A meeting of the Clackmannanshire and Stirling Integration Joint Board will be held on Tuesday 22 March 2016 at 2.00-4.00pm, in Boardroom, Forth Valley College, Alloa Campus
Please notify apologies for absence to [email protected]
AGENDA
1. NOTIFICATION OF APOLOGIES For Noting
2. NOTIFICATION OF SUBSTITUTES For Noting
3. DECLARATION(S) OF INTEREST For Noting
4. URGENT BUSINESS BROUGHT FORWARD BY CHAIRPERSON
5. MINUTE OF THE CLACKMANNANSHIRE & STIRLING INTEGRATION JOINT BOARD MEETING HELD ON 24 FEBRUARY 2016 For Approval
6. MATTERS ARISING
7. CHAIR & VICE CHAIR AND STANDING ORDERS For Agreement (Paper presented by Shiona Strachan)
8. DELAYED DISCHARGE PROGRESS REPORT For Noting (Paper presented by Phillip Gillespie)
9. STRATEGIC PLAN For Approval (Paper presented by Shiona Strachan)
10. HOUSING CONTRIBUTION STATEMENTS For Approval (Paper presented by Susan White)
11. GOVERNANCE
11.1 CLINICAL AND CARE GOVERNANCE FRAMEWORK For Approval (Paper presented by Dr Tracey Gillies)
11.2 INFORMATION GOVERNANCE For Approval (Paper presented by Alison Gallagher)
11.3 COMPLAINTS PROCESS For Approval (Paper presented by Elaine Vanhegan)
11.4 EQUALITY For Noting & Approval (Paper presented by Lesley Fulford)
12. RISK STRATEGY For Approval (Paper presented by Hugh Coyle)
13. SCOTTISH LAW COMMISSION REPORT ON ADULTS WITH INCAPACITY (Paper presented by Val de Souza) For Noting
14. SUPPORT SERVICES For Noting (Paper presented by Shiona Strachan)
15. LOCAL DELIVERY PLAN For Discussion (Paper presented by Dr Graham Foster)
16. ANY OTHER COMPETENT BUSINESS
17. DATE OF NEXT MEETING
*Wednesday 30 March 2016, 2.00-4.00, Kildean Suite, Forth Valley College, Stirling Campus Wednesday 27 April 2016, 2.00-4.00, Kildean Suite, Forth Valley College, Stirling Campus
Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 5 on the agenda
Minute of Clackmannanshire & Stirling Integration Joint Board meeting held on 24 February 2016
For Approval
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Minute of the Clackmannanshire & Stirling Integration Joint Board meeting held on Wednesday 24 February 2016, at 2.00pm, in Castle Suite, Forthbank Stadium, Stirling.
Present: Alex Linkston, Chairman (Chair) Councillor Les Sharp, Council Leader (Vice Chair) Councillor Donald Balsillie John Ford, Non-Executive Board Member Fiona Gavine, Non-Executive Board Member Tracey Gillies, Medical Director Jane Grant, Chief Executive Tom Hart, Staff Representative- going to use his job title Shubhanna Hussain-Ahmed, Unpaid Carers Representative Morag Mason, Service User Representative for Stirling Natalie Masterson, Third Sector Representative Ewan Murray, Chief Finance Officer Elizabeth Ramsay, Unpaid Carers Representative Abigail Robertson, Staff Representative Pamela Robertson, Staff Representative Wendy Sharp, Third Sector Representative Councillor Christine Simpson Elaine Vanhegan, Head of Performance Management, NHS Forth Valley Angela Wallace, Nurse Director Councillor Graham Watt
In Attendance: Iain Burns, Internal Audit and Fraud Team Leader, Clackmannanshire Stewart Carruth, Chief Executive, Stirling Council Phillip Gillespie, Assistant Head of Social Services Stephanie McNairney, Project Administrator, NHS Forth Valley (Minute) Calum MacDonald, ISD Morag McLaren, Head of Organisational Development Elaine McPherson, Chief Executive Kathy O’Neill, General Manager, CHP’s Shiona Strachan, Chief Officer Chris Sutton,
1. APOLOGIES FOR ABSENCE
Apologies for absence were intimated on behalf of:
Councillor Johanna Boyd, Council Leader Joanne Chisholm, Non-Executive Board Member Val de Souza, Chief Social Work Officer Councillor Scott Farmer Graham Foster, Executive Board Member Councillor Kathleen Martin Teresa McNally, Service User Representative for Clackmannanshire Dr Scott Williams
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2. NOTIFICATION OF SUBSTITUTES
• Prof Angela Wallace substituted for Joanne Chisholm • Dr Tracey Gillies substituted for Dr Graham Foster as Executive Board member • Councillor Graham Watt substituted for Councillor Kathleen Martin • Sheila McGhee substituted for Teresa McNally
3. DECLARATION(S) OF INTEREST
There were no declarations of interest.
4. URGENT BUSINESS BROUGHT FORWARD BY CHAIRPERSON
There was no urgent business brought forward.
5. MINUTE OF MEETING HELD ON 26 JANUARY 2015
The minute of the meeting held on 26 January 2016 was approved as an accurate record, subject to the following clarifications:
• Correction of the dates in Item 3. This should read 11 December • Addition of Liz Rowlett in attendance
6. MATTERS ARISING
The Chairman advised that, following discussion, there were no plans to make amendments in relation to Registered Social Landlords.
There was a query around the involvement of housing services, and it was clarified that housing was not a delegated function of the IJB but that officers were liaising with respective agencies, and there was representation from housing services on various groups, including the Housing Contribution Group where the housing services have led the work.
7. CHAIR AND VICE CHAIR OF INTEGRATION JOINT BOARD
Following discussion around Chair and Vice Chair arrangements for the coming period it was agreed that, subject to any required amendments to the Standing Orders and Integration Scheme, Councillor Les Sharp would be nominated as Chair, and John Ford as Vice Chair from 1 April 2016 for a period of one year. This would be followed by a one year chairmanship from Stirling Council.
The Chief Officer was asked to bring back a further paper to confirm what was required to support the preferred option.
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8. STRATEGIC PLAN
The draft Strategic Plan is nearing completion following two periods of consultation. Shiona Strachan provided an overview of the minor amendments which had been made since the Integration Joint Board last had sight.
Any specific comments or suggested amendments were to be sent to Shiona Strachan by Friday 26 February, and a final version Strategic Plan was to be brought to the March meeting.
The Integration Joint Board:
• Approved the draft Strategic Plan • Approved the revised draft easy read Strategic Plan • Approved the consultation & engagement report for publication • Approved the staff engagement report for publication • Noted the ongoing work in relation to the quantum of resources to be transferred to the IJB
9. STRATEGIC NEEDS ASSESSMENT
Chris Sutton and Dr Oliver Harding provided a presentation on some of the key content of the Strategic Needs Assessment, and there followed discussion on some of the pertinent public health and social issues in Clackmannanshire and Stirling.
Any comments on the Strategic Needs Assessment were to be sent to Shiona Strachan by Friday 26 February.
The Integration Joint Board approved the draft Strategic Needs Assessment for publication subject to the comments made, and approved further work to be undertaken to understand the differences between and within localities and communities.
10. INTEGRATION JOINT BOARD DEVELOPMENT SESSION OUTPUT
Morag McLaren provided an overview of the outputs from the development session.
The Integration Joint Board noted the content of the report and agreed to future developments as set out in section 5 of the report.
Interest was also expressed in the possibility of arranging a programme of service visits.
11. DELAYED DISCHARGE PROGRESS REPORT
Phillip Gillespie provided an update on the status of Delayed Discharges.
A summary of people delayed at the census point in December 2015 was provided as well as an overview of the management actions being taken.
The Integration Joint Board noted performance and acknowledged the management actions undertaken. Page 4 of 6
12. PARTICIPATION AND ENGAGEMENT STRATEGY
Chris Sutton advised that a Participation and Engagement Strategy had been developed by the Participation and Engagement Work stream, which had representation from all key partners, and consulted on more widely.
The Integration Joint Board approved the draft Participation and Engagement Strategy, and noted the development of an action plan to support the strategy.
13. PARTNERSHIP FUNDING
Ewan Murray provided an update to the information provided at the December meeting in relation to partnership funding arrangements. A separate budget setting report would be brought to the March meeting of the Integration Joint Board.
Ewan Murray was to establish whether any additional monies associated with the Carers Bill would be forwarded to the Integration Joint Board or its constituent parties.
The Integration Joint Board: • noted the updates summary of partnership funding and projected expenditure • noted the process of evaluation and review of projects funded through Integrated Care Programme, Delayed Discharge funding and Partnership Bridging Resource • Delegated authority to Chief Officer to agree interim funding of up to 6 months to support posts, to allow evaluation review and alignment with Strategic Plan priorities on behalf of the Integration Joint Board • Agreed to receive, for consideration and approval, a detailed spending plan for Partnership Funding • Delegated authority to the Chief Executives to consider support arrangements for the Integration Joint Board and bring forward proposals for consideration and approval
14. INTERNAL AUDIT
Ewan Murray provided an overview of arrangements to put in place adequate and proportionate internal audit arrangements, and noted a rolling appointment across three named individuals.
The Integration Joint Board agreed internal audit services as set out within the report, and agreed the appointment process for an Integration Joint Board Chief Internal Auditor.
15. EXTERNAL AUDIT
Ewan Murray advised that Grant Thornton UK LLP had been appointed as external auditors by the Accounts Commission for the 2015/16 audit.
The Integration Joint Board noted the appointment. Page 5 of 6
16. PROGRAMME WORKSTREAM UPDATE
Lesley Fulford provided an update on the progress to date of programme workstreams in the implementation of Health and Social Care Integration across Clackmannanshire and Stirling. It was noted that work was progressing well, but that tight timescales lay ahead.
The Integration Joint Board noted the content of the report and progress to date.
17. ANY OTHER COMPETENT BUSINESS
There was a hold in Integration Joint Board members diaries for a special meeting on 30 March for any business not concluded by that date. Notification will be given in due course as to whether the meeting is required.
18. DATE OF NEXT MEETING
Wednesday 22 March 2016, 2.00-4.00, Boardroom, Forth Valley College, Alloa Campus.
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Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 7 on the agenda
Integration Joint Board Chairperson and Vice- Chairperson Appointment Procedure and Standing Orders
(Paper presented by Shiona Strachan)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Ruth McColgan, Solicitor, Stirling Council Date: 22 March 2016 List of Background Papers: Section 6 of The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 The Integration Joint Board’s Integration Scheme The Integration Joint Board’s Standing Orders as approved on 27 October 2015
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Title/Subject: Integration Joint Board Chairperson and Vice-Chairperson Appointment Procedure
Meeting: Clackmannanshire & Stirling Integration Joint Board
Date: 22 March 2016 Submitted By: Shiona Strachan, Chief Officer Action: For Approval
1. Introduction
1.1 The Integration Joint Board through discussion at its meeting on 24 February 2016, requested that the procedure for the Chairperson and Vice-Chairperson appointment be looked at and, specifically, that the possibility of the constituent local authorities ‘sharing’ each local authority Chairperson and Vice-Chairperson ‘appointing period’ be considered more fully.
2. Executive Summary
2.1. The current framework for Integration Joint Board Chairperson and Vice- Chairperson appointment does not allow for the constituent local authorities to ‘share’ each local authority Chairperson and/ or Vice-Chairperson appointing period. This paper sets out how that framework might be amended to reflect the constituent local authorities’ proposal that they be permitted to share the appointing periods in this way; each appointing a Chairperson or Vice- Chairperson for one year of each respective local authority Chairperson or Vice-Chairperson appointing period (of two year duration).
3. Recommendations
The Integration Joint Board is asked to:
3.1. Agree that the local authorities should be able to ‘share’ each local authority appointing period for both the Chairperson and Vice-Chairperson and if so, endorse amendment to the Integration Joint Board’s Standing Orders to enable them to do so; and
3.2. Approve the amendments to the Standing Orders as set out at 5.12 and 5.13 of this paper to reflect practice. Please note that the Standing Orders with all suggested amendments are included as Appendix 2 to this paper.
3.3. Note initial discussion with Scottish Governments is detailed in section 5.8 and
3.4. Delegate to Chief Officer to continue discussion in respect of the Integration Scheme and to advise Integration Joint Board of the outcomes in due course.
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4. Background
4.1. Section 6 of the The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 provides a framework for Chairperson and Vice- Chairperson appointment within which the Integration Joint Board must operate; see Appendix 1. The Integration Joint Board’s Integration Scheme provides a high level overview of the procedure for Integration Joint Board Chairperson and Vice-Chairperson appointment. The Integration Joint Board’s Standing Orders, as adopted by the Board on 27 October 2015, prescribe in more detail the arrangements for Chairperson and Vice-Chairperson appointments between all the constituent authorities.
4.2 This paper was preceded by discussions between the constituent local authorities, and is presented against the backdrop that 1 April 2016 marks the beginning of a two year local authority Chairperson appointing period. The Integration Joint Board sought, through discussion at its meeting on 24 February 2016, a paper setting out how it would need to amend its existing governance framework in order to facilitate the approach favoured by the constituent local authorities that they ‘share’ each local authority Chairperson and Vice-Chairperson appointing period.
5. Current Framework for Chairperson and Vice-Chairperson Appointments and Proposed Amendment to that Framework
5.1. At present the framework for Integration Joint Board Chairperson and Vice Chairperson appointment, consisting of:
• the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (the Order) specifically s.6 thereof; • The Integration Joint Board’s Integration Scheme (the Scheme); and • The Integration Joint Board’s Standing Orders, as adopted on 27 October 2015 (the Standing Orders),
provides that Chairperson appointment will rotate every two years between the Health Board and a constituent local authority. Similarly, it provides that the Vice-Chairperson appointment shall rotate in the same pattern; sitting with the constituent local authorities when the Health Board appoint the Chairperson and vice versa.
5.2. As such, under that framework, the Health Board would appoint the Chairperson for each alternating appointing period. In each second alternating appointing period, Stirling Council would appoint the Chairperson and in the other second alternating appointing period, Clackmannanshire Council would appoint the Chairperson. The detail of this is contained within Standing Order 7, prior to amendment, at Appendix 2.
5.3. The Order is binding upon the Integration Joint Board. The Scheme is binding upon the Integration Joint Board and the constituent authorities unless
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amendment were to be approved by the Scottish Ministers. Any such amendment would be for the constituent authorities to seek as opposed to the Integration Joint Board. The Integration Joint Board’s Standing Orders may be amended by the Integration Joint Board at any meeting provided due intimation is provided and subject to a two thirds majority of voting members of the Integration Joint Board approving any such amendment(s); Standing Order 20 at Appendix 2 is referred to.
5.4. The Integration Joint Board’s Standing Orders are more prescriptive than the Order and the Scheme, as set out at 5.2 above. Amendment of the Standing Orders, as set out at Standing Order 7 of Appendix 2, would give effect to the constituent local authorities’ preferred procedure for Chairperson and Vice- Chairperson appointment. Without such amendment, the proposed arrangement re constituent local authorities sharing the Chairperson appointment would be a breach of the Integration Joint Board’s Standing Orders. If adopted, the amended Standing Orders would prescribe that the local authorities each appoint a Chairperson for one year of each local authority Chairperson appointing period and similarly, a Vice-Chairperson for one year of each local authority Vice-Chairperson appointing period.
5.5. The Board should be aware that this proposed arrangement is arguably contrary to the intention behind 6(2) of the Order, see Appendix 1, which appears to intend that one local authority appoint for the two year appointing period. It is also arguably not supported by the comparable provisions within the Scheme. Both those instruments reflect what the constituent local authorities originally planned to do (i.e. to appoint for two year periods). Nonetheless, it is proposed that the amendment is potentially workable under the Order and the Scheme as it does not cut across the provisions therein but instead proposes a local supplementary agreement to operate within the terms those instruments.
5.6. Importantly, the local authorities’ proposal regarding Chairperson and Vice- Chairperson appointment would be consistent with the proportionate representation on the Integration Joint Board as is the case with the existing framework for appointments.
5.7. It would be necessary, alongside any amendment to the appointment procedure, to implement a procedure for notification of Chairperson and/ or Vice-Chairperson appointment to ensure clarity between all the constituent authorities as to where appointments sit at all times. It would be sensible that such a notification procedure mirror the procedure that would otherwise be followed by a constituent authority if it were to replace their Chairperson or Vice-Chairperson during any period of appointment. Standing Order 7.5 at Appendix 2 is referred to, if adopted, it would address this.
5.8. As members will be aware, this Integration Joint Board is unique in its constitution therefore this issue has not arisen elsewhere. Section 6 of the Order was drafted following consultation with this area as to its intended approach to the Chairperson appointment procedure, which was as set out at 5.2 above. In light of this departure from previous procedure, as intimated to
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the Scottish Government, this proposed approach has also been intimated to the Scottish Government and discussions are ongoing with them as to whether minor amendment to the Scheme may be required in due course to support the proposed approach to sharing the Chairperson and Vice-Chairperson appointments. The Scottish Government are supportive of the partnership and acknowledge that issues will arise given its unique constitution.
5.9. It would follow that the proposed amendments within this paper regarding Chairperson appointment should similarly apply to the Vice-Chairperson appointment during the local authority Vice-Chairperson appointing period (which will be during each Health Board Chairperson appointing period) to ensure proportionate participation. This has been reflected in the suggested amendments to Standing Order 7. As such, each local authority Vice- Chairperson appointing period would similarly be shared (i.e. one year of appointment each) between Stirling Council and Clackmannanshire Council.
5.10. No amendment to the Chairperson or Vice-Chairperson appointment procedure for local authorities as proposed in this report and reflected in the Standing Orders at Appendix 2, if adopted, is to amend NHS Forth Valley’s rights in respect of their appointing periods for the Chairperson and Vice- Chairperson. NHS Forth Valley shall continue to appoint the Chairperson for each full alternating two year Health Board Chairperson appointing period and the Vice-Chairperson for each two year Health Board Vice-Chairperson appointing period, as per the Order, the Scheme and the Standing Orders.
Further amendment to Standing Orders
5.11. Two further amendments require to be made to the Standing Orders, amendments which have previously been endorsed by this Board on 27 October 2015, namely:
(i) The adoption of a bi-monthtly meeting scheduled at 8.1 to reflect practice from 1 April 2016; and (ii) The provision only of online copies of agendas and reports for meetings to the public as opposed to hard copies, at 10.3, these are available through integration web page.
5.12. The opportunity is hereby taken to seek the Integration Joint Board’s formal adoption of these amendments into the Standing Orders, as per Appendix 2.
6. Conclusions
6.1. This paper sets out how the Integration Joint Board may amend its governance framework to accommodate the approach favoured by the constituent local authorities that they share local authority Chairperson and Vice-Chairperson appointing periods.
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7. Resource Implications
7.1. N/A
8. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
8.1. The Chairperson and the Vice-Chairperson will play a key role in the Integration Joint Board’s operation and in ensuring that the Integration Joint Board complies with its legal obligations. It is in the Integration Joint Board’s interests that it have a clear procedure for Chairperson and Vice-Chairperson appointments.
9. Legal & Risk Implications
9.1. There is a risk that this proposed course of action is contrary to the intention behind s.6 of the Order and to the intention behind the relevant paragraphs of the Scheme. Any amendment to the Scheme which is ‘necessary or desirable’ (s.46 Public Bodies (Joint Working) (Scotland) Act 2014) would be a matter for the constituent authorities to agree and progress. It is not within the Integration Joint Board’s power to direct that any amendment be sought. It is noted that if any such amendment to the Scheme were to be considered appropriate to support the proposed approach, it would be minor in nature.
10. Consultation
10.1. The proposal in this paper arose from consultation between constituent local authorities. It was then discussed by this Board at its meeting on 24 February 2016.
10.2. Governance leads for the constituent parties have been consulted in the preparation of this paper.
11. Equality and Human Rights Impact Assessment
11.1. N/A
12. Exempt reports
12.1. No
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Appendix 1
Extract from Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014
6. Appointment of chairperson and vice-chairperson where integration scheme prepared by two or more local authorities
(1) A chairperson is to be appointed by a constituent authority for a term of office, not to exceed three years (an “appointing period”). (2) The constituent authorities must agree whether the chairperson will be appointed by the Health Board or by one of the local authorities in the first appointing period. (3) In the second appointing period— (a) if the chairperson appointed under paragraph (2) was appointed by the Health Board, the chairperson must be appointed by one of the local authorities; (b) If the chairperson appointed under paragraph (2) was appointed by one of the local authorities, the chairperson must be appointed by the Health Board. (4) The appointment of the chairperson is to alternate between the Health Board and a local authority, so that in each second alternating appointing period the chairperson is appointed by the Health Board. (5) The Health Board, or as the case may be, a local authority, which is not entitled to appoint the chairperson in respect of an appointing period must appoint the vice- chairperson of the integration joint board in respect of that period. (6) A constituent authority may change the person appointed by that authority as chairperson or vice-chairperson during an appointing period. (7) A local authority may only appoint as chairperson or vice-chairperson a member of the integration joint board nominated by it in accordance with article 5(2)(a). (8) The Health Board may only appoint as chairperson or vice-chairperson a member of the integration joint board nominated by it in accordance with article 5(2)(b) who is a non-executive director of the Health Board.
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Appendix 2
STANDING ORDERS
1. TITLE AND INTERPRETATION
1.1. These are the Standing Orders of the Clackmannanshire and Stirling Health and Social Care Integration Joint Board (hereinafter called “the IJB”).
1.2. The Interpretation Act 1978 will apply to the interpretation of these Standing Orders as it applies to the interpretation of an Act of Parliament.
2. COMMENCEMENT
2.1. These Standing Orders will apply from and including 22 March 2016.
3. INTRODUCTION AND GENERAL PRINCIPLES
3.1. The IJB has been established by order made under Section 9 of the Public Bodies (Joint Working) (Scotland) Act 2014. These standing orders regulate the procedure and business of the IJB and its committees. All meetings of the IJB and its committees will be conducted in accordance with these standing orders.
3.2. The following general principles will be given effect to in the application of these Standing Orders:-
3.2.1. that the role of the Chairperson is to ensure that the business of the meeting is properly dealt with and that clear decisions are reached
3.2.2. that the Chairperson will seek to promote and identify consensus among the voting members of the IJB
3.2.3. that the Chairperson has a responsibility to ensure that the view of all participants are expressed including the advice of officers when this is necessary to inform the decision, and
3.2.4. that meetings are conducted in a proper and timely manner with all members sharing responsibility for the proper and expeditious discharge of business.
4. DEFINITIONS
4.1. “Confidential Information” has the meaning ascribed to it in Appendix 1.
4.2. “Constituent Authorities” means Clackmannanshire Council, established under the Local Government etc (Scotland) Act 1994 and having its principal
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offices at Kilncraigs, Alloa FK10 1EB, Stirling Council, established under the Local Government etc (Scotland) Act 1994 and having its principal offices at Viewforth Stirling FK8 2ET and Forth Valley Health Board, established under section 2(1) of the National Health Service (Scotland) Act 1978 (operating as “NHS Forth Valley“) and having its principal offices at Carseview House, Castle Business Park, Stirling, FK9 4SW or any of them as the context admits.
4.3. “Exempt Information” has the meaning ascribed to it in Appendix 2. There are 15 categories of exempt information. A full explanation, including any qualifications to the descriptions of exempt information, is provided in Appendix 2.
4.4. “Integration Joint Board Order” means the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014.
4.5. “Local Authorities” means Clackmannanshire Council, established under the Local Government etc (Scotland) Act 1994 and having its principal offices at Kilncraigs, Alloa FK10 1EB, and Stirling Council, established under the Local Government etc (Scotland) Act 1994 and having its principal offices at Viewforth Stirling FK8 2ET or either of them as the context admits.
4.6. “NHS FV” means Forth Valley Health Board, established under section 2(1) of the National Health Service (Scotland) Act 1978 (operating as “NHS Forth Valley“) and having its principal offices at Carseview House, Castle Business Park, Stirling, FK9 4SW.
4.7. “Professional Members” means the non-voting members of the IJB as defined in Standing Order 5.2.
4.8. “Stakeholder Members” means the non-voting members of the IJB as defined in Standing Order 5.3.
5. MEMBERSHIP
5.1. The voting members of the IJB are:
5.1.1. three Councillors appointed by Clackmannanshire Council, 5.1.2. three Councillors appointed by Stirling Council, 5.1.3. six Directors of NHS FV of whom four shall be non-Executive Directors and two shall be Executive Directors, subject always to Standing Order 11.
5.2. The non-voting members of the IJB are
5.2.1. the joint Chief Social Work Officer for Clackmannanshire and Stirling, 5.2.2. the Chief Officer of the IJB, 5.2.3. the Proper Officer of the IJB appointed under section 95 of the Local Government (Scotland) Act 1973,
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5.2.4. a registered medical practitioner whose name is included in the list of primary medical services performers prepared by NHS FV in accordance with regulations made under section 17P of the National Health Service (Scotland) Act 1978, 5.2.5. a registered nurse who is employed by NHS FV or by a person or body with whom NHS FV has entered into a general medical services contract, 5.2.6. a registered medical practitioner employed by NHS FV and who is not providing primary medical services.
5.3. The additional members, also non-voting, are such additional members as the IJB have seen fit to appoint (not being a Councillor of either of the Local Authorities or a Non-Executive Director of NHS FV) and at least one member appointed by the IJB in respect of each of the following groups:-
5.3.1. a representative of staff of the parties engaged in the provision of services provided under the Integration Functions, 5.3.2. Third Sector Bodies carrying out activities related to health and social care for the areas of the Constituent Authorities, 5.3.3. Service Users residing in the areas of the Local Authorities, 5.3.4. persons providing unpaid care in the areas of the Local Authorities.
5.4. Subject to Standing Orders 5.5 and 5.6, members of the IJB are appointed to serve for a period of three years and may be reappointed for one further term of office.
5.5. Voting members will be deemed to have their appointment to the IJB withdrawn if they no longer meet the criteria set out in Standing Order 5.1, and the appointing party will be able to remove that member by giving notice under Article 10 of the Integration Joint Board Order.
5.6. Non-voting members, as detailed in Standing Orders 5.2 and 5.3, shall remain a member of the IJB for as long as they hold the office in respect of which they were appointed.
5.7. If a voting member resigns from the IJB, the appointing party will be entitled to appoint another representative to the IJB pursuant to Standing Order 5.1.
5.8. Removal of a voting member shall be in accordance with Article 10 of the Integration Joint Board Order.
6. FIRST MEETING OF THE IJB
6.1. The business of the first meeting of the IJB shall be –
6.1.1. to adopt standing orders 6.1.2. to set a programme of meetings 6.1.3. to appoint additional members
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6.1.4. to deal with any urgent business keeping to the terms of the law and these Standing Orders.
7. CHAIRPERSON AND VICE-CHAIRPERSON
7.1. The first Chairperson of the IJB shall be appointed by NHS FV and the first Vice-Chairperson shall be appointed by one of the Local Authorities. They will serve for the period to 31 March 2016.
7.2. The Chairperson appointed to serve from 1 April 2016 for a period of two years shall be appointed by the Local Authorities and the Vice-Chairperson shall be appointed by NHS FV to serve for the same period.
7.3. The appointment of subsequent Chairpersons and Vice-Chairpersons must alternate between NHS FV and the Local Authorities in accordance with Article 6 of the Integrated Joint Board Order and the IJB’s Integration Scheme. In each respective Local Authority appointing period, which the Integration Scheme provides shall last for two years, the Local Authorities hereby agree to each appoint a Chairperson for one year of each respective two year local authority Chairperson appointing period. The Local Authorities hereby agree to similarly appoint a Vice-Chairperson for one year of each respective two year local authority Vice-Chairperson appointing period.
7.4. NHS FV and the Local Authorities may only appoint the Chairperson and Vice-Chairperson from the voting members of the IJB subject to the further proviso that NHS FV may only appoint a voting member who is a Non- Executive Director to these positions.
7.5. Subject to Standing Order 7.4, any Constituent Authority may change the person appointed by them as Chairperson or Vice-Chairperson during their term of office. The relevant Constituent Authority will provide written notice to the Chief Officer and to the Chief Executives of each of the other two Constituent Authorities confirming the name and position of the new appointment of Chairperson or Vice-Chairperson and confirmation of when that individual’s appointment as Chairperson or Vice-Chairperson will take effect. Such notice is to be provided 21 days before that appointment of Chairperson or Vice-Chairperson takes effect. The same notification procedure shall be followed when the Local Authority who did not appoint the Chairperson or Vice-Chairperson at the start of the local authority Chairperson or Vice-Chairperson appointing period, appoints the Chairperson or Vice-Chairperson after one year of any local authority Chairperson or Vice- Chairperson appointing period, in accordance with Standing Order 7.3.
7.6. The Chairperson shall have discretion, with or without discussion, to determine all questions of procedure where no specific provision is made under these Standing Orders.
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8. CALLING MEETINGS
Ordinary meetings
8.1. The IJB will operate a bi-monthly cycle of meetings in its first year of operation and will review the frequency of meetings thereafter. All meetings will be held on the days, at the times and in the places fixed by the IJB and as then published in its Programme of Meetings.
8.2. The first meeting of the IJB is to be convened at a time and place determined by the Chairperson.
Special meetings
8.3. The Chairperson may call a meeting of the IJB at such other times as he or she sees fit.
8.4. A request for a meeting of the IJB to be called may be made in the form of a requisition specifying the business proposed to be transacted at the meeting and signed by at least two thirds of the voting members, presented to the Chairperson.
8.5. If a request is made under Standing Order 8.4 and the Chairperson refuses to call a meeting, or does not call a meeting within 7 days after the making of the request, the members who signed the requisition may call a meeting.
8.6. The business which may be transacted at a meeting called under Standing Order 8.4 is limited to the business specified in the requisition.
9. NOTICE OF MEETINGS
9.1. Before each meeting of the IJB, or a committee of the IJB, a notice of the meeting specifying the time, place and business to be transacted at it signed by the Chairperson, or a member authorised by the Chairperson to sign on the Chairperson's behalf, is to be sent electronically to every member of the IJB or sent to the usual place of residence of every member of the IJB so as to be available to them at least five clear working days before the meeting.
9.2. A failure to serve notice of a meeting on a member in accordance with Standing Order 9.1 shall not affect the validity of anything done at that meeting.
9.3. In the case of a meeting of the IJB called by members the notice is to be signed by the members who requisitioned the meeting in accordance with Standing Order 8.4.
9.4. Public notice of the time and place of meetings, listing the business to be transacted, will be intimated on the websites of the each of the Constituent Authorities at least three clear working days before the meeting. If the
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meeting is convened at shorter notice, then the notice will be intimated at the time it is convened.
10. PUBLIC ACCESS
10.1. Every meeting of the IJB will be open to the public, except in special circumstances which are set out below:-
10.1.1. the public will be excluded from a meeting of the IJB where it is likely, because of the business itself or what might be said, that Confidential Information would be given to members of the public; and/or
10.1.2. the IJB may decide, by passing a resolution at any meeting, to exclude the public when it is considering an item of business if it is likely because of the business itself or what might be said, that Exempt Information would be given to members of the public. The resolution to exclude the public will make clear which part of the proceedings of the meeting it applies to and explain why the information is exempt.
10.2. If the Chief Officer or the Proper Officer believes that it is likely that Exempt Information or Confidential Information will be given to members of the public they may exclude the whole of a report (or any part of a report) from public viewing. Every copy of any report in that category (or part of that report) will either be marked “Not for Publication” or marked “Confidential”.
10.3. Copies of agendas and reports for meetings of the IJB will be available for the public from the IJB’s website as hosted by, or available via, the Constituent Authorities own websites, during normal office hours for three clear working days before meetings. Minutes of meetings of the IJB will be published.
10.4. Except at the discretion of the Chairperson or where arrangements have been made to allow remote attendance at, or for the webcasting of, the meeting, the IJB will not allow the taking of photographs, use of mobile telephones, or music players during meetings, or to the radio or television broadcasting or tape or digital recording of meetings.
10.5. Members of the public will not be permitted to speak or take part in a meeting of the IJB.
10.6. The Chairperson has power to exclude any member of the public from a meeting in order to prevent or suppress disorder or other behaviour which is impeding or is likely to impede the proceedings of the IJB.
11. ATTENDANCE, QUORUM AND REMOTE ATTENDANCE
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11.1. If a voting member is unable to attend a meeting of the IJB, the Constituent Authority which nominated the member, is to use its best endeavours to arrange for a suitably experienced substitute, who is either a councillor or, as the case may be, a member of the Health Board, to attend the meeting in place of the voting member.
11.2. Professional Members will have a named, appointed deputy who is suitably qualified to attend a meeting of the IJB in that Professional Member’s absence. If a Professional Member is unable to attend a meeting of the IJB that member will arrange for their named deputy to attend the meeting. On appointment, a Professional Member will identify their named deputy. It will be for the IJB to determine whether that person is suitable for appointment as the Professional Member’s deputy.
11.3. If a Stakeholder Member is unable to attend a meeting of the IJB that member may arrange for a suitably experienced proxy to attend the meeting. On appointment, a Stakeholder Member will identify the substitute or substitutes whom they wish to nominate to attend in their absence. It will be for the IJB to determine whether those persons are suitably experienced.
11.4. A substitute attending a meeting of the IJB by virtue of Standing Order 11.1 may vote on decisions put to that meeting.
11.5. No business is to be transacted at a meeting of the IJB unless at least one half of the voting members is present. One half of the voting members of the IJB being the quorum.
11.6. If there is no quorum within 15 minutes from the designated start time for a meeting of the IJB, the Chairperson will adjourn the meeting to another date and time. If the Chairperson is among those absent, the minute will record that no business was transacted because of the lack of the necessary quorum.
11.7. If during any meeting the attention of the Chairperson is called to the number of voting members present, the roll will be called and, if a quorum is not present, the meeting will immediately be adjourned.
11.8. If less than a quorum is entitled to vote on an item because of declarations of interest, that item cannot be dealt with at that meeting.
11.9. Where proper facilities are available, and at the direction of the Chairperson, a member may be regarded as being present at a meeting if he is able to participate from a remote location by a video or other communication link.
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11.10. A voting member participating in a meeting from a remote location will be counted for the purposes of deciding if a quorum is present in accordance with Standing Order 11.9.
11.11. At the discretion of the Chairperson, a member participating in a meeting from a remote location will be excluded from the meeting when an item of business is being considered and it is likely that Confidential Information or Exempt Information would be disclosed.
12. CONDUCT OF MEETINGS
12.1. At each meeting of the IJB, or a committee of the IJB, the Chairperson, if attending the meeting, is to preside.
12.2. If the Chairperson is absent from a meeting of the IJB or a committee of the IJB, the Vice-chairperson is to preside.
12.3. If the Chairperson and Vice-Chairperson are both absent from a meeting of the IJB or a committee of the IJB, a voting member chosen at the meeting by the other voting members attending the meeting is to preside.
12.4. A substitute appointed in terms of Standing Order 11 may not preside.
12.5. If it is necessary or expedient to do so a meeting of the IJB, or of a committee of the IJB, may be adjourned to another date, time or place.
13. URGENT BUSINESS
13.1. Urgent business may be considered at a meeting of the IJB if the Chairperson rules that there is a special reason why the business is a matter of urgency. The reason(s) will be stated at the meeting and recorded in the minutes.
14. ORDER OF BUSINESS
14.1. The business of the IJB will proceed in the order specified in the notice calling the meeting which will be as follows, unless circumstances dictate otherwise:-
14.1.1. Notification of Apologies 14.1.2. Notification of Substitutes 14.1.3. Declarations of Interest 14.1.4. Urgent Business brought forward by the Chairperson in terms of Standing Order 13. Any such business will be intimated at the
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start of the meeting and discussed in the order determined by the Chairperson. 14.1.5. Minutes and Matters Arising
14.2. After the IJB has been sitting for two hours and not longer than two and a half hours, there will be an automatic break of at least 10 minutes. At the discretion of the Chairperson the break may be extended to not more than 30 minutes.
15. CONFLICT OF INTEREST
15.1. A member must disclose any direct or indirect pecuniary or other interest in relation to an item of business to be transacted at a meeting of the IJB, or a committee of the IJB, before taking part in any discussion on that item.
15.2. Where an interest is disclosed under Standing Order 15.1, the other members present at the meeting in question must decide whether the member declaring the interest is to be prohibited from taking part in discussion of or voting on the item of business.
16. RECORDS
16.1. A record must be kept of the names of the members attending every meeting of the IJB or of a committee of the IJB.
16.2. Minutes of the proceedings of each meeting of the IJB or a committee of the IJB, including any decision made at that meeting, are to be drawn up and submitted to the next ensuing meeting of the IJB or the committee of the IJB for agreement after which they must be signed by the person presiding at that meeting.
17. DECISION MAKING
17.1. Where the IJB is to take a decision, the Chairperson will determine whether there is consensus among members on the proposed decision. In the absence of consensus, the question will be determined by a majority of votes of the voting members attending.
17.2. Where the proposed decision consists of a recommendation in a report submitted to the IJB, the recommendation may be moved and seconded by a voting member. Where no amendment to that recommendation is moved and seconded, the Chairperson following discussion will put the matter to the vote for or against the motion. Where an amendment is moved and seconded the Chairperson following discussion will put the matter to a vote for the amendment or the motion.
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17.3. Any motion relevant to the item of business under discussion may be moved by a voting member. If seconded, the motion will be dealt with in accordance with Standing Order 17.2 above.
17.4. In the event of an equality of votes, no decision may be made on that item of business at the meeting and Standing Order 18 will apply.
18. DISPUTE RESOLUTION
18.1. In the event of an equality of votes, the matter will be remitted to the Chief Officer to carry out such further work and to provide such further information as may be required to enable the IJB to reconsider the matter at a future meeting and reach a majority decision.
19. REVOCATION OF PREVIOUS RESOLUTIONS
19.1. No motion which seeks to alter or revoke a decision of the IJB, or has that effect, will be considered or passed until at least six months after the decision was taken originally, unless no less than two thirds of members present and entitled to vote at any IJB meeting agree to reconsider the decision.
20. ALTERATIONS TO STANDING ORDERS
20.1. The IJB shall have the power to alter these Standing Orders at any of its meetings or at a special meeting convened for such purpose provided due intimation of such proposed alterations shall have been sent to each member at least three clear working days before such meeting. All such alterations require to be approved by a two thirds majority of those present and voting.
21. ESTABLISHMENT OF COMMITTEES
21.1. The IJB may establish committees of its members for the purpose of carrying out such of its functions as the IJB may determine. If the IJB chooses do so, it will
21.1.1. determine who will act as Chairperson of that committee 21.1.2. prepare and adopt a Scheme of Delegation setting out the role and remit of the committee and 21.1.3. amend these Standing Orders to set out inter alia the composition, quorum, programme of meetings and all other relevant matters governing the operation of the committee.
22. APPLICATION OF STANDING ORDERS
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22.1 In the event that there is any inconsistency between these Standing Orders and the IJB’s Integration Scheme, the IJB’s Integration Scheme shall prevail. Appendix 1
Confidential Information
Section 50A of the Local Government (Scotland) Act 1973 does not apply to the IJB. Notwithstanding this the IJB has adopted, at Standing Order 10, the key substantive aspects of that Section. The IJB hereby adopts the definition of confidential information within that Section 50A as amended to apply to the IJB:
“Confidential Information” means –
(a) information furnished to the IJB or any of the Constituent Authorities by a Government department upon terms (however expressed) which forbid the disclosure of the information to the public; and (b) information, the disclosure of which to the public is prohibited by or under any enactment or by the order of a court.
It is rare to come across this restriction in practice but not unknown. The Government Protective Marking System comprises five markings. In descending order of sensitivity they are: TOP SECRET, SECRET, CONFIDENTIAL, RESTRICTED and PROTECT. Officers should seek advice from Legal Services if their report has drawn on material from a classified source. The terms ‘UNCLASSIFIED’ or ‘NON’ or ‘NOT PROTECTIVELY MARKED’ indicate that no obligation of confidence attaches to the material in a report so marked.
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Appendix 2
Exempt Information
Section 50J and Schedule 7A of the Local Government (Scotland) Act 1973 do not apply to the IJB. Notwithstanding this the IJB hereby adopts the definition of Exempt Information as defined within that Section 50J and detailed in Schedule 7A as amended to apply to the IJB.
No Description of Exempt Information Qualifications 1 Information relating to a particular employee, former Information relating to a person employee or applicant to become an employee of, or a of a description specified in any particular office holder, former office-holder or applicant to of paragraphs 1 to 4 is not become an office-holder under, the IJB or any of the exempt information by virtue of Constituent Authorities. that paragraph unless it relates 2 Information relating to any particular occupier or former to a person of that description in occupier of, or applicant for, accommodation provided by or at the capacity indicated by the the expense of the IJB or any of the Constituent Authorities. description. 3 Information relating to any particular applicant for, or recipient or former recipient of, any service provided by the IJB or any of the Constituent Authorities. 4 Information relating to any particular applicant for, or recipient or former recipient of, any financial assistance provided by the IJB or any of the Constituent Authorities.
5 Information relating to the adoption, care, fostering or None education of any particular child or relating to the supervision or residence of any particular child in accordance with a supervision requirement made in respect of that child under the Social Work (Scotland) Act 1968.
6 Information relating to the financial or business affairs of any Information falling within particular person (other than the IJB or any of the Constituent paragraph 6 is not exempt Authorities). information by virtue of that paragraph if it is required to be registered under— (a) the Companies Acts (as defined in section 2(1) of the Companies Act 2006); b) the Friendly Societies Act 1974; (c) the Industrial and Provident Societies Act 1965 to 1978; or (d) the Building Societies Act 1962. 7 Information relating to anything done or to be done in respect None of any particular person for the purposes of any of the matters referred to in section 27(1) of the Social Work(Scotland) Act 1968 (providing reports on and supervision of certain persons).
