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Integration Joint Board 
Meeting 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


Thursday, 24 September 2020 at 10:00 


Virtual Meeting 
Venue Address 


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2 

3 

3.1 

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Arrangements in Terms of COVID-19 

In light of the current COVID-19 pandemic, this meeting will be held remotely 
in accordance with the provisions of the Local Government (Scotland) Act 
2003. A recording of the meeting will be available to view at https ://north- 
ayrshire.public-i.tv/core/portal/home 

Apologies 


Declarations of Interest 

Members are requested to give notice of any declarations of interest in 
respect of items of business on the Agenda. 

Minutes/Action Note 

The accuracy of the Minutes of the meeting held on 27 August 2020 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). 

Matters Arising 

Consider any matters arising from the minutes of the previous meeting. 

Director’s Report 

Submit report by Stephen Brown, Director (NAHSCP) on developments 
within the North Ayrshire Health and Social Care Partnership (copy 
enclosed). 

Financial Performance: Period 4 

Submit report by Caroline Cameron, Chief Finance & Transformation Officer 
on the financial position of the North Ayrshire Health and Social Care 
Partnership (copy enclosed). 


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2 

3 

3.1 

4 

5 


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6 Annual Performance Report 2019-20 

Submit report by Neil McLaughlin, Performance and Information Systems 
Manager on the North Ayrshire Health and Social Care Partnership Annual 
Performance Report 2019-20 (copy enclosed). 

7 MB PAC - Quarter 1 Performance Monitoring 

Submit report by Neil McLaughlin, Performance and Information Systems 
Manager on the progress being made by the Health and Social Care 
Partnership in delivering the strategic priorities set out in the 3-year strategic 
plan (copy enclosed). 

8 Meeting dates for 2021 

Submit report by Karen Andrews, Team Manager (Governance) on proposed 
dates for meetings of the IJB and IJB PAC for 2021 (copy enclosed). 

9 Urgent Items 

Any other items which the Chair considers to be urgent. 

Webcasting - Virtual Meeting 

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 Provost 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. 

If you have any queries regarding this, please contact 

committeeservices@north-ayrshire.gov.uk. 


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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 
NHS Ayrshire and Arran 
North Ayrshire Council 
NHS Ayrshire and Arran 
NHS Ayrshire and Arran 
North Ayrshire Council 


Professional Advisors 

Stephen Brown 
Caroline Cameron 
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 
Clive Shephard 
Jackie Weston 
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 
Independent Sector Representative 
Independent Sector Rep (Depute for Jackie Weston 
Third Sector Representative 
(Chair) IJB Irvine Locality Forum 
(Chair) Garnock Valley Locality Forum 


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Agenda Item 3 



NORTH AYRSHIRE 

Health and Social Care 
Partnership 


North Ayrshire Health and Social Care Partnership 
Minute of Integration Joint Board Virtual meeting held on 
Thursday 27 August 2020 at 10.00 a.m. 


Present 

Councillor Robert Foster, North Ayrshire Council (Chair) 

Bob Martin, NHS Ayrshire and Arran (Vice-Chair) 

Councillor Timothy Billings, North Ayrshire Council 
Adrian Carragher, NHS Ayrshire and Arran 
Councillor Anthea Dickson, North Ayrshire Council 
Councillor John Sweeney, North Ayrshire Council 

Stephen Brown, Director of Health and Social Care Partnership 

Caroline Cameron, Chief Finance and Transformation Officer 

Dr Paul Kerr, Clinical Director 

Alistair Reid, Lead Allied Health Professional Adviser 

Dr Calum Morrison, Acute Services Representative 

David Thomson, Associate Nurse Director/IJB Lead Nurse 

David Donaghey, Staff Representative (NHS Ayrshire and Arran) 

Louise McDaid, Staff Representative (North Ayrshire Council) 

Graham Searle, Carers Representative (Depute for Marie McWaters) 

Clive Shepherd, Service User Representative 
Vicki Yuill, Third Sector Representative 
Jackie Weston, Independent Sector Representative 
Janet McKay, Chair (Garnock Valley Locality Forum) 

In Attendance 

Thelma Bowers, Head of Service (Mental Health) 

Alison Sutherland, Head of Service (Children, Families and Criminal Justice) 
Michelle Sutherland, Partnership Facilitator 
Ruth Betley, Senior Manager (Arran Services) 

Karen Andrews, Team Manager Governance 
Angela Little, Committee Services Officer 
Diane McCaw, Committee Services Officer 
Mhari Lindsay, Senior Customer Officer (ICT) 

Also in Attendance 

Karlyn Watt, Deloitte 


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Apologies for Absence 

John Rainey, NHS Ayrshire and Arran 
David MacRitchie, Chief Social Work Officer 
Jean Ford, NHS Ayrshire and Arran 

Dr. Louise Wilson, GP Representative 
Marie McWaters, Carers Representative 

Helen McArthur, Principal Manager (Health and Community Care Services) 

1. Apologies 
Apologies were noted. 

2. Declarations of Interest 

There were no 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. 

3. Minutes/Action Note 

The accuracy of the Minutes of the meeting held on 13 February and 16 July 2020 
were confirmed and the Minutes signed in accordance with Paragraph 7 (1) of 
Schedule 7 of the Local Government (Scotland) Act 1973. 

The Board discussed the Community Alarm/Telecare and UK Care Home Industry 
actions and the impact of the pandemic on the timescales for reporting. Whilst work 
will continue in these area, full reports would not be available until 2021. 

The Board agreed (a) when appropriate, the Director’s report provide updates on 
progress on Community Alarm/Telecare and UK Care Home Industry; and (b) that full 
reports on these areas would be provided to the IJB in 2021. 

4. North Ayrshire Alcohol and Drug Partnership Update 

Submitted report by Peter McArthur providing an overview of the activities and actions 
of the ADP since the Drug Death Summit. Appendix 1 to the report provided details 
of the £83,726 funding from the Drug Death Task Force (DDTF). The DDTF working 
Action Plan was outlined at Appendix 2. 

Members asked questions and were provided with further information in relation to:- 

• Work by North Ayrshire on a potential pan Ayrshire bid for Test of Change for 
Multiple Complex Needs, but that a local bid would be submitted if a pan 
Ayrshire bid was not feasible; 

• Further work that is being done on information sharing agreements and a 
meeting that will take place in August between Public Health Scotland and 
Police Scotland to look at this area; 


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• Work of the Homelessness Taskforce that will include examining difficulties that 
can be experienced registering with a GP and securing a same day 
appointment and information on this that will be provided directly to Councillor 
Dickson; 

• An application to the Home Office for a pilot on the use of Budival to offer a 
wider range of medication-assisted treatment to individuals and a report from 
the Specialist Pharmacist that will be provided to Members; and 

• That the Chair, in consultation with officers, consider writing to the Scottish 
Government to encourage inclusion of the interface between services for those 
leaving prison in their protocol. 


Noted. 

5. Director’s Report 

Submitted report by Stephen Brown, Director (NAHSCP) on developments within the 

North Ayrshire Health and Social Care Partnership. 

The report provided an update on the following areas:- 

• Ayrshire and Arran Staff and Wellbeing Listening Service; 

• Integrated Mental Health Service; 

• IJB Self-Assessment Questionnaire; 

• Foundation Apprenticeship success; 

• Care Home Clinical and Professional Care Home Oversight Group; 

Members asked questions and were provided with further information in relation to:- 

• The continuation of the financial support to care homes through the Scottish 
Government’s sustainability payments and the examination of claims to ensure 
staff are receiving full pay; 

• Details of the Ayrshire and Arran Staff and Wellbeing Listening Service that will 
be recirculated to the Third Sector; and 

• Low rates of Covid-19 infection in Ayrshire and Arran and that future Director 
reports that will include a brief update on Covid-19 related issues. 


Noted. 

6. 2019/20 Audited Annual Accounts 

Submitted report by Caroline Whyte, Chief Finance and Transformation Officer on the 
Audited Annual Accounts for 2019/20, attached at Appendix 1. Appendix 2 included 
the ISA260 letter from Deloitte LLP and the letter of representation to be signed by the 
Chief Finance Officer (NAHSCP ). 


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The IJB’s accounts for the year to 31 March 2020 were submitted to Deloitte LPP in 
accordance with the agreed timetable. Deloitte have given an unqualified opinion that 
the 2019/20 financial statements give a true and fair view of the financial position and 
expenditure and income of the IJB for the year, concluding that the accounts have 
been properly prepared in accordance with relevant legislation, applicable accounting 
standards and other reporting requirements. No monetary adjustments have been 
identified and the IJB’s position remains as reported to the IJB Performance and Audit 
Committee on 25 June 2020. 

The Board agreed to (a) note (i) that Deloitte LLP have completed their audit of the 
annual accounts for 2019-20 and have issued an unqualified independent report 
auditor’s report; and (ii) the recommendations within the Deloitte LLP report; and (b) 
approve the Audited Annual Accounts to be signed for issue. 

7. External Audit Report 

Submit report by Deloitte on the External Audit Report 2019/20 for North Ayrshire 
Integration Joint Board. An Action Plan was appended to the report and detailed 
recommendations for improvement and follow-up information from the previous year’s 
action plan. 

The key messages of the report were:- 

• it was expected that an unmodified audit opinion would be issued; 

• effective financial planning and management arrangements were in place with 
a strong and consistent finance team; 

• whilst a short-term financial balance had been achieved, the IJB had been 
unable to repay any of the debt due to North Ayrshire Council; 

• the Medium Term Financial Plan had not yet been updated and the IJB was 
unable to evidence it is financially sustainable in the medium to longer term; 

• the IJB had strong leadership and appropriate governance arrangements had 
been put in place in response to the Covid-19 pandemic; and 

• It continues to have an embedded performance management culture. 


Noted. 

8. Quarter 1 Finance Update 

Submit report by Caroline Cameron, Chief Finance & Transformation Officer on the 
financial position of the North Ayrshire Health and Social Care Partnership. 

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 movement in the overall budget 
position for the partnership following the initial approved budget and the mobilisation 
plan submission was provided at Appendix E to the report. 


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Members asked questions and were provided with further information in relation to 
social care costs, including some growth, that have been projected to March 2021. 

The Board agreed to (a) note (i) the overall integrated financial performance report for 
the financial year 2020-21 and the overall projected year-end overspend of £0.027m 
at period 3; (ii) the estimated costs of the Covid mobilisation plan of £7.2m, including 
savings delays, and the associated funding received to date; (iii) the financial risks for 
2020-21, including the impact of Covid 19, and that there is no recommendation at this 
time to implement a formal Financial Recovery Plan for the IJB; and (b) approve the 
budget changes outlined at section 2.8. 

9. ASN Naming of Unit 

Submit report by Alison Sutherland, Head of Service (Children, Families and Justice 
Services) on the outcome of the consultation process undertaken with the community 
and relevant parties to name the residential and respite houses under construction in 
Stevenston and scheduled to open in summer 2021. 

The Board agreed to name the residential facility, Red Rose House and the respite 
house, Roslin House. 

10. Strategic Plan 

Submit report by Michell Sutherland, Partnership Facilitator on the development of a 
one year ‘bridging plan’ to be published by March 2021. Details were provided of the 
challenges identified as a result of the pandemic and discussions with the Scottish 
Government and other HSCPs that resulted in the ‘bridging plan’ approach, with the 
development of a longer-term Strategic Commissioning plan to be published by March 
2022 . 

The Board agreed to (a) the production of a one-year bridging strategic plan covering 
the period April 2021 to March 2022, to reflect on the current plan, outline the recovery 
and the 2030 vision; and (b) develop a longer-term detailed strategic commissioning 
plan, setting out the IJBs direction to 2030,to be published by March 2022. 

11. Arran Integrated Island Services - Changes to the Initial Agreement 

Submit report by Ruth Betley, Senior Manager (Health and Community Care) on 
changes to Arran Integrated Island Services Initial Agreement to align to the standard 
guidance within the Scottish Capital Investment Manual (SCIM). 

The changes related to reformatting the order of the document to align specifically to 
the SCIM guidance, some small changes to link sections appropriately and an addition 
to address the possible disposal in the future of any existing buildings. An opening 
section was also added reflecting the changes/accelerated service change and 
models of delivery and accelerated facility closures that have taken place since the 
original Initial Agreement was submitted. 


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Members asked questions and were provided with further information in relation to an 
engagement exercise that had previously taken place and further engagement that 
would be arranged and include the community pharmacy and local community. 

The Board agreed to (a) note the changes to the Arran Integrated Island Services 
Initial Agreement; and (b) the re-submission of the Initial Agreement to the Scottish 
Government. 

12. Minutes of Meetings for Discussion 
12.1 IJB PAC 

Submit the Minutes of the meetings of the IJB PAC held on 6 March and 25 June 2020. 

The IJB PAC Vice Chair advised that whilst the minutes related to the previous 
financial year, some significant areas to highlight included:- 

• The Care Home Commissioning Strategy that will continue to be a major area; 

• Whilst most performance targets are being met, a review/refresh of targets has 
been agreed to ensure they are still meaningful and appropriate; 

• Disparity between North and the other Ayrshire IJB’s in discharging from 
hospitals; 

• Recommendations from the Auditor’s report around the availability of PAC 
agendas and minutes; and 

• The future 6-monthly provision of an Alcohol and Drugs report to the PAC. 


Noted. 

12.2 Strategic Planning Group 

Submitted the Minutes of the meeting of the Strategic Planning Group held on 28 
January 2020. 

Noted. 

The meeting ended at 11.50 a.m. 


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NORTH AYRSHIRE 

Health and Social Care 
Partnership 


North Ayrshire Integration Joint Board - Action Note 


Updated following the meeting on 27 August 2020 


No. 

Agenda Item 

Date of 
Meeting 

Action 

Status 

Officer 

1 . 

Community Alarm/Telecare 
Services Transition from 

Analogue to Digital 

26/9/19 

That an update report on progress be 
submitted to a future meeting. 

Submit to meeting in 

2021 

Helen 

McArthur 

2. 

UK Care Home Industry 

19/12/19 

Receive a further report examining the 
issues raised in the Plugging the Leaks in 
the UK Care Home Industry report from a 
North Ayrshire context, including the 
lessons learned from care home closures 
and in consultation with both staff, 
independent and third sectors. 

Submit to meeting in 
April/May 2020 

Stephen 

Brown 



13/2/20 

Agreed that the Care Home Providers be 
consulted at an early stage in the work to 
examine the issues raised in the Plugging 
the Leaks in the UK Care Home Industry 
report from a North Ayrshire context. 




Thursday, 10 September 2020 


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Agenda Item 4 



NORTH AYRSHIRE 

Health and Social Care 
Partnership 




Integration Joint Board 
24th September 2020 

Subject: 

Director’s Report 



Purpose: To advise members of the North Ayrshire Integration Joint Board 

(IJB) of developments within the North Ayrshire Health and Social 
Care Partnership (NAHSCP). 


Recommendation: That members of the IJB note progress made to date. 


Glossary of Terms 

NHS AA 

NHS Ayrshire and Arran 

HSCP 

Health 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 Health and Social Care Partnership (NAHSCP) 
nationally, locally and Ayrshire wide. 

2. 

CURRENT POSITION 


National Developments 

2.1 

Programme for Government 


The Scottish Government launched their Programme for Government on 1 st 
September. Chapter 2 in the document outlines the Health and Social Care aspects. 
The headlines from this chapter include 


• Continue to suppress - and preferably eliminate - COVID-19. 

• Remobilise our NHS Services focusing on (1) a move to deliver safely as 
many of its normal services as possible; (2) ensuring the capacity that is 
necessary to deal with the continuing presence of COVID-19; and (3) preparing 
the health and care services for the wider pressures of the winter season 

• Extend the seasonal flu vaccine to those working in social care who provide 
direct personal care, those over 55, those living with someone who is shielding, 
and those aged 50-54 depending on vaccine supplies, to protect people and 
our NHS this winter. 


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• Immediately establish an independent review of adult social care. This will 
examine how adult social care can most effectively be reformed to deliver a 
national approach to care and support services. This will include 
consideration of a national care service. This will report by Jan 2020. The 
Terms of Reference can be accessed through this link 

• Implementation of the Drug Deaths Taskforce recommendations 

• Create a new role of Patient Safety Commissioner 

• New NHS pay award being negotiated and consideration being given in this in 
relation to rewarding staff for their recent efforts 

• Scale up access to digital care - for both physical (Near Me video 
consultations) and mental health (Cognitive Behavioural Therapies) care and. 
Develop its use in social care with initial focus on care homes. 

• Develop a nationwide network of community treatment centres to help 
patients manage their conditions and get treatments closer to home 

• Redesign our accident and emergency services to ensure patients get safe 
and effective care in a way that protects them from exposure to COVID-19 

• Expand mental health and wellbeing support for health and social care 
staff, including the development of a Health and Social Care Mental Health 
Network and enhanced access to digital resources 

• Implement a Workforce Specialist Service, which will provide confidential 
assessment and treatment for mental ill health. This will be delivered through 
a multi-disciplinary team of mental health care providers, and be supported by 
the continued delivery of digital wellbeing resources through the National 
Wellbeing Hub and the National Wellbeing Helpline 

• Establish community health and wellbeing services that will support 
children, young people and their families - and have a particular focus on 
mental health - across all local authorities in 2021 

• Work with Boards to retain, develop and support Mental Health 
Assessment Centres, as part of a broader approach to improving access to 
appropriate help as quickly as possible for people with mental health needs or 
distress 


The full document can be accessed here. 


Ayrshire Wide Developments 


2.2 


Learning Disability Information App 



New Autism, 


The new NHS A&A Autism, ADHD, FASD, 
Learning Disability Information App was 
launched on 28 th August 2020. 


ADHD, FASD, 
and 

Learning 
Disability App 


The app provides a single space for local and 
national information on Autism, ADHD, FASD 
and Learning Disability. It is free and very easy 
to find. To get the app download “NHS Ayrshire 
& Arran” container app by searching “NHS 
Ayrshire & Arran” in your Apple or Android app 
store. 


If you have any information you would like to share through the App please email 
david.campbell3@aapct.scot.nhs 

North Ayrshire Developments 


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2.3 Suicide Prevention Week - 7 ^ to 14 ^ September 2020 

Every year in September a wide community of people across the world take time to 
raise awareness and consider the impact of suicide in our communities. 

Since 2002, when the Scottish Executive launched “Choose Life-A National Strategy 
and Action Plan to Prevent Suicide in Scotland”, this week in September has been 
used to raise the profile of the work, activity and experiences of those helping to 
achieve the target of reducing suicides across Scotland 

During Suicide Prevention Week 2020 in North Ayrshire 

❖ The 13 ways social media campaign for young people was re-launched to 
promote positive responses to those expressing suicidal thoughts and which 
supports young people to help and support each other 

❖ The North Ayrshire campaign “13 ways to support your friend” will seek to 
promote positive suicide prevention information which promote the message 
that suicide is not the solution 

❖ This year there was a recorded “Zoom” discussion with some of those involved 
in the original campaign highlighting how young people have been coping 
during lockdown and their thoughts on how relevant the messages still are. 

❖ Young people especially, and all partner organisations, will be encouraged to 
share Instagram, Tweets, and Facebook posts promoting the 13 key messages 

❖ The new National Campaign “United to prevent Suicide” featured across many 
digital platforms with new branding and new messages to highlight Scotland’s 
commitment to preventing Suicide 

❖ Key messages and other mental health information displayed across Council 
and other partner websites and social media. 

❖ Social Services Access teams are working on their own pathway for supporting 
young people referred to them after a suicide attempt-in order to ensure 
consistent support and information for the young people and their families. 

❖ Work continues across the area in addressing crisis interventions through local 
Distress Brief Interventions work in partnership with frontline staff such as 
police, primary care and ambulance. 


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COVID Update 

2.4 

SuDDort for Commissioned Care Providers 


COSLA Leaders and the Scottish Government have agreed an approach to supporting 
the social care sector to ensure that reasonable additional costs will be met. A 
consistent set of principles are in place to ensure that the social care sector remains 
sustainable during the emergency response to COVID 19. These principles have been 
agreed by Scottish Government on the basis that they will meet all reasonable 
additional provider costs as they are aligned to mobilisation plans. 

Transitional arrangements for the national principles for sustainability payments have 
been agreed and are in place from September 2020 onwards. 

There are two main areas: 

Social Care Staff Support Fund: 

• Criteria and eligibility is set out in the Coronavirus (Social Care Support Fund) 
Reauiations 2020 and accomoanvina auidance here. 

• Providers should pay staff who are absent from work as a result of COVID 19 their 
expected income (as defined by Employment Rights Act 1996). 

• The current regulations are in place until the end of September, this is under review 
by Scottish Government. 

• Consideration is being given to extending this beyond the end of September. 

Social Care Sustainability Payments: 

On 28 th August 2020 the Scottish Government and COSLA Leaders agreed the 
transitional arrangements for Social Care Sustainability payments. These are 

• Care Home Occupancy Payments will begin to taper with 75% of voids caused 
by the continued impact of COVID paid in September, 50% in October and 25% 
in November. These will continue to be paid at 80% of the National Care Home 
Rate; 

• The planned care approach for care and support and community-based services 
will remain in place until the end of October to allow a transition period; 

• Additional costs for personal protective equipment, infection prevention control 
and staffing related costs, in line with Scottish Government guidance, will 
continue to be met in line with current arrangements and are subject to ongoing 
review and engagement with the sector; and 

• Social Care Support Fund payments will continue subject to extension of 
the regulations. 

In North Ayrshire we are working closely with our commissioned care providers to 
assess claims for support and also to understand and support the development of 
future business models to ensure ongoing sustainability. The Commissioning Team 
issued a survey to all providers to gather their feedback on the Covid-19 response 
and the responses are being collated, this will be reported back to the IJB at a later 
date. 

2.5 

Care Homes 


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All Care Homes in North Ayrshire remain COVID-free with no current outbreaks to 
report. Weekly staff testing in Care Homes has continued to improve with over one 
thousand staff per week now being tested. As restrictions have been lifted relating to 
visiting within Care Homes, risk assessments have been consistently submitted by 
Care Homes in advance of each phase. These have been scrutinised and signed-off 
by the Care Home Oversight Group and the Director of Public Health. 


Work is now underway to vaccinate Care Home staff and residents for seasonal flu. 

3. 

PROPOSALS 

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 Implications: 

N/A 

Community Benefits: 

N/A 


Direction Required to 

Direction to 


Council, Health Board or 

1. No Direction Required 


Both 

2. North Ayrshire Council 



3. NHS Ayrshire & Arran 



4. North Ayrshire Council and NHS Ayrshire & Arran 



5. CONSULTATION 


5.1 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. 

6. CONCLUSION 

6.1 Members of IJB are asked to note the ongoing developments within the North Ayrshire 
Health and Social Care Partnership. 


For more information please contact Stephen Brown, Director/Chief Officer on 01294 
317723 or sbrown(a)north-avrshire.qov.uk 


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Agenda Item 5 



NORTH AYRSHIRE 

Health and Social Care 
Partnership 


Integration Joint Board 
24 September 2020 

Subject: 

2020-21 - Month 4 Update 


Purpose: 

To provide an overview of the IJB’s financial performance as at 
Period 4 including an update on the estimated financial impact of the 
Covid-19 response. 

Recommendation: 

It is recommended that the IJB: 



(a) notes the overall integrated financial performance report for the 
financial year 2020-21 and the overall projected year-end 
overspend of £0.066m at period 4; 

(b) notes the estimated costs of the Covid mobilisation plan of 
£7.2m, including savings delays, and the associated funding 
received to date; 

(c) note the financial risks for 2020-21, including the impact of 
Covid 19, and that there is no recommendation at this time to 
implement a formal Financial Recovery Plan for the IJB; 

(d) approve the budget changes outlined at section 2.8. 


Glossary of Terms 

NHS AA 

NHS Ayrshire and Arran 

HSCP 

Health and Social Care Partnership 

MH 

Mental Health 

CAMHS 

Child & Adolescent Mental Health Services 

RAG 

Red, Amber, Green 

UNPACS 

UNPACS, (UNPIanned Activities) - Extra Contractual Referrals 

NRAC 

NHS Resource Allocation Committee 

GAE 

Grant Aided Expenditure 

PAC 

Performance and Audit 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, before the impact of Covid-19, is a year-end overspend of 
£0.066m for 2020-21 which is an adverse movement of £0.039m. It should be noted 
that this is at a point relatively early in the financial year and there is scope for this 


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position to fluctuate due to in-year cost and demand pressures and assumptions in 
relation to funding and the achievement of savings. The position has been adjusted to 
reflect the potential impact of Lead Partnership services. In the absence of any 
alternative risk sharing agreement for lead partnership services an NRAC share of the 
projected position has been assumed as this would be in line with the allocation in 
previous years. The South and East partnerships did not report at period 3 so this is 
the first month that their recharges are included in the report with a net adverse impact 
of £0.028m on the North HSCP. 

1.3 From the core projections, overall the main areas of pressure are learning disability 
care packages, looked after children and adult in-patients within the lead partnership. 
However, there has been significant progress to reduce the pressures in these areas. 
The financial projection of effectively a break-even position demonstrates the progress 
made towards financial balance as part of the 2019-20 recovery plan and other service 
transformation plans contributing to reduced costs. The position also demonstrates 
that the work started before the pandemic to ensure the IJB moved into the new 
financial year in a financially sustainable position has not been delayed or impacted by 
the Covid-19 response. If this position can be sustained as we move through the year, 
and assuming all Covid-19 costs are fully funded, the IJB will secure financial balance 
and repay £1.5m of the debt to North Ayrshire Council as planned. 

1.4 The most up to date position in terms of the mobilisation plan for Covid-19 based on 
the return to the Scottish Government on 14 August projects £7.2m of a financial 
impact, which is split between additional costs of £6.1 m and anticipated savings delays 
of £1.115m. The impact of savings delays has been built into the core financial 
projection above on the basis that there is less confidence that funding will be provided 
to compensate for this. There are financial risks associated with Covid-19 as the IJB 
has yet to receive confirmation of the full funding allocation, to date we have received 
a share of £83m nationally (£3.5m for North Ayrshire) to assist with pressures for social 
care services, we have not received any funding to date to fund any additional health 
costs. It is anticipated that funding for NHS Boards for Health Services will be allocated 
by the end of September. 

1.5 Until the funding for Covid-19 is confirmed there is a risk that there may be a shortfall 
in funding to fully compensate the North Ayrshire IJB for the additional costs. However, 
there is no recommendation at this time to implement a Financial Recovery Plan on the 
basis that: 

• There is increasing confidence that additional costs will be funded based on the 
recently received and future expected funding allocations; 

• It is likely that any gap will be clearer towards the end of September when NHS 
Board funding allocations are expected to be confirmed; 

• The potential worst-case scenario in terms of any funding shortfall would be in 
the range of £1.3m and £1.9m, if this gap materialises there are areas we could 
explore to mitigate later in the year as part of a recovery plan if required; 

• The most significant area of additional Covid cost is the purchase of PPE for 
social care, the model for the purchase and supply is currently under review 
and any options to change from the current model are likely to reduce the future 
estimated costs; 

• The period 4 position projects a balanced financial position (excluding Covid) 
and this does not include any assumption re the £1.5m held by the Council 
towards the IJB debt, this position assumes the debt repayment is made as 
planned, this position also incorporates estimated delays with savings delivery. 


17 




The financial position will continue to be reported to the IJB at each meeting, these 
reports will outline the monthly financial projections and the updated position in relation 
to estimates for Covid costs. This will include the ongoing consideration of whether a 
Financial Recovery Plan may be required in the future. 

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 plans to work towards financial balance. 

The report also includes detail of the estimated costs and potential financial impact of 
the Covid-19 response. 

FINANCIAL PERFORMANCE - AT PERIOD 4 

2.2 The projected outturn position at period 4 reflects the cost of core service delivery and 
does not include the costs of the Covid 19 response as these costs are considered 
separately alongside the funding implications. 

Against the full-year budget of £252.768m there is a projected year-end overspend of 
£0.066m (0.03%). 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. Following this approach, 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 £0.644m in social care services offset by a projected underspend of 
£0.578m in health services. 

As highlighted at the end of last year the payroll turnover target was to be centralised 
for future years as the approach in previous years left some service areas with 
unachievable targets whilst other areas were able to overachieve, it was agreed that a 
more transparent approach would be to manage the payroll turnover and vacancy 
savings centrally. This approach has been adopted for 2020-21, this has helped to de¬ 
clutter the financial report and to make it more transparent re the overall turnover target 
and the progress towards achieving this across the partnership. Section 2.6 highlights 
progress with the partnership vacancy target. 

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 Health and Community Care Services 

Against the full-year budget of £69.757m there is an underspend of £1.184m (1.7%) 
which is an adverse movement of £0.153m. The main variances are: 


a) Care home placements including respite placements (net position after service user 
contributions) - underspent by £1,024m (adverse movement of £0.373m). The care 
home budget moved into a sustainable position towards the end of 2019-20 and the 
opening position for the budget for 2020-21 was expected to be an underspend 
position as at that time we set the budget at a level to fund 810 places and we were 
funding 782. The occupancy in care homes has fallen further in the first quarter of 
2020-21 and there are significant vacancies in care homes, the projected 


18 




underspend includes a steady net increase of 10 placements per month until the 
year-end. The main reason for the adverse movement is a reduction of £0.293m to 
the respite budget as the Carers funding previously allocated to this area is no 
longer required as the respite budget is projecting an underspend. 

b) Independent Living Services are overspent by £0.321 m (adverse movement 
£0.021 m) which is due to an overspend on physical disability care packages within 
the community and direct payments. There is an expectation that there will be some 
recovery of funds from Direct Payments where services have ceased, this may 
improve the projected position. There will be further work undertaken with the 
implementation of the Adult Community Support framework which will present 
additional opportunities for reviews and will ensure payment only for the actual 
hours of care delivered. The roll out of the CM2000 system for Adult services was 
postponed towards the year-end due to the Covid response and will be implemented 
early October. 

c) Care at home is projected to overspent by £0.049m (adverse movement £0.033m). 
Significant progress was made during 2019-20 to reduce the overspend as part of 
the Financial Recovery Plan, the remaining overspend was considered and 
addressed as part of the budget approved for 2020-21 as part of the overall budget 
re-alignment, demand pressures and savings included in the budget. This left care 
at home with resources to grow the service during the year which has assisted with 
the response to Covid 19. The financial projections reflect recent recruitment and 
assumes maintaining the service at the current level until the end of 2020-21 and 
we are currently reviewing the financial impact of transferring work from two of the 
commissioned framework providers to the in-house service. 

d) Aids and adaptations projected underspend of £0.300m (no movement). There 
have been significant delays with carrying out assessments and providing 
equipment and adaptations during lock down. The year to date spend at period 4 
is less than £0.100m, but there are some larger orders recently placed. It is 
expected that during the year there will be considerable delays with this spend, the 
level projected currently is in line with the underspend in 2019-20 and it is likely this 
underspend will be greater, however this cannot be determined at this stage in the 
year. 

e) Carers Act Funding is projected to underspend by £0.443m (£0.293m favourable 
movement) based on the currently committed spend and delays with taking forward 
developments to support carers. The total uncommitted budget is £0.560m so this 
projected position assumes there will be carers’ support plans undertaken and a 
level of demand/services identified from these plans to be delivered later in the year. 
The favourable movement is due to the return of £0.293m from the respite budget 
as the Carers funding previously allocated to this area is no longer required as the 
respite budget is projecting an underspend. 


2.4 Mental Health Services 

Against the full-year budget of £77.324m there is a projected underspend of £0.202m 
(0.3%) which is an adverse movement of £0.558m. The main variances are: 

a) Learning Disabilities are projected to overspend by £1,827m (adverse movement 
£0.204m), included within this is £1,503m (£0.068m adverse movement) in relation 
to community care packages and £0.367m (£0.175m adverse movement) for 
residential placements. The adverse movement in residential placements relates 


19 




to double running costs for service users unable to move to Trindlemoss due to 
COVID and we continued to pay for their previous placement until they could move 
in. The 2020-21 budget for all adult care packages (LD, PD and MH) were realigned 
with any projected underspends in other areas being used to reduce the LD 
projected overspend. 2020-21 savings relating to the implementation of the Adult 
Community Support Contract are delayed as the full implementation of the CM2000 
system has been postponed as the focus has been on the response to COVID-19, 
the financial benefits of the system are included in the projection later in the year. 
Community Learning Disability Care packages are proving to be one of the most 
challenging areas to address overspends. The current projection assumes the 
current level of commissioned support will continue for the year, there are 
opportunities to reduce this commitment as a significant number of these care 
packages were reduced or suspended during lock down, these will be reviewed 
when services are re-started to ensure support is re-started at the appropriate level, 
this may potentially reduce the year-end projected position. 

b) Community Mental Health services are projected to underspend by £0.254m 
(£0.046m favourable movement) mainly due to a reduction in care packages. There 
has been a reduction in the number of care packages since the start of the year and 
there have been some temporary reductions to care packages during lock-down, 
currently these are assumed to be temporary reductions, these will also be reviewed 
when brought back online. 

c) The Lead Partnership for Mental Health has an overall projected underspend of 
£1.361 m (adverse movement of £0.435m) which consists of: 

• A projected overspend in Adult Inpatients of £0.600m (adverse movement of 
£0.329m) mainly due to the delay in closing the Lochranza ward on the Ailsa 
site. The ward closed during August 2020 but the assumption around staff re¬ 
deployment costs have been increased which is the reason for the adverse 
movement and the overspend may reduce if alternatives can be identified for 
displaced staff sooner. 

• UNPACS is projected to underspend by £0.187m (no movement) based on 
current placements, this is also an improved position from last year. 

• A projected underspend of £0.350m in Elderly Inpatients due to the completion 
of the work to reconfigure the Elderly Mental wards, this represents the part-year 
saving with the full financial benefit being available in 2021-22 (est £0.934m). 
Staff re-deployment costs have been included in the projection and the 
underspend may increase if alternatives can be identified for displaced staff 
sooner. 

• A projected underspend in MH Pharmacy of £0.190m (no movement) due to 
continued lower substitute prescribing costs. 

• The target for turnover or vacancy savings for the Lead Partnership is held within 
the Lead Partnership as this is a Pan-Ayrshire target. There is a projected over¬ 
recovery of the vacancy savings target of £1.187m in 2020-21, further 
information on this is included in the table below: 


Vacancy Savings Target 

(£0.400m) 

Projected to March 2021 

£1,587m 

Over/(Under) Achievement 

£1.187m 


There were significant vacancy savings delivered during 2019-20 from lead partnership 
services and these were brought into the financial position during the year as it became 
clear that services were not going to be able to recruit to all vacancies. The current 


20 




projection to the year-end is informed by the recruitment plans and the confidence in 
recruitment success and realistic timescales for filling individual vacancies. 

The main areas contributing to this position are noted below: 

• Adult Community Health services £0.143m 

• Learning Disability £0.060m 

• Addictions £0.041 m 

• CAMHS £0.170m 

• Mental Health Admin £0.280m 

• Psychiatry £0.488m 

• Psychology £0.387 

• Associate Nurse Director £0.033m 


2.5 Children Services & Criminal Justice 

Against the full-year budget of £35.981 m there is an overspend of £0.336m (1 %) which 
is a favourable movement of £0.223m. The main variances are: 

a) Looked After and Accommodated Children are projected to overspend by £0.398m 

(favourable movement of £0.301 m). The main areas within this are noted below: 

• Children’s residential placements are projected to overspend by £0.543m 
(£0.178m favourable movement), as at period 4 there are 17 placements with 
plans to reduce this by 4 by the end of October and an assumption that there will 
be no further placements during the year, therefore ending the year with 13 
placements. The favourable movement is mainly due to one placement ending 
sooner than budgeted (£0.126m movement) and another transferring to 
children’s care packages (£0.052m movement). Budget plans for 2020-21 were 
based on starting the year with 18, reducing to 14 by the end of Q1 and to 10 
places by the end of Q2 and for the remainder of the year. Progress with plans 
to move children from residential placements have been impacted by Covid-19 
as there has been an impact on Children’s Hearings and this has limited the 
availability of tenancies. However, despite these delays it is positive that there 
were no children placed into external residential placement during lock down and 
the numbers did not increase. Children’s services are hopeful to further improve 
the position as we move through the year as starting the 2021-22 financial year 
with 13 placements will impact on the savings planned for next year. 

• Fostering placements are projected to overspend by £0.093m (no movement) 
based on the budget for 129 places and 133 actual placements since the start of 
the year. The fostering service is an area we are trying to grow, and a recruitment 
campaign was undertaken early in the new year to attract more in-house foster 
carers to limit the ongoing requirement for external foster placements. There are 
a number of additional fostering placements attributed to Covid-19 which are out 
with these numbers as the costs have been included on the Covid-19 mobilisation 
plan. 

• Kinship placements are projected to underspend by £0.173m on the budget for 
359 places and 342 actual placements since the start of the year. 


2.6 Turnover/Vacancy Savings 


21 





The payroll turnover target has been centralised for 2020-21 as it was noted last year 
that some service areas have historic targets which cannot be achieved whilst others 
overachieve, the financial monitoring report was cluttered with over and underspends 
as a result and a more transparent way to report on progress with the overall 
achievement of payroll turnover is to manage it centrally. The turnover target for the 
North Lead Partnership for Mental Health services is detailed within the Lead 
Partnership information at section 2.4. 

