bodies should think "what can I do in my role". It was acknowledged that while this approach is already being taken in some areas, adoption of such working practices is "patchy". To help start to prepare for the forthcoming Duty, we plan to re-establish the health and homeless group to take forward the findings from the Masters study, start planning for implementation of the Duty and to help embed homelessness prevention practice within HSCP structures. Some of this work is already being done in practice therefore the structure would ensure to build on good practice and look at ways to strengthen our prevention approach. 4 Policy Implications 4.1 The Housing Bill once announced will have implications on the following Health and Social Care policies: • HSCP strategic plan: Prevention and early intervention • Reducing inequalities 5 Directions 5.1 This report Links to 2023/2024 Directions: (Public Health Team Plan) 1 – Health and Wellbeing 2 – Living in the community 3 – Positive experience and dignity 5 – Health inequalities 5.2 Links to Single Midlothian Plan: • Midlothian Will Be Healthier Page 186 of 286
Page 187
Midlothian Integration Joint Board • Midlothian Will Support Residents to improve Employability and Outcomes in our Communities • Midlothian will work towards reducing poverty. • Midlothian will Get it Right for Every Child 6 Equalities Implications 6.1 This work focuses on populations vulnerable to health inequalities or want to improve their wellbeing. 7 Resource Implications 7.1 The intention is for planning to be sustainable without specific funding, working collaboratively as part of shared priority actions to embed the approach across the partnership. 8 Risk 8.1 The intention is for planning to be sustainable without specific funding, working collaboratively as part of shared priority actions to embed the approach across the partnership. 9 Involving people 9.1 The aim to engage with professionals in the first instance until more details around the guidance is known. Then when appropriate to collaborate with service users and the public. 10 Background Papers 10.1 N/A AUTHOR’S NAME Ruth Flynn DESIGNATION Public Health Practitioner CONTACT INFO Ruth.flynn2@nhs.scot DATE 01.10.24 Appendices: Appendix 1: Abstract of Master project Page 187 of 286
Page 188
Page 188 of 286
Page 189
Abstract of Master project “What is the perspective of professional groups within Midlothian Health and Social Care Partnership (HSCP) on the ‘duty to ask and act’ to prevent homelessness?” Introduction: Homelessness is a public health issue affecting individuals in Scotland. There continues to be an increasing prevalence despite efforts by the Scottish Government to reduce it through strategies like policies that promote housing as a priority for individuals. Research has shown a cause-and-effect relationship between homelessness and health, suggesting early involvement of health and social care workers as well as partnership with other services as a possible solution to prevent homelessness. In response to this, the Scottish Government is working towards a new housing bill in which duties will be placed on wider public bodies to ask and act to prevent homelessness. This dissertation therefore aims understanding the experiences of Midlothian health and social care staff who work with homeless individuals and their opinions as useful considerations in anticipation for implementation of the duty. Methods: This qualitative study utilised semi-structured interviews to collect data from eight health and social care workers who work within the Midlothian Health and Social Care Partnership (HSCP). Interviews were transcribed and thematic analysis resulted in three key themes. Findings: The three key themes identified are: ‘outlook on the policy’, ‘Implementing Change’ and ‘Partnership and Governance in Midlothian Council’. Participants generally supported the policy's preventative approach and welcomed wider professional involvement. Though key challenges were identified, participants gave various suggestions that would aid implementation. They highlighted the importance of management and frontline relationships in decision and implementation of changes as this factor could fuel their motivation to work effectively. Participants noted difficulties in working in partnership with other professionals, especially with communication and information sharing. Regardless of their support of the policy's aims, professionals emphasized the need for system, organizational and culture changes to ensure effective implementation. Conclusion: This study revealed that participants are envisioned to implement the policy, are keen to build on the care they provide for the homeless population and welcoming to the duty to ask and act that enables better collaboration with other services to provide holistic care for individuals. Page 189 of 286
Page 190
Page 190 of 286
Page 191
Midlothian Integration Joint Board Thursday, 24th October 2024, 14:00-16:00. Integrated Assurance Report Executive summary This report is presented to provide the Midlothian Integration Joint Board with assurance around the processes in place to deliver clinical and care governance and risk and resilience management by the Midlothian Health and Social Care Partnership. The structure for oversight of safe, effective, and person-centred care and professional governance consists of the Clinical and Care Governance Group and service level Quality Management Groups (QMGs). The oversight of the recently established Social Work Assurance Group (SWAG) combines with the Governance and Assurance Framework and QMG/CCGG processes to provide assurance for all Social Work services in the HSCP. In addition, a number of specialist subgroups ensure focus on identified risks and most common harms. A culture of shared learning and improvement is promoted. The Governance and Assurance Framework (GAF) has been in use for 5 reporting cycles and work to refine this approach is ongoing. 6 Governance Groups report to the Senior Management Team: Clinical and Care Governance, Integrated Workforce Governance Board, Finance and Performance, Business Governance, Digital Programme Board, and the Partnership Forum. Work continues to ensure that areas highlighted as medium or low assurance by services in the Governance and Assurance Framework are scrutinised by the relevant Governance Group (Appendix 1). Group Service, Service, and Team Plans are in place across the HSCP, and plans have been developed for the delivery of progress reports to address identified risks for the next financial year. This aims to provide a consistent and complete picture of the assurance being reported and will support the ambition and work in progress to implement a total Quality Management System (QMS) linking clinical and care governance with the management of performance and resources. A joint Care Inspectorate, Healthcare Improvement Scotland and His Majesty’s Inspectorate of Constabulary inspection into Adult Support and Protection arrangements within Midlothian has been completed since the last Integrated Assurance Report was presented to the IJB. This follows on from the recent report into the Joint Inspection of Physical Disabilities Services. Item number: 5.11 Page 191 of 286
Page 192
2 MHSCP delivered its Annual Assurance Report to the NHS Lothian Healthcare Governance Committee on 17th September 2024. The Committee agreed to accept moderate assurance that MHSCP has comprehensive systems in place to deliver safe, effective and person - centred care. That report is included as an appendix to this report. (Appendix 2) This report also confirms that the Partnership’s structures and processes for risk management, resilience and major incident planning address the requirements of Midlothian Council and the Lothian NHS Board. This includes the maintenance of the Partnership’s Risk Register and processes which support the appropriate escalation of identified risks. Board members are asked to discuss and approve the contents of this report. Page 192 of 286
Page 193
3 Midlothian Integration Joint Board Integrated Assurance Report 1 Purpose 1.1 This is the Integrated Assurance report provided by the Midlothian HSCP to the Midlothian Integration Joint Board (IJB). 2 Recommendations 2.1 Board members are asked to discuss and approve the content of this report. 3 Background and main report 3.1 This report updates the IJB on the activity undertaken to provide assurance around the delivery of safe, effective, and person-centred care in Midlothian and the processes in place to cover risk and resilience. 3.2 6 Governance Groups report to the Senior Management Team and Executive Leadership Team: Clinical and Care Governance, Integrated Workforce Governance Board, Finance and Performance, Business Governance, Digital Programme Board, and the Partnership Forum. Work continues to ensure that areas highlighted as medium or low assurance by services in the Governance and Assurance Framework are additionally reviewed by the relevant Governance Group (Appendix 1). Risk is a standing item within the terms of reference of all six groups. 3.3 Clinical and Care Governance and Assurance Structure and Processes The Clinical and Care Governance Group (CCGG) meets quarterly to provide oversight of the safety, effectiveness, and person centredness of Midlothian Health and Social Care Partnership (MHSCP) services. Group Service, Service and Team Plans have been in place across the HSCP since April 2023. The associated implementation of the Governance and Assurance Framework (GAF) and a review of meeting structures provide the CCGG with a complete picture of the assurance being provided and any identified risks to the delivery of clinical services and social care being reported across all services at every meeting. Service level Quality Management Groups (QMGs) report to the CCGG on the systems, processes, and evidence of clinical and care governance, risk management, and quality management activity. The QMGs are expected to meet at least four times per year and submit a quarterly Governance and Assurance Framework submission and completed CCGG template. The quarterly reporting Page 193 of 286
Page 194
4 template collates evidence for assurance and provides information about actions in place relating to the learning arising from investigation of adverse events and complaints, implementation of actions around safety alerts, specific standards and guidance, improvement work, action plans arising from audit and inspection activity and any other service-specific issues which could have impact on the quality and safety of care the service provides. QMGs are required to deliver an annual summary report in the form of a short presentation to the CCGG and other service managers. The GAF continues to evolve, reflecting learning across our system, changes in our structures and modifications to the digital application. This approach supports a culture of learning alongside the provision of oversight of assurance levels across the system. Since the initial implementation of the GAF in 2023, completion rates and quality have been improving. Simple digital reminders have been successfully implemented to ensure teams collate system data and use the framework to facilitate discussions across the safe, effective, person centred and regulatory domains. The digital application is then used to input the consensus reached in terms of impact, assurance and overall governance across the measures within the domain areas. Tableau interfaces with the GAF application to provide a digital dashboard for oversight across the HSCP (Appendix 3.) Quarterly reporting to the Executive Leadership Team provides oversight of the assurance levels across all areas of responsibility. Service Managers have responsibility to follow up the progress of their action plans through line management processes and within the CCGG for good practice and learning to be shared. The role of Chief Social Work Officer, which carries statutory functions, now sits within the HSCP following the recent retiral of the Head of Children’s Services. The Head of Adult Services is now Chief Social Work Officer for Midlothian Council. The CSWO is a member of the IJB. QMG processes are integrated, and managers report on all HSCP business, thus providing assurance regarding social work services. The oversight of the Social Work Assurance Group (SWAG) combines with the Governance and Assurance Framework and QMG/CCGG processes to provide assurance for all Social Work services in the HSCP. The SWAG meets fortnightly currently and is chaired by the CSWO with attendance from the Deputy CSWO and the Group Service Manager for the HSCP. Since inception, it has provided leadership and assurance regarding the improvement plan for Newbyres Care Village, Care at Home, Mental Welfare Commission Reports and has also had oversight over all improvement plans developed following Care Inspectorate inspections of services. All new Policies and Procedures for Social Work services are approved at SWAG and there is a role in overseeing audit and quality assurance work. SWAG covers all social work services in Midlothian including those services which are outwith the delegated functions of the Midlothian IJB. 3.3 The Clinical and Care Governance Group The Clinical and Care Governance Group meets on a quarterly basis. Since the last report to the IJB, two meetings have taken place. MHSCP delivered its Annual Assurance Report to the NHS Lothian Healthcare Governance Committee on 17th September 2024. The Committee agreed to accept moderate assurance that MHSCP has comprehensive systems in place to deliver Page 194 of 286
Page 195
5 safe, effective and person - centred care. That report is included as an appendix to this report. (Appendix 2) 3.4 Investigating and Learning from Adverse Events and Complaints Three groups are established to provide oversight of all significant adverse events reported within NHS Lothian services delivered by Midlothian HSCP. Specific groups address in-patient falls at Midlothian Community Hospital, and pressure ulcers which are two of the most common reported harms. A Morbidity and Mortality Review group is established at Midlothian Community Hospital to undertake multidisciplinary review of unexpected in-patient deaths as a further measure to develop learning to improve the delivery of safe care. The Midlothian Safety and Experience Action Group (MSEAG) has oversight of all significant adverse events (adverse events which result in harm assessed as moderate or above), including the death or suicide of patients engaged with mental health and substance use services or unexpected medical deaths. This group commissions external reviews of major harm or death significant events in line with NHS Lothian protocols. The MSEAG minutes are submitted to the Lothian Patient Safety and Experience Action Group, and all Serious Adverse Events approved as complete in Midlothian require the approval of the NHS Lothian Medical Director and Executive Nurse Director before final closure. The HSCP Senior Management Team (SMT) receives a fortnightly report of performance in the management of complaints and the reporting and management of adverse events on the Datix system. Datix is a web-based tool which can be accessed by all NHS Lothian staff to report and learn from safety concerns, adverse events with harm and near misses. It helps in the collection and analysis of information to inform action plans which support safety and quality improvement. The system also provides modules to support the administration of Complaints, Claims and Service and Team level Risk Registers, to provide an integrated information system. Quarterly oversight of themes and learning arising from complaints and adverse events has been added to the MSEAG agenda and is also addressed at quarterly NHS Lothian performance meetings. At the time of writing 6 Significant Adverse Event (SAEs) are under investigation. Chart 1 shows Midlothian’s closed median is higher than the reported median, preventing the development of a backlog. Chart 2 shows Midlothian HSCP’s performance regarding SAEs which are overdue. One level 1 SAE has been open for over 6 months at the time of writing, and one other non-level 1 review has breached the 70-day target for its completion. Work continues to support actions that will enable local teams to address all adverse events within the Healthcare Improvement Scotland guidance timescales. Work is also continuing to maintain and further improve SAE review performance against timescales and assure the quality of the reviews and the implementation of learning gained. Ongoing review of learning needs is undertaken and the SMT works with the Quality Improvement Support Team of NHS Lothian to discuss actions required and to enable appropriate learning opportunities to be identified and delivered. Page 195 of 286
Page 196
6 Outstanding actions from previously investigated Significant Adverse Events are recorded on Datix and continue to be monitored by the MSEAG to ensure that they are completed. Chart 1:Midlothian Serious Adverse Events reported and closed at 2nd September 2024 Chart 2 Midlothian Overdue Adverse Events Reported with Major Harm and Death at 2nd September 2024 Page 196 of 286
Page 197
7 Work to develop an adverse events management process for Social Work and Social Care services was paused due to inspectorial activity which commenced in May of last year and will be progressed as resources to undertake this work are released from other priority activity. As a result, processes for adverse event management and oversight for Midlothian Council services within the HSCP currently remain less mature. Ultimately, the aspiration is that MSEAG will have oversight of all adverse events across the HSCP. The Social Work Assurance Group (SWAG) provides a route for the governance of all Social Work and Social Care services and, has proven to be key in providing assurance that services are operating well and safely. This has been particularly the case with the improvement work at Newbyres Care Village. Following a review of falls within Highbank Intermediate Care facility, a number of recommendations have been progressed, including improvements in falls risks assessment documentation, handover information, team working and specifically debriefs and support from the Technology Enabled Care (TEC) team. Complaints are generally managed through the respective organisations’ complaints handling processes, although efforts are made to respond in an integrated way where required and appropriate. A range of Elected Member, MP and MSP enquires tend to be channelled through a Council route and are usually managed by respective Heads of Service. Performance against KPIs and an analysis of themes and learning from complaints received in relation to NHS Lothian services delivered within the MHSCP is monitored by MSEAG and reported to quarterly NHS Lothian performance review meetings. This report covers data up to June 2024 from the report received from the NHS Lothian Patient Experience team on 17th September 2024. Charts 3 and 4 illustrate the numbers of complaints received via the NHS complaints processes which relate to services delivered within the Midlothian HSCP. Chart 3: Number of Stage 1 complaints received. Chart 4: Number of Stage 2 complaints received. Page 197 of 286
Page 198
8 Chart 5 illustrates performance regarding Stage 2 complaints responses. Of the 38 Stage 2 complaints received in the 12 months illustrated, only 1 failed to meet the 20- day target for the provision of a response – this reflected the complexity of the complaint which involved a range of services, one being provided from another Directorate in NHS Lothian. At the time of writing Midlothian is involved in responding to three open complaints, which are within the KPI for response. Chart 5: % achievement of Stage 2 responses within 20-day KPI. Work continues to share learning from the investigation of adverse events and complaints and to improve local services in line with findings and recommendations. 3.5 Clinical and Professional Oversight of Care Homes The Scottish Government published My Health, My Care, My Home - Healthcare Framework for Adults Living in Care Homes in June 2022. An Advice Note on Enhanced Collaborative Clinical and Care Support for Care Homes issued on 14 December 2022 provides guiding principles and a framework to continue cross sector work to continue to improve the health and wellbeing of people living in care homes. Work is continuing in Midlothian and on a pan-Lothian basis to ensure these recommendations are met and that partners involved in the delivery of care home services are engaged in shaping the model going forward. The approach recognises that the role of the HSCP is different to that of the inspection and regulation responsibilities exercised by the Care Inspectorate. 3.6 Inspections The Clinical and Care Governance Group maintains oversight of the inspections undertaken by regulatory bodies, including the monitoring of action plans for improvements. Managers log service inspection reports with their QMG submissions. MHSCP services are subject to external inspections from statutory bodies. This includes Healthcare Improvement Scotland, the Mental Welfare Commission, and the Care Inspectorate. These reports are lodged at SMT, and actions plans monitored operationally and reported through the QMGs, CCGG, The East and Midlothian Public Protection Committee, and the Social Work Assurance Group. Immediate action is taken when internal concerns or external inspections identify improvements which are required to address standards of care. Operational and professional leads have shared oversight of action plans. Implementation is led by Service Managers and progress monitored and supported through operational and care and clinical governance routes, ensuring the implementation of actions deliver sustainable improvement. Page 198 of 286
Page 199
