Agenda Document Pack - Health and Social Care Integration Joint Board - 16/09/2026
North Lanarkshire Council · 16 September 2026
Back to Health and Social Care Integration Joint Board — 16 September 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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10 September 2026 Members of the Health and Social Care Integration Joint Board Chief Executive’s Office Rachel Blair Chief Officer (Legal, Democratic and Strategy) Civic Centre, Windmillhill Street, Motherwell ML1 1AB www.northlanarkshire.gov.uk Notice is given that a Meeting of the Health and Social Care Integration Joint Board is to be held in the Remote Meeting, on Wednesday, 16 September 2026 at 09:30 AM which you are requested to attend. The agenda of business is attached. Rachel Blair Chief Officer (Legal, Democratic and Strategy) Members : Clerk Name: Clerk Telephone: Clerk Email: A McCrory, C Barclay, B Baudo, B Burgess, P Couser, B Moore, S White. Page 1 of 264
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Agenda 1 Declarations of Interest In Terms of the Ethical Standards In Public Life Etc. (Scotland) Act 2000 2 Health and Social Care Integration Joint Board Minute of 17 June 2026 Submit minute of previous meeting held on 17 June 2026. 5 - 12 3 Performance, Finance and Audit Committee - Minute of Meeting held on 20 May 2026 Submit minute of the Performance, Finance and Audit Committee held on 20 May 2026. 13 - 18 4 Membership and Meeting Changes 5 Integration Joint Board Rolling Action Log/Matters Arising Submit the rolling action log for consideration. 19 - 26 6 Chief Officer Report Submit report by the Chief Officer, Health and Social Care North Lanarkshire. 27 - 34 7 External Auditor’s Annual Audit Report 2025/26 Submit report by the Chief Finance Officer. 35 - 72 8 Audited Annual Accounts 2025-26 Submit report by the Chief Finance Officer. 73 - 128 9 Medium Term Financial Outlook 2027-2030 Submit report by the Chief Finance Officer. 129 - 138 10 IJB Annual Performance Report 2025/26 Submit report by the Chief Officer (Planning, Performance and Quality Assurance) 139 - 188 11 Commnuity Mental Health Team Update Submit report by the Interim Head of Health. 189 - 198 12 Equality Outcomes 2026-2030 Submit report by the Chief Officer (Planning, Performance and Quality Assurance). 199 - 204 Page 3 of 264
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13 Obesity Pathway Innovation Programme - Quarter 1 Update Submit report by the Head of Transformation and Change. 205 - 214 14 Paediatric Modernisation Board Submit report by the Service Manager. 215 - 224 15 Nursing Future Workforce and Newly Qualified Practitioners Submit report by the Nurse Director. 225 - 232 16 Self-Assessment Questionnaire Results Submit report by the Head of Corporate Governance. 233 - 260 17 IJB Work Plan Submit report by the Head of Corporate Governance. 261 - 264 18 Risks Consider emerging risks arising from the business on the agenda. 19 Date of Next Meeting The date of the next meeting is scheduled to take place on Wednesday, 16 December 2026 at 9.30am. Page 4 of 264
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HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD WEDNESDAY, 17 JUNE 2026 AT 9.30AM PRESENT NHS Lanarkshire Brian Moore (Chair). Lesley-Ann McDonald North Lanarkshire Council Councillors McCrory (Vice Chair); Barclay; Baudo and Burgess. ALSO PRESENT Staff Representatives Catherine McGinty - NHSL John Watson – NLC Lived Experience Representatives David Wood – Third sector representative Ann Muir – Service user representative Harry Robertson – Carer representative Professional Advisors Alison Gordon, Joanne Jenkins, Josephine Pravinkumar North Lanarkshire Health and Social Care Partnership Maria Barry; Claire Chalmers; Morag Dendy; Diane Fraser; Pauline Izat; Lucy Munro; Nicola Scott; Kerry Taylor; Rose Walker NHS Lanarkshire Jen Hayes; Fiona McEwan; Kirsty Orr; Clerk Mark Hamill, NLC. Apologies Councillor Barclay; Philip Cousar; Claire Rae; and Siobhan White. WELCOME AND APOLOGIES 1. The Chair welcomed all attendees to the meeting and the apologies were noted. Decided: that apologies be noted. DECLARATIONS OF INTERESTS 2. The Board noted that there were no declarations of interest. Item 2 Page 5 of 264
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HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD WEDNESDAY, 17 JUNE 2026 AT 9.30AM PREVIOUS MINUTE FROM THE INTEGRATION JOINT BOARD COMMITTEE HELD ON 18 MARCH 2026 3. There was submitted the minute of the meeting of the Integration Joint Board held on 18 March 2026. Decided: that the minute of the meeting of the Integration Joint Board held on 18 March 2026 be approved. PERFORMANCE, FINANCE AND AUDIT COMMITTEE – MINUTE OF MEETING HELD ON 18 FEBRUARY 2026 4. There was submitted the minute of the meeting of the Integration Joint Board Performance, Finance and Audit Committee held on 18 February 2026. Decided: that the minute of the meeting of the Integration Joint Board Performance, Finance and Audit Committee held on 18 February 2026, be approved. MEMBERSHIP AND MEETING CHANGES 5. The Chair advised that there had been no membership changes since the last meeting of the Board. Decided: that it be noted that there were no membership changes. INTEGRATION JOINT BOARD ROLLING ACTION LOG/MATTERS ARISING 6. There was submitted the rolling action log providing an update on a number of actions arising from previous meetings. The Board noted the timeline in respect of action 35 “home support staffing”. Decided: that the updates provided and the addition to the rolling action log be noted. CHIEF OFFICER REPORT 7. There was submitted a report by the Chief Officer, Health and Social Care Partnership: (1) providing an update on the key areas of work and service developments that have taken place within North Lanarkshire in relation to the work of the Integration Joint Board; (2) summarising a number of highlights: (a) the launch of the Alcohol and Drugs Strategic Plan (2026-2035); (b) that Lynn Melville, Health Care Support Worker of NHS Lanarkshire had been awarded the 2026 Nursing Support Worker of the Year at the grand RCN Scotland Nurse of the Year Awards 2026, recognising outstanding nursing care and support across Scotland; (c) an unannounced inspection by Healthcare Page 6 of 264
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HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD WEDNESDAY, 17 JUNE 2026 AT 9.30AM Improvement Scotland; and (d) governance arrangements in terms of the change to the composition and voting arrangements of the Integration Joint Boards. Decided: that the key areas of work and service developments that have taken place within North Lanarkshire in relation to the work of the Integration Joint Board be noted. UNAUDITED NORTH LANARKSHIRE IJB ANNUAL ACCOUNTS 8. There was submitted a report by the Chief Finance Officer, Health and Social Care Partnership: (1) providing an overview of the unaudited North Lanarkshire IJB Annual Accounts for the financial year 2025/26; (2) setting out the annual governance statement and associated reports for inclusion within the statutory accounts; (3) seeking approval for the submission of the unaudited annual accounts to Audit Scotland in line with legislative requirements; and (4) noting the requirement to publish the North Lanarkshire IJB Annual Accounts 2025/26. Decided: (1) that the Annual Governance Statement and associated reports for inclusion in the statutory accounts be approved; (2) that the unaudited North Lanarkshire IJB Annual Accounts 2025/26 at Appendix 1 be approved; (3) that the submission of the unaudited annual accounts to Audit Scotland be approved; and (4) that the arrangements for publication of the North Lanarkshire IJB Annual Accounts 2025/26 in line with the legislative requirements be acknowledged. IJB ANNUAL PERFORMANCE REPORT 9. There was submitted a report by the Chief Officer (Health and Social Care North Lanarkshire): (1) seeking approval to delegate authority to the Chief Officer (North Lanarkshire Health and Social Care Partnership), to publish the draft Annual Performance Report by 31 July 2026, in compliance with statutory requirements; and (2) advising that the finalised report, would be presented to the next meeting of the Health and Social Care Integration Joint Board for approval. Decided: (1) that authority be delegated to the Chief Officer (North Lanarkshire Health and Social Care Partnership), to publish the draft Annual Performance Report by 31 July 2026; and Page 7 of 264
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HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD WEDNESDAY, 17 JUNE 2026 AT 9.30AM (2) that the finalised report, be presented to the next meeting of the Health and Social Care Integration Joint Board. STRATEGIC COMMISSIONING PLAN 2026/2029 10. There was submitted a report by the Chief Officer (Planning, Performance and Quality Assurance): (1) setting out the new Strategic Commissioning Plan 2026/29; (2) outlining the delivery of the Plan over the medium term; (3) advising that an engagement and consultation process had been undertaken to contribute to the development of the Plan. Decided: that the Strategic Commissioning Plan 2026/2029 be approved. PUBLIC HEALTH ANNUAL REPORT 11. There was submitted a report by the Director of Public Health and Health Policy: (1) summarising the Public Health Annual Report; (2) highlighting key findings which included indicating persistent health inequalities, low health life expectancy, high avoidable mortality, and rising demand linked to aging population; and (3) setting out the actions to be taken in response to the key findings. Decided: that the Public Health Annual Report be noted. DISCHARGE WITHOUT DELAY PROGRAMME UPDATE AND NORTH YHSCP IMPROVEMENT PLAN 12. There was submitted a report by the Chief Officer (Adult Social Work Services): (1) providing an update on the Discharge Without Delay Programme; (2) outlining the progress across the four priority areas; (3) setting out details of the current performance; and (4) highlighting the ongoing work to address concerns highlighted around complex mental health delays and adults with incapacity/guardianship issues. Decided: that the continued direction and development of Discharge Without Delay in Lanarkshire be endorsed. FRAILTY STRATEGY UPDATE 13. There was submitted a report by the Associate Medical Director for Frailty: (1) informing that the Strategy for Preventing and Managing Frailty had led to developed significant progress across hospital and community services; (2) advising that the strategy had improved staff training, digital tools to support frailty identification, investment in workforce, and strengthened pathways to support people at home; (3) advising that the strategy continues to prioritise early identification, prevention; coordinated care; and (4) summarising current progress and priorities for the Frailty work plan for 2026/27. Decided: that the Frailty work plan for 2026/27 be acknowledged. Page 8 of 264
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HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD WEDNESDAY, 17 JUNE 2026 AT 9.30AM UNSCHEDULED CARE PROGRESS REPORT AND WINTER PLANNING 14. There was submitted a report by the Head of Planning and Development: (1) providing an update on the progress of unscheduled care and winter planning; (2) advising that NHS Lanarkshire was well below the NHS Scotland Emergency Access Standards for 2025/26; and (3) informing that services across NHS Lanarkshire, remain committed to the refocused and supported implementation of agreed short and medium-term improvement actions. Decided: that the contents of the report be noted. COMING HOME IMPLEMENTATION 15. There was submitted a report by the Chief Officer (Adult Social Work Services): (1) providing an update on the progress of the implementation of the Coming Home programme within North Lanarkshire; (2) advising that there had been an increase in demand within the Dynamic Support Register; (3) highlighting the reduction in inappropriate out of area placements and increased throughput; (4) outlining ongoing pressures relating to delayed discharge and community capacity; and (5) detailing the support provided to enable the continuation of multi-agency action to develop sustainable, community-based solutions in line with the Coming Home programme. Decided: (1) that the current position and increasing demand within the Dynamic Support Register be noted; (2) that the progress achieved, including reduced inappropriate out-of-area placements and increased throughput be acknowledged; (3) that the ongoing pressure relating to delayed discharge and community capacity be recognised; and (4) that continued support to multi-agency action to develop sustainable, community-based solutions in line with the Coming Home programme be acknowledged. SUPPORTING RESLIENCE ACROSS COMMUNITIES: UNPAID CARERS REPORT 16. There was submitted a report by the Chief Officer (Planning, Performance and Quality Assurance): (1) noting the significant contribution unpaid carers make to health and social care services; (2) informing that the Carers (Scotland) Act 2016 implementation funding is used to support unpaid carers, including young carers; (3) advising of the Page 9 of 264
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HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD WEDNESDAY, 17 JUNE 2026 AT 9.30AM ongoing commitment to a preventative, strengths-based approach to supporting unpaid carers; (4) intimating that whilst there are ongoing challenges for unpaid carers local feedback in the national State of Caring 2025 report, had been more positive; and (5) setting out proposals to support unpaid carers going forward. Decided: that the proposals to support unpaid carers be endorsed. COMMUNITY SOLUTIONS 17. There was submitted a report by the Interim Chief Officer (Getting it Right for Everyone): (1) summarising the current position with the Community Solutions programme; (2) setting out the next steps and planned actions, to support resilient communities; and (3) highlighting the wider role of VANL as the Third Sector Interface for North Lanarkshire. Decided: (1) that the contents of the report be noted; (2) that the ongoing work undertaken, through the Community Solutions programme to support resilient communities be endorsed; and (3) that the wider role of VANL, as the Third Sector Interface for North Lanarkshire be endorsed. NORTH LANARKSHIRE ADP – SELF ASSESSMENT SURVEY 18. There was submitted a report by the Chief Officer (Planning, Performance and Quality Assurance): (1) seeking approval of the draft North Lanarkshire Alcohol and Drug Partnership (ADP) Annual report, attached in the Appendix to the report, for submission to the Scottish Government by 10 July 2026; (2) setting out the support and governance arrangements in place to deliver the National Mission priorities and the Partnership Delivery Framework objectives; (3) summarising the arrangements currently in place for each of the priority areas; (4) informing that the survey had been designed to collect information on a range of aspects relating to the delivery of ADP strategic output and the delivery on priorities in line with additional investment priority areas. Decided: (1) that the North Lanarkshire Alcohol and Drug Partnership Annual report, as outlined in the appendix, be approved; (2) that the arrangements in place across each priority area, be noted; and (3) that the final version of the survey, be submitted to the Scottish Government by 10 July 2026. Page 10 of 264
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HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD WEDNESDAY, 17 JUNE 2026 AT 9.30AM NORTH SUPPORT CARE AND CLINICAL GOVERNANCE ANNUAL REPORT 19. There was submitted a report by the Medical Director: (1) detailing the clinical governance arrangements in place for services delegated to the Board; and (2) providing an overview of the activity of the North Support Care and Clinical Governance Committee from 1 April 2025 to 31 March 2026. Decided: that the clinical governance arrangements in place be noted. ANNUAL ‘SPEAK UP’ WHITSTLEBLOWING REPORT 2025/26 20. There was submitted a report by the Executive Nurser Director: (1) providing details of the Speak Up, (also known as Whistleblowing) activity in NHS Lanarkshire in 2025/26 against key performance indicators within the National Whistleblowing Standards. Decided: that the contents of the report be noted. SELF ASSESSMENT QUESTIONNAIRE 21. There was submitted a report by the Chief Officer (North Lanarkshire Health and Social Care Partnership): (1) detailing the Self-Assessment questionnaire, previously approved at the North Lanarkshire Integration Joint Board in June 2025, attached at appendix one; (2) proposing that the self-assessment questionnaire be circulated to Board members electronically for completion; and (3) advising that the results would be anonymous, summarised and the outcome reported to the next meeting of the Board. Decided: that the questionnaire be issued to Board Members, and the outcome be reported to the next meeting of the Board. IJB WORKPLAN 22. There was submitted a report by the Business Support Manager setting out the Work Plan of the North Lanarkshire Integration Joint Board. Decided: that the updated Work Plan for the North Lanarkshire Integration Joint Board be noted. RISK 23. Arising from the business discussed, it was noted that there are no new emerging risks to be added to the risk register and there are no material alterations to the accessed levels of risk/risk tolerance or mitigating controls. Decided: that it be noted that no new risks had been identified. Page 11 of 264
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HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD WEDNESDAY, 17 JUNE 2026 AT 9.30AM DATE OF NEXT MEETING 24. That the next meeting take place on Wednesday, 16 September 2026 at 9.30am. Page 12 of 264
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INTEGRATION JOINT BOARD (PERFORMANCE, FINANCE AND AUDIT) COMMITTEE WEDNESDAY, 20 MAY 2026 AT 9.30AM PRESENT North Lanarkshire Council Councillors McCrory (Chair); Barclay; Baudo; and Burgess. NHS Lanarkshire Brian Moore (Vice-Chair); and Philip Couser. ALSO PRESENT Heath and Social Care Partnership: Claire Rae; Joanne Jenkins; Nicola Scott; Lucy Munro; and Kerry Taylor. NHS: Mark Dell; Pauline Izat and Siobhan White. North Lanarkshire Council: Francis Scott; Maria Barry and Clare Louise McDonald. Other Attendees Catherine McGinty and John Watson – Unison David Wood – Voluntary Action North Lanarkshire Harry Robertson – North Lanarkshire Carers Together/Carer Representative WELCOME AND APOLOGIES 1. The Chair welcomed all attendee’s to the meeting and noted apologies. Decided: that apologies be noted. DECLARATIONS OF INTERESTS 2. The Committee noted that there were no declarations of interest. PREVIOUS MINUTE FROM THE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT COMMITTEE – 18 FEBRUARY 2026 3. There was submitted the minute of the meeting of the Integration Joint Board Performance, Finance and Audit Committee held on 18 February 2026 for approval. Decided: that the minute of the meeting of the Integration Joint Board Performance, Finance and Audit Committee held on 18 February 2026, be approved. Item 3 Page 13 of 264
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INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT ROLLING ACTION LOG 4. There was submitted the rolling action log providing an update on a number of actions arising from previous meetings. Decided: that the update on the rolling action log be noted. MATTERS ARISING 5. The Chair sought any matters arising from the Action Log. Decided: there were no matters arising from the Action Log. FINANCIAL MONITORING REPORT 2025/26 6. There was submitted a report by the Chief Finance Officer, Health and Social Care Partnership: (1) summarising the financial performance of North Lanarkshire University Health and Social Care Partnership for the period from 1 April to 31 March 2026; (2) advising that for 2025/26 there was an underspend of £30.511m before the removal of £26.769m earmarked and ringfenced balances, resulting in an underspend of £3.742m; and (3) highlighting the key financial pressures on the budget. Arising from discussion, it was agreed that more information on the health underspend, offset by out of area and private health care be provided in the next report. Decided: (1) that the outturn position for 2025/26, together with the underspend of £30.511m before the removal of £26.769m earmarked and ringfenced balances, resulting in an underspend of £3.742m be acknowledged; and (2) that the contents of the report be otherwise noted. IJB RESERVES STRATEGY 2026/27 7. There was submitted a report by the Chief Finance Officer, Health and Social Care Partnership: (1) providing an update on the review of the North Lanarkshire Integration Joint Board reserves; (2) informing that a comprehensive review of all reserves had been undertaken; (3) advising that following the review, a revised reserves position had been developed, as set out in Appendix one to the report; and (4) seeking approval to retain the 4% target risk based and contingency reserves. Decided: (1) that the realignments and revised reserves, detailed in Appendix one of the report, be approved; (2) that the retention of the 4% target for risk based and contingency reserves, as detailed in section seven of the report, be approved; and (3) that the contents of the report be otherwise noted. Page 14 of 264
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PERFORMANCE REPORT UPDATE – 1 OCTOBER TO 31 DECEMBER 2025 QUARTER 3 2025/26 8. There was submitted a report by the Chief Officer (Planning, Performance and Quality Assurance), North Lanarkshire Council: (1) setting out an overview of performance of the Integration Joint Board for the period from 1 October to 31 December 2025, Quarter 3; and (2) enclosing within the appendix to the report Areas for Improvement. Arising from discussion, it was suggested: (1) that a report be submitted to a future meeting of the Health and Social Care Integrated Joint Board, or the development session being held on Alcohol Services and Alcohol Prevention/Harms and Smoking Cessation; and (2) that a site visit for Members of the Board to the Addiction Services be arranged to highlight the good work being undertaken. In addition, in relation to the Care Homes section, it was noted that the length of stay metric target is noted in days, and the quarters are noted in percentages, therefore an explanation would be included in the report going forward. Decided: that the Performance Report Update, for the period from 1 October to 31 December 2025, Quarter 3 and accompanying appendix, be noted. INTERNAL AUDIT PROGRESS REPORT 2025/26 9. There was submitted a report by the Chief Finance Officer, Health and Social Care Partnership: (1) setting out progress in respect of Internal Audit work for 2025/26; (2) summarising the key issues arising from the Internal Audit Plan 2025/26; and (3) enclosing within the appendices to the report the Progress Report, a Summary of Relevant Partner Reports and the Final IJB Financial Sustainability Report. Arising from discussion, it was requested that the report on Self Directed Support, previously submitted to North Lanarkshire Council’s Audit and Scrutiny Panel on 14 May 2026 be circulated to members for their information, and inclusion on the agenda at the next meeting of the Committee, which was agreed. Decided: that the Internal Audit Progress Report 2025/26 be noted. DRAFT INTERNAL AUDIT PLAN 2026/27 10. There was submitted a report by Audit Scotland: (1) attaching the proposed North Lanarkshire Integration Joint Board Annual Audit Plan 2025/26; (2) setting out the joint working arrangements between North Lanarkshire Council and NHS Lanarkshire Internal Audit teams which would continue in order to deliver the IJB Internal Audit Service; and (3) requesting delegated authority be granted to the Chief Finance Officer, to agree with the Chief Officer (Audit and Risk) (NLC), and the Chief Internal Auditor (NHSL), the scope of the audit assignments in the Internal Audit Plan for 2026/27, including the allocation of responsibilities for completion of assignments. Decided: (1) that the Internal Audit Plan for 2026/27, attached at Appendix one be approved; Page 15 of 264
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(2) that the continuation of joint working arrangements between North Lanarkshire Council and NHS Lanarkshire Internal Audit teams, to deliver the IJB Internal Audit Service, be approved; and (3) that the Chief Finance Officer, be delegated authority, to agree with the Chief Officer (Audit and Risk) (NLC), and the Chief Internal Auditor (NHSL), the scope of the audit assignments in the Internal Audit Plan for 2026/27, including the allocation of responsibilities for completion of assignments. CHIEF FINANCE OFFICER ROLE 11. There was submitted a report by the Chief Financial Officer, Health and Social Care Partnership: (1) setting out changes to the Chief Finance Officer role; (2) informing that the proposed changes intend to strengthen governance, reduce single point of failure risk, and improve workforce succession planning, with no reduction in service to the Integration Joint Board; and (3) highlighting the additional support which would be provided by North Lanarkshire Council. Decided: (1) that the rationale for the proposed changes to the Chief Finance Officer role be acknowledged; (2) that the proposed changes to the Chief Finance Officer role, recognising the additional support to be provided by North Lanarkshire Council, be approved; and (3) that the arrangements, designed to strengthen governance, reduce single point of failure risk, and improve workforce succession planning, with no reduction in service to the Integration Joint Board (IJB), be noted. ANNUAL GOVERNANCE STATEMENT – ACTION PLAN PROGRESS 12. There was submitted a report by the Chief Officer, Health and Social Care North Lanarkshire: (1) providing an outline of the actions agreed with the External Auditor, Internal Auditor and the Senior Management Team, to further develop the IJB governance framework; (2) summarising within Appendix one to the report, the progress against each of the agreed actions; and (3) advising that further progress reports be presented to future meetings of the Committee. Decided: (1) that further progress reports be submitted to future meetings of the Committee; and (2) that the contents of the report be noted. INTEGRATION JOINT BOARD RISK REGISTER 13. There was submitted a report by the Chief Officer, Health and Social Care North Lanarkshire: (1) providing an update on the IJB risk register; (2) detailing the nine current risks contained in the risk register; (3) informing that two risks are considered very high, three risks are considered high and four risks are considered medium; and (4) summarising the control measures in place for each of the risks, and the risk actions in progress to mitigate impact. Page 16 of 264
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Decided: that the risks identified, the control measures in place, and the risk actions in progress to mitigate the impact, be noted. NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN 14. There was submitted a report by the Business Support Manager detailing the Work Plan of the North Lanarkshire Integration Joint Board Performance, Finance and Audit Committee. Decided: that the updated Work Plan of the North Lanarkshire Integration Joint Board Performance, Finance and Audit Committee be noted. RISK 15. Arising from the business discussed, it was noted that there are no new emerging risks to be added to the risk register and there are no material alterations to the accessed levels of risk/risk tolerance or mitigating controls. Page 17 of 264
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 34. 10 December 2025 7 Chief Officer Report C Rae Pick up vaccination service concerns and explore pop-up clinics. September 2026 In progress Update 16 September– added to work plan for December to allow a paper to be taken to both North / South IJBs 35. 10 December 2025 7 Chief Officer Report C Rae Continue monitoring home support staffing and mitigation plans Ongoing In progress 40. 10 December 2025 11 Paediatric Modernisation L Munro Report on hospital-at-home pilot and workforce developments September 2026 Complete 16 September - On agenda for September 2026 41. 10 December 2025 12 Care Academy M Dendy Develop delivery framework and metrics for recruitment impact September 2026 Update 16 September– added to work plan for December to allow discussions with South to take place first Item 5 Page 19 of 264
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3 CLOSED ACTIONS NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 5. 19.06.24 Item 6 Digital System Transformation M Dendy Delegate to the IJB PFA committee -To provide the IJB PFA with additional financial information relating to the programme Report provided to IJB PFA 21st August 2024 Complete 6. 19.06.24 Item 7 Mental Health & Wellbeing Delivery Plan R McGuffie Shared new action plan with the group in Sept/October Action Planned shared and stakeholder sign off currently underway. Complete 28 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to systematically share learning to identify and develop: - Service redesign focused on early intervention and prevention. - Approaches focused on improving the recruitment and retention of the workforce. “business as usual" item 29 25.09.24 Item 9 Integration Joint Boards Finance C Rae Work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully “business as usual" item Page 21 of 264
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4 and Performance Report 2024 understand and improve outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand the impact of preventative approaches. 30. 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Evaluate whether the local commissioning of care and support services, and the contracting of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people. “business as usual" item 26 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that their Medium-Term Financial Plans are up to date and reflect all current known and foreseeable costs to reflect short and longer-term financial sustainability challenges. 25.02.25 – Due to be discussed at the next IJB in March 19.03.2025 Discussed on agenda 19.03.25 Complete 31. 25.02.25 Item 6 Q2 Performance Report Improved communication about progress and ensure a shared understanding of what CAMHs services can offer. 21.05.25 - Mark Dell confirmed a communications plan is underway, including a scoping exercise to avoid duplication and engagement with key players. Mark Dell Complete Page 22 of 264
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5 assured the communication would be out soon and would include guidance for elected members. 04.06.2025 – Timeline agreed between MD & CR for end of June 2025. 16.09.2025 - Mark Dell confirmed the strategy circulated to GPs and Health Visitors, followed by wider staff and elected members. A toolkit is going to be provided to support constituent queries. 33. 19.03.20 25 Item 4 Matters Arising Learning Disability Workforce paper to be brought to PF&A Complete 25. Future Meeting C Rae Host a future meeting face to face in Chryston hub 19.03.2025 – March date was cancelled new date to be re-arranged 16.09.2025 - Visit scheduled for 18th September. Complete Chair and Vice- Chair visited Chryston Hub in September 2025 with future invites to SMT walk rounds. 27 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, Complete – Moved to Governance Page 23 of 264
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6 workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability. monitoring log for IJB PFA 32. 25.02.25 Item 8 Financial Monitoring Suggestion that Pharmacy Savings Approach could be brought back to IJB to get a restock of where things are and where they are going. 16.09.2025 - Regular update will be included in the work plan. Completed – added to IJB work plan 36. 10 Decemb er 2025 8 Chief Finance Officer Report - Medium Term Financial Outlook 2026- 2029 N Scott Prepare reserve strategy with timelines for review and reallocation. 18 March 2026 Complete - on agenda 18 March 2026 37. 10 Decemb er 2025 8 Chief Finance Officer Report - Medium Term Financial Outlook 2026- 2029 N Scott Update Board in March on savings progress and settlement impact. 18 March 2026 Complete - on agenda 18 March 2026 38. 10 Decemb er 2025 9 The Lanarkshire Advocacy Plan M Dendy Share launch details and ensure visibility on websites Complete 39. 10 Decemb er 2025 10 CAMHS Recovery & Renewal M Dell Continue comms push on mental health resources and waiting-well support Complete 42. 10 Decemb er 2025 13 Coming Home Report A Breen Embed learning from short-term interventions into workforce development June 2026 Complete – On agenda for 17 June 2026 Page 24 of 264
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7 43. 10 Decemb er 2025 13 Coming Home Report A Breen / C Rae Explore regional solutions and escalate funding concerns June 2026 Complete - On agenda for 17 June 2026 44. 10 Decemb er 2025 16 ADP Annual Reporting Survey M Dendy Provide update report aligned with stakeholder review June 2026 Complete – ADP overview at IJB Development Session 10 June 2026 & 2026 ADP Survey on agenda for 17 June 2026 Page 25 of 264
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1 REPORT Item No: 7 SUBJECT: Chief Officer Report TO: North Lanarkshire Integration Joint Board Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Kerry Taylor, Head of Corporate Governance DATE: 16 September 2026 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Kerry Taylor, Head of Corporate Governance ☒ Reviewed By: Claire Rae, Chief Officer ☒ Endorsed By: ☐ Item 6 Page 27 of 264
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2 3. RECOMMENDATIONS 3.1 It is recommended that the IJB • Note and comment on the key areas of work and service developments that have been taking place within North Lanarkshire in relation to the work of the Integration Joint Board 4. CHIEF OFFICER REPORT 4.1 Extension of IJB Voting Rights The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment Order 2025 (“the 2025 Order”) requires Integration Joint Boards to extend voting rights to members representing service users, unpaid carers and the third sector from 1 September 2026. Revised statutory guidance will use the collective term “Lived Experience Representatives” to refer to these category members. The 2025 Order also provides that, where a Lived Experience Representative is unable to attend a meeting of the Integration Joint Board, the member may arrange for a suitably experienced substitute to attend in their place. Revised statutory guidance is expected to be issued for use by all Integration Joint Boards. The guidance will supplement the legislative framework and provide advice on best practice, including the roles, responsibilities and membership of IJBs and the principles required to support effective and consistent governance. As the revised guidance is not yet available, no changes have been presented to the Integration Joint Board in relation to the Integration Scheme. Discussions have also taken place with colleagues in South Lanarkshire to ensure a consistent approach. A review of the Standing Orders were approved at the Performance, Finance and Audit Committee in August 2026, however it was noted further changes may be required after the guidance is received. The Lived Experience Representatives currently appointed under the service user, unpaid carer and third sector categories will remain appointed pending publication of the revised statutory guidance and consideration by the Board of any future arrangements for the recruitment and appointment of category members. 4.2 Roles, Responsibilities and Membership of the Integration Joint Board Scottish Government published new guidance on 28 August 2026 ‘Roles, Responsibilities and Membership of the Integration Joint Board Guidance and Page 28 of 264
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3 advice to supplement the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014 and Amendment Order 2025. This guidance is intended for use by all members of an Integration Joint Board (IJB), particularly the Chairs, Vice-Chairs and Standards Officers. It provides advice on best practice and supplements the existing legislative framework. The document focuses on the roles, responsibilities and membership of the IJB, setting out principles to support effective and consistent governance. The publication can be accessed here: Roles, Responsibilities and Membership of the Integration Joint Board 4.3 Standards Officer The Ethical Standards in Public Life (Scotland) Act 2000 (Register of Interests) Regulations 2003 require devolved public bodies to have a Standards Officer. The Public Bodies (Joint Working) (Scotland) Act (Consequential Amendments and Savings) Order 2015 has determined that Integration Joint Boards are devolved public bodies for the purposes of the Ethical Standards legislation and accordingly the IJB needs to make arrangements to have a Standards Officer. The Board is asked to formally nominate for approval by the Standards Commission, Kerry Taylor, Head of Corporate Governance, as the Standards Officer of the North Lanarkshire Integration Joint Board. The Standards Commission has to approve the North Lanarkshire Integration Joint Board nomination. Following the Board’s decision on this matter, the Chief Officer will write to the Standards Commission with the appropriate information, setting out the NLIJB’s agreement of the nomination. Further information on the role of the Standards Officer can be found in this publication from the Standards Commission: Advice on the Role of a Standards Officer 4.4 Programme for Government The Programme for Government announced this week by the FM, signals a substantial shift in the future organisation of public services in Scotland, with reform intended to improve sustainability, reduce duplication and maximise investment in frontline services. The HSCP will continue to monitor developments closely and assess the implications for integration, local governance arrangements and the delivery of health and social care services in North Lanarkshire as further detail emerges. Full details of the publication can be accessed here: Programme for Government 2026 to 2031 - gov.scot Page 29 of 264
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4 4.5 CI Home Support Grades Recent Care Inspectorate inspections of our Home Support services have resulted in all evaluated areas now being graded as either Good or Very Good. This reflects the significant commitment of staff and managers to continuous improvement and provides important external assurance regarding the quality, safety and effectiveness of services being delivered to people across North Lanarkshire. Continued focus will be placed on sustaining this performance and building on identified areas of good practice. 4.6 Savings & Value Board The Savings & Value Board was established after agreement of the Integration Joint Board Medium Term Financial Plan in March 2026. The purpose of the Savings and Value Board is to provide robust oversight, governance and assurance of the delivery of the approved savings programme, supporting the Partnership’s commitment to financial sustainability. The Board meets monthly, with regular updates provided to the Senior Management Team and formal quarterly reports will be submitted to the Performance, Finance and Audit Committee through the established financial monitoring processes. 4.7 Investing in Prevention As part of our ongoing commitment to shifting from crisis response to prevention and improving population health outcomes, a workshop focused on Prevention Spend and Investment Prioritisation has been scheduled for October 2026. The purpose of the session is to develop a shared understanding of how we can use the evidence available to us to make informed decisions about where resources can have the greatest impact on outcomes, inequalities and long term sustainability. Updates will be presented to the Integration Joint Board in due course. 4.8 Monklands Replacement Project On 25 June 2026, the Cabinet Secretary for Health and Care, Angela Constance MSP, made a statement to the Scottish Parliament about the future of the Monklands Replacement Project. The Monklands Replacement Project Reset Oversight Board held its first meeting on 30 July 2026. The board will decide the necessary actions for the reset phase and oversee their implementation. It has membership from key partners involved in the plans for the new University Hospital Monklands including: NHS Lanarkshire and North Lanarkshire Integration Joint Board; the Scottish Government; North Lanarkshire Council; NHS Scotland sub-national Page 30 of 264
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5 planning colleagues (west and east); Public Services Delivery Scotland, which includes NHS Scotland Assure – the body that ensures that planned infrastructure is safe and cost-effective. 4.9 North Lanarkshire Health and Social Care Partnership iMatter Staff Experience Survey The iMatter Staff Experience Survey was issued to staff within North Lanarkshire Health and Social Care Partnership in June 2026. Managers received team reports in July 2026 and had the opportunity to meet with their team to discuss the results and develop a team action plan. The overall response rate for the partnership was 71% and the Employee Engagement Index was 80. Out of the 29 questions, 11 of these have an increased score from last years results with 18 questions receiving the same score. The biggest increase in score is ‘I feel that senior leaders who are responsible for my organisation are sufficiently accessible’ which has increased from 58 to 69. An overarching action plan for the Health and Social Care Partnership is currently being developed. 4.10 National Records Scotland Data – Probable Suicides Suicide prevention remains a priority within North Lanarkshire and across Lanarkshire's Mental Health Strategy. Governance arrangements continue to be strengthened through the North Lanarkshire Suicide Prevention Implementation Group and the Lanarkshire Suicide Prevention Reference Steering Group, supporting partnership working, shared learning and oversight of the local action plan. A comprehensive programme of prevention, awareness raising and workforce development activity continues to be delivered, including suicide prevention training, targeted public awareness campaigns and community engagement initiatives focused on groups at increased risk. Whilst Police Scotland provides real-time intelligence to support local monitoring and early intervention, validated suicide statistics for North Lanarkshire are published retrospectively by the National Records of Scotland and will be available for reporting to IJB in December 2026. 4.11 Strategic Commissioning Plan 2026-2029 Following the approval of the Strategic Commissioning Plan 2026 – 2029 at the June IJB, work has progressed with key leaders, managers and stakeholders across health and social care to redefine the Programme of Work, with associated measures of success. Embedding the Programme of Work clearly within the revised Oversight Groups which are designed to encourage whole Page 31 of 264
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6 system working, will strengthen the rigour and ambition for change. This work will be reported to the next IJB, along with confirmation of a date for the formal launch of the Strategic Commissioning Plan which will be an interactive session celebrating the range of work being done to improve the lives of people and of staff. 4.12 Mental Welfare Commission Annual Report 2025/26 The Mental Welfare Commission for Scotland published its 2025/26 Annual Report on 30 June 2026, highlighting its work to protect and promote the rights of people with mental illness, learning disability, dementia and related conditions. During the year, the Commission visited 139 services across Scotland and engaged with more than 1,000 individuals, family members and carers to understand their experiences of care and treatment. The report acknowledges the continued pressures on services, including workforce shortages, increasing demand and financial constraints, while recognising examples of positive change and improvement. The Commission emphasises the ongoing importance of a human rights-based approach to care and the need for continued partnership working to support meaningful and sustainable improvements. The report can be accessed here: mwcscot.org.uk/sites/default/files/2026- 07/AnnualReport_2025-26.pdf 4.13 Accounts Commission – Local Government Budgets 2026/27 The Accounts Commission has published its latest analysis of local government budgets, highlighting continued financial pressures across councils and the impact on health and social care integration. The report notes that councils will contribute £4.3 billion to Integration Joint Boards (IJBs) in 2026/27, an increase of £220 million compared with the previous year. However, it concludes that funding growth is not keeping pace with rising demand and the increasing cost of delivering social care services. The publication reinforces the Accounts Commission's earlier assessment that the financial position of IJBs is critical. It highlights that IJBs are planning around £180 million of budget reductions, with more than £100 million expected from social care savings, while reserves have reduced to a level that is insufficient to address forecast budget gaps. The report reiterates the need for IJBs to make difficult decisions to ensure services remain financially sustainable in the face of growing demand. The report can be accessed here: audit.scot/uploads/2026- 06/nr_260611_lg_council_budgets.pdf Page 32 of 264
