Combined IJB Pack 25.9.24

North Lanarkshire Council · 25 September 2024
Back to Health and Social Care Integration Joint Board — 25 September 2024 and its agenda

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A meeting of the IJB will be held on 
Wednesday 25th September 2024
at 2pm-4.30pm via MS Meetings
If anyone would like to join this meeting, please contact the governance team 
at NLHSCPGovernance@lanarkshire.scot.nhs.uk  for the relevant information.
Chair: Cllr Anne McCrory 
AGENDA
No. Item Action Attachment Reporting
1. Welcome &
Apologies 
For Noting  Chair
2. Declaration of
Interests
Members are invited to
declare any interest in
relation to agenda items
Board
Members
3. Minutes IJB
( 19th June 2024)
For Approval Attachment Chair
4. Minutes IJB PFA
( 21st August 2024)
For Approval Attachment Chair 
5. Matters Arising/
Rolling Action Log
For Noting Attachment Chair
6. Chief Officer
Update
For Noting Verbal Ross
McGuffie
Strategic Planning & Development
7. Mental Health
Hospital Based
Clinical Complex
Care
For Approval Attachment Ross
McGuffie 
8. Primary Care
Transformation
For Noting Attachment Ross
McGuffie
Performance & Finance 
9. Integration Joint
Boards Finance
and Performance
Report 2024
For Noting  Attachment Ross
McGuffie
10.  Audit Scotland
Annual Audit
Report 2023/24.   
To Follow John Boyd?
11. Audited Annual
Accounts 
To Follow Ross
McGuffie 
12. Financial
Monitoring
For Noting Attachment Ross
McGuffie

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13. Annual
Performance
Report 2023/24
For Approval Attachment Morag Dendy
Governance & Policy 
14. Risk Update For Approval Attachment Stacey
Anderson
15. Registered Social
Landlords
For
Endorsement
Attachment Morag Dendy
16. Appointment of the
Chief Officer,
Health and Social
Care Partnership 
To Follow 
For Noting 
17. Risk Consider from the business discussed any
new emerging risks to be added to risk
register or whether the discussion materially
alters the accessed levels of risk/risk
tolerance or mitigating controls 
18. Date of Next
Meeting
4th December 2024
9.30am-12pm
For Noting

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ITEM 3  Integration Joint Board
Committee 
Minutes from a meeting held on Microsoft Teams
on Wednesday 19th June 2024 at 9.30am-10.55am 
Present:  
Voting
Members:
Councillor Claire Barclay North Lanarkshire Nominated Councillor 
Councillor Bob Burgess North Lanarkshire Council Nominated Councillor 
Phillip Couser  NHS Lanarkshire Nominated Non Exec Director 
Councillor Paul Kelly North Lanarkshire Council Nominated Councillor 
Councillor Anne
McCrory(Chair)
North Lanarkshire Council Nominated Councillor 
Brian Moore  NHS Lanarkshire Nominated Non Exec Director
Non-Voting
Members:       
Professional
Advisors
Amanda Kilburn Chief Finance Officer North HSCP 
Ross McGuffie Chief Officer, North Lanarkshire HSCP
Stakeholders: Margaret Gibb Interim Chief Exec, VANL
Third Sector Rep 
Cathy McGinty NHSL Partnership/Staff Side Rep 
Harry Robertson Carer Representative 
Elizabeth Seaton
(left 10.25am)
Carers Together 
OFFICER IN
ATTENDANCE:
Stacey Anderson Support Services Project Manager 
Stacey Connor (Minutes) Governance Support Manager 
Morag Dendy Chief Officer Planning, Performance & Quality 
Mark Dell Communications Manager 
Diane Fraser Chief Officer Adult Social Work Services 
Peter McCrossan Director of AHPs 
Des Murray Chief Executive NLC 
Sharon Murray Interim Nurse Director NLHSCP 
Dr Josephine
Pravinkumar
Director of Public Health 
Dr Tyra Smyth  General Practitioner  (GP) 
Maggs Thomson
(Left 10am)
Head of Health North HSCP   
APOLOGIES: Paul Carey Audit Scotland 
Nauman Dar  NHS Lanarkshire Nominated Non Exec Director 
Dr Kenneth Dagg Secondary Care Medical Practitioner

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Jann Gardner Chief Executive NHS Lanarkshire 
Alison Gordon  Head of Children & Families & Justice Services
CSWO of NLC 
Dr Lucy Munro Medical Director NL 
Fiona Owens Audit Scotland 
John Watson Employee Representative NLC Unison 
Siobhan White NHS Lanarkshire Nominated Non Exec Director 
Maria Williamson Senior Manager, Quality Assurance 
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 of IJB (27th March 2024) 
The previous minutes were agreed as an accurate reflection of the discussion.     
4. Matters Arising/ IJB Action Log     
Matters Arising 
There were no matters arising. 
IJB Action Log 
Ross McGuffie updated the committee regarding the below actions: 
IJB Self-Assessment Report – Audit Scotland have re started the self-
assessment work so looking to start this again, due to the changes in membership
it is planned to discuss this at the liaison session in November to give new
members some time to settle in. 
Improving Cancer Journey- Paper planned to be shared for IJB PFA in August. 
National Care Service- Update for mosaic is on today’s agenda. 
5. Chief Officer Update     
Ross McGuffie provided the committee with a verbal update as follows:
 Running senior team walk rounds across different services which picks
up on feedback from iMatter around visibility if the senior leadership
team.

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 Health promoting health service in acute is pushing a different way of
working to take a more holistic approach for patients to have an improved
way of life – links to the back to basics discussed at the June liaison
session.
 Chryston has officially opened now and a future IJB will be held here,
seeing opportunities for joint working already. 
 A public health round table event was held on prevention to focus on
population health and wellbeing. Locally have a public health action team
established with a focus on obesity – starting to look at the key prioritises
for all partners.  Working on a whole system agreement for physical
activity as part of this work. 
 Held a development session with Strathclyde university to look at the
work on going-looking at areas of potential development
 National NHS Scotland conference was last week Morag Dendy and
others presented the work undertaken by the home assessment teams
within Lanarkshire – taken half delayed discharge bed days out of the
system. 
 Regional planning session held to look at collaboration around regional
planning – looking to push as much service delivery at a local level. Key
priorities are around- oncology, vascular and diagnostics.
 Focus will be to reach 1410 delays nationally for delayed discharges this
equates to 34.6 per 100 thousand of the population. 
Brian Moore asked how will the public health action team updates come through
this committee. Ross McGuffie advised will work together to pull a whole system
piece. Planning to establish an overarching steering group to look at the agenda
as a whole to then commission workstreams to progress particular areas. The
overarching group would report to the NHS board, council committee and IJB. Dr
Josephine Pravinkumar added there is national learning that can be used to assist
this as well. 
6. Digital System Transformation- Mosaic       
A report was shared to detail the scale and scope of digital system transformation
taking place across social work and social care and setting out the progress of the
implementation and integration of the following digital products within North
Lanarkshire:
 Mosaic – New Social Work & Social Care Case Management System
 CM2000 – Dynamic Scheduling System for Care at Home Services
 ELMS2 – Equipment Management System (Integrated Equipment &
Adaptation Service) 
The project is entering a critical phase with a planned go Live date of October
2024 and further details of the project timeline are included within the paper. 
The digital system transformation activity taking place across the partnership is
considerable and the key projects detailed within this report are all entering critical
phases and will all go Live before the end of this calendar year. Each of the project
teams continue to work with all stakeholders, including Senior Managers, front line

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staff and integrated teams across the partnership, to ensure a smooth transition
as each produce goes live and to ensure the benefits outlined within the report
are realised.   
The council digital team has done some work to look at the strategic approach in
preparation of the system moving to the cloud. The team is in place and there are
governance mechanisms to support delivering staff training for the new system.
Information in section 5.11 of the report outlines the requirements of what is
needed to run the service on a daily basis. 
Cllr Kelly asked will health staff have access to information with the new system
and is there some flexibility to change the go live date if there are any issues.
Morag Dendy replied the cloud based element of the system will allow access for
health staff. In terms of the timescales there is some flexibility but there is close
oversight with the governance of the programme as well as close relationships
with the providers to manage any issues early on. 
Phillip Couser asked how do we ensure that this digital transition is not just a new
IT package but transformational change. He added what reporting will come to
this committee. Morag Dendy replied in terms of the transformational change this
has been supported by a number of workshops to future proof the service in terms
of practice particularly recognising that when SWISS became dysfunctional
workarounds were discovered so acknowledge this going forward. For the data
and reporting the performance team have been running reports and involved in
the work which is reporting into the chief executive performance reviews. 
Brian Moore requested that at the next PFA committee can additional financial
information be provided to give the committee the assurance needed as they have
provided funding for the work; this was noted and Morag Dendy will progress. 
The IJB committee:
i. Note the content of the report.
ii. Acknowledge the progress made towards the implementation of new digital
systems across the partnership, and their associated benefits. products. 
MD   
7. Mental Health and Wellbeing Delivery Plan     
The Mental Health and Wellbeing Strategy Board and the majority of project
groups were stood down in March 2020 due to the COVID-19 pandemic. Whilst
Strategy delivery was restarted in January 2021, there was a further disruption
over the summer of 2021 when all non-essential meetings were stood down owing
to the pressure on services. 
Over the course of 2022, we were able to look forward, endeavouring to take
advantage of the opportunities and experiences of working in different ways. All
workstreams reviewed their delivery plans to ensure that they took account of the
impact of Covid-19; build on our recovery plans and the new ways of working that
have developed over the course of the pandemic, whilst retaining a focus on the
vision and objectives set out in the original Lanarkshire Mental Health and
Wellbeing Strategy.

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The report outlines the progress made across all Strategy workstreams and sets
out our progress in developing a Mental Health and Wellbeing Delivery Plan for
Lanarkshire aligned to Scotland’s Mental Health and Wellbeing, the new national
Mental Health and Wellbeing Strategy launched in 2023 by COSLA and the
Scottish Government. 
Ross McGuffie highlighted there are now 4 different workstreams from the original
plan, a new programme of work around national suicide prevention plan and an
annual recovery plan.  Transformed the approach at emergency department
pulled together community responses to reduce police responses to 68% and
supporting individuals going through stress and distress; pulling together a
national work shop on this. 
The next strategy will undertake a gap analyses against the national strategy to
create an action plan which is Lanarkshire specific. Plan to bring next delivery plan
back to the committee around September/ October 
Dr Tyra Smyth noted there are significant challenges in different areas of the
system. Ross McGuffie responded to offer some assurance around work being
undertaken to manage potential gaps. 
Phillip Couser asked will the current strategy be removed and replaced by the new
action plan. Ross McGuffie advised when the plan runs out it will be replaced with
the national plan and action plan supporting the work. 
The following recommendations were agreed:
(1) Acknowledges the process and timeline to develop a Lanarkshire Mental
Health and Wellbeing Delivery Plan aligned to the National, Scottish
Government/COSLA Mental health and Wellbeing Strategy and separate Delivery
Plan, both published in 2023;
(2) Agrees to receive the final draft Delivery Plan for approval at its next
meeting in September 2024;
(3) Agrees that Delivery Plan will subject to the endorsement of South
Lanarkshire IJB; NHS Lanarkshire Board; North and South Lanarkshire Councils;
and North and South Lanarkshire Community Planning Partnerships.   
8. Public Health Annual Report     
Dr Josephine Pravinkumar present the committee with the annual public health
report.  This year Dr Pravinkumar has taken the opportunity to reflect on key Public
Health priorities which featured in the previous annual report 2021/22 and she has
viewed this reflection through the “What we Said” and “What Happened” lens. The
main theme of the report is around the work with anchor oganisations. Some of
the things that public health has made progress with are as follows: 
• The cost of living plan actions has been incorporated into the NHS Lanarkshire
anchor plan in order to ensure a streamlined approach.
 All oral health improvement programs and the National Dental Inspection
Programme have been remobilised; NHS dental activity has continued to
increase.

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 Progress in the area of long-term conditions in 2023 in NHS Lanarkshire
has included completion of a Test of Change (pilot) with regards to support
for patients attending the respiratory laboratory to quit smoking, which has
now been successfully incorporated into usual practice.
 Ongoing work around immunisations particularly for measles. Also looking
at Hepatitis C and V elimination programs.
 Reflecting on priorities for heath promoting health services going forward.
 Next year will be looking at children and young people as a key focus of
the report. 
Phillip Couser inquired do we have the ambition to pick some elements of the
health survey results to focus our effort as part of the preventative work as can’t
target everything. Dr Josephine Pravinkumar noted key focuses are around
obesity work, tobacco control and cardiovascular elements. 
Dr Tyra Smyth asked where is the vision to progress the work within primary care.
It was advised that there is a primary care vision session being planned to
strengthen some of the primary care approaches. 
The Integration Joint Board Committee noted the following:
(1) The lower life expectancy and higher premature deaths in Lanarkshire
compared to Scotland, and inequalities in these figures across
Lanarkshire, necessitates whole systems working as a key priority,
applying multidisciplinary, interagency, and collaborative approaches to
prevention, early intervention and ongoing care.
(2) To support the delivery of the NHSL Anchor Strategic Plan, particularly
taking a more inequalities focused approach to service delivery.
(3) Strengthen opportunities to work with other anchors on common goals to
support community wealth building which are evolving through working in
partnership.   
9. Winter Planning Business Case Report 2024 
The report shared is to provide the Board with a final report on the Winter Planning
Business Case activity. 
The Scottish Government allocated additional funding in 2021/2022 and
2022/2023 to increase capacity across the health and social care system. In
February 2022, the North Lanarkshire Integration Joint Board approved a
business case for the commitment of the additional funding, while also taking the
opportunity to target nonrecurring reserves to implement a series of proposals. 
The original business case was costed at just over £20m with a range of proposals
to enhance assessment and planning capacity across the partnership, increase
the direct provision of supports and services across a range of organisations, and
invest in key infrastructure supports to deliver the wider change agenda.   
Workstreams were established to implement plans and proposals against the
following headings:  
• Home Assessment Team

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• Enhanced Integrated Rehabilitation Provision 
• Community Nursing 
• Increased Capacity Across Home Support Service
• Assistive Technology Team 
• Hospital at Home 
• Building Capacity of Independent Sector Providers   
• Investment in Communities     
Progress has been achieved across all the workstreams within the business case,
with enhanced capacity and improvements evident across a range of services and
settings. Further work is required to ensure that the enhancements are further
embedded within Enabling Hubs and the emergent. 
Cllr Kelly asked for some reassurance that we will be able to take forward the
business case or will we need to consider additional funding sources. Morag
Dendy responded now is an opportunity to shape services going forward and align
resources to where there is the biggest impact. 
The IJB note the content of the report and endorse the achieved milestones
and next steps set out in the report.   
10. Unaudited North Lanarkshire IJB Annual Accounts 2023/2024 
The unaudited annual accounts are tabled within the report shared and have been
prepared in line with proper accounting practice but remain subject to audit by
Audit Scotland. 
As prescribed by the Local Authority Accounts (Scotland) Regulations 2014 and
in line with previous years, the unaudited annual accounts will be available for
public inspection in the Council Office for a three-week period from Monday 1 July
2024 until Friday 19 July 2024 inclusive. The Regulations also require publication
of the annual accounts on the North Lanarkshire IJB website.  The unaudited
annual accounts are therefore available online from Friday 28 June 2024 until the
date the audited Annual Accounts are published. It is planned that the audited
annual accounts will be signed off at the IJB on 25th September 2024.   
There will be a slight amendment to the list of risks to take into account a new risk
around the pharmacy pressures within the prison service, this will be corrected
before the accounts are published. 
Brian Moore noted significant underspend in mental health and addictions is there
any risks of this money being reclaimed by Scottish Government (SG) in future if
not spent.  Amanda Kilburn advised there is a plan to spend the funds which SG
are aware of. Awaiting confirmation for funding of 2024/25 have been advised
80% of letters will be issued in the first quarter. 
The following recommendations were agreed:
(1) Approve the Annual Governance Statement and associated
reports for inclusion in the statutory accounts;

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(2) Approve the unaudited North Lanarkshire IJB Annual
Accounts 2023/24 at Appendix 1;
(3) Approve the submission of the unaudited annual accounts to
Audit Scotland; and
(4) Acknowledge the arrangements for publications of the North
Lanarkshire IJB Annual Accounts 2023/24 in line with the
legislative requirements.   
11. Membership Update     
A paper was shared to advise of the replacement of 2 Non-Executive Directors
from NHS Lanarkshire and 1 elected member to the IJB and to confirm the
appointment of a new IJB chair. 
The rules about IJB membership are contained in statutory instruments and
reflected in the Integration Scheme. These state that Board members are
appointed for three years unless their membership is terminated earlier.
Membership can be renewed for further periods of three years at a time or a new
member appointed. 
Elected members – North Lanarkshire Council 
All of the current elected members have been appointed within the three-year term
of office. 
Furthermore, at the meeting of North Lanarkshire Council held on Thursday, 28
March 2024, it was agreed that Councillor Anne McCrory would replace Councillor
Michael McBride on North Lanarkshire Health and Social Care Integration Joint
Board taking effect from 28th April 2024. In addition to this Councillor McCrory
has also been nominated as Chair. 
Non- Executive Directors – NHS Lanarkshire 
The NHS Lanarkshire Board reviewed its Non-Executive Directors portfolios and
formally proposed the replacement of Mr Ally Boyle and Mr James Muir with Mr
Nauman Dar and Ms Siobhan White. Mr Phillip Courser will remain a member of
the board and Mr Brian Moore also, in addition to being the Vice Chair of the
committee. 
Ross McGuffie recorded his thanks to the contributions of Cllr Michael McBride,
Ally Boyle and James Muir. 
The IJB noted the updated membership. 
12. North Lanarkshire IJB Governance Document Update 2024 
The report provides an overview of the recently reviewed/updated governance
documents in regards to reporting for the North Lanarkshire Integration Joint
Board. A continuous review of the IJB governance documents/policy will
commence across the financial year with updates regularly being provided to the

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IJB. The report focuses on the governance surrounding the Code of Conduct and
Declaration of Interest, Directions and Record Management. 
The IJB committee:
3.1 Reviewed the updated IJB Governance Report. 
3.2 Acknowledged that the Code of Conduct and Declaration of Interest Forms
have been issued to IJB members for completion for 2024- 2025. 
3.3 Approved the recommendation to include a Directions summary as a
standing item on the IJB and IJB PFA Agenda.  
3.4 Noted the review of the Records Management Plan of North Lanarkshire
Integration Joint Board as part of the IJB Governance work plan for 2024-25.   
13. Risk Management Report     
Following on from the risk report presented at the IJB meeting on the 27th March
2024, alongside the financial update report, it was agreed by the board that the
Financial Challenges risk rating would increase from High to Very High. 
At the IJB PFA meeting on 22nd May 2024, the following risk changes were
approved: 
 Delivery of CAMHs service, risk rating reduced from High to Medium
 Ineffective Governance arrangements, risk rating reduced from Medium
to Low.
 Unscheduled Care, risk rating reduced from Very High to High.
 Introduction of a new risk relating to pharmacy pressures within prison
service rated high and adult social care (this risk is currently being
developed). 
Following these changes there are currently two other risks rated as Very High on
the IJB risk register.
 IJB 06/21 – Prescribing Activity and Costs
 IJB 01/21 – Financial Challenges 
There are six high rated risks on the IJB risk register. 
 IJB 04/21 - Notional Set Aside Budget
 IJB 12/21 - Staff Health & wellbeing
 IJB 15/22 – Cost of Living
 IJB 16/22 – National Care Service
 IJB 19/23 – Service sustainability
 IJB 20/23 – Workforce sustainability
 IJB 21/24- Pharmacy Pressures within Prison Service 
 IJB 12/22 – Unscheduled Care 
The IJB currently has 19 risks identified on its IJB risk register with 10 risks rated
as high or very high. 
The IJB note the contents of the report which includes the latest version of
the IJB risk register and a note of those operational risks highlighted by the

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Heath & Social Care North Lanarkshire partnership that impact upon
delivery of IJB business. 
Following changes to the financial position across NHS Lanarkshire, North
Lanarkshire Council and North Lanarkshire IJB agreed that the financial
challenges risk is reviewed and consideration made to increasing the risk
level of the risk from High to Very High.   
14. Risk 
There were no new risk identified. 
15. Date of Next Meeting 
25th September 2024
2-4pm

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ITEM 4                             Integration Joint Board
Performance, Finance & Audit Committee 
Minutes from a meeting held on Microsoft Teams
on Wednesday 21st August 9.30am-12pm
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 
Nauman Dar
(Left 11.05am)
NHS Lanarkshire Nominated Non Exec Director 
Councillor Paul Kelly  North Lanarkshire Council Nominated Councillor 
Councillor Anne McCrory North Lanarkshire Council Nominated Councillor 
Brian Moore (Chair) NHS Lanarkshire Nominated Non Exec Director 
Siobhan White
(Left 11am)
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: Elizabeth Seaton
(Left 9.55am)
Carers Together 
John Watson
(Joined 9.40am)
Unison Rep 
In
Attendance:
Andrea Breen
(Observer)
Senior Manager Adult Social Work 
Stacey Connor
(Minutes)
Governance Support Manager 
Mark Dell Communications Manager 
Morag Dendy Head of Planning, Performance & Quality 
Sharon Murray Interim Nurse Director North HSCP 
Sharon Simpson
(Observer)
General Manager NE Sector 
Maggs Thomson Head of Health NHSCP 
Karen Workman
(Observer)
Senior Manger Adult Social Work 
Apologies: 
Stacey Anderson  Support Services, Project Manager 
Paul Carey Audit Scotland 
Diane Fraser Head of Adult Social Work Services 
Margaret Gibb  Interim Chief Exec, VANL
Third Sector Rep 
Cathy McGinty  NHSL Partnership/Staff Side Rep

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Dr Lucy Munro Medical Director North HSCP 
Harry Robertson Carer Representative 
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 (22nd May 2024) 
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: 
Future Meeting-Working with Chryston to identify a space big enough for
December meeting to be hosted here. Also considering using meeting room
10 (new meeting room at Kirklands) for face to face meetings in 2025. 
5. Community Alarms Service     
The Community Alarm Service operates 24 hours per day, 7 days a week,
365 days per year. When the individual activates the alarm, a signal is sent
via the telephone line to the alarm receiving centre in North Lanarkshire
which is staffed 24 hours a day, 365 days a year. A Response Advisor (call
handler) speaks directly to the person to find out what kind of assistance is
required. 
Within the last report to committee the service was planning to conduct a
wide-ranging service review, however following feedback from various
stakeholders and improved Care Inspection grades it was evident that the
service was effective, staff were committed, and service users satisfied
with the support provided therefore the scope of the review was adjusted,
to focus on the staffing element of the service.   
The service has already changed around 3000 analogue alarms to a
Hybrid digital ready unit which do not use the analogue telephone line, with
a further 1000 planned to be exchanged by November 2024. 
Housing have undertaken an upgrade of all Sheltered Housing
developments to a new Warden Call system that will be fully digital ready
when the Digital ARC is implemented and are installing equipment in the

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remaining developments (which were upgraded a few years ago) to have a
Digital connection available in readiness for the move to Digital. 
During the course of the financial year 23/24 £325,000 had been spent
purchasing 1500 hybrid alarms.  It is anticipated that £1,275,000 will be
available to continue with the purchase of hybrid digital alarms in this
financial year. There is a projected increase in cost therefore a funding gap
for future years that requires to be sourced. 
The charge for the community alarm service increased to £3.57 per week
51p per day) from the 1st April 2024, despite the slight increase being
applied the charge for the community alarm service within North
Lanarkshire remains one of the lowest when compared to all other local
authorities across Scotland. A benchmarking exercise was undertaken to
further understand charging across the country.   
This report gave an update on the Community Alarm Service. It highlighted
the work undertaken for the transition of analogue to digital; both the
challenges and progress were noted. Additionally, the positive Community
Alarm Service gradings from the Care Inspectorate were recognised. From
engagement and consultation, it is agreed that the service staffing resource
requires review. Finally, it noted the service charging position. 
Phillip Couser queried is the scale of uptake where we would want it to be.
Ross McGuffie advised there is a stable position, throughout all the
changes we have not seen a change in use pattern. 
Cllr Barclay questioned for those on the new system has it been a smooth
transition or has there been any issues.  Ross advised that the early stage
of the transition was where the challenges were, as not sure where the
changes were taking place now have been linking with telephone providers
directly. 
Moving the hybrid alarms is allowing us to be ahead of the moves. Karen
Workman added we are receiving roughly 130 alarm requests a month.
The service has worked closely with the technology and housing teams to
reduce any disruptions. 
Cllr Burgess asked do we have figures on loss of units over time. Ross
McGuffie replied numbers are roughly static for active users- reduction is
due to patients going into care or deaths in the community. 
Brian Moore queried will the fire alarm compatible issue be resolved in the
future. It was advised that this would be resolved naturally though the
digital programme. 
The IJB PFA agreed the following recommendations:
(1) Acknowledged the contents of this Community Alarm Service update
report. 
(2) Acknowledge the ongoing work being undertaken to support the
transition from analogue to digital and the work completed to date. 
(3) Acknowledged the progress and challenges of progressing the move
to the new digital ARC platform and the extensive work completed to date
in preparation for this.
(4) Acknowledged the positive Care Inspectorate grading that the
service received from the Care Inspectorate.

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(5) Acknowledged the position with current and future charging for the
service.   
6. Home Support Service     
The report informed on the progress on the implementation of the redesign
of the Home Support Service which was approved in 2018. It outlined the
work that has been undertaken following the recovery from the pandemic
focusing on areas such as demand, complexity of support, workforce
challenges, new models of delivery from acute setting and changing
demographics. This demonstrates that the model approved in 2018 remains
fit for purpose and aligns with the current aims and objectives of the Strategic
Commissioning Plan. 
The model was based on the outputs of the Cross−Party Working Group, the
advice from support officers and wider officer research, the proposed new
model focuses on five major elements:
• Integrated Model (Discharge to Assess in Localities) 
• Same Day Response/Reablement/First Support (Intensive and
time limited) 
• Specialist Teams (e.g. supporting people with frequently changing
needs and end of life / Palliative Care) 
• Ongoing Paid Support (allocation of an individual budget to deliver
individual outcomes as part of SDS) 
• Quality Assurance (improving standards of care) 
The plan outlined that the Home Support Service was to be a functional
model based on two elements; assessment and planning (overall
assessment and planning activity or the service) and long-term service
delivery which will be referred to as the Living Well Service (providing
support to those with complex health and social care needs). 
The impact of change detailed showed improvement of the quality and
consistency of care and support, improved recruitment and retention,
addressed impaired staff morale, improved Care Inspectorate grades and
maximise efficiencies and capacity within the service.  This will be supported
by good governance, clear infrastructure, a skilled workforce and improved
culture and environment.   
This has been an incredible amount of work undertaken to ensure that the
operating model is fit for purpose and can adapt into the future as we
respond to whole system changes.   A further update will be provided with
the finalised operating model and associated workforce establishment to the
committee. 
Key areas of focus for the work include:
 Assessment and Planning
 Living Well Service
 Dynamic scheduling system
 Engagement particularly with other boards

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 Quality Assurance 
Demonstrator sites are operational in Airdrie and Wishaw which will be rolled
out further and updates will be brought back to the committee as the work
progresses. 
John Watson noted concerns around the volume of care commission
inspections and the impact this has on the staff. Ross McGuffie advised
Diane Fraser and Alison Gordon are picking up discussions and raising
these concerns formally with the lead inspector. In North have had 19
inspections comparted to 1 in South so looking to seek more of a balance. 
Some of the members asked were there particular reasons for North
receiving this amount of inspections. Ross McGuffie advised there are
different lead inspectors so it can be down to individual approach. Some
areas have been received grades 2 inspections with areas for improvement
identified which are being addressed; care inspectorate are aware of
improvement processed taking place. This has been raised at the national
whole system group as a concern and will be raised again. 
Cllr Kelly asked will the new dynamic scheduling be included as part of staff
training plans. It was confirmed a training team has been identified to support
staff and linking with the provider of the new system directly to offer ongoing
support. Have also identified champions for the system. 
Phillip Couser queried are trends determined by demographics for those with
complex needs. The response advised that there is an increased complexity
in some cases and clear that we are currently over providing packages so
should see a reducing number as reviews take place but increased
complexity of cases. Looking at up skilling workforce to ensure staff are as
skilled as they can be to be able to provide more complex care for patients. 
Cllr Burgess asked regarding more complex patients and is there more care
time being allocated to staff to undertake tasks. Karen Workman advised
new dynamic scheduling will assist in allocating the required time in real time
and taking into account feedback from staff around this. 
Cllr Barclay enquired are we comparable to other Health authorities for the
amount of inspections undertaken. Ross McGuffie replied we have not
looked at this data yet until we try to manage this locally but will consider this
in future. 
Brian Moore commented that despite the number of inspections there will be
opportunities for learning from the findings and further reports from the Care
Inspectorate on this service area should be brought back to the committee. 
The IJB PFA  acknowledge the developments within Home Support
Service and the progress being made to implement the approved
operating model.

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7. Home Assessment Team/ Discharge without Delay Programme Update 
In September 2021 the IJB approved the establishment of a Change Fund
to create additional capacity and support the remobilisation and redesign of
services post Covid, to enable the delivery of the Programme of Work for the
North Lanarkshire Health and Social Care Partnership, and to achieve the
ambitions set out in the Partnership’s Strategic Commissioning Plan. 
North Lanarkshire’s Home Assessment Team, (HAT), is a multi-disciplinary
social work, health and social care resource which applies a whole system
approach to planning and preparation for hospital discharge and admission
avoidance by facilitating both assessment and intervention within each
person’s own home. HAT will support by adjusting the balance of care both
at the front door and back door of hospitals. 
The report presented provided an update on the establishment of HAT in
North Lanarkshire, which includes background, progress to date, plans,
recruitment update, successes, risks and next steps. 
The delivery of high-quality support is critical to support individuals who are
at risk of admission to a hospital or who have complex discharge needs. The
improvement work to establish the Home Assessment Team (HAT) is critical
to the delivery of the Plan for North Lanarkshire and the University Health
and Social Care North Lanarkshire Strategic Commissioning Plan. 
HAT provide assessment at home with a focus of complementing
established practice and supporting service redesign and streamlining of
other key areas of work including the longer-term vision of the development
and implementation of an enabling hub approach across the North
Lanarkshire Health and Social Care Partnership. 
Cllr Kelly requested some feedback around links for HAT with health
services. Morag Dendy advised working on a video to capture the
enthusiasm of the staff and promote the service. This work is being done as
it’s what’s right for people and want staff to feel they have done a good day’s
work. Have no direct control with Acute colleagues but lots of platforms to
link in for a whole system approach. Also working with South colleagues to
develop on a Lanarkshire process. 
The IJB PFA Committee:
1. Acknowledged the report.
2. Endorsed the strategic direction of HAT and the implementation of HAT
across North Lanarkshire.
3. Acknowledged the significant development in HAT practice across North
Lanarkshire 
8. Self-Directed Support Update     
The report provided an update on the progressive implementation of Self-
Directed Support SDS) nationally and the position locally with reference to

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7 
the Self-Directed Support Framework of Standards updated by Social Work
Scotland in May 2024. The report reinforced the whole system approach to
continuing to promote maximum choice and control for people living in North
Lanarkshire. 
Self-directed support is the approach threading through all of the work of the
Health and Social Care partnership. The ability to respond to people uniquely
and continue to individualise responses including where an individual budget
supports choice and control will remain the route to mitigate the impact of
demographic change, cost of living challenges, workforce pressures and
shared pressures across health services. 
The priority of work over the next 12 months, informed by the completion of
a Self-Evaluation will be building resilience and sustainability:
• In communities – helping people to help themselves first, ensuring
the best information, advice and access to self-assessment / self
help
• In the Sector – recognising the importance of partnerships with all
stakeholders, articulating that through good market facilitation and
a focus on community wealth building
 In the workforce – training and development, fully using the care
academy and developing the role of Scottish Care 
Cllr Barclay noted some concerns –between discharge from hospital and
funding allocations being sorted is the patient linked in with. Morag Dendy
noted assessment of someone in crisis is the not the best time to establish
long term need to trying to balance short term support and longer term
capacity so constantly link with patients during the process to ensure needs
are met. 
Brian Moore referred to a Care Solutions annual report from September
2021 which contained a section on the Self Directed Support Network which
has negative comments on the experience of SDS and he requested that the
self-evaluation capture the views of individual users. 
The IJB PFA:
1. Acknowledged the progress made in North Lanarkshire to promote
choice and control through Self-Directed Support
2. Noted that a future report will be brought to detail the findings of a
Self-Evaluation and associated Action Plan   
9. Improving The Cancer Journey 
In June 2021 the North Lanarkshire IJB endorsed Phase 1 of a two-part
application to the fund to scope the local approach in partnership with VANL.
In March 2023 Phase 2 of the application was approved supporting access
to funding of £2m to improve the cancer journey across Lanarkshire, the
paper offered an update of progress since the launch of the service in March
2024.

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8 
The Improving Cancer Journey (ICJ) approach aligned to Community
Solutions, Improving Lives mobilising the community voice around cancer as
well as wider long-term conditions to complement the national approach to
inclusion, promote successful engagement with more deprived communities
and facilitate volunteering models. 
The Phase 2 Application outlined the resource provided by Macmillan, which
was equivalent to employ 3.5 whole time equivalent staff, which was
matched against the funding within the Improving Lives Initiative (ILI) of
£412,800 to employ a combined team of 10 Community Connectors. This
approach was designed to ensure everyone in North Lanarkshire diagnosed
with cancer can easily access the support they need, when they need it to
enable them to live as well and as independently as possible. 
The committee appreciated the presentation of the data and the use of
graphics. Comments were made on the referrals gender split and the
percentage of referrals by SIMD area. 
The IJB PFA  noted the progress in the provision of support for people
with a cancer diagnosis and those affected by a diagnosis to improve
the cancer journey for individuals, their carers, their families and
friends.   
10. Our Health Together   
A report was shared with the committee to present the new NHS
Lanarkshire healthcare strategy ‘Our Health Together Living Our Best Lives
in Lanarkshire’ 2024-2031.   
Our Health Together (OHT) sets out the NHS Board’s strategy for the
period dating from 2024 to 2031. The strategy was developed following an
extensive stakeholder engagement programme that ran from April to
August 2023 and involved patients, carers, our staff and local communities,
including children and young people. 
OHT provides the overarching strategic direction and is aligned to the
Transformation and Reform programme that is already underway. The
strategy also reflects both local and national priorities. The four reform
groups referenced as the priority areas of focus within the document will
become the delivery arm of ‘Our Health Together’ going forward.  These
groups will develop implementation plans for the short to medium term and
will continue to engage and involve key stakeholders in their work. 
There was a long engagement exercise to pull this work together. There
are key themes within the document around: Primary Care, Mental Health,
Urgent Care and Planned Care. 
This will be considered for future discussion at an IJB liaison session. Can
also consider linking to updates around the SCP.

