Agenda Document Pack - Midlothian Integration Joint Board - 24/08/2023
Midlothian Council · 24 August 2023
Back to Midlothian Integration Joint Board — 24 August 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Notice of Meeting and Agenda Midlothian Integration Joint Board Venue: Virtual Meeting, Date: Thursday, 24 August 2023 Time: 14:00 Morag Barrow Chief Officer Contact: Clerk Name: Mike Broadway Clerk Telephone: 0131 271 3160 Clerk Email: mike.broadway@midlothian.gov.uk Further Information: This is a meeting which is open to members of the public. Page 1 of 256
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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 the MIJB held on 22 June 2023 - for Approval 5 - 24 4.2 Minute of the Strategic Planning Group of 27 April 2023 - for noting 25 - 32 5 Public Reports 5.1 Chairs Update - Councillor McManus (Verbal) 5.2 Chief Officers Report – Morag Barrow, Chief Officer 14:20 – 14:30 33 - 40 For Decision 5.3 Annual Performance Report Final Approval - Gill Main, Integration Manager 14:30 – 14:40 41 - 132 For Discussion 5.4 Finance Update - Claire Flanagan, Chief Finance Officer 14:40- 14:50 133 - 140 5.5 IJB Performance Report - Elouise Johnstone, Performance Manager 14:50-15:00 141 - 156 5.6 Learning Disability Service Review - Nick Clater, Head of Adult Services 15:00-15:30 157 - 200 5.7 Public Health Recommendations for Midlothian IJB in response to Director Of Public Health Report Jim Sherval, Public Health Consultant 15:30-15:40 201 - 208 For Noting Page 2 of 256
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5.8 IJB Self Development Plan - Duncan Stainbank, Chief Internal Auditor 15:40-15:50 209 - 218 5.9 IJB Performance Framework - Elouise Johnstone, Performance Manager 219 - 242 5.10 Governance Position Overview - Gill Main, Integration Manager 243 - 248 5.11 Strategic Commissioning Plan 2025-28 Development Timeline - Gill Main, Integration Manager 249 - 256 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting will be held on Thursday 12 October 2023. Page 3 of 256
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday 22 June 2023 2.00pm Virtual Meeting held using Microsoft Teams. Present (voting members): Val de Souza (Chair) Angus McCann Cllr Kelly Parry Cllr Pauline Winchester Cllr Stuart McKenzie (substitute for Cllr Colin Cassidy) Cllr Derek Milligan Present (non-voting members): Morag Barrow (Chief Officer) Joan Tranent (Chief Social Work Officer) Claire Flanagan (Chief Finance Officer) Cllr McManus Wanda Fairgrieve (Staff side representative) Grace Chalmers (Staff side representative) Miriam Leighton (Third Sector) In attendance: Andrew Fleming (NHS Lothian) Nick Clater (Head of Adult & Social Care) Grace Cowan (Head of Primary Care and Older Peoples Services) Peter Knight Fiona Stratton (Chief Nurse) Matthew Curl Kevin Anderson Elouise Johnstone (Programme Manager for Performance) Jim Sherval Apologies: Cllr Colin Cassidy Rebecca Green (Clinical Director) Midlothian Integration Joint Board Thursday 24 August 2023 Item No 4.1 Page 5 of 256
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2 Midlothian Integration Joint Board Thursday 9 February 2023 1. Welcome and introductions The Chair, Val de Souza, welcomed everyone to this virtual Meeting of the Midlothian Integration Joint Board. 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 Minutes of Meeting of the MIJB Board held on 13 April 2023 was submitted. A debate took place regarding the savings option that was discussed during the previous minute due to the different interpretations understood by the committee as to whether this was a recruitment pause or a savings paused. It was suggested that we finalise this in item 5.4 to make sure that all voting members are happy with this correction from this discussion. It was highlighted that Andrew Flemming is mentioned twice in the previous minutes as present voting members and in attendance, can this be corrected? Could it be clarified which section of the report the minutes is in? 4.2 The Minutes of Meeting of the MIJB Strategic Planning Group held on 27 April 2023 were submitted and noted. 5. Public Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.1 Chair’s Update - Presented by Val de Souza Val began by commending the Chief Officer's report on the agenda, noting the comprehensive detail and numerous To note the Chair’s update All To Note Page 6 of 256
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3 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments awards that highlighted significant progress in the partnership. Val appreciated the report's breadth of topics, expressing gratitude to Morag and the entire team for their efforts. There was a mention of a chair review regarding proposed meeting dates from the Chair's report on the agenda. A correction was made to a previous report concerning the adjustment of February school dates for the 2024 calendar. A change in leadership roles was discussed via email correspondence. Cllr McManus was confirmed as the new chair for IJB, with Val moving to Vice Chair. Cllr McManus will chair the upcoming meeting on August 24th, while Val will temporarily take over the chair of the audit and risk committee. Val provided an update on a response received from the cabinet secretary in relation to challenges and discussions at the IJB. A meeting plan with civil servants from the Scottish government's policy and finance departments was shared. No updates have been received since the response, prompting Val to consider reaching out to the cabinet secretary for clarification on the engagement with civil servants. COSLA's involvement in the discussion was mentioned, and Val intends to contact COSLA to determine their preferred approach and representative, possibly Cllr Paul Kelly, Chair for Health and Social Care. Val plans to arrange a meeting inviting all IJB members to attend. In conclusion, Val will write to the cabinet secretary to inquire about Scottish government representatives and will Page 7 of 256
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4 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments reach out to COSLA. Another IJB meeting is scheduled, and all members are encouraged to participate. 5.2 Chief Officers Report – Presented by Morag Barrow, Chief Officer The report indicated that while system pressure had slightly eased in recent weeks, there was an increase in demand for acute services. The Midlothian area showed improved performance in reducing delayed discharges, with ongoing reporting to the Scottish government and collaboration with Cllr Parry and Dr. Grace Vickers to monitor delayed patients. The IJB hosted a visit by Marie Todd, focusing on the contribution of rehabilitation, particularly allied health professionals. The visit, held in May, received positive feedback and recognition. Thanks were extended to Peter for initiating this visit. A strategic inspection with the care inspectorate commenced in May, focusing on integrated inspections, specifically related to physical disability. Nick is leading this effort, and updates will be provided as feedback is received. Four nominations were received from the NHS for the Celebrating Success Awards, acknowledging outstanding performance within Midlothian Council across various categories. The standards 1-5 for medication-assisted treatment were successfully submitted, with work underway on standards Page 8 of 256
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5 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments 6-10, due for completion by March next year. Appreciation was expressed to Nick and the team for their efforts. Cllr Parry commended the well-organised and structured visit by Marie Todd, acknowledging the positive impression it left. Cllr Derek raised concerns about the takeover of Lloyds pharmacy by the same company that acquired Cobines in Bonnyrigg. He urged caution about reliance on a small number of companies and highlighted objections raised by Lloyds regarding additional pharmacies in the area. Cllr Derek emphasised the need to plan for the growth of Midlothian over the next 10 years, ensuring that facilities and services match the increasing demand. He proposed collaborative discussions between council planners and board members to identify required facilities and funding sources for development. Morag and Cllr Mulligan agreed that there is a need to assess the capacity for a specific piece of work related to health facilities. Cllr Mulligan suggested further discussions offline to explore potential support for this endeavour. Cllr Mulligan emphasised the need to address the consistent lack of health facilities in planning applications. The opportunity for the IJB to set out requirements for health facilities and lead in this regard was discussed, with the willingness of various members to contribute. Page 9 of 256
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6 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Angus raised a question about the reduction in discharge days from 55 to 27 and its significance. Morag highlighted the substantial effort behind this improvement, including process changes, audits, and collaboration with Acute colleagues. The sustainability of this improvement was acknowledged, while recognising the volatility of the system leading to occasional spikes in delays. The volatility of the system was noted, with spikes in delays being possible due to pressures in other parts of the system. While the improvement was praised, it was understood that challenges and fluctuations may persist. Cllr McManus discussed the departure of Lloyds Pharmacy and highlighted the positive impact of independent pharmacists who bring a more personalized approach to healthcare services. Appreciation was expressed for the dedication of staff in the sector. Cllr McManus commended the achievement of targets, particularly mentioning a visit to number 11 and the positive impact of substance use services. The commitment of the team in providing assistance and advice was acknowledged, with a focus on potential improvements and infrastructure for future discussions. Gill assured the group that efforts are underway to plan for future health facilities in collaboration with the local development planning team of the council. Progress was made in engaging with various stakeholders, and a review of gathered information and needed input from health and social care was planned for the SPG meeting on July 6th. Page 10 of 256
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7 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Congratulations were extended to the team for their participation in the award process. Andrew sought more details about the issues with the Bonnyrigg health centre and asked about mitigation strategies. Concerns about the national control zone and the impact of agency staff were raised. Morag and Fiona provided insights into the measures taken to address the situation and ensure the sensitivity of agency staff utilisation. A question was posed about whether Midlothian could implement a system similar to East Lothian, where someone at the Royal Infirmary diverts patients to the most appropriate care. Grace explained the efforts to redirect patients and the role of the Emergency Access Standards meeting. The use of different nursing categories and the role of senior nurses were discussed. Grace shared that data- driven decisions were being made to address hot spots and control costs associated with agency staffing. Morag provided an update on the Legionella issue at the Bonnyrigg health centre, highlighting the measures taken and ongoing testing and remediation efforts. Fiona: The approach to agency staffing was discussed, emphasizing the move towards framework agencies and staff banks for temporary staffing. Page 11 of 256
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8 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.3 Draft Annual Accounts - Paper presented by Claire Flanagan, Chief Finance Officer This discussion covered the draft unaudited accounts for the financial year 22-23. The main focus of the accounts was on the management commentary, which highlighted the operations and key developments of the IJB during the year. The presentation outlined the following key points: The management commentary began with the context of the Covid exit and referenced the new IJB strategic plan for 22-25. The infrastructure supporting the strategic plan through the strategic planning group was also mentioned. The discussion highlighted the operations of the IJB throughout the year, covering core, hosted, and set aside services. The key areas discussed included primary care, mental health, justice, home care, disability, and falls- related services. The discussion noted ongoing work within the dietetic service, hosted by Midlothian on behalf of all four IGBs. It also referenced the support provided for the Royal Edinburgh Campus redevelopment, which faced delays due to financial and funding challenges. The pressures within acute hospitals were highlighted, along with the support provided by the health and social care partnership's intermediate care services. Successful initiatives like the same-day emergency care program were mentioned. Page 12 of 256
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9 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments A summary of the year-end financial position was provided, indicating a deficit of £10.3 million. This deficit was explained as the IJB incurring expenditures against its earmarked reserves. The IJB's financial performance against its in-year delegated budget and the significant movement in reserves were also discussed. An overview of the financial position was presented by service area, emphasizing operational underspend despite significant financial challenges in areas like prescribing, general medical services, learning disabilities, and set aside. The challenges faced by the IJB, including population growth, workforce challenges, and financial landscape difficulties, were explained, along with external factors impacting the financial position. The presentation covered the statement of responsibilities, highlighting the roles of the Chair (Val) and Chief Finance Officer. The remuneration report and annual governance statement were noted, with the latter to be included in the audit and risk committee version due to scheduling changes. The unaudited accounts document was described as comprehensive and included sections for independent auditors and the accounts themselves, which would be completed after the external audit. The accounts presentation provided an overview of the IJB's financial performance and key developments during the financial year, highlighting challenges, successes, and ongoing Page 13 of 256
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10 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments initiatives. 5.4 2022 Financial Recovery Options Report - Paper presented by Morag Barrow, Chief Officer & Claire Flanagan, Chief Finance Officer During the meeting, a proposal was presented to address the funding gap resulting from not receiving the full allocation from Midlothian council. The proposal included options to manage the additional funding gap and support for extra care housing: A change in approach was proposed for the extra care housing recovery action. Instead of withdrawing completely, the proposal suggested supporting Midlothian council by allocating older people currently on the waiting list to these properties while continuing to provide care at home services. This would allow the extra care housing to be utilised when a budget allocation becomes available. Discussions were held regarding securing capital funding as a non-recurring one-off benefit to support the transition from analogue to digital. This decision was deferred to the June council meeting. The recommendations included a split of recurring and non-recurring options. Option 2 involved a slight shift (8%) towards external care at home provision. The proposal was to utilize the general reserve, with a minimum of The board accepts the recommendations into the report. Page 14 of 256
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11 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments £100,000 or more depending on the funding gap and support from council members. Concerns were raised about the allocation of extra care housing and the possibility of council tenants or RSL tenants being excluded. The reassurance was provided that the focus would be on ensuring fair allocation. The impact of the changes on vacancies and the care at home team was discussed. It was noted that the use of agency staff would mitigate significant changes in this regard. Meeting participants expressed support for the adjusted housing options and flexibility in reallocating resources. The use of reserves to cover financial gaps was approved. The costs associated with the analogue to digital transition were discussed, including the initial costs for equipment and ongoing expenses. The importance of council support for capital planning was highlighted. Questions were raised about ensuring effective reserve management and mechanisms to prevent similar funding gaps in the future. It was acknowledged that while reserves offer a buffer, caution is necessary given the ongoing financial challenges. The proposal was well-received, and participants expressed support for the measures presented to address the funding gap and ensure the effective allocation of resources for housing and digital transition. Page 15 of 256
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12 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.5 Analogue to Digital Transition - Paper presented by Matthew Curl, Digital Programme Manager Matthew Curl highlighted the need to update the existing analogue telecare alarms to digital telecare due to the switchover in the analogue to digital network. He emphasised the importance of ensuring that analogue alarms on the digital network receive proper signals to avoid potential risks in emergency situations. The goal is to commit to the new technology and avoid wasting resources on outdated analogue alarms. Moving forward with digital alarms requires engaging with suppliers and considering potential impacts on the supply chain. The opportunity to establish a digital foundation for alarms is presented, enabling the use of core information as data. This shift to digital technology also offers the ability to identify and address alarms that may pose a risk if they are not functioning properly. The anticipated costs for the transition to digital telecare alarms may exceed the previously mentioned budget of £1,000,000. The implementation timeline is set to begin with the procurement process going live in September. The transition is planned to be completed over a 70-week period, with around 25-30 installations per week. However, there are potential risks and challenges related to external supplier support and technical capabilities. The new model of telecare involves using a sim card within the alarm unit, allowing clients to communicate with the Page 16 of 256
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13 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments alarm receiving centre through a mobile network. This new approach comes with a monthly revenue cost ranging from £3 to £5 per client. Matthew mentioned that the full switchover of approximately 1,800 clients to digital telecare alarms is targeted for December of the following year. The team faces challenges in ensuring timely installations and confirming external supplier support for the transition. Attendees of the meeting sought clarification on delivery times for implementation and the transition's impact on clients. The discussion emphasised the need for a successful transition to digital telecare to enhance efficiency, safety, and communication in emergency situations. 5.6 Integrated Impact Process Approval - Paper presented by Gill Main, Integration Manager Gill provided an overview of the paper, which addresses the need to improve compliance with equality duties in response to the HR freeze request. Given the board's role as the strategic commissioning group, Gill explained that the integrated impact process (IIA) would be applied to board activities, including the strategic commissioning plan and policies. The goal is to ensure operational delivery and provide assurance to the board. The IIA process aims to enhance compliance with equality duties and provide assurance to the board regarding operational delivery. This process will be applied to various Page 17 of 256
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14 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments board activities. The paper proposes rolling out the IIA process to operational areas. Board activities requiring an IIA will be identified and referenced in the relevant board papers. The IIA process has received approval and scrutiny, and it has been successfully applied in the past, including the recovery actions paper. Angus raised a point about ensuring that the board papers are well-organised and coherent when the IIA process is applied. He suggested having someone review the board papers to ensure clarity and organisation. Conclusion: The board expressed support for proceeding with the integrated impact process and applying it to various board activities. Angus's suggestion to review and improve the organisation of board papers was noted for future considerations. The implementation of the IIA process was considered beneficial for enhancing compliance and providing assurance in relation to equality duties. 5.7 IJB Performance Report – paper presented by Eloise Johnstone, Performance Manager Eloise provided an overview of the management data report, which outlined the goal of shifting care from hospital to the community. The report outlined the aim of achieving a percentage shift in advance of care from hospitals to the community. Process measures were identified to support this goal. The board accepts the recommendations into the report. Page 18 of 256
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15 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments The report specified the schedule for reviewing the data. The Assurance and Performance Review (APR) was discussed in the Strategic Planning Group (SPG) meeting. The Promise Assurance Group would also analyse validated data, with a dedicated session scheduled for this purpose once the data is published in the week commencing 3rd July. The analysis would be completed by 20th July. Angus inquired about the determination of the specific amount of care shift. Eloise explained that additional process measures had been suggested during discussions, with a focus on length of stay in both acute and community hospitals. The process measures are being refined based on this feedback, and the revised measures will be shared with the Promise Assurance Group for further input. Conclusion: The board acknowledged the importance of shifting care from hospital to the community and discussed the data review schedule. Eloise clarified the process for refining process measures and highlighted the commitment to continue working towards the outcome goal. 5.8 Integrated Assurance Report – Paper presented by Fiona Stratton, Chief Nurse Fiona presented the updated version of the Clinical Assurance, Risk, and Resilience Report, which is circulated twice a year. The report combines clinical assurance with risk and resilience information. Appendices include details The board accepts the recommendations into the report. Page 19 of 256
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16 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments about the governance and assurances framework, as well as the annual report submitted to the NHS Lothian Health Care Governance Committee. Fiona explained that the report provides a comprehensive overview of clinical assurance and risk and resilience matters. It includes updated data and relevant documentation. Andrew raised a query about the indication of escalated accounts and types of issues raised in complaints, including those from elected members and MSPs. Fiona clarified that while there is currently no thematic analysis of all complaints, themes often revolve around communication and involvement. Complaints are managed by managers according to standards set by the Public Standards Ombudsman. Fiona highlighted that risk and resilience are tested through exercises, including test callouts. She cited an example of a real-life incident involving a boat capsizing in Leith, which demonstrated the effectiveness of local systems in responding to emergencies. Andrew sought clarification on the process of analysing escalated complaints and whether there were desktop exercises conducted for resilience and major incident planning. Conclusion: The board acknowledged the content of the report, which provides valuable insights into clinical assurance, risk, and Page 20 of 256
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17 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments resilience matters. Fiona addressed inquiries related to complaints and inquiries, as well as risk and resilience testing. The board expressed satisfaction with the report's comprehensive approach to these critical areas of focus. 5.9 Midlothian Response to Director of Public Health Annual Report - Paper presented by Jim Sherval, Consultant in Public Health Jim presented the Public Health Annual Report, which focuses on preventing ill health and addressing health inequalities through a health and equalities lens. The report emphasises primary prevention and socio-economic factors. Collaborations with various departments aim to prevent future mental health challenges, and strong prevention sections have been integrated into planning areas. Jim highlighted that Midlothian is experiencing an increase in population, particularly among individuals aged 75 and over. The report acknowledges the challenges posed by austerity and financial difficulties, emphasising the need for generating greater social value through collaborative efforts between large organisations like the council and health board. Val inquired about the theme of employability and its relation to the workforce gap. Jim mentioned the appointment of a Head of Workforce Development in Midlothian and highlighted the strengthened operational development across various departments. Page 21 of 256
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18 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Andrew questioned the decline in male life expectancy at birth shown in Figure 8 of the report, specifically in the context of Midlothian. Jim explained that premature mortality, drug-related deaths, and smaller population numbers could contribute to this trend. Further analysis will be conducted to delve into early intervention and rehabilitation efforts. Angus raised concerns about headache disorders affecting different age groups and emphasised the need for early intervention. Jim acknowledged the vague burden of ill health in the population due to various factors. Val requested information on Midlothian's actions and key milestones over the next year, seeking tangible outcomes from the report. Jim committed to providing more details on employability in August and discussing the level of detail to be delivered. Conclusion: The board discussed various aspects of the Public Health Annual Report, including population growth, employability, life expectancy, and specific health issues. Jim provided insights into the challenges and strategies highlighted in the report. The board requested further analysis and tangible actions, and Jim committed to addressing these points in future discussions, particularly regarding employability. 5.10 Interim Learning Disability Review - Paper submitted by Nick Clater, Head of Adult Services Nick presented an interim update on the Learning Disability Review. The review was prompted by an increasing Page 22 of 256
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19 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments number and complexity of learning disabilities, budgetary pressures, and the transition of young people from children’s services. The final report is expected to be presented in August. The review is addressing the growing challenges related to the rising number and complexity of learning disabilities. Financial pressures within learning disability services and the transition of young people from different services are contributing factors. Nick highlighted the long-standing budgetary pressures within learning disability services, particularly concerning the cost of care. These financial challenges are exacerbated by the higher number of young people transitioning between services. The transition of individuals from Joans services and Nicks services within the disability and spectrum disorders has become more complex and challenging. This has led to increased financial pressures and risk management considerations. The report provides an interim update on the ongoing review and outlines the steps being taken to address the issues. A final report is anticipated to be presented in August, which will provide a comprehensive overview of the findings and recommendations. . Page 23 of 256
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20 Midlothian Integration Joint Board Thursday 9 February 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Conclusion: The board discussed the challenges posed by the increasing number and complexity of learning disabilities, budgetary pressures, and the transition of young people between services. Nick provided an interim update on the Learning Disability Review, and the board is expected to receive a final report in August. The importance of addressing the financial pressures and ensuring effective risk management was highlighted during the discussion. 6. Private Reports No private business to be discussed at this meeting. 7. Any other business No additional business had been notified to the Chair in advance. 8. Date of next meeting The next meetings of the Midlothian Integration Joint Board would be held on: • Thursday 24 August 2023 2pm (Action: All Members to Note) The meeting terminated at 4.00 pm. Page 24 of 256
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Midlothian Integration Joint Board Meeting Date Time Venue Strategic Planning Group Thursday 27 April 2023 14.00 Virtual Meeting held using MS Teams. Chair: Gill Main (Integration Manager) Vice Chair: Vacant Present (MIJB members): Keith Chapman Angus McCann Present (HSCP): Nick Clater (Head of Adult Services) Fiona Kennedy (Group Service Manager) Chris King (Finance) Elouise Johnstone (Programme Manager, Performance) Kevin Dickson (Programme Manager) Wanda Fairgrieve (Lead Partnership Representative) Emma-Jane Gunda (Assistant Strategic Programme Manager) In attendance: Laura Hill Saty Kaur Colin Cassidy Strategic Planning Group Thursday 27 April 2023 Page 25 of 256
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2 Strategic Planning Group Thursday 27 April 2023 Lesley Crozier Graeme McGuire Rachael Honeyman Jim Sherval Apologies: Claire Flanagan Fiona Stratton Morag Barrow James Hill Laura Hutchison Miriam Leighton Rebecca Green Lynne Douglas Pat Wynne Annette Laing Joan Tranent 1. Welcome and introductions Gill Main (Chair) welcomed everyone to the meeting. 2. Order of Business The order of business was as set out in the agenda. 3. Minutes of Meeting The Minutes of Meeting of the Strategic Planning Group held on 23 February 2023 were reviewed and approved. 4. Public Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 Chairs Update GM reported the Board approved and Issued Directions for 2023-24s. GM also noted that Directions were available on Page 26 of 256
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3 Strategic Planning Group Thursday 27 April 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments the Midlothian Health and Social Care webpage and thanked Nick McDowell and Caroline Shilton for their work on this. GM acknowledged continuing service pressures and recognised the good quality planning work underway in spite of ongoing capacity challenges. GM advised that the first iteration of the Group Service Specification, Service/Programme Plans, and Team Plans have been submitted for 2023-24 and SMT are reviewing these. 4.2 Finance and Performance Update – Chris King CK confirmed the HSCP position for the year end is now closed. The Council’s position due to close next week. CK is waiting for the IJB to close and described the extremely tight position resulting in a 15k underspend for Health. CK reported the 3 key areas of pressure are Midlothian Community Hospital, Nursing, and GP prescribing. 4.3 PAGG update – Elouise Johnstone EJ reported that the last meeting of the Performance and Assurance Group took place on 9th March where they reviewed the IJB performance framework. EJ advised that, following the IJB on 27th April, the PAGG has been commissioned to review and suggest local improvement goals for the IJB in 2023-24. The next meeting is on the 4th of May. Page 27 of 256
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4 Strategic Planning Group Thursday 27 April 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.4. Workforce Governance Group update – Gill Main GM advised the first Board of the ongoing work to prepare for the Midlothian HSCP Workforce Governance Board scheduled for the 5th of September 2023. This includes a series of discovery sessions to shape the two subgroups that will progress the work of the Board. The two subgroups are proposed to be Workforce Planning, chaired by GM and Workforce Engagement, chaired by FK. 5. Reports 5.1 Topic in Focus Set-Aside Financial Update: Q3 Position – Graeme McGuire GMcG provided an overview of a prepared slide-deck describing the Q3 position and then took questions and supported discussion. EJ questioned the agency spend and whether this was due to buying more agency hours or if the costs have increased. GMcG confirmed the answer is a combination of both and stated sickness levels have risen to 6-7%. GMcG stated the patient safety is at the centre of decision making. Angus McCann asked Graeme for his view on the 3% target savings in cancer drugs. GMcG said it is a frustrating process and is looking at skill mixing within vacancies. Page 28 of 256
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5 Strategic Planning Group Thursday 27 April 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments GM reminded the group of the discussion during GMcG last presentation to SPG regarding the potential to explore the Midlothian usage of set aside and the power of the 2023-24 Directions 5.1 and 9.1 in this regard. GM also asked GMcG what his ask would be of the group and GMcG confirmed a better connection between primary and secondary care. GM suggested taking a focused strategic and collaborative approach to Directions 5.1 and 9.1 Action: The group agreed it would be helpful for a session with Midlothian and NHSL Finance, Planning, and Performance to consider Direction 5.1 and 9.1 GM also suggested working with Midlothian and NHSL finance, Planning and Performance as part of the planning in relation to Midlothian IJB Strategic Commissioning Plan 2025-28. The group agreed Action: GM to liaise with GM GM September 2023 October 2023 5.2 Items for Decision Integrated Impact Assessment Process – Kevin Dickson KD summarised the legislative duty if the IJB to give consideration to the quality impact for all Strategies, policies, plans, provision and activities of the Board, including that of the HSCP in delivering the ambitions of the Page 29 of 256
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6 Strategic Planning Group Thursday 27 April 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments Midlothian IJB Strategic Commissioning Plan 2022-25. SG and the EHRC required Midlothian IJB to create and implement a process to screen, identify, complete and monitor the impact of IIAs by the end of March 2023. The first draft of a process to screen, identify, complete and monitor the impact of IIAs came to the meeting of the SPG in February 2023 and the recommended changes have been adopted. KD asked the group to recommend this process for approval to the June Board EJ commented this process will greatly improve the performance reporting in this area. KD also noted the oversight implications for SPG in regards to the reviewing the HSCP mechanism to also record and report to the Board using a similar process. GM reiterated that the Equality Duty and requirement for the IJB to give due consideration to equality issues could not be delegated and that this meant the HSPC is required to report to the IJB on how it is considering equality issues as it delivers on the ambition of the Strategic Commissioning Plan. LC confirmed this was the correct interpretation of the Public Sector Equality Duty. Noting this, GM noted this would now suggest a similar process was adopted for SPG and a request for SMT to report to SPG on the HSCP consideration to equality issues The group agreed to recommend this process for approval to the June Board. The group agreed for a similar process to be implanted for SPG. Action: The Planning team will implement and oversee this process Action: The group agreed a paper should now go to SMT regarding the requirement to adopt a similar process and report GM GM GM 22nd June 2023 For 29th June SPG July 2023 Page 30 of 256
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7 Strategic Planning Group Thursday 27 April 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments in its screening, identification, completion and monitoring of impact in relation to equalities in operational planning work. biannually to SPG 5.3 Annual Performance Review Skeleton Draft – Elouise Johnstone EJ asked the group to consider the proposed skeleton draft, make any comments and note the publication dates. Due to the release of PHS management data in Mid-May, the first draft will come to SPG on 29th June 2023, the data scrutinised by PAGG on 29th July 2023, and the final version going to Midlothian IJB Board on 26th August. GM thanks EJ and the APR Writing Group for the work completed to date. GM then commented that it will be impossible to meet the Scottish Government deadline due to data release dates but noted Midlothian IJB has contacted Scottish Government and asked for an extension to the deadline. GM noted the recommendations for review and scrutiny via SPG, and PAGG prior to the August Board and advised inviting MIJB Board Members to join SPG on 29th of June 2023, and PAGG on 20th of July 2023. The group agreed for Board members to join SPG and PAGG. Action: Invites to be circulated to Board Members EJG / JK / Democratic Services End of May 2023 Page 31 of 256
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8 Strategic Planning Group Thursday 27 April 2023 Report Title/Summary Decision Action Owner Date to be Completed/Comments EJ reported that a focus on the ‘looking forward’ section required some input from Heads of Service and Professional Leads to better understand the planned main thrust of operational activity in 2023-24. GM suggested a short and targeted discussion with SPG leads (40 mins). Angus commented that a session would be valuable with directed questions on each key issues helpful. The group agreed to commission EJ to lead a session to establish the areas Heads of Service and Professional Leads would like to be included in the ‘Looking Forward’ section of the APR EJ End of May 2023 6. Any other business Report Title/Summary Decision Action Owner Date to be Completed/Comments None raised. 7. Date of next meeting The next meeting of the Strategic Planning Group will be held on 29 June 2023 at 2.00pm. Actions: All Members please note and progress the actions detailed in this document The meeting terminated at 4.00pm Page 32 of 256
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Midlothian Integration Joint Board Thursday 24th August 2023, 14:00 – 16:00 Chief Officer’s Report Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting August 2023. Board members are asked to: • Note the content of the report. # Item number: 5.2 Page 33 of 256
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Midlothian Integration Joint Board Midlothian Integration Joint Board Chief Officer Report 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting August 2023. 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 Officer Budget allocation Upon agreement by the IJB Board following June Board meeting, a follow up letter requesting to meet with Scottish Government/Cosla relating to budget allocation from Midlothian Council, has been issued to Scottish Government by Chair of the IJB. Dates to formally meet are being negotiated, but likely to be the end of summer. System pressure Midlothian HSCP performance relating to delayed discharge remains in an improved position, with a position that sees the numbers of patients delayed fall within trajectory. A stretch performance indicator has been agreed with NHS Lothian for 2023/24. Midlothian Community Hospital - Glenlee ward Following the ceasing of Covid funding from Scottish Government, NHS Lothian have agreed to fund the 20 beds as a decant facility to support maintenance work at Royal Infirmary of Edinburgh. These beds will support patient flow, freeing up acute hospital beds to support right care, right time, and in the right place. Additional capacity within East Lothian Community Hospital will be utilised by NHS Lothian, to support additional orthopaedic rehabilitation beds that Midlothian patients will have access to. Change of Chief Allied Health Professional (AHP) This is the last update provided by the current Chief AHP, Hannah Cairns who will be taking up the equivalent post in Edinburgh HSCP from 21st August. There will be a short gap before the new post holder, Claire Ross (currently Head of Podiatry, NHS Lothian) starts on 25th September. Plans have been made to ensure that the affected teams are well supported, and the impact is as limited as possible on Hannah’s outstanding portfolio areas. Hannah has asked that her thanks are passed onto all Board members who welcomed her and have provided support and guidance since she started in Midlothian in November 2021. Page 34 of 256
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Midlothian Integration Joint Board Hannah has very much enjoyed her time in Midlothian and remains heavily invested in its success as a key partner in Lothian. She intends to maintain a strong relationship with current colleagues in Midlothian as well as supporting the incoming Chief AHP in her new role. The HSCP team would like to thank her for her commitment and contribution to Midlothian and wish her well in her new role. Morag Barrow, Chief Officer - Morag.barrow@nhslothian.scot.nhs.uk 3.2 Head of Adult Services Inspection The Care Inspectorate and Health Improvement Scotland have announced an inspection of Physical Disability and Long-Term Conditions and their carers. There is a newly established Inspection Activity Board chaired by Nick Clater (Head of Adult Services) that will provide governance and assurance around the different work streams associated with inspection work. To date, there has been benchmarking activity (against other published inspection reports) in Physical Disabilities and Adult Support and Protection. A Group Service Manager is leading on this and is currently conducting a staff survey for social work/social care and Occupational Therapy staff to share their views. Reviewing and updating operational policies and procedures is a priority for us. Timeously, there is council wide commitment to review all procedural documents; this will incorporate all relevant adult social care procedures. Learning Disability: New Accommodation/Respite Funding has been secured to develop Primrose Lodge in Loanhead as accommodation for four people with profound and multiple learning disabilities. The building is designed to support people with the most complex needs to live locally, and to reduce the risk of inappropriate admission to hospital or being placed away from home. People with Profound and Multiple Disability have the same rights as any other citizen to live at the heart of their community and the proposed development site is ideal in many ways, in that it is in the heart of the town, with easy access to community facilities. The large garden is also a real advantage for the tenants. There will also be respite accommodation for two people in a separate part of the building. Mental Health/Substance Use Services Midlothian HSCP have fully embedded and was on target for 2023 Medicated Assisted treatment (MAT) standards 1-5 and have been confirmed provisional green and now progressing for sustainability by HSCP team. Midlothian continue to progress with MAT standards 6-10 and have developed action plan to implement over 23/24. Midlothian is currently on target and have been confirmed RAG (red/amber/green) rated Amber for each MAT standard 6-10. Nick Clater, Head of Adult Services - nick.clater@midlothian.gov.uk 3.3 Head of Primary Care and Older People The Joint Committee on Vaccination and Immunisation (JCVI) advice is currently awaiting the winter 2023 Flu and Covid booster vaccination programme. A Chief Medical Officer (CMO) letter for the COVID-19 Vaccination programme will follow this update. The CMO letter, dated 18 April 2023, detailing eligible cohorts for the winter 2023 seasonal flu vaccination is available as CMO (2023)05, and the CMO letter dated 6 June 2023 for seasonal flu vaccination for children is available as CMO (2023)09. Page 35 of 256
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Midlothian Integration Joint Board Whilst the HSCP still await this advice, it is known that the Winter programme will start on 4th September and vaccinations will be offered to all cohorts by 11th December 2023, with the campaign to run until 31st March 2024. • New variant vaccine expected to be deployed for this programme for certain groups (assumed delivery of stock mid-October) • By vaccinating most individuals by 11th December, it gives people the minimum two- week period for flu immunity to build, before the Christmas break and the social mixing that this entails. • Co-administration target of 90% • Citizens appearing in more than one cohort will be co-administered when recommended Covid vaccine is available. Protection from Covid vaccination is highest in the first three months following vaccination, therefore proposed sequence of delivery is as follows: • Focus on Flu Only clinics during September (including 2-5yrs Childhood Flu): 50-64 years, Health and Social Care Staff (non-frontline), Teachers and Prisons. • From 2nd October co-administration of Flu and current Covid vaccine: Health and Social Care Staff (frontline), 65–74-year-olds. From 16th October co-administration of Flu and new Covid vaccine: 75 years+, Weakened Immune System patients, Housebound and Care Homes, prompts to book for those aged 6 months - 64 years at risk. Grace Cowan, Head of Primary Care & Older PeopleGrace.cowan@nhslothian.scot.nhs.uk 3.4 Planning, Performance and Programme Midlothian Local Development Plan Supported by the Midlothian Strategic Planning Group (SPG), the HSCP have undertaken a significant piece of work to understand the impact of the scale of growth in Midlothian between 2023 and 2036. This has included reviewing the anticipated change in local demographics and impact on 20 minutes communities because of an additional 12,500 houses in Midlothian. Work is ongoing to ensure that the right information from Midlothian Health and Social Care can positively influence decisions relating to future planning and potential developer contributions. Joint working continues with Midlothian Council Planning Team, elected members, Midlothian HSCP services, GPs, Public Health, and Community Pharmacy. Annual Performance Report (APR) A significant focus in the last quarter for the HSCP team has been Midlothian IJB’s Annual Performance Report (APR) 2022-23. Work this year has focused on describing impact and not just activity. Midlothian IJB Strategic Commissioning Plan 2025-28 The HSCP team have begun work creating and initiating the project plan for the development of the new Midlothian IJB Strategic Commissioning Plan 2025-28. This includes a significant scoping and stakeholder consultation period. The team are looking forward to sharing preliminary data and ideas for the Board’s consideration and development in January 2024. Page 36 of 256