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7 4.14 Accounts Commission Report on Integration Joint Board Finances 2024/25 The Accounts Commission’s Integration Joint Boards (IJBs) Financial Bulletin 2024/2025 provides an independent assessment of the financial performance of IJBs in 2024/25, drawing on annual accounts, audit reports and budget- setting information. The bulletin also considers the financial outlook for 2025/26 and highlights the increasing financial pressures facing the sector. The report can be accessed here: Integration Joint Boards: Financial bulletin 2024/25 Financial bulletin 2024/25 The key messages in the report are that: • Despite a real-term funding increase of 2.3% in 2024/25, financial pressures and demand for services continue to outstrip available resources, placing IJBs in a critical financial position and raising concerns regarding long-term sustainability • Total reserves continue to fall, reducing financial resilience across the sector. Reserves decreased by 12% to £404 million, with almost half of IJBs holding no contingency reserves • The majority of IJBs reported in-year operational overspends. While unplanned use of reserves has reduced, there has been a significant increase in additional financial contributions from NHS boards and councils, which is not sustainable given the financial pressures on partner organisations • The estimated funding gap for 2025/26 is £449 million (approximately 3.6% of net expenditure). While marginally lower than the prior year, it remains significant and requires realistic and deliverable savings plans • While 78% of planned savings were achieved in 2024/25, there is limited clarity on whether these savings are recurring • IJBs continue to rely on non-recurring measures, including reserves and one- off savings, to achieve financial balance. This approach is unsustainable and reinforces the need for recurring savings and service transformation • IJBs will need to take decisive action and make difficult decisions about how services are delivered, including potential redesign, prioritisation and reduction of services. Greater transparency with service users and communities will be required on the implications of these changes CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Kerry Taylor kerry.taylor@lanarkshire.scot.nhs.uk Page 33 of 264
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REPORT Item No: 8 SUBJECT: External Auditor’s Annual Audit Report 2025/26 TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 16 September 2026 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report presents the findings of the External Auditor for 2025/26, including the External Auditor's Letter to the IJB, the Annual Audit Report, and management responses to audit recommendations. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Consider the findings and conclusions contained within the External Auditor's Annual Audit Report for 2025/26. (2) Approve the management responses to the audit recommendations contained within the External Auditor's Annual Audit Report. (3) Note that the External Auditor has issued an unmodified audit opinion on the 2025/26 financial statements. 4. VARIATIONS TO DIRECTIONS 5. EXTERNAL AUDIT OVERVIEW 5.1 The North Lanarkshire Integration Joint Board (IJB) is required to prepare Annual Accounts in accordance with statutory and professional accounting requirements and to submit these for external audit. 5.2 The Annual Accounts for the year ended 31 March 2026 have been prepared audited by Audit Scotland. Prior to approving the Annual Accounts, members are required to consider the findings and recommendations arising from the external audit. Yes No N/A Item 7 Page 35 of 264
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5.3 The External Auditor's Letter to the IJB is attached at Appendix 1 and the Annual Audit Report, including management responses to audit recommendations, is attached at Appendix 2. 6. EXTERNAL AUDIT FINDINGS AND ASSURANCE 6.1 The External Auditor's Annual Audit Report summarises the outcome of the 2025/26 audit and provides an assessment of: • Financial statements • Financial management and sustainability • Governance and transparency arrangements • Wider scope audit responsibilities 6.2 The External Auditor has concluded that the financial statements provide a true and fair view of the financial position of the North Lanarkshire IJB as at 31 March 2026 and of its income and expenditure for the year then ended. An unmodified (unqualified) audit opinion has been issued in respect of the 2025/26 financial statements as highlighted in the External Auditor’s Letter to the IJB at Appendix 1. 6.3 Where recommendations have been identified by the External Auditor, management responses and implementation arrangements are included within Appendix 2 for Board approval. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as 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 dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A Page 36 of 264
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7.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Sustainability – Short Term High Nicola Scott Financial Sustainability – Medium Term Very High Nicola Scott Financial Sustainability – Long Term Very High Nicola Scott Governance Failure High Nicola Scott Failure to meet Legislative Requirements Medium Pauline Izat / Morag Dendy / Joanne Jenkins 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance and Technology) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of IJB Financial Plan and Reserves Strategy aligns with and supports the IJB Strategic Commissioning Page 37 of 264
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other engagement activity and local plans across the Community Planning Partnership Plan to ensure robust financial monitoring and scrutiny. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 – External Auditor’s Letter to the IJB 2025/26 Appendix 2 - Audit Scotland Annual Audit Report 2025/26 Chief Finance Officer Members seeking further information, please contact Nicola Scott on 07581007187. Page 38 of 264
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4th Floor, 8 Nelson Mandela Place, Glasgow, G2 1BT Phone: 0131 625 1500 Email: info@audit.scot www.audit.scot Health and Social Care Integration Joint Board 16 September 2026 North Lanarkshire Integration Joint Board Audit of the 2025/26 annual accounts Independent Auditor’s Report 1. My audit work on the 2025/26 annual accounts is now substantially complete. Subject to outstanding audit procedures outlined below, I anticipate being able to issue unmodified audit opinions in the Independent Auditor's Report on 16 September 2026. The proposed Independent Auditor’s Report is attached at Appendix A. 2. Outstanding audit procedures include the following: • final review of the revised set of annual accounts • final engagement lead quality review • subsequent event procedures up to the date of signing. Annual Audit Report 3. Under International Standards on Auditing in the UK (ISA (UK)), I am required to report specific matters identified from the audit of the annual accounts to those charged with governance of the North Lanarkshire Integration Joint Board in sufficient time to enable appropriate action. For North Lanarkshire Integration Joint Board, those charged with governance is the Health and Social Care Integration Joint Board. I present for the Board's consideration my draft Annual Audit Report on the 2025/26 audit. The section headed "Significant findings and key audit matters" sets out the issues identified in respect of the annual accounts, including those that I am required to report to you. 4. The Annual Audit Report also sets out conclusions on the wider scope areas that frame public audit as set out in the Code of Audit Practice. 5. The Annual Audit Report will be issued in final form after the audit of the annual accounts has been completed. Uncorrected misstatements 6. I also report to those charged with governance all uncorrected misstatements in the annual accounts which I have identified during the Page 39 of 264
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course of my audit, other than those of a trivial nature, and request that these misstatements be corrected. 7. There are no uncorrected misstatements to report. Other ISA (UK) matters 8. In presenting this letter and the Annual Audit Report to the Health and Social Care Integration Joint Board, I seek confirmation from those charged with governance on the following matters: • if they are aware of any instances of actual, suspected, or alleged fraud, • if they are aware of any subsequent events that have occurred since the date of the financial statements, • if they are content that the methods, assumptions, and data used in making accounting estimates in the annual accounts are appropriate, • if all related party relationships and transactions they are aware of are reflected in the annual accounts, and • if they are aware of any non-compliance with laws and regulations. 9. Any issues that I have identified from my audit in relation to other ISA (UK) matters that I am required to report to those charged with governance have been reported in the section headed “Other matters to report” in the Annual Audit Report. Representations from the Section 95 Officer 10. As part of the completion of the audit, I am seeking written representations from the Chief Finance Officer, who is the Section 95 Officer, on aspects of the annual accounts, including the judgements and estimates made. 11. A draft letter of representations is attached at Appendix B. This should be signed and returned to me by the Section 95 Officer with the signed annual accounts prior to the Independent Auditor’s Report being signed. Page 40 of 264
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Appendix A: Proposed Independent Auditor’s Report Independent auditor’s report to the members of North Lanarkshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2026 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet, and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26 (the 2025/26 Code). In my opinion, the accompanying financial statements: • give a true and fair view of the state of affairs of North Lanarkshire Integration Joint Board as at 31 March 2026 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2025/26 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 02 December 2022. My period of appointment is five years, covering 2022/23 to 2026/27. I am independent of North Lanarkshire Integration Joint Board in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services Page 41 of 264
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prohibited by the Ethical Standard were not provided to North Lanarkshire Integration Joint Board. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on North Lanarkshire Integration Joint Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on North Lanarkshire Integration Joint Board’s current or future financial sustainability. However, I report on North Lanarkshire Integration Joint Board’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Finance Officer and North Lanarkshire Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Finance Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Finance Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Finance Officer is responsible for assessing North Lanarkshire Integration Joint Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue North Lanarkshire Integration Joint Board’s operations. North Lanarkshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes Page 42 of 264
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my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using my understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of North Lanarkshire Integration Joint Board; • inquiring of the Chief Finance Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of North Lanarkshire Integration Joint Board; • inquiring of the Chief Finance Officer concerning North Lanarkshire Integration Joint Board’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among my audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non- compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of North Lanarkshire Integration Joint Board’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's Page 43 of 264
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website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report I have audited the parts of the Remuneration Report described as audited. In my opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Finance Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Page 44 of 264
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Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • I have not received all the information and explanations I require for my audit. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. John Boyd FCPFA Audit Scotland 8 Nelson Mandela Place Glasgow G2 1BT Page 45 of 264
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Appendix B: Letter of Representations (ISA (UK) 580) John Boyd, Audit Director Audit Scotland 4th Floor 8 Nelson Mandela Place Glasgow G2 1BT North Lanarkshire Integration Joint Board Annual accounts 2025/26 Dear John This representation letter is provided in connection with your audit of the annual accounts of North Lanarkshire Integration Joint Board, hereafter referred to as North Lanarkshire IJB, for the year ended 31 March 2026 for the purpose of expressing an opinion as to whether the financial statements give a true and fair view and have been properly prepared, and for expressing other opinions on the Remuneration Report, Management Commentary, and Annual Governance Statement. I confirm to the best of my knowledge and belief and having made appropriate enquiries of the Joint Board, North Lanarkshire Council and NHS Lanarkshire, the following representations given to you in connection with your audit of North Lanarkshire IJB’s annual accounts for the year ended 31March 2026. General I have fulfilled my responsibilities for the preparation of the 2025/26 annual accounts as set out in your 2025/26 Annual Audit Plan. All the accounting records, documentation, and other matters of which I am aware are relevant to the preparation of the annual accounts have been made available to you for the purposes of your audit. All transactions undertaken by North Lanarkshire IJB, and those on behalf of North Lanarkshire IJB at the partner bodies, have been recorded in the accounting records and are properly reflected in the financial statements I confirm that the effects of uncorrected misstatements are immaterial, individually and in aggregate, to the financial statements as a whole. As you have reported, there are no uncorrected misstatements. Financial Reporting Framework The annual accounts have been prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26 (2025/26 Code), mandatory guidance from LASAAC, and the requirements of the Local Government (Scotland) Act 1973, the Local Page 46 of 264
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Government in Scotland Act 2003, and the Local Authority Accounts (Scotland) Regulations 2014. In accordance with the Local Authority Accounts (Scotland) Regulations 2014, I have ensured that the financial statements give a true and fair view of the financial position of North Lanarkshire IJB at 31 March 2026 and the transactions for 2025/26. Accounting Policies and Estimates All material accounting policies applied are as shown in the note included in the financial statements. The accounting policies are determined by the 2025/26 Code, where applicable. Where the 2025/26 Code does not specifically apply, I have used judgement in developing and applying an accounting policy that results in information that is relevant and reliable. All accounting policies applied are appropriate to North Lanarkshire IJB’s circumstances and have been consistently applied. The methodology, significant assumptions, and data used in making accounting estimates are reasonable, and have been properly reflected and disclosed in the financial statements in accordance with the 2025/26 Code. Judgements made in making estimates have been based on the latest available and reliable information. Estimates have been revised where there are changes in the circumstances on which the original estimate was based or as a result of new information or experience. Going Concern Basis of Accounting I have assessed North Lanarkshire IJB’s ability to continue to use the going concern basis of accounting and have concluded that it is appropriate. I am not aware of any material uncertainties that may cast significant doubt on North Lanarkshire IJB’s ability to continue to adopt the going concern basis of accounting. Assets All assets at 31 March 2026 of which I am aware have been recognised in the annual accounts in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26. There are no plans or intentions that are likely to affect the carrying value or classification of the assets recognised in the financial statements. Liabilities All liabilities at 31 March 2026 of which I am aware have been recognised in the annual accounts in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26. There are no plans or intentions that are likely to affect the carrying value or classification of the liabilities recognised in the financial statements Page 47 of 264
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Litigation and Claims All known actual or possible legal claims have been disclosed to you and have been accounted for and disclosed in the financial statements in accordance with the 2025/26 Code. Fraud I understand my responsibilities for the design, implementation, and maintenance of internal control to prevent fraud and I believe I have appropriately fulfilled those responsibilities. I have provided you with all information in relation to: • my assessment of the risk that the financial statements may be materially misstated as a result of fraud, • any allegations of fraud or suspected fraud affecting the financial statements, and • fraud or suspected fraud that I am aware of involving management, employees who have a significant role in internal control, or others that could have a material effect on the financial statements. Laws and Regulations I have disclosed to you all known instances of non-compliance or suspected non-compliance with laws and regulations whose effects should be considered when preparing financial statements. Related Party Transactions All material transactions with related parties have been appropriately accounted for and disclosed in the financial statements in accordance with IAS 24, as adopted by the 2025/26 Code. I have made available to you the identity of all of North Lanarkshire IJB’s related parties and all the related party transactions of which I am aware. Page 48 of 264
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Remuneration Report The Remuneration Report has been prepared in accordance with the Local Authority Accounts (Scotland) Regulations 2014, and all required information of which I am aware has been provided to you. Management Commentary I confirm that the Management Commentary has been prepared in accordance with statutory guidance, and the information is consistent with the financial statements. Corporate Governance I confirm North Lanarkshire IJB has undertaken a review of the system of internal control during 2025/26 to establish the extent to which it complies with proper practices set out in Delivering Good Governance in Local Government: Framework 2016. I have disclosed to you all deficiencies in internal control identified from this review or of which I am otherwise aware. I confirm that the Annual Governance Statement has been prepared in accordance with the Delivering Good Governance in Local Government: Framework 2016 and the information is consistent with the financial statements. There have been no changes in the corporate governance arrangements, or issues identified, since 31 March 2026 which require to be reflected in the Annual Governance Statement or annual accounts. Events Subsequent to the Date of the Balance Sheet All events subsequent to 31 March 2026 for which IAS 10, as adopted by the 2025/26 Code, requires adjustment or disclosure have been adjusted or disclosed. Yours sincerely Nicola Scott CPFA Chief Finance Officer Page 49 of 264
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North Lanarkshire Integration Joint Board 2025/26 Annual Audit Report - DRAFT Prepared for North Lanarkshire Integration Joint Board and the Controller of Audit September 2026 Page 50 of 264
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North Lanarkshire Integration Joint Board: 2025/26 Annual Audit Report - DRAFT | 2 Contents Summary of audit opinions and conclusions 3 Introduction 4 Audit scope, responsibilities, and fee 5 Audit of the annual accounts 7 Wider scope and Best Value audit 13 Appendix 1 20 Appendix 2 22 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility. Page 51 of 264
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Summary of audit opinions and conclusions | 3 Summary of audit opinions and conclusions Audit of the annual accounts 1 All audit opinions stated that the annual accounts were free from material misstatement. 2 The balance sheet included in the unaudited financial statements included materially incorrect values as these reflected the prior year balances rather than current year. This resulted in an increase to the balance sheet of £27.263 million. All audit adjustments required to correct the financial statements were processed by North Lanarkshire Integration Joint Board. Wider scope and Best Value audit 3 North Lanarkshire Integration Joint Board has effective and appropriate arrangements in place for Financial Management; Vision, Leadership and Governance; and Use of Resources to Improve Outcomes. 4 Challenges remain in delivering financial sustainability over the medium term, with significant budget gaps forecast. It is important that North Lanarkshire Integration Joint Board, working with its strategic partners, develops a financially sustainable operating model, moving away from the reliance on delivering significant in-year savings or cost reduction measures that risk short-term decision making. 5 North Lanarkshire Integration Joint Board has effective and appropriate arrangements in place for securing Best Value. Page 52 of 264
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Introduction | 4 Introduction Purpose of the Annual Audit Report 1. The purpose of this Annual Audit Report is to report the significant matters identified from the 2025/26 audit of North Lanarkshire Integration Joint Board’s annual accounts and the wider scope areas specified in the Code of Audit Practice (2021). 2. The Annual Audit Report is addressed to North Lanarkshire Integration Joint Board, hereafter referred to as ‘North Lanarkshire IJB’ and the Controller of Audit, and will be published on Audit Scotland’s website in due course. Appointed auditor and independence 3. John Boyd, of Audit Scotland, has been appointed as external auditor of North Lanarkshire IJB for the period from 2022/23 until 2026/27. As reported in the Annual Audit Plan, John Boyd as engagement lead and the audit team are independent of North Lanarkshire IJB in accordance with relevant ethical requirements, including the Financial Reporting Council’s Ethical Standard. There have been no developments since the issue of the Annual Audit Plan that impact on the continued independence of the engagement lead or the rest of the audit team from North Lanarkshire IJB, including no provision of non-audit services. Acknowledgements 4. We would like to thank North Lanarkshire IJB and its staff, particularly those involved in preparation of the annual accounts, for their cooperation and assistance during the audit. We look forward to working together constructively over the remainder of the five-year audit appointment. Page 53 of 264
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Audit scope, responsibilities, and fee | 5 Audit scope, responsibilities, and fee Scope of the audit 5. The audit is performed in accordance with the Code of Audit Practice, including supplementary guidance, International Standards on Auditing (ISA) (UK), and relevant legislation. These set out the requirements for the scope of the audit which includes: • An audit of the financial statements and an opinion on whether they give a true and fair view and are free from material misstatement. • An opinion on statutory other information published with the financial statements in the annual accounts, namely the Management Commentary and Annual Governance Statement. • An opinion on the audited part of the Remuneration Report. • Conclusions on North Lanarkshire IJB’s arrangements in relation to the wider scope areas: Financial Management; Financial Sustainability; Vision, Leadership and Governance; and Use of Resources to Improve Outcomes. • Reporting on the body’s arrangements for securing Best Value. • Provision of this Annual Audit Report. Responsibilities and reporting 6. The Code of Audit Practice sets out the respective responsibilities of North Lanarkshire IJB and the auditor. A summary of the key responsibilities is outlined below. Auditor’s responsibilities 7. The responsibilities of auditors in the public sector are established in the Local Government (Scotland) Act 1973. These include providing an independent opinion on the financial statements and other information reported within the annual accounts, and concluding on North Lanarkshire IJB’s arrangements in place for the wider scope areas and Best Value. 8. The matters reported in the Annual Audit Report are only those that have been identified by the audit team during normal audit work and may Page 54 of 264
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Audit scope, responsibilities, and fee | 6 not be all that exist. Communicating these does not absolve North Lanarkshire IJB from its responsibilities outlined below. 9. The Annual Audit Report includes an agreed action plan at Appendix 1 setting out specific recommendations to address matters identified and includes details of the responsible officer and dates for implementation. North Lanarkshire Health and Social Care Integration Joint Board’s responsibilities 10. North Lanarkshire Health and Social Care Integration Joint Board (the Board) has primary responsibility for ensuring proper financial stewardship of public funds, compliance with relevant legislation and establishing effective arrangements for governance, propriety, and regularity that enables it to successfully deliver its objectives. The features of proper financial stewardship include: • Establishing arrangements to ensure the proper conduct of its affairs. • Preparation of annual accounts, comprising financial statements for North Lanarkshire IJB that give a true and fair view and other specified information. • Establishing arrangements for the prevention and detection of fraud, error and irregularities, and bribery and corruption. • Implementing arrangements to ensure its financial position is soundly based. • Making arrangements to secure Best Value. • Establishing an internal audit function. Audit Fee 11. The audit fee for the 2025/26 audit was reported in the Annual Audit Plan and was set at £35,480. There have been no developments that impact on planned audit work required, therefore the audit fee reported in the Annual Audit Plan remains unchanged. National performance audit reporting 12. The Auditor General for Scotland and the Accounts Commission regularly publish performance audit reports. These cover a range of matters, many of which may be of interest to North Lanarkshire IJB and the Board. Details of national and performance audit reports published over the last year can be seen in Appendix 2. Page 55 of 264
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Audit of the annual accounts | 7 Audit of the annual accounts Main judgements All audit opinions stated that the annual accounts were free from material misstatement. The balance sheet included in the unaudited financial statements included materially incorrect values as these reflected the prior year balances rather than current year. This resulted in an increase to the balance sheet of £27.263 million. All audit adjustments required to correct the financial statements were processed by North Lanarkshire Integration Joint Board. Audit opinions on the annual accounts 13. North Lanarkshire IJB’s annual accounts were approved by the Board on 16 September 2026 and certified by the appointed auditor on 16 September 2026. The Independent Auditor’s Report is included in North Lanarkshire IJB’s annual accounts, and this reports that, in the appointed auditor’s opinion, these were free from material misstatement. Audit timetable 14. The unaudited annual accounts and all working papers were received on 18 June 2026 in accordance with the agreed audit timetable. Materiality 15. The concept of materiality is applied by auditors in planning and performing an audit, and in evaluating the effect of any uncorrected misstatements on the financial statements or other information reported in the annual accounts. 16. Broadly, the concept of materiality is to determine whether misstatements identified during the audit could reasonably be expected to influence the decisions of users of the annual accounts. Auditors set a monetary threshold when determining materiality, although some issues may be considered material by their nature. Therefore, materiality is ultimately a matter of the auditor’s professional judgement. 17. Materiality levels for the audit of North Lanarkshire IJB were determined at the risk assessment phase of the audit and were reported in the Annual Audit Plan, which also reported the judgements made in Page 56 of 264
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Audit of the annual accounts | 8 determining materiality levels. These were reassessed on receipt of the unaudited annual accounts. Materiality levels were updated and these can be seen in Exhibit 1. Exhibit 1 2025/26 Materiality levels for North Lanarkshire IJB Materiality North Lanarkshire IJB Materiality – set at 2% of gross expenditure £17.473 million Performance materiality – set at 75% of materiality. As outlined in the Annual Audit Plan, this acts as a trigger point. If the aggregate of misstatements identified during the audit exceeds performance materiality, this could indicate further audit procedures are required. £13.105 million Reporting threshold – set at 5% of materiality. £0.874 million Source: Audit Scotland Significant findings and key audit matters 18. ISA (UK) 260 requires auditors to communicate significant findings from the audit to those charged with governance, which for North Lanarkshire IJB is the North Lanarkshire Health and Social Care Integration Joint Board (the Board). 19. The Code of Audit Practice also requires public sector auditors to communicate key audit matters. These are the matters that, in the auditor’s professional judgement, are of most significance to the audit of the financial statements and require most attention when performing the audit. 20. In determining key audit matters, auditors consider: • Areas of higher or significant risk of material misstatement. • Areas where significant judgement is required, including accounting estimates that are subject to a high degree of estimation uncertainty. • Significant events or transactions that occurred during the year. 21. The significant findings and key audit matters to report are outlined in Exhibit 2. Page 57 of 264
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Audit of the annual accounts | 9 Exhibit 2 Significant findings and key audit matters Significant findings and key audit matters Outcome Material adjustment required to the balance sheet The balance sheet in the unaudited accounts that were issued for public inspection had not been updated for the current year and instead disclosed the prior year position. This required a material adjustment to be made to both short-term debtors and usable reserves. North Lanarkshire IJB has adjusted for the error, increasing both short-term debtors and usable reserves by £27.263 million. Source: Audit Scotland Qualitative aspects of accounting practices 22. ISA (UK) 260 also requires auditors to communicate their view about qualitative aspects of North Lanarkshire IJB’s accounting practices, including accounting policies, accounting estimates, and disclosures in the financial statements. Accounting policies 23. The appropriateness of accounting policies adopted by North Lanarkshire IJB was assessed as part of the audit. These were considered to be appropriate to the circumstances of North Lanarkshire IJB, and there were no significant departures from the accounting policies set out in the Code of Practice on Local Authority Accounting in the United Kingdom (the Code). Accounting estimates 24. No significant accounting estimates were identified as having been employed by management in preparing the financial statements. Disclosures in the financial statements 25. The adequacy of disclosures in the financial statements was assessed as part of the audit. The quality of disclosures was adequate, with additional levels of detail provided for disclosures around areas of greater sensitivity, such as related party transactions. Significant matters discussed with management 26. All significant matters identified during the audit and discussed with the body’s management have been reported in the Annual Audit Report. Page 58 of 264
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Audit of the annual accounts | 10 Audit adjustments 27. Audit adjustments were required to the financial statements to correct misstatements that were identified from the audit. Details of all audit adjustments greater than the reporting threshold of £0.874 million are outlined in Exhibit 3. Exhibit 3 Audit adjustments Details Financial statements lines impacted Comprehensive Income and Expenditure Statement (CIES) Balance Sheet Audit adjustments to financial statements Dr Cr Dr Cr £000 £000 £000 £000 1. As noted at Exhibit 2, the balance sheet in the unaudited accounts had not been updated for the current year, and instead disclosed the prior year position. Short Term Debtors 27,263 Usable Reserves 27,263 Net impact on financial statements 0 0 Audit adjustments in disclosures 1. Remuneration Report: The remuneration report did not disclose the officers who had been in post for part of the prior year. This was corrected to show their total earnings for the year as well as the FTE. This extended to the Pension Benefits table which was updated to show these officers’ Pension Contributions and Accrued Pension Benefits in the prior year. 2. Remuneration Report: The Total Earnings in 2025/26 for both officers in post were overstated as they included employer pension contributions and employer national insurance contributions. This was corrected to only include their salary figures. Page 59 of 264
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Audit of the annual accounts | 11 3. Usable Reserves: Adjustments were required to the opening balances of some categories of usable reserves within Note 7 to the accounts to ensure these aligned with the previously audited balance as at 31 March 2025. References to “ring-fenced” reserves have also been removed as this is not the correct terminology for North Lanarkshire IJB, with previously disclosed balances reclassified as “Earmarked Reserves – Other Services”. These adjustments have resulted in a net increase of £3.456 million in the opening balance disclosed for “Earmarked Reserves – Other Services”. Source: Audit Scotland 28. Management of the body processed audit adjustments for all misstatements identified greater than the reporting threshold. As a result, there are no uncorrected misstatement to report. Significant risks of material misstatement identified in the Annual Audit Plan 29. Audit work has been performed in response to the significant risks of material misstatement identified in the Annual Audit Plan. The outcome of audit work performed is summarised in Exhibit 3. Page 60 of 264
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Audit of the annual accounts | 12 Exhibit 3 Significant risks of material misstatement to the financial statements Risk of material misstatement Planned audit response Outcome of audit work Fraud caused by management override of controls Management is in a unique position to perpetrate fraud because of management’s ability to override controls that otherwise appear to be operating effectively. The audit team will: • Agree balances and transactions to North Lanarkshire Council and NHS Lanarkshire financial reports, ledgers and correspondence. • Obtain assurances from the auditors of North Lanarkshire Council and NHS Lanarkshire over the completeness, accuracy and allocation of income and expenditure. • Review significant adjustments at year end where we consider there to be greatest risk of material misstatement through management override of controls. • Review financial monitoring reports during the year. • Evaluate significant transactions outside the normal course of business. • Assess the adequacy of controls in place for identifying and disclosing related party relationships and transactions in the financial statements. From carrying out the planned audit procedures, we have not identified any indication of material misstatement in the financial statements through fraud or error caused by management override of controls. Conclusion: No evidence of fraud caused by management override of controls. Source: Audit Scotland Prior year recommendations 30. The body has made good progress in implementing the agreed prior year audit recommendations as outlined in Appendix 1. Page 61 of 264
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Wider scope and Best Value audit | 13 Wider scope and Best Value audit Conclusion North Lanarkshire Integration Joint Board has effective and appropriate arrangements in place for Financial Management; Vision, Leadership and Governance; and Use of Resources to Improve Outcomes. Challenges remain in delivering financial sustainability over the medium term, with significant budget gaps forecast. It is important that North Lanarkshire Integration Joint Board, working with its strategic partners, develops a financially sustainable operating model, moving away from the reliance on delivering significant in-year savings or cost reduction measures that risk short-term decision making. North Lanarkshire Integration Joint Board has effective and appropriate arrangements in place for securing Best Value. Audit approach to wider scope and Best Value Wider scope 31. As reported in the Annual Audit Plan, the wider scope audit areas are: • Financial Management. • Financial Sustainability. • Vision, Leadership and Governance. • Use of Resources to Improve Outcomes. 32. Audit work is performed on these four areas and a conclusion on the effectiveness and appropriateness of arrangements North Lanarkshire IJB has in place for each of these is reported in this chapter. Best Value 33. The duty on auditors to consider the arrangements in place to secure Best Value applies to North Lanarkshire IJB as it falls within section 106 of the Local Government (Scotland) Act 1973. Page 62 of 264
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Wider scope and Best Value audit | 14 34. Consideration of the arrangements North Lanarkshire IJB has in place to secure Best Value has been carried out alongside the wider scope audit. Significant wider scope and Best Value risks 35. Audit work has been performed in response to the significant wider scope and Best Value risks identified in the Annual Audit Plan. The outcome of audit work performed is summarised in Exhibit 4. Page 63 of 264
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Wider scope and Best Value audit | 15 Exhibit 4 Significant wider scope and Best Value risks as identified in our Annual Audit Plan Significant risk Planned audit response Outcome of audit work Financial sustainability In recent years, North Lanarkshire IJB has been able to achieve financial balance. North Lanarkshire IJB faces significant financial challenges. The IJB has forecast a budget gap of £18.322 million for year ended 31 March 2027. North Lanarkshire IJB needs to ensure resources are allocated to areas of strategic priority and user need. North Lanarkshire IJB have established medium and longer- term financial plans. However, these should continue to be developed to ensure assumptions around funding and savings are incorporated. With the financial and operational challenges facing the IJB, it is important that the organisation work with partners to establish a financially sustainable operating model. The audit team will: • Establish the extent to which North Lanarkshire IJB’s financial plans have been developed to incorporate funding and savings assumptions in order to establish a financially sustainable operating model. • Review the plans in place to identify any budget gaps. • Review any other financial plans developed and assess the appropriateness of the financial plans and any assumptions made. • Review financial monitoring reports to assess the financial position, including progress of partner bodies in achieving planned savings. • Review controls in place and updates to financial plans to assess financial sustainability. Audit work performed found: • The body has developed medium and longer-term financial plans which are aligned to the body’s updated Strategic Commissioning Plan (SCP) and priorities. The Medium Term Financial Plan (MTFP) for 2026/27 to 2028/29 identified a budget gap before savings of £23.923 million for 2026/27. Savings programmes have been identified and agreed to reach a balanced budget for 2026/27. • The most recent Medium Term Financial Outlook (MTFO) for 2027/28 to 2029/30 models three budget scenarios. Under currently envisaged conditions, the MTFO forecasts a three- year budget gap of £28.128 million, of which £15.204 million relates to 2027/28. • The assumptions made in the financial plans are reasonable and clearly demonstrated within papers presented to members. • Regular budget monitoring reports provide timely updates on in-year financial performance. Conclusion: North Lanarkshire IJB has developed medium and longer-term financial plans, and these are linked to its SCP and priorities. However, North Lanarkshire IJB continues to face challenges to financial sustainability. Source: Audit Scotland Page 64 of 264
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Wider scope and Best Value audit | 16 Conclusions on wider scope audit Financial Management 36. The audit work performed on the arrangements North Lanarkshire IJB has in place for securing sound financial management found that these were effective and appropriate. This judgement is evidenced by: • North Lanarkshire IJB having suitably qualified and experienced staff leading the finance function, which has sufficient skills, capacity, and capability to effectively fulfil its role. • North Lanarkshire IJB having effective arrangements in place for the scrutiny of arrangements that support sound financial management, and effective scrutiny and challenge provided by the Performance, Finance & Audit Committee. • detailed financial monitoring reports being submitted quarterly to the Performance, Finance & Audit Committee. These reports provide a comprehensive overview of any budget adjustments, the forecast year-end outturn and explanations for any significant operational projected variances against budget, and performance against savings targets. 37. North Lanarkshire IJB approved its 2025/26 budget in March 2025. A budget gap before savings of £14.959 million was identified. Efficiency savings through service redesign and transformation were identified to reach a balanced budget for 2025/26. 38. Of the £14.959 million of savings identified, £9.107 million total savings were achieved. There were further underspends against budget in year, including against employee costs and hosted services. Additional funding of £27 million was also received in year from partner bodies, which has been earmarked for use in future years for areas including unscheduled care and other health care. As a result, North Lanarkshire IJB reported a surplus on the provision of services of £27.263 million at 31 March 2026. Financial Sustainability 39. The audit work performed on the arrangements North Lanarkshire IJB has in place for securing financial sustainability found that these were effective and appropriate, however challenges remain in delivering financial sustainability over the medium term, with significant budget gaps forecast. This judgement is evidenced by: • North Lanarkshire IJB having effective arrangements in place for identifying risks to financial sustainability over the medium and longer-term, and understanding medium and longer-term demand pressures that could impact on available resources. Page 65 of 264