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No Description of Exempt Information Qualifications 8 The amount of any expenditure proposed to be incurred by Information falling within the IJB or any Constituent Authority under any particular paragraph 8 is exempt contract for the acquisition of property or the supply of goods information if and so long as or services. disclosure to the public of the amount there referred to would be likely to give an advantage to a person entering into, or seeking to enter into, a contract with the IJB or any Constituent Authority in respect of the property, goods or services, whether the advantage would arise as against the IJB or any Constituent Authority or as against such other persons. 9 Any terms proposed or to be proposed by or to the IJB or any Information falling within Constituent Authority in the course of negotiations for a paragraph 9 is exempt contract for the acquisition or disposal of property or the information if and so long as supply of goods or services. disclosure to the public of the terms would prejudice the IJB or any Constituent Authority in those for any other negotiations concerning the property or goods or services. 10 The identity of the IJB or any Constituent Authority (as well as None of any other person, by virtue of paragraph 6 above) as the person offering any particular tender for a contract for the supply of goods or services. 11 Information relating to any consultations or negotiations, or Information falling within contemplated consultations or negotiations, in connection with paragraph 11 is exempt any labour relations matter arising between the IJB or any of information if and so long as the Constituent Authorities or a Minister of the Crown and disclosure to the public of the employees of, or office-holders under, the IJB or any of the information would prejudice the Constituent Authorities. IJB or any Constituent Authority in those or any other consultations or negotiations in connection with a labour relations matter arising as mentioned in that paragraph. 12 Any instructions to counsel and any opinion of counsel None (whether or not in connection with any proceedings) and any advice received, information obtained or action to be taken in connection with— (a) any legal proceedings by or against the IJB or any of the Constituent Authorities, or (b) the determination of any matter affecting the IJB or any of the Constituent Authorities, (whether, in either case, proceedings have been commenced or are in contemplation). 13 Information which, if disclosed to the public, would reveal that Information falling within the IJB or any Constituent Authority proposes— paragraph 13 is exempt (a) to give under any enactment a notice under or by virtue of information if and so long as which requirements are imposed on a person; or disclosure to the public might (b) to make an order or direction under any enactment. afford an opportunity to a person affected by the notice, order or direction to defeat the purpose or one of the purposes for which the notice, order or direction is to be given or made.
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No Description of Exempt Information Qualifications 14 Any action taken or to be taken in connection with the None prevention, investigation or prosecution of crime. 15 The identity of a protected informant. None
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Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 8 on the agenda
DELAYED DISCHARGE PROGRESS REPORT
(Paper presented by Phillip Gillespie)
For Noting
Approved for Submission by Shiona Strachan, Chief Officer Author Phillip Gillespie, Assistant Head of Social Services Date: 22 March 2016 List of Background Papers:
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Title/Subject: Delayed Discharge Progress Report Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Phillip Gillespie, Assistant Head of Social Services Action: For Noting
1. Introduction
1.1 The purpose of this paper is to update the Integration Joint Board on the performance of the Clackmannanshire and Stirling Partnership in relation to the national delayed discharge target of 2 weeks. The longer term trend information relating to delayed discharge performance is set out in appendices 1, 2 and 3 of this report.
2. Recommendation
2.1 The Integration Joint Board (IJB) is asked to; • note the performance of the partnership based on the February 2016 census and provide appropriate challenge;
3. Background
3.1 As at February census date, there were a total of 4 patients delayed awaiting discharge from hospital for Clackmannanshire, and 1 patient delayed for more than 2 weeks. In Stirling, there was a total of 7 patients delayed awaiting discharge from hospital, of which 4 patients were delayed for more than 2 weeks.
3.2 Table 1 - Clackmannanshire Council Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb 15 15 15 15 15 15 15 15 15 16 16 Total delays at census point (As of 0 2 5 6 3 2 3 8 2 4 4 15th of each month) Total numbers of 0 1 0 4 1 2 1 1 0 1 1 delays over 2 weeks
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Table 2 - Stirling Council Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb 15 15 15 15 15 15 15 15 15 16 16 Total delays at census point (As of 1 15 11 11 7 9 10 17 5 8 7 15th of each month) Total numbers of 0 3 3 6 3 4 10 6 1 1 4 delays over 2 weeks
3.3 In addition to standard delays, there are patients whose discharge is complex (code 9) and whose discharge is part of a longer discharge planning process (code 100). The latter tend to be patients who are in long stay learning disability or mental health inpatient services. Code 100 relates to those patients who have been assessed for transfer to a specialist resource where no such resource is available or exists. Examples of this include patients awaiting transfer to a community setting as part of a commissioning or resettlement programme. As of 15 February 2016, Clackmannanshire and Stirling both had 1 patient each with a Code 100 applied.
3.4 Code 9 was introduced for very limited circumstances where NHS Chief Executives and local authority Directors of Social Work (or their nominated representatives) could explain why the discharge of patients was out with their control. These include patients delayed due to awaiting place availability in a high level needs’ specialist facility where no facilities exist and where an interim option is not appropriate, patients for whom an interim move is deemed unreasonable or where an adult may lack capacity.
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Table 3 - shows the total number of standard delays in Clackmannanshire expressed as bed days lost.
Table 3 - Clackmannanshire Council Apr May June July Aug Sept Oct Nov Dec Jan Feb 15 15 15 15 15 15 15 15 15 16 16 Total Bed Days lost 0 26 23 122 33 43 49 87 14 32 49 Standard Delays Total Bed Days Occupied 0 N/A N/A 120 17 43 29 27 0 25 28 over 2 weeks
Table 4 shows the total number of standard delays in Stirling expressed as bed days lost
Table 4 - Stirling Council Apr May June July Aug Sept Oct Nov Dec Jan Feb 15 15 15 15 15 15 15 15 15 16 16 Total Bed Days lost 60 106 140 248 95 109 316 233 33 68 110 standard Delays Total Bed Days Occupied N/A N/A N/A 178 64 85 301 172 18 25 92 over 2 weeks
4. Analysis of reasons for delay
4.1 The principal reasons for delay during the reporting period in both Stirling and Clackmannanshire was the result of the primary choice of care home being unavailable and patients awaiting the conclusion of a legal process/Guardianship. At the February census 6 patients were delayed awaiting the conclusion of a legal process in Stirling and 3 patients delayed in Clackmannanshire. The primary reason for Guardianship delays during this reporting period was a delay in acquiring legal aid for private Guardianship applications.
4.2 In Stirling there were a total 27 discharges from hospital of which 19 patients were discharged home with a care package 6 patients were discharged to a care home and 2 patients to intermediate care. In total 24 patients from Stirling were added to Edison the electronic recording system during the reporting period.
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4.3 In Clackmannanshire 7 patients were discharged form hospital with 4 patients returning home with a package of care 3 patients admitted to a care home and 1 patient admitted to intermediate care. In total 9 patients from Clackmannanshire were added to Edison the electronic recording system during the reporting period.
5. Conclusions
5.1 The report sets out the performance of the Clackmannanshire and Stirling Partnership based on the census data of 15 February 2016. The report advises the Integration Joint Board on the principal reasons for delay and the actions being taken forward by the Partnership to mitigate the delays.
6. Resource Implications
6.1 N/A
7. Impact on IJB Outcomes, Priorities and Outcomes
7.1 The actions outlined in this report contribute to the delivery of the National and local outcomes set out in the Strategic Plan.
8. Legal & Risk Implications
8.1 Risk as above.
9. Consultation
9.1 The Head of Social Services, the General Manager for Forth Valley Community Health Partnership's and the Chief Officer for Clackmannanshire & Stirling Health and Social Care Partnership have been consulted in the compiling of this report.
10. Equalities Assessment
10.1 N/A
11. Exempt reports
11.1 No
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Appendix 1
Delayed Discharges Over 2 Weeks by Month and Local Authority Excludes Codes 9 and 100
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Appendix 2
Delayed Discharges OBDs Over 2 Weeks by Month and Local Authority Excludes Codes 9 and 100
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Appendix 3
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Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 9 on the agenda
Strategic Plan
(Paper presented by Shiona Strachan)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Lesley Fulford, Programme Manager Chris Sutton, Service Manager Strategy Robert Stevenson, Senior Planning Manager Date: 22 March 2016 List of Background Papers: 2015.10.27 Clackmannanshire & Stirling IJB - Strategic Plan & Strategic Needs Assessment Update 2016.02.24 Clackmannanshire & Stirling IJB - Strategic Plan Appendix 1 – Draft Strategic Plan Appendix 2 – Draft Easy Read Strategic Plan Appendix 3 – EQIA
Title/Subject: Strategic Plan Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Lesley Fulford, Programme Manager
Action: For Approval
1. Executive Summary
1.1. As set out by the Public Bodies (Joint Working) (Scotland) Act 2014 the Partnership must prepare and publish a Strategic Plan prior to 1 April 2016.
1.2. This paper provides the revised draft Strategic Plan to the Integration Joint Board for approval to publish pending final financial resource information.
1.3. In addition this paper provides information on engagement and consultation work undertaken to revise and develop the draft Strategic Plan.
2. Recommendations
The Integration Joint Board is asked to:
2.1. Approve the final draft Strategic Plan (appendix 1) which has been revised following a period of public consultation.
2.2. Approve the final draft easy read Strategic Plan (appendix 2) which has been revised following a period of public consultation.
2.3. Approve the equality and impact assessment (appendix 3) for publication.
3. Strategic Plan
3.1. As set out by the Public Bodies (Joint Working) (Scotland) Act 2014 the Partnership must prepare a Strategic Plan that: • Sets out the arrangements for carrying out the integration functions over the period of the plan • Sets out how those arrangements are intended to achieve, or contribute to achieving, the national health and wellbeing outcomes and the Partnerships local vision and outcomes • Sets out the separate arrangements for carrying out the integration functions in relation to each locality area • Has due regard to the effect which any arrangements may have on services, facilities and resources. • Has regard of the integration delivery principles • Has regard of the national health and wellbeing outcomes & local outcomes • Includes other material as considered fit
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3.2. The Strategic Plan was developed based on discussion and engagement at a series of events held throughout the year.
• A range of fora were attended during January 2015 during consultation on the integration scheme • Staff engagement events held in May and June 2015 • Public Engagement Event May 2015 • Public Engagement Events September & October 2015
3.3. Integration Joint Board Members are asked to approve the draft Strategic Plan in appendix 1 for publication.
4. Consultation & Engagement
4.1. The Board approved the consultation and engagement report at the 24 February meeting which detailed the engagement work to develop the draft Strategic Plan and consultation undertaken.
5. Financial Plan
5.1. The UK Spending Review published in November 2015 and the subsequent Scottish Draft Budget set out the short to medium outlook for public finances of year on year real term reductions in overall public expenditure until 2020. This financial settlement is set against the demographic pressures outlined within the Strategic Needs Assessment and the need to redesign services to meet our vision and outcomes. The Integration Joint Board will require to ensure that all of the redesigned and commissioned services are aligned to the eight priorities within the Strategic Plan through a process of both review and alignment of the existing redesigns already underway within the partner agencies during 2016/17.
6. Conclusions
6.1. The Partnership have a statutory requirement within the Public Bodies (Joint Working) (Scotland) Act 2014 to publish a Strategic Plan no later than 1 April 2016. This report provides an update on progress and presents a final draft Strategic Plan for the Integration Joint Boards approval to publish pending final financial resource information.
7. Resource Implications
7.1. Chief Finance Officers across all three partners are refining budget papers and will be presenting budget information under a separate agenda item at this meeting.
8. Impact on IJB Outcomes, Priorities and Outcomes
8.1. Approving this plan will ensure the Board meets their statutory duty to publish a Strategic Plan before 1 April 2016.
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9. Legal & Risk Implications
9.1. If the Integration Joint Board do not approve the draft Strategic Plan at the 22 March meeting there is a risk the Board will not meet their statutory duty to publish a Strategic Plan before 1 April 2016.
10. Equalities and Human Rights Assessment
10.1. The strategic Plan is subject to an Equalities Impact and Human Rights Assessment which is attached at appendix 3.
11. Exempt reports
11.1. No
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Appendix 1 – Draft Strategic Plan
See separate file
Appendix 2 – Draft Easy Read Strategic Plan
See separate file
Appendix 3 – Equality & Impact Assessment
See separate file
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Standard Impact Assessment Document (SIA) Please complete electronically and answer all questions unless instructed otherwise.
Section A
Q1: Name of EQIA being completed i.e. name of policy, function etc. Clackmannanshire & Stirling Health and Social Care Partnership draft Strategic Plan & Strategic Needs Assessment Q1 a; Function Guidance Policy Project Protocol Service Other, please detail
Q2: What is the scope of this SIA
Service Specific Discipline Specific Other (Please Detail)
Clackmannanshire & Stirling Health and Social Care Partnership Adult & older adult services.
Q3: Is this a new development? (see Q1)
Yes No
Q4: If no to Q3 what is it replacing?
Q5: Team responsible for carrying out the Standard Impact Assessment? (please list) Lesley Fulford, Programme Manager, Clackmannanshire & Stirling Health and Social Care Partnership Robert Stevenson, Senior Planning Manger, NHS Forth Valley Chris Sutton, Service Manager, Strategy, Clackmannanshire & Stirling Councils Janette Fraser, Head of Planning, NHS Forth Valley David Niven, Planning & Commissioning Officer, Clackmannanshire & Stirling Councils Oliver Harding, Public Health Consultant, NHS Forth Valley
Q6: Main person completing EQIA’s contact details
Name: Telephone Number:
Department: Email:
Q7: Describe the main aims, objective and intended outcomes The scope of the health and social care partnership is adults and older adults. The strategic plan is a three year plan.
The main aim of the draft Strategic Plan is to enable people in the Clackmannanshire and Stirling Health & Social Care Partnership area to live full and positive lives within supportive communities. The intended outcomes are:
• Self-Management - Individuals, their unpaid carers and families are enabled to manage their own health, care and wellbeing;
1 Page of 10 • Community Focused Supports – Supports are in place, accessible and enable people, where possible, to live well for longer at home or in homely settings within their community; • Safety - Health and social care support systems help to keep people safe and live well for longer; • Decision Making - Individuals, their carers and families are involved in and are supported to manage decisions about their care and • wellbeing; • Experience – Individuals will have a fair and positive experience of health and social care
Our Priorities:
• Further develop systems to enable front line staff to access and share information across professions and organisations. This will enable people receiving services, named care coordinators, and other relevant staff to minimise the time spent duplicating assessment and maximise opportunities to create ‘seamless’ personal outcomes focused care. • Support more co-location of staff from across professions and organisations to enable working in an integrated way where this facilitates the best quality of care, support, and enablement/independence to be achieved. • Develop single care pathways which recognise that there are many more conditions than services available. While one size doesn’t fit all there are benefits to be had from providing consistent and predictable processes. • Further develop anticipatory and planned care services for people with multiple long term conditions. This will include people with dementia and will be tailored to meet people’s preferred personal outcomes and maximises their ability to be actively involved in managing their own conditions. • Provide more single points of entry to services where named care coordinators help people receive more holistic services. Internal links will be made to any other services and supports needed rather than service users approaching each service anew. • Deliver the Stirling Care Village to realise many of the expected benefits of greater levels of Health & Social Care Integration. This will include improved personal outcomes and reduced numbers of assessments by demonstrating many of the innovations noted above. • Develop seven-day access to appropriate services to maximise quality of care; the potential for rehabilitation and recovery; and flow through acute and community services. • Take further steps to reduce the number of unplanned admissions to hospital and acute services by supporting more prevention, early intervention (including Technology Enabled Care), and community based services. This includes medical and social forms of prevention that could impact on future health such as providing information about local groups and activities that can help people stay socially connected and physically active along with more ‘Keep Well’ style health screening and support. Q8: (i) Who is intended to benefit from the function/service development/other (Q1) – is it staff, service users or both?
Staff Service Users Other Please identify ___Providers, third sector, independent sector
(ii) Have they been involved in the development of the function/service development/other?
Yes No
(iii) If yes, who was involved and how were they involved? If no, is there a reason for this action? Comments:
All prescribed stakeholder representatives (as set out in the Public Bodies (Joint Working)(Scotland) Act (2014)) have been involved in the development of the draft Strategic Needs Assessment and draft Strategic Plan through membership of the Strategic Planning Group and Integration Joint Board.
Please see draft consultation and engagement report for the specific detail of engagement work completed
2 Page of 10 over 2014 and 2015 which informed the drafting of the draft Strategic Needs Assessment and draft Strategic Plan and the consultation work undertaken on the draft Strategic Plan in late 2015 which lead to the current revised version. Both the engagement work and consultation involved all prescribed stakeholders.
(iv) Please include any evidence or relevant information that has influenced the decisions contained in this SIA; (this could include demographic profiles; audits; research; published evidence; health needs assessment; work based on national guidance or legislative requirements etc) Comments:
Please see the draft Strategic Needs Assessment for details of the population, including: age, gender, ethnic origin, religion, sexual orientation, population projections, physical disability, learning disability, mental health and wellbeing.
Please also see the draft consultation and engagement report and staff engagement report which has influenced the development of the draft Strategic Plan.
Please also see the Public Bodies (Joint Working)(Scotland) Act (2014) and supporting orders which sets out the legislative requirements for the partnership in relation to the Strategic Plan.
Q9: When looking at the impact on the equality groups, you must consider the following points in accordance with General Duty of the Equality Act 2010 see below:
In summary, those subject to the Equality Duty must have due regard to the need to: • eliminate unlawful discrimination, harassment and victimisation; • advance equality of opportunity between different groups; and • foster good relations between different groups Has your assessment been able to demonstrate the following: Positive Impact, Negative / Adverse Impact or Neutral Impact?
What impact has your review Comments had on the following Provide any evidence that supports ‘protected characteristics’: Adverse/ Positive Neutral your conclusion/answer for Negative evaluating the impact as being positive, negative or neutral (do not leave this area blank) Age x The Strategic Needs Assessment highlights the aging population across Clackmannanshire and Stirling with the proportion of over 75’s being expected to double by 2037 and the increasing numbers who will experience multiple co morbidities.
It is anticipated that the Strategic Plan will have a positive impact on ageing and older people as parts of the plan have been specifically designed, in consultation with local people, with the specific needs of this group in mind.
Further development of anticipatory and planned care services will ensure people are enabled to live full and
3 Page of 10 positive lives in supportive communities.
Providing more single points of entry will help ensure services are wrapped around people.
Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services in order to respond to these changing demographics. Disability (incl. physical/ x The Strategic Plan & Strategic Needs sensory problems, learning Assessment highlights the number of difficulties, communication people with care support needs and needs; cognitive impairment) health conditions in the community:
With a focus on early intervention, prevention and better choice and control the integrated care plan is expected to have a positive impact on disabled people.
The plan takes a more holistic approach to the needs of disabled people and is moving to an approach more in line with the social model of disability that promotes independence and autonomy and places the service user at the centre of their care/ support.
The recognition of the role of carers, many of which may become unwell themselves, should result in more support for both service user and unpaid carers and a better environment for both groups. Gender Reassignment x We are anticipating a neutral impact. Marriage and Civil x We are anticipating a neutral impact. partnership Pregnancy and Maternity x We are anticipating a neutral impact. Race/Ethnicity x The detail of the population can be found in the Strategic Needs Assessment.
Further development of anticipatory and planned care services will ensure people are enabled to live full and positive lives in supportive communities.
Providing more single points of entry 4 Page of 10 will help ensure services are wrapped around people.
Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services in order to respond to these changing demographics. Religion/Faith x The detail of the population can be found in the Strategic Needs Assessment.
Further development of anticipatory and planned care services will ensure people are enabled to live full and positive lives in supportive communities.
Providing more single points of entry will help ensure services are wrapped around people.
Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services in order to respond to these changing demographics. Sex/Gender (male/female) x The Strategic Needs Assessment highlights 69096 males and 73674 females. It further highlights the inequality in life expectancy between males and females. We anticipate the strategic plan will have a positive impact.
Further development of anticipatory and planned care services will ensure people are enabled to live full and positive lives in supportive communities.
Providing more single points of entry will help ensure services are wrapped around people.
Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services in order to respond to these changing demographics. Sexual orientation x The Strategic Plan & Strategic Needs Assessment could not accurately report 5 Page of 10 sexual orientation at national or local level and believe it is unlikely numbers are underrepresented.
Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services in order to respond to these changing demographics. Staff (This could include x The Strategic Plan & Strategic Needs details of staff training Assessment highlights there are completed or required in approximately 3055 staff who will be relation to service delivery) affected by the health and social care partnership strategic plan:
• Clackmannanshire Council 255 • Stirling Council 316 • NHS Forth Valley 2484
The partnership has developed training and organisational development plans to support staff.
Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services in order to respond to these changing demographics.
Cross cutting issues: Included are some areas for consideration. Please delete or add fields as appropriate. Further areas to consider in Appendix B Unpaid Carers x Unpaid carers are represented on the Strategic Planning Group and Integration Joint Board and have been part of the development of the strategic needs assessment and strategic plan. Homeless x Housing contribution statements have been developed and are currently out to consultation to be finalised. Language/ Social Origins x Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services. Literacy x Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services. Low income/poverty x Locality plans will take account of 6 Page of 10 communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services. Mental Health Problems x See disability section above Rural Areas x Throughout the consultation process the different experience of care was evident. A rural strategy will require to be developed to ensure services respond to rural needs in a way that wraps services around people and enables people to live full and positive lives in supportive communities. Armed Services Veterans, x Councils and Health Board have Reservists and former established policies in place. Members of the Reserve Forces Third Sector x Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services. Independent Sector x Locality plans will take account of communities within localities and the more detailed Locality Plans will provide further detail as to how the partnership will design services. Q10: If actions are required to address changes, please attach your action plan to this document. Action plan attached?
Yes No
Q11: Is a detailed EQIA required?
Yes No Please state your reason for choices made in Question 11.
The Strategic Needs Assessment at a Local Authority level will help inform the more detailed iteration of plans which will set out more detail of how we will achieve the vision and ambitious outcomes for the partnership. N.B. If the screening process has shown potential for a high negative impact you will be required to complete a detailed impact assessment.
Date EQIA Completed 01 / 03 / 2016
Date of next EQIA 01 / 03 / 2019 Review
Signature Print Name
Department or Service
7 Page of 10 Please keep a completed copy of this template for your own records and attach to any appropriate tools as a record of SIA or EQIA completed. Send copy to [email protected]
8 Page of 10
B: Standard/Detailed Impact Assessment Action Plan
Name of document being EQIA’d:
Date Issue Action Required Lead (Name, title, Timescale Resource Implications Comments and contact details) 12/01/2016 Locality Plans Locality plans will March 2017 be developed over 2016.
Further Notes:
Signed: Date:
Page 9 of 10
Page 10 of 10
Strategic Plan
DRAFTDRAFTClackmannanshire and Stirling Strategic Plan
2016 - 2019 Health and Social Care Partnership
Clackmannanshire and Stirling Strategic Plan
DRAFT
Clackmannanshire and Stirling Strategic Plan
Contents
Foreword ...... 2 Background to Health & Social Care Integration ...... 3 ...... Clackmannanshire & Stirling Health and Social Care Partnership ...... 3 Integration Joint Board ...... 3 Chief Officer ...... 3 ...... The Strategic Plan ...... 3 ...... Localities ...... 3 Community Planning Partnerships ...... 3 The Case for Change ...... 4 ...... Why do we need to change? ...... 4 Profile of Clackmannanshire Council & Stirling Council Areas ...... 4 Our Vision and Outcomes ...... 9 Our Local Vision and Outcomes ...... 9 Outcomes ...... 9 How we will achieve Improved Outcomes ...... 10 What does all of this mean for you? ...... 11 Services workingDRAFT in partnership ...... 11 Key Themes and Ambitions ...... 12 Our Priorities ...... 15 Case Studies ...... 16 Localities ...... 18 .. .. . Geographical Profile of Forth Valley ...... 19 Which Health and Social Care Services are included within Integration? ...... 20 ...... NHS Forth Valley Services ...... 20 ...... Clackmannanshire Council & Stirling Council Services ...... 20 Housing Contribution Statement ...... 21 Snapshots of Local Services ...... 21 The Financial Plan ...... 22 ...... Development of this Strategic Plan and Next Steps ...... 23 ...... Glossary ...... 24
1 Clackmannanshire and Stirling Strategic Plan
Foreword
Our vision is to enable people in the We know that the proportion of admissions to hospital. Getting Clackmannanshire and Stirling Health & Social older adults in our population is involved at an early stage can lead to Care Partnership area to live full and positive increasing and that more people have better long term outcomes. People lives within supportive communities. complex needs. We also know that living with a number of long-term Clackmannanshire Council, Stirling Council and there are significant differences and and complex health conditions have a NHS Forth Valley have put in place new partnership inequalities – between and within better quality of life when they are able arrangements to deliver adult health and social care our communities. We are committed to manage and be more in control of services. This is to improve the health and wellbeing to working with all our partners to their health and care. prevent and reduce inequalities, of our residents. We want to ensure that people We have developed this three-year promote equality of access and tackle have healthier, fuller lives and live as independently plan which sets out how we will deliver patterns of ill health in communities. and safely as possible in their own communities. services to meet current need but also the needs We will also make best use of all of the resources We want to ensure that we engage with individuals of the population in the future. Fundamental to available to address the agreed priorities for the and their unpaid carers at an early stage in their care this will be making best use of resources to deliver partnership. journey and avoid, wherever possible, unplanned efficient and effective health and social care. This plan has been developed with help and comment from many individuals and groups. We would like to take this opportunity to thank DRAFTeveryone who has given their time to attend events, respond to the consultation questions, and contributed to sections of the plan. All of your involvement is appreciated and over the coming years we look forward to engaging with everyone who has an interest in health and social care to help deliver on our Plan.
Shiona Strachan Chief Officer, Clackmannanshire & Stirling, Health and Social Care Partnership
Clackmannanshire and Stirling 2 Clackmannanshire and Stirling Strategic Plan
Background to Health & Social Care Integration
Clackmannanshire & Stirling Health and The Strategic Plan Social Care Partnership This document, the Strategic Plan, describes The Public Bodies (Joint Working) (Scotland) Act how the Clackmannanshire and Stirling Health 2014 requires Health Boards and Local Authorities and Social Care Partnership will make changes to integrate the planning for, and delivery of, adult and improvements to develop health and social health and social care services. Clackmannanshire services for adults over the next three years. This Council, Stirling Council and NHS Forth Valley have is a high level plan underpinned by a number of established a Health and Social Care Partnership national and local policies, strategies and action across the Clackmannanshire and Stirling Council plans which will be profiled and updated on the areas. The partnership approach will also be Clackmannanshire & Stirling Integration web-page. extended to third and independent sector It will provide the strategic direction for how health colleagues. and social care services will be shaped in this area in Localities Integration Joint Board the coming years and describes the transformation that will be required to achieve this vision. The plan The Clackmannanshire & Stirling Partnership area The Integration Joint Board has representatives from explains what our priorities are, why and how we will be divided into three smaller areas called Clackmannanshire and Stirling Councils, NHS Forth decided upon them and how we intend to make a localities. The development of localities will support Valley Health Board, the Third Sector, representatives difference by working closely with partners in the the principle of collaborative working across primary of those who use health and social care services, and DRAFTClackmannanshire and Stirling area. and secondary health care, social care and third and unpaid carers. The Board, through the Chief Officer, The Strategic Plan for Clackmannanshire and Stirling independent sector provision. Further service and has responsibility for the planning, resourcing and will take account of the Strategic Plan for the condition related planning will be undertaken over operational oversight of integrated services within Falkirk partnership area, particularly where it relates the coming period including the development of the Strategic Plan. to some of the specialist and hospital services locality and neighbourhood plans to tailor services Chief Officer which are planned and delivered across the Forth to local circumstances. The Chief Officer is responsible for management Valley area. The Plan will also take account of the Community Planning Partnerships of the integrated budget and ensuring integrated Strategic Plans for other neighbouring partnerships, The Clackmannanshire and Stirling Health & service delivery. The Chief Officer is accountable recognising that some services are planned on Social Care Partnership will work closely with to the Integration Joint Board and to the Chief a regional basis and that some residents in the the Community Planning Partnerships in both Executives of the Health Board and the Local Clackmannanshire and Stirling Council areas access Clackmannanshire (Clackmannanshire Alliance) and Authorities for the delivery of integrated services. services delivered by neighbouring Health Boards. Stirling (Stirling Community Planning Partnership) to ensure that all efforts are aligned to the respective Single Outcome Agreements.
Clackmannanshire and Stirling 3 Clackmannanshire and Stirling Strategic Plan
The Case for Change Clackmannanshire and Stirling Population 2014
Why do we need to change? 142,770 We recognise that the way we provide care needs to change in order to meet both current and future challenges. If we do nothing, health and care services Age 0-15 24,618 17.2% as they are will not be able to deliver the high quality service we expect. Age 16-49 63,021 44.1% Research at a national level along with local conversations has shown that there are a number of reasons why we need to change, which include: Age 50-64 28,926 20.3% Those who use our services are asking us to deliver more integrated care Age 65-74 14,942 10.5% More people are living longer, many with a range of conditions and illnesses, therefore demand for existing services is changing 73,674 69,096 Age 75+ 11,263 7.9%
We need to continuously improve services and contribute to better Source: NRS 2014 mid-year population estimates. personal outcomes The table above tells us that in 2014 Clackmannanshire & Stirling had a There is an opportunity to make better use of public resources. combined population of 142,770, with 73,674 females and 69,096 males. In the following graphs and tables we present a snap shot of information that helps to show the scale and nature of the need for Health and Social Care services across Clackmannanshire & Stirling and some key Population Projections and Age Distribution characteristics of the current population. Clackmannanshire and Stirling A Strategic Needs Analysis containing muchDRAFT more comprehensive information, statistics and analysis relating to a range of conditions specific 75+ to each local authority area will be published in 2016. Further work will be undertaken during 2016 to provide Strategic Needs Analysis information at 65-74 2037 a more local level again and this will be used to inform the locality planning 50-64 work referred to previously on page 3. This will ensure implementation is 2012 Ag e tailored to specific local needs for example needs experienced in rural areas or 16-49
areas where there are higher levels of drug or alcohol misuse. 0-15 Profile of Clackmannanshire Council & Stirling Council Areas The total population of Clackmannanshire is expected to stay relatively 0 10,000 20,000 30,000 40,000 50,00060,000 70,000 stable between now and 2037 while the population of Stirling is Populaon expected to rise steadily up to 2037. During this period we expect to see a pronounced increase in the number of people aged 65 years and over Source: NRS 2014 mid-year Population estimates in both areas, and this includes a more than doubling of the population of The bar chart above shows age groups for the population of people aged 75 years and over. Clackmannanshire & Stirling in 2012 and estimated figures for the same age groups in 2037. Clackmannanshire and Stirling 4 Clackmannanshire and StirlingClackmannanshire and Stirling Strategic Plan
Household Composition Population by Urban / Other Urban Areas Clackmannanshire and Stirling Rural Category Large Urban Areas C & S Scotland Accessible Rural Clackmannanshire, Stirling Accessible Small Towns One-person household, aged under 65 18.5% 21.6% Remote Rural One-person household, aged 65+ 12.8% 13.1% and Scotland Remote Small Towns Couple / family everyone aged 65+ 8.5% 7.5% 4.9% 6.1% Source: 2011 Census The table above shows the make up of households in Clackmannanshire & 14% 3.4% Stirling compared to Scotland from the 2011 Census. 11.7% 39.8% 28.7% 35.1% 53.3% 9.3% 46.2% People with a Disability 13.1% 34.5% Clackmannanshire and Stirling People with a Learning Disability 707 Clackmannanshire Stirling Scotland known to GP practices * Source: Scottish Government Urban/Rural Classification 2013/14 and National Records of People with a Physical 9,252 Scotland. Disability ^ People with a severe mental healthDRAFT The Population by Urban / Rural Category information presented above shows condition known to GP practices v 1,178 that both Clackmannanshire and Stirling have a significantly different pattern of settlement types and locations compared with the average for Scotland. Neither * Source: QOF register 2014 Clackmannanshire or Stirling have any Large Urban areas. ^ Source: 2011 Census
v Source: QOF as at March 2014 It should be noted that Stirling has just over one third of its population living in a combination of Accessible Rural and Remote Rural areas compared with 14% in The combined ‘People with a Disability’ information presented above compares Clackmannanshire and 18% on average across Scotland. favourably to equivalent rates across Scotland. Clackmannanshire has slightly higher than the national average rates of people who have learning disabilities and people who have physical disabilities. Stirling has below the national average rates for all three classes of disability and Clackmannanshire also has a lower than the national average rate of people who have a severe mental health condition known to GP practices.
Clackmannanshire and StirlingClackmannanshire and Stirling 5 Clackmannanshire and Stirling Strategic Plan
Long Term Conditions Dementia Clackmannanshire and Stirling Clackmannanshire and Stirling People diagnosed with Dementia 1,073 25,000 20,000 Alzheimer Scotland estimate of 15,000 number of people with Dementia 2,345 10,000
Number of People 5,000 Source: QOF as at March 2014
0 The table above shows (based on 2014 data) there are 1,073 people diagnosed Asthma CHD COPD Diabetes Heart Failure Hypertension Stroke & with Dementia in Clackmannanshire & Stirling, while Alzheimer’s Scotland estimate (Coronary (Chronic Transient Heart Obstrucve Ischaemic the number of people living with Dementia in Clackmannanshire and Stirling to be Disease) Pulmonary Aack (TIA) Disease) approximately 2,345.
Source: QOF as at March 2014 Hospital Inpatient Care 2010-12 The bar chart above shows the number of people in Clackmannanshire & Stirling with a long term condition such as asthma or hypertension. Clackmannanshire and Stirling People who had emergency Estimated Number of Long Term Conditions by admissions to hospital 26,107 Age Group Clackmannanshire and Stirling DRAFTPeople aged 65+ with two or more 2,891 100 emergency admissions in a year 90 1 disorder 80 2 disorders 70 3 disorders Source: ScotPHO Health and Wellbeing Profiles 2014 60 4 disorders 50 5+ disorders The table above shows (based on 2014 data) that there were 26,107 emergency 40
Paents (% ) admissions to hospital from Clackmannanshire & Stirling during 2010 to 2012 and 30 20 of those admissions 2,891 people were aged 65+ and had 2 or more emergency 10 0 admissions within a 12 month period. 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+ The Estimated Number of Long Term Conditions by Age Group graphic to the left Age Group (years) demonstrates that as the proportion of older adults increases in Clackmannanshire and Stirling there will be an increase in the number of people with multiple long Source: The Challenge of Multimorbidity in Scotland, Professor Stewart Mercer term conditions e.g. diabetes; heart and lung conditions. The bar chart above shows the percentage of patients by age category and the number of long term conditions they are estimated to have. People with more than one long term condition are currently making many trips to hospital clinics to see a range of specialists which might be coordinated in a better way. Clackmannanshire and Stirling 6 Clackmannanshire and Stirling Strategic Plan
Alcohol & Drug Misuse Long Term Mental Health Conditions, Percentage of Clackmannanshire and Stirling Population within Gender and Age Group. Clackmannanshire and Stirling Indicator Clackmannanshire Stirling Scotland Alcohol related hospital stays* 510.5 456.2 696.9 12 Alcohol related mortality* 38.9 16.7 21.4 10 Drug related hospital stays* 79.9 89.5 124.6 Males 8 Drug related mortality* 14.7 6.6 10 Females
6 Source: ScotPHO Drug Profile 2013/14 *rate per 100,000 population (%) 4
Alcohol related mortality is the rate per 100,000 people where alcohol is the 2 underlying cause of death. The rate in Clackmannanshire was slightly above 0 the national rate in 2009, fell below the national average for the following three 0 to 15 16 to 24 25 to 34 35 to 49 50 to 64 65 to 74 75 to 84 85 and over years, only to rise above it in 2013. In Stirling, the alcohol related mortality rate Age group has been below the Scottish average in each year from 2009 to 2013. In 2012/2013 across Clackmannanshire and Stirling there were an estimated Source: 2011 Census 1,450 people aged 15-64 experiencing problem drug use. Problem drug use can The bar chart above is taken from the 2011 household census. The bar chart lead to a number of health and social problems. The estimated prevalence of DRAFTillustrates the percentage of the population in Clackmannanshire and Stirling who those with a problem drug use has increased in Clackmannanshire and Stirling have identified themselves or someone in their household as having a mental between 2009/10 and 2012/13. health condition, split across gender and age. The question does not define a This is in contrast to Scotland as a whole, where the estimated percentage of the mental health condition or take into account multiple mental health conditions. population experiencing problem drug use has fallen slightly.
Clackmannanshire and Stirling 7 Clackmannanshire and Stirling Strategic Plan
The Carers Strategy for Scotland 2010-2015 states that “Carers are equal partners in the planning and delivery of care and support. There is a strong case based on human rights, economic, efficiency and quality of care grounds for supporting carers. Without the valuable contribution of Scotland’s carers, the health and social care system would not be sustained. Activity should focus on identifying, assessing and supporting carers in a personalised and outcome-focused way and on a consistent and uniform basis.” The green box below highlights how many people have been identified as providing unpaid care in the Clackmannanshire and Stirling Partnership area and acknowledges there are likely to be many DRAFTmore. Carers 12,958 People in the Clackmannanshire and Stirling Partnership area identified themselves as unpaid carers. (2011 Census) Approximately 1/3 of these unpaid carers are known to local services It is estimated that there are as many as 10,000 more unpaid carers in the Partnership area – 23,000 in total (Scottish Health Survey, 2013) 1,386 carers in Clackmannanshire provide 50 plus hours unpaid care per week (2011 Census) 1,991 carers in Stirling provide 50 plus hours unpaid care per week (2011 Census)
Clackmannanshire and Stirling 8 Strategic Plan
Our Vision and Outcomes
Our Local Vision and Outcomes Outcomes Our Vision is to enable people in the There are nine National Health and Wellbeing Outcomes set by the Scottish Government that our Partnership Clackmannanshire and Stirling Health & Social Care will deliver against: Partnership area to live full and positive lives within National Health & Wellbeing Outcomes supportive communities. People are able to look after and improve their own health and Our local outcomes are based on the national 1 Healthier living wellbeing, and live in good health for longer. Health and Wellbeing Outcomes and were developed in partnership with all stakeholders: People, including those with disabilities, long-term conditions, or who 2 Independent living Self-Management - Individuals, their unpaid are frail, are able to live as far as reasonably practicable, independently carers and families are enabled to manage their at home, or in a homely setting, in their community. own health, care and wellbeing; People who use health and social care services have positive 3 Positive experiences and Community Focused Supports – Supports are experiences of those services, and have their dignity respected. outcomes in place, they are accessible and enable people, where possible, to live well for longer at home Health and social care services are centred on helping to maintain or 4 Quality of life or in homely settings within their community; improve the quality of life of service users. Safety - Health and social care support systems Health and social care services contribute to reducing health help to keep people safe and live wellDRAFT for 5 Reduce health inequality inequalities. longer; Decision Making - Individuals, their carers People who provide unpaid care are supported to look after their own 6 Carers are supported and families are involved in and are supported health and wellbeing, including to reduce any negative impact of their to manage decisions about their care and caring role on their own health and well-being. wellbeing; People who use health and social care services are safe from harm. Experience – Individuals will have a fair and 7 People are safe positive experience of health and social care People who work in health and social care services are supported to 8 Engaged workforce continuously improve the information, support, care and treatment they provide, and feel engaged with the work they do.
To deliver Best Value and ensure scarce resources are used effectively 9 Resources are used effectively and efficiently in the provision of health and social care services. and efficiently
9 Clackmannanshire and Stirling Strategic Plan
How we will achieve Improved Outcomes
All integration activity must be delivered with full recognition of the Planning and Delivery Principles, The main purpose of the integration planning and delivery principles is to as set out in the Public Bodies Act. The principles improve the wellbeing of service-users and to ensure that those services are set out the values and approach that we will adopt provided in a way which: whilst working together. are integrated from the point of view of service-users take account of the particular needs of different service-users takes account of the particular needs of service-users in different parts of the area in which the service is being provided take account of the particular characteristics and circumstances of different service-users respects the rights of service-users take account of the dignity of service-users take account of the participation by service-users in the community in which service-users live protects and improves the safety of service-users improves the quality of the service DRAFT are planned and led locally in a way which is engaged with the community (including in particular service-users, those who look after service-users and those who are involved in the provision of health or social care) best anticipates needs and prevents them arising makes the best use of the available facilities, people and other resources
ClackmannanshireClackmannanshire and Stirling and Stirling 10 Strategic Plan
What does all of this mean for you?
Services working in partnership By bringing health and social care services across Clackmannanshire & Stirling together, we have the opportunity to improve our outcomes through joint working, better communication, improved efficiency and reduced duplication. The people of Clackmannanshire & Stirling will be at the heart of redesigning services. They will be involved in designing changes to services which will focus on people and put them first. Through working together, we can start to tackle the issues identified in our Strategic Needs Assessment. We recognise the critical role of the whole workforce in determining the success of partnership working. We held staff engagement events across It is essential that our plans are informed and owned Clackmannanshire and Stirling and these were by those who work most closely with service users, attended by colleagues from the third and their families and carers and their local communities. DRAFTindependent sectors as well as health and This will include volunteers and staff from third and social care staff. We encouraged and supported independent sector providers as well as those who participants to imagine a more integrated future work in statutory health and social care services. By and asked them to describe what this would look recognising the strengths and all of the resources and feel like from the perspective of an individual within partnerships and communities, and taking using health or social care services. The individual advantage of opportunities such as shared learning, was given a generic name - Sam - so that they we can maximise outcomes for people and improve could be either male or female. Everyone’s ‘Sam’ wellbeing. experienced different health and care needs and was in contact with different services. Through completing this exercise, we identified key themes that would enable integrated services to make things better for Sam. In the following section we will describe the key themes. 11 Clackmannanshire and Stirling Strategic Plan
Key Themes and Ambitions
Keeping SAM at the centre and using material gathered as part of the engagement sessions and from other events, we have identified our ambitions for what an ‘integrated future’ should look like for each Theme:
“Sam can “Sam’s unpaid access the right carer knows who 1 Early intervention and prevention. The right care is delivered for me at the right time service at the to call and talk to right time” if they need help.”