9 Earlier this year the Care Inspectorate led a second phase of joint inspection and development of Adult Support and Protection in collaboration with Healthcare Improvement Scotland and His Majesty’s Inspectorate of Constabulary in Scotland. The Midlothian Partnership were part of phase two joint inspections with an aim to provide national assurance about individual local partnership areas’ effective operations of adult support and protection key processes, and leadership for adult support and protection. The focus of this inspection was on whether adults at risk of harm in the Midlothian partnership area were safe, protected and supported. The joint inspection of the Midlothian partnership took place between January 2024 and July 2024. The Inspection considered key processes and strategic leadership. The final report released on 11th July 2024 concluded that the Midlothian partnership delivered adult support and protection processes that protected and supported adults at risk of harm. There were some strong areas of practice, particularly management oversight of Council Officer practice, the risk assessment framework and the quality of chronologies and risk assessments when completed. The inspection found that overall, strategic leaders ensured the delivery of competent and effective adult support and protection practice. Strategic leaders’ vision for adult support and protection was strong and well understood by staff to ensure effective governance. The Inspectors concluded the partnership’s key processes and strategic leadership for adult support and protection were effective with areas for improvement. There were clear strengths in both domains supporting positive experiences and outcomes for adults at risk of harm, which collectively outweighed the areas for improvement. On the 15th of July 2024 the Care Inspectorate notified Local Authorities and Health and Social Care Partnerships of their intention to undertake a review of social work governance and assurance arrangements. The review commenced in July 2024 and will conclude in December 2024. It is being carried out under Section 53 of the Public Services Reform (Scotland) Act 2010. Through the review the Care Inspectorate will answer these questions. How well do 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? They will span all areas of statutory social work including adults, children and justice social work services and will cover all local authority areas in Scotland. The review will include: a review of documents, a national staff survey, interviews with key leaders from across Scotland and a range of focus groups with middle and senior managers. Now the ASP inspection has been concluded, attention will turn to progressing a Council Social Work and Occupational Therapy review. It is intended that this review will include data analysis on waiting lists, capacity, demand, the skill set of the Page 199 of 286
Page 200
10 workforce and pathways between services. Extensive consultation and engagement with key stakeholders and staff will also contribute to the process. Through the QMGs, we have developed a more systematic approach to managing recommendations from Mental Welfare Commission themed reports. Generally, such reports have a range of actions for Scottish Government, NHS Boards and HSCPs. These are worked into an Action Plan for later submission back to the Mental Welfare Commission. Governance is provided by reports coming to the HSCP SMT and the Social Work Assurance Group (where appropriate). 3.7 Risk Management Midlothian HSCP is compliant with the NHS Lothian Risk Management Policy and Midlothian Council Risk Management Policy and Strategy. The Risk Management process within Midlothian was audited in 2021 and the finalised report confirmed that the Risk Management processes within Midlothian provided high assurance and demonstrated best practice in several areas: • Midlothian HSCP Senior Management Team meets monthly, and risk is a standing agenda item. • Service level risks registers are locally managed, and oversight is held by Heads of Service for review and escalation to the Senior Management Team (if required). • Risks are routinely monitored through these escalating levels with additional risk oversight held by Midlothian Council and Midlothian IJB both strategically and operationally. • Each risk recorded either operationally or strategically have actions associated to mitigate the risk, these are routinely monitored through the appropriate level of monitoring as mentioned above. • Each risk has a risk owner identified who is the accountable person for managing the related actions and providing routine updates on the status of the risk. 3.8 Resilience and Major Incident Planning Midlothian Health and Social Care Partnership supports its partner organisations, NHS Lothian and Midlothian Council, to deliver their obligations as responders to major incidents. The Partnership provides Midlothian IJB with any relevant assurance in relation to incident management and response which supports its responsibilities as a Category 1 responder. Midlothian Health and Social Care Partnership maintains major incident plans in line with NHS Lothian’s Resilience Policy and provides assurance through NHS Lothian’s reporting cycle on resilience, major incident planning and business continuity. A virtual control room is in place for incident management along with physical control rooms in both Midlothian Community Hospital and Fairfield House. Service Managers are required to review and update their service-specific resilience and business continuity plans annually which feed into the overarching Midlothian Resilience Plan. Page 200 of 286
Page 201
11 3.9 Risk Register Operational risks are captured in the Partnership Risk Register, which is updated and reviewed regularly, and when required escalated to the NHS Lothian Corporate Risk Register and Midlothian Council Strategic Risk Profile. HSCP mitigation plans contribute to the overarching corporate risk registers held by NHS Lothian and Midlothian Council. The following risks on the NHS Lothian Corporate Risk Register are relevant to the Midlothian HSCP: • 4 Hours Emergency Access Target • Hospital Bed Occupancy 4.0 Policy Implications 4.1 This report should provide moderate assurance to the IJB that relevant clinical and care governance policies are appropriately implemented in Midlothian, and that appropriate mechanisms are in place to assess and manage risk and ensure service resilience. 5.0 Directions 5.1 Clinical and care governance, risk management and resilience planning are implicit in various directions that relate to the delivery of care. 6.0 Equalities Implications 6.1 The Governance and Assurance Framework requires services to provide assurance that they are complying with the Equalities duties including the completion of Integrated Impact Assessments (IIA’s) where necessary. This supports the HSCP to comply with its equality duties. 7.0 Resource Implications 7.1 Resource implications are identified by managers as part of service development. and additional resource may at times be required to ensure required standards of clinical and care governance, risk management and resilience planning are met. The expectation is that these activities are embedded in service areas and teams and that staff have time built in to attend the relevant oversight groups and undertake the associated responsibilities. Page 201 of 286
Page 202
12 8.0 Risk 8.1 This report is intended to keep the IJB informed of governance arrangements and any related risks and to provide assurance to members around improvement and monitoring activity. 8.2 All risks associated with the delivery of services are monitored by managers and where appropriate they are reflected in the risk register. 9.0 Involving people 9.1 Midlothian staff are involved in the development and ongoing monitoring of processes related to clinical and care governance and risk identification, assessment and management. Public representatives on the IJB will have an opportunity to provide feedback and ideas. 10.0 Background Papers N/A AUTHOR’S NAME Fiona Stratton, Claire Ross, Nick Clater, and Roxanne King DESIGNATION Chief Nurse, Chief AHP, Head of Service Adultand Executive Business Manager CONTACT INFO fiona.stratton@nhslothian.scot.nhs.uk claire.l.ross@nhslothian.scot.nhs.uk nick.clater@midlothian.gov.uk roxanne.king@nhslothian.scot.nhs.uk DATE 7th October 2024 Appendices: Appendix 1: Midlothian HSCP Governance Structure Appendix 2: Midlothian HSCP Annual Report (2024) to NHS Lothian Healthcare Governance Committee Appendix 3: Midlothian Integrated Governance and Assurance Framework Quarter 1 overview July 2024 Page 202 of 286
Page 203
Appendix 1 Page 203 of 286
Page 204
Page 204 of 286
Page 205
NHS Lothian Meeting: Healthcare Governance Committee Meeting date: 17 September 2024 Title: Midlothian Health and Social Care Partnership Annual Report to the NHS Lothian Healthcare Governance Committee Responsible Executive: Morag Barrow, Joint Director Report Author: Fiona Stratton, Chief Nurse 1 Purpose This report is presented for: Assurance ☒ Decision ☐ Discussion ☐ Awareness ☐ This report relates to: Annual Delivery Plan ☒ Local policy ☒ Emerging issue ☐ NHS / IJB Strategy or Direction ☒ Government policy or directive ☒ Performance / service delivery ☒ Legal requirement ☐ Other [please describe] ☐ This report relates to the following LSDF Strategic Pillars and/or Parameters: Improving Population Health ☐ Scheduled Care ☐ Children & Young People ☒ Finance (revenue or capital) ☐ Mental Health, Illness & Wellbeing ☒ Workforce (supply or wellbeing) ☒ Primary Care ☒ Digital ☒ Unscheduled Care ☒ Environmental Sustainability ☐ This aligns to the following NHS Scotland quality ambition(s): Safe ☒ Effective ☒ Person-Centred ☒ Any member wishing additional information should contact the Responsible Executive (named above) in advance of the meeting. Page 205 of 286
Page 206
Page 2 of 36 2 Report summary 2.1 Situation The purpose of this report is to provide the committee with an assessment of the quality and safety of care provided in Midlothian Health and Social Care Partnership (MHSCP) and work being undertaken to address risks and improve quality and safety. The committee is recommended to accept moderate assurance that MHSCP has comprehensive systems in place to deliver safe, effective and person - centred care. 2.2 Background Scope of Services The Midlothian Health and Social Care Partnership (MHSCP) is responsible for the management and oversight of a range of delegated community-based health and social care services delivered within Midlothian and for two hosted pan Lothian services, Dietetics and the Adults with Complex and Exceptional Needs Service (ACENS). Full details are provided in the service scope appendix (Appendix 1).] 2.3 Assessment Structures and Processes for Management and Oversight of Safety Management and governance structures Midlothian HSCP’s governance structure is composed of key meetings that deliver oversight of the governance processes within the MHSCP. These meetings and their inter-relationships are illustrated in Figure 1. The workforce planning and staff Governance meetings are currently paused due to capacity issues but key functions of these groups continue to be delivered by the Workforce Governance Board and the Executive Leadership team Page 206 of 286
Page 207
Page 3 of 36 Figure 1: Midlothian HSCP Governance Structure Page 207 of 286
Page 208
Page 4 of 36 Management and governance processes The fora in which data are reviewed and acted upon are described below. Detail is provided in the service assurance mapping table (Appendix 2). Senior Management Team/Executive Leadership Team The Senior Management Team meets monthly and provides oversight of all clinical and care services within the HSCP. The Executive Leadership Team meets fortnightly meeting to maintain oversight of strategic and operational workstreams. Informal escalation mechanisms support the raising of any urgent issues or safety concerns through operational and professional reporting lines at any time. The agendas of the SMT and ELT ensure regular reporting is received about the safety, performance and quality of services provided across the partnership, and for any emerging concerns about safety and quality of care to be raised. All meetings are minuted and required actions are logged. A range of groups with remits for specific issues relating to clinical and care governance support the SMT and ELT to deliver oversight of clinical and care quality and are described below. Midlothian Safety and Experience Action Group MSEAG MSEAG is chaired by the Chief Nurse and meets fortnightly on behalf of the SMT to support and oversee the management of Significant Adverse Events within MHSCP, i.e. those events where moderate and major harm or death are reported. The group make decisions on the type of review required, commission Level 1 and Local Management Reviews and provide governance and assurance around the completion of reviews and action plans. Organisational Duty of Candour Decisions are made by this group. Data regarding adverse event reporting, closures, common harms, complaints received, and complaint management performance are reviewed quarterly to identify themes and consider any actions required. Attendance at MSEAG ensures that service level activities including the management of complaints and adverse events, safety huddles, inspection activity, and the local review of data around specific harms, including falls, pressure ulcers, medication errors, and healthcare associated infection provide key members of the Senior management Team with a regular overview of safety issues across the partnership. Clinical and Care Governance Group (CCGG) The Clinical and Care Governance Group (CCGG) meets quarterly and reports to the Integration Joint Board (IJB) twice yearly. The CCGG is chaired by the Chief Nurse and is attended by the Clinical Director, Chief AHP, Heads of Service, Service Managers, and key staff with Quality Improvement, Risk Management and Performance roles. Services are required to convene a Quality Management Group, submit a quarterly template and deliver an annual summary presentation at a CCGG meeting. Verbal reporting of any concerns about new or changed key risks and progress against any outstanding relevant actions where low or medium assurance has been provided on care or clinical governance Page 208 of 286
Page 209
Page 5 of 36 indicators is provided. The reports received by the CCGG are the evidence of assurance for the annual report to the Healthcare Governance Committee and the reporting to the IJB. Quality Management Groups (QMGs) Quality Management Groups (QMGs) organised at service level and are chaired by Integrated Service Managers. QMGs are required to meet at least four times per year to review activity, data and evidence of assurance around the safety, effectiveness, and person centredness of the services delivered. They complete a reporting template (Appendix 3) designed around Healthcare Improvement Scotland’s healthcare quality inspection themes. There is an explicit expectation that Integrated Service Managers review their QMG report with their Head of Service. QMGs are required to maintain oversight of the inspections of commissioned services undertaken by regulatory bodies, and the monitoring of action plans for improvements associated with Healthcare Improvement Scotland inspections and Care Inspectorate Inspections of internally provided regulated services. The Primary Care Cluster Quality Network of the 11 Midlothian GP practices, chaired by the Cluster Quality Lead and attended by the Clinical Director, also provides a quarterly report of quality & safety activities to the CCGG. Oversight and action on Common Harms Working groups are established to drive improvement work in relation to common healthcare-related harms. Midlothian Community Hospital (MCH) convenes groups focusing on Medicines Management, Falls, and Food, Fluid and Nutrition. Infection Control is a standing item on the monthly Senior Charge Nurse meeting chaired by the Integrated Service Manager and links are maintained between the MCH team and specialist Infection Prevention and Control Nurses. A group also meets to review any pressure ulcers reported to have been acquired by people in receipt of healthcare and to deliver recommendations on improvement actions required. Governance and Assurance Framework (GAF) Clinical and Care Governance indicators are a component of the Midlothian HSCP Governance and Assurance Framework (GAF). The GAF is a quarterly reporting template completed on a web-based application developed in collaboration with the Digital Innovations Team. The GAF uses the domains Safe, Effective, Person Centred and Regulatory to support assessment of impact and provision of assurance levels to support measurement and governance across the local system. The GAF was designed to enable all teams and services within Midlothian to use organisational data sources to facilitate discussion, assess risk and enable consensus and ownership of mitigation and associated action plans. Supported by the Digital Innovations Team, the digital application enables teams to submit their findings Page 209 of 286
Page 210
Page 6 of 36 Following implementation of the GAF last year, engagement continues to improve. Tableau provides digital oversight of GAF status across the HSCP (Appendix 3a) enabling the Executive Leadership Team to have oversight of the assurance levels across their areas of responsibility. Service Managers have responsibility to follow up the progress of their action plans through line management processes and meetings within the HSCP structure provide opportunity for good practice and learning to be shared. The NHS Lothian Accreditation and Care Assurance Standards (LACAS) The NHS Lothian Accreditation and Care Assurance Standards (LACAS) provide a framework to give organisational and service-user assurance that quality person- centred care is being delivered consistently across all NHS Lothian’s hospital services. The Framework has been developed to promote Quality Assurance activity which can be utilised to inform and drive improvement in line with NHS Lothian’s objectives, Quality Strategy and Quality Management Approach. LACAS cycles are embedded within the Quality Management Approach within Midlothian Community Hospital (MCH), and evidence from the most recent cycle is reported in on pages 18-19 of this report. MCH Morbidity & Mortality (M&M) group Senior medical staff have established a quarterly Morbidity & Mortality (M&M) group to review all in-patient deaths in Midlothian Community Hospital. Medical and Nursing Team members are encouraged to attend and share learning with the whole group. Meetings are minuted, with an action log, and are submitted for oversight at the Clinical Care Governance Group (CCGG). Scale-up has progressed and now includes Psychiatry of Old Age ward, and Hospital at Home as there are advantages to linking up the M&M discussions across specialties the Medicine of the Elderly wards, to detect any emerging themes, shared learning, and develop collaborative working across the site. Care Home Rundown A weekly care home rundown is established with a focus on the delivery of the Healthcare Framework for Care Homes and the support needed and provide to care homes to deliver clinical and professional standards in care homes. The group is chaired by the Chief Nurse and reviews Care Home Support Team inputs and provides a locus for the discussion and escalation of any concerns around staffing, training, infection prevention and control and incidents (adverse events). Data is provided from the NHS Lothian Health Protection Team on infection outbreaks. Work is underway to agree how to measure the impact of Care Home Support teams. The Midlothian Care Home Support team is working to support the rollout of a digital tool (Restore 2) to support the early identification of deterioration and prompt appropriate management aligned to residents’ Future Care Plans. Escalation Processes The formal meetings within the structure described above provide regular opportunities for the reporting, discussion and analysis of quality-of-care issues. Midlothian HSCP places an emphasis on relationships being key to the work of integration and the size of the Page 210 of 286
Page 211
Page 7 of 36 partnership fosters appropriate early escalation through management and professional lines. Methods depend on urgency/severity, and include face to face and all electronic methods. An MS Teams channel is established to ensure that an urgent meeting of the Executive Leadership Team can be convened regardless of the location of the members. As illustrated and described in Appendix 2a, Midlothian HSCP can evidence steady and continued improvement in performance against KPIs on SAE review completion, and a sustained position in complaints handling. Underpinning that high level data is a commitment to ensuring that the quality of investigations is not overridden by a focus on delivery to timescales alone – i.e. meeting the target but missing the opportunity to fully explore and identify learning. There has been a dedicated focus this year on encouraging Service Managers to include more information in Local Case Reviews, in particular risk assessments and documentation of safety mitigations, and this has been helpful in being able to make an informed and confident decision about whether to commission a level 1 review or close without further investigation. 2.3.1 Service Quality and Safety Assessment Safe care in Midlothian HSCP In Midlothian HSCP safe care is focussed on: • Deploying staff with the right skills in the right numbers to the place they are most needed • Identifying, assessing, recording, and managing key risks (TRAK risk assessment, speciality and patient condition specific risk assessment, public protection activity, Person Centred Care Plans, Infection Prevention and Control, and falls prevention activity) • Recognising, escalating, and managing (acute) deterioration appropriately across a range of settings, including care homes • Supporting adherence to medicines management and clinical guidelines and policies to provide a high standard of pharmaceutical care • Delivering Realistic Medicine and care, including the quality, coverage and communication of Future Care Planning (including DNACPR and eKIS) • Learning from adverse events and complaints in order to minimise or mitigate against avoidable harm across our services • Proactive and assertive approaches in working with people at most risk of harm from substance use The groups that form the governance structure detailed in section 2.3 utilise data on indicators of safety as described in the Assurance Mapping Document in Appendix 2. Current evidence about safety Significant Adverse Events (SAEs) The mean number of reported SAEs per month appears stable. Figure 1 illustrates data downloaded directly from Datix which shown all reported SAEs over the 18-month period Page 211 of 286
Page 212