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Wider scope and Best Value audit | 17 • North Lanarkshire IJB having savings plans in place to manage forecast budget deficits, and a reserves strategy in place to manage the use of reserves if the required level of savings cannot be met. • North Lanarkshire IJB making appropriate arrangements to develop medium and longer-term financial plans and linking these to its Strategic Commissioning Plan and priorities. 40. North Lanarkshire IJB’s Medium Term Financial Plan (MTFP) for 2026/27 to 2028/29 identified a budget gap before savings of £23.923 million for 2026/27. Savings programmes were identified and agreed to reach a balanced budget for 2026/27. 41. North Lanarkshire IJB’s three-year Medium Term Financial Outlook (MTFO) for 2027/28 to 2029/30 updates the assumptions in the MTFP for 2026/27 to 2028/29 and highlights the emerging financial risks and challenges over the next three years. 42. The MTFO is modelled on three scenarios to reflect the inherent uncertainty on medium-term financial planning. These scenarios provide an indication of the potential financial impact should future conditions prove more or less favourable than currently anticipated. Under currently envisaged conditions, the MTFO forecasts a three-year budget gap of £28.128 million, of which £15.204 million relates to 2027/28. 43. As a result of the ongoing challenges in delivering financial sustainability, the following recommendation has been made, with further details outlined in Appendix 1. Recommendation 1 Financial sustainability: North Lanarkshire IJB should further develop its medium-term financial plan to show the scenarios, assumptions and measures required to deliver a financially sustainable operating model. This should support strategic planning and balanced budgets by setting out, with partner bodies, the service redesign, transformation and efficiency programmes needed and the level of service deliverable within available funding. The new Programme for Government announced in September 2026 focuses on improving outcomes and addressing national challenges with wide ranging proposed reform 44. The Scottish Government’s Programme for Government 2026-31 focuses on eradicating child poverty, growing the economy, tackling the climate emergency, and delivering strong NHS and public services. Within health and social care, it prioritises reducing waiting times, Page 66 of 264
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Wider scope and Best Value audit | 18 improving access to care, and shifting more services from hospitals into community settings to support prevention and independent living. 45. The Programme proposes modernisation and significant reform, including replacing the current 14 territorial health boards with two strategic health boards. For Integration Joint Boards (IJBs), the Programme signals potential reform of health and social care governance and delivery arrangements. While the direction of travel is towards greater integration, prevention and community-based care, the full implications for IJBs remain uncertain. Greater clarity is expected in the coming months as the Scottish Government undertakes planned consultation and engagement on the future of social care and local governance. Vision, Leadership and Governance 46. The audit work performed on the arrangements North Lanarkshire IJB has in place around its Vision, Leadership and Governance found that these were effective and appropriate. This judgement is evidenced by: • North Lanarkshire IJB having a Strategic Commissioning Plan in place that clearly sets out its vision, strategy, and priorities and reflect the pace and depth of improvement required to realise these in a sustainable manner. The Strategic Commissioning Plan recognises the importance of partnership working to support necessary transformational change for the improvement of health and wellbeing in the local area. • North Lanarkshire IJB involving service users, delivery partners, and other stakeholders in the development of its vision, strategy, and priorities to ensure these align to their needs. • North Lanarkshire IJB having clear financial and performance reporting in place that is linked to National Outcomes, and effective scrutiny and challenge of performance provided by the Performance, Finance & Audit Committee. • North Lanarkshire IJB having effective governance arrangements in place in general, as reflected in the Annual Governance Statement included in the accounts. 47. Historically, only councillor members appointed by North Lanarkshire Council and non-executive directors appointed by NHS Lanarkshire were voting members. However, through The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment Order 2025, from 1 September 2026 voting rights will be extended to the third sector, service user and unpaid carer representatives. These individuals remain appointed as independent stakeholder representatives but will gain voting rights. The Board’s Standing Orders have been reviewed and amended to incorporate these changes. Page 67 of 264
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Wider scope and Best Value audit | 19 Use of Resources to Improve Outcomes 48. The audit work performed on the arrangements North Lanarkshire IJB has in place around its Use of Resources to Improve Outcomes found that these were effective and appropriate. This judgement is evidenced by: • North Lanarkshire IJB being able to demonstrate a clear link between the use of resources and delivery of its priorities. • North Lanarkshire IJB having arrangements in place to benchmark its performance across key national and local indicators to identify areas for improvement. North Lanarkshire IJB’s Annual Performance Report provides a comprehensive overview of performance in-year and allows the Board to identify where improvement is required and appropriate action to achieve this. • North Lanarkshire IJB’s Chief Officer attending quarterly performance review meetings with the Chief Executives of partner bodies, with performance measures taken from both the health and social care systems. These meetings ensure corrective actions are agreed for areas requiring improvement. Quarterly reports outlining the agreed corrective actions are then presented to the Performance, Finance & Audit Committee to allow further review. Conclusions on Best Value 49. The audit work performed on the arrangements North Lanarkshire IJB has in place for securing Best Value found these were effective and appropriate. This judgement is evidenced by: • North Lanarkshire IJB having well established and effective governance arrangements in place, with the Best Value being a key aspect of the governance arrangements. • North Lanarkshire IJB’s Strategic Commissioning Plan, which establishes outcomes and priorities that partner bodies are expected to deliver through delegated functions. Performance against these priorities is monitored through regular reporting to the Board and the Performance, Finance & Audit Committee, including scrutiny of financial performance, service performance, risk management, and delivery of transformation programmes. • the arrangements North Lanarkshire IJB has in place around the four wider scope audit areas, which are effective and appropriate, contribute to it being able to secure Best Value. Page 68 of 264
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Appendix 1 | 20 Appendix 1 Action plan 2025/26 2025/26 recommendations Matter giving rise to recommendation Recommendation Agreed action, officer and timing 1. Financial Sustainability North Lanarkshire IJB’s three-year Medium Term Financial Outlook (MTFO) for 2027/28 to 2029/30 updates the assumptions in the Medium Term Financial Plan (MTFP) for 2026/27 to 2028/29 and highlights the emerging financial risks and challenges over the next three years. Under currently envisaged conditions, the MTFO forecasts a three-year budget gap of £28.128 million, of which £15.204 million relates to 2027/28. North Lanarkshire IJB continues to face significant financial challenges over the medium term, with substantial recurring budget gaps identified over the medium term. North Lanarkshire IJB should further develop its medium-term financial plan to show the scenarios, assumptions and measures required to deliver a financially sustainable operating model. This should support strategic planning and balanced budgets by setting out, with partner bodies, the service redesign, transformation and efficiency programmes needed and the level of service deliverable within available funding. Accepted In line with 2025/26, forecasts will continue to be presented to the IJB in September and December ahead of the final Budget paper in March. These will include detailed information on all 3 scenarios (Envisaged, Pessimistic & Optimistic). The assumptions will continue to be discussed and agreed with Health & Council finance contacts to ensure they are in line with NLC & NHSL Financial Plans. The Savings & Value Board meets monthly to track progress of the 26/27 Savings and these meetings will also be used to consider the next 3 financial years forecasts. Budget Briefings with Members will take place again between October and February to discuss budget gaps and resulting savings proposals. The IJB CFO will attend Elected Member briefings in January alongside NLC CFO to ensure they are fully aware of the IJB financial position before agreeing the Council contribution to the IJB. Responsible Officer: Nicola Scott, Chief Finance Officer Agreed date: March 2027 Page 69 of 264
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Appendix 1 | 21 Follow-up of prior year recommendations Matter giving rise to recommendation Recommendation, agreed action, officer and timing Update 1. Financial Sustainability In recent years, North Lanarkshire IJB has been successful in achieving short term financial balance. However, it still faces significant financial challenges and difficult decisions in ensuring resources are allocated to areas of strategic priority and user demand. Current Medium Term Financial Plan is estimating a funding gap of £51.8 million over the three years to 2027/28, and the Long Term Financial Outlook identifies cost pressures in 2028/29 of £40 million rising to £58 million in 2034/35. Risk – North Lanarkshire IJB does not have sufficient reserves to fund its projected future net expenditure. Recommendation The IJB should continue to: • develop and refine the arrangements it has in place for securing financial sustainability, including its medium and long term financial plans and savings plans • work effectively in partnership with the local council and the health board on service transformation • apply its reserves strategy to effectively manage the use of reserves to supplement savings and efficiencies when required. Management Response A financial outlook for the 3 year period has been prepared and is being presented to Board Members on 17th September 2025. This outlines the forecast budget gaps for the next 3 years and will lead into Board Development sessions where savings will be discussed for approval at a later Board. The outlook clearly identifies the current reserves position and the impact non achievement on savings will have on reserves. Discussions have taken place with both NLC & NHSL on the forecast position and an Elected Members briefing session within NLC was undertaken in June this year with another scheduled in the Autumn to ensure all relevant parties are aware of the forecast. The medium term and long term outlooks will continue to be reviewed throughout the year with budget setting for 2026/27 set for March 2026. Responsible Officer: Chief Finance Officer/Chief Officer Agreed date: Ongoing Superseded The agreed actions have been implemented, but financial sustainability remains a risk. A refreshed recommendation has been made given the challenges in place. Page 70 of 264
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Appendix 2 | 22 Appendix 2 Supporting national and performance audit reports Report name Date published Local government budgets 2025/26 22 May 2025 NHS in Scotland: Spotlight on governance 28 May 2025 Delivering for the future: Responding to the workforce challenge 7 August 2025 Flooding in communities: Moving towards flood resilience 28 August 2025 Adult Disability Payment 18 September 2025 Scotland’s colleges 2025 2 October 2025 Improving care experience: Delivering The Promise 8 October 2025 Local government performance: Spotlight on culture and leisure services 23 October 2025 Financial sustainability and taxes 13 November 2025 NHS in Scotland 2025: Finance and performance 4 December 2025 Delayed discharges: A symptom of the challenges facing health and social care 8 January 2026 Community health and social care: Performance 2025 8 January 2026 Administration of Scottish income tax 2024/25 16 January 2026 Local Government in Scotland: Financial bulletin 2024/25 29 January 2026 The Scottish Budget 2026/24: Supplement to the Financial bulletin 2024/25 12 February 2026 Integration Joint Boards: Finance bulletin 2024/25 26 February 2026 Annual Assurance and Risks Report: A review of 2024/25 local government audits in Scotland 12 March 2026 Page 71 of 264
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North Lanarkshire Integration Joint Board 2025/26 Annual Audit Report - DRAFT Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit.scot www.audit.scot AS.5.0 Page 72 of 264
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REPORT Item No: SUBJECT: Audited Annual Accounts 2025/26 TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 16 September 2026 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report presents the audited North Lanarkshire Integration Joint Board (IJB) Annual Accounts for 2025/26 for approval. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Approve the Audited North Lanarkshire IJB Annual Accounts 2025/26. (2) Authorise the Chair and Chief Finance Officer to sign the Annual Accounts on behalf of the IJB. (3) Note that the signed Annual Accounts will be published on the North Lanarkshire HSCP website in accordance with statutory requirements. 4. VARIATIONS TO DIRECTIONS 5. AUDITED ACCOUNTS 2025/26 5.1 The North Lanarkshire Integration Joint Board (IJB) is required to prepare Annual Accounts in accordance with statutory and professional accounting requirements and to submit them for audit. 5.2 The Annual Accounts for the year ended 31 March 2026 have been audited by Audit Scotland and are attached at Appendix 1. Yes No N/A Item 8 Page 73 of 264
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5.3 Audit Scotland has issued an unmodified opinion on the 2025/26 financial statements. The External Auditor's findings and recommendations are presented separately to the Board. 6. APPROVAL OF THE ANNUAL ACCOUNTS 2025/26 6.1 The Annual Accounts 2025/26 have been prepared in accordance with proper accounting practices and statutory requirements. Appropriate accounting policies have been applied consistently, reasonable and prudent judgments have been exercised, and proper accounting records have been maintained. 6.2 The accounts present the financial performance and financial position of the North Lanarkshire IJB for the year ended 31 March 2026. 6.3 Approval of the audited Annual Accounts will enable the IJB to fulfil its statutory financial reporting obligations for 2025/26. Following approval by the Board, the Annual Accounts will be signed by the Chair and Chief Finance Officer and made publicly available in accordance with statutory requirements. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as 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 dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. Page 74 of 264
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Relevant Risk Register Details Current Risk Level Risk Owner Financial Sustainability – Short Term High Nicola Scott Financial Sustainability – Medium Term Very High Nicola Scott Financial Sustainability – Long Term Very High Nicola Scott Governance Failure High Nicola Scott Failure to meet Legislative Requirements Medium Pauline Izat / Morag Dendy / Joanne Jenkins 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance and Technology) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns with and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Page 75 of 264
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Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 - Audited North Lanarkshire IJB Annual Accounts 2025/26 Chief Finance Officer Members seeking further information, please contact Nicola Scott on 07581007187. Page 76 of 264
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AUDITED ANNUAL ACCOUNTS For the Year Ended 31 March 2026 Page 77 of 264
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1 | P a g e CONTENTS Management Commentary 2 Role of the IJB 2 National Health & Wellbeing Outcomes 3 A profile of North Lanarkshire 4 University Health & Social Care Partnership 5 2025/26 Achievements 6 Measuring Performance Under Integration 9 Key Risks, Uncertainties & Challenges 11 Financial Performance 2025/26 14 Reserves Strategy 17 Acknowledgements 18 Statement of Responsibilities 19 Remuneration Report 21 Annual Governance Statement 24 Independent Auditors Report 33 Comprehensive Income and Expenditure Statement 38 Movement in Reserves Statement 39 Balance Sheet 40 Notes to the Financial Statements 41 Note 1. Material Accounting Policy Information 41 Note 2. Events After the Balance Sheet Date 43 Note 3. Expenditure and Funding Analysis by Nature 44 Note 4. Taxation and Non-Specific Grant Income 44 Note 5. Corporate Services 45 Note 6. Short Term Debtors and Creditors 45 Note 7. Useable Reserves: General Fund 45 Note 8. Related Party Transactions 47 Note 9. Hosted Services 48 Note 10. VAT 49 Note 11. External Audit Costs 50 Page 78 of 264
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2 | P a g e Management Commentary Role of the IJB The Public Bodies (Joint Working) (Scotland) Act 2014 requires Health Boards and Local Authorities to integrate the planning and delivery of adult health and social care services. This agreement sets out how the Health Board and Local Authority work together to deliver these responsibilities through an integrated partnership. The IJB was established as a corporate body by Scottish Government and became operational in June 2015 with integrated delivery of health and social care services commencing on 1 April 2016. It is a joint venture between NHS Lanarkshire (NHSL) and North Lanarkshire Council (NLC). The functions delegated to the IJB, under 2014 Act, are detailed in the formal partnership agreement between the two partner organisations, NLC and NHSL referred to as the Integration Scheme.1 These include: • Accident and emergency services provided in a hospital • Inpatient services related to general, respiratory and rehabilitation medicine • Palliative care services • Community health services including Lanarkshire wide hosted services • Social care services. The IJB will be responsible for the Strategic Planning of the functions delegated to it and for ensuring the delivery of its functions through the locally agreed operational arrangements set out within the Integration Scheme. The Strategic Direction is detailed within the Strategic Commissioning Plan.2 The IJB comprises of eight voting members, made up of four Elected Members appointed by NLC and four Non-Executive Directors appointed by NHSL. Non-voting members include the Chief Officer, Chief Finance Officer, service professionals, third sector representatives, service users, carers, and staff representatives. 1 NL IJB Integration Scheme 2025 2 Strategic Commissioning Plan 2023-26 Page 79 of 264
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3 | P a g e National Health & Wellbeing Outcomes The Partnership’s central purpose is to improve outcomes for people who use health and social care services, and for their carers, by focusing on delivery of the nine National Health and Wellbeing Outcomes, which are set by the Scottish Government and apply consistently across all Integration Joint Boards in Scotland. Outcome 1 People are able to look after and improve their own health and wellbeing and live in good health for longer Outcome 2 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community Outcome 3 People who use health and social care services have positive experiences of those services and have their dignity respected. Outcome 4 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Outcome 5 Health and social care services contribute to reducing health inequalities. Outcome 6 People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing. Outcome 7 People using health and social care services are safe from harm. Outcome 8 People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. Outcome 9 Resources are used effectively and efficiently in the provision of health and social care services. Whilst many older people are expected to experience better health than previous generations at the same age, a significant proportion will continue to live with complex and multiple long‑term conditions. This will contribute to a sustained increase in demand for health and social care services, including home support, care home provision, community‑based healthcare, equipment and adaptations, and increased demand for GP services and prescribing. These demographic and demand pressures are reflected in the activity and performance information presented in the following section. Page 80 of 264
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4 | P a g e A profile of North Lanarkshire The 2022 census provided a number of updated statistics pertaining to the population of North Lanarkshire. The diagram below shows the percentage movements in each category since the 2011 census. Population 341,890 4th largest area in Scotland and the 5th most populated Population Trends 2011 – 2022 25 to 44 age group 7.3% Over 75’s 21% Population Projections to 2043 Population 1.2% Over 75’s 71.4% Unemployment 3.3% = lowest since 2005 Long Term sick or disabled 6% Health Comparisons 2011 – 2022 Individuals self-reporting as “not in good health”. 24.6% (+6039) Individuals self-reporting as in “fairly good health”. 15% (+7036) Individuals self-reporting with ‘long term health conditions’ 30.6% (+43,943) Individuals self-reporting mental health issues 158.6% (+24,903) Individuals self-reporting as providing informal / unpaid care 31.6% (+10,877) Page 81 of 264
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5 | P a g e University Health & Social Care Partnership Within North Lanarkshire, NHSL and NLC deliver integrated services as the Partnership. It is therefore essential staff from both organisations working together to plan and deliver services under the direction of the IJB. Purpose The long-term vision for the Partnership was set out in the original Strategic Plan 2016- 2026 and continues as the over-arching vision of the Strategic Commissioning Plan 2023-26. This states that the people of North Lanarkshire will achieve their full potential through: Ambitions To implement the vision, the Partnership has 5 key ambitions which were revised in 2023, following engagement with stakeholders, taking experience gained since 2016 and looking at the current and future challenges facing the Partnership. • Living safe, healthy and independent lives in their communities. • Receiving the information, support and care they need, efficiently and effectively, at the right time, in the right place and in the right way. • Ensuring North Lanarkshire is the best place in Scotland to grow up. KEY AMBITIONS 1. Do the right thing first time 2. Increased focus on prevention, early intervention and tackling inequalities by working with communities and people 3. Develop and support a workforce for the future 4. Improve mental health and wellbeing 5. Support people through a whole family approach Page 82 of 264
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6 | P a g e 2025/26 Achievements The Integration Joint Board continues to monitor progress against its strategic commissioning intentions and key performance indicators through regular performance reporting and periodic updates on progress with change and improvement activity. Delivery throughout 2025/26 has been characterised by continued implementation of the Strategic Commissioning Plan 2023-2026 alongside the development of a new Strategic Commissioning Plan for 2026-2029. This has reflected an ongoing focus on prevention, tackling inequalities and strengthening community- based supports, with our activity aligned to the national priorities and our local learning derived from the current planning cycle. Supporting People Earlier and Closer to Home The Partnership has continued to develop its whole system approach to supporting people to access the right support at the right time, reducing reliance on hospital-based and reactive services. This has been underpinned by the continued development of the “Getting It Right for Everyone” approach, which focuses on improving coordination of support through principles such as a single shared assessment, a lead professional, and a “no wrong door” approach. This approach has supported a stronger emphasis on prevention, early intervention and independence. In practice, this has been demonstrated through the continued development of community-based models of care, including Home Assessment Teams and the wider “Home First” approach being employed across the partnership. These models support people to be assessed and receive care within their own homes wherever possible, reducing unnecessary hospital and care admissions whilst also supporting timely discharge from hospital. There is evidence of positive progress in shifting the balance of care. The number of days people experience delayed discharge remains lower in North Lanarkshire than the national average, while national data indicates that delayed discharge bed days have increased compared to pre‑pandemic levels. Falls rates for older people have also remained below the national average. These developments have been reinforced through continued collaboration across health, social care and community partners, as well as through engagement with national stakeholders. External engagement, including ministerial visits, has recognised the role of locally developed models in supporting improved discharge and admission avoidance. Improving Access and Delivering Person Centred Care The Partnership has continued to strengthen its focus on person centred care, ensuring that services are accessible, responsive and shaped around the needs of individuals and communities. Progress has been made in expanding Self-Directed Support, with increasing numbers of people directing their own care through individual budgets. This reflects a continued commitment to promoting choice, control and independence. Activity to support this has included local engagement initiatives and partnership events, including a Self-Directed Support roadshow which brought together partners, staff, carers and people with lived experience to share learning, recognise progress and strengthen the collective approach across North Lanarkshire. Page 83 of 264
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7 | P a g e Further progress has been made through the development and launch of the Lanarkshire Advocacy Plan, which supports a rights-based approach and strengthens access to independent advocacy for individuals who require additional support to make their views known. At a national level, survey data indicates that satisfaction across a number of health and care experience measures remains lower than pre-pandemic levels. The position in North Lanarkshire reflects these wider trends, reinforcing the importance of continued focus on access, communication and coordination of care. Strengthening Services for Children and Young People Significant progress has been delivered in modernising services for children and young people, particularly in relation to mental health and neurodevelopmental services. The CAMHS and Neurodevelopmental Services Recovery and Renewal Programme has delivered substantial changes to service pathways, including the establishment of a single, consistent pathway for neurodevelopmental assessment and the full implementation of the Choice and Partnership Approach model. These changes have improved consistency, transparency and the ability to plan service capacity over time, supported by more robust data and the use of electronic patient records. Performance has improved, with waiting times reducing and national referral-to-treatment standards largely achieved. Governance arrangements have now transitioned from a programme structure to business-as-usual operational and clinical governance. At the same time, demand for neurodevelopmental assessment continues to exceed capacity, reflecting national trends. Work is ongoing to address this through service redesign, additional capacity and collaboration with national partners. Broader service modernisation has also been progressed through the Paediatric Modernisation Programme. This has included stabilisation of medical staffing rotas, development of Hospital at Home pathways, and continued improvement in care assurance and service delivery models. These developments support more sustainable services and improved outcomes for children and families. Supporting People with Complex Needs and Reducing Inequalities The Partnership has continued to take forward work to support individuals with complex needs and reduce inequalities in outcomes across communities. Implementation of the national “Coming Home” agenda has led to improvements in the management of delayed discharges and inappropriate placements for people with learning disabilities and complex care needs. The introduction of the Dynamic Support Register has improved visibility and oversight of individuals at risk, supporting more proactive and coordinated interventions. Targeted investment has enabled the establishment of a specialist team to support complex discharge planning and improve outcomes for individuals, including reducing unnecessary hospital stays and supporting people to live closer to home. Despite this progress, significant challenges remain. Increasing complexity of need, particularly among younger adults with neurodevelopmental conditions, combined with workforce and housing pressures, continues to impact on service delivery. Inequalities in outcomes across Page 84 of 264
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8 | P a g e deprived and more affluent communities also persist, reflecting both local and national challenges. These issues continue to inform the Partnership’s strategic priorities, with a strengthened focus on prevention, early intervention and community-based support. Developing a Sustainable Workforce Developing and sustaining a skilled workforce remains a key priority. Significant progress has been made through the continued development of the Lanarkshire Care Academy, a collaborative initiative across NHS Lanarkshire, North and South Lanarkshire Councils and wider partners. The Care Academy provides a coordinated approach to workforce planning, focusing on attraction to the sector, recruitment, retention and development. Activity has included targeted recruitment campaigns, expansion of apprenticeships and school-based pathways, and development of employability programmes that support individuals into health and social care roles. This includes work with schools, colleges and universities to create clear pathways into employment, alongside programmes supporting adults and those facing barriers to employment to access training and job opportunities within the sector. These initiatives are set within the context of significant workforce demand, with health and social care continuing to represent the largest employment sector locally. The Care Academy’s work is therefore critical in building capacity, addressing inequalities and supporting long-term sustainability of services. Planning for the Future Alongside delivery of current priorities, significant work has been undertaken to develop the next Strategic Commissioning Plan for 2026–2029. This has been informed by extensive engagement with staff, partners and communities and reflects learning from delivery of the current plan. Emerging priorities include a strengthened focus on prevention and early intervention, tackling inequalities, supporting communities and improving access to services. These priorities align with national policy direction and will guide future transformation activity. The Partnership has also continued to plan for seasonal pressures, including winter planning, with a focus on maintaining patient flow, strengthening community capacity and supporting people to remain at home wherever possible. Ongoing improvement activity across a range of services continues to demonstrate the impact of collaborative working and system-wide approaches to improving outcomes for the people of North Lanarkshire. Page 85 of 264
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9 | P a g e Measuring Performance Under Integration The Annual Performance Report for 2025/26 will be presented to the Integration Joint Board in September 2026, providing an opportunity to reflect on the progress made across the Partnership and to recognise the contribution of staff, partners and communities in delivering integrated health and social care services. The report highlights both key achievements and the ongoing challenges facing the Partnership, including sustained demand, increasing complexity of need, and wider demographic and socio-economic pressures. Since 2016, Integration Joint Boards have been required to report against the Core Suite of Integration Indicators, which form part of a national framework used across Scotland. These indicators support the assessment of progress towards the National Health and Wellbeing Outcomes and provide a consistent basis for understanding how effectively services are improving outcomes for individuals and communities. The most recent published data relates to the 2024/25 reporting period and is presented in detail within the Annual Performance Report 2024/25. Use of this dataset ensures that analysis is based on the most complete and robust information available. Comparative performance data indicates that outcomes across a number of indicators continue to reflect the impact of sustained system pressures. These include an ageing population, an increasing prevalence of long-term conditions, and the ongoing effects of deprivation across North Lanarkshire. Collectively, these factors continue to drive demand for both acute and community-based services, alongside persistent workforce recruitment and retention challenges. During 2025/26, the Partnership has continued to respond to these challenges through delivery of key transformation programmes aligned to its Strategic Commissioning Plan. This includes further development of Home First approaches, alongside national recognition of local delivery models such as the Home Assessment Team. There has also been a sustained focus on early intervention, prevention and the expansion of community-based care. Progress has also been made in strengthening community engagement and preventative approaches. A programme of local engagement activity has supported improved access to services and strengthened links between statutory services, communities and third sector partners. Targeted activity has also continued to address inequalities, including focused engagement with priority population groups to improve uptake of key prevention programmes. The Partnership has continued to strengthen its governance, performance and assurance arrangements during the year. This has supported a more robust and transparent approach to monitoring performance and driving continuous improvement across services. Financial governance has also remained a key priority, with the approval of a balanced budget and Medium-Term Financial Plan for 2025/26 reflecting the ongoing focus on financial sustainability and delivery within available resources. Service-level improvements have been delivered across a number of areas, including improved access to Psychological Therapies and Speech and Language Therapy, alongside the continued development of digital systems to support service delivery and performance reporting. In addition, programmes focused on frailty, adult support, mental health, and alcohol and drug Page 86 of 264
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10 | P a g e services have progressed, reflecting a whole-system approach to improving outcomes and reducing harm. Overall, the Partnership continues to make progress towards the National Health and Wellbeing Outcomes. Performance remains broadly comparable with similar authorities and the Scottish average in many areas. Where improvement is required, this is identified through the established performance framework and is being addressed through targeted action, service redesign, and strengthened governance arrangements. Core Suite of Integration Indicators Title North Lanarkshire Scotland UHSCNL Trend Scotland Trend Premature mortality rate (per 100,000 persons) 545 442 WORSE WORSE Emergency Admission Rate (per 100,000 of population) 12,683 11,959 BETTER BETTER Emergency Bed Day Rate (per 100,000 of population) 120,763 113,627 BETTER BETTER Emergency re-admission to hospital within 28 days of discharge (per 1,000 of discharges) 112 103 BETTER BETTER Proportion of last 6 months of life spent at home or in a community setting 88.9% 89.2% NEUTRAL BETTER Falls rate (per 1,000 population aged 65+) 22.1 22.5 WORSE BETTER Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections 77.5% 81.9% BETTER BETTER Percentage of adults with intensive care needs receiving care at home 65.6% 64.7% WORSE BETTER Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) 825 952 BETTER WORSE Performance is better than previous reporting period Performance is neutral to previous reporting period Performance is worse than previous reporting period Page 87 of 264
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11 | P a g e Key Risks, Uncertainties & Challenges Given the current political and economic environment, the Partnership continues to face a range of significant risks and uncertainties which may impact on service delivery and financial sustainability. These risks are regularly reviewed as part of the IJB’s Medium-Term Financial Planning process and are monitored through the Partnership’s risk management framework, as outlined in the following section. Financial Risks and Uncertainties The principal financial risks facing the Partnership include: • Uncertainty regarding future funding levels from partner organisations and the Scottish Government • Ongoing cost pressures, including general inflation and future pay awards • Increasing costs associated with equipment and adaptations • The outcome of national negotiations in relation to care home rates • Inflationary pressures within commissioned services, including providers operating outwith national frameworks seeking increases significantly above inflation • The reliance on non-recurring measures in addressing in-year financial pressures Operational Risks and Uncertainties In addition to the financial challenges, the Partnership faces a number of operational risks, including: • The potential impact of savings measures on service delivery, including the risk of increases in delayed discharge and bed occupancy • Ongoing challenges in recruiting and retaining suitably skilled staff to meet increasing demand • Potential disruption to the supply of key materials and services • The emergence of increasingly complex care needs which are not fully predictable at the point of financial planning • Volatility within the external care market and the level of support required to maintain provider sustainability • An increasing number of providers seeking to operate outside of national contractual frameworks, leading to more complex placement and pricing negotiations • The operational impact of rising provider costs, which may affect the availability and timeliness of placements • Changes in UK and Scottish Government policy and priorities which may affect funding, service delivery models, and strategic direction These risks are reflected within the IJB’s Strategic Risk Register and are subject to ongoing monitoring and mitigation through established governance arrangements. Page 88 of 264
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12 | P a g e Risk Management Effective risk management is fundamental to the delivery of the IJB’s strategic objectives and the provision of safe, sustainable health and social care services. The IJB Risk Management Strategy complements the established risk management arrangements within each partner organisation and ensures that risk management remains a key element of governance and decision-making across the Partnership. Risk reporting continues to form a substantive item of business at both Integration Joint Board and Performance, Finance and Audit (PFA) Committee meetings. The PFA Committee has delegated responsibility for the oversight and scrutiny of financial and performance-related risks associated with the functions of the IJB. There are three principal risk registers in operation across the Partnership: • The IJB Strategic Risk Register, which sets out the key risks to the delivery of the IJB’s strategic objectives • The Health operational risk register, maintained within NHS Lanarkshire systems • The Social Work operational risk register, maintained within North Lanarkshire Council systems Strong links continue to be maintained with the corporate risk management functions within both partner organisations. The IJB’s approach to risk management is aligned with, and supported by, the risk management strategies of both NHS Lanarkshire and North Lanarkshire Council. A revised Strategic Risk Register was approved by the Integration Joint Board in March 2026, reflecting a refreshed assessment of the key risks facing the Partnership. In parallel, work has been progressing on the development of an updated IJB Risk Management Strategy, undertaken jointly with both partner organisations. This strategy is now in draft form, with final amendments being completed, and is scheduled for consideration by the PFA Committee in August 2026. At the time of writing, there are nine open risks recorded within the IJB Strategic Risk Register, five of which are assessed as either high or very high. The table below provides a summary of those risks categorised as high and very high. Page 89 of 264
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13 | P a g e Current Risk Level Risk Risk Description Financial Sustainability: Medium Term The Public Bodies (Joint Working) (Scotland) Act 2014 requires IJB’s to set a balanced budget as part of their strategic planning. This is essential for delivering integrated functions and budgets under IJB’s control, as outlined in the Act’s statutory guidance. There is a risk of North Lanarkshire Integration Joint Board failing to meet this statutory duty by not delivering financial balance over the medium three-year financial planning cycle due to income levels not keeping pace with increasing demand and costs pressures. Very High Financial Sustainability: Long Term Forecasting over an extended period remains inherently uncertain, particularly given the potential for policy change, economic volatility and wider system pressures. Despite this uncertainty, it is essential that the IJB adopts a long-term perspective to ensure it can identify emerging risks early and take proactive steps to safeguard financial sustainability. There is a risk of North Lanarkshire Integration Joint Board not forecasting the long-term factors appropriately resulting in being unable to achieve a balanced budget over the 10-year forecasting timeline. Very High Financial Sustainability: Short Term The Public Bodies (Joint Working) (Scotland) Act 2014 requires IJB’s to set a balanced budget as part of their strategic planning. This is essential for delivering integrated functions and budgets under IJB’s control, as outlined in the Act’s statutory guidance. There is a risk of North Lanarkshire Integration Joint Board not achieving a balanced budget within the current year as approved by the IJB annually in March. High Governance Failure There is a risk that less than robust scrutiny arrangements and appropriate internal processes and procedures are either not in place or are ineffective, leading to a lack of leadership, accountability or scrutiny, resulting in a failure to meet key objectives, financial overspends or reputational damage. High Delayed Discharge There is a risk that patients are not being discharged in a timely manner resulting in suboptimal patient flow, impacting on poor patient and staff experience and poorer outcomes of care. High Page 90 of 264
