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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 


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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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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/ 



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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 




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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 

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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 
dirug use vrill [be safe, 
heaUhy. inolnded and 
supported 

Less harm is 
caused by aloohoJ 

1 

’vulnerable people 
are diven^d from 

Ihe juslioe system, 
wherever possible 
and those in ttK 
jiGtiae system are 
supirarted 


ArecDveTy 
orient aled 
approach which 
reduces harni 
and prevents 
- deaths 


People and 

bensfil frofn 

iruftegratsd 
perEoo-ce^ed 
supp^^tD achieve 
their recovBiy 


Delivery Commitments 


Educaftnn 
P log ra runes 
Eaily 

inlerventkMi 

Harm 

reducicMi 


Whale femi^ 
support 

AanesslD support 
Families involved ir 
plenraing, -defiireiy 
and service 
development 


Family fdoussed 
apprcachs 
Reducing 
oonEumplior 
Partners weilcMig 
to prevent harm 
and violarrce 


The right support 
at Ihe right time 
Prison health & 





available 


Treatnnerrt 
recovery 
pnc grammes 
Focussed on 
most ai risk 


ADP Governance 

Strategic plan 

Quality improvement plan 

Governance structure 

Risk register 

Perfonmance reporting 

Workforce plan 

Financial transparency 

Equalities impact 
assess menl 

Comniunicalion, 

engagements 

participation 

External review 


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 




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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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Transformation and Sustainability 


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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Transformation and Sustainability 


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 
Board 


Tactical 


Strategic 


NHS 

Corporate Management 
Team 


Integrated 

Governance 

Committee 


Digital 

Programme 

Management 

Group 


Capital 

Programme 

Management 

Group 


Caring for .Ayrshire 
Programme Board 


Tactical priantisatian 
through interaction of 
groups in the oval 


Infrastructure 
Programme Board 


Clinical 

Programme Board 


Tij Ije 


For further details on the governance boards and groups in terms of purpose and 
membership, please see Appendix 4. 


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Transformation and Sustainability 


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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Transformation and Sustainability 


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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Transformation and Sustainability 


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Transformation and Sustainability 


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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Transformation and Sustainability 


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Transformation and Sustainability 


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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Transformation and Sustainability 


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Transformation and Sustainability 


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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Transformation and Sustainability 


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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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/ 


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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 


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Transformation and Sustainability 


C5:rinB for Ayrshire - High Lovet Pncsject Stages 






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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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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 


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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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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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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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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 



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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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143 







Transformation and Sustainability 


Appendix 2 - Proposed Caring for Ayrshire Management Structure 




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145 
































































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) 


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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 


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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 


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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. 


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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