The turnover targets and projected achievement for the financial year for Health and 
Social Care services out with the Lead Partnership is noted below: 



Social Care 

Health 

Services 

Vacancy Savings Target 

*(£1,957m) 

(0.645m) 

Projected to March 2021 

£1,957m 

0.829m 

Over/(Under) Achievement 

0 

0.184m 


(*the target for social care services has been increased on a non-recurring basis for 2020-21 only by 
£0.110m to offset the saving for the roll out of Multi-Disciplinary Teams, as no permanent reductions to 
the structure can be identified at this time but will be by the service from 2021-22 onwards) 

The position in the table above reflects the assumption in the current financial 
projections. For social care vacancies there have been significant vacancy savings to 
period 4 due to delays with recruitment and a total of £0.856m has been achieved to 
date. It is not anticipated that the level of vacancies will continue at this rate to the 
financial year-end, the full annual target is expected to be achieved on the basis that 
there will vacancies sustained at around 64% of that level. We may potentially exceed 
the target, as was the case in previous years, but the likelihood of this will not be known 
with confidence until services and recruitment re-starts fully over the coming months. 

The Health vacancy projection to the year-end is informed by the recruitment plans and 
confidence in recruitment to posts for the remainder of the year. 

The main areas contributing to the health and social care vacancy savings are spread 
across a wide range of services with vacancy savings being achieved in most areas, 
the most notable in terms of value being social worker posts (across all services), the 
Community Mental Health Teams and Allied Health Professionals. 


2.7 Savings Progress 


a) The approved 2020-21 budget included £3.861 m of savings. 


RAG Status 

Position at Budget 
Approval 

Cm 

Position at 
Period 4 

Cm 

Red 

- 

0.274 

Amber 

2.801 

1.887 

Green 

1.060 

1.700 

TOTAL 

3.861 

3.861 


b) The main areas to note are: 


22 




i) Red savings of £0.274m relating to reducing LD sleepovers and the 
review of Adoption Allowances, both of which have been impacted by 
Covid-19, the delays in these savings have been included in the overall 
projected outturn position; 

ii) Whilst all savings remain on the plan to be delivered there are delays with 
some savings with delays in implementation due to Covid-19, for 
example the implementation of the Adult Community Support Framework 
as the introduction of the CM2000 system is on hold as providers are 
focussing on COVID related service and staffing issues; 

iii) The confidence with some savings has increased since the budget was 
set due to the progress made towards the end of 2019-20, for example 
with freeing up additional capacity for Care at Home services by reducing 
care home placements. 

Appendix C provides an overview of the savings plan, this highlights that during 2020- 
21 it is anticipated that a total of £2.872m of savings will be delivered in-year, with 
£0.989m of savings potentially delayed or reduced. The delays are due to Covid-19 
and have been included in the mobilisation plan return to the Scottish Government, but 
at this stage they have also been reflected in the overall projected outturn position as 
there is less confidence that the impact of savings delays will be compensated with 
additional funding. 

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. Whilst some of our plans were put on hold due to Covid, 
the transformation plans will be re-mobilised at pace to ensure we taken any 
opportunities to join up the re-design services as they come back online. The 
Transformation Board has re-started in July and there will be a concerted effort to 
ensure the maximum savings delivery can be achieved in-year, to assist with the 
current year position and to ensure there is no budget gap rolled forward into 2021 -22. 

2.8 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 D highlights the movement in the overall budget position for the partnership 
following the initial approved budget. 

Reductions Requiring Approval: 

The specific reductions the IJB are required to approve are: 

• Prescribing £1,497m - reduction to the prescribing budget to reflect revised 
base budgets for pharmacists and reparenting of cost centres. 

• TEC project £0.053m - non-recurring contribution to the pan Ayrshire TEC 
project 

It is recommended that the IJB approve the budget reductions outlined above. 


23 




Future Planned Changes: 

An area due to be transferred in the future are 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 
and Arran that the financial responsibility will not transfer until balance is found. In the 
meantime, we are managing services and plans are well progressed to reduce the 
projected overspend prior to any transfer. 

2.9 NHS - Further Developments/Pan Ayrshire Services 

Lead Partnerships: 

The IJB outturn position is adjusted to reflect the impact of Lead Partnership services. 
During 2019-20 agreement was reached with the other two Ayrshire partnerships that 
in the absence of any service activity information and alternative agreed risk sharing 
arrangements that the outturn for all Lead Partnership services would be shared across 
the 3 partnerships on an NRAC basis. This position will be the default position at the 
start of 2020-21 as the further work taken forward to develop a framework to report the 
financial position and risk sharing across the 3 partnerships in relation to hosted or lead 
service arrangements has been delayed by the requirement to focus efforts on the 
Covid response. 

The underspend in relation to North Lead Partnership services is not fully attributed to 
the North IJB as a share has been allocated to East and South partnerships, similarly 
the impact of the outturn on East and South led services will require to be shared with 
North. East and South did not report at month 3 and an on-line impact on North was 
assumed. At month 4 the impact on NAHSCP is a £0.028m overspend (£0.053m 
underspend for East and £0.081 m overspend for South) 

East HSCP - projected underspend of £0.146m (£0.053m NRAC share for NAHSCP). 
The main areas of variance are: 

a) Primary Care and Out of Hours Services (Lead Partnership) - there is a projected 
underspend of £0.085m on the Primary Care Lead Partnership budget. This 
relates to savings in Primary Care Transformation / Integration offset by a small 
overspend on Ayrshire Urgent Care Services and Contracting and Support 
Services. In previous financial years, GP practices in difficulty have required 
additional funding to ensure sustainability and continuity of patient care. There 
are presently no practices in difficulty however this remains an extremely fluid 
area of the budget and continues to be closely monitored. 

b) Prison and Police Healthcare (Lead Partnership) - £0.054m projected 
underspend relates to anticipated part-year savings from vacant posts within the 
Service, partially offset by recharged costs in respect of temporary management 
arrangements. 

South HSCP - projected overspend of £0.221 m (£0.081 m NRAC share for NAHSCP). 
The overspend is mainly due to an overspend in the community store. 

Set Aside: 


24 




The budget for set aside resources for 2020-21 is assumed to be in line with the amount 
for 2019-20 (£30.094m) inflated by the 3% baseline uplift, this value was used in the 
absence of any updated information on the share of resources and is £30.997m. 

At the time of setting the IJB budget it was noted that this may require to be updated 
following the further work being undertaken by the Ayrshire Finance Leads to establish 
the baseline resources for each partnership and how this compares to the Fair Share 
of resources. It was anticipated that 2020-21 would be used as a shadow year for 
these arrangements, however this work has been delayed due to the Covid-19 
response. A further update will be provided to IJBs as this work progresses. 

The acute directorate, which includes the areas covered by the set aside budget, is 
overspent by £2.1 m after 4 months. £1.8 million is attributable to COVID-19. 

In the early stages of the pandemic the combination of additional social care provision 
and lower hospital attendance largely removed bed pressure at Crosshouse. In recent 
weeks however there has been an increase in demand. 

The Health Board and the IJBs continue to work together to ensure patients are 
looked after in the most suitable environment. 


COVID-19 - FINANCE MOBILISATION PLAN IMPACT 

2.10 Summary of position 

The IJB were provided with a report on 16 July 2020 which highlighted the potential 
financial impact of the Covid-19 response and the significant financial risk to the IJB. 
From the outset of the pandemic the HSCP acted very swiftly to respond and developed 
a mobilisation plan detailing the additional activities to support our response, alongside 
the estimated financial impact. Financial returns have been submitted to the Scottish 
Government on a regular basis, on the premise that any additional costs aligned to 
mobilisation plans would be fully funded. There is a risk that if the full cost of the Covid- 
19 response is not funded that the IJB may require to recover any overspend in-year. 

The IJB were updated in August outlining the up to date cost estimates, the financial 
year-end projections and any potential funding gap based on scenarios re Covid-19 
funding. The IJB also need to consider any action required to recover the financial 
position in-year. 

2.11 Mobilisation Plan Costs 

The cost return for North Ayrshire HSCP submitted on 22 June 2020 estimated 
additional costs of £7.255m for the duration of 2020-21. The costs remain estimates 
as the situation continually evolves and there have been several iterations of the 
financial plan. The most recent mobilisation plan cost submission submitted on 14 
August 2020 estimates the costs to be £7.211 m to March 2021. 

The majority of the additional costs for the HSCP relate to the provision of social care 
services and the most significant areas are PPE, additional staff costs for staff absence 
and student nurses, loss of income due to closed services, additional care home 
placements, payments to commissioned care providers to ensure future sustainability 
and the impact on our approved savings programme. 


25 




The mobilisation plan submission is included as Appendix E. The main areas of cost 
together with the change in estimates from June are summarised below: 


Service Area 

Previous 
(22 June 
2020) 
£m 

Latest 
(14 Aug 
2020) 
£m 

Increase^ 

Decrease) 

£m 

Payments to Providers 

1.648 

1.655 

0.007 

Personal Protective Equipment (PPE) 

1.628 

2.052 

0.424 

Savings Delays 

1.508 

1.115 

-0.393 

Nursing - Students and Bank Staff 

0.848 

0.733 

-0.115 

Care at Home Capacity 

0.669 

0.416 

-0.253 

Loss of Income 

0.442 

0.442 

0.000 

Staff Cover 

0.425 

0.425 

0.000 

Care Home Beds - Delayed Discharges 

0.396 

0.396 

0.000 

Fostering Placements 

0.000 

0.196 

0.196 

Other costs 

0.221 

0.311 

0.090 

Offsetting cost reductions 

-0.530 

-0.530 

0.000 

TOTAL 

7.255 

7.211 

-0.044 


Further information on the elements of the plan are included in the IJB report from 16 
July 2020. There is little movement in the overall estimated cost but there are some 
significant movements for individual cost elements, the main areas where estimates 
have been updated are noted below: 

• Payments to providers have been re-phased to reflect the extension of the 
principles to the end of September and the cessation of support thereafter, this 
is currently being reviewed by COSLA and the Scottish Government to 
determine the best approach to taper down support and also the model of 
support for ongoing increases in costs beyond the end of September; 

• PPE returns have been updated to include the continuation of the current 
purchasing arrangements that are currently in place for social care PPE, i.e. 
being that social care providers (including the HSCP) primarily source and 
procure their own supplies and use the cluster PPE hubs as a top up and 
emergency stock. A business case is being developed by the Scottish 
Government for approval at the end of August, this will determine the future 
supply of PPE, a change in approach, for example with SG centrally sourced 
and supplied PPE will change the estimated future costs; 

• Savings delays have been re-visited based on the P3 position with a more 
optimistic view of deliverable savings in the year; 

• Nursing - Students and Bank staff have been reduced in line with updated cost 
estimated supplied by NHS finance, the previous estimate was based on limited 
information provided by NES on the posts, the position has been clarified in 
relation to the individual students; 

• Care at Home Capacity has been reduced following analysis of the period 3 
position, the original estimate was a 5% increase in capacity, in reality the 
increase has been less as the 2020-21 budget already allowed for an element 
of growth within the service, the current estimates include maintaining the 
current capacity levels until March 2021 and for an additional 20 planned posts; 

• Fostering placements have been added to the updated plan, there are 20 
additional short term placements which have been necessary due to Covid-19, 
these have been facilitated by the Scottish Government permitting foster carers 
to look after 3 or more children and it has been difficult to reduce these 


26 




placements with the impact on Children’s Hearings. The updated estimates 
assume half of these placements will remain at the end of September and all will 
be removed by December. 

2.12 Covid-19 Funding Position 

At the outset of the pandemic there was an assurance that subject to any additional 
expenditure being fully aligned to local mobilisation plans, including the IJB responses, 
reasonable funding requirements will be supported. This was on the basis that a 
process would be developed for these to be accurately and immediately recorded and 
shared with the Scottish Government. The basis of this reporting was drawn up and 
agreed with COSLA and Health and Social Care Partnerships. 

On 12 May 2020 we received confirmation of initial funding of £50 million, particularly 
to support immediate challenges in the social care sector. This interim funding was 
released to support sustainability across the sector and the ongoing provision of social 
care, while further work is undertaken to provide the necessary assurance for further 
allocations of funding to support additional costs. The share of this allocation is 
£1.339m for North Ayrshire. 

Following on from this on 3 August it was confirmed that in recognition of challenges 
for Local Authorities, IJBs and social care providers, and commensurate with data 
submitted through the local mobilisation plan financial returns, the Scottish 
Government would provide an additional tranche of funding up to £50 million to meet 
costs. The full funding will be provided on the basis of appropriate evidence and 
assurance in respect of actual expenditure and will continue to be considered within 
the context of the overall package of financial support. On 10 August it was advised 
that £25m of this funding would be released immediately, the North Ayrshire share is 
£0.669m and has been allocated on an NRAC/GAE basis in line with the original 
£50m. Following submission of cash flow information £8m of the remaining up to 
£25million was allocated on 26 th August of which £1.5m was allocated to North IJB. 
The remaining £17m has not yet been allocated and the distribution of this funding will 
be reliant on additional information being provided to the Scottish Government to 
evidence the funding requirement. 

To date this is the total funding received to date, i.e. £3.508m towards the social care 
response. No funding has been allocated for the Health delivered services, the NHS 
Boards were required to submit detailed quarter 1 returns to the Scottish Government 
on 14 August and these will inform an allocation at the start of October, this will include 
the allocation to IJBs for health services. 

Whilst the allocations of funding for social care are welcomed to support cash flow for 
Local Government and provides some assurance that funding will be released, this is 
clearly not sufficient to fund all our highlighted pressures and there remains a 
significant gap. The Scottish Government are considering the approach to a further 
funding allocation and we expect to be notified of the outcome early in October, for 
both Health and Social Care allocations. 

2.13 Covid - Financial Risk 

There are a number of financial risks related to the Covid-19 response for North 
Ayrshire IJB, risks include: 

• Delays in funding being confirmed result in the IJB considering balancing the 
budget based on funding assumptions in the absence of a confirmed funding 
allocation; 


27 




• Scottish Government funding is not sufficient to fully fund the response and there 
is a shortfall in funding when allocated; 

• Risk that financial position cannot be recovered in-year and the IJB overspend 
and add to the debt owed to North Ayrshire Council; 

• If insufficient funding is provided an exercise will be required at a later stage to 
re-allocate costs and funding to the 3 IJB areas for Lead Partnership services, 
this could lead to greater costs being aligned to the North IJB particularly for any 
shortfall in funding for Primary Care including Covid Assessment Hubs; 

• Further uncertainty of funding for pressures which may continue beyond 2020- 
21, including for example PPE; 

• Currently provider Sustainability Payment Principles are due to cease at the end 
of September with tapering down of support, some elements may be extended 
beyond that time, there is an ongoing responsibility for HSCPs to ensure the 
sustainability of the social care sector; 

• Financial position from 2021 -22 onwards and the impact on public sector funding 
and the future funding of Health and Social Care services. 

The table below summarises the overall estimated Covid-19 costs for the North HSCP 
alongside the funding received to date to highlight the potential gap: 


ESTIMATED COVID COSTS 

Social 

Care 

£m 

Health 

£m 

Total 

£m 

Additional Spend 

5.414 

0.682 

6.096 

Delayed Savings 

1.115 

0 

1.115 

Total Costs 

6.529 

0.682 

7.211 

Covid Funding - to date - £83m social care 

(3.508) 

0 

(3.508) 

Up to additional £17m 

tbc 

0 

tbc 

Estimated Net Spend (Exc Savings) 

1.906 

0.682 

2.588 

Actual Spend to 14 August (exc savings delay) 

2.937 

0.457 

3.394 

YTD Net Spend (Exc Savings) 

(0.571) 

0.457 

(0.114) 


• The savings delays impact estimated at £1.115m has been removed from the 
above net position as these delays have already been factored into the period 4 
position, this is a prudent approach on the basis that despite this financial impact 
being highlighted on mobilisation plan returns there is no agreement in principle re 
savings delays being financially compensated for; 

• The estimated additional costs to March 2021 compared to the funding received to 
date leaves an estimated balance of £2.588m for which funding has not yet been 
received or allocated; 

• The year to date spend to 14 August is noted in the table and compared to the 
funding received to date gives a surplus of £0.114m 

The funding received to date is not the final allocation of funding for IJBs for the Health 
and Social Care response to Covid-19, we fully expect to receive an allocation for 
Health services towards the end of September and the initial allocation of up to £100m 
for social care services has been allocated in response to cash flow issues faced by 
some Local Authorities and also to provide confidence that funding will flow through the 
system to allow for sustainability payments to be made to commissioned social care 
providers. 

To two scenarios below illustrate the estimated worst-case scenarios where funding 
may not be sufficient to cover the estimated costs: 


28 




Total Potential 
Gap 

£m 

Scenario 1 

£100m NRAC/GAE Social Care & Health Fully Funded 1.906 

or: 

Scenario 2 

Policy Areas Fully Funded* 1.311 

*policy areas/decisions including PPE, Sustainability Payments, delayed 
discharge care home beds, Student Nurses 


The estimated worst-case scenario funding shortfall is estimated to be between 
£1,3m and £1.9m based on the two scenarios above. The below illustrates the 
ways in which this financial risk can be mitigated: 


Lobby for 
further Funding 


Review all 
Commitments - 

more 

slippage/offsets 

(Integrated 

budget) 


Controls on 
Further Covid-19 
Spend (YTD risk 
lower) 


Mitigate Risk 


Improve 

Savings Delivery 
(eg comm 
packages, 
children's 
placements) 

Reduce Services 

Management 
Actions - eg 
Recruitment 
Freeze, 
uncommitted 
non-essential 
spend 


as brought on¬ 
line (eg Day 

Services, Comm 
Packages) 



Given the scale of the financial risk at this stage in the year it is not recommended that 
the IJB consider a formal financial recovery plan at this time. 

This recommendation is on the basis that: 

• There is increasing confidence that additional costs will be funded based on the 
recently received and future expected funding allocations; 

• It is likely that any gap will be clearer towards the start of October when NHS 
Board funding allocations are expected to be confirmed; 

• The potential worst-case scenario in terms of any funding shortfall would be in 
the range of £1.3m and £1,9m, if this gap materialises there are areas we could 
explore to mitigate later in the year as part of a recovery plan if required; 

• The most significant area of additional Covid cost is the purchase of PPE for 
social care, the model for the purchase and supply is currently under review 


29 






and any options to change from the current model are likely to reduce the future 
estimated costs; 

• The period 4 position projects a balanced financial position (excluding Covid) 
and this does not include any assumption re the £1.5m held by the Council 
towards the IJB debt, this position assumes the debt repayment is made as 
planned, this position also incorporates estimated delays with savings delivery. 

The financial position will continue to be reported to the IJB at each meeting, these 
reports will outline the monthly financial projections and the updated position in relation 
to estimates for Covid costs. This will include the ongoing consideration of whether a 
Financial Recovery Plan may be required in the future. 

3. PROPOSALS 

3.1 Anticipated Outcomes 

Continuing to closely monitor the financial position will allow the IJB to take corrective 
action where required to ensure the partnership can deliver services in 2020-21 from 
within the available resource, thereby limiting the financial risk the funding partners, i.e. 
NAC and NHS AA. 

The estimated costs and funding in relation to the Covid-19 response also require to 
be closely monitored to ensure that the IJB can plan for the impact of this and to ensure 
that the IJB is in the position to re-claim funding to compensate for the additional costs. 

3.2 Measuring Impact 

Ongoing updates to the financial position will be reported to the IJB throughout 2020- 
21 . 


4. IMPLICATIONS 


Financial: 

The financial implications are as outlined in the report. 

Against the full-year budget of £252.768m there is a projected 
overspend of £0.066m (0.03%). The report outlines the main 
variances for individual services. 

This is an early indication of the projected outturn at month 4, 
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. 

One of the main areas of risk is the additional costs related to the 
Covid-19 response and these are detailed in the report together 
with an updated position in relation to funding. 

Human Resources: 

None 

Legal: 

None 

Equality: 

None 

Children and Young 
People 

None 

Environmental & 
Sustainability: 

None 


30 




Key Priorities: 

None 

Risk Implications: 

Within the projected outturn there are various over and 
underspends including the non-achievement of savings. The 
greatest financial risk for 2020-21 is the additional costs in relation 
to Covid-19. 

Community Benefits: 

None 


Direction Required to 

Direction to 


Council, Health Board or 

1. No Direction Required 


Both 

2. North Ayrshire Council 



3. NHS Ayrshire & Arran 



4. North Ayrshire Council and NHS Ayrshire & Arran 



4. 

CONSULTATION 

4.1 

This report has been produced in consultation with relevant budget holders and the 
Partnership Senior Management Team. 


The IJB financial monitoring report is shared with the NHS Ayrshire and Arran and 
North Ayrshire Council Head of Finance after the report has been finalised for the IJB. 

5. 

CONCLUSION 

5.1 

It is recommended that the IJB: 


(a) notes the overall integrated financial performance report for the financial year 
2020-21 and the overall projected year-end overspend of £0.066m at period 4; 

(b) notes the estimated costs of the Covid mobilisation plan of £7.3m, including 
savings delays, and the associated funding received to date; 

(c) note the financial risks for 2020-21, including the impact of Covid 19, and that 
there is no recommendation at this time to implement a formal Financial Recovery 
Plan for the IJB; 

(d) approve the budget changes outlined at section 2.8. 


For more information please contact: 

Caroline Cameron, Chief Finance & Transformation Officer on 01294 324954 or 
carolinecameron@north-avrshire.qov.uk 

Eleanor Currie, Principal Manager - Finance on 01294 317814 or 

eleanorcurrie@north-ayrshire.qov.uk 


31 




















2020-21 Budget Monitoring Report-Objective Summary as at 31 st July 2020 _ Appendix A 


Partnership Budget - Objective Summary 

2020/21 Budget 


Council 

Health 

TOTAL 

Over/ 
(Under) 
Spend 
Variance at 
Period 3 

Movement in 
projected 
variance 
from Period 

3 

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 

56,037 

54,674 

(1,363) 

13,720 

13,899 

179 

69,757 

68,573 

(1,184) 

(1,337) 

153 

: Locality Services 

23,317 

22,669 

(648) 

4,755 

4,799 

44 

28,072 

27,468 

(604) 

(1,098) 

494 

: Community Care Service Delivery 

28,600 

28,592 

(8) 

0 

0 

0 

28,600 

28,592 

(8) 

14 

(22) 

: Rehabilitation and Reablement 

1,982 

1,694 

(288) 

1,922 

1,910 

(12) 

3,904 

3,604 

(300) 

(282) 

(18) 

: Long Term Conditions 

1,776 

1,345 

(431) 

4,949 

5,100 

151 

6,725 

6,445 

(280) 

35 

(315) 

: Integrated Island Services 

362 

374 

12 

2,094 

2,090 

(4) 

2,456 

2,464 

8 

(6) 

14 

MENTAL HEALTH SERVICES 

24,843 

26,465 

1,622 

52,481 

51,061 

(1,420) 

77,324 

77,526 

202 

(356) 

558 

: Learning Disabilities 

18,643 

20,470 

1,827 

448 

448 

0 

19,091 

20,918 

1,827 

1,623 

204 

: Community Mental Health 

4,726 

4,521 

(205) 

1,685 

1,636 

(49) 

6,411 

6,157 

(254) 

(208) 

(46) 

: Addictions 

1,474 

1,474 

0 

1,351 

1,341 

(10) 

2,825 

2,815 

(10) 

25 

(35) 

: Lead Partnership Mental Health NHS Area Wide 

0 

0 

0 

48,997 

47,636 

(1,361) 

48,997 

47,636 

(1,361) 

(1,796) 

435 

CHILDREN & JUSTICE SERVICES 

32,136 

32,472 

336 

3,845 

3,845 

0 

35,981 

36,317 

336 

559 

(223) 

: Irvine, Kilwinning and Three Towns 

3,197 

3,136 

(61) 

0 

0 

0 

3,197 

3,136 

(61) 

(45) 

(16) 

: Garnock Valley, North Coast and Arran 

1,256 

1,176 

(80) 

0 

0 

0 

1,256 

1,176 

(80) 

(76) 

(4) 

intervention Services 

2,098 

2,088 

(10) 

315 

315 

0 

2,413 

2,403 

(10) 

(10) 

0 

: Looked After and Accommodated Children 

17,680 

18,078 

398 

0 

0 

0 

17,680 

18,078 

398 

699 

(301) 

: Quality Improvement 

4,310 

4,393 

83 

0 

0 

0 

4,310 

4,393 

83 

(6) 

89 

: Public Protection 

628 

633 

5 

0 

0 

0 

628 

633 

5 

(2) 

7 

: Justice Services 

2,506 

2,506 

0 

0 

0 

0 

2,506 

2,506 

0 

(2) 

2 

: Universal Early Years 

461 

462 

1 

3,120 

3,120 

0 

3,581 

3,582 

1 

1 

0 

: Lead Partnership NHS Children's Services 

0 

0 

0 

410 

410 

0 

410 

410 

0 

0 

0 

PRIMARY CARE 

0 

0 

0 

51,024 

51,024 

0 

51,024 

51,024 

0 

0 

0 

ALLIED HEALTH PROFESSIONALS 




5,498 

5,498 

0 

5,498 

5,498 

0 

0 

0 

MANAGEMENT AND SUPPORT COSTS 

8,012 

8,061 

49 

4,160 

3,935 

(225) 

12,172 

11,996 

(176) 

9 

(185) 

CHANGE PROGRAMME 

1 

1 

0 

1,011 

1,011 

0 

1,012 

1,012 

0 

17 

(17) 

OUTTURN ON A MANAGED BASIS 

121,029 

121,673 

644 

131,739 

130,273 

(1,466) 

252,768 

251,946 

(822) 

(1,108) 

286 

Return Hosted Over/Underspends East 

0 

0 

0 

0 

441 

441 

0 

441 

441 

582 

(141) 

Return Hosted Over/Underspends South 

0 

0 

0 

0 

419 

419 

0 

419 

419 

553 

(134) 

Receive Hosted Over/Underspends South 

0 

0 

0 

0 

81 

81 

0 

81 

81 

0 

81 

Receive Hosted Over/Underspends East 

0 

0 

0 

0 

(53) 

(53) 

0 

(53) 

(53) 

0 

(53) 

OUTTURN ON AN IJB BASIS 

121,029 

121,673 

644 

131,739 

131,161 

(578) 

252,768 

252,834 

66 

27 

39 


2020-21 Budget Monitoring Report - Detailed Variance Analysis Appendix B 


32 




















































Budget 

EOOO's 

Outturn 

EOOO's 

Over/ 

(Under) 

Spend 

Variance 

EOOO’s 


COMMUNITY CARE AND HEALTH 

69,757 

68,573 

(1,184) 


Locality Services 

28,072 

27,468 

(604) 

Older People care homes inc respite - underspend of £1.024m based on734 placements (694 plus 40 new funding) and including 

Income from Charging Orders - under recovery of £0.078m 

Independent Living Services : 

* Direct Payment packages- overspend of £0.131 on 62 packages. 

* Residential Packages - overspend of £0.058m based on 33 packages. 

Community Care Service Delivery 

28,600 

28,592 

(8) 

Outwith the threshold for reporting 

Rehabilitation and Reablement 

3,904 

3,604 

(300) 

Aids and Adaptations - underspend of £0.300m related to the reduced number of OT assessments taking place during COVID 19. 

Long Term Conditions 

6,725 

6,445 

(280) 

Carers Centre - projected underspend of £441 k, budget vired in 19/20 of £293k to OP Repsite returned to increase projected underspend 
Anam Cara - projected overspend in Employee costs of £25k due to pilot of temporary post with a view to longer term savings in bank & 
casual hours 

Integrated Island Services 

2,456 

2,464 

8 

Outwith the threshold for reporting 



Budget 

EOOO's 

Outturn 

EOOO's 

Over/ 

(Under) 

Spend 

Variance 

EOOO’s 


MENTAL HEALTH SERVICES 

77,324 

77,526 

201 


Learning Disabilities 

19,091 

20,918 

1,827 

Residential Packages- overspend of £0.367m based on 41 current packages, including future transfers to Trindlemoss. 

Community Packages (inc direct payments) - overspend of £1.84m based on 337 current packages. The direct payments projection is 
based on 41 current packages. Covid 19 community service reductions were approx. £191k for first qtr and a further £97k reduction for 
Day services not delivered 

Community Mental Health 

6,411 

6,157 

(254) 

Employee costs - on line with budget 

Community( inc direct payments) and Residential Packages underspend of £0.202m based on 92 community packages, 31 Direct 
Payments and 29 residential placements. 

Addictions 

2,825 

2,815 

(10) 

Outwith the threshold for reporting 

Lead Partnership (MHS) 

48,997 

47,636 

(1,361) 

Adult Community - underspend of £0.143m due to vacancies. 

Adult Inpatients- overspend of £0.600m due to a delay in closing the Lochranza wards and revised assumptions on redeployed staff. 
UNPACs - underspend of £0.187m based on current placements and assumed service level agreement costs. 

Elderly Inpatients - underspend of £0.300m which includes the £0.934m of unallocated funding following the elderly MH review. 

Learning Disability - underspend of £0.060m due to vacancies. 

CAMHS - underspend of £0.200m due to vacancies. 

MH Admin - underspend of £0.300m due to vacancies. 

Psychiatry - underspend of £0.508m due to vacancies. 

MH Pharmacy - underspend of £0.190m mainly within substitute prescribing. 

Psychology- underspend of £0.447m due to vacancies. 


33 






























Budget 

EOOO's 

Outturn 

EOOO's 

Over/ 

(Under) 

Spend 

Variance 

EOOO's 


CHIDREN'S AND JUSTICE SERVICES 

35,981 

36,317 

336 


Irvine, Kilwinning and Three Towns 

3,197 

3,136 

(61) 

Outwith the threshold for reporting 

Garnock Valley, North Coast and 
Arran 

1,256 

1,176 

(80) 

Employee Costs - Projecting £0.054m underspend due to a substantive post being vacant . This will be offsetting an overspend in employee Costs within 
Quality Improvement. 

Transports costs - Projected underspend of 0.010m due a reduction in spend in Staff Mileage costs, assumes a 65% spend of all mileage budgets 
across the service. 

Intervention Services 

2,413 

2,403 

(10) 

Outwith the threshold for reporting 

Looked After and Accommodated 
Children 

17,680 

18,078 

398 

Employee Costs - Projected overspend of £0.029m which is due to additional hours/overtime hours being worked within the Children's Houses 

Looked After Children placements - Projected underspend of £0.073m, favourable movement of £163k which is made up of the followina:- 

Kinship - projected underspend of £0.172m. Budget for 359 placements, currently 342 placement but projecting 350 placements by the year end. (Note 
£81 k pressure money allocated in P4) 

Adoption - projected overspend of £0.033m. Budget for 69 placements, currently 71 placements. 

Fostering - projected overspend of £0.93m. Budget for 129 placements, currently 133 placements and projecting 133 placements by the year end. 
Fostering Xtra - projected overspend of £0.037m. Budget for 32 placements, currently 34 placements but projecting 34 placements by the year end. 
Fostering Respite - Projected underspend of £0.050m which is due to respite services not taking place due to COVID 

Private fostering - projected underspend of £0.018m. Budget for 10 placements, currently 10 placements. 

IMPACCT carers - projected online Budget for 2 placements, currently 2 placements. 

Residential School placements - Projected overspend £0.543m, current number of placements is 17, assumption that 3 will end in September and 1 
ending in October and no further new admissions resulting in 13 placements at the year end. No secure placements. 

Quality Improvement 

4,310 

4,393 

83 

Employee Costs - Projected Overspend E6/k, Note E6UK overspend relates to employee acting up to Senior Manager which will being onset with her 

vacant post within the Irvine Locality. Additional costs CSW payments, £30k also being paid to employee for ASN School, these additional costs are being 
offset with vacant posts in other teams. - No Movement 

Transports costs - Projected underspend of £25k due a reduction in spend in Staff Mileage costs, assumes a 65% spend of all mileage budgets across 
the service. Favourable movement £1k due to previously % reduction in expected mileage spend. 

Community Packages - Projected underspend of £17k, adverse movement of £8.8k 110 Community Packages on establishment list. 

Direct Payments - Projected Underspend £39k, favourable movement of £9k which is due to increase % clawback from 8% to 10%. Current number of 
packages in place is 42 and projecting an increase of further 5 packages until end of FY, savings of around £36k made due to temporary decreases in 
packages due to PA being furloughed. 

Public Protection 

628 

633 

5 

Outwith the threshold for reporting 

Justice Services 

2,506 

2,506 

0 

Outwith the threshold for reporting 

Universal Early Years 

3,581 

3,582 

1 

Outwith the threshold for reporting 

: Lead Partnership NHS Children's 
Services 

410 

410 

0 

Outwith the threshold for reporting 

PRIMARY CARE 

51,024 

51,024 

0 

Outwith the threshold for reporting 

ALLIED HEALTH PROFESSIONALS 

5,498 

5,498 

0 

Outwith the threshold for reporting 

MANAGEMENT AND SUPPORT 

12,172 

11,996 

(176) 

Over recovery of payroll turnover on health services. 

CHANGE PROGRAMME & 
CHALLENGE FUND 

1,012 

1,012 

0 

Outwith the threshold for reporting 

TOTAL 

252,768 

251,946 

(822) 



Threshold for reporting is + or - £50,000 


34 


























2020-21 Savings Tracker ________ Appendix C 


Savings 

reference 

number 

Description 

Dellverablllty 
Status at 
budget 
setting 

Approved 

Saving 

2020/21 

Em 

Deliverability 
Status 
Month 4 

Saving 
Delivered @ 
Month 4 

Em 

Projected to 
Deliver 
during Year 
Em 

Projected 

Shortfall 

Em 

Comment 

Children, Families & Criminal Justice 

1 

Children and Young People - External Residential 
Placements 

Amber 

0.583 

Amber 


0.284 

0.299 

Currently projecting an overspend. Some plans to move children 
have been impacted by COVID. Expect to have 13 places at the 
year-end when the original plan was to have 10 places, will impact 
on savinas for 2021-22. 

2 

Adoption Allowances 

Amber 

0.074 




0.074 

Current projected overspend but outcome of the adoption review to 
be implemented 

3 

Children's Services - Early Intervention and Prevention 

Amber 

0.050 

Green 

0.050 


- 

Fully achieved, met through efficiencies across Children's services 

4 

Fostering - Reduce external placements 

Green 

0.036 

Amber 

- 


0.036 

Not been able to reduce placements, may progress later in the 
year. 

5 

Community Support - Children's Care Packages 

Amber 

0.008 

Green 

0.008 

" 

" 

Tender delayed, saving can be met through budget underspend for 
2020-21. 

Mental Health and LD Services 

6 

LD - Reduction to Sleepover Provision 

Amber 

0.200 




0.200 

Cluster sleepover models centred around core supported 
accomodation are being considered but will be delayed. The 
supported accomodation build timescales have slipped due to 
COVID. 

7 

Learning Disability Day Services 

Amber 

0.279 

Amber 


0.050 

0.229 

The provision of day care is being reviewed to ensure it can be 
delivered safely. This will include a review of the staffing, anew 
staffing structure has been planned which will deliver the full year 
saving but will be delayed until January 2021. 

8 

Trindlemoss 

Green 

0.150 

Amber 

0.150 

- 

- 

Fully achieved but final tenancies to be decided. 

9 

Mental Health - Flexible Intervention Service 

Green 

0.008 

Green 

0.008 

- 

- 

Fully achieved, slightly over-delivered (£10k) 

Health and Community Care 

10 

Roll out of multidisciplinary teams - Community Care 
and Health 

Amber 

0.110 

Green 


0.110 


For 2020-21 only this saving has been added to the vacancy 
savings target to be met non-recurringly. There are a number of 
vacancies across Community Care and Health but at this stage the 
service can not identify posts to be removed on a permanent basis, 
will be formalised and removed from establishment from 2021 -22. 

11 

Carers Act Fundina - Respite in Care Homes 

Green 

0.273 

Green 

0.273 

- 

- 

Fully achieved 

12 

Care at Home - Reablement Investment 

Amber 

0.300 

Green 

- 

0.300 

- 

Expect to fully achieve, level of service activity within budget. 

13 

Care at Home - Efficiency and Capacity Improvement 

Amber 

0.135 

Green 

" 

0.135 

- 

Expect to fully achieve, level of service activity within budget. 

14 

Day Centres - Older People 

Amber 

0.038 

Amber 



0.038 

Day centres are currently closed and staff have been re-deployed, 
will look for opportunities to release savings when the services re¬ 
open. 

15 

Charging Policy - Montrose House 

Amber 

0.050 

Amber 

" 

" 

0.050 

New charging policy in place, achieving the saving has been 
impacted by movement in care home placements. 

Whole System 

16 

Adults - New Supported Accommodation Models 

Amber 

0.063 

Amber 

" 

0.025 

0.038 

Project has slipped. Expected completion date is early 2021. 
Saving was based on 5mths, Assume only2mths are achieved 

17 

Adult Community Support - Commissioning of 

Services 

Amber 

0.638 

Amber 

- 

0.512 

0.126 

Implementation of CM2000 was delayed due to Covid, expect to 
bring system on line for Adult providers from the start of October. 

18 

Charging Policy - Inflationary Increase 

Green 

0.050 

Amber 


0.025 

0.025 

Charging has been suspended during COVID 19, with the 
exception of care homes and community alarms, expect to bring 
back on line in September. 