Page 8 of 36 preceding the writing of this report. These data are presented and discussed quarterly at the MSEAG, and attendees are updated fortnightly on any new SAERs which have been reported. Data and analysis are provided in Appendix 2a. Figure 1 Our analysis concludes that the numbers of reported SAERs within mental health, substance use, and all other services is static. However, we do note that annual data for 2023 ‘drug-related’ deaths published on 20th August 2024 shows a return to previous levels after a year of many fewer reported drug deaths in 2022 (Appendix 4). The role of the HSCP and the Mid and East Lothian Drug and Alcohol Partnership (MELDAP) in addressing this significant public health issue is recognised. Work to engage people who use substances with services to support them and reduce harm continues to be a priority for the HSCP and its partners. Data on mental health and substance use major harm and death events have been separated out for the first time this year to enable an analysis of events affecting these patients to be illustrated and for any trends across all other services, including the community hospital to be more clearly identified. Review Outcomes Appendix 2 includes summary tables of Quality Improvement Support Team (QIST) data provided to the Partnership on the outcome codes for adverse event reviews at closure. This evidences the work undertaken by MSEAG to address a backlog of local reviews in 2021. Care and service delivery problems were pertinent to the outcome being identified in 5 out of 48 reviews over 3 years. Three reviews within the last calendar year have been closed with the finding that care or service delivery problems contributed to the adverse event. Page 212 of 286
Page 213
Page 9 of 36 All events involving harm to a patient provide an opportunity for learning, and Midlothian HSCP can evidence the implementation of specific action plans to address the learning from reviews with an outcome of 3 and 4. No common underlying themes or causes of avoidable harm have been identified in these three reviews. Data is prepared and discussed on a 6- monthly basis to support a Lothian -wide discussion of the incidence, process of review and learning from deaths of patients who were receiving NHS Lothian Mental Health and Substance Use Services at the time of or immediately preceding their death. Table 1 Table 1 illustrates that Midlothian HSCP commissioned a higher proportion of Level 1 SAE reviews than other partnerships but that all LCRs identified an review outcome of 1 (Table 4). This suggests that our focus on quality of initial Local Case reviews is effective in the early identification of care and service delivery problems impacting on the outcome, thereby supporting the appropriate commissioning of external reviews. Table 2 Evidence about safety - External inspections – Midlothian Community Hospital Midlothian Community Hospital has not been subject to any external inspections since the last annual report to the Healthcare Governance Committee in 2023. Page 213 of 286
Page 214
Page 10 of 36 The most recent unannounced Healthcare Improvement Scotland visit took place in September 2020, and all follow up actions were completed. The most recent Mental Welfare Commission visit to was undertaken in July 2022 and reported in March 2023. Actions identified to address recommendations following this inspection around communication with families and the use of section 47 certificates have been completed, but recommendations about the provision of NHS Lothian psychology input for patients in Penny Lane and Rose Lane wards remain outstanding due to additional funding being unavailable. The HSCP Chief Nurses across the 4 Lothian Partnerships agreed with the Nurse Director for Primary and Community undertake a programme of unannounced supportive visits over 2023/24. These have initially focussed on bed-based areas, although it is recognised work should be progressed to deliver assurance in community teams also. The first iteration of these visits has enabled testing of readiness for an unannounced inspection and provided support to Senior Charge Nurses in identifying areas of strength and actions to improve in preparation for any formal inspection activity as it arises. Midlothian Community Hospital benefited from unannounced visits to two ward areas in January 2024,providing helpful feedback and assurance around MCH’s preparedness for a formal unannounced inspection. Evidence about Safety - Joint Inspections – Midlothian HSCP MHSCP services are subject to external inspections from statutory bodies. This includes Healthcare Improvement Scotland, the Mental Welfare Commission, and the Care Inspectorate. These reports are lodged at SMT and actions plans monitored operationally and reported through the QMGs, CCGG, The East and Midlothian Public Protection Committee, and the Social Work Assurance Group. Immediate action is taken when internal concerns or external inspections identify improvements which are required to address standards of care. Operational and professional leads have shared oversight of action plans. Implementation is led by Service Managers and progress monitored and supported through operational and care and clinical governance routes, ensuring the implementation of actions deliver sustainable improvement. Since the last report to the Healthcare Governance Committee in 2023, Scottish Ministers requested that the Care Inspectorate lead a second phase of joint inspection and development of Adult Support and Protection in collaboration with Healthcare Improvement Scotland and His Majesty’s Inspectorate of Constabulary in Scotland. The national inspection activity programme follows the phase one inspections that took place in 2017/2018. Phase two is closely linked to the Scottish Government’s improvement plan for adult support and protection, and the national implementation groups which support it. The Midlothian Partnership were part of phase two joint inspections with an aim to provide national assurance about individual local partnership areas’ effective operations of adult support and protection key processes, and leadership for adult support and protection. The focus of this inspection was on whether adults at risk of harm in the Midlothian partnership area were safe, protected and supported. The joint inspection of the Midlothian partnership took place between January 2024 and July 2024. Page 214 of 286
Page 215
Page 11 of 36 The Inspection considered key processes and strategic leadership. The final report released on 11th July 2024 concluded that the Midlothian partnership delivered adult support and protection processes that protected and supported adults at risk of harm. There were some strong areas of practice, particularly management oversight of Council Officer practice, the risk assessment framework and the quality of chronologies and risk assessments when completed. The inspection found that overall, strategic leaders ensured the delivery of competent and effective adult support and protection practice. Strategic leaders’ vision for adult support and protection was strong and well understood by staff to ensure effective governance. The Inspectors concluded the partnership’s key processes and strategic leadership for adult support and protection were effective with areas for improvement. There were clear strengths in both domains supporting positive experiences and outcomes for adults at risk of harm, which collectively outweighed the areas for improvement. On the 15th July 2024 the Care Inspectorate notified Local Authorities and Health and Social Care Partnerships of their intention to undertake a review of social work governance and assurance arrangements. The review commenced in July 2024 and will conclude in December 2024. It is being carried out under Section 53 of the Public Services Reform (Scotland) Act 2010. Through the review the Care Inspectorate will answer these questions. How well do 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? They will span all areas of statutory social work including adults, children and justice social work services and will cover all local authority areas in Scotland. The review will include: a review of documents, a national staff survey, interviews with key leaders from across Scotland and a range of focus groups with middle and senior managers. Service Improvement Work to Address Safety Issues In addition to specific learning from individual adverse events and known risks, improvement work is undertaken to address the most common reported harms. Common Reported Harms Analysis of moderate, major harm and death events over the last year, compared to a similar analysis over a 3-year period (Table 3) shows pressure ulcers to be consistently identified as the most common cause of serious harm to our patients. Unexpected death Page 215 of 286
Page 216
Page 12 of 36 and self-harm are the most common cause of major harm or death in Mental Health and Substance Use Services. Violence and Aggression are addressed through NHS Lothian’s Health and Safety systems and processes. The Pareto Chart, table and narrative in Appendix 2a provides a detailed breakdown of MHSCPs common reported serious harms. Table 3: Top 5 Common Harms, 2021-24, compared to 2023-24: Top 5 common harms 2021-2024 2023-24 1 Pressure ulcer Pressure ulcer 2 Patient fall Unexpected death (MH/SU services) 3 Unexpected death Patient falls (MCH) 4 Violence/aggression/abuse/harassment Violence/aggression/abuse/harassment 5 Medication error Self-harm Pressure Ulcers Pressure Ulcers are the most common healthcare-associated harm reported in Midlothian HSCP. Healthcare Improvement Scotland identify that Pressure Ulcers are one of the most common causes of harm within the hospital and care home setting. At a Midlothian level, data evidences that within the HSCP they are a harm more frequently experienced by people in their own homes than they are for hospitalised patients or those resident in care homes. A narrative around the data currently available in relation to pressure ulcer incidence and severity and the MHSCP’s ability to comment on the prevention of avoidable harm is provided in Appendix 2a (Indicator 8). Analysis of data undertaken for the purpose of this annual report highlighted the potential for a more data driven approach to the review of pressure ulcers reported in Midlothian to be adopted. NHS Lothian’s Prevention and Management of Pressure Ulcers Policy requires that all patients are systematically assessed, and effective preventative strategies are implemented to reduce the risk to the skin of breakdown and facilitate healing of damaged tissue from pressure, shear, friction, and moisture. A group within Midlothian meets fortnightly to review and quality assure individual pressure ulcer reviews and share learning, however, this work does not currently produce data which could provide assurance about the implementation of the NHS Lothian policy. The Tissue Viability Service (TVS) provides specialist advice and support for the prevention and management of pressure ulcers, including educational study days. The Prevention and Management of Pressure Ulcers policy details specific pathways for the Acute and Community settings. This has been in place since 2021 and is due to be reviewed this year. As part of this review process stakeholder consultation will allow consideration of the current pathways to identify any changes required. Work is underway to bring the six community hospitals who don’t have regular access to medical photography Page 216 of 286
Page 217
Page 13 of 36 into the TVS e-wound clinic. This is where images are used to triage for specialist advice or visits and for recording pressure ulcer development, improvement, or deterioration which is a requirement of the policy. The Scottish Patient Safety Programme has updated the change package and driver diagram available to provide support with evidencing improvement work in relation to pressure ulcer prevention and management. Discussion has taken place with the Lead Nurse for Tissue Viability about developing a collaborative approach across the HSCPs utilising these tools and establishing or refreshing local improvement groups. The Lead Nurse for Tissue Viability committed to providing support in developing a quality improvement approach to data collection and evidencing outcomes. The National Association of Tissue Viability Nurses Scotland is in the process of updating the prevention leaflet for patients, this has been adapted by Lothian in the past and will be implemented once the updates are complete. The DATIX system is used to record incidence of pressure ulcer occurrence across all sites and there are specific pathways to follow as part of the review process. It has been identified that these are not user friendly and can lead to confusion with learning not always identified. This will be included as part of the policy review. The Lead Nurse for Tissue Viability in NHS Lothian was consulted while the annual report was being prepared. The Tissue Viability Lead Nurse will continue to support review of all major harm pressure ulcers - these are reported predominantly by District Nursing Teams. The continued independent assessment of major pressure ulcers and provision of support with identifying the learning to take forward service improvement has been confirmed, as has the provision of in-person education sessions to update and refresh knowledge with the team involved. This will continue to be offered to all areas, alongside the improvement group work. The Terms of Reference for the Midlothian Pressure Ulcer Group is being updated to reflect the gaps identified and the group will have input form the TVS going forward. Work to develop and support the group to progress and be able to provide evidence of assurance by using a data driven quality management approach to the prevention, identification and management of healthcare acquired pressure ulcers in Midlothian will be progressed. Unexpected Deaths in Mental Health and Substance Use Services A specific adverse event management pathway is in place to review the care provided to people who are engaged with Mental Health and Substance Use Services (or who engaged during the 12 months prior to their death) which includes ensuring the requirement is met to notify Healthcare Improvement Scotland (HIS) of suicides and suspected suicides, and for the Mental Welfare Commission to receive appropriate notifications. And outcomes of these Local care Reviews are included in the data Tables 1&2. In 2023/2024, an increased number of deaths of Midlothian patients engaged with Substance Use Services was reported, including a concentrated spike of 5 deaths over a 1-week period in July 2023. Immediate intelligence highlighted that these deaths were attributable to an unprecedented change in (street) drug availability; it was established that Page 217 of 286
Page 218
Page 14 of 36 the 5 patients who died were known to each other. As an immediate response to those 5 deaths, the Substance Use Service reached out to patients known to participate in high- risk substance use practices to raise their awareness of the immediate risks, in addition to their usual risk management plans. The Integrated Service Manager convened an urgent Core Group Meeting involving multi- agency representation including Midlothian Substance Use Services, the Alcohol and Drug Partnership, local and national Public Health experts and Police Scotland. The purpose of the meeting was to share information and local intelligence and to identify actions to reduce harm to patients and the wider community of citizens who use substances, particularly street benzodiazepines. Harm reduction advice pertinent to the local circumstances were agreed and approved with public health involvement and disseminated across Lothian and nationally. All known patients were provided with harm reduction advice and information to raise awareness of the risks posed by benzodiazepines, with intensive assertive outreach support over the period of highest assessed risk. Drug Related Deaths in Midlothian The National Records Office published the annual report on drug related deaths (DRDs) in Scotland on 20th August 2024. The report detailed that following a very significant fall in numbers of DRDs reported in Midlothian in 2022 (n=4), the incidence of DRDs returned to a level closer to that reported between 2019 and 2021 with 20 deaths attributed to drugs in 2023. More information is provided in a briefing note prepared for elected members of Midlothian Council provided in Appendix 4. Strenuous efforts continue to identify people who use substances and to bring them into treatment as the evidence base about improved safety for substance users engaged in services is strong. Work to continue to deliver the Medication Assisted Treatment Standards (MAT) continues and is outlined in the briefing. In-patient Falls – a patient safety issue Midlothian Community Hospital has one rehabilitation ward, one NHS Lothian step-down ward, one palliative care/ continuing care ward, and two mental health wards for older people. The majority of patients are assessed on admission as presenting with a high risk of experiencing a fall. The All Falls Rate per 1000 occupied bed days (OBD) (Figure 3) and Falls With Harm Rate per 1000 OBDs (Figure 4) show consistent reduction in falls incidence. This is attributed to data driven improvement work across all ward areas supported by the Lead Nurse for Quality and within scope of the Lothian Accreditation and Care Assurance Standards (LACAS), which is discussed in more detail from page 20 of this report. Page 218 of 286
Page 219
Page 15 of 36 Figure 3 Figure 4 The most recent LACAS cycle reports mean 75% attainment of standards in relation to falls in Midlothian Community Hospital (Figure 5). Although this is one of the lower attainment levels across the whole programme, this figure is not a reflection of work to reduce in patient falls being afforded low priority. The figures represent performance (incidence/ Falls Rates) in relation to the current definition of falls which includes the reporting as a fall, incidents where patients place themselves on the floor- a known feature of the presentation of some patients within the mental health wards. A proposed update of The Scottish Patient Safety Programme falls definition (Appendix 5) will support Page 219 of 286
Page 220
Page 16 of 36 more accurate data capture and greater confidence in the assessment of impact of mitigations and improvement activity, and in the provision of assurance. Figure 5 In rehabilitation wards, and elsewhere, a culture of positive risk taking is adopted to enable patients at high risk of falls to undertake activities to regain strength, balance, confidence and mobility after major illness and injury. The risk of falls occurring has to be balanced against the risk of inactivity in order to achieve rehabilitation outcomes. Service improvement work to address inpatient falls at Midlothian Community Hospital includes: Current work • MCH Falls Prevention Multi-disciplinary Group meets bi-monthly with representation from all 5 wards • All 5 wards are focusing on Falls Prevention LACAS Standard 3 - using a Quality Management approach, analysing data to gain an understanding before applying change ideas (Pareto charts – times & location of falls) • Analysis of OBD data on Falls & Falls with harm is shared and discussed as well as sharing successes • Improving the quality of falls risk assessment practices across all 5 wards Current change ideas being tested: • Use of Twilight shift to provide additional staff at times of known higher falls incidence • Orange poster to alert staff of patients who are at the highest risk of falling (fallen once before / raised delirium score (4AT) / signs of stress & distress) • Identifying high risk patients during daily safety brief • Breakfast clubs Page 220 of 286
Page 221
Page 17 of 36 • Planned activities at times of high falls • Evaluating ward routines • Correct usage of Falls Prevention alarms • Checklist (known as ‘Appendix A’) completed after every fall Next Steps • Consideration of work to improve bone health – Calcium supplements what’s best? • Dietary intake – ensuring patients receive sufficient Calcium & Vitamin D from meals being provided within MCH? Celebrating Success Loanesk Ward has achieved sustained improvement and reduction in falls. It’s baseline Median of 4.07 is below the National target of 4.7 and a period of 2 years & 6 months has elapsed since a fall with harm has occurred. Whilst the adopted target aligned to the national Aim to reduce all falls by 20% within Mid- Lothian Community Hospital by January 2024 and to reduce falls with harm by 20% within Mid-Lothian Community Hospital by January 2024was not achieved in all areas, significant improvements have been. This is demonstrated in the overall reduction in Falls and the length of time between Falls with Harm The visibility of this work and the ongoing work to inform staff, patients and their families all contribute to the effectiveness of falls reduction activity in the Community Hospital. Falls – a public health Issue Falls are a major cause of injury, hospitalisation, and mortality among older people. A sustained focus on reducing falls in the wider population is a focus for the MHSCP and the Chief AHP has a lead role for this important work. Recent developments have included refreshed content and appearance of both the falls public webpage and the NHS Lothian staff intranet pages. The public webpage includes links to immediate support, a video on how to get up after a fall and includes information for people in different settings across Lothian. The refreshed webpage can be accessed here. A new Falls Dashboard has been developed and tested. This creates data on falls across the system which can be filtered by geographic location and includes rates of falls, provides better visibility across the system in relation to falls. A refreshed NHS Lothian Falls Strategy is expected this autumn. Significant Adverse Events - Infections Midlothian Community Hospital reported one major harm event relating to infection in the year covered in this report. Although not ranking as a ‘Top 5’ common harms, recognition of the occurrence of a major harm event resulting from a treatment-related infection of this type (Clostridium Difficile), in a context of low overall numbers of serious harm events, is appropriate. Investigation identified process and sampling issues which may have contributed to the late detection of this infection, but on balance it is not thought those improvements would have altered the outcome for the patient affected. Page 221 of 286
Page 222
