Integration Joint Board
Meeting
NORTH AYRSHIRE
Health and Social Care
Partnership
Thursday, 24 October 2019 at 10:00
Council Chambers
Ground Floor, Cunninghame House, Irvine, KA12 SEE
1 Apologies
2 Declarations of Interest
Members are requested to give notice of any declarations of interest in
respect of items of business on the Agenda.
3 Minutes and Action Note
The accuracy of the minutes of the meeting held on 26 September 2019
will be confirmed and the Minutes signed in accordance with Paragraph 7
(1) of Schedule 7 of the Local Government (Scotland) Act 1973 (copy
enclosed).
3.1 Matters Arising
Consider any matters arising from the minutes of the previous meeting.
Quality and Performance
4 Director's Report
Submit report by Stephen Brown, Director (NAHSCP) on developments
within the North Ayrshire Health and Social Care Partnership (copy
enclosed).
5 Alcohol and Drug Partnership Annual Report
Submit report by Paul Main, Independent Chair (ADP) on the annual
report submitted to the Scottish Government as part of local reporting
arrangements with the Alcohol and Drug Partnership (ADP) (copy
enclosed).
1
6 Alcohol and Drug Partnership Strategy
Submit report by Paul Main, Independent Chair (ADP) on the new Alcohol
and Drug Partnership (ADP) Strategy (copy enclosed).
7 Preventing Drug Related Deaths: An Update from 2018
Submit report by Paul Main, Independent Chair (ADP) on the actions
taken by the North Ayrshire Drug Death Prevention Group (DDPG) (copy
enclosed).
Strategy and Policy
8 Carers Short Breaks Statement
Submit report by Kimberley Mroz, Project Manager on the Carers Short
Breaks Statement (copy enclosed).
9 Community Care Occupational Therapy
Submit report by Alistair Reid, Lead Allied Health Professional and Helen
McArthur, Principal Manager on Community Care Occupational Therapy
(copy enclosed).
10 Caring for Ayrshire: Project initiation Document
Submit report by Stephen Brown, Director (NAHSCP) on the Caring for
Ayrshire - Project Initiation Document (copy enclosed).
11 Enhanced intermediate Care and Rehabilitation Services
Submit report by Alistair Reid, Lead Allied Health Professional Adviser on
Enhanced Intermediate Care and Rehabilitation Services (copy enclosed).
Budget
12 Reserves Policy
Submit report by Caroline Cameron, Chief Finance & Transformation Officer
on the updated Partnership Reserves Policy (copy enclosed).
13 Financial Monitoring Report
Submit report by Caroline Cameron, Chief Finance and Transformation
Officer on the Health and Social Care Partnership's financial performance to
August 2019 (copy enclosed).
14 Urgent items
Any other items which the Chair considers to be urgent.
2
Webcasting
Please note: this meeting may be filmed for live and subsequent broadcast
via the Council’s internet site. At the start of the meeting, the Chair will
confirm if all or part of the meeting is being filmed.
You should be aware that the Council is a Data Controller under the Data
Protection Act 1998. Data collected during the webcast will be retained in
accordance with the Council’s published policy, including, but not limited to,
for the purpose of keeping historical records and making those records
available via the Council’s internet site.
Generally, the press and public seating areas will not be filmed. However,
by entering the Council Chambers and using the press or public seating area,
you are consenting to being filmed and consenting to the use and storage of
those images and sound recordings and any information pertaining to you
contained in them for webcasting or training purposes and for the purpose of
keeping historical records and making those records available to the public.
If you have any queries regarding this and, in particular, if you believe that
use and/or storage of any particular information would cause, or be likely to
cause, substantial damage or distress to any individual, please contact
committeeservices@north-ayrshire.gov.uk.
3
Integration Joint Board
Sederunt
Voting Members
Councillor Robert Foster (Chair) North Ayrshire Council
Bob Martin (Vice-Chair) NHS Ayrshire & Arran
Councillor Timothy Billings
Jean Ford
Councillor Anthea Dickson
John Rainey
Adrian Carragher
Councillor John Sweeney
North Ayrshire Council
NFIS Ayrshire and Arran
North Ayrshire Council
NFIS Ayrshire and Arran
NFIS Ayrshire and Arran
North Ayrshire Council
Professional Advisors
Stephen Brown
Caroline Whyte
Dr. Paul Kerr
David MacRitchie
Dr. Calum Morrison
Alistair Reid
David Thomson
Dr Louise Wilson
Stakeholder Representatives
David Donaghey
Louise McDaid
Marie McWaters
Graham Searle
Sam Falconer
Fiona Thomson
Clive Shephard
Nigel Wanless
Val Allen
Vicki Yuill
Vacancy
Janet McKay
Director North Ayrshire Health and Social Care
Chief Finance and Transformation Officer
Clinical Director
Chief Social Work Officer - North Ayrshire
Acute Services Representative
Lead Allied Health Professional Adviser
Associate Nurse Director/IJB Lead Nurse
GP Representative
Staff Representative - NHS Ayrshire and Arran
Staff Representative - North Ayrshire
Carers Representative
Carers Representative (Depute for Marie McWaters)
(Chair) IJB Kilwinning Locality Forum
Service User Representative
Service User Rep (Depute for Fiona Thomson)
Independent Sector Representative
Independent Sector Rep (Depute for Nigel Wanless)
Third Sector Representative
(Chair) IJB Irvine Locality Forum
(Chair) Garnock Valley Locality Forum
4
Agenda Item 3
NORTH AYRSHIRE
Health and Social Care
Partnership
North Ayrshire Health and Social Care Partnership
Minute of Integration Joint Board meeting held on
Thursday 26 September 2019 at 10 a.m.
Present
Councillor Robert Foster, North Ayrshire Council (Chair)
Bob Martin, NHS Ayrshire and Arran (Vice-Chair)
Councillor Timothy Billings, North Ayrshire Council
Councillor Anthea Dickson, North Ayrshire Council
John Rainey, NHS Ayrshire and Arran
Adrian Carragher, NHS Ayrshire and Arran
Stephen Brown, Director of Health and Social Care Partnership
Caroline Whyte, Chief Finance and Transformation Officer
David Donaghey, Staff Representative (NHS Ayrshire and Arran)
Louise McDaid, Staff Representative (North Ayrshire Council)
Graham Searle, Carers Representative (Depute for Marie McWaters)
Fiona Thomson, Service User Representative
Nigel Wanless, Independent Sector Representative
Val Allen, Independent Sector Representative
Vicki Yuill, Third Sector Representative
In Attendance
Thelma Bowers, Head of Mental Health
Alison Sutherland, Head of Service (Children, Families and Criminal Justice)
Janet Davies, IJB Professional Lead for Psychology
Helen McArthur, Principal Manager (Health and Community Care Services)
Karen Andrews, Team Manager (Governance)
Angela Little, Committee Services Officer
Apologies for Absence
Councillor John Sweeney, North Ayrshire Council
Dr Paul Kerr, Clinical Director
Alistair Reid, Lead Allied Health Professional Adviser
Dr. Louise Wilson, GP Representative
Dr Callum Morrison, Acute Services Representative
Jean Ford, NHS Ayrshire and Arran
David MacRitchie, Chief Social Work Officer
Marie McWaters, Carers Representative
Janet McKay, Chair, Garnock Valley HSCP Locality Forum
5
1. Welcome
The Chair welcomed Alison Sutherland, Head of Service (Children, Families and
Criminal Justice) and Val Allen, Independent Sector Representative to the Integration
Joint Board.
2. Declarations of Interest
In terms of Standing Order 7.2 and Section 5.14 of the Code of Conduct for Members
of Devolved Public Bodies there were no formal declarations of interest.
3. Minutes/Action Note
The accuracy of the Minute of the meeting held on 29 August 2019 was confirmed
and the Minute signed in accordance with Paragraph 7 (1) of Schedule 7 of the Local
Government (Scotland) Act 1973.
3.1 Matters Arising
The Board noted that all matters arising are on track for completion by the
appropriate timescales.
4. Psychological Services: Waiting Times
Submitted report by Janet Davis, IJB Professional Lead for Psychology on the
improvement plans, trajectories and progress against the Scottish Government
Waiting Time Standard for Psychological Services, as detailed at Appendix 1 to the
report. Appendix 2 provided a wider data set that reflected progress in activity,
longest waits and the number of people waiting more than 18 weeks for access to
psychological therapies.
The presentation provided information on:-
• The waiting times standard and the background to the psychological therapy
waiting times standard;
• Update on progress, including compliance levels across services and
benchmarking against other Health Boards;
• Highlights in respect of recruitment, pan-Ayrshire multi-disciplinary
Psychological Interventions Governance and Training Group, Service
developments and developments in data systems; and
• Risks which include specialist Psychological resource, full impact of additional
permanently funded posts limited by vacancies, maternity leave, difficulty
recruiting to fixed terms cover and sustainability of the SG/NES funding stream
if the SG do not commit to permanently;
• Capacity in the wider workforce such as limitations in release of staff for
training, protected time for delivery of psychological work post-training and
erosion of impact of training;
• Data systems - limited provision of accessible and accurate demand capacity
data to inform on waiting time queues and workforce planning for all levels of
psychological work.
6
Members asked questions and were provided with further information in reiation to:-
• Recognition by the Scottish Government that the data systems do not aiiow
for the coiiection of the appropriate data to provide accessibie and accurate
demand capacity data to inform on waiting time queues and workforce
pianning;
• Work by the NHS and the Council to address the issues within the data
systems that can be changed at a iocai ievel and the investment of additionai
resources to deai with waiting times;
• No issues in filling permanent posts in Ayrshire and Arran, despite difficuities
in recruiting nationaiiy and to fixed term posts;
• The similar waiting times being experienced by other Heaith Boards, who
therefore have no capacity to assist neighbouring Heaith Boards;
• The deveiopment of a Waiting Time Initiative, as a short-term solution, to
examine the whole Partnership resource and target the longest wait across
the Partnership
• CAMHS as the first point of contact and the distress intervention modei that
is available in some areas;
• The Locaiity Partnerships that have identified mental health as one of their
priorities;
• Good work that is being done by the Third and voiuntary sectors; and
• That stress leveis of staff are not currently being monitored.
Fiona Thomson ieft the meeting during this item.
The Board agreed (a) that the Director (NAHSCP) contact the Fiona Thomson to
discuss her views and concerns reiating to Psychologicai Services; and (b) to note
the very informative and interesting presentation.
5. Director’s Report
Submitted report by Stephen Brown, Director (NAHSCP) on deveiopments within
the North Ayrshire Heaith and Social Care Partnership.
The report highlighted the foiiowing work that has been undertaken
• Consuitation on the Independent Review of Learning Disability and Autism in
the Mentai Health Act;
• The Scottish Government’s Programme for Government which sets out a
number of commitments aimed at improving the lives of care experienced
people;
• The Service User Invoivement Initiative that wiii be launched by Community
Justice Ayrshire;
• The ground-breaking ceremony that took piace on 16 September 2019 for an
Additionai Support Needs Schooi and Respite and Residentiai facility for
chiidren and young peopie;
7
• Partnership working between services who deliver group care settings for
older people and the creation of an Intergenerational Working Case Study
bookiet that provides exampies of intergenerational working across North
Ayrshire;
• Digital Resource for Carers; and
• Community Eating Disorder Service.
The Board noted the ongoing deveiopments within the North Ayrshire Health and
Social Care Partnership.
6. Community Alarm/Telecare Services Transition from Analogue to Digital
Submitted report by Heien McArthur, Principai Manager on the transition from
analogue to digital service internet protocol (IP). Telecommunication providers will
terminate the current anaiogue system and replace it with a digitai internet protocoi
(IP) from 2025. Users will require to have digitai phone iines in order to access the
community aiarm and teiecare technology that assists them to remain independent
in their own homes.
Members asked questions and were provided with further information in relation to:-
• Future funding pians that will require to be put in place to meet the costs of
replacing the analogue system with a digitai internet protocoi; and
• Unknown factors in terms of the total costs to users and the Council, whether
the telecoms companies should contribute to the costs of replacing existing
equipment and if there wili be operationai or financiai benefits of the new
system.
The Board agreed to (a) receive an update report to a future meeting; and (b) note
the report.
7. Carers Respite Break Statement
The Director of the North Ayrshire Heaith and Social Care Partnership advised that
some further work was required on the Cares Respite Break Statement and the report
wouid be considered at the next meeting of the IJB.
Noted.
9. Budget Monitoring Report - July 2019
Submitted report by Caroiine Whyte, Chief Finance and Transformation Officer on
the projected year-end outturn for the financial year as at July 2019, including
commitments against the available resource, explanations for the main budget
variances, an update on progress in terms of savings delivery and actions required
to work towards financiai balance.
8
Appendix A to the report provided the financial overview of the partnership position,
with detailed analysis provided in Appendix B. Details of the savings plan were
provided at Appendix C. Appendix D outlined the financial recovery plan to bring
overall service delivery back into line with the available resource and Appendix E
highlighted the movement in the overall budget position for the partnership and
budget reductions requiring approval.
Members asked questions and were provided with further information in relation to:-
• Purchased hours for care at home that are stopped when a service user is in
hospital and in-house hours that are re-directed and used elsewhere; and
• Additional hours required to cover a service handed back to the Council by a
provider experiencing staff shortages.
The Board agreed to (a) note the projected year-end overspend of £1.997m; (b)
approve the financial recovery plan, as detailed in Appendix D to the report; (c)
approve the changes in funding as detailed in Section 2.11 and Appendix E of the
report; and (d) note the potential impact of the Lead Partnerships.
11. Strategic Planning Group Minutes
Submitted the Minutes of the Strategic Planning Group meeting held on 29 May 2019.
The Board was advised of a bespoke Mental Health Programme set up by a pupil at
Largs Academy, who has secured funding to create a tailored programme to provide
training for school staff and parent workshops.
Noted.
12. IJB Performance and Audit Committee Minutes
Submitted the Minutes of the IJB Performance and Audit Committee meeting held on
27 June 2019, that were in draft form and would be approved at the next meeting.
The Board was advised that the Internal Audit of the Lead Partnership Arrangements
had found high priority actions around consistency. The Internal Audit Plan for
2019/20 had been agreed and would include an audit of performance management
arrangements within the IJB.
Noted.
The Meeting ended at 11.20 a.m.
9
NORTH AYRSHIRE
Health and Social Care
Partnership
North Ayrshire Integration Joint Board - Action Note
Updated following the meeting on 26 September 2019
No.
Agenda Item
Date of
Meeting
Action
Status
Status
Date
Officer
1.
Veterans First Point (VIP)
Service
21/3/19
That an update report on the
long-term sustainability plan be
submitted to the IJB Meeting on
29 August 2019.
Ongoing - plan to report
to the October meeting
October
2019
Thelma
Bowers
2.
Community Care Occupational
Therapy Report
21/3/19
That an update report on
progress be submitted to the IJB
Meeting on 24 October 2019.
Ongoing - plan to report
to the October meeting
October
2019
Alistair Reid
3.
Ministerial Strategic Group
Review of Progress with
integration of Health and Social
Care: Self-Evaluation
16/5/19
That an overall progress update
be submitted to a future meeting
in 2019.
Ongoing - plan to report
to the December
meeting
December
2019
Caroline
Whyte
4.
Community Alarm/Telecare
Services Transition from
Analogue to Digital
26/9/19
That an update report on
progress be submitted to a
future meeting.
Ongoing
TBC
Helen
McArthur
5.
Carers Respite Break Statement
26/9/19
A revised report to be submitted
to the October meeting.
Report to October
meeting
October
2019
Kimberley
Mroz
Thursday, 03 October 2019
10
Agenda Item 4
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
24th October 2019
Subject:
Director’s Report
Purpose:
To advise members of the North Ayrshire Integration Joint Board
(IJB) of developments within the North Ayrshire Heaith and Sociai
Care Partnership (NAHSCP).
Recommendation: That members of IJB note progress made to date.
Glossary of Terms
NHS AA
NHS Ayrshire and Arran
HSCP
Heaith and Social Care Partnership
1.
EXECUTIVE SUMMARY
1.1
This report informs members of the Integration Joint Board (IJB) of the work
undertaken within the North Ayrshire Heaith and Social Care Partnership (NAHSCP)
nationally, locally and Ayrshire wide.
2.
CURRENT POSITION
National Developments
Consultations
2.1
Draft Carers Strateoic Policy Statement Consultation
The Scottish Government has issued a consultation on the Draft Carers Strategic
Policy Statement Consultation which is open from 30'^ September 2019 to 13**^
December 2019. The consultation can be accessed through the following link :
httDs://www.aov.scot/Dublications/carers-strateaic-Dolicv-statement-draft-
consultation/
The Carers Strategic Policy Statement is intended to assist local and national strategic
planning and policy development in the statutory, independent and third sector to
understand the existing national policies and approaches in place to support unpaid
carers in Scotland.
11
2.2
Call for Evidence : Independent Review into the Delivery of Forensic Mental Health
Services
The Scottish Government have commissioned a review of forensic mental health
services in Scotland to enable these to be delivered as effectively as possible. The
principal aim is to review the delivery of forensic mental health services in hospitals,
prisons and the community.
Derek Barron, Chair of the Independent Review into Delivery of Forensic Mental
Health Services, has invited NHS Ayrshire and Arran to provide evidence to the
Review by 15*^ November 2019.
2.3
Named Person Service
On 1®' September John Swinney, Depute First Minister (DFM), announced that the
Scottish Government would no longer pursue legislation to make the provision of a
named person for every child a statutory entitlement. However, this does not mean
that the named person policy has been scrapped. Children In North Ayrshire are
benefitting from a key point of contact who can offer help and support to children and
families when they need it.
The DFM’s announcement should have little Impact on the functions of the current
Named Person Service in North Ayrshire, or the processes that have been developed,
or the support given to children and their parents. Even though the legislation was
never enacted, North Ayrshire Health & Social Care Partnership and Education made
the decision to take forward the role of the Named Person and the Named Person
service in line with its Getting it Right for Every Child policy. North Ayrshire will
continue to ensure the named person role and named person service is being
delivered in line with existing laws and guidance on data protection, confidentiality,
human rights and other relevant rules of law.
Whilst we will need to review terminology we continue to be committed to the principles
of Getting it Right for Every Child and the delivery of a high quality service supporting
children, young people and families.
We will review the functions, processes and governance of the Named Person Service
and the documentation, processes and procedures around the named person. This
review of current local processes and the assurance that they remain compliant with
all existing legislation will be led through the Children’s Services Strategic Partnership.
2.4
Health and Care Experience Survey 2019-20
The Health and Care Experience survey is beinq issued this month. This is a kev part
of the Scottish Care Experience Survey Programme, a suite of national surveys which
provide local and national Information on the quality of health and care services from
the perspective of those using them.
As with previous surveys, the Health and Care Experience survey 2019-20 captures
experiences of accessing and using GP practice and Out of Hours services, aspects
of care and support, and caring responsibilities and related support. The survey
informs a number of the core intearation indicators aimed at measurina proaress
towards our national health and wellbeing outcomes.
12
The survey will be sent to a sample of people who are registered with a GP
practice. The last survey attracted over 130,000 responses, which enabled analysis
and reporting at National, Local Authority, Partnership, GP cluster and GP practice
level. A summary of the findings from the 2017-8 survey is available here .
Given this is a key data source for better understanding person-centred care and the
experience of using services this will be shared across the Partnership, and also
through broader networks where possible.
Ayrshire Wide Developments
Prevention, Early Intervention and Recovery Service (PEAR)
North Ayrshire Alcohol and Drug Partnership is pleased to announce the launch of a
newly commissioned service. PEAR (Prevention, Early Intervention and Recovery)
will be available to all people living in North Ayrshire who feel they require support for
themselves and / or their families, in relation to alcohol and drugs.
The new service will be run by Turning Point Scotland and many staff employed will
have “lived experience” of alcohol or drugs, which will enhance the delivery of the
service.
The aim of the new service is to support individuals who are at risk of, or active in,
problematic drug or alcohol use. It will offer psycho-social support in a trauma
informed way to individuals not requiring medical interventions, offering brief
interventions, one to one, group work and alternative therapies.
Staff are encouraged to make referrals and the attached form will enable anyone to
do this. Staff are welcome to visit the service to fully experience the range of services
on offer or contact the service for further information. The attached poster provides
more information on PEAR and the services they will provide, as well as how to get in
touch.
w
—
w
leaflet (poster Turning Point
version).docx Scotland Referral.de
New App for Addiction Services
NHS Ayrshire and Arran has developed an app which provides
you with all the Information you might need to seek help for
yourself or someone you know who has a drug or alcohol
addiction. If you or someone you know needs Information or
support about drugs or alcohol but find it hard to speak about
this, this free app can help.
At the moment the app has been populated with mainly North
Ayrshire addiction related information. Stage 2 will be developed
and rolled out to East and South Ayrshire over the coming
months.
Ayrshire
& Arran
til to^l****
13
2.7
16 Days of Action Campaian
During the 16 Days of Action Campaign Community Justice Ayrshire and members
of East, North and South Ayrshire Violence Against Women Partnerships are hosting
a pan-Ayrshire gender based violence conference on Friday 29 November 2019 at a
venue in Ayr. The conference will explore various forms of gender based violence
across the life course. The conference Is primarily aimed at front line practitioners
and we would welcome delegates from across a variety of disciplines within statutory
and third sector agencies.
Planning for the event is well underway and we are delighted to have some eminent
speakers coming along to the conference:
• Dr Marsha Scott (Scottish Women’s Aid)
• Fiona Drouet (#EmilyTest)
• Jasvinder Sanghera (Forced Marriage and Flonour Based Abuse)
• Det Supt Gordon McCreadie (Police Scotland)
Other speakers are still to be confirmed. In addition, there will also be a variety of
workshops on the day which will showcase some of the fantastic work taking place
across Ayrshire to tackle different forms of gender based violence.
North Ayrshire Developments
2.8
North Ayrshire Child Protection Committee Newsletter - 1^ Issue
Please see link to the first Child Protection Committee newsletter! These will be
released quarterly and will provide information to workers across North Ayrshire
regarding news and activity within North Ayrshire Child Protection Committee
httD://childorotectionnorthavrshire.info/cDc/media/2014/03/CPC-Newsletter-ISSUE-1-
SeD-2019.Ddf
2.9
Thinkina Different, Doina Better Experience
Over 1000 staff across the partnership have attended the FISCP Thinking Different,
Doing Better experience. The next step is to open the doors to communities to
offer them the opportunity to go through the experience.
Three community sessions have been arranged during October and community
groups and individuals will be encouraged to book a place on these sessions via the
links below
14th October 2om - 4.30 pm
https://www.eventbrite.co.uk/e/copv-of-thinkina-different-doina-better-the-north-
avrshire-hsco-exoerience-tickets-73271855091
18th October 9-11.30am
https://www.eventbrite.co.uk/e/thinkina-different-doina-better-the-north-avrshire-
hscp-experience-tickets-73272342549
23rd October 2-4.30om
https://www.eventbrite.co.uk/e/thinkina-different-doina-better-the-north-avrshire-
hscp-experience-tickets-73272783869
3.
PROPOSALS
14
3.1
Anticipated Outcomes
Not applicable.
3.2
Measurinq Impact
Not applicable
4.
IMPLICATIONS
Financial:
None
Human Resources:
None
Legal:
None
Equality:
None
Children and Young People
None
Environmental & Sustainability:
None
Key Priorities:
N/A
Risk Impiications:
N/A
Community Benefits:
N/A
Direction Required to
Direction to
Council, Health Board or
1. No Direction Required
V
Both
2. North Ayrshire Council
3. NHS Ayrshire & Arran
4. North Ayrshire Council and NHS Ayrshire & Arran
4.
CONSULTATION
4.1
No specific consultation was required for this report. User and public involvement is
key for the partnership and all significant proposals will be subject to an appropriate
level of consultation.
5.
CONCLUSION
5.1
Members of IJB are asked to note the ongoing developments within the North Ayrshire
Health and Social Care Partnership.
For more information piease contact Stephen Brown, Director/Chief Officer on 01294
317723 or sbrown(5)north-avrshire.qcsx.qov.uk
15
Agenda Item 5
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
_ 24 October 2019
Subject: Alcohol and Drug Partnership Annual Report 2018-
_2019_
Purpose: To brief the IJB on the annual report submitted to the Scottish
Government as part of local reporting arrangements with the Alcohol
_ and Drug Partnership (ADP). _
Recommendation: To take cognizance of the reporting and outcomes in relation to the
ministerial priorities, updates, and future planning which will assist
in shaping the upcoming new ADP strategy.
Glossary of Terms
ADP
Alcohol and Drug Partnership
HSCP
Health and Social Care Partnership
NHS AA
NHS Ayrshire and Arran
1.
EXECUTIVE SUMMARY
1.1
The annual ADP Report (Appendix 1) has been submitted to the Scottish Government
in line with the 30**^ September 2019 deadline. A range of partners were asked to
provide their service delivery input in line with the delivery Plan commitments outlined
in the 2015-2018 ADP Strategy.
1.2
The ADP financial commitments are outlined within the Annual Report and detail the
specific areas of spend required by Scottish Government. Throughout the document
the development and initiatives outlined are financed by these funds. The underspend
outlined (£131,000) is in the main, due to vacancies.
The report requires underspend proposals to be outlined and this work has begun.
They will be cross referenced with the upcoming ADP strategy and in line with specific
Ministerial Priorities.
1.3
Priorityl - DAISy Implementation.
The Scottish Government intend to implement a service user recording system (DAISy
Drug and Alcohol Information System) along with an outcomes-based recovery web
reporting Tool (ROW, Recovery Outcome Web) in all services where possible. This
will ensure consistency in data reporting and cleansing through NHS Information
Services Division. All services require training and implementation plans to roll out.
1.4
Priority 2 - Tackling Alcohol and Drug Related Deaths
A local Drug Death Prevention Group has been established and has developed an
action plan to prevent drug related deaths. Key improvement areas include further
enhancing the work in relation to the supply of Naloxone, working in a whole systems
approach with families and communities, continued support of community recovery
activities, promotion of peer support and the value of ‘lived experience’ and the
provision of a newly tendered service for early intervention and prevention (Turning
Point Scotland).
16
1.5 Priority 3 - Ensuring a proactive approach to responding to prisoners and associated
throughcare who experience aicohoi/drugs problems.
The partnership has robust links to prisons, Justice services and Community Justice
Ayrshire. New deveiopments inciude peer led recovery groups within prisons, gap
anaiysis of individuals returning to Ayrshire placed in outer prison faciiities and iinks
upon iiberation. The North Ayrshire Drug and Aicohoi Recovery Services (NADARS)
have developed a partnership clinic focussing on those who are most at risk and have
compiex needs. This ciinic wiil engage with those upon iiberation to ensure aii support
needs are in place.
1 .6 Priority - 4 Continued implementations of activity based on recommendations within
the Care Inspection report and evidence of Quaiity Principles for Alcohol and Drug
Services. The NADARS service recently employed 4 new full time permanent staff
members who have iived experience of substance use who are now in recovery. Aii
HEAT and Locai Deiivery Pian standards have been met inciuded quick access to
treatment and delivery of Aicohoi Brief Interventions..
1.7 Formal arrangements for Working with Partners
The report outlines the strategic reporting structures of the ADP and responsibility in
relation to scrutiny by the chief officer’s group.
The wider subgroups and iinked groups provide an exchange of communication and
actions which flow to and from the ADP.
2. BACKGROUND
2.1 The Scottish Government requires aii ADP’s to submit annual reports to evidence
progress made within the partnership and ensure public funds disbursed are used
accordingiy within ministerial priorities in reiation to aicohoi and drugs. People with
experience of problem alcohol/drug use and those affected are involved in the
pianning, development and delivery of services.
3. PROPOSALS
3.1 The IJB is asked to acknowledge the report submitted and its responses to the
Scottish Government and the current ADP Strategy. This report wiii further inform the
new ADP strategy (2019 - 2024) to be delivered aiong with the assessment of need.
3.2 Anticipated Outcomes
The annuai report outlines the response to the Scottish Government priorities and
deiivers on the expectations in iine with the strategy and the deiivery framework set
out for ADP’s.
Looking forward, our new strategy will include delivery plans, an improvement pian,
a risk register and an ambition of enhanced governance and reporting arrangements
with the Chief Officers Group, CPP Board and IJB.
The new strategy also features greater collaboration on a pan Ayrshire basis through
the Community Justice Ayrshire, an Ayrshire Heaith and Justice group and, where
appropriate, co-ordination with the three Ayrshire ADP’s. Additionally, there is a
focus on continuous improvement through engagement with and learning from key
groups and agencies including the Scottish Drugs Forum, Scottish Recovery
Consortium, Scottish Famiiies Affected by Aicohoi and Drugs, the Drugs Death Task
Force, Alcohol Focus Scotland and Public Health Scotland.
17
3.3
Measurinq Impact
The ADP strategy contains a key set of delivery commitments, informed by the ADP
strategy framework priorities and outcomes. This report adheres to the improvement
goals set within that.
The ADP reports quarterly to Scottish Government and has key performance
measures within the HSCP Performance and Audit Committee report also.
IMPLICATIONS
Financial:
The ADP is supported by Scottish Government monies. The
upcoming strategy will continue to identify need locally and
funding in response to that in line with the delivery framework.
Human Resources:
The Alcohol and Drugs Partnership works across agencies with a
wide range of staff.
Legal:
Nil
Equality:
The ADP Strategy and Delivery Plan has been through the
Equality Impact Assessment Process.
Children and Young
People
Senior management within the HSCP in Children and Families
have been consulted and contributed to this report.
The Rights, Respect and Recovery Strategy, the outcomes of
which the ADP will be tested against, has a clear focus on Getting
It Right For Children, Young People and Families.
Environmental &
Sustainability:
The ADP, by focussing its work on prevention and early
intervention and locality-based recovery programmes contributes
to this.
Key Priorities:
The ADP strategy helps support the delivery of the North Ayrshire
HSCP Strategic Plan.
Risk Impiications:
The ADP is focussed on preventing harm in people affected by
alcohol and drugs, their families and carers.
Community
Benefits:
The ADP is committed to working within a Recovery Orientated
Systems of Care and Whole Systems approach model to
incorporate wider benefits to the community and Community
Planning Priorities.
Direction Required to
Councii, Heaith Board or
1. No Direction Required
V
Both
2. North Ayrshire Council
(where Directions are required
3. NHS Ayrshire & Arran
piease compiete Directions
Tempiate)
4. North Ayrshire Council and NHS Ayrshire & Arran
5.
CONSULTATiON
5.1
All ADP members and partners were consulted in relation to the production of the
Annual Report.
6.
CONCLUSiON
6.1
The 2018 - 2019 ADP annual report provides information in relation to finance, key
priority areas and partnership working. The continued rise in drug related deaths and
18
our responses are ever shifting and changing. The ADP Drug Death Prevention Group
have several improvement actions in place which requires multi-agency support. The
continued commitment by the ADP in relation to peer support and creation of new
recovery referral pathways is further enhanced by the tender for the new Turning
Point, Scotland Service - Prevention, Early intervention And Recovery service
(PEAR).
For more information piease contact Paul Main paulmain(a)north-avrshire.qov.uk or
Thelma Bowers at thelmabowers@north-avrshire.qov.uk
19
APPENDIX 1
ADP ANNUAL REPORT 2018-19 (NORTH AYRSHIRE ADP)
1
Document Details:
ADP Reporting Requirements 2018-19
1. Financial framework
2. Ministerial priorities
3. Formal arrangements for working with local partners
Appendix 1 Feedback on this reporting template.
In submitting this completed Annual Report we are confirming that this has been signed off by both the ADP Chair and Integrated
Authority Chief Officer.
The Scottish Government copy should be sent by 30 September 2019 for the attention of Amanda Adams to:
alcoholanddruqdeliverv@qov.scot copied to Amanda.adams@qov.scot
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1. FINANCIAL FRAMEWORK - 2018-19
Your report should identify all sources of income (excluding Programme for Government funding) that the ADP has received,
alongside the funding that you have spent to deiiver the priorities set out in your local plan. It would be helpful to distinguish
appropriateiy between your own core income and contributions from other ADP Partners. It is heipful to see the expenditure on
alcohol and drug prevention, treatment & recovery support services as well as dealing with the consequences of probiem aicohol
and drug use in your locaiity. You should also highlight any underspend and proposais on future use of any such monies**.
A) Total Income from all sources
Funding Source
(If a breakdown is not possible please show as a total)
preventing and reducing alcohol and drug
use, harm and related deaths
Scottish Government funding via NHS Board baseline allocation to Integration Authority
£1,302,676
Additional funding from Integration Authority (excludes Programme for Government Funding)
Funding from Local Authority
Funding from NHS (excluding NHS Board baseline allocation from Scottish Government)
£462,922
Total Funding from other sources not detailed above
Carry forwards
Total (A)
£1,765,598
B) Total Expenditure from sources
preventing and reducing alcohol and
drug use, harm and related deaths
Prevention (include community focussed, early years, educational inputs/media, young
people, licensing objectives, ABIs)
£513,933
Treatment & Recovery Support Services (include interventions focussed around treatment
for alcohol and drug dependence)
£924,516
Dealing with consequences of problem alcohol and drug use in ADP locality
£196,149
Total (B)
£1,634,598
C) 2018-19 Total Underspend from all sources: (A-B)
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Income (A)
Expenditure (B)
Under/Overspend
£1,765,598
£1,634,598
£131,000 Under
D) 2018-19 End Year Balance from Scottish Government earmarked allocations (through NHS Board
Baseline)
* Income £
Expenditure £
End Year Balance £
2018-19 investment for
preventing and
reducing alcohol and
drug use, harm and
related deaths
£1,765,598
£1,634,598
£131,000
Carry-forward of
Scottish Government
investment from
previous year (s)
Note: * The income figure for Scottish Government should match the figure given in table (a), unless there is a carry forward
element of Scottish Government investment from the previous year.
