Wednesday 22 June 2016 at 2.00 - 4.00Pm, in Boardroom, Forth Valley College, Alloa Campus

A meeting of the Clackmannanshire and Stirling Integration Joint Board will be held on Wednesday 22 June 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 27 APRIL 2016 For Approval

6. MATTERS ARISING

7. DELAYED DISCHARGE PROGRESS REPORT For Noting (Paper presented by Kathy O’Neill)

8. PARTNERSHIP FUNDING

8.1 INTEGRATED CARE FUND: 2015/16 SCOTTISH For Noting and Approval GOVERNMENT RETURN (Paper presented by Ewan Murray)

8.2 UPDATE ON EVALUATION AND REVIEW OF For Noting and Approval INTEGRATED CARE PROGRAMME (Paper to Follow) (Paper presented by Ewan Murray)

9. PROGRAMME WORKSTREAMS UPDATE For Noting (Paper presented by Lesley Fulford)

10. GOVERNANCE

10.1 AUDIT COMMITTEE For Approval (Paper presented by Ewan Murray)

10.2 CODE OF CONDUCT & STANDARDS OFFICER For Approval (Paper presented by Shiona Strachan)

10.3 COMMISSIONING FOR HEALTH AND SOCIAL CARE For Noting (Paper presented by Chris Sutton)

10.4 STRATEGIC RISK REGISTER For Approval (Paper presented by Hugh Coyle)

11. LOCALITY PLAN DEVELOPMENT (Paper to Follow) For Noting and Approval (Paper presented by Lesley Fulford)

12. COMMUNICATIONS ACTION PLAN AND DEVELOPMENT OF For Noting VISUAL IDENTITY (Paper presented by Deborah Kilpatrick)

13. LOCAL DELIVERY PLAN 2016/17 For Noting (Paper presented by Dr Graham Foster)

14. STIRLING CARE VILLAGE – FULL BUSINESS CASE For Approval (Paper presented by Kathy O’Neill)

15. COMMUNITY SERVICES DIRECTORATE For Noting (Paper presented by Kathy O’Neill)

16. MODELS OF NEIGHBOURHOOD CARE For Noting and Approval (Paper presented by Irene Warnock & Chris Sutton)

17. ANY OTHER COMPETENT BUSINESS

17.1 SUPPORT SERVICES (Verbal update by Shiona Strachan)

17.2 STIRLING COUNCIL REDESIGN (Verbal update by Stewart Carruth)

18. DATE OF NEXT MEETING

Wednesday 21 September 2016, 2.00-4.00, Kildean Suite, Forth Valley College, Stirling Campus

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 5 on the agenda

Minute of Clackmannanshire & Stirling Integration Joint Board meeting held on 27 April 2016

For Approval

Page 1 of 8

Minute of the Clackmannanshire & Stirling Integration Joint Board meeting held on Wednesday 27 April 2016, at 2.00pm, in Kildean Suite, Forth Valley College, Stirling Campus.

Present: Councillor Les Sharp, Council Leader (Chair) John Ford, Non-Executive Board Member (Vice Chair) Councillor Donald Balsillie Councillor Johanna Boyd, Council Leader Stewart Carruth, Chief Executive, Stirling Council Joanne Chisholm, Non-Executive Board Member Val de Souza, Chief Social Work Officer Councillor Scott Farmer Graham Foster, Executive Board Member Fiona Gavine, Non-Executive Board Member Jane Grant, Chief Executive Ms Tracey Gillies, Medical Director Tom Hart, Employee Director Shubhanna Hussain-Ahmed, Unpaid Carers Representative for Stirling Alex Linkston, Chairman Councillor Kathleen Martin Morag Mason, Service User Representative for Stirling Natalie Masterson, Third Sector Representative for Stirling Ewan Murray, Chief Finance Officer Teresa McNally, Service User Representative for Clackmannanshire Elaine McPherson, Chief Executive, Clackmannanshire Council Kathy O’Neill, General Manager, Community Services Directorate Elizabeth Ramsay, Unpaid Carers Representative for Clackmannanshire Abigail Robertson, Chair, Joint Trade Union Pamela Robertson, Chair, Forth Valley Joint Trade Union Forum Wendy Sharp, Third Sector Representative for Stirling Councillor Christine Simpson Shiona Strachan, Chief Officer Lesley Fulford, Programme Manager Elaine Vanhegan, Head of Performance Management, NHS Forth Valley Prof Angela Wallace, Nurse Director

In Attendance: Jim Boyle, Chief Finance Officer, Stirling Council Elsbeth Campbell, Communications, NHS Forth Valley Kevin O'Kane, Audit Manager, Stirling Council Margaret Robbie, PA to Chief Officer (Minute) Chris Sutton, Service Manager, Clackmannanshire & Stirling Social Services Sarah Dickie (Shadowing Prof Angela Wallace)

1. APOLOGIES FOR ABSENCE

There were no apologies given.

2. NOTIFICATION OF SUBSTITUTES Page 2 of 8

There were no notifications of substitutes.

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 22 MARCH 2016

The minute of the meeting held on 22 March 2016 was approved as an accurate record.

6. MINUTE OF MEETING HELD ON 30 MARCH 2016

The minute of the meeting held on 30 March 2016 was approved as an accurate record.

7. MATTERS ARISING

All matters were covered within substantive agenda items.

8. DELAYED DISCHARGE PROGRESS REPORT

Kathy O'Neill provided an update on the status of Delayed Discharges.

A summary of people delayed at the census point in March 2016 was provided as well as an overview of the management actions being taken. Kathy also advised that services were also considering a public campaign to promote Power of Attorney.

The Integration Joint Board noted performance and acknowledged the management actions being undertaken.

9. PARTNERSHIP FUNDING

Ewan Murray advised that the purpose of this report was to update the Integration Joint Board on the following:

• Progress on the review and evaluation of projects supported through Partnership Funding Streams including Integrated Care Fund, Delayed Discharges Funding and Partnership Bridging Resources.

Page 3 of 8

• An update on reported expenditure, subject to audit, to 31 March 2016 against these funding streams • Further detail on use of the Partnerships share of £250m Integration Fund Clackmannanshire £2.390 million Stirling £3.800 million

Ewan advised that a short life working group has been established to carry out an evaluation and review of projects funded through partnership funding streams in 2015/16. A full report and proposed spending plan will be submitted to the 22 June 2016 Integration Joint Board for approval.

The Integration Joint Board noted:

• the content of the report • that a further report will come to the 22 June 2016 meeting

10. PROGRAMME WORKSTREAMS UPDATE

The Integration Joint Board noted the content and progress to date.

11. EQUALITIES MAINSTREAMING & OUTCOMES REPORT

Lesley Fulford advised 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.

Equality Outcomes are distinct to each organisation and need to reflect its functions, responsibilities, priorities and methods of working. At its meeting on 22 March 2016 the Board approved the adoption of outcomes based on the local outcomes already identified in the preparation of the Integration Scheme and the Strategic Plan

The Integration Joint Board:

• Noted the work undertaken to draft the report • Approved the draft report for publication by 30 April 2016.

12. GOVERNANCE

12.1 CHIEF INTERNAL AUDITOR

This paper confirms the nomination of Stirling Council’s Audit Manager (Kevin O’Kane) as Chief Internal Auditor to the Integration Joint Board, and sought formal ratification of this appointment, which is for the period covering financial years up to 31 March 2019.

The Integration Joint Board:

Page 4 of 8

• Approved the appointment of Kevin O'Kane as Chief Integration Auditor of the Integration Joint board • Noted that a draft internal audit plan for 2016/17 paper would be presented on 22 June 2016

12.2 AUDIT SCOTLAND REPORT

Kevin O'Kane, Auditor, Stirling Council presented this paper. This paper builds on the previous report published in December 2015. It sets out a number of key messages: transformational change is not happening fast enough; new approaches are emerging although they are small scale; there is a lack of national leadership. Forth Valley had received a good practice note within the Audit Scotland report regarding Advice Line for You (ALFY) and the Closer to Home service. It is anticipated that the third, planned Audit Scotland report will be published in the near future.

The Integration Joint Board noted the contents of the report, key messages and recommendations

13. PUBLIC HEALTH REPORT

Dr Graham Foster presented this report. This is a report on the health of the local area and describes the demographics and background health of the local population and highlights a number of key areas of public health work ongoing in NHS Forth Valley. This is the first report produced by Dr Foster and covers the period from 2013 - 15. The report is no longer published but is available electronically via NHS Forth Valley website; where possible the electronic version provides web links to relevant background data and other useful resources and web sites.

The Integration Joint Board noted the NHS Forth Valley Report of the Director of Public Health 2013 - 15

14. COMMUNICATIONS PROTOCOL & FRAMEWORK

Elsbeth Campbell, Head of Communication, NHS Forth Valley presented this report on behalf of all partners. The purpose of the report is to set out a proposed framework and protocol for internal and external communication by the Integration Joint Board. Clear, consistent, timely and accessible communications for service users, carers, employees, communities and other stakeholders will increase understanding of what health and social care integration involves and what it means for individuals and their care. This framework has been developed jointly by NHS Forth Valley, Falkirk, Clackmannanshire and Stirling Councils.

It is recognised that while many of the issues will be similar for both Health and Social Care Partnerships, there will be a need to develop distinctive communications for each Partnership to reflect differences in approaches, priority and timing. Work is currently underway to develop an action plan which will outline key communications activities and opportunities. The action plan will be brought forward to the 22 June meeting of the Integration Joint Board. Page 5 of 8

The Integration Joint Board:

• Approved the framework and protocol for internal and external communications • Noted that an action plan will be brought to the 22 June 2016 Meeting

15. CARERS (SCOTLAND) ACT 2016

Chris Sutton presented this paper and provided an update on the main provisions of the Carers (Scotland) Act 2016. The Act was passed on 4 February 2016 and it is anticipated that the Act will be implemented from April 2017. The intention of the Act is to ensure that unpaid carers of any age are supported to continue with their caring role, should they wish to do so, and are able to have a life alongside their caring responsibilities. The legislation places a duty on Local Authorities to provide support to those unpaid carers who meet local eligibility criteria and a universal entitlement to have an assessment. Adult Unpaid Carers within the partnership are in scope of the Integration Joint Board. The 2011 census for the area indicated that there was approx 13,000 carers in Clackmannanshire & Stirling. There will be costs associated with this Act.

The Integration Joint Board noted: • the Carers (Scotland) Act 2016.

16. STRATHENDRICK

Val de Souza presented this paper and advised that the paper provides the Integration Joint Board with information in relation to the work being carried out in South West Rural Stirling. A series of meetings have been held with local people and representatives to explore the development of a community care based hub model, centred around Strathendrick care home. At Stirling Council on 10 December 2015 a request was made for a further update on 19 May 2016. A further update outlining potential service delivery options will be presented to the Integration Joint Board in October 2016.

The Integration Joint Board:

• Noted the contents of the report • Noted a further update will be brought in September 2016

17. NATIONAL CARE STANDARDS CONSULTATION

Lesley Fulford advised that in 2015 Scottish Government had announced a review of the National Care Standards. A public consultation had been undertaken and the first stage consultation has been concluded and the principles and consultation report are attached. The principles have been agreed at national level and the next step is that general and specific standards which will be phased in from April 2017.

The Integration Joint Board noted: Page 6 of 8

• The principles and consultation report which are attached.

18. STIRLING CARE VILLAGE

Kathy O'Neill provided an update on the current development progress for the Stirling Care Village. This report provides the Integration Joint Board with an update on progress to complete the Full Business Case for Stirling Care Village and progress to financial close to allow construction to commence following the required approvals. The Stirling Care Village predates the establishment of the Integration Joint Board but the service case for change had been previously supported by the Integration Joint Board at their meeting of 11 December 2015, and is a key commitment within the Strategic Plan.

The Integration Joint Board:

• Noted the report • Agreed that a paper on the final Full Business Case including resource implications will be brought forward to the 22 June 2016 meeting

19. ANY OTHER COMPETENT BUSINESS

CNORIS - Ewan Murray confirmed that the CNORIS cover is now in place for the Integration Joint Board.

20. DATE OF NEXT MEETING

Wednesday 22 June 2016, 2.00pm Boardroom, Forth Valley College, Alloa Campus

Page 7 of 8

Page 8 of 8

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 7 on the agenda

DELAYED DISCHARGE PROGRESS REPORT

(Paper presented by Kathy O’Neill)

For Noting

Approved for Submission by Shiona Strachan, Chief Officer Author Jim Robb, Assistant Head of Service Adult Care Date: 22 June 2016 List of Background Papers:

Page 1 of 10

Title/Subject: Delayed Discharge Progress Report Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016

Submitted By: Jim Robb, Asst Head of Service Adult Care, 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 May 2016 census and provide appropriate challenge.

• the management actions being undertaken as outlined in 7.2

3. Background

3.1 As at May census date (15 May), there were 5 patients delayed awaiting discharge from hospital for Clackmannanshire, 4 of whom were delayed more than 2 weeks. In Stirling, there was a total of 11 patients delayed awaiting discharge from hospital, of which 6 patients were delayed for more than 2 weeks. While the May figures are relatively high they are consistent with previous peaks during 2015/16 and it is rather early to conclude that a pattern has been established.

3.2 Table 1 - Clackmannanshire Council May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May 15 15 15 15 15 15 15 15 16 16 16 16 16 Total delays at census point (As of 2 5 6 3 2 3 8 2 4 4 1 4 5 15th of each month) Total numbers of 1 0 4 1 2 1 1 0 1 1 0 2 4 delays over 2 weeks

Page 2 of 10

Table 2 - Stirling Council May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May 15 15 15 15 15 15 15 15 16 16 16 16 2016 Total delays at census point (As of 15 11 11 7 9 10 17 5 8 7 3 10 11 15th of each month) Total numbers of 3 3 6 3 4 10 6 1 1 4 1 3 6 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).

3.4 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 May 2016, there were 2 patients in Clackmannanshire and 2 patients in Stirling with a Code 100 applied.

3.5 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. As of 15 May 2016 there were 3 patients in Clackmannanshire and 4 patients in Stirling in the Guardianship process. There were also 3 patients from Clackmannanshire and 4 from Stirling who were awaiting specialist arrangements for discharge.

3.6 It should be noted that the Scottish Government have highlighted a view that the best practice timescale for discharge is 72 hours. While the official target remains 2 weeks it is appropriate that future statistics present the practice for both 72 hours and 2 weeks in order that the Partnerships performance can be evaluated within that context.

Page 3 of 10

Table 3 - shows the total number of delays in Clackmannanshire excluding code 9 and 100, expressed as cumulative bed days occupied. (Note: this is different from national Bed Days Occupied as it is not census data)

Table 3 - Clackmannanshire Council May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May 15 15 15 15 15 15 15 15 16 16 16 16 16 Total Bed Days occupied 26 23 122 33 43 49 87 14 32 49 4 63 140 Standard Delays Total Bed Days Occupied N/A N/A 120 17 43 29 27 0 25 28 0 54 129 over 2 weeks

Table 4 shows the total number of delays in Stirling, excluding code 9 and 100, expressed as cumulative bed days occupied. (Note: this is different from national Bed Days Occupied as it is not census data)

Table 4 - Stirling Council May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May 15 15 15 15 15 15 15 15 16 16 16 16 16 Total Bed Days occupied 106 140 248 95 109 316 233 33 68 110 64 127 175 standard Delays Total Bed Days Occupied N/A N/A 178 64 85 301 172 18 25 92 55 84 153 over 2 weeks

3.7 Once again while these figures are relatively high they are consistent with previous peaks during 2015/16 and it is rather early to conclude that a pattern or long term trend has been established

4. Analysis of reasons for delay

4.1 The principal reasons for delay during the reporting period in Stirling was the result of the primary choice of care home being unavailable and patients awaiting the conclusion of a legal process/Guardianship.

4.2 In Stirling there were a total 18 discharges from hospital of which 9 patients were discharged home with a care package; 5 patients were discharged to a care home and 4 patients to intermediate care. In total 23 patients from Stirling were added to Edison the electronic recording system during the reporting period.

Page 4 of 10

4.3 In Clackmannanshire there were a total of 10 discharges from hospital of which 8 patients were discharged with a care package; 2 patients admitted to a care home and 0 patients admitted to intermediate care. In total 10 patients from Clackmannanshire were added to Edison the electronic recording system during the reporting period.

5. Intermediate Care

5.1 As the partnership moves towards preventative approaches of care delivery, it is important to acknowledge the usage of intermediate care beds which form alternative pathways to hospital admission, or support timely discharge. Admissions and discharges to short stay assessment beds have been monitored for the months of March and April 2016. There are 25 Intermediate Care beds in Stirling and 7 in Clackmannanshire.

Admissions Step Up Step Down Delayed Discharge Clackmannanshire 2 6 0 Stirling 8 11 5

Discharges Home Hospital/Deceased Care Home Clackmannanshire 2 3 3 Stirling 5 4 1

5.2. It should be noted that while the Intermediate Care beds are routinely used the turnover in the beds is such that there are rarely beds available to respond to short notice requests to transfer service users out of hospital quickly at times of high bed pressure within the hospital. Some analysis of the referral route and eligibility criteria as well as identifying blockages that minimise turnover would be beneficial at this time if there is a view that greater availability of these beds is to assist at times when there is a high demand for beds within the hospital.

5.2 Reablement services are offered across the Partnership to support service users in their recovery and to ensure appropriate assessment of levels of care need. It is acknowledged that there are hotspots in capacity within these services, caused mainly by difficulties in resourcing care at home providers following episodes of reablement. This is particularly challenging in the rural locality of Stirling. A review of reablement services is presently underway and will report to the Clackmannanshire & Stirling Joint Management Team, further work will be require to link to long term home care provision.

5.3 The Annual Home Care Returns completed for 2015 (2016 not available until July) confirms an increase of 7.5% over the two years 2013-15 in overall care at home hours being delivered, including a decrease in the total number of service users receiving a service and an increase in service users receiving 10 hours+ indicating a more complex package of care at home service being provided. However, while the Annual Return evidences that the home care service continues to grow it is clear that the growth is not keeping pace on the requirements of the delayed discharge framework. Further joint work is

Page 5 of 10

planned with the independent homecare sector during 2016/17 with a view to increasing capacity via a combination of active recruitment and retention strategies and efficient deployment of staff as well as re-ablement training for all home care staff.

6. Unplanned Admissions

6.1 While a reduction in the rate of emergency inpatient bed days is no longer a Health Improvement, Efficiency, Access Treatment (HEAT) target, reduction in emergency admissions to hospital (rate of population) is a national indicator for the NHS. More detailed reporting and analysis of this information will assist in confirming the rate of admission and repeat admissions for individual patients and by G.P practice in order that potential alternatives to admission can be explored. This has the potential to avoid admissions and subsequently reduce delays in discharge.

7. Conclusions

7.1 The report sets out the performance of the Clackmannanshire and Stirling Partnership based on the census data of 15 May 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.

7.2 The IJB are asked to note that there is ongoing service improvement work in the re-designing of pathways to support prevention of admission to hospital and facilitating safe, timely discharge in order to maintain our present performance. Specifically:

• Analysis of unplanned and repeat admissions in order to clarify whether any admissions could be avoided thus addressing potential delayed discharge at an early point in the process. • Confirm that there is effective use of Admission and Discharge Policy • Analysis of the performance of the Intermediate Care Beds and Re- ablement Teams in supporting the discharge and avoiding unecessary admission. • Develop a medium to long strategy in working with the Home Care providers in relation to recruitment and retention issues in order to increase capacity while training the providers in reablement and enablement in order to sustain the work of the Reablement Teams. • It is the intention to present performance information in relation to both 72 hours and 2 weeks once baseline figures and methodology have been agreed. This will allow the Partnerships performance to be evaluated in line with national changes in reporting due to be implemented during July 2016.

8. Resource Implications

8.1 N/A

Page 6 of 10

9. Impact on IJB Outcomes, Priorities and Outcomes

9.1 The actions outlined in this report contribute to the delivery of the National and Local outcomes set out in the Strategic Plan.

10. Legal & Risk Implications

10.1 Risk as above.

11. Consultation

11.1 The Head of Social Services, the General Manager for Forth Valley Community Services Directorate and the Chief Officer for Clackmannanshire & Stirling Health and Social Care Partnership have been consulted in the compiling of this report.

12. Equalities Assessment

12.1 N/A

13. Exempt reports

13.1 No

Page 7 of 10

Appendix 1

Delayed Discharges Over 2 Weeks by Month and Local Authority Excludes Codes 9 and 100

Page 8 of 10

Appendix 2

Delayed Discharges OBDs Over 2 Weeks by Month and Local Authority Excludes Codes 9 and 100

Page 9 of 10

Page 10 of 10

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 8.1 on the agenda

Partnership Funding: Integrated Care Fund – 2015/2016 Scottish Government Return

(Paper presented by Ewan C. Murray, Chief Finance Officer)

For Approval Approved for Submission by Shiona Strachan, Chief Officer Author Ewan C. Murray, Chief Finance Officer David Niven, Programme Coordinator (Integrated Care Fund) Date: 22 June 2016 List of Background Papers: 13 May 2015 – 8. Integrated Care Programme 11 December 2015 – 8.1 Partnership Allocations Update 24 February 2016 – Partnership Funding 30 March 2016 – Due Diligence, Financial Assurance and First Year Budget 27 April 2016 – Partnership Funding

Page 1 of 34

Title/Subject: Partnership Funding: Integrated Care Fund – 2015/2016 Scottish Government Return Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Ewan C. Murray, Chief Finance Officer Action: For Approval

1. Introduction

1.1 The purpose of this report is to present the draft 2015/16 Scottish Government End of Year Report on use of Integrated Care Fund for approval.

2. Recommendations

The Integration Joint Board is asked to:

2.1. Approve the attached draft Integrated Care Fund, End of Year report (Appendix 1) for submission to the Scottish Government.

3. Background

Integrated Care Fund

3.1. In September 2013, the Scottish Government announced additional resources of £100m to Health and Social Care Partnerships in 2015/2016 through the Integrated Care Fund .The purpose of the allocation is to support the delivery of improved outcomes from health and social care integration, help drive the shift towards prevention and further strengthen approaches to tackling inequalities. In March 2015, the Scottish Government announced an additional £200m to be shared between partnerships during the period 2016-2018. The Clackmannanshire & Stirling Partnership’s allocation of Integrated Care Fund is £2.48m per annum, over the three years, 2015-2018.

3.2. Partnerships were asked to submit an Integrated Care Plan to the Scottish Government in December 2014, providing evidence based proposals setting out local principles and investment priorities, proposed allocations against the priorities and implementation and governance arrangements. The Plan outlined that the Integrated Care Fund will be used to support a focus on prevention, early intervention and care and support for people with complex and multiple conditions, particularly in those areas where multi-morbidity is common in adults under 65, as well as in older people.

Page 2 of 34

4. Scottish Government Report on Integrated Care Fund 2015/16

4.1 As documented in the 27 April 2016 IJB Partnership Funding paper the Scottish Government requested the submission of a report for Year 1 of the Integrated Care fund by end of May 2016. The Chief Officer has submitted a draft report subject to the Integration Joint Board reviewing and approving a final version of the report at its 22 June 2016 meeting. The draft report is attached for consideration and approval (appendix 1). The format of the return is based on a pro-forma provided by Scottish Government.

5. Resource Implications

5.1 The resource implications are detailed within the return.

6. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

6.1 The resources set out in this report represent a significant element of the overall resource available to support the priorities of the approved Strategic Plan.

7. Legal & Risk Implications

7.1 No specific risks identified.

8. Consultation

8.1 The Reshaping Care Strategy Group and Joint Management Team have been consulted on this report.

9. Equality and Human Rights Impact Assessment

9.1 Per Strategic Plan.

10. Exempt reports

10.1 Not exempt

Page 3 of 34

Appendix 1 - Draft Integrated Care Fund End of Year Report

Clackmannanshire & Stirling INTEGRATED CARE FUND – END YEAR REPORTING TEMPLATE 2015/16

This year end report has been prepared following discussion by the Reshaping Care Strategy Group and the Joint Management Team. The report is submitted in draft form pending the formal agreement from the Integration Joint Board on 22 June 2016.

The report has been completed on the national template.

Page 4 of 34

INTEGRATED CARE FUND – END YEAR REPORTING TEMPLATE 2015/16

Integrated Care Fund – 2015/16 – End-Year Financial Summary

Clackmannanshire & Stirling Partnership – Total ICF allocation for 2015/16: £0.96m+£1.52 = £2.48million

Allocation for 2015/16 Total Year Spend Resource Carried Forward £’000 £’000 £’000 1.1 Test and Deliver action to ensure a 721 287 responsive 24/7 Health & Social Care Model

1.2 Develop and Extend intermediate care 508 390 model to all adults – particularly implement a dementia intermediate care pathway

1.3 Embedding a range of person centred 280 104 anticipatory and prevention planning – across areas of poverty and high multimorbidity 2.1 Extending Community Based Supports 187 187

2.2. Direct Support to Carers 217 217 2.3 Communications, Navigation/Way 51 49 Finding 2.4 Targeted Resource to Support Lifestyle 20 20 Change 3.1 Enablers for Transformational Change 497 299

Total ICF spend - 2015/16 2,480 1,551 929 Notes: 1) The Transitional Integration Joint Board approved the Integrated Care Plan at its meeting of 13th May 2015 with further detail of the programme being presented to the Transitional Integration Joint Board Briefing session on 28th August 2015. 2) The Partnership are considering the Integrated Care Plan as year 1 of a 3 year investment programme which will be subject to ongoing monitoring, scrutiny and review particularly in light of the development and approval of the partnership's Strategic Plan. It should be noted that the above is not considered as an underspend but rather a timing of expenditure issue across the 3 year investment programme. The Integration Joint Board will manage the difference in

Page 5 of 34

timing of expenditure compared to timing of allocation through its financial management regime. The Partnership anticipate, particularly in light of a very challenging financial environment, that this approach will assist with sustainability of the programme.

Page 6 of 34

Integrated Care Fund – 2015/16 – Achievement of ICF Outcomes

ICF Themes: Service re-design, Prevention, Early Intervention, Care & Support Funding Breakdown: Please provide a breakdown of the funding for each activity or project i.e. health board, local authority, third sector organisation, independent sector organisation

WORK STREAM ACHIEVEMENT OF SOURCE OF DATA USED TO ACTION TAKEN THEME(S) FUNDING BREAKDOWN ACTIVITY OR OUTCOMES FOR MONITOR PROGRESS FOLLOWING PROJECT 2015/16 APPROVAL OF JUNE 2016 REVIEW RECOMMENDATIONS

1.1 Test and Deliver More people supported Data used to monitor progress The recommendations Service re-design, Rapid Response Social Care action to ensure a to live independently at has been gathered by and within coming from the Prevention, Early Capacity Stirling £125,500 – responsive 24/7 home Through a time of services and presented in reports Integrated care Intervention, Care Local Authority Health & Social Care crisis / increasing in Jan’16 (for period Apr-Dec’15) Programme (ICP) & Support Model vulnerability / acute Overnight Care - and in May’16 (for period Jan- Review being illness Mar’16). Reports are fed into the presented to the Clackmannanshire - Attached to MECS and ICP (Integrated Care Programme) Reshaping Care The commissioning of Review Process and the Strategy Group (RCSG), available to Night Nurses “Responsive” recommendations form the Joint Management £72,500 – Local Authority Assessment and Care Review are fed into the Team (JMT) and services particularly Overnight Care - Stirling - Reshaping Care Strategy Group Integration Joint Board focussing on ability to Attached to MECS and deliver appropriate (RCSG), the Joint Management (IJB) in Jun’16 will available to Night Nurses service at times of Team (JMT), and then to the IJB include any action £72,500 – Local Authority urgency out-with normal (Integration Joint Board) – necessary to address weekday hours and at scheduled for the 22Jun’16 IJB any performance NHS Forth Valley Closer to weekends. This meeting. issues. Such Home & ALFY Services particularly focuses on recommendations are including: 24/7 Rapid avoidance of The role, remit and linkages of likely to include using Response (RR) Nursing & unnecessary admission the Reshaping Care Strategy the period between Closer to Home RR AHPs, to hospital and Group are outlined in the diagram 1Jul’16 to 30Sept’16 to Night Nursing, and CPN prevention of social resource in Partnership Page 7 of 34

crisis or escalation to in Appendix 1. undertake actions with Falkirk IJB £450,000 – long term care and within the following NHS Forth Valley A mixture of quantitative and requires: range: qualitative data is provided to: Total Allocation £720,500 Sufficient Capacity of • Further detailed Rapid Access • Measure the level of impact review of services Community Care on the expected outcomes of • Disinvest from services to provide a the service changes, and to services safe, prevention based, • Demonstrate the reach • Merging and re- alternatives to hospital achieved by service changes admission. profiling the best (more output focussed). parts of a number o Dedicated capacity of existing services for 7 day This approach is one that has into one Rehabilitation / been developed over a number of redesigned service. Reablement cycles of improvement and • Support Assessment reporting with the Change Fund /urgent and is clearly demonstrated improvement intervention and within the Change Fund End of activity to deliver increasing capacity Programme Report. The Change an existing service, Community Fund End of Programme Report is ensuring alignment Nursing available at the following web with other services to meet outcomes Enabling Services link. o • Monitoring service to respond quickly http://nhsforthvalley.com/health- implementation and appropriately services/az-of-services/reshaping- utilising project to urgent need care-for-older- activity and people/clackmannan-and- performance data To achieve this outcome stirling/reshaping-care-change- Page 8 of 34

we have been working fund/ • Services continue to develop and deliver: on an ‘as is’ basis • Additional capacity A sample of reports recently of Rapid Response received for this work stream are Community Care for embedded below: adults • Revised criteria on duration of rapid Closer to Home response care from Report Apr16.pdf 72hrs to circa 5 days

• Provided a 7 day

dedicated urgent AHP response: OT and Physio • Provided a 7 day dedicated urgent enhanced nursing response • Provided enhanced overnight support • Supported and co- produced the development of the frailty / enhanced care at home model • Resourced Leadership/ time to develop a resilient co-ordinated

Page 9 of 34

Community Response model 1.2 Develop and Shift the balance of care Data used to monitor progress The recommendations Service re-design, Consolidation/Development Extend intermediate to enable more adults has been gathered by and within coming from the Care & Support of Reablement in care model to all to remain in their own services and presented in reports Integrated care Clackmannanshire £345,000 adults – particularly homes as independently in Jan’16 (for period Apr-Dec’15) Programme (ICP) – Local Authority implement a as possible. and in May’16 (for period Jan- Review being dementia Additional Support costs for intermediate care Mar’16). Reports are fed into the presented to the Refining and Extending new Dementia short stay pathway ICP (Integrated Care Programme) Reshaping Care Intermediate care Review Process and the Strategy Group (RCSG), beds in Allan Lodge models for adults with recommendations form the Joint Management £120,000 – Local Authority physical disabilities, Review are fed into the Team (JMT) and Allan Lodge - 0.5 WTE Dementia, Learning Reshaping Care Strategy Group Integration Joint Board Community Psychiatric Disabilities and Mental (RCSG), the Joint Management (IJB) in Jun’16 will Health. Nurse & 0.5 WTE OT Team (JMT), and then to the IJB include any action Transition posts £44,742 –

(Integration Joint Board) – necessary to address NHS Forth Valley To achieve this outcome scheduled for the 22Jun’16 IJB any performance we have: meeting. issues. Such Intermediate Care • Extended the recommendations are Assessment Post £42,000 – enablement A mixture of quantitative and approach to a likely to include using Local Authority qualitative data is provided to: greater proportion the period between Integration of Rehab & of service users 1Jul’16 to 30Sept’16 to • Measure the level of impact Reablement, OT Posts including undertake actions Implementing on the expected outcomes of Review, Intermediate Care, within the following recommendations of the service changes, and to Care Village, Housing & range: “Keys to Life” for • Demonstrate the reach Health Model - Leadership service users with a achieved by service changes Page 10 of 34

learning disability (more output focussed). • Further detailed & Planning Capacity Backfill • Included relevant review of services £51,512 – NHS Forth Valley This approach is one that has groups of existing • Disinvest from service users within been developed over a number of Total Allocation £508,254 services the enablement cycles of improvement and • Merging and re- approach reporting with the Change Fund • profiling the best Provided additional and is clearly demonstrated intensive care at parts of a number within the Change Fund End of home packages as of existing services Programme Report. The Change an alternative to into one Fund End of Programme Report is residential care redesigned service. • Integrated available at the following web • Support Reablement and link. improvement Rehabilitation http://nhsforthvalley.com/health- services activity to deliver services/az-of-services/reshaping- • Developed and an existing service, care-for-older- transitioned to the ensuring alignment people/clackmannan-and- Stirling care village with other services stirling/reshaping-care-change- integrated model to meet outcomes including early fund/ • implementation of Monitoring service intermediate care A sample of reports recently implementation model for received for this work stream are utilising project individuals with embedded below: activity and dementia in Allan performance data Lodge • Services continue • Outlined and Scoped Dementia Short on an ‘as is’ basis out the options for a Stay Beds at Allan Lo similar model in

Page 11 of 34

Clackmannanshire • Increased hospital CPN at Dementia SW assessment Short Stay Beds ICF capacity • Developed a transition plan for Stirling Care Village • Developed an Intermediate Care Strategy 1.3 Embedding a More people supported Data used to monitor progress The recommendations Service re-design, Keepwell Nurse Assessor range of person to live well and has been gathered by and within coming from the Prevention, Early £33,000 – NHS Forth Valley centred anticipatory independently at home. services and presented in reports Integrated care Intervention, Care and prevention in Jan’16 (for period Apr-Dec’15) Programme (ICP) & Support Anticipatory Care Planning planning – across Embedding a range of and in May’16 (for period Jan- Review being £149,137 – NHS Forth areas of poverty and person centred Valley high multimorbidity Mar’16). Reports are fed into the presented to the anticipatory and ICP (Integrated Care Programme) Reshaping Care prevention planning 0.5 WTE Band6 Dietician Review Process and the Strategy Group (RCSG), £22,843 – NHS Forth Valley approaches across all recommendations form the Joint Management community services Review are fed into the Team (JMT) and ARBD Case Management whilst focussing Reshaping Care Strategy Group Integration Joint Board Model £75,000 – NHS Forth specialist ACP resource (RCSG), the Joint Management (IJB) in Jun’16 will Valley to areas of poverty and Team (JMT), and then to the IJB include any action The ARBD Service has not high multimorbidity with (Integration Joint Board) – necessary to address been progressed to more awareness of the scheduled for the 22Jun’16 IJB any performance implementation during under 65yrs population meeting. issues. Such 2015/16 resulting in zero and those with mental recommendations are

Page 12 of 34

health problems. A mixture of quantitative and likely to include using spend. The service is being qualitative data is provided to: the period between reassessed for ICF To achieve this outcome 1Jul’16 to 30Sept’16 to investment during 2016/17. we have: • Measure the level of impact undertake actions There is a strong evidence Keep Well Primary on the expected outcomes of Prevention within the following base for the service and the service changes, and to • Supported range: when viewed across the • Individuals Demonstrate the reach programme its progress is • experiencing achieved by service changes Further detailed seen to be a matter of inequalities through (more output focussed). review of services timing of investment rather primary prevention • Disinvest from than whether to invest. programme This approach is one that has services targeting health been developed over a number of • Merging and re- Total Allocation £279,980 inequalities (Keep cycles of improvement and profiling the best Well). reporting with the Change Fund Anticipatory Care parts of a number and is clearly demonstrated Planning of existing services within the Change Fund End of Adults Frailty / into one Programme Report. The Change Multimorbidity redesigned service. • Fund End of Programme Report is Scaled up ACP • Support through targeted available at the following web improvement support to link. activity to deliver Individuals with http://nhsforthvalley.com/health- multimorbidities, at an existing service, services/az-of-services/reshaping- risk of hospital ensuring alignment care-for-older- admission or with other services people/clackmannan-and- recently discharged to meet outcomes from hospital to stirling/reshaping-care-change- • Monitoring service remain well and fund/ implementation living at home. Page 13 of 34

• Proactively A sample of reports recently utilising project supported the needs received for this work stream are activity and of carers of embedded below: performance data individuals referred • Services continue to above on an ‘as is’ basis • Shared learning and embeded Primary Keepwell ICF Report May16.pdf Prevention and ACP approaches in mainstream services

Nutritional Support: ACP ICF Report Prevention Models Apr16.pdf • Delivered nutritional support to more individuals in care homes and supported more adults with complex care needs • Supported Service users with nutritional support needs identified through the ACP/frailty/ 24/7 pathway • Delivered more Food First Training to care providers,

Page 14 of 34

Care Homes, Carers

Area Wide Model Implementation in conjunction with Falkirk Plan

Alcohol Related Brain Damage

To achieve this outcome we will: • Develop a nurse-led case management service that will offer a community based, assertive outreach model of care for adults with ARBD / Korsakoff Syndrome and their carers.

