ITEM 4 Minute of Meeting of the PFA Committee held on 21 February 2024
North Lanarkshire Council · 27 March 2024
Back to Health and Social Care Integration Joint Board — 27 March 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 ITEM 4 Integration Joint Board Performance, Finance & Audit Committee Minutes from a meeting held on Microsoft Teams on Wednesday 21st February 2024 2pm-4.30pm Present: Voting Members: Councillor Claire Barclay North Lanarkshire Council Nominated Councillor Councillor Bob Burgess North Lanarkshire Council Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non Exec Director Councillor Michael McBride North Lanarkshire Council Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director James Muir NHS Lanarkshire Nominated Non Exec Director Non-Voting Members in Attendance Professional Advisors: Amanda Kilburn Section 95 Finance Officer Ross McGuffie Chief Officer, North Lanarkshire HSCP Stakeholders: Cathy McGinty NHSL Partnership/Staff Side Rep Harry Robertson Carer Representative Elizabeth Seaton Carers Together John Watson Unison Rep In Attendance: Stacey Anderson Support Services, Project Manager John Boyd Audit Scotland Stacey Connor (Minutes) Governance Support Manager Nauman Dar (Shadowing) NHS Lanarkshire Nominated Non Exec Director Mark Dell Communications Manager Trudi Marshall Nurse Director North HSCP Fiona Owens Audit Scotland Dr Josephine Pravinkumar Director of Public Health Apologies: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Paul Carey Audit Scotland Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Work Services Maddy Halliday Chief Exec, VANL Third Sector Rep Councillor Paul Kelly North Lanarkshire Council Nominated Councillor Dr Lucy Munro Medical Director North HSCP
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2 Maggs Thomson Head of Health NHSCP ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes IJB PFA (18th October 2023) The previous minutes were approved as an accurate reflection of the discussion. 4. Matters Arising/ Action Log There were no matters arising. Ross McGuffie updated the committee on the action log as follows: Item 11 Financial Plan Provision of Smoke Alarms –Have procured additional alarms this week which will work with the current system and the new system for smoke alarms. An update will come to a future meeting. Item 18 IJB Self-Assessment Report- No update. Item 23 Risk Register- This will be discussed at a future liaison session, Item 24 Performance Report- A report to update on SWISS progress will be tabled at the May PFA. 5. Chryston Hub Update The report was shared with the IJB PFA committee to provide an update on the development and delivery of Chryston Community Health Clinic. The build Programme began on Monday 14th February 2022 with a completion date of early August 2023 identified. In tandem with the facility development, a process was initiated with NHSGG&C (and associated H&SCP’s) to begin the process of repatriation of the identified clinical services. A Service Level Agreement (SLA) continues to be in place and as of January 2024 a notice of cessation is now formally lodged with GG&C. This exposed H&SCNL to a £392k financial gap if services where to be delivered within the known funded establishment and skill mix of the NHS Lanarkshire service model.