Note **Underspend Proposals
The ADP is currently reflecting on the overall budget position and they are in the process of identifying the allocation of
non-recurring funding with partners. Early proposals include a prison Navigator Programme in collaboration with the
Scottish Violence Reduction Unit, Community Justice Ayrshire to enhance pathways, support and risk management upon
liberation.
Plans are being developed for a community engagement event to allow for a Participatory Budget initiative process in
relation to prevention of drug deaths implementing a whole systems approach for the community. The main focus on this
PB process will to be to involve and be informed by individuals, families and communities with lived experience.
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4
2. MINISTERIAL PRIORITIES
Please describe in bullet point format your locai Improvement goals and measures for delivery in the foiiowing areas during 2018-
19:
PRIORITY
^IMPROVEMENT GOAL 2018-19
This should include your
percentage target for each
priority area where applicable.
PROGRESS UPDATE
Maximum of 300 words for each
priority. This should include
percentage of delivery against target
ADDITIONAL
INFORMATION
Maximum of 150
words
1. Preparing Local Systems to
Comply with the new Drug &
Alcohol Information System
(DAISy)
• Ensure processes are in
piace to prepare for the
impiementation for the new
DAISy system
All services have reviewed their systems,
processes and paperwork and are
prepared to enter data into DAISy. This
inciudes any relevant services based
within the prison.
We have reviewed our compliance with
the 12 weeks follow up review data in
preparation for DAISy. We have also
implemented the ROW tool as a local
outcome measure.
The North Ayrshire ADP is on target for
commencement of DAISy.
Awaiting
implementation of
DAISy in January
2020.
We have identified
staff to undertake
the DAISy ‘Train for
Trainers course’.
Stili awaiting training
dates.
2. Tackling drug and alcohol
related deaths (DRD &
ARD)/risks in your local ADP
area.
Which includes - Increasing
the reach and coverage of the
• Set up a North Ayrshire
specific Drug Death
Prevention Group;
During 2018, The North Ayrshire Drug
Death Prevention Group (DDPG) was
convened as an ADP iocai subgroup of
the iarger pan-Ayrshire Drug Death
Prevention Group. This inciusive group
The group meets bi¬
monthly but will
convene quickly in
the event of any
iocai adverse activity
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national naloxone programme
for people at risk of opiate
overdose, including those on
release from prison and
continued development of a
whole population approach
which targets harder to reach
groups and focuses on
communities where
deprivation is greatest.
Increase the availability of
Naloxone across North
Ayrshire
Utilise peer workers to target
and engage with individuais
has met reguiarly and has developed an
Action Plan focussing on specific priority
areas:
Caring for peopie in contact with
services
• Reaching those not in contact with
services.
• Reducing Risk
• Working with Families and
Communities
Across North Ayrshire there has been an
increased focus in widening the use and
suppiy of Naloxone. In the last year over
220 Naloxone kits were distributed which
was an increase from previous years. It
was reported that 13 lives have been
saved in North Ayrshire though the
administration of Naioxone. This figure
wiii be higher but unfortunately many
‘saves’ go unreported. There is an
opportunity to widen the availability and
access to Naloxone across the H&SCP
and North Ayrshire Council and we would
expect as a minimum target to increase
deiivery of 60 kits in the next year (a
proposai is currentiy being deveioped).
or increase risk
within the community
that may require or
benefit from
partnership response
Further work and
analysis with Police
Scotiand in reiation
to data avaiiabie and
drug deaths are
taking piace.
The ADP are testing
our processes
against the SDF
Staying Alive (2019)
Good Practice
Indicator 1
Increased Naloxone
distribution wiii be a
key priority for the
ADP during 2019/20.
The ADP are testing
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not known to service or not During 2018/19, the North Ayrshire Drug our processes
currently engaged in service; and Alcohol Recovery Service (NADARS) against the SDF
reviewed its staffing skill mix and, based Staying Alive (2019)
on positive Peer Support initiatives Good Practice
implemented by the ADP, complemented Indicator 8
its Addiction Service workforce by
recruiting to 4 full time permanent
Recovery Development Workers A pilot has been
(previously known as Peer Recovery proposed to take
Workers). Through this staff group and place in HMP
other peer workers, there has been a pro- Kilmarnock where
active targeting of individuals not known individuals will
to service and those who have ‘dropped’ receive nasal
out of service. Pro-active support has naloxone (Nyxoid)
been offered across 3 Community Cafes for their possession,
in North Ayrshire and within HMP thus increasing the
Kilmarnock whilst peer workers have also numbers of those
set up recovery support groups focussing liberated with access
not only on alcohol and drug recovery but to naloxone
also Blood Borne Virus identification and
• Ensure that the new service treatment support. The ADP has inbuilt
being procured by the ADP within a new service
has outcomes relating to During 2018/19 the ADP commissioned a specification that:
early intervention, assertive new service which focuses on the the required skill mix
outreach and supporting following priority areas: is a minimum of one
harder to reach groups. Area 1 - Identification, education and third of the workforce
prevention secured for
Area 2 - Brief Intervention and psycho- individuals with lived
social support experience of
Area 3 - Ongoing Recovery support for alcohol/drug use and
individuals, carers and families in recovery i.e. Peer
_^__ Support Workers.
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3. Ensuring a proactive and
planned approach to
responding to the needs of
prisoners affected by problem
drug and alcohol use and their
associated through care
arrangements, including
women
Support the implementation
plan of the Community
Justice Ayrshire (CJA) Local
Improvement Plan through
the Health & Justice
Thematic Group.
Working in partnership with
the CJA further develop the
service user involvement
model for people involved in
community justice services.
Develop peer-led support
approaches for individuals
involved with justice services
Attendance at the HMP Kilmarnock
‘community links’ drop-in sessions to
engage with men prior to liberation, and
then linking then into community supports
as required.
Delivery of a peer-led recovery group
within HMP Kilmarnock
Links made with HMP Greenock and
HMP Polmont to identify any gaps in
provision for people returning to Ayrshire
post-liberation.
Contribute to the development of the
practice guide to service user
The commissioning
and procurement
process have been
completed, with a
new service provider
(Turning Point,
Scotland)
commencing in
August 2019.
The work of
Community Justice
Ayrshire and their 9
areas of focus in their
CJLOIP (which include
‘gender specific
approaches’ and
‘keeping out of the
justice system’) has
significant crossover
with the ADP. This will
be developed further
with the collaboration
with the ADP, SVRU
and CJA project at
HMP Bowhouse and
also throuoh a oan
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who have alcohol or drug
issues, including individuals
in HMP Kilmarnock.
involvement (SUI) in justice settings in
association with the University of
Strathclyde and CYCJ.
Share the learning from the SUI project to
date through contribution to pan-Ayrshire
SUI events, and celebrate success
achieved to date.
NADARS have implemented a test of
change partnership clinic to engage with
individuals with the most complex needs.
The clinic will Include those being
liberated from prison who are in receipt of
a methadone prescription. The clinic will
promote and maximise client opportunity
for review with their prescriber and offer
the opportunity to have a conversation
with essential partner agencies who may
support them in their recovery journey. By
introducing this approach, it is hoped that
this will promote stability and expedite
recovery for each client involved. The
service would aim to stabilise all clients
involved with this more supportive
approach and refer them back to
mainstream management.
Ayrshire health and
justice group which
will develop areas for
diversion of
prosecution and
consistency in
practices with SAS /
NHS.
4. Continued implementation
of improvement activity at a
local level, based on the
individualised
recommendations within the
• Increasing involvement and
referrals by statutory drug and
alcohol services to peer
support services.
NADARS now employ 4 full time peer
recovery workers. This development has
enhanced pathways across services and
strengthened links between statutory
In recent years the
Partnership has
benefitted from the
experience of
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Care Inspectorate Report, services and local recovery communities, individuals with lived
which examined local • jhe ADP to develop family experience, many of
implementation of the Quality inclusive practice is embedded North Ayrshire ADP work in partnership whom who are now
Principles. across funded services. with individuals with lived experience of role models in
addiction and service providers to deliver recovery working in
• Embedding a systematic recovery meetings. These are co- the voluntary and
approach to monitor produced. statutory sectors,
performance improvement Our learning from
activity of all ADP funded In the commissioning of the new tler2/3 them and their
services. support services. North Ayrshire ADP contribution to the
stipulated that a percentage of the work lives of people at
• The ADP would benefit from force required to be made up of risk of harm is
further evaluation of timely individuals with lived experience of significant. The
access to services. addiction. Partnership is
committed to
The ADP have developed links with continuing to learn
Scottish Families Affected by Alcohol and from people with
Drugs (SFAD). NADARS staff have lived experience as
attended an information session well as examining
regarding family and bereavement feedback and good
support available and routinely offer this practice at a local,
to service to family and carers. national and
international level.
NADARS have been focusing on more
welcoming family inclusive practice, in
particular, regarding documentation and
including families and carers to attend
appointments. Suggestion boxes have
also been placed within clinic settings to
garner the views of family members and
carers.
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The new ADP funded tier2/3 support
service will offer family and carer support,
this was an explicit factor in the
commissioning process.
North Ayrshire ADP have worked with
NAG commissioning and procurement
department to refresh the current service
level agreements, incorporating ADP
outcomes and ministerial priorities and
implement a robust monitoring process.
This process will be carried out jointly
with the commissioning and procurement
team, and representatives from the ADP.
This process will be monitored through
the ADP Finance group.
North Ayrshire ADP funded services
continue to meet and exceed the national
waiting time targets.
As part of the new strategy development
a large proportion of engagement took
place with stakeholders, individuals using
services and members of the community.
* SMART (Specific, Measurabie, Ambitious, Relevant, Time Bound) measures where appropriate
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3. FORMAL ARRANGEMENT FOR WORKING WITH LOCAL PARTNERS
What is the formal arrangement within
your ADP for working with local partners
including Integrated Authorities to report
on the delivery of local outcomes?
As well as reporting to the North Ayrshire Community Planning Board the ADP now reports to
the Chief Officer Group along with related updates on Child Protection, Adult Protection,
MAPPA and Violence Against Women.
This permits the work of the ADP to be scrutinised by the COG which is chaired by the local
authority Chief Executive and has members including Director of H&SC and pan Ayrshire post
holders including Chief Exec of NHS Ayrshire & Arran, police Divisional Commander.
Similar reporting progresses to the Integrated Authority which will soon include updates on
performance, improvement plans and escalating risks.
Each of the ADP sub-groups has a designated section within the Delivery Plan, in order to
demonstrate a clear focus on the delivery of actions contributing to the strategic priorities of
Prevention, Protection, Recovery and Communities, incorporating national and local outcomes.
Ministerial priorities. Opioid Replacement Therapy recommendations and local contribution to
the Single Outcome Agreement.
The ADP Delivery Plan is reviewed by each of the subgroups on a regular basis and a quarterly
update is provided to the ADP Strategic Management Team. The ADP reports within the Health
& Social Care Partnership/ Integration Joint Board structure.
The ADP has representation within several strategic structures in order to highlight work taking
place and contribution to cross cutting agendas. These include-
• Strategic Planning Group (H&SCP Strategic Priorities)
• Children Services Strategic Plan
• Safer North Ayrshire Partnership (CPP Local Outcome Improvement Plan)
• Community Engagement Network
• Housing First
• Prison Reference Group
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• BBV Managed Care Network
• Community Justice Ayrshire
• M.A.D (User Involvement Council)
• FASD Steering Group
• Education Representative in the Health & Wellbeing Group
• Chief Officers Group
In submitting this compieted Investment Plan, we are confirming that this has been signed off by both the ADP Chair and
Integrated Authority Chief Officer.
Paul Main, Chair, North Ayrshire Alcohoi and Drug Partnership.
Paul Main. Date.
Stephen Brown, North Ayrshire Integrated Authority, Chief Officer.
Stephen Brown. Date.26 September 2019
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APPENDIX 1:
1. Please provide any feedback you have on this reporting template.
Nothing of note to feedback
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Agenda Item 6
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
24 October 2019
Subject:
Alcohol and Drug Partnership Strategy
Purpose:
To allow the IJB to review the new Alcohol and Drug Partnership
(ADP) Strategy prior to approval by the Community Planning
Partnership Board.
Recommendation:
The IJB is asked to ratify the Alcohol and Drug Partnership Strategy
prior to approval by the Community Planning Partnership Board.
Glossary of Terms
ADP
Alcohol and Drug Partnership
HSCP
Health and Social Care Partnership
NHS AA
NHS Ayrshire and Arran
1.
EXECUTIVE SUMMARY
1.1
The previous Alcohol and Drug Partnership Strategy covered the period from 2015-
2018. The new Alcohol and Drug Strategy for ratification is attached at Appendix 1
with a summary version at Appendix 2.
1.2
The Scottish Government produced new policy documents over the course of the
strategy:
• Rights, Respect, Recovery: alcohol and drug treatment strategy 2018
• Alcohol Framework 2018, Preventing Harm.
These documents set out a series of outcomes and priority actions for Scotland,
supporting the delivery of the Public Health Priorities and these have been reflected
in the new strategy.
1.3
The Scottish Government also produced a new partnership delivery framework for
Alcohol and Drug Partnerships (ADPs). ADPs will continue to lead the development
and delivery of a local comprehensive and evidence-based ADP strategy to deliver
local outcomes. This should be achieved through applying a whole system approach
to deliver sustainable change for the health and wellbeing of local populations. The
delivery framework has been reflected In the new strategy.
1.4
Due to vacancies within the ADP support team, the Strategic Planning and Change
Team delivered the development of the new ADP Strategy working with a key range
of partners.
2.
BACKGROUND
2.1
The Scottish Government advises that its new ADP partnership delivery framework
should include the following key features:
• A clear and collective understanding of the local system in particular its
impact, how it is experienced by local communities, and how effectively it
ensures human rights are met.
• Informed by the above, a locally agreed strategic plan, which sets out the
long-term measurable outcomes and priority actions for the local area.
33
focussing on preventing and reducing the use of and harm from alcohoi and
drug use and the associated health inequaiities.
• People with experience of probiem aicohol/drug use and those affected are
invoived in the planning, deveiopment and deiivery of services. This wiil
require a shared understanding of the roies of duty holders and duty bearers
in the context of a human rights-based approach.
• A quaiity improvement approach to service pianning and deiivery is in piace.
• Clear governance and oversight arrangements are in place which enabie
timeiy and effective decision making about service planning and deiivery; and
enable accountability to iocai communities.
• A recognition of the role played by the third sector and arrangements which
ensure their invoivement in the pianning, development and delivery of
services aiongside their public-sector partners.
This framework is captured on page 5 of the new strategy. The strategy also captures
strategic pianning, quaiity improvement, financial planning, governance & oversight,
reiationships with the Integration authority and other key partners.
2.2
Due to vacancies within the ADP support team, the Strategic Planning and Change
Team deiivered the development of the new ADP Strategy. The Strategic Pianning
Lead chaired a writing group made up of partners from North Ayrshire Aicohol and
Drug Partnership, North Ayrshire Heaith and Sociai Care Partnership inciuding the
Drug and Alcohoi Recovery Service, Finance Team and Strategic Pianning &
Change Team, NHS Ayrshire & Arran Prevention and Service Support Team and
Arran Public Heaith Team and the North Ayrshire Councii Commissioning Team.
An engagement group was also developed and this co-produced an engagement
approach with chiidren and young people affected by parental alcohol and drug use.
2.3
The new ADP strategic priorities have been generated from the writing group
reviewing and implementing:
• Successes and learning from the North Ayrshire Aicohoi and Drug
Partnership Strategy 2015-2018,
• Engagement and feedback from peopie and our local communities, including
young peopie,
• Learning from peopie with lived experience of drugs and aicohol, their famiiies
and carers,
• Undertaking a detaiied needs assessment,
• Reviewing national strategy developments,
• Assessing current performance and
• Deveioping an outcomes framework to meet local and national priorities.
3.
PROPOSALS
3.1
The IJB is asked to ratify the Aicohoi and Drug Partnership Strategy prior to approval
by the Community Pianning Partnership. The fuii strategy is attached at Appendix 1
with a summary version at Appendix 2.
All of the supporting information is now on the ADP website at
httD://www.nahscD.orq/north-avrshire-alcohol-and-druq-DartnershiD-adD/
34
3.2
Anticipated Outcomes
■
The ADP strategy framework includes five outcomes which are supported by five
priorities. This outcomes work has been generated from a review of national and local
outcome approaches.
3.3
1_
Measurina Impact
1
The ADP strategy contains a key set of delivery commitments, informed by the ADP
strategy framework priorities and outcomes.
The ADP already reports quarterly to Scottish Government and has key performance
measures within the HSCP Performance and Audit Committee report. Additional work
will begin shortly to create of a performance reporting score-card arrangement.
4. IMPLICATIONS
Financial:
The ADP is supported by Scottish Government monies. The three
year resource allocation is noted in the commissioning and
financial section of the strategy.
Human Resources:
The Alcohol and Drugs Partnership works across agencies with a
wide range of staff.
Legal:
Nil
Equality:
An Equality Impact Assessment has been completed.
Children and Young
People
Children and young people In North Ayrshire were consulted as
part of the strategy development process.
Environmental &
Sustainability:
The ADP by focussing Its work on prevention and early
intervention and locality-based recovery programmes.
Key Priorities:
The ADP strategy helps support the delivery of the North Ayrshire
HSCP Strategic Plan.
Risk Impiications:
The ADP Is focussed on preventing harm in people affected by
alcohol and drugs, their families and carers.
Community
Benefits:
Direction Required to
Direction to :-
Council, Health Board or
1. No Direction Required
X
Both
2. North Ayrshire Council
3. NHS Ayrshire & Arran
4. North Ayrshire Council and NHS Ayrshire & Arran
5.
CONSULTATION
5.1
The Strategic Planning and Change Team undertook a wide-ranging consultation,
using focus groups with young people, people affected by drugs and alcohol, their
carer’s and families, plus door-step Interviews and an online survey.
Four key questions were co-produced, with children and young people affected by
parental alcohol and drug issues to help inform the strategy.
A total of 384 people were involved and opposing views were expressed about the
role people, families, communities and wider society had to play in preventing and
supporting people with drugs and alcohol issues.
35
The consultation feedback highlighted eight key areas for improvement and this
information has been mapped to the ADP strategy priorities and provided to the
delivery groups to support an improvement in their delivery commitments.
6.
CONCLUSION
6.1
The new ADP strategy provides an effective framework on which to build effective
prevention and early intervention approaches and support for people affected by
alcohol and drugs, their families and carers. Communities will play a key role in
working with the partnership to reduce harm and grow recovery approaches.
For more information please contact Paul Main on pmain(a)north-ayrshire.gov.uk or Thelma
Bowers on tbowers(3)north Ayrshire.gov.uk on 01294 317763
36
ALCOHOLAND
DRUG STRATEGY
2019-2024
l«fl£ II NORTH AME H/K MIM10 KIMED ra
DlOm AND raa. EITOIG A HEW
HARMS Of AllM AND im ITOE ARE fUUY SUITOR
THEIR COMMUNHIES ID FIND THER OWN im Of REOM^
37
DOCUMENTS REFERENCED
Scotland's alcohol and drug strategy, Rights,
Respect, Recovery and the Alcohol Framework
2018.
Scottish Government Partnership Delivery
Framework to Reduce the Use of and Harm
from Alcohol and Drugs, 2019
RELATED DOCUMENTS
Staying Alive in Scotland: Scottish Drugs Forum
Report (June 2016)
Let's deliver care together - HSCP strategic
plan 2018-2021
Dying for a Drink - Scottish Health Action on
Alcohol Problems (October 2018)
The Ayrshire Mental Health Conversation:
Priorities and Outcomes 2019-2027
Responding to Drug Use with Kindness,
Compassion and Hope: A report from the
Dundee Drugs Commission (2019)
New public health priorities for a healthier
nation (June 2018)
ACKNOWLEDGEMENTS
Strategic Planning and Transformation Team
ADP writing group members,
ADP engagement group members.
Those supporting the engagement process
including children and young people affected
by parental alcohol and drug use, those with
lived experience, families, carers, the ADP
development workers and our communities.
CONTENTS
Foreword 4-5
Alcohol and Drug Partnership Strategic Plan 6-7
Our vision 8
Who are we and what do we do? 8
Our Strategic Priorities and Outconnes 9-11
Partnership Principles 12
Needs Assessnnent 13-15
Stakeholder Engagennent 16-17
Delivery Connnnitnnents 18-19
Our Partners 20
Our Connnnissioning and Financial Annbitions 21-23
Governance 24
Contact Us 25
39
3
FOREWORD
Since being appointed Chair of the North
Ayrshire Alcohol and Drug Partnership the
increasing impact of the harm caused by
drugs and alcohol on the lives of individuals,
families and the communities of North
Ayrshire is clearly evident, as is the desire to
do all that we can to reduce this harm. Every
life lost is a tragedy and we commiserate
with the families and friends that have lost
loved ones.
What has also been clearly evident to me is the
dedication, commitment and effort of families and
friends, the statutory services, the third sector and
volunteers whose individual and collective efforts
save lives and reduce harm. On behalf of everyone
involved in the Partnership can I thank every single
person for the work that you have done and the
contribution you have made.
40
In recent years the Partnership has benefitted from
the experience of individuals with lived experience,
many of whom who are now role models in recovery
working in the voluntary and statutory sectors. Our
learning from them and their contribution to the lives
of people at risk of harm is significant. The Partnership
is committed to continuing to learn from people with
lived experience as well as examining feedback and
good practice at a local, national and international
level.
Our recent local consultation which informs this
strategy provides commentary on a range of options,
solutions and improvements for the Partnership to
consider. From more police enforcement of legislation,
a greater focus on prevention and recovery, increased
engagement and the use of lived experience and
adopting a stronger partnership, public health
focussed approach. The responses to our consultation
have been greatly welcomed and confirm the need for
a range of responses from an increasing number of
agencies, groups and individuals to tackle the
complexity of alcohol and drug use.
Looking beyond the experiences of people in North
Ayrshire we welcome the learning and work of others.
This includes the report ‘Drug Use with Kindness,
Compassion and Flope' published by Dundee Drugs
Commission. Our engagement with and learning from
key groups and agencies including the Scottish Drugs
Forum, Scottish Recovery Consortium, Scottish
Families Affected by Alcohol and Drugs, the Drugs
Death Task Force, Alcohol Focus Scotland and Public
Flealth Scotland has never been more important.
Collectively this learning, engagement and feedback
has informed our new 5-year strategy which places a
greater focus on a public health approach to solutions,
consistent use of evidence bases, engagement with
individuals and communities with lived experience,
tackling stigma and developing trauma informed,
person centred approaches. Additionally, we will
increase our collaboration with groups and
organisations that work across Ayrshire including the
Community Justice Ayrshire and pan-Ayrshire Flealth
and Justice groups.
Pml yflain
Paul Main
Independent Chair of the Aleohol
and Drug Partnership Oetober 2019
r
41
5
^ftari'?-cce6^Aoo&^-ea99»«ccanoBcesek:;aca*40Cft»JtiiKft«ca g>«dcB&««eD3i<a-cvK«i«es«»fiae»*c«^aeee»»9«cs9«4es
People in North Ayrshire have the
right to be treated with dignity and
respect, enjoying a healthy life -
free from the harms of alcohol and
drugs. People are fully supported
within their communities to find
recovery.
*
/
y
• ' t f
Human rights approach
Person-centred
Kindness
Equality, diversity and respect
Trauma informed
Evidence based
Partnership ‘whole system solutions'
Public health approach
Learning from lived experience
Challenging stigma
Collaborative leadership
Innovative approaches
Strategic plan
Quality improvement plan
Covernance structure
Pisk register
Performance reporting
Workforce plan
Financial transparency
Equalities impact assessment
Communication, engagement
& participation
External review
/
■t
42
PRIORITIES
© Prevention, education and early
intervention
® Whole Family Approach
Aiiiiiii ■■■■»■ ■ ■-■■A kb b bkhhikb bIA.^kb B-B>taA^KBBKAA#BB bAA
© A reduction in the affordability,
availability and attractiveness of
alcohol
*jBibii'ii*4ii>#i<BBBAili:iKi<i«***i'*i*Bi#B'. B444«ri>B>i-iHHBB-i«*A
© Public health approach to justice
© A recovery oriented approach
which reduces harm and prevents
deaths
>
OUTCOMES
© Fewer people develop problem
drug use
© Children and families affected by
alcohol and drug use will be safe,
healthy, included and supported
• + **«*#*»» IP I
© Less harm is caused by alcohol
@ Vulnerable people are diverted
from the justice system,
wherever possible, and those
in the justice system are fully
supported
4ABBBABinfci-BB-fl-*B-BBBKrfl«BBBi>^«W»iBBIilt-B'B'iBB«BB'BK4iiah
© People access and benefit from
effective, integrated person-
centred support to achieve their
recovery
DELIVERY COMMITMENTS
© Education programmes
© Early intervention
© Harm reduction
■.•■***■ ■ *««•«.. ft ilAAiii iJ'Piiftftii ■ l'i*ftft.lft4«iffti* Iftft*
@ Whole family support
© Access to support
© Families involved in planning,
delivery and service development
© Family focussed approaches
© Reducing consumption
© Partners working to prevent harm
and reduce violence
© The right support at the right time
© Prison health & wellbeing services
available
© Treatment & recovery programmes
© Focussed on most at risk
People in North Ayrshire have the right to be
treated with dignity and respect, enjoying a
healthy life - free from the harms of alcohol and
drugs. People are fully supported within their
communities to find their own type of recovery.
North Ayrshire Alcohol and Drug Partnership
(the Partnership) works with people, families,
local communities and partners to identify their
strengths and assets, to reduce the impact of
alcohol and drug use across North Ayrshire.
OUR STRATEGIC PRIORITIES AND OUTCOMES
The Partnership will focus on five strategic priorities
to deliver our vision.
Working collaboratively with people, local communities and partners,
the following strategic priorities have been identified:
® Prevention, education and early intervention,
® A whole family approach,
® A reduction in the affordability, availability and attractiveness of alcohol,
® A public health approach to justice and
® A recovery oriented approach which reduces harms and prevents deaths.
DEVELOPING OUR STRATEGIC PLAN
• 4 + #»l«**ii|fl** + »'l* + + l>«* + * ■■« + *» I «***■'!** + ■****>«* + *» I « + **«« + **■ + *#*■««* + ■«« + + #■* + *#■« + **■«**!» ■■** + » I ** + »«*« + * ■« + **■« + **«•■»
To support the development of the strategy an ADP Strategy Writing Croup was created
made up of partners from North Ayrshire Alcohol and Drug Partnership, North Ayrshire
Health and Social Care Partnership including the Drug and Alcohol Recovery Service,
Finance Team and oriented, NHS Ayrshire & Arran Prevention and Service Support Team
and Arran Public Health Team and the North Ayrshire Council Commissioning Team.
The strategic priorities have been generated from:
© Successes and learning from the North
Ayrshire Alcohol and Drug Partnership
Strategy 2015-2018,
® Engagement with and feedback from
people, our local communities and
partners, including young people,
® Learning from people with lived
experience of drugs and alcohol, their
families and carers,
© Undertaking a detailed needs
assessment.
© Reviewing national strategy and policy
developments,
® Assessing current performance and
® Developing an outcomes framework
to meet local and national priorities.
4
ADP OUTCOMES
The five Strategic priorities enable the Partnership to deliver the following outcomes
which have been identified by reviewing local and national policy drivers:
Children and
families affected
by alcohol and
drug use will be
safe, healthy,
included and
supported
Vulnerable
people are
diverted from
the justice system,
wherever possible
and those in the
People access
and benefit
from effective,
integrated
person-centred
support to
achieve their
recovery
PARTNERSHIP
PRINCIPLES
The Partnership has developed a set of underlying principles, by reviewing the
feedback provided by people and partners taking part in the strategy
engagement process. These principles allow the partnership to challenge
behaviours which may be unhelpful in supporting improvements going forward.
® Human rights approach
®
® Person centred
® Trauma informed
®
® Kindness
®
® Evidence based
®
® Challenging stigma
Equality, diversity and respect
Partnership ‘whole system’ approach
Learning from lived experience
Collaborative leadership
Innovative approaches
Public health approach
12
48
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To support the development of this new strategy, a detailed needs assessment
was developed, in partnership with NHS Ayrshire and Arran public health
colleagues. The needs assessment reviewed information from both national,
regional and local sources. We reviewed data from 2008 to the present date,
where available.
The needs assessment focussed on:
© Key demographic information -
population, deprivation and
economic activity
® Key health measures - addiction
related hospital stays, drug
prevalence and drug deaths
® Impact on young people - child
protection and hospital admissions
® Alcohol and drug related crime
© Local cost of alcohol
© North Ayrshire workforce
Our needs assessment tells us where there have been improvements and areas
that require the Partnership to focus its activities on.
49
NORTH AYRSHIRE ALCOHOL AND DRUG PARTNERSHIP
NEEDS ASSESSMENT
Alcohol hospital
admissions continue to
fall but North Ayrshire
rates are 32% higher
than Scottish average.
For Young people - over
a four year period, we
have seen a decrease in
the number of drug
related presentations.
Yet this appears to
coincide with an
increase In alcohol
related presentations.
The prevalence of
problem drug use in
North Ayrshire is higher
than the Scottish
average. Data indicates
approximately 1,800
local people are
affected by problem
drug use.
Stigma
remains a
significant
barrier
Increase
in drug
related
deaths
Since 2010, North
Ayrshire has continually
had lower levels of drug
related crime than the
Scottish average
Problematic drug
and alcohol use
disproportionately
impacts deprived
communities
Drug related admissions
have increased, the rate
of drug related
hospitals stays in North
Ayrshire is more than
double the Scottish
figure.
Number of
individuals
admitted has
fallen from 936
people 2011 to
782 people
in 2017
14
50
Justice services have
a role to play
t • • • #
Recovery is
community based
• **t***:«i*i'«i**i«**i**i^*«i«i***4!i>**«*
Respect, equality
and diversity
* * 4 *
Services need to be
person-centred,
trauma informed and
better integrated
The whole family
needs support
*
*
*
«
«
a
Improve partnership
working and positive
collaboration
«
*
9
«
«
9
*
*
9
«
More needs to be done
to protect those most
at risk of harm
and death
STAKEHOLDER
ENGAGEMENT
Listening to the views of people, families and carers across North Ayrshire was
hugely important when developing the Alcohol and Drugs Strategy. Differing
views were expressed about the role people, families, local communities,
partners and wider society had to play in preventing and supporting people
with drugs and alcohol issues.
A strategy engagement group finalised
the key engagement questions and
process.
Three hundred and eighty-four (384)
people were engaged using a range of
methods - from focus groups with
young people, people affected by
drugs and alcohol, their carers and
families, plus face to face interviews
and an online survey. The feedback
highlighted eight key issues for
improvement, which have been linked
to the ADP priorities in the diagram
below.
... V *
16
52
Educate and
honestly inform
Enhancing
messaging
and media
Prevention,
education and
early
intervention
ENGAGEMENT ISSUES TOR IMPROVEMENT -
UNKING TO ADP KEY PRIORITIES
Learning from
lived experience
Address
inequalities
i
Enforcement/Criminal
Justice Services
*■ ■ + + + P4 + *l« + 4iii4 + 4l« + *l P44 11444 1444 ■'444#
4
4
4
4
4
*
P ■
4
Provide
alternatives
Develop
services
Link to mental
health services
ADP PRIORITIES
Whole family
approach
A reduction in
the affordability,
availability and
attractiveness
of alcohol
r
Public health
approach
to justice
A recovery
oriented
approach which
reduces harm
and prevents
death
r
53
r
DELIVERY
COMMITMENTS
«**■«*•■« + * I***!
To deliver our strategic priorities and agreed outcomes, the
Partnership has developed a strategic reporting arrangement
as noted in the diagram opposite.
As well as ensuring that the
Partnership is accountable, this
approach will be enhanced to create
strategic delivery groups and delivery
plans to deliver its commitments.
This delivery group and plan
approach, reporting to the
Partnership Strategic Croup, has
worked well in the past, overcoming
challenges and delivering success.
The Partnership will ensure that all
services adhere to the ‘Quality
Principles’ which detail the standard
expectations of care and support in
drug and alcohol services. The
Partnership will also ensure that the
Local Delivery Plan (LDP) standard
relating to drug and alcohol
treatment waiting times is met (this
supports sustained performance in
fast access to services) and ensure
that LDP standard relating to the
delivery of Alcohol Brief Interventions
is met.
t
Chief Officer Croup
Adult
Protection
Committee
t
Community Planning
Partnership
•
•
• • •
• m. •
•
•
..
» •
•
•
•
•
1 Safer
•
•
•
1 North
•
•
•
•
1 Ayrshire
•
•
•
1 Partnership ;
•
•
•
•
; i
Health and Social
Care Partnership
Integration Joint Board
ALCOHOL AID DRUG PARTNERSHIP
Strategic Croup
mm
HhH
Violence I
Women i
Partnership 1
• • •
• • •
•••
• •
• •
•• •
• • •
Child
Protection
Committee
• •
• •
Each of the delivery groups will also identify a range of quality improvements which can be accessed on our website at
http:/^www.nahscp.org/north-ayrshire-alcohol-and-drug-partnership-adp
55
19
4
OUR
PARTNERS
1 ►
The Partnership works with a wide range of people, local
communities and partner organisations at a local, regional and
national level. The partners involved come from a wide range
of sectors including statutory, third, independent and
charities.
The Partnership has representation
within several strategic structures
across North Ayrshire, to highlight
work taking place and provide a
contribution to cross cutting
agendas.
The partners work together on the
ADP delivery commitments and
delivery plans to ensure delivery of
the best outcomes for the people of
North Ayrshire.
OUR COMMISSIONING AND
FINANCIAL AMBITIONS
Commissioning Ambitions
The ADP commissioning process is a continuous cycle through three key stages; strategic planning
(this strategy), procuring services and monitoring & evaluation. During 2018/19 the ADP procured
a new early intervention and prevention service, recognising the need to invest additional monies
in this area.