2.1 Extending More people supported Data used to monitor progress The recommendations Service re-design, Royal Voluntary Service Community Based to live well and has been gathered by and within coming from the Prevention, Early Well & Connected Supports independently at home services and presented in reports Integrated care Intervention, Care (Clackmannanshire &

through or following a in Jan’16 (for period Apr-Dec’15) Programme (ICP) & Support Stirling) £70,243 – Third

Page 15 of 34

time of crisis / increased and in May’16 (for period Jan- Review being Sector Organisation vulnerability / acute Mar’16). Reports are fed into the presented to the illness / dementia ICP (Integrated Care Programme) Reshaping Care Alzheimer Scotland Post diagnosis. Review Process and the Strategy Group (RCSG), Diagnosis Link Worker & recommendations form the Joint Management Community Connections The commissioning of Review are fed into the Team (JMT) and Programme £72,353 – Third services that support Reshaping Care Strategy Group Integration Joint Board Sector Organisation people to improve or (RCSG), the Joint Management (IJB) in Jun’16 will Town Break SCIO – maintain their physical Team (JMT), and then to the IJB include any action and social health and Dementia Projects Assistant (Integration Joint Board) – necessary to address £19,145 – Third Sector independence while scheduled for the 22Jun’16 IJB any performance returning to or Organisation meeting. issues. Such remaining within their recommendations are HSCI Community Grant own homes and A mixture of quantitative and likely to include using Fund £25,000 – Third Sector communities for longer. qualitative data is provided to: the period between Organisation This includes third sector • 1Jul’16 to 30Sept’16 to provided services that: Measure the level of impact Total Allocation £186,750 on the expected outcomes of undertake actions compliment and extend within the following the reablement journey the service changes, and to range: using local volunteer • Demonstrate the reach support; community achieved by service changes • Further detailed based dementia support (more output focussed). review of services services; and small grant This approach is one that has • Disinvest from funding for purely been developed over a number of services voluntary community cycles of improvement and • Merging and re- groups that promote reporting with the Change Fund profiling the best

Page 16 of 34

ongoing independence and is clearly demonstrated parts of a number and social connection. within the Change Fund End of of existing services Programme Report. The Change into one To achieve this outcome Fund End of Programme Report is redesigned service. we have: available at the following web • Support • Extended the enablement link. improvement approach to include http://nhsforthvalley.com/health- activity to deliver 6 weeks of third services/az-of-services/reshaping- an existing service, sector provided care-for-older- ensuring alignment volunteer support people/clackmannan-and- with other services following discharge stirling/reshaping-care-change- to meet outcomes from reablement/ fund/ • rehabilitation/ Monitoring service ReACH and ACP implementation A sample of reports recently teams – step down utilising project received for this work stream are support. embedded below: activity and • Extended the performance data enablement • Services continue approach to include on an ‘as is’ basis 6 weeks of third Alz Scot ICF Report sector provided Apr16.pdf

volunteer support following self/family/GP referral – step up Tow n B reak ICF Report May16.pdf support. This will include a focus on those experiencing

Page 17 of 34

inequalities and multiple/long term conditions. • Provided a rolling year long programme of post- diagnostic dementia support for those with a new diagnosis. • Continued to deliver the community connections programmes of dementia specific events and activities including: football reminiscence; walking group; musical memories; and dementia café. • Supported people with dementia by delivering a cognitive stimulation therapy programme and provided group support and help to

Page 18 of 34

promote wellbeing and social interaction. • Delivered a small community grants fund for local voluntary groups that welcome new participants/ members and contribute to social and physical health. 2.2. Direct Support Carers are supported to Data used to monitor progress The recommendations Service re-design, Princess Royal Trust for to Carers live healthy and has been gathered by and within coming from the Early Intervention, Carers Clackmannanshire independent lives even services and presented in reports Integrated care Care & Support £89,206 – Third Sector if the person that they in Jan’16 (for period Apr-Dec’15) Programme (ICP) Organisation care for experiences and in May’16 (for period Jan- Review being periodic times of crisis / Mar’16). Reports are fed into the presented to the Stirling Carers Centre increased vulnerability / ICP (Integrated Care Programme) Reshaping Care £127,313 – Third Sector acute illness / or long Review Process and the Strategy Group (RCSG), Organisation term condition(s). recommendations form the Joint Management Total Allocation £216,519 Review are fed into the Team (JMT) and To achieve this outcome Reshaping Care Strategy Group Integration Joint Board we have: (RCSG), the Joint Management (IJB) in Jun’16 will • Provided emotional and practical support Team (JMT), and then to the IJB include any action & advice to Carers on (Integration Joint Board) – necessary to address a 1-1 basis to address scheduled for the 22Jun’16 IJB any performance a range of issues Page 19 of 34

• Identified and offered meeting. issues. Such support to a wide recommendations are range of carers A mixture of quantitative and likely to include using including “hidden” qualitative data is provided to: carers the period between • Undertaken carer • Measure the level of impact 1Jul’16 to 30Sept’16 to assessments on on the expected outcomes of undertake actions behalf of Social the service changes, and to within the following Services in Stirling range: area • Demonstrate the reach • Worked in achieved by service changes • Further detailed partnership with (more output focussed). Social Services, NHS review of services and Voluntary This approach is one that has • Disinvest from Organisations been developed over a number of services including Community • Merging and re- Anticipatory Care and cycles of improvement and profiling the best Hospital Enhanced reporting with the Change Fund Discharge teams and is clearly demonstrated parts of a number • To provide within the Change Fund End of of existing services information and Programme Report. The Change into one advice to carers Fund End of Programme Report is redesigned service. • To establish • Support signposting and available at the following web referral services with link. improvement other agencies http://nhsforthvalley.com/health- activity to deliver • To produce services/az-of-services/reshaping- an existing service, information and care-for-older- ensuring alignment advice in a range of with other services formats e.g. leaflets, people/clackmannan-and- newsletter, web stirling/reshaping-care-change- to meet outcomes Page 20 of 34

• To provide a meeting fund/ • Monitoring service place and a focal implementation point for carers A sample of reports recently utilising project • To provide support to received for this work stream are secure respite / short embedded below: activity and breaks / information performance data / funding • Services continue • To provide rural and on an ‘as is’ basis urban peer group Stirling Carers ICF Report Apr16.pdf support. • To provide welfare benefits advice • To advocate on behalf of carers if Clackmannanshire Carers ICF Report Ap appropriate • To provide training sessions to Social Service, NHS and other statutory staff around carers issues • Supported liaison with other relevant agencies in signposting carers to services and in contributing to policy and service developments 2.3 Personal outcomes for Data used to monitor progress The recommendations Service re-design, Living It Up £9,223 – NHS Communications, individuals and carers has been gathered by and within coming from the Early Intervention, Forth Valley are at the centre of the Page 21 of 34

Navigation/Way plan. services and presented in reports Integrated care Care & Support Community Navigator Finding in Jan’16 (for period Apr-Dec’15) Programme (ICP) £40,000 – Third Sector Workforce is engaged and in May’16 (for period Jan- Review being Organisation and developed Mar’16). Reports are fed into the presented to the Total Allocation £49,223 Health and social care ICP (Integrated Care Programme) Reshaping Care services contribute to Review Process and the Strategy Group (RCSG), reducing health recommendations form the Joint Management inequalities Review are fed into the Team (JMT) and Reshaping Care Strategy Group Integration Joint Board Needs are identified at (RCSG), the Joint Management (IJB) in Jun’16 will a locality level and local Team (JMT), and then to the IJB include any action service provision and (Integration Joint Board) – necessary to address redesign is tailored to scheduled for the 22Jun’16 IJB any performance the locality. meeting. issues. Such recommendations are To achieve this outcome A mixture of quantitative and we have: likely to include using qualitative data is provided to: Community Navigator the period between • Made links with • Measure the level of impact 1Jul’16 to 30Sept’16 to GP’s, CPN’s, ACP on the expected outcomes of undertake actions Nurses and care within the following workers to: 1) offer the service changes, and to range: a navigation service • Demonstrate the reach where relevant achieved by service changes • Further detailed public sector service (more output focussed). review of services users are helped to access local This approach is one that has • Disinvest from community services been developed over a number of services

Page 22 of 34

and supports; cycles of improvement and • Merging and re- 2)increase reporting with the Change Fund profiling the best knowledge and and is clearly demonstrated parts of a number understanding within the Change Fund End of of existing services amongst local public sector colleagues of Programme Report. The Change into one local community Fund End of Programme Report is redesigned service. based activities and available at the following web • Support services; and 3) to link. improvement establish referral http://nhsforthvalley.com/health- activity to deliver pathways. services/az-of-services/reshaping- an existing service, • Made contact with care-for-older- ensuring alignment individuals and their carers following people/clackmannan-and- with other services referral, to link them stirling/reshaping-care-change- to meet outcomes with local services. fund/ • Monitoring service • Worked with implementation A sample of reports recently residents, utilising project community groups, received for this work stream are activity and service providers embedded below: and statutory performance data partners to identify • Services continue local assets, on an ‘as is’ basis Living it Up ICF including volunteers Report Apr16.pdf and existing

community

networks. • Publicised the HSCI small grant fund.

Page 23 of 34

To achieve this outcome we have: Living it Up • Worked to promote volunteer opportunities with 3rd sector interfaces and voluntary organisations, and promoted educational opportunities • Signposted to relevant services/ products/ interests • Produced ‘how to guides and worked with libraries to enhance their service 2.4 Targeted People are able to live Data used to monitor progress The recommendations Service re-design, Active Stirling: Active Living Resource to Support in good health for has been gathered by and within coming from the Early Intervention, for Life £20,000 – Third Lifestyle Change longer services and presented in reports Integrated care Care & Support Sector Organisation

in Jan’16 (for period Apr-Dec’15) Programme (ICP) Health & Social Care Total Allocation £20,000 services contribute to and in May’16 (for period Jan- Review being reducing health Mar’16). Reports are fed into the presented to the inequalities ICP (Integrated Care Programme) Reshaping Care Review Process and the Strategy Group (RCSG),

Page 24 of 34

Coproduction recommendations form the Joint Management Review are fed into the Team (JMT) and Carers are supported Reshaping Care Strategy Group Integration Joint Board

(RCSG), the Joint Management (IJB) in Jun’16 will Personal Outcomes for Individuals are at the Team (JMT), and then to the IJB include any action centre of the plan. (Integration Joint Board) – necessary to address scheduled for the 22Jun’16 IJB any performance To achieve these meeting. issues. Such outcomes we have: recommendations are Exercise Referral A mixture of quantitative and likely to include using Scheme qualitative data is provided to: the period between • Delivered an outcomes based • Measure the level of impact 1Jul’16 to 30Sept’16 to brief exercise on the expected outcomes of undertake actions intervention the service changes, and to within the following focusing on range: • Demonstrate the reach behaviour change, targeting those who achieved by service changes • Further detailed are living in one of (more output focussed). review of services the identified areas • Disinvest from of need, or receiving This approach is one that has services income support, and been developed over a number of suffering from at cycles of improvement and • Merging and re- least one long term reporting with the Change Fund profiling the best condition. and is clearly demonstrated parts of a number • Expanded scheme within the Change Fund End of of existing services into communities of Programme Report. The Change into one identified need, redesigned service. delivering Fund End of Programme Report is Page 25 of 34

consultations and available at the following web • Support programmes within link. improvement such communities. http://nhsforthvalley.com/health- activity to deliver • Provided free access services/az-of-services/reshaping- an existing service, to the scheme for care-for-older- those who are in the ensuring alignment most need. people/clackmannan-and- with other services • Established referral stirling/reshaping-care-change- to meet outcomes pathway from the fund/ • Monitoring service exercise referral implementation A sample of reports recently scheme into other utilising project person centred received for this work stream are activity and community services embedded below: such as Keep Well performance data and Employability • Services continue who target similar on an ‘as is’ basis Active Living for Life individuals from ICF Report Apr16.pd areas of need. • Expanded the scope of the scheme to offer free access to the facilities for carers of GP referral patients. 3.1 Enablers for Resources are used Data used to monitor progress The recommendations Service re-design, OD & Workforce Transformational effectively and has been gathered by and within coming from the Prevention, Early Development £114,354 Change efficiently services and presented in reports Integrated care Intervention, Care Information and eHealth in Jan’16 (for period Apr-Dec’15) Programme (ICP) & Support Positive experiences and in May’16 (for period Jan- Review being programme social care

Page 26 of 34

and outcomes Mar’16). Reports are fed into the presented to the integration £40,000 ICP (Integrated Care Programme) Reshaping Care Engaged Workforce Review Process and the Strategy Group (RCSG), Business Development Support £196,362 OD & Workforce recommendations form the Joint Management Development Review are fed into the Team (JMT) and Flexible Fund £133,285 Reshaping Care Strategy Group Integration Joint Board Information and eHealth (RCSG), the Joint Management (IJB) in Jun’16 will Total Allocation £484,001 programme social care Team (JMT), and then to the IJB include any action integration (Integration Joint Board) – necessary to address scheduled for the 22Jun’16 IJB any performance Business Development meeting. issues. Such Support recommendations are A mixture of quantitative and Flexible Fund - utilised in likely to include using qualitative data is provided to: line with a submitted the period between and agreed plan with • Measure the level of impact 1Jul’16 to 30Sept’16 to reshaping care strategy on the expected outcomes of undertake actions group. the service changes, and to within the following range: • Demonstrate the reach achieved by service changes • Further detailed (more output focussed). review of services This approach is one that has • Disinvest from been developed over a number of services cycles of improvement and • Merging and re- reporting with the Change Fund profiling the best and is clearly demonstrated parts of a number

Page 27 of 34

within the Change Fund End of of existing services Programme Report. The Change into one Fund End of Programme Report is redesigned service. available at the following web • Support link. improvement http://nhsforthvalley.com/health- activity to deliver services/az-of-services/reshaping- an existing service, care-for-older- ensuring alignment people/clackmannan-and- with other services stirling/reshaping-care-change- to meet outcomes fund/ • Monitoring service implementation utilising project activity and performance data • Services continue on an ‘as is’ basis

Page 28 of 34

INTEGRATED CARE FUND – END YEAR REPORTING TEMPLATE 2015/16

Integrated Care Fund - Indicators of progress Question Comment

How has ICF funding allowed The Clackmannanshire & Stirling Integrated Care Programme reports to the Reshaping Care Strategy Group (RCSG) at links to be established with monthly meetings. The RCSG is a sub group of the Joint Management Team. The Integration Joint Board is a statutory wider Community Planning partner to both the Alliance (Clackmannanshire) and the Stirling Community Planning Partnership. The IJB Strategic Plan is activity? aligned to the strategic priorities for the Community Planning Partnerships and the ICF supports the achievement of the joint outcomes.

ICF funding has also enabled investment to be made in projects / services that are targeted to address inequalities and that enable public, independent and third sector organisations to play an important role in aligning the needs of service users and the priorities of CPP partners.

Locality Planning work across Clackmannanshire and Stirling is now progressing including further engagement, building on the Strategic Plan priorities and further developing the strategic needs assessment to locality level.

Early intervention and prevention is at the heart of Community Planning and the integration of Health and Social Care services, by anticipating inequalities and preventing them from happening. One example of this approach has been the targeted support in early intervention and self-management of long term health conditions offered by the Keep Well service. Investment from the ICF has broadened the service to address additional health conditions and widening the applicable age range of clients.

What progress has been made The Clackmannanshire & Stirling Integrated Care Programme is committed to moving towards strategic commissioning that linking ICF activity to work uses the principles of coproduction in the design and delivery of services ICF investment in 2015-16 has been directed to being taken forward through areas of strategic priorities to support transformational change and further integration of services. This approach will be Strategic Commissioning more further strengthened in future years with the Strategic Needs Assessment and the Strategic Plan along with the Integrated broadly? Care Fund Review, which is nearing conclusion, being used to direct future discussion on services commissioned to meet local need. The initial results and recommendations of the ICF Review will be considered at the Integration Joint Board meeting on the 22nd June ’16. ICF funding is crucial to support the change programme enabling investment in priorities identified in the Strategic Plan.

Page 29 of 34

Work is currently underway led by the Strategic Planning Group to develop a Market Facilitation Statement to support the delivery of the Strategic Plan.

How has ICF funding The ICF investment has supported services to tailor their provision to priorities such as inequalities within communities, strengthened localities targeting some communities rather than all, and offering free programmes to the unpaid carers of targeted service users as including input from Third well as the service users themselves. Sector, Carers and Service Users? Examples of this include ICF support for a dedicated Rural Unpaid Carers Support Worker covering Rural Stirling; Keep Well services targeted at specific risk groups within communities and specific geographical communities identified through Community Planning Partnerships as experiencing pronounced inequalities; and Active Stirling providing free access to the ‘Active Living for Life’ exercise referral and support scheme for unpaid carers of people referred by their GP as well as the person initially referred.

All of these approaches help to demonstrate that strategic priorities can be progressed by targeted activity tailored to local geographies and demographics which echoes the main underlying message of the localities approach.

Third Sector Interface staff from both Clackmannanshire and Stirling and a Carers’ Centre representative have been closely involved in the Outcomes Scoring Workshops that form the basis of the ongoing ICF Review in relation to 2016/17. The ICF Review will feed into the RCSG which makes recommendations on the Joint Management Team (JMT) that then in turn makes recommendations to the IJB for consideration at the IJB meeting on the 22nd June ‘16. The ICF Review is based on a local Programme Budget Marginal Analysis (PBMA) style approach and it is hoped that the results and recommendations from the Review will be adopted by the IJB and inform subsequent ICF allocation.

What evidence (if any) is The development and implementation of the Partnership’s Performance Framework will help to measure / indicate / available to the partnership provide evidence for, the sustainability of ICF investments over time. that ICF investments are sustainable? The focus of the review currently being carried out in relation to 2016/17 investment areas is to ensure full alignment with the Strategic Plan – the funding will be focused on consolidation of and contribution to change to support early intervention and prevention and to support people to live full and positive lives within supportive communities. The partnership is utilising the body of evidence at international, national and local level to inform investment decisions and will use the review mechanism in addition to the performance information to ensure effectiveness, efficiency and sustainability.

Where applicable - what The Clackmannanshire & Stirling Integrated Care Programme has been developed in alignment with the National Action Plan progress has been made in

Page 30 of 34

implementing the National for Multi-Morbidity including: Action Plan for Multi- Morbidity? Care Planning and consultations help people to have control over their conditions, care and support and to achieve their personal outcomes. Outcomes based assessments & Holistic care planning – during:

NHS Forth Valley - Anticipatory Care Planning within Theme 1.3;

Clackmannanshire & Stirling Council social Services - Extended Intermediate Care & Reablement supported within Theme 1.2;

Royal Voluntary Service – Well and Connected (Clackmannanshire & Stirling) within Theme 2.1; and

Alzheimer Scotland – Post Diagnostic Link Worker & Community Connections Programme within Theme 2.1

Integrated care and support builds on community assets and promotes independence, wellbeing and resilience. Self- Management information, advice and support to help people stay well, active and at work & Build enablement and generalist skills in the workforce – during:

NHS Forth Valley – ‘Keepwell’ within Theme 1.3;

Royal Voluntary Service – Well and Connected (Clackmannanshire & Stirling) within Theme 2.1;

Alzheimer Scotland – Post Diagnostic Link Worker & Community Connections Programme within Theme 2.1;

Local Third Sector Interfaces - Community Navigation (Simplifying Access to Community Supports) within Theme 2.3; and

Active Stirling - Active Living for Life within Theme 2.4

Page 31 of 34

INTEGRATED CARE FUND – END YEAR REPORTING TEMPLATE 2015/16

Question Comment

Please provide a brief narrative around how the ICF has been used in year The Clackmannanshire and Stirling Strategic Plan was approved in March one towards achieving the overall outcomes set out in the strategic plan. 2016 and as such ICF in 2015/16 was assessed against the National Outcomes. In the process of reviewing year 1 of the ICF (2015/16) and developing recommendations for the use of ICF in 2016/17, services resourced through the ICF have been assessed against National Outcomes, some of which overlap with the outcomes set within the Strategic Plan. Only services in alignment with the Strategic Plan will be recommended to receive ICF resource during 2016/17 and beyond. 2015/16 services resourced through the ICF demonstrate alignment with the priorities detailed in the Strategic Plan.

Page 32 of 34

INTEGRATED CARE FUND – END YEAR REPORTING TEMPLATE 2015/16

PARTNERSHIP DETAILS

Partnership name: Clackmannanshire & Stirling Contact name(s) David Niven Contact Telephone 01786 233 904 Email [email protected] Date Agreed 2 June 2016

The content of this template has been agreed as accurate by:

……………………………….. (Shiona Strachan) Chief Officer, Clackmannanshire & Stirling H&SC Partnership

……………………………….. (Ewan Murray) CFO, Clackmannanshire & Stirling H&SC Partnership

……………………………….. (Kathy O’Neill) for NHS Forth Valley Board

.. (Val de Souza) for Local Authority

.. (Gareth Ruddock) for Third Sector - Clackmannanshire

.. (Natalie Masterson) for Third Sector - Stirling

.. (Theresa Cull) for Independent Sector

When complete and signed please return to:

Brian Nisbet GE-18, St Andrew House, Regent Road, Edinburgh, EH1 3DG

Or send via e-mail to [email protected]

Page 33 of 34

Page 34 of 34

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 8.2 on the agenda

Update on Evaluation and Review of Integrated Care Programme

(Paper presented by Ewan C. Murray)

For Noting and Approval Approved for Submission by Shiona Strachan, Chief Officer Author Ewan C. Murray, Chief Finance Officer David Niven, Programme Coordinator (Integrated Care Fund) Date: 22 June 2016 List of Background Papers: 28 August 2015 – 7. Delayed Discharge 13 May 2015 – 8. Integrated Care Programme 11 December 2015 – 8.1 Partnership Allocations Update 24 February 2016 – Partnership Funding 30 March 2016 – Due Diligence, Financial Assurance and First Year Budget 27 April 2016 – Partnership Funding

Page 1 of 14

Title/Subject: Update on Evaluation and Review of Integrated Care Programme Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Ewan C. Murray, Chief Finance Officer Action: For Noting and Approval

1. Introduction

1.1 The purpose of this report is to update the Board on the evaluation and review process being undertaken with regard to use of partnership funding and present initial recommendations whilst the review is concluded. This follows the report on 27 April which updated the Integration Joint Board on the progress of the review and evaluation process and 2015/16 expenditure.

2. Recommendations

The Integration Joint Board is asked to:

2.1. Note the Integrated Care Programme Review Process that has been carried out to date as detailed in Appendix 1 2.2. Approve the Initial Integrated Care Programme Review Recommendations and Proposed Allocation of Partnership Funds detailed in Section 4.6 and Appendix 2 to this report. 2.3. Note the Partnership Funding resources available to the partnership for 2016/17 and 2017/18 as detailed in Section 4.4 2.4. Note the development of options to align investment of Partnership Funding to Strategic Plan Priorities and Population Need as detailed in Sections 4.5 and 4.6

3. Background

Integrated Care Fund

Page 2 of 14

outlined that the Integrated Care Fund will be used to support a focus on prevention, early intervention and care and support for people with complex and multiple conditions, particularly in those areas where multi-morbidity is common in adults under 65, as well as in older people.

Bridging Funding

3.3. Integrated Care Fund is intended to build on the Reshaping Care for Older People Change Fund, which ran from 2011-2015. To enable Partnership areas to continue and build on initiatives established through the Change Fund, approval was given for unallocated resource to be carried forward to be used to transition a limited number of relevant Reshaping Care for Older People initiatives to Integrated Care Fund. This included resources required to bridge additional health and social care rehabilitation and Reablement services which will be mainstreamed as part of the workforce model for Stirling Care Village.

Delayed Discharge Fund

3.4. In January 2014, the Scottish Government allocated an additional £100m over three years to Partnerships via NHS Boards, aimed at preventing delays in discharge and preventing admissions to hospital and attendances at Accident and Emergency. The intended cumulative effect was to reduce pressure across the system and to support health boards and local authorities to deliver good quality care and support for people at home or in a homely setting. Delayed Discharge funds must be targeted on initiatives which support achievement of the government target. The Clackmannanshire & Stirling Partnership’s allocation for the three years 2015-2018 is £0.744m per annum.

3.5. Although the Integrated Care Fund and Delayed Discharge fund have defined parameters of use, the collective resource has the potential to enable transformational change and improvement to service provision across the whole system. Therefore, to allow the impact of the total resource contribution to be evaluated, a consistent approach to governance, monitoring and reporting will be applied across all partnership funds.

Integrated Care Programme

3.6. Combined the services and projects funded through Integrated Care Fund, Delayed Discharge and Bridging Resources are known collectively as the Integrated Care Programme.

4. Considerations

4.1. The previous report on partnership funding detailed resources of £1.098m being carried forward from 2015/16.

Page 3 of 14

2016/17 and 2017/18 Resources Available

4.2. £0.022m of the resource carried forward relates specifically to Delayed Discharges funding and requires to be deployed on initiatives which support addressing delayed discharges.

4.3. Taking into account the Scottish Government allocations in relation to Delayed Discharge and the Integrated Care Fund, the level of resource carried forward from 2015/16 and the balance of the Integration Fund, as previously reported to the Board, the overall resources available for the partnership totals £8.003m as detailed in the table below.

4.4. Given the risks associated with the full year effect of implementation of the Living Wage no assumption has been made at this point that there will be a balance available from the Integration Fund in 2017/18 however a review of cost estimates is ongoing.

Review of Partnership Funded Projects

4.5 An initial review of Partnership funded projects has been undertaken and the resulting recommendations have been used to inform the potential commitments. A summary of the review process and initial recommendations are attached as Appendices I and II to this report and the specific initial recommendations are detailed at Section 4.6.

4.6 The initial recommendations from the review requiring approval are: • To complete a review of the Closer to Home service and associated supports in Autumn 2016 • To establish a discussion including both Chief Officers and key service personnel to align monitoring, evaluation and decision making for pan Forth Valley services supported by Partnership Funding including the Rapid Response Frailty Clinic and Discharge Hub • To further consider options to merge or reduce elements of the Anticipatory Care Planning, Community Psychiatric Nurse support to Allan Lodge and Care Home Psychiatric Liaison and report present preferred options alongside the review of Closer to Home in Autumn 2016. • To disinvest from the HELP packs project from 30 September 2016 • To disinvest from Improvement of Medical Housing Assessment from 30 September 2016 – this project did not commence.

Page 4 of 14

• To disinvest from the 0.5 WTE Dietician post from 30 September 2016 subject to an appropriate exit strategy being put in place • To disinvest from the Royal Voluntary Service: Well and Connected Project from 30 September 2016 • To disinvest from the Community Navigation Project from 30 September 2016 • To support the Active Stirling – Active Living Project for 2016/17 on the basis it becomes self supporting from 2017/18 onward • To continue the other services detailed in Appendix 2 at the resource levels indicated for 2016/17 with further investment in 2017/18 being dependent on the further work proposed within this report.

Aligning Investment to Strategic Plan Priorities and Population Need

4.7 Notwithstanding the requirement to complete Round 4 of the evaluation and review process scheduled for Autumn 2016 there is now a need to take stock of the current profile of investments and re-profile these to: • ensure alignment with the Strategic Plan priorities • ensure alignment with population need as evidenced through the Strategic Needs Assessment and Locality Profiles; and • address the previously reported risk of recurrent over-commitment against partnership funding streams. Based on the potential 2017/18 resource requirement per Appendix II of £3.926m and annual allocations of £3.224m the risk of recurrent over commitment is currently estimated at £0.702m though this would reduce to approximately £0.200m when Stirling Care Village is implemented.

4.8 Options are being developed to meet the aims detailed above which will be further developed and appraised before presentation to the September 2016 meeting for approval.

5. Conclusions

5.1. This report indicates that further work is required going forward to ensure service sustainability within resources available and, specifically, manage the transition of services between now and delivery of Stirling Care Village.

6. Resource Implications

6.1. The resource implications are detailed in the body of the paper.

7. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

7.1. The resources set out in this report represent a significant element of the overall resource available to support the priorities of the approved Strategic Plan.

Page 5 of 14

8. Legal & Risk Implications

8.1. The significant risks to the proposals set out of in this paper are the risks around future partnership funding allocations including the integration fund and specifically the costs of implementing the living wage and the approval and delivery of Stirling Care Village.

9. Consultation

9.1. The Reshaping Care Strategy Group, Joint Management Team, Chief Finance Officers of Clackmannanshire and Stirling Council and Director of Finance of NHS Forth Valley have been consulted on the evaluation and review process.

10. Equality and Human Rights Impact Assessment

10.1. Per Strategic Plan. Where proposals are agreed to stop or significant change a project or service an Equality and Human Rights Impact Assessment will be prepared.

11. Exempt reports

11.1. Not exempt

Page 6 of 14

Appendix 1 1. Review of Partnership Funded Projects

1.1. As documented in the 27 April 2016 IJB Partnership Funding paper, a short life working group was established as a sub-group of the Reshaping Care Strategy Group to review projects and services funded through partnership funding streams in 2015/16. The working group, known as the ICP Review Group has delivered the review within the set time frame and made recommendations to the Reshaping Care Strategy Group. Recommendations include how to begin to address the previously identified risk of shortfall on a recurrent basis. The Reshaping Care Strategy Group has considered the recommendations in detail and supported the recommendations to go forward to the Joint Management Team. The Joint Management Team has considered the recommendations and supports them to go forward to the IJB.

1.2. The ICP review process was based on a local PBMA (Programme Budget Marginal Analysis) approach. This method was used previously when reviewing the Change Fund for Reshaping Older People’s Care at the end of 2013/14. Following the 2013/14 Change Fund review and upon witnessing a presentation by Professor Cam Donaldson of Glasgow Caledonian University at an Integration event in Dunblane contact was made with Professor Donaldson. Professor Donaldson came to Stirling in the summer of 2014 to meet with Change Fund support team members where the local method was presented. Professor Donaldson acknowledged the review process used as demonstrating good practice and confirmed that it was a PBMA approach.

1.3. On the 25 February 2016 the methodology for the review and the personnel on the ICP Review Group were proposed to, and approved by, the Reshaping Care Strategy Group.

1.4. The ICP Review Group was established with eight members from a diversity of organisations including both local Third Sector Interfaces, Stirling Carers Centre, NHS Forth Valley, Social Services and finance colleagues. The group was chaired by the Assistant Head of Social Services for Adult Services.

1.5. The ICP Review was divided into four rounds each with a dedicated time frame. This report will provide recommendations on the first three rounds based on the review process. Round four is scheduled for Nov/Dec 2016 and is limited to the Health and Social Services that make up Closer to Home. Closer to Home services began in December 2015 and it is recommended that funding should be committed through to 31st March 2017 to provide time for the service to develop, the review to be carried out, and for the recommendations of the review to be considered and approved.

1.6. The ICP Review Group reviewed services on the basis of reports provided by services for the 2015/16 financial year or for shorter periods if services where not running for the full financial year. The ICP Review Group also took into consideration the information provided by services in Service Specification documents detailing plans for the 2016/17 financial year. Reports were requested based upon a format developed over a series of reporting cycles

Page 7 of 14

during the Change Fund and focused on demonstrating performance against the outputs and outcomes committed to in the previous service specification.

1.7. The review process started by undertaking a non-financial assessment of services. Each individual ICP Review Working Group member scored each services report and service specification against a slightly modified version of the National Health and Wellbeing Outcomes for both the impact and reach of the service. The ICP Review Group then met over a series of half day workshops, shared their individual scores for each service, and discussed the service to identify consensus scores. The consensus scores and notes of the discussion at the workshops where recorded in real time on a spreadsheet that was projected enabling all to see, contribute and challenge. Everyone contributed to the agreed consensus scores and the wording of the notes at each workshop.

1.8. Once the ICP Review Working Group had completed the non-financial review of each service it made comment on the value for money of the service. Some services that had recently started where not in a position to provide sufficient data to inform the scoring process and were scored on their concept to enable them to be compared with other better established services. This too was noted.

1.9. Upon completion of the reviews the scores for all the services were compared and ranked to give an indication of relative performance with respect to delivering on outcomes. Subsequently a second indicator of progress was created by dividing the outcome score for the service by the cost of the service in 2015/16 to give a cost per benefit point score. Cost per benefit point is not an absolute indicator of merit because there is a limit to the outcomes score that can be achieved. Services at the upper end of the cost scale will always have a relatively high cost per benefit point but this indicator provides another perspective on a service and it has proven to be useful at adding further understanding of relative merits between services with similar outcomes scores.

1.10. Both indicators, the outcomes score and the cost per benefit point, were then used to identify outlying services in terms of relative performance across the programme. The services identified as outliers where then looked at more closely and the notes form the review process used to inform the recommendations for each of the services. The ICP Review Group along with the RCSG and JMT have been aware throughout that there is a need to reduce the overall spend during 2016/17 and 2017/18.