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9 
The IJB PFA endorse the ‘Our Health Together’ strategy. 
11. North Lanarkshire ADP Annual Reporting Survey 2023/24 
The Alcohol and Drug Partnership (ADP) Annual Reporting Survey is
designed to collect information from all ADPs across Scotland on a range of
aspects relating to the delivery of the National Mission during the financial
year 2023/24. 
The data collected is used to better understand the challenges and
opportunities at the local level and the findings will be used to help inform
the following nationally:
• The monitoring of the National Mission;
• The work of a number of national groups including the Whole
Family Approach Group, the Public Health Surveillance Group and
the Residential Rehabilitation Working Group, amongst others;
and
• The priority areas of work for national organisations which support
local delivery. 
Once the data is analysed and findings are published at an aggregate level
as Official Statistics on the Scottish Government website 
The detail in the Annual Reporting Survey reflects the positive work reported
through the IJB in March 2024 and through the PFA in October 2023. 
National drug death figures have increased in 2023- there has been 1072
deaths reported. There were 103 deaths in 2023 for North Lanarkshire
compared to 65 in 2022 which is an increase of 38 from the previous year.
Each death is reviewed and considered to identify any learning going
forward.  The committee expressed concern about the increase in NLC and
requested that further information be brought back to the IJB PFA. 
Work has been done with HIS across Scotland to look at learning from the
differences in drug related deaths in partnerships. There is a refresh of ADP
leads and strategic leads in September which should lead to different
information sharing across Scotland. 
The IJB PFA approve the following recommendations: 
(1) Noted the content of the report
(2) Approved the Alcohol and Drug Partnership (ADP) Annual Reporting
Survey 2023/24 for submission 
12. Internal Audit Annual Report 2023 24 
The Internal Audit Annual Audit Report for 2023/2024 provided a high-level
overview of the activity undertaken by the Internal Audit teams during the
year, as reflected in the annual opinion.

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10 
Based on the work undertaken directly on behalf of the IJB and being
informed by internal audit work undertaken independently by each
respective internal audit function within North Lanarkshire Council and NHS
Lanarkshire, it is concluded that reasonable assurance can be placed upon
the adequacy and effectiveness of the IJB’s framework of governance, risk
management, and internal controls for the year ending 31 March 2024. 
Internal Audit will, as part of the agreed 2024/2025 workplan, develop and
agree arrangements to undertake follow-up work on the implementation of
actions agreed in response to relevant audit recommendations and report on
this work to the PFAC during 2024/2025. 
It was noted the overall opinion is ‘reasonable assurance’ but when you look
at the definitions at the end of the paper, there is no ‘reasonable assurance’
instead the definitions are: substantial, adequate or limited.  The committee
would like clarity of which one ‘reasonable assurance’ would fall into. 
The committee also noted comments on the timing of this report as the
committee would have preferred to have received it prior to the 2023/24
unaudited annual accounts being published in June so the governance
statement could include the internal audit opinion for the year. A request to
internal audit for 24/25 and future years would be to have this information
before the statutory publication of the unaudited accounts in June. 
Amanda Kilburn will feed both points noted above to the internal audit on
behalf of the committee. 
The IJB PFA  endorse the opinion of the Chief Internal Auditors that
Reasonable Assurance can be placed upon the adequacy and
effectiveness of the IJB’s framework of governance, risk management
and internal control for the year ended 31 March 2024. 
AK   
13. Q4 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. 
Areas identified as red and require improvement this quarter are:
• Cervical screening
• Childhood Immunisations

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11 
• 6-8 week reviews
• Reablement and rehabilitation
• Adult mental health
• SLT
• Dietetics
• Complaints
• Smoking cessation
• Adult social work 
Brian Moore asked is there any work planned to review health visitors similar
to district nursing reviews. Sharon Murray advised considering a review as
there is significant different in caseloads across areas need to look at
boundaries. Testing a HV app to improvement communication between staff
and patients. There was also discussion regarding the over reliance on
paper based systems. The current performance regarding SLT was also
noted. 
The IJB PFA noted the contents of the report and the appendix.   
14. Supporting Unpaid Carers- Carers Support Allocation   
Previous reporting to the IJB outlined the planned approach to strengthen
supports to unpaid carers. The report identified a number of carers led and
carers informed initiatives introduced over the past year, highlighting our
wider approach to engagement with, and the participation of, carers and
carer organisations. The report shared provides an update on the current
financial position and the budget allocated to carers support.
A previous report to the IJB in May 2024 provided details of support
arrangements in place for unpaid Carers and progress with the
implementation of the Carers Act.   
In addition, the response to a Freedom of Information request (released
March 2024) on the Analysis of Carers (Scotland) Act 2016 funding 2022-
2023 was included and noted the unallocated spend in North Lanarkshire
stood at £1,032,017. This figure was based on caring related spend reported
to Committee in 2022. Since then, there has been further investment in the
carer support aligned to approaches and developments outlined in our
Carers Strategy 2024-2027. The report also included details of the position
with Ear Marked Reserves related to the implementation of the Carers Act
Support Act.  The financial position reported as of 28 February 24 was
£2.596m.   
The position as of Feb 24 on Ear Marked Reserves related to the
implementation of the Carers Support Act has changed slightly with
£188,000 utilised, leaving a balance of £2.408m. As this value is non-
recurring, this will be used to support shorter term initiatives that improve
outcomes for Carers. 
The IJB PFA:
(1) Endorsed the approach to supporting Carers in North Lanarkshire

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12 
(2) Noted the current financial position and budget allocation in relation
to carers support.   
15. A Shared British Sign Language Plan for Lanarkshire 2024- 2030 
The British Sign Language (Scotland) Act 2015, required certain public
bodies including Health Board and Local Authorities to develop a BSL plan
every six years. 
A Shared BSL Plan for Lanarkshire 2024-2030, is the second shared BSL
local plan for Lanarkshire covering the work of NHS Lanarkshire, North
Lanarkshire Council and South Lanarkshire Council. 
The plan for Lanarkshire sets out actions around ten priority areas which will
be monitored through equalities forums, these are: 
• Delivery the Lanarkshire BSL Local Plan 2024-2030
• BSL Accessibility
• Children, Young People and their Families
• Access to Employment
• Health and Wellbeing 
• Celebrating BSL Culture
• BSL Data 
• Transport 
• Access to Justice
• Democratic Participation 
The IJB PFA note the contents of the report. 
16. Risk Register     
The purpose of this report is to provide a summary to the IJB PFA on risk
management activity, noting any amendments or additions to the current risk
register. 
The IJB currently has 19 risks identified on its IJB risk register with 11 risks
rated as high or very high. 
Very High Risks
• IJB 06/21 – Prescribing Activity and Costs- Sitting at 38% of target
achieved, this is for polypharmacy reviews rather than prescription switches
which means the target will continue to rise over the year. 
• IJB 01/21 – Financial Challenges 
High Risks
• IJB 04/21 - Notional Set Aside Budget
• IJB 12/21 - Staff Health & wellbeing
• IJB 15/22 – Cost of Living
• IJB 16/22 – National Care Service
• IJB 19/23 – Service Sustainability
• IJB 20/23 – Workforce Sustainability

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13 
• IJB 12/22 – Unscheduled Care 
Risks identified by H&SC NL as potentially impacting on IJB business are
highlighted in the report. 
The Pharmacy Pressures within the Prison Service is a new risk that has
been added to the IJB Risk Register as per IJB approval in June 2024. Costs
associated with this has risen substantially meaning it is an area of concern.   
Following recent performance reporting that has been presented to the IJB
focused around Speech and Language Therapy, it is recommended that a
risk relating to the performance of the Speech and Language Therapy
Service is added to the IJB risk register as detailed in the IJB Risk Overview
Dashboard. The group were in agreement that this should be added as a
risk to offer some assurance/oversight. 
Brian Moore noted previously got a list of Health and Council risk which may
impact on the committee; to consider potentially including going forward. 
Recommendations agreed:
3.1 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. 
3.2  The IJB PFA noted the inclusion of one new risk to the IJB Risk
Register regarding Pharmacy Pressures within the Prison System. 
3.3 The IJB PFA is asked to consider the addition of a risk relating to the
Speech and Language Therapy Service to the IJB Risk Register following
recent performance reports.   
17.  Risk     
There were no new risks identified.     
18.  Date of Next Meeting     
23rd October 2024
2pm-4.30pm

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ITEM 5  North Lanarkshire Integration Joint Board 
ROLLING ACTION LOG 
NO  DATE  ITEM
NO 
DESCRIPTION  ACTION
BY 
ACTION & PROGRESS  DUE DATE  COMPLETION
STATUS
2. 31.8.22 Item
6
IJB Self-Assessment
Report
R
McGuffie
Consider hosting a development session
to
further explore the self-evaluation work 
Ongoing –
future Liaison
session topic –
Planned for 13th
November 2024
Liaison
5. 19/6/24 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  
6. 19/6/24 Item
7
Mental Health &
Wellbeing Delivery
Plan
R
McGuffie
Shared new action plan with the group in
Sept/October

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REPORT 
Item No: 7 
SUBJECT: Mental Health Hospital Based Clinical Complex Care (HBCCC)
TO: Integrated Joint Board Committee
Lead
Officer for
Report:
Ross McGuffie, Chief Officer, NL HSCP
Author(s) of
Report 
Ross McGuffie, Chief Officer, NL HSCP 
DATE: 25 September 2024 
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: ☐   
This paper has been prepared by Ross McGuffie, Chief Officer and has been shared
with partners of the NHS Lanarkshire Board and North Lanarkshire Council. 
3. RECOMMENDATIONS
The IJB is asked to:
1) Note the progress made since the last update with all patient reviews completed,
a number of patients supported to mainstream care and a new in-house site
(Udston Hospital) identified for the new HBCCC service model, with
redevelopment plans now at an advanced stage.

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2 
2) Note the ongoing engagement programme with families to ensure a co-design
approach to the new facility. 
3) Request further updates to show the finalised site plans and costings once
complete. 
4.  VARIATIONS TO DIRECTIONS? 
5. BACKGROUND/SUMMARY OF KEY ISSUES
5.1 BACKGROUND
5.1.1  The IJB was updated at the meeting on 27th March 2024 that HC One formally
notified NHS Lanarkshire of its intention to terminate the existing contract for
HBCCC services at Hatton Lea. 
5.1.2  Mental Health HBCCC beds are largely used for patients with dementia
exhibiting aggressive or challenging behaviours. Previously, patients would
largely remain in HBCCC beds for life, but following a definition change in
2015, when a patient’s presentation changes they are now expected to be
moved to a more suitable and homely environment, such as a mainstream
Care Home. There is now a simple eligibility question of ‘can your care needs
be properly met in any other setting than a hospital?’, and if so, the aim is to
support the patient to be moved to a less intensive setting, which is very
positive for improving the quality of life of the individual.
5.1.3  Pre-pandemic, NHS Lanarkshire developed a Bed Modelling Plan which was
signed off by the NHS Board in 2017, which included a specific action around
reviewing the model of Mental Health Hospital Based Complex Clinical Care
(HBCCC). This resulted in the aim of the consolidation of contracted HBCCC
provision onto one site, at Hatton Lea care home in Bellshill.
5.1.4 In November 2022, approval was granted by both Lanarkshire IJBs to
terminate the contract at Cumbernauld Care Home, which took place on 31st
July 2024 as planned.  
5.1.5 On 25th January 2024, HC One notified NHS Lanarkshire of its intention to
terminate the contract for HBCCC beds at Hatton Lea. Extensive discussions
have been taking place with the provider since this date. 
5.1.6 At the time of HC One serving notice on 25th January 2024, there were 39
patients supported at Hatton Lea, with an annual contract cost of £3,270,493. 
Yes  ☐ No ☒ N/A ☐

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5.2 NEXT STEPS
5.2.1 Following notice of the termination of the contract with Hatton Lea, a review of
the HBCC model across Lanarkshire has taken place in order to ensure that
there is limited impact to patient care and wellbeing. 
5.2.2 All families affected were contacted by HC One on 19th March, with face to
face sessions held on site at Hatton Lea on 26th March, with representation
from HC One, NHS Lanarkshire and the Social Work departments from North
and South partnerships.  
5.2.3 All HBCCC patients have been reviewed on a multi-disciplinary basis, with
current expectations that around 12 patients will transfer into ongoing
HBCCC, with the remaining residents transferring into mainstream care. 
5.2.4 At present there are now only 20 patients remaining in the HBCCC beds at
Hatton Lea, following moves to mainstream care. 
5.2.5 In creating a new model, the focus remains on ensuring the key aspects
sought from the original review of HBCCC services are sustained: 
 Care on one central site with good transport links will be easier to access for
families and carers as well as to assess and follow up by all disciplines of
NHS Lanarkshire staff and partners in both North and South Lanarkshire.
 Opportunity exists to reinvest in the service through employment, skills and
training to provide best evidence care, treatment and rehabilitation.
 By consolidating some functions under a single site, the organisation
eliminates the possibility of different standards and practices being applied in
different areas. This is a major benefit to the patient’s wellbeing.
 Enhanced medical/nursing/AHP input within the current NHS Lanarkshire
Mental Health estate would enable an improved care pathway, including
robust multi-disciplinary assessment prior to admission and review focussed
resident’s individual needs; improved care planning leading to improved
throughput; and improved patient and carer outcomes.
 Meeting each patient’s changing care needs through robust multi-disciplinary
assessment will ensure more positive patient /carer outcomes whilst
identifying changing care requirements that would precede residents moving
to future clinically appropriate care settings.
 Achievement of NHS Lanarkshire’s strategic objective of achieving best
outcomes and value for money, ensuring that all resources are deployed to
best effect, achieving transformational change in desired outcomes and value
for money. 
5.2.6 On 11th March, NHS Lanarkshire issued a preliminary market brief to invite
expressions of interest for external provision of an HBCC service, but no
notices of interest were received. On that basis, attention turned to providing
an in-house model. 
5.2.7 A ward at Udston Hospital has since been identified, with significant process
made around agreeing the layout and design of the ward, creating a 17

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4 
bedded ward with en-suite bathrooms and positive day space, including
access to an outdoor courtyard. 
5.2.8 Two information evenings were held with families on 17th and 18th July on site
at Udston. Families were shown the floor plans and architect drawings to see
what the space could look like and were also shown round the CAMHS suite
to see what is possible with strong engagement. While the CAMHS facility
clearly has a different focus, it was designed in collaboration with patients and
families and feels very different to a normal NHS facility, whilst still meeting all
Infection, Prevention and Control standards. 
5.2.9 The Engagement Officer from the Children’s Services Unit that led the
engagement with patients and families for the CAMHS suite is leading the
same process for the HBCCC design. The first meeting with families was held
on 2nd September and will now continue right through until completion. 
5.2.10 Work is ongoing with NHS Lanarkshire estate’s team to finalise costs for the
work, with a projected completion date of March 2025. 
5.2.11 Positive meetings have continued with HC One to ensure continuity of care
during this transition period towards the new opening of the new facility. 
5.2.12 Monthly joint briefings are being shared with families from the partnership and
HC One. 
6. CONCLUSIONS
6.1  Since the last update to the IJB, the contract with Cumbernauld Care Home
came to an end on 31st July 2024. 
6.2  The termination of contract between HC One and NHS Lanarkshire has
resulted in the need for a further review of the HBCCC model to ensure
patient care is continuously delivered and patient needs are being met as per
the HBCCC guidelines. 
6.3 A multi-agency group has been in place to coordinate individual patient
reviews, engagement with families and the development of a new in-house
model for HBCCC services. 
6.4 A new in-house unit for HBCCC will be opened at Udston Hospital, with a
projected date of March 2025. 
6.5 Engagement continues with the families affected to ensure a positive co-
design of the new space. 
7. IMPLICATIONS
7.1 NATIONAL OUTCOMES
Link(s) to National Health and Wellbeing Outcomes

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5 
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) 
7.3 FINANCIAL 
This paper has been reviewed by Finance: 
7.4 RISK ASSESSMENT/RISK MANAGEMENT 
Relevant Risk Register
Details 
Current Risk Level  Risk Owner 
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 
Yes  ☒ No ☐ N/A ☐

Page 32

6 
☐ 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 
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: 
Yes  ☐ No ☒EQIA will be
developed
N/A ☐
Yes /
Date
added 
☐ No ☐ N/A ☒

Page 33

7 
8. BACKGROUND PAPERS  
None. 
9. APPENDICES 
None. 
CHIEF ACCOUNTABLE OFFICER (or Depute)   
Members seeking further information about any aspect of this report, please contact
the following; Ross McGuffie Ross.McGuffie@lanarkshire.scot.nhs.uk

Page 34

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 35

1 
REPORT 
Item No: 8 
SUBJECT: Primary Care Transformation 
TO: Integration Joint Board Committee
Lead
Officer for
Report:
Dr Mark Russell, Medical Director, South Lanarkshire University
Health & Social Care Partnership 
Author(s) of
Report
Dr Mark Russell, Medical Director, South Lanarkshire University
Health & Social Care Partnership
DATE: 25 September 2024 
1. PURPOSE OF REPORT
To outline the progress made in developing an action plan for Primary Care
Transformation. 
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: ☒ 
South Lanarkshire IJB

Page 36

2 
3. RECOMMENDATIONS 
It is recommended that the IJB:
[re
(1) Recognise the challenges facing General Practice in particular and the current
measures in place to support.
(2) Acknowledge the whole system change required to ensure sustainable
Primary Care provision for the population of Lanarkshire. 
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/SUMMARY OF KEY ISSUES
5.1 The legacy of historical primary care investment in Lanarkshire over the last
30 years - with Lanarkshire is now 12% below the National Resource
Allocation Formula share of Scottish GP practice spending - has resulted in it
now having the lowest primary care capacity in Scotland (whole time
equivalent number of GPs 30% below national average).
5.2 This has resulted in challenges for patients in accessing General Practice,
both:
 Being able to contact their GP practice.
 Getting a consultation with an appropriate clinician once they have
contacted the practice. 
5.3 General Practice access is a national issue but because of its relative
shortage of GPs, Lanarkshire is at the forefront of this challenge.
5.4 There is no national excess of GPs to attract to Lanarkshire, and the low
historic investment - in both General Practice and supporting infrastructure,
including interface pathways - makes it unlikely that it would be possible to
attract them even if there was.
5.5 The Primary Care Improvement Programme (PCIP) has delivered significant
additional resource, with a pharmacotherapy service available to every
practice, Treatment rooms delivering Community Treatment and Care
services available across every locality and responsibility for vaccination
having been taken from General Practices and moved to delivery by a central
service. In addition, new roles such as Community Link Workers have been
Yes ☐ No ☒ N/A ☐

Page 37

3 
made available to all practices. However, these interventions have not
succeeded in fully mitigating the challenges posed by the mismatch of GP
supply and demand (either nationally or locally), with the key national
deliverables not well aligned with drivers for General Practice access.
5.6 A comprehensive three horizons plan has therefore been developed to
address the challenges in General Practice: 
 Improve recruitment and retention to Lanarkshire practices.
 Work with all Lanarkshire practices to focus on improving their access
within existing resources.
 Develop alternative access routes to services for patients outside of
General Practice. 
5.7 A proactive support infrastructure has been created to assist practices who
identify that their sustainability is compromised. Senior officers meet on a
weekly basis to monitor practices with ongoing challenges and to ensure that
the Health Board’s resources are utilised to address issues and support
change within individual practices. 
6. PRIMARY CARE REFORM
6.1 The future for the provision of Primary Care lies not just with independent
contractor services, but a broad range of services which provide care which
meets the key principles of Primary Care – services which provide first contact
care in a way which is comprehensive, co-ordinated, and provides continuity
of care for patients. 
6.2 Alongside Mental Health Planned and Unscheduled care, Primary Care is a
key component of Lanarkshire’s new healthcare strategy, Our Health
Together which has previously been shared with the IJB.
6.. Given that importance of primary care to the overall healthcare system, it is
imperative that change is outcome focused. Key outcomes are:
6.3.1 Right person, right place, first time
 Ensure that patients can get access when they perceive they have an
urgent need.
 Ensure that continuity of care is maintained and that GPs are able to follow
up patients in a consistent way.
 Minimise demand on other parts of the Health system which should be
dealt with in primary care (failure demand). 
6.3.2 Patient satisfaction
 Reduce waiting times for general practice.
 Ensure that non-GP primary care services deliver to patient need and
primary care values, to ensure that patients do not present subsequently to
general practice for the same problem.

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4 
6.3.3 Effective and efficient systems
 Ensuring that GPs have timely access to diagnostics, supported by real-
time specialist advice where appropriate, to ensure that patient journeys
are completed within primary care where this is appropriate.
 Ensuring that GP have access to leading-edge Digital Systems to enable
them to manage their patients effectively. 
6.4 There are three key areas where significant change will be required to
preserve access to primary care.
6.5 Firstly, while many services currently have elements of patient self-referral, it
is evident from a recent Patient Voice project - where over 1000 patients were
contacted about their experience of accessing primary and secondary care
services - that there is very variable population understanding of the myriad of
available pathways. If future alternatives to General Practice care are to
achieve traction, a coherent model which can be easily understood is
essential.
6.6 A codesign process will therefore be required to develop an understanding of
how new services should be designed and how existing core services can the
redeveloped. In the first instance, redevelopment of core services will examine
how they can offer more comprehensive services within their exiting scopes,
so that there is less reliance on General Practice to provide senior clinical
decision-making. However, there is likely to be further opportunity for
broadening of scope within those services broad service purpose. In practical
terms, District Nursing Teams will be strengthened with Advance Practitioner
support funded from Primary Care Improvement Fund (PCIF) to improve the
management of patients on their case load, but in the longer term, they could
become the hub service leading management of all patients with significant
frailty within a locality. 
6.7 Over the last year, there has been significant investment from PCIF in
Musculoskeletal (MSK) Physiotherapy. In this first instance this will help to
reduce waiting lists, but it is planned that over time, this service will take first-
contact responsibility for the 16% of GP consultations which currently result
from MSK problems.
6.8 Secondly, many parts of the healthcare system have come to rely on General
Practice as an intermediary to connect care and to provide prescribing or
investigation requesting close to the patient. Whilst this has provided some
benefits it is important to understand the implications of this now. Data
collected in a snapshot exercise in April 2024 showed that between 7.4% and
8.7% of General Practice capacity is absorbed by this activity. This is
equivalent to 1900-2200 appointments per week – with representing capacity
could be freed up by better whole system processes and digital integration. In
addition, 19% of GP consultations were impacted by providing follow on care

Page 39

5 
for other services. A whole system programme of change will be required to
bring about this change.
6.9 Finally, the combination of necessarily altered modes of care during the
pandemic and workforce challenges has proved disruptive to patterns of care
within General Practice. Evidence from a number of practices who have taken
part in the Primary Care Access Programme shows that there are
opportunities to improve access through improvements in contact processes
and efficiency gains through improved continuity of care. There is a challenge
to deploying this at scale and it will require close working with the GP Sub-
Committee and the local general practice community. Opportunities to use
technology to improve co-ordination of care and provide new means of
communication for those who wish to use it will also need to be explored. To
complement this work, a robust communications plan with clear, transparent
and honest key messages on the future of general practice will be required.
7. CONCLUSIONS
7.1 Given the above, the focus for 2024/25 an action plan is in place targeting four
key areas of work:
 Maximising the productivity and effectiveness of existing PCIP resource.
 Development of a programme of work to ensure that is the existing
capacity of General Practice is used optimally, and exploration to identify
technology which could assist and can be deployed across all practices. 
 Utilising the infrastructure of the new NHS Lanarkshire Interface
Directorate to drive the whole system change required for the codesign of
new pathways into secondary care and ensure that community resources,
such as Community and Treatment and Care facilities are easily available
to Secondary Care without the necessity to involve General Practice.
 A programme, working with third sector groups, to codesign new
(managed service) first contact services which are comprehensive, co-
ordinated and provide continuity of care for patients where appropriate. 
7.2 Oversight of the delivery of this action plan sits with the Primary Care Strategy
Board, chaired by Director of Health and Social Care, South Lanarkshire
University HSCP. As a core workstream of NHS Lanarkshire’s Our Health
Together Strategy, programme management support is being provided by the
NHS Lanarkshire Property, Planning and Performance Directorate. 
7.3 Supporting workstreams will undertake a communications and engagement 
exercise across primary and secondary care and ensure that future Digital 
plans align with Primary Care strategic goals – such as easy access to patient 
records across all primary care services. Initial investment has been made 
using end-of-year PCIP funding, with the agreement of Scottish Government, 
in the development of a Digital Front Door platform to support access to new 
and redesigned primary care services.

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6 
8. IMPLICATIONS
8.1 Other Implications 
8.1.1 The contents of this report are material to the delivery of the IJB Strategic
Commissioning Plan 2023 – 2026, notably the following key ambitions: 
• Do the right thing first time 
• Increased focus on prevention, early intervention and tackling inequalities
by working with communities and people   
• Develop and support a workforce for the future   
8.2 Equality Impact Assessment and Consultation Arrangements 
8.2.1 An Equality Impact Assessment will be carried out as necessary within
workstreams. 
8.2.2 The voice of patients will be centred in the redesign programme. An exercise
involving telephone contact with over 1000 patients has already been
completed. A general communications and engagement plan was developed
to support the project, with a range of stakeholders engaged throughout and
at key points (including GPs, pharmacists and patients). 
8.2.3 Communities and stakeholders will be appropriately involved in service
redesign processes. 
9. 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 41

7 
10. ASSOCIATED MEASURE(S)
10.1 Employee Implications
10.1.1 Staff and Trade Union colleagues will be appropriately involved in service
redesign processes. 
10.2 Financial
10.2.1 Current financial challenges make service redesign challenging and also vital
to ensure continued high-quality care. 
10.2.2 The PCIF is now fully committed and therefore ensuring maximal efficiency in
funded workstreams is key to enabling funding to be released to fund broader
programmes of change.   
This paper has been reviewed by Finance:
Yes   No  N/A 
10.3 Risk Assessment / Risk Management 
Relevant Risk Register
Details 
Current Risk Level  Risk Owner 
Choose an item. 
10.4  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

Page 42

8 
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 
11. 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 
12. BACKGROUND PAPERS
None. 
13. APPENDICES
None.

Page 43

9 
CHIEF ACCOUNTABLE OFFICER (or Depute)   
Professor Ross McGuffie
Chief Officer, Health and Social Care North Lanarkshire 
Members seeking further information about any aspect of this report, please contact
the following:
Dr Mark Russell, Medical Director, 
South Lanarkshire University Health and Social Care Partnership
email: mark.russell@lanarkshire.scot.nhs.uk

Page 44

10 
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 45

1 
REPORT 
Item No: 9 
SUBJECT: Integration Joint Boards Finance and Performance Report 2024
TO: Integration Joint Board Committee
Lead
Officer for
Report:
Ross McGuffie, Chief Officer NL HSCP 
Author(s) of
Report
Stacey Anderson, Service Support Project Manager NL HSCP 
DATE: 25th September 2024 
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:
SLT and
shared at the
IJB Liason
Session on
11/09/2024
☒ Endorsed By: ☐

Page 46

2 
3. RECOMMENDATIONS
3.1 It is recommended that the IJB note the contents of the report. 
3.2 Follow the recommendations set out within the report including; 
• 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. 
• Ensure that the annual budgets and proposed savings are achievable and
sustainable. The budget process should involve collaboration and clear
conversations with IJB partners, workforce, people who use services and
other stakeholders around the difficult choices required to achieve financial
sustainability. 
•  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.
• Work collaboratively with other IJBs and partners to understand what data is
available and how it can be developed and used to fully 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. 
• 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. 
4.  VARIATIONS TO DIRECTIONS? 
5. BACKGROUND/SUMMARY OF KEY ISSUES 
5.1 Background   
5.1.1 This report builds on previous audits and shows that Integration Joint Boards -
IJBs - are managing in a complex landscape of unprecedented pressures,
Yes  ☐ No ☒ N/A ☐

Page 47

3 
challenges and uncertainties. In particular, the demand for services continues
to increase.
5.1.2 IJBs are supporting an aging population, with many people having multiple
and more complex medical conditions.
5.1.3 Health inequalities are widening, with the focus on crisis medical treatment
and care, rather than measures that support people maintain good health and
wellbeing.
5.1.4 It is reported that funding has decreased by 9% in real terms in 22-23 and
financial sustainability risks have been identified by auditors in the vast
majority of IJBs.
5.1.5 These are not easy issues to resolve, despite a driven and committed
workforce.
5.1.6 IJBs alone cannot address these challenges across the sector. Whole system
collaborative working is needed as part of a clear national strategy that takes
account of the wider needs of our communities. 
5.2 Finance Overview 
5.2.1 The financial health of IJBs continues to weaken and there are indications of
more challenging times ahead. 
5.2.2 IJB funding has decreased in real terms compared to 2021/22, with non-
recurring savings, arising from unfilled vacancies, led to the majority of IJBs
reporting a surplus on the cost of providing services. 
5.2.3 The majority of the total planned savings were achieved, but over a third were
only achieved on a one-off basis. 
5.2.4 Total reserves held by IJBs have almost halved in 2022/23 largely due to the
use or return of Covid-19 related reserves. 
5.2.5 The projected financial position is set to worsen, with increasing reliance on
non-recurring sources of income not being sustainable. 
5.2.6 Financial sustainability risk has been identified by auditors in the vast majority
of IJBs and Medium- Term financial plans need to be updated to reflect all
cost pressures currently known. 
5.3  Data Overview 
5.3.1 Data quality is insufficient to fully assess the performance of IJBs but national
indicators show a general decline in performance and outcomes. 
5.3.2 Data quality is insufficient to fully assess the performance of IJBs and inform
improvement of outcomes for service users with a lack of joined-up data
across the system. 
5.3.3 Available national indicators show a general decline in performance and
outcomes for people using social care and community health services.

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4 
5.4  Shifting the Balance of Care 
5.4.1 The percentage of expenditure on institutional and community-based Adult
Social Care services has largely remained static with a small increase in the
proportion spent on accommodation-based services.
5.4.2 Increase in the number of individuals receiving care at home or in the
community. However, these changes are marginal when viewed over the time
since the inception of health and social care integration in 2015.
5.4.3 Lack of social care capacity remains an obstacle to improving patient flow and
reducing the number of delayed discharges. 
5.5. Commissioning and Procurement Overview 
5.5.1 Commissioning and procurement practices for social care services continues
to be largely driven by budgets, competition, and cost rather than outcomes
for people. Improvements to commissioning and procurement arrangements
have been slow to progress but are developing. 
5.5.2 Improvements to commissioning and procurement arrangements have been
slow, with cost rather than outcomes driving decision-making. 
5.5.3 Current commissioning and procurement practices are a risk for the
sustainability of service providers and the workforce and are not always
delivering improved outcomes for people. National approaches to improve
commissioning have been slow to progress but are developing.
5.5.4 There is an increasing desire to move towards more ethical and collaborative
commissioning models but it has not yet been universally adopted. 
6. CONCLUSIONS 
6.1 In order to support the IJBs in addressing the challenges outlined within the
report, it is recommended within the report that Integration Joint Boards should: 
• 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 
• Ensure that the annual budgets and proposed savings are achievable and
sustainable. The budget process should involve collaboration and clear
conversations with IJB partners, workforce, people who use services and
other stakeholders around the difficult choices required to achieve financial
sustainability 
•  Work collaboratively with other IJBs and partners to systematically share
learning to identify and develop: 
-Service redesign focused on early intervention and prevention

Page 49

5 
-Approaches focused on improving the recruitment and retention of the
workforce 
• Work collaboratively with other IJBs and partners to understand what data is
available and how it can be developed and used to fully 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 
• 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. 
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)
7.3 FINANCIAL 
This paper has been reviewed by Finance: 
Yes  ☒ No ☐ N/A ☐

Page 50

6 
7.4 RISK ASSESSMENT/RISK MANAGEMENT 
Relevant Risk Register
Details 
Current Risk Level  Risk Owner 
Financial Challenges  Very High AK
Notional Set – Aside
Budget 
High RMcG
Service Sustainability  High RMcG 
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
Engagement and Participation
elements of this report were carried
out by Audit Scotland. 
☐ 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

Page 51

7 
7.6 INEQUALITIES & FAIRER SCOTLAND DUTY 
EQIA Completed & Fairer Scotland Impact Assessment Form Completed and
attached to report: 
EQIA added to website: 
8. BACKGROUND PAPERS
• Integration Joint Boards' Finance and performance 2024 (audit.scot)
• Integration Joint Boards' Finance and performance 2024 | Audit Scotland 
9. APPENDICES
Appendix 1- Integration Joint Boards Finance and Performance 2024 Report.   
CHIEF ACCOUNTABLE OFFICER (or Depute)   
Members seeking further information about any aspect of this report, please contact
the following; Ross McGuffie Ross.McGuffie@lanarkshire.scot.nhs.uk 
Yes  ☐ No ☐ N/A ☒
Yes /
Date
added 
☐ No ☐ N/A ☒

Page 52

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 53

9 
Appendix 1
Integration
Joint Boards
Finance and performance 2024 
July 2024

Page 54

2
Contents 
2
Key messages 3
Recommendations 6
1. Introduction 7
2. The context 11
3. Financial performance 15
4. Performance 26
5. Commissioning and procurement 42
Endnotes 48
Appendix 1 50
Appendix 2 58 
Audit team
The core audit team

Page 55

3
Contents 
3
consisted of:
Kathrine Sibbald, Zoe
McGuire, Chris Lewis,
Chris Dorrian and
Philip Keane, under
the direction of Carol
Calder.

Page 56

Key messages 3 
3
Key messages 
1 Integration Joint Boards (IJBs) face a complex landscape of
unprecedented pressures, challenges and uncertainties. These
are not easy to resolve and are worsening, despite a driven and
committed workforce. The health inequality gap is widening,
there is an increased demand for services and a growing level
of unmet and more complex needs. There is also variability in
how much choice and control people who use services feel
they have, deepening challenges in sustaining the workforce,
alongside increasing funding pressures.
2 We have not seen significant evidence of the shift in the
balance of care from hospitals to the community intended by
the creation of IJBs. They operate within complex governance
systems that can make planning and decision making difficult.
They cannot address the issues across the sector alone. Whole-
system collaborative working is needed as part of a clear national
strategy for health and social care that will promote improved
outcomes across Scotland but reflects the need to respond to
local priorities.
3 The workforce is under immense pressure reflecting the wider
pressures in the health and social care system. Across the
community health and social care sector there are difficulties 
in recruiting and retaining a skilled workforce. The Covid-
Key messages

Page 57

Key messages 4 
4
19 pandemic, the cost-of-living crisis and the impact of the
withdrawal from the European Union have deepened existing
pressures. Unpaid carers are increasingly relied on as part of the
system but are also disproportionately affected by the increased
cost-of-living. Without significant changes in how services are

Page 58

Key messages 5 
5
provided and organised, these issues will get worse as demand
continues to increase and the workforce pool continues to
contract.
4 Uncertainty around the direction of the plans for a National
Care Service and continued instability of leadership in IJBs
have also contributed to the difficult context for planning and
delivering effective services. We are seeing examples of IJBs
trying to work in new and different ways, but there is a lack of
collaboration and systematic shared learning on improvement
activities.
5 The financial outlook for IJBs continues to weaken with
indications of more challenging times ahead.
• In common with other public sector bodies, financial
pressures arising from rising inflation, pay uplifts and Covid-
19 legacy costs are making it difficult to sustain services
at their current level and, collaborative, preventative and
person-centred working is shrinking at a time when it is most
needed.
• The financial outlook makes it more important than ever that
the budget process involves clear and open conversations
with IJB partners, workforce, people who use services and
other stakeholders around the difficult choices required to
achieve financial sustainability.
• Overall funding to IJBs in 2022/23 decreased by nine per
cent in real terms or by one per cent in real terms once
Covid-19 funding is excluded. The total reserves held by IJBs
almost halved in 2022/23, largely due to the use and return of
Covid-related reserves. The majority of IJBs reported notable
savings, but these were largely arising on a non-recurring
basis from unfilled vacancies.