Service Monitoring
All statutory, independent and third sector services funded by the Partnership are subject to
proportionate levels of service monitoring. As a minimum, funded services meet with relevant
Senior Manager(s), the Lead Officer (ADP) and a Contract Management Officer on at least a
bi-annual basis to undertake a Service Monitoring Review, which focusses on inputs and desired
outcomes, based on national and local objectives.
The Lead Officer (ADP) and Contract Management Officer also visit each funded service on at
least an annual basis to ensure that service objectives are being met and there is sufficient evidence
which demonstrates this. Overall, the service monitoring approach focusses on ensuring partnership
working which achieves positive outcomes for service users and carers. Where this is not the case
timeous action is taken, which focusses on partnership working to resolve issues or concerns.
57
AMBITIONS
The Partnership faced financial uncertainty for a number of years with the funding being allocated as a
non-recurring allocation on an annual basis through NHS Boards. This meant that any new investment
required consideration of how to adapt to any funding constraints.
For 2019-20 baseline funding to support ADP
projects has been transferred to NHS Boards for
onward delegation to Integration Authorities. This
provides the Partnership with assurance over future
funding and services can be planned on that basis.
The full funding allocation should be spent on the
provision of projects and services which deliver
locally agreed outcomes in relation to reducing the
use of, and harm from, alcohol and drugs. The
funding allocation is the minimum that should be
spent on these services.
The Partnership funding is now ring-fenced and the
Integration Authority has the ability to hold reserves.
This is an important principle and supports an
approach to protecting the resource and allows
flexibility over more than one year on how to
prioritise and manage investment. The ADP
approved a three-year budget for 2019-20 to 2021-
22 in March 2019, this budget plan which is regularly
reviewed, included agreeing to recurring investment
where services had been funded non-recurrently
year on year and uses the flexibility of the carry
forward position across the three years.
THE THREE-YEAR APPROVED BUDGET ALLOCATION IS SUMMARISED BELOW:
BUDGET
2019/20
BUDGET BUDGET
2020/21 2022/23
Prevention (includes community focussed, early years,
W educational inputs/media, young people, licensing
W objectives, Alcohol Brief Interventions)
£522,903
£537,331
I
!
£541,106 1
1 Treatment & Recovery Support Services (includes
1 interventions focussed around treatment for alcohol
and drug dependence)
£1,136,796
£1,143,158
.
1
£1,149,370 1
1
1
. 4
Other
£102,618
£105,035
1
£107,524 £
. j
Ij Total Budgeted Expenditure
£1,762,317
£1,785,524
P
£1,798,0001
P
The Partnership, in line with other public services, has an ambition to shift the balance
of spend and investment towards prevention and early intervention services.
GOVERNANCE
■«**■<**»»«* + »■■«* + ■> fl«*»l«**»l«**l«**#|ifi**» ■«**»■#**■*■***»«**» I ***»■«*»■«**#■«*#• I **#■-■«*»■«*
To ensure that the Partnership delivers on its agreed
outcomes; whilst working effectively with its partners, people
and communities, the following governance and oversight
arrangements will be developed.
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Detailed governance and oversight arrangements are available on our website
at http://www.nahscp.org/north-ayrshire-alcohol-and-drug-partnership-adp/
A summary copy of the full ADP strategic Plan can be accessed on our website at
http://www.nahscp.org/north-ayrshire-alcohol-and-drug-partnership-adp
If you have any comments or questions about this document, please feel free
to contact us using the details below:
To find out how we can help, please call 01294 310632
Follow us on Twitter @NorthAADP
North Ayrshire ADP, North Ayrshire Health and Social Care Partnership,
Cunninghame House, Irvine KA12 SEE
You can get this pack in other formats such as Braille,
audio tape or large type, and in community languages if you ask us.
:
■■■
■* V ^
il ^
I n _ i_
■If".-.'
61
25
North Ayrshire ADP
North Ayrshire Health and Social Care Partnership
Cunninghame House
Irvine KAI2 SEE
62
Alcohol and Drug Strategy Summary
2019-2024
nUKinfl/ICiHIKL
dLCOHa S DRUG
pmraf
PEOPLE IN NORTH AYRSHIRE HAVE THE RIGHT TO BE TREATED WITH
DIGNITY AND RESPECT, ENJOYING A HEALTHY LIFE - FREE FROM THE
HARMS OF ALCOHOL AND DRUGS. PEOPLE ARE FULLY SUPPORTED WITHIN
THEIR COMMUNITIES TO FIND THEIR OWN TYPE OF RECOVERY.
63
1. Foreword
Since being appointed Chair of the North Ayrshire Alcohol and Drug Partnership the Increasing impact of the harm caused by drugs
and alcohol on the lives of individuals, families and the communities of North Ayrshire is clearly evident, as Is the desire to do all
that we can to reduce this harm. Every live lost Is a tragedy and we commiserate with the families and friends that have lost loved
ones.
What has also been clearly evident to me is the dedication, commitment and effort of families and friends, the statutory services,
the third sector and volunteers whose individual and collective efforts save lives and reduce harm. On behalf of everyone Involved
In the Partnership can I thank every single person for the work that you have done and the contribution you have made.
In recent years the Partnership has benefitted from the experience of individuals with lived experience, many of whom who are now
role models in recovery working in the voluntary and statutory sectors. Our learning from them and their contribution to the lives of
people at risk of harm is significant. The Partnership is committed to continuing to learn from people with lived experience as well
as examining feedback and good practice at a local, national and international level.
Our recent local consultation which informs this strategy provides commentary on a range of options, solutions and improvements
for the Partnership to consider. From more police enforcement of legislation, a greater focus on prevention and recovery and
increased engagement, use of lived experience and adopting a stronger partnership, public health focussed approach. The
responses to our consultation have been greatly welcomed and confirm the need for a range of responses from an increasing
number of agencies, groups and individuals to tackle the complexity of alcohol and drug use.
Looking beyond the experiences of people In North Ayrshire we welcome the learning and work of others. This includes the report
‘Drug Use with Kindness, Compassion and Hope’ published by Dundee Drugs Commission. Our engagement with and learning
from key groups and agencies including the Scottish Drugs Forum, Scottish Recovery Consortium, Scottish Families Affected by
Alcohol and Drugs, the Drugs Death Task Force, Alcohol Focus Scotland and Public Health Scotland has never been more
important.
Collectively this learning, engagement and feedback has informed our new 5-year strategy which places a greater focus on a public
health approach to solutions, consistent use of evidence bases, engagement with individuals and communities with lived
experience, tackling stigma and developing and using trauma informed, person centred approaches. Additionally, we will increase
our collaboration with groups and organisations that work across Ayrshire including the Community Justice Authority and pan
Ayrshire Health and Justice groups.
ADP Strategy - Summary VO.l
2
October 2019
64
Our focus on engagement and learning will allow us to continually test and improve the Partnerships services, practice, plans and
policies against existing evidence and developing good practice so that we collectively contribute to reducing harm, saving lives
and supporting people in recovery.
Paul Main
Independent Chair of the Alcohol and Drug Partnership
October 2019
ADP Strategy - Summary VO.l
3
October 2019
65
2. ADP Strategy Framework
Working with people, local communities and partners the ADP has developed a ‘plan on a page’ approach showing the key areas of
focus for the next five years.
Vision
People in North Ayrshire have the right to be treated with dignity and respect, enjoying a healthy life - free from the harms of alcohol and
drugs. People are fully supported within their communities to find their own type of recovery.
Priorities
ADP Principles
Human righls
approach
Person-centred
Kindness
Equality, diversity
and respect
Trauma informed
Evidence based
Partnership "v^hole
system solutions'
Public healih
approach
Learning from lived
eKperience
Challenging stigma
Collaborative
leadership
Innovairve
approaches
Pneventioii,
education and
early
nnlberventkin
Whole Famiy
Approach
A reduction in Ihe
afford ahilty,
avalability and
attractiveness o!
alcohol
Public [health
approach to
justice
L
Outcomes
1
r
1 ^
Fewer people
devek^p pmUem
dirug use
Chiidien and families
atfeoted by alcohol and
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ADP Strategy - Summary VO.l
4
October 2019
66
3. Contact Us
A copy of the full ADP strategic Plan can be accessed on our website at http://www.nahscp.orq/north-avrshire-alcohol-and-druq-
partnership-adp/ . If you have any comments or questions about this document, please feel free to contact us using the details
below:
Contact us
* To find out how we con help, please call 01294 310632
* Follow us on Twitter (5)NorthAADP
* North Ayrshim ADP, North Ayrshire Health and SDoiol Care Partnership, Cunninghome House, Irvine
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ADP Strategy - Summary VO.l
5
October 2019
67
Agenda Item 7
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
_ 24 October 2019
Subject: Preventing Drug Related Deaths: an update from 2018
Purpose: The purpose of this report is to update the Integrated Joint Board
(IJB) of the actions taken by the North Ayrshire Drug Death
Prevention Group (DDPG). This paper outlines the ongoing work by
the North Ayrshire Alcohol and Drug Partnership (ADP) and partner
agencies to prevent drug related deaths in North Ayrshire. This
report provides an update on actions taken following a previous
report submitted to the IJB in 2018 (Preventing Drug Related
Deaths: A Framework for Ayrshire and Arran)
Recommendation: It is recommended that the IJB:
Note the increase in confirmed drug related deaths in 2018, the
projected increase in reported drug related deaths in North Ayrshire
for 2019 and the actions in place to prevent future drug related
deaths.
Note the creation of the North Ayrshire DDPG and actions taken to
date.
Note and supports the expansion of the Naloxone programme.
Glossary of Terms
IJB
Integrated Joint Board
DDPG
Drug Death Prevention Group
ADP
Alcohol and Drug Partnership
ISD
Information Services Division Scotland
HSP
Health & Social Care Partnership
N/A DDPG
North Ayrshire Drug Death Prevention Group
DDRG
Pan Ayrshire Drug Death Review Group
NADARS
North Ayrshire Drug and Alcohol Recovery Service
1.
EXECUTIVE SUMMARY
1.1
The purpose of this report is to highlight actions taken during 2018/19 to prevent
drug related deaths In line with the anticipated outcomes from the IJB paper
submitted in June 2018 and outlined below:
• Creation of a North Ayrshire DDPG ensuring local learning and national
direction are implemented quickly as preventative actions.
• Creation of drug related death prevention improvement plan whilst using the
68
Pan Ayrshire Drug Death Review Group (DDRG) as a coordinating link
• Strengthen pan-Ayrshire working arrangements with a focus on preventive
activities
The report highlights innovative partnership models of prevention, early intervention,
treatment and care being deveioped and delivered across North Ayrshire.
2.
BACKGROUND
2.1
There were 1,187 confirmed drua reiated deaths in 2018 in Scotland (253 more
than in 2017). This is the iargest number of drug related deaths in Scotland since
reporting began in 1996.
• There were 82 confirmed drug related deaths in Ayrshire and Arran in 2018
(compared to 61 in 2017 and 85 in 2016)
• South Ayrshire had 15 confirmed drug reiated deaths in 2018;
• East Ayrshire had 29 confirmed drug related deaths in 2018;
• North Ayrshire had 38 confirmed drug reiated deaths in 2018
Thus far, in 2019, there have been 34 reported suspected (not confirmed) druq
reiated deaths in North Ayrshire
2.2
Considering the increasing trend of drug reiated deaths across Scotiand, this
situation has now been described as an ‘national emergency’.
2.3
The Scottish Government have identified a national Taskforce group and invested
£20 million to tackle the rising number of drug related deaths. The first Taskforce
meeting took place on 17 September 2019 and examined the main causes of drug
related deaths. This Taskforce wiii promote action to improve health outcomes for
people who use drugs, and will advise what changes, in practice or in the iaw, couid
help save lives. The North Ayrshire DDPG looks forward to influencing this
discussion and implementing specific findings and direction from this group. The
Taskforce have since contacted every ADP across Scotland requesting the ADP
send in ideas (maximum of 5 ideas) on how we can stem the rise in drug related
deaths in Scotiand. The ADP are actively engaging with the Task Force and iiaising
with other Ayrshire ADP’s in this consuitation.
3.
PROPOSALS
3.1
The North Ayrshire DDPG was convened as a subgroup of the North Ayrshire ADP
whiist maintaining communication links with the wider Pan Ayrshire Drug Death
Review Group. The DDRG has brought together local and national agencies to take
cognisance of the recommendations within the ‘National Staying Aiive in Scotland’
report and the Pan-Ayrshire ‘Everybody Matters, Preventing Drug Related Deaths: A
Framework for Ayrshire and Arran 2018-202T report. The DDRG has identified and
implemented several actions aimed at preventing drug related deaths.
3.2
The DDPG have produced a local Improvement Plan which identifies key priority
improvement areas covering the themes of:
• Caring for people in contact with services
• Reaching those not in contact with services.
• Reducing Risk
• Working with Families and Communities
This pian focuses on those high-risk individuals who are vulnerable to overdose and
69
involved in high risk drug taking.
3.3
Examples of actions undertaken, and ongoing improvement areas identified:
• Same day contact with service for individuals released from prison (requiring
NADARS support);
• Quick access to treatment and care interventions including mental, physical,
sexual and Blood-Borne Virus-related support;
• Support staff to undertake psychological therapy training to deliver trauma
informed practise;
• Use of regular drug screening;
• Regular key worker and prescriber reviews;
• Increased availability of Harm Reduction interventions including Opiate
Substitution Therapy and Injecting Equipment Provision;
• Recruitment of 4 Recovery Development Workers within statutory services
increasing the availability of support from individuals with lived experience who
are in recovery;
• Increased roll out the supply of Naloxone;
• Work with Housing and Homeless Hostels to Improve pathways of support and
Increase communication;
• Commission the procurement of a new Prevention, Education and Early
Intervention service (ADP have allocated approximately over £300,000 per
year for the next 3 years to implement this new approach). Turning Point,
Scotland have just been awarded the contract;
• Planned engagement strategy to work in partnership with Police Scotland to
retain challenging behaviour clients within treatment and care services
• Lock boxes will be given to all clients who have child care responsibilities along
with the 'Keeping methadone safe' booklet
• Social Care Addiction Child and Parent Impact Report (CPIR) being developed
in partnership with Children's Services to identify appropriate social care
support for parents who have childcare responsibilities.
• The NHS Prevention & Service Support Team will continue to provide a range
of training courses many of which include valuable educational information
about overdose awareness, poly drug misuse and risks of lowered tolerance
• Positively promote family engagement with Scottish Families Affected by
Alcohol and Drugs (SFAD) following bereavement
3.4
Naloxone:
Across North Ayrshire there has been an increased focus in widening the use and
supply of Naloxone (this medication is used to block or reverse the effects of opiod
drugs, particularly within the setting of drug overdoses). In the last year over 220
Naloxone kits were distributed which was an increase from previous years. It was
reported that, a minimum of 13 lives have been saved in North Ayrshire though the
administration of Naloxone (this figure will be higher but unfortunately many ‘saves’
go unreported). There is an opportunity to widen the availability and access to
Naloxone across all partners, individuals, families and the wider community.
3.5
Injecting Equipment Provision
There are currently a range of community-based Injecting Equipment Provision (lEP)
available across North Ayrshire including pharmacy needle exchange availability and
specialist clinics delivered by North Ayrshire Drug & Alcohol Recovery Service
(NADARS) staff. These services are delivered in line with the Sexual Health Blood
Borne Virus Framework and the Scottish Government Guidelines for lEP Provision
70
and Lord Advocates Guidance.
The NADARS continues to examine ways of increasing accessibiiity and avaiiability
of Harm Reduction interventions inciuding additional needie exchange provision
within the NADARS base whiist having to mitigate against a 16% budget reduction in
the last 4 years from the NHS Public Health ‘Outcomes Framework’ bundle
allocation.
3.6
Consultation:
The ADP engaged the community in a pubiic consultation which 384 peopie
responded to and a significant number of responses came from those aged under 25
and individuals with lived experience of drug and aicohol use. Continued
engagement activity and iistening from individuals and families with lived experience
will be key to the partnership’s continuous improvement.
The ADP held a conversation event on 20 September 2019 and invited a group of
individuais from across the North Ayrshire community. This provided an opportunity
to present the DDRG Improvement Plan and seek engagement and feedback on the
identified actions. There is an opportunity to buiid upon this event and look at wider
engagement across North Ayrshire.
At the North Ayrshire Council meeting on 25'*^ September the Council agreed to
declare a drugs death emergency and asked that the Health and Social Care
Partnership to convene a drugs death summit of Community Planning Partners to
consider multi-disciplinary iocai drug policy, funding and service improvements.
3.7
Funding Opportunity:
In addition to the improvement actions detaiied within this report, the ADP have
identified funding (£50,000) to encourage and attract innovative suggestions and
proposals from the communities of Irvine and the 3 Towns locality initially (this
targeted approach is evidenced based data on the highest risk geographical
localities in North Ayrshire reiating to drug related deaths) are being explored. The
ADP are planning a Participatory Budgeting type approach whereby individuais,
groups, services and partners can apply for funding.
3.8
New Ayrshire and Arran Addiction APP:
The above has been created for downioad to phones to enable individuals to have
access to a wide range of information available in reiation to the foiiowing:
• Local services and Support
• Helpful Websites
• Current Aierts
• Who to contact in an emergency
• Events in your area inciuding free training
• Seif help
• What is happening in Ward 5 (Addiction faciiity at Woodland View)
The APP is available by downloading “Healthzone UK” from the apple or Android
store and search for “Ayrshire and Arran Addictions”, ieafiets wiii be distributed.
3.9
Anticipated Outcomes
71
The partnerships learning, engagement and feedback has informed a new 5-year
strategy which places a greater focus on a public health approach to solutions,
consistent use of evidence bases, engagement with individuals and communities
with lived experience, tackling stigma and developing trauma informed, person
centred approaches. Additionally, increased collaboration with groups and
organisations that work across Ayrshire including the Community Justice Authority
and pan Ayrshire Health and Justice groups will become more important.
Our focus on engagement and learning will allow us to continually test and improve
the Partnerships services, practice, plans and policies against existing evidence and
developing good practice so that we collectively contribute to reducing harm, saving
lives and supporting people in recovery.
We will continue to encourage local learning and rapid partnership responses to
complex high risk individuals who are vulnerable to overdose and seek to develop
innovative and wider partnership multi agency participation in the DDPG agenda
3.10
Measurina Impact
The DDPG Improvement plan will be used to gauge and measure development and
partnership working to jointly prevent drug related deaths. Yearly information is also
published by ISD in relation to drug related deaths.
4.
IMPLICATIONS
Financial:
Costs included within ADP funding allocation.
Human Resources:
The ADP will be seeking support from staff across all partner
agencies to support actions to prevent drug related deaths and
to help support the roll out the Participatory Budgeting approach
during 2019/20
Legal:
There are no obvious legal issues
Equality:
Any revision or development of new policies will be Equality
Impact Assessed as they progress.
Children and Young
People
Any work and actions progressed will be implemented with a
view of positively impacting on children’s health and care needs.
Environmental &
Sustainability:
No obvious sustainability or environmental issues.
Key Priorities:
Actions and improvements link directly with Ministerial Priorities
and support the delivery of local strategic and operation plans
across statutory and partner services.
Risk Implications:
Actions are aimed at reversing the trend of increasing drug
related deaths and preventing future deaths
Community
Benefits:
Improvements will increase community confidence in
partnership approaches to drug related deaths.
Direction Required to
Direction to
Councii, Heaith Board or
1. No Direction Required
V
Both
2. North Ayrshire Council
(where Directions are required
3. NHS Ayrshire & Arran
piease compiete Directions
Tempiate)
4. North Ayrshire Council and NHS Ayrshire & Arran
72
5.
CONSULTATION
5.1
ADP partners and stakeholders have been engaged with and consulted regarding
the ADP strategy development and actions aimed at preventing drug related deaths
6.
CONCLUSION
6.1
Drug related deaths are preventable.
The IJB are asked to note the content of the report and where appropriate support
the actions and improvements aimed at preventing drug related deaths.
For more information piease contact Paui Main, ADP Chair, on 01294 310632 or
paulmain(5)north-avrshire.qov.uk
73
Agenda Item 8
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
24th October 2019
Subject:
North Ayrshire IJB Carer’s Short Breaks Statement
Purpose:
To present the North Ayrshire HSCP Carers Short Breaks Statement
to the IJB for consideration and approval.
Recommendation:
The Integration Joint Board approves the Short Breaks Statement,
included in Appendix 1.
Glossary of Terms
NHS AA
NHS Ayrshire and Arran
HSCP
Health and Social Care Partnership
1.
EXECUTIVE SUMMARY
1.1
The Carers (Scotland) Act 2016 came into force on 1 April 2018. It places legislative
requirements on the Integration Joint Board, including the requirement to publish a
statement setting out information about short breaks, including what services are
available for carers.
2.
BACKGROUND
2.1
The Carers (Scotland) Act 2016 which came into force on 1 April 2018 places a duty to
prepare and publish a Short Breaks Services Statement. Section 35 of the Act states
that:
• A Short Breaks Services Statement means a statement of information about the
short breaks services available for carers and cared-for persons.
• The information must be accessible to, and proportionate to the needs of, the
persons to whom it is provided.
• Scottish Ministers may by regulations make further provision about the preparation,
publication and review of short breaks services statements.
The Carers Act required the statement to be published by 31 December 2018. The North
Ayrshire statement has been prepared in conjunction with the North Ayrshire Carer’s
Advisory Group.
3.
PROPOSALS
3.1
Positive outcomes for carers are supported when they receive breaks from caring and
this also helps to prevent any future breakdown in the caring relationship. It is important
to acknowledge that carers may also need to combine their caring role with other family
activities, responsibilities or employment. This requires the approach to short breaks
being tailored to individual carer need.
74
The purpose of the short breaks statement is to inform and advise young and adult
carers, staff and the wider community of planned, short break opportunities for carers
who care for someone living in North Ayrshire. The statement provides useful links and
ideas of available supports, regardless of eligibility and level of support needed, and how
to access a break from caring. The statement focusses on supports for planned short
breaks with a focus on early intervention and support for carers to continue in their caring
role.
The IJB are asked to note the North Ayrshire Short Breaks statement and approve the
publication of the statement, in line with legislative requirements of the Carers Act.
3.2
Anticipated Outcomes
The publication of the Short Breaks Statement fulfils a legislative requirement as part of
the Carer’s Act. The statement should provide greater transparency and sign posting to
services available to carers in North Ayrshire.
3.3
Measurina Impact
1
The statement will be reviewed annually by the carers team. Services provided to carers
formally through Carers assessments are recorded and monitored by services.
4. IMPLICATIONS
Financial:
Any short break services provided by the HSCP
would be as a result of a carers assessment and the
funding provided for the Carers Act is to fund the
services identified and agreed from those
assessments, in line with agreed eligibility criteria.
Human Resources:
None
Legal:
The legal implications are those duties placed on
the IJB under the provisions of the Carers
(Scotland) Act 2016.
Equality:
The statement supports fair access to information re
short breaks to all carer groups.
Children and Young People
The statement refers to supports for Young Carers.
Environmental & Sustainability:
None
Key Priorities:
Supporting Carers to continue in their caring role is
a key priority of the HSCP.
Risk Impiications:
None
Community Benefits:
The statement supports fair access to information re
short breaks to all carer groups, this includes
signposting to services available in communities.
Direction Required to
Direction to
Council, Health Board or
1. No Direction Required
Both
2. North Ayrshire Council
X
3. NHS Ayrshire & Arran
4. North Ayrshire Council and NHS Ayrshire & Arran
5.
CONSULTATION
5.1
In developing this statement, consultation was carried out with carers and staff from
the voluntary sector and HSCP, including the Carers Advisory Group and Unity (North
Ayrshire Carers Centre)
75
6. CONCLUSION
6.1 It is recommended that the Integration Joint Board approves the Short Breaks
Statement, thereafter this can be published to enhance existing carers information
and resources.
For more information please contact Kimberley Mroz, Policy Manager on 01294
317709 or kmroz(a)north-ayrshire.gov.uk
76
North Ayrshire
Short Break Services
Statement
North Ayrshire
Carers Centre
NORTH AYRSHIRE
Health and Social Care
Partnership
77
Document Control
Prepared By
Kimberley Mroz - Self-directed Support & Unpaid
Carers Policy Manager
Authorised By
Stephen Brown - Director of North Ayrshire Health
& Social Care Partnership
Source Location
\\NAYRHQVSD1\Public\SSPUBLIC\SSHQ\mm4doc
s\Senior Manager\HEALTH & COMMUNITY
CARE\LONG TERM CONDITIONS (on
GDPR)\Carers (on GDPR)\Short Break Statement
Published Location
http://www.nahscp.org/
Reiated documents
Carer (Scotland) Act 2016 Statutory Guidance -
http://www.aov.scot/Resource/0053/00533009.pdf
Acknowiedgements
httDs://www.sharedcarescotland.org.uk/
Version Control
Version being Published
Draft vO.7
Date of Publish (Month & Year)
October 2019
Author
Kimberley Mroz - Self-directed Support &
Unpaid Carers Policy Manager
Review Date (Month & Year)
October 2020 (Directory ongoing)
2
78
1. Introduction
4
2. Short Breaks
What is a Short Break?
Who can have a Short Break?
What can a Short Break look like?
Why take a Short Break?
How to access a Short Break?
3. Short Break Options (Links)
4. Carers Voices
5. Appendices
9
9
10
79
Introduction
The Carers (Scotland) Act 2016 requires Local Authorities to prepare, publish and
review a Short Break Services Statement under Section 35 .
It is NAHSCP’s (North Ayrshire Health & Social Care Partnership’s) responsibility to
prepare this Statement along with local carers and the people they care for, the
Carers Advisory Group, North Ayrshire Carers Centre, as well as staff and other third
sector partners.
The purpose of the Short Break Statement is to inform and advise young and adult
carers, staff and the wider community of planned, short break (often referred to as
respite) opportunities for carers who care for someone living in North Ayrshire. The
Statement provides useful links and ideas, what is available regardless of eligibility
and level of support needed, and how to access a break from caring.
The Statement does not focus on carer situations that occur due to emergencies or
crisis with the carer or cared for person. It is about supporting planned short breaks
from your caring responsibilities.
Short Breaks
What is a Short Break?
The Carers (Scotland) Act 2016 does not provide a legal definition of a short break.
Shared Care Scotland; one of the seven National Carer Organisations, considers a
short break to be;
‘a service which is provided to give the unpaid carer a rest from their caring
responsibilities.’
In North Ayrshire we believe a short break should be personalised, it can be creative
and will have different meanings for each individual carer and it is;
‘Anything that allows a person, of any age, to have some time away from their
caring routines and responsibilities'
A short break is a type of planned support that allows carers to have a rest. It should
help your emotional and physical health and wellbeing. It can also support the
relationship with the person you care for to help you feel able to continue caring. The
short break should make a difference to your life and make you feel you have had
time for yourself.
4
80
The short break approach provides you with choice and fiexibiiity. It involves a
conversation with you and the person(s) you care for to determine what a break from
caring means, or might look like, for you. NAHSCP have for many years provided
services that have given important and required reiief to many carers by providing
short term care for the cared-for person(s). This care has been mostiy provided in a
care home or day care service and is often the oniy help many carers request.
In 2018/19, NAHSCP supported 210 carers and the cared for person (over 65 years
of age) to receive pianned traditionai breaks across 32 residential care settings in
North Ayrshire.
NAHSCP’s Anam Cara Service provides dedicated short breaks for oider aduits with
a diagnosis of dementia who reside in North Ayrshire. Carers who use this service
shared the foiiowing;
‘It was so reassuring for us to know that we were leaving him in such safe caring
hands. Facilities like Anam Cara are priceless to carers. ’ Walker family
‘Thank you for doing what you do and for showing us a new road in our journey with
dad. ’ Bennett family
Even when services are delivered in the most personaiised way possibie, you may
find traditionai types of support are not suitable for you or the cared-for person. You
may find you need something different/or in addition to the standard provision of
carer support because you, the person(s) you care for and your circumstances are
unique to you.
In 2018/19, 33 carers (all age groups) applied through Unity North Ayrshire Carers
Centre to Shared Care Scotiand Short Breaks Fund to receive innovative short
breaks covering a range of activities and equipment, some of our carers who have
utiiised this fund shared the foiiowing
‘It felt good having me time without worries and stress. ’
7 got new football boots and it made me feel better as I now play for a team’
‘It made a difference to myself just being out as this doesn’t happen very often. To
my partner it was a chance of company as he is with me 24/7. It was a good day for
us both’
NAHSCP have asked young and adult carers how a break from caring makes them
feei.
You toid us you are more abie and willing to care when you feei well and have
meaningful time away from your caring responsibiiities. You also stated knowing
what is out there gives you more choice and controi to consider what you need.
5
81
Who can have a Short Break?
This Statement is for young and adult carers, and the cared-for person. It also
provides guidance for NAHSCP staff and other organisations who support carers in
North Ayrshire.
Under the Act a ‘carer’ is an individual who provides or intends to provide care for
another individual.
An ‘adult carer’ is at least 18 years old and a ‘young carer’ is either under 18 years
old or has turned 18 but is still at school.
Carers look after family members or friends who need help to live day to day due to
illness, disability, mental health, addiction issues or simply as they grow older.
You can be any age, care for more than one person and do not need to live in the
same house as the cared-for person(s). Often caring is associated with physical
tasks but giving emotional support is a huge part of caring, and often more stressful.
As well as a carer you are a parent, partner, grandparent, brother, sister, daughter,
son and/or friend. Some carers care for each other and you may have your own
health and/or social care needs.
What can a short break look like?
Your caring circumstances are personal to you and not every short break requested
will be the same. The type or length of short break depends on your identified
eligible need and what matters to you most, as identified in your ACSP (Adult Carer
Support Plan) or YCS (Young Carer Statement). An ACSP or YCS is an opportunity
to discuss with the HSCP what support or services you need. This will look at how
caring affects your life, including for example, physical, mental and emotional needs,
and whether you are able to carry on caring.
A break from caring can;
• Be for a few hours a day to spend time with other family or friends, maintain
friendships and take a break from your caring role/routine
• Be during the day or night with replacement support or telehealth/care, if
needed
• Allow you to have a life outside and/or alongside your caring role
• Involve the person you care for having a break away from home, allowing you
some time for yourself
• Involve you and the person you care for having a break together
For more examples of what a short break can look like visit Shared Care Scotland’s
Short Break Stories.
6
82
Why take a Short Break?
The benefits from taking a break from caring are different for each carer. A break
from caring can help in many ways by reducing the stress and anxiety of day to day
life. It can maintain or improve physical and emotional health and wellbeing. It can
support the caring relationship as well as those with other family and friends, often
reducing isolation. Carers also use the opportunity of a short break to refresh and
recharge helping achieve more balance in life.
North Ayrshire carers shared some further comments on their break from caring
stating that it;
‘Gave me time to myself as I care every day and always need to rush back, having
the day off to do something I enjoy was great. ’
‘It was of great benefit to us both, mentally and physically and gave us a good boost. ’
‘It enabled me to get a break as I was very lethargic beforehand. ’
‘We were a family for the day!’
How can I get a Short Break?
From 1st April 2018, NAHSCP must provide support to young and adult carers based
on their assessed identified needs.
The ACSP or YCS will look at your whole caring situation, the impact of caring on
your quality of life and the risk to you and the person you care for if you are not able
to continue caring. Through good caring conversations your ACSP or YCS will
highlight these areas and help decide your level of support. This could range from
receiving information, advice and signposting to relevant universal or community
supports all the way through to targeted commissioned supports and services.
An ACSP is for adult carers, who request or are offered and accept the chance to
complete their ACSP. The Plan Is a record of agreed outcomes to achieve or
maintain. You will receive a copy of your ACSP and can share with anyone you wish.
NAHSCP will help you complete your ACSP, applying North Ayrshire Carer Elialbilitv
Criteria to determine your level of support.
If you self-identify and request your ACSP, Service Access Teams are the point of
referral, based in your local health and social care office. fSee Appendix 1 for who to
contact and a flow chart of steps to understand how to apply for a short break).
If you live in North Ayrshire but care for someone in another authority area, it is that
other local authority who holds the duty to offer and prepare your ACSP or YCS.
The YCS is for young carers, who request or are offered and accept the chance to
complete their YCS. The Statement is a record of agreed outcomes to achieve or
maintain. You will receive a copy of your YCS and can share with anyone you wish.
7
83
NAHSCP and Education Services have agreed that Head Teachers and Pastoral
staff will support young carers to prepare and complete their YCS and apply North
Ayrshire Young Carer Eligibility up to the levels of moderate risk/impact. Where your
needs are thought to be substantial or critical, Education will request assistance to
identify an appropriate Lead Professional to help.
However, not all breaks from caring will meet NAHSCP’s eligibility and require a
separate funding for you. Many of your outcomes can be met through universal
services such as Health or Education, community support or from services already
received by the cared-for person. Where this is not the case and your own carer
funding is agreed, Self-directed Support options will be offered to consider how best to
plan, take and pay for your short break. There are four options which allow you to
decide how much control and responsibility of your funding you want. These options
are:
• A Direct Payment - you receive a cash payment from the HSCP and arrange,
pay for and manage the short break you choose to meet your assessed need.
• An Individual Service Fund - HSCP arranges and pays for the support you
choose but you manage this with the provider to meet your assessed need.
• HSCP arranged services - HSCP chooses, arranges, delivers and pays for
the support they think best meets your assessed needs.
• A mixture of the above three options for different types of short breaks from
caring.
NAHSCP will consider all parts of your short break to waive any cost to you but there
may be some parts that you will have to pay for. Each individual short break will be
considered on its own circumstances. For more information on charging for breaks
from caring in North Ayrshire view the following links.
• North Ayrshire Charging Policy 2019/20.
• North Ayrshire Guidance on Waiving Charges for Carers.
• http://www.leqislation.qov.uk/ssi/2018/31/contents/made
If your needs for support are agreed and a break for you from caring is decided,
appropriate care for the person you normally care for will need to be detailed in your
ACSP or YCS. In some cases, this can be provided by family, friends or other
community supports, but there may be a need for formal replacement care.
Replacement care according to the Act is;
“Care provided to the cared-for person, which replaces care previously given by
the carer and which is provided as a form of support to the carer so the carer can
have a break from caring.”