Page 8 of 14

Appendix 2 Source of Project Name Recommended Potential Initial ICP Review Recommendation Resource: 16/17 17/18 ICF or Resource Resource Delayed Allocation Requirement Discharge 1.1 Test and ICF Rapid Response Social Care £130,520 £131,825 Deliver action to Capacity ensure a Overnight Care - Clacks - £81,398 £82,212 responsive 24/7 Attached to MECS and Health & Social available to Night Nurses Care Model - This is now Overnight Care - Stirling - £78,000 £76,154 effectively the Attached to MECS and combined available to Night Nurses Closer to Home is in Round 4 of the ICP Review – Scheduled for Autumn 2016 additional 24/7 Rapid Response £468,000 £472,680 investment in Nursing & Closer to Home Closer to Home Rapid Response AHPs and ALFY across Night Nursing Health & Social Care. Including 0.5 WTE Community links to Psychiatric Nurse beginning level 3 TOTAL £757,918 £762,871 Closer to Home activity in terms Delayed Rapid Response Frailty £150,184 £151,686 Requires pan Forth Valley Discussion, of supporting Discharge Clinic consideration and decision making. Rapid Response Discharge Hub £88,880 £89,769 Requires pan Forth Valley Discussion, Frailty Clinic. consideration and decision making. HELP Packs £11,500 £0 Recommend Disinvestment from 30 September 2016 Rehab Support Workers at £54,018 £54,558 Recommend continue service with funding at Stirling Community Hospital current rates for 16/17

OT in Hospital Discharge £42,000 £42,420 Recommend continue service with funding at

Page 9 of 14

Source of Project Name Recommended Potential Initial ICP Review Recommendation Resource: 16/17 17/18 ICF or Resource Resource Delayed Allocation Requirement Discharge Team current rates for 16/17 Hospital Discharge Team - £123,073 £124,304 Recommend funding at current rates for 16/17 Stirling (Linked to Rapid with improvement activity to deliver service, Response Social Care ensuring alignment with other services to meet above) outcomes Hospital Discharge Team - £92,456 £93,381 Recommend funding at current rates for 16/17 Clackmannanshire - with improvement activity to deliver service, includes Closer to Home ensuring alignment with other services to meet pick up. outcomes AHP Capacity at Stirling £85,651 £86,508 Recommend continue service with funding at Community Hospital current rates for 16/17 TOTAL £647,762 £642,625 1.2 Develop and ICF Consolidation/Development £358,800 £362,388 Recommend continue service with funding at Extend of Reablement in Clacks current rates for 16/17 subject to ongoing intermediate review care model to all Intermediate Care Social £43,935 £44,374 Recommend funding at current rates for 16/17 adults – Work Assessment Post with improvement activity to deliver service, particularly ensuring alignment with other services to meet implement a outcomes dementia intermediate Additional Support costs for £142,249 £149,546 Recommend funding at current rates for 16/17 care pathway new Dementia short stay with improvement activity to deliver service, beds in Allan Lodge ensuring alignment with other services to meet outcomes

Page 10 of 14

Source of Project Name Recommended Potential Initial ICP Review Recommendation Resource: 16/17 17/18 ICF or Resource Resource Delayed Allocation Requirement Discharge Allan Lodge - 0.5 WTE £23,476 £23,711 Recommend merging or reducing elements of Community Psychiatric existing services to create leaner more efficient Nurse and effective services between July – Sept 2016 Review and Integration of £20,626 £27,776 Recommend continue service with funding at Rehab, Reablement and OT current rates for 16/17 The work of this post Functions Transformational should inform 17/18 Reablement/ Rehab/ OT Change Post – 0.5 WTE investment across system Improvement of Medical £0 £0 Recommend Disinvestment from 30 September Housing Assessment 2016 TOTAL £589,086 £607,796 Delayed 5 Long Term Care beds £82,500 £83,325 Consider meeting cost from Integration Fund Discharge Balance in 16/17 Strathendrick £171,646 £173,362 Consider meeting cost from Integration Fund Balance in 16/17 TOTAL £254,146 £256,687 1.3 Embedding a ICF Keepwell Nurse Assessor £32,167 £32,489 Recommend continue service with funding at range of person current rates for 16/17 centred Anticipatory Care Planning £150,708 £152,215 Recommend merging or reducing elements of anticipatory and existing services to create leaner more efficient prevention and effective services between July – Sept 2016 planning – across 0.5 WTE Band6 Dietician £22,800 £0 Recommend Disinvestment from 30 September areas of poverty 2016 and high Alcohol Related Brain £56,250 £75,750 Requires pan Forth Valley Discussion, multimorbidity Damage (ARBD) Case consideration and decision making. Management Model TOTAL £261,925 £283,482

Page 11 of 14

Source of Project Name Recommended Potential Initial ICP Review Recommendation Resource: 16/17 17/18 ICF or Resource Resource Delayed Allocation Requirement Discharge 2.1 Extending ICF Royal Voluntary Service: £13,750 £0 Recommend Disinvestment from 30 September Community Well and Connected 2016 Based Supports (Clackmannanshire & Stirling) Alzheimer Scotland Post £41,405 £55,758 Recommend continue service with funding at Diagnostic Link Worker & current rates for 16/17 Community Connections Programme Town Break Stirling - £12,000 £16,160 Recommend continue service with funding at Dementia Projects Assistant current rates for 16/17 HSCI Community Grant £25,000 £25,000 Recommend continue service with funding at Fund current rates for 16/17 TOTAL £92,155 £96,918 2.2. Direct ICF PRT Carers £56,860 £76,571 Recommend continue service with funding at Support to Clackmannanshire current rates for 16/17 Carers Stirling Carers Centre £79,443 £106,983 Recommend continue service with funding at current rates for 16/17 TOTAL £136,303 £183,554 2.3 ICF Dallas / Living it Up £6,000 £6,060 Recommend continue service with funding at Communications, current rates for 16/17 Navigation/Way Community Navigation £0 £0 Recommend Disinvestment from 30 September Finding 2016 TOTAL £6,000 £6,060 2.4 Targeted ICF Active Stirling - Active Living £9,375 £0 Recommend continue service with funding at Resource to for Life current rates for 16/17 service has volunteered Support Lifestyle to become self-supporting post 2016/17 Change TOTAL £9,375 £0

Page 12 of 14

Source of Project Name Recommended Potential Initial ICP Review Recommendation Resource: 16/17 17/18 ICF or Resource Resource Delayed Allocation Requirement Discharge 3.1 Enablers for ICF OD Advisor £41,833 £42,251 Recommend continue service with funding at Transformational current rates for 16/17 Change Senior Information Analyst £46,128 £46,589 Recommend continue service with funding at current rates for 16/17 Integrated Care Fund £39,301 £39,694 Recommend continue service with funding at Coordinator current rates for 16/17 Administrator 1WTE @ £25,569 £25,825 Recommend continue service with funding at Band 4 current rates for 16/17 Programme Manager £74,713 £76,556 Recommend continue service with funding at Integration current rates for 16/17 2 part time Integration £39,868 £40,267 Recommend continue service with funding at Engagement Officers current rates for 16/17 Flexible Pot £151,876 £153,395 Recommend continue service with funding at current rates for 16/17 TOTAL £419,288 £424,577 Bridging Support Enhanced Discharge AHPs £91,960 £92,880 Recommend continue service for 16/17 – Will to Care Village be mainstreamed when Stirling Care Village implemented. Stirling Intermediate Care £391,126 £395,037 Recommend continue service for 16/17 – Will be mainstreamed when Stirling Care Village mainstreamed. Care Home Psychiatric £41,230 £41,642 Recommend merging or reducing elements of Liaison existing services to create leaner more efficient and effective services between July – Sept 2016 Southwest Rural Stirling £153,350 £154,884 Recommend continue service with funding at Intermediate Care current rates for 16/17 TOTAL £677,666 £684,443

Page 13 of 14

Source of Project Name Recommended Potential Initial ICP Review Recommendation Resource: 16/17 17/18 ICF or Resource Resource Delayed Allocation Requirement Discharge

2016/17 2017/18 £’000 £’000 TOTAL RESOURCE REQUIREMENT 3,852 3,926

NOTES / OTHER CONSIDERATIONS: 1. It is recommended that Anticipatory care Planning (ACP) delivery should be provided by a more diverse group of staff with less delivery done by the currently funded dedicated District Nursing team. The ACP investment from the ICP (potentially reduced from current levels) should be shifted away from delivery and towards training and equipping others to do ACPs 2. The Alcohol Related Brain Damage (ARBD) service recommended for investment is supported by information available in the Strategic Needs Assessment. 3. The Rapid Access Frailty Clinic and Discharge Hub services recommended for investment during 2016/17 should be reviewed jointly with other partners including Falkirk partnership during summer 2016 to investigate future requirements in relation to overall coordination of discharge and assessment procedures and should include links with Social Services Assessment and Discharge Teams. 4. There is a broad ranging shortage of performance information provided by services receiving finance through the ICP. It is recommended that more tightly governed project management activity is established around ICP services (e.g. through more detailed planning activity with services receiving investment and monthly programme board meetings that receive exception reports against the detailed plans). 5. All services recommended for disinvestment have been contacted directly to advise them of the situation and to discuss minimising the impact of the recommendations.

Page 14 of 14

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 9 on the agenda

Programme Workstreams Update

(Paper presented by Lesley Fulford)

For Noting

Approved for Submission by Shiona Strachan, Chief Officer Author Lesley Fulford, Programme Manager Date: 22 June 2016 List of Background Papers: 2015.09.17 Clackmannanshire & Stirling PB - Programme Work Streams Progress Report 2015.12.11 - Clackmannanshire & Stirling IJB - Work Stream Progress Report 2016.02.24 Clackmannanshire & Stirling IJB - Work Stream Progress Report 2016.04.27 Clackmannanshire & Stirling IJB - Work Stream Progress Report

Page 1 of 14

Title/Subject: Health and Social Care Integration Programme Plan Update

Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Lesley Fulford, Programme Manager Action: For Noting

1. Introduction

1.1 The purpose of the report is to provide an update to the Integration Joint Board on the programme of work to implement health and social care integration.

2. Executive Summary

2.1. The Public Bodies (Joint Working) (Scotland) Act 2014 sets out a number of statutory requirements for Health and Social Care Partnerships to meet in order to implement health and social care integration.

2.2. The Integration Joint Board has received regular reports noting the programme of work to ensure the Board is satisfying itself that all relevant matters are being progressed in a timely manner.

2.3. The key achievements since the report in April 2016 and future actions for these work stream groups are attached in Appendix 1.

2.4. The representatives in each of the technical work streams are detailed in Appendix 2.

2.5. In the April and May meetings of the Programme Board, members reviewed the work completed to date and are considering the work now required to be taken forward and how this will be structured.

3. Recommendations

The Integration Joint Board is asked to:

3.1. Note the content of the report and progress to date.

4. Background

4.1. The Public Bodies (Joint Working) (Scotland) Act 2014 sets out a number of statutory requirements for Health and Social Care Partnerships to meet in order to implement health and social care integration.

Page 2 of 14

5. Integration Programme Plan

5.1. The Integration Programme Plan and associated work streams have ensured the delivery and implementation of a range of tasks that are required to support new integration arrangements and to ensure the Partnership met their statutory obligations prior to 1 April 2016.

5.2. The work stream groups established to support integration arrangements are as follows:

. Strategic Planning group . Strategic Plan Working Group . FV wide Governance group . FV wide Finance group, with two supporting sub groups . FV wide HR workforce group . FV wide Performance and Measurement group . FV wide Data Sharing Partnership group . FV wide Clinical and Care Governance group . FV wide Risk Management group . Clackmannanshire & Stirling Partnership OD and Workforce Development group.

5.3. The key achievements updates since the report in April 2016 and future actions for these work stream groups are attached in Appendix 1.

6. Conclusions

6.1. Work has progressed within challenging deadlines, which has required strong commitment from all partners to ensure the Partnership met its statutory obligations under the Public Bodies (Joint Working) (Scotland) Act 2014 by 1 April 2016.

6.2. A number of the work streams have significant areas of work and will continue as part of the longer terms change programme. This programme of further work will be established through a review conducted by the Programme Board.

7. Resource Implications

7.1. The Integration Joint Board should note that the respective partners are contributing significant resources to support integration as reflected in the membership and areas of work being taken forward in the respective work streams. Continued support from partners will be required to ensure the Partnership delivers on improved outcomes.

Page 3 of 14 8. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

8.1. By completing the work associated with the work streams the Partnership has met its statutory obligations under the Public Bodies (Joint Working) (Scotland) Act 2014 by 1 April 2016. The primary focus for the work streams was on meeting the core legal requirements and those provisions within the Integration Scheme by this deadline.

8.2. Further work is now required to ensure the Partnership embeds these activities.

9. Legal & Risk Implications

9.1. None to note.

10. Consultation

10.1. Work stream outputs, where required, will be subject to consultation.

11. Equality and Human Rights Impact Assessment

11.1. Equalities and Human Rights Impact Assessments will be carried out as required for each work stream. The recommendations in this report do not require an Equalities and Human Rights Assessment.

12. Exempt reports

12.1. No

Page 4 of 14 13. Appendix 1 – Programme Work Stream Update Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales Strategic Lesley • Published the approved final version • Develop Locality Needs June 2016 Planning Fulford of the Strategic Plan and Easy Read Assessments Working Group version • Develop Locality Plans 2016 / 2017 • Develop Market Facilitation December 2016 Statement Governance Patricia . IJB Complaints policy . IJB to put in place its own 30 April 2016 Cassidy and procedures in place code – Ethical Standards in Public Life etc (Scotland) Act . FOI policy and procedures 2000 November 2016 and Publications Scheme in line with FOISA in place . Creation of Records Management Policy, retention . IJB approved EQIA template to schedules and when invited 31 March 2018 be used submission to the Keeper of the Plan in line with PRSA . Published the Equalities Outcomes and Mainstreaming Report 2016

Finance Fiona . Completion of the initial . Refining the budget details Review- June 2016 Ramsay budget setting . Develop and agree . Completion of the the financial reporting financial regulations arrangements

. Completion of internal and . Preparation of the external Audit recommendations 2015/16 accounts HR Workforce Helen . Strategic Workforce plan approved . Further analysis of the June 2016 Kelly . Initial analysis of workforce data workforce data complete • Operational Plan to be

Page 5 of 14 Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales . Joint Staff Forum meetings drafted to support the June 2016 arranged bi-monthly until March Strategic Workforce plan. 2017 • Continue engagement with Trade Union Colleagues with 5 Joint Staff Forums having taken place • Further Workforce Analysis is being undertaken which will be a key input into the development of Locality plans • Focus in next few months 2016/17 will be to review and redefine HR implementation plan • Strengthening Links events attended by members of the HR Workforce • HR input into HSCI risk register and mitigating factors identified

Performance Elaine . Performance Management . Further development & Vanhegan Framework developed and required as IJB becomes Measurement approved by IJBs in March – established move to implementation . Work stream will continue to meet. . Finalise relevant and priority Focus will be: indicators for Year 1 based on - To refine sample national outcomes and needs of scorecards in line with May 2016

Page 6 of 14 Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales Strategic Plan strategic plan priorities. - Create a project plan . Prepared Integration for implementation of May 2016 functions performance target the Performance list and Non integration Framework and functions performance target covalent use moving list forward using shared dashboard portal . Close liaison continues with - Review reporting May 2016 other work streams to prevent requirements - duplication i.e. Data Sharing ongoing IM&T - Review the Integration June 2016 functions performance target list & Non integration functions performance target list on agreement of operational functions Data Sharing Jonathan . Information Sharing Board (ISB) . Older People’s IJB Project Board - Partnership Procter bid for funding received in services requirements April December. Agreement to carry analysis in the process forward funding to next year to of being defined by the support wider review of Data service lead End February Sharing Partnership options . Data Sharing requirements . Data Sharing Specifications for to be identified 3 workstrands being pulled together . Outline requirements for IT network access being . Technical workstrands and requested from managers March 2016 initial IJB requirements in various departments April / May 2016

Page 7 of 14 Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales being scoped and developed . Data Sharing Portal Proof of Concept Options paper April 16 . Draft Portal Proof of presented to Programme Concept Options Paper Board presented to Programme Board in April 2016 . Site Connectivity Tests to be completed Awaiting council . Delayed discharges SW information requirements analysis • Initial ICT issues & expected in next progressed and fed into new infrastructure and tech quarter data collection exercise for requirements scoped out partners and work-plan being drawn together . Initial ICT priorities identified and specified by Partnerships and shared with Technical Sub May 2016 Group SC Plan expected end June

April 2016

To be progressed over next 6 months Identify by JMTs – March16 Clinical & Tracey . Clinical and Care Governance . Terms of Reference to be June 2016 Care Gillies Framework agreed by IJB agreed for the Clinical and Governance (March 2016) Care Governance Oversight Group and

Page 8 of 14 Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales group to be established Risk Hugh . Risk Management Strategy . Risk Reporting June 2016 Coyle agreed by IJB (March 2016) Framework (Appendix to Strategy) to be completed . Risk Register drafted, following workshop with members of the . Risk Register to be Joint Management Team / completed in tandem June 2016 reviews by work stream leads. with e.g. Strategic Plan actions. A paper outlining progress and next steps was submitted to the Programme Board in 2016

. Risk Training for e.g. IJB As required. members Participation Chris • Participation and Engagement . Action plan for September 2016 & Sutton Strategy was approved at implementation will now Engagement February IJB be developed. • Strategic Planning Group completed Stakeholder analysis, this will be used to inform the next phase of the work Organisational Morag Clackmannanshire & Stirling Clackmannanshire & Stirling Development McLaren • OD support in planning/facilitating • Phase 2 of staff engagement June 2016 for & Workforce service development workshops (e.g. sessions in June 2016, delivery, July 2016 Development Community Nursing, Single Point of focussed on identifying key for outputs

Access, Community GP Fellows) priorities that will deliver aims

Page 9 of 14 Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales • Initial proposals for Joint Leadership of Strategic Plan and Management Development • Delivery of action plans to To be agreed approved by JMT and IJB. support proposals signed off for IJB development Both Partnerships • Development support for Aug-Sept 2016 • Sharing of lessons learned from Strategic Plan Working Group

national groups which members of • Initial scoping work of mapping By Aug 2016 the OD / WD group attend. workforce development activity and initiating process to identify joint priorities for Workforce Development and Training priorities • Deliver Partnership ‘Playing to Your Strengths’ Leadership To be agreed Development Programme.

• Support in developing Autumn 2016 Participation and Engagement Strategy Action Plan • Planning for participation in national ‘Collaborative By Dec. 2016 Leadership in Practice’ programme

Both Partnerships • Support Chief Officer & Senior Ongoing Leaders to identify Leadership

development needs and

Page 10 of 14 Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales priorities for 2016. • Support the Chief Officer and Senior Leaders to review and Ongoing develop Joint Management & Governance Structures to meet the needs of the new Partnership. • Development of medium – long term OD & Workforce To be agreed Development Plans for next 3- 5 years (in line with the Integrated Workforce Plan). • Identify Joint Training & Development priorities based To be agreed on the Framework, to make best use of resources available

Page 11 of 14 Appendix 2 – List of Work Stream Members

Strategic Planning Working Group • Lesley Fulford, Programme Manager (Chair) • Chris Sutton, Service Manager, Strategy • Robert Stevenson, Senior Planning Manager • Oliver Harding, Public Health • David Niven, ICF Coordinator • Polly Roger, Third Sector Engagement Officer • Liz Rowlett, Third Sector Engagement Officer • Louise Johnston, Planning & Commissioning Manager • Calum McDonald, LIST Analyst • Carol Johnson, Partnership Analyst • Divya Prakash, OD Advisor

Strategic Planning Group

• Shiona Strachan (Chair) • Helen Macguire (Service User Representative) • Eileen Wallace (Service User Representative) • May Kirkwood (Unpaid Carer Representative) • Ian McCourt (Unpaid Carer Representative) • Helena Scott (Third Sector Representative) • Sheila McGhee (Third Sector Representative) • Bette Locke (NHS, Service Manager) • Irene Warnock (NHS, Lead Nurse) • Lorraine Robertson (NHS, Service Manager) • Phil Cummins (LA, Service Manager) • Linda Melville (LA,Service Manager) • Janice Young (LA, Acting Service Manager) • Marjory Mackay • Lesley Corr • Lorraine Linton • Janice White • Theresa Prescott • Susan White • Steve Mason / Carol Hamilton • Ewan Murray • Janette Fraser / Robert Stevenson • Chris Sutton • Louise Johnston • Elaine Vanhegan • Divya Prakash • Pamela Robertson • Abigail Robertson • Tom Hart • Lesley Fulford

Page 12 of 14 • Kathy O’Neill • Clinical and Care Governance Leads: Val de Souza; Dr Tracey Gillies and Dr Scott Williams

Governance (FV Wide) • Patricia Cassidy (Chair) • Suzanne Thomson • Elaine Vanhegan • Lesley Fulford • Shiona Strachan • Janice McCrum • Colin Moodie • Jack Frawley • Ruth McColgan • Deirdre Coyle

Finance (FV Wide) • Fiona Ramsay (Chair) • Patricia Cassidy • Bryan Smail • Iain Burns • Simon Dryburgh • Suzanne Thomson • Ewan Murray • Shiona Strachan • Lesley Fulford • Jim Boyle • Bryan Smail • Nikki Bridle • Amanda Templeman

HR Workforce (FV Wide) • Helen Kelly • Karen Algie • Kristne Johnstone • Chris Alliston

Performance & Measurement (FV Wide) • Patricia Cassidy, Chief Officer, Falkirk Partnership • Philip Morgan Klein, Falkirk Council • Chris Sutton, Clackmannanshire Council • Elaine Vanhegan, NHS Forth Valley (Chair) • Paul Woolman, NHS Forth Valley • Lesley Fulford, Programme Manager • Carol Johnson, Clackmannanshire Council • Shiona Strachan, Chief Officer, Clackmannanshire & Stirling Partnership

Page 13 of 14 Data Sharing Partnership (FV Wide) • Jonathan Procter (Chair) • Scott Jaffray • Lesley Fulford • Linda Allen • Marilyn Gardiner • John Munro • Heather Robb • Carol Johnson • Karen Wilson • Suzanne Thomson

Clinical & Care Governance • Tracey Gillies • Val de Souza • Joe McElholm

Risk • Hugh Coyle (Chair) • Gail Caldwell • Judi Richardson • David Bright

Participation & Engagement • Chris Sutton • Lesley Fulford • Divya Prakash • Liz Rowlett • Polly Roger

Organisational Development & Workforce Development • Morag McLaren (Chair) • Abigail Robertson • Alastair Hair • Divya Prakash • Jim Thompson • Lisa Dunbar • Liz Rowlett • Pam Robertson • Jean Beagley • Lesley Fulford • Lorna Young • Shiona Strachan

Page 14 of 14

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 10.1 on the agenda

Audit Committee

(Paper presented by Ewan C. Murray, Chief Finance Officer)

For Approval

Approved for Submission by Shiona Strachan, Chief Officer Author Ewan C. Murray, Chief Finance Officer Date: 22 June 2016 List of Background Papers: Integrated Resourcing Advisory Group Guidance

Page 1 of 6

Title/Subject: Audit Committee Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Ewan C. Murray, Chief Finance Officer Action: For Approval

1. Introduction

1.1 The Board discussed at its meeting of 30 March 2016 the establishment of an Audit Committee. The purpose of this paper is to bring forward proposals for establishment, membership and terms of reference for the Audit Committee.

2. Recommendations

The Integration Joint Board is asked to:

2.1. Approve the establishment of an Audit Committee

2.2. Appoint the Vice-Chair of the Integration Joint Board as chairperson of the Audit Committee. The chairperson would be counted as one of the voting members from NHS Forth Valley

2.3. Consider and approve the draft terms of reference (appendix 1) including agreement of Chairperson and membership of the Audit Committee

3. Background

3.1. The Public Bodies (Joint Working) (Scotland) Act 2014 establishes the framework for Integration of Health and Social Care in Scotland. The Scottish Government established the Integrated Resources Advisory Group (IRAG) to develop professional guidance. This guidance outlines that it is the responsibility of the Integration Joint Board to make appropriate and proportionate arrangements for consideration of the audit provision and annual financial statements which are compliant with good practice governance standards in the public sector.

3.2. The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 empowers the IJB to establish committees but, at the same time, sets out some limitations on this power. In relation to membership of committees the Order states “A committee established under paragraph (1) must include voting members, and must include an equal number of the voting members appointed by the Health Board on the one hand and the local authority or, as the case may be, local authorities, on the other hand.”

3.3. The order states that membership must include voting members, it does not prescribe that it may not also include non voting members.

Page 2 of 6

3.4. The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 further states that any decision must be agreed by a majority of votes of the voting members who are members of the committee.

4. Conclusions

4.1. Whilst there is no legal obligation on the Integration Joint Board to establish an audit committee it is considered good practice given the level of resource falling under its span of responsibilities and the associated complexities and risks.

5. Resource Implications

5.1. Within existing resources.

5.2. If approved the Integration Joint Board Standing Orders will require to be updated to reflect the Audit Committee.

6. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

6.1. No direct impact. However good governance systems will assist in achieving Best Value from deployment of resources available.

7. Legal & Risk Implications

7.1. The establishment of an audit committee is not a legal obligation. It is, however, considered to be good practice and should assist in identifying and mitigating risk.

8. Consultation

8.1. The draft remit for the committee has been the subject of discussion between the Chief Finance Officer, Chief Officer, Chief Internal Auditor for the Integration Joint Board, and officers of the constituent authorities.

9. Equality and Human Rights Impact Assessment

9.1. It is considered that no equality issues arise from the decision sought from the IJB by this report.

10. Exempt reports

10.1 Not exempt.

Page 3 of 6

Appendix 1 CLACKMANNANSHIRE AND STIRLING HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE DRAFT TERMS OF REFERENCE

Constitution The IJB shall appoint the Committee. The Committee should agree the professional advisors it requires on a regular and adhoc basis. The Committee is required to review its terms of reference on an annual basis.

The Committee will meet at least twice per annum. The Committee will be supported and serviced by the Chief Finance Officer. The Audit Committee will report to the Integration Joint Board

Chairperson The Integration Joint Board shall appoint the Chairperson of the Committee who will be one of the voting members of the Committee.

Membership The Integration Joint Board shall appoint the membership of the Committee. It is proposed the membership consists of four voting members with one being from each of Clackmannanshire Council and Stirling Councils and two being from NHS Forth Valley plus two non-voting members.

Quorum 3 of the voting members being present will constitute a quorum.

Functions Referred The following functions of the Integration Joint Board shall stand referred to the Audit Committee –

1. Assess the adequacy and effectiveness of the Integration Joint Board’s internal controls and corporate governance arrangements and consider the annual governance reports and assurances to ensure that the highest standards of probity and public accountability are demonstrated;

2. Ensure existence of and compliance with an appropriate Risk Management Strategy. Review risk management arrangements and receive regular risk management updates and reports;

3. Review and approve the Internal Audit Annual Plan on behalf of the Integration Joint Board, receive reports and oversee and review progress on actions taken on audit recommendations and report to the Integration Joint Board on these as appropriate;

4. Consider the External Audit Annual Plan on behalf of the Integration Joint Board, receive reports and consider matters arising from these and management actions identified in response before submission to the Integration Joint Board; The Audit Committee may also consider relevant national audit reports particularly those relating to Health and Social Care Integration from Audit Scotland.

5. Consider annual financial accounts and related matters before submission to and approval by the Integration Joint Board; and

Page 4 of 6

6. The committee is responsible for ensuring best value for those delegated functions.

7. The Committee is authorised by the Integration Joint Board to investigate any activity within its terms of reference, and in so doing, may seek any information it requires.

Page 5 of 6

Page 6 of 6

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 10.2 on the agenda

Code of Conduct and Standards Officer

(Paper presented by Shiona Strachan)

For Approval

Approved for Submission by Shiona Strachan Author Ruth McColgan Date 22 June 2016 List of Background Papers: Scottish Government Letter to Chief Officer dated 1 April 2016 Model Code of Conduct for Integration Joint Board Standards Commission for Scotland: Advice on the Role of a Standards Officer Scottish Government Guidance: Roles, Responsibilities & Membership of IJB

Page 1 of 10

Title/Subject: Code of Conduct and Standards Officer Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Ruth McColgan, Solicitor, Stirling Council Elaine Vanhegan, Head of Governance, NHS Forth Valley Janice McCrum, Solicitor, Clackmannanshire Council Andrew Wyse, Team Leader Legal Services, Clackmannanshire Council Action: For Approval

1. Introduction

1.1 As a public body, the Integration Board is required, under the Ethical Standards in Public Life (Scotland) Act 2000, to adopt a Code of Conduct setting out how its members should conduct themselves in undertaking their duties.

1.2 Connected to the obligation to have a Code of Conduct and similarly arising by reason of the Board’s status as a public body, the Integration Joint Board is required (as per the Ethical Standards in Public Life (Scotland) Act 2000 (Register of Interests) Regulations 2003) to have a ‘Standards Officer’. A Standards Officer has certain roles and responsibilities connected to the upholding of ethical standards by members of the public body.

2. Executive Summary

2.1 The Integration Joint Board is legally required to adopt a Code of Conduct and to appoint a Standards Officer. The Scottish Government have, as communicated by letter of 1 April 2016 (Appendix 1) to Chief Officers, produced a Model Code of Conduct for Integration Joint Boards. This Paper seeks the Board’s approval of that Model Code of Conduct for members of the Clackmannanshire & Stirling Integration Joint Board, subject to formal Scottish Government approval. In addition, the Standards Commission for Scotland have sought confirmation from the Chief Officer of this Board’s nomination to the post of Standards Officer. This Paper seeks the Board’s nomination of Andrew Wyse (Team Leader Legal Services, Clackmannanshire Council) as Standards Officer for the Clackmannanshire & Stirling Integration Joint Board. This nomination will be subject to approval by the Standards Commission.

3. Recommendations

The Integration Joint Board is asked to:

3.1. Approve the Code of Conduct at Appendix 2, subject to approval by the Scottish Government;

Page 2 of 10

3.2. Agree that members should abide by the terms of the Code of Conduct at Appendix 2 on an interim basis pending approval by the Scottish Government and formal adoption;

3.3. Nominate Andrew Wyse (Team Leader Legal Services, Clackmannanshire Council) as this Integration Joint Board’s Standards Officer, subject to approval by the Standards Commission;

3.4. Agree that the Key Duties and Responsibilities of the Standards Officer of this Board will be as listed at Appendix 3;

3.5. Delegate authority to the Chief Officer to liaise with the Standards Commission for Scotland regarding the nomination of the Standards Officer and with the Scottish Government regarding the approval of the Code of Conduct, on the Board’s behalf.

4. Background

4.1 On 1 April 2016 the Scottish Government, after a period of consultation, issued a Model Code of Conduct for Integration Joint Boards. Integration Joint Boards were asked to submit their Code of Conduct to the Scottish Government for approval by 21 June 2016. If the Board approves the Code at this June meeting, it will be submitted to the Scottish Government for formal approval before being adopted.

4.2 The Standards Commission has agreed a mechanism for appointment of a Standards Officer for an Integration Joint Board with the Scottish Government. As such, the Integration Joint Board, via the Chief Officer, has been asked by the Standards Commission to provide information as to its nomination for this role. This Paper is brought to the Board prior to a substantive response being provided to the Standards Commission.

5. Members’ Code of Conduct

5.1. As a public body, the Integration Joint Board is required to adopt a Code of Conduct, setting out how its members will conduct themselves and so ensuring that they uphold high ethical standards. It was not considered appropriate that the Model Code which already exists for ‘Public Bodies’ simply be adopted by Integration Joint Boards and as such, this tailored Code has been developed by the Scottish Government with input from relevant stakeholders for adoption by all Integration Joint Boards.

5.2. The Model Code of Conduct for Integration Joint Boards was issued by the Scottish Government on 1 April 2016 and is included as Appendix 2. Details of this Integration Joint Board have been inserted throughout the template.

5.3. The Scottish Government have advised that they expect the Model Code of Conduct to be implemented in full by Integration Joint Boards. Only in

Page 3 of 10

exceptional circumstances would they accept a request to amend to this Code prior to approving it. No substantive amendment is sought and this Board is being asked to adopt the Model Code of Conduct as issued by the Scottish Government.

5.4. The Code of Conduct will apply to all members of the Integration Joint Board, voting and non-voting.

5.5. It will be the personal responsibility of all Integration Joint Board members to read and understand the Code of Conduct, which may vary from the other Codes of Conduct to which they are subject. Some of the key provisions of the Code include:

• Principles and expectations regarding member conduct; • Registration of interests by members and consideration of categories of same; • Declarations of interest by members; and • Lobbying and access to members of the public.

5.6. If the Board agrees to adopt this Code of Conduct for its members, the Code will be submitted to the Scottish Government for approval. Once the Code of Conduct has been formally approved by the Scottish Government, the Board will be required to publish its Code of Conduct together with a Register of Members’ Interests.

Appointment of a Standards Officer

5.7. As already stated, as a public body, the Integration Joint Board is required to uphold high ethical standards in respect of member conduct and transparency. As is required by the Ethical Standards in Public Life (Scotland) Act 2000 (Register of Interests) Regulations 2003 that includes the appointment of a Standards Officer who has certain roles and responsibilities in terms of promoting and upholding those standards. One of the responsibilities of the Standards Officer will be to ensure that appropriate training is given to members on the Code of Conduct.

5.8. The Standards Commission is an independent body whose purpose is to encourage implementation of high ethical standards in public bodies. One key role of the Standards Officer will be to liaise with the Standards Commission. The nomination of a Standards Officer by this Board will require to be endorsed by the Standards Commission.

5.9. Liaison with the Commission for Ethical Standards in Public Life in Scotland may also be required by the Standards Officer; that Commission is responsible for investigating complaints about the conduct of members of public bodies and also for monitoring how people are appointed to the boards of Public Bodies.

5.10. The Standards Commission has agreed an approval process with the Scottish Government’s Directorate for Health and Social Care Integration, under which

Page 4 of 10

the Chief Officers of Integration Joint Boards have been requested to provide the following information to the Standards Commission:

(i) A summary of the Standards Officer’s key responsibilities; (ii) The name of the nominated individual; (iii) Whether the nominated individual is an existing Monitoring or Standards Officer; and (iv) The steps they have taken to assure themselves of the individual’s suitability.

It is therefore necessary that the nominated Standards Officer is appropriately qualified and experienced.

5.11. The key duties and responsibilities considered relevant for the Standards Officer of this Board have been included as Appendix 3. The Standards Commission recently provided Guidance as to the role of a Standards Officer of a public body; that Guidance is included at Appendix 4. The key duties and responsibilities for the Standards Officer for this Board have been drawn from the Standards Commission’s Guidance.

5.12. The role of the Standards Officer is connected to the ethical standards framework created by the Ethical Standards in Public Life (Scotland) Act 2000 (as amended). That Act applies to the Integration Joint Board and members should be aware of its terms.

5.13. The appropriateness of Andrew Wyse (Team Leader Legal Services, Clackmannanshire Council) holding this appointment, which even after approval by this Board remains subject to Standards Commission approval, will be kept under review by the Integration Joint Board. As the Board develops over the coming months and years it may conclude that this appointment more appropriately sits elsewhere. If the Board comes to that view, it could not substitute someone else into the post of Standards Officer without the prior approval of the Standards Commission.

6. Conclusions

6.1 The Integration Joint Board is required to have a Code of Conduct for Members and to appoint a Standards Officer. For the reasons set out in this Paper, it is appropriate for the Board firstly to approve the Model Code of Conduct and secondly to nominate Andrew Wyse (Team Leader Legal Services, Clackmannanshire Council) as Standards Officer of the Board. The Board should be aware that its approval of same is not final and as highlighted in this report, the Code of Conduct requires to be formally approved by the Scottish Government and the Standards Officer nomination requires to be approved by the Standards Commission for Scotland.

7. Resource Implications

7.1. Within existing resource and will be reviewed.

Page 5 of 10

8. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

8.1 The Members’ Code of Conduct, once approved, will require members to operate within a clear framework which highlights acceptable conduct and issues which members should be aware of. As such, the Board can be satisfied that it is pursuing its Outcomes & Priorities in an open and transparent manner.

8.2 The Integration Joint Board’s Standards Officer, once approved, will play a key role in promoting the ethical standards of the Board, further ensuring that it can pursue its Outcomes & Priorities in an open and transparent manner.

9. Legal & Risk Implications

9.1. In addition to satisfying a statutory requirement, the proposed Code of Conduct will provide a clear conduct framework within which all Board members must operate. Provided that framework is implemented and communicated to Board members, it will reduce the risk of members acting, even unknowingly, in a way which might compromise the Board’s integrity.

9.2. By nominating a Standards Officer, the Integration Joint Board will be acting in compliance with the legislation applicable to it and also minimising the risk of members acting in a way which is not compliant with the ethical framework(s) imposed on it in legislation, as there will be an officer nominated to oversee this compliance.

9.3. The adoption of a Members’ Code of Conduct and the nomination of an appropriate Standards Officer are both aspects of good governance.

10. Consultation

10.1. Governance leads for the constituent authorities and the Chief Officer were consulted in the preparation of this paper.

10.2. Andrew Wyse (Team Leader Legal Services, Clackmannanshire Council) officer nominated for appointment as Standards Officer herein was consulted in the preparation of this paper.

11. Equality and Human Rights Impact Assessment

11.1. N/A

12. Exempt reports

12.1. N/A

Page 6 of 10

Appendix 1 Scottish Government Letter to Chief Officer dated 1 April 2016

See attached file

Page 7 of 10

Appendix 2

Code of Conduct for Clackmannanshire & Stirling Integration Joint Board

(being the Scottish Government Model Code of Conduct for Integration Joint Board with this Board’s details inserted)

See Separate File

Page 8 of 10

Appendix 3

Key Duties and Responsibilities of Standards Officer

1. The Standards Officer is responsible for ensuring that appropriate training is given to Board Members on the Ethical Standards Framework, the Members’ Code of Conduct and any guidance issued by the Standards Commission on the Model Code of Conduct. This includes ensuring training is provided on induction and also on a regular basis thereafter. 2. The Standards Officer should contribute to the promotion and maintenance of high standards of conduct by providing advice and support to members on the interpretation and application of the Code of Conduct. 3. The Standards Officer is responsible for ensuring the body keeps an accurate and up to date Register of Interests. 4. The Standards Officer should be responsible for ensuring the Members’ Register of Gifts and Hospitality is maintained. 5. The Standards Officer should ensure the body has in place a consistent approach to obtaining and recording declarations of interest at the start of its meetings. 6. The Standards Officer may have an investigatory role if local resolution is attempted in respect of complaints or concerns made about a Member’s conduct. 7. The Standards Officer should also ensure that officers are aware of / familiar with the requirements of the Member’s Code of Conduct. 8. The Standards Officer may be required report to the Board from time to time on matters relating to the Ethical Standards Framework that may require review. 9. Act as the principal liaison with the Standards Commission for Scotland and also, if required, with the Commissioner for Ethical Standards in Public Life in Scotland.