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Midlothian Integration Joint Board Measuring Personal Outcomes and Impact It has been previously reported on the HSCP team’s contribution to the ‘Towards Relational Public Services’ conference 2023, held at Northumbria University. As a result, Audit Scotland and Health Improvement Scotland have both reached out to learn from our work in relational performance and outcome measurement. The team have also been invited to share their work at the Government Outcomes Lab Social Outcomes Conference in September 2023. Gill Main, Integration Manager - Gill.main3@nhslothian.scot.nhs.uk 3.5 Chief Allied Health Professional Digital Programme The work of the Digital Programme is progressing at pace with the most recent highlight report (below) being shared with the HSCP Digital Implementation and Programme Board (June ’23), the HSCP Senior Management Team (July ’23) and Midlothian Council Digital First Board (August ’23). HSCP Governance and Assurance Framework As a component of the improved integrated governance arrangements, implementation of the HSCP Governance and Assurance Framework has begun. Training was completed with Senior Managers in July 2023 with some service areas testing the submission process in Quarter 1 of financial year 2023-2024. Learning from this phase will be shared with the SMT in August 2023 and will influence enhancement of the process over the next 6-9 months when it is anticipated that all HSCP service areas will be using the framework. Hannah Cairns, Chief AHP - hannah.cairns@nhslothian.scot.nhs.uk 3.6 Primary Care The long-term provision of General Medical Services for the population of Danderhall has now been secured and will be delivered by Newbattle Medical Practice, with a formal practice merger taking place in the first week of August. Patients will still be seen for face-to-face Page 37 of 256
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Midlothian Integration Joint Board consultations in Danderhall but will also have the option to be seen at Newbattle if they prefer this. Communication has been distributed to all patients to inform them of the change in practice leadership, and to explain their forthcoming plans to use a digital platform to facilitate rapid access to the right person or service for their needs. The HSCP also continues to support 3 other practices to test add-on digital access for their patients to help manage increased demand. The rate of direct clinical activity per person in Midlothian remains higher than in previous years, and also in comparison to other Lothian HSCPs. Prescribing The HSCP Pharmacy team continue to make good progress against their financial efficiency plans, with a performance of 51% achieved against year-end target in Q1 of 2023-24. However, there remains much work to be done with prescribing & medication costs being the biggest current financial deficit pressure within Health. From a patient safety perspective, the Pharmacy Hub continues to mature, with an impressive >90% turnaround time for medicines reconciliation now taking place within 48 hours after hospital discharge (Scottish Patient Safety Standard). Rebecca Green, Clinical Director – rebecca.green@nhslothian.scot.nhs.uk 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. 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. Page 38 of 256
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Midlothian Integration Joint Board 10 Background Papers AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO 0131 271 3402 DATE August 2023 // Page 39 of 256
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Midlothian Integration Joint Board Thursday 24th August 2022, 14:00-16:00 Annual Performance Report 2022-23 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 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 2022/23. The broad content of the Annual Performance Report was approved with the Strategic Planning Group (SPG) reviewing the first skeleton draft on 27th April 2023. Management data was received from Public Health Scotland in May 2023. The first full draft of the Annual Performance Report was discussed and scrutinised at the Strategic Planning Group (SPG) meeting held on the 6th July 2023, with further operational oversight at the Midlothian HSCP Senior Management Team (SMT) on 17th July 2023. The data was scrutinised at the Performance, Assurance, and Governance Group (PAGG) on 20th July 2023 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. All Governance Groups recognised the work of the Planning and Performance Teams to build on strengths of the 2021/22 Annual Performance Report and develop the content to be more reflective of the new Strategic Commissioning Plan 2022/25. Following review, scrutiny, and amendment, the Midlothian IJB Annual Performance Report 2022/23 is now presented to the Board for approval and the delegated authority for Morag Barrow, Chief Officer, to publish this report before 31st August 2023. Board Members are asked to: • Note the content of the Annual Performance Report, • Approve this report, and • Grant delegated authority to the Chief Officer, Morag Barrow, to publish this report before 31st August 2023. Item number: 5.3 Page 41 of 256
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Midlothian Integration Joint Board Midlothian Integration Joint Board Annual Performance Report 2021-22 1 Purpose 1.1 The Midlothian Annual Performance Report 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 2022-23. 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 • Grant delegated authority to the Chief Officer, Morag Barrow, to publish this report before 31st August 2023. 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 11th May 2023 and are discussed in the report. As 2022/23 is not a reporting year for the Health and Care Experience survey, several indicators have no update for this report. The indicators with no update for 2022/23 are: • Indicator 1: Adults are able to look after their health very well or quite well. • Indicator 2: Adults supported at home agreed that they are supported to live as independently as possible. • Indicator 3: Adults supported at home agreed they had a say in how their help, care or support was provided. Page 42 of 256
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Midlothian Integration Joint Board • Indicator 4: Adults supported at home agreed that their health and social care services seemed to be well coordinated. • Indicator 5: Adults receiving care or support rated it as excellent or good. • Indicator 6: Adults had a positive experience of the care provided by their GP practice. • Indicator 7: Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life. • Indicator 8: Carers feel supported to continue in their caring role. • Indicator 9: Adults supported at home agreed they felt safe. 3.4 The broad content of the Annual Performance Report was approved with the Strategic Planning Group (SPG) reviewing the first skeleton draft on 27th April 2023. Management data was received from Public Health Scotland in May 2023. The first full draft of the Annual Performance Report was discussed and scrutinised at the Strategic Planning Group (SPG) meeting held on the 6th July 2023, with further operational oversight at the Midlothian HSCP Senior Management Team (SMT) on 17th July 2023. 3.5 The data was scrutinised at the Performance, Assurance, and Governance Group (PAGG) on 20th July 2023 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. 3.6 All Governance Groups recognised the work to build on strengths of the 2021/22 Annual Performance Report and develop the content to be more reflective of the new Strategic Commissioning Plan 2022/25. 3.7 Following feedback from both the Strategic Planning Group (SPG), the Senior Management Team (SMT), and the Performance, Assurance and Governance Group (PAGG), the content and structure of draft Annual Performance Report has been reviewed with the following notable amendments. • National Indicators (p11 and p15): reinforcing that there has been no Scottish Government update on the National Indicators 1-9. This is additionally mentioned with each relevant Indicator throughout the main report and within the Data Appendix from p67. • Premature Mortality (p17): following the national data update. • Emergency admissions (p17 and p20): following receipt of validated PHS data and including comment of number of Midlothian nursing home beds. • End of Life Care (p21): additional comment highlighting data limitations and discussion relating to the choice of, and capacity for community-based care. • Acuity (p20): highlighting increasing complexity and lack of national measure to measure this. • Readmission Rate (p20): clarifying the exclusion of ‘virtual wards’ or Hospital at Home from this data. • Health Inequalities (p30): discussing premature mortality in Midlothian and comment in relation to long-term conditions with a higher prevalence in Midlothian. This includes discussion about the impact of substance-use related deaths in Midlothian. • Inspections (p35): comment on an increase in inspection activity in 2022/23. Page 43 of 256
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Midlothian Integration Joint Board • Falls (p36/37): additional information relating to falls, associated works, and clarification on the operational definition for National Indicator 16. 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 31 August 2023. 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. 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. Page 44 of 256
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Midlothian Integration Joint Board 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, Strategic Programme Manager: Performance CONTACT INFO Via email or MS Teams DATE 04/08/2023 Appendices: Appendix One: Midlothian Annual Performance Report 2022/23 Page 45 of 256
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1 Midlothian Integration Joint Board Annual Performance Report 2022/23 Page 47 of 256
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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 The main challenges of 2022-23 ............................................................. 12 How did we do? ......................................................................................... 14 How we are reporting our data .............................................................. 14 The National Indicators ........................................................................... 15 Working with local Communities .............................................................. 47 Looking forward ........................................................................................ 50 Inspections ................................................................................................ 53 IJB Business ............................................................................................... 62 Integration Functions and Governance Decisions ................................... 62 Data Appendix ........................................................................................... 65 Ministerial Steering Group Targets ............................................................ 85 Page 48 of 256
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3 Executive Summary 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 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 Commissioning 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. In 2022/23 we focused on understanding how local communities’ needs had changed before making decisions about how to improve and build the right support. This has helped us prepare for a challenging 2023-24 financial position with transformation initiatives that can assess and adapt to change. 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. The challenges we faced Some of the challenges services face today have emerged due to COVID-19, and some are due to wider change in the health and care system. How people want to experience health and social care, the cost-of-living crisis, and environmental issues have impacted on how we need to respond. We must focus more on prevention and early intervention to prevent ill or worsening health, meet people’s needs in times of crisis and support them to take action. This includes working with partners to ensure there is a range of appropriate, good quality accommodation that supports people to thrive. Some people are waiting longer for planned care which means they needed more support at home and in the community, and more people are choosing to spend the last days of their lives at home. Advances in digital technology means more services can be provided online and we must ensure we continue to meet everybody’s needs. Page 49 of 256
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4 Our progress towards the National Outcomes In 2022/23, our services continued to support people to look after their own health and wellbeing. By seeing ourselves as ‘facilitators’ and not ‘fixers’ we promoted self-management and 92% of people in Midlothian said they were able to look after and improve their health and wellbeing and live in good health. The rate of emergency admissions to hospital for people living in Midlothian reduced in 2022/23, but the number of days they need to stay in hospital increased. This is partly because Midlothian has fewer nursing home beds than other areas and people who needed more care than could be provided in their own home couldn’t be discharged from hospital. The overall number of days people stayed in hospital when they were ready to go home reduced in 2022/23, but people aged 75 and over were more likely to be delayed in hospital when they were ready to go home than other age groups. Fewer people in Midlothian were readmitted to hospital within 28 days of being discharged than the year before. We believe people are the experts in their own lives. We have been having ‘Good Conversations’ in Midlothian for over a decade and our commitment to the ‘Midway’ has helped us work alongside people to achieve the things that matter most to them. 120 staff have undertaken ‘Good Conversations’ training this year. We continued to work with our GP colleagues. People were concerned about getting appointments when they need them. GP activity has returned to pre-COVID-19 levels in Midlothian and GPs had more contact with people than other areas across Lothian. 45% of people have seen the same GP for repeat consultations over the last 6 months. For adults who are 65 years and older this rises to between 50-65%. We have continued to increase the number of specialist services located in GP practices including Community Treatment & Assessment Clinics (CTAC) in all GP Practices. We worked with a range of partners to continue to create opportunities that improve health, wellbeing, and quality of life for people and communities in Midlothian. For example, our Older People’s Service provided more than 230 online, outdoor, and creative opportunities each month for older people to connect with each other and have worked alongside ArtLink to support people with disabilities enjoy participating in the Arts. We invested in a Volunteer Coordinator to expand and coordinate local volunteers. People who volunteer tell us that their mental health and wellbeing has improved (92%), as well as their physical health and wellbeing (85%). 69% of volunteers report increased motivation and activity levels. More than half (54%) experience a reduction in loneliness, and more engagement in their community (31%). We developed better services for people experiencing poor mental health by working closely across health and social care, housing, and the Third Sector. In 2022/23 our teams supported 34 people into employment, education or volunteering and increased people’s opportunities to succeed. Where we are born, live and work can impact our health and wellbeing. While not everyone living in a deprived area will experience high levels of deprivation, there is a link between deprivation and poorer health outcomes. Diabetes, ischaemic heart disease, Chronic Obstructive Pulmonary Disease Page 50 of 256
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5 and dementia are all long-term conditions that contribute to premature death in Midlothian more frequently than across Scotland as a whole. We have continued to invest in our Health Inclusion Team who work with the people most affected by health inequalities to improve their quality of life. In 2022/3 the team found new ways to reach and support people who find it difficult to access health care e.g., people affected by homelessness, substance use, domestic abuse, or people with caring responsibilities. In our last Annual Performance Report, we noted we had work to do to better support carers. We listened to carers, people who receive care, a range of staff, and other partners as we developed the Midlothian Carers Strategy for 2022-25. People told us that the priorities in the strategy were highly relevant to provide the support they needed. Our services and supports aim to keep people safe from harm and prevent avoidable risks. In 2022/23 we received 929 Adult Support and Protection referrals compared to 674 the year before. The main type of harm investigated was financial harm, commonly for women at risk (67%), and adults aged 65 and over (52%). Nearly 80% of adults supported at home agreed they felt safe. In 2022/23 we saw a reduction in the number of people aged 65 and over being admitted to hospital as a result of a fall. Despite this, falls remain in the top ten reasons for people in Midlothian being admitted to hospital. Our Frailty Programme explored and defined the falls pathway across Midlothian to understand where improvements could be made in the care we provide, and our community alarm systems help kept people safe and well in their own homes. During 2022/23 there were 26,694 responses to alarms within the home for Midlothian Residents. This is an increase of 6% compared to last year. We worked to improve the experience of our workforce and develop our workforce planning capacity skills. In 2022/23 we published the first Midlothian Health and Social Care Partnership Integrated Workforce Plan 2022/25, developed our staff Communication, Engagement and Experience Delivery Plan, and introduced a range of staff wellbeing supports including the ‘Changing Gear’ programme to help staff leave work each day and focus on other parts of their life. During 2022/23, the Care Inspectorate completed 18 inspections in Midlothian. The majority of services inspected were given a rating of adequate, good, or very good. Our budget and spending Ensuring we make best use of our resources is a complex task. In 2022/23, we had a total budget of £173m and ended the financial year with an overspend of £10.3m. This included an underspend on our operations of £0.4m and the use of earmarked reserves funding during the year, predominantly for COVID-19. Our health services were overspent, and NHS Lothian provided the IJB with additional one-off funding of £1.4m to break even against these budgets. In March every year, Midlothian Council and NHS Lothian make a budget offer to the IJB, based on levels of funding set by Scottish Government. This year Midlothian Council did not offer to pass over the agreed amount in full and the IJB has explored options to mitigate this reduction in funding supported by a multi-year financial plan for how the resources available to the IJB will be used to deliver the ambitions of the Strategic Plan. Despite financial challenge, the IJB has Page 51 of 256
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6 prioritised supported an increase in wages in line with the living wage and asked services to ensure fair working by offering guaranteed hours. Looking ahead The years ahead will be some of the most challenging that health and social care have ever faced. We will need to better understand how peoples’ and communities’ needs change and build the right offers of support, with the resources we have available. The IJB will continue to invest in population health and improve community alternatives to hospital-based care. Integrated workforce planning is new for health and social care, and we will develop our skills in this across 2023/24. The needs of our workforce are changing and dependent on many new factors. 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. People and communities have valuable skills and experience to design and improve the health and care services that matter to them. We want to work with communities to ensure that we are planning and developing the right local health and care services. As we better understand the changing needs of communities, we need to be clear about when we are implementing change, and when we need to think in much bigger terms about transformation. We will continue to take a transformational approach with a range of related and dependent initiatives then do whatever it takes to ensure that learning can be spread across the whole system at scale and at pace. We recognised health and social care does not have the infrastructure to share data in the way we need and asked our partners to put in place mechanisms that allow safe and integrated data sharing. Our ambitious digital plan was launched in 2022 and will provide innovative solutions to some of our most complex challenges. In 2023/24, we have asked NHS Lothian and Midlothian Council to ensure we can access data by Health and Social Care Partnership area. This will help us to identify and address equality issues, meet different needs, and encourage participation. We will have to make better use of existing technologies and provide people with access to accurate information and services. We need to provide information about how well our hosted services are performing to the other Lothian Health and Social Care Partnerships and NHS Lothian. We have worked hard in 2022/23 to make sure our hosted services can provide the right information in a consistent way and are leading the way in the development of this approach for Hosted Services in 2023/24. In 2023/24 we also need to plan for and start writing our next Strategic Commissioning Plan for 2025 to 2028. Our planning and performance team will ensure the consultation, review, and governance around our most important piece of planning is done well and includes everyone that wants to be involved. Page 52 of 256
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7 Foreword Welcome to our 8th Annual Performance Report which reflects on our progress and performance from 1st April 2022 to 31st March 2023 In 2022-23 Midlothian Integration Joint Board (IJB) and Midlothian Health and Social Care Partnership (HSCP) have delivered care, support and treatment that contributes to improved outcomes for people and communities. This Annual Report explains our performance; how well we have provided the right care, at the right time, in the right place through early intervention and prevention, support and treatment. This has been an important year for Midlothian Integration Joint Board as we set out our vision for a new future in our Strategic Commissioning Plan for 2022-25. During the first year of this plan, services made significant progress in improving how we plan and deliver care, found opportunities to work together in new ways, and strengthened our community connections. As I reflect on the contribution of integrated health and social care over the past year, we made good progress in how we support people in communities to live good lives. Understanding local communities, what makes people healthy, and how we support good health and wellbeing has supported more people to live the lives they choose. We have learned that before we can make decisions about how we should improve, we must be prepared to do things differently. Simple changes can have significant consequences. Much of 2022-23 has focused on understanding how local communities’ needs have changed and building the right support. This has helped us prepare for a challenging 2023-24 financial position with transformation initiatives that can assess and adapt to change. This year also saw the publication of our first Integrated Workforce Plan 2022-25. We have increased our capacity to plan our workforce to meet our duties in relation to the Health and Care (Staffing) (Scotland) Act. We have worked with staff across the partnership, listened to each other, and worked together to support staff to remain safe and well. We continue to depend on our strong relationships with local communities and delivery partners who work alongside statutory services. Improving outcomes is only possible when everyone's contribution is valued. This takes teamwork and true partnership to succeed, and I am delighted we have invested in developing ways to describe and learn from how we work together by telling our story and progress through outcome mapping. I would like to sincerely thank everyone who has contributed to improving outcomes for local communities over the past year. I am proud to lead health and social care in Midlothian and know that together we can support everyone in our communities in health, wellbeing, and good lives, lived well. Morag Barrow Chief Officer, Midlothian IJB Page 53 of 256
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8 Introduction Who we are The Midlothian 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 Commissioning 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 behalf of Midlothian IJB. 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 54 of 256
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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 55 of 256
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10 Our Strategic Commissioning Plan 2022-2025 We also measure our performance against our objectives in our Strategic Commissioning 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 Commissioning 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 56 of 256
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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. We used a range of feedback to inform our outcome mapping including: • 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. 2022/23 is not a reporting year for the HACE Survey so there is no update from the data reported in the Annual Performance Report 2021/22. In November 2021 the survey was posted to a random sample of people registered with a GP in Scotland based on information available on 6 October 2021. 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. 1,772 people responded from Midlothian - less than 2% of Midlothian’s population. The response rate increased with age and was highest in the 65+ age group (44%). This is compared to a response rate of 10% for those aged 17-34. In 2020 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. o For Indicators 1-9 the data for 2021/22 is compared with 2019/20 only. o For Indicators 11-20 the data for 2021/22 in compared with the previous 4 years. You can see the details of our performance in the Data Appendix at the end of this report. Page 57 of 256
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12 The main challenges of 2022-23 The IJB was set up in 2015 to develop local solutions to improve health and care services. We still face some of the same issues such as an ageing population, inequalities in health, a national workforce shortage, increasing reliance on unpaid carers and growing pressures on acute hospitals. Some of the challenges services face today have emerged due to COVID-19, the cost-of-living crisis, and environmental issues and some are new as the wider system of health and care has changed and people have changed how they want to experience health and social care. Shifting the balance of care Our Strategic Commissioning Plan focuses on early intervention and prevention, support and treatment, and support in times of crisis and emergency. It has been a challenge to find the right balance between meeting people’s needs in times of crisis while also supporting them to take action to prevent ill or worsening health in the future. Whole population programmes of prevention and early intervention will reduce pressure on emergency services in the future. However, it has been difficult to distribute and prioritise resources for more community services because we need to keep people safe in times of crisis. The foundations of good health and wellbeing We are concerned that the lack of available specialist accommodation for people with mental health needs led to people being delayed in hospital. We need a better range of accommodation that can provide the right support for people to thrive. This is particularly true for people who also use substances. Policy and funding restrictions National policies or the ring-fencing of funding for specific care and support made it difficult for services to provide support in other areas. For example, it can be difficult to help people who need support with alcohol use alongside other substances as the funding was primarily provided for substance use. Transitions from children services to adult services for people with Learning Disabilities When people move from children’s services to adult services, differences in funding and services can make the transition difficult. Cost of Living Crisis Higher costs-of-living impacted the health and wellbeing on people, families, and young children. Longer waiting lists Some people waited longer for planned care which means they needed more support to cope at home. The impact of waiting longer meant people became more unwell, and some needed more support. This meant some people reached a crisis where it could have been avoided. Changes to end of life care More people choose to spend the last days of their lives at home - including people with young families and younger people, who are very unwell with cancer, needing care in our community hospital. Increase in support for the menopause Our GP colleagues supported an increase in women to manage the symptoms of the menopause. Page 58 of 256
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13 Integrating digital systems Advances in digital technology meant more services could be provided online and we must ensure we have a range of offers and supports to meet everybody’s needs. While the number of technologies and apps to support service delivery increases, Health & Social Care do not share technology. Workforce Recruitment and retention, staff engagement and staff wellbeing continued to be a national and local challenge. Page 59 of 256
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14 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. For some National Indicators, the number of responses from each locality were too small to be published. 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 the icon below to show good examples of: Page 60 of 256
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15 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. 2022/23 is not a reporting year for the HACE Survey so there is no available update or change in the data from the Annual Performance Report 2021/22. National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. 92% Adults supported at home agreed that they are supported to live as independently as possible. 73% Adults supported at home agreed they had a say in how their help, care or support was provided. 70% Adults supported at home agreed that their health and social care services seemed to be well coordinated. 64% Adults receiving care or support rated it as excellent or good. 79% Adults had a positive experience of the care provided by their GP practice. 62% Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life. 81% Carers feel supported to continue in their caring role. 27% Adults supported at home agreed they felt safe. 79% Page 61 of 256
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16 . National Indicator Our result Our Progress Premature Mortality Rate (People under 75) 428 per 100,000 Emergency Admission Rate 9,788 per 100,000 Emergency Bed Day Rate 112,579 per 100,000 Readmission to hospital within 28 days. 99 per 1,000 Proportion of the last 6 months of life spent at home or a community setting. 88% Falls Rate (People over 65) 18.9% Care services graded Good or better in Care Inspectorate Inspections. 78% Adults with intensive care needs are receiving care at home. 60% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 784 per 1,000 Health and Care resource spent on hospital stays where the person was admitted as an emergency. 23% Page 62 of 256
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17 National Indicators used to measure this outcome. * There is no update to the national data for 2022/23 in relation to this indicator. Our services aim to support people to look after their own health and wellbeing. By seeing ourselves as ‘facilitators’ and not ‘fixers’ we promote self-management through services including welfare advice, and information and support for people who are managing difficult circumstances. 92% of people in Midlothian said they are able to look after and improve their health and wellbeing and live in good health. 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 2022/23, the premature mortality rate increased in Midlothian and is now almost at the average rate across the whole of Scotland. The rate of emergency admissions to hospital during 2022/23 matches what we would expect to see based on the number of people living in Midlothian. This is also the case for the other Health and Social Care Partnerships across the NHS Lothian area. National Indicator Our result Our Progress Adults are able to look after their health very well or quite well.* 92% Premature Mortality Rate (People under 75) 428 per 100,000 Emergency Admission Rate 9,788 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 63 of 256
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18 Inclusive vaccinations – flexible services and information Vaccination teams improved how they share information with people. The team worked with community groups including the Midlothian Ukrainian Coffee Morning and held vaccination clinics at No11 in Dalkeith so people with mental health and substance use issues were able to get their vaccinations in a familiar environment, without needing to travel. The Preschool Immunisation team supported 1,800 young children to get a flu vaccination at a range of convenient locations including leisure centres, libraries, specialist nurseries and working men’s clubs. They offered twilight sessions, drop ins, and joint appointments for siblings. Parents were able to give consent over the phone, which meant other family members could bring children along. Improving dental health in Care Homes Some people find it more difficult to keep their mouth and teeth clean. This can be due to a physical difficulty from a stroke, arthritis, or arm injury, be caused by medicines that cause a dry mouth, or due to difficulties accessing dental care. The Caring for Smiles Team supported 10 nursing and care homes with a Dental Health Support Worker who visits every 8 - 10 weeks. They assisted care staff to ensure that every resident has an oral health risk assessment and daily oral care plan. Staff training was offered, and all care staff were encouraged to undertake accredited oral care training at SCQF level. The team also offered denture marking and signposted people if they needed urgent dental care with a general dental practitioner or the specialist special care oral health service. Supporting people with Chronic Obstructive Pulmonary Disease The Community Respiratory Team supported people at home with Chronic Obstructive Pulmonary Disease. When people become unwell, the team arranged treatment and support. This could mean talking to the GP or a team prescriber to get the right medicine that could prevent an unnecessary trip to hospital. They provided reassurance to people and gave guidance to them, to GPs, and to carers. By providing specialist treatment and support at home 189 unnecessary stays in hospital were avoided. This is a 12.5% increase compared with 2021/22, and accounts for 1,134 hospital bed days. Page 64 of 256
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19 National Indicators used to measure this outcome. The indicators used in this section relate to the experience of people when they receive care in hospital. * There is no update to the national data for 2022/23 in relation to this indicator. National Indicator Our result Our Progress Adults supported at home agreed that they are supported to live as independently as possible*. 73% Adults supported at home agreed they had a say in how their help, care or support was provided*. 70% Emergency Admission Rate 9,788 per 100,000 Emergency Bed Day Rate 112,579 per 100,000 Readmission to hospital within 28 days 99 per 1,000 Proportion of the last 6 months of life spent at home or a community setting. 88% Falls Rate (People over 65) 19% Adults with intensive care needs are receiving care at home. 60% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 784 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 65 of 256
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20 There is no update for the national data that describe how well adults feel they are supported at home or if they were involved in decisions about their care or support. Care Opinion is an online platform that people can use to give us up to date feedback about the care and support they receive. In the past year this has included experience of care provided by Midlothian Community Hospital, Hospital at Home, and GP services. The national data tell us that we are supporting 88% of people to spend the last 6 months of their life at home or in a homely setting. This data does not include information about whether this was someone’s preferred option, however our community services report they are seeing an increase in the number of people who choose to be cared for at home at the end of their life. In 2022/23, the number of people in Midlothian being admitted to hospital in an emergency reduced. However, the number of days they need to stay in hospital increased. This is partly because Midlothian has fewer nursing home beds than other areas and people who need more care than can be provided in their own home cannot be discharged from hospital. This reduced the number of available hospital beds for people who needed to be admitted. Our local data tell us that people aged 75 and over are only a small number of attendances at A&E, but often spend longer there than younger age groups. Three-quarters of 75-year-olds in the UK have more than one long term condition and often need more time for the right assessment, treatment, and care. This is even higher for people aged 85 and over. The two most likely reasons that people aged 75 and over need to go to A&E are confusion (delirium) and hip fractures. This age group accounts for about half of emergency admissions to hospital, and three-quarters of people who experience a delay in their discharge from hospital are aged 75 and over. In 2022/23 the overall number of days people stayed in hospital when they were ready to go home reduced. However, this was not the same for all age groups. People aged 75 and over were more likely to be delayed in hospital when they were ready to go home than other age groups. The number of days people aged 75 and over were in hospital when they were ready to be discharged (per 1,000 population) increased in Midlothian by 51%. Longer stays in hospital could be due to people being admitted to hospital in an emergency being more unwell than in the past. This is called ‘acuity’ and there is no agreed national measure for this, but we are trying to better understand this by using what we know about people’s health, e.g. the number of health conditions a person is managing. In 2022/23 fewer people in Midlothian were readmitted to hospital within 28 days of being discharged than the year before. It is important to note that the rate of readmission applies to hospital stays and does not include ‘virtual wards’ like the Hospital at Home service. Page 66 of 256
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21 Volunteers building stronger communities One of the ways we can support people living in communities is by supporting volunteers. In Midlothian in 2022/23, when people went home from hospital, more of them remained well at home. People who were discharged from hospital were often supported by volunteers who helped them get used to new equipment, make connections in the community, ask for support and build confidence and independence. We invested in a Volunteer Coordinator to expand and coordinate local volunteers. Volunteers supported people to attend the gym, join the library, visit community cafes, join craft classes, go to the cinema, attend cooking lessons, go walking, visit Dalkeith country park, use public transport, visit Edinburgh, attend fayres, gain confidence with mobility aids, and connect with neighbours. Supporting people to enjoy these activities built friendships and new connections, helped people access support and resources, establish positive routines, and created a new sense of community. People told us that volunteers helped them make new connections and be more active in their community, which improved their mental and physical wellbeing. Regaining independence after hospital The Rehabilitation Garden at Midlothian Community Hospital was co-designed and created in partnership with the NHS Lothian Charity, the Conservation Volunteers, the Cyrenians, and the Community Payback team. Officially opened in June 2022, the garden provides outside space for people to work towards their rehabilitation goals, while taking part in practical activities they enjoy and improving their sense of wellbeing. The garden created opportunities for practical activities, for example walking and moving around on different surfaces and gardening that support rehabilitation. These activities increased skills and confidence with balance, hand dexterity, mobility, memory, working with others. People are often more engaged and motivated when working outdoors. This provides an opportunity for people to be more confident about going home, as the garden is a place where people can practise their everyday skills. Page 67 of 256
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22 Supporting people to live well with a cancer diagnosis Cancer can have a huge impact on people and their families. People told us their most frequent concerns are money, anxiety, fatigue, and uncertainty about the future. The Improving the Cancer Journey programme supports people to focus on what matters most to them and to live as well as they can with a cancer diagnosis. This year, they increased the number of people they supported by 26%. They worked with 74 people with a cancer diagnosis and 20 carers or family members affected by cancer. 40% of people were given extra support with welfare rights and benefits advice. They also provided help with housing, blue parking badges, and support from food banks. Page 68 of 256
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23 National Indicators used to measure this outcome. * There is no update to the national data for 2022/23 in relation to this indicator. People are the experts in their own lives. We have been running Good Conversations courses in Midlothian for over a decade to work alongside people to achieve the things that matter most to them. Over the past 12 months this has gained momentum and became a core part of the HSCP’s system-wide approach called the Midway. The Midway is how Midlothian HSCP welcomes people into services, how staff work alongside them, and how we contribute to them achieving their personal outcomes. 120 staff have undertaken the training this year. For people with one or more long term condition, the Midway approach supports them to manage their health and wellbeing effectively. Good Conversations help staff connect people with the right services to get the right help at the right time. Our ‘no wrong door’ approach has contributed to improved outcomes for people. National Indicator Our result Our Progress Adults supported at home agreed they had a say in how their help, care or support was provided*. 70% Adults supported at home agreed that their health and social care services seemed to be well coordinated*. 64% Adults receiving care or support rated it as excellent or good*. 79% Adults had a positive experience of the care provided by their GP practice*. 62% Readmission to hospital within 28 days. 99 per 1,000 Proportion of the last 6 months of life spent at home or a community setting. 88% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 784 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 69 of 256
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24 GPs are independent contractors, and we continued to work closely together. The HACE survey covers elements of services that are delivered by GP independent contractors, and elements that are delivered by the HSCP. 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 Clinic (CTAC) are also available at GP practices. Coordinating care and better outcomes The Physical Disabilities team focused on what matters to the people they support using the ‘Good Conversations’ approach. This helped them connect people to services quickly. An example of this is when the team supported someone with several physical health conditions who was struggling to manage everyday tasks in the home. They shared that they were experiencing difficulties with their mental health. The team provided equipment and adaptations needed to help the person at home and connected them with Mental Health Services. By listening to what mattered, the team supported the person to access the right help for both their physical and mental wellbeing. The person told us this helped them be more confident and independent. Individualised and flexible treatment and care Community Treatment & Assessment Clinics (CTAC) are one of the ways we ensure people are able to see the right person, at the right place, and at the right time. There is a CTAC service in all Midlothian GP Practices, run by highly skilled nursing staff. Services include blood tests and blood pressure checks requested by the GP, removal of stitches or staples after an operation or injury, wound care, injections, ear irrigation, Doppler scans, catheter care, and long-term condition monitoring. On average CTAC teams offer over 2,000 appointments each week, and provide information, treatment, and support that helps people better understand their condition, manage, and recover. The CTAC team provided specialised person-centred care, by giving people the information they need to make decisions about their care. The service helped a young person regain their confidence, reconnect with friends and family, return to work, and enjoy what matters most to them, by helping them better manage their condition leading to recovery. Ulcers on both legs had contributed to the person becoming isolated and being unable to work or travel. The CTAC team arranged flexible, individualised appointments with the same nurse over 6 months, who explained the condition and the treatment options. The person was supported to set personal goals and was involved in decision-making to agree the right care. As a result of working together, within 6 months the person had returned to work and was able to travel abroad. Page 70 of 256
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25 Each GP practice in Midlothian has a tailored model of delivery to meet the needs of its own population. As a result, there is flexibility in the range and number of professionals available at each practice and how people contact the practice team. We know that people are concerned about seeing their GP and getting appointments when they need them. When we talk about ‘GP activity’ we mean the number of contacts GPs have with people, e.g., appointment, telephone call, eConsult. In Midlothian, GP activity has returned to pre-COVID-19 levels. This year, GPs in Midlothian have consistently had more contact with people than other areas across Lothian. Our data tell us that GPs in Midlothian are completing between 10,500 – 16,300 clinical contacts each week. We have seen a change in the number of people who need appointments urgently for medical advice or assessment. People who see a GP on the day they contact the surgery are approximately 50% of all GP appointments. In December 2022, the demand for GP appointments increased by 82% in Midlothian. This was due to an increase in throat infections and press reports raising public concerns that this could lead to a more serious and life-threatening infection known as invasive group A streptococcal disease. GP services worked hard to keep people safe and avoid them going to hospital unnecessarily. Local data tell us that on average 45% of people have seen the same GP for repeat consultations over the last 6 months. For adults who are 65 years and older this rises to between 50-65%. Improving support for the menopause Nurse-led reviews for women taking Hormone Replacement Therapies helped people improve their health and wellbeing. Changes in how we talk about the menopause mean that more women are coming forward for treatment and support. Our GP colleagues recognised an urgent need to do things differently, so that women get better access to the information and medicines that are right for them. Comments from women include: “I was using my patches wrongly”, “I felt able to ask questions about my HRT”, “I did not realise I needed contraception with HRT as I was still in my 40s”, “I’ve never had a review before and found it beneficial to have a chat about my HRT”. Page 71 of 256