Sam and his/her unpaid carer When Sam requires to make contact with services he/she can do so easily and quickly, have a named care coordinator knowing where to go for help. This is supported through, for example, availability of relevant (or single point of contact), who and appropriate 7-day services, co-located services and single points of access which operate ‘facilitates’ care and support beyond business hours. planning, being able to ensure Sam also has easy access to information about community based voluntary groups and activities. timely access to appropriate This helps Sam to stay socially connected and physically active within the local neighbourhood. services. DRAFTThis reduces the likelihood of isolation and minimises the need for formal services.
“Sam is supported to 2 Service users are supported to self manage Sam has an integrated, single, shared care plan for the and plan care proactively plan, which is regularly reviewed (including future.” with Sam’s unpaid carer), and which is also anticipatory in nature. This plan is flexible Those providing care and support proactively “Sam lives enough to respond where their needs change, identify any change in Sam’s condition and a life – not and ensures that outcomes are shared, even ensure early intervention, avoiding the need for always dealing if Sam loses capacity. a subsequent crisis response. with a crisis.”
Clackmannanshire and Stirling 12 Strategic Plan
“Sam takes on responsibilities for Sam is supported to self-manage, through his/her care and has 3 Service Users exercise Choice & Control education and awareness-raising. This is fewer unnecessary balanced by ensuring that Sam and Sam’s intrusions into unpaid carer know who to contact/where to go, his/her life” should she/he need help. Technology solutions Sam is well- informed, has a clear understanding are in place which enables Sam to be more of what to expect and from whom, and is able “Sam has the independent, by providing care closer to home. to access all of the necessary information. Sam is information to Care is better co-ordinated, with fewer people in control, having choice and ownership of care make decisions involved, consistent faces, and a frequency of arrangements (e.g. through Self-directed Support), about what he/ involvement matched to Sam’s needs. including where and when it is provided. she needs.”
“Sam’s care Sam and Sam’s unpaid carer receive high- is wrapped quality, holistic, person-centred, outcomes- 4 Staff are skilled and supported to deliver around his/her focussed care, which meets their individual person-centred and integrated care DRAFTneeds, not the needs and is effectively coordinated and other way streamlined even when moving between round.” services.
“Sam’s unpaid carer is fully Unpaid carers are themselves well-supported, 5 Carers are recognised and valued as equal involved and engaged their own needs having been assessed and partners in the design and delivery of care as an equal partner by met in a timely manner. all health and care providers”
13 Clackmannanshire and Stirling Strategic Plan
If Sam is admitted to hospital; effective joint “Sam does planning takes place (including with Sam’s 6 There is a focus on Rehabilitation, Recovery not require unpaid carer) to ensure a smooth, safe and and Reablement across all services. There are unplanned, timely discharge. Rehabilitation and fewer avoidable admissions and discharge emergency, reablement services are in place which help planning is effective and efficient. hospital care” Sam to remain at home, or to return home quickly, but safely, following a period in hospital.
“Sam and “Sam is Sam’s unpaid carer 7 Services work together with communities to This is supported able to stay have access to through improved improve access to services and build capacity – at home and additional, targeted working with third sector and community groups participate in information and advice availability and use across and within localities. This reduces health community to support them to of assets within the inequalities within and across our communities. activities” manage their health community. DRAFT& care needs”
Clackmannanshire and Stirling 14 Strategic Plan
Our Priorities Provide more single points of entry to Deliver the Stirling Care Village to realise services where named care coordinators help many of the expected benefits of greater In order to address the key themes presented on people receive more holistic services. Internal levels of Health & Social Care Integration. This the previous pages and to achieve our ambitions for links will be made to any other services and will include improved personal outcomes Sam we will: supports needed rather than service users and reduced numbers of assessments by Further develop systems to enable front approaching each service anew. demonstrating many of the innovations noted line staff to access and share information above. across professions and organisations. This Develop seven-day access to appropriate will enable people receiving services, named services to maximise quality of care; the care coordinators, and other relevant staff potential for rehabilitation and recovery; and to minimise the time spent duplicating flow through acute and community services. assessment and maximise opportunities to Take further steps to reduce the number of create ‘seamless’ personal outcomes focused unplanned admissions to hospital and acute care. services by supporting more prevention, early Support more co-location of staff from intervention (including Technology Enabled across professions and organisations to Care), and community based services. This enable working in an integrated way where this includes medical and social forms of prevention facilitates the best quality of care, support, and that could impact on future health such as enablement/independence to be achieved. providing information about local groups and Develop single care pathways which activities that can help people stay socially recognise that there are many more conditionsDRAFT connected and physically active along with than services available. While one size doesn’t fit more ‘Keep Well’ style health screening and all there are benefits to be had from providing support. consistent and predictable processes. Further develop anticipatory and planned The decisions associated with our priorities care services for people with multiple long identified in this section of the Strategic Plan will be term conditions. This will include people with based on the efficient and effective use of available dementia and will be tailored to meet people’s resources, what we already know works well in this preferred personal outcomes and maximises area, and from the evidence base and findings of their ability to be actively involved in managing well conducted local, national, and international their own conditions. research.
15 Clackmannanshire and Stirling Strategic Plan
Case Studies Below are some examples that have been shared with us about how services across We already have good examples of how joined up working between health, social Clackmannanshire and Stirling are working together to support better outcomes: care, the independent and third sector can make a difference. We know that our staff are keen to build on existing relationships and remove barriers to joined up working. Janet is 27 and has a long term mental illness. She lives at home on her own. She has The focus will be on co-locating and integrating teams, starting where there is found it difficult to maintain relationships with family and friends. While she would already evidence of joint working, and supporting more streamlined and coordinated very much like to work, this has been difficult due to frequent episodes of mental illness. pathways for those who use our services. Janet has experienced times of crisis in her life and she has been detained in hospital due to significant concerns about her safety in the community. Mary had a Stroke and was admitted to hospital. She is now ready to go home, but not Having these yet able to live independently on her own as she did before. Janet is now arrangements in place supported by the enables Janet and those that support Integrated Mental Health her to recognise when her mental health Mary needs is fragile and what supports are likely to Through one Team based at her local help with everyday tasks enable Janet’s mental health to stabilise assessment, by an Occupational Resource Centre. She has a key such as showering, walking, meal once again. She can contact her key worker Therapist from the Integrated worker who has supported Janet to preparation and shopping. This and, if necessary, a prearranged plan Reablement Team, Mary agrees a develop care management and usually involves Homecare, can be put in place before a crisis care plan which deals with all of her risk management plans. Physiotherapy, Occupational Therapy, results in her returning needs. Equipment is promptly provided meal delivery, social care for some to hospital. and the Reablement Home Carers visit With Janet equipment and emergency alarm as Mary twice a day to help her return as feeling confident that services well as potentially some other far as possible to her former will support her in the way which community based DRAFT independent self. she has identified as being effective supports. Mary is and at the time she needs them, she is reviewed regularly by the confident that she can cope better through Occupational Therapist or developing social contacts in group work Physiotherapist and after three settings and by undertaking voluntary months Mary no longer needs work with a view to employment homecare. With the Reablement Home in the future. Janet has Carers support she has met her goals of avoided falling into crisis and With some walking to the local shop and has not required emergency extra bathing equipment, carrying out most treatment in many months. She meal delivery service and a everyday tasks. continues to be able to access community alarm, Mary feels support as and when she has safe and happy to live at identified she requires it. home independently She feels far more in control.
Clackmannanshire and Stirling 16 Strategic Plan
Mr Brown (81) lives at home with his wife and had fallen three times during the night Mrs Smith was a resident in a local Independent Sector Care Home for the last six within 4 months. The social care Mobile Emergency Care Service (MECS) had been called months of her life, due to a progressing life limiting condition. each time. Mrs Brown is frightened that her husband will not be able to stay at home with her if he keeps on falling. She wants to continue to care for him but she does not Care home staff know how she can do this and keep them both safe. NHS Forth Valley and Strathcarron Hospice were able to initiate have supported the care sensitive conversations with The assessment MECS support home staff to develop good Mrs Smith and her family identified that Mr Brown a falls pathway and they regarding progression and had difficulty locating the toilet quality skills and knowledge automatically alerted the management of her illness at night, he had recent diagnosis about providing quality falls service to Mr Brown’s of dementia, his medications end of life care. early in her care. case and a full falls made him drowsy and his assessment was offered mobility was slower than and completed. Through sensitive would be expected. Mrs Smith died discussion an advanced care peacefully in her care plan tailored to her needs was Mr Brown is home with her family developed. This included her wishes now able to safely go present. The family felt their regarding her physical, psychosocial and Mr Brown was to the toilet at night and mother had a good death spiritual outcomes and also decisions offered an enhanced Telecare continues his falls preventionDRAFT and her care had been with regards to resuscitation. Her GP solution in the form of an alternative exercises with his wife. sensor light. He was also offered a excellent. was involved and key information He has not short course of therapeutic day care on her medical records fallen again. where he learned strength and updated. balance exercises and he saw Due to anticipating his GP to discuss his needs and planning for Mrs Brown medication. was supported to access advanced care, no crisis arose, a regular short break to no Out of Hours medical enable her to both continue calls were required and no within her caring role and admission to hospital to sustain a life out was necessary. with it.
17 Clackmannanshire and Stirling Strategic Plan
Localities
The Public Bodies (Joint Working) (Scotland) Act There will be three localities within the 2014 requires the partnership to identify localities Clackmannanshire and Stirling partnership: one
for the planning and delivery of services at a local locality in Clackmannanshire and two in Killin level. A locality is defined in the Act as a smaller Stirling. These three localities areas are Tyndrum A85 area within the borders of the partnership area. sufficiently large to offer scope for Crainlarich Lochearnhead The development of localities will support the service planning and development, principle of collaborative working across primary while also providing scope for local and secondary health care, social care and third and involvement. The three localities are independent sector provision. There will be a strong aligned as far as possible with the ways in Callander focus on community involvement and engagement which Primary and Secondary Health Services, A84 aligned with the existing place based initiatives and Housing and Social Services, and other services, Aberfoyle Dunblane Community Planning Partnership neighbourhood are currently delivered. The localities reflect the River Forth Alva A91 Dollar level activity across Clackmannanshire and Stirling. needs of Clackmannanshire and Stirling areas Loch Alloa Lomond A811 This will include community test sites and will and recognise the differences between the large Stirling support the wider aspirations for communities rural area and Stirling City. Drymen across the partnership area. The three localities are: DRAFT Clackmannanshire - Population 51,280 Stirling City with the Eastern Villages, Bridge of Community Hospitals Allan and Dunblane - Population 70,222 Clackmannanshire Locality Rural Stirling - Population 21,038 Rural Stirling Locality Stirling City with the Eastern Villages, *Population figures are mid year estimates from Bridge of Allan and Dunblane Locality 2013 Scottish Neighbourhood Statistics Clackmannanshire & Stirling Health & Social Care Partnership Area
Clackmannanshire and Stirling 18 Strategic Plan
Geographical Profile of Forth Valley
This map shows the localities created within Clackmannanshire & A82 Dundee Stirling, and shows the Falkirk area Killin to highlight the whole geographical A90 Tyndrum area covered by NHS Forth Valley. A85 The map also illustrates the location A85 Crainlarich Lochearnhead of Forth Valley Royal Hospital which Perth provides acute services to all of Forth Valley. 2
A8 A9
2 Callander A9 A917 A83 A91 A8 Anstruther 4 Aberfoyle Dunblane A915 River Forth Alva A91 Dollar Glenrothes Loch Alloa A97 Lomond A811 Acute Hospital Stirling A92 Kirkcaldy DRAFTA985 1 Community Hospitals Drymen A92 Clackmannanshire Locality Kincardine 1 Larbert Rural Stirling Locality A8 Stirling City with the Eastern Villages, Falkirk Boness Bridge of Allan and Dunblane Locality Polmont A82 A80 Falkirk Council Area A1 Clackmannanshire & Stirling Health Edinburgh & Social Care Partnership Area Livingston A720 Dalkeith A8 Glasgow
Motherwell
19 Clackmannanshire and Stirling Strategic Plan
Which Health and Social Care Services are included within Integration?
Our partnership will be responsible for planning and NHS Forth Valley Services Clackmannanshire Council & Stirling Council commissioning integrated services and overseeing Community based services Services their delivery. These services cover all adult social Social work services for adults and older people care, adult primary and community health care District Nursing Services and support for adults with physical services and the elements of adult hospital care Services related to substance addiction or disabilities and learning disabilities which will offer the best opportunities for service dependence Mental health services redesign. Services provided by Allied Health Professionals The health and social care partnership will have in outpatient clinics or out of hospital Drug and alcohol services a key relationship with acute health services and Public dental service / Primary medical services Adult protection and domestic abuse will work closely with the full range of Community (including out of hours) / General dental, Carers support services Planning Partners to optimise wellbeing throughout Ophthalmic and Pharmaceutical services Community care assessment teams the area. This approach will include working with Services provided out-with a hospital in relation Support services third sector organisations, independent sector, to geriatric medicine and palliative care and all of the other public sector bodies to deliver Care home services Community Mental Health and Learning flexible locality based services, including services Adult placement services Disability services commissioned on a Forth Valley wide basis such as Health improvement services Continence and kidney dialysis services Alcohol and Drugs Services. DRAFTprovided out-with hospitals Aspects of housing support, and provision of While doing so, we will make the most of assistance including aids and adaptations, and Services that promote public health opportunities to work in partnership directly with gardening assistance communities in the planning and design of services. Day services Local area co-ordination Respite provision Occupational therapy services Re-ablement services, equipment and telecare
Clackmannanshire and Stirling 20 Strategic Plan
There are other, hospital based, services that are Housing Contribution Statements Snapshot of Local Services included for planning purposes. This will ensure that Housing providers have for many years contributed Did you know? we are planning for the whole pathway of care for positively to improving health and well-being across individuals. These services are listed below. Across Clackmannanshire and Stirling: our communities. It is not only about enabling Accident and Emergency independent living for people, but also being Community Nurses provide more than 1500 home Inpatient hospital services relating to (General more effective in helping to prevent admissions visits and treatment room appointments each Medicine / Geriatric Medicine / Rehab to hospital, alleviating delayed discharge and week. Medicine / Respiratory / Psychiatry of Learning contributing to tackling health inequalities affecting Community Rehabilitation Teams (ReACH) assess Disability) the population. more than 60 new people who have been referred Palliative care services Overall, to achieve improved outcomes across with rehabilitation / reablement needs, and make Inpatient hospital services provided by General the population it is important that Integration around 300 community based visits, each week. Medical Practitioners. Authorities and Strategic Housing Authorities work Social Services commission 11,500 hours per week Hospital based Mental Health and addiction or closely together on key aspects of housing support of post reablement Personal Care at Home from dependence services including: private sector providers that is provided free of Assessing the range of housing support needs charge to service users. across the population and understanding the Integrated Mental Health Services in link with health and social care needs; Clackmannanshire receive 200 appropriate Identifying common priorities that are reflected referrals per month and strive to maximise in both the Local Housing Strategy and the proportion of referrals that are picked up by DRAFTStrategic Commissioning Plan; community based mental health services (current Identifying and making best use of resources target is 65%). A similar approach is being adopted to meet the housing support needs of the local across Stirling. population. Care Homes contracted with Social Services are at Housing Contribution Statements have been 90% occupancy levels with 228 beds across 4 care developed for Clackmannanshire and Stirling on an homes in Clackmannanshire and 511 beds across individual local authority basis and can be accessed 13 care homes in Stirling. on the Clackmannanshire & Stirling Integration web- page.
21 Clackmannanshire and Stirling Strategic Plan
The Financial Plan
Partnership Budget The partnership budgets have been set taking into Financial and Economic Outlook account: The budget has been set taking into account the The UK Spending Review published in November requirements of The Public Bodies (Joint Working) A ‘due diligence’ process which examined the 2015 and the subsequent Scottish Draft Budget set (Scotland) Act 2014, national guidance and the budgets and expenditure for the 3 financial out the short to medium outlook for public finances Integration Scheme for the partnership. years preceding the establishment of the of year on year real term reductions in overall public partnership expenditure until 2020. This financial settlement The partnership budget for 2016/17 totals £X.XXXm. National guidance on budgets for Health and is set against the demographic pressures outlined The budget is made up from contributions from the Social Care Partnerships from the Integrated within the Strategic Needs Assessment and the NHS Forth Valley, Clackmannanshire Council and Resourcing Advisory Group (IRAG) need to redesign services to meet our vision and Stirling Council as follows: outcomes. The Integration Joint Board will require to The financial settlements to NHS Boards and ensure that all of the redesigned and commissioned £m Local Authorities for 2016/17 from Scottish services contribute to the delivery of the eight Government NHS Forth Valley X.XXX priorities identified within this Strategic Plan. This Clackmannanshire Council X.XXX will be achieved through a process of review and closer alignment of the changes already underway Stirling Council X.XXX within the partner agencies during 2016/17. Total Partnership Budget 2016/17 X.XXX In the early part of financial year 2016/17 the DRAFTPartnership will develop a Financial Plan to underpin this strategic plan setting out how it intends to best utilise the resources available to meet the priorities stated within this plan. It is the intention to develop a Financial Plan covering 3 years to allow medium to longer term service planning.
Clackmannanshire and Stirling 22 Strategic Plan
Development of this Strategic Plan and Next Steps
The improved service delivery methods proposed Participation and Engagement as part of Health and Social Care Integration have The process undertaken to develop the Strategic Plan not been developed in isolation. The approaches has been underpinned by the Partnerships desire detailed in this plan are the result of many cycles of to ensure the participation and engagement of all continuous improvement, national guidance and stakeholders. A Participation and Engagement Strategy strategies, and many local strategies and plans. A will be published on the Clackmannanshire & Stirling summary of some of the national guidance and Integration web-pages. legislation, local strategies, plans, processes and events is provided below: How will we know we have been successful? National A Performance Framework is being developed The Public Bodies (Joint Working) (Scotland) based on national guidance and national and Act 2014; local indicators. This will also help to measure progress against the national and local outcomes. The Social Care (Self-directed Support) The framework will be published on the (Scotland) Act 2013; and Clackmannanshire & Stirling Integration web-page. Community Empowerment (Scotland) Act 2015. Next Steps Equality Act 2010 DRAFTThe Strategic Plan for the Clackmannanshire & Stirling Alcohol, Drug and Tobacco Strategies Partnership is based on a Strategic Needs Assessment and draws on a range of existing initiatives and plans Local Plans and Strategies which are consistent with the vision and outcomes Joint Strategic Commissioning Plan for Older for the Partnership. The Strategic Needs Assessment Developing the Plan & Consultation People’s Care 2013-2023 along with the National Outcomes, the Housing Autism strategy The Strategic Plan was developed as a result Contribution Statements for Clackmannanshire and Mental Health strategy of a series of engagement events held during Stirling Councils, the Performance Framework, the 2015 and it was consulted upon between the Clackmannanshire and Stirling Integrated Carers Participation & Engagement Strategy, and the Easy 18 November and the 24 December 2015. Strategy implementation Plans Read version all form part of the Strategic Plan. The resulting comments have shaped the During the life of the Strategic Plan further work will Clackmannanshire and Stirling Integrated Care final version of the plan. A report outlining be carried out to develop the detailed priority and Programme the results of the consultation process is implementation plans; the three Locality Plans; and available on the Clackmannanshire & Stirling the Market Facilitation Plan. Integration web-page.
23 Clackmannanshire and Stirling Strategic Plan
Glossary
Acute Care is a branch of health care where people The Housing Contribution Statement (HCS) sets ReACH is an NHS Forth Valley Service which receive active but short-term treatment for a severe out the arrangements for carrying out the housing provides outreach Physiotherapy and Occupational injury or episode of illness, an urgent medical functions delegated to the Integration Authority Therapy services covering “Rehabilitation & condition, or during recovery from surgery. Acute under the Public Bodies (Joint Working) (Scotland) Assessment in Community & Home”. care services are generally provided in a formal Act 2014. Strategic Commissioning is the term used hospital setting. The Independent Sector encompasses those for all the activities involved in assessing and Anticipatory Care / Plans can take many forms traditionally referred to as the ‘private’ sector. It forecasting needs, linking investment to agreed however it is expected to help reduce avoidable includes organisations of varying types and sizes, desired outcomes, considering options, planning and unscheduled acute admissions for people with amongst them single providers, small and medium the nature, range and quality of future services pre-existing conditions. The purpose of advanced/ sized groups and national providers. and working in partnership to put these in place. anticipatory care planning is to support the Joint commissioning is where these actions are Long Term Conditions (LTC) are conditions that individual to have greater choice, and control of undertaken by two or more agencies working last a year or longer, impact on many aspects of care preferences through communication across together, often from a pooled or aligned a person’s life, and may require ongoing care and the support team, across agencies and across care budget. ( National Steering Group for Strategic support. The definition does not relate to any one settings. Commissioning 2012) condition, care group or age category, so it covers The Body Corporate Model is a model of adults and older people as well as children and The Strategic Needs Assessment is an analysis of integration where a Health Board and Local mental as well as physical health issues. Common the health and social care needs of the population Authority delegate the responsibility for planningDRAFT long term conditions include epilepsy, diabetes, to inform and guide service planning. The main and resourcing service provision for health and some mental health problems, heart disease, goal of the Strategic Needs Assessment is to social care services to an Integration Joint Board, chronic pain, arthritis, inflammatory bowel disease, accurately assess the health and care needs of a established as a separate entity. asthma and chronic obstructive pulmonary disease local population in order to improve the physical Health Inequalities are the unfair and avoidable (COPD). and mental health and wellbeing of individuals and communities. differences in people’s health across social groups Reablement is about giving people the opportunity and between different population groups. Health and the confidence to relearn/regain some of the Technology Enabled Care refers to the use of Inequalities do not occur randomly or by chance, skills they may have lost as a result of poor health, telehealth, telecare and telemedicine in providing but are socially determined by circumstances largely disability / impairment or entry into hospital or care for people that is convenient, accessible and beyond an individual’s control. These circumstances residential care. As well as regaining skill, reablement cost-effective. These services use technology to disadvantage people and limit their chance to live a supports service users gain new skills to help them support people to live safely and independently in longer, healthier life. maintain their independence. their own homes, and can be helpful to people at risk of falls.
Clackmannanshire and Stirling 24 Strategic Plan
Glossary
The Third Sector is a term used to describe the range of organisations that are neither public sector nor private sector. It includes voluntary and community organisations (both registered charities and other organisations such as self-help groups and community groups), social enterprises, mutuals and co-operatives. It also includes local intermediary organisations (Third Sector Interfaces).
A further glossary of terms can be found on the Clackmannanshire & Stirling IntegrationDRAFT web-page.
25 Clackmannanshire and Stirling Strategic Plan
DRAFT
Clackmannanshire and Stirling Strategic Plan
Publications in Alternative Formats
We are happy to consider requests for this publication in other languages or formats such as large print. Please call 01324 590886 (24hrs), fax 01324 590867 or email [email protected] DRAFT
Clackmannanshire and Stirling
Clackmannanshire and Stirling Strategic Plan - Easy Read Version
2016 - 2019 Health and Social Care Partnership
Hello, Clackmannanshire Council, Stirling Council and NHS Forth Valley will be working together in new ways to help people to stay healthy, happy and independent. People are living longer and often with more health problems. We want to help with this and make sure everyone has the same chance of good health and wellbeing. We want to make sure that people stay healthy. We want people to be more in control of their health and care. We want people to live happily at home for as long as possible. This is our 3 year plan. It is called The Strategic Plan.
Shiona Strachan, Chief Officer, Clackmannanshire and Stirling, Health and Social Care Partnership
Why are things changing?
People have asked for better joined up services from the NHS and Councils.
People are living longer and with more health problems.
We can spend public money in a better way.
There is a new Government law called The Public Bodies (Joint Working) (Scotland) Act 2014. The law says that the NHS and Council areas have to work together to provide adult care. This is called integration. Clackmannanshire Council, Stirling Council and NHS Forth Valley are now in a Health and Social Care Partnership to provide integrated adult care. Who will help to make it happen?
This is the plan of how we will make adult services better. The Integration Joint Board and the Chief Officer need to make sure the integrated services are delivered well.
What are the outcomes?
Outcomes are the result of what we do. We will look for outcomes in these areas to see if things are getting better.
Self-Management - People are able to look after their health, care and wellbeing.
Community Supports - People can live well at home or in a home they like in their community, for as long as possible.
Safety - People are safe and live well for longer.
Choice - People make choices about their care.
Feelings - People are happy with the care they get.
Everyone getting care should feel well supported. Everyone should feel that their care support teams are working well together to provide their care. In the next 3 years, together we will
Make sure that your care team can easily find out and share important information about your care.
Make sure that staff who work best together for you work in the same place.
Make sure it’s easy to understand what will happen when you need help.
Set up support plans for people with long term health problems.
Make it easier for you to contact the service you need for help.
Set up more 7 days a week health and care services.
Open the Stirling Care Village.
Spend money on what works well.
Help unpaid carers to stay healthy and feel supported so that they can continue to provide care.
Try to help people stay healthy and well at home so that they only go into hospital when they need to.
Together we can work to make sure you get the best care. Localities
Killin Tyndrum A85
Crainlarich Lochearnhead
Callander A84 Aberfoyle Dunblane River Forth Alva A91 Dollar Loch Alloa Lomond A811 Stirling Drymen
Community Hospitals Clackmannanshire Locality Rural Stirling Locality Stirling City with the Eastern Villages, Bridge of Allan and Dunblane Locality Clackmannanshire & Stirling Health & Social Care Partnership Area
The Clackmannanshire & Stirling Partnership area will be divided into three smaller areas called localities to help plan and deliver services.
Publications in Alternative Formats
We are happy to consider requests for this publication in other languages or formats such as large print. Please call 01324 590886 (24hrs), fax 01324 590867 or email [email protected]
Clackmannanshire & Stirling Transitional Board
22 March 2016
This report relates to Item 10 on the agenda
Health and Social Care Integration Report on Consultation on Housing Contribution Statements
(Paper presented by Susan White and Steve Mason)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author: Susan White (Housing Development & Regeneration Leader, Clackmannanshire Council) and Steve Mason (LHS Officer, Stirling Council) Date: 22 March 2016 List of Background Papers: Housing Contribution Statement for Clackmannanshire Housing Contribution Statement for Stirling Scottish Government [2015] Housing Advice Note Joint Improvement Team [2015] Making the Connection: Guide to assessing the housing related needs of older and disabled households
Title/Subject: Consultation on Housing Contribution Statements Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Shiona Strachan Action: For Approval
1. Introduction
1.1. This paper presents the finalised Housing Contribution Statements for the Clackmannanshire and Stirling Integration Authority. The Housing Contribution Statements for Clackmannanshire and Stirling are contained at Appendix 1 and 2.
2. Executive Summary
2.1. Housing Contribution Statements are an integral part of the Strategic Plan. The Statements have been compiled, highlighting the key housing related issues for Stirling and Clackmannanshire. The draft Statements were subject to public consultation in February 2016.
3. Recommendations
3.1. The Board approves the finalised Housing Contribution Statements as set out in Appendix 1 and 2.
4. Background
4.1. At its meeting on 26 January 2016, the Board approved the draft Housing Contribution Statements for formal consultation. Prior to the consultation commencing, the drafts were amended as a result of comments received from Stirling Voluntary Enterprise and Forth Valley Alcohol & Drug Partnership.
4.2. The period of consultation covered two weeks up to 26 February 2016.
4.3. There were a total of 11 responses to the consultation. It was not possible in all cases to identify who had submitted comments. Some responses were simply expressing agreement with the content of the HCSs. Some were lengthy and detailed. A summary of the significant comments is provided in Appendix 3.
4.4. The Housing Contribution Group has a role in developing the housing related work of the Partnership and will be working with partner agencies, third sector bodies, service users and unpaid carers. Four workshops are planned in 2016 to examine the accommodation and support needs of different groups of service users and unpaid carers. The first is to be in April 2016 and will look at meeting the accommodation needs of people experiencing mental health difficulties. These exercises will also help to inform the Councils' Local Housing Strategies.
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4.5. The consultation has proved to be a worthwhile process which will assist the Partnership and the Housing Contribution Group to focus on key issues. The revised Housing Contribution Statements will include a future commitment to developing a single joint Housing Contribution Statement for Clackmannanshire & Stirling.
5. Resource Implications
5.1 The housing-related resources identified for the functions set out in the Government's advice note, detailed in the Aids and Adaptations Service Scoping Update report presented to the Board on 26 January 2016, are currently being verified. The Board will receive an update on resources at the meeting and figures will be set out in the Housing Contribution Statements as agreed by the board.
5.2 The Board agreed at the meeting in January that current delivery arrangements will continue and that senior officers from all three organisations will develop an outcomes based Service Level Agreement (SLA) between the Integration Joint Board and Clackmannanshire and Stirling Councils. This will be drawn up via the Housing Contribution Group, in line with the priorities set out in the Strategic Plan and the Housing Contribution Statements.
6. Impact on IJB Outcomes, Priorities and Outcomes
6.1. This is in line with statutory requirements and priorities.
7. Legal & Risk Implications
7.1. Not applicable for purposes of this report.
8. Consultation
8.1. The first phase of consultation took place through the Strategic Planning Group and through a workshop facilitated by the Joint Improvement Team which was attended by a range of stakeholders. The second phase of consultation took place over two weeks in February. A wide range of partner organisations were encouraged to download the documents from the website and to make comment.
9. Equalities Assessment
9.1. No Equalities and Human Rights Impact Assessment is required for the recommendations in this paper.
10. Exempt reports
10.1. Not exempt.
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Clackmannanshire Council’s Housing Contribution Statement
2016 - 2019
Health and Social Care Integration Strategic Plan Clackmannanshire and Stirling Health & Social Care Partnership Strategic Plan
Clackmannanshire Council's Housing Contribution Statement 2016/19
The Partnership’s Strategic Plan describes in the following terms the importance of joint working with Strategic Housing Authorities: Housing providers have for many years contributed positively to improving health and well-being across our communities. It is not only about enabling independent living for people, but also being more effective in helping to prevent admissions to hospital, alleviating delayed discharge and contributing to tackling health inequalities affecting the population. This is taken very seriously in Clackmannanshire and the Council's Local Housing Strategy, which sets out the future priorities for housing in the area, has a vision that every household in Clackmannanshire should have access to a good quality and affordable home, with advice and support services that meet their need. Overall, to achieve improved health and social care outcomes across the population, it is important that Integration Authorities and Strategic Housing Authorities work closely together on key aspects of housing support including: Assessing the range of housing support needs across the population and understanding the link with health and social care needs; Identifying common priorities that are reflected in both the Local Housing Strategy and the Strategic Commissioning Plan; Identifying and making best use of resources to meet the housing support needs of the local population.
The format of the Housing Contribution Statement is specified by Scottish Government in its Housing Advice Note1.
This is Clackmannanshire's Housing Contribution Statement. There is a separate plan for the Stirling area.
For the future, we are committed to developing a joint Housing Contribution Statement for Clackmannanshire & Stirling.
1 The Housing Advice Note was published in September 2015 and is ‘Statutory Guidance to Integration Authorities, Health Boards and Local Authorities on their responsibilities to involve housing services in the Integration of Health and Social Care, to support the achievement of the National Health and Wellbeing Outcomes’.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 1 Clackmannanshire's Housing Contribution Statement 2016/19 1. The role of the local housing sector in the governance arrangements for the integration of health & social care.
Clackmannanshire Council's Housing Service is represented on the Health and Social Care Integration Strategic Planning Group, and the Council also has Councillor representation on the Transitional Board of the Partnership. Housing officers from both Clackmannanshire and Stirling Councils meet with colleagues from Social Services and NHS in the joint Stirling and Clackmannanshire Housing Contribution Group, which has the remit to compile the Housing Contribution Statement, working with partners and colleagues to identify relevant resources, needs, priorities and challenges for housing services. The Group is supported by the Joint Improvement Team. Registered Social Landlords (Housing Associations) are consulted to ensure their views are included within the work of the Group. Wider consultation in Clackmannanshire generally takes place through: The Community Planning 'Alliance' framework, which brings together the wide range of community partners The Private Sector Adaptations Review Panel, which involves Occupational Therapists and private sector housing officers Council housing adaptation group Focus sessions as required with individual groups
2. An overview of the shared evidence base and key issues identified in relation to housing needs and the link with health and social care needs.
Connection between Strategic Needs Assessment (SNA) and Housing Needs and Demand Assessment (HNDA) The SNA and HNDA both identify a number of trends in the needs of specialist groups for accommodation and support
The main housing-related issues and gaps in the joint evidence base are described in the Table below
Older people The 2012 based projections show that between 2012 and 2037:
The overall population in Clackmannanshire is projected to decrease by 2%, around 1,200 people, over the next 25 years. This is a reverse of the 2010 predictions that showed an overall increase of 6,800 people. Net outward migration is greatest amongst 16-29 year olds - this has a major effect on population balance as the future population gets older.
A net average of 169 people between the age of 0 - 44 left Clackmannanshire each of the past 2 years. 26 more people 65+ came into the area than left. This trend points to a significant long term increase (over the next 25 years) of 79% of over 65 year olds and 126% of people over 75 years. Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 2 Clackmannanshire's Housing Contribution Statement 2016/19
There are 5 registered care homes in Clackmannanshire with 233 places, 196 of whom are long stay residents (Scottish care home census March 2014). Data from the 2014 Scottish Care Home Census indicates that 68% of all residents of care homes within Clackmannanshire required nursing care and 32% had a diagnosis of dementia.
There are 176 sheltered flats and bungalows in the area, providing warden care on site.
The Council's newest housing development will provide 21 amenity bungalows and flats by early 2016. All other housing developments are capable of meeting the needs of older people with a high level of accessibility as standard.
Figures suggest that around 13% of over 75 year olds suffer from dementia.
People with physical At least 1,691 people of all ages in Clackmannanshire were assessed as having a physical disability last year. According to disabilities census information 2011, just over 5.000 of all ages classed themselves as having some kind of physical disability. Over the council area, there are around 31 wheelchair properties owned by housing associations and the Council has 2 wheelchair and 37 ambulant disabled properties. 285 approved medical adaptations were carried out in the Council's stock in 2014/15. There were 22 grant assisted major adaptations carried out in the private sector in 2014/15. There are around 1,600 pieces of adaptation equipment in use across Clackmannanshire.
People with learning 156 people in Clackmannanshire completed a community care assessment due to learning disabilities. disabilities In Clackmannanshire there are 10 supported places for clients with learning disabilities. New Struan School caters for autistic children and has several residential places for children coming from outwith Clackmannanshire. More information needs to be gathered on the number of people with learning disabilities who rely on the support of their ageing parents. There are 3 care homes located in the Clackmannanshire area for people with learning disabilities.
People experiencing 161 people in Clackmannanshire completed a community care assessment last year due to mental health issues. There is mental health often a link with mental health issues and homelessness and the Council offers support service to allow people to live in their difficulties own tenancy.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 3 Clackmannanshire's Housing Contribution Statement 2016/19 People affected by There are services within the statutory and voluntary sector in Clackmannanshire offering the full range of treatment and drug and alcohol interventions to support the recovery of those affected by alcohol and/or drugs. These services are available for adults and misuse young people and a family support service for substance misuse is also available. The number of people with alcohol related brain disorder (ARBD) and other drug and alcohol related problems is increasing. This can lead to a range of housing issues including homelessness, anti-social behaviour and problems with tenancy sustainment, all of which require additional housing support options. Forth Valley Alcohol and Drug Partnership is carrying out work to see if the lives of those with ARBD can be improved by giving them a timely diagnosis and tailor made care plan.
Survivors of domestic There are 2 self contained units that are used for families fleeing domestic abuse. abuse Children and young people coming out of care are not part of the Integration Authority, but these issues are highlighted as a Vulnerable young priority because they inevitably overlap with other services and are important to prevention of future problems. people: Young people coming out of care who require housing are placed in temporary accommodation until a permanent place can be found. Support is provided from social services, through-care, after-care team. Young people taking on their first tenancy will be supported by the housing support team to help sustain the tenancy.
Black & minority According to research carried out in 2007, the size of the ethnic minority community in Clackmannanshire is around 1,100, ethnic communities : the 2011 census shows 1,900 people coming from black & ethnic minority backgrounds.
Travelling Community Clackmannanshire has a site with capacity for 17 travelling families, including a pitch suitable for a wheelchair user. The site is rarely full.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 4 Clackmannanshire's Housing Contribution Statement 2016/19
3. Shared outcomes and service priorities linking the Strategic Commissioning Plan and Local Housing Strategy.
The nine national health and well-being outcomes are: 1 Healthier living People are able to look after and improve their own health and wellbeing, and live in good health for longer. 2 Independent living People, including those with disabilities, long-term conditions, or who are frail, are able to live as far as reasonably practicable, independently at home, or in a homely setting, in their community. 3 Positive experiences and outcomes People who use health and social care services have positive experiences of those services, and have their dignity respected. 4 Quality of life Health and social care services are centred on helping to maintain or improve the quality of life of service users. 5 Reduce health inequality Health and social care services contribute to reducing health inequalities. 6 Carers are supported 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 well-being. 7 People are safe People who use health and social care services are safe from harm. 8 Engaged workforce People who work in health and social care services are supported to continuously improve the information, support, care and treatment they provide, and feel engaged with the work they do. 9 Resources are used effectively and efficiently To deliver Best Value and ensure scarce resources are used effectively and efficiently in the provision of health and social care services.
Clackmannanshire's Local Housing Strategy (LHS) 2012-17 has a vision that every household in our area should have access to a good quality and affordable home, with advice and support services that meet their needs. This is pivotal to the health and wellbeing of our citizens. The Housing Strategy therefore supports the improvement of these social care services and health outcomes.
The Health and Social Care Integration framework will support partners to come together in a focussed way, to agree the key shared priorities. Essential to this will be the development of the Integration Authority's Strategic Needs Assessment, which will provide more detailed and accurate information to inform the necessary improvements to service delivery. Shared priorities will include sharing data, faster assessment, reshaping care for older people and integrated delivery of services.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 5 Clackmannanshire's Housing Contribution Statement 2016/19 The 8 priorities identified in the Housing Strategy, and their outcomes, detailed below, contribute to these national outcomes, but particularly to outcome 2: Independent Living, outcome 4: Quality of Life, outcome 7: People are Safe and outcome 9: Resources are used effectively and efficiently.
Priority Outcome Activity New Housing Quality affordable housing We will continue to develop and implement innovative and flexible models for providing cost effective Supply is maximised new housing, and maximise the amount of housing across all tenures.
Best Use of The housing we already We need to use the housing we already have to maximum effect to ensure we can cater for the Existing Housing have is optimised and diverse needs of the growing number of households. We need a diverse housing system so that effective in providing choice people have more control and more choice. Our ‘Housing Options’ approach will enable us to meet and meeting need housing need and help to prevent housing crises, with a wider range of solutions which will help us to use stock more effectively, and we will continue to look at allocations policies and nomination arrangements to make sure those most in need can be prioritised. We consider the scope to alter Council and housing association properties to better suit demand.
Homelessness Homelessness is reduced We aim to target resources at prevention to provide better outcomes for people and reduce the need and homeless and for costly crisis intervention. All evidence nationally points to crisis prevention being the most effective potentially homeless method in dealing with homelessness and requires a multi agency approach, including education, households have access to voluntary and employability services. A focus is needed on services to young people (although not all effective and appropriate are part of the Integration Authority in this partnership), single people and on prevention, as with the housing options development of the Housing Options service. It is important to target resources to help people stay in the tenancies they already have. The average cost to the Council of a failed tenancy for a family, and resulting homeless application, can be up to £25,000. Offering support services, such as basic living skills and money and benefit advice, will help to prevent tenancies failing. We undertake an assessment of support needs for all households applying as homeless ensuring that support needs are established early, so that services can work together to ensure a good housing solution for clients.
Support for Those requiring assistance Through ‘Reshaping Care for Older People’, Council, Health, Voluntary and Independent Sector Independent to live independently at colleagues are working together to establish how best to provide services for our older people. Living home have access to In line with the national ‘Getting It Right For Every Child’ (GIRFEC) principles and our Corporate effective housing support Parenting Strategy, we need to ensure that there is suitable housing available for vulnerable young people, including supported housing. We will target services to support young people and give them the skills necessary to live independently. Many young people need help with basic living skills, including budgeting and cooking. Some also need support with mental health, alcohol and drug related issues. A high number of young people who have a tenancy end up leaving within the first year. For some, intensive support is required and there can be issues with isolation and getting young people to engage. For others, more general support or information and advice, including preparing for a tenancy, is needed. The Council’s Housing Management service has established an initiative to
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 6 Clackmannanshire's Housing Contribution Statement 2016/19 work directly with young people coming through the care route, to ensure they receive the support they need to sustain their tenancy and live independently. (in relation to children and young people, the Integration Scheme refers to adults aged 18 years and over - children's legislation extends the responsibility of councils' children's services for young people leaving care/aftercare). We are monitoring the length of time people stay in their tenancies and can now identify people who may be at risk of tenancy failure when they receive an offer of a house. We have adopted person centred services involving a full assessment of vulnerability and early identification of support needs and potential risks to a tenancy. This means that more intensive support can be targeted to these households to help them to sustain their tenancy, reducing the number of abandonments and preventing homelessness. The Housing Support service targets people with multiple and complex needs who are homeless or at risk of homelessness. With the rise in the number of people with multiple and complex needs, the delivery of support will remain a central priority in the coming years. Work needs to continue to improve referral processes and information sharing between services
Specialist People have access to Specialist housing ranges from mainstream housing with major adaptations to housing for specific Housing specialist or adapted client groups. Smaller, minor adaptations can also allow people to continue to live in their own homes. accommodation where There is a lack of variety of specialist accommodation in Clackmannanshire. Most is provided by the there is an assessed need Council and RSLs and ranges from amenity and sheltered housing to more specialist accommodation suitable for people with learning disabilities and wheelchair accessible housing. Of the 812 properties available, the vast majority are for older people with only 32 (4%) for people with learning disabilities and 33 (4%) for people with a physical disability. Few purpose built specialist accommodation units have been provided in recent years. Of the 354 registered care places available throughout Clackmannanshire, the majority are for older people. Around one quarter are for people with complex needs and one quarter for people with learning disabilities, many of these being older people. There are very few places for people with mental health issues and young people. Adult care figures have shown an annual increase in the number of people with learning disabilities over the last few years. Many are now in their late 40s and 50s with very elderly parent carers and who have never lived on their own. Many may also have more complex needs due to their increasing age. This will present challenges in the future as we will need to provide accommodation that will suit this ageing client group. We will also need to enable young people with learning disabilities to become independent as early as possible so that they can plan for their future and we can develop services and plan housing provision accordingly. A Clackmannanshire and Stirling Housing and Social Services Strategy identified ways to improve services and specialist accommodation provision across both councils. A work programme is underway and specialist housing will be delivered on all appropriate new housing developments.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 7 Clackmannanshire's Housing Contribution Statement 2016/19 There remains an issue around notification of discharge from hospital and often unrealistic expectations, from customers and professionals, of what housing providers can deliver, particularly within short timescales invariably involved.