Page 9 of 10

Appendix 4

Standards Commission for Scotland: Advice on the Role of a Standards Officer]

See Separate File

Page 10 of 10

Health and Social Care Integration Directorate Integration Partnerships Division

T: 0131 244 5453 E: [email protected]

To: Integration Joint Board Chairs  CC: Chief Officers

1 April 2016

Dear Colleagues

Integration Joint Boards – Code of Conduct

Implementation of integration is now well under way, with Integration Joint Boards (IJBs) established and fully operational from today.

IJBs are, as you know, “devolved public bodies” for the purposes of the Ethical Standards in Public Life etc. (Scotland) Act 2000, which means that each IJB must produce a Code of Conduct setting out how its members should conduct themselves in undertaking their duties. This should be based on the Model Code of Conduct for Members of Devolved Public Bodies, applying to members and the business of the IJB. The Model Code is available to view on the Scottish Government website: http://www.gov.scot/Publications/2014/02/4841/downloads. IJBs are required to submit their Code to the Scottish Government for approval by 21st June 2016.

We have worked with the Commissioner for Ethical Standards and the Standards Commission to prepare a template Code that can be adopted by all IJBs; a copy is attached with this letter. We expect IJBs to implement the Code in full. If, however, in exceptional circumstances, you feel you need to make an amendment to the Code, we would ask that you provide the reasons for any changes when you submit the Code to us for approval. We will then consider your request.

Once an IJB’s Code has been approved by the Scottish Government, the IJB must publish their Code as well as a Register of Members’ Interests. When we write to you to confirm approval of your Code, we will remind you of this requirement.

I would be grateful if you could send your draft Code of Conduct to Lauren Glen by email at [email protected] by 21st June 2016. Thank you for your help on this.

Yours faithfully

ALISON TAYLOR

CODE of CONDUCT

for

MEMBERS

Clackmannanshire & Stirling Integration Joint Board

CODE OF CONDUCT for MEMBERS of Clackmannanshire & Stirling Integration Joint Board

CONTENTS

Section 1: Introduction to the Code of Conduct

Appointments to the Boards of Public Bodies

Guidance on the Code of Conduct

Enforcement

Section 2: Key Principles of the Code of Conduct

Section 3: General Conduct

Conduct at Meetings

Relationship with Integration Joint Board Members and Employees of Related Organisations

Remuneration, Allowances and Expenses

Gifts and Hospitality

Confidentiality Requirements

Use of Health Board or Local Authority Facilities by Members of the Integration Joint Board

Appointment to Partner Organisations

Section 4: Registration of Interests

Category One: Remuneration

Category Two: Related Undertakings

Category Three: Contracts

Category Four: Houses, Land and Buildings

Category Five: Interest in Shares and Securities

Category Six: Gifts and Hospitality

Category Seven: Non-Financial Interests

Section 5: Declaration of Interests

General

Interests which Require Declaration

Your Financial Interests

Your Non-Financial Interests

The Financial Interests of Other Persons

The Non-Financial Interests of Other Persons

Making a Declaration

Frequent Declaration of Interests

Dispensations

Section 6: Lobbying and Access to Members of Public Bodies

Introduction

Rules and Guidance

Annexes

Annex A: Sanctions Available to the Standards Commission for Breach of Code

Annex B: Definitions and Explanatory Notes

SECTION 1: INTRODUCTION TO THE CODE OF CONDUCT

1.1 The Scottish public has a high expectation of those who serve on the boards of public bodies and the way in which they should conduct themselves in undertaking their duties. You must meet those expectations by ensuring that your conduct is above reproach.

1.2 The Ethical Standards in Public Life etc. (Scotland) Act 2000, “the 2000 Act”, provides for Codes of Conduct for local authority Councillors and members of relevant public bodies; imposes on councils and relevant public bodies a duty to help their members to comply with the relevant Code; and establishes a Standards Commission for Scotland, “The Standards Commission” to oversee the new framework and deal with alleged breaches of the Codes.

1.3 The 2000 Act requires the Scottish Ministers to lay before Parliament a Code of Conduct for Councillors and a Model Code for Members of Devolved Public Bodies. The Model Code for members was first introduced in 2002 and has now been revised in December 2013 following consultation and the approval of the Scottish Parliament. These revisions will make it consistent with the relevant parts of the Code of Conduct for Councillors, which was revised in 2010 following the approval of the Scottish Parliament.

The Public Bodies (Joint Working) (Scotland) Act 2014 (Consequential Amendments & Savings) Order 2015 has determined that Integration Joint Boards are “devolved public bodies” for the purposes of the 2000 Act.

1.4 This Code for Integration Joint Boards has been specifically developed using the Model Code and the statutory requirements of the 2000 Act. As a member of Clackmannanshire & Stirling’s Integration Joint Board “the IJB”, it is your responsibility to make sure that you are familiar with, and that your actions comply with, the provisions of this Code of Conduct which has now been made by the IJB.

This Code applies when you are acting as a member of Clackmannanshire & Stirling’s Integration Joint Board and you may also be subject to another Code of Conduct.

Appointments to the Boards of Public Bodies

1.5 Whilst your appointment as a member of an Integration Joint Board sits outside the Ministerial appointment process, you should have an awareness of the system surrounding public appointments in Scotland. Further information can be found in the public appointment section of the Scottish Government website at http://www.appointed-for-scotland.org/.

Details of IJB membership requirements are set out in the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 and further helpful information is contained in the “Roles, Responsibilities and Membership of the Integration Joint Board” guidance, which also includes information on Equality Duties and Diversity.

Public bodies in Scotland are required to deliver effective services to meet the needs of an increasingly diverse population. In addition, the Scottish Government’s equality outcome on public appointments is to ensure that Ministerial appointments are more diverse than at present. In order to meet both of these aims, a board should ideally be drawn from varied backgrounds with a wide spectrum of characteristics, knowledge and experience. It is crucial to the success of public bodies that they attract the best people for the job and therefore it is essential that a board’s appointments process should encourage as many suitable people to apply for positions and be free from unnecessary barriers. You should therefore be aware of the varied roles and functions of the IJB on which you serve and of wider diversity and equality issues.

1.6 You should also familiarise yourself with how the Clackmannanshire & Stirling IJB policy operates in relation to succession planning, which should ensure that the IJB has a strategy to make sure they have the members in place with the skills, knowledge and experience necessary to fulfil their role economically, efficiently and effectively.

Guidance on the Code of Conduct

1.7 You must observe the rules of conduct contained in this Code. It is your personal responsibility to comply with these and review regularly, and at least annually, your personal circumstances with this in mind, particularly when your circumstances change. You must not at any time advocate or encourage any action contrary to the Code of Conduct.

1.8 The Code has been developed in line with the key principles listed in Section 2 and provides additional information on how the principles should be interpreted and applied in practice. The Standards Commission may also issue guidance. No Code can provide for all circumstances and if you are uncertain about how the rules apply, you should in the first instance seek advice from the Chair of the IJB. You may also choose to consult your own legal advisers and, on detailed financial and commercial matters, seek advice from other relevant professionals.

1.9 You should familiarise yourself with the Scottish Government publication “On Board – a guide for board members of public bodies in Scotland” and the “Roles, Responsibilities and Membership of the Integration Joint Board” guidance. These publications will provide you with information to help you in your role as a member of an Integration Joint Board, and can be viewed on the Scottish Government website.

Enforcement

1.10 Part 2 of the 2000 Act sets out the provisions for dealing with alleged breaches of this Code of Conduct and where appropriate the sanctions that will be applied if the Standards Commission finds that there has been a breach of the Code. Those sanctions are outlined in Annex A.

SECTION 2: KEY PRINCIPLES OF THE CODE OF CONDUCT

2.1 The general principles upon which this Code is based should be used for guidance and interpretation only. These general principles are:

Duty You have a duty to uphold the law and act in accordance with the law and the public trust placed in you. You have a duty to act in the interests of Clackmannanshire & Stirling IJB and in accordance with the core functions and duties of the IJB.

Selflessness You have a duty to take decisions solely in terms of public interest. You must not act in order to gain financial or other material benefit for yourself, family or friends.

Integrity You must not place yourself under any financial, or other, obligation to any individual or organisation that might reasonably be thought to influence you in the performance of your duties.

Objectivity You must make decisions solely on merit and in a way that is consistent with the functions of Clackmannanshire & Stirling IJB when carrying out public business including making appointments, awarding contracts or recommending individuals for rewards and benefits.

Accountability and Stewardship You are accountable for your decisions and actions to the public. You have a duty to consider issues on their merits, taking account of the views of others and must ensure that Clackmannanshire & Stirling IJB uses its resources prudently and in accordance with the law.

Openness You have a duty to be as open as possible about your decisions and actions, giving reasons for your decisions and restricting information only when the wider public interest clearly demands.

Honesty You have a duty to act honestly. You must declare any private interests relating to your public duties and take steps to resolve any conflicts arising in a way that protects the public interest.

Leadership You have a duty to promote and support these principles by leadership and example, and to maintain and strengthen the public’s trust and confidence in the integrity of Clackmannanshire & Stirling IJB and its members in conducting public business.

Respect

You must respect fellow members of Clackmannanshire & Stirling IJB and employees of related organisations supporting the operation of the IJB and the role they play, treating them with courtesy at all times. Similarly you must respect members of the public when performing duties as a member of Clackmannanshire & Stirling IJB.

2.2 You should apply the principles of this Code to your dealings with fellow members of Clackmannanshire & Stirling IJB, employees of related organisations supporting the operation of the IJB and other stakeholders. Similarly you should also observe the principles of this Code in dealings with the public when performing duties as a member of Clackmannanshire & Stirling IJB.

SECTION 3: GENERAL CONDUCT

3.1 The rules of good conduct in this section must be observed in all situations where you act as a member of the IJB.

Conduct at Meetings

3.2 You must respect the chair, your colleagues and employees of related organisations supporting the operation of the IJB in meetings. You must comply with rulings from the chair in the conduct of the business of these meetings. You should familiarise yourself with the Standing Orders for Clackmannanshire & Stirling IJB, which govern the Board’s proceedings and business. The “Roles, Responsibilities and Membership of the Integration Joint Board” guidance, will also provide you with further helpful information.

Relationship with IJB Members and Employees of Related Organisations

3.3 You will treat your fellow IJB members and employees of related organisations supporting the operation of the IJB with courtesy and respect. It is expected that fellow IJB members and employees of related organisations supporting the operation of the IJB will show you the same consideration in return. It is good practice for employers to provide examples of what is unacceptable behaviour in their organisation and the Health Board or local authority of the IJB should be able to provide this information to any IJB member on request.

Public bodies should promote a safe, healthy and fair working environment for all. As a member of Clackmannanshire & Stirling IJB you should be familiar with any policies of the Health Board and local authority of the IJB as a minimum in relation to bullying and harassment in the workplace, and also lead by exemplar behaviour.

Remuneration, Allowances and Expenses

3.4 You must comply with any rules applying to the IJB regarding remuneration, allowances and expenses.

Gifts and Hospitality

3.5 You must not accept any offer by way of gift or hospitality which could give rise to real or substantive personal gain or a reasonable suspicion of influence on your part to show favour, or disadvantage, to any individual or organisation. You should also consider whether there may be any reasonable perception that any gift received by your spouse or cohabitee or by any company in which you have a controlling interest, or by a partnership of which you are a partner, can or would influence your judgement. The term “gift” includes benefits such as relief from indebtedness, loan concessions or provision of services at a cost below that generally charged to members of the public.

3.6 You must never ask for gifts or hospitality.

3.7 You are personally responsible for all decisions connected with the offer or acceptance of gifts or hospitality offered to you and for avoiding the risk of damage to public confidence in your IJB. As a general guide, it is usually appropriate to refuse offers except:

(a) isolated gifts of a trivial character, the value of which must not exceed £50;

(b) normal hospitality associated with your duties and which would reasonably be regarded as appropriate; or

3.8 You must not accept any offer of a gift or hospitality from any individual or organisation which stands to gain or benefit from a decision that Clackmannanshire & Stirling IJB may be involved in determining, or who is seeking to do business with your IJB, and which a person might reasonably consider could have a bearing on your judgement. If you are making a visit in your capacity as a member of Clackmannanshire & Stirling IJB then, as a general rule, you should ensure that your IJB pays for the cost of the visit.

3.9 You must not accept repeated hospitality or repeated gifts from the same source.

3.10 As a member of a devolved public body, you should familiarise yourself with the terms of the Bribery Act 2010 which provides for offences of bribing another person and offences relating to being bribed.

Confidentiality Requirements

3.11 There may be times when you will be required to treat discussions, documents or other information relating to the work of Clackmannanshire & Stirling IJB in a confidential manner. You will often receive information of a private nature which is not yet public, or which perhaps would not be intended to be public. You must always respect the confidential nature of such information and comply with the requirement to keep such information private.

3.12 It is unacceptable to disclose any information to which you have privileged access, for example derived from a confidential document, either orally or in writing. In the case of other documents and information, you are requested to exercise your judgement as to what should or should not be made available to outside bodies or individuals. In any event, such information should never be used for the purposes of personal or financial gain or for political purposes or used in such a way as to bring Clackmannanshire & Stirling IJB into disrepute.

Use of Health Board or Local Authority Facilities by Members of the IJB

3.13 Members of Clackmannanshire & Stirling IJB must not misuse facilities, equipment, stationery, telephony, computer, information technology equipment and services, or use them for party political or campaigning activities. Use of such equipment and services etc. must be in accordance with the Health Board or local authority policy and rules on their usage. Care must also be exercised when using social media networks not to compromise your position as a member of Clackmannanshire & Stirling IJB.

Appointment to Partner Organisations

3.14 In the unlikely circumstances that you may be appointed, or nominated by Clackmannanshire & Stirling IJB as a member of another body or organisation, you are bound by the rules of conduct of these organisations and should observe the rules of this Code in carrying out the duties of that body.

3.15 Members who become directors of companies as nominees of their IJB will assume personal responsibilities under the Companies Acts. It is possible that conflicts of interest can arise for such members between the company and the IJB. It is your responsibility to take advice on your responsibilities to the IJB and to the company. This will include questions of declarations of interest.

SECTION 4: REGISTRATION OF INTERESTS

4.1 The following paragraphs set out the kinds of interests, financial and otherwise which you have to register. These are called “Registerable Interests”. You must, at all times, ensure that these interests are registered, when you are appointed and whenever your circumstances change in such a way as to require change or an addition to your entry in the IJB’s Register. It is your duty to ensure any changes in circumstances are reported within one month of them changing.

4.2 The Regulations1 as amended describe the detail and timescale for registering interests. It is your personal responsibility to comply with these regulations and you should review regularly and at least once a year your personal circumstances. Annex B contains key definitions and explanatory notes to help you decide what is required when registering your interests under any particular category. The interests which require to be registered are those set out in the

1 SSI - The Ethical Standards in Public Life etc. (Scotland) Act 2000 (Register of Interests) Regulations 2003 Number 135, as amended.

9 following paragraphs and relate to you. It is not necessary to register the interests of your spouse or cohabitee.

Category One: Remuneration

4.3 You have a Registerable Interest where you receive remuneration by virtue of being:

• employed; • self-employed; • the holder of an office; • a director of an undertaking; • a partner in a firm; or • undertaking a trade, profession or vocation or any other work.

This requirement also applies where, by virtue of your employment in a particular post, you are required to be a member of the IJB.

4.4 In relation to 4.3 above, the amount of remuneration does not require to be registered and remuneration received as a member does not have to be registered.

4.5 If a position is not remunerated it does not need to be registered under this category. However, unremunerated directorships may need to be registered under category two, “Related Undertakings”.

4.6 If you receive any allowances in relation to membership of any organisation, the fact that you receive such an allowance must be registered.

4.7 When registering employment, you must give the name of the employer, the nature of its business, and the nature of the post held in the organisation.

4.8 When registering self-employment, you must provide the name and give details of the nature of the business. When registering an interest in a partnership, you must give the name of the partnership and the nature of its business.

4.9 Where you undertake a trade, profession or vocation, or any other work, the detail to be given is the nature of the work and its regularity. For example, if you write for a newspaper, you must give the name of the publication, and the frequency of articles for which you are paid.

4.10 When registering a directorship, it is necessary to provide the registered name of the undertaking in which the directorship is held and the nature of its business.

4.11 Registration of a pension is not required as this falls outside the scope of the category.

Category Two: Related Undertakings

4.12 You must register any directorships held which are themselves not remunerated but where the company (or other undertaking) in question is a subsidiary of, or a parent of, a company (or other undertaking) in which you hold a remunerated directorship.

4.13 You must register the name of the subsidiary or parent company or other undertaking and the nature of its business, and its relationship to the company or other undertaking in which you are a director and from which you receive remuneration.

4.14 The situations to which the above paragraphs apply are as follows:

• you are a director of a board of an undertaking and receive remuneration declared under category one – and • you are a director of a parent or subsidiary undertaking but do not receive remuneration in that capacity.

Category Three: Contracts

4.15 You have a registerable interest where you (or a firm in which you are a partner, or an undertaking in which you are a director or in which you have shares of a value as described in paragraph 4.19 below) have made a contract with the IJB of which you are a member:

(i) under which goods or services are to be provided, or works are to be executed; and

(ii) which has not been fully discharged.

4.16 You must register a description of the contract, including its duration, but excluding the consideration.

Category Four: Houses, Land and Buildings

4.17 You have a registerable interest where you own or have any other right or interest in houses, land and buildings, which may be significant to, of relevance to, or bear upon, the work and operation of the body to which you are appointed.

4.18 The test to be applied when considering appropriateness of registration is to ask whether a member of the public acting reasonably might consider any interests in houses, land and buildings could potentially affect your responsibilities to the organisation to which you are appointed and to the public, or could influence your actions, speeches or decision making.

Category Five: Interest in Shares and Securities

4.19 You have a registerable interest where you have an interest in shares comprised in the share capital of a company or other body which may be significant to, of relevance to, or bear upon, the work and operation of (a) the body to which you are appointed and (b) the nominal value of the shares is:

(i) greater than 1% of the issued share capital of the company or other body; or

(ii) greater than £25,000.

Where you are required to register the interest, you should provide the registered name of the company in which you hold shares; the amount or value of the shares does not have to be registered.

Category Six: Gifts and Hospitality

4.20 You must register the details of any gifts or hospitality received within your current term of office. This record will be available for public inspection. It is not however necessary to record any gifts or hospitality as described in paragraph 3.7 (a) to (c) of this Code.

Category Seven: Non–Financial Interests

4.21 You may also have a registerable interest if you have non-financial interests which may be significant to, of relevance to, or bear upon, the work and operation of the IJB to which you are appointed. It is important that relevant interests such as membership or holding office in other public bodies, clubs, societies and organisations such as trades unions and voluntary organisations, are registered and described. This requirement also applies where, by virtue of your membership of a particular group, you have been appointed to the IJB.

4.22 In the context of non-financial interests, the test to be applied when considering appropriateness of registration is to ask whether a member of the public might reasonably think that any non-financial interest could potentially affect your responsibilities to the organisation to which you are appointed and to the public, or could influence your actions, speeches or decision-making.

SECTION 5: DECLARATION OF INTERESTS

General

5.1 The key principles of the Code, especially those in relation to integrity, honesty and openness, are given further practical effect by the requirement for you to declare certain interests in proceedings of the IJB. Together with the rules on registration of interests, this ensures transparency of your interests which might influence, or be thought to influence, your actions. For further detail on the declaration requirements of Clackmannanshire & Stirling IJB, you can refer to the IJB’s Standing Orders.

5.2 IJBs inevitably have dealings with a wide variety of organisations and individuals and this Code indicates the circumstances in which a business or personal interest must be declared. Public confidence in Clackmannanshire & Stirling IJB and its members depends on it being clearly understood that decisions are taken in the public interest and not for any other reason.

5.3 In considering whether to make a declaration in any proceedings, you must consider not only whether you will be influenced but whether anybody else would think that you might be influenced by the interest. You must, however, always comply with the objective test (“the objective test”) which is whether a member of the public, with knowledge of the relevant facts, would reasonably regard the interest as so significant that it is likely to prejudice your discussion or decision making in your role as a member of Clackmannanshire & Stirling IJB. You will wish to familiarise yourself with your IJB’s standing orders and the “Roles, Responsibilities and Membership of the Integration Joint Board” guidance.

5.4 If you feel that, in the context of the matter being considered, your involvement is neither capable of being viewed as more significant than that of an ordinary member of the public, nor likely to be perceived by the public as wrong, you may continue to attend the meeting and participate in both discussion and voting. The relevant interest must however be declared. It is your responsibility to judge whether an interest is sufficiently relevant to particular proceedings to require a declaration and you are advised to err on the side of caution. If a board member is unsure as to whether a conflict of interest exits, they should seek advice from the board chair in the first instance.

5.5 As a member of Clackmannanshire & Stirling IJB you might also serve on other bodies. In relation to service on the boards and management committees of limited liability companies, public bodies, societies and other organisations, you must decide, in the particular circumstances surrounding any matter, whether to declare an interest. Only if you believe that, in the particular circumstances, the nature of the interest is so remote or without significance, should it not be declared. You must always remember the public interest points towards transparency and, in particular, a possible divergence of interest between your IJB and another body. Keep particularly in mind the advice in paragraph 3.15 of this Code about your legal responsibilities to any limited company of which you are a director.

Interests which Require Declaration

5.6 Interests which require to be declared if known to you may be financial or non- financial. They may or may not cover interests which are registerable under the terms of this Code. Most of the interests to be declared will be your personal interests but, on occasion, you will have to consider whether the interests of other persons require you to make a declaration. The paragraphs which follow deal with (a) your financial interests (b) your non-financial interests and (c) the interests, financial and non-financial, of other persons.

5.7 You will also have other private and personal interests and may serve, or be associated with, bodies, societies and organisations as a result of your private and personal interests and not because of your role as a member of an IJB. In the context of any particular matter you will need to decide whether to declare an interest. You should declare an interest unless you believe that, in the particular circumstances, the interest is too remote or without significance. In reaching a view on whether the objective test applies to the interest, you should consider whether your interest (whether taking the form of association or the holding of office) would be seen by a member of the public acting reasonably in a different light because it is

13 the interest of a person who is a member of an IJB as opposed to the interest of an ordinary member of the public.

Your Financial Interests

5.8 You must declare, if it is known to you, any financial interest (including any financial interest which is registerable under any of the categories prescribed in Section 4 of this Code). If, under category one (or category seven in respect of non- financial interests) of section 4 of this Code, you have registered an interest as a

• Councillor or a Member of another Devolved Public Body where the Council or other Devolved Public Body, as the case may be, has nominated or appointed you as a Member of the IJB, or you have been appointed to the IJB by virtue of your position under the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014; you do not, for that reason alone, have to declare that interest.

There is no need to declare an interest which is so remote or insignificant that it could not reasonably be taken to fall within the objective test.

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 integration joint board, or a committee of the integration joint board, before taking part in any discussion on that item.

Where an interest is disclosed under the above terms the onus is on the member declaring the interest to decide whether, in the circumstances, it is appropriate for that member to take part in the discussion of, or voting on the item of business.

You must withdraw from the meeting room until discussion of and voting on the relevant item where you have a declarable interest is concluded. There is no need to withdraw in the case of an interest which is so remote or insignificant that it could not reasonably be taken to fall within the objective test.

Your Non-Financial Interests

5.9 You must declare, if it is known to you, any non-financial interest if:

(i) that interest has been registered under category seven (Non-Financial Interests) of Section 4 of the Code; or

(ii) that interest would fall within the terms of the objective test.

There is no need to declare an interest which is so remote or insignificant that it could not reasonably be taken to fall within the objective test.

You do not have to declare an interest solely because you are a Councillor or Member of another Devolved Public Body or you have been appointed to the IJB by virtue of your position under the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014.

The Financial Interests of Other Persons

5.10 The Code requires only your financial interests to be registered. You also, however, have to consider whether you should declare any financial interest of certain other persons.

You must declare if it is known to you any financial interest of:-

(i) a spouse, a civil partner or a co-habitee; (ii) a close relative, close friend or close associate; (iii) an employer or a partner in a firm; (iv) a body (or subsidiary or parent of a body) of which you are a remunerated member or director; (v) a person from whom you have received a registerable gift or registerable hospitality; (vi) a person from whom you have received registerable expenses.

There is no need to declare an interest if it is so remote or insignificant that it could not reasonably be taken to fall within the objective test.

5.11 This Code does not attempt the task of defining “relative” or “friend” or “associate”. Not only is such a task fraught with difficulty but is also unlikely that such definitions would reflect the intention of this part of the Code. The key principle is the need for transparency in regard to any interest which might (regardless of the precise description of relationship) be objectively regarded by a member of the

public, acting reasonably, as potentially affecting your responsibilities as a member of the IJB and, as such, would be covered by the objective test.

The Non-Financial Interests of Other Persons

5.12 You must declare if it is known to you any non-financial interest of:-

There is no need to declare the interest if it is so remote or insignificant that it could not reasonably be taken to fall within the objective test.

There is only a need to withdraw from the meeting if the interest is clear and substantial.

Making a Declaration

5.13 You must consider at the earliest stage possible whether you have an interest to declare in relation to any matter which is to be considered. You should consider whether agendas for meetings raise any issue of declaration of interest. Your declaration of interest must be made as soon as practicable at a meeting where that interest arises. If you do identify the need for a declaration of interest only when a particular matter is being discussed you must declare the interest as soon as you realise it is necessary.

5.14 The oral statement of declaration of interest should identify the item or items of business to which it relates. The statement should begin with the words “I declare an interest”. The statement must be sufficiently informative to enable those at the meeting to understand the nature of your interest but need not give a detailed description of the interest.

Frequent Declarations of Interest

5.15 Public confidence in an IJB is damaged by perception that decisions taken by that body are substantially influenced by factors other than the public interest. If members are frequently declaring interests at meetings then they should consider whether they can carry out their role effectively and discuss this at the earliest opportunity with their chair.

Similarly, if any appointment or nomination to another body would give rise to objective concern because of your existing personal involvement or affiliations, you should not accept the appointment or nomination.

Dispensations

5.16 In some very limited circumstances dispensations can be granted by the Standards Commission in relation to the existence of financial and non-financial interests which would otherwise prohibit you from taking part and voting on matters coming before your IJB and its committees.

5.17 Applications for dispensations will be considered by the Standards Commission and should be made as soon as possible in order to allow proper consideration of the application in advance of meetings where dispensation is sought. You should not take part in the consideration of the matter in question until the application has been granted.

SECTION 6: LOBBYING AND ACCESS TO MEMBERS OF PUBLIC BODIES

Introduction

6.1 In order for Clackmannanshire & Stirling IJB to fulfil its commitment to being open and accessible, it needs to encourage participation by organisations and individuals in the decision-making process. Clearly however, the desire to involve the public and other interest groups in the decision-making process must take account of the need to ensure transparency and probity in the way in which Clackmannanshire & Stirling conducts its business.

6.2 You will need to be able to consider evidence and arguments advanced by a wide range of organisations and individuals in order to perform your duties effectively. Some of these organisations and individuals will make their views known directly to individual members. The rules in this Code set out how you should conduct yourself in your contacts with those who would seek to influence you. They are designed to encourage proper interaction between members of public bodies, those they represent and interest groups. You should also familiarise yourself with the “Roles, Responsibilities and Membership” guidance for members of an Integration Joint Board.

Rules and Guidance

6.3 You must not, in relation to contact with any person or organisation that lobbies do anything which contravenes this Code or any other relevant rule of Clackmannanshire & Stirling IJB or any statutory provision.

6.4 You must not, in relation to contact with any person or organisation who lobbies, act in any way which could bring discredit upon Clackmannanshire & Stirling IJB.

6.5 The public must be assured that no person or organisation will gain better access to or treatment by, you as a result of employing a company or individual to lobby on a fee basis on their behalf. You must not, therefore, offer or accord any preferential access or treatment to those lobbying on a fee basis on behalf of clients compared with that which you accord any other person or organisation who lobbies

or approaches you. Nor should those lobbying on a fee basis on behalf of clients be given to understand that preferential access or treatment, compared to that accorded to any other person or organisation, might be forthcoming from another member of Clackmannanshire & Stirling IJB.

6.6 Before taking any action as a result of being lobbied, you should seek to satisfy yourself about the identity of the person or organisation that is lobbying and the motive for lobbying. You may choose to act in response to a person or organisation lobbying on a fee basis on behalf of clients but it is important that you know the basis on which you are being lobbied in order to ensure that any action taken in connection with the lobbyist complies with the standards set out in this Code.

6.7 You should not accept any paid work relating to health and social care:-

(a) which would involve you lobbying on behalf of any person or organisation or any clients of a person or organisation.

(b) to provide services as a strategist, adviser or consultant, for example, advising on how to influence the IJB and its members. This does not prohibit you from being remunerated for activity which may arise because of, or relate to, membership of the IJB, such as journalism or broadcasting, or involvement in representative or presentational work, such as participation in delegations, conferences or other events.

Members of Integration Joint Boards are appointed because of the skills, knowledge and experience they possess. The onus will be on the individual member to consider their position under paragraph 6.7.

6.8 If you have concerns about the approach or methods used by any person or organisation in their contacts with you, you must seek the guidance of the chair of Clackmannanshire & Stirling IJB in the first instance.

ANNEX A

SANCTIONS AVAILABLE TO THE STANDARDS COMMISSION FOR BREACH OF THE CODE

(a) Censure – the Commission may reprimand the member but otherwise take no action against them;

(b) Suspension – of the member for a maximum period of one year from attending one or more, but not all, of the following:

i) all meetings of the public body;

ii) all meetings of one or more committees or sub-committees of the public body;

(iii) all meetings of any other public body on which that member is a representative or nominee of the public body of which they are a member. (c) Suspension – for a period not exceeding one year, of the member’s entitlement to attend all of the meetings referred to in (b) above;

(d) Disqualification – removing the member from membership of that public body for a period of no more than five years.

Where a member has been suspended, the Standards Commission may direct that any remuneration or allowance received from membership of that public body be reduced, or not paid.

Where the Standards Commission disqualifies a member of a public body, it may go on to impose the following further sanctions:

(a) Where the member of a public body is also a councillor, the Standards Commission may disqualify that member (for a period of no more than five years) from being nominated for election as, or from being elected, a councillor. Disqualification of a councillor has the effect of disqualifying that member from their public body and terminating membership of any committee, sub-committee, joint committee, joint board or any other body on which that member sits as a representative of their local authority.

(b) Direct that the member be removed from membership, and disqualified in respect of membership, of any other devolved public body (provided the members’ code applicable to that body is then in force) and may disqualify that person from office as the Water Industry Commissioner.

In some cases the Standards Commission do not have the legislative powers to deal with sanctions, for example if the respondent is an executive member of the board or appointed by the Queen. Sections 23 and 24 of the Ethical Standards in Public Life etc. (Scotland) Act 2000 refer.

Full details of the sanctions are set out in Section 19 of the Act.

ANNEX B

DEFINITIONS AND EXPLANATORY NOTES

“Chair” includes Board Convener or any person discharging similar functions under alternative decision making structures.

“Code” code of conduct for members of devolved public bodies

“Cohabitee” includes a person, whether of the opposite sex or not, who is living with you in a relationship similar to that of husband and wife.

“Group of companies” has the same meaning as “group” in section 262(1) of the Companies Act 1985. A “group”, within s262 (1) of the Companies Act 1985, means a parent undertaking and its subsidiary undertakings.

“Parent Undertaking” is an undertaking in relation to another undertaking, a subsidiary undertaking, if a) it holds a majority of the rights in the undertaking; or b) it is a member of the undertaking and has the right to appoint or remove a majority of its board of directors; or c) it has the right to exercise a dominant influence over the undertaking (i) by virtue of provisions contained in the undertaking’s memorandum or articles or (ii) by virtue of a control contract; or d) it is a councillor of the undertaking and controls alone, pursuant to an agreement with other shareholders or councillors, a majority of the rights in the undertaking.

“A person” means a single individual or legal person and includes a group of companies.

“Any person” includes individuals, incorporated and unincorporated bodies, trade unions, charities and voluntary organisations.

“Public body” means a devolved public body listed in Schedule 3 of the Ethical Standards in Public Life etc. (Scotland) Act 2000, as amended.

“Related Undertaking” is a parent or subsidiary company of a principal undertaking of which you are also a director. You will receive remuneration for the principal undertaking though you will not receive remuneration as director of the related undertaking.

“Remuneration” includes any salary, wage, share of profits, fee, expenses, other monetary benefit or benefit in kind. This would include, for example, the provision of a company car or travelling expenses by an employer.

“Spouse” does not include a former spouse or a spouse who is living separately and apart from you.

“Undertaking” means: a) a body corporate or partnership; or b) an unincorporated association carrying on a trade or business, with or without a view to a profit.

ADVICE ON THE ROLE OF A STANDARDS OFFICER

1. Introduction

1.1 The Standards Commission for Scotland (Standards Commission) acknowledges that, unlike the role of a Council’s Monitoring Officer, the Standards Officer of a devolved public body has limited responsibilities as specified within The Ethical Standards in Public Life etc. (Scotland) Act 2000 (Register of Interests) Amendment Regulations 2003 (Scottish Statutory Instrument 2003/135). It may be that there is not an individual within a devolved public body who has the specific job title of ‘Standards Officer’. This Advice Note is, therefore, aimed at any individual who is either solely or jointly responsible for undertaking the duties and responsibilities outlined below, regardless of whether or not they have the formal title of Standards Officer.

1.2 This Advice Note aims to assist Standards Officers by providing an outline of the role and responsibilities, within the ethical standards framework, of a Standards Officer operating within a Schedule 3 devolved public body and the duties they may be expected to discharge. However, it is not intended to be prescriptive as the Standards Commission recognises that governance and staffing arrangements are entirely a matter for each devolved public body to determine.

2. Background

2.1 The Standards Commission’s functions are provided for by the Ethical Standards in Public Life etc. (Scotland ) Act 2000 (the 2000 Act) as amended by the Scottish Parliamentary Commissions and Commissioners etc. Act 2010. The 2000 Act created an ethical standards framework whereby councillors and members of devolved public bodies are required to comply with Codes of Conduct, approved by Scottish Ministers, together with Guidance issued by the Standards Commission.

2.2 The role of the Standards Commission is to:  Encourage high ethical standards in public life; including the promotion and enforcement of the Codes of Conduct and to issue guidance to councils and devolved public bodies.  Adjudicate on alleged breaches of the Codes of Conduct, and where a breach is found, to apply a sanction.

1. V18/12/15

2.3 Complaints about potential breaches of the Codes of Conduct are investigated by the Commissioner for Ethical Standards in Public Life in Scotland (CESPLS). Following the investigation, and where the CESPLS determines that a contravention of a Code of Conduct is established, the CESPLS will then submit a Report to the Standards Commission.

2.4 The Standards Commission will review the Report and determine whether to:  direct the CESPLS to carry out further investigations;  hold a hearing; or  do neither.

2.5 If the decision of the Standards Commission is to hold a hearing, this process will be used to determine whether a councillor or member of a devolved public body has contravened either the Councillors’ Code or the Members’ Code. If the evidence presented to the Standards Commission’s Hearing Panel supports, on the balance of probabilities, that a breach of the Code had occurred the Hearing Panel will then determine the level of sanction to be applied in accordance with the 2000 Act.

2.6 Individual Codes of Conduct have been created and approved for all devolved public bodies described within Schedule 3 of the 2000 Act. Codes of Conduct currently apply to the following categories of public bodies:

 National Bodies e.g. Scottish Legal Aid Board  Regional Bodies e.g. Highlands and Islands Enterprise  National Health Service Boards  Health & Social Care Integrated Joint Boards  Further Education Colleges  National Parks  Regional Transport Partnerships  Community Justice Authorities

There are approximately 1400 Board Members appointed to Devolved Public Bodies.

3. Members of the Devolved Public Body

3.1 The Standards Officer is responsible for ensuring that appropriate training is given to Board Members on the Ethical Standards Framework, the Members’ Code of Conduct and the guidance issued by the Standards Commission on the Model Code of Conduct. This includes ensuring training is provided on induction and also on a regular basis thereafter.

3.2 The Standards Officer should contribute to the promotion and maintenance of high standards of conduct by providing advice and support to members on the interpretation and application of the Code of Conduct.

3.3 Under Scottish Statutory Instrument 2003/135, the Standards Officer is responsible for ensuring the body keeps a Register of Interests. The Standards Officer should ensure

2. V18/12/15

the Members’ Register of Interests in maintained and that a reminder to update entries on the Register of Interests is issued to Members at least once a year.

