South Lanarkshire Integration Joint Board

Council Offices, Almada Street Hamilton, ML3 0AA

Dear Member

The Members listed below are requested to attend a meeting of the above Board to be held as follows:-

Date: Tuesday, 25 June 2019 Time: 14:00 Venue: Committee Room 1, Council Offices, Almada Street, Hamilton, ML3 0AA

The business to be considered at the meeting is listed overleaf.

Yours sincerely

Lindsay Freeland Calum Campbell Chief Executive Chief Executive South Lanarkshire Council NHS Lanarkshire

Members South Lanarkshire Council John Bradley, Allan Falconer, Richard Lockhart, Jim McGuigan

NHS Lanarkshire Philip Campbell, Michael Fuller, Lilian Macer, Lesley Thomson

Substitutes South Lanarkshire Council Maureen Chalmers, Fiona Dryburgh, Hugh Macdonald, Richard Nelson

1 BUSINESS

1 Declaration of Interests

2 Minutes of Previous Meeting 5 - 12 Minutes of the meeting of the South Lanarkshire Integration Joint Board held on 16 April 2019 submitted for approval as a correct record. (Copy attached)

3 Minutes of the South Lanarkshire Integration Joint Board 13 - 18 (Performance and Audit) Sub-Committee Minutes of the meeting of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee held on 26 February 2019 submitted for noting. (Copy attached)

Item(s) for Monitoring

4 Financial Monitoring 2018/2019 19 - 36 Report dated 17 June 2019 by the Director, Health and Social Care. (Copy attached)

5 Performance Monitoring Report 37 - 52 Report dated 28 May 2019 by the Director, Health and Social Care. (Copy attached)

Item(s) for Consideration

6 Unaudited Annual Accounts 2018/2019 53 - 108 Report dated 14 June 2019 by the Chief Financial Officer. (Copy attached)

7 Draft Integration Joint Board Annual Performance Report 2018/2019 109 - 142 Report dated 25 May 2019 by the Director, Health and Social Care. (Copy attached)

8 Investing to Modernise South Lanarkshire Council Care Facilities - 143 - 150 Progress Update Report dated 20 May 2019 by the Director, Health and Social Care. (Copy attached)

9 Urgent Care Out of Hours Service 151 - 154 Report dated 24 May 2019 by the Director, Health and Social Care. (Copy attached)

10 Health and Social Care Integration - Ministerial Strategic Group 155 - 196 Report Update Report dated 24 May 2019 by the Director, Health and Social Care. (Copy attached)

11 Adult and Older People Day Services Review Proposal 197 - 204 Report dated 22 May 2019 by the Director, Health and Social Care. (Copy attached)

12 South Lanarkshire Adult Protection Committee Biennial Report 205 - 210 Report dated 28 May 2019 by the Director, Health and Social Care. (Copy attached)

Any Other Competent Business

For further information, please contact:- Clerk Name: Joyce McDonald Clerk Telephone: 01698454521 Clerk Email: [email protected]

4 Agenda Item

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD

Minutes of meeting held in Committee Room 1, Council Offices, Almada Street, Hamilton on 16 April 2019

Chair: Councillor John Bradley

Present: Health and Social Care Partnership V de Souza, Director, Health and Social Care and Chief Officer; M Moy, Chief Financial Officer NHS Lanarkshire Board Philip Campbell, Non Executive Director (Depute); Michael Fuller, Non Executive Director; Neena Mahal, Non Executive Director (substitute for Lilian Macer); Lesley Thomson, Non Executive Director South Lanarkshire Council Councillors Allan Falconer, Richard Lockhart and Jim McGuigan

Attending: NHS Lanarkshire C Campbell, Chief Executive; C Cunningham, Head of Commissioning and Performance; M Docherty, Nurse Director; E Duguid, Communication Manager; L Findlay, Medical Director; M Hayward, Head of Health and Social Care (Rutherglen/Cambuslang and East Kilbride); B McGurn, Deputy Clinical Director Partners G Bennie, VASLAN; H Biggins, Service User (Older People); V Johnstone, Carers’ Representative; Dr K McIntyre, GP Representative; M Moncrieff, South Lanarkshire Health and Social Care Forum; R Ormshaw, Scottish Care South Lanarkshire Council I Beattie, Head of Health and Social Care (Hamilton and Clydesdale); M Kane, Health and Social Care Programme Manager; G McCann, Head of Administration and Legal Services; J McDonald, Administration Adviser; L Purdie, Chief Social Work Officer

Also Attending: Audit Scotland S Lawton, Senior Auditor NHS Lanarkshire A Armstrong, Nurse Director, North Lanarkshire Health and Social Care Partnership; M Reid, Head of Health Improvement South Lanarkshire Council S Baxter, Independent Chair, Child and Adult Protection Committees; R Leith, Community Participation and Development Manager; C McLean, Lead Officer, Child Protection Committee; B Perrie, Planning and Performance Manager University of the West of Scotland Dr Julie Clark, Senior Lecturer; Dr Nick Jenkins, Senior Lecturer

Apologies: NHS Lanarkshire Board Lilian Macer, Non Executive Director NHS Lanarkshire L Ace, Director of Finance; T Wilson, Health Service Trade Union Representative

South Lanarkshire Council L Freeland, Chief Executive; P Manning, Executive Director (Finance and Corporate Resources); S Smellie, Unison, South Lanarkshire Council Trade Union Representative

1 Declaration of Interests No interests were declared.

2 Voting Membership and Rotation of Chair and Depute Chair - Integration Joint Board and Performance and Audit Sub-Committee A report dated 11 March 2019 by the Director, Health and Social Care was submitted advising of the reappointment of 2 of the voting members from NHS Lanarkshire and a change to the Chair and Depute Chair of the South Lanarkshire Integration Joint Board (IJB) and the Performance and Audit Sub-Committee.

The approved IJB Standing Orders provided details of the term of appointment for voting members together with the arrangements for appointing the Chair and Depute Chair of the IJB. The Terms of Reference for the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee specified that the Sub-Committee would be chaired by the Depute Chair of the IJB and that responsibility for chairing the Sub-Committee would transfer in accordance with the appointment of the Chair and Depute Chair of the IJB.

The appointment of voting members to the IJB was for a period of 3 years and, consequently, the appointment of Mr Phil Campbell, Non Executive Director and Ms Lilian Macer, Non Executive Director, both NHS Lanarkshire expired on 31 March 2019. NHS Lanarkshire had confirmed the reappointment of both for a period of 3 years, with effect from 1 April 2019.

In terms of the approved IJB Standing Orders, responsibility for appointing the Chair and Depute Chair of the IJB transferred to the other party with effect from 1 April 2019 for a period of 3 years. South Lanarkshire Council had confirmed the appointment of Councillor John Bradley as Chair of the IJB and NHS Lanarkshire had confirmed the appointment of Mr Phil Campbell, Non Executive Director as Depute Chair of the IJB.

In addition, responsibility for chairing the Performance and Audit Sub-Committee would transfer in accordance with the appointment of the Chair and Depute Chair of the IJB.

Councillor Falconer raised concerns in relation to the process for the appointment of the Chair and Depute Chair of the IJB and the governance arrangements for the IJB. The Head of Administration and Legal Services confirmed that the process for the appointment of the Chair and Depute Chair of the IJB was governed by The Public Bodies Joint Working (Scotland) Act 2014 and that the process which had been followed in relation to those appointments, as well as the governance arrangements, complied with the relevant legislation.

The Board decided:

(1) that confirmation of the reappointment of Mr Phil Campbell, Non Executive Director and Ms Lilian Macer, Non Executive Director by NHS Lanarkshire as 2 of its voting members on the IJB be noted;

(2) that confirmation by South Lanarkshire Council of the appointment of Councillor John Bradley as Chair of the IJB be noted;

(3) that confirmation by NHS Lanarkshire of the appointment of Mr Phil Campbell, Non- Executive Director, NHS Lanarkshire as Depute Chair of the IJB be noted; 6

(4) that it be noted that responsibility for chairing the Performance and Audit Sub-Committee would transfer in accordance with the appointment of the Chair and Depute Chair of the IJB; and

(5) that it be noted that the reappointments and the appointments of Chair and Depute Chair of the IJB and the Performance and Audit Sub-Committee be for a period of 3 years with effect from 1 April 2019.

3 Minutes of Previous Meeting The minutes of the meeting of the South Lanarkshire Integration Joint Board held on 12 February 2019 were submitted for approval as a correct record.

The Board decided: that the minutes be approved as a correct record.

4 Minutes of Special Meeting The minutes of the special meeting of the South Lanarkshire Integration Joint Board held on 25 March 2019 were submitted for approval as a correct record.

The Board decided: that the minutes be approved as a correct record.

5 Minutes of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee The minutes of the meeting of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee held on 27 November 2018 were submitted for noting.

The Board decided: that the minutes be noted.

6 Financial Monitoring 2018/2019 A report dated 5 April 2019 by the Director, Health and Social Care was submitted providing a summary of the financial position of the Health and Social Care Partnership (HSCP) for the period:-

 1 April 2018 to 28 February 2019 in relation to Health Care Services  1 April 2018 to 1 February 2019 in relation to Social Work and Housing Services

An underspend of £2.409 million had been reported by NHS Lanarkshire for the South Lanarkshire HSCP for the period 1 April 2018 to 28 February 2019.

An overspend of £0.815 million had been reported by South Lanarkshire Council for the South Lanarkshire HSCP for the period 1 April 2018 to 1 February 2019.

An underspend of £0.300 million had been identified on the primary care transformation fund which was ring fenced.

Work had been undertaken to further develop the reconciliation of in-year budget adjustments and a summary of the budget adjustments since 1 April 2018 was provided in Appendix 1 to the report.

Details were provided on how the budget would be managed and a summary of the budget variance position was provided in Appendix 2 to the report.

Details were also provided on the hosted services which were led by South Lanarkshire HSCP and North Lanarkshire HSCP and a summary of the position in respect of each was provided in appendices 3 and 4 to the report.

Further details were provided on the Reserves and a summary of the position was provided in Appendix 5 to the report.

The Integrated Resources Advisory Group Finance Guidance placed a responsibility on the lead partner for a hosted service to manage overspends and, with the exception of ring-fenced funding, offset overspends with any retained underspends. This arrangement had been in place since 1 April 2016 and it was proposed that this principle be endorsed in respect of 2018/2019.

Officers responded to members’ questions in relation to various aspects of the report.

The Board decided:

(1) that the financial position of the South Lanarkshire Health and Social Care Partnership be noted; and

(2) that the hosted service agreement, as detailed above, be endorsed.

7 Performance Monitoring Report A report dated 22 March 2019 by the Director, Health and Social Care was submitted providing a summary of performance against the key performance measures assigned to the integration of Health and Social Care in South Lanarkshire.

The Public Bodies Joint Working (Scotland) Act 2014 placed a duty on Health and Social Care Partnerships to establish performance monitoring reports in line with the agreed suite of 23 performance measures and 6 measures which had been identified by the Ministerial Steering Group.

Progress against the key performance actions and measures for the 23 national integration indicators and the 6 Ministerial Steering Group measures were provided in the appendices to the report.

There were a number of areas of development which had been identified in relation to performance management, following a workshop on performance which had been facilitated by the Head of Commissioning and Performance, which would be included in future performance reports.

Officers responded to members’ questions in relation to various aspects of the report.

The Board decided: that the report be noted.

[Reference: Minutes of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee of 26 February 2019 (Paragraph 4)]

8 Risk Management Update A report dated 22 March 2019 by the Director, Health and Social Care was submitted providing an update on the current Risk Management arrangements for the South Lanarkshire Integration Joint Board (IJB).

As part of the arrangements to support the integration of Health and Social Care, a Risk Register for the IJB had been prepared to capture strategic risks relating to the delivery of services likely to affect the IJB’s delivery of the Strategic Commissioning Plan.

The Risk Register, attached as an appendix to the report, had been prepared in consultation with partners and had been reviewed against the existing risk registers of NHS Lanarkshire and South Lanarkshire Council.

Following approval of the Strategic Commissioning Plan (SCP) for 2019 to 2022, the Risk Register required to be reviewed to ensure its compliance with the SCP and a number of legislative changes.

It was proposed that a workshop for members of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee be organised to review and update the current Risk Register which would be submitted to a future meeting of the IJB for approval.

Officers responded to members’ questions in relation to various aspects of the report.

The Board decided: that the Risk Register be reviewed and submitted to a future meeting of the South Lanarkshire Integration Joint Board for approval.

[Reference: Minutes of 4 December 2018 (Paragraph 7)]

9 Child Sexual Exploitation A report dated 18 March 2019 by the Director, Health and Social Care was submitted on Child Sexual Exploitation (CSE) and the implications for South Lanarkshire.

Following a review of the national Child Protection Improvement Programme (CPIP), 2 reports were published which contained various recommendations and actions to strengthen the child protection system in Scotland. Details of the recommendations were contained in the report.

South Lanarkshire was represented on the national Child Sexual Exploitation group which was responsible for the implementation of the national CSE action plan and development of proposals for policy and practice improvement within the wider context of child sexual abuse. An annual update report had been published by the national group which highlighted that South Lanarkshire had met its local action plan targets.

A Child Sexual Exploitation and On Line Safety Sub-Group had been established with responsibility for ensuring the recommendations and actions from the review were implemented within South Lanarkshire. Details of the work undertaken by the Sub-Group were also contained in the report.

Awareness raising campaigns had been undertaken and, in consultation with young people directly affected by CSE, an awareness raising poster had been produced which would be displayed in various prominent locations throughout South Lanarkshire.

The Board decided: that the report be noted.

10 Carers (Scotland) Act 2016 - Update A report dated 22 March 2019 by the Director, Health and Social Care was submitted on the progress with the implementation of the duties of the Carers (Scotland) Act 2016.

The Carers (Scotland) Act 2016 was implemented on 1 April 2018 and placed a duty on Integration Joint Boards to support the implementation of the Act which aimed to support carers’ health and wellbeing and make caring more sustainable.

To support the implementation of the Act the following work had been undertaken:-

 continued implementation of the statutory functions outlined in the Carers (Scotland) Act 2016  development of a service specification to facilitate a procurement exercise for the delivery of carer support services, information and advice, short breaks, consultation and engagement, training, practical support and assistance for adult and young carers  development of online information resources for carers and partner agencies  publication of the Local Eligibility Criteria, Short Breaks Service Statement and the Carers Strategy 2019/2020  contribution to the development of an information platform in relation to Self-Directed Support and carers

In order to ensure that continued support to carers was being provided in line with the requirements of the Carers (Scotland) Act, the current contractual/service level agreements with South Lanarkshire Carers Network and Lanarkshire Carers Centre had been reviewed.

In consultation with NHS Lanarkshire and South Lanarkshire Council, a service specification for the future delivery of carer supports and services in South Lanarkshire had been developed. It was proposed that a Direction be issued to NHS Lanarkshire and South Lanarkshire Council to procure services which met the requirements of the Carers (Scotland) Act 2016.

Discussion took place in relation to the implementation of the Carers (Scotland) Act and the implications for service users.

The Board decided:

(1) that the progress which had been made in relation to the implementation of the Carers (Scotland) Act 2016, as detailed in the report, be noted; and

(2) that a Direction be issued to South Lanarkshire Council and NHS Lanarkshire to procure carers’ services which met the requirements of the Carers (Scotland) Act 2016.

[Reference: Minutes of 4 December 2018 (Paragraph 13)]

11 Lanarkshire Mental Health and Wellbeing Strategy A report dated 22 March 2019 by the Director, Health and Social Care was submitted on the development of the Lanarkshire Mental Health and Wellbeing Strategy.

The Scottish Government’s Mental Health Strategy 2017 to 2027 detailed a range of commitments in relation to mental health improvement, including services and recovery to ensure delivery of effective, quality care and treatment for people with a mental illness, their carers and families.

The main themes of the Strategy were:-

 prevention and early intervention  access to treatment and joined up accessible services  the physical wellbeing of people with mental health problems  rights, information use and planning

A Mental Health and Wellbeing Strategy for Lanarkshire, attached as an appendix to the report, that took account of the national ambitions and local aims, was being developed and would include 6 main chapters, as detailed in the report. To support the development of the Strategy, a series of consultation events would be undertaken with stakeholders to ensure the final strategy reflected the needs of service users, carers and the wider Lanarkshire population.

The Mental Health and Wellbeing Strategy for Lanarkshire would be submitted to a future meeting of the South Lanarkshire Integration Joint Board for approval.

The Board decided: that the report be noted.

[Reference: Minutes of 11 September 2018 (Paragraph 12)]

12 Early Intervention, Prevention and Health Improvement – Building and Celebrating Communities A report dated 25 March 2019 by the Director, Health and Social Care was submitted providing an update on the Building and Celebrating Communities programme of work.

The Health and Social Care Partnership had undertaken work in relation to Building and Celebrating Communities which was specifically aimed at working with communities to identify what it was that communities:-

 were best placed to do when it came to health and social care  were best placed to do with some help from outside agencies  needed outside agencies to do for them when it came to health and social care

This work would use the philosophy of a strengths based approach to build capacity and resilience in communities, particularly with regards to early intervention, prevention and health improvement. The Partnership was, therefore, keen to develop this approach as the method through which communities were engaged and facilitated to develop their own solutions to local issues.

To support the above, events were held across South Lanarkshire, following which a report was prepared by the external facilitators summarising the key findings and recommendations. As a result, a programme of work, known as Building and Celebrating Communities, had been established which would link with the 6 public health priorities, as detailed in the report.

A self-assessment of how Health and Social Care Services could respond to the 6 public health priorities would be undertaken and the results shared with the wider Community Planning Partnership.

In addition, the University of the West of Scotland had undertaken a scoping study of the Building and Celebrating Communities programme of work, which was detailed in the appendix to the report.

Dr Julie Clark and Dr Nick Jenkins, Senior Lecturers, University of the West of Scotland then gave a joint presentation on the Building and Celebrating Communities programme of work.

The Chair thanked the Senior Lecturers for their presentation.

The Board decided: that the report be noted.

[Reference: Minutes of 5 December 2017 (Paragraph 10)]

13 Any Other Competent Business There were no other items of competent business.

Chief Officer’s Closing Remarks The Director, Health and Social Care referred to the achievements of the South Lanarkshire Health and Social Care Partnership and thanked members of the South Lanarkshire Integration Joint Board (IJB) for their support and contribution to the work of the IJB.

12 Agenda Item

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD (PERFORMANCE AND AUDIT) SUB-COMMITTEE

Minutes of meeting held in Committee Room 5, Council Offices, Almada Street, Hamilton on 26 February 2019

Chair: South Lanarkshire Council Councillor John Bradley

Present: NHS Lanarkshire Board Lesley Thomson, Non Executive Director South Lanarkshire Council Councillor Jim McGuigan

Attending: Health and Social Care Partnership I Beattie, Head of Health and Social Care (Hamilton and Clydesdale); M Moy, Chief Financial Officer NHS Lanarkshire C Cunningham, Head of Commissioning and Performance; M Hayward, Head of Health and Social Care (Rutherglen/Cambuslang and East Kilbride) South Lanarkshire Council J McDonald, Administration Adviser; L Purdie, Chief Social Work Officer

Also Attending: Audit Scotland D Richardson, Senior Audit Manager; S Lawton, Senior Auditor

Apologies: Health and Social Care Partnership V de Souza, Director, Health and Social Care and Chief Officer; M Kane, Health and Social Care Programme Manager NHS Lanarkshire Board Philip Campbell, Non Executive Director (Depute) NHS Lanarkshire M Docherty, Nurse Director; L Findlay, Medical Director

Chair’s Opening Remarks The Chair, on behalf of the Sub-Committee members, welcomed Lesley Thomson, Non Executive Director, NHS Lanarkshire to her first meeting of the Sub-Committee and the appropriate introductions were made.

1 Declaration of Interests No interests were declared.

2 Minutes of Previous Meeting The minutes of the meeting of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee held on 27 November 2018 were submitted for approval as a correct record.

The Sub-Committee decided: that the minutes be approved as a correct record.

3 Set Aside Budget Laura Ace, Director of Finance, NHS Lanarkshire and Marie Moy, Chief Financial Officer gave a joint presentation on the set aside budget for the Integration Joint Board (IJB).

The Public Bodies Joint Working (Scotland) Act 2014 placed a duty on Health and Social Care Partnerships to create a coherent, single cross-sector system for local joint strategic commissioning of health and social care services and a single process through which a shift in the balance of care could be achieved.

An overview of the set aside budget was provided together with details of how the budget was managed and monitored.

The Chair thanked the Director of Finance and Chief Financial Officer for their joint presentation.

Officers responded to members’ questions in relation to the management and governance arrangements relating to the set aside budget.

The Sub-Committee decided: that the presentation be noted.

4 Performance Monitoring Report A report dated 17 January 2019 by the Director, Health and Social Care was submitted providing a summary of performance against the key performance measures assigned to the integration of Health and Social Care in South Lanarkshire.

Progress against the key performance actions and measures for the 23 national integration indicators and the 6 Ministerial Steering Group measures were provided in the appendices to the report.

There were a number of areas of development which had been identified in relation to performance management, following a workshop on performance which had been facilitated by the Head of Commissioning and Performance, that would be included in future performance reports.

The Sub-Committee decided: that the content of the report be noted.

[Reference: Minutes of the South Lanarkshire Integration Joint Board of 12 February 2019 (Paragraph 5)]

5 Development of Strategic Commissioning Plan 2019 to 2022 A report dated 11 January 2019 by the Director, Health and Social Care was submitted on the development of the Strategic Commissioning Plan (SCP) 2019 to 2022.

The Public Bodies (Joint Working) (Scotland) Act 2014 placed a duty on Health and Social Care Partnerships to develop and have in place an approved 3 year SCP detailing the strategic objectives of the South Lanarkshire Health and Social Care Partnership.

The South Lanarkshire Integration Joint Board (IJB) had approved the Strategic Commissioning Plan for 2016 to 2019. However, the landscape for Health and Social Care had changed since the SCP had been approved and the SCP had subsequently been updated to reflect the changing agenda.

The updated SCP would be used as the basis for the development of the SCP for 2019 to 2022. Details were provided on the consultation with key stakeholders which had taken place and had informed the development of the draft SCP 2019 to 2022, attached as an appendix to the report.

The SCP 2019 to 2022 would be submitted to the NHS Lanarkshire Board and South Lanarkshire Council’s Executive Committee for noting prior to it being submitted to the South Lanarkshire Integration Joint Board for approval by 1 April 2019.

Members were invited to provide comments on the draft SCP 2019 to 2022 to the Head of Commissioning and Performance to allow consideration of the inclusion of any comments received in the final SCP 2019 to 2022 which would be submitted to the special meeting of the IJB on 25 March 2019 for approval.

The Sub-Committee decided: that the content of the report be noted.

[Reference: Minutes of the South Lanarkshire Integration Joint Board of 12 February 2019 (Paragraph 8)]

6 Chief Social Work Officer Annual Report 2017/2018 A report dated 14 January 2019 by the Chief Social Work Officer was submitted on the Chief Social Work Officer’s Annual Report 2017/2018.

There was a statutory requirement for all local authorities to appoint a professionally qualified Chief Social Work Officer (CSWO) who must be registered with the Scottish Social Services Council (SSSC).

The role of the CSWO was to provide professional advice and guidance to local authorities, elected members and officers in the provision of social work services. The CSWO also had a responsibility for overall performance improvement and the identification and management of corporate risk insofar as those related to social work services.

The CSWO was required to prepare an annual report of activity, which followed a standardised reporting framework, for submission to the Chief Social Work Advisor for Scotland.

Information was provided on the content of the CSWO’s Annual Report, which was attached as an appendix to the report.

The Sub-Committee decided: that the Chief Social Work Officer’s Annual Report 2017/2018, attached as an appendix to the report, be noted.

[Reference: Minutes of the South Lanarkshire Integration Joint Board of 12 February 2019 (Paragraph 9)]

7 Risk Register A report dated 7 February 2019 by the Director, Health and Social Care was submitted on the updated Risk Register for the South Lanarkshire Integration Joint Board (IJB).

As part of the arrangements to support the integration of Health and Social Care, a Risk Register for the IJB had been prepared to capture strategic risks relating to the delivery of services likely to affect the Joint Board’s delivery of the Joint Strategic Commissioning Plan.

The Risk Register had been prepared in consultation with partners and had been reviewed against the existing risk registers of NHS Lanarkshire and South Lanarkshire Council.

The IJB, at its meeting on 12 September 2017, had approved the Risk Register for the IJB and had agreed that an update report be submitted to the IJB and the Performance and Audit Sub- Committee on an annual basis.

It was proposed that the updated Risk Register, attached as an appendix to the report, be noted and that progress reports be submitted to the Sub-Committee on a regular basis.

The Sub-Committee decided: that the content of the report be noted.

[Reference: Minutes of the South Lanarkshire Integration Joint Board of 26 June 2018 (Paragraph 18) and Minutes of 27 November 2018 (Paragraph 8)]

8 Community Planning Partnership – Health and Social Care Contribution A report dated 7 February 2019 by the Director, Health and Social Care was submitted on the South Lanarkshire Health and Social Care Partnership’s contribution to the delivery of the South Lanarkshire Community Plan – Stronger Together.

The South Lanarkshire Community Plan detailed the priorities and outcomes for the Health and Social Care Partnership for 2017 to 2027. The main theme of the Community Plan was focused on tackling poverty, deprivation and inequality and was underpinned by Partnership Improvement Plans (PIPs) which detailed the action plans and performance measures for each of the Partnership’s key thematic areas.

The South Lanarkshire Health and Social Care PIP was closely aligned to the South Lanarkshire Strategic Commissioning Plan and details of the priority outcomes contained in the PIP were provided in the report.

The Sub-Committee decided: that the content of the report be noted.

9 Summary of Recent National Audit Reports and Policy Imperatives A report dated 14 January 2019 by the Director, Health and Social Care was submitted on a number of national reports and policies which would impact on the South Lanarkshire Integration Joint Board (IJB).

Details of the recently published legislation and documents which had implications for the IJB were provided in the report.

Those areas that required to be actioned would be contained in the Strategic Commissioning Plan 2019 to 2022. In addition, workshops for IJB members and stakeholders would be facilitated to ensure collective discussion and agreement in relation to those areas that had implications for the IJB.

The Sub-Committee decided: that the content of the report be noted.

[Reference: Minutes of the South Lanarkshire Integration Joint Board of 12 February 2019 (Paragraph 14)]

10 Annual External Audit Plan and Audit Fee 2018/2019 A report dated 14 February 2019 by the Director, Health and Social Care was submitted on the External Auditor’s Annual Audit Plan for 2018/2019 and audit fee for the South Lanarkshire Integration Joint Board (IJB).

The Public Bodies (Joint Working) (Scotland) Act 2014 placed a duty on Integration Joint Boards (IJBs) to prepare annual accounts and for those accounts to be audited in accordance with Part VII of the Local Government (Scotland) Act 1973.

Audit Scotland had been appointed by the Accounts Commission and the Auditor General for Scotland as the external auditors of the South Lanarkshire Integration Joint Board for the period 2016/2017 to 2020/2021.

Details of the External Auditor’s planned scope and timing of audit work was provided in the appendix to the report.

Based on an assessment of the following local circumstances, the 2018/2019 audit fee had been set at Audit Scotland’s Audit Services Group standard fee applicable to IJBs of £25,000:-

 local risk areas for the IJB  governance and accountability arrangements, control environment and risk assessment and management procedures  an initial review of internal audit and the reliance that could be placed on its work  review of the outcomes from previous audits  systems and procedures in place for the production of timeous IJB financial statements  progress with the implementation of the integration scheme and strategic plan  any issues that might impact on the audit opinion

The Sub-Committee decided: that the content of the report be noted.

[Reference: Minutes of 27 February 2018 (Paragraph 10)]

11 External Audit Review of Internal Audit A report dated 18 February 2019 by the Director, Health and Social Care was submitted on the outcome of Audit Scotland’s review of internal audit.

Audit Scotland’s Code of Audit Practice required external auditors to undertake an annual assessment of the internal audit function to establish the effectiveness of internal audit arrangements.

The outcome from Audit Scotland’s assessment of the South Lanarkshire Integration Joint Board’s (IJB) internal audit service for 2018/2019 had concluded that the service operated in accordance with the Public Sector Internal Audit Standards. A letter of confirmation was attached as an appendix to the report.

The Sub-Committee decided: that the content of the report be noted.

10 Any Other Competent Business There were no other items of competent business.

18 Agenda Item

4 Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 25 June 2019 Report by: Director, Health and Social Care

Subject: Financial Monitoring 2018-2019

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  advise the Integration Joint Board of the financial position of the South Lanarkshire Health and Social Care Partnership for the period from 1 April 2018 to 31 March 2019 (Health Care Services) and 1 April 2018 to 31 March 2019 (Social Work and Housing Services) [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):- [recs] (1) that that the contents of the report be noted; (2) that, as detailed at paragraphs 6.7.7. to 6.7.9., the draw down over three years of £0.508 million from the Palliative Care earmarked reserve of £0.808m be noted to match fund the lottery award of £0.508m for the establishment of the Compassionate Lanarkshire project by the St Andrew’s, Kilbryde and Strathcarron Hospices; (3) that the amount of £1.570m is transferred to ring-fenced reserves as outlined in paragraph 11.3.1; (4) that the amount of £0.918m is transferred to earmarked reserves as outlined in paragraph 11.3.2; and (5) that the amount of £1.257m is transferred to the contingency reserve as outlined in paragraph 11.3.3. pending the finalisation of the medium to long term financial plan in consultation with both partners. [1recs] 3. Background 3.1. This report is based on the Financial Monitoring reports received from the Director of Finance of NHS Lanarkshire (NHSL) and the Executive Director, Finance and Corporate Resources of South Lanarkshire Council (SLC). The position detailed in these reports is, therefore, based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in line with their financial policies. This is the sixth Financial Monitoring report presented for the financial year 2018-2019.

4. Summary and Next Steps 4.1. The financial position as at 31 March 2019 is summarised as follows:  there is an underspend of £3.333m on Health Care Services

19  there is an underspend of £0.412m on the Primary Care Improvement Fund which is ring-fenced  there is an overspend of £0.201m on Social Care and Housing Services which has been offset by an additional non-recurring contribution from the SLC partner  there is an overspend of £0.346m on the Housing Revenue Account (HRA) which has been offset by an additional contribution from the SLC partner in line with the agreed accounting policy

4.2. The budget variance is analysed by Care Services at Appendix 2.

5. Budget Adjustments 5.1. During the year, work has been progressed to further develop the reconciliation of in- year budget adjustments. A summary of the budget adjustments between 1 April 2018 and 28 February 2019 was presented to the IJB on 16 April 2019. The remaining budget adjustments for the period to 31 March 2019 are attached at Appendix 1 for information.

6. Reasons for Major Budget Variances – Health Services 6.1. Locality and Other Services 6.1.1. There is a net underspend of £1.656m across the localities and other services. Other services include boundary service level agreements, Social Care funding, management team costs, school nursing and the apprenticeship levy.

6.1.2. The net underspend on employee costs totals £0.086m and is mainly due to vacancies across Nursing Services, Physiotherapy Services and Administration and Clerical Support Services within the localities totalling 21.93 WTE. There are incremental pay increases across many services, however, these cost pressures are being offset in-year by the vacancies.

6.1.3. On 30 October 2017, the Strategic Service redesign proposal to move Care Services from one ward in the Udston Community Hospital to more appropriate and suitable community settings was approved by the IJB. Patient, family and staff engagement plans were initiated and a communication strategy with all key stakeholders was initiated. During the transition period from November 2017 to March 2018, new admissions to the Douglas Ward were reduced and patients with continuing care hospital based complex care needs were transferred to appropriate care settings. The arrangements for the de-commissioning of the Douglas Ward were finalised from April 2018. Over this same period, a number of successful tests of change were also being undertaken to develop a solid foundation for the development of the locality model. These included faster access to home care, the successful testing of intermediate care beds within a residential care setting, the provision of rapid response teams which support people home from hospital and the provision of enablement support through focused and joined up Physiotherapy, Occupational Therapy and home care support.

6.1.4. During this period, the plans to redirect to best effect the funding released from the bed remodelling service redesign with the further development of the locality model were finalised and approved by the IJB on 12 February 2019. These included the provision of additional Home Care, Community Nursing staff, Allied Health Professionals and Pharmacists. The plans are being implemented.

6.1.5. As a result of the timing of the disinvestment in beds within Udston Hospital and the re-investment in the additional community capacity across Health and Social Care

20 Services, a non-recurring underspend of approximately £0.643m was reported in- year.

6.1.6. In 2016-2017, £2.300m of the Social Care Fund was allocated to meet the recurring cost of additional care home placements created between 2011 and 2016. These placements were in addition to the number of placements that could be supported from the core SLC Social Work budget. This level of funding continues to be available to the IJB in 2019-2020, however, it was always anticipated that there would be a reduction in the required number of specific placements moving forward as alternative models of care were implemented. It was reported that the commitment against this budget had reduced in 2018-2019 by £0.494m. As part of the 2019-2020 savings strategy, therefore, on 25 March 2019 the IJB approved that £0.602m of this funding could be redirected to meet 2019-2020 cost pressures. A non-recurring underspend of £0.494m is, therefore, reported at 31 March 2019. The demand for care home placements will continue to be closely monitored.

6.1.7. A total budget of approximately £0.221m did not have a commitment against it in 2018-2019. Savings totalling £0.229m have, therefore, been approved by the IJB on 25 March 2019. This funding will, therefore, be redirected to meet cost pressures in 2019-2020.

6.1.8. The remainder of the underspend on non-pay costs was £0.212m which related to net underspends across surgical sundries, drugs and travel costs.

6.1.9. The total net underspend on non-pay costs was therefore £1.570m.

6.2. Addiction Services 6.2.1. There is an underspend of £1.153m.

6.2.2. The underspend is due mainly to vacancies across Nursing Services (6.03 WTE) and travel costs. The allocation of £1.007m to ADP received in 2018-2019 will be ring-fenced as a reserve at the year-end.

6.3. Medical and Nursing Directorate 6.3.1. There is an underspend of £0.064m.

6.3.2. There is an underspend of £0.027m within the medical directorate due to vacancies and an underspend of £0.037m in the nursing directorate.

6.4. Prescribing 6.4.1. A break-even position is being reported in respect of prescribing activity to January 2019.

6.4.2. The cost per item continues to be less when compared with the previous year. Item numbers are also below a 1% increase when compared with the previous year.

6.4.3. Although the actual prescribing efficiencies were lower than the projected target, the South Lanarkshire Health and Social Care Partnership (HSCP) achieved efficiencies of £1.332m.

6.4.4. Over the last few months there has been an increase in the number of drugs in short supply. This has resulted in an increase in the cost of these drugs which puts pressure on the prescribing spend. It is possible that the ongoing uncertainty about EU withdrawal may further impact on drug availability which may impact on prescribing spend in 2019-2020. This could result in proposed prescribing

21 efficiencies not being realised. Historically, the cost per item in the Cambuslang/Rutherglen locality is also higher when compared with other localities across Lanarkshire however, it is consistent with the Glasgow Health Board practices.

6.4.5. The Prescribing Quality and Efficiency Programme has been in place between 2016 and 2019. The aim of the programme was to improve the quality of prescribing through engagement with all prescribers, tackling unwarranted variation and waste, and, where it may exist, to remove harm. The programme had good success towards achieving its aim.

6.4.6. Responsibility for Primary Care prescribing lies with the HSCP. Each locality is supported by a Prescribing Management Team to support the Locality Quality Medicines Action Groups with the delivery of the prescribing plans where efficiencies can be achieved. These teams are led by Locality Prescribing Advisers. Going forward, the Deputy Lead Pharmacists for prescribing management will continue to be the key links within the structure to promote the continued improvement which is being embedded across the Partnership. Prescribing costs will, therefore, continue to be monitored and reliance will be placed on the programme of actions to manage prescribing activity.

6.5. Out of Area Services 6.5.1. There is an overspend of £0.583m.

6.5.1. This is mainly due to higher costs being charged by external facilities and also the cost of services to support individuals with complex care needs. A plan has been agreed by the partners and is currently being implemented. The management action will take effect in 2019-2020. The overspend will, therefore, require to continue to be managed in-year.

6.6. Area Wide Services 6.6.1. There is an underspend of £0.397m.

6.6.2. Area Wide Services include Central Nursing Services, Corporate Services, Health Promotion Services, Pharmacy Services, Winter Planning Services and Alcohol and Drug Partnership Services. The underspend of £0.397m is mainly due to unfilled posts in the Pharmacy Service.

6.7. Hosted Services Led by South Lanarkshire 6.7.1. The Hosted Services which are led by the South Lanarkshire HSCP are outlined at Appendix 3.

6.7.2. There is a net underspend of £1.414m as at March 2019. The significant variances are in respect of the following services:  Primary Care Improvement Fund £0.412m under  Community Dental Services £0.349m under  Occupational Therapy Services £0.305m under  Palliative Care Services £0.244m under  Physiotherapy Services £0.167m under  Out of Hours Services £0.116m under  Diabetic Services £0.229m over

6.7.3. The underspend in respect of the Primary Care Improvement Plan (PCIP) is £0.412m. The implementation of the PCIP is complex and a range of work streams have been established to take this forward. A report was presented to the IJB on 12

22 February 2019. The IJB is asked to approved the underspend of £0.412m in respect of the PCIF allocation as ring-fenced reserve.

6.7.4. The underspend across Community Dental Services (£0.349m) is mainly as a result of 8.88 WTE vacancies across dental nursing and senior medical and dental staff. This is an improvement when compared to the position reported in July 2018 of 14.58 WTE.

6.7.5. The underspend across Occupational Therapy Services is £0.305m. The net underspend across pay costs is £0.172m. There are 7.94 WTE vacancies in OT posts. The underspend in pay costs as a result of the vacancies is offset by incremental salary increases which are managed in-year. There are also underspends across travel, printing and stationery non-pay budgets (£0.133m).