In 2011/12, 44% (235) of all applicants assessed as homeless were young people, many of whom lack the skills necessary to sustain a tenancy. Approximately one fifth of them do not sustain a tenancy beyond 1 year and some return as repeat homeless applicants. We also have young people coming through the care system who have high tenancy failure rates.
There is a need for further accommodation with support, such as the new project at Hallpark, to help this vulnerable group live comfortably and safely in the wider community. Interim supported accommodation, where young people can learn skills necessary to maintain a tenancy and live independently, either on their own or with someone else, will reduce tenancy breakdown.
Further close working with Social Care and Health services and the independent and third sectors is required to define need, identify gaps in supply, deliver the right type of housing required and improve communication to ensure a co-ordinated approach to assessment of housing need. With Health and Social Care integration and the shift to community based support, we will agree models of accommodation that allow independence with support onsite or nearby.
The Private Sector Stock Condition survey (2009) suggests that there are around a further 194 households in the private sector requiring a major adaptation. The number of major adaptations carried out in the public sector has fluctuated over the last 5 years but, since 2010, the number and cost has continued to increase. As a statutory requirement, adapting housing in both the public and private sectors will be an ever increasing priority and a challenge to resource. With the growing demand for adaptations there is an increasing cost and complexity of adapting existing housing. We are faced with substantial costs for redesigning existing houses, often requiring extensions to deliver the extra space needed, and consideration needs to be given to the policy of adaptation compared with relocation.
The Council does not currently provide any short-stay gypsy traveller halting sites, having assessed and analysed the potential need for such sites. Historically, we have not had a serious problem with unauthorised encampments. The Council rarely has a waiting list for available pitches at its own site and occupancy remains consistent throughout the year. Recent experience suggests that there may be a move towards the national trend for smaller sites. We will keep the situation regarding need under review.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 8 Clackmannanshire's Housing Contribution Statement 2016/19 Energy Efficiency Energy efficiency is Energy efficiency is a priority because of its impact on individual households and their quality of life, and Fuel Poverty improved and fuel poverty and because of the damaging effect on the environment. The Council will engage with partners such and carbon emissions are as local RSLs, British Gas and the Scottish Government to successfully complete projects contributing reduced across all tenures. to increased energy efficiency across all housing tenures. In 2011, it was estimated that 5,110 families in Clackmannanshire were in fuel poverty (22.8% of all households). However, this overall figure masks individual areas with concentrations of high fuel poverty levels Households suffering from fuel poverty can be especially vulnerable so it is crucial to target this group to ensure that these individuals are aware of all the programmes available to assist them. Some will also be affected by welfare reform, cutting their household benefits and reducing rent subsidies which will have a negative effect on fuel poverty levels.
Improving Organisations and Developing joint working with the voluntary sector is a Council priority and the Clackmannanshire Neighbourhoods partnerships working with Third Sector Interface (CTSI) and the Tenants’ and Residents’ Federation, in particular, have an and Communities communities will improve important role to play in this. The Housing Service will look to develop area plans with partners, the quality of life for all targeting resources and initiatives to the agreed priority areas households Housing New, improved and We must consider more innovative and flexible ways to promote and deliver development, making use Investment innovative funding of existing assets, such as land allocated for housing or unused buildings suitable for redevelopment opportunities will ensure a to housing. The Council’s annual Strategic Local Programme will set out the plans to deliver housing flow of funds to achieve projects, along with housing associations and developers. essential housing priorities
4. An overview of the housing- related challenges going forward and improvements required.
Specific challenges will be identified throughout the consultation period. Those identified so far include:
Barriers to sharing information, in terms of data collection and establishing overall need and gaps in service, in terms of casework for individual cases and for potentially vulnerable people for emergency planning. Need to look at overall circumstances of an individual and services work together more Earlier notification admission to hospital and need for support (including adaptations) to be arranged Services available to home owners and tenants are sometimes different Need for a specialist housing Occupational Therapy service Recycling/re-use of adaptation equipment Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 9 Clackmannanshire's Housing Contribution Statement 2016/19 Support for people with alcohol and drug dependency issues (including ARDB) Care needs of ageing prison population (particularly sex offenders) who will need to be re housed in the community eventually (although this is not part of the Integration Scheme) Community safety for vulnerable adults Consider healthy weight and lifestyle issues as part of housing and environment design
These challenges will be considered by the Housing Contributions Group, and ways found to resolve the issues they raise. This will be done through improved networking and taking on board lessons from good practice.
5. Current and future resources and investment required to meet these shared outcomes and priorities
We are in the final stage of verifying the budgets which will be transferred to the Integrated Authority. This will be confirmed before 1 April 2016.
Legislation sets out the housing related functions that must be delegated by the two local authorities to the Clackmannanshire & Stirling Integration Joint Board by 1 April 2016. The specified housing adaptations, aids and equipment functions that fall within the scope of the integration scheme and will transfer to the Joint Board include: 1) Statutory Private Sector Housing Disabled Adaptation Grants (Clackmannanshire & Stirling Councils) 2) Council Housing Adaptations (Clackmannanshire & Stirling Councils) 3) Council Housing Garden Maintenance Scheme (Clackmannanshire & Stirling Councils) 4) Private Housing Garden Maintenance Scheme (Stirling Council) 5) Private Sector Housing Minor Adaptations (Clackmannanshire Council) 6) Care & Repair Service (Stirling Council) 7) Equipment (Clackmannanshire and Stirling Councils)
A Service Level Agreement, based on the Strategic Plan priority outcomes, will be drawn up to continue delivery of the existing operational service arrangements for the delegated housing functions. There will be ongoing development of procedures to ensure effective delivery of these housing services, to help meet the priorities set out in the three partners' strategic planning documents.
6. Additional Statement by Integration Authorities.
The Integration Joint Board will work with the housing authorities to ensure delivery of outcomes.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan 10 Clackmannanshire's Housing Contribution Statement 2016/19
Stirling Council’s Housing Contribution Statement
2016 - 2019
Health and Social Care Integration Strategic Plan Clackmannanshire and Stirling Health & Social Care Partnership Strategic Plan
Stirling’s Housing Contribution Statement 2016/19
The Partnership’s Strategic Plan describes in the following terms the importance of joint working with Strategic Housing Authorities: ‘Housing providers have for many years contributed positively to improving health and well-being across our communities. It is not only about enabling independent living for people, but also being more effective in helping to prevent admissions to hospital, alleviating delayed discharge and contributing to tackling health inequalities affecting the population. Overall to achieve improved outcomes across the population it is important that Integration Authorities and Strategic Housing Authorities work closely together on key aspects of housing support including: Assessing the range of housing support needs across the population and understanding the link with health and social care needs; Identifying common priorities that are reflected in both the Local Housing Strategy and Strategic Commissioning Plan; Identifying and making best use of resources to meet the housing support needs of the local population. Separate Housing Contribution Statements have been developed for Clackmannanshire and Stirling on an individual local authority basis.’ The format of the Housing Contribution Statement is specified by Scottish Government in its Housing Advice Note1. For the future, there is a commitment to developing a joint Housing Contribution Statement for Clackmannanshire & Stirling.
1 The Housing Advice Note was published in September 2015 and is ‘Statutory Guidance to Integration Authorities, Health Boards and Local Authorities on their responsibilities to involve housing services in the Integration of Health and Social Care, to support the achievement of the National Health and Wellbeing Outcomes’.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan Page 1 Stirling’s Housing Contribution Statement 2016/19
1. Articulate briefly the role of the local housing sector in the governance arrangements for the integration of health & social care.
Stirling and Clackmannanshire Councils are represented on the Integration Joint Board of the Partnership by three Councillors from each Council who are voting members. Stirling Housing and Clackmannanshire Housing are both represented on the Strategic Planning Group. Both services meet with colleagues from Social Services and NHS in the joint Stirling & Clackmannanshire Housing Contribution Group, which has a remit to compile the Housing Contribution Statement, working with partners to identify needs, challenges, priorities and resources for the housing service. The group is supported by the Joint Improvement Team. The views of Housing Associations (RSLs) are included in the work of the group. In Stirling local RSLs have agreed that Stirling Council will represent their interests on the Strategic Planning Group and feedback through Stirling’s Strategic Housing Forum. In Stirling wider consultation takes place though:- The Strategic Housing Forum : This brings together local housing associations, private developers, private landlords, The Housing OT Adaptations Group : This brings together Occupational Therapists and Housing staff to improve the delivery of adaptation services, Meetings take place as required with the older people’s reference group, the multi cultural partnership, the ACCESS group, the private rented sector forum and the gypsy traveller working group.
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2. Provide a brief overview of the shared evidence base & key issues identified in relation to housing needs & the link with health & social care needs. 3. Set out the shared outcomes and service priorities linking the Strategic Commissioning Plan and Local Housing Strategy.
The Strategic Needs Assessment (SNA) includes similar trends and issues to Stirling’s Housing Needs and Demand Assessment 2011 (HNDA) and Local Housing Strategy 2012 (LHS). Stirling’s HNDA http://www.stirling.gov.uk/__documents/temporary-uploads/housing-_and_-customer-service/local-housing-strategy/stirlings-hnda- 19july2011v2.pdf Stirling’s LHS http://www.stirling.gov.uk/__documents/temporary-uploads/housing-_and_-customer-service/local-housing-strategy/stirlings-lhs-2012- jan13.pdf Both HNDA and LHS identify a number of trends (outlined below) in the needs of specialist groups for accommodation and support. These have been updated to 2015 where more recent information is available. 2.1 Older people While the population is increasing steadily, the 65+ age group is increasing at a much faster rate. Whilst Stirling’s total population is likely to increase by 5.8% to 2030, the number of people aged 65 + will increase by 51% and those 85+ by 120%. It is estimated that the number of older people with a moderate to severe disability, dementia or a learning disability will increase by 30% to 2020 - from 4,649 to 5,340. Although prevalence rates for dementia stay constant, the number of people with dementia is increasing due to the increasing number of older people, particularly the very elderly. Within the Stirling Council area, the existing accommodation for older people is 17 residential care, intermediate care and nursing homes. These provide a total of 602 places, of which 299 are social services funded long term care places. There are a further 770 houses which are suitable to the needs of older people including sheltered housing and amenity older persons’ houses. Today all new homes should meet the needs of people with specialist needs. The Council and RSLs now build houses that meet ‘varying needs’ standards which enable the house to meet people’s needs as they move through the stages of life. For the private sector, the more demanding building regulations have ensured that new housing now also meets people’s changing needs. Cowane’s Housing Association is keen to develop housing for people with dementia. The Council’s Housing service is also considering the possible future (2019+) conversion of a care home into housing for people with dementia. Increasingly new houses in all sectors should now meet the needs of those with dementia.
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The Council’s own new build programme tends to focus on the construction of bungalows, suited to the needs of older people and disabled people. Based on 2014 research undertaken with the Scottish Futures Trust and by Stirling University, the Council is working with a developer to plan the construction of appropriate housing for older owner occupiers who are stuck in inappropriate lower value market housing. The Council’s programmes of adaptations and care & repair are well funded and tend to meet the needs. Further work is required by all partners to develop a falls programme. 2.2 People with Physical Research suggests that there will be a 70% increase in the numbers of physically disabled people (from 5,400 in 2010 to Disabilities 9,200 in 2030). The increase is almost exclusively due to the increasing number of older people, particularly those over 85. The Council area has 5 registered care homes that cater for the needs of people with disabilities (including one care home that accommodates people with Prader-Willi syndrome – this is a national resource and therefore not specific to the Stirling area). The Council and its partners meet the accommodation needs of people with physical disabilities in a number of ways. These include the provision of a limited amount of specialist grouped accommodation, individual houses built to meet specific needs, social rented houses built to varying needs standards, lifetime homes built by private developers and by means of adaptations to existing homes. In order to add their two existing developments (54 units), Blackwood is planning a further small development in Stirling. A joint development with Scottish Veterans Garden City Association is also in the pipeline - it is likely to meet the needs of former soldiers with physical disabilities. Wherever possible, the Council and the local RSLs include wheelchair accommodation in new build schemes and consider one-off new build projects where they can meet the very specific needs of particular households. No further grouped accommodation is planned at present. 2.3 People with Learning Estimates suggest that around 1,800 people in the Council area have a mild or moderate learning disability, 350 have a Disabilities profound or multiple disability and 800 have an autism spectrum disorder (ASD). The Council provides services to 445 adults with learning disabilities of which 50 have an autism spectrum disorder (ASD). Over the last 5 years, 19 units of accommodation have been provided by the Council at Torbrex and by Forth Housing Association in Raploch. Based on the Strategic Needs Assessment and the individual transition planning by the Learning Disability Service, further discussion is required to determine future accommodation requirements. 2.4 People experiencing The Council area has 3 registered care homes specifically for people experiencing mental health difficulties. mental health difficulties While some mainstream accommodation has been made available in the past, there is anecdotal evidence that more accommodation is needed in order to enable people to live with a greater level of independence. If this were the case, the Housing service is well placed to be able to respond to requests for accommodation.
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The incidence of homelessness could be reduced, if more mental health support were available to people who are homeless/ threatened with homelessness. 2.5 People affected by drug The incidence of people affected by drugs & alcohol misuse is a growing problem that can lead to homelessness. The and alcohol misuse Stirling Alcohol & Drug Partnership (SADP) addresses issues relating to substance misuse and the harm that it causes. There is a range of statutory & third sector services to support those affected by alcohol and /or drugs and their families. 2.6 People with ARBD An estimated 60 people have Alcohol Related Brain Damage (ARBD) and this figure is likely to increase dramatically. The Council’s Local Housing Strategy reported on the need for a rehabilitation facility for people with ARBD in Forth Valley. 2.7 Survivors of domestic abuse The incidence of Domestic Abuse continues to be a significant issue. It is the Council’s homelessness service and Women’s Aid that tend to respond to survivors’ accommodation and support needs. In addition to a 7 person refuge, Stirling Women’s Aid has 4 dispersed lets and provides outreach support. 2.8 Vulnerable young people Although a Children’s Services activity, the Council’s Youth Housing Liaison Group works well on behalf of vulnerable young people; its membership includes homelessness staff and the Throughcare Aftercare Team. The Bridge Project and Barnardos both play an important role in the provision of accommodation and support and interventions to reduce substance misuse and the associated impacts. There is a need for more intermediate accommodation with support for young people who are not yet ready to take on their own tenancy. A number of options are under discussion. 2.9 Black & minority ethnic Although there have been discussions with Stirling’s Multi Cultural Partnership, the Council needs to develop its working communities relationships with BME groups in relation to housing issues. Welcoming Syrian refugees to Stirling is a key objective of the Council and its partners. 2.10 Gypsy Travellers Stirling has a Gypsy Travellers site which meets the needs of resident Gypsy Travellers and those passing through. There is a Gypsy Traveller Working Group (covering Stirling & Clackmannanshire) to ensure the proper delivery and coordination of services. 2.11 Showpeople There is a showpeople’s site in Stirling. The showpeople that live there tend to be highly self sufficient.
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4. Provide an overview of the housing-related challenges going forward and improvements required
4.1 Housing Support The housing support provided as part of the Housing service is largely the housing support provided to homeless people in order to help them establish and maintain a tenancy. Because it does not include any element of personal care it is not the type of housing support that ‘may’ be included within the Health & Social Care Partnership. Housing support funding is also used to fund the Bridge Project and a Council grant to Stirling Womens’ Aid. The Housing service would be happy to explore opportunities to improve aspects of service delivery. The Housing Service also provides housing support to mainstream tenants, residents of sheltered housing, and to tenants of housing associations and those in the private rented sector. The provision of support is based around a support plan which includes money advice and income maximisation. 4.2 Homelessness The homelessness service provided by Stirling Council is extensive. There may well be opportunities to improve aspects of service delivery. This could be explored with the Partnership. 4.3 Developing extra care Extra care housing/ very sheltered housing is a type of provision which was not part of the model developed in Stirling housing/ very sheltered as part of the agenda for Reshaping Care for Older People. Based on the emerging information from the Strategic Needs housing Assessment including the demographic profile and the national research that demonstrates the improved quality of care and support for older people, further work should be undertaken to establish the level of need, review the existing provision and identify the most appropriate model(s), with a view to inclusion in the Council’s Strategic Housing Investment Plan, if appropriate. 4.4 Developing appropriate Ref 2.1 above - This project has identified 2 sites for potential development. housing for older owners 4.5 Developing accommodation Ref 4.3 above - this is not a type of provision which was part of the model developed in Stirling as part of the agenda for for those with dementia Reshaping Care for Older People. Opportunities now exist to develop some dementia friendly housing, working in partnership with the Dementia Centre at Stirling University. 4.6 Revenue funding for new By and large, the capital costs of developing new housing can be found but identifying revenue costs continues to be developments challenging. 4.7 Evaluate housing for those Ref 2.3 above - Research is required to evaluate the new housing built in recent times in St Ninians and Raploch for with a learning disability people with a learning disability. 4.8 Intermediate There is an acknowledged need for more intermediate supported accommodation for those that cannot sustain their accommodation own tenancy.
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4.9 BME Communities and Ref 2.10 above – The Housing service along with Health and Social Services need to develop their knowledge and skills in Syrian Refugees relation to meeting the needs of Syrian Refugees and other applicants from BME communities. 4.10 Getting beyond prevalence While prevalence rates have their place in the identification of likely specialist needs and in planning the provision of rates housing, a gap that exists is the identification of those who actually need specialist accommodation, when and where. 4.11 Paying for the time when Specialist housing can lay empty for a number of reasons eg during the period when Social Services is identifying a new specialist housing sits tenant or preparing someone to take up the tenancy, etc. Further joint work is required to ensure the most efficient empty and effective use of the specialist housing which is available to minimise any void periods. 4.12 Falls As noted above further work is required to develop the falls programme locally.
4.13 Minimising delayed There may a need for Housing Options advice and assistance to be provided to people who are in hospital to ensure that discharges : Early any barriers to their return home are identified and tackled as early as possible. identification of A small annual budget might assist some service users to return home sooner eg for a house to be cleaned and made accommodation issues ready for the service’s user’s return. 4.15 OT in Housing In order to improve service delivery and to ensure the most efficient and effective use of resources to meet individual needs, there is a strong case for having specific OTs who can give priority to assessments relating to the Housing service. 4.16 Funding RSL Adaptations The Scottish Government’s funding of adaptations by housing associations is presently outwith the scope of the health and social care integration agenda. The Council’s Strategic Housing Forum considers this to be inconsistent and an issue worthy of review at a national level. At present the funding is awarded direct to RSLs on an annual basis. 4.17 Fuel Poverty The Local Housing Strategy 2012 (Pages 19/20) highlights the problem of Fuel Poverty and mentions measures that are being taken to improve the situation locally. The Strategic Needs Assessment highlights the fact that Fuel Poverty continues to be a key issue.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan Page 7 Stirling’s Housing Contribution Statement 2016/19
5. Set out the current and future resource and investment required to meet these shared outcomes and priorities. Identify where these will be funded from the Integration Authority’s integrated budget and where they will be funded by other (housing) resources.
We are in the final stage of verifying the budgets which will be transferred to the Integrated Authority. This will be confirmed before 1 April 2016. Legislation sets out the housing related functions that must be delegated by the two local authorities to the Clackmannanshire & Stirling Integration Joint Board by 1 April 2016. The specified housing adaptations, aids and equipment functions that fall within the scope of the integration scheme and will transfer to the Joint Board include: 1) Statutory Private Sector Housing Disabled Adaptation Grants (Clackmannanshire & Stirling Councils) 2) Council Housing Adaptations (Clackmannanshire & Stirling Councils) 3) Council Housing Garden Maintenance Scheme (Clackmannanshire & Stirling Councils) 4) Private Housing Garden Maintenance Scheme (Stirling Council) 5) Private Sector Housing Minor Adaptations (Clackmannanshire Council) 6) Care & Repair Service (Stirling Council) 7) Equipment (Clackmannanshire and Stirling Councils) A Service Level Agreement, based on the Strategic Plan priority outcomes, will be drawn up to continue delivery of the existing operational service arrangements for the delegated housing functions. There will be ongoing development of procedures to ensure effective delivery of these housing services, to help meet the priorities set out in the three partners' strategic planning documents.
6. Additional Statement by Integration Authorities.
The Integration Joint Board will work with the housing authorities to ensure delivery of outcomes.
Clackmannanshire & Stirling Health & Social Care Partnership Strategic Plan Page 8 Stirling’s Housing Contribution Statement 2016/19
Summary of Consultation Responses APPENDIX 3
1.1. Comments on both Housing Contribution Statements
Unknown Contributor(s)
Why are there two HCSs? Because there are two separate local authority housing services which have approached their Local Housing Strategies in different ways. In time it is hoped that there can be just one HCS The HCS does not go into The initial HCS was intended to identify the key particulars on what it intends accommodation and support issues. The to do to provide and cater for Partnership’s Housing Contribution Group will needs develop this work over the coming years.
1.2. Comments on Stirling Housing Contribution Statement : A summary of the significant comments received on the Stirling Housing Contribution Statement (HCS) and the responses are as follows:-
Stirling ACCESS Panel
Stirling’s ACCESS panel There has been a continuing dialogue between makes wide ranging of Stirling’s Housing Service and the ACCESS Group. comments on the The Group has visited and assessed the Council’s accessibility of the houses new build properties provided both in the public and private sectors. Given the detailed nature of the comments, the ACCESS Group has been invited to join with a Senior Manager, Project Officers and the Architect in order to explore their comments. Stirling Voluntary Enterprise
SVE make a number of In seeking to ensure the provision of appropriate important points about the accommodation and support, the Partnership needs general population, Houses to be clear about what are primarily Local Housing in Multiple Occupation, Strategy (LHS) issues and what issues are specific private landlords and enough to Health and Social Care that they need to students. be raised through the HCS.
In the view of Stirling’s Housing Service, the issues that SVE has raised can and are being dealt with appropriately though the Local Housing Strategy process within Stirling Council.
SVE has been invited to discuss these issues further.
1.3. Comments on Clackmannanshire Housing Contribution Statement : A summary of the significant comments received on the Clackmannanshire Housing Contribution Statement (HCS) and the responses are as follows:-
Unknown contributor(s)
All communication should be We try not to use jargon and keep the message clear. in plain English. An equalities impact An equalities impact assessment is being carried out assessment, which includes on the overarching Strategic Plan. This will cover the the impact of the roll-out of HCS. universal credit, should be included. Concerns expressed about The intention is that these gaps will be filled by the gaps in services targeted services. highlighted, including need for healthy weight and lifestyle to be consideration of design. There is no Care and Repair Although there is not a separate care and repair service. service, older people and those with a disability do have access to minor adaptations, which help to prevent falls etc, This is provided through Social Services. Questionnaire design flawed. Design was kept the same as the Strategic Plan format, but points noted. No mention of working with Letting agents and private landlords have been Letting Agencies who may consulted previously in planning for housing have large customer base strategies. They will be included in ongoing consultations and workshops in the future. Liaise with landlords on This idea will be pursued. capping of gas meters as a potential flag for vulnerability. Look into previous plans by We will check this out for lessons learned. Falkirk Council to develop a Forth Valley emergency system.
Council employee
Support for reinstatement of This is being progressed as a priority. specialist Housing OT
Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 11.1 on the agenda
Clinical and Care Governance
(Paper presented by Dr Tracey Gillies)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Dr Tracy Gillies Date: 22 March 2016 List of Background Papers: Clinical and Care Governance Framework Scottish Government [2014].
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Title/Subject: Clinical and Care Governance Framework Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Dr Tracey Gillies Action: For Approval
1. Introduction
1.1 This paper presents the draft Clinical and Care Governance Framework for consideration and approval.
1.2 The draft Framework has been developed by the clinical and care leads from NHS Forth Valley and Val de Souza, Chief Social Work Officer as part of the work stream on behalf of the partnership.
1.3 The arrangements outlined in the draft Framework are designed to assure the Integration Joint Board, Clackmannanshire Council, NHS Forth Valley and Stirling Council that the quality and safety of services delivered by staff, and the outcomes achieved from delivery of those services, are the best possible and will make a difference to the lives of residents.
2. Executive Summary
2.1. The draft Framework has drawn on the national guidance and has been developed to complement the existing Clinical and Care Governance approach and processes within Clackmannanshire Council, NHS Forth Valley and Stirling Council.
2.2. The draft Framework proposes the establishment of a Clinical and Care Governance Oversight Group which will report to the Integration Joint Board. The membership and terms of reference for this group will be further developed to reflect the full range of services being directly delivered by partners and commissioned.
2.3. It is acknowledged that the proposed Framework will be further developed over time to reflect the experience of integrated working and governance required as local requirements for services are better understood and evolve as part of the strategic planning process.
3. Recommendations
The Integration Joint Board is asked to:
3.1. Note and acknowledge the work carried out by the work stream to develop the Clinical and Care Governance Framework
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3.2. Agree the Clinical and Care Governance Framework as described within appendix 1, including the establishment of a Clinical and Care Governance Oversight Group.
3.3. Delegate authority to Tracey Gillies and Val de Souza as part of the work stream to establish the Clinical and Care Governance Oversight Group and further develop the terms of reference for the Clinical and Care Governance Oversight Group on behalf of the IJB.
4. Background
4.1. The national guidance and Framework on Clinical and Care Governance for integrated health and social care services was issued in 2014 and is fully reflected within this draft Framework for the partnership.
4.2. It should be noted that the national guidance and Framework will be used by Healthcare Improvement Scotland, The Care Inspectorate and Scottish Ministers when reviewing the effectiveness of arrangements in place to support the delivery of safe, effective and person centred services.
4.3. The effective implementation of clinical and care governance for integrated services requires co ordination across a range of services, including those in the independent and third sectors.
5. Main Body Of The Report
5.1. The local draft Framework outlines the roles, responsibilities and actions that are required to ensure governance arrangements are in place to support integrated health and social care services.
5.2. This draft Framework does not change the professional accountabilities but is designed to complement the existing approach and processes.
5.3. The draft Clinical and Care Governance Framework is attached at Appendix 1. Section 3 of the draft Framework contains the working definition of Clinical and Care Governance, which is based on five key principles:
• Clearly defined governance functions and roles are performed effectively • Values and openness of accountability are promoted and demonstrated through actions • Informed and transparent decisions are taken to ensure continuous quality improvement • Staff are supported and developed • All actions are focused on the provision of high quality, safe and effective person centred services.
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5.4. The draft Framework proposes the establishment of an integrated Clinical and Care Governance Oversight Group to ensure effective clinical and care governance across the partnership for those functions in scope.
5.5. Further work will be required by the work stream to establish the membership and full terms of reference for this group to support the delivery of this draft Framework and the required reporting cycles to the Integration Joint Board. In addition the establishment of the proposed Oversight Group needs to link to a number of the key frameworks currently being established by the Integration Joint Board, most notably risk management and performance.
6. Conclusions
6.1. As noted above this paper proposes the adoption of the draft Framework which is founded on the national guidance and the existing local approach and processes. The Framework proposes the establishment of a Clinical and Care Governance Oversight Group which will report to the Integration Joint Board. 6.2. Subject to approval of the draft Framework further work is required through the work stream to establish the full terms of reference for the proposed Clinical and Care Governance Oversight Group.
7. Resource Implications
7.1. The establishment of the proposed Oversight Group will involve services in providing a range of support and information. The draft Framework and the proposed Oversight Group have been developed to compliment as far as possible the existing processes. The development of the terms of reference, membership and the reporting cycles to the Board will further establish the actual resource requirements.
8. Impact on Integration Joint Board Outcomes and Priorities
8.1. Clinical and Care Governance should have a high profile at all levels to ensure that people receive quality of care. The principles for Clinical and Care Governance are aligned to the strategic priorities as expressed within the draft Strategic Plan.
9. Legal & Risk Implications
9.1. A key purpose of clinical and care governance is to support staff and services to continuously improve the quality and safety of care and to identify and address poor performance within a structured framework. As noted above in section 4 the national guidance and Framework will be used by Healthcare Improvement Scotland, The Care Inspectorate and Scottish Ministers when reviewing the effectiveness of arrangements in place to support the delivery of safe, effective and person centred services.
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10. Consultation
10.1. The draft Framework has been developed by the Clinical and Care Governance work stream on behalf of the partnership.
11. Equality and Human Rights Impact Assessment
11.1. The local draft Framework fully reflects the national guidance.
12. Exempt reports
12.1. Not exempt
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HEALTH AND SOCIAL CARE INTEGRATION:
FORTH VALLEY CLINICAL AND CARE GOVERNANCE FRAMEWORK
The Scottish Government, National Health and Wellbeing Outcomes: A framework for improving the planning and delivery of integrated health and social care services:
“Health and social care services should focus on the needs of the individual to promote their health and wellbeing, and in particular, to enable people to live healthier lives in their community. Key to this is that people’s experience of health and social care services and their impact is positive; that they are able to shape the care and support that they receive; and that people using services, whether health or social care, can expect a quality service regardless of where they live.”
Public Bodies (Joint Working) (Scotland) Act 2014
DRAFT January 2016
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Document Control
Version Issue Date Distributed to
1. INTRODUCTION ...... 3
2. PURPOSE OF THE FRAMEWORK ...... 3
3. DEFINITION OF CLINICAL AND CARE GOVERNANCE ...... 4 4. ROLE OF A CLINICAL AND CARE GOVERNANCE OVERSIGHT GROUP IN MONITORING AND ASSURING THE QUALITY OF CARE AND SERVICES ...... 5
5. ROLES AND RESPONSIBILITIES ...... 6
CHAIRS, COUNCIL LEADERS, NHS NON-EXECUTIVE DIRECTORS & ELECTED MEMBERS ...... 7 CHIEF EXECUTIVES, CHIEF OFFICERS, DIRECTORS OR EQUIVALENT ...... 7 ALL THOSE PROVIDING CARE & SERVICES ...... 9
6. REPORTING ARRANGEMENTS ...... 9
7. INFORMATION SHARING ...... 9
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1. Introduction
The main purpose of the integration of health, social work and social care services in Scotland is to improve the wellbeing of people who use such services, in particular those whose needs are complex and who require services and support from both health and social care.
Integration Schemes, drawn up for both of Forth Valley’s Integration Joint Boards (IJB) are intended therefore to arrange services that can deliver better outcomes for the people of Forth Valley. Services will be set up to deliver the national health and wellbeing outcomes that are prescribed by Scottish Ministers in Regulations under Section 5(1) of the Public Bodies (Joint Working) (Scotland) Act 20141.
The national health and wellbeing outcomes apply across all integrated health and social care services, and ensure that Health Boards, Local Authorities and IJBs are clear about responsibility and accountability for the delivery of shared priorities. Scottish Ministers will also bring together performance management arrangements for health and social care. National health and wellbeing outcomes, together with the integration planning and delivery principles, are grounded in a human rights based and social justice approach.
2. Purpose of the framework
Improved outcomes and effective services for service users and their unpaid carers require alignment of culture, values and language. This framework is intended to empower clinical and care staff to contribute to the improvement of quality of care i.e. to make it safer, more effective and person centred – by making sure that there is a strong voice of the people and communities who use services in the process of designing those services.
The context in which the clinical and care governance framework, for both IJBs, will be implemented is one of a developing legislative framework with a wide range of policy drivers. Partner organisations across Falkirk, Clackmannanshire and Stirling will work to deliver services that are responsive, integrated and coordinated to meet the needs of individuals and communities in line with the strategic intentions expressed in law and policy.
The clinical and care governance arrangements described in this framework are designed to assure Forth Valley’s two IJBs, NHS Forth Valley and the area’s three Local Authorities, that the quality and safety of services delivered by its staff, and the outcomes achieved from delivery of those services, are the best possible and make a positive difference to the lives of the people of Forth Valley.
It is acknowledged that this framework will be updated to reflect experience of joint working and as local requirements for services are better understood and evolve.
In addition the framework will evolve as service delivery models change and the workforce become more integrated and changes to regulation occur.
1 Power to prescribe national outcomes Public Bodies (Joint Working) (Scotland) Act 2014
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3. Definition of Clinical and Care Governance
The Scottish Government’s National Framework, to guide Health and Social Care Partnerships on the setting up of their clinical and care governance arrangements has served as a useful foundation document for the Forth Valley Framework.
3.1. Annex C of the Public Bodies (Joint Working) (Scotland) Act 2014 Clinical and Care Governance Framework sets out in some detail the working definition to be applied to Integrated Health and Social Care Services in Scotland. This working definition is as follows:
a) Clinical and care governance is the process by which accountability for the quality of health and social care is monitored and assured. It should create a culture where delivery of the highest quality of care and support is understood to be the responsibility of everyone working in the organisation – built upon partnership and collaboration within teams and between health and social care professionals and managers.
b) It is the way by which structures and processes assure Integration Joint Boards, Health Boards and Local Authorities that this is happening – whilst at the same time empowering clinical and care staff to contribute to the improvement of quality – making sure that there is a strong voice of the people and communities who use services, their unpaid carers and their families.
c) Clinical and Care Governance should have a high profile, to ensure that quality of care is given the highest priority at every level within integrated services. Effective clinical and care governance will provide assurance to patients, service users, unpaid carers, clinical and care staff, managers, and members of the Integration Joint Boards.
• Quality of care, safety of service users, effectiveness and efficiency drive decision making about the planning, provision, organisation and management of services; • The planning and delivery of services take full account of the perspective of patients, service users, unpaid carers, and their families; • Unacceptable clinical and care practice will be detected and addressed.
d) Effective Clinical and Care Governance is not the sum of all these activities; rather it is the means by which these activities are brought together into this structured framework and linked to the corporate agenda of Integration Authorities, NHS Boards and Local Authorities.
e) An important element of clinical and care governance is to support staff in continuously improving the quality and safety of care. However, it will also ensure that wherever possible poor performance is identified and addressed. All health and social care professionals through their codes of practice and their regulatory bodies will remain accountable for their individual clinical and care decisions.
f) Clinical and care governance issues may relate to the organisation and management of services rather than to individual decisions. All aspects of the work
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of Integration Authorities, Health Boards and Local Authorities should be driven by and designed to support efforts to deliver the best possible quality of health and social care. Clinical and care governance is principally concerned with those activities which directly affect the care, treatment, protection and support people receive whether delivered by individuals or teams.
4. Role of a Clinical and Care Governance Oversight Group in monitoring and assuring the quality of care and services
The work of the IJBs will be outlined in documents known variously as a Strategic Plan for the Falkirk IJB and a Strategic Commissioning Plan for the Stirling and Clackmannanshire IJB. This will link closely with the Strategic Outcome Local Delivery Plan (SOLD) developed by the Community Planning Partnership. Successful strategic planning will result in partnership working to deliver and plan services that focus on people and their outcomes. Each IJB will have a plan that sets out its arrangements for integrated health and social care and how those arrangements will lead to the improvement of the outcomes for the communities it serves.
The quality of care provided within Forth Valley and each partnership will be overseen by a Clinical and Care Governance Group (CCGG) reporting to each IJB. This will provide assurance to NHS Forth Valley, Falkirk, Clackmannanshire and Stirling Local Authorities, that clinical and care governance as part of the planning and delivery of services is being delivered effectively.
The members of each Clinical Care Governance Group will include:-
• Medical Director
• Nurse Director
• Chief Social Work Officers
Attendees will be:-
• Chief Officer
• Head of Adult Care
The role of each CCGG will be to ensure that there is effective clinical and care governance within the Partnership that provides assurance to patients, service users, unpaid carers and their families, clinical and care staff, managers, and members of the IJB.
Each will ensure that:
• The quality of care and safety of service users is paramount and that effectiveness and efficiency drives decision-making about the planning, provision, organisation and management of services; • The planning and delivery of services take full account of the perspective of patients and service users; • Unacceptable clinical and care practice will be detected and addressed
The CCGG will be responsible for ensuring that the five key principles of clinical and care governance is delivered by each IJB:
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1. The partnership has clearly defined governance functions and roles are performed effectively; 2. Values of openness and accountability are promoted and demonstrated through actions; 3. Informed and transparent decisions are taken to ensure continuous quality improvement; 4. Staff are supported and developed; 5. All actions are focused on the provision of high quality, safe, effective and person- centred services underpinned by a human rights based ethos.
The basis for the work of each CCGG is set out as five process steps in the National Framework:
1. Information on the safety and quality of care is received 2. Information is scrutinised to identify areas for action 3. Actions arising from scrutiny and review of information are documented 4. The impact of actions is monitored, measured and reported 5. Information on impact is reported against agreed principles.
This will include review and scrutiny as appropriate of key information including that relating to :
• The National Health and Wellbeing outcomes • National Care standards • Practice and standards around public protection, specifically, adult support and protection, child protection, the management of offenders, domestic violence and substance misuse • The quality of decisions made by Mental Health Officers in support of service users and in the provision of care, while recognising the statutory framework around this role. • The quality and safety of integrated health and social care services, including health and safety issues • Service user and carer engagement • Thematic analysis of adverse event data including complaints • Significant adverse events including significant case reviews • Impact assessment and learning from external publications( including policies, guidelines, inquiries , monitoring and standards ) • Professional regulation and fitness to practice • Responses to external scrutiny and internal investigation
The CCGG will establish an information sharing and strategic relationship with the two groups established to provide oversight of all aspects of public protection, namely the Public Protection Forum in the Stirling and Clackmannanshire area and the Chief Officers’ Public Protection Group in Falkirk.
5. Roles and Responsibilities
The National Framework identifies clear roles for members of the IJB and how they fulfil these.
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Chairs, Council Leaders, NHS Non-Executive Directors & Elected Members
• Create an organisational culture that promotes human rights and social justice, values partnership working through example; affirms the contribution of staff through the application of best practice including learning and development; is transparent and open to innovation, continues learning and improvement. • Establish that integrated clinical and care governance policies are developed and regularly monitor their effective implementation. • Seek reassurance that practice and standards related to public protection are robust • Require that rights, experience, expertise, interests and concerns of service users, unpaid carers and communities inform and are central to the planning, governance and decision-making that informs quality of care. • Ensure that transparency and candour are demonstrated in policy, procedure and practice. • Seek assurance that effective arrangements are in place to enable relevant Health and Social Care professionals to be accountable for standards of care including services provided by the third and independent sector. • Require that there is effective engagement with all communities and partners to ensure that local needs and expectations for health and care services and improved health and wellbeing outcomes are being met. • Ensure that clear robust, accurate and timely information on the quality of service performance is effectively scrutinised and that this informs improvement priorities. This should include consideration of how partnership with the third and independent sector supports continuous improvement in the quality of health and social care service planning and delivery. • Seek assurance on effective systems that demonstrate clear learning and improvements in care processes and outcomes. • Seek assurance that staff are supported when they raise concerns in relation to practice that endangers the safety of service users and other wrong doing in line with local policies for whistleblowing and regulatory requirements. Chief Executives, Chief Officers, Directors or Equivalent
• Embed a positive, sharing and open organisational culture that creates an environment where partnership working, openness and communication is valued, staff supported and innovation promoted. • Provide a clear link between the organisational and operational priorities of NHS Forth Valley, Falkirk, Clackmannanshire and Stirling Local Authorities served by the two IJBs; objectives and personal learning and development plans, ensuring that staff have access to necessary support and education. • Implement quality monitoring and governance arrangements that include compliance with professional codes, legislation, standards, guidance and that these are regularly open to scrutiny. This must include details of how the needs of the most vulnerable (i.e. children and adults at risk) people in communities are being met. • Implement systems and processes to ensure a workforce with the appropriate knowledge and skills to meet the needs of the local population. • Implement effective internal systems that provide and publish clear, robust, accurate and timely information on the quality of service performance. • Develop systems to support the structured, systematic monitoring, assessment and management of risk. • Implement a coordinated risk management, complaints, feedback and adverse events/incident system, ensuring that this focuses on learning, assurance and improvement.
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• Lead improvement and learning in areas of challenge or risk that are identified through local governance mechanisms and external scrutiny. • Develop mechanisms that encourage effective and open engagement with staff on the design, delivery, monitoring and improvement of the quality of care and services. • Promote planned and strategic approaches to learning, improvement, innovation and development, supporting an effective organisational learning culture. • Establish clear lines of communication and professional accountability from point of care to Executive Directors and Chief Professional Officers accountable for clinical and care governance: 1. This will include a relationship of accountability between the Adult Support and Protection Committee, the Child Protection Committee, the Strategic Oversight Group, MAPPA, the Alcohol and Drugs Partnership and Violence Against Women (VAW). It is expected that the Public Protection Forum and the Chief Officers Public Protection Group would undertake this function. 2. It is expected that this will include articulation of the mechanisms for taking account of the training environment for all health and social care professionals training (in order to be compliant with all professionals’ regulatory requirements). • Ensuring compliance with professional standards, codes of practice and performance requirements and alignment of activities with organisational objectives and service user outcomes. • Promoting learning from good practice, adverse incidents, complaints and risks. • Creating an environment that supports the contribution of staff, their safety and professional development as well as supporting and enabling innovation.