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3 The intention was to decommission Muirhead Clinic, however NHSL has offered this accommodation to another service and the site responsibility will transfer to SLH&SCP at the end of January 2024. The IJB has already approved additional funding (£212K) to support double running costs for one quarter to allow safe transition of repatriated services. There is however some comfort that the £392K funding gap previously identified may not be required. It was noted the committee will hold a future meeting at the new Chryston hub to allow members to have a walk round of the Health facility and also the school within the hub. Details will be shared in due course. Ross McGuffie noted that an updated capital plan for Primary Care linking with council services as well will be developed. Phillip Couser asked what work are we doing to look at new ways of working in the community hub and also have staff from GGC been transferred over as part of the Health Board boundary change. Ross McGuffie advised work is being done to look at the future operating models working with councils particularly creating synergy with the teams based in the same locations. Working with education colleagues to look at CAMHS and immunisation programs developing. Currently discussion is ongoing with HR colleagues to look at some Mental Health teams staff moving across. Cllr McBride advised Police Scotland may also become involved in future hubs across the community. Ross McGuffie advised there is a partnership agreement penned that will allow staff across the different agencies to use facilities and enhance partnership working. The IJB PFA: 1) Note the active and ongoing progress with the delivery of this capital programme. 2) Note the progress with the repatriation of the clinical services from NHS Greater Glasgow & Clyde (NHSGG&C) and their associated Health and Social Care Partnerships (HSCP’s) 3) Note the previously identified financial gap reported Feb 2023 and work to date to progress towards final conclusion. 6. Hospital At Home The report tabled outlined the current Hospital at Home service provision, the service expansion updates, and the strategic risks to the longevity of maintaining increased performance. Hospital at Home (H@H) was initially set up as an Admission Avoidance service by NL H&SCP in 2011. The service covers all areas of North Lanarkshire and areas of South Lanarkshire (excluding Camglen) With prior endorsement from the (then recently retired) Cabinet Secretary for Health, all areas of Scotland were to introduce a H@H service. Having created the first H@H Service in 2011, the task for Lanarkshire was to
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4 provide full geographical coverage by the service, and expand our virtual bed capacity in already existing localities In 2022 the H@H service undertook a large scale project to introduce the service and provide 12 virtual beds in the Clydesdale locality within South Lanarkshire, and to extend the operating hours of the whole service. In February 2022 the service participated in the organisation’s “Firebreak” process and used the opportunity to test the value in extending their operating hours to later in the evening and weekends. This was evaluated with the learning and outcomes used to inform future decision making and service changes. As part of Health Improvement Scotland (HIS) non‐recurring funding programmes, they financially supported the recruitment of 2 Band 5 RGNs to administer the infusion of IV Furosemide to identified Heart Failure patients. This was with the intent that these patients, as identified by Heart Failure nurses as being clinically safe to remain at home for infusion, would no longer need to occupy an inpatient bed for up to 5 consecutive days for infusion only purposes. These patients are still clinically responsible to the Heart Failure service and H@H are responsible for the infusion only. Phillip Couser queried if the geriatric recruitment something we are still progressing. Ross McGuffie advised still progressing this but there is ongoing work to consider how the service can run. Trudi Marshall advised H@H in Lanarkshire was the first in Scotland so went with consultant led model to manage anxieties of it being a new service, but now we are in a different space where we can consider going with Advanced Nurse Practitioners (ANP) staff. Phillip Couser also asked do we have occupancy activity data. Ross McGuffie advised we have data but it is not a fixed number as it is not against a set number of beds and even with consultant led model it is still a far cheaper model in comparison to traditional hospital beds. Cllr Burgess noted he has some community intelligence of young men passing away with heart attacks recently he asked has this been raised anywhere else. Dr Pravinkumar advised covid and flu cases have decreased recently so doesn’t appear to link to this but there is no further intelligence. Brian Moore queried around the funding source for the service. Ross McGuffie advised this has been funding though non-recurring source to date and currently awaiting confirmation in the new financial year of funding continuing. The IJB PFA agreed following recommendations: (1) In line with the Scottish Government initiative to implement a Hospital at Home service in every Board in Scotland, that NHS Lanarkshire shall expand their service provision to the Clydesdale locality within South Lanarkshire.