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26 Changes to seeing the GP GPs have made a number of changes to improve access and communication, and the Midlothian HSCP Digital Programme is supporting 3 more practices to improve access by using eConsult. Most practices have increased their use of social media and some use SMS texting to relieve pressure on the phonelines. GP Practice teams have improved how people get their medicines. All practices now offer online repeat prescription ordering. One practice has now reduced the turnaround time to one day. The GP management of Danderhall Practice has changed in 2022-23. Midlothian HSCP worked with them to help ensure a smooth transition. GPs are providing more support in Danderhall with the number of appointments continuing to increase. The Practice team can now book people a same- day appointment at the minor ailment clinic, and routine face to face appointment capacity has increased. Early data tell us that fewer people from Danderhall are going to A&E for conditions that a GP could manage. Easier access to the practice building and removing the buzzer and intercom system may have contributed to this change. Crisis and Emergency In 2022/23, we reviewed how we involve older people in planning and making decisions about their care if they become very unwell. Anticipatory Care Planning is a person-centred, proactive approach to help people think ahead, consider what matters to them, and plan for future care. Thinking ahead can help people feel more in control of their health and wellbeing. Having good conversations and creating an Anticipatory Care Plan ensures people’s wishes are known. This reduces stress if people become very unwell, allowing health and care staff to confidently act on people’s preferences. For people who live in care homes, this can reduce the number of people who are admitted to hospital when their preference is to stay at home. We worked with the British Institute of Human Rights, Care Homes, health and social care practitioners and GP practice teams to improve the way care home residents, families, carers, and staff work together to create meaningful anticipatory care plans. More people who live in care homes avoided an unnecessary stay in hospital when their anticipatory care plan was clearly written. The person’s preferences within the plan are used to ensure all decisions made in an emergency situation are person-centred. More than 154 care home staff were trained in anticipatory care planning and reported feeling more confident in having the skills to support anticipatory care planning. Page 72 of 256
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27 National Indicators used to measure this outcome. * There is no update to the national data for 2022/23 in relation to this indicator. In 2022/23, we worked with a range of partners to continue to create opportunities that improve health, wellbeing, and quality of life for people and communities in Midlothian. Our Older People’s Service provided more than 230 online, outdoor, and creative opportunities each month for older people to connect with each other. Our Care at Home service has been reviewed to ensure it is sustainable and fit for the future. National Indicator Our result Our Progress Adults receiving care or support rated it as excellent or good*. 79% Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life*. 81% Emergency Bed Day Rate 112,579 per 100,000 Readmission to hospital within 28 days 99 per 1,000 Falls Rate (People over 65) 18.9% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 784 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 73 of 256
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28 Volunteering plays a critical role in improving quality of life. People are motivated to volunteer for a number of reasons, including the opportunity to gain knowledge and skills, to give back to their community and help others, to gain the experience they need to move into studies or employment, and following support they themselves had in the past. We know volunteering has positive health outcomes, and volunteers have shared their experiences of feeling more motivated, skilled, and confident. Volunteers have opportunities to develop new skills in health and social care, and many use these skills to go on to study or get a job. The data tell us that retired and unemployed people who volunteer are often healthier than people who do not. Volunteers from lower income households are often much healthier than those who do not from similar households. The evidence also suggests that young people in particular benefit from volunteering. People who volunteered told us that their mental health and wellbeing improved (92%), as well as their physical health and wellbeing (85%). 69% of volunteers reported increased motivation and activity levels. More than half (54%) experienced a reduction in loneliness, while over a third reported increased confidence (38%) and more engagement in their community (31%). We have developed better services for people experiencing poor mental health, by working closely across health and social care, housing, and the Third Sector. In 2022/23 our teams have supported 34 people into employment, education or volunteering and increased people’s opportunities to succeed. Improving support for people with neurological conditions Midlothian HSCP worked with partners including the Thistle Foundation, ArtLink and Cerebral Palsy Scotland to better understand the needs of people with neurological conditions. Supported by Scottish Government funding and in partnership with Cerebral Palsy Scotland we improved the pathway for people living with Cerebral Palsy. By working together and sharing information, this project will keep the views of people at the centre of decisions when future services and support are designed. We worked alongside ArtLink to support people with neurological conditions to tell the story of how they experience of health and social care. Improving quality of life for Adults with Complex and Exceptional Needs The Adults with Complex & Exceptional Needs Service (ACENS) supports people over the age of sixteen who have been assessed as having exceptional healthcare needs and their families at home, and in the community. Most people receiving care from the ACENS team have a life-limiting condition and require specialist care, equipment, and technology in their own environment. This highly skilled team tailors support to each person’s individual needs and supports them to continue to live at home, build relationships, and participate in the activities that matter to them. Page 74 of 256
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29 Tramway In partnership with Cherry Road Day Services for people with Learning Disabilities, Midlothian HSCP sponsored the multi-sensory ‘Human Threads’ exhibition at the Tramway contemporary arts venue in Glasgow, from May - August 2022. The celebrated the common threads that make connections between people with complex disabilities and the wider world. The exhibition represented many years of work between Artlink and Cherry Road Learning Centre which supports people with profound and multiple developmental disabilities and their carers. The exhibition was a large scale, multi-sensory, interactive landscape which invited audiences on a journey of light, sound, touch, and smell, providing the opportunity to look at who we are through a completely different lens. People who attended Cherry Road thought this was a positive experience and enjoyed creating national artwork. Page 75 of 256
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30 National Indicators used to measure this outcome. The Scottish Index of Multiple Deprivation (SIMD) is how the Scottish Government identifies deprivation in Scotland. SIMD data is organised into 10 data zones, from the most to the least deprived. In Midlothian, approximately 31,522 people live in a zone that is considered to be the most deprived. People living in the most deprived areas are 30% more likely to need a prescription for anxiety or depression, and 24% of children live in poverty. We know families that include a person with a disability are more likely to be financially disadvantaged than other families. Where we are born, live and work can impact our health and wellbeing. While not everyone living in a deprived area will experience high levels of deprivation, we know there is a link between deprivation and poorer health outcomes. This means people who live in the most deprived communities are more likely to die before the age of 75 (premature mortality) compared to those living in the least deprived areas. People living in remote rural areas have the lowest premature mortality rates, with higher premature mortality in large urban areas. There are a number of long-term conditions that contribute to people dying earlier, as well as reducing the number of years people live in good health. Diabetes, ischaemic heart disease, Chronic Obstructive Pulmonary Disease and dementia are all long-term conditions that contribute to premature death in Midlothian more frequently than across Scotland as a whole. More people in Midlothian have their health affected by lower back and neck pain, headache disorders, anxiety disorders, and diabetes than across Scotland as a whole. A small proportion of premature deaths in Midlothian will be related to substance use. For 2022/23 this data is XX%. We cannot assume that deaths related to substance use occur only in people under the age of 75. We know that stopping smoking increases your chances of living a longer and healthier life. People who can stop smoking reduce their risk of heart disease, stroke, respiratory disease, and cancer. Stopping smoking can lead to improvements in the symptoms of smoking-related diseases, and also improve mental health and wellbeing. The Scottish Government and NHS Boards agreed to work towards a smoke free National Indicator Our result Our Progress Premature Mortality Rate (People under 75) 428 per 100,000 Emergency Admission Rate 9,788 per 100,000 5 Health Inequalities Health & social care services contribute to reducing health inequalities Page 76 of 256
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31 Scotland by 2034. To do this, we worked to help people successfully stop smoking, especially in our most deprived areas. Reducing smoking during pregnancy Fewer people smoking also reduces the risk of people being exposed to second-hand smoke (passive smoking). This benefits the development of babies and children in particular. We also know that if parents stop smoking, it is less likely their children will become smokers. Children living with parents or others who smoke are much more likely to start smoking themselves. We offered 1:1 sessions in community venues across Midlothian with information and support for pregnant women and their partners. In Midlothian 12.6% of pregnant women smoked at their first midwifery appointment. The Health Improvement Team worked with midwives, health visitors, and family nurse partnerships to improve training and information. A ‘smoking in pregnancy’ training module was developed for NHS staff and Midwives had equipment and training to offer carbon monoxide monitoring. We saw a 300% increase in the number of women who made a quit attempt with the Smoking Cessation service. Improving access to health and care Our Health Inclusion Team worked with the people most affected by health inequalities including people affected by homelessness, substance use, domestic abuse, or people with caring responsibilities. The team offered support in local settings including temporary accommodation, food banks, and community groups. In 2022/23 they supported over 120 people with a wide range of health needs. This included blood borne virus testing, physical checks, cervical screening tests, immunisations, weight management support, substance support, support to access services and registering with a GP or Dentist. Page 77 of 256
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32 Supporting people with Learning Disability Our Day Services provided opportunities for people to learn new skills and connect with each other. We worked in partnership with Thera Trust to increase our ability to provide integrated care and support. Our Expert Panels delivered change that mattered most to people. The Complex Care Expert Panel’s financial recommendations for Community Change Fund spending priorities were approved. This included recruiting a new Transition Development Worker, making improvements to Day Service venues for people with complex needs, developing a Positive Behavioural Support Training Programme, and supporting grants to Third Sector organisations. The Human Rights Expert Panel created its first programme of activity. Bi-monthly meetings will oversee work to ensure we are promoting and protecting peoples’ human rights and our duties under human rights law. Supporting people with the cost of living The rising cost of living is affecting people who are struggling to pay energy bills and buy enough food. More people are having to choose between eating and staying warm. The British Red Cross provided practical support, such as food vouchers, slow cookers, and recipes, to help people enjoy warm, healthy, affordable meals and pay energy bills. This support has contributed to a number of the most vulnerable people in our communities remaining safe. Page 78 of 256
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33 National Indicators used to measure this outcome. * There is no update to the national data for 2022/23 in relation to this indicator. In our last Annual Performance Report, we noted we had work to do to better support carers. Midlothian achieved slightly higher (40%) than the national average (39%) in the 2021/22 HACE survey when asking carers if they felt they had a say in the services provided for the person they care for. This was significantly higher (54%) in the VOCAL survey and likely due to the work of VOCAL to provide support and promote self- advocacy with carers. The VOCAL survey also provided us with local insight into what matters most to people who undertake a caring role. Information and support helps people to provide care for as long as they are willing and able to do so. 17% of carers did not feel they had a say in the services provided for the person the look after. This was greater for those caring for someone due to substance use (31%) or visual impairment (26%) and those caring for people aged 16-25 (26%). More than a third of carers (38%) did not feel services were well coordinated and described additional stress caused by having to interact with several agencies. Nearly a quarter of carers (24%) told us there were no services available to provide care whilst they take a break. Additionally, 39% of carers told us there was nobody else to provide care, and 27% reported that the person they care for will not accept care from others. 33% of carers in Midlothian told us that would like to see more services in their local communities at a time that suits them and was provided in one place. 40% of carers wanted help to understand legal rights and entitlements, and 36% wanted help to contact statutory agencies like health, social care, or education. National Indicator Our result Our Progress Carers feel supported to continue in their caring role*. 27% 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Page 79 of 256
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34 Providing the right support In 2022/23 we increased the number of Adult Carer Support Plans by 150%. We focused on listening to carers, our partners, people, and communities to ensure that we use all our available resources in ways to make the biggest difference. We have collaboratively developed a range of supports to improve the experience of carers including plans for a Midlothian Community Care Cooperative. People told us that the priorities in our Carer’s strategy were highly relevant to provide the support they needed: • Identifying carers, and helping people recognise when they are providing a caring role, • Improving access to support, information, and advice, • Supporting health and wellbeing (including breaks from caring), • Planning ahead, • Financial support, and • Involving carers in care decisions and designing services and supports for the future. The Midlothian Carers Strategy 2022-25 was published in 2022. Carer Relief Companion scheme Our Carer Relief Companion scheme is a programme where volunteers support families by spending time with the person they care for doing their preferred activities, whether playing dominoes or reminiscing over old photographs. For a few hours each week, volunteers give carers the opportunity to look after their own health and wellbeing by offering companionship to the person they are caring for while they take a short break. “I would like to record my thanks …. This was to provide a companion service to my father (who)…has been diagnosed with Alzheimer's Dementia. The provision of the companion service enabled him to have additional contact with someone other than me. Whilst he did not realise it, I think he was becoming quite lonely on his own. …the companion service team … took time to listen and understand my father and my circumstances and to seek to identify someone suitable to provide the companion service. The companion who was identified really made the service easy as she clearly understood the circumstances and was very accommodating in terms of my father's increasingly acute memory loss - often the conversation would need to start from square one again and the volunteer was patient. I would have no hesitation in recommending the companion service to others. It gave me real peace of mind knowing that someone else was looking in on my Dad and providing that extra interaction for him at a much-needed time”. Page 80 of 256
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35 National Indicators used to measure this outcome. * There is no update to the national data for 2022/23 in relation to this indicator. During 2022/23, the Care Inspectorate completed 18 inspections in Midlothian which is an increase of 80% compared with last year. The majority of services inspected were given a rating of adequate, good, or very good. A summary of the key findings can be found later in this report. Over two-thirds of Health and Social Care Partnerships across Scotland saw a reduction in this national indicator. We received 929 Adult Support and Protection referrals in 2022/23, compared to 674 the year before. This is an increase of 225 referrals (37.8%) and an 100% increase over two years. The main type of harm investigated was financial harm, most commonly for women at risk of harm (67%), and adults aged 65 and over (52%). National Indicator Our result Our Progress Adults supported at home agreed they felt safe*. 79% Emergency Admission Rate 9,788 per 100,000 Emergency Bed Day Rate 112,579 per 100,000 Readmission to hospital within 28 days. 99 per 1,000 Falls Rate (People over 65) 18.9% Care services graded Good or better in Care Inspectorate Inspections. 78% 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 81 of 256
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36 We continue to improve the number of ways people can access the right information at the right time. Self-management approaches focus on supporting people to take action to prevent ill or worsening health. We know that people are more likely to take positive action in relation to their health and wellbeing when information is easy to find, including online resources. In 2022/23 we have seen a reduction in the number of people aged 65 and over being admitted to hospital as a result of a fall. Falls remain in the top ten reasons for people in Midlothian being admitted to hospital. Reducing falls and reducing how many people need to go to hospital will help people stay well, improve wellbeing, and reduce pressure on the wider system. For older people, we know that falls can be associated with being unwell. However, falls should not be considered as an inevitable consequence of getting older. This indicator is based on information about people aged over 65 who are admitted to hospital after a fall. The good work we are doing to prevent people falling or providing personalised care for people who have fallen in their homes to prevent going to hospital, is not described by this indicator. Safe use of medicines A way to help people stay safe at home is to make sure their medicines are well managed. This includes ensuring carers understand how to give, and keep clear records of, medicines. The practice learning and development team developed medication training, supported by the NHS Pharmacy facilitator and the Midlothian HSCP Clinical Pharmacist, for our Care at Home Management team. The training was well-received. When people leave hospital, their medicines have often changed. These changes need to be communicated to GPs and community pharmacists quickly and accurately. This is called ‘Medicines Reconciliation’. The national Scottish Patient Safety Programme target is to complete this within 48hrs of the GP receiving a hospital discharge letter. The Medicines Reconciliation Hub reviews the medicines for people in Midlothian who are discharged from hospital. The hub is led by highly skilled pharmacy technicians and all 12 GP practices in Midlothian have access to the hub. We have increased staffing within the hub, which has led to medicines being reviewed within 48 hours over 80% of the time. Online support for mental health Midspace is the online resource for mental health and wellbeing information in Midlothian Nearly 15,000 people in Midlothian have accessed Midspace for information and support. A further 723 people have accessed the integrated mental health team through social media. A newsletter also provided information for the whole community. Page 82 of 256
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37 We also know that falls are often not reported. Even when falls are reported, the systems we use to record information are not well connected, and do not consistently identify opportunities to prevent falls in the future. We have worked to better understand how we can contribute to reducing the risk of older people falling, and we will continue to work with all our partners in Midlothian. In 2022-23 our Frailty Programme explored and defined the falls pathway across Midlothian to understand where improvements could be made in the care we provide. This work highlighted opportunities for prevention and early intervention, and combined with our ‘Good Conversations’ approach, these changes improved our ability to provide high quality, person-centred care in the right place at the right time. Our work to keep people safe and well at home also includes the use of telehealth equipment. Our community alarm systems help keep people safe and well in their own homes. We provide a range of sensors that are linked to a call centre. This helps people feel able to remain in her own home and feel safe. During 2022/23 there were 26,694 responses to alarms within the home for Midlothian Residents. This is an increase of 6% compared to last year. Supporting people who use substances The Substance Use team provided information, advice, and support to people and their families. We developed supports, treatment, and care including new medical treatments and increasing the safe use of needles. Scotland has the highest drug death rate in the UK. Across Scotland, there were 797 suspected drug deaths during the first nine months of 2022. The average age of a drug death has increased from 32 in 2000 to 44 in 2021. Overall numbers are falling but still remain high. People living in the most deprived areas are 15 times as likely to have a drug-related death as those in the least deprived areas. Accidental overdose is a common cause of death among people who use heroin, morphine, and similar drugs. Naloxone is a drug that reverses the effects of an overdose. Administration of naloxone provides time for emergency services to arrive and for further treatment to be given. The Substance Use team provided training on the use of naloxone kits for people at risk of opioid overdose, for their friends and family, and for our workforce. In 2022/23, 168 kits were replenished by Midlothian and East Lothian Drugs, the Substance Use Service, and peer workers. Page 83 of 256
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38 National Indicators used to measure this outcome. These are no National Indicators to measure our progress towards this outcome, so we use staff surveys to evaluate our performance. Staff experience iMatter is an annual survey sent to all employees across health and social care in the Lothians. In 2022, 48% of the workforce in Midlothian HSCP completed the survey. This is a small decrease (2%) on the previous year. 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. The maximum score is 100, and in 2022 Midlothian scored 78. This is an increase compared to last year. A recent staff survey was completed by 90 social care staff. Approximately 85% described a positive experience of supervision, leadership, and training opportunities. Staff also reported improvements in strategic and locality planning, commissioning, and how we measure our performance. Communication, Engagement and Experience Delivery Plan In 2022/23 all staff across the partnership were invited to take part in a 4-month consultation on how we could improve the experience of working in Midlothian. Over 200 staff provided feedback, and this fed into the vision, aims and objectives of our Communication, Engagement and Experience Delivery Plan. Surveys, forums, team meetings and workshops shaped the language, aims, and actions in the plan. Midlothian HSCP will listen to staff as we deliver, review, and reshape the workplace experience. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide Bringing people together The ‘Soup Stop’ at Midlothian Community Hospital brings staff together, take a break with some healthy food and chat with our Senior Management and Executive Management in an informal and relaxed atmosphere. Staff have told us this has built a better sense of working together and improved staff wellbeing. Page 84 of 256
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39 Working in health and social care is a rewarding career but can be challenging physically and emotionally. Our staff have told us that competing demands can make it difficult to ‘switch off.’ We introduced the ‘Changing Gear’ programme to help staff leave work at the end of the day and focus on the other parts of their life. The programme is delivered over four 30-minute sessions and aims to teach simple techniques for the body and mind. Yoga, simple exercises, mindfulness, and worry management have been funded through a small grant provided by NHS Lothian charity. All staff who have taken part would recommend the course to others and 92% of staff rated the programme as very good or excellent. The environment can have a significant impact on our mental health. It can create a sense of social support, provide comfort, and increase motivation and creativity. Following successful funding bids, the NHS Lothian charity supported Midlothian HCSP and the Dalkeith Guerrilla Gardeners to create two wellbeing spaces with the Haven and staff wellbeing room at Midlothian Community Hospital, and the garden at Number 11, St Andrews Street. In 2023/24, we are hoping to provide more wellbeing spaces for our workforce in Penicuik, Bonnyrigg, and Dalkeith. Midlothian HSCP Integrated Workforce Plan and Workforce Development In December 2022 we published the first Midlothian Health and Social Care Partnership Integrated Workforce Plan for 2022-2025. This plan recognises local and national challenges, how we are responding to ongoing pressures, and ensure we have a workforce fit for the future. We must do more to support our workforce. This means investing in the wellbeing, training, and development of our workforce, including our Third Sector partners and unpaid carers. We know our workforce is our greatest asset, and we must ensure we have the right staff, in the right place, at the right time. Good Workforce Planning will ensure that our workforce has the knowledge and skills to deliver health and care in the future. We must invest in developing a skilled, flexible, and adaptable workforce. In 2022/23 we progressed plans to establish a Workforce Governance Board to oversee the delivery of our Integrated Workforce Plan. Our two main areas of focus will be workforce planning, and workforce engagement. We will ensure we have reliable and accurate information about workforce demand, vacant posts, and recruitment times. This will include the development of workforce planning tools, and a review of operational workforce planning opportunities. As we develop our workforce planning skills, we will plan in partnership with NHS Lothian, Midlothian Council, Higher Education Institutions, and the Third and Independent Sectors to ensure we have an integrated workforce, fit for the future, that puts people at the heart of all we do. We have highly skilled and experienced teams in Midlothian HSCP. However, we faced staff retention challenges, particularly in relation to nursing, care at home staff, and mental health officers. In addition to our work on staff engagement and experience, we are increasing staff development opportunities. A new local Career Development Toolkit will be developed in 2023/24, to ensure staff have a clear route to develop and progress. Page 85 of 256
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40 Bright Futures for staff at Midlothian Community Hospital Midlothian Community Hospital reviewed its staffing model to ensure that staff had the right skills and the right support to provide the highest quality care. • All Health Care Support Workers took part in a development programme with a combination of formal and informal training. There are 13 clinical competencies matched to the areas people work and include record keeping, vital signs, ordering of specimens, and simple wound management. • A range of Nursing Assistant roles were available including nursing assistants in training, qualified nursing assistants, and student nurse assistant practitioners. All staff undertook training in person-centred care planning, and leadership skills. • Newly qualified nurses were offered a supportive environment with a structured 2-day induction, and support by the new Clinical Facilitator to continue to learn and develop in areas like medicine management and leadership skills. They also took part in formal structured courses including NHS Lothian’s Newly Qualified Nurse programme and the Flying start programme. All student nurses received a welcome pack and were supported by the Clinical Facilitator with all aspect of nursing care. Weekly education sessions were available to students of any visiting professional. Page 86 of 256
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41 National Indicators used to measure this outcome. * There is no update to the national data for 2022/23 in relation to this indicator. We allocate the integrated budget we receive from Midlothian Council and NHS Lothian. Our Strategic Commissioning Plan sets out an overall plan for our delegated services every three years. We asked services to prioritise a number of outcomes. Financial planning allocated funding to each service to ensure the health and care needs of the people of Midlothian were met. This involved considering the best way to use available resource to provide the highest quality of care. Midlothian Health and Social Care Partnership directly managed this funding and made decisions about how services use the money they received. Resources have been stretched due to salary increases for our staff and our commissioned services, and a larger population with more complex needs. 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. National Indicator Our result Our Progress Adults supported at home agreed that their health and social care services seemed to be well coordinated*. 64% Emergency Admission Rate 9,788 per 100,000 Proportion of the last 6 months of life spent at home or a community setting. 88% Falls Rate (People over 65) 18.9% The number of days people aged over 75 spend in hospital when they are ready to be discharged. 784 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 87 of 256
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42 Reviewing medication By working closely with GP Practices, the Pharmacy team worked to make sure that people take the safest, most effective medicines. This included carrying out polypharmacy reviews, where a person’s medicines are looked at to make sure they are all still needed. Preventing hospital admissions Some of our community teams provided care to prevent admission to hospital. In 2022/23 we developed an electronic data dashboard to tell us when someone from Midlothian is in A&E. This information helped community teams work alongside A&E colleagues and avoid admission where possible. The dashboard was also used by the Flow Team to coordinate the care of people while they were in hospital, and when they were ready to go home. The dashboard provides up-to-date information, so planning for people to be discharged from hospital is done as early as possible. Better integrated collaborative working to continue to achieve best value The Dietetic Prescribing Support Team worked with people who were discharged from hospital, and people living in Care Homes. The team made sure these people have the right nutritional support, which may include Oral Nutritional Supplements. The team worked closely with GP practices to promote the updated Malnutrition Care Pathway and training. Working alongside Care Home staff, a more efficient referral process was jointly developed. Communication between teams improved. As a result, the team saw people earlier, by ensuring that care home residents saw a dietitian at the right time, we spent less despite the increased cost of supplements. Page 88 of 256
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43 How We Spent Our Money (2022/23) We had a total budget of £173m and ended the financial year with an overspend of £10.3m. This included an underspend on our operations of £0.4m and the use of earmarked reserves funding during the year, predominantly for COVID-19. For more information see our Annual Accounts. Budget Spend Variance Direct Midlothian Services Community AHPS 2,234,069 2,101,440 132,629 Community Hospitals 6,205,539 6,563,225 -357,686 District Nursing 6,085,440 5,858,168 227,272 General Medical Services 17,275,583 17,511,583 -236,000 Health Visiting 2,397,793 2,505,868 -108,076 Mental Health 3,030,656 2,849,066 181,590 Other 1,383,805 7,597,473 -6,213,668 Prescribing 19,660,453 20,328,369 -667,916 Resource Transfer 7,112,274 7,109,434 2,840 Older People 26,304,227 25,552,368 751,859 Learning Disabilities 18,228,653 18,983,957 -755,304 Mental Health 1,134,041 1,188,778 -54,737 Physical Disabilities 3,829,016 3,846,579 -17,562 Assessment and Care Management 3,616,499 3,583,197 33,302 Other 3,499,315 7,367,121 -3,867,806 Midlothian Share of pan-Lothian Set Aside 21,494,976 22,586,023 -1,091,046 Mental Health 2,802,063 3,050,666 -248,603 Learning Disabilities 1,338,475 1,353,181 -14,706 GP Out of Hours 1,327,876 1,396,803 -68,927 Rehabilitation 947,650 782,937 164,713 Sexual Health 758,821 773,731 -14,910 Psychology 1,282,550 1,183,509 99,041 Substance Misuse 517,656 497,070 20,586 Allied Health Professions 1,780,607 1,657,908 122,699 Oral Health 1,355,200 1,304,536 50,665 Other 3,825,622 3,716,635 108,987 Dental 6,347,653 6,347,653 0 Ophthalmology 1,743,994 1,743,994 0 Pharmacy 3,829,726 3,829,726 0 171,350,233 183,171,000 -11,820,767 Non recurring funding support from NHS Lothian 1,480,000 1,480,000 172,830,233 183,171,000 -10,340,767 Subject to audit Page 89 of 256
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44 Financial Challenges during 2022/23 COVID-19 Funding During the pandemic, Midlothian, in line with Scottish Government guidance, stepped up a range of services to support a system wide response to COVID-19. The cost projections associated with these services were reported to us through the Scottish Government Local Mobilisation Plan. During the 2020/21 to 2022/23 financial years the associated costs were funded by designated COVID-19 funding. The Scottish Government confirmed the funding would not be available in the 2023/24 financial year. In response, we assessed and reprioritised funding streams to ensure both clinical and financial sustainability of these services. Social Care There was an overspend within adult services, specifically for clients with learning disabilities. This pressure was offset by a significant underspend in services for older people. Health There were operational overspends within Community Hospitals because of workforce challenges and overspend within the prescribing and general medical services budgets. 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 were also increased requirements for equipment provided by the Community Equipment Store. The main pressure for Set Aside services was within Gastroenterology Services and the ongoing pressure with drug costs for the treatment of long-term gastroenterology conditions. Junior Medical pay pressure also continued, where additional staffing was required to fill gaps in rotas and where there were service pressures. The Junior Medical position has improved significantly from previous years but continued to be a pressure. The health arm of the IJB was operationally overspent and NHS Lothian provided the IJB with additional one-off funding of £1.4m to support break even against these budgets. Page 90 of 256
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45 Main Areas of Spend (2017/18-2022/23) 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. 96,030 34,336 20,328 17,512 14,965 0 20000 40000 60000 80000 100000 Community Hospital Prescribing GMS Other £ 000's Main areas of spend 2017/18-2022/23 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 Page 91 of 256
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46 Budget challenges in Midlothian In March every year, Midlothian Council and NHS Lothian make a budget offer to the IJB, based on levels of funding set by Scottish Government. The IJB then review these offers and accept or reject them as part of its annual financial assurance process. This year Midlothian Council did not offer to pass over the agreed amount in full, and the IJB voted not to accept this offer. The Council’s position did not change, and the IJB has continued to explore options to mitigate this reduction in funding. This includes developing a multi-year financial plan to support how the resources available to the IJB will be used to deliver the ambitions of the Strategic Plan. It became clear across 2022/23 that the financial situation had become more difficult as we better understood the impact of events since March 2020. Despite this, the IJB supported an increase in wages in line with the living wage and asked services to ensure fair working by offering guaranteed hours. The years ahead will be some of the most challenging that health and social care have ever faced. This means we will need to better understand how peoples’ and communities’ needs have changed and build the right offers of support, with the resources we have available. The IJB will continue to invest in population health and improve community alternatives to hospital-based care. Page 92 of 256
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47 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. Midlothian Integration Joint Board and Midlothian Health and Social Care Partnership are part of the Midlothian Community Planning Partnership. By working together, we want to see people leading healthier, safer, greener, 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 2022/3 we reviewed how we could most effectively contribute to the ‘Single Midlothian Plan’ and work with the Community Planning Partnership members, to achieve more together than health and social care can do alone. We will lead the 'Midlothian will be Healthier' thematic area 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. The Third Sector has strong roots in local areas and supports a system-wide understanding of our communities that is invaluable. Our ongoing partnership with the Third Sector is at the core of our work in communities. The Community Planning Partnership annual conference took place in November 2022, where the results of the Midlothian Citizen’s Panel Survey were presented. Over 1,000 people were asked their views on what matters most to them in their communities and what they think we should be focusing on. 565 people replied to a questionnaire and the three priorities people wanted the health and social care to focus on to ‘Make Midlothian Healthier’ were: • Support the health needs of a growing and ageing population • Provide support to vulnerable people • Improve wellness and support 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 has been based on the wishes of people and communities and explored opportunities to work with more of the partners in our Community Planning Partnership. Page 93 of 256
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48 Communication & Engagement We constantly involve people who use our services, their carers, and people who support them develop and deliver our services. This year we consulted people to ask for their views on a range of services including: Palliative End of Life Care Project We were one of two pilot sites chosen to take part in a project, funded by the Scottish Government and Marie Curie, to explore ways to capture feedback from bereaved family members about palliative and end of life care. We spoke to 61 people including family members, community district nurses and staff from Midlothian Community hospital. Key themes that emerged were: • The importance of relationships and being treated as a whole person in a good death • The importance of being able to make choices in a good death • Getting help needed when it is needed • The importance of specialist advice and care, especially at the very end of life Neurological conditions We worked with Artlink to listen to people with a neurological condition and understand their experiences, to help us make sure everyone can get the care and support they need to live well. We commissioned an author and speaker on disability, social inclusion, and empowerment to interview people and present her findings. Additional funding for carers As part of the process for allocating additional funding from the Scottish Government to support carers we consulted with 40 stakeholders and unpaid carers on the services we deliver, gaps and what could be improved or developed. We asked about: • Carer Identification • Information, support, finances, and breaks • Carer Health and wellbeing • Planning ahead Community justice We undertook a variety of consultations including the Citizens Panel; individuals in care at HMP Edinburgh; individuals allocated to Justice Social Work or engaging in groups including Unpaid work as part of Community Payback Orders. Key themes from these consultations included: • A need to redesign our exit questionnaires for all individuals on Community Payback Orders. • Development of an effective, person-centred, and trauma informed Restorative Justice pilot that promotes and prioritises the voice of survivors. We are one of the first local authorities in Scotland to take forward this ground-breaking, innovative, and partnership-led work and consultation, engagement, research and training and development all contributed to the design of the project. Page 94 of 256
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49 Transitions for people with learning disabilities. The Transition Forum looked at how we plan and provide support for people aged 14-25 who require additional support as they make the transition to young adult life. Over 30 people replied to our online questionnaire. The main themes were: • People said they wanted support for mental health, independent living and social activities • People felt they could be better supported for planning in the future • People felt they were unsure of the support available to them during transitions Page 95 of 256
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50 Looking forward To meet the needs of people and communities we will need to deliver on the strategic priorities of all our partners. We have identified themes and priorities that we must work together to achieve: • Provide more preventative care • Understand how peoples’ and communities’ needs have changed and build the right offers of support • Ensure effective and efficient services while also maintaining quality • Improve socio-economic, health, wellbeing, and personal outcomes We must develop a whole-system approach to how we design and deliver our services. We must share decision making and share responsibility for outcomes and use proactive and consistent approaches to improve our performance. Working with communities People and communities have valuable skills and experience to design and improve the health and care services that matter to them. We want to work with communities to ensure that we are planning and developing the right local health and care services. We want to be confident that all our delegated services are committed to quality community engagement and be able to describe how well they are working with communities. To do this, we will undertake a self-evaluation using the Health Improvement Scotland Quality Framework for Community Engagement and Participation across 2023-24. This will complement our outcomes- focused approach by prioritising outcomes over activity, describe the impact of our partnership working, describe the changes made as a result of feedback, and how potential impact is being monitored. In 2023/24, we will ensure we have identified and supported engagement activity in 4 ways: • We will work with communities to complete the Health Improvement Scotland self- evaluation and identify key areas for improvement • We will be clear on how we expect all our delegated services work with communities • All our delegated services will report on the specific engagement activities relating to service planning and design • We will be able to describe our internal governance systems for community engagement activities Designing our services As we better understand the changing needs of communities we will continue to assess, adapt, and innovate to ensure what we offer is what people need. We need to be clear about when we are implementing change, and when we need to think in much bigger terms about transformation. Page 96 of 256
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51 Change is when we modify our actions to achieve better results or to meet changing targets or resources. This usually involves implementing well-defined shifts in activity. Transformation involves bigger reinvention, sometimes in profound ways, can often involves rethinking our core beliefs and patterns of long-term behaviour. We will continue to take a transformational approach with a range of related and dependent initiatives then do whatever it takes to ensure that learning can be spread across the whole system at scale and at pace. Workforce Integrated workforce planning is new for health and social care, and we will develop our skills in this area across 2023/24. This includes our preparations to deliver the requirements of the Health and Care (Staffing) (Scotland) Act. The needs of our workforce are changing and dependent on many new factors. 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. As we transform our services, we will continue to work with partners from all sectors to develop an integrated workforce that is fit for the future. Support evidence based workforce planning Attract the best staff into health and care employment Support staff through education and training to equip them with the skills to deliver the best quality of care Make health and social care organisations "employers of choice" by ensuring staff are, and feel, valued and rewarded Create a workforce and leadership culture focusing on the health and well-being of staff Page 97 of 256
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52 Data, Digital and Technology We recognised health and social care does not have the infrastructure to share data in the way we need and asked our partners to put in place mechanisms that allow safe and integrated data sharing. Our ambitious digital plan was launched in 2022 and will provide innovative solutions to some of our most complex challenges. Outdated IT and limitations around data sharing are barriers to helping us transform at the speed and scale that we need to. Efficiently linking information to how we plan our services does not just improve care and save money, it also frees up time to let our services and teams do their best work. Starting this work has helped us understand our success is dependent on releasing the data we need from individual services and using this in an integrated way. We also know that data alone does not make better decisions. People and communities are expecting a new standard of care to support social and health needs. We must respond with a fast, joined up data-informed approach, analysed by connected systems and highly skilled teams. In 2023/24, we have asked NHS Lothian and Midlothian Council to ensure we can access data by HSCP area. This will help us to identify and address equality issues, meet different needs, and encourage participation. We will have to make better use of existing technologies and provide people with access to accurate information and services. Hosted service reporting We need to provide information about how well our hosted services are performing to the other Lothian Health and Social Care Partnerships and NHS Lothian. We have worked hard in 2022/23 to make sure our hosted services can provide the right information in a consistent way and are leading the way in the development of this approach for Hosted Services in 2023/24. Planning ahead In 2023-24 we also need to plan for and start writing our next Strategic Commissioning Plan 2025- 28. Our planning and performance team will ensure the consultation, review, and governance around our most important piece of planning is done well and includes everyone that wants to be involved. Page 98 of 256