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14 | P a g e Financial Performance 2025/26 As outlined earlier in this Annual Report, North Lanarkshire Integration Joint Board (IJB) delivers and commissions a range of health and social care services to the local population. The Board is responsible for the strategic planning of the functions delegated to it and for ensuring the delivery of those functions through the operational arrangements set out in the integration scheme. To support the delivery of these services, funding is provided through budgets delegated from both North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL). The level of funding available to the IJB continues to be significantly influenced by the financial settlements received by these partner organisations from the Scottish Government. In line with these arrangements, the IJB agreed its delegated budgets at the start of the financial year. These budgets were subsequently adjusted during the year to reflect additional Scottish Government funding allocations, alongside the planned use of reserves to support service delivery and manage financial pressures. The final budget position is reflected within the tables presented below. North Lanarkshire IJB Budget 2025/26 £m Social Care Services Original Allocation 219.931 Additional Contributions form NLC 0.945 Budgeted Use of Reserves 0 Closing Budget 220.876 Health Care Services Original Allocation including set aside and hosted services 627.291 Scottish Government additional allocations 60.255 Budgeted Use of Reserves 0 Closing Budget 687.546 Total Budget 2025/26 908.422 Throughout 2025/26, the Partnership continued to operate within a highly challenging financial environment. Ongoing demand pressures, cost inflation, and workforce challenges have remained key issues across both Health and Social Care services. Whilst savings were incorporated within the Medium-Term Financial Plan, full delivery of these savings continues to be challenging within the current operating environment. Despite these pressures, the IJB recorded an overall underspend for the financial year. Page 91 of 264
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15 | P a g e North Lanarkshire IJB Financial Performance 2025/26 £m Net Operational Underspend 31.949 Less: Planned use of reserves during the year (4.686) Accounting Surplus on Provision of Services (Page 33) Movement in Reserves (Page 34) 27.263 The Partnership delivered a net operational underspend of £31.949m during 2025/26. This position includes expenditure funded through the planned use of reserves totalling £4.686m. Under accounting regulations, expenditure funded from reserves is recognised in full within the Comprehensive Income and Expenditure Statement, with the corresponding reserve movements reported separately within the Movement in Reserves Statement. Consequently, the surplus on the provision of services reported in the statutory accounts is £27.263m. A significant proportion of this surplus relates to funding received for specific purposes where expenditure will occur in future financial years and therefore will be held as earmarked balances. The majority of these relate to commitments within Health Services, reflecting funding received for commitments extending into 2026/27 in line with Scottish Government and NHS Lanarkshire direction. Key balances include funding for ligature works, prevention activity, unscheduled care and medicines growth. These balances will be carried forward and held within reserves to support delivery in future years, as reflected within the Reserves Strategy. After adjusting for these balances, the IJB’s underlying operating position represents an underspend of £3.742m. This comprises: • An underspend of £3.297m within services delegated to Health • An underspend of £0.445m within services delegated to Social Care The overall outturn position reflects a range of operational variances across integrated services, with the most significant areas summarised in the table on page 17. Overall Financial Position The overall financial position reflects the continued use of a range of measures to support financial sustainability, including: • Targeted use of reserves to support recurring and non-recurring pressures • Delivery of savings through service redesign and efficiency measures • Ongoing focus on workforce planning • Robust financial governance and monitoring arrangements The final outturn position will be reflected in the Comprehensive Income and Expenditure Statement and Movement in Reserves Statement within the annual accounts. Differences between the management outturn presented in this report and the statutory financial statements may arise due to differences in accounting presentation between partner organisations. Page 92 of 264
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16 | P a g e Delegated Service Variance £m Over / Underspend Reason Ambition Statement Employee Costs 3.688 Underspend Recruitment and retention challenges continue to affect a number of service areas, with difficulties in filling posts due to skills shortages and wider labour market pressures. Whilst this has resulted in reduced pay expenditure, it has also contributed to additional costs in some areas through the use of agency, bank and overtime arrangements. Workforce pressures remain a key financial and operational risk for the Partnership. 3 Hosted Services 5.041 Underspend North Lanarkshire IJB commissions a number of services where North Lanarkshire is the host organisation for services carried out within South Lanarkshire. Overall, there was an underspend which includes underspends in areas such as Speech and Language Therapy, CAMHS, Forensic Psychiatry and Psychological Therapies, partially offset by overspends in services including Family Nurse Partnership, Learning Disability Services and Adult Psychiatry. In line with established arrangements, the lead IJB retains responsibility for managing financial risks associated with hosted services. 1, 2, 4, 5 Payments to Other Bodies (2.623) Overspend Integrated services provided by Social Care on behalf of the IJB includes Care at Home and Care Homes. A net overspend was reported within these areas which is representative of the increasing demand on these services. 1, 3, 5 Prescribing 0.014 Underspend Prescribing continues to represent a significant area of expenditure within Health Services. Following a substantial overspend in 2024/25, the prescribing budget was increased for 2025/26 to reflect underlying demand and cost pressures. The marginal underspend reflects a more stable position in-year, however underlying pressures remain, with both the volume of items dispensed and the average cost per item increasing compared to the previous year. 2, 4 Page 93 of 264
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17 | P a g e Reserves Strategy The IJB has the same legal status as a local authority and is therefore able to hold reserves under Section 106 of the Local Government (Scotland) Act 1973. A Reserves Strategy is in place to provide protection against unexpected cost pressures and to support the overall financial stability of the Partnership. The IJB Reserves Strategy for 2025/26 allows flexibility to respond to potential financial fluctuations. This includes the ability to increase contingency reserve balances where resources permit, thereby strengthening financial resilience in future years where available funding may be more constrained and a planned drawdown of reserves may be required to support financial balance. To support this approach, and in recognition of the current financial risk environment, the target level for the contingency reserve has been set at 4% of the mainstream financial envelope. In addition, the IJB has committed to a range of actions linked to the Strategic Commissioning Plan Programme of Work. Funding has therefore been earmarked for specific projects to ensure that resources are deployed effectively and represent best value in delivering the National Health and Wellbeing Outcomes. The table below provides a breakdown of the underspend transferred to reserves at the year end. Analysis of Underspend Transferred to IJB Reserves at Year End 2025/26 £m Earmarked Reserves 20.516 Risk & Contingency 6.747 Total Underspend Transferred to Reserves 27.263 Page 94 of 264
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18 | P a g e Acknowledgements We would like to acknowledge the significant effort required to both produce the annual accounts and successfully manage the finances of the IJB and to record our thanks to the Finance teams in both NLC and NHSL and colleagues in other services for their continued hard work and support. Siobhan White Chair Date: Claire Rae Chief Officer Date: Nicola Scott CPFA Chief Finance Officer Date: Page 95 of 264
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19 | P a g e Statement of Responsibilities Responsibilities of the North Lanarkshire Integration Joint Board The North Lanarkshire IJB is required to: • Make arrangements for the proper administration of its financial affairs and to ensure that the proper officer of the board has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this IJB, that officer is the Chief Finance Officer. • Manage its affairs to secure economic, efficient, and effective use of resources and safeguard its assets. • Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far, as is compatible with the legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003). • Approve the Annual Accounts for signature. I confirm that these Annual Accounts were approved for signature at a meeting of the North Lanarkshire Integration Joint Board on 16 September 2026. Signed on behalf of the North Lanarkshire Integration Joint Board Siobhan White Chair Date: Page 96 of 264
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20 | P a g e Responsibilities of the Chief Finance Officer The Chief Finance Officer is responsible for the preparation of the Integration Joint Board’s Annual Accounts in accordance with proper practices as required by legislation and as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (Accounting Code). In preparing the Annual Accounts, the Chief Finance Officer has: • Selected suitable accounting policies and then applied them consistently. • Made judgements and estimates that were reasonable and prudent. • Complied with legislation. • Complied with the Local Authority Code (in so far as it is compatible with legislation). The Chief Finance Officer has also: • Kept proper accounting records which were up-to-date. • Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that these Annual Accounts present a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2026 and the transactions for the year then ended. Nicola Scott CPFA Chief Finance Officer Date: Page 97 of 264
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21 | P a g e Remuneration Report The Local Authority Accounts (Scotland) Regulations 2014 (SSI No.201/200) require local authorities and IJB’s in Scotland to prepare a Remuneration Report as part of the annual statutory accounts. The information in the tables below is subject to external audit. The explanatory text in the Remuneration Report is reviewed by Audit Scotland to ensure it is consistent with the financial statements. Voting Board Members Voting IJB members constitute councillors nominated as board members by constituent authorities and NHS representatives nominated by the NHS Board. The voting members of North Lanarkshire IJB were appointed through nomination by NLC and NHSL. The regulations require disclosure of remuneration information for ‘relevant’ persons. A ‘relevant’ person in relation to the Remuneration Report includes a senior officer holding office with associated authority, whether on a permanent or temporary basis, in the financial year to which that Remuneration Report relates. The Board Members do not receive remuneration or expenses directly from the IJB. Any remuneration or reimbursement of expenses for voting board members is governed by the relevant IJB partner organisation. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting member costs by the partner. The details of the Chair and Vice Chair appointments held during 2025/26 are outlined in the table below: Name Post Held Nominated by Brian Moore IJB Chair ( 1 April 2025 - 01 April 2026) NHS Lanarkshire Cllr Anne McCrory IJB Vice Chair ( 01 April 2025 - 31 March 2026) North Lanarkshire Council Brian Moore resigned as Chair on 31 August 2026 and was replaced by Siobhan White on 1 September 2026. The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlement of voting IJB members. Therefore, no pension rights disclosures are provided for the Chair or the Vice Chair. There were no exit packages payable during the financial year. Page 98 of 264
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22 | P a g e Officers of the IJB The IJB does not directly employ any staff in its own right, however specific post-holding officers are non voting members of the Board. The Chief Officer and the Chief Finance Officer are appointed by the North Lanarkshire IJB and employed by NLC. Both posts are seconded to the IJB in line with the local arrangements. The Chief Officers received the following remuneration in the period: Total Earnings Name and Post Title Total Earnings 2024/25 2025/26 £ £ 62,466 Claire Rae 132,187 (FYE 125,275) Chief Officer 1 April 2025 - 31 March 2026 31,249 Nicola Scott 89,986 (FYE 85,118) Chief Finance Officer 1 April 2025 - 31 March 2026 62,333 Ross McGuffie - (FYE 124,325) Chief Officer 1 April 2024 – 30 September 2024 43,960 Amanda Kilburn - (FYE 83,570) Chief Finance Officer 1 April 2024 – 9 October 2024 Pay band information is not separately provided as all staff pay information has been disclosed in the information above. Pension Benefits In respect of officers’ pension benefits the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis, there is no pension liability reflected on the IJB balance sheet for the Chief Officer or the Chief Finance Officer. The IJB however, has responsibility for funding the employer contributions for the current year in respect of the officer time spent fulfilling the responsibilities of their role on the IJB. The following table shows the IJB’s funding during the year to support officers’ pension benefits. The table also shows the total value of the accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions. Page 99 of 264
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23 | P a g e Name and Post Title In Year Pension Contribution Accrued Pension Benefits For Year to For Year to For Year to For Year to 31/03/2025 31/03/2026 Description 31/03/2025 31/03/2026 £ £ £ £ Claire Rae 4,060 8,592 Pension 1,310 4,178 Chief Officer Lump Sum - - Nicola Scott 2,031 5,849 Pension 13,050 41,071 Chief Finance Officer Lump Sum 13,180 40,827 Ross McGuffie 2,676 - Pension 18,554 - Chief Officer Lump Sum - - Amanda Kilburn 3,030 - Pension 8,209 - Chief Finance Officer Lump Sum - - Siobhan White Chair Date: Claire Rae Chief Officer Date: Page 100 of 264
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24 | P a g e Annual Governance Statement The Annual Governance Statement reports on the effectiveness of the IJB’s governance arrangements and system of internal control and explains how the IJB complies with the Code of Corporate Governance3 and meets the requirements of the ‘Delivering Good Governance in Local Government’ framework developed by CIPFA and SOLACE (most recent guidance). Scope of Responsibility The IJB is responsible for ensuring that its business is conducted in accordance with the law and appropriate standards, that public money is safeguarded, properly accounted for, and used economically, efficiently, and effectively. The IJB also aims to foster a culture of continuous improvement in the performance of the IJB’s functions and to make arrangements to secure best value. To meet this responsibility, the IJB has established arrangements for governance which includes a system of internal controls. The system is intended to manage risk to support the achievement of the IJB’s policies, aims and objectives. Reliance is also placed on the NLC and NHSL systems of internal control which support compliance with both organisations’ policies and promotes achievement of each organisations aims and objectives, as well as those of the IJB. This system can only provide reasonable and not absolute assurance of effectiveness. Purpose of the Governance Framework The governance framework comprises the systems and processes, and culture and values, by which the IJB is directed and controlled. It enables the IJB to monitor the achievement of the objectives set out in the IJB’s Strategic Commissioning Plan. The governance framework is regularly reviewed and updated to reflect best practice, new legislative requirements, and the expectations of stakeholders. The system of internal control is based on an ongoing process designed to identify and prioritise the risks in the achievement of the IJB’s objectives, to evaluate the likelihood of those risks being realised, the impact should they be realised, and to manage them effectively. Governance Framework and Internal Control System The IJB comprises eight voting members, with one from each partner organisation assuming the role of Chair and Vice Chair. Four are Council Members nominated by NLC and four are Non- Executive Members appointed by NHSL. The term of office is for a period of three years. There are also a number of non-voting professional and stakeholder members on the IJB board. Stakeholder members currently include third sector representatives, carers, staff representatives, service users and professional members including the Chief Officer and Chief Finance Officer. The IJB, via a process of delegation from NLC and NHSL, has responsibility for the planning, resourcing and operational delivery of all delegated health and social care within its geographical area. 3 Code of Corporate Governance Page 101 of 264
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25 | P a g e The IJB also continues to review and develop its governance arrangements to ensure they remain effective and proportionate in supporting future strategic priorities, legislative requirements and partnership working arrangements. The main features of the governance framework are: Principles ▪ The IJB follows the principles set out in the Convention of Scottish Local Authorities (COSLA) and the Accounts Commission in 1996 Code of Guidance on Funding External Bodies and Following the Public Pound for both resources delegated to the IJB, and resources paid to its Local Authority and Health Service partners. Formal Frameworks ▪ The IJB is formally constituted through the Integration Scheme agreed by NLC and NHSL and approved by Scottish Ministers. ▪ The IJB operates within an established procedural framework. The roles and responsibilities of board members and officers are defined within standing orders, scheme of delegation and financial governance arrangements which are subject to regular review. The IJB Code of Corporate Governance was approved by the IJB on 18 July 2017 and is subject to ongoing updates as required. Board members adhere to an established Code of Conduct and are supported by induction and ongoing training and development. ▪ The Partnership has robust structures in place with our partners, which are based on service delivery, care and interventions that are person centred, timely, outcome focused, equitable, safe, efficient, and effective. Reports are presented to the IJB throughout the year which provide evidence to demonstrate the delivery of our core components within our framework and the Clinical and Care Governance principles specified by Scottish Government. Strategic Planning ▪ The overarching strategic vision and objectives of the IJB are detailed in the IJB Strategic Commissioning Plan which sets out the key outcomes that the IJB is committed to delivering with its partners. ▪ The Strategic Commissioning Plan Board sets out the IJB’s approach to engage with stakeholders. Consultations on the future vision and activities of the IJB is undertaken with its Local Authority, Health Service partners and stakeholders. The IJB regularly publishes information regarding its performance. ▪ The financial plans outline the financial challenges and opportunities the Partnership faces in the medium to long term and provides a framework which will support the IJB to remain financially sustainable. It complements the IJB Strategic Commissioning Plan, highlighting how the financial plans will support the delivery of the IJB’s strategic objectives and priorities. Page 102 of 264
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26 | P a g e Oversight ▪ Effective scrutiny and service improvement activities are supported by the formal submissions of reports, findings and recommendations by Inspectorates and the appointed Internal Audit Service to the Partnership’s Senior Management Team, the main IJB board and the Performance, Finance and Audit Committee, as appropriate. ▪ Performance management, monitoring of service delivery and financial governance is provided by the Partnership to the IJB, who are accountable to both the Local Authority and the Health Board. It reviews reports on the effectiveness of the integrated arrangements including the financial management of the integrated budget. This ensures there is a regular scrutiny at senior management, committee, and board level. Information on performance can be found in the Annual Performance Report published on the Partnership’s website4. Risk Management ▪ In line with the continued and ongoing review of the IJB Risk Register, new and emerging risks or changes in risk level are agreed at each Senior Management Team, IJB and PFA meeting as appropriate. The current strategic risks at the time of writing are summarised within the Management Commentary and reflect the updated Strategic Risk Register approved by the IJB in March 2026. Financial Control ▪ The Board’s CFO has designated responsibility for the administration of the Board’s financial affairs. The CFO is responsible for advising the Board on all financial matters and for monitoring and reporting on the Board’s financial performance and position. The CFO also oversees the development and implementation of appropriate financial strategies to manage risk, ensure effective use of delegated resources and support compliance with governance standards. NHSL and NLC remain fully accountable for the financial performance of their service area against the budget allocated. Transformational Change ▪ The IJB financial plans and the Strategic Commissioning Plan reflects the requirement to transform how health and social care services are delivered across the Partnership to ensure the sustainability of health and social care services going forward. Together with the IJB Reserves Strategy, these plans are regularly reviewed over their lifespan and amended as necessary to reflect the current challenges and pressures the Partnership face. Review of Adequacy and Effectiveness ▪ Due to the nature of the IJB membership, a conflict of interest can arise between individual board and committee members and the responsibilities they have to the IJB. It is the responsibility of board and committee members to declare any potential conflicts of interest, and it is the responsibility of the Chair of the relevant board or committee to ensure sure declarations are appropriately considered and acted upon. 4 UHSCNL Website Page 103 of 264
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27 | P a g e ▪ The IJB has responsibility for conducting an annual review of the effectiveness of the system of internal control and the quality of data used throughout the organisation. The review is informed by the work of the Senior Management Team, who have the responsibility for the development and maintenance of the internal control framework, the work of the internal and external audit teams and other independent inspectorates. ▪ Internal Audit undertakes an annual programme following an assessment of risk completed during the strategic audit planning process. The appointed NHSL Chief Internal Auditor in conjunction with the NLC Chief Officer (Audit and Risk), provide an annual report to the IJB PFA Committee giving an independent opinion of the adequacy and effectiveness of the governance framework, risk management and internal controls. ▪ Based on the audit work undertaken directly on behalf of the IJB and being informed by internal audit, work undertaken independently by each respective internal audit function within NLC and NHSL, the NHSL Chief Internal Auditor and the NLC Chief Officer (Audit and Risk) are able to conclude that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal controls. ▪ The review process has not identified any significant governance weaknesses which require disclosure; however, opportunities for further improvement have been identified and are captured within the action plan set out below. Roles and Responsibilities The Chief Officer is the Accountable Officer for the Partnership and has day to day operational responsibility to monitor delivery of integrated services, with oversight from the IJB. The IJB complies with the CIPFA statement on ‘The Role of the Chief Finance Officer in Local Government 2014’. The IJB Chief Finance Officer (CFO) has responsibility for the Partnership’s financial arrangements and is professionally qualified and suitably experienced to lead and advise the IJB finance functions. The IJB complies with the requirements of the Public Sector Internal Audit Standards and the approved Internal Audit Charter for the IJB. The appointed NHSL Chief Internal Auditor has responsibility for the IJB internal audit functions and is professionally qualified and suitably experienced to lead and direct internal audit staff. The Internal Audit Service operates in accordance with the Public Sector Internal Audit Standards. Board members and officers of the IJB are committed to the concept of sound internal control and effective delivery of health and social care services. The IJB PFA Committee operates in accordance with CIPFA ‘Audit Committee Principles in Local Authorities in Scotland and Audit Committees Practical Guidance for Local Authorities’. The committee core function is to provide the IJB with independent assurance on the adequacy of the risk management framework, the internal control environment, the integrity of the financial reporting and governance arrangements. Page 104 of 264
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28 | P a g e Action Plan To support the continual improvement of the IJB’s governance arrangements, an action plan has been developed. This incorporates findings from the IJB self-assessment process, recommendations from Audit Scotland’s Annual Audit Report, and recommendations arising from internal audit work undertaken during 2025/26. Progress against these actions will be reported to and monitored by the Performance, Finance and Audit Committee. Ref Improvement Area Agreed Action Responsible Person Original Date Revised Date 2023/24 1 2023/24 Self- Assessment Agreed actions Recognition that there is a formalised risk sharing agreement in place with NHSL, NLC and SL IJB within the risk management strategy but no reference to similar in relation to performance and finance. Review: Being addressed as part of the revised risk management strategy 2026 Chief Officer December 2025 August 2026 2024/25 1 2024/25 Self- Assessment Agreed actions Holding to Account - effective scrutiny, challenge and support of services by the Management Team and by IJB members when reviewing presented papers. Review: Action plan will be developed following conclusion of the 2026 Self Evaluation exercised issues to members. Chief Officer December 2025 October 2026 2025/26 1 Audit Scotland Annual Audit Report 2024/25 Ongoing work is required to strengthen the IJB’s approach to financial sustainability, including the continued development of medium and long-term financial planning, delivery of savings, and effective partnership working with the Council and Health Board to support service transformation. Chief Financial Officer December 2025 Complete Page 105 of 264
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29 | P a g e Ref Improvement Area Agreed Action Responsible Person Original Date Revised Date 2025/26 2 Internal Audit Review of IJB Governance Arrangements 1. Ensure that appropriate and timely action is taken to fully address the previously agreed audit recommendations in line with agreed timescales and that the actions are regularly monitored. Chief Officer December 2025 Complete 2. Ensure that NL HSCP Audit Charter is updated and reviewed to reflect the current environment and working arrangements whilst taking account of the Global Internal Audit Standards. Chief Officer (Audit & Risk) (NLC) and Chief Internal Auditor (NHS) September 2025 Complete 3. Ensure that the Rolling Action Log presented to each IJB and PFAC is fully completed following each meeting, with details of discussions and/or decisions regarding actions required, progress to date, proposed completion dates and completion status. Chief Officer August 2025 Complete Page 106 of 264
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30 | P a g e Ref Improvement Area Agreed Action Responsible Person Original Date Revised 2025/26 3 Internal Audit IJB Strategy 1. The current Strategic Commissioning Plan will expire in 2026, and a programme of work is required to undertake a review of lessons learned, consider alignment with other key strategies, agree the preferred approach and timescales for developing the next plan, and establish clear governance and Board oversight arrangements for its development and delivery. Review: The plan is due to be presented to the IJB in September 2026 Head of Planning, Performance and Quality April 2026 September 2026 2. Ensure that the governance arrangements for development and monitoring of the next SCP are clearly articulated and understood. Head of Planning, Performance and Quality November 2026 November 2026 3. A review of programme governance arrangements is required to ensure more frequent and responsive reporting is in place, providing earlier identification of risks and enabling timely remedial action Head of Planning, Performance and Quality November 2026 November 2026 Page 107 of 264
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31 | P a g e Ref Improvement Area Agreed Action Responsible Person Original Date Revised Date 2025/26 4 Internal Audit IJB Financial Sustainability 1. Progress is required in developing a sustainable long-term financial strategy based on recurring savings and reduced reliance on reserves, alongside establishing strengthened governance arrangements, including a dedicated Savings Board, to improve transparency and delivery of savings. Chief Finance Officer April 2026 Complete 2. Development and enhancement of financial reporting is required to provide full supporting detail for risk-based scenarios, alongside improving clarity and transparency through consideration of a single consolidated financial overview. Chief Finance Officer September 2026 September 2026 Page 108 of 264
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32 | P a g e Internal Audit Opinion Internal control remains, primarily, a management responsibility to ensure that the partnership conducts its business in a manner that has due regard to the principles of good governance. Overall, the results of work undertaken to provide assurance include reports produced by Audit Scotland and a range of governance reports undertaken jointly with the partner organisations to help to inform an opinion on whether the internal controls for the Partnership have in place are adequate. The joint internal audit opinion is that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control. Conclusion and Opinion on Assurance It is our opinion that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s governance arrangements. The IJB has adhered to the stated principles of good governance, acted in the public interest, and been committed to continuous improvement. The scrutiny and oversight of the IJB PFA Committee contributes effectively to these arrangements. There were no significant control weaknesses, issues, or failure in the expected standards for good governance, risk management and internal control. We consider that the internal control environment provides reasonable and objective assurance that any significant risks impacting on the IJB’s principal objectives will be identified, actions taken to avoid or mitigate their impact and are consistent with the recommendations of the CIPFA/SOLACE Framework (2016). Claire Rae Chief Officer Date: Siobhan White Chair Date: Page 109 of 264
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33 | P a g e Independent Auditors Report Independent auditor’s report to the members of North Lanarkshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2026 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet, and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26 (the 2025/26 Code). In my opinion, the accompanying financial statements: • give a true and fair view of the state of affairs of North Lanarkshire Integration Joint Board as at 31 March 2026 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2025/26 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 02 December 2022. My period of appointment is five years, covering 2022/23 to 2026/27. I am independent of North Lanarkshire Integration Joint Board in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to North Lanarkshire Integration Joint Board. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Page 110 of 264
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34 | P a g e Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on North Lanarkshire Integration Joint Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on North Lanarkshire Integration Joint Board’s current or future financial sustainability. However, I report on North Lanarkshire Integration Joint Board’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Finance Officer and North Lanarkshire Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Finance Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Finance Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Finance Officer is responsible for assessing North Lanarkshire Integration Joint Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue North Lanarkshire Integration Joint Board’s operations. North Lanarkshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Page 111 of 264
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35 | P a g e Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using my understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of North Lanarkshire Integration Joint Board; • inquiring of the Chief Finance Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of North Lanarkshire Integration Joint Board; • inquiring of the Chief Finance Officer concerning North Lanarkshire Integration Joint Board’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among my audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of North Lanarkshire Integration Joint Board’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Page 112 of 264
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36 | P a g e Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report I have audited the parts of the Remuneration Report described as audited. In my opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Finance Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Page 113 of 264
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37 | P a g e Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • I have not received all the information and explanations I require for my audit. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. John Boyd FCPFA Audit Scotland 8 Nelson Mandela Place Glasgow G2 1BT Page 114 of 264
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38 | P a g e Comprehensive Income and Expenditure Statement This statement shows the cost of providing services in accordance with generally accepted accounting practices. It includes, on an accrual basis, all expenses and related income during the financial year. Due to the funding arrangements of the IJB, there are no material statutory or presentation adjustments between the accounting position reported in the Comprehensive Income and Expenditure Statement and the funding received from partner organisations. The movement in the General Fund balance therefore reflects the financial transactions recognised within the CIES. As a result, an Expenditure and Funding Analysis is not required and is not presented within these annual accounts. 2024/25 North Lanarkshire Integration Joint Board Note 2025/26 Gross Expenditure Gross Income Net Expenditure Gross Expenditure Gross Income Net Expenditure £m £m £m £m £m £m 263.773 263.773 Social Care Services 276.538 276.538 83.086 83.086 Health Care Services 80.175 80.175 135.965 135.965 Family Health Services 145.617 145.617 199.089 199.089 Hosted Services 9 211.644 211.644 0.278 0.278 Corporate Services 5 0.331 0.331 81.709 81.709 Prescribing 80.986 80.986 75.143 75.143 Set Aside for Hospital Acute Services 78.367 78.367 (0.283) (0.283) Covid-19 Costs 0.000 0.000 838.760 0.000 838.760 Total Cost of Services 873.658 0.000 873.658 (838.790) (838.790) Taxation and Non- Specific Grant Income 4 (900.921) (900.921) 838.760 (838.790) (0.030) (Surplus) or Deficit on Provisions of Services (Movement in Reserves) 873.658 (900.921) (27.263) Page 115 of 264
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39 | P a g e Movement in Reserves Statement This statement shows the movement in the IJB’s reserves during the financial year, analysed between usable and unusable reserves. Due to the nature of the IJB’s funding arrangements, there are no material statutory adjustments between the accounting position reported in the Comprehensive Income and Expenditure Statement and the movement in the General Fund. Movements in reserves therefore reflect the financial transactions recognised during the year together with any transfers to or from earmarked reserves. North Lanarkshire Integration Joint Board Total Reserves General Fund £m Movement in Reserves during 2024/25: Opening Balance at 1 April 2024 (75.524) Total Comprehensive Income and Expenditure (Increase) or decrease in 2024/25 (0.030) Closing Balance at 31 March 2025 (75.554) Movement in Reserves during 2025/26 Opening Balance at 1 April 2025 (75.554) Total Comprehensive Income and Expenditure (Increase) or decrease in 2025/26 (27.263) Closing Balance at 31 March 2026 (102.817) Page 116 of 264
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40 | P a g e Balance Sheet The balance sheet shows the value of the IJB’s assets and liabilities as at 31 March 2026. The net assets of the IJB (assets less liabilities) are matched by the reserves held by the IJB. 31 March 2025 North Lanarkshire Integration Joint Board Notes 31 March 2026 £m £m 75.554 Current Assets 6 102.817 Short Term Debtors 0.000 Current Liabilities 6 0.000 Short Term Creditors 75.554 Net Assets 102.817 75.554 Usable Reserves: General Fund 7 102.817 75.554 Total Reserves 102.817 The Statement of Accounts presents a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2026 and its income and expenditure for the year then ended. Notes to the Financial Statements numbers 1 to 11 found on pages 41 - 50, form part of the financial statements. The unaudited accounts were authorised for issue on 17 June 2026 and the audited financial statement were authorised for issue on 16 September 2026 Balance Sheet signed by: Nicola Scott CPFA Chief Finance Officer Date: Page 117 of 264
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41 | P a g e Notes to the Financial Statements Note 1. Material Accounting Policy Information General Principles The financial statements summarise the transactions of the Integration Joint Board (IJB) for the financial year 2025/26 and its position as at 31 March 2026. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. It is a joint venture between North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL). The financial statements have been prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26 (the Code), supported by International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires a different treatment. Each partner organisation applies its own accounting policies as applicable. The accounts have been prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. Standards issued but not yet effective (including IFRS 18 Presentation and Disclosure in Financial Statements, effective from 1 January 2027) have been reviewed and are not anticipated to have a material impact on the IJB. Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: • Expenditure is recognised when goods or services are received, and their benefits are used by the IJB. • Income is recognised when the IJB has a right to the income, for instance, by meeting any terms and conditions required to earn the income and receipt of the income is probable. • Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the balance sheet. • Where debts may not be received, the balance of debtors is written off. Funding The IJB is primarily funded through contributions from its statutory funding partners, NLC and NHSL. Expenditure is incurred as the IJB commissions specified health and social care services from the funding partners for the benefit of service recipients in North Lanarkshire and service recipients in South Lanarkshire for services that are delivered under hosted arrangements and on a pan-Lanarkshire basis. Page 118 of 264
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42 | P a g e The funding relating to the year under review is recognised as income in the CIES and will normally be income added to the General Fund. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received from partners. The movement in General Fund balance is therefore solely due to the transactions shown in the CIES. Cash and Cash Equivalents The IJB does not operate a bank account or hold cash. All transactions are settled on behalf of the IJB by the funding partner. Consequently, the IJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. There is therefore no requirement for the IJB to produce a cash flow statement. The funding balance due from and to each funding partner as at 31 March 2026 is represented as a debtor or creditor on the IJB’s balance sheet. Employee Benefit The IJB does not directly employ staff. Staff are formally employed by the funding partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a Pensions Liability on its balance sheet. The IJB has a legal responsibility to appoint a Chief Officer. A Chief Finance Officer has also been appointed to the IJB. More details on these arrangements are provided in the remuneration report. The charges for the employing partners are treated as employee costs. Where material, the absence entitlement at 31 March is accrued, for example in relation to annual leave earned but not yet taken. In the case of North Lanarkshire IJB any annual leave earned by the Chief Officer and Chief Finance Officer but not yet taken is not considered to be material. Provisions, Contingent Liabilities and Contingent Assets Provisions are liabilities of uncertain timing or amount. A provision is recognised as a liability on the balance sheet when there is an obligation on 31 March due to a past event, settlement of the obligation is probable, and a reliable estimate of the amount can be made. Recognition of a provision will result in expenditure being charged to the CIES and will normally be a charge to the General Fund. A contingent liability is a possible liability arising from events on or before 31 March, whose existence will only be confirmed by later events. A provision that cannot be reasonably estimated, or where settlement is not probable, is treated as a contingent liability. A contingent liability is not recognised in the IJB’s balance sheet but is disclosed in a note where it is material. A contingent asset is a possible asset arising from events on or before 31 March, whose existence will only be confirmed by later events. A contingent asset is not recognised in the IJB’s balance sheet but is disclosed in a note only if it is probable to arise and can be reliably measured. Indemnity Insurance / Clinical and Medical Negligence The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding board member and officer responsibilities through the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). NLC and NHSL have responsibility for claims in respect of the Page 119 of 264