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5 (2) In line with the Board’s Unscheduled Care strategy, that Hospital at Home should seek to expand their operating hours to increase virtual bed capacity. (3) To ensure that the service is achieving maximum efficiency and operating in line with the Boards strategic objectives, a Rapid Strategic Review would be undertaken. 7. Health Care Resettlement for Asylum Seekers & Refugees Across Lanarkshire Ross McGuffie spoke to the report which provided an overview on the arrivals of refugees, asylum seekers and unaccompanied asylum seeking children to Lanarkshire. The report also provided an update on the work of the healthcare resettlement team that was developed as a response on an interim basis to support those arrivals. In December 2021 the Home Office and Mears established an emergency contingency accommodation for single male asylum seekers at a hotel in East Kilbride. The Scottish Government in conjunction with COSLA committed to support Ukrainian people coming to live in Scotland via the Homes for Ukraine scheme and The Super Sponsor scheme. In May 2022 welcome hubs were set up within 2 hotels in Lanarkshire with a further 4 established in June 2022 with the Scottish Government extending the hotel contracts until March 2024. Ross McGuffie advised there is a Health Improvement manager and admin staff in post to undertake health needs assessment for this population. Currently down to 1 hotel (Bruce hotel) with roughly 70 men still awaiting housing, have also linked with tower programme via North Lanarkshire council to help progress. Ross McGuffie noted his thanks to the teams that have been involved. Cllr Burgess questioned has there been a rise in Tuberculosis cases linked to the programme. Dr Pravinkumar advise nationally there has been a discussion around routine screening been undertaken as there has been a slight increase. There has been a TB network established which is coordinated through Public Health Scotland. Dr Pravinkumar will share additional information with the committee to offer assurance. The IJB PFA noted the report and requested further updated when available. JP 8. Care Home Support Following communication from the Cabinet Secretary on 17th May 2020 there were additional requirements for the Executive Director of Nursing, Midwifery and Allied Health Professionals within NHS Lanarkshire (NMAHP) which included:
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6 • Providing professional oversight and clinical leadership and support ensuring health needs of care home residents are met. • Outbreak management • Oversight of testing and review of test results, and supporting the development and implementation of a range of testing approaches for care homes. • Conduct assurance visits and monitor information trends from safety huddle providing professional and clinical advice on provision of health care needs. • Support compliance with IPC whilst monitoring trends and escalations via safety huddle. • Support education and training in care homes in IPC measures. There are 86 care homes across Lanarkshire, 28 within North Lanarkshire and 58 within South Lanarkshire. There are approximately 3600 residents and 3200 staff working within the care home sector. Lanarkshire HSCPs have already began evolving their arrangements in collaboration with care homes, focusing on improvement, sustainability and viability, considering the learning and experience of the pandemic and the strong, positive relationships built between our local partners and the care home staff, residents and their families. The 2022 National framework has been development through a session involving staff, care inspectorate and commissioned services. Cllr Barclay asked has this collaborative work been fast tracked due to the pandemic. Trudi Marshall advised prior to covid there was a very small number of staff to support care homes but with national funding being available this has helped to expand the service as a whole. By working in collaboration with the care home provider’s outcomes have improved. Funding is due to stop at the end of the financial year and risk implications will need to be considered as well as options for future funding. Brian Moore asked are all care homes engaging with our staff. Trudi Marshall advised majority are engaging but for those who are not we approach the care inspectorate to assist in engagement. The well-being work within care homes has been really welcomed by the service. Ross McGuffie noted unhappiness is around the national care home contract and that some areas have done more than others. The IJB PFA agreed to consider the professional oversight and clinical leadership that is provided to the care home sector. 9. Community Nursing Review Community Nursing is a planned service that is delivered in all six localities and provides nursing care to people that cannot leave their homes to access nursing care within health centres.
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7 It provides this service to all age ranges and people can have a one off intervention or be on caseloads for a significant period of time. Anyone can refer into community nursing services including patients and carers. This service was last reviewed in 2006 therefore a review of community nursing within North Lanarkshire HSCP was commissioned by Nurse Director, Health & Social Care North Lanarkshire on 20 August 2023 with the aim to develop a model which meets the needs of our changing demographics and also to support improved workforce planning with clear career progression pathways. The report also outlined the vision and purpose of the service. We are currently testing out Single Point of Access which will tie into future models of care. Section 5.3.4. of the report outlined the new training programme for District Nurses, have also created own internal training programme which is now all work based learning rather than staff taking time out. Phillip Course queried if there has been enough investment to the service. Trudi Marshall advised Morse roll out has concluded and all staff have ipads now which has been an investment to the service. Have been looking at care assurance for quality of care within district nursing caseloads too. Still need to consider other digital investments that could be used within the service for preventative and proactive work. James Muir asked what other methods can we use to measure that the training programme has gone well. Trudi Marshall replied it has been successful in stabilising the workforce and that we review recruitment and retention in tandem, particularly through the practice development team undertaking surveys with trainees. It was noted that although we train staff but they then move to other services or Boards. Cllr Burgess asked is there a period of time that staff need to remain in the role before they move on. Trudi Marshall advised the previous programme of training would cost £48k per staff member whereas now costs roughly £1200. NHS Lanarkshire policy is that staff who complete higher education should remain in post for 2 years; would consider using the policy depending on the situation. Brian Moore asked what is the extend of the work staff which other Health and Social Care staff could undertake and is there national work reviewing the DNs workforce and role. Trudi Marshall advised in Lanarkshire there is differences even locally, have established a community nursing group for Scotland to benchmark across the service to bring this into line. Brian Moore asked when will an update come back to the committee; Trudi Marshall noted should be in next 6 months. The IJB PFA considered progress of Community Nursing review as recommended.