Page 59

Key messages 6 
6
• IJBs have had to achieve savings as part of their partner
funding allocations for several years. The projected funding
gap for 2023/24 has almost tripled, in comparison to the
previous year, with over a third anticipated to be bridged by
non-recurring savings, with a quarter of the gap bridged using
reserves. This is not a sustainable approach to balancing
budgets.
6 Data quality and availability is insufficient to fully assess the
performance of IJBs and inform how to improve outcomes
for people who use services with a lack also of joined up data
sharing. However, available national indicators show a general
decline in performance and outcomes.
7 Current commissioning and procurement practices are driven
largely by budgets, competition, and cost rather than outcomes
for people. They are not always delivering improved outcomes
and are a risk for the sustainability of services. Improvement to
commissioning and procurement arrangements has been slow
to progress but is developing. There are some positive examples
of where more ethical and collaborative commissioning models
are being adopted.

Page 60

Recommendations 6 
6
Recommendations 
This report and the recommendations focus on IJBs, however
to respond to the significant and complex challenges in primary
and community health and social care all the bodies involved
need to work collaboratively on addressing the issues – IJBs alone
cannot address the crisis in the sector. The next iteration of this
annual report will be produced jointly with the Auditor General 
for Scotland and will take a whole system approach and will make
recommendations to the Scottish Government, councils, NHS boards
as well as IJBs, as appropriate.
Integration Joint Boards should:
• 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
• ensure that the annual budgets and proposed savings are achievable and
sustainable. The budget process should involve collaboration and clear
conversations with IJB partners, workforce, people who use services and other
stakeholders around the difficult choices required to achieve financial sustainability
• 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
• work collaboratively with other IJBs and partners to understand what data is
available and how it can be developed and used to fully understand and improve

Page 61

Recommendations 7 
7
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
• 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.

Page 62

1. Introduction 7 
7
1. In 2022 and 2023 the Accounts Commission published a bulletin
setting out the financial position of the 30 Scottish IJBs. This year’s
report expands on this and provides a high-level independent analysis of
IJBs, commenting on: 
• the financial performance of IJBs in 2022/23 and the financial
outlook for IJBs in 2023/24 and beyond
• performance against national health and wellbeing outcomes and
targets alongside other publicly available performance information
• a ‘spotlight’ focus on commissioning and procurement of social
care. 
2. This report focuses solely on IJBs. While it comments on how
they interact and perform within the wider system, the work does
not comment on the work of councils, NHS boards or the Scottish
Government or make recommendations to these bodies. In future
reports we will expand the scope to include these public bodies.
This will allow us to consider community health and social care as a
whole system and look at how different parts work together when
planning and delivering services. 
3. Supporting this report we have also published: 
• a supplement collating the performance information considered in
the report
• a checklist of questions, based on the issues raised in this report,
for IJB board members to consider
• a summary of the discussion at a stakeholders’ roundtable session
we hosted in February 2024 that has helped inform this report.
1. Introduction
About this report

Page 63

1. Introduction 8 
8
What is an IJB? 
4. An IJB is responsible for the governance, planning and resourcing of
social care, primary and community healthcare and unscheduled hospital
care for adults in its area. 
5. The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act)
requires the 32 Scottish councils and 14 territorial NHS boards to work
together in partnerships to integrate how social care and community
healthcare services are provided. IJBs were created as part of the Act as
separate legal bodies. Exhibit 1 (page 9) sets out how these IJBs
operate. 
6. There are 31 partnerships across Scotland. Stirling and
Clackmannanshire councils have formed a single partnership with NHS
Forth Valley. The majority of NHS boards have a partnership with more
than one IJB and five IJBs cover the same geographical area as their
health boards. 
7. Highland follows a different arrangement, a Lead Agency model.1 This
Accounts Commission report focuses on the work of the IJBs and does
not comment on the performance of the Highland Health and Social
Care Partnership as its scrutiny sits with the Auditor General for Scotland
rather than the Accounts Commission. 
8. The aim of integration is to ensure that people receive the care
they need at the right time and in the right setting, with a focus on
community-based, preventative care; improving the outcomes for
patients, people who use services, carers and their families. The services
are provided by a mixture of public, private and third sector providers
dependent on who is most suitable to deliver those services. 
9. The Act sets out which services are required to be delegated by
councils and NHS boards to the IJBs as a minimum. This includes social
care and primary and community healthcare. Services within this scope
include for example, services for adults with physical disabilities, mental
health services, drug and alcohol services and unscheduled health care.
Some IJBs have also integrated other services. For example, 11 IJBs also
have strategic responsibility for children’s social care services and 16 IJBs
have strategic responsibility for criminal justice social work.

Page 64

1. Introduction 9 
9
Service delivery
• IJB directs the NHS board and
council to deliver services 
• The extent of the IJB’s
operational responsibility for
delivering services is defined by
the level of detail included in its
directions to each partner. The
more detailed its directions, the
more it will monitor operational
delivery. 
NHS board
and council 
Level of operational
responsibility 
Accountable to:
the electorate
Accountable to:
Scottish ministers and
the Scottish Parliament,
and ultimately the
electorate
IJB
• Responsible for planning
health and care services
• Has full power to decide
how to use resources
and deliver delegated
services to improve
quality and people’s
outcomes
Council
• Delegates specific
services to the IJB
• Provides money and
resources
NHS board
•
•
Delegates specific
services to the IJB
Provides money and
resources
Jointly accountable to:
council and NHS board
through its voting
membership and
reporting to the public
Exhibit 1.
How IJBs work
NHS board and
council accountable
to IJB for the
delivery of services
as directed

Page 65

1. Introduction 10 
10 
IJB 
Source: What is integration? A short guide to the integration of health and social care services
in Scotland, April 2018, Audit Scotland 
IJB accountable
for overseeing the
delivery of services

Page 66

1. Introduction 11 
11 
10. Audit Scotland has published reports and is currently undertaking
work, on behalf of the Accounts Commission and the Auditor General
for Scotland, on some of these service areas. 
• Adult mental health Report published 13 September 2023.
• Children and young people who need additional support for 
learning Blog published 17 May 2022.
• Drug and alcohol services: An update Report published
8 March 2022 and Drug and alcohol services – audit scope
Ongoing work to be published Autumn 2024.
• Social care briefing Report published 27 January 2022.
• General Medical Services contract progress Audit scope report
to be published spring 2025.

Page 67

2. The context 11 
11 
11. Social care and primary and community healthcare services in
Scotland currently face complex and unprecedented pressures and
challenges. These challenges are not easily resolved and are worsening.
There is an increased demand for services, deepening challenges in
sustaining the workforce, alongside increasing financial pressures. These
longstanding challenges have been exacerbated by the cost-of-living
crisis, increasing cost of provision of services and a changing policy
landscape. The Covid-19 pandemic has also had a lasting impact on this
sector, given the impact on health and social care staff and the need to
continue to protect vulnerable people. 
12. The Independent Review of Adult Social Care2  (Feeley Review)
(published in February 2021), and the scrutiny of the National Care 
Service (Scotland) Bill has stimulated a lot of public debate and
consideration of the need for change in the sector. But, to date there has
been limited change for people experiencing or working in social care.
It is important to emphasise that this is not a reflection on individuals
working in the sector. Our experience, through this work, is that those
involved, at all levels, are driven and passionate about improving the lives
of people who need support. 
13. IJBs cannot address the issues across the sector alone, whole-
system collaborative working is needed as part of a clear national
strategy. In the Auditor General for Scotland’s NHS in Scotland 2023
report, he stated that ‘there are a range of strategies, plans and policies
in place for the future delivery of healthcare, but no overall vision. To 
shift from recovery to reform, the Scottish Government needs to lead on
the development of a clear national strategy for health and social care. It
should include investment in preventative measures and put patients at
the centre of future services’. 
IJBs are facing significant financial sustainability challenges and
cost pressures are only increasing 
2. The context
IJBs face a complex landscape of considerable challenges
and uncertainties

Page 68

2. The context 12 
12 
14. In common with other public sector bodies, financial pressures arising
from rising inflation, pay uplifts, the cost-of-living crisis and Covid-19
legacy costs are making it difficult to sustain services at their current
level. IJBs are also experiencing an increase in prescribing costs. IJBs
have had to achieve savings as part of their partner funding allocations 
for several years and achieving these savings, while maintaining service
levels, has become increasingly difficult. IJBs are now having to consider
more significant options as statutory duties have to be prioritised. This

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2. The context 13 
13 
includes ending funding for some care and support services, to ensure
financial sustainability in the medium to long term. 
The demand and need for services continue to increase and
become more complex
15. Demographic changes and the increasing complexity of care needed
are driving an increase in the demand for services. For example, an
estimated one in 25 people of all ages in Scotland received social care
support and services at some point during 2022/23. It is estimated that
76 per cent of these people are aged 65 and over, and 63 per cent are
aged 75 and over.3 An estimated 20 per cent of Scotland’s population is
aged over 65. In many rural and island areas this population group is even
higher, for example 27 per cent of the population in Argyll and Bute and
the Western Isles are over 65.4 
16. The proportion of the population over the age of 65 is projected to
grow by nearly a third by mid-2045. Since currently around three-quarters
of people receiving social care support are aged 65 or over, this means
that there will likely be a substantial rise in the number of people requiring
social care support. It is likely this pattern reflects the challenges across
most other services commissioned by IJBs. A recent study found that
93 per cent of people aged over 65 who received social care had two
or more medical conditions simultaneously.5  People over 75 are around
twice as likely to require outpatient or inpatient care compared to those
aged in their mid-20s.6 
The workforce is under immense pressure
17. Across the primary and community health and social care sector
there are difficulties in recruiting and retaining a skilled workforce.
Without significant changes in how services are provided and organised,
this issue will get worse as demand continues to increase and the
workforce pool continues to contract. The number of people aged 25-44
is predicted to fall from 1.4 million to 1.3 million by 2045. Meanwhile
the number of people aged over 75 will rise from 469,000 in 2021 to
774,000 in 2045.7 
18. We have previously highlighted how the effects of the pandemic
worsened existing pressures on the social care workforce causing
experienced staff to leave their posts. Our ongoing monitoring and
discussions with stakeholders show that these issues remain and the
cost-of-living crisis and the ongoing impact of withdrawal from the
European Union have added to the pressures. 
19. The staff vacancy rates across social care and support services
in Scotland is high. At 31 December 2022, 49 per cent of services

Page 70

2. The context 14 
14 
reported vacancies; 63 per cent of these services with vacancies
reported problems filling them. The percentage of care services reporting
vacancies had been consistent over time up to and including 2020,
before a large increase of 11 percentage points reported in 2021.8

Page 71

2. The context 15 
15 
20. Almost 90 per cent of social care providers stated recruitment and
retention was problematic for them in a survey carried out by Scottish
Care.9 This survey also found that a quarter of staff leave an organisation
within the first three months of joining. Providers find they are competing
for staff: 
• across other public, independent and third sector providers with
differences in pay and terms and conditions
• with the hospitality and retail sectors, who pay more for less
demanding roles
• with the health sector with an increasing disparity between health
sector and social care sector wages – the current pay gap is 19 per
cent between adult social care workers and NHS entry level pay. 
The cost-of-living crisis is affecting the demand for services as well
as the ability to provide them
21. The increased costs of living have exacerbated the workforce
challenges as the low wages are making it a less favourable career
choice. This is particularly an issue for those providing care at home
services who are experiencing an increase in petrol costs and are not
always reimbursed in a timely manner, or, in some cases, at all for all
their journeys. 
22. Unpaid carers are also disproportionately affected by the increased
cost-of-living crisis. People in the most deprived areas are more likely to
provide 50 or more hours of unpaid care a week compared to people
living in the least deprived areas.10 
23. The cost of provision of services has also increased. Homecare costs
per hour have increased by 19 per cent between 2016/17 and 2022/23.
Residential care costs per week (for those aged 65 and over) have
increased by 23 per cent between 2016/17 and 2022/23. There are also
significant cost differences between urban and rural areas.11 
24. In particular, for smaller, independent and third sector service
providers, increased costs are causing problems for the sustainability of
services. For example, in residential care homes, an increase in fuel costs
to heat and provide power for residents has made their financial viability
increasingly challenging. 
IJBs operate within complex governance systems that can make
planning and decision making difficult
25. We previously reported in our Health and social care integration: 
update of progress report, that the current model of governance is 
An unpaid carer is
anyone who cares
for someone who
is ill, disabled, older,
has mental health
concerns or is
experiencing addiction
and is not paid by a
company or council to
do this. Primarily, this
is a family member or
friend.

Page 72

2. The context 16 
16 
complicated, with decisions made at IJB, council and health board level.
We found that cultural differences between partner organisations are 
a barrier to achieving collaborative working and achieving key priorities.
These challenges have not been resolved.

Page 73

2. The context 17 
17 
Instability of leadership continues to be a challenge for IJBs
26. A notable turnover of senior leadership positions since the start of
health and social care integration continues to be a concern. Half of 
all IJBs experienced turnover in either their chief officer and/or chief
finance officer posts in the last two years. Across 2021/22 and 2022/23,
seven Chief Officers, 11 Chief Financial Officers, one IJB chair and one
chief social work officer changed. Instability in leadership teams has
the potential to disrupt strategic planning at a time when difficult and
significant decisions need to be made. It can affect the culture of an
organisation at a time when the workforce is under pressure. 
Plans for a National Care Service have brought uncertainty for IJBs
27. In June 2022, the Scottish Government introduced the National Care
Service (Scotland) Bill to Scottish Parliament. The Bill was intended to
ensure: 
• consistent delivery of high-quality social care support to every
single person who needs it across Scotland, including better
support for unpaid carers
• that care workers are respected and valued. 
28. The main elements of the Bill were the proposed creation of a
National Care Service, including a national board, making Scottish
Ministers accountable for social work and social care support. The
original Bill also set out to transfer social care and social work council
functions, staff and assets to Scottish Ministers or local care boards. This
put in question the role and responsibility of IJBs and caused uncertainty
for IJBs on the timescales for implementing the proposed National Care
Service and what form it would likely take. This has complicated IJBs
ability to undertake medium- and long-term financial planning. 
29. After some delays, Stage 1 of the Bill was passed in March 2024.
Amendments planned for the NCS Bill now mean IJBs will be reformed
rather than replaced by 2029/30. IJBs should therefore ensure they have
effective medium- and longer-term planning in place and continue to
drive improvements in how they commission and deliver services.

Page 74

3. Financial performance 15 
15 
IJB funding has decreased in real terms compared to
2021/22 
30. IJBs receive their funding as annually agreed contributions from their
council and NHS board partners. Funding is largely received to cover
in-year expenditure on providing services but can also be received for
specific services and national initiatives to be funded in future years. 
31. Funding to IJBs in 2022/23 decreased by £1.1 billion (nine per cent)
in real terms to £11.0 billion; a £342 million decrease in cash terms 
Exhibit 2. IJBs received £1.0 billion of additional funding in 2021/22
to support their response to the Covid-19 pandemic. Excluding the
2021/22 Covid-19 related funding, this shows an underlying decrease of
£68 million in real terms, representing a 1.0 per cent decrease. 
£553m £1,024m 
3. Financial performance
The financial health of IJBs continues to weaken and there
are indications of more challenging times ahead
Exhibit 2.
Real terms movement in IJB funding   
£10,987m  £11,025m  £10,957m

Page 75

3. Financial performance 16 
16 
2020/21 2021/22 2022/23 
Partner funding (real terms) Covid-19 funding (real terms) 
Source: IJB audited annual accounts 2020/21, 2021/22 and 2022/23 and ONS deflators

Page 76

3. Financial performance 17 
17 
Non-recurring savings, largely arising from unfilled
vacancies, led to the majority of IJBs reporting a
surplus on the cost of providing services 
32. Nineteen IJBs reported a surplus on the cost of providing services,
but these underspends were driven largely by vacancies and staff
turnover (Exhibit 3, page 17). Three IJBs reported a break-even 
position and the remaining eight IJBs recorded an overspend of two per
cent, or under, of their net cost of services. The three IJBs reporting a
break-even position did so after receiving additional funding allocations
from their partner bodies. The net underspend position on the costs of
providing services across IJBs was £110 million. 
33. The IJBs ability to meet the rising demand for their services and
maintain service quality, is weakened by unfilled vacancies. The IJBs
reporting a surplus would be unlikely to do so if the workforce was at full
capacity. 
The majority of the total planned savings were
achieved, but over a third were achieved only on a
one-off basis 
34. IJBs achieved 84 per cent of their £77 million planned savings
target in 2022/23. Over a third of this was achieved on a non-recurring
basis. This means that these savings will be carried forward to be found
again in future years. Identifying and achieving savings every year on
a recurring basis, and moving away from relying on one-off savings, is
essential for IJBs to maintain financial sustainability. 
Total reserves held by IJBs have almost halved in
2022/23 due largely to the use or return of Covid-19
related reserves 
35. By the end of 2022/23, all IJBs reported a reduction in their total level
of reserves, decreasing by £560 million to £702 million, a 44 per cent
reduction. 
36. The decrease in the overall reserves balance was largely the result
of a reduction in the reserves of funding that the Scottish Government
specifically provided for the response to the Covid-19 pandemic. The
Covid-19 related reserves decreased by 97 per cent, from £502 million
to £14 million. Auditors confirmed that over two-thirds (£333 million) of
the Covid-19 reserve reduction was a result of unused balances being

Page 77

3. Financial performance 18 
18 
returned to the Scottish Government.

Page 78

3. Financial performance 19 
19 
Eilean Siar
South Ayrshire
North Lanarkshire
Angus
Moray
Argyll & Bute
East Ayrshire
Dundee
East Dunbartonshire
South Lanarkshire
Perth & Kinross
Falkirk
Inverclyde
Fife
North Ayrshire Renfrewshire
Clackmannanshire & Stirling
East Renfrewshire
East Lothian
Edinburgh
Dumfries & Galloway
Orkney
West Dunbartonshire
Glasgow
West Lothian
Midlothian
Aberdeen
Exhibit 3.
Operational surplus as a proportion of net cost of service

Page 79

3. Financial performance 20 
20 
Scottish Borders
Aberdeenshire
Shetland 
-3 -2 -1 0 1 2 3 4 5 6 7
Percentage 
Source: IJB audited annual accounts 2022/23

Page 80

3. Financial performance 21 
21 
37. The exceptional impact of Covid-19 reserve movements can obscure
underlying reserve movements. When Covid-19 reserve movements 
are excluded, the total value of reserves was reduced by 10 per cent
(£72 million) from £760 million to £687 million. 
38. IJBs hold reserves for a variety of reasons, including reserves held
to address specific local or national policy initiatives or to mitigate the
financial impact of unforeseen circumstances. The reserves held by IJBs
consisted largely of four main areas (Exhibit 4, page 19), as follows: 
• Earmarked reserves of £426 million (£426 million in 2021/22) held
by individual IJBs for a range of local planned purposes, such as
reserves for multidisciplinary teams, interim care beds, as well as
more generic reserves associated with winter planning and local
reserves to support newer innovative practices that contribute
towards strategic change.
• Ring-fenced reserves of £79 million (£185 million in 2021/22)
provided to support Scottish Government national policy objectives.
Examples include the Primary Care Improvement Fund, Mental
Health Recovery and Renewal, Mental Health Action 15,
Community Living Change Fund and Alcohol and Drug Partnership
funding.
• Contingency reserves of £183 million (£148 million in 2021/22) that
have not been earmarked for a specific purpose. IJBs have more
flexibility on the use of this type of reserves which are often used
to mitigate the financial impact of unforeseen circumstances.
• Covid-19 related reserves of £14 million (£502 million in 2021/22),
representing all unspent funding received to support the impact of
the pandemic on IJB services.

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3. Financial performance 22 
22 
Source: IJB audited annual accounts 2022/23 
39. Reserves ring-fenced to support Scottish Government national policy
objectives saw a 57 per cent reduction of £106 million to £79 million.
These national initiatives include programmes for primary care
improvement and mental health programmes. 
40. These reserve balances largely represent non-recurring amounts 
2%
Covid-19 reserves
61%
Earmarked reserves
11%
Ringfenced reserves
26%
Contingency reserves
Exhibit 4.
2022/23 Reserves

Page 82

3. Financial performance 23 
23 
of money that can only be used for specific and defined national policy
priorities. As these non-recurring reserves are utilised, funding will
need to be identified to fund any continuing associated initiatives on a
sustainable basis. 
41. The reduction in reserves was slightly offset by increases in the
contingency reserves and other locally earmarked reserves. Contingency
reserves have continued to increase, largely as a result of unplanned
vacancy savings, and now represent a quarter of the total year end
reserves balance.

Page 83

3. Financial performance 20 
20 
Eilean Siar
North Lanarkshire
Inverclyde
West Dunbartonshire
Angus
Falkirk
Renfrewshire
East Dunbartonshire
Clackmannanshire & Stirling
Dundee
South Ayrshire
Midlothian East
Ayrshire
Aberdeen
Perth & Kinross
South Lanarkshire
North Ayrshire
Fife
Glasgow
Argyll & Bute
East Lothian
Aberdeenshire
Orkney
Scottish Borders
West Lothian
East Renfrewshire
Dumfries & Galloway
Moray Edinburgh Shetland
Exhibit 5.
Year end IJB reserves as a proportion of net cost of services

Page 84

3. Financial performance 21 
21 
Contingency as a proportion
of net cost of service 
Ringfenced/ earmarked
reserves as a proportion
of net costs of services 
0 2 4 6 8 10 12 14 16
Percentage 
Source: IJB audited annual accounts 2022/23

Page 85

3. Financial performance 22 
22 
42. Contingency reserves are uncommitted funds held by IJBs to
mitigate the financial impact of unforeseen circumstances and the
amount held will vary depending on individual IJB reserve policies. A
review of a sample of ten IJB reserve policies showed that the majority
(eight) had a contingency reserve target of two per cent of annually
budgeted expenditure. There is no statutory maximum or minimum level
of contingency reserves. 
43. Seventeen IJBs reported an increase in their contingency reserves
leading to a net increase of 24 per cent (£35 million) to £183 million
between 2021/22 and 2022/23. Across the IJBs, contingency reserves,
as a proportion of the net cost of services, ranged from zero per cent to
four per cent (Exhibit 5, page 20). Two thirds of IJBs had contingency
reserve levels of over two per cent of the net cost of services. Five IJBs
had no contingency reserves. 
The projected financial position is set to worsen 
44. Twenty five IJBs agreed their 2023/24 budget before the start of the
financial year. Delays in the agreement of savings plans and uncertainty
around NHS partner funding were the most common reasons for IJBs
not agreeing a balanced budgets before the start of the financial year. 
45. IJBs do not always receive notification of funding allocations from
NHS boards before the start of the financial year. This adversely affects
the IJBs’ ability to plan expenditure, can cause delays to decision-making
and lead to vacancies being held unfilled due to uncertainty over funding. 
46. The projected funding gap for 2023/24 has almost tripled
in comparison to the previous year. All IJBs reported an increase in their
projected funding gap with the exception of Orkney IJB. The 2023/24
projected funding gap was £357 million representing a 187 per cent
increase from the 2022/23 projected funding gap (£124 million). Funding
gaps, as a proportion of the 2022/23 net cost of services, ranged from
one to ten per cent (Exhibit 6, page 22).

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3. Financial performance 23 
23 
Dumfries & Galloway
Eilean Siar
Scottish Borders
Edinburgh
Falkirk
Perth and Kinross
Orkney
Midlothian
Moray
Argyll & Bute
South Lanarkshire
Fife
East Lothian
West Dunbartonshire
Renfrewshire
Glasgow
Clackmannanshire & Stirling
West Lothian
Aberdeen
Shetland
East Ayrshire
North Lanarkshire
Angus
Aberdeenshire
North Ayrshire
Exhibit 6.
Funding gap as a proportion of net cost of service

Page 87

3. Financial performance 24 
24 
Orkney
East Dunbartonshire
Dundee
South Ayrshire
Inverclyde 
0 2 4 6 8 10
Percentage 
Source: Auditor data return

Page 88

3. Financial performance 25 
25 
47. Of the total funding gap, 53 per cent (57 per cent in 2021/22) is
anticipated to be met by identified savings, 24 per cent from the use of
reserves, with actions yet to be identified to bridge the remaining gap 
Exhibit 7. 
Source: Auditor data return 
6%
Other
43%
Agreed savings - recurring
11%
Agreed savings - non-
recurring
16%
Unidentified savings (includes
savings for which no detailed
or agreed plans are in place)
24%
Use of reserves
Exhibit 7.
2023/24 IJB funding gap planned action

Page 89

3. Financial performance 26 
26 
The increasing reliance on non-recurring sources of
income is not sustainable 
48. At the time of the 2023/24 budget setting, over a third of the
projected funding gap was anticipated to be bridged by one-off sources
of funding, ie on a non-recurring basis. A quarter of the projected funding
gap was planned to be bridged by the use of non-recurring reserves
and a further fifth of the identified savings were anticipated to be non-
recurring. 
49. In addition, a significant proportion of the funding gap did not have
planned savings action agreed against it at the time of budget setting.
These unidentified savings made up 16 per cent of the total projected
funding gap and were the result of eight IJBs not starting the 2023/24
financial year with a balanced budget. 
50. The increased reliance on non-recurring sources of income to fund
recurring budget pressures is unsustainable in the medium to long term.
The identification and delivery of recurring savings and a reduced reliance
on drawing from reserves to fund revenue expenditure will be key to
ensuring long-term financial sustainability. 
Financial sustainability risks have been identified by
auditors in the vast majority of IJBs 
51. Auditors identified financial sustainability risks for 80 per cent of
IJBs as part of their 2022/23 audits. Findings suggested that there was
a reliance on non-recurring savings and sources of income to achieve
financial balance. 
52. As recurring savings get more difficult to identify and achieve, the
need for a more significant transformation of services, in order to achieve
financial sustainability, becomes more important. 
53. IJBs are currently facing a range of significant and growing challenges
and uncertainties impacting financial sustainability and service provision,
including: 
• uncertainty around the level and terms of future funding
settlements and funding allocations for specific initiatives
• significant recruitment and retention challenges, both with the IJB
and partner bodies and with external providers in the sector
• rising demand and increasing complexity of care arising from the

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3. Financial performance 27 
27 
demographic challenges of an ageing population
• cost-of-living crisis and inflationary cost pressures, including
prescribing costs, making it more expensive to maintain the same
level of services

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3. Financial performance 28 
28 
• ongoing legacy cost impacts of Covid-19, including vaccination
programmes, testing and Personal Protective Equipment costs. 
54. An initial analysis of 2024/25 budget setting reveals that the projected
funding gap for IJBs has increased again to £456 million. This increase
underlines the importance of IJB board members having clear and frank
conversations not only at the board level, but with partners, providers 
and the wider public, about the decisions that will be required to achieve
future savings and the likely implication these decisions will have on the
services individuals currently receive. 
Medium-Term Financial Plans need to be updated to
reflect all cost pressures currently known 
55. The majority of IJBs have an up to date Medium-Term Financial
Plan in place, but auditors found a third needed to update their plan. It
is essential that IJBs ensure Medium-Term Financial Plans are updated,
reflecting all known and foreseeable costs, to allow informed decision-
making on the delivery of sustainable service provision and reform in the
future.

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4. Performance 26 
26 
Data quality and availability is insufficient to
fully assess the performance of IJBs and inform
actions to improve outcomes for service users with a
lack of joint data across the system 
56. The Public Bodies (Joint Working) (Scotland) Act 2014 sets out 
nine National Health and Wellbeing Outcomes. These seek to measure
the impact that integration is having on people’s lives. These national
outcomes are underpinned by 23 associated national indicators, although
four indicators have not been finalised for reporting. These national
indicators have been developed from national data sources to provide
consistency in measurement. IJBs are also encouraged to devise their
own performance indicators for their area. Each IJB produces an annual
performance report which sets out publicly its performance against key
performance indicators. 
57. Our review of IJB annual performance reports for 2022/23 shows
the majority report against the key national performance indicators. All
set out performance against their own identified strategic priorities.
Some IJBs have developed their own indicators, as suggested in the
Act, to help demonstrate how they are working towards their strategic
outcomes. This allows for flexibility in reporting on local performance but
means that describing a comprehensive national picture of performance
is not possible. 
58. Published performance information is not always clearly linked
to the National Health and Wellbeing Outcomes with some gaps in
the completeness of national performance information. Nine of the
national integration performance indicators are based on the biennial
4. Performance
Data quality and availability is insufficient to fully assess the
performance of IJBs, but national indicators show a general
decline in performance and outcomes 
The IJB Performance
Supplement to this
report sets out the
performance of each
IJB against the 19
national indicators
available under the
National Health and
Wellbeing Outcomes.

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4. Performance 27 
27 
Health and Care Experience Survey (HACE). Response rates for the
HACE are generally quite low, with more deprived areas experiencing
the lowest response rates. This increases the risk that there may be
underrepresentation of the experience of certain groups of people and
areas.

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4. Performance 28 
28 
59. In our engagement with stakeholders, we heard a consistent
message that data is key to a whole system approach and performance
management needs to be redefined to reflect this. They indicated a range
of challenges around data that is currently collected: 
• The current data does not provide good evidence on how the
performance of one part of the system impacts on either other
parts of the social care system or the system as a whole. This
means the current performance data is of limited use in helping
to inform system changes which might improve performance and
deliver better long-term outcomes.
• There is too much emphasis on data that is used by individual
organisations for their governance and operational purposes rather
than the collective partnership focus on its priorities. Current
arrangements do not reflect a ‘whole-systems’ approach to
performance management and reporting.
• A lack of good data on primary care as it is voluntary for GP’s to
report.
• Data is more routinely collected and published on health services
than social care services. 
Work to improve the data sets is at an early stage
but is progressing 
60. Work is being carried out by the Scottish Government and
Public Health Scotland to improve data and allow the comparison 
of performance including the development of the Care & Wellbeing
dashboard. This was launched in November 2023 and is populated with
management information and updated on a weekly basis. IJB chairs and
chief officers have access to the system to monitor significant shifts in
performance and anomalies in the data. The system is still in its early
stages of development and use. 
61. There are other resources that can be utilised to assist in the analysis
of data. In our Health and social care integration: update of progress
2018 report we set out the existence of Local Intelligence Support Team
(LIST) analysts. Using a LIST analyst to tailor and interpret local data helps
IJBs to better understand local need and demand and to plan and target
services. 
62. There are also examples of individual IJBs starting to manage their
data in more innovative ways, for example at Midlothian IJB.
(Case study 1, page 28)

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4. Performance 29 
29 
Midlothian IJB coordinates health and social care support to nearly
97,000 people. To better understand how the IJB contributes to personal
outcomes for people, it asked all Midlothian HSCP services to track their
contribution to improving outcomes using an outcome mapping approach
by January 2024.
Outcome mapping is a way to understand how services contribute
to people achieving the outcomes that matter to them and can help
services make more targeted, locally informed decisions about how to
design, deliver or commission services. This approach allows them to
describe what they do, who with, what people learn and gain as a result,
how this makes them feel and the difference this makes in their lives.
The outcome mapping approach was developed by ‘a Scottish software
and consultancy company in partnership with the Midlothian HSCP
Planning and Performance team.
Each ‘stepping-stone’ of the outcome map framework includes a set 
of success criteria aligned to the Care Inspectorate joint inspection
framework. The outcome map is colour-coded to show an evaluation
of the extent to which the service is making progress towards personal
outcomes and confidence in how strong the evidence is to support
that progress rating. This results in a two-factor rating system for each
‘stepping-stone’ in the outcome map.
The IJB also uses outcome mapping and has developed a Strategic
Commissioning Map that provides a real-time picture of the whole
system progress towards their strategic aims and the nine National
Health and Wellbeing Outcomes by linking to service outcome maps.
Outcome mapping is now central to performance measurement in the
planning and performance teams. It is part of the triangulation of three
types of data: service activity, population experience, and personal
outcomes. The information collected from each of these three areas
together provides objective, whole system evidence that supports
services to develop meaningful action plans for change.
Currently 60 per cent of service areas are using the framework. Some
services are using this system to articulate, record, examine, and evaluate
service provision and actively using this tool to support service redesign.
Resourcing pressures continue to present challenges for some areas to
find the time and space to complete a first map and a programme of
targeted support is in place to help those areas with the most significant
delivery pressures.
The partnership has shared this work with Healthcare Improvement
Case study 1.
Midlothian IJB outcome mapping

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4. Performance 30 
30 
Scotland (HIS), the Scottish Government team developing the National
Improvement Framework for Adult Social Care and Community Health
and most recently the team developing a new improvement framework
for health that will support person centred care. 
Source: Midlothian HSCP

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4. Performance 31 
31 
Available national indicators show a general decline
in performance and outcomes for people using social
care and primary and community healthcare services 
63. As set out in the thematic sections below (and in the performance
information supplement) there is a general decline in performance against
the national indicators. 
64. The following sections draw out performance findings against key
themes set out in the bullet points below. Alongside nationally available
data, for each theme we also describe the context and challenges. Some
case studies of examples are also set out in Appendix 1 (page 50).
These illustrate examples of where IJBs are using or developing different
working practice to improve performance and outcomes. 
• Theme 1 – Prevention and early intervention
• Theme 2 – Shifting the balance of care
• Theme 3 – Person-centred care/choice and control
• Theme 4 – Reducing inequalities
• Theme 5 – Unpaid carers/community resilience. 
Theme 1 Indicators – Prevention and early
intervention 
Collaborative, preventative and person-centred working is
shrinking at a time when it is most needed. Instead of a focus
on care at the right place at the right time, there is a shift to
reactive services with little capacity to invest in early intervention
and prevention.
65. Addressing individuals’ health and social care needs at an earlier
stage through prevention and early intervention promotes better
outcomes for individuals, improving their quality of life and independence,
and reduces the need for costly support and care later on. The 2021
Independent Review of Adult Social Care in Scotland (Feeley Review) set
out the need for an increased focus on preventative, early intervention
and anticipatory forms of support and a shift away from a crisis
intervention. However, this is difficult to progress when the pressures on
services are so acute. 
66. As financial pressures have increased, eligibility criteria for individuals
accessing social care services have tightened. With this, opportunities 
to undertake prevention and early intervention focused services have

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4. Performance 32 
32 
decreased. IJBs and their partner bodies have instead signposted
less formalised support in the community, often provided by third and
voluntary sector organisations. However, we have found that the financial
challenges are leading IJBs and other funding bodies such as NHS
boards and councils to reduce grant funding to these service providers
reducing the capacity to meet and address these lower level, often more
preventative focused needs.