6.7.6. The underspend across Palliative Care Services (£0.244m) is mainly as a result of 5.59 WTE vacancies across medical staff.  on 5 December 2017, the IJB approved the new model of Palliative Care Services to provide a total of 36 beds across NHSL via 24 beds in St Andrews Hospice (Airdrie) and 12 beds in the Kilbryde Hospice (East Kilbride)  it was recognised that whilst this was the preferred option from the Short Life Working Group, there were other considerations which required to be considered in relation to existing service provision. This was particularly the case for people living in the North Locality (Cumbernauld, Kilsyth and surrounding areas) and Cambuslang/Rutherglen  it was, therefore, proposed the new arrangements would, as far as possible, commence on 1 April 2018. In order to support the transition to the new model, non-recurring costs were estimated to be approximately £1.648m over the transition period. Earmarked reserves were, therefore, approved by the South Lanarkshire IJB (£0.808m - 49%) and by the North Lanarkshire IJB (£0.840m - 51%)  as the South Lanarkshire IJB is the lead for this Hosted Service, part of the earmarked reserve held by the North Lanarkshire IJB was transferred to the South Lanarkshire IJB to meet the costs incurred for the Palliative Care Services provided by the Strathcarron Hospice. The amount of funding transferred in 2018-2019 was, therefore, £0.569m  as a result of a successful exit strategy from the Cambuslang/Rutherglen service provision which was led by the Director of Finance of NHSL, costs were avoided in 2018-2019 and it was not necessary to draw down the earmarked reserve held by South Lanarkshire IJB of £0.808m.

6.7.7. St Andrew’s, Kilbryde and Strathcarron Hospices were successful in a bid to secure an award from the National Lottery Community Fund to establish a partnership project, Compassionate Lanarkshire, for a period of three years. The aim of the project is to support vulnerable and isolated individuals and families in Lanarkshire who are affected by a life-limiting illness such as cancer, chronic obstructive pulmonary disease, heart disease and progressive neurological conditions.

6.7.8. The opportunity to access the lottery funding by the three hospices to expand the current Palliative Care Service capacity, however, is subject to certain conditions, one of which is the requirement to match fund the lottery funding as follows: Year 1 2019-2020 £0.169m Year 2 2020-2021 £0.170m Year 3 2021-2022 £0.169m Total £0.508m

23 6.7.9. The IJB is, therefore, asked to note that the part of the earmarked reserve for Palliative Care Services of £0.808m will be drawn down to comply with the award condition and secure the lottery funding. Including contributions from each hospice, over £1.000m will be available over the three years to ensure individuals living with life limiting conditions and their families have increased access to specialist Palliative Care support both in their own homes and their communities.

6.7.10.The underspend across Physiotherapy Services (£0.167m) is mainly as a result of 9.66 WTE Physiotherapist vacancies.

6.7.11.The underspend across Out of Hours Services (£0.116m) includes the budget and costs from Glasgow for the boundary change areas.

6.7.12.The overspend across Diabetic Services (£0.229m) is mainly as a result of additional spend on insulin pumps and glucose monitors.

6.7.10 In line with the Integrated Resources Advisory Group Finance Guidance, the lead partner for a Hosted Service is responsible for managing any overspends incurred. With the exception of ring-fenced funding, the lead partner can also retain any underspends which may be used to offset the overspends. This arrangement has been in place since 1 April 2016. At the IJB meeting on 16 April 2019, The IJB endorsed the continued application of this principle in respect of 2018-2019.

6.8. Hosted Services Led by North Lanarkshire 6.8.1. The Hosted Services which are led by the North Lanarkshire HSCP, are outlined at Appendix 4. In line with the Hosted Services agreement, a break-even position is reported.

7. Average Vacancy Factor (NHSL) 7.1. The year to date WTE position against the funded establishment across Health Care Services is summarised as follows:

Establishment Actual Variance 1,381 WTE 1,316 WTE 65 WTE 100% 95.3% 4.7%

7.2. The average vacancy factor for the Health Care Services delegated to the Partnership is currently 4.7%. This compares to a vacancy factor of 5% at the end of February 2019 and an average of 9.4% during 2017- 2018. Additional hours are worked through bankaide, overtime and excess part-time hours, the cost of which is included within the financial position reported.

7.3. At the meeting of the IJB (Performance and Audit) Sub-Committee on 21 May 2019, further information was requested on the impact of vacancies on service delivery, in particular, waiting lists. This information is being compiled and will be included in a report to the next sub-committee meeting.

8. Set Aside Activity 8.1. The set-aside budget is a notional budget which represents the consumption of hospital resources by South Lanarkshire residents.

8.2. Based on the 2015-2016 activity levels at the 2017-2018 prices, the notional set- aside budget was previously agreed as £54.715m.

8.3. Based on the latest available information, namely the 2016-2017 activity data at the 2018-2019 prices, the budget was restated to £54.919m and the actual estimated

24 expenditure is calculated to be £56.453m, which is £1.534m than the agreed notional budget.

8.4. Following discussion with the Executive Director of NHSL, similar to the accounting treatment agreed in previous years, the most up-to-date notional budget of £54.919m will be the amount included in the IJB Annual Accounts 2018-2019 as an estimate of expenditure. It is recognised that this will not necessarily reflect the actual usage of these hospital services by the IJB, however, it has been endorsed as an acceptable approach pending further updates from the Information Services Division.

8.5. The NHSL Director of Finance, in consultation with the Chief Financial Officer, continues to improve the monitoring arrangements for the Hospital Acute Services. The calculation of the notional set-aside allocation and the confirmation of actual activity levels is a complex accounting process. The allocation will be updated on receipt of further validated 2017/2018 activity levels from Information Services Division (ISD). This information, however, may not be available until November 2019, based on previous experience. The set-aside budget will be updated to reflect ongoing developments as updated information becomes available.

9. Social Care Services 9.1. An underspend across Adult and Older People Services of £0.292m is reported which is mainly as a result of a reduction in the funding required for named care home placements and is offset by an under recovery in income. There are a range of factors contributing to other overspends and underspends in respect of this demand led budget which are, for the most part, offsetting.

9.2. An underspend of £0.156m is reported in respect of Substance Misuse Services. This underspend is a result of vacancies which are in the process of being filled.

9.3. The Housing General Account is overspent by £0.248m due to the demand for adaptations.

9.4. Income is under-recovered by £0.390m which is an adverse variance. The under- recovery of income is as a result of the costs of the named care home placements being lower than anticipated and less funding being required from the Social Care Fund. This under-recovery is partly offset by the receipt of income from service users during the year which related to a contribution to care costs incurred in a previous year. This income is therefore non-recurring.

9.5. In summary, the total of the above variances is an overspend of £0.201m. It is recognised that the requirement for Social Care Services is difficult to predict and the level of demand can fluctuate, particularly during the winter period. This overspend has been included by the SLC partner in their overall position for 2018-2019. A break-even position is, therefore, reported as a result of the additional non-recurring contribution from the SLC partner.

9.6. In line with the agreed accounting policy, an overspend on the HRA at 31 March 2019 will be offset by an additional partner contribution from SLC. If the year-end position is an underspend, this will be retained within the HRA. An overspend on the HRA of £0.346m is reported in respect of an increase in the demand for adaptations.

10. 2018-2019 Savings 10.1. The 2018-2019 financial plan was approved by the IJB in March 2018. Efficiency savings of £0.230m for Social Care and Housing Services and £0.539m for Health Care Services were approved in March 2018 and June 2018 respectively. It was

25 also noted the remaining funding gap of £0.110m would be monitored during the year.

10.2. In respect of Social Care and Housing Services, the approved savings of £0.230m are being implemented. To date, the savings are on target and no slippage is being reported.

10.3. In respect of Health Care Services, the budgets totalling £0.539m have been removed in line with the agreed savings plans. These budgets were held separately and have now been re-allocated to fund inflationary cost pressures mainly across non-pay budgets. The funding gap of £0.110m was offset by in-year underspends.

11. Reserves 11.1. The position in respect of the South Lanarkshire IJB reserves is attached at Appendix 5 for information.

11.2. No earmarked reserves were drawn down in March 2019. The balance on reserves, therefore, remains at £7.278m, of which £6.727m is ring-fenced and earmarked and £0.551m is a contingency balance.

11.3. The year-end outturn is a net underspend of £3.745m.

11.3.1.The IJB is asked to approve the establishment of the following ring-fenced reserves totalling £1.570m:  a ring-fenced reserve of £0.412m in respect of the underspend against the Primary Care Improvement Fund  a ring-fenced reserve of £1.062m in respect of the underspend against the ADP allocation received in 2018-2019  a ring-fenced reserve of £0.096m in respect of Scottish Government funding received for telehealth projects including Attend Anywhere, Antenatal Pathway and BHF

11.3.2.The IJB is asked to approve the establishment of the following earmarked reserves totalling £0.918m:  an earmarked reserve of £0.214m to implement the business plan for the recruitment of Pharmacists to GP Practices across South Lanarkshire  an earmarked reserve of £0.119m to support Physical Activity Health and Well Being Programmes across South Lanarkshire as part of the Health Promotion strategy  an earmarked reserve of £0.032m to progress the implementation of the iHUB Project  an earmarked reserve of £0.553m in line with the IJB Financial Plan 2019/2020 approved on 25 March 2019

11.3.3.The proposed establishment of ring-fenced and earmarked reserves totals £2.488m. The IJB is asked to transfer the balance of the underspend of £1.257m to the contingency reserve pending the finalisation of the medium to long term financial plan in consultation with both partners.

11.3.4.Subject to IJB approval, the balance on reserves would therefore be as follows: Ring-fenced £5.266m Earmarked £3.949m Contingency £1.808m Total £11.023m

11.4. A review of all reserves will be undertaken and reported to a future meeting of the IJB (Performance and Audit) Sub-Committee.

12. Employee Implications 12.1. There are no employee implications associated with this report.

13. Financial Implications 13.1. The financial implications are as outlined in the report.

14. Other Implications 14.1. The main risk associated with the IJB’s revenue budget is that either or both partners may overspend.

14.2. Prescribing cost volatility represents the most significant risk within the NHS element of the Partnership’s budget. Demand for Care at Home Services represents the most significant risk within the Council’s element of the Partnership’s budget. These risks are managed by both NHSL and SLC through their detailed budget management and probable outturn arrangements.

14.3. An overview of the financial performance for all 31 Integration Authorities (IA’s) for the financial year 2018-2019 was prepared by the Chief Financial Officer Network and submitted to the Scottish Government. The most up-to-date overview currently available is based on the financial information at December 2018. The key highlights are as follows:

14.3.1.The total annual budget reported was £8.968bn.

14.3.2.All 31 IAs provided a forecast outturn to 31 March 2019. At that stage, 22 IAs were projecting an overspend, eight IAs were projecting an underspend and one IA was projecting a break-even position. The South Lanarkshire IJB was one of the eight IAs which was reporting a net underspend.

14.3.3.The totality of all the cost pressures was £97m. The main factors contributing to this are summarised as follows:  non delivery of savings £62m  demographics growth £16m  staffing cost pressures £10m  prescribing cost pressures £9m

14.3.4.The totality of all the cost pressures is partly offset by underspends estimated to be £22.6m due mainly to vacancies and also the phasing of the new funding allocations for strategic priorities. The projected net overspend for all 31 IAs was, therefore, anticipated to be £74.4m. It was estimated that this financial position would be addressed in the following ways:-  anticipated additional funding from partners £32.0m  agreed financial recovery plan with no impact for partners £5.4m  requested Scottish Government brokerage for 1 IA £17.0m

14.3.5.The funding solution for the balance of the cost pressures of approximately £20m remained ‘not yet determined’ or still had to be publicly reported at that stage in respect of nine IAs.

14.3.6.In respect of reserves, the following observations are highlighted:

27  11 IAs have no reserves  four IAs have ring-fenced/earmarked reserves but no contingency reserve  15 IAs have ring-fenced/earmarked reserves and contingency reserves. The amount of the contingency reserve ranges for £0.017m to £7.429m  one IAs is in a repayment arrangement with the partner

14.3.7.Based on the information available at December 2018, the net movement on IA’s reserves was projected to be a reduction of £32m from 1 April 2018 of £125m to £93m (Earmarked £67m (72%); Contingency £26m (28%). The projected reserve balance represents 1% of the total income of £8.9bn.

14.4. There are no sustainable development issues associated with this report.

15. Equality Impact Assessment and Consultation Arrangements 15.1. This report does not introduce a new policy, function or strategy or recommend a change to an existing policy, function or strategy and, therefore, no impact assessment is required.

15.2. Consultation was undertaken with both the Director of Finance for NHSL and the Executive Director of Finance and Corporate Resources of SLC in terms of the information contained in this report.

16. Directions 16.1. The extent to which the existing directions to each partner require to be varied is detailed in the table below:

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 17 June 2019

Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community People who use Health and Social Care Services have positive experiences of those services, and have their dignity respected

28 Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services Health and Social Care Services contribute to reducing health inequalities

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

People who use Health and Social Care Services are safe from harm People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Resources are used effectively and efficiently in the provision of Health and Social Care Services

Previous References  none

List of Background Papers  none

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Marie Moy, Chief Financial Officer Ext: 3709 (Phone: 01698 453709) Email: [email protected]

30 Appendix 1

SOUTH LANARKSHIRE Locality and Addiction Medical and Prescribing Out-of-Area Area Wide Hosted Hosted Family Set-Aside Social Work Total HEALTH AND SOCIAL CARE PARTNERSHIP BUDGET Other Services Services Nursing Services Services Services- Services- Health and Housing Directorate South North Services £m £m £m £m £m £m £m £m £m £m £m £m

Revised Budget As Per February 2019 Finance Report Based on Opening Budget Restated 26.7144 4.190 2.918 66.208 3.918 6.366 42.672 48.428 90.080 56.453 164.127 512.074

Budget Adjustments March 2019 West Of Scotland Out of Hours Triage Pilot 0.125 0.125 Prescribing 0.100 0.100 Dental Income 0.019 0.019 Budget Realignment (CPT Transfer) 0.007 (0.007) 0.000 Other Income 0.002 0.007 0.009 Budget Adjustments 0.289 (0.001) (0.001) 0.278 (0.001) 0.204 0.581 (0.124) 1.225

Budget Adjustments March 2019 Sub Total 0.298 (0.001) (0.007) 0.100 (0.001) 0.278 0.151 0.204 0.581 0.000 (0.124) 1.479

Revised Budget As Per March 2019 Finance Report 27.012 4.189 2.911 66.308 3.917 6.644 42.823 48.632 90.661 56.453 164.003 513.553

31 Appendix 2

SOUTH LANARKSHIRE ANNUAL YEAR TO DATE YEAR TO DATE VARIANCE HEALTH AND SOCIAL CARE PARTNERSHIP BUDGET BUDGET BUDGET ACTUAL GENERAL RING-FENCED TOTAL 2018/2019 Mar 2019 Mar 2019 Mar 2019 Mar 2019 Mar 2019 £m £m £m £m £m £m Health Care Services Locality and Other Services 27.012 27.012 25.356 1.656 1.656 Addiction Services 4.189 4.189 3.036 1.153 1.153 Medical and Nursing Directorate 2.911 2.911 2.847 0.064 0.064 Prescribing 66.308 66.308 66.308 0.000 0.000 Out of Area Services 3.917 3.917 4.611 -0.694 (0.694) Area Wide Services 6.644 6.644 6.492 0.152 0.152 Hosted Services 91.455 91.455 90.041 1.002 0.412 1.414 Family Health Services 90.661 90.661 90.661 0.000 0.000 Set-Aside Budget 54.919 54.919 54.919 0.000 0.000 Expenditure - Sub Total 348.016 348.016 344.271 3.333 0.412 3.745

Social Care Services Adult and Older People Services 164.991 164.991 164.699 0.292 0.292 Substance Misuse Services 1.393 1.393 1.237 0.156 0.156 Grounds Maintence Services 0.084 0.084 0.084 0.000 0.000 Performance & Support Services 0.344 0.344 0.355 (0.011) (0.011) Housing Services - General Fund 1.712 1.712 1.960 (0.248) (0.248) Total Expenditure 168.524 168.524 168.335 0.189 0.189 Gross Income (7.380) (7.380) (6.990) (0.390) (0.390) Net Expenditure 161.144 161.144 161.345 (0.201) (0.201)

Housing Services - HRA 2.859 2.859 3.205 (0.346) (0.346)

Social Care and Housing Services Sub-Total 164.003 164.003 164.550 (0.547) (0.547)

TOTAL EXPENDITURE 512.019

FUNDED BY:

SLC Funding 119.006 Total - SLC 119.006

NHS Lanarkshire Funding 351.837 Social Care Funding 19.057 Resource Transfer 22.119 Total - NHSL 393.013

TOTAL 512.019

32 Hosted Services Appendix 3

Led by the South Partnership TOTAL South Lanarkshire IJB - 49% Share North Lanarkshire IJB - 51% Share Annual YTD YTD YTD Annual YTD YTD YTD Annual YTD YTD YTD Budget Budget Actual Variance Budget Budget Actual Variance Budget Budget Actual Variance 2018/2019 Mar 2019 Mar 2019 Mar 2019 2018/2019 Mar 2019 Mar 2019 Mar 2019 2018/2019 Mar 2019 Mar 2019 Mar 2019 £m £m £m £m £m £m £m £m £m £m £m £m

Community Dental Services 6.022 6.022 5.673 0.349 2.951 2.951 2.602 0.349 3.071 3.071 3.071 0.000 Out of Hours Services 7.802 7.802 7.686 0.116 3.823 3.823 3.707 0.116 3.979 3.979 3.979 0.000 Palliative Care Services 6.833 6.833 6.589 0.244 3.348 3.348 3.104 0.244 3.485 3.485 3.485 0.000 Physiotherapy Services 8.772 8.772 8.605 0.167 4.298 4.298 4.131 0.167 4.474 4.474 4.474 0.000 Primary Care Services 0.641 0.641 0.591 0.050 0.314 0.314 0.264 0.050 0.327 0.327 0.327 0.000 Occupational Therapy Services 7.299 7.299 6.994 0.305 3.577 3.577 3.272 0.305 3.722 3.722 3.722 0.000 Diabetic Services 3.326 3.326 3.555 (0.229) 1.630 1.630 1.859 (0.229) 1.696 1.696 1.696 0.000 Sub Total 40.695 40.695 39.693 1.002 19.941 19.941 18.939 1.002 20.754 20.754 20.754 0.000

Ring Fenced Funding Primary Care Improvement Fund 2.128 2.128 1.716 0.412 1.043 1.043 0.631 0.412 1.085 1.085 1.085 0.000

TOTAL 42.823 42.823 41.409 1.414 20.983 20.983 19.569 1.414 21.840 21.840 21.840 0.000

33 Hosted Services Appendix 4

Led by the North Partnership TOTAL South Lanarkshire IJB - 49% Share North Lanarkshire IJB - 51% Share Annual YTD YTD YTD Annual YTD YTD YTD Annual YTD YTD YTD Budget Budget Actual Variance Budget Budget Actual Variance Budget Budget Actual Variance 2018/2019 Mar 2019 Mar 2019 Mar 2019 2018/2019 Mar 2019 Mar 2019 Mar 2019 2018/2019 Mar 2019 Mar 2019 Mar 2019 £m £m £m £m £m £m £m £m £m £m £m £m

Sexual health Services 2.421 2.421 2.428 (0.007) 1.186 1.186 1.186 0.000 1.235 1.235 1.242 (0.007) Continence Services 2.108 2.108 2.133 (0.025) 1.033 1.033 1.033 0.000 1.075 1.075 1.100 (0.025) Immunisation Services 2.149 2.149 2.303 (0.154) 1.053 1.053 1.053 0.000 1.096 1.096 1.250 (0.154) Speech and Language Therapy Services 5.250 5.250 4.992 0.258 2.573 2.573 2.573 0.000 2.678 2.678 2.420 0.258 Children and Adolescents Mental Health Services 5.880 5.880 5.542 0.338 2.881 2.881 2.881 0.000 2.999 2.999 2.661 0.338 Childrens Services 10.291 10.291 10.169 0.122 5.043 5.043 5.043 0.000 5.248 5.248 5.126 0.122 Integrated Equipment and Adaptations Store 0.540 0.540 0.799 (0.259) 0.265 0.265 0.265 0.000 0.275 0.275 0.534 (0.259) Dietetics Services 3.411 3.411 3.252 0.159 1.671 1.671 1.671 0.000 1.740 1.740 1.581 0.159 Podiatry Services 3.760 3.760 3.831 (0.071) 1.842 1.842 1.842 0.000 1.918 1.918 1.989 (0.071) Prisoner Healthcare Services 1.502 1.502 1.466 0.036 0.736 0.736 0.736 0.000 0.766 0.766 0.730 0.036 Blood Borne Viruses Services 1.545 1.545 1.587 (0.042) 0.757 0.757 0.757 0.000 0.788 0.788 0.830 (0.042) Hospital at Home 1.909 1.909 2.065 (0.156) 0.935 0.935 0.935 0.000 0.974 0.974 1.130 (0.156) Mental Health and Learning Disability Services 58.482 58.482 58.236 0.246 28.656 28.656 28.656 0.000 29.826 29.826 29.580 0.246

TOTAL 99.248 99.248 98.803 0.445 48.632 48.632 48.632 0.000 50.616 50.616 50.171 0.445

34 South Lanarkshire IJB Appendix 5 Position As At 31 March 2019

Useable Reserve 2016/2017 2017/2018 2018/2019 Balance as at Transfers Transfers Balance as at Transfers Transfers Balance as at 31 March 2017 Out In 31 March 2018 Out In 31 March 2019 Ring-Fenced Reserves £m £m £m £m £m £m £m Primary Care and Mental Health Transformation Fund 2.749 0.000 0.932 3.681 0.000 0.000 3.681 Alcohol and Drug Partnership Fund 0.473 0.000 0.000 0.473 (0.473) 0.000 0.000 Physio Trauma and Orthopaedics Pilot 0.000 0.000 0.093 0.093 (0.093) 0.000 0.000 OT Trauma and Orthopaedics Pilot 0.000 0.000 0.083 0.083 (0.083) 0.000 0.000 Home and Mobile Health Monitoring Pilot 0.000 0.000 0.042 0.042 (0.042) 0.000 0.000 Antenatal to 6 months Pathway Pilot 0.000 0.000 0.017 0.017 (0.017) 0.000 0.000 Family Health Services 0.015 0.000 0.000 0.015 0.000 0.000 0.015 Total Ring-Fenced 3.237 0.000 1.167 4.404 (0.708) 0.000 3.696 Earmarked Reserves Palliative Care Services 0.000 0.000 0.808 0.808 0.000 0.000 0.808 Prescribing Fund 0.636 0.000 0.100 0.736 0.000 0.000 0.736 Social Care Contingency 0.000 0.000 0.701 0.701 0.000 0.000 0.701 Transitional Fund 0.696 (0.121) 0.000 0.575 (0.200) 0.000 0.375 Training Fund - Health Visitors 0.000 0.000 0.220 0.220 0.000 0.000 0.220 Telehealth Project 0.191 0.000 0.000 0.191 0.000 0.000 0.191 IT Federated Trust Environment 0.000 0.000 0.070 0.070 (0.070) 0.000 0.000 Diabetes Capacity Plan 0.000 0.000 0.022 0.022 (0.022) 0.000 0.000 Total Earmarked 1.523 (0.121) 1.921 3.323 (0.292) 0.000 3.031 Contingency 1.359 (0.808) 0.000 0.551 0.000 0.000 0.551 General Fund 6.119 (0.929) 3.088 8.278 (1.000) 0.000 7.278

36 Agenda Item

5 Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 25 June 2019 Report by: Director, Health and Social Care

Subject: Performance Monitoring Report

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  update the Board on performance against the key performance measures assigned to the integration of Health and Social Care  outline future performance reporting opportunities [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):- [recs] (1) that the current performance trends be noted; and (2) that the proposed development work regarding performance management arrangements be noted. [1recs] 3. Background 3.1. The Health and Social Care Delivery Plan and the work of the Ministerial Steering Group (MSG) in Health and Social Care have identified six key areas through which trends over-time will be monitored, with a view to supporting improvement and learning within partnerships and across Scotland.

3.2. A key emphasis behind this work is realising the national ambition to shift the balance of care through strategic commissioning which shifts the focus from acute and residential settings to community based alternatives.

3.3. In addition, a number of performance measures which relate to the functions managed by the Health and Social Care Partnership (HSCP) are also reported to the NHS Lanarkshire Board, the South Lanarkshire Council Social Work Resources Committee and South Lanarkshire Community Planning Partnership.

3.4. This report outlines the trends in performance with regards to the six MSG measures and also the measures within the wider Integration Joint Board (IJB) performance framework.

3.5. MSG data in this report is for South Lanarkshire residents regardless of the health board area of treatment. With the exception of delayed discharge bed days there are data lags associated with indicators, roughly three months for admissions and Unscheduled Care bed days with longer lags for mental health and geriatric long stay bed days.

4. Summary of the Six MSG Indicators 4.1. A&E Attendances – continue to show an upwards trend of 3.29% when compared against the 2017/18 figures. These figures are not dissimilar to the national trends observed across Scotland

4.2. Emergency Admissions 4.2.1. Emergency admissions remain at similar levels to 2017/18 with a decrease of two admissions representing less than 0.01%.

4.3. Unscheduled Care Bed Days 4.3.1. The trends remain positive year on year with a 6.15% decrease observed between 2017/18 and 2018/19.

4.4. Delayed Discharges 4.4.1. There has been significant work undertaken over the last 18 months to refocus efforts in supporting a reduction in the number of Delayed Discharges in line with the Audit Scotland report on this issue as well as the internally generated Delayed Discharge Action Plan. In total the Partnership has reduced bed days associated with non-code nine reasons by 3,652 over the period April – March 2018/19 when compared with the previous year.

4.5. Last six months of life by setting 4.5.1. The overall position has shown a positive shift from 84.2% in 2013/14 to 87% in 2018/19 for the proportion of people spending the last six months of life in the community as opposed to a hospital setting.

4.6. Balance of Care 4.6.1. Figures have remained broadly consistent over the last six years, in that nearly 83% of people aged 75+ remain at home unsupported. A further 8.9% of people aged 75+ are being supported at home who have complex care needs.

4.7. Appendix 1 gives a more detailed overview of each of the above indicators.

4.8. From an IJB perspective, there are further suite of 31 measures, (some of which overlap with the six MSG referred to above) which are reported on a regular basis. The content and detail of these is contained in Appendix 2.

5. Summary and Next Steps 5.1. Further areas of development across the six main MSG targets are being led by the Partnership, working alongside acute colleagues. These will be described in a future report to the IJB.

6. Employee Implications 6.1. There are no employee implications associated with this report.

7. Financial Implications 7.1. There are no financial implications associated with this report.

8. Other Implications 8.1. There are no additional risks associated with this report.

8.2. There are no sustainable development issues associated with this report.

8.3. There are no other implications at this stage.

9. Equality Impact Assessment and Consultation Arrangements 9.1. This report does not introduce a new policy, function or strategy or recommend a change to an existing policy, function or strategy and therefore, no impact assessment is required.

9.2. Consultation on this work has and will continue to be part of discussions with the strategic commissioning group and locality planning groups.

10. Directions 10.1.

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 28 May 2019

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

39 Resources are used effectively and efficiently in the provision of Health and Social Care Services

Previous References  none

List of Background Papers  none

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Craig Cunningham, Head of Commissioning and Performance Ext: 3704 (Phone: 01698 453704) Email: [email protected]

40 Appendix 1

South Lanarkshire HCSP Health and Social Care Delivery Plan Measures

1. Context 1.1. The Health and Social Care Delivery Plan and the work of the Ministerial Steering Group (MSG) in Health and Social Care have identified six key areas through which trends overtime will be monitored, with a view to supporting improvement and learning within partnerships and across Scotland.

1.2. A key emphasis behind this work is realising the national ambition to shift the balance of care through strategic commissioning which shifts the focus from acute and residential settings to community based alternatives. This report gives a short overview of the South Lanarkshire position with regards to the following areas:  unplanned admissions  occupied bed days for unscheduled care  A&E performance  delayed discharges  end of life care  the balance of spend across institutional and community services

1.3. Summary of the MSG indicators in South Lanarkshire for currently available data: April - February 2018/19:  A&E attendances up by 3.29% against 2017/18  emergency admissions down by -0.01% against 2017/18  unscheduled bed days down by -6.15% against 2017/18

April – March 2018/19  Delayed Discharge non-code nine bed days down by 10% April – March against 2017/18

2017/18 2018/19 Increase/ Decrease A&E Attendances (April - Feb) 96,324 99,492 3.29% Emergency Admissions (April - Feb) 35,976 35,974 -0.01% UC Bed days (April - Feb) 208,967 196,116 -6.15% Delayed Discharge Non-Code 9 bed days 36,780 33,128 -10% (April - March)

41 a) A&E Attendances The following graphs show the performance against trajectory. The trajectory has been revised to reflect seasonality; this does not affect the overall target numbers. This trajectory has been calculated assuming that A&E attendances could be maintained at the previous year level. Attendances continue to be a challenge for the Partnership, April 2018 - February 2019 there were 6,472 additional attendances than anticipated, 99,492 against a target of 93,020. However, February performance improved with the Partnership -314 attendances against target.

South Lanarkshire A&E Attendances

10,000

9,500

9,000

8,500

8,000

7,500

7,000

6,500

6,000

5,500

5,000

Jul-15

Jul-16

Jul-17

Jul-18

Jan-16

Jan-17

Jan-18

Jan-19

Jun-15

Jun-16

Jun-17

Jun-18

Oct-15

Oct-16

Oct-17

Oct-18

Apr-15

Apr-16

Apr-17

Apr-18

Sep-15

Feb-16

Sep-16

Feb-17

Sep-17

Feb-18

Sep-18

Feb-19

Dec-15

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Dec-18

Aug-15

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Aug-17

Aug-18

Nov-15

Nov-16

Nov-17

Nov-18

Mar-16

Mar-17

Mar-18

May-15

May-16

May-17 May-18

Attendances Target Attendances

b) Emergency Admissions The graph below shows emergency admissions against the agreed trajectory. Performance deteriorated April 2018 to February 2019 with 807 additional admissions than anticipated – 35,974, against a target of 35,167. During February 2019 performance improved - 537 fewer admissions than anticipated.

South Lanarkshire Emergency Admissions 4,000

3,500

3,000

2,500

2,000

1,500

Jul-15

Jul-16

Jul-17

Jul-18

Jan-16

Jan-17

Jan-18

Jan-19

Jun-15

Jun-16

Jun-17

Jun-18

Oct-15

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Oct-18

Apr-15

Apr-16

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Apr-18

Sep-15

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Sep-16

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Sep-18

Feb-19

Dec-15

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Aug-18

Nov-15

Nov-16

Nov-17

Nov-18

Mar-16

Mar-17

Mar-18

May-15

May-16

May-17 May-18 Emergency Admissions Target Admisssions

c) Unscheduled Bed Days The graph below tracks the month-on-month actual performance longitudinally against the trajectory agreed for unscheduled bed days. Acute bed days for April 2018 to February 2019 were 2,897 fewer than anticipated, 196,116 against the target of 193,219. It should be noted that there is routinely a few months lag in terms of completed episodes of care and bed days for April to February will increase.

South Lanarkshire Unscheduled Care Bed days Acute Specialties

24,000

22,000

20,000

18,000

16,000

14,000

12,000

10,000

Jul-15

Jul-16

Jul-17

Jul-18

Jan-16

Jan-17

Jan-18

Jan-19

Jun-15

Jun-16

Jun-17

Jun-18

Oct-15

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Apr-15

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Mar-17

Mar-18

May-15

May-16

May-17 May-18

Actual Target

Both Mental Health (MH) and Geriatric Long Stay (GLS) bed days have shown a significant reduction from January 2015, and are currently performing well against target levels. As with Acute bed days there is a lag in data, which is longer for MH and GLS specialties, and bed days will increase.

South Lanarkshire Unscheduled Geriatric Long Stay 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0

Geriatric GLS Target

South Lanarkshire

Unscheduled Mental Health 20,000 18,000 16,000

14,000

12,000 10,000 8,000 6,000 4,000 2,000 0

Mental Health MH Target

d) Delayed Discharge Bed Days A comparison of April to March 2018/19 against the previous year shows improved performance, with a 10% reduction in non-code nine delayed discharge bed days. Bed days for March 2019 were 391 bed days beyond target, 2708 against the target of 2,317.

The graph below include patients in offsite beds and takes into account progress in embedding improvements outlined in the delayed discharge improvement plan.

South Lanarkshire Delayed Discharge Bed Days (exc. Code 9s) 5,000 4,000 3,000 2,000 1,000

Jul-16

Jan-16

Jun-17 Jun-18

Oct-17 Oct-18

Feb-17 Apr-17 Feb-18 Apr-18 Feb-19

Sep-15 Sep-16

Dec-16 Dec-17 Dec-18

July-15

Aug-17 Aug-18

Nov-15

Mar-16 May-16

Non-code 9 Bed days Target

46 Delayed discharge bed days for the financial year to date show an overall reduction for non-code nine bed days of 10% when compared to the same period in the preceding year. This follows the continued year on year improvement as highlighted in the table and graphs below. The second of the two graphs shows the reduction in median bed days from August 2015.

Negative = DD Non 2017 2018 Negative = DD Non fewer code 9 fewer than code 9 2016 2017 than 2016 2017 April 3,655 3,392 -263 April 3,392 2,269 -1,123 May 3,650 3,635 -15 May 3,635 2,550 -1,085 June 3,602 3,065 -537 June 3,065 3,213 148 July 3,156 3268 112 July 3,268 2,770 -498 Aug 2,930 3246 316 August 3,246 2,650 -596 Sept 3,134 3213 79 Sept 3,213 2,933 -280 Oct 3,635 3972 337 October 3,972 3,093 -879 Nov 3,091 3625 534 Nov 3,625 2,598 -1,027 Dec 3,284 2910 -374 Dec 2,910 2,771 -139 Jan 3,186 2184 -1,002 Jan 2,184 2,862 678 Feb 3,519 2293 -1,226 Feb 2,293 2,711 418 March 3,497 1977 -1,520 March 1,977 2,708 731 Total 40,339 36,780 -3,559 36,780 33,128 -3,652

The following graph shows the reduction in median bed days over the previous years.

South Lanarkshire H&SCP Non Code 9 bed days

4,500 3,822 4,000 3,257 3,500 2,817

3,000

2,500

2,000

1,500

Jul-16 Jul-17 Jul-18

Jan-16 Jan-17 Jan-18 Jan-19

Jun-16 Jun-17 Jun-18

Oct-15 Oct-16 Oct-17 Oct-18

Apr-16 Apr-17 Apr-18

Sep-16 Sep-15 Feb-16 Feb-17 Sep-17 Feb-18 Sep-18 Feb-19

Dec-15 Dec-16 Dec-17 Dec-18

Aug-18 Aug-15 Aug-16 Aug-17

Nov-15 Nov-16 Nov-17 Nov-18

Mar-16 Mar-17 Mar-18 Mar-19

May-18 May-16 May-17

All delays excluding code 9 Median

ISD published data shows that bed days during March 2019 for all delay reasons increased by 1102 when compared to March 2018, comprising an increase of 731 non code nine bed days, with an increase of 371 code nine bed days. This is not unexpected given the exceptional variation highlighted in the chart below.

South Lanarkshire Bed days All reasons 5,016

4,516 UCL 4,343

4,016 CL 3,631 3,516

3,016 LCL 2,919 Bed Days All BedDays All Reason 2,516

2,016

Jul-16 Jul-17 Jul-18

Jan-16 Jan-17 Jan-18 Jan-19

Jun-18 Jun-16 Jun-17

Oct-18 Oct-15 Oct-16 Oct-17

Apr-16 Apr-17 Apr-18

Feb-18 Feb-19 Sep-15 Feb-16 Sep-16 Feb-17 Sep-17 Sep-18

Dec-15 Dec-16 Dec-17 Dec-18

Aug-15 Aug-16 Aug-17 Aug-18

Nov-15 Nov-16 Nov-17 Nov-18

Mar-16 Mar-17 Mar-18 Mar-19

May-16 May-17 May-18 Aug-15 - Feb-19

There are significant pieces of work being undertaken in the undernoted areas – all of which are aimed at continuing to assist in reducing admissions and increasing flow through the hospital setting. a) an ongoing modernising of home care b) revising model of intermediate care across inpatient, residential, day care and community facilities c) redesigning the CCA pathway

In addition to the foregoing, there is a series of actions which continue to be taken to sustain the improved performance and to keep demand with the increasing flow of patients associated with the pattern of increased admissions and reduced unscheduled care beds. These include:  daily conference calls with locality teams with Hairmyres and Wishaw Hospital Management Teams and Discharge Facilitators to review cases and lists which has contributed to a reduction in both homecare and CCA delays  weekly meetings at Hairmyres to review all delays over 14 days  continued working on consistent pathway for all CCA patients, including information to relatives throughout inpatient stay, including closer collaborative working  increased ownership/familiarisation of process by all Senior Charge Nurses

49  addressing the number of patients not clinically ready for discharge at time of care package being available (typically within 48 hours)  increasing the number of am referrals  improved referrals over weekends and Wednesdays  maximising the use of an Estimated Date of Discharge. (This includes a ’step by step’ approach being used to ensure technology is working to support embedding use of EDD and dynamic board rounds)  implementation of – and adherence to - the Choices Protocol with regards to care home placement. When first choice is unavailable interim placements have been put in place.  improved use of intermediate care approaches and beds across a number of settings improved awareness of new recording systems and associated coding (following transfer of process from Edison to Trakcare) e) Last Six Months of Life by Setting Percentage of people who spend their last six months in a community setting has steadily increased over the previous three years. With a shift of resources from acute to community, it is expected that the numbers of people who spend the last six months in the community will increase. Initially the Partnership aims to achieve the average of their benchmarking group, within three years the aim is to achieve above average in line with North Lanarkshire.

The table below confirms the Partnership is increasing the proportion of South Lanarkshire residents who spend the last six months of life in the community. The percentage of people who spend the last six months of life in a large hospital has fallen since 2013/14 to 12.3% during 2017/18, slightly above the target of 12.2%. Fewer people spend their last six months in either community hospitals or hospice/palliative care units.