Page 18 of 36 MCH receives support from the Infection Prevention and Control Team, and infection control is, as described in this paper, a standing item for discussion at the MCH Senior Charge Nurse fortnightly meeting and a dimension of the LACAS framework for which a standard attainment averaging 93% was achieved across the hospital, providing moderate assurance on the Infection Prevention and Control standard. Medication Administration Errors Medication errors have featured as one of the top 5 most common reported harms over the last 3 year period, but do not appear in this year’s top 5 due to a change in allocation and ownership of adverse event management reviews. Recognising that a medication administration error resulted in a major harm event and mindful that a change in reporting does not equate a change in risk, work to promote medicines safety is reported here. Within the MCH in-patient areas, improvements have been progressed in response to medicines errors reported on the Datix system. The Pharmacy team work alongside other members of the multi-disciplinary team ensuring analysis of risk and appropriate mitigation of the root causes are progressed. Changes to controlled drug process as a result of error review has reduced Datix reports with Schedule 2 CDs in MCH. The revised NHS Lothian Controlled Drug Safe Use of Medicines Procedure was implemented in May 2024, supported by an extensive programme of staff training. Improvement activities include: • introduction of security bags for less commonly used controlled drugs • training of staff on accurate measuring of liquids • introduction of pharmacy spot checks in addition to 4-monthly audits • introduction of weekly liquid measurements by ward staff • Measures introduced to reduce medication errors including missed doses and administration errors • Introduction of second check paperwork ensuring ‘fresh pair of eyes’ review of administration record (Kardex) after each drug round • One-to-one training on medication administration and policy for all nursing staff in MCH facilitated by Clinical Educator and Pharmacy Technician (ongoing, fully complete on rehabilitation and step down wards which were prioritised due to higher risk areas) • Focussed communication on medicine administration in line with Datix trends • Liaison with medical staff to ensure prompt rewriting of kardexes and improved communication regarding changes in medication The availability of Hospital Electronic Prescribing and Medicines Administration (HEPMA) within MCH would mitigate for or further reduce these events - therefore its absence remains on Midlothian’s risk register. Page 222 of 286
Page 223
Page 19 of 36 The MHSCP Pharmacy Service has member of staff in every practice in Midlothian and the Immediate Discharge Letter (IDL) Medicines Reconciliation Hub ensures that all IDLs in Midlothian are completed within the SPSP target turnaround time of 48hrs (Figure 6). Pharmacists and pharmacy technicians systematically undertake all medicines reconciliation for all Midlothian patients discharged from hospital. This ensures that any changes made to a patient’s prescription during a hospital stay are promptly and accurately assimilated into the patients ongoing (repeat) medicines list in practice systems. Many of these patients will receive a phone call or text from the pharmacy staff, informing them of any changes with the aim of improving safety, reducing errors and improving concordance. Figure 6: Midlothian Pharmacy IDL Hub Turnaround Performance Frailty During 2024 the Professional Leads have been working to engage relevant stakeholders and identify potential opportunities for a new system-wide Frailty pathway in Midlothian, founded on the principles of Realistic Medicine. A Quality Management approach has been taken to this complex work with our stakeholders to understand what currently or historically not worked well or is presenting barriers to change, including the provision of safe care for elderly & frail people. Ecosystem mapping has allowed us to capture a high-level view of how eight current key stakeholder resources connect and how a typical person’s journey may traverse or fall through that network. (In-patient Rehab Team, Sport & Leisure Wellbeing Team, Community Treatment and Care (CTAC), Midlothian Assessment and Rehab Service (MART), Older People Social Work Team, Hospital at Home, General Practice Advanced Physiotherapy Practitioner Team, and VOCAL). Subsequent to this, the use of design methodology and tools has allowed us to define 4 main areas of focus to progress to co- design with patients and carers and then initial testing and measurement. It is anticipated that the universal use of Rockwood Frailty Score assessments and its common language, which can be understood and applied by all professionals and services, will be the key intervention to unlocking access to a sliding scale/spectrum of integrated resources depending on a person’s stage of frailty (rather than just their age), allowing them to more seamlessly move across traditional service boundaries and silos Page 223 of 286
Page 224
Page 20 of 36 without repeated referrals and re-assessments. This will also help move balance of frailty resource and supported intervention back to prevention and early intervention. Over time, a programme of community engagement and the development of digital solutions (including a Frailty passport) will also underpin and support this approach. Recognition of the Deteriorating Patient Healthcare Support Workers (HCSWs) at Midlothian Community Hospital (MCH) have been engaging in an education programme, the Vital Signs knowledge framework, delivered to support the early recognition and escalation of the deteriorating patient. All HCSWs at MCH have been offered this training with uptake leading to 85% now being compliant with the skillset. The introduction of News on Trak and the recording of National Early warning scores (EWS) on TRAK has increased the completeness of observations - no EWS score can be produced without complete set of observations. The benefits of this approach include increased accuracy of EWS scoring, reducing risk of human error in calculation, increased reliability of EWS completed on time (frequency) with alerts to time observations due / overdue. The resulting increased ease and clarity of documentation supports timely escalation to an appropriate clinical responder using escalation functionality built into the system. Assurance is providing by each ward monthly through the Person-Centred Assurance Tool (PCAT) and 6 monthly through the Lothian Accreditation Care Assurance Standards (LACAS) Deteriorating Patient Standard. In the most recent LACAS cycle MCH obtained an average of 93% compliance with the standard and can provide moderate assurance for the Deteriorating Patients standard. Management of safety and risk – Midlothian Community Hospital Lothian Accreditation and Care Assurance Standards (LACAS) The most recent cycle of LACAS was completed in July. All 5 in-patient areas at Midlothian Community Hospital submitted a completed LACAS self-assessment for this cycle. Awards are detailed in Table 4 Table 4: Midlothian Community Hospital LACAS cycle July 2024 award Edenview 7 Gold Loanesk 7 Gold Glenlee 6 Gold Penny Lane 5 Silver Rose Lane 5 Gold The findings provide evidence of the quality of care from bedside to Board. The report released on Monday 19th August 2024 proposed that ‘Moderate Assurance’ is provided Page 224 of 286
Page 225
Page 21 of 36 that there are systems and process in place to deliver the LACAS Programme – this position has been maintained from last year. The report further suggests that ‘Moderate Assurance’ can be provided that consistent high-quality person-centred care is being delivered across all Adult Inpatient Areas at this time. This is an improved position from the July 2023 report where limited assurance was provided. Table 5 evidences the progress across the 5 ward areas since LACAS was introduced. Table 5: Ward Cycle trends This LACAS review cycle has again identified clear themes in good practice and areas for improvement, which will continue to inform quality improvement priorities at ward and hospital site level. Figure 2 illustrates the average attainment across the hospital in relation to the LACAS standards. The report states that a high standard of care was again observed across all wards which was evidenced during the Ward Observations visits. There is an opportunity to share good practice and learning from teams who achieved a moderate level of assurance in certain Standards. The wards will now be supported to complete an improvement plan based on their LACAS results and supported by the Lead Nurse to identify improvement priorities and change ideas. Figure 2: Midlothian Community Hospital Average Attainment LACAS Standards July 2024 Page 225 of 286
Page 226
Page 22 of 36 Associated with the LACAS programme, weekly reports are provided to the Chief Nurse and Integrated Service Manager on the completion of standard risks assessments for in-patients at Midlothian Community Hospital. These ensure management oversight of coverage and currency of inpatient risk assessments recorded on Trak. This has promoted focused discussion with Senior Charge Nurse meetings resulting in improved performance in the completion of risk assessments across all domains in all 5 in-patient areas. Management of Safety and Risk – Clinical and Care Governance Processes Service Managers articulate key service level risks and mitigations in their quarterly QMG submissions. Recruitment and retention is cited in the majority as a key risk to the delivery of safe and effective care, as is staff sickness absence. Continued appropriate risk assessment and escalation is identified as a key activity to drive the delivery of safe and effective care and is now a legal requirement as a result of the enactment of the Health and Care Staffing legislation in April of this year. An overarching concern in Midlothian is the growth of the population and the mismatch between resources and demand. The HSCP is driving a Digital Strategy and Transformation Programme as part of the strategic response to these overarching challenges. General Practitioners cite population growth, increasing activity, and shrinking revenue combined with a freeze on capital spending for premises as combining to generate significant risk to GP practice sustainability and ultimately patient safety if General Medical Services are reduced or compromised. More generally, managers cite uncertainty around financial constraints and the prospect of service redesign and organisational change as impacting on staff morale. Discussion takes place at the CCGG to support appropriate used of risk registers and understanding of thresholds for escalation for these and other issues which are beyond the day-to-day influence of service managers to change and control. The most recent quarterly templates provide some examples of the safety issues recognised by Service Managers and of work being undertaken across services in Midlothian HSCP to improve safety in relation to these risks: • Pharmacy: changes to drop down menus to reduce errors in drug selection • Vaccination service: Staff training and review and development of Standard Operating Procedures • Health Visiting: Implementation of the Neglect Toolkit and training in Infant Behavioural Observation • General Practice: Primary Care Improvement Plan and a 5-year Operational plan to support and maintain patient access using new approaches and maximising the deployment of skills within multidisciplinary teams Page 226 of 286
Page 227
Page 23 of 36 • District Nursing: Local and Pan Lothian Review to deliver sustainability, including a quality improvement project around the model of care for patients with Type 2 Diabetes, new referral process and ‘paper lite’ approach. • Adults with Complex and Exceptional Needs Service (ACENS): redesigned pathway to the commencement of tracheostomy – ventilation for patients with Muscular Dystrophy • Midlothian Community Hospital: Work to address out of hours medical cover with development of an updated Advance Nurse Practitioner model; continued escalation of risks associated with lack of access to HEPMA • Mental Health and Substance Use: Focussed work to improve documentation as a result of improvements in recording in clinical records being recognised as required through SAERs; Implementation of MAT standards 6-10 • Physiotherapy: Competency mapping for Advanced Practice • Dietetics: contributing to strategic development SLWG for pathway for type 1 diabetes and work with Diabetes Specialist Nurses on insulin pump titration protocol Effective Care Midlothian HSCP’s Clinical and Care Governance Framework promotes an evidence- based approach to the delivery of care and has been in place for just over a year. The Partnership recognises the need to work to improve the quality of evidence available from these reports, and to develop some from a very descriptive approach to the consistent provision of data on activity and impact. The most significant factors impacting on the delivery of effective care cited within the quarterly reports relate to demand exceeding capacity, resulting in waiting lists for treatment or care. Action plans are in place to address waiting lists for the Weight Management Service (Dietetics), Attention Deficit Hyperactivity Disorder Diagnosis (Adult Mental Health), and Musculoskeletal Physiotherapy. Midlothian HSCP is participating in the Pan Lothian District Nursing Review, with specific local workstreams related to financial deficit aligned to that work. A number of productivity workstreams are underway and planned to release time to care and support the delivery of the most effective care on the principle of right person, right care, right time. This includes a new referral system, testing of paper lite approaches, and considering skill mix, education and workforce planning for future needs. A successful project delivered in partnership with Pharmacy has delivered a streamlined, cost effective and clinically effective pathway for wound dressing selection by the district nursing teams in Midlothian has resulted in £61k of savings since the start of the project. Additionally, prompt access to the required dressings has allowed the district nursing service to make more timely interventions for patients. This, in combination with education sessions supported by the tissue viability nurse has resulted in an improvement in the care of patients. The model developed in Midlothian Page 227 of 286
Page 228
Page 24 of 36 is currently being spread to the other HSCPs in the Lothians through supported project management from the corporate Sustainability and Value Team. The Mental Health and Resilience Service previously open to only people under 65 is now available to adults of all ages, ensuring same day self-referral access for anyone who resides in Midlothian – aged 18+ and seeking support with their mental health and mental wellbeing. This service works in partnership with Penumbra, offering crisis support, and distress brief interventions in social crises. The mental health service has recognised and seeks to address the known impact on health outcomes for people with enduring mental illness. Clinics are established to provide holistic, whole person health and wellbeing support to patients receiving lithium and clozapine treatment. A lithium clinic for patients who prefer not to attend their GP has been established. Dietetics are delivering service improvement initiatives across multiple specialities, including prehabilitation, seeking funding for expanding provision in oncology, provision of input to the endometriosis service, review of Irritable Bowel Syndrome pathway, education for mental health staff at the Royal Edinburgh Hospital and extensive improvement work in paediatrics. Person Centred Care Complaints All Midlothian HSCP services have a formal complaints procedure which is advertised and made available to patients on their request, and a standardised process is followed to deliver a response to the complainant within set time scale. Local systems for oversight and scrutiny aim to ensure responses to concerns and Stage 1 & 2 complaints meet the Scottish Complaints Ombudsman’s targets. Data and analysis of MHSCP complaints I located in Appendix 2a. GP practices handle their own complaints separately, and complaints made about MHSCP services made via Midlothian Council are not reported to NHS Lothian; neither are included in this data. The Director and Chief Nurse receive a weekly report on performance in complaints handling. Actions to address any issues causing delays in investigating and responding to complaints are prioritised, ensuring a timely response is provided to concerns people have raised about care provided. SMT receives an update on complaints performance for each meeting and MSEAG undertakes a quarterly overview of performance which is submitted to SMT and ELT. Although numbers are generally low, an increase in complaints received by Midlothian HSCP has been observed in 2023-24 with the median monthly number of complaints rising from 2 to 5. In addition to the pattern observed over previous years of a number Page 228 of 286
Page 229
Page 25 of 36 of individual complaints across a number of different services themed around treatment, staff behaviour, and communication, the increase reported is largely attributable to complaints about the Attention Deficit and Hyperactivity Disorder (ADHD) diagnosis and treatment pathway for adults in Mental Health Services, and waiting times and access to medications on the weight management pathway in Dietetics. Both these services have a degree of profile within the media and complaints received are potentially associated with news coverage. An analysis of complaints handling performance data is provided in Appendix 2a. Recurring themes in complaints across all services relate to concerns about staff behaviours, arising from individual consultations/interactions. These are dealt with individually with the practitioner involved. However overarching work on the Midway equipping staff with interpersonal skills, support through 1-1 supervision, personal development planning and appraisal, and the Staff Wellbeing Programme, are activities that seek to deliver improved experience for staff and by implication, for people who use our services. The quarterly QMG templates submitted detail across a number of services that seek to improve patient experience and deliver a person-centred approach. No 11 has established a panel for people who have used MHSCP services. This is organised in conjunction with Community Advocacy Project (CAP) and ensures the voice of people with lived experience informs service provision and planning. Similarly peer workers employed by Health in Mind are based within mental health and substance use services and co-located with health and social care professionals to provide a supportive presence for people attending appointments and who arrive seeking support across their treatment and recovery journey. Close working relationships are maintained with the Carers Organisation VOCAL to provide direct support and staff training. This aims to provide relevant support information and advice to the families of people using mental health and substance use services. A group has been established for the carers of people with dementia to provide support, access to advocacy and to build relationships and provide a voice that can shape services. The Musculo-skeletal Physiotherapy Service and the GP practice-based Advanced Physiotherapy Practitioners are deploying a new way of gathering Patient Reported Experience Measures (PREM) using the JISC survey platform. Data is collected around a range of experience measures which is being utilised to inform service delivery and planning. Domains being measured include: • ease of arranging appointments, • extent to which patients feel their needs were met, • the quality of information shared about the patient’s condition and self management advice, • involvement in decisions about care and treatment (see Figure 3 below), Page 229 of 286
Page 230
Page 26 of 36 • feeling listened to • Explaining things in a way the patient could understand. • Having enough time • Being treated with care and concern • Satisfaction with extent to which care was coordinated/joined up with other departments • More general health advice • What the service did well • What could have been better Figure 3: Example of PREM data This is District Nursing Team Leaders have been testing a change to gather feedback about the experience of receiving the District Nursing Service. A telephone questionnaire was developed by Team Leaders who contact recently discharged patients from a colleague’s caseload to provide a degree of objectivity. Whilst this requires time and has been found to be achievable only when other pressures and priorities permit, this has provided helpful positive feedback that supports morale and builds confidence across the service to engage with patients and their families helping to drive service improvement and change and ever more person-centred approaches. The Health & Care Experience (HACE) survey 2024 reports that despite the challenges of the past year with securing ongoing General Medical Services at Danderhall, and restrictions on premises and capacity at Bonnyrigg Health Centre due to Legionella Species last year (now resolved), overall patient satisfaction with the care provided by their General Practice in Midlothian has increased to 68%, from 62% in 2022, and satisfaction with arrangements to speak to a doctor has increased to 61%, from 56% in 2022. Performance is now similar to the average across Scotland. This improvement Page 230 of 286
Page 231
Page 27 of 36 has been achieved through a planned improvement programme after the last HACE results, consisting of HSCP support via development of the Primary Care Improvement Plan multidisciplinary services, patient-facing communication and supported self- management campaigns, and collaborative projects with GP practices to improve continuity of care and demand/capacity management. 2.3.2 Workforce Oversight of staffing The availability of the right number and skill mix of clinical and care staff is fundamental in the delivery of safe, effective, and person-centred care. Midlothian Community Hospital (MCH) operates a daily safety huddle led by the hospital’s Coordinating Charge Nurse. The meeting reports to senior management an assessment staffing across the multi-disciplinary team and the alignment of that capacity to the demands, needs, acuity and risks across the 5 in-patient areas for the next 24 hours. This feeds into the completion of the online Safecare tool which is linked to the Healthroster system. MCH’s compliance with the Safecare staffing tool is monitored and is consistently reported at above 90%, and in the second week of August 2024 was 100%. Safecare compliance is a key contributor to the common staffing method as an element of delivering the requirements of health and care staffing legislation, and is monitored by the Integrated Service Manager and reported to the Chief Nurse. No other service areas within the Partnership have a real time staffing tool available at this time. However, local experience of managing workload and staffing pressures during the Covid-19 pandemic enhanced local practices in collating and reporting staffing information. Various methods are employed, with some community teams utilizing technology as an alternative to in-person meetings to operate staffing ‘huddles’. Daily ‘Prepstat’ reporting commenced in December 2023 and has evolved from a brief daily virtual meeting to routine online reporting and an agreed escalation process for exceptions requiring senior management support and mitigating actions. All services within the Partnership engage with Prepstat reporting. This provides an ongoing picture of staffing and demand pressures as an adjunct to the utilization of staffing and workload tools. Health and Care (Staffing) (Scotland) Act 2019 Midlothian HSCP has established an Integrated Workforce Governance Board with Workforce Planning and Workforce Engagement subgroups. These support overall work to ensure plans are in place to deliver workforce plans that ensure the delivery of safe staffing levels across all our directly provided services. The Board has directed work to provide assurance and information around the duties and implications of the ‘Safe Staffing’ legislation including a benchmarking exercise was undertaken to support the provision of assurance around the implementation of the legislation within Midlothian HSCP. Page 231 of 286