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4. Performance 30 
30 
67. Leaving lower-level health and social care needs unaddressed until
they become more significant tends to lead to increased complexity of
need, the requirement for a more resource intensive intervention and
less positive outcomes for individuals in the longer term. It is essential
that IJBs and their partner bodies find ways to protect and increase the
health and social care interventions at an earlier stage. This will be key to
addressing future demand pressures arising from demographic shifts to
an older population in a more financially sustainable manner. 
68. How well individuals consider themselves able to look after their
health is indicative of the IJBs’ and partner bodies’ effectiveness in
addressing and supporting individual needs to sustain healthy lives in
the community. Since 2013/14, there has been a deterioration by four
percentage points of adults who are able to look after their health either
‘very well’ or ‘quite well’ Exhibit 8. All the IJBs recorded a reduction in
this measure over the period 2013/14 to 2022/23. Fourteen IJBs saw a
reduction greater than average over this period, with three IJBs recording
a reduction greater than five percentage points. 
Percentage of adults
able to look after their
health very well or
quite well
95% 91%
-4%
2015/16 2017/18 2019/20 2021/22 2023/24
Exhibit 8.
Theme 1 indicators

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4. Performance 31 
31 
Source: Core Suite of Integration Indicators, Public Health Scotland

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4. Performance 32 
32 
Source: Core Suite of Integration Indicators, Public Health Scotland 
69. Emergency admissions rate and the emergency bed day rate are
often used as indicators of how well IJBs are reducing unnecessary
hospital stays and situations where individuals remain in hospital while
they are deemed to be fit enough to return to a more community-based
setting. 
70. Positively, there has been an eight per cent reduction in the
emergency admissions rate as well as a five per cent reduction in the
emergency bed day rate since 2016/17. Compared to 2020/21 there is
an 16 per cent increase in the emergency bed day rate, however this
reflects the impact of the Covid-19 pandemic Exhibit 9. 
71. Eighteen IJBs recorded a reduction in emergency bed day rate over
the period 2016/17 to 2022/23 Exhibit 9. Of the twelve that recorded an
12,229 11,276
Emergency admission
rate (per 100,000
population)
2016/17 2018/19 2020/21 2022/23 -8%
2017/18 2019/20 2021/22
125,979 119,806
Emergency bed day
rate (per 100,000
population)
-5%
2016/17 2018/19 2020/21 2022/23
2017/18 2019/20 2021/22
Exhibit 9.
Theme 1 indicators

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4. Performance 33 
33 
increase, two IJBs record an increase of over 10 per cent. 
72. Some IJBs have put in place schemes and plans and maintain early
intervention and prevention services. For example, Aberdeen City have
set up a listening service to offer first-level support for people with low-
level mental health challenges, addressing issues such as bereavement,
redundancy, and life changes that can impact overall wellbeing. In Fife, a
text chat service was launched in November 2022 enabling young people
aged 12 to 19 to have direct, confidential access to the school nursing
service. Further examples are set out in Appendix 1 (page 50).

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4. Performance 34 
34 
Theme 2 Indicators – Shifting the balance of care 
There is a recognition by the Scottish Government, councils and
NHS boards that the balance of care needs to shift out of hospital
to the community. Although this was the intention of the creation
of IJBs, we have not seen significant evidence of this happening.
73. Part of the aims of the integration of health and social care was 
to help shift resources away from the institutional settings, such as
hospitals and residential care institutions, and into more community-
based services. The rationale for this is that, alongside it often being 
a more cost-effective way of providing services, it also helps promote
greater independence and improved outcomes for the individual. 
74. There has been an increase in the provision of services in the
community, with an increase in the percentage of adults with intensive
care needs receiving care at home and in the proportion of end-of-life
care provided at home or in a community setting. At the same time, the
percentage of expenditure on institutional and community-based Adult
Social Care services has largely remained static with a small increase in
the proportion spent on accommodation-based services. 
75. Indicators tracking the balance of care and provision of services in the
community have largely shown an increase in the number of individuals
receiving care at home or in the community. However, these changes 
are marginal when viewed over the period since the inception of health
and social care integration in 2015. There are also indications of pressures
impacting the access to community-based services and the capacity of
community services (Exhibit 10, page 33).

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4. Performance 35 
35 
Percentage of adults
with intensive care
needs receiving care at
home
62% 65%
+3%
2016 2017 2018 2019 2020 2021 2022 2023
Proportion of last 6
months of life spent
at home or in a
community setting
87% 89%
2016/17 2018/19 2020/21 2022/23 +2%
2017/18 2019/20 2021/22
Percentage of patients
provided with
advanced booking
to GP practice (3 or
more working days in
advance)
77%
50% -27%
2013/14 2015/16 2017/18  2019/20 2020/21 2022/23
841 902
Number of days people
aged 75+ spend in
hospital when they are
ready to be discharged
(per 1,000 population)
+7%
2016/17 2018/19 2020/21 2022/23
2017/18 2019/20 2021/22 2023/24
Exhibit 10.
Theme 2 indicators

Page 105

4. Performance 36 
36 
Source: Core Suite of Integration Indicators, Public Health Scotland

Page 106

4. Performance 37 
37 
76. At the same time there has been a deterioration in the experience of
those receiving those services in the community nationally Exhibit 11. 
Source: Core Suite of Integration Indicators, Public Health Scotland 
77. The Auditor General for Scotland NHS in Scotland 2023 report
states that ‘lack of social care capacity remains an obstacle to improving
patient flow and reducing the number of delayed discharges from
hospital. This is supported by data showing that many patients whose
discharge is delayed are awaiting the completion of care arrangements
to allow them to live in their own home (awaiting social care support),
waiting for a place in a nursing home, or awaiting the completion of a
post-hospital social care assessment’. 
Percentage of adults
supported at home
who agree that they
are supported to live
as independently as
possible
81% 79%
-2%
2019/20 2021/22
Percentage of
adults supported at
home who agree
that their services
and support had an
impact in improving
or maintaining their
quality of life
80% 78%
-2%
2019/20 2021/22
Exhibit 11.
Theme 2 indicators

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4. Performance 38 
38 
78. Examples of approaches to shift the balance of care from the hospital
to community settings are set out in Appendix 1 (page 50).

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4. Performance 39 
39 
Theme 3 Indicators – Person-centred care: choice and
control 
The amount of choice and control service users feel they have is
variable across the country
79. In 2010, the Scottish Government and COSLA set out a ten-year
self-directed support (SDS) strategy with the aim of supporting people’s
right to direct their own social care support. The Social Care (Self-directed
Support) (Scotland) Act 2013 was part of the SDS strategy and set out
how councils should offer people options for how their social care is
managed.12 
80. The Scottish Government, IJBs, councils, providers and service users
and their carers recognise the gap between what the SDS legislation
is designed to do and what is happening for people trying to access
services in parts of Scotland. While there are examples of people being
supported in effective ways through SDS, not everyone is getting the
choice and control envisaged through the strategy. Some people who
use services feel they have a lack of choice and need to accept what is
offered with the type of care they receive being driven by the service
provider. This is most recently evidenced in the Scottish Parliament’s
Health, Social Care and Sport Committee post-legislative scrutiny of the
Self-directed Support (Scotland) Act 2013 phase 1 report.13 Examples
of increased flexibility, choice and control were given for both individuals
and unpaid carers but the Committee also reflected that many areas
of improvement are required. For example, a need to improve the
consistency of implementation between councils and improve clarity
and knowledge around SDS by providing more support and guidance to
navigate the process. 
81. People who use services and their carers highlight issues accessing
services. Either the times at which services are available is unsuitable
or the process required to access them is overly complicated. Service
users also highlighted a lack of coordination and communication between
services, often having to repeat their symptoms or issues multiple times
as they move from service to service. Poor data sharing was highlighted
as a contributing factor. 
82. People who use services described being put to bed at 2pm or left
in bed for hours at a time during the day. This was largely attributed to
care services being under-resourced and care workers having to schedule
their day to fit in additional people. 
83. Research14 has found that while those who received SDS generally
had positive experiences and found it beneficial, more than one-quarter
of people who use SDS had their option chosen by someone else.

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4. Performance 40 
40 
84. The percentage of people who are receiving social care support
through SDS is increasing, estimated at 88.5 per cent in 2021/22, up
from 77.1 per cent in 2017/18.

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4. Performance 41 
41 
2019/20 2021/22
Agreed Disagreed 
Source: Core Suite of Integration Indicators, Public Health Scotland 
85. In general, there has been a deterioration in the proportion of adults
who felt that they had a say in how their care is provided Exhibit 12.
The latest year of data (for 2023/24) shows that 60 per cent of adults
supported at home who disagreed that they had a say in how their help,
care or support was provided. Due to how the data is collected this data
is not comparable to previous years. 
86. The Care Inspectorate amended their approach to inspections of care
services in response to the Covid-19 pandemic. Inspection activity was
shifted to focus on services where there were concerns or intelligence
suggesting that they are a higher risk. The overall trend since 2020/21
has seen a reduction in the number of care services graded as either
‘good’ or better Exhibit 13. 
29%
71%
25%
75%
Exhibit 13.
Proportion of care services graded ‘good’ (4) or better in Care Inspectorate
inspections

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4. Performance 42 
42 
83%     76%  75%  77%
2020/21 2021/22 2022/23 2023/24 
Source: Core Suite of Integration Indicators, Public Health Scotland 
Exhibit 12.
Percentage of adults supported at home who agree that they had a say in
how their help, care or support was provided

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4. Performance 43 
43 
87. There is limited national data on access to GPs. (The Auditor General
for Scotland’s upcoming report on the General Medical Services
contract will look further at the availability and quality of data.) However,
the percentage of people reporting a positive experience of care at
their GP practice between 2015/16 and 2023/24 has declined by 17
points Exhibit 14. There has been a decline across all IJBs and the gap
between the best and worst performing areas has widened. 
88. Some examples of IJBs working with partners to intervene to give
people more choice and control and feedback on the services they
receive are set out in Appendix 1 (page 50). 
Percentage 
100
90
80
70
60
50
40
30
20
10
0
2015/16 2017/18 2019/20 2021/22 2023/24 
Exhibit 14.
Percentage of people with positive experience of care at their GP practice

Page 113

4. Performance 44 
44 
Min Scottish average Max 
Source: Core Suite of Integration Indicators, Public Health Scotland

Page 114

4. Performance 45 
45 
Theme 4 Indicators – Reducing inequalities 
The Covid-19 pandemic has exacerbated existing inequalities
89. A recent review15 of health inequalities found that the health of
people living in Scotland’s most deprived areas is not keeping up with
the rest of society. The health inequality gap is widening, evident through
increased drug deaths, infant mortality and a fall in life expectancy in
more deprived areas. People living in deprived areas have a significantly
lower healthy life expectancy, 26 years less for males and 25 for females
in the most deprived decile compared to the least deprived decile.
This gap has been widening over the past decade.16 
90. Research has found people who access social care, unpaid 
carers and those who work in the social care sector have been
disproportionately impacted (both directly and indirectly) by the Covid-
19 pandemic and mitigation measures.17 The review also highlights that
some groups could experience multiple and compounding inequalities.
There is a risk that equality groups and people most at risk of having their
human rights breached are set back by changes to and reductions in
service provision, particularly as finances become tighter. 
91. Respondents to a survey about their experiences of social care18 who
did not receive support but felt they needed it, were proportionally more
likely to be non-white, disabled, living in deprived areas, LGBO (lesbian,
gay, bisexual, other) and unpaid carers. 
The premature mortality rate is increasing with rates
higher in more urban and more deprived areas 
92. The premature mortality rate is increasing across Scotland Exhibit 15
with a one per cent increase between 2016 and 2022. 
Exhibit 15.
Theme 4 indicator

Page 115

4. Performance 46 
46 
Source: Core Suite of Integration Indicators, Public Health Scotland 
Premature mortality
rate per 100,000
population
440 442
+1%
2016 2017 2018 2019 2020 2021 2022

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4. Performance 47 
47 
93. IJBs were found to have consistently lower rates of premature
mortality in areas that were more rural and/or relatively more affluent.
Five IJBs, all from more urban and less affluent areas (Dundee, Glasgow
City, Inverclyde, North Lanarkshire, West Dunbartonshire), have
consistently had relatively high premature mortality rates. 
Emergency bed day rates are greater in areas with
higher levels of deprivation 
94. There is a clear relationship between the emergency bed day rate
and the deprivation and affluence of an area. Using the Improvement
Service’s family groupings of IJB areas, shows that areas with higher
levels of deprivation have higher levels of emergency day bed rates than
areas that are more affluent Exhibit 16. 
30000
20000
10000
0
-10000
-20000
-30000
-40000 
2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 
Family groups are
groupings of IJBs
that are similar in the
type of population
they serve (deprivation
and affluence levels)
as well as the type of
area they serve (rural,
semi-rural and urban).
Exhibit 16.
Emergency bed day rate (per 100,000 population): Difference to Scottish rate

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4. Performance 48 
48 
Note: Grouping 1 represents the least deprived/affluent IJB areas and grouping 4 represents the most
deprived/affluent
Source: Core Suite of Integration Indicators, Public Health Scotland, Improvement Service (deprivation
and affluence grouping)

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4. Performance 40 
40 
95. Example case studies in Appendix 1 (page 50) set out some
programmes IJBs have in place to tackle inequalities in their communities
and improve outcomes for all. 
Theme 5 Indicators – Unpaid carers 
The reliance on unpaid carers is increasing as the social care
workforce is under added pressure
96. There is an enormous reliance on unpaid carers to support the social
care system. These carers provide support to friends or family who
need it. Carers can claim an allowance of £81.90 a week if they care for
someone at least 35 hours a week. An additional carer support payment
of £288.60 twice a year is also available to some carers. Although the
exact number of unpaid carers is not known, as many carers don’t
identify themselves as such, there are an estimated 800,000 unpaid
carers in Scotland; this includes 30,000 young carers under the age of
18.19 The social care system relies on the contribution of the community
and unpaid carers with the value of unpaid care estimated at £36 billion a
year in Scotland.20 The Feeley Review stated that ‘The role communities
play in supporting adults to remain active in their community simply
cannot be overstated.’21 
97. This reliance on unpaid carers is increasing as the social care paid
workforce is under increased pressure. This is unsustainable. 
98. Carers are feeling the mental, physical and financial pressure of a
system under strain. Carers Scotland’s latest State of Caring survey22
found that over half (54 per cent) of carers said that their physical health
had suffered because of their caring role, with one in five (20 per cent)
suffering a physical injury from caring. Forty-four per cent of those on
Carers Allowance are cutting back on food and heating. Research23
carried out by the Carers Trust on the experience of older carers found: 
• 80 per cent said their physical health had been affected by their
caring role
• 87 per cent said their mental health and wellbeing had been
affected by their caring role
• 82 per cent felt as though their caring role has financially affected
them; 37 per cent have used less gas and electricity in their homes
as a way to save money, and 19 per cent have skipped meals in
the past 12 months
• 46 per cent of carers had missed some form of health appointment
due to their caring role. This will have knock effects for the
efficiency of the health service.

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4. Performance 41 
41 
Source: Core Suite of Integration Indicators, Public Health Scotland 
99. Caring responsibilities fall disproportionately on women, people
living in rural areas and people living in deprived areas. National indicators
also illustrate the declining sense of wellbeing for unpaid carers and those
needing care Exhibit 17. There are provisions in the NCS Bill to improve
support to unpaid carers but this has been subject to ongoing delays. 
100. Some IJBs have set up interventions to support unpaid carers such
as Falkirk and Clackmannanshire Carers Centre who provide information
and signposting to those who are assessed as low or moderate on the
unpaid carers eligibility for support.
40%
Percentage of carers
who feel supported to
continue in their caring
role
31% -9%
2015/16 2017/18 2019/20 2021/22 2023/24
Exhibit 17.
Theme 5 indicator

Page 120

5. Commissioning and procurement 42 
42 
5. Commissioning and
procurement
Commissioning and procurement practices for social care
services continue to be largely driven by budgets,
competition, and cost rather than outcomes for people.
Improvements to commissioning and procurement
arrangements have been slow to progress but are
developing 
101. Our 2022 Social Care briefing highlighted commissioning
arrangements as a key issue stating: ‘Commissioning tends to focus
on cost rather than quality or outcomes. Current commissioning and
procurement procedures have led to competition at the expense of
collaboration and quality.’ In this section of this report, we focus on this
issue and consider what progress is being made. 
What are commissioning and procurement? 
102. Commissioning identifies what is to be provided. It is the process
each IJB uses to set out to its partner councils and NHS boards, what
it requires them to provide to meet its strategic plan for social care and
primary and community health services, based on population needs and
available budgets. Procurement establishes how and who will provide the
services. It is the process of contracting or purchasing specific services 
to meet those requirements. The IJBs do not procure the services. This
is done by the relevant councils or the NHS and can be from the public,
private and third sector. Scotland Excel assists some councils in procuring
services and has developed national adult social care frameworks.
Currently, the private sector provide 54 per cent of social care services,
24 per cent by councils, 21 per cent by the third sector and the remaining
element (one per cent) by health boards.24 
103. All IJBs have integration strategic commissioning plans. The 2014
Act sets out requirements for the plans that are also supported by
Scottish Government guidance issued in 2015.25 The plans are required
to: 
• be reviewed at least every three years

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5. Commissioning and procurement 43 
43 
• set out what the arrangements are to carry out the tasks of the IJB
over the three years

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5. Commissioning and procurement 44 
44 
• divide the area geographically into at least two localities for setting
out these arrangements with each locality done separately
• include how the arrangements are intended to contribute to
achieving the national health and wellbeing outcomes. 
104. The commissioning of social care and primary and community 
health services is a cyclical process carried out by a Strategic Planning
Group for each IJB. This group must consider the outcomes for people
and how the needs and availability of services change. Healthcare
Improvement Scotland and the Care Inspectorate have produced a quality
framework26 to evaluate the effectiveness of strategic planning. 
105. The Independent Review of Adult Social Care in Scotland,
considered in detail the arrangements for commissioning and procuring
social care services in Scotland. The review identified ten changes
needed in commissioning and procurement practices. 
Improvements to commissioning and procurement
arrangements have been slow, with cost rather than
outcomes driving decision-making 
106. Commissioning and procurement decisions are currently driven
largely by achieving the range and volume of services required at the
lowest cost. This is understandable given the financial pressures and
increased demand faced by IJBs, but the pressure on the service
providers to remain competitive can reinforce a focus on driving down
prices. This can be at the cost of promoting service quality, equality,
innovation and collaboration with others, to improve people’s outcomes. 
107. Tenders for support packages for people are often constructed
around time and task of the service, rather than the outcomes. This lack
of flexibility in the system means that NHS and council resources can get
tied up in providing services that aren’t effective in improving outcomes.
More flexibility is needed across the system. 
108. The cyclical nature of the commissioning and procurement, mean
that time and resource are focused on contracts renewal processes
instead of a more strategic long-term approach. 
109. As set out at paragraph 25, the current model of governance is
complicated. This can cause difficulties when trying to commission
services in a collaborative way. All stakeholders, including providers and
users need to be part the strategic commissioning process in order to
reflect what people need and want. This current approach also does not

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5. Commissioning and procurement 45 
45 
fully allow for innovation of the sector in finding solutions. 
110. The current commissioning and procurement system lacks a
process of accountability when people do not receive the services they
need. People have described the process of accessing social care as

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5. Commissioning and procurement 46 
46 
‘notoriously difficult’ and ‘over-complicated’ and needing to ‘fight for’ and
‘justify’ their support where they had a negative experience.27 
Current commissioning and procurement practices
are a risk for the sustainability of service providers
and the workforce 
111. Current arrangements are heavily reliant on a stable provider market
and workforce but there are exacerbating financial and workforce issues
facing providers, risking the viability of some. 
112. A consequence of the current cyclical commissioning and
procurement arrangements is that many risks around the effective
delivery of service are largely put onto the providers. For example, where
the cost of energy makes a service more expensive to deliver than the
contract provides for, the provider is still required to provide the service,
bearing the loss. 
113. There is uncertainty for all providers, particularly in the third sector
around future funding and their role in service provision. Providers
are also experiencing challenges with providing services and fulfilling
contracts largely due to difficulties with workforce recruitment and
retention: 
• Private and third sector providers find that council commissioning
rates are not enough to deliver social care and support and
residential, personal and nursing care, and pay expenses such as
staff, training and overheads. These providers say they cannot
compete with councils where pay and terms and conditions are
better than they can provide due to the flat cash settlement local
government receives from the Scottish Government.
• Non-committal framework agreements leading to zero hours or
short hour contracts for staff.
• Contracts that do not cover travel costs, especially challenging in
rural Scotland which were particularly badly affected by fuel price
rises.
• Growth in split shifts and reduction in paid sleepovers for staff.
• Although there has been an uplift in adult social care workers’
wages, this has not been universally applied for all social care
workers as some roles have been out of scope for the intended
policy outcome. This has focused on uprating pay for those on
the lowest incomes. There is no equivalent uplift for those with
supervisor or manager roles making these positions less desirable.

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5. Commissioning and procurement 47 
47 
• High levels of overtime and agency costs.
• High and ongoing recruitment costs, particularly in more rural areas.

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5. Commissioning and procurement 48 
48 
114. Local government have been calling for multi-year funding
settlements from the Scottish Government to support providers with
medium- to long-term planning. This is currently being discussed through
the Verity House Agreement and the fiscal framework discussions. 
115. As set out in the context section, the workforce feel undervalued
in the system and there are unprecedented numbers of vacancies 
(paragraph 19). The Fair Work Convention Report28 set out that
‘Despite some good practice and efforts by individual employers, the
wider funding and commissioning system makes it almost impossible for
providers to offer fair work.’ Without urgent progress on the fair working
agenda nationally it is likely that the risks to the sustainability of the sector
will deepen. 
Current commissioning and procurement practices
are not always delivering improved outcomes for
people 
116. People who use services are often not involved in commissioning
and procurement processes and therefore services are not necessarily
reflective of what people need and want. The Independent Review
of Adult Social Care in Scotland29 reported that commissioning using
generic frameworks based on an hourly rate does not work well for
people who have fluctuating needs for support, particularly support for
mental health. 
117. The Self-directed Support (Scotland) Act 2013 was designed to
ensure people had choice and control in how their social care support
is provided. As highlighted at paragraph 80, there is a recognised
implementation gap in this policy. The Scottish Parliament’s Health,
Social Care and Sport Committee post-legislative scrutiny of the Act has
highlighted concerns around commissioning in relation to SDS including: 
• the importance of facilitating collaborative commissioning
conversations
• a need to develop a marketplace of providers
• a need to end competitive tendering and restrictive procurement
processes
• the disparity in the relative available funding under different SDS
options. 
Fair work is work that
offers all individuals
an effective voice,
opportunity, security,
fulfilment and respect.
It balances the rights
and responsibilities
of employers and
workers.

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5. Commissioning and procurement 49 
49 
There is an increasing desire to move towards more
ethical and collaborative commissioning models but
it has not yet been universally adopted 
118. There are examples of IJBs attempting to adopt collaborative and
ethical commissioning processes in their strategies but these appear 
to be at an early stage. Almost a third of IJBs have adopted the Unison
Ethical Charter for Social Care Commissioning30 which is based on ethical
commissioning principles. 
119. IJBs are reaching out for support from IRISS (Institute for Research
and Innovation in Social Services) in collaborative commissioning,
for example work to improve outcomes-based commissioning with
East Dunbartonshire, East Ayrshire and Orkney IJBs with Healthcare
Improvement Scotland. IRISS has also been supporting West
Dunbartonshire and North Ayrshire IJBs to change commissioning to a
more collaborative approach. Both projects are at an early stage but they
have highlighted that the relationship between stakeholders are a key
aspect of addressing commissioning arrangements. Significant time and
resource capacity is needed to work out these relationship issues. 
120. There are some strong examples of how IJBs are working to
commission in a more collaborative and flexible way including Aberdeen
IJB and Fife IJB. Two examples are set out in Appendix 1 (page 50). 
National approaches to improve commissioning have
been slow to progress but are developing 
121. Across stakeholders we have engaged with, there is a recognition
that commissioning needs to improve. The Feeley Report recommended
that the Scottish Government and COSLA develop and agree ethical
commissioning principles and core requirements. This is happening
through the development of the NCS Bill, an Adult Social Care Ethical
Commissioning Working Group was set up (also including the Institute for
Research and Innovation in Social Services (IRISS), Social Work Scotland
(SWS) and the Coalition of Care and Support Providers in Scotland
(CCPS)). This group is developing a framework for ethical commissioning
and has identified nine ethical commissioning principles: 
• Person-led care and support
• Outcomes-focused practices
• Human rights approach
• Full involvement of people with lived experience 
Ethical
commissioning 
aims to embed ethical
standards into the
commissioning and
procurement process
to ensure the process
is around equity and
quality for people, not
just around efficiency
and cost.

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5. Commissioning and procurement 50 
50 
• Fair working practices
• High-quality care and support
• Climate and circular economy

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5. Commissioning and procurement 51 
51 
• Financial transparency, sustainable pricing and commercial viability
• Shared accountability. 
122. Current Scottish Government plans are that the NCS Bill will include
a clear and comprehensive definition of ethical commissioning, with a
National Care Service Board31 providing national oversight, guidance and
practical support.32

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Endnotes 48
48
1 Lead Agency model - In Highland the NHS Board and council have adopted a
different model for integration, a lead agency model. NHS Highland leads on adult
services and Highland Council leads on children’s services. Therefore, there is no
Integrated Joint Board but an Integration Joint Monitoring Committee to monitor the
planning and delivery of services. Revisions to the National Care Service Bill currently
being developed, propose that Highland adopt a reformed IJB model as these are
implemented.
2 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021
3 People supported through Social Care Services: Support provided or funded by health
and social care partnerships in Scotland 2022/23, Public Health Scotland, March 2024.
4 Mid-2022 Population Estimates, Scotland, National Records of Scotland, March 2024.
5 Scotland’s Health and Demographic profile, Social Research, Scottish Government,
June 2022.
6 Scotland’s Unsustainable Health Service Modelling NHS demand to 2040,
Our Scottish Future Health Commission, December 2023.
7 Population projections of Scotland - National Records of Scotland January 2023.
8 Staff vacancies in care services 2022, Care Inspectorate and Scottish Social Services
Council, September 2023.
9 Workforce Recruitment and Retention Survey Findings, Scottish Care,
September 2021
10 People who access social care and unpaid carers in Scotland, Scottish Government,
June 2022
11 Local Government Benchmarking Framework, Improvement Service, February 2024
12 Self-directed support (SDS) aims to improve the lives of people with social care needs
by empowering them to be equal partners in decisions about their care and support.
Four fundamental principles of SDS are built into legislation – participation and dignity,
involvement, informed choice and collaboration. The Social Care (Self-directed
Support) (Scotland) Act 2013 gave councils responsibility, from April 2014 onwards,
for offering people four options for how their social care is managed:
– Option 1: The individual or carer chooses and arranges the support and manages
the budget as a direct payment.
– Option 2: The individual chooses the support and the authority or other
organisation arranges the chosen support and manages the budget.
Endnotes

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Endnotes 49 
49 
– Option 3: The authority chooses and arranges the support.
– Option 4: A mixture of options 1, 2 and 3. 
13 Post-legislative scrutiny of the Social Care (Self-directed Support) (Scotland) Act 2013:
Phase 1: SP Paper 577, Health, Social Care and Sport Committee, May 2024.

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Endnotes 50 
50 
14 My Support My Choice: People’s Experiences of Self-directed Support and Social
Care in Scotland National Report, ALLIANCE and Self Directed Support Scotland,
October 2020.
15 Leave No-one Behind The state of health and health inequalities in Scotland, The
Health Foundation, An Independent Review, David Finch, Heather Wilson, Jo Bibby,
January 2023.
16 Health Life Expectancy in Scotland 2019-2021, National Records of Scotland,
December 2022.
17 Adult Social Care in Scotland – Equality Evidence Review, Scottish Government,
June 2022.
18 Health and Care Experience Survey, Scottish Government, May 2022.
19 Scotland’s Carers Update Release, Scottish Government, December 2022.
20 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021.
21 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021.
22 State of Caring Survey 2023, Carers Scotland, November 2023.
23 Experiences of Older Adult Unpaid Carers in Scotland, Carers Trust Scotland,
March 2023.
24 Summary of No. of registered care services at 31 March 2024, Care Inspectorate.
25 Strategic commissioning plans: guidance, Scottish Government, December 2015.
26 Evaluating the Effectiveness of Strategic Planning: Quality Framework, Care
Inspectorate and Healthcare Improvement Scotland.
27 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021.
28 Fair Work in Scotland’s Social Care Sector 2019, Fair Work Convention,
February 2021.
29 Independent Review of Adult Social Care in Scotland, Derek Feeley, February 2021.
30 UNISON’s ethical care charter, UNISON.
31 The remit and membership of a National Care Service Board will be determined by at
Stage 2 of the National Care Service Bill. The overarching purpose of the Board ‘will
be to ensure consistent, fair, human rights-based social care support and community
health services, underpinned by effective complaints mechanisms and enhanced
advocacy services’.
32 National Care Service (NCS) (Scotland) Bill: Scottish Government Response to Stage
1 report, Letter from Minister for Social Care, Mental Wellbeing and Sport to Health,
Social Care and Sport Committee, March 2024.

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Appendix 1 50 
50 
These case studies set out some examples of where integrated joint
boards are using or developing different working practice to improve
performance and outcomes. 
Preventing Frailty by Improving Nutrition (Shetland)
People providing care and support have an important role in recognising
risk and preventing malnutrition. A project in the summer of 2022 led 
by the dietetics department in collaboration with Shetland residential
teams including social care workers, seniors, care home cooks and care
at home staff in the community. The project included reviewing dietetic
patients care, menu and mealtime observations and advice, training
needs analysis and delivery of MUST (Malnutrition Universal Screening
Tool) training.
The IJB reported that confidence in ability to screen for malnutrition,
provide nutrition advice and care, and actioning nutritional care plans was
considerably increased following training, which was provided to more
than 100 staff across Shetland.
Whole Family Wellbeing Funding programme (national
scheme)
The Whole Family Wellbeing Funding (WFWF) is a £500 million Scottish
Government investment in preventative whole family support measures.
Appendix 1
Case studies
Case study 2.
Early intervention and prevention services

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Appendix 1 51 
51 
The aims of the fund are to support the change that is necessary 
for reducing the need for crisis interventions in families, and to move
investment towards early intervention and prevention. The scheme is
funded nationally from 2022 to 2026 with any new systems or services
funded locally after that period.

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Appendix 1 52 
52 
The programme is split into three parts:
• to provide direct support to Children’s Services Planning
Partnerships (CSPPs) to help expand and deliver whole family
support services as well as support transformational change
• to support local transformation through National Support for Local
Delivery
• support projects that take a cross Scottish Government approach to
system change which progress the aims of WFWF.
An evaluation report of year one funding of the first two parts reports
that substantial progress has been made so far across most CSPPs.
However, they have found it difficult to achieve the pace of progress
envisaged by the Scottish Government in year one of the funding.
In South Lanarkshire, the funding has enabled the recruitment of peer
support workers with lived experience who are able to reduce the stigma
of needing support. The funding also enabled the creation of a team
of early years staff, based in NHS Lanarkshire, that will give support to
families that have children under the age of five. In addition, the funding
enabled the expansion of Pathfinders, a school-based family project that
aims to reduce the need for later intervention.
The funding has supported North Ayrshire to add two further locations
to their Family Centred Wellbeing Service. The fund has also seen
the expansion of North Ayrshire’s Health Visiting Team, which aims to
support early intervention and prevention for children by working with the
whole family. 
Source: Scottish Government and Shetland Health and Social Care
Partnership

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Appendix 1 53 
53 
Home First Response Service (Glasgow)
Glasgow’s Home First Response Service has the aim of ensuring frail
people spend less time in hospital. The service is community led and
made of multi-disciplinary frailty teams. Each team is led by advanced
frailty practitioners based in hospitals with 26 now in post following a
successful pilot of the service.
One in three people identified during the pilot were discharged the same
day with a care plan having been put in place.
To enable fast access to the community services needed to move frail
people out of hospitals and back home, the service uses a hub and
spoke service model with each of the six Health Partnerships in Glasgow
having their own frailty teams.
The teams liaise with other healthcare colleagues in the community
including advanced nurse practitioners, pharmacists and allied health
practitioners. This ensures that people receive the same level of care that
they would in a hospital setting.
The Home First Response Service has been achieving, on average,
a 50 per cent early turnaround rate per month.
Integrated Discharge Hub (West Lothian)
The West Lothian Integrated Discharge Hub (IDH) was set up in 2018 at
St John’s Hospital to improve delayed discharges and reduce the time it
was taking make arrangements for people requiring care and support in
the community following discharge from hospital.
To plan the safe and timely discharge of patients, an inter-agency team
consisting of discharge coordinators, hospital social workers, Carers of
West Lothian as well as inhouse care team staff work with patients and
their families to plan their discharge and how their ongoing requirements
will be met in the community.
Since the implementation of the discharge hub the IJB reports that
improvements have been seen, with reduced lengths of stay, reduced
occupied acute bed days, improved performance for days lost to delays
in discharge and improved processes for interim placements when a
patient is waiting for care home placement.
Between December 2022 and April 2023, the average number of days
between a person being admitted to St John’s Hospital and being
identified as needing the support of the discharge hub has been reduced
by 52 per cent. The length of stay for patients getting help from the
Case study 3.
IJBs shifting the balance of care

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Appendix 1 54 
54 
discharge hub has also been reduced by 28 per cent during the same
period.
The success of the discharge hub has drawn interest from other IJBs
across Scotland.