Professional Leadership
The Chief Social Work Officers, the NHS Medical Director and the NHS Nursing Director (together, “the CCG Leads”) will take the lead role in relation to Clinical and Care Governance. The NHS Medical and Nursing Directors have arrangements in place for co- ordinating these functions across clinical groups, the Chief Social Work Officers will have arrangements in place for co-ordinating these functions across social care groups.
Although a number of leaders are identified below it is noted that leadership should take place at all levels. Each individual professional is expected to ensure that their professional practice and continuing educational development is evidence based with a focus on regulatory and continuous professional development requirements and standards.
Medical Director
The NHS Medical Director is the individual appointed by NHS Forth Valley to provide the professional leadership for medical services and appointed by the Scottish Ministers as an Executive Board Member of NHS Forth Valley.
Nurse Director
The NHS Nursing Director is the individual appointed by NHS Forth Valley to provide the professional leadership for nursing and midwifery services and appointed by the Scottish Ministers as an Executive Board Member of NHS Forth Valley.
Chief Social Work Officer
The role of the Chief Social Work Officer (CSWO) is to provide professional advice on the provision of social work services which assists authorities in understanding many of the complexities which are inherent across social work services. The principal functions relate
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to governance, management of risk, protection and the deprivation of liberty. The CSWO is a 'proper officer' in relation to the social work function: an officer given particular responsibility on behalf of a local authority, where the law requires the function to be discharged by a specified post holder. The CSWO has responsibility to advise on the specification, quality and standards of services commissioned.
All those providing care & services
Each individual professional is expected to ensure that their professional practice and continuing educational development is evidence based with a focus on regulatory and continuous professional development requirements and standards.
• Practice in accordance with their professional standards, codes of conduct and organisational values. • Be responsible for upholding professional and ethical standards in their practice and for continuous development and learning that should be applied to the benefit of the public. • Understand their responsibilities relating to Public Protection. • Have the necessary policies and procedures in place to report and manage incidents of suspected, witnessed or actual harm. • Ensure the best possible care and treatment experience for service users and families. • Provide accurate information on quality of care and highlight areas of concern and risk as required. • Work in partnership with management, service users unpaid carers and other key stakeholders in the designing, monitoring and improvement of the quality of care and services. • Speak up when they see practice that compromises the safety of patients or service users in line with local whistleblowing policy and regulatory requirements. • Engage with colleagues, patients, service users, communities and partners to ensure that local needs and expectations for safe and high quality health and care services, improved wellbeing and wider outcomes are being met.
6. Reporting Arrangements
The Public Protection Forum, the Chief Officers Public Protection Group and other service based groups as they are established will send reports directly to the NHS Forth Valley Clinical and Care Governance Group and to relevant Local Authority Scrutiny Committees responsible for overseeing the quality of social work and social care services.
Formal reports will be made by each CCGG every six months.
7. Information, Governance and Sharing
Existing information management and data sharing protocols will continue to be applied. The standing principles that pertain to information governance will remain, these include the responsibility to keep information securely and to share only what is necessary to provide safe care.
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Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 11.2 on the agenda
Information Governance
(Paper presented by Alison M Gallacher)
For Approval and Noting
Approved for Submission by Shiona Strachan, Chief Officer Author Alison M Gallacher, Solicitor, Stirling Council Lesley Fulford, Programme Manager Deirdre Coyle, Head of Information Governance, NHS Forth Valley Janice McCrum, Solicitor, Clackmannanshire Council Date: 22 March 2016 List of Background Papers:
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Title/Subject: Information Governance Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Alison M Gallacher
Action: For Approval and Noting
1. Introduction
1.1 On 1 April 2016, certain statutory functions of Clackmannanshire Council, Stirling Council and NHS Forth Valley will be transferred to the Integration Joint Board (although the services to which those functions relate will continue to be delivered by Clackmannanshire Council, Stirling Council and NHS Forth Valley). By virtue of Section 25 of the Public Bodies (Joint Working)(Scotland) Act 2014 the Integration Joint Board will have all of the powers and duties which apply in connection with the carrying out of those functions.
1.2 The Integration Joint Board has information governance responsibilities in relation to the information which is holds and uses to enable it to carry out its statutory functions. These responsibilities are distinct from the corresponding responsibilities held by Clackmannanshire Council, Stirling Council and NHS Forth Valley. It will be important to establish whether responsibilities fall to Clackmannanshire Council, Stirling Council, NHS Forth Valley or the Integration Joint Board. Although this will often be obvious, it will be a matter of fact to be determined on a case by case basis.
2. Executive Summary
2.1 The Integration Joint Board has information governance responsibilities in relation to the information which is holds and uses to enable it to carry out its statutory functions under the Public Bodies (Joint Working)(Scotland) Act 2014. These specifically relate to:-
2.1.1 The Data Protection Act 1998: i. Identifying who is a data controller; ii. Registration as a data controller with the Information Commissioner’s Office; iii. Responding to Subject Access Requests; iv. Information Sharing; and v. Information Security Incident Reporting.
2.1.2 The appointment of a Senior Information Risk Officer.
2.1.3 The Freedom of Information (Scotland) Act 2002: i. Responding to Freedom ff Information Requests; and ii. Submitting a Publication Scheme to The Office of the Scottish Information Commissioner for approval
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2. Recommendations
The Integration Joint Board is asked to:
2.1. Note the responsibilities of the Integration Joint Board in terms of The Data Protection Act 1998, The Freedom of Information (Scotland) Act 2002, the Environmental Information (Scotland) Regulations 2004 and the Public Records (Scotland) Act 2011 all as outlined in the Report and the updating of the Integration Joint Board web page.
2.2. Approve • NHS Forth Valley responding to Subject Access Requests on behalf of the Integration Joint Board for an initial period of nine months (until the end of 2016) and adopt the proposed Subject Access Request Procedure Flowchart attached as Appendix 1; • The Information Security Incident Reporting Policy attached as Appendix 2; • NHS Forth Valley responding to Freedom of Information Requests, review request and appeals on behalf of the Integration Joint Board for an initial period of nine months (until the end of 2016) and adopt the proposed Freedom of Information Procedure Flowchart attached as Appendix 3; and • The Model Publication Scheme attached as Appendix 4.
2.3. Delegate authority to the Chief Officer to:
• Register the Integration Joint Board as a Data Controller with the Information Commissioner’s Office • Adopt Scottish Accord for the Sharing of Personal Information by signing the Declaration of Acceptance; • Enter into any Information Sharing Protocols under Scottish Accord for the Sharing of Personal Information required to facilitate information sharing arrangements; and • Act as Senior Information Risk Owner.
3. Background
3.1. No Reports in respect of Information Governance have been previously brought before the Integration Joint Board. This Report sets out the legislative requirements, in respect of information governance, which the Integration Joint Board must comply with.
4. The Data Protection Act 1998
4.1. Clackmannanshire Council, Stirling Council and NHS Forth Valley are each already individually Data Controllers in terms of the Data Protection Act 1998 and as such are therefore each responsible for their own compliance with the provisions of the Data Protection Act. Although the Council and Health are already working together to deliver services, Clackmannanshire Council and Stirling Council are the Data Controllers of Clackmannanshire Council and
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Stirling Council data and NHS Forth Valley is the Data Controller of Health data.
4.2. It is likely that the Integration Joint Board will only rarely be in physical possession of ‘Personal Data’ (in terms of the Data Protection Act 1998) as information reported by the Council and the Health Board to the Integration Joint Board will, generally, be in aggregated form. However, the Information Commissioner’s Office has recently advised that as at 1 April 2016, when Clackmannanshire Council, Stirling Council and NHS Forth Valley delegate functions to the Integration Joint Board, because the Integration Joint Board is then statutorily obliged in terms of Section 25(2) of the Public Bodies (Joint Working) (Scotland) Act 2014 to carry out these functions then the Integration Joint Board will become a Data Controller. The result is that as at 1 April 2016 Clackmannanshire Council, Stirling Council, NHS Forth Valley and the Integration Joint Board, become joint Data Controllers.
4.3. The Integration Joint Board will also be a Data Controller for information and records it does physically hold about it business, its members and operational matters such as enquiries, complaints and feedback. As a Data Controller, the Integration Joint Board, must comply with all of the requirements of the Data Protection Act 1998 including Registration, responding to Subject Access Requests and the processing of Personal Data.
5. Registration with Information Commissioners Office as a Data Controller
5.1. Section 17 of the Data Protection Act 1998 provides that “personal data must not be processed unless an entry in respect of the data controller is included in the register maintained by the Commissioner under Section 10”. Data Controllers who hold certain limited categories of personal data are exempt from registration. It is likely that the Integration Joint Board is an exempt Data Controller. However, in time the Integration Joint Board will almost certainly come to hold and process personal data, for example in relation to complaints, and will require to register at that time. To ensure that this is not overlooked it is possible to voluntarily register with the Information Commissioners Office.
5.2. It is recommended that the Integration Joint Board registers with the Information Commissioner’s Office as a Data Controller and that the Chief Officer is designated as the Integration Joint Board’s Data Controller.
6. Subject Access Request
6.1. Where personal data is held by the Integration Joint Board it is important to establish whether Clackmannanshire Council, Stirling Council, NHS Forth Valley or the Integration Joint Board controls it. This is because the Data Controller is responsible for responding to Subject Access Requests made in terms of Section 7 of the Data Protection Act. Subject Access Requests are requests made by an individual, who is known as a Data Subject, to see or obtain a copy of their personal data which is held by and processed by the Data Controller.
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6.2. NHS Forth Valley has agreed to respond to Subject Access Requests on behalf of the Integration Joint Board for an initial period of nine months (until the end of 2016). It is proposed that they do so by following the proposed Subject Access Request Procedure Flowchart.
6.3. It is recommended that the Integration Joint Board accept NHS Forth Valley’s offer to respond to Subject Access Requests on behalf of the Integration Joint Board for an initial period of nine months (until the end of 2016) and adopt the proposed Subject Access Request Procedure Flowchart attached as Appendix 1.
7. Information Sharing
7.1. Effective, fair and lawful and secure sharing of information about service- users is essential to providing an integrated service and achieving efficient service-delivery. The Public Bodies (Joint Working)(Scotland) Act 2014 allows for information sharing between a local authority, a Health Board and an Integration Joint Board for the purposes of the carrying out of integrated functions.
7.2. Clause 10.4 of the Clackmannanshire and Stirling Health and Social Care Partnership Integration Scheme requires that where personal information is shared to carry out functions and/or the delivery of integrated services the Parties, including the Integration Joint Board, shall enter into Information Sharing Protocols
8. Scottish Accord for Sharing Personal Information
8.1. Although it was initially envisaged that the Scottish Accord for Sharing Personal Information would be adopted as a national model for information sharing it has instead only been adopted on a regional basis. It has been adopted as the overarching model used within Forth Valley and the three Forth Valley Councils, and NHS Forth Valley are parties, as is the now defunct Central Scotland Fire and Rescue Service and Central Scotland Police. Any specific information sharing arrangements between any combination of the Scottish Accord for Sharing Personal Information signatories are then set out in detail in a separate Information Sharing Protocol which sits underneath the Scottish Accord for Sharing Personal Information. Clackmannanshire and Stirling Councils, NHS Forth Valley and the Common Services Agency for the Scottish Health Service are, for example, all parties to an Information Sharing Protocol used to support all aspects of The Health and Social Care Data Integration and Intelligence Project which enables matching of health and social care datasets to plan for and deliver integrated services.
8.2. The Integration Scheme acknowledges at Clause 10.1 that Clackmannanshire Council, Stirling Council and NHS Forth Valley are all already parties to the Scottish Accord for Sharing Personal Information and at Clause 10.2 obliges them to review it to ensure that it is fit for purpose and for adoption by the Integration Joint Board. If it is fit for purpose then the parties are to recommend that the Integration Joint Board become a party to it.
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8.3. The parties are of the opinion that the Scottish Accord for Sharing Personal Information does not remain fit for purpose in the longer term. The establishment of Police Scotland, a national police force, is encouraging a move away from regional multi agency information sharing arrangements such as the Scottish Accord for Sharing Personal Information. In addition, The Scottish Government are currently working on a replacement model for it called the ‘IT Toolkit’. This has not yet been finalised. However, at the present time, the Scottish Accord for Sharing Personal Information is still commonly used and considered to be the appropriate model for the Integration Joint Board to adopt.
8.4. It is recommended that the Integration Joint Board adopt the Scottish Accord for Sharing Personal Information and that authority is delegated to the Chief Officer to sign the Declaration of Acceptance of the Scottish Accord for Sharing Personal Information and any specific Information Sharing Protocols required to facilitate information sharing arrangements.
9. Review of Information Sharing Arrangements
9.1. Clackmannanshire and Stirling Councils and Forth Valley Health Board have an ongoing responsibility to continue to develop information technology systems and procedures to enable information to be shared appropriately and effectively between themselves and the Integration Joint Board.
9.2. Any Information Sharing Protocols will provide for the information sharing initiatives and information governance arrangements in place to be reviewed regularly to ensure that they continue to meet their objectives.
10. Integration Joint Board operational guidance and procedures
10.1. Individual services will be required to develop detailed operational information sharing procedures to ensure that information flows and the methods of information sharing are understood by practitioners and staff to support the care of people who use services.
10.2. The Chief Officer should ensure that any required guidance and procedures are developed and implemented on behalf of the Integration Joint Board during 2016/17.
11. Security Incidents
11.1. The Data Protection Act 1998, at Data Protection Principle 7, requires Data Controllers, which would include the Integration Joint Board, to have appropriate technical and organisational measures in place to ensure the security of any Personal Data held and processed by the Integration Joint Board. This includes sharing it with the Council and Health. Information Sharing Protocols amongst the parties make provision for this, including arrangements for the management of any information security incidents including a provision for parties to notify one another in the event of an
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information security incident. This will be done in line with each parties’ own Information Security Incident Reporting Policy. The Integration Joint Board should therefore have its own Information Security Incident Reporting Policy.
11.2. It is recommended that the Integration Joint Board adopt the proposed Information Security Incident Reporting Policy, a copy of which is attached as Appendix 2.
12. Senior Information Risk Owner
12.1. Both the Cabinet Office and the Scottish Government advocate that all public bodies should appoint a Senior Information Risk Owner who is responsible for information risk as good practice. As a public body, it is appropriate that the Integration Joint Board also has a Senior Information Risk Owner.
12.2. The Senior Information Risk Owner is responsible for:
• the information risk profile of the Integration Joint Board; • identifying all of the information risks in relation to the responsibilities of the Integration Joint Board; and • making sure that appropriate mitigations are in place so that the risks can be accepted.
12.3. It is recommended that the Chief Officer will act as the Senior Information Risk Owner of behalf of the Integration Joint Board.
13. Freedom of Information (Scotland) Act 2002
13.1. Although the Data Protection Act 1998 only regulates the processing of personal data, the Integration Joint Board is classed as a Scottish Public Authority for the purposes of the Freedom of Information (Scotland) Act 2002 and the Environmental Information (Scotland) Regulations 2004. As such all information held by the Integration Joint Board is covered by Freedom of Information (Scotland) Act 2002 and the Environmental Information (Scotland) Regulations 2004.
14. Freedom of Information Requests
14.1. The Freedom of Information (Scotland) Act 2002 and the Environmental Information (Scotland) Regulations 2004 entitle applicants to be provided with information and environmental information, respectively, held by a Scottish Public Authority, within twenty working days of the date of request. Applicants who are dissatisfied with a response to a request have a right to seek a review of that decision. They also have a right, if they remain dissatisfied, to appeal to the Office of the Scottish Information Commissioner and ultimately to appeal to the Court of Session on a point of law only.
14.2. NHS Forth Valley has agreed to respond to Freedom of Information Requests, Review Requests and Appeals on behalf of the Integration Joint Board for an
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initial period of nine months (until the end of 2016). It is proposed that they do so by following the Proposed Freedom of Information Procedure Flowchart.
14.3. It is recommended that the Integration Joint Board accept NHS Forth Valley’s offer to respond to Freedom of Information Requests, Review Requests and Appeals on behalf of the Integration Joint Board for an initial period of nine months (until the end of 2016) and adopt the proposed Freedom of Information Procedure Flowchart attached as Appendix 3.
15. Publication Scheme
15.1. As a Scottish Public Authority the Integration Joint Board is also required, under Section 23 of The Freedom of Information (Scotland) Act 2002, to maintain a Publication Scheme which sets out the types of information that a Scottish Public Authority routinely makes available (called a ‘Guide to Information’) and how members of the public can access that information. The Publication Scheme must be approved by the Office of the Scottish Information Commissioner.
15.2. It is recommended that the Integration Joint Board adopt the Model Publication Scheme already approved by the Office of the Scottish Information Commissioner, a copy of which has been populated as appropriate, and is attached as Appendix 4.
16. Integration Joint Board Web Page
16.1. The Publication Scheme will be published on the Integration Joint Board web page at http://nhsforthvalley.com/about-us/health-and-social-care- integration/clackmannanshire-and-stirling/ along with information on how to make a Subject Access Request and Freedom of Information Request and where to direct any such request together with links to additional resources such as the Information Commissioner’s Office website for Data Protection advice and the Office of the Scottish Information Commissioner website for advice on Freedom of Informations.
17. Public Records (Scotland) Act 2011
17.1. The Integration Joint Board is also obliged to comply with the Public Records (Scotland) Act 2011. The Public Records (Scotland) Act 2011 promotes efficient and accountable record keeping by public authorities. It requires an authority to produce and implement a Records Management Plan. The plan must clearly describe the way an Authority manages the records it creates, in any format, when performing its functions.
17.2. Records Management Plans must be agreed with the Keeper of the Records of Scotland and regularly reviewed by an Authority. The Keeper has embarked on a phased programme to approve Records Management Plans. The Integration Joint Board will not be required to produce a Records Management Plan until the request for submission of a draft is made. Generally the Keeper provides six months’ notice of any such request.
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18. Conclusions
18.1. Each of the constituent authorities have all worked together to ensure that the Integration Joint Board meets its statutory duties in relation to information governance by 1 April 2016.
19. Resource Implications
19.1. Each of the constituent authorities are dedicating resources to support the Integration Joint Board to meet its information governance requirements. Ongoing support will continue to be required to enable the information governance arrangements to be met and reviewed as appropriate. In addition, NHS Forth Valley has agreed to respond to Freedom of Information Requests and Subject Access Requests on behalf of the Integration Joint Board for an initial period of nine months (until the end of 2016) when this arrangement will be reviewed.
20. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
20.1. This work will ensure that the Integration Joint Board meet the core legal requirements in relation to information governance and so be able to continue its work in terms of the Public Bodies (Joint Working)(Scotland) Act 2014.
21. Legal & Risk Implications
21.1. The Integration Joint Board will need to comply with the requirements of the Data Protection Act 1998, the Freedom of Information (Scotland) Act 2002, the Environmental Information (Scotland) Regulations 2004 and the Public Records (Scotland) Act 2011. If the Integration Joint Board does not complete the work outlined in this Report by 1 April 2016 then there is a risk that the Integration Joint Board will not meet is statutory obligations.
22. Consultation
22.1. A short life sub group of the governance work stream was set up to look at Information Governance arrangements and was consulted in the preparation of this Report.
23. Equality and Human Rights Impact Assessment
23.1. N/A.
24. Exempt reports
24.1. No.
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Appendix 1
Subject Access Request Procedure Flowchart
Appendix 2
Information Security Incident Reporting Policy
Appendix 3
Freedom of Information Procedure Flowchart
Appendix 4
Publication Scheme
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Item 12.3 - Appendix 1
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Item 12.3 - Appendix 2
Clackmannanshire and Stirling Integration Joint Board
Information Security Incident Reporting
Date of First Issue: Not yet issued Approved by : Integration Joint Board On: 24 February 2016 Current Issue Date: 24 February 2016 Review Date: February 2017 EQIA: Complete Lead Authors: Chris Sutton, Service Manager, Social Services Lesley Fulford, Programme Manager HSCI
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Clackmannanshire and Stirling Health and Social Care Partnership (‘the IJB’) Information Security Incident Reporting
1. Purpose
1.1. The purpose of this document is to describe the procedures for identifying and reporting, responding to, monitoring and learning from the loss or potential loss of information and ICT hardware e.g. Laptops, netbooks, iPads, smartphones, USB keys/data sticks, Vasco/Citrix tokens, or hard copies of files or documents.
1.2. The objective of Information Security Incident Reporting is to record, investigate and resolve any actual or potential breaches of information security and to take actions that will avoid or reduce the impact or probability of a similar incident in the future.
2. Scope
2.1. This process is applicable to all areas of the IJB.
3. Overview
3.1. All information and ICT equipment will be subject to formal incident reporting and escalation procedures where a loss or potential loss or other breach has occurred.
3.2. The incident reporting will be used to log all information security events including ‘near misses’.
3.3. A security incident is an event which causes or could potentially cause: • loss of equipment • loss of system or information availability • unauthorised disclosure of confidential information • corruption of information • disruption of an activity • financial loss • reputational damage • legal action/breach of legislation
3.4. Examples of incidents include: • loss of portable equipment e.g. laptop or tablet • loss of removable media e.g. USB key • loss of paper files containing personal and/or sensitive equipment • unauthorised accessing or use of an ICT system
3.5. As soon as possible after an incident occurs, the following should be established: • when and where the incident took place • when the incident was discovered • who is reporting the incident • who was involved in the incident • where the incident took place e.g. an address or ‘in the post’ • whether this is an actual incident or a ‘near miss’ • what the cause of the incident is e.g. theft, accidental loss • the type of data (how sensitive) involved and details of who is involved if this relates to personal data
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• the type of asset involved (if appropriate) • who has been made aware of this • who the Information Owner is and if they have been advised • whether this has been or should be reported to Police Scotland and a crime number received
3.6. Whilst every employee is responsible for ensuring that no information security breaches occur as a result of their actions, all employees should be aware of their responsibility to report any potential suspected or actual incidents.
3.7. Information security breaches which are caused deliberately or by reckless behaviour or non-compliance with any IJB Information Management Policy and associated guidelines may result in disciplinary action.
4. Responsibilities
4.1. Users are responsible for reporting incidents promptly and providing any additional information as requested.
4.2. The Chief Officer is responsible for: • ensuring all incidents are logged and allocated a reference number • initiating investigation of all reported incidents timeously • escalating to the SIRO as appropriate • ensuring that a resolution is agreed, achieved and recorded • approving closure of incidents
4.3. The Chief Officer is responsible for: • ensuring that all recorded incidents are reported, where appropriate, to the IJB • reviewing recorded incidents and making recommendations for change to processes or procedures to reduce risk of similar breaches in the future • for agreeing the proposed reporting process and any procedure changes to reduce risk
4.4. SIRO is responsible for ensuring that the IJB is • aware of any serious breaches • provided with statistics on Information Compliance issues • aware of the notification of breaches to Information Commissioner (ICO)
5. Procedure for Reporting Security Incidents
5.1. The above details should be reported to the Chief Officer as soon as possible providing as much information as possible.
5.2. Incidents will be prioritised according to their severity and impact (or potential impact) on the organisation or on the people whose data has been the subject of the incident. These priorities will be High, Medium and Low.
5.3. It is recognised that information security incidents vary that where immediate action is necessary to prevent something happening incidents may require to be resolved prior to being reported. However, such incidents should be reported as soon as possible.
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5.4. Every incident, however minor, should be recorded to ensure that the risk of recurrence is avoided, reduced or mitigated.
5.5. Incidents deemed to be ‘near misses’ should also be recorded to identify areas where we may wish to improve controls or processes for the future.
5.6. Resolution of incidents will be agreed and allocated by the Chief Officer.
5.7. Where incidents may have a direct effect on individuals, these will be advised to the SIRO.
5.8. Where incidents are deemed to be notifiable to the ICO, the Chief Officer will ensure that these are processed and addressed timeously and that notification takes place as soon as possible.
5.9. Incidents will remain open until satisfactorily resolved. This may include referral to the IJB or action required by the SIRO.
5.10. All incidents will be reviewed to ensure that the risk of recurrence is mitigated.
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Item 12.3 - Appendix 3
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Item 12.3 - Appendix 4
Clackmannanshire & Stirling Integration Joint Board
Publication Scheme
Date of First Issue: Not yet issued Approved by : Not yet approved On: Current Issue Date: Draft – 2 March 2016 Review Date: EQIA: Lead Authors:
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Introduction
Individuals can ask the Integration Joint Board (IJB) to provide any information that we hold and, if it is both legal to do so and practical to do so, we will. In addition, the Freedom of Information (Scotland) Act 2002 (the Act) requires all Scottish public authorities to produce and maintain a Guide to Information, also known as a publication scheme.
Guide to Information
The purpose of this guide to information is to:
• allow the public to see what information is available and what is not available in relation to each class; • state what charges may be applied (for most information, there is no charge); • explain how to find the information easily; • provide contact details for enquiries and to get help with access to the information; and • explain how to request information that has not been published.
The Guidance is split into the following six sections:
• availability and formats; • exempt information; • copyright and re-use; • charges; • contact details; and • the classes of information that we publish.
Availability and formats
Much of the information will be available on our webpage. We offer alternative arrangements for people who do not wish to, or who cannot, access the information either online or by inspection at our premises. For example, we can usually arrange to send out information in paper copy (although there may be a charge for this).
Exempt information
We will publish the information we hold that falls within the classes of information below. If a document contains information that is exempt under Scotland’s freedom of information laws (for example sensitive personal data or a trade secret), we will remove or black out the information before publication and explain why.
Copyright and re-use
Where the IJB holds the copyright in its published information, the information (except logos) may be copied, reproduced and/or re-used without formal permission subject to your acceptance of the Open Government Licence (version 1) for public sector information. This allows use and re-use of information freely and flexibly with only a few conditions, such as:
• it is copied or reproduced accurately; • it is not used in a misleading context; and • the source of the material is identified.
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By using and/or re-using information in which the IJB holds the copyright, you accept the terms and conditions of the Open Government Licence. Where the IJB does not hold the copyright in information we publish, we will make this clear. Where there is any third-party copyright information, you will need to obtain permission from the copyright holders to use and/or re-use the information.
Charges
Public Bodies are able to chargelimited fees for requests made under the Act. The Clackmannanshire & Stirling Integration Joint Board will not charge for these requests.
Contact details and how to request information not included in this guide
You can contact us for assistance with any aspect of this information guide and if you want to ask us for information that is not included in the guide:
Clackmannanshire & Stirling Integration Joint Board Freedom of Information Enquiries Information Governance Department Colquhoun Street Stirling FK7 7PX Telephone: 01786 433284 Email: TBC
We will also advise you how to ask for information that we do not publish or how to complain if you are dissatisfied with any aspect of the publication scheme. If you wish to make a request for information not contained in the publication scheme please contact us at email. There is detailed guidance on the IJB web pages.
The Classes of Information
We publish information that we hold within the following classes. Once information is published under a class we will continue to make it available for the current and previous two financial years.
Where information has been updated or superseded, only the current version will be available. If you would like to see previous versions, you may make a request to us for that information.
The classes are:
• Class 1: About the IJB • Class 2: How we deliver our functions and services • Class 3: How the IJB takes decisions and what it has decided • Class 4: What the IJB spends and how it spends it • Class 5: How the IJB manages its human, physical and information services • Class 6: How the IJB procures goods and services from external providers • Class 7: How the IJB is performing • Class 8: Our commercial publications - we do not hold or publish any information under this class
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The Classes of Information – The IJB
Class Description
1 About The IJB
The background as to how and why The IJB was established is on our website: 1.1 who we are http://nhsforthvalley.com/about-us/health-and-social-care- integration/clackmannanshire-and-stirling/ Contact Information
If you would like more information about health and social care integration or you would like to share your thoughts with us then please contact us at: where to find us, how 1.2 to contact us [email protected]
By telephone: 01259225080
Address: 4th Floor, Kilncraigs, Greenside Street, Alloa
Introducing the IJB (Integrated Joint Board)
The Integrated Joint Board will become legally responsible for the effective delivery of a large range of services within health and social care in April 2016. Clackmannanshire & Stirling is currently preparing for these changes and has established a ‘shadow’ IJB. The membership of the IJB is largely prescribed by the Public Bodies (Joint Working) (Scotland) Act 2014. The members outlined below are the twelve voting members that make up the ‘shadow’ IJB along with the additional non-voting members. how we are managed 1.3 and our external Integration Joint Board Members relations Voting Members • Chair - Alex Linkston, NHS Forth Valley • Vice Chair - Councillor Les Sharp, Clackmannanshire Council • Councillor Donald Balsillie, Clackmannanshire Council • Councillor Kathleen Martin, Clackmannanshire Council • Councillor Johanna Boyd, Stirling Council • Councillor Christine Simpson, Stirling Council • Councillor Scott Farmer, Stirling Council • Jane Grant, NHS Forth Valley
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• Fiona Gavine, NHS Forth Valley • John Ford, NHS Forth Valley • Dr Graham Foster, NHS Forth Valley • Mrs Joanne Chisholm, NHS Forth Valley • Ms Tracey Gillies, NHS Forth Valley • Professor Angela Wallace, NHS Forth Valley
Non Voting Members • Val De Souza • Shiona Strachan (Chief Officer) • Stewart Carruth, Stirling Council • Elaine McPherson, Clackmannanshire Council • Dr Scott Williams • Tom Hart, NHS Forth Valley • Pam Robertson, Clackmannanshire Council • Abigail Robertson, Stirling Council • Elizabeth Ramsay, Clackmannanshire • Shubhanna Hussain-Ahmed, Stirling • Teresa McNally, Clackmannanshire • Morag Mason, Stirling • Natalie Masterton, Stirling • Angela Leask-Sharp, Clackmannanshire • Wendy Sharp, Stirling • Gareth Ruddock, Clackmannanshire
How the IJB operates is set out in the Integration Scheme. How we deliver our 2 The Integration Scheme which was approved by Scottish functions and services Ministers in September 2015 can be found here.
Our strategies and 2.1 Our Strategic Plan can be found here. policies
Information for service 2.2 users:
How we make decisions will be set out in the Integration Scheme, see 2 above. How we take decisions
3 and what we have Our decisions, including the minutes of the Board Meetings decided and sub-committees, will be published on our web pages, which are here.
What we spend and Details of our spending will be placed on the Integration web 4 how we spend it page when available.
How we manage our 5 human, physical and information resources
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The staff who provide the services will either be employed by Clackmannanshire Council, Stirling Council or NHS Forth Valley. The IJB will not employ staff directly. Information about their terms and conditions of staff are available Our human resources 5.1 through partners.
www.nhsforthvalley.com www.clacksweb.org.uk/ www.stirling.gov.uk/home
The services commissioned by the IJB will be delivered by the Councils and the NHS and all three organisations have their own Information Governance Policies and procedures.
The IJB has developed a Freedom of Information process. Our information
5.2 resources Each partner has information governance processes and
these are available through partners.
www.nhsforthvalley.com www.clacksweb.org.uk/ www.stirling.gov.uk/home
The physical resources used by those providing services that the IJB has commissioned will be predominantly owned by the Councils and the NHS who will each follow their own Our physical resources 5.3 procedures.
www.nhsforthvalley.com www.clacksweb.org.uk/ www.stirling.gov.uk/home
How we procure goods 6 and services from Details of how we procure services will be placed on our external providers integration web pages when available.
The IJB will only came into existence on 1 April 2016 and 7 How we are performing information about the performance of the IJB will appear in time on our web pages.
Our commercial 8 The IJB does not have any. publications
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Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 11.3 on the agenda
Complaints Protocol
(Paper presented by Elaine Vanhegan)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Karen Maclure, Brian Forbes, Chris Sutton and Elaine Vanhegan Date: 22 March 2016 List of Background Papers: Clackmannanshire and Stirling Partnership Integration Scheme 2015
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Title/Subject: Health and Social Integration Care Complaints Protocol Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Elaine Vanhegan & Chris Sutton Action: For Approval
1. Introduction
1.1 This paper presents the Health and Social Care Complaints Protocol for consideration and approval.
1.2 The Protocol was developed as part of the Governance Workstream central to the overall programme to deliver the requirements of health and social care integration in Forth Valley.
1.3 The Integration Schemes for the Partnerships in Forth Valley set out a number of provisions relating to the implementation of the integration of adult health and social care. One key aspect of this is around the handling of complaints.
2. Executive Summary
2.1 The integration of Health and Social Care services provides the opportunity to provide seamless services across Adult Care. This enhanced level of service integration requires, in time, to be reflected in a single approach to complaints handling making it easier for service users and clients to give feedback, both positive and negative, on the services they receive.
2.2 The Protocol sets out how complaints will be handled in the coming year. The process will be reviewed acknowledging the national changes intimated around complaints handing in both health and social care services. Current local procedures remain extant at this stage with the Chief Officer maintaining an oversight of complex cases.
2.3 It is anticipated that, in due course, the separate complaints handling arrangements for the different providers will be integrated into a standardised approach, and be consistent with the model Complaints Handling Procedure (CHP) developed by the Scottish Public Services Ombudsman (SPSO).
3. Recommendations
The Integration Joint Board is asked to:
3.1. Note and acknowledge the work carried out by the work stream to develop the Complaints Protocol.
3.2. Approve the Complaints Protocol acknowledging the forthcoming changes nationally in terms of complaints handling.
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4. Background
4.1. The requirement to develop an approach to complaints handling was detailed within the Integration Schemes of the two partnerships within Forth Valley.
4.2. There are different processes within Health, Social Care and Housing which are managed through specific guidance pertaining to the relevant service.
4.3 The Scottish Government are currently working to develop guidance on complaints for Health and Social Care Partnerships to help ensure an integrated approach to handling complaints and annual performance reporting. This will largely follow the SPSO model Complaints Handling Procedure (CHP) including reference to the existing statutory Social Work and NHS complaints arrangements. The Scottish Government aims to publish guidance in Spring 2016.
5. Main Body Of The Report
5.1. The protocol describes the context and why a protocol is required at this stage, considering definitions of complaints and when issues cannot be dealt with through this route.
5.2. It describes the process for the handling of complaints supported by a flowchart to further explain the detail. In respect of any complex issues where a complaint covers a number of areas between health and social care the Chief Officer will review and maintain oversight of the process and outcome.
5.3. The linkage to the Clinical and Care Governance Framework is highlighted in terms of reporting trends and also, of critical importance, in terms of learning from complaints and ultimately improving service provision.
6. Conclusions
6.1. As noted above this paper proposes a complaint protocol for the coming year acknowledging that this will be reviewed in light of Scottish Government recommendations forthcoming in the Spring.
7. Resource Implications
7.1. Current resources for the handling of complaints will support the process.
8. Impact on Integration Joint Board Outcomes and Priorities
8.1. Core to the requirements of the Integration Scheme
9. Legal & Risk Implications
The Complaints Protocol is required to minimise risk and limit litigation and is a core part of functioning organisations.
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10. Consultation
10.1. The Complaints protocol has been reviewed through the workstream structure supporting the implementation of the Integration of Health and Social Care.
11. Equality and Human Rights Impact Assessment
11.1. The Protocol fully reflects the current national guidance.
12. Exempt reports
12.1. Not exempt
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Health and Social Care Integration Complaints Protocol February 2016
Contents
Context 3
Why do we require a complaints handling protocol? 3
What is a complaint? 4
What is not a complaint? 4
Who can complain? 4
How will complaints to Health & Social Care be processed? 5
Reporting our performance 6
Learning from complaints 6
Links to national developments 6
Monitoring and review of protocol 7
2
Health and Social Care Integration Complaints Protocol February 2016
1.0 Context
The Public Bodies (Joint Working)(Scotland) Act 2014 aims to improve the wellbeing of service users and unpaid carers, in particular those whose needs are complex and who require services delivered jointly by health, social work and social care services in Scotland.
The Patient Rights (Scotland) Act 2011 supports the Scottish Government’s vision for a high quality, person-centred NHS and applies to all staff working within the NHS in Scotland and to all independent contractors and their staff who provide NHS services. It details what patients in Scotland have a right to expect from their health service, no matter whether they are delivered by NHS staff or on behalf by independent contractors or their staff. The Act gives patients a legal right to give feedback on their experience of healthcare and treatment and to provide comments, raise concerns or complaints. The Integration Schemes for the Partnerships in Forth Valley set out a number of provisions relating to the implementation of adult health and social care. One key aspect of this is around the handling of complaints.
This protocol sets out how complaints will be handled and will be reviewed during the next year acknowledging the national changes intimated around complaints handing in both health and social services. Current procedures remain extant at this stage which are governed nationally.
2.0 Why do we require a complaints handling protocol?
Adult Health and Social Care partners are committed to providing high quality services to service users, unpaid carers and the wider community. Occasionally things go wrong and when this happens it is important that we act quickly to resolve the situation. Complaints show us where we are not achieving what people expect of us, and where we are failing to meet our own standards. In other words, they give us a chance to improve our service. Listening to service users and unpaid carers helps us to put things right, learn from our mistakes and improve our services. The integration of Health and Social Care services provides the opportunity to provide seamless services across Adult Care. This enhanced level of service integration requires, in time, to be reflected in a single approach to complaints handling making it easier for service users and clients to give feedback, both positive and negative, on the services they receive. This protocol therefore seeks to provide an improved and more consistent approach to complaints handling across Health and Social Care organisations. It is anticipated that, in due course, the separate complaints handling arrangements for the different public sector providers will be integrated into a standardised approach, and be consistent with the model Complaints Handling Procedure (CHP) developed by the Scottish Public Services Ombudsman (SPSO).
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3.0 What is a complaint?
A complaint is an expression of dissatisfaction about an action or lack of action, or about the standard of service provided by us or on our behalf. Predominantly this is about the care and service we provide. The importance of a cross linkage to the Clinical and Care Governance Framework should be highlighted.
For example:
delays in responding to enquiries and requests failure to provide a service failure to meet our care standards failure to meet needs dissatisfaction with our policy for the provision of care treatment by, or attitude of, a member of staff or a contractor acting on our behalf failure to follow the proper administrative process.
4.0 What is not a complaint?
The above definition is broad, however not every concern raised is a complaint. For example, a complaint is not:
a first request for a service an enquiry about a process or procedure a request for information or an explanation of our policy or practice a request under the Freedom of Information Act or Data Protection Act.
There are also other matters we can't deal with under the complaints procedure. These include:
where a statutory right of appeal exists any service where you can use other methods to appeal insurance claims a complaint we have already investigated and given a final decision on complaints that are in court or have already been heard by a court or a tribunal or where there is intimation of a claim
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5.0 Who can complain?
Anyone can make a complaint in person, by telephone, by email or in writing. If appropriate signed consent is given by the service user, someone can complain on their behalf e.g. family member, friend, MSP/MP. This protocol acknowledges the support and involvement of other agencies where an individual wishes to make a complaint about health or social care services, for example, Advocacy Services, Care Inspectorate, Local Health Councils, the Mental Welfare Commission and the Citizens Advice Bureau.
6.0 How will complaints to Health & Social Care be processed?
NHS Forth Valley, Stirling and Clackmannanshire, Falkirk Joint integrated Boards have a body corporate model in place. This is where the Health Board and Local Authority create a partnership in the form of an Integration Joint Board, which plans and commissions services that are then delivered by the Health Board and Local Authority. This means that the Health Board and Local Authority remain responsible for the delivery of Health and Social Care services.
Whilst complaints about service delivery will be dealt with through the existing Health, Social Work & Housing complaints procedures, we aim over time to adopt an integrated approach that ensures complaints are handled efficiently, effectively, timeously and in a person- centred way.
In the management of complaints: 1) There will be identified officers from both Health and Social Care with a lead responsibility for complaints handling.
2) Information Sharing Protocols will be put in place at the correct level to enable staff to respond to the issues raised. This will be continually reviewed and developed to ensure the appropriate level of information can be shared by those who need it, in accordance with the legal framework. It is proposed that an ISP to support this complaints protocol is developed in the coming weeks.
The following approach is proposed for complaints handling, whether the complaint is of a sector-specific or cross-service nature:
Step 1: Service User submits complaint to either Health or Social Care service
Step 2: Service receiving the complaint identifies the core issue being complained about and identifies the lead service for each issue raised:
(a) Single service complaint - If the matter falls clearly with either Health or Social Care, then the matter will be resolved by that sector in accordance with their current complaints procedure. No requirement will be needed for cross-sector liaison.
(b) Cross-service complaint - The organisation with responsibility for the predominant issue will be nominated to take the lead in collating the response to the complaint. The response to a secondary issue from another sector will be incorporated into the response to ensure a
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single, joined-up response. The collective response will be agreed by the designated complaints officers. The right of challenge/appeal to each issue will fall within the relevant sector's complaints procedure.
In complex cross-service cases, each sector will identify the issues identified in the complaint, undertake separate investigations on each matter and then share respective outcomes before drafting co-ordinated and complimentary responses, ensuring they cover all aspects of the complaint. The designated complaints officers from each sector will liaise to agree responsibilities for responding to each issue and drafting of responses to service users, either jointly or collectively as appropriate.
Where agreement cannot be reached on respective responsibilities for dealing with a complaints issue, the matter will be referred to the Chief Officer to resolve.
Service user information will be updated in due course (via leaflets and web pages) making it clear to service users on 'How to make a complaint' and provide contact details.
The Flowchart in Appendix 1 summarises the approach.
7.0 Reporting our performance
We will develop key performance indicators to help assess performance in relation to the handling of complaints, to facilitate continuous improvement and to report externally to service users.