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8 10. Winter Resilience Operation Flow commenced in early 2023, with a 9-day Firebreak taking place that reduced site occupancy by around 15% and supported NHS Lanarkshire to move from black to red status on 6th March 2023. Since then, learning from this intervention has led to the Operation Flow 2 action plan and developments that commenced in summer 2023 with the aim of having the whole system better prepared for winter 23/24. One of the key areas of learning from Operation Flow has been the positive impact of targeted and intensive firebreaks. Early January is always a significant pressure point across the health and social care system following two four-day weekends, so a proactive Firebreak took place from Wednesday 3rd – Friday 12th January 2024. Following the January firebreak, a learning review was undertaken, with a number of highlights noted: • Structured, organised and robust processes • Team working and MDT collaboration • Timely discharge planning • Real time solutions found for challenges • Focus on patient safety and getting the right care in the right place at the right time • Occupancy reduced • Ward beat achievement improved • Increased discharges • Improved weekly performance • Frailty team at front door – 25% avoided downstream moves A number of challenges were also noted that require further exploration and development: Weekend Care Home discharges Reduced referrals and discharges during Christmas week Off-site bed purpose – need clear expectations with staff, patients and families Side room demand due to flu/covid impacting both 8hr and 12hr performance Referral rates, unplanned referrals and cancelled discharges remain high Admin capacity to keep Trak updated Delayed Discharge performance has remained much more stable than in previous winter periods, with strong and consistent discharge rates of over 100 per week being maintained since October and throughout December and January.
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9 Ross McGuffie advised that partners are undertaking review of the winter plan which will be coordinated nationally and will start to embed any learning into the plan for Easter and consider proactive firebreaks. Brian Moore asked from a North perspective is there capacity to reduce delayed discharges further. Ross McGuffie noted the original target was in the 70s which is below the national target, so far largely been able to get there consistently. Next step is to get into 60s with a key focus on home assessment and working with multi-disciplinary teams. The IJB PFA noted the progress made through Operation Flow and the impact so far over the winter period. 11. 2024/25 Budget Briefing John Boyd from Audit Scotland advised will have a draft audit plan shared by the end of March, there are no significant issues to bring to attention of the committee. Awaiting work from NHS and council to influence the plan. Ross McGuffie delivered a presentation to the committee to outline the current financial position. There has been no budget uplift and the pay award for next year has not been included in the below figures. There is a system-wide deficit forecast of £112.5m in 2024/25 • £78.2m for the rest of Health • £17.7m for North • £16.7m for South There has already been some work undertaken in NHS North HSCP on prescribing savings and financial management which has reduced the expected savings. Next steps are: • Continued review of financial planning assumptions for 2024/25 • Review of all current vacancies including length of time left vacant • Financial management of all areas of budgets currently in an overspend position • Continued service reviews including home support and self-directed support packages • Engagement working with key stakeholders, in the transformation of reform process • Collaboration with South Management Team primarily to review hosted services and joint working arrangements across Lanarkshire • Budget proposals submitted for approval • Tracking and reporting on agreed savings plans • Focus on reviewing areas of over spends James Muir requested details of timeline that will enable delivery of firm actions and what is the challenge to meet the savings targets. Ross McGuffie advised need to set a balanced budget by end of the financial year. As part