3.4 The Standards Officer should be responsible for ensuring the Members’ Register of Gifts and Hospitality is maintained. The Standards Officer should ensure that a reminder to update entries on the Register of Gifts and Hospitality is issued to Members at least once a year and that Members are aware of the duty to report any change in their circumstances within one month.

3.5 The Standards Officer should ensure the body has in place a consistent approach to obtaining and recording declarations of interest at the start of its meetings.

3.6 The Standards Officer may have an investigatory role if local resolution is attempted in respect of complaints or concerns made about a Member’s conduct.

3.7 The Standards Officer should also ensure that officers are aware of / familiar with the requirements of the Member’s Code of Conduct.

3.8 The Standards Officer may be required report to the Board from time to time on matters relating to the Ethical Standards Framework that may require review. The Standards Officer should report any concerns about compliance with the Code of Conduct to the Chief Executive.

3.9 The Standards Officer should provide support to the body’s Governance or Standards Committee, if such a committee has been established.

4. The Standards Commission

4.1 The Standards Officer will be the principal liaison officer between the body and the Standards Commission and may assist the Standards Commission whenever necessary in connection with any complaints against a Member of the body and in all matters relevant to the Ethical Standards Framework.

4.2 The Standards Officer should be the point of contact for the Standards Commission and should advise the Standards Commission if they are leaving their post.

4.3 The Standards Officer should try to attend any events arranged by the Standards Commission in order to be kept up to date with all relevant developments in respect of the Ethical Standards Framework and to help keep the Standards Commission abreast of any issues or tends that emerge.

4.4 The Standards Officer should familiarise themselves with the content of the Standards Commission’s professional briefings and should ensure these are circulated to Members. The Standards Officer should also regularly review the Standards Commission’s decisions and advise Members of any relevant learning points that have arisen at recent Hearings.

4.5 The Standards Officer should respond to any relevant Standards Commission’s consultations including any consultations in respect of proposed revisions to its guidance.

5. The CESPLS

3. V18/12/15

5.1 The Standards Officer will be the principal liaison officer between the body and the CESPLS and should assist the CESPLS whenever necessary in connection with the investigation of complaints against a Member of the body. This includes providing information and evidence as requested and making arrangements for interviewing of any officers or other Members if CESPLS requires them as witnesses

5.2 If local resolution in respect of complaints or concerns made about a Member’s conduct is deemed inappropriate in the circumstances or is unsuccessful, the Standards Officer may be responsible for reporting any alleged breach of the Code of Conduct to the CESPLS.

6. Other Standards Officers

6.1 The Standards Officer should try to develop relationships with other Standards Officers to share knowledge, experience and information about best practice and to see whether any joint training sessions for Members can be arranged.

4. V18/12/15

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 10.3 on the agenda

Commissioning for Health & Social Care

(Chris Sutton)

For Noting

Approved for Submission by Shiona Strachan, Chief Officer Author Louise Johnston, Planning & Commissioning Manager, Social Services Chris Sutton, Service Manager, Social Services Date 22 June 2016 List of Background Papers: Scottish Government, Achieving Sustainable Quality in Scotland’s Healthcare. A ‘20:20’ Vision Scottish Government, The 2020 Vision: a Route Map Bohl, E, When the Salami’s Gone – SOLACE guide to commissioning & sourcing Local Government Association, Commissioning for better outcomes: a route map Appendices: Appendix One: Glossary of Terms

Page 1 of 10

Title/Subject: Commissioning for Health and Social Care

Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Chris Sutton Action: For Noting

1. Introduction

1.1 The purpose of this report is to provide the Integration Joint Board with an overview of the process for commissioning and contracting health and social care services for adults and older people across the Clackmannanshire and Stirling Partnership. This report outlines the key considerations for the future joint commissioning of health and social care services across the Partnership, to deliver on the vision and objectives as set out in Clackmannanshire and Stirling Health and Social Care Partnership Strategic Plan.

2. Recommendations

The Integration Joint Board is asked to:

2.1. Note the contents of this report and provide challenge and comment.

3. Background

3.1. Appendix 1 provides a glossary of terms used in this paper.

3.2. The Strategic Plan sets out the framework to improve the health and wellbeing outcomes for the people of Clackmannanshire and Stirling. To achieve the vision to enable people in the Partnership area to live full and positive lives in supportive communities we must deliver the right mix of supports and services in partnership with our local communities.

3.3. Strategic Joint Commissioning is fundamental to delivering improved outcomes by better aligning investment to the needs and priorities of the Partnership. The task of commissioning is to deliver sustainable health and social care services in the context of growing demand, medical advances in the treatment of disease and increased financial austerity.

3.4. Effective commissioning requires a thorough understanding of:

• current activity, the support and services that are delivered by NHS Forth Valley, Clackmannanshire and Stirling Councils, other partner organisations, independent contractors including GPs, pharmacists, dentists and opticians, third sectors and community organisations and the support provided by unpaid carers and volunteers;

Page 2 of 10

• demand, the current and future needs of our population and communities; • resources, the collective resources of all partners and stakeholders, including staffing, buildings and community assets; and • evidence about the quality and impact of specific interventions, services and supports.

3.5. The Strategic Needs Assessment, completed to inform the development of the Strategic Plan, provides us with some of this information. The Strategic Needs Assessment identified the key challenges and pressures for the health and social care partnership over the coming years. Data analysis is now taking place at Locality level which will complement the Strategic Needs Assessment and inform Locality planning.

3.6. The NHS Forth Valley healthcare strategy 2016 -21 is being prepared, following a comprehensive review of clinical services and a period of public, patient and staff consultation. The reports of the 8 clinical service review work streams and the detailed feedback from the public, patient and staff consultation, have informed the development of the strategy, which will be completed in Autumn 2016. Further engagement with staff, public and patients will take place to show how their input has shaped the strategy and to inform plans for implementation. Once complete, NHS Forth Valley's Healthcare Strategy 2016-2021 will be used to inform future planning and commissioning across the Clackmannanshire and Stirling Partnership.

3.7. The role of commissioning has traditionally been to ensure that there was a sufficient supply of appropriate services to meet identified needs. There is a requirement to accelerate redesign activity across the health and social care sector, with a clear focus on prevention, self care, reablement and recovery, and towards more integrated service delivery. In the context of delivering social care, increasingly more people have choice and control about the selection of the type of services and supports provided, the provider organisation and the funding arrangements. These shifts require a new relationship between commissioners, providers and local citizens.

3.8. The changes in the commissioning environment can be categorised as a shift from market management to market shaping or market facilitation. Collaboration and engagement with communities, people using health and social care services, health and social care professionals including GPs, pharmacists, dentists and opticians and third and independent sector providers, will be used to inform our work with service providers. The development of a Market Position Statement is a key step in engaging existing and new organisations/providers and ensuring that they have an understanding of the strategic priorities for the partnership and what this means for future service design and development.

Page 3 of 10

4. Report

4.1. Clackmannanshire Council spent £22.08 million on adult social care services in 2015/16. Externally commissioned care made up £16.4 m of this spend, 74% of the total provision. Stirling Council spent £31.8 million on adult social care services in 2015/16 for Stirling Council. Externally commissioned care makes up £25.9m, 81.7%. of the total provision. The adult social care provision includes nursing and residential care, respite care, day support and care at home services.

4.2. 98% of NHS Forth Valley services are directly delivered. NHS Forth Valley directly deliver health care services and work in partnership with other health service providers including independent sector providers to deliver patient care. There are a range of cross charging and funding mechanisms in place for specialist healthcare with Tertiary and Specialist Boards and for the provision of national services, where required. There are also national frameworks including nationally agreed contracts for independent contractors such as GPs, Dentists, Pharmacists and Opticians and for the procurement of pharmaceutical and medical supplies and other services. NHS Forth Valley is expected to manage allocated resources accordingly within these nationally negotiated contracts and frameworks.

4.3. Commissioning should be driving and supporting improved outcomes for individuals. Our commissioning priorities are moving away from traditional task and time based models to being aligned to the National Health and Well Being Outcomes and our local vision and the priorities as set out in the Strategic Plan. The scale of transformational change required to support sustainable service delivery will also mean taking decisions to disinvest. These decisions should be based on transparent, outcomes based measurement, linked to strategic priorities.

4.4. Commissioning for outcomes involves:

• Shifting the focus from activities to results; • Moving away from counting the quantity or number of services given to measuring the impact that those services have achieved; • Placing people at the heart of service delivery as we get a better understanding about which services and interventions make a positive difference to people's lives

The approach to delivering effective commissioning follows a cycle with four quadrants with different phases:

Phase Key activities Analyse The analysis of need, of capacity, assets and resources and the capability of the market. Agreeing priority needs with partners. Defining the outcomes to meet those needs. Plan Gap analysis, stakeholder engagement, the design of services and service pathways, developing a joint commissioning strategy

Page 4 of 10

Do Implementing the commissioning plan, facilitating the market, building capacity, sourcing the providers capable of meeting a specification and contracting for the new services. Delivering to users. Review Contract monitoring and reviewing the effectiveness of the strategy. Reviewing and learning from delivery and feedback and consultation with service users and unpaid carers.

4.5. High quality commissioning requires strong technical skills including skills in data analysis, information management, tendering, performance and contract management. Commissioners also require negotiation and relational skills and the ability to work creatively and collaboratively across partnerships, with communities and with service providers, to deliver cultural and whole-systems change. Effective joint commissioning underpinned by strong leadership, evidence based decisions and clear communication will support the partnership to implement and deliver on its shared vision.

4.6. Joint commissioning arrangements between NHS Forth Valley and Stirling and Clackmannanshire Councils are already in place. This includes arrangements for the delivery of services and supports using the Integrated Care Fund and previously the Change Fund and as part of the Integrated Mental Health Service. In some cases, joint commissioning arrangements are in place across the Forth Valley area e.g. for the provision of Independent Advocacy Services, substance misuse services in conjunction with the three Alcohol and Drug Partnerships and for adult complex care provision. As the Partnership determines the detailed requirements for planning the delivery of services and supports at a partnership and locality level, there will be increased opportunities to design and commission services jointly.

4.7. One example of a new approach to commissioning is through the development by Clackmannanshire and Stirling Social Services of the Partners in Choice Framework, designed to promote choice, increase innovation and support providers to deliver personalised services. This is being introduced in mental health and learning disability services and it is planned for implementation from April 2017.

4.8. Central to this Framework is how supported people, their families and unpaid carers are empowered to work with all the assets and resources available to them and enable organisations to deliver innovative, flexible and personalised support to meet individual outcomes, within individual budgets.

4.9. The Framework will be an open procurement exercise with minimum criteria for service quality and boundaries around price will apply. The open nature of the Framework Agreement will not restrict the approach to future market shaping and development. For example in response to identified gaps in local provision, services may be formally commissioned, or providers may be approached to develop innovative and services.

4.10. The objective is to work collaboratively with providers to deliver outcome focussed services that support early intervention and prevention, promote

Page 5 of 10

independence and increase choice. This is central to shaping and developing the local health and social care market so that local provision aligns with strategic objectives and priorities and is co-produced. Social Services Planning & Commissioning staff are working jointly with providers and local communities to respond to unmet need and develop proposals about new ways of working or ways in which services can diversify or options for providers coming together to deliver services and supports differently. This has included care at home and care home providers diversifying the type of services and supports available, and working more closely with unpaid carers to respond to their needs, for example, in the rural communities of Stirling. For example, discussions are in progress with the independent care homes to consider developing day opportunities for service users.

4.11. Monitoring and review of standards is critical to maintaining and improving service quality, and addressing any areas of poor performance and ensuring that providers are meeting the agreed objectives. The monitoring and review of external provision is designed to be risk-based and proportionate. Commissioners evaluate risk, based on seeking information about performance from different sources including complaints, feedback from staff members or service users and their families and from other agencies or regulatory bodies, The range and type of intervention or support provided can vary depending on the on the factors involved, which may include:

• Where significant concerns are raised about a service by users or their representatives, staff, regulatory bodies, other partners, the media, the public etc. • Number of complaints and patterns/trends in complaints • Services where there are significant concerns, such as staff turnover, staff absence, the level of serious incidents • Number of adult support and protection concerns and patterns/trends • A breakdown of the service, which would potentially have a significant budgetary impact or a requirement for reconfiguration. • Where changes in the service effects its overall cost, leading to concerns about the viability or cost of the service • Where the provider is in breach of the terms and conditions of the contract • Where the model of service no longer complies with strategic objectives • Where changes to legislation effect existing arrangements or the providers’ ability to provide a service

4.12 Contract monitoring involves the following activities:

• collection of consistent and measurable data about services (quantitative and qualitative); • collation of information from a variety of sources including complaints data, feedback from stakeholders and survey information; and • analysis, consideration and informed judgements about the information obtained.

Page 6 of 10

This information is then used to:

• Identify and resolve any shortcomings of individual providers and within the service; • Review and raise service and contractual standards; • Support service-purchasing decisions, including those involving suspension or termination of contracts as a result of continuing unsatisfactory performance; and • Support and stimulate wider market management and strategic commissioning decisions.

5. Resource Implications

5.1. This report is for information and noting. There are no resource implications directly associated with this report.

6. Impact on Integration Joint Board Outcomes and Priorities

6.1. The objectives in this report are consistent with the vision and priorities of the Integration Joint Board.

7. Legal & Risk Implications

7.1. There are no legal or risk implications arising directly from this report, which is for information only.

8. Consultation

8.1 This report is for information only. Full consultation will be integral to any future commissioning activities.

9. Equality and Human Rights Impact Assessment

9.1. Not applicable. This report is for information only.

10. Exempt reports

10.1. Not exempt.

Page 7 of 10

Appendix 1 – Glossary of Terms

Term Description Assets based approach Builds on the skills, knowledge, experience, networks and resources that individuals and communities bring Contract management Identifying and resolve any shortcomings of individual providers Review and raise contractual standards Support service purchasing decisions. Including those involving suspension or termination of contracts as a result of continuing unsatisfactory performance, and Support and stimulate wider market management and strategic commissioning decisions Contract monitoring Contract monitoring involves the following activities: Collection of consistent and measurable data about services (quantitative and qualitative) Collation of information from a variety of sources including complaints data, feedback from other stakeholders and survey information Analysis, consideration and informed judgements about the information obtained Co-production Maximising local resources and knowledge to find solutions through collaborative working, community-led activity and creatively engaging with people in informing and influencing decision making. Gap analysis Helps an organisation identify and quantify the difference between the ideal future state and its present state Joint Commissioning Where strategic commissioning actions are undertaken by two or more agencies working together, typically health and local government, and often from a pooled or aligned budget. Joint Strategic Needs A Joint Strategic Needs Assessment looks at the Assessment current and future health and care needs of local populations to inform and guide the planning and commissioning of health, well-being and social care services within a local area. Market Facilitation Entails capturing and sharing market intelligence, structuring the market and intervening in the market. Market Position Statement A provider facing document that brings together material from a range of sources such as needs assessments, surveys, contract monitoring, market reviews and statistics into a single document. The data presented should help providers to develop effective business plans and redesign their services in line with agreed strategic priorities. Procurement Term used to focuses on the process of acquiring goods, works and services.

Page 8 of 10

Reablement Reablement: Relearning the skills necessary for daily living following illness, usually with guidance and support from health professionals, so that there is an improvement in function and increased independence. Reablement is often described as ‘helping people to do for themselves rather than doing it to or for them’. It is short term, intensive support that enables people to optimise their independence. The aim of reablement is to maximise independence, choice and quality of life, and reduce the need for support in the future. Regulatory bodies A regulatory agency is an agency responsible for exercising autonomous authority over some area of human activity in a regulatory or supervisory capacity. Rehabilitation Rehabilitation: An active process by which those disabled by injury/disease achieve a full recovery, or if full recovery is not possible, realise their optimal physical, mental and social potential and are integrated into their most appropriate environment. Rehabilitation is goal orientated and involves a mixture of clinical, therapeutic, social and environmental interventions. The aim of rehabilitation is to maintain or increase independence and allow the person to live in their own home for as long as possible and are supported with the provision of short-term care support and/or therapeutic intervention e.g. physiotherapy or occupational therapy. Secondary Care Secondary care is the health care services provided by medical, surgical and dental specialists and other health professionals who generally do not have first contact with patients: for example, cardiologists, urologists, orthopaedic surgeons and oral and maxillofacial surgeons. It includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury or other health condition, such as in a hospital emergency department. It also includes skilled attendance during childbirth, intensive care, and medical imaging services.

Self directed support Self-directed support allows people to choose how their support is provided to them by giving them as much ongoing control as they want over the individual budget spent on their support. Option 1 – you take a direct payment Option 2 – you decide and the local council arranges support Option 3 – after talking to you, the council decides and arranges support Option 4 – you use a mixture of ways to decide on your

Page 9 of 10

support Self management Taking responsibility for one's own behaviour and wellbeing Social enterprises Social enterprises trade to tackle social problems, improve communities, people's life chances, or the environment. They make their money from selling goods and services in the open market, but they reinvest their profits back into the business or the local community. Strategic commissioning Whole system process from researching and analysing needs of people to developing commissioning strategies and work programmes. It entails working with providers and citizens to develop, stimulate and innovate redesign through co-produced specifications. This enables services to be designed and commissioned that reflect current and future needs of a population and also determines how public bodies decide to spend available resources to achieve the best possible outcomes for local people. Tertiary care Specialised consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment. Examples of tertiary care services are major trauma, cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.

Page 10 of 10

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 10.4 on the agenda

Strategic Risk Register

(Paper presented by Hugh Coyle)

For Approval

Approved for Shiona Strachan, Chief Officer Submission by Authors Gail Caldwell, Pharmacy Director, NHS Forth Valley, Andy Aitken / Judi Richardson, Performance and Change Team, Clackmannanshire Council, Hugh Coyle, Corporate Risk Co-Ordinator, Falkirk Council, and David Bright, Risk and Resilience Manager, Stirling Council Date: 22 June 2016 List of Background Papers: 2016.03.22 Clackmannanshire & Stirling IJB - Risk Management Strategy

Page 1 of 10

Title/Subject: Strategic Risk Register Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016

Submitted By: Hugh Coyle Action: For Approval

1. Introduction

1.1 The purpose of this short report is to provide Integration Joint Board members with a Strategic Risk Register (SRR), at Appendix 1, for approval.

2. Recommendations

The Integration Joint Board is asked to:

2.1 approve the Strategic Risk Register at Appendix 1

2.2 review the Strategic Risk Register as part of the Integration Joint Board’s broader governance arrangements (as per recommendations within Agenda Item 10.1 Sub-committees)

2.3 note that, whilst assurance can be provided that the Strategic Risk Register reflects current risks, the risk landscape and governance structures are still developing, and therefore, the Strategic Risk Register will continuously evolve.

3. Background

3.1 The Integration Joint Board approved the Risk Management Strategy in March 2016, and agreed that a Strategic Risk Register be developed by June 2016

3.2 Lead Officers for each risk have provided a summary of their risk(s)

3.3 The Strategic Risk Register is the mechanism for assessing and monitoring the Integration Joint Board’s strategic risks, i.e. the risks to achieving the Integration Joint Board’s Strategic Plan and Financial Plan.

4. Conclusions

4.1 The Strategic Risk Register (at Appendix 1) outlines the key risks to achieving the Health and Social Care Partnerships Strategic Plan and Financial Plan; though the risk landscape and governance structures will continuously evolve.

5. Resource Implications

5.1 The delivery of the Strategic Plan, and effective management of the associated risks, will be dependent on the continued resource commitment of partner organisations.

6. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

6.1 The key risks are failure to effectively identify and manage the risks to achieving the outcomes and priorities detailed within the Health and Social Care Partnerships Strategic Plan and Financial Plan.

7. Legal & Risk Implications

7.1 The key risks are failure to effectively:

1. Implement the Risk Management Strategy effectively. 2. Identify and assess risks to delivering the Health and Social Care Partnerships Strategic Plan and Financial Plan. 3. Meet the commitments made within the Integration Scheme.

8. Consultation

8.1 The Strategic Risk Register has been developed through consultation with the Chief Officer, Programme Board, and Clackmannanshire & Stirling Joint Management Team.

9. Equality and Human Rights Impact Assessment

9.1. Not applicable.

10. Exempt reports

10.1. No.

APPENDIX 1: CLACKMANNANSHIRE AND STIRLING HEALTH & SOCIAL CARE PARTNERSHIP’S STRATEGIC RISK REGISTER

Risk Type Risk Title / Description Current Risk Score Lead Officer

SHORT-TERM PRIORITIES: SIGNIFICANT INTEGRATION UNCERTAINTIES / CHALLENGES 1 Financial Stability and Commissioning Financial and (including sustainable capacity across all sectors, and High Chief Finance Officer Operational co-location / sharing of teams and assets) a) Delivery of 16/17 savings programmes b) Full year effect of implementing Living Wage c) Delivery of the relevant elements of NHS Scotland Outcomes Framework within reduced resources d) Continued uncertainty relating to some Scottish Government allocation where the delivery of outcomes will lie within functions delegated to the IJB Risks e) Delivery of Alcohol and Drug services within reduced financial envelope f) Potential recurrent shortfall relating to investment of Partnership Funding Streams g) Implementation of major service redesign and significant service change

a) Establish leadership group and agree membership and terms of reference a) In place and developing b) Develop working understanding of how efficiency programmes from MCB, PBB and NHS Board Plan b) Ongoing – work being interface with IJB and Chief Officer / Chief Finance Officer accountabilities undertaken across Forth Valley c) Establish financial reporting arrangements including operational reporting to Chief Officer and quarterly via the Finance Workstream reporting to Integration Joint Board as per terms of Integration Scheme c) Developing over 2016-17: First d) Establish savings monitoring arrangements report due September IJB e) Establish protocols for variations of budgets and directions .Partnership Funding: June 2016 f) Monitor Scottish Government and COSLA approach / policy on Living Wage and relationship to Integration d) Developing over 2016-17 Joint Board e) Developing over 2016-17 Controls/ g) Review and assess deliverability of savings and efficiency programmes f) In place and ongoing Actions h) Facilitate an Integration Joint Board development session on financial issues within first quarter of financial g) Review underway year h) First session in June 2016 i) Review and agree relationship with Alcohol and Drugs partnership including financial plan and impact on i) In place and developing outcomes j) Review currently taking place j) Produce and agree evaluation of impact and outcomes form investment of Partnership Funding Streams and k) Developing over 2016-17 agree investment plan for 2016/17 and 2017/18 l) PBMA approach in place for k) Develop financial strategy to compliment and support delivery planning that to implement Strategic Plan review of the partnership funding l) Examine options and appraisal and prioritisation approaches such as PBMA Programme Budgeting and Marginal Analysis - a prioritisation tool to aid decision making) and their relevance and applicability to the challenges faced by the partnership

Leadership, Decision Making and Scrutiny 2 (including effectiveness of governance arrangements and High Chief Officer Governance potential for adverse audits and inspections) Failure to establish effective governance structures and to implement them effectively. This could result in failing to comply with legislation and inability to deliver Risks Strategic Plan outcomes, and criticism by audit and inspection bodies a)2016 b)2016 – re designs within partner organisations Controls / a) Governance Framework has been established – currently in implementation phase currently taking place. Joint Management Team and Actions b) Establish clear joint management structure arrangements Leadership Group in place. Will be subject to further development as re designs move to implementation phases. 3 Partnership Stability Medium Constituent Partners Partnership

Risks Unique three way partnership fails to further develop due to differing priorities and needs.

a) Joint Governance Framework established – currently in implementation phase a) 2016 Controls/ b) Integration Scheme in place b) In place Actions c) Regular meetings between CEX and Leaders of the Councils established to ensure flow of c) Ongoing communication 4 Clinical and Performance of the IJB Low Chief Officer Performance Failure to implement the Performance Management Framework and thus: a) assure the IJB of progress with the delivery of the Strategic Plan Risks b) achieve the legislative requirements in terms of monitoring against the National Outcomes and Core Indicator set

a) Maintain Performance Management Work Stream to drive forward Framework implementation a-e) Ongoing b) Ensure clarity of key priorities within Strategic Plans to ensure focus for the IJB in performance f)Review April 2017 assessment c) Ensure proportionality & use of data wisely Controls / d) Work closely with Strategic Planning Group and influence development of realistic measurement Actions e) Minimise duplication and bureaucracy to make performance management and reporting meaningful and realistic f) Further develop Covalent and use of shared portal to ensure a consistent approach and minimise multiple entry and manual data capture

MEDIUM-TERM PRIORITIES: HIGH RISKS, BUT ARE CURRENTLY WELL MANAGED BY PARTNERS 5 Culture / HR Management / Workforce Planning Human (including developing culture, behaviours, and values; Low HR Work Stream Lead Resources sustainable change skills / capabilities, and absence) a) The lack of a consistent approach across all partners to workforce planning for the in scope workforce is a potential risk b) Change can unsettle staff and impact on levels of performance: potential that performance reduces, mistakes are made, and absence rates increase Risks c) Negative impact on industrial relations as a result of inadequate communication/ consultation d) Recruitment, retention, and the need to build multi-disciplinary teams

a) Workforce Group established b) Workforce Strategy developed c) Regular communication to staff d) Organisational Development working with staff to support culture change Controls / a-h) In place and ongoing Actions e) Web pages established to communicate key documents f) Regular team meetings g) Joint Staff Forum has been established h) Joint Staff Forum meeting regularly every 2-3 months. Workforce Strategy developed

Experience of a) Service User and b) Unpaid Carers 6 (including engagement, feedback, and complaints. High Participation and Engagement Work Stream Lead Partnerships Key challenges: measuring and evidencing change) a) Fail to engage adequately and fully with stakeholders, in particular those harder to reach groups b) Fail to adequately plan and delivery services as a result of limited communication, engagement and participation with stakeholders Risks c) Fail to take into account the needs of stakeholders d) Fail to have identified lead who can develop and follow through Participation and Engagement Strategy a) Service users, carers, staff and the Third sector are members of the Integration Joint Board and the a & c – h) in place and ongoing Strategic Planning Group b)September 2016 b) Participation and Engagement Strategy in place – and an Action Plan is being developed c) IJB report template includes sections on Consultation and Equalities Assessment, which ensures that the Board are aware of the extent of this is any reports where decisions are being taken d) Equality and Poverty Impact Assessment will be completed where required e) Equality Outcomes and Mainstreaming Report produced Controls / f) A range of mechanisms and groups are in place to enable participation and engagement including staff Actions engagement sessions, Joint Staff Forum, the Older People’s Forum, (Unpaid) Carers Forum, Community Care Health Forum (CCHF) g) A range of communication arrangements are in place including staff newsletters, articles in the local newspapers and Health and Social Care web-pages h) Complaints and monitoring reports are produced i) Look at ways of broadening representation of different groups

7 a) Information Management and b) Governance (including a) ICT systems / infrastructure; and High Lead Officer – Information Information b) Data protection and data sharing) a) Risk of increased demand for areas of provision (e.g. Closer to Home) and lack of resources (both capacity and capability covering health & social care combined) b) Risk of lack of common information provision across council social work areas (e.g. three councils data recording provision and rules differ combined with lack of reporting outputs from three council areas) c) Inability to provide the HSCIDIIP (Health and Social Care Data Integration and Intelligence Project) dataset from council areas for national data reporting d) NSS LIST (National Services Scotland Local Intelligence Support Team) resource ceases to be funded centrally e) Risk of development plans not being a clear priority across four partners, to enable Portal project to be delivered on time Risks f) Clarity on the Funding and Support Model for Clinical Portal Programme g) Agreement of appropriate of ISPs (Information Sharing Protocols) and SLAs (Service Level Agreements) being in place for data sharing h) Risk of technical solution to meet cross-site authentication will not meet user requirements or expectations i) Risk of potential ongoing technical and legal issues in relation to access to information across all partners

Risk Outlook: As time goes on and controls / systems are put in place, the technical risk may lessen – but the issues of data sharing and information governance will still remain, as the IJB’s scope and their partners’ change , including partnerships with the private and / or third sector

a) Closer to Home risk, getting temporary MSc student over summer and three year PhD student working on this evaluation studies starting September. Additional resources may be required b) Carrying out study of processes for delayed discharges across three Councils during summer. This will encompass definitions and recording practices. Other data recording provision being considered by NSS LIST (National Services Scotland Local Intelligence Support Team) Controls / c) Will do local record linkage and report provision, piloting with Falkirk Council and continue with a-d) August 2016 Actions others as possible e-g)subject to funding availability d) Build in-house information teams with sufficient permanent resource to carry out functions e) Robust project management for portal project once funding approved f) Robust discussions with both IJB fund holders - taken forward via joint data protection officers group g) Manage user expectations to fit with what is technically possible

LONG-TERM PRIORITIES

8 Effective Links with Other Partnerships (e.g. Community Planning, Third and Voluntary sectors, Low Chief Officer Partnerships Criminal Justice, and Housing)

Risks There is a risk of lack of cohesive planning between partners. This could lead to ineffective use of staff resources, and potential failure to meet Strategic outcomes.

Links are currently established with partners, including: a) Criminal Justice Authority (CJA) and Community Planning Partnership (CPP) (note: these are Statutory links) b) Alcohol and Drugs Partnership (ADP) and Public Protection fora Controls / a-e) in place and ongoing Actions c) Third and Independent Sectors – representation as appropriate at IJB and Strategic Planning Group d) Housing Contribution Group e) Other Integration Authorities – via the Chief Officer and Chief Finance Officer Networks

9 a) Risk of Neglect, harm, abuse and or exploitation Public Protection Forum Public Low b) Risk to Self, to others, from others (Val de Souza, Chief Social Work Officer, Clacks & Stirling) Protection ADDITIONAL NOTES 1 These permeate throughout all risks above. Culture, Values, The risk involves failure to appreciate differences and work towards and enabling a shared culture. and Behaviours 2 Risk Type and All risks affect multiple National and Local Outcomes. Outcomes 3 The consequences / impacts of each risk can be multiple – including reputation, harm, and financial. Impact / The Risk Scoring Guidance (which will be provided to Lead Officers) should assist in assessing impact. Consequences

Clackmannanshire & Stirling Integration Joint Board

22 June May 2016

This report relates to Item 11 on the agenda

Locality Plans

(Paper presented by Lesley Fulford)

For Approval & Noting

Approved for Submission by Shiona Strachan, Chief Officer Author Lesley Fulford, Programme Manager

Date: 22 June 2016 List of Background Papers: Localities Guidance http://www.gov.scot/Resource/0048/00481100.pdf 2015.10.27 Clackmannanshire & Stirling IJB - Localities

Page 1 of 9

Title/Subject: Locality Plan Development Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016

Submitted By: Lesley Fulford

Action: For Approval and Noting

1. Introduction

1.1 This report outlines the proposed process to develop the Locality Plans for the Clackmannanshire & Stirling Health and Social Care Partnership Localities.

2. Executive Summary

2.1 The Strategic Plan was approved by the Integration Joint Board in March 2016 and the focus is now moving to develop a more detailed implemtation plan and key set of priorities. Locality planning is a central part of this process.

2.2 The Health and Social Care localities for planning purposes were approved at the Integration Joint Board in October 2015 to enable the partnership to plan and to meet the timescales for the Strategic Plan. [appendix 1].

2.3 There has been considerable activity in both Clackmannanshire and Stirling to develop new models of service delivery and to engage further with communities. As part of the outcome of this work Stirling Council will adopt a four locality model. It is not inconsistent with the larger two locality approach adopted by the Integration Joint Board for the purposes of planning which should remain in place, but there does need to be some further work to realign the boundaries to support a shared approach, common priorities and ultimately service delivery.

2.4 The key inputs to the development of Locality Plans are:

• Engagement Reports (Published January 2016) • Clackmannanshire & Stirling Health and Social Care Partnership Strategic Needs Assessment (Published January 2016) • Locality Profiles for the three Localities • Workforce Analysis • Staff Engagement Sessions (Summer 2016) • Mapping of key strategic priorities • Mapping of key improvement priorities

2.5 The table below sets out a proposed outline timescale for development of Locality Plans. As noted above this work will need to align to the service and community planning approaches being developed across the partnership area.

Page 2 of 9

2.6 Staff engagement sessions are taking place over June 2016. Staff are drawn from all the partners and the focus of the sessions has been to re engage them with the Strategic Plan and to facilitate the identification of key priorities and ‘easy wins’. Further open sessions, including engagement with GPs, acute services, unpaid carers and service user/patients will be held over the autumn as part of the development of the locality plans

Table 1 – Locality Plan Outline Development Timescales

Task Deadline Draft outline framework for Locality Plans (using inputs September 2016 outlined above at 2.2) Present outline Locality Plans to Strategic Planning Group for October 2016 initial discussion and comment Engagement and planning sessions October-November 2016 Present revised outline Locality Plans to Strategic Planning November & Group for approval to proceed to Integration Joint Board December 2016 Present revised outline Locality Plans to Integration Joint January 2017 Board for approval to consult publicly Public Consultation on Draft Locality Plans February- March 2017 Re draft Locality Plans based on feedback April 2017 Present to Strategic Planning Group for comment and May 2017 approval to proceed to Integration Joint Board Present to Integration Joint Board for comment and approval June 2017 to publish

3. Recommendations

3.1 The Integration Joint Board is asked to:

• Approve the proposed process to develop the Clackmannanshire & Stirling Health and Social Care Partnership Locality Plans.

• Note the use of the Locality Profiles (appendix 2) for discussion within planning sessions

• Approve and note that while the three locality model for the purposes of health and social care integration planning will continue across the partnership, that in Stirling further work is required to more closely align the internal boundaries to support a shared approach, common priorities and ultimately service delivery

4. Background to Locality Plans

4.1 The Public Bodies (Joint Working)(Scotland) Act 2014 (the Act) require the Partnership area covering Clackmannanshire and Stirling Councils to have a minimum of two localities. A locality is defined in the Act as a smaller area within the borders of the Partnership area. Page 3 of 9

4.2 The Scottish Government Localities Guidance sets out the principles upon which localities should be established and under which they must operate:

a) Support the principles that underpin collaborative working to ensure a strong vision for service delivery is achieved. Robust communication and engagement methods will be required to assure the effectiveness of locality arrangements. b) Support GPs to play a central role in providing and co-ordinating care to local communities, and, by working more closely with a range of others – including the wider primary care team, secondary care and social care colleagues, and third sector providers – to help improve outcomes for local people. c) Support a proactive approach to capacity building in communities, by forging the connections necessary for participation, and help to foster better integrated working between primary and secondary care."[6.4]

4.3 Localities will provide a planning function for delivery of health and social care services across the health and social care localities.

4.4 There is a requirement for locality development to align with the place based initiatives within Clackmannanshire and Stirling. This includes the community test sites and wider aspirations for communities within Stirling and in Clackmannanshire the community action plans.

4.2 As noted within the summary above, there has been considerable activity in both Clackmannanshire and Stirling to develop new models of service delivery and to engage further with communities. As part of the outcome of this work Stirling Council will adopt a four locality model. It is not inconsistent with the larger three locality approach adopted by the Integration Joint Board for the purposes of planning but there does need to be some further work to realign the boundaries to support a shared approach, common priorities and ultimately service delivery.

4.5 The Integration Authority will be a statutory Community Planning Partner and requires to function as part of this context. The Community Empowerment (Scotland) Act 2015 is expected to come into force by Summer 2016. It places Community Planning Partnerships on a statutory footing and introduces a legal duty for them to plan and deliver local outcomes and address inequalities across their Partnership areas. Community Planning Partnerships will require to produce Local Outcome Plans for their Council areas, but also Locality Plans for identified areas of particular disadvantage. The development of localities in the context of Health and Social Care Integration must be complimentary to the development of Local Outcome Plans and should not cut across these requirements or add to administrative requirements.

Page 4 of 9

5. Clackmannanshire & Stirling Localities

5.1 At its meeting on 27 October 2015 the Integration Joint Board approved the formation of three Localities within the Health and Social Care Partnership area.

5.2 The communities included in each Locality are listed in Appendix 1. As noted above some work is required to align the boundaries within Stirling.