TOTAL SOCIAL CARE SAVINGS 3.045 0.489 1.441 1.115 


35 









































































Health: 


Savings 

reference 

number 

Description 

Deliverability 
Status at 
budget 
setting 

Approved 

Saving 

2020/21 

£m 

Deliverability 
Status 
Month 4 

Saving 
Delivered @ 
Month 4 

£m 

Projected to 
Deliver 
during Year 
£m 

Projected 

Shortfall 

£m 

Comment 

19 

Trindlemoss 

Green 

0.120 

Green 

0.120 

- 

- 

Fully achieved 

20 

Packaqes of care 

Green 

0.100 

Green 

0.100 

- 

- 

Fully achieved 

21 

Elderly Mental Health inpatients (lead partnership) 

Green 

0.216 

Green 

0.216 

- 

- 

Fully achieved 

22 

MH Payroll Turnover (lead partnership) 

Green 

0.100 

Green 

0.100 

- 

- 

Fully achieved 

23 

North Payroll Turnover 

Green 

0.280 

Green 

0.280 

- 

- 

Fully achieved 


TOTAL HEALTH SAVINGS 0.816 0.816 0.000 0 







|TOTAL NORTH HSCP SAVINGS 

1 3.861 

1.305 

1.441 

1.115 


36 
























2020-21 Budget Reconciliation 


Appendix D 


COUNCIL 

Period 

Permanent 

or 

Temporary 

£ 

Initial Approved Budget 



96,963 

Rounding error 



4 

Error in budget 



1,299 

Resource Transfer 



22,769 

WAN Circuits Budget Transfer - Kyle Road - New data Connection (Store Costs) 

1 

P 

(D 

British Sign Lanaguage funding transferred to Democratic Services 

3 

P 

(5) 

Budget Reported at Month 4 



121,029 


HEALTH 

Period 

Permanent 

or 

Temporary 

£ 

Initial Approved Budget 



149,830 

Resource Transfer 



(22,769) 

Adjustment to base budget 

1 

P 

(90) 

2019/20 Month 10-12 budget adjustments 

1 

P 

3,999 

Non recurring Funding 19/20 

3 

T 

(298) 

Full Year effect of Part Year Reductions 

3 

P 

(54) 

Additional COVID funding 

3 

T 

1,339 

Additional living wage funding 

3 

P 

186 

VIP Funding 20/21 

3 

T 

105 

Primary Care Prescribing - Uplift 

3 

P 

2,060 

Primary Care Prescribing - CRES 

3 

P 

(756) 

Outcomes Framework - Breast Feeding 

3 

T 

33 

South HSCP VIP contribution 

3 

T 

20 

ANP Allocation - MIN 

3 

T 

20 

Training Grade Funding 

3 

P 

49 

Funding transfer to Acute (Medical Records) 

3 

T 

(33) 

Public Health Outcomes Bundle 

3 

T 

235 

Specialist Pharmacist in Substance Misuse 

3 

T 

12 

Prescribing Reduction - COVID 

3 

T 

(540) 

Lochranza Discharges to South HSCP 

3 

P 

(170) 

Precribing Reduction 

4 

P 

(1,497) 

Training Grade Funding 

4 

T 

36 

TEC Contribution 

4 

T 

(53) 

Admin posts from South HSCP 

4 

P 

54 

Uplift Adjustment 

4 

P 

21 

Budget Reported at Month 4 



131,739 


COMBINED BUDGET 252,768 


37 















































Appendix E 


Name of Body 

North Ayrshire HSCP 

Finance Contact: 

Caroline Cameron, Chief 

Date of last update 

11/08/2020 


Delayed Discharge Reduction- Assumptions 

Supporting Narrative 

Delayed Discharge Reduction- Additional Care Home Beds 

32 placements from March to date where funding accellerated or agreed to reduce DD in hospital and expediate discharge, further DD in hospital but not all will require care home placement 

Delayed Discharge Reduction- other measures 

Anam Cara Respite in-house respite facility being used temporarily for step down 



Revenue 

Capital 


H&SCP Costs 

Apr-20 

May-20 

Jun-20 

Jul-20 

Aug-20 

Sep-20 

Oct-20 

Nov-20 

Dec-20 

Jan-21 

Feb-21 

Mar-21 

2020/21 

2020/21 

Body incurring 
cost (NHS or 
LA) 

Supporting Narrative 

Delayed Discharge Reduction- Additional Care Home Beds 

82,102 

78,564 

78,564 

78,564 

78,564 








396,358 


LA 

Only requested funding to August on the basis that interim funding is to facilitate discharge and HSCP would 
have to fund placements in the longer term. This is to fund 32 specific placements, not assuming there will 
be additional fundinq for any new discharges to maintain DD performance. 

Delayed Discharge Reduction- other measures 

5,453 

4,362 

4,362 

4,362 

4,362 

4,362 







27,263 


LA 

Anam Cara Respite facility being used temporarily for step down - cost is only in relation to lost income from 
respite charging, existing staff group delivering care 

Delayed Discharge Reduction- other measures 

60,151 












60,151 


LA 

Adaptations and equipment purchased to get social care surge sites ready for use, would likely to be further 
costs if sites are required to be brouqht into use in the future. 

Personal protection equipment 

259,469 

263,477 

249,157 

142,248 

142,248 

142,248 

142,248 

142,248 

142,248 

142,248 

142,248 

142,248 

2,052,335 


NHS/LA 

Sourcing majority of PPE for social care locally. Currently sourcing about 85%-95% (range depending on 
items) of social care PPE supply by HSCP with the rest coming from NSS top up supply. Orders placed 
totalling £912k as at 18th June. Assumption that from October onwards (linked to MoU for PPE Hub) NSS 
supply will potentially increase to provide 50% of requirement, however there remains a risk that costs will 
continue to rise and this depends on arrangement for national distribution . 

Deep cleans 


224 

971 










1,195 


NHS 


Estates & Facilities cost 


4,790 

3,549 










8,339 


NHS 


Additional staff Overtime and Enhancements 

70,596 

43,682 

47,882 

50,000 

50,000 

50,000 

25,000 

25,000 

25,000 

12,500 

12,500 

12,500 

424,660 


LA 

Cost of additional staff hours to cover absence, mainly in Care at Home Services and residential Children’s 
Houses 

Additional temporary staff spend - Student Nurses & AHP 


227,159 

142,067 

142,067 

142,067 

79,704 







733,063 


NHS 

Actual spend to June for student nurses and other nursing and AHP additional hours, from July onwards 
based on student costs plus £50k estimate of onqoinq additional bank hours. 

Additional temporary staff spend - Health and Support Care 
Workers 



40,958 










40,958 


NHS 


Additional costs for externally provided services 

220,798 

278,694 

314,548 

264,036 

264,036 

188,268 

25,000 

25,000 

25,000 

25,000 

25,000 


1,655,380 



Provision per month for additional payments to providers primarilty for PPE and sickness absence, position 
statement shared with providers in line with COSLA commissioning guidance. Additional provision for 
occupany payments to care homes from April to September and assuming tapered reduction in Sept. 

Included provision for 5% increase in costs for community support services (care at home and adults) from 
April to September, not included at 25% as not seen requests at that level, this may increase as sickness 
policy is implemented. Included small provision for support after Sept with PPE and infection control costs. 

Additional FHS Payments- GP Practices 

13,527 

6,203 

7,000 

7,000 

7,000 








40,730 


NHS 

Additional GP sessions for Arran for the hospital and to support local team in co-ordinating planning and 
response 

Loss of income 

88,500 

88,500 

88,500 

88,500 

88,500 








442,500 


LA 

Ceased provision of day services and respite, also suspended charges for community supports on basis of 
rapid chanqes to care, capacity to ensure accurate financially assessed charqes and also financial hardship. 

Additional Travel Costs 


1,304 

4,553 










5,857 




IT & Telephony Costs 


937 











937 




Equipment & Sundries 


75,584 











75,584 


NHS/LA 

Thermometers moved herefrom PPE 

Children and Family Services 

6,952 

12,166 

20,856 

34,760 

34,760 

34,760 

17,380 

17,380 

17,380 




196,394 



Additional Fostering Placements, 20 increased placements from April to now which are Covid related 
temporary placements, delay in children's hearings and housing has led to a delay in moving children on from 
foster care. Cost of 20 placements as they came on line from April, assume 10 will leave care by Sept and a 
further 10 between October and December. 

Other- Security Costs PPE Store 

8,000 

8,000 

8,000 

8,000 

8,000 

8,000 







48,000 


LA 


Other- Additional Care at Home Capacity 

38,845 

38,845 

38,845 

38,845 

38,845 

31,649 

31,649 

31,649 

31,649 

31,649 

31,649 

31,649 

415,768 


LA 

Additional costs for in-house service to ensure service can faciliate hospital discharge and put in place care 
packages despite operating at high absence levels. Demands for this service have increased with more 
individuals and families choosing to be cared for at home. 

Offsetting cost reductions - HSCP 

(108,007) 

(108,007) 

(108,007) 

(68,583) 

(68,583) 

(68,583) 







(529,770) 


NHS/LA 


Total 

746,386 

1,024,484 

941,805 

789,799 

789,799 

470,408 

241,277 

241,277 

241,277 

211,397 

211,397 

186,397 

6,095,703 



Subtotal 

6,095,703 

Expected underachievement of savinqs (HSCP) 

139,375 

139,375 

139,375 

139,375 

139,375 

139,375 

46,458 

46,458 

46,458 

46,458 

46,458 

46,458 

1,115,000 


NHS/LA | | 

Total 

885,761 

1,163,859 

1,081,180 

929,174 

929,174 

609,783 

287,735 

287,735 

287,735 

257,855 

257,855 

232,855 

7,210,703 















Total 


7,210,703 

1 Local Authority- Actual Spend 

535,748 1 

831,861 1 

^T05a25fH 

i 

358,372 

r—i 

mssm 


mmm 


H 




| Local Authority- Accrual 

904,830 | 

970,158 | 

928,998 | 

787,599 | 

787,599 | 

537,571 | 

287,735 | 

287,735 | 

287,735 | 

257,855 | 

257,855 | 

232,855 | 



38 


















































































Agenda Item 6 



NORTH AYRSHIRE 

Health and Social Care 
Partnership 


Integration Joint Board 

September 2020 


Subject: 

Annual Performance Report 2019-20 

Purpose: 

To approve the publication of the North Ayrshire Health and Social 
Care Partnership (NAHSCP) Annual Performance Report 2019-2020 

Recommendation: 

Integration Joint Board (IJB) to approve the publishing of 
Partnership’s 2019-20 Annual Performance Report 


Glossary of Terms 

NHS AA 

NHS Ayrshire and Arran 

NAHSCP 

North Ayrshire Health and Social Care Partnership 


l. 

EXECUTIVE SUMMARY 

1.1 

Section 42 of the Public Bodies (Joint Working)(Scotland) Act 2014 requires 
partnerships to publish an annual performance report setting out an assessment of 
performance in planning and carrying out the integration functions for which they are 
responsible. 

1.2 

Guidance for Health and Social Care Integration Partnership Performance Reports 
(published by the Scottish Government, March 2016) was followed to ensure the 
content of our performance report met the requirements set out in the guidance. 

1.3 

The legislated publication date for Annual Performance Reports is 31st July, 
however, the Scottish Government understood that Integrated Authorities (IA) may 
not be able to publish their final 2019-20 reports by the 31 st July deadline and may 
postpone publication until 30th September in accordance with provisions made in 
the Coronavirus (Scotland) Act 2020 . 

1.4 

Latterly the publication date being extended to 30th September 2020 as a resultant 
impact of the COVID-19 pandemic on operational and support services was agreed 
at the Performance and Audit Committee on the 25th June 2020. 

2. 

CURRENT POSITION 

2.1 

With the agreed extension to the publication of the annual report a public notice was 
added to the partnership website stating the reason for the publication being extended 
to 30th September. 


39 




















2.2 

A draft of Annual Performance Report was presented at the Performance and Audit 
Committee on the 03rd September for initial review and following discussion a few 
amendments were made and the final document completed. 

2.3 

The annual report meets the minimum requirements as set out in the Guidance for 
Health and Social Care Integration Partnership Performance Reports (published by 
the Scottish Government, March 2016). We continue to build on this minimum 
requirement by including dedicated sections reporting on Children and Justice 
services. 


The report is the collation, through collaboration with stakeholders, of the significant 
service highlights relating to the works and initiatives undertaken by partnership 
services in the support of our strategic plan objectives. 

These highlights include cross-service exemplars: 

• Drug and Alcohol Recovery Service: maintaining the of low levels of 
methadone prescribing at 757 people at year end 

• Money Matters Team: enabling over £15M in life supporting entitled benefits 
to be accessed 

• Children and young people becoming accommodated: at year end the 
number of children accommodated in external placements was 26; a reduction 
from 33 at the beginning of the year 

• Care at Home and Community Alert Services: service inspection added to 
the Very Good grading for Care and Support with an Excellent grading for 
Management and Leadership 

These specific highlights are representative of the varied services provided by the 
partnership and the role they play in the support of some of the most vulnerable people 
in the community to live independently for as long as possible. 

2.4 

Publication 


This annual performance report is part of a suite of partnership public-facing 
documents. These documents are available from the NAHSCP website, 

www.nahsco.ora. 

3. 

PROPOSALS 

3.1 

The NAHSCP 2019-20 Annual Performance Report is published by the revised 
deadline of 30th September 2020. 

3.2 

Anticipated Outcomes 


Informing the people of North Ayrshire and wider stakeholders on the progress of 
health and social care integration, specifically relating to: 


40 


















• Outcomes for local people; 

• Locality health and social care needs; 

• Service provision (including lead partnership responsibilities and commissioned 
services); 

• Transformational Change; 

• Budget and financial information. 

3.3 

Measuring Impact 


With the publication of the Annual Performance Report 2019-20 the partnership will 
have met its obligations under the Public Bodies (Joint Working)(Scotland) Act 2014. 

4. 

IMPLICATIONS 


Financial: 

There are no additional financial implications 

Human Resources: 

There are no implications for staff 

Legal: 

There are no legal issues. 

Equality: 

No issues 

Children and Young 

People 

No issues 

Environmental & 
Sustainability: 

No issues 

Key Priorities: 

This would ensure we fulfil our obligations in the Integration Scheme. 

Risk Implications: 

None identified. 

Community Benefits: 

Community is aware and informed about community-based health and social care 
services, plans and outcomes. 


Direction Required to Council, 

Direction to :- 


Health Board or Both 

1. No Direction Required 

X 


2. North Ayrshire Council 



3. NHS Ayrshire & Arran 



4. North Ayrshire Council and NHS Ayrshire & Arran 



5. 

CONSULTATION 

5.1 

Staff, partnership stakeholders, the Partnership Senior Management Team (PSMT) 
and IJB Performance and Audit Committee (PAC) were consulted on the Annual 
Performance Report. 

6. 

CONCLUSION 

6.1 

The Integrated Joint Board are asked to consider and approve the publication of the 
North Ayrshire Health and Social Care Partnership’s 2019-20 Annual Performance 
Report. 


41 







For more information please contact: 


Neil McLaughlin, Manager Performance and Information Systems on 01294 317744 or 

NMcLauqhlin@north-ayrshire.qov.uk 

Or 

Caroline Whyte, Chief Finance and Transformation Officer on 01294 324954 or 

carolinewhyte@north-avrshire.qov.uk 


42 




North Ayrshire Health and Social 
Care Partnership 



Annual Performance 
Report 

ini Q_on 



Vision: 



all people who live in North Ayrshire are 
able to have a safe, healthy and active life 


43 

























Reflections from Stephen Brown 


Our annual performance report 2019-20 reflects on how 
Partnership services have contributed to meeting national and 
local priorities over the year. We have continued to deliver 
safe, sustainable health and social care services throughout the 
year and, although we have faced significant pressures in the 
areas of mental health, hospital discharges and some aspects of 
our children's services, there has also been some significant 
progress and success. 

These highlights include the continued progress around 
Recovery in our alcohol and drugs services, including the 
sustained reductions in the number of individuals being 
supported via methadone prescriptions. Our Money Matters 
Team supported people across our communities to successfully 
claim for over £15 million of benefits that they were entitled to 
but not previously receiving. The positive inspection of our care 
at home and community alert services retaining a grading of 
Very Good for Care and Support and adding to this with an 
Excellent grading for Management and Leadership highlights the 
significant role these services play in supporting some of our 
most vulnerable people to continue to live independently for as 
long as possible. 

Our greatest challenge remains our ability to manage demand 
within budget. The HSCP ended the year with a £0.154m 
overspend. This will be added to the debt to the Council carried 
forward from previous years. 

Our transformation plan continues to drive forward our programme of 
improvement aligned to bringing services closer together to improve the 
health and social care outcomes for the people of North Ayrshire. These 
plans ensure we can use our resources effectively but also ensures that 
services are mobilised effectively to meet the demands of the COVID-19 
pandemic through 2020-21 and beyond. 


As committed to last year, I engaged with over 2,000 staff members through our 
Thinking Different Doing Better experience, and we were able to extend the 
experience to local community groups as well as hundreds of Health and Care 
students from Ayrshire College. The suggestions, feedback and conversations 
provided through these sessions has helped inform our transformation 
programme and will also inform our forthcoming refresh of our Strategic Plan. 

I want to thank all of our partners and all of the staff working within 
North Ayrshire Health and Social Care Partnership for their continued 
hard work and dedication to improving the lives of people living in 
North Ayrshire. 



Stephen Brown 

Director, North Ayrshire Health and Social Care Partnership 









Contents 


f i 

Visions, Values and Priorities 


Structure of this report 


Performance related to National Health and Wellbeing Outcomes 


National Indicators 


Performance related to Children and Justice Services Outcomes 


Localities 


Transformation Programme 


Lead Partnership Reporting 


Inspection of Services 


Financial Performance and Best Value 


Appendix 

L j 


l 


46 















Vision, Values and Priorities 


North Ayrshire Health and Social Care Partnership (NAHSCP/the Partnership) is striving for a vision 
where: 


“All people who live in North Ayrshire are able to 
have a safe, healthy and active life” 


Our Partnership includes health and social care services within Health and Community Care 
Services, Mental Health and Learning Disability Services and Children, Families and Justice 
Services. 

In this, our fifth annual performance report, we look back on the progress we have made, share some 
of our successes and reflect on some areas that have proved challenging. 

The partnership refreshed the three-year Strategic Plan, this report aligns with the second year of our 
second Strategic Plan. The new Strategic Plan allowed us to confirm with the people who use our 
services and North Ayrshire residents and staff that we should continue to focus on these five 

priorities: 

• Tackling Inequalities 

• Engaging Communities 

• Bringing Services Together 

• Prevention and Early Intervention 

• Improving Mental Health and Wellbeing 


People who use our services and North Ayrshire residents will experience our Partnership values in 
the way our staff and volunteers engage with you and how we behave. We will: 

• Put you at the centre 

• Treat you with respect 

• Demonstrate efficiency 

• Care 

• Be inclusive 

• Embody honesty 

• Encourage innovation 


2 


47 






Structure of this report 


We have measured and evaluated our performance in relation to: 


Scottish Government National Health and Wellbeing Outcomes 
Children’s and Justice Services Outcomes 
Local measurements 


The North Ayrshire Health and Social Care Partnership continues to have lead partnership 
responsibilities across Ayrshire and Arran for Mental Health and Learning Disability Services as well 
as Child Health Services (including immunisation and infant feeding). We have reflected on some of 
the highlights and challenges of leading these services across Ayrshire. 


We will show that all our services (those provided by our Partnership staff and those provided by 
other organisations on our behalf) are providing high quality care and support to the people of North 
Ayrshire. 


Finally, the partnership continues to face financial challenges in delivering and improving services 
from within the available budget. During the year we have made significant progress towards 
achieving financial balance and overall service sustainability. We have detailed our financial position 
and reflected on how we continue to provide assurance that we are delivering Best Value in North 
Ayrshire for Health and Social Care services 


3 


48 


1 

Performance in relation to National Health 
and Wellbeing Outcomes 


As we completed our fifth year, the Partnership continued to focus our 
efforts on providing services that improve the lives of all the people 
living in North Ayrshire. 


Our five strategic objectives link directly to the nine national Health 
and Wellbeing Outcomes. These outcomes provide a roadmap for us 
and we can demonstrate progress against each. 


4 


49 




Outcome 1 

People are able to look after and improve their own health and wellbeing 
and live in good health for longer 


Our Highlights 


58% increase in referrals/ signposting to the Community Link Workers 
67% increase in Community Link Worker consultations 
76% Reduction in Alcohol intake for those supported by NADARS 


1.1 The Community Link Worker Service continues to provide a valuable support within 
all GP Surgeries in North Ayrshire. There was a total of 3,327 people signposted or referred to 
the Community Link Worker service in North Ayrshire from April 2019 to March 2020. This is 
an increase of 58% from the previous year. 82% of the people engaged with the service 
(2,714). The significant increase in 

Consultation numbers is likely as a result Of Community Link Workers 

the additional staff members being fully 
embedded within the team. 

The three highest recorded reasons for 
attending the service are for: 

• Mental Health and Wellbeing 

• Financial 

• Social 

1.2 The Health & Wellbeing Service 

delivered by KA Leisure received 773 new referrals and undertook 2,695 classes, with a total 
of 42,132 attendances at supported physical activity sessions in 2019/20. The Mind and Be 
Active Service delivered by KA Leisure received 276 new referrals, undertook 490 
supported classes and had 11,041 attendances at specific Mind and Be Active supported 
physical activity sessions in 2019-20. Across the year there were 885 follow up consultations 
completed at 6/12 months and 114 referrals made to health care providers or external 
agencies. 


Signposting, Engaging and Consultations 


7,663 



Signposted People Engaged with Consultations 
Service 

□ 2018-19 ■ 2019-20 


5 


50 







1.3 The North Ayrshire Drug and Alcohol Recovery Service (NADARS), has 

continued to demonstrate high levels of performance by meeting national and local standards 
and targets, such as, access to treatment waiting times, provision of alcohol brief interventions 
(ABIs), the roll out of Naloxone supplies and maintaining a low level of methadone prescribing 
to individuals. 



The team continues to identify new ways of working to provide a more agile and streamlined 
service and further improve performance. This work has been evidenced by the delivery of 
early intervention services in the delivery of Alcohol Brief Interventions (ABI). 


Target set by Scottish Government - Priority Settings 

3,419 

Total ABI delivery in Priority Settings (Ayrshire & Arran) 

3,524 


Target set by Scottish Government in Wider Settings 

855 

Total ABI delivery in Wider Settings (Ayrshire & Arran) 

2,927 


People being supported by NADARS during 2019 -20 can be evidenced further by; 



76% Reduction in alcohol intake 

66% Reduction in non - prescribed drug use 



51% Improvement in physical health 
50% Improvement in physiological health 
50% Improvement in social functioning 


6 


51 















Outcome 2 

People, including those with disabilities or long-term conditions, or who are 
frail, are able to live, as far as reasonably practicable, independently and at 
home or in a homely setting in their community 


Our Highlights 


58% increase in service users receiving Care at Home Support 
4% increase in service users receiving Community Alarm 
Emergency Admissions 2% above 2015-16 baseline 


2.1 The number of Service users being provided with Care at Home support increased to 3,527 
in 2019-20 from 2,230 in 2018 -19, a 58% increase. The number of people receiving a 
Community Alert increased from 4,912 in 2018-19 to 5,103, a 4.5% increase in support. 


2.2 


Through independent inspection, Excellent’ grades were awarded to Three 
Towns, North Coast and Arran Care at Home Service and Irvine, Garnock 
Valley & Community Alarm for leadership. The Inspection report stated 
that; 






“People receiving the service should be sure that the service is well managed. We 
found the service had an excellent management team who were skilled and highly 
motivated in their role. Managers showed and promoted leadership values at all 
levels of the service” 


The inspection sought comments and views about the quality of service through the 
distribution of questionnaires, as well as, telephone calls and emails to service users, relatives 
and carers. Additionally, service users were visited in their own homes and inspectors spoke 
to a small group of people who received support from the service. Some of the comments from 
across the inspections are captured below: 


7 


52 






“I am very grateful for the service North Ayrshire Council Care at Home team 
provide, it allows me to stay at home and they help me to be as independent as 
possible” 



2.3 A report was presented to the Integration Joint Board on the supports that the Partnership will 
provide Community Alert and Telecare users during telecommunication providers switch to 
Digital from Analogue telephony systems, Community Alarm/ Telecare Service Transition from 
Analogue to Digital . 

2.4 At 31 March 2020 we have seen an improvement in Emergency Admissions compared with 
2018-19 and nearing the initial the Ministerial Strategic Group baseline year of 2015-16 with 
only 2% variance. 


Emergency Admissions 


21,500 


21,000 


20,919 


20,658 


20,500 


19,984 


19,945 


20,000 


1 


19,475 


19,500 


19,000 


18,500 


Total Apr 15 - Mar 16 Total Apr 16 - Mar 17 Total Apr 17 - Mar 18 Total Apr 18 - Mar 19 Total Apr 19 - Mar 20 


8 


53 


















Outcome 3: 

People who use health and social care services have positive experiences of 
those services, and have their dignity respected 


Our Highlights 


The Dirrans Centre carried out a total of 40 ‘What Matters to You’ conversations 
The Health and Social Care Partnership received a total of 54 compliments 
Creation of “Opening the Shutters!” 


3.1 The Dirrans Centre carried out a total of 40 What Matters to You’conversations in June 
2019. The ‘What matters to you?’ conversation aims to encourage and support more 
conversations between people who provide health and social care and the individuals, families 
and carers who receive that care. This aims to shift the focus from ‘what is wrong with you’ to 
what matters to you’ 

The key findings from the conversations were as follows; 

• Attending the Dirrans Centre 

• Having regular support and meaningful activities 

• Family 

• Having appropriate support as they grow older 

• Mobility 

• Getting out into the Community/accessibility 

• Financial support 

This positive re-framing of conversations using a person-centred approach resulted in the 
ability to address personal issues and difficulties raised during the conversations. From these 
conversations it was agreed that the following would be actioned; 

• Individuals with accessibility issues would be supported to obtain a MyBus pass which 
was successfully advocated to cover the Garnock Valley area. Staff also support 
individuals by travelling with them on public transport to build confidence and promote 
independence. 

• Events would take into consideration the wider family unit, with the aim of building 
positive relationships to enable open and honest conversations. 

• Individuals are referred to the Money Matters team and supported with their financial 
worries to enable them to continue attending and benefiting from the service. This will 
help attendees cut costs and budget where necessary. 


9 


54 





3.2 


During 2019-20, 69 compliments (54 Social Care; 15 NHS) were recorded by 
the Health and Social Care Partnership relating to the service provided and the 
professionalism demonstrated by partnership staff. A sample of the 
compliments received include: 



Compliments 

Compliment to staff at the Eating Disorder Clinic in Irvine. Their support and 
guidance helped service users get well. Family wrote email to comment on the 
determination of staff 

Thankyou letter, thanking staff for treating with consideration and kindness during 
recent stay in Ward 1 Rehab at Woodland View 

Compliment received in relation to adaptations in place enabling SU to safely and 
confidently use stairs. Grateful for HSCP allowing work to go ahead. 

The gentleman has been attending the Douglas Grant Rehabilitation Centre for the 
last 6 weeks and wished to let us know that he feels the Centre has a wonderful 
team of staff. 

Compliment to care at home staff with gratitude on behalf of family for support they 
provided to the service user. Their professionalism and dedication made it possible 
for him to remain at home until he passed away. 

“Service Access Irvine member of staff received thank you for all aids provided and 
for service they provided” 


3.3 


In total 246 complaints were received, 125 Social Care; 121 NHS. Of the Social 
Care complaints 20.8% (26) were upheld across all service areas. 


Complaints Upheld by Social Care Service 



Health and Comm Care 
Children Families and Crim Justice 
Support Services 
Mental Health 



10 


55 









Of the 26 upheld complaints, 7 (27.9%), were categorised as relating to a vulnerable person. 
In terms of categories the table shows the recorded category and whether it related to a 
vulnerable person. 


Complaint Category 

Upheld 

Vulnerable Person 

Communication 

5 

1 

Missed/late appointment 

1 

0 

Sensitive issue 

1 

1 

Service provision/delivery 

9 

2 

Staff behaviour (incl. alleged or perceived) 

6 

1 

Waiting times 

3 

1 

Other 

1 

1 


Of the 121 recorded North Ayrshire NHS complaints, 40 were Stage 1 and 81 were stage 2 
complaints. 


NHS Stage 1 and 2 Complaints by Service 

Rehab/C on firming Care 
Criminal Justice Services 
Childrens Services 
Arran Services 
Psychology & Psychological Services 
North Adult Primary Care Mental Health 
Inpatients - Elderly Mental Health 
Locality Services 
Universal Early Years 
Acute/IPCU 

Child & Adolescent Mental Health (CAMHS) 


Complaint Category 

Stage 1 

Stage 2 

Attitude and behaviour 

8 

13 

Clinical treatment 

18 

43 

Communication (oral) 

1 

7 

Communication (written) 

3 

1 

Competence 

0 

1 

Date for appointment 

7 

10 

Patient property / expenses 

1 

0 

Personal records 

2 

2 

Premises 

0 

1 

No Category 

0 

3 



11 


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3.4 Our Community Link Worker Service was involved in the creation of a mental health and 

wellbeing group called Opening the Shutters. This group meets weekly and has an active 
presence on social media. The age range is 18 to 80 giving people a safe and secure space to 
feel part of something and not feel alone in the world of mental health. The group is supportive 
of each other and pick topics each week to discuss. 



“I hit rock bottom and didn’t know how I was going to come through that journey, 
thanks for caring reaching out and listening I can now see light at the end of the 
tunnel and getting stronger every day!” 

“I personally think this an amazing group, we trust and support each other through 
out struggles” 

“This group is organised and maintained from the heart, where we find the energy 
to keep going” 


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Outcome 4 

Health and social care services are centred on helping to maintain or 
improve the quality of life of people who use those services 


Our Highlights 


Successful Pilot of OT being placed in General Practices 
97% increase in Naloxone kits distributed in Ayrshire and Arran 
100 key partners attend addictions summit 


4.1 An Occupational Therapist (OT) has been funded temporarily in the Largs Medical 
Group practice one day per week and early indications show positive outcomes. The OT 
provides follow up appointments helping people get people back into work and preventing long 
term mental health problems. 

Feedback from GP’s and patients offered the following when asked what has been beneficial 
about having an OT based within the practice; 



“Practical skills to patients so they can move forward in their lives, good to inten/ene 
early before symptoms entrenched” 

“Enable trust to be built up in the MDT. She has helped us to understand which 
patients may benefit from her input” 

“As she is based here, we can speak to her directly, and tell our patients that she will 
see them here rather than them having to go elsewhere” 

Patients 

“7 got support returning to work following a period of depression and anxiety. I was 
supported to evaluate myself and put strategies in place. ” 

“I made good progress with managing my anxiety. Also made beneficial changes to 
my lifestyle. ” 

“My sleep has improved, and I now have a clear mind and improved lifestyle.” 


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4.2 


Beating the Blues and Silver Cloud are interactive online treatment programmes that 
use cognitive behavioural therapy (CBT) to help people experiencing mild depression and/or 
anxiety. The programme involves completing exercises and learning CBT techniques that can 
help with depression and anxiety. To embed the learning and techniques each week tasks are 
to be completed between sessions. 

The graph below is for the new system and represents the number of patients referred to the 
service from across Ayrshire. 

Referrals to cCBT (2019-2020) 

250 

200 

150 


100 

50 


0 

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 

East North South Total 



4.3 North Ayrshire held a Drugs Summit in January 2020 at Saltcoats Town Hall to explore what is 
currently being carried out locally and nationally relating to the prevention of drug 
related deaths. Over 100 key partners, stakeholders and members of the 
community were in attendance. Following the summit Engagement Officers from 
1 Connected Communities engaged in Naloxone training to cascade within North 
Ayrshire localities. 



4.4 


1,268 Naloxone kits were distributed within Ayrshire 2019-20 in Community 
Settings. The number of kits distributed has almost doubled compared with 
2018/19 with 642 kits. 


1,268 


Training in Naloxone also continues: 


642 



99 NHS staff completed the Naloxone LearnPro module 

622 Overdose Awareness sessions provided 
59 People completed Naloxone Training for Trainers 


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This training can be put into practice at any moment as was the case for one worker: 


Case Study 



A Justice Services Worker recognised individuals she had previously worked with 
in a shopping centre in Irvine. Noticing something was wrong, she approached the 
group and identified a person unconscious and displaying other signs of overdose. 
She administered her naloxone kit and phoned an ambulance. The person came 
around and was later taken to hospital. 



4.5 The North Ayrshire Alcohol and Drug Partnership released their new strategy in 2019. The 
strategy is underpinned with the following vision: 

“People in North Ayrshire have the right to be treated with dignity, 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” 

In order to deliver this vision, the Partnership will focus on five strategic priorities: 

• 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 orientated approach which reduces harm and prevents deaths. 

These 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. 


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Feedback was gathered by the Engagement Steering Group and was focussed around four 
key questions 

1. What more do you think can be done to prevent alcohol or drugs related problems? 

2. What more can communities do to help overcome alcohol or drug problems? 

3. What do you think has worked well in terms of dealing with alcohol or drugs misuse? 

4. What do you think has not worked so well? 

329 individual responses were received via our online questionnaire, “doorstep interviews” and 
individual questionnaires. We also had summary responses from eight focus groups - three 
young person groups and five adult groups. Of the total number of responses (384), 82 
reported being young people (The rest being unknown or adult). 



“I have personally found groups, drug education and peer mentoring a massive help” 

“Presence and visibility of police” 

“Nothing or very little” 

“People on methadone - being on a substitute for over 20 years is not therapeutic” 
“Discharging service users for DNA without finding out why” 


4.6 Action on Hearing Loss Scotland’s Community Hearing Support Service is a pan- 

Ayrshire funded service providing hearing aid maintenance and support. During 2019-20 the 
service supported 129 Community Hearing drop-ins. The Help to Hear service support 
people to make the most of their hearing aid and manage their hearing loss effectively. During 
the year 158 people completed the annual survey with the following highlight results: 

• 74% of participants rated the quality of our hearing aid maintenance and repairs as 
‘excellent’, with a further 24% rating it as ‘good’ 

• 82% of people rated the friendliness of staff and volunteers as ‘excellent’, and the 
remaining 18% rating it as ‘good’ 

• 77% of people rated the service overall as ‘excellent’, with a further 21 % rating it as 
‘good’ 

• 57% of participants told us that the support we provided had made a ‘big improvement’ 
to their daily life 

• 78% told us they felt better because they could talk to someone who really understood 
their hearing loss 

• 77% told us that socialising with family and friends is easier 

• 77% said they felt more independent because they could hear better 


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Outcome 5 

Health and social care services contribute to reducing health inequalities 


Our Highlights 


23.84% of Learning Disability Service Users accessed employment opportunities 
The final Syrians from our resettlement programme were in homes by March 2020 
The money matters financial gains for 2019/20 was over £15.3m 


5.1 During January, together with the opening of Trindlemoss Day Opportunities Centre, Job 
Coaches have focused on exploring their role within learning disability day services, with a 
view to ensuring that their activity reflects and benefits the community change agenda. 
Collaboration with a broad range of community partners was key to developing current and 
creating new collaborations. This resulted in 23.84% of learning disability service users 
accessing employment opportunities during 2019/20. 

5.2 The final Syrians from our resettlement programme were in homes by March 2020 - meaning 
the Council has supported over 200 people since the first families arrived five years ago. Now 
as part of a new UK-wide programme for Syrian Resettlement, the Council will provide a 
haven for a further 30 refugees (six families) by March 2021. 

5.3 Our Money Matters Team once again supported the most vulnerable people in our 
communities accessing entitle benefits to the incredible sum of £15.3m, an increase of £5.8m 
from 2018-19. This is a great achievement against a backdrop of austerity/welfare reform cuts 
and is testimony to everyone’s work in the Money Matters Team. 


Money Matters - Annual Comparison 



Casework 
Advice Line 
Charging 
Appeals 
Macmillan 
Kinship 


£5,370,135.49 

£4,395,527.03 


£2,025,279.21 


£1,867,490.63 


1,243,889.16 
403,602.91 


5.4 We finalised our Independent Advocacy Strategic Plan: ‘Empowering Inclusion’. We are 
committed to ensuring people have their voice heard, can express their needs, make informed 
decisions and have their rights and interests protected. 


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The Partnership recognises the importance of advocacy in: 

• Empowering people to express their own needs and make their own decisions 

• Enabling people to access information, explore options and make informed decisions 

• Providing a voice for people who are unable to do so 

• Ensuring a safeguard for vulnerable people 

This has resulted in advocacy being available to adults with learning disabilities, adults 
affected by mental ill health, adults with addiction issues, adults with physical disabilities, 
adults with brain injury, children and young people, and older adults. 


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Outcome 6 

People who provide unpaid care are supported to look after their own 
health and wellbeing. I ncluding to reduce any negative impact of their 
caring role on their own health and wellbeing 


Our Highlights 


2 unpaid adult carers supported to successfully complete their Level 2 SVQ 
Carers Development Officer is now in post 
27% increase in uptake of Carers registration cards 


6.1 Carers are equal partners in care and experienced in the care they provide to their family, 
friends or neighbours. The NAHSCP Carers Team and Learning & Development 
Team supported two North Ayrshire unpaid adult 
carers to successfully complete their Level 2 SVQ in 
Social Services and Healthcare based on their caring 
role. 


6.2 We expanded training options available to unpaid carers across 
North Ayrshire by working in partnership with the Learning and 
Development Team, Housing Team and Unity North Ayrshire Carers 
Centre to offer access to online and face to face training. 

6.3 We also involved carers in dementia training being delivered across 
North Ayrshire. Pictured is Sally Powell (carer) supporting Craig 
Hatton - Chief Executive North Ayrshire Council who is experiencing 
the ageing suit 



“It’s been a great experience and it’s 
helped me to overcome some of the 
barriers that I had about myself. It’s also 
encouraged me to apply for more training, 
and now I’m doing another course through 
my son’s school. I’m really glad that I did 



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6.4 The Team have been pivotal in the pan Ayrshire pilot to improve carer involvement in hospital 
discharge and ensure unpaid carers are equal partners in the care of their family/friends. They 
are building on previous acute services centred work led by Angela Rowe - NHS A&A and 
have commenced the same with our Community Hospital sites at Woodland View. 

