Skip to main content

Full text of "Integration Joint Board - 24/09/2020"

See other formats


Official-Protect 


NORTH AYRSHIRE 
Health and Social Care 
Partnership 



Integration Joint Board 
September 2020 
Agenda Item No. 

Subject: 

Q1 2020-21 MB 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 


1 















Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 



• 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 

Measurina 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 Behind, lR 

Qtr 

28 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. 


2 

















Official-Protect 


NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 


3 


























Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 



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 
Ay rs h i re 


scottlshcare 



North Ayrshire Council 



Ayrshire 
Sc Arran 


4 


Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 


5 





















Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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. 


6 



Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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. 


7 


Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


Summary of Performance 

Position at Quarter 1 2020-21 


Areas of Focus - RED 

Children, Families, Justice - 4 
Health & Community Care -1 


1 - Strategic Plan 


28 - Strategic Plan 1 

Measures to 


Measures Meeting 

Monitor - Amber 


Targets - Green 


Mental Health -11 


Absence Measures Not Meeting Targets 

Both NAC & NHS met target for Quarter 1 


Financial Position 


£0.027m projected overspend 


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 

O 

A 


Reported 1 
Quarter 
Behind 

Q1 

16 

1 

28 

6 

Q2 





Q3 





Q4 






Thresholds: - Red: 10+%; Amber: >5% and <10%; Green: <5% 


8 






















Official-Protect 


NORTH AYRSHIRE 
HealUi and Social Care 
Partnership 

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 


9 
































Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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% 


10 









Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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. 


11 























Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 


12 






































Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 reduced significantly since pre^COVID-l 9._ 

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 compl eted 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 reduc ed s ignificantly since pre-COVID-19;_ 

Timescale for Improvements 


Continue to monitor throughout year as social distancing rules change 


13 



























Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


Description 

Number of patients waiting for CAH package (Community) 

Health and Wellbeing 
Indicator 

Quality of Life 

Strategic Objective 

Bringing Services Together 


Target 

Current 

Status 

Q4 

2019-20 

Q1 

2020-21 

Q2 

2020-21 

Q3 

2020-21 

Q4 

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 


14 






































Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 b e de livered by Marcji2021 with^ongoing review^acJiquarter 


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 


15 
























Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


• 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 b e de livered by Marcji2021 with^ongqing review ^acl^ 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% 

■J 





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. 


16 
























Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 pre sent. _ 


17 






















Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 CAMHS and Community Paediatrics, there has been low 
acceptance and suitability for 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. 


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. 


18 





Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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. 



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 clinic spaco_ 


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 


19 






















Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 monitor ed th roughou t the yea r 


20 



























Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 


21 







































Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 


22 



























Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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% 

■J 





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. 


23 






































Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 


24 







Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 

25 




Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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. 


26 




Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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. 


27 







Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 


28 




Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 


29 





Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 ln: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. 


30 




Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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. 


31 





Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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. 


32 



Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


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 


Official-Protect 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


CAMHS & CEDS 


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) 


34 





Official-Protect 



NORTH AYRSHIRE 
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 


35 




Official-Protect 



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 


36 


Official-Protect 


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; 
HSCP-Planning; MHS-Community; MHS-Learning Difficulties. (Appendix III, page 49) 


NHS - Sickness absence from NHS 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). 


37 




Official-Protect 



'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. 

Savinas 

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 


38 









Official-Protect 


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 



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 


39 








Official-Protect 



Jl 

'NORTH AYRSHIRE 


Over 1 8 - The information in the data cards represent the last 3 months available data. Heam p£SS5S C!m! 


2000 


Emergency Admissions Over 18 


1500 

1000 

500 



0 


^ ^ ^ ** ^ 

•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 




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 















Official-Protect 


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 1 000 

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 1 000 

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 1 000 

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 1 000 

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 1 000 

2.0 

2.1 

1.8 

3.4 

1.8 

1.2 

May 


41 























Official-Protect 


Appendix II - All Performance Measures 

Thresholds: Red - 10+%; Amber - >=5% and <10%; Green - <5% 



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) 


A 

A 


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 




























Official-Protect 



NftHTH flYH SHIRF 


Average waiting time on C&F fieldwork waiting list 

86 

Red 

• 

New 

Measure 

125 

• 



Health and 5o< 
Partners! 