This will build on the SPSO indicators already developed as part of the national Model Complaints Handling Procedure (CHP) and typically include details on:
number and type of complaints recorded number and percentage of complaints resolved at each stage (Stage 1/Stage 2) number of social care complaints escalated to Complaints Review Panel (Stage 3) number and percentage of complaints upheld/not upheld/partially upheld average time taken to resolve complaints at each stage service user satisfaction in dealing with complaints
Complaints details will be analysed for trend information to ensure we identify service failures, areas for improvement and take appropriate action. Performance in complaints handling will be reported to the Health and Social Care Integration Joint Board, on a regular basis. Linkage will be made to the Clinical and Care Governance Framework and the reporting of trends and issues.
8.0 Learning from complaints
Learning from complaints and the experience of our service users is a critical component of the management of complaints. Senior management will review the information gathered from complaints regularly and consider whether services could be improved or internal policies and procedures updated. As a minimum, complaints data will be used to identify the root causes and management actions taken to reduce the risk of recurrence. Learning will be shared and fed back to improve services and service delivery. Again linkage will be made with the work undertaken through Clinical and Care Governance.
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9.0 Links to national developments
The Scottish Government are currently working to develop guidance on complaints for Health and Social Care Partnerships to help ensure an integrated approach to handling complaints and annual performance reporting. This will largely follow the SPSO model Complaints Handling Procedure (CHP) including reference to the existing statutory Social Work and NHS complaints arrangements. The Scottish Government aims to publish guidance in Spring 2016.
A draft Scottish Public Services Ombudsman Act Amendment Order 2016 is currently before the Scottish Parliament for approval. This will add Integration Joint Boards to the list of organisations under SPSO’s jurisdiction. The Scottish Government have also recommended changes to Social Work complaints procedures to help align and integrate processes.
In practice, it is expected the revised procedure will bring the NHS complaints procedure more closely into line with the model Complaints Handling Procedure (CHP) operating in Local Authorities, and with the Scottish Government’s proposed arrangements for Social Services complaints.
The current Social Work Complaints Procedures timescales are:
Stage One: Front line resolution within 28 days
Stage Two: Complete investigation within 28 days
The current NHS procedure timescales are:
Local Resolution within 3 days
Complete investigation within 20 days
The proposed CHP model is based on a 2-stage process:
Stage One: Front line resolution within 5 days
Stage Two: Complete investigation within 20 days
The model CHP aims to resolve more complaints at source, learn more from the service users feedback and use feedback to improve service delivery. This approach brings a sharper focus to frontline ownership and early resolution of complaints.
10.0 Monitoring and review of protocol
This protocol will be reviewed during the course of the year to ensure it remains fit for purpose and in accordance with local and national developments to improve complaints handling described above.
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Appendix 1
Integration of Health and Social Care Complaints Process
A Service User may complaint in person, by phone, by email or in writing to either Health or Social Services.
Service receiving complaint identifies the core issue being raised and identifies the lead service for each issue.
SINGLE Is the complaint a Single CROSS SERVICE Service or Cross-Service SERVICE complaint?
If the matter falls clearly with either Health or Social Care, then the matter Is the complaint a complex cross- will be resolved by that sector in NO YES accordance with their current service complaint complaints procedure
Each sector will identify the The organisation with responsibility for issues identified in the the predominant issue will be responsible complaint to take the lead in collating the response
to the complaint. The response to a secondary issue from another sector will be incorporated into the response to ensure a single, joint-up response. Each sector will undertake the separate investigations to Any review required will be undertaken take place on each matter by the Chief Officer.
The right of challenge/appeal to each Involved sectors share issue will fall within the relevant respective outcomes before organisations process. drafting co-ordinated and complimentary responses, ensuring they cover all aspects of the complaint
Designated complaint officers from each sector liaise to agree responsibilities for responding to each issue and drafting of responses to service users, either jointly or collectively as appropriate.
Note: where agreement cannot be reached on respective responsibilities the matter will be referred to the Chief officer.
Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 11.4 on the agenda
Equality Duties
(Paper presented by Lesley Fulford)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Lesley Fulford, Programme Manager Date: 22 March 2016 List of Background Papers: Equality Act 2010 The Equality Act 2010 (Specific Duties) (Scotland) Regulations
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Title/Subject: Equality Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Lesley Fulford, Programme Manager Action: For Approval
1. Introduction
1.1 This report advises the Integration Joint Board of the duties placed on it by equality legislation and makes recommendations on how these should be fulfilled in the first year of operation.
2. Executive Summary
2.1. The Scottish Government added Integration Joint Board’s (IJB) to Schedule 19 of the Equality Act 2010 and to The Equality Act 2010 (Specific Duties) (Scotland) Regulations. This means that all Integration Joint Boards are subject to the equality legislation and Specific Duties.
2.2. The Equality Act 2010 provides a legal framework to protect the rights of individuals and advance equality of opportunity for all. The Act restated and simplified 116 separate pieces of earlier equality legislation into one Act, the bulk of which came into force in October 2010.
3. Recommendations
It is recommended that the Integration Joint Board agrees:
3.1. the proposed model for equality impact assessments (appendix 1) is used where an equality impact assessment is required;
3.2. the Chief Officer will prepare and publish the information required to fulfil the Board’s specific duties in relation to mainstreaming and outcomes.
4. Equality Legislation
4.1. The Equality Act 2010 will be familiar to the Integration Joint Board members. It provides the legislative framework for preventing discrimination and advancing equality of treatment. All organisations are bound by its provisions but public organisations have additional duties. As the Integration Joint Board has previously been advised, it is a public organisation subject to these duties. Significant obligations arise firstly from the public sector equality duty
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and, secondly, from the specific duties arising from regulations made by the Scottish Ministers.
4.2. The public sector equality duty set out in s149 of the Equality Act 2010 places an obligation on public authorities, in the exercise of their functions, to have due regard to the need to: • eliminate unlawful discrimination, harassment and victimisation; • advance equality of opportunity between different groups; and • foster good relations between different groups.
4.3. The broad purpose of the equality duty is to integrate consideration of equality and good relations into the day-to-day business of public authorities. The duty requires organisations to consider how they could positively contribute to the advancement of equality and good relations. It requires equality considerations to be reflected into the design of policies, the delivery of services and is a crucial consideration when changes which may impact on groups who share protected characteristics are made to services.
4.4. In the main this duty has been met by public authorities developing means to assess the impact of proposals in relation to the public sector equality duty and then having regard to the outcome of that assessment in its decision making. This approach flows both from the public sector equality duty itself and one of the specific duties referred to below.
4.5. The Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012 place specific equality duties on public authorities, including the Board. Not all of the duties are relevant as the Integration Joint Board is not an employer. The specific duties which are relevant to note include: • reporting on the mainstreaming of the equality duty; • agreeing and publishing equality outcomes; and • assessing and review policies and practices.
5. Equality Impact Assessment
5.1. As noted above, the equality impact assessment is an appropriate method through which the public sector can demonstrate that it has given ‘due regard’ to the needs of people who may experience discrimination from unequal treatment and prejudice. It is important to consider equality otherwise there is a risk that decisions taken may result in discrimination and worsen inequality. This could result in decisions being open to challenge which can be costly, time consuming and damaging to reputation.
5.2. An equality impact assessment is likely to be required when the Integration Joint Board is making a decision which is likely to impact on people. This will cover any new or revisions to strategies, policies, strategic plans, major programmes, projects, budget and service decisions which are likely to impact on staff and /or service users.
5.3. At the present time all partners have equality impact assessment procedures in place. It is proposed that the Integration Joint Board consider adopting the
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proposed Equalities and Poverty Impact Assessment tool in appendix 1 to be used where required. This can be reviewed if required to develop an integrated equality impact assessment process.
6. Equality Mainstreaming and Equality Outcomes
6.1. Mainstreaming means that equality is built into the way the Partnership will work; the way decisions are made; the way people who work for and on behalf of the Board behave; our performance and how we can improve. In other words, equality should be a component of everything the Integration Joint Board does. Mainstreaming the equality duty has a number of benefits including:
. equality becomes part of the structures, behaviours and culture of an authority . an authority knows and can demonstrate how, in carrying out its functions, it is promoting equality . mainstreaming equality contributes to continuous improvement and better performance.
6.2. The duty imposed on the Board is to publish a report on the progress is has made to make the equality duty integral to the exercise of its functions no later than 30 April 2016. Plainly, there is a challenge in reporting at this stage as the Integration Joint Board has been in existence for a very short period of time and the integration functions will be delegated only a month before the date on which the report requires to be published. The report will not be lengthy and is likely to focus on the processes put in place for mainstreaming equality in the future and importantly on the consideration of equality in the development of the Strategic Plan.
6.3. Equality Outcomes are distinct to each organisation and need to reflect its functions, responsibilities, priorities and methods of working. It is suggested that the Integration Joint Board adopt outcomes based on the local outcomes already identified in the preparation of the Integration Scheme and the Strategic Plan. These are:
• Self Management - Individuals, their carers and families are enabled to manage their own health, care and wellbeing; • Community Focused Supports – Supports are in place, accessible and enable people, where possible, to live well for longer at home or in homely settings within their community; • Safety - Health and social care support systems help to keep people safe and live well for longer; • Decision Making - Individuals, their carers and families are involved in and are supported to manage decisions about their care and wellbeing; • Experience – Individuals will have a fair and positive experience of health and social care
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6.4. Over the coming year, the development of the Strategic Plan Implementation and Delivery Plan and the establishment of locality profiles will provide an opportunity to review the Equality Outcomes for the Partnership. It is suggested that any Equality Outcomes established at this stage are reviewed with a view to more focussed outcomes informed by the first year of operation being adopted in April 2017. This would align with the review of Equalities Outcomes by NHS Forth Valley, Clackmannanshire Council and Stirling Council.
7. Integration Joint Board Responsibilities
7.1. The Integration Joint Board must publish a report on the progress it has made in integrating the general equality duty by 30 April 2016. This must include:
. annual breakdown of the information it has gathered under its duty to gather and use employee information . report on mainstreaming the equality duty with details of the progress that it has made in gathering and using that information to enable it to better perform the general equality duty . A set of equality outcomes.
The Integration Joint Board is also required to assess the impact on equality of their policies and practices, including the Strategic Plan.
7.2. As the Integration Joint Board does not have any employees, there is not a requirement to meet the various employee reporting regulations. The NHS Board and Councils will remain the employers and will continue to report through existing arrangements. The Integration Joint Board may however want to consider receiving these reports for information.
7.3. The Strategic Needs Assessment, supporting the Strategic Plan, sets out the information available to the Integration Joint Board in identifying needs and priorities, and will be used as the basis of the progress report.
8. Conclusions
8.1. It is proposed the Integration Joint Board approve the recommendations contained in this paper.
9. Resource Implications
9.1. This will require support from equality leads in each of the partner organisations.
10. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
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10.1. These actions will ensure the Integration Joint Board meets its obligations under Equality Act 2010 and to The Equality Act 2010 (Specific Duties) (Scotland) Regulations.
11. Legal & Risk Implications
11.1. Time is limited to produce the equality outcomes and associated report.
12. Consultation
12.1. Governance leads in all partner organisations have been consulted n the drafting of this paper.
13. Equality and Human Rights Impact Assessment
13.1. Not required.
14. Exempt reports
14.1. No
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Appendix 1 – EQIA Template
Standard Impact Assessment Document (SIA) Please complete electronically and answer all questions unless instructed otherwise.
Section A Q1: Name of EQIA being completed i.e. name of policy, function etc.
Q1 a; Function Guidance Policy Project Protocol Service Other, please detail
Q2: What is the scope of this SIA Service Specific Discipline Specific Other (Please Detail)
Q3: Is this a new development? (see Q1) Yes No
Q4: If no to Q3 what is it replacing?
Q5: Team responsible for carrying out the Standard Impact Assessment? (please list)
Q6: Main person completing EQIA’s contact details Name: Telephone Number: Department: Email:
Q7: Describe the main aims, objective and intended outcomes
Q8: (i) Who is intended to benefit from the function/service development/other (Q1) – is it staff, service users or both? Staff Service Users Other Please identify ___Providers, third sector, independent sector (ii) Have they been involved in the development of the function/service development/other? Yes No (iii) If yes, who was involved and how were they involved? If no, is there a reason for this action?
(iv) Please include any evidence or relevant information that has influenced the decisions contained in this SIA; (this could include demographic profiles; audits; research; published evidence; health needs assessment; work based on national guidance or legislative requirements etc) Comments:
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Appendix 1 – EQIA Template
Q9: When looking at the impact on the equality groups, you must consider the following points in accordance with General Duty of the Equality Act 2010 see below: In summary, those subject to the Equality Duty must have due regard to the need to: • eliminate unlawful discrimination, harassment and victimisation; • advance equality of opportunity between different groups; and • foster good relations between different groups Has your assessment been able to demonstrate the following: Positive Impact, Negative / Adverse Impact or Neutral Impact? What impact has your Comments review had on the Provide any evidence that following ‘protected supports your characteristics’: Positiv Adverse/ conclusion/answer for Neutral e Negative evaluating the impact as being positive, negative or neutral (do not leave this area blank) Age Disability (incl. physical/ sensory problems, learning difficulties, communication needs; cognitive impairment) Gender Reassignment Marriage and Civil partnership Pregnancy and Maternity Race/Ethnicity Religion/Faith Sex/Gender (male/female) Sexual orientation Staff (This could include details of staff training completed or required in relation to service delivery)
Cross cutting issues: Included are some areas for consideration. Please delete or add fields as appropriate. Further areas to consider in Appendix B Unpaid Carers Homeless Language/ Social Origins Literacy Low income/poverty Mental Health Problems Rural Areas Armed Services Veterans, Page 8 of 10
Appendix 1 – EQIA Template Reservists and former Members of the Reserve Forces Third Sector Independent Sector
Q10: If actions are required to address changes, please attach your action plan to this document. Action plan attached? Yes No
Q11: Is a detailed EQIA required? Yes No Please state your reason for choices made in Question 11.
The Strategic Needs Assessment at a Local Authority level will help inform the more detailed iteration of plans which will set out more detail of how we will achieve the vision and ambitious outcomes for the partnership. N.B. If the screening process has shown potential for a high negative impact you will be required to complete a detailed impact assessment.
Date EQIA Completed DD / MM / YYYY Date of next EQIA Review DD / MM / YYYY Signature Print Name Department or Service
Please keep a completed copy of this template for your own records and attach to any appropriate tools as a record of SIA or EQIA completed. Send copy to [email protected]
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Appendix 1 – EQIA Template B: Standard/Detailed Impact Assessment Action Plan Name of document being EQIA’d:
Date Issue Action Required Lead (Name, Timescale Resource Comments title, and Implications contact details) 12/01/2016 Locality Plans Locality plans will March 2017 be developed over 2016.
Further Not es:
Signed: Date:
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Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 12 on the agenda
Risk Management Strategy
(Paper presented by Hugh Coyle)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Authors Hugh Coyle, Falkirk Council, David Bright, Stirling Council, Judi Richardson, Clackmannanshire Council, and Gail Caldwell, NHS Forth Valley. Date: 22 March 2016 List of Background Papers: 1. Strategic Risk Management Policy (Draft)
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Title/Subject: Risk Management Strategy Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Hugh Coyle Action: For Approval
1. Introduction
1.1 This brief report provides Integration Joint Board Members with an updated Risk Management Strategy, for information and approval.
1.2 The implementation of a Risk Management Strategy is a requirement within the Integration Scheme.
2. Executive Summary
2.1 The Risk Management Strategy has been developed by the Forth Valley Risk Work-stream members, which includes the risk advisors from the 3 Councils and NHS.
2.2 The Risk Management Strategy dove-tails with each partners’ existing Corporate Risk Management Policies / Strategies, which are described at Appendices 1 – 4.
2.3 The Integration Joint Board are required to undertake further work to develop and agree their Risk Management Strategy Reporting Framework, i.e. the process for cascading risks. An example is provided at Appendix 5. This reflects current structures, but these may change in the coming year. This will be developed as part of (and should be seen as forming part of) the broader governance arrangements – including audit, clinical and care governance, and performance management. Further work is also required to develop the appropriate (sub) Committee structure.
2.4 A Strategic Risk Register is being developed by the Stirling and Clackmannanshire Joint Management Team, with support from the risk advisors. This will assess strategic risks, i.e. risks which affect the delivery of the Integration Joint Board’s Strategic Plan.
2.5 The Chief Officer plans to submit the Strategic Risk Register to the Integration Joint Board in June 2016, for discussion and approval. The Risk Management Strategy Reporting Framework will then provide a clear process for ongoing monitoring of the Strategic Risk Register by the Integration Joint Board, the senior leadership team (currently the Joint Management Team), and the partners’ Corporate Management Teams.
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2.6 The Forth Valley Risk Work-stream members will continue to support the Integration Joint Board – including exploring opportunities for additional Integration Joint Board risk management training.
3. Recommendations
The Integration Joint Board is asked to:
3.1 Consider and approve the Risk Management Strategy;
3.2 Note that the Strategic Risk Management Reporting Framework (example at Appendix 5) should be developed alongside relevant (sub) Committee / Fora structures and governance arrangements;
3.3 Note that a Strategic Risk Register is being developed by the Clackmannanshire & Stirling Joint Management Team. The Chief Officer plans to submit the Strategic Risk Register to the Integration Joint Board in June 2016, for discussion and approval; and
3.4 Note that the Forth Valley Risk Work-stream members will continue to support the Forth Valley Integration Joint Boards.
4. Resource Implications
4.1. The actions required from the Integration Joint Board are outlined above.
4.2. The Risk Work-stream will continue to support the Integration Joint Board.
5. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
5.1. The key risks are failure to effectively identify and manage the risks to achieve the outcomes and priorities detailed within the Integration Joint Board’s Strategic Plan.
6. Legal & Risk Implications
6.1. The key risks are failure to effectively:
1. implement the Risk Management Strategy effectively; 2. identify and assess risks to delivering the Integration Joint Board’s Strategic Plan; and 3. meet the commitments made within the Integration Scheme.
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7. Consultation
7.1. The Chief Officer and Clackmannanshire & Stirling Joint Management Team members have been consulted on the draft Risk Management Strategy and the actions above.
8. Equality and Human Rights Impact Assessment
8.1. None.
9. Exempt reports
9.1. None.
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Forth Valley Health & Social Care Partnerships
Risk Management Strategy
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CONTENTS
1. POLICY – THE RISK MANAGEMENT APPROACH ...... 3 2. STRATEGY – IMPLEMENTING THE POLICY ...... 4 3. GOVERNANCE, ROLES AND RESPONSIBILITIES ...... 6 4. MONITORING AND MEASURING THE EFFECTIVENESS OF RISK MANAGEMENT ARRANGEMENTS ...... 7 5. COMMUNICATION AND TRAINING ...... 8 APPENDIX 1: STRATEGIC RISK MANAGEMENT REPORTING FRAMEWORKS: EXAMPLE 1: NHS FORTH VALLEY ...... 9 APPENDIX 2: STRATEGIC RISK MANAGEMENT REPORTING FRAMEWORKS: EXAMPLE 2: FALKIRK COUNCIL ...... 10 APPENDIX 3: STRATEGIC RISK MANAGEMENT REPORTING FRAMEWORKS: EXAMPLE 3: STIRLING COUNCIL ...... 11 APPENDIX 4: STRATEGIC RISK MANAGEMENT REPORTING FRAMEWORKS: EXAMPLE 4: CLACKMANNANSHIRE COUNCIL ...... 12 APPENDIX 5: STRATEGIC RISK MANAGEMENT REPORTING FRAMEWORKS: EXAMPLE 5: IJB (DRAFT) ...... 13
DOCUMENT HISTORY
Document DRAFT FVHSCP’s Lead Hugh Coyle and Title: Risk Management Strategy Reviewer: HSCP Programme Managers Owner: FV Risk Managers Superseded Drafts Oct and Dec 2015 Version: Version No: Draft v4.6 – 04 March 2016 Next Review March 2017 Date:
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1. POLICY – the risk management approach
1.1 This Risk Management Strategy (RMS) dove-tails with each partner’s existing Corporate Risk Management (CRM) Strategies, which are described at Appendices 1 – 4.
1.2 The IJB are required to undertake further work to develop and agree their RMS Reporting Framework. An example is provided at Appendix 5. This reflects current structures, but these may change in the coming year. This will be developed as part of (and should be seen as forming part of) the broader governance arrangements – including audit, clinical and care governance, and performance management. Further work is also required to develop the appropriate (sub) Committee structure.
1.3 The Integration Joint Board (IJB) is committed to embedding a culture whereby risk management is recognised as a continuous process, demanding awareness and action from employees at every level, to reduce the possibility and impact of injury and loss. Risk management should be seen as an enabler to achieving objectives, of both the partnership and individual partners.
1.4 The IJB will ensure that a robust and transparent system of clinical governance and risk management is in place to assure the IJB, its public and other stakeholders. This involves providing a safe and effective care and treatment for patients and clients, and a safe environment for employees and others who interact with the services delivered under the direction of the IJB.
1.5 The IJB believes that appropriate application of good risk management will prevent or mitigate the effects of loss or harm and will increase success in the delivery of better clinical and financial outcomes, objectives, achievement of targets, and fewer unexpected problems.
1.6 Clinical governance and risk management are inextricably linked.
1.7 Risk management is an integral part of good management practice, and learning from adverse events is a major priority for the IJB. As health and social care is becoming increasingly complex it is important that sufficient time and resource is applied to this area. Delivering and managing safe and effective care to the people who use our services whilst ensuring the health, safety, and welfare of our staff, patients, (unpaid) carers, and visitors is a top priority for the organisation.
1.8 This strategy encourages decision makers to be ‘risk aware’ rather than ‘risk averse’. This includes encouraging innovation and recognising ‘opportunity related risk’, provided that the risks are assessed and justified in the context of the anticipated benefits for patients, clients, (unpaid) carers, and the IJB.
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1.9 Key benefits of effective risk management:
• appropriate, defensible, timeous, and best value decisions are made; • risk ‘aware’ not risk ‘averse’ decisions are based on a balanced appraisal of risk and enable acceptance of certain risks in order to achieve a particular goal or reward; • high achievement of objectives and targets; • high levels of morale and productivity; • better use and prioritisation of resources; • high levels of user experience / satisfaction with a consequent reduction in adverse incidents, claims, and / or litigation; and • a positive reputation is established for the IJB.
1.10 The IJB will receive assurance reports (internal and external) not only on the adequacy but also the effectiveness of its risk management arrangements and will consequently value the contribution that risk management makes to the wider governance arrangements of the IJB.
2. STRATEGY – Implementing the policy
2.1 The primary objectives of this strategy will be to:
• promote awareness of risk and define responsibility for managing risk within the IJB; • establish communication and sharing of risk information through all areas of the IJB; • initiate measures to reduce the IJB’s exposure to risk and potential loss; and • establish standards and principles for the efficient management of risk, including regular monitoring, reporting, and review.
2.2 This strategy takes a positive and holistic approach to risk management. The scope applies to all risks, whether relating to the clinical and care environment, patient / service user / (unpaid) carers and employee safety and wellbeing, business risk, opportunities or threats.
2.3 Risk management requires the consistent identification, assessment, management, monitoring, and reporting of risks to the IJB, as shown overleaf:
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2.4 Each stage will be outlined further within the SRM guidance document(s).
2.5 Risk affects every activity to a greater or lesser degree and failure to acknowledge this can lead to serious consequences – including harm, financial loss, service interruption, criticism or reputational damage, and legal penalties.
2.6 If the HSCP is to manage risk effectively, they need to demonstrate that risks are managed in a systematic and structured manner and reviewed regularly. This includes:
• Strategic Risks: This includes the risks to achieving (opportunity) or failing to achieve (threat) the IJB’s desired outcomes and objectives as set out within the Strategic Plan. These are managed by the senior leadership team (currently the Joint Management Team / Group (JMT/G)).
• Corporate Risks: This includes the risks (opportunity or threat) to achieving the goals of individual partners. These are managed by each partners’ Corporate Management Team (CMT). Where a risk affects multiple partners and / or requires strategic leadership they should be escalated to the senior leadership team and IJB and proposed to be treated as strategic risks.
• Operational Risks: This includes the risks to individual service units, and would be managed by operational managers. Where a risk affects multiple units and/or requires more senior leadership they should be escalated to the senior leadership team and proposed to be treated as corporate risks.
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• Project Risks: This includes the risks (opportunity or threats) to successfully delivering the project – in terms of outcomes, costs, or anticipated benefits that the project will deliver. These should be managed by the senior leadership team.
2.7 Specific risks will be owned by / assigned to whoever is best placed to manage the risk and oversee the development of any new risk controls required. Risk controls should be proportionate and take account of the IJBs tolerance for risk and available options for managing risk.
2.8 Risks will be scored consistently using the agreed risk matrix, contained in the SRM guidance, to analyse risk in terms of likelihood and potential impact, taking account of controls and actions.
2.9 The IJB will demonstrate a commitment to a ‘lessons learned’ culture that seeks to learn from both good and poor experience in order to replicate good practice and reduce adverse events and associated complaints, accidents / near misses and claims. The risk advisors across Forth Valley will work together to ensure that lessons learnt are identified and shared with both HSCPs.
3. Governance, Roles and Responsibilities
3.1 Integration Joint Board Members of the Integration Joint Board are responsible for:
• oversight of the IJB’s risk management arrangements; • receipt and review of reports on strategic risks and any key operational risks that require to be brought to the IJB’s attention; • ensuring they are aware of any risks linked to recommendations from the Chief Officer concerning new priorities / policies and the like (e.g. inclusion of a ‘risk implications’ section on Board papers); and • ensuring that the Chief Officer implements and monitors mitigating actions and reports progress.
3.2 Chief Officer The Chief Officer has overall accountability for the IJB’s risk management framework, ensuring that suitable and effective arrangements are in place to manage the risks relating to the functions within the scope of the IJB. The Chief Officer will keep the Chief Executives of the IJB’s partner bodies informed of any significant existing or emerging risks that could seriously impact the IJB’s ability to deliver the outcomes of the Strategic Plan or the reputation of the IJB.
3.3 Chief Financial Officer The Chief Financial Officer will be responsible for promoting arrangements to identify and manage key financial and business risks, risk mitigation, and insurance.
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3.4 Senior Leadership Team Members of the senior leadership team are responsible (either collectively, or by nominating a specific member of the team) for:
• supporting the Chief Officer and Chief Financial Officer in fulfilling their risk management responsibilities; • arranging professional risk management support, guidance and training from partner bodies; • receipt and review of regular risk reports on strategic, shared, and key operational risks and escalating any matters of concern to the IJB; and • ensuring that the standard procedures set out in section three of this strategy are actively promoted across their teams and within their areas of responsibility; and • reporting back to the IJB on risks.
3.5 Employees / All persons working under the direction of the IJB Risk management should be integrated into daily activities with everyone involved in identifying current and potential risks where they work. Individuals have a responsibility to make every effort to be aware of situations which place them or patient’s / service user’s / (unpaid) carer’s / others at risk of harm; to identified hazards and implement safe working practices developed within their service areas; and to report near misses and incidents of harm so that these can be investigated and lessons learnt.
3.6 Others / Specialists It is the responsibility of relevant specialists from the partner bodies to attend meetings as necessary to consider the implications of risks and provide relevant advice. This includes internal audit, external audit, chief legal / risk officers, (sub) committees, clinical and non clinical risk managers / advisors, and health and safety advisors.
3.7 Corporate Management Teams of Partner Bodies Corporate management teams of partner bodies are responsible for:
• ensuring that they routinely seek to identify any residual risks and liabilities they retain in relation to the activities under the direction of the IJB; and • escalating and reporting risks to the Senior Leadership Team and IJB when they exceed their risk tolerance and / or where they may affect the achievement of the HSCPs Strategic Plan.
4. Monitoring and measuring the effectiveness of risk management arrangements
4.1 The IJB operates in a dynamic and challenging environment. A suitable system is required to ensure risks are monitored for change in context, scoring, and controls.
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4.2 Risk and perfromance management is key to the effective delivery of strategic objectives. Monitoring will include review of the IJB’s risk profile at senior management team level and report up to the IJB and relevant (sub) committees.
4.3 The Strategic Plan, performance reviews, and audits / inspections will also inform the identification of new risks or highlight where existing risks require more attention.
4.4 Key risk performance indicators (PIs) will be linked where appropriate to specific risks to provide assurance on the performance of certain control measures. For example, specific clinical incident data can provide assurance that risks associated with the delivery of clinical care are controlled, or, budget monitoring PIs can provide assurance that key financial risks are under control.
4.5 The IJB will ensure that a Risk Management Improvement Plan that will shape future risk management priorities and inform subsequent revisions of this policy and strategy and drive continuous improvement in risk management across the HSCPs.
5. Communication and Training
5.1 This strategy will be communicated to all employees, via the integration web pages, and cascading by senior leadership teams.
5.2 Suitable guidance and training will be developed and agreed with the senior leadership teams, to ensure that this strategy is implemented effectively at strategic, operational, and project levels.
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Appendix 1: Strategic Risk Management Reporting Frameworks: Example 1: NHS Forth Valley
QUALITY ASSURANCE IN FORTH VALLEY CLINICAL GOVERNANCE RISK MANAGEMENT ASSURANCE, ACCOUNTABILITY AND REPORTING FRAMEWORK
NHS BOARD
G O V E Performance & Clinical Staff Governance Audit Committee R Resources Cmtt Governance Cmtt Cmtt N E Overview of Risk Associated clinical Associated staff Systems Control N Including financial & risks & adverse risks & adverse C organisational events events E
CG Working Area Partnership Health & Safety CMT Group Forum Committee M A N A G CEO Ops Group E M E N Women & Children Specialist & In-Patients & T & Sexual Health CHP Service Unit Ambulatory Care Unit Emergency Unit Facilities Unit Service Unit
RISK NETWORK
Appendix 2: Strategic Risk Management Reporting Frameworks: Example 2: Falkirk Council Corporate Risk Management (CRM) Framework
Project/Partner Boards (Decision Making Role) Executive Audit Committee (Decision Making Role) (Oversight Role) e.g. CPP Leadership Group
Corporate Management Team
Internal Audit Manager
Corporate Risk Management Group CWG/ Project / Project Teams (Corporate Risk Review & Scrutiny role) Risk-Based Internal Audit (Plans, Performance & Risk Reviews - Inc. (Inc. Reviews of Corporate Risk Register. Progress Reports and Risk Register) Register and CRM Work-Plan and Effectiveness)
Services Sub-Groups/ Workstreams (Operational Management Of Risk role) External Audits & Inspections (Plans, Performance & Risk Reviews - inc (Plans, Performance & Risk Reviews - inc CWG/ Project / Partnership Risk Register Service Risk Register & 6-Monthly Risk Updates
Appendix 3: Strategic Risk Management Reporting Frameworks: Example 3: Stirling Council Corporate Risk Management (CRM) Framework
Appendix 4: Strategic Risk Management Reporting Frameworks: Example 4: Clackmannanshire Council Corporate Risk Management (CRM) Framework
Service Thematic Corporate Risk Review & Reporting Cycle Decision Risks Risks Risks
Review service Internal monthly logs quarterly – Escalate*? No monitoring & Mgmt Team Service Business Plan review
Yes Annual & ad hoc Internal monthly governance & Yes monitoring &
Risk Forum policy checks review
Corporate
Review corp. Internal monthly Review thematic log 6-monthly – Demote? No monitoring & policy alignment Mgmt Team Corporate Plan review Corporate
Report quarterly 6-monthly report Annual reports to Service to Resources & to Resources & Committees Audit Audit
Committee
*See policy for guidance and criteria on escalation/demotion between risk registers.
Appendix 5: Strategic Risk Management Reporting Frameworks: Example 5: IJB (Draft)
This is a draft example of how risks may be escalated within the HSCP and Partner Bodies. It reflects current structures, but these may change in the coming year.
INTEGRATION JOINT BOARD
(SUB) COMMITTEES / FORA
e.g. Audit, Finance and Resources, Performance, and Clinical Care Governance
SENIOR LEADERSHIP TEAM
(currently the Joint Management Team / Group)
CORPORATE MANAGEMENT TEAMS
(of Partner Bodies)
Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 13 on the agenda
Scottish Law Commission Report On Adults With Incapacity
(Paper presented by Val de Souza)
For Noting
Approved for Submission by Shiona Strachan, Chief Officer Author Phil Cummins, Service Manager, Partnership, Clackmannanshire / Stirling Councils and NHS Forth Valley Date: 22 March 2016 List of Background Papers: Appendix One: Response To Questions Relating To Consultation On The Scottish Law Commission Report On Adults With Incapacity
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Title/Subject: Scottish Law Commission Report On Adults With Incapacity Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Phil Cummins Action: For Noting
1. Introduction
1.1 The purpose of this report is to provide Clackmannanshire and Stirling Integration Joint Board with a brief overview of the initial response in respect to the Consultation Paper on the Scottish Law Commission Report on the Adults with Incapacity and specific issues associated with 'deprivation of liberty'.
2. Executive Summary
2.1. In October 2014, the Scottish Law Commission published a report on Adults with Incapacity which focussed on deprivation of liberty as it relates to persons who may be subject to the Adults with Incapacity legislation and associated issues. The report made a number of recommendations and contained a draft Bill, amending the Adults with Incapacity (Scotland) Act 2000 (‘the 2000 Act’) and the Mental Health (Care and Treatment)(Scotland) Act 2003 (‘the 2003 Act’).
2.2. The Commission’s report concluded that adults without incapacity are being confined to hospital wards and residential facilities in Scotland without any underlying legal process which is contrary to Article 5 of the ECHR. Since the paper has been published relevant public authorities have been asked to consider their practices in the light of the Commission’s views. The Commission’s report refers to existing legal authority under which adults with incapacity may presently be detained. While the existing legislation provides mechanisms for authorising a deprivation of liberty as a means of avoiding some of the issues highlighted by the Commission the Scottish Government are of the view that the concerns and recommendations raised by the Commission in their report warrant exploration. In particular, the Scottish Government considers that the existing mechanisms do not necessarily provide a sustainable way forward.
2.3. The consultation paper seeks views on specific matters raised in the Commission’s report, with particular reference to the Commission’s draft Bill and how that would work alongside the existing legislation. It also takes the opportunity to seek general views on wider aspects of the 2000 Act that may benefit from review. It is understood that the findings from the wider consultation will be utilised to help inform the decisions regarding any wider review of the 2000 Act.
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3. Recommendations
The Integration Joint Board is asked to note:
3.1. The Commission report looks at persons within hospital settings and persons within a community setting and recommends a different approach for each setting.
3.2. For hospital settings, an authorisation process is recommended whereby a medical practitioner will be able to put measures in place to prevent an adult with cognitive impairments, who is in hospital for the treatment of physical illness, leaving the hospital if certain conditions are satisfied.
3.3. The Commission observe in the course of their report that Scots law lacks a specific process for the authorisation of measures to prevent a patient from leaving a hospital where this is required to keep them safe during and after treatment for physical health problems.
4. Background
4.1. The Commission’s report and draft bill seeks to address a legal problem which has been an issue in the UK since 2005 and the conclusion of the Bournewood case. This particular case concerned an individual who had been treated on a reputed informal basis in a psychiatric hospital but against the wishes of his carers who had been deprived access to him. The European Court of Human Rights (ECHR) found that there had been a breach of the European Convention on Human Rights (ECHR). It determined that the admission to a psychiatric hospital and continued residence there of a person with learning difficulties such that he could not consent to being where he was, represented a deprivation of liberty, could not be characterised as voluntary and needed to take place under a lawful process in order to comply with Article 5 (prohibition of detention without proper process of law) of the ECHR.
4.2. Following the decision on Bournewood, the Commission was approached by a number of bodies including the Mental Welfare Commission, ENABLE Scotland and the Mental Health and Disability Subcommittee of the Law Society of Scotland to examine the implications of this decision for the law in Scotland. Accordingly the issue was included in their Eighth Programme of Law Reform. The Commission commenced this piece of work with a discussion paper concerning adults with incapacity and deprivation of liberty. The findings from the discussion paper informed the Report and draft Bill. In making their recommendations, the Commission assessed recent case law from the European Court of Human Rights, and courts within the UK to identify the circumstances in which a placement in residential care accommodation or restrictions placed on a person in hospital for treatment or assessment would constitute a deprivation of liberty and must be authorised in law to comply with Article 5 of the ECHR.
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4.3. In particular, in March 2014, the UK Supreme Court handed down a judgement in the case of P V Cheshire West which clarified that there is a deprivation of liberty for the purposes of Article 5 ECHR where the person is under continuous supervision and control and is not free to leave and the person lacks capacity to consent to these arrangements. The effect of this decision is that careful consideration should be given to ensure that appropriate processes are in place to authorise any deprivation of liberty and to whether any changes to current processes are required. The Supreme Court ruling is not binding on Scotland but is nevertheless influential.
5. Main Body Of The Report
5.1. Please refer to Appendix One: Response To Questions Relating To Consultation On The Scottish Law Commission Report On Adults With Incapacity.
6. Conclusions
6.1. Not Applicable.
7. Resource Implications
7.1. In 2010, the Scottish Government introduced new requirements aimed at achieving enhanced regulatory impact assessments of primary legislation, secondary legislation, codes of practice and guidance. In line with these requirement the Commission concludes that it's recommendations pave the way for the minimum possible level of intervention in the lives of individuals required to ensure that the rights and freedoms guaranteed by Article 5 of the ECHR are given their proper effect. Accordingly, any costs likely to be incurred are expected to be at the lowest possible level.
7.2. The Commission envisage that the schemes for authorisation of deprivation of liberty in both hospitals and community settings would operate in such a way as to minimise the need for resort to the court.
8. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
8.1. In contrast to the position conveyed above, if the Commission's recommendations are to be implemented, the Scottish Government may wish to explore how resources, especially the time of doctors and mental health officers, can be released from elsewhere in guardianship processes. Financial and property guardianship is one area where this might be possible. Similarly, the Integrated Joint Board may need to consider how additional demands on doctors and mental health officers will be managed in relation to other priorities and outcomes if the Bill is accepted.
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9. Legal & Risk Implications
9.1. It is understood that the number of legal orders associated with the 2000 Act already pose increasing demands on mental health officers and medical practitioners and the proposals outlined in the Commission's draft Bill are unlikely to reduce challenges and demands associated with workload pressures. Nevertheless, if a claim were to be made in a Scottish court for a breach of Article 5, that court would require to take account of relevant case law and depending on the basis for the legal challenge the subsequent court could have significant implications in terms of managing risk(s) and future practice.
10. Consultation
10.1. The Head and Assistant Head of Social Services have both been consulted in compiling this report.
11. Equality and Human Rights Impact Assessment
11.1. Not applicable.
12. Exempt reports
12.1. No
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Appendix One: Response To Questions Relating To Consultation On The Scottish Law Commission Report On Adults With Incapacity
QUESTIONS RELATING TO THE DRAFT BILL PROVISIONS ON HOSPITAL SETTINGS
1. Is a process (beyond the process of applying for guardianship or an intervention order from the court) required to authorise the use of measures to keep an adult with incapacity safe whilst in a hospital?
Yes
The issue of restraint to keep adults safe in any setting should be addressed in the wider review of the Adults with Incapacity Scotland Act.
In principle there should be a legal framework for allowing medical staff to prevent an adult with incapacity from leaving hospital for their own safety. Under present law proxies can make decisions in regard to medical treatment and in relation to where someone should live. The powers do not enable proxies to consent to restraint.
The Mental Health Care and Treatment Act 2003 allows for the treatment of mental disorder so cannot be used to prevent someone leaving hospital when receiving medical care for physical ill health.
Not all adults who lack capacity are subject to an Order under the Adults with Incapacity Scotland Act. Just as it would be unrealistic and disproportionate to apply for guardianship in every case to allow for medical treatment (S47 certificates authorise medical treatment issued by the doctor) it would be unrealistic to expect a guardianship application in relation to an adult with incapacity who attempts to leave hospital.
2. Section 1 of the Commission’s draft Adults with Incapacity Bill provides for new sections 50A to 50C within the 2000 Act, creating measures to prevent an adult patient from going out of hospital. Is the proposed approach comprehensive?
Yes
A certificate could be issued alongside a section 47 certificate to authorise restraint in a hospital ward to allow for treatment.
Are there any changes you would suggest to the process? The timescale should be prescribed to ensure that adults are not kept in hospital for longer than necessary. It is suggested that the time limits are 28 days but extendable after a further assessment to be compliant with the principles of the Act
Proxies should be consulted and if not immediately available the doctor should be required to say what s/he has done to gain the views of guardians and welfare attorneys if applicable, or the named person/nearest relative if there is no proxy.
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3. Please comment on how you consider the draft provisions would work alongside the existing provisions of the 2000 Act, in particular section 47 (authority of persons responsible for medical treatment).
See above
QUESTIONS RELATING TO THE DRAFT BILL PROVISIONS ON COMMUNITY SETTINGS
1. Is a process required to authorise the restriction of an individual’s liberty in a community setting (beyond a guardianship or intervention order) if such restriction is required for the individual’s safety and wellbeing?
Yes but not as proposed in the draft Bill.
Please give an explanation for your answer
If an adult is subject to a welfare guardianship under the Adults with Incapacity Act or has a welfare attorney with powers to decide where the adult should live then there should be a simplified process. The proxy should be consulted and should consent (or otherwise) to the restriction. Adults should be supported to have as much freedom as possible within the care home and in the care home grounds and therefore principle of least restriction for the adult should be made explicit in any process. A notification to the Mental Welfare Commission stating the justification for the restriction may be required as an extra safeguard along with an opportunity for an interested person to appeal against the restriction.
It is considered that more robust measures would protect the rights of those who do not have a proxy in place. They may have gone into a care home voluntarily and lost capacity while a resident of the care home or alternatively may have been admitted under S13ZA SWSA. However is considered not necessary to introduce a new authorisation process which is as administratively onerous as a guardianship application when a more appropriate route might be through guardianship.
The wider review of the AWIA should consider whether S13ZA is sufficient to allow admission into care settings given that most care settings for older people and people with profound disabilities are restrictive in order to ensure safety for their residents. It should consider the requirements in relation to guardianship on admission to a care setting.