2013/2014 2014/2015 2015/2016 2016/2017p 2017/2018 2018/2019 Community 84.2% 84.4% 84.9% 86.9% 87.1% 87.0% Community Target 84.2% 84.4% 84.9% 87.0% 86.6% Large Hospital 14.0% 14.3% 13.9% 12.3% 12.3% 11.7% Large Hospital Target 14.0% 14.3% 13.9% 12.2% 12.2%

f) Balance of Care The percentage of people over 75 who are not thought to be in any other setting, or receiving any Home Care, has increased during 2015/16. South Lanarkshire is at the average level when measuring against their peer group. Given the increase in the 75+ age group, the 2015/16 percentage remains the target through to 2018/19.

2013/2014 2014/2015 2015/2016 2016/2017p 2017/2018 2018/2019 Home (unsupported) 81.4% 82.2% 82.1% 82.5% 82.9% Home (unsupport) Target 81.0% 81.8% 81.7% 82.0% 82.0% 82.0% Home Supported 9.6% 9.0% 9.0% 9.0% 8.9% Home Support Target 9.6% 9.0% 9.0% 9.0% 9.0% 9.0%

Balance of care improvements figures, shown above, were based on the over 75 population, generally those with the more complex needs. Currently the percentage of people over 75 who remain at home without support is above target by slightly below 1%.

50 SOUTH LANARKSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP INTEGRATED JOINT BOARD QUARTERLY REPORT

Apr-19 (MSG info is Apr - Jan 2019 / NI No SOURCE Measure data Is latest) Dec-18 Sep-18 Jun-18 Comments OUTCOME 1: People are able to look after and improve their own health and wellbeing5 and live in good health for longer 1 NI - 1 Percentage of adults able to look after their health very well or quite well 92% 92% 92% 92%

OUTCOME 2: People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community

Percentage of adults supported at home who agreed that they are supported to live 2 NI - 2 as independently as possible 81% 81% 81% 82% NI - 12 / MSG 1a / 3 NHS Emergency admission rate (per 100,000 population) 2964 10252 9808 10006 4 NI - 13 Emergency bed day rate (per 100,000 population) 125323 124817 122 126436 5 NI - 14 Readmission to hospital within 28 days (per 1,000 population) 97 97 97 96

6 NI - 18 Percentage of adults with intensive care needs receiving care at home 62% 62% 62% 62% Number of days people spend in hospital when they are ready to be discharged 7 NI - 19 (per 1,000 population) 1118 1118 1118 1341 Percentage of health and care resource spent on hospital stays where the patient 8 NI - 20 was admitted in an emergency 24% 24% 23% 23%

Indicator under Percentage of people admitted to hospital from home during the year, who are development by ISD 9 NI - 21 discharged to a care home - Data not available

Indicator under Percentage of people who are discharged from hospital within 72 hours of being development by ISD 10 NI - 22 ready NA NA NA NA - Data not available

11 MSG 4 Delayed Discharges Bed days standard delays 3332 9974 9614 8882 12 MSG 3a A&E Attendances 9299 26371 27440 27920 13 MSG 2A UC Bed Days 13972 54112 55395 57754

14 MSG Emergency Admissions 33314 10302 9808 10005 OUTCOME 3: People who use health and social care services have positive experiences of those services, and have their dignity respected NI - 15 / 15 MSG 5a Proportion of last 6 months of life spent at home or in a community setting 87.1% (2017/2018) 86.9% (2016/2017) Balance of care: Percentage of population in community or institutional settings (all 16 MSG 6 ages) 90.9% (2017/2018) 90.7% (2016/2017)

51 Percentage of adults supported at home who agreed that they had a say in how 17 NI - 3 their help, care, or support was provided 69% 69% 69% 69%

Percentage of adults supported at home who agreed that their health and social 18 NI - 4 care services seemed to be well co-ordinated 74% 74% 74% 74%

19 NI - 5 Total % of adults receiving any care or support who rated it as excellent or good 78% 78% 78% 78%

Percentage of people with positive experience of the care provided by their GP 20 NI - 6 practice 81% 81% 81% 81% OUTCOME 4: Health and Social Care services are centred on helping to maintan or improve the quality of life of people who use those services Proportion of care services graded 'good' (4) or better in Care Inspectorate 21 NI - 17 inspections 81% 81% 81% 84%

Percentage of adults supported at home who agree that their services and support 22 NI - 7 had an impact on improving or maintaining their quality of life 82% 82% 82% 82% OUTCOME 5: Health and social care services contribute to reducing health inequalities

23 NI - 11 Premature mortality rate per 100,000 persons 431 431 431 460

OUTCOME 6: People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing

24 NI - 8/NHS Total combined % carers who feel supported to continue in their caring role 32% 32% 32% 32% Identify the number of new carers identified and supported each year through the 25 third sector 326 368 313 284 OUTCOME 7: People who use health and social care services are safe from harm

26 NI - 9 Percentage of adults supported at home who agreed they felt safe 82% 82% 82% 82%

OUTCOME27 NI - 16 8: PeopleFalls whorate perwork 1,000 in health population and socialaged 65+ care services feel engaged with the work they do and are supported23 to continuously improve23 the information, support,23 care and treatment they 22 provide

Indicator under Percentage of staff who say they would recommend their workplace as a good development by ISD 28 NI - 10 place to work NA NA NA NA - Data not available OUTCOME 9: Resources are used effectively and efficiently in the provision of health and social care services

Indicator under development by ISD 29 NI - 23 Expenditure on end of life care, cost in last 6 months per death NA NA NA NA - Data not available

52 Agenda Item

6 Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 25 June 2019 Report by: Chief Financial Officer

Subject: Unaudited Integrated Joint Board Annual Accounts 2018/2019

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  provide the Unaudited Integration Joint Board Annual Accounts for the financial year 2018/2019 in line with the legislative requirements [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):- [recs] (1) that the Unaudited Integration Joint Board Annual Accounts for 2018/2019, as appended to this report, be noted; and (2) that the arrangements for publication of the Integration Joint Board Annual Accounts for 2018/2019 in line with the legislative requirements be noted. [1recs] 3. Background 3.1. The Public Bodies (Joint Working) (Scotland) Act 2014 was passed by the Scottish Parliament on 25 February 2014 and received Royal Assent in April 2014. The Integration Joint Board (IJB) is a legal entity in its own right, created by Parliamentary Order, following Ministerial approval of the Integration Scheme.

3.2. NHS Lanarkshire (NHSL) and South Lanarkshire Council (SLC) have delegated functions to the IJB which has the responsibility for strategic planning, resourcing and ensuring delivery of all Integrated Services.

3.3. The IJB is specified in legislation as a “Section 106” body under the terms of the Local Government Scotland Act 1973. It is therefore expected to prepare Annual Accounts in compliance with the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2016/2017 (the “Code of Practice”) and the International Financial Reporting Standard (IFRS).

4. IJB Annual Accounts 2018/2019 4.1. The Unaudited IJB Annual Accounts 2018/2019 are attached as an appendix. The Annual Accounts have been prepared in line with proper accounting practice, but remain subject to audit by Audit Scotland, who will complete their audit by 30 September 2019, having reported their findings to the IJB in advance of that date.

53 4.2. As prescribed by the Local Authority Accounts (Scotland) Regulations 2014 and in line with the previous year, the Unaudited IJB Annual Accounts will be available for public inspection in the Council Offices for a three week period from Friday, 28 June 2019 until Thursday, 19 July 2019 inclusive. The Regulations also require publication of the Annual Accounts on the IJB’s website. The Unaudited Annual Accounts are therefore available online from 28 June 2019 until the date the audited Annual Accounts are published.

4.3. Following completion of the external audit and having taken into consideration any findings reported by Audit Scotland, the audited IJB Annual Accounts 2018/2019 will be submitted to the IJB for approval before 30 September 2019.

4.4. The IJB Annual Accounts 2018/2019 will thereafter be available in both hard copy and on the website for at least five years, together with any further reports provided by the External Auditor that relates to the audited accounts. The IJB Annual Accounts 2018/2019 must be published by 31 October 2019 and any further reports by External Auditor by 31 December 2019.

5. Employee Implications 5.1. There are no employee implications associated with this report.

6. Financial Implications 6.1. The financial implications are as outlined in the report.

7. Other Implications 7.1. This report relates to all national outcomes as effective governance arrangements will ensure that the IJB can fulfil its statutory duties.

7.2. The main risk associated with the IJB is that one or both partners could overspend. The risk has been closely managed by each partner during the financial year under review. The budget monitoring arrangements in place ensured that corrective action could be taken including additional partner contributions as appropriate to address increases in demand for Health and Social Care Services.

7.3. There are no sustainable, environmental or other implications arising directly from this report.

8. Equality Impact Assessment and Consultation Arrangements 8.1. This report does not introduce a new policy, function or strategy and therefore, no impact assessment is required.

8.2. The Director of Finance, NHSL and the Executive Director, Finance and Corporate Resources of SLC were both consulted on the content of this report.

9. Directions 9.1. The extent to which the existing Directions to each partner require to be varied is detailed in the table below:

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Marie Moy Chief Financial Officer

Date created: 14 June 2019

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

Previous References  none

List of Background Papers  Appendix

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD

ANNUAL ACCOUNTS UNAUDITED

2018/2019

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Page

Management Commentary 3

Statement of Responsibilities 19

Remuneration Report 20

Annual Governance Statement 23

Comprehensive Income and Expenditure Statement 36

Movement in Reserves Statement 37

Balance Sheet 38

Notes to the Accounts 39

Audit Arrangements 51

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MANAGEMENT COMMENTARY

Introduction The South Lanarkshire Integration Joint Board (IJB) was established as a body corporate by order of Scottish Ministers in October 2015 with integrated delivery of health and social care services commencing in April 2016. 2018/2019 is the third year of operation for the IJB.

The functions delegated by South Lanarkshire Council (SLC) and NHS Lanarkshire (NHSL) to the IJB are detailed in the Integration Scheme which is available at South Lanarkshire Integration Scheme1. The South Lanarkshire Health and Social Care partnership (partnership) refers to the joint working arrangements between the partners SLC and NHSL. The IJB is a separate legal entity which is responsible for the strategic planning and commissioning of the wide range of health and social care services across South Lanarkshire. The partnership is responsible for the operational delivery of the IJB’s strategic directions.

The purpose of the IJB is to improve the wellbeing of people who use health and social care services and their carers’ and to deliver on the Scottish Government’s nine national health and wellbeing outcomes. In addition to these, extensive participation and engagement activity was undertaken in respect of the South Lanarkshire Strategic Commissioning Plan (SCP).

The year under review was the third and final year of the first SCP and, following consultation with key stakeholders, the priorities for 2018/2019 were refreshed at the start of the year. Since then the SCP for 2019 - 2022 has been approved by the IJB on 25 March 2019. The outcome of the consultation process is detailed on pages 24 and 25 of the Annual Governance Statement. The priorities which were originally identified still remain relevant today and, together with the nine health and well-being outcomes, form the basis of the commitment of the IJB to progress the integration of health and social care services.

There are multi-faceted factors which impact on the demand for health and social care services across South Lanarkshire, particularly for those whose needs are complex.

▪ In 2018, the population was 319,020. This is an increase of 0.3% from 318,170 in 2017. Over the same period, the population of Scotland increased by 0.2%. ▪ The age profile of residents is as follows: 17% are 15 years of age or younger, 63% are aged between 16 and 64 years, 11% are aged between 65 and 74 years and 8% are over 75 years of age. ▪ When compared to other Scottish local authority areas, in the period up to 2026, the 16 to 24 years age group is projected to see the largest percentage decrease at 9%. The 75 years and over age group however is projected to see the largest percentage increase at 26.5%. In terms of size, the age group of 45 to 64 years is projected to remain the largest. ▪ In comparison to the Scottish average, life expectancy in continues to be lower for males and females across all age groups. In particular, many older people and a growing number of younger people are living with two or more long term conditions such as diabetes and respiratory disease. ▪ South Lanarkshire has 431 data zones, 6.1% of the total across Scotland. Data zones have no standard geographical size and can vary from a small urban area to a large rural spread. In 2016, there were 6,976 data zones in Scotland. 1,046 data zones (15%) were assessed as the most deprived areas. 62 of the 431 data zones (14.4%) in South Lanarkshire ranked within the worst 15% in Scotland. This represents the highest number recorded since 2004.

This management commentary provides an overview of the key outcomes relating to the objectives and strategy of the IJB. It considers our financial performance for the year ended 31st March 2019 and provides an indication of the issues and risks which may impact upon our finances in the future.

1http://www.southlanarkshire.gov.uk/slhscp/downloads/file/59/south_lanarkshire_health_and_social_care_integration_scheme

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MANAGEMENT COMMENTARY (Cont.)

The Role and Remit of the IJB The IJB has responsibility for the strategic planning and commissioning of a wide range of health and social care services within the South Lanarkshire area. The health and social care partnership services include: ▪ accident and emergency (A&E) services provided in a hospital; ▪ inpatient services related to general medicine, geriatric medicine, rehabilitation medicine, respiratory medicine and palliative care services in a hospital; ▪ community health services including Lanarkshire-wide or hosted services; and ▪ social care services (excluding children’s services and justice services).

The IJB is made up of eight voting members: four elected members appointed by SLC and four non-executive directors appointed by NHSL. Non-voting members of the Board include the Chief Officer, the Chief Social Work Officer, the Nurse Advisor, the Medical Advisor, the Chief Financial Officer, the Registered Medical Practitioner and representatives for staff, the third sector, service users and carers.

During the year, the IJB approved the extension of the terms of reference of the IJB (Performance and Audit) Sub-Committee to include financial governance with the overall aim being to strengthen the link between performance and financial data as part of the implementation and further development of the strategic commissioning intentions.

The purpose of the review of our SCP at the start of 2018/2019 was to focus our efforts on the achievement of our priorities over the remaining term of the current plan and to build upon the successes achieved to date. The comprehensive review of the SCP undertaken in 2019 confirmed that our vision remains consistent and clear:

“Working together to improve health and wellbeing in the community – with the community.”

The IJB’s Business Model and Strategy The business model for the IJB is managed by the partnership through core leadership groups, which ensure cross-care and cross-locality working. The IJB's SCP 2019-20222, the SLC Connect Plan 2017-20223 and the NHS Lanarkshire Healthcare Strategy, Achieving Excellence4 are aligned.

Front-line service delivery continues to be carried out by SLC and NHSL across four localities in line with the directions from the IJB to NHSL and SLC. These directions outline what the IJB requires both bodies to do, the funding allocated to these functions and the mechanisms through which the performance in delivering the directions will be monitored.

The IJB’s Outcomes for the Year Strong financial planning and management, the achievement of best value and the allocation of resources to support sustainable models of service delivery from a whole system perspective continue to underpin everything that the IJB and the partners do to ensure our limited resources are targeted to achieve our outcomes to best effect.

The performance framework continues to be embedded across the localities to monitor our achievement of the 9 national health and well-being outcomes and the 13 priority areas we agreed to focus on as a result of the extensive participation and engagement activity recently undertaken. In addition to these commitments, in order to ensure more integrated working across the wider health and social care pathways, the six Ministerial Steering Group indicators also continue to be monitored. The key highlights are outlined on page 5.

2https://www.southlanarkshire.gov.uk/slhscp/downloads/file/176/south_lanarkshire_integrated_joint_board_meeting_monday_25_march _2019_agenda_pack_and_notice 3 https://www.southlanarkshire.gov.uk/downloads/file/11921/connect_council_plan_2017-2022 4 https://www.nhslanarkshire.scot.nhs.uk/download/achieving-excellence/?wpdmdl=4137&ind=1544710644558 60 Page | 4

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MANAGEMENT COMMENTARY (Cont.)

The IJB’s Outcomes for the Year (Cont.)

▪ Similar to the national trend experienced across Scotland, A&E attendances continue to show an upwards trend of 3.29% when compared to the previous year. There were a total of 99,492 attendances between April 2018 and February 2019.

▪ Despite this increase, unplanned admissions remain at similar levels to last year with a decrease of 2 admissions representing less than 0.01%. The average length of stay for emergency admissions has also reduced in 2018/2019, which is a positive movement.

▪ The trend in respect of occupied bed days for unscheduled care remains positive year on year with a 6.15% decrease observed between 2017/2018 (208,967 bed days) and 2018/2019 (196,116 bed days from April 2018 to February 2019), a reduction of 12,851 bed days. This reduction allows hospitals to focus more on planned care. An extended range of community services are being provided which means that individuals who would previously have been cared for in Lockhart Hospital and the Douglas Ward in Udston Hospital are now able to be cared for in their own home environment. The funding previously associated with these beds has been reinvested to expand the community care services.

▪ The impact and inconvenience to people who have been in hospital but are ready to return home has been minimised. Delayed discharge bed days have reduced by 3,652 bed days in 2018/2019 when compared to the previous year, a reduction of 10%. This reflects the significant work undertaken over the last 18 months to re-focus efforts in line with an Audit Scotland report on this matter and the partnership’s own Delayed Discharge Action Plan.

▪ The proportion of people spending the last six months of life in the community as opposed to a hospital setting has shown a positive movement from 84.2% in 2013/2014 to 87% in 2018/2019. From new activity data collated, fewer people are dying in hospital (2017/2018 – 51%; 2013/2014 - 57%).

▪ The balance of spend across health and social care has remained broadly consistent over the last six years. Approximately 83% of people aged 75+ remain at home unsupported. A further 8.9% of people aged 75+ are being supported at home who have complex care needs.

The 2018/2019 Annual Performance Report, which sets out our key highlights will be published in July 2019. During the year, a range of transformational changes have been progressed by the IJB.

➢ Modernising Care Facilities

The SCP 2016 – 2019 included a direction to the council to ‘reduce reliance on nursing and residential care through the development of proposals to remodel a proportion of residential care beds to focus on transitional support and the “home for life” principle’. SLC also approved the investment of £17.6m to replace the existing care homes with new care facilities. Plans are therefore being progressed to modernise the South Lanarkshire care facilities which will enable more people to be supported in their own homes following periods of extended rehabilitation in a purpose built facility.

As many of our community-based supports are strengthened, increasingly, people who might previously have moved into a care home on a long term basis because of ill health and/or increasing dependency can now be supported in their own home.

There has been, and continues to be, widespread engagement with stakeholders and communities. The public have told us that they would prefer to be cared for in their own homes.

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➢ Modernising Care Facilities (Cont.)

The ongoing programme of modernising our care homes seeks to build on this desire for ‘home first’ care and support. The model of care being developed will enhance our ability to meet changing care needs, particularly in light of the significant population changes experienced to date and the future population changes projected. Crucially, the programme will also be built on the strong partnership foundations that are making the increase in independent living possible. The ambition is to improve people’s lives and offer real choice.

An investment in Hamilton/Blantyre marks out the first phase. It will focus on a state-of-the-art, new-build facility at the site of the former St Joseph’s school in Blantyre. The new Care Hub which will serve South Lanarkshire, has four distinct elements: ▪ 20 transitional care beds for adults and older people (transitional care offers short term support with the objective of allowing people to return home following a period of ill health or crisis. Transitional care can also be preventative, preventing hospital admission) ▪ A centre of excellence – specialising in training and development of health and social care staff. Although unique to the proposed Hamilton/Blantyre facility, this will support all localities. ▪ A community-facing hub featuring: A café; Demonstration site (showcasing our Telehealth technology and how that can improve lives); Guidance and support for unpaid carers; Linkage and signposting into a raft of community-based voluntary and third sector support ▪ 20 technology enabled homes for adults and older people.

At its meeting on Wednesday 8 May 2019, South Lanarkshire Council’s Social Work Committee voted in favour of a site at Flush Park, beside Lanark Lifestyles, Lanark as the preferred option for a second Care Hub that will serve Clydesdale.

The Lanark Hub will include long term residential care beds and similarly will also offer transitional care. The Hub will replace Lanark’s existing council run care home McClymont House which will continue to offer residential care until the new facility is built.

The Council’s Social Work Committee also gave its backing to the continued development of proposals to site a third Care Hub in the Larkhall/Stonehouse Area. Plans for this third Hub are at an early stage but like the above, they include proposals for short, long stay and transitional care – all supported by the robust infrastructure of the partnership. This includes a strong, community- facing ethos.

This is a key capital project which is being progressed by SLC to meet our commissioning intention. This strategic development increases the opportunity for people to access different care approaches and is in line with the Scottish Government’s 2020 vision to shift the balance of care so that more people are looked after in their own home or in a homely setting. The focus is very much on the aforementioned desire for people to remain at home when possible and appropriate. It is also anticipated that this strategy will support the increasing number of unpaid carers in our communities.

➢ Locality Developments

The development of the locality model underpins the IJB’s strategic direction to support people to remain at home and in their communities and also to shift the balance of care from hospital and residential provision to community based alternatives. The locality model focuses on developing single points of access, seven day services, rapid and appropriate levels of response, enablement, rehabilitation, intermediate care, technology enabled care, discharge to assess, effective care management and end of life care.

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MANAGEMENT COMMENTARY (Cont.)

➢ Locality Developments (Cont.)

The disinvestment in beds within Udston Hospital allowed the reinvestment of £0.701m to enhance community support and build on the outcome of tests of change. This investment has been directed to increase the capacity of the rapid response short-term care at home teams and the integrated care and support teams. The assessment and care management systems have been remodelled and additional pharmacy support has been secured. Following a homecare mobile/agile working review, new digital technology was rolled out to social work to enable homecare staff to access and input real-time information on clients. This is intended to improve the accuracy of information available to social work staff and increase productivity by reducing paperwork and duplication of work when recording case details. In addition to this, home care services use mobile technology and a new scheduling system is currently being procured by SLC to further improve this functionality.

The Integrated Community Support Team provides multi-disciplinary support from nurses, physios and home care staff on a 24/7 basis. This provides people with a single point of contact. A number of services are now moving towards 7 day working. This was highlighted in the SCP consultation as an area for further development.

The Clydesdale Integrated Community Support Team-Acute Care Team comprises of nurses, allied health professionals and overnight home carers who provide home-based care and rehabilitation. The success of the joint working and enhanced relationships in this team has led to acute care being delivered by the team.

This highly innovative approach has allowed people experiencing acute infections or sudden deterioration in their health to be supported to remain at home - negating the need for an otherwise inevitable hospital admission. This truly integrated model has promoted a person-centred approach and enhances the experience for the service user and their family. Improved communication, reduced duplication and blurring of roles across services have contributed to improving the outcomes – and the lives – of people who have used this service. This approach will inform future service delivery and improvements across the partnership.

Within the East Kilbride locality, an intravenous therapies initiative supports patients to receive treatment at home where they would historically have been admitted to hospital. This specialist service development primarily sits within the community and is delivered by a single profession. Although specialist skills are required, the care delivered does not require the coordination of multiple professions.

➢ Support for Carers

The Carers (Scotland) Act 2016 aims to support carers’ health and wellbeing and help make caring more sustainable.

▪ In 2018/2019, the number of registered carers increased by 514 (15%) from 2,949 to 3,463. ▪ A Planning and Development Officer was appointed in January 2019 and the partnership’s Carers Strategy was updated for 2019 - 2022. ▪ Recognising that a short breaks service statement is one of the IJB’s new statutory duties, South Lanarkshire was part of the national group which developed the guidance for all local authorities. ▪ In 2019/2020, providers will be invited to tender for the delivery of carer support services, information and advice, short breaks, consultation and engagement, training, practical support and assistance for adult and young carers.

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MANAGEMENT COMMENTARY (Cont.)

➢ Support for Carers (Cont.)

Similar to the national trend, slightly fewer carers felt supported to continue in their caring role across South Lanarkshire (2017/2018 – 32%; 2015/2016 - 39%). However from recent local data, 71% of respondents felt the range of services currently offered met their needs as carers. Customer Service Excellence reports show a continuous improvement over a three year period.

➢ South Lanarkshire Health and Social Care Forum

The South Lanarkshire Health and Social Care Forum, which has representation on a variety of boards, committees, groups and service reviews, played a central role in supporting the development of the SCP 2019 - 2022 and also the locality plans which will underpin the SCP. Through active participation in stakeholder events and locality planning group meetings, the Forum ensure their members influence future services and represent the views of people in their local communities. A recent mapping exercise highlighted that the Forum access almost 100,000 people, which is almost a third of the population of South Lanarkshire. The Forum also actively participated on a range of national groups including working with NHS24 to set up a standard website for GP’s and participating in the consultation for the national GP contract. Members also influenced key strategic groups including the Carers Act Implementation Group and the Remote and Rural Working Group, both led by the Scottish Government.

➢ Palliative Care Services

Palliative Care services are now established at the Kilbryde Hospice in East Kilbride which provides 12 inpatient beds for individuals at difficult times in their lives. This facility also complements the community supports and services which are already in place and reflects the preferences of people – expressed during the review of palliative care services – to receive end of life care in their own home.

The St Andrew’s, Kilbryde and Strathcarron Hospices were successful in a bid to secure an award from the National Lottery Community Fund to establish a partnership project, Compassionate Lanarkshire, for a period of three years. The aim of the project is to support vulnerable and isolated individuals and families in Lanarkshire who are affected by a life-limiting illness such as cancer, chronic obstructive pulmonary disease, heart disease and progressive neurological conditions. The lottery award will be match funded by the IJB and, including contributions from each Hospice, over £1.000m will be available over the three years to ensure individuals living with life limiting conditions and their families have increased access to specialist palliative care support both in their own homes and their communities.

➢ Re-designation of Lockhart Hospital

Local GPs were no longer able to provide medical input at Lockhart Hospital in Clydesdale. As a result, inpatient services were withdrawn and the hospital was formally re-designated as a community health and social care services base from which alternative services are provided. Extensive stakeholder engagement is ongoing with local community groups to shape the future health and social care delivery in Lanark and the surrounding areas, in line with the IJB’s Consultation and Engagement Framework which takes account of and applies the seven national standards for community engagement.

As well as being able to support more people at home, there has been reduced numbers of delayed discharges, performance in relation to hospital flow in Wishaw Hospital has improved and there has continued to be reduced numbers of unscheduled care bed days.

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MANAGEMENT COMMENTARY (Cont.)

➢ VASLan

The IJB continued to allocate £0.650m to the third sector to promote early intervention and prevention activities. In partnership with VASLan, the third sector and South Lanarkshire Leisure and Culture, a range of innovative initiatives were taken forward which included physical activity prescribing programmes to support people to take responsibility for their own health and wellbeing, particularly young people. These activities have had a positive impact on people’s mental health and wellbeing.

➢ Housing Services

Sustainable housing is recognised as vital in enabling people who are frail, vulnerable or disabled, to be supported to live within the community, this helps to reduce and prevent unplanned hospital admissions and enable timely returns when people are fit to go home. The Affordable Housing Supply Programme has significantly increased the supply of suitable, affordable and sustainable housing across South Lanarkshire, delivering on average 270 new affordable homes per year (2016 - 2019). This has included new homes built to Housing for Varying Needs standards, as well as specially adapted homes to meet the particular housing needs of disabled people and families. Approximately, 1,600 homeless households were supported through homelessness, including people with multiple complex needs and 1,100 homeless households were provided with a permanent home. On average, 1,603 adaptations were completed across private (533) and council (1,070) homes each year. These adaptations enable people and households with particular needs, including older people and people with mobility needs and disabilties, to continue to live independently within their own homes in the community.

➢ IJB Developments and National Profile

In 2016/2017, Audit Scotland recommended that, due to the size and complexity of the integration agenda, a programme of development should be established to support the Members of the IJB with the implementation of the SCP. The IJB has been committed to taking forward the integration of health and social care services and members have participated in a range of events, awareness sessions and development meetings throughout the year, from both a strategic and locality planning perspective. External stakeholders have also attended the sessions to offer advice and guidance and share learning from other partnership areas.

The South Lanarkshire innovative initiative to address speech and language inequalities won the prestigious national Quality Improvement Awards 2018 ceremony. The Think Activity Project, pioneered in Kello hospital in Biggar to combat the impact of sedentary behaviour within hospital, also won the Scottish Health Award. The learning from this pioneering project is being shared with other teams across acute and community hospitals within Lanarkshire.

The South Lanarkshire Health and Social Care Partnership was selected as one of 4 areas used by Audit Scotland to assess progress with integration. In turn, a number of areas of good practice and future challenges were identified.

The partnership is committed to communicating with the residents of South Lanarkshire and the staff who deliver the health and social care services. Meaningful engagement is a priority for the Chief Officer who regularly reaches 15,000 people through her ‘Val’s blog’. The IJB website receives 3,000 visits per month and workshops led by our Communication Manager have provided the opportunity for constructive discussion and been described as ‘inspiring’ ‘timely’ and ‘insightful’.

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MANAGEMENT COMMENTARY (Cont.)

The IJB’s Financial Position at 31 March 2019 The delegated funds for the IJB come from SLC and NHSL. The level of funding available to the IJB is therefore heavily influenced by these organisations’ grant settlements from the Scottish Government. Consistent with the majority of public sector organisations, both SLC and NHSL have, over many years, faced challenges balancing their respective budgets due to cost pressures exceeding the provisional level of funding available. Notwithstanding these pressures, within the financial envelope available to each partner and following a process of consultation, the IJB agreed a financial plan for 2018/2019 in order to achieve a balanced budget by 31 March 2019.

Both partners maintained the 2017/2018 baseline funding for the IJB in 2018/2019. Additional funding for NHSL was received and passed on to the IJB during the year. SLC also provided additional recurring funding of £0.547m at the year-end to meet the cost of demographic growth (£0.201m) and additional Housing Revenue Account adaptations (£0.346m).

Work has been progressed to further develop the reconciliation of in-year budget adjustments. The funding available to the IJB in 2018/2019 therefore increased during the year as follows:

Opening Budget 2018/2019 (Restated as at mid-year ) £481.365m Family Health Services £5.882m Investment (Demographic Growth, Inflationary and Other Cost Pressures) £4.100m Pay Award and Apprenticeship Levy £3.896m Living Wage £2.400m Primary Care Improvement £2.128m Out Of Hours Services £1.814m Prescribing £1.020m Alcohol and Drug Partnership £1.007m Carers Act £1.000m Family Nurse Partnership Expansion £0.903m Area Wide Services £0.721m Transfer from Acute Services - Bed Remodelling £0.701m Insulin Pumps £0.598m Health Visitors £0.583m Other £10.438m Total Additional Funding In Year (Recurring and Non-Recurring) £37.191m Total Partner Contributions As At 31 March 2019 £518.556m

The total funding for the IJB in 2018/2019 was £518.556m (NHSL- £392.013m; SLC - £126.543m). This is included in the comprehensive income and expenditure statement at page 36.

A financial strategy to address the cost pressures in 2018/2019 was agreed with both partners. The profile of expenditure which is detailed at note 4 on page 43 is summarised as follows: ▪ 32% is allocated to front line social care services (£166.237m) ▪ 18% is allocated to family health services (£90.661m) ▪ 13% is spent on prescribing (£66.308m) ▪ 18% is incurred on a range of hosted services including the 49% share of those hosted services led by the South Lanarkshire IJB (£90.041m) ▪ 11% represents the large hospital services notional set-aside budget (£54.919m) ▪ 8% is incurred on a range of health care services (£42.317m) ▪ 0.4% relates to housing services (£1.960m) ▪ 0.03% is incurred in IJB corporate services (£0.163m) 66 Page | 10

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MANAGEMENT COMMENTARY (Cont.)

The IJB’s Financial Position at 31 March 2019 (Cont.) The comparison between 2017/2018 and 2018/2019 of the actual expenditure on services stated gross is illustrated in the graph below. The expenditure aligned to services has increased between the years by a total of £19.180m (2017/2018 - £493.426m; 2018/2019 - £512.606m). Similar to last year, the increase in expenditure in 2018/2019 is mainly attributable to inflationary cost increases and demographic growth.

Comparison of Expenditure 2017/2018 and 2018/2019 250

225

200

175

150

125

100

0 Social Care Family Health Prescribing Hosted Hospital Acute Health Care Housing Corporate Services Services Costs Services Services Services Services Services

2017/2018 2018/2019

Key Risks and Uncertainties The risk management framework is further discussed in the Annual Governance Statement on pages 27 and 28. The IJB Risk Management Strategy complements the existing risk management processes within each partner. All three risk registers are reviewed regularly by the management team. The two high risks facing the IJB are the efficient and effective use of resources and shifting the balance of care to community based alternatives. The availability and sustainability of GP services, prescribing cost increases and the impact of withdrawing from the European Union are operational risks which both partners require to manage.

The Director of Finance of NHS Lanarkshire continued to make progress with the exercise to update the notional set-aside budget. Based on the 2016/2017 activity levels at the 2018/2019 prices, this notional budget, which represents the consumption of hospital resources by South Lanarkshire residents, is estimated to be £54.919m.

Similar to the previous year, the notional budget can also be included as the estimated expenditure for the 2018/2019 annual accounts. It is recognised that this will not necessarily reflect the actual usage of these hospital services by the IJB in 2018/2019 however it has been endorsed as an acceptable approach pending further updates from the Information Services Division. This critical judgement in respect of the complex accounting treatment of the hospital acute services (set- aside) therefore follows the advice issued by the Scottish Government on how the sum set-aside should be recorded in the annual accounts and is explained in more detail at note 2 on page 41.

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Matters of Strategic Importance

The health and social care landscape is changing. The 20/20 Vision, the Primary Care Improvement Plan, the Mental Welfare Commission patients’ rights pathway and changes to the legislation are just some of the key drivers which are influencing the evolving models of care.

➢ Primary Care Services

The modernisation of Primary Care Services and the General Medical Services Contract are two of the most significant planning and policy developments aimed at changing how services are developed and transformed to meet different demands in the future. The development of the primary care service is therefore a priority for Lanarkshire. South Lanarkshire IJB is the lead for this hosted service. The Primary Care Improvement Plan is an ambitious transformational programme for Lanarkshire comprising of a range of workstreams covering the digital plan, vaccination transformation programme, pharmacotherapy implementation plan, community treatment and care services, urgent care in-hours services and premises. In support of this agenda, the use of ‘Attend Anywhere’ has also been expanded between GPs and Acute Services to allow the more efficient use of resources. The full 2018/2019 Primary Care Investment Funding was £5.649m. The 2019/2020 allocation will increase to £7.767m.

➢ Social Care Services

Projected growth in elderly demographics and the increasing complexity of need, together with inflationary rises, continue to drive the cost pressures across home support, care home placements and adaptations. In line with the national joint Scottish Government and COSLA guidance on eligibility, which ensures that resources are targeted at those most in need, and taking into consideration the introduction of the Self-Directed Support Act, the Carers Act and free personal care for individuals under the age of 65 years, the IJB approved the implementation of a prioritisation/eligibility framework which stratifies four levels of needs and risks. The implications of the prioritisation framework will depend on individual service users’ needs going forwards. Cost avoidance assumptions have been reported by the partner to the IJB and these will be monitored throughout the year as part of the development of the future financial strategy.

A commissioning intention within the SCP 2019 – 2022 is the implementation of a model of day opportunities which supports people’s personal outcomes and preferences. There are 19 centres across South Lanarkshire, 13 focused on providing support for older people and 6 for adults. The property estate is in very good condition. Although the variation in use ranges from 56% to 69% across localities, dependency levels are increasing due mainly to the prevalence of dementia. A Neighbourhood Networks pilot has also been established. Over the coming year, a review will be undertaken which will involve key stakeholders in the development of a model which will be more responsive to supporting the individual’s personal outcomes and also be agile in meeting future demand for the next 10 years and beyond, in line with the strategic direction.

➢ Mental Health and Learning Disability Services

The 10 year national strategy for mental health and learning disability services focuses on increasing access to seamless care pathways and efficient, effective utilisation of resources. Mental health and wellbeing is prioritised in the SCP.

Mental health and learning disability services are a hosted service which is led by North Lanarkshire IJB. The national aspiration is that mental health and physical health will be seen as equal. A Lanarkshire Mental Health and Wellbeing Strategy is being jointly developed for Lanarkshire. The aim of the strategy includes the following:

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MANAGEMENT COMMENTARY (Cont.)

➢ Mental Health and Learning Disability Services

▪ improve access to mental health supports, including accessing services closer to home; ▪ align physical health needs with mental health needs; ▪ tackle stigma and discrimination; ▪ further develop early intervention and prevention initiatives for all age groups; and ▪ promote good mental health for all.

The strategy will give due consideration to the workforce requirements. Transformation of mental health in primary care is also a priority in the Primary Care Improvement Plan.

The partnership currently has an integrated model of mental health care which offers appropriate supports to individuals at the right time. The Primary Care and Mental Health Transformation programme has seen increased contribution of a wide range of healthcare professionals, increased access to the right help at the right time, GPs feeling more supported with this agenda, fewer unnecessary hospital admissions and an increased ability to self-manage. Distress Brief Intervention/crisis services have also been introduced to support staff in the Police and Accident and Emergency Departments in recognising and supporting people with mental health issues.

In 2018/2019, the mental health funding was £1.358m. This will increase to £2.099m in 2019/2020.

➢ Alcohol and Drug Partnership Strategy

Additional funding of £1.007m is being received in each of the three years 2018/2019 to 2020/2021 to reduce the morbidity and mortality caused by problem alcohol and drug use in South Lanarkshire. The new funding will be invested to meet the needs of individuals in a more joined up person centred way and will build on the current tiered model of intervention adopted by all four localities to date.

Due to the lead-in time to establishing the new service, the first year’s investment has been transferred to a ring-fenced reserve and will be available to take forward the establishment of a first responders team within a road to recovery task force. This will involve Police Scotland, Strathclyde Fire and Rescue Services, addiction psychologists and outreach harm reduction workers based within community hubs and working with peer led experience. Advocacy and assertive outreach workers will also be a strong focus on the delivery of care and will involve people with lived experience. System change to deliver new models of care will be implemented in years two, three and beyond and this will include new approaches to delivering drug and/or alcohol treatment and support. The anticipated benefits of this programme include reducing the stigma around poor mental health and problematic substance use, strengthening collaboration across key partners with a focus on prevention and a whole family approach to support those affected by problem drug/alcohol use.

➢ Urgent Care Out of Hours Services

A national independent review of Urgent Care Out of Hours (OOH) was commissioned by the Scottish Government in 2015. This was due to the challenges emerging nationally in the ability to deliver services out of hours mainly as a result of the reduction in the number of GPs prepared to work in the OOH period. This review was led by Sir Lewis Ritchie.