Page 232
Page 28 of 36 Reduced Working Week The 2023/24 pay settlement included agreement that all NHS staff employed under Agenda for Change (AFC) will reduce their working week in a phased manner from 37.5 hours to 36 hours (or proportionate change for part time employees) over the next 3 years to support improved wellbeing. This change is being implemented in a planned and phased way to ensure patient and staff safety. Considerable work is ongoing to devise approaches that will ensure safe staffing can be maintained. NHS employed clinical staff in MHSCP continue to work the hours contracted prior to April 2024 with a transitional allowance being paid to reflect the agreement reached while the planning required to ensure services have staffing levels and working patterns that ensure safe care. Implementation will be progressed in line with NHS Lothian guidance. Work continues to scope out , risk assess and plan mitigations for the impact of reduced staffing hours on levels of service provision and to address the gaps that the reduction in the working week will create. TURAS Midlothian HSCP is committed to investing time and workforce into monitoring and promoting the benefits of positive conversations around appraisals. The MHSCP Executive Business Manager attend the NHS Lothian Appraisal Champion Board. Participation offers significant benefits by creating a dedicated platform for ensuring consistency and enhancing the appraisal process across the board area, ensuring that appraisals are aligned with organisational and partnership goals, professional development needs and regulatory requirements. It promotes a culture of continuous improvement, providing our workforce with clear feedback, support, and career development opportunities. Through involvement in sharing best practice and addressing challenges collectively, MHSCP is committed to improving the quality of appraisals leading to increased staff engagement, job satisfaction and retention, ultimately contributing to better care and a more resilient workforce. Midlothian HSCP is working to improve appraisal completion rates and work is progressing to review the local TURAS data and complete a data cleanse to support improved reporting accuracy. A number of data anomalies have been identified that are corrupting the overall compliance figure reported. This is being investigated and learning will be shared as the work progresses. Sickness Absence Midlothian HSCP is engaging with NHS Lothian’s Sickness Absence Board which has been convened to provide a structured forum supported by Employee Relations practitioners to promote more consistent and effective absence management. The Board discusses and seeks to address the underlying causes of employee absences, promotes early intervention and wellbeing for staff, and aims to prevent absences and quicker recovery and return to work. The collaborative approach fosters a culture of transparency and support, improving employee wellbeing and morale. Page 232 of 286
Page 233
Page 29 of 36 Midlothian Health and Social Care Partnership plans to convene a local Absence Management Group to monitor and address local absences to deliver improved workforce stability, enhanced service delivery and improved overall organisational wellbeing. Staff Wellbeing Staff Wellbeing Delivery Plan (2021-24) continues to be implemented with the aim of developing innovative solutions to improve and support staff wellbeing, for both NHS Lothian and Midlothian Council staff within Midlothian Health & Social Care Partnership. The plan covers the domains of engagement, communication, access to support, leadership, mental wellbeing, and environment. Previous initiatives included work to ensure all community-based staff can access essential facilities, a range of health awareness and health promoting activities, work to develop the availability of peer support and to improve awareness and uptake of mental health and wellbeing services. Over the past 12 months the partnership has enhanced the environment through the addition of nine wellbeing spaces including the staff courtyard at the community hospital. the corridors at MCH have brightened and the talents of service users highlighted by displaying bespoke artwork. Opportunities have been created for staff to come together for a nutritious meal at 19 soup stops, and openly encouraged spontaneous acts of kindness through café baskets, the donation of over 50 gift boxes, and sharing 200 cups of kindness. This year MHSCP continues to proactively support staff through the psychological and emotional demands of their job by offering the first Staff Mental Wellbeing workshops in addition to mindfulness, team wellbeing sessions, and one to one peer support and coaching. Listening to Feedback A range of mechanisms are in place to hear staff experience including team meetings, leadership walk rounds, iMatter and exit questionnaires. NHS Lothian Partnership and Midlothian Council Staff Side representatives attend and contribute to Senior Management Team. A regular Partnership meeting, chaired by the lead Partnership representative, ensures a specific focus on staff experience and views. A leadership Forum in December 2023 focused on effective collaborative working in order to achieve strategic priorities and deliver operational goals and another forum will take place this autumn. Communication and Engagement Awareness has developed of issues that are important to our staff group and of work needed to support improved staff engagement. Our teams continue to face ongoing challenges of workforce pressures, increasing demand and complexity in the context of significant financial constraint and uncertainty. The overall Midlothian HSCP iMatter score from the survey reported in July 2024 was 78, with an increase in response rate from the previous year. Page 233 of 286
Page 234
Page 30 of 36 A Communication and Engagement Strategy and a Communication Plan was developed and implemented to deliver a more cohesive approach, offering staff across the partnership opportunities to identify how they would like to give and receive information. While Executive Team members are regularly ‘out and about’, this refreshed approach has created some opportunities for front line practitioners to meet and discuss their experience of delivering care to people in Midlothian with Senior Managers. The EMT is committed to a culture of psychological safety where staff feel able to raise concerns about the quality and safety of care. In the event that a member of staff felt unable to speak out, concerns can be raised through Partnership representatives, direct contact with the professional leads (Chief Nurse, Clinical Director, Chief AHP, or Chief Social Work Officer), or alternatively through NHS Lothian ‘speak up advocates’. If all other routes are exhausted, the formal whistleblowing procedures of NHS Lothian or Midlothian Council can be used to provide a confidential route for concerns to be raised. Whistleblowing In May 2023 a Whistleblowing concern which related to Financial and Corporate governance practices and processes and the implementation of policies and procedures within Midlothian HSCP was raised. Actions progressed following the completion of the investigation are based on ensuring the delivery of organisational best practice. Financial Governance • Development of a register of standard operating procedures. • Staff refresher on PECOS purchasing system and procedures • Review of Authorised Signatory Database in line with NHS Lothian financial plans Corporate Governance Utilisation of space within Midlothian: capacity reviews were initiated for GP premises across Midlothian in 2023/24. This work will be extended to cover all premises in Midlothian to understand both outpatient needs and staff requirements with the aim to developing a premises management approach that ensures premises capacity to support service delivery and staff wellbeing. Implementation of Policies and Procedures Developing a review process for all Standard Operating Procedures within Midlothian Health and Social Care Partnership. Speak up Week Speak Up Week runs from Monday 30th September until Friday 4th October 2024 and the theme for this year is 'Enabling Speaking Up'. The premise of the week is for staff to have increased awareness, feel engaged and energised with a renewed commitment to the healthy culture of speaking up. Activities during the week will encourage discussing topics including leadership and whistleblowing culture, access to the whistleblowing process, psychological safety, understanding the experiences of all those involved in speaking up, and building trust. Page 234 of 286
Page 235
Page 31 of 36 2.3.3 Financial There are no financial impacts arising from this report, however the committee should note the challenging financial position related to budget allocation, demand and demography in Midlothian, and the subsequent anticipated impact on performance and delivery. 2.3.4 Risk Assessment/Management Midlothian Health and Social Care Partnership has a well-established Risk Management process in place with routine oversight and governance through Senior Management Team and Executive Leadership Team Meetings. This ensures that risks are captured at the appropriate level and Senior managers have a comprehensive view of all significant risks across the organisation. Risk mitigation aligns with NHS Lothian’s corporate risk register to provide a coordinated and proactive risk management strategy for the organisation. No new risks have been added to the NHS Lothian Corporate Risk Register this year. Local operational risks are captured in the Midlothian Partnership Risk Register, which is updated and reviewed regularly, and high risks are escalated to the NHS Lothian Corporate Risk Register. Midlothian HSCP has notified NHS Lothian of two new high-level risks this year, but due to mitigation plans being in place locally, they have not been escalated to NHS Lothian Risk Register. These risks are summarised below, with detail provided in Appendix 6. 5716 – Workforce Risk identified in relation to HSCPs ability to deliver on all aspects of the HSCP Integrated Workforce Plan 2022-25 This is in the context of a national workforce crisis and continuing and complex influencing factors both locally and nationally. 3612 – Finance Risk that the HSCP may not deliver financial balance The financial situation faced by the Integrated Joint Board (IJB) in Midlothian has reached a critical point, as evidenced by the quarter one forecast projection of approximately £9 million overspend in the 2024/25 financial year. Within the IJB health budgets there is a projected overspend of £2.3m with the key drivers being Prescribing (£1.2m) & Set Aside (£0.6m). In the 2024/25 financial year the IJB has no general reserve. The absence of general reserves means the IJB cannot rely on previously accumulated funds to cover this deficit. Page 235 of 286
Page 236
Page 32 of 36 This situation necessitates the development and implementation of comprehensive financial recovery plans and transformation of services to ensure both financial sustainability and the continued delivery of high-quality care. The Financial Recovery Plan process is ongoing, but continued increase in demand has led to the requirement to identify additional actions and this process in ongoing. All plans are thoroughly assessed to evaluate their impact on staff, patients, and Midlothian’s capacity to deliver safe, effective, and patient-centred care. As part of this evaluation, mitigating actions are carefully developed to minimise any potential adverse effects, ensuring that the recovery plans are implemented with the least possible disruption. HSCP mitigation plans continue to contribute to the following ongoing risks on the NHS Lothian Corporate Risk Register: Risk 5186 - Emergency Access Midlothian HSCP has put in place strategic and operational mechanisms to mitigate risks associated with access delays. The Midlothian HSCP Flow app provides oversight of every Midlothian resident in the Emergency Department, or a hospital bed. Real time actions are agreed and progressed to ensure people are receiving care in the most appropriate setting, as close to home as possible, ensuring all possible avenues to support emergency access across the whole system are secured by local action in Midlothian. Risk 5187 - Hospital Bed Occupancy (Previously Timely Discharge of Inpatients) Midlothian continues to deliver substantial infrastructure to support clinically effective ‘Home First’ pathways which provide care as close to home as possible and thereby mitigate risks associated with inappropriate hospital bed occupancy. Midlothian remains fully committed to the NHS Lothian programme of work on Unscheduled Care which is delivered through integrated, multiagency approaches which link with third sector capacity and carer support. The Flow App described above has further enhanced the work of the MHSCP ‘Flow Team, ensuring in-patient admissions to acute services are identified, tracked and actions in place to support progress through their care pathway. This includes identification of patients who can receive their treatment at home under the care of the Discharge to Assess (D2A) or Hospital at Home (H@H) or other teams, or nearer to home in Midlothian Community Hospital or Highbank Intermediate Care Facility. The Discharge Without Delay (DWD) workstream continues to be progressed within Midlothian Community Hospital. Daily multidisciplinary (MDT) rapid rundowns enable identification and ownership of the tasks required to facilitate discharge, facilitated by locally designed discharge planning boards in each in-patient area. A continuous Page 236 of 286
Page 237
Page 33 of 36 improvement approach has been adopted ensuring that learning continues to contribute to pathway and service improvements. Effective information sharing and communication, including clear and consistent messaging with patients and families around discharge planning to set expectations appropriately, continue to be a key contributors to reduced length of stay. At a national level A Collaborative Response and Assurance Group (CRAG) has been convened and Midlothian’s improvement is in line with the required trajectory with further improvement anticipated. Risk 3829 – Sustainability model of General Practice A comprehensive analysis of the progress and risks associated with sustainability of the model of General Practice in Midlothian has been undertaken, with the Integrated Joint Board’s oversight. The Primary Care Improvement Plan (PCIP) also has the oversight of NHS Lothian’s Director of Primary Care and the GP-subcommittee of the LMC. The latest revision of the Midlothian Primary Care Improvement Plan was reviewed earlier this year, and funding continues to prioritise support of the priorities identified by the Scottish Government in its second Memorandum of Understanding (MOU2). All vaccinations have now been transferred to the HSCP. All 11 practices have access to the Midlothian Pharmacy medicines reconciliation Hub with >95% of all immediate hospital discharge letters being dealt with within 48 hours delivering obvious safety benefits for patients, as well as practice-based pharmacist support. All practices also have access to practice-based Community Treatment And Care (CTAC) and phlebotomy services. Following a recent adverse event relating to the unsupervised administration of a medication, a full review of the service is taking place, with the development of a detailed improvement action plan, progress against which will be monitored by the HSCP professional leads via the MSEAG and CCGG groups. Although Musculoskeletal Advanced Physiotherapy Practitioners (MSK-APP) are not one of the Scottish Government’s priority workforce group the HSCP has committed to retaining funding in place as the service is highly valued by local GPs: 93% of cases are managed without further GP input once seen by physiotherapist. Funding (60% supplemented from Action- 15) is also in place for Primary Care Mental Health Nurses in each practice, which allow direct and timely access to patients for mental health assessment, triage and signposting to the most appropriate resources or service for their needs, as well as practice Wellbeing workers (commissioned to third sector Thistle Foundation). The rapid growth and projected age profile of the Midlothian population is more marked than the Scottish or Lothian average and is expected to create considerable challenges for local mismatch between demand and capacity in Primary Care over the next 10 years. An operational plan to mitigate for the risks to patient access to general medical services is in place, and a practice sustainability risk matrix (including weighted scorings for list size growth, aging population, deprivation, workforce vacancies, and premises limitations) is used to help identify practices at risk and allocate appropriate support and resources, including the allocation of GMS-funded list expansion grants (LEGUPs). A detailed impact assessment and premises plan is in place to mitigate for the current Page 237 of 286
Page 238
Page 34 of 36 pause in Scottish Government capital premises funding for new GP practice premises, focusing primarily on the Shawfair area, and then the South Bonnyrigg/Rosewell area. And a standardised practice business continuity plan for all 11 practices will ensure the effective and safe coordination of patient access to general medical services in the event of any acute premises restrictions in future. Primary Care sustainability and capacity of to meet increased demand due to increasing population, age, and frailty will remain on Midlothian’s HSCP risk register, as predicted population growth is significantly higher than the rest of Lothian. Two unresolved, moderate risks at Midlothian Community Hospital persist: • 5652 – No HEPMA • 5430 – OOH medical cover MCH is the only community hospital site which does not have the Hospital Electronic Prescribing Management Administration (HEPMA) system, as central funding was not allocated for its provision. This creates a risk, due to variation in process, that medication errors and medication-related harm occur during the transcription of HEPMA information to paper kardexes prior to transfer of patients from acute sites to Midlothian Community Hospital (MCH), or that a patient is transferred without a kardex at all. Staff have been fully briefed regarding the potential risk of transcription errors and encouraged to make duplicate checks etc, but this control is not completely reliable and does not effectively manage the ongoing risk which is evidenced by reported medication errors. Current out of hours (OOH) medical cover at MCH is via Lothian Unscheduled Service (LUCS) GPs, apart from overnight which is provided by the Hospital At Night (HAN) service. However, LUCS GPs may not be on site, often cannot access to patient medical records on TRAK and may not have necessary competencies to provide necessary treatments. This creates a patient safety risk of delayed or potentially inappropriate treatment for deteriorating patients or requiring admission/transfer to an acute site. To mitigate this risk, admission criteria based on LUCS competencies has been tested and implemented by the Midlothian Flow Hub to control the acuity of patients being transferred from acute sites. All other ongoing key risks have been reviewed in the last year, and have appropriate mitigations and governance in place, as described elsewhere in this report. 2.3.5 Equality and Diversity, including health inequalities There are no new actions arising from this report which would require the completion of an impact assessment. 2.3.6 Other impacts Not applicable Page 238 of 286
Page 239
Page 35 of 36 2.3.7 Communication, involvement, engagement, and consultation There are no changes proposed within this paper which would have a negative impact upon people who use our services. The committee should take assurance that the HSCP maintains an active dialogue with key stakeholders and consult on service changes as required. 2.3.8 Route to the Meeting This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report. • Midlothian HSCP Executive Leadership Team 19 August 2024 • Midlothian Safety and Experience Action Group 20 August 2024 2.4 Recommendation Assurance – The Committee is asked to agree and accept moderate assurance that MHSCP has comprehensive systems in place to deliver safe, effective and person - centred care based on the evidence presented that controls upon which the organisation relies to manage the risk(s) are in the main suitably designed and effectively applied. A moderate amount of residual risk remains, as described in this paper; where further action is required; clear actions have been identified and plans are in place; in some instances the residual risk is greater than “insignificant”. 3 List of appendices The following appendices are included with this report: • Appendix 1 Service Scope Appendix 1- Midlothian -Service scope appendix30-08-24FINAL UPDATED.docx • Appendix 1a Service Scope NHS Lothian Dietetics (Hosted) Appendix 1a Midlothian Service Scope Appendix Hosted Lothian Dietetic Service.docx • Appendix 2 Service Assurance Mapping Appendix Table Appendix 2 - Midlothian HSCP- Assurance mapping appendix table FINAL 300824.docx • Appendix 2a Service Data for Healthcare Governance Page 239 of 286
Page 240