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53 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 HSCP. 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 St Joseph's Services - Circle of Best Practice 1 - Care at Home 10/02/2023 5 Very Good 5 Very Good 4 Good - 5 Very Good St Joseph's Services - Circle of Best Practice 2 - Care at Home 10/02/2023 5 Very Good 5 Very Good 4 Good - 5 Very Good St Joseph's Services - Circle of Best Practice 3 - Care at Home 10/02/2023 5 Very Good 5 Very Good 4 Good - 5 Very Good 6 Excellent 5 Very Good 4 Good 3 Adequate 2 Weak 1 Poor Page 99 of 256
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54 Recommendations and Areas for Improvement (if any) Name Recommended Improvement St Joseph's Services - Circle of Best Practice 1 - Care at Home 1. The service should ensure that staff are appropriately trained and receive refresher training as and when required to meet the care and support needs of people. This should also be reflected in robust training records, so the care provider is confident that its workforce is appropriately skilled St Joseph's Services - Circle of Best Practice 2 - Care at Home 1. The service should ensure that staff are appropriately trained and receive refresher training, as and when required, to meet the care and support needs of people. This should also be reflected in robust training records, so the care provider is confident that its workforce is appropriately skilled. St Joseph's Services - Circle of Best Practice 3 - Care at Home 1. The service should ensure that staff are appropriately trained and receive refresher training, as and when required, to meet the care and support needs of people. This should also be reflected in robust training records, so the care provider is confident that its workforce is appropriately skilled. Care Homes for Older People Name Date People's wellbeing Leadership Staff team Setting Care & support planning Aaron House 17/03/2023 4 Good - 4 Good - - Aaron House 26/07/2022 3 Adequate 4 Good 3 Adequate 4 Good 4 Good Aaron House 21/12/2022 3 Adequate - 3 Adequate - 4 Good Drummond Grange 16/05/2022 4 Good 4 Good 4 Good 4 Good 4 Good Guthrie House 15/11/2022 3 Adequate 4 Good - - - Nazareth House 04/05/2022 3 Adequate 3 Adequate 3 Adequate - - Nazareth House 24/11/2022 4 Good 4 Good 4 Good 4 Good 4 Good Newbyres Village 29/04/2022 4 Good - - - - Newbyres Village 16/09/2022 3 Adequate 3 Adequate 3 Adequate 4 Good 4 Good Pittendriech 01/11/2022 3 Adequate 3 Adequate 3 Adequate 3 Adequate 3 Adequate Rosehill 28/10/2022 3 Adequate 3 Adequate 3 Adequate 4 Good 3 Adequate Springfield Bank 07/12/2022 4 Good 4 Good 4 Good 3 Adequate 4 Good Page 100 of 256
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55 Recommendations and Areas for Improvement Name Recommended Improvement Drummond Grange 1. To ensure that people are receiving regular interactions and engagement from staff is important. This should include encouragement and availability of resources to undertake activities for people who are supported in their bedrooms. 2. To ensure that people experience high quality care and support that is right for them, all staff should undertake further equality and diversity training. The training should be reflective and include discussion on how to put learning into practice. 3. To improve the environment of the home the provider should continue to develop a refurbishment plan, specifically for Pentland and Kevok. 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. 4. People should be helped to live well right to the end of their life. The manager and staff should develop with people their anticipatory care plan. This should include information received both from the person and those important to them, which ensures staff know what they should do if a person’s health deteriorates. Guthrie House 1. People should be able to maintain and develop their interests and activities in a way that is meaningful for them. People who choose not to, or are not able to, participate in group activities, should have opportunities for social activities and be supported to pass their time in meaningful ways. To support this, the provider should ensure that people are supported with individual social opportunities in line with their choices and preferences This could include the deployment of activity staff and involvement of care staff in order to be able to offer social opportunities for people on a regular basis. 2. People should be confident that their personal plans reflect things that are important to them and how their needs and wishes are to be met. 3. People should be able to enjoy a positive dining experience that is as free from intrusive noise and interruptions as possible. 4. The provider should ensure that any treatment or intervention that residents receive is safe and effective. Nazareth House 1. Personal plans should accurately reflect the care provided. 2. 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. Page 101 of 256
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56 Name Recommended Improvement 3. All staff should undertake the relevant level of training to promote their understanding and skills relating to supporting people with dementia. The training should reflect the promoting excellence framework for people with dementia, at a minimum of skilled level. 4. To improve the environment of the home the provider should continue to develop a refurbishment plan. This should include, but not be restricted to redecoration, repairs, equipment replacement and improving the garden area. The plan should detail the timescales for refurbishment to take place and be reviewed on a regular basis. 5. 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. 6. 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. Newbyres Village 1. The provider should ensure that care staff are appropriately trained to meet the moving and handling needs of people and that this is delivered in a safe manner. This practice should also be underpinned through observation of practice by management. This is to support the ongoing development of staff, ensuring they are competent, skilled, and able to reflect on their practice to continue to meet people’s needs. 2. The provider should ensure that there is a structured team meetings and support and supervision system in place for staff (which incorporates observations and reflections of practice). This is to support the ongoing development of staff, ensuring they are competent, skilled, and able to reflect on their practice to continue to meet people’s needs. 3. The provider should ensure people's care planning documentation is reviewed on a regular basis and the systems and processes used by staff reflect this in a consistent way. Pittendriech 1. People who need help to take their medication should have confidence that they will receive it safely from appropriately skilled staff. Page 102 of 256
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57 Name Recommended Improvement 2. To ensure people are supported appropriately in a meaningful way, all staff should be consistent in their approaches to people who exhibit stress and distress. This would include de-escalation techniques, what leads to the person becoming upset, and in what circumstances to administer prescribed medication. All of which would be recorded in their personal plan. 3. To ensure people are kept safe, the provider should implement appropriate procedures for the control and prevention of infection. 4. To ensure that people's needs are fully met as agreed in their personal plan, including medication, all documentation should be consistently and accurately recorded. Springfield Bank (7 December 2022) 1. Personal plans should accurately reflect care provided and give clear instruction to all staff including agency staff. 2. To ensure people are supported appropriately in a meaningful way, all staff should be consistent in their approaches to people who exhibit stress and distress. This would include de-escalation techniques, what leads to the person becoming upset, and in what circumstances to administer prescribed medication. All of which should be recorded in their personal plan. 3. 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. 4. Observation and reflection of staff practice should become a regular part of staff development. This would enable staff to reflect on their practice and evidence how training undertaken enhances staff skills and knowledge. Springfield Bank (23 May 2023) 1. To ensure people are supported appropriately in a meaningful way, all staff should be consistent in their approaches to people who exhibit stress and distress. This would include de-escalation techniques and what leads to the person becoming upset. All of which should be recorded in the personal plan and reviewed. To support staff, observed practices and self-reflection of how the techniques were put into practice should be part of their development. 2. 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. 3. 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. 4. 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 Page 103 of 256
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58 Name Recommended Improvement meaningful activities. People with specific communication needs or cognitive impairment should also be supported to participate. 5. 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 opportunity to engage in activities meaningful to them. Page 104 of 256
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59 Care Homes for Adults with a Learning Disability Name Date People's wellbeing Leadership Staff team Setting Care & support planning Dougall Court 09/05/2022 3 Adequate 3 Adequate 4 Good 2 Weak - Dougall Court 02/09/2022 4 Good - - 3 Adequate - No recommendations and Areas for Improvement. Care Homes for Adults with a Learning Disability and Autism Name Date People's wellbeing Leadership Staff team Setting Care & support planning Parkside Court 19/05/2022 4 Good 3 Adequate - - - No recommendations and areas for improvement Page 105 of 256
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60 Housing Support Service Name Date People's wellbeing Leadership Staff team Setting Care & support planning Bluebird Care 02/03/2023 4 Good 4 Good 4 Good - 4 Good Recommendations and Areas for Improvement Name Recommended Improvement Bluebird Care 1. To ensure people are kept safe and limit the spread of infectious diseases, (including but not limited to COVID-19) the care provider should ensure that staff are trained to have the knowledge and application of guidance from the Infection Prevention and Control Manual. 2. To ensure people are kept safe and limit the spread of infectious diseases (including but not limited to COVID-19) the care provider should work closely with people to develop person-centred care plans and risk assessments which reflect the Scottish Government and Health Improvement Scotland guidance. 3. To ensure that people are supported in a consistent way and do not feel rushed, the provider should improve on current scheduling practices. 4. To safeguard people who use the service and meet legal requirements the provider should not employ any person in the provision of a care service unless that person is fit to be employed. Policy and practice must take account of the Adult Support and Protection (Scotland) Act (2007). Page 106 of 256
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61 Support Service Name Date People's wellbeing Leadership Staff team Setting Care & support planning Cherry Road Resource Centre 14/03/2023 4 Good 4 Good - 3 Adequate 5 Very Good Recommendations and Areas for Improvement Name Recommended Improvement Cherry Road Resource Centre 1. To ensure people are kept safe and limit the spread of infectious diseases, (including but not limited to COVID-19), the care provider should ensure that staff are trained to have the knowledge and application of guidance from the Infection Prevention and Control Manual. 2. To ensure people get the most out of life and experience positive mealtime experiences the provider should engage with people, their relatives, and staff to explore if or how a balance could be agreed which is reflective of the Keys to Life Strategy. Page 107 of 256
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62 IJB Business Integration Functions and Governance Decisions Integration Functions 1. 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. 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 2022/23, we reviewed and published the progress update on our Mainstreaming Equality Report Update (for 2021/23) and Action Plan (for 2023/25). This report details the progress we have made with our mainstreaming equality work alongside our NHS and Local Authority partners and set out our ambitions and action plan for 2023/25. In 2022 we worked with the Equality and Human Rights Commission to develop a better understanding of our duties as a Public Body and help us ensure that improving equality is at the centre of our decisions. We developed a process to help identify, complete, review and monitor the impact of our decisions for all new and revised strategies, policies and plans, provisions, practices, and activities. 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 2022/23, we completed IIAs for the following new or revised strategies, policies and plans, provisions, practices, and activities. • Midlothian HSCP Staff Wellbeing Delivery Plan • Midlothian HSCP Establishment of the Midlothian Mental Health and Resilience Service • Midlothian HSCP Chest, Heart and Stroke, Scotland (CHSS) Long COVID Service 2. Developing a new approach to Directions Directions are the mechanism by which we set out our main priorities for the services delegated to us and how we instruct NHS Lothian and Midlothian Council on how to approach this and allocate financial Page 108 of 256
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63 resources. In 2022/23 we improved how progress is measured to recognise the individual and collective contribution made by our partners in a number of ways: • A log of Directions This was created to ensure compliance with the Statutory Guidance from the Scottish Government and review progress against our current Directions. • A review of how to set Directions. This looked at ensuring control around strategic planning, financial allocation, performance monitoring and review of priority actions. The Board reappraised the value of issuing high numbers of operational Directions and decided to move towards a more strategic approach for 2023-24. • A series of workshops for officers of the HSCP and Board members These supported the development of a strategic set of Directions that reflected the Board’s best hopes for the people and communities of Midlothian, and gave operational services the ability to explore, design, and create the transformation required. • Six monthly updates on Midlothian IJB Performance The Midlothian Performance Framework sits alongside the Midlothian HSCP Performance Framework and brings together the strategic ambitions of the organisation with operational activity captured in the Midlothian HSCP Governance and Assurance Framework. Looking forward, our Directions for 2023/24 are aligned to the nine National Health and Wellbeing Outcomes and share the overarching strategic vision of the Lothian Strategic Development Framework, the Midlothian Council 5-Year Plan, and the ambitions of the Midlothian Community Planning Partnership. This integrated approach is designed achieve the greatest change in the shortest time possible to improve the outcomes that matter most to people and communities. Directions for 2023/24 were issued on 30th March to the chief executives of NHS Lothian and Midlothian Council. 3. Developing new Performance Framework Our new Performance Framework has been produced to support strategic measurement for 2023/24. This will sit alongside the Midlothian HSCP Performance Framework and bring together the strategic ambitions of the organisation with operational activity captured in the Midlothian HSCP Governance and Assurance Framework. Following development by the Performance, Assurance and Governance Group, the Board were presented with a first draft of the Performance Framework on 13th October 2022 and approved the new framework on 9th February 2023. 4. Outcome mapping and the OutNav software In 2021/22 we worked with Matter of Focus to develop a framework to describe how we work with people and communities to improve outcomes. In 2022/23 we focused on ensuring we are able to tell our story consistently and meaningfully about supporting people to achieve the things that matter most to them. This included designing a whole system approach that helps us examine and review our Activity (governance) and Experience (population information), alongside Outcomes. Based on the learning from 2021/22, we designed and developed a single, common approach for all services and our commissioned partners to tell their story. This allowed us to describe the contribution we make to changing outcomes and transformed the way we talk about data. We have not simply taken old processes and made them electronic, we have provided a meaningful way for services to describe their Page 109 of 256
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64 contribution to population change and directly contribute to how we are measuring progress towards our 6 strategic aims. We tested our new approach in autumn 2022. This helped us make further improvements and include more service areas in OutNav. We are confident this work will help us move towards a truly outcomes-focused approach, while still meeting our statutory reporting requirements for service activity and output data. We currently have approximately 40% of our service areas on the system and all areas have been asked to record outcomes in this way by January 2024. Governance Decisions 1. IJB Membership • Patricia Donald, Non-Executive NHS Board member, left the Board in June 2022 • Carolyn Hirst, Non-Executive NHS Board member, left the Board in August 2022, also stepping down as Chair • Dr Johanna Simpson was reinstated as a non-voting Board member in August 2022 • Dr Rebecca Green was appointed as a new non-voting Board member in August 2022 • Val De Souza, Non-Executive NHS Board member, was appointed to the Board in August 2022, also being appointed Chair • Councillor Kelly Parry was appointed to the Board in August 2022 • Councillor Colin Cassidy was appointed to the Board in August 2022, also being appointed Vice Chair • Jock Encombe, Non-Executive NHS Board member, stepped down as a voting Board member in February 2023 • Andrew Fleming, Non-Executive NHS Board member, was appointed as new voting Board member in March 2023 2. Model Schemes • Code of Conduct approved on 16th June 2022 • Standing Orders approved on 9th February 2023 • Register of Interest updated August 2022 • Scheme of Integration presented on 15th December 2022 and approved by Scottish Government on 15th May 2023. Please note this is an NHS Lothian and Midlothian Council Scheme 3. Finance • Audited Annual Accounts 2021-22 approved 15th September 2022 • Medium-term Financial Plan 2022-23 – 2026-27 noted 15th December 2022 • Funding Agreed for Equalities Lead post 9th February 2023 4. IJB Performance • Annual Performance Report approved on 13th October 2022 • Annual Performance Report published on 31st October 2022 5. Directions • Directions 2023-24 approved on 16th March 2023 • Directions 2023-24 issued on 30th March 2023 Copies of the relevant reports can be found in the committee reports on the Midlothian Integration Joint Board pages of the Midlothian Council website. Page 110 of 256
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65 Data Appendix * There is no update to the national data for 2022/23 in relation to this indicator. In 2021-22, Midlothian’s performance was the same compared to 2020-2021. Overall performance across Scotland got worse by 2 percentage points. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance. 91% 93% 92% 91% 0% 20% 40% 60% 80% 100% East Locality West Locality Midlothian Scotland Percentage of adults able to look after their health very well or quite well 93% 92% 93% 91% 50% 60% 70% 80% 90% 100% 2019/20 2021/22 Percentage of adults able to look after their health well or very well Midlothian Scotland National Indicator Our result Our Progress Adults are able to look after their health very well or quite well*. 92% Page 111 of 256
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66 * There is no update to the national data for 2022/23 in relation to this indicator. In 2021-22, Midlothian’s performance worsened compared to 2020-2021 by 7 percentage points. Overall performance across Scotland got worse by 3 percentage points. Midlothian’s performance was worse than across Scotland. We have more work to do in relation to national performance. Locality numbers have been suppressed due to low response rate. 80% 73% 81% 79% 50% 60% 70% 80% 90% 100% 2019/20 2021/22 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*. 73% 73% 79% East Locality West Locality Midlothian Scotland Percentage of adults supported at home who agreed that they are supported to live as independently as possible Page 112 of 256
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67 * There is no update to the national data for 2022/23 in relation to this indicator. In 2021-22, Midlothian’s performance improved compared to 2020-2021 by 4 percentage points. Overall performance across Scotland got worse by 4 percentage points. Midlothian’s performance was the same as across Scotland. We are doing well in relation to national performance. Locality numbers have been suppressed due to low response rate. 70% 71% 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 67% 71% 75% 71% 50% 60% 70% 80% 90% 100% 2019/20 2021/22 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*. 70% Page 113 of 256
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68 * There is no update to the national data for 2022/23 in relation to this indicator. In 2021-22, Midlothian’s performance stayed the same compared to 2020-2021 Overall performance across Scotland got worse by 8 percentage points. Midlothian’s performance was worse than across Scotland. We have more work to do in relation to national performance. Locality numbers have been suppressed due to low response rate. 64% 66% 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% 65% 74% 66% 50% 60% 70% 80% 90% 100% 2019/20 2021/22 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*. 64% Page 114 of 256
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69 * There is no update to the national data for 2022/23 in relation to this indicator. In 2021-22, Midlothian’s performance improved compared to 2020-2021 by 16 percentage points. 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. West locality numbers have been suppressed due to low response rate. 90% 79% 75% East Locality West Locality Midlothian Scotland Percentage of adults receiving any care or support who rated it as excellent or good 63% 79%80% 75% 50% 60% 70% 80% 90% 100% 2019/20 2021/22 Percentage of adults receiving any care of 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*. 79% Page 115 of 256
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70 * There is no update to the national data for 2022/23 in relation to this indicator. In 2021-22, Midlothian’s performance worsened compared to 2020-2021 by 7 percentage points. Overall performance across Scotland got worse by 12 percentage points. Midlothian’s performance was worse than across Scotland. There is more work to do in relation to national performance. 59% 66% 62% 67% East Locality West Locality Midlothian Scotland Percentage of people with positive experience of the care provided by their GP practice 69% 62% 79% 67% 50% 60% 70% 80% 90% 100% 2019/20 2021/22 Percentage of people with a 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*. 62% Page 116 of 256
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71 * There is no update to the national data for 2022/23 in relation to this indicator. In 2021-22, Midlothian’s performance improved compared to 2020-2021 by 13 percentage points. Overall performance across Scotland got worse by 2 percentage points. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance. Locality numbers have been suppressed due to low response rate. 81% 78% 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 68% 81%80% 78% 50% 60% 70% 80% 90% 100% 2019/20 2021/22 Percentage of adults supported at home who agreed that their 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*. 81% Page 117 of 256
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72 * There is no update to the national data for 2022/23 in relation to this indicator. In 2021-22, Midlothian’s performance worsened compared to 2020-2021 5 percentage points. Overall performance across Scotland got worse by 4 percentage points. Midlothian’s performance was worse than across Scotland. We have more work to do in relation to national performance. 20% 33% 27% 30% East Locality West Locality Midlothian Scotland Percentage of carers who feel supported to continue in their caring role 32% 27% 34% 30% 0% 10% 20% 30% 40% 50% 2019/20 2021/22 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*. 27% Page 118 of 256
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73 * There is no update to the national data for 2022/23 in relation to this indicator. In 2021-22, Midlothian’s performance improved compared to 2020-2021 by 12 percentage points. Overall performance across Scotland got worse by 3 percentage points. Midlothian’s performance was the same as across Scotland. We are doing well in relation to national performance. Locality numbers have been suppressed due to low response rate. 79% 80% East Locality West Locality Midlothian Scotland Percentage of adults supported at home who agreed they felt safe 67% 79% 83% 80% 50% 60% 70% 80% 90% 100% 2019/20 2021/22 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% Page 119 of 256
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74 In 2021-22, Midlothian’s premature mortality rate increased compared to 2021-2022 by 5%. Overall premature mortality rate across Scotland decreased by 5%. Midlothian’s rate was lower than across Scotland. We are doing well in relation to national performance. Midlothian Scotland 375 400 425 450 475 2017 2018 2019 2020 2021 2022 Rate (per 100,000) Premature mortality rate (per 100,000 population) National Indicator Our result Our Progress Premature Mortality Rate (People under 75) 428 per 100,000 Page 120 of 256
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75 In 2022-23, Midlothian’s emergency admission rate reduced compared to 2021-2022 by 15% i.e., the number of people who needed to be urgently admitted to hospital decreased. The emergency admission rate across Scotland reduced by 4%. Midlothian’s rate was lower than across Scotland. We are doing well in relation to national performance. *Where noted the calendar year 2022 is used as a proxy for 2022/23 due to the national data for 2022/23 being incomplete. We have done this following guidance from Public Health Scotland. 8,742 8,360 9,788 11,155 East Locality West Locality Midlothian Scotland Rate (per 100,000) Rate of emergency admissions for adults 2022* (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 Rate (per 100,000) Rate of emergency admissions for adults 2022* (per 100,000) National Indicator Our result Our Progress Emergency Admission Rate 9,788 per 100,000 Page 121 of 256
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76 In 2022-23, Midlothian’s emergency bed day rate increased compared to 2021-2022 by 7% i.e., people spent more days in hospital as part of an emergency admission. The emergency bed day rate across Scotland increased by 2%. Midlothian’s rate was higher than across Scotland. We have more work to do in relation to national performance. 99,236 94,585 113,427 113,134 East Locality West Locality Midlothian Scotland Rate (per 100,000) Rate of emergency bed days for adults 2022* 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 Rate (per 100,000) Rate of emergency bed days for adults (per 100,000) National Indicator Our result Our Progress Emergency Bed Day Rate 113,427 per 100,000 Page 122 of 256
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77 *Where noted the calendar year 2022 is used as a proxy for 2022/23 due to the national data for 2022/23 being incomplete. We have done this following guidance from Public Health Scotland. In 2022-23, Midlothian’s readmission rate reduced compared to 2021-2022 by 6%. Overall readmission rates across Scotland reduced by 8%. Midlothian’s rate is lower than across Scotland. We are doing well in relation to national performance. 94 85 99 101 East Locality West Locality Midlothian Scotland Rate (per 1,000) Rate of readmissions to hospital within 28 days of discharge per (1,000 admissions) 2022* Midlothian Scotland 40 60 80 100 120 140 2017/18 2018/19 2019/20 2020/21 2021/22 2022 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. 99 per 1,000 Page 123 of 256
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78 *Where noted the calendar year 2022 is used as a proxy for 2022/23 due to the national data for 2022/23 being incomplete. We have done this following guidance from Public Health Scotland. In 2022-23, Midlothian’s performance stayed the same compared to 2021-2022. Overall performance across Scotland reduced by 1%. Midlothian’s performance was lower than across Scotland. We have more work to do in relation to national performance. East Locality West Locality 80% 83% 85% 88% 90% 93% 95% Jan-Mar Apr-Jun Jul-Sep Oct-Dec 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. 88% Page 124 of 256
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79 *Where noted the calendar year 2022 is used as a proxy for 2022/23 due to the national data for 2022/23 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 Proportion of last 6 months of life spent at home or in a community setting Page 125 of 256
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80 In 2022-23, Midlothian’s falls rate reduced compared to 2021-2022 by 6 percentage points. Overall falls rate across Scotland reduced by 1 percentage point. Midlothian’s rate was lower than across Scotland. We are doing well in relation to national performance. *Where noted the calendar year 2022 is used as a proxy for 2022/23 due to the national data for 2022/23 being incomplete. We have done this following guidance from Public Health Scotland. 16.1 18.7 19.0 22.0 East Locality West Locality Midlothian Scotland Rate (per 1,000) Falls rate per 1,000 population aged 65+ 2022* Midlothian Scotland 14 16 18 20 22 24 26 28 2017/18 2018/19 2019/20 2020/21 2021/22 2022 Rate (per 1,000) Falls rate per 1,000 population aged 65+ National Indicator Our result Our Progress Falls Rate (People over 65) 19% Page 126 of 256
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81 In 2022-23, Midlothian’s performance worsened compared to 2021-2022 by 6 percentage points. Overall performance across Scotland worsened by 1 percentage point. Midlothian’s performance was lower than across Scotland. We have more to do in relation to national performance. Midlothian Scotland 70% 75% 80% 85% 90% 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 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. 72% Page 127 of 256
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82 In 2022-23, Midlothian’s performance decreased compared to 2021-2022 by 5 percentage points. Overall performance across Scotland decreased by 1 percentage point. Midlothian’s performance was lower than across Scotland. We have more to do in relation to national performance. *Where noted the calendar year 2022 is used as a proxy for 2022/23 due to the national data for 2022/23 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 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. 60% Page 128 of 256
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83 In 2022-23, Midlothian’s performance worsened compared to 2021-2022 by 51%. Overall performance across Scotland got worse by 21%. Midlothian’s performance was better than across Scotland. We are doing well in relation to national performance. *Where noted the calendar year 2022 is used as a proxy for 2022/23 due to the national data for 2022/23 being incomplete. We have done this following guidance from Public Health Scotland. Midlothian Scotland 200 400 600 800 1,000 1,200 1,400 2017/18 2018/19 2019/20 2020/21 2021/22 2022 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. 784 per 1,000 Page 129 of 256
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84 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. Midlothian Scotland 10% 15% 20% 25% 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 National Indicator Our result Our Progress Health and Care resource spent on hospital stays where the person was admitted as an emergency. 23% Page 130 of 256
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85 Ministerial Steering Group Targets Updated targets for 2022/23 were developed by the HSCP, agreed by the IJB, and submitted to Scottish Government in June 2022. Our targets were set to prioritise an increase in system stability. MEASURE 2018- 19 2019- 20 2020- 21 2021- 22 2022- 23 STATUS Maintain emergency admissions into hospital from Midlothian at or below 767 / month 8,841 10,966 9,207 9,606 8,458 Achieved* Maintain number of unscheduled hospital bed days: acute specialties at or below 5,074 / month 62,372 59,798 57,459 57,394 60,452 Achieved* Maintain the use of unscheduled: • geriatric long-stay beds (all ages) • mental health beds (all ages) at or below 2021/22 levels 13,551 15,162 12,806 13,708 12,802 12,511 16,638 11,934 16,747 12,345 Not achieved* Maintain Emergency Department Attendance (all ages) at or below (2,629 / month) 29,688 33,319 26,390 33,155 33,233 Not achieved* Maintain Delayed Discharge Occupied Bed Days at or below 820 / month 12,934 10,412 7,150 6,135 12,608 Not achieved* Reduce the percentage of time people spend in a large hospital in their last six months of life 9.8% 9.1% 7.4% 7.9% No data N/A Maintain the proportion of people over the age of 65 who are living in the community at 97% or higher 96.5% 96.7% 97% 97% No data N/A SOURCE: Public Health Scotland Integration Performance Indicators June 2023 *Where noted the calendar year 2022 is used as a proxy for 2022/23 due to the national data for 2022/23 being incomplete. We have done this following guidance from Public Health Scotland. Page 131 of 256
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Midlothian Integration Joint Board Thursday 24th August 2023, 14:00-16:00 Finance Update – Quarter 1 2023/24 Executive summary Both the IJB’s partners (Midlothian Council and NHS Lothian) have undertaken quarter one financial reviews. This process requires the available financial information to be analysed and subsequently used to project a forecast outturn position. Board members are asked to: • Note the quarter one financial review undertaken by partners. • Note the update on financial recovery plans. • Note the IJBs general reserve position. • Note the previously agreed posts from the general reserve and agree to the continued funding on the integration planning and performance team from reserves. # Item number: 5.4 Page 133 of 256
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Midlothian Integration Joint Board Midlothian Integration Joint Board Finance Update – Quarter 1 2023/24 1 Purpose 1.1 This report lays out the results of the partner’s (Midlothian Council and NHS Lothian) quarter one financial reviews and considers how these impact on the projected financial position of the IJB for 2023/24. Plus, reports on the quarter one monitoring of the IJB financial recovery plans and the current reserves position. It also asks the IJB to agree to the continued funding of the integration planning and performance team. 2 Recommendations 2.1 As a result of this report Members are being asked to: - • Note the quarter one financial review undertaken by partners. • Note the update on financial recovery plans. • Note the IJBs general reserve position. • Note the previously agreed posts from the general reserve and agree to transfer the continued funding of the integration planning and performance team from general to earmarked reserves. 3 Background and main report 3.1 At the IJB meetings during March and April 2023, the IJB considered its budget offers from Partners which resulted in the IJB not accepting the Midlothian Council offer due to a significant reduction of £1.33m in funding included within it. 3.2 Subsequently Midlothian Council has approved to support the HSCP with the costs associated with the transition from analogue to digital alarms. This will be from the Councils capital budget and supports the one-off purchase of digital alarms c £1m. 3.3 The budget offers made by Partners at the start of the financial year are shown below: IJB Opening Budget 2023/24 £m £m Midlothian Council 56.593 Baseline Budget 56.593 New Scottish Government Monies 1.333 Reduction to Budget (1.333) NHS Lothian 94.970 Baseline Budget 92.719 Uplift & Other 2.251 Total 151.563 (Fig 1: IJB Opening Budget 2023/24) Page 134 of 256
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Midlothian Integration Joint Board 3.4 Both partner organisations have now completed their quarter one (Q1) financial reviews which provides a forecast financial outturn for 2023/24. The Midlothian Council and NHS Lothian Q1 financial reviews are based on information to the end of June 2023 and should be noted in the context of challenging financial climate and the timing of financial recovery plans being agreed. 3.5 The Q1 financial review position for the IJB is a projected overspend of £7.8m and a breakdown is shown below: Annual Budget as at end of June 2023 Forecast Expenditure Q1 Forecast Under/(Over) Spend £m £m £m Core 71.406 72.674 (1.268) Hosted 12.249 12.325 (0.077) Set Aside 20.917 22.956 (2.039) Health 104.571 107.956 (3.384) Social Care 56.578 61.065 (4.487) Total 161 169 (7.871) (Fig 2 : IJB Quarter 1 review forecast) 3.6 The budget movements from the partners budget offers at the start of the financial year to the budget position at Q1 are a combination of minor technical adjustments, additional funding allocations from Scottish Government. 3.7 The forecast position reflects the projections for both partners. NHS Lothian have presented their overall Q1 financial projections to their Finance & Resources Committee on the 9th August 2023. Midlothian Council presents their Q1 financial projections to their Council meeting on the 29th August 2023. 3.8 The forecast highlights a significant overspend for the IJB projected, within the health IJB budgets there is £1.2m projected overspend relating to prescribing and £2m relating to set aside budgets. The set aside position within the IJBs financial plan included a £1.3m predicted overspend so a deterioration in the position from budget setting to Q1. This is made up of Gastroenterology drugs, the drugs pressure across acute is significant and has been growing due mainly to new medicines. Within Medicine of the Elderly there are overspends in medical pays predominantly at the RIE. Similarly General Medicine facing increased costs in medical staffing. 3.9 NHS Lothian have received additional in year funding from Scottish Government and as yet have not allocated the new medicines funding or the sustainability funding to services and for their forecast purposes it has been retained centrally. It is likely that some new medicines funding will be allocated to delegated services given the pressures reported on drugs budgets within set aside services. Further to this and as in previous years, NHS Lothians Director of Finance and the Chief Finance Officers continue to have a shared ambition that providing that NHS Lothian can achieve a breakeven position for 2023/24 then an additional payment will be made to the IJB to meet the final IJB year-end overspend within health services. Page 135 of 256
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Midlothian Integration Joint Board 3.10 The Social Care overall forecast is reporting a £4.4m projected overspend a significant swing from the 2022/23 year end position to Q1. The areas of concern reporting an overspend are the resource panel budget and in particular learning disabilities but also overspends within care homes Newbyres and Highbank. 3.11 To support the financial position the IJB has a challenging financial recovery plan programme which was part of the budget setting of the IJB, you’ll see below the recovery plans went from £4.7m to £5.6m after agreement at Junes IJB. 23/24 Base Target 23/24 Revised Target £m £m Financial Recovery Plans core 1.846 1.846 hosted 0.221 0.235 set aside* 1.678 1.678 social care 0.953 1.826 Total 4.698 5.584 (Fig 3 : IJB Financial Recovery Plans 2023/24) 3.12 Performance against these plans is detailed in appendix 1. 3.13 Further to the financial recovery plans the IJB continues to hold a general reserve, at the June meeting the IJB agreed its final recovery actions to support the reduced budget offer of £1.33m and recognising these actions would not deliver a full year effect agreed to utilise the general reserve to support the balance, this was c £0.460m. This value may need reviewed in light of the Q1 forecast. 3.14 Given the forecast and the notes above particularly around the planned use of reserves, the assumption regarding set aside breaking even and the new medicines and sustainability funding received by NHS Lothian there is potential improvements in the forecast position, and these are noted in figure 4 below. The table also notes that there may be additional benefits from where financial recovery plan performance improves. Annual Budget as at end of June 2023 Forecast Expenditure Q1 Forecast Under/(Over) Spend £m £m £m Core 71.406 72.674 (1.268) Hosted 12.249 12.325 (0.077) Set Aside 20.917 22.956 (2.039) Health 104.571 107.956 (3.384) Social Care 56.578 61.065 (4.487) Total 161.149 169.020 (7.871) planned use of general reserves (June IJB) 0.460 assumption on set aside budgets breaking even 2.039 Page 136 of 256
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Midlothian Integration Joint Board new medicine and sustainability funding tbc further delivery on financial recovery plans tbc Revised Total Range tbc - (5.371) (Fig 4 : IJB Quarter 1 revised position) 3.15 Due to the financial position projections, it is worth reviewing the IJBs general reserve position again and the below table shows this position. 23/24 24/25 25/26 26/27 27/28 General Reserves £m £m £m £m £m Closing balance 2022/23 6.182 5.334 4.927 4.500 4.051 Drawn down/planned to utilise in year 0.388 0.407 0.427 0.449 0.471 Drawn down/planned to utilise in year 0.460 DRAFT closing balance 5.334 4.927 4.500 4.051 3.580 Reserve Policy @ 2% 3.300 3.300 3.400 3.400 3.400 Position against Policy 2.034 1.627 1.100 0.651 0.180 Analogue to Digital alarms Est Care at Home block contracts OutNav Balance 5.334 4.927 4.500 4.051 3.580 (Fig 5 : IJBs DRAFT general reserve projections) 3.16 The IJB has made commitments against its general reserve in prior years in relation to specific posts to support the integration planning and performance team and the IJB and this can be seen in the table, to support these service teams and the HSCP teams operational budget management we are looking for support regarding realigning the funding for this team for the next 5 years from the general reserve to the IJBs earmarked reserve. 3.17 The outturn projections will continue to be refined throughout the year, and regular updates will be brought back to the IJB. The main outstanding risk not included in the above projections is the settlement of the local authority pay award. We await clarity to assess the impact of this with partner Midlothian Council. Currently the above projections assumes 3% in line with Council, we require early dialogue with Midlothian Council regarding the pass through of any additional funding for a pay award higher than the assumed 3% to the IJBs delegated budgets. 4 Policy Implications 4.1 There are no policy implications from this report. 5 Directions 5.1 There are no implications for Directions at this stage. Page 137 of 256
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 There are no equalities implications from this report. 7 Resource Implications 7.1 The resource implications are laid out above. 8 Risk 8.1 The risk regarding the pay awards settlement is raised above in report. 8.2 The “business as usual” risks raised by this report are already included within the IJB risk register. 9 Involving people 9.1 The IJB papers are publically available. 10 Background Papers 10.1 None AUTHOR’S NAME Claire Flanagan DESIGNATION Chief Finance Officer CONTACT INFO claire.flanagan@nhslothian.scot.nhs.uk DATE August 2023 Appendices: Appendix One: Financial Recovery Plans 2023/24 by Theme Page 138 of 256
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Appendix 1 – Financial Recovery Plans 2023/24 by Theme Base Target: March 23/24 (£m) Revised Target: 23/24 (£m) Q1 Target (£m) Q1 Saving (£m) Q1 Variance: Over/(Under) (£m) Core Workforce 0.273 0.273 0.068 0.029 (0.039) Core GP Prescribing 1.297 1.297 0.324 0.223 (0.102) Core Procurement and Contracts 0.060 0.060 0.015 0.030 0.015 Core Capacity/Service Redesign 0.198 0.198 0.050 0.050 0.000 Core NHS Lothian Thematic Programmes 0.018 0.018 0.005 0.000 (0.005) Core Sub total 1.846 1.846 0.462 0.331 (0.131) Hosted Workforce 0.074 0.074 0.019 0.019 0.000 Hosted GP Prescribing 0.000 0.000 0.000 0.000 0.000 Hosted Procurement and Contracts 0.001 0.015 0.004 0.004 0.000 Hosted Capacity/Service Redesign 0.141 0.141 0.035 0.032 (0.003) Hosted NHS Lothian Thematic Programmes 0.005 0.005 0.001 0.000 (0.001) Hosted Sub total 0.221 0.235 0.059 0.055 (0.004) Set Aside Workforce 0.238 0.238 0.060 0.032 (0.028) Set Aside Acute Medicines 0.056 0.056 0.014 0.000 (0.014) Set Aside Procurement and Contracts 0.007 0.007 0.002 0.002 0.000 Set Aside NHS Lothian Thematic Programmes 0.006 0.006 0.001 0.001 (0.000) Set Aside Other* 1.372 1.372 0.000 0.000 0.000 Set Aside Sub total 1.678 1.678 0.077 0.035 (0.042) Social Care Workforce 0.192 0.192 0.048 0.007 (0.041) Social Care Procurement and Contracts 0.161 0.161 0.040 0.073 0.033 Social Care Capacity/Service Redesign 0.600 1.473 0.368 0.000 (0.368) SC Sub total 0.953 1.826 0.456 0.080 (0.376) Grand Total 4.697 5.584 1.053 0.501 (0.552) Note - planned use of IJB general reserve to support delivery. Note* - assumption regarding set aside budgets Page 139 of 256
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Midlothian Integration Joint Board Thursday 24th August 2023, 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 2022/23. Due to the processes required to validate these data, the full reporting year is not yet 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 the Midlothian IJB meeting on 13th April 2023, the Performance, Assurance, and Governance Group (PAGG) was commissioned to consider a local improvement goal(s) for the IJB. The group met on 4th May and collaboratively produced one improvement goal with 8 locally relevant process measures. Due to Public Health Scotland timelines for publication of validated data, an additional meeting of the Performance, Assurance, and Governance Group (PAGG) was scheduled. This took place on the 20th of July 2023. Members are asked to: • Note the performance against the IJB Improvement Goals for 2023/24 (Appendix 1). • Approve the proposed local Improvement Goal and test of associated measures. • Note the additional meeting for scrutiny of the Annual Performance Report. Item number: 5.5 Page 141 of 256
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Midlothian Integration Joint Board Midlothian Integration Joint Board IJB 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 2022/23. Due to the processes required to validate these data, the full reporting year is not yet 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). • Approve the proposed local Improvement Goal and test of associated measures. • Note the additional meeting for scrutiny of the Annual Performance Report Data Appendix. 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 The Midlothian HSCP Performance Manager and the Principal Information Analyst (PHS Local Intelligence Support Team) continue to support the NHS Lothian Performance Business Unit with work to progress development of a local Tableau dashboard. This would permit more recent management data to be available to Lothian HSCPs in a way that better informs understanding of whole-system activity. Page 142 of 256