6. Proposed Locality Plan Development Process

6.1 A number of inputs will inform Locality Plan development: • Engagement Reports (Published January 2016) • Clackmannanshire & Stirling Health and Social Care Partnership Strategic Needs Assessment (Published January 2016) • Staff Engagement Sessions (Summer 2016) • Mapping of key strategic priorities • Mapping of key improvement priorities • Locality Profiles for the three Localities • Workforce Analysis • Community Conversations within Stirling

6.2 These inputs will allow the Strategic Plan Working Group to compose a draft outline Locality Plan. The outline draft will contain: • Description of the Locality • Locality profile • Priorities for the Locality • How the Locality will implement the priorities over the life of the Strategic Plan 2016-2019.

6.3 Table 1 below sets out a proposed timescale for development of Locality Plans

Table 1 – Locality Plan Development Proposed Timescales Task Deadline Draft outline framework for Locality Plans (using inputs July - September outlined above at 2.2) 2016 Present outline Locality Plans to Strategic Planning Group for October 2016 discussion and comment Present revised outline Locality Plans to Strategic Planning 24 November 2016 Group for approval to proceed to Integration Joint Board Present revised outline Locality Plans to Integration Joint January 2017 Board for approval to consult publicly Public Consultation on Draft Locality Plans February / March 2017 Re draft Locality Plans based on feedback April 2017 Present to Strategic Planning Group for comment and May 2017 approval to proceed to Integration Joint Board Present to Integration Joint Board for comment and approval June 2017 to publish

Page 5 of 9

6.4 Consideration will be given as to how implementation of the Locality Plans will be measured and monitored as per the requirements of the Performance Management Framework this will be taken forward through collaboration with the Performance Work Stream.

7. Current Planning Structures & Considerations

7.1 Locality Plan development requires to link with a number of other Community Planning Partners and geographical areas which are wider than Health and Social Care.

• The Community Empowerment Act will require Community Planning Partnerships to develop Local Outcome Improvement Plans and Locality Plans for smaller populations with identified areas of particular disadvantage. • The Cabinet Secretary for Health, Wellbeing and Sport announced in October 2015 that the GMS Quality and Outcomes Framework would be dismantled in preparation for the new contract in 2017 by developing a transitional arrangement in Scotland for the GP contract with support for continued quality improvement during 2016/17. It is envisaged that the transitional GMS contract for 2016/17 will focus on continued quality improvement enabled by practices working collaboratively in “Clusters”. • The transforming communities agenda – new delivery models are being explored and the principle has been agreed that locality ‘hubs’ will be created, spanning a number of areas and offering a wide range of support. • The locality approach being developed within Stirling Council • The role of, and learning from the test sites • Strategic planning priorities for the consiituent partners such as inequalities

7.2 Work is being undertaken in partnership with Community Planning Partners and GPs to ensure there is clarity over the requirements for each of these aspects.

7.3 The Health and Social Care Rural Stirling and Stirling City Localities sit well with the four locality model that Stirling Council plan to adopt. However, the proposed boundaries differ at this time, due to the data zones that have been used. The Integration Joint Board and Stirilng Council will require to work together to align boundaries more closley.

8. Locality Profiles

8.1 The Locality Profiles will be one of the inputs outlined in section 6.1 to the development of Locality Plans. These are an extension of the Strategic Needs Assessment (approved by the Integration Joint Board at their meeting on 24 February 2016) into the smaller health and social care Locality areas.

8.2 Locality Profiles are a starting point and will require to be reviewed and updated as the Partnerhsip learns from exisiting transformational work and use of such needs assessment work matures within the Partnership.

8.3 The Local Intelligence Support Team (LIST) analysts seconded to the Partnership from Information Statistics Division (ISD) part of National Services

Page 6 of 9

Scotland (NSS) supported the development of this work.

8.4 The profile sets out a range of measures and presents data for the three Localities, the Partnership and Scotland (appendix 2). This appendix also lists a number of notes and caveats to the measures or data sources.

8.5 A detailed methodology paper has also been produced to ensure we retain the skills and capacity to repeat Locality profiles as and when required (appendix 3) locally.

8.6 Some data has been redacted in the profile due to a potential risk of disclosure. Appendix 2 provides further details on these figures.

8.7 Benefits of the Locality Profiles and how they could be used:

• The profiles will support partners and services by informing discussion on operational impact of decisions and planning decisions for the future. • The Locality profiles along with the Strategic Needs Assessment will help ensure the Locality action plans are based on needs within the Localities and are aligned to the Strategic Plan.

8.8 To illustrate how the profiles could be used some key points are listed below:

• 22.4% of the population in the Rural Stirling Locality is over 65 years of age - this will provide challenges in how we provide services in a sustainable way within the Locality. • Rural Stirling Locality has the lowest population and number of dwellings per square kilometre – this will provide challenges in how we provide services in a sustainable way within the Locality. • There is a gap between the number of people with a diagnosis in all three Localities and the estimated number of people living with Dementia from Alzheimers Scotland – this would be an area to explore further • The rate per 1000 of the population for all three Localities is lower than the Scottish figure for Asthma, COPD, Heart Failure, Stroke / TIA, Mental Health and Depression – this would be an area to explore further • Rural Stirling Locality has a higher number of GPs per 1000 of the population than Stirling City or Clackmannanshire however the average time to get to a GP by car or public transport is more than double • Stirling City has the highest number of total bed days occupied and bed days occupied (rate per 1000 of population) – we may wish to consider the pathway people in this Locality follow to understand how we might support discharge more readily

9. Conclusions

9.1 The outlined process will support and inform the development of the Locality Plans. The Locality Plans will be developed with practitioners, clinicians , services and local communtiies.

Page 7 of 9

10. Resource Implications

10.1 Whilst there are no specific resource implications at this time, this proposal will require input from a range of support services within partners such as: planning; forums; information services.

10.2 Work is being undertaken in partnership with Community Planning Partners and GPs to ensure there is clarity over the requirements for each of the planning aspects required to be taken forward. Particularly with GP Locality Planning Group, the Strategy & Performance Manager in Clackmannanshire Council and the Children, Communities and Enterprise services within Stirling Council.

11. Impact on IJB Outcomes, Priorities and Outcomes

11.1 The Localities are key to the identification of priorities and their delivery as outlined in the Guidance.

12. Legal & Risk Implications

12.1 The recommendations are consistent with statutory requirements.

12.2 Work may be required to ensure alignment with other Locality Plans, geographical areas and developments locally.

13. Consultation

13.1 Members of the Strategic Plan Working Group and the Strategic Planning Group have been consulted on this paper.

13.2 Consulation will be undertaken with Community Planning Partnerhsip leads in both Councils.

13.3 Consultation on draft Locality Plans will take place with all stakeholder groups across February and March 2017.

13.4 The analytical and strategy leads in the partner organisations, LIST analysts, Chief Finance Officer and Chief Officer have been consulted on the profiles as well as the drafting of this paper.

14. Equalities Assessment

14.1 A full Equality Impact Assessment will be undertaken as part of the Locality Plan development process.

14.2 Equality indicators have been included in the profiles to promote visibility of this information and to encourage use in planning decisions.

15. Exempt reports

15.1 Is this report exempt? No Page 8 of 9

Appendix 1 – Health and Social Care Localities

The communities included in each Locality are listed below:

Clackmannanshire: • Clackmannan, Kennet and Forestmill • Alloa South and East • Alloa West • Sauchie • Tullibody South • Alloa North • Fishcross, Devon Village and Coalsnaughton • Tullibody North and Glenochil • Menstrie • Dollar and Muckhart • Alva • Tillicoultry

Stirling City with the Eastern Villages, Bridge of Allan and Dunblane • Bannockburn • Cambusbarron and Carron Valley • Stirling East • Torbrex • Town Centre • Forthside • Raploch • Wallace • Sauchenford • Borestone • Fallin • Western Villages • Logie • Bridge of Allan • Dunblane West • Dunblane East

Rural Stirlingshire • Blane Valley • Strathendrick • Teith Valley • Callander • Highland (Tyndrum, Killin etc)

Page 9 of 9

Clackmannanshire & Stirling Health & Social Care Partnership Locality Profiles

The Clackmannanshir e & Stirling Health and Social Care partnership has identified 3 localities for strategic planning purposes.

What is this document designed to do? This profile presents a ‘picture’ of current need and demand in the Localities. It is hoped that the information presented in this profile used in conjunction with local expertise and knowledge can influence future analysis and ultimately the delivery of services in the localities. The information should inform discussion for the localities and support further analysis to inform operational impact of decisions and planning decisions for the future.

Clackmannanshire

Rural Stirling

Stirling City

Note: The acute hospital that serves Clackmannanshire & Stirling is the Forth Valley Royal Hospital in Larbert. Some residents in Rural Stirling also access nearby Glasgow hospitals.

About the data Data was gathered from a number of sources at Datazone (or Postcode) level and aggregated to locality level. Data is presented in a number of forms; counts, percentages, rates and ratios - information on how all this data was calculated is available in the accompanying methodology document. Indicators have been included where data was available and in all cases, the most recently available data has been used. Notes and caveats are displayed at the bottom of this table.

The shaded locality areas on the map correspond to the coloured columns in the data table below.

Stirling City with the Eastern Data Stirling & Clackmannanshire Rural Stirling Villages, Bridge Scotland Type Clackmannanshire of Allan and Dunblane

EQUALITY INDICATORS 1 Age - % aged over 65 % 18.2% 22.4% 17.2% 18.4% 18.0% 1 Gender - Male:Female Ratio Ratio 49:51 48:52 48:52 48:52 49:51 2 Ethnicity - % ethnic minority population % 4.3% 5.1% 7.9% 6.2% 8.2% 3 Religion - % with religious beliefs % 50.0% 56.0% 55.0% 53.0% 56.3% 4 % of those Married or in a Civil Partnership % 49.0% 57.2% 47.4% 49.5% 45.0% 5 Sexual Identity (Gender Reassignment) N/A N/A N/A N/A N/A 5 Sexual Orientation N/A N/A N/A N/A N/A 6 Live Births - Rate per 1,000 population Rate 10.7 7.1 9.4 9.5 10.5 7 Physical Disability - Rate per 1,000 Rate 72.3 54.8 63.3 65.3 67.1 7 Learning Disability - Rate per 1,000 Rate 4.1 3.8 4.6 4.3 5.0 Hearing or Visual Impairment – Rate per 1,000 7 Rate 90.1 95.1 85.7 88.7 90.0 POPULATION 1 Population 0-15 years Count 9,082 3,531 12,005 24,618 -

1 Population 16-49 years Count 21,938 7,999 33,084 63,021 - 1 Population 50-64 years Count 10,841 4,917 13,168 28,926 -

1 Population 65-74 years Count 5,569 2,703 6,670 14,942 - 1 Population 75-84 years Count 2,845 1,498 4,097 8,440 - 1 Population 85+ years Count 915 537 1,371 2,823 - 1 Total Population Count 51,190 21,185 70,395 142,770 - 8 Population Per Square km Rate 322.6 12.0 164.2 60.0 - 9 Dwellings Per Square km Rate 151.5 5.5 71.6 30.0 - 10 Urban/Rural - % living in an Urban Area % 38.9% 0.0% 69.9% 48.4% - 10 Urban/Rural - % living in a Small Town % 48.6% 15.6% 11.8% 25.6% - 10 Urban/Rural - % living in a Rural Area % 12.5% 84.4% 18.3% 26.0% - 1 Dependency Ratio Rate 56.2 64.0 52.2 55.3 58.0 LIFE CIRCUMSTANCES Adults claiming incapacity benefit/severe 11 disability allowance % 5.6% 2.8% 4.3% 4.6% 5.1% 12 Population income deprived % 15.5% 6.6% 10.9% 11.9% 13.1% Working age population employment deprived 13 % 15.1% 67.4% 10.6% 11.7% 12.2% Working age population claiming out-of-work 14 benefits % 14.6% 6.0% 9.9% 11.0% 12.0%

People living in 15% most 'access deprived' 15 areas % 2.6% 52.9% 1.6% 16.7% 15.0% Housing - % of properties in Council Tax band 9 A % 26.3% 4.7% 17.0% 18.6% 21.4% Housing - % of properties in Council Tax band 9 A - C % 64.8% 30.9% 51.2% 53.2% 60.9% Housing - % of properties in Council Tax band 9 F-H % 11.3% 40.3% 21.9% 20.7% 12.7% 16 Single adult dwellings % 37.6% 30.1% 34.4% 34.9% 37.5%

(*) indicates values that have been suppressed due to the potential risk of disclosure (-) is applied to denote that a direct Scotland Comparator is either unavailable or deemed to be extraneous.

Stirling City with the Eastern Data Stirling & Clackmannanshire Rural Stirling Villages, Bridge Scotland Type Clackmannanshire of Allan and Dunblane

LIFESTYLE & RISK FACTORS Drug-related Hospital Stays – per 100,000 17 population Rate 67.6 * * 84.1 122.0 Alcohol Related Hospital Stays – per 100,000 18 population Rate 491.6 247.2 402.7 412.6 671.7 Deaths from alcohol conditions – per 100,000 19 population Rate 19.2 * * 18.5 30.0 GENERAL HEALTH 20 Dementia - QOF Register List Size Count 276 285 437 998 - Dementia - Alzheimer's Scotland Estimated 21 Prevalence (65+) Count 714 388 1025 2127 - 20 Asthma QOF Rate per 1,000 population Rate 54.7 60.6 60.5 58.5 63.3 20 COPD QOF Rate per 1,000 population Rate 20.1 20.3 20.7 20.4 22.1 20 CHD QOF Rate per 1,000 population Rate 37.6 44.4 43.4 41.7 41.4 Heart Failure QOF Rate per 1,000 population 20 Rate 7.4 7.0 7.2 7.2 8.2 20 Diabetes QOF Rate per 1,000 population Rate 44.6 44.5 48.8 46.3 48.5 20 Stroke & TIA QOF Rate per 1,000 population Rate 17.8 21.6 21.3 20.2 21.6 20 Cancer QOF Rate per 1,000 population Rate 20.3 28.6 22.4 23.3 23

Mental Health QOF Rate per 1,000 population 20 Rate 6.8 7.2 8.3 7.5 8.8 20 Depression QOF Rate per 1,000 population Rate 56.4 57.6 69.0 61.7 62.8 Cancer Early Deaths Rate (Per 100,000 Pop.) 22 Rate 181.7 160.8 160.3 166 154.6 Patients with a psychiatric hospitalisation (Per 23 100,000 Pop.) Rate 337.6 170.0 281.0 281.5 291.6 SERVICE PROVISION 24 Number of GP Practices Count 7 10 12 29 - 25 Number of GP's per 1,000 population Rate 0.9 1.3 0.9 1.0 0.9 Average time to get to a GP surgery (drive Time 26 time) (Mins) 3.6 6.1 3.3 3.8 - Average time to get to a GP surgery (public Time 26 transport) (Mins) 9.0 20.8 9.1 10.9 - Patients with emergency hospitalisations – rate 27 per 100,000 population Rate 6579 5723 6757 6511 7500 Patients (65+) with multiple emergency hospitalisations - rate per 100,000 population 28 Rate 3978 3497 4850 4333 5160 Discharge Rate per 1,000 Pop - Patients (65+) 29 admitted with a fall Rate 18.3 11.8 19.2 17.6 20.5 Delayed discharges - Total Bed Days Occupied 30 Count in 2015 2349 1264 5115 8728 - Delayed discharges - Average Delay (Days) in 31 Count 2015 19.9 19.2 19.9 19.8 - Delayed discharges - Bed days occupied (Rate 32 Rate per 1,000 pop.) in 2015 57.5 74.1 90.6 76.3 -

33 Total Number of Care Home beds Count 380 156 562 1098 -

33 Number of Beds in Residential Homes Count 115 74 264 453 -

33 Number of Beds in Nursing homes Count 265 82 298 645 -

(*) indicates values that have been suppressed due to the potential risk of disclosure (-) is applied to denote that a direct Scotland Comparator is either unavailable or deemed to be extraneous.

Stirling City with the Eastern Data Stirling & Clackmannanshire Rural Stirling Villages, Bridge Scotland Type Clackmannanshire of Allan and Dunblane

SERVICE PROVISION

34 Number of NHS/LA Care Homes Count 2 1 3 6 -

34 Number of Private Care Homes Count 6 3 10 19 -

34 Number of Voluntary Care Homes Count 3 2 6 11 - % of last 6 months spent at home or in a 35 community setting % 92.3% 90.8% 90.3% 91.1% 90.8% People receiving Telecare services (incl. 36 Community Alarm) - Rate per 1,000 people Rate 42.1 26.4 25.3 31.5 23.0 People receiving Day Care services - Rate Per 37 1,000 people Rate 8.2 1.5 1.9 - - People receiving Care at Home - Rate per 38 1,000 people Rate 22.1 11.6 14.4 - - CARERS % of People who provide unpaid care - 0-19 39 hours % 4.8% 6.0% 5.3% 5.2% 5.2% % of People who provide unpaid care - 35+ 40 hours % 3.5% 2.8% 2.9% 3.1% 3.3%

(*) indicates values that have been suppressed due to the potential risk of disclosure (-) is applied to denote that a direct Scotland Comparator is either unavailable or deemed to be extraneous.

Glossary QOF – the Quality Outcomes Framework is the annual reward and incentive programme detailing GP practice achievement results. It rewards practices for the provision of quality care and helps standardise improvement in the delivery of primary medical services. CHD – Coronary Heart Disease is the term that describes what happens when your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries. COPD – Chronic Obstructive Pulmonary Disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. TIA - a Transient Ischaemic Attack (TIA) or "mini stroke" is caused by a temporary disruption in the blood supply to part of the brain.

Notes & Caveats 1. Midyear population estimates 2014 – National records for Scotland. Dependency Ratio is calculated using the population estimates and is –‘Those aged under 16 or of state pensionable age, per 100 working age population’. 2. Ethnicity – Ethnic minority population - % of population who are not White (Scottish), White (British) or White (Irish) – Derived from Scotland Census 2011 population. 3. Religion - % with religious beliefs (Total Population minus those with no religious beliefs and those who did not state a religion). Derived from Scotland Census 2011 population. 4. Census 2011 – those married and those who are living in a registered same-sex civil partnership (or co-habiting) as a percentage of the population aged 16 years or older. 5. There is currently no robust data collection of Information on Sexual orientation, and Sexual Identity of the Scottish population. There is limited sexual orientation data available (very small sample size) at a Local Authority level but no figures are available for locality profiling.

6. Live Births – Presented as a Crude Rate (per 1,000 population) – “Live birth: a child which at birth, having been completely expelled, shows signs of life or breathes”. http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general- publications/vital-events-reference-tables/2014/section-3-births 7. Scotland's Census 2011 - National Records of Scotland (Table QS304SC - Long-term health conditions). Crude rates per 1,000 population. Note: Hearing or visual impairment includes blindness, impaired sight, deafness and impaired hearing. 8. Population per square kilometre derived from National records of Scotland Population estimates 2014 and area (hectare) (1 Km 2 = 0.01 hectares) by datazone from the Scottish Assessors’ Association’s Assessors’ Portal data (2014). 9. Dwellings per square kilometre derived from Scottish Assessors’ Association’s Assessors’ Portal data (2014) (1 Km 2 = 0.01 hectares) ( http://www.nrscotland.gov.uk/statistics-and- data/statistics/statistics-by-theme/households/household-estimates/small-area-statistics-on- households-and-dwellings ) 10. Urban/Rural Classification - Scottish Government six-fold Urban Rural Classification 2013/14. % of population living in each category (see methodology document for how these figures were calculated). ( http://www.gov.scot/Topics/Statistics/About/Methodology/UrbanRuralClassification ) 11. Number and percentage of all adults aged 16+ claiming incapacity benefit/severe disability allowance (SDA) or employment and support allowance (ESA). 12. Percentage of total population classified as income deprived within SIMD income domain (SIMD 2012). 13. Percentage of working age population classified as employment deprived within SIMD income domain (SIMD 2012) 14. Percentage of working age population claiming 'key out of work benefits'. This is a combined count of claimants on Jobseeker's Allowance (JSA), Employment and Support Allowance (ESA), Incapacity Benefit (IB) or Severe Disablement Allowance ('Incapacity benefits'), Income Support with a child under 16 or no partner Lone parent and other Income Support (including IS Disability Premium) or Pension Credit with each person being counted only once. 15. Percentage of population living in 15% most 'access deprived' areas (2001 Data Zones) in Scotland, based on ISD population-weighted SIMD (SIMD 2012) – Population data from NRS (2014). 16. Percentage of dwellings subject to a Council Tax discount of 25 per cent. This may include, for example, dwellings with a single adult, dwellings with one adult living with one or more children, or with one or more adults who are 'exempted' for Council Tax purposes (NRS 2014). 17. General acute inpatient & day case stays with a diagnosis of drug misuse in any diagnostic position; 3-year rolling average (2012/13-2014/15) number and directly age-sex standardised rate per 100,000 population (ISD Scotland (SMR01, Linked Database)). 18. General acute inpatient and day case stays with a diagnosis of alcohol misuse in any diagnostic position: number and directly age-sex standardised rate per 100,000 population (ISD Scotland (SMR01, Linked Database)) (2014/15). 19. Alcohol related deaths (underlying cause): 5-year rolling average (2010-2014) number and directly age-sex standardised rate per 100,000 population (NRS). 20. QOF DATA - Data source: ISD QOF Database, as at 29th June 2015 plus notifications of adjustments from NHS Boards. Totals may still be subject to further revisions locally. QOF Prevalence data presented as Rate per 1,000 GP register population . Note - Dementia is presented as a count rather than a rate to align with the Alzheimer’s Scotland’s estimate. It is expected that the vast majority of dementia patients on the QOF register are 65+, so the Alzheimer’s Scotland estimated prevalence (65+) has been provided to show possible underestimation of QOF register data in cases where Dementia is not clinically diagnosed. It is not possible to split the QOF register by age band so these two figures are not directly comparable.

21. Estimated dementia prevalence per locality based on NRS 2014-based datazone population estimates and the EuroCode dementia prevalence rates (Alzheimer Europe (2009) EuroCoDe: prevalence of dementia in Europe http://www.alzheimer- europe.org/index.php?lm3=CEE66BE91B37 ). Age 65+ population only. 22. Early deaths from cancer (under 75s); 3-year rolling average (2012-2014) number and directly age- sex standardised rate per 100,000 population (NRS). 23. Patients discharged from psychiatric hospitals: 3-year rolling average (2011-2013) number and directly age-sex standardised rate per 100,000 population. (Note - Patients are counted only once per year). 24. ISD Scotland – General Practice and their Patient populations. GP practices were assigned to localities by matching their postcode to datazone. http://www.isdscotland.org/Health- Topics/General-Practice/Workforce-and-Practice-Populations/Practices-and-Their-Populations/ - Correct as at 1 st January 2016. 25. ISD Scotland – GPs and Other Practice Workforce. Calculated GP headcount per 1,000 population (NRS 2014). http://www.isdscotland.org/Health-Topics/General-Practice/Workforce-and-Practice- Populations/Workforce/ 26. Statistics.Gov.Scot – Travel times to key services by car or public transport. The methodology for generating average drive times to services involves generating drive times for each Census Output Area and then calculating a population weighted average for each Data Zone. For this indicator 2012 data was used. The times presented in the table are an average of all datazones which make up that locality. 27. Patients discharged from hospital following an emergency admission: 3-year rolling average (2011- 2013) number and directly age-sex standardised rate per 100,000 population. (Note - Patients who are counted in different LA may only be counted once for the NHS Board) (ISD Scotland (SMR01, Linked Database)). 28. Patients aged 65+ years with 2 or more emergency hospital admissions, discharged from hospital: 3-year rolling average (2011-2013) number and directly age-sex standardised rate per 100,000 population. (Note - A patient will be counted as multiple admission only if they resided in the same geography during both admissions) (ISD Scotland (SMR01, Linked Database)) 29. Discharge rate per 1,000 population for those aged 65 and over admitted with a fall (2014/15). Extracted from ISD SMR01 database and rate calculated with NRS mid-year population estimate 2014. 30. Total Bed days occupied by delayed discharges for Clackmannanshire & Stirling residents between 1 st Jan – 31 st Dec 2015. Data extracted from EDISON system at episode level and postcode of residence used to assign to localities (postcode matched to Datazone). Bed days occupied is the number of days from the date ‘ready for discharge’ to the date of discharge. Total bed days occupied was calculated by summing bed days occupied for all patients in the locality. (Code 100 patients are excluded.) 31. The average delay for delayed discharge patients in Clackmannanshire & Stirling (1 st Jan – 31 st Dec 2015) was calculated by dividing the total bed days occupied by the number of delayed discharges. (Code 100 patients are excluded.) 32. Crude rate per 1,000 population (18+ population – NRS 2014) of total bed days occupied by delayed discharges for Clackmannanshire & Stirling residents (1 st Jan – 31 st Dec 2015). (Code 100 patients are excluded.) 33. Total number of care home beds in all care homes within the locality. Data split by those beds in Residential care homes and Care homes with nursing care. Figures from ISD/Care Home Inspectorate (2015). (The Scottish Care Home Census is collected on an annual basis and covers all adult care home establishments that are registered with the Care Inspectorate). 34. Numbers of Care homes from ISD/Care Home Inspectorate (2015). (The Scottish Care Home Census is collected on an annual basis and covers all adult care home establishments that are registered with the Care Inspectorate). Split by sector - Local Authority/NHS run, privately operated and Voluntary establishments.

35. ISD Scotland (SMR01 and NRS Death Records). This measure has been calculated by subtracting the number of bed days spent in an acute hospital setting in the 6 months prior to death from the maximum number of bed days a patient could have spent in hospital in the 6 months prior to death (182.5 days). 36. Crude rate per 1,000 population (18+) of clients in receipt of either a community alarm, a full Telecare package or both during between April and March (2014/15). Clackmannanshire data was taken from the 2014/15 Adult Care Bulletin and the Stirling data was extracted from the SWIS Social Care System at postcode level and aggregated into Localities. Comparative Scotland figure was taken from the Scottish Governments Social Care Survey 2015 (2014/15 data). These figures should be treated with caution as there may be differing recording practices between the two local authorities. 37. Day Care – crude rate per 1,000 population (18+) of those in receipt of a day care service in 2014/15. Clackmannanshire data was taken from the Adult Care Bulletin 2014/15 which publishes data from the Clackmannanshire CCIS system. Stirling Data was aggregated to locality level from a postcode level extract. This includes personal and non-personal care and day care from direct payments. These figures should be treated with caution as there may be differing recording practices between the two local authorities. 38. Home Care – crude rate per 1,000 population (18+) of those who’ve received some hours of Home Care (either LA, Private or Voluntary) during the year 2014/15. Clackmannanshire numbers are from the Adult Care Bulletin 2014/15 and Stirling numbers are taken from 2014/15 extract of the Social Care SWIS system at postcode level and aggregated up. These figures should be treated with caution as there may be differing recording practices between the two local authorities. 39. Percentage of people providing 0-19 hours of care at home based on Census 2011 data. Number of carers providing 0-19 hours care as a percentage the total census population (All ages). 40. Percentage of people providing 35+ hours of care at home based on Census 2011 data. Number of carers providing 35+ hours care as a percentage the total census population (All ages).

Methodology

An accompanying methodology document details how the localities were defined, summarises the data sources and explains how rates and figures we’re calculated. Additionally there is further information on the limitations of the data.

Locality Maps

Locality Profiling Methodology Appendix 3

Locality profiles were prepared by aggregating data gathered at Intermediate Zone to Partnership Locality Levels. The Localities and their corresponding Intermediate Zones are presented below:

*Note – 2001 Intermediate Zones & Data Zones were used in the data collection for this project as insufficient data was available at the time using 2011 data zones. Data zones were updated based on the 2011 Census, and better reflect the socio-economic conditions in small areas. As data providers update to 2011 data zones it will be possible to update the Locality profiles. Government Guidance on the introduction of 2011 data zones (published 2014) - http://www.gov.scot/Resource/0048/00483471.pdf

Stirling City with the Eastern Villages, Rural Stirlingshire Clackmannanshire Bridge of Allan and Dunblane S02001163 Clackmannan, Kennet and Sauchenford S02001164 Blane Valley Forestmill S02000152 Bannockburn S02001165 Strathendrick S02001164 Alloa South and East S02000153 Cambusbarron and Carron Valley S02001166 Teith Valley S02001179 Alloa West S02000154 Borestone S02001168 Highland S02001183 Sauchie S02000155 Stirling East S02001169 Callander S02001182 Tullibody South S02000156 Fallin S02001170 Alloa North S02000157 Fishcross, Devon Village and Torbrex S02001171 Coalsnaughton S02000158 Town Centre S02001172 Tullibody North and Glenochil S02000159 Forthside S02001173 Menstrie S02000160 Raploch S02001174 Dollar and Muckhart S02000161 Wallace S02001175 Alva S02000162 Western Villages S02001176 Tillicoultry S02000163 Logie S02001177 Bridge of Allan S02001178 Dunblane West S02001180 Dunblane East S02001181

Data Sources

The following table details the data sources used to populate the locality profile table: Data Source Assigned to Locality by: Notes NRS – National Records Scotland 2001 Datazone 2014 Population Estimates aggregated up from Datazone to Locality Level Census 2011 2001 Datazone Range of indicators extracted from 2011 Census data available at 2001 Datazone level, again aggregated up to Locality Level. http://www.scotlandscensus.gov.uk/ods-web/data- Despite being 5 years old, census data is the newest available for some warehouse.html topics. QOF Register Practice Postcode QOF data are not available by patient postcode so locality rates were estimated by aggregating the registers for all GP practices in each GP Quality Outcomes Framework locality. GP practice postcode allowed mapping to the HSCP Localities. - Prevalence data for a range of conditions recorded Patients could live in one locality and attend a GP in another locality in QOF registers therefore these numbers should be considered an estimation and interpreted with caution. Social Care Data Client Postcode Social Care data has been matched to locality using the client postcode. Note that Community care team boundaries do not necessarily align with the HSCP locality boundaries.

ScotPHO 2001 Datazone The ScotPHO team within ISD were able to provide an extract of their - The Scottish Public Health Observatory profile data at 2001 datazone level. This was then aggregated up to (ScotPHO) collaboration is co-led by ISD Scotland Locality level. and NHS Health Scotland

ACaDMe 2001 Datazone Accessed through the NHS Corporate Data Warehouse and queried - (ACaDMe stands for Acute, Cancer, Deaths using the Business objects universe. Extracted at datazone level and and Mental Health. The datamart contains linked aggregated to locality level data. inpatient and daycase (SMR01), mental health (SMR04), cancer registration (SMR06) and death (NRS) records) EDISON Patient Postcode Data extract requested from NHS Forth Valley Analytical team for 2015 - a real-time national information system that delayed discharges/bed days at patient level. records and shares information on patients delayed, the care setting in which they are delayed and the main reason for the delay.

How the indicators were calculated

Datazone data – most data (with the exception of GP QOF and Social Care Data) was available at Datazone level. Master Datasets were constructed in IBM SPSS in the following format with a row of data per Datazone (see below). Using the functions within SPSS we calculated a total (or mean) for each Locality by summing (or averaging) the datazone rows that relate to each locality.

Postcode data – the Social care data and GP QOF data was only available at client postcode or GP Practice postcode so we used a postcode-datazone lookup file to match each postcode to a datazone. After this stage, the calculation of each indicator was identical to the process for Datazone data as described above.

Postcode Lookup File available here - http://www.gov.scot/Topics/Statistics/SIMD/SIMDPostcodeLookup

Rates & Ratios Rates were calculated as follows:

• Rate per 1,000 or 100,000 population e.g Crude Rate – Physical Disability per 1,000 population = x 1,000

퐍퐮퐦퐛퐞퐫 퐨퐟 퐩퐞퐨퐩퐥퐞 퐰퐢퐭퐡 퐚 퐩퐡퐲퐬퐢퐜퐚퐥 퐝퐢퐬퐚퐛퐢퐥퐢퐭퐲 퐢퐧 퐋퐨퐜퐚퐥퐢퐭퐲 퐗 • Dependency Ratio - ‘those aged under 16 or of state pensionable age, per 100 working age population’ 퐂퐞퐧퐬퐮퐬 퐏퐨퐩퐮퐥퐚퐭퐢퐨퐧 퐟퐨퐫 퐋퐨퐜퐚퐥퐢퐭퐲 퐗 = (midyear dependant population)/(midyear working population) x 100

• Population per Hectare = midyear population estimate/locality area (hectares – 2001 datazone) • Dwellings per Hectare = Number of dwellings (2012)/locality area (hectares – 2001 datazone)

Urban Rural Classification

3 Urban/Rural Categories were created using the Scottish Government 6 fold Urban Rural Classification by banding them into the following categories:

1 – Urban Areas (1 & 2) 2 – Small Towns (3 & 4) 3 – Rural Areas (5 & 6)

The data was gathered at datazone level with a 6-fold SG Urban Rural Classification attached to each datazone. The data was aggregated to locality level and the % of people living in each category was calculated.