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Appendix 1 55 
55 
The Joint Dementia Initiative (Falkirk)
The Joint Dementia Initiative (JDI) is a registered service in the Falkirk
Health and Social Care Partnership. It has two main services: a one-to-
one support service, which provides care and support at the user’s own
home, and a Home from Home service, which provides support to users
in a group setting.
The JDI service aims to help people with dementia to continue to live 
the life they want to live by continuing to live at home in their own
communities for as long as possible. This is delivered through meaningful
engagement with service users, families, and key stakeholders from
across Falkirk HSCP following a person-centred approach to the care
provided.
A review of the JDI was carried out in April 2021 that included arranging
engagement events with service users, their families, carers, staff, and
stakeholders. The aim was to improve outcomes for families and carers
and identify specific areas of concern and gaps in service delivery.
Identified as an important issue at the engagement events, the
partnership looked at the flexibility of the service and dementia being a
24/7 illness. The partnership is working to provide evening and weekend
support for families and carers, due to start in August 2024. These
improvements would allow the partnership to achieve outcomes from
their strategic plan.
A current project is being carried out to change Adult Placement Carers
in the Home from Home service from self-employed to employees of
the partnership. This change aims to improve recruitment and retention
rates for the service.
The JDI has been successful in achieving funding from multiple funds
including the Dementia Innovation Fund and the Carers Challenge Fund.
This has allowed the Initiative to renovate their community space as well
as create two part time support worker posts to help provide evening
and weekend support to service users 
Source: NHS Greater Glasgow and Clyde, West Lothian Health and Social
Care Partnership, and Falkirk Health and Social Care Partnership

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Appendix 1 56 
56 
Community Brokerage Network (North and South Ayrshire)
The Community Brokerage Network is well established in the Ayrshires
and provide brokers, who offer free independent information about
self-directed support to people and their carers at any stage in their
social care journey, whether they are entitled to a formal social care
assessment or not. They have successfully connected people with
services that have helped them achieve their personal outcomes in a
way that works for them. A Brokerage Framework for Scotland has
recently been produced by Self-directed Support Scotland and its
partners to help encourage the use of this model further across Scotland.
Care Opinion (Falkirk)
Care Opinion is an online integrated platform where people can safely
share their experience of any health service or Care Inspectorate-
registered providers of adult social care services. Care Opinion has
national scale and visibility and has worked with all Scottish health boards
as well as ten HSCPs. Over 29,000 stories have been shared about
health and social care services in Scotland on the Care Opinion platform.
Care Opinion enables Falkirk HSCP and the commissioned providers to
use online feedback as one method of learning from lived experience.
The aim is to drive forward quality service improvements, build a
reputation for openness, to potentially avoid formal complaints, and
develop a culture of transparency across the Partnership. 
Source: Self Directed Support Scotland, Falkirk Health and Social Care
Partnership 
Case study 4.
Choice and control

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Appendix 1 55
Case study 5.
Work to reduce inequalities 
55 
Welfare Advice & Health Partnerships (WAHPs) programme
(Glasgow)
Scottish Government funding is enabling 84 GP Practices across the
most deprived parts of Glasgow to host a dedicated welfare and health
adviser one day per week. According to the Partnership this has had a
positive impact on patient health, poverty and health inequalities, while
also freeing up staff time for clinical care. In the last year, there have
been 3,997 referrals made by WAHP practice staff across Glasgow,
achieving a reported £3.3 million in financial gains and £1.1 million in debt
managed for people.
eFRAILTY Power BI dashboard (West Lothian)
The eFRAILTY Power BI Dashboard was created with the aim to provide
a snapshot of the make-up of frailty within the West Lothian population
with the goal of identifying people who could benefit from help,
improving the health inequality gap. The dashboard also has the aim of
mapping frailty data by GP postcode to enable the targeting of resources.
The data in the dashboard uses the Rockwood clinical frailty score from
patient and carer self-assessment forms. These forms are collected at
vaccination centres each year during the patient’s annual flu jab. The
frailty data is collected by the vaccination nurses and then entered into
GP systems before being extracted and used to populate the eFRAILTY
dashboard.
The dashboard is still in the scoping and data-gathering phase, however
the Partnership is looking at options for how to put the data to use. An
example given by the Partnership for the use of the data was to refer
patients graded as having mild frailty to their Xcite Exercise referral
scheme. 
Source: Glasgow City Health and Social Care Partnership, Scottish
Government, and West Lothian Health and Social Care Partnership

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Appendix 1 56 
56 
Established in October 2020, Granite Care Consortium (GCC) is
composed of a mix of ten independent and third sector care providers
delivering over 12,000 hours of care a week to more than 1,200 people.
GCC was set up with the aim of creating market stability, improving
outcomes for service users and building a consistent trained and skilled
workforce. Competitive methods of commissioning and procurement
were identified as presenting a risk of providers reducing their services or
exiting the market completely. Providers also often work in silos with little
input or communication from other services.
Aberdeen City Health and Social Care Partnership (ACHSCP),
commissioned GCC to take a collaborative approach, with a focus on the
outcomes for the individual. This saw GCC move away from a ’time and
task’ model towards one built around the service user. The collaboration
between providers allows different types of support to be added to a
care plan without the need for time consuming reassessments.
For example, someone receiving mental health support who then
required personal care could have this added to their care plan in a matter
of hours.
Collaboration has also enabled greater data sharing and visibility. GCC
use data at a local level as well as city wide to inform decision-making. A
recent test of change has seen the introducing of hotspots allowing GCC
to focus on where demand for care is greatest.
Funding is provided in monthly blocks by ACHSCP which allows GCC
to flex individual care and support packages without the need for social
worker authorisation. This speeds up the process, improving outcomes
for individuals. The number of days those aged 75+ in Aberdeen City are
waiting to be discharged from hospital (per 1,000 population) stands at
112 as of November 2023. This is down from 579 in 2019/20.
GCC faces the same workforce challenges as the wider sector but is
using its outcomes focussed model as a positive tool to aid recruitment
and retention. Learning and development is also a large part of the
workforce strategy with GCC working in partnership with Robert Gordon
University to develop new ways of delivering training.
I have felt partnership working between ACHSCP and GCC has been
stronger than my previous experience before GCC – Social Worker
Building trust, both from ACHSCP and the ten partnering service
providers, was crucial in delivering this model. Challenging traditional
ways of working and thinking was acknowledged by GCC as difficult 
Case study 6.
Granite Care Consortium

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Appendix 1 57 
57 
but it reports that there is now genuine trust between all parties and the
culture of collaboration is now embedded within the consortium.

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Appendix 1 58 
58 
The Scottish Parliament Health, Social Care and Sport Committee have
identified this work as a good model to provide the basis to develop best
practice in ethical commissioning. 
Source: LGBF Indicators, GCC Annual Report 2020-21 
Established in 2021 the Care at Home Collaborative was a Collaborative
of 16 Independent Care at Home Providers who delivered over
90 per cent of externally commissioned care at home services in the Fife
IJB area. The Collaborative in June 2024 are now made up of 41 care at
home Providers including Fife Council. The split between service delivery
is approximately 30 per cent Council and 70 per cent Collaborative.
The aim of the collaborative is to involve all member organisations in
active engagement and participation as well as to share best practice and
lessons learned. The collaborative also aims to benefit from the economy
of scale of working together, for example securing funding to maintain a
higher weekend pay rate has helped the retention of staff.
One of the members of the collaborative, Cera Care, commented: 
‘Since joining the Collaborative we have seen a dramatic improvement in
the services we deliver as a whole in Fife. It has given us the opportunity
to communicate with Scottish Care, Fife Council and External Providers
together to input ideas and suggestions across to help each other and
the people we care for.’
The collaborative makes use of a GPS tool called ‘Pin-Point’ which is a
live dashboard of services used to manage commissioning. The IJB is
able to manage capacity across the whole system by using monitoring
and escalation systems that are connected to the collaborative.
A recent self-evaluation saw that previous recruitment and retention
issues encountered by providers have been continuously improving and
attributable to the success of the Collaborative. 
Case study 7.
Fife Care Collaborative

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Appendix 1 59 
59 
Source: Fife Health and Social Care Partnership

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Appendix 2 58 
58 
Previous work 
In 2022 and in 2023, the Accounts Commission published bulletins
setting out the financial performance of IJBs. Together with the Auditor
General for Scotland and Audit Scotland, we have reported more
widely on the progress of health and social care integration and social
care in Scotland. This includes reports in 2015 and 2018 setting out
improvements needed by integration authorities. Our work in 2014
and 2017 set out the progress of the self-directed support legislation
implementation and found while implementation was happening
successfully in some areas, not everyone was getting the choice and
control in their social care support envisaged in the legislation. In January
2022, a joint Social Care briefing set out the significant ongoing
challenges impacting the delivery of social care services. 
We aim to answer the following audit questions in this report:
• How well are IJBs responding to contextual challenges and
improving their performance and the outcomes for people?
• How financially sustainable are IJBs and how are they responding
to the financial challenges they face?
• How are IJBs using commissioning and procurement to improve
performance and deliver improved outcomes in the lives of people
who use social care services? 
Our findings are based upon:
• the 2022/23 audited accounts and annual audit reports of IJBs and
supplementary returns provided by appointed auditors
• the 2022/23 annual performance reports and Chief Social Work
Officer reports of IJBs
• national data sets including core integration indicators and the Local
Government Benchmarking Framework (LGBF)
Appendix 2
Methodology

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Appendix 2 59 
59 
• a review national reports and guidance
• a review of relevant published research
• interviews with key stakeholders including IJB chief officers and
chief finance officers. 
In February 2024, we hosted a roundtable discussion bringing together
key stakeholders to consider the critical issues for IJBs and in particular

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Appendix 2 60 
60 
the provision of social care. The discussion covered immediate challenges
as upcoming issues in the medium and long term. The discussion helped
to inform this report and also identify future work for the Accounts
Commission. The additional output sets out a summary of discussion. 
Advisory Group
To support our work, an Advisory Panel was established to provide
challenge and insight at key stages of the audit process. Members sat in
an advisory capacity only and the content and conclusions of this report
are the sole responsibility of Audit Scotland. 
Members of the group included representatives from Health and Social
Care Scotland, COSLA, Care Inspectorate, The ALLIANCE, Coalition
of Care and Support Providers Scotland, Scottish Care and SPICe. We
would like to thank them for their support.

Page 148

61 
Integration Joint
Boards
Finance and performance 2024

Page 149

62 
Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN
Phone: 0131 625 1500 Email: info@audit.scot 
www.audit.scot 
ISBN 978 1 915839 44 2

Page 150

63 
1. The Public Bodies (Joint Working) (Scotland) Act 2014 created a
legislative requirement for IJBs to report on their performance against a
suite of care integration indicators. 
2. Around half of the indicators are based on information coming out of
the biennial Health and Care Experience Survey and the remaining
indicators are largely based on health, community and death information
and are available on an annual basis. 
3. Public Health Scotland collect and report on this information annually.
Background Information on the core integration indicators, including
caveats and detailed source information, can be found here. 
4. Below, we set out the trend in the available data and an indication of
the movement since the indicator was last reported on. 
Note: Where there is an asterix * the data for 2023/24 is not comparable to previous years due to
changes in survey question wording. Where the data is not directly comparable in the trend data a
dotted line depicts the change. 
Supplement 1. Prepared by Audit Scotland | July 2024
Core suite of integration
indicators
IJB Finance and performance 2024
National trend information

Page 151

64 
National Indicator
1. Percentage of adults able
to look after their health
very well or quite well
Yearly trend data for all
IJBs across Scotland
Latest year
change
(percentage
points)
94.5 92.9 92.9 90.9 90.7
-0.2
2015/16 2023/24
2. Percentage of adults
supported at home
who agree that they
are supported to live as
independently as possible
80.8 78.8 72.4 *Data not
comparable 2019/20 2023/24
Cont.

Page 152

Supplement 1. Core suite of integration indicators 2 
2
National Indicator
3. Percentage of adults
supported at home who
agree that they had a say
in how their help, care or
support was provided
4. Percentage of adults
supported at home who
agree that their health and
social care services seemed
to be well coordinated
5. Percentage of adults
receiving any care or
support who rate it as
excellent or good 
6. Percentage of people
with positive experience of 
Yearly trend data for all
IJBs across Scotland 
75.4 70.6 
2019/20 
73.5 66.4 
2019/20 
80.2 75.3 
2019/20 
85.3 82.7 78.7
Latest year
change
(percentage
points) 
59.6 *Data not
comparable
2023/24 
61.4 *Data not
comparable
2023/24 
70.0 *Data not
comparable
2023/24
care at their GP practice 
7. Percentage of adults
supported at home who 
2015/16 
80.0 78.1
66.5 68.5
2023/24
2.0
agree that their services and
support had an impact in
improving or maintaining
their quality of life
8. Percentage of carers who 
2019/20
69.8 *Data not
comparable
2023/24
feel supported to continue
in their caring role 40.0 36.6 34.3 29.7 31.2 1.5 
9. Percentage of adults
supported at home
who agree they felt
safe  11. Premature mortality rate

Page 153

Supplement 1. Core suite of integration indicators 3 
3
2015/16 
82.8 79.7 
2019/20
2023/24 
72.7 *Da
t
a
n
o
t
c
o
m
p
a
r
a
b
l
e
2023/24 
457 466
per 100,000 persons 440
2016
42
5
432 426 442
2022
-5.1
Cont.

Page 154

Supplement 1. Core suite of integration indicators 4 
4
National Indicator
12. Emergency admission
rate (per 100,000
population) 
Yearly trend data for all
IJBs across Scotland 
12,229 11,942 12,284 12,529 
10,964  11,643  11,276 
Latest year
change
(percentage
points) 
-3.2 
13. Emergency bed day rate
(per 100,000 population)
2016/17
2016/17 
125,979 121,174
2022/23
2022/23 
119,806 
14. Emergency
readmissions to hospital
124,118 
20210166/1/717
119,75
3
102,875 
120 
115,308
20220222/2/323
3.9
within 28 days of discharge
(rate per 1,000 discharges)
101 
20210166/1/717
103 103 105 107 102 
20220222/2/323
-4.3 
15. Proportion of last
6 months of life spent at
home or in a community
setting  87.4 
20210166/1/717 
88.0  88.0 88.2
90.2 89.7 
88.9 
20220222/2/323 
-0.8 
16. Falls rate per 1,000
population aged 65+ 
21.
4 20210166/1/717  22.2
22.
5
22.8

Page 155

Supplement 1. Core suite of integration indicators 5 
5
21.7 
22.6  2
2
.
6
0
2
0
2
2
0
2
2
2
/
2
/
3
2
3
17. Proportion of care
services graded ‘good’ (4) or
better in Care Inspectorate
inspections 
82.5 
2020/21 
75.8 75.2 77.0
2023/24  1.8 
18. Percentage of adults
with intensive care needs
receiving care at home 61.6
2016
19. Number of days
61.1
62.1  63.0 63.0 64.5  64.6 
919
64.8 
2023 
0.2
people aged 75+ spend
in hospital when they are
ready to be discharged
84
1
762 79
3
77
4 
484 
748
90
2 
-1.9
(per 1,000 population) 20201166/17/17 20220323//224    4

Page 156

Supplement 1. Core suite of integration indicators 6 
6
1. Percentage of adults able to look after their health very well or quite well 
IJB 2023/24
Scotland average 90.7
Trend from
previous year
Compared to
Scottish average
Aberdeen City 90.4 Down Below
Aberdeenshire 93.4 Down Above
Angus 91.1 Down Above
Argyll and Bute 92.4 Up Above
Clackmannanshire and Stirling 90.8 Down Above
Dumfries and Galloway 91.2 Down Above
Dundee City 88.3 Down Below
East Ayrshire 89.1 Down Below
East Dunbartonshire 93.8 Up Above
East Lothian 92.0 Down Above
East Renfrewshire 92.7 Up Above
Edinburgh 91.9 Up Above
Falkirk 91.0 Up Above
Fife 91.4 Up Above
Glasgow City 87.6 Down Below
Inverclyde 88.9 Down Below
Midlothian 92.5 Up Above
Moray 92.2 Down Above
North Ayrshire 89.1 Up Below
North Lanarkshire 87.4 Down Below
Orkney Islands 93.7 Up Above
Perth and Kinross 93.9 Up Above
Renfrewshire 88.7 Down Below
Scottish Borders 93.5 Up Above
Shetland Islands 94.6 Up Above
South Ayrshire 91.9 Up Above
Individual current IJB performance, change since previous year reported
and comparison to Scottish average in current year

Page 157

Supplement 1. Core suite of integration indicators 7 
7
South Lanarkshire 89.4 Down Below
West Dunbartonshire 88.4 Down Below
West Lothian 89.5 Down Below
Western Isles 91.7 Down Above

Page 158

Supplement 1. Core suite of integration indicators 8 
8
2. Percentage of adults supported at home who agree that they are supported to
live as independently as possible 
IJB 2023/24
Scotland average 72.4
Compared to
Scottish average
Aberdeen City 76.8 Above
Aberdeenshire 78.4 Above
Angus 74.1 Above
Argyll and Bute 79.4 Above
Clackmannanshire and Stirling 67.2 Below
Dumfries and Galloway 73.0 Above
Dundee City 77.1 Above
East Ayrshire 81.2 Above
East Dunbartonshire 79.8 Above
East Lothian 74.7 Above
East Renfrewshire 80.4 Above
Edinburgh 75.2 Above
Falkirk 67.6 Below
Fife 70.0 Below
Glasgow City 72.3 Below
Inverclyde 75.9 Above
Midlothian 76.5 Above
Moray 71.9 Below
North Ayrshire 67.5 Below
North Lanarkshire 67.7 Below
Orkney Islands 77.7 Above
Perth and Kinross 73.9 Above
Renfrewshire 65.5 Below
Scottish Borders 77.4 Above
Shetland Islands 95.4 Above
South Ayrshire 70.5 Below
South Lanarkshire 67.2 Below
West Dunbartonshire 62.7 Below
West Lothian 69.7 Below
Western Isles 78.9 Above 
Note: results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years

Page 159

Supplement 1. Core suite of integration indicators 9 
9
due to changes in survey wording.

Page 160

Supplement 1. Core suite of integration indicators 10 
10 
3. Percentage of adults supported at home who agree that they had a say in how
their help, care or support was provided 
IJB 2023/24
Scotland average 59.6
Compared to
Scottish average
Aberdeen City 56.5 Below
Aberdeenshire 66.2 Above
Angus 62.4 Above
Argyll and Bute 56.9 Below
Clackmannanshire and Stirling 57.9 Below
Dumfries and Galloway 60.3 Above
Dundee City 65.1 Above
East Ayrshire 69.5 Above
East Dunbartonshire 67.7 Above
East Lothian 63.9 Above
East Renfrewshire 75.0 Above
Edinburgh 57.2 Below
Falkirk 59.7 Above
Fife 51.0 Below
Glasgow City 61.5 Above
Inverclyde 67.8 Above
Midlothian 61.9 Above
Moray 59.5 Below
North Ayrshire 50.6 Below
North Lanarkshire 57.1 Below
Orkney Islands 68.1 Above
Perth and Kinross 67.9 Above
Renfrewshire 54.3 Below
Scottish Borders 63.4 Above
Shetland Islands 66.5 Above
South Ayrshire 59.5 Below
South Lanarkshire 55.4 Below
West Dunbartonshire 59.1 Below
West Lothian 53.5 Below
Western Isles 69.0 Above 
Note: results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years

Page 161

Supplement 1. Core suite of integration indicators 11 
11 
due to changes in survey wording.

Page 162

Supplement 1. Core suite of integration indicators 12 
12 
4. Percentage of adults supported at home who agree that their health and social
care services seemed to be well coordinated 
IJB 2023/24
Scotland average 61.4
Compared to
Scottish average
Aberdeen City 63.1 Above
Aberdeenshire 69.8 Above
Angus 55.6 Below
Argyll and Bute 66.2 Above
Clackmannanshire and Stirling 56.0 Below
Dumfries and Galloway 61.3 Below
Dundee City 63.9 Above
East Ayrshire 70.4 Above
East Dunbartonshire 66.4 Above
East Lothian 67.1 Above
East Renfrewshire 63.6 Above
Edinburgh 63.1 Above
Falkirk 53.9 Below
Fife 53.0 Below
Glasgow City 65.2 Above
Inverclyde 68.7 Above
Midlothian 74.4 Above
Moray 65.7 Above
North Ayrshire 55.5 Below
North Lanarkshire 56.0 Below
Orkney Islands 68.2 Above
Perth and Kinross 57.3 Below
Renfrewshire 55.3 Below
Scottish Borders 62.1 Above
Shetland Islands 72.8 Above
South Ayrshire 62.8 Above
South Lanarkshire 58.2 Below
West Dunbartonshire 54.3 Below
West Lothian 58.2 Below
Western Isles 63.2 Above 
Note: results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years

Page 163

Supplement 1. Core suite of integration indicators 13 
13 
due to changes in survey wording.

Page 164

Supplement 1. Core suite of integration indicators 14 
14 
5. Percentage of adults receiving any care or support who rate it as excellent
or good 
IJB 2023/24
Scotland average 70.0
Compared to
Scottish average
Aberdeen City 74.9 Above
Aberdeenshire 70.0 Equal
Angus 65.2 Below
Argyll and Bute 76.8 Above
Clackmannanshire and Stirling 64.8 Below
Dumfries and Galloway 68.8 Below
Dundee City 68.0 Below
East Ayrshire 78.6 Above
East Dunbartonshire 77.7 Above
East Lothian 76.3 Above
East Renfrewshire 74.0 Above
Edinburgh 74.1 Above
Falkirk 73.1 Above
Fife 63.0 Below
Glasgow City 71.2 Above
Inverclyde 70.7 Above
Midlothian 65.6 Below
Moray 68.7 Below
North Ayrshire 68.4 Below
North Lanarkshire 65.8 Below
Orkney Islands 82.5 Above
Perth and Kinross 70.1 Above
Renfrewshire 66.1 Below
Scottish Borders 72.6 Above
Shetland Islands 88.2 Above
South Ayrshire 75.4 Above
South Lanarkshire 66.7 Below
West Dunbartonshire 66.9 Below
West Lothian 62.1 Below
Western Isles 76.1 Above 
Note: results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years

Page 165

Supplement 1. Core suite of integration indicators 15 
15 
due to changes in survey wording.

Page 166

Supplement 1. Core suite of integration indicators 16 
16 
6. Percentage of people with positive experience of care at their GP practice 
IJB 2023/24
Scotland average 68.5
Trend from
previous year
Compared to
Scottish average
Aberdeen City 60.2 Down Below
Aberdeenshire 62.3 Up Below
Angus 62.1 Down Below
Argyll and Bute 83.9 Up Above
Clackmannanshire and Stirling 72.3 Up Above
Dumfries and Galloway 77.0 Up Above
Dundee City 71.2 Up Above
East Ayrshire 55.7 Down Below
East Dunbartonshire 69.4 Up Above
East Lothian 71.1 Up Above
East Renfrewshire 74.9 Up Above
Edinburgh 75.1 Up Above
Falkirk 69.4 Up Above
Fife 65.1 Up Below
Glasgow City 73.7 Up Above
Inverclyde 65.0 Up Below
Midlothian 67.9 Up Below
Moray 68.6 Up Above
North Ayrshire 60.0 Down Below
North Lanarkshire 52.8 Up Below
Orkney Islands 90.1 Up Above
Perth and Kinross 75.7 Up Above
Renfrewshire 63.3 Down Below
Scottish Borders 73.7 Up Above
Shetland Islands 87.4 Up Above
South Ayrshire 78.0 Up Above
South Lanarkshire 56.5 Up Below
West Dunbartonshire 63.8 Down Below
West Lothian 65.7 Up Below
Western Isles 85.5 Up Above

Page 167

Supplement 1. Core suite of integration indicators 17 
17 
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
Compared to
IJB 2023/24
Scotland average 69.8
Scottish average
Aberdeen City 74.4 Above
Aberdeenshire 73.6 Above
Angus 70.1 Above
Argyll and Bute 75.0 Above
Clackmannanshire and Stirling 66.1 Below
Dumfries and Galloway 69.1 Below
Dundee City 71.3 Above
East Ayrshire 74.0 Above
East Dunbartonshire 69.8 Equal
East Lothian 76.1 Above
East Renfrewshire 89.6 Above
Edinburgh 72.0 Above
Falkirk 61.4 Below
Fife 67.0 Below
Glasgow City 69.7 Below
Inverclyde 73.6 Above
Midlothian 76.0 Above
Moray 69.3 Below
North Ayrshire 67.6 Below
North Lanarkshire 67.7 Below
Orkney Islands 79.6 Above
Perth and Kinross 75.8 Above
Renfrewshire 64.2 Below
Scottish Borders 76.2 Above
Shetland Islands 70.7 Above
South Ayrshire 67.4 Below
South Lanarkshire 63.3 Below
West Dunbartonshire 64.0 Below
West Lothian 64.9 Below
Western Isles 67.0 Below 
Note: results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years

Page 168

Supplement 1. Core suite of integration indicators 18 
18 
due to changes in survey wording.

Page 169

Supplement 1. Core suite of integration indicators 19 
19 
8. Percentage of carers who feel supported to continue in their caring role 
IJB 2023/24
Scotland average 31.2
Trend from
previous year
Compared to
Scottish average
Aberdeen City 37.1 Up Above
Aberdeenshire 29.7 Down Below
Angus 33.7 Up Above
Argyll and Bute 37.6 Down Above
Clackmannanshire and Stirling 32.8 Up Above
Dumfries and Galloway 28.8 Down Below
Dundee City 34.3 Up Above
East Ayrshire 36.0 Up Above
East Dunbartonshire 25.8 Down Below
East Lothian 35.8 Up Above
East Renfrewshire 28.4 Up Below
Edinburgh 31.3 Up Above
Falkirk 30.7 Up Below
Fife 30.3 Up Below
Glasgow City 34.5 Up Above
Inverclyde 31.9 Up Above
Midlothian 34.6 Up Above
Moray 28.2 Down Below
North Ayrshire 31.6 Up Above
North Lanarkshire 28.5 Up Below
Orkney Islands 34.0 Down Above
Perth and Kinross 31.9 Down Above
Renfrewshire 28.5 Up Below
Scottish Borders 28.0 Down Below
Shetland Islands 46.3 Up Above
South Ayrshire 30.0 Down Below
South Lanarkshire 28.1 Down Below
West Dunbartonshire 26.7 Down Below
West Lothian 25.8 Up Below
Western Isles 32.6 Down Above

Page 170

Supplement 1. Core suite of integration indicators 20 
20 
9. Percentage of adults supported at home who agree they felt safe 
IJB 2023/24
Scotland average 72.7
Compared to
Scottish average
Aberdeen City 72.4 Below
Aberdeenshire 79.3 Above
Angus 63.7 Below
Argyll and Bute 72.6 Below
Clackmannanshire and Stirling 66.8 Below
Dumfries and Galloway 76.3 Above
Dundee City 76.5 Above
East Ayrshire 75.8 Above
East Dunbartonshire 84.6 Above
East Lothian 79.6 Above
East Renfrewshire 79.5 Above
Edinburgh 78.6 Above
Falkirk 69.5 Below
Fife 69.1 Below
Glasgow City 72.6 Below
Inverclyde 72.7 Equal
Midlothian 79.9 Above
Moray 70.0 Below
North Ayrshire 67.5 Below
North Lanarkshire 68.4 Below
Orkney Islands 84.1 Above
Perth and Kinross 76.8 Above
Renfrewshire 66.9 Below
Scottish Borders 71.9 Below
Shetland Islands 87.5 Above
South Ayrshire 73.6 Above
South Lanarkshire 66.2 Below
West Dunbartonshire 66.7 Below
West Lothian 67.6 Below
Western Isles 75.8 Above 
Note: results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years

Page 171

Supplement 1. Core suite of integration indicators 21 
21 
due to changes in survey wording.

Page 172

Supplement 1. Core suite of integration indicators 22 
22 
11. Premature mortality rate per 100,000 persons, by calendar year
Trend from 
Compared to
IJB 2022
Scotland average 442
previous year Scottish average
Aberdeen City 441 Down Below
Aberdeenshire 338 Down Below
Angus 390 Down Below
Argyll and Bute 398 Up Below
Clackmannanshire and Stirling 407 Down Below
Dumfries and Galloway 428 Down Below
Dundee City 546 Down Above
East Ayrshire 515 Down Above
East Dunbartonshire 302 Up Below
East Lothian 357 Down Below
East Renfrewshire 264 Down Below
Edinburgh 411 Up Below
Falkirk 473 Down Above
Fife 431 Down Below
Glasgow City 615 Down Above
Inverclyde 542 Up Above
Midlothian 428 Up Below
Moray 330 Down Below
North Ayrshire 527 Down Above
North Lanarkshire 510 Down Above
Orkney Islands 393 Up Below
Perth and Kinross 380 Up Below
Renfrewshire 463 Down Above
Scottish Borders 358 Up Below
Shetland Islands 282 Down Below
South Ayrshire 422 Down Below
South Lanarkshire 459 Down Above
West Dunbartonshire 551 Down Above
West Lothian 439 Down Below
Western Isles 473 Up Above

Page 173

Supplement 1. Core suite of integration indicators 23 
23 
12. Emergency admission rate (per 100,000 population)
Trend from 
Compared to
IJB 2022/23
Scotland average 11,276
previous year Scottish average
Aberdeen City 9,360 Down Below
Aberdeenshire 8,572 Up Below
Angus 11,525 Up Above
Argyll and Bute 11,968 Down Above
Clackmannanshire and Stirling 13,037 Up Above
Dumfries and Galloway 12,102 Down Above
Dundee City 13,097 Up Above
East Ayrshire 13,582 Down Above
East Dunbartonshire 11,098 Up Below
East Lothian 9,173 Down Below
East Renfrewshire 9,216 Down Below
Edinburgh 7,340 Down Below
Falkirk 14,679 Up Above
Fife 12,872 Up Above
Glasgow City 11,163 Down Below
Inverclyde 12,444 Down Above
Midlothian 9,517 Down Below
Moray 8,273 Down Below
North Ayrshire 13,449 Down Above
North Lanarkshire 15,111 Down Above
Orkney Islands 9,538 Down Below
Perth and Kinross 12,526 Up Above
Renfrewshire 10,778 Down Below
Scottish Borders 9,840 Down Below
Shetland Islands 9,746 Up Below
South Ayrshire 14,303 Down Above
South Lanarkshire 12,530 Down Above
West Dunbartonshire 13,015 Down Above
West Lothian 11,153 Down Below
Western Isles 14,277 Up Above

Page 174

Supplement 1. Core suite of integration indicators 24 
24 
13. Emergency bed day rate (per 100,000 population)
Trend from 
Compared to
IJB 2022/23
Scotland average 119,806
previous year Scottish average
Aberdeen City 99,923 Up Below
Aberdeenshire 87,853 Up Below
Angus 96,778 Up Below
Argyll and Bute 118,552 Up Below
Clackmannanshire and Stirling 115,181 Up Below
Dumfries and Galloway 142,256 Up Above
Dundee City 114,287 Up Below
East Ayrshire 130,667 Up Above
East Dunbartonshire 126,381 Up Above
East Lothian 115,986 Down Below
East Renfrewshire 108,721 Up Below
Edinburgh 98,783 Down Below
Falkirk 135,305 Up Above
Fife 118,148 Up Below
Glasgow City 133,843 Up Above
Inverclyde 154,188 Up Above
Midlothian 118,079 Up Below
Moray 98,741 Up Below
North Ayrshire 151,553 Down Above
North Lanarkshire 126,261 Up Above
Orkney Islands 86,572 Down Below
Perth and Kinross 121,394 Up Above
Renfrewshire 130,472 Down Above
Scottish Borders 131,395 Up Above
Shetland Islands 72,909 Up Below
South Ayrshire 172,992 Up Above
South Lanarkshire 122,237 Up Above
West Dunbartonshire 152,062 Up Above
West Lothian 95,797 Up Below
Western Isles 133,554 Up Above

Page 175

Supplement 1. Core suite of integration indicators 25 
25 
14. Emergency readmissions to hospital within 28 days of discharge
(rate per 1,000 discharges) 
IJB 2022/23
Scotland average 102
Trend from
previous year
Compared to
Scottish average
Aberdeen City 119 Down Above
Aberdeenshire 92 Down Below
Angus 115 Up Above
Argyll and Bute 84 Down Below
Clackmannanshire and Stirling 126 Down Above
Dumfries and Galloway 95 Up Below
Dundee City 139 Down Above
East Ayrshire 104 Down Above
East Dunbartonshire 79 Down Below
East Lothian 88 Down Below
East Renfrewshire 69 Down Below
Edinburgh 92 Down Below
Falkirk 141 Down Above
Fife 117 Up Above
Glasgow City 96 Down Below
Inverclyde 76 Down Below
Midlothian 96 Down Below
Moray 80 Down Below
North Ayrshire 100 Down Below
North Lanarkshire 117 Up Above
Orkney Islands 69 Down Below
Perth and Kinross 137 Up Above
Renfrewshire 80 Down Below
Scottish Borders 121 Up Above
Shetland Islands 68 Down Below
South Ayrshire 100 Down Below
South Lanarkshire 100 Down Below
West Dunbartonshire 82 Down Below
West Lothian 95 Down Below
Western Isles 108 Down Above

Page 176

Supplement 1. Core suite of integration indicators 26 
26 
15. Proportion of last 6 months of life spent at home or in a community setting 
IJB 2022/23
Scotland average 88.9
Trend from
previous year
Compared to
Scottish average
Aberdeen City 90.3 Down Above
Aberdeenshire 90.7 Down Above
Angus 92.2 Down Above
Argyll and Bute 89.6 Down Above
Clackmannanshire and Stirling 89.3 Down Above
Dumfries and Galloway 88.5 Down Below
Dundee City 90.0 Down Above
East Ayrshire 88.9 Down Equal
East Dunbartonshire 88.1 Down Below
East Lothian 88.0 Up Below
East Renfrewshire 87.7 Down Below
Edinburgh 88.0 Down Below
Falkirk 88.1 Down Below
Fife 89.8 Down Above
Glasgow City 88.0 Down Below
Inverclyde 87.8 Down Below
Midlothian 87.1 Down Below
Moray 90.5 Down Above
North Ayrshire 87.9 Down Below
North Lanarkshire 89.0 Down Above
Orkney Islands 90.9 Down Above
Perth and Kinross 88.7 Down Below
Renfrewshire 88.8 Up Below
Scottish Borders 87.7 Down Below
Shetland Islands 93.4 Down Above
South Ayrshire 87.6 Down Below
South Lanarkshire 88.8 Down Below
West Dunbartonshire 87.7 Down Below
West Lothian 89.8 Down Above
Western Isles 90.1 Down Above