The Commission should consider the inclusion of the power to restrict liberty within guardianship application processes.
The Commission could also consider the introduction of a short term certificate of up to 28 days to allow significant restriction while an application for a guardianship was being progressed.
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2. The proposed legal authorisation process will not be required for a person who is living in a care home where the front door is ordinarily locked, who might require seclusion or restraint from time to time.
Do you agree that the authorisation process suggested by the Commission should not apply here?
No
Please give an explanation for your answer.
It is problematic to define "from time to time". A locked door is a restriction if the person cannot use a key pad or lock or does not know where the door is or how to use the door.
3. In proposing a new process for measures that may restrict an adult’s liberty, the Commission has recommended the use of ‘significant restriction ‘ rather than deprivation of liberty and has set out a list of criteria that would constitute a significant restriction on an adult’s liberty.
Please give your views on this approach and the categories of significant restriction.
The Commission recommended that a legal authorisation process will not apply universally to all adults in care settings but only to those who are subject to a significant restriction in a community setting, defined by having more than one measure of restraint on a regular basis. However the categories are far reaching and it is thought they would apply to most adults in care homes.
We would consider that having a locked door is a significant restriction of liberty if an adult does not know how to get out. Most dementia units are upstairs which is a barrier to adults leaving that part of the care home and building design would have a significant impact on whether all residents would fall under the significant restriction category. Additionally it is increasingly unusual for people to be admitted to a care home if they are both cognitively able to decide and physically able to leave.
It is also possible to restrict someone's liberty at home either through constant supervision by a carer, care provider or through the use of telecare. The fact that people living at home are excluded does not appear consistent.
4. The authorisation process provides for guardians and welfare attorneys to authorise significant restrictions of liberty. Do you have a view on whether this would provide sufficiently strong safeguards to meet the requirements of article 5 of the ECHR?
Yes - if all interested parties were in agreement and depending on the powers held by proxies.
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Please give an explanation for your answer It would depend on the powers held by proxies.
5. The Bill is currently silent on whether it should be open to a relevant person to seek a statement of significant restriction in relation to a person subject to an order under the 1995 or 2003 Acts which currently do not expressly authorise measures which amount to deprivation of liberty. Please give your views on whether these persons should be expressly included or not within the provisions, and reasons for this.
It is hard to see why the Bournewood ruling would not also apply to people placed in care settings subject to orders under 1995 Act and 2003 Act. However it is thought that restrictions could be more appropriately added to the conditions of an order.
6. The process to obtain a statement of significant restriction would, as the bill is currently drafted, sit alongside existing provisions safeguarding the welfare of incapable adults, and require the input of professionals already engaged in many aspects of work under the 2000 Act, such as mental health officers (MHOs) and medical practitioners.
Please give your views on the impact this process would have on the way the Act currently operates.
If you do not agree with the approach taken by the Commission, please outline any alternative approaches you consider appropriate.
Stirling Council considers that any review of the Adults with Incapacity Scotland Act should take into account case law as it relates to matters of human rights and also the position taken by the ECHR.
The wider review should address restraint and other forms of deprivation of liberty. If this issue is addressed in isolation then the effect of this change is in danger of being disproportionate, administratively inefficient and not consistent with the principles of the legislation.
The draft Bill is considered neither proportionate nor manageable. It is thought that the criteria for significant restriction would apply to most adults in care homes and indeed to some people living at home. If implemented the proposal would impact severely on Mental Health Officer services. At a time where it is recognised that there is a national shortage of MHOs introducing such a measure would undermine Local Authorities' ability to exercise their statutory duties. Similarly medical staff and the Sherriff Courts would be equally overwhelmed.
As proposed in the draft Bill the process would result in duplication of effort. The process for an application for restriction of liberty is similar to an application for an intervention order or guardianship. A requirement for an incapacity report , an MHO report and a Court process appears disproportionate if someone already has an order in place and a proxy who can already consent (or otherwise) to decisions that significantly impact the adult's health, safety, wellbeing and liberty.
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It is thought that robust legal authorisation would be required in some circumstances. For people who have entered a care setting voluntarily and then subsequently lost capacity there is no currently legal framework for keeping them in a care setting and for providing care. If adults in this situation have a change in their condition requiring restraint or are moved to a more restrictive area of the building (e.g. upstairs) then it would be appropriate to have a legal process and authorisation. However, if as part of that legal process Sheriffs exercise their powers to instruct the local authority to additionally apply for guardianship (as per the draft Bill) then it is unlikely that the local authority would choose to apply for significant restriction of liberty without also applying for guardianship to reduce duplication of effort. This could mean that an adult could be subject to two separate orders which appears to be over-restrictive and unnecessary.
The Commission could consider whether it would be appropriate to make the power to consent to significant restriction part of the guardianship application and whether the court could confer powers on a welfare guardian to consent to significant restriction if it was shown to be necessary, provide benefit and be least restrictive.
A mandatory training programme would have to be provided for managers of care settings to consistently recognise when criteria for significant restriction are met. Managers of care settings should not have responsibility for undertaking the statement of significant restriction but should be a significant contributor to the assessment. Care provision operates under contract to the local authority and therefore the responsibility for assessing whether significant restriction of liberty applies should rest with the local authority. The consideration of restriction of liberty should be routinely considered by the multi-agency team and family at review.
16. Is a process required to allow adults to appeal to the Sheriff against unlawful detention in a care home or adult care placement? Yes Is the proposed approach comprehensive? Yes
Are there any changes you would suggest? No NEXT STEPS AND WIDER REVIEW
The Scottish Government is also currently consulting on the Draft Delivery Plan 2016 - 2020 United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). That plan includes the following commitment: - We will consult on the Scottish Law Commissions review of the Adults with Incapacity Act in relation to its compliance with Article 5 of the ECHR, specifically in relation to Deprivation of Liberty and thereafter carry out a scoping exercise in relation to a wider review of the Adults with Incapacity legislation.
All responses to this consultation will be carefully considered as part of the
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scoping process in relation to a wider review of Adults with Incapacity legislation . To further assist that process we would therefore welcome responses to the following questions:
1.Over and above the question of deprivation of liberty considered by the Commission do you believe the 2000 Act is working effectively to meet its purpose of safeguarding the welfare and financial affairs of people in the least restrictive manner? No not in all aspects Please give an explanation for your answer Please see answer to question 2
2.If you have answered no, can you please suggest two or three key areas which any future wider review of the provisions of the 2000 Act might consider.
Powers to admit an adult with incapacity to a care home under Section13ZA of the Social Work (Scotland)Act 1984 need to be reviewed as it is our opinion that these provisions are problematic in relation to human rights legislation.
We consider that intervention orders and guardianships should be considered and granted by the Tribunal Service rather than the Sherriff Courts, as with compulsory measures under the Mental Health Care and Treatment Scotland Act 2003. There is a "one size fits all" approach taken by most solicitors in relation to the range of powers in their applications. Sheriffs do not have the expertise to consider what are the appropriate powers in individual cases. Consequently guardianships are at times granted unnecessarily and for longer than necessary and powers granted which are unnecessarily restrictive. This is despite MHOs not supporting the full range of powers or not supporting the application because they deem it unnecessary.
Power of Attorney needs to be reviewed. It is too easy for people to be persuaded to grant power of attorney and for these powers to be misused. Power of Attorney should have a level of scrutiny and it is suggested that it should be overseen and administered by the Tribunal Service rather than by solicitors themselves.
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Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 14 on the agenda
Support Services
(Paper presented by Shiona Strachan)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Lesley Fulford, Programme Manager Date: 22 March 2016 List of Background Papers: The papers that may be referred to within the report or previous papers on the same or related subjects.
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Title/Subject: Support Services Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Lesley Fulford, Programme Manager Action: For Noting
1. Introduction
1.1 This paper outlines the progress of the work taking place to identify the support required by the Integration Joint Board to carry out its range of functions.
1.2 The partnership's Integration Scheme contains a commitment to identify what is required and agree how services to support the work of the Integration Joint Board will be delivered.
2. Executive Summary
2.1. Access to support services and resources for the Integration Joint Board will be required on an ongoing basis to ensure the Board is able to meet its statutory responsibilities as set out in the Public Bodies (Joint Working) (Scotland) Act 2014.
2.2. The development of the range of strategies, plans and policies to date to support the development of the Integration Joint Board has drawn on a mixture of ring fenced support and posts and considerable input from the existing corporate services from Clackmannanshire Council, NHS Forth Valley and Stirling Council.
2.3. The development of the framework for the Integration Joint Board has increased understanding of the nature and level of resource required going forward, which will be different from the current focus on planning. Work has been progressing to clarify the ongoing requirements to more accurately reflect the agreed framework for operation and discharge of functions by the Board but has not yet fully concluded.
3. Recommendations
The Integration Joint Board is asked to:
3.1. Note the ongoing work in relation to the development of the support arrangements for the Board. 3.2. To note the commitment within the local Integration Scheme, and
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3.3. To agree that proposals for consideration and approval will be brought forward by the Chief Officer at the June 2016 meeting
4. Background
4.1. At the Integration Joint Board meeting on 24 February 2016 the Board approved to “Delegate authority to the Chief Executives, in conjunction with the Chief Officer, to consider the support arrangements for the Integration Joint Board and bring forward proposals for consideration and approval.”
4.2. Section 4.5 of the Integration Scheme states that :
In the Shadow Year, the Parties will identify the corporate resources currently utilised to carry out the Integration Functions and agree (a) how any or all of those will be provided to the Integration Joint Board to support it to discharge its duties under the Act, and (b) how this resource will be funded. The Parties will ensure that representatives from relevant corporate support services are involved in this process, such as representatives from finance, legal/governance, information governance, equalities, performance management/data analysis, human resources, risk management, community engagement and strategic planning.
4.3. As noted above, the body of work to date to support the development of the Integration Joint Board and planning for integration has drawn on a mixture of ring fenced support and posts and considerable input from the existing corporate services from Clackmannanshire Council, NHS Forth Valley and Stirling Council. Colleagues from the range of corporate services have been involved in the work streams. We are now moving to a different stage of development and work is currently progressing both within this partnership and, as appropriate, with the Falkirk partnership to clarify the ongoing requirements in the light of the developing framework for operation of the Integration Joint Board.
5. Conclusions
5.1. Work has been progressing to clarify the ongoing requirements to more accurately reflect the agreed framework for operation and discharge of functions by the Board but has not yet fully concluded.
6. Resource Implications
6.1. Each partner body will be required to provide support to the Integration Joint Board.
7. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
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7.1. The nature of the support required will change as the Integration Joint Board moves from the planning stage to delivery and the support needs require to reflect this to ensure that the Board is able to discharge effectively the full range of its functions.
8. Legal & Risk Implications
8.1. The requirement is not legislative but is part of the local Integration Scheme.
9. Consultation
9.1. All governance leads have been consulted in the preparation of this paper.
10. Equality and Human Rights Impact Assessment
10.1. This paper does not require an assessment.
11. Exempt reports
11.1. No
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Clackmannanshire & Stirling Integration Joint Board
22 March 2016
This report relates to Item 15 on the agenda
Draft NHS Forth Valley Local Delivery Plan 2016/17
(Paper presented by Dr Graham Foster)
For Discussion
Approved for Submission by Shiona Strachan, Chief Officer Author Janette Fraser, Head of Planning, NHS Forth Valley Date: 22 March 2016 List of Background Papers: Local Delivery Plan Guidance 2016/17 – DL (2016) 1 – Scottish Government
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Title/Subject: Draft NHS Forth Valley Local Delivery Plan Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 March 2016 Submitted By: Dr Graham Foster Action: For Discussion
1. Introduction
1.1. This paper presents the first draft of the NHS Forth Valley Local Delivery Plan 2016/17. The Local Delivery Plan is the performance contract between the Scottish Government and NHS Board, and has been prepared in collaboration with the Chief Officer of the Health and Social Care Integration Partnership.
2. Recommendations
2.1. The Integration Joint Board is asked to consider the Draft Local Delivery Plan 2016/17 and to inform the development of the final version, to be submitted to Scottish Government by 31 May 2016. There will be continued opportunities over the next two months for the Health and Social Care Integration Partnerships to further inform the preparation of the final Local Delivery Plan.
3. Background
3.1. Significant policy developments underway include the national clinical strategy, integration of Health & Social Care, national conversation and a range of service reviews. The scale of challenges that NHS Scotland faces means that we need to deliver fundamental reform and change to the way that the NHS delivers care.
3.2. The Scottish Government has provided Local Delivery Plan Guidance to be considered alongside the guidance for Health & Social Care Partnerships on strategic commissioning and Scotland’s spending plans and draft budget for 2016-17. It should also be considered within the context of wider health & Social Care policy developments outlined above. The guidance has stressed the importance that Health and Social Care Integration Partnerships are involved in the preparation of Local Delivery Plans.
The Local Delivery Plan is structured around the priorities described in the guidance:
• Health Inequalities and Prevention • Antenatal and Early Years • Safe Care • Person Centred • Primary Care
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• Integration • Scheduled Care • Unscheduled Care • Mental Health
In addition to the priorities, the following are also included:
• Financial Planning • Community Planning Partnerships • Workforce Planning
The Local Delivery Plan sets out:
• The strategic context for the priority areas • Progress made during 2015/16 • Improvement actions planned for 2016/17 • Performance Management
3.3. The performance management sections for each priority area incorporate the Local Delivery Plan standards set by the Scottish Government, in addition to local measures. Delivery against these Local Delivery Plan standards will require the combined action of Health Boards, Local Authorities and the Integration Joint Board.
3.4. The Local Delivery Plan guidance from the Scottish Government makes specific reference to integration:
All Health and Social Care partnerships will be fully functional by April 2016, having published Strategic Commissioning Plans. These plans are for all the functions and budgets under their control. NHS Boards will have been fully involved in the development of the Strategic Commissioning Plans and will ensure that these are aligned with the LDP.
NHS Boards and Local Authorities delegate appropriate national and local standards/targets to their Health Social Care Partnerships, along with the relevant functions and budgets. Whichever functions and standards/targets are integrated, it will be important that robust planning operates to reflect interdependencies so that for instance, where non- elective care is integrated and elective is not, then these two must operate in a mutually supportive way. Delivery of many of the integration indicators will fall, in the main, to the NHS Boards, so Boards will want to consider, in conjunction with their Health and Social Care Partnership, an annual Operational or Delivery Plan, outlining how they will jointly deliver the priorities of the Strategic Commissioning Plan and the LDP.
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The LDP should set out a summary of how the delivery of national and local standards/targets will be aligned between the local planning and operational structures.
This is a draft Local Delivery Plan and therefore there will be an opportunity to include further references to health and social care partnership plans, including the Strategic Plan which is to be approved by the IJB in March 2016, and the outcomes of the NHS Forth Valley Healthcare Strategy, as these continue to develop over the next few months.
Further assessment also continues, to ensure that the local measures and targets in the draft LDP are measurable from a performance management perspective.
4. Conclusions
• NHS Boards were asked to submit a draft Local Delivery Plan by 4 March 2016 (revised date from Government – 21 March 2016). • The Scottish Government has agreed to provide feedback on drafts during March. • NHS Boards should submit their final Local Delivery Plan by 31 May 2016.
5. Resource Implications
5.1. Boards are required to submit financial plans in March 2016.
6. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
6.1. As described in the Local Delivery Plan.
7. Legal & Risk Implications
7.1. Not determined.
8. Consultation
8.1. Not required.
9. Equality and Human Rights Impact Assessment
9.1. No separate Impact Assessment required for the Local Delivery Plan.
10. Exempt reports
10.1. No Page 4 of 4
NHS FORTH VALLEY
DRAFT LOCAL DELIVERY PLAN
2016-17
Draft 1.4 – 01 03 16
Content 1 Background ...... 5 1.1 Introduction ...... 5 1.2 2020 Vision ...... 5 1.3 Equality Duty 2010 ...... 5 1.4 Challenges in Forth Valley ...... 6 1.5 Strategic Principles ...... 7 1.6 Strategic Planning Framework ...... 8 1.7 Performance Management ...... 8 1.7.1 Context ...... 8 1.7.2 Health and Social Care Partnerships and the LDP ...... 9 1.8 Challenges in Forth Valley ...... 11 1.9 LDP Structure ...... 11 2 National Improvement Priorities ...... 13 2.1 Health Inequalities and Prevention ...... 13 2.1.1 Strategic Context ...... 13 2.1.2 Progress During 2015-16 ...... 14 2.1.3 Improvement Actions 2016-17 ...... 16 2.1.4 Performance Management ...... 16 2.2 Antenatal and Early Years ...... 17 2.2.1 Strategic Context ...... 17 2.2.2 Progress During 2015-16 ...... 17 2.2.3 Improvement Actions 2016-17 ...... 19 2.2.4 Performance Management ...... 20 2.3 Safe Care ...... 21 2.3.1 Strategic Context ...... 21 2.3.2 Progress During 2015-16 ...... 22 2.3.3 Improvement Actions 2016-17 ...... 24 2.3.4 Performance Management ...... 25 2.4 Person-Centred ...... 26 2.4.1 Strategic Context ...... 26 2.4.2 Progress During 2015-16 ...... 26 2.4.3 Improvement Actions 2016-17 ...... 28 2.4.4 Performance Management ...... 29 Page 2 of 54 NHS Forth Valley Draft Local Delivery Plan 2016-17 – Version 1.4 – 01 03 16
2.5 Primary Care ...... 30 2.5.1 Strategic Context ...... 30 2.5.2 Progress During 2015-16 ...... 30 2.5.3 Improvement Actions 2016-17 ...... 32 2.5.4 Performance Management ...... 33 2.6 Integration ...... 34 2.6.1 Strategic Context ...... 34 2.6.2 Progress During 2015-16 ...... 34 2.6.3 Improvement Actions 2016-17 ...... 35 2.6.4 Performance Management ...... 36 2.7 Scheduled Care ...... 37 2.7.1 Strategic Context ...... 37 2.7.2 Progress During 2015-16 ...... 37 2.7.3 Improvement Actions 2016-17 ...... 38 2.7.4 Performance Management ...... 39 2.8 Unscheduled Care ...... 40 2.8.1 Strategic Context ...... 40 2.8.2 Progress During 2015-16 ...... 40 2.8.3 Improvement Actions 2016-17 ...... 41 2.8.4 Performance Management ...... 42 2.9 Mental Health ...... 43 2.9.1 Strategic Context ...... 43 2.9.2 Progress During 2015-16 ...... 44 2.9.3 Improvement Actions 2016-17 ...... 44 2.9.4 Performance Management ...... 45 3 Overarching Improvement Areas ...... 46 3.1 Financial Planning ...... 46 3.1.1 Performance Management ...... 47 3.2 Community Planning Partnerships ...... 48 3.2.1 Strategic Context ...... 48 3.2.2 Progress during 2015-16 ...... 49 3.2.3 Improvement Actions 2016-17 ...... 50 3.2.4 Performance Management ...... 50
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3.3 Workforce Planning ...... 51 3.3.1 Strategic Context ...... 51 3.3.2 Progress During 2015-16 ...... 52 3.3.3 Improvement Actions 2016-17 ...... 53 3.3.4 Performance Management ...... 53 APPENDIX 1 – NHS Forth Valley Strategic Planning Matrix ...... 54
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1 Background
1.1 Introduction
The Local Delivery Plan (LDP) remains the delivery contract between Scottish Government and NHS Boards in Scotland, as we continue the transition towards integrated health and social care. LDPs require to focus on the priorities for the NHS in Scotland and support delivery of the Scottish Government’s national performance framework, the Health and Social care outcomes that are being developed in partnership, and the 2020 Vision for high quality, sustainable health and social care. The LDP Guidance, issued on 13 January 2016, contained a number of standards Boards are expected to deliver in 2016-17 (see Table 1, Page 10). This LDP will set out how NHS Forth Valley is going to deliver them.
1.2 2020 Vision
The NHS Scotland vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting: We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re- admission.
1.3 Equality Duty 2010
The NHS Forth Valley LDP 2016-17 emphasises how important it is to improve the health of the population, and to get the experience of care right for every individual, every time. It recognises that the key to this is recognising the differences across, and within, our diverse population, and focussing on providing person-centred care. Our LDP therefore directly supports NHS Forth Valley in the discharge of the General Equality Duty 2010.
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1.4 Challenges in Forth Valley
NHS Forth Valley is facing the challenges and constraints of increasing demand and limited resources. We have an ageing population and people are living longer (Figure 1), which simultaneously brings a rise in people in middle and older age with multiple morbidities.
Figure 1: Population Charts showing the increasing Age Profile in Forth Valley 2015- 2035
In addition, the number of single occupancy dwellings is increasing and there are other signs that people may have less family and informal social support than was previously the case. The traditional health service structure needs to change to put the patient in the centre, which aligns with the Scottish Government’s 2020 Vision. This will require a shift towards achieving a better balance between hospital centred care and community centred care and from episodic disjointed care towards joined- up integrated care.
Furthermore, various reports indicate that “high levels of public resources are devoted annually to alleviating social problems and tackling failure demand” (the cost and consequences of poverty, unemployment and inequalities) (Christie, 2011). This will be our biggest challenge in ensuring that services are designed around the needs of patients in the future. NHS Forth Valley will continue to place a high priority on working with partners to tackle deprivation and inequality and promote health and wellbeing.
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1.5 Strategic Principles
The principles outlined below will be integral to the Board’s overall approach, however once the NHS Forth Valley Healthcare Strategy is finalised in 2016, following a period of consultation, the Board’s strategic principles will be revised to reflect the Healthcare Strategy: Providing consistent high quality, safe and sustainable services across the whole system, integrating care in partnerships appropriately. Ensuring all care is patient focussed while planning and delivering care in partnership with our population. Increasing focus and pace on shifting the balance of care - develop community and primary care services through facilitating supported self management, anticipatory care planning, integrating care pathways, locality planning and workforce development. Minimising time spent in acute care and focus acute care on complex, unscheduled emergency care, specialist elective care with day surgery /23hr surgery the norm, minimising length of stay and ensuring the majority of service provision is as close to home as possible. Collaborative working should be focussed on reducing inequalities, prevention through an asset based approach and on early years.
In applying these principles we will take into account the ‘Health and Wellbeing Outcomes’ (Joint Public Bodies Act 2014) which are set out below: 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, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 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 service users. Health and social care services contribute to reducing health inequalities People who provide unpaid care are supported to reduce the potential impact of their caring role on their own health and well-being. People who use health and social care services are safe from harm. People who work in health and social care services are supported to continuously improve the information, support, care and treatment they provide and feel engaged with the work they do. Resources are used effectively in the provision of health and social care services, without waste. The improvement actions described in this LDP take full account of these outcomes and are designed to support their delivery.
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1.6 Strategic Planning Framework
NHS Forth Valley has undertaken a strategic Clinical Services Review with the aim of producing a revised Healthcare Strategy for 2016-2021 that reflects the NHS Scotland 2020 Vision and the NHS Scotland National Clinical Strategy. The Forth Valley Clinical Service Review (CSR) began with a Case for Change document setting out the nature and scale of the challenges we face including the ageing population, increasing public expectations, technological advances and the rise in complex and multiple morbidity. The Clinical Services Review has looked in depth at challenges and opportunities within eight complementary work streams:-
Cancer Care Mental Health and Learning Disabilities Clinical Support and Infrastructure Long Term Conditions & Multiple Emergency Care and Out of Hours Morbidity Frail Older People and End of Life Planned Care Care Care of Women and Children
The CSR will also ensure that NHS Forth Valley is ready to engage fully in the integration agenda and deliver the outcomes expected in local Community Planning Partnership Strategic Outcomes and Local Delivery Plans. During 2016-2017 the implementation of Strategic Plans developed with Health and Social Care Partnerships, will be an important part of the local planning agenda.
The Healthcare Strategy will also describe how we will build the capacity of community based services, will reflect the content of the Health and Social Care Partnership Strategic Plans and will be taken forward in the context of the national conversation, the national clinical strategy and the review of primary care out of hours services.
1.7 Performance Management
1.7.1 Context
Performance Management is a critical component of the LDP and associated plans which include, for example, scheduled and unscheduled care. The role of performance management is to ensure that our efforts are clearly targeted and that desired outcomes and improvements are achieved. The overall approach, detailed within NHS Forth Valley’s Performance Management Framework, continues to underline the principle that performance management is integral to the delivery of quality improvement and core to sound management, governance and accountability, prioritisation and decision making.
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The Scottish Government has an established set of performance management principles to promote a culture in which targets and standards are delivered within the spirit they were intended, recognising that clinical decision making is more important than the absolute delivery of targets and standards. The principles are:
NHS Scotland’s Performance Management Framework supports delivery of the Scottish Government’s outcomes and Health Directorates’ strategic objectives. Performance measures demonstrate the progress towards delivering our strategy for improving the quality of patient care. Performance measures help deliver a wider system aim and the impact on the whole system must be considered. Design the system, deliver the performance. Clinical decision making in the interest of the patient is always more important than unequivocal delivery of targets. Local flexibility in delivery. Targets should support diversity and reduce inequalities. Staff should be engaged in target setting and target delivery. Best practice in Performance Management and delivery is shared. Data and measurement are key aspects of Performance Management.
1.7.2 Health and Social Care Partnerships and the LDP
In developing our priorities for the LDP 2016-17 NHS Forth Valley has considered our existing locally agreed improvement aims. The LDP guidance for 2016-17 states clearly that Health Boards and their partners in local government must take account of the effect of their plans on the outcomes for health and wellbeing set out in legislation as part of integration of health and social care, and on the indicators that underpin them. There is a legal duty for Health and Social Care Partnerships to produce a strategic plan and a duty for the delegating parties to be fully involved throughout that process. Health and Social Care Partnerships are established from 1 April 2016 and it is important that they are now engaged in the preparation of this LDP with a relationship based on collaboration and alignment.
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Table 1 - LDP Standards and Linkage to National Improvement Priorities
NHS LDP Standard National Improvement Priorities Detect Cancer Early Health Inequalities & Prevention Cancer Waiting Times Scheduled Care Dementia Post Diagnostic Support Primary Care Treatment Time Guarantee (TTG) Scheduled Care 18 Weeks Referral to Treatment (RTT) Scheduled Care 12 Weeks First Outpatient Appointment Scheduled Care Early Access to Antenatal Services Antenatal & Early Years IVF Waiting Times Scheduled Care CAMHS Waiting Times Scheduled Care Psychological Therapies Waiting Times Scheduled Care Clostridium Difficile Infections Safe Care SAB (MRSA/MSSA) Safe Care Drug and Alcohol Treatment Waiting Times Scheduled Care Alcohol Brief Interventions Health Inequalities & Prevention Smoking Cessation Health Inequalities & Prevention GP Access Primary Care Sickness Absence Person-Centred Care Accident and Emergency Waiting Times Unscheduled Care Financial Performance Finance
Delivery against these LDP standards will require the combined action of Health Boards, Local Authorities and Integration Authorities. The LDP standards are intended to provide assurance on sustaining delivery which will only be achieved by evolving services in line with the 2020 Vision. Progress against NHS LDP Standards will continue to be reported to the NHS Board. The Scottish Government will continue to review the LDP standards to ensure that their definitions are consistent with changes in service delivery.
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1.8 Challenges in Forth Valley
There are a number of significant risks and challenges that will have to be addressed during 2016-17 and in the longer term, which are included in the specific action areas described in this LDP. These include: Sustainability of Primary Care services. Integration agenda and working through the first year of the Health and Social Care Partnerships. Emergency Access, Delayed Discharges and overall waiting times. More targeted focus on Health Inequalities. Workforce recruitment, retention and absence. Financial context.
NHS Forth Valley’s approach to this increasingly complex environment is supported by a number of more detailed plans which set out the specific actions that underpin how we will address these issues. The planning matrix for NHS Forth Valley is provided in Appendix 1 of this plan.
1.9 LDP Structure
The LDP sets out how NHS Forth Valley with its local partners will improve services and health outcomes during 2016-17. The national improvement priority areas are:
Health Inequalities and Prevention Scheduled Care Antenatal and Early Years Unscheduled Care Safe Care Mental Health Person-Centred Financial Planning Primary Care Community Planning Partnership Integration Workforce
The LDP Guidance, issued on 13 January 2016, contained the NHS LDP standards Boards are expected to deliver in 2016-17 (see Table 1 on page 10). This LDP will set out how NHS Forth Valley plans to deliver these standards. Each section in the LDP is structured as follows: Strategic Context. Progress during 2015-16. Improvement Actions 2016-17. Performance Management.
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In developing the LDP 2016-17, the following guidance and policies have been considered: The LDP guidance. Health and Social Care Partnerships guidance on their strategic commissioning plans. Scotland’s Spending Plans and Draft Budget 2016-17.
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2 National Improvement Priorities
2.1 Health Inequalities and Prevention
2.1.1 Strategic Context
NHS Forth Valley is committed to enabling those more at risk of health inequalities – physical, mental or both – to make better choices and positive steps toward better health and wellbeing. Four areas have been identified for specific NHS action: NHS procurement policies should support employment and income for people and communities with fewer economic levers. Where national procurement contracts are in place, the use of these in NHS Boards in mandatory however where feasible, procurement policies endeavour to support the local community. Actions relating to employment policies that support people to gain employment or ensure fair terms and conditions for all staff (2016/17 Workforce Plan). Actions to support staff to support the most vulnerable people and communities. Health improvement actions to promote healthy living and better mental health.
This activity is also focussed through the NHS workforce and the Health Promoting Health Service as well as with the wider community.
The Obesity Route Map sitting within the wider context of the National Performance Framework, recognises management and treatment as an important companion to tackling overweight and obesity in Scotland. The Scottish Government is committed to ensuring that cost effective and appropriate weight management services and treatments for obesity are provided for patients using a tiered approach.
The Nutrition & Dietetic Health Improvement Team (NDHIT) works in partnership with Local Authorities and third sector organisations to empower and support individuals, groups and communities to improve their health and access to healthier food options. The NDHIT uses food as a means of engaging with communities as well as the mechanism to address a range of both health and social issues. The team is focusing on addressing health inequalities with vulnerable adults, families and communities, concentrating on the worst 15% by SIMD.
NHS Forth Valley is working with Community Planning Partnerships to meet outcomes within Single Outcome Agreements (SOAs) and Single Outcome Local Delivery Plans (SOLD) which will impact on health. There is a contribution from NHS Forth Valley to each Community Planning Partnership, including the development of health inequalities actions as a cross-cutting issue across all theme groups, the
Page 13 of 54 NHS Forth Valley Draft Local Delivery Plan 2016-17 – Version 1.4 – 01 03 16 development of an Equality and Diversity Impact Assessment (EQIA) process for CPPs and the application of health impact assessment.
2.1.2 Progress During 2015-16
The main improvement and prevention activities in 2015-16 included smoking cessation services, health protection including immunisation and population health screening, alcohol brief interventions (ABI), the health promoting health service framework, Keep Well health assessments, the delivery of the sexual health and BBV framework, support to community planning and the SOAs and the joint work of the Forth Valley Alcohol and Drugs Partnership.
The Stop Smoking Service has continued to plan and deliver smoking cessation services in community venues using different approaches to ensure delivery of the HEAT standard. Stop Smoking services will continue to focus on areas of greatest need (40% SIMD) and with inequalities groups who are known to have higher than average rates of smoking prevalence, including people with mental health issues as well as priority groups, such as pregnant women. The approach being developed is closer working with community planning partners, such as local employability partnership members, to identify those who are ready to stop smoking and providing support.
Health Promoting Health Service (HPHS): NHS Forth Valley made considerable progress with the HPHS agenda in 2015-16. Improvements in the majority of the areas for development within the monitoring framework were noted with feedback from Health Scotland reporting 35 of the action areas complete, 7 partially met and 2 unmet.
Although the national funding for Keep Well has been withdrawn, NHS Forth Valley plans to continue with primary anticipatory care work in Forth Valley, as this underpins the work on addressing health improvement and health inequalities. It includes specific work on, for example employability, substance misuse and healthy weight.
Forth Valley Alcohol and Drug Partnership (FVADP) commissioned a strategic needs assessment for substance misuse. Additionally the Local Enhanced Service (LES) for ABIs delivery within Primary Care has been reviewed, as well as the Opiate Replacement Therapy (ORT) LES. Education evenings for GPs have taken place, as well as an evaluation of GPs’ views on Opiate Replacement Therapy (ORT).
The Quality Improvement Framework Board of the FVADP delivered key milestones within the service improvement plan, such as providing workforce development support to Community Pharmacy Staff on recovery. Health visiting staff have benefited from additional training support on alcohol and drugs within the familial setting, all supported by FVADP. Page 14 of 54 NHS Forth Valley Draft Local Delivery Plan 2016-17 – Version 1.4 – 01 03 16
NHS Forth Valley will continue to increase the numbers of staff trained to recognise and support victims of domestic abuse. Additionally, planning will continue to ensure appropriate NHS Forth Valley input to Multi Agency Risk Assessment Conferences.
NHS Forth Valley is working towards implementation of Tiers 2 and 3 of NHS Forth Valley’s Weight Management Service (FVWMS). This service has achieved excellent results, after three years of project development, 45% of participants lost 5% of body weight exceeding the Scottish Government target of 30%. NHS Forth Valley is supporting a range of food activities in local communities, including capacity building with staff and volunteers. Capacity is being built within NHS and partner organisations on delivering key nutrition messages to facilitate behaviour change. NHS Forth Valley continues to maintain the innovative “Choose to Lose” website resource.
NHS Forth Valley uses the Scottish Procurement advertising portal for all tenders and uses the “Quick Quote” for goods and services under £25,000. The portal gives Scottish small and medium enterprises and supported businesses, the opportunity to bid for these NHS Forth Valley contracts. NHS Forth Valley Procurement has awarded major contracts during 2015-16 via the Public Contracts Scotland Portal, including the Community Language Interpreting and the Translation Service.
Key areas of progress include the Board’s maintenance of the Healthy Working Lives silver award; reaccreditation of the UNICEF Baby Friendly Initiative award for acute services; further development of green space health improvement planning for NHS Forth Valley estates; delivery of a number of workplace physical activity programmes; and campaigns and increased numbers of staff undertaking health behaviour change training. NHS Forth Valley will continue to deliver the National Working Health Service and Fit For Work programmes.
The NHS Forth Valley Health and Employability Working Group aims to co-ordinate NHS activity related to health and work, and wider partnership working, including support for the work of the three Local Employability Partnerships (LEPs).
Sexual Health (SH) and Blood Borne Viruses (BBV) are more prevalent in certain vulnerable groups. The SH and BBV MCN supports and monitors the five high level outcomes set out in the Scottish Government’s SH & BBV Framework document 2015-20 to tackle the health inequalities gap. The aim is to reduce the number of sexually transmitted infections and unintended pregnancies and to ensure sexual relationships are free from coercion and harm in a Scottish society.
NHS Forth Valley is committed to the improvement of mental health and wellbeing in the population as we recognise that it underpins many other issues such as substance use, employability, crime and health behaviours in general. This relates to the person-centred approach across various settings e.g. through the Health Promoting Health Service, Keep Well, Community Planning Partnerships and the Integration of Health and Social Care. Page 15 of 54 NHS Forth Valley Draft Local Delivery Plan 2016-17 – Version 1.4 – 01 03 16
2.1.3 Improvement Actions 2016-17
Support those most at risk of Health Inequalities through targeted interventions to support vulnerable people and harder to reach communities. Specific actions will include developing employment opportunities within the NHS and local partners for disadvantaged groups; reducing alcohol and drug related harm and promoting recovery orientated systems of care, identifying unrecognised health risks. Deliver Health Improvement by continuing to prioritise actions to reduce the harmful effects of cigarette smoking and engaging hard to reach groups. Protect vulnerable groups from harm with a continued focus on Child Protection. Deliver the BBV and Sexual Health Framework, and population health screening and immunisation programmes. Continue to promote healthy eating and reduce obesity through the Child Healthy Weight Programme (Max in the Middle) in local schools, adult healthy weight initiatives including the ‘Choose to Lose’ website and support staff and visitors through a change to healthy vending machines in all NHS sites.
2.1.4 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
Measures – Focus on Health Improvement and Prevention LDP Standard Enabling people at risk of health inequalities to make better choices and positive steps toward better health Sustain and embed Alcohol Brief Interventions in 3 priority settings of primary care, A&E and antenatal, and broaden delivery in wider settings Sustain and embed successful smoking quits, at 12 weeks post quit, in the 40% SIMD areas Prevention - Early diagnosis and treatment improves outcomes People diagnosed and treated in 1st stage of breast, colorectal and lung cancer (25% increase) Local Measure Prevention Screening Programme Performance (Cervical, Bowel, Breast) Immunisation Programmes (Adult and Children) - uptake Deliver Child Healthy Weight interventions New diagnosis of Hepatitis C & Hepatitis C treatments completed
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2.2 Antenatal and Early Years
2.2.1 Strategic Context
NHS Forth Valley will follow the strategic context set out in Getting it Right for Every Child (GIRFEC), Child Protection Guidance, the Children and Young People (Scotland) Act 2014 and the ongoing work being taken forward through the Early Years Collaborative. Specifically, under the Act, Health Boards will be responsible for providing a Named Person service for every child up to 5 and a singular Child’s Plan for every under 5 who requires one.
The Children and Young People (Scotland) Act 2014 is planned to ‘go live’ in August 2016 and provides a series of ‘must dos’ for the NHS, Local Authorities and their partners. Within that context and the wider umbrella of Getting it Right For Every Child (GIRFEC) we, with our local partners, are also implementing 3 national quality improvement programmes.
The Early Years Collaborative (EYC) and the Maternity and Children Quality Improvement Collaborative (MCQIC) are National Improvement Programmes designed to improve the health and wellbeing of populations across Scotland and in the words of the EYC ‘make Scotland the Best Place to Grow Up.’ The EYC is driven through partnership leadership groups in Clackmannanshire, Falkirk and Stirling. The NHS contributes actively to the leadership groups and also to a variety of tests of change.
In Forth Valley we have also developed links between those national programmes and the Raising Attainment For All (RAFA) programme and are delivering ‘Quality Improvement across the Child’s Journey’ (conception to 18 years).
NHS Forth Valley is anticipating the launch of a new national dental strategy later this year which will also include dental programme improvements.
2.2.2 Progress During 2015-16
A Forth Valley wide implementation plan for Getting it Right For Every Child encompasses the three Local Authorities, Police Scotland and third sector organisations. This will ensure that future services are integrated and use consistent processes and procedures for providing staff training, planning and evaluating service provision for children and young people, regardless of where they live in Forth Valley.
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Preparing to implement the responsibilities in terms of the Children and Young People (Scotland) Act, NHS Forth Valley has undertaken a robust analysis of the local health visitor workforce using the National Caseload Weighting Tool and identified the number of additional Health Visitors required. This has informed the development of a Workforce Plan for Health Visitors, including baseline information and the additional numbers being recruited through to 2018. NHS Forth Valley is working with local education providers to agree training places and local arrangements. Local processes around the named person are being considered, for example, information sharing protocols are under development.
A significant amount of work has been undertaken by a range of staff including midwives, health visitors, early years staff, nutrition and dietetics health improvement team (NDHIT) and partner organisations to progress Antenatal and Early Years Plans.
NHS Forth Valley has exceeded the 80% target for women booking to Antenatal Services before the 12th week. A stretch aim was developed and implemented to target 80% of women accessing antenatal care by the 10th week of pregnancy. NHS Forth Valley’s performance in respect of the stretch aim during 2015 for the year was:
<10weeks 87.5% <12 weeks 91.1%
NHS Forth Valley has achieved and maintained the 90% target for women to commence IVF Treatment within 12 months from referral. This aim remains a key priority for the Health Board.
The National Childsmile Programme is fully implemented locally, delivering a blend of universal and targeted dental health promotion that delivers a significant number of preventative interventions to children from birth to Primary 4. The Board will continue to work with local dental teams to improve the delivery and targeting of the programme in 2016-17.
The Child Healthy Weight Programmes Max in the Middle and Max in the Class, reflect our conceptual framework of developing resilience and being person centred (up to 1500 ten and eleven year olds participate every year and by the very nature of this programme drive forward this agenda). Interventions are biased towards schools whose catchment area takes in ‘deprived’ communities. In addition, the Max in the Class programme has trained 16 new members of staff who have since delivered a six session programme to approximately 400 participants.
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The NDHIT, with links to the local Maternal and Infant Nutrition Group, have also implemented the NHS Scotland National Nutritional Guidance i.e. Setting the Table; Healthy Start Campaigns – Welfare foods and vitamins; Weaning Project; and Family Food Journeys. Moreover the NDHIT have led on providing and supporting practical food activities; and training and support to public health nurses and community organisations to improve and provide consistent information for parents.
2.2.3 Improvement Actions 2016-17
Deliver the Children and Young People (Scotland) Act 2014 requirements including the target of providing a Named Person for every child up to age 5 by end March 2016 (Legal Requirement by 1 August 2016). Ensure that there are arrangements in place by 31 March 2016 to identify every child under 5 who requires a statutory Child’s Plan and ensure the workforce has the capacity, training and protocols to deliver the Child’s Plan by 1 August 2016. Implement the Early Years Collaborative Programme with partners across Forth Valley with the aim of delivering on the stretch aims through a range of local initiatives using improvement methodology and local tests of change. Deliver the workforce plan to recruit health visitors towards the target numbers for 2018 (GIRFEC).
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2.2.4 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
Measures Monitoring Implementation of the Children and Young People (Scotland) Act Development of key measures to ensure delivery of key aspects e.g. o Staff training o Implementation of the Named Person o Preparedness for implementation of the a statutory Child’s Plan LDP Standard Antenatal access supports improvements in breast feeding rates and other important health behaviours At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation Local Measure Participation in Early Years Collaborative – Stretch Aims: o To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths and infant mortality o To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected milestones at the time of the child’s 27-30 month child health review, by end-2016 o To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017
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2.3 Safe Care
2.3.1 Strategic Context
Delivery of the National Scottish Patient Safety Programme (SPSP) continues as a key strategic priority for NHS Forth Valley and is reflected in both the Board’s Quality Improvement Strategic Plan as well as in topic specific improvement plans supporting the Hospital Standardised Mortality Ratio (HSMR) improvement plan.