The review resulted in a new model of delivery for Lanarkshire which was an Urgent Care Resource Hub in Hamilton supported by an Urgent Care Centre in Airdrie Health Centre, Airdrie. The OOH Service is a hosted service led by the South Lanarkshire IJB.

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MANAGEMENT COMMENTARY (Cont.)

➢ Urgent Care Out of Hours Services (Cont.)

Within the OOH Service, a significant number of mitigating actions are in place to address the workforce issues in an ever changing and challenging environment. This includes the commitment to expand the nursing service in order to address GP sustainability problems alongside a range of other initiatives which continue to be progressed.

Despite pro-active action being taken by the partner to maintain service availability, due to the lack of GP cover, the OOH Service has had to consolidate on one site (Hamilton site) 12 times in 2018 and four times so far this year. Patient and staff safety is the overarching priority.

The GP sustainability issues for the OOH Service are also mirrored in the In Hours Service with a number of GP practices experiencing challenges in terms of sustainability. In addition to this, OOH Service challenges are also attributed to a range of other issues for example, changes in pension arrangements, fewer doctors prepared to work unsocial hours and fatigued from working daytime hours.

A support group has been formed to ensure staff and clinical governance is maintained while there are workforce challenges within the Service.

➢ Technology Advancements

The partnership is committed to implementing digital technology to help people to manage their own health and well-being at home and in the community and to support staff to work efficiently.

The South Lanarkshire IJB is the lead for technology enabled care, the extension of which has been very successful in supporting an increasing number of the population to self-care and self- manage through simple smart technology and applications from their mobile phones. This includes home health monitoring, and ‘Attend Anywhere’ where care can been supported remotely. The partnership and the hospices have also explored the use of the ECHO technology to support illness and end of life care.

There are Telehealth champions in each locality and the partnership has also been successful in attracting Scottish Government funding to expand the technology enabled solutions across Lanarkshire. The roll out of the new technology to allow people to monitor blood pressure at home, thereby reducing the need for GP consultations and securing more accurate readings, is an exemplar outcome which was shared with the Cabinet Secretary for Health and Sport during a recent visit to Hunter Health Centre in East Kilbride.

In July 2018, a Federated Trust was formed between the South and North partnerships and NHSL to take forward the technical work which will allow staff across Lanarkshire to communicate effectively across digital platforms. Replacing the community health system (MIDAS) and improving Wi-Fi access are also key priorities for the partnership and NHSL.

A key strategic priority is the development of the SMART/technology enabled care demonstration site which is being funded by the Scottish Government. This development, which is aimed at supporting older, frail adults and their families on the use of technology, will inform the modernising care facilities strategy.

Scotland’s Digital Health and Care Strategy outlines the need for a national digital platform and a once for Scotland approach. The partnership’s digital vision also aspires to this ambition.

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MANAGEMENT COMMENTARY (Cont.)

➢ Early Intervention and Prevention

Over recent years there have been significant legislative and policy developments which focus on the principles of empowerment and self-determination and recognise the need to build strong and resilient communities. In early June 2017, a conversation was facilitated across key stakeholders within South Lanarkshire to recognise the strengths and assets within communities and to explore how the partnership can best serve the communities’ needs. This led to the Building and Celebrating Communities (BCC) programme. A research project conducted by the University of the West of Scotland concluded that there is strong support, particularly at the senior level, for the partnership’s approach to supporting community health and resilience whilst mitigating resource constraints. The BCC approach is considered to be particularly appropriate in South Lanarkshire as a mechanism for addressing the challenges of poverty, economic stress and service provision across diverse communities. Population ageing was identified as a major challenge, alongside isolation and loneliness for both older and young people. A high degree of alignment was perceived between the BCC approach and the statutory priorities in relation to the health and wellbeing outcomes, clinical excellence and the integration of health and social care. The priority moving forward will be to secure the resources to put BCC into action.

➢ Monklands Replacement / Refurbishment Project

The Monklands Replacement / Refurbishment Project is an exciting and positive vision for the University Hospital Monklands and the local and wider community it serves. This is a major investment in the Lanarkshire hospital estate. The Monklands of the future would support the required clinical model of how clinicians will treat patients in the future. It would also meet the objectives set out in the NHSL Healthcare Strategy Achieving Excellence, which sets out the following ambitions:

▪ to shift care away from inpatient treatment to day case, day treatment, outpatient and community care; ▪ to develop pan-Lanarkshire hospital centres of excellence; and ▪ to support the healthcare needs of the wider West of Scotland.

The indicative timescales include approval of the outline business case mid-2019 and full business case approval in 2020.

➢ Financial Sustainability

The IJB financial strategy must ensure sustainability for the current and future years whilst recognising the significant challenges for both partners currently. Efficient, effective and affordable services fit for the future will need to be developed as part of the integration and transformational change activities. If these activities do not generate the required level of savings or if funding released from a whole system approach to IJB cost reduction activity is not passed to the IJB, then there is a risk future budgets will not be balanced.

A range of cost pressures are prevalent including the ongoing impact of demographic growth across social care services and the volatility of prescribing activity and price increases, particularly in the context of the uncertainty associated with the European Union withdrawal.

The Scottish Government announced on 31st January 2019 that they are to bring forward a three year funding settlement from 2020/21. This will allow both partners and the IJB to set a budget for more than one year, to facilitate more integrated planning and budgeting and a more strategic approach to financial decision making. Following the recently published Scottish Government Health and Social Care Medium Term Financial Framework, guidance is also awaited on the financial assumptions to be relied upon within the local medium term financial framework for South Lanarkshire over the three years 2020/2021 to 2022/2023. 71 Page | 15

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

MANAGEMENT COMMENTARY (Cont.)

➢ Financial Sustainability (Cont.)

The newly approved SCP 2019 - 2022 outlines the direction of travel for the next three years for the Partnership. The Plan gives a commitment to 13 strategic priorities and 44 commissioning intentions. These are supported by 33 ‘Directions’ issued by the IJB to the Council and the NHS Board as part of implementing the commissioning intentions.

Four Locality Plans have been developed and agreed which localise the ambitions detailed in the SCP. There are therefore a range of activities which localities will lead on in 2019/2020 including: ▪ Developing systems and processes which secure wider community participation and engagement ▪ Strengthening collaboration and communication across agencies working directly with people who require our support ▪ Engaging and working directly with communities, particularly with regards to the BCC work

The 2019/2020 Financial Plan was approved by the IJB on 25 March 2019 and set out the parameters to achieve a balanced budget by 31 March 2020. Cost pressures and current and future policy commitments are projected to total £18.129m. Additional funding of £15.738m was received from both partners. The balance of the cost pressures of £2.391m is being partly addressed by the savings strategy of £1.838m. The financial plan also highlights that reliance is being placed on reserves of £0.553m and non-recurring cost reductions of £0.232m.

Annual Accounts 2018/2019 As the South Lanarkshire IJB was established under the Public Bodies (Joint Working) (Scotland) Act 2014, it falls within section 106 of the Local Government (Scotland) Act 1973 and is required to prepare annual accounts in accordance with the Local Authority Accounts (Scotland) Regulations 2014.

▪ The final year-end outturn for the IJB is a net underspend of £3.745m. An underspend was reported by NHSL which was mainly due to the lead in time to spend new funding and also vacancies across a range of services.

▪ A break-even position was reported by SLC following an additional non-recurring partner contribution of £0.547m to fund the demand for social care services during the year as a result of demographic growth (£0.201m) and adaptations within the Housing Revenue Account (£0.346m). The net cost of named care home placements reduced during the year.

The surplus of £3.745m represents 0.7% of the total funding available of £518.556m. It is critical to note that part of this underspend will be non-recurring. This position also reflects a break-even position in respect of prescribing costs.

Slippage in the 2018/2019 savings totalling £0.110m was also highlighted as a non-recurring cost pressure.

A total of £1.000m was transferred from the IJB reserves during 2018/2019. The total amount which is being transferred to reserves at 31 March 2019 is £3.745m. The net movement on reserves in 2018/2019 is therefore an increase of £2.745m as detailed in the movement in reserves statement on page 37. The balance on reserves as at 31 March 2019 is £11.023m. The establishment of a minimum level of contingency reserves is recommended good practice. The contingency reserve has increased by £1.257m from £0.551m to £1.808m pending a review of the reserves balances and the finalisation of the medium to long-term financial plan for the IJB.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

MANAGEMENT COMMENTARY (Cont.)

Annual Accounts 2018/2019 (Cont.) Hosted services are those services which are delivered on a pan-Lanarkshire basis by one IJB on behalf of the other IJB. In line with the Integrated Resource Advisory Group Finance Guidance, the lead partner for a hosted service is responsible for managing any overspends incurred. With the exception of ring-fenced funding, the lead partner can also retain any underspends which may be used to offset other overspends. There was an underspend of £1.414m in respect of the hosted services led by the South Lanarkshire IJB, £0.412m of which is ring fenced to take forward the future commitments associated with the Primary Care Improvement Fund. Of this total, £0.202m (49%) is attributable to the South Lanarkshire IJB.

The full cost of services which are hosted by the South Lanarkshire IJB are reflected in our accounts. There is no adjustment to reflect the activity on behalf of the North Lanarkshire IJB. The treatment of this critical judgement is explained fully at note 2 on pages 40 and 41 and reflects our responsibility in relation to service delivery and the risk and reward associated with it.

The services which are hosted by North Lanarkshire IJB on behalf of the South Lanarkshire IJB and the hosted services which are led by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB are detailed in note 10 on pages 46 and 47. A break-even position is reported across both of these areas.

Internal Audit undertook a specific programme of audit work in 2018/2019. Actions recommended from 2017/2018 audit work were also followed up near the end of 2018/2019.

The IJB have committed, within the 2018/2019 IJB Governance Statement, to continue to align financial and commissioning strategies in the future. In consultation with our partners, we will continue to review the way we currently deliver health and social care services to ensure we achieve our priorities and they offer best value. The financial position for public services continues to be challenging.

Conclusion Audit Scotland Health and Social Care Integration Progress Update 2018 – reported that progress with integration has been slow overall and identified a number of areas for action under the broad headings of collaborative leadership, integrated finances, strategic planning, governance and accountability, information sharing and meaningful engagement.

In November 2018, the Auditor General and Accounts Commission issued the Health and Social Care Integration: Update on Progress Report. This report highlights that, while some improvements have been made to the delivery of health and social care services, IJBs, councils and NHS boards need to show a stronger commitment to collaborative working to achieve the real long-term benefits of an integrated system.

On 4 February 2019, the Ministerial Strategic Group (MSG) for Health and Community Care also undertook a review of progress which further developed the improvement actions highlighted by Audit Scotland. Twenty five proposals were made by the MSG. A national self-evaluation tool was created which brought together the actions of both reports.

In respect of the twenty five proposals, the self-assessment indicated the South Lanarkshire HSCP response to one proposal was exemplary. This is in relation to the establishment of meaningful, sustained and effective community engagement and participation with a wide range of stakeholders. There is also a dedicated Health and Social Care Forum which involves public representation. 17 proposals were assessed as already established and 4 proposals were partly established. No proposal were not yet established. 3 proposals would be assessed by the Scottish Government. A detailed actions plan is being developed to further progress the integration of services across South Lanarkshire.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

MANAGEMENT COMMENTARY (Cont.)

Conclusion (Cont.) Effective from 1 April 2019 for a period of three years, Councillor John Bradley was appointed as the Chair of the IJB and the Depute Chair of the IJB (Performance and Audit) Sub-Committee. Mr Philip Campbell, Non Executive Director of NHSL, was appointed as the Depute Chair of the IJB and the Chair of the IJB (Performance and Audit) Sub-Committee.

The partnership will continue to explore alternative pathways to divert people into more appropriate forms of support. Much of this will require a coordinated and consistent communications message to the public, together with concerted action planning with colleagues in acute services.

John Bradley Val de Souza Marie Moy

Chair Chief Officer Chief Financial Officer

Date 25 June 2019 Date 25 June 2019 Date 25 June 2019

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

STATEMENT OF RESPONSIBILITIES

Responsibilities of the South Lanarkshire Integration Joint Board

The South Lanarkshire Integration Joint Board (IJB) is required to: ▪ make arrangements for the proper administration of its financial affairs and to secure that the proper officer of the IJB has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this IJB, that officer is the Chief Financial Officer. ▪ manage its affairs to secure economic, efficient and effective use of resources and safeguard its assets. ▪ ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003). ▪ approve the Annual Accounts for signature.

Responsibilities of the Chief Financial Officer

As Chief Financial Officer I am responsible for the preparation of the IJB’s Annual Accounts in accordance with proper practices as required by legislation which, in terms of the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2016/2017 (the Accounting Code), as supported by the International Financial Reporting Standard (IFRS), is required to give a true and fair view of the financial position of the South Lanarkshire Integration Joint Board at the financial year end and its income and expenditure for the year then ended.

In preparing the Annual Accounts, I am responsible for: ▪ selecting suitable accounting policies and applying them consistently; ▪ making judgements and estimates that are reasonable and prudent; ▪ complying with legislation; and ▪ complying with the Accounting Code in so far as it is compatible with legislation.

I am also required to: ▪ keep proper accounting records which are up to date; and ▪ take reasonable steps to ensure the propriety and regularity of the finances of the IJB.

I certify that these Annual Accounts present a true and fair view of the financial position of the South Lanarkshire Integration Joint Board as at 31 March 2019 and the transactions for the year then ended.

Chief Financial Officer Marie Moy Date 25 June 2019

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

REMUNERATION REPORT

Introduction The Remuneration Report has been prepared in accordance with the Local Authority Accounts (Scotland) Regulations 2014 which requires, at least, disclosure about the remuneration and the pension benefits of any person whose remuneration is £150,000 or more.

Integration Joint Board The Standing Orders of the IJB, as prescribed by the Public Bodies (Joint Working) (Integration Joint Board) Order 2014, sets out the detail regarding IJB membership, voting and the calling of meetings.

The IJB comprises eight voting members, four of whom are elected members appointed by South Lanarkshire Council and four of whom are non-executive directors appointed by the NHS Lanarkshire Health Board. The term of office of members is for a period of three years. The appointments of Chair and Depute Chair are for a period of 2 years with the current appointments being effective from 1 April 2019.

There are also non-voting representatives on the IJB drawn from health and social care professionals, employees, the third sector, service users and carers.

Remuneration: IJB Chair and Depute Chair The board members do not currently receive remuneration or expenses directly from the IJB however voting board members will be remunerated by their relevant IJB partner organisation.

The IJB does not provide any additional remuneration to the Chair, Depute Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting member costs borne by the partner.

The details of the Chair and Depute Chair appointments held during 2018/2019 are outlined in the table below. No taxable expenses were paid by the IJB in 2017/2018 or 2018/2019.

Period Post Held Name Nominated by April 2018 to Chair Mr Philip Campbell NHS Lanarkshire March 2019

April 2018 to Depute Chair Cllr. John Bradley South Lanarkshire Council March 2019

Effective from April 2019, Councillor John Bradley is the Chair of the IJB and Mr Philip Campbell is the Depute Chair.

The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlements of the voting IJB members. The pension rights disclosures for the Chair and the Depute Chair are set out in the remuneration reports of each partner organisation as appropriate.

Senior officers The Chief Officer is appointed by the IJB in consultation with NHS Lanarkshire Health Board and South Lanarkshire Council. The Chief Officer is employed by South Lanarkshire Council. Although their contract of employment is with South Lanarkshire Council, the Chief Officer is regarded as an employee of the IJB for 50% of their time.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

REMUNERATION REPORT (Cont.)

Senior officers (Cont.) The Chief Financial Officer is appointed by the South Lanarkshire IJB and is employed by South Lanarkshire Council. The Chief Financial Officer, whose services have been secured under the requirements of section 95 of the Local Government (Scotland) Act 1973, is seconded to the IJB in line with the local arrangements.

The IJB is responsible for the strategic planning and commissioning of health and social care services. Each partner is responsible for the operational delivery of the IJB’s strategic directions. The IJB does not directly employ any Health or Social Care staff. They are employed by either NHS Lanarkshire or South Lanarkshire Council and remuneration for staff is reported in the annual accounts of the relevant employing organisation.

Remuneration: Officers of the IJB The remuneration of the senior officers is set with reference to national arrangements as well as local decisions on management structures and their associated remuneration levels. The Scottish Joint National Committee for Local Authority Services sets out the spinal column salary points for Chief Officers which can be utilised in setting salary levels for such posts. The senior officers received the following remuneration in the year:

Name Salary, fees, 2018/2019 2017/2018 allowances Total Remuneration Total Remuneration

Val de Souza £65,818 £65,818 £64,129 Chief Officer (April 2018 to March 2019)

Marie Moy5 £34,026 £34,026 £32,889 Chief Financial Officer (April 2018 to March 2019)

The remuneration disclosed in the table above is the proportion of remuneration received in relation to the activity of the South Lanarkshire IJB during 2018/2019. The Chief Officer is appointed to the South Lanarkshire IJB however South Lanarkshire Council continues to meet 50% of the costs of this post directly. This reflects the Chief Officer’s responsibilities for Children and Justice Services, Performance and Support Services and Money Matters Advice Services which are not delegated functions to the IJB. The Chief Officer, as the Director of Health and Social Care, also contributes to the strategic direction of South Lanarkshire Council as part of the Corporate Management Team. The Chief Financial Officer is also appointed to the North Lanarkshire IJB. The remuneration in respect of this post is therefore shown separately in the North Lanarkshire IJB Annual Accounts.

There were no exit packages awarded during the financial year.

There were no taxable expenses paid to the Chief Officers or the Chief Financial Officer in 2017/2018 or 2018/2019.

Disclosure by Pay Bands As required by the regulations, the following table shows the number of persons whose remuneration for the year was £50,000 or above, in bands of £5,000.

Remuneration Band Number of Employees in Band Number of Employees in Band 2018/2019 2017/2018 £60,000 - £64,999 - 1 £65,000 - £69,999 1

5 The remuneration of the post holder is also disclosed in the North Lanarkshire IJB Annual Accounts 2018/2019 Remuneration Report 77 Page | 21

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

REMUNERATION REPORT (Cont.)

Pension Benefits In respect of officers’ pension benefits, the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis, there is no pensions liability reflected on the IJB balance sheet for the Chief Officer or any other officers. The IJB however, has responsibility for funding the employer contributions for the current year in respect of the officer time spent on fulfilling the responsibilities of their role on the IJB.

The senior officers are members of the Strathclyde Pension Fund which is a Local Government Pension Scheme (LGPS).

The LGPS is a defined benefit statutory scheme, administered in accordance with the Local Government Scheme Regulations 2014.

The costs of the pension scheme contributions for the year to 31 March 2019 are shown in the table below:

Name To 31 March 2019 To 31 March 2018

Val de Souza In-year pension contributions £25,406 £24,754 Chief Officer (April 2018 to Accrued pension benefits £43,355 £39,577 March 2019) Movement in accrued £3,778 £38,246 pension benefits

Lump Sum £61,995 £60,404

Marie Moy In-year pension contributions £13,134 £12,695 Chief Financial Officer Accrued pension benefits £26,142 £23,936 (April 2018 to March 2019) Movement in accrued £2,206 £1,659 pension benefits

Lump Sum £41,047 £39,676

The pension benefits detailed in the table above relate to the total amount attributable to each post on a full-time basis. A pro-rata approach has not been adopted.

The information contained within the Remuneration and Pension Benefits sections above is subject to audit.

John Bradley Val de Souza

Chair Chief Officer

Date 25 June 2019 Date 25 June 2019

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

ANNUAL GOVERNANCE STATEMENT 2018/2019

Introduction The Annual Governance Statement explains the governance arrangements and the system of internal control for the IJB and reports on their effectiveness.

Scope of Responsibility The IJB is responsible for the commissioning of health and social care supports and services to improve the outcomes for the people of Lanarkshire. It is responsible for ensuring its business is conducted in accordance with legislation and proper standards and that public money is safeguarded and properly accounted for.

It also has a statutory duty of best value and is required to make arrangements to secure continuous improvement and performance, while maintaining an appropriate balance between quality and cost, having regard to economy, efficiency and effectiveness. To meet these responsibilities, the IJB has established arrangements for governance which includes a system of internal control to ensure its functions are exercised in a timely, inclusive, open, honest and accountable manner. This includes: ▪ setting the strategic direction, vision, culture and values of the IJB; ▪ engaging with and, where appropriate, leading communities; ▪ monitoring whether strategic partnership objectives have been achieved; ▪ ensuring services are delivered cost effectively; and ▪ ensuring appropriate arrangements are in place for the management of risk.

The system of internal control is proportionate to the IJB’s strategic responsibility and reliance is placed on the NHS Lanarkshire and South Lanarkshire Council systems of internal control. The effective operation of each partner’s financial and corporate systems, processes and internal controls are key to the achievement of the IJB’s outcomes. The internal control system can only provide reasonable and not absolute assurance of effectiveness.

The Purpose of the Governance Framework The overall aim of the governance framework is to ensure that resources are directed in accordance with agreed policy and according to priorities, that there is sound and inclusive decision making and there is clear accountability for the use of those resources in order to achieve desired outcomes for service users and communities. The governance framework enables the IJB to monitor the attainment of the partnership outcomes.

The system also aims to identify and manage key risks. This includes evaluating the likelihood of those risks materialising and their potential impact, if realised. Internal controls cannot eliminate all risks of failing to achieve policies, aims and objectives however they are a significant part of the governance framework and are designed to manage risk at a reasonable level.

The governance framework within the IJB is set out in the South Lanarkshire IJB Code of Corporate Governance6 which comprises of the systems, processes, culture and values by which the IJB is directed and controlled. The Code of Corporate Governance is consistent with the seven core principles of the Delivering Good Governance in Local Government Framework (CIPFA 2016) and also the International Framework, Good Governance in the Public Sector.

Review of Adequacy and Effectiveness The Local Authority Accounts (Scotland) Regulations 2014 require a review at least once in each financial year of the effectiveness of the system of internal control. The IJB is required to report publicly on compliance with its own Code of Corporate Governance on an annual basis including how it has monitored the effectiveness of its governance arrangements during the year under review and planned future changes. The review undertaken for 2018/2019 was informed by:

6 http://www.southlanarkshire.gov.uk/slhscp/downloads/file/73/south_lanarkshire_ijb_code_of_corporate_governance) 79 Page | 23

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

DRAFT ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Review of Adequacy and Effectiveness (Cont.)

▪ an annual self-assessment against the IJB’s Local Code of Corporate Governance consistent with the principles and recommendations of the new CIPFA/SOLACE Framework (2016); ▪ IJB internal audit reports; ▪ IJB external audit reports; ▪ relevant reports by other external scrutiny bodies and inspection agencies; ▪ a review of the principal risks and uncertainties and how these are being managed; ▪ an assessment of impact of the 2018/2019 continuous improvement actions undertaken; ▪ an assessment of the IJB’s ability to achieve future service priorities including consideration of ongoing service sustainability; and ▪ the outcome of the self-assessment of the proposals outlined in the Ministerial Strategic Group for Health and Community Care’s report on the Review of Progress with Integration of Health and Social Care.

The review was also informed by cross-assurances from each partner, NHS Lanarkshire and South Lanarkshire Council, including consideration of their internal audit and external audit reports.

Assessment of Governance Arrangements

The assessment of the IJB governance framework and internal control system confirmed that no significant control weaknesses or significant failures have arisen in the expected standards for good governance, risk management and internal control. There are therefore no issues arising that would require to be disclosed in this statement. The key conclusions which contributed to this overall assessment are detailed below.

➢ Strategic Commissioning Framework

Following the period of extensive participation and engagement activity across the four localities, the first SCP 2016 - 2019 was approved in March 2016. The SCP detailed 10 key priorities which had emerged from the consultation activities.

In line with the IJB Participation and Engagement Strategy and also the National Standards for Community Engagement, the Health and Social Care Partnership is committed to continue to engage with all key stakeholders including but not limited to IJB Voting Members, Senior Officers, VASLan, Health and Social Care Forum and Seniors Together.

In 2018, on behalf of the IJB, a refresh of the SCP was led by the Strategic Commissioning Group, a statutory group as outlined in the Regulations and Orders to support the Public Bodies (Joint Working) (Scotland) Act 2014. The refresh was a lighter touch which focussed on reviewing and updating the commissioning intentions set against the 10 key priorities. The directions to each of the partners were approved on 26 March 2018.

The refresh of the SCP in 2018 formed the basis of the SCP 2019 - 2022 which was subsequently approved on 25 March 2019. Comprehensive locality engagement events were held to support the development of the new SCP 2019 - 2022 where over 1,000 delegates participated and shared their views across eight sessions.

The key messages emanating from the public and stakeholder consultation activities evidenced that there was consensus that the vision of working together to improve health and wellbeing in the community – with the community and the original 10 strategic themes remain as relevant today as when first agreed in 2016.

The SCP 2019/2020 sets out 13 strategic priorities and 43 new commissioning intentions.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

DRAFT ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Assessment of Governance Arrangements (Cont.)

➢ Strategic Commissioning Framework (Cont.)

In prioritising the strategic themes, the public deemed the most important three to be early intervention, prevention and health improvement followed by mental health and then delivering core duties. A number of new and emergent areas were identified which included the transitional arrangements from Children’s Services to Adult Services and homelessness. It was also highlighted that more work was required to develop the enablers to integration, an observation which was included in the Audit Scotland Report on Health and Social Care Integration Update on Progress (November 2018). Promoting models of self-care and self-management, developing different models of intermediate care to support people to remain at home and strengthening locality planning were also highlighted as key priorities.

Assurance has been provided in the Annual Performance Reports to the IJB that the strategic intentions outlined within the SCP were being implemented.

The strength, contribution and influence of locality planning continues to develop.

Locality Planning Groups, which consist of representatives from the third sector, community-based organisations and service user representatives, have played a key role in informing and influencing the development of their respective locality plans. The members of these groups have local knowledge of the area and are best placed to identify the priorities, objectives and measurable actions against which we can measure performance and progress.

The Locality Plans take account of each locality’s unique strengths and assets as well as the respective challenges within each locality. They also demonstrate the strategic fit with the SCP 2019 - 2022.

In partnership with NHSL and SLC, the IJB continues to have effective and robust structures in place to deliver the commissioning intentions. The good governance arrangements across the partnership also effectively contribute to the implementation of NHS Lanarkshire Healthcare Strategy Achieving Excellence7, the Health and Social Care Delivery Plan8, the Annual Operating Plan9 and the Council Plan Connect 2017-202210. The partnership also supports the agreed outcomes for Children’s Services and Justice Services.

SLC and NHSL will be required to carry out a review of the Integration Scheme before 6 October 2020, five years from the day on which the scheme was originally approved.

➢ Performance Monitoring Framework

Progress against the commissioning intentions has been monitored throughout the year. The performance management framework has evolved significantly, embedding a genuine performance culture across each of the localities.

There are a suite of 31 measures. The IJB and the IJB (Performance and Audit) Sub-Committee receive quarterly reports on performance, as well as six-monthly updates on the Measuring Performance Under Integration dataset. This is the framework which was introduced in 2017 by the Scottish Government as a means of providing a consistent approach to understanding the impact of integration on the health and social care system across a small number of indicators.

7 https://www.nhslanarkshire.scot.nhs.uk/download/achieving-excellence/?wpdmdl=4137&ind=1544710644558 8 https://www.gov.scot/publications/health-social-care-delivery-plan/ 9 https://www.nhslanarkshire.scot.nhs.uk/download/2018-august-29-board-papers/?wpdmdl=3137&ind=1535455710598 10 https://www.southlanarkshire.gov.uk/downloads/file/11921/connect_council_plan_2017-2022 81 Page | 25

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

DRAFT ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Assessment of Governance Arrangements (Cont.)

➢ Performance Monitoring Framework (Cont.)

The South Lanarkshire IJB Annual Performance Report 2018/2019 provides further information on our progress during the year.

The Annual Performance Report for 2017/2018 was considered by the IJB at the meeting on 26 June 2018. This provided an overview of performance against the strategic objectives in the second year. The statutory deadline of 31 July 2018 was met. The Annual Performance Report for 2018/2019 is currently being compiled. The structure, content and presentation of the Annual Performance Report is being further developed to better inform stakeholders and provide a more informative and user friendly publication.

The operational committees in SLC and NHSL also receive quarterly updates on performance, as well as more detailed reporting on any service areas that are causing concern. There is a commitment across the partnership to continue to use performance data to drive further improvement and support informed decision making in respect of strategic planning and commissioning.

The performance monitoring arrangements are effective and continue to be improved.

➢ Financial Monitoring Framework

The Financial Plan for 2018/2019 was agreed on 26 March 2018. In accordance with the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the IJB issued directions effective from 1 April 2018 to NHS Lanarkshire Health Board and South Lanarkshire Council in respect of the delivery of integrated functions and how resources were to be allocated for resultant services. The budget was further refined during the course of the year by both partners and also updated to reflect additional in-year funding.

The Health and Social Care Medium Term Financial Framework was published by the Scottish Government on 4 October 2018. This framework supports the Health and Social Care Delivery Plan and sets out in more detail the potential approach and type of initiatives required to ensure continued delivery of a financially balanced and sustainable Health and Social Care system. The financial assumptions upon which this national framework has been based are still to be tested locally.

The Financial Plan for 2019/2020 sets out the parameters to achieve a balanced budget. The medium to long term financial strategy is being developed and will provide a balanced and objective analysis of service priorities, financial affordability and other resource constraints, including the workforce. The strategy will set the context for ongoing decisions on significant delivery issues and responses to the changes in the external environment. These include the impact of the free personal care for people under 65, the Mental Health Strategy, the Primary Care Improvement Plan, the Alcohol and Drug Partnership Strategy, the national care home contract, the Carers (Scotland) Act 2016, the Health and Care (Staffing) (Scotland) Bill and the EU withdrawal. This plan is currently under review. In the interim, reliance is being placed on the medium term financial strategies of each partner.

During the year, the Chief Financial Officer, in consultation with both partners, reviewed and further developed the financial monitoring arrangements for the IJB with particular focus on the effectiveness and transparency of the financial framework. During the year, the financial reporting by NHSL was extended to include an audit trail of the in-year funding allocations highlighting recurring and non-recurring funding. This work will be further developed in 2019/2020.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

DRAFT ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Assessment of Governance Arrangements (Cont.)

➢ Financial Monitoring Framework (Cont.)

A total of six financial monitoring reports were presented to the IJB and the IJB (Performance and Audit) Sub-Committee during the year. The timing of the meetings at the start of the financial year however still requires to be addressed to reduce the gaps in the availability of the reports.

Each of the partners, SLC and NHSL have a proven track record of sound financial management and robust monitoring arrangements to manage their finances in year. Effective financial controls were in place across the partnership in 2018/2019. The IJB places reliance on these existing financial monitoring arrangements.

Throughout the year, the financial monitoring reports set out the key financial risks including in particular variance explanations. It had been intended that further work would be undertaken in 2018/2019 to more specifically align the financial allocations to the SCP intentions and the directions to each partner. This will be progressed in 2019/2020.

The Scottish Government has committed to providing longer term financial settlements in 2019/2020 for the financial years 2020/2021 and beyond. This will be a significant development. Up-front investment is required to ensure sufficient health and social care community services can be established and sustained. The delay in receiving confirmation of in-year funding allocations from the Scottish Government for the health partner causes uncertainty.

The financial monitoring arrangements are effective and continue to be improved.

➢ Risk Management Framework

A Risk Management Strategy and risk register are in place. Risks have been effectively monitored throughout the year with action being taken to mitigate those risks which are higher than the tolerance level set. Quarterly updates are taken on the risk register to the IJB (Performance and Audit) Sub Committee. As part of developing a common understanding of risk and how this relates to the IJB, a number of workshops have also been facilitated with key stakeholders.

There are currently 13 risks which are assessed as follows: 2 – High; 10 – Medium and 1 – Low. All of these risks are strategic in nature to reflect the role of the IJB as the body that Commissions Services in line with the direction of travel set out in the SCP. The 2 high risks relate to the following:

 Efficient and effective use of resources (IT/premises/governance)

There is a risk of failure to progress to appropriate co-location including shared IT. The partnership may fail to maximise the potential of integrated working and avoid duplication of effort which would impact negatively on integration. Actions to mitigate this risk include completing the proposed federated trust approach for IT and finalising the joint protocol for co-location.

 Shifting the balance of care to community based alternatives

There is a risk of failure to reduce reliance on residential and acute models of delivery. The partnership may fail to avoid/reduce unnecessary admissions to residential care and avoid/reduce hospital admissions. Actions to mitigate this risk include further developing locality pathways to maintain people at home and the implementation of the modernising care facilities strategy.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

DRAFT ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Assessment of Governance Arrangements (Cont.)

➢ Risk Management Framework (Cont.)

A risk management workshop was undertaken on 21 May 2019 to assess the risk environment, taking into consideration the SCP 2019 - 2022. The current Risk Register will be updated.

There are a number of operational risks which continue to be effectively managed by both partners, SLC and NHSL. These include:

 The availability and sustainability of GP services.

The implementation of the new national contract agreed in 2017 continues, alongside a longer term Primary Care Improvement Plan which is a hosted service led by the South Lanarkshire IJB. Practical measures to reduce the pressure on GP practices include additional pharmacists, plans to move the responsibility for vaccinations to Health Board staff and a rolling programme to transfer the property responsibility to the NHS Board where GPs feel it is the property burden which is affecting the practice’s attractiveness.

 Prescribing Costs Increases

A break-even position was reported on the prescribing budget at 31 March 2019. Notwithstanding the ongoing effective control through the Prescribing Quality and Efficiency Plan, price increases and volatility continue to impact on prescribing costs. Reliance continues to be placed on the prescribing reserve which totals £0.736m. This reserve represents 1.1% of the prescribing budget of £66.308m.

 EU Withdrawal

EU withdrawal is an external factor. Mitigating actions cannot fully diminish this risk and there continues to be significant uncertainty. An operational group which has been set up to support winter planning activity will also be an integral part of the response to the preparations for Brexit. This group comprises of individuals with expertise in areas potentially impacted by EU withdrawal. The resilience structure will facilitate the rapid assessment of issues as they emerge and designated channels will support decision-making.

A collaborative exercise has commenced with the North Lanarkshire Health and Social Partnership and NHSL to further strengthen the risk management framework with a particular focus on shared risks and assurance arrangements. There are also a number of legislative changes including the implementation of free personal care for individuals under 65 and Scotland’s Public Health Priorities 2018.

An Information Sharing Agreement between the partners for South Lanarkshire has been developed to ensure that every person’s data is protected and accessible when needed.

Cyber security remains a priority. A 'learn pro-module' is available for staff and all teams have been encouraged to complete this.

A revised and updated risk register will be presented to the IJB for consideration and approval and thereafter will be scrutinised on a quarterly basis by the IJB (Performance and Audit) Sub- Committee.

The risk management arrangements are effective and continue to be improved.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

DRAFT ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Assessment of Governance Arrangements (Cont.)

➢ Operational Oversight and Transformational Change

During the year, the range of transformational changes which have been progressed by the IJB are summarised in the Management Commentary on pages 4 to 9 and pages 12 to 16. The South Lanarkshire IJB Annual Performance Report 2018/2019 will also include an overview of the key service developments and achievements realised in 2018/2019.

The hosted services arrangements were reviewed in 2019 in consultation with the North Lanarkshire IJB. The objective of the review was to create the conditions to agree a shared response to mutual issues of strategic importance. The membership of the hosted services group was reduced to a core group of 10 officers and the terms of reference were revised to focus on significant variance in performance from target, significant variance from budget, service development requests and savings proposals.

Making transformational change at the same time as managing existing services and funding pressures continue to be challenging, particularly within the current financial climate. The workforce plan continues to be developed to address the future implications of the Safe Staffing legislation and the requirement to maintain staffing levels. The vacancy factor in 2018/2019 was an average of 4.8% (66 WTE). This is lower than the average vacancy factor of 9.4% in 2017/2018.

➢ Consultation and Engagement

There is strong collaboration between the two Local Authorities, the Health Board and both IJBs in Lanarkshire. There is a commitment to develop a whole-system approach to the delivery of integrated health and social care services to improve the outcomes of the local population. There is strong collaborative working relationships in place with the Health and Social Care Forum, VASLan, the third sector and Carers. Staff engagement, Trade Union and staff side representation are essential to maintaining effective employee relations particularly during times of change and service redesign.

During 2018/2019, significant public engagement was undertaken by the IJB to ask the public where they thought the partnership’s resources and efforts should be targeted. The overriding message is that from an outcomes perspective, people wish to be supported to remain at home for as long as possible. The top three themes identified from locality, public and online consultation and participation activity were early intervention, prevention and health improvement, delivering our core duties and mental health and wellbeing.

The Carers Strategy 2019 – 2022, which was developed following seven carer involved consultations, focus groups and surveys as well as a full review of the current services in provision, was published in April 2019. The key duties and powers of the Act were analysed to ensure strategy development meets legislative requirements and additionally addresses the needs of carers. Within the strategy we have identified a range of priorities which will be implemented to support carers to try to reduce the impact that their caring role has on their own health and wellbeing. Ongoing engagement activity will continue to influence the remodelling of carers supports and services.

179 carers participated in shaping the final Carers Short Breaks Statement which will be available from 2019/2020 onwards

Our communication strategy continues to support the partnership’s objectives.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

DRAFT ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Assessment of Governance Arrangements (Cont.)

➢ Consultation and Engagement (Cont.)

Our BCC campaign was a finalist at the 2018 NHS Scotland Communications Awards. The NHSL response to the cyber-attack of 2017 won the Best Crisis Communication Award. ‘Meet the Experts’ won the Best Campaign Award.

Our partners in communities play an important role and a recent film documents the success of ReConnect, a project run by Healthy Valleys which has tackled loneliness and isolation amongst our older adults across rural Clydesdale.

The IJB as part of its statutory duties progressed a number of other key issues including agreeing and submitting our second Climate Change Statement outlining how the IJB will work to support climate change duties.

The partnership was subject to a Care Inspectorate thematic review of the Self-directed Support processes in South Lanarkshire. The findings of the review were consistent with the self- assessment previously undertaken.

The IJB continues to be supported to develop as an entity of the public sector and to assist it in discharging its leadership duties. Part of this support has been IJB development time on the morning of each IJB meeting, with a number of topics discussed as part of this, for example the Audit Scotland Report, Ministerial Strategic Group Action Plan, Community Planning and the SCP 2019 - 2022.