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43 | P a g e services for which they are statutorily responsible for and that they provide. Unlike NHS Boards, the IJB does not have any ‘shared risk’ exposure from participation in CNORIS. The IJB participation in the scheme is therefore comparable to normal insurance arrangements. Known claims are assessed as to the value and probability of settlement. Where it is material, the overall expected value of known claims taking probability of settlement into consideration, is provided for in the IJB balance sheet. The likelihood of receipt of an insurance settlement to cover any claims is separately assessed and where material, presented as either a debtor or disclosed as a contingent asset. Debtors and Creditors Financial instruments are recognised in the balance sheet when an obligation is identified and released as that obligation is fulfilled. Debtors are held at fair value and represent funding due from partner bodies that was not utilised in year. There are no creditor balances. Reserves A reserve is the accumulation of surpluses, deficits, and appropriation over a number of years. Reserves of a revenue nature are available and can be spent or earmarked at the discretion of the IJB. Reserves should be split between usable and unusable on the balance sheet. As at 31 March 2026, the usable reserve balance totals £102.817m. There are no unusable reserves. Hosted Services Within Lanarkshire, each IJB has operational responsibility for the service which it hosts on behalf of the other IJB. In delivering these services each IJB has primary responsibility for the provision of the services and bears the risk and reward associated with this service delivery in terms of demand and the financial resources required. As such the IJB is considered to be acting as ‘principal’, and the full costs are reflected within the annual accounts for the services which it hosts. This is the basis on which North Lanarkshire IJB accounts have been prepared. The relevant share of the pan Lanarkshire and area wide service expenditure is therefore included in the North Lanarkshire IJB on the basis of 52% of the total expenditure, 48% of the services relating to the South Lanarkshire IJB are also included as the North Lanarkshire IJB is acting as the principal for the delivery of these services. In line with the Integrated Resource Advisory Group Guidance, the IJB responsible for the management of the hosted service is also responsible for managing overspends. As a result, these are accounted for within the Annual Accounts of the lead IJB. The same accounting treatment was adopted where an underspend arose in respect of a hosted service. Note 2. Events After the Balance Sheet Date The Chief Finance Officer authorised the unaudited annual accounts for issue on 17 June 2026. Events after the balance sheet date are those events that occur between the end of the reporting period and the date when the statements are authorised for issue. Where events take place before the date of authorisation and provide information about conditions existing as at 31 March 2026, the figures in the financial statements and notes would Page 120 of 264
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44 | P a g e be adjusted in all material aspects to reflect the impact of this information. There have been no material events since the date of the balance sheet which require revision to the figures in the Annual Accounts. Note 3. Expenditure and Funding Analysis by Nature The following table shows the gross expenditure and funding for North Lanarkshire IJB against subjective headings: Expenditure and Funding Analysis by Nature 2024/25 2025/26 £m £m Social Care Services 263.773 276.538 Health Care Services - Localities 70.341 69.076 Health Care Services - Area Wide 8.420 9.671 Health Care Services - Out of Area 4.041 1.428 Family Health Services 135.965 145.617 Hosted Services - Led by North IJB 155.183 164.327 Hosted Services - Led by South IJB 43.907 47.317 IJB Operating Costs 0.278 0.331 Prescribing Costs 81.709 80.986 Set Aside 75.143 78.367 Total Cost of Services 838.760 873.658 Partners Funding Contributions and Non-Specific Grant Income (838.790) (900.921) (Surplus)/Deficit on Provision of Services (0.030) (27.263) Note 4. Taxation and Non-Specific Grant Income The following table shows the funding contribution from the two partner organisations: Taxation and Non-Specific Grant Income 2024/25 2025/26 £m £m Funding Contribution from NHS Lanarkshire (630.765) (682.618) Funding Contribution from North Lanarkshire Council (208.025) (218.303) Total (838.790) (900.921) The funding contribution from the NHSL Board shown above includes £78.367m in respect of ‘Set Aside’ resources relating to acute hospital services. These are provided by NHSL which retains responsibility for managing the costs of providing these services. The IJB however has responsibility for the consumption and level of demand placed on these resources. Page 121 of 264
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45 | P a g e Note 5. Corporate Services NLC and NHSL provide a range of support services for the IJB including finance, personnel, planning, audit, payroll, debtor, and creditor services. There is no charge to the IJB for these support services. The costs associated with running the IJB are shown in the following table: IJB Operating Costs (Corporate Services) 2024/25 2025/26 £m £m Staff Costs 0.240 0.293 Audit Fees 0.035 0.035 Administration Costs 0.003 0.003 Total 0.278 0.331 Note 6. Short Term Debtors and Creditors Short Term Debtors 2024/25 2025/26 £m £m NHS Lanarkshire 50.276 78.761 North Lanarkshire Council 25.278 24.056 Total 75.554 102.817 Short Term Creditors 2024/25 2025/26 £m £m NHS Lanarkshire - - North Lanarkshire Council - - Total - - Note 7. Useable Reserves: General Fund The purpose and operation of the General Fund is set out in the IJB Reserves Policy, approved in March 2026. The General Fund balance may be designated for specific purposes, including: • Earmarked reserves, where resources are committed to support approved service developments, programme delivery, or specific financial commitments • Contingency reserves, held to mitigate identified financial risks and provide resilience against unforeseen events and financial pressures At 31 March 2026, the IJB transferred funding to earmarked reserves to support agreed commitments and the Strategic Commissioning Plan Programme of Work. Contingency reserves have also been increased in line with the IJB’s financial strategy to support financial sustainability and manage future uncertainty. The following table shows the movement in reserves during 2025/26. Page 122 of 264
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46 | P a g e USEABLE RESERVES Balance as at 31 March 2025 Net Transfers during 2025/26 Balance as at 31 March 20256 £m £m £m Alcohol and Drug Partnership Funding 3.681 0.450 4.131 Blood-Borne Viruses Services 0.318 (0.043) 0.275 Community Living Change Fund 0.054 (0.054) 0.000 Long Covid Pathways Funding 0.289 (0.289) 0.000 Hospital at Home Services 0.915 (0.034) 0.881 Mental Health and Learning Disability Services 5.203 0.923 6.125 North Planning Band 2-4 Posts & Pharmacy Training 3.065 (0.969) 2.096 Nursing Funding 0.646 0.629 1.275 Adult Social Care Winter Preparedness Fund 1.000 0.000 1.000 Carers Act Support 2.604 (0.165) 2.439 Children and Adolescent Mental Health Services 3.042 (0.172) 2.870 Digital and IT Strategy 3.646 (0.490) 3.156 Earmarked Reserves - Other Services 6.890 (3.986) 2.904 Home Support Resilience 0.577 (0.327) 0.250 IJB Financial Plan 2023/2026 2.616 (1.441) 1.175 Mental Health 2.917 0.868 3.785 Minor Repair and Replacement Programme of Works 1.811 8.876 10.687 Prescribing Fund 5.066 0.000 5.066 Social Care Services 0.316 0.769 1.085 Winter Funding Business Case 0.309 (0.287) 0.022 Unscheduled Care 0.000 13.254 13.254 Children's Services 0.000 2.651 2.651 Medicine Growth 0.000 0.620 0.620 Total Earmarked Reserves 44.965 20.783 65.748 Total Contingency Reserve 30.589 6.480 37.069 TOTAL USEABLE RESERVES 75.554 27.263 102.817 Restatement: In 2024/25 a balance of £0.666m for Ring Fenced Reserves - Other was reported, this has been combined with Earmarked Reserves – Other Services resulting in a combined opening balance of £6.889m. Page 123 of 264
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47 | P a g e Note 8. Related Party Transactions The IJB has related party transactions with NLC and NHSL. The nature of the partnership means that the IJB both influences and is influenced by its partner organisations. Non-voting Board members are not directly employed by NHSL; however, NHSL meets 50% of the cost of the Chief Officer and the full cost of the Chief Finance Officer. These costs are included within the IJB Operating Costs (Corporate Services) in the Comprehensive Income and Expenditure Statement and are detailed in Note 5. The transactions and balances disclosed within the IJB Annual Accounts provide additional information on these related party relationships. There are also elements of expenditure recorded against NLC where the underlying funding is provided by NHSL. In particular, resource transfer funding, including the Social Care Fund, is included within the NHSL budget but is utilised to support the delivery of social care services provided by NLC. Expenditure on Services Provided 2024/25 2025/26 £m £m NHS Lanarkshire 574.747 596.826 Resource Transfer to North Lanarkshire Council 56.462 57.306 NHS Lanarkshire Total 631.209 654.132 North Lanarkshire Council 264.013 276.831 Resource Transfer from NHS Lanarkshire (56.462) (57.306) North Lanarkshire Council Total 207.551 219.525 Funding Contributions Received 2024/25 2025/26 £m £m NHS Lanarkshire (630.765) (682.618) North Lanarkshire Council (208.025) (218.303) Total (838.790) (900.921) Debtors 2024/25 2025/26 £m £m NHS Lanarkshire 50.276 78.761 North Lanarkshire Council 25.278 24.056 Total 75.554 102.817 Page 124 of 264
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48 | P a g e Note 9. Hosted Services North Lanarkshire IJB act as the lead for a number of delegated services on behalf of South Lanarkshire IJB. It therefore commissions services on behalf of South Lanarkshire IJB and reclaims the costs involved. Since North Lanarkshire IJB is acting as ‘principal’ in these transactions, the total gross expenditure and the consequential reimbursement is included in the CIES even though 48% of the hosted budget is consumed by South Lanarkshire. Host: North Lanarkshire North Lanarkshire Services 2024/25 Consumed by South Lanarkshire 2024/25 Service North Lanarkshire Services 2025/26 Consumed by South Lanarkshire 2025/26 £m £m £m £m 1.667 0.879 Blood-Borne Virus Services 1.766 0.884 13.683 6.901 Children and Adolescents Mental Health Services 13.819 7.808 16.556 6.881 Childrens Services 17.127 8.235 3.210 1.213 Continence Services 3.271 1.580 4.339 2.212 Dietetics Services 4.814 2.309 3.046 1.463 Hospital at Home 3.537 1.619 4.925 2.991 Immunisation Services 5.574 3.294 (0.000) 0.392 Integrated Equipment and Adaptation Store (0.040) 0.272 90.305 44.674 Mental Health and Learning Disability Services 96.667 47.002 4.627 2.480 Podiatry Services 4.630 2.385 2.327 1.019 Prisoner Healthcare Services 2.332 1.238 3.819 1.849 Sexual Health Services 3.688 1.840 6.678 3.607 Speech and Language Therapy Services 7.142 3.583 155.182 76.561 Total Services Hosted by North Lanarkshire IJB 164.327 82.049 Similarly, South Lanarkshire IJB acts as the lead for a number of delegated services on behalf of North Lanarkshire IJB. The value consumed by North Lanarkshire equates to 52% of South Lanarkshire IJB hosted budget. As this expenditure is incurred for the residents of North Lanarkshire, it is included in the CIES. Page 125 of 264
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49 | P a g e Host: South Lanarkshire Consumed by North Lanarkshire 2024/25 South Lanarkshire Services 2024/25 Service Consumed by North Lanarkshire 2025/26 South Lanarkshire Services 2025/26 £m £m £m £m 4.529 7.687 Community Dental Services 4.566 3.773 1.302 2.455 Brain Injury Unit 1.397 1.276 2.613 6.200 Diabetic Services 3.710 3.696 0.244 0.638 Improving Cancer Journey 0.213 0.332 4.712 8.460 Occupational Therapy Services 5.521 4.207 5.565 10.103 Out of Hours Services 5.653 5.013 5.097 7.707 Palliative Care Services 5.584 4.881 6.407 10.959 Physiotherapy Services 6.552 5.772 0.476 0.762 Primary Care Services 0.503 0.303 12.962 24.927 Primary Care Improvement Fund 13.618 13.055 43.907 79.898 Total Services Hosted by South Lanarkshire IJB 47.317 42.308 The table below shows the total of hosted serviced included in the CIES: 2024/25 Hosted Services 2025/26 £m £m 155.182 Total Services Hosted by North Lanarkshire IJB 164.327 43.907 Total Services Hosted by South Lanarkshire IJB and Consumed by North 47.317 199.089 Total Included in Comprehensive Income and Expenditure Statement 211.644 Note 10. VAT The Integration Joint Board (IJB) is not registered for Value Added Tax (VAT) as it does not make taxable supplies and operates as a commissioning body. Accordingly, the IJB does not charge or recover VAT directly. The VAT treatment of income and expenditure reflected in the financial statements is determined by the VAT status of the partner organisation delivering the underlying services, as each partner is subject to different statutory VAT recovery arrangements: • Where North Lanarkshire Council (NLC) is the provider, amounts are generally recognised net of VAT, as the Council is able to recover VAT on non-business activities under Section 33 of the Value Added Tax Act 1994. Where VAT is not recoverable by the Council, the associated expenditure is recognised inclusive of VAT. • Where NHS Lanarkshire (NHSL) is the provider, expenditure is generally recognised inclusive of VAT, as VAT incurred by NHS bodies is only recoverable in limited circumstances under Section 41 of the Value Added Tax Act 1994 and therefore typically forms part of the cost of service delivery. Page 126 of 264
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50 | P a g e Transactions between the IJB and its partner bodies arise from statutory responsibilities and the integration arrangements established under the Public Bodies (Joint Working) (Scotland) Act 2014. Such arrangements are considered to be non-business activities carried out under a special legal regime and are therefore outside the scope of VAT. Services provided by the Chief Officer and other officers are supplied under similar statutory arrangements and are also treated as being outside the scope of VAT. Note 11. External Audit Costs Fees payable to Audit Scotland in respect of external audit services undertaken in accordance with Audit Scotland's Code of Audit Practice in 2025/26 were £35,480 (2024/25 £35,180). Audit Scotland did not undertake any non-audit services. Page 127 of 264
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REPORT Item No: 10 SUBJECT: Medium Term Financial Outlook 2027-2030 TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 16 September 2026 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report advises the IJB of the medium term financial forecast position for 2027- 2030. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Acknowledge Medium Term Financial Outlook (MTFO) position for 2027/28 to 2029/30 (2) Acknowledge the forecast funding gap over the 3 year cycle (3) Recognise this outlook will be subject to ongoing review with an update reported in December before the Medium Term Financial Plan (MTFP) is presented to the Board for approval in March. (4) Acknowledge the forecast reserves position. 4. VARIATIONS TO DIRECTIONS 5. STRATEGIC FINANCIAL OVERVIEW 5.1 This report provides an early assessment of the Partnership's medium-term financial outlook for the period 2027/28 to 2029/30. It updates the financial planning assumptions approved within the Medium-Term Financial Plan (MTFP) 2026/27 to 2028/29 and provides an indication of the emerging financial risks and challenges facing the Partnership over the next three years. The assumptions underpinning this outlook will continue to be reviewed and refined ahead of the MTFP being presented to the Integration Joint Board (IJB) in March 2027. Yes No N/A Item 9 Page 129 of 264
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5.2 The financial outlook has been prepared using the MTFP approved by the IJB on 18 March 2026 as the baseline position. Based on updated assumptions, the Partnership is forecasting an envisaged three-year budget gap of £28.128m, of which £15.204m relates to 2027/28. This represents a significant improvement compared with the position reported within the approved MTFP and reflects revised assumptions across a number of key cost and funding drivers. 5.3 The outlook continues to be subject to a high level of uncertainty. The most significant risks to the forecast position remain future pay awards, prescribing costs, social care demand, contractual inflation and the level of funding settlements received from partner organisations. 5.4 The Partnership is currently forecasting useable reserves of £42.135m, providing short-term financial resilience. However, reserves are a finite resource and cannot be relied upon as a sustainable solution to recurring budget pressures. Consequently, the development and delivery of recurring service redesign, transformation and efficiency programmes will remain essential to achieving long-term financial sustainability. 5.5 A revised Medium-Term Financial Outlook will be presented to the IJB in December 2026 following receipt of further financial intelligence and ahead of the detailed Medium-Term Financial Plan being submitted for approval in March 2027. 6. FINANCIAL OUTLOOK 6.1 The financial environment facing Health and Social Care Partnerships continues to be challenging. Demand for services continues to increase as a result of demographic change, increasing complexity of need and wider health inequalities, whilst resources remain constrained. These factors continue to place significant pressure on the long- term sustainability of health and social care services. 6.2 Locally, the Partnership continues to experience growth in demand-led services, including care at home, care home placements, prescribing and mental health services. Alongside contractual inflation and workforce costs, these remain the key factors influencing the medium-term financial outlook. 6.3 The financial planning assumptions used within this outlook have been developed using the best information currently available. These assumptions will continue to be reviewed and refined as further information becomes available regarding funding settlements, pay awards, inflationary pressures and service demand trends ahead of the Medium-Term Financial Plan being presented in March 2027. 7. FORECAST ASSUMPTIONS 7.1 The Medium-Term Financial Outlook has been prepared using the most up-to-date information currently available. The assumptions reflect known contractual commitments, forecast demand growth, pay pressures, prescribing trends and anticipated funding levels. Given the uncertainty surrounding a number of these factors, optimistic, envisaged and pessimistic scenarios have been developed and are detailed in Appendices 1 to 3. Page 130 of 264
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Table 1: Summary of Financial Planning Assumptions Envisaged Assumption 2027/28 Impact £m Risk Rating National Care Home Rate 10% 5.342 � High Care at Home & General Contract Inflation 6.26% 8.262 � High Social Care Demand 5% 4.086 � Very High Health Development Pressures 2% - 3% 15.407 � Very High Prescribing 5% 4.432 � Very High Social Care Pay Award 3% 3.436 � High Health Pay Award 2% 4.157 � Medium Others Specific costs 2.989 � Medium 7.1.1 To reflect the uncertainty inherent in medium-term financial planning, optimistic and pessimistic scenarios have been developed alongside the envisaged position. These scenarios are based on applying a range of risk-adjusted assumptions to the key cost and funding drivers, providing an indication of the potential financial impact should future conditions prove more favourable or less favourable than currently anticipated. Contractual Pressures 7.1.2 The National Care Home Rate remains unknown beyond 2026/27. Although the actual increase approved for 2026/27 was 5.76%, the financial outlook continues to assume a 10% annual increase reflecting ongoing uncertainty and inflationary pressures within the sector. This results in a forecast pressure of £5.342m in 2027/28. 7.1.3 Care at Home contract inflation reflects anticipated Scottish Living Wage increases and is based on the weighted 2026/27 increase of 6.26%. Inflationary pressures across other expenditure budgets have been estimated using a blend of the latest OBR and Bank of England forecasts. Together these pressures generate a projected burden of £8.262m in 2027/28. Demand Pressures 7.1.4 Demand for social care services continues to increase and a provision of 5% annual growth has been included throughout the planning period. This results in a pressure of £4.086m in 2027/28. 7.1.5 Additional pressures across Health Services include Service Level Agreements, Resource Transfer commitments and other national and regional developments. These have been included based on detailed forecasts provided by NHS Lanarkshire and generally reflect annual increases of between 2% and 3%. 7.1.6 Local cost pressures within both Health and Social Care also reflect the phased implementation of elements of the 2026/27 savings and transformation programme, recognising that service redesign initiatives can take time to be fully embedded and deliver their recurring financial benefits. In addition, the outlook includes recurring pressures identified through in-year financial monitoring which will require sustainable funding solutions going forward. Pay Pressures 7.1.7 Social Care pay awards have been forecast at 3% in 2027/28 and 2028/29, reducing to 2% in 2029/30, consistent with current planning assumptions within North Page 131 of 264
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Lanarkshire Council's Financial Plan. This creates a cost pressure of £3.436m in 2027/28. 7.1.8 Health pay awards are assumed at 2% per annum throughout the planning period, generating a pressure of £4.157m in 2027/28. It is assumed that any nationally agreed NHS pay awards will continue to be fully funded by the Scottish Government, although this position will not be confirmed until the Scottish Budget is announced in December. 7.1.9 Members should note that Strathclyde Pension Fund is currently undertaking its triennial valuation and indicated in June that the funding position of the scheme remains strong. The outcome of the valuation is expected to be reported to the Pension Fund Committee in September and may result in a reduction to the current employer contribution rate from 17.5% to 15%. Should this occur, it would have a favourable impact on the Partnership's future social care cost pressures. The financial implications will be reflected in the December Medium-Term Financial Outlook, as appropriate. Prescribing 7.1.10 Prescribing expenditure remains one of the Partnership's most significant financial risks. Whilst a marginal underspend of £0.014m was achieved in 2025/26, prescribing costs continue to be influenced by national pricing arrangements, market conditions and increasing levels of clinical activity. A growth assumption of 5% per annum has therefore been retained within the outlook, generating a pressure of £4.432m in 2027/28. Funding 7.1.11 Funding contributions from both Partners remain subject to the Scottish Government Finance Settlement, which will not be announced until December 2026. In the absence of confirmed allocations, the outlook assumes recurring funding increases of 2% for Health Services and 6.26% for Council Services, consistent with current planning assumptions. In addition, a recurring increase of £1.0m per annum has been included to reflect the anticipated ongoing benefit of the Social Work funding formula change introduced in 2026/27. Collectively, these assumptions generate additional income of £32.906m in 2027/28. 8. MEDIUM TERM FINANCIAL OUTLOOK SUMMARY 8.1 Using the financial planning assumptions detailed in Section 7, a range of risk-based scenarios have been modelled to reflect the uncertainty inherent in medium-term financial planning. These scenarios provide an indication of the potential financial impact should future conditions prove more favourable or less favourable than currently anticipated. 8.2 Table 2 summarises the forecast budget gap under the envisaged, optimistic and pessimistic scenarios for the period 2027/28 to 2029/30. Table 2: Three-Year Financial Scenarios Forecast Gap 2027/28 £000 2028/29 £000 2029/30 £000 Total £000 Envisaged £15.204 £6.728 £6.196 £28.128 Optimistic £8.341 £5.063 £4.237 £17.641 Pessimistic £16.072 £7.371 £7.107 £30.551 Page 132 of 264
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8.3 It is recommended that the IJB adopts the envisaged scenario as the basis for its financial planning. This scenario projects a cumulative budget gap of £28.128m over the three-year planning period 2027/28 to 2029/30, with £15.204m relating to 2027/28. 8.4 While the financial outlook represents a significant improvement compared with the position approved within the Medium-Term Financial Plan in March 2026, a substantial recurring funding gap remains. The Partnership therefore continues to face significant financial challenges over the medium term. The scale of the challenge reinforces the need for continued service redesign, transformation and efficiency activity to ensure the long-term financial sustainability of the Partnership. 8.5 Over the coming months, officers will continue to refine the financial outlook and develop proposals to address the projected budget gap. A further update will be presented to the IJB in December 2026 ahead of the Medium-Term Financial Plan being submitted for approval in March 2027. 9. Reserves 9.1 As reported to the Performance, Finance & Audit Committee in August, the year-end reserves position is currently forecast as £102.817m as shown in Table 3. Table 3 Reserves £m Ring Fenced 14.985 Earmarked 45.697 Sub Total 60.682 Risk Based 21.270 Contingency 20.865 Sub Total 42.135 Total 102.817 9.2 Assuming all approved 2026/27 savings are achieved, and the Partnership delivers a break-even position in 2026/27, the forecast level of useable reserves available to support future financial challenges will be £42.135m. 9.3 While the current reserves position provides short-term financial resilience, reserves are a finite resource and cannot be relied upon to address recurring budget pressures on a sustainable basis. The delivery of recurring savings, service redesign and transformation will therefore remain critical to the Partnership's long-term financial sustainability. 10. IMPLICATIONS 10.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as 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 dignity respected ☐ Page 133 of 264
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Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 10.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 10.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 10.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated where necessary. Relevant Risk Register Details Current Risk Level Risk Owner Financial Sustainability – Short Term High Nicola Scott Financial Sustainability – Medium Term Very High Nicola Scott Financial Sustainability – Long Term Very High Nicola Scott Governance Failure High Nicola Scott Failure to meet Legislative Requirements Medium Pauline Izat / Morag Dendy / Joanne Jenkins 10.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance & Technology) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Page 134 of 264
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☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 10.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 11. BACKGROUND PAPERS None. 12. APPENDICES Appendix 1 Envisaged Budget Scenario Appendix 2 Optimistic Budget Scenario Appendix 3 Pessimistic Budget Scenario Nicola Scott Chief Finance Officer Members seeking further information, please contact Nicola Scott on 07581 007187. Page 135 of 264
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Appendix 1 ENVISAGED BUDGET SCENARIO 3 Year SOCIAL CARE HEALTH TOTAL SOCIAL CARE HEALTH TOTAL SOCIAL CARE HEALTH TOTAL Total EXPENDITURE Contractual Pressures National Care Home Contract 5,342,397 - 5,342,397 5,428,127 - 5,428,127 5,970,939 - 5,970,939 16,741,463 Contract Inflation 8,261,684 - 8,261,684 9,103,014 - 9,103,014 9,672,896 - 9,672,896 27,037,595 General Health Supplies - 396,442 396,442 - 404,371 404,371 - 412,458 412,458 1,213,272 Pay Pressures 2026/27 Pay Award 3,435,848 4,156,557 7,592,405 3,252,417 4,239,688 7,492,105 2,233,326 4,324,482 6,557,808 21,642,318 Social Care: Demand SDS, Independent Care Homes & IEAS 4,085,897 - 4,085,897 4,290,192 - 4,290,192 4,504,701 - 4,504,701 12,880,790 Purchase of Healthcare Service Level Agreements - 204,007 204,007 - 208,087 208,087 - 212,249 212,249 624,344 Resource Transfer - 1,303,451 1,303,451 - 1,329,520 1,329,520 - 1,356,110 1,356,110 3,989,081 Health: Development Pressures Local - 6,701,279 6,701,279 1,142,220 1,142,220 - 1,025,199 1,025,199 8,868,698 National & Regional - 25,585 25,585 - 26,353 26,353 - 27,144 27,144 79,081 Scottish Government Allocations - 6,776,125 6,776,125 - 6,776,125 6,776,125 - 6,776,125 6,776,125 20,328,375 - GP Prescribing Demand and Price Increases - 4,431,800 4,431,800 - 4,653,390 4,653,390 - 4,886,060 4,886,060 13,971,250 Others Recurring burdens 2,989,475 - 2,989,475 - - - - - - 2,989,475 TOTAL EXPENDITURE 24,115,301 23,995,246 48,110,547 22,073,749 18,779,755 40,853,504 22,381,863 19,019,827 41,401,690 130,365,741 INCOME Partner Contributions North Lanarkshire Council (13,177,218) (13,177,218) (13,939,556) (13,939,556) (14,749,619) (14,749,619) (41,866,392) NHS Lanarkshire (18,544,389) (18,544,389) (18,779,754) (18,779,754) (19,019,827) (19,019,827) (56,343,970) Charges Uplifts Community Alarms (72,393) - (72,393) (76,761) - (76,761) (80,599) - (80,599) (229,752) Resource Transfer Transfer from Health to Social Care (1,112,138) - (1,112,138) (1,329,520) - (1,329,520) (1,356,110) - (1,356,110) (3,797,769) TOTAL INCOME (14,361,748) (18,544,389) (32,906,138) (15,345,836) (18,779,754) (34,125,591) (16,186,328) (19,019,827) (35,206,155) (102,237,883) BUDGET GAP 9,753,553 5,450,857 15,204,410 6,727,913 0 6,727,914 6,195,535 0 6,195,535 28,127,858 2027/28 2028/29 2029/30 Page 136 of 264
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Appendix 2 OPTIMISTIC BUDGET SCENARIO 3 Year SOCIAL CARE HEALTH TOTAL SOCIAL CARE HEALTH TOTAL SOCIAL CARE HEALTH TOTAL Total EXPENDITURE Contractual Pressures National Care Home Contract 4,968,429 - 4,968,429 5,013,379 - 5,013,379 5,479,623 - 5,479,623 15,461,431 Contract Inflation 8,261,684 - 8,261,684 9,103,014 - 9,103,014 9,672,896 - 9,672,896 27,037,595 General Health Supplies - 392,478 392,478 - 400,327 400,327 - 404,251 404,251 1,197,056 Pay Pressures 2026/27 Pay Award 3,418,669 4,135,774 7,554,443 3,235,642 4,218,490 7,454,132 2,221,484 4,281,345 6,502,829 21,511,404 Social Care: Demand SDS, Independent Care Homes & IEAS 3,064,423 - 3,064,423 3,056,762 - 3,056,762 3,049,120 - 3,049,120 9,170,304 Purchase of Healthcare Service Level Agreements - 202,987 202,987 - 207,047 207,047 - 210,132 210,132 620,166 Resource Transfer - 1,303,451 1,303,451 - 1,329,520 1,329,520 - 1,356,110 1,356,110 3,989,081 Health: Development Pressures Local - 1,358,566 1,358,566 1,253,856 1,253,856 - 1,212,147 1,212,147 3,824,569 National & Regional - 25,585 25,585 - 26,353 26,353 - 27,144 27,144 79,081 Scottish Government Allocations - 6,776,125 6,776,125 - 6,776,125 6,776,125 - 6,776,125 6,776,125 20,328,375 - GP Prescribing Demand and Price Increases - 4,387,482 4,387,482 - 4,606,856 4,606,856 - 4,788,827 4,788,827 13,783,165 Others Recurring burdens 2,989,475 - 2,989,475 - - - - - - 2,989,475 TOTAL EXPENDITURE 22,702,680 18,582,448 41,285,128 20,408,796 18,818,574 39,227,371 20,423,123 19,056,081 39,479,203 119,991,702 INCOME Partner Contributions North Lanarkshire Council (13,177,218) (13,177,218) (13,939,556) (13,939,556) (14,749,619) (14,749,619) (41,866,392) NHS Lanarkshire (18,582,448) (18,582,448) (18,818,574) (18,818,574) (19,056,080) (19,056,080) (56,457,102) Charges Uplifts Community Alarms (72,393) - (72,393) (76,761) - (76,761) (80,599) - (80,599) (229,752) Resource Transfer Transfer from Health to Social Care (1,112,138) - (1,112,138) (1,329,520) - (1,329,520) (1,356,110) - (1,356,110) (3,797,769) TOTAL INCOME (14,361,748) (18,582,448) (32,944,196) (15,345,836) (18,818,574) (34,164,410) (16,186,328) (19,056,080) (35,242,408) (102,351,015) BUDGET GAP 8,340,932 0 8,340,932 5,062,960 0 5,062,960 4,236,795 0 4,236,795 17,640,688 2027/28 2028/29 2029/30 Page 137 of 264
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Appendix 3 PESSIMISTIC BUDGET SCENARIO 3 Year SOCIAL CARE HEALTH TOTAL SOCIAL CARE HEALTH TOTAL SOCIAL CARE HEALTH TOTAL Total EXPENDITURE Contractual Pressures National Care Home Contract 5,449,245 - 5,449,245 5,547,588 - 5,547,588 6,113,441 - 6,113,441 17,110,274 Contract Inflation 8,261,684 - 8,261,684 9,103,014 - 9,103,014 9,672,896 - 9,672,896 27,037,595 General Health Supplies - 400,407 400,407 - 408,415 408,415 - 420,749 420,749 1,229,570 Pay Pressures 2026/27 Pay Award 3,521,744 4,198,123 7,719,867 3,336,368 4,282,085 7,618,454 2,292,641 4,411,404 6,704,045 22,042,366 Social Care: Demand SDS, Independent Care Homes & IEAS 4,290,192 - 4,290,192 4,729,936 - 4,729,936 5,214,755 - 5,214,755 14,234,883 Purchase of Healthcare Service Level Agreements - 205,027 205,027 - 209,128 209,128 - 214,377 214,377 628,532 Resource Transfer - 1,303,451 1,303,451 - 1,329,520 1,329,520 - 1,356,110 1,356,110 3,989,081 Health: Development Pressures Local - 6,701,279 6,701,279 702,404 702,404 - 144,447 144,447 7,548,130 National & Regional - 25,585 25,585 - 26,353 26,353 - 27,144 27,144 79,081 Scottish Government Allocations - 6,776,125 6,776,125 - 6,776,125 6,776,125 - 6,776,125 6,776,125 20,328,375 - GP Prescribing Demand and Price Increases - 4,476,118 4,476,118 - 4,699,924 4,699,924 - 4,984,269 4,984,269 14,160,311 Others Recurring burdens 2,989,475 - 2,989,475 - - - - - - 2,989,475 TOTAL EXPENDITURE 24,512,340 24,086,114 48,598,454 22,716,907 18,433,954 41,150,860 23,293,734 18,334,625 41,628,359 131,377,674 INCOME Partner Contributions North Lanarkshire Council (13,177,218) (13,177,218) (13,939,556) (13,939,556) (14,749,619) (14,749,619) (41,866,392) NHS Lanarkshire (18,163,804) (18,163,804) (18,433,954) (18,433,954) (18,334,625) (18,334,625) (54,932,383) Charges Uplifts Community Alarms (72,393) - (72,393) (76,761) - (76,761) (80,599) - (80,599) (229,752) Resource Transfer Transfer from Health to Social Care (1,112,138) - (1,112,138) (1,329,520) - (1,329,520) (1,356,110) - (1,356,110) (3,797,769) TOTAL INCOME (14,361,748) (18,163,804) (32,525,552) (15,345,836) (18,433,954) (33,779,790) (16,186,328) (18,334,625) (34,520,953) (100,826,296) BUDGET GAP 10,150,592 5,922,310 16,072,902 7,371,070 0- 7,371,070 7,107,406 0 7,107,406 30,551,378 2027/28 2028/29 2029/30 Page 138 of 264
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1 Item No: 11 SUBJECT: Annual Performance Report 2025/26 – University Health & Social Care North Lanarkshire TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest, Performance Manager DATE: 16 September 2026 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ Prepared by: Performance Manager Reviewed by: Senior Manager, Strategy & Performance Item 10 Page 139 of 264
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2 3. RECOMMENDATIONS It is recommended that the IJB: (1) Review and approve the content of the Annual Performance Report 2025/26 – University Health & Social Care North Lanarkshire, which is appended to this report. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES The Public Bodies (Joint Working) Regulations 2014 requires that North Lanarkshire IJB publish an Annual Performance Report by July 31st, every year. The content of the Annual Performance Report is focused on the National Integration Indicators (the Core Suite and Ministerial Steering Group indicators). The purpose of standardising Annual Performance Reports for Integration Authorities is to support consistency of reporting for these indicator sets, facilitate benchmarking and provide a suitable framework for understanding the performance of Health and Social Care services. The Annual Performance Report 2025/26 – University Health & Social Care North Lanarkshire (APR) presents our performance in relation to these metrics, performance information relating to inspections carried out by the Care Inspectorate, alongside additional local performance information in the form of the Chief Executive’s scorecard. Progress against the National Health & Wellbeing Outcomes is also described in the report. There is a dedicated section presenting and describing financial performance for 2025/26. In order to comply with the requirements to publish the APR by 31st July 2026, a draft version has been available on the IJB website since that date, pending approval by the IJB. This was required due to the timescales imposed on the partnership to produce and publish an Annual Performance Report by 31st July using Public Health Scotland data that they do not publish until July 2026; the prior publications of the data set are for use as management information only. Members should note the most up-to-date available has been used in the report, however for many indicators this relates to previous years. 6. CONCLUSIONS The Annual Performance Report 2025/26 – University Health & Social Care North Lanarkshire describes progress made in pursuit of the National Health & Wellbeing Outcomes against the challenging position for Health and Social Care nationally, reflected in the performance for some of the metrics presented in the report. Performance in North Lanarkshire is broadly comparable with similar authorities and the Scottish average in many areas; the Health and Yes ☐ No ☐ N/A ☒ Page 140 of 264
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3 Social Care Partnership actively manages any areas requiring performance improvement through its established performance framework. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The content of the Annual Performance Report focusses on the National Integration Indicators (the Core Suite and Ministerial Steering Group indicators). A performance framework is in place within University Health and Social Care North Lanarkshire to ensure the continual monitoring of performance data and information, and any improvement actions associated with performance monitoring. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Yes ☐ No ☐ N/A ☒ Page 141 of 264
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4 Relevant Risk Register Details Current Risk Level Risk Owner IJB 11.21 - Oversight of Performance Activity Low Claire Rae NLC RIA0000460 – Performance & planning High NLC – Social Work/Social care 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services The Annual Performance Report outlines the roles of our community stakeholders and highlights their active contribution to service delivery across North Lanarkshire. ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery The APR provides information on engagement with and participation of community stakeholders. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings The APR provides performance information that will enable stakeholder representatives to participate in wider discussions about performance. ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership The performance information included in the APR supports locality planning. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Page 142 of 264
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5 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS The results for each General Practice, General Practice Cluster, Health and Social Care Partnership and NHS Board, as well as time series trends where applicable, are available via an online dashboard hosted by Public Health Scotland. Public Health Scotland provide detailed reporting on the annual rates for the Core Suite of Integration Indicators for each Integration Authority area and Scotland Annual information used to review progress towards achieving each of the national health and wellbeing outcomes. This is available at the following website: Core suite of integration indicators 7 July 2026 - Core suite of integration indicators - Publications - Public Health Scotland 9. APPENDICES Appendix One – Annual Performance Report 2025/26 – University Health & Social Care North Lanarkshire CHIEF ACCOUNTABLE OFFICER (or Depute) Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following; Stephen Forrest – Performance Manager Stephen.Forrest@lanarkshire.scot.nhs.uk Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒ Page 143 of 264
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Contents Foreword ........................................................................................................................ 3 Executive Summary ....................................................................................................... 4 National Health and Wellbeing Outcomes Framework ................................................... 6 Performance Dashboard............................................................................................. 6 Scottish Health and Care Experience Survey ............................................................. 7 National Outcome Indicators – Benchmarking – 2025/26 ........................................... 8 Core Suite of Integration Indicators ............................................................................ 9 National Integration Indicators – Benchmarking ....................................................... 11 Measuring Performance Under Integration (MPUI) ...................................................... 12 Managing Performance Under Integration ................................................................... 14 ................................................................................................................................. 16 Summary of Financial Performance (2025/26) ............................................................. 25 Care Inspectorate Grades 2025/26 .............................................................................. 28 Care Homes ................................................................................................................. 28 Other services .......................................................................................................... 29 Getting It Right for Everyone ........................................................................................ 31 An Enabling Approach ................................................................................................. 31 Our new Strategic Commissioning Plan ....................................................................... 32 Appendices .................................................................................................................. 33 Appendix 1 – Summary of Performance against Core Suite of Integration Indicators ........... 33 Appendix 2 – HSCP Performance Dashboard ..................................................................... 35 Glossary of Terms ........................................................................................................ 43 Page 145 of 264
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Foreword Welcome to the 2025/26 Annual Performance Report for University Health and Social Care North Lanarkshire. We’re pleased to share this year’s Report, covering the period from April 2025 to March 2026. This report offers a comprehensive overview of how we’ve performed across key national and local indicators, including the National Health & Wellbeing Outcomes, Core Integration Indicators, Ministerial Strategic Group measures, and our own local benchmarks. Throughout the year, the Integration Joint Board has received regular updates on our progress, and you can explore these reports alongside previous Annual Performance Reports on our website: North Lanarkshire Health and Social Care Partnership This report goes beyond presenting data; it offers a clear view of the impact, commitment, and collective effort across our services, partners and communities. It highlights the progress we have made together, recognises the people driving that progress, and reflects the innovation shaping how we deliver support. At the same time, it provides an honest account of the challenges we continue to face, alongside the actions we are taking to respond, improve and deliver better outcomes for our communities. The first section focuses on statutory performance reporting, including national comparisons, benchmarking and trend analysis. In some cases, data limitations have impacted our ability to present a full picture; where this occurs, we’ve explained the reasons clearly. The remainder of the report dives deeper into each of the National Outcomes, showcasing the progress, improvements, and impact of our work throughout 2025/26. Page 146 of 264