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Midlothian Integration Joint Board 3.6 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. 3.7 A&E Attendances 2022/23 Target Rate per 100,000 people 2,629 / month 2022/23 Running Average 2,769 / month The validated data are available up to March 2023. Based on this information, the target is not currently being met. The most recent non-validated management information data indicate an improvement. 3.8 Emergency Admissions 2022/23 Target Rate per 100,000 767 / month 2021/22 Rate 801 / month The validated data are only available up to March 2022. Based on this information, the target is not currently being met. The most recent non-validated management information data indicate an improvement. 3.9 Unplanned Bed Days (Acute) 2022/23 Target Rate per 100,000 5,074 / month 2021/22 Rate 4,783 / month The validated data are only available up to March 2022. Based on this information, the target is currently being met. 3.10 Delayed Discharge Occupied Bed Days 2022/23 Target Rate per 100,000 820 / month 2022/23 Running Average 1,051 / month The validated data are only available up to March 2023. Based on this information, the target is not currently being met. The most recent non-validated management information data indicate that system activity levels continue to present a significant challenge to achieving the target set. 3.11 End of Life – Percentage of Last Six Months Spent in Large Hospitals 2022/23 Target Rate <8.7% 2020/21 Rate 7.5% The validated data are only available for 2020/21. 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. 3.12 Balance of Care 2022/23 Target Rate >96.4% 2020/21 Rate 97% (provisional data) Page 143 of 256
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Midlothian Integration Joint Board The validated data are only available on a provisional basis for 2020/21. 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. 3.13 IJB Local Improvement Goal Following the Midlothian IJB meeting on 13th April 2023, the Performance, Assurance, and Governance Group (PAGG) was commissioned to consider a local improvement goal(s) for the IJB. The group met and collaboratively produced one improvement goal with a number of proposed locally relevant process measures. The Goal, Outcome and Balancing Measures are detailed below: Goal: The balance of care from hospital to community-based care in Midlothian will have shifted by x% by March 2025 (percentage to be defined). Outcome Measure: % of shift from hospital to community-based care Balancing Measures: (quarterly from PHS) Our recommendation is to use the MSG indicators here as we already report on these. 3.14 The process measures need to be tested and refined as there are some technical information access issues to be resolved. The Performance Team will fully test the measures during August 2023 and provide an update, which will include a plan to resolve any outstanding data sharing challenges. 3.15 Annual Performance Report Following the Strategic Planning Group meeting on 27th April 2023 it was agreed that all Board members be invited to join a meeting of the Performance Assurance and Governance Group to participate in the review of the validated data that will be published within the Annual Performance Report. This took place on the 20th of July, with a robust discussion and helpful feedback provided regarding the data sources, the progress made across the system, and the data visualisations used in the Annual Performance Report. 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. Page 144 of 256
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Midlothian Integration Joint Board 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 Further opportunity for improvement would be to consider, develop, and agree an Improvement Goal that recognises and meaningfully measures the impact of continued instability across health and social care systems including the ongoing challenge of supporting workforce wellbeing. 8.2 The risk of not finding solutions to address these 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 (PAGG) meet monthly to review and discuss these measures as part of wider data assurance. Membership of the group will be expanded to ensure increased 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 6th August 2023 Appendices: Appendix One: Local Intelligence Support Team (LIST) Report describing progress against the IJB improvement goals 2022/23. Page 145 of 256
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Midlothian HSCP MSG Indicators Performance from April 2019 to December 2022, with 2020/21 MSG targets and trends Local Intelligence Support Team (LIST), July 2023 Page 147 of 256
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Contents 1. Methodology 2. Data completeness 3. A&E attendances a) weekly figures by age group 5. Emergency admissions 6. Unplanned bed days: a) Acute b) Mental Health 7. Delayed discharges occupied bed days 8. End of life 2Page 148 of 256
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Data completeness Source: MSG data release Jun-23, PHS 3 Indicator Published until Provisional until Data completeness issues 1. A&E attendances Mar-23 n/a - 2. Emergency admissions Mar-22 Mar-23 (SMR01) Nov-21 = 95%, Nov- 22=95%, Feb-23=95% 3a. Unplanned bed days (acute) Mar-22 Mar-23 (SMR01) Nov-21 = 95%, Nov- 22=95%, Feb-23=95% 3b. Unplanned bed days (GLS) n/a Mar-23 (SMR01E) Quarters ending: Jun-22 = 92%; Sep-22 = 97%; Dec-22 = 92%; Mar-23=90% 3c. Unplanned bed days (MH) Mar-22 Mar-23 (SMR04) Quarters ending: Jun-22 = 91% 4. Delayed discharges occupied bed days Mar-23 n/a - 5. Last 6 months of life (% in community setting) 2020/21 2021/22 - 6. Balance of care (% at home) n/a 2021/22 - Page 149 of 256
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Data Sources 2020/21 MSG Targets • Source: MSG data release v1.63, Jun-23; Public Health Scotland • These are official monthly figures released by PHS and will be nationally published (some data is provisional and not yet published) • Next data release: Sep-23 4Page 150 of 256
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A&E Attendances Source: MSG data release Jun-23; data published up to Mar-23 • The rate of attendances in 2020/21 was 21% lower than 2019/20, and 17% lower than the 2017/18 baseline year. Much of this may be due to covid-19. • The rate of attendances had increased back to typical levels by Aug-20, but steadily decreased again until Mar-21 when it started increasing. • During the summer periods it has tended to exceed the 2020/21 target level, and to dip below it during January and February. • The 2020/21 target was met 5 Target = maintain Annual Monthly 2020/21 Target Rate (per 100,000) 31,543 2,629 2019/20 Rate (per 100,000) 33,319 2,777 2020/21 Rate (per 100,000) 26,391 2,199 2021/22 Rate (per 100,000) 33,155 2,763 2022/23 Rate (per 100,000) 33,233 2,769 Page 151 of 256
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Emergency Admissions Source: MSG data release Jun-23; data published up to Mar-22 • The rate of emergency admissions dropped in Apr- 20 due to Covid-19, but quickly returned to more typical levels – although remained lower than 2019/20 until March-21 • In the first quarter of 2021/22 the admissions rate increased above the 2020/21 target level and above 2020/21 levels; this discrepancy has reduced since • The 2020/21 target was met 6 Target = 5% decrease Annual Monthly 2020/21 Target Rate (per 100,000) 9,207 767 2019/20 Rate (per 100,000) 10,969 914 2020/21 Rate (per 100,000) 9,209 767 2021/22 Rate (per 100,000) 9,606 801 Page 152 of 256
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Unplanned Bed Days - Acute Source: MSG data release Jun-23; data published up to Mar-22 • The rate dropped drastically in Apr-20 due to Covid-19, but was back to a more typical level by Jul-20. • The rate has remained stable since then • The 2020/21 target was met 7 Target = 10% decrease Annual Monthly 2020/21 Target Rate (per 100,000) 60,888 5,074 2019/20 Rate (per 100,000) 64,726 5,394 2020/21 Rate (per 100,000) 57,462 4,789 2021/22 Rate (per 100,000) 57,394 4,783 Page 153 of 256
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Delayed Discharges Occupied Bed Days Source: MSG data release Jun-23; data published up to Mar-23 • The rate of delayed discharge occupied bed days at the start of 2020/21 was especially low due to Covid-19 • The rate remained mostly lower than 2019/20’s during 2020/21 and 2021/22; during the first half of 2022/23 it rose, but came down again to around 1,000 during the rest of 2022/23 • The 2020/21 target was met 8 Target = 20% decrease Annual Monthly 2020/21 Target Rate (per 100,000) 9,836 820 2019/20 Rate (per 100,000) 14,336 1,195 2020/21 Rate (per 100,000) 9,779 815 2021/22 Rate (per 100,000) 8,249 687 2022/23 Rate (per 100,000) 12,608 1,051 Page 154 of 256
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End of Life - Percentage of Last Six Months Spent in Large Hospitals Source: MSG data release Jun-23; data published up to 2020/21 9 • The 2020/21 target was met • The provisional percentage for 2021/22 is below the target but is higher than the 2020/21 level Target = decrease Annual 2020/21 Target <8.7% 2019/20 9.1% 2020/21 7.5% Page 155 of 256
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Midlothian Integration Joint Board Thursday 24th August 2023 14:00-16:00 Learning Disability Service Review Executive summary This report provides Midlothian Integration Joint Board (MIJB) with the findings of the Review of Learning Disability Services within Midlothian. Board members are asked to: • Note the contents of the Learning Disability Service Review report, • Consider the recommendations outlined in the report, and • Approve recommendations within the report. # Item number: 5.6 Page 157 of 256
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Midlothian Integration Joint Board Midlothian Integration Joint Board Learning Disability Service Review 1 Purpose 1.1 The purpose of this paper is to provide the findings of the review of Learning Disability Services within Midlothian. 2 Recommendations 2.1 As a result of this report what are Members being asked to: - • Note the contents of the Learning Disability Service Review report, • Consider the recommendations outlined in the report, and • Approve recommendations within the report. 3 Background and main report 3.1 The MIJB received a report on Learning Disability Services in August 2022 which outlined the pressures on the Learning Disability Services within Midlothian, the increasing numbers and complexity of those requiring support and the significant financial pressures associated with meeting these care needs. The Board agreed that a review of Learning Disability Services should be progressed. 3.2 The Chief Officer commissioned an independent consultant to undertake this review in January 2023. 3.3 The scope of the review included the governance, planning, resourcing, commissioning, and delivery of Learning Disability Service provision in Midlothian. 3.4 The full report of the findings of the review is attached at appendix 1. 3.5 The evidence demonstrates that there are significant demographic and financial challenges in provision of health and social care services for people with learning disabilities in Midlothian. 3.6 The prevalence in Midlothian is above the Scottish average and the projected growth in the population will continue to place a significant pressure on all services and the financial resources required. 3.7 Achieving a balanced financial position has proved difficult with expenditure exceeding the allocated budget. Pressure on the budget will continue with increasing numbers of young people coming through transition from children’s services to adult services who have very complex needs. Page 158 of 256
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Midlothian Integration Joint Board 3.8 Whilst comparative expenditure analysis indicates the costs of provision are within the mid-range across all partnership’s in Scotland, there is a need to transform the way support and care is delivered to ensure: • Services are safe and sustainable and enable people to reach their full potential, with good quality support built around their individual needs and outcomes; • The resource allocation processes are fair and consistent; and • Efficiencies are maximised to secure best value for supporting people and the wider community. 3.9 Improvement work is already being progressed in relation to transitions from Children’s to Adult Services, Self-Directed Support, Commissioning and Contract Monitoring. 3.10 Recommendations have been made to support the planning and resourcing of learning disability services, to redesign models of service provision and to ensure that there is good governance and effective management to deliver the best possible outcomes for people with learning disabilities, their families, and carers, within the resources available. 4 Policy Implications 4.1 The aims and ethos of the Learning Disability services as articulated through the relevant strategic plans fit with the general policy direction of the Midlothian IJB, in providing more care closer to home and more care being community based. 4.2 The strategic planning within the Partnership reflects the actions required within the national policy frameworks: The Same as You? (2000); The Keys to Life (2013-21); Towards Transformation (2021); Principles of Good Transitions 3 (2017) and Coming Home: Complex Care Needs and Out Of Area Placements (2018) and Coming Home Implementation (2022) 5 Directions 5.1 The report links to Directions 2.2; 4.1; 4.2; 4.3; 5.1; 6.1; 6.2; 7.1; 7.2; and 9.1. 6 Equalities Implications 6.1 The work undertaken by the Learning Disability Services aims to significantly reduce inequalities for that client/patient group. 6.2 Expert Panels have been established to give people with lived experience of a learning disability the opportunity to directly participate in the design and development of services, and to implement a series of measures to promote human rights. 7 Resource Implications Page 159 of 256
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Midlothian Integration Joint Board 7.1 It is noted that there are financial pressures within Learning Disability Services which have made it difficult to achieve a balanced position. 7.2 The 2022-23 outturn position was of a £755K overspend. 7.3 There is a £1.3m projected pressure for those who will transition from child to adult services over the next 3 years. 7.4 The review has identified potential areas for transformation to support future sustainability including overnight provision; transitions; day services and transport. 8 Risk 8.1 The financial pressure within Learning Disability Services presents a risk to Midlothian IJB if the expenditure continues to exceed the budget available. 8.2 There is a potential reputational risk associated with the re-design of services and resistance to change. 8.3 There are workforce risks that reduced availability of care staff may impact the capacity and ability to deliver services, in particular for those requiring new packages of care; the aging workforce profile of the HSCP workforce may impact service delivery. 8.4 There is a risk that uncertainty regarding long-term arrangements for the commissioning of social care may create a level of instability in the market that could impact on long-term planning. 9 Involving people 9.1 Midlothian HSCP Learning Disability Service teams, external providers providing commissioned services and People First have been engaged in the review process. 10 Background Papers 10.1 None AUTHOR’S NAME Nick Clater DESIGNATION Head of Adult Services, Midlothian HSCP CONTACT INFO Nick.clater@midlothian.gov.uk DATE 07/08/2023 Appendices: Appendix One: Midlothian Learning Disability Service Review Report August 2023 Page 160 of 256
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1 | P a g e Learning Disability Service Review August 2023 Page 161 of 256
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2 | P a g e Introduction The Midlothian Integrated Joint Board received a report on Learning Disability Services in August 2022 which outlined the numbers of people receiving Learning Disability Services in Midlothian and the increasing complexity of their care needs which is contributing to significant financial pressure on the Learning Disability budget. The Midlothian Integrated Joint Board requested a review of Learning Disability Services be undertaken which was commissioned by the Chief Officer in January 2023. The scope of the review included the governance, planning, resourcing, commissioning and delivery of Learning Disability Service provision in Midlothian. This paper outlines the findings of the review and makes recommendations for service improvements. Benchmarking has been undertaken with other partnerships including Midlothian’s Local Government Benchmarking Family (LGBF) for adult social care services. The LGBF allows some comparison with similar types of area and populations. Midlothian’s LGBF includes Angus, Argyll and Bute, East Lothian, Highland, Moray, Scottish Borders and Stirling. Background Learning disabilities refer to a varied group of conditions that affect a diverse group of people. The Scottish Government’s Keys to Life strategy defines a learning disability as a significant and lifelong condition which is present prior to the age of eighteen and which has a significant effect on a person’s development. This means that a person with a learning disability will be likely to need help to understand information, learn skills and live a fulfilling life. Some people with a learning disability will also have healthcare needs and require support to communicate1. People with a learning disability face different issues depending on their condition and indeed other factors such as where they live. Some people with learning disabilities may have very complex needs, some less complex. The levels of support required vary considerably depending on the person. Some people with a learning disability may also behave in ways that are perceived as challenging which means that their behaviour challenges services and support providers not that the person is themselves challenging. People with a learning disability want to be as independent as they can within their own community and wish to have more choice and control over their lives in order to reach their full potential, with good quality support built around their individual needs and outcomes. They have the same rights as every other member of society and the same need to be treated with dignity and respect. They have the right to be valued as individuals and lead fulfilling lives and to access and participate in their communities and benefit from a fair and inclusive society, as well as contributing to the local economy. 1 Keys to life: implementation framework and priorities 2019-2021 - gov.scot (www.gov.scot) Page 162 of 256
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3 | P a g e National Context The Scottish Government's vision for people with learning disabilities and complex needs within Scotland is that everyone is supported to lead full, healthy, productive, and independent lives in their communities, with access to a range of options and life choices. Clear policy and legislative frameworks are in place in Scotland that individually and collectively seek to support people to protect their rights and have control over their lives and enable access to assessment, treatment and supports required. Table 1 provides a summary of the relevant legislation for consideration within Learning Disability Services. Table 1: Legislation Social Work (Scotland) Act 1968 The main duty to assess a person’s community care needs and decide whether to arrange any services. Any assistance should be based on an assessment of the person’s care needs and should take account of their preferences Adults with Incapacity (Scotland) Act 2000 Provides a framework for safeguarding the welfare & managing the finances of adults, who lack capacity due to mental illness, learning disability or a related condition, or an inability to communicate. Mental Health (Care and Treatment) (Scotland) Act 2003 Increased the rights and protection of people with mental illness, learning disability and personality disorder and sets out when and how patients can be treated and how their rights are protected. This Act is currently under review. Adult Support and Protection (Scotland) Act 2007 Requires public bodies to work together to support and protect adults and decide whether someone is an adult at risk of harm. The Act defines adults at risk as people aged 16 years or over who: may be unable to safeguard their well-being, rights, interests, or their property; may be harmed by other people; because of a disability, illness or mental disorder and are more at risk of being harmed than others who are not so affected The Equality Act 2010 Brings together over 116 separate pieces of legislation into one single Act. The Act provides a legal framework to protect the rights of individuals and advance equality of opportunity for all. It provides a discrimination law that protects individuals from unfair treatment and promotes a fair and more equal society. Welfare Reform Act 2012 The Act includes the phased introduction of Universal Credit and the phased replacement of Disability Living Allowance (DLA) with the Personal Independence Payment (PIP) for working-age adults. The Social Care (Self- directed Support) (Scotland) Act 2013 – Supports the principle that people have informed choice about the way that their social care and support is provided to them. The Act aims to ensure that people who need support have more control over how their support needs are met, and how their support is provided so that better outcomes are achieved and people are enabled to live as full a life as possible. Public Bodies (Scotland) Act 2014 Sets out the arrangements for the integration of certain NHS and local authority social work functions. Carers (Scotland) Act 2016 Aims to ensure better and more consistent support for carers and young carers so that they can continue to care, if they so wish, in better health and to have a life alongside caring Page 163 of 256
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4 | P a g e The Same as You ? (2000) People with learning Disabilities should be able to lead normal lives The Keys to Life (2013-21) A healthy life Choice and control Independence Active citizenship Towards Transformation (2021) Human Rights Mental Health, Health and Social Care Employment Education Digital Exclusion Communication Principles of Good Transitions 3 (2017) Inform, structure and support young people wth additional needs between the ages of 14 and 25 making the transition to adult life Coming Home: complex care needs and out of area palcements 2018 and Coming Home Implementation 2022 Strengthen community services Commissioning & Service Planning Positive Behavioural support Figure1: National Policy Context Development of Learning Disability Services has been driven by national strategies and policies to improve the life choices and quality of life of people with learning disabilities by ensuring they are included in every aspect of community life as equal citizens and that the voice of every person with learning disabilities is heard and respected (Figure 1). A priority within the keys to life 2 is that all adults with learning disabilities, including those with complex needs, experience meaningful and fulfilled lives. This includes where individuals live as well as the services they receive. Towards Transformation3 sets out to ensure that progress is made in transforming Scotland for autistic people and people with learning/intellectual disabilities. The Scottish Transitions Forum published Principles of Good Transitions 34 which aims to improve the experience of children and young adults (14 to 25 years) as they make the transition to adult life and sets out seven principles of good transitions to enable young people with additional support needs to achieve their full potential. Coming home: complex care needs and out of area placements5 provides information about the issues, and potential actions to improve outcomes for those people with learning disabilities who are unable to receive appropriate support in their local communities, and who have either been admitted to assessment and treatment units, or are living in out-of-area placements. The Coming Home Implementation Report makes recommendations for actions to be taken at national and local levels to reduce the number of delayed discharges and out-of-area placements for people with learning disabilities and complex care needs. The Scottish Government identified Change Fund monies to support improvement actions. 2 Home - The keys to life 3 Learning/intellectual disability and autism: transformation plan - gov.scot (www.gov.scot) 4 Download 'Principles of Good Transitions 3' - Scottish Transitions Forum 5 Coming home: complex care needs and out of area placements 2018 - gov.scot (www.gov.scot) Page 164 of 256
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5 | P a g e Learning Disability & Autism Themes From Consultation Rights and involvement in care planning and decision making Health and Wellbeing Transition Feeling Safe Working Together Housing Support Opportunities Local Context The Midlothian Health and Social Care Partnership are responsible for services that help people live well and get support when they need it. This includes all community health and social care services for adults in Midlothian and some hospital-based services. The Midlothian Health and Social Care Partnership Strategic Plan 2022 to 20256 sets out the vision, values and strategic aims: Vision: People in Midlothian are enabled to lead longer and healthier lives Values: We will provide the right support at the right time in the right place Strategic Plan 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. The Strategic Plan commits to empowering people with learning disabilities and autism to recognise and realise their human rights and to participate in community life free from fear, harassment and abuse. There is an emphasis on health and wellbeing throughout life and for people to feel safe at home and in their community. The importance of the right housing, flexible, good quality support, friendships and relationships, imaginative day opportunities and jobs are really important to people and are reflected in the plan. Key themes from consultation on the plan are summarised in figure 27. Figure 2 Key Themes from Learning Disability and Autism Strategic Plan Consultation 6 What we do Information - Midlothian Health and Social Care Partnership 7 Midlothian HSCP Learning Disability Strategic Plan Consultation Report 2021 Page 165 of 256
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6 | P a g e The plan sets out the priorities for learning disability and autism services and builds on the priorities within the 2019-22 plan. The priorities for the current and previous plan are shown in Table 2. Table 2 Strategic Plan 2019-2022 Strategic Plan 2022-25 Prevention and early intervention Support People to Stay Healthy: • Improve opportunities for health and social care to work together • Run Health Fairs to inform health improvement activity Empower people with learning disabilities and Autism to recognise and realise their human rights and to participate in community life free from fear, harassment and abuse. Support the wellbeing of people with Learning Disabilities and Autism throughout their life including screening and health, relationship and wellbeing. Improve the Experience of Transition from School to Adult Life and Create appropriate developmental opportunities in Adult Life. Support and treatment Strengthen Services: • Review day services to determine the range & capacity required. • Redesign, develop and/or commission services for young people - with pathways between services, education, and employment; for older people - based on maintaining friendships and keeping active; and for people with Dementia. • Tailor and personalise experiences to support adults with complex learning disabilities and adults with autism. • Discontinue the use of day services out with Midlothian unless there is a clear reason Develop a greater range of Housing Options for People with Learning Disability and Autism including building units in Bonnyrigg and Loanhead Increase the availability of Flexible and Person Centred Day Opportunities to support greater choice including the development of appropriate community opportunities and services for people with complex needs. Support people to live in suitable accommodation: • Build expertise across services to support people with complex needs to live ordinary lives. • Commission new build housing for people with a Learning Disability using clustered models, supported by Technology Enabled Care. Review Transport to ensure more flexible and tailored provision. Develop Robust Community Services for People with Complex Needs Develop a Broader Range of Respite and Breaks Support for People with Learning Disability and Autism. Improve information on Advice, Support and Services for Autistic People and People with a Learning Disability. Crisis and Emergency Avoid inappropriate hospital admission: • Develop robust community services incorporating Positive Behavioural Support to support people with complex needs in crisis. Support people to participate in community life, free from fear of harassment and abuse Support People with Complex Care Needs in Crisis Page 166 of 256
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7 | P a g e The strategic planning within the partnership reflects the actions required within the national policy frameworks. The action plan supporting implementation of the learning disability and autism strategic priorities details actions up to 2022. The implementation of the Strategic Plan is supported by Expert Panels which are designed to give people with lived experience of a learning disability the opportunity to directly participate in the design and development of services and to implement a series of measure to promote human rights. There are four main Expert Panels: • Human Rights; • Health Equality; • Complex Day Service; and • Change Fund. In addition short life Expert Panels may be formed for specific service developments. The Expert Panels provide reports on their activity and progress to the Strategic Planning Group. The creation of the Expert Panels and their active involvement in development of learning disability services in Midlothian demonstrates the positive commitment to working together to ensure service provisions are designed to be more inclusive and better informed to meet the needs of people with a learning disability, their families and carers to enable them to participate in community life free from fear, harassment and abuse. Recommendation: • The action plan supporting implementation of the Learning Disability and Autism Strategic Plan is refreshed to reflect the current three year period 2022-2025 to support implementation. Population Growth Midlothian is the second smallest Local Authority in mainland Scotland but the fastest growing with a projected population growth of 13.8% by 2028 on the 2018 baseline. The majority of population growth is projected to come from net migration (12.4%). This will bring challenges for health and social care services and will change communities. Figure 3 Projected Population Growth 2018-28 Page 167 of 256
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8 | P a g e 6.3 5.2 0.01.02.03.04.05.06.07.08.09.010.0 Dundee City Shetland Islands Inverclyde East Lothian Dumfries &… Na h-Eileanan Siar North Lanarkshire Clackmannanshire Midlothian West… Scottish Borders East Renfrewshire East Ayrshire Renfrewshire Aberdeen City Moray North Ayrshire East… Highland Falkirk Stirling City of Edinburgh Angus South Ayrshire Aberdeenshire Orkney Islands West Lothian Argyll & Bute Glasgow City South Lanarkshire Fife Perth & Kinross Adults with a Learning Disability Known to Local Authorites per 1000 Population (source SCLD Learning Disability Statistics Scotland 2019) Adults known per 1,000 population Scotland Between 2018 and 2028, each age group is expected to increase in size. The 75 and over age group is projected to see the largest percentage increase (+40.9%). In terms of size, however, 25 to 44 are projected to become the largest age group overall (Figure 3). Prevalence of Learning Disabilities There are challenges in estimating the number of adults living with a learning disability with no authoritative estimate in Scotland8. The main sources of population estimates for people with learning disabilities are the Learning Disabilities Scotland Statistics, Scotland’s Census and the Pupil Census. The Learning Disability Scotland Statistics (LDSS) last published data in 2019. The data is drawn from local authorities on people with learning disabilities who were • Aged 16 and 17 and not in full time school education; • Aged 18 and over; and, • Who had contact with the local authority in the previous year. This data does not include information on adults with learning disabilities who did not meet the above criteria. It is important to note that the number of people known to local authorities will depend on the services offered and the application of their respective eligibility criteria for support. Although the numbers are not meant to be an estimate of the full population they do provide an indication of those who are currently eligible for support. Figure 4 demonstrates the rate per 1000 population for all local authorities in Scotland. For comparative purposes Midlothian’s LGBF for adult social care are highlighted in pink and Midlothian is highlighted in red. Figure 4 Estimated Adult Population with Learning Disability known to Local Authorities 8 The challenges of estimating Scotland’s learning disabled population and why it matters | FAI (fraserofallander.org) Page 168 of 256
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9 | P a g e 487 people have learning disabilities-0.6% of population 100 children and 387 adults have learning disabilities 265 males and 222 females have learning disabilities 12.4% of adults with learning disabilities have paid emploment compared with 60.5% of all adults 50.3% of people with learning disabilities live in social rented accommodation compared with 25.2% of all people Only 14.2% of people with learning disabilties rate their health as very good compared with 52.9% of all people In 2019, it was estimated that there were 23,584 adults with a learning disability known to local authorities across Scotland, 5.2 people per 1,000 populations. In Midlothian there were 466 adults with a learning disability who were known to the local authority, 6.3 people per 1,000 populations9. The LDSS data indicates there was a 10% growth in the number of people known to Midlothian local authority in 2019 from 2018 and 0.6% growth in the Scotland population (Table 3). Table 3: Adults with learning Disabilities known to Local Authorities 201810 2019 % Change in Number 2018- 2019 Number Rate per 1000 population Number Rate per 1000 population Midlothian 422 5.8 466 6.3 10%↑ Scotland 23446 5.2 23584 5.2 0.6%↑ Since 2015, the Scottish Government has funded the University of Glasgow to create a Scottish Learning Disability Observatory (SLDO), to understand more about the health inequalities faced by people with learning disabilities and to make those needs more overtly visible. The whole population census which is carried out every 10 years provides a self reported estimate of the number of people with learning disabilities. Analysis of the 2011 Census by the Scottish Learning Disability Observatory11 estimated that 0.5% of Scotland’s population has a learning disability; data from the Census for Midlothian are summarised in figure 5 and identifies 0.6% of the population has a learning disability. The Census also evidences the significant inequalities experienced by people with learning disabilities with respect to their employment, accommodation and health and well being compared to the whole Midlothian population. Figure 5: Midlothian 2011 Census Information for those with Learning Disabilities Another source of population data is the Pupil Census which provides an estimate of the number of children currently in schools who are receiving support. The Pupil Census 2022 identified that there were 179 school 9 2019 Report - SCLD 10 2018 Report - SCLD 11 Midlothian | Census 2011 Information | Scottish Learning Disabilities Observatory (sldo.ac.uk) Page 169 of 256
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10 | P a g e 0 20 40 60 80 100 120 <25 26-35 36-45 46-55 56-65 66-75 76-85 85+ Age Profile of Adults with a Learning Disability Receiving Support children attending Midlothian Schools who had a learning disability diagnosis in 202212. It is noted that the figures in the census data maybe under reported as children maybe on waiting lists for assessment which will delay diagnosis. Saltersgate School provides specialist additional support for those with the most complex needs and all these children will transition to adult services. There are established links with Saltersgate to track their care needs and the resources required to meet these. More children with learning disabilities are now attending mainstream primary and secondary schools. There are less robust arrangements to track the children in mainstream education however work is underway to address this. The age profile of adults in receipt of learning disability services demonstrates 20% of these are young adults who have recently transitioned from children’s services (up to age 25); 35% are in the 26-45 year age group and 12% are over 65 years (Figure 6). The number of older age clients maybe understated as some provision may be allocated to older people cost centre. Figure 6 Age Profile of Adults in Receipt of Learning Disability Services Agreed statistics on the learning disability population are important to influence the planning, design and resourcing of services. There are limitations with the data and therefore only crude estimates of potential growth of the learning disability population can be made. It is anticipated that the learning disability population will increase as the population of Midlothian grows. A crude estimate of this growth has been calculated using National Records Scotland population growth estimates 2018-202813 and the estimated 0.6% prevalence of learning disabilities from the 2011 Census (Figure 7). 12 Pupil census supplementary statistics - gov.scot (www.gov.scot) 13 Midlothian Council Area Profile (nrscotland.gov.uk) Page 170 of 256
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11 | P a g e 500 520 540 560 580 600 620 640 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 Estimated Midlothian Population with Learning Disability 2018-2028 Figure 7: Estimated Growth in Midlothian Learning Disability Population 2018-2028 This estimated increase in the learning disability population is consistent with: • Increasing numbers of children being diagnosed with a learning disability; • Increasing numbers of families moving into new build housing within Midlothian, with a proportion of these having children with a learning disability or additional support needs; and • The increasing numbers of young people transitioning from children’s to adult services. This anticipated growth in the Learning Disability population will continue to place significant pressure on all services and the financial resources required to manage the increase in demand for care and support. Recommendations: • Opportunities to lobby for improved data collection and to increase the information available are maximised at a national level with the SLDO, Public Health Scotland and the Scottish Government to support strategic planning of Learning Disability Services. • To continue to develop more formal tracking processes with education to ensure there is more robust information for all children with learning disabilities who will require transitioning to adult services and produce an annual report detailing the anticipated cost of transitions to support future financial planning. • To develop local data collection on the known population with Learning Disabilities within Midlothian to inform future planning Page 171 of 256
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12 | P a g e Current Service Provision Assessment and Case Management Social Work have a duty to assess a person’s community and social care needs and uses eligibility criteria to determine whether to arrange any services. The eligibility criteria used in Midlothian is in line with the 2009 national guidance14. The eligibility criteria are graded into four bands, which describe the seriousness of risk to independence or the consequences if needs are not addressed. The bands are: Critical; Substantial; Moderate; and Low. Figure 8 provides a definition of these categories of risk. Eligibility Criteria Definition Critical Indicates that there are major risks to an individual’s independent living or health and well-being likely to call for the immediate (now or within 1-2 weeks) or imminent (within 6 weeks) provision of social care services (high priority). Substantial Indicates that there are significant risks to an individual’s independence or health and wellbeing likely to call for the immediate or imminent provision of social care services (high priority). Moderate Indicates that there are some risks to an individual’s independence or health and wellbeing. These may call for the provision of some social care services managed and prioritised on an ongoing basis or they may simply be manageable over the foreseeable future (within 6 months) without service provision, with appropriate arrangements for review. Low Indicates that there may be some quality of life issues, but low risks to an individual’s independence or health and wellbeing with very limited, if any, requirement for the provision of social care services. There may be some need for alternative support or advice and appropriate arrangements for review over the foreseeable future or longer term (Next 12 months or subsequently) Figure 8: Risk Criteria Definitions Currently, in Midlothian, care packages are provided to meet critical and substantial criteria. The guidance acknowledges that, in managing access to finite care resources, local authorities and their local partners focus first on those people assessed as having the most significant risks to their independent living or wellbeing. Where people are assessed as being in the ‘critical’ and ‘substantial’ risk categories their needs will generally call for the immediate or imminent provision of services. The Health and Social Care Partnership provides a range of community care support services to people with learning disabilities with varying levels of support needs. It is acknowledged that services are important to upholding the human rights of this client group and the involvement of individuals in their care planning and decision making is fully supported. 14 NATIONAL STANDARD ELIGIBILITY CRITERIA AND WAITING TIMES FOR THE PERSONAL AND NURSING CARE OF OLDER PEOPLE - GUIDANCE (www.gov.scot) Page 172 of 256
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13 | P a g e There are currently 409 people In Midlothian with a Learning Disability who meet eligibility for social care support. It is estimated there are around another 100 people with a diagnosed learning disability who are supported by universal service provision. There is a dedicated Social Work Learning Disability Team who are responsible for the social work assessment, care planning and case management for this client group. The team comprises 13 staff. The social work assessment is based on the Talking Points: Personal Outcomes Approach 15 and focuses on what matters to the person to understand the extent to which they are achieving the outcomes important to them and determine their preferences as well as their eligibility for support. During the review the Social Work team identified that there can be a degree of subjectivity in the assessment process and suggested that some refinement of the definitions for eligibility within learning disability would support more consistent application. Assessments are completed and recorded on the case management system, Mosaic. Where an individual has been assessed as requiring support the assessments are reviewed by the Resource Panel with funding being made available once approved. The selection of and decision in relation to care providers for people with a learning disability is managed through the assessment and care planning processes in accordance with Self Directed Support. There can be a wide range of complexity within this client group and as people’s circumstances change they may present in crisis and /or with behaviours that challenge. The team gave examples of creative and innovative solutions to manage risk, provide support and ensure safety of individuals and the wider community. Self Directed Support Self Directed Support (SDS) aims to ensure that people who are eligible for social care support can have greater choice and control over how they receive their services. Social care services and supports should be planned, commissioned and procured in a way that involves people and offers them real choice and flexibility in how they meet their personal outcomes. There are four options for self directed support: Option 1: Direct Payment, a payment is made to the person to purchase their own support Option 2: The person decides who is to provide support and the local authority arranges support Option 3: The local authority decides and arranges the support Option 4: a mix of the above Currently 6% of the learning disability adult social care budget is paid in direct payments. It has not been possible to determine the proportion of support provided under each of the SDS options due to variations in recording practices. However, it was reported that as there are a large number of providers within Midlothian, it is normal practice for the allocated worker to discuss with the individual which care providers might best meet their support needs and seek a consensus on the provider to be appointed under SDS option 3. 15 Talking Points: personal outcomes approach - practical guide | The Learning Exchange (iriss.org.uk) Page 173 of 256
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14 | P a g e Therefore it is considered that the majority of provision is within this option as people do not have to exercise SDS options 1 or 2 to have a choice on who provides their support. The partnership has developed an SDS Improvement Plan for 2023-24 to support the continued roll out of SDS within Midlothian taking account of the Self Directed Support Framework of Standards16 . These standards and the SDS principles have been used to identify high level outcomes, key objectives and improvement tasks with an initial focus on four of the twelve standards: Standard 4: Meaningful and measurable recording practices; Standard 5: Accountability; Standard 8: Worker autonomy; and, Standard 9: Transparency. An SDS Steering Group has been established to oversee and monitor implementation of the improvement plan. Recommendations: • Consideration is given to refining the definitions for eligibility within Learning Disability to support a more consistent approach. • The SDS improvement plan is fully implemented within the Learning Disability Service to inform and develop excellent standards in practice. Commissioned Services The majority of direct support is provided though services commissioned from external organisations. The annual Resource Panel budget for Learning Disability Service provision is £17.5m. This is spent on support services commissioned exclusively from external care providers. The care and support services currently commissioned by Midlothian Health and Social Care partnership have evolved from historic commissioning arrangements. In the main services are provided by established locally based care providers who have a strong presence in the community. Effective relationships have been built up over time at all levels enabling good outcomes, flexibility and coproduced support arrangements. In particular, providers have been very positive about the Providers’ Forum and how effective it has been in supporting collaborative working and sharing resources especially during the COVID-19 pandemic. The services commissioned by Midlothian Health and Social Care Partnership aim to support people to live independently on their own or in shared tenancies. All services are registered with the Care Inspectorate either as Care at Home and /or Housing Support Services. The type and amount of support an individual will receive will be determined by their assessment and aims to achieve a range of personal outcomes (figure 9). 16 Self-directed Support Framework of Standards, including practice statements and core components - Social care - self- directed support: framework of standards - gov.scot (www.gov.scot) Page 174 of 256