The work has been initiated with four wards within Woodland View to provide staff with 
resources, training and a carer referral pathway to assist in the identification and support 
around hospital discharge and including unpaid carers. 

This work will be further supported 
by the expanded team after 
recruiting a new Carers 
Development Officer whose focus is 
to update and implement the current 
NAHSCP Carers Strategy. 

6.5 We have seen a further uptake in 
the use of the Carers Appreciation 
Card with 681 carers now registered 
for their card, an increase of 27% 
from the previous year. 



6.6 


In collaboration with Carers UK/Scotland, a Digital 
resource for Carers has been launched to provide 
comprehensive information and support for carers. 


* 


carersuK 

making life better for carers 


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Outcome 7 

People who use health and social care services are safe from harm 


Our Highlights 


5,103 people received a Community Alarm 
3,129 people received Enhanced Telecare 
Care at Home and Community Care Inspections resulted in ‘Excellent’ gradings 
22% increase in Child Protection Registrations 


7.1 


In 2019-20 we continued to expand the use of Community Alarms and 
Enhanced Telecare with 5,103 people receiving a community alarm and 
3,129 in people receiving enhanced telecare. 



Number of People with Community Alarm and Telecare 



■ Community Alarm ■ Telecare 


7.2 Our Care Inspectorate annual inspection of Care at Home and Community Alert services 
concluded earlier this year - with verbal feedback being received. The service retained it’s 
‘Very good’ grade for Care and Support and was given an ‘Excellent’ grading for 
Management and Leadership. 


This grading means that the service is considered by external regulators as ‘outstanding’ and 
‘sector leading’. Whilst there are a handful of public sector services grades at this level across 
Scotland, all the others are very small - supporting between 10-25 people. 


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This is the first time that any service of the size of our own, has been awarded such a grade. 
To put this in context, our Care at Home Service supports approximately 2,000 people across 
North Ayrshire with our Community Alert Service supporting over 5,000 people. 

The reports can be found on the Care Inspectorate site: 

Inspection Report - Irvine, Garnock Valiev and Community Alarm - Housing Support Service 

Inspection Report Three Towns, North Coast and Arran - Housing Support Service 


7.3 We ended the year 2019-20 with an increase of children registered on the Child Protection 
Register; 137 children from 73 families registered, an increase of 17% on the previous year. 


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Outcome 8 

People who work in health and social care services feel engaged with the 
work they do and are supported to continuously improve the information, 
support, care and treatment they provide 


Our Highlights 


Over 2,000 members of staff experienced our Thinking Different Doing Better 
New HSCP Facebook page launched 


8.1 


Over 2,000 members of staff have now experienced our 
Thinking Different Doing Better sessions. 
Thinking Different Doing Better is a unique, interactive 
experience, which has been designed in partnership 
with local community groups, businesses, volunteers, 
our third and independent sector partners and staff 
working across the Health and Social Care Partnership. 



Staff attended a 3-hour experience, which consists of 90 minutes of experiential learning, 
followed by a 90-minute intimate discussion with the HSCP Director, Stephen Brown. The 
experience was developed to enable 3 objectives to be met: 



- To facilitate a greater learning by all staff on the North Ayrshire 
Health and Social Care Partnership, our priorities, values and 
partners 

- To provide an opportunity for participants meet colleagues from 
other services and give their views on things such as financial spend 
and how we, as a Partnership, can do better. 

- To inspire staff to think differently and focus on our assets, both in 
the community and within people, which should ultimately lead to 
improved outcomes across each of our five priorities. 


The initiative was also extended to the public 
for the same purpose of providing an immersive 
visual experience on all the partnership’s 
assets and constraints. 



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8.2 The new partnership Facebook page was launched in February 2020 - 
www.facebook.com/NorthAyrshireHSCP . This will enable the partnership to reach the wider 
communities, sharing more news and events. 

8.3 The partnership measures and develops internal engagement through the use if iMatter and 
the NAC Our Voice staff surveys. These helped to determine areas for support, improvement 
and innovation across teams and services through learning experience. 

In 2019-20 partnership staff scored high engagement rates within both surveys with 79% in 
iMatter and 72.5% in Our Voice. In total 1,474 partnership staff across 204 teams responded 
to the iMatter questionnaire and 548 NAHSCP Council employed staff responding to the NAC 
Our Voice survey. 

8.4 Each year we celebrate the contribution individuals and teams make to the health 
and wellbeing of the people of North Ayrshire in our Breakfast for Champions event. In 
previous years our Partnership Staff Awards have successfully recognised employees and 
volunteers from North Ayrshire Council, NHS Ayrshire and Arran, the Third Sector and the 
Independent Sector. 


This time the Partnership Staff Awards 
became the Partnership Awards. 

We developed our awards to better 
appreciate the role of the community 
as partners in health and social care - 
reflecting our “delivering care together” 
approach. We did this by two main 
changes. For the first time we invited 
members of the public to nominate 
individuals and teams. Second, we 
ensured that nominations included 
community champions, unpaid carers 
and other members of the public. 

The twelve categories (Individual and Team) look for evidence for the demonstration of our 
seven values. We had 16 team finalists and 23 individual finalists. 

The finalists included Bourtreehill Drop in centre (Age Concern), The Scottish Centre for 
Personal Safety, Ailn Volunteer Board, Ward 2 Woodland View, Break the Silence, Justice 
Services, Care at home, A New Hope, Lend an Ear volunteer team, North Ayrshire Carers 
Centre staff team, Psychology Management administrators, Child Protection post admissions 
administration team plus individuals from the community including unpaid carers and staff from 
the Partnership. 



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Outcome 9: 

Resources are used effectively and efficiently in the provision of health and 
social services 


Our Highlights 


99.14% of ICT service users were seen within 1 day of referral. 

6,431.27 Care at Home hours lost 
10,537 days of ICT service as an alternative to hospitalisation 


9.1 


Our Intermediate Care Team (ICT) 

supports people to regain their independence 
by supporting them when they are either 
discharged from hospital, or in their own 
homes, to prevent admission to hospital. This 
early intervention and prevention approach 
provided 10,537 days of ICT service (during 
2019-20) as an alternative to hospitalisation, a 
continued improvement from 2018-19. A 
specific highlight is in the performance of initial 
service user contact with 99% service users 
being seen within 1 day of referral. 


ICT Bed Days Avoided 



9.2 Compared to 2018-19 we have seen a decrease in care at home hours lost due to the 

cancellation of hospital discharges with 6,431 hours lost compared to 6,907 from the previous 
year. This is as a result of our dedicated team within Crosshouse hospital continuing to work 
with our hospital colleagues to reduce the number of discharge cancellations. 


6,907 



Hours lost due to hospital 
discharges being cancelled 


9.3 We launched the Scottish Government’s whole system approach to the diet and healthy 
weight Public Health priority in October with our other partners such as NHS and Leeds 
Beckett University. We are one of three early adopter sites for this priority and have agreed 
one of four in-depth partnerships with Sports Scotland to progress a shared approach. The 
focus of the programme is to improve the food and physical activity environment experienced 
by children and their families. 


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9.4 The HSCP has co-produced a mental health and wellbeing information ‘pocket 
guide’ with Largs Academy Mental Health Youth Ambassadors and The North 
Coast Locality Forum. This approach was shared with Education Services who are 
developing this approach across all the North Ayrshire localities. The aim of this 
pocket guide raises awareness to the services/people in the North Coast to assist 
young people achieve positive mental wellbeing. The intention is to produce the 
‘Pocket Guide’ for every academy pupil and every cluster school Primary 7 pupil as part of 
their transition. 

9.5 The HSCP Alcohol and Drug Partnership sponsors the Third Sector Interface on Arran, which 
is the lead agency in hosting a drug and alcohol research post. This post is exploring the 
specific impacts of drugs and alcohol on island communities and developing a partnership 
action plan. 



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2 

National Health and Wellbeing I ndicators 


The Scottish Government identified 23 indicators (4 remain in development) that were felt evidenced the 9 National Health and 
Wellbeing Outcomes. Nine indicators come from the biennial Health and Care Experience Survey (see below) and the additional 14 
indicators (also below), which evidence the operation of NAHSCP, come from the NHS Information Services Division (ISD) survey. 
This survey represents a sample of the community and asks about the collective services received whether it be from Social 
Services, NHS, the collective HSCP or private or voluntary organisations. The survey responses do not separate each organisation’s 
service provision. 

Due to the COVID-19 pandemic, the data completeness and validation for these indicators has been delayed as Public Health 
Scotland personnel have been re-tasked to other prioritised works. The information below represents the most up-to-date calendar 
year information with the financial year updates available in due course accessible from Public Health Scotland . The rates presented 
below relate to the year for which data is most recently available for each indicator and as such the ranking value should also be 
regarded as an indicator and not the final rank. 


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72 





Health and Social Care Experience Indicators 

2015-16 

2017-18 

2019-20 

Not 

available 

Scottish Av % Diff 

Rank against Family 

Group 

(2017-18) 

Adults able to look after their health very well or quite well 

93% 

91% 

- 

93% 

4 

Adults supported at home who agreed that they are 
supported to live as independently as possible 

82% 

84% 

- 

81% 

1 

Adults supported at home who agreed that they had a say in 
how their help, care, or support was provided 

77% 

70% 

- 

76% 

7 

Adults supported at home who agreed that their health and 
social care services seemed to be well co-ordinated 

78% 

74% 

- 

74% 

6 

Adults receiving any care or support who rated it as excellent 
or good 

79% 

78% 

- 

80% 

7 

People with positive experience of the care provided by their 

GP practice 

84% 

80% 

- 

83% 

6 

Adults supported at home who agree that their services and 
support had an impact on improving or maintaining their 
quality of life 

82% 

82% 

- 

80% 

2 

Carers who feel supported to continue in their caring role 

43% 

39% 

- 

37% 

4 

Adults supported at home who agreed they felt safe 

79% 

80% 

- 

83% 

6 


To support service improvement, the Scottish Government has identified local authority / Partnership benchmarking families. These 
family groups are made up of eight local authorities that share similar social, demographic and economic characteristics. Comparing 
our performance information with our family group should provide a more meaningful comparison with similar areas and allow for 
greater opportunities for shared learning and best practice. Rankings are on a scale of 1-8, where 1= best performing, 8=worst 
performing. 

North Ayrshire is partnered in its family group with: East Ayrshire, Dundee, Western Isles, Glasgow, Inverclyde, North Lanarkshire 
and West Dunbartonshire. 

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Indicators based on Administrative data 

2016-17 

2017-18 

2018-19 

Value 

(calendar 

year) 

Scottish Av/ 

% Diff 

Rank against 
Family Group 

Premature mortality rate. (Under 75s age-standardised 
death rates for all causes per 100,000 population). 

490 


456 

(2019) 

432 

2 

Rate of Emergency Hospital Admissions for adults (per 
100,000 population) 

16,249 

16,481 

16,513 

16,894 

(2019) 

12,602 

8 

Rate of emergency bed days for adults.* 

1 39,750 

149,902 

142,441 

149,356 

(2019) 

117,478 

7 

Readmissions to hospital within 28 days of discharge. 

105 

106 

107 

112 

(2019) 

104 

6 

Proportion of last 6 months of life spent at home or in 
community setting. 

87% 

87% 

88% 

88% 

(2019) 

89% 

8 

Falls rate per 1,000 population aged 65+ 

20 

24 

22 

22 

(2019) 

23 

3 

Proportion of care services graded 'good' (4) or better in 

Care Inspectorate Inspections. 

81% 

87% 

88% 

88% 

(2019-20) 

82% 

3 

Percentage of adults with intensive needs receiving care at 
home, (all levels of CAH) 

49% 

49% 

63% 

(2018) 

63% 

(2018) 

62 

3 

Number of days people aged 75+ spend in hospital when 
they are ready to be discharged per 1000 population) 

624 

1,033 

1,126 

1,366 

(2018-19) 

793 

7 

Percentage of total health and care spend on hospital stays 
where the patient was admitted in an emergency. 

26% 

29% 

28% 

28% 

(2018-19) 

24% 

8 


As well as the National Health and Wellbeing indicators, we regularly report on local measures to help us to evidence performance 
against the nine National Health and Wellbeing Outcomes and our Strategic Priorities. The list of local indicators can be found in 
Appendix 1 (see page 69). 

From January 2017, The Ministerial Strategic Group for Health and Community Care (MSG) advised that in order to measure the 
impact of integration they would be monitoring a suite of indicators. These are indicators which the government view as being 


29 


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appropriate to measure progress with integration and for which data is available to enable a comparison across partnership areas 
and to report on progress at a national level. The full list of indicators can be found in Appendix 2 (see page 82). 


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3 

Performance in relation to the three 
Children's Outcomes and three J ustice 
Service Outcome 


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Children’s Outcomes 


Outcome 1: Our children have the best start in life and are ready to succeed 

Outcome 2: Our young people are successful learning, confident individuals, effective 
contributors and responsible citizens 

Outcome 3: We have improved the life chances for children, young people and families at 
risk 


1.1 There has been an increase in the percentage of children either solely breastfed or mixed. 

With 19 . 69 % either breastfed or mixed at the 6-8 weeks review, which is a slight 
improvement from the 2018-19 figure of 19.51 % 

13 . 19 % 

1.2 Our Universal Early Years team which consists of social workers, health visitors, 

speech and language therapists, welfare rights advisors, mental health nurses and 
employability workers. This multi-disciplinary team continued to provide support to 
ensure the improving health of young children was priority. The percentage of 
children with BMI centile greater than 91 (meaning they are overweight or very 9.98% 

overweight) at 27-month review increased from 9.98% to 13.19%. 

1.3 Through various consultations with stakeholders; the Partnership has implemented several 
initiatives throughout the year to support children, young people and their families. These 
include: 

- A fully implemented the National Health Visiting Pathway which promotes the 
importance of prevention and early identification: getting the right support for families at the 
right time. 

- Our integrated Universal Early Years’ Service provides individualised, early intervention 
care and supports to the child and their family. This service includes expertise from health 
visiting, social work, speech and language and perinatal mental health. In addition, we 
have a strong support team who can provide in house, person centred support to families 
on a variety of issues as and when families need it. 

- Almost half of requests from health visitors remain within Universal Early Years, 
demonstrating our focus on early intervention and prevention; 

- The service has access to wide range of additional supports from within the wider NHS, 
local authority (day care and early nursery placement) and third sector (Barnardos) 



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A refresh of our award-winning Young People’s Citizenship and Participation 
Strategy ensuring our young people continue to have a voice in local and national 
decisions that affect them. 




The Partnership Learning and Development 
Team have been working in partnership with 
colleagues in Education to deliver a 
Foundation Apprenticeship course in 
Social Services and Healthcare. This was 
delivered to nine 6th year pupils from across 
North, East and South Ayrshire at Irvine 
Royal Academy. All nine pupils achieved 
the National Progression Award as part of 
the course, with five going on to 
successfully complete a placement in a 
health and social care setting, 
achieving an SVQ and completing the 
full Foundation Apprenticeship. 


Mental Health Youth Ambassadors from Kilwinning Academy have engaged in 
democratic decision- making processes in the co-creation of Kilwinning Library as a 
Wellbeing Hub and learning Centre. Our Youth Ambassadors are contributing to 
our Youth Poverty Commission, the first in Scotland, as part of the Year of Young People 
Poverty and Inequality workstream 

There was a consultation with the Mental Health Youth Ambassadors in an En- 
Lightening Capacity Building Event’ to redress their perceived deficit of bespoke 
Mental Health services for young people on Arran. The Capacity Building session was very 
well received by The Mental Health Youth Ambassadors who engaged enthusiastically 
articulating their needs, issues and aspiration for bespoke Youth Mental Health Services. 

There was an event within the North Coast which aimed to engage the Mental Health 
Youth Ambassadors in a bespoke breakfast blether & capacity building session to a co- 


78 










produce a pocket guide to wellbeing services in the North Coast; designed for and by 
young people. The initiative was a direct result from the discussion dinner/expressed 
needs, issues and aspirations of the young people. 

- Our Family Firm corporate parenting policy, procedures and protocols, which supports 
young care experienced people with training and employability. 

- Our Joint Child Poverty Action Plan was submitted to the Scottish Government in 
June 2019. Initial feedback suggests we are demonstrating more progress than many other 
local authorities to prevent and mitigate the effects of child poverty and reduce future levels 

1.4 Since its inception, the SNAP (STOP NOW AND PLAN) initiative has supported children 
ages 8 -11 engaging in aggressive and anti-social behaviour at school or in the community. 
Experienced and highly trained staff work with each family to assess challenges and problems 
and develop an action plan aimed to reduce the potential of anti-social behaviour and chances 
of conflict with family, peers and authority figures. 

For the period 2019-20, 100% of children who have been involved through SNAP have been 
sustained within their local school. 

1.5 The Rosemount Team deliver family focused, consistent and connected practice that 
supports positive change through meaningful relationships. From April 2019 to March 2020 the 
Rosemount team worked with 324 young people and their parents/carers. Although the 
number of referrals to the service have decreased (the previous financial year the team 
worked with 359 cases) the numbers of young people being maintained at home remains high 
with 94% of young people remaining with their parents/carers on a long-term basis. 

1.6 The re-structured Children and Families Services included School-based Social 
Workers ensuring greater integration between health and social care and we are in the 
process of creating three multi-disciplinary Locality Teams based in local secondary schools. 
The first of these teams, located at Kilwinning Academy, became operational in early 
September 2019 and we have gathered both qualitative and quantitative data around the 
impact this model is having on prevention and early intervention work, the numbers of children 
being accommodated, and the number of children being placed on compulsory and statutory 
measures. Very early analysis of our data indicates that there is positive movement as a result 
of locality working. Accommodation has now been identified for the Three Towns locality team 
and further work is being driven forward in the Garnock Valley. 


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1.7 The North Ayrshire Family Wellbeing Service is 

based in the heart of the community; it is staffed by skilled 
people who know the local area and offers a ‘one-stop 
Shop’ of support. The team work alongside children and 
families, supporting them to thrive, whilst aiming to create 
profound change within the community they live in. 

Support is offered to families to help them understand and 
address the challenges and risks which may have led to 
their vulnerability, promote connection to their local communities, and improve financial stability 
and resilience. 

The primary aims of the support to communities to become more resilient and a place where 
children feel safe, valued, understood and supported with some highlights being: 

• Supported 84 individuals who reached out for Family Support during a time of challenge or 
crisis, providing emotional support to encourage mindfulness, help manage stress and build 
resilience. 

• Supported families to manage debt of £83,241.94 

• Delivered a Programme of Community Engagement events to the community and other 
families connected to the HUB over a 12-month period providing social activities, trips and 
holiday activities to encourage informal engagement and peer support 

• Secured funding from the Scottish Government to organise a Family Fun Day within the 
Community with a focus on Children’s Rights. This was attended by over 200 children 
and families that brought the community together for lots of fun activities, play, and food! 

• Reached out to a further 7 communities across North Ayrshire, where there was a need or 
vulnerability - Castlepark, Saltcoats, West Kilbride, Dairy, Beith and Kilwinning 

• Offered trauma informed Kinship Care Support to help families navigate both the emotional 
and legal complexities of living in kinship care arrangements. 

1.8 Reducing the number of children and young people becoming 
accommodated continues to be a priority. At the start of 2019-20 there were 33 children 
and young people looked after in external residential placements, and at the end of the year 
that number was down to 26. This continues to be a focus for session 2020-21. 

1.9 The Throughcare and Aftercare teams support young people moving on from being 
accommodated away from home to the next stage of their lives. They are there to listen and 
respond to young people’s emerging needs in any way they can. 


0 0 
Children tst 

SCOTLAND'S NATIONAL CHILDREN’S CHARITY 



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Support is offered in a variety of ways, for example, the team has a 
dedicated Employability Advisor who supports young people to 
explore pathways into employment, training or education. Advice 
offered is adaptable to suit individual needs as their employment, 
education or training journey progresses. In addition, staff can assist 
young people in finding their own accommodation and provide 
bespoke emotional and practical support through what can be, for 
some, challenging and uncertain times, as well as exciting. At the end 
of July 2019, 66% of young people receiving aftercare services, 
where the economic activity was known, were in employment, 
education or training. This compares favourably with the nationwide 
figure which was 44%. 

The teams are dynamic, creative and flexible to meet the emerging and individual needs of 
care experienced young people offering advice and guidance to those who need support in 
applying for benefits, as well as those who are applying for educational bursaries, care 
leaver’s bursaries and financial support. Assistance can also be provided on legal matters, 
emotional health and wellbeing and life skills. 

1.10 The Advocacy support that is provided in North Ayrshire is by Barnardo 
Hear 4u Advocacy Service. The service provides advocacy for 
children and young people aged 5-26 who are looked after and 
accommodated in residential, foster care, kinship and at home, on 
the child protection register and those with Additional Support Needs. 

Barnardo’s run specialist advocacy services across the UK and are 
there for young people who need someone to support them, protect 
their rights and help them speak out. Their advocates are 
independent, and they don’t work for local councils, social services or 
the NHS. They strive to explain the wishes of the young person, 
represent their case and do not give their personal opinions. 

Barnardo’s advocates role includes: 

o Attending meetings with or on behalf of children/young people where decisions are 
made - for example, children’s hearings, looked after reviews, child protection 
processes. 

o Writing letters on behalf of young persons and assisting them with complaints or 
appeals. 

o Helping children and young people to access information so that they can make 
informed decisions. 

o Helping children and young people understand decision making processes and what 
their rights are within these. 

o Giving children and young people a voice to help them achieve their full potential. 

o Empowering children and young people to develop their confidence/skills in self- 
advocacy 

o Listening to young people is at centre to all the work they carry out as advocates. 



66% of CYP 
receiving aftercare 
services were in 
employment, 
education or 
training 


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Around the end of the year there were 96 children receiving advocacy support, 62 of whom 
were care experienced young people (CEYP). 

1.11 Nurture-based training approaches continue to be cascaded across the Children and 
Families residential services. In order to introduce and develop these approaches, there has 
been extensive work in: awareness raising sessions for all staff; the concept of nurture being 
utilised within supervision, team meetings and development sessions. Nurture Champions 
have been identified across the service and managers have been completing a four-day 
training course. Nurture training continues to be rolled out across other services including 
Early Years, Education & Housing. 

We have a child protection training calendar for professionals to ensure that children are 
protected from violence and can recover from traumatic experiences. This includes training on 
children’s rights, domestic abuse and, trauma informed practice. 

Our Child Protection Committee is supporting the Everyone Has a Story training it has 
been agreed that this training will be delivered towards the end of 2020 early 2021. There will 
be scope for 15 staff to attend this training and the course will support practitioners in adult 
and children’s services to respond to children affected by parental substance use. 

To enhance the skills of our workforce and improve outcomes for young people and families 
the North Ayrshire Alcohol and Drug Partnership (ADP) has invested in the C.H.AT, training 
(Children Harmed by Alcohol Tool). During 2019 there were 44 staff from across 
children and family’s services trained to deliver this intervention. C.H.A.T. can be used with 
children, young people and families harmed by problematic alcohol use. The aim of the 
resource is to build resilience and protective factors in children and families. 

The C.H.A.T. training has recently been evaluated by Alcohol Focus Scotland and key findings 
have highlighted that following training 100% of participants were more aware of the impact of 
harmful parental drinking on children and families and felt more confident in raising the issue 
of alcohol with families. A further evaluation will take place in 2020 to explore the impact of 
C.H.A.T. in our work with young people and families. 

1.12 Our Fostering and Adoption Team continues to run successful campaigns to increase 
the number of foster carers and families who would like to foster and adopt children. The 
number of foster carers in the local authority remains steady (98 as at the end of 2019-20) but 
since the launch of a communications campaign in January 2020 we have had 33 enquiries 
and recruited 6 new carers. 

Our Fostering and Adoption Team launched their communications campaign which aims to 
encourage local people to consider becoming a foster carer or adoptive parent to a child in 
North Ayrshire. As part of the campaign one of our looked after children designed a new 
colourful logo for the Family Placement Team. The logo will appear on outdoor adverts, as well 
as being rolled out across our social media channels, with the hashtag 
#youjusthaventmetmeyet. 


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1.13 At the start of 2019-20 there were 328 children and young people in a Kinship placement 
to 248 Kinship Carers. Over the course of the year we received 60 referrals, approved 23 new 
kinship carers, and had 18 new Kinship Orders granted. By the end of the year, there were 
343 children and young people in a Kinship Care placement to 262 Carers. 

1.14 We know that North Ayrshire proportionally has higher levels of Child Protection activity 
than across the country as a whole (the rate per 1,000 of children aged 0-15 on the Child 
Protection register in North Ayrshire at the end of July 2019 was 4.6, which was higher than 
the national figure of 2.8). Despite this, there has been a marked improvement around Child 
Protection timescales in 2019-20 compared to previous years. 

1.15 The North Ayrshire Child Protection Committee (NACPC), on updating their 

website - http://childprotectionnorthayrshire.info/cpc/# - launched a social media campaign 
around child protection and distributed child protection materials, in partnership with the 
community hubs distributing food during the pandemic, to families who received food 
deliveries. The CPC also offers multi-agency practice development opportunities for workers in 
relation to child protection. This training is designed and delivered in relation to the general 
contact workforce, the specific contact workforce and the intensive contact workforce. A total 
of 1362 people attended multi-agency training, bespoke inputs and workshops in 2019. 

1.16 The Significant Case Review working group, renamed Making Change Happen, has now 
met on three occasions. The three areas for improvement we shall be taking forward will focus 
on: Increasing professional curiosity/responsibility; enhancing opportunities for reflection 
(including self/peer supervision); and improving understanding of the child’s 
experience/perspective, ensuring adult voices are not over-privileged. 

1.17 The Young People’s (YP) Suicide Taskforce (formerly the Young People’s 
Operational Suicide Prevention Group) has continued to meet regularly, with governance from 
the Young People’s Strategic Suicide Prevention Group (YPSSPG). A key piece of work taken 
forward by the YP Suicide Taskforce has been the 13 Ways campaign. A series of 13 
animations with key messages focusing on young people supporting each other, were 
developed and released via social media. The animations illustrated one of each of 13 
messages, with a narration by a young person and an animation to illustrate the message. 
Young people were central to developing the language, visuals and stories, and were 
supported to contribute meaningfully specifically (but not exclusively) through the Year of the 
Young People (YOYP) Ambassadors. The campaign has been very well received and has 
been given a positive response perhaps because of the ownership by all groups and the 
young people of the messages and the rationale. Young people have been the best 
ambassadors - the YOYP ambassadors winning the category prize for Mental Health and 
Wellbeing in the Youth Link awards for this work. The campaign has continued to be further 
developed in 2019 and 2020, with celebrity endorsement to widen the reach of the messages. 

1.18 The Champions Board is a group of care experienced young people aged 15-23yrs who 
work together with Corporate Parents to create change within the care system, as well as 


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working to develop a Mental Health toolkit and advice specifically for 
care experienced Children and Young People. Over the past year the 
champions Board have continued to challenge the language and stigma 
that exists within the care system. 

The Champions Board have created the new Children, Families & 
Justice Services logo. 



1.19 The recently refurbished Meadowcroft building which 

opened in mid-January, is a bespoke facility which is home to 
several specialist teams who provide a range of intensive and 
creative interventions to support our children, young people and 
families. The teams based at Meadowcroft include; Rosemount 
Crisis Intervention Team, Programmes Approach Team, 
Corporate Parenting Team, Throughcare Team and Residential 
Social Workers. 



The teams relocated to the Meadowcroft building just before the 
COVID-19 pandemic and have continued to provide a robust 
service to our vulnerable young people and families. The facility 
provides first rate space for staff as well as comfortable meeting 
rooms for young people, kitchen facilities to help work on 
independent-living skills, and an art room. 



1.20 



Work is well underway in the construction of 
the brand new, state of the art Additional 
Support Needs (ASN) School and 
Respite and Residential Accommodation in 
Stevenston. This development presents a 
unique, exciting and innovative opportunity 
for the Partnership and Education Services 
to better meet the needs of children and 
young people with additional support needs 
in North Ayrshire. The facility will enable 


professionals to work together, in an integrated way, to benefit some of our most 
disadvantaged children and young people. This opportunity affords our children and young 
people with complex needs the opportunity to access the very best in technology, facilities and 
resources, in their local area. 


1.21 Through 2019-20 we have increased communication through use of social media. We have 
a new and updated Child Protection Website, Facebook page and Twitter account, as well as 
a monthly Children, Families and Justice Services newsletter and a Handbook. We will 
continue to explore and utilise different ways of communicating with all our families and 
partners. 


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1.22 Our new Head of Service appointed in September, has implemented monthly ‘drop-in’ 

sessions for staff and for young people to increase communication, chat over good practice 
and take forward any items which need to be addressed. In addition, ‘Collegialitea’ sessions 
were established so that staff could come together, from a range of services, to meet each 
other discuss key areas for improvement. These sessions have been well received. 


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Justice Service Outcomes 


Outcome 1: Community safety and public protection 
Outcome 2: The reduction of re-offending 

Outcome 3: Social inclusion to support desistance from offending 


1.1 The targets set for unpaid work are pan-Ayrshire targets. The latest Government statistics on 
Community Payback Orders (CPO) (2018-19) show that North Ayrshire has the third 
highest number of CPO’s imposed per 10,000 population in Scotland at 64.5 per 10,000 
population. In comparison, East Ayrshire has the highest in Scotland at 65.7 and South 
Ayrshire sit at 52.3. The Scottish average is 42.6 per 10,000 population. 

There has been a steady decline in the number of Criminal Justice Social Work Reports 
(CJSW) since 2015-16, however 2019-20 has indicated a slight upward turn. The latest 
Government statistics on CJSWs for 2018-19 reveal North Ayrshire at 80.8 per 10,000 
population. In comparison, East Ayrshire has the second highest at 113.5 and South Ayrshire 
sit at 82.6. The Scottish average is 70.8 per 10,000 population. 

1.2 Our Justice Services continue to have a positive impact on the local community through the 
Community Payback Order (CPO) unpaid work scheme. For the seventh year we have 
continuously over-achieved against targets for CPO level 1 and level 2. 


Level 1 CPO unpaid work completed within 3 months 


98 . 9 % 



^■% Completed Local Target 


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Level 2 CPO unpaid work completed within 6 months 



Completed Local Target 


1.3 We currently have 190 people of all ages and abilities undertaking unpaid work. The unpaid 
work teams undertake a variety of tasks for the benefit of local communities, including; 

• Foodbank - undertaking collections for a local Foodbank at Church of Nazarene in 
Ardrossan. They then carry out distribution of the allocated food across North Ayrshire. 

• Painting and Decorating - our teams undertook painting the Main Hall in Whitlees 
Community Centre, Ardrossan. There is ongoing work in community-based facilities in 
Arran. 

• Removals - support is provided to local Charity shops by collecting donated furniture and 
delivering purchased items. This is a valuable resource for those who might find it difficult 
to pay for uplift and delivery of large items. 

• Workshops - our three workshops are equipped to undertake training in woodworking 
skills and arts and crafts. Service users who have disabilities or health issues may not be 
able to undertake heavier work, they also have an opportunity to make items which are 
sold with the funds going to the Income Generation Fund. 

• Employability - working with all justice service users to provide support in working towards 
employment; a significant factor in reducing re-offending. 

1.4 Reintegration into communities is very much the ethos of Community Payback 
Orders and with that aim in mind we have Employability Mentors based 
within the Community Payback, Unpaid Work Team. Since coming into post the 
mentors have been successful in supporting 27 service users into full time 
employment, 9 in the last year. The team have sourced and placed a significant 
number of service users into training that is likely to increase future employment 
opportunities. In addition to this they have supported 3 services users into 
various full-time education courses. 



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The Mentors, alongside Economies and Communities, CEIS (Community Enterprise in 
Scotland) and DWP (Department for Work and Pensions) organised a ‘Recruit with Conviction 
Event’ at the Ardrossan Hub in May 2019. Employers from a variety of sectors attended 
including advice from Disclosure Scotland. In addition to this they completed a presentation at 
HMP Kilmarnock to 20 employers to demonstrate skills and abilities of service users to aid 
their further employment 

1.5 The Early Intervention from Custody (Women) project continued to offer support to 
women to access existing health and other services, particularly Addictions and Mental Health 
services, to improve their health outcomes. The project also seeks to develop improved 
integrated pathways between Health and Social Care Services in North Ayrshire, leading to 
sustainable improvements in how services work together and deliver services more effectively. 

Case Study 


MsG 


Ms G appeared in court in October and was referred to the Early Inten/ention Sen/ice for 
extra support. The allocated staff member completed a home visit and discussed what 
support could be provided by staff. Ms G was having difficulty in relation to her existing 
welfare benefits and was unsure if she was eligible for other benefits as a result of a recent 
serious injury. A referral to Money Matters was made and Ms G was able to resolve the 
issue surrounding her existing welfare issue. Moreover, she was provided with relevant 
information regarding her recent injury and helped apply for relevant welfare. Additionally, 
Ms G reported that she suffered from depression and would like to be provided a safe 
space to undertake counselling for childhood sexual abuse. A referral was made to the 
Occupational Therapy to address these issues. Furthermore, Ms G was provided with 
information for a local charity - Break The Silence, which was established to provide 
support to survivors of childhood sexual abuse. Ms G continues to attend Occupational 
Therapy and has reported great improvements in her mood. 


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Case Study 


Ms E 

Ms E has been engaging with the Early Intervention Sen/ice since August 2019 after being 
referred for support regarding substance abuse and counselling. During this time, she lost 
her partner to an overdose which left her in a state of uncertainty as they had previously 
managed the household and benefits. Thus, on the passing of her partner she was now 
required to set up her own bank account and update her housing application. Ms E was 
supported by the allocated work who drove her to attend Housing Services with the 
necessary paperwork. Within the same day, Ms E was helped to set up her own bank 
account, so she may receive her welfare payments. Ms E noted how excited and proud she 
felt on doing this as it had been years since she had, had her own bank account. 


During her engagement with the sen/ice Ms E has had great difficulty at times affording 
food. On one such occasion, the allocated worker alongside the supporting Occupational 
Therapist accompanied Ms E to several food banks within the area to source a food parcel. 
This involved driving from Ms E’s home address to her local food bank, however, they had 
no parcels left. Following this, Ms E was driven to two further foodbanks within the North 
Ayrshire locale until a food parcel could be sourced for her. This support ran past normal 
working hours, however, both workers felt it was imperative to ensure Ms E had food at 
home. Ms E continues to engage with the service and reports how “thankful and grateful” 
she is of the support. 



1.6 The Caledonian Women’s Service offers emotional and practical support to women, 
advice on safety planning, risk assessment and advocacy. Working in partnership with the 
women, we aim to reduce their vulnerability and work with other services, including; education, 
housing, Police Scotland and the voluntary sector, so that women and their families are better 
supported. 

In 2019-20 the team worked with 140 individuals across Ayrshire (an increase of 17 from the 
previous year). Offering a variety of services and support, from safety planning sessions, to 
longer term interventions and support the team currently continue to support 54 women across 
North Ayrshire. 

The Caledonian Women’s Service are currently piloting women’s well-being groups as a 
means of reducing isolation, building new relationships and gaining feedback in a more trauma 
informed way - 2 have taken place across Ayrshire so far. 


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1.7 Women’s Service staff provide supervision and case management of Community Payback 
Orders (CPOs) imposed by the courts for women who have more complex risk and needs as 
referred by Justice Services locality teams. Some of the positive outcomes are listed below; 

• Reduction in number of revocations 

• Reduction in offending behaviour whilst subject to a CPO 

• Excellent advocacy from case mangers regarding mental health issues and improved 
pathways to Health Services in North and South Ayrshire due to collective work with the 
Occupational Therapist 

• Collaborative work in all areas with services such as Money Matters and the Financial 
Inclusion Team has led to services user’s income being maximised and numerous 
women received significant amounts of backdated money 

Whilst there have been positive destinations for many women, this is an area where we would 
hope to improve. Our aim is to encourage and support service users to be in education/training 
or employment (either voluntary or paid) prior to the end of their Order. 

1.8 Diversion From Prosecution (Diversion) is delivered within each locality Justice 
Service following an assessment by a Justice Social Worker. However, up until the past few 
years referrals from the Procurators Fiscal (PFs) were very small and it was agreed to develop 
a more structured service across the Partnership in order to coordinate more directly with the 
Crown Service. Since integration, referrals have increased significantly, and particularly in the 
past year with a drive to increase Diversion nationally in response to specific Justice outcomes 
in the updated national alcohol and drug policy ‘Rights, Respect and Recovery’ 

The numbers of Procurators Fiscal (PF) assessment requests have increased by 37% from 
2017-18 to 2019-20, which has resulted in a 34% rise in the number of Diversions allocated. In 
the past, Diversion would last approx. 6 - 8 weeks and generally be for first offences, so that 
the intervention would be offence focussed, whereas recently a change in PF referral criteria 
places the focus on less serious offences rather than whether it is a first offence, so that many 
cases presenting in the past year have had a longer offending history. 


Diversion 


203 



Assessment Requests Reports Submitted No. of Diversions Completions 

■ 2017-18 12018-19 12019-20 


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The Diversion service has proved a positive support based on feedback received: 

• 96% rated the intervention as excellent/very good in helping them address their 
offending behaviour 

• 98% rated staff as excellent/very good in helping them address their issues 

• 100% of participants stated the Diversion service had met their needs. 