% 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 

A 

6 

© 




Number of individuals waiting for CAH package (Community) 

30 

Red 

■j 

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 

© 


1 

© 




Number of individuals confirmed with a care at home package 

650 

p/q 

Amber 

A 

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 











































Official-Protect 



NftHTH flYH SHIRF 


Addictions referrals to Treatment within 3 weeks (Alcohol) 

90 % 

Green 

© 

98 . 6 % 

© 

100 % 

© 



Health and So> 
Partner 

:ini Care 
lip 

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 % 

a 




Number of ABIs Delivered (Priority Area - Pan Ayrshire) 

855 

p/q (Pan 
Ayrshire) 

Red 

• 

860 

© 

607 

• 




Number of ABIs Delivered (Non-Priority Area - Pan Ayrshire) 

214 

p/q (Pan 
Ayrshire) 

Red 

• 

438 

© 

92 

• 




Number of Naloxone Kits Supplied 

60 

Green 

© 

145 

© 

955 

© 




CAMHS - Seen within 18 weeks (RTT) 

90 % 

Red 

• 

New 

Measure 

63 % 

• 




Psychological Therapies - Seen within 18 weeks (RTT) 

90 % 

Red 

• 

New 

Measure 

75 % 

• 




AMHT - All accepted urgent referrals will be offered assessment 
within 24 hours. 

100 % 

Green 

© 

New 

Measure 

100 % 

© 




AMHT - All accepted routine referrals will be offered assessment 
within 4 weeks. 

100 % 

Red 

• 

New 

Measure 

26 % 

• 




Adult Liaison (Pysch & Alcohol) - All accepted Emergency 

Department referrals will be seen within 60 minutes. 

100 % 

Red 

• 

New 

Measure 

85 % 




All accepted Urgent mental health referrals will be seen within 24 
hours from Acute wards (Medical & Surgical at Ayr and Crosshouse) 

100 % 

Green 

© 

New 

Measure 

100 % 

© 




Every patient assessed by mental health liaison will be offered an 
individualised discharge care plan 

100 % 

Red 

• 

New 

Measure 

• 

Not 

Available 




EMH - All accepted urgent referrals within the acute hospital will be 
seen within 24 hours 

100 % 

Red 

• 

New 

Measure 

45 % 

• 





44 



























Official-Protect 


NORTH AYH SHIRF 

■ial Care 
lip 


EMH - All accepted routine referrals within the acute hospital will be 
seen within 48 hours 

100 % 

Red 

• 

New 

Measure 

38 % 

• 



Health and 50' 
Partners 

EMH - All accepted referrals from community hospitals will be seen 
within 5 working days 