As part of developing the new SCP for 2019 - 2022 a far reaching participation and engagement process was adopted during the year and this followed the principles set out in the IJB participation and engagement strategy. Feedback on this has been positive and is summarised in the new SCP. From an impact perspective the IJB is confident that this plan takes the partnership forward another stage in its development.

A review of the risk register was also undertaken as part of developing the new SCP.

Our BCC programme is geared to exploring how we can generate more space for communities to create the things that matter to them - and how we can support these activities. An example of this approach in action is the South Lanarkshire Autism Resources Coordination Hub (ARCH), brought into being in 2016 following the previous autism resource closing. Since its inception, ARCH has been focussed on facilitating the development of autism support in South Lanarkshire communities - much of which is delivered by communities themselves - alongside partners in the statutory, private and third sectors.

Each partner also has established effective relationships, collaborative working and contractual arrangements with other public, private and voluntary organisations in delivering services.

The consultation and engagement arrangements are effective and continue to evolve to support the delivery of the nine national health and wellbeing outcomes.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

DRAFT ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Assessment of Governance Arrangements (Cont.)

➢ Estimates and uncertainties

The operation of the set-aside budget for unscheduled care services is a key area of uncertainty. Both hospital and community services must operate together to maximise the efficacy of unscheduled care services. A whole system approach is adopted by the partners.

A Lanarkshire Unscheduled Care Improvement Board is in place, jointly chaired by the IJB Chief Officers and the Director of Acute Services, with representation from all key stakeholders. Key strategic projects include “front door” assessment, discharge to assess, re-ablement and re- direction. Performance and improvement actions are progressed to further improve the unscheduled care targets. Notwithstanding this work, there are challenges in trying to move further funding from the acute sector into the community sector. The management of ‘set-aside’ budgets is complex however NHSL have been committed to establishing an appropriate mechanism for its operation.

Due to the complexity of allocating costs, there is a substantial time lag with ISD data to agree the notional set-aside budget which means the strategic review of changes in resource use is 18 months in arrears. This does not prevent service changes as these are modelled on a case by case basis based on local data. Local development work with ISD is underway to assess if more basic but more timely information linked to the financial ledgers could be more useful for monitoring purposes.

Cost pressures across acute services, for both the set-aside and non-set-aside services, have been managed by the health partner since 2016. Given the extent of the pressures which are facing acute services, now and in the future, it will be challenging to sustain this approach if the current financial constraints continue.

➢ Self-evaluation Framework and Independent Assessments

The 2018/2019 Internal Audit Plan was approved by the IJB on 11 September 2018. The annual programme of internal audit work is based on a strategic risk assessment. The 2018/2019 internal audit plan was agreed on 11 September 2018 and included a review of risk management, performance management and assurance mapping. Internal audit also followed up the actions arising from audits undertaken in 2017/2018. The assurance mapping assignment also reviewed progress of audit actions falling due during 2018/2019 and progress with action plans developed by the Chief Financial Officer in response to audit findings and general governance issues.

The findings and recommendations of internal audit, external audit and inspection bodies are reported to the IJB. The IJB (Performance and Audit) Sub Committee is integral to ensuring that recommendations are acted upon and improvements in internal control and governance are monitored.

An audit of South Lanarkshire Council’s statutory duty to deliver Best Value was undertaken by Audit Scotland in October and November 2018. The final report was published in March 2019. The report concluded that the IJB and the two partners, SLC and NHSL, had made good initial progress in health and social care integration and there are examples of changes to models of service delivery designed to improve outcomes for residents.

These include the extension of palliative care services through an additional 12 inpatient beds being opened in Kilbryde Hospice, East Kilbride. In addition, funds have been redirected into community services such as homecare, district nursing and other community-based support services. Despite this adverse trend, there is evidence of performance improvements in the following areas: 87 Page | 31

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

DRAFT ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Assessment of Governance Arrangements (Cont.)

➢ Self-evaluation Framework and Independent Assessments (Cont.)

▪ unscheduled bed days are decreasing year-on-year ▪ there has been a reduction in bed days lost as a result of delayed discharge ▪ the proportion of people spending the last six months of their lives in the community is increasing.

It was also highlighted that, similar to many partnerships across Scotland, the IJB continues to face challenges including increasing levels of emergency admissions and unplanned hospital attendances.

The observations set out in the Health and Social Care Integration: Update on Progress Report and the proposals contained within the report from the Ministerial Strategic Group for Health and Community Care are being progressed by the partnership. The outcome of the self-assessment was highlighted in the Management Commentary on page 17.

An external audit plan has been approved for 2018/2019.

The IJB members have been provided with the opportunity to attend development and awareness sessions during 2018/2019 covering a broad range of subject matters.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Overview of Control and Governance Improvements during 2018/2019 Improvement areas to further strengthen the IJB’s governance arrangements were identified in the 2017/2018 Annual Governance Statement. The timeline for achieving these improvements was a two year period to 31 March 2020. A progress report in respect of these ongoing actions is detailed below.

Area for improvement identified in Action Undertaken 2018/2019 2018/2019

Ensure the financial and commissioning A balanced budget was set for 2018/2019 and strategies of the IJB and each partner identified savings were implemented. continue to be aligned in order to progress the health and social care integration Work has progressed on the medium to long term agenda and respond to the national and financial strategy and an update was presented to local policy initiatives within the context of the IJB (Performance and Audit) Sub-Committee on-going significant financial challenges. on 21 May 2019.

Careful consideration is being given to two key Review Financial Framework reports issued during the year as follows: ▪ Review Financial Regulations ▪ The Audit Scotland report on Health and ▪ Finalise the medium to long term Social Care Integration Update on Progress financial strategy which was published in November 2018; and ▪ Further develop transparency and ▪ The Ministerial Strategic Group for Health and financial management reporting Community Care’s report on the Review of ▪ Specify the resources to be attached to Progress with Integration of Health and Social the directions in line with strategic Care which was published in February 2019 commissioning plan intentions. and outlined a range of proposals. ▪ Consider the options to review the alignment of financial resources to A self-evaluation was subsequently undertaken reflect the population and locality and an action plan is being developed to further needs strengthen the existing arrangements in consultation with the partners. Chief Financial Officer April 2018 to March 2020 Notwithstanding the further improvements which will be progressed, the current financial governance framework has been complied with.

Further develop the performance The performance management framework has management framework to secure continued to be developed and embedded across improvement activity and evidence the the partnership. shift in the balance of care. Comparative information and trend analysis is Review Performance Framework emerging. Further areas of development across the six main Ministerial Strategic Group targets ▪ Review performance targets and are being led by the partnership working outcomes alongside acute colleagues. ▪ Review shifting the balance of care ▪ Review the ongoing sustainability of Performance monitoring reports include services improvement actions to sustain performance improvements as appropriate. Head of Commissioning and Performance April 2018 to March 2020

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Overview of Control and Governance Improvements during 2018/2019 (Cont.)

Area for improvement identified in Action Undertaken 2018/2019 2018/2019

Continue to embed governance structures The governance arrangements have continued to across the partnership and promote a be strengthened in particular, the Support, Care culture that fully endorses and accepts and Clinical Governance Committee is becoming challenge among partners. embedded across the partnership and the Population Health & Primary and Community Review Governance Arrangements Services Governance Committee has been established. ▪ Embed governance framework and link to the directions pathway The terms of reference of the IJB (Performance ▪ Review terms of reference of and Audit) Sub-Committee have been extended Performance and Audit Sub-Committee and include financial governance. ▪ Provide ongoing support and personalised development Development sessions with the IJB are now being opportunities for IJB members undertaken on the morning of the day the IJB ▪ Progress learning and review meets. Awareness sessions have also been held opportunities which actively encourage to ensure IJB Members, Health Board Members meaningful and constructive feedback and Elected Members are kept informed of from key stakeholders. transformational change and ongoing developments. The understanding of the Chief Officer governance requirements underpinning health April 2018 to March 2020 and social care integration is developing including an increased awareness of decision-making responsibilities and processes.

Learning and review opportunities have been actively promoted. An example includes the awareness seminar held by Audit Scotland on the outcome of the Health and Social Care Integration Update on Progress report.

All key stakeholders were invited to contribute to the self-evaluation of the proposals outlined in the Ministerial Strategic Group for Health and Community Care’s report on the Review of Progress with Integration of Health and Social Care. An action plan is being developed.

Implementation of national agreements Significant progress has been made in respect of and new legislative duties the implementation of legislative changes and national policy initiatives. Progress reports have ▪ GMS 2018 contract been presented to the IJB on key priorities ▪ Carers (Scotland) Act 2016 throughout the year including primary care ▪ Contribute to consultations (e.g. Safe services, mental health and learning disability Staffing Bill and Free Personal Care to services, the alcohol and drug partnership under 65s) programme and the Carers (Scotland) Act 2016.

Heads of Health and Social Care Work on key priorities is ongoing including April 2018 to March 2020 contributing to Scottish Government consultations.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

ANNUAL GOVERNANCE STATEMENT 2018/2019 (Cont.)

Overview of Control and Governance Improvements for 2019/2020 Following consideration of the internal review of the adequacy and effectiveness of the IJB governance arrangements, in addition to the four ongoing continuous improvement actions identified for the period from April 2018 to March 2020, one further action will be progressed to strengthen the good governance controls as summarised in the table below.

Ref. Area for Improvement and Improvement Action Agreed Lead Officer and Outcome To Be Achieved Timeline

1 Further consideration of the A range of actions have been Chief Officer Ministerial Strategic Group agreed across the partnership to (MSG) proposals. take forward the MSG proposals. April 2019 to The MSG have indicated that a March 2020 second self-evaluation will be undertaken in 12 months to assess progress. Update reports will be presented to the IJB to advise of progress during 2019/2020 as appropriate.

Internal Audit Opinion Internal control remains, primarily, a management responsibility to ensure that the IJB conducts its business in a manner that has due regard to the principles of good governance. The audit opinion is based upon audit work undertaken during the year and knowledge of the IJB’s wider governance, risk management and control arrangements. In 2018/2019, the Internal Audit opinion is that, overall, reasonable assurance can be placed on the adequacy and effectiveness of the IJB’s framework of governance, risk management and control arrangements for the year ending 31 March 2019.

Conclusion and Opinion on Assurance During 2018/2019, the third year of operation, the IJB has adhered to the stated principles of good governance, acted in the public interest and been committed to continuous improvement. The IJB continued to demonstrate that the governance arrangements and framework within which it operates are sound and effective and are consistent with the principles and recommendations of the CIPFA/SOLACE Framework (2016). While recognising that continuous improvement actions will be progressed during the fourth year of operation, it is the IJB’s opinion that there is sufficient evidence that the IJB’s Local Code of Corporate Governance is operating effectively and is complied with in all significant respects. Any significant risks impacting on the IJB’s principal objectives will be identified and actions taken to avoid or mitigate their impact. Systems are in place to regularly review and improve the governance framework.

In South Lanarkshire, the Health and Social Care Partnership’s vision is to work together to improve health and wellbeing in the community - with the community. The IJB recognises the need to focus on the long term and take account of the impact of current decisions and actions on future generations. This assurance is limited, however, to the work undertaken during the year, the assurances provided by each partner and the evidence available at the time of preparing this statement.

John Bradley Val de Souza

Chair Chief Officer

Date 25 June 2019 Date 25 June 2019 91 Page | 35

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT FOR THE YEAR ENDED 31 MARCH 2018

This statement shows the actual cost of providing services in accordance with generally accepted accounting practices, the total funding contributions from the partners and the surplus on activities during the year.

2017/2018 (Restated) 2018/2019 Gross Gross Net Gross Gross Net Expenditure Income Expenditure Income £m £m £m £m £m £m 156.703 (0.221) 156.482 Social Care Services 166.237 0.000 166.237

85.223 0.000 85.223 Family Health Services 90.661 0.000 90.661

67.571 0.000 67.571 Prescribing Costs 66.308 0.000 66.308

87.102 0.000 87.102 Hosted Services 90.041 0.000 90.041

54.715 0.000 54.715 Hospital Acute Services 54.919 0.000 54.919 (Notional Set Aside Budget)

40.169 0.000 40.169 Health Care Services 42.317 0.000 42.317

5.020 (3.008) 2.012 Housing Services 5.165 (3.205) 1.960

0.152 0.000 0.152 Corporate Services 0.163 0.000 0.163 (Note 6)

496.655 (3.229) 493.426 Cost of Services 515.811 (3.205) 512.606

Taxation and Non- 0.000 (495.585) (495.585) Specific Grant Income 0.000 (515.351) (515.351) (Note 5)

(Surplus) on provision of services and total 496.655 (498.814) (2.159) comprehensive 515.811 (518.556) 2.745 (income) and expenditure (Note 10)

The IJB was established on 6 October 2015. Integrated delivery of health social care services commenced on 1 April 2016. 2018/2019 is the second year of operation for the IJB.

There are no statutory or presentation adjustments which affect the IJB’s application of the funding received by partners.

The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts.

The income and expenditure statement has been restated in 2017/2018 to reflect the revised position in relation to hosted services. Further details are provided at Note 2 and Note 9.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

MOVEMENT IN RESERVES STATEMENT

This statement shows the movement in the year on the IJB’s reserves. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices.

Movements in Reserves during 2018/2019 General Fund Total Balance Reserves £m £m

Opening balance at 1 April 2018 8.278 8.278

Total Comprehensive Income and Expenditure 2.745 2.745

Increase or decrease in 2018/2019 2.745 2.745

Closing balance at 31 March 2019 11.023 11.023

Movements in Reserves during 2017/2018 General Fund Total Balance Reserves £m £m

Opening balance at 1 April 2017 6.119 6.119

Total Comprehensive Income and Expenditure 2.159 2.159

Increase or decrease in 2017/2018 2.159 2.159

Closing balance at 31 March 2018 8.278 8.278

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

BALANCE SHEET AS AT 31 MARCH 2019

The balance sheet shows the value as at 31 March 2018 of the IJB’s assets and liabilities at the balance sheet date. The net assets of the IJB are matched by the reserves held by the IJB.

Notes 31 March 2019 31 March 2018 £m £m

Long term assets 7 3.154 0.000 Long term debtors

Current assets 8 7.869 8.278 Short term debtors

Net assets / (liabilities) 11.023 8.278

Usable reserves 11 11.023 8.278

Total reserves 11.023 8.278

The Statement of Accounts present a true and fair view of the financial position of the South Lanarkshire Integration Joint Board as at 31 March 2019 and its income and expenditure for the year then ended.

The unaudited accounts were authorised for issue on 25 June 2019.

Marie Moy

Chief Financial Officer

Date: 25 June 2019

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

NOTES TO THE ACCOUNTS

1. Accounting policies

1.1 General principles The Annual Accounts summarise the transactions of the IJB for the financial year 2018/2019 and its position at the year end of 31 March 2019.

The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a section 106 body as defined in the Local Government (Scotland) Act 1973. It is a joint venture between South Lanarkshire Council and NHS Lanarkshire.

The financial statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2018/2019, supported by the International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment.

1.2 Going concern The accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future.

1.3 Accounting convention The accounts are prepared under the historical cost convention.

1.4 Accruals of income and expenditure Activity is accounted for in the year that it relates to and not simply when financial transactions are undertaken. In particular: ▪ Expenditure is recognised when goods or services are received and their benefits are used by the IJB. ▪ Income is recognised when the IJB has a right to the income, for instance, by meeting any terms and conditions required to earn the income, and receipt of the income is probable. ▪ Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the balance sheet. ▪ Where debts may not be received, the balance of debtors is written down.

1.5 Funding The IJB is primarily funded through funding contributions from the statutory funding partners, South Lanarkshire Council and NHS Lanarkshire, to fund its services. Expenditure is incurred as the IJB commissions specified health and social care services from the funding partners for the benefit of service recipients in South Lanarkshire.

1.6 Cash and cash equivalents The IJB does not operate a bank account or hold cash. Transactions are settled on behalf of the IJB by the funding partners. Consequently, the IJB does not present a “cash and cash equivalent” figure on the balance sheet. There is therefore no requirement for the IJB to prepare a cash flow statement. The funding balance due to or from each funding partner as at 31 March 2019 is represented as a debtor or creditor on the IJB’s balance sheet.

1.7 Employee benefits The IJB does not directly employ staff. Staff are formally employed by the funding partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a pensions liability on its balance sheet.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

NOTES TO THE ACCOUNTS (Cont.)

1.8 Corporate services The IJB has a legal responsibility to appoint a Chief Officer. A Chief Financial Officer has also been appointed to the IJB. The details in respect of these arrangements are outlined in the Remuneration Report. The charges from the employing partner are treated as employee costs within Corporate Services.

The absence entitlement of both the Chief Officer and the Chief Financial Officer as at 31 March 2019 is not material and has therefore not been accrued.

1.9 Indemnity Insurance The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding board member and officer responsibilities.

NHS Lanarkshire and South Lanarkshire Council have responsibility for claims in respect of the services that they are statutory responsible for and that they provide.

Unlike NHS Boards, the IJB does not have any “shared risk” exposure from participation in the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). The IJB participation in CNORIS is therefore analogous to normal insurance arrangements.

1.10 Debtors and creditors Where income and expenditure have been recognised but cash has not been received or paid, a debtor or creditor for the relevant amount is recorded in the balance sheet.

1.11 Reserves A reserve is the accumulation of surpluses, deficits and appropriation over a number of years. Reserves of a revenue nature are available and can be spent or earmarked at the discretion of the IJB. Reserves should be split between usable and unusable on the balance sheet. As at 31 March 2019, the useable reserve balance totals £million. There are no unusable reserves.

2. Critical judgements and estimation uncertainty The critical judgements made in the financial statements relating to complex transactions are in relation to the accounting treatment of hosted services and the hospital acute services (set-aside).

The aforementioned areas of expenditure are therefore included in the financial statements on the basis of estimated figures. Estimates are made taking into account the best available information, however, actual results could be materially different from the assumptions and estimates used.

2.1 Hosted services In applying the accounting policies set out above, the IJB has had to make a critical judgement relating to complex transactions in respect of values included for services hosted within South Lanarkshire IJB for North Lanarkshire IJB.

Within Lanarkshire, each IJB has operational responsibility for the services which it hosts on behalf of the other IJB. In delivering these services the IJB has primary responsibility for the provision of the services and bears the risk and reward associated with this service delivery in terms of demand and the financial resources required. As such, the full costs are reflected within the annual accounts for the services which the IJB hosts. This is the basis upon which the 2018/2019 annual accounts have been prepared. The 2017/2018 figures have been prepared on the same basis.

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NOTES TO THE ACCOUNTS (Cont.)

2. Critical judgements and estimation uncertainty (Cont.)

2.1 Hosted services (Cont.) The relevant share of the pan Lanarkshire and area wide service expenditure is therefore included in the South Lanarkshire IJB on the basis of 49% of the total expenditure. 51% of the services relating to the North Lanarkshire IJB are also included as the South Lanarkshire IJB is acting as the principal for the delivery of these services.

In line with the Integrated Resource Advisory Group Guidance, the IJB responsible for the management of the hosted service is also responsible for managing overspends. As a result, these are accounted for within the annual accounts of the lead IJB. The same accounting treatment was adopted where an underspend arose in respect of a hosted service.

2.2 Hospital Acute Services (Set Aside) The legislation sets out that Integration Authorities are responsible for the strategic planning of hospital services most commonly associated with the emergency care pathway along with primary and community health care and social care services.

In respect of the current financial year 2018/2019, the notional figure for the sum set aside for 2018/2019 has been agreed with NHSL as £54.919m. This amount will be included in both the NHSL Health Board and IJB annual accounts 2018/2019.

This notional figure is based on 2016/2017 activity levels uprated to reflect the 2018/2019 price basis and adjusted for planned service changes which have resulted in the transfer of resources from acute services to community services during 2018/2019. This figure has been reviewed and supplemented by additional planning information on resource use.

It should be noted therefore that the sum set aside recorded in the annual accounts will not therefore reflect actual hospital use in 2018/2019.

The agreement in place between NHSL and the IJB is that the services covered within the set aside arrangements will be provided for the agreed notional sum and that the risk of the cost of the directed services exceeding the agreed notional sum is borne by NHSL during the year.

The methodology to cost these set-aside services is complex. The activity data upon which the set-aside figure is based is currently 18 months in arrears.

The notional figure for the sum set-aside which was originally reported in the annual accounts in 2016/2017 was £55.154m. This was based on 2014/2015 activity levels uprated to reflect the 2016/2017 price basis.

Based on the 2016/2017 activity data which is now available, the 2016/2017 restated budget was £54.645m and the actual cost was estimated to be £55.397m, in line with the agreed costing methodology.

In comparison to the budget, the additional cost borne by NHSL in 2016/2017 in respect of the set-aside services was therefore estimated to be £0.752m.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

In comparison to the amount included in the 2016/2017 annual accounts, the variance is £0.243m, which represents 0.05% of the net cost of services in 2016/2017 which totalled £482.437m.

This arrangement continues to be transitional pending further advice from the Scottish Government on the set-aside concept in order to further develop the arrangements required to meet the legislation and the statutory guidance. In line with the agreed cost allocation methodology, the cost estimates will be updated when more information becomes available in order to inform how the set-aside services are being used and to aid the future strategic planning of this resource.

3. Events after the reporting period The Chief Financial Officer authorised the audited accounts for issue on 10 September 2019. There have been no other material events since the date of the balance sheet which requires revision to the figures in the Accounts.

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

NOTES TO THE ACCOUNTS (Cont.)

4. Expenditure and Income Analysis by Nature

2017/2018 Expenditure and Income 2018/2019 2018/2019 (Restated) £m £m £m 156.703 Social Care Services 166.237

85.223 Family Health Services 90.661

67.571 Prescribing Costs 66.308

38.816 Hosted Services - Led by the South IJB (Note 9) 41.409

48.286 Hosted Services - Led by the North IJB 48.632

87.102 Hosted Services – Total 90.041

54.715 Hospital Acute Services (Notional Set Aside Budget) 54.919

29.056 Health Care Services – Localities 31.214

6.618 Health Care Services - Area Wide 6.492

4.495 Health Care Services - Out-of Area 4.611

40.169 Health Care Services – Total 42.317

3.008 Housing Services - Housing Revenue Account 3.205

2.012 Housing Services - General Fund 1.960

5.020 Housing Services – Total 5.165

0.152 Corporate Services 0.163

496.655 Total Gross Expenditure 515.811

(106.350) Funding Contribution - South Lanarkshire Council (116.348)

(382.021) Funding Contribution - NHS Lanarkshire (392.013)

0.000 North Lanarkshire IJB Hosted Service Funding 0.000

(3.229) Specific Service Income (3.205)

(7.214) Other Service Income (6.990)

(498.814) Total Income (518.556)

(2.159) Surplus on the provision of services (2.745)

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

NOTES TO THE ACCOUNTS (Cont.)

5. Taxation and Non-Specific Grant Income

2017/2018 2018/2019 (Restated) £m £m (382.021) Funding Contribution from NHS Lanarkshire (392.013) (113.564) Funding Contribution from South Lanarkshire Council (123.338) (495.585) Total (515.351)

The funding contribution from the NHS Board shown above includes £million in respect of the “set aside” resources relating to acute hospital and other resources. These are provided by NHS Lanarkshire which retains responsibility for managing the costs of providing these services.

The IJB however, has responsibility for the consumption of, and level of demand placed on, these resources.

There are no other non-ring fenced grants or contributions.

The funding contributions from the partners shown above exclude any funding which is ring-fenced for the provision of specific services. Such ring-fenced funding is presented as income in the Cost of Services in the Comprehensive Income and Expenditure Statement.

The only ring fenced contribution is in relation to the Housing Revenue Account and totals £3.008m. Income and expenditure in relation to a local authority's own direct provision of housing must be recorded separately within a Housing Revenue Account as laid out in Section 203 of the Housing (Scotland) Act 1987.

6. Corporate Services

31 March 2018 31 March 2019 £m £m 0.125 Staff Costs 0.135 0.024 External Audit Fee 0.025 0.003 Administration Costs 0.003 0.152 Total 0.163

7. Long Term Debtors

31 March 2018 31 March 2019 £m £m 0.000 NHS Lanarkshire Health Board 3.154 0.000 South Lanarkshire Council 0.000 0.000 Total 3.154

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NOTES TO THE ACCOUNTS (Cont.)

8. Short Term Debtors

31 March 2018 31 March 2019 £m £m 7.577 NHS Lanarkshire Health Board 7.168 0.701 South Lanarkshire Council 0.701 8.278 Total 7.869

9. VAT The IJB is not VAT registered and as such the VAT is settled or recovered by the partner agencies.

The VAT treatment of expenditure in the IJB’s accounts depends on which of the partner agencies is providing the service as these are treated differently for VAT purposes.

VAT payable therefore is included as an expense only to the extent that it is not recoverable from Her Majesty’s Revenue and Customs. VAT receivable is excluded from income.

The services provided by the Chief Officer to the IJB are outside the scope of VAT as they are undertaken under a specific legal regime.

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NOTES TO THE ACCOUNTS (Cont.)

10. Hosted Services - Income and Expenditure On behalf of the North Lanarkshire IJB within the NHS Lanarkshire area, the South Lanarkshire IJB acts as the lead for a number of delegated hosted services. It therefore commissions services on behalf of the North Lanarkshire IJB and reclaims the costs involved. The payments that are made on behalf of the North Lanarkshire IJB, and the consequential reimbursement, are included in the Comprehensive Income and Expenditure Statement.

The net amount of expenditure and income relating to these hosted services arrangements is shown below:

2017/2018 2018/2019 Delegated Services - Expenditure Income from Net Hosted Services Expenditure Income from Net on hosted hosted Expenditure on hosted hosted Expenditure services services services services £m £m £m £m £m £m 1.844 (1.844) 0.000 Primary Care Transformation 1.085 (1.085) 0.000 3.075 (3.075) 0.000 Community Dental Services 3.071 (3.071) 0.000 2.949 (2.949) 0.000 Out of Hours Services 3.979 (3.979) 0.000 1.475 (1.475) 0.000 Diabetic Services 1.696 (1.696) 0.000 3.446 (3.446) 0.000 Occupational Therapy Services 3.722 (3.722) 0.000 3.133 (3.133) 0.000 Palliative Care Services 3.485 (3.485) 0.000 0.318 (0.318) 0.000 Primary Care Services 0.327 (0.327) 0.000 4.170 (4.170) 0.000 Physiotherapy Services 4.474 (4.474) 0.000 Services hosted by the South Lanarkshire IJB 20.410 (20.410) 0.000 21.840 (21.840) 0.000 on behalf of the North Lanarkshire IJB Services hosted by the South Lanarkshire IJB 18.406 19.569 on behalf of the South Lanarkshire IJB Services hosted by the South Lanarkshire IJB 38.816 41.409 Total (Note 4)

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102 SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

NOTES TO THE ACCOUNTS (Cont.)

10. Hosted Services - Income and Expenditure (Cont.) Similarly, the North Lanarkshire IJB within the NHS Lanarkshire area acts as the lead for a number of delegated hosted services on behalf of the South Lanarkshire IJB. The payments that are made by the North Lanarkshire IJB on behalf of the South Lanarkshire IJB, and the consequential reimbursement, are included in the Comprehensive Income and Expenditure Statement, since this expenditure is incurred for the residents of South Lanarkshire.

The net amount of expenditure and income relating to those arrangements hosted by the North Lanarkshire IJB is shown below:

2017/2018 2018/2019

Expenditure Income from Net Delegated Services - Expenditure Income from Net on hosted hosted Expenditure Hosted Services on hosted hosted Expenditure services services services services £m £m £m £m £m £m 1.135 (1.135) 0.000 Sexual Health Services 1.186 (1.186) 0.000 1.059 (1.059) 0.000 Continence Services 1.033 (1.033) 0.000 1.082 (1.082) 0.000 Immunisation Services 1.053 (1.053) 0.000 2.588 (2.588) 0.000 Speech and Language Therapy Services 2.573 (2.573) 0.000 2.691 (2.691) 0.000 Child & Adolescent Mental Health Services 2.881 (2.881) 0.000 4.886 (4.886) 0.000 Children’s Services 5.043 (5.043) 0.000 0.265 (0.265) 0.000 Integrated Equipment and Adaptations Services 0.265 (0.265) 0.000 1.589 (1.589) 0.000 Dietetics Services 1.671 (1.671) 0.000 1.800 (1.800) 0.000 Podiatry Services 1.842 (1.842) 0.000 0.693 (0.693) 0.000 Prisoner Healthcare Services 0.736 (0.736) 0.000 0.777 (0.777) 0.000 Blood Borne Viruses 0.757 (0.757) 0.000 0.000 0.000 0.000 Hospital at Home Services 0.935 (0.935) 0.000 29.721 (29.721) 0.000 Mental Health Services 28.656 (28.656) 0.000

48.286 (48.286) 0.000 Services hosted by the North Lanarkshire IJB 48.632 (48.632) 0.000 on behalf of the South Lanarkshire IJB

NOTES TO THE ACCOUNTS (Cont.)

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103 SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019 11. Usable Reserve: General Fund The IJB holds a balance on the General Fund for two main purposes: ▪ To earmark, or build up, funds which are to be used for specific purposes in the future, such as known or predicted future expenditure needs. This supports strategic financial management. ▪ To provide a contingency fund to cushion the impact of unexpected events or emergencies. This is regarded as a key part of the IJB’s risk management framework. The table below shows the movements on the General Fund balance, analysed between those elements earmarked for specific planned future expenditure, and the amount held as a general contingency.

2017/2018 2018/2019 Balance as at Transfers Transfers Balance as at Useable Reserve Transfers Transfers Balance as at 1 April 2017 Out In 31 March 2018 Out In 31 March 2019 £m £m £m £m Ring-Fenced Reserves £m £m £m 2.749 0.000 0.932 3.681 Primary Care and Mental Health Transformation Fund 0.000 0.000 3.681 0.473 0.000 0.000 0.473 Alcohol and Drug Partnership Fund (0.473) 1.062 1.062 0.000 0.000 0.000 0.000 Primary Care Improvement Fund 0.000 0.412 0.412 0.000 0.000 0.000 0.000 Telehealth Projects 0.000 0.096 0.096 0.015 0.000 0.000 0.015 Family Health Services 0.000 0.000 0.015 0.000 0.000 0.235 0.235 Ring-fenced Reserves - Other (0.235) 0.000 0.000 3.237 0.000 1.167 4.404 Total Ring-Fenced Reserves (0.708) 1.570 5.266 Earmarked Reserves 0.000 0.000 0.808 0.808 Palliative Care Services 0.000 0.000 0.808 0.636 0.000 0.100 0.736 Prescribing Fund 0.000 0.000 0.736 0.000 0.000 0.701 0.701 Social Care Contingency 0.000 0.000 0.701 0.696 0.121 0.000 0.575 Transitional Fund (0.200) 0.000 0.375 0.000 0.000 0.000 0.000 Financial Plan 2019/2020 0.000 0.553 0.553 0.000 0.000 0.220 0.220 Training Fund - Health Visitors 0.000 0.000 0.220 0.191 0.000 0.000 0.191 Telehealth Project 0.000 0.000 0.191 0.000 0.000 0.000 0.000 Pharmacy Services 0.000 0.214 0.214 0.000 0.000 0.000 0.000 Health Promotion Activity Programme 0.000 0.119 0.119 0.000 0.000 0.092 0.092 Earmarked Reserves - Other (0.092) 0.032 0.032 1.523 0.121 1.921 3.323 Total Earmarked Reserves (0.292) 0.918 3.949 1.359 0.808 0.000 0.551 Contingency Reserves 0.000 1.257 1.808 6.119 0.929 3.088 8.278 General Fund (1.000) 3.745 11.023

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104 SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

NOTES TO THE ACCOUNTS (Cont.)

12. Related Party Transactions The IJB has related party transactions with NHS Lanarkshire and South Lanarkshire Council. In particular, the nature of the partnership means that the IJB may influence, and be influenced by, its partners. The following transactions and balances included in the IJB’s accounts are presented to provide additional information on the relationships.

2017/2018 Transactions with NHS Lanarkshire 2018/2019 (Restated) £m £m (382.021) Funding Contributions received from NHS Lanarkshire (392.013) 0.000 Service Income received from NHS Lanarkshire 0.000 334.780 Expenditure on Services Provided by NHS Lanarkshire 344.246 0.000 Key Management Personnel: Non-Voting Board 0.000 Members 0.027 Support Services 0.025 (47.214) Net Transactions with NHS Lanarkshire (47.742)

Key Management Personnel: The non-voting Board members are not directly employed by NHS Lanarkshire however a contribution of 50% of the cost of the Chief Officer and the Chief Financial Officer is made by NHS Lanarkshire. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. Details of the remuneration of these post holders is included in the Remuneration Report.

NHS Lanarkshire provide a range of support services for the IJB including finance services, personnel services, planning services, audit services, payroll services and creditor services. There is no charge from NHS Lanarkshire to the IJB for these support services.

31 March Balances with NHS Lanarkshire 31 March 2018 2019 £m £m 7.577 Debtor balances: Amounts due from NHS Lanarkshire 10.322 0.000 Creditor balances: Amounts due to NHS Lanarkshire 0.000 7.577 Net Balance with NHS Lanarkshire 10.322

2017/2018 Transactions with South Lanarkshire Council 2018/2019 £m £m (113.564) Funding Contributions received from South Lanarkshire Council (123.338) (3.229) Service Income received from South Lanarkshire Council (3.205) 161.723 Expenditure on Services Provided by South Lanarkshire Council 171.403 0.125 Key Management Personnel: Non-Voting Board Members 0.000 0.000 Support Services 0.138 45.055 Net Transactions with South Lanarkshire Council 44.998

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105 SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2018/2019

NOTES TO THE ACCOUNTS (Cont.)

12. Related Party Transactions (Cont.) Key Management Personnel: The Chief Officer and the Chief Financial Officer are non- voting Board members and are directly employed by South Lanarkshire Council.

Only 50% of the cost of the Chief Officer is allocated by South Lanarkshire Council to the IJB. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. The cost is shared equally between South Lanarkshire Council and NHS Lanarkshire.

Only 50% of the cost of the Chief Financial Officer is allocated by South Lanarkshire Council to the IJB. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. The cost is shared equally between South Lanarkshire Council and NHS Lanarkshire.

Details of the remuneration of these post holders is included in the Remuneration Report.

South Lanarkshire Council also provide a range of support services for the IJB including finance services, personnel services, planning services, legal services, audit services, payroll services and creditor services. There is no charge from South Lanarkshire Council to the IJB for these support services.

31 March Balances with South Lanarkshire Council 31 March 2018 2019 £m £m 0.701 Debtor balances: Amounts due from South Lanarkshire Council 0.701 0.000 Creditor balances: Amounts due to South Lanarkshire Council 0.000 0.701 Net Balance with South Lanarkshire Council 0.701

The financial information contained in the IJB Annual Accounts excludes any values associated with transactions between each of the partners. This has been removed to prevent double counting.

13. New standards issued but not yet adopted The Code requires the disclosure of information relating to the impact of an accounting change that will be required by a new standard that has been issued but not yet adopted. The IJB considers that there are no such standards which would have significant impact on its annual accounts.

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Audit Arrangements

Under the arrangements approved by the Commission for Local Authority Accounts in Scotland (“The Accounts Commission”), the auditor with overall responsibility for the audit of the accounts of the South Lanarkshire IJB for the year ended 31 March 2018 is Audit Scotland, 4th Floor, 102 West Port, Edinburgh, EH3 9DN.

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108 Agenda Item

7 Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 25 June 2019 Report by: Director, Health and Social Care

Subject: Draft Integration Joint Board Annual Performance Report 2018/2019

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  present a draft copy of the Integration Joint Board’s Annual Performance Report for 2018/2019 and to highlight progress [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):- [recs] (1) that the progress with the Annual Performance Report for 2018/2019 be noted; and (2) that the Director, Health and Social Care be authorised to sign off the Annual Performance Report for 2018/2019 by the deadline of 31 July 2019. [1recs] 3. Background 3.1. Section 42 of the Public Bodies (Joint Working) (Scotland) Act 2014 requires that Annual Performance Reports (APRs) are prepared by an Integration Authority or Integration Joint Board (IJB) in a South Lanarkshire context. The 2014 Act obliges that the APR should cover the preceding year’s activity and be published four months after the end of that reporting year.

3.2. The purpose of the APR is to ensure that performance is open and accountable, whilst at the same time providing an overall assessment of performance in relation to planning and carrying out integration functions. The final Report should also be viewed in the context of being for the benefit of Partnerships and their communities, particularly in communicating how the Partnership is progressing with integration.

3.3. Whilst there is no formal requirement to submit the APR to the Scottish Government, the content and assessment of performance within the Report is expected to be used and acted upon locally. The report should also be of interest to Health Boards and local authorities in monitoring the success of the integration arrangements they have put in place, as specified within their Integration Scheme.

3.4. To assist Health and Social Care Partnerships (HSCP), the Scottish Government issued Guidance for HSCP Performance Reports in March 2016. Although it is at the discretion of local Partnerships to decide areas to include in their APR, this guidance provided a helpful framework and recommended the following areas for inclusion:

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 a summary of progress against the nine National Health outcomes using as a minimum, the 23 core national performance indicators  financial performance and best value  reporting progress with localities  inspection of services, summarising any activity undertaken by Healthcare Improvement Scotland, the Care Inspectorate, Audit Scotland, Accounts Commission and Scottish Housing Regulator in the year of review

3.5. As with previous years, the APR is aligned to reporting progress against the intentions outlined in the Strategic Commissioning Plan (SCP). For this particular APR, it will cover the last year of the 2016-2019 SCP.