Case Study 


Mr C 

Mr C was referred to the service following several reports of public disorder. When 
undertaking the assessment, the writer was made aware that Mr C had been diagnosed 
with Asperger’s a few years earlier, however no community-based supports were presently 
in place due to him refusing to engage with services - stating that he could not tell people 
how he was feeling. Much frustration, reported feelings of helplessness and being 
misunderstood by society resulted in his withdrawal from his family, friends and the 
community and any attempts to reintroduce him resulted in displays of threatening and 
abusive behaviour. Through much engagement with Mr C, partnership working with the 
Learning Disability Team and the National Autistic Society, staff utilised additional pictorial 
cues and interventions to encourage Mr C to understand his feelings and to communicate 
more effectively. This intervention changed the focus of communication for Mr C and he 
now feels able to express himself in alternative ways which (though the use of emojis on 
his phone) do not result in frustration and inappropriate behaviour. Mr C recently applied 
for College, where he hopes to develop his passion for music. 


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4 

Reporting on Localities 


North Ayrshire is home to over 136,000 people, all living in its many 
towns, villages and islands. These places are home to many different 
communities, each with their own characteristics and needs. 

We recognise that a one - size all approach to services delivery is not 
appropriate. A blanket service may be of great 

benefit to one community and of little value 

to another. 


Great 

Cumbrae 


That is why we are now designing local 
services based on local need, identifyin 
the health and social care priorities 
in communities and developing 
services that help people access 
the right services at the right time. 



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Overview 


Throughout the 2019-20 service year, our six Locality Planning Forums (LPF) have 
continued to represent local communities within the Health and Social Care Partnership. 

Following on from the review of the LPF governance structures in September 2018, each 
forum has engaged in further information and awareness raising sessions in order to better 
serve their local communities. In addition to inputs by HSCP officers at LPF meetings, a half 
day capacity building seminar was hosted in December 2019. The outcome of these sessions 
has included: 

• Clarity on the role and value of planning health and care services at the local level 

• A greater understanding - for all members - on how to progress concerns, issues or 
recommendations through the HSCPs governance structure 

• The development of an ‘engagement calendar’ highlighting various activities, events 
and celebration days that LPFs can be involved in 

Further, throughout 2019-20, HSCP Locality Planning Forums have increased representation 
on Community Planning Partnership Locality Partnerships. This has resulted in several pieces 
of joint engagement work with local communities across North Ayrshire. 

It is anticipated, that as HSCP teams become more organised into localities, our LPFs will 
have a greater role in engaging with local communities to understanding local needs and 
concerns. Through effective engagement, it is the continued role of LPFs to be the voice of 
local people in the HSCP, ensuring services are designed to meet local need. 


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Arran 

Throughout the service year, Arran initiated their first joint Locality Planning Partnership and 
Locality Planning Forum meetings. These new joint groups aligned the CPP and HSCP locality 
groups into one structure. In December 2019, an engagement event was held with the Patient 
Service User groups in Lamlash Medical Practice and Brodick Library to inform residents of 
the joined-up way of working and discussing how local people can be involved. This event 
resulted in several positive outcomes, such as: 

• Enhancing the engagement network on Arran 

• Improved awareness of the roles of local groups and organisations 

• Highlighted concerns identified by local resident groups for action 

Focus has been on improving services that support the mental health of young people. 
In early December 2020 a capacity building event took place with Mental Health Youth 
Ambassadors from Arran High School, to discuss local services and address a perceived lack 
of appropriate youth mental health services on the island. 

The Capacity Building session was very well received by The Mental Health Youth 
Ambassadors who engaged enthusiastically articulating their needs, issues and aspirations for 
bespoke Youth Mental Health Services. The young people expressed the need: 

• to de-stigmatise the ‘Wellbeing Centre’ and develop safe spaces all around the school 

• explore more creative types of wellbeing including art, music and pet therapy 

• develop balanced physical wellbeing by ensuring more sporting options directly 
targeting girls and prioritising all sports like football, basketball, netball & rugby 

• explore the potential of group therapies 

• introduce qualifications around Mental Health including an alternative curriculum 

• enhance communications regarding wellbeing and the opportunities within the wellbeing 
centre. 

Following this event, it was agreed to explore the pursuit of Community Investment Funding. In 
March 2020, a further capacity building event took place with several local partners at the 
Arran Outdoors Centre with the aim to pursue a joint CIF bid to address the needs identified by 
young people. This event was considered a success and activity will now take place to pursue 
a CIF application and other funding to support developments for young people on the island. 


In support of the local community and 
encourage younger people into a career in 
the Health and Social Care Partnership, a jobs fair 
was held in support of choice and opportunities 
available. 



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During the service year, the Garnock Valley progressed work to help address the concern of 
social isolation and loneliness experienced by local people. On 8th December 2019, 
the LPF hosted an event in the Montgomery Court Community Hub bringing together local 
partners from Community Learning and Development, Community Link Workers, St Bridget’s 
Primary School and the Beith Trust. 

The session aimed to: 

• Identify local need in the Garnock Valley 

• Consider how social isolation and loneliness could be address in the locality. 

The session included many active engagement methods, including: 

• Icebreakers, brainstorming, idea snowballing, social singing and inter-generational 
work. 

Impact Stars were used to evaluate participants experiences, and importantly they had the 
opportunity to identify what they would like to see developed in their locality that they could 
redress the issues of Social Isolation and Loneliness moving forward. 

One agreed solution was for Montgomery Court to develop lunch and/or activity clubs with 
additional developmental support to them to help build more local capacity. Further 
development was identified with other third sector groups, who may wish to develop new 
services in the area with possible groups to include the Beith Trust who have agreed to deliver 
cooking sessions and training for the targeted communities. 

This bottom-up approach at a locality level was identified as a positive way to redress Social 
Isolation and Loneliness based on expressed needs, issues and aspirations. Further sessions 
are planned to engage with more groups to further enhance the approach and address the 
concerns of social isolation and loneliness. 


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Following concerns raised by LPF members in relation to local mental health concerns, a 
decision was made with local partners to pursue a consortium bid for funding from the National 
Lottery. 


Discussions then raised awareness that several local groups and third sector partners were 
seeking to apply for funding to deliver local programmes to support mental health. The 
suggestion was made to pursue a joint bid in order to ensure a more collaborative approach to 
service delivery and perhaps lever in greater resources for local people. 

A ‘Coffee, Cake and Chat’ event took place in December 2019 bringing together partners 
from Community Learning and Development, Community Link Workers, Kilwinning Library and 
Third sector Partners. 

The event proved to be very enlightening and positively motivating regarding new 
developments and a more co-operative approach: 

• to build more bespoke family services 

• to minimise silo working within the locality 

• to develop/detail a consortium lottery bid to add leverage/resources within the locality 

• to use the library space for future developments to de-stigmatise services 

• to introduce qualifications around Mental Health including an alternative curriculum 

The group will now seek further partners to participate in the consortium approach including 
Further Education and explore the development of a Wellbeing Academy. 

Further developing the consortium approach, in March 2020, the LPF led on an engagement 
activity with local partners to consider the development of a local Wellbeing Curriculum for the 
Kilwinning area, namely in delivering the ‘Practical Approaches to Mental Health’ 
programme to the local people and groups. 

The event discussed how best to deliver to jointly deliver the curriculum, ensuring wide 
reaching engagement and participation by local people who require the service. Going 
forward the consortium of organisations pledged to a more corporate way forward; maximising 
the impact and minimising duplication by: 

• Co-facilitating the course 

• Minimising silo working within the locality 

• Using corporate approaches to monitor/evaluate the programme 

• Using the library space for future developments 

• De-stigmatising Mental Health Services 

• Introducing accredited and non-accredited learning around Mental Health 


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Irvine 





In February 2020, Irvine Locality Planning Forum engaged with the Parent Council from Irvine 


In February 2020, Irvine Locality Planning Forum engaged with the Parent Council from Irvine 
Royal Academy to raise awareness of the forthcoming Addictions Participatory 
Budgeting (PB) Event. As part of their new strategy, North Ayrshire Alcohol and Drug 
Partnership ran a PB event to provide funding to local groups to deliver local projects to help 
address drug and alcohol misuse. 


The Irvine LPF, along with colleagues from Connected Communities and other senior staff, 
provided key support and guidance to members of Parent Council. This was identified as a 
need following an increase in concerns in relation to drug misuse among pupils. In addition to 
addressing concerns over substance misuse, discussions looked at the potential to CO- 
deliver’ a response to mental health concerns within the school. 


The Awareness Raising Session was positively received by the parent council, pupil 
representatives and senior staff, identifying evolving mental health/drug concerns within the 
school community and potential partnership responses. 



During 2019-20, the North Coast LPF invited two Mental Health ambassadors from Largs 
Academy to join the forum. Both S6 pupils, they added a much-valued youth voice to the 
group. Following on from discussions at the forum and concerns raised regarding the increase 
in mental health concerns of pupils in the North Coast, the LPF organised a ‘Discussion 
Dinner’ with pupils of Largs Academy and their parents to look at addressing local Mental 
Health Concerns. The discussions then generated the idea of producing a Mental Health 
information leaflet for all young people in the North Coast area that would be CO-produced’ 
by young people. 


On World Mental Health Day (10th October 2019) a bespoke ‘Breakfast Blether’ and 
capacity building session took place in order to co-produce a ‘Pocket Guide to Wellbeing 
Services’. 


The Capacity Building Session was sponsored by UNISON enabling a social breakfast as a 
medium to engage. Pupils felt strongly that the Guide should be a discrete fold away, paper- 
based tool rather than an app or online medium as some young people don’t always have 
access to the internet. It was also agreed that this would be a useful tool for all primary seven 
pupils transitioning to the academy from the associated cluster schools. As such, many 
aspects had to be considered, such as; the language used, advice provided was suitable for 
all ages, and signposted supports were approved by Education and CAMHS. 


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Through further support from the LPF, funding was sought to enable the printing and 
distribution of 2000 guides. 

In February 2020, the LPF took part in a capacity building session looking at Practical 
Approaches to Mental Health. The overall aim was to enable members to increase their 
knowledge and awareness of Mental Health and thereafter be empowered to cascade the 
session within their respective communities. 

The Capacity Building session was very well received by the participants and the potential 
impact within communities enthusiastically discussed. The participants were in the main 
practitioners, a parent and 2 youth ambassadors all keen to implement. 



Over the past year, the Three Towns Locality Planning Forum has continued to work towards 
addressing their local priorities of; improving the mental health and wellbeing of young people, 
reducing social isolation, and improving support to those with complex needs. 


Several key action points where planned for delivery by LPF members during the 2019-20 
service year but have been postponed due to the COVID-19 Pandemic. Actions for delivery 
included: 

• Rolling out of Practical Approaches to Mental Health’ to communities and 
Third Sector organisations in the Three Towns. 

• Accessing ‘Cash Back for Communities’ funding to implement a 2-year physical 
wellbeing programme 

• Deliver a ‘Hogwarts’ themed event to help reduce the impact of Social Isolation on 
young people 

• Seek to develop a ‘Wellbeing curriculum’ in the Three Towns 

It is hoped these actions can still be delivered when safe and appropriate to do so. 

Throughout the service year, in recognising the value of working closely with the local 
community, the LPF began actively engaging with local support groups and projects. In this 
way, the group aims to work in collaboration within their local community to address their 
identified priorities. 

In February, discussion took place with forum members, colleagues from Connected 
Communities and representatives from Ardeer Church to assess the possibility of establishing 
a support base there to provide support to young people with poor mental health. This service 
would also seek to implement some form of financial inclusion, such as a Credit Union for 
young people. Unfortunately, discussion have been delayed due to the impact of the COVID- 
19 Pandemic. 

Community Link Workers based in the Three Towns have benefitted from the identification of 
local support groups. When working with local people, Community Link Workers have been 


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able to advise of the wide range of support groups available within the local area. This has 
included referrals to projects that support men’s mental health, such as the ‘New Hope 
project’; and the Saltcoats Link-up’ project and the Hope’ project delivered by 
CLASP, which aim to address social isolation. 


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5 

Transformation Programme 


North Ayrshire’s Transformation Team support Partnership 
teams to identify, develop and deliver system wide 



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Review of Integration 

The North Ayrshire Integration Joint Board submitted its Ministerial Steering Group (MSG) 
Review of Integration self-assessment which highlighted areas of both good practice 
and improvement to the Scottish Government in May 2019. The Scottish Government MSG 
integration review identified the following key areas, with sub proposals, to both enable and 
improve the effectiveness and pace of integration: 

• Collaborative Leadership and Relationship Building 

• Integrated finance and financial planning 

• Effective strategic planning for improvement 

• Governance and accountability 

• Ability and willingness to share information 

• Meaningful and sustained engagement 

Since May 2019 a wide range of work has been undertaken across service areas to address 
identified areas of improvement, which will improve the pace of integration and these are 
noted below: 


Collaborative Leadership and Relationship Building 

• Development of a partnership Workforce Development Strategy 

• Third and Independent Sector teams are represented as part of Thinking Different: Doing 
Better 

• Independent sector involved in the development of the new Care Home Commissioning 
Strategy 


Integrated finance and financial planning 

• Development of medium-term financial plan 

• The support for a section 95 officer and the HSCP reserves policy has been approved 

• Development of IJB Directions. Workshops have been held pan - Ayrshire to discuss a 
consistent approach to Directions 


Effective strategic planning for improvement 

• Succession planning and ongoing IJB development sessions 

• Review governance processes, budget setting arrangements and the links to succession 
planning 


Ability and Willingness to share information 

• Improvements around performance information, benchmarking and reporting information to 
the Performance & Audit Committee continues. 

• Drive to make information more accessible to the public and delivery of an accessible Annual 
Performance Report 


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Meaningful and sustained engagement 

• A new approach of working directly with communities and key groups in their settings has 
been developed. 




Communities 

• The HSCP ‘Thinking Different: Doing Better’ initiative has delivered 137 staff 
sessions in total (2113 attendees), 17 college sessions (292 attendees), champions 
board (11 participants), University of West of Scotland (10 attendees), 5 community 
sessions (75 attendees) and 24 sessions for colleges/community (388 attendees). 

• This promotes the HSCP as a positive employer offering access positions after young 
people have completed their studies. 

• The HSCP, building on its positive relationships with the connected communities’ team, 
was identified by Scottish Government as one of three national test sites for CO- 

Creating libraries for wellbeing’ leading to the creation of a wellbeing hub in 
Kilwinning library, which was co-designed with the Mental Health Youth Ambassadors 
from Kilwinning academy. 


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Health and Community Care 

• Primary Care Implementation Plan - Primary Care continues to move its model 
to a multidisciplinary approach with the provision of practice-based pharmacists, MSK 
physiotherapists and mental health practitioners. 

• Community link workers cover all the practices across North Ayrshire. GP Practices 
continue to develop their GP clusters, working together on quality improvement 
activities within their geographical areas. 

• The HSCP has been working with NHS Ayrshire and Arran in developing its ‘Caring 
for Ayrshire’ 10-year vision for locality health and wellbeing. Within Ayrshire, 90 per 
cent of all health and care contacts take place within a community setting, with the 
remaining 10 per cent in a hospital setting. We want to improve ail these contacts, 
beginning with providing more services closer to home or in a homely setting, and 
working in partnership with our communities to support improved health and wellbeing. 
In support of the initiative a number of project updates have been presented to the 
Integration Joint Board in recognition of the North Ayrshire HSCP requirements to the 
initiative; 

Caring for Ayrshire - Project Initiation Document (PIP) . 

Caring for Ayrshire Programme - Informing, Engagement and Communication Plans 


Children, Families and Justice Services 

• NHS Ayrshire & Arran and North Ayrshire Health and Social Care Partnership are 
building a new national facility for young people at Ayrshire Central Hospital in Irvine. 

• The Council has approved plans for the new National Secure Adolescent 
Inpatient Service (NSAIS), with building expected to start in July / August 2020. 
This will be a 12-bedded unit for children aged 12 to 17 years who have complex 
difficulties and need a high level of care. It will provide the first secure adolescent 
inpatient service for young people in Scotland. 

• This unit is a key strand of NHS Scotland’s Mental Health Strategy 2017-2027 

• ASN development -The construction phase of the New ASN Residential & Respite 
(R&R) Houses and the new ASN Campus has seen us work together with various 
different teams across the Council including Education, NHS, Facilities Management, 
Property Maintenance & Investment as well as continued engagement with the parents 
and the young people who currently attend the Mungo Foundation Respite facility to 
improve the lives and the wellbeing of all of the children & young people who will reside 
in the new facilities. 


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• The Children with Disabilities team are going to have offices within the new ASN school 
which will also contribute to improving the lives of the Children & Young people who will 
attend the New ASN School as well as those who reside in the R&R Houses. 

Mental Health and Learning Disability Services 

• Warrix Avenue is a purpose-built community-based rehabilitation services located in 
Irvine, North Ayrshire. The service offers time limited interventions to individuals with 
severe and enduring mental health needs. The environment offers opportunity for 
individuals, as part of their recovery journey, as close to independent living as possible. 

The interdisciplinary team at Warrix Avenue aspire to promote hope, opportunity and 
recovery through “doing with, not for” by working in partnership with individuals. 
Warrix Avenue has now been open for 1 year; our first admission into the unit was on 
the August 2019. 

Since the opening of Warrix Avenue we have: 

• Received 15 referrals. 

• Supported 8 admissions. 

• Required to transfers 3 individuals back to acute in-patient service at Woodland 
View (due to relapse in mental health, which has led to lack of engagement within 
their rehabilitation programmes) 

• Facilitated 1 discharge back to the community 

• As part of setting up Trindlemoss (our “day opportunities” centre), we welcomed 
around 60 representatives, volunteers and community leaders to visit the premises in 
December 2019 (in parallel with service user, family and staff visits). Invitees ranged 
from Irvine Locality Policing Team and the Local Debating group through to 
Waterbabies and Turtletots who were both interested in the pool facility as a possible 
rental facility. 

• With a new emphasis on community-based health and wellbeing (“from the heart of the 
community”), the facility has the potential for use by such community groups - 
combining enterprise and the community integration. 


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6 

Reporting on Lead Partnership Responsibility 


Each Ayrshire health and social care partnership has lead 
responsibility for specific services across Ayrshire. 

North Ayrshire Health and Social Care Partnership has lead responsibility 
for: 


Mental health services (including psychology, CAMHs, learning disability assessment and 
treatment) 

Child health services (including child immunisation and infant feeding) 


East Ayrshire Health and Social Care Partnership has lead responsibility for primary care and out 
of hours community response 

South Ayrshire Health and Social Care Partnership had lead responsibility for technology enable 
care (TEC) and falls prevention. 


Details of North Ayrshire’s performance in these services is available from the other Partnership publications 
that can be found by clicking on each Partnership name: 


East Ayrshire Health and Social Care Partnership 


South Ayrshire Health and Social Care Partnership 


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Mental Health Services 


Across Scotland both primary and secondary schools have reported increase numbers of 
children and young people presenting with stress, anxiety, depression, low mood and self- 
harm. This demand has also been reflected by an increase in referrals to specialist Child 
and Adolescent Mental Health Teams (CAMHS). This increase has undoubtedly put 
a strain on several services, not least on the families of the young people. 

In January 2018, the Ayrshire and Arran Wellness Model looked to test a whole system 
model of mental health support by developing a fully integrated approach aligning specialist 
child and adolescent mental health teams with developing initiatives in partnership with North 
Ayrshire schools and other parts of the community. The aim of the whole system approach: 

• By the end of 2020, there will be clear evidence of a shift in the emotional wellbeing of 
children and young people within one locality (Kilwinning) evidenced by more 
appropriate requests for assistance being made to CAMHS. 

The Ayrshire & Arran Wellness Model has significantly influenced, managed and changed the 
demand pressures placed on specialist mental health services to children and young people in 
a locality, ensuring those individuals with serious mental health concerns are seen timeousiy 
and appropriately. This model fits around children and young people’s needs using a broader 
lens for mental health services, and one that incorporates the wider system, supporting young 
people wherever they are. 


Stakeholder comments 

“Feel really empowered after today” 

“What is the follow up to today; needs to be something” 

“There is improved communication with CAMHS and School. Great there are 
named people in CAMHS to contact -Education, Kilwinning Academy. ” 

“Make all parents aware of what is out there other than CAMHS” 

“The KWM is much better from a GP point of view - GP KMP” 

“Whole world of support that people need to know about” 

“Didn’t know all these services were in Kilwinning schools - Parent” 

“It has raised confidence of what is urgent and what isn’t - Primary HT” 


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In addition, being a positive approach to children and young people’s needs, the Wellbeing 
Model has received various accolades: 

• ICICI9 -19th International Conference on Integrated Care, San Sebastian, 
Basque Country 1-3 April 2019. A successful abstract based on the Kilwinning Wellness 
Model has resulted in the Kilwinning Wellness Model being asked to present a poster at the 
Conference in San Sebastian at the International Conference on Integrated Care in April 
2019. 

• 9th May 2019 - Mental Health Access Improvement Support Team - Kilwinning 
Wellness won a prize for its innovative work and showing both qualitative and quantitative 
data. 

• 24th June 2019 Dynamic Earth Edinburgh - the Kilwinning Wellness Model is part of 
the presentation of Improving outcomes for children and young people and Parental 
empowerment. 

NHS Ayrshire & Arran developed a Drug and Alcohol mobile application (app) which 
provides people with all the information someone might need to seek help for themselves or 
someone they know who has a drug or alcohol addiction. 

This app provides information about: 

• Local services and support 

• Helpful websites 

• Current alerts 

• Who to contact in an emergency 

• Events in your including free training 

• Self-help 

• What is happening in Ward 5 (Addiction facility at Woodland View) 

As of 1st April 2020 , the Adult Community Mental Health Service was due to co¬ 
locate and reside at the 3 Towns Resource Centre. All construction and cosmetic works 
were completed on time, however, due to the COVID-19 pandemic essential ICT works were 
redirected and reprioritisation and therefore has not been completed at this time. As such a 
decision was taken to postpone all staff moving in. The footfall of staff through the building, 
and existing accommodations (Ayrshire Central Hospital and Caley Court) has been reduced 
to minimum numbers, with other staff working from home but able to mobilise from there as 
appropriate. 

The Annual operating plan for Psychological therapies and CAMHS waiting times 
was submitted to the Scottish Government during December 2019. Regular meetings have 
been established with the Scottish Government during January to March 2020. An update 
report was provided to the Integration Joint Board, Scottish Government Waiting Times 
Standard for Psychological Therapies , in September providing an update on progress against 
the waiting times standards. 


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The planned trajectories/actions are being revised further due to the impact of the COVID-19 
emergency to reflect anticipated change in demand. 

One of our Alzheimer Scotland dementia nurse consultants in NHS Ayrshire and 
Arran, was nominated in the Leader of the Year category at the Scottish Health Awards. 
She recently helped set up a Carers Academy to offer support and advice to those caring 
for someone with dementia. The joint initiative between University Crosshouse Hospital in 
Kilmarnock and the University of the West of Scotland has been a big success so far. She 
said, 



“We have a huge vision about helping people with dementia to live longer and 
healthier lives at home, if that’s what they want to do. A lot of people who are 
living at home are dependent on family members, so we wanted to try to 
support them in meeting the care needs of their loved ones. The Carers 
Academy has been running for six months. We focus on helping people 
develop practical skills so they can continue in their caring role. Our carers 
are totally inspiring in their commitment to their loved ones and their 
willingness to do what they can to help someone stay at home. It’s hugely 
rewarding to be part of it.” 



“We’ve had great feedback. A lot of carers have said it helps in terms of 
advance planning and understanding some of the signs and symptoms. 
They’ve also spoken about it reducing some of the isolation they feel and the 
benefits of peer-to-peer learning and sharing experiences with other carers.” 


During 2019-20, Woodland View was visited twice by the Mental Welfare Commission in 
July and September. On both occasions the inspectors responded with recommendations. 
Woodland View provides older people’s rehabilitation as well as dementia, mental health and 
addiction services for people across Ayrshire and Arran. 

During the July visit inspectors met and reviewed the care and treatment of all five patients, 
whilst speaking with the charge nurse, staff nurses and healthcare assistants throughout the 
day and noted 1 recommendation related to additional training needs. 


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The full report can be found here - Report on unannounced visit to Woodland View, Wards 9, 
10 and 11 . 

During the September visit inspectors met with and reviewed the care and treatment of 11 
patients and two relatives. They spoke with charge nurses, staff nurses, health care assistants 
and the bed manage and made 2 recommendations related to essential document access and 
the delayed discharge process. 

The full report can be found here - Report on announced visit to Woodland View . 


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Child Health Services 


Child Health Service is responsible for the comprehensive 
immunisation/screening/health review programmes and 
fail-safe aspects provided to the eligible population 
across Ayrshire and Arran. The Child Health Service is 
governed by Scottish Government legislation and 
protocols. 



• The Children’s Immunisation Service provides the Ayrshire school-based immunisation 
programme, including Human Papilloma virus (HPV), Diphtheria, Tetanus and Polio, Meningitis 
ACWY, and Measles, Mumps and Rubella (MMR). In North Ayrshire this programme is offered to 
7,712 (0.55% increase on previous year) pupils between the cohorts of SI to S6. The annual 
influenza vaccine is offered to 12,585 (23.03% increase on previous year) pupils from Primary 1 
to 7. As part of the roll out of the Vaccination Transformation programme, 8 new staff nurses have 
been recruited to deliver the routine childhood clinics within North Ayrshire. 

• Health visitors in the infant feeding service continue to promote, protect and support 
breastfeeding, referring mums to the community infant feeding nurse for support with more 
complex issues. Audit shows that the care provided if of a high standard and well received. Work 
remains ongoing across Ayrshire to increase the number of premises signed up to the 
Breastfeeding Friendly Scotland scheme 


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7 

I nspection of Services 


The Partnership works closely with independent care providers to ensure 
that the care and support provided is being delivered in line with peoples’ 
outcomes, offers best value, meets regulatory requirements and keeps 
people healthy, safe and well. 

Care services provided by Partnership teams also undergo external 
inspections and are subject to rigorous review and inspection. 

Working together, we ensure that all required standards of quality and 
safety are met. 



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Independent Care Providers who provide care services on our behalf 

Independent care and 3rd sector providers, via the contract management framework, maintain 
and improve their standards of care and support on an on-going basis. We use a range of 
methods to monitor performance, including: 

• Compliments, complaints and feedback from staff, carers and people who use services 

• Information that we collect, before visits, from the provider or from our records 

• Local and national information, for example, Care Inspectorate reports 

• Visits to providers, including observing care and support and looking at records and 
documents 


The information below represents how services are performing, monitored via the contract 
management framework and ensures services are safe, effective and most of all, that they 
meet people’s needs. 


Ensuring an acceptable level of support is provided to all service users our contract monitoring 
team undertake assessment for quality assurance. 



https://www.careinspectorate.com/index.php/publications-statistics/93-public/datastore 


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Care services provided by Partnership teams 

The services that the Partnership provides undergo inspection from the Care Inspectorate. In 
2019-20, 12 internal services were inspected, 2 scheduled and 10 unscheduled, and the table 
below shows the care grades awarded. 

The highlights of the inspections over the last year have been: 

• ‘Very Good’ grade awarded to Achnamara Children’s House. 

• ‘Very Good’ grades awarded to our Adoption Service and Fostering Service 

• ‘Excellent’ grades awarded to Three Towns, North Coast and Arran CAH Service and 
Irvine, Garnock Valley & Comm Alarm 

• ‘Very Good’ grade for Anam Cara 

• ‘Very Good’ grade for Stevenson Day Care & Resources 


Children & Families 

Service 

Care Inspectorate 

Number/Inspection 

Date 

Quality Theme - Care Grades (Out of 6) 

Canmore (U) 

08 May 19 

CS2003001160 

Quality of Care & Support - 4 

Quality of Environment - 4 

Quality of Management & Leadership - 3 

Adoption Service (A - Short 
Notice) 

04 June 19 
CS2004080741 

Quality of Care & Support - 5 

Quality of Management & Leadership - 5 

Fostering Service 
(A - Short Notice) 

04 June 19 
CS2004085341 

Quality of staffing - 5 

Quality of Care & Support - 5 

Canmore Children’s House 
(U) - Follow up visit 

15 August 2019 
CS2003001160 

Gradings from May 2019 

Quality of Care & Support - 4 

Quality of Environment - 4 

Quality of Management & Leadership - 3 

The Meadows Children’s 
House(U) 

27 August 2019 
CS2007142325 

Quality of Supporting Wellbeing - 4 

Quality of Leadership - 3 

Quality of Care & Support - 4 

Achnamara Children's 

House(U) 

6 February 2020 
CS2007142322 

Quality of Supporting Wellbeing - 5 

Quality of Care & Support - 5 


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Community Care 


Service 

Care Inspectorate 

Number/Inspection 

Date 

Quality Theme - Care Grades (Out of 6) 

Anam Cara (U) 

02 May 19 

CS2008177877 

Quality of Care & Support - 4 

Quality of Supporting Wellbeing - 5 

Stevenson Day Care & 
Resource (U) 

08 May 19 

Quality of Care & Support - 5 

Quality of Staffing - 5 

Quality of Environment - 5 

Montrose House (U) - 
Follow up visit 

11 July 2019 
CS2003001167 

Quality of Supporting Wellbeing - 4 
Quality of Care & Support - 4 

Three Towns, North Coast 
and Arran CAH Service (U) 

18-Feb-20 

CS2008192560 

Quality of Leadership - 6 

Quality of Care & Support - 5 

Irvine, Garnock Valley & 
Comm Alarm (U) 

18 February 2020 
CS2008192553 

Quality of Leadership - 6 

Quality of Care & Support - 5 

Dementia Support Service 
(U) 

3 February 2020 

CS2012306108 

Quality of Staffing - 4 

Quality of Care & Support - 4 


One of the Scottish Government’s suite of National Indicators is the proportion of care services 
graded as ‘good’ (4) or above in Care Inspection grades. 

At the end of 2019-20 there had been 3 inspections of 2 services where 1 quality theme 
resulted in a value below 4. 

All reports on inspected Partnership services are reviewed within the applicable service groups 
led by senior management. Further assurance and oversight will be performed by the Social 
Work Governance Board to ensure inspection recommendations and actions are met and 
reviewed as necessary. 

All inspection reports are available via the Care Inspectorate web site here -> Inspection 
Reports . 


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8 

Financial Performance and Best Value 


Financial information is part of our performance management framework 
with regular reporting of financial performance to the IJB. 

This section summarises the main elements of our financial performance for 
2019 / 20 . 



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Partnership Revenue Expenditure 2019/20 


The overall financial performance against budget for the financial period 2019-20 was an 
overspend of £0.154m (£1,250m over in social care services and £1,096m underspend in health 
services). This position includes the £1,486m budget being held on behalf of the IJB by the 
Council for debt repayment, as this was required to be transferred back to the IJB at the financial 
period-end. 

This overspend will add to the historic debt carried forward from previous years. 

The IJB plans during 2019-20 were that prior to the £1,486m set aside for debt repayment being 
reallocated to the partnership that the IJB would work towards delivering financial balance in¬ 
year which would have allowed the full amount set-aside to be allocated towards the debt at the 
period-end. The full repayment was not possible during 2019-20. 


2018-19 

Budget 

£000 

2018-19 

Actual 

£000 

Variance 
(Fav) / 
Adv 

£000 


2019-20 

Budget 

£000 

2019-20 

Actual 

£000 

Variance 
(Fav) / Adv 
£000 

65,900 

65,952 

52 

Health and Community 

Care 

71,521 

72,051 

530 

73,308 

72,982 

(326) 

Mental Health 

77,490 

78,245 

755 

35,591 

35,705 

114 

Children, Families and 

Justice 

35,392 

36,665 

1,273 

48,916 

48,839 

(77) 

Primary Care 

53,154 

53,007 

(147) 

4,636 

4,588 

(48) 

Allied Health Professionals 

5,200 

5,089 

(111) 

6,821 

5,970 

(851) 

Management and Support 
Costs 

9,456 

7,114 

(2,342) 

2,623 

2,290 

(333) 

Change Programme 

1,579 

1,435 

(144) 

237,795 

236,326 

(1,469) 

TOTAL EXPENDITURE 

253,792 

253,606 

(186) 

(237,795) 

(237,795) 

0 

TOTAL INCOME 

(253,792) 

(253,792) 

0 

0 

(1,469) 

(1,469) 

OUTTURN ON A 

MANAGED BASIS 

0 

(186) 

(186) 

0 

524 

524 

Lead Partnership 

Allocations 

0 

133 

133 

0 

(945) 

(945) 

OUTTURN ON AN IJB BASIS 

0 

(53) 

(53) 

0 

277 

277 

Earmarking 

0 

207 

207 

0 

2,562 

2,562 

FINAL OUTTURN POSITION 

0 

154 

154 


Table 1: Financial Performance for 2018/19 


The main areas of variance during 2019-20 are noted below: 

Health and Community Care - overspend of £0.530m mainly relates to an 
overspend in care at home placements, models of care and elderly in-patients partially offset 
by underspends in care homes, adaptations, district nursing and health care packages. 

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Mental Health — overspend of £0.755m which relates to an overspend in learning 
disability care packages partly offset by underspends in community mental health and the Lead 
Partnership for mental health (psychology, child and adolescent mental health services 
(CAMHS), Action 15 and psychiatry). 

Children, Families and Justice - overspend of £1.273m is mainly related to an 
overspend in residential and secure placements. 

In general, the areas above are overspent within the social care aspect of service provision 
which is demand led and subject to fluctuations throughout the period. These are at times 
difficult to deliver within budget as some services by their nature can be low in volume but at 
very high cost. 

Management and Support Costs - underspend of £2.342m mainly relates to the 
period-end allocation of the £1,5m for the debt repayment and budget pressure funding where 
spend commitments were delayed and therefore funding was not transferred to services in¬ 
year. 

It is disappointing that the IJB end the financial period with a relatively small increase (£0.154m) 
to the debt owed to North Ayrshire Council, taking the total closing debt balance to £5.293m. 
Despite this there were a number of key successes for 2019-20: 

• Continue to demonstrate the IJB position being accounted for in a truly integrated way 
with resource shifting from the NHS budget to offset Social Care pressures; 

• Implemented the financial recovery plan and the actions therein contributed to a steady 
reduction to the forecast overspend through the year, despite new demands for services 
partly offsetting the financial impact of the plan; 

• Savings totalling £4.5m were delivered in-year, against an approved plan of £6.1 m, with 
savings delivered in excess of those being assessed as low risk for delivery at the start 
of the financial year; 

• Progress with reducing the financial overspends specifically for care home and 
children’s residential placements which will have a significant impact on the financial 
plans and sustainability for future years; and 

• Further work has been undertaken to establish where there are areas where there has 
been a significant variation and movement during the period which has resulted in a re¬ 
alignment of the opening budget moving into 2020-21. 

Moving into 2020/21, the Partnership is proactively working to provide safe and effective 
services for the residents of North Ayrshire within the financial envelope. However, the main 
risk to the partnership moving into the new financial period is the uncertainty around the 
Covid-19 pandemic. 

From the outset of the pandemic the HSCP acted very swiftly to respond by reprioritising 
resources to protect and adapt core services to support the safety of our staff and communities. 

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Whilst responding to the specific needs of North Ayrshire communities our approach is 
informed by the extensive and continually evolving range of national guidance which has been 
produced at pace by the Scottish Government and other agencies. It has been a real challenge 
for the North Ayrshire HSCP, and for partnerships across Scotland, to operate in this 
unprecedented environment, keeping up with the evolving position and associated demands 
and impacts on services. 

The HSCP developed a mobilisation plan detailing the additional activities to support our 
response to COVID-19, alongside the estimated financial impact. The plan provides a focal 
point for the partnership’s response to the pandemic and this set out clearly from the start how 
we would adapt and mobilise services to either expand or retract, re-prioritise activities and 
resources and highlights the areas of greatest risk. 

Key areas of the mobilisation plan submitted to the Scottish Government include: 

• Reducing the level of delayed discharges for patients in acute, Mental Health inpatients and 
community hospitals; 

• Island resilience with planning supported by a Multi-Disciplinary Team approach including 
local GPs; 

• Our community hospital response to managing potentially high bed occupancy levels, 
alongside staff availability and the flow from acute; 

• Maintain as far as possible mental health services, with community provision limiting face 
to face contact and flexibility of resources for in-patient services to ensure no cessation of 
services; 

• Resilience and sustainability of current levels of care at home provision, alongside 
increasing capacity to facilitate hospital discharge and support shielded individuals; 

• Step Up/Step Down residential provision, establish provision of temporary residential or 
nursing care provision to both facilitate quicker hospital discharge and to avoid further 
hospital admissions from the community, including planning for contingency surge capacity; 

• Supporting adults with complex needs by ensuring alternative community supports on 
closure of respite and day services alongside social distancing requirements; 

• Maintaining existing levels of care in our children’s services to protect vulnerable children 
and adopting new ways of keeping in touch with vulnerable children; 

• Established “enhanced” locality-based Community Hubs to support vulnerable individuals, 
including those shielding; and 

• Sourcing and establishing reliable supply chains of Personal Protective Equipment (PPE). 

The mobilisation plan is monitored regularly and updates on the costs associated with the 
NAHSCP response to COVID-19 are submitted to the Scottish Government. 


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Financial outlook, risks and plans for the future 


In October 2018, the Scottish Government 
published the Medium-Term Health 
and Social Care Financial 
Framework which sets out the future 
shape of Health and Social Care Demand 
and Expenditure. 

Within the report it outlined that the 
Institute of Fiscal Studies and Health 
Foundation reported that UK spending on 
healthcare would require to increase in 
real terms by an average of 3.3% per year over the next 15 years to maintain NHS provision 
at current levels, and that social care funding would require to increase by 3.9% per year to 
meet the needs of a population living linger and an increasing number of younger adults living 
with disabilities. The report recognised that despite additional planned investment in health 
and social care the system still needs to adapt and change. 