100 % 

Red 

■j 

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 

O 

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 % 

© 





45 

























Official-Protect 


Appendix III - Workforce Absence 

Table la NAC 2020-21 Data 


NORTH AYRSHIRE 
Health and Social Care 
Partnership 


Di rectorate/Section 

FTE 

Ap Til 

May 

June 

Jul 

Aug 

Sep 

Oct 

Nov 

Dec 

Jan 

Feb 

Mar 

TTD 

YTD Ta rget 

Variance 

Of - F id"v*-oi% 

94.90 

1.29 

1.30 

122 










101 

193 

221 

Of - InlervcM Serv 

93.10 

0.75 

0.00 

1.01 










242 

3.16 

-0.74 

Of - Juslicc Service 

07.70 

023 

0.03 

1j05 










221 

324 

-042 

n Of - LAA-C 

12301 

1.43 

1.17 

0.52 










321 

426 

-124 

Off - P “airt Dec &. Rct 

1950 

0.(50 

0.00 

0.31- 










026 

125 


Of - Unrver £ariy Vrs 

1020 

000 

0.00 

000 










000 

125 

-125 

Oiik* ,: ar iFies&iLEtice 

4O041 

1.04 

i.Cn 

054 










259 

j.ia 

-0.53 

1 I'LL - Arran Scrvccs 

9.04 

D.M 

0.00 

0.00 










O0Oi 

125 

-125 

HOC - Com m Cane Scrv 

61794 

005 

1.00 

003 










209 

322 

-023 

HOC - L polity SnhE 

10003 

1.12 

010 

051 










123 

225 

-0.72 

HOC - Lorg Term Cord 

22.94 

0.17 

on 

004 










1.09 

125 


HOC - PrmaryCare Serv 

1003 

2.20 

0.00 

000 










220 

125 

0.95 

HOC - Rehab & keaale 

1340 

0.DO 

0.00 

000 










000 

2.95 

-2.05 

1 ieaHh Si Can - murity Care 776.75 

0.04 

o.es 

021 










260 

303 

-042 

HSCP - Finance 

27.14 

0.49 

0.02 

0.00 










050 

2M 

-129 

HSCP fterfa nr an ce 

950 

0.00 

0.00 

000 










000 

125 

-ti -ml 

.L. J* 

HSCP Planning 

9JS0 

3.59 

2.4& 

201 










8.09 

239 

6.59 

HiOP Firance & Tm nsfonr 

39.94 

0.01 

013 

020 










004 

2.15 

-121 

Ml li - Addictions 

21j00 

1.04 

003 

019 










206 

445 

-329 

MHfi - Community 

1900 

2.09 

2:10 

127 










604 

625 

0.69 

MHS - Lcarring Orff 

4956 

2*9 

233 

122 










7.13 

625 

0.90 


Mcnal Mcaltsi 


H5£P Guineas; Ad rn in 


H5CP Senior Ma 

HSCP 


m. 1 * 

17459 


246 

029 



1000 


1.44 


1.03- 

0.40- 

000 


1.49 


048 

OUJG 


1,40925 


195 


000 


021 


270 


j.n 


527 

593 

0.05 

124 

241 

-0.56 

1.44 

205 

- 0.61 


-024 


46 

































































Official-Protect 



Table 1b NAC 2019-20 Data 


NORTH AYRSHIRE 
Health and Social Care 
Partnership 


# 

D irectorate/Section 

April 

May 

June 

Jyl 

Aug 

Sep 

Oct 

Nov 

Dec 

Jan 

Feb 

Mer 

YTD 

YTD Target 

Vari ence 

40 

BuLriKS Adminiulra !iur 

0.45 

0.70 

0.97 










2.12 

175 

-0.63 

41 

CF - Fieldwork 

0J3 

1.02 

1.14 










2.99 

175 

024 

42 

CF - IrilnvenC Serv 

1.71 

1 .54 

092 










4.17 

175 

142 

43 

•CF - Jjsli-Lt Service 

1.14 

107 

202 










5.23 

175 

246 

44 

CF - LAAC 

1.73 

106 

2.15 










5.94 

175 

3.19 

45 

CF - Ft^-.L Dft- & Rev 

GOO 

000 

000 










0.00 

175 

-175 

46 

CF - Llnrver Early Vra 

0.00 

045 

000 










0.45 

175 

-2.30 

4 ? 

HCC - Amin Serv'ces 

000 

017 

000 










0.17 

175 

-2.53 

■13 

HOC - Comm On 5c-v 

1.22 

1.26 

1.16 










3.66 

175 

091 

49 

MCC - Locality Service 1 .* 

1.50 

061 

0.79 










3.11 

175 

036 

50 

l+CC - Lang Term Good 

0.71 

013 

0.13 










0.97 

175 

-1.73 

51 

l+CC - Primary Can; Serv 

0.00 

1.10 

000 










1.10 

175 

-1.65 

52 

HOC - Rehab ii Rea tie 

2.26 

166 

346 










3.53 

175 

533 

53 

H5CP - Finance 

0.09 

OOO 

0.19 










0.23 

175 

-2.47 

54 

MH5- Addictions 

0.59 

1.59 

192 










4.10 

175 

135 

55 

MHS - CuinrnL’iity 

1.30 

150 

191 










6.71 

175 

396 

56 

MHS - Learning CHFf 

2.07 

147 

2j67 










9.01 

175 

626 

57 

Pl an & Perlarmai'-it 

031 

1.04 

131 










2.66 

175 

-0.09 

53 

Scnicir Mb lageri* 

0.00 

0.00 

000 










0.00 

175 

-175 


59 H5CP 



1.16 


OQ 


1.23 


3.69 


2.75 


E 


0.94 


47 




























Official-Protect 


Table 2 NHS 2020-21 

• Continuing system issues has resulted in data being unavailable 



NORTH AYRSHIRE 
Health and Social Care 
Partnership 


48 


Official-Protect 



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 

1 4 

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 

18,572 

20,1 95 

1 ,623 

448 

448 

O 

19,020 

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 

O 

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 

1 (76) 

O 

O 

o 

1 ,256 

1 ,180 

(76) 

Intervention Services 

2,1 04 

2,094 

(lO) 

31 5 

31 5 

o 

2,419 

2,409 

(lO) 

North Ayrshire Wide Services 

1 7,626 

18,325 

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 

O 

41 O 

41 O 

o 

41 O 

41 O 

O 

PRIMARY CARE 

O 

O 

O 

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 

18 

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 

O 

O 

582 

582 

O 

582 

582 

Return Hosted Over/Underspends North 

o 

O 

O 

O 

O 

O 

O 

O 

O 

Return Hosted Over/Underspends South 

o 

o 

o 

o 

553 

553 

o 

553 

553 

Receive Hosted Over/Underspends South 

o 

o 

o 

o 

O 

O 

o 

O 

O 

Receive Hosted Over/Underspends East 

o 

o 

o 

o 

O 

O 

o 

O 

O 

Allocation of PC IF from East 

o 

o 

o 


O 

O 


O 

O 

Allocate the Action 1 5 underspend to East 
and South 

o 

o 

o 


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 






























































Official-Protect 



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 















































Official-Protect 



’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