Page 177

Supplement 1. Core suite of integration indicators 27 
27 
16. Falls rate per 1,000 population aged 65+ 
IJB 2022/23
Scotland average 22.6
Trend from
previous year
Compared to
Scottish average
Aberdeen City 20.8 Down Below
Aberdeenshire 17.2 Down Below
Angus 26.5 Up Above
Argyll and Bute 27.6 Down Above
Clackmannanshire and Stirling 23.8 Up Above
Dumfries and Galloway 20.2 Up Below
Dundee City 33.5 Up Above
East Ayrshire 18.4 Down Below
East Dunbartonshire 22.6 Up Equal
East Lothian 21.3 Down Below
East Renfrewshire 23.7 Down Above
Edinburgh 23.1 Down Above
Falkirk 25.3 Up Above
Fife 26.8 Down Above
Glasgow City 27.3 Down Above
Inverclyde 23.7 Up Above
Midlothian 20.0 Down Below
Moray 17.7 Down Below
North Ayrshire 20.4 Up Below
North Lanarkshire 20.0 Down Below
Orkney Islands 19.9 Up Below
Perth and Kinross 27.8 Up Above
Renfrewshire 25.1 Up Above
Scottish Borders 15.8 Down Below
Shetland Islands 24.4 Up Above
South Ayrshire 19.4 Down Below
South Lanarkshire 22.7 Up Above
West Dunbartonshire 23.7 Up Above
West Lothian 19.8 Down Below
Western Isles 22.8 Down Above

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Supplement 1. Core suite of integration indicators 28 
28 
17. Proportion of care services graded ‘good’ (4) or better in
Care Inspectorate inspections 
IJB 2023/24
Scotland average 77.0
Trend from
previous year
Compared to
Scottish average
Aberdeen City 70.7 Up Below
Aberdeenshire 78.5 Up Above
Angus 71.3 Up Below
Argyll and Bute 77.3 Down Above
Clackmannanshire and Stirling 84.6 Up Above
Dumfries and Galloway 74.2 Down Below
Dundee City 77.5 Up Above
East Ayrshire 78.0 Up Above
East Dunbartonshire 85.6 Down Above
East Lothian 82.5 Up Above
East Renfrewshire 89.3 Up Above
Edinburgh 83.5 Up Above
Falkirk 86.9 Up Above
Fife 68.7 Up Below
Glasgow City 82.7 Up Above
Inverclyde 80.6 Up Above
Midlothian 76.4 Up Below
Moray 81.1 Up Above
North Ayrshire 82.9 Up Above
North Lanarkshire 75.8 Down Below
Orkney Islands 70.7 Up Below
Perth and Kinross 70.8 Down Below
Renfrewshire 75.4 Down Below
Scottish Borders 70.6 Down Below
Shetland Islands 88.9 Up Above
South Ayrshire 73.4 Up Below
South Lanarkshire 79.9 Up Above
West Dunbartonshire 81.4 Down Above
West Lothian 85.1 Up Above
Western Isles 89.8 Up Above

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Supplement 1. Core suite of integration indicators 29 
29 
18. Percentage of adults with intensive care needs receiving care at home 
IJB 2023
Scotland average 64.8
Trend from
previous year
Compared to
Scottish average
Aberdeen City 54.6 Equal Below
Aberdeenshire 62.9 Down Below
Angus 63.1 Up Below
Argyll and Bute 68.3 Down Above
Clackmannanshire and Stirling 70.4 Up Above
Dumfries and Galloway 77.8 Up Above
Dundee City 61.8 Up Below
East Ayrshire 71.6 Up Above
East Dunbartonshire 65.1 Down Above
East Lothian 62.0 Up Below
East Renfrewshire 64.4 Down Below
Edinburgh 68.8 Up Above
Falkirk 67.8 Up Above
Fife 59.2 Down Below
Glasgow City 59.3 Up Below
Inverclyde 67.4 Down Above
Midlothian 70.3 Up Above
Moray 60.6 Down Below
North Ayrshire 77.7 Up Above
North Lanarkshire 69.9 Down Above
Orkney Islands 69.5 Down Above
Perth and Kinross 63.8 Down Below
Renfrewshire 63.8 Up Below
Scottish Borders 59.5 Down Below
Shetland Islands 77.7 Down Above
South Ayrshire 63.6 Down Below
South Lanarkshire 62.9 Down Below
West Dunbartonshire 70.2 Down Above
West Lothian 63.7 Up Below
Western Isles 60.2 Equal Below

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Supplement 1. Core suite of integration indicators 30 
30 
19. Number of days people aged 75+ spend in hospital when they are ready to be
discharged (per 1,000 population) 
IJB 2023/24
Scotland average 902
Trend from
previous year
Compared to
Scottish average
Aberdeen City 220 Down Below
Aberdeenshire 667 Up Below
Angus 166 Down Below
Argyll and Bute 912 Up Above
Clackmannanshire and Stirling  814 Up Below
Dumfries and Galloway 1,304 Down Above
Dundee City 428 Down Below
East Ayrshire 700 Up Below
East Dunbartonshire 444 Down Below
East Lothian 238 Up Below
East Renfrewshire 391 Down Below
Edinburgh 1,087 Down Above
Falkirk 1,283 Down Above
Fife 681 Down Below
Glasgow City 962 Down Above
Inverclyde 554 Up Below
Midlothian 639 Down Below
Moray 980 Down Above
North Ayrshire 1,087 Up Above
North Lanarkshire 973 Up Above
Orkney Islands 1,002 Up Above
Perth and Kinross 664 Down Below
Renfrewshire 150 Down Below
Scottish Borders 1,605 Up Above
Shetland Islands 452 Down Below
South Ayrshire 1,943 Down Above
South Lanarkshire 1,008 Down Above
West Dunbartonshire 1,327 Down Above
West Lothian 871 Up Below
Western Isles 1,478 Up Above

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31 
Supplement 1. Core suite of integration indicators 22

Page 182

32 
AUDITSCOTLAND
Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN
T: 0131 625 1500  E: info@ audit.scot
www.audit.scot

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33 
IJB members questions 
This tool is designed to provide IJB members with examples of
questions they may wish to use to consider the IJB’s financial and
performance position. The questions relate to points raised in our report 
Integration Joint Boards: Finance and performance 2024. 
Please note, this is not an exhaustive list of questions and considerations
should be made of your individual IJB’s particular circumstances and level
of applicability in relation to the findings. 
Findings Questions Notes
General
Supplement 2. Prepared by Audit Scotland | July 2024
Integration Joint Boards
Finance and performance 2024
IJB members questions supplement

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34 
• IJBs face a complex
landscape of considerable
challenges and uncertainties.
• IJBs are facing significant
financial sustainability
challenges and cost
pressures are only increasing.
• The demand and need for
services continue to increase
and become more complex.
• The workforce is under
immense pressure.
• The cost-of-living crisis is
affecting the demand for
services as well as the ability
to provide them.
• Instability of leadership
continues to be a challenge
for IJBs.
• Plans for a National Care
Service have brought
uncertainty for IJBs.
• Do we, the IJB, have
a comprehensive
understanding of the
present and longer-term
needs of the population
we serve?
• Do we have a clear plan
on how to address the
significant challenges
facing community health
and social care?
• How are we seeking to
address recruitment and
retention challenges?
• Is there sufficient
leadership capacity within
the IJB to effectively plan
service provision and
transformation?
• Are you clear about
what your roles and
responsibilities are as an
IJB Board member? 
Cont.

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Supplement 2. Integration Joint Boards Finance and performance 2024 2 
2
Findings Questions Notes
Finance
• The fi ancial health of IJBs
continues to weaken and
there are indications of more
challenging times ahead.
• IJB funding has decreased
in real terms compared to
2021/22.
• Non-recurring savings, arising
from unfilled vacancies,
led to the majority of IJBs
reporting a surplus on the
cost of providing services.
• The majority of the total
planned savings were
achieved, but over a third
were only achieved on a
one-off basis.
• Total reserves held by
IJBs have almost halved in
2022/23 largely due to the
use or return of Covid-19
related reserves.
• The projected fi ancial
position is set to worsen.
• The increasing reliance on
non-recurring sources of
income is not sustainable.
• Financial sustainability risks
have been identified by
auditors in the vast majority
of IJBs.
• Medium-term fi ancial plans
need to be updated to reflect
all costs pressures currently
known.
• Has the Medium-term
financial plan been
updated to reflect all
costs pressures currently
known?
• What proportion of the IJB
budget is proposed to be
funded from non-recurring
sources of income?
• Are reserve levels in line
with the IJBs reserve
policy? How long can
current levels of use be
maintained?
• Are the savings targets
achievable on a recurring
basis? 
Cont.

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Supplement 2. Integration Joint Boards Finance and performance 2024 3 
3
Findings Questions Notes
Data
• Data quality is insufficient to
fully assess the performance
of IJBs but national indicators
show a general decline in
performance and outcomes.
• Data quality is insufficient to
fully assess the performance
of IJBs and inform
improvement of outcomes
for service users with a lack
of joined-up data across the
system.
• Work to improve the data
sets is at an early stage but is
progressing.
• Available national indicators
show a general decline in
performance and outcomes
for people using social care
and community health
services.
• Is the current available data
suffi ient to assess how
well the IJB is performing?
• How well does
performance data support
decision making?
• What actions are the IJB
undertaking to improve
data collection, quality and
sharing? 
Prevention and early intervention
• Collaborative, preventative
and person-centred working
is shrinking at a time when
it is most needed. Instead
of a focus on care at the
right place at the right time,
there is a shift to reactive
services with little capacity
to invest in early intervention
and prevention.
• How are the IJB prioritising
and targeting resources
on prevention and early
intervention?
• How are the IJB working
with partner bodies to
promote and signpost to
preventative services? 
Cont.

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Supplement 2. Integration Joint Boards Finance and performance 2024 4 
4
Findings Questions Notes
Shifting the balance of care
• The percentage of
expenditure on institutional
and community-based
Adult Social Care services
has largely remained static
with a small increase in
the proportion spent on
accommodation-based
services.
• Increase in the number of
individuals receiving care at
home or in the community.
However, these changes are
marginal when viewed over
the time since the inception
of health and social care
integration in 2015.
• Lack of social care capacity
remains an obstacle to
improving patient flow and
reducing the number of
delayed discharges from
hospital.
• Are the IJB successfully
shifting service provision
from an institutional
setting to a community
setting?
• How are the IJB
increasing the capacity of
services provided in the
community? 
Person centred care – choice and control
• The amount of choice and
control service users feel
they have is variable across
the country.
• How are the IJB ensuring
that the views of service
users are considered as
part of decision-making?
How clearly can you see
the impact of this?
• What actions are the IJB
undertaking to increase
the choice and control for
service users over their
support and care? 
Cont.

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Supplement 2. Integration Joint Boards Finance and performance 2024 5 
5
Findings Questions Notes
Reducing inequalities
• The Covid-19 pandemic
has exacerbated existing
inequalities.
• The premature mortality rate
is increasing with rates higher
in more urban and more
deprived areas.
• Emergency bed day rates are
greater in areas with higher
levels of deprivation.
• What steps are the IJB
taking to identify and
address inequality?
• Is consideration of
inequalities embedded in
IJB decision-making? 
Unpaid carers
• The reliance on unpaid carers
is increasing as the social
care workforce is under
added pressure.
• Does the IJB know the
number of unpaid carers in
their area?
• What proportion of these
unpaid carers have carer
support plans in place?
• How is the IJB improving
support for unpaid carers? 
Cont.

Page 189

Supplement 2. Integration Joint Boards Finance and performance 2024 6 
6
Findings Questions Notes
Commissioning and procurement
• Commissioning and
procurement practices
for social care services
continues to be largely driven
by budgets, competition, and
cost rather than outcomes
for people. Improvements
to commissioning and
procurement arrangements
have been slow to progress
but are developing.
• Improvements to
commissioning and
procurement arrangements
have been slow, with cost
rather than outcomes driving
decision-making.
• Current commissioning and
procurement practices are
a risk for the sustainability
of service providers and the
workforce.
• Current commissioning
and procurement practices
are not always delivering
improved outcomes for
people.
• There is an increasing
desire to move towards more
ethical and collaborative
commissioning models but it
has not yet been universally
adopted.
• National approaches to
improve commissioning have
been slow to progress but
are developing.
• What steps have the IJB
made to move towards
commissioning in a more
collaborative way?
• What steps have the IJB
taken to move the focus of
commissioning to a basis
of quality or outcomes
rather than on cost?

Page 190

Supplement 2. Integration Joint Boards Finance and performance 2024 7 
7
Audit Scotland, 4th Floor, 102 West Port,
Edinburgh EH3 9DN T: 0131 625 1500  E:
info@audit.scot
www.audit.scot

Page 191

1 
REPORT 
Item No: 12 
1. PURPOSE OF REPORT
1.1 This paper is coming to the Integration Joint Board (IJB) for:   
For approval  For endorsement  For noting 
1.2 This report provides a summary of the financial position of the North Lanarkshire
University Health and Social Care Partnership (UHSCNL) for the period 1 April
2024 to 30 June 2024. 
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 the contents of the report; and
(2) Acknowledge the projected outturn for 2024/25 is an underspend of £1.429m. 
4. VARIATIONS TO DIRECTIONS 
5. BACKGROUND/SUMMARY OF KEY ISSUES
5.1 This report is based on the financial monitoring reports received from NHS
Lanarkshire Director of Finance and North Lanarkshire Council Head of Financial
Solutions.  The position detailed in these reports is therefore based on the
information contained in each partner’s respective financial systems and includes
accruals and adjustments in-line with their financial policies.   
6. CONCLUSIONS
6.1 As detailed in the following table, the IJB projected outturn position, is an
underspend of £1.429m, assuming the current trajectory of spend continues until
the end of this financial year.  Currently there is no ring-fenced funding included in
this reported position.   
SUBJECT: Financial Monitoring Report 2024/25
TO: Integration Joint Board Committee
Lead Officer
for Report:
Ross McGuffie Chief Officer NL HSCP
Author(s) of
Report
Amanda Kilburn, Chief Finance Officer 
DATE: 25 September 2024
Yes  No  N/A

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2 
6.2  Appendices 1 to 3 show a detailed budget position for each care group including
South led hosted services. 
6.3 In line with Scottish Government guidance, unspent ring-fenced funding must be
transferred to relevant reserves at the end of each financial year for use in later
years.  Subject to IJB approval, in-year underspends will be allocated to manage,
on a non-recurring basis, ring-fenced commitments, Strategic Commissioning Plan
commitments and any funding gap which has been highlighted in the North
Lanarkshire IJB financial plans. 
7. 2023/24 FINANCIAL PERFORMANCE
7.1 The current financial forecast for 2024/25 projects a yearly underspend of
£1.429m relating to various under and overspends across the whole integrated
budget.  A summary of the main variances including financial challenges and key
pressures are highlighted below: 
7.1.1 Employee Costs – projected underspend of £14.547m 
As reported throughout 2023/24, there are continuing challenges in terms of
recruitment and retention across all service areas.  For a wide range of posts
recruitment has been unsuccessful due to the availability of the skills mix required
or the competition being offered by other private and public sectors.     
As highlighted in the financial plan, included in this underspend is £6.961m relating
to a non-recurring reduction in pension contributions.  This will be used to offset
overspends in other areas of Adult Social Care during 2024/25 to allow time for
savings plans to be realised.   
7.1.2 Payments to Other Bodies (PTOB) – projected overspend of £4.824m 
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 care plans is 1,477 resulting in a overspend of £1.749m. 
 SDS is similarly overspend due to a budget to fund 2,617 care plans against
2,711 care plans for 2024/25.   
This is an area which is currently under review and is included in the 2 year
savings delivery plan.  Further details are at Appendix 6. 
7.1.3 Prescribing – projected overspend of £5.108m
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
£m £m £m £m £m
Health Care Services 523.988 5.435 529.423 528.053 1.369
Social Care Services 263.395 0.000 263.395 263.336 0.059
TOTAL 787.383 5.435 792.818 791.389 1.429
Annual
Budget
2024/25Care Group
Projected Year
End Variance
2024/25
Projected Year
End Spend         
2024/25
In Year
Drawdown
From
Reserves
Revised
Budget
2024/25

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3 
prescribing data available to April 2024.   The forecast will be updated as further
data becomes available.   
7.1.4 North Lanarkshire Hosted Services – projected overspend of £2.924m
The main variances within North Lanarkshire hosted services relate to: 
 Continence Services – overspend of £0.664m which is related to increases in
product and delivery costs. 
 Children Services – overspend of £1.597m which is mainly due to additional
expenditure relating to diabetic glucose monitoring machines and insulin
pumps. 
 Prisoner Healthcare – overspend of £0.663m due to the increase in costs
linked to the delivery of the new pharmacy contract and drug prices associated
with prescribing. 
7.2 Throughout the year, adjustments are made to the original budget due to
additional budget allocations and budget transfers.  Appendix 4 provides a
reconciliation of the main budget adjustments applied this financial year and the
table below shows the current funding allocation received from Scottish
Government: 
Scottish Government Allocations 2024/25
£m
Alcohol and Drug Partnership Funding 2.146
Digital Mental Health Licences 0.120
Distress Brief Intervention 2.780
Enhanced Mental Health Outcomes Framework* 6.286
Family Nurse Partnership 1.074
Long Covid Support Fund 0.224
Meningitis C Funding 0.106
Specialty and Specialist Doctors Contract 0.194
TOTAL 12.930 
*Further discussion is underway with Scottish Government regarding this funding
stream as the allocation received in July does not cover all the partnerships
current Mental Health commitments. 
8. SAVINGS
8.1 The saving delivery plan commenced in April 2024 with a target of £29.093m over
financial years 2024/25 and 2025/26.    
8.2 CORE management team and various sustainability and value groups have been
meeting on a regular basis to discuss and monitor the management actions
reported in the financial plans to progress savings and redesign of services to help
support future years budget planning.  This includes the following areas of work: 
 Review of financial planning assumptions for 2024/25.
 Review of all current vacancies including length of time left vacant.
 Review of discretionary spend and supplementary staffing.
 Updates on saving planning in significant areas of budget pressures.

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4 
 Various service reviews across the partnership.
 Collaboration with South UHSCP Management Team primarily to review hosted
services and joint working arrangements across Lanarkshire.
8.3  The current IJB savings position at the end of June 2024, show total savings
achieved of £6.331m and is summarised in the table below:   
8.4 Appendix 6 shows a detailed list, including target value, of all IJB approved saving
plans. 
9. GENERAL RESERVES
9.1 It is important for the long-term financial stability and the sustainability of the IJB
that sufficient funds are held in reserve to manage unanticipated pressures from
year to year.  The requirement for financial reserves is acknowledged in statue
and is part of a range of measures in place to ensure that s106 public bodies do
not over-commit themselves financially. 
9.2 The current IJB reserves position for 2024/25 after adjustments for the drawdown
of in-year reserves, is a revised balance of £70.089m and is summarised in the
table below: 
9.3 Appendix 5 shows a detailed list of all reserve movement during this financial year. 
29.093
6.331
4.910
1.421
Delivery Plan Target
Total Savings Achieved
Health Achieved to Date
Social Care Achieved to Date
0.000 5.000 10.000 15.000 20.000 25.000 30.000
£m
North Lanarkshire IJB
2 Year Savings Delivery Plan (£m)
Opening
Balance As At
1 April 2023          
Proposed
Transfers
To / From
Reserves
Drawdown
from
Reserves
Revised
Balance As At
30 June 2024
£m £m £m £m
NHSL Ring-Fenced Reserves 23.773 0.000 (4.474) 19.298
NLC/NHSL Earmarked Reserves 20.975 0.000 (0.619) 20.356
NLC/NHSL Risk-Based Reserves 17.045 0.000 0.000 17.045
NHSL Contingency Reserves 13.390 0.000 0.000 13.390
NLC/NHSL Closed Reserves 0.341 0.000 (0.341) (0.000)
75.524 0.000 (5.435) 70.089Total
LEAD SUMMARY

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5 
9.4 Regular updates will be provided to the IJB throughout the year as analysis and
reviews of all reserves are monitored to ensure they continue to meet on-going
pressures and remain fit for purpose. 
10. VACANCY POSITION 2024/25
10.1 The table below shows the full time equivalent (FTE) vacancy numbers at 30 June
2024 within each service compared against their budgeted establishment: 
* Over establishment is in relation to Mental Health commitments highlighted in
para 7.2 above. 
10.2 To help cover the vacant posts throughout the year, agency staff, bankaide,
overtime and excess part time hours is used, the cost of which is included within
the financial position reported.  A detailed analysis of these costs is at appendix 7. 
11.  DIGITAL FINANCE POSITION 2024/25
11.1 Below is a summary of the current North Lanarkshire IJB digital programmes of
work and the agreed funding associated with each: 
Establishment Actual Vacancies
FTE FTE FTE
North West Locality 394.82 368.21 26.61
North East Locality 332.09 314.56 17.53
Adult Services 294.58 287.60 6.98
Children Services* 492.38 548.16 -55.78
Mental Health* 1,165.83 1,172.48 -6.65
Social Care Services 986.90 820.85 166.05
Home Support 1,000.17 861.23 138.94
Other 228.76 228.76 0.00
TOTAL 4,895.53 4,601.85 293.68
Position as at 30 June 2024
Service
Overtime                            Excess
Part Time Bankaide  Agency   TOTAL
£m £m £m £m £m
North West Locality 0.027 0.009 0.143 0.008 0.186
North East Locality 0.022 0.007 0.112 -0.002 0.139
Adult Services 0.015 0.016 0.067 0.002 0.100
Children Services 0.042 0.013 0.155 0.000 0.210
Mental Health 0.083 0.023 0.937 1.193 2.236
Social Care Services 0.194 - - 0.000 0.194
Home Support 1.023 - - - 1.023
Other 0.004 0.004 0.015 - 0.023
TOTAL 1.409 0.071 1.428 1.201 4.110
SERVICE
Costs As At 30 June 2024

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6 
11.2 Currently two of the three programmes are progressing within their allocated
funding however, Community Alarms envisage a gap in recurring funding from
2026/27 onwards.  To ensure future financial transparency, the Medium Term
Financial Plan will be updated to reflect this additional pressure. 
12.  IMPLICATIONS
12.1 NATIONAL OUTCOMES  
Social Work Case Management System (MOSAIC) COST £m FUNDING £m
Year 1 (23/24) 0.213
Year 2 (24/25) 0.174
Year 3 (25/26) 0.114
Year 4 (26/27) 0.114
Year 5 (27/28) 0.114
Year 6 (28/29) 0.114
Year 7 (29/30) 0.114
TOTAL COST OF PROGRAMME 0.957
Capital Budget (0.157)
Non-Recurring Funding (0.100)
Earmarked Reserve (0.700)
TOTAL FUNDING AVAILABLE (0.957)
Home Support Scheduling System (ACCESS) COST £m FUNDING £m
Year 1 (23/24) 0.521
Year 2 (24/25) 0.610
Year 3 (25/26) 0.547
Year 4 (26/27) 0.312
Year 5 (27/28) 0.326
Year 6 (28/29) 0.340
TOTAL COST OF PROGRAMME 2.656
Recurring Revenue Budget (0.224)
Earmarked Reserve (2.432)
TOTAL FUNDING AVAILABLE (2.656)
Community Alarms Analogue to Digital COST £m FUNDING £m
Year 1 (24/25) 0.399
Year 2 (25/26) 0.229
Year 3 (26/27) 0.279
TOTAL COST OF PROGRAMME 0.907
Capital Budget (0.087)
Recurring Revenue Budget (0.135)
Earmarked Reserve (0.465)
TOTAL FUNDING AVAILABLE (0.687)
Recurring Funding Gap From Year 3 (26/27) 0.220

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7 
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 
☒
12.2 ASSOCIATED MEASURE(S) 
Each partner is required to remain within their approved budgetary provision.   
12.3 FINANCIAL 
This paper has been reviewed by Finance:
Yes  No  N/A 
12.4 RISK ASSESSMENT/RISK MANAGEMENT 
The strategic financial risks detailed in the IJB Risk Register has been updated
where necessary and are included in a separate report to the IJB. 
Relevant Risk Register Details  Current Risk Level  Risk Owner 
Financial Challenges High Amanda Kilburn
Prevention and Detection of Fraud,
Bribery and/or Corruption
Low Ross McGuffie
National Set-Aside Budget High Ross McGuffie
Hosted Services Medium Ross McGuffie
Prescribing Activity and Costs Very High Ross McGuffie
Third and Voluntary Sector Low Ross McGuffie
Ineffective Governance Arrangements Medium Ross McGuffie 
12.5 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 Head of Financial Solutions
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

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8 
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 and supports the
IJB Strategic Commissioning Plan
to ensure robust financial
monitoring and scrutiny. 
12.6  INEQUALITIES & FAIRER SCOTLAND DUTY
Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact
Assessment Form Completed and EQIA added to website: 
Yes  No  N/A 
13. BACKGROUND PAPERS 
None. 
14. APPENDICES 
Appendix 1 - North Lanarkshire IJB Budget Position 
Appendix 2 - Hosted Services Led by North Lanarkshire 
Appendix 3 - Hosted Services Led by South Lanarkshire 
Appendix 4 - North Lanarkshire IJB Budget Reconciliation 2024/25 
Appendix 5 – North Lanarkshire IJB Movement on Reserves 
Appendix 6 – North Lanarkshire IJB 2 Year Savings Delivery Plan 
Appendix 7 – Analysis of Additional Employee Costs 2024/25   
Chief Finance Officer   
Members seeking further information about any aspect of this report, please contact
Amanda Kilburn on telephone number 07816 126362.

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9 
North Lanarkshire IJB Revenue Budget Position 1 April 2024 to 30 June 2024 Appendix 1
Annual
Year To Date
Variance
Projected Year
End Outturn
Budget Budget Actual Total Total
2024/25 June 2024 June 2024 June 2024 2024/25
£m £m £m £m £m
Health Care Services
Locality and Other Services 62.321 15.873 14.995 0.878 3.513
Addiction Services 4.625 1.446 1.443 0.002 0.010
Medical and Nursing Directorate 4.034 1.144 1.048 0.096 0.383
Prescribing 72.295 18.074 19.351 (1.277) (5.108)
Out of Area Services 4.318 1.079 0.858 0.221 0.885
Area Wide Services 7.702 1.751 1.583 0.168 0.672
Hosted Services 174.188 46.752 46.498 0.254 1.015
Family Health Services 125.402 31.127 31.127 0.000 0.000
Set-Aside Budget 74.537 18.634 18.634 0.000 0.000
Total Expenditure - NHSL 529.423 135.881 135.538 0.342 1.369
Social Care Services
Social Care Services Gross Expenditure 265.652 81.739 81.731 0.009 0.028
Social Care Services Gross Income (4.487) (1.381) (1.390) 0.010 0.031
Social Care Services Net Expenditure 261.165 80.359 80.340 0.018 0.059
Housing Revenue Account 2.229 0.686 0.686 0.000 0.000
Social Care, Housing and Transport Services Net Expenditure 263.394 81.044 81.026 0.018 0.059
Total Expenditure - NHSL and NLC 792.818 216.925 216.564 0.361 1.429
Annual
Budget
2024/25
£m
NHS Lanarkshire Funding (523.988)
Social Care Funding (23.417)
Resource Transfer (23.975)
Commissioned Services (6.962)
Transfer from Reserves (Approved) (5.435)
Total Funding - NHSL (583.778)
NLC Funding - Social Care Services (206.811)
NLC Funding - Housing Services (2.229)
Transfer from Reserves (Approved) 0.000
Total Funding - NLC (209.040)
Total Funding - NHSL and NLC (792.818)
Year To Date
Care Group
Funded By:

Page 200

10 
Hosted Services Appendix 2
June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024
Budget Actual Variance Budget Actual Variance Budget Actual Variance
£m £m £m £m £m £m £m £m £m £m £m £m
Sexual Health Services 3.321 0.885 0.903 (0.017) 1.727 0.460 0.478 (0.017) 1.594 0.425 0.425 0.000
Continence Services 2.475 0.625 0.790 (0.166) 1.287 0.325 0.491 (0.166) 1.188 0.300 0.300 0.000
Immunisation Services 2.072 0.518 0.710 (0.192) 1.078 0.269 0.462 (0.192) 0.995 0.249 0.249 0.000
Speech and Language Therapy Services 7.066 1.767 1.594 0.173 3.674 0.919 0.746 0.173 3.392 0.848 0.848 0.000
Children and Adolescents Mental Health Services 9.309 3.373 3.148 0.224 4.841 1.754 1.529 0.224 4.469 1.619 1.619 0.000
Childrens Services 12.272 3.173 3.572 (0.399) 6.382 1.650 2.049 (0.399) 5.891 1.523 1.523 0.000
Integrated Equipment and Adaptations Store 0.567 0.142 0.138 0.004 0.295 0.074 0.070 0.004 0.272 0.068 0.068 0.000
Dietetics Services 4.239 1.111 1.013 0.098 2.204 0.578 0.480 0.098 2.035 0.533 0.533 0.000
Podiatry Services 4.890 1.230 1.125 0.104 2.543 0.639 0.535 0.104 2.347 0.590 0.590 0.000
Prisoner Healthcare Services 2.008 0.517 0.682 (0.166) 1.044 0.269 0.434 (0.166) 0.964 0.248 0.248 0.000
Blood Borne Viruses Services 1.854 0.463 0.411 0.052 0.964 0.241 0.189 0.052 0.890 0.222 0.222 0.000
Hospital at Home 2.616 0.737 0.731 0.006 1.360 0.383 0.377 0.006 1.256 0.354 0.354 0.000
Mental Health and Learning Disability Services 81.877 22.285 21.753 0.532 42.576 11.588 11.056 0.532 39.301 10.697 10.697 0.000
TOTAL 134.568 36.825 36.571 0.254 69.975 19.149 18.895 0.254 64.593 17.676 17.676 0.000
Led by the North Partnership
South Lanarkshire IJB - 48% Share
Year to DateAnnual
Budget
2024/25
Annual
Budget
2024/25
Year to Date
North Lanarkshire IJB - 52% ShareYear to DateAnnual
Budget
2024/25
Hosted Services Appendix 3
June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024
Budget Actual Variance Budget Actual Variance Budget Actual Variance
£m £m £m £m £m £m £m £m £m £m £m £m
Community Dental Services 7.944 1.975 1.811 0.165 4.131 1.027 1.027 0.000 3.813 0.948 0.783 0.165
Brain Injury Unit 2.216 0.565 0.575 (0.009) 1.153 0.294 0.294 0.000 1.064 0.271 0.281 (0.009)
Out of Hours Services 9.978 2.494 2.257 0.237 5.188 1.297 1.297 0.000 4.789 1.197 0.960 0.237
Palliative Care Services 7.104 1.800 1.773 0.027 3.694 0.936 0.936 0.000 3.410 0.864 0.837 0.027
Physiotherapy Services 11.709 2.927 2.665 0.262 6.089 1.522 1.522 0.000 5.620 1.405 1.143 0.262
Primary Care Services 0.857 0.214 0.176 0.038 0.446 0.111 0.111 0.000 0.412 0.103 0.065 0.038
Occupational Therapy Services 8.919 2.248 2.034 0.214 4.638 1.169 1.169 0.000 4.281 1.079 0.865 0.214
Diabetic Services 4.244 1.061 1.267 (0.206) 2.207 0.552 0.552 0.000 2.037 0.509 0.715 (0.206)
Primary Care Improvement Fund 23.221 5.805 5.606 0.200 12.075 3.019 3.019 0.000 11.146 2.787 2.587 0.200
TOTAL 76.193 19.091 18.163 0.928 39.620 9.928 9.928 0.000 36.573 9.164 8.236 0.928
Annual
Budget
2024/25
Year to Date
South Lanarkshire IJB - 48% Share
Led by the South Partnership
Annual
Budget
2024/25
Year to Date Annual
Budget
2024/25
Year to Date
North Lanarkshire IJB - 52% Share

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11 
North Lanarkshire IJB Budget Reconciliation 2024/25 Appendix 4
2024/25 NHSL Financial Allocation to North Lanarkshire HSCP £m 2024/25 NLC Financial Allocation to North Lanarkshire HSCP £m
2024/25 North Lanarkshire HSCP Financial Allocation 338.816 2024/25 North Lanarkshire HSCP Financial Allocation 206.812
Set-Aside Budget 74.537 NLC Funding - Housing Services 2.229
South Hosted @ 52% 39.188 NLC Financial Allocation at 21 June 2024 209.041
Family Health Service South @ 52% 124.475
NHSL Financial Allocation at 31 May 2024 577.016
Budget Adjustments Posted in Month 3
Draw Down From Reserves 1.747
Increase in ERS Usage 1.943
Long Covid, ADP, Men C Funding 0.387
Budget Realignment 0.981
Increase in Hosted Services Led by South 1.358
Increase in Area Wide Services 0.072
Other Budget Adjustments 0.273
NHSL Financial Allocation at 30 June 2024 583.777