It can be challenging to determine who will benefit from the replacement care. Refer
to the previous link North Ayrshire Guidance on Waiving of Charges for Carers (Point
5) for clarification.
8
84
If you and the person you care for want to take a break together, this break would
potentially meet both of your needs. The cost for any support would be included in
the cared-for person’s support package. Any charge or cost under this choice of
break wouid be appiied (50/50 spiit) between you and the cared-for person.
Short Break Options
Caring means something different for everyone. It is important to recognise when a
break is needed. There are lots of different options that can be expiored whether it is
an hour each week, a day here and there, a week or two for a hoiiday or a
combination of aii of these.
There are many usefui organisations that can heip you to arrange, enjoy and pay for
a break such as NAHSCP, North Ayrshire Carers Centre and other iocal charities or
condition specific organisations. Ciick the link Support for Carers for a full list of
resources that can heip you make informed choices about your short break.
Carers Voices
NAHSCP would appreciate any feedback on this Short Break Services Statement in
order that we may continue to provide clear and up to date information on breaks
from caring.
Anyone can contact the North Ayrshire Carers Team at carersteam@north-
avrshire.aov.uk with specific feedback on the Statement or useful ideas and links for
short break options. You can also share your stories and experiences of short
breaks that made or continues to make, a difference in your iife.
Piease also share your suggestions for ensuring the Statement is communicated to
everyone that needs it.
The North Ayrshire Short Breaks Service Statement will be reviewed annuaiiy by the
Carers Team.
As a carer, if you do not think you or the person you care for are getting the service
that you are entitied to, you can contact us :-
• by teiephone, to the relevant department
• in person at your iocai HSCP Office
• in writing to: HSCP, 5'^ Fioor West, Cunninghame House, Irvine, KA12 SEE
• Completing the oniine compiaints form at;
www.north-avrshire.aov.uk/compiaints
9
85
Service Access Social Work Team Contacts
1. Arran Health & Social Care Office
Shore Road
Lamlash
KA27 8JY
Tel: 01770 600742
2. Irvine Health & Social Care Office
Bridgegate House
Irvine
KA12 8BD
Tel: 01294 310000
3. Kilbirnie Health & Social Care Office
Craigton Road
Kilbirnie
KA25 6LJ
Tel: 01505 684551
4. Saltcoats Health & Social Care Office
Saltcoats Town Hall
Countess Street
Saltcoats
KA21 5HW
Tel: 01294 310005 (Option 2)
5. Brooksby Medical Resource Centre
31 Brisbane Road
LARGS
KA30 8LH
Tel : 01475 687592
86
r
Appendix 2
How to Access a Short Break in North Ayrshire
NAHSCP has a duty and responsibility to support carers identified eligible needs. In
order to receive information and support, or help to access a short break you should;
Adult Carer
Young Carer
Contact your local Health & Social
Care Partnershio Office fSee Above)
Speak to your Head Teacher or
Pastoral Suooort Staff in School
Request an Adult Carer Support Plan
Request a Young Carer Statement
Social Worker/Social Work Assistant
Head Teacher or Pastoral Support
Discusses with you how your caring responsibilities
affect you & the level of support you qualify for
Discusses with you how your caring responsibilities
affect you & the level of support you qualify for
Your Support Plan
Your Support Plan
Discusses how your needs might be met
including short breaks & the options to provide
& fund vour short break
Discusses how your needs might be met
including short breaks & the options to provide
& fund vour short break
Or You Can ■■■
Think about a break from caring with help from your network of supportive friends
and family discussing this together with the cared-for person.
You may also need some outside help to consider a break from caring and can
contact North Ayrshire Carers Centre to discuss what type of short break options
might meet your needs. To find out more telephone: 01294 311333, visit them at
174, High Street, Irvine or click the link https://www.unitv-enterprise.com/carers-
centers/.
87
DIRECTION
From North Ayrshire Integration Joint Board
NORTH AYRSHIRE
Health and Social Care
Partnership
1.
Reference Number
26092019-
2.
Date Direction issued by iJB
26092019
3.
Date Direction takes effect
26092019
4.
Direction to
North Ayrshire Council
X
NHS Ayrshire & Arran
Both
5.
Does this direction supercede,
amend or cancel a previous
direction - if yes, include the
reference numbers(s)
Yes
No
X
6.
Functions covered by the direction
Carers services as defined in the Carer’s Act 2016.
7.
Full text of direction
North Ayrshire Council are required to publish the Short Breaks statement and
provide access to services as outlined therein, this will be delivered in line with agreed
eligibility criteria for carers.
8.
Budget allocated by Integration
Joint Board to carry out direction
Carer’s Act funding and existing social care provision and budgets in relation to
respite services will be used to deliver any commitments.
9.
Performance Monitoring
Arrangements
Will be monitored by HSCP Carer’s team.
10.
Date of Review of Direction (if
applicable)
88
Agenda Item 9
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
_ 24th October 2019
Subject: Community Care Occupational Therapy Update
Purpose:
The purpose of this paper is to update the Integration Joint Board
on:
- The current waiting time position for occupational therapy
assessment within the community care teams in North Ayrshire
- Progress made to date to reduce these waiting times
- Actions planned to further improve this position
Recommendation: It is recommended that the Integration Joint Board:
- Note the content of this paper
- Approve the actions proposed to further improve this position
Glossary of Terms
HSCP
Health and Social Care Partnership
AHP
Allied Health Professional
IC&R
Intermediate Care and Rehabilitation
OT
Occupational Therapist
IJB
Integration Joint Board
1.
EXECUTIVE SUMMARY
1.1
For some time now, there has been challenge around the capacity of the
occupational therapy teams in North Ayrshire, with people waiting longer than is
desirable for occupational therapy assessment in community care.
In March 2019, a paper was brought to the Integration Joint Board to provide
assurance around the steps already taken to improve the position. A stretch aim
was agreed - that by the end of September 2019, 90% of referrals to community
care occupational therapy will be seen within eight weeks of referral.
This paper summarises the steps taken since February, provides update on the
improving waiting time position, and proposes actions to further improve the position.
2.
BACKGROUND
2.1
The primary goal of occupational therapy is to enable people to participate in the
activities of everyday life. Occupational therapists achieve this outcome by working
with people and communities to enhance individuals’ abilities to engage in the tasks
or activities they want to, need to, or are expected to undertake, or by modifying the
89
occupation or environment to better support function.
2.2
The scope of this paper pertains to the occupationai therapy input provided by those
teams employed by North Ayrshire Council which have traditionally sat within the
community care teams.
These teams provide assessment and interventions which promote independence,
keep people at home, and at their functionai optimum. Traditionaiiy the focus of
such input has been mainly around the provision of equipment - such as, for
exampie, toileting equipment, bath lifts or environmentai adaptations - from the
provision of a ramp, shower adaptation, or stair lift, through to complex major
extensions to properties.
2.3
In March 2019, a paper was tabled at the Integration Joint Board (IJB) to advise on
the current waiting time position for occupationai therapy assessment within the
community care teams in North Ayrshire, progress made to date to reduce these
waiting times, and actions planned to further improve this position.
2.4
Despite the range of improvement initiatives already progressed, the paper
highlighted that as of February 2019, waiting times for occupational therapy
assessment in North Ayrshire remained higher than acceptabie. Although the paper
highlighted some variance across teams, as of February 2019 there were 226
peopie waiting an average of 105 days for occupational therapy assessment.
2.5
In March 2019, the IJB noted the contents of the paper tabled, and approved the
action pian outlined in the paper. The IJB requested an update paper be brought
back to update as to progress made.
2.6
This paper buiids upon the March 2019 paper, and provides update on
• Current wait times for occupational therapy assessment
• Actions progressed in the iast six months
And outlines plans for continued improvement
3.
UPDATE POSITION SEPTEMBER 2019
3.1
ACTION PLAN UPDATE
Tabie 1 below provides update against each of the actions approved in March 2019:
Table 1
Action
Update October 2019
3.1.1
A Quality Improvement
approach is being progressed,
with a stretch aim set that:
‘90% of referrals to the
occupational therapy team are
seen within 8 weeks of referral,
by the end of September 2019’
The aim was agreed and has focussed efforts in its pursuit.
A suite of measures are being used to monitor progress and
consider impact. These are presented in section 3.2 of this
paper.
In August 2019, 76% of referrals to occupational therapy in North
Ayrshire community care were seen within eight weeks of referral.
90
3.1.2
Equipment training wiil be An element of equipment training has continued, alongside joint
rolled out across other working to promote confidence and competence amongst staff
professional groups, to groups who would not traditionally provide such equipment,
improve early access to low freeing up the specialist occupational therapy time and skills for
risk, high volume equipment, complex cases.,
and protect occupational
therapy capacity and specialist Further discussions are planned, with the appropriate stake
skill set for more complex holders to support roll out of this approach across wider staff
situations. groups.
3.1.3 Professional triage of Triage of referrals by the Senior Occupational Therapists has
occupational therapy referrals continued, aligned to the Intermediate Care and Rehabilitation
through the IC& R hub will hub, with a significant proportion of requests for assistance being
continue, with a ‘rehab first’ streamed to other community rehabilitation options, in support of
approach being promoted a right service, right time approach.
wherever possible.
Further, this provides a new assurance that for those who do
require to wait, they are waiting in the right place, with risk
managed - urgent need being passed to Intermediate Care Team
for immediate response.
3.1.4 Flousing options approach will Flousing options‘train the trainer’training has been completed,
continue, with plans to train Officers from North Ayrshire Health and Social Care Partnership
local staff to become trainers (HSCP) are currently working with the other two Ayrshire Local
in this approach; cascading a Authorities to provide a sustainable training programme in
‘housing options’ approach Ayrshire and further embed this approach across practice,
across services which enables ensuring early conversations with people around the long term
practitioners to have early sustainability of home accommodation.
conversations with regards to
long term suitability of homes
3.1.5 Internal professional work will Joint working continues to embed across occupational therapy
continue, promoting joint within NAHSCP, with mentoring approaches enabling
working, joint training and straightforward adaptation work to be progressed without onward
reducing unnecessary referral.
transitions between the
different components of the The Complex Case forum has reduced in frequency as a result of
occupational therapy regular professional supervision, and associated decreased
profession in North Ayrshire demand for such a forum.
3.1.6 The occupational therapy The timescales associated with recruitment processes have
workforce will be increased, meant that some appointees to these temporary posts have only
within existing available taken up post in recent weeks with others still awaiting confirmed
resources, to create additional start dates. An appropriate level of induction will require to be
capacity and further narrow the completed before the value of this additional capacity can be
gap between referrals and realised.
allocations.
In addition, movements within the existing workforce, and a 10%
Use Care & Repair budget of absence rate have further limited the availability of occupational
E125K , to employ additional therapy over the last few months,
assessment and review
capacity as follows: As a result, despite timeous action to recruit as approved,
• North -1WTE OT, for additional capacity within occupational therapy has not yet been
11 months experienced
• South-1 WTE OT&
0.5 WTE OTA, for 11
months
• Extend the 3 Senior
OT grade 11 for 12
months.
91
3.2 CURRENT WAITING TIME POSITION
3.2.1 As of the 1®' September 2019, there were 195 people waiting an average of 65 days
for occupational therapy assessment in North Ayrshire.
Since the last report to IJB in March 2019, there has been little significant change to
the number of people waiting for assessment.
There has, however, been an increase in the number of referrals received, and
continued challenge around the capacity of a small and fragile workforce.
Despite this, the average waiting time has considerably decreased to 65 days,
bringing achievement of the set aim closer.
Performance is illustrated further through the following charts:
3.2.2
Chart 1 - Percentage of People Being Seen by Occupational Therapy Within
Eight Weeks of Referrai
% Seen within 8 Weeks of referral
%
median
66.5 %
Month Sep 2018 to Aug 2019
92
3.2.3 Chart 2 - Number of People waiting for occupational therapy assessment in
North Ayrshire
Number of people waiting for Occupational
Month - Sep 2018 to Aug 2019
median
185
people
3.2.4 Chart 3 - Average Wait, in days, for occupational therapy assessment in North
Ayrshire
Average Wait, in days, for occupational therapy
assessment in North Ayrshire
93
3.2.5
Chart 4 - occupational therapy Referral Information
Number
of
referrals
per
month
Occupational therapy Referral Information
■ number of
new referrals
jii Referrals
triaged to
other service
I I I I
Q.
>
u
CL)
D
o
cu
LTi
o
"Z.
Q
cuo
3
<
Month Seo 2018 to Aug 2019
4.0 PROPOSALS _
4.1 Despite the small scale, and fragile nature of the substantive workforce, coupled with
increased demand for occupational therapy, it is encouraging to see that the
average days waiting for assessment has reduced considerably since the paper
brought to IJB in March 2019.
Further, there can be a level of assurance accepted that the triage approach is
ensuring people are streamed quickly to the service most likely to best meet their
needs, and that those who do require to wait for occupational therapy assessment
are those people who require such specialist assessment, with high risk cases being
addressed appropriately.
That said, there has been little change in the number of people waiting for
occupational therapy assessment, and the overall aim has not yet been achieved.
It is, therefore, proposed that the improvement approach continue, with the following
focus:
• Continue the triage approach to referrals, with a focus on process to ensure
maximum efficiency
• Continue the internal professional work around joint working and supervision
to support effective, safe, evidence-based practice which takes a ‘rehab first’
approach
• Continue to progress plans around equipment training; to protect specialist
occupational therapy capacity for complex cases and improve experience
around access to simple, low risk equipment solutions.
• Continue work with electronic systems to ensure accurate data for
performance monitoring and reporting
• Given the timescales around recruitment, and within recurring available
finance, seek to extend new recruits beyond original timescales.
94
4.2
Anticipated Outcomes
The approach taken to date, and outlined as planned above, seeks to ensure the
best outcomes for the people of North Ayrshire, and best use of the occupational
therapy resource available.
4.3
Measurinq Impact
A suite of measures including referral numbers, service activity, and waiting times
will continue to be monitored, with regular reports to the Director of North Ayrshire
HSCP, and North Ayrshire Health and Care Governance group, and future update
report back to IJB on progress.
5. IMPLICATIONS
Financial:
Nil
Human Resources:
Nil
Legal:
Nil.
Equality:
Nil
Children and Young
People
Nil.
Environmental &
Sustainability:
Nil
Key Priorities:
The content of this paper relates to the HSCP’s strategic
priorities around early Intervention and prevention, and bringing
services together
Risk Implications:
The steps already taken, and actions proposed in this paper
seek to mitigate risks associated with people waiting for
community care occupational therapy assessment
Community
Benefits:
Nil
Direction Required to
Direction to
Councii, Heaith Board or
1. No Direction Required
X
Both
2. North Ayrshire Council
3. NHS Ayrshire & Arran
4. North Ayrshire Council and NHS Ayrshire & Arran
6.
CONSULTATION
6.1
The attached report has been developed in consultation with the Senior
Occupational therapists, the AHP Leadership team, and the Community Health and
Care senior management team in North Ayrshire.
7.
CONCLUSION
7.1
This paper has provided update to the Integration Joint Board on :
95
The improving waiting time position for community care occupational therapy
assessment in North Ayrshire
And
Actions planned to further improve this position
The IJB are asked to :
Note the content of this paper
Approve the actions proposed within, to further improve this position
For more information piease contact
Alistair Reid, Lead Allied Health Professional on 07825227834 or
Alistair.Reid@aapct.scot.nhs.uk ,
Or
Helen McArthur, Principal Manager, Health and Community Care Services on 01294
317883 or hmcarthur@north-avrshire.qov.uk
96
Agenda Item 10
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
24th October 2019
Subject:
Caring for Ayrshire - Project Initiation Document [PID]
Purpose:
The purpose of this report is to seek approvai from North Ayrshire
Health and Social Care Partnership IJB of the Caring for Ayrshire -
Project Initiation Document [PID], along with the associated
governance structure being put in place.
Recommendation:
The North Ayrshire Health and Social Care Partnership IJB is asked
to:
•Approve the Caring for Ayrshire Programme - Project Initiation
Document [PID]
•Accept North Ayrshire Health and Social Care Partnership have a
significant role within the programme; and
•Approve the governance structure and supporting processes
contained within the PID
Glossary of Terms
NHS AA
NHS Ayrshire and Arran
PIA
Programme Initial Agreement
PID
Project Initiation Document
SCIM
Scottish Capital Investment Manual
SPOG
Strategic Planning & Operational Group
1.
EXECUTIVE SUMMARY
1.1
The purpose of this report is to seek approval from North Ayrshire Health and Social
Care Partnership IJB of the Caring for Ayrshire - Project Initiation Document [PID],
along with the associated governance structure being put in place.
1.2
The Caring for Ayrshire Programme - Project Initiation Document has been
developed to provide all key phases and stages, delivery methodologies, key
milestones in support of the project as well as how it will be governed.
1.3
The PID was reviewed, discussed and supported at the 21 August 2019 meeting of
the Caring for Ayrshire Programme Board and a number of recommendations and
enhancements were proposed which have now been incorporated into the updated
draft PID for your endorsement. To ensure realignment of the governance route the
PID was re-submitted to the Caring for Ayrshire Programme Board on 19 September
2019 and to the Integrated Governance Committee on the 18*^ September 2019.
97
2.
BACKGROUND
2.1
Caring for Ayrshire is the whole system health and care service redesign over that
10 year strategic direction and beyond as opposed to any redesign or change that
would be over a shorter timescale.
Due to a wide range of factors that are not unique to Ayrshire, it is evident that we all
need to adopt and embrace new ways of delivering our health, social care and
wellbeing services, for future sustainability.
A PID was developed to inform the Caring for Ayrshire Programme Board on the
programmes aims and objectives in delivering a whole system redesign approach
across Ayrshire & Arran in terms of our health and care services. In addition to this,
it outlined all key phases and stages, delivery methodologies, key milestones
encompassing our stakeholder engagement and communication activity along with
the recommended governance and management structure.
Commitment along with successful engagement and collaboration with North
Ayrshire Health and Social Care Partnership will be key to delivery and
implementation of the programme, along with working with our local authority and
community based stakeholders.
3.
PROPOSALS
3.1
In recognition of the Caring For Ayrshire Programme, the PID has been developed
outlining the aims and objectives along with all key phases and stages and the delivery
approach. This has been endorsed at both the Caring for Ayrshire Programme Board
and Integrated Governance Committee, and we are now seeking approval from North
Ayrshire Health and Social Care Partnership.
3.2
Anticipated Outcomes
The overall outcomes of the Caring for Ayrshire Programme is to redesign and
implement a whole system approach to our health, care and wellbeing services, with
a view to that 10 year strategic vision and beyond in meeting our demands across
Ayrshire and Arran. This can only be completed by working with our Joint Integration
Boards, as we look to transform services with a more community based focus, in
delivering and meeting the needs of our citizens with the right care in the right place
at the right time.
3.3
Measurina Impact
As part of the Caring For Ayrshire programme there will be benefits realisation carried
out when implementing and delivering the capability of transformed health, care and
wellbeing services. By collaborating with North Ayrshire Health and Social Care
Partnership, we aim to jointly agree and track key performance indicators, along with
outcomes and value In redesigning and transforming services. This will become more
evident with further joint engagement under our scoping, planning & development
phases.
98
4. IMPLICATIONS
Financial:
NHS Ayrshire & Arran have been allocated some initial funding
from Scottish Government for this current finical year 2019/20,
to allow the programmes initiation phase to commence along
with some early discovery. The approach will be to follow the
Scottish Capital Investment Manual (SCIM) process, and in
recognition of the approach Caring for Ayrshire programme, will
look to develop a Programme Initial Agreement [PIA].
At this stage there are no immediate financial implications,
however through developing the PIA, and specifically the
finance and economic cases on how future health, social care
and wellbeing services will be redesigned and transformed,
implications on finances will be reviewed.
Human Resources:
There are currently no direct Human Resource implications, but
it needs recognising that successful delivery and close joint
working with North Ayrshire Health and Social Care Partnership
will be embedded within the programme.
At this stage no specific identification of key stakeholders has
been made into who will be required to support and assist with
redesigning our future services
It is however envisaged this will be on a more matrix
engagement rather than dedicated full time
Legal:
At this stage we do not foresee any policy or legal implications.
Equality:
As part of our Scoping phase of the programme we aim to
undertake an Equality Impact Assessment, involving all
partnerships as well as key internal and external stakeholders.
The outputs of the assessment will be shared once available.
Children and Young
People
At this stage we have not been able to quantify the impact with
the Children and Young People’s services, however recognise
the importance of factoring in such services for the future and as
part of the wider programme.
Environmental &
Sustainability:
At this stage we are not able to clearly identify the implications on
the environment, however through close working collaboration
with North Ayrshire Health and Social Care Partnership,
throughout the lifecycle of the project these will become more
apparent as and when uncovered.
Key Priorities:
We envisage this programme of work being fundamental in
support of North Ayrshires Health and Social Care Partnerships
priorities, as well as the wider Ayrshire and Arran health, care and
wellbeing services.
Risk Impiications:
A risk register for the programme is in development, and through
joint working with our Strategic Planning & Operational Group
[SPOG] membership will be producing a more detailed risk and
issue log that can be made available.
However it can be noted we have articulated some initial high
level risks, issues and dependencies, which can be found within
the PID [See section 8].
Community
Benefits:
At this stage we are not able to clearly identify all the community
benefits, however through close working collaboration with North
Ayrshire Health and Social Care Partnership, throughout the
99
lifecycle of the project these will become more apparent under the
planning and development phases. _
Direction Required to
Direction to
Council, Health Board or
1. No Direction Required
Both
2. North Ayrshire Council
(where Directions are required
3. NHS Ayrshire & Arran
piease compiete Directions
Tempiate)
4. North Ayrshire Council and NHS Ayrshire & Arran
X
5.
CONSULTATION
5.1
By working within the existing governance and close working relationships with our
Strategic Planning & Operational Group, the programme of work and related activity
is being reviewed and monitored on a regular basis, providing a collaborative and joint
approach in delivering a whole system approach around redesigning health, care and
wellbeing services.
6.
CONCLUSION
6.1
• Approve the Caring for Ayrshire Programme - Project Initiation Document
(PID);
• Accept North Ayrshire Health and Social Care Partnership have a significant
role within the programme; and
• Approve the governance structure and supporting process contained within
the PID.
For more information piease contact Stephen Brown on xxxx xxxxxxx or
SBrown@north-ayrshire.gov.uk
Stephen Brown
Director for Health and Sociai Care
North Ayrshire Partnership
24 September 2019
100
Transformation and Sustainability
Project Initiation Document
Caring for Ayrshire
Contents
Name
Job Title or Role
Signature
Date
Authored by:
Elaine McClure
Russell Scott
Jacqui Stevenson
Portfolio Programme Manager
Senior Programme Manager
Engagement Support Officer
Completion of the following signature blocks signifies the approver has read, understands, and
agrees with the content of this document.
Endorsed by:
Caring for Ayrshire Programme
Board
19‘''Sept 2019
Endorsed by:
Integrated Governance
Committee
Iff'^Sept 2019
Approved by:
NHS Board
East IJB
South IJB
North IJB
Version: 0.4 Date Endorsed: 19/09/2019 Status: Final Page: 1 of 55
Author: Elaine McClure, Portfolio Programme Manager
Russell Scott, Senior Programme Manager
Jacqui Stevenson, Engagement Support Officer
101
Transformation and Sustainability
1.0 Executive Sunnmary.3
2.0 Introduction.4
2.1 Purpose of this document.4
2.2 Overview of programme.4
3.0 Strategic Aims.6
4.0 Local change drivers.7
5.0 Draft Project Governance Structure.9
6.0 Stages of the Project.10
6.1 Initiation.11
6.2 Scoping.12
6.3 Planning and Development.14
6.4 Implementation.16
6.5 Existing Project Activity.18
6.6 The Business Case Process.20
6.7 The Programme Initial Agreement.21
6.8 Ensuring Convergent Planning.24
7.0 Stakeholder Engagement and Insights.25
8.0 Constraints (i.e. Risks / Issues / Dependencies).33
9.0 Proposed Indicative Timeline.34
Appendix 1 - Caring for Ayrshire Stakeholder Engagement and Participation Plan
.36
Appendix 2 - Proposed Caring for Ayrshire Management Structure.44
Appendix 3 - Programme Initial Agreement Phase 1.46
Appendix 4 - Governance - Boards/Groups purpose and memberships.49
Appendix 5 - Primary Care Programme Improvement Plans 2019/20.53
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1.0 Executive Sumnnary
Caring for Ayrshire is the whole system health and care service redesign
over that 10 year strategic direction and beyond as opposed to any
redesign or change that would be over a shorter timescale.
Due to a wide range of factors that are not unique to Ayrshire, it is evident
that we all need to adopt and embrace new ways of delivering our health
and care services. These include but are not restricted to:
• The un-precedented impact of demographic change
• Serious concerns around the sustainability of existing services in
key areas such as workforce, facilities and supporting infrastructure
(including digital)
• Deprivation on our population and the need to address health
inequalities
• The need to adopt and embrace new ways of delivering our health
and care services, for a sustainable future;
On reflection of these concerns, we set out our aims in ‘Our Health 2020
vision’:
• Partnership and co-production between individuals, communities
and the NHS and its partners in the public, third and independent
sectors.
• Deliver a strong local health and social care service, able to support
people in their day to day lives to get the best from their health.
• Shift the focus on making home and communities the main hub for
care, rather than hospitals and institutions incorporating new models
of care.
• Where hospital care is needed, ensure that this is person centred,
safe and effective.
• Promote partnership and co-production between individuals,
communities and all planning partners across the public, third and
independent sectors.
• Ensure that multi-agency pathways are integrated and seamless.
• Maximise the use of technology as an enabler to improve health and
well-being.
• Reduce health inequalities by focusing on prevention, anticipation,
supported self-management and more targeted investment in
services moving forward.
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2.0 Introduction
2.1 Purpose of this document
This document is the Project Initiation Document [PID] for the Caring for Ayrshire
Programme (the Project). Its purpose is to define the project in order to provide a
comprehensive basis for its authorisation and subsequent management with a view
to ensuring its eventual overall success in sustaining future health and care services
across NHS Ayrshire & Arran.
The two primary aims of this document are:
• To set out the purpose and objectives of the project and how it will be
governed, conducted and evaluated, in order to provide assurance that it is
viable and will provide appropriate outcomes. This will provide a sound
basis on which the Programme Initial Agreement - the first key stage in the
formal business case process - will be based, along with an indication of
those resources required to support and ultimately deliver required outputs;
• To act as a base statement against which the Caring for Ayrshire
Programme Board can plan, assess progress, monitor on-going project
viability and report to the Integrated Governance Committee [IGC],
throughout the project therefore negating duplication of effort by ensuring
that the process followed generates the required outputs in all areas.
2.2 Overview of programme
The Caring for Ayrshire Programme will, at a strategic level deliver, a whole
system redesign for NHS Ayrshire & Arran citizens in transforming and sustaining
health and care services.
The programme will be delivered through the work of the
• Clinical Programme Board as design authority for the clinical model for
whole system service delivery.
• Infrastructure Programme Board responsible for the strategic delivery
and prioritisation of tactical and strategic infrastructure developments to
enable the implementation of the clinical model.
• Capital Programme Management Group and Digital Programme
Management Group responsible for the management of tactical
infrastructure programmes (facilities and digital) and their delivery.
• Stakeholder Engagement and Insights Group who will be responsible
for ensuring both internal and external stakeholder engagement
throughout the lifecycle of the programme, whilst supporting the
management of timely communications.
• Project Delivery Team encompassing a relevant subject matter
expertise who will review existing service challenges and risks; scope the
required processes, define the benefits associated with delivering
services differently; outline the key alternative options available; and
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Transformation and Sustainability
come together to support effective whole-system dialogue, engagement,
planning and change under the auspices of the wider project. A
suggested Project Delivery Team structure is included in Appendix 2.
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Transformation and Sustainability
3.0 Strategic Ainns
The project will look to define, design and implement a whole system redesign
underpinned by developing models of health and care across NHS Ayrshire &
Arran. Strategic aims are to:
■ Develop a coherent and cohesive strategic vision for the future provision of
sustainable services within NHS Ayrshire & Arran;
■ Engage with the public, patients and staff in developing this vision;
■ Develop long term sustainable infrastructure, including facilities and
supportive infrastructure along with technical architecture that is able to
deliver this vision;
■ Link national strategy, local strategies, professional guidance and identify
best practice with proposals to meet identified local need;
■ Develop coherent models for health and care service provision that, when
implemented, will ensure the delivery of efficient and effective services that
are appropriate to the needs of the local population;
■ Recommend models for service delivery that encapsulate the total patient
journey, paying particular attention to the primary/secondary care interface;
■ Develop recommendations that are specific, realistic, time-bound and costed
in order to ensure transition from project development to implementation
phases;
■ Ensure that all resources assigned to the project are utilised in an effective
and efficient manner in order to secure the delivery of the project aims;
■ Align and incorporate all project outputs into the relevant national business
case process, as identified in the Scottish Capital Investment Manual (SCIM),
in order to ensure that any funding required is fully understood; appropriately
presented; and secured timeously.
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Transformation and Sustainability
4.0 Local change drivers
In addition to the national requirement to review health and care services, there are
a number of pressures and other change drivers impacting on the provision of
services locally. These drivers can be considered under the two key headings
clinical issues and management issues. These are detailed below:
Our population is getting older - More people are living into old age, and whilst
this is good news, it does bring with it some challenges. Demand for health and
care services is ever-increasing as people live longer but people are often now
living with multiple long-term conditions, reduced independence, and increasingly
complex need for health, care and social support. We need to make sure that
people lead not just longer lives, but longer, healthier lives.
Poor health - We are fortunate in Ayrshire and Arran to live in a beautiful part of
Scotland with a mix of urban and rural areas and scenic coastline and Islands.
However, we do face challenges due to the need to better support those people
living in our poorer and more rural communities who face increasing levels of
poverty, social isolation and loneliness. Often as a result of the complex
interaction between health and social needs, there is a higher instance of illness
and poor health in some parts of Ayrshire and Arran than other areas of Scotland.
Examples include higher than average deaths and hospitalisation rates due to
chronic heart disease, cancer, stroke, COPD and asthma; higher than average
child obesity rates; and increasing rates of dementia, Alzheimer’s disease,
depression and drug-related deaths.
Our staff - To provide high quality health and care services we need the right
number and the right mix of well-trained staff. The NHS across Scotland is
experiencing challenges with the way we are able to organise our staff. Some
specialist staff don’t see enough patients to maintain and build their expertise and
sometimes, due to a lack of specialist staff in some areas, people are not able to
see a specialist as quickly as we would like. We also face difficulties in recruiting
to some staff disciplines such as GPs and social care workers. As a result, we
have too many staff vacancies, which often means we need to employ temporary
staff to keep services running which is very expensive and impacts on the quality
of care for patients.
Budget - As a publicly funded service we need to make sure we control the
amount of money we spend. One of the biggest challenges we face is that the
costs of providing health and care are rising more rapidly than the budget we have
available.
Buildings are no longer fit-for-purpose - Some of our key healthcare facilities
were built many years ago and are now deteriorating and no longer offer the best
environment for providing modern, high quality health and care. Advances in
surgery, anaesthetics and technology means people no longer need to spend
weeks in hospital and can return home or to a homely setting sooner. However,
despite the developments we do not have the buildings, facilities and
infrastructure needed in our communities to make best use of the advantages that
medical and technological advances can bring.
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Transformation and Sustainability
Access to health and care services - Within Ayrshire and Arran we already
offer a wide range of health and care services in our communities so that people
have access to the healthcare they need as close to their home as possible.
However, many people are still unaware of the wide range of health and care
professionals they can seek help and support from. As a result, the demand on
GP time and the number of people attending at Emergency Departments
continues to increase, often resulting in waiting times that are longer than we
would like. We need to look at how we can better support people to access the
health and care services they need at the right time and in the right place.
Hospital is not always the best place to provide care - Evidence shows that
the best place for people to recover is at home or within a homely setting. Long
stays in hospital negatively impact on a person’s ability to return to normal activity,
particularly for older people. We need to look at different ways to deliver care so
that long stays in hospital are the exception and not the norm.
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Transformation and Sustainability
5.0 Draft Project Governance Structure
DRAFT Caring for Ayrshire Governance Arrangements v 0.08
NHS Ayrshire and Arran
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For further details on the governance boards and groups in terms of purpose and
membership, please see Appendix 4.
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6.0 Stages of the Project
There are four key stages to the development and delivery of the project. Each of these
stages are considered in turn below.
Caring for Ayrshire - High Level Project Stages
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6.1 Initiation
This document is itself the first step towards the initiation of the Caring for Ayrshire
programme. The purpose of this stage is to set out in the broadest terms possible
the need for, as well as the purpose and key phases of the project.
During the initiation stage, commitment will be sought from all key stakeholders and
agencies to participate in the programme and to implement its findings. Also at this
stage, the Caring for Ayrshire Programme Board will be asked to endorse and
commit to the strategic aims of the programme, as well as the structure and process
to take it forward.
Desired Outputs:
■ Commitment to undertaking the programme;
■ Commitment to the strategic aims and objectives;
■ Commitment to project structure, process and high level timelines;
■ Programme Plan in support of delivery;
■ Establishment of Caring for Ayrshire Programme Board; and
■ Identification of key stakeholders
■ Agree Terms of Reference and Governance
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Transformation and Sustainability
6.2 Scoping
On completion of the initiation phase, the Programme Board will lead the formal
scoping of the project and this will clearly set out the boundaries of the programme
through identifying the whole system redesign approach and implementation for
NHS Ayrshire & Arran. This will be done through informing, engaging and
consultation with NHS Ayrshire & Arran staff, Integrated Joint Board staff. Clinical
Groups and the public and patients that our health and care services serve.