The focus of the financial framework is on the main health and social care expenditure 
commitments, as set out below. 

• Over the course of this parliament, baseline allocations to frontline health boards will be 
maintained in real terms, with additional funding over and above inflation being allocated 
to support the shift in the balance of care. 

• Over the next five years, hospital expenditure will account for less than 50% of frontline 
NHS expenditure. This relates to the policy commitment to ‘shift the balance of care’, 
with a greater proportion of care provided in a setting close to a person’s home rather 
than in a hospital. 

• Funding for primary care will increase to 11% of the frontline NHS budget by 2021-22. 
This will amount to increased spending of £500 million, and about half of this growth will 
be invested directly into GP services. The remainder will be invested in primary care 
services provided in the community. 

• The share of the frontline NHS budget dedicated to mental health, and to primary, 
community, and social care will increase in every year of the parliament. For adults, and 
in some cases for children, these services, along with unscheduled hospital care, are 
now managed by Integration Authorities. 



The Ministerial Strategic Group (MSG) for Health and Community Care published a 
report following the Review of Progress with Integration of Health and Social Care (February 
2019). Within the integrated finance and financial planning area the proposals include: 

• Health Boards, Local Authorities and IJBs should have a joint understanding of their 
respective financial positions as they relate to integration 

• Delegated budgets for IJBs must be agreed timeously 

• Delegated hospital budgets and set aside requirements must be fully implemented 

• Each IJB must develop a transparent and prudent reserves policy 


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• Statutory partners must ensure appropriate support is provided to IJB Section 95 
officers 

• IJBs must be empowered to use the totality of resources at their disposal to better meet 
the needs of their local populations. 


The Partnership has a responsibility, with our local hospital services at University Hospital 
Crosshouse and University Hospital Ayr, for planning services that are mostly used in an 
unscheduled way. The aim is to ensure that we work across the health and care system to deliver 
the best, most effective care and support. Service areas most commonly associated with 
unplanned use are included in the ‘Set Aside’ budget. Set Aside budgets relate to the 
strategic planning role of the Partnership. Key areas within this budget are: 

• Accident and emergency 

• Inpatient services for general medicine 

• Geriatric medicine 

• Rehabilitation 

• Respiratory 

• Learning disability, psychiatry and palliative care services provided in hospital 


Acute Services within NHS Ayrshire and Arran continue to face budget pressures around 
the costs of covering a high level of medical vacancies and the increasing needs of patients 
requiring nursing support above funded levels. There have been a high number of unfunded 
beds in use to meet demands and this pressure has been managed in-year by NHS Ayrshire 
and Arran in line with the Integration Scheme. The ability to plan with the overall resource for 
defined populations and user groups and to use budgets flexibly is one of the hallmarks of 
integrated care. 

It is recognised that there is a need to understand the progress that is being made towards 
planning across the full pathway of care, including the acute hospital component and the way in 
which the statutory guidance on the use of delegated hospital budgets is being applied in 
practice. 

Set Aside resources, as well as Lead Partnership were recognised as areas requiring further 
development as part of the review of the Integration Scheme carried out in 2017 and in the 
Strategic Planning, Commissioning and Delivery of Health and Social Care Services within NHS 
Ayrshire and Arran report to the IJB on 13 June 2018. 

This report sets out arrangements for the next steps in respect of ‘fair share’ commissioning 
within the NHS Ayrshire and Arran health and social care system. The report also outlines future 
developments in respect of Directions as per the model provided by the Public Works (Joint 
Working) Scotland Act 2014 for IJBs to commission services from Councils and NHS Boards. 

Pan-Ayrshire workshops have been held with representatives from the Scottish Government to 
take forward a national pilot project on ‘fair share’ commissioning using Directions. This 
national pilot will ensure that delegated hospital budgets and Set Aside budget requirements will 
be fully implemented. The Ministerial Strategic Group for Health and Community Care Review 


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of Progress with Integration of Health and Social Care report published February 2019 set this 
out as a key proposal under integrated finances and financial planning requirements. 

The Scottish Government issued Statutory Guidance in January 2020 outlining the requirements 
for the use of Directions from Integration Authorities to Health Boards and Local Authorities. 
The guidance sets out how to improve practice in the issuing (by IJBs) and implementation (by 
Health Boards and Local Authorities) of directions issued under the Public Bodies (Joint 
Working) (Scotland) Act 2014. This new guidance supersedes the Good Practice Note 
on Directions issued in March 2016. The Scottish Government worked closely with IJB Chief 
Officers to better understand the diversity of practice across Scotland surrounding directions and 
to identify good practice. They also discussed the use of directions with a range of local systems 
at regular partnership engagement meetings, including with Health Board and Local Authority 
Chief Executives. The three Ayrshire HSCPs supported Scottish Government colleagues to 
develop the guidance and provided feedback on its practical application. 

Preparatory work is well underway with the support of the Scottish Government, NHS Ayrshire 
and Arran and the other Ayrshire HSCPs to progress and develop the set-aside arrangements 
and lead partnership services to fully implement the legislative requirements. Including 
arrangements in relation to the use of Directions, Commissioning Plans and overall progress 
towards a Fair Share allocation of resources. Progress with this work has been delayed 
due to focussing on the COVID-19 response and will require to be progressed later in 2020-21. 

In March 2017, the IJB approved the first Medium Term Financial Plan covering the period 
2017-2020. This is being refreshed and will be presented to the IJB during 2020, this was 
planned to be presented to the IJB in June 2020, however this has not been possible due to 
focussing on the COVID-19 response and also the ongoing uncertainty over costs and funding 
not only for 2020-21 as part of the response but also the impact on future funding for the public 
sector. 

Availability of funding for public services correlates with economic growth, which continues to be 
weak with continuing uncertainty on the impact of Brexit and the COVID-19 pandemic. 
The partnership is supporting the continuing work within the Council and NHS Ayrshire & Arran 
to minimise the impact of Brexit and the COVID-19 pandemic. An area of risk to the partnership 
is the consequence of the funding pass through from the Council and NHS and the availability 
of workforce. The implementation of new policy initiatives and the lifting of the public sector pay 
cap also impact on the funding available for core services and the flexibility to use resource in 
line with local requirements. 


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The most significant risks faced by the IJB over the medium to longer term, alongside mitigation, 
are summarised below: 


Impact of budgetary 
pressures 


•Mitigation 

• Medium Term Financial Plan 

• Strategic Plan 

• Change Programme/Service 
Redesign 

•Active Demand Management 

• COVID-19 Funding 


Delivery of the Change 
Programme 


•Mitigation 

•Transformation Board 

• Programme Leads 

• Strategic Planning Officers 
Group (SPOG) 

•Transformation Team Project 
Management Support 


Culture and 
practice 


•Mitigation 

•Thinking Different, Doing 
Better HSCP experience 

• Multi Disciplinary Team 
Approach 

• Strategic Workforce Plan 

•Valued Health and Social Care 
Services 


These risks emphasise the importance of effective planning and management of resources. It is 
therefore crucial that we focus on early intervention, prevention and recovery if we 

are to work within the total delegated partnership budget. 

To achieve its vision, the Partnership recognises it cannot work in isolation. The Partnership will 
continue to strengthen relationships with colleagues within the Community Planning Partnership 
to ensure a joint approach to improving the lives of local people. 

Most importantly, the Partnership must work more closely with local people and 
maximise the use of existing assets within communities to improve the overall health and 
wellbeing of people in North Ayrshire. 


Best Value 

North Ayrshire IJB is responsible for ensuring that its business is conducted in accordance with 
the law and proper standards, and that public money is safeguarded and properly accounted for 
and used economically, efficiently and effectively. 

The governance framework comprises the systems and processes, and culture and 
values by which the IJB is directed and controlled and the activities through which it accounts 
to, engages with and leads the community. It enables the IJB to monitor the achievement of its 
strategic objectives and to consider whether those objectives have led to the delivery of 
appropriate, cost-effective services. 

Regular performance information is provided to the Performance and Audit Committee, IJB 
members and operational managers. Benchmarking is used to compare performance with other 
organisations to support change and improvement. The contribution towards the national 
outcomes is monitored through its quarterly and annual performance reports. The budget also 

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recognises the need to link expenditure to outcomes, but there is still a need to improve the 
links between budget and outcomes. There is evidence of transformation taking place at 
strategic and operational level within the partnership. 

We have begun to see some of the benefits of integrated system working for example in 
supporting older people to remain at home or get home from hospital as soon as possible. 

Some of our achievements in 2019/20 include: 

• The Community Link Worker service provided 6,273 links to local and national 
supports and services. 

• The Money Matters Team undertook 4,951 and achieved financial gains of over 
£15million for individuals 

• Our new Facebook page launched in February. The page will enable the partnership to 
reach a wider audience, sharing our news and events with more people within our 
communities. www.facebook.com/NorthAyrshireHSCP . 

• Work began on the new ASN Campus which will provide respite and residential 
accommodation for young people with additional support needs. 

• The Alcohol and Drug Partnership produced a new 5-year Alcohol and Drug 
Strategy 2019-2024 focussed on the prevention of harm across communities. 

• Justice Services appointed a dedicated Desistance Officer to support people in the 
justice system to integrate meaningfully within local communities. 

• Joint working between the Health and Social Care Partnership, North Ayrshire Council’s 
Communities Directorate and partners has led to the creation of a North Ayrshire 

Intergenerational working case study booklet 

• In collaboration with Carers UK/Scotland, a Digital resource for Carers has been 
launched to provide comprehensive information and support for carers. 

• The Police Triage Pathway is now fully rolled out with regular referrals through the Crisis 
Resolution Team. 

• Child and Adult Mental Health Service (CAMHS) the wellness model was 
implemented in the Largs locality. 

• NHS Ayrshire and Arran and the three Integration Joint Boards of the health and social care 
partnerships in East, North and South Ayrshire launched their “Caring for Ayrshire” 
vision, outlining how health and care services could be delivered over the next ten years 
across Ayrshire and Arran. 


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• Around 150 key partners, stakeholders and members of the community including emergency 
services, charities and community groups attended a Drugs Death Summit to 
collectively explore what is currently being carried out locally and nationally and discuss what 
else can be done collectively to prevent drug related deaths. 

• The new state-of-the-art Trindlemoss day opportunities service and residential 
accommodation unit for North Ayrshire residents with learning disabilities is now up and 
running. It offers the chance for people with learning disabilities to take part in a host of 
activities and learn new skills whilst promoting their independence. 

• The interactive staff and public experience Thinking Different Doing Better has 
welcomed staff, community and students to challenge how we all work together to improve 
the health and wellbeing of our population. 

The fifth year as an integrated Health and Social Care Partnership has seen progress towards 
achieving financial balance and overall service sustainability. The IJB has a deficit of £5.293m 
(2018-19 £5.139m) as it moves into 2020-21. There is a repayment plan to allow the deficit to 
be recovered over the medium term to support the financial sustainability of the Partnership. 

The IJB recognises it must deliver services within its financial envelope for 2020-21 and our 
transformation programme will continue with delivery of the savings plan and service redesign, 
albeit with some delays due to services prioritising the COVID-19 response. 

There is a focus on the integration of services to deliver real change to the way services 
are being provided, with a realism that maintaining the status quo is no longer sustainable and 
changes need to be made in the way services are accessed and provided. The scale and pace 
of change will be accelerated as services need to adapt to ‘the new normal’ following the 
COVID-19 pandemic, however the requirement to change and re-design services to improve 
outcomes for individuals would exist despite the financial and pandemic pressures. 

There is an expectation that within North Ayrshire the pattern of spend will change and there 
will be a shift in the balance of care from institutional to community settings. The integration of 
health and social care provides a unique opportunity to change the way services are delivered, 
it is an opportunity to put people at the heart of the process, focussing on the outcomes they 
want by operating as a single health and social care service. 

The IJB through the Strategic Plan outlines the belief that together we can transform health 
and social care services to achieve the joint vision for the future “all people who live in 
North Ayrshire are able to have a safe, healthy and active life”. Moving into 
2020-21, we are working proactively to address the financial challenges, while at the same 
time, providing high-quality and sustainable health and social care services for the communities 
in North Ayrshire. 


Reporting on Localities 

The Partnership has arrangements to consult and involve localities via their locality forums. 
The IJB has established six Locality Planning Forums, reflecting the previously agreed local 
planning areas. These provide Board Members with the opportunity to be involved in 


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considering the priorities for each area and outline the role for each Community Planning 
Partner in meeting these priorities in conjunction with the local communities. 

This spend has been split into localities by initially allocating spend which could be directly 
identified to a locality and the remainder which was not locality specific was allocated on a 
population basis. Per the table below 38.1% of spend was allocated based on population 
which means at this stage the spend per locality can only be used as a guide and will not fully 
reflect actual locality usage of services. This is an area which developed during the year with 
Children and Justice Services moving to a locality-based approach in late 2019/20. The full 
impact of this will be seen in 2020/21. 

The population information used is given below and was taken from the 2018 mid-year 

population statistics (sourced from NRS). 


Age Group 

Irvine 

Kilwinning 

Three 

Towns 

Garnock 

Valley 

North 

Coast 

& 

Cumbrae 

Arran 

TOTAL 

Children 
age 0-15 

31.1% 

13.0% 

25.5% 

14.1% 

13.8% 

2.5% 

100% 

Adults 
aged 16-64 
years 

29.9% 

12.1% 

24.6% 

15.2% 

15.1% 

3.0% 

100% 

Older People 
aged 65+ 

25.6% 

10.2% 

21.9% 

13.8% 

23.6% 

4.9% 

100% 

Share of total 
population 

29.1% 

11.8% 

24.2% 

14.7% 

16.7% 

3.4% 

100% 

Total allocated on population basis 

By locality 

Total 


% of 
spend 
allocated 
on this 
basis 



This resulted in the following spend per locality: 



Irvine 

Kilwinning 

Three 

Garnock 

North 

Arran 

TOTAL 




Towns 

Valley 

Coast 


EOOO's 


EOOO's 

EOOO's 

EOOO's 

EOOO's 

EOOO's 

EOOO's 


2018/19 Expenditure 

74,679 

28,266 

58,860 

36,975 

42,655 

12,171 

253,606 

% share of spend 

29.4% 

11.1% 

23.2% 

14.6% 

16.8% 

4.8% 

100.0% 

% of total population 

29.1% 

11.8% 

24.2% 

14.7% 

16.7% 

3.4% 

100.0% 


Where to find more information 

If you would like more information on IJB strategies, plans and policies and our performance and 
spending, please refer to the following websites. 

www.north-avrshire.aov.uk/council/strategies-plans-and-policies 

www.north-avrshire.qov.uk/council/performance-and-spendinq 


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9 

Appendix 


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Local Indicators 


Performance Indicator 

2016 -17 

2017-18 

2018-19 

2019-20 

Target 

Status 

People subject to level 1 Community 
Payback Order (CPO) Unpaid Work 
completed within three months 

93.37% 

95.33% 

95.6% 

98.9% 

57% 

© 

Individuals subject to level 2 

Community Payback Order (CPO) 

Unpaid Work completed within six 
months 

95.63% 

94.27% 

97.3% 

97.6% 

67% 

© 

Number of Learning Disability service 
users in voluntary placements 

71 

67 

58 

57 

43 

© 

Number of bed days saved by ICT, 
Intermediate Care Team (formerly 

ICES), providing alternative to acute 
hospital admission 

4,730 

5,463 

6,563 

10,537 

3,060 

© 

People seen within 1 day of referral to 

ICT 

98.5% 

95.66% 

100% 

99.14% 

90% 

© 

Number of people receiving Care at 

Home 

1,715 

2,021 

1,793 

1,970 

1,703 

© 

Number of secure remands for under 

18s 

1 

0 

- 

- 

5 

© 

Addictions referrals to treatment within 

3 weeks (Alcohol) 

93.7% 

(at Q3) 

95% 

100% 

98.6% 

90% 

© 

Addictions referrals to treatment within 

3 weeks (Drugs) 

95.0% 

(at Q3) 

98% 

100% 

100% 

90% 

© 

Children who have been through Stop 
Now and Plan (SNAP) who have been 
sustained within their local school 

100% 

100% 

100% 

N/A 

100% 

© 

Preschool children protected from 
disease through % uptake of child 
immunisation programme (Rotavirus) 

95.53% 

96.10% 

91% 

91.1% 

92.2% 

A 

Preschool children protected from 
disease through % uptake of child 
immunisation programme (MMR1) 

96.21% 

96% 

95% 

93.3% 

98.2% 

A 

Care at Home capacity lost due to 
cancelled hospital discharges (shared 
target with acute hospital services) 
(number of hours) 

7,153 

6,305 

6,907 

6,431.2 

7 

4,000 

• 

Uptake of Child Flu Programme in 
schools 

75.25% 

74.70% 



72.1% 

© 


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MSG Indicators 


Performance Indicator 

2016-17 

2017-18 

2018-19 

2019-20 

Ta rget 

Status 

Emergency admissions to acute hospitals 

1,840 

1,763 

1,622 

1,334 

1,836 

© 

Emergency admissions to acute hospitals 
(rate per 1000) 

13.6 

13 

12 

12 

13.6 

© 

Admissions from emergency department 

1,202 

1,131 

1,007 

638 

1,173 

© 

Admissions from emergency department 
(rate per 1000) 

8.9 

8.4 

7.5 

8.0 

8.7 

© 

% people at emergency department who go 
onto ward stay (conversion rate) 

36 

34 

33 

32 

33 

© 

Unscheduled 'hospital bed days' in acute 
hospital 

12,333 

8,798 

9,348 

9,528 

12,320 

© 

Unscheduled 'hospital bed days' in acute 
hospital (rate per 1000) 

91 

65 

69 

81 

91 

© 

Unscheduled 'hospital bed days' in long stay 
mental health hospital 

6,782 

5,866 

(Marl8) 

8,128 

(Decl8) 

7,149 

(Mar20) 

6,782 

• 

Unscheduled 'hospital bed days' in long stay 
mental health hospital (rate per 1000) 

50 

43.3 

60 

52 

50.1 

• 

Unscheduled 'hospital bed days' in geriatric 
long stay 

1,665 

1,454 

943 

1,211 

1,772 

© 

Unscheduled 'hospital bed days' in geriatric 
long stay (rate per 1000) 

12.3 

10.7 

7 

10.2 

13 

© 

Emergency department attendances 

3,385 

3,292 

3,039 

2,527 

3,292 


Emergency department attendances (rate 
per 1000) 

25 

24.3 

22.5 

24.9 

24.4 

• 

% people seen within 4 hrs at emergency 
department 

91.4 

88.5 

87 

90 

95 

• 

Delayed Discharges bed days (all reasons) 

781 

1,889 

1,916 

2,073 

1,515 

• 

Delayed Discharges bed days (all reasons) 

(rate per 1000) 

7.1 

17.3 

17.5 

18.5 

13.9 

• 

Delayed Discharges bed days (code 9) 

308 

279 

196 

372 

770 

© 

Delayed Discharges bed days (Code 9) (rate 
per 1000) 

2.8 

2.5 

1.8 

2.1 

7 

© 


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Where to find more information 


If you would like more information on IJB strategies, plans and policies and our performance and 
spending, please refer to the following websites. 

• www.nahscp.org/partnership-strategies-plans-reports/ 

• www.nahscp.org/performance/ 

• www. n hsaaa.net/about-us/how-we-perform/ 

• www.north-ayrshire.gov.uk/council/strategies-plans-and-policies 

• www.north-ayrshire.gov.uk/council/performance-and-spending 


Additional financial information for Ayrshire wide services can be found in: 

www.east-ayrshire.qov.uk/SocialCareAndHealth/East-Ayrshire-Health-and-Social-Care- 

Partnership/Governance-Documents.aspx 

www.south-avrshire.qov.uk/health-social-care-partnership/strateqy.aspx 


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NORTH AYRSHIRE 
Health and Social Care 
Partnership 



Agenda Item 7 


Integration Joint Board 
September 2020 
Agenda Item No. 

Subject: 

Q1 2020-21 IJB PAC Report 

Purpose: 

To update the Committee on the Quarter 1 performance 
monitoring information of the Partnership 

Recommendation: 

Committee reviews the summary and agrees the content of the 
full report. 


1. 

EXECUTIVE SUMMARY 

1.1 

This report is to provide for discussion the Health & Social Care Partnership 
(HSCP) Integration Joint Board (IJB) Quarterly Performance Report in delivering 
the 5 strategic priorities as set out in the strategic plan and against the National 
Outcomes. 

2. 

CURRENT POSITION 

2.1 

The report is structured around the HSCP service areas delivering against the 
five strategic priorities: 

• Tackling Inequalities 

• Engaging Communities 

• Bringing Services Together 

• Prevention and Early Intervention 

• Improving Mental Health & Wellbeing 

and includes additional elements as; areas of focus, Head of Service highlights 
and challenges, finance, MSG indicator updates and absence information. 

2.2 

Measure and Target Review 


For 2020-21 a full and complete cross-service review of all performance 
measures was undertaken resulting in changes to the set of measures attributed 
to our strategic objectives and to reflect the continuing transformation of services 
to meet continual service demand. 

A specific report was presented to the Performance and Audit Committee listing 
all changes for 2020-21. These included: 

• Target resetting 

• Removal of measures are that no longer reflective of the service 
improvement 


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• The inclusion of new measures to meet service improvement and 
current operational demand 

All measures continue to be aligned to the current strategic plan and the 
monitoring of services through 2020-21 and bridging year as well as the re¬ 
mobilisation of teams and services while retaining focus on the changing COVID- 
19 restrictions. 

2.3 

The unprecedented situation of the COVID-19 pandemic saw partnership 
services react fluidly to meet the new demands in support of the community and 
hospitals. Throughout the coming year the quarterly report will highlight the effect 
of the pandemic across our services and communities and will show the ways in 
which integrated partnership working progresses change at pace and scale, 
ensuring positive person-centred care. 

2.3 

Anticipated Outcomes 


Specific key performance measures are scrutinised in detail and with context, 
reasoning and mitigating actions discussed in explanation of those measures not 
meeting target and actions to improve performance. 

2.4 

Measuring Impact 


Regular review of key performance measures will allow members to monitor the 
progress of the Partnership in implementing and delivering our five Strategic 
Priorities. The high-level position at 30 th June 2020 is as follows: 


Reported 1 

Qtr U 

Qtr 

G, 28 W A, 1 


For Quarter 1 we have 6 measures that are reported 1 quarter in arrears. The 
applicable RAG status for these measures will be included in the subsequent 
quarter counts. 


Where applicable measures are reviewed at monthly service specific Senior 
Management Team meetings in order that any measure not meeting target is 
identified early for implementing rectifying actions. 


At Q1 The projected outturn, before the impact of COVID-19, is a year-end 
overspend of £0.027m for 2020-21 .There is scope for this position to fluctuate 
due to in-year cost and demand pressures. The position has been adjusted to 
reflect the potential impact of Lead Partnership services. 


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NORTH AYRSHIRE 
Health and Social Care 
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3 

IMPLICATIONS 


With the undertaking of a full review the report will provide a greater focus on the 
context and reasoning provided for fluctuations in those measures not meeting 
targets. With continual review, the measures presented will bring closer together 
the thread of the of monitoring and management of local and national 
performance information. There is then a greater opportunity for more dedicated 
and detailed analysis as identified. 


Financial: 

None 

Human Resources: 

None 

Legal: 

None 

Equality: 

A balance of performance indicators is shown for all age 
ranges and across our 5 strategic priorities 

Environmental & 
Sustainability: 

None 

Key Priorities: 

The report is structured around the HSCP service areas and 
the 5 strategic priorities. 

Risk Implications: 

None 

Community Benefits: 

None 


Direction Required to 

Direction to: - 


Council, Health Board or 

1. No Direction Required 

X 

Both 

2. North Ayrshire Council 


(where Directions are required 

3. NHS Ayrshire & Arran 


please complete Directions 
Template) 

4. North Ayrshire Council and NHS Ayrshire & Arran 



5. 

CONSULTATION 

5.1 

Discussion has taken place with all service Senior Management Teams, HSCP 
Director, Performance and Audit Committee members as well as performance 
and data analysts. 

6. 

CONCLUSION 

6.1 

The Integrated Joint Board are asked to review and consider the content of the 

Q1 2020-21 report. 


For more information please contact Neil McLaughlin on: 
01294 317744 or NMcLaughlin@north-ayrshire.gov.uk 


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Delivering care 
together 


NORTH AYRSHIRE 

Health and Social Care Partnership 


Performance and Audit Committee Report 

Quarter 1 2020-21 
(April 2020-June 2020) 


August 2020 


TSI 


North 

Ayrshire 


scottishcare 

The voice of the independent care sector in Scotland 


ik 

North Ayrshire Council 

Comhairle Siorrachd Air a Tuath 



Ayrshire 
& Arran 


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Contents 

Introduction.6 

Overview.6 

Summary of Performance.8 

Red - Areas of Focus Summary.9 

Children, Families and Justice.25 

Head of Service Statement.25 

Health and Community Care.29 

Head of Service Statement.29 

Mental Health.31 

Head of Service Statement.31 

System Wide.37 

Absence Statement.37 

Finance.38 

MSG Trajectories.39 

Appendix 1.41 

Appendix II - All Performance Measures.42 

Appendix III - Workforce Absence.46 

Appendix IV - Finance.49 

Appendix V - Glossary of Acronyms.50 


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Introduction 

The purpose of this report is to afford a high-level overview of the progress being made by 
the Health & Social Care Partnership in delivering the strategic priorities as set out in our 
3-year strategic plan. 

A glossary of acronyms used within this report is contained in Appendix V. 


Overview 

The 2018-21 Partnership strategy is focused on core impact actions that add tangible 
service benefits and have subsequent influence on associated areas of challenge and 
transformation. Throughout the implementation period of this strategy, we will continue to 
monitor progress on core performance areas whilst benchmarking and setting new targets 
and actions to support our strategic objectives. The performance measures provided 
during this period reflect the transformational change being undertaken, as well as the 
continued demand and impact on core services. The measures are grouped where impact, 
dependency and causation has been defined between measures and are connected to 
service improvement. 

Through consultation we will continue to measure our performance against the 9 National 
Health and Wellbeing Outcomes plus the Partnership’s 5 Strategic Priorities: 

• Tackling Inequalities 

• Engaging Communities 

• Improving Mental Health and Wellbeing 

• Bringing Service Together 

• Prevention and Early Intervention 


The projected outturn, before the impact of COVID-19, is a year-end overspend of 
£0.027m for 2020-21, it should be noted that this is the first monitoring period and at a 
point relatively early in the financial year. 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 has been adjusted to reflect the potential impact of 
Lead Partnership services. 

From the core projections, overall the main areas of pressure are learning disability care 
packages, looked after children and adult in-patients within the lead partnership. However, 
there has been significant progress to reduce the pressures in these areas. The financial 
projection of effectively a break-even position demonstrates the progress made towards 
financial balance as part of the 2019-20 recovery plan and other service transformation 
plans contributing to reduced costs. The position also demonstrates that the work started 
before the pandemic to ensure the IJB moved into the new financial year in a financially 
sustainable position has not been delayed or impacted by the COVID-19 response. If this 
position can be sustained as we move through the year, and assuming all COVID-19 costs 
are fully funded, the IJB will secure financial balance and repay £1.5m of the debt to North 
Ayrshire Council as planned. 


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Workforce absence information is still being affected by national system issues within the 
NHS resulting in detailed information not being accessible. NHS partnership employee’s 
absence at the end of Quarter 1 is 3.81,0.68 days below the quarterly target of 4.5 days. 
NAC partnership employee’s absence at the end of Quarter 1 is 2.76 days, 0.35 days 
below the quarterly target of 3.11 days. 


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Summary of Performance 

Position at Quarter 1 2020-21 


Areas of Focus - RED 

Children, Families, Justice - 4 
Health & Community Care -1 
Mental Health -11 


Absence Measures Not Meeting Targets 

Both NAC & NHS met target for Quarter 1 

Financial Position 

£0.027m projected overspend 


1 - Strategic Plan 
Measures to 
Monitor - Amber 


28 - Strategic Plan 
Measures Meeting 
Targets - Green 


Measures reported in arrears 

% uptake of child immunisation programme 
(Rotavirus) 

% uptake of child immunisation programme 
(MMR1) 

% of preschool children protected from disease 
through uptake of primary immunisations (12 
months) 

The percentage of babies still being breast-fed at 
6/8 week review (Breastfeeding drop-off rate) 

% of children with BMI percentile >91 

% of children meeting developmental milestones 


Quarterly Comparison 


Quarter 


▲ 


Reported 1 
Quarter 
Behind 

Q1 

16 

1 

28 

6 

Q2 





Q3 





Q4 






Thresholds: - Red: 10+%; Amber: >5% and <10%; Green: <5% 


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Red - Areas of Focus Summary 


Service 

Strategic Objective 

Indicator Description 

Target 

Value 

Go to 

page 

Children, 
Families & 
Justice 
Services 

Bringing Services 
Together 

Average waiting time on C&F 
fieldwork waiting list 

86 

125 

11 

Children, 
Families & 
Justice 
Services 

Tackling Inequalities 

% of new CPO clients with a 
supervision requirement seen by 
a supervising officer within a 
week 

93% 

50% 

12 

Children, 
Families & 
Justice 
Services 

Tackling Inequalities 

% of individuals subject to CPO 
Unpaid Work Level 1 
completed within expected 
timescale 

90% 

0% 

12 

Children, 
Families & 
Justice 
Services 

Tackling Inequalities 

% of individuals subject to CPO 
Unpaid Work Level 2 
completed within expected 
timescale 

90% 

0% 

13 

Health and 
Community 
Care 

Bringing Services 
Together 

Number of patients waiting for 
CAH package (Community) 

30 

64 

14 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

Number of ABIs Delivered 
(Priority Area - Pan Ayrshire) 

855 

607 

14 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

Number of ABIs Delivered (Non 
- Priority Area - Pan Ayrshire) 

241 

92 

15 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

CAMHS - Seen within 18 weeks 
(RTT) 

90% 

63% 

16 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

Psychological Therapies - Seen 
within 18 weeks (RTT) 

90% 

75% 

17 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

AMHT - All accepted routine 
referrals will be offered 
assessment within 4 weeks. 

100% 

26% 

19 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

Adult Liaison (Psych & Alcohol) - 
All accepted Emergency 
Department referrals will be 
seen within 60 minutes. 

100% 

85% 

20 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

Every patient assessed by 
mental health liaison will be 
offered an individualised 
discharge care plan 

100% 

Not 

Available 

21 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

EMH - All accepted urgent 
referrals within the acute 
hospital will be seen within 24 
hours 

100% 

45% 

21 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

EMH - All accepted routine 
referrals within the acute 
hospital will be seen within 48 
hours 

100% 

38% 

22 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

EMH - All accepted referrals 
from community hospitals will be 
seen within 5 working days 

100% 

33% 

23 

Mental 

Health 

Services 

Improving Mental Health 
and Wellbeing 

All accepted urgent Crisis 
Resolution Team referrals will 
receive contact within 4 hours 

100% 

63% 

23 


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Positive movements 
Red -> Green 


Measure 

Target 

Change 

Number of days individuals spend in hospital beyond their 
discharge date (Bed Days Lost) 

1,936 

3,919 to 1,223 

Average working days lost to sickness absence per 
employee 
- NAC 

3.11 p/q 

3.67 to 2.76 

Percentage working days lost to sickness absence per 
employee 
- NHS 

4.5% p/q 

5.45% to 3.81% 


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Areas of Focus - In Detail 


Description 

Average waiting time on C&F fieldwork waiting list 

Health and Wellbeing 
Indicator 

Improve Life Chances 

Strategic Objective 

Bringing Services Together 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

86 

Red 

• 


125 

• 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 

We have historic data for this measure, however these figures relate to a pre-COVID-19 
baseline, so are inappropriate for comparison 


Actions to Improve Performance 


COVID-19 has had an impact on delivery of services, with only the most critical cases receiving 
services. In addition to this, the availability of staff in order to address waiting lists has been 
impacted on - due to shielding and underlying health conditions of staff members. 

There have also been vacancies due to staff leaving post. In addition to this, it has been 
identified that further resources are required in order to address demand. 

Actions 


• Staff who have been shielding are returning to work as are those with underlying health 
conditions. 

• Recruitment on going for members of staff who have left post 

• Recruitment on going for new 17.5-hour Social Worker post which has been created in 
order to address demand. 


Timescale for Improvements 


It is hoped that in the next 3 months an improvement will be noted in the number of cases 
waiting to be allocated. This will allow for recruitment process to be completed and new staff 
members to join the team. 


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Description 

% of new CPO clients with a supervision requirement seen by a 
supervising officer within a week 

Health and Wellbeing 
Indicator 

Community Safety & Public Protection 

Strategic Objective 

Tackling Inequalities 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

93 

Red 

• 


50% 

• 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 

We have historic data for this measure, however these figures relate to a pre-COVID-19 
baseline, so are inappropriate for comparison 

As a result of COVID-19 restrictions and courts prioritising serious cases, only 2 CPO’s were 
disposed during this quarter. 


Actions to Improve Performance 


Due to the unprecedented nature of the lockdown, it is difficult to propose any actions. 1 of the 2 
new CPOs were not seen in a week however we continue to experience difficulties with some 
court related activities in terms of information as different parts of the system respond to 
lockdown easing at different rates. 

Any potential actions are deferred until comparable data from the second quarter is available; 
this will hopefully identify any gaps that may be present/appear as we continue to shape our 
services to respond to easing of restrictions, return of staff to offices, etc. 


Timescale for Improvements 


Please see above. 


Description 

% of individuals subject to level 1 CPO unpaid work completed 
within expected timescale 

Health and Wellbeing 
Indicator 

Community Safety & Public Protection 

Strategic Objective 

Tackling Inequalities 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

90 

Red 

• 


0% 

• 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 

We have historic data for this measure, however these figures relate to a pre-COVID-19 
baseline, so are inappropriate for comparison 

No Unpaid work was carried out during the quarter as a result of COVID-19 restrictions, resulting 
in no completed unpaid work CPO’s 


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Actions to Improve Performance 


All Unpaid work was suspended due to COVID-19, this was recognised by the Scottish 
Government and an automatic 12-month extension for all unpaid work orders was imposed to 
ensure no Order’s expired during COVID-19 restrictions. 

Unpaid work office resumed on a small scale as of 1st August 2020, it must be noted that some 
COVID-19 social distancing remains, therefore the number of hours and days offered to service 
users^has reducedjsignificantly since pre-COVID-19._ 

Timescale for Improvements 


Continue to monitor throughout year as social distancing rules change 


Description 

% of individuals subject to level 2 CPO unpaid work completed 
within expected timescale 

Health and Wellbeing 
Indicator 

Community Safety & Public Protection 

Strategic Objective 

Tackling Inequalities 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

90 

Red 

• 


0% 

• 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 

We have historic data for this measure, however these figures relate to a pre-COVID-19 
baseline, so are inappropriate for comparison 

No Unpaid work was carried out during the quarter as a result of COVID-19 restrictions, resulting 
in no completed unpaid work CPO’s_ 

Actions to Improve Performance 


All Unpaid work was suspended due to COVID-19, this was recognised by the Scottish 
Government and an automatic 12-month extension for all unpaid work orders was imposed to 
ensure no Order’s expired during COVID-19 restrictions. 

Unpaid work office resumed on a small scale as of 1st August 2020, it must be noted that some 
COVID-19 social distancing remains, therefore the number of hours and days offered to service 
users^has reducedjsignificantly s ince pre-C O VID-19. _ 

Timescale for Improvements 


Continue to monitor throughout year as social distancing rules change 


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Description 

Number of patients waiting for CAH package (Community) 

Health and Wellbeing 
Indicator 

Quality of Life 

Strategic Objective 

Bringing Services Together 


Target 

Current 

Q4 

Q1 

Q2 

Q3 

Q4 


Status 

2019-20 

2020-21 

2020-21 

2020-21 

2020-21 

30 

Red 


64 





• 


• 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 


Actions to Improve Performance 


There are a number of actions in place which have been implemented throughout Quarter 1 to 
ensure improvement in performance to achieve the target of 30 service users in the community 
awaiting a Care at Home service. Whilst this is a new target which hasn’t previously been 
reported, the number of individuals in the community awaiting a Care at Home service has 
reduced throughout 2020 and work continues to achieve the target of 30 individuals awaiting 
Care at Home services in the community. 

Within the In-House Care at Home service there has been a number of actions taken to increase 
Care at Home capacity to ensure greater scope to support individuals getting home from hospital 
without delay. This includes additional contracted hours to existing Care at Home staff, 
temporary contracts for bank Care at Home staff and several recruitment events to increase 
staffing within the Care at Home establishment. These actions have been successful in 
increasing the capacity of the Care at Home service to facilitate greater levels of support to 
those in the community awaiting Care at Home services. 


Timescale for Improvements 


This work is ongoing and is a priority area for the Partnership. 


Description 

Number of ABIs Delivered (Priority Area - Pan Ayrshire) 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 

Current 

Q4 

Q1 

Q2 

Q3 

Q4 


Status 

2019-20 

2020-21 

2020-21 

2020-21 

2020-21 

855 

Red 

860 

607 





• 

© 

• 





Trend Commentary 


This is the first quarter that we have failed to meet the trajectory since the ABI standard was 
introduced. The number of Priority Area ABI’s completed in the quarter has decreased by 253 
(29%) from the Quarter 4 figure 

• For the first time since reporting that this quarterly target has not been met - ostensibly due 
to the impact of COVID-19 


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Performance was reduced due to the impact of COVID-19 (limited face to face contact with 
clients, staff working from home, renegotiation of the GP ABI Local Enhanced Service 
agreement, fewer opportunities for staff to deliver an ABI & some staff being redeployed into 
different priority tasks). 