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12 
North Lanarkshire IJB
Movement on Reserves Audit Trail NHSL & NCL
Opening
Balance As At
1 April 2024           
Transfers
To / From
Reserves
Drawdown
from
Reserves
Revised
Balance As At
30 June 2024
Movement
in
Reserves
2024/25
£m £m £m £m £m
NHSL Alcohol and Drug Partnership Funding 3.597 (0.420) 3.177 (0.420)  1, 2, 4, 5
NHSL Area Wide Services - Refugees and Displaced Persons 0.106 0.106 0.000  1, 2, 4, 5
NHSL Blood-Borne Viruses Services 0.194 0.194 0.000  1, 2, 4, 5
NHSL Children and Adolescent Mental Health Services 2.849 2.849 0.000  1, 2, 4, 5
NHSL Community Living Change Fund 1.164 1.164 0.000  1, 4, 5
NHSL District Nursing  0.292 (0.191) 0.101 (0.191)  1, 2, 3, 4, 5
NHSL Family Nurse Practitioner Funding 0.072 0.072 0.000  1, 2, 3, 4, 5
NHSL Frailty Nursing 0.401 (0.118) 0.283 (0.118)  1, 2, 3, 4, 5
NHSL Hospital at Home Services 0.962 (0.098) 0.864 (0.098)  1, 2, 4, 5
NHSL Learning Disabilities Health Checks 0.491 0.491 0.000   2, 3
NHSL Long Covid Pathways 0.234 (0.153) 0.081 (0.153)  2, 3, 4, 5
NHSL Mental Health Action 15 0.729 (0.675) 0.054 (0.675)  1, 2, 4, 5
NHSL Mental Health Covid Clinicians (Cossette) 0.052 0.052 0.000  1, 2, 4, 5
NHSL Mental Health Diagnostic Support Service Dementia Post 0.972 (0.090) 0.882 (0.090)  1, 2, 3, 4, 5
NHSL Mental Health Digital Therapy Post 0.111 0.111 0.000  1, 2, 3, 4, 5
NHSL Mental Health Distress Brief Intervention 3.396 (1.399) 1.998 (1.399)  1, 2, 4, 5
NHSL Mental Health Eating Disorders 0.036 0.036 0.000  1, 2, 4, 5
NHSL Mental Health Neurodevelopmental Pathways 0.074 (0.063) 0.011 (0.063)  1, 2, 4, 5
NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 0.000  1, 2, 4, 5
NHSL Mental Health Wellbeing in Primary Care Services 0.148 0.148 0.000  1, 2, 4, 5
NHSL North Planning Band 2-4 Posts & Multi-Disciplinary Teams 2.719 (1.148) 1.570 (1.148)  1, 2, 3, 4, 5
NHSL PCR Prison Care Network Transforming Nursing Rolls 0.013 0.013 0.000  1, 2, 3, 4, 5
NHSL School Nursing 0.622 (0.023) 0.599 (0.023)  1, 2, 3, 4, 5
NHSL Specialist Doctor Contracts 0.194 0.194 0.000  1, 2, 3, 4, 5
NHSL Staff Wellbeing 0.254 0.254 0.000  3
NHSL Third Sector Initiatives To Improve Health 0.247 (0.091) 0.156 (0.091)   1, 2, 3, 4, 5
NHSL Unscheduled Care Funding 2.790 2.790 0.000  1, 2, 3, 4, 5
NHSL Upper GI Dietetics Band 4 0.027 (0.006) 0.022 (0.006)  3
23.773 0.000 (4.474) 19.298 (4.474)
Opening
Balance As At
1 April 2024     
Transfers
To / From
Reserves
Drawdown
from
Reserves
Revised
Balance As At
30 June 2024
Movement
in
Reserves
2024/25
£m £m £m £m £m
NHSL Adult Social Care Winter Preparedness Fund 1.000 1.000 0.000  1, 2, 3, 4, 5
NLC Adaptations Fund 0.308 0.308 0.000  2, 4
NLC Adult Protection (share with C&F and NHSL) 0.050 0.050 0.000  1, 2, 4, 5
NLC Advocacy Services 0.065 0.065 0.000  1, 2, 4, 5
NHSL Breast Feeding Team (2 year funding) 0.705 (0.057) 0.648 (0.057)  1, 2, 5
NLC Business Case - Non-Recurring NLC Costs 1.319 1.319 0.000  1, 2, 3, 4, 5
NLC Carers Act 2018 - Support 2.596 2.596 0.000    1, 2, 4, 5
NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.268 0.268 0.000  4
NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.107 (0.058) 0.049 (0.058)  3
NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000  1, 5
NHSL Dietetics Services - Double Running Costs 0.064 (0.009) 0.055 (0.009) 
NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.465 0.465 0.000  2, 3
NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.699 3.699 0.000    2, 3
NLC Digital and IT Strategy Technology Improvements - Other 0.389 0.389 0.000 
NLC Digital and IT Strategy Technology Improvements - SWIS 0.700 0.700 0.000  2, 3
NLC Financial Strategy - Changes to LA Services Muirpark 0.027 0.027 0.000 
NHSL Health Inequalities - Screening 0.044 (0.007) 0.037 (0.007)  2
NHSL Health Visiting Students/Trainees 0.311 (0.081) 0.230 (0.081)  3
NLC Home Support Resilience (2 year funding) 0.656 0.000 0.656 0.000  3, 4
NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.087 0.087 0.000  3
NLC IJB Helpline (2 years funding) 0.360 0.360 0.000  1, 4, 5
NHSL Kylepark Works 0.134 0.134 0.000  4, 5
NLC Mental Health Social Workers 2 x NL10 x 24 months 0.162 0.162 0.000  3, 4
NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000  2, 4
NHSL Minor Capital Works 1.027 1.027 0.000  3
NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.450 (0.042) 0.408 (0.042)    1, 2, 5
NHSL Organisational Development Fund 0.260 0.260 0.000  3
NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.569 (0.015) 0.554 (0.015)  1, 2, 3
NLC Planned Date of Discharge - Discharge To Assess 0.109 0.109 0.000  1, 5
NHSL Podiatry Services - Foot Screening 0.350 0.350 0.000  1, 2
NHSL Prisioner Healthcare - Transitional Project Band 8A 0.020 (0.019) 0.001 (0.019)  3
NHSL Regrading of Posts Including Backpay 0.250 0.250 0.000   3
NHSL Scottish Clinical Leadership Fellowship 0.060 (0.023) 0.037 (0.023)  3
NHSL Sexual Health Services - Forensic Medical 0.152 (0.050) 0.102 (0.050)  1, 2
NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.404 0.404 0.000  1, 2
NLC Social Care Contracting Staff within Quality Assurance Services 0.087 0.087 0.000  3
NLC/NHSL Staff Training Academy 2.042 (0.175) 1.868 (0.175)   3
NHSL Vulnerable and Complex Cases - Test of Change 0.816 (0.084) 0.732 (0.084)  5
20.975 0.000 (0.619) 20.356 (0.619)
To Be
Drawn
Down
2024/25
To Be
Drawn
Down
2025/26
LEAD RING-FENCED RESERVES
Ongoing
TOTAL RING-FENCED RESERVES
LEAD EARMARKED RESERVES
TOTAL EARMARKED RESERVES
Ambition
Statement &
Performance
APPENDIX 5
Ambition
Statement &
Performance
To Be
Drawn
Down
2024/25
To Be
Drawn
Down
2025/26
Ongoing

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13 
Appendix 5 Continued 
Opening
Balance As At
1 April 2024          
Transfers
To / From
Reserves
Pending
Drawdown
from
Reserves
Revised
Balance As At
30 June 2024
Movement
in
Reserves
2024/25
£m £m £m £m £m
NHSL Prescribing Fund 4.361 4.361 0.000   2, 4
NLC Social Care Demand 12.684 12.684 0.000    2, 4
17.045 0.000 0.000 17.045 0.000
Opening
Balance As At
1 April 2024                  
Transfers
To / From
Reserves
Drawdown
from
Reserves
Revised
Balance As At
30 June 2024
Movement
in
Reserves
2024/25
£m £m £m £m £m
NHSL Contingency Balance Held By NHSL 13.390 13.390 0.000   
13.390 0.000 0.000 13.390 0.000
Opening
Balance As At
1 April 2024               
Transfers
To / From
Reserves
Drawdown
from
Reserves
Revised
Balance As At
30 June 2024
Movement
in
Reserves
2024/25
£m £m £m £m £m
NHSL PCR Prison Care Network Transforming Nursing Rolls 0.341 (0.341) (0.000) (0.341)  1, 2, 3, 4, 5
0.000 0.000
0.341 0.000 (0.341) (0.000) (0.341)
75.524 0.000 (5.435) 70.089 (5.435)
KEY (5.435)
1
2
3
4
5
LEAD CONTINGENCY FUND RESERVES
To Be
Drawn
Down
2024/25
To Be
Drawn
Down
2025/26
Ongoing
Ambition
Statement &
Performance
CLOSED RESERVES
TOTAL CLOSED RESERVES
TOTAL RESERVES
LEAD RISK-BASED RESERVES
TOTAL RISK-BASED RESERVES
Develop and support a workforce for the future.
Improve mental health and wellbeing.
Supporting people through a whole family approach.
Ambition
Statement &
Performance
Ambition
Statement &
Performance
Increased focus on prevention, early intervention and tackling inequalities by working with communities and people.
Ambition Statement & Performance
Do the right thing first time.
To Be
Drawn
Down
2024/25
To Be
Drawn
Down
2025/26
Ongoing
TOTAL CONTINGENCY FUND RESERVES
LEAD
To Be
Drawn
Down
2024/25
To Be
Drawn
Down
2025/26
Ongoing

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14 
APPENDIX 6
2024/25 2025/26
Achieved
to Date
Achieved
to Date
£m £m £m £m £m
1 Ongoing Prescribing Savings 2.280 0.549 0.549 1.731
2 Financial Management - North Consequential Funding 3.446 3.446 3.446 0.000
3 Service Redesign: Mental Health Hospital Based Complex Care Contracted Beds                                           2.600 0.000 2.600
4 Review of Discretionary Spend 2.188 0.000 2.188
5 Review of Supplementary Staffing 0.982 0.296 0.296 0.686
6 Workforce Management and Service Redesign 4.699 0.311 0.311 4.388
7 Financial Management - Support Costs and Vacancy Review 1.486 0.309 0.309 1.177
17.681 4.910 0.000 4.910 12.771
2024/25 2025/26
Achieved
to Date
Achieved
to Date
£m £m £m £m £m
8 Financial Management - Overspends 4.827 0.000 4.827
9 Service Redesign: Review of Provision of Registered Social Landlords 0.600 0.266 0.266 0.334
10 Review of Supplementary Staffing 0.750 0.750 0.750 0.000
11 Service Redesign and Contract Review 0.400 0.405 0.405 (0.005)
12 Review of Operating Model Supporting Back to Basics 3.825 0.000 3.825
13 Financial Management - Vacancy Review 1.000 0.000 1.000
11.402 1.421 0.000 1.421 9.981
29.083 6.331 0.000 6.331 22.752
Reference
1
2
3
4
5
6
7
8
Reference
8
9
10
11
12
13
Review of all unfunded posts (£4.324m).  Redesign of Continence Service delivery schedule and products (£0.375m). 
Review of all vacant posts and realignment of support costs to all funding streams to show true cost of each service.
Review of non traditional respite, advocacy and community services.
Review of whole system approach to ensure that when people contact our services the response is quick and effective, with a focus on helping people to help
themselves first.
Review of all vacant posts.
Reducing current overspends to align with allocated budgets. (IEAS, Independent Care Homes, SDS, Private Sector Housing Grants)
Review of all Registered Social Landlords services in North Lanarkshire keeping with the approach taken by other local authorities by opting to reconfigure some
existing sheltered/very sheltered housing to retirement models.
Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review.
North Lanarkshire IJB
2024/25 & 2025/26 - 2 Year Savings Delivery Plan
Total Health Care Services
Reference
Reference
Total Adult Social Care Services
TOTAL
Total
Achieved
Health Care Services
RAG Rating
Adult Social Care Services
RAG Rating
Health Care Services Savings Delivery Plan
Review all areas of discretionary spend including postage, stationery and printing, staff travel and subsistence, domestic supplies, subscriptions and licenses
and hospitality.
Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review.
Adult Social Care Services Savings Delivery Plan
Outstanding
Target to
Date
The prescribing efficiency programme will continue.  This will include additional efficiencies around medicines of low clinical value, drug patent expiry list, product
switches, complex rebates and prescribing waste.
Reducing current overspends to align with allocated budgets.  For 2024/25, this is being off set by non-recurring consequential funding from Scottish
Government.
Additional non-recurring funding received in year from Scottish Government.  This will be used in 2024/25.
Outstanding
Target to
Date
2 Year Savings Delivery Plan (Target = £17.681m)
Plan Total
Achieved
2 Year Savings Delivery Plan (Target = £11.402m)
Plan
The current model of HBCCC is being reviewed with a view of moving patients into a more suitable and homely environment, such as a mainstream care home
which would be a less intensive setting whilst also improving the quality of life of the individual.

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15 
Analysis of Additional Employee Costs 2024/25 Appendix 7
North West
Locality                           
£
North East
Locality                        
£
Adult
Services                 
£
Children
Services            
£
Mental
Health                 
£
Other           
£
TOTAL       
£
1 50,169 38,615 22,052 56,191 305,642 4,702 477,371
2 41,325 32,875 23,320 46,102 264,497 7,042 415,161
3 51,328 40,468 21,249 52,407 367,143 3,350 535,945
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
TOTAL 142,822 111,958 66,621 154,700 937,282 15,094 1,428,477
North West
Locality                         
£
North East
Locality                        
£
Adult
Services             
£
Children
Services               
£
Mental
Health                 
£
Social
Care
Services                 
£
TOTAL      
£
1 6,112 -1,743 - - 286,364 - 290,733
2 - - 589 -80 569,840 - 570,349
3 1,526 - 1,229 - 337,115 - 339,870
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
TOTAL 7,638 -1,743 1,818 -80 1,193,319 0 1,200,952
North West
Locality                         
£
North East
Locality                        
£
Adult
Services             
£
Children
Services               
£
Mental
Health                 
£
Social
Care
Services                 
£
Home
Support     
£
Other           
£
TOTAL        
£
1 7,896 6,109 4,121 14,860 30,578 -5,031 -36,239 737 23,031
2 11,173 8,470 4,855 17,042 30,317 84,416 341,911 2,508 500,692
3 7,738 7,429 5,896 10,311 21,831 65,331 331,451 1,247 451,234
4 48,786 385,446 434,232
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
TOTAL 26,807 22,008 14,872 42,213 82,726 193,502 1,022,569 4,492 1,409,189
North West
Locality                         
£
North East
Locality                        
£
Adult
Services             
£
Children
Services               
£
Mental
Health                 
£
Other           
£
TOTAL       
£
1 4,408 2,005 7,033 9,061 9,873 1,559 33,939
2 2,745 3,160 4,339 3,462 5,718 1,250 20,674
3 1,508 1,689 4,890 850 6,956 776 16,669
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
TOTAL 8,661 6,854 16,262 13,373 22,547 3,585 71,282
BANKAIDE COSTS YEAR TO DATE
OVERTIME COSTS YEAR TO DATE
EXCESS PART TIME COSTS YEAR TO DATE
Period
Period
Period
Period
AGENCY COSTS YEAR TO DATE

Page 206

1 
REPORT 
Item No: 13 
SUBJECT: Annual Performance Report 2023/24 – University Health & Social
Care North Lanarkshire
TO: Integration Joint Board Committee
Lead
Officer for
Report:
Morag Dendy, Chief Officer  Planning, Performance and Quality
Assurance 
Author(s) of
Report
Stephen Forrest – Performance Manager, Graeme Cowan – Senior
Manager, Strategy & Performance
Contact
details for
Author(s) of
Report
Stephen Forrest – Performance Manager
Stephen.Forrest@lanarkshire.scot.nhs.uk
Graeme Cowan – Senior Manager, Strategy & Performance
cowang@northlan.gov.uk
DATE: 25th September 2024 
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

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2 
3. EXECUTIVE SUMMARY
Per the legislative requirements, North Lanarkshire IJB has published a draft Annual
Performance Report, presenting the performance in relation the National Integration
Indicators and other performance and inspection information. The draft report is
submitted to the IJB for approval. 
4. RECOMMENDATIONS
It is recommended that the IJB Committee:
(1) Review the content of the draft Annual Performance Report 2023/24 -
University Health & Social Care North Lanarkshire, which is appended to this
report.
(2) Approve for publication the content of the draft Annual Performance Report
2023/24 - University Health & Social Care North Lanarkshire. 
5.  VARIATIONS TO DIRECTIONS? 
6. BACKGROUND/SUMMARY OF KEY ISSUES
North Lanarkshire IJB is required by the Public Bodies (Joint Working) Regulations
2014 to publish an Annual Performance Report by July 31st each 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 in this way is
to support Integration Authorities in improving the consistency of reporting for these
indicator sets. 
7.  SUMMARY OF KEY ISSUES
The Annual Performance Report 2023/24 - University Health & Social Care North
Lanarkshire presents the performance in relation to these metrics, alongside
performance information relating to inspections carried out by the Care Inspectorate
and 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. A section has been dedicated to presenting and describing
financial performance for 2023/24.
Yes  ☐ No ☐ N/A ☒

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3 
In order to comply with the requirements to publish the APR by 31st July 2024, 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 is not published on their website until 04th July 2024, as previous
publications of the data set are provided to the Integration Authorities for
management use only. The document appended is a draft, with a desktop published
version being produced by colleagues in North Lanarkshire Council Graphic Design.
Some sample pages of the desktop published version are also appended for the
Board’s information.
Members should note the most up-to-date available has been used in the report,
however for many indicators this relates to previous years; for indicators NI12 –
NI16, the performance for calendar year 2023 is presented per the instructions of
Public Health Scotland as the 2023/24 data for these indicators has not been
validated for publication. 
8. CONCLUSIONS
The Annual Performance Report 2023/24 - University Health & Social Care North
Lanarkshire describes progress made in pursuit of the National Health & Wellbeing
Outcomes. This progress has been made against a challenging position for Health
and Social Care nationally, which is reflected in the performance in 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 and in
those areas where performance improvements are required, this is managed through
the performance framework in place within the Health and Social Care Partnership.
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
☒

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Resources are used effectively and efficiently in the provision of Health and
Social Care Services 
☒
9.2 ASSOCIATED MEASURE(S)
The content of the Annual Performance Report is focused on the National Integration
Indicators (the Core Suite and Ministerial Steering Group indicators). A framework is
in place within the North HSCP to ensure the continual monitoring of performance
data and information, and any improvement actions associated with the performance
monitoring. 
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 
Level 2 Risk Register NL H&SCP
- Meeting performance targets
High Ross McGuffie 
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 
☐ 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 APR provides information on
community stakeholders and how
they are involved in our services.
Yes  ☒ No ☐ N/A ☒

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5 
☒ Provide regular feedback on how
stakeholder engagement and participation is 
shaping and influencing service
development and delivery
The APR provides information on
engagement with 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 discussion
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. 
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
The results of the Health and Care Experience Survey are available in full, with
results for each General Practice, General Practice Cluster, Health and Social Care
Partnership and NHS Board, as well as time series trends where applicable, via an
online dashboard hosted by Public Health Scotland.
 Health and Care Experience Survey 2023/24: National Results
 Health and Care Experience Survey 2023/24 Technical Report
 Health and Care Experience Survey 2023 to 2024: Results by geography 
Yes  ☐ No ☐ N/A ☒
Yes /
Date
added 
☐ No ☐ N/A ☒

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6 
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:
https://publichealthscotland.scot/publications/core-suite-of-integration-
indicators/core-suite-of-integration-indicators-4-july-2023/ 
11. APPENDICES
Appendix One   Annual Performance Report 2023/24 - Health & Social Care North     
Lanarkshire
Appendix Two – Sample desktop published pages
Appendix Three – PowerPoint presentation 
CHIEF ACCOUNTABLE OFFICER (or Depute)  
Chief Officer 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
Graeme Cowan – Senior Manager, Strategy & Performance
cowang@northlan.gov.uk

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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

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Appendix 1 
Annual Performance Report 2023/24 
University Health & Social Care North Lanarkshire

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9 
1. Foreword
As Chief Officer of the North Lanarkshire Health and Social Care Partnership, it gives me
great pleasure to present the Annual Performance Report for the financial year 2023/24.
This report encapsulates our collective efforts and achievements in delivering high-quality
health and social care services to the residents of North Lanarkshire. 
Over the past year, our partnership has continued to make significant strides in enhancing
the well-being and quality of life for individuals across our community. Through the
collaborative efforts of the North Lanarkshire Integrated Joint Board, NHS Lanarkshire, North
Lanarkshire Council, and the North Lanarkshire Health and Social Care Partnership, we
have witnessed several commendable accomplishments that highlight our commitment to
excellence in care delivery. 
One of the key successes of the past year has been our unwavering dedication to person-
centred care. By placing individuals at the heart of everything we do, we have been able to
tailor our services to meet their unique needs and preferences, fostering a culture of
empowerment and dignity. Whether it's supporting older adults to live independently,
providing essential care and support to individuals with disabilities, or offering mental health
services that promote recovery and resilience, our approach has always been rooted in
compassion and respect. 
Furthermore, our focus on innovation and service improvement has led to the
implementation of several initiatives aimed at enhancing the efficiency and effectiveness of
our delivery model. From the adoption of digital technologies to streamline processes and
improve access to care, to the development of integrated care pathways that facilitate
seamless transitions between
services, we have continually sought
out innovative solutions to meet the
evolving needs of our population. 
I am also delighted to highlight the
collaborative partnerships forged with
community organisations, voluntary
groups, and other stakeholders,
which have played a vital role in
extending the reach of our services
and promoting holistic health and
well-being. By working together, we
have been able to leverage the
strengths and resources of our
collective network to deliver impactful
outcomes and drive positive change
in our communities. 
As we reflect on the achievements of
the past year, it is essential to
acknowledge the dedication and hard
work of our staff, volunteers, and
partners who have contributed
tirelessly to the success of our
endeavours. Their unwavering
commitment to excellence and their
passion for making a difference have
been instrumental in shaping the
positive outcomes we celebrate
today.

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10 
Looking ahead, we remain steadfast in our commitment to building on our successes and
addressing the challenges that lie ahead. By continuing to foster collaboration, innovation,
and a relentless focus on improving outcomes for those we serve, I am confident that we will
continue to make meaningful progress towards our shared vision of a healthier, more
inclusive North Lanarkshire. 
In closing, I extend my sincere gratitude to all who have contributed to the achievements
documented in this report. Your dedication, creativity, and tireless efforts are truly inspiring. 
Ross McGuffie - Chief Officer, University Health & Social Care North Lanarkshire

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11
2. Contents
Contents
1. Foreword ....................................................................................................... 9
2. Contents ...................................................................................................... 11
3. National Health and Wellbeing Outcomes ................................................... 13
4. Introduction ................................................................................................. 13
5. National Health and Wellbeing Outcomes Framework ................................ 15
6. Measuring Performance Under Integration (MPUI) ..................................... 22
7. Managing Performance Under Integration .................................................. 28
HSCP University status ........................................................................................ 28
CAMHS Udston development and service recovery ............................................. 29
New Chryston Health Centre ................................................................................ 31
Breastfeeding ....................................................................................................... 32
Family support workers ......................................................................................... 32
Cancer Support .................................................................................................... 33
New winter health hub to help direct patients to most appropriate care ................ 34
Spring Health Hub Launch .................................................................................... 35
Healthy Schools .................................................................................................... 36
Reablement, Rehabilitation and Home Assessment Teams ................................. 37
Coming Home Summary ...................................................................................... 37
HMP Shotts improvements ................................................................................... 39
MAT standards progress ...................................................................................... 40
Launch of North Lanarkshire Alcohol & Drug Partnership website ....................... 40
Children and Young People Mental Health Directory of Services and Resources
launched ............................................................................................................... 41
New team members devoted to supporting North Lanarkshire’s District Nurse and
Mental Health teams ............................................................................................. 42
Carer Engagement, Involvement and Participation .............................................. 43
Carer Support Network ......................................................................................... 43
LENS Workshops - Turning Ideas into Action Programme ................................... 43
Community Solutions ............................................................................................ 44
Support in the Right Direction ............................................................................... 45
Improving Lives Initiative ...................................................................................... 45

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12
Community Connectors ........................................................................................ 46
Crisis Care – Distress Brief Intervention (DBI) ...................................................... 46
Engagement & Participation North Lanarkshire .................................................... 47
Engagement and Participation Strategy 2024-2027 ............................................. 48
Strategic Engagement and Participation Working Group ...................................... 48
Embedding Participation ....................................................................................... 49
Care Opinion ........................................................................................................ 49
Podiatry case study .............................................................................................. 50
Summary of Financial Performance ...................................................................... 50
8. Care Inspectorate Grades 2023/24 ............................................................. 53
NLC Care Homes .............................................................................................. 53
Other services ................................................................................................... 54
9. Strategic Planning ....................................................................................... 55
Strategic Commissioning Launch 2023 - 2026 Event ........................................ 55
10. Looking Forward – Our Next Steps ............................................................. 57
11. Appendices ................................................................................................. 58

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13 
3. National Health and Wellbeing Outcomes
National Health and Wellbeing Outcome 1
People are able to look after their own
health and wellbeing and live in good
health for longer 
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 
National Health and Wellbeing Outcome 3
People use health and social care services
have positive experiences of those services
and have their dignity respected
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 
National Health and Wellbeing Outcome 5 Health and Social Care Services contribute
to reducing health inequalities
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
National Health and Wellbeing Outcome 7 People using health and social care services
are safe from harm 
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
National Health and Wellbeing Outcome 9 Resources are used effectively and
efficiently in the provision of health and
social care services 
4. Introduction 
Welcome to the Annual Performance Report of the North Lanarkshire Health and Care
Partnership (HSCP) for the period from April 2023 to March 2024. 
This report presents a range of both qualitative and quantitative information, demonstrating
our performance in relation to the National Health & Wellbeing Outcomes, National Core
Integration Indicators, Ministerial Strategic Group indicators, and local performance
measures. The Integration Joint Board receives regular progress reports on performance,

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14 
and you can find these reports, along with our previous Annual Performance Reports on our
website: https://www.hscnorthlan.scot/ . 
The Annual Performance Report provides an opportunity to reflect on the past year and
celebrate the accomplishments of North Lanarkshire Health and Social Care services,
employees, and partners. It acknowledges the ongoing collaborative work undertaken with
service users, carers, families, and communities to improve on performance. Moreover, it
recognises and acknowledges the existing and future challenges that the partnership faces,
many of which are influenced by the long-lasting effects of the COVID-19 pandemic. The
report presents data and information on performance and describes significant
developments in 2023/24. 
The initial section of the report focuses on statutory reporting of performance information
showing a comparison with the Scottish position and a trend analysis is provided to
understand the local context for these performance indicators. Regrettably, due to
circumstances beyond the partnership's control, we are unable to present a complete picture
for some of the indicators and where this is the case, the reasons for this limitation are
explained within the corresponding section of the report. 
The remaining part of the report provides more information for each of the National
Outcomes, highlighting the various advancements and achievements throughout the year
2023/24

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15 
5. 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 
Scottish Health and Care Experience Survey
Scottish Health and Care Experience Survey
Indicator Title  NL
2015/16
NL
2017/18
NL
2019/20
NL
2021/22
NL
2023/24
Scotland
2023/24
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 91.70% 90.30% 90.50% 87.50% 87.41% 90.66%

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16 
NI - 2 Percentage of adults supported at home who agreed that
they are supported to live as independently as possible     77.60% 79.80% 67.74% 72.39% 
NI - 3
Percentage of adults supported at home who agreed that
they had a say in how their help, care, or support was
provided    
71.20% 67.10% 57.11% 59.62% 
NI - 4
Percentage of adults supported at home who agreed that
their health and social care services seemed to be well co-
ordinated    
70.20% 66.60% 56.04% 61.36% 
NI - 5 Percentage of adults receiving any care or support who
rate it as excellent or good     77.80% 74.00% 65.76% 70.02% 
NI - 6 Percentage of people with positive experience of care at
their GP practice 79.30% 75.50% 68.30% 51.80% 52.80% 68.52% 
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    
75.70% 77.00% 67.70% 69.75% 
NI - 8 Percentage of carers who feel supported to continue in
their caring role 41.20% 33.20% 32.60% 25.10% 28.46% 31.19% 
NI - 9 Percentage of adults supported at home who agreed they
felt safe     80.00% 79.80% 68.44% 72.67% 
N.B. Results for indicators 2, 3, 4, 5, 7 and 9 from 2019/20 on are not directly comparable to results in previous years due to changes in survey wording and methodology. 
Performance is better than previous reporting period 
Performance is worse than previous reporting period

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17 
National Outcome Indicators – Benchmarking – 2023/24 
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
90.66% 87.41% 89.06% 91.70% 88.27% 89.09% 88.94% 88.44% 87.60%
Percentage of adults
supported at home who agree
that they are supported to live
as independently as possible
72.39% 67.74% 81.17% 78.86% 77.05% 67.46% 75.90% 62.67% 72.28%
Percentage of adults
supported at home who agree
that they had a say in how
their help, care or support was
provided
59.62% 57.11% 69.51% 68.99% 65.13% 50.64% 67.78% 59.11% 61.46%
Percentage of adults
supported at home who agree
that their health and social
care services seemed to be
well co-ordinated
61.36% 56.04% 70.42% 63.16% 63.87% 55.47% 68.65% 54.33% 65.18%
Percentage of adults receiving
any care or support who rate
it as excellent or good
70.02% 65.76% 78.59% 76.08% 68.01% 68.39% 70.72% 66.87% 71.24%
Percentage of people with
positive experience of care at
their GP practice
68.52% 52.80% 55.72% 85.51% 71.19% 60.03% 64.97% 63.83% 73.74%
Percentage of adults
supported at home who agree
that their services and support
had an impact in improving or
maintaining their quality of
life
69.75% 67.70% 74.02% 67.00% 71.25% 67.62% 73.64% 63.97% 69.73%

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18 
Percentage of carers who feel
supported to continue in their
caring role
31.19% 28.46% 36.02% 32.57% 34.34% 31.57% 31.88% 26.67% 34.48%
Percentage of adults
supported at home who agree
they felt safe
72.67% 68.44% 75.77% 75.76% 76.52% 67.48% 72.67% 66.67% 72.61% 
The table above provides a comparison for 2023/24 with North Lanarkshire’s ‘Family Group’ of Integration Authorities for those National
Outcome Indicators that are sourced from the Health and Care Experience Survey. The results highlight some areas where improvement might
be made, including supporting people to live as independently as possible, health and social care services being well co-ordinated, improving
or maintaining quality of life, people having a positive experience of care at their GP practice and carers feeling supported to continue in their
caring role. 
Use of 2023 calendar year data instead of 2023/24 financial year data for indicators 12, 13, 14, 15 and 16
The primary source of data for these indicators are Scottish Morbidity Records (SMRs) which are nationally collected discharge-based hospital
records. Following recommendations made by Public Health Scotland (PHS) and communicated to all Health and Social Care Partnerships, the
most recent reporting period available is calendar year 2023; this ensures that these indicators are based on the most complete and robust
data currently available. 
Indicator 20
The data for Indicator NI – 20, Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency
is no longer available from Public Health Scotland and has been excluded from this report. 
Core Suite of Integration Indicators        
Indicator Title NL 2017 NL 2018 NL 2019 NL 2020 NL 2021 NL 2022 Scotland
2022
HSCNL
Trend
Scotland
Trend
NI -11 Premature mortality rate per 100,000
persons 482 517 515 581 580 510 442             
Indicator Title NL
2018/19
NL
2019/20
NL
2020/21
NL
2021/22
NL
2022/23 NL 2023 Scotland
2023
HSCNL
Trend
Scotland
Trend

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19 
NI -12 Emergency admission rate (per 100,000
population) 15829 16280 13829 15122 15111 15396 11707  
NI – 13 Emergency bed day rate (per 100,000
population) 120784 122569 107300 121842 126261 122120 112883  
NI – 14
Emergency readmissions to hospital
within 28 days of discharge (rate per
1,000 discharges)
101 106 123 115 117 116 104 
NI - 15
Proportion of last 6 months of life
spent at home or in a community
setting
89% 89% 90% 90% 89% 89% 89%  
NI – 16 Falls rate per 1,000 population aged
65+ 23 21 19 21 20 21 23      
NL
2018/19
NL
2019/20
NL
2020/21
NL
2021/22
NL
2022/23
NL
2023/24
Scotland
2023/24
HSCNL
Trend
Scotland
Trend
NI -17
Proportion of care services graded
‘good’ (4) or better in Care Inspectorate
inspections
76% 83% 80% 78% 77% 76% 77% 
NL 
2018
NL 
2019
NL 
2020
NL 
2021 NL 2022 NL 2023 Scotland
2023
HSCNL
Trend
Scotland
Trend
NI – 18 Percentage of adults with intensive
care needs receiving care at home 75% 74% 75% 75% 71% 70% 65% 
NL
2018/19
NL
2019/20
NL
2020/21
NL
2021/22
NL
2022/23
NL
2023/24
Scotland
2023/24
HSCNL
Trend
Scotland
Trend
NI – 19
Number of days people spend in
hospital when they are ready to be
discharged (per 1,000 population)
996 1109 781 821 970 973 902 
Performance is better than previous reporting period 
Performance is worse than previous reporting period

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20 
National Integration Indicators – Benchmarking – 2023 
Scotland North
Lanarkshire
East
Ayrshire
Western
Isles
Dundee
City
North
Ayrshire Inverclyde West
Dunbartonshire
Glasgow
City
Latest
data
Premature mortality
rate per 100,000 442 510 515 473 546 527 542 551 615 2022
Emergency admission
rate per 100,000 11707 15396 14294 13464 14335 14009 12689 13642 11513 2023
Emergency bed day
rate for adults per
100,000
112883 122120 125700 125928 110615 142222 148350 141660 127396 2023
Emergency
readmission to
hospital within 28 days
of discharge (per 1,000
discharges)
104 116 107 97 147 101 79 84 96 2023
Proportion of last 6
months of life spent at
home or in the
community
89.1% 89.1% 89.5% 90.8% 90.7% 88.2% 87.7% 88.2% 88.0% 2023
Falls rate per
population aged 65+ 23 21 19 21 35 22 26 24 27 2023
Proportion of care
services graded ‘Good’
(4) / better in Care
Inspectorate
Inspections
77.0% 75.8% 78.0% 89.8% 77.5% 82.9% 80.6% 81.4% 82.7% 2023/24

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21 
Percentage of adults
with intensive care
needs receiving care at
home
64.8% 69.9% 71.6% 60.2% 61.8% 77.7% 67.4% 70.2% 59.3% 2023
Number of days
people aged 75+
spend in hospital
when ready to be
discharged, per 1,000
population
902 973 700 1478 428 1087 554 1327 962 2023/24 
The table above provides a comparison across the National Integration Indicators, within North Lanarkshire’s ‘Family Group’ of comparators.
Our comparative position is fairly positive on areas such as emergency bed day rate (reflecting the lower average length of stay in hospital),
falls rate, and the proportion of people with intensive needs supported at home. However, the figures also highlight areas that we can improve
on across a range of areas.

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22 
6. Measuring Performance Under Integration (MPUI)
Emergency Admissions - Based on agreed trajectories,
our objective for 2023/24 was to achieve a 5%
reduction in emergency admissions by March 2024.
Performance throughout the year was generally
positive; either in line with, or positive when compared
with the trajectory set. 
2,000
2,500
3,000
3,500
4,000
4,500
Emergency Admissions April 2019 - March 2024
Performance Trajectory

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23 
Unscheduled Bed Days - Based on agreed trajectories,
our objective for 2023/24 was to achieve a reduction in
the number of unscheduled bed days. The trajectory
for the reduction in bed days was based on the ongoing
reducing length of stay improvement work and the
embedding of the Flow Foundations Bundle across all
acute and community wards, to improve efficiency and
effectiveness across the whole system. 
0
5,000
10,000
15,000
20,000
25,000
30,000
Apr-19
Jun-19
Aug-19
Oct-19
Dec-19
Feb-20
Apr-20
Jun-20
Aug-20
Oct-20
Dec-20
Feb-21
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
Unscheduled Care Bed Days Acute Specialties April 2019 - March 2024
Performance Trajectory

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24 
A&E Attendances - Based on agreed trajectories, our
objective for 2023/24 was to achieve a 10% reduction
in A&E attendances. Performance throughout the year
was generally positive when compared with the
trajectory set. 
4,000
5,000
6,000
7,000
8,000
9,000
10,000
11,000
12,000
Apr-19
Jun-19
Aug-19
Oct-19
Dec-19
Feb-20
Apr-20
Jun-20
Aug-20
Oct-20
Dec-20
Feb-21
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
A&E Attendances April 2019 - March 2024
Performance Trajectory

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25 
Delayed Discharge - Based on agreed trajectories, our
objective for 2023/24 was to reduce the number of
occupied bed days due to standard delays. 
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Apr-19
May-19
Jun-19
Jul-19
Aug-19
Sep-19
Oct-19
Nov-19
Dec-19
Jan-20
Feb-20
Mar-20
Apr-20
May-20
Jun-20
Jul-20
Aug-20
Sep-20
Oct-20
Nov-20
Dec-20
Jan-21
Feb-21
Mar-21
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
Delayed Discharge Bed Days Standard Delays April 2019 - March 2024
Standard Bed Days Target

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End of Life Care - The percentage of the last six months
of life spent at home or in community settings has
gradually increased since 2015/16. 
82.0%
83.0%
84.0%
85.0%
86.0%
87.0%
88.0%
89.0%
90.0%
91.0%
% spent at home or in community setting (6 months)
Community Community Target

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Balance of Care - The percentage of people aged 75+
who live at home in North Lanarkshire remains high;
this compares well with the Scottish average and other
similar Health & Social Care Partnerships. 
N.B Full financial year figures are not available at time of publication 
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.  
80.0%
81.0%
82.0%
83.0%
84.0%
85.0%
86.0%
87.0%
Balance of Care - Home (unsupported) - 75+
Home (unsupported) Home (unsupport) Target

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28 
7. 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 
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 
National Health and
Wellbeing Outcome 5
Health and Social Care Services
contribute to reducing health
inequalities
HSCP University status 
Glasgow Caledonian University (GCU) has granted university status to North Lanarkshire
Health and Social Care Partnership (HSCP). The granting of this status highlights the
contribution of Lanarkshire Health and Social Care Partnership as an organisation that offers
significant opportunity for education, training, research and innovation.
The organisations share common values and a commitment to the common good, with the
aim to transform lives across North Lanarkshire, exemplified through the academic
partnership of University Health and Social Care North Lanarkshire.