It is proposed that a co-design and collaborative approach will also involve members
of the public which will be established to provide a public perspective to this initial
scoping stage. In parallel to this, there will be engagement with staff through various
forums and social media to identify a staff-side perspective on the priorities for review
within this project. The main focus with staff-side will be to scope the models of care
and pathways required to support a whole system redesign across health and care
services in Ayrshire & Arran. Business and Infrastructure [both physical and
technical] will also be scoped in close working relationship with Infrastructure
Programme Board.
Any issues arising through the scoping phase that are of such importance that they
must be dealt with immediately or are of such a nature that they can be addressed
out with the confines of the Caring for Ayrshire programme, should be acted on as
they are identified.
Appendix 1 contains more detail on the proposals for Stakeholder Engagement,
Participation and Communications Plans.
Desired Outputs:
■ Establishment of appropriate engagement and methodologies;
■ Initial scoping of Project Delivery Team, incorporating Business Change
Team with any appropriate working groups defined;
■ Arrange stakeholder events to scope clinical models of care;
• Agreed content/configuration/means of presenting Clinical Models of care;
• Agreed objectives in line with the strategic aims;
• Data analysis of themes from staff and the public to ensure conscientious
consideration to inform next stage
• Undertake Equality Impact Assessment (EQIA)
• Development of robust project plan, including timeline with specific
objectives', and
■ Take account of lessons learned and recommendations from other NHS
Boards.
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6.3 Planning and Development
The planning and development phase of the programme will constitute the main
piece of work with regards to the whole system redesign. Through this piece of work,
the working groups established to examine the models of care identified within the
scoping element of the project will review the existing provision of these services.
This will lead to the identification of any key issues and the development of potential
solutions to these issues. This will result in the development of realistic, robust and
costed action plans detailing how a whole system redesign will be implemented and
provided in the future.
In undertaking this work, the working groups will link closely with the project delivery
team who will provide expert advice on the proposals. The proposals will be
submitted to the Caring for Ayrshire Programme Board at key stages of their
development for additional ‘strategic checks’ to ensure the coherence of the work
across the working groups.
In examining the proposals put forward, the Programme Board will draw on the
diverse range of skills and experience that its members possess but it will also pull
in the resources of the Stakeholder Engagement and Insights Group to ensure a
public perspective on the proposals on the key stages of development.
On completion of the planning and development phase, a robust coherent strategy
will be developed by the Project Team and proposed to the Caring for Ayrshire
Programme Board for submission to IGC, NHS Board and IJBs. Once approval has
been provided by IGC, NHS Ayrshire & Arran Board and IJBs, the draft strategy will
be subject to wide-ranging public consultation and will be used in informing the
development of the Programme Initial Agreement [PIA] required to be submitted to
Scottish Government.
Any issues arising through the planning and development phase that are of such
importance that they must be dealt with immediately or are of such a nature that they
can be addressed out with the confines of the Caring for Ayrshire Programme Board,
should be acted on as they are identified.
Desired outputs:
■ Identified issues within existing service provision;
■ Involvement of all stakeholders including staff, the public and patients;
■ Completion of a whole-system mapping and alignment analysis;
■ Subsequent development of a coherent strategy;
■ Agreement from NHS Board and IJBs to consult on the Strategy;
■ Initial population of the Programme Initial Agreement template; and
■ Established public consultation mechanisms.
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6.4 Implementation
Following finalisation of the draft strategy, it’s recommended that a Project Delivery
Team' will be required to oversee the delivery and implementation of the project,
supported by specific and subject matter expertise resources. These resources will
form part of the Project Delivery Team encompassing a business change team that
will include a combination of staff and public representation, with the necessary skills
and experience and will be responsible for supporting the successful implementation
of the strategic recommendations. See Appendix 2 for proposed high level structure.
The current view would be to develop a more detailed approach, which will look to
draw out the core roles and responsibilities in more detail in support of a Project
Delivery Team, in support of the implementation phase. The approach will also
look to outline the key deliverables, aims and objectives of the team and how it will
be governed for the project implementation activity.
Any issues arising through the Implementation phase that are of such importance
that they must be dealt with immediately or are of such a nature that they can be
addressed out with the confines of the Caring for Ayrshire Programme Board, should
be acted on as they are identified.
Desired outputs:
■ Established Caring for Ayrshire project delivery team, with whole system
redesign business change team embedded supporting by relevant working
groups as defined;
■ Collaborative approach embedded for co-design and user centred
approach;
• Agreed project plans and reporting structures in place;
• Development of a range of additional business case elements as required
by the preferred options agreed in discussion with Scottish Government.
This may include Outline Business Cases, Full Businesses Cases;
Standard Business Cases; locally funded elements; and requests for
alternative funding, e.g. Section 75 agreements.
• Benefits Realisation outcomes;
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6.5 Existing Project Activity
It is important to recognise that this strategic process will be required to incorporate
a number of valid projects and related activities that are already underway. This will
include:
• The development of an Initial Agreement related to the delivery of sustainable
services on Arran, a long-standing area of concern;
• Early discussion on potential changes to the service delivery model for
Cumbrae, restricted to the collection and collation of data and information
required to inform any future model of care for the island in reflection of its
unique circumstance;
• Option appraisal activity to support the consolidation of in-patient mental
health services at Woodland View in line with previously agreed strategy;
• Option Appraisal on East Ayrshire Community Hospital [EACH] whose PFI
contract expires in 5 years with a mandatory 4 year notice period.
In parallel to the Caring for Ayrshire Programme, we need to be very cognisant and
recognise existing activity as noted above, along with synergies with our major
transformational programmes of work already in progress within NHS Ayrshire &
Arran and Health and Social Care Partnerships. One programme in particular is
that of the Primary Care Improvement Programme for a Pan Ayrshire approach,
which in collaboration with the Health and Social Care Partnerships and Integration
Joint Boards are delivering on the commitments set out in the new General Medical
Services (GMS) contract.
6.5.1 Primary Care Improvement Programme [PCIP]
Integration Authorities, the Scottish GP Committee (SGPC) of the British Medical
Association (BMA), NHS Boards and the Scottish Government have agreed
priorities for transformative service redesign in Primary Care in Scotland over a
three year planned transition period. These priorities include vaccination services,
pharmacotherapy services, community treatment and care services, urgent care
services and additional professional services including acute musculoskeletal
physiotherapy services, community mental health services and community link
worker services. This is to support and underpin the national aim to enable GPs to
use other skills and expertise to do the job they train to do, with the view of
refocusing the GP role will the notion of health care services being delivered and
supported via a wider primary care multi-disciplinary team - where it is safe,
appropriate, and improves patient care.
Within NHS Ayrshire & Arran, a dedicated Primary Care Programme have been
working on delivering a number of key objectives in meeting the aims and
objectives, along with looking at a more Multi-Disciplinary Team [MDT] adoption
across Ayrshire and Arran. A number of commitments have been agreed in
collaboration with each of the HSCPs and have outlined their targets and
deliverables up to 2022.
Having sight on these within the Caring for Ayrshire Programme along with being
informed of progress throughout the programme will be important to ensure
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Strategic alignment to the delivery of a whole system redesign approach, therefore
close working relationships should be embedded between both programmes.
See Appendix 4 - Primary Care Programme Improvement Agreed Plans for
2019/20
6.5.2 Primary Care Improvement Programme Engagement and Communication
The Primary Care Improvement Programme have recognised the need for an
ongoing commitment to redesign Primary Care services, engaging fully with GP
colleagues, the public, along with all other stakeholders and partners. Since the
development of the PCIP there have been a series of engagement events with GP
Practices, Clusters and discussions at HSCP GP Locality Forums, where there has
been opportunity to involve GP Practices in plans and decision making. HSCPs
have included primary care as part of the engagement with the public for their
strategic plans. In undertaking the review, the Implementation Support Team have
noted a need to strengthen regular updated communication to all stakeholders and
this will be in the form of a snap shot newsletter each month from the team.
The pan Ayrshire Engagement and Communication Group, chaired by the Head of
Primary Care and Out of Hours Community Responses, have produced a
Communication Plan for the duration of the PCIP. The communication objectives of
the plan are to ensure:
Pathways to Access Care:
• Engaging and informing the public and professionals of new pathways of
care within Primary Care to ensure people access the right service at the
right time
• Contributing to pan Ayrshire work to inform self-care, self-management
and supportive and connected communities.
• Linking with pan Ayrshire health and social care work communicating
new pathways of care
Engagement:
• Continuous engagement, including mapping all our stakeholders
• Regular stakeholder engagement events with specific services as well as
overall informative sessions
Communications
• Internal and external communications
• An online and social media presence
• Opportunities to share best practice, news and invite feedback
The communication plan will also link to each of the HSCP communication
plans as well as the NHS Ayrshire & Arran communication plan.
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119
Transformation and Sustainability
6.6 The Business Case Process
NHS Scotland’s business case process, which represents the defined investment
route for the programme, is laid out in the Scottish Capital Investment Manual.
(SCIM). This defines three main stages or phases requiring local, regional and
national review and approval:
• Phase 1: The Initial Agreement (lA) relating to initial scoping;
• Phase 2: The Outline Business Case (OBC) relating to pre-procurement
planning and;
• Phase 3: The Full Business Case (FBC) relating to selection of a
solution/procurement following competition.
The Caring for Ayrshire programme will be working within the boundaries of the NHS
Scotland Business Case process, and to ensure appropriate elements are covered
and supported, key senior management within NHS Ayrshire & Arran will be having
close and regular communications with Scottish Government to clarify the
requirements and needs throughout.
http://www.scim.scot.nhs.uk/
Service- Plarawr^
r 1
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r
Local Delrvery Plan
Si Evahialioin {PME]
(LDPJ
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I n rllal Agree me nt
(I A)
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Transformation and Sustainability
6.7 The Programme Initial Agreement
The global investment strategy proposed for the overall Caring for Ayrshire
programme requires a different but not totally unique first stage of the business case
process to be presented to Scottish Government. This must recognise how all key
partners have reviewed, prioritised and scheduled proposed future developments in
an appropriate strategic context, thereby ensuring that the right investment decisions
are being taken at the right time for the right reasons as components of an over¬
arching integrated strategy.
This strategy, which is being discussed extensively with the Scottish Government,
sees a single “programme” business case as the primary output of the first stage of
this business case process that documents the strategic planning undertaken;
defines the key projects required to deliver the necessary changes; and presents an
indicative “preferred way forward” on a themed/domains basis that can be explored
further through the detail presented in future individual business cases identified
within it. Effectively, this “programme” document is intended to act as the “Initial
Agreement” (lA) stage for the whole process, in the understanding that individual
investment elements identified will still require subsequent individual business case
stages to be progressed albeit without the need for separate lA’s.
In recognition of the approach being adopted under the SCIM process, in support
of the Caring for Ayrshire programme, it is proposed to develop a Programme
Initial Agreement [PIA] using a phased development methodology, thus working on
proposals in parallel with the new models of care service redesign activity. This
could conceivably be split into two distinct phases, with the notion of having a more
comprehensive worked through PIA following the post consultation activity and
analysis that will need to be completed. By adopting this method it would ensure
engagement from the outset, openness and transparency throughout with key
stakeholders, look to reduce on timescales for any formal submission, remain
aligned with Scottish Government and Scottish Health Councils procedures and
potentially avoid duplication of effort whilst mitigating any major risks and concerns.
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Transformation and Sustainability
6.7.1 Phase 1
The proposal would be to start drafting an initial PIA, covering the Executive
Summary, outlining the Strategic Case, provide early Economic Case, indicative
Financial Case and Commercial Case, with a high level Management Case in
support of the Caring for Ayrshire Programme aims and ambitions, of new models
of care within NHS Ayrshire & Arran.
This will look to provide the context of what this programme is about, existing
challenges and current need for changes, proposed outcomes and benefits in
new models of patient care.
This should also summarise a high level indicative Rough Order of Magnitude
[ROM] cost for investment requirements associated with changes in the model of
service care delivery and identify the strategic / service possible options around
new models of care to be taken forward to OBC stage.
It is expected that any service planning necessary to support such changes has
already been carried out, as identified within the Strategic Assessment and that
NHS Ayrshire & Arran have sought and followed the advice from the Scottish
Health Council on the level of public and stakeholder engagement expected both
prior to and beyond this stage.
A description of the existing services / activity provision including information,
where relevant for NHS Ayrshire & Arran and the Health and Social Care
Parternships will be summarised in covering current models of care, acute
services, primary care, outpatient services, community services etc. Phase 1 will
also look to conduct baseline assessment in capturing the analysis on all
locations of these services and who is delivering such services.
We will also look to indicate and highlight the need for change to current
services, describe new models of care drawing from the outputs from the
discovery and defining stages of the service redesign and co-creation activities,
with high level indicative costs in support of transforming services and being able
to sustain a quality health and care service to citizens across NHS Ayrshire &
Arran.
See Appendix 3 for further details on initial PIA construct in support of Phase 1.
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JacquI Stevenson, Engagement Support Officer
122
Transformation and Sustainability
C5:rinB for Ayrshire - High Lovet Pncsject Stages
K ■
f V -i-:
iropanfl
P|»rin*ne 5
□evebomenT
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6.7.2 Phase 2
It is recommended to ensure our formal post - consultation activity has been
completed, prior to completing phase 2 development of the PIA. This would allow
the programme in taking account the feedback along with ensuring NHS Ayrshire &
Arran, HSCPs and IJB’s have been consulted on the analysis and outcomes of the
consultation process and outcomes on any new proposed models of care.
The suggestion would be to look at updating the PIA, with additional information, or
indeed making any amendments to the phase 1 submission based on the
proposals in support of whole system redesign models of care, and agreement
from the respective governance boards prior to the formal implementation phase.
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Transformation and Sustainability
6.8 Ensuring Convergent Planning
Based on the experience gained from previous programmes, advice from other
stakeholders and learning from other NHS boards it is recognised that a key
challenge associated with any complex strategic planning process is to ensure
convergence in services planning. This is especially important when different groups
are responsible for initial discussion relating to different highly specialised areas
within the overall strategy as is the case here.
Within the Caring for Ayrshire Programme, this issue could be addressed through:
• Establishing the proposed governance structure that demonstrates
appropriate levels of management and control.
• Agreeing clear terms of reference and remits for any “control groups” and all
sub-groups generating outputs at the outset.
• Clearly stating any questions/issues that should be responded to along with
the format any response is expected in. Not just to ensure due process is
followed - but also to ensure that essential business case requirements are
met. (Failure to do this will result in duplication of effort and cost).
• Building in opportunities for the sharing of ideas and “cross-referencing” on
developing thinking and challenges between sub-groups as the process
moves forward.
• Formally planning for the process/event that will seek to bring potentially
disparate thinking together into an appropriately considered overarching
position moving forward.
It is therefore recommended that the programme undertakes some form of whole-
system mapping and alignment analysis workshop’, whereby representatives of
the various planning groups are asked to take part and respond to proposals,
challenges, how things maybe different along with any working assumptions. This
will help support the overall programme, confirms any gaps, overlaps or divergence
in thinking. It also confirms clarity on global proposals moving forward and is
essential to effective progression including supporting the business case
development process.
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Transformation and Sustainability
7.0 Stakeholder Engagement and Insights
In support of delivering the Caring for Ayrshire Programme there will be the need to
continue the stakeholder engagement and insights along with communications,
throughout. In support of a ‘whole system’ co-creation and redesign approach
around models of care as outlined, there will be open and transparent engagement
both with internal and external stakeholders, as well as public engagement
throughout, to aid informing and shaping the project as well as supporting the future
implementation. Identifying, developing and maintaining inclusive relationships with
a portfolio of key stakeholders, networks and partnerships across multiple sectors,
including the people of Ayrshire & Arran, the public sector, independent and the third
sector, will be paramount in facilitating user insights and opportunities for actively
engaging with and working in collaboration with NHS Ayrshire & Arran and Health
and Social Care Partnerships.
The Stakeholder Engagement and Insights Group [still to be formally formed and
established] will provide management oversight and governance, drawing upon the
Scottish Approach to Service Design principals [see link to webpage below],
ensuring a ‘user centred, researched based’ methodology, incorporating Co
design, iterative and collaborative approach to delivering the project. By adopting a
structured Service Design framework and approach, the Stakeholder Engagement
and Insights Group will be able to support and assure the delivery of a whole
system redesign, aligned to the projects high level stages.
https://www.qov.scot/publications/the-scottish-approach-to-service-desiqn/
Appendix 1 - Caring for Ayrshire Stakeholder Engagement, Participation and
Communications Plan, provides a breakdown on the approach, activities, outputs
and resources being proposed in support of the programmes aims and objectives.
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Jacqui Stevenson, Engagement Support Officer
125
Transformation and Sustainability
The Scottish Approach to Service Design
This approach to service design means that people who work or access the
services will have time to understand the problem they’re faced with from a range
of perspectives, before they create a solution. The Design Council’s Double
Diamond model is a visual diagram showing these design stages.
The Double Diamond shows the importance of taking time to understand the
problem before designing solutions. Each diamond shape illustrates the process of
creating or exploring many possible ideas before refining these to the best idea.
The first diamond does this to confirm the problem, and the second to design the
solution.
Caringfor Ayrshire Service Design Approach _
Understand Design
the problem the solution
The seven principles to service design are described below.
The 7 principles of the Scottish Approach to Service Design
We explore
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Transformation and Sustainability
7.1 Stakeholder Engagement and Communications Progress
A significant amount of stakeholder engagement and communication activity has
been undertaken already as part of the Early Pre Engagement Phase. This has
enabled us to gain some early insights, views, and concerns from both internal and
external stakeholders as well as having the opportunity to set the scene around the
programme ambitions.
The following outlines the activity to date:
Internal Staff Engagement - May 2018 to July 2019
• CEO-led staff briefing sessions
o 3 X Senior manager briefings (for onward cascading to teams) [May -
June 2018]
o 7 X Staff discussion Sessions [June - July 2018}
o 6 X Leading reform sessions across UHA and UHC [Feb - Mar 2019]
o 9 X Participating and contributing to reform sessions across various
locations [June - July 2019]
o 6 X Delivery plan sessions with Acute, Medical Services/Specialties and
Obstetrics and Gynaecology [Feb - Apr 2019]
• Employee Director-led staff focus groups (Jul 18 to Dec 18) - report available.
Key Agency/Partner Engagement - June 2018 - June 2019
• 16 X CEO-led briefing sessions with MPs and MSPs, Elected Members across
North, East and South Ayrshire, IJB Chads, North, East and South Executive
Officers Community Planning Partners, Public Involvement Groups, East
Ayrshire Children’s Cabinet, Scottish Government and Ayrshire College health
and social care students
• Engagement Support Officer - Key Partner Engagement
o Public Engagement Group (Nov 2018 to Apr 2019) - membership of the
pan-Ayrshire Public Engagement Group has been reviewed with
additional input secured from operational engagement staff within
Health and Social Care Partnerships, third sector, independent care
sector. Public Health and Primary Care Improvement Programme, in
addition to existing NHS/HSCPs Communications and Engagement
leads and Scottish Health Council - group continues to meet bi¬
monthly.
o NHS and Local Authority Communications Leads (Jan 19) - co¬
ordination of internal communications processes agreed to be able to
more easily share information with staff across NHS and the three
Health and Social Care Partnerships (HSCPs).
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127
Transformation and Sustainability
o Formal presentations and/or input into various planning forums
including North Ayrshire Community Engagement Network, Scottish
Health Council, Ayrshire Equalities Partnership, Clinical Programme
Board Stakeholder Event, East Ayrshire H&SCP Stakeholder Forum
and Strategic Planning Group and Strategic Service Change
Programme Managers - [Dec 2018-June 2019]
o Early discussions exploring potential for joint-working/future strategic
partnerships with key organisations support target stakeholder groups
including Ayrshire College, Children Centrestage Catalyst Project
and East Ayrshire What Matters 2 U Project- [June 2019j
Communication Methods
• Information Materials
o Development and promotion of leaflet and postcard.
o Engagement briefing pack issued to all Public Engagement Group
members to enable them to deliver Caring for Ayrshire Conversations
across Locality Planning/Community Settings (200 hard copies since
distributed by South Ayrshire Community Engagement Officers and 100
copies distributed by Scottish Health Council Local Officers).
o Stop Press; Daily Digest; News Flash; Dialogue regularly promoting and
encouraging staff participation in Caring for Ayrshire Programme.
o Articles within newsletters e.g. Public Involvement Network.
• Online Communications
o Updated web presence through launch and regular updating of the
Caring for Ayrshire ‘micro-site ’ ( www. nhsaaa. net/caringforavrshire) .
o The launch of the Caring for Ayrshire animation with almost 700 views
online since publication on 17 January 2019
(httDs://vimeo.com/311926569) .
o Social media campaign (Facebook and Twitter).
Discovery Insights
• Caring for Ayrshire Conversations (467 anonymous comments themed as a
result of face-to-face Caring for Ayrshire Conversations with over 170
individuals)
• Two multi-stakeholder Caring for Ayrshire Conversation events (April
2019). A copy of the presentation delivered at each event is available
at httDs://www.nhsaaa.net/media/7017/carina-for-avrshire-conversation-
DOwerpoint-Dresentation.Ddf) . The events were attended by 63
individuals representing health and care sector staff (including third
and independent sectors); education sector; locality planning groups;
community councils; and interested members of the public.
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Transformation and Sustainability
Furthermore, 42 of those individuals have since expressed interest in
taking up a Public Partner role to support delivery of the Caring for
Ayrshire Transformation Programme.
o 5 X focused group and individual discussions with a range of individuals
attending community groups or events (resulting in an additional 108
individuals participating in face-to-face Caring for Ayrshire
Conversations), including North Ayrshire All Together Now, Ayrshire
Self-Management Network, Branching Out Community Initiative and
East Ayrshire Carers Centre - [May -July 2019]
• 7 X Information stalls at various community events across Ayrshire to
raise awareness of the Caring for Ayrshire Transformation Programme
and the need for health and care services to change reaching almost
1200 individuals. This included Public Involvement Network Group
Development Day, East Ayrshire Getting Together Event Planning Day,
East Ayrshire Getting Together Event, East Ayrshire Strategic Planning
Group, East Ayrshire Getting Together Event, North Ayrshire Fairer
Food Participatory Budgeting and COPD Event - [Feb - June 2019]
o Feedback Survey (Online/Hard Copy)
■ Survey feedback tool May 2019-31 August 2019 (available for
completion online at
https:/ /WWW. smartsurvev.co.uk/s/carinaforavrshire/ and available
as a downloadable copy) - c.211 completed surveys received
to date.
Assuring Best Practice
o Training and Development
• Best practice engagement and consultation briefing (Jan 19) for
all Strategic Service Change Programmes Programme
Managers and Public Engagement Group members - with
presentation input from The Consultation Institute and Scottish
Health Council.
• PMO staff achieved The Consultation Institute Certificate of
Professional Development (December 2018) and Engagement
Support Officer achieved The Consultation Institute Advanced
Practitioner Certificate (May 2019).
o Assuring Consistency of Approach
• Liaison with Strategic Service Change Programmes -
Programme Managers to support their programmes to have
robust plans in place for informing, engaging and consulting
activity, with greater assurance that plans have been informed
by Equality Impact Assessment and pre-consultation risk
assessment wherever appropriate.
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Transformation and Sustainability
o What Matters To You Day 2019
• Pan-Ayrshire activity to deiiver the ‘What Matters To You Day’
campaign on and/or around 6 June 2019.
An outline high level targeted timeline in supporting continued Stakeholder
Engagement and Insights activity, to help shape and inform the Caring for Ayrshire
programme redesign can be found below. It’s proposed to allow sufficient time to
ensure widespread engagement and insights, including co-design methodologies to
develop the draft models of care; followed by a period of sense-checking utilising a
deliberative process such as Citizen’s Jury for example, and then formal public
consultation prior to any agreed strategy and final Programme Initial Agreement
being signed off for implementation.
Dedicated communications support will be required throughout the project to ensure
consistent and clear communications, and to ensure wider public awareness,
dealing and managing any associated media and press releases.
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Transformation and Sustainability
Key milestones and indicative dates for engagement and consultation
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Transformation and Sustainability
Desired outputs:
■ Stakeholder Engagement and Insights outputs from Discovery Phase;
■ Defined models of care and care pathways;
■ User persona mapping analysis as part of Re-Design process;
■ Resourcing profile for Stakeholder Management and Communication
workplans
■ Data sharing / co-creation to inform model of care;
■ Alternative models of care by domain/locality, e.g. Acute services, primary
care, etc.;
■ Agreement on alternative options requiring further consideration;
■ Senior Stakeholder and Scottish Health Council agreement to proceed;
■ Updated Joint Communications and Stakeholder Engagement Plan; and
■ 12 week consultation exercise plus Post Consultation & Evaluation.
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Transformation and Sustainability
8.0 Constraints (i.e. Risks / Issues / Dependencies)
Constraint
Brief description
Level [H,M,L]
Timescales
There is a risk of insufficient timescales to
enable full discovery, definition and developing
options, incorporating robust, widespread
stakeholder and public engagement with
consultation legalities prior the deadline of
submitting a formal Programme Initial
Agreement.
H
Resources
Currently there are no dedicated resources for
a project delivery team to support and delivery
of this project. There may be a requirement
also to commission/procure certain specialised
expertise externally.
H
Clinical Models of
Care
There is no formal agreed and defined models
of care and pathways in support of whole
system re-design. Two workshops will take
place in August 2019 to commence
development of models of care.
H
Lack of possible
solutions
We may find there is a lack of possible
solutions both technically and physically other
than what already exists throughout NHS
Ayrshire & Arran.
L
Funding
There is a risk to the programme due to limited
budget and agreed funding, in being able to
implement a Pan Ayrshire whole system
redesign.
M
Alignment of Service
Reform Programmes
There is a dependency to ensure alignment
and collaboration with all IJB’s and HSCPs
with other programmes of work around Service
Reform.
M
Reputational damage
The risk that the regional service reform
agenda creates confusion and therefore
impacts negatively on public perception of the
Caring for Ayrshire aims and ambitions.
H
Social Media
Exposure
There is a risk of negative and inaccurate
publicity of the programme of work, using
channels such as social media which will need
careful consideration.
M
Contractual
Arrangements
Due to existing contractual agreements in
place both locally and at regional level, this
may affect any proposals due to legal
challenges.
M
Workforce
There is a risk that any new models of care
may result in recruitment challenges, and
impact on retention of current workforce.
M
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Transformation and Sustainability
9.0 Proposed Indicative Timeiine
ID
Milestone
Project Phase
Indicative Dates
Comments
1
High Level PID discussion
Paper
Initiation
19*'^ July 2019
Issue draft PID
2
Caring for Ayrshire
Programme Board
19'f^ July 2019
Seek endorsement
and commitment
3
Terms of Reference/
Governance
Initiation
19*^^ Aug
Issued
4
Project Execution Plan
Drafted
Initiation
19*^^ Aug
May take other
format
5
Transformation
Leadership Group
15*^ August 2019
No longer Required.
Now replaced by IGC
6
CfAP Clinical Models and
Pathways Insights Events
Scoping
21®'and 28*" August
2019
Event/ workshop to
scope Clinical
Models of care
7
Final PID and Project
Execution Paper [C4AP]
Board
Initiation/
Scoping
21®* August 2019
19 September 2019
8
Integrated Governance
Committee
18*" September 2019
9
Caring for Ayrshire
Programme Board
19*" September 2019
10
NHS Board
7*" October 2019
11
South Ayrshire IJB
9*" October 2019
12
East Ayrshire IJB
9*" October 2019
13
North Ayrshire IJB
24*" October 2019
14
CfAP Launch Event
TBC
15
Caring for Ayrshire
Programme Board [C4AP]
28*" Oct, 20*" Nov and
18*" Dec
16
Options of Models of care
Agreed
Scoping
Oct- Nov 2019
17
CfAP Discovery Phase :
-Stakeholder Engagement
Methods defined
-Data Analysis
-Data Sharing/ Co¬
creation
-Stakeholder Working
Groups
-Agree Specification of
Services
-Agree Objectives
-Develop Project Plans
Scoping
July - Sep 2019
18
CfAP Define Phase:
-Whole System services
proposal
-Challenges and Issues
identified
-Strategy Developed
-Engagement of Staff,
Public & Patients
Planning & Dev
Oct - Dec 2019
19
Programme Initial
Agreement [PlAj-
Phase 1 - Drafting
commences
Scoping /
Planning and
Dev
Oct - Mar 2020
As per section 6.5
proposal adopt 2
phased development
approach for PIA
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134
Transformation and Sustainability
ID
Milestone
Project Phase
Indicative Dates
Comments
20
CfAP Design Phase:
-Data Sharing & Co-
Design
-Options Appraisal
-Agreement to consult on
Strategy
-Consultation Planning
Planning & Dev
Oct - Dec 2020
21
Models of Care ‘Sense
Check’ Consultation via
eg Citizens Jury
Planning & Dev
Dec 2019
To confirm most
appropriate
mechanism. Seek
clarity from SG and
Scottish Council
22
Formal Consultation
Phase Commences
Planning & Dev
Jan 2020
Approx. 12 weeks
23
Programme Initial
Agreement - Phase 1
Submission
Planning & Dev
March 2020
Proposed date
awaiting confirmation
from Scottish
Government on
proposals for
Programme Initial
Agreement
24
Post Consultation &
Evaluation
Planning & Dev
Apr - May 2020
25
Programme Initial
Agreement -
Phase 2 -Drafting
commences [If Required]
Planning & Dev
May-June 2020
Anticipated timeline,
dependent on
Scottish Government
discussions
26
Establish Project Delivery
Team with embedded
Business Change Team
Implementation
Mar - May 2020
27
Whole System Redesign
Groups enabled
Implementation
Mar - May 2020
28
Participation & Co-Design
Embedded
Implementation
Ongoing
29
Project Plans for
Implementation
Implementation
May- June 2020
30
Programme Initial
Agreement - Phase 2
Submission
Implementation
June - July 2020
31
Development of a range
of additional business
case elements as
required
Implementation
Commence July 2020
Page 35
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Transformation and Sustainability
Appendix 1 - Caring for Ayrshire Stakeholder Engagement and Participation Plan
DRAFT
Caring for Ayrshire Stakeholder Engagement and Participation Plan
July 2019 to May 2020
1.0 Background
1.1 The Delivery, Recovery and Transformation Plan - Communication and Engagement
Plan was approved for implementation by Ayrshire & Arran NHS Board on 8 October
2018. This was the first plan to outline how the NHS Board and East, North and
South Ayrshire Health and Social Care Partnerships would work collaboratively to
initiate communication and engagement efforts with public stakeholders to raise
public awareness and acceptance for the need for health and care services to
change. The plan set out the engagement objectives; guiding principles; key
communication messages; and outlined a range of initial actions to be undertaken
between September 2018 and December 2018.
1.2 An update to the original Communication and Engagement Plan, entitled the ‘Caring
for Ayrshire Informing and Engaging Action Plan’ was endorsed by the
Transformation Leadership Group (TLG) on 18 January 2019. The updated action
plan proposed the additional actions required from December 2018 until 31 March
2019 to continue to raise stakeholder awareness and seek acceptance of the need
for change. This updated action plan provided greater clarity on the desired
outcomes; provided additional stakeholder analysis; and outlined the actions required
to deliver on the agreed outcomes.
1.3 It was agreed by TLG on 1April 2019 that timescales for pre-phase engagement
could extend until 30 June 2019 to ensure adequate time and resource was
dedicated to enable continued scene-setting regarding the need for change prior to
moving to the next phase of engagement in summer 2019.
1.4 Key achievements to date include:
• The launch of the Caring for Ayrshire animation with over 700 views online
since publication on 17 January 2019 (https://vimeo.com/311926569) ;
• Updated web presence through launch and regular updating of the Caring for
Ayrshire ‘micro-site’ ( www.nhsaaa.net/carinqforavrshire) and ongoing social
media campaign (Facebook and Twitter);
• Development and promotion of information materials (leaflet ; postcard);
• Co-ordination of internal communications processes to be able to more easily
share information with staff across NHS and the three Health and Social Care
Partnerships (HSCPs);
• Two multi-stakeholder Caring for Ayrshire Conversation events held 24 April
and 30 April. A copy of the presentation delivered at each event is available at
https://www.nhsaaa.net/media/7017/carinq-for-avrshire-conversation-
powerpoint-presentation.pdf) . The events were attended by 63 individuals
representing health and care sector staff (including third and independent
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Transformation and Sustainability
sectors); education sector; locality planning groups; community councils; and
interested members of the public. Furthermore, 42 of those individuals have
since expressed interest in taking up a Public Partner role to support delivery
of the Caring for Ayrshire Transformation Programme.
• Information stalls or input at various community events and meetings across
Ayrshire to raise awareness of the Caring for Ayrshire Transformation
Programme and the need for health and care services to change;
• Early discussions exploring potential for joint-working/future strategic
partnerships with key organisations e.g. Ayrshire College;
• Membership of the pan-Ayrshire Public Engagement Group has been
reviewed with additional input secured from operational engagement staff
within Health and Social Care Partnerships, third sector, independent care
sector. Public Health and Primary Care Improvement Programme, In addition
to existing NHS/HSCPs Communications and Engagement leads and Scottish
Health Council - group continues to meet bi-monthly;
• Best practice engagement and consultation briefing held 31 January 2019 for
all Strategic Service Change Programmes Programme Managers - with input
from The Consultation Institute and Scottish Health Council;
• Engagement briefing pack (online and hard copy) issued to all Public
Engagement Group members to enable them to deliver Caring for Ayrshire
Conversations across Locality Planning/Community Settings;
• Survey feedback tool launched early May 2019 (available for completion
online at https://www.smartsurvev.co.Uk/s/carinqforavrshire/ and available as a
downloadable copy) with over 200 completed surveys received;
• Ensuring that all transformational change workstreams continue to have robust
plans in place for informing, engaging and consulting activity, with greater
assurance that plans have been informed by Equality Impact Assessment and
pre-consultation risk assessment wherever appropriate;
• Pan-Ayrshire activity to deliver the ‘What Matters To You Day’ campaign on
and/or around 6 June 2019.