Page 36 of 36 Appendix 2a MHSCP Data for Healthcare Governance appendix 300824 FINAL.docx • Appendix 3 MHSCP Clinical and Care Governance Template Appendix 3 MHSCP CCGG quarterly reporting template 300824 FINAL.docx • Appendix 3a MHSCP GAF Q1 Appendix 3a MHSCP GAF Q1 2024-25 300824 FINAL.docx • Appendix 4 Drug Related Deaths in Midlothian 2023 – briefing note Appendix 4 MHSCP 2024 DRD 2023 briefing.docx • Appendix 5 Scottish Patient Safety Programme Falls Definition Appendix 5 MHSCP 2024 HCG falls.docx • Appendix 6 MHSCP, New Risks on Partnership Register Appendix 6 MHSCP 2024 New Partnership Risks Graded High.docx Page 240 of 286
Page 241
Appendix 3 – MHSCP Governance and Assurance Framework Overview Q1 2024/5 Page 241 of 286
Page 242
Page 242 of 286
Page 243
Midlothian Integration Joint Board Thursday, 24th October 2024, 14:00-16:00 Independent Investigation of the National Health Service in England Report (The Darzi Report) Executive summary This report considers the recent Independent Investigation of the National Health Service in England and presents some of the key themes as they relate to Midlothian IJB for discussion. Lord Darzi was commissioned by the UK Government Secretary of State for Health & Social Care to undertake a rapid investigation of the NHS in England that considered patient access, quality of care and overall performance. The report considers how demand for healthcare has changed, the reasons why it has risen, and examines the challenges faced across the system (appendix 1). A summary of the report produced by Carnall Farrar is also provided in appendix 2. Although the report was written in regard to NHS England, there are many similarities to the Scottish position including challenges with integration and issues of capacity and demand. Additionally, the report raises some key themes that Midlothian IJB may wish to discuss. Members are asked to: • Review the Independent Investigation of the National Health Service in England (appendices 1 and 2). • Consider some of the key themes as they relate to Midlothian IJB. • Discuss and consider if the Board wishes to take any action in response. Item number: 5.12 Page 243 of 286
Page 244
Midlothian Integration Joint Board Midlothian Integration Joint Board Independent Investigation of the National Health Service in England Report (The Darzi Report) 1 Purpose 1.1 This report considers the recent Independent Investigation of the National Health Service in England and presents some of the key themes as they relate to Midlothian IJB for discussion. 2 Recommendations 2.1 As a result of this report, Members are asked to; • Review the Independent Investigation of the National Health Service in England (appendices 1 and 2). • Consider some of the key themes as they relate to Midlothian IJB. • Discuss and consider if the Board wishes to take any action in response. 3 Background and main report 3.1 Lord Darzi was commissioned by the UK Government Secretary of State for Health & Social Care to undertake a rapid investigation of the NHS in England that considered patient access, quality of care and overall performance. The report considers how demand for healthcare has changed, the reasons why it has risen, and examines the challenges faced across the system (appendix 1). A summary of the report produced by Carnall Farrar is also provided in appendix 2. 3.2 Although the report was written in relation to NHS England, there are many similarities to the Scottish position including challenges with integration and issues of capacity and demand. Additionally, the report raises some key themes that Midlothian IJB may wish to discuss. 3.3 Aligning strategy and resources Darzi notes that strategic ambitions have not been followed with the appropriate allocation of funding steams and that poor productivity in Acute services has continued to drive increasing expenditure. Despite hospital funding increasing from 47% to 58% of the NHS budget since 2006 and a 17% increase in hospital staff since 2019, Darzi notes there are 7% fewer out-patient appointments per consultant and 18% less activity per emergency department clinician. This contrasts with over 60% of all healthcare activity taking place in primary care and Darzi recommends Page 244 of 286
Page 245
Midlothian Integration Joint Board that financial flow is changed to sustain and expand GP, mental health & community services at a local level. 3.4 Midlothian IJB have already commissioned the Strategic Planning Group (SPG) to scope out viable opportunities to support General Practice in Midlothian and work in underway to consider a set of proposals for the Boards review. Seeking opportunities to divert resources appropriate from secondary care and ensuring people receive safe, efficient, and person-centred services close to home from the services best placed to deliver this care and support is a priority workstream to support local ambitions and national strategy. 3.5 General Practice provides General Medical Services to every person in Midlothian whenever they need them. Practices are a key first point of access for a range of health and social care issues, at relatively low cost per capita. The independent contractor model allows practices to maximise local productivity by being in control of their own resources and matching them to demand and workload as needed. The Health and Care Experience Survey (HACE) 2024 shows that access to a GP in Midlothian has improved in the last 2 years and data from the Tableau and Discovery dashboards that self-attendance at A&E with subsequent discharge home (suggesting low acuity problem) has not increased. 3.6 However, this should be viewed as a temporary position only and the Board may wish to consider how to plan for the significant pressure on health and social care that lie ahead. The rate of direct clinical activity in general practice in Midlothian is already higher than in the other Lothian HSCPs and this is unlikely to be sustainable in longer-term with appropriate review to funding. Increased primary demand from disproportionately high morbidity across a range of long-term conditions and the demand cumulating from long waiting lists for hospital services coupled with a predicted 22.9% growth in the Midlothian population over the next 10 years (and 40% growth in the over 75 years population), creates a risk to the sustainability of community services including General Practice and the provision of general medical services locally. 3.7 Planning ahead Darzi highlights 3 areas of emerging increases in mortality: cardiovascular disease, cancer, and dementia. Local and national public health approaches and re- designed pathways of care emphasising the significance of preventative care and early intervention strategies will be required to improve long-term health outcomes and maximise available resources. 3.8 Although prevention is a focus of Midlothian IJBs strategy, the Board may wish to consider increasing support and resources specifically for preventative strategies that could significantly improve health and care within the community. Although it is unhelpful to evaluate prevention intervention by what they cost, there is a risk that this approach will require a range of reallocated or new resource commitments and result in agreed disinvestment in other areas or exacerbate the current financial challenges. 3.9 Additionally, the appropriate use of evidence-based medicines for the prevention and treatment of these conditions is also likely to create increased pressure on the local prescribing budget, and this should be noted as a risk. Page 245 of 286
Page 246
Midlothian Integration Joint Board 3.10 Wider Perspective The review is written from the perspective of the NHS and its underlying and underpinning principles. This leads to some useful insights, but also highlights a number of noteworthy omissions. Darzi mentions the need for accountability but does not address how the system frequently discourages ownership. The report also highlights the need for people to work together but makes no mention of the leadership styles that predicate how the system behaves and can prevent people being able to work together. Most importantly, the report notes that the focus of managers and leaders is predominately cost and measures, rather than recognising the causes of cost, and where there is value. 3.11 The mechanisms of the NHS are underpinned by the principles of New Public Management. In this context, no matter what improvements are desired, the principles of New Public Management will ultimately dictate their design and behaviour. We know the workforce will collectively behave as the 'system' drives them to with any attempt to shift this met by pressure to comply. The only solution is to remove systemic barriers and to allow the new to replace the old. 3.12 Data quality, planning and intelligence support Darzi notes a step-change improvement in data quality is required and, while there are some examples of good practice, the NHS has struggled with data-sharing to improve the quality of care. 3.13 However, without well designed integrated data sets and solutions, attempting to tie pieces of the system together when they are not designed to do risks a much bigger challenge. This approach risks embedding processes that are highly inefficient and ultimately make change more difficult. 3.14 In Midlothian, data sharing across health and social care continues to be challenging. Faster progress is required to ensure data sharing agreement are in place to support the creation of an integrated health and care data dashboard with the potential to generate new insights across the system that can truly transform service delivery. Darzi is unequivocal in support for integrated, multidisciplinary team drawing insights from integrated datasets. However, without the ability to integrate data and have confidence in their interpretation, progressing the wrong initiatives remains a risk. 3.15 The Board may wish to consider how they are able to support the ambition to the and effectively utilise integrated datasets, and create population level insights that inform strategic planning, operational service design to improve outcomes. 3.16 Opportunities for new outlooks Midlothian IJB has an opportunity to consider the disproportionate level of attention on data collection and analysis within the acute hospital sector. The Board may wish to consider if reporting using acute hospital metrics e.g. delayed discharges, readmission rates has contributed to a culture of “what gets measured gets managed” and the risk of what gets measured, gets funded. Page 246 of 286
Page 247
Midlothian Integration Joint Board 3.17 There is an opportunity to consider the need for both effectiveness and efficiency, the concepts and actions we apply to understand these concepts and understand how they are distinctly different from each other. 3.18 Efficiency is easier to identify and measure, most often aiming to cut costs, or improve, but whether an efficiency is effective is more difficult to determine. Effectiveness is about understanding how well we are working, and we rarely focus on measuring this. 3.19 However, if we did invest in understanding effectiveness, we would better understand the causes of cost. If we better understand effectiveness and what creates cost, we can also reduce costs. Understanding and evaluating effectiveness also considers value, waste, variation, and outcomes (not outputs) and supports the systemic change required to drive improvement or innovation. In this context, a reductionist approach of solving individual problems is not how to either understand these concepts or drive innovation in a complex system. 3.20 There is an opportunity to consider how the Board wishes to address the challenges of working within complexity and the means by which to approach this. 4 Policy Implications 4.1 There are no implications for policy as a direct result of this report. 5 Directions 5.1 There are no implications for Directions as a direct result of this report. 6 Equalities Implications 6.1 There are no implications for people with protected characteristics as a direct result of this report. 7 Resource Implications 7.1 There are no implications for Best Value as a direct result of this report. However, should the board wish to consider any action in response to this report, identified resource and capacity and for any action must be considered and agreed by members. Page 247 of 286
Page 248
Midlothian Integration Joint Board 8 Risk 8.1 There are no direct risks to Midlothian IJB as a result of this report. However, there are key similarities and parallels to be drawn that create opportunities to reframe the IJBs response to system pressures. 9 Involving people 9.1 n/a 10 Background Papers 10.1 None AUTHOR’S NAME Gill Main DESIGNATION Integration Manager CONTACT INFO Via email or MS Teams DATE 02/10/2024 Appendices: Appendix 1: Independent Investigation of the National Health Service in England Appendix 2: Darzi Investigation of the NHS In England Summary Page 248 of 286
Page 249
Page 249 of 286
Page 250
Page 250 of 286
Page 251
Midlothian Integration Joint Board Thursday, 24th October 2024, 14:00-16:00 MIJB Finance Update - 2024/25 projected out-turn and Further revision to Medium Term Financial Strategy. Executive summary Midlothian Integration Joint Board (IJB) members are aware of the financial challenges that the IJB. The IJB, working closely with its partners, has stepped up its financial monitoring and management processes in year and this paper lays out: • The most recent financial out-turn position for 2024/25. If further information regarding the quarter two financial reviews is available from the Partners, this will be shared verbally at this meeting. • An update of the IJB’s Medium Term Financial Strategy (MTFS). • A reflection on the discussion held at the IJB’s Finance Workshop on 19th September 2024. • A consideration of further recovery actions that will be required to bring the IJB back into financial balance in 2024/25 and 2025/26. It is proposed that an updated MTFS will be presented to the IJB at its December 2024 meeting. Given the timescales and the discussions required to develop and deliver further recovery actions, it is suggested that the IJB have a finance workshop in November 2024. Members are asked to: • Note the financial out-turn forecast below, based on the Health month 5 position and the revised Q1 position from Social Care. • Note the on-going revisions to the MTFS. • Note the next actions for financial recovery/financial planning up to March 2025 • Agree to additional finance workshop in November 2024 Item number: 5.13 Page 251 of 286
Page 252
Midlothian Integration Joint Board Midlothian Integration Joint Board MIJB Finance Update – Quarter 2, 2024/25 and Further revision to Medium Term Financial Strategy 1 Purpose 1.1 This report sets out the following: • An update of the IJB’s forecast out-turn position based on the most recently available information. If further information is available from the Partners, this will be shared verbally at this meeting. • An update of the IJB’s Medium Term Financial Strategy (MTFS) • A reflection on the discussion held at the IJB’s Finance Workshop on 19th September 2024.including • A consideration of further recovery actions that will be required to bring the IJB back into financial balance in 2024/25 and 2025/26. • Given that the IJB does not next meet until December 2024 and the timescales required to consider, develop, and agree further recovery actions its proposed that the IJB holds financial recovery workshop in November 2024 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the financial out-turn forecast below, based on the Health month 5 position and the revised Q1 position from Social Care. • Note the on-going revisions to the MTFS. • Note the next actions for financial recovery/financial planning up to March 2025. • Agree to additional finance workshop in November 2024 3 Background and main report 3.1 At its March 2024 meeting, the IJB set a balanced budget for 2024/25. This was based on three elements – o The delivery of a range of recovery actions both in the health and social care budgets. o Working with the other Lothian’s IJBs and NHSiL colleagues to resolve an outstanding pressure within the Set Aside budgets. o Management of the demand within the social care services in year to bring the operational budgets back into balance. 3.2 Recognising the nature of the financial challenge in 2024/25 (and in future years) the IJB has stepped up its financial management and planning processes, taking 2024/25 financial updates to each meeting and continuously reviewing its future Page 252 of 286
Page 253
Midlothian Integration Joint Board financial plan (The Medium-Term Financial Strategy (MTFS)) with a view to publishing a further MTFS in December 2024. This work is however, constrained by the financial information available from the IJB partners – NHS Lothian and Midlothian Council – and the quarter two forecast 24/25 out-turn was not available at the time of the preparation of this paper. However, both partners have provided the IJB with their updated five-year financial plans which allows a further revision to the IJB’s own MTFS. 3.3 Based on the most recent financial forecast (that is an out-turn forecast based on the month 5 position from NHS Lothian and an adjusted quarter 1 position from Midlothian Council) the projected 24/25 out-turn position is 3.4 This is an improvement on the position noted at the quarter one forecast (an overspend of £9.1m) with the main improvement being in the social care budget. This is a result of further work around the delivery of the social care recovery actions and a detailed review of the financial forecasting for the social care commissioned services. Appendix 1 lays out the movements between the quarter one forecast and the position above. The underlying financial pressures identified in the quarter one financial forecast remain. That said, indications from NHS Lothian colleagues are that there has been a significant deterioration in the prescribing position, and it is likely that the core health forecast position above will deteriorate further as a result. 3.5 The IJB is a Strategic Planning body. The purpose of its budget is to allow it to deliver its Strategic Plan. However, this comes with the responsibility to manage that budget appropriately which means that the IJB must not only set a balanced budget but also ensure that the budget breaks even in year. Operational management of the IJB’s services (and therefore the day-to-day utilisation of the IJBs funds) rests in the hand of the Partners. In operational terms the social care and core health budgets are managed by the Midlothian Health and Social Care Partnership and the hosted and set aside budgets by NHS Lothian. The IJB receives assurance around the operational management and governance of its budgets through the partners and obviously some of the members of the IJB are also operational managers in the HSCP with the Chief Officer of the IJB also being the Director of the Health and Social Care partnership. Table 1 - Midlothian IJB - 2024/25 projected out-turn £000's Health Core (2,198) Hosted (19) Set Aside (610) Social Care (5,500) Total (8,327) Figures - variance, (overspend)/Underspend Page 253 of 286
Page 254
Midlothian Integration Joint Board 3.6 The IJB is governed by its Integration Scheme which makes provision for the management of its budget. The scheme notes that – • The management of the IJB’s budget rests with the Chief Officer • If an overspend is forecast, then the Partners will present the IJB with a recovery plan. • If the proposed remedial action will not prevent the overspend then the Chief Financial Officer will, together with the relevant party develop a proposed recovery plan. • The IJB must be satisfied with that recovery plan, and that plan is subject to the IJB’s approval. 3.7 The quarter one forecast an overspend in year and the partners have brought back a series of recovery actions to the IJB. In additional to this the HSCP has stepped up its own financial management and has held a series of detailed recovery meetings to progress the agreed recovery actions (from the IJB’s budget setting) and also to develop further proposals. 3.8 The IJB held a finance workshop after its business meeting on 19th September 2024. This workshop presented further schemes that are being developed in year, and a consideration of transformational work that will change the way that the HSCP (and its own Partners) deliver their services. This transformational work is designed to both allow the IJB to deliver its delegated functions within the resources available to it and to continue to deliver its Strategic Plan. Appendices 2 and 3 lay out the outlines of these programmes. This workshop also addressed the issues operational financial management and governance as discussed above. 3.9 These recovery actions are in response both to the requirement to achieve financial balance in year, and to bring together a balanced five-year financial plan (the MTFS) which will articulate in financial terms how the IJB will deliver its Strategic Plan. 3.10 The Integration Scheme further addresses in year financial management, in that the IJB can request further financial allocations from the partners but notes that, failing all recovery actions then any residual overspend must be met by the party wherein the overspend fell. 3.11 The Chief Officer and the Chief Finance Officer are very conscious of the responsibilities of the IJB and remain in close dialogue with the Partners both to ensure that they support any proposed recovery actions and that they are fully appraised of the financial pressures facing the IJB. However, to break-even in 2024/25 and given the time constraints, a series of ‘emergency’ actions may now be required. 3.12 As was discussed above, the MTFS will be continually updated to reflect the nature of the financial challenges in future years and to support the design of a balanced multi-year financial plan. Appendix 4 shows the current update along with a series of notes clarifying the contents of each line. At this time this shows a very challenging series of financial pressures, but this will change as the plan is further developed. There are four key elements that now require to be input into this plan: Page 254 of 286
Page 255