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Executive Summary 2025/26 has been a year of challenge and change for University Health and Social Care North Lanarkshire (UHSCNL). With demand rising and complexity increasing, our teams have responded by accelerating improvement, strengthening partnerships and focusing on what makes the biggest difference for people and communities. Across services, the emphasis has been on delivering high-quality, person-centred care, improving flow through the system, and ensuring that more people are supported to live well, safely and independently at home. This year, we celebrated several key milestones: • Strengthened delivery of Home First approaches, supporting more people to receive assessment, care, recovery and support at home, and reducing reliance on hospital-based care. • Continued progress in improving access to services, including waiting time improvements in key areas such as Speech and Language Therapies and expanded delivery of Adult Psychological Therapies. • Development of innovative service models, including the Whole School Model for neurodevelopmental support, recognised at a national level for its approach to early intervention and system integration. • Targeted action to reduce health inequalities, including community-led engagement and improved access to screening for underrepresented groups. • Enhanced partnership working with communities, carers and the third sector, supporting improved engagement, co-production and access to support. • Progress in strengthening commissioning and provider oversight, contributing to improved service quality and reduced risk across commissioned services. • Continued investment in workforce development and engagement, including delivery of staff roadshows and development of future workforce pathways through initiatives such as the Care Academy. We also made significant progress in strategic planning and governance: • The Strategic Commissioning Plan – We developed our new Strategic Commissioning Plan during 2025/26. • The Integration Joint Board (IJB) approved a balanced budget for 2026/27, ensuring continued investment in prevention, early intervention, and community- based care. Page 147 of 264
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• Our academic partnerships with the University of Strathclyde, Glasgow Caledonian University, and the University of the West of Scotland have flourished, positioning UHSCNL as a University-designated operating division and a national leader in research, innovation, and workforce development. As we look ahead, our priorities remain clear: • Prevention – The continued shift from crisis response to early intervention, anticipatory support, and community-based approaches. • Tackling Inequality – Targeting our resources more intensively toward areas of greatest need and tailoring services to local contexts. • Stronger Places & Communities – The continued expansion of community hubs, strengthening the third sector and embedding place-based working. • Enabling Healthy Living – Promote whole-person wellbeing, address mental health, substance use, physical health, and social connection. • Equitable Access – Simplify pathways, reduce barriers, improve coordination, and ensure inclusive digital transformation. Page 148 of 264
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6 National Health and Wellbeing Outcomes Framework Since 2016/17, Integration Authorities have been required by legislation to report on the Core Suite of Integration Indicators within their Annual Performance Reports. These indicators were developed to help Integration Authorities review their progress towards achieving each of the National Health and Wellbeing Outcomes, which focus on improving how services are provided and the difference that integrated health and social care services should make for people. The indicators were developed in consultation with a wide range of stakeholders and are intended for consideration within the wider context of health and social care. They help us, as a partnership, identify areas for improvement and assist us with planning for the future. Indicator values are derived from national data sources for each of the 23 indicators to enable comparability between local areas and with Scotland. There are 23 indicators in total, comprising nine indicators based on the Health and Care Experience Survey and ten other measures mainly using health activity, community and deaths information. The remaining four indicators cannot be reported on as national data is not available or there is not yet a nationally agreed definition. The nine indicators based on the Health and Care Experience Survey, which has been run every two years since 2009, detail people's experiences of accessing and using various services. The Health and Care Experience Survey (successor to the GP and Local NHS Services Patient Experience Survey) asks about people’s experiences of accessing and using their GP practice and Out of Hours services, aspects of care and support provided by local authorities and other organisations and caring responsibilities and related support: https://www.gov.scot/publications/national-health-wellbeing-outcomes-framework Performance Dashboard The Health & Social Care Partnership also has in place a corporate performance dashboard which is monitored and reported on a quarterly basis and is attached as Appendix 2. This comprises a range of performance metrics and Key Performance Indicators that are used to give the Strategic Leadership Team and Integration Joint Board an assurance of progress against key performance targets. Page 149 of 264
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7 Scottish Health and Care Experience Survey Scottish Health and Care Experience Survey – North Lanarkshire Indicator Title 2017/18 2019/20 2021/22 2023/24 2025/26 Scotland 2025/26 HSCNL Trend from Previous Survey Scotland Trend from Previous Survey NI -1 Percentage of adults able to look after their health very well or quite well 90.3% 90.5% 87.5% 87.4% 87.7% 90.6% ⬆ ⬇ NI - 2 Percentage of adults supported at home who agreed that they are supported to live as independently as possible 75.4% 77.6% 79.8% 67.7% 67.1% 73.6% ⬇ ⬆ NI - 3 Percentage of adults supported at home who agreed that they had a say in how their help, care, or support was provided 71.4% 71.2% 67.1% 57.1% 56.1% 63.9% ⬇ ⬆ NI - 4 Percentage of adults supported at home who agreed that their health and social care services seemed to be well co-ordinated 69.7% 70.2% 66.6% 56.0% 56.7% 65.0% ⬆ ⬆ NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 75.4% 77.8% 74.0% 65.8% 61.9% 72.1% ⬇ ⬆ NI - 6 Percentage of people with positive experience of care at their GP practice 75.5% 68.3% 51.8% 52.8% 56.9% 70.7% ⬆ ⬆ NI - 7 Percentage of adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 75.6% 75.7% 77.0% 67.7% 65.3% 71.7% ⬇ ⬆ NI - 8 Percentage of carers who feel supported to continue in their caring role 33.2% 32.6% 25.1% 28.5% 33.6% 31.9% ⬆ ⬆ NI - 9 Percentage of adults supported at home who agreed they felt safe 79.9% 80.0% 79.8% 68.4% 64.5% 74.7% ⬇ ⬆ N.B. Please note results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years due to changes in survey wording. Also results for 2019/20 and 2021/22 for indicators 2, 3, 4, 5, 7 and 9 are comparable to each other, but not directly comparable to figures in previous years due to changes in survey wording and methodology. Page 150 of 264
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8 National Outcome Indicators – Benchmarking – 2025/26 Indicator Scotland North Lanarkshire East Ayrshire Eilean Siar Dundee City North Ayrshire Inverclyde West Dunbartonshire Glasgow City Percentage of adults able to look after their health very well or quite well 90.6% 87.7% 89.0% 93.5% 90.3% 88.8% 88.7% 89.9% 87.5% Percentage of adults supported at home who agree that they are supported to live as independently as possible 73.6% 67.1% 64.6% 82.2% 78.9% 71.5% 80.0% 77.5% 72.9% Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided 63.9% 56.1% 60.8% 69.5% 67.0% 56.5% 62.5% 61.1% 67.2% Percentage of adults supported at home who agree that their health and social care services seemed to be well co- ordinated 65.0% 56.7% 54.8% 76.6% 68.9% 64.1% 62.2% 62.7% 68.9% Percentage of adults receiving any care or support who rate it as excellent or good 72.1% 61.9% 73.3% 93.5% 71.8% 70.4% 65.9% 64.9% 76.8% Percentage of people with positive experience of care at their GP practice 70.7% 56.9% 55.9% 84.8% 71.9% 62.6% 62.6% 67.9% 75.7% Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life 71.7% 65.3% 67.8% 79.5% 71.2% 67.2% 65.2% 70.3% 72.7% Percentage of carers who feel supported to continue in their caring role 31.9% 33.6% 32.0% 37.5% 28.3% 27.1% 31.2% 29.7% 36.2% Percentage of adults supported at home who agree they felt safe 74.7% 64.5% 64.8% 99.3% 79.3% 73.7% 83.7% 72.6% 75.0% The table above provides a comparison for 2025/26 with North Lanarkshire’s ‘Family Group’ of Integration Authorities for those National Outcome Indicators sourced from the Health and Care Experience Survey. Page 151 of 264
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9 Public Health Scotland Data The Public Bodies (Joint Working) (Scotland) Act 2014 requires that Integration Authorities report on the Core Suite Integration Indicators in their Annual Performance Reports. These indicators act as a measure of progress towards achieving each of the national Health and Wellbeing Outcomes. These indicators are based on the most complete and robust data currently available, as provided by Public Health Scotland (PHS) to all Health and Social Care Partnerships. For more information regarding the background and purpose of the indicators, please see the Background and glossary document for this publication: https://publichealthscotland.scot/media/39472/2026-07-07-coresuiteindicators-background-and-glossary.pdf Core Suite of Integration Indicators Scottish Health and Care Experience Survey North Lanarkshire Indicator Title 2020/21 2021/22 2022/23 2023/24 2024/25 Scotland 2024 HSCNL Trend Scotland Trend NI -11 Premature mortality rate per 100,000 persons 578 575 507 541 543 426 ⬇ ⬆ Please note that only data until 2024 is available for this indicator. Indicator Title 2021/22 2022/23 2023/24 2024/25 2025 Scotland 2025 HSCNL Trend Scotland Trend NI – 12 Emergency admission rate (per 100,000 population) 15071 15037 14547 12427 12488 11470 ⬇ ⬇ Please note that financial year data is only available up to 2024/25. NI – 13 Emergency bed day rate (per 100,000 population) 124446 131187 128433 121258 116005 108988 ⬆ ⬆ Page 152 of 264
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10 NI – 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 115 117 114 114 114 104 ⬌ ⬇ NI – 15 Proportion of last 6 months of life spent at home or in a community setting 89.8% 89.0% 88.8% 88.8% 88.8% 89.3% ⬌ ⬆ NI – 16 Falls rate per 1,000 population aged 65+ 20.6 19.8 20.7 21.9 22.9 22.2 ⬇ ⬇ Indicator Title 2021/22 2022/23 2023/24 2024/25 2025/26 Scotland 2025/26 HSCNL Trend Scotland Trend NI – 17 Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections 78.1% 77.0% 75.8% 77.5% 87.6% 83.1% ⬆ ⬆ Indicator Title 2020/21 2021/22 2022/23 2023/24 2024/25 Scotland 2024 HSCNL Trend Scotland Trend NI – 18 Percentage of adults with intensive care needs receiving care at home 75.1% 75.0% 71.5% 69.7% 65.6% 64.7% ⬇ ⬆ Please note that only data from 2018 - 2024 (calendar years) is available for this indicator. Indicator Title 2021/22 2022/23 2023/24 2024/25 2025/26 Scotland 2025/26 HSCNL Trend Scotland Trend NI – 19 Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) 831 950 927 783 854 873 ⬇ ⬆ Page 153 of 264
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11 National Integration Indicators – Benchmarking Indicator Scotland North Lanarkshire East Ayrshire Western Isles Dundee City North Ayrshire Inverclyde West Dunbartonshire Glasgow City Latest data Premature mortality rate per 100,000 426 543 490 437 521 532 491 509 564 2024 Emergency admission rate per 100,000 11470 12488 15289 13282 15727 14594 13174 13369 10968 2025 Emergency bed day rate for adults per 100,000 108988 116005 129228 138779 101478 147915 140026 148644 121623 2025 Emergency readmission to hospital within 28 days of discharge (per 1,000 discharges) 104 114 108 87 149 103 90 85 90 2025 Proportion of last 6 months of life spent at home or in the community 89.3% 88.8% 89.4% 87.0% 90.3% 87.9% 88.3% 87.2% 88.1% 2025 Falls rate per population aged 65+ 22.2 22.9 20.6 25.3 34.5 20.2 22.2 23.2 28.4 2025 Proportion of care services graded ‘Good’ (4) / better in Care Inspectorate Inspections 83.1% 87.6% 76.6% 85.7% 76.7% 87.8% 80.2% 84.2% 90.4% 2025/26 Percentage of adults with intensive care needs receiving care at home 64.7% 65.6% 70.1% 54.3% 65.9% 77.0% 66.6% 70.1% 62.0% 2024 Number of days people aged 75+ spend in hospital when ready to be discharged, per 1,000 population 873 854 802 2277 244 1738 431 1440 1074 2025/26 Page 154 of 264
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12 Measuring Performance Under Integration (MPUI) Based on agreed trajectories, our objective for 2025/26 was to achieve a reduction in emergency admissions and performance throughout the year was generally positive; either in-line with, or positive when compared with the trajectory set. The agreed trajectory for 2025/26 was for a reduction in the number of A&E attendances and the level of performance delivered was generally positive when compared with the trajectory set. 0 1,000 2,000 3,000 4,000 5,000 North Lanarkshire - Emergency Admissions - April 2021 - March 2026 Performance Trajectory 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 Apr21 Jun21 Aug21 Oct21 Dec21 Feb22 Apr-22 Jun-22 Aug-22 Oct-22 Dec-22 Feb-23 Apr-23 Jun-23 Aug-23 Oct-23 Dec-23 Feb-24 Apr-24 Jun-24 Aug-24 Oct-24 Dec-24 Feb-25 Apr-25 Jun-25 Aug-25 Oct-25 Dec-25 Feb-26 North Lanarkshire - A&E Attendances - April 2021 - March 2026 Performance Trajectory Page 155 of 264
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13 Based on agreed trajectories, our objective for 2025/26 was to achieve a reduction in the number of unscheduled bed days. The trajectory for the reduction in bed days reflected the ongoing work to reduce length of stay, including the development of the Target Operating Model, the Flow Navigation Centre and the continued work across all acute and community wards to improve efficiency and effectiveness. Based on agreed trajectories, our objective for 2025/26 was to reduce the number of occupied bed days due to standard delays. There was significant effort to improve our locality and community response to facilitating hospital discharges, including embedding Getting It Right for Everyone and our Enabling Approach, which contributed to a reduction in bed days. 0 5,000 10,000 15,000 20,000 25,000 30,000 Apr21 Jun21 Aug21 Oct21 Dec21 Feb22 Apr-22 Jun-22 Aug-22 Oct-22 Dec-22 Feb-23 Apr-23 Jun-23 Aug-23 Oct-23 Dec-23 Feb-24 Apr-24 Jun-24 Aug-24 Oct-24 Dec-24 Feb-25 Apr-25 Jun-25 Aug-25 Oct-25 Dec-25 Feb-26 North Lanarkshire - Unscheduled Care Bed Days - Acute Specialties - April 2021 - March 2026 Performance Trajectory 0 500 1,000 1,500 2,000 2,500 3,000 3,500 Apr-21 May-21 Jun-21 Jul-21 Aug-21 Sep-21 Oct-21 Nov-21 Dec-21 Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22 Oct-22 Nov-22 Dec-22 Jan-23 Feb-23 Mar-23 Apr-23 May-23 Jun-23 Jul-23 Aug-23 Sep-23 Oct-23 Nov-23 Dec-23 Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26 Delayed Discharge Bed Days - Standard Delays - April 2021 - March 2026 Standard bed days Target Trajectory Page 156 of 264
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14 Managing Performance Under Integration National Health and Wellbeing Outcome 1 People are able to look after their own health and wellbeing and live in good health for longer The Partnership continued to prioritise prevention, early intervention and reducing health inequalities, recognising that supporting people to maintain and improve their health and wellbeing is fundamental to reducing demand across the wider system. This work has focused on strengthening our community engagement, improving access to screening and health improvement services and delivering targeted interventions for those most at risk of poorer outcomes. A key area of focus during the year has been improving access to preventative services, particularly in relation to screening. We undertook targeted work to engage with communities who are less likely to access routine screening, including collaborative work with local partners to support cervical screening participation among South Asian women. This included direct engagement with community groups and in faith settings, alongside the development of culturally appropriate digital resources to improve awareness and address barriers to access. This targeted approach reflects the Partnership’s wider commitment to tackling inequalities and ensuring that services are accessible to all communities. Alongside this, the Partnership has continued to support a range of public health and harm reduction initiatives. Work delivered through the Alcohol and Drug Partnership has focused on reducing drug-related harm and improving access to support, including the ongoing delivery of Medication Assisted Treatment standards, overdose prevention activity and assertive outreach. This work contributes to national priorities under the National Mission while also supporting local prevention efforts and improving outcomes for vulnerable individuals. Page 157 of 264
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15 National Health and Wellbeing Outcome 2 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community Supporting people to live independently at home remained a key priority in 2025/26, with a focus on reducing reliance on hospital- based care, improving flow through the wider health and social care systems, and strengthening community-based alternatives. This reflects both the strategic direction set out within the Strategic Commissioning Plan and the increasing demand pressures across health and social care, particularly within acute services and social care provision. A key area of focus has been the continued development of “Home First” approaches, in particular, supporting people to return home as quickly as possible following an admission to hospital and where appropriate, to avoid admission to a facility altogether. This includes a strong emphasis on assessment and recovery at home, ensuring that we plan and deliver care to promote independence and reduce longer-term reliance on services. The Home Assessment Team has played a central role in delivering this approach, supporting early discharge from hospital and enabling individuals to receive assessment and support within their own homes. This model of care has received national attention, including a ministerial visit during the reporting period, highlighting the Partnership’s approach to delivering integrated, person-centred care within the community and its contribution to reducing hospital stay and improving patient outcomes. Alongside discharge and recovery at home, the Partnership has continued to progress broader system developments to support people living independently in the community. This includes ongoing work to develop and implement a cohesive frailty pathway, supporting older adults and those with complex needs through earlier intervention, proactive care planning and coordinated multi-disciplinary support. The development of this approach reflects an increasing focus on anticipatory care and managing risk within the community, rather than responding to crisis within acute settings. Page 158 of 264
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16 Work has also progressed to strengthen the delivery of care at home and community-based supports, recognising the growing demand for these services and the pressures this places on the system. Redesign activity has focused on developing a more enabling approach to care, supporting people to maintain independence for as long as possible, alongside the introduction of improved systems and processes to support service delivery and planning. These developments have taken place within a challenging operating environment. Demand for both care at home and care home provision has continued to exceed planned levels in some areas, reflecting demographic pressures and increasing complexity of need. Workforce capacity remains a constraint across a number of services and impacts on the pace at which we deliver change and manage our capacity to meet the demand. Despite these challenges, progress made during 2025/26 demonstrates a continued move towards a more community-focused model of care, with stronger integration between services and an increasing emphasis on prevention, rehabilitation and recovery within people’s own homes. The Partnership will continue to build on this progress, recognising that further transformation is required to ensure long-term sustainability and to meet the needs of the population effectively. Page 159 of 264
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17 National Health and Wellbeing Outcome 3 People who use health and social care services have positive experiences of those services and have their dignity respected During 2025/26, the Partnership has continued to focus on improving people’s experience of services, recognising that timely access, continuity of support and person-centred care are critical to achieving positive outcomes. This has included strengthening engagement with people, carers and communities, alongside ongoing work to improve the consistency and responsiveness of services across the system. A key area of focus has been the development of more effective approaches to engagement and participation, ensuring that the voices of people who use services help to inform service design and improvement. This has included continued work to strengthen links with community and voluntary sector partners, as well as direct engagement activity with individuals and communities through events including the Participation Day, helping us to understand local needs and experiences. These approaches support the Partnership’s wider commitment to person-centred care and to designing services that reflect what matters most to people, which was the core theme of the Participation Day event. Supporting unpaid carers has remained a priority during the year, recognising the vital role carers play in sustaining people within their communities. Engagement activity, including programme- level work linked to carers’ development, has provided opportunities to understand carers’ experiences and identify areas for improvement in the support available to them. This work aligns with the Partnership’s Carers Strategy and reflects a continued focus on improving identification, access to support and the overall experience of carers. The Partnership has also taken steps to strengthen feedback and organisational learning through ongoing engagement with staff and frontline services. A programme of leadership engagement and staff roadshows has provided opportunities to gather insight on service pressures, challenges and areas for improvement directly from those delivering care. This has supported a stronger connection between strategic leadership and frontline delivery, helping to inform improvement activity and ensuring that we embed the learning from frontline staff across our services. Page 160 of 264
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18 Alongside engagement activity, we are using our performance information and feedback to identify areas where improvements are required. Whilst many people do report positive experiences of services, pressures on capacity and demand can affect the timeliness and responsiveness of support in some areas. Work continues to ensure that people receive the right support, at the right time, delivered in a way that respects their dignity and individual needs. The Partnership remains committed to strengthening participation, improving communication and ensuring that people’s experiences directly inform service design and delivery. Whilst there has been significant progress, continued effort is required to ensure consistent positive experiences across all services, particularly in the context of increasing demand and system pressures. Page 161 of 264
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19 National Health and Wellbeing Outcome 4 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services Throughout the year, the Partnership continued to focus on improving the quality, accessibility and responsiveness of services, recognising that timely access to appropriate support is fundamental to maintaining and improving people’s quality of life. This has included a strong emphasis on service redesign, improving access to care and strengthening pathways across a range of services, particularly where demand and complexity of need continue to increase. A key area of progress was the work to progress a Whole School Model approach to neurodevelopmental support, aimed at providing earlier intervention, improving access to assessment and enabling better coordination of support within educational settings. This approach has attracted national attention, including engagement with Scottish Government, reflecting its potential to deliver more integrated and accessible support for children and families. Alongside this, work has continued to improve access to a range of therapy services. Speech and Language Therapy services have demonstrated improvement over the reporting period, including delivery of the targeted level of performance for the waits for the first time, reflecting the sustained effort by the service to address waiting times and improve access. Similarly, Adult Psychological Therapies services have continued to expand and adapt their delivery models, including increased use of digital approaches to improve accessibility, choice and responsiveness for people. These improvements have taken place within a wider context of increasing demand for services and the need to adapt models of care to meet changing population needs. Service redesign and modernisation activity has focused on ensuring that individuals are able to access the right support at the right time, delivered in a way that supports independence and improves overall quality of life. The Partnership has continued to develop integrated approaches to service delivery, improving coordination between services and reducing the fragmentation of care and support. This includes strengthening pathways across health and social care, improving the use of multidisciplinary working and supporting more person-centred planning and delivery of services. Page 162 of 264
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20 Despite progress, services continue to operate within a challenging environment; increasing demand, workforce pressures and the complexity of need impact directly on access and waiting times. Whilst improvements were realised in key services during the year, further work is required to ensure consistent and timely access for all who require support. The Partnership will continue to build on progress made during 2025/26, focusing on further service redesign, strengthening early intervention and improving access to support, in order to enhance quality of life for people who use health and social care services. National Health and Wellbeing Outcome 5 Health and Social Care Services contribute to reducing health inequalities Reducing health inequalities remained a priority across 2025/26, recognising the significant variation in health outcomes and access to services across different communities within North Lanarkshire. This has included a focus on targeted interventions, improving the accessibility of services and strengthening partnership working to ensure that we tailor care and support to the needs of local populations. A key aspect of this work has been improving access to preventative services for communities who are less likely to engage with routine healthcare. Targeted screening activity has focused on addressing barriers to access and improving awareness of services, particularly within communities where uptake has historically been lower. This has included collaborative work with community organisations and local groups to design and deliver easier access to services, ensuring that information and services are culturally appropriate and responsive to the needs of individuals. Our wider public health and community- based approaches support the reduction of health inequalities, including partnership activity aimed at addressing the broader determinants of health. This has included continued collaboration with local partners and the third sector to strengthen community resilience, improve access to support and ensure that individuals are able to engage with services at an early stage. Page 163 of 264
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21 Alongside prevention activity, the Partnership has continued to focus on ensuring equitable access to services across the system. This includes recognising the impact that demand pressures and capacity constraints can have on different population groups and taking steps to better understand and respond to variation in access and outcomes. Strengthening data and insight continues to be an important part of this approach, supporting more targeted and effective action to address inequalities. Despite progress, reducing health inequalities remains a long-term challenge, influenced by a range of social, economic and demographic factors. While targeted approaches during 2025/26 have supported improved engagement and access in some areas, further work is required to ensure that all individuals are able to access support and achieve positive health outcomes. The Partnership will continue to build on this work, focusing on strengthening targeted interventions, improving access to services and working with communities and partners to address the underlying causes of inequality. National Health and Wellbeing Outcome 6 People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing The Partnership continued to recognise the essential role that unpaid carers play in supporting individuals to live independently within their communities. Supporting carers to maintain their own health and wellbeing, and to access appropriate support, remains a key priority, particularly given the increasing complexity of need and the pressures experienced across the wider health and social care system. Work during the year has focused on strengthening support for carers and improving engagement with those who may not currently be accessing services. This includes activity to raise awareness of available support, improve identification of carers and ensure that individuals are able to access assistance at an earlier stage where required. Engagement activity, including development work linked to carers support, has provided opportunities to better understand carers’ Page 164 of 264
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22 experiences and identify areas for improvement in the delivery of services. A key theme emerging during the reporting period is the challenge of identifying and supporting “hidden carers”, particularly those who may not recognise themselves as carers or those who are not currently engaged with services. Addressing this requires strong partnership working across health, social care and community organisations, as well as improved communication and outreach to ensure that carers are aware of the support available to them. The Partnership has also continued to develop its approach to carers support in line with its strategic commitments, working with partners to strengthen the range of services and supports available locally. This includes ensuring that carers are able to access information, advice and practical support, alongside opportunities to influence service development and participate in shaping future provision. Demand for support continues to increase, highlighting the need for continued focus on improving reach and consistency of support. Ensuring that we support carers to maintain their own health and wellbeing will remain a key priority. Page 165 of 264
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23 National Health and Wellbeing Outcome 7 People using health and social care services are safe from harm The Partnership has continued to prioritise the safety of people who use services, recognising this as a fundamental aspect of high-quality health and social care. This has included maintaining robust safeguarding arrangements and strengthening quality assurance processes. A key component of this approach has been the ongoing development of assurance and quality frameworks, supporting oversight of service delivery and improvement activity. This includes continued monitoring of service performance, engagement with inspection and regulatory processes, and the use of audit and review activity to identify risks and areas for improvement. These arrangements support a structured approach to ensuring that services are safe, effective and responsive to the needs of individuals. The Partnership has also continued to strengthen its approach to organisational risk management during the year. Work has taken place to improve the identification, articulation and monitoring of risks. This includes a focus on aligning risk management across partner organisations, supporting a more consistent and integrated approach to risk. In addition, work has progressed to enhance resilience and business continuity arrangements, recognising the importance of maintaining safe services during periods of disruption or increased demand. This includes strengthening planning arrangements and ensuring that services are able to respond effectively to unforeseen events while maintaining continuity of care and support. Alongside these system-level developments, safeguarding activity continues across a range of services, supporting individuals who may be vulnerable or at risk of harm. This includes partnership working with other agencies to ensure appropriate protection arrangements are in place and that we support individuals to both maintain and enhance their safety and wellbeing. While robust arrangements are in place, the Partnership recognises that maintaining safety is an ongoing priority in the context of increasing demand and system pressures. A focus on strengthening assurance, improving risk management and ensuring that services remain safe, effective and responsive to the needs of the population will continue in 2026/27. Page 166 of 264
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24 National Health and Wellbeing Outcome 8 People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Throughout 2025/26, the Partnership has continued to recognise the central role of the workforce in delivering safe, effective and person-centred services. Supporting staff, developing skills and maintaining workforce capacity have remained key priorities throughout the year, particularly in the context of ongoing demand pressures and challenges in recruitment and retention across a number of service areas. A key focus has been strengthening workforce development and supporting staff to deliver high-quality care. This includes ongoing work to develop future workforce capacity through initiatives such as the Care Academy, supporting recruitment into social care roles and creating opportunities for training, development and career progression. These approaches aim to build a sustainable workforce pipeline while supporting individuals to develop the skills required for the evolving needs of the wider population. Alongside workforce development, the Partnership has continued to prioritise staff engagement and communication. During the reporting period, staff engagement roadshows and leadership visits took place across services, providing opportunities for staff to share experiences, highlight challenges and contribute to service improvement discussions. These activities have helped to strengthen links between strategic leadership and frontline services, ensuring that staff perspectives directly inform decision-making and improvement activity. Page 167 of 264
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25 The operating environment during 2025/26 has continued to present challenges for the workforce. Vacancy levels remain significant across some services, highlighting the importance of continued focus on workforce planning, wellbeing and support. Despite these challenges, staff across the Partnership have demonstrated ongoing commitment to delivering high-quality care and support. The contribution of the workforce has been central to the progress made across services during the year, including the delivery of improvements in access, service redesign and the continued provision of care within a demanding and changing environment. The Partnership remains committed to supporting the workforce, recognising that continued investment in staff, skills and organisational culture is essential to delivering sustainable services. Further work will focus on strengthening workforce planning, enhancing development opportunities and ensuring that we support our staff to deliver high-quality care in a challenging environment. National Health and Wellbeing Outcome 9 Resources are used effectively and efficiently in the provision of health and social care services Summary of Financial Performance (2025/26) The challenges experienced in 2023/24 and 2024/25 continued into 2025/26, with funding constraints, increasing demand and cost pressures remaining significant across health and social care services. While the Medium-Term Financial Plan identified a budget gap for the year and delivery of planned savings remained challenging, the Partnership continued to progress service transformation aligned to the Strategic Commissioning Plan and maintained strong financial control. Despite these ongoing pressures, the Partnership delivered a year-end underspend, which was inclusive of the planned use of reserves. The underspend in 2025/26 was delivered through: • flexible use of recurring and non-recurring funding, including targeted use of reserves • delivery of savings through service redesign and efficiency measures, although only partial achievement was realised • continued focus on workforce planning and vacancy management • progress in the Strategic Commissioning Plan programme of work and wider transformation activity • robust financial governance, monitoring and audit controls Page 168 of 264
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26 North Lanarkshire IJB delivers and commissions a wide range of integrated health and social care services. The funding for services is through delegated budgets from North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL), with overall resources heavily influenced by Scottish Government settlements. The total budget available to the IJB for 2025/26 was £908.422m, including additional Scottish Government allocations and adjustments made during the year. The table below provides a summary of the funding from each Partner over the last four financial years. The reported outturn position, prior to the removal of ring fenced and earmarked balances, is a £31.949m underspend. This includes the use of £4.686m reserves resulting in a net surplus on the provision of services of £27.263m. North Lanarkshire IJB Financial Outturn 2025/26 £m Underspend as at 31 March 2026 31.949 Use of Reserves In-Year (4.686) Surplus on Provision of Services Movement in Reserves 27.263 A significant proportion of this surplus relates to funding received for specific purposes where expenditure will occur in future financial years and therefore will be held as ring fenced, or earmarked balances. After adjusting for these balances, the IJB reports an underlying underspend of £3.742m. This comprises: • An underspend of £3.297m within services delegated to Health • An underspend of £0.445m within services delegated to Social Care Funding £m 2022/23 2023/24 2024/25 2025/26 North Lanarkshire Council (188.180) (201.591) (208.025) (220.876) NHS Lanarkshire (482.813) (544.843) (555.622) (609.179) Set Aside (66.858) (74.575) (75.143) (78.367) Total (737.851) (821.009) (838.790) (908.422) Annual (Increase) / Decrease £m 13.679 (83.158) (17.781) (69.632) Page 169 of 264
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27 Key Variances There are four key financial variances linked to the Partnership’s strategic ambitions: • Employee Costs – £3.688m underspend – The continued recruitment and retention challenges across services resulted in vacancies and reduced pay expenditure, partially offset by additional agency and overtime costs. Workforce pressures remain a key risk. • Hosted Services – £5.041m underspend – Overall underspend driven by areas such as Speech & Language Therapy, CAMHS and Psychological Therapies, partially offset by overspends in Adult Psychiatry, Learning Disability Services and Family Nurse Partnership. • Payments to Other Bodies – £2.623m overspend – Ongoing demand pressures within Care at Home and Independent Care Homes continue to exceed planned activity levels, reflecting increased complexity and volume of care packages. • Prescribing – £0.014m underspend – Following a significant overspend in 2024/25, the prescribing budget increased in 2025/26. The position stabilised in year, although underlying pressures remain due to rising volumes and unit costs. Reserves Position The year end position reflects a substantial transfer of funding to reserves to support future commitments and financial sustainability: • Opening reserves (1 April 2025): £75.554m • Surplus transferred to reserves: £27.263m • Closing reserves (31 March 2026): £102.817m These balances include ring fenced, earmarked and contingency reserves aligned to Scottish Government funding conditions, strategic priorities and risk mitigation, strengthening the Partnership’s financial resilience going forward. Overall Position Overall, the 2025/26 financial outturn demonstrates that the Partnership has maintained financial stability in a highly challenging environment. We achieved this through a combination of effective financial management, continued service transformation and the strategic use of reserves. However, significant risks remain, particularly in relation to: • sustained demand growth and increasing complexity of need • ongoing workforce pressures • affordability and deliverability of future savings Page 170 of 264
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28 • continued reliance on non-recurring measures These factors will continue to shape the Partnership’s financial strategy and reinforce the importance of transformation and medium to long term financial planning. Full details are available within the Unaudited Annual accounts, which are located within the 2025- 26 Key Documents Section of the website: About Us | Health and Social Care North Lanarkshire Care Inspectorate Grades 2025/26 Ensuring the delivery of safe, high-quality care remains a priority for the Partnership. Care Inspectorate inspections undertaken during 2025/26 demonstrate that the majority of regulated services across North Lanarkshire continue to achieve positive grades, reflecting ongoing improvement activity and a strong focus on quality and safety. The Partnership delivers a range of registered adult services, all of which are regulated by the Care Inspectorate and subject to ongoing scrutiny and inspection. During the reporting period, inspections were undertaken across a number of services, with five of the seven registered services achieving grades of Good (4) or Very Good (5), providing independent assurance of the quality of care and support being delivered. The Care Inspectorate assesses services against a range of quality indicators, awarding grades on a scale of Unsatisfactory (1) to Excellent (6). Airdrie and Motherwell Home Support Services are currently awaiting further inspection and continue to progress improvement plans aimed at strengthening performance and supporting better outcomes for people who use services. Care Homes As of 31 March 2026, there were 27 registered care homes operating within North Lanarkshire. Care Inspectorate inspection activity during the year demonstrated that the majority of services continued to achieve positive gradings across the key quality indicators, reflecting ongoing commitment to the delivery of safe, effective and person-centred care. Twenty-four care homes were assessed against the key question, How well do we support people's wellbeing? The majority achieved grades of Good or Very Good, with Summerlee House Care Home achieving an Excellent grading. This represents a positive improvement on the previous year and reflects the continued focus on quality improvement and resident wellbeing. Page 171 of 264
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29 Inspection findings also highlighted positive outcomes in relation to care planning and support arrangements. While some services continue to face challenges, providers are working closely with regulators, the Partnership and other stakeholders to deliver improvement activity and maintain high standards of care. Where concerns were identified during the year, appropriate quality assurance and regulatory processes were implemented to support improvement and safeguard residents. These arrangements included targeted oversight, improvement planning and, where necessary, temporary restrictions on admissions while services addressed identified issues. The Partnership will continue to work closely with care home providers and the Care Inspectorate to support continuous improvement, strengthen quality assurance arrangements and ensure people receive safe, high-quality care. Other services The Partnership continues to work closely with commissioned providers to ensure the delivery of safe, effective and person-centred care across a wide range of community-based services. During 2025/26, the Care Inspectorate carried out 53 inspections across services operating within the SDS framework. Inspection findings were generally positive, with most services achieving grades of Good or Very Good across the quality indicators assessed. Three services (Active Care and Support Services, Potential Living (VAMW), and Support for Ordinary Living (SOL)) achieved Excellent ratings, reflecting the high quality of support provided and a strong commitment to people's wellbeing. How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Excellent 1 0 0 1 0 Very Good 12 5 5 5 4 Good 9 5 9 15 8 Adequate 2 2 3 1 2 Not assessed 3 15 10 5 13 0246810121416 Care Inspectorate Grades -North Lanarkshire based Care Homes as at 31/03/2026 Page 172 of 264