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10 of the process both partner organisations need to link together, the Council have more experience of managing financial challenges of this scale. Sessions are taking place with senior management teams and a finance board has been established- scrutiny will come from HSCP, NHS board and local authority. Brian Moore noted need to make it clear to new members that we need to set a balanced budget and the implications if we don’t. Stacey Anderson added currently reviewing induction document for new members which includes the scheme of delegation. Cllr McBride requested that the presentation be shared with the group. It was noted there will be a liaison session on 13th March to focus on the budget. The committee acknowledged the financial update. 12. Financial Monitoring The report shared provided a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period 1 April 2023 to 31 December 2023. As detailed in within the report, the IJB projected outturn position, prior to removal of ring-fenced funding, is an underspend of £5.796m, assuming the current trajectory of spend continues until the end of this financial year. A summary of the main variances including financial challenges and key pressures are highlighted below: Employee Costs – underspend of £10.518m There are continuing challenges in terms of recruitment and retention across all service areas. Recruitment plans continue to be progressed to fill vacancies as quickly as possible however this is proving challenging in the current market. Payments to Other Bodies (PTOB) – overspend of £1.229m There are two main areas of overspend within PTOB which are independent care homes and self-directed support (SDS) costs. Independent care homes have a yearly budget to fund 1,361 care plans but at present the number of projected care plans is 1,501 resulting in a projected overspend of £0.708m. SDS is similarly overspend due to a budget to fund 2,617 care plans against 2,817 estimated care plans for 23/24. In line with the IJB strategy to address the demand pressures within the plan, a drawdown of £2.337m from the social care demand reserve is being used to offset the current projection. An action plan is currently under development which focuses on overdue client reviews and ensuring outcomes and budgets are aligned.
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11 Prescribing – overspend of £0.824m The current overspend is attributable to the continued increase in costs associated with the number of medicines being prescribed. This projection is based on actual prescribing data available to September 2023. The forecast will be updated as further data becomes available. Similar to the increase in SDS demand, the prescribing increase was in part forecast and reported in the financial plan and therefore a drawdown of £3.835m from the prescribing reserve is being used to offset the current overspend. Work continues to mitigate this overspend through the savings program and from a non-recurring allocation being issued to fund the pharmacy tariff increase amounting to £1.598m for the IJB. North Lanarkshire Hosted Services – overspend by £2.641m The 3 main areas of overspend within the NL hosted services relate to continence service, children services and prisoner healthcare, due to increases in product costs and additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. There is also an increase in costs linked to the delivery of the new pharmacy contract and drug price associated with prisoner healthcare. Phillip Couser asked where can we realistically close the vacancies gap and manage the impact on temporary staff. He also queried noted if there are seasonal variations in prescribing which show particular patterns. Trudi Marshall noted have a level of vacancies across the system not filled but we don’t want to remove these as there is still a level of unmet need, looking at new roles coming into the system such as assistant practitioners and apprentices. Medical colleagues are also looking at vacancies and manage use of locum staff. Stacey Anderson advised in summer can see peak in patients stocking up on medication for holidays and then around October public health messages increase which encourages prescription uptake. Cllr McBride noted that social care services have a high vacancy level, how is it developing currently. Amanda Kilburn advised awaiting Mental health outcomes funding unfortunately the wrong amount has been allocated and it was only issued last week. In social care its social care mainstream vacancies where the rate is coming down, Amanda Kilburn will provide a breakdown of the figures with the group. The IJB PFA committee: (1) Acknowledged the contents of the report; and (2) Acknowledged the projected outturn for 2023/24 is an underspend of £5.796m. AK
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12 13. IJB Reserves Strategy 2023/24 A paper was shared with the committee to provide an update for IJB reserves. Consistent with a number of other Health and Social Care Partnerships, an underspend was reported to the IJB on 21 June 23 totaling £35.495m and was transferred to reserves. This 2022/23 underspend included funding made available by the Scottish Government to progress policy commitments and national priorities. The reserve balances at 31 March 2023 were £97.946m. This figure comprised of £47.408m earmarked reserves to support the delivery of projects which span financial years and £27.577m ring-fenced monies to enable the IJB to deliver on specific Scottish Government funded programmes. The remaining balance of £22.961m, are risk-based and contingency reserves which are not held to meet any