Midlothian Integration Joint Board • A proper review of the opening social care pressure. At this time, it seems very challenging to bring the social care position back into recurrent balance and if this is not possible in 2024/25 then a longer-term plan is required. • A clearer understanding of the financial impact of transitions and demography, the current numbers simply being proxies. • There are no recovery actions in this plan for social care and these along with further recovery actions for the health budgets require to be included. • It is not clear what, if any, additional resources will be made available for social care and health provision from the UK budget on 30/10/24 and the Scottish Government’s budget in 3/12/24. Having completed the above, a final MTFS will be presented to the IJB at its December 2024 meeting. 3.13 The next formal meeting of the IJB is in December 2024. However, it’s important that the IJB has a proper opportunity to consider the recovery actions being proposed both for 2024/25 and for future years along with the transformation programme which will be required to bring the IJB back into long term balance. The appendices which lay out proposed schemes remain at a very high level and these need to be worked up for the IJB’s consideration. It is therefore suggested that a further finance workshop is schedule for an appropriate date in November. 3.14 There remain a range of risks of which the most significant being: • Pay Awards – both in health and in social care, the full funding of these is dependent on additional funds from the Scottish Government. Given the nature of this funding that may increase the financial challenges. • Service and Supplies Inflation – estimates have been made for the increased costs of drugs in future years along with the increased costs of the delivery of social care commissioned from third parties. Given the experience of the past few years this is a major risk. • Mapping onto the IJB’ Strategic Plan – this challenge, identified previously remains. It is possible that any recovery actions are simply a financial reaction to financial pressures, and this may present a risk to the delivery of the IJB’s Strategic Plan. Work continues to ensure that the financial plan (MTFS) support the delivery of the Strategic Plan. 3.15 As was discussed above, by the end of December the IJB will have a clearer picture of the Scottish Government’s budget and any further financial plans from its Partners. Ideally at its December meeting a clear plan for the delivery of financial balance in 2024/25 can be presented with a revised MTFS and a series of indicative recovery actions to allow the IJB to deliver a balanced financial position or 2025/26. 4 Policy Implications 4.1 There are no new policy implications in this paper. 5 Directions Page 255 of 286
Page 256
Midlothian Integration Joint Board 5.1 There is no requirement for a new or a revision to any existing IJB directions in this paper. 6 Equalities Implications 6.1 This report has no implications for groups of people with protected characteristics. 7. Resource Implications 7.1 The financial considerations are discussed above. 8 Risk 8.1 The risk around the management of the IJB’s financial resources is captured in the IJB’s risk register 9 Involving people 9.1 There are no direct implications for people in this paper. 10 Background Papers 10.1 IJB Quarter one finance updated – presented to the IJB at its August 2024 meeting. AUTHOR’S NAME David King DESIGNATION Interim Chief Finance Officer CONTACT INFO David.king4@scot.nhs DATE October 2024 Appendices: Appendix 1: Movements between the Quarter 1 social care out-turn forecast and the amended value. Appendix 2: Further short-term bridging actions being developed Appendix 3: Further transformational areas being developed Appendix 4: Revised Medium-Term Financial Strategy Page 256 of 286
Page 257
Appendix 1: Movements in the social are out-turn forecast Q1 to amended value used above Page 257 of 286
Page 258
Page 258 of 286
Page 259
Appendix 2: Further short-term bridging actions being developed Page 259 of 286
Page 260
Page 260 of 286
Page 261
Appendix 3: Further transformational areas being developed Page 261 of 286
Page 262
Page 262 of 286
Page 263
Appendix 4: Revised Medium-Term Financial Strategy Midlothian Integration Joint Board Revised Medium Term Financial Strategy Notes 25/26 26/27 27/28 28/29 29/30 Health £000's £000's £000's £000's £000's Core (3,537) (4,334) (5,159) (6,017) (6,920) 1 Hosted (297) (485) (594) (711) (833) 1 Set Aside (1,496) (1,568) (1,726) (1,893) (2,064) 1 Social Care Opening (4,000) (6,000) (7,000) (8,000) (9,000) 2 In Year Pressures (1,128) (1,128) (1,128) (1,128) (1,128) 3 Transitions/Demography (2,000) (1,000) (1,000) (1,000) (1,000) 4 Add'n MLC Allocations 1,128 1,128 1,128 1,128 1,128 5 Total (11,330) (13,386) (15,479) (17,621) (19,817) Notes 1. This is an extract from the first iteration of the NHS Lothian five-year plan. Recovery actions are in the process of being developed to manage these pressures. 2. The opening position is to move the social care forecast onto the same basis as the health forecast. That is, any pressures not recurrently resolved in year will require to be managed in future years. The opening position for 2025/26 is simply a proxy and required to be developed. There are no recovery actions in this position. 3 and 5. Midlothian Council's MTFS makes provision for pay awards for the staff employed in social care along with a provision for inflation in the costs of third-party social care. Any funding from Midlothian Council will require to be formally agreed by Midlothian Council 4. Work is underway to refine these values. Page 263 of 286
Page 264
Page 264 of 286
Page 265
Midlothian Integration Joint Board Thursday, 24th October 2024, 14:00-16:00 Midlothian Community Payback Order Annual Report 2023-2024 Executive summary The Community Payback Order (CPO) was introduced under the Criminal Justice and Licensing (Scotland) Act 2010 and came into effect on 1st February 2011. The legislation that had governed these disposals, the Criminal Procedure (Scotland) Act 1995 (the 1995 Act), was amended by the Criminal Justice and Licensing (Scotland) Act 2010. Section 227ZM of the Criminal Procedure (Scotland) Act 1995 imposes a duty on local authorities to submit annual reports on the operation of the CPO. Each Local Authority area submits their annual report to Community Justice Scotland who prepare a summary report which will be laid before Parliament by 31st March 2024, in accordance with the 1995 Act, and then published online. The template for the 2023-2024 annual report has changed in its format with a greater emphasis on qualitative data alongside statistical information to answer the set questions. A CPO may include one or more requirements: *Supervision, *Unpaid work or other activity, Programme, Compensation, Residence, Mental health, Drug Treatment, Alcohol Treatment, Conduct and Restricted movement (electronic monitoring). It can be made for a period of time between 6 months and 3 years, other than when it consists solely of an unpaid work or other activity requirement in which case it must be completed within 6 months unless the court determines otherwise. * These are the only 2 requirements that can be standalone. The other requirements must have supervision included also. This report is a summary of the 2023-2024 CPO Annual Report. Members are asked to: Note the contents of the report. Item number: 5.14 Page 265 of 286
Page 266
Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian CPO Annual Report 2023-2024 1 Purpose 1.1 This report sets out the activity carried out by the Midlothian Justice Service as part of the supervision and management of those subject to a Community Payback Order (CPO) during 2023-2024. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the contents of the report. 3 Background and main report 3.1 The requirement for ‘annual reports on community payback orders’ is outlined in section 227ZM of the Criminal Procedure (Scotland) Act 1995 (the 1995 Act). The report is submitted, as soon as practicable, after the end of each reporting year on the operation of Community Payback Orders within the Local Authority area. The “reporting year” means a year ending on 31st March. Once all Annual Reports are completed, Community Justice Scotland will prepare a summary report to be published online. The summary report will be laid in Parliament by 31 March 2025, in accordance with the 1995 Act and Local Authorities will be updated by Community Justice Scotland (CJS) when the summary report will be laid and published. 3.2 Key points from the report: Reducing risk of reoffending: In Midlothian we have continued to work with men and women subject to Community Payback Orders who present with a wide range of presenting risk and needs - mental health, substance use, adverse childhood experiences, trauma and negative experiences of education and or employment. Over the reporting year, 227 Community Payback Orders (CPO) were imposed; 154 with a supervision requirement and 149 with an Unpaid Work requirement. The aim of supervision is to reduce and manage the risk of re-offending, and of causing harm, through providing the individual with opportunities to engage in a process of change; with the aim of increasing their ability to desist from offending in the longer term. A range of supports are provided to service users including our ‘Stride’ programme focused on improving men’s emotional management skills and decision making. We utilise a multiagency approach to support individuals and develop individualised case Page 266 of 286
Page 267
Midlothian Integration Joint Board management plans to effectively address the risk and needs associated with an individual’s offending behaviour. The work undertaken by our Unpaid Work Team is underpinned by the ideals of reparation, rehabilitation and reintegration and aims to provide a clear pathway to support those who have been convicted of offences to achieve a positive destination and provide meaningful benefit to our local communities. During the current reporting year the Unpaid Work team completed 309 projects benefitting 236 beneficiaries, an increase from the previous reporting year where we completed 278 projects benefiting 221 beneficiaries. We strive to target beneficiaries most in need, as well as communities most affected by crime and anti-social behaviour. We continued to deliver and develop an internal training pathway for service users as part of the ‘other activity’. During 2023-2024 eighty-three individuals achieved 110 qualifications. The health and safety induction is delivered by staff following an accredited SCQF level 4 syllabus and if service users would like to obtain the qualification they complete an assessment at the end of the induction; we have issued 76 awards to individuals through this method. In total, 98 awards have been completed through our internal training pathway and this year we had our first two clients complete SVQ Level 2 qualification in Work Skills. This has been an exciting development, and one service user used their qualifications to successfully apply to College and started a full time course in August 2024 Organisational improvements and ongoing challenges: Transition of young people from Children to Adult Justice Services was noted as an area for development in the previous annual report. During 23/24 we worked alongside Community Justice Co-ordinator to undertake consultation with young people, stakeholders, third sector partners and social work staff. This research will shape development of policies around transition to ensure that are services continue to be informed by research and knowledge of best practice with the rights of the child at the core. Collaborative working across justice partnerships: We have continued to develop our interventions and services to support service users to live in, and be part of, their community and be responsible citizens. During the reporting year we partnered with colleagues from the Psychological Services Team to ensure that staff are confident in how to respond, and work alongside, those with complex needs and to ensure that risk assessments and risk management plans are robust. This is achieved through weekly formulation sessions and access to clinical supervision with a Psychologist. Through this they are supported to manage the complexities of the work and reduce the risk of vicarious trauma. We work with third sector partners in our local communities to enable service users to improve their connections and promote reintegration. Working in partnership with the 3rd sector we provide 34 placements available each week. Individual placements are available in local charity shops, a cat and dog home, foodbanks and pantries, and community gardens. We commission a service from Cyrenians who provide 12 placements over 3 days in a community garden. In the reporting year 23 clients undertook their Unpaid Work Requirement with Cyrenians, completing 915 hours of work. This community garden is in the grounds of a local Community Hospital where those requiring hospital care and their families can access a safe, relaxing outdoor space Page 267 of 286
Page 268
Midlothian Integration Joint Board We continue to make use of personal change programmes under the ‘other activity’ to assist service users develop skills to increase desistance. Individuals have undertaken programmes with Venture Trust, Midlothian Psychological Services and the internal Justice Services bespoke groupwork programmes: STRIDE (for men) and SPRING (for women). Case Studies/feedback: *James* received a CPO with a requirement to complete 165 Unpaid Work Hours within a period of 1 year. This was James’ first offence, which had a detrimental impact upon his employment, family relationships and his mental health. James had been employed for 20 years prior to receiving this Order and due to his offending had lost his job. Through working closely with Community Payback Case Managers and Unpaid Work Supervisors, a plan was developed to support him to gain confidence, and support him onto a pathway into further education and future employment. James initially gained Health and Safety in the Workplace (SCQF Level 4) and Emergency First Aid at Work in-house. Gaining these qualifications increased James’ confidence and led him to access other training and employment services such as Access to Industry, Skills Development Scotland and Community Life-Long Learning and Education (CLLE). Furthermore, James successfully secured funding through CLLE in order to gain his HGV Class 2 licence and was able to maximise his ‘other activity’ hours. When James completed his unpaid work order, he was still engaging with CLLE and had developed great working relationships with many support services throughout Midlothian. James provided feedback to Unpaid Work staff on completion of his order stating: “I am very grateful to the assistance and support from Midlothian Unpaid Work team, especially the team who in my opinion are exceptional in the course of their duties. It was them that put me in touch with CLLE who in turn are now funding me for the process of applying to be an HGV driver”. • “I think routine is the most important for people on a CPO. If you have structure, commitment then it gets you away from people and old behaviour. Previously I had a tag and that forced me to be more structured and planned. With the tag I knew I had to be home and this helped me break a cycle of being out late at night partying.” • LC stated the CPO has been keeping him out of trouble and that he has got ‘good stuff’ out of this, including support with his tenancy and being linked in with CGL. He reflected that it has been positive to speak to his social worker and his Recovery Coordinator from CGL around his alcohol use and feels that he has a better understanding of his feelings around his use of alcohol and that his alcohol use has reduced. • “I have really enjoyed my time at CS and Supervision. I was always made to feel valued, considered and like I was worth something. I will really miss the service”. Beneficiary Feedback: • “Thank you so much for the wonderful help. Without this help my sister would not be able to afford the house move which had enabled her to more into assisted living which allows us to relax more.” • “Just wanted to say thank you so much for all your help today with the uplift from our garden and outhouse - it was so brilliant to get it all cleared” • “Delighted with the service that they have given us at the Penicuik Family Learning Centre. They left the area clean and tidy. They even went the extra mile and took things to the dump for us.” Page 268 of 286
Page 269
Midlothian Integration Joint Board • “Superb service. All off the team were polite, respectful, and incredibly hard working. I am extremely grateful. Thanks very much.” 4 Policy Implications 4.1 None 5 Directions 5.1 This report is for the financial year 2023-2024 and I have referenced the relevant directions: Living in the Community 2.1 Positive Experiences and Dignity 3.1 & 3.2 Quality of life 4.1 Health inequalities 5.1 Safe from harm 7.1, 7.2 & 7.3 5.2 This report does not highlight any issues with respect to abilities to deliver on existing Directions or the need for revisions. 6 Equalities Implications 6.1 An Inequalities Impact Assessment has been completed. 6.2 The Justice Service utilises information from a range of sources, including the HSCP Joint Needs Strategic Assessment and Justice Analytical Services (Scottish Government) to ensure that the work undertaken meets the needs of those from the area and those who have been affected by crime 7 Resource Implications 7.1 An Inequalities Impact Assessment has been completed. 8 Risk 8.1 The main risk associated with the delivery of Community Payback Orders remains the Courts and the wider public having the confidence in the effectiveness of CPOs in reducing the risk of harm and of re-offending. 9 Involving people 9.1 The Justice Service ensure that the needs of the local community are considered, and we achieve this through seeking feedback at regular intervals from beneficiaries and those involved in the Justice system. We have a well- established focus group ‘Bound’ whose participants are community advisors of Page 269 of 286
Page 270
Midlothian Integration Joint Board clients, past and present. They critique decisions made through the Community Justice Improvement Plan to help steer necessary changes and directly contribute to service delivery by being part of the recruitment process for Justice Social Workers. 9.2 The Community Justice (Scotland) Act places a duty of co-operation on community justice partners to work together to plan and decide how services are tailored locally. Consultation remains key to the work undertaken by Community Justice Partnership and over the reporting year a variety of methods have been used to ensure that community voices are captured to support development and delivery of service provision. This includes working to understand and incorporate the voices of victims of crime, survivors, those with lived experience and their families into our planning and implementation of services. 10 Background Papers 10.1 Please see appendices for the full copy of the Midlothian CPO Annual Report for the reporting year. Should further information be required the following papers can be provided on request: • Midlothian Community Payback Annual Report 2023-2024; • Community Payback Order (Practice Guidance). AUTHOR’S NAME Julie Jessup DESIGNATION Service Manager, Justice and Protection Services CONTACT INFO Julie.jessup@midlothian.gov.uk DATE 25.9.24 Appendices: Appendix 1: Midlothian Community Payback Order (CPO) 2023/24 Page 270 of 286
Page 271
Midlothian Integration Joint Board Thursday, 24th October 2024, 14:00-16:00 Review of Risk Management Policy Executive summary The Midlothian Integration Board (IJB) approved its risk management policy at its meeting in February 2016 and best practice would require the IJB now reviews its risk management policy. A paper was presented to the IJB’s Audit and Risk Committee at its June 2024 meeting which considered a review of the risk management policy and ask the committee for its view. The review was largely to ensure that the policy was less generic and more specific to the IJB. The Audit and Risk Committee agreed to the correction of a couple of typos and a small change to the text. The Audit and Risk Committee recommended that this revised risk management policy be adopted by the IJB. Members are asked to: • Adopt the revised IJB risk management policy. # Item number: 5.15 Page 271 of 286
Page 272
Midlothian Integration Joint Board Midlothian Integration Joint Board Review of Risk Management Policy 1 Purpose 1.1 This report sets out the revised IJB risk management policy. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Adopt the revised IJB risk management policy 3 Background and main report 3.1 The IJB agreed and adopted its Risk Management Policy at its February 2016 meeting. 3.2 At its December 2017 meeting, the IJB’s Audit and Risk Committee reflected on the policy and noted that ‘the IJB’s risk register (and risk management process) recognises the risk to the IJB’s own business – that is the preparation and delivery of the Strategic Plan. The IJB’s does not consider ‘operational’ risks, being the risks managed by the partners unless these risks are so significant that they would impact on the IJB’s Strategic plan. That said, it should be remembered that IJB is not in a position to manage such operational risks and would, in any event, depend on the management actions of the partners’ 3.3 The Risk Management Policy now requires to be revised, reflecting the experience of the IJB over the past eight years. 3.4 The 2016 Risk Management Policy has been reviewed taking into account - • The Audit and Risk Committee’s reflection on what risks should be captured in the register, that is risks to the production and delivery of the Strategic Plan and the operational risks that will impact on the delivery of the Strategic Plan • That the policy should reflect more correctly the current arrangement for the management of the IJB and the support from the IJB partners. 3.5 The changes are not material but reflect that the IJB does not directly employ staff, deliver services directly nor have its own senior management team. 3.6 This revised risk management policy was presented to the IJB’s Audit and Risk committee at its June 2024 meeting for consideration. It was agreed to amend a few typos and make a simple change to the text (under item 1.5 the text was Page 272 of 286
Page 273
Midlothian Integration Joint Board changed to ‘treat, tolerate and mitigate risk’ instead of ‘terminate, transfer or treat risk). 3.7. The Audit and risk committee agreed to recommend the adoption of this revised risk management policy to the IJB. 4 Policy Implications 4.1 This is not a new policy but a revision to an existing one. 5 Directions 5.1 This report neither requires a new direction nor any amendments to the IJB’s existing directions. 6 Equalities Implications 6.1 This report has no implications for groups of people with protected characteristics. 7 Resource Implications 7.1 There are no resource implications arising from this report. 8 Risk 8.1 This report is about the IJB’s policy on the management of risk, as such it does not change the risks that the IJB is required to manage. 9 Involving people 9.1 The IJB holds its meetings in public and makes its papers available to the public. 10 Background Papers 10.1 None. AUTHOR’S NAME David King DESIGNATION Interim Chief Finance Officer CONTACT INFO David.king4@nhs.scot DATE October 2024 Appendices: Appendix 1: Revised IJB Risk Management Policy Page 273 of 286