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30 Quality assurance activity during the year identified areas where further improvement was required within a small number of services. Where concerns were identified, providers worked with the Care Inspectorate and quality assurance to implement improvement actions and strengthen service delivery. The Partnership continues to maintain active oversight of commissioned services through a combination of contract monitoring, quality assurance activity and partnership working with providers. This approach supports continuous improvement, promotes good practice and helps ensure that people receive safe, high-quality care and support. How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? How well do we support Children and Young People's Rights and Well-Being Excellent 3 0 4 0 0 0 Very Good 43 12 30 1 11 0 Good 22 21 25 1 21 0 Adequate 6 4 4 0 6 1 Weak 0 3 2 0 1 0 Not assessed 3 37 12 75 38 0 0 10 20 30 40 50 60 70 80 Care Inspectorate Grades - Self Directed Support including Care at Home as at 31/03/2026 Page 173 of 264
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31 Getting It Right for Everyone During 2025/26, the Partnership has continued to embed Getting It Right for Everyone as the organising framework for how services are designed, delivered and improved across North Lanarkshire. This approach builds on our local learning and learning from our participation in the national GIRFE pathfinder activity, providing a consistent, person-centred and whole-system model for health and social care delivery. Getting It Right for Everyone helps people to receive the right support, from the right person, at the right time. It brings services together around the individual, ensuring support is coordinated, responsive and focused on achieving positive outcomes for the people that we support. Underpinning our approach is a shared set of values and principles, including “Home First”; the assumption that we should support people in their own home wherever possible, a focus on prevention, empowering people, working as one system and a commitment to no waits, which shapes how our services operate in practice. The Partnership has continued to strengthen its operating model by moving away from fragmented and reactive approaches towards a more coordinated and enabling system. The previous ways of working, which following analysis we found were characterised by multiple handoffs, duplication and inconsistent pathways, are being replaced by a model that emphasises one assessment, a lead person approach and reduced duplication of work with individuals and families. This shift reflects a deliberate move to operate to principles and values rather than rules, supporting professional judgement, strengthening relationships and ensuring that decision-making is closer to people and communities An Enabling Approach A central element of this work has been the development of an enabling approach, empowering localities and multi-disciplinary teams to work together as one system to meet the needs of their populations. Across localities, this has supported improved coordination of care through multidisciplinary team working, clearer pathways identified through the introduction of journey mapping and ensuring that there is “no wrong door” to accessing our services, a reduction in unnecessary handoffs and duplication, and an increased use of community and preventative supports. The introduction of a lead person approach has further strengthened continuity of care, ensuring that individuals experience a more coordinated response and do not need to repeat their story across services. Page 174 of 264
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32 Technology and digital approaches have also been utilised to support independence and improve access to services, while community connectors and health improvement links have strengthened the Partnership’s ability to address health inequalities and promote wellbeing at a local level. Progress during 2025/26 reflects the early stages of a longer-term, whole-system transformation programme. Looking ahead, the expected impact of this approach includes improved targeting of resources toward those most in need, greater use of advice, guidance and community support for individuals with lower-level needs, enhanced support for carers and improved participation and choice in how people’s needs are met. In the longer term, this will support a more streamlined system, with fewer repeat contacts and onward referrals, and a stronger focus on prevention and early intervention. The Partnership expects this to result in quicker and more effective responses for people, with a greater emphasis on helping individuals to help themselves. Our new Strategic Commissioning Plan Building on this progress, the Partnership will continue to deliver its new Strategic Commissioning Plan through a set of refreshed strategic priorities. These priorities provide the focus for the next phase of transformation and align directly with the Getting It Right for Everyone and Enabling Approach. The Partnership’s focus will be on: • Prevention – Continuing the shift from crisis response to early intervention and anticipatory care, supporting people at an earlier stage and reducing the need for more intensive services. • Tackling Inequalities – Targeting resources and interventions toward communities with the greatest need, improving access to services and reducing variation in outcomes. • Stronger Places and Communities – Developing locality-based approaches, strengthening community capacity and working with the third sector to deliver place-based support. • Enabling Healthy Living – Supporting whole-person wellbeing through coordinated approaches to physical health, mental health, substance use and social connection. • Equitable Access – Improving how people access services by simplifying pathways, reducing barriers and improving coordination across the system. Delivering on these priorities will require a continued focus on whole-system working, effective use of resources and sustained cultural change across the Partnership. Senior leadership, practitioners, partners and communities all have a critical role in ensuring that we embed the principles of Getting It Right for Everyone in all of our day-to-day practice. The Partnership recognises that this represents a significant and ongoing transformation. However, the progress made during 2025/26 provides a strong foundation for the next phase of delivery, supporting a system that is more responsive, more integrated and better able to meet the needs of people and communities across North Lanarkshire. Page 175 of 264
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33 Appendices Appendix 1 – Summary of Performance against Core Suite of Integration Indicators Scottish Health and Care Experience Survey North Lanarkshire Indicator Title 2017/18 2019/20 2021/22 2023/24 2025/26 NI -1 Percentage of adults able to look after their health very well or quite well 90.3% 90.5% 87.5% 87.4% 87.7% NI - 2 Percentage of adults supported at home who agreed that they are supported to live as independently as possible 75.4% 77.6% 79.8% 67.7% 67.1% NI - 3 Percentage of adults supported at home who agreed that they had a say in how their help, care, or support was provided 71.4% 71.2% 67.1% 57.1% 56.1% NI - 4 Percentage of adults supported at home who agreed that their health and social care services seemed to be well co-ordinated 69.7% 70.2% 66.6% 56.0% 56.7% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 75.4% 77.8% 74.0% 65.8% 61.9% NI - 6 Percentage of people with positive experience of care at their GP practice 75.5% 68.3% 51.8% 52.8% 56.9% NI - 7 Percentage of adults supported at home who agree that their services and support had an impact on improving or maintaining their quality of life 75.6% 75.7% 77.0% 67.7% 65.3% NI - 8 Percentage of carers who feel supported to continue in their caring role 33.2% 32.6% 25.1% 28.5% 33.6% NI - 9 Percentage of adults supported at home who agreed they felt safe 79.9% 80.0% 79.8% 68.4% 64.5% Page 176 of 264
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34 Indicator Title 2020/21 2021/22 2022/23 2023/24 2024/25 NI -11 Premature mortality rate per 100,000 persons 578 575 507 541 543 Indicator Title 2021/22 2022/23 2023/24 2024/25 2025 NI – 12 Emergency admission rate (per 100,000 population) 15071 15037 14547 12427 12488 NI – 13 Emergency bed day rate (per 100,000 population) 124446 131187 128433 121258 116005 NI – 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 115 117 114 114 114 NI – 15 Proportion of last 6 months of life spent at home or in a community setting 89.8% 89.0% 88.8% 88.8% 88.8% NI – 16 Falls rate per 1,000 population aged 65+ 20.6 19.8 20.7 21.9 22.9 Indicator Title 2021/22 2022/23 2023/24 2024/25 2025/26 NI – 17 Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections 78.1% 77.0% 75.8% 77.5% 87.6% Indicator Title 2020/21 2021/22 2022/23 2023/24 2024/25 NI – 18 Percentage of adults with intensive care needs receiving care at home 75.1% 75.0% 71.5% 69.7% 65.6% Indicator Title 2021/22 2022/23 2023/24 2024/25 2025/26 NI – 19 Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) 831 950 927 783 854 Page 177 of 264
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35 Appendix 2 – HSCP Performance Dashboard KPI Target 2025-26 2024/25 Q4 2025/26 Q1 2025/26 Q2 2025/26 Q3 2025/26 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year Current Performance Alcohol Brief Interventions North 3047 501 482 508 453 556 Alcohol Brief Interventions (all settings) NHSL 7381 1470 1518 1601 1474 1475 % breastfeeding attrition rate (% of mums who ever breastfed but stopped by 6-8 wk review) 46.6% 31.7% 35.1% 34.9% Quarterly/ 2 quarters behind Quarterly/ 2 quarters behind ... Cervical Screening 80% 69.6% 69.7% 69.9% 69.8% 70.4% Immunisations – %s of 2 year olds 95% 94.8% 94.8% 94.4% 94.3% 94.4% Immunisations – %s of 5 year olds 95% 88.7% 89.6% 89.5% 90.5% 90.2% Addictions – Completed Waits 90% 99.3% 98.7% 99.5% 96.7% 93.5% Addictions – Ongoing Waits 90% 98.2% 97.9% 99.5% 92.1% 100% Page 178 of 264
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36 Percentage of people who have completed 6-8 week review 90% 84.4% 81.0% 85.6% Quarterly/ 2 quarters behind Quarterly/ 2 quarters behind ... ... Delayed discharge bed days - standard delays 31,796 27,160 5,432 13,232 20,461 26,683 A&E Attendances - NL Residents 116,456 28,896 30,588 30,616 28,742 Quarterly/ 1 quarter behind … Emergency Admissions - NL Residents 44,001 11,583 11,750 11,919 Quarterly/ 2 quarters behind Quarterly/ 2 quarters behind … Unscheduled Bed Days - all specialties, NL residents 294,999 83,412 82,077 83,549 Quarterly/ 2 quarters behind Quarterly/ 2 quarters behind … Inpatient Activity – Readmissions 7 days 8 6.49 6.22 6.40 7.06 5.66 Inpatient Activity – Readmissions 28 days ... 14.09 14.11 14.16 14.82 13.26 ... Percentage of patients waiting less than 12 months to begin PDS (waiting less than 12 months/total number waiting) 70% 83.5% 80.4% 85.3% 89.2% 95.5% Page 179 of 264
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37 Mental Health - bed occupancy rate ... 94.0% 90.6% 95.3% 97.2% 95.9% ... Assistive Technology - Number Of People With Technology (0-17 yrs) 1,452 33 22 22 25 28 Assistive Technology - Number Of People With Technology (18-64yrs) 622 270 303 298 321 Assistive Technology - Number Of People With Technology (65+) 912 673 745 727 734 Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 1788 317 604 940 1157 Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 63.0% 62.4% 60.4% 66.9% 66.9% Reablement - % Of People With No or 70% 62.5% 65.3% 56.8% 51.2% 47.3% Page 180 of 264
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38 Reduced Home Support Service Required At End Of Process HAT – % Of People where HAT service ends within 1/2 days from Assessment to service completion ... 7.0% 8.8% 10.0% 8.2% 14.0% ... HAT – % Of People with no further service required on completion of HAT ... 55.2% 61.7% 71.6% 72.6% 70.8% ... IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 73.4% 72.7% 79.2% 80.7% 81.9% 18 Week RTT Performance – CAMHS NHSL (NORTH HOSTED) 90% 93.5% 96.5% 94.6% 96.3% 98.2% 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 75.0% 75.6% 83.9% 81.2% 82.5% Consultant Outpatient WT - 90%* 21.8% 20.8% 19.4% 18.4% 19.5% Page 181 of 264
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39 Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90%* 66.2% 71.5% 73.7% 75.4% 83.8% Consultant Outpatient WT - Learning Disability - 12wks (NHSL) (NORTH HOSTED) 90%* 100% 100% 100.0% 75% 100% Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90%* 80.3% 76.0% 71.1% 77.2% 76.4% Admission to MH Wards: Proportion NHSL Patients >=95% 98.5% 99.1% 99.1% 98.4% 99.3% MSK Podiatry - 12wks (NORTH HOSTED) 90%* 100% 98.3% 99.7% 98.0% 100% Podiatry - 12wks (NORTH HOSTED) 90%* 100% 100% 99.6% 100% 100% Podiatry - domiciliary visits - 90%* 100% 100% 100.0% 100% 100% Page 182 of 264
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40 12wks (NORTH HOSTED) SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 17.6% 42.7% 79.9% 87.8% 91.9% SLT - Adult - 12wks (NORTH HOSTED) 90%* 79.2% 82.8% 83.5% 94.1% 91.9% Dietetics - 12wks (NORTH HOSTED) 90%* 62.5% 69.8% 78.9% 91.1% 78.6% Complaints Processed 20 Working Days(NHSL) 50% 37% 31% 26% 37% 20% Complaints Processed Within Timescale (NLC) 85% 60.0% (Stage 1) 76.9% (Stage 2) 92.1% (Stage 1) 76.5% (Stage 2) 78.8% (Stage 1) 92.9% (Stage 2) 86.8% (Stage 1) 100.0% (Stage 2) 77.1% (Stage 1) 94.1% (Stage 2) ... ... Care Home Placements At End Of Quarter - Per 1000 Popn 65+ 24 21.9 22.1 22.3 22.2 21.9 Care Home Placements At End Of Quarter - Per 1000 Popn 75+ 50 45.4 46.1 46.6 46.1 45.5 Care Home - Average Length of Stay 865 776.0 735 881 978 782 Page 183 of 264
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41 Number Of People With Self Directed Support 1,000 2214.0 2193 2272 2227 2268 Number Of People With A Direct Payment 240 395.0 356 368 367 378 Sustain and embed successful smoking quits, at 12 weeks post quit, in 40% of SIMD areas. Cumulative. (AOP) (NORTH HOSTED) 545 239 68 154 Quarterly/ 2 quarters behind Quarterly/ 2 quarters behind ... For Referrals in Period, Proportion Completing Duty to Inquire With Investigatory Powers From Referral Within Timescale 60% 86.2% 88.1% 91.7% ... For Referrals in Period, Proportion Going to Case Conference From DTI With Investigatory Powers Within Timescale 60% 28.6% 22.2% 20.0% ... Page 184 of 264
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42 Proportion of Adult Welfare Concerns in Period with No Further Action 50% 86.2% 91.2% 90.1% ... TURAS compliance (NHSL, North) >80% 71% 79% 75% 74% 75% Breakeven Position - YTD Variance Including Prescribing (NHSL) >=0 £4.534M underspend (Q4 is the year end position) £0.248m underspend £0.375 underspend £0.420 Underspend £3.297m Underspend ... ... ... Breakeven Position - YTD Variance Excluding Prescribing (NHSL) >=0 9.291M underspend (Q4 is the year end position) £0.248m underspend £0.375 underspend £0.413 Underspend £3.283m Underspend ... ... ... Prescribing Savings Target 4.326M £1.746m saving achieved £1.068m achieved to date £2.092m achieved to date £2.816m achieved to date £4.341 achieved ... ... ... Breakeven Position - Projected Outturn (NLC) >=0 £6.181m underspend -£5.939m overspend £4.406m overspend £2.645 overspend £0.445 underspend ... ... ... Sickness Absence (NHSL, North) 4% 7.45% 7.09% 7.05% 7.75% 7.13% Sickness Absence (NLC) - days lost per person 9.22 12.92 3.35 8.15 12.99 17.92 Page 185 of 264
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43 Glossary of Terms ADP The Alcohol and Drug Partnership (ADP) is responsible for commissioning and developing local strategies for tackling problem alcohol and drug use and promoting recovery based on an assessment of local needs. Adult Protection Committee The Adult Protection Committee is a multi-agency committee which monitors and reviews what is happening locally to safeguard adults. It is made up of senior staff from many of the agencies involved in protecting adults who may be at risk. Adult Support & Protection (ASP) Adult Support and Protection relates to the protection of adults at risk of harm and the measures and duties within the Adult Support and Protection (Scotland) Act 2007. Annual Performance Reports Section 42 of Public Bodies (Joint Working) (Scotland) Act 2014 requires that each Integration Authority prepare an Annual Performance Report. The purpose of the report is to provide an overview of performance in planning and carrying out integrated functions and is produced for the benefit of Partnerships and their communities. More detail is available in guidance on the Scottish Government website, while required content is set out in The Public Bodies (Joint Working)(Content of Performance Reports)(Scotland) Regulations 2014. CAMHS The NHS Lanarkshire Child & Adolescent Mental Health Service (CAMHS) is a specialist service for infants, children and young people. Delayed Discharge A delayed discharge occurs when a patient is ready to leave a hospital or similar care provider but is still occupying a bed. Emergency Admission An emergency admission is one where a patient is admitted to hospital urgently and unexpectedly (i.e. the admission is unplanned). Health & Care Experience Survey The Health and Care Experience Survey is a national survey which asks about people’s experiences of accessing and using their GP practice and Out of Hours services • aspects of care and support provided by local authorities and other organisations • caring responsibilities and related support Health and Wellbeing Outcomes There are nine health and wellbeing outcomes which apply to integrated health and social care services and ensure that Health Boards, Local Authorities and Integration Authorities are clear about their shared priorities by bringing together responsibility and accountability for their delivery. More detail is available in the National Health and Wellbeing Outcomes Framework. Integration Authority Integration Authorities are responsible for planning, designing and commissioning health and social care services in an integrated way from a single budget in order to take a joined up approach, more easily shifting resources to best meet need. This term broadly means the person or body which is responsible for the planning and direction of integrated health and social care services. However, the terms ‘Health Page 186 of 264
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44 and Social Care Partnership’ or simply ‘Partnership’ are in more common usage. Integration Joint Board (IJB) Health Boards and Local Authorities delegate a significant number of functions and resource to the Integration Joint Board, which is responsible for the planning of integrated arrangements and onward service delivery. Measuring Performance Under Integration (MPUI) A small set of indicators was developed as a way of measuring performance of Health & Social Care Partnerships. Ministerial Strategic Group for Health and Community Care (MSG) A key strategic decision taking group in relation to transformational change in health and community care in Scotland. The group is chaired by the Cabinet Secretary for Health and Sport and the COSLA Spokesperson for Health and Social Care. National Core Integration Indicators A core suite of indicators that Integration Authorities use to measure progress towards the National Health and Wellbeing Outcomes. National Health & Wellbeing Outcomes There are nine national health and wellbeing outcomes which apply to integrated health and social care. Health Boards, Local Authorities and Integration Authorities work together to ensure that these outcomes are meaningful to people in their area. Unscheduled Bed Day A bed-day is a day during which a person stays overnight in a hospital. An unscheduled bed day is where the patient’s admission was unplanned. Page 187 of 264
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1 REPORT Item No: 12 SUBJECT: Reintegration of Community Mental Health Team Nursing Service TO: North Lanarkshire Integration Joint Board Lead Officer for Report: Claire Rae, Chief Officer, UHSCNL Author(s) of Report Pauline Izat, Interim Head of Health, UHSCNL DATE: 16 September 2026 1. PURPOSE OF REPORT The purpose of this report is to seek approval to reintegrate the operational management responsibility for CMHT (Community Mental Health Team) nursing services currently delegated to South Lanarkshire University Health and Social Care Partnership (SL UHSCP) back to North Lanarkshire University Health and Social Care Partnership (UHSCNL), aligning operational management and accountability with the clinical governance, professional leadership and system assurance arrangements that already sit within UHSCNL. The proposal is proportionate, low-disruption and does not involve any change to service delivery models or workforce terms and conditions. Medical staff within South Lanarkshire CMHT’s are already managed and professionally governed by the Mental Health, Learning Disability and Addictions Unit (MHLDA) unit hosted within UHSCNL. This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Approved by South Lanarkshire Integration Joint Board Item 11 Page 189 of 264
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2 Prepared By: ☐ Reviewed By: ☐ Endorsed By: ☐ 3.RECOMMENDATIONS 3.1. The Integration Joint Board is asked to approve the following recommendations: - (1) that the content of the report be noted; and (2) that the Integration Joint Board (IJB) approve the proposal to reintegrate the operational management of the CMHT nursing services currently delegated to SL UHSCP back to UHSCNL, thereby aligning operational responsibility with the existing clinical governance and professional leadership arrangements that are already in place. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 CMHT’s in both HSCP’s are embedded within locality management structures. In North Lanarkshire, CMHT accountability was absorbed within existing locality service manager portfolios. In South Lanarkshire, due to fewer localities and broader service manager portfolios, this was not considered safe or sustainable. A dedicated CMHT Service Manager post was established in South Lanarkshire. This post reports to Hamilton Locality Manager without a substantive funding solution. South Lanarkshire previously funded a temporary General Manager. This post supported previous transition of services to South Lanarkshire Health and Social Care Partnership and provided an interface with MHLDA Unit hosted in North Lanarkshire Health and Social Care Partnership. Whilst this role added value, it was not sustainable in long term and came to a natural end with retirement of the post holder. Since then, CMHT’s within South Lanarkshire have been operating in a system of dual and divergent governance routes – locality based operational management (SL) and system level clinical governance (NL). 5.2 Adult and Older People’s Mental Health Services in NHS Lanarkshire operate as a single clinical system hosted by UHSCNL, which holds responsibility for clinical governance, professional leadership and system assurance. Inpatient services, medical staff, psychology, administration and professional governance are managed within North Lanarkshire Health and Social Care structure while CMHT’s are geographically aligned to localities across North and South Lanarkshire. Yes ☐ No ☒ N/A ☐ Page 190 of 264
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3 5.3 Children and Young People Mental Health Services (CAMHS) in Lanarkshire are provided on a pan Lanarkshire basis and are hosted within the Specialist Children’s Services Unit within North Lanarkshire. Professional assurance accountabilities are aligned to MHLDA professional leadership structure aligned with MHLDA unit. 5.4 In 2019, following approval by both Integration Joint Boards (IJBs), operational management responsibility for the nursing component of CMHTs in South Lanarkshire was delegated to South Lanarkshire Health and Social Care Partnership, alongside transfer of the associated nursing budget. Governance arrangements, however, remained with North Lanarkshire and no management resource transferred. The decision was underpinned by positive intent: to strengthen locality-based delivery and improve responsiveness to local need. These principles remain valid and continue to be reflected in effective day-to-day collaborative working. 6. CONCLUSIONS 6.1. After six years of operation, there has been sufficient opportunity to reflect on the impact of these arrangements. Local experience indicates that while frontline service delivery has remained stable, the separation of operational management from system- wide mental health clinical governance has introduced unintended complexity. This has resulted in fragmented oversight, duplicated assurance processes and constrained decision-making, particularly in relation to service change, workforce configuration and resource deployment. National scrutiny has increasingly emphasised the importance of clear leadership, simplified governance and single-system accountability for mental health services. Audit Scotland and the Scottish Government’s Mental Health Scrutiny and Assurance Evidence Review both highlight that unclear or fragmented lines of responsibility weaken system assurance and learning. Against this backdrop, it is appropriate to revisit the current arrangements to ensure they remain fit for purpose. 6.2. Reintegration at this point strengthens patient safety by aligning operational management with existing mental health clinical governance structures, reducing avoidable system risk without altering service delivery models or undermining staff contribution. Clinical governance responsibility already rests with UHSCNL. This proposal therefore focuses on aligning operational management and line accountability with those established governance arrangements. 6.3. The proposal also addresses an existing asymmetry in professional governance. Psychiatric Consultant and aligned medical support input to South Lanarkshire CMHT’s is already managed and clinically governed within UHSCNL. Bringing CMHT nursing services under the same operational management framework restores a more coherent, multidisciplinary model of clinical leadership and accountability. This approach is consistent with the direction of travel set out through national mental health scrutiny and assurance arrangements, including those led by Healthcare Improvement Scotland and the Mental Welfare Commission. Page 191 of 264
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4 6.4. From a workforce perspective, the proposal supports staff by establishing clear, consistent and aligned management arrangements across NHS Lanarkshire’s Adult and Older People’s Mental Health Services. Aligning South Lanarkshire CMHT arrangements with those operating in North Lanarkshire improves clarity of leadership, professional accountability and escalation routes, and reduces unnecessary complexity for staff working across the wider mental health system. 6.5. The proposal is explicitly driven by the need to strengthen patient safety through better alignment of operational management with existing clinical governance arrangements. By restoring single-system operational accountability for CMHT nursing services, the proposal supports clearer oversight of quality, risk management and organisational learning. No change is proposed to service access, pathways or models of care. This is inclusive of the Service Manager who will continue to be provided with a working base within South Lanarkshire that is capable of maintaining appropriate level of managerial visibility and ease of staff access. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The principal risks associated with the current arrangements relate to fragmented operational accountability alongside system-wide clinical governance, including delayed escalation of cross-system issues, duplicated assurance routes and constrained decision-making in relation to workforce configuration and service Page 192 of 264
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5 change. Reintegration mitigates these risks by aligning operational management with established mental health governance structures, while maintaining locality-based delivery and partnership working. If the proposed reintegration is accepted an implementation meeting and plan will be completed by the current General Manager (South Lanarkshire), Service Manager for Mental Health and the General Manager for Mental Health, Learning Disability and Addictions. The implementation plan will then be shared via the appropriate governance routes. 7.3 FINANCIAL There are no additional financial pressures arising from this proposal. This represents a budget transfer aligned to the current establishment and service delivery model, with no deficit impact for either partnership. Existing CMHT nursing budgets will revert to UHSCNL control. The current 50% contribution from SL UHSCP towards the CMHT Service Manager post will continue unchanged, reflecting the Lanarkshire-wide benefit of the role. Monies have been identified within mental health budget that will cover remainder of cost. This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner N/A Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved Yes ☒ No ☐ N/A ☐ Page 193 of 264
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6 ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: This proposal does not introduce a new policy, function or strategy, or recommend a change to an existing policy, function or strategy and, therefore, no impact assessments are required. 8. BACKGROUND PAPERS Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒ Page 194 of 264
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7 None 9. APPENDICES Please include a glossary of terms if not already included. None CHIEF ACCOUNTABLE OFFICER - Claire Rae, Chief Officer, UHSCNL Members seeking further information about any aspect of this report, please contact the following; Pauline Izat, Interim Head of Health, University Health and Social Care, North Lanarkshire Pauline.Izat@lanarkshire.scot.nhs.uk Page 195 of 264
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8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed Page 196 of 264
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1 REPORT Item No: 13 SUBJECT: Equality Outcomes 2026-2030 TO: Integration Joint Board Lead Officer for Report: Head of Planning, Performance & Quality Assurance Author(s) of Report Senior Manager, Strategy & Performance DATE: 15 September 2026 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Senior Manager, Strategy & Performance ☒ Reviewed By: Head of Planning, Performance & Quality Assurance ☒ Endorsed By: ☐ 3. RECOMMENDATIONS It is recommended that the Integration Joint Board: (1) Approve the Equality Outcomes for University Health and Social Care North Lanarkshire for the period 2026-2030. 4. VARIATIONS TO DIRECTIONS? Item 12 Page 199 of 264
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2 5. SUMMARY 5.1 This report presents University Health and Social Care North Lanarkshire’s Equality Outcomes for the period 2026-2030 for consideration and approval, prior to being published on the University Health and Social Care North Lanarkshire website. 5.2 The report presents a finalised version of the Equality Outcomes which are required to enable the Board to meet its statutory duties under the Public Sector Equality Duty (PSED), and which are informed by evidence, monitoring data and engagement activity, to guide future equality-related work. 5.3 The report demonstrates how the Equality Outcomes provide evidence of the Partnership’s progress in meeting its statutory equality duties and reducing inequalities in access to, experience of, and outcomes from health and social care services. 6 BACKGROUND 6.1 The PSED, established by section 149 of the Equality Act 2010, requires the Integration Joint Board, as a listed authority in Scotland, to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations between people who share protected characteristics and those who do not. In addition, the IJB is subject to the Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012, which require public authorities to publish Equality Outcomes every four years. Integration Joint Boards were added to the list of Scottish public authorities subject to both the general and specific equality duties in June 2015. 6.2 Under the PSED, University Health and Social Care North Lanarkshire have a responsibility to embed equality, diversity and inclusion across its governance, planning and service delivery. Equality performance and improvement activity are guided by a set of Equality Outcomes, developed and monitored on a four year cycle to ensure a strategic and evidence-based approach to addressing inequalities and improving outcomes for protected groups. 7. REPORT 7.1 In March 2026, an Equality Outcomes Progress Report was presented to the Board. This report evidenced progress made to achieving identified Equality Outcomes for the period 2022-2026. These Equality Outcomes focused on reducing inequality, improving accessibility and independence, strengthening engagement with seldom Yes ☐ No ☒ N/A ☐ Page 200 of 264
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3 heard groups, supporting a sustainable independent sector, and expanding technology enabled care. The report highlighted the progress made through targeted action to improve access, reduce barriers, and respond to local needs. 7.2 A new set of Equality Outcomes for 2026–2030 was also presented to the Board in draft in March, having been developed following analysis of a range of evidence sources. These include population needs and inequality data for North Lanarkshire, national and local research and policy priorities, and evidence of inequality across communities. This analysis included consideration of key areas such as suicide prevention and mental health, carers’ rights and recognition, domestic abuse and male violence against women and girls, and the needs of Black and ethnic minority communities. The development of the outcomes has also been informed by relevant external frameworks and recommendations, including the Equality and Human Rights Commission’s A Fairer Scotland report and the Council of Europe’s Group of Experts on Action against Violence against Women and Domestic Violence (GREVIO) findings. All Protected Characteristics under the Equality Act 2010, have been considered in ensuring the Equality Outcomes contribute to advancing equality and reducing inequalities in health and social care. 7.3 Since March 2026 further consultation and engagement with staff and partner organisations has taken place with the draft outcomes also shared with equalities groups in North Lanarkshire. A final version of the Equality Outcomes 2026-2030 is now presented to the Board, as detailed below. 7.4 Outcome 1 – Choice and Control in Social Care People across North Lanarkshire have choice and control in how their social care is arranged, particularly older people and disabled people. Outcome 2 – Suicide Prevention Suicide rates across North Lanarkshire are reduced, including for boys and men Outcome 3 – Culturally Sensitive Services The delivery of Health and Social Care services, including personal care and mental health services, is culturally sensitive and recognises the needs of North Lanarkshire’s Black and ethnic minority and faith based communities. Outcome 4 – Gender Sensitive approach to Domestic Abuse Mental Health and Addiction Services recognise the need for a gender sensitive, sex based approach to domestic abuse, ensuring services appropriately support women in North Lanarkshire and contribute to improved safety and recovery. Outcome 5 – Equitable Support for Carers Carers across North Lanarkshire experience equitable access to health and social care support, are recognised as equal partners in care, and do not face disadvantage or discrimination because of their caring role. This includes: Adult carers Young carers and parent carers Lesbian, Gay and Bisexual carers Carers with the protected characteristic of Gender Reassignment Page 201 of 264
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4 7.5 The Equality Outcomes for 2026-2030 have been developed to build on the achievements and learning arising from the 2022-2026 Outcomes, moving from broad pandemic recovery and engagement activity towards targeted, person-centred approaches that address persistent inequalities. 7.6 Evidence gathered has informed a focused outcome to reduce suicide rates, particularly among boys and men. Learning from service redesign and delivery during and after the pandemic also reinforced the importance of choice, control and independence for older and disabled people, leading to an outcome that aims to ensure people are empowered in how their social care is arranged. Feedback from engagement with seldom-heard communities, including in the North Lanarkshire Council funded ‘Our Lives’ research, identified continuing inequalities in access to and experience of services. These are reflected in outcomes focused on culturally sensitive health and social care services for Black and Minority Ethnic communities and a sex-based approach within mental health and addiction services to improve support, safety and recovery for women subject to male violence. In addition, the recognised contribution of the independent and third sector, together with the importance of partnership working and support networks, has informed a new outcome focused on ensuring carers experience equitable access to support, are recognised as equal partners in care, and do not face disadvantage or discrimination. 7.7 Collectively, the 2026-2030 Equality Outcomes represent a progression towards embedding equality, inclusion and human rights within service design and delivery, with a stronger focus on addressing identified inequalities and improving outcomes for those most at risk of disadvantage. 8. IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ Page 202 of 264
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5 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL This paper has been reviewed by Finance: 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Consultation on the draft equality outcomes commenced with involvement of the Strategic Planning Group. The approval of the draft outcomes will allow further engagement to take place with key stakeholders. ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of Yes ☐ No ☐ N/A ☒ Page 203 of 264
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6 expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 10. BACKGROUND PAPERS None. 11. APPENDICES HEAD OF PLANNING, PERFORMANCE & QUALITY ASSURANCE Members seeking further information about any aspect of this report, please contact the following; Graeme Cowan, Senior Manage – Strategy & Performance CowanG@northlan.gov.uk Yes ☐ No ☒ N/A ☐ Yes / Date added ☐ No ☒ N/A ☐ Page 204 of 264
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1 REPORT Item No: 14 SUBJECT: Obesity Pathway Innovation Programme – Quarter 1 Update TO: Integrated Joint Board Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Jonathan Cavana, Head of Transformation & Change - Weight Management Service DATE: 16 September 2026 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Jonathan Cavana, Head of Transformation & Change, Weight Management Service 3. EXECUTIVE SUMMARY The Obesity Pathway Innovation Programme (OPIP) continues to deliver against the agreed timelines following approval of its Stage 2 Work Plan by Innovate UK. Programme governance, risk management, evaluation, benefits realisation and stakeholder engagement arrangements are now established, providing a strong foundation for delivery. Recruitment is progressing well, with programme management posts filled and additional Dietetic, Pharmacist and administrative staff being recruited to expand clinical capacity. Academic partnerships with the University of Strathclyde and University of Glasgow are being established to support evaluation, alongside the appointment of a dedicated Research Fellow in September. Item 13 Page 205 of 264
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2 A key milestone will be the launch of a new virtual weight management and anti- obesity medication pathway in September. The pathway will improve access to treatment for people with significant cardiometabolic disease while increasing service capacity. The OPIP Digital Platform remains the programme's central transformational component. It will provide an integrated digital ecosystem supporting referral, assessment, treatment, self-management, remote monitoring and population health management across the Lanarkshire Weight Management Service (LWMS). The platform is designed to improve access, increase efficiency, support anti-obesity medication delivery, reduce inequalities and create sustainable models of care. Quarter 1 has seen significant progress in digital infrastructure development, including agreements to utilise Public Services Delivery Scotland hosting, the national OpenEHR Clinical Data Repository and the Seer 2 analytics platform. The approach has received Scottish Government endorsement and is attracting national interest as a reusable digital capability for future health and care programmes. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB: (1) Note the contents of the report (2) Support the ambitions of the OPIP delivery plan in transforming weight management service provision (3) Support the long-term sustainability plan though partnership engagement and scale and adoption of reusable system capabilities within other services. 5. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 6. BACKGROUND UHSCNL, on behalf of NHSL has been granted an OPIP funding award of £7,547,605 for a 3-year obesity R&D and innovation project. This programme will run from May 2026 until March 2029 and will focus on delivering sustainable transformational change, by increasing capacity and offering new self-management approaches and new prevention & treatment models of care within the clinical, community and digital care pathways offered by the Lanarkshire Weight Management Service (LWMS). Yes ☐ No ☒ N/A ☐ Page 206 of 264
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3 7. SUMMARY OF KEY ISSUES The OPIP Stage 2 Work Plan has been accepted by Innovate UK and includes detailed information on milestones & deliverables mapped against costed work packages and stage gates, critical dependencies identified across governance, platform planning, evaluation & partner engagement, a risk matrix, benefits realisation plan, communications & stakeholder engagement plans and a subcontractor management plan. The OPIP Board has been established, co-chaired by Josephine Pravinkumar and Clarie Rae, this group will have representation from senior Medical, Pharmacy, eHealth & Finance and will meet throughout the duration of the programme. Initial management and co-ordination staff recruitment is complete and recruitment of Dietitians, Pharmacists and A&C staff to increase care clinical pathway and obesity medication prescription capacity is underway. Additional project specific staff will be recruited later in the programme of work. The Monitoring & Evaluation Framework theory based local model is being developed and initial commissioning of academic partners, University of Strathclyde and University of Glasgow, is underway with a full-time OPIP Research Fellow starting in September. An industry research partner will also be commissioned in year 1. Agreement has been reached in principle to use the West of Scotland Data Safe Haven to support data transfer for OPIP research, as a test case for future NHSL research projects. In addition, initial conversations have taken place with the Innovate UK appointed external evaluation partner, the National Institute for Health & Care Research Rapid Service Evaluation Team (REVAL) at the University of Manchester. The OPIP approach consists of a new Virtual Care Pathway (VCP), expansion of the Prevent programme, a package of 12 innovation projects designed to address long- term issues & rate limiting factors within the LWMS and a central digital platform that will support all aspects of delivery of the LWMS. A new clinical weight management & obesity medication care pathway will be initiated in September. This new model within the LWMS is a VCP, built on a shared care model that distributes treatment between Primary Care, Secondary Care and community, clinical, commissioned & digital elements of the LWMS, co-ordinated from a central hub. It focuses on Secondary Care Cardiometabolic referrals from specialties including cardiology, hepatology, nephrology, respiratory medicine, endocrinology and obesity services. Patient prioritisation includes cardiometabolic cohorts, including those with established Cardiovascular Disease, Chronic Kidney Disease, Metabolic Dysfunction- Associated Steatohepatitis, Heart Failure, Obstructive Sleep Apnoea & Polyendocrine Metabolic Ovarian Syndrome alongside specific clinical criteria. A new model of community weight management is currently being tested. Prevent is a community-based, remotely clinically supervised intervention, augmented with integrated digital clinician appointments, home blood testing and digital wrap around resources. The digital wraparound support includes a Citizen app that supports weekly digital weight management content, planned & asynchronous communications, digital Page 207 of 264