The Quality Improvement Strategic Leadership Group is currently taking forward the development of the Board’s Quality Improvement Strategy for 2016-19, which incorporates the SPSP and Early Years Collaborative, together with other local priorities. The Board has developed a Clinical Governance Balanced Scorecard which incorporates the ten patient safety essentials. Performance is reported and reviewed at each meeting of the Clinical Governance Committee.
The ten patient safety essentials are in place across the organisation with mechanisms to independently assure progress, including care assurance ward visits; structured review of adverse events such as unplanned transfers to critical care; and infection control ward visits.
The Board continues to report progress with the supplementary heart failure bundle process measures and has demonstrated sustained improvement across the two relevant main clinical areas i.e. cardiology and a general medical ward. Plans are being made to step down data collection in these areas to support spread to a further ward which provides care for patients including those with heart failure. Although there are no specific outcome measures associated with the heart failure bundle, reliable care for these patients contributes to the overall SPSP aim of reducing mortality. Sustained compliance at target with the Surgical Site Infection (SSI) theatre bundle has been demonstrated across all theatres and the frequency of national data reporting has now been stepped down. Improvement actions in relation to venous thromboembolism (VTE) are being progressed as part of the roll out of the structured ward round and will be supported by the implementation of electronic prescribing during 2016-17. Work has been undertaken during the year 2015-16 with local authority colleagues to develop a Clinical Care Governance (CCG) framework, which will support safe care, moving forward as Health and Social Care Partnerships become formally established at the 1 April 2016. NHS Forth Valley continues to be committed to safe, effective and person centred care being at the heart of all aspects of care and service delivery.
2.3.2 Progress During 2015-16
Pressure ulcer care forms part of the SPSP and is one of measures of harm in the Scottish Patient Safety Indicator. The NHS Forth Valley Tissue Viability Service is a nurse led service, which aims to provide specialist advice and support on chronic or complex wounds/complex skin care needs to health care professionals within NHS Forth Valley. The service also incorporates the services of lymphoedema key workers.
The service covers the whole of Forth Valley and this includes visiting care homes, patients’ own homes, community hospitals, acute hospital, health centres, community outreach clinics and HMP prisons. The service adopts a zero tolerance approach to skin ulcers with the objective of preventing all avoidable skin ulcers for people living in the Forth Valley area. Tissue Viability nurses lead and support various specialist clinics, including diabetic foot clinic, vascular clinic, consultant specialist wound clinic and weekly tissue viability clinic. Part of the team’s remit is also to give telephone advice utilising, when possible, the use of digital photographs.
Examples of improvements in the safety of care in the last 12 months include:
Acute Adult Programme Continued reduction in HSMR. (21.1% since 2008) Sepsis - 12% decrease in year on year mortality on data provided nationally by Public Health Intelligence. Two learning sessions have been held as part of the local deteriorating patient and sepsis collaborative. Sustained improvement (reduction) in the number of pressure injuries across acute services. Sustained decrease in the number of falls in a care of the elderly pilot ward. Sustained improvement and high reliability in the use of heart failure bundle in the cardiology ward and a general medical ward. SSI theatre bundle – performance at target for 16 months. Sustained improvement in the number of patients with an accurate inpatient prescription chart within 24 hours of admission.
Maternity and Children’s Quality Improvement Collaborative Sustaining ≥95% of women who are satisfied with the care they receive. Sustained improvement in the use of the post partum haemorrhage prevention and management bundles. Sustained improvement in % compliance with team huddles (maternal care team). Sustained improvement in the % of birth plans signed and dated by women and midwives.
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Sustained reliability in the use of the PVC insertion and maintenance bundles (Paediatrics).
Primary Care Patient Safety Programme 86% of practices participated in the safety climate survey with increased scores demonstrated over the five safety domains of workload, communication, leadership, teamwork and systems from 2013-14 to 2014-15. Sustained improvement in non-steroidal anti-inflammatory drug co-prescribing.
Mental Health Implementation of admission and discharge checklists. Continued process for review of episodes of restraint to review circumstances leading to the restraint, management of the restraint and generation of any learning points.
Healthcare Acquired Infection Reduction in SAB rates remain challenging, however the last three quarters (April – Dec 2015) have seen continued reduction, including reduction in hospital acquired SABs. Peripheral Venous Catheter (PVC) insertion maintenance bundle across FVRH implemented and audited. There have been no PVC SABs since July 2015. Analysis of healthcare acquired SABs especially patients with osteomyelitis, discitis, septic arthritis etc to identify cause of the previous primary infection. The last three quarters (April – Dec 2015) have remained consistent, including a continued reduction in hospital acquired CDIs. NHS Forth Valley has one of the lowest rates of CDIs in NHS Scotland. All recommendations of the Vale of Leven Enquiry Report have been addressed in full. Recent unannounced HEI inspection of Forth Valley Royal Hospital and announced inspection of Clackmannanshire Community Healthcare Centre have provided positive assurance in local delivery of HAI standards.
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2.3.3 Improvement Actions 2016-17
Monitor SPSP programmes progress via the Quality Improvement Strategic Leadership Group with bi-monthly progress reports from all workstreams. This includes review of data on the national SPSP dashboard to benchmark progress with outcomes and identify any other Boards where learning can be sought. Deliver the Person Centred Health and Care Strategy 2015-17, which details NHS Forth Valley’s priorities and commitments, to further embed person centred care. Work with Local Authorities and care providers to achieve the aim of a 50% reduction in grade 2-4 pressure ulcers acquired in hospital or care home by end of 2017. Maintain progress in improving rates of Healthcare Acquired Infection.
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2.3.4 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
Measure: LDP Standard NHS Boards are expected to improve SAB INFECTION RATES DURING 2016-17. Research is underway to develop a new SAB standard. Staphylococcus Aureus Bacteraemia (SAB) rate Clostridium Difficile (CDI) rate Local Measure Hospital Standardised Mortality Ratio (HSMR) Scottish Patient Safety programme (SPSP) workstreams: - Acute Adult - Maternity & Children - Mental Health - Primary Care Ten patient safety essentials: - Hand Hygiene - Leadership Walkrounds - Communications: Surgical Brief and Pause - Communications: General Ward Safety Brief - Intensive Care Unit (ICU) Daily Goals - Ventilator Associated Pneumonia Bundle - Early Warning Scoring - Central Venous Catheter Insertion Bundle - Central Venous Catheter Maintenance Bundle - Peripheral Venous Cannulla Stroke care bundle
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2.4 Person-Centred
2.4.1 Strategic Context
The Strategic Quality Improvement Framework is an improvement programme dedicated to improving patient experience and delivering person centred services. NHS Forth Valley remains committed to improving patient experience as a key aspect of the quality improvement priorities that underpin the efficiency productivity and quality programme in NHS Forth Valley.
The development of the Person Centred Health and Care strategy in 2015 set out: Our Vision for Person Centred Health & Care for NHS Forth Valley. Our drivers for developing the strategy. Our principles for achieving our vision from Patient Focus Public Involvement (PFPI) Our priorities and how we will achieve these commitments are contained within the Person Centred Health and Care delivery plan.
2.4.2 Progress During 2015-16
Significant progress has been made in the development and launch of the Person Centred Health & Care Strategy with an assured governance reporting structure. A Person Centred Steering Group is also in place. This has allowed NHS Forth Valley to build on what has already been achieved and has enabled the organisation to progress towards a programme of continuous improvement, supporting the five “must do with me” principles.
The “#hello my name is” campaign was successfully launched in 2015 and is embedded in Positive First Impressions/Communication training which is being rolled out across the organisation.
The person centred model has been developed within the management of complaints, in order to ensure that the process is personal in supporting patients, families and carers during their complaints journey and where possible attempting to achieve local resolution. Additionally, the focus on the performance of managing and handling complaints and feedback will continue.
The bereavement service has been developed with the appointment of bereavement co-ordinators within the Woman & Children’s Directorate to support the needs of those who have suffered loss.
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The Self Assessment for 2014-15 was based on the annual report, feedback, comments, concerns and complaints (Implementation of the Patient Rights (Scotland) Act 2011), which was submitted by all Boards to the Scottish Government in June 2015.
As the focus was different from previous Participation Standard self assessments, the findings will provide a baseline for Boards with the opportunity to demonstrate future improvements.
The Scottish Health Council has assessed NHS Forth Valley as having met Level 2 (Implementation) for both Section 1 (Patient Focus) and Section 3 (Governance Arrangements). This concurs with the Self Assessment submitted by NHS Forth Valley. Due to this, no further evidence is required.
The development of volunteering roles continues within NHS Forth Valley. 2015 has seen the introduction of volunteering within the acute dementia ward in FVRH. This project has enhanced patient experience using distraction techniques with social interactions such as art and music therapies.
NHS Forth Valley has taken the opportunity to have in place a reporting forum for Person Centred Care. This system captures patient experience and feedback reported from weekly inpatient surveys, a number of feedback mechanisms such as postcards and how the organisation is progressing with implementing the Patient Rights (Scotland) Act 2011.
The inpatient children’s ward has introduced "What Matters to Me". Each child is encouraged to complete a poster about what matters to them while they are in hospital and this is displayed at the bedside for all healthcare professionals to read prior to any interaction with the child. The children can write what matters to them or draw pictures. Common themes are “I want my Mummy to stay, I don’t like needles and I would like to sleep longer in the morning”.
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2.4.3 Improvement Actions 2016-17
Work towards delivering the Person Centred Health & Care Strategy, which provides a framework for change, covering the Person Centred Agenda. Implement the delivery plan to fulfil our Person Centred Health and Care commitment. Continue to roll out the Communication & Positive First Impressions programme across the organisation. Agree an action plan that will be informed by the outputs of the Clinical Services Review and the recommendations in the new national Strategic Framework for Palliative and End of Life Care. Develop a solid structure to support the continual delivery of a bereavement model. Involve patients and the public in service change, redesign and improvement of care and wellbeing. Ensure that all patients throughout their journey will be given the opportunity to say what, and who, matters to them, are supported to ensure this is achieved and that this is reviewed regularly. Establish a robust infrastructure to support the continuous development of volunteering across NHS Forth Valley. Support staff to access patients’, families’ and carers’ spiritual needs, making necessary referrals to the Spiritual Care team. Ensure that the organisation can demonstrate that services have been evaluated to demonstrate that they meet the needs of our diverse community and that any barriers to access have been addressed.
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2.4.4 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
Measures LDP Standard Sickness absence 4% Local Measure The “Five Must Do’s With Me” - What matters to you - Who matters to you - What information do you need - Nothing about me without me - Personalised contact Clinical Quality Indicators - Pressure area care - Food, Fluid & Nutrition - Falls Falls with harm rate Percentage of complaint responses within 20 days Reduction in the number of complaints Number of complaints acknowledged in 3 working days Number of complaints referred to Ombudsman Number of complaints upheld by the Ombudsman Percentage of staff having completed an eKSF annual review Long and short term absence rates Patient and Carer Experience
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2.5 Primary Care
2.5.1 Strategic Context
Successful primary care is integral to the 2020 Vision and integrated health and social care. The majority of healthcare interactions start and finish in primary care, both in-hours and out-of-hours. In the context of an ageing population with more people living with two or more long term conditions, the number of interactions will increase as they are supported to self-manage their conditions and live at home for as long as possible.
Introduction of the post QOF (Transitional Quality Arrangements) revisions to the General Medical Services (GMS) contract will be developed in 2016-17.
Sir Lewis Ritchie’s review of out of hours primary care services will be addressed through the Local Unscheduled Care Plan.
Priorities continue to be informed by Delivering Quality in Primary Care whilst focussing on whole system working, management of long term conditions, effective and rational use of prescribing resources, service improvement and development of effective ways of working in the community. The latter has evolved to support the integration agenda with emphasis on locality planning and effective interface working.
2.5.2 Progress During 2015-16
Last year NHS Boards set out their prioritised actions being pursued to increase capacity in primary care, covering General Practice, Dentistry, Optometry, Pharmacy and Out of Hours. This focused on four key themes: leadership & workforce, planning & interfaces, technology & data, contracts & resources. Progress on these four key themes is outlined below. These are in line with the 2020 Vision and Health and Social Care Integration to manage as much care as close to home as appropriate.
Leadership & workforce NHS Forth Valley has a highly skilled and committed primary care workforce. Capacity challenges are being increasingly experienced within primary care and community settings. GP sustainability issues are managed constructively and collaboratively, through effective multi-professional working, engagement with practices and organisational support. There is strong engagement with services, a co-ordinated clinical leadership structure led through a Primary Care Leadership Forum, and strong links with the Professional Advisory Committee structure. Page 30 of 54 NHS Forth Valley Draft Local Delivery Plan 2016-17 – Version 1.4 – 01 03 16
Planning & interfaces Positive progress has been made in developing a locality planning structure and progressing the principles of anticipatory care. Locality Action Plans have been developed for the six Forth Valley localities to inform the Strategic Plans of the Health and Social Care Partnerships. The Whole Systems Working Project has also prioritised locality development recognising that this is key to effective health and social care integration and aligned with priorities for the 2016-17 GMS contract.
The Anticipatory Care Plan (ACP) group has been set up with a key objective to develop and pilot a draft single ACP to be considered nationally by the Living Well in Communities Programme. Further work around ACP is focussed on reducing avoidable admissions and readmissions and providing ambulatory options to admission through the frailty clinic and extended community teams including a new Closer to Home service and the roll out of the ALFY advice line for vulnerable older people.
There is ongoing focus on delivering the Dementia Strategy with work on all national commitments being co-ordinated through the Dementia Steering Group which reports to the CHP Quality Improvement Risk Management Group (QIRMG).
Technology & data There has been continued focus on effective information sharing across service interfaces. 4.2% of Forth Valley patients now have a Key Information Summary. An intranet based adverse event reporting tool called MoSES (‘Morbidity and Mortality Significant Event System) has been developed to support interface collaboration and is being tailored to the specialty using it. The system is used primarily for reporting clinical events and will facilitate clinical meetings and discussions. It is anticipated that data extracted from MoSES will help identify trends and themes relating to adverse events and inform future patient safety work.
Contracts & resources Despite the challenges of an ageing population, multiple morbidities, increasing expectations and polypharmacy, NHS Forth Valley has maintained a Cost per Patient prescribing position below the Scottish average. Key to effective use of resources is effective collaboration between GPs and the Pharmacy Support Team which has undergone transition to expand and provide additional support for practices in difficulty.
Work is underway in preparation for the transitional GMS contract in 2016-17, to identify and support locality cluster quality leads.
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GP recruitment and retention remains a significant challenge. The Board has provided continued support to practices in difficulty and managed 2c practices. The development of multi-professional teams will continue.
2.5.3 Improvement Actions 2016-17
Stabilise the currently available GP workforce to maintain the available medical capacity in primary care by supportive actions for practices facing recruitment difficulties and a proactive approach to those facing future challenge. Develop a broad based multidisciplinary workforce based in primary care including AHPs, community nurses, pharmacists and optometrists, to deliver a model of care that increases the capacity available to see people in an “out of hospital” community setting. Provide a sustainable service avoiding the need for admission for those whose needs can be met through self management and the use of ACPs, concentrating on patients with multi-morbidity and the frail elderly. Align and extend “out of hospital” improvement initiatives, such as, ACP, ALFY and Closer to Home with “core” community work. Implement a prioritisation programme for investment to ensure premises and IT infrastructure in primary care are fit for purpose and maximise the opportunity for effective patient care. Support ongoing quality improvement work, aligned with the principles of Delivering Quality in Primary Care, co-ordinated by the Primary Care Quality Improvement Group. Ensure primary care involvement in health and social care integration and influence in priority setting.
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2.5.4 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
Measures LDP Standard Often a patient's first contact with the NHS is through their GP practice. It is vital, therefore, that every member of the public has fast and convenient access to their local primary medical services to ensure better outcomes and experiences for patients. 90% of people will have 48 hour access or advance booking to an appropriate member of the GP team Delivery of dementia post diagnostic support Local Measure Flu immunisation rates Childhood immunisation rates Prescribing costs Allied Health Professionals (AHP) waits Musculoskeletal (MSK) waits – see also Scheduled Care Number of patients with an ACP Long term conditions bed days – conditions are Asthma, COPD, Diabetes, CHD
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2.6 Integration
2.6.1 Strategic Context
NHS Forth Valley is working with its local authority partners and has established two Health and Social Care Partnerships; a partnership between NHS Forth Valley and Falkirk Council and a multi authority partnership between NHS Forth Valley, Clackmannanshire and Stirling Councils. The partnerships are being established in line with the Public Bodies (Joint Working) (Scotland) Act 2014 and the supporting guidance.
Integration Joint Boards (IJBs) have been formally established since 3 October 2015. Full delegation of functions will be transferred to the Integration Authorities from 1 April 2016, following approval of the Strategic Plan and associated budgets. From 1 April, a range of functions will fall under the Integration Authority as set out in the Schemes of Delegation.
Quality and safety for people who use our services must remain at the forefront during 2016-17 when the Health and Social Care Partnerships take on responsibility for health and social care services.
2.6.2 Progress During 2015-16
NHS Forth Valley and its Local Authority partners agreed to pursue the Body Corporate model which will result in delegation by Local Authorities and the Health Board of all functions within scope of integration, to a new entity governed by an IJB with accountability for overseeing the provision of functions.
Transitional Boards were replaced by IJBs during 2015-16 and these have progressed with preparing for integration on 1 April 2016. Chairs and Chief Officers were appointed in 2015. Strategic Planning Groups have developed draft Strategic Plans which will be finalised by March 2016 and set out the strategic priorities for the Health and Social Care Partnerships for the next 3 years.
Strategic Planning Group arrangements are well established in both Partnerships and have supported the production of the strategic needs assessments; housing contribution statements; and draft strategic plans. Draft plans for each Partnership were approved by the IJBs and have been subject to a period of consultation which has now ended. Plans are being revised for final sign off by each IJB in March.
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Both Partnerships undertook a commissioned approach to agreeing priorities for partnership funds based on national guidance, local learning from the Change Fund processes and emerging priorities from the strategic planning process. Implementation of plans, using Partnership funding, is at an early stage and both Partnerships will be undertaking robust evaluations to ensure funding is closely aligned with strategic plan priorities.
NHS Forth Valley agreed a suite of measures to ensure stability in the provision of Community Health Partnership (CHP) Services during 2015-16. This included retaining CHP Sub Committees, Joint Management Team, PPF and Staff Partnership Forum. As new partnership arrangements have become established some of these arrangements have now been discontinued.
Positive progress has continued in engaging GPs, community health staff, Social Work and the Third Sector in locality focused discussions regarding integration and joint priorities.
2.6.3 Improvement Actions 2016-17
Continue the Strategic Planning process and develop an annual operational delivery plan for each Health and Social Care Partnership. Agree key frameworks to underpin the work of the Partnership and the strategic planning process, including a Performance Framework, Clinical & Care Governance Framework, Participation & Engagement Strategy, and Workforce Strategy. These will clarify the contribution of the Health Board to delivering the Strategic Plan. Undertake a further iteration of the Strategic Needs Assessment at locality level. Primary Care clinical leads are playing a proactive role in supporting Chief Officers to develop models of locality planning. Align current partnership funding plans, including Integrated Care Fund (ICF) and Delayed Discharge Funds with Partnership Strategic Plan priorities. Agree the distribution of the integration funds in 2016-17. Implement a robust evaluation process in each Partnership to review all Partnership funding arrangements by June 2016. NHS Forth Valley will continue to work with the Partnerships to support and develop the Joint Staff Forum and the implementation of the agreed workforce strategy priorities.
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2.6.4 Performance Management
Performance Management is a legislative requirement for the Health and Social Care Partnerships with the production of an Annual Report as a minimum. The key measures and targets around integration will be driven by the Strategic Plans and the performance management arrangements are being developed accordingly. Cognisance will be taken of the national indicators for the Integration of Health and Social Care that were published in 2015.
Measures Local Measure The Performance Framework sets out a consistent approach across both Partnerships in relation to responsibility for, and reporting on, national and local targets and priorities. As part of the Integration Scheme, Health and Social Care Partnerships must prepare a list of measures against Integration and Non Integration functions. Total bed days lost to delayed discharge. Measurement around supporting admission avoidance and expediting early discharge to be confirmed. Delayed Discharges over 14 days Delayed Discharges over 72 hours Number of Code 9 Delays Bed days lost to Code 9 Delays
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2.7 Scheduled Care
2.7.1 Strategic Context
The national context sees an ageing population driving increasing levels of referral, which, in turn add to the demand for elective services. It is important that we develop a sustainable response to the changing environment and address the core capacity of elective services to ensure that demand is met. The vast majority of people awaiting elective treatment will be treated locally or within NHS Scotland facilities, such as the Golden Jubilee National Hospital.
It is a legal requirement for Boards to comply with the Treatment Time Guarantee (TTG) and, during 2016-17 NHS Forth Valley will comply with this requirement. Capacity plans will reflect the demand and capacity for each speciality to ensure a full appreciation of emerging challenges.
It is essential that services use existing resources efficiently, that variation is reduced and managed and variability in patient pathways is addressed to ensure that the right service is available in the right place at the right time.
2.7.2 Progress During 2015-16
Despite good progress during 2015-16 demand continues to increase and recent increases in the numbers of people waiting represent a challenge. Progress has been made regarding targets for CAMHS and psychological therapies. NHS Forth Valley Board has also made a significant financial commitment to the CAMHS, increasing clinical capacity. Together with the additional resources, a focus on service re-design has supported the management team in addressing the challenges. It also provided the opportunity to review all systems and practice within the service. The recruitment of an Information Co-ordinator has provided assurance that accurate data can now be collated and measured. Waiting times have also improved for the endoscopy service.
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2.7.3 Improvement Actions 2016-17
Deliver the access standards for patients in Endoscopy, CAMHS, Psychological Therapies and Musculoskeletal (MSK). Maintain the delivery of TTG and the Cancer standards. Reduce the percentage of patients waiting over 12 weeks for an outpatient appointment in line with an agreed trajectory by March 2016. Implement the National Scheduled Care Programme “Getting Ahead”. Activities will focus on implementation of the National Scheduled Care Programme (sustainability). Implementation of the “Getting Ahead” programme will look to develop sustainable whole systems management for elective services.
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2.7.4 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
Measures LDP Standard Maintain Early diagnosis and treatment improves outcomes. 31 days from decision to treat (95%). 62 days from urgent referral with suspicion of cancer (95%). People diagnosed and treated in 1st stage of breast, colorectal and lung cancer (25% increase). Maintain 12 weeks Treatment Time Guarantee (TTG 100%). Eligible patients commence IVF treatment within 12 months (90%). Deliver Shorter waits can lead to earlier diagnosis and better outcomes for many patients as well as reducing unnecessary worry and uncertainty for patients and their relatives. 18 weeks Referral to Treatment (RTT 90%). 12 weeks Treatment Time Guarantee (TTG 100%) 12 weeks for first outpatient appointment (95% with stretch 100%). 18 weeks referral to treatment for Specialist Child and Adolescent Mental Health Services (90%). 18 weeks referral to treatment for Psychological Therapies (90%). Services for people are recovery focussed, of good quality and can be accessed when and where they are needed. Clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery (90%). Local Measures Diagnostic 42 day wait Close monitoring of: Outpatient unavailability Inpatient unavailability
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2.8 Unscheduled Care
2.8.1 Strategic Context
The Scottish Government introduced the 6 Essential Actions programme for unscheduled care in June 2015-16 which included a focus on optimising the admission and discharge balance in hospitals each day and appropriately avoiding admission wherever possible. During 2016-17 the programme will continue with a focus on improving discharge processes including collation of ward level admission and discharge information and review against operating models on a daily, weekly and monthly basis. As in 2015-16 the focus will remain on delivering actions under the ‘6 Essential Actions’ of:
Clinically Focussed and Empowered Hospital Management. Hospital Capacity and Patient Flow (Emergency and Elective) Realignment. Patient Rather Than Bed Management – Operational Performance Management of Patient Flow. Medical and Surgical Processes Arranged to Improve Patient Flow through the Unscheduled Care Pathway. Seven Day Services Appropriately Targeted to Reduce Variation in Weekend and Out of Hours Working. Ensuring Patients are Optimally Cared for in their Own Homes or Homely Setting.
During 2015-16 further activity was also identified in the FV Winter Plan and development of two Partnership Integrated Health and Social Care Plans.
2.8.2 Progress During 2015-16
Improvement in NHS Forth Valley, achieving 95% compliance and improvement in the number of 12 hour breaches and reduction in 8 hour breaches. Change introduced to acute care for medicine – all patients now reviewed by Consultant within 12 hours of admission. Frailty model pilot being implemented– to improve pathway for older people. Ambulatory Medicine consultant allocated to triage GP calls - bring back patient as urgent follow-up where appropriate. Frailty Clinic operating 5 days per week. Evaluation of impact to be carried out in 2016. Ward action plan will be developed to address the requirements of the 6 essential actions. Continued roll out of IHO programme. Page 40 of 54 NHS Forth Valley Draft Local Delivery Plan 2016-17 – Version 1.4 – 01 03 16
Discharge lounge introduced 7 days per week and discharge support team now in place 7 days per week. Additional Physiotherapy and OT rehab services are in place at weekends.
2.8.3 Improvement Actions 2016-17
Develop services further by reinforcing clinical decision making and roles, in particular Clinical Directors, ward based Consultants, and Advanced Professional Practitioners to ensure patient flow across extended hours and weekends. Continued roll out of IHO programme. Review Length of Stay (LOS) for patients in Acute and Community Hospital with a focus on reducing LOS through establishment of a daily audit of patients and escalation plan to support patients who meet the criteria for discharge from a hospital setting. Introduce frailty criteria for unscheduled care admission to ensure the appropriate route for patients. Complete pathway work for Mental Health, Orthopaedics, Surgical Specialities, Radiography to improve flow. Work with Scottish Ambulance Service to review pathway for patients who fall, minimising admission to hospital. Review Redirection Policy to ensure Out Of Hours (OOH) and other healthcare services flow is working optimally. Review and redesign the FV GP OOH Service in line with the recommendations following the National Review of GP OOH Services. Review and further develop the use of Closer to Home and promote the use of the Advice Line for You (ALFY) as an alternative to admission.
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2.8.4 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
Measures LDP Standard High correlation between emergency departments with 4 hour wait performance between 95 and 98% and elimination of long waits in A&E which result in poorer outcomes for patients. 95% (with stretch 98%) of patients attending ED / Minor Injuries will be seen, treated and discharged or transferred within 4 hours.
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2.9 Mental Health
2.9.1 Strategic Context
Performance against the mental health access standards continues to show a rise in the number of people starting treatment. A Mental Health Improvement programme to support NHS Boards to improve access to services and meet the waiting times standard sustainably has been announced. The programme will be delivered by Healthcare Improvement Scotland, which will establish a Mental Health Access Improvement Support Team (MHAIST). MHAIST will work in partnership with NHS Boards to identify enablers and barriers to the Board being able to deliver improved access and meet the waiting times standard, and support Boards to review their mental health access improvement plans in light of that joint consideration of local enablers and barriers to delivery. MHAIST will take a phased approach, working intensively with a small number of Boards at a time.
NHS Education for Scotland will continue to deliver a programme of education, training and support to increase workforce capacity in CAMHS and psychological therapies, and to improve the quality of supervision.
In December 2014, the Scottish Government set a HEAT target for the NHS in Scotland to deliver a maximum waiting time of 18 weeks from referral to treatment. To date, this target has not been achieved for CAMHS although significant improvements have been made. Overall there has been an increase in referrals to the service over the past 12-18 months, which has added to the challenge in meeting the target.
The Scottish Government made the timely delivery of psychological therapies a priority in “A Mental Health Strategy for Scotland 2012-15”. In December 2014 the NHS Scotland HEAT target for Psychological Therapies became active. This stated that at least 90% of people requiring a psychological therapy will start treatment within 18 weeks of referral.
Improving Post Diagnostic Support (PDS) is one of the two key improvement areas in ‘Scotland’s National Dementia Strategy’ (June 2010). The Scottish Government announced its intention to introduce a post-diagnostic support target to ensure people with dementia receive the help they need following diagnosis.
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2.9.2 Progress During 2015-16
NHS Forth Valley has contributed to the national Mental Health and Learning Disability Inpatient Bed Census published in 2015 and is actively preparing for the 2016 census. Additional resources have been put in place to support IM/IT systems for mental health services locally. Initially, information will be collected regarding bed capacity, thereafter moving towards collecting community activity data, which will provide appropriate benchmarking in due course.
Progress has been made regarding targets for CAMHS and psychological therapies. NHS Forth Valley has made a financial commitment to CAMHS, increasing clinical capacity.
As part of the Clinical Services Review, the Mental Health and Learning Disability work stream provided a better understanding of the anticipated level of need locally, service priorities including assistance in identifying optimum number of inpatient beds, and how best to target staff training and development.
Work has commenced with all partners taking forward a whole system approach to defining a Dementia Pathway that will support capacity building for the link workers and partners. For example, partnership working with Alzheimer’s Scotland and NHS Forth Valley has continued to improve.
2.9.3 Improvement Actions 2016-17
Work with the Mental Health Access Improvement Support Team to identify enablers and barriers to the delivery of improved access and meet the waiting times standard. Deliver the access standards for patients in CAMHS and Psychological Therapies. Review Psychological Therapies to improve services including a workforce development plan. Identify a clear direction of travel for those with a dementia diagnosis within the health & social care agenda. Gain commitment from Statutory Services and Third Sector partners to support service delivery for individuals with dementia.
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2.9.4 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
LDP Standard Early action is more likely to result in full recovery and improve wider social development outcomes. 18 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (90%) Timely access to healthcare is a key measure of quality and that applies equally to mental health services 18 weeks referral to treatment for Psychological Therapies (90%) Enable people to understand and adjust to a diagnosis, connect better and plan for future care Delivery of dementia post diagnostic support Local Measures National Dementia related caseload criteria for the link worker is 50 per WTE Increase in link worker capacity for Dementia – to be measured by (reduced) waiting times Measure Dementia specific average monthly and annually of referrals
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3 Overarching Improvement Areas
3.1 Financial Planning
It is essential that our services are as effective and efficient as possible to ensure that we continue to meet demand changes arising from demography, improving care standards, the introduction of new technology, new and changing drug indications and meeting targets and guarantees.
Following the draft Scottish Budget in December 2015, its associated implications and an update of issues facing the NHS it is estimated that cash savings of 6% (£27m) are required in 2016-17. Cash savings of this magnitude will carry risk and there will be implications for a service which is workforce based. Every effort is focused on minimising spend on temporary workforce costs (Medical Agency, Nurse Bank and Agency and Administration Bank).
Whilst NHS Forth Valley has been notified of an indicative uplift of 4.6% this includes the local share of £250m which it is understood that Scottish Ministers will give direction to Boards to allocate to Integrated Joint Boards to allocate to Social Care – this accounts for 2.9% of the uplift leaving 1.7%. This is further reduced by a 7.5% reduction in ‘bundled’ allocations, a reduction in estimated resources available for the New Medicines Fund (estimated reduction from £ 85m to £60m nationally) and an overall reduction in funding for Alcohol and Drug Partnerships of approximately 21%.
Increased costs are anticipated including basic pay uplift 1%, increase in national insurance contributions as a consequence of national pension changes equating to a further 1.4%, auto-enrolment refresh, apprenticeship levy (0.5%), prescribing increases (1.5% volume and 2.75% price increase for primary care; 10% for acute hospital drugs and further estimated costs for new drugs approved by the Scottish Medicines Consortium); and general prices of 2% (NHS inflation tends to be ahead of general inflation). Further additional recurrent costs are anticipated to meet demographic change and to ensure LDP targets are met for 4 hour maximum wait in Accident and Emergency; 12 week Treatment Time Guarantee; and 12 week outpatient standard together with setting aside resources for winter of 2016.
The Financial Plan and Capital Plan 2016-17 – 2020-21 is scheduled for approval at the end of March 2016. It will also be updated as we work through and rebalance our resource use as needs and priorities emerge through both the local Clinical Services Review and the Strategic Plans of the two Health and Social Care Partnerships.
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However it is important to stress that change brings with it risk. The financial challenge of integrating funding streams from health and social care at a time when real cost reductions are required is significant.
The requirement to align resource utilisation to Community Planning priorities, to NHS priorities, to deliver change arising from Strategic Plans and to develop locality planning will make financial control ever more complex in the timeframe of this Financial Plan.
3.1.1 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
Measures LDP Standard Operate within agreed revenue resource limit; capital resource limit; and meet cash requirement
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3.2 Community Planning Partnerships
3.2.1 Strategic Context
The NHS Board contribution to Community Planning supports the delivery of health improvement and health inequalities as recommended by the Christie Commission, and helps to ensure delivery of the Scottish Government’s 2020 Vision.
The Falkirk Community Planning Partnership (CPP) is currently developing a Strategic Outcomes and Delivery Plan (SOLD) to set out the CPP’s commitment from 2016 to 2020 to focus attention, resources and efforts on the things that make Falkirk ‘the place to be’.
In Clackmannanshire the SOA priorities 2013-23 have been agreed jointly by all partners within the Alliance. Priorities are to be delivered in a more integrated whole systems approach, focusing on prevention and early intervention.
The Stirling Leadership Group has agreed joint priorities for delivering the SOA via task group action plans. CPP task groups in Stirling have NHS Forth Valley representative leads supporting implementation of strategic priorities in respect of Tackling Poverty and Inequalities, Local Employability Partnership (LEP) and Children and Young People.
In light of the Public Bodies (Joint Working) (Scotland) Act, NHS Forth Valley has, during 2015-16, been engaging Clackmannanshire, Falkirk and Stirling Community Planning Partnerships (CPPs) in the production of: 1. Integration Schemes for both the Falkirk Health and Social Care Partnership and the Clackmannanshire / Stirling Health and Social Care Partnership and; 2. Draft Strategic Plans for both Health and Social Care Partnerships.
Both Health and Social Care Partnership Strategic Plans identify health Improvement and health inequality reduction as key outcomes for Health and Social Care Partnerships and recognise the importance of planning and delivering Health and Social Care in partnership with CPPs.
This work has run concurrently with the NHS Forth Valley Clinical Services Review (CSR). The purpose of the CSR is to inform the development of the next NHS Forth Valley Health Care Strategy. Delivering improvement on the majority of the themes emerging from the CSR is contingent upon positive partnership working between NHS Forth Valley and the 3 CPPs.
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3.2.2 Progress during 2015-16
Clarity of Senior NHS Forth Valley representation on all 3 CPP Leadership groups has been established with the NHS Board Chairman, Chief Executive, Director of Public Health and CHP General Manager being represented on CPP Leadership Groups. The Director of Public Health has re-established the Forth Valley Health Improvement and Health Inequalities Group.
Integrated Care Funding has been accessed to develop a programme of work to enhance third sector support for patients via primary care. This aims to learn lessons for best approaches in integrating primary and secondary prevention support.
Some examples of NHS Forth Valley’s contribution to the individual CPPs progresses:
NHS Forth Valley and the Falkirk CPP The Health Promotion Lead Officer is taking a lead role to support Falkirk CPP in the development of the Falkirk SOLD and in particular the ‘Mental Health and Wellbeing’ priority and the ‘Our Population will be Healthier’ outcome.
NHS Forth Valley and the Stirling CPP Progress is being made in implementing health inequalities as a cross cutting theme of the SOA. NHS Forth Valley has been leading partnership work with Stirling Council and NHS Health Scotland in developing a Health Inequalities Assessment tool for use by the Task Groups to assess their Prevention Plans in terms of the likely impact they will have on health inequalities. Development of health assessment for young people on activity agreements and associated partnership support through ‘Opportunities For All’, which is an employability initiative for young people. Development of Exercise and Referral programme within the Callander area based on learning from work already done in Falkirk and Stirling. The Integrated Care Fund is being used to develop targeted inequalities activity within the current Stirling Exercise and Referral programme, which is supported by NHS Forth Valley.
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NHS Forth Valley and Clackmannanshire CPP The anticipatory care nurse team is receiving referrals from social work and third sector colleagues, supporting the integration agenda. Since the programme started in 2015, there have been over 500 contacts in Clackmannanshire. Improved outcomes for young people in reducing smoking, alcohol and substance misuse using the social influence approach.
3.2.3 Improvement Actions 2016-17
Across the Community Planning Partnerships NHS Forth Valley Health Improvement and Health Inequalities Group will confirm joint priorities and agreed actions with three CPPs. NHS Forth Valley Health Improvement and Health Inequalities Group will produce an Annual HIHI Report. NHS Forth Valley and the Falkirk CPP Support delivery of the Falkirk CPP SOLD. NHS Forth Valley and the Clackmannanshire CPP Develop an outcomes focused joint action plan supporting primary prevention within targeted communities with a focus on mental health and well being and links with employability. NHS Forth Valley and the Stirling CPP Provide ongoing support for development, delivery and review of CPP action plans. Develop community and locality action plans based on identified needs and assets.
3.2.4 Performance Management
In addition to the Improvement Actions outlined above, NHS Forth Valley will contribute to the delivery of outcomes from the local Single Outcome Agreements and SOLD. These measures will be used by the CPP to monitor and assess progress and manage performance and will be used at appropriate levels within NHS Forth Valley to direct improvement activity. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
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3.3 Workforce Planning
3.3.1 Strategic Context
NHS Forth Valley continues to deliver against the commitments contained within our Workforce Strategy 2014-16. This Strategy was developed in partnership and details how the Board will deliver our workforce aims as follows:
To develop a modern, sustainable workforce. To become a model employer. To create and maintain a healthy and modern culture.
The priorities within the national “Everyone Matters Implementation Framework” are fully incorporated as part of our Workforce Strategy and therefore a key focus for our HR and Organisational Development teams.
Our Clinical Services Review has now been completed and will inform the new NHS Forth Valley Health Care Strategy 2016-20. This will ensure that we have appropriate models of safe and quality care in place, and optimise the use of resources and facilities.
Currently, NHS Forth Valley has an ageing and predominantly female workforce. The demographic of our staff and local communities requires that we deliver innovative, proactive workforce solutions.
NHS Forth Valley, with its partners, has made progress towards implementing Health and Social Care Integration. In support of the strategic plans, each Health and Social Care Partnership has recently approved a Strategic Workforce Development Plan. Whilst presenting opportunities for positive development, this also places additional challenges on the system to resolve from 2016 and beyond. In order to address these challenges, we remain committed to the continuous development of our workforce through their skills and competencies and through our annual programme of workforce planning.
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3.3.2 Progress During 2015-16
During 2015-16 good progress was made in implementing the five Everyone Matters Priorities within NHS Forth Valley, some of which will continue through 2016-17. In 2015-16 NHS Forth Valley achieved the IIP Silver award, further developed a system wide inclusive staff recognition scheme and delivered proactive recruitment initiatives.
In support of our Strategy and in accordance with CEL 52 (2011), NHS Forth Valley continues to develop local workforce plans for all services and staff groups which support the delivery of commitments within our current Healthcare Strategy and will inform the development of the Health Care Strategy 2016-20.
In recognition of the crucial role that workforce plays in supporting continuous quality improvement to deliver flexible and responsive services, NHS Forth Valley and the University of Stirling continue to work collaboratively to deliver the National Nursing and Midwifery Workforce Tools and Planning Programme (NMWWP) Workforce Education Toolkit.
NHS Forth Valley, as part of the workforce planning process, has already started to identify potential gaps in the future workforce using age demographic information. This work will continue in 2016-2017 taking into account: Outputs from Clinical Services Review. Age profile. Ageing population and demographics in NHS Forth Valley. Hard to fill posts – Paediatrics, Microbiology, Old Age Psychiatry, Middle Grade A&E doctors. Provision of sustainable services over 7 days. Expansion of Regional and National working. Health and Social Care Partnership Strategic Plans.
In 2016-17 this work will continue to be extended to other job families across NHS Forth Valley.
The 2016-17 implementation plan in support of Everyone Matters will build on the work progressed in 2015-16. The outline of our plan focuses on developing our Values Matters and Staff Experience Programmes; reviewing our local work strategy to ensure it remains aligned to the Vision for Clinical Services; progressing work towards the Investors in Young People Standard; and future implementation of our Leadership Matters plan in support of partnership and integration within health and across agencies.
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3.3.3 Improvement Actions 2016-17
The Workforce Plan 2016-17: This year, we will complete our 11th Workforce Plan and this will be published in August 2016. This will build on a strong background of effective change management, service redesign and skill mix review, consistent with the national and local strategic view under the Everyone Matters 2020 Vision. Workforce Strategy - The Workforce Strategy will be reviewed to reflect the outcome of the Clinical Services Review. This will ensure we continue to deliver the requirements of the Staff Governance Standard and the five national priorities within the Everyone Matters Workforce Vision Implementation Framework. Attendance Management and Well being – We will maintain our current focus in order to build on successes achieved within 2015-16 to continuously improve the health and well-being of our staff and to reduce absence rates to facilitate delivery of the national standard.
3.3.4 Performance Management
In addition to the Improvement Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS Forth Valley to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board.
Measures LDP Standard Sickness absence 4%
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APPENDIX 1 – NHS Forth Valley Strategic Planning Matrix
NHS Forth Valley Healthcare Strategy
(Under Review 2016)
NHS Forth Local Delivery Plan Valley Annual Plan (Contract with SG)
Plan against 6 Financial & Workforce Activity & Single Essential Actions Capital Plan Plan Capacity Outcome from unscheduled Plan Agreements/ care Local Delivery Plan
Winter Plan
Underpinned by: Local Strategies e.g. eHealth, Workforce Modernisation Directorate Plans
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