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15 | P a g e 77% 8% 15% Breakdown of average daily hours commissioned Day hours Night Hours (Wake) Sleepover Hours Type of Support •Prompting or assistance with personal care •Tasks associated with daily living preparing meals, shopping •Care in relation to physical disability •Support to manage their behaviour •Maintaining their tenancy •Managing finances •Engaging in interests / hobbies •Engaging in meaningful activities in the community •Managing their health / disability Personal Outcomes •Living independently in their own or shared tenancies •Being able to maintain a tenancy •Being and keeping themselves safe •Seeing other people •Being part of the community Figure 9 Types of Support and Personal Outcomes Supported Living Services and Housing Support There are nine key providers in Midlothian commissioned to provide supported living services and housing support. A number of providers have developed specialism in particular areas of support, for example, supporting people with more complex needs; providing good quality care for an ageing client group. It is also noted that many care staff have supported individuals over long periods of time and have developed longstanding relationships with the people they support; this is valued by the people who receive support. 73% of the overall expenditure within the learning disability service is attributed to Supported Living Services and Housing Support with an annual cost of £13.3m. This reflects the high costs of supporting individuals who cannot live independently without large amounts of support including individuals who require 24/7 care. The majority of the support (77%) is delivered by care providers during the day. 23% of the daily hours commissioned are for overnight support. This is provided either as sleepover or as waking night support (Figure 10). Overnight provision accounts for around 18.6% of the supported living and housing expenditure with just over 10 % (circa £1.3m) attributed to sleepover support. Figure 10 Breakdown of average daily hours commissioned Page 175 of 256
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16 | P a g e It is noted that where possible overnight support is shared however staff reported that it is difficult to change to from single to shared provision for people in neighbouring tenancies when their sleepover arrangements have been long established. With improvements in the availability and variety of technological solutions to assist people to be supported in the community several partnerships across Scotland have taken the opportunity to review their overnight support and identify arrangements for a safe and effective transition from sleepover support to suitable alternative arrangements, in accordance with assessed need. These include the use of Technology Enabled Care and responder services. Learning from other partnership areas the redesign of future overnight service provision which meets the objectives of supporting people to live safely and as independently as possible, at home or in a homely setting, in a risk enabling and cost effective way should be explored. Recommendation: • A review of overnight support is undertaken to optimise arrangements to support people to live safely and as independently as possible in a risk enabling way in accordance with their assessed need and to achieve best value. Housing The right housing is a key part of being independent and feeling included in the community. People with a learning disability have a right to live in ordinary houses in ordinary streets with adaptations if required and to be supported where needed. This includes people with the most complex needs. The strategic plan recognises the importance of housing with specific action to develop a greater range of Housing Options for People with Learning Disability and Autism including building units in Bonnyrigg and Loanhead. There are a range of housing options available to people with a learning disability in Midlothian depending on the complexity of their care and support needs. It has been identified that there is a need for more shared tenancies to offer the type of support people need and to share staff particularly for those who require overnight support to achieve best value. There are well established good working relationships with housing colleagues to identify suitable tenancies for individuals however it is reported the current housing application process, based on individual applications, makes it more difficult to identify and secure suitable housing for supported living in shared tenancies and is identified as an area for further development. Other housing developments being progressed in the current year include: • Bonnyrigg High Street – development of eight flats to support individuals with mild learning disabilities who can live relatively independently providing they have easy access to support. Building works commenced with anticipated completion summer 2024. • Primrose Lodge, Loanhead – Conversion of previous NHS facility to supported accommodation for four individuals with complex learning and physical disabilities. There may also be option for a small respite service for adults with physical disabilities. Building works due to commence autumn 2023 Page 176 of 256
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17 | P a g e • Children’s Residential Care Home – Plans have been agreed in principle for a current residential care home service to be commissioned as a supporting living service for adults. This will allow the young adults currently supported there to continue to be supported in the same house. • There are plans with one provider to deregister a small residential care home facility and for this to developed for supported living accommodation Recommendation: • To work with Housing colleagues to develop a process for housing application and allocation for suitable accommodation for supported living in shared tenancies for people with learning disabilities; • To support the housing developments being progressed and continue to identify future provision in line with the aspirations within the Strategic Plan Shared Lives Midlothian Shared Lives Midlothian is an adult placement service providing day placements, short breaks and long term care for adults with mild to moderate learning disabilities enabling them to live with a carer in their home as part of their family. There are two shared lives coordinators who support placements and match carers with individuals who need support. There are 16 active carers in Midlothian: • 8 provide long term placements for 9 clients • 6 provide short breaks (weekend/ week for respite) and • 5 who offer day care and befriender carers for 14 clients Some carers offer both long term care and short breaks and some day care and short breaks. Success is dependent on the matching process. It was reported that there is a need for more provision of short breaks and day care. There are sustainability challenges if more carers cannot be recruited to the service, with the last recruitment drive only achieving a gain of one carer. Recommendation: • Develop opportunities to maximise recruitment of Shared Lives Carers to enable more day care and short break provision • Monitor provision of Shared Lives Midlothian over the medium term to ensure sustainability Day Services The strategic plan sets out a specific action to increase the availability of flexible and person centred day opportunities to support greater choice including the development of appropriate community opportunities and services for people with complex needs. Day services for people with a Learning Disability in Midlothian have developed over time in response to major policy changes such as the closure of Learning Disability hospitals; change in local authority day services from an adult training model to an inclusion and resource centre model in the 1990s; national policies such as the Same as You’ (2000) and The Keys to Life (2013); and local Midlothian reviews (2006, 2017 and 2019). Page 177 of 256
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18 | P a g e Cherry Road Cherry Road provides Day Services for people with learning disability and complex needs from its base in Bonnyrigg. A comprehensive staff review and restructure was implemented at Cherry Road in October 2011 with the aim of transforming the service into a centre for learning, innovation, experimentation and creativity. The importance of Interaction is central and opportunities for people with complex needs to interact with others and their environment are used to build on learning and to enhance the skills of staff and their understanding of the people who they support, and to understand what support and activity really works for them. During the Covid-19 pandemic, a variation to registration was submitted to the Care Inspectorate to provide an element of care at home / outreach in the community, in addition to the use of the day centre premises. Learning from this change in provision showed that when people have the right kind of support in the community it can be transformative for them. There are currently 23 people attending the day service and 26 people being supported through outreach. The recent Care Inspectorate inspection highlighted the positive outcomes being experienced by people using the service with the high level of staff consistency and motivation resulting in establishment of meaningful working relationships, high quality, person centred, care planning and people are being supported to achieve their individual aspirations. People are actively involved in a variety of activities both at the resource centre and within the local community. There are strong links with the local community that encourage the growth of informal support networks. People benefit from this in a variety of ways, including meeting new people, establishing links that support individual interests, and introducing different ideas and experiences. There is close working with Artlink Midlothian which has offered a blend of social care and art which has enriched the lives of people with profound and multiple learning disabilities (PMLD). Box 1: Cherry Road Artlink Project This approach takes into account the individual and their internal landscapes seeking to motivate and inspire the person, to amuse, bring happiness, curiosity and desire to reach out and engage with the world around them. The model of support is an organic process which naturally develops stronger relationships between people. As we build trust with the individual their courage and confidence increases and their potential is noticed by others. People with PMLD have a voice and can influence models of practice which are more innovative and creative and truly person centred and impact on the people who have previously made assumptions of what is a good life for people with PMLD The artists have taught us to look at and listen to the world around us differently, to change our perceptions and learn how to see the world we occupy and the people in it as richly diverse and to embrace everyone’s contribution. Page 178 of 256
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19 | P a g e Community Access Teams The Community Access Teams were formed following the Day Service Review of 2006 and support adults with learning disabilities in various communities of Midlothian. They operate out of six hubs and run programmes of activities which aim to build upon the individual aspirations of the participants. There are currently 44 service users and 133 day placements over the week- average of 27/ day. Each Hub offers a range of different activities with some being more active in the community than others. Examples of community developments include the running of a community soup café in Mayfield on a Monday, using an existing Development Trust service and the very popular Tea Dance at a local community club on a Friday which attracts up to 70 participants a week. Challenges with transport, community resources and permanence of the workforce have impacted on service development. The service has limited capacity for those with higher dependency needs and those who require 1:1 support. There are opportunities to learn from the experience during the pandemic and services improvements resulting from this to redesign the future day service provision within Cherry Road and the Community Access Team. Bringing these teams together and defining who should have a centre based service and those who will benefit from more tailored outreach will enable maximization of resources and expertise. The increasing numbers of those with more complex needs and young adults in transition must inform provision together with access to appropriate, safe and well designed spaces in communities. Recommendation: • The future design and delivery model for the directly provided services, Cherry Road and CAT, needs to be progressed taking account of the increasing complexity and numbers of young people in transition, models of support and the access to appropriate, safe and well designed spaces in communities. Box 2: Young Community Access Team (YCATs) operates from two hubs, Dalkeith Bowling Club and The Beacon in Gorebridge, and specialises in supporting the transition of young adults between the ages of 18- 24 from school to adult services. A person centred plan is developed with each service user and provides information about them, their outcomes, communication and support needs. YCATs offers a range of activities that are tailored to individual interests and needs of each participant including dance, ball sports, boccia, work experience at the Penicuik Storehouse, bike rides, travel training, education through Skill Accreditation programme in partnership with Borders College and cooking healthy meals. The service utilises community resources such as libraries, leisure centres and local businesses to provide a comprehensive programme of activities. Special activities such as outings to places of interest, bowling and cinema visits are also arranged to promote social interaction and community participation. YCATs produced an annual report in 2022 detailing the broad range of activities offered throughout the year and included service user feedback which was very positive. Page 179 of 256
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20 | P a g e Commissioned Day Service Provision There are seven key providers commissioned to provide day services for around 140 service users. These include three services in Edinburgh and one service in East Lothian. The service in East Lothian and one of the services in Edinburgh are attended by a number of people as a historic arrangement. Covid has had an enduring impact on day service provision. New services have been established to support more young people transitioning from Children’s Services but there is still a need for more safe spaces for them to learn new skills and transition to their own accommodation. In addition there are a growing number of older people with learning disability who require ongoing day support. Table 4 summarises information related to the day services currently commissioned by Midlothian HSCP. Table 4: Commissioned Day Services Garvald Mayfield • Largest centre based day service for people with mild to moderate learning disability in Midlothian Garvald Edinburgh • Attended by a number of people with learning disability as a historic arrangement Teen + • Day service for young adults with more complex needs Upward Mobility • Provide creative educational day services offering young people with Learning Disability a broader spectrum of experience and a defined pathway on leaving school. YAS (LASC) • Newly established day service that supports younger adults transitioning from school Capability Scotland • Day service for adults between the ages of 18 and 65 with physical, sensory and associated learning disabilities. Fisherrow • Day service run by East Lothian. Historic and longstanding arrangement for a number or Midlothian residents that attend. From the previous day service reviews one recommendation of the Expert panels was to explore different models of contracting services with the aim of creating a collaborative environment with all parties signing up, and working to a clear set of outcomes and success measures that: • Formalises collaboration to accelerate and strengthen shared goals • Drives innovation and fresh thinking • Allows smaller and larger organisations to work together • Maintains each parties strengths and unique identity • Uses whole system outcomes to align success for each party • Risk share across all parties and any ‘gain’ or ‘pain’ is linked with good or poor performance overall and not to the performance of individual parties There is a further need to be more proactive in planning and commissioning a range of services that reflect the demographic pressures and the aspirations highlighted in the Strategic Plan. Page 180 of 256
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21 | P a g e Recommendation: • Explore different models of contracting services with the aim of creating collaborative commissioning environment. • Increase the availability of flexible and person centred day opportunities for all age groups to support greater choice and opportunities Other Provision Local Area Coordination Midlothian HSCP grant funds Enable to provide a Local Area Coordination service that provides support to people with disabilities to help them access services within the community. Local Area Coordinators will work with individuals, families and communities to make local activities and services more inclusive and to provide support for individuals for as long as they feel the need for support. Neighbourhood Networks There are two neighbourhood networks in Midlothian, one in Penicuik and one in Dalkeith. They focus on young people in transition concentrating on three outcomes in particular: Independent Travel; Natural Friendships/Relationships; and Money Management. Activity is developed around people and enables a preventative approach reducing the need for formal care and support. Social Opportunities There are a range of grant funded services that create and facilitate local social opportunities for people with a Learning Disability such as: • Gig Buddies: Enabling people with learning disabilities to lead the life they want. They match people up with a volunteer who shares the same cultural tastes so they can go to mainstream events as friends; and, • get2gether: Enabling people to achieve their potential with the right support and encouragement through a range of activities such as in person and online social events; courses aimed at building better relationships; and skill building workshops. Box 4: Neighbourhood Networks A Network has up to 10 members who live near each other supported by a Community Living worker who lives in or around the same area. It supports people with learning disabilities to live an active, healthy life, safely, within their own homes and be fully involved within their local communities, learning essential life skills, becoming more independent whilst spending more time with friends and becoming less reliant on paid support. The support from the Community Living Worker is flexible, which means it’s there when members need it and not when they don’t. The proximity of the Community Living Worker means that they are able to intervene prior to a crisis and will identify the need for additional or specialist support quickly. Page 181 of 256
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22 | P a g e Artlink Midlothian Artlink is an arts and disability organisation that supports participation in the arts to realise personal and social change and increase opportunities to take part in the arts for those who experience disadvantage or disability. Artlink Midlothian has developed a number of projects: • The Socialites- Bespoke projects for young people with learning disability and autism • Out of the Ordinary -Workshops shaped by the interests and lived experiences of people with profound learning disabilities • KMADOTCOM -Artist Studio • The Makers Workshops- Creative Learning for Young Adults • Cherry Road Learning Centre • A Performing Arts Programme As an organisation Artlink have been consistently successful at identifying and levering in additional resource to the Midlothian Programmes from organisations such as Creative Scotland; National Lottery; Inspiring Scotland; RS MacDonald Community Trust; Health Improvement Scotland; Scottish Government. Employment Support A person’s career is often a big part of their life and identity, but for many people with learning disabilities, paid work is out of reach even when they want to work and have skills and talents to offer employers, especially when given the right support. As previously highlighted in the Census data, the level of people with learning disabilities in paid employment within Midlothian is significantly lower than in the general population and few people with learning disabilities have the opportunity to participate in an intensive supported employment programme tailored to their support needs.17 People have said through the Strategic Planning consultation process that they want more opportunity to work or get work experience and more support to help find and keep jobs including opportunities for work experience; training for employers; real, permanent jobs; and volunteering opportunities. Project SEARCH is a programme which supports young people with disabilities into employment. The programme has been successfully implemented in other areas of Scotland including West Lothian and Edinburgh. Midlothian Council’s FOCUS team offers support to adults with a disability into work. However there is significant under capacity to deliver on people’s aspirations to work and models such as Project Search that have been successful in other areas of Scotland, should now be explored for Midlothian including the potential for partnership working with a neighbouring authority in this activity. Recommendation: • Explore employability opportunities for people with a learning disability including models such as Project Search in partnership with the Focus Team and other employability organisations to improve the learning and employment opportunities in Midlothian. 17 New research on learning disabilities in Scotland | FAI (fraserofallander.org) Page 182 of 256
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23 | P a g e Health staff should have more training to understand learning disabilities and the health issues Access to General Practice is difficult: appointment systems and econsult are not accessible Seeing the same medical professional for each appointment and having more time really helps Letters from NHS are difficult to understand resulting in people missing appointments Health information should be more accessible and available in easy read formats More direct links with NHS and support organisation would be helpful People do not always understand what doctors and health professionals are saying There should be more help with mental health especially for men Carer Support The Partnership has updated their Carer Strategy 2022-25 which sets out their strategic priorities: Carer Identification; Access to Support, Information and Advice; Health and Wellbeing (including breaks from caring); Planning Ahead; Financial Support; Carer Involvement. Carer support is commissioned through VOCAL Midlothian. In 2022-23 VOCAL supported 243 carers who were caring for someone with a primary condition recorded as Learning Disability or Autistic Spectrum Disorder. This is 20.4% of all carers supported by the Midlothian service. There were 284 cared for whose primary condition is recorded as Learning Disability or Autistic Spectrum Disorder so 32% of this caring group have multiple caring roles; that is, they are caring for more than one person, for example they maybe a parent caring for multiple children, caring for a child and adult relative or caring for adult siblings etc. Of those receiving support 90% are caring for a son or daughter and all carers are caring over 35 hours per week. Advocacy There is strong partnership working with People First (Scotland) to ensure the human rights of people with learning disability are considered in all aspects of service design, development and delivery. Independent advocacy is commissioned to ensure that, where necessary, an individual’s voice is heard in the planning of their care and support. Health and Wellbeing Themes from the consultation on the strategic plan identified the importance of good health and wellbeing throughout life. The strategic plan has a specific action to Support the wellbeing of people with Learning Disabilities and Autism throughout their life including screening and health, relationships and wellbeing. People with a learning disability have worse health outcomes and are more likely to experience a number of health conditions. They die, on average, 20 years earlier than people in the general population, often from causes that could be prevented or treated. As they grow older, people with learning disabilities have many of the same age related health and social care needs as other people but they also face specific challenges associated with their learning disability. This includes a higher incidence of epilepsy, autistic spectrum disorder and sensory impairments. There are key themes arising from the consultation on the strategic plan, from the evaluation of the Health Fair (Box 3) and through engagement with People First regarding access to healthcare services for people with learning disabilities (figure 11). Figure 11 Themes from Consultation and Health Fair on Access to Healthcare Services Page 183 of 256
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24 | P a g e A programme of health, relationship and wellbeing courses was delivered through the Local Area Coordination Service in 2022-23 which focused on Mental Health; Healthy Relationships; Sexual Health and Wellbeing; Social Media Safety and Awareness; Cancer (Breast Cancer, Cervical Cancer, Testicular Cancer, Bowel Cancer); Self Image; Budgeting and Financial Management. Development of accessible health information is being overseen by the Health Equality Expert Panel. Community Learning Disability Team The Community Learning Disability Team (CLDT) provides specialist health care, advice and treatment to adults with a learning disability through locally based multidisciplinary teams. This team has 9 staff (7.64 WTE) directly managed within Midlothian HSCP made up of Community Learning Disability Nursing, Physiotherapy and Occupational Therapy. Other disciplines within the team are managed centrally within NHS Lothian and include Psychiatry, Psychology, Speech and Language Therapy and Dietetics. The service aims to improve both the physical and mental health of people with learning disabilities by providing efficient and effective health care based on individual needs and supports other health and social care agencies to provide mainstream services to people with learning disabilities that will enable health improvement and reduce barriers when accessing services. The service works closely with the social work learning disability team and all care providers to address the health care needs of individuals. When referrals are received, they are placed on the main Mid CLDT waiting list on TRAK- the NHSLothian patient management system. Referrals are screened and response to all referrals is prioritised depending on clinical need. Following screening and clinical discussion referrals are allocated to the appropriate individual discipline waiting list. Depending on the nature of the referral multiple disciplines may be required to provide input to the person. Adherence to the standard NHS waiting time of 18 weeks for follow up is embedded in team processes however it is difficult to get accurate reports on waiting times performance. Each discipline within the team holds its own waiting list with separate systems in place to prioritise casework depending on need/clinical risk. Box 3: Health Fair A Health Fair for people with a learning disability and their carers was held in May 2023 as part of the 2023 Learning Disability Week. The Fair was organised by the HSCP together with Midlothian Learning Disability Providers’ Forum, People First, Midlothian Sport & Leisure, NHS Lothian, and Local Area Coordination Service. It was well attended with more than 100 participants taking part in workshops, activities, and visiting stalls with ideas and suggestions about how staying fit and healthy can really help people to lead a full and independent life. Whilst the event concentrated on fun the Fair emphasised serious underlying messages about tackling the health inequalities experienced by people with Learning Disability. This included the trial of a new accessible website to support informed decision making around attending screening, early detection of health issues, advice on safe and healthy relationships, oral health, and access to health services, vaccination, and exercise programmes. Page 184 of 256
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25 | P a g e The absence of a single system reflects the broad nature of referral requests and the discipline specific responsibility to adhere to a varied range of clinical standards. Emergency referrals for mental health crisis and behaviours that challenge are progressed within 24-72 hours with Learning Disability Consultant Psychiatry input being available across Lothian. Recommendations: • General Practice and Primary Care Services are supported to improve access for people with learning disabilities including adaptation of appointment systems, improving continuity of care and providing more easy read health information • Training needs analysis is completed for all health and social care staff on all aspects of learning disabilities and appropriate training provided to address any identified gaps. • Opportunities to improve management processes and develop CLDT waiting times report should be explored Financial Position The budget and expenditure from 2018-19 to 2022-23 is detailed in Table 5. The table includes the living wage uplifts that have been funded by the Scottish Government. Table 5 2018/19 2019/20 2020/21 2021/22 2022/23 Adult Health and Social Care Learning Disability Budget 12510 13598 15102 16549 18229 Learning Disability spend 14338 16214 15812 16528 18984 Variance -1878 -2617 -710 21 -755 Living Wage Uplift 2.6% 3.5% (from May) 3.3% 2.2% + 4.7% in Dec 4.16% Source: Midlothian Integration Joint Board Unaudited Annual Accounts The table demonstrates that whilst there has been significant investment in Learning Disability services over the past five years there remains a pressure on expenditure. The outturn position at end 2023 was an overspend of £755K which is equivalent to 4% of the budget. The average spend per person receiving support in 2019 was circa £35K per annum and this has increased to £45Kper annum in 2022-23. Increases in the Living Wage, number and complexity of transitions cases and year on year increase in transport costs have contributed to the increased expenditure. It is recognised that there is considerable variability in the amount of support individuals receive with around 17% of clients with the most complex needs accounting for 50% of the overall Learning Disability expenditure. Page 185 of 256
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26 | P a g e 109 45 46 24 19 21 19 13 16 11 10 5 7 5 5 16 0 20 40 60 80 100 120 Expenditure Profile Packages of Care 2021 Figure 12 provides a breakdown of the expenditure profile for all care packages (excluding those with value less than £500 per annum) in 2021. It highlights that there are a large number of lower cost packages of care relative to a small number of high cost packages of care. Figure 12 Expenditure Profiles of Packages of Care 2021 Overall Expenditure A breakdown of the overall expenditure is shown in Figure 13. Figure 13 Breakdown of Expenditure • Supported Living Services (Care at Home, Day Carer and Housing Support) account for around 73% of the expenditure. This reflects the high costs of supporting individuals who cannot live independently without large amounts of support including those who require 24/7 care. • Day centre placements accounts for 10% of all expenditure • Residential Care accounts for around 7% of the expenditure • Respite care accounts for 2% of the expenditure. Respite provision is essential to sustain an individual’s current care arrangements and preventing the need for more expensive supported living packages of Page 186 of 256
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27 | P a g e 299.51 278.56 0.00 100.00 200.00 300.00 400.00 500.00 600.00 700.00 Shetland Islands Aberdeenshire Na h-Eileanan Siar Scottish Borders Orkney Islands Dumfries and Galloway Argyll and Bute Dundee City South Ayrshire Stirling East Lothian West Dunbartonshire Perth and Kinross East Ayrshire East Renfrewshire Midlothian East Dunbartonshire Renfrewshire Falkirk Moray Inverclyde North Lanarkshire South Lanarkshire Fife North Ayrshire City of Edinburgh Aberdeen City Angus Clackmannanshire Glasgow City West Lothian Highland Gross Learning Disability spend per head of 18-64 population (18-64 years) 2020/21 (Source Local Financial Returns (LFRS) 2020-21 and NRS mid 2020 population estimates) LD Spend per head 18-64 population Scotland care being required. It is noted that individuals will also benefit from respite funded out of the carer’s budget. • 6% of the budget is allocated for Direct Payments Comparison of Expenditure There is no directly comparable means to estimate how the expenditure on Learning Disability Services in Midlothian compares to other partnerships. The Local Financial Returns (LFRS) 2020-2118 provide an estimate of the gross expenditure by adult social care services on adults with learning disabilities aged 18-64. The methodology used to calculate the estimates in the LFRS may vary between local authorities and although this means the data are not directly comparable the available data does give some indication of spends. The LFRS and National Records Scotland (NRS) mid 2020 population estimates have been used to estimate the gross learning disability spend per head of population aged 18-64 years for each local authority area(Figure 14). This comparison places Midlothian in the mid range with an estimated spend per head of just under £300. Figure 14 Gross Learning Disability Spend Per Head of 18-64 Year Population Learning Disability Services face considerable challenges in order to address identified current and future demographic pressures. Changing demographics are well rehearsed and people with a learning disability are living significantly longer but have a poorer health profile than the general population. Many will need to be supported for life. Over the course of a year there can be a significant number of changes to care packages as a result of: • Increased or reduced support needs due to changes in circumstances and/or conditions; • Life events such as transitioning from school, leaving home, growing old; 18 Scottish local government finance statistics (SLGFS) 2020-21: workbooks - gov.scot (www.gov.scot) Page 187 of 256
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28 | P a g e • Changes to shared living services that can affect shared support. It is estimated that young people with Learning Disabilities transitioning from Children’s to Adult Services will result in a further pressure of circa £1.9m over the next 3 financial years. In addition, each year there will be individuals who present in crisis requiring emergency interventions. These individuals often have very complex care needs and as a result the corresponding care package to meet their needs can be significant. Monitoring of Expenditure The social work IT system MOSAIC holds a record of the financial commitment for each care package. All invoices are paid through this system and payments cannot be made without a financial commitment being recorded and authorised in MOSAIC. There are some known issues with the system which include potential: • Over commitment: this may be where the service may not be fully provided due to service user being in hospital or on holiday or cancels support or where the care package has changed but not been updated within the system; • Unpaid commitment: Where there are delays in paying invoices; and, • Incorrect Service Information – where some historical configuration means there are some anomalies in the general principles applied to recoding of financial commitment. Expenditure on services provided directly by Midlothian Council is not recorded in MOSAIC and although notional costs can be attributed these are not currently accurate. Block contract are generally recorded and paid through MOSAIC meaning the overall financial commitment is recorded, but recording of variations and client level information for block contracts is inconsistent. Like all health and social care partnerships across Scotland, there is a need and a desire to review how support and care is delivered in all settings and to transform services to meet public expectations and stakeholder aspirations within a context of fiscal responsibility. Whilst care is needs led it is also resource bound and as such delivery of all services must be done in the context of best value – ensuring that there is good governance and effective management of resources with a focus on improvement, to deliver the best possible outcomes. Recommendations: • Continue to develop and transform services with a focus on improvement, good governance and effective management of resources to deliver the best outcomes • Continue to monitor costs and use data and evidence to compare with other areas • Improve the system for processing and monitoring of expenditure and payments within the MOSAIC system to improve transparency and more accurate reporting • Provide financial planning support to the Learning Disability Service to forecast the future cost of service provision based on growth estimates and develop the financial plan required to mitigate these Page 188 of 256
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29 | P a g e Transition Planning Transition out of Children’s Services can be challenging for people and their family carers when long-term placements and support from services ends and different approaches to meeting needs are applied in Adult Services. Throughout this review staff across all areas have commented on the need to improve the transitions of young people from Children’s Services into Adult Services. The partnership has recognised this need within the strategic plan with a specific action to improve the experience of transition from school to adult life and create appropriate developmental opportunities in adult life. To support this the partnership are in the process of recruiting a Practice Development Worker for Transition who will work across Children’s and Adults Services to:- • Facilitate the improvement of support for young people with additional needs between the ages of 14 and 25 who are making the transition to young adult life. • Lead and support staff and partners to inform structure and encourage the continual improvement young people’s experience of transition. • Provide a resource to staff in facilitating practice development in transition based on the Principles of Good Transition 3 within the workforce. • Be a champion for young people in transition and their families and family carers, providing opportunities for them to pursue their goals and aspirations within their local communities • Advise and support practitioners who are working alongside young people and their families to plan, assess, design and implement their support choices. • Support and influence change within adult services and local communities, and provide advice and assistance to team members in order to enable the people they work with to maintain and/or build informal support networks in their communities. A Transitions Forum is being established to oversee the improvement plan and activities and will report to the GIRFEC (Getting It Right for Every Child) Board. Whilst the transitions from children’s to adult services are critical it is noted that many adults with learning disabilities live with their families, usually their parents. In some instances they may be caring for an older frail parent while they, too, are getting older. Forward planning is important to explore alternative care arrangements when families/carers are no longer able to provide long-term care to ensure care is continued to be provided in a proactive and planned way. Recommendations: • To develop and implement an improvement plan to improve the experience of transition from school to adult life and create appropriate developmental opportunities in adult life • To ensure planning is undertaken within the care review process to develop strategies for individuals whose carers are aging and develop appropriate care and support plans as early as possible to prevent the need for crisis care Page 189 of 256
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30 | P a g e Transport Transport and travel is integral to the delivery of preventative and proactive care services that enable people to participate in their community and neighbourhood. The provision of transport is a key concern for older people and people with disabilities. The Scottish Government’s Keys to Life implementation framework emphasises the importance of opportunity, choice and participation for people with disabilities, as well as promoting accessibility and active citizenship for all. The partnership’s strategic plan has a specific action to Review Transport to ensure more flexible and tailored provision. The Midlothian Transport Policy (Adults) 2017 describes the approach to the provision of transport for people who have been assessed as eligible for support from Adult Social Care services in Midlothian and to transport to and from any service that has been identified or organised to meet this assessed need. The policy rests on the assumption and expectation that people will make their own transport arrangements to access community care services, and that funded transport will only be provided if there is there no other reasonable way to safely access the services for which they are eligible. The policy also indicates that people who qualify for benefits to help with travel will be expected to use these to pay towards their travel costs. People with Motability cars driven by themselves or family, friends, or carers will not be eligible for transport unless it is assessed that it would be unreasonable to expect that the person would use the vehicle to access their care service. Practitioners use their professional knowledge and case experience in determining an individual’s eligibility for support with transport. Options considered to support people with transport include helping them to use public transport, training to travel independently, an individual or shared taxi, transport in a Council car or bus. At the time of review 261 journeys per week were provided for 136 people, with 60% of all journeys for single passengers. In early 2020 240 journeys were provided for 121 people, with 67% of those for single passengers. These figures do not include the journeys provided by the Midlothian Council Welfare Transport Team, who were transporting 27 people (sharing) to five different destinations across Midlothian each week. Costs for transport are in the region of £10K per week, with an average of £72 per person. The volume of provision suggests a significant proportion of people accessing day services have transport provided even though they are in receipt of benefits to help with travel. Service users pay a contribution of £1 per journey. There are core issues with provision which include: • Lack of taxis/drivers making it difficult to meet the demand for transport. There are often only single bids submitted for each available contract, with little competition or opportunity for cost control. • School transport – most of the operators also provide school journeys, which impacts availability and start/finish times of day services. Around 50% attend a shorter day due to time restrictions on journeys. Page 190 of 256
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31 | P a g e • Ending of current contracts by operators – established journeys may be ended by operators due to staff shortages (both drivers and travel escorts) and, in some instances, journeys cannot be provided elsewhere. This can impact the ability of the individual to attend their day services. • Rising costs – Operators are reporting that their income is impacted by the rising costs of diesel and of repairs and maintenance to vehicles. This is being reflected in increased cost of transport. • Contractual obligations – A number of individual taxi journeys were put in place during the Covid period because of social distancing rules. These should now be reduced for reasons of availability and cost, however the Travel Team have advised that, as these contracts have been in place for over a year, there is a contractual obligation to maintain them. • Out of area journeys – there are still a number of individuals who attend services out with Midlothian. Transport for these journeys is often difficult to obtain or very expensive. There are currently three individuals for whom suitable transport cannot be sourced due to vehicle or escort shortages. • Lack of clarity around the daily charges being invoiced for taxi services. It is proving difficult to meet transport needs with the operators who are commissioned to provide this service. This presents a risk to the fair and equitable distribution of resources and impacts our ability to provide transport to those who need it. It is recognised that a review of transport is underway and this significant area of expenditure needs to be addressed. Recommendation: • Further work is required to; ensure consistency of assessment and eligibility for provision; work with procurement and providers to optimise use of transport and explore all options to ensure that the transport needs of adults with a Learning Disability can be met. • To review and update the Transport Policy Coming Home Implementation By March 2024 the Scottish Government wants to see real change with out-of-area residential placements and inappropriate hospital stays greatly reduced, to the point that out-of-area residential placements are only made through individual or family choices and people are only in hospital for as long as they require assessment and treatment. Current Position in Midlothian Midlothian has very low usage of hospital beds for people with learning disability with people only being in hospital for as long as they require assessment and treatment. There are no Midlothian residents delayed in hospital. The redevelopment of the Royal Edinburgh Hospital Campus includes provision of high quality facilities for those with an intellectual /learning disability receiving inpatient care for their mental health. Midlothian has very low usage of these hospital beds and the funded capacity within the new campus will reduce from 3 to 1 which is in keeping with current utilisation. Page 191 of 256
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32 | P a g e The new bed configuration will release funding which will allow further strengthening of community provision in Midlothian to minimise use of hospital inpatient care. The amount of funding is still to be confirmed. In addition there are plans in place to convert the former inpatient facility at Primrose Lodge to provide a new service that will support four individuals with complex learning and physical disabilities. It is anticipated that commissioning activity for this will commence in autumn 2023. Midlothian HSCP has a policy of not placing individuals outside Midlothian unless there it is assessed that it would not be appropriate for the individual to live in Midlothian. An exception to this may be considered if a highly specialist service that is not available in Midlothian is required. There are a number of people that Midlothian HSCP supports in out of area placements due to historic arrangements. Most people have been in these placements for a long period of time and the individuals, their legal guardians and Midlothian HSCP agree it would not be appropriate for these individuals to be moved. Currently there are 22 people with Learning Disabilities in out of area placements. • 12 of these individuals are in residing close to Midlothian and have been in these placements for over 10 years. • 7 Individuals are in out of area placements that are more than 20 miles from Midlothian and have been for over 10 years and it is not assessed as appropriate for them to be relocated back to Midlothian • 3 people whose ordinary residence remains with Midlothian were placed out of area or transitioned to out of area adult services in the past 3 years. These placements are out of area to meet an assessed social care need. The relatively good position in respect of out of area placements and delayed discharge for the learning disability and autism groups is supported by policy decisions in relation to: • The building of 12 purpose built local authority tenancies at Teviot Court in Penicuik. • The recruitment of a Positive Behavioural Support Lead Officer supported by a Positive Behavioural Support Steering Group. • The procurement of expertise from third sector organisations specialising in support for people with Complex Care needs in local communities. • The development of local intelligence in relation to people at high risk of family or placement breakdown. • The use of a Safe House model to avoid inappropriate admission to hospital settings for anything other than assessment or treatment. Complex Care Change Fund Funding was made available to support implementation with guidance outlining that the funding should be used to: • Reduce the delayed discharges of people with complex needs. • Repatriate those people inappropriately placed outside of Scotland. Page 192 of 256