Actions to Improve Performance 

• Given the current situation regarding COVID-19 we await the Scottish Governments 
Guidance for ABI delivery for 2020/21 (and to ascertain if an ABI can be reported on if 
delivered via Virtual Technology as opposed to the traditional face to face approach) 

• Agreement to be reached regarding GP ABI delivery and reporting 

• The Prevention and Service Support Team (PSST) will continue to monitor, record and 
report all ABI activity, on a quarterly basis, provided by our partners from both priority 
areas and non-HEAT wider settings. 

• PSST will continue to offer support and training, if requested, to our partners. 

• North Ayrshire ADP is seeking funding to engage with local pharmacies to deliver ABI’s 
(within the Priority Setting group) 


Timescale for Improvements 

To be deliver ed by March 2021 with ongoing review each quarter 


Description 

Number of ABIs Delivered (Non - Priority Area - Pan Ayrshire) 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 

Current 

Q4 

Q1 

Q2 

Q3 

Q4 


Status 

2019-20 

2020-21 

2020-21 

2020-21 

2020-21 

214 

Red 

438 

92 





• 

© 

• 





Trend Commentary 


This is the first quarter that we have failed to meet the trajectory since the ABI standard was 
introduced. 

The number of Priority Area ABI’s completed in the quarter has decreased by 346 (79%) from 
the Quarter 4 figure 

• For the first time since reporting that this quarterly target has not been met - ostensibly due 
to the impact of COVID-19 

Performance was reduced due to the impact of COVID-19 (limited face to face contact with 
clients, staff working from home, renegotiation of the GP ABI Local Enhanced Service 
agreement, fewer opportunities for staff to deliver an ABI & some staff being redeployed into 
different priority tasks). 


Actions to Improve Performance 


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• Given the current situation regarding COVID-19 we await the Scottish Governments 
Guidance for ABI delivery for 20/21 (and to ascertain if an ABI can be reported on if 
delivered via Virtual Technology as opposed to the traditional face to face approach) 

• Agreement to be reached regarding GP ABI delivery and reporting 

• The Prevention and Service Support Team (PSST) will continue to monitor, record and 
report all ABI activity, on a quarterly basis, provided by our partners from both priority 
areas and non-HEAT wider settings. 

• PSST will continue to offer support and training, if requested, to our partners. 

• North Ayrshire ADP is seeking funding to engage with local pharmacies to deliver ABI’s 
(within the Priority Setting group) 


Timescale for Improvements 

To be deliver ed by March 2021 with ongoing review each quarter 


Description 

CAMHS - Seen within 18 weeks (RTT) 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

90% 

Red 

• 


63% 

• 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 

We have historic data for this measure, however these figures relate to a pre-COVID-19 
baseline, so are inappropriate for comparison 

Alongside the impact of COVID-19, due to a change in data recording guidance on what 
constitutes treatment, as of February 2020, a new Referral to Treatment data set has been 
used. Previously CAMHS recorded Referral to Assessment as treatment as long as it covered 
the advice set out from ISD (January 2020 figures). Figures recorded from February 2020 cover 
the new way of recording, treatment has only started when they are allocated and working with a 
clinician 

Quarterly Breakdown: 

Total Seen: 308 

Total Seen within 18 weeks:194 
This data is subject to change 

The numbers seen and numbers seen within 18 weeks may change slightly as a result of priority 
piece of clinical admin validation 


Actions to Improve Performance 


CAMHS about to undergo Service Review in line with new CAMHS Service Specification. 


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CAMHS data is monitored weekly through weekly activity reports as well as monthly in the 
Waiting Times Meeting and NHS Performance Governance Report. The Team also has regular 
meetings with Scottish Government where any current and potential future issues are discussed. 

14 th Sept 2020 - Initial update to SPOG with plan of work and agreed direction. 

21 st Dec 2020 - Progress update to SPOG 


Timescale for Improvements 


31 st March 2021 - New arrangements/processes/ways of working to be implemented. If Board 
agreement is required for any changes, these should be sought prior to 31 March. 


Description 

Psychological Therapies - Seen within 18 weeks (RTT) 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 


Current 

Status 


Q4 

2019-20 


Q1 

2020-21 


Q2 

2020-21 


Q3 

2020-21 


Q4 

2020-21 


90% 


Red 


75% 


Trend Commentary 


This is a new measure being reported in the PAC for the first time 

We have historic data for this measure, however these figures relate to a pre-COVID-19 
baseline, so are inappropriate for comparison 

Of the 14 teams included in this measure, 4 were compliant. 

Quarterly Breakdown: 

Total Seen: 640 

Total Seen within 18 weeks: 482 

Psychological Therapies waiting times continue to remain below the 90% compliance standard. 
However, the waiting times have remained stable through the COVID-19 period and overall 
numbers of patients waiting have reduced. Psychological Therapies were 75.2% compliant as of 
July 2020 compared to 74.9% compliant in February 2020. 

The Psychological Service provision of Psychological Therapies has been maintained, as close 
to business as usual, from the outset of the pandemic using remote delivery (telephone and 
NearMe). While some Psychological Service staff were refocused on supporting staff wellbeing 
resources (e.g. Acute Wellbeing Hub) and contributing to essential service provision in the 
teams they were embedded in, the majority of staff retained their usual work focus and moved to 
remote working. 

Referral demand and Waiting Times. Referral demand has reduced across all Psychological 
Specialties. This has enabled staff to work through existing cases and to start new patients. 
Where possible, new patients have been started in waiting time order. The exception is where 
remote delivery has not been an option. Waiting times must therefore be considered with some 
caution at present. 


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While the reduced referral demand has enabled overall waiting time compliance to hold up since 
February, there is variability across the Psychological Specialties. Some Specialties are 
experiencing improved waiting times while others are experiencing increased waiting times. For 
example, the COVID-19 restrictions have had positive impact on the waiting times for the Clinical 
Health and Neuropsychological Specialties, with both managing to achieve compliance, while 
there has been a negative impact on waiting times within the Specialties of CAMHS and 
Community Paediatrics. 

The majority of Adult patients have accepted remote delivery of treatment. Within the 
Psychological Specialties of CAMPIS and Community Paediatrics, there has been low 
acceptance and suitability for remote working. This relates to the predominance of 
neurodevelopmental and neuropsychological work within CAMPIS and Community Paediatrics, 
and the limited evidence base and options to deliver these specialist assessments to children 
remotely. 


Actions to Improve Performance 


The service provision which has been paused includes face-to-face assessment and treatment; 
neuropsychological assessment in adults; neurodevelopmental and neuropsychological 
assessment in children, and: therapeutic groups. To reinstate this provision, service adaptations 
and developments have been progressed and reported on in the mobilisation plan (August 2020 
until March 2021). Actions include: 

- Continue remote delivery of psychological assessment and treatment where this is 
appropriate (e.g. dependent on individual circumstances, risk assessment and 
management, therapeutic modality). 

Expand access to an increased range of SG supported SilverCloud Computerised 
Cognitive Behavioural Therapy (cCBT) digital options. 

- Assess the requirement for and implement the recently available SG supported Internet- 
Enabled (IESO) digital option, as part of a tiered model of service delivery. 

Development of local guidelines, based on recent national and international evidence 
base and guidance, to provide guidance on remote delivery of neuropsychological and 
neurodevelopmental assessments. 

Re-instate face-to-face clinical contact that had been paused. Local guidelines have 
been co-produced, with Infection Control, to inform staff of the necessary safety 
measures and PPE to resume face-to-face assessment, as domiciliary visit and at out¬ 
patient clinics. The Service is now receiving confirmation of availability of clinic space 
and is planning reinstatement of face-to-face clinics in September. 

Reinstate face-to-face therapy using a blended approach with remote therapy when the 
benefits of doing so off-set risks (e.g. using remote delivery initially to engage a new 
patient who is anxious about attending a clinic setting, or to review a patient who 
otherwise could not attend their appointment due to financial costs), therefore removing 
barriers to accessing psychological therapy. 

Development of a remote trans-diagnostic group therapy for Adults presenting with 
distress and emotional regulation problems. It is estimated that this therapeutic group 
would be suitable for the majority of the patients waiting for Psychological input, 
removing or reducing the need for additional individual input. 


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Re-instate clinical supervision, reflective practice sessions and consultation to the wider 
clinical team who are delivering psychological interventions, including clinicians training 
in psychological treatments (e.g. Diploma in CBT, Masters and Doctorate Trainees). This 
activity will be expanded as the wider clinical staff group are released and given 
protected time for psychological work. 

- Continue to adapt provision of teaching, training and clinical placements to support 
Trainees in formal professional Psychology training courses as key to increasing capacity 
and access to psychological therapies. 

Reinstate training in psychological therapies for the wider staff team to increase capacity 
for delivery of psychological work. 

- Staff wellbeing Supports. Psychological Service staff have provided dedicated 
Psychology provision to support local staff wellbeing resources in the Acute and 
Community settings. During the COVID-19 response period, where reduced referrals 
were experienced, this support was delivered without detriment to the waiting times 
standard. However, this provision is being phased down as the COVID-19 related staff 
wellbeing needs reduce to enable clinical staff to refocus their capacity on patient care. A 
local Board proposal to sustain staff wellbeing supports through additional resource has 
been submitted. 


Timescale for Improvements 


Through further expansion of remote and digital working, and re-instatement of face-to-face 
activity, increase activity levels across the Psychological Service are expected to be achieved to 
pre-COVID-19 levels by September 2020. In April 2019, 335 new patients were seen. In April 
2020, a reduced number of 209 new patients were seen, related to COVID-19 restrictions. It is 
expected that waiting times will hold and gradually improve over the next quarter based on 
reduced referrals, increased activity, including face-to-face, service redesign and news ways of 
working. 

The Waiting Times for Psychological Therapies AOP submitted to SG in March 2020, reported a 
trajectory for compliance with the 90% standard by April 2021, assuming full staff capacity. 
Greater clarity on these trajectories will be available over the next two quarters as we see the 
changing referral demand against our ability to meet with existing capacity and within the context 
of COVID-19 restrictions and available cl ini c space. _ 


Description 

AMHT -All accepted routine referrals will be offered assessment 
within 4 weeks. 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

100% 

Red 

• 


26% 

• 




Trend Commentary 

This is a new measure being reported in the PAC for the first time 


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Please treat this figure with caution. The North recording systems have been changed to 
capture the new way of integrated working. There has also been confusion across the Teams on 
how to update the system with virtual contacts (virtual /telephone consultations implemented 
during COVID-19). 

Quarterly Breakdown 

Total Routine Referrals: 266 
Total Seen Within 4 Weeks: 69 


Actions to Improve Performance 


The data will be validated and updated/amended accordingly. This measure will be 
reviewed/monitored at the Mental Health SMT Performance and Finance monthly management 
meeting 

Quarter 2 report will include updated Quarter 1 figures 


Timescale for Improvements 


End of Quarter 2, 2020 


Description 

Adult Liaison (Psych & Alcohol) - All accepted Emergency 
Department referrals will be seen within 60 minutes. 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 


Current 

Status 


Q4 

2019-20 


Q1 

2020-21 


Q2 

2020-21 


Q3 

2020-21 


Q4 

2020-21 


100% 


Red 


85% 


Trend Commentary 


This is a new measure being reported in the PAC for the first time 

Quarterly Breakdown 

Total Referrals: 119 

Total Seen within 60 minutes: 101 


Actions to Improve Performance 


This measure will be reviewed/monitored at the Mental Health SMT Performance and Finance 
monthly management meeting 


Timescale for Improvements 


Continue to be monitored throughout the year 


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Description 

Every patient assessed by mental health liaison will be offered an 
individualised discharge care plan 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

100% 

Red 

• 


Not 

Available 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 

We are currently unable to get this data for Quarter 1. The CarePartner reporting functions have 
impacted the gathering of this data which has to be done manually. 


Actions to Improve Performance 


Senior Data Analyst to undertake a bespoke piece of work to identify the incident rate of care 
plan. Initial findings will be shared with Service Manager to identify any gaps in provision and 
subsequent actions will be identified and monitored. This measure will be reviewed/monitored at 
the Mental Health SMT Performance and Finance monthly management meeting 

The Quarter 2 report will include the Quarter 1 figures 


Timescale for Improvements 


End of Quarter 2, 2020 


Description 

EMH - All accepted urgent referrals within the acute hospital will be 
seen within 24 hours 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 


Current 

Status 


Q4 

2019-20 


Q1 

2020-21 


Q2 

2020-21 


Q3 

2020-21 


Q4 

2020-21 


100% 


Red 


45% 


Trend Commentary 


This is a new measure being reported in the PAC for the first time 

EMH - Elderly Mental Liaison Team 

Quarterly Breakdown 

Total Urgent Referrals: 66 
Total Seen within 24 Hours: 30 


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This data is subject to change and is to be treated with caution. 

Since the beginning of the COVID-19 lockdown period some administration constraints have 
been identified that have contributed to a delay in data input. There has also been confusion on 
how to record telephone/virtual contacts since the implementation at the start of COVID-19. 

The EMH Liaison data for the numbers of patients seen within the specific timescale is known to 
be lower than have actually been seen. 


Actions to Improve Performance 


Data Cleansing task in operation. This measure will be reviewed/monitored at the Mental Health 
SMT Performance and Finance monthly management meeting 


Timescale for Improvements 


End of Quarter 2, 2020 


Description 

EMH - All accepted routine referrals within the acute hospital will 
be seen within 48 hours 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

100% 

Red 

• 


38% 

• 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 

Quarterly Breakdown 

Total Routine Referrals: 77 
Total Seen within 48 Hours: 29 

This data is subject to change and should be treated with caution. 

Since the beginning of the COVID-19 lockdown period some administration constraints have 
been identified that have contributed to a delay in data input. 

The EMH Liaison data for the numbers of patients seen within the specific timescale is known to 
be lower than have actually been seen. 


Actions to Improve Performance 


Data Cleansing task in operation. This measure will be reviewed/monitored at the Mental Health 
SMT Performance and Finance monthly management meeting. 


Timescale for Improvements 


End of Quarter 2, 2020 


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Description 

EMH - All accepted referrals from community hospitals will be seen 
within 5 working days 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

100% 

Red 

• 


33% 

• 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 

Quarterly Breakdown 

Total Referrals: 39 

Total Seen within 5 working days: 13 

This data is subject to change and is to be treated with caution 

Since the beginning of the COVID-19 lockdown period some administration constraints have 
been identified that have contributed to a delay in data input. 

The EMH Liaison data for the numbers of patients seen within the specific timescale is known to 
be lower than have actually been seen. 


Actions to Improve Performance 


Data Cleansing task in operation. This measure will be reviewed/monitored at the Mental Health 
SMT Performance and Finance monthly management meeting. 


Timescale for Improvements 


End of Quarter 2, 2020 


Description 

All accepted urgent Crisis Resolution Team referrals will be 
received contact within 4 hours 

Health and Wellbeing 
Indicator 

Healthier 

Strategic Objective 

Improving Mental Health and Wellbeing 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

100% 

Red 

• 


63% 

• 





Trend Commentary 


This is a new measure being reported in the PAC for the first time 
Quarterly Breakdown - The figure of 63% is significantly underreported 
This data is subject to change and is to be treated with caution. 


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All referrals need to be categorised to ensure the correct criteria is applied. In addition, data 
gaps were identified and will be addressed in the categorisation exercise. This was missed as 
the Team has changed processes during lockdown with more phone calls than face to face 
assessments and the Team were unsure on how to record. 


Actions to Improve Performance 


Data cleaning exercise to be completed by Senior Data Analyst and refreshed figures will be 
available shortly. This measure will be reviewed/monitored weekly in the Weekly Acute Activity 
Reports in addition to the Mental Health SMT Performance and Finance monthly management 
meeting. 


Timescale for Improvements 


End of Quarter 2, 2020 


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Children, Families and Justice 

Head of Service Statement 

The COVID-19 pandemic has created challenges for all services on global, national and local 
levels. As expected, this has had an impact on child protection strategic and operational practice 
within North Ayrshire. This briefing provides an update on the work that is currently happening to 
protect our vulnerable children, young people and families during these unprecedented times. 


Child Protection Practice 


HSCP - Child Protection Conferences are continuing to take place either on a virtual or a physical 
basis and on a smaller scale (Senior Officer, Social Worker and Social Work Team Manager 
present). 

There is still a requirement to visit children on the Child Protection Register on at least a weekly 
basis. Currently 98% of children with a child protection plan have been visited within a 2 week 
period within North Ayrshire. 

Virtual Child Protection training is ongoing within the partnership. 

A child protection sub-group is meeting fortnightly on a multi-agency basis to give regular updates 
and share information. 

Education - HSCP & Education staff have an agreed protocol for supporting our vulnerable 
children and young people. This has involved establishing a multi-agency forum which meets 
weekly to allocate support to children and young people (CYP) & families at risk. The multi-agency 
meetings consider applications submitted in advance using a robust resilience matrix and 
assessment process based on the National Practice model. Several forums have taken place with 
94 vulnerable young people discussed and support measures implemented via the mainstream 
hubs. There are 8 hubs across North Ayrshire Council. 

Outreach support and respite is being offered for a very small number of families where children 
have severe and complex needs. This is discussed on a case by case basis. 

Education support is also ongoing in our outreach facilities for young people who would not benefit 
from attending a hub. 

157 Pre-5 children have now also been allocated a place in day-care or with a childminder. 

Children & Families staff have been developing packs of resources, distributing craft sets, 
colouring books, letters to all care experienced CYP and gift packs to support our most vulnerable 
families. This has been well received. 

Acute Health Services - Health have noted an increase in Initial Referral Discussion (IRD) 
activity. Child protection concerns are varied and include parental mental health concerns, 
domestic abuse, drug and alcohol issues, assault of child, unexplained injuries, indecent images, 
neglect and poor home conditions. For those CYP who do not meet the IRD threshold in North 
Ayrshire, a multi-agency IRD scrutiny group has been set up to review referrals (highlighting very 
strong practice). 

Police - Police Scotland response to child protection has not changed. If there is any risk to a 
child, then the Police will adopt their current procedures and take steps to safeguard the child in 
question. Inter-Agency Referral Discussions are a crucial part in multi-agency decision making, 
ensuring that any investigations or actions are undertaken in a child centric manner and decisions 
made are recorded in an auditable and transparent fashion. 

SCRA-The children’s hearings system and Scottish Children’s Reporter Administration (SCRA) is 
significantly affected by the Coronavirus pandemic. Some discretion applies to the timing of other 

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hearings by virtue of the emergency legislation. Given the limited amount of participation that can 
be accommodated, the reporter applies discretion, using criteria to decide whether to proceed with 
hearings or to postpone. The reporter makes every effort to consult with the allocated social 
worker as part of making the decision on whether to arrange any of these hearings. 


Child Health Services 


Childhood immunisations have continued to be delivered throughout the COVID-19 pandemic in 
North Ayrshire. The family is contacted prior to the appointment to ensure there is no one within 
the home with COVID-19 symptoms, to advise that only one adult should attend the appointment 
with the baby/child and to be reassured that the nurse will be wearing PPE. The nurses have 
reported that the attendance and immunisation uptake rates have been good. There have been a 
few occasions where a home visit has been supported to immunise the baby due to shielding 
requirements. 

The School Immunisation programme has been stalled as a result of the schools not 
operating. The missed immunisations will be caught up in 2020/21 session. However, this, along 
with the implications for the staggered school attendance, will have significant implications to how 
we staff this service in the coming year to ensure we maintain this public health 
requirement. Planning is underway to consider the implications for the school flu programme for 
2020 . 

North Ayrshire Universal Early Years (UEY) service has continued to support children and families 
throughout COVID-19. Initially Primary Visits (baby aged 11-14 days) and the 6-week check, in 
addition to any supports needed for families identified as having additional requirements, e.g. child 
protection, complex parenting issues, were the only home visits performed. Health Protection 
Guidance and NHS Ayrshire and Arran’s Infection Control Guidance has always been adhered to 
by staff attending home visits. The other HV National Timeline visits were performed over 
telephone supports, however in the last number of weeks we have piloted “Near Me" technology 
which allows the UEY teams to send an appointment for the parents to attend a virtual 
consultation. The plan is to roll Near Me out to all UEY staff as we move forward in the “new 
normal”, especially to support our core families. 

Weekly reports have been requested by Scottish Government on the number of Pathway visits 
performed. 

In addition to the Pathway visits, UEY staff have continued to support vulnerable families, weekly 
contacts for the Shielding families and provided Named Person reports. 

There has been excellent joint work between UEY and education to identify places for children 
within Early Years establishments and day care. 

During COVID-19 breastfeeding supports have continued via Universal Early Years and for the 
most complex feeding issues, Mums have been supported through a variety of routes: home visits, 
telephone consultations and near me appointments. 

Recruitment was stalled for school nurse appointments, but interviews are scheduled to take place 
in June/July. 


Children’s Houses 


Throughout the lockdown period our children and young people in our children’s houses and in 
foster care, kinship care and external placements have managed exceptionally well. We have 
experienced a very small number of young people absconding from the children’s houses, and in 
these cases, professionals’ meetings have taken place to support the young people involved. To 
this end, four young people were taken into respite accommodation during the lockdown period. 
We have successfully moved one young person to his own tenancy from one of our children’s 
houses and a further two housing applications have been submitted. 

We are continuing with ‘virtual’ Fostering Panels, Adoption & Permanency Panels. 

Since our Communications campaign started, we have approved a further 12 foster carers. 


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Child Protection / Vulnerable Children & Young People Statistics 

We have created a weekly data dashboard for all children and young people who are vulnerable 
and require support. 

The updated weekly dataset provides information ‘at a glance’ in relation to child protection and 
vulnerable young people statistics throughout the COVID-19 pandemic. This is analysed and 
discussed on a weekly basis. We are now required to send this data to Scottish Government on a 
weekly basis as part of a National dataset. 

Key Messages from this data include: 

• Increased CP activity in all localities 

• Increase in numbers of CYP being moved to other family members because of 
safeguarding issues 

• Professionals meetings taking place to support CYP who are having difficulty during 
lockdown period & as a result of absconding from our Houses. 

Child Protection Public Engagement 

Messages via social media and our updated website and are accessible to young people and 
members of the community within North Ayrshire. We also co-ordinated the publication and 
delivery of child protection resources to all of the community hubs to promote child protection 
messages to all members of communities within North Ayrshire. 

Suicide Prevention in Young People 

The Young People’s Strategic Suicide Prevention Group (YPSSPG) and Young People’s Suicide 
Taskforce will be reconvened in June 2020. Young people who overdose in the current situation 
are being monitored and further support from the Taskforce is being requested as necessary. 

Early Release Prisoners 

12 prisoners were released between 30 April to 28 May. Robust planning and support ensured that 
there were no issues surrounding reintegration back into communities. 

MAPPA meetings are ongoing and taking place virtually. 

SCR ‘Making Change Happen’ Group 

The group met on two occasions between January and March and work was postponed because 
of Lockdown. The group met for the first time on 16 June and there was a real appetite to progress 
actions. One such action for the next meeting is to scope current practice in relation to Supervision 
across all services and write a proposal for how we integrate better practice with partners to 
empower and support staff but ultimately to improve outcomes for children, young people and 
families. A written update will be taken to the Child Protection Committee after the summer to 
report on progress. 


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Next steps 


• Continue to build on existing progress to deliver high quality outcomes for children and 
families 

• Continue to adapt practice & procedure as we move through the different phases of the 
Routemap through and out of lockdown 

• Careful planning is underway regarding re-instating physical Contact arrangements (based 
on Government, Public Health & SWS guidelines 

• Continue to reduce the number of children and young people in external placements 

• Work is ongoing to deliver our Recovery Strategy taking on board the learning from this 
experience 

• Creation of a CF&J improvement and action plan 

• Progress the recommendations from the Independent Care Review 


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Health and Community Care 

Head of Service Statement 


COVID-19 Challenges 

Quarter 1 of 2020/2021 saw the beginning of the Partnership’s response to the COVID-19 
Pandemic which impacted greatly on Health and Community Care services. Due to the restrictions 
in place on social distancing and lockdown measures, several services were required to adapt their 
normal working practices to ensure compliance to the restrictions in place, whilst continuing to 
deliver essential services to the most vulnerable service users in the communities across North 
Ayrshire. Staff across all areas of Health and Social Care have shown extraordinary resilience in 
the face of such challenging times and have continued to deliver much needed support. 

As part of Health and Community Care Services Business Continuity Planning, several services 
were temporarily closed and/or reduced in capacity including Older People’s Day Services and 
Dementia Support Services. Anam Cara’s Respite service was adapted to form part of the COVID- 
19 response to surge capacity and was created as a step-down facility for individuals being 
discharged from acute settings. A further two surge sites were identified and readied in 
preparation for a peak in the virus. Furthermore, several lower level Care at Home services were 
temporarily suspended to ensure provision could be directed to those most in need of critical 
services. 

As part of the Scottish Government’s response to the COVID-19 pandemic the Partnership were 
set a target of having 0 delayed discharges from all acute hospital settings. In order to achieve this 
target a Pan Ayrshire Hospital Transitions working group was established, led by NAHSCP, with 
colleagues from East Ayrshire Health and Social Care Partnership, South Ayrshire Social Care 
Partnership and Crosshouse Hospital. Furthermore, within Health and Community Care a Delayed 
Discharge working group was established to provide a daily focus on reviewing Delayed 
Discharges across all hospital sites. Throughout Quarter 1 Health and Community Care services 
in North Ayrshire continued to prioritise hospital discharges to ensure continuous flow from all 
acute sites, achieving a significant reduction in delays from 78 Delayed Discharges at the 
beginning of Quarter 1 to the lowest of 5 Delayed Discharges during this quarter. North Ayrshire 
has been recognised nationally by Scottish Government with the significant improvement in the 
reduction of delayed discharges. 


Care at Home 


There remain significant pressures on Care at Home Services within the North Partnership and 
further additional pressures around discharges for people who require funding to transfer to care 
homes. This is further complicated by Health Protection Scotland and Public Health Guidance 
around the admission to and operation of Care Homes in that further delays can be attributed to 
both testing requirements and service users/families’ anxieties in moving into a Care Home facility. 
However, staff within Health and Community Care Services are continuing to work alongside 
colleagues in all acute sites, families and service users with a focus on supporting individuals to 
return home safely following admissions into hospital, and where they cannot do so, to be safely 
supported in the most appropriate care setting. 

The Care at Home service has continued to respond to the demand for Care at Home provision 
and have delivered vital services to thousands of individuals who remained at home throughout the 
pandemic. The Care at Home service has also seen a significant reduction in delays for 


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individuals awaiting Care at Home supports on discharge from hospital to its lowest levels in 12 
months. Within the In-House Care at Home service there has been a number of actions taken to 
increase Care at Home capacity to ensure greater scope to support individuals getting home from 
hospital without delay. This includes additional contracted hours to existing Care at Home staff, 
temporary contracts for bank Care at Home staff and several recruitment events to increase 
staffing within the Care at Home establishment. These actions have been successful in increasing 
the capacity of the Care at Home service to facilitate greater levels of support to those both in 
acute hospital sites and the community awaiting Care at Home services. 

Over 173,000 Care at Home visits were delivered across North Ayrshire in the month of May at the 
height of the COVID-19 pandemic by both Partnership Care at Home, Community Alarm and 
Telecare staff and external Care at Home Providers. 


Personal Protective Equipment (PPE) 

The response to the COVID-19 pandemic also saw the introduction of enhanced infection control 
requirements, which had a significant impact on the North Partnership’s delivery of community 
services. This required the enhancement of infection control measures around personal protective 
equipment (PPE) and these requirements have remained in place throughout Quarter 1. As such, 
a dedicated team within Health and Community Care Services was established to manage and 
focus on the ongoing sourcing, purchasing, stock management, delivery and distribution of 
personal protective equipment. The Community Equipment Store in Kyle Road, Irvine, has been 
the hub for the Partnership’s PPE activity, with a dedicated production line established in 
Bridgegate House Irvine, to support the daily distribution of PPE across North Ayrshire. There are 
currently over 26 daily distributions of PPE at drop off points across North Ayrshire, totalling over 
100 PPE drop offs weekly to Partnership staff across mainland North Ayrshire and on the islands 
of Cumbrae and Arran. The North Partnership’s Community Equipment Store was identified as the 
Social Care PPE Hub for the whole of North Ayrshire for the Scottish Governments distribution of 
PPE from the National Distribution Centre for all social care providers, unpaid carers and Personal 
Assistants and continues to operate as a vital resource for PPE and infection control support. It is 
anticipated that the Social Care PPE Hubs will continue for a minimum of six months and will be 
reviewed again nationally in October 2020. 


Enhanced Intermediate Care 


North Ayrshire Health and Social Care Partnership’s Enhanced Intermediate Care Team has 
continued to provide a seven-day service throughout Quarter 1 with a focus on facilitating early 
discharge from hospital and providing an alternative to acute hospital admission. This service has 
continued with direct input in service users’ homes, following strict Health Protection Scotland 
infection control guidance, to support individuals to remain safe and well in their own homes 
throughout the COVID-19 pandemic. The team formed close working relationships with colleagues 
within Crosshouse Hospital during the pandemic response. One example of this has been the 
close links made with colleagues within the Intensive Care Unit in Crosshouse Hospital as part of 
the In:Spire (Intensive Care Syndrome: Promoting Independence and return to employment) 
project. This allowed the team to work alongside intensive care consultants in supporting early 
referral for post COVID-19 patients who had experienced a lengthy stay in intensive care to 
receive multi-disciplinary supports via the North’s Enhanced Intermediate Care Team on discharge 
from hospital to aid and support their recovery. 


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Mental Health 


Head of Service Statement 

The ten- year Ayrshire Mental health strategy developed in 2019/2020 in alignment with the 
national mental health strategy continues to be the driving force to whole systems transformation 
across communities and services with key impact actions developed at a local level which also 
reflect the 9 National Health and Wellbeing Outcomes plus the Partnership’s 5 Strategic Priorities. 

The North Ayrshire Health and Social Care Partnership as Lead Partnership for Mental health has 
Governance oversight for monitoring of progress and reporting against the strategy. In the capacity 
of Lead Partnership for mental health, North HSCP has also led on the development of a phase 2 
and 3 mobilisation plan in response to the COVID-19 Pandemic. The plan for phase 3 takes 
account of the learning from COVID-19 response and covers the longer period to March 21 
demonstrating how the full range of services will be delivered by the end of the timeline, 
specifically bringing back any services that have paused, the detail of the work undertaken to 
model demand and projected plans to tackle waiting lists. The plan illustrates in alignment with this 
request the development of new ways of working and innovations in service delivery and work 
which will be delivered on renewal and re-design. This includes a response to the Minister for 
Mental Health request issued to Boards in her letter of 14 th July with a specific request that 
services established for the assessment of unscheduled mental health presentations are visible in 
mobilisation plans 

This urgent mobilisation activity however has enabled some service developments to be expedited 
at pace whilst some have required to be paused. 


Adult Community Mental Health Services 

As of 1 st April 2020, the Adult Community Mental Health Service was due to integrate and reside at 
the 3 Towns Resource Centre. All construction and cosmetic works were completed on time and 
the furniture had arrived and was built. Due to COVID-19, IT required prioritisation and therefore 
has not been completed at this time. There has been a delay to the teams moving into the building 
given reduced IT availability, COVID-19 and business continuity planning. The community mental 
health services teams moved into the new accommodation in June 2020 and are fully 
operationalising the new integrated model of service delivery. The footfall of staff through the 
building, and existing accommodations (Ayrshire Central Hospital and Caley Court) has been 
reduced to minimum numbers, with other staff working from home but able to mobilise from there 
as appropriate. 


PAN-Ayrshire Unscheduled Care Mental Health Services 

As of 1 st April 2020, there was an agreement that Crisis and Liaison (Adult, Alcohol and Elderly) 
teams would align together under a new unscheduled care mental health service managed by Julie 
Barrett as Senior Manager, and Mairi Gribben as Service Manager. However, due to COVID-19 
and associated challenges, this realignment was expedited on 23 rd March 2020. The service has 
continued to work through this period on service re-design to maximise workforce capacity, whilst 
also working on the development of a longer term proposal for a fit for purpose Unscheduled care 
Mental Health service which continues to build on developments in previous years. This includes 
the investment required in a sustainable solution to Emergency department re-directions at the 
request of the Scottish Government and embedded in mobilisation plans. 


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Psychological Services 

Baseline - The Psychological Service provision of Psychological Therapies has been maintained, 
as close to business as usual, from the outset of the pandemic using remote delivery (telephone 
and NearMe). The infrastructure for NearMe was already in use within the Psychological 
Specialties of Adult Mental Health and Clinical Health and has since been rolled out across the 
wider Psychological Specialties. 

At the outset of the pandemic, and in preparation for disruption to service delivery, RAG ratings 
were undertaken of open cases, the most vulnerable patients identified, and care plans developed. 
Patients waiting for assessment and treatment were contacted by letter or telephone. While some 
Psychological Service staff were refocused on supporting staff wellbeing resources (e.g. Acute 
Wellbeing Hub) and contributing to essential service provision in the teams they were embedded 
in, most staff retained their usual work focus and moved to remote working. 


Referral demand and Waiting Times - Referral demand has reduced across all Psychological 
Specialties. This has enabled staff to work through existing cases and to start new patients. Where 
possible, new patients have been started in waiting time order. The exception is where remote 
delivery has not been an option. Waiting times must therefore be considered with some caution at 
present. Waiting times have been maintained at pre-COVID-19 levels. 

In the earlier phase of the COVID-19 response, there was reduced activity related to staff shifting 
from a clinic based face-to-face service to a home and remote working service, and to identifying 
those patients suitable for remote working. While the reduced referral demand has enabled overall 
waiting time compliance to hold up since February, there is variability across the Psychological 
Specialties. Some Specialties are experiencing improved waiting times while others are 
experiencing increased waiting times. The COVID-19 restrictions have had greatest impact on the 
waiting times for the Child Specialties of CAMHS and Community Paediatrics. 

New referrals have been accepted, assessed remotely and, where suitable for psychological input, 
placed on waiting lists. The majority of Adult patients have accepted remote delivery of treatment. 
Within the Psychological Specialties of CAMHS and Community Paediatrics, there has been low 
acceptance and suitability for remote working. This is in contrast to Medical Paediatrics which has 
a 95% acceptance of remote working. This relates to the predominance of neurodevelopmental 
and neuropsychological work within CAMHS and Community Paediatrics, and the limited evidence 
base and options to deliver these specialist assessments to children remotely. 


Recovery Plan - The service provision which has been paused includes face-to-face assessment 
and treatment; neuropsychological assessment in adults; neurodevelopmental and 
neuropsychological assessment in children, and: therapeutic groups. 

To reinstate this provision, service adaptations and developments have been progressed and 
reported on in the mobilisation plan August 2020 until March 2021. 

Actions include: 

- Continue remote delivery of psychological assessment and treatment where this is 
appropriate (e.g. dependent on individual circumstances, risk assessment and 
management, therapeutic modality). 

Expand access to an increased range of SG supported SilverCloud Computerised 
Cognitive Behavioural Therapy (cCBT) digital options. 

- Assess the requirement for and implement the recently available SG supported Internet- 
Enabled (IESO) digital option, as part of a tiered model of service delivery. 


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Development of local guidelines, based on recent national and international evidence base 
and guidance, to provide guidance on remote delivery of neuropsychological and 
neurodevelopmental assessments. 

Re-instate face-to-face clinical contact that had been paused. Local guidelines have been 
co-produced, with Infection Control, to inform staff of the necessary safety measures and 
PPE to resume face-to-face assessment, as domiciliary visit and at out-patient clinics. 
Psychological Service staff are now receiving notification of their access to clinics and are 
planning a return to face-to-face work in September. Access is reduced from pre-COVID-19 
levels but will enable targeting of patients waiting for face-to-face. 

Reinstate face-to-face therapy using a blended approach with remote therapy when the 
benefits of doing so off-set risks (e.g. using remote delivery initially to engage a new patient 
who is anxious about attending a clinic setting, or to review a patient who otherwise could 
not attend their appointment due to financial costs), therefore removing barriers to 
accessing psychological therapy. 

Development of a remote trans-diagnostic group therapy for Adults presenting with distress 
and emotional regulation problems. It is estimated that this therapeutic group will be 
suitable for the majority of the patients waiting for Psychological input, removing or reducing 
the need for additional individual input. 

- Through the developments of further expansion of remote and digital working, and re¬ 
instatement of face-to-face activity, increase activity levels across the Psychological 
Service to pre-COVID-19 levels by September 2020. In April 2019, 335 new patients were 
seen. In April 2020, a reduced number of 209 new patients were seen, related to COVID-19 
restrictions. 

Re-instate clinical supervision, reflective practice sessions and consultation to the wider 
clinical team who are delivering psychological interventions, including clinicians training in 
psychological treatments (e.g. Diploma in CBT, Masters and Doctorate Trainees). This 
activity will be expanded as the wider clinical staff group are released and given protected 
time for psychological work. 

- Continue to adapt provision of teaching, training and clinical placements to support 
Trainees in formal professional Psychology training courses as key to increasing capacity 
and access to psychological therapies. 

Reinstate training in psychological therapies for the wider staff team to increase capacity for 
delivery of psychological work. 


Staff Wellbeing - Local health and social care staff can access first phase psychological first aid 
and brief intervention through the local Staff Care service, the recently launched local Listening 
Service which will expand its remit to the independent scare sector staff, the national information 
and helpline resource of PRoMIS and NHS 24, and the Acute and Community Wellbeing Hubs. 
Immediate access to stepped-up formal Psychological Therapy provision will continue to be 
provided from within existing Psychological Services resource until end August. A local proposal to 
sustain staff wellbeing supports, positively evaluated during the COVID-19 response, is being 
presented to the Board late August. 