2.0 Planning for Next Stage of Engagement: July 2019 to May 2020
2.1 Late summer/early Autumn 2019 will see a shift from ‘discovery’ phase engagement
into a more focused period of active participation with the key aim of ascertaining and
clearly articulating a joint stakeholder vision for the future of health and care services
across all stakeholder groups (‘define phase’), supported by active stakeholder
participation in the co-design and sense-checking of a new model of care
(‘development phase’).
2.2 Following completion of the development phase, a 12 week period of formal public
consultation will be required prior to a final decision on the future model of care. To
meet proposed deadlines for submission of the Programme Initial Agreement, it is
essential that the consultation concludes before 31 March 2020.
2.3 Risk - the national and regional service reform agenda could conflict with the
proposed Caring for Ayrshire engagement efforts and subsequently result in public
confusion, increased cynicism and poor public relations. As such, it is important that
all external communications and messaging over the next 12 months across NHS
and between the three Health and Social Care Partnerships (H&SCPs) sensitively
dovetail and complement Caring for Ayrshire communications, including all
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Transformation and Sustainability
comnnunications relating to any regionally/nationally driven reform agendas being
proposed across NHS Ayrshire & Arran Acute Services, as well as any redesign of
community-based services managed by H&SCPs. As such, there will be a need for
extensive and robust Public Relations and communication management, robust
media relations and ongoing monitoring, for which there is limited available
communication capacity within existing resources. It proposed that consideration be
given to commissioning high-level Public Relations consultancy support to manage
the complex communications environment.
3.0 Proposed Stakeholder Engagement, Participation and Communications Plan
3.1 The actions described throughout the remainder of this document relate solely to
delivery of the communications, engagement and participation activities necessary to
deliver the desired outcomes of the Caring for Ayrshire programme (as described in
the Project Initiation Document) and do not take into account the additional work
required around communicating the wider service reform agenda.
3.2 As alluded to above, successful delivery is therefore dependent on robust project
management of communications and engagement activity; securing adequate staff
and budget resources to deliver (discussed in more detail at section 5.0); and the
need to continue to factor in the potential public relations impact of communications
and engagement activity around other strands of acute services and H&SCP service
reform agendas as discussed above at 2.3 (the impact of which is yet to be fully
scoped and understood).
3.3 A summary of key milestones for delivery within proposed timescales is detailed at
Figure 1 with a more detailed summary of key actions at Figure 3. A descriptive
overview of the key actions and outputs required at each stage, including potential
options/proposals for delivery, is discussed below at section 4.0.
Figure 1
Key milestones and indicative dates for engagement and consultation
N09
c
Jan
Feb
Mar
Discovery
Define
Development
Formal Consultation
c
staff, patient & public dialogue methods
]
Data analysis/sharing & campaign prep
CG-design draft
model of care
Jo
c.g. Citizen's Jury
Consultation planning & prep
12 week public consultation
I
IVtoy
Post consultation
analysis &. evaluation
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Transformation and Sustainability
4.0 Proposed Actions with Indicative Target Dates
4.1 Completion of Discovery Phase
The discovery engagement phase has been ongoing since early 2019. In order to
formally close off this phase, several actions are now required to build on the work to
date so as to offer assurance that adequate discovery insights have been coiiated
from across a wide range of key stakehoider groups (muiti-sector heaith and care
staff, partners and the wider pubiic) and that those insights have been
conscientiously considered to inform the next stage of programme deveiopment.
4.1.1 Ensure robust governance, pianning and engagement processes are in piace
to facilitate ease of involvement of staff, patient and public stakeholders:
• Feedback mechanisms are in place to enable stakeholder insights to be
captured and collated for conscientious consideration, specificaiiy ongoing
maintenance/updating of web microsite; SmartSurvey oniine tooi and
assuring hard copies of all materials with ciosing date for discovery data
collation to cease proposed as 31 August 2019;
• Engagement Support Officer to establish and administer a Stakeholder
Engagement and Insights Group (first meeting w/b 14 October 2019)
(reporting directiy to Caring for Ayrshire Programme Board) to have
oversight of aii informing, engaging and consuitation activity, supported and
informed by a new Caring for Ayrshire Stakeholder Forum and Youth
Commission, as weii as more formaiised iinks to existing formal public
invoivement structures through the existing Ayrshire-wide Pubiic
Engagement Group i.e.
Figure 2 - Proposed Stakehoider Governance and Associated Groups
Stakeholder Engagement &
Insights Group
Caring for Ayrshire
Stakeholder Forum
I
Caring for Ayrshire
Youth Commission
H&SC staff/providers,
patients, service users,
public, community groups
Ayrshire College student
ambassadors, UWS reps,
CLD youth group reps, MSYi
Public Engagement Group
NHS Public Involvement
Network Group (PING)
HSCP Locality Groups
Third/Independent Sector
Provider Forums
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Transformation and Sustainability
• Agree and implement consistent policy and process for engagement and
consultation risk assessment and Equality Impact Assessment -
requires support of Equalities Adviser (to be invited as member of
Stakeholder Engagement and Insights Group to lead and advise on EQIA
process);
4.1.2 Ongoing discovery of key stakeholder insights to inform the work to develop a
draft model of care:
• Initiating staff discussions through internal events involving key clinicians
and key health and care staff to gain insights to inform the initial drafting of
early proposals for a new model of care - two initial events in August 2019
followed by a programme of wider staff engagement and communications
with potential support of OD and Employee Director and team throughout
September and October 2019.
4.2 Define Phase
4.2.1 Assure clarity of purpose and readiness to co-design a new model of care with
the involvement of key stakeholders:
• Secure specialist design and user-experience expertise to lead and
support delivery of co-design activity throughout the design phase -
resource dependent and required to be in place by 30 September 2019;
• Thematic analysis of all data collated during the discovery phase - option
to commission external social research organisation to analyse for
neutrality (resource dependent) or internal analysis (staff capacity to be
scoped) - complete discovery data analysis by 30 September 2019;
• Data-sharing to feedback findings, including key themes, to stakeholders
and decision-makers i.e. publication of report and data sharing to widely
share feedback to date during October 2019.
4.2.2 Design a suite of communications and campaign materials to help inform and
support stakeholder engagement:
• Further develop the use of social media and other online and/or
technology-enabled engagement methods to embed a process for online
and technology-enabled dialogue with the wider public - capacity to deliver
dependent on securing additional communications capacity (potentially
tendering/commissioning external social media consultancy) by 30
November 2019;
• Design and develop user-experience based ‘personas’ (i.e. a fictional
family case study), supported by an extensive communications campaign,
to provide and widely share a tangible and accessible example of how
future proposals might impact on individuals and families across Ayrshire
and Arran for use during consultation - will require dedicated
communications and graphic design capacity (possible outsourcing
required due to limited internal resources) - by 30 November 2019.
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Transformation and Sustainability
4.3 Developnnent (Design) Phase
4.3.1 A draft model of care is co-designed with the involvement of key stakeholders:
• ‘Scottish Approach to Service Design’ co-design methodology is utilised to
assure the involvement of stakeholders in the design of the new clinical
model of care - identify/commission a co-design facilitator and propose a
minimum of five design workshops with multi-stakeholder involvement
(including public) (1 x each H&SCP area plus x 2 acute hospital sites) by
31 October 2019.
4.3.2 Key stakeholders have opportunity to reflect and comment on early draft
proposals for the new model of care through active involvement in sense¬
checking prior to public consultation:
• Innovative and inclusive public involvement methodology (i.e. citizen’s jury
or citizen’s assembly) to assure representative stakeholder involvement in
the sense-checking of the draft model of care - deliver a robust deliberative
process to sense-check draft model of care by 31 December 2019.
• Focused group discussions(s) to explore in detail and better understand the
potential impact (positive and negative) of draft model(s) of care to inform
EQIA - propose this be a key remit of Stakeholder Forum and Youth
Commission to help inform initial EQIA development by 31 December
2019.
4.3.3 Robust consultation planning and delivery of best practice public consultation
to inform decision-making on the future model of care:
• Commission ongoing advice and support from The Consultation Institute to
provide neutral assurance that best practice engagement and consultation
is being observed by 30 September 2019;
• Develop and submit a detailed consultation plan for approval by the
Stakeholder Engagement and Insights Group (w/b 4 November 2019) and
Caring for Ayrshire Programme Board on 20 November 2019.
• Develop and submit formal consultation materials i.e. detailed consultation
document; easy-read consultation document; feedback questionnaire; and
relevant supporting technical documents for approval by the Stakeholder
Engagement and Insights Group (w/b 2 December 2019) and Caring for
Ayrshire Programme Board on 18 December 2019.
• Undertake formal 1 2 week period of public consultation January to March
2020 on draft proposals for the future model of care.
• Analysis of consultation feedback followed by a period of conscientious
consideration by all decision-making bodies across NHS Board and the
three IJBs - detailed analysis of consultation feedback will require to be
fully reported and considered prior to formal decision on agreed model of
care - feedback analysis completed by 30 April 2020 followed by IJB x
3 and NHS Board consideration > May 2020.
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Transformation and Sustainability
5.0 Resources Required
5.1 Existing Resources
5.1.1 To date, there has been no dedicated staff resource specificaiiy for the Caring
for Ayrshire Programme. To date, the Programme Management Office within
the Directorate for Transformation and Sustainability has been providing
programme management, project management and engagement officer
support, with additionai ad-hoc input from the NHS Ayrshire & Arran
Communications Manager and team where capacity allows.
5.1.2 More recently, a temporary Senior Programme Manager has been appointed
to enable robust project initiation and project execution planning to support the
Caring for Ayrshire Programme Board, supported by the temporary
Engagement Support Officer. A permanent Senior Programme Manager is
currentiy being recruited and some of that role will be dedicated to supporting
the Caring for Ayrshire programme.
5.2 Proposed Resources
5.2.1 To assure sufficient capacity to deliver the actions proposed within this plan it
is recommended that additionai engagement and communications staff
resources fully dedicated to delivery of the Caring for Ayrshire Programme be
considered i.e.:
• 1.0 WTE Engagement Support Officer Band 6;
• 1.0 WTE Communications and Digitai Media Officer (c. Band 6) - new post
or secondment;
• 1.0 WTE Engagement Support Assistant - Events/Admin Support (c. Band
3/4) - new post or secondment.
5.2.2 Proposais within this plan also require approvai to tender/commission for
external specialist expertise, i.e.:
• Speciaiist User-Experience (UX)/Design expertise
• Sociai research/data analysis
• Sociai media consultancy
• Public Relations expertise/consuitancy
• Graphic design/campaign development (if no capacity internaiiy)
• Deiiberative engagement expertise e.g. Citizen’s Jury faciiitation and
associated need for randomised sampling from eiectorai role
• The Consultation Institute (advisory roie/quality assurance)
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Transformation and Sustainability
Figure 3 - Stakeholder Engagement and Participation Plan: Summary of Key Actions with Indicative Timescales
Action Aug-19
Sep-19
Oct-19
Nov-19
Dec-19
Jan-20
Feb-20
Mar-20
Apr-20
May-20
Commission The Consultation Institute (advisory/quality assurance)
Close feedback survey/discovery data collection.
Two initial stakeholder events (clinicians)
Ongoing staff engagement and communications
Complete EQIA (on engagement process)
Establish Stakeholder Engagement and Insights Group
Complete analysis of discovery data
Secure specialist design/UX expertise
Complete engagement/consultation risk assessment
Discovery data sharing
Deliver a minimum of five multi-stakeholder design workshops
Secure additional capacity to deliver online/social media engagement
Develop 'user persona' communications campaign and resources
Develop and approve a detailed consultation plan
Establish Stakeholder Forum/Youth Commission
Develop formal consultation materials
Deliver deliberative process (e.g. Citizen's Jury) to sense-check model of care
Complete EQIA (on draft proposals) with involvement of stakeholders
Formal 12 week consultation period
Consultation feedback analysis
Conscientious consideration of consultation feedback by IJBs/NFIS Board
>Mayl9
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Transformation and Sustainability
Appendix 2 - Proposed Caring for Ayrshire Management Structure
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Transformation and Sustainability
Appendix 3 - Programme Initial Agreement Phase 1
Development of
PIA
Indicative
Timeline
Requirement under SCIM
Relationship with CfAP - Stakeholder
Engagement & Insights and Consultation
of Models of Care Redesign Activity
Executive
Summary
Oct 2019
To provide a summary of the overall CfA programme, existing
challenges and current need for changes, proposed outcomes and
benefits in patient care.
By drawing upon the Caring for Ayrshire Programme Strategic
Assessment, Project Initiation Document and other associated pre
early engagement materials.
Earlv Enaaoement Phase - Use cutouts,
documentation and learning from early Pre
engagement activity, using and drawing upon
the need for transformational changes in
support of sustaining future health and care
services, with whole system redesign
approach.
Strategic Case
Nov/Dec
2019
A description of the existing health and care services / activity
provision throughout NHS Ayrshire & Arran, covering areas such
as:
• List of Acute Services
• Our Primary Care Services
• Inpatient Beds
• Community Services
• Support Services
• Outpatient services
Analysis conducted on locations of services will be carried out,
including the condition and performance (as identified in the
Board’s PAMS) of existing assets affected by the programmes
aims and objectives.
The need for change will be outlined and why new models of care
are required in support of a sustainable future health and care
service. Identification of challenges, risks, issues, dependencies
and constraints will also be captured
Using the outputs from the insights, stakeholder engagement
activity so far and from the ‘Discovery’ and ‘Define’ phases of the
CfA Service Redesign approach.
Discovery Phase - From the consolidation of
the activity and work undertaken to date in
fulfilling the discovery phase of the
programme, can look to populate draft
strategic case.
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Transformation and Sustainability
Economic Case Jan/Feb As this is only Phase 1, the PIA will have to be explained in a way Discovery and Define Phase - Using outputs
2020 that describes the new Models of Care outcomes and identifies a and creations form the analysis from the
list of known individual projects that will be required to achieve this. discovery phase will help shape early thoughts
It must also include a Do Nothing or a Do Minimum option that will on the economic case. Acknowledging early
be used as a benchmark for determining the relative value of the indications from initial Define activity such as
other proposed solutions under consideration. Stakeholder Engagement and Insights Group
will aid populating the case.
A summary would be required with the potential high level outlined
options that will support and facilitate the implementation the new
Models of Care and must include:
-Acute Services proposals
-Creation of Health and Well Being Centres/ Hubs
-Services that will be delivered in different facilities by shifting the
balance of care to community and at home
-The use of technology in support of remote and virtual services
We can at a high level at this stage provide a description of the
proposed service / activity provision including information, where
relevant, on:
-The services or activities to be delivered by these new models
of care.
However we will not be at this stage looking to identify any
proposed locations of the services / activities.
Commercial Case Feb/Mar Some early outline details around of how Define and Develop Phase - Having worked
2020 prepared/resourced/organised NHS Ayrshire & Arran and the through the models of care and user personas
Health and Social Care Partnerships are, can be drafted following in how health and care services could be
the outputs of the ‘Define’ stage and early ‘Planning & transformed and delivered in the future will
Development’ phase. The notion would be to further refine this support the commercial viability of the
under phase 2 of the PIA development. programmes aims and ambitions.
Initial thoughts around the Procurement Strategy could be
prepared, evidencing that consideration has been given to all
procurement options in line with legislation and that a preferred
way forward would be identified as part of phase 2.
The Governance section can be completed comprehensively.
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Transformation and Sustainability
taking into account the proposals within the PID and project
execution document in identifying the governance arrangements
for the project. This should include the various Boards or
Committees who will provide oversight, constrictive challenge,
guidance and decision making and overall approval. This can also
cover the Project/Programme Management structures of the teams
along with the identified roles and responsibilities
Finance Case
Mar 2020
Providing a comprehensive financial case at this stage would be
difficult, however we would look to provide an indicative range of
costs across the new models of care, with the caveat these would
be refined under phase 2.
An organisational financial situation statement could be included
that explores the options for the funding streams and what
expectations exist around provision of funds - both capital and
revenue going forward.
The resources proposed for the project can be identified and
include an assessment of their suitability and availability currently
and projected throughout the length of the programme in support
of delivery and implementation.
We would look to identify any known constraints on revenue or
capital funding, which would include along with any known or
anticipated contributions from planning partners or external sources.
Define and Develoo Phase - Onlv hiah level
indicative financial aspects will be available at
this time, and recommended that phase 2
focuses on the finance case.
Management
Case
Mar 2020
We would be well placed in providing the organisational
management case that demonstrates the governance for the
Programme and associated projects. This would cover a summary
of the key individuals, organisations. Boards and Committees
represented and how they have been involved in the development
of the overall Programme.
Provide an overview of the capability of those tasked with
delivering the project both internally and externally along with an
assessment by the organisation of its readiness to take the
Programme/Projects forward including any specific workforce
arrangements required to support the proposed resourcing.
Discoverv, Define and Develop Phase -
Working through the programme activity from
the outset will help develop the management
case, drawing upon all the outputs, analysis
and options on new models of care will provide
bases on the management aspects.
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Transformation and Sustainability
Appendix 4 - Governance - Boards/Groups purpose and memberships
Board/ Group
Purpose
Membership
NHS Corporate
Management Team
• To provide assurance to the Board that robust systems are in place
for the monitoring, management and improvement of services in
terms of quality, safety, people and financial performance.
• To discuss any business pertaining to the operation of the
organisation, ensuring that CMT maintain an overview and that a
strategic, coordinated and agreed approach is established in
respect of current programmes of work and any required actions.
• To take decisions that require corporate endorsement and support
from the Chief Executive and other directors.
• Chief Executive (Chair)
• Director of Acute Services
• Director of Corporate Support Services
• Director of Finance
• Director of HSCP - East
• Director of HSCP - North
• Director of HSCP - South
• Director of Human Resources
• Director of Public Health
• Employee Director
• Director of Transformation and Sustainability
• Medical Director
• Nurse Director
Integrated
Governance
Committee
• To provide assurance to the NHS Board that issues identified in
specific governance Committees are discussed across the
Board thereby ensuring joined up corporate governance
• The lead Director for each of the five other standing Board
Governance Committees will be in attendance.
• The Chief Executive and Corporate Business Manager will
attend to provide information and advice.
• The Non -Executive Director in position as Chair/Vice Chair
of each Integrated Joint Board will attend to provide
representation for each Health and Social Care Partnership.
• The Committee may co-opt additional advisors as required.
Caring for Ayrshire
Programme Board
• To discharge the function of a Programme Board for the Caring for
Ayrshire Programme.
• To provide oversight and direction to the work of the. Clinical
Programme Board, Infrastructure Programme Board, Capital
Programme Management Group and Digital Programme
Management Group and Stakeholder Engagement and Insights
Group in relation to the Caring for Ayrshire Programme.
• Chief Executive (Chair)
• Director for Transformation and Sustainability
• Chair of Infrastructure Programme Board
• Chair of Capital Programme Management Group
• Co-chair of Clinical Programme Board
• Chair of Stakeholder Engagement and Insights Group
• Public Representatives from Stakeholder Engagement/
Insights Group
Clinical Programme
Board
• Forum for providing strategic oversight around all clinical aspects
within NHS Ayrshire & Arran, linking service delivery with
integrated use of digital and TEC - eHealth leads and as well as
Andy Grayer to attend to support this function
• Joint Medical Director (Co Chair)
• Director of Nursing (Co Chair)
• Associate Medical Director University Hospital Crosshouse
• Associate Medical Director University Hospital Ayr
• Associate Medical Director Primary and Community Care
• Associate Medical Director Mental Health
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Transformation and Sustainability
Board/ Group
Purpose
• Through the CPB this board will be a design authority for the
clinical service models and pathways of care. This will cover short,
medium and longer term service change in line with the
overarching strategic intent.
Infrastructure
Programme Board
• This group will give leadership and strategic direction to the work to
develop the capital and digital plans to deliver the clinical model in
the short, medium and long term within NHS Ayrshire & Arran.
Capital Programme
Management Group
• The Capital Programme Management Group (CPMG) will be
responsible for driving the Capital programme forward and
delivering project outcomes.
Page 50
Membership _
• Associate Medical Director Women, Children and Diagnostics
• Associate Medical Director Acute Services
• Associate Nurse Director Acute Services
• Associate Nurse Director/Head of Midwifery Women &
Children
• Associate Nurse Director East Ayrshire Health & Social Care
Partnership
• Associate Nurse Director North Ayrshire Health & Social
Care Partnership
• Associate Nurse Director South Ayrshire Health & Social
Care Partnership
• Assistant Director Quality Improvement
• Associate AHP Director
• Healthcare Sciences - to agree with these disciplines who
would be best to contribute on their behalf
• Chair, Area Clinical Forum
• Director of Pharmacy
• Director of Public Health
• Clinical Director, East Ayrshire Health & Social Care
Partnership
• Clinical Director, North Ayrshire Health & Social Care
Partnership
• Clinical Director, South Ayrshire Health & Social Care
Partnership
Director of Health and Social Care, East Partnership (Chair) /
(SRO)
Director of Health and Social Care, North Partnership
Director of Health and Social Care, South Partnership
Director of Acute Services
Director for Transformation and Sustainability
Director for Corporate Support Services
Head of Property Services, Strategy and Partnerships
Assistant Director of Digital Services
Workforce representatives (as required)
Finance representatives (as required) _
Director of Corporate Support Services (Chair)
Programme SROs
Project Directors
Assistant Director of Estates and Clinical Support Services
150
Transformation and Sustainability
Board/ Group
Purpose
Membership
• CPMG will be accountable and responsible to the Corporate
Management Team (CMT) for the delivery of individual projects /
programmes within agreed timescales and costs.
• Assistant Director (Programmes)
• Head of Capital Planning Services
• Senior representatives from corporate functions (Finance,
Health & Safety etc)
• Operational Manager(s) (Representatives from other
Operational departments who will act as bridge between
Programme and Service)
• Staff side representatives(s)
Digital Programme
Management Group
• The Digital Programme Management Group (DPMG) will be
responsible for driving digital services forward and delivering
project outcomes.
• DPMG will be accountable and responsible to the Corporate
Management Team (CMT) for the development and delivery of
projects included in the Board’s Digital Services Development
Plans (Strategic and Tactical). In conjunction with service users,
the Group is responsible for overseeing the delivery of digital
transformation and the realisation of associated benefits.
• Director of Corporate Support Services (Chair)
• Assistant Director of Digital Services
• Head of Digital Systems Programmes and Development
• Digital Services Clinical Director
• Digital Services Clinical Lead
• Digital Services Nurse Consultant
• Director of Pharmacy or representative
• Medical Director or representative
• Nurse Director or representative
• Director of Transformation and Sustainability or
representative
• Directors of Health and Social Care Partnerships or
representatives
• Clinical Directors of Health and Social Care Partnerships or
representatives
• Director of Finance or representative
• Director of Acute Services or representative
• Director of HR or representative
• Chair of the Primary care and Community Digital Services
Group.
Stakeholder
Engagement/ Insights
Group
• The Stakeholder Engagement / Insights Group will provide
oversight management and co-ordination for the responsibility in
ensuring both internal and external stakeholder engagement
throughout the lifecycle of the programme, whilst supporting the
management of timely communications.
• Additionally the remit of this group will be to facilitate and gain
stakeholder, public, third sector and independent sector insights
around informing and shaping the whole system redesign in a co¬
creation approach.
• Director of Transformation and Sustainability
• Engagement Support Officer
• Employee Director
• Equality and Diversity Adviser
• Five Public Representatives - 3 x HSCP, third sector and
independent sector (5No)
Page 51
151
Transformation and Sustainability
Appendix 5 - Primary Care Programme Improvement Plans 2019/20
Area
Commitment
Target for 2019/20
Status [RAG]
Pharmacotherapy
Recruit a total of 29 new wte staff members to roll out
service
Recruit to remaining skill mix of staff to complete
pharmacotherapy model in all GP Practices. Monitor
performance and qualitative measures being established to
demonstrate and ensure task transfer and correct skill mix
Green
Establish a training academy model
Continue to develop approach to training linking with national
groups and workforce planning
Green
Serial prescribing - establish a systemic and standard
approach for phased implementation and roll out plan.
Continue to roll out as per timelines in plan and monitor impact
on workload.
Green
Area
Commitment
Target for 2019/20
Primary Care Nurse
Service
Recruit to 9 nurse graduate roles to develop Primary
Care Nurse role
Commitment achieved. 9 nurses in post Jan 19 (3 in each
HSCP)
Green
Design proposed workforce model for delivering
community treatment and care (CTAC) for consultation
with services and stakeholders.
A vision for CTAC linked to wider community nursing to be
agreed between stakeholders at design event June 2019
A focussed project group taking forward under the Community
Treatment and Care Project (CTAC) Group. Model due to be
presented for consultation August 2019.
Green
Area
Commitment
Target for 2019/20
Vaccination
Transformation
Programme
Preschool Programme - scope and cost pan Ayrshire
model
Model to be agreed by August 2019 with service being
implemented end of 2019 - rolled out until 2021.
Green
Travel vaccinations - await national guidance for safe
delivery requirements
Agree timelines and approach between 2019 and 2021 to
progress preschool, travel, influenza, and other at risk groups
Green
Influenza Programme - scope the use of nurse bank
Will be progressed through CTAC model design.
Green
At risk group - focus on pregnant ladies. Vaccines to
be delivered at 20 week scan or by community midwife
Commitment achieved. Service transferred 1 October 2018
Green
Page 53
153
Transformation and Sustainability
Area
Commitment
Target for 2019/20
Urgent Care
Maintain and maximise Pharmacy First and Eyecare
Ayrshire
Establish Standardised Pathways for Advanced Practitioners
linked to MDT
Green
Provide infrastructure /pathways for consistent
signposting and navigation to alternative service
Support Implementation of NHS 24 Practice Websites
Green
Undertake social media/communication campaign for
right care, right person
Commitment achieved. Communication plan and public
campaign messages being taken forward through the
Communications Group for launch by end of April 2019.
Green
Seek to become test of change site for Advanced
Paramedics
Test commenced late 2018 in GP Practice- Ongoing monitoring
Green
Create local collaborative with clusters to undertake
quality improvement activity
Work will continue with HIS and local programme team to
develop national initiatives and projects being carried out
Green
Scope home visit activity and share best
practice/protocols
Will be progressed with Clusters and GP Practices to inform an
advanced practice model by August 2019
Green
Area
Commitment
Target for 2019/20
Multi-disciplinary
Team (MDT) in
General Practice
MSK Physio - Recruit to an additional 7 MSK Advanced
Physio roles
Commitment achieved. All recruited by December 2018
Work with core service to review and refine model, identifying
where further resource can be added.
Green
Primary Care Mental Health Services - Continue to
invest in Community Mental Health and scope
pathways/models
Continue to develop pan Ayrshire model and seek further
additional investment from Action 15
Green
Community Link Workers - sub Group established to
scope roles and try ensure consistency of approach
Evaluate the models across the HSCP and support a
consistency of service the Community Link Workers provide
across Ayrshire and Arran
Green
• ANP Academy:
• Cohort 1-14 from Sept 2017 to complete in 2019
• Cohort 2-10 commenced September 2018
11 due to complete in 2019
Cohort 3 to commence September 2019
Green
Page 54
154
Transformation and Sustainability
Future Plans for Primary Care Improvement programme 2020-2022
The Primary Care Improvement Programme are proposing that further plans are developed through an iterative process, involving all clusters and localities to
understand the different priority needs within each HSCP. Work has already begun around this, with the following high level time line and activities being listed
below:
• June - August 2019
A series of workshops with a stakeholders to learn from current changes and determine future service models as outlined in the new contract
o Stakeholder workshop to design Community Treatment and Care service
o All GP Practices to attend workshop to inform effective practice based MDT working and influence the whole system clinical model
o Stakeholder workshop to design a preferred model for advanced practice assisting with on the day demand in General Practice.
• August - October 2019
o HSCPs are provided with information on their expected allocated funding, along with the range priorities agreed through the workshop
sessions.
o Clusters consider where they think gaps are and what would assist them to deliver the new contract
o Clusters have a joint discussion with their HSCP to form a Partnership wide view aligned to the HSCP strategic priorities
o Pull together into a pan Ayrshire proposal which then goes through the relevant Implementation Groups for detailed design and project
planning
• October 2019
o Present proposals and outcomes of discussions for further consideration or further information required with HSCPs and Clusters.
• November/December 2019
Final PCIP 2020-2022 prepared and presented to IJBs, LMC and NHS Board:
7 October - NHS Board
27 November - East Ayrshire IJB
2 December - Ayrshire & Arran NHS Board
11 December - South Ayrshire IJB
17 December - GP Sub Committee/ Local Medical Committee
19 December - North Ayrshire IJB
Page 55
155
Agenda Item 11
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
24 October 2019
Subject:
Enhanced Intermediate Care and Rehabilitation
Services
Purpose:
This paper provides update to the Integration Joint board on the
progress made in North Ayrshire, in Implementing the enhanced
model for Intermediate Care and Rehabilitation. It seeks support for
continued funding and development of the model, in support of
North Ayrshire Health and Social Care Partnership’s strategic
ambitions.
Recommendation:
The Integration Joint Board is asked to :
* Note the progress made in implementing the enhanced model for
Intermediate Care and Rehabilitation in North Ayrshire;
* Note the financial implications of funding the service for the
remainder of 2019-2020; and
* Consider the funding required to sustain the model on a longer
term basis as part of the budget planning for next year.
Glossary of Terms
NHS AA
NHS Ayrshire and Arran
HSCP
Health and Social Care Partnership
IJB
Integration Joint Board
ICT
Intermediate Care Team
SPOG
Strategic Planning Operations Group
1.
EXECUTIVE SUMMARY
1.1
The Enhanced Intermediate Care and Rehabilitation Services went live on 19
November 2018 following approval of a business case by NHS Ayrshire and Arran
and the three Ayrshire IJBs. The impact of the service has been monitored regularly
through the Strategic Planning Operations Group (SPOG) to ensure it delivers in line
with the business case. The outputs of the Pan-Ayrshire Enhanced Intermediate
Care and Rehabilitation model demonstrates the Impact the service is making in
terms of avoiding hospital admission, and providing a positive experience for the
people of North Ayrshire.
1.2
The investment was not fully funded with part-year funding of £316k allocated during
2018-19, the additional cost to continue investment for the full year during 2019-20 is
£260k, this would require to be incorporated into the IJB financial position for this
year. The funding required to sustain the model on a longer-term basis from 2020-
21 will be Included as part of the budget planning for next year.
156
2.
BACKGROUND
2.1
PAN AYRSHIRE ENHANCED INTERMEDIATE CARE AND REHABILITATION
2.1.1
A paper was brought to the Integration Joint Board (IJB) in North Ayrshire in
September 2018, to provide an overview of the work being undertaken to meet the
Pan -Ayrshire Enhanced model for intermediate care and rehabilitation as part of
the New models of care for older people and people with compiex care needs.
2.1.2
The Pan-Ayrshire Enhanced Intermediate Care and Rehabiiitation model was
developed around Enhanced Intermediate Care and Rehabiiitation Hubs which
provide a singie point of access, with screening and clinical triage, ensuring the
person is seen by the right service, first time and inciudes 7 day working. The model
supports people at different stages of their recovery journey and iinks up and buiids
on existing intermediate care and rehabiiitation services reducing dupiication and
fragmentation of services across Ayrshire and Arran and offering better outcomes for
peopie.
2.1.3
The Enhanced Intermediate Care and Rehabiiitation Services went live on 19
November 2018 after approval of the business case by NHS Ayrshire and Arran and
the three Ayrshire IJBs. This has been monitored regulariy through the Strategic
Pianning Operations Group (SPOG) to ensure it delivers in line with the business
case.
2.1.4
The impacts described within the original business case refiected the cumulative
impact of all aspects of the model working together to ensure the reduction in
occupied bed days, drawing on sound iocal and nationai evidence. The business
case proposed a 30% increase to 2335 referrais (1295 from Partnership pius 1040
from ACE Practitioners) to Enhanced Intermediate Care and Rehabiiitation, which
wouid result in cost avoidance of £4,052,014 for a required investment of £2,516,175
to empioy an additional 51.4 WTE staff across Ayrshire and Arran.
This equates to 24,860 Bed days avoided, which is the equivalent of the closure of
28 beds in University Hospital Ayr and 39 beds in University Hospitai Crosshouse.
In order to avoid any doubie counting, oniy the Enhanced Intermediate Care Teams
(EICT) referrals were used in the business case.
2.2
FINANCE
2.2.1
The business case was predicated on acute hospital savings offsetting the
investment and during 2018-19 the investment was funded by the Heaith Board on a
part-year basis. However, with the approach taken in the 2019-20 budget to pass
through the funding upiift to the partnership there is an expectation that the IJBs will
fund the full year impact of the investment. The 2019-20 approved IJB budget did
not inciude provision to fund the fuii year impact of the service and it was noted as
an unfunded pressure. The intention was to review the impact of the investment
during 2019-20 to determine future funding aiongside the work to progress the
formai commissioning of acute services.
2.2.2
Part year funding of £982,370 was provided by NHS Ayrshire and Arran in 2018-19
to fund the modei, this has now been incorporated into the overall financial allocation
to the IJBs. If all posts identified through the business case are fiiled, this leaves a
Pan Ayrshire shortfaii of £1,533,805 to sustain the modei.
157
The North element of this is:
• Full Year Budget £807,534
• Part Year Funding £316,000
• Recurring Shortfall (assuming all posts are appointed to) £491,534
Note the projected shortfall in 2019-20 is only £260,000 due to vacant posts.
2.2.3
The ongoing pan-Ayrshire work to progress Directions and the acute set aside has
not progressed to the stage of having confidence that an approach to accessing
acute resources to fund the investment will be possible In the short to medium term.
The service has been established with a permanent staff group in place, the
unfunded element of the cost of the service for 2019-20 is £260k. The IJB are asked
to note that the continuation of the service will add an unfunded pressure of £260k to
the overall projected outturn for the IJB.
The funding required to sustain the model on a longer term basis from 2020-21 will
be included as part of the budget planning for next year. This includes the ongoing
Pan Ayrshire work on the set aside budget and directions.