Page 274
Page 274 of 286
Page 275
Midlothian Integration Joint Board Risk Management Policy Version No. 1.1 Date Effective: 00/00/0000 Review Date: 27/05/24 Page 275 of 286
Page 276
P a g e | 1 CONTENTS Policy – the risk management approach ................................................................................................ 2 Implementing the policy ...........................................................................................................................4 1. Introduction ........................................................................................................................................ 4 2. Risk management process ................................................................................................................. 4 3. Application of good risk management across the IJB activities ........................................................... 5 Realising the risk management vision ................................................................................................... 6 4. Risk management vision and measures of success ........................................................................... 6 Risk leadership and accountability ........................................................................................................ 6 5. Governance, roles and responsibilities ............................................................................................... 6 Resourcing risk management ................................................................................................................. 7 6. Resourcing the risk management framework ..................................................................................... 7 7. Resourcing those responsible for managing specific risks .................................................................. 7 Training, learning and development ...................................................................................................... 8 8. Risk management training and development opportunities ................................................................ 8 Monitoring activity and performance ......................................................................................................8 9. Monitoring risk management activity .................................................................................................. 8 10. Monitoring risk management performance ..........................................................................................8 Communicating risk management ......................................................................................................... 9 11. Communicating, consulting on and reviewing the risk management framework .................................. 9 Appendix 1 Risk Matrix ..........................................................................................................................10 Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. v. 1.1 Superseded Version: V 1.0 Date Effective: 00/00/0000 Review Date: 27/05/2024 Page 276 of 286
Page 277
P a g e | 2 Policy – the risk management approach 1.1 The Midlothian Integration Joint Board (the Board) is committed to a culture where its those involved in planning and delivering the IJB’s strategy are encouraged to develop new initiatives, improve performance and achieve goals safely, effectively and efficiently by appropriate application of good risk management practice. 1.2 In doing so the Board aims to provide safe and effective care and treatment for patients and clients, and a safe environment for everyone working within the Joint Board and others who interact with the services delivered under the direction of the Joint Board. 1.3 The Board believes that appropriate application of good risk management will prevent or mitigate the effects of loss or harm and will increase success in the delivery of better clinical and financial outcomes, objectives, achievement of targets and fewer unexpected problems. 1.4 The Board purposefully seeks to promote an environment that is risk ‘aware’ and strives to place risk management information at the heart of key decisions. This means that the Board can take an effective approach to managing risk in a way that both address significant challenges and enable positive outcomes. 1.5 In normal circumstances: • Any very low or low risk is acceptable without further action to prevent or mitigate risk, • Any medium risk is tolerable – control measures implemented or introduced must be cost effective, • Any high risk may be tolerable – providing the Board is assured regarding the adequacy and effectiveness of the control measures in place. Any further control measures implemented or introduced must be cost effective in relation to the risk. • Any critical risks is considered unacceptable and measures must be taken to treat, tolerate and mitigate these risks to a tolerable position. 1.6 This can be seen clearly in the following matrix: Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. V1.1 Superseded Version: V 1.0 Date Effective: 00/00/0000 Review Date: 27/05/2024 Page 277 of 286
Page 278
P a g e | 3 1.7 The Board promotes the pursuit of opportunities that will benefit the delivery of the Strategic Plan. Opportunity-related risk must be carefully evaluated in the context of the anticipated benefits for patients, clients and the Board. 1.8 The Board will receive assurance reports (internal and external) not only on the adequacy but also the effectiveness of its risk management arrangements and will consequently value the contribution that risk management makes to the wider governance arrangements of the Board. 1.9 The Board, through the following risk management strategy, has established a Risk Management Framework, (which covers risk policy, procedure, process, systems, risk management roles and responsibilities). Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. V 1.1 Superseded Version: V 1.0 Date Effective: 00/00/0000 Review Date: 27/05/24 Page 278 of 286
Page 279
P a g e | 4 Implementing the policy 1.1 The primary objectives of the policy will be to: ◼ promote awareness of risk and define responsibility for managing risk within the Integration Joint Board; ◼ establish communication and sharing of risk information through all areas of the Integration Joint Board; ◼ initiate measures to reduce the Integration Joint Board’s exposure to risk and potential loss; and, ◼ establish standards and principles for the efficient management of risk, including regular monitoring, reporting and review. 1.2 This policy takes a positive and holistic approach to risk management. The scope applies to all risks, whether relating to the clinical and care environment, employee safety and wellbeing, business risk, opportunities or threats. 1.3 Strategic risks represent the potential for the Integration Joint Board (IJB) to achieve (opportunity) or fail to meet (threat) its desired outcomes and objectives as set out within the Strategic Plan, and typically these risks require strategic leadership in the development of activities and application of controls to manage the risk. 1.4 Operational risks represent the potential for impact (opportunity or threat) within or arising from the activities of an individual service area or team operating within the scope of the Joint Board’s directions. Parent bodies will retain responsibility for managing operational risks as operational risks will be more ‘front-line’ in nature and the development of activities and controls to respond to these risks can be led by local managers and team leaders. Where a number of operational risks impact across multiple service areas or, because of interdependencies, require more strategic leadership, then these can be proposed for escalation to ‘strategic risk’ status for the IJB. 1.5 All risks will be analysed consistently with an evaluation of risk using the risk matrix shown in Appendix 1. 1.6 This document represents the risk management framework to be implemented across the Joint Board and will contribute to the Joint Board’s wider governance arrangements. 2. Risk management process 2.1 Risk Management is about the culture, processes and structures that are directed towards realising potential opportunities whilst managing adverse effects1. It is pro- active in understanding risk and uncertainty, it learns and builds upon existing good practice and is a continually evolving process that has an important role in ensuring that defensible and beneficial decisions are made. 2.2 The IJB will embed risk management practice by consistent application of the risk management process shown in the diagram on the right, in the planning of all all areas of service delivery and its own business activities. 1 Australia/ New Zealand Risk Management Standard, AS/NZS 4360: 2004 Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. V 1.1 Superseded Version: V 1.0 Date Effective: 00/00/0000 Review Date: 27/05/2024 1. Introduction Page 279 of 286
Page 280
P a g e | 5 3. Application of good risk management across the IJB activities 3.1 Standard procedures (3.1.1 – 3.1.10) will be implemented across all areas of activity that are under the direction of the IJB in order to achieve consistent and effective implementation of good risk management. 3.1.1 Full implementation of the risk management process. This means that risk management information should (wherever possible) be used to guide major decisions in the same way that cost and benefit analysis is used. 3.1.2 Identification of risk using standard methodologies and involving subject experts who have knowledge and experience of the activity or process under consideration. 3.1.3 Categorisation of risk under the headings below: ◼ Strategic Risks: such as risks that may arise from Political, Economical, Social, Technological, Legislative and Environmental factors that impact on the delivery of the Strategic Plan outcomes. ◼ Operational Risks: such as risks that may arise from or impact on Clinical Care and Treatment, Social Care and Treatment, Customer Service, Employee Health, Safety & Well-being, Business Continuity/ Supply Chain, Information Security and Asset Management. 3.1.4 Appropriate ownership of risk. Specific risks will be owned by/ assigned to whoever is best placed to manage the risk and oversee the development of any new risk controls required. 3.1.5 Consistent application of the agreed risk matrix to analyse risk in terms of likelihood of occurrence and potential impact, taking into account the effectiveness of risk control measures in place. The risk matrix to be used is attached in Appendix 1. 3.1.6 Consistent response to risk that is proportionate to the level of risk. This means that risk may be terminated; transferred elsewhere (ie to another partner or third party); tolerated as it is; or, treated with cost effective measures to bring it to a level where it is acceptable or tolerable for the Joint Board in keeping with its appetite/ tolerance for risk. In the case of opportunities, the Joint Board may ‘take’ an informed risk in terms of tolerating it if the opportunity is judged to be worthwhile pursuing and the Joint Board is confident in its ability to achieve the benefits and manage/ contain the associated risk. 3.1.7 Implementation and maintenance of a risk register as a means of collating risk information in a consistent format allowing comparison of risk evaluations, informed decision-making in relation to prioritising resources and ease of access to information for risk reporting. 3.1.8 Reporting of strategic risks and key operational risks to the Audit & Risk Committee on a quarterly basis and to the IJB on an annual basis, unless the quarterly reporting to the Audit & Risk Committee identifies a risk the IJB needs to be made aware of immediately. 3.1.9 Operation of a procedure for movement of risks between strategic and operational risk registers will be facilitated by the Chief Officer . 3.1.10 Routine reporting of risk information within and across teams and a commitment to a ‘lessons learned’ culture that seeks to learn from both good and poor experience in order to replicate good practice and reduce adverse events and associated complaints and claims. Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. V 1.1 Superseded Version: V 1.0 Date Effective: 00/00/0000 Review Date: 27/05/2024 Page 280 of 286
Page 281
Realising the risk management vision P a g e | 6 4. Risk management vision and measures of success 4.1 In working towards this risk management vision the Board aims to demonstrate a level of maturity where risk management is embedded and integrated in the decision making and operations of the IJB. 4.2 The measures of success for this vision will be: ◼ good financial outcomes for the Board ◼ successful delivery of the strategic plan, ◼ successful outcomes from external scrutiny ◼ fewer unexpected/ unanticipated problems in the delivery of the Board’s directions ◼ fewer incidents/ accidents/ complaints ◼ fewer claims/ less litigation Risk leadership and accountability 5. Governance, roles and responsibilities 5.1 Integration Joint board Members of the Integration Joint Board are responsible for: ◼ oversight of the IJB’s risk management arrangements; ◼ receipt and review of reports on strategic risks and any key operational risks that require to be brought to the IJB’s attention; and, ◼ ensuring they are aware of any risks linked to recommendations from the Chief Officer concerning new priorities/ policies. 5.2 Chief Officer The Chief Officer has overall accountability for the IJB’s risk management policy, ensuring that suitable and effective arrangements are in place to manage the risks relating to the functions within the scope of the IJB. The Chief Officer will keep the Chief Executives of the IJB’s partner bodies informed of any significant existing or emerging risks that could seriously impact the IJB’s ability to deliver the outcomes of the Strategic Plan or the reputation of the IJB. 5.3 Chief Finance Officer The Chief Finance Officer will be responsible for promoting arrangements to identify and manage key business/financial risks and risk mitigation. Support from the IJB’s Partners for the IJB’s Partners are responsible for: ◼ supporting the Chief Officer and Chief Financel Officer in fulfilling their risk management responsibilities; ◼ arranging professional risk management support, guidance and training from partner bodies; Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. V1.1 Superseded Version: V 1.0 Date Effective: 00/00/0000 Review Date: 27/05/2024 Appropriate and effective risk management practice will be embraced throughout the Integration Joint Board as an enabler of success, whether delivering better outcomes for the people of Midlothian, protecting the health, safety and well-being of everyone who engages with the IJB or for maximising opportunity, delivering innovation and best value, and increasing performance. Page 281 of 286
Page 282
P a g e | 7 ◼ receipt and review of regular risk reports on strategic, shared and key operational risks and escalating any matters of concern to the IJB; and, ◼ ensuring that the standard procedures set out in section three of this strategy are actively promoted across their teams and within their areas of responsibility. 5.4 Individual Risk Owners It is the responsibility of each risk owner to ensure that: ◼ risks assigned to them are analysed in keeping with the agreed risk matrix; ◼ data on which risk evaluations are based are robust and reliable so far as possible; ◼ risks are defined clearly to make explicit the scope of the challenge, opportunity or hazard and the consequences that may arise; ◼ risk is reviewed not only in terms of likelihood and impact of occurrence, but takes account of any changes in context that may affect the risk; ◼ controls that are in place to manage the risk are proportionate to the context and level of risk. 5.5 Partner Bodies It is the responsibility of relevant specialists from the partner bodies, (such as internal audit, external audit, clinical and non clinical risk managers and health and safety advisers) to attend meetings as necessary to consider the implications of risks and provide relevant advice. It is the responsibility of the partner bodies to ensure they routinely seek to identify any residual risks and liabilities they retain in relation to the activities under the direction of the IJB. 5.6 Senior Information Risk Owner Responsibility for this specific role will remain with the individual partner bodies. Resourcing risk management 6. Resourcing the risk management Policy 6.1 Much of the work on developing and leading the ongoing implementation of the risk management Policy for the Board will be resourced through the partners support to the IJB arrangements (referred to in 5.4). 6.2 Wherever possible the IJB will ensure that any related risk management training and education costs will be kept to a minimum, with the majority of risk-related courses/ training being delivered through resources already available to the IJB (the partner body risk managers/ risk management specialists). 7. Resourcing those responsible for managing specific risks 7.1 Where risks impact on a specific partner body and new risk control measures require to be developed and funded, it is expected that the costs will be borne by that partner organisation. 7.2 Financial decisions in respect of the IJB’s risk management arrangements will rest with the Chief Finance Officer. Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. V 1.1 Superseded Version: V 1.0 Date Effective: 00/00/0000 Review Date: 27/05/2024 Page 282 of 286
Page 283
P a g e | 8 Training, learning and development 8.1 To implement effectively this policy, it is essential for people to have the competence and capacity for managing risk and handling risk judgements with confidence, to focus on learning from events and past experience in relation to what has worked well or could have been managed better, and to focus on identifying malfunctioning ‘systems’ rather than people. 8.2 Training is important and is essential in embedding a positive risk management culture across all activities under the direction of the IJB and in developing risk management maturity. The Chief Officer will regularly review risk management training and development needs and source the relevant training and development opportunities required (referred to in 5.4). Monitoring activity and performance 9. Monitoring risk management activity 9.1 The Board operates in a dynamic and challenging environment. A suitable system is required to ensure risks are monitored for change in context and scoring so that appropriate response is made. 9.2 Monitoring will include review of the IJB’s risk profile at the Chief Officer’s level on a quarterly basis. 9.3 The risk register will be reviewed quarterly and presented to the IJB’s Audit and Risk committee for consideration and comment. 9.4 It is expected that partner bodies will use IJB risk reports to keep their own organisations updated on the management of the risks, highlighting any IJB risks that might impact on the partner organisation. 10. Monitoring risk management performance 10.1 Measuring, managing and monitoring risk management performance is key to the effective delivery of key objectives. 10.2 Key risk indicators (KRIs) will be linked where appropriate to specific risks to provide assurance on the performance of certain control measures. For example, specific clinical incident data can provide assurance that risks associated with the delivery of clinical care are controlled, or, budget monitoring PIs (Performance Indicators) can provide assurance that key financial risks are under control. 10.3 The performance data linked to the Strategic Plan will also inform the identification of new risks or highlight where existing risks require more attention. 10.4 Reviewing the Board’s risk management arrangements on a regular basis will also constitute a ‘Plan/ Do/ Study/ Act review cycle that will shape future risk management priorities and activities of the Board, inform subsequent revisions of this policy and drive continuous improvement in risk management across the Board. Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. V 1.1 Superseded Version: N/A Date Effective: 00/00/0000 Review Date: 27/05/24 8. Risk management training and development opportunities Page 283 of 286
Page 284
P a g e | 9 10.5 10.5 Communicating risk management 11.1 Effective communication of risk management information across the Board is essential to developing a consistent and effective approach to risk management. 11.2 Copies of this policy will be widely circulated via the Chief Officer and will form the basis of any risk management training arranged by the IJB. 11.3 This policy and strategy will be reviewed regularly to ensure that it reflects current standards and best practice in risk management and fully reflects the Integration Joint Board’s business environment. Document Title: Risk Management Policy and Strategy Owner: Chief Officer Version No. Final DraftV 1.1 Superseded Version: V 1.0 Date Effective: 00/00/0000 Review Date: 27/05/2024 11. Communicating, consulting on and reviewing the risk management policy Page 284 of 286
Page 285
P a g e | 10 Appendix 1 Risk Matrix Risk Impact Risk should be analysed consistently across the IJB in terms of the significance of its impact and the likelihood of occurrence. The Risk Matrix is therefore the tool that is to be used for this purpose. Impact When considering the consequences of a potential risk, all scenarios must be considered. It may even be appropriate to consider the worst case scenario, however, those undertaking the risk analysis must be able to provide a robust rationale and have evidence to support their selection. For example, if ‘death’ could be the ultimate potential impact in relation to a specific problem, the risk assessors must have knowledge that this outcome has occurred in the past either internal or external to the IJB area of control; Likelihood Similarly when considering the likelihood of occurrence, the risk assessor’s judgement must be based on the prevalence of the event/ circumstance and outcome, backed up by experience and data such as relevant incidents/ events. Evaluation As shown in the matrix below, Impact x Likelihood produces an evaluation of the significance of risk, described as ‘Low’, ‘Moderate’, ‘High’ or ‘Very High’. How a risk is evaluated will determine how the risk is then treated: Very Low (1-3), Low (4-8), Medium (9-15), High (16-20), Critical (25) Page 285 of 286
Page 286
Page 286 of 286