specific liability and offer the IJB some flexibility to deal with unforeseen events or emergencies. When reviewing reserves have identified £10.183m of reserves which are no longer needed for the originally purpose. Would look to move this money into contingency reserves if agreed by the committee. Ross McGuffie added some areas we have not been able to progress and for others funding has come from other sources. Brian Moore asked will Scottish Government look to claw back any spend which has not been spent as planned. Ross McGuffie advised they do not mechanism to claw back on ring fenced contingency reserves. Amanda Kilburn added only clawed back covid funding last year which they allocated and for long covid the reserve sits within the council budget, it was created around 3 years ago and it has never been needed. Cllr McBride noted there has been some discussion around ring fencing certain areas of the council budgets do we need to do the same. Amanda Kilburn advised ring fenced reserves are from Scottish Government, they can only be used for the purpose the outline. Earmarked reserves are created by the HSCP locally to meet areas of demands, if something came up that required funding would create a new ear marked reserve and bring back to the committee for approval. The IJB PFA Committee: (1) Acknowledged the contents of the report; and (2) Approved the proposed realignment of reserves in appendix 1 of the report.
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13 14. Q2 Performance Report The Chief Officer has joint quarterly performance review meetings with the Chief Executives of NHS Lanarkshire and North Lanarkshire Council. These meetings are supported by a Chief Executives Performance Framework, comprising a range of performance measures taken from across both the health and social work systems, including relevant targets and trajectories for the measures presented. Each quarter there are areas for improvement identified within the performance framework; these are identified using a RAG rating and those measures that are flagged as Red or Amber are subject to improvement or corrective action. The performance review meetings are used as a means for jointly agreeing these actions. Area identified in this report as rated as red are as follows: Cervical screening Childhood Immunisations 6-8 week reviews Reablement and Rehabilitation CAMHS Medical Paediatrics Speech & Language Therapy Dietetics Adult Social Work Ross McGuffie advised performance scrutiny panel has been running for the last few months, it bring in reps from each service which is RAG rated as red or amber for assurance. Brian Moore noted Speech & Language Therapy (SLT) did previously provide a more detailed report. Also for CAMHS we are still not achieving the target set. He asked is there anything the committee should be aware of now. Ross McGuffie advised for SLT there is a programme board to support the service and now getting more accurate data. Ross McGuffie advised for Q3 the CAMHS figure is over 70% and seeing rapid improvement every month in the next cycle of CAPA there has just been a delay linked to reporting cycles. The IJB PFA committee noted the report. 15. Risk Register The report provides a summary to the IJB PFA on risk management activity, noting any amendments or additions to the current risk register.
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14 A full review of the risk management reporting within the IJB has taken place as part of the risk strategy review and in line with the dynamic developments and changes the new NHS Lanarkshire Risk Manager is implementing within the board. This review included how risk reporting is managed and presented at IJB and a further evaluation of the improvement methodology aligned with the risk actions. In order to provide a robust overview of these developments, a risk management session was held at the IJB Liaison Session in November. Moving forward the IJB will continue to receive a risk management overview report and the IJB PFA will receive a risk in focus report to enable deeper discussion around risk actions and mitigations and strength the IJB risk governance processes. The IJB currently has 17 risks identified on its IJB risk register with 11 risks rated as high or very high. The report outlined a risks in focus for the committee to consider if the current risk score and mitigations are suitable. Brian Moore acknowledged that we need to consider reviewing financial risks as more information becomes available. He proposed to add a recommendations tab in future for the committee to consider updates required for particular risks. Stacey Anderson will add this for future reports. The IJB PFA noted the contents of the presentation which includes a review of the highest rated risks within the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. SA 16. Risk It was noted to consider continued funding for hospital at home and financial risks going forward. 17. Date of Next Meeting 22nd May 2024 2pm-4.30pm