2.3
ENHANCED INTERMEDIATE CARE AND REHABILITATION IN NORTH
AYRSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP
2.3.1
The investment of £807k in North Ayrshire was to provide an additional 16 WTE staff
across a range of disciplines including:
• Allied Health Professions
• Pharmacy
• Nursing
• Business support
• General Practitioner sessions
All posts, with the exception of the GP sessions were recruited to as part of a wide
ranging successful recruitment campaign.
Further, the investment provided funding required to deliver service across 7 days
per week.
2.3.2
As described in the original business case, and earlier paper brought to the
Integration Joint Board, investment into intermediate care and rehabilitation in North
Ayrshire was across three main components:
• Hub - To support right service, right time approach by increasing business
support capacity, to allow effective referral management, and reduce the
duplication experienced associated with multiple referrals
• Enhanced intermediate care and rehabilitation - to increase the capacity
within the team, to progress the skill mix of the team, and to allow appropriate
level of workforce availability so as to provide service across seven days per
week
• Community rehabilitation - to increase capacity within the less urgent, more
goal orientated community rehabilitation options, which protect enhanced
intermediate care and rehabilitation for the fast response, admission
avoidance work.
3.
IMPACT
3.1
Referrals for the full range of Intermediate care and rehabilitation options in North
158
Ayrshire now all stream through the Intermediate Care and Rehabilitation hub taking
around 1,000 referrals per month.
3.2
Intermediate Care and Rehabilitation Service is now provided seven days per week,
with a focus on activity which provides alternatives to acute hospital admission.
Relationships with key referral stakeholders continue to develop, with regular
referrals, to avoid admissions, received from:
• Primary care
• Ayrshire Unscheduled Care Service
• Scottish Ambulance Service
• Emergency department at University Hospital Crosshouse
3.3
At any one time, the enhanced Intermediate Care Team (ICT) are supporting around
130 individuals at home in North Ayrshire, as an alternative to acute hospital care.
3.4
Referrals
In order to ascertain if progress is being made against the outputs of the business
case, the target for North Ayrshire investment of £807,534, for an extra 16 staff was
for an additional 407 referrals, giving an annual target of 1672 referrals
3.4.1
North Ayrshire Enhanced ICT saw a decrease of referrals to 1,207 in 2018-19 when
compared to the previous year. This represents a 20% decrease on 2017-18
referrals. However, the 2018-19 figure still represents an 8% increase on the
baseline year used in the business case. For North the performance from the 12-
month business case target is 1,762. Based on current performance the trajectory
would be 1,609. This is a projected shortfall of 153.
3.4.2
The reduction in referrals to the enhanced intermediate care team in North Ayrshire
is likely due to the more mature triaging being undertaken in the North Ayrshire Hub
ensuring right person to the right place, first time - with less urgent referrals now
being streamed to community rehabilitation options, for example the Health and
Therapy Team, or domiciliary physiotherapy teams.
3.5
Hospital Bed Davs Saved
The business case attributed 10 bed days to an avoided admission, in addition, it
attributed 3 days for supported discharge by EICT staff.
3.6
Using the above metrics, for the 9-month period from 19 November 2018 to July
2019 (254 days), the North Ayrshire Enhanced Intermediate Care and Rehabilitation
Teams avoided the following bed days:
• North - 7,116
This equates to an additional 28 people, not requiring acute hospital care every day.
3.7
Benefits for Service Users
The independent evaluation of impacts for service users by the Scottish Health
Council produced some helpful feedback as well as areas for further improvement.
In order to give an indication of how well/able individuals were before and after
receiving support from the services, to give a sense of distance travelled, the
following scores out of ten were given.
• North - 3.7 and 6.7.
159
3.8
In addition, individuals were asked to score the overall services out of five, with the
following resuits observed:
• North - 4.9.
Whiist individuais provided some key areas for improvement around the
quaiity/speed of assessments and the resource avaiiabie, feedback received was
overwhelmingly complimentary and evidenced real benefits for individuais.
PROPOSALS
4.1
1
The Enhanced Intermediate Care and Rehabilitation model in North Ayrshire is !
demonstrating positive eariy outcomes, supporting a significant number of people to
remain at home and independent, and providing a seven day aiternative to hospital I
admission.
i
4.2
As the model develops further, and the workforce matures, there will be opportunity
to consider how the various components of intermediate care and rehabilitation in
North Ayrshire - Intermediate Care team. Health and Therapy Team, Community
rehabiiitation Aiiied Health professional Services - aiign further with the deveioping
modei around locality based muiti discipiinary teams.
4.3
The current financiai arrangements create an uncertainty around the future of the
enhanced model, with a number of associated risks.
It is proposed that funding is factored into the IJB financiai position for 2019-20, and
consideration be given around funding on a longer term basis from 2020-21 as part
of the budget planning for next year.
This wiil create a welcomed stability for the modei which wiii in turn support ongoing
deveiopment and strategic aiignment with the other partnership priorities.
4.4
Anticipated Outcomes
The model ensured a reconfiguration of existing services to improve service user i
experience, increase the capacity of intermediate care and rehabilitation, and
improve interface with acute care in Ayrshire. The model supports the strategic j
ambitions around promoting independence, self management, and supporting
peopie to live at home or in a homeiy setting.
4.5
Measurino Impact
■
The impact of the enhanced intermediate care and rehabilitation model continues to ;
be monitored as described, with reguiar updates provided to the Strategic Planning
Operations Group (SPOG) and NHS Ayrshire and Arran Corporate Management [
Team.
5. IMPLICATIONS
■
Financial:
Part of the funding (£982,370) has been provided by NHS Ayrshire
and Arran on a Pan Ayrshire basis.
This recurring shortfali for North is £491,534 for North Ayrshire on a
full year basis.
160
The 2019-20 impact is a shortfall of £260,000 as not all posts were
appointed, and some have subsequently become vacant.
Human Resources:
The new Model required an additional 51.4WTE staff across
Ayrshire, 16 in North Ayrshire, on permanent contracts. This
strengthened existing ICT and Community Rehab services. In
addition. Organisational Development work was undertaken across
Ayrshire to move from 5-7 day working for ICT teams.
Legal:
No issues
Equality:
No issues
Children and Young
People
No issues
Environmental &
Sustainability:
No Issues
Key Priorities:
The model ensured a reconfiguration of existing services and
structures to increase access to Intermediate Care and
Rehabilitation services, reduce system wide inefficiency, develop the
interface with Acute Hospital Services, improve service user
experience which helps to meet the increased demand for health
and social care in Ayrshire and Arran. This is in line with our
priorities for Prevention and Early Intervention and Bringing Services
Together.
Risk Implications:
There are a number of risks associated with lack of clarity around
the financial sustainability of this model :
Reputational
Service planning
Ability to further develop/ progress future improvements
Workforce stability
Community
Benefits:
This model aspires to keep people independent, safe, and at home
or in a homely setting and provide alternative to acute hospital
admission
Direction Required to
Direction to:
Councii, Heaith Board or
1. No Direction Required
Both
2. North Ayrshire Council
3. NHS Ayrshire & Arran
X
4. North Ayrshire Council and NHS Ayrshire & Arran
6. CONSULTATION
6.1 There has been on-going consultation through the Models of Care work, and the
Intermediate Care and Rehabilitation Network, as well as updates to Strategic
Planning and Operations Group, Transformational Leadership Group, and NHS
Ayrshire and Arran’s Corporate Management Team.
This paper has been developed in consultation with the Senior Leadership team in
Community Heath and Care, the AHP Leadership team, and the North Ayrshire
HSCP Finance Leads
161
CONCLUSION
7.
7.1 While still in early stages, the model is showing good evidence that it is making a
difference for the people of North Ayrshire In terms of avoiding unnecessary acute
hospital admission and is largely on target to meet the outputs outlined in the
business case.
However, uncertainty around future funding is causing understandable insecurity
within the staff teams and making ongoing planning and alignment with wider
partnership programmes of work challenging.
It is recommended that the funding required to sustain the model is considered on a
longer term basis from 2020-21 as part of the budget planning for next year.
For more information please contact Alistair Reid, Lead Allied Health Professional on
07825227834or Alistair.Reid(5)aapct.scot.nhs.uk
162
DIRECTION
From North Ayrshire Integration Joint Board
NORTH AYRSHIRE
Health and Social Care
Partnership
1.
Reference Number
24102019-Agenda No.
2.
Date Direction issued by iJB
24102019
3.
Date Direction takes effect
24102019
4.
Direction to
North Ayrshire Council
NHS Ayrshire & Arran
X
Both
5.
Does this direction supercede,
amend or cancel a previous
direction - if yes, include the
reference numbers(s)
Yes
No
X
6.
Functions covered by the direction
Enhanced Intermediate Care and Rehabilitation Services
7.
Full text of direction
NHS Ayrshire and Arran are to continue to deliver the investment in the Enhanced
Intermediate Care and Rehabilitation Model for the remainder of 2019-20. The
continued service delivery is based on the current recruited workforce.
8.
Budget allocated by Integration
Joint Board to carry out direction
The estimated cost of the service for 2019-20 is £576k, of which £316k is funded as
part of the IJB baseline budget and the remaining £260k will be met from within the
overall HSCP budget. The sustainability of the investment in the service will be
included as part of the budget planning for 2020-21.
9.
Performance Monitoring
Arrangements
The impact of the service is monitored through SPOG (Strategic Planning Operations
Group).
10.
Date of Review of Direction (if
applicable)
March 2020
163
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
24 October 2019
Agenda Item No.
Subject:
IJB Reserves Policy
Purpose:
To seek approval for the updated IJB Reserves Policy
Recommendation:
The Integration Joint Board are asked to:
a) Approve the updated IJB Reserves Policy detailed in Appendix
1 .
Glossary of Terms
NHS AA
NHS Ayrshire and Arran
NAG
North Ayrshire Gouncil
NAHSCP
North Ayrshire Health and Social Gare Partnership
IJB
Integration Joint Board
PAG
Performance and Audit Gommittee
1.
EXECUTIVE SUMMARY
1.1
The Reserves Poiicy outiines the statutory and regulatory framework for reserves and
the operation of reserves. The poiicy is one of the key financiai governance
documents and is one of a number of key IJB policies that are due for review.
2.
BACKGROUND
2.1
The first reserves poiicy was approved in 2016 and is due for review, the poiicy is one
of several which were agreed as part of preparations for Integration and before there
was a clear understanding of how arrangements wouid operate in practice.
2.2
The purpose of a reserves policy is to:
• outiine the legisiative and reguiatory framework underpinning the creation, use or
assessment of the adequacy of reserves;
• identify the principles to be employed by the IJB in assessing the adequacy of the
IJB’s reserves;
• indicate how frequentiy the adequacy of the IJB’s balances and reserves will be
reviewed; and
• set out arrangements reiating to the creation, amendment and use of reserves and
baiances.
164
3.
PROPOSALS
3.1
The IJB Reserves Policy has been reviewed, the fundamental operation of reserves
has not changed. The main update to the Policy is to incorporate the policy in relation
to holding a negative reserve balance and to be clearer in relation to responsibilities
for planning for adequate reserves as part of the IJB budget planning.
The updated reserves policy has been reviewed and approved by the IJB
Performance and Audit Committee and is now remitted to the IJB for formal approval.
3.2
Anticipated Outcomes
Improved governance and clarity around the operation of reserves.
3.3
Measuring Impact
The level of reserves will be considered as part of the budget setting process each
year and be formally approved by the IJB.
4.
IMPLICATIONS
Financial:
None
Human Resources:
None
Legal:
None
Equality:
None
Environmental &
Sustainability:
None
Key Priorities:
None
Risk Implications:
None
Community Benefits:
None
5.
CONSULTATION
5.1
The updated reserves policy has been reviewed by the IJB Performance and Audit
Committee and has been shared with the Directors of Finance for NAC and NHS
AA.
6.
CONCLUSION
6.1
The Integration Joint Board are asked to:
• Approve the updated IJB Reserves Policy detailed in Appendix 1.
For more information piease contact:
Caroiine Cameron, Chief Finance & Transformation Officer on 01294 324954 or
caroiinecameron(5)north-avrshire.qov.uk
- Finance on 01294 317814 or
Eleanor Currie, Principal Manager
eleanorcurrie@north-avrshire.qov.uk
165
North Ayrshire Integration Joint Board
Reserves Policy
Date Effective: October 2019
Review Date: September 2022
166
1. Background
1.1 To assist local authorities (and similar bodies) in developing a framework for
reserves, CIPFA have issued guidance in the form of the Local Authority
Accounting Panel (LAAP) Bulletin 55 - Guidance Note on Local Authority
Reserves and Balances. This guidance outlines the framework for reserves, the
purpose of reserves and some key issues to be considered when determining
the appropriate level of reserves. As the North Ayrshire IJB has the same legal
status as a local authority, i.e. a section 106 body under the Local Government
(Scotland) Act 1973 Act, and is classified as a local government body for
accounts purposes by the Office of National Statistics (ONS), it is able to hold
reserves which should be accounted for In the financial accounts and records
of the IJB.
1.2 The purpose of a reserve policy is to:
• outline the legislative and regulatory framework underpinning the creation,
use or assessment of the adequacy of reserves;
• identify the principles to be employed by the IJB In assessing the adequacy
of the IJB’s reserves;
• indicate how frequently the adequacy of the IJB’s balances and reserves
will be reviewed; and
• set out arrangements relating to the creation, amendment and use of
reserves and balances.
1.3 In common with local authorities, the IJB can have reserves within a usable
category.
2. Statutory/Regulatory Framework for Reserves
Usable Reserves
2.1 Local Government bodies - which includes the IJB for these purposes - may
only hold usable reserves for which there is a statutory or regulatory power to
do so. In Scotland, the legislative framework includes:
Usable Reserve Powers
General Fund Local Government Scotland Act 1973
2.2 For each reserve there should be a clear protocol setting out:
• the reason / purpose of the reserve;
• how and when the reserve can be used;
• procedures for the reserves management and control; and
• the review timescale to ensure continuing relevance and adequacy.
167
3. Operation of Reserves
3.1 Reserves are generally held to do three things:
• create a working balance to help cushion the impact of uneven cash flows
- this forms part of general reserves;
• create a contingency to cushion the impact of unexpected events or
emergencies - this also forms part of general reserves; and
• as a means of building up funds, often referred to as earmarked reserves,
to meet known or predicted liabilities.
3.2 The balance of the reserves normally comprises of three elements:
• funds that are earmarked or set aside for specific purposes. In Scotland,
under Local Government rules, the IJB cannot have a separate Earmarked
Reserve within the Balance Sheet, but can highlight elements of the General
Reserve balance required for specific purposes. The identification of such
funds can be highlighted from a number of sources:
o future use of funds for a specific purpose, as agreed by the IJB; or
o commitments made under delegated authority by Chief Officer, which
cannot be accrued at specific times (e.g. year end) due to not being
in receipt of the service or goods;
• funds which are not earmarked for specific purposes, but are set aside to
deal with unexpected events or emergencies; and
• funds held in excess of the target level of reserves and the identified
earmarked sums. Reserves of this nature can be spent or earmarked at the
discretion of the IJB.
3.3 The Integration Scheme outlines that where there is an underspend in the
operational budget that this can either fund additional capacity in-year or be
carried forward to fund capacity in future years. Any final underspend in the
operational budget in-year will be credited to IJB General Fund reserve.
4. Role of the Chief Finance Officer
4.1 The Chief Finance Officer is responsible for advising on the targeted optimum
levels of reserves the IJB would aim to hold (the prudential target). The IJB,
based on this advice, should then approve the appropriate reserves strategy as
part of the budget process.
5. Adequacy of Reserves
5.1 There is no guidance on the minimum level of reserves that should be held. In
determining the prudential target, the Chief Finance Officer must take account
of the strategic, operational and financial risks facing the IJB over the medium
term and the IJB’s overall approach to risk management.
168
5.2 In determining the prudential target, the Chief Finance Officer should consider
the IJB’s Strategic Plan, the medium term financial outlook and the overall
financial environment. Guidance also recommends that the Chief Finance
Officer reviews any earmarked reserves as part of the annual budget process
and development of the Strategic Plan.
5.3 In light of the size and scale of the IJB’s responsibilities, over the medium term
it is proposed to hold a prudent level of general reserves. This value of reserves
must be reviewed annually as part of the IJB Budget and Strategic Plan; and in
light of the financial environment at that time. Where it is assessed that the
financial environment at the time of setting the budget does not support a
prudent level of reserves to be held this should be reported to the IJB together
with an aspirational reserves position. The level of other earmarked funds will
be established as part of the annual financial accounting process.
5.4 The Integration Scheme states that where there is an overspend in the
operational budget the Parties will consider making interim funds available to
the IJB. Where funds are not provided and the IJB has insufficient General
Fund reserves the IJB may report a negative reserves position on the Balance
Sheet. This position must be addressed with a plan agreed between the IJB
and the Parties in relation to future plans to address the negative reserves
position.
6. Reporting Framework
6.1 The Chief Finance Officer has a fiduciary duty to ensure proper stewardship of
public funds.
6.2 The level and utilisation of reserves will be formally approved by the IJB based
on the advice of the Chief Finance Officer. To enable the IJB to reach a
decision, the Chief Finance Officer should clearly state the factors that
influenced this advice.
6.3 As part of the budget report the Chief Finance Officer should state:
• the current value of general reserves, the movement proposed during the
year and the estimated year-end balance and the extent that balances are
being used to fund recurrent expenditure;
• the adequacy of general reserves in light of the IJB’s Strategic Plan, the
medium term financial outlook and the overall financial environment;
• an assessment of earmarked reserves and advice on appropriate levels and
movements during the year and over the medium term; and
• if the reserves held are under the prudential target, that the IJB should be
considering actions to meet the target through their budget process.
169
7. Accounting and Disclosure
7.1 Expenditure should not be charged directly to any reserve. Any movement
within Revenue Reserves is accounted for as an appropriation and is
transparent. Entries within a reserve are specifically restricted to ‘contributions
to and from the revenue account’ with expenditure charged to the service
revenue account.
170
Agenda Item 13
NORTH AYRSHIRE
Health and Social Care
Partnership
Integration Joint Board
24 October 2019
Subject:
Budget Monitoring - Month 5 (August 2019)
Purpose:
To provide an update on financial performance to August 2019,
including the projected outturn for the 2019-20 financial year.
Recommendation:
It is recommended that the IJB:
a) Note the projected year-end overspend of £2.308m;
b) Approve the changes in funding as detailed in section 2.11 and
Appendix E; and
c) Note the potential impact of the Lead Partnerships.
Glossary of Terms
NHS AA
NHS Ayrshire and Arran
HSCP
Health and Social Care Partnership
MH
Mental Health
CAMHS
Child & Adolescent Mental Health Services
BRAG
Blue, Red, Amber, Green
UNPACS
UNPACS, (UNPIanned Activities) - Extra Contractual Referrals
GRES
Cash Releasing Efficiency Savings
NES
NHS Education Scotland - education and training body
NRAC
NHS Resource Allocation Committee
1.
EXECUTIVE SUMMARY
1.1
The report provides an overview of the financial position for the partnership and
outlines the projected year-end outturn position informed by the projected expenditure
and income commitments, these have been prepared in conjunction with relevant
budget holders and services. It should be noted that although this report refers to the
position at the July period end that further work is undertaken following the month end
to finalise projections, therefore the projected outturn position is as current and up to
date as can practicably be reported.
1.2
The projected outturn is a year-end overspend of £2.308m for 2019-20 which is an
adverse movement of £0.311 m from the previous reporting period. There is scope for
this position to fluctuate due to in-year cost and demand pressures and assumptions
in relation to funding and the achievement of savings. The position at July was a
projected overspend of £1.997m and a financial recovery plan was approved by the
IJB to work towards delivering financial balance. Progress against the plan will be
closely monitored as the IJB may be required to approve additional actions later in the
financial year if the planned impact is not realised.
1.3
There has been as adverse movement in the position which mainly relates to the
inclusion of the full year funding impact of the Intermediate Care and Rehab model of
care. The main areas of pressure continue to be learning disability care packages.
171
care homes, care at home, looked after children, and adult In-patients within the lead
partnership. Alongside the specific actions outlined in the financial recovery plan
services will continue to deploy tight financial management controls to support
bringing expenditure back into line with budget.
1.4
It is essential that the IJB operates within the delegated budget and commissions
services from the Council and Health Board on this basis as financial balance needs
to be achieved. The service transformation programme and the delivery of those
service changes will be at the forefront as this will have the greatest impact on the
delivery of financial balance and the ongoing sustainability and safety of services.
2.
CURRENT POSITION
2.1
The report includes an overview of the financial position including commitments
against the available resource, explanations for the main budget variances, an update
on progress in terms of savings delivery and action required to work towards financial
balance.
FINANCIAL PERFORMANCE
2.2
Against the full-year budget of £242.359m there is a projected overspend of £2.308m
(0.95%). An integrated view of the financial position should be taken; however, it is
useful to note that this overall position consists of a projected overspend of £2.345m
in social care services offset by a projected underspend of £0.037m in health services.
The Integration Scheme outlines that there is an expectation that the IJB takes
account of the totality of resources available to balance the budget in year.
Appendix A provides the financial overview of the partnership position. The sections
that follow outline the significant variances in service expenditure compared to the
approved budgets with detailed analysis provided in Appendix B.
2.3
Community Care and Health Services
Against the full-year budget of £67.775m there is a projected overspend of £1.488m
(2.2%) which is an adverse movement of £0.384m. The main reasons for the projected
overspend are:
a) Care home placements including respite placements - projected to overspend
by £0.167m (£0.01 Om adverse movement). This Is mainly due to funding a
number of emergency respite placements on a permanent basis which brings
the care home respite budget online but increases the overspend on permanent
placements to £0.367m. This was agreed as it was likely that the emergency
placements would not be discharged, and it allows the permanent placements
to be financially assessed with the individual contributing appropriately to their
care. Permanent placements will continue to be managed to bring the budget
back into line. The projection can vary due to factors other than the number of
placements e.g. the impact of interim funded places and outstanding requests
for funding, this will require to be monitored closely. These overspends are
partially offset by a projected over-recovery of Charging Order income of
£0.200m which is based on income received to date and improved processes
to track the charging orders.
b) Independent Living Services are projected to overspend by £0.268 (favourable
movement of £0.048m) which is due to an overspend on physical disability care
172
packages within the community and residential packages. There will be further
work undertaken with the implementation of the Aduit Community Support
framework which will present additional opportunities for reviews and payment
only for the actual hours of care delivered.
c) Packages of care are projected to underspend by £0.097m which is an adverse
movement of £0.006m. This is due to delays in new packages offsetting the
use of supplementary staffing for existing packages, this has improved from the
2018-19 position.
d) Care at home (purchased and in house) projected to overspend by £0.595m
which is an adverse movement of £0.097m. The overspend is due to an
increase in provided hours and the budget being reduced to refiect the 2019-
20 approved saving. The overspend on in-house services relates to providing
additionai hours to cover a service that a provider handed back and the in-
house service had to increase capacity to ensure the safety of vuinerable
service users within the community of the North Coast locaiity and aiso the
need to faciiitate patient discharges from Crosshouse Hospitai. The projection
assumes that the number of hours currentiy being invoiced wiii reduce following
an internai review of the hours provided. The service currently has, between
hospitals and community individuais waiting on a care at home package and
individuals waiting on an increase in their care packages.
e) Long Term Conditions (Ward 1), projected overspend of £0.270m (adverse
movement of £0.006m) which is mainly due to an overspend in employee costs
to ensure staffing ieveis are at a safe ievel. This is a recurring pressure for
which funding requires to be identified. This wiii be reviewed during 2019-20
aiong with other wards. Ward 2 is projected to be £0.026m underspent
(favourabie movement of £0.026m) but this is subject to continuing to receive
£0.504m of funding from East HSCP for their patients. East have indicated their
intention to reduce the number of commissioned beds.
f) Community Care empioyee costs are projected to overspend by £0.308m
(adverse movement of £0.020m) due to supernumerary / unfunded posts.
These posts wiii be allocated to the appropriate service to manage the costs
within the deiegated budget.
g) Locality services employee costs are projected to overspend by £0.176m
(adverse movement of £0.031 m) due to a projected shortfall in payroli turnover
targets.
h) Carers Act Funding is projected to underspend based on the currently
committed spend. This couid fiuctuate depending on the volume of carers’
support plans undertaken and the level of demand/services identified from
these pians. This underspend will be used in the first instance to fund the
projected overspend on care home respite placements.
i) Intermediate Care (exciuding Modeis of Care) is projected underspend by
£0.089m due to vacancies.
j) Intermediate Care and Rehab Models of Care is projected to overspend by
£0.260m which represents the full year funding impact of the modei. This is
subject to a separate report on the agenda, and whiist the IJB has not formally
agreed to fund this investment on a permanent basis the posts are filled on a
permanent basis and the additionai cost is unavoidable. The projected
173
overspend is based on the posts which are currentiy fiiied, with an assumption
that any vacancies would be heid untii a longer term decision on funding
investment is taken.
k) Aids and adaptations - are projected to underspend by £0.200m per the
approved recovery plan.
2.4
Mental Health Services
Against the fuii-year budget of £75.483m there is a projected overspend of £1.275m
(1.7%). The main reasons for the projected overspend are:
• Learning Disabiiities - projected overspend of £1.364m, of which £1.157m
is in relation to community care packages and £0.361 m for residentiai
placements. The projection assumes that the ievel of invoice variations
wili be higher than previously assumed and some slippage with planned
new packages. These overspends are partially offset by vacant posts.
• Community Mentai Health - is projected to underspend by £0.031 m
(adverse movement of £0.022m) mainly due to vacancy savings (after
aiiocating £0.090m of payroii turnover) and an underspend in care
packages.
• Addictions - is projected to be underspent by £0.095m (favourable
movement of £0.005m) due to vacant posts.
• Lead Partnership for Mental Health - overall projected overspend of
£0.037m (favourable movement of £0.053m) which consists of:
Overspends:
• Aduit inpatients £0.580m (favourable movement of £0.009m) - mainly due
to the delay in closing the Lochranza ward on the Aiisa site. The ability to
close Lochranza will be dependent on discharging at least two patients.
The projection also assumes that a fifth bed will be sold by October 2019.
• Psychiatry £0.025m (favourabie movement of £0.020m) - overspend
primarily due to agency costs. Agency staff are used in the absence of
being abie to recruit permanent posts.
• UNPACS £0.242m (no movement) - based on current piacements and an
increased charge from the state hospital for the period Aprii to August
2019.
Underspends:
• CAMHS £0.270m (favourabie movement of £0.015m) - due to vacancies
and deiays with recruitment. This is after applying £0.150m of payroii
turnover.
• Psychology £0.160m (no movement) - due to vacancies. This is after
applying £0.150m of payroll turnover.
174
• Adult Community Mental Health £0.069m (no movement) - due to
vacancies.
• MH Pharmacy £0.154m (no movement) - due to continued lower
substitute prescribing costs.
• MH Admin £0.125m (favourable movement of £0.009m) - due to
vacancies.
Note that elderly inpatients are reporting an adverse position at month 5 due to holding
vacancies in relation to reconfiguring the wards. This resulted in using supplementary
staff in the interim, but it is assumed to be online following implementation of the
elderly mental health review.
2.5
Children & Justice Services
Against the full-year budget of £35.745m there is a projected overspend of £1.069m
(3%) which is an adverse movement of £0.150m. The main reasons for the projected
overspend are:
a) Residential Schools and Community Placements - projected overspend of
£1.262m (favourable movement of £0.109m). The projection is based on the
current number of placements and estimated discharge dates for each
placement. There are currently 22 placements and 2 secure placements. The
reported projection assumes 3 discharges in December with the remaining 19
assumed to be still in a placement at the year end. There is no provision for any
increase in placements. The favourable movement relates to two children
transferring to the children with a disabilities care package budget. Whilst there
has been some progress In reducing the overall number of external placements
the financial benefit of this has been offset by unplanned secure placements.
b) Looked After Children Placements - projected underspend of £0.118m (adverse
movement of £0.018m) due to the current demand for fostering, adoption and
kinship placements.
c) Early Years - projected to underspend by £0.018m (adverse movement of
£0.026m) mainly due to the level of vacancies in heath visiting. This is after
allocating £0.200m of payroll turnover and accounting for £0.175m of potential
additional costs for the regrading of the HV posts.
d) Children with Disabilities Residential Placements - projected underspend of
£0.177m (adverse movement of £0.188m) due to two children transferring from
Residential Placements.
2.6
Management and Support Costs
Against the full-year budget of £9.319m there Is a projected underspend of £1.496m
(16%) which is a favourable movement of £0.255m. This underspend relates to the
potential delay in commitment for pressure funding set aside in the 2019-20 budget,
the requirement for this funding will need to be closely monitored and may require to
be delegated to services as and when required.
2.7
Primary Care and Prescribing
Prescribing is the responsibility for the Health Board to fund and under the terms of
the Integration Scheme the Health Board continues to underwrite the prescribing
position across the three Ayrshire IJBs. At month 5 prescribing is projected to be
175
£1.107m overspent. This is not included in the projected outturn due to the NHS
underwriting the overspend.
2.8 Savings Progress
a) The approved 2019-20 budget included £6.134m of savings.
RAG Status Position at Budget Position at
Approval Period 5
_Em_£m_
Red _:_ 0.393 _
Amber _ 2.980 _ 2.529 _
Green _ 3.154 _ 3.212 _
I TOTAL I 6.134 | 6.134 ~
b) The projected year-end outturn position assumes:
i) £0.215m of the Red savings in relation to reducing LD sleepovers may
not be delivered as planned and this is reflected in the overall projected
outturn position; and
ii) The £0.328m risk of savings relating to Trindlemoss is partially reflected
(£0.178m) in the projected overspend position as there is ongoing work
to establish the deliverability of the saving given that the savings were
based on the service being operational from September.
If progress is made to deliver the savings this would improve the overall outturn
position (LD sleepovers) or prevent the overspend increasing further (Trindlemoss).
The projected financial position assumes that all remaining savings on the plan will be
delivered. Progress with savings delivery requires to be closely monitored to ensure
the impact on the financial position can be assessed and corrective action taken where
necessary. Appendix C provides an overview of the savings plan, this highlights that
at this stage a total of £2.319m of savings have been delivered successfully.
The Transformation Board is in place to provide oversight and governance to the
programme of service change. A focus of the Board is to ensure plans are in place
to deliver savings and service change, with a solution focussed approach to bringing
programmes back on track.
2.9 Financial Recovery Plan _
The Integration Scheme requires the implementation of a recovery plan if an
overspend position is being projected, to take action to bring overall service delivery
back into line with the available resource. The previously approved financial recovery
plan is included in Appendix D.
This includes specific targeted actions with a focus on addressing the pressure areas,
the actions will not only improve the projected overspend this year but will also
address recurring overspends in service areas moving into future years. The plan
requires the IJB support and approval, while many of the plans are operational
management actions there may be some resistance from service users and
communities to any changes to care packages and services.
176
The plan will be monitored closely and is underpinned by more detailed plans with
clear actions for high risk service areas. One of the most significant risk areas is
Learning Disabilities, a more detailed plan with all actions including tracking progress
with reviews is co-ordinated between the service and finance and transformation
team. Weekly cross-service progress meetings are being held to track progress and
ensure are implemented at pace.
The overall recovery plan will be an Iterative document to remain under review.
Progress with the plan will be monitored against to ensure it has the required impact
and this will feature in future reporting to the IJB. The plan was agreed in September
therefore at this stage it is difficult to quantify the impact, further detail in relation to
progress and financial impact will be included In future financial monitoring reports.
There is a risk that if the planned Impact is not achieved that further actions will require
to be added to the plan and these may include actions that would impact on the quality
and performance of front-line services. The plan also highlights areas where a future
policy decision may be required by the IJB to support delivery, where required this will
be brought back to the IJB.
2.10 Financial Risks
The 2019-20 budget setting paper noted unfunded pressures which could present a
risk to the projected outturn position. This included:
a) Paid as if at work is a pressure relating to health employed staff and the
payment of a holiday pay element for regular additional payments, e.g.
overtime. The cost across the Health Board is estimated to be £1.4m but is
unclear at this stage what the cost will be for each service, for North Ayrshire
this is estimated to be around £0.2m. When the cost pressure value Is known
the partnership will look to services to fund from within existing resources where
possible.
b) There is a potential pressure in relation to GP practices in difficulty. This is a
dynamic pressure which we will look to manage In-year. If this cannot be
achieved, then the default position would be to fund the North fair share of this
(circa £0.2m) from any underspend In the Primary Care Improvement Fund
(PCIF).
In addition to these pressures there is a potential reduction to the funding available for
Ward 2 in Woodland View as East HSCP are reviewing the number of beds they want
to commission from the ward.
The IJB may be asked to take further decisions during 2019-20 in relation to managing
the above pressures.
2.11 Budget Changes
The Integration Scheme states that “either party may increase it’s in year payment to
the Integration Joint Board. Neither party may reduce the payment in-year to the
Integration Joint Board nor Services managed on a Lead Partnership basis.... without
the express consent of the Integration Joint Board”.
Appendix E highlights the movement in the overall budget position for the partnership
following the initial approved budget.
_ Reduction Requiring Approval:
Ml
2.12
The specific reductions that the IJB are required to approve are:
• Prescribing EO.SSOm - relates to a reduction an allocation for tariff reduction to
global sum, this reduction is a flow through of a reduction in Scottish
Government funding to the Health Board. As the Health Board underwrite
prescribing budgets there is no risk to the IJB of this reduction.
It is recommended that the IJB approve the budget reductions outlined above.
Future Planned Changes:
Further areas which are outstanding and will be included in future reports include:
1) Transfer of hub funding to the Communities Directorate (approx. £57k)
2) The transfer of the Douglas Grant and Redburn rehab wards from acute services
to the North HSCP. The operational management of these wards has already
transferred to the partnership, but the due diligence undertaken on the budget has
highlighted a funding shortfall. It has been agreed with NHS Ayrshire & Arran that
the financial responsibility will not transfer until balance is found. In the meantime,
we are managing services and working to reduce the projected overspend prior to
any transfer.