4. Context to South Lanarkshire Draft Report and Format 4.1. Attached in Appendix 1 is a full copy of the draft APR for the South Lanarkshire Health and Social Care Partnership (SLHSCP). From the draft, the APR for SLHSCP covers each of the above areas and is structured as follows:

Section Heading Summary of Content 1 Introduction and Provides the context within which this APR overview been produced 2 Our Strategic Context Summarises what the HSCP is working to achieve in South Lanarkshire 3 Localities in the South Overview of progress with locality planning Lanarkshire Partnership 4 How are we meeting Outlines progress against the 10 strategic our strategic priorities priorities and nine National Health and and outcomes Wellbeing Outcomes 5 Areas for Where we know we need to improve our Improvement services 6 How our external A strategic oversight of our regulatory partners view what we registered services. do 7 How we used the Provides an overview of the financial budget? performance of the HSCP for 2018/2019 9 Overview of How we are doing against the 23 Core performance indicators for integration

5. Summary of our Headline Achievements for 2018/2019 5.1. A number of important achievements have been realised over the course of 2018/2019. A summary of these is detailed as follows:  a reduction in the number of bed days associated with emergency admissions to hospital or unscheduled care, thus allowing hospitals to focus more on planned care  minimising the impact and inconvenience to people who have been in hospital and are ready to return home. Our delay discharge bed days have fallen by 10% over the period 2017/2018 to 2018/2019  increasing the number of people who spend the last six months of life at home from 84.2% in 2013/2014 to 87% in 2018/2019  maintaining consistency in the number of people with complex needs who are being supported to remain at home

110  a successful consultation and engagement process to sense check our priorities and agree additional ones for the next three years as part of developing our new SCP  good progress with our transformation/service modernisation agenda in relation to care home modernisation, the ongoing roll-out of telehealth and telecare, successfully rolled out tests of change including home based IV Therapies and respiratory support  revised needs profiling with projected demand to assist with future service planning and targeting of resources  four Locality Plans developed and agreed which localise the ambitions detailed in the SCP

6. Next Steps 6.1. Following approval by the IJB, the draft APR will be subject to further changes and updating as appropriate, prior to it being finalised and published by 31 July 2019. The Report will then be made available on the Health and Social Care Partnership website.

6.2. A new SCP for the period 2019-2022 was approved by the IJB at its meeting on 25 March 2019. Future APRs will report on progress against this plan to assure the Board that the strategic direction set out in the Plan is being implemented.

7. Employee Implications 7.1. There are no employee implications associated with this report.

8. Financial Implications 8.1. There are no financial implications associated with this report.

9. Other Implications 9.1. There are no additional risks associated with this report.

9.2. There are no sustainable development issues associated with this report.

9.3. There are no other implications at this stage.

10. Equality Impact Assessment and Consultation Arrangements 10.1. This report does not introduce a new policy, function or strategy or recommend a change to an existing policy, function or strategy and therefore, no impact assessment is required.

10.2. This report is an APR and relates to the Strategic Commissioning Plan 2016-2019, which was extensively consulted on.

11. Directions 11.1. Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

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Val de Souza Director, Health and Social Care

Date created: 25 May 2019

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

Previous References  Strategic Commissioning Plan 2019 – 2022 - Integration Joint Board, 25 March 2019 (Paragraph 2)  Annual Performance Report 2017/2018 – Integration Joint Board, 26 June 2018 (Paragraph 9)

List of Background Papers  None

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Martin Kane, Programme Manager Ext: 3743 (Phone: 01698 453743) Email: [email protected]

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South Lanarkshire Integration Joint Board Annual Performance Report 2018/19

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Contents

Page

1) Introduction and Overview

2) Our Strategic Context

3) Localities in the South Lanarkshire Partnership

4) Meeting the Strategic Priorities and Outcomes

5) Areas for Improvement

6) How our external partners view

7) How we have used the budget

8) Next Steps and Further Information

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FOREWARD

We are pleased to introduce our Annual Performance Report for 2018/19 for South Lanarkshire’s Integration Joint Board, detailing our achievements for the year and the way forward across the forthcoming years.

Our vision is clear: “Working together to improve health and wellbeing in the community – with the community.” In making this vision real, the IJB with its key partners has made some real and tangible progress in supporting and enabling people to remain in their home and community in line with their wishes. Some of the key headline points which support this are:

• A reduction in the number of bed days associated with emergency admissions to hospital or unscheduled care, • Minimising the impact and inconvenience to people who have been in hospital and are ready to return home. Our delay discharge bed days have fallen by 10% over the period 2017/18 to 2018/19 • Increasing the number of people who spend the last 6 months of life at home from 84.2% in 2013/14 to 87% in 2018/19 • Maintaining consistency in the number of people with complex needs who are being supported to remain at home. • A successful consultation and engagement process to sense check our priorities and agree additional ones for the next three years as part of developing our new Strategic Commissioning Plan • Good progress with our transformation/service modernisation agenda with in relation of care home modernisation, the ongoing roll – out of telehealth and telecare; successfully rolled out tests of change including home based IV Therapies and respiratory support • Revised needs profiling with projected demand to assist with future service planning and targeting of resources • Four Locality Plans developed and agreed which localise the ambitions detailed in the Strategic Commissioning Plan

Looking forward and building on the above, the IJB and its partners undertook significant work throughout 2018/19 to develop a new Strategic Commissioning Plan for the period 2019-22. This new Plan seeks to build upon the achievements outlined in this Annual Performance Review (APR), which will be the final APR associated with the 2016-19 Strategic Commissioning Plan.

Finally, we’d like to thank everyone who’s contributed and participated in the attainment of these achievements to date. We look forward to working in close partnership with you as you help us to shape health and social care for the future.

Val de Souza Philip Campbell

May 2019

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1.0 Introduction and Overview South Lanarkshire Integration Joint Board (IJB) has just completed its third full year of operation as a formally constituted public body. Much has happened in this three year period, including some very positive developments and achievements.

This report represents the IJB’s third Annual Performance Report (APR) and builds upon progress outlined in last year’s APR. Importantly, the APR is a statutory requirement of the Public Bodies (Joint Working) (Scotland) Act 2014 and gives the IJB, the Parties (Council and NHS Board) and the wider partners of the Health and Social Care Partnership, the opportunity to celebrate success and outline some of the priorities for the future.

2.0 Our Strategic Context

Policy Drivers The strategic context within which the Health and Social Care Partnership operates is both wide ranging and complex, taking into account national legislation, policies and strategies as well as strategies relevant to South Lanarkshire. Although the extensive legal policy and legal framework remains extant, there has been a number of new and existing policy areas which have impacted significantly on health and social care services since the 2017/18 APR. Examples of such areas are detailed below:

• Prioritisation/Eligibility – in line with national guidance issued previously, the IJB approved the implementation of a Prioritisation/Eligibility framework which stratifies four levels of needs and risks (Low, Moderate, Substantial and Critical) • Scotland’s Public Health Priorities - prioritises and focuses wider public health reform on

➢ Healthy places and communities ➢ Early years ➢ Mental wellbeing ➢ Harmful substances ➢ Poverty and inequality ➢ Healthy weight and physical activity

• The Carers (Scotland) Act 2016 – continued implementation of the Act which will bring a number of additional duties within the scope of the IJB with regards to carer enablement plans, young carer support plans, eligibility criteria and short breaks • The Community Plan and Neighbourhood Plans – with an agreed overarching objective - to tackle deprivation, poverty and inequality • Rapid Re-Housing Transition Plans – to reduce and mitigate against the impact of homelessness across Scotland, local Rapid Rehousing Transition Plans set out how outcomes can be improved for those people affected by homelessness • Achieving Excellence – which supports NHS Lanarkshire’s aim of developing an integrated health and social care system which has a focus on prevention, anticipatory care and supported self- management • Primary Care Transformation – the modernisation of Primary Care Services and General Medical Services (GMS) Contract are two of the most significant planning and policy developments aimed at changing how services are developed and transformed to meet different demands in the future 4

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• Audit Scotland Health and Social Care Integration Progress Update 2018 – reported that progress with integration has been slow overall and identified a number of areas for action under the broad headings of collaborative leadership, integrated finances, strategic planning, governance and accountability, information sharing and meaningful engagement.

Service Demand In addition to the above, and as part of ongoing activity to understand current and future demand, a new suite of data has been produced with regards to changing needs and demographics in South Lanarkshire. A summary of the key issues is outlined below:

UPDATED TABLE TO FOLLOW

What the Public are Telling Us?

Throughout 2018/19, we undertook a significant public engagement process to ask the public where they thought we should target our resources and efforts. The overriding message is that from an outcomes perspective, they wish to be supported to remain at home for as long as possible and the top three themes they identified from locality, public and online consultation and participation activity were:

• Early intervention, prevention and health improvement – empowering people to be more responsible and self-aware with regards to the importance of good health and wellbeing is a key aspect of shifting the balance of care. Early intervention and prevention applies in equal measure to people with good and not so good health. It is acknowledged that early intervention strategies can mitigate against the effects of health problems once identified. We want to focus our early intervention and prevention on an age and stage basis recognising that children will be the adults of tomorrow.

• Delivering our Core Duties – health and social care services are required to work within a clearly defined legal and policy framework. In doing so, some of the services provided are statutory, for example protecting vulnerable children, young people and adults or delivering accessible community services, free at the point of use. These duties are very important to ensuring we support our local citizens. Our ambition is to continue to deliver high quality core services and that there is relevant, timely and appropriate information, support and care available to those who need it most.

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• Mental Health and wellbeing – mental health includes our emotional, psychological, and social wellbeing and affects how we think, feel, and act. It is one of the most significant and complex areas of demand in health and social care services. Our focus needs to shift more towards prevention and early intervention as part of a conscious strategy to reduce the impact on people’s lives. Staff and services across settings, in recognition of the interplay between physical and mental health, should support and care for individuals in a mental health inclusive way and reduce stigma and discrimination.

It is against this strategic context that South Lanarkshire IJBs continues to strive to make health and social care services better for the people of South Lanarkshire through further integrated working.

3.0 Localities in the South Lanarkshire Partnership

ADD LINKS ABOVE TO LOCALITY PLANS

Key to all our ambitions and priorities is to further embed our commitment to the locality Community First Tiered Model, which essentially outlines the levels of proportionate support which health and social care services will work to provide. Whilst implementing this approach we will minimise disruption to those who, for whatever reasons, depend on our services.

The strength, contribution and influence of the locality planning agenda continues to grow. Some of the key achievements for 2018-19 include:

• Locality Plans which take account of each locality’s unique strengths and assets, as well as the respective challenges within each locality and also demonstrating the strategic fit with the Strategic Commissioning Plan 2019-22. • Locality Planning Groups, which consist of representatives from the third sector, community-based organisations and service user representatives and have played a key role in informing and influencing the development of their respective locality plans. The

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members of these groups have local knowledge of the area and are best placed to identify the priorities, objectives and measurable actions against which we can measure performance and progress. • Comprehensive locality engagement events to support the development of the new Strategic Commissioning Plan 2019-22 where over 1,000 delegates participated across eight sessions, sharing their views.

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Activity for Localities in 2019-2020

Providing strategic Utilising locality leadership at a profiling information local level for on needs to drive this health and social agenda forward care services

Implementing the Developing locality plan whilst systems and demonstrating the processes which contribution of the locality to deliver the secure wider Strategic community Commissioning Plan participation and 2019-22 engagement

Demonstrate the impact they are Strengthening making against the 9 collaboration and health and wellbeing communication across agencies outcomes and working directly with associated people who require performance our support measures

Engaging and working directly with communities, Streamlining across particularly with points to services and regards to the supports Building and Celebrating Communities (BCC) work

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4.0 Meeting the Strategic Priorities and Outcomes

In this section we have highlighted some of the good work that the Partnership has achieved over the last year and how this links to the National Health and Wellbeing outcomes. Below we have linked the national health and wellbeing outcomes to the most appropriate strategic priorities however, our priorities cut across multiple outcomes, and in some cases all of the health and wellbeing outcomes. This information comprises of various sources to give a rounded overview from both a qualitative and quantitative perspective:

• Ministerial Steering Group indicators (MSGs) • Inputs and service developments that are progressing or working well • Stories from what people have told us

Health and Social Work will work together to deliver on our duties to ensure that the people of South Lanarkshire receive relevant information, support and care.

NI - 9 Percentage of adult supported at home Scotland South who agreed they felt safe Lanarkshire 83% 82%

NI - 15 Proportion of last 6 months of life spent at home or in a community setting 88% 87%

We have developed Palliative Care services to provide 12 inpatient beds in the South Lanarkshire area, at Kilbryde Hospice. This will benefit those who require specialist palliative care support within the East Kilbride, Cambuslang, Rutherglen and Hamilton areas, meaning residents in Cambuslang and Rutherglen will have access to this type of service within Lanarkshire for the first time.

The model complements the community supports and services which are already in place and which continue to be developed within Lanarkshire to provide integrated care in support of patients in locality settings. This also reflects the preferences of people – expressed during the review of palliative care services – to receive end of life care in their own home, and also continues to recognise the importance of hospice provision and the services they provide that will support Lanarkshire residents.

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“My dad was diagnosed with advanced stomach cancer in March this year. We were told he would only survive 3-6 months. As soon as he was discharged the community team visited and explained about the just in case box and gave us information on how to contact them 24/7 if we had any questions or if my dad needed any additional medication etc. Over the couple of months we had to contact them numerous times to ask if they could administer additional anti sickness meds or stronger painkillers. Over this time we met many team members and each

one was as nice as the last, always reassuring us and keeping my dad as comfortable as

possible. I cannot begin to explain what this meant to us as a family knowing that no matter, day or night, someone would be there to help and support us. One day when my dad was near the end of his life the community nurses came in numerous times to try and get his sickness and pain under control. They explained everything they were doing and why they were doing it. At a time like this it makes so much difference knowing that they were there

and my dad was their priority at this stressful time. There was numerous occasions that we

had to phone them at all hours day and night and each time we were met with caring, patient

staff who nothing was a bother.”

The table below confirms the Partnership is increasing the proportion of South Lanarkshire residents who spend the last six months of life in the community.

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Work with communities, partners and staff to deliver initiatives that prevent ill health and intervene early, avoiding the escalation of need.

NI - 1 Percentage of adults able to look after Scotland South their health very well or quite well Lanarkshire 93% 92%

A key aspect in achieving a shift in the balance of care is the whole early intervention and prevention agenda, whereby people are supported as best as possible to be responsible for their own health and wellbeing. As stated previously there is broad public support in recognising that it is not only formal services that contribute to supporting people to live healthily and independently.

• A significant amount of work has been done in partnership with South Lanarkshire Leisure and Culture in supporting people to look after and be more responsible for their own health and wellbeing. Examples of this positive work includes targeting young people through specific Physical Activity Programmes and also aligning supports to more formal health and social care services such as Physical Activity Prescribing programme. • A range of active health initiatives, including Physical Activity which are part of approaches to early intervention, prevention and health improvement have been introduced. These show that people who have completed a programme, report that it has been hugely beneficial for their mental health and wellbeing • The IJB has created £650,000 ring fenced funding for Third Sector growth. This has shown positive outcomes, particularly from an early intervention and prevention perspective. Initiatives to tackle social isolation, increase volunteering, community participation and health and wellbeing have all been key strands of this investment and all are required to demonstrate positive impact on the IJB priorities and health and wellbeing indicators

Quality Improvement Awards 2018. The commitment of health, social care staff and other partners to improving support for children and young families in South Lanarkshire was recognised at a national award ceremony. One of the innovative initiatives to address speech and language inequalities won the award in their category at the Scottish Governments prestigious Quality Improvement Awards 2018.

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Collaborative efforts to tackle child poverty and a pioneering partnership project to reduce infant exposure to second hand smoke also made the national shortlist, chosen from hundreds of entries, for the showcase event. The respective projects have been delivered by South Lanarkshire Health and Social Care Partnership (SLHSCP) staff, in close conjunction with South Lanarkshire Council Education Resources.

The Think Activity Project Scottish Health Award Winner, The Think Activity Project, pioneered in Kello hospital, Biggar, South Lanarkshire, was established to combat the well-documented impact of sedentary behaviour within hospital. Staff are sharing the learning from the pioneering project with other teams across acute and community hospitals within Lanarkshire. For more information visit: https://bit.ly/2XQ47Sn

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The role and contribution of unpaid carers is recognised and valued as crucial. Our commitment is to identify carers within our communities and offer responsive supportive services that respond to personal circumstances

NI - 8 Total combined % carers who feel Scotland South supported to continue in their caring role Lanarkshire 37% 32%

Across Scotland there has been a small decline in the level of positive feedback in relation to the ‘integration’ related indicators contained in the national survey when comparing 2017/18 with 2015/16. This is reflected in the South Lanarkshire position where 32% (2017/18) of carers in comparison to 39% (2015/16) felt supported to continue in their caring role. However from our own local data, a recent survey undertaken by the Partnership received feedback from 306 (not associated with any individual organisation) carers in response to the question "Do you think the range of services currently offered meet the needs of carer in South Lanarkshire". From this 12% said fully meets and 59% partly meets, we also asked carers to respond to "I feel my needs are met" and 33% strongly agreed that they were supported.

As part of the Carers (Scotland) Act 2016 we have developed a new Carers Strategy 2019-22 in line with the Strategic Commissioning Plan. The Strategy was developed following seven carer involved consultations, focus groups and surveys as well as a full review of the current services in provision. Within the strategy we have identified a range of priorities which will be implemented to support carers to try to reduce the impact their care role has on their own health and wellbeing.

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• 179 carers participated in shaping the final Carers Short Breaks Statement which will be available from 2019/20 onwards • We have developed carer enablement plans following the national framework guidelines placed against low/moderate/substantial/critical risk/impact. • Health and wellbeing Adult carer indicators within the categories: Health and wellbeing, Relationships, Living environment, Employment and training, Finance. Life balance and Future planning. • A Money Matters Advice service remains in situ in South Lanarkshire with a team of four dedicated carer welfare rights officers, one based in each locality. A strong culture of welfare rights referrals exists amongst our commissioned organisations with specific links on the local authority website carers’ pages and welfare rights information published across various Partnership carer documents.

A dedicated grandmother has revealed how life-changing personal experiences have underpinned her lead role in an independent community group geared to improving health and social care. Margaret Moncrieff, who is the Chair of South Lanarkshire Health and Social Care Forum helped care for a close family member at just nine years of age. In her 40s Margaret, now 69, cared for her late mother when she was diagnosed with dementia. Profoundly affected by the experience, Margaret went on to work on a dementia outreach project later in her life. Now retired, the grandmother of four devotes much of her spare time to the Forum. The organisation has been appointed by the Partnership to support wider public involvement in planning and decision-making about local health and social care services. “It’s been extremely gratifying to see developments made in policy, plans and procedures as a direct result of Forum involvement,” added Margaret. “I’ve felt reassured that through my role I’ve been able to truly influence better services for patients and their carers - at a very human level.” Read the full story here: https://bit.ly/2He3iOf

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We will transform the way we support people to assist them to care for themselves and to identify the health and care outcomes they desire. Using telehealth and telecare to assist in this will be integral to our overall approa

ch. NI - 4 Percentage of adults supported at home Scotland South who agreed that their health and social Lanarkshire care services seemed to be well co- 74% 74% ordinated

Through significant improvement in the extent and numbers of applications of new technology, the extension of technology enabled care has been very successful in South Lanarkshire in supporting an increasing number of the population to self-care and self-manage through simple smart technology and apps from their mobile phones. This has real potential to continue to grow and very much follows modern life, whereby phones, apps and generic technology devices are intrinsic to the way in which people live.

AWAITING STATISTICAL INFORMATION ON TELEHEALTH

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Flo technology the icing on the cake for top baker Julie A successful baker has described how Flo Telehealth texting technology has proved to be the icing on the cake in regaining full health. A year ago, Julie Chambers, a mum-of-two who bakes everything from wedding to intricate novelty cakes, discovered she was living with high cholesterol and blood pressure during a routine health check. Julie, from East Kilbride in South Lanarkshire, was referred by her GP into a Physical Activity Programme (PAP), which included a six week exercise course at a local gym – and use of Florence Simple Telehealth text messaging system, or ‘Flo’ for short. “When I discovered I had high blood pressure, it was concerning,” said Julie. “I’ve got to admit, however, that the prospect of having to go to a Doctor’s surgery or clinic to get it regularly checked was enough to raise my blood pressure even higher! Between work and family I lead a very busy lifestyle. “I felt like I didn’t want to be taking up the valuable time of clinicians either. “Being offered the use of Flo was a brilliant alternative – and I think the hassle free-nature of it, without having to commute and take time out of a busy day, probably gave a truer reflection of my day-to-day readings.” Julie was equipped and taught how to self-monitor her blood pressure and texted readings from home – where she also works from – every day. A digital system was specifically programmed. If Julie’s readings were outwith prearranged parameters she was advised of what action to take via text message. Clinicians were also able view real time information about Julie at any time. Through the PAP, run by South Lanarkshire Leisure & Culture, Julie also established a regular fitness regime attending her local gym four times a week. Julie said: “Regular exercise has really provided me with sense of wellbeing. The high blood pressure is now under control and I’m in great health. “Throughout the process, I had the peace of mind that I was linked to professionals and supported through the Flo text system.“I also liked the fact it was responsive to the data I was providing. My job is all about accurate quantities and ingredients. Inputting my readings and receiving confirmation I was on track was really reassuring.” Lanarkshire Telehealth team is a Lanarkshire-wide service hosted within South Lanarkshire Health & Social Care Partnership.

Widely regarded as a major partner in the Scottish Government’s Home & Mobile Health Monitoring programme, Lanarkshire has had 3,500 patients, like Julie, remotely monitoring their blood pressure (with a further 3,500 monitoring other health conditions) to date.

Morag Hearty, NHS Lanarkshire Telehealth manager, who is also National Strategic lead for the Technology Enable Care/ Home & Mobile Health Monitoring, said: “Telehealth is a vital component of the transformation of health and care delivery. It can support people to feel safe, more confident in their everyday life as well as making sure people are independent where possible.”

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It is recognised that increasingly, care services need to expand to be responsive on a 24/7 basis.

NI - 5 Total % of adults receiving any care or Scotland South support who rated it as excellent or good Lanarkshire 80% 78%

• The Integrated Community Support Team provides multi-disciplinary co-ordinated inputs from Nurses, Physio and homecare on a 24/7 basis. In addition, a number of services are now moving towards 7 day working, thereby extending support to service users across the week • Providing more services across 7 days was highlighted in the consultation as an area for further development

Clydesdale Integrated Community Support Team-Acute Care Team (ICST ACT) comprises of nurses, Allied Health Professionals and overnight Home Carers who provide home-based care and rehabilitation. The success of the joint working and enhanced relationships has led to acute care being delivered by the team. The highly innovative approach has allowed people experiencing acute infections or sudden deterioration in their health to be supported to remain at home - negating the need for an otherwise inevitable hospital admission. This is

truly integrated model has promoted a person-centred approach and enhances experience for

the service user and their family. Improved communication, reduced duplication and blurring of roles across services have contributed to improving the outcomes – and the lives – of people who have used this service. This approach will inform future service delivery and improvements across the South Partnership.

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Intermediate Care includes a range of community based services and approaches that maximise a person’s recovery and promote including an appropriate alternative to unnecessary hospital admission, enabling timely discharge from hospital and reducing premature admission to long term residential care.

NI - 2 Percentage of adult supported at home Scotland South who agreed that they are supported to Lanarkshire live as independently as possible 81% 8% NI - 18 Percentage of adults with intensive care 61% 62% needs receiving care at home

NI - 19 Number of days people spend in hospital 762 1,118 when they are ready to be discharged (per 1,000 population)

Modernising Care Facilities Plans have been agreed to modernise of care facilities which will enable more people to be supported in their own homes following periods of extended rehabilitation in a purpose built facility. Whilst the future model of care delivered from the new establishments would focus on a range of alternative supports; including transitional/intermediate care; access to technology enabled housing; and be community facing. The new facilities will also support increased episodes of respite care as well as continuing to support those with ongoing residential care needs.

Delayed Discharge Bed Days There has been significant work undertaken over the last 18 months to refocus efforts in supporting a reduction in the number of Delayed Discharges in line with the Audit Scotland report as well as the internally generated Delayed Discharge Action Plan. In total the Partnership has reduced bed days associated with non-code nine reasons by 3,652 over the period April – March 2018/19 when compared with the previous year. The no of Bed days for March 2019 were 391 bed days beyond target, 2708 against the target of 2,317. The latest years successes mean a 19.6% reduction in the number of delayed discharge bed days over the last year.

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The graph below include patients in offsite beds and takes into account progress in embedding improvements outlined in the delayed discharge improvement plan.

South Lanarkshire Delayed Discharge Bed Days (exc. Code 9s) 5,000 4,000 3,000 2,000 1,000

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NI - 7 Percentage of adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life

• The Affordable Housing Supply Programme has significantly increased supply of suitable, affordable and sustainable housing across South Lanarkshire, delivering on average 270 new affordable homes per year (2016-19). This has included new homes built to Housing for Varying Needs standards, as well as specially adapted homes to meet the particular housing needs of disabled people and families • Approximately, 1,600 homeless households were supported through homelessness, including people with multiple complex needs. • 1,100 homeless households were provided with a permanent home

Housing adaptations to support On average, over 1,600 adaptations were independent living completed across private (533) and council (1,070) homes each year.

Private These adaptations enable people and households with particular needs, including Council older people and people with mobility needs and disabilties, to continue to live independently All within their own homes in the community.

0 1,000 2,000

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Integration presents us with an opportunity to develop single points of contact for health and social care services and thus reduce duplication of effort and potential bureaucracy.

NI - 3 Percentage of adults supported at home who agreed that they had a say in how their help, care, or support was provided

• The 24/7 Integrated Community Support Team (ICST) provides people with a single point of contact so that whenever assistance is required, there will be a response from someone who is aware of the patient’s needs • This was an area highlighted in our consultation events within localities for further development • Within East Kilbride an IV (Intravenous) therapies initiative has been set up to support patients to receive treatment at home, where they would historically have been admitted to hospital. This specialist service development primarily sits within the community as the service is delivered by a single profession in the community and although requires specialist skills, the care delivered does not require the coordination of multiple professions.

IV Therapy Patient Story: Mrs A

The community based IV Therapy service was introduced to Mrs A, a 69 year old lady who lives with her husband in East Kilbride, as an alternative to hospital based care.

Mrs A felt she had spent “almost all of last year in hospital” having spent 9 months of the year from Jan 2017 to Dec 2017 as an in-patient because of frequent readmissions to receive IV therapy.

The option to receive the treatment at home was welcomed by the family who were delighted with this service development. Mrs A could continue with living her life at home whilst getting the essential treatment she needed. Her husband, who also had health concerns, also benefited as he no longer needed to struggle to visit Mrs A at the hospital on a daily basis

As part of the home based service community nursing staff had enhanced training to deliver IV antibiotics in people’s homes. Mrs A’s husband is now being trained by Health professionals to administer the IV therapy in the future, as his wife has a long- standing condition. This will continue to be monitored by Mrs A’s GP and the East Kilbride Community Nursing Team.

Listen to Mr and Mrs A’s story by clicking on the hyperlink… ADD IN HYPERLINK 21

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The Wayfinders A small band of volunteers have been set up to offer a trailblazing service at the heart of health and social care. The Wayfinders - based in Hunter Community Health Centre in East Kilbride – are tasked with welcoming and helping patients and visitors find their way in the five storey, state of the art facility. As well as offering directions, the Wayfinders’ main tasks include providing a friendly and welcoming atmosphere to patients and visitors arriving and explaining the resources and services available to the public in the building. For more information watch this film https://vimeo.com/308430043

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We will have an integrated model of mental health care which offers appropriate supports to individuals at the right time.

NI - 6 Percentage of people with positive experience of the care provided by their GP practice

• The Primary Care and Mental Health Transformation programme has seen increased contribution of a wide range of healthcare professionals, increased access to the right help at the right time, GPs feeling more supported with this agenda, fewer unnecessary hospital admissions and an increased ability to self-manage

• Distress Brief Intervention/crisis services have been introduced to support staff in the Police and Accident and Emergency Departments in recognising and supporting people with mental health issues.

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Ensuring that integration arrangements have the necessary support services to enhance and strengthen the overall approach of the Partnership in achieving better integrated strategic and operational delivery of health and social care services.

NI - 10 Percentage of staff who say they would recommend their workplace as a good place to work

Audit Scotland Review of Progress with Integration The Partnership was selected as one of 4 areas used by Audit Scotland to assess progress with integration. In turn, a number of areas of good practice and future challenges were identified.

Communication Strategy Our communication strategy continues to support the partnership’s objectives. ‘Val’s blog’ (Director of Health and Social) regularly reaches 15,000 people. The website receives 3000 visits per month and workshops led by our communication manager have been described as ‘inspiring’ ‘timely’ and ‘insightful’. Our Building and Celebrating Communities campaign was a finalist at the 2018 NHS Scotland Comms awards with the response the cyber-attack of 2017 winning best crisis communication award. Meet the Experts won best campaign.

Partners in Communities Our partners in communities play an important role and a recent film documents the success that’s been had by ReConnect. Run by Healthy Valleys, ReConnect has tackled loneliness and isolation amongst our older adults across rural Clydesdale.

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Other Key Areas of Progress

The IJB as part of its statutory duties progressed a number of other key issues including:

• Agreeing and submitting our second Climate Change Statement outlining how the IJB will work to support climate change duties • The Partnership was subject to a Care Inspectorate thematic review of the Self-directed Support (SdS) processes in South Lanarkshire. The findings of the review were consistent with the self- assessment previously undertaken and this will formally be reported later in the year. • The Carers Strategy 2019 - 2022 was published in April 2019. This was developed through carer involved consultations, focus groups and surveys as well as a full review of the current services in provision. The key duties and powers of the Act were analysed to ensure strategy development meets legislative requirements and additionally address the needs of carers. • The IJB continues to be supported to develop as an entity of the public sector and to assist it in discharging its leadership duties. Part of this support has been IJB development time on the morning of each IJB meeting, with a number of topics discussed as part of this, for example the Audit Scotland Report, Ministerial Strategic Group Action Plan, Community Planning and the Strategic Commissioning Plan. • Across 2018/19, as part of developing the new Strategic Commissioning Plan (SCP) for 2019-2022 a far reaching participation and engagement process was adopted and this followed the principles set out in the IJB participation and engagement strategy. Feedback on this has been positive and is summarised in the new SCP. From an impact perspective the IJB is confident that this plan takes the Partnership forward another stage in its development. • A review of the risk register was undertaken as part of developing the new SCP.

Our Building and Celebrating Communities programme is geared to exploring how we can generate more space for communities to create the things that matter to them - and how we can support these activities. An example of this approach in action is The South Lanarkshire Autism Resources Coordination Hub (ARCH), brought into being in 2016 following the previous autism resource closing. Since its inception, ARCH has been focussed on facilitating the development of autism support in South Lanarkshire communities - much of which is delivered by communities themselves - alongside partners in the statutory, private and third sectors. For the first time individuals and organisations who have been previously working independently of each other are discovering shared interests and collaborative ventures. For more information visit: https://bit.ly/2THmVUx

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Continence Project

The Care Home Continence Project, involving a variety of partners, has saw small changes to continence care in care homes elicit life-changing benefits. Research has identified incontinence as a risk factor that increases skin damage, infection and falls in

older people. The initiative allowed care home staff to improve the quality of care through better recording of processes and introducing small changes including optimising fluid and reducing caffeine intake. The outcomes of the project – piloted at David Walker Gardens in Rutherglen – led to improvements including a reduction in falls by 65%, urinary infections being halved and skin damage reduced by one third. The A&E Attendancesproject has also significantly reduced the amount of continence pads used at the homes. The pilot was developed with South Lanarkshire Health and Social Care Partnership working closely with colleagues in North HSCP, NHS Lanarkshire and NHS National

Services Scotland and work is underway to implement the project out across South MSGsLanarkshire and beyond. For more info visit: https://youtu.be/REOx5PNGTX4

Despite a slight increase in A&E attendances and admissions to hospital, there has been a significant reduction in unscheduled care bed days and also bed days associated with delayed discharges. In turn, the Partnership is now providing an extended range of community services which means that the type of patient who would previously have been cared for in Lockhart Hospital – 30 beds, and Douglas Ward, Udston Hospital, are now able to be cared for in their own home environment and the funding previously associated with these beds reinvested in community care services.

5.0 Areas for Improvement In conjunction with the above, the Partnership has identified that there are also a number of areas where improvement activity requires to be taken forward in the next year. Examples of areas which have been identified are:

A&E Attendances – continue to show an upwards trend of 3.29% when compared against the 2017/18 figures. These figures are not dissimilar to the national trends observed across Scotland. Attendances continue to be a challenge for the Partnership, April 2018 - February 2019 there were 6,472 additional attendances than anticipated, 99,492 against a target of 93,020. However, February performance improved with the Partnership -314 attendances against target.

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South Lanarkshire A&E Attendances

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Apr-17

Apr-18

Sep-15

Feb-16

Sep-16

Feb-17

Sep-17

Feb-18

Sep-18

Feb-19

Dec-15

Dec-16

Dec-17

Dec-18

Aug-15

Aug-16

Aug-17

Aug-18

Nov-15

Nov-16

Nov-17

Nov-18

Mar-16

Mar-17

Mar-18

May-15

May-16

May-17 May-18 Attendances Target Attendances

The Partnership will continue to explore alternative pathways to divert people into more appropriate forms of support. Much of this will require a coordinated and consistent communications message to the public, together with concerted action planning with colleagues in acute services.

Emergency Admissions - remain at similar levels to 2017/18 with a decrease of two admissions representing less than 0.01%. Performance deteriorated April 2018 to February 2019 with 807 additional admissions than anticipated – 35,974, against a target of 35,167. During February 2019 performance improved 537 fewer admissions than anticipated.

South Lanarkshire Emergency Admissions 4,000

3,500

3,000

2,500

2,000

1,500

Jul-15

Jul-16

Jul-17

Jul-18

Jan-16

Jan-17

Jan-18

Jan-19

Jun-15

Jun-16

Jun-17

Jun-18

Oct-15

Oct-16

Oct-17

Oct-18

Apr-15

Apr-16

Apr-17

Apr-18

Sep-15

Feb-16

Sep-16

Feb-17

Sep-17

Feb-18

Sep-18

Feb-19

Dec-15

Dec-16

Dec-17

Dec-18

Aug-15

Aug-16

Aug-17

Aug-18

Nov-15

Nov-16

Nov-17

Nov-18

Mar-16

Mar-17

Mar-18

May-15

May-16

May-17 May-18 Emergency Admissions Target Admisssions

139

6.0 How our external partners viewed the quality of what we do Information to follow

7.0 How we have used the budget The financial envelope available to the IJB in 2018/2020 was in excess of £500m per annum and this is graphically depicted as follows:

2018/2019 FINANCIAL ALLOCATIONS (£M) Other Services, 18

Locality and Other Health Services, 26 Set-Aside Notional Allocation - Acute Social Care and Services, 55 Housing Services, 164

Prescribing, 66

Family Health Services, 90 Hosted Services, 90

140

released from a whole system approach to IJB cost reduction activity is not passed to the IJB, then there is a risk future budgets will not be balanced.

8.0 Next Steps and Further Information The newly approved Strategic Commissioning Plan 2019-2022 outlines the direction of travel for the next three years for the Partnership. The Plan gives a commitment to 13 Strategic Priorities and 44 Commissioning Intentions. These are supported by 33 ‘Directions’ issued by the IJB to the Council and the NHS Board as part of implementing the Commissioning Intentions. Further information on this plan can be found ADD LINK TO SCP 2019-2022.

Should you wish further information on the plan please contact Euan Duguid.

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142 Agenda Item

8 Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 25 June 2019 Report by: Director, Health and Social Care

Subject: Investing to Modernise South Lanarkshire Council Care Facilities - Progress Update

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  provide an update regarding the progress made with the implementation of the Investing to Modernise South Lanarkshire Care Facilities programme

2. Recommendation(s) 2.1. The Integration Joint Board is asked to note the following recommendation(s):- [recs] (1) that the content and next steps outlined in Sections 6 and 8 of the report be noted; (2) that it be noted that Flush Park, Lanark has been identified as the preferred site, subject to suitability, for the replacement of McClymont House; and (3) that the seven spokes for the Clydesdale model referred to in Section 5.7 be noted. ] 3. Background 3.1. The recently approved Strategic Commissioning Plan (SCP) 2019-22, sets out a commitment to support more people to remain at home and in their community. A number of commissioning intentions were outlined within the Plan to support this ambition, one of which was reducing the overall reliance on residential and inpatient forms of care.

3.2. Within the Plan, a specific commissioning intention was agreed to implement the new care facilities model to provide people with more choice and options to be maintained at home and in the community. The Integration Joint Board (IJB) consequently issued an associated ‘Direction’ to both South Lanarkshire Council (SLC) and NHS Lanarkshire (NHSL) to reduce reliance on nursing and residential care through the development of proposals to remodel a proportion of residential care beds to focus on transitional support and the ‘home for life’ principle.

3.3. Previous reports to the Council’s Social Work Resources Committee (June and November 2018 respectively), provided updates on progress with the implementation of this ‘Direction’ through the agreed ‘Investing to Modernise’ programme for SLC’s residential care home estate.

143

3.4. Previous reports, noted that £18million capital funding had been identified to re- provide alternative facilities as part of managing new and changing demands on existing services.

3.5. For the Hamilton locality, a new care facility will be built in Blantyre. The future model of care delivered from the new establishment will focus on a range of alternative supports, including transitional/intermediate care, access to technology enabled housing and be a community facing facility. Residential care within Hamilton locality will continue to be delivered at Dewar House.

3.6. In terms of Clydesdale, it was noted that the delivery model would be developed to recognise the specific needs of this locality. The focus would consider the current infrastructure of McClymont House and the need to replace it in order to continue to meet regulatory requirements. There were also opportunities to consider how this could link to a wider ‘Hub and Spoke’ model for the locality. A commitment was given to work up the detail of how this would look, particularly with regards to the location of a Hub and the nature of the Spokes.

3.7. Similarly, this approach has been adopted for the Larkhall/Stonehouse area, in that background work and analysis has been undertaken within the locality to ascertain which options will be the best fit in delivering a future Health and Social Care model.

3.8. This report will provide an update of progress for the Blantyre development and Clydesdale model, together with the next steps being considered.

4. Progress to date with the Blantyre Site 4.1. There are five areas to update as follows:

4.2. Progress with specification for new build and planning permission 4.2.1. The specification for the new care facility in Blantyre has been completed and the planning application was submitted on 29 May 2019, with an anticipated site start of October 2019 with an estimated 18 month build programme.