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33 | P a g e • Redesign the way services are provided for people with complex needs. The Midlothian allocation is £312,000. The guidance for the use of the fund is not prescriptive but broadly should be used to improve community-based support to people with complex care needs and redesign local services for people with complex needs. The key feature of the Midlothian approach to date has been supporting people in tenancies, including Teviot Court, located at the heart of our communities that they will be proud to live in. These include carefully thought out design elements that look ordinary but are the result of a lot thought and individualised and proactive planning. A short life Expert Panel was convened to plan for and oversee the expenditure of the Midlothian Change Fund allocation. The panel has referred to research and best practice, as well as liaising regularly with leads in other areas through Social Work Scotland and with the existing Midlothian Learning Disability and Autism Providers, Users, and Carers, Networks. The proposed developments include: • People First Film from users perspective to be used for staff training by multiple agencies; • Film from staff experience to be used for staff training by multiple agencies; • Property renovation for complex care day services: Pathead Pavilion and Rosewell Pavilion; • Partially fund the renovation of Primrose Lodge • Renovation of semidetached house at Teviot Court to develop place of safety/crisis service • Positive Behaviour Support training to develop local expertise and resources • Transition training • Complex care transition practitioner to support improvements in transition linked to the Principles of Good Transition • Grants to partner organisations to encourage creative responses to community services for people with Complex Need. • Development and implementation of Midlothian Dynamic Support Register. It is anticipated that these developments will improve access to crisis services; flexible support responses and family support); improve transitions from children’s to adult services and promote Positive Behaviour Support and development of practice. Recommendation: • Continue to implement the actions and improvement plan for complex care within the available resources provided through the Change Fund Page 193 of 256
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34 | P a g e 0 5 10 15 20 25 30 <24 25-34 35-44 45-54 55-64 65+ Age profile HSCP Learning Disability Service Workforce Workforce Planning The partnership have an overarching workforce plan in place to support the development of the workforce under the five pillars framework of Plan; Attract; Train; Employ; and Nurture. Midlothian has a growing and aging population which will increase demand for health and social care services. The age profile of the staff within the partnership’s Learning Disability Services demonstrates some demographic challenges within the workforce with 46% of the workforce over the age of 55 (Figure15) Figure 15 Workforce Age Profile within the HSCP Learning Disability Services Workforce planning is essential to ensuring sustainability of service provision and that the workforce have the required knowledge, skills and experience to meet the needs their service user. It was highlighted that there are challenges in enabling social care staff to develop competencies to manage the health care needs of some service users particularly within Cherry Road. This has resulted in the need to provide nursing support through agency and the district nursing service to meet the clinical needs of individuals. It is recognised that there are people who will be coming through transition who will have more complex physical health needs and the future model of provision and capacity to support these will be essential. Recommendations: • Consideration is given to the current and future Cherry Road service users’ clinical needs and whether there is a requirement to provide a more integrated and permanent solution for nursing input to ensure service users’ needs are met timeously. • A Learning Disability Workforce Plan is developed to ensure services are sustainable and can continue to meet the diverse needs of this population. Page 194 of 256
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35 | P a g e Governance and Quality Assurance Resource Panel The resource panel reviews assessments for adults with learning disabilities. The Resource Panel includes team leaders from both health and social care and a senior manager/finance representative to support decision making. On average the Resource Panel receives around 250 requests each year. This highlights the volume of changes to packages of care and the level of ongoing assessment and review activity taking place. The Resource Panel provides assurance related to:- • Equitable allocation of resources and consistent decision making; • Adherence to relevant policies about the provision of assessment; and, • Oversight of assessment. Internal Audit In 2022 Internal Audit completed an audit of the governance, decision making process for packages of care, budget monitoring arrangements, payments to providers and considered the level of assurance was substantial but noted that some policies and procedures required to be updated and a terms of reference for the resource panel should be developed and documentation of the reason for selection of providers should be improved. The majority of care provision for people with Learning Disabilities is commissioned from external care providers, most of which are third sector organisations. Management of contracts is the responsibility of individual service areas. Internal Audit assessed the level of assurance for commissioning and contract monitoring to be limited. Work has commenced on reviewing the commissioning process and development of a commissioning strategy including improving contract monitoring arrangements. Reviews A key area of governance around packages of care is the completion of reviews which should be completed on a regular basis. The most recent data from 2022 indicates that 50% (n=203) of care packages have been reviewed within one year and 66% (n=270) within two years (Table 6). Work is underway to get back to business as usual and to complete the outstanding reviews. More robust mechanisms to report on the number and proportion of reviews completed needs to be put in place. Table6: Cases with Review 2020: % of Cases 2022: % of Cases Within the previous year 47% 50% Within the previous 2 years 62% 66% Quality Assurance There are a number of measures in place to oversee the quality of support being delivered. A Quality Assurance officer is in post to work directly with care providers to identify, monitor address any quality of care issues. A Disabilities Quality Improvement Group (QIG) has been established to oversee all Health and Social Care service provision. The QIG meets quarterly and considers • Quality improvement projects; Page 195 of 256
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36 | P a g e • Inspections undertaken by the care inspectorate; and, • Audits undertaken by the quality assurance officer. It is noted audits are undertaken and monthly reports are received for most major contract providers but not all providers are being monitored particularly where the provision falls under SDS Option 2 and out of area providers. Incident Reporting and Monitoring – An updated incident reporting mechanism has been rolled out to improve consistency and accuracy of incident reporting to Midlothian HSCP. This will provide more accurate data on the number of incidents, and any emerging trends allowing corrective and preventative action to be taken. Regular Provider Review Meetings are arranged on a quarterly basis, or in response to specific issues. These meetings have proved to be a useful forum for collaborating and sharing best practice, and there has been positive engagement from providers at these meetings. There would, however, be merit in re-establishing a more formal framework for review meetings with individual providers. Recommendation: • The recommendations related to the internal audit findings need to be fully completed; • The review of the commissioning and contract monitoring process is completed and commissioning strategy developed and implemented; • A more robust process is established to monitor and report on the number and proportion of case reviews completed; • Mechanisms are developed to ensure audits are undertaken of Option 2 providers and Out of Area Providers; • Establish a more formal framework for review meetings with individual providers. Risks In completing the review the following main risks were identified: • The financial pressures within Learning Disability Services present a financial risk if the expenditure continues to exceed the budget available; • There is a risk that re-commissioning activity could potentially result in additional budgetary pressure. A detailed analysis of service areas prioritised for re-commissioning should be undertaken and individual risk assessments prepared for each service area; • There is a risk that reduced availability of care staff may impact the capacity and ability to deliver services in particular for those requiring new packages of care; • There is a potential risk with the aging profile of the HSCP workforce impacting on service delivery; • There is a risk that uncertainty regarding long term arrangements for the commissioning of social care may create a level of instability in the market that could impact long term planning; • There is a reputational risk associated with redesign of services and resistance to change. Engagement and collaborative approaches must ensure there is appropriate consultation with service users and carers to understand their perspective and views on current and future commissioning arrangements. Page 196 of 256
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37 | P a g e Conclusion The planning, development and delivery of learning disability services in Midlothian follow the principles and recommendations set out within the strategic frameworks. There is good evidence of partnership working across all services, providers and partners with clear commitment and motivation to empowering people with learning disabilities to recognise and realise their human rights and to participate in community life free from fear, harassment and abuse. The evidence demonstrates that there are significant demographic and financial challenges in provision of health and social care services for people with learning disabilities. The prevalence in Midlothian is above the Scottish average and the projected growth in the population will continue to place a significant pressure on all services and the financial resources required. Achieving a balanced financial position has proved difficult with expenditure exceeding the allocated budget. Pressure on the budget will continue with increasing numbers of young people coming through transition from children’s services to adult services who have very complex needs. Whilst comparative expenditure analysis indicates the costs of provision are within the mid range across all partnerships in Scotland there is a need to transform the way support and care is delivered to ensure: • Services are safe and sustainable for people to reach their full potential, with good quality support built around their individual needs and outcomes; • The resource allocation processes are fair and consistent; and • Efficiencies are maximised to secure best value for the people being supported and the wider community. Improvement work is already being progressed in relation to transitions, SDS, transport provision and commissioning of service. Recommendations have been made to support the planning and resourcing of learning disability services, to redesign models of service provision and to ensure that there is good governance and effective management to deliver the best possible outcomes for people with learning disabilities, their families and carers, within the resources available. Page 197 of 256
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38 | P a g e Summary of Recommendations Strategic Planning 1. The action plan supporting implementation of the Learning Disability and Autism Strategic Plan is refreshed to reflect the current three year period 2022-2025 to support implementation. Prevalence Data 2. Opportunities to lobby for improved data collection and to increase the information available are maximised at a national level with the SLDO, Public Health Scotland and the Scottish Government to support strategic planning of Learning Disability Services. 3. To continue to develop more formal tracking processes with Education to ensure there is more robust information for all children with learning disabilities who will require transitioning to adult services and produce an annual report detailing the anticipated cost of transitions to support future financial planning. 4. To develop local data collection on the known population with Learning Disabilities within Midlothian to inform future planning Assessment and Case Management 5. Consideration is given to refining the definitions for eligibility within Learning Disability to support a more consistent approach. 6. The SDS improvement plan is fully implemented within the Learning Disability Service to inform and develop excellent standards in practice Supported Living Services and Housing Support 7. A review of overnight support is undertaken to optimise arrangements to support people to live safely and as independently as possible in a risk enabling way in accordance with their assessed need and to achieve best value. 8. To work with Housing colleagues to develop a process for housing application and allocation for suitable accommodation for supported living in shared tenancies for people with learning disabilities 9. To support the housing developments being progressed and continue to identify future provision in line with the aspirations within the Strategic Plan 10. Develop opportunities to maximise recruitment of Shared Lives Carers to enable more day care and short break provision 11. Monitor provision of Shared Lives Midlothian over the medium term to ensure sustainability Day Services 12. The future design and delivery model for the directly provided services, Cherry Road and CAT, needs to be progressed taking account of the increasing complexity and numbers of young people in transition, models of support and the access to appropriate, safe and well designed spaces in communities. 13. Explore different models of contracting services with the aim of creating collaborative commissioning environment. 14. Increase the availability of flexible and person centred day opportunities for all ages to support greater choice and opportunities Employability 15. Explore employability opportunities for people with a learning disability including models such as Project Search in partnership with the Focus Team and other employability organisations to improve the learning and employment opportunities in Midlothian. Health and Wellbeing 16. General Practice and Primary Care Services are supported to improve access for people with learning disabilities including adaption of appointment systems, improving continuity of care and providing more easy read health information 17. Training needs analysis is completed for all health and social care staff on all aspects of learning disabilities and appropriate training provided to address any Page 198 of 256
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39 | P a g e identified gaps. 18. Opportunities to improve management processes and develop CLDT waiting times report should be explored Financial 19. Continue to develop and transform services with a focus on improvement, good governance and effective management of resources to deliver the best outcomes 20. Continue to monitor costs and use data and evidence to compare with other areas 21. Improve the system for processing and monitoring of expenditure and payments within the MOSAIC system to improve transparency and more accurate reporting 22. Financial planning support is provided to the Learning Disability Service to forecast the future cost of service provision based on growth estimates and develop the financial plan required to mitigate these Transitions 23. To develop and implement an improvement plan to improve the experience of transition from school to adult life and create appropriate developmental opportunities in adult life 24. To ensure planning is undertaken within the care review process to develop strategies for individuals whose carers are aging and develop appropriate care and support plans as early as possible to prevent crisis care Transport 25. Further work is required to; ensure consistency of assessment and eligibility for provision; work with procurement and providers to optimise use of transport and explore all options to ensure that the transport needs of adults with a Learning Disability can be met. 26. To review and update the Transport Policy Coming Home Implementation/ Change Fund 27. Continue to implement the actions and improvement plan for complex care within the available resources provided through the Change Fund Workforce Planning 28. Consideration is given to the current and future Cherry Road service users’ clinical needs and whether there is a requirement to provide a more integrated and permanent solution for nursing input to ensure service users’ needs are met timeously. 29. A Learning Disability Workforce Plan is developed to ensure services are sustainable and can continue to meet the diverse needs of this population. Governance and Quality Assurance 30. The recommendations related to the internal audit findings need to be fully completed 31. The review of the commissioning and contract monitoring process is completed and commissioning strategy developed and implemented 32. A more robust process is established to monitor and report on the number and proportion of case reviews completed 33. Mechanisms are developed to ensure audits are undertaken of Option 2 providers and Out of Area Providers 34. Establish a more formal framework for review meetings with individual providers Page 199 of 256
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Midlothian Integration Joint Board Thursday 24th August 2023, 14:00-16:00 Midlothian Public Health Recommendations in response to Director of Public Health Annual Report Executive summary On 22nd June 2023, the Consultant for Public Health in Midlothian presented the NHS Lothian Director of Public Health’s Annual Report to Midlothian Integration Joint Board. The Board requested that recommendations for strategic action in relation to this report be presented at the August Board to further progress the strategic ambitions of the Midlothian Integration Joint Board Strategic Commissioning Plan 2022-25. As part of the Strategic Commissioning process, it is vital that Integration Authorities work in partnership with people, communities, and partner organisations to jointly agree and clearly communicate its vision for health and wellbeing in Midlothian. Good quality housing, education and employment are fundamental in shaping an individual’s opportunity to be healthy. Economic inactivity is a cause of health inequality, social exclusion, and poverty and associated with lower life expectancy than people who live in areas with high employment. Midlothian Health and Social Care Partnership (HSCP) is one of the largest employers within Midlothian. This size and stable roots with the community mean that Midlothian Health and Social Care Partnership (HSCP) has the potential to make a large positive contribution to the health and wellbeing of local people beyond proving healthcare. Projected increases in the Midlothian population will impact all health and social care services across Midlothian, Lothian and nationally, increasing the demand for existing services and require new service models. Taking a proactive approach to local employability could harness and nurture opportunities for local workforce recruitment and development and support the ability improve health and wellbeing. Although not an employer, Midlothian Integration Joint Board (IJB) produces Strategic Commissioning Plans that identify health and social care needs and explain how delegated services will be delivered by NHS Lothian and Midlothian Council. Supporting opportunities for good quality employment is one way in which Midlothian Integration Joint Board (IJB) Item number: 5.7 Page 201 of 256
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Midlothian Integration Joint Board and Midlothian Health and Social Care Partnership (HSCP) can directly impact the wider determinants of health. Members are asked to: • Note the priorities of the Director of Public Health Report 2023 including the responsibility of Anchor Institutions to take action and support the health and wellbeing of our communities, • Consider commissioning the Strategic Planning Group alongside with Midlothian Health and Social Care Partnership Workforce Governance Board to complete a scoping exercise alongside all key stakeholders to establish the current landscape in relation to employability and employment support for local people entering health and social care employment, including the identification of opportunities for improvement, and • Consider content of the paper as key evidence when reviewing the priorities of health and a social care in the developing new the new Midlothian IJB Strategic Commissioning Plan 2025/28. # Page 202 of 256
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian Public Health Recommendations in response to Director of Public Health Annual Report 1 Purpose 1.1 This report presents recommendation for how Midlothian Integrated Joint Board might consider responding to the NHS Lothian Director of Public Health Annual Report 2022. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the priorities of the Director of Public Health Report 2023 including the responsibility of Anchor Institutions to take action and support the health and wellbeing of our communities, • Consider commissioning the Strategic Planning Group alongside with Midlothian Health and Social Care Partnership Workforce Governance Board to complete a scoping exercise alongside all key stakeholders to establish the current landscape in relation to employability and employment support for local people entering health and social care employment, including the identification of opportunities for improvement, and • Consider content of the paper as key evidence when reviewing the priorities of health and a social care in the developing new the new Midlothian IJB Strategic Commissioning Plan 2025/28. 3 Background and main report 3.1 Background On 22nd June 2023, the Consultant for Public Health in Midlothian presented the NHS Lothian Director of Public Health’s Annual Report to Midlothian Integration Joint Board. The Board requested that recommendations in relation to this report suggesting strategic action be presented at the August Board that would also further progress the strategic ambitions of the Midlothian Integration Joint Board Strategic Commissioning Plan 2022-25. 3.2 The Fundamentals of Good Health and Wellbeing As part of the Strategic Commissioning process, it is vital that Integration Authorities work in partnership with people, communities, and partner organisations to jointly agree and clearly communicate its vision for health and wellbeing in Midlothian. Identifying local health and social care needs will also support the Health and Social Care Partnership (HSCP) to appropriately plan and deliver services with the intention of seeing progress towards improved health and wellbeing outcomes. 3.3 Good quality housing, education and employment are fundamental in shaping an individual’s opportunity to be healthy. However, the public’s perceptions of what Page 203 of 256
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Midlothian Integration Joint Board influences health is most often attributed to individual behaviour and access to care rather than the established evidence base demonstrating the much wider determinants of health. 3.4 Research shows that people hear nuanced messages about health through an individualised lens which can obscure people’s awareness of the significance of social determinants. Improving how we communicate public health messaging and seeking to take intentional action through our strategic planning to increase quality in the fundamentals of good health and wellbeing in our communities will drive real change. 3.5 Anchor Institutions Anchor Institutions are defined as ‘large public sector organisations rooted in and connected to their local communities. They can improve health through their influence on local social and economic conditions by adapting the way they employ people, purchase goods and services, use buildings and spaces, reduce environmental impact, and work in partnership.’ (The Health Foundation, 2021). Anchors are often public sector organisations, which have extended their supporting role beyond initial service identity as part of the Scottish Government’s drive for public service reform. They are most often cited as part of wider Community Wealth Building (CWB) programmes, under fair employment and just labour markets. Anchors are key within both Midlothian Council and NHS Lothian strategy. Midlothian Council is commitment to developing and implementing Community Wealth Building (CWB) and the NHS Lothian Strategic Development Framework (LSDF) includes Anchors within one of its 6 pillars. Work is underway through The Anchor Institution Programme Board that includes the 4 Lothian Health and Social Care Partnerships. 3.6 Employment in Midlothian During 2022, 81% of the population of Midlothian was economically active compared with 77% across Scotland as a whole (Nomis, 2023). Of the 19% economically inactive within Midlothian: 27% are ‘Retired’, 26% are ‘Long Term Sick’ and 24% are ‘Looking After Family/Home’. This economically inactive group surveyed is almost 7 times the number of staff within Midlothian Health & Social Care Partnership employed by either NHS Lothian of Midlothian Council. 3.7 High unemployment rates are associated with poorer health outcomes. Economic inactivity is a cause of health inequality, social exclusion, and poverty. It is 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 (The Health Foundation, 2022). 3.8 Midlothian Health and Social Care Partnership (HSCP) is one of the largest employers within Midlothian. This size and stable roots within the community mean that Midlothian Health and Social Care Partnership (HSCP) has the potential to make a large positive contribution to the health and wellbeing of local people beyond proving health and social care. For example, through widening the access to quality local work. 3.9 Population Growth in Midlothian Midlothian Council has allocated or plans to allocate land for approximately 12,500 homes by 2036. The average household size for Midlothian was 2.25 people (National Records of Scotland, 2022). This would suggest that housing could be Page 204 of 256
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Midlothian Integration Joint Board allocated for an extra 28,125 people within Midlothian (2022-2036). Therefore, excluding growth rate fluctuations from other factors such as deaths or births, the population could increase by 30% from 94,700 (Nomis, 2023) to 122,825 (2036). It is worth noting that, the housing proposition for Midlothian is largely 4 bedroom detached properties which could result in significantly higher population increases than indicated by the National Records of Scotland average. 3.10 Midlothian Health and Social Care Partnership Through our employing partners NHS Lothian and Midlothian Council. Midlothian Health & Social Care Partnership (HSCP) employs approximately 1,610 staff, or 1,544 whole time equivalent (WTE). The largest staff groups within Midlothian Health and Social Care Partnership (HSCP) are the three Group Service areas of Primary Care and Older People, Adult Services, and Allied Health Professions. 3.11 The five largest Services are Mental Health and Substance Use, Dietetics, Care at Home, Sport and Leisure, and Community Nursing. In total, these areas account for 50% of all staff employed across Midlothian Health & Social Care Partnership (Midlothian Council & NHS Lothian) 3.12 Additionally, a workforce of approximately 1,200 regulated by the Scottish Social Services Council (SSC) in the private and voluntary sectors in Midlothian providing services and support for adults. This workforce work within ‘Housing Support/Care at Home’ (50%), ‘Care Home for Adults’ (45%) and ‘’Adult Day Care (5%). 3.13 Employment Challenges The stability of the Adult Social Care workforce has become a significant and urgent issue across Scotland. The evidence suggests that workforce supply is most limited in care at home and care homes staff groups. In February 2022 the shortage occupation list was expanded to include social care, care assistant, and home care worker roles. Some potential reasons for hard to fill posts in these areas includes: • increasing demand from competing comparable sectors • more attractive roles in other sectors • comparatively low pay in the context of a Cost-of-Living-Crisis e.g., care support in social care is comparably lower when compared with equivalent roles in the NHS. 3.14 The TURAS Data Intelligence (TDI) platform reported in March 2023 that the largest vacancy rates across NHS Lothian were District Nursing (17.7%), Occupational Therapy (10.1%), Mental Health Nursing (10.2%) and Adult Nursing (9.8%). It is worth noting that these job types have shown a consistent trend of increasing vacancy rate since December 2015. 3.15 Legislative Duties The Health and Care (Staffing) (Scotland) Act, 2019 is the first legislation in the UK to set out requirements for safe staffing across both health and care services. The legislation aims to support appropriate staffing levels to ensure safe effective high- quality care -through legislating a consistent transparent evidence-based approach to decisions around staffing. 3.16 Quality workforce planning requires Integration Authorities to work alongside Health Boards and Local Authorities to ensure the availability of an appropriately trained workforce to deliver those services. To do this effectively, Health and Social Care Partnerships (HSCPs) develop Integrated Workforce Plans that set out the Page 205 of 256
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Midlothian Integration Joint Board operational actions required and work alongside NHS Boards and Local Authorities as the employing partners. 3.17 The Case for Strategic Action Projected increases in the Midlothian population will impact all health and social care services across Midlothian, Lothian and nationally, increasing the demand for existing services and require new service models. Taking an Anchors Institution approach to employability could harness and nurture opportunities for local workforce recruitment and development and support the ability to continue to meet communities evolving needs. 3.18 Improving employability outcomes in our communities is a key priority of the 2023- 27 Community Planning Partnership’s Single Midlothian Plan and a joint action has been agreed to identify opportunities to establish collaborative practices between NHS Lothian and Midlothian Council that support Midlothian Health and Social Care Partnership (HSCP) and Local Employability Partners to create more opportunities for local people to enter work within health and social care. 3.19 Supporting opportunities for good quality employment is one way in which Midlothian Integration Joint Board (IJB) and Midlothian Health and Social Care Partnership (HSCP) can directly impact the wider determinants of health. 3.20 There are a number of mechanisms that can be useful in supporting local people enter into meaningful employment and retain staff. Employability actions can include: • increasing the utilisation of Employability Programmes, • increasing Modern Apprenticeships or Kick Start programmes • maximising recruitment opportunities for the local population. • developing, increasing, benefitting from, and understanding local and national workforce supply pipelines including volunteering and the Third Sector. 3.21 Although not an employer, Midlothian Integration Joint Board (IJB) produces Strategic Commissioning Plans that identify health and social care needs and explain how delegated services will be delivered by NHS Lothian and Midlothian Council. As part of this process, Midlothian Integration Joint Board (IJB) can request that NHS Lothian and Midlothian Council maximise the opportunities to support meaningful local employment. 3.22 Midlothian Integration Joint Board may wish to consider commissioning the Strategic Planning Group and the Midlothian Health and Social Care Partnership Workforce Governance Board alongside NHS Lothian and Midlothian Council partners to carry out a scoping exercise to establish • the existing policies, processes and structures to support local people entering meaningful employment within health and social care. This should include the current opportunities for those who have particular barriers to employment, • baseline information on the demographics of our current workforce, and how representative this is of our population, and • opportunities for improvement. Page 206 of 256
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Midlothian Integration Joint Board 3.23 This will support the Midlothian Integration Joint Board (IJB) and Health and Social Care Partnership (HSCP) contribution to Community Planning Partnership work that will be undertaken as part of the Single Midlothian Plan to establish collaborative practices in order to create more opportunities for local people to enter work within health and social care. 4 Policy Implications 4.1 The content of this report may have implication for recruitment policy. It is recommended that discussion and agreement on action parameters are agreed with NHS Lothian and Midlothian Council as the employing organisations. 5 Directions 5.1 There are no direct implications for Directions in relation to this report. 5.2 However, this report recommends Midlothian Integrated Joint Board consider commissioning a scoping exercise to establish the current landscape in relation to employability and employment support for local people, including the identification of opportunities for improvement. 5.3 This may result in Midlothian Integrated Joint Board exploring the feasibility of issuing an additional Direction under ‘No 8: Workforce’ specifically designed to increase the number of people in our communities supported to commence meaningful employment within Midlothian Health and Social Care Partnership (HSCP). 6 Equalities Implications 6.1 There are no direct equality implications in relation to this report. However, should Midlothian Integration Joint Board consider a future Direction to support the policy implications of this Direction would need to be fully considered in partnership NHS Lothian and Midlothian Council as the two employing organisations. Revisions to policy would likely have implications for groups of people with protected characteristics and require the completion of an Integrated Impact Assessment (IIA) by both organisations. 7 Resource Implications 7.1 There are no direct resource implications in relation to this report. 8 Risk 8.1 There is a risk that by not taking action to facilitate change in relation to local employment, Midlothian IJB will not see the desired progress towards improved health and well-being for the people and communities. The risk of not taking intentional action to support local people into meaningful employment where possible is far reaching for both health and social care. Page 207 of 256
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Midlothian Integration Joint Board 8.2 Additionally, the mechanisms and method adopted by Midlothian IJB to communicate with people and communities must include understanding how public health messages will land. Establishing a clear message and communication plan through key policies like the Midlothian IJB Strategic Commissioning Plan 2025/28 and its associated Directions, a Midlothian IJB Market Facilitation Plan, the Midlothian IJB Scheme of Publication, and the Midlothian HSCP Integrated Workforce Plan is vital. 9 Involving people 9.1 Consultation on any work commissioned by Midlothian Integration Joint Board will be undertaken with all key stakeholders. 10 Background Papers 10.1 No background papers. AUTHOR’S NAME and DESIGNATION Gill Main, Integration Manager Jim Sherval, Consultant in Public Health Becky Hilton, Strategic Programme Manager for Population Health Kevin Dickson, Strategic Programme Manager for Workforce and Strategy CONTACT INFO Via email or MS Teams DATE 07/08/2023 Appendices: None References: National Record of Scotland (2022) Households and Dwellings in Scotland. Available at: https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/households/household-estimates/2022 (Accessed: 07 August 2023). Nomis (2023) Office for National Statistics. Available at: https://www.nomisweb.co.uk/reports/lmp/la/1946157423/printable.aspx (Accessed: 07 August 2023). The Health Foundation (2021)., Anchors in a storm: Lessons from anchor action during COVID-19. Available at: Anchors in a storm - The Health Foundation (Accessed 08 August 2023). The Health Foundation (2022) Relationship between employment and health. Available at: https://www.health.org.uk/evidence-hub/work/employment-and- underemployment/relationship-between-employment-and-health (Accessed: 07 August 2023). Page 208 of 256
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Midlothian Integration Joint Board Thursday 24th August 2023, 14:00-16:00 Midlothian Integration Joint Board Draft Self- Improvement Plan Executive summary The purpose of this report is to update the Midlothian Integration Joint Board (MIJB) on the Draft Board Self-Improvement Plan that was created following the MIJB Development Workshop led by the Improvement Service held on the 11 May 2023 (appendix 1). This draft Improvement Plan will require additional discussion, clarification, and agreement to finalise a set of actions for Board members to undertake or delegate as appropriate. A development session is proposed for 9th November 2023 to finalise and agreed the MIJB Self-Improvement Plan and further develop Board member ownership of the actions required to take forward these improvements. Members are asked: • To note the draft MIJB Self-Improvement Plan, and • To note and agree the proposed the arrangements for an MIJB development session on 9th November 2023 to develop the MIJB Self-Improvement Plan Item number: 5.8 Page 209 of 256
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Midlothian Integration Joint Board Page 2 Midlothian Integration Joint Board Midlothian Integration Joint Board Draft Self- Improvement Plan 1. Purpose 1.1 The purpose of this report is to update the Midlothian Integration Joint Board (MIJB) on the Draft Board Self-Improvement Plan that was created following the MIJB Development Workshop led by the Improvement Service held on the 11th May 2023 (appendix 1). 2. Recommendations 2.1 Members are asked to: • Note the draft MIJB Self-Improvement Plan, and • Note and agree the proposed the arrangements for an MIJB Development Session on 9th November 2023 to develop the MIJB Self-Improvement Plan. 3. Background and main report 3.1 Following discussions with the MIJB Chief Officer scoping discussions were held with the Improvement Service to facilitate a self-assessment of the MIJB. A scope for this self-assessment was then agreed in February 2023. 3.2 The purpose of the self-assessment was to focus on the MIJB in terms of its functioning and effectiveness, reflect upon strengths and identify areas where there may be scope for improvement. 3.3 A self-assessment questionnaire was distributed to all MIJB members in April 2023 focusing on the following key areas: • IJB Response to COVID-19 • Leadership and Relationships • Governance and Accountability • Community Engagement and Participation • Outcomes and Impact • Performance Management and Use of Evidence 3.4 MIJB Development Workshop held on May 11th 2023 facilitated by the Improvement Service. This workshop utilised the collated results from the self- assessment questionnaire to facilitate a further self-assessment process to identify improvement plan actions. These have subsequently been collated into the Draft Self-Improvement Plan presented in appendix 1. Page 210 of 256
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Midlothian Integration Joint Board Page 3 3.5 This draft Improvement Plan will require additional discussion, clarification, and agreement to finalise a set of actions for Board members to undertake or delegate as appropriate. A further Development session will be held in November 2023 to finalise the MIJB Draft Self-Improvement Plan and agree Board ownership of the actions identified. 4. Policy Implications 4.1 There are no policy implications noted at this stage. 5. Directions 5.1 There are no Directions implications arising from this report. 6. Equalities Implications 6.1 There are no equalities implications arising from this report. 7. Resource Implications 7.1 There are no direct resource implications any resource to support Board members in improvement will be agreed as part of the finalised Self- Improvement Plan. 8. Risks 8.1 Risk are identified as part of the MIJB Draft Self-Improvement Plan. 9. Involving People 9.1 Consultation on Internal Audit planning will be undertaken with all key stakeholders. 10. Background Papers 10.1 None. AUTHOR’S NAME Duncan Stainbank DESIGNATION MIJB Chief Internal Auditor CONTACT INFO Duncan.stainbank@midlothian.gov.uk DATE 04/08/2023 Appendices: Appendix One: MIJB PSIF Draft Self-Improvement Plan Appendix 1. Page 211 of 256
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Midlothian IJB – PSIF Self-Assessment Draft PSIF Improvement Plan – May 2023 Improvement actions Lead Implications [Risk, Cost, Resource] Target Date Measure Outcomes 1. Look at ways to ensure the agenda for Board meetings allows for more strategic planning and debate. 1. Determine what existing agenda items can be shortened, removed, or marked for info only. Chair Risks • Could become controversial. • Reducing time to debate current issues. • Duplicating discussions elsewhere. Costs • Staff time. • Opportunity cost. September 2023 (To be agreed) New format for agendas established. Board debates and discussions become more strategic and longer term, leading to more effective delivery of change. 2. Draw from existing material to undertake a SWOT analysis for IJB in order to identify areas for future strategic discussions and work programme development. Chair, Vice Chair, Chief Officer and SPG Chair To be agreed SWOT analysis completed. 3. Develop a work programme of key strategic questions for planning and debate beyond current timescales, set annually but with regular review (place in annual IJB workplan). Chair, Vice Chair, Chief Officer and SPG Chair To be agreed Work programme developed. 4. Deliver programme of work identified under action 3, including preparatory development sessions or briefing papers. Chair and Board To be agreed Board members actively engage on strategic programme. Appendix 1 Page 213 of 256
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Improvement actions Lead Implications [Risk, Cost, Resource] Target Date Measure Outcomes 2. Review the IJB’s current mechanisms for engaging with key stakeholders, service users and the wider public to more effectively seek their views. 1. Undertake a ‘Community Engagement’ self-assessment with the Board. Chair, Vice Chair, Chief Officer and SPG Chair Risks • We don’t achieve effective outcomes. • Ineffective engagement – we don’t reach all stakeholders. • Managing capacity to undertake this work – sacrifice other work for this. • Time constraints for Board members to engage – need to ensure Board members engage. • Managing expectations on what can be achieved – need to be clear. Risks if improvement action not implemented. December 2023, if current programme of work reviewed to allow time for this work to take place. June 2024 based on current work programme. (To be agreed) Self-assessment exercise has taken place with the Board. Midlothian IJB can evidence that it delivers outcomes, including our Strategic Aims, that matter for the people of Midlothian. 2. Clarify aims and objectives of engagement activity. • Ensure this connects with people. Board Aims and objectives of engagement activity have been established. 3. Review current engagement mechanisms to ensure all stakeholders are engaged, including those who are seldom heard. • Going to people instead of people coming to us. Chair, Vice Chair, Chief Officer, Executive Business Manager and SPG Chair Review has taken place as part of self-assessment. 4. Engage early on the new Strategic Commissioning Plan. Chair, Vice Chair, Chief Officer, SPG Chair and Board Members October 2024 (To be agreed) Process measures tbc once Plan has been approved. 5. Look to extend Third Sector summit work already taking place. IJB Members Board member attendance at sessions. Page 214 of 256
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Improvement actions Lead Implications [Risk, Cost, Resource] Target Date Measure Outcomes • Invite Board members to contribute to similar sessions/ workshops. • Out of touch, not doing what communities want. • Won’t see transformation of Health and Social Care services. • Lose trust of community. Costs • Costs associated with different engagement mechanisms. • Staff capacity to undertake this work. June 2023 – Invites sent to members. 6. Increase understanding of the outcomes that we are trying to achieve. • System-wide buy-in. IJB Members and HSCP December 2023 if current programme of work reviewed to allow time for this work to take place. June 2024 based on current work programme. (To be agreed). Number of services on- boarded to OutNav system. Page 215 of 256
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Improvement actions Lead Implications [Risk, Cost, Resource] Target Date Measure Outcomes 3. Consider how the IJB can further align resources to facilitate the desired shift to early intervention and prevention. 1. Identify and map areas where HSCP currently working in prevention and early intervention. Look to highlight existing good work and consider what resources are currently allocated here. This understanding should help reviewing performance and directions for next year. Public Health Consultant for Midlothian Risks • Raising expectations with the public. • Affordability and sustainability. • De-commissioning services can be very difficult with local interests in services. • If invest more money in this area, means less money for somewhere else. Need to acknowledge this is an intended choice and to map out any unintended impact. • Limited capacity. • Need budgeting over longer timescales to better plan. Need to lobby Scottish Government for a more sustainable Late Autumn 2023 (To be agreed) Report of output of the scoping and mapping of activity. Progress made in prevention and early intervention approaches that support work on inequalities. 2. Look to involve external partners to support work in this area, e.g., Third Sector, Public Health Scotland (PHS). Improvement Service (IS) to make PHS connections. Public Health Consultant for Midlothian / Barry McLeod (IS) (To be agreed) External support has been provided. 3. Develop meaningful definitions and scope of ‘prevention’ and ‘early intervention’ to better focus work in this area. Engage and link with Children Services and Children, Adolescent Mental Health Services (CAMHS) and Mental Health to raise awareness around early intervention and prevention and highlight existing good work in Public Health Consultant for Midlothian Ongoing Meaningful definitions developed. Page 216 of 256
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Improvement actions Lead Implications [Risk, Cost, Resource] Target Date Measure Outcomes this area. Look to raise these issues earlier in schools. budget stream to IJBs. Costs • The cost is time for services. • 4. Consider current approaches to eligibility criteria and what this means for staff interventions. Capacity permitting, consider possibility of looking at two existing projects and consider what options there are to intervene earlier. Look to engage with the Scottish Government around the output of this work. Chief Officer and Chair September 2023 (To be agreed) Movement nationally on eligibility criteria. 5. Examine what opportunities there are for shared working/services in prevention and early intervention with Community Planning Partners, East Lothian HSCP, Alcohol and Drug Partnerships, etc. Chief Officer Ongoing Demonstrated in performance reporting. Page 217 of 256