Notes & Caveats

1. Midyear population estimates 2014 – National records for Scotland. Dependency Ratio is calculated using the population estimates and is – ‘those aged under 16 or of state pensionable age, per 100 working age population’. 2. Ethnicity – Ethnic minority population - % of population who are not White (Scottish), White (British) or White (Irish) – Derived from Scotland Census 2011 populations. 3. Religion - % with religious beliefs (Total Population minus those with no religious beliefs and those who did not state a religion). Derived from Scotland Census 2011 population. 4. Census 2011 – those married and those who are living in a registered same-sex civil partnership (or co-habiting) as a percentage of the population aged 16 years or older. 5. There is currently no robust data collection of Information on Sexual orientation, and Sexual Identity of the Scottish population. There is limited sexual orientation data available (very small sample size) at a Local Authority level but no figures are available for locality profiling. 6. Live Births – Presented as a Crude Rate (per 1,000 population) – “Live birth: a child which at birth, having been completely expelled, shows signs of life or breathes”. http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/vital- events-reference-tables/2014/section-3-births 7. Scotland's Census 2011 - National Records of Scotland (Table QS304SC - Long-term health conditions). Crude rates per 1,000 population. Note: Hearing or visual impairment includes blindness, impaired sight, deafness and impaired hearing. 8. Population per square kilometre derived from National records of Scotland Population estimates 2014 and area (hectare) (1 Km2 = 0.01 hectares) by datazone from the Scottish Assessors’ Association’s Assessors’ Portal data (2014). 9. Dwellings per square kilometre derived from Scottish Assessors’ Association’s Assessors’ Portal data (2014) (1 Km2 = 0.01 hectares) (http://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/households/household-estimates/small-area-statistics-on- households-and-dwellings) 10. Urban/Rural Classification - Scottish Government six-fold Urban Rural Classification 2013/14. % of population living in each category (see methodology document for how these figures were calculated). (http://www.gov.scot/Topics/Statistics/About/Methodology/UrbanRuralClassification) 11. Number and percentage of all adults aged 16+ claiming incapacity benefit/severe disability allowance (SDA) or employment and support allowance (ESA). 12. Percentage of total population classified as income deprived within SIMD income domain (SIMD 2012). 13. Percentage of working age population classified as employment deprived within SIMD income domain (SIMD 2012). 14. Percentage of working age population claiming 'key out of work benefits'. This is a combined count of claimants on Jobseeker's Allowance (JSA), Employment and Support Allowance (ESA), Incapacity Benefit (IB) or Severe Disablement Allowance ('Incapacity benefits'), Income Support with a child under 16 or no partner Lone parent and other Income Support (including IS Disability Premium) or Pension Credit with each person being counted only once. 15. Percentage of population living in 15% most 'access deprived' areas (2001 Data Zones) in Scotland, based on ISD population-weighted SIMD (SIMD 2012) – Population data from NRS (2014). 16. Percentage of dwellings subject to a Council Tax discount of 25 per cent. This may include, for example, dwellings with a single adult, dwellings with one adult living with one or more children, or with one or more adults who are 'exempted' for Council Tax purposes (NRS 2014). 17. General acute inpatient & day case stays with a diagnosis of drug misuse in any diagnostic position; 3-year rolling average (2012/13-2014/15) number and directly age-sex standardised rate per 100,000 population (ISD Scotland (SMR01, Linked Database)). 18. General acute inpatient and day case stays with a diagnosis of alcohol misuse in any diagnostic position: number and directly age-sex standardised rate per 100,000 population (ISD Scotland (SMR01, Linked Database)) (2014/15). 19. Alcohol related deaths (underlying cause): 5-year rolling average (2010-2014) number and directly age-sex standardised rate per 100,000 population (NRS). 20. QOF DATA - Data source: ISD QOF Database, as at 29th June 2015 plus notifications of adjustments from NHS Boards. Totals may still be subject to further revisions locally. QOF Prevalence data presented as Rate per 1,000 GP register population. Note - Dementia is presented as a count rather than a rate to align with the Alzheimer’s Scotland’s estimate. It is expected that the vast majority of dementia patients on the QOF register are 65+, the Alzheimer’s Scotland estimated prevalence (65+) has been provided to show possible underestimation of QOF register data in cases where Dementia is not clinically diagnosed. It is not possible to split the QOF register by age band so these two figures are not directly comparable. 21. Estimated dementia prevalence per locality based on NRS 2014-based datazone population estimates and the EuroCode dementia prevalence rates (Alzheimer Europe (2009) EuroCoDe: prevalence of dementia in Europe http://www.alzheimer- europe.org/index.php?lm3=CEE66BE91B37). Age 65+ population only. 22. Early deaths from cancer (under 75s); 3-year rolling average (2012-2014) number and directly age-sex standardised rate per 100,000 population (NRS). 23. Patients discharged from psychiatric hospitals: 3-year rolling average (2011-2013) number and directly age-sex standardised rate per 100,000 population. (Note - Patients are counted only once per year). 24. ISD Scotland – General Practice and their Patient populations. GP practices were assigned to localities by matching their postcode to datazone. http://www.isdscotland.org/Health-Topics/General-Practice/Workforce-and-Practice-Populations/Practices-and-Their-Populations/ - Correct as at 1st January 2016. 25. ISD Scotland – GPs and Other Practice Workforce. Calculated GP headcount per 1,000 population (NRS 2014). http://www.isdscotland.org/Health-Topics/General-Practice/Workforce-and-Practice-Populations/Workforce/ 26. Statistics.Gov.Scot – Travel times to key services by car or public transport. The methodology for generating average drive times to services involves generating drive times for each Census Output Area and then calculating a population weighted average for each Data Zone. For this indicator 2012 data was used. The times presented in the table are an average of all datazones which make up that locality. 27. Patients discharged from hospital following an emergency admission: 3-year rolling average (2011-2013) number and directly age-sex standardised rate per 100,000 population. (Note - Patients who are counted in different LA may only be counted once for the NHS Board) (ISD Scotland (SMR01, Linked Database)). 28. Patients aged 65+ years with 2 or more emergency hospital admissions, discharged from hospital: 3-year rolling average (2011-2013) number and directly age-sex standardised rate per 100,000 population. (Note - A patient will be counted as multiple admission only if they resided in the same geography during both admissions) (ISD Scotland (SMR01, Linked Database)) 29. Discharge rate per 1,000 population for those aged 65 and over admitted with a fall (2014/15). Extracted from ISD SMR01 database and rate calculated with NRS mid-year population estimate 2014. 30. Total Bed days occupied by delayed discharges for Clackmannanshire & Stirling residents between 1st Jan – 31st Dec 2015. Data extracted from EDISON system at episode level and postcode of residence used to assign to localities (postcode matched to Datazone). Bed days occupied is the number of days from the date ‘ready for discharge’ to the date of discharge. Total bed days occupied was calculated by summing bed days occupied for all patients in the locality. (Code 100 patients are excluded.) 31. The average delay for delayed discharge patients in Clackmannanshire & Stirling (1st Jan – 31st Dec 2015) was calculated by dividing the total bed days occupied by the number of delayed discharges. (Code 100 patients are excluded.) 32. Crude rate per 1,000 population (18+ population – NRS 2014) of total bed days occupied by delayed discharges for Clackmannanshire & Stirling residents (1st Jan – 31st Dec 2015). (Code 100 patients are excluded.) 33. Total number of care home beds in all care homes within the locality. Data split by those beds in Residential care homes and Care homes with nursing care. Figures from ISD/Care Home Inspectorate (2015). (The Scottish Care Home Census is collected on an annual basis and covers all adult care home establishments that are registered with the Care Inspectorate). 34. Numbers of Care homes from ISD/Care Home Inspectorate (2015). (The Scottish Care Home Census is collected on an annual basis and covers all adult care home establishments that are registered with the Care Inspectorate). Split by sector - Local Authority/NHS run, privately operated and Voluntary establishments. 35. ISD Scotland (SMR01 and NRS Death Records). This measure has been calculated by subtracting the number of bed days spent in an acute hospital setting in the 6 months prior to death from the maximum number of bed days a patient could have spent in hospital in the 6 months prior to death (182.5 days). 36. Crude rate per 1,000 population (18+) of clients in receipt of either a community alarm, a full Telecare package or both between April and March (2014/15). Clackmannanshire data was taken from the 2014/15 Adult Care Bulletin and the Stirling data was extracted from the SWIS Social Care System at postcode level and aggregated into Localities. Comparative Scotland figure was taken from the Scottish Governments Social Care Survey 2015 (2014/15 data). These figures should be treated with caution as there may be differing recording practices between the two local authorities. 37. Day Care – crude rate per 1,000 population (18+) of those in receipt of a day care service in 2014/15. Clackmannanshire data was taken from the Adult Care Bulletin 2014/15 which publishes data from the Clackmannanshire CCIS system. Stirling Data was aggregated to locality level from a postcode level extract. This includes personal and non-personal care and day care from direct payments. These figures should be treated with caution as there may be differing recording practices between the two local authorities. 38. Home Care – crude rate per 1,000 population (18+) of those who’ve received some hours of Home Care (either LA, Private or Voluntary) during the year 2014/15. Clackmannanshire numbers are from the Adult Care Bulletin 2014/15 and Stirling numbers are taken from 2014/15 extract of the Social Care SWIS system at postcode level and aggregated up. These figures should be treated with caution as there may be differing recording practices between the two local authorities. 39. Percentage of people providing 0-19 hours of care at home based on Census 2011 data. Number of carers providing 0-19 hours care as a percentage the total census population (All ages). 40. Percentage of people providing 35+ hours of care at home based on Census 2011 data. Number of carers providing 35+ hours care as a percentage the total census population (All ages).

GP QOF Data – Limitations

Crude prevalence figures were calculated at locality level by assigning each GP practice to a locality (by Practice Postcode) and aggregating the practice registers within each locality. There are a number of potential limitations with this methodology:

• A GP practice could provide a specialist service (or have a GP with specialist interest) for one or more particular disease/condition, resulting in an artificially high rate in one locality. • GP practices could be located near to a locality boundary resulting in some patients being included in the numbers for their neighbouring locality. • Prevalence data within the QOF are collected in the form of practice "registers". A QOF register may count patients with one specific disease or condition, or it may include multiple conditions. There may also be other criteria for inclusion on a QOF register, such as age or recency of diagnosis. • Caution needs to be taken when interpreting QOF prevalence since the rates are simply the total number of patients on the register, expressed as a proportion or percentage of the total number of patients registered with the practice. They are not adjusted to account for patient age distribution or other factors that may differ between general practices. Furthermore, although registers may be restricted (e.g. to only include persons over a specified age) the QOF prevalence rate is based on the total number of persons registered with the practice (the practice list size) at one point in time.

Social Work Data – Limitations

Social Work data was gathered from different sources and systems; for Clackmannanshire the data was obtained from the 2014/15 Adult Care Bulletin which uses the Community Care Information System (CCIS) as its source, for the two Stirling localities data was requested as a postcode level extract from the social care services team. With Clackmannanshire being a local authority area as well as a H&SC partnership locality, the majority of indicators were routinely available in the Adult Care Bulletin.

For Stirling it was necessary to split the data into the two localities, this was achieved by matching postcode of residence to 2001 Datazone and then Locality. Services provided to clients who live in another area of Scotland (e.g. a client who receives very specialist services paid for by Stirling Social Work Services, but resides at a dedicated centre in another partnership) are not included as it is not possible to assign these patients to a locality. It should be noted that though the number of these patients is small, they have not been excluded from Clackmannanshire data.

The social work indicators should be treated with caution as there may be differing recording and operational practices between the two local authorities, additionally there is no Partnership level rate presented for the indicators where it is considered that it may not be appropriate to combine the Clackmannanshire & Stirling data sources.

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 12 on the agenda

Communications Action Plan and Development of Visual Identity Options

(Paper presented by Deborah Kilpatrick)

For Approval

Approved for Submission by Shiona Strachan, Chief Officer Author Elsbeth Campbell, Head of Communications, NHS Forth Valley Deborah Kilpatrick, Senior Communications Advisor, Stirling Council Karen Payton, Communications & Community Team Leader, Clackmannanshire Council Date: 22 June 2016 List of Background Papers: 2016.04.27 Clackmannanshire & Stirling Health and Social Care Partnership - Communications Protocol and Framework

Page 1 of 12

Title/Subject: Communications Action Plan and Development of Visual Identity Options Meeting: Clackmannanshire & Stirling Integration Joint Board Date: June 2016 Submitted By: Elsbeth Campbell, Head of Communications (NHS Forth Valley), Deborah Kilpatrick, Senior Communications Advisor (Stirling Council) Karen Payton, Communications & Community Team Leader (Clackmannanshire Council). Action: For Approval

1. Introduction

1.1 The Communications Action Plan (set out at Appendix 1) outlines a range of proposed activities and actions which will be taken forward over the next 12 months to promote the work of the Health and Social Care Partnership and ensure local staff are kept updated on key developments. The action plan is supported by a wider Communications Framework which was agreed at the April 2016 Board meeting to ensure a joined up and consistent approach to communications across the Partnership.

2. Executive Summary

2.1. The action plan has been developed by the communications leads from NHS Forth Valley, Clackmannanshire and Stirling Councils. It reflects some of the key communication activities being taken forward in other Partnerships across Scotland as well as local priorities identified by the Integration Joint Board. The potential development of a consistent visual identity for the Health and Social Care Partnership has also been raised and further information, including recommendations on how options could be developed and a suggested approval process, is set out at Appendix 2.

3. Recommendations

The Integration Joint Board is asked to:

3.1. Approve the attached communications action plan for the next 12 months.

3.2. Note that the plan will be reviewed and updated to take account of any new opportunities or emerging issues during this period.

3.3. Approve the recommended approach and preferred option for the development of visual identity options, outlined in Appendix 2

4. Background

Page 2 of 12

4.1 The Communications Framework aims to ensure that:

o Staff, third sector and independent service providers have access to information about health and social care integration and are kept informed of relevant changes and developments which affect them and the services they provide in a consistent and co-ordinated way.

o Service users, families, unpaid carers and the public are reassured that they will still have access to the health and social care services they require and are kept updated on relevant local developments, benefits and improvements.

o A joined-up approach to communications which builds on effective and well established arrangements for collaborative working across the three partner organisations.

5. Resource Implications

5.1 No additional communications resources have been identified to support the Health and Social Care Partnership, so action plans and activities will need to take account of the current available capacity across NHS Forth Valley and the two Local Authorities.

6. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

6.1. The Communications Action Plan will ensure the delivery of key messages and communications activity to support the implementation of the Strategic Plan and the work of the Health and Social Care Partnership.

7. Legal & Risk Implications

7.1 There are no additional legal and risk implications associated with this plan.

8. Consultation

8.1 The action plan takes account of key strategic objectives and priorities identified as a result of the consultation on the Strategic Plan as well as feedback from engagement sessions.

9. Equality and Human Rights Impact Assessment

9.1. It is recognised that there are equalities issues in relation to the provision of accessible communications and these will be taken into account.

Page 3 of 12

10. Exempt reports

10.1. No

Page 4 of 12

Appendix 1 - Communications Action Plan

Background It is recommended that all communications activities for the Clackmannanshire and Stirling Health and Social Care Partnership should follow a best practice model.

This means they should be: • Based on clear, measurable objectives. • Implemented in a flexible way which meets the needs of the stakeholders. • Use a range of tactical options. Examples of this could include community engagement, media, print, digital activity, including email and social, and internal and external online media. • Subject to evaluation and review to check they are effective.

Objectives The communications objectives for the Clackmannanshire and Stirling Health and Social Care Partnership are set out within the joint protocol which identifies two key priorities: • Staff, voluntary organisations and independent service providers in NHS Forth Valley and the three local authorities have access to information about health and social care integration and are kept informed of relevant changes and developments which affect them and the services they provide in a consistent and co-ordinated way

• Service users, families, unpaid carers and the public are reassured that they will still have access to the health and social care services they require and are kept updated on relevant local developments, benefits and improvements

Strategy

The vision for the Clackmannanshire and Stirling Health and Social Care Partnership is “to enable people in Clackmannanshire and Stirling to live full and positive lives within supportive communities.”

This document also sets out the local vision and outcomes which the Councils and NHS Forth Valley wish to achieve through the Partnership, alongside the nine national outcomes. These are:

• Self Management - Individuals, their carers and families are enabled to manage their own health, care and well being. • Community Focussed 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 and supported to mange decisions about their care and wellbeing. • Experience – People have a fair and positive experience of health and social care.

Page 5 of 12

Communications has an important contribution to make to the achievement of these outcomes. The Partnership‘s vision includes a commitment to communicating in a way which is clear, accessible, understandable and ensures a two-way conversation. The agreed communications protocol and action plan will shape the way in which the Partnership communicates, internally and externally, and help ensure planned communications activities have a clear link to the delivery of the agreed local and national outcomes.

Implementation This section sets out a range of tactical activities that could be taken forward on behalf of the Clackmannanshire and Stirling Health and Social Care Partnership. It is based on information available at the present time and will be refined and reviewed as plans progress. Objective Tactical Timescale Audience Comments Implementation Highlight start of new Local media 1 April 2016 Staff Completed – integrated release and photo Service Users briefing arrangements. of IJB members and Unpaid update issued to local Carers shared with media General Public local staff and news Information shared release on partner websites covered in and intranets both local papers Email from Chief Officer circulated to local staff

Provide update on Arrange local June/July 2016 General Public Strategic Plan media briefing Service Users consultation and interviews with Voluntary and highlight vision, key Chief Officer and Community plans and priorities Chair Organisations

Provide support for Agree process to April 2016 onwards IJB cycle of IJB review agendas to meetings identify potential promotional opportunities and any issues which may require communications advice or support

Monitor agreed Review, if required, Ongoing Local Media approach to media based on management experience and learning from specific issues Develop potential Recommendations June 2016 All stakeholders options for a on proposed

Page 6 of 12

cohesive, consistent process and visual identity which timescale to be reflects the vision developed and strategic objectives of the HSCP Showcase the joint Identify areas of General Public work of staff and best practice and Ongoing Service Users services covered by share these and Unpaid the HSCP and internally and Carers highlight the benefits externally Staff to staff, services users, carers and Relevant news 4 editions per year other key stories and updates stakeholders included in Clackmannanshire Council’s The View newspaper and NHS Forth Valley’s Community Health News magazine as well as Partner staff newsletters Ongoing

Promote existing and new joint service Ongoing developments

Identify opportunities to showcase best practice via key national events and awards Ensure staff are Issue regular Staff Quarterly Staff updated on progress Briefing Updates and key developments as Publicise Staff Ongoing plans progress Engagement Events

Ensure that Ongoing common issues raised by staff in other fora are captured and addressed in outgoing communications Ongoing Evaluate delivery

Page 7 of 12

mechanisms for staff information to ensure that they being delivered to the right people and using the most Ongoing appropriate channels

Include relevant news stories and updates included in Partner staff newsletters

Highlight examples Issue media August 2016 General Public of how the briefing on how Service Users integration fund is integrated care and Unpaid being used and the funds will be used Carers difference it is locally making to local people Include details in relevant Partner publications

Highlight updates and case studies on Partnership web pages Develop existing Ongoing All stakeholders Initial bank of photographs photographs and visuals to collated for support Strategic communications Plan and activity web pages Develop key facts e.g. number of staff December 2016 General Public and figures about involved, budget, Service Users the HSCP range of services and Carers delivered Ensure that online Review and update Ongoing General Public information is joint web pages Service Users accurate, up-to-date and Unpaid and accessible Carers Local Voluntary and Community organisations Raise the profile of Identify Ongoing Staff Key awards joint initiatives and opportunities to General Public include: help recognise the showcase best Service Users • Herald work of local staff practice via key and Unpaid Society national events and Carers Awards

Page 8 of 12

awards • Cosla Excellenc Develop processes e Awards to identify best • Scottish practice and Health capture feedback Awards from staff • Scottish Care Awards Raise awareness of Highlight annual Annually ( April IJB key achievements progress and 2017 onwards) Service Users and progress against achievements and Unpaid national and local Carers outcomes General Public Local Voluntary and Community Organisations

Evaluation

Evaluation provides the evidence to demonstrate how effective and efficient we are in delivering our communication activities and to justify what we do. Good evaluation allows us to gather insight on which to optimise our channels during the implementation and make recommendations for future planning. Good evaluation is not just about collecting data, monitoring, measuring and reporting back on numbers. It is about preparing our evaluation early in the overall communication planning process to ensure that we collect the right data and evidence and this should include output, outtake and outcome measures.

Appropriate evaluation measures should be developed for communications activity and these should be reported regularly. The evaluation should cover both intermediary and organisational outcomes.

Examples of intermediary communications outcomes could include volume and tone of coverage, attendance at events, email click through, dwell time on web pages, number of downloads etc.

Organisational outcomes include attitudinal change, awareness (e.g. engagement of a public that was otherwise unaware of the service) and behavioural change (e.g. people accessing services in a different way).

Page 9 of 12

Appendix 2 - Develop of a Visual Identity

Background

The possibility of developing a consistent visual identity for the Health and Social Care Partnership has been raised and this paper identifies options for taking forward this work, including a development and approval process.

The development of a separate brand has not been recommended because:

• Following and strengthening existing interim style guidelines will ensure a consistent and recognisable style, while remaining within the capacity of in-house graphic design resources

• Establishing a separate brand could cause confusion and concern amongst the general public and staff

• Integration is about creating strong partnerships between existing organisations not about creating separate stand-alone new organisations

• Partner organisations already have strong, well established identities which are widely recognised, understood and trusted

Instead, the partner's current logos have been used, ensuring that partners are represented fairly and equally, within a set of agreed guidelines.

However, it is recognised that there are opportunities to build on the current approach and develop a consistent visual identity for the Health and Social Care Partnership. This could include specific messaging to create a unifying identity and help explain the aims and purpose of the Health and Social Care Partnership. Style guides could also be developed to ensure that future key documents and reports produced by the Partnership have a consistent look and feel.

Once the identity is developed and agreed it should be used consistently to help build a sense of common purpose and sense of quality and reliability. Guidelines will be developed for its usage and its application will be carefully monitored to ensure it is used appropriately. The identity should be used to support new ways of working and experiences that illustrate the aims and purpose of the Partnership.

DEVELOPMENT PROCESS

Options

Page 10 of 12

We have identified three potential options for the way forward:

1) Continue with the existing arrangement of using the three partnership organisations’ long established identities

2) Look at how the existing brands of the three partner organisations could be developed and supported with specific messaging to create a unifying identity and help explain the aims and purpose of the Health and Social Care Partnership

3) Commission the development of a separate brand for the Health and Social Care Partnership

Option 1, while practical, has limitations and there are already examples of where the current identity guidelines have not been followed correctly.

Option 2 is the preferred option as it provides the opportunity to build on and strengthen the existing interim identity guidelines, help convey the aims and objectives of the Partnership and ensure a more consistent approach to the design and layout of future documents and reports.

Option 3 is not recommended because: • Establishing a separate brand could cause confusion and concern amongst the general public and staff

• Integration is about creating strong partnerships between existing organisations not about creating separate stand-alone new organisations

• Partner organisations already have strong, well established identities which are widely recognised, understood and trusted

It is therefore proposed that a new visual identity should be developed which builds on and supports the existing brands of the three partner organisations. The work would overseen by a small group comprising the Chair and Vice Chair of the Integration Joint Board and the Chief Officer, with support from the Communications and Community Team Leader at Clackmannanshire Council, the Senior Communications Advisor from Stirling Council and the Head of Communications at NHS Forth Valley.

The design process would take into account the following issues:-

Page 11 of 12

• Target audience • Communications objectives - linked to the Partnership’s vision and values • Current branding issues and how this piece of work might help address these • What is required – e.g. flexible in application, fonts, type only or including a graphic, colours to use/colours to avoid • Communications objectives • How the visual identity would be applied – e.g. reports, publications, presentations, newsletter, banners, digital items etc.

Additional feedback and suggestions should also be gathered to help inform the design brief. This could include focus groups and/or questionnaires covering areas such as what would they want people to think and feel about the Partnership and key words and phrases they would want to associate with the Partnership.

Following the agreement of the design brief, creative design options will be prepared by either Clackmannanshire or Stirling Councils' graphic design teams, depending on in-house workload capacity, and presented to the Chair, Vice Chair and Chief Officer for discussion.

Once creative options have been approved by that group, it is proposed that these would be tested on small internal and external focus groups. The internal group would be made up of a diagonal slice of employees and the external could draw on volunteers from the Clacks 1000 citizens panel and the Stirling Council citizens panel.

The view from these exercises would be used to finalise and agree the recommended visual identity with the Chair, Vice Chair and Chief Officer. It would then be brought to the IJB for final approval. It is anticipated that this process would take around 12 months to complete.

Guidelines for the new branding would then be developed and it would need to be rolled out to ensure a consistent use across all communications material relating to the partnership. Work would also be undertaken to raise awareness of the new brand internally and externally, as appropriate.

Page 12 of 12

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 13 on the agenda

NHS Forth Valley Local Delivery Plan 2016-17

(Paper presented by Graham Foster)

For Noting

Approved for Submission by Graham Foster, Director of Public Health and Strategic Planning Author Janette Fraser, Head of Planning, NHS Forth Valley Date: 22 June 2016 List of Background Papers: Local Delivery Plan Guidance 2016-17 (The Scottish Government)

Page 1 of 4

Title/Subject: NHS Forth Valley Local Delivery Plan 2016-17 Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Dr Graham Foster Action: For Noting

1. Introduction

1.1. The purpose of this paper is to ask members to note the NHS Forth Valley Local Delivery Plan 2016-17 which was approved by the NHS Board on 31 May 2016 and submitted to the Scottish Government.

2. Recommendations

The Integration Joint Board is asked to:

Note the content of the NHS Forth Valley Local Delivery Plan 2016-17.

3. Background

3.1. The draft NHS Forth Valley Local Delivery Plan 2016-17 was approved by the Performance & Resources Committee on Tuesday 23 February 2016, with delegated authority from the NHS Board. The draft Local Delivery Plan was submitted to the Scottish Government on 18 March and Scottish Government departments provided feedback on the Local Delivery Plan draft during April and May 2016. The Local Delivery Plan was then updated and amended, taking into consideration the feedback from Scottish Government Health Department and the responses from Executive and Senior Management Leads in NHS Forth Valley and Health and Social Care Partnership Chief Officers, to the feedback.

4. Main Body Of The Report

4.1. The Local Delivery Plan 2016-17 was approved by the NHS Board on 31 May and the Plan was submitted to the Scottish Government.

4.2. The Local Delivery Plan is supported by the NHS Board Annual Plan which sets out the Board’s priorities and actions for the year ahead in greater detail and by the Directorate Plans, which will set out the contribution of each Directorate to the overall annual plan. Corporate Plans will be added in 2106- 17 to describe the contribution of the Corporate and Area Wide services to delivering the Annual Plan.

Page 2 of 4

4.3. The Scottish Government 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 budget for 2016- 17. The draft Local Delivery Plan was previously considered by the Clackmannanshire and Stirling and Falkirk Integration Joint Boards.

5. Conclusions

The Integration Joint Board is asked to note the content of the NHS Forth Valley Local Delivery Plan 2016-17.

6. Resource Implications

The Local Delivery Plan is expected to be delivered within existing resources.

7. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

The Local Delivery Plan is consistent with Integration Joint Board Outcomes.

8. Legal & Risk Implications

Risks are identified within the narrative.

9. Consultation

The Chief Officer contributed to preparing the draft Local Delivery Plan and the final Plan. The draft Local Delivery Plan was considered at a previous Integration Joint Board meeting.

10. Equality and Human Rights Impact Assessment

The NHS Forth Valley Local Delivery Plan 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 Local Delivery Plan therefore directly supports NHS Forth Valley in the discharge of the General Equality Duty 2010.

11. Exempt reports

Page 3 of 4

Page 4 of 4

NHS FORTH VALLEY Local Delivery Plan 2016-17

NHS Forth Valley Local Delivery Plan 2016-17 Page 2 of 60

Content 1 Background ...... 4 1.1 Introduction ...... 4 1.2 2020 Vision ...... 4 1.3 Equality Duty 2010 ...... 4 1.4 Challenges in Forth Valley ...... 5 1.5 Strategic Principles ...... 6 1.6 Strategic Planning Framework ...... 7 1.7 Performance Management ...... 7 1.8 Challenges in Forth Valley ...... 10 1.9 LDP Structure ...... 10 2 National Improvement Priorities ...... 12 2.1 Health Inequalities and Prevention ...... 12 2.2 Antenatal and Early Years ...... 17 2.3 Safe Care ...... 22 2.4 Person-Centred ...... 27 2.5 Primary Care ...... 31 2.6 Integration ...... 37 2.7 Scheduled Care ...... 40 2.8 Unscheduled Care ...... 43 2.9 Mental Health ...... 46 3 Overarching Improvement Areas ...... 50 3.1 Financial Planning ...... 50 3.2 Community Planning Partnerships ...... 52 3.3 Workforce Planning ...... 55 APPENDIX 1 – NHS Forth Valley Strategic Planning Matrix ...... 58 Glossary ...... 59

NHS Forth Valley Local Delivery Plan 2016-17 – Version 2.0 – 23 05 16 Page 3 of 60

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 implementation of 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 9). This LDP will set out how NHS Forth Valley is going to address them.

The LDP should be considered in the context of the financial environment, set out in section 3.1 and the National Clinical Strategy for Scotland (2016).

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 4 of 60

1.4 Challenges in Forth Valley

NHS Forth Valley is facing the challenges and constraints of increasing demand and finite 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

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 5 of 60

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, 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 - developing 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 focusing 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 6 of 60

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 Healthcare Strategy 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 7 of 60

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 were formally established on 1 April 2016 and it is important that they are now engaged in the delivery of this LDP with a relationship based on collaboration and alignment.

NHS Forth Valley Local Delivery Plan 2016-17 Page 8 of 60

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 Joint Boards. 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 9 of 60

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 9). 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 10 of 60

In developing the LDP 2016-17, the following guidance and policies have been considered:  The LDP guidance.  Health and Social Care Partnerships guidance and their strategic commissioning plans.  Scotland’s Spending Plans and Budget 2016-17.

NHS Forth Valley Local Delivery Plan 2016-17 Page 11 of 60

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 is 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 deliver 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

NHS Forth Valley Local Delivery Plan 2016-17 Page 12 of 60

development of an Equality and Diversity Impact Assessment (EQIA) process for CPPs and the application of health impact assessment.

Forth Valley NHS continues to work with the Alcohol and Drug Partnerships to drive forward the partnerships’ aims of developing a recovery oriented system of care across the whole area. In addition, the whole population approach to reducing alcohol related harm is being progressed. The letter of 7 January from the Cabinet Secretary for Health and Wellbeing has been noted and acted upon. NHS Forth Valley will continue to work towards high levels of performance against both the Alcohol Brief Intervention Standard and the Drug and Alcohol Waiting Time Standard.

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.

NHS Forth Valley made considerable progress with the Health Promoting Health Service (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 targeted 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

NHS Forth Valley Local Delivery Plan 2016-17 Page 13 of 60

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.

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 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

NHS Forth Valley Local Delivery Plan 2016-17 Page 14 of 60

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.

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 15 of 60

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  Delivery of Child Healthy Weight interventions  New diagnosis of Hepatitis C & Hepatitis C treatments completed

NHS Forth Valley Local Delivery Plan 2016-17 Page 16 of 60

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.

It is acknowledged that implementing the Children and Young People (Scotland) Act (2014) and introducing the new universal Health Visiting pathway, will have an impact on the Health Visiting workforce. This is being addressed in part by ring fenced funding to 2018 to train new Health Visitors and increase Health Visitor posts. A workforce plan has been completed which indicates a risk related to the number of current Health Visitors who may choose to retire from the service in the next 5 years. A training plan is under development to mitigate this and work towards service sustainability when the current financial support from Scottish Government ceases.

The universal Health Visiting pathway will be rolled out from April 2016, consistent with Scottish guidance. New supportive management posts have been introduced which combine professional and operational responsibilities and team leader posts will be recruited to develop caseload supervision model. This will assist NHS Forth Valley to develop a clinical career pathway for Health Visitors.

It is anticipated that with the plans described above, NHS Forth Valley will have sufficient capacity to deliver the Named Person Service by August 2016 and the Health Visiting Pathway fully by 2018.

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 17 of 60

The GIRFEC Implementation Group is co-ordinating a phased approach to the activities required to implement the 2014 Act, including staff awareness. The Group interfaces with two multi-agency partnership Groups (Stirling/Clackmannanshire and Falkirk) ensuring a consistent and joined up approach. Senior practitioners across key service areas have been identified to undertake local training and awareness raising in respect of the main areas of the 2014 Act and its service implications. Training and awareness sessions have been planned on a priority basis, first targeting those staff involved directly in children’s services, followed by all staff groups. In addition, in anticipation of the introduction of the NES online resources, the NHS Forth Valley Staff Brief, which is cascaded to all staff, contains general GIRFEC information.

Within Forth Valley, there are three areas with dedicated Health Visiting (Named Person) teams. A secure email box is in place for each of the teams, to which Police Scotland send Police Concern Reports and a protocol is in place for accessing and responding to the email box. The three local authorities also have dedicated email boxes for their education services. The system is monitored closely and any amendments necessary will be introduced by 31 August 2016. Work is also being progressed to finalise a joint information sharing protocol to be endorsed by all agencies.

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 18 of 60

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.

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 19 of 60

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.

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 providing a Named Person for every child up to age 5.  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 and train health visitors towards the target numbers for 2018 (GIRFEC).

NHS Forth Valley Local Delivery Plan 2016-17 Page 20 of 60

2.2.4 Performance Management

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 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

NHS Forth Valley Local Delivery Plan 2016-17 Page 21 of 60

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 were established formally on 1 April 2016.

NHS Forth Valley Local Delivery Plan 2016-17 Page 22 of 60

Reduction in falls and fall related harm remains a key strategic priority for NHS Forth Valley. A falls reduction improvement plan is lead by a Falls Strategic Group and a Falls Implementation Group. A post fall review tool is in use. To date a sustained reduction in falls has been achieved in the pilot wards but this impact has not yet been sustained across the organisation. 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. This priority is a key part of the nursing and midwifery care assurance system and approach. The senior charge nurse drives this improvement within each ward area. This important work is supported by the Tissue Viability Service. 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. We have adopted a zero avoidable approach to the prevention of pressure ulcers with the objective of preventing all avoidable skin ulcers for people living in the Forth Valley area.

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 23 of 60

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.  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  Whilst SAB infection reduction continues to be a challenging area, for the period April 2015 – March 2016 NHSFV achieved a 5% decrease in SABs compared to April 2014 - March 2015. There has been a continued reduction each quarter and the last quarter (Jan-Mar 2015) had the lowest case numbers since 2013. NHSFV has been proactive in reducing SAB numbers, for example a Peripheral Venous Catheter (PVC) insertion maintenance bundle has been implemented and audited across FVRH. This year has seen a 25% reduction in hospital acquired SABs and there have been no PVC SABs since July 2015.  Communication has continued to improve and each directorate receives a specific report for their area, which includes SABs, CDIs and all device associated bacteraemias (an initiative that is unique in NHS Scotland). NHS FV has also revised and implemented various insertion and maintenance bundles for invasive devices including PVC, CAUTI, long lines (Hickman, CVC, PICC etc), LVPs, LP, and chest drains to reduce infection risk.  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 and continues to maintain low numbers.

NHS Forth Valley Local Delivery Plan 2016-17 Page 24 of 60

The Antimicrobial Management Group reviews all cases for opportunities to reduce the CDI numbers further.  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.

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 continued improvements in HSMR.  Deliver key actions associated 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 including SABs

NHS Forth Valley Local Delivery Plan 2016-17 Page 25 of 60

2.3.4 Performance Management

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

NHS Forth Valley Local Delivery Plan 2016-17 Page 26 of 60

2.4 Person-Centred

2.4.1 Strategic Context

The Strategic Quality Improvement Framework is our approach to focussing on quality, including safety and patient experience. The approach is 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 27 of 60

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”.

NHS Forth Valley Local Delivery Plan 2016-17 Page 28 of 60

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 29 of 60

2.4.4 Performance Management

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

NHS Forth Valley Local Delivery Plan 2016-17 Page 30 of 60

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. It is envisaged that the transitional GMS contract for 2016/17 will focus on continued quality improvement, enabled by practices working collaboratively in “Clusters”. Transitional GMS arrangements and cluster-working will be considered within the context of integration, current work around locality planning, the RCGP vision for general practice, the national clinical strategy and sustainability issues relating to the recruitment and retention of GPs.

In Forth Valley we have six locality groupings developed to support collaborative work and aligned with the Localities Guidance for Health and Social Care Integration. While it is expected that the localities will form, and inform, the basis of cluster working, clusters are likely to be smaller, more discrete groupings of practices within localities.

Work is ongoing with all practices to identify a Practice Quality Lead (PQL) and for all clusters to have an appointed GP working as a Cluster Quality Lead (CQL) to support improvement work. It is anticipated that the Cluster Lead will also be a GP based within the Cluster.

Collaborative cluster working, focussed on continuous quality improvement, will inform the delivery of new models of care and development of a more resilient community infrastructure that will deliver community based, anticipatory and preventative care.

There will be a need to ensure;

 Effective communication and information sharing  Minimisation of bureaucratic processes  Effective engagement with practices  Appropriate linkage between cluster working and locality planning to avoid duplication and disengagement  Focus on enabling collaborative working where practices work together helped by provision of data and information that within networks

NHS Forth Valley Local Delivery Plan 2016-17 Page 31 of 60

 Organisational and OD support to recognise CQL training and development needs  Alignment of clusters and CQLs within organisational and Primary Care Clinical Leadership infrastructure  Efficient recruitment process for CQLs and clarity of funding arrangements

NHS Forth Valley faces sustainability challenges due to GP recruitment and retention issues. We have learned from implementing multi-professional working models through adopting 2c practices at Bannockburn and Kersiebank.

Sir Lewis Ritchie’s review of out of hours primary care services will be addressed through the Local Unscheduled Care Plan.

During 2015/16 a pilot project looked at the input of community pharmacy in the Medicines Reconciliation Process following discharge from FVRH. The project showed a positive impact on patient safety and it is our intention to extend this Quality Improvement work to involve all community pharmacies in NHS Forth Valley throughout 2016/17.

Pharmacy Locality Co-ordinator roles have been developed to work with relevant stakeholders to support the development of an effective Pharmacy network which will link in to the Locality model and support cluster working.

The recent review of the Control of Entry to the Pharmaceutical List will result in a revision of the Boards Pharmaceutical Care Services Plan. The locality co-ordinator roles will support this review.

Building capacity across Primary care remains a key priority for Pharmacy Services. Through Prescription for Excellence, a new 'Pharmacy First' community pharmacy service has been introduced locally to support the challenges of accessing GP services in hours and out of hours. This local service allows community pharmacists to treat uncomplicated urinary tract infections, impetigo and COPD exacerbations under locally agreed Patient Group Directions (PGD). This will help reduce the number of GP consultations and reduce the number of visits to Out Of Hours for these common conditions.

In order to support and build clinical capacity across GP practices with significant GP workforce challenges, additional primary care pharmacy posts were appointed in September 2015 to support a new primary care Multi-Disciplinary Team (MDT). To build clinical capacity within MDTs working in community hospitals and care home facilities additional pharmacist posts were appointed in January/February 2016. Both these initiatives have been funded through Primary Care Development Funding.

The need to mainstream and exploit the value of telehealth services has been highlighted as a priority through the Clinical Service Review, particularly through the

NHS Forth Valley Local Delivery Plan 2016-17 Page 32 of 60

Long Term Conditions and Frailty work streams and through work aligned with the implementation of the Dementia Strategy. Remote access to information remains a challenge for community workers and has been prioritised within the e-health strategy. Most practices use online prescription ordering services, with an increasing number offering online appointments. This is being highlighted through the Forth Valley Practice Managers Group.