4.3. Future registration requirements with Care Inspectorate 4.3.1. There have been initial discussions with the Care Inspectorate regarding the registration requirements for the new facility. The philosophy and model which underpins this has been broadly welcomed by the Care Inspectorate, and therefore discussions which have taken place to date have been positive.

4.4. De-commissioning of Kirkton House and McWhirters House 4.4.1. The process of de-commissioning for both Kirkton House and McWhirters House is progressing as planned. However, since de-commissioning arrangements commenced, there has been significant movement in numbers due to a range of factors including:  a number of individuals have had their care and support needs re-assessed and identified as now requiring nursing care  a number have chosen to move to alternative SLC care homes  the continued reduction in referrals to these care homes due to increased levels of support to continue to meet people’s care and support needs in their own homes  cessation of long term care admissions, knowing the long term future of the homes in question

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4.5. The net result of the foregoing is that 21 residents who were in either Kirkton or McWhirters have been successfully supported to transition to another local authority care home in South Lanarkshire. All changes to existing care plans and any associated movement of service users have been undertaken in a person centred and sensitive way and this is reflected in the comments and feedback from residents and their families.

4.6. Communication Strategy 4.6.1. A detailed Communication Strategy has been developed with support from the Communications Team of SLC. The Plan includes communications to care home residents, their families, local Elected Members, care home staff and the wider workforce. Importantly, this will also include engagement with the local community and local media. A variety of mediums will be utilised to communicate key messages with a ‘calendar’ of consultation and engagement beginning with the Community Council, local parish church and members of the public. Whilst some of this has already been partially implemented, it is planned that remaining actions and intentions are taken forward in line with appropriate timescales.

4.7. Workforce planning, engagement and training 4.7.1. In terms of workforce planning and development, it is recognised that the skills mix and workforce profile to resource and manage the new facility will be different to existing job profiles. Consequently, a number of job profiles have been drafted which reflect the skills and staffing model required for the new facilities. The proposed new posts are currently undergoing a job evaluation process. In addition, a supervisory structure, sample rotas outlining shift plans and capacity required, a training plan and start and finish times have been developed. Both the job profiles, rotas and training plan have already been shared with Trade Union colleagues, care home staff, Personnel Services and managers.

5. Progress with Clydesdale Model 5.1. The Council’s Social Work Resources Committee at its meeting on 8 May 2019 approved the re-provisioning of McClymont House, Lanark to be replaced by a new care hub on the preferred site of Flush Park. Significant background work and analysis has been undertaken within the Clydesdale locality to ascertain which options will be the best fit in delivering a future Health and Social Care model for Clydesdale.

5.2. Whilst this work encapsulates the Plan to re-provision McClymont House with a modern and fit for purpose establishment, this work reached significantly beyond this to consider how Health and Social Care Services can be further integrated, recognising the unique challenges of a large rural area.

5.3. This piece of work has been led by the Clydesdale Options Planning Group (COPG), comprising of wide representation. The following elements have been considered:  views of residents, their relatives and care staff from McClymont (meeting held 10 January 2019)  the public views from recent consultation activity, for example the SCP consultation, Elected Member sessions and dialogue with the community regarding the future use of Lockhart Hospital  the changing demands and needs of the Clydesdale population  the assets already in existence and how these can be better utilised  a preferred site for the location of a new care facility

145  how the capital plan funding to re-provision McClymont can be best used to enhance and future proof a model of Health and Social Care which best supports the people of Clydesdale

5.4. From a public viewpoint, and also consistent with the views heard in the creation of the SCP, the need to have significant flexibility and choice in service provision has been an underlying theme. A further key commissioning theme is early intervention and prevention, self-care and self-management and supporting people to remain at home, where possible.

5.5. The feedback from carers during the consultation and engagement process was clear and consistent that support for those with caring responsibilities, recognising the value of their contribution and involving them from the outset both in designing local care provision and in planning individual care packages should be a priority. Offering personalised support both for carers and those they support enables them to further participate in family and community life.

5.6. Whilst Clydesdale has challenges arising from its rurality, it also has many valuable assets. These include a very strong community spirit, a diverse Third Sector and committed staff. It hosts quality physical assets which offers great potential to further enhance what already exists. A mapping of area assets re-affirmed this to the COPG.

5.7. In recognition of the geography of the Clydesdale locality, a ‘Hub and Spoke’ approach has been identified as the preferred model of service delivery. This combines access to a relatively central provision in Lanark, aligned with a more local service in a number of ‘townships’.

5.7.1. The ‘Hub and Spoke’ model will comprise of the following:  a new care facility to be based in Lanark, which will become the Clydesdale Health and Social Care Hub and provide support across the full geographical area of Clydesdale in relation to residential care, transitional care and respite provision; intensive rehabilitation and re-ablement support, telecare and telehealth expertise, multi – purpose accommodation, a Third Sector Hub/interface in Clydesdale and a community facing space  the seven Spokes will be Lanark, Carluke, Forth, Carnwath/Carstairs, Biggar, Douglas and Lesmahagow/Kirkmuirhill and will build upon existing assets within these communities. Where more specialist support is required, these Spokes will draw on the Hub and other area wide services such as Community Hospitals to meet the person’s needs. However, the philosophy of the Spokes will be to provide support as much as possible close to the person’s home  access to local facilities recognising the challenges and limitations that people living in rural areas face in accessing transport and local services

5.8. In consultation with all those listed at 5.3, including Elected Members, Lanark was evaluated as being the preferred choice of location for a new Care Facility. This was due to it being the most accessible town in Clydesdale with associated transport links. The COPG undertook work to identify suitable sites for the new care facility. A total of 10 sites were identified, seven in the town of Lanark and a further three outwith as potential backup.

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5.9. The COPG visited all seven sites in the Lanark area to visualise, understand and assess the geography/topography of the site. Following this, the group undertook an options appraisal which considered the suitability of each site and scoring them in relation to the following criteria:  location – proximity to the centre of Lanark  suitability and flexibility – considered the footprint of the site and if it offered the necessary flexibility to have more than just the Hub on the site  transport – how well linked the site would be to public transport, walking or coming by car  community links – proximity to other potential services such as Third Sector, sheltered housing or indeed other facilities which would have footfall from the wider community  geography – the layout of the site, including visual appearance and whether or not it was flat, sloped or uneven  costs – including requirement to purchase and demolition of existing buildings and if for example, the site would require significant work to make it accessible

5.10. On completion of this work, the top two sites which were closest fit to the criteria were:  preferred site – Flush Park, Lanark (Site adjacent to Lanark Lifestyles)  backup/second choice – existing McClymont site, although it is recognised that this would come with other considerations such as decanting to another site, to allow a new facility to be built

5.11. The preferred site has been initially surveyed and whilst there are a number of challenges to be addressed, this could be an appropriate site for development. This site is currently designated as a football playing field and priority greenspace therefore detailed discussions with planning and Sports Scotland as well as ground condition tests will be required to confirm the feasibility of this location.

5.12. The COPG will continue to work on the finer details of the relationship and functioning of the Hub with the Spokes.

6. Larkhall and Stonehouse Modelling 6.1. The commitment to develop services in the Larkhall/Stonehouse area was approved by the Council’s Social Work Resources Committee at its meeting on 28 November 2018 and reaffirmed at its meeting on 8 May 2019 when once again approval was given to develop options for the Larkhall/Stonehouse corridor. This work is at an early stage but there are some distinct proposals:  there will be a new build included in the overall re-provisioning programme that will serve the Larkhall/Stonehouse area and wider area as appropriate/needed  the new build will be in/close to Larkhall due to the demographic details and needs analysis  the new build will likely be a combination of short and long term residential placements (i.e. residential care, respite care, intermediate/reablement)  the new build will be in keeping with the overall principles of the Care Facilities vision, will encompass a community facing element and by its nature will require to be flexible in usage to meet and adapt to the future needs of the community

6.2. A comprehensive needs analysis has been completed. Currently, the focus of activity has been on updating the needs analysis and asset mapping for this area, whilst undertaking further stakeholder engagement, for example with Elected Members.

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6.3. Given that the process to develop the options for Clydesdale (outlined above) has worked well, a similar options group has been setup for the Hamilton locality to look specifically at the needs and option for the Larkhall/Stonehouse area.

6.4. On completion of this work, proposals will be brought back for consideration and discussion at a future meeting of the Council’s Social Work Resources Committee. Ongoing discussion and communication with Elected Members will be a key part of finalising this.

6.5. In reflecting the current age and stage of Canderavon House, the future delivery model within this facility will focus on intermediate care. There will be a transitional phase which will ensure that people will continue to be provided with more choice and options to be maintained at home and in the community.

7. East Kilbride and Rutherglen Cambuslang 7.1. At a future stage, similar locality modelling (as outlined above) will be undertaken for both East Kilbride and Rutherglen/Cambuslang areas. This will ensure resources in these communities continue to respond positively to local needs in keeping with the overarching principles of the care facilities programme.

7.2. However, it is recognised that existing residential care facilities within both localities are modern, fit for purpose and have greater flexibility to adapt. At this stage, there are no plans to reconfigure these care homes.

8. Next Steps 8.1. In summary, there are a number of next steps with the development and implementation of the Investing to Modernise Programme as outlined below:  conclude planning consent for the new build care facility in Blantyre. Subject to approval, commence the build programme  complete the de-commissioning activity associated with Kirkton House and McWhirters House to allow full transition to the Blantyre site  it has been agreed that an options paper be prepared for consideration by the Executive Care Facilities Steering Group by 20 June 2019 to enable a considered approach regarding the future of these care homes  finalise workforce planning activity with regards to role profiles, skill mix and training for existing staff to allow smooth transition to Blantyre  ensure continuous and regular communication with key stakeholders regarding progress with Blantyre and the wider Investing to Modernise programme  finalise outstanding work on the Clydesdale model with a view to presenting this to a future meeting of the Council’s Social Work Resources Committee for approval  develop options for the Larkhall/Stonehouse corridor of the Hamilton/Blantyre locality which take forward the proposals outlined in Section 6 of this report

9. Employee Implications 9.1. There are no employee implications associated with this report.

10. Financial Implications 10.1. Financial implications associated with this report will brought back to the SWC and IJB for consideration as the options are more fully developed.

148

11. Other Implications 11.1. There are no other risk implications associated with this report.

11.2. There are no sustainable development issues associated with this report.

11.3. There are no other issues associated with this report.

12. Equality Impact Assessment and Consultation Arrangements 12.1. There is no requirement to carry out an impact assessment in terms of the proposals contained within this report.

12.2. There has been significant consultation and engagement with stakeholders throughout the development of this programme. This will continue to be intrinsic to the development of the Blantyre site and also in relation to the options for the Clydesdale locality and Larkhall/Stonehouse area of the Hamilton locality.

13. Directions 13.1. The extent to which the existing directions to each partner require to be varied is detailed in the table below:

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 20 May 2019

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

149 People who use Health and Social Care Services are safe from harm People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Resources are used effectively and efficiently in the provision of Health and Social Care Services

Previous References  Integration Joint Board Report 11 September 2018 (Paragraph 10)

List of Background Papers  The Strategic Commissioning Plan 2019-2022  Social Work Committee Report 20 June 2018 – Investing to Modernise South Lanarkshire Council Care Facilities  Social Work Committee Report 28 November 2018 - Investing to Modernise – Phase 2, Clydesdale  Social Work Committee Report 8 May 2019 - Investing to Modernise South Lanarkshire Council Care Facilities - Progress Update

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Evelyn Devlin, Service Manager, Transitions Ext: 3938 (Phone: 01698 453938) Email: [email protected]

150 Agenda Item

9 Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 25 June 2019 Report by: Director, Health and Social Care

Subject: Urgent Care Out of Hours Service

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  provide an update on the current staffing challenges within the Urgent Care Out of Hours Service [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):-

(1) that the current workforce challenges within the Urgent Care Out of Hours Service and the mitigating actions to address be noted. [1recs] 3. Background 3.1. There was a national independent review of Urgent Care Out of Hours (OOH) commissioned by the Scottish Government in 2015. This was due to the challenges emerging nationally in the ability to deliver services out of hours, primarily through a reduction in the number of GPs prepared to work in the OOH period. This review was led by Sir Lewis Ritchie.

3.2. The review resulted in a new model of delivery for Lanarkshire which was an Urgent Care Resource Hub in Hamilton supported by an Urgent Care Centre in Airdrie Health Centre, Airdrie.

3.3. The OOH Service is a hosted service, managed by South Lanarkshire Health and Social Care Partnership.

3.4. The Urgent Care Resource Hub in Hamilton hosts a range of clinical staff, and is the base for call handlers, cars and drivers. The health care staff include GPs, Nurse Practitioners, Mental Health Nurses, Paediatric Nurses, Advanced Nurse Practitioners (ANPs) and Pharmacists. The Urgent Care Centre in Airdrie is staffed by GPs, nursing staff and is supported by reception staff.

3.5. In recent years, the Service has been successful in recruiting nursing staff to take on additional roles. This is largely in relation to ANPs who can now see many of the patients previously seen by GPs. However, there are also additional mental health and paediatric nursing staff who provide an important augmentative service.

151 3.6. This report is to highlight the challenges being encountered in maintaining this Service in the background of GP and recruitment issues in relation to both the GP and nursing workforce.

4. Workforce Challenges 4.1. GP Sustainability 4.1.1. Within the OOH Service there are salaried and sessional GPs who work directly or through an agency. Having GP cover across the two sites is important in terms of business continuity. Due to lack of GP cover, the Service has had to consolidate on one site (Hamilton site) 12 times last year and four times so far this year.

4.1.2. The GP sustainability issues for the OOH Service are mirrored in the In Hours Service with a number of GP practices experiencing challenges in terms of sustainability. In addition to this, OOH Service challenges are also attributed to a range of other issues for example, changes in pension arrangements, fewer doctors prepared to work unsocial hours and fatigued from working daytime hours.

4.2. Nursing Sustainability 4.2.1. Within the OOH Service, there has been a commitment to expand the nursing service in order to support GP sustainability problems. There have been a number of initiatives involving different roles and responsibilities, including introduction of Mental Health Nurses, Paediatric Nurses and last year ANPs. The growth of ANPs has been challenging due to the attrition to GP Practices and other roles in the NHS. However, the Service is continuing to recruit and is reviewing the model to look at improving retention. This is also the case for Nurse Practitioners.

4.2.2. With the increased attrition and vacancy factor (70%), the Service is continuing to review the skill mix and consider how we support ANPs and Nurse Practitioners in the future. This includes the opening of a nurse bank for these groups of staff for the first time.

5. Mitigating Actions 5.1. A support group has been formed to ensure staff and clinical governance is maintained while there are workforce challenges within the Service.

5.2. The Service has put a significant number of mitigating actions in place to address the workforce issues in an ever changing and challenging environment. Patient and staff safety is the overarching priority. Whilst ensuring every effort is made to maintain a service on both sites.

5.3. Mitigating Actions  support group established to introduce, maintain and monitor actions to improve sustainability  GP pay rates reviewed to ensure Lanarkshire consistent with the rest of the West of Scotland  work with professional leads to support the growth of an alternative workforce, for example mental health, paediatrics nursing and pharmacy  NHS Lanarkshire bank employing NPs and ANPs, with professional governance arrangements in place  recruit to ANPs specifically for OOH  agreement with NHS 24 to rotate sessions for NHS 24 ANPs to have face to face patient contact with professional governance arrangements in place  pursue opportunities to offer slots to Nurse Practitioners within acute to develop competencies to work within OOH

152  have a rolling recruitment and accompanying training for new Nurse Practitioners  a pilot with an Emergency Department Consultant used to re triage NHS 24 calls and redirect to reduce demand  use of technology to support virtual consultations using ‘Attend Anywhere’

6. Employee Implications 6.1. There are no employee implications associated with this report.

7. Financial Implications 7.1. There are no financial implications associated with this report.

8. Other Implications 8.1. The OOH workforce problems have been identified as high risk on the NHS Lanarkshire Risk Register.

8.2. There are no sustainable development issues associated with this report.

8.3. There are no other issues associated with this report.

9. Equality Impact Assessment and Consultation Arrangements 9.1. This report does not introduce a new policy, function or strategy, or recommend a change to an existing policy, function or strategy and therefore no impact assessment is required.

9.2. There is also no requirement to undertake any consultation in terms of the information contained in this report.

10. Directions 10.1.

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 24 May 2019

153 People who use Health and Social Care Services have positive experiences of those services, and have their dignity respected Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services Health and Social Care Services contribute to reducing health inequalities

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

Previous References  none

List of Background Papers  none

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Marianne Hayward, Head of Health and Social Care Ext: 3704 (Phone: 01698 453704) Email: [email protected]

154 Agenda Item

10 Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 25 June 2019 Report by: Director, Health and Social Care

Subject: Health and Social Care Integration - Ministerial Strategic Group Report Update

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  present the Board with an update on the Ministerial Steering Group Report with regards to Health and Social Care Integration [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):- [recs] (1) that the content of the report be noted. [1recs] 3. Background 3.1. A report was presented to the Performance and Audit Sub-Committee (PASC) in February 2019 informing the Committee of a number of recent national reports directly impacting on Health and Social Care Services. In re-capping these reports were:  NHS in Scotland 2018 – Audit Scotland  Health and Social Care Integration – Update on Progress November 2018 – Audit Scotland Report  Social Work in Scotland – Impact Report – December 2018 – Audit Scotland  Health and Social Care Integration Progress Review – Ministerial Strategic Group (MSG), February, 2019

3.2. It is the MSG report which forms the basis of this short update to Committee, given that there were a number of actions emanating from this around the six identified themes of:  collaborative leadership  integrated finances and financial planning  effective strategic planning and improvement  collective understanding of governance and accountability  information sharing in relation to frameworks and good practice  meaningful engagement of communities, supported people and carers

3.3. Whilst the report detailed 25 improvement actions against the six themes with defined timescales and assigned leads, a more immediate piece of work was requested by the MSG in relation to the completion of self-assessment of progress by all 31 Health and Social Care Partnership areas across Scotland.

155

3.4. A national template was issued to support consistency in evaluation and sent to all councils, health boards and Integration Joint Boards (IJBs) to collectively consider how much progress they are making against the findings contained within the MSG report.

3.5. The completed template was required to be returned to the MSG by 15 May 2019.

4. Progress to Date in South Lanarkshire 4.1. As part of achieving a wide and representative view of progress in South Lanarkshire, the Chief Officer has worked with colleagues in the Council, NHS Board, IJB members and members of the Senior Management Team to capture the collective views of the South Lanarkshire position.

4.2. Each of the organisations and groups noted above completed separate templates and work was then undertaken by the Chief Officer and Head of Commissioning and Performance to assimilate these into a composite view of progress in a South Lanarkshire context.

4.3. A copy of the draft return is detailed in Appendix 1 for information and it is anticipated that there will be feedback either individually or across Scotland from MSG as part of the ongoing development of Health and Social Care Integration.

4.4. In addition to this, there will also be the expectation that this is part of ongoing improvement and that local partnerships will be required to evidence ongoing progress against the 25 MSG actions. Follow-up activity will be undertaken by Audit Scotland and MSG to this effect.

5. Employee Implications 5.1. There are no employee implications associated with this report.

6. Financial Implications 6.1. There are no financial implications associated with this report.

7. Other Implications 7.1. There are no additional risks associated with this report.

7.2. There are no sustainable development issues associated with this report.

7.3. There are no other implications at this stage.

8. Equality Impact Assessment and Consultation Arrangements 8.1. This report does not introduce a new policy, function or strategy or recommend a change to an existing policy, function or strategy, therefore, no impact assessment is required.

8.2. This proposal has been worked up in conjunction with all key stakeholders.

9. Directions 9.1.

Direction to: 1. No Direction required 2. South Lanarkshire Council

156 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 24 May 2019

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

Previous References  Report to Performance and Audit Sub-Committee, 26 February 2019

List of Background Papers  Health and Social Care Integration - Ministerial Strategic Group Report Update - Appendix 1

157

158 10

Ministerial Strategic Group for Health and Community Care

Integration Review Leadership Group

Self-evaluation For the Review of Progress with Integration of Health and Social Care

March 2019

159

MINISTERIAL STRATEGIC GROUP FOR HEALTH AND COMMUNITY CARE (MSG) REVIEW OF PROGRESS WITH INTEGRATION OF HEALTH AND SOCIAL CARE - SELF EVALUATION

There is an expectation that Health Boards, Local Authorities and Integration Joint Boards should take this important opportunity to collectively evaluate their current position in relation to the findings of the MSG review, which took full account of the Audit Scotland report on integration published in November 2018, and take action to make progress. This evaluation should involve partners in the third and independent sectors and others as appropriate to local circumstances. This template has been designed to assist with this self-evaluation.

To ensure compatibility with other self-evaluations that you may be undertaking such as the Public Services Improvement Framework (PSIF) or those underpinned by the European Foundation for Quality Management (EFQM), we have reviewed examples of local self-evaluation formats and national tools in the development of this template. The template is wholly focused on the 25 proposals made in the MSG report on progress with integration published on 4th February, although it is anticipated that evidence gathered and the self-evaluation itself may provide supporting material for other scrutiny or improvement self-evaluations you are, or will be, involved in.

Information from local self-evaluations can support useful discussions in local systems, sharing of good practice between local systems, and enable the Integration Leadership Group, chaired by the Scottish Government and COSLA, to gain an insight into progress locally.

In completing this template please identify your rating against each of the rating descriptors for each of the 25 proposals except where it is clearly marked that that local systems should not enter a rating. Reliable self-evaluation uses a range of evidence to support conclusions, therefore please also identify the evidence or information you have considered in reaching your rating. Finally, to assist with local improvement planning please identify proposed improvement actions in respect of each proposal in the box provided. Once complete, you may consider benchmarking with comparator local systems or by undertaking some form of peer review to confirm your findings.

We greatly appreciate your assistance in ensuring completion of this self-evaluation tool on a collective basis and would emphasise the importance of partnership and joint ownership of the actions taken at a local level. Please share your completed template with the Integration Review Leadership Group by 15th May 2019 – by sending to [email protected]

It is our intention to request that we repeat this process towards the end of the 12 month period set for delivery of the all of the proposals in order that we can collectively demonstrate progress across the country.

Thank you. Integration Review Leadership Group MARCH 2019

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Name of Partnership South Lanarkshire Health and Social Care Partnership Contact name and email Craig Cunningham, Head of Commissioning and Performance address Date of completion 30 April 2019

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Key Feature 1 Collaborative leadership and building relationships Proposal 1.1 All leadership development will be focused on shared and collaborative practice. Rating Not yet established Partly established Established Exemplary Descriptor Indicator Lack of clear Leadership is Leadership in place has Clear collaborative leadership is in place, leadership and developing to had the ability to drive supported by a range of services including HR, support for support integration. change with collaboration finance, legal advice, improvement and strategic integration. evident in a number of key commissioning. All opportunities for shared areas. Some shared learning across partners in and across local learning and collaborative systems are fully taken up resulting in a clear practice in place. culture of collaborative practice. Our Rating X

Evidence / The examples of successfully achieving partnership outcomes as a result of shared and collaborative practice include the Notes following: • An integrated locality senior management structure is in place. • Progress has been made across the MSG indicators associated with Delayed Discharge, Unscheduled Care Bed Days and the proportion of the last six months of life spent at home or in a community setting. • A ward in a community hospital was closed and the funding was reallocated across the whole system. • A community hospital was re-designated. • Palliative care services were reviewed. • Some integrated teams have been developed. • A prioritisation policy has been introduced. • The primary care implementation plan has been introduced. • The modernisation of care facilities is being progressed. • Leadership across locality planning groups is evolving and developing. • A dedicated resource to provide an appropriate environment for three people with very complex needs has been established. Page 3 of 37

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Proposed We are jointly committed to continuous improvement over the next twelve months and a comprehensive action plan will be improvement agreed by the end of July 2019. actions Two key priorities which will be included in the action plan to develop this proposal are as follows:

1. Shared leadership development opportunities will continue to be progressed across the South Lanarkshire IJB (IJB), NHS Lanarkshire (NHSL) and South Lanarkshire Council (SLC). It is intended that this will also blend with and further develop the operational delivery arrangements associated with the Health and Social Care Partnership (HSCP).

2. Opportunities to further strengthen the support arrangements across the key ‘enabling’ functions, including Human Resources, Information Management and Technology Services, Finance Services, Property Services and Legal Services, are being identified and will be implemented as appropriate following consultation with the partners.

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Proposal 1.2 Relationships and collaborative working between partners must improve Rating Not yet established Partly established Established Exemplary

Indicator Lack of trust and Statutory partners Statutory partners and other Partners have a clear understanding of each other's understanding of each are developing trust partners have a clear working practices and business pressures and can other's working and understanding of understanding of each identify and manage differences and tensions. practices and each other's working other's working practices Partners work collaboratively towards achieving business pressures practices and and business pressures – shared outcomes. There is a positive and trusting between partners. business pressures. and are working more relationship between statutory partners clearly collaboratively together. manifested in all that they do.

Our Rating X

Evidence / There is a clear understanding across the Partnership of the priorities. Joint problem solving is very good and reflects the Notes evolvement of a consistent approach. There is a commitment and willingness to work with others to address challenges and the understanding of different cultures, procedures and policies is developing.

There is a view that the voting members of the IJB understand that their role on the IJB is secondary to their role on the Council or NHS Board. Proposed Two key priorities which will be included in the action plan to develop this proposal are as follows: improvement actions 1. Assurance mapping will be jointly undertaken across the partnership to identify opportunities to reduce areas of duplicate reporting whilst still maintaining effective governance arrangements for both partners and the IJB.

2. The current programme of organisational development work will continue to be progressed across all levels of the partnership. This programme will also build on the planned outcome of the review of support arrangements across the key ‘enabling’ functions.

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Proposal 1.3 Relationships and partnership working with the third and independent sectors must improve Rating Not yet established Partly established Established Exemplary Indicator Lack of engagement Some engagement Third and independent Third and independent sectors fully involved as with third and with the third and sectors routinely engaged in partners in all strategic planning and commissioning independent sectors. independent sectors. a range of activity and activity focused on achieving best outcomes for recognised as key partners. people. Their contribution is actively sought and is highly valued by the IJB. They are well represented on a range of groups and involved in all activities of the IJB.

Our Rating X

Evidence / The examples of effective partnership working with the third and independent sectors include the following: Notes • There is a strong commitment to developing the third and independent sector and this is recognised by the IJB and both partners. • The Third Sector Interface is represented on the IJB, the Strategic Commissioning Group and the Locality Planning Groups. • Third Sector representatives are actively involved in a wide range of HSCP engagement activities and have been crucial in working with communities to support and realise change. • There is an aspiration to embed the community capacity building programme and the assets based approach to the development of community services across the localities and this work is progressing. • The IJB has a good relationship with the independent sector providers who are represented on the IJB, the Strategic Commissioning Group and the Locality Planning Groups.

Proposed Three key priorities which will be included in the action plan to develop this proposal are as follows: improvement actions 1. The opportunity to further develop an early intervention and prevention strategy through the commissioning of the third and independent sector will be further assessed as part of the medium to long term financial strategy. This will be influenced by the financial landscape and the availability of funding to support this ambition.

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2. Further opportunities to increase the involvement of the Third Sector in operational activity will be explored and included in performance data around HSCP delivery.

3. The contribution of both the Third and Independent Sector partners to the achievement of the health and well being outcomes will be maximised. Through consultation and agreement, barriers to achieving this will be identified and addressed.

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Key Feature 2 Integrated finances and financial planning Proposal 2.1 Health Boards, Local Authorities and IJBs should have a joint understanding of their respective financial positions as they relate to integration Rating Not yet established Partly Established Established Exemplary Indicator Lack of consolidated Working towards Consolidated advice on the Fully consolidated advice on the financial position advice on the financial providing financial position on shared on shared interests under integration is provided to position of statutory consolidated advice interests under integration is the NHS/LA Chief Executive and IJB Chief Officer partners’ shared on the financial provided to the NHS/LA from corresponding financial officers when interests under position of statutory Chief Executive and IJB considering the service impact of decisions. integration. partners’ shared Chief Officer from interests under corresponding financial Improved longer term financial planning on a whole integration. officers when considering system basis is in place. the service impact of decisions. Our Rating X

Evidence / Financial advice is available from both Partners to the Chief Officer and the IJB and takes account of the impact of strategic Notes decisions, albeit predominantly within respective budget areas.

Financial reporting arrangements to the senior management team and the IJB are in place and effective.

Proposed One key priority which will be included in the action plan to develop this proposal is as follows: improvement actions 1. The financial monitoring arrangements for the IJB will continue to be developed to support the implementation of the strategic commissioning plan and the directions. 2. Increase awareness of all IJB members - and wider elected members/senior officers – of overall financial issues pertinent to both partners. Page 8 of 37

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Proposal 2.2 Delegated budgets for IJBs must be agreed timeously Rating Not yet established Partly Established Established Exemplary Indicator Lack of clear financial Medium term Medium term financial and Medium to long term financial and scenario planning planning and ability to financial planning is scenario planning in place is fully in place and all delegated budgets are agree budgets by end in place and working and all delegated budgets agreed by the Health Board, Local Authority and IJB of March each year. towards delegated are agreed by the Health as part of aligned budget setting processes. budgets being Board, Local Authority and agreed by the Health IJB by end of March each Relevant information is shared across partners Board, Local year. throughout the year to inform key budget Authority and IJB by discussions and budget setting processes. There is end of March each transparency in budget setting and reporting across year. the IJB, Health Board and Local Authority.

Our Rating X Evidence / The budget for the IJB for the forthcoming year is agreed before 31 March. This has been achieved each year since 2016. Notes To date, it has not been possible to agree budgets earlier in the financial year or for a longer term period (i.e. more than one year). This current budget setting timeframe reflects the one year financial settlement from the Scottish Government and the uncertainty of funding beyond that. As a result, the status quo in respect of funding allocations tends to be maintained between the partners to maintain service continuity and stability. Both partners have complied with the Scottish Government requirement to pass on new funding and both partners have striven to maximise the funding allocations to the IJB and minimise the savings expected from the IJB. The identification of savings by each partner has predominantly been considered within the partner’s respective budget areas.

Medium to longer term financial planning arrangements are in place for each partner as appropriate. The IJB places reliance on these existing arrangements and the Chief Financial Officer is developing forecasts for consideration by the IJB in consultation with both partners.

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Proposed One key priority which will be included in the action plan to develop this proposal is as follows: improvement actions 1. Based on each partner’s assessment of their future financial landscapes as set out in their medium term financial plans, a consolidated medium to long term financial strategy is being developed for consideration by the IJB which will include scenario planning and inform the future budget setting process for the partners and the IJB. 2. Without 3 year financial planning which includes more specificity re year on year budgets, it will not be possible to do completely.

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Proposal 2.3 Delegated hospital budgets and set aside budget requirements must be fully implemented Rating Not yet established Partly Established Established Exemplary

Indicator Currently have no plan Working towards Set aside arrangements are Fully implemented and effective arrangements for to allow partners to developing plans to in place with all partners the delegated hospital budget and set aside budget fully implement the allow all partners to implementing the delegated requirements, in line with legislation and statutory delegated hospital fully implement the hospital budget and set guidance. budget and set aside delegated hospital aside budget requirements. budget requirements. budget and set aside The set aside budget is being fully taken into budget The six steps for account in whole system planning and best use of requirements, in line establishing hospital resources. with legislation and budgets, as set out in statutory guidance, statutory guidance, are fully to enable budget implemented. planning for 2019/20. Our Rating X Evidence / The set-aside concept is difficult. The ISD activity information is useful reference data, which informs the notional set-aside budget, Notes but as it is 18 months to 2 years out-of-date limited reliance can be placed on this for future service modelling. Notwithstanding this, a significant amount of work has been undertaken to identify and agree the notional set-aside budget and a transparent approach has been adopted to this.

There are examples of the transfer of resources from the set-aside budget e.g. the closure of a ward within a community hospital and the re-allocation of the funding across the whole system. The approach to adjusting budget followed the approach used in previous developments in community services, e.g. ‘Same as You’ funding. The funding was re-allocated following a review of the actual direct current costs recorded through the financial ledger and a forward looking financial assessment of the impact of the operational changes in service delivery. No reference was made to the notional set-aside budget as the ISD information was too far in arrears and it therefore lacks the transparency in its cost allocations that would be needed if it were to be linked back to releasable units of input. Page 11 of 37

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Significant progress has been made through the establishment of the pan-Lanarkshire strategic groups of the Unscheduled Care and Delayed Discharge Improvement Board and the Bed Modelling Steering Group. These groups provide evidence of collaborative planning in relation to both partnership and delegated hospital services and have coordinated a shift in the balance of care through off-site bed reductions and site closures.

While this presents a proven and effective format for collaborative working, further development is required to broaden the scope of this approach to cover all delegated hospital services.

Proposed Three key priorities which will be included in the action plan to develop this proposal are as follows: improvement actions 1. The transparent whole system approach adopted to service redesign across the partnership will continue to be adopted and refined. This will be led through the Unscheduled Care Board and other joint working arrangements.

2. In consultation with ISD, NHS Lanarkshire will progress the pilot work at a local level which will help to develop the understanding at both a local and national level of the set-aside concept including the practical challenges and the competing funding priorities.

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Proposal 2.4 Each IJB must develop a transparent and prudent reserves policy Rating Not yet established Partly Established Established Exemplary Indicator There is no reserves A reserves policy is A reserves policy is in place A clear reserves policy for the IJB is in place to policy in place for the under development to identify reserves and hold identify reserves and hold them against planned IJB and partners are to identify reserves them against planned spend and contingencies. Timescales for the use of unable to identify and hold them spend. Clear timescales for reserves are agreed. Reserves are not allowed to reserves easily. against planned the use of reserves are build up unnecessarily. Reserves are used Reserves are allowed spend. Timescales agreed, and adhered too. prudently and to best effect to support full to build up for the use of implementation the IJB’s strategic commissioning unnecessarily. reserves to be plan. agreed. Our Rating X

Evidence / A reserves policy is in place and the ring-fenced and ear-marked reserves are transparent. Notes The level of the contingent reserve balance is not sufficient. It will however be challenging to increase this within the current financial climate. A judgement call requires to be made between spending resources to meet demand today and investing resources as a contingency for tomorrow’s cost pressures.

Proposed One key priority which will be included in the action plan to develop this proposal is as follows: improvement actions 1. The scope to incorporate a realistic target to increase the IJB contingency reserve within the IJB Financial Plan will be assessed in consultation with each partner as part of the future budget setting process.

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Proposal 2.5 Statutory partners must ensure appropriate support is provided to IJB S95 Officers. Rating Not yet established Partly Established Established Exemplary

Indicator IJB S95 Officer Developments IJB S95 Officer provides IJB S95 Officer provides excellent advice to the IJB currently unable to underway to better high quality advice to the and Chief Officer. This is fully supported by staff and provide high quality enable IJB S95 IJB, fully supported by staff resources from the Health Board and Local advice to the IJB due Officer to provide and resources from the Authority who report directly to the IJB S95 Officer to a lack of support good quality advice Health Board and Local on financial matters. All strategic and operational from staff and to the IJB, with Authority and conflicts of finance functions are integrated under the IJB S95 resources from the support from staff interest are avoided. Officer. All conflicts of interest are avoided. Health Board and and resources from Strategic and operational Local Authority. the Health Board and finance functions are Local Authority undertaken by the IJB S95 ensuring conflicts of Officer. A regular year-in- interest are avoided. year reporting and forecasting process is in place. Our Rating X

Evidence / The IJB Chief Financial Officer is responsible for the strategic financial planning for two IJBs circa £1 billion. Notes The Health Board and Local Authority Directors of Finance are responsible for the operational finance functions within their respective partner organisations.

Regular monthly reports are provided and the format and content has been refined based on experience to date.

The interface between the strategic and operational finance functions requires to be further developed as the partnership matures. .

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Proposed One key priority which will be included in the action plan to develop this proposal is as follows: Improvement actions 1. The options to improve the interface between the strategic and operational finance functions in line with the MSG proposal are being explored. In consultation with both partners, this will include consideration of IJB CFO capacity and a review of roles and responsibilities across the finance functions to further develop the financial support arrangements for the Chief Officer and the senior management team across the partnership.

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Proposal 2.6 IJBs must be empowered to use the totality of resources at their disposal to better meet the needs of their local populations. Rating Not yet established Partly Established Established Exemplary Indicator Total delegated Total delegated Total delegated resources Total delegated resources are effectively deployed resources are not resources have been are effectively deployed as as a single budget and their use is reflected in defined for use by the brought together in a single budget and their directions from the IJB to the Health Board and IJB. Decisions about an aligned budget use is reflected in directions Local Authority. The IJB's strategic commissioning resources may be but are routinely from the IJB to the Health plan and directions reflect its commitment to taken elsewhere and treated and used as Board and Local Authority. ensuring that the original identity of funds loses its ratified by the IJB. separate health and identity to best meet the needs of its population. social care budgets. Whole system planning takes account of The totality of the opportunities to invest in sustainable community budget is not services. recognised nor effectively deployed. Our Rating X

Evidence / Budgets are agreed at the outset of the financial year and it is possible to plan for budgetary change as part of the plan for the Notes year.

The budgets are aligned but, for the most part, are treated as separate health and social care budgets as each partner requires to manage financial pressures as a result of operational demands within their respective area of the budget and in line with their financial and technical regulations. Notwithstanding this, there are examples of joint partnership working where opportunities emerge to deploy new funding across the whole system e.g. ICF monies as well as some specific examples of existing funding e.g. Udston,.

The governance arrangements across the three organisations require to be complied with. The development of service redesign proposals and the consultation arrangements can be complex and lengthy and may result in decisions which impact on IJB delegated services being ratified by the IJB at the end of the development stage. Page 16 of 37

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Proposed Two key priorities which will be included in the action plan to develop this proposal are as follows: improvement actions 1. The strategic commissioning intentions will be further developed to promote the involvement of the IJB and the partners at the appropriate stages of service development where maximum beneficial impact can be achieved.

2. In order to further improve the deployment of budgets in line with the MSG proposal, best practice examples in relation to the management of budgets by other partnerships will be identified and evaluated.