33 


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NORTH AYRSHIRE 
Health and Social Care 
Partnership 


CAMHS & CEPS 


Key priorities for noting: 

• The national CAMHS Specification was released during January/February and meetings 
with the Scottish Government established to agree revised actions to ensure compliance 
and reporting progress for the new specification. These planning conversations have 
continued through this period, aligned to mobilisation planning with Scottish Government 
representatives on the daily, then weekly Mental Health briefing meetings. 

• The AOP mitigation plan for the Scottish Government re projected shortages in 
Psychological Service provision has been revised to reflect current challenges in alignment 
with the mobilisation plan for services phase 2 and 3. In response to this the service will be 
undertaking an exercise to harmonise what is currently three locality caseloads into one 
Pan Ayrshire caseload. It is envisaged that all waiting lists will also be merged when the 
current COVID-19 working arrangements have ceased. 

The following actions were implemented successfully to manage the pandemic: 

• All known children and young people already engaged in the service have been receiving 
telephone contact over the course of fortnightly cycles with their parents/ carers/ guardians’ 
able contact us at any point 

• Patients actively contacted and kept engaged, waiting no more than a fortnight between 
contacts. 

• Anticipated adaptation of Neuro assessment clinics with consideration for infection control 
to allow engagement with children for completion of assessment, to recommence August 
2020 

• Continued to undertake ‘urgent’ work throughout the pandemic 

• Restructure of team into two staff groups: one group of staff at work undertaking triage, 
assessment & allocation of referrals with the other team working from home engaging via 
Attend Anywhere and telephone, 

• All team clinic locations have been risk assessed and able to utilise the space however in a 
reduced capacity, 

• Moved the young people who are known to the service and requiring a face to face contact 
from their Locality care coordinators or the Intensive Support Team to release capacity for 
the duty and triage system, 

• Organised clinic space to increase available face to face appointments from 3 per day to 24 
per day offering a mixture of nursing, OT, Psychology, SALT and Psychiatry, 

• Worked with the staff team to review their caseloads and allocated appointments to people 
who are on the waiting list, and offered face to face appointments to young people who 
have indicated that they would prefer to wait rather than use NHS Near Me 

• National Adolescent Secure In-patient Service - Design work is complete, and the full 
business case has continued to be developed through this period - projected completion 
date for the full business case is the end of August 2020. 


Addiction Services 


• Staff have continued to offer all interventions during the last 3 months with more face to face 
appointments/visits being offered in addition to increased telephone contact. 

• Staff have been trialling out the use of Virtual Technology (Near Me) 

• A new Mobilisation Plan (phase 3) has been agreed and is being implemented which includes 
increasing face to face contacts for all new and existing clients 

• Ward 5 reintroduced the rehabilitation element of its programme over the last month (although 
Ward is working on a reduced bed capacity basis as the ward environment has had to be 
relocated to another ward to help facilitate essential fire stop work in Woodland View) 

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Health and Social Care 
Partnership 


• Our Prevention and Service Support Team staff have reintroduced some training (on agreed 
priority topics) and as part of the Mobilisation Plan, have adapted their training courses so that 
they be delivered remotely, virtually and now face to face (although at a smaller scale than 
previous) 

The Pan Ayrshire Alcohol Brief Intervention quarterly delivery target has not been met for the first 
time ever, ostensibly due to the impact of COVID-19. An improvement plan has been identified 
and is being implemented. 


Learning Disabilities 

The Learning Disability Service continues to undergo significant transformation, driven now by the 
need to respond to and advocate on behalf of clients in the context of the pandemic, as much as 
by its existing change agenda. After opening in January of this year, Trindlemoss Day 
Opportunities continued to develop its collaborations and programme of activities. Of the 20 
available tenancies at Trindlemoss, 17 are now occupied. 

The Assessment and Treatment Unit at Arrol Park has successfully moved to its new site in Ward 
7a at Woodlands View. 

As with all services, the impact of the pandemic has been profound, and introduced delays to 
some planned activities, particularly the move to the new Complex Needs Unit at Trindlemoss. 

That move did take place on the 8 th of June, and the Unit (now known as Trindlemoss House) is 
currently functioning, with 5 of 6 available spaces occupied. The planned co-location of the Social 
Work and NHS components of the community team has by necessity been postponed; however, 
their existing strong joint working practices have ensured a co-ordinated response to the ongoing 
crisis. 

Remote support has also been a feature of other activity across the service, including the delivery 
of Wellness Recovery Action Planning (WRAP) sessions by Day Opportunities staff, and the use of 
Near Me by the Community Team. All within the service are deeply conscious of the 
marginalisation experienced by people with learning disabilities in general; the potential for the 
pandemic to compound this through the erosion or diversion of activity; and the need to ensure 
that they benefit from the learning and any investment which flows out of the ongoing crisis. 


Inpatient Services 

Service development highlights include the following during the Quarter 1 period: 

Highlights 

• Reconfigured inpatient services in face of COVID-19 pandemic to create assessment ward and 
potential treatment ward for COVID-19 positive cases. 

• Continued review of contingency plans and operational practice as new expectation/guidance 
received re PPE etc 

• Successfully recruited to a number of important posts including AMH and EMH Consultant 
Psychiatrist posts and CNM for Rehabilitation and Forensic Services 

• Supported introduction of Emergency Department redirection pathway to avoid persons in 
mental health/social crisis being assessed at Emergency Department where possible 

• Had positive visits to Ailsa and Woodland View by A&A Chief Executive, Medical Director, 
Nurse Director, Head of Mental Health and Associate Nurse Director to visit staff on wards and 
hear how COVID-19 has affected them and service delivery 

• Refurbishment works continued to Clonbeith and Dunure wards at Ailsa 


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NORTH AYRSHIRE 
Health and Social Care 
Partnership 


• Plan to allow eventual closure of Lochranza Ward at Ailsa identified with alternative community 
provision identified 

• Opening of Staff Wellbeing Hubs - ACH and Ailsa 


Challenges 

• Supporting anxious families unable to visit loved ones due to coronavirus considerations 

• Sustaining delivery of services while 20+ substantive staff unavailable longer term due to 
COVID-19 shielding considerations 

• Ensuring resilience across services associated with Coronavirus recognising will be months in 
duration and encouraging staff to take annual leave 

• Supporting development of NHS A&A remobilisation plans for Scottish Government 

• Supporting increased demand for inpatient services whilst balancing Woodland View Fire Stop 
works programme and potential need to reconfigure services if COVID-19 considerations 
become priority again 


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NORTH AYRSHIRE 
Health and Social Care 
Partnership 


System Wide 

Absence Statement 


NAC - staff absence to 30 th June 2020 is detailed in Appendix 2. The quarterly target has changed 
from 2.75 to 3.11. Sickness absence from NAC staff in the partnership is 2.76 days, 0.35 days 
below the quarterly target of 3.11 working days and 34% lower than the same period in 2019/20 
(3.69 days). 

The teams not meeting target at the end of Q1: CF-Fieldwork; HCC-Primary Care Service; 
FISCP-Planning; MHS-Community; MFIS-Learning Difficulties. (Appendix III, page 49) 


NHS - Sickness absence from NFIS staff in the partnership is 3.81 days, 0.68 days below the 
quarterly target of 4.5 working days and is 57% lower than the same period in 2019/20 (5.97 days). 


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NORTH AYRSHIRE 
Health and Social Care 


Finance 


Projected Financial Position 

The projected outturn, before the impact of COVID-19, is a year-end overspend of £0.027m for 2020-21, it 
should be noted that this is the first monitoring period and at a point relatively early in the financial year. 
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 has been adjusted to reflect the potential 
impact of Lead Partnership services. 

From the core projections, overall the main areas of pressure are learning disability care packages, looked 
after children and adult in-patients within the lead partnership. However, there has been significant progress 
to reduce the pressures in these areas. The financial projection of effectively a break-even position 
demonstrates the progress made towards financial balance as part of the 2019-20 recovery plan and other 
service transformation plans contributing to reduced costs. The position also demonstrates that the work 
started before the pandemic to ensure the IJB moved into the new financial year in a financially sustainable 
position, has not been delayed or impacted by the COVID-19 response. If this position can be sustained as 
we move through the year, and assuming all COVID-19 costs are fully funded, the IJB will secure financial 
balance and repay £1.5m of the debt to North Ayrshire Council as planned. 

Savings 

The savings plan for 2020-21 anticipates that a total of £2.746m of savings will be delivered in-year, with 
£1.115m of savings potentially delayed or reduced. The delays are due to COVID-19 and have been 
included in the mobilisation plan return to the Scottish Government, but at this stage they have also been 
reflected in the overall projected outturn position as there is less confidence that the impact of savings 
delays will be compensated with additional funding. 

COVID-19 impact 

The IJB were provided with a report on 16 July 2020 which highlighted the potential financial impact of the 
COVID-19 response and the significant financial risk to the IJB. From the outset of the pandemic the HSCP 
acted very swiftly to respond and developed a mobilisation plan detailing the additional activities to support 
our response, alongside the estimated financial impact. Financial returns have been submitted to the 
Scottish Government on a regular basis, on the premise that any additional costs aligned to mobilisation 
plans would be fully funded. 

There is a risk that if the full cost of the COVID-19 response is not funded that the IJB may require to 
recover any overspend in-year. In July the IJB agreed that a follow up report would be presented to the IJB 
in August outlining the updated cost estimates, the financial year-end projections and any potential funding 
gap based on scenarios re COVID-19 funding. The IJB also need to consider any action required to 
recover the financial position in-year. 

Moving Forward 

Continuing to closely monitor the financial position will allow the IJB to take corrective action where required 
to ensure the partnership can deliver services in 2020-21 from within the available resource, thereby limiting 
the financial risk the funding partners, i.e. NAC and NHS A&A. 

The estimated costs and funding in relation to the COVID-19 response also require to be closely monitored 
to ensure that the IJB can plan for the impact of this and also to ensure that the IJB is in the position to re¬ 
claim funding to compensate for the additional costs. 

The full Quarter 1 financial report will be available via the North Ayrshire website - IJB 2020/21 Quarter 1 
Finance Update 


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MSG Trajectories 


NORTH AYRSHIRE 
Health and Social Care 
Partnership 


MSG information is provided by the Information Services Division of the NHS and is subject to 
monthly change due to the data completeness and validation process undertaken by the SOURCE 
team. 


Under 18 - The information in the data cards represent the last 3 months available data. 

Emergency Admissions; Under 18 Unscheduled Bed Days - Acute 



* 20-21 Actual —*—19-20 Actual * 20-21 Actual —*—19-20 Actual 


Emergency Admissions - Acute 


Unscheduled Bed Days - Acute 

March 2020 - 194 


March 2020 - 180 

April 2020 - 96 


April 2020-112 

May 2020 - 99 


May 2020 - 92 


A&E Attendances 

March 2020 - 176 
April 2020 - 90 
May 2020 - 96 


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NORTH AYRSHIRE 


Over 18 - The information in the data cards represent the last 3 months available data. Heath and Social Caro 


Emergency Admissions Over 18 

2000 
1500 
1000 
500 



0 


.rP .r? rP 

* vO 




n? .rP ,rP ^ .fr 

^ <<«? 

•20-21 Actual ♦ 19-20 Actual 


Unplanned Bed Days - Acute Over 18 


12000 

10000 

8000 

6000 

4000 

2000 

0 




• 20-21 Actual —•— 19-20 Actual 


Delayed Discharges (All Reasons) 


3000 

2000 

1000 

0 



•---♦ 



Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 


-♦—20-21 Actual 19-20 Actual 


Emergency Admissions - Acute 


Unscheduled Hospital Days 

March 2020- 1,137 


March 2020-8,851 

April 2020 - 850 


April 2020-5,713 

May 2020 - 1,066 


May 2020-6,144 


A&E Attendances 


Delayed Discharge bed Days - All 

March 2020 - 638 


March 2020 - 2,073 

April 2020 - 793 


April 2020 - 787 

May 2020 - 996 


May 2020 - 466 


Delayed Discharge bed Days -H&SC 

March 2020- 1,701 
April 2020 - 595 
May 2020 - 332 


40 


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Appendix I 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


MSG Trajectories with Rates 

Note - figures up to January 2020 are presented as complete, others a subject to change due to 
data completeness and are for restricted management information purposes only. 



Monthly Data 

Performance Indicator 

Dec 

2019 

Jan 

2020 

Feb 

2020 

Mar 

2020 

April 

2020 

May 

2020 

Performance 

Data Last 

Updated 

Number of Emergency 
Admissions to Acute 

Hospitals 

1,715 

1,663 

1,385 

1,237 

946 

1,165 

May 

Emergency Admissions to 
Acute Hospitals Rate per 

1000 

12.7 

12.3 

10.3 

9.2 

7.0 

8.6 

May 

Number of Admissions from 

Emergency Dept. 

1,121 

1,034 

943 

814 

883 

1,092 

May 

Admissions from Emergency 
Dept. Rate per 1000 

8.3 

7.7 

7.0 

6.0 

6.6 

8.1 

May 

Emergency Dept, conversion 

rate 

35 

32 

32 

32 

45 

42 

May 

Number of unscheduled 

hospital bed days in Acute 

1 1,021 

10,870 

9,216 

7,396 

5,825 

6,236 

May 

Unscheduled Hospital Bed 
days in acute rate per 1000 

81.8 

80.7 

68.4 

67.0 

43.2 


April 

Number of Emergency Dept. 
Attendances 

3,241 

3,268 

2,975 

2,527 

1,961 

2,592 

May 

Emergency Dept, attendances 
Rate per 1000 

24.1 

24.3 

22.1 

18.8 

14.6 

19.2 

May 

Number of Delayed 

Discharges bed days (all 
reasons) 

2,1 10 

2,333 

2,164 

2,073 

787 

466 

May 

Number of Delayed 

Discharges bed days (all 
reasons) rate per 1000 

19.3 

21.3 

19.8 

18.9 

7.2 

4.3 

May 

Number of Delayed 

Discharges bed days (code 9) 

21 7 

229 

197 

372 

192 

134 

May 

Number of Delayed 

Discharges bed days (Code 9) 
rate per 1000 

2.0 

2.1 

1.8 

3.4 

1.8 

1.2 

May 


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Appendix II - All Performance Measures 

Thresholds: Red - 10+%; Amber - >=5% and <10%; Green - <5% 


sg' 

NORTH AYRSHIRE 
Health and Social Care 
Partnership 


Measure 

Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

2020-21 

% of children looked after in a community placement 

91% 

Green 

90% 

90.52% 






© 

© 

© 




Number of families with more than 1 consecutive foster placements 

3 

Green 

New 

3 






© 

Measure 

© 




Number of families with more than 1 moves into care 

3 

Green 

New 

2 






© 

Measure 

© 




Number of families with more than 1 consecutive residential 

3 

Green 

New 

0 




placements 


© 

Measure 

© 




Increase the number of Children accessing Direct Payments 

43 

Green 

45 

44 






© 

© 

© 




Increase the number of in-house foster carers 

95 

Green 

98 

101 






© 

© 

© 




Preschool children protected from disease through % uptake of child 

97% 

Amber 

90.3% 


immunisation programme (Rotavirus) 


& 

▲ 


Preschool children protected from disease through % uptake of child 

96.5% 

Green 

93.7% 


immunisation programme (MMR1) 


© 

© 


% of preschool children protected from disease through uptake of 

97% 


New 


primary immunisations (12 months) 



Measure 

Information reported in arrears due to data 

The percentage of babies still being breast-fed at 6/8-week review 

49.3% 


New 


validation timescales 

(Breastfeeding drop-off rate) 



Measure 


% of children with BMI percentile >91 

10.5% 


New 





Measure 


% of children meeting developmental milestones 

78% 


New 





Measure 


% young people receiving aftercare who are in employment, 

44% 

Green 

New 

58.82% 




education or training 


© 

Measure 

© 





42 


171 




























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Average waiting time on C&F fieldwork waiting list 

86 

Red 

• 

New 

Measure 

125 

• 



_NORTH AYE 

Health and So 
Partners 

SHIRE 
:ial Care 
lip 

% of new CPO clients with a supervision requirement seen by a 
supervising officer within a week 

93% 

Red 

• 

New 

Measure 

50% 

• 




% of individuals subject to level 1 CPO unpaid work completed within 
expected timescale 

90% 

Red 

• 

New 

Measure 

0% 

• 




% of individuals subject to level 2 CPO unpaid work completed within 
expected timescale 

90% 

Red 

• 

New 

Measure 

0% 

• 





Number of Adults accessing Direct Payments 

140 

Green 

© 

139 

© 

137 

© 




Percentage of ICT service users seen within 1 day of referral 

90% 

Green 

© 

99.14% 

© 

98.01% 

© 




Number of Service users receiving Care at Home 

2,167 

Green 

© 

1,970 

© 

1,980 

© 




Number of days individuals spend in hospital beyond their discharge 
date (bed days lost) 

1,936 

Green 

© 

3,919 

• 

1,223 

© 




Number of patients waiting for CAH package (Hospital) 

12 

Green 

© 

84 

& 

6 

© 




Number of individuals waiting for CAH package (Community) 

30 

Red 

• 

New 

Measure 

64 

• 




Number of Service Users delayed due to funding being confirmed 

10 

Green 

© 

8 

• 

2 

© 




Number of Service Users delayed in discharge to a care home after 
funding confirmed 

10 

Green 

© 

" 

i 

© 




Number of individuals confirmed with a care at home package 

650 

p/q 

Amber 

▲ 

New 

Measure 

590 

A 




Number of individuals in receipt of Digital/Telecare Technology 

5,500 

Green 

© 

New 

Measure 

4,400 

© 





Number of LD service users in voluntary placements. 

43 

Green 

© 

57 

© 

57 

© 





43 


172 








































Official-Protect 


WORTH AYRSHIRE 
icial Care 
lip 


Addictions referrals to Treatment within 3 weeks (Alcohol) 

90% 

Green 

98.6% 

100% 



Health and So< 
Partners 


© 

© 

© 



Addictions referrals to Treatment within 3 weeks (Drugs) 

90% 

Green 

100% 

100% 





© 

© 

© 




Addictions referrals to Treatment within 6 weeks (Alcohol) 

100% 

Green 

100% 

100% 





© 

© 

© 




Addictions referrals to Treatment within 6 weeks (Drugs) 

100% 

Green 

100% 

100% 





© 

<9 

© 




Number of ABIs Delivered (Priority Area - Pan Ayrshire) 

855 

Red 

860 

607 





p/q (Pan 
Ayrshire) 

• 

© 

• 




Number of ABIs Delivered (Non-Priority Area - Pan Ayrshire) 

214 

Red 

438 

92 





p/q (Pan 
Ayrshire) 

• 

© 

• 




Number of Naloxone Kits Supplied 

60 

Green 

145 

955 





© 

© 

© 




CAMHS - Seen within 18 weeks (RTT) 

90% 

Red 

New 

63% 






• 

Measure 

• 




Psychological Therapies - Seen within 18 weeks (RTT) 

90% 

Red 

New 

75% 






• 

Measure 

• 




AMHT - All accepted urgent referrals will be offered assessment 

100% 

Green 

New 

100% 




within 24 hours. 


© 

Measure 

© 




AMHT - All accepted routine referrals will be offered assessment 

100% 

Red 

New 

26% 




within 4 weeks. 


• 

Measure 

• 




Adult Liaison (Pysch & Alcohol) - All accepted Emergency 

100% 

Red 

New 

85% 




Department referrals will be seen within 60 minutes. 


• 

Measure 

• 




All accepted Urgent mental health referrals will be seen within 24 

100% 

Green 

New 

100% 




hours from Acute wards (Medical & Surgical at Ayr and Crosshouse) 


© 

Measure 

© 




Every patient assessed by mental health liaison will be offered an 

100% 

Red 

New 

• 




individualised discharge care plan 


• 

Measure 

Not 

Available 




EMH - All accepted urgent referrals within the acute hospital will be 

100% 

Red 

New 

45% 




seen within 24 hours 


• 

Measure 

• 





44 


173 
























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EMH - All accepted routine referrals within the acute hospital will be 
seen within 48 hours 

100% 

Red 

• 

New 

Measure 

38% 

• 



Health and So< 
Partners 

EMH - All accepted referrals from community hospitals will be seen 
within 5 working days 

100% 

Red 

• 

New 

Measure 

33% 

• 




The elderly mental health liaison service will aim for a reduction in 
return referrals by 20% 

20% 

Reduction 

Green 

© 

New 

Measure 

-25% 

© 




All accepted urgent Crisis Resolution Team referrals will be received 
contact within 4 hours 

100% 

Red 

• 

New 

Measure 

63% 

• 




The Crisis Resolution Team will support individuals for up to a 
maximum of 21 days 

100% 

Green 

© 

New 

Measure 

95.3% 

© 




The Crisis Resolution Team will support the early discharge of 
patients from inpatients, reducing average lengths of stay 

5% 

Reduction 

Green 

© 

New 

Measure 

-14.3% 

© 





Average working days lost to sickness absence per employee 
- NAC 

3.11 

p/q 

Green 

© 

14.43 

• 

2.76 

© 




Percentage working days lost to sickness absence per employee 
- NHS 

4.5% 

p/q 

Green 

© 

5.45% 

• 

3.81% 

© 





:ial Care 

ip 


45 


174 

























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Appendix III - Workforce Absence 

Table la NAC 2020-21 Data 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


HSCP Planning 


Health it Community Care 

776.75 

094 

0.85 

091 

HSCP - Finance 

27.14 

0.48 

0.02 

090 

HSCP Performance 

850 

090 

0.00 

090 


MO 


3.59 


2.48 


2.91 


Directorate/Section 

FTE 

April 

May 

June Jul Aug 

Sep Oct Nov 

Dec Jan 

Feb 

Mar 

YTD 

YTD Target 

Varience 

CF - Fieldv*orfc 

8490 

129 

1.39 

122 





391 

190 

291 

CF - Intervent Serv 

83.10 

0.7 S 

0.66 

191 





242 

3.16 

*0.74 

OF - Justice Services 

67.70 

053 

0.93 

19S 





281 

324 

-042 

CF-LAAC 

12391 

143 

1.37 

052 





331 

456 

-1.24 

CF - Pract Oev & Rev 

1950 

090 

0.00 

036 





036 

125 


CF - Unrver tarty Yrs 

1620 

090 

0.00 

090 | 





090 

125 


Child, Fam ifees&Justice 

40041 

1.04 

1.01 

054 





259 

3.12 


HCC - A/ran Services 

9.64 

090 

0.00 

090 



090 

125 


HOC - Comm Care Serv 

61754 

09S 

1.00 

093 



289 

322 


HCC - locality Services 

10093 

1.12 

0.19 

051 



153 

255 


HCC * long Term Cond 

2254 

0.17 

0.88 

094 



199 

125 


HCC * Primary Care Serv 

1090 

220 

0.00 

090 



220 

125 

095 

HCC - Rehab & fteabie 

1340 

090 

0.00 

090 



090 

295 



050 

OOO 


898 


238 

125 


239 


6.59 


HSCP Finance & Transform 

3994 

0.61 

ai3 

020 



094 

215 


MHS - Addictions 

2140 

194 

0.83 

0.19 



296 

445 


MHS - Community 

1890 

298 

210 

157 



694 

625 

0.69 

MHS - Learning Oiff 

4956 

288 

233 

192 



7.13 

625 

058 

Mcrtal Health 

89.16 

246 

1.92 

149 

1 1 1 

1 1 1 

1 _ 1 _ 1 _L S57 J 

552 

095 

HSCP Business Admin 

17459 

0.89 

0.48 

048 



154 

241 


HSCP Senior Managers 

1090 

144 

0.00 

090 



1.44 

295 

-0.61 

HSCP 

1.4893S 

195 

090 

051 

276 

3.11 

-0J4 


46 


175 

































Official-Protect 


NORTH AYRSHIRE 
Health and Social Care 
Partnership 

Table 1b NAC 2019-20 Data 


# 

A 

Di rectorate/Section 

April 

May 

June 

Ail 

Aug 

Sep 

Oct 

Nov 

Dec 

Jan 

Feb 

Mar 

YTD 

YTD Target 

Varience 

40 

Butneu Administration 

0.45 

0.70 

097 










2.12 

2.75 


41 

CF - Fieldwork 

093 

102 

1.14 










2.99 

2.75 

024 

42 

CF - Intervent Serv 

1.71 

1.54 

092 










4.17 

2.75 

142 

43 

CF - justice Services 

1.14 

2.07 

292 










5.23 

2.75 

2.48 

44 

CF - LAAC 

1.73 

2.06 

2.15 










5.94 

2.75 

3.19 

45 

CF - Pract Dev & Rev 

0.00 

000 

090 










0.00 

2.75 


46 

CF - Unrver Earty Yrs 

0.00 

0.45 

090 










045 

2.75 

-2J0 

47 

HOC - Arran Services 

0.00 

017 

090 










0.17 

2.75 

-2 

48 

HGC - Comm Care Serv 

122 

1.26 

1.16 










3.66 

2.75 

091 

49 

HOC - Locality Services 

1.50 

051 

0.79 










3.11 

2.75 

036 

50 

HOC - Long Term Cond 

0.71 

013 

0.13 










0.97 

2J75 

-1.78 

51 

HOC - Primary Care Serv 

0.00 

1.10 

090 










1.10 

2.75 

-1.65 

52 

HOC - Rehab fli Reabie 

226 

2.66 

3.46 










8.58 

2.75 

583 

S3 

HSCP - Finance 

0.09 

0.00 

019 










0.28 

2.75 

-247 

54 

MHS - Addictions 

0.59 

159 

192 










4.10 

2.75 

13S 

55 

MHS - Community 

130 

350 

191 










6.71 

2.75 

396 

56 

MHS - Learning Diff 

237 

3.47 

2.67 










9.01 

2.75 

626 

57 

Plan & Performance 

031 

154 

191 










2.66 

2.75 

-0.09 

58 

Senior Managers 

0.00 

0.00 

090 










0.00 

2.75 

-2.7S 

59 

HSCP 

1.16 

150 

153 

3.69 

2.75 

094 


47 


176 
























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Table 2 NHS 2020-21 


Continuing system issues has resulted in data being unavailable 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


48 


177 


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NORTH AYRSHIRE 
Health and Social Care 
Partnership 


Appendix IV - Finance 


Partnership Budget - Objective Summary 

2020/21 Budget 

Council 

Health 

TOTAL 

Budget 

Outturn 

Over/ 

(Under) 

Spend 

Variance 

Budget 

Outturn 

Over/ 

(Under) 

Spend 

Variance 

Budget 

Outturn 

Over/ 

(Under) 

Spend 

Variance 

E'OOO 

E'OOO 

E'OOO 

E’OOO 

E’OOO 

E'OOO 

E’OOO 

E'OOO 

E'OOO 

COMMUNITY CARE AND HEALTH 

56,074 

54,590 

(1,484) 

13,752 

13,899 

147 

69,826 

68,489 

(1,337) 

: Locality Services 

23,630 

22,532 

(1 ,098) 

4,799 

4,799 

o 

28,429 

27,331 

(1 ,098) 

: Community Care Service Delivery 

28,608 

28,622 

14 

O 

O 

o 

28,608 

28,622 

14 

: Rehabilitation and Reablement 

1 ,985 

1 ,695 

(290) 

1 ,902 

1 ,91 O 

8 

3,887 

3,605 

(282) 

: Long Term Conditions 

1 ,487 

1 ,363 

(124) 

4,941 

5,1 OO 

1 59 

6,428 

6,463 

35 

: Integrated Island Services 

364 

378 

1 4 

2,1 1 O 

2,090 

(20) 

2,474 

2,468 

(6) 

MENTAL HEALTH SERVICES 

24,794 

26,234 

1,440 

52,748 

50,952 

(1,796) 

77,542 

77,186 

(356) 

: Learning Disabilities 

1 8,572 

20,195 

1 ,623 

448 

448 

O 

1 9,020 

20,643 

1 ,623 

: Community Mental Health 

4,739 

4,531 

(208) 

1 ,635 

1 ,635 

O 

6,374 

6,1 66 

(208) 

: Addictions 

1 ,483 

1 ,508 

25 

1 ,340 

1 ,340 

o 

2,823 

2,848 

25 

: Lead Partnership Mental Health NHS Area Wide 

O 

O 

0 

49,325 

47,529 

(1 ,796) 

49,325 

47,529 

(1 ,796) 

CHILDREN & JUSTICE SERVICES 

32,186 

32,745 

559 

3,815 

3,815 

O 

36,001 

36,560 

559 

Irvine, Kilwinning and Three Towns 

3,281 

3,236 

(45) 

O 

O 

o 

3,281 

3,236 

(45) 

Garnock Valley, North Coast and Arran 

1 ,256 

1 ,1 80 

(76) 

O 

O 

o 

1 ,256 

1 ,1 80 

(76) 

Intervention Services 

2,1 04 

2,094 

(lO) 

31 5 

31 5 

o 

2,41 9 

2,409 

(lO) 

North Ayrshire Wide Services 

1 7,626 

1 8,325 

699 

O 

O 

o 

1 7,626 

1 8,325 

699 

Quality Improvement 

4,31 O 

4,304 

(6) 

O 

O 

o 

4,31 O 

4,304 

(6) 

Public Protection 

636 

634 

(2) 

O 

O 

o 

636 

634 

(2) 

Justice Services 

2,506 

2,504 

(2) 

O 

O 

o 

2,506 

2,504 

(2) 

Universal Early Years 

467 

468 

1 

3,090 

3,090 

o 

3,557 

3,558 

1 

: Lead Partnership NHS Children's Services 

o 

O 

0 

41 O 

41 O 

o 

41 O 

41 O 

O 

PRIMARY CARE 

o 

O 

0 

52,521 

52,521 

o 

52,521 

52,521 

O 

ALLIED HEALTH PROFESSIONALS 




5,443 

5,443 

o 

5,443 

5,443 

o 

MANAGEMENT AND SUPPORT COSTS 

7,975 

8,1 86 

21 1 

3,888 

3,686 

(202) 

1 1 ,863 

1 1 ,872 

9 

CHANGE PROGRAMME 

1 

1 8 

1 7 

1 ,01 1 

1 ,01 1 

O 

1 ,012 

1 ,029 

1 7 

OUTTURN ON A MANAGED BASIS 

121,030 

121,773 

743 

133,178 

131,327 

(1,851) 

254,208 

253,100 

(1,108) 

Return Hosted Over/Underspends East 

O 

O 

0 

O 

582 

582 

O 

582 

582 

Return Hosted Over/Underspends North 

o 

O 

0 

O 

O 

O 

O 

O 

O 

Return Hosted Over/Underspends South 

o 

o 

0 

o 

553 

553 

o 

553 

553 

Receive Hosted Over/Underspends South 

o 

o 

0 

o 

O 

O 

o 

O 

O 

Receive Hosted Over/Underspends East 

o 

o 

0 

o 

O 

O 

o 

O 

O 

Allocation of PC IF from East 

o 

o 

0 


O 

O 


O 

O 

Allocate the Action 1 5 underspend to East 
and South 

o 

o 

0 


O 

O 


O 

O 

OUTTURN ON AN IJB BASIS 

121,030 

121,773 

743 

133,178 

132,462 

(716) 

254,208 

254,235 

27 


49 


178 























































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NORTH AYRSHIRE 
Health and Social Care 
Partnership 


Appendix V - Glossary of Acronyms 


Acronym 

Description 

A&E 

Assessment and Enablement 

ABI 

Alcohol Brief Intervention 

ACH 

Ayrshire Central Hospital 

ADHD 

Attention Deficit Hyperactivity Disorder 

AMHT 

Adult Mental Health Team (North Ayrshire Only) 

AOP 

Annual Operating Plan 

C&F 

Children and Families 

CAH 

Care at Home 

CAMHS 

Child and Adolescent Mental Health Team 

CareNA 

Care North Ayrshire 

CBT 

Cognitive Behaviour Therapy 

CMHT 

Community Mental Health Team 

CNM 

Clinical Nurse Manager 

COVID-19 

The naming associated with the global pandemic 

CP 

Child Protection 

CPO 

Community Payback Order 

CYP 

Children & Young People 

CYPSG 

Children & Young Peoples Strategic Group 

EMH 

Elderly Mental Health (Pan Ayrshire) 

FBC 

Full Business Case 

GP 

General Practitioner (Practice) 

HCC 

Health and Community Care 

HSCP 

Health & Social Care Partnership 

ICT 

Intermediate Care Team 

IGPAG 

Information Governance Pan Ayrshire Group 

IRD 

Initial Referral Discussion 

LAA 

Looked After & Accommodated 

LAAC 

Looked After & Accommodated Children 

LD 

Learning Disabilities 

LOT 

Local Operational Teams 

MADART 

Multiple Agency Domestic Abuse Response Team 

MH 

Mental Health 

MH PRG 

Mental Health Public Reference Group 

MHS 

Mental Health Service 

MSG 

Ministerial Strategy Group for Health and Community Care 

NAC 

North Ayrshire Council 

NADARS 

North Ayrshire Drug and Alcohol Service 

ORT 

Opiate Replacement Therapy 

OT 

Occupational Therapy 

PAC 

Performance and Audit Committee 

PC 

Primary Care 


50 


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NORTH AYRSHIRE 
Health and Social Care 
Partnership 


PCMHT 

Primary Care Mental Health Team 

PDS 

Post Diagnostic Support 

PRG 

Public Reference Group 

PRoMIS 

Patient-Reported Outcomes Measurement Information System 

PPE 

Personal Protective Equipment 

PSST 

Prevention and Service Support Team 

Res 

Resources 

RTT 

Referral To Treatment 

SALT 

Speech and Language Therapy 

SCRA 

Scottish Children's Reporter Administration 

SDS 

Self-Directed Support 

SG 

Scottish Government 

SSSC 

Scottish Social Services Council 

TCAT 

Transforming Care After Treatment 

UEY 

Universal Early Years 

YPSSPG 

Young People's Strategic Suicide Prevention Group 


51 


180 


















Agenda Item 8 



NORTH AYRSHIRE 

Health and Social Care 
Partnership 



Integration Joint Board 
24th September 2020 

Subject: 

Meeting Dates 2021 

Purpose: 

To advise members of the draft timetable for meetings of the IJB and 
the IJB PAC for 2021 

Recommendation: 

That IJB agree the dates for meetings of the Integration Joint Board 
and the Performance and Audit Committee. 


Glossary of Terms 

NHS AA 

NHS Ayrshire and Arran 

HSCP 

Health and Social Care Partnership 

IJB 

Integration Joint Board 

PAC 

Performance and Audit Committee 


1 . 

EXECUTIVE SUMMARY 

1.1 

The schedule of meetings for the Integration Joint Board (IJB) and Performance and 
Audit Committee (PAC) is required for the forthcoming year. 

2. 

PROPOSALS 

2.1 

Meetings of the IJB have previously taken place on a monthly basis (12 meetings). It 
is proposed to reduce this to 10 meetings per year and remove the meetings in April 
and July to avoid the council recess periods. 

2.2 

The Performance and Audit Committee will continue to meet on a quarterly basis. 

2.3 

The timing of meetings has taken budget reporting and performance schedules into 
consideration. The timetable has been created to avoid clashes with other NHS and 
Council meetings and avoid recess periods of the Council. 

2.4 

The proposed dates for the IJB and PAC meetings are detailed below. The schedule 
of meetings are attached in Appendix 1. 


Integration Joint Board 

Performance and Audit Committee 


14 th January 2021 

5 th March 2021 


11 th February 2021 

25 th June 2021 


18 th March 2021 

3 rd September 2021 


13 th May 2021 

26 th November 2021 


17 th June 2021 



26 th August 2021 



23 rd September 2021 



21 st October 2021 



18 th November 2021 



16 th December 2021 



181 

































2.5 

Anticipated Outcomes 


N/A 

2.6 

Measurinq Impact 


N/A 

3. 

IMPLICATIONS 


Financial: 

None 

Human Resources: 

None 

Legal: 

None 

Equality: 

None 

Children and Young People 

None 

Environmental & Sustainability: 

None 

Key Priorities: 

None 

Risk Implications: 

None 

Community Benefits: 

None 


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 



4. 

CONSULTATION 

4.1 

Consultation has taken place with the Chair and Vice Chair, IJB and Chair, PAC as 
well as other relevant officers and officers on the proposed timetable. 

5. 

CONCLUSION 

5.1 

IJB members are asked to agree the proposed dates for both IJB and PAC. 


For more information please contact Karen Andrews, Team Manager (Governance) 
on [01294 317725.] or [kandrews@north-ayrshire.gov.uk] 


182 





Appendix 1 

NORTH AYRSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP 
MEETINGS SCHEDULE 2021 

INTEGRATION JOINT BOARD 


Integration Joint Board [10.00 a.m.] 

IJB Pre-Agenda Meeting [10.00 a.m.] 

14 th January 2021 [Private Session] 

N/A 

11 th February 2021 

2 nd February 2021 

18 th March 2021 

9 th March 2021 [2.00 p.m.] 

13 th May 2021 

4 th May 2021 

17 th June 2021 

8 th June 2021 

26 th August 2021 

17 th August 2021 

23 rd September 2021 

14 th September 2021 [2.00 p.m.] 

21 st October 2021 

12 th October 2021 

18 th November 2021 

9 th November 2021 

16 th December 2021 

7 th December 2021 


IJB PERFORMANCE AND AUDIT COMMITTEE [10.00 a.m.] 

5 th March 2021 
25 th June 2021 
3 rd September 2021 
26 th November 2021 


183