Lead Partnerships
North Ayrshire HSCP
Services managed under Lead Partnership arrangements by North Ayrshire Health
and Social Care Partnership are projected to be £0.051 m (£0.037m MH and £0.014m
Children) overspent. Full detail on the underspend is given in section 2.4 above.
South Ayrshire HSCP
Services hosted and/or led by the South Partnership are forecast to be online. The
Community Equipment Store was funded with an additional £0.280m as part of the
budget for this year, however it continues to be a source of pressure. It should be
noted that expenditure is volatile depending on the timing of purchases.
East Ayrshire HSCP
Services managed under Lead Partnership arrangements by East Ayrshire Health and
Social Care Partnership are projected to marginally overspend by £0.288m in total.
The overall Primary Care Lead Partnership projected overspend is £0.266m and this
projected variance mainly relates to additional payments within Primary Medical
Services to GP practices currently experiencing difficulty (mainly practices that the
NHS Board is administering due to previous GPs handing back contracts). The GP
practices in difficulty issue is extremely fluid however negotiations are progressing
with practices with a view to them returning to independent contractor status.
Additional Ayrshire Urgent Care Services costs resulting from increased rates being
paid to attract GPs over certain periods can prove challenging to fill without financial
incentives. These additional costs are partially offset by savings in Dental services.
This reflects the month 4 position for East as their next update is month 6.
Further work is being taken forward to develop a framework to report the financial
position and impact of risk sharing arrangements across the 3 partnerships in relation
to hosted or lead service arrangements. This is to ensure the IJB are fully sighted on
178
the impact for the North Ayrshire partnership. The IJB will be kept Informed of
progress with this work which is being progressed by the Ayrshire Partnership Finance
Leads.
At month 5 the impact of the Lead Partnerships has been calculated based on the
average NRAC share which is the method that was used in previous years and has
been agreed by the Ayrshire Finance Leads.
The NRAC shares are: North 36.6%, South 30.5% and East 32.9%
2.14
Set Aside
The Integration Scheme makes provision for the Set Aside Budget to be managed in¬
year by the Flealth Board with any recurring over or under spend being considered as
part of the annual budget setting process. The 2019-20 set aside budget for North
FISCP is £30.094m, based on expenditure in 2018-19. The acute directorate, which
includes the areas covered by the set aside budget, is overspent by £5.5m after 5
months.
58 additional and unfunded beds were open at the 31st March 2019. Crosshouse and
Ayr hospitals have experienced a high level of demand and delayed discharges,
resulting in increased operational pressures and additional expenditure.
During 2018-19 the North Partnerships use of the set aside resources was £30.094m
against the NRAC ‘fair share’ of £28.697m which is £1.127m above the ‘fair
share’. There is an expectation that the North Partnership will move towards its ‘fair
share’. The Models of Care programmes including the Intermediate Care and Rehab
investment and the Palliative End of Life proposals being developed represent agreed
or potential Investment in community services with a view to reducing acute
beds. This is in effect a mechanism to reduce the set aside resources.
3.
PROPOSALS
3.1
Anticipated Outcomes
Continuing to implement and monitor the financial recovery plan will allow the IJB to
take the action where required to ensure the partnership can deliver services in 2019-
20 from within the available resource, thereby limiting the financial risk the funding
partners, i.e. NAC and NFIS AA.
The transformational change programme will have the greatest impact on the financial
sustainability of the partnership, the IJB require to have a clear understanding of
progress with plans and any actions that can be taken to bring the change programme
into line.
3.2
Measurina Impact
Updates to the financial position will be reported to the IJB throughout 2019-20.
179
4. IMPLICATIONS
Financial:
The financial implications are as outlined in the report.
Against the full-year budget of £242.359m there is a projected
overspend of £2.308m (0.95%). The report outlines the action being
taken and proposed action to reduce the projected overspend.
There are a number of assumptions underpinning the projections
which could change as we progress through the year. We will
continue to work with services to ensure the most accurate and
reliable position is reported.
The financial recovery plan details planned actions to reduce the
projected overspend, this plan will require to be closely monitored and
reviewed to determine if further actions may be required to bridge the
gap.
The main areas of financial risk which may impact on this position are
highlighted in the report.
Human Resources:
None
Legal:
None
Equality:
None
Children and Young
People
None
Environmental &
Sustainability:
None
Key Priorities:
None
Risk Impiications:
Within the projected outturn there are various over and underspends
including the non-achievement of savings which need to be
addressed. If the financial recovery plan does not deliver the required
improvements to the financial position, there is a risk that further
actions will require to be identified and service quality and
performance may be compromised to achieve financial balance.
Community
Benefits:
None
Direction Required to
Direction to :-
Councii, Heaith Board or
1. No Direction Required
Both
2. North Ayrshire Council
3. NHS Ayrshire & Arran
4. North Ayrshire Council and NHS Ayrshire & Arran
V
4. CONSULTATION
4.1 This report has been produced in consultation with relevant budget holders and the
Partnership Senior Management Team.
The report is shared with the Director of Finance for NHS Ayrshire and Arran and the
Executive Director Finance and Corporate Support for North Ayrshire Council.
180
5. CONCLUSION
It is recommended that the IJB:
a) Note the projected year-end overspend of £2.308m;
b) Approve the changes in funding as detaiied in section 2.11 and Appendix E; and
c) Note the potentiai impact of the Lead Partnerships.
For more information piease contact:
Caroiine Cameron, Chief Finance & Transformation Officer on 01294 324954 or
caroiinecameron(5)north-avrshire.qov.uk
Eleanor Currie, Principal Manager - Finance on 01294 317814 or
eleanorcurrie@north-avrshire.qov.uk
181
2019-20 Budget Monitoring Report-Objective Summary as at 31 August 2019 _ Appendix A
Partnership Budget - Objective Summary
2019/20 Budget
Council
Health
TOTAL
Over/
(Under)
Spend
Variance at
Period 4
Movement
in
projected
budget
variance
Budget
Outturn
Over/
(Under)
Spend
Variance
Budget
Outturn
Over/
(Under)
Spend
Variance
Budget
Outturn
Over/
(Under)
Spend
Variance
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
£'000
COMMUNITY CARE AND HEALTH
54,814
56,038
1,224
12,961
13,225
264
67,775
69,263
1,488
1,104
384
: Locality Services
24,919
25,726
807
" 4,486
4,400
(86)
29,405
30,126
721
608
113
: Community Care Service Delivery
26,035
27,204
1,169
0
0
0
26,035
27,204
1,169
991
178
: Rehabilitation and Reablement
1,765
1,568
(197)
' 1,912
2,055
143
3,677
3,623
(54)
(100)
46
: Long Term Conditions
1,736
1,205
(531)
" 4,574
4,787
213
6,310
5,992
(318)
(395)
77
: Integrated Island Services
359
335
(24)
1,989
1,983
(6)
2,348
2,318
(30)
0
(30)
MENTAL HEALTH SERVICES
23,654
25,148
1,494
51,829
51,610
(219)
75,483
76,758
1,275
1,276
(1)
: Learning Disabilities
17,830
19,302
1,472
511
403
(108)
18,341
19,705
1,364
1,329
35
: Com mm unity Mental Health
4,459
4,481
22
1,611
1,558
(53)
6,070
6,039
(31)
(53)
22
: Addictions
1,365
1,365
0
1,345
1,250
(95)
2,710
2,615
(95)
(90)
(5)
: Lead Partnership Mental Health NHS Area Wide
0
0
0
48,362
48,399
37
48,362
48,399
37
90
(53)
CHILDREN & JUSTICE SERVICES
32,135
33,144
1,009
3,610
3,670
60
35,745
36,814
1,069
919
150
: Intervention Services
3,859
3,950
91
325
371
46
4,184
4,321
137
157
(20)
: Looked After & Accomodated Children
16,325
17,341
1,016
0
0
0
16,325
17,341
1,016
1,059
(43)
: Fieldwork
4,713
4,765
52
0
0
0
4,713
4,765
52
6
46
:CCSF
311
266
(45)
0
0
0
311
266
(45)
(21)
(24)
: Criminal Justice
2,627
2,627
0
0
0
0
2,627
2,627
0
0
0
: Early Years
394
376
(18)
2,868
2,868
0
3,262
3,244
(18)
(44)
26
: Policy & Practice
3,906
3,819
(87)
0
0
0
3,906
3,819
(87)
(252)
165
: Lead Partnership NHS Children's Services Area
Wide
0
0
0
417
431
14
417
431
14
14
0
PRIMARY CARE
0
0
0
47,169
47,169
0
47,169
47,169
0
0
0
ALLIED HEALTH PROFESSIONALS
5,131
5,081
(50)
5,131
5,081
(50)
(50)
0
MANAGEMENT AND SUPPORT COSTS
7,412
6,080
(1,332)
1,907
1,743
(164)
9,319
7,823
(1,496)
(1,241)
(255)
CHANGE PROGRAMME
655
655
(50)
1,082
1,082
0
1,737
1,737
(50)
(50)
0
TOTAL
118,670
121,065
2,345
123,689
123,580
(109)
242,359
244,645
2,236
1,958
278
Return Hosted Over/Underspends East
0
0
0
0
(17)
(17)
(34)
17
Return Hosted Over/Underspends South
0
0
0
0
(16)
(16)
(32)
16
Receive Hosted Over/Underspends East
0
0
0
0
105
105
105
0
REVISED PROJECTED OUTTURN
118,670
121,065
2,345
123,689
123,580
(37)
242,359
244,645
2,308
1,997
311
2019-20 Budget Monitoring Report - Detailed Variance Analysis per service Appendix B
182
COMMUNITY CARE AND HEALTH
Locality Services
Community Care Service Delivery
Budget
£000's
Outturn
Over/
(Under)
Spend
Variance
£
67,775
69,263
1,488
Older People permanent care homes - projected overspend of £0.367m based on 816 placements. Respite
care is projected to be online.
Income from Charging Orders - projected over recovery of £0.200m'
Independent Living Services:
* Direct Payment packages- projected underspend of £0.089m on 62 packages and a net decrease of 1
^21 packages expected during the year..
* Residential Packages - projected overspend of £0.020m based on 35 packages.
* Community Packages (physical disability) - projected overspend of £0.159m based on 49 packages
NHS Packages of Care - projected underspend of £0.097m due to use of supplementary staffing offset by
slippage in other packages.
Care at home
- in house service - projected overspend of £0.139m based on the current level of contracted costs remaining
until the year end. Care at home staff have been incurring additional hours as there are moratoria on four of the
purchased care providers.
- Purchased Care at home - projected overspend of £0.456m. This is after reducing the budget by £0.500m to
reflect the agreed 19-20 saving. There are four moratoria in place but the hours purchased from other providers
has increased.
Direct Payments - projected underspend of £0.106m based on 28 packages continuing until the year end.
Transport costs - projected overspend of £0.055m due to increase in staff mileage within care at home.
Admin costs - projected overspend of £0.80m mainly due to mobile phone equipment.
Supplies and Services - projected overspend of £0.125m in relation to uniforms and other supplies.
Voluntary Organisations - projected overspend £0.088m mainly in relation to the Alzheimer service.
Income - projected over recovery £0.043m mainly in relation to CM2000 non compliance charges.
183
Budget
£000's
Outturn
£000's
Over/
(Under)
Spend
Variance
£000's
Rehabilitation and Reablement
3,677
3,623
(54)
Employee costs - projected underspend £0.190m due to vacancies.
Intermediate Care and Rehab Models of Care - projected to overspend by £0.260m which is the full year
funding impact.
Aids and Adaptations - projected underspend of £0.200m per the approved recovery plan
Long Term Conditions
6,310
5,992
(318)
Ward 1 - projected overspend of £0.270m due to the use of supplementary staffing.
Ward 2 - projected underspend of £0.026m assuming £0.504m of funding transfers from East HSCP in relation
to Kirklandside patients.
Elderly CMHT - underspend of £0.044m due to vacancies.
Carers Act Funding - projected underspend of £0.561 m based on the committed spend. This could fluctuate
depending on the volume of carers’ assessments undertaken and the level of demand/services identified from
these assessments. This underspend will be used in the first instance to cover the projected overspend on care
home respite placements.
Integrated Island Services
2,348
2,318
(30)
Outwith the threshold for reporting
MENTAL HEALTH SERVICES
75,483
76,758
1,275
Learning Disabilities
18,341
19,705
1,364
Residential Packages- projected overspend of £0.361 m based on 41 current packages.
Community Packages (inc direct payments) - projected overspend of £1.157m based on 291 current
packages less 5% invoice variances. The projection assumes savings of £0.490m will be achieved and that any
new packages or increases to current packages will be cost neutral. The direct payments projection is based
on 40 current packages with a net increase of 3 to the year end less £0.102m recovery of unspent balances.
Employee costs - projected underspend £0.073m mainly due to vacant posts
Community Mental Health
6,070
6,039
(31)
Outwith the threshold for reporting
Addictions
2,710
2,615
(95)
Employee costs - projected underspend £0.095m due to vacant posts
ADP - projected online position.
184
Budget
£000's
Outturn
Over/
(Under)
Spend
Variance
£
Lead Partnership (MHS)
Adult Community - projected underspend of £0.069m due to vacancies.
Adult Inpatients- projected overspend of £0.580m due to a delay in closing the Lochranza wards. Assumes a
5th bed is sold from October.
UNPACs - projected overspend of £0.242m which includes the charges from the state hospital (April - August
2019).
LDS - assumed online pending completion of the relocation of services to Woodland View.
Elderly Inpatients - assumed online pending the finalisation of the elderly mental health bed redesign.
Addictions - projected underspend of £0.030m due to vacancies.
CAMHS - projected underspend of £0.270m due to vacancies.
MH Admin - projected underspend of £0.125 due to vacancies..
Psychiatry - projected overspend of £0.025m due to agency costs.
MH Pharmacy - projected underspend of £0.154m mainly within substitute prescribing.
Psychology- projected underspend of £0.160m due to vacancies.
Action 15 - assumed online position
CHIDREN'S AND JUSTICE
SERVICES
35,745
36,814
1,069
Intervention Services
4,184
4,321
137
Employee costs - projected overspend of £0.013m mainly due to incremental drift.
Supported Carers Scheme - projected overspend of £0.031 m based on 6 carers supporting 6 children.
Transport Costs - projected overspend of £0.043m in relation to mileage costs.
Third Party payments - projected overspend of £80k (combination , Children's 1st Advocacy and Action for
Children (Functional Family Therapy)
185
Budget
£000's
Outturn
£000's
Over/
(Under)
Spend
Variance
£000's
Looked After & Accom Children
16,325
17,341
1,016
Looked After Children olacements- oroiected underspend of £0.118m based on the followina:-
Kinship - projected overspend of £0.050m. Budget for 339 placements, currently 334 placement but projecting
345 placements by the year end.
Adoption - projected overspend of £0.003m. Budget for 74 placements, currently 74 placements.
Fostering - projected underspend of £0.039m. Budget for 120 placements, currently 122 placements but
projecting 114 placements by the year end.
Fostering Xtra - projected underspend of £0.137m. Budget for 32 placements, currently 25 placements but
projecting 24 placements by the year end.
Private fostering - projected underspend of £0.081 m. Budget for 11 placements, currently 10 placements.
IMPACCT carers - projected underspend of £0.016m. Budget for 4 placements, currently 2 placements.
Residential School placements including community packages - projected overspend of £1.262m. The
projection is based on the current number of placements and estimated discharge dates for each placement
based on the support from the mainstreamed Challenge Fund project. There are currently 22 placements. The
projection assumes 3 discharges in December with the remaining 19 assumed to be still in a placement at the
year end. There is no provision for any increase in placements.
Fieldwork
4,713
4,765
52
Various minor overspends on transport and the out of hours service.
CCSF
311
266
(45)
Outwith the threshold for reporting
Criminal Justice
2,627
2,627
0
Outwith the threshold for reporting
Early Years
3,262
3,244
(18)
Outwith the threshold for reporting
Policy & Practice
3,906
3,819
(87)
Employee costs - projected overspend of £0.084m due to non achieved payroll turnover.
Residential Placements - projected underspend of £0.177m. This underspend has reduced as two children
transferred from residential provision.
Lead Partnership (CS)
417
431
14
Outwith the threshold for reporting
186
Budget
£000's
Outturn
£000's
Over/
(Under)
Spend
Variance
£000's
PRIMARY CARE
47,169
47,169
0
Outwith the threshold for reporting
ALLIED HEALTH PROFESSIONALS
5,131
5,081
(50)
Outwith the threshoid for reporting
MANAGEMENT AND SUPPORT
9,319
7,823
(1,496)
Projected underspend - this underspend relates to pressure funding awarded as part of the 2019-20 and the
pressures have not yet arisen. This funding will be closely monitored and delegated to services as and when
required.
CHANGE PROGRAMME &
CHALLENGE FUND
1,737
1,737
(50)
Outwith the threshoid for reporting
TOTAL
242,359
244,645
2,236
Threshold for reporting is + or- £50,000
2019-20 Savings Tracker
Appendix C
187
Savings
reference
number
Description
Responsible Senior
Management Lead
Deliverability
Status at
budget setting
Approved
Saving
2019/20
£
Deliverability
Status Month
5
Net Saving
Achieved at
Period 5
£000's
Heaith and Community Care
SP-HSCP-19-02
Roll out of multidisciplinary teams - Community Care and Health
Helen McArthur
Amber
55,000
Amber
0
SP-HSCP-19-04
Day Centres - Older People
Helen McArthur
Green
38,232
Green
38,232
SP-HSCP-19-05
Deliver the Strategic Plan objectives for Older People's Residential Services
Helen McArthur
Green
130,350
Amber
0
SP-HSCP-19-09
Care at Home - Reablement Investment
Helen McArthur
Amber
500,000
Amber
0
SP-HSCP-19-12
Assessment and Self Directed Support
Isabel Marr
Green
150,000
Amber
0
NHS - HSCP-9
Packages of Care
Isabel Marr
Amber
150,000
Green
150,000
Mental Health and Learning Disabilities
SP-HSCP-19-01
Integration of the Learning Disability team
Jan Thomson
Amber
56,000
Green
56,000
SP-HSCP-19-07
Mental Health - Tarryholme /Trindlemoss (Council element)
Jan Thomson
Amber
328,000
Red / Amber
0
NHS - HSCP-1
Trindlemoss (full year impact is £0.370m)* NHS element
Jan Thomson
Amber
250,000
Green
0
SP-HSCP-19-10
LD - Reduction to Sleepover Provision
Jan Thomson
Amber
215,000
Red
25,000
SP-HSCP-19-11
Reprovide Fergushill/Hazeldene at Trindlemoss & redesign commissioned
services
Jan Thomson
Green
111,000
Amber
0
SP-HSCP-19-06
Adult Community Support - Commissioning of Services
Jan Thomson/Julie
Green
388,000
Amber
1,500
NHS - HSCP-4
UnPACs - 7% reduction*
John Taylor
Green
200,000
Amber
0
NHS - HSCP-5
Substitute Prescribing - 5% reduction*
John Taylor
Green
135,000
Green
135,000
NHS - HSCP-3
Review of Elderly Mental Health Inpatients*
William Lauder
Green
727,000
Green
0
NHS - HSCP-6
See a 5th bed at Woodland View - MH inpatients*
William Lauder
Amber
90,000
Amber
0
188
Children, Families and Justice Services
SP-HSCP-19-03
Fostering - reduce external placements.
Mae Henderson
Green
127,408
Green
127,408
SP-HSCP-19-08
Children's residential olacements tCFt
Mae Henderson
Amber
355,000
Amber
0
Partnership Wide
SP-HSCP-19-13
Charging Policy
Lisa Duncan
Green
200,000
Green
200,000
NHS-HSCP-10
Reduce business admin services
Julie Davis
Green
50,000
Green
50,000
NHS-HSCP-11
ICF Project - Partnership Enablers
Michelle Sutherland
Amber
27,000
Green
27,000
NHS-HSCP-12
ICF Project - Buckreddan care home
Michelle Sutherland
Amber
16,000
Green
16,000
NHS-HSCP-13
Uncommitted ICF Funding
Michelle Sutherland
Green
80,000
Green
80,000
SP-HSCP-19-20
Living Wage
n/a
Green
187,000
Green
187,000
NHS - HSCP-7
Resource Transfer to South Lanarkshire
n/a
Green
40,000
Green
40,000
SP-HSCP-19-14
19/20 impact of 18/19 part year savings
Stephen Brown
Green
113,000
Green
113,000
SP-HSCP-19-15
Respite
n/a
Green
200,000
Green
200,000
SP-HSCP-19-16
Payroll Turnover Target
Stephen Brown
Amber
500,000
Amber
208,333
SP-HSCP-19-17
Lean Efficiency Programme
Stephen Brown
Green
50,000
Amber
0
NHS - HSCP-2
Payroll Turnover Target - Mental Health *
Thelma Bowers
Amber
300,000
Green
300,000
NHS - HSCP-8
Payroll Turnover Target - Other Services
Thelma Bowers
Amber
365,000
Green
365,000
6,133,990 2,319,473
189
Recovery Plan (Approved 26 September 2019)
Appendix D
Ref
Service Area
Action
Service Impact
IJB
Support
Included
in P4
Position
EOOO's
Planned
Impact
£ OOO's
Responsible
Officer
Health and Community Care:
1
Care at Home
Reduction in Care at Home Provision:
-reduce weekly hours of purchased provision by between 50 and 100 hours per
week, by c losing c ases for c lients adm itted to hospital
-review care packages with any reduction in hours closed to offset the overspend
-continue to review the actions of Independent Providers in the use ofCM2000 for
maximum efficiency
-further roll out and embed the reablement approach in CAM service to allow
packages to be reduced
May lead to delays in care at home packages being
delivered and may impact on hospital discharges and
increase delayed discharges. May have impact on Waiting
li st. Ri sk of thi s wi II be mitigated by ensuri ng resources are
used efficiently, with a risk based approach to allocating
resources.
200
Helen McArthur
2
Care Homes - Respite
Placements
Heaith and Community Care Service to enforce a poiicy and criteria in
relation to emergency respite in commissioned care home settings:
- significant increase in emergency respite where in m any cases residents are
placed in longterm care, action taken to fund long term placements in September
-change of practicefor social workers in relation to use of respite
- provide clairty to com missioned care home providers that respite beds will be
used for shortterm care to ensure expectations ofservice, care home and service
user are aligned
Action has been taken to address current placements to
ensure the service delivered is equitable, that the HSCP are
appropriately financially assessing residents and that the
commissioned care homes are funded for long term care
placements. The appropriate useof emergency respite
placements will be reinforced to the social work team. The
longer term commissioning and use of respite provision for
older people is being considered as part of the Care Home
Strategy.
V
V
Helen McArthur
3
Equipment & Adaptations
Temporary reduction (2019-20 oniy) in the equipment and adaptations
budget.
-mirrors the reductbn made in 2018/19 to assist with overall financial position,
would not be sustainable on a recurring basis as provision of equipment
fundamental to keeping people safe at home
-priority for equipment provision will be;
1. support for end of life care
2. com plete adaptations started or comm itted to in writing prior to tightened control
of expenditure
3. maintain equipment and adaptations in situ and on which service users depend
4. provide essential equipment to support avoidance of hospital adm ission
Potential delays to equipment and adaptations for service
users, this will be kept under review together with any waiting
lists and impact on deliveryof community based services,
including monitoring the costs of any delays in supporting
individuals to be supported in the community.
200
Helen McArthur
190
Ref
Service Area
Action
Service Impact
IJB
Support
Included
in P4
Position
£000's
Planned
Impact
£ OOO's
Responsible
Officer
Mental Health and Learning Disabilities:
4
Learning Disabilities
Prioritised Review of Aduit Community Packages:
-targeted reviews to be carried out immediately, reviews co-ordinated on a
prioritised list with a focus on individuals moving service provider following the
outcome of the tender exercise and with high cost packages being prioritised
-will be supported with significant additional LD social work capacity with additional
professional lead, additional social workers and the employment of agency staff to
accellerate planned reviews
-reviews will ensure the split of personal and non-personal care is appropriate and
equitable (to ensure equity of provision and charging)
-direct payments to be reviewed to progress claw-back of underspends
-incorporates looking at clients where the service provided has been less than than
commissioned to formalise re-alignment of care packages based on need
Service users will be reviewed by a dedicated review team,
the outcome should ensure that all reviews are up to date and
appropriate and equitable levels of care are being provided.
This process may cause some anxiety for service users as
there is an expectation that significant reductions can be
made to care packages. No reduction will be made to care
packages unless deemed to be safe and appropriate by the
service, however there maybe some resistance to change
from service users, their families and advocates.
V
750
Thehia Bowers
5
Learning Disabilities
Trindlemoss development finalise the financial impact of the new
service (LD day service, complex care unit and supported
accommodation):
-for 2019/20 require to plan to mitigate delay in savings being achieved
- opportunities to further reduce cost of amalgamating day services
-identifying supports required for service users in supported accommodation
- policy in relation to eligibilty and prioritisation for supported accommodation,
model of care blueprint for other supported accommodation coming online
The opening of the new service at Trindlemoss (originally
planned August2019) has been delayed due to delays in the
buiIding works, this has impacted on the timescales for
service users and patients transferring. The service will
require to be configured around the affordability of the care
and support, taking into account the positive environment and
the opportunities the shared accommodation space offers in
terms of reducing existing high cost care packages.
V
tbc
Thehia Bowers
6
Learning Disabilities
Sleepovers - develop policy in relation to 24 hour care for Adults in the
Commnunify:
- policy decision to not provide one to one 24 hour sleepover service where there
are:
* supported accommodation alternatives available;
* opportunities for service users to share a service (will be idertified by
geographically mapping services); or
* where technology supports can be provided supported by a responder service.
- Recovery plan action and financial impact is based on a plan to deliver a
responder service from the Trindlemoss supported accommodation to support
removal of sleepovers in the area
This will result in the removal of one to one 24 hour support
from service users, an enhanced overnight service will be
provided from Trindlemoss to support capacity for response.
Individual service user safety will be a priority and the one to
one support will only be removed where safe to do so.
V
128
Thehia Bowers
7
Learning Disabilities
Transition Cases (Adults aged 65+) :
- reviews undertaken jointly with LD and Older People's service which will deliver
some savings, some work outstanding in relation to these reviews where changes
to care packages have been idertified
-further action to scrutinise outcome of reviews and equity of service provision
across client groups, particularly for high cost care packages which are not
equitable with community care provided in Older People's services
- requires a clear policy decision in relation to transitions of care and funding for
community based supports
Service users are being reviewed with a view to reducing the
cost of packages as the clients transition to the Older
People's service. Some reviews for high cost community
packages have identified individuals suitable for the criteria
of long term care but resistance from service users to change
from current care and support. If care packages cannot be
reduced the IJB will be asked to agree a policy decision on
the level of care provided in such cases.
V
134
Thehia
Bowers/Helen
McArthur
191
Ref
Service Area
Action
Service Impact
IJB
Support
Included
In P4
Position
£000's
Planned
Impact
£ OOO's
Responsible
Officer
8
Adult Community
Packages
Adult Resource Group no overall increase in care package provision:
-ARC in place for pMlental Health and Learning Disability care packages for
approval, ARC will no longer be permitted to approve any increase to eKisting or
new care packages unless there has been a reduction in service elsewhere
-will require social workers to proactively review caseload and use finite resource
available to support whole clientgroup
- arrangemerts will remain in place until the service brings the overall expenditure
on community care packages back into line
Service users assessed as requiring a service will have to
wait until resource has been identified to fund the care
package, this is equitable with waiting lists for other services
where resources are limited. This may result in de^ys in
supports being provided but will also ensure that the service
is managing, directing and prioritising resources effectively.
V
V
Thehia Bowers
9
All
Self Directed Support:
-exploring how to embed this alongside the asset based approach promoted
through the HSCP Thinking Different, Doing Better experience into services to
change how we deliver services and balance service user and community
expectations
- undertaking self-evaluation for North Ayrshire against good practice, this will
include stakeholder engagement to develop future approach
Positive impactto embed Self Directed Support, with a view
to being realistic in managing expectations of services and
service users. Address a perceived inequity in how services
are delivered and how embedded SDS is across social care
services.
V
Stephen Brown
Children and Families:
10
Looked After and
Accomodated Children
Children's External Residential Racements bring forward planned
discharge dates:
-overspend due to delays in bringing children back from expensive external
residertial placemerts due to timescales slipping, recovery action based on pulling
forward all estimated timescales by one month and moving to planned level of 14
placements by March 2020
- scrutiny of detailed plans for individual children, to be reviewed alongside the
internal children's houses to free up capacity to bring children back to NA sooner
-closeworking with Education services as shared ambition and requiremerts to
provide educational supports within NA
-formalise and reinforce governance arrangements for approval of new external
children's placemerts
Transformation plan to support more looked after children in
North Ayrshire is focussed on delivering more positive
outcomes for Children. Accellerating plans to move children
to different care settings is challenging for the service as
these are sensitive complex cases.
200
Alison Sutherland
192
Ref
Service Area
Action
Service Impact
IJB
Support
Included
in P4
Position
£000's
Planned
Impact
£ OOO's
Responsible
Officer
Other:
11
All
Recruitment freeze non-frontline posts:
- hold recruitment to all vacait norvfrort line care posts, eg support services,
admin support
- partnership vacancy scrutiny group remains in place and will ensure posts are not
approved for recruitment until the new finaixial year
Minimal impact on front line services but depending on where
vacancies arise during the rest of the year could have an
impact on the capcitay of support services, in particular to
respond to service requests. Tfie HSCP vacancy scrutiny
group will ensure consideration is given to the impact on
services when recruitment is delayed for individual posts.
200
Caroline Whyte
12
Al
Moratorium non-essential expenditure:
- communication issued to all budget holders (social care and health) with an
instruction to delay or cease any areas of discretional spend (areas including
supplies and services, training, third party payments etc)
-finance teams will liaise with budget holders as part of regular engagement and
budgets will be removed non-recurrinqlyto a How target reductbn to be met
Minimal impact on front line services but is a shortterm one-
off approach to reducing expenditure.
185
Caroline Whyte
13
M
Systems improvements re care packages:
- Extension of CM2000to adult services which will enable payment to care
providers based on actual service delivered, being rolled out to some providers in
advance of new tender
-finance working with services to review areas where service delivered differs
from that commissioned to improve systems and basis of financial projections, this
work also supports ongoing reviews
- action plan in relation to improving projections and actions identified from recent
internal audit report re Community Based Care, irxiuding streamlining systems arxt
processes to remove duplication, scope for error and reliablity of information
Significant work requriedto review systems across social
care services where different approaches are used for
different service areas, some areas involve duplication of
information and systems. Work will result in more assurance
re the information reported, in eluding fin an dal projections and
will also ensure the partnership has assurance that we only
pay for the direct care delivered.
V
Thelma
Bowers/Helen
McArthur/Carol in
e Whyte
TOTAL 1,997
193
2019-20 Budget Reconciliation
Appendix E
COUNCIL
Period
Permanent
or
Temporary
£
Initial Approved Budget
95,067
Resource Transfer
3
P
22,993
ICF Procurement Posts - Transfer to Procurement
3
T
(85)
FPC under 65's Scottish Government Funding
3
P
702
Transfer to IT WAN circuit Kilwinning Academy
4
P
(3)
Waste Collection Budget
4
P
27
CLD Officer from ADP Budget to E & C
4
T
(31)
Period 5 reported budget
118,670
HEALTH
Period
Permanent
or
Temporary
£
Initial Approved Budget (based on month 9 of 2018-19)
145,425
Adjustments to reflect month 10 -12 of 2018-19 including non¬
recurring amounts
(1,845)
Opening baseline budget for 19-20
143,580
Resource Transfer
3
P
(22,993)
Superannuation Uplift
3
P
2,994
Voluntary Redundancy Scheme
3
P
271
Post from acute - PA to Clinical Nurse Manager, Long Term
conditions
3
P
15
Post from acute - Clinical Nurse Manager, Long Term Conditions
3
P
34
Functional Electrical Stimulation (Physio Equip) Equipment from
acute
10
Pharmacy Fees
3
P
19
HPV Boys Implementation
3
P
18
Action 15 (anticipated increase)
3
P
930
Post from Acute -Specialist Pharmacist in Substance Misuse
3
T
12
Old age liaison psychiatrist from acute
3
P
108
Patient Transport Service
3
P
49
Infant feeding nurse
3
T
41
Associate Medical Director responsibility payment to Medical
Director
3
T
(24)
Associate Medical Director sessions to the Medical Director
3
T
(71)
Contribution to the Technology Enabled Care (TEC) project
3
T
(50)
Superannuation Uplift Overclaimed
4
P
(270)
Action 15 overclaimed
4
T
(485)
Prescribing Reduction
5
P
(550)
Medical Training Grade Increase
5
P
51
Period 5 reported budget
123,689
GRAND TOTAL
242,359
194
DIRECTION
From North Ayrshire Integration Joint Board
NORTH AYRSHIRE
Health and Social Care
Partnership
1.
Reference Number
24102019-^
2.
Date Direction issued by iJB
24102019
3.
Date Direction takes effect
24102019
4.
Direction to
North Ayrshire Council
NHS Ayrshire & Arran
Both
X
5.
Does this direction supercede,
amend or cancel a previous
direction - if yes, include the
reference numbers(s)
Yes
X-26092019-08
No
6.
Functions covered by the direction
All NAHSCP delegated functions
7.
Full text of direction
NHS Ayrshire and Arran & North Ayrshire Council are required to:
• Action the budget changes outlined in para 2.11 and Appendix E; and
• Deliver the Financial Recovery Plan detailed in Appendix D.
8.
Budget allocated by Integration
Joint Board to carry out direction
North Ayrshire Council £118.670m
NHS Ayshire & Arran £123.689m
TOTAL £242.359m
9.
Performance Monitoring
Arrangements
Regular financial updates will be reported to the IJB during 2019-20, the financial
recovery plan will be monitored to ensure this aligns with delivering financial balance.
10.
Date of Review of Direction (if
applicable)
n/a
195