Key Feature 3 Effective strategic planning for improvement Proposal 3.1 Statutory partners must ensure that Chief Officers are effectively supported and empowered to act on behalf of the IJB. Rating Not yet established Partly Established Established Exemplary Indicator Lack of recognition of The Chief Officer is The Chief Officer is The Chief Officer is entirely empowered to act and and support for the not fully recognised recognised as pivotal in is recognised as pivotal in providing leadership at a Chief Officer's role in as pivotal in providing leadership and is senior level. The Chief Officer is a highly valued providing leadership. providing leadership. recruited, valued and leader and accorded due status by statutory accorded due status by partners, the IJB, and all other key partners. Health Board and statutory partners. Local Authority There is a clear and shared understanding of the partners could do Health Board and Local capacity and capability of the Chief Officer and their more to provide Authority partners provide senior team, which is well resourced and high necessary staff and necessary resources to functioning. resources to support support the Chief Officer Chief Officers and and their senior team fulfil their senior team. the range of responsibilities Our Rating X

Evidence / The CO is a key member of the CMT of both organisations and makes a vital contribution to partnership working. The Chief Officer Notes is well respected and has gained a reputation for achieving successful outcomes. She is pragmatic, committed to taking people with her on the journey and exercises sound professional judgement. The requirement to strengthen the support from the enablers across the partnership in delivering on the integration outcomes has been recognised.

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Proposed Two key priorities which will be included in the action plan to develop this proposal are as follows: improvement actions 1. Development sessions to promote the statutory role and strategic responsibilities of the Chief Officer and the IJB across the partners will continue to be undertaken. This will include consideration of responsibility for strategic decision-making.

2. The resources available to take forward the integration agenda will be reviewed and additional resources agreed with partners to progress transformational change as necessary.

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Proposal 3.2 Improved strategic inspection of health and social care is developed to better reflect integration. Rating Not yet established Partly Established Established Exemplary Indicator

Our Rating

Evidence / NOT FOR LOCAL COMPLETION - NATIONAL INSPECTORATE BODIES RESPONSIBLE Notes

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Proposal 3.3 National improvement bodies must work more collaboratively and deliver the improvement support partnerships require to make integration work. Rating Not yet established Partly Established Established Exemplary Indicator

Our Rating Evidence / NOT FOR LOCAL COMPLETION - NATIONAL BODIES RESPONSIBLE Notes

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Proposal 3.4 Improved strategic planning and commissioning arrangements must be put in place. Rating Not yet established Partly Established Established Exemplary Indicator Integration Authority Integration Authority Integration Authority has Integration Authority regularly critically analyses and does not analyse and developing plans to undertaken an analysis and evaluates the effectiveness of strategic planning evaluate the analyse and evaluate evaluated the effectiveness and commissioning arrangements. There are high effectiveness of the effectiveness of of strategic planning and quality, fully costed strategic plans in place for the strategic planning and strategic planning commissioning full range of delegated services, which are being commissioning and commissioning arrangements. implemented. As a consequence, sustainable and arrangements. There arrangements. high quality services and supports are in place that is a lack of support The Local Authority and better meet local needs. from statutory The Local Authority Health Board provide good partners. and Health Board support for strategic The Local Authority and Health Board provide full provide some planning and support for strategic planning and commissioning, support for strategic commissioning, including including staffing and resources for the partnership, planning and staffing and resources and recognise this as a key responsibility of the IJB. commissioning. which are managed by the Chief Officer. Our Rating X

Evidence / There is strong evidence of effective strategic planning, grounded in public, service user and staff consultation and engagement. Notes The Strategic Commissioning Plan for 2019/2022 takes account of a robust needs assessment which links to locality planning and future directions.

There is scope for greater detail in the commissioning directions issued to the partners such that greater operational oversight can be undertaken by the IJB.

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Proposed Three key priorities which will be included in the action plan to develop this proposal are as follows: improvement actions 1. The capacity of the HSCP Planning, Performance and Strategy Team will be increased to ensure the significant transformational change programme is successfully implemented. This will include consideration of administration support and system development.

2. The medium to long term financial strategy will be developed in line with the SCP for 2019/2022 and the financial envelope for the respective directions will be confirmed.

3. Greater detail will be provided in future strategic directions to the partners

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Proposal 3.5 Improved capacity for strategic commissioning of delegated hospital services must be in place. Rating Not yet established Partly Established Established Exemplary

Indicator No plans are in place Work is on-going to Delegated hospital budget Delegated hospital budget and set aside or practical action ensure delegated and set aside arrangements arrangements are fully integrated into routine taken to ensure hospital budgets and are fully in place and form strategic commissioning and financial planning delegated hospital set aside part of routine strategic arrangements. There is full alignment of budgets. budget and set aside arrangements are in commissioning and financial arrangements form place according to planning arrangements. There is effective whole system planning in place part of strategic the requirements of with a high awareness across of pressure, commissioning. the statutory Plans are developed from challenges and opportunities. guidance. existing capacity and service plans, with a focus on planning delegated hospital capacity requirements with close working with acute sector and other partnership areas using the same hospitals. Our Rating X

Evidence / There is transparency over the notional set-aside budget allocations which is directly attributable to the approach and commitment Notes of the Director of Finance of NHSL. Following consultation with the NHSL Director of Acute Services, there are examples of transferring resources from hospitals to community services. It is however difficult to continue to make the set-aside concept “real” and implement the further transfer of resources in the face of ongoing financial pressures which require to be managed.

The line management of the set-aside still remains with Acute Services who take responsibility for the management of cost pressures. Further work is required to fully understand how the delegated hospital budgets are used and, importantly, agreeing

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opportunities to influence change in relation to same.

Proposed One key priority which will be included in the action plan to develop this proposal is as follows: improvement actions 1. A whole system approach to service redesign and the utilisation of the notional set-aside budgets will be further developed. This will take into consideration emerging thinking on the implementation of the set-aside concept across partnerships. This approach will also build on greater visibility of, and involvement in, the planning proposals associated with all unscheduled care, including end to end clinical pathways and the utilisation of resources to support the patient journey.

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Key Feature 4 Governance and accountability arrangements Proposal 4.1 The understanding of accountabilities and responsibilities between statutory partners must improve. Rating Not yet established Partly Established Established Exemplary Indicator No clear governance Partners are working Clear understanding of Clear understanding of accountability and structure in place, lack together to better accountability and responsibility arrangements and arrangements are of clarity around who understand the responsibility arrangements in place to ensure these are reflected in local is responsible for governance across statutory partners. structures. Decisions about the planning and service performance, arrangements under Decisions about the strategic commissioning of delegated functions sit and quality of care. integration to better planning and strategic wholly with the IJB and it is making positive and understand the commissioning of delegated sustainable decisions about changing the shape of accountability and health and social care care in its localities. responsibilities of all functions sit with the IJB. partners. The IJB takes full responsibility for all delegated functions and statutory partners are clear about their own accountabilities. Our Rating X

Evidence / Whilst there is some duplication across committees of the IJB and those of the 2 partners, there is understanding of where the Notes ultimate decision making lies in relation to the respective service areas. The challenge in this area lies in the understanding of strategic and/or operational responsibilities which may on occasion be integral to the service area being considered.

There is a clear recognition of the accountabilities and importance of clinical support and care governance. This is developing effectively across the partnership.

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Proposed As highlighted in respect of the MSG proposal 1.2, the following key priority will also contribute to the development of this proposal: improvement actions 1. Assurance mapping will be jointly undertaken across the partnership to identify opportunities to reduce areas of duplicate reporting whilst still maintaining effective governance arrangements for both partners and the IJB.

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Indicator 4.2 Accountability processes across statutory partners will be streamlined. Rating Not yet established Partly Established Established Exemplary Indicator Accountability processes Accountability Accountability processes are Fully transparent and aligned public reporting is in place unclear, with different processes being scoped for better alignment, across the IJB, Health Board and Local Authority. rules being applied scoped and with a focus on fully supporting across the system. opportunities identified integration and transparent for better alignment. public reporting. Our Rating X

Evidence / Each partner has maintained their existing governance and accountability responsibilities in order to continue to comply with their own statutory Notes responsibilities and regulations.

Some progress has been made in a few service areas to streamline accountability processes e.g. the integrated substance misuse team.

This action will be extended to assess the benefit of reporting social work activity information to the South Lanarkshire IJB (Performance and Audit) Sub Committee.

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Proposal 4.3 IJB chairs must be better supported to facilitate well run Boards capable of making effective decisions on a collective basis. Rating Not yet established Partly Established Established Exemplary

Indicator IJB lacks support and IJB is supported to The IJB Chair is well The IJB Chair and all members are fully supported in their unable to make effective make effective supported, and has an open roles, and have an open and inclusive approach to decisions. decisions but more and inclusive approach to decision making, going beyond statutory requirements. support is needed for decision making, in line with There are regular development sessions for the IJB on the Chair. statutory requirements and is variety of topics and a good quality induction programme seeking to maximise input of is in place for new members. The IJB has a clear key partners. understanding of its authority, decision making powers and responsibilities. Our Rating X

Evidence / The Chair is provided with full support to undertake the role and has access to information and support from the officers of the HSCP. Notes There are a range of competing demands which the Chair, Vice Chair and Voting Members require to manage. In particular, it has been challenging to commit to IJB development sessions in addition to core responsibilities for the IJB and the partner bodies.

Proposed One key priority which will be included in the action plan to develop this proposal is as follows: improvement actions 1. Further support and development opportunities will be explored to ensure the Chair, Vice Chair and Voting Members are equipped to fulfil their responsibilities. It is anticipated the involvement of the Chair and Vice Chair on the national group will support achievement of this MSG proposal.

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Proposal 4.4 Clear directions must be provided by IJB to Health Boards and Local Authorities. Rating Not yet established Partly Established Established Exemplary Indicator No directions have been Work is ongoing to Directions are issued at the Directions are issued regularly and at the end of a issued by the IJB. improve the direction end of a decision making decision making process, involving all partners. There is issuing process and process involving statutory clarity about what is expected from Health Boards and some are issued at the partners. Clear directions are Local Authorities in their delivery capacity, and they time of budget making issued for all decisions made provide information to the IJB on performance, including but these are high by the IJB, are focused on any issues. Accountability and responsibilities are fully level, do not direct change, and take full account transparent and respected. Directions made to the Health change and lack detail. of financial implications. Board in a multi-partnership area are planned on an integrated basis to ensure coherence and take account of the whole system. Our Rating X

Evidence / Directions are issued at the start of every financial year to reflect the key strategic priorities of the IJB. These have expanded over the lifetime of Notes the IJB and there are now 33 directions. In addition, a process exists to ensure directions are issued to implement strategic policy developments emerging in-year. The financial envelop to support the implementation of each direction requires to be further detailed.

Proposed There are a range of actions set out in respect of the MSG proposals at section 2 which will also contribute to the development of this proposal. improvement A further key priority which will be included in the action plan is as follows: actions 1. Work will be undertaken over the next 12 months to align the performance and financial monitoring reports with each of the directions to provide the IJB with oversight of the implementation of the Strategic Commissioning Plan 2019/2022 by each partner.

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Proposal 4.5 Effective, coherent and joined up clinical and care governance arrangements must be in place. Rating Not yet established Partly Established Established Exemplary Indicator There is a lack of There is partial The key role clinical and The key role clinical and professional leadership plays in understanding of the key understanding of the professional leadership plays supporting safe and appropriate decision making is fully role clinical and key role clinical and in supporting safe and understood. Arrangements for clinical and care professional leadership professional leadership appropriate decision making is governance are well established and providing excellent plays in supporting safe plays in supporting fully understood. There are support to the IJB. and appropriate decision safe and appropriate fully integrated arrangements making is not well decision making. in place for clinical and care Strategic commissioning is well connected to clinical and understood. Necessary governance. care governance and there is a robust process for sharing clinical and care Arrangements for information about, for example, inspection reports governance clinical and care findings and adverse events information, and continuous arrangements are not governance are not learning is built into the system. well established. clear Our Rating X

Evidence / Clinical and care governance arrangements are in place. Our Notes Reporting across all public protection arrangements is in place.

Further work is planned to embed the clinical and care governance framework throughout localities as integrated teams continue to develop.

Proposed Two key priorities which will be included in the action plan to develop this proposal are as follows: improvement actions 1. The clinical and care governance arrangements will be further embedded across the localities to strengthen integrated partnership working.

2. The clinical and care governance reporting arrangements to the South Lanarkshire IJB (Performance and Audit) Sub-committee will considered as part of the planned assurance mapping exercise.

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Key Feature 5 Ability and willingness to share information

Proposal 5.1 IJB annual performance reports will be benchmarked by Chief Officers to allow them to better understand their local performance data. Rating Not yet established Partly Established Established Exemplary Indicator Work is required to Work is ongoing to Integration Authority annual Integration Authority annual reports are well developed to further develop further develop reports are well developed to reflect progress and challenges in local systems, to Integration Authority Integration Authority reflect progress and ensure public accessibility, and to support public annual reports to annual reports to challenges in local systems, understanding of integration and demonstrate its impact. improve consistency in improve consistency in and ensure all statutory The annual report well exceeds statutory required reporting, better reflect reporting, better reflect required information is information is reported on. Reports are consistently well progress and challenges progress and reported on, by July 2019. presented and provide information in an informative, in local systems, and challenges in local Some benchmarking is accessible and readable format for the public. ensure all statutory systems, and ensure underway and assisting required information is all statutory required consistency and presentation reported on by July information is reported of annual reports. 2019. on, by July 2019. Our Rating X

Evidence / The Annual Performance Reports are produced timeously with the statutory information embedded therein. The Annual Performance Report is Notes also shared with other partnerships. Benchmarking exercises are undertaken across all key performance areas. The outcome of the MSG indicators and the health and well being indicators are routinely reported to IJB. The Chief Social Work Officer report is also produced annually and presented to the IJB.

Proposed One key priority which will be included in the action plan to develop this proposal is as follows: improvement actions 1. A review with comparable partnerships will be undertaken to share learning opportunities.

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Proposal 5.2 Identifying and implementing good practice will be systematically undertaken by all partnerships. Rating Not yet established Partly Established Established Exemplary

Indicator Work is required to Work is about to The Integration Authority Annual reports are used by the Integration Authority to improve the Integration commence on annual report is presented in a identify and implement good practice and lessons are Authority annual report development of the way that readily enables other learned from things that have not worked. The IJB’s to identify, share and annual report to enable partnerships to identify, share annual report is well developed to ensure other use examples of good other partnerships to and use examples of good partnerships can easily identify and good practice. practice and lessons identify and use practice and lessons learned learned from things that examples of good from things that have not Inspection findings and reports from strategic inspections have not worked. practice. worked. and service inspections are always used to identify and share good practice. Better use could be Inspection findings are made of inspection routinely used to identify and All opportunities are taken to collaborate and learn from findings to identify and share good practice. others on a systematic basis and good practice is share good practice. routinely adapted and implemented.

Our Rating X

Evidence / The HSCP has shared various examples of good practice at national events and information sharing sessions with COs including a Notes presentation to the Cabinet Secretary for Health and Sport.

Inspection findings are shared and discussed at SMT and continuous improvement opportunities are cascaded as appropriate.

Proposed As highlighted in respect of the MSG proposal 5.1, the following key priority will also contribute to the development of this proposal: improvement actions 1. A review with comparable partnerships will be undertaken to share learning opportunities.

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Proposal 5.3 A framework for community based health and social care integrated services will be developed. Rating Not yet established Partly Established Established Exemplary

Indicator

Our Rating

Evidence / NOT FOR LOCAL COMPLETION - NATIONAL BODIES RESPONSIBLE Notes

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Key Feature 6 Meaningful and sustained engagement

Proposal 6.1 Effective approaches for community engagement and participation must be put in place for integration.

Rating Not yet established Partly Established Established Exemplary Indicator There is a lack of Engagement is usually Engagement is always carried Meaningful engagement is an ongoing process, not just engagement with local carried out when a out when a service change, undertaken when service change is proposed. Local communities around service change is redesign or development is communities have the opportunity to contribute integration. proposed. proposed. meaningfully to locality plans and are engaged in the process of determining local priorities. Our Rating X

Evidence / There has been significant community engagement in the compilation of the Strategic Commissioning Plan for 2019/2022 and the associated Notes locality plans. There is a strong track record of a local engagement particularly in respect of sensitive decisions which have been made by the IJB and the partnership. There is a dedicated communications officer and a communications strategy to maximise local engagement and awareness of HSCP activity and progress. The IJB has a dedicated website with information flow across a range of mediums.

A consultation and engagement strategy is in place. Bi-annual meetings are held with all Elected Members to ensure they are aware of the HSCP activity in particular within their respective local areas. Public representatives are routinely involved in locality developments. There is a dedicated Health and Social Care Forum which involves public representation. This Forum and Carers are both represented on the IJB, the Strategic Commissioning Group and the Locality Planning Groups and are pro-actively engaged and committed to progressing the integration outcomes. The IJB is represented on the wider community planning partnership and is involved in each of the four PIPs.

Proposed Two key priorities which will be included in the action plan to develop this proposal are as follows: improvement actions 1. Additional engagement activities will be identified with individuals and local communities, further progressing the ethos and aspirations of the Building and Celebrating Communities approach.

2. Mechanisms to capture feedback from the public and key stakeholders in real time will be established.

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Proposal 6.2 Improved understanding of effective working relationships with carers, people using services and local communities is required.

Rating Not yet established Partly Established Established Exemplary Indicator Work is required to Work is ongoing to Meaningful and sustained Meaningful and sustained engagement with service improve effective improve effective engagement with service users, carers and communities is in place. This is given working relationships working relationships users, carers and communities high priority by the IJB. with service users, with service users, is in place. carers and communities. carers and There is a relentless focus on improving and communities. There is a good focus on implementing best practice to maximise engagement. improving and learning from There are well established and recognised effective There is some focus best practice to maximise working relationships that ensure excellent working on improving and engagement and build relationships. learning from best effective working relationships. practice to improve engagement. Our Rating X

Evidence / Exemplary examples of public engagement are set out in response to the MSG proposal 6.1 and examples of work with carers are set out in Notes response to the MSG proposal 6.3. The Communications Officer is actively engaged with local groups to support their own engagement strategies and maximise the involvement of the public in supporting the development of local health and care services. There has been extensive and ongoing community engagement as part of the care facilities modernisation programme.

Proposed Two key priorities which will be included in the action plan to develop this proposal are as follows: improvement actions 1. A training programme will be implemented to further develop the role of patient representatives to increase awareness of structures and ensure the range of concerns and priorities of all patients are captured and effectively communicated.

2. Joint working opportunities with other bodies will be identified to maximise community engagement with the public, carers and voluntary organisations.

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Proposal 6.3 We will support carers and representatives of people using services better to enable their full involvement in integration. Rating Not yet established Partly Established Established Exemplary

Indicator Work is required to Work is ongoing to Carers and representatives on Carers and representatives of people using services on improve involvement of improve involvement of the IJB are supported by the the IJB, strategic planning group and locality groups are carers and carers and partnership, enabling fully supported by the partnership, enabling full representatives using representatives using engagement. participation in IJB and other meetings and activities. services. services. Information is shared to allow Information and papers are shared well in advance to engagement with other carers allow engagement with other carers and service users in and service users in responding to issues raised. Carers and representatives responding to issues raised. of people using services input and involvement is fully optimised. Our Rating X

Evidence / Carers are actively involved in the IJB, the Strategic Commissioning Group and the Locality Planning Groups. The Carer representatives on the Notes IJB in particular play a very active role representing the interests of all carers. Well established and effective local work with Carers is also in place including conferences and work with young Carers. Carers and the Health and Social Care Forum are well engaged in the Locality Partnership Groups and both make a significant contribution to the achievement of outcomes. There continues to be active engagement as part of consultation events in support of the strategic commissioning intentions. A wide range of engagement activities have been undertaken to develop the action plan to enact the new Carers (Scotland) Act 2016. Funding is also allocated to support carer activities.

Proposed One key priority which will be included in the action plan to develop this proposal is as follows: improvement actions 1. The Carers’ Strategy will be further developed to ensure the effective implementation of the Carers (Scotland) Act 2016 and the achievement of local priorities.

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196 Agenda Item

11 Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 25 June 2019 Report by: Director, Health and Social Care

Subject: Adult and Older People Day Services Review Proposal

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  advise that a Review of all Adult and Older People Social Care Day Service provision will be undertaken and will include both services provided directly by the Health and Social Care Partnership and Independent Day Services commissioned and purchased by the South Lanarkshire Health and Social Care Partnership [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to note the following recommendation(s):- [recs] (1) that the content of the report be noted; (2) that the commencement of the Review of Day Services for Adult and Older People be noted; (3) that it be noted that progress reports will be submitted to future meetings of the Integration Joint Board; and (4) that upon completion of the Day Services Review, an update report be submitted to the Board with an associated action plan for consideration. 1recs] 3. Background 3.1. South Lanarkshire Council (SLC) currently delivers or purchases a range of Day Services for both Adults and Older People within local communities. These services have traditionally been organised around a buildings based resource and are broadly similar in setup and delivery to other models which either continue to exist or previously existed across Scotland. The Day Service delivery model in South Lanarkshire has not significantly changed since the inception of SLC (1996).

3.2. Day Services are not universally accessed, with access being available to individuals with a certain level of social care need/vulnerability following a social work assessment. Day Services provide an important function in supporting wellbeing, keeping people active and reducing social isolation. Whilst Day Services offer service users the opportunity to develop skills, abilities and interests, in kind support is also offered to carers.

3.3. Within the Council’s registered Day Services estate, the majority of the facilities have either been newly built or refurbished in the last 15 years, therefore, the buildings based asset of the estate is in reasonably good condition. The annual budget for registered Day Services in 2018/2019 totalled £8.42million, with a 50/50 split between Adults and Older People. 197

3.4. There are 19 SLC registered Day Service settings operating:  13 Day Services focussing primarily on older people aged 65+  6 Day Services supporting adults with a learning disability

3.5. Council Day Service provision across both the Adult and Older People sectors is considered to be high performing, as evidenced both by inspected grades awarded by the Care Inspectorate and feedback from service users and families. This user satisfaction has been externally acknowledged with Day Services for Older People holding the Customer Services Excellence award.

3.6. Day Support Services in the community are also provided through Community Support Teams based in local social work offices which support adults with a learning disability to access services and other community based supports. The Community Support Team Service has a staffing component of £425,000.

3.7. Day Service provision is also delivered through the independent sector. Analysis of commissioned and spot-purchased Day Services in 2018/2019 demonstrated costs of £0.6million for older people and £1.06 million for specialist Day Services for adults with multiple and complex needs.

4. Rationale for consideration of review 4.1. Shifting the Balance of Care and growing community assets is recognised as being a priority both nationally and for South Lanarkshire Health and Social Care Partnership (SLHSCP). Through continued consultation activities, culminating in the South Lanarkshire Strategic Commissioning Plan (SCP) 2019-2022 and the Building and Celebrating Communities (BCC) agenda, the key themes based on the nine national health and wellbeing outcomes have, as a focus, on local services being provided and grown in response to local need. A Review of Day Services will inform service development proposals at a locality level, involving locality engagement.

4.2. Similarly, in considering a number of recent and new policy directives, for example, Self-Directed Support (SDS), the South Lanarkshire Prioritisation Framework and the Carers (Scotland) Act 2016, SLC Day Services and any commissioned Day Service provision will require to align with these demonstrating personalised service user outcomes. Through a Review of Day Services, the integration of new directives can be scoped and implemented, importantly ensuring future equity across service user groups and localities.

4.3. The Day Service Review will examine the evidence around dependency levels and care characteristics of service users which have increased significantly since the inception of the traditional styles of Day Service to both Older People and Adults. Previously, some Day Services were specifically registered to support individuals with a diagnosis of dementia within the day estate. However, given the increase in the prevalence of dementia among individuals attending day services across all 13 of the Council’s Older Peoples’ Day Services, now more than 80 per cent of service users attending Day Services are living with a dementia condition. Therefore, the staffing models and establishments agreed some 20 years ago now require review to address such needs and deliver flexibility in service provision going forward.

4.4. There is variability in Day Service provision, uptake and demand, for example, service users attending Day Services also being supported additionally by workers from other care organisations and there is a variance in day demand across localities with percentage use ranging between 56% to 69%. An overview of placement take up is detailed in Appendix 1. 198

4.5. The Day Service Review will offer the opportunity to reflect upon both core requirements and unique characteristics of each locality, for example, Clydesdale with one of the lowest locality populations (61,474), has one of the highest number of available registered placements across Adult and Older People Day Services at 1,040 weekly, where only 585 (56%) of these are currently utilised. However, further analysis also evidences other complications in the Clydesdale area where there is now no Day Service provision further south than Lanark, following the closure of Bield Day Care. Locality profile analysis will be a core feature of the Day Service Review.

4.6. A further area for exploration will be transport, with the Review examining the potential to develop how the asset base and transport resources could be utilised within an integrated and blended locality model of support service which offers increased flexibility and choice for service users and carers. Since mid-2017, there has been a co-location of both Adults and Older People’s Day Care within the Lifestyles Stonehouse resource, leading to an evolving level of integrated delivery of services. Initial evaluation suggests that the potential of Integrated Day Care Service (IDS) promoted social cohesion between the users of different services and the wider community.

4.7. A pilot project in Clydesdale offering Intermediate Day Care (IDC) for older people was introduced during 2017, the purpose being to offer short term services to individuals recently discharged from hospital or who were at risk of hospital admission. Individuals were supported to set and achieve their own personal goals towards improving their overall health and wellbeing, with supported early intervention through IDC. A formal evaluation of this project in September 2018 indicated that this approach is worthy of further consideration and this would be considered within the Day Services Review.

4.8. Neighbourhood Networks is a pilot project currently being tested in Lanark and East Kilbride localities running until June 2020. Neighbourhood Networks provides an opportunity for adults with a learning disability who are on the fringe of requiring formal supports, to be involved in a network of friends and community opportunities at a local level. Information and learning from this pilot will inform the Review.

4.9. In terms of Day Service workforce and the potential to build on an IDS agenda, consideration will be given to the variation in roles and remits between Adult and Older Day Service workers and a current job evaluation is underway which will assist in informing the Review.

4.10. The scope of the Review including consultations, considerations and elements to be reviewed are set out in Appendix 2.

5. Employee Implications 5.1. The Review will include consideration of existing staffing resources and requirements and will be characterised by staff engagement and participation through the review process.

6. Financial Implications 6.1. The Review will consider financial resource availability, and any proposed review service recommendations will include a financial appraisal. However, it is anticipated that this will remain within the same financial envelope of £10.5million across all services within the scope of the Review. 199

7. Other Implications 7.1. There are no additional risks associated with this report.

7.2. There are no sustainable development issues associated with this report.

7.3. There are no other issues associated with this report.

8. Equality Impact Assessment and Consultation Arrangements 8.1. An equality impact assessment will be undertaken in relation to this Review since the outcome of any proposals following review may impact on some protected groups.

8.2. Consultation and engagement will be part of an ongoing process throughout the Review as identified in the consultation activity noted in Appendix 2.

9. Directions 9.1.

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 22 May 2019

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

People who use Health and Social Care Services are safe from harm

200 People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Resources are used effectively and efficiently in the provision of Health and Social Care Services

Previous References  none

List of Background Papers  none

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Ian Beattie, Head of Health and Social Care Ext: 3701 (Phone: 01698 453701) Email: [email protected]

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Appendix 1

Adult and Older People Day Services attendance – at March 2019 Locality Service Weekly Weekly registered occupied placements placements McClymont 120 77 MacLachlan 60 40 Lesmahagow 60 56 Clydesdale Total OP 240 173 (72%) Harry Smith 500 338 Carluke 300 74 Total adults 800 412 (51%) combined totals 1,040 585 (56%) Nisbet 60 46 Canderavon 60 43 St Andrews 120 103 Newberry 120 54 Whitehill 60 55 Hamilton Jimmy 120 65 Swinburne Total OP 540 366 (68%) Fairhill 300 197.5 Stonehouse 300 122 Total adults 600 319.5 (53%) combined totals 1,140 685.5 (60%) Parkhall 120 67 Meldrum 120 112 Saltire 60 54 East Total OP 300 233 (77%) Kilbride Murray Owen 300 179 Total adults 300 179 (60%) combined totals 600 412 (69%) Rutherglen Harry Heaney 150 87 Total OP 150 87 (58%) Eastfield 300 173 (57%) Total adults 300 173 (57%) combined totals 450 260 (58%)

SLC wide 3,230 1,942.5 (60%)

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Appendix 2

Scope of the review

A plan to undertake the Review will include detail and timescales on the following:-

Consultation:  service user and carer consultation  staff consultation  localities consultation  GP communities and other community health services  localities profiling of service user groups and future projected populations  engagement with communities  engagement with the private, voluntary and Third Sectors  engagement with housing and property services

Proposed elements to be included in the Review are:-  all Older People Day Services  all Adult Lifestyle Services  Community Support Teams  Commissioned Services  purchased services for adults with complex needs  the use of Day Services by tenants of sheltered and very sheltered accommodation

The Review will also afford the opportunity to consider how Health and Social Care Integration could be embedded in a Day Service model and thus further contribute to the shifting the balance of care agenda.

It may be prudent to engage activity for this Review from an independent consultative perspective to ensure objectivity and transparency. This would enable the opportunity for comparative research and benchmarking against other Health and Social Care Partnership (HSCP) Day Service provision in a broader context.

It is anticipated that the Review activity would report back its initial findings in December 2019 with theoretical service model options for consideration. Any implementation for future redesign would be undertaken in a subsequent phase following agreement on a preferred service model.

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204 Agenda Item

12 Report Report to: South Lanarkshire Integration Joint Board Date of Meeting: 25 June 2019 Report by: Director, Health and Social Care

Subject: South Lanarkshire Adult Protection Committee Biennial Report

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  advise of the South Lanarkshire Adult Protection Committee Biennial Report [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):- [recs] (1) that the content of the report be noted; and (2) that the actions detailed with regards to public information, awareness raising, self–evaluation and learning and development be noted. [1recs] 3. Background 3.1. South Lanarkshire Adult Protection Committee (SLAPC) has finalised its fifth Biennial Report covering the period 2016-2018. The report highlights the work of the Committee over the last two years and the developments it will be embarking on in the future. The work of the SLAPC is reflected in local practice and aims to meet local and national needs in keeping adults safe from harm.

4. Fulfilling Functions 4.1. The SLAPC is responsible for developing and implementing adult protection policy and strategy across and between the multi-agency workforces. Under Section 42 of the Adult Support and Protection (Scotland) Act 2007 the Committee performs a number of crucial functions:  to keep under review the procedures and practices of member agencies that relate to the safeguarding of adults at risk in South Lanarkshire  to provide information and advice, or make proposals to any member agency or relevant body on the exercise of functions that relate to the safeguarding of adults at risk  to promote co-operation and communication within and between the public bodies, third sector, private and charity organisations  to promote improvement in skills and knowledge of staff providing services to adults at risk  to respond to the requirements of Scottish Ministers as required

205 5. Adult Protection Committee Business Plan 5.1. The SLAPC business plan sets out the high level priorities for addressing Adult Support and Protection (ASP) in South Lanarkshire and is aimed at frontline service provision with a clear focus on providing improved outcomes for adults at risk of harm and their families. The SLAPC continually reviews this plan to ensure that its actions are implemented. In turn the plan informs the priorities for joint self- evaluation and learning and development.

6. Continuous Improvement 6.1. The SLAPC continues to ensure quality assurance is an integral part of the adult protection improvement process, with all multi-agency evaluations of adult protection led by the SLAPC Quality Assurance Group. This group maintains an overview of single and multi-agency audit and evaluation activities based on issues of local and national concern and implements findings, actions and outcome measures as a result.

6.2. The SLAPC has in place an ambitious programme of multi-agency audit and self- evaluation activity. Over the past two years, self-evaluation tasks have been completed from a number of sources including two large scale multi-agency case file audits, SLAPC Adult Protection in Care Homes and SLAPC and the Care Inspectorate, Adult Protection Key Processes. The audit and self-evaluation activity highlighted that there was strengths across the agencies in terms of keeping adults safe from harm and also identified areas for improvement which continue to be monitored by the Quality Assurance Group via robust action plans.

7. Policies, Procedures and Protocols 7.1. The SLAPC designs and evaluates clear and robust multi-agency adult protection policies, procedures, protocols and guidance. It also ensures public bodies and other agencies have in place their own up-to-date adult protection policies and procedures and relevant materials and ensure that these are developed around existing and emerging local and national key issues and that they publish and regularly review their own adult protection procedures. Over the reporting period a number of guidance and procedures have been introduced and reviewed, including, Social Work Adult Support and Protection (Scotland) Act 2007 Procedures, SLAPC Large Scale Investigation Procedures and SLAPC Significant Case Review Guidance (reviewed) (2018).

8. Learning and Development 8.1. The importance of professional judgement in dealing with the risk and uncertainty of adult protection situations means that training must be a core consideration. Multi- agency training is an essential component in building common understanding and fostering good working relationships, which are vital to effective adult protection. The Adult Protection Committee is well placed to help develop and deliver such training through its comprehensive SLAPC Learning and Development Programme. Practitioners and Managers can learn about ASP by attending various training events throughout the year. The aim is to continue to raise awareness of ASP and ensure staff know how to recognise and report concerns. Partners are actively encouraged to link with the SLAPC Learning and Development Worker to ensure staff within organisations at all levels have the required knowledge and skills in this area.

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9. Public Protection 9.1. The SLAPC believe that improved outcomes for the people of South Lanarkshire can be achieved by promoting and facilitating links between all of the Public Protection disciplines. Having these close links ensures that areas of overlap and commonality are identified and that a consistent approach to planning and service delivery continues to be delivered. To that end, a Public Protection Strategy and Action Plan has been developed and the Committee will continue to deliver on its outcomes. Throughout the reporting period, the Public Protection Team have worked closely to develop and implement various joint Protocols and Guidance including, Joint (Child and Adult Protection) Multi-Agency Chronologies Guidance (2017), South Lanarkshire’s Multi-agency Transition and Escalation Processes for High Risk or Complex Cases (2017) and South Lanarkshire’s Multi-agency ‘Forced Marriage’ Guidance (2017) and MAPPA and ASP Joint Operating Protocol (2017). Two Public Protection events have been held to highlight to the workforce the cross cutting themes in the Public Protection arena which were very well received.

10. Statistics 10.1. The SLAPC monitor ASP statistics on a quarterly basis and prepare and present a report to both the Adult Protection Committee and Public Protection Chief Officers Group detailing key performance areas. During the reporting period 2016-2018, there has been a 4% increase in referrals from 1,998 to 2,006 respectively.

11. Source of Referral 11.1. South Lanarkshire Health and Social Care Partnership (SLHSCP) continue to receive ASP referrals from various sources as shown in the following table:

2016/17 2017/18 NHS 132 172 Scottish Ambulance Service 2 3 Police Scotland 742 657 Scottish Fire and Rescue 32 38 Office of Public Guardian 3 7 Care Inspectorate 19 9 Voluntary Organisation 24 26 Social Work 148 204 Care Home non SLC 220 218 Other Care Provider non SLC 125 165 Other Care Provider SLC 62 70 Self 31 4 Family 31 17 Member of public 5 7 Anonymous 6 10 Other 50 30 Other sources 114 147 Unknown 252 222 Total 1998 2006

11.2. SLAPC recognise that ongoing work is required to continue to increase the rate of adult protection referrals from key partners and the public. Training will be targeted at the multi -agency workforce to raise their awareness and work will continue to look at creative ways to engage the public meaningfully in the adult protection agenda.

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12. Location of Harm 12.1. The location of harm remains varied in South Lanarkshire. Of significance, adults being harmed within their own home account for just under half of all ASP referrals in the period 2016–2018. In 2016-2017, the figures show that the second most likely place an adult would experience harm was within a care home 20% (401 ASP referrals) with public areas 15% (307 ASP referrals). In 2017-2018 statistics remain the same in relation to care homes at 20% (399 ASP referrals) with public areas decreasing by 1% to 14% (272 ASP referrals).

12.2. Across South Lanarkshire the number of care home referrals remains high. This may be attributed to improved staff awareness of adult protection, influence from the Care Inspectorate or as a consequence of the care home environment. Given these statistics, care home referrals remain a priority area of interest for SLAPC going forward.

13. Harm Type 13.1. Physical harm continues to be the most frequent harm type reported in 2016-2018 with statistics showing 26% consecutively. These findings are comparable to those in the last Biennial Report. There continues to be an increase in self-neglect from 9% to 10% and self-harm remains static over the reporting period at 16%. This could be explained by the work SLAPC have been doing to promote awareness and understanding in self-neglect and self-harm cases in staff training and development sessions.

14. Challenges 14.1. The main challenges for the SLAPC over the reporting period have been and continue to be:  increased demand on services in an ever more challenging financial climate  extending public awareness and understanding of adult protection  adult protection in relation to care homes  ageing population and increasing numbers of vulnerable adults living in our communities

15. Future 15.1. The SLAPC continues to meet its objectives contained within the Business Plan and remains committed to maintain a clear focus on working in partnership to achieve better outcomes for adults at risk of harm in South Lanarkshire. Partners are encouraged to consider their contribution to the work of the SLAPC by ensuring staff across the multi-agency workforce are supported to access the many and varied learning opportunities which aim to enhance and embed their learning of ASP.

16. Employee Implications 16.1. There are no employee implications associated with this report.

17. Financial Implications 17.1. There are no financial implications associated with this report.

18. Other Implications 18.1. There are no additional risk implications associated with this report.

18.2. There are no sustainable development issues associated with this report.

18.3. There are no other issues associated with this report.

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19. Equality Impact Assessment and Consultation Arrangements 19.1. This report does not introduce a new policy, function or strategy, or recommend a change to an existing policy, function or strategy and therefore no impact assessment is required.

19.2. There is also no requirement to undertake any consultation in terms of the information contained in this report.

20. Directions 20.1.

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 28 May 2019

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

209

Previous References  none

List of Background Papers  South Lanarkshire Adult Protection Committee Biennial Report

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Saffa Baxter, Independent Chair, South Lanarkshire Child Protection Committee Ext: 4128 (Phone: 01698 894128) Email: [email protected]

Julie Stewart, Lead Officer, Adult Protection, South Lanarkshire APC Ext: 4145 (Phone: 01698 894145) Email: [email protected]

210