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.

Child dental health has been monitored routinely since 2004 in Primary 1 and Primary 7 pupils. With the development of the Childsmile Programme from 2007 onwards a national target was introduced to monitor one aspect of this programme, fluoride varnish applications, in two target age groups, 3 and 4 year olds. Although Forth Valley did not meet the March 2014 target of 60% of children aged three and four years old receiving two or more fluoride varnish applications for all quintiles of deprivation, high levels were achieved among the most deprived quintiles and substantial improvements in dental caries, with corresponding reductions in dental general anaesthetics for children, have been achieved. In order to better monitor changes in the oral health of children and provide a more comprehensive understanding of the impact of improvement work, NHS Forth Valley has developed a Child Dental Health Dashboard highlighting a range of data.

With an ageing population and associated growth in age related eye conditions, opportunities to optimise the role of primary care optometry will be considered.

2.5.2 Progress During 2015-16

Last year NHS Boards set out their prioritised actions 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 33 of 60

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.

Planning & interfaces Positive progress has been made in developing a locality planning structure and progressing the principles of anticipatory care. Locality Action Plans are being 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.

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. 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 34 of 60

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.

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 35 of 60

2.5.4 Performance Management

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  Dashboard for monitoring child dental health

NHS Forth Valley Local Delivery Plan 2016-17 Page 36 of 60

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 Act 2014 and the supporting guidance.

Integration Joint Boards (IJBs) have been formally established since 1 April 2016. Full delegation of functions 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 fall under the Integration Authority as set out in the Integration Scheme.

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 with delegation by Local Authorities and the Health Board of all functions within scope of integration, to an IJB with accountability for overseeing the provision of functions.

Transitional Boards progressed with preparing for integration on 1 April 2016. Chairs and Chief Officers were appointed in 2015. Strategic Planning Groups have developed Strategic Plans which were 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. Strategic plans for each Partnership were subject to a period of consultation and are now approved.

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 37 of 60

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 Services Directorate (CSD) Services during 2015-16. This included retaining Sub Committees, Joint Management Team, PPF and Staff Partnership Forum. As the IJBs 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

 Contribute to the Strategic Planning process and support the development of an annual operational delivery plan for each Health and Social Care Partnership.  With the IJBs 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.  Interpret 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.  Support the implementation of a robust evaluation process in each Partnership to review all Partnership funding arrangements.  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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 38 of 60

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

NHS Forth Valley Local Delivery Plan 2016-17 Page 39 of 60

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 the Board will make every endeavour to meet the TTG target. However it should be recognised that in the current constrained financial environment, achieving the TTG targets will be challenging for the Board. It is proving difficult to maintain the 12 week Outpatient standard locally. During 2016/17 we will make every effort to improve the position in Forth Valley. Within CAMHS and psychological therapies, we have increased the available capacity considerably, however it is likely to be some time before we are able to make a significant improvement in the associated referral to treatment standards.

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. A range of projects are being delivered using mental health innovation funding to improve access to CAMHS and psychological services. The redesign has 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 40 of 60

2.7.3 Improvement Actions 2016-17

 Make progress with delivering the access standards for patients in Endoscopy, CAMHS, Psychological Therapies and Musculoskeletal (MSK).  Strive to maintain the delivery of TTG and the Cancer standards, recognising that there is a significant resource risk associated with their delivery.  Make progress towards reducing the percentage of patients waiting over 12 weeks for an outpatient appointment by March 2017. This will impact on our ability to deliver the 18 week referral to treatment standard (RTT target 90%).  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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 41 of 60

2.7.4 Performance Management

Measures LDP Standard 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).  Eligible patients commence IVF treatment within 12 months (90%). 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  Access to MSK services Close monitoring of:  Outpatient unavailability  Inpatient unavailability

NHS Forth Valley Local Delivery Plan 2016-17 Page 42 of 60

2.8 Unscheduled Care

2.8.1 Strategic Context

The Scottish Government introduced the 6 Essential Actions programme for unscheduled care in June 2015 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 in 2016-17 will remain on delivering the “6 Essential Actions”, working closely with the national team to support implementation, as outlined in NHS Scotland Director of Performance’s letter to Board leads regarding unscheduled funding for 2016-17 and the associated reporting arrangements.

The “6 Essential Actions” are:

 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.

Every effort will be made towards achieving 95% compliance, as per the trajectory set out in the NHS Forth Valley response to the Director of Performance’s letter.

During 2015-16 further activity was also identified in the FV Winter Plan and development of two Partnership Integration Health and Social Care Plans.

NHS Forth Valley Local Delivery Plan 2016-17 Page 43 of 60

2.8.2 Progress During 2015-16

 Improvement in NHS Forth Valley, towards 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 and bring back patient as urgent follow-up where appropriate. Delete frailty  Commenced development of ward action plans to address the requirements of the 6 essential actions.  Continued roll out of IHO programme.  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, Charge Nurses and Advanced Professional Practitioners to ensure patient flow across extended hours and weekends.  Continued roll out of IHO programme (NHS Forth Valley is one of three national pilots working with the Institute of Health Optimisation (IHO) to help reduce delays for patients. The aim of the programme is to even out the peaks and troughs. The IHO patient flow programme will continue to be rolled out in acute wards during 2016-17).  Introduce frailty criteria for unscheduled care admission to ensure the appropriate route for patients.  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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 44 of 60

2.8.4 Performance Management

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 45 of 60

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. Whilst is is anticipated that the target will remain a challenge during 2016-17, we will make every effort to meet this.

Mental Health innovation funding, along with local investment, has been used to fund 3 of the 9 additional mental health nursing posts for CAMHS. The innovation funding was also used to contribute to the Interventions for Vulnerable Youth Project which has supported frontline professionals to weigh up the best approach to treatment and risk management and to the Safespot mobile App, which incorporates mental wellbeing and positive safety planning into children’s mobile devices.

During 2016-17 it is planned to use innovation funding to develop a CAMH intensive treatment service to support children in the community and to provide additional capacity in Tier 2 provision, to provide early and effective intervention as well as prevention. It is also planned to enhance psychological therapies for young offenders in 2 national prisons in the area.

NHS Forth Valley Local Delivery Plan 2016-17 Page 46 of 60

The recently appointed Information Co-ordinator within CAMHS has supported an improvement in process and data collection within the service. This development has resulted in the ability to assess the impact any new posts and to provide accurate and meaningful reports around workforce, waiting times and waiting list management.

A training needs analysis was completed in 2015 and priority areas identified were Cognitive Behavioural Therapy, Talking Therapies, Dyolic Developmental Psychotherapies and Family Therapy.

All essential actions within the CAMHS action plan have been completed and the redesign process will continue, which will focus on improving efficiency, performance and capacity within the service. Due to challenges around recruitment and staff relocating, the service is not yet up to full capacity. It is anticipated that by September 2016 a full complement of staff will be in post.

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. Whilst Board performance against the psychological therapies target improved in the latter part of 2015 and early 2016, capacity issues due to staff absence and retirals and a growth in referrals have made sustaining the improvement difficult. Every effort will be made to achieve this target, however it is anticipated that the target will remain a challenge during 2016-17.

Mental Health innovation funding has been used in the psychological therapies service, and in 2016-17, clinical psychologists for older people and substance misuse will be recruited along with a Cognitive Behaviour Therapist for adult mental health. The funding is being used to address some of the service gaps identified in the review of services.

Recent improvements in local data collection and analysis have allowed reporting of clinical activity at an individual clinician level and this enables the impact of additional psychological therapies funding to be tracked and assessed, for each new post appointed.

A training needs analysis has been completed across mental health services and the principal training needs to be addressed are Cognitive Behaviour Therapy with services for adults and older people, perinatal and eating disorder services and also for psychosis; Supervision for people with learning disabilities; phased based interventions for trauma; non-pharmacological interventions for stress and distress in dementia.

NHS Forth Valley Local Delivery Plan 2016-17 Page 47 of 60

The 2015-16 psychological therapies action plan was implemented fully. This included the internal redesign of the psychology service to improve accountability and supervision arrangements and a review of job plans, with new staff appointed on generic job descriptions to maximise flexibility. All 9 WTE new posts were recruited to successfully. A wider redesign of psychological therapies is progressing.

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.

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 48 of 60

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.  Make progress with delivering 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.

2.9.4 Performance Management

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 annual referrals

NHS Forth Valley Local Delivery Plan 2016-17 Page 49 of 60

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 Scottish Budget in February 2016, its associated implications and an update of issues facing the NHS, identified a requirement for cash savings of 6% (£26.614m) in 2016-17. Cash savings of this magnitude 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 uplift of 4.6% this includes the local share of £250m which direction has been given to Boards to allocate to Integration 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% scheduled for April 2017), 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; reducing the percentage of patients waiting in excess of the 12 week outpatient standard, together with setting aside resources for winter of 2016.

NHS Forth Valley Local Delivery Plan 2016-17 Page 50 of 60

The initial Financial Plan 2016-17 – 2020-21 was approved at the end of March 2016. This has been 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. In March 2016, £4.923m recurrent cash savings remained unidentified and a risk of £10m - £12m highlighted. A further update, including the draft Capital Plan will be considered by the Board at the end of May, however approximately £2m recurrent cash savings still require to be identified.

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

Measures LDP Standard  Operate within agreed revenue resource limit; capital resource limit; and meet cash requirement

NHS Forth Valley Local Delivery Plan 2016-17 Page 51 of 60

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 Single Outcome Local 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) and the development of the NHS Forth Valley Healthcare 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 52 of 60

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 CSD 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 53 of 60

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 will develop a Health Improvement Strategy to coordinate activity across the multi-agency partners and target the underlying causes of health inequality. 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 54 of 60

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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 55 of 60

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 32 (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, Everyone 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.

NHS Forth Valley Local Delivery Plan 2016-17 Page 56 of 60

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

Measures LDP Standard  Sickness absence 4%

NHS Forth Valley Local Delivery Plan 2016-17 Page 57 of 60

APPENDIX 1 – NHS Forth Valley Strategic Planning Matrix

NHS Forth Valley Healthcare Strategy Health and (Under Review 2016) Social Care Partnership Strategic Local Delivery Plan Plans

NHS Forth Valley

Annual Plan

Unscheduled Care Financial & Workforce Elective Single Plan Capital Plan Plan Capacity Outcome Plan Agreements/ Local Delivery Plan

Winter Plan

Underpinned by:  Local Strategies e.g. eHealth, Workforce Modernisation  Directorate and Corporate Plans

NHS Forth Valley Local Delivery Plan 2016-17 Page 58 of 60

Glossary

ABI Alcohol brief interventions ACP Anticipatory Care Plan AHP Allied Health Professionals ALFY Advice Line for You BBV Blood Borne Viruses CAMHS Child and Adolescent Mental Health Services CAUTI Catheter-Associated Urinary Tract Infections CCG Clinical Care Governance CDI Clostridium Difficle CEL 52 Scottish Government Workforce Planning Guidelines CHD Chronic Heart Disease CSD Community Services Directorate COPD Chronic obstructive pulmonary disease CPP Community Planning Partnership CQL Cluster Quality Lead CSR Clinical Services Review CVC Central Venous Catheter ED Emergency Department eKSF Knowledge and Skills Framework EQIA Equality and Diversity Impact Assessment EYC Early Years Collaborative FVADP Forth Valley Alcohol and Drug Partnership FVWMS NHS Forth Valley’s Weight Management Service GIRFEC Getting it Right for Every Child GMS General Medical Services HAI Healthcare associated infection HEAT Health Efficiency Access Treatment (targets – Scotland) HEI Healthcare Environment Inspectorate (Scotland) HIHI Health Improvement & Health Inequalities HPHS Health Promoting Health Service HSMR Hospital Standardised Mortality Ratio ICF Integrated Care Fund ICU Intensive Care Unit IHO Institute for Healthcare Optimization IJB Integration Joint Boards IT Information technology IVF In vitro fertilisation LDP Local Delivery Plan LEP Local Employability Partnership LES Local Enhanced Service LOS Length of stay LP Lumbar puncture LPVs Left portal vein MCN Managed Clinical Network MCQIC Maternity and Children Quality Improvement Collaborative MDT Multi-Disciplinary Team MHAIST Mental Health Access Improvement Support Team

NHS Forth Valley Local Delivery Plan 2016-17 Page 59 of 60

MoSES Morbidity and Mortality Significant Event System MSK Musculoskeletal NDHIT The Nutrition & Dietetic Health Improvement Team NMWWP National Nursing and Midwifery Workforce Tools and Planning Programme OD Operational Development OOH Out of Hours ORT Opiate Replacement Therapy PDS Post Diagnostic Support PFPI Patient Focus Public Involvement PGD Patient Group Directions PICC Peripherally Inserted Central Catheter PPF Public Partnership Forum PQL Practice Quality Lead PVC Peripheral Venous Catheter QIRMG Quality Improvement Risk Management Group QOF Transitional Quality Arrangements RAFA Raising Attainment For All RCGP Royal College of General Practitioners RTT 18 Weeks Referral to Treatment SAB Staphylococcus aureus bacteraemia (Meticillin Resistant (MRSA/MSSA) Staphylococcus aureus / Meticillin susceptible Staphylococcus aureus) SH Sexual Health SIMD Scottish Index of Multiple Deprivation SOAs Single Outcome Agreements SOLD Single Outcome Local Delivery Plans SPSP National Scottish Patient Safety Programme SSI Surgical Site Infection TTG Treatment Time Guarantee VTE Venous thromboembolism

NHS Forth Valley Local Delivery Plan 2016-17 Page 60 of 60

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 14 on the agenda

Stirling Care Village – Full Business Case Update

(Paper presented by Kathy O’Neill, General Manager, Community Services Directorate)

For Approval Approved for Submission by Shiona Strachan, Chief Officer Author Kathy O’Neill, General Manager, Community Services Directorate Morag Farquhar, Project Director Ewan C. Murray, Chief Finance Officer (in capacity as Project Accountant) Date: 22 June 2016 List of Background Papers: Stirling Care Village Update - 27 April 2016 Stirling Care Village – Case for Change Element of Full Business Case, 11 December 2015 (Transitional Board)

Page 1 of 8

Title/Subject: Stirling Care Village – Full Business Case Update Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Kathy O’Neill, General Manager Action: For Approval

1. Introduction

1.1 This report provides the Integration Joint Board with an update on completion Full Business Case for Stirling Care Village and presents the key service implications for the Integration Joint Board.

1.2 Capital investment, asset and facilities management are outwith the scope of delegated functions of the Integration Joint Board and as such the technical elements of the Full Business Case are not relevant as the Integration Joint Board is not the procuring authority. A redacted version of the Full Business Case document will be published in due course.

2. Background

2.1 An important milestone in the Stirling Care Village project has been reached with completion of the Full Business Case (FBC). 2.2 The project is being progressed jointly between Stirling Council, NHS Forth Valley and the Scottish Ambulance Service (the participants) supported by Forth Valley College. The proposed development is being taken forward as a Design Build Finance and Maintain (DBFM) project through hub East Central Scotland Ltd (hubco) in which the Council, NHS Forth Valley and Scottish Ambulance Service are Participants. 2.3 The preferred way forward will see a step change in the provision of Older People’s Services with the creation of the Care Hub: a 116 place facility with a focus on integrated care provision and short stays enabling older people to remain in or go back to their own homes, avoiding long term residential care as far as possible. The Care Hub is one of the key elements within the wider plan for reshaping the care of older people. Also to be provided will be Primary and Unscheduled Care Services in a new building along with Diagnostic Services and a base for the Scottish Ambulance Service. A separate facility will be constructed on the site for the Ambulance Service who propose to relocate their workshop facility, also currently elsewhere in Stirling. 2.4 The Outline Business Case for the project was approved by the participants in December 2013 before ongoing discussion with the Capital Investment Group and being approved by them in March 2015. Due to the previously reported national financial position and European Standards of Accounting (ESA 10), completion of the Full Business Case was delayed and a two stage process undertaken with the first stage, The Case for Change, approved by all the participants of the project in November 2015. Feedback on the first stage was received from Capital Investment Group members in April 2016 and the FBC

Page 2 of 8

document has subsequently been revised and completed with all financial and economic information. 2.5 The Integration Joint Board agreed the core principles of the case for change element of the Full Business Case in December 2015 subject to the Full Business Case incorporating the full resources.

2.6 Delivery of the Stirling Care Village is an agreed priority for the Integration Joint Board within the Strategic Plan.

2.7 The participants are required to individually approve the Full Business Case through their own governance systems. NHS Forth Valley approved the Full Business Case in private session on 31st May 2016. Stirling Council have agreed delegated authority to officers to provide the necessary approvals and Scottish Ambulance Service will consider the Full Business Case in the near future.

2.8 The Full Business Case has now been submitted to Scottish Government for consideration at the Capital Investment Group meeting of 7th June 2016. This consideration will be subject to the participants approvals detailed in 2.7 being in place prior to financial close.

2.9 Given that the service implication detailed in section 4 of this report relate to services falling under the span of responsibilities of the Integration Joint Board it is imperative that the Board understand and approve the service and financial implications prior to the project reaching financial close.

3. Recommendations

The Integration Joint Board is asked to:

3.1. Note the background of the project including the approvals processes.

3.2. Note the service implications of the project in relation to functions delegated to the Integration Joint Board

3.3. Approve the resource implications identified for the services delegated to Integrated Joint Board as detailed in Section 5 and Appendix I of this report.

4. Service Implications

4.1 There are a number of key system challenges in delivering this new model:

• The Care Hub is one element of a wider range of community support including preventative services such as community rehabilitation and Reablement and availability of crisis services such as Closer to Home. These can help support people to remain well at home and avoid unnecessary admission to Hospital. There will be a need to continue to prioritise and potentially increase partnership funding in these areas.

Page 3 of 8

• Ongoing availability of home care and long term care places to maintain flow through the Care Hub will be essential, as will the continued provision of respite care outwith the Care Hub facility, as planned. • The Old Age Psychiatry Service will need to be effective in moving to an intermediate care bed model, with successful implementation of NHS Continuing Care guidance to reduce current long lengths of stay. • Stirling Council has been successful in redesigning its care home services with only one care home (Allan Lodge) continuing to care for a small number of long term care residents (currently 4). The Council has given an ongoing commitment to support the care of these residents for as long as it is required.

4.2 There are also a number of system changes and developments which will have a positive impact on the care model over time:

• The Care Hub will increase the availability of intermediate care beds in Stirling, maximising the opportunity for patients to return home. • The Care Hub workforce model includes additional health staff (e.g., AHP’s and specialist nurses) to support an intermediate care model. • Partnership funding is currently being utilised to bridge additional health and social care rehabilitation and reablement services. The Care Village will mainstream these services and associated costs with the expansion of intermediate care beds in the Care Hub. • The Care Hub will offer more opportunity for patients to “step up” from home, avoiding the potential for admission. • Complementary work is ongoing in rural Stirlingshire to develop community hub type services, focussed around Strathendrick Care Home. • The introduction of the GP Fellow (Community Physician) role within Forth Valley will also complement this development.

5. Resource Implications

5.1. The financial and economic cases have been updated in completing the Full Business Case. The Full Business Case process requires the options identified at Outline Business Case to continue to be tested for affordability and good value. This process has continued to show that the preferred way forward as detailed above continues to prove to be both affordable and good value.

5.2. Subject to participant and Scottish Government approvals there is a need to move the project to financial close as quickly as possible to mitigate against the risk of inflation.

5.3 It is, however, imperative for the Integration Joint Board to understand and approve the resource implications associated with it’s delegated functions and within the overall affordability of the project. A redacted summary affordability statement is provided in Appendix 1 of this paper.

Page 4 of 8

Key Affordability Assumptions for Overall Project:

This illustrates that the project is affordable based on the following key assumptions: • Detailed costed workforce planning for the care hub. • Release of resource for commissioning respite care equal to 14 beds outwith the care village (£0.153m). • Release of net revenue resources totalling £0.504m • Scottish Government revenue support for the unitary charge in line with the financial case within the Full Business Case • NHS Forth Valley funding of £ 0.049m to support future primary care capacity (included in NHS Forth Valley Financial Plan). • Stirling Council funding of £ 0.287m in lieu of capital injections. • Recovery for VAT on the unitary charge is allowable. • Costs for Soft Facilities Management (FM) services, retained Facilities Management responsibilities, Utilities, and Rates are in line with estimates made.

Key Resource Implications for Services Delegated to Integration Joint Board

• Costed workforce plan for Care Hub with total annual cost of £4.836m which includes provision to mainstream c£0.530m of investment from Partnership Funding Streams.

• Release of net revenue resources totalling £0.504m

• Inclusion of £2.962m of Primary & Urgent Care service resources funded from existing budgets. • Release of resource for commissioning respite care equal to 14 beds outwith the care village (£0.153m). • Ongoing availability of home care, long term care places and community supports to support flow through the Care Hub

6. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

6.1. Delivery of Stirling Care Village is an agreed priority within the partnerships Strategic Plan

Page 5 of 8

7. Legal & Risk Implications

7.1. Legal Advisors have been appointed as part of the project governance structure and continue to provide advice to the participants.

7.2. A detailed risk assessment has been undertaken and Risk Register developed in association with hubco. Joint and separate risks have been identified, costed and included in the financial analyses within the Full Business Case.

7.3. Major or high cost public sector risks are in relation to funding, specifically revenue funding support from Scottish Government, recovery of VAT on the Unitary Charge, unfavourable market conditions. The largest, in financial terms, single risk is that of VAT being chargeable on the Unitary Charge payment, although it is of low probability. HMRC will review the Project Agreement and advise of the VAT treatment.

8. Consultation

8.1. There has been extensive consultation processes throughout both the Outline and Full Business Case stages. This has included Public, Officer and Elected Member consultation and briefings.

9. Equality and Human Rights Impact Assessment

9.1. No specific equality issues are identified in this report.

10. Exempt reports

10.1. Not exempt

Page 6 of 8

Page 7 of 8

Page 8 of 8

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 15 on the agenda

Community Services Directorate

Paper presented by Kathy O’Neill

For Noting

Approved for Submission by Shiona Strachan, Chief Officer Author Kathy O’Neill, General Manager Date: 22 June 2016 List of Background Papers: None to note

Page 1 of 4

Title/Subject: Community Services Directorate Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Kathy O’Neill Action: For Noting

1. Introduction

1.1 The purpose of this paper is to confirm to the Integration Joint Board the operational arrangements for community health services following the disestablishment of the Community Health Partnership on 1 April 2016.

2. Recommendations

The Integration Joint Board is asked to note the Paper.

3. Background

3.1. Community Health Partnerships were legally disestablished on 1 April 2015. However, Health Boards were asked to implement transitional arrangements for Community Health Partnerships pending the legal establishment of Integration Joint Boards. In Forth Valley structures remained in place during 2015/16 until new arrangements including Integration Joint Boards and Strategic Planning Groups were in place.

3.2. The Community Health Partnership in Forth Valley supported both a partnership function, as per legislation, and a service delivery function as a single Directorate of NHS Forth Valley.

3.3. From April 2016, all of the formal partnership functions of the Community Health Partnership as they relate to adult services are now the responsibility of Integration Joint Boards.

4. NHS Forth Valley Community Services Directorate

4.1. From April 2016, the service delivery functions previously carried out by the Forth Valley Community Health Partnership will continue to be carried out by the single Community Services Directorate on behalf of NHS Forth Valley.

4.2. The Community Services Directorate will continue to deliver the same range of services provided by the former Community Health Partnership. Some of these services fall within the operational oversight function of the Integration Joint Board; others fall within the Strategic Planning function of the Integration

Page 2 of 4

Joint Board but are part of the “set aside” budget arrangements (e.g. mental health inpatient services); and a number of services fall out with the scope of adult health and social care integration.

5. Conclusions

5.1. Through NHS Forth Valley, the Community Services Directorate will implement the directions of the Integration Joint Board as they relate to those community health services in scope. The General Manager of the Community Services Directorate will continue to work closely with the Chief Officer of the IJB to ensure community services in Clackmannanshire & Stirling support the development and implementation of the Strategic Plan.

6. Resource Implications

6.1. There are no additional resource, or legal implications arising from this paper

7. Impact on Integration Joint Board Outcomes, Priorities and Outcomes

7.1. The Community Services Directorate will support the Integration Joint Board in implementing its outcomes and priorities.

8. Legal & Risk Implications

8.1. None to note

9. Consultation

9.1. As this is a continuation of an existing service delivery arrangement no formal consultation has been undertaken.

10. Equality and Human Rights Impact Assessment

10.1. As this is a continuation of existing service delivery arrangements, no equalities assessment has been undertaken.

11. Exempt reports

11.1. No

Page 3 of 4

Page 4 of 4

Clackmannanshire & Stirling Integration Joint Board

22 June 2016

This report relates to Item 16 on the agenda

Models of Neighbourhood Care

(Paper presented by Chris Sutton)

For Noting and Approval

Approved for Submission by Shiona Strachan, Chief Officer Author Chris Sutton, Service Manager , Social Services Date 22 June 2016 List of Background Papers: Royal College of Nursing (2015) The Buurtzorg Nederland (home care provider) model : Observations for the United Kingdom Health and Social Care Integration Directorate (2016) Letter about Models of Neighbourhood Care - Buurtzorg Appendices: Appendix One: Clackmannanshire and Stirling Partnership: Expression of Interest: Models of Neighbourhood Care - Buurtzorg

Page 1 of 9

Title/Subject: Models of Neighbourhood Care

Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 22 June 2016 Submitted By: Chris Sutton Action: For Noting and Approval

1. Introduction

1.1 The purpose of this report is to provide background information to the Integration Joint Board about testing a neighbourhood model of care in Scotland. The report also seeks the Board's approval to further develop the Clackmannanshire and Stirling Partnership expression of interest in testing this model in the communities in South West Rural Stirling.

1.2 The proposal is to develop an outline business case for the re design services using the Buurtzorg principles in rural West Stirlingshire within the area covered by the G63 postcode - Balfron; Killearn; Drymen; Buchlyvie and Strathblane (total GP practice population 10873), building on the work already taking place in that area to engage and work with our communities.

2. Recommendations

2.1. The Integration Joint Board is asked to:

• note the contents of this report • approve the further development of an outline business case in relation to models of neighbourhood care using the principles of Buurtzorg and building on the work already taking place in the area in relation to ‘working with our communities’ • approve the continued engagement with the Scottish Government with a view to securing a pilot programme to establish a multi disciplinary model of neighbourhood care • agree that the outline business case will be brought back for consideration by the Integration Joint Board in due course

3. Background

3.1 Buurtzorg was founded in the Netherlands in 2006/7. It began as a neighbourhood model of nursing care. Buurtzorg has extended to provide a wider range of services and supports including domestic care, hospice and respite services. Over a ten year period, the organisation has grown from one team of four nurses to having over 10,000 staff in 850 self organising teams.

Page 2 of 9

3.2 Buurtzorg is based on a set of three core principles:

• Putting the person at the centre of care with an emphasis on promoting self-care and independence and the active involvement of family, neighbours and the wider community; • Autonomy for the staff providing care with freedom to work in small, self-managed teams, supported by a light back office function and with minimal administrative requirements; • A strong focus on preventing unnecessary admission to hospital and ensuring those being discharged from hospital are cared for in their own homes or in a homely setting.

The Buurtzorg approach has secured international acclaim for the high levels of satisfaction from those who receive the service. This has included positive feedback from staff members and the reduction in the use of hospital based resources and associated cost effectiveness.

3.3 The principles of Buurtzorg align closely with the Scottish Government's ambitions for Health and Social Care Integration, the Community Empowerment (Scotland) Act 2015, the National Health and Wellbeing Outcomes, the National Clinical Strategy, the current review of District Nursing and the Self-directed Support Strategy. The ethos is consistent with supporting choice, control, flexibility and improving personal outcomes for individuals.

3.4 In November 2015, a delegation of civil servants, NHS Board/Local Authority representatives and members of the Chief Nursing Officer's team visited the Netherlands to see Buurtzorg in practice. This included officers from the Clackmannanshire and Stirling Partnership area. The visit focused on the day- to-day experience of Buurtzorg staff and the people who use their services. Delegates shadowed a nurse and gained an understanding about the impact of the Buurtzorg approach on career progression, leadership, accountability and support arrangements (including coaching and IT support).

3.5 The Scottish Government asked for expressions of interest to test the Buurtzorg approach across Scotland. It was proposed that half the tests would be nurse led and that half would be a form of "Buurtzorg plus", where either multiagency teams or social care providers adopt the Buurtzorg principles.

3.6 This approach is consistent with service developments across Forth Valley, across the Health and Social Care Partnership and builds on the work already in place in relation to working with communities within the rural locality of Stirling, designed to promote person-centred care and the active engagement of people using health and social care services, unpaid carers, volunteers and local residents and harnessing the flexibility and contribution of the third sector and other local organisations. A neighbourhood approach to delivering health and social care services meets the strategic priorities within the Clackmannanshire and Stirling Health and Social Care Partnership Strategic Plan 2016-2019. Specifically, this approach will promote information sharing, support co-location of multi-disciplinary teams, develop single points of access for key services and will be targeted to reduce the number of unplanned

Page 3 of 9

admissions to hospital and support people to remain in their own homes, wherever possible.

3.7 The test site or pilot would be closely linked to the Technology Enabled Care Programme and the proposals for use of the Transformation of Primary Care Fund. The focus on extending multi-disciplinary models of service delivery, improving self management and building on existing goof practice in Anticipatory Care Planning are key features of the proposed test.

3.8 It is planned that the tests will be designed over the next six months and will operate for a two - three year period. It is expected that the tests will be targeted at addressing unscheduled admissions and/or delayed discharge and will make a specific contribution to the delivery of the National Health and Wellbeing Outcomes and associated indicators.

4. Report

4.1 The principles of Buurtzorg are not new. There is close alignment with the community and person centred approach to delivering District Nursing and community nursing services in Scotland, and, more recent developments in anticipatory and intermediate care have similar core values. However, it is recognised that there will be a need to adapt Buurtzorg for delivery within the Scottish context.

4.2 The Buurtzorg approach mirrors much of the work that we are currently progressing across the Clackmannanshire and Stirling Partnership. The principles are aligned to the philosophy of "Closer to Home" which characterises our approach to changing models of health and social care. The principles can be seen in the priorities set out in the Clackmannanshire and Stirling Strategic Plan 2016 – 2016; specifically the emphasis on promoting person centred - care, the active engagement and involvement of people using health and social care services, unpaid carers and local citizens.

4.3 The intention, in line with the national expectations, is to test Buurtzorg in a small area with a view to understanding the potential benefits and sharing the learning both at a national level and across the wider Partnership area.

4.4 The proposal is to test the application of Buurtzorg in a small number of communities in South West Rural Stirlingshire. It is proposed that the model will be a form of "Buurtzorg plus" developing a multi-disciplinary team focused on a defined locality, covering a small group of GP practices rather than a ‘pure’ Buurtzorg. It is intended that the model will support the delivery of the Locality Plan for the rural area of Stirling and will support the move to integrated, community-based multi-professional teams, based around General Practice. Appendix One provides more information about the proposed test in the form of a high level expression of Interest which has been submitted to the Scottish Government. The next session with the Scottish Government is scheduled for 27 June 2016.

Page 4 of 9

4.5 It is intended that the tests will form part of a nationally facilitated programme and be supported with input from the Improvement Hub (iHub). The support will include delivery of national and local workshops, coaching and evaluation. Taking into account wider developments that will impact on the health and social care system and on the health and wellbeing outcomes, over the next two-three years, the design and approach to evaluation will be critical. In order to understand the specific benefits of adopting Buurtzorg, the tests will need to identify the ways in which adopting the neighbourhood ethos and approach has impacted on the intended outcomes.

4.6 There is no significant additional funding attached to the test or pilot sites and the additional support would come to the partnership in the form of the Improvement resource described above.

4.7 While the improvement support would be valuable there is sufficient interest within the partnership to continue to develop an outline business case for further consideration.

5. Resource Implications

5.1. There are no direct resource implications.

6. Impact on Strategic Plan Outcomes and Priorities

6.1. The objectives in this report are consistent with the vision and outcomes of the Strategic Plan 2016-2019.

7. Legal & Risk Implications

7.1. There are no legal or risk implications arising directly from this report, which is for information only.

8. Consultation

8.1 The proposed test is based on the consultation conducted to date to support the development of the Strategic Plan, the contents of the Strategic Needs Assessment. It is proposed that there will be full consultation as the work progresses to design the test.

9. Equality and Human Rights Impact Assessment

Not applicable.

Page 5 of 9

10. Exempt reports

10.1 Not exempt.

Page 6 of 9

Appendix One

Clackmannanshire and Stirling Partnership: Expression of Interest : Models of Neighbourhood Care - Buurtzorg

OUTLINE PROPOSAL

The proposal is to develop and re design services using the Buurtzorg principles in rural West Stirlingshire within the area covered by the G63 postcode - Balfron; Killearn;Drymen; Buchlyvie and Strathblane (total GP practice population 10873).

The village of Balfron is the largest of the communities and has both building base and service resource [including AHP; care at home; District Nursing; third sector] that would lend itself to re design of services:

• Person centred, outcomes focused assessment and care delivery • Anticipatory Care Planning • Care home bed based intermediate care to support hospital discharge and prevention of admission • Referral pathway from the nurse led Forth Valley telephone service ALFY [Advice Line For You] • Intermediate Care to people within their own homes • Care at Home services - including the independent and third sector • Technology enabled care • Palliative and end of life care at home and support to people with chronic conditions, including dementia • Community based early intervention - including links to local groups and third sector community initiatives such as lunch clubs, meal makers and Food Train • Local base along with GP practice which is located nearby for District Nursing • Closer to Home - enhanced 24/7 health and social care service to provide an alternative to admission • ReACH- rehabilitation at home service

A programme of community engagement is already underway as part of the wider development of place based services. In terms of the Stirling Single Outcome Agreement, this proposal would ensure that this group of rural communities are well served and better connected - specifically that people are able to maintain their independence and are able to access appropriate support when they need it. The proposal is also aligned to the Strategic Plan for the Health and Social Care Partnership and in particular the locality planning for rural areas and is aligned to the Primary Care Transformation Fund outline proposals.

The Buurtzorg principles and approach would provide a solid framework for the development of the services into locally led and delivered services on a 24/7 basis..

Page 7 of 9

OUTCOMES

Staff Resource increased job satisfaction, recruitment and retention in all sectors- we have difficulty recruiting and retaining; autonomy for local teams [including commissioned services]; co ordinated pathways; increased utilisation of all available resources.

Talking Points - widely used across the Stirling area - strong basis for evaluation of impact and an expected higher patient/client/carer satisfaction.

ACP- improved uptake and use of Anticipatory Care Planning to support people with long term complex needs and embedded into the approach

Reduction of Admissions and Delays to Discharge - people coming from this rural area of Stirling can be admitted to a range of hospitals - including those in the Glasgow area. There is considerable potential within a locally led and delivered service to deliver real improvements through enhanced responsiveness, improved confidence in services and utilisation of local knowledge and networks in relation to both unnecessary admission and discharge.

Health and Wellbeing - Supporting more people in their local community to lead active lives including people with long term conditions, complex needs and dementia. Greater utilisation of community resources and build community capacity

Seamless Services - Hub development allied to the operation of all services within a Buurtzorg principles based framework would have the potential to develop a single point of contact and service delivery - and over the span of the small scale test as it develops to reduce the management and bureaucracy footprint.

PARTNERS

Support from all key partners including the professional leads and GPs. The partnership has already participated in the visits to the Netherlands and in the national discussions. Should the submission proceed to stage two further discussion and more detailed consultation including the communities would be a key part of the development of the small scale test.

FUNDING

There are a number of funding streams already in place or being applied for which have the potential for alignment to support the development of the small scale test. In addition there are local resources both building and personnel which could be utilised in a different way. The majority of the current provision is from mainstream budgets.

Any additional short term funding would be welcome particularly around organisational development and planning/improvement support.

SUSTAINABILITY

Page 8 of 9

All partners are committed to working with local communities to develop a sustainable model. We are clear that we cannot continue to deliver services in the current way.

There is evidence of the partnership being able to develop and sustain new services and transformational change for service delivery both in the rural and city areas. The proposal is focused on utilisation of a range of existing resource across the communities rather than short term funding streams.

Page 9 of 9