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Midlothian Integration Joint Board Thursday 24th August 2023, 14:00-16:00 IJB Performance Framework Executive summary The purpose of this report is to provide the IJB with an update of the Performance Framework for 2023-2024. A draft of the Midlothian IJB Performance Framework was provided to the Board for approval in March 2023. This paper sets out the detail of the how the performance framework has been updated to ensure it continues to meet the reporting requirements of the IJB. Measures are organised within the following key areas: • IJB Strategic Aims • Ministerial Steering Group Indicators • IJB Local Improvement Goal • IJB Directions (National Health and Wellbeing Outcomes). The Performance Framework has been updated following discussion of the new local Improvement Goal 2023-24. The Performance Framework is designed to inform half-year and year-end reporting for Directions for 2023-24. The evidence required to populate the Directions reports will be gathered by the Performance Team, and the data sources and HSCP governance (where appropriate) are detailed within the Framework. Members are asked to: • Note the updated Performance Framework. Item number: 5.9 Page 219 of 256
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Midlothian Integration Joint Board Midlothian Integration Joint Board IJB Performance Report 1 Purpose 1.1 The purpose of this report is to provide the IJB with an update of the Performance Framework for 2023-2024. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the updated Performance Framework. 3 Background and main report 3.1 A draft of the Midlothian IJB Performance Framework was provided to the Board for approval in March 2023. This paper sets out the detail of the how the performance framework has been updated to ensure it continues to meet the reporting requirements of the IJB. 3.2 There are a number of performance-related matters reserved for the Integration Joint Board: Performance Management 12.15 The Integration Joint Board shall approve the content, format, and frequency of performance reporting. 12.16 The Integration Joint Board shall approve its performance report for the reporting year. 3.3 There is a statutory duty on the IJB to report on performance: Integration authority: performance report (1) Each integration authority must prepare a performance report for the reporting year. (2) A performance report is a report setting out an assessment of performance during the reporting year to which it relates in planning and carrying out the integration functions for the area of the local authority. 3.4 The Performance Framework describes the measures, data sources and frequency for: Page 220 of 256
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Midlothian Integration Joint Board • IJB Strategic Aims • Ministerial Steering Group Indicators • IJB Local Improvement Goal • National Health and Wellbeing Outcomes • IJB Directions. 3.5 The Performance Framework has been updated following discussion of the new local Improvement Goal 2023-24. The local Improvement Goal is discussed in more detail in the IJB Performance Update for August 2023. 3.6 Following the Midlothian IJB meeting on 13th April 2023, the Performance, Assurance, and Governance Group (PAGG) was commissioned to consider a local improvement goal(s) for the IJB. 3.7 The group met and collaboratively produced one improvement goal with a number of proposed locally relevant process measures. The Goal, Outcome and Balancing Measures are detailed below: Goal: The balance of care from hospital to community-based care in Midlothian will have shifted by x% by March 2025 (percentage to be defined). Outcome Measure: % of shift from hospital to community-based care Balancing Measures: (quarterly from PHS) Our recommendation is to use the MSG indicators here as we already report on these. 3.8 The process measures need to be tested and refined as there are some technical information access issues to be resolved. The Performance Team will fully test the measures during August 2023 and provide an update, which will include a plan to resolve any outstanding data sharing challenges. 3.9 The Performance Framework is designed to inform half-year and year-end reporting for Directions for 2023-24. 3.10 The evidence required to populate the Directions reports will be gathered by the Performance Team, and the data sources and HSCP governance (where appropriate) are detailed within the Framework. 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. Page 221 of 256
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Midlothian Integration Joint Board 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. 5.3 There have been no revisions or new Directions during the current 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 some 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 Given the dependency on limited resources of partners within Midlothian Council and NHS Lothian in relation to data access, storage and governance, there is a risk that this work may not progress at an adequate pace and scale. 9 Involving people 9.1 The Performance Assurance & Governance Group (PAGG) meet monthly to review and discuss these measures as part of wider data assurance. 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 6th August 2023 Appendices: Appendix One: Midlothian IJB Performance Framework Page 222 of 256
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Midlothian Integration Joint Board Performance Framework 2023/24 Page 223 of 256
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Contents Measures IJB Strategic Aims Ministerial Steering Group Indicators IJB Local Improvement Goals IJB Directions (National Health and Wellbeing Outcomes) Page 224 of 256
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Midlothian IJB Strategic Aims 2023-24 Aim Data Source Frequency 1 Increase people’s support and opportunities to stay well, prevent ill or worsening health, and plan ahead. OutNav* Service outcome data** Annually & end of Strategic Plan period 2 Enable more people to get support, treatment and care in community and home-based settings. OutNav* Service outcome data** Annually & end of Strategic Plan period 3 Increase people’s choice and control over their support and services. OutNav* Service outcome data** Annually & end of Strategic Plan period 4 Support more people with rehabilitation and recovery OutNav* Service outcome data** Annually & end of Strategic Plan period 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. OutNav* Service outcome data** Annually & end of Strategic Plan period 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. OutNav* Service outcome data** Annually & end of Strategic Plan period *Aggregated OutNav data ** Not all services are currently using OutNav so local service outcome data will be used Page 225 of 256
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Ministerial Steering Group Indicators 2023-24 Measure Data Source Frequency Accident and Emergency Attendance Local Intelligence Support Team Release Quarterly Emergency admissions into hospital Local Intelligence Support Team Release Quarterly Number of unplanned hospital bed days: acute specialties (all ages) Local Intelligence Support Team Release Quarterly Number of unplanned geriatric long-stay beds (all ages) Local Intelligence Support Team Release Quarterly Number of unplanned mental health beds (all ages) Local Intelligence Support Team Release Quarterly Delayed Discharges Occupied Bed Days Local Intelligence Support Team Release Quarterly End of Life - Percentage of Last Six Months Spent in Large Hospitals Local Intelligence Support Team Release Annual Balance of Care - Percentage of 65+ Population Living at Home (supported and unsupported) Local Intelligence Support Team Release Annual Page 226 of 256
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Midlothian IJB Local Improvement Goals 2023-24 Improvement Goal The balance of care from hospital to community-based care in Midlothian will have shifted by x% by March 2025 (percentage to be defined). 2023/24 Outcome % of shift from hospital to community-based care Data Source Various TBC as per process measure testing August 2023 Frequency Collection: Monthly Reporting: as per IJB meeting schedule Balancing Measures MSG indicators (see previous page for definitions) Data Source Public Health Scotland (Local Intelligence Support Team) Frequency Quarterly Page 227 of 256
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National Health and Wellbeing Outcomes 2023-24 Outcome Data Source Frequency Health & Wellbeing: People are able to look after and improve their health and wellbeing and live in good health for longer Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual 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 Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Positive Experiences & Dignity: People who use health & social care services have positive experiences of those services, and have their dignity respected Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Quality of Life: Health & social care services help to maintain or improve the quality of life of people who use those. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Health Inequalities: Health & social care services contribute to reducing health inequalities. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Support for Carers: People who provide unpaid care are supported to look after their health and wellbeing. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Safe from Harm: People using health & social care services are safe from harm. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Page 228 of 256
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Workforce: Staff are engaged with their work and are supported to continuously improve the information, support, care and treatment they provide. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Use of Resources: Resources are used effectively and efficiently Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Page 229 of 256
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8 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. No Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 1.1 All services delegated to Midlothian IJB must demonstrate through service planning and reporting how they have increased collaborative and integrated working that improves population health and wellbeing, by January 2024. Midlothian HSCP will provide assurance on the content of Service Plans to support collaborative and integrated working to improve population health. By July 2023, Midlothian HSCP will provide assurance that the content of 100% of Service Plans supports collaborative and integrated working to improve population health. By January 2024, Midlothian HSCP will provide assurance that the content of 100% Service Reports includes evidence of collaborative and integrated working to improve population health. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Feedback from people who experience services Health & Care Experience Survey** 1.2 To support proactive population approaches to health, wellbeing and wellness, services should ensure service planning demonstrates reduced medicalisation of non-medical issues, by January 2024. Midlothian HSCP will provide assurance on the content of Service Plans to support reduced medicalisation of non-medical issues. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of Service Plans supports reduced medicalisation of non-medical issues. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Health & Care Experience Survey** Midlothian IJB Directions 2023-24 Page 230 of 256
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9 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. No Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 2.1 All services delegated to Midlothian IJB must evidence the connection with communities, partners, and use of technology to improve self management and self monitoring, by January 2024. Midlothian HSCP will provide assurance on the content of Service Reports to demonstrate connection with communities, partners, and use of technology to improve self management and self monitoring. The Digital Oversight Programme Board will provide assurance on progress towards its aims and objectives. By January 2024, Midlothian HSCP will provide assurance that the content of 100% Service Reports includes evidence of connection with communities, partners, and use of technology to improve self management and self monitoring. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Digital Oversight Programme Board Documentation Health & Care Experience Survey** 2.2 All services delegated to Midlothian IJB must ensure service planning describes a clear process to ensure fair access, by January 2024. Midlothian HSCP will provide assurance on actions as detailed in the Midlothian IJB Mainstreaming Equalities Report & Action Plan 2023-25. By January 2024, Midlothian HSCP will provide assurance of progress towards actions as detailed in the Midlothian IJB Mainstreaming Equalities Report & Action Plan 2023-25. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Health & Care Experience Survey** Tableau Waiting Time data (disaggregated by relevant demographic indicator) Page 231 of 256
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10 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected No Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 3.1 All services delegated to Midlothian IJB will contribute to the IJBs ability to describe activity, experience and outcomes. Services use and develop outcome mapping, by January 2024. Midlothian HSCP will provide assurance on the content of Service Plans to support the measurement of activity, experience and outcome. Midlothian HSCP will provide assurance on the content of Service Reports to demonstrate the development and use of outcome mapping. By July 2023, Midlothian HSCP will provide assurance that the content of 100% of Service Plans supports the measurement of activity, experience and outcome. By January 2024, Midlothian HSCP will provide assurance that the content of 100% Service Reports includes evidence of the development and use of outcome mapping. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) OutNav 3.2 All relevant services delegated to Midlothian IJB must develop and demonstrate an increase in the effective and proactive outreach to people living with frailty, by January 2024. Midlothian HSCP will provide assurance on the content of relevant Service Plans to support proactive outreach to people living with frailty. Midlothian HSCP will provide assurance on the content of Service Reports to By July 2023, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans supports support proactive outreach to people living with frailty. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Page 232 of 256
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11 demonstrate the proactive outreach to people living with frailty. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports includes evidence of evidence of proactive outreach to people living with frailty. 3.3 All services delegated to Midlothian IJB should review practices and further develop person-centred approaches to support recovery including The Midway and Good Conversations Approach, by January 2024. Midlothian HSCP will provide assurance on the content of Service Reports to demonstrate the review of practices and further developments in person-centred approaches to support recovery including The Midway and Good Conversations Approach. Midlothian HSCP will provide assurance on progress towards training the HSCP workforce in the Good Conversations Approach. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of Service Reports includes evidence of review of practices and further developments in person-centred approaches to support recovery including The Midway and Good Conversations Approach. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) HSCP Organisational Development records TURAS / MPM Personal Development Plans Page 233 of 256
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12 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. No Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 4.1 NHS Lothian and Midlothian Council must ensure accessible feedback mechanisms for all people and communities by January 2024 in order to develop innovative, integrated service offers and supports. Number of NHS Lothian feedback mechanisms meeting accessibility legislative requirements. Number of Midlothian Council feedback mechanisms meeting accessibility legislative requirements. By January 2024, all NHS Lothian feedback mechanisms meet accessibility legislative requirements. By January 2024, all Midlothian Council feedback mechanisms meet accessibility legislative requirements. Assessment of NHS Lothian feedback mechanisms against accessibility legislative requirements. Assessment of Midlothian Council feedback mechanisms against accessibility legislative requirements. OutNav Health & Care Experience Survey** 4.2 In order to maximise opportunities to improve personal outcomes, all services delegated to Midlothian IJB should ensure that the principles of self management are embedded in service delivery design, by January 2024. Midlothian HSCP will provide assurance on the content of relevant Service Plans to ensure that the principles of self management are embedded in service delivery design. Midlothian HSCP will provide assurance on the content of Service Reports to demonstrate evidence of the principles of self management being embedded in service delivery design. By July 2023, Midlothian HSCP will provide assurance that the content of 100% of Service Plans supports the principles of self management being embedded in service delivery design. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of Service Reports includes evidence of the principles of HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Page 234 of 256
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13 self management being embedded in service delivery design. 4.3 All relevant services delegated to Midlothian IJB should evidence how they are sharing information about Self Directed Support (SDS) options, and recording changes in uptake, by January 2024. Midlothian HSCP will provide assurance on the content of relevant Service Plans to support sharing information about Self Directed Support (SDS) options. Midlothian HSCP will provide assurance on the content of relevant Service Reports to demonstrate evidence of sharing information about Self Directed Support (SDS) options. Midlothian HSCP will provide assurance on the content of relevant Service Reports to demonstrate evidence of changes in uptake of Self Directed Support (SDS) options. By July 2023, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans support sharing information about Self Directed Support (SDS) options. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of sharing information about Self Directed Support (SDS) options. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of changes in uptake of Self Directed Support (SDS) options. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Finance data Page 235 of 256
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14 5 Health Inequalities Health & social care services contribute to reducing health inequalities. No Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 5.1 NHS Lothian and Midlothian Council must ensure that data can be disaggregated by HSCP area in order to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. This should include ensuring • systems and data have the capabilities to collect and filter data appropriately by HSCP area and by protected characteristics • health and social care workforce are suitably trained and skilled to gather and input this data, and • data quality assurance, by January 2025. Percentage of electronic systems that have capacity to record HSCP area and protected characteristics. Percentage of electronic systems that support extraction and disaggregation when reporting data. Percentage of health and social care workforce who are suitably trained and skilled to gather and input this data. Percentage of services with data quality assurance processes and structures in place. By January 2025, HSCPs have timely, credible, disaggregated data to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. By January 2025, Midlothian HSCP will provide assurance that 100% of the appropriate health and social care workforce are suitably trained and skilled to gather and input this data. By January 2025, Midlothian HSCP will provide assurance that 100% of services have data quality assurance processes and structures in place. This is new and will need to be designed with NHS Lothian and Midlothian Council. Page 236 of 256
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15 5.2 NHS Lothian and Midlothian Council must explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities by January 2024. Monitor activities of appropriate existing forum and / or establish short-life working group to explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities. The Digital Oversight Programme Board will provide assurance on progress towards its aims and objectives. By January 2024, a Joint Plan will be in place that describes the priority actions agreed between NHS Lothian and Midlothian Council. This should include, but not be limited to: Timeline Allocation of tasks Integrated Impact Assessment Stakeholder Engagement Governance structures (HSCP, NHS Lothian eHealth, Midlothian Digital Services). Audit of *agreed key meeting documentation, including but not limited to: Minutes Papers Action Plans Action Trackers Digital Oversight Programme Board Documentation Page 237 of 256
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16 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. No Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 6.1 All services delegated to Midlothian IJB that aim to move care from hospital to home should ensure service planning considers the impact of this on unpaid carers, and evidence appropriate supportive actions, by January 2024. Midlothian HSCP will provide assurance on the content of relevant Service Plans to support consideration of the impact on unpaid carers of the movement of care from hospital to home. Midlothian HSCP will provide assurance on the content of relevant Service Reports to demonstrate evidence of appropriate supportive actions. By July 2023, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans support consideration of the impact on unpaid carers of the movement of care from hospital to home. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans includes evidence of planned appropriate supportive actions. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Health and Care Experience Survey** 6.2 Explore and define the demand for and the benefit of a Midlothian Care and Support Co-operative in order to provide a platform that facilitates brokerage of personalised support for carers, identifies local assets, and enhances local economic value by January 2024. Key documentation completed, including but not limited to: Integrated Impact Assessment Stakeholder Engagement Options Appraisal Commissioning Plan. By January 2024, a Midlothian Care and Support Co-operative will be established. Reporting from successful commissioned organisation Health and Care Experience Survey** Page 238 of 256
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17 7 Safe from Harm People using health & social care services are safe from harm. No Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 7.1 All relevant services delegated to Midlothian IJB must explore and evaluate the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to a traditional referral pathways, by January 2024. Midlothian HSCP will provide assurance on the content of relevant Service Plans to support the exploration and evaluation of the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to a traditional referral pathways. By July 2023, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans support exploration and evaluation of the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to a traditional referral pathways. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) 7.2 Where there is a statutory responsibility to manage harmful behaviours, all services must communicate the impact of action taken to maximise people's safety in our communities, by January 2024. Midlothian HSCP will provide assurance on the content of relevant Service Reports that include evidence of the impact of action taken to maximise people's safety in our communities. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of the impact of action taken to maximise people's safety in our communities. HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Health and Care Experience Survey** Local Government Benchmarking Framework 7.3 Services should improve the people who use substances’ understanding of their rights and responsibilities in relation to supported self assessment and risk management, by January Midlothian HSCP will provide assurance on the content of relevant Service Plans to support improvements in the people who use substances’ understanding of their rights and responsibilities in relation to By July 2023, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans support improvements in the people who use substances’ understanding of their rights HSCP Service Plans & Reports (Governance provided by HSCP Finance & Performance) Page 239 of 256
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18 2024. Services should evaluate the relationship between this work and any reduction in harm or improvements in personal outcomes. supported self assessment and risk management. Midlothian HSCP will provide assurance on the content of relevant Service Reports that include evidence of improvements to the people who use substances’ understanding of their rights and responsibilities in relation to supported self assessment and risk management. Midlothian HSCP will provide assurance on the content of relevant Service Plans to support evaluation of the relationship between this work and any reduction in harm or improvements in personal outcomes. Midlothian HSCP will provide assurance on the content of relevant Service Reports that include evidence of evaluation of the relationship between this work and any reduction in harm or improvements in personal outcomes. and responsibilities in relation to supported self assessment and risk management. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence improvements to the people who use substances’ understanding of their rights and responsibilities in relation to supported self assessment and risk management. By July 2023, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans support evaluation of the relationship between this work and any reduction in harm or improvements in personal outcomes. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of the evaluation of the relationship between this work and any reduction in harm or improvements in personal outcomes. Feedback from people who experience services. OutNav Page 240 of 256
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19 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care and treatment they provide. No Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 8.1 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the integrated Midlothian HSCP Staff Engagement Plan 2023-24. Midlothian HSCP will provide assurance on the progress towards the objectives of the integrated Midlothian HSCP Staff Engagement Plan 2023-24. By January 2024, Midlothian HSCP will provide assurance that the HSCP Staff report increased levels of engagement with their work. By January 2024, Midlothian HSCP will provide assurance that the HSCP Staff report increased confidence in their abilities to continuously improve the information, support, care and treatment they provide. HSCP Workforce Governance Documentation HSCP Staff Engagement Plan Action Tracker iMatter Staff feedback Quality Improvement Team reports 8.2 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the Midlothian HSCP Integrated Workforce Plan 2022-25. Midlothian HSCP will provide assurance on the progress towards the objectives of the Midlothian HSCP Integrated Workforce Plan 2022-25 actions delivered. HSCP Workforce Governance Documentation HSCP Workforce Plan Action Tracker iMatter Staff feedback Page 241 of 256
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20 9 Use of Resources Resources are used effectively and efficiently. No Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 9.1 Maximise opportunities to work collaboratively across Lothian to design an approach and methodology to better understand and evidence the use of the set aside budget and associated services by HSCP area. This should include mechanism to better understand the impact of community prevention and early intervention activity across the whole system. NHS Finance colleagues attending *agreed key meetings, including but not limited to: Midlothian Integration Joint Board Strategic Planning Group Planning and Transformation HSCP Performance Leads Steering Group Relevant Service Working Groups. HSCPs are provided with consistent, clear information relating to the use of the set aside budget and associated services. HSCPs can provide consistent, clear information to demonstrate the impact of community prevention and early intervention activity across the whole system. Audit of *agreed key meeting documentation, including but not limited to: Minutes Papers Action Plans Action Trackers 9.2 All services delegated to Midlothian IJB must be able to demonstrate Best Value with evidence based data and meet cost efficiency targets in 2023- 24, 2024-25, and 2025-26. Midlothian HSCP will provide assurance on the content of Service Reports that include evidence of providing services in ways that achieve Best Value. Midlothian HSCP will provide assurance on the content of Service Reports that include evidence of meeting annual cost efficiency targets. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of Best Value. By year-end 2023-24, 2024-25, and 2025- 26, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of meeting annual cost efficiency targets. HSCP Service Reports (Governance provided by HSCP Finance & Performance) Financial Quarter and Year End Reports Page 242 of 256
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Midlothian Integration Joint Board Thursday 24th August 2023, 14:00-16:00 Annual Review of Midlothian Integration Joint Board Governance Requirements Executive summary This report sets out key action required to ensure the statutory governance requirements of Midlothian Integration joint Board are fulfilled. The additional pressures experience across health and social care from March 2020 resulted in some statutory governance requirements being paused or extension for completion. Midlothian Integration Joint Board continues to monitor governance arrangements, review, and update as required. Key areas for review in 2023/24 are: • Records Management Plan • Scheme of Publication • Risk Register Policy Board members are asked to: 1. Note the key areas of action. 2. Highlight any areas of concern and propose any required amendments. Item number: 5.10 Page 243 of 256
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Midlothian Integration Joint Board Midlothian Integration Joint Board Annual Review of Midlothian Integration Joint Board Governance Requirements 1 Purpose 1.1 This report sets out key action required to ensure the statutory governance requirements of Midlothian Integration joint Board are fulfilled. The additional pressures experience across health and social care from March 2020 resulted in some statutory governance requirements being paused or extension for completion. 1.2 Midlothian Integration Joint Board continues to monitor governance arrangements, review and update as required. 2 Recommendations 2.1 As a result of this report Members being asked to: - • Note the key areas of action. • Highlight any areas of concern and propose any required amendments. 3 Background and main report 3.1 Integration Joint Boards are public bodies and must ensure that arrangements are established to comply with their public body duties. The Public Bodies (Joint Working) (Scotland) Act 2014 includes duties to develop a Strategic Plan for integrated functions and budgets, prepare an Annual Performance Report and publish an annual Financial Statement. There are also duties placed on Integration Joint Boards by specific legislation as follows 3.1.1 Scheme of Integration The Public Bodies (Joint Working) (Scotland) Act 2014 sets out the statutory duty for health boards and local authorities to work together to provide integrated health and care and the requirement for both parties to jointly establish a Scheme of Integration. This NHS Lothian Midlothian Council scheme outlines the establishment, governance, scope, and operation of the Midlothian IJB. A new Midlothian Scheme of Integration was approved by Scottish Government on 15th May 2023. 3.1.2 Code of Corporate Governance The Board is responsible for ensuring that its business is conducted in accordance with the law and proper standards. This is to allow the public funds and the assets at its disposal to be safeguarded and used efficiently and effectively in pursuit of best value. Page 244 of 256
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Midlothian Integration Joint Board Furthermore, Board Members are responsible for the governance of the business affairs of the Board. This includes setting the strategic direction, vision, culture, and values of the Board and establishing appropriate and cost-effective systems, processes, and internal controls to allow the strategic objectives to be delivered. In April 2021, the Board approved the Midlothian Integration Joint Board Local Code of Corporate Governance based on the Delivering Good Governance in Local Government Framework 2016 published by the Chartered Institute of Public Finance and Accountancy (CIPFA) and the Society of Local Authority Chief Executives’ (SOLACE). There has been no change to the CIPFA guidance which underwrites the Code since the Midlothian Integration Joint Board Code was approved in 2021. While there is no immediate need to review this Code, it would be good practice to review and to ensure it is still relevant in practice. This will be led by internal audit in 2024/25. 3.1.3 Standing Orders The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 sets out the provisions which apply to the membership, proceedings, and operation of all Integration Joint Boards. The Board agreed Standing Orders to regulate the conduct and proceedings of meetings of the Board in terms of the above Order on 9th February 2023. 3.1.4 Register of Interest In accordance with the Ethical Standards in Public Life (Scotland) Act 2000 (Register of Interests) Regulations 2003, Board Members of devolved public bodies are required to give notice of their interests under the seven categories of renumeration; related undertakings; contracts; houses, land, and buildings; interest in shares and securities; gifts and hospitality; non- financial interests. All members of the IJB (voting and non-voting) are required to complete a declaration form. This is a living document and should be updated by Members as and when circumstances change. The acceptance of office and the disqualification statements equally do not have one specific date as they have been submitted by each Board Member as appropriate to individual circumstance. The Standards Officer will ensure all current members of Midlothian Integration Joint Board have signed a declaration form in relation to the Midlothian IJB Register of Interest and liaise with the Integration Manger to ensure that Scottish Government is informed of the location of these published records on the IJB pages of the website. 3.1.5 Code of Conduct The Ethical Standards in Public Life (Scotland) Act 2000 requires each Integration Joint Board to produce a Code of Conduct for members in line with the Model Code. Some members may have already signed similar codes of conduct i.e., Code of Conduct for Councillors; however, they are still required to sign the Integration Joint Board's code of conduct as their duties Page 245 of 256
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Midlothian Integration Joint Board as Integration Joint Board members should be independent of the responsibilities that they may have by virtue of other posts. Midlothian IJB reviewed and approved its revised Code of Conduct in 2022 on 16th June 2022. The Code of Conduct applies to all IJB members who are subject to the Code by virtue of their appointment. The standards officer will ensure that a declaration of acceptance of office is received from all members. 3.1.6 Scheme of Delegation Integration Joint Boards must appoint a Chief Officer and a Chief Finance Officer (Section 95 Officer). Other officers also carry out duties on behalf of the Board and should be detailed in the Scheme of Delegation. The Scheme of Delegation was included in the 2023 review of Standing Orders to help ensure sound decision-making, adequate control, and good governance. The Scheme sets out the powers and responsibilities of significance to the MIJB’s discharge of its statutory responsibilities which it has chosen to delegate to those officers. The Midlothian Scheme of Delegation currently details delegation to the Chief Officer, Chief Finance Officer, the Chief Internal Auditor, and the Standards Officer. Midlothian IJB also receives support from officers and employees of the Council and the Health Board, and the Board may wish to consider any further noted delegations that would assist in the smooth running of the Board. 3.1.7 Records Management The Public Records (Scotland) Act 2011 details the requirements of all public authorities in relation to records management. Under Section 1 Integration Joint Boards must prepare and implement a records management plan which sets out proper arrangements for the management of their records. The records management plan must be submitted for agreement by the Keeper of the Records of Scotland. The plan must account for all the public records for which the authority has responsibility. The plan must detail the functions of each authority and the types of records created in pursuance of these functions. It will show the policies and procedures in place for the appropriate storage, retention, disposal, archiving and security of these records. A senior officer of the Integration Joint Board will therefore be the Records Manager and responsible for overseeing the development and implementation of the records management plan and for approving it prior to submission for the Keeper's agreement. In Midlothian, this is the Executive Business Manager. This plan was last reviewed in 2017 and will be urgently reviewed by the Executive Business Manager and the Midlothian Audit and Risk Committee prior to Board review and submission to the Keeper of the Records of Scotland for consideration and approval. Page 246 of 256
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Midlothian Integration Joint Board 3.1.8 Scheme of Publication Section 23 of the Freedom of Information (Scotland) Act 2002 requires Integration Joint Boards to develop and put in place a publication scheme, along with a guide setting out what information it will make available. It is important that consideration is given to the publication scheme and associated guides to information to make clear how the Board intends to communicate with people and communities. The Board adopted the Scottish Information Commissioner’s Model Publication Scheme on 31 May 2017. The Model publication scheme was updated in 2018 and 2021 by the Scottish Information Commissioner should now be to be reviewed and updated. This should also include changes in the location of information on the Midlothian Council Website and the Boards ambitions to review and improve Community Engagement. The Executive Business Manager will review this Scheme and ensure any revisions to the Scheme of Publication must be approved by the Scottish Information Commissioner. This will be reviewed in 2023 via the Midlothian Audit and Risk Committee 3.1.9 Risk Register Policy Midlothian IJB Risk Register Policy was last reviewed in 2016. This will be reviewed in 2023 by the Executive Business Manager and subsequently the Midlothian Audit and Risk Committee. 4 Policy Implications 4.1 Implementation, updating and maintenance of the above IJB governance is a statutory requirement. 5 Directions 5.1 There are no implications for Directions arising from this report. 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. 8 Risk 8.1 These tasks are required to support the proper governance of Midlothian IJB. Page 247 of 256
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Midlothian Integration Joint Board 9 Involving people 9.1 The IJB’s meetings are public, and all of its papers are available on the internet. 10 Background Papers 10.1 No background papers. AUTHOR’S NAME & DESIGNATION Gill Main, Integration Manager Alan Turpie, Standards Officer CONTACT INFO Via email or MS Teams DATE 03/08/2023 Appendices: N/A Page 248 of 256
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Midlothian Integration Joint Board Thursday, 24th August, 14:00-16:00 Midlothian Integrated Joint Board Strategic Commissioning Plan 2025-28 Development Timeline Executive summary In order to meet the legal requirements of the Public Bodies (Joint Working) (Scotland) Act 2014, Midlothian Integration Joint Board is required to develop, consult on, and publish a new Strategic Commissioning Plan in 2025. In line with the requirements of the Act, Midlothian Integration Joint Boards must set out its strategic ambitions to see progress for the Communities of Midlothian towards achieving the 9 National Health and Wellbeing Outcomes. This should include the arrangements for the delegated services over the period of the plan. The proposed timeline for the development of the Strategic Commissioning Plan for 2025- 28 is set out in appendix 1. This plan details the action and proposed support from officers of Midlothian Health and Social Care Partnership (HSCP) Planning, Performance and Programme Team to lead a series of consultation and feedback exercises with Board Members, services, partners, community groups, people, their families and carers between August 2023 and February 2025. Members are asked to: • Note the proposed development timeline of the Midlothian Integration Joint Board (IJB) Strategic Commissioning Plan for 2025/28 (appendix 1). • Support the invitation to and participate in workshops, consultation exercises, and feedback. # Item number: 5.11 Page 249 of 256
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian Integrated Joint Board Strategic Commissioning Plan 2025-28 Development Timeline 1 Purpose 1.1 This report sets out the proposed timeline for the development of the Midlothian Integration Joint Board (IJB) Strategic Commissioning Plan for 2025/28. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the proposed development timeline of the Midlothian Integration Joint Board (IJB) Strategic Commissioning Plan for 2025/28 (appendix 1). • Support the invitation to and participate in workshops, consultation exercises, and feedback. 3 Background and main report 3.1 In order to meet the legal requirements of the Public Bodies (Joint Working) (Scotland) Act 2014, the Midlothian Integration Joint Board (IJB) is required to develop, consult on, and publish a new Strategic Plan in 2022. 3.2 In line with the requirements of the act the plan must: • set out the arrangements for delivering the integration functions of the delegated services over the period of the plan, • set out how those arrangements are intended to achieve, or contribute to achieving, the 9 National Health and Wellbeing Outcomes, • include any other information the IJB considers to be relevant. 3.3 Section 33 of the Act, and the Statutory Government Guidance on Strategic Commissioning Plans, also places a duty on Midlothian Integration Joint Board (IJB to undertake a wide and varied engagement in the development of the plan and publish a statement on the consultation undertaken at the same time as the publication of the Strategic Commissioning Plan. 3.4 The proposed timeline for the development of the Strategic Commissioning Plan for 2025-28 is set out in appendix 1. This plan details the action and proposed support from officers of Midlothian Health and Social Care Partnership (HSCP) Planning, Performance and Programme Team to lead a series of consultation and feedback exercises with Board Members, services, partners, community groups, people, their families and carers between August 2023 and February 2025. Page 250 of 256
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Midlothian Integration Joint Board 4 Policy Implications 4.1 There are no direct policy implications as a result of this report. However, the new Strategic Commissioning Plan 2025-28 will influence all service delivery, redesign, and commissioning and may result in the future review of operational policy within the HSCP. 5 Directions 5.1 This report does not • directly impact upon service ability to deliver an existing Direction, • raise the need to bring suggested revisions or discuss operational implications for an existing Direction, or • highlight the potential requirement for a new Direction that should be brought to the Strategic Planning Group (SPG) 5.2 However, it should be noted that the new Strategic Commissioning Plan 2025/28 will be the foundation of all future Directions. 5.3 The Directions issued to NHS Lothian and Midlothian Council for 2025/26 will align with the Strategic Plan 2025/28. 6 Equalities Implications 6.1 This report does not • have direct implication for groups of people with protected characteristics, or • result in the requirement for Midlothian Integration Joint Board (IJB) to revise or develop new strategies, policies and plans, provisions, practices, and activities at this time. 7 Resource Implications 7.1 Budgetary pressures across the coming months may impact on Midlothian Integration Joint Boards (IJBs) strategic aspirations and/or the future financial allocation to service areas. 7.2 Financial resource will be aligned with the intention of progressing the ambitions of the new Strategic Commissioning Plan 2025/28. This will require alignment to the principles of integration, and ‘Best Value’ with evidence-based data. 8 Risk 8.1 A Strategic Commissioning Plan that does not consider the strengths and opportunities with the wider system risks being ineffective and out of touch with local priorities or local service delivery capacity. Page 251 of 256
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Midlothian Integration Joint Board 8.2 In additional to engagement with people and communities, the operational, financial, and strategic assurance from Midlothian Health and Social Care Partnership (HSCP) services will inform the decision making of Midlothian Integration Joint Board (IJB) in relation to strategic focus and priority areas for transformation. 8.3 The ability of Midlothian Integration Joint Board (IJB) to confidently assess whether the new Strategic Commissioning Plan can be appropriately FAST (Frequently discussed, Ambitious scope, Specific milestones, and Transparent) relies on the ability of Midlothian Health and Social Care Partnership (HSCP) services to clearly articulate operational information. 9 Involving people 9.1 Midlothian Integration Joint Board will ensure a wide range of stakeholders are invited to contributed to the development of the plan. This will be described and detailed in Consultation Report 10 Background Papers 10.1 No background papers. AUTHOR’S NAME Gill Main DESIGNATION Integration Manager CONTACT INFO Via MS Teams or email DATE 26/06/2023 Appendices: Appendix One: MIJB Strategic Commissioning Plan 2025-28 Timeline Page 252 of 256
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Midlothian Integration Joint Board Appendix 1: Strategic Commissioning Plan Timeline Page 253 of 256
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HSCP Consultation with HSCP, Partners, & Community Groups Writing Group Planning July 23 Aug 23 Nov23 Jan 24 May 24 Sept 24 Dec 24 Feb 25 April 25 IJB Approve SCP SCP 2022-25 Published SPG Note Planning Schedule Writing Group Produce 1st Draft Writing Group Produce 2nd Draft SCP 2025-28 Planning Timeline HSCP SMT review HSCP Feedback from HSCP, Partners, & Community Groups SPG Review Draft Stakeholder Consultation 1 What is the change we want to see? How should we tackle this? IJB Reviews 1st Draft SPG Workshop SMT Note Planning Schedule Writing Group Revisions IJB Workshop Stakeholder Consultation 2 How do we articulate the change? Public Consultation 1 Does this reflect the future you want to see? Writing Group Revisions IJB Reviews 2nd Draft SPG Review Revisions SPG Workshop SPG Review Revisions HSCP SMT review Public Consultation 2 IJB Workshop IJB Note Planning Schedule Community Planning Partnership Consultation IJB Public Engagement Statement Published HSCP SMT review HSCP Comms Events Page 255 of 256
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