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4 data collection & automatic reporting, digital registrations & check-ins and direct links to digital clinical assessment appointments. The OPIP Digital Platform is the core enabling technology of the programme, providing a digitally enabled, end-to-end weight management ecosystem that supports patient access, assessment, referral, treatment, self-management and long-term monitoring. Designed as the central hub for the LWMS, the platform brings together clinical case management, virtual care pathways, population health management, personalised communications, citizen-facing mobile and web applications, community support connections, remote monitoring, decision support tools and integration with NHS digital systems. The platform aims to increase service capacity, improve access to evidence-based obesity care, support the deployment of anti-obesity medications, reduce health inequalities and create a scalable, sustainable digital infrastructure. In Quarter 1, progress was made in developing this digital infrastructure. Agreement was reached with Public Services Delivery Scotland (PSDS) to host the weight management software in their cloud environment and data in the new OpenEHR Clinical Data Repository, the future integrated health and care record for Scotland that will enable the Digital Front Door. Endorsement was received from the SG Technical Design Authority for our platform approach and that it would be a test case for the National Digital Platform development pipeline. Agreement was reached that reporting data should be on the Seer 2 national data analytics platform which hosts a range of public health data sets, allowing new combinations of data for analytics, research & service planning purposes. Initial conversations have taken place with the Scottish Government and PSDS about GP records integration. Requests were received from the Scottish Cardiometabolic Impact Study (SCoMIS) and the Connect.Me programme, Scotland’s remote monitoring& digital pathway service, to understand how they could reuse the platform capabilities OPIP generates. In addition, mapping of the digital platform system capability and interoperability requirements was carried out to support the new care pathways, intervention programmes, screening & identification tools, referral tools and innovation project digital assets. OPIP includes 12 additional innovation projects and work to initiate these projects will commence in Quarters 2 & 3 of the first year of the programme of work. These projects focus on areas such as 3rd Sector parter engagement, targeting underrepresented & priority groups and developing packages of digital self-management resources. They are independent from the Prevent expansion and the VCP and are not being developed as part of the core digital platform build, but they will be dependent of the platform capabilities to operate. A key focus in the upcoming quarter is to develop a detailed sustainability roadmap. This roadmap will aim to support long-term sustainability of the new care pathways, treatment models, interventions and LWMS capacity developed through OPIP, beyond the OPIP funding cycle. However, it will also focus on scalability and adoption of these newly developed capabilities beyond the LWMS into a broad range of services. Key aspects of this work will be to identify the long-term ownership model and operational requirements of the assets developed and agree evidence requirements to support sustainability and future adoption decisions. The OPIP team will begin to Page 208 of 264
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5 explore scalability opportunities across additional pathways and incorporation of the approaches developed and system capabilities within priority areas of work and the Research & Innovation and Evaluation & Change Teams will support the development of the evidence base to further these ambitions. Examples of the services which may be supported by the assets produced by OPIP include Community Link Workers, Occupational Therapy or Community Mental Health as well as Diabetes & Cardiovascular Disease Management, but this list is not exclusive, and all options will be explored. 8. CONCLUSIONS OPIP will deliver a step change in obesity care across Lanarkshire by increasing access to treatment, expanding clinical capacity and improving health outcomes through innovative models of care and digital transformation. The programme will introduce treatment models, enabling more people to access evidence-based weight management support and anti-obesity medications in a timely and sustainable way. OPIP will strengthen self-management, reduce health inequalities and improve care for people living with obesity and related long-term conditions. Central to the programme is the development of a digital platform that integrates referral, assessment, treatment, monitoring and personalised support, creating a more efficient and patient-centred service. Through robust research, evaluation and partnership working, OPIP will generate evidence on clinical outcomes, patient experience, workforce impact and economic value, supporting long-term sustainability and informing future service redesign across Lanarkshire. To maximise the benefit, scalability and adoption of OPIP beyond the LWMS, the programme will develop a reusable digital and service transformation platform rather than a single-service obesity initiative. The OPIP Digital Platform has already attracted interest from national programmes seeking to reuse its capabilities and has been recognised as a potential use case within the National Digital Platform development pipeline. The platform's capabilities, including digital referrals, case management, remote monitoring, citizen-facing applications, personalised communications, virtual care pathways, analytics and population health management, have significant applicability across long-term condition management and prevention programmes. Support from the IJB on adoption of these system capabilities within a broad range of services, is essential to ensure the programme can generate benefits far beyond obesity care, creating a sustainable platform for wider health and care transformation across Lanarkshire and Scotland. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes Page 209 of 264
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6 People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9.2 ASSOCIATED MEASURE(S) N/A 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT The OPIP risk register is primarily focused on programme delivery, in line with the plans outlined in the funding application and grant award. As OPIP is still in the setup phase, the operational risks that will be associated with the delivery of the programme of work have not yet transferred to corporate or partnership risk registers. However, this has been highlighted as an action that will be taken forwards by the OPIP Board in Quarter 2. Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details Page 210 of 264
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7 ☒ Involve stakeholders in the development work aimed at achieving the national outcomes A range of local and national stakeholder were involved in developing the aims and objectives of the OPIP programme of work ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A EQIAs will be completed for the individual innovation programmes. Page 211 of 264
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8 10. BACKGROUND PAPERS N/A 11. APPENDICES Please include a glossary of terms if not already included. . CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Jonathan Cavana Head of Transformation & Change Lanarkshire Weight Management Service Jonathan.cavana@lanarkshire.scot.nhs.uk Page 212 of 264
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction Page 213 of 264
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10 10 Performance Management / Governance arrangements 11 Date direction will be reviewed Page 214 of 264
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1 Item No: 15 SUBJECT: Paediatric Modernisation Board TO: Integration Joint Board Lead Officer for Report: Lucy Munro, Medical Director, NLHSCP Author(s) of Report Laura Jack, Service Manager, Specialist Children’s Health Services Unit DATE: 16 September 2026 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Laura Jack ☒ Reviewed By: Lucy Munro ☒ Endorsed By: ☐ 3. EXECUTIVE SUMMARY The report will provide detail of the Paediatric Modernisation Board Structure, objectives and progress of work to date. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB note the contents of the report and progress of work achieved to date. Item 14 Page 215 of 264
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2 4.2 It is recommended that the IJB note the scale of challenge to delivery of sustainable transformational change. The success of programme delivery will require clinical modelling and clinician support. This has to be balanced proportionately with safe delivery of care whilst transformational work progresses. 5. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 6. BACKGROUND 6.1 The Paediatric Modernisation Board is chaired by Dr Adam Daly, Associate Medical Director for the Health and Social Care Partnership in North Lanarkshire. Membership includes professional leadership, operational management colleagues and corporate support colleagues (Communication, Digital and HR Teams). Roles and responsibilities of board members were defined at the outset. There is a clear of expectation of each of the members regards representation and role in delivering the programme of work. 6.2 The Paediatric Board is focussed on modernisation of service delivery and clinical activity generated via acute hospital and aligned community based paediatric services. The delivery of the services within scope of board, inclusive of in-patient care are the responsibility of the Specialist Children’s Health Services Unit, and hosted on behalf of NHS Lanarkshire within North Lanarkshire Health and Social Care Partnership. The Board forms part of NLHSCP Strategic Commissioning Plan and reports to North Lanarkshire CORE, North Lanarkshire Integration Joint Board, South Lanarkshire Integration Joint Board and NHS Lanarkshire. 6.3 The agreed remit of Board is: - • Ensure a collaborative, inclusive approach to the design and delivery of a programme of work to implement the Paediatrics Modernisation Programme Plan • Monitoring the financial position across the Programme, including the use of Scottish Government funding for specific areas of work; • Encourage and strengthen links between the Programme, North and South Lanarkshire Paediatrics Services Plans and other relevant strategies of all key partners; • Approve Programme documents and deliverables; • Monitor the progress of Programme and delivery plans; Yes Health Board ☒ No ☐ N/A ☐ Page 216 of 264
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3 • Approve significant changes to the Programme scope, objectives, deliverables, funding and timescales; • Provide assurance that outputs are operationally fit for purpose and implemented satisfactorily; • Identify and manage risks and issues ensuring mitigating actions • Agree and track benefits realisation and achievement of outcomes • Approve Programme closure following implementation and ensure that any end project reports, issues, lessons learned and risks are documented and passed on to the appropriate body. In Spring 2026, a refresh was undertaken and the Modernisation Board commissioned four new subgroups groups to progress this work. Each subgroup has representation from clinical, operational, administrative staff groups, with subject matter experts (e.g. digital, finance, HR) co-opted when required. • Engaged and Supported Staff: Improvements focused on staff wellbeing, culture and leadership, development and induction. • Digital Transformation: Improvements focused on systems, equipment and training. • Right Care, Right Place, Right Time: Improvements focused on clinical pathways, clinical and administrative processes, efficiency, value and sustainability. • Empowered and Informed Stakeholders: Improvements focused on two-way communication and shared understanding with internal and external NHS and HSCP stakeholders, children, young people and their families and the public. 6.7 The Paediatric Modernisation Board planned activity has to be considerate of clinical demand challenge that is faced in winter months. The Modernisation Board has delivered:- • Getting it Right approach (‘Let’s Get It Right’) with Integrated Community Children’s Nursing Service (ICCNS), Acute Paediatric Nursing, School Nursing, School Immunisation Teams, Family Nurse Partnership, Throughcare and Aftercare and CAMHS/NDS services. Workshops have been running since late 2025 with a focus on joint working, review of service streams, cross working, service review and development and team development. Support from wider NHSL departments have been sought for unit learning, development and creative thinking, such as CAMHS LD, FNC, Transition services, locality working etc. • Paediatric Hospital at Home (H@H) officially launched December 2025, following a period of strategic planning and ratification of two clinical pathways. To date there are now four active clinical pathways, with over 30 patients having benefited from H@H care, accounting for 100+ bed days. H@H steering group aims: o Embed a safe and sustainable model providing hospital-level paediatric care at home where clinically appropriate. Page 217 of 264
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4 o Increase virtual capacity, support admission avoidance and earlier discharge, and maintain links with school and family life – working with Flow Navigation Services model. o Agree clinical criteria, governance, escalation, workforce, data and outcome measures to demonstrate quality, safety, experience and impact on bed use. Early data indicates: o Profession buy in demonstrated. o Positive impact on child/young person and their families, as demonstrated by parent feedback. Plans to support the service to achieve the Scottish Government trajectory of 7 beds by December 2026: o Continue to develop additional pathways, increasing scope of service o Extend hours to enable three times daily treatments o Build resilience within the workforce to ensure consistent staffing capacity to deliver service through recruitment o Develop a single person medication check protocol, reducing pressure on staff capacity, this will be particularly beneficial during Winter pressures. The Modernisation Board will complete:- • Delivery of a robust complex continence pathway. This is in draft but requires further review with wider subgroup team. The design of a possible waiting list initiative also in progress to tackle longest waits as well as support with regard to product provision with national guidance available. • Increase medical training opportunities by August 2026 • Provide nursing and medical workforce review (including ICCN) to ensure safe staffing compliance and services enabled for modernised pathways/activity – both Ward, community and Hospital @ Home. • Continue with winter planning arrangements, including practical escalation steps and mitigations to support flow within Acute Paediatrics/H@H and ICCN services • Future proof access and flow utilising support from Flow Navigation Centre plus – building on work with Open Access for Paediatric Ward. A targeted Waiting List Initiative (WLI) is currently underway to support children awaiting initial assessments, alongside a review of capacity and demand for returning patients. This work aims to reduce the longest waits, improve access to appointments and support delivery of sustainable improvements across Community Paediatrics. At commencement of WLI (April 2026) there were 1843 children awaiting appointment, with now as at August 2026 there are 988 waiting initial assessment. Trajectories indicated we will able to reduce this further by December 2026. We are also: Page 218 of 264
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5 o Increasing medical training opportunities by August 2026 o Undertaking a nursing and medical workforce review (including ICCN) to ensure safe staffing compliance and services enabled for modernised pathways/activity – both Ward, community and Hospital @ Home. o Continuing with winter planning arrangements, including practical escalation steps and mitigations to support flow within Acute Paediatrics/H@H and ICCN services o Future proofing access and flow utilising support from Flow Navigation Centre plus – building on work with Open Access for Paediatric Ward. 7. SUMMARY OF KEY ISSUES 7. 1 The pace of transformational change is limited by the capacity of clinicians to commit time to developing and testing new and innovative pathway. This is due to clinical demand, which can be variable throughout seasons of year. Activity increases significantly during the winter months, largely due to respiratory virus prevalence, resulting in increased patient volumes, higher acuity and additional workforce pressures. To maintain safe and effective clinical services during these periods, workforce planning arrangements are strengthened through proactive rota management and additional staffing measures where required. Consequently, capacity for non-clinical activity, including service redesign and improvement work, is reduced during peak periods, with greater opportunity to progress transformational work out with winter pressures. In addition, the Board has identified the need to better understand whether current medical workforce capacity is sufficient to support both clinical service delivery and ongoing service improvement activity. Work is being explored with Human Resources to consider a medical workforce review aligned to the nursing workforce analysis currently underway. This will help inform future workforce planning and support sustainable delivery of the modernisation programme. It should also be noted that the elements of this work are impacted by current service level agreements with tertiary partners. This requires sensitive discussion via regional planning process. A number of future modernisation opportunities are influenced by existing service arrangements with regional and tertiary partners. Ongoing discussions continue between NHS Lanarkshire, NHS Greater Glasgow and Clyde and other stakeholders regarding elements of routine specialist paediatric care and urgent care pathways. Page 219 of 264
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6 Across paediatric specialties there can be variation in the interpretation of secondary and tertiary care responsibilities, referral pathways and clinical ownership. This is influenced by historical service arrangements, differing specialty models and the availability of specialist expertise within local and regional services. These discussions are particularly relevant to some urgent care pathways, where decisions regarding the most appropriate location of care, clinical responsibility and transfer arrangements may involve a range of partners, including tertiary services and national transport services. While such interface challenges are not unique to Lanarkshire, establishing strong collaborative relationships and shared understanding with regional partners remains fundamental to service sustainability, pathway development and future opportunities for redesign. Discussions will continue through established regional planning and governance arrangements. 8. CONCLUSIONS 8.1 The IJB should note the progress of work to date. 8.2 The IJB should note that timescale of progress is balanced with clinical demand and activity and is affected by a seasonal element of intensity due to clinician availability. 8.3 The IJB should note that discussions in regard to service level agreement with regional partners will be supported by NHS Lanarkshire Planning colleagues. 9. IMPLICATIONS There is potential that there will be a shift in balance of care away from acute hospital to community care based sites and/or homes. This has potential further challenge demand for space within local health centres. 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ Page 220 of 264
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7 People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL There are no specific financial implications of work to date. Programme of works is considerate of current financial environment. This paper has been reviewed by Finance: Yes No N/A x 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Empowered and Informed Stakeholders subgroup. H@H feedback monitored by Engagement Officer. ☐ Provide stakeholders with information on how to get involved Page 221 of 264
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8 ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery This is provided via staff meetings, steering group and subgroup meetings and via engagement officer reporting. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Representation within Programme Boards of community and acute colleagues who interface with acute and community paediatric care. ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA is in progress and will be considerate and informed by UNCRC legislation. Yes No N/A In progress EQIA added to website: Yes No N/A Page 222 of 264
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9 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) ___ Members seeking further information about any aspect of this report, please contact the following; Laura Jack - Laura.Jack@lanarkshire.scot.nhs.uk Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: Page 223 of 264
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10 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed Page 224 of 264
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1 REPORT Item No: SUBJECT: Nursing Future Workforce and Newly Qualified Practitioners TO: North Lanarkshire Integration Joint Board Lead Officer for Report: Joanne Jenkins, Nurse Director Author(s) of Report Caroline Martin, Marie Rooney & Carrie McCulloch, Associate Nurse Directors DATE: 16 September 2026 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Joanne Jenkins ☒ Reviewed By: North Lanarkshire Senior Management Team ☒ Endorsed By: ☐ Item 15 Page 225 of 264
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2 3. EXECUTIVE SUMMARY 4. RECOMMENDATIONS 4.1 It is recommended that the IJB note the contents of the report. (1) Note the current nursing workforce position and projected workforce challenges across Adult, Mental Health and Children's Services. (2) Note the actions being taken to support workforce sustainability and mitigate workforce risks. (3) Note that workforce projections and recruitment activity will continue to be monitored and reported through existing governance arrangements. 5. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 6. BACKGROUND 6.1 North Lanarkshire HSCP faces ongoing challenges in both supplementary staffing usage in addition to the recruitment of registered nursing staff across Children’s, Adult and Mental Health Services. Workforce planning intelligence indicates a reduction in the number of individuals entering the nursing profession, with undergraduate nursing programmes experiencing reduced applications and higher attrition levels. If there was no action at this point there is potential impact on the ability to meet future service demand. 6.2 A sustainable nursing workforce is essential to the delivery of safe, effective and person-centred care and to supporting delivery of the Health and Care (Staffing) (Scotland) Act 2019 and local strategic priorities. 7. SUMMARY OF KEY ISSUES 7.1 Workforce Supply Analysis of nursing student numbers indicates a reduction in the future supply of registered nurses. Competition across NHS Scotland is likely to further reduce the number of newly qualified practitioners available for recruitment to community services. Yes ☐ No ☒ N/A ☐ Page 226 of 264
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3 This highlights the ongoing risk associated with relying solely on reactive recruitment to only currently vacant posts. As a result we are currently undertaking proactive recruitment measures to improve sustainability and reduce supplementary staffing spend. 7.2 Workforce Projections The Workforce projections for Nursing Bands 5 and 6 outline the growing gap between current recruitment trajectories for Adult, Mental Health and Children’s Services and how this will look in the coming years. At the moment, projections for Band 5 and 6 nursing across all three areas is showing a worsening vacancy position year on year between now and 2030, on the basis that we are losing more (outflow) staff on the assumption of turnover at 7% than the numbers of staff joining the workforce (inflow). This presents a significant nursing workforce risk with potential impact on safe staffing, service resilience, continuity of care and long-term workforce sustainability. 7.3 Mitigating Actions A range of workforce planning measures are being implemented to improve workforce resilience, including proactive recruitment approaches, recruitment of Newly Qualified Nurses where appropriate, workforce redesign and continued monitoring of supplementary staffing expenditure. A review of the blueprint for staffing is underway for Mental Health and Learning Disability inpatient areas. The current review of the nursing workforce in paediatric inpatients is coming to completion and will be presented for investment over the coming month. Community nursing review is also drawing to a close and will recommend future skill mix and opportunities for transformation. The position will continue to be monitored through established workforce governance arrangements and reported through management structures as required. 7.4 Current Position A planned programme of workforce stabilisation is currently in progress across North Lanarkshire HSCP. This will include further work to identify workforce requirements across each job family, determine the appropriate level of recruitment and develop a sustainable workforce plan aligned to future service delivery needs. Recruitment of Band 5 Newly Qualified Nurses will be aligned to funded vacancies arising throughout 2026/27, with vacancies being utilised to support the transition to a more stable substantive workforce. Page 227 of 264
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4 The position regarding any requirement for over establishment recruitment will be kept under review as workforce modelling is completed. Alongside this, supplementary staffing usage and associated expenditure will continue to be closely monitored, with further actions taken to reduce reliance on temporary staffing where possible and mitigate financial risk. The overall approach is intended to support workforce sustainability, improve recruitment and retention, and ensure safe and effective service delivery. 8. CONCLUSIONS The projected reduction in the supply of registered nurses presents a strategic workforce challenge for North Lanarkshire HSCP. Workforce modelling indicates that without ongoing mitigation there is potential for increasing vacancy levels across key nursing services. Work is underway to strengthen workforce resilience and support future workforce sustainability. The IJB is asked to note the position and the actions being taken to manage the associated risks. Future reports will be provided to the IJB with an updated position. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9.2 ASSOCIATED MEASURE(S) Page 228 of 264
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5 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of Page 229 of 264
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6 expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included. . CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Page 230 of 264
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7 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction Page 231 of 264
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8 10 Performance Management / Governance arrangements 11 Date direction will be reviewed Page 232 of 264
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1 REPORT Item No: 19 SUBJECT: Self-Assessment Questionnaire TO: Integration Joint Board Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Kerry Taylor, Head of Corporate Governance DATE: 16 September 2026 1. PURPOSE OF REPORT The purpose of this report is to inform the Board of the results of the self-assessment survey of the Board’s administrative arrangements and activity. The Board is invited to discuss the results and identify any action required. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Kerry Taylor, Business Support Manager ☒ Reviewed By: HSCP SMT 1 September 2025 ☐ Endorsed By: ☐ Item 16 Page 233 of 264
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2 3. RECOMMENDATIONS 3.1 It is recommended that the IJB • Notes the results of the self-assessment survey; and • Discuss if any actions should arise from the results 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND 5.1 The Chartered Institute of Public Finance and Accountancy (CIPFA) Framework suggests that committees involved in scrutiny and internal control should periodically conduct a self-assessment of their effectiveness and operation. The aim is to involve members in close consideration of the role of the committee and its members, its administrative arrangements and the context in which it operates. 5.2 A questionnaire was originally developed and approved by North Lanarkshire Integration Joint Board on 18 June 2025. The questionnaire was presented to Board in June 2026 for approval of issue to Members. 5.3 The self-assessment was circulated to all Board members on 8 July 2026 and was open for completion until Thursday 27 August 2026. Five board members completed the questionnaire, which is a decrease from 8 responses in 2025. 5.4 The results are anonymised and appended to this report at Appendix 1 for discussion. 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ Yes ☐ No ☐ N/A ☒ Page 234 of 264
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3 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.5 ENGAGEMENT & PARTICIPATION The development of the proposed self-assessment questionnaire was presented during an IJB Development session in June 2025. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved Page 235 of 264
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4 ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS N/A Page 236 of 264
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5 11. APPENDICES Appendix 1 –North Lanarkshire Integration Joint Board Self-Assessment Questionnaire Results 2025 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Kerry Taylor kerry.taylor@lanarkshire.scot.nhs.uk Page 237 of 264
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Responses 5 Average Time 28:37 DurationClosed 50 Strongly Agree 1 Agree 2 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 Days 1. I am aware that the Board’s role and powers are set out in Standing Orders Page 238 of 264
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2. I consider that the Board’s role and powers are clear and understood Strongly Agree 1 Agree 2 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 3 Neither Agree not Disagree 1 Disagree 0 Strongly Disagree 0 Don't know 0 3. I consider that the Board is regarded by stakeholders as a positive influence Page 239 of 264
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Strongly Agree 1 Agree 1 Neither Agree not Disagree 3 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 2 Neither Agree not Disagree 1 Disagree 1 Strongly Disagree 0 Don't know 0 4. I consider that the Board’s decisions are respected and acted upon by the partners 5. I consider that there is adequate communication amongst officers and Board members Page 240 of 264
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3 Responses 7. I consider that the Board is of an appropriate size and composition Strongly Agree 0 Agree 3 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 6. Please provide any comments or suggestions in relation to section A: Purpose and Status Page 241 of 264
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Strongly Agree 1 Agree 2 Neither Agree not Disagree 1 Disagree 1 Strongly Disagree 0 Don't know 0 Strongly Agree 0 Agree 5 Neither Agree not Disagree 0 Disagree 0 Strongly Disagree 0 Don't know 0 8. I consider that the Board is provided with adequate officer support (professional and administrative) 9. I consider that meetings are sufficiently frequent and at appropriate times of the year Page 242 of 264
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11. I consider that meeting papers are distributed appropriately (timeliness and format) to enable me to properly prepare Strongly Agree 0 Agree 1 Neither Agree not Disagree 4 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 0 Agree 2 Neither Agree not Disagree 1 Disagree 1 Strongly Disagree 1 Don't know 0 10. I consider that the Board maintains a work plan balancing forward planning with flexibility for reactive work Page 243 of 264
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Strongly Agree 1 Agree 4 Neither Agree not Disagree 0 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 3 Neither Agree not Disagree 0 Disagree 1 Strongly Disagree 0 Don't know 0 12. I consider that reports and minutes provide relevant, appropriate and sufficient information 13. I consider that start times and time allowed for meetings provide sufficient time for business to be done Page 244 of 264
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14. I consider that public access to reports and meetings is maximised and excluded only where legally justified Strongly Agree 1 Agree 2 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 0 Agree 3 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 15. I consider that the Board is able to secure the attendance and assistance of appropriate senior officers Page 245 of 264
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1 Responses Strongly Agree 2 Agree 3 Neither Agree not Disagree 0 Disagree 0 Strongly Disagree 0 Don't know 0 16. I consider that the Board is able to secure appropriate professional advice when required 17. Please provide any comments or suggestions in relation to section B: Administrative Arrangements & Support Page 246 of 264
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18. I consider that my role on the Board is clear Strongly Agree 0 Agree 4 Neither Agree not Disagree 1 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 1 Neither Agree not Disagree 3 Disagree 0 Strongly Disagree 0 Don't know 0 19. I consider that the Board has an appropriate mix of knowledge, expertise, experience and skills Page 247 of 264
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Strongly Agree 0 Agree 0 Neither Agree not Disagree 3 Disagree 1 Strongly Disagree 1 Don't know 0 Strongly Agree 0 Agree 0 Neither Agree not Disagree 3 Disagree 2 Strongly Disagree 0 Don't know 0 20. I receive sufficient and appropriate training and briefings to be effective in my role as a Board member 21. I undertake personal development relevant to my role and responsibilities as a Board member Page 248 of 264
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Strongly Agree 1 Agree 2 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 2 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 22. I consider that the Chair promotes and encourages effective and efficient meetings including input from officers and members 23. I consider that members prepare, attend meetings and actively contribute Page 249 of 264
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1 Responses Strongly Agree 1 Agree 2 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 24. Please provide any comments or suggestions in relation to section C: Members 25. I consider that the Board functions in a positive and constructive manner, including interaction amongst members and with officers Page 250 of 264
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27. I consider that the Board provides constructive challenge to officers Strongly Agree 1 Agree 0 Neither Agree not Disagree 4 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 0 Neither Agree not Disagree 2 Disagree 1 Strongly Disagree 0 Don't know 1 26. I consider that scrutiny is encouraged and accepted as a means to improve Page 251 of 264
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28. I consider that the Board receives adequate responses from officers to questions 29. I feel comfortable asking candid questions and pursuing full answers Strongly Agree 1 Agree 2 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 2 Neither Agree not Disagree 1 Disagree 0 Strongly Disagree 0 Don't know 1 Page 252 of 264
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30. I consider that decisions and recommendations are captured to enable them to be recorded accurately 31. I consider that decisions are executed properly and in a timely manner and are followed up by Board Strongly Agree 2 Agree 3 Neither Agree not Disagree 0 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 2 Neither Agree not Disagree 1 Disagree 0 Strongly Disagree 0 Don't know 1 Page 253 of 264
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33. I consider that the Board has good working relations with key officers, members and organisations Strongly Agree 0 Agree 2 Neither Agree not Disagree 3 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 2 Agree 0 Neither Agree not Disagree 3 Disagree 0 Strongly Disagree 0 Don't know 0 32. I consider that there is evidence from meeting papers and minutes of impacts or improvements from Board activity Page 254 of 264
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35. Please provide any comments or suggestions in relation to section secti on D: Effectiveness 1 Responses Strongly Agree 1 Agree 0 Neither Agree not Disagree 3 Disagree 0 Strongly Disagree 1 Don't know 0 34. I consider that stakeholders (including other members and the public) are engaged with the Board’s activity and are encouraged to participatein the Board’s activity Page 255 of 264
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Strongly Agree 0 Agree 4 Neither Agree not Disagree 1 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 4 Neither Agree not Disagree 0 Disagree 0 Strongly Disagree 0 Don't know 0 36. I consider that interaction with Board’s committees and groups is defined and understood 37. I consider that meetings are attended by external representatives where appropriate Page 256 of 264
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39. I consider that the Board’s role in relation to performance monitoring is defined and understood Strongly Agree 0 Agree 2 Neither Agree not Disagree 2 Disagree 1 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 2 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 38. I consider that the Board’s role in relation to the Board’s annual accounts and audit of those accounts is defined and understood Page 257 of 264
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41. I consider that members consider fully the contents and conclusions of the Strategic Commissioning Plan before its approval Strongly Agree 1 Agree 3 Neither Agree not Disagree 1 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 1 Neither Agree not Disagree 2 Disagree 1 Strongly Disagree 0 Don't know 0 40. I consider that the Board’s role in relation to risk management is defined and understood Page 258 of 264
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Strongly Agree 1 Agree 2 Neither Agree not Disagree 2 Disagree 0 Strongly Disagree 0 Don't know 0 Strongly Agree 1 Agree 2 Neither Agree not Disagree 1 Disagree 1 Strongly Disagree 0 Don't know 0 42. I consider that strategic planning arrangements are defined and appropriate controls are in place 43. I consider that the Board contributes to effective accountability to the public through challenge of strategic planning process and controls Page 259 of 264
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0 Responses 0 responses submitted 45. Please list here, any particular support or development topics you think would be of benefit to you and/or the Board 4 Responses 46. Please leave any additional comments or suggestions here 3 Responses 44. Please provide any comments or suggestions in relation to section E: Matters Specific to Board Remit and Activities Page 260 of 264
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Officer Meeting Date Recurrence Reason / Notes Wednesday 16 September 2026 Chief Officer Report Chief Officer 16 September 2026 Standing Item Chief Finance Officer Report Chief Finance Officer 16 September 2026 Standing Item Audited Annual Report & Financial Statement 2024/25 Chief Finance Officer 16 September 2026 Annual Audited Annual Accounts must be presented to Board and published online by 30 September each year Audit Scotland - Final Audit Report 2025/26 Chief Finance Officer 16 September 2026 Annual IJB Self-Assessment Questionnaire (Results) Business Support Manager 16 September 2026 Annual IJB SAQ approved at IJB in June 2025 to be issued annually Equality Outcomes Head of Planning, Performance & Quality Assurance 16 September 2026 Update after first presented in March 2026 Paediatric Modernisation Board Medical Director 16 September 2026 Update report requested at previous IJB meeting CMHT Update Head of Heath 16 September 2026 NMHAHP Workforce Nursing Director 16 September 2026 Wednesday 16 December 2026 Chief Officer Report Chief Officer 16 December 2026 Standing Item Chief Finance Officer Report Chief Finance Officer 16 December 2026 Standing Item Vaccination Update Head of Health 16 December 2026 Postponed to December (update on action log) to allow report through both North / South Item 17 Page 261 of 264
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Officer Meeting Date Recurrence Reason / Notes Care Academy Head of Planning, Performance & Quality Assurance 16 December 2026 Postponed to December (update on action log) IDS Review Head of Health / Head of Adult Social Work 16 December 2026 Quality Assurance Annual Report Head of Planning, Performance & Quality Assurance 16 December 2026 Annual Probable Suicide 2024 Report Head of Adult Social Work 16 September 2026 Annual Postponed from September – data not available yet. To be reported annually – date dependant on publishing dates from National Records Scotland (NRS) Alcohol Specific Deaths 2024 Report Head of Planning, Performance & Quality Assurance 16 September 2026 Annual Postponed from September – data not available yet. To be reported annually – date dependant on publishing dates from National Records Scotland (NRS) Drug Related Deaths 2024 Report Head of Planning, Performance & Quality Assurance 16 September 2026 Annual Postponed from September – data not available yet. To be reported annually – date dependant on publishing dates from National Records Scotland (NRS) Coming Home Report – Dynamic Support Register Head of Adult Social Work 16 December 2026 Biannual Page 262 of 264
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Officer Meeting Date Recurrence Reason / Notes Freedom of Information Requests Business Support Manager 16 December 2026 Quarterly To be included in the Chief Officer Report. Quarterly reporting submitted to Scottish Information Commissioner. Future Reports Pharmacy Savings Approach Pharmacy Lead TBC As requested at Board meeting – incorporated to work plan Review of IJB Performance, Finance and Audit Committee Business Support Manager TBC Primary Care Improvement Plan (PCIP) Update Chief Officer / Medical Director TBC Chief Officer Report Chief Officer Standing Item Standing Item IJB Budget – Medium Term Financial Plan Chief Finance Officer March 2027 Annual Chief Social Work Officer Report Chief Social Work Officer March 2027 Annual Home Support Head of Adult Social Work March 2027 Unaudited Annual Accounts Report Chief Finance Officer June 2027 Annual IJB Annual Performance Report Head of Planning, Performance & Quality Assurance June 2027 APR must be published online by 31 July each year Public Health Annual Report Director of Public Health 17 June 2026 Annual Page 263 of 264
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Officer Meeting Date Recurrence Reason / Notes IJB Self-Assessment Questionnaire (Issue) Business Support Manager 17 June 2026 Annual IJB SAQ approved at IJB in June 2025 to be issued annually Coming Home Report – Dynamic Support Register Head of Adult Social Work 17 June 2026 Biannual Page 264 of 264