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29 
Through enhanced and extended partnership working, there is an aim to develop
sustainable, innovative and practical solutions to health and social care challenges, directly
benefiting and transforming lives North Lanarkshire communities and leading innovation in
health and care for the benefit of the whole of Scotland.
As part of the agreement, GCU renewed its strategic partnership with NHS Lanarkshire and
signed a Memorandum of Understanding with North Lanarkshire Council, consolidating the
formal, multi-agency collaboration.
CAMHS Udston development and service recovery 
A new £1.5 million specialist centre transforming the way children and young people in
Lanarkshire receive mental health care was officially opened in 2023/24. Maree Todd MSP,
Minister for Social Care, Mental Wellbeing and Sport, opened the new Child and Adolescent
Mental Health Service (CAMHS) outpatient facility at Udston Hospital.

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30 
The state-of-the-art facility, hosted by Health & Social Care North Lanarkshire, assesses and
treats young people aged 18 years old and younger who have emotional, behavioural or
mental health difficulties.
The bespoke designed centre provides specialist services including:
 CAMHS assessment
 Neurodevelopmental treatments
 Talking treatments
 Psychiatry
 Medication
It is a completely new facility specifically for young people, developed with input from young
people and their families, ensuring that it is tailored to meet their needs and this new
specialist centre is an important part of the new, modern mental health service for
Lanarkshire’s young people.
We know that mental health issues can have a significant impact on children and young
people and that it is crucial that they receive the support they need as quickly as possible. In
addition to the new state-of-the-art facility, the service has introduced a new way of working
which allow patients to pick their appointment dates and times. The Child and Adolescent
Mental Health Service is now using the innovative CAPA (The Choice and Partnership
Approach) model. Developed by CAMHS consultant psychiatrists, this model involves
working closely with children and young people to offer a ‘choice’ appointment, allowing
them to choose the time and date of their appointment, making it more convenient and
accessible for them, helping to ensure children and young people receive the support they
need, when they need it. cutting waiting times for an initial assessment
The new facility ensures that we see young people in an environment that puts them at ease
and is designed specifically for, and by them, which provides the best possible environment
to make a positive impact on peoples’ lives and by offering more timely and effective

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31 
treatment, in the best possible environment, we are helping young people to get back on
track and achieve their potential.
New Chryston Health Centre 
In December 2023, the new state-of-the-art community health clinic was opened in Chryston,
representing a £3.65 million investment in the community that will benefit patients for many
years to come. The new larger community health clinic, which is part of the Chryston
Community Hub, features 17 clinical rooms over 682 square metres of space, providing a
variety of community services ranging from midwifery and Health visitors to breastfeeding
support and treatment rooms. 
Serving more than 27,000 local people, the new clinic replaces Muirhead Clinic which
provided a limited number of community health services due to its size and lack of dedicated
car parking. The development of a modern health clinic that delivers key services in the
heart of their community is a fundamental positive change, providing an opportunity to
further tackle health inequalities by improving the delivery of services; shaping them around
the needs of patients. It is a significant part of our commitment to provide all community
services in people’s local areas through integrated health and social care teams. 
The facility was purpose built with engagement from the local community who worked with
us to design and deliver it so that it meets their needs, building stronger co-operation
between patients, their carers and families, staff and all partner agencies. 
Following similar successful joint projects with North Lanarkshire Council, the new facility is
part of a wider development including the new Chryston Primary School. This approach
reflects a wider vision to create town and community hubs for everyone. The hub in Chryston
is the first of its kind and will offer significant benefits to the wider community for local groups
and organisations to use.

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Breastfeeding
Hundreds of new babies across North Lanarkshire are now being given the best possible
start in life every year thanks to a range of breastfeeding initiatives. The number of babies
breastfed in their first days in North Lanarkshire’s most deprived areas has increased by
more than 12% in the last five years. North Lanarkshire Council also became Scotland’s first
local authority to achieve gold status in the Breastfeeding Friendly Scotland Local Authority
Award.
As part of its commitment to supporting breastfeeding in the workplace and wider
community, the council has implemented a number of initiatives over the last three years
with 30.4% of babies now being breastfed by their 6 - 8-week review.
North Lanarkshire has worked collaboratively with the Scottish Government to develop the
new evidence-based accreditation process aimed specifically at local authorities in
Scotland. This has led to a wide range of North Lanarkshire Council’s services incorporating
breastfeeding into their delivery in order to positively impact on culture and practice to
promote long-term progress in breastfeeding.
Family support workers
North Lanarkshire now has eight new family support workers dedicated to providing an extra
layer of support and advice to mums with a new baby. Working as part of Health Visiting
Teams, family support workers engage with new parents and provide guidance to support
infant feeding and care of their baby. They work to Baby Friendly Standards with the aim of

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33 
building and strengthening the confidence of new parents getting to know and bond with
their baby.
Cancer Support 
A new service ensuring that cancer patients are offered emotional, practical and financial
support was officially launched in Lanarkshire during March 2024, as part of a successful
model being adopted around Scotland to deliver services that will make a positive impact for
people who have been newly diagnosed with cancer. 
North Lanarkshire are working with a range of partners across Lanarkshire, including
Macmillan Cancer Support, VANL, South Lanarkshire University Health & Social Care
Partnership and VASLAN to make sure local people affected by cancer can access the help
they need – via just one call or email. 
Anyone affected by cancer, including family members and carers, can access the new
Lanarkshire Macmillan Improving the Cancer Journey Service at any stage from diagnosis to
beyond treatment. The service is part of Lanarkshire’s cancer pathway, offering all people
newly diagnosed with cancer a meeting with a dedicated one-to-one support
worker/specialist. They will then help the person access a wide range of non-clinical
supports, from benefits advice and emotional support to help at home or with other practical
needs, with the partner agencies working together to provide a seamless, accessible and
personal support for people affected by cancer.

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34 
New winter health hub to help direct patients to most appropriate care 
A new Winter Health Hub was launched in 2023/24, designed to help Lanarkshire residents
access a wide range of healthcare services during the winter period. The online hub
provides a centralised portal, outlining the healthcare options available to help people to
seek the right care in the right place. 
The website gives a guide to the healthcare support available throughout winter as well as
details of pharmacy and GP opening times over the festive period. It also directs to support
available for mental health, the cost of living and weather and travel advice.

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35 
Spring Health Hub Launch 
A new online Spring Health Hub was launched in 2023/24, designed to help Lanarkshire
residents to navigate the wealth of healthcare options available and empower them in
seeking the right care at the right place, offering a wealth of information on all available
healthcare services, tailored specifically to the spring season. 
The Hub covers a variety of areas to assist with health and wellbeing, such as information on
seasonal allergies, information and advice for those in need of mental health support, or
seeking guidance on maintaining your wellbeing; the hub serves as a centralised web
resource and a go-to destination for essential healthcare information.

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36 
Healthy Schools 
To give the future generation of Lanarkshire the healthiest start possible, NHS Lanarkshire
has partnered with education services in North and South Lanarkshire Councils to equip
schools with an updated health and wellbeing resource for all pupils; Healthy Schools. 
The covid-19 pandemic disrupted the life of every child and had consequences for their
wellbeing, further highlighting the importance of Healthy Schools which supports children
and young people from nursery throughout Primary and Secondary school with their health
and wellbeing. 
This interactive website is used by teaching staff to empower children and young people to
make positive choices, and it’s available to be accessed by all members of the public,
meaning parents and carers can use it too. 
Created in 2014 with input from children and young people, it provides a safe space for
pupils to learn about various topics that can support them as they grow such as nutrition,
mental and physical health, substance misuse, planning for change and more. 
It has now been re-launched in 2023/24 with a new look and design, updated materials for
all levels and now has new resources specifically aimed at S5 and S6 pupils. To mark this,
NHS Lanarkshire held an event in September 2024 to showcase it to various stakeholders
within Lanarkshire. The website can be visited at www.healthyschools.scot. 
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

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37 
in a homely setting in their
community 
Reablement, Rehabilitation and Home Assessment Teams
The aim of Rehabilitation and Reablement services in North Lanarkshire is to ensure that our
residents are able to achieve, maintain, and recover their independence through appropriate
supports at home and in their communities, including preventative approaches, self-
management and choice over supports and services. The way we deliver services is
changing and there is an overall shift in the balance of care toward delivering services by
Self-directed Support, allowing people to have greater choice and control in their own lives.
The development of the North Lanarkshire Reablement service is interdependent with our
work to develop Home Assessment Teams and the development of Locality Enabling
Approach within North Lanarkshire.
We know that our work in this area contributes to an increase in wider Health and Social
Care system capacity and an improvement in patient flow by reducing the occupied bed
days caused by any Delayed Discharge from NHS facilities. The work started during 2023/24
will continue to develop a cohesive and integrated approach to Reablement and
Rehabilitation practice across Home Assessment Teams, Home Support and Integrated
Rehabilitation Teams. The work to expand this approach to services that support admission
prevention and avoidance will be developed in the next year.
The Home Assessment Team take a multi-disciplinary approach to person centred care and
work to the principle of “Home First”, enabling people to be discharged from NHS care,
supported to return home for a period of assessment where their rehabilitation and care
needs can be assessed and understood in their own home environment. Throughout
2023/24, HAT received an increasingly greater volume of referrals and through raising
awareness and understanding of the practice of assessment at home and the overall “Home
First” approach, this is now embedded in everyday practice in North Lanarkshire. During
2023/24, the service discharged it’s 2000th patient, with an according number of referrals
received. This represents an enormous achievement for a service developed in challenging
circumstances post-pandemic.
Coming Home Summary
The Coming Home Report was published in November 2018, detailing the issues
experienced by authorities managing Out of Area Placements and delayed discharge
arrangements for people with Learning Disabilities and Complex Needs. This report had
been produced in response to issues raised by the Mental Welfare Commission in their
earlier report “No Through Road”. The Coming Home Report identified that some people
with learning disabilities and complex needs were living far from home or in NHS hospitals
and that there was an urgent need to address this issue.
The report was the first time that an overview report was available for Scotland on the
characteristics and circumstances of people with complex needs who are placed into care
settings, those that are distant from their families and communities, or those who
unfortunately remain in hospital settings beyond the clinical need for them to be there.

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38 
In February 2021, the Scottish Government through their Community Living Change Fund
allocated £20 million to Integration Authorities across Scotland. The allocation was designed
to bring home people with complex needs and those with enduring mental health problems
that are placed outside Scotland, and also to support the discharge of those that have
endured long stays in hospital settings. A review would also be conducted of current
arrangements and how community-based solutions could be designed that would negate or
limit future long term hospital use and out of country placements, and the inappropriate use
of institutional care settings including private and local authority for people with complex
needs.
North Lanarkshire’s allocation of funding is £1,298.332 to support this work until March 2025.
A multidisciplinary team was recruited to carry out the initial work, consisting of a social
worker (SW), a social work mental health officer (MHO) and a resource worker (RW). The
team planned to recruit a registered nurse, however were unsuccessful in recruiting to that
post. The work of the team has included the establishment of the Dynamic Support Register
(DSR), with an overview of an initial assessment of each person on the register.  To produce
this has required collaborative work with the person, their families, a funded coming home
advocacy service and an allocated social worker to produce an assessment of each person’s
situation and to establish a forward plan for them. A RAG rating is used to understand the
cases and at the end of 2023/24, we had 31 people on the DSR, 17 of whom were identified
as red.
A comprehensive review of the work in 2023/24 was carried out and identified the need for
development of approaches for such complex cases to prevent and expedite delayed
discharge and redesign the way services are provided to prevent hospital admission. A
number of themes emerged from the review, which will form the basis of development and
improvement work in the next year, including:
 Training and development to support a suitably skilled and experienced workforce.
 Increased collaborative and coordinated multidisciplinary approaches to support
people to live in their own home.
 Research and analysis of the long-term demand and the resource required to meet
that demand and the needs of those with the most complex needs within North
Lanarkshire. 
National Health and
Wellbeing Outcome 3
People use health and social
care services have positive
experiences of those services
and have their dignity
respected

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39 
HMP Shotts improvements 
Following an inspection by Healthcare Improvement Scotland (HIS), an improvement plan
was put in place to implement the 22 initial recommendations made in the inspection report.
At the close of 2023/24, of the 22 initial recommendations made, 20 have been fully
completed and closed, with the 2 outstanding recommendations only remaining open due to
their dependence on a wider Pharmacy review. 
In addition to the HIS inspection and improvement plan, a comprehensive service review of
Prisoner Healthcare was Commissioned in January 2022 and all 31 actions originating from
that review are now closed. 
The significant service changes and improvements made in the Prison Health Centre at
HMP Shotts resulted in HIS commending the efforts made to address the recruitment,
retention, and overall staffing issue in the prison. The service held open days, undertook
focussed work to address staff culture and psychological safety. In addition, improvements
were made in how staff meetings were prioritised and managed, questionnaires were issued
to gain feedback on the work carried out and sessions held to engage and communicate with
the staff affected by the changes. The work has impacted positively on recruitment and
retention and a careers event showcasing the unique job opportunities for registered nurses
and final year nursing students at Shotts prison took place in February 2024. This event
gave the nurses the chance to visit the health centre at HMP Shotts and learn about multi-
disciplinary teams working in prison healthcare.

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40 
The workforce position at HMP Shotts improved greatly during 2023/24 and in addition to the
commendation from HIS, feedback from colleagues is that the work has been transformative
in the working environment at HMP Shotts. 
MAT standards progress 
Significant progress has been made during 2023/24 in implementing the Medication Assisted
Treatment (MAT) Standards, which has seen transformation in practice and how those
standards are embedded within service delivery.
The service has made significant improvements with regard to the collection and use of both
experiential and process data. Better data allows for reflective practice and a continual
process of review and evaluation of the evidence in relation to the MAT standards, ensuring
continued positive progress. The national benchmarking report released this year shows
significant improvements and progress for North Lanarkshire in our implementation of the
standards. The majority of standards are embedded in everyday practice with only two of the
ten remaining to be met fully, with plans in place and progressing to achieve those two
standards.
North Lanarkshire have been approached by the national MIST Team (MAT Implementation
Support Team) to participate in a video communication to be shared with other areas
celebrating the positive progress made with implementation in North Lanarkshire, presenting
our work as an example of best practice.
Launch of North Lanarkshire Alcohol & Drug Partnership website

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41 
North Lanarkshire Alcohol & Drug Partnership (ADP) was established in 2019 as a strategic,
multi-agency partnership made up of key agencies and stakeholders including local services,
people with lived and living experience of substance use and family members, all working
together to tackle alcohol and drug related harms and improve the health and wellbeing of
our communities, families and individuals affected by alcohol or drugs.
The work of the ADP is centred around improving quality, offering choice and creating more
connections to keep people safe, well and thriving. 
To assist people accessing support and services, and to make information and advice
around alcohol and drugs more accessible, a new website was launched during 2023/24.
For more information visit the North Lanarkshire ADP website www.northlanadp.org 
Children and Young People Mental Health Directory of Services and Resources launched 
A new directory dedicated to mental health services and resources developed specially for
and with children and young people across Lanarkshire was launched in 2023/24.
Developed by University Health & Social Care North Lanarkshire, the directory is a result of
extensive engagement with children, young people and a range of stakeholders. It has been
created to help young people and their families access mental health services and supports
they feel suit them and their circumstances best.
Hosted on the NHS Lanarkshire website, the directory is divided into North and South
Lanarkshire resources with some services being available across both areas. Information
available includes:
 Ways to help and improve wellbeing
 Varying levels of support
 Websites and helplines
 Online workshops

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42 
New team members devoted to supporting North Lanarkshire’s District Nurse and Mental
Health teams 
During 2023/24, North Lanarkshire welcomed 17 new assistant practitioners dedicated to
providing a further layer of support for multi-disciplinary teams working in the community.
To support rising demands for community services, the new roles have been developed to
bridge the gap between healthcare support workers and registered nurses.
NHS Lanarkshire is the first health board in Scotland to put in place a pathway for assistant
practitioners to go through a Higher National Diploma course and move directly into the third
year of nurse training. 
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

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43 
Carer Engagement, Involvement and Participation
In alignment with the principles of Equal Partners in Care (EPIC) and Getting It Right for
Everyone (GIRFE), our local approaches have been informed through engagement and
participation opportunities, Carer Strategy planning, Community Solutions approaches and
our ongoing commitment to genuine partnership working and co-produced / jointly agreed
approaches to supporting unpaid carers. 
Carer Support Network
We have a strong and well-established Carer Support Network (CSN), bringing together a
wide range of Community and Voluntary Sector organisations involved in supporting carers,
to minimise the risk of people “slipping through the support net.” This network involves a
diverse range of age-related, or condition specific organisations, as well as a much wider
range of community organisations with a direct, or indirect role around supporting carers. As
examples, a range of diverse organisations such as Getting Better Together, Watch Us
Grow, Bazooka Arts, The Haven and PAMIS, amongst others, are all part of the CSN.
LENS Workshops - Turning Ideas into Action Programme
The LENs ‘Turning Ideas into Action’ programme has been co-designed to enhance and
develop a range of interventions and ideas within the Community Solutions Programme in
North Lanarkshire. It aligns with the aims of North Lanarkshire’s University Health and Social
Care Partnership and is designed to support its objectives and mission. The Programme will
be available to a range of partners within Community Solutions, with priority given to third
sector partners. The Programme inspires, empowers, provides a framework for enabling
leadership and gives permission for people to take action. 
The Programme planning and delivery began in March 2024, with a co-production workshop
with key stakeholders and follow-up discussions with partners, to identify the following six
ideas:
 Community Connector Pathway Development

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44 
 The future of the Hospital Discharge Programme
 The future of the Carer Breather and Carer Sitter Services
 The expansion of the volunteer driver scheme
 Proactive Engagement with People in the Community
 Development of a Locality Community Weight Management Service Model 
The Programme involves an intensive series of six workshops to be delivered in financial
year 2024/25, culminating in the identified ideas being presented to an Investment Panel
comprising senior Decision Makers from the Health & Social Care Partnership and its
statutory partners. 
Each idea will be sponsored and supported by a representative of the statutory partners and
a representative from the Community and Voluntary Sector (CVS).
Community Solutions 
Community Solutions, established in 2012, is a successful, cross-sector health and social
care investment and improvement programme for North
Lanarkshire. Community Solutions is improving people’s
health, wellbeing, quality of life and equality by investing in
community-led initiatives which build community, family and
individual strengths and resources, with a focus on
prevention and early intervention. Community Solutions
ensures a co-ordinated approach throughout North
Lanarkshire, promoting local opportunities and solutions for
and with people, avoiding the need for more formal services
for longer periods of time.  Community Solutions is an
effective and active example of co-production: a true
partnership between people, communities and services. 
The range of achievements via the Community Solutions
Programme Approach include significant development
through local anchor organisations; Support in the Right
Direction, Community Connectors and Improving Cancer Journeys. Community Solutions
builds capacity in the wider Health and Social Care System by facilitating the allocation of
funding to enable Community and Voluntary sector organisations to deliver support to priority
groups, providing information and guidance on key issues such as governance, planning,
training, accreditation, finance and evaluation. 
The Community Solutions model has been used in Children’s Services to test out new
models of support to address distress and promote positive mental health. A significant
portion of new Scottish Government funding targeted at early intervention and community
support through the Children and Young People’s Mental Health and Wellbeing Framework
is allocated to organisations though VANL to develop new supports in partnership with
school clusters, children, young people and their families. Future investment will be used to
continue the community capacity building work already well embedded in the Community
Solutions Programme through Voluntary Action North Lanarkshire. The new Improving Lives
work stream will see development across a number of key priorities for the Partnership in
line with the aims of the Strategic Commissioning Plan and will ensure there is sufficient
capacity within the community and voluntary sector to respond to demand.

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45 
Support in the Right Direction
The Scottish Government funded a national ‘Support in the Right Direction’ (SiRD)
programme from 2019-2024. The programme aimed to empower people and carers who are
receiving social care support and services to be equal partners in their care, giving them real
choice and control over their lives, including:
 Decisions about where they live and the services they receive
 Participation in fulfilling activities and their community
 Employment, if appropriate 
The national SIRD Fund is managed by Inspiring Scotland on behalf of the Scottish
Government. 30 organisations across the 32 local authority areas in Scotland are funded to
deliver SIRD projects. Voluntary Action North Lanarkshire (VANL) managed the SiRD fund
for North Lanarkshire, and distributed this funding through the Community Solutions
Programme to two Community and Voluntary Sector (CVS) organisations:
 Equals Advocacy
 North Lanarkshire Disability Forum (NLDF)
 NLDF have hosted two Community Connectors since 2019, who were responsible
for:
 Raising awareness of SDS throughout North Lanarkshire
 Supporting those who are not yet eligible for an individual social care budget by
linking them to key supports 
At the end of 2023/24, £463,800 of SiRD funding over the five-year period has
supported 2,576 individuals providing 820 people with general independent support, 392
people with case work, and 442 individuals with focused support.
Improving Lives Initiative 
As the SiRD funding came to an end in 2024, NLDF have secured a further £808.9k funding
over two years through the Community Solutions Improving Lives Initiative (ILI).

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46 
The proposal for ILI was developed collaboratively with:
 the Community Solutions Governance Group
 University Health and Social Care North Lanarkshire (UHSCNL) Core Management
team
 NHS Lanarkshire Health Improvement senior staff
 Macmillan Cancer Support 
The ILI aims to help improve people’s physical, mental, and social wellbeing through a
locally co-ordinated approach to providing community-based support for vulnerable and
equality groups, as set out in the Community Solutions Strategy and Investment Plan 2022-
25.
Community Connectors 
ILI/ICJ funding has enabled NLDF to continue to fund Community Connectors and employ a
further eight, making a team of 10 Community Connectors to support people who are living
with a long-term condition/disability and those affected by cancer, including their carers, with
accessing non-clinical support. 
The Community Connectors are responsible for:
 Signposting people to community supports provided by CVS organisations and
where appropriate, linking to statutory services such as the Home Assessment and
Integrated Rehabilitation Teams.
 Practical support, such as form filling
 Linking into community groups, or activities
 Providing information on benefits/funds/initiatives
 Emotional support 
In 2023/24, 696 people with long-term conditions were referred to NLDF for support through
the ILI service. 406 of these referrals were carried over from the SiRD programme. 
A total of 1,016 referrals were received in North Lanarkshire during 2023-24 from both the ILI
and ICJ services. 
National Health and
Wellbeing Outcome 7
People using health and social
care services are safe from
harm 
Crisis Care – Distress Brief Intervention (DBI)
The need to improve the response to people presenting in distress has been strongly
advocated by people who have experience of distress and by front line service providers,

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47 
resulting in the launch of the Scottish Government Distress Brief Intervention (DBI)
Programme. 
DBI is a non-clinical intervention, consisting of two interrelated parts: - 
 For adults (those over 16), Level 1 sees trained front-line staff such as health, police,
ambulance and primary care staff help ease the person’s distress, provide a
compassionate response and where appropriate, involves an offer of a seamless
referral, with confidence and clarity to a DBI Level 2 service. 
For the children and young people (CYP), i.e. those aged 14 and above, in four North
Lanarkshire schools currently involved in a pilot (until 2026), the Level 1 service will be
provided through the Pupil Support team within the school. Level 1 staff within these
organisations are trained to provide a compassionate response to individuals experiencing
distress and offer them the opportunity to be referred to a brief (around 14 days),
compassionate, community-based problem-solving intervention (DBI Level 2). 
 Level 2 is provided by commissioned and trained third sector staff who contact the
person within 24-hours of referral and provide community-based problem solving
support, wellness and distress management planning, supported connections and
signposting. 
The Scottish Government’s “Protecting Scotland, Renewing Scotland, the Governments
Programme for Scotland, 2020-21, published Sep 2020, set out that it expected local health
boards and H&SC Partnerships to have DBI embedded locally by 2024. 
Following a pilot, Lifelink have been commissioned to deliver a pan-Lanarkshire Distress
Brief Intervention service, with funding agreed for a 3-year period and North Lanarkshire
Council acting as the lead authority in a tri-partite agreement. Trained and dedicated staff
from Lifelink will contact people within 24-hours of referral and provide community-based
problem solving support, wellness and distress management planning, supported
connections and signposting for all people referred to the DBI service. 
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
Engagement & Participation North Lanarkshire
During 2023/24, there has been continued focus on further developing our approach
engagement and participation that ensures the voices of supported people; carers and our
communities are strengthened. The refreshed Engagement and Participation Strategy 2024-
27 is the result of co-production with our local communities. Several stakeholder events were
held to help shape the refreshed content and ensure that the National Standards for
Community Engagement, promoted by Scottish Community Development Centre, have been
applied throughout.

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The Strategic Engagement and Participation Working Group (SEPWG) have identified three
main areas of investment that support Engagement and Participation across our
communities (Community, Carers and Supported People). Our ambition is to ensure strong
voices to:
• Improve communication and increase connections.
• Increase awareness of what matters.
• Increase capacity for early intervention and prevention.
Following on from the successful procurement exercise resulting in a contract award to North
Lanarkshire Disability Forum (NLDF) as the lead partner, alongside Lanarkshire Links and
Voice of Experience Forum, work has begun again on the recommendations from an
independent review of our engagement and participation structures that concluded in June
2022.
There is a long history of engagement and participation in North Lanarkshire and the
strength of connection across our network continues to promote involvement and
representation. There have been some key achievements over the past year as set out
below.
Engagement and Participation Strategy 2024-2027
In the second half of 2023/24, a focused effort was directed towards refreshing the
Engagement & Participation Strategy to serve as the foundation across all areas of our
work. In the development of the Strategy, we have actively engaged with stakeholders;
representatives of community-based organisations, supported people, carers and staff
teams.
The learning from these sessions has highlighted what is considered good engagement and
participation, and provided confirmation that the refreshed strategy should:
• Be short and user friendly.
• Be an overarching strategy that can guide communication and action planning across
all areas of services and supports.
• Build from the current strategy, including what we have learned and what people
have told us.
It is anticipated that the Strategy will support all stakeholders across our networks and it is
purposefully written with accessibility in mind to assist people who do not work in the sector
but have an interest in Health and Social Care, and/or are receiving services and supports.
Strategic Engagement and Participation Working Group
The primary function of the Strategic Participation and Engagement Working Group
(SEPWG) is to lead and progress the development of the refreshed Strategy 2024-27.
The group brings together representation from across the partnership and includes people
who have a specific role to support and develop engagement and participation. The primary
objective is to coordinate, streamline and synchronise the various activities and initiatives
across North Lanarkshire that are aimed at fostering robust and effective engagement and

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participation, prioritise community involvement and also to ensure that the voices, needs,
and perspectives of people in North Lanarkshire are not just heard but actively integrated
into the design and delivery of our services.
Embedding Participation
There has been good progress in 2023/24, with an increase in the resource and capacity
across community-based organisations to strengthen the voice of supported people,
particularly those who tend to be harder to reach, e.g. BAME, LGBTQI+ and those who live
in more rural communities.
We recognise the importance of ensuring that engagement and participation is meaningful
and not tokenistic, and to support this, the principles of engagement and participation are
now included in the Staff Induction programme, both as written information and as a direct
input to programme for new social work and social care practitioners.
A wide range of stakeholders have been actively engaged in the development of the
Strategy, whether through consultation or direct involvement. Promoting and implementing
the Strategy is a shared responsibility to support:
• An evidence base on how people experience our services and how their
experience shapes and improves future development of services and supports.
• The voice of supported people in our communities
• Increased capacity for early intervention and prevention.
• Two-way communication and a strengthened feedback loop back to decision makers.
• Increased use of feedback and the role of lived experience in the improvement of
services and supports.
• Increased connections with supported people and communities that are harder to
engage with.
• Increased awareness of what is important to supported people and their
communities.
Care Opinion
We recognise the importance of feedback and actively promote the use of Care Opinion,
which is an independent, non-profit, web-based feedback platform where people submit
stories to share their experiences of health and social care services. These can be both

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positive and negative. They are moderated and quickly forwarded to the relevant area of
service who can respond directly to the story. Since 2020:
• 310 stories have been submitted through Care Opinion by people of North
Lanarkshire.
• 239 of these stories have been shared during 2023/24.
The majority of stories received a response from the service within 24 hours.
Podiatry case study
The Podiatry service has completed a successful recovery, with significant re-design being
embedded in practice during 2023/24. Following a change management process, the hub
single point of access model, alongside Active Clinical Referral Triage (ACRT) has been
embedded in Podiatry practice, resulting in waiting times being maintained within the 12-
week target, whilst offering a “rapid access” of 48 hours (2 working days) for people with
urgent presentations of new wounds.
Building on this success, the focus for the next 2-3 years is on developing a “grass-roots”
clinically led Research strategy and a culture of Quality Improvement, Evidence and
Research based practice. This work will be facilitated by our strategic academic partners at
Glasgow Caledonian University, who have been working with clinical podiatry staff and the
musculoskeletal Consultant Podiatrist to develop a departmental research strategy. The aim
is to encourage and facilitate colleagues at all levels to lead on service evaluation, quality
improvement projects and traditional research. Two examples of this work in action are:
 Nail Surgery service evaluation - The Clinical Lead for Nail surgery is working
alongside the NHS Lanarkshire Research and Development department, the service
development lead and a specialist Podiatrist who is a current PhD Fellow to carry out
a service evaluation. NHS Lanarkshire Podiatry are the only service in Scotland that
are carrying out a robust evaluation on TCA. As such, the department has been
asked to share the learning and the outcomes with other health boards.
 Comparison of digital self-directed advice verses clinician-led self-care to support
musculoskeletal health - The total service demand for Musculoskeletal (MSK)
complaints is 28% and of this, 11% are directed to non-clinician supported self-care
via the NHS Lanarkshire Podiatry website. Current data suggests that after an
average of 161 days, 80% of patients directed to self-care did not re-engage with the
service. Following a further average of 698 days, 72% of patients did not re-engage
with the service.
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
The financial year 2023/24 presented fresh challenges for the Health and Social Care
Partnership, including a continued recovery from the pandemic, the cost of living crisis, a
changing demographic profile, pressures attributable to hospital discharges, staffing
shortages, rising costs and increased demand for services.

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51
Through regular updates to the board from the Chief Finance Officer (CFO) and by ensuring
decisions made throughout 2023/24 were taken to support financial sustainability, the North
Lanarkshire IJB has successfully managed to deliver year-on-year financial balance. This
has been achieved through:
• flexible use of recurring and non-recurring funding;
• creation and use of reserves for specific commitments;
• delivery of approved savings through efficiency measures and redesign;
• a focus on workforce planning and the Strategic Commissioning Plan Programme of
Work;
• effective governance and audit controls.
North Lanarkshire IJB delivers and commissions a range of health and social care services
to our local population. This is funded through budgets delegated from both North
Lanarkshire Council and NHS Lanarkshire. The level of funding available to the IJB is
therefore heavily influenced by the grant settlement that the organisations receive from the
Scottish Government. The combined recurring and non-recurring budgets available to the
IJB during 2023/24 to progress the intended commissioning in line with the Strategic
Commissioning Plan, was circa £821m. Included within this funding is a ‘Large Hospital
Service’ (Set Aside) budget totalling £74.575m. This budget is set in respect of the functions
delegated by the Health Board that are carried out in a hospital setting. The Set Aside
budget is determined by apportioning the hospital expenditure to individual patient episodes,
separating out episodes for services delegated to the IJB from those that are not, and then
assigning these to the relevant IJB based by postcode.
Also included is £40.641m for several delegated services where South Lanarkshire IJB acts
as the lead host on behalf of North Lanarkshire IJB. The value consumed by North
Lanarkshire equates to 52% of the South Lanarkshire IJB hosted budget.

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52 
Throughout 2023/24, the CFO financial monitoring reports to the IJB projected an
underspend; this was prior to the transfer of year-end balances to general and earmarked
reserves at the financial year end.  This included the transfer of specific ring-fenced monies
(including Scottish Government funding for Mental Health Services, Alcohol & Drug
Services, Hospital at Home, and other Nursing) in line with Scottish Government guidance. 
Note: The figures differ to financial reporting elsewhere, such as the Comprehensive Income
and Expenditure Statement (CIES) due to differences in the presentation of in year
adjustments between the partners. 
The year-end underspend totalled £18.710m.  Drawdown of reserves in 2023/24 totalled
£41.132m, leaving a deficit on the provision of services of £22.422m. 
The following provides a high-level summary of the key pressures and the main reasons why
the IJB’s final outturn resulted in an underspend against its budget in 2023/24:
 The net underspend of £7.800m for Locality and Other Services relates to the
ongoing challenge of recruitment and retention of staff across all mainstream service
areas.  This underspend also includes Scottish Government funding of £4.277m,
allocated to help address the current staffing pressures.  This funding will be carried
forward into 2024/25 within specific ring-fenced reserves to be used in 2024/25. 
 North Lanarkshire Hosted Services have a combined net underspend totalling
£5.063m.  This is due to additional funding received from Scottish Government
(£4.457m), which will be carried forward into 2024/25 and allocated against approved
spending plans within Mental Health.  The remaining underspend is in relation to
vacant posts across the service. 
 Addiction Services have a net underspend of £3.597m.  The total underspend relates
to Scottish Government ring-fenced funding, which will be carried forward for use in
2025/26. 
 Social Care Services have a net underspend of £3.331m and this relates to the
ongoing challenge of recruitment and retention of staff across all service areas. 
 The Prescribing net overspend of £1.781m is attributable to the continued increase in
costs associated with the number of medicines being prescribed. 
 Medical/Nursing Directorate and Area Wide Services have a combined net
underspend totalling £0.967m that is due to additional Scottish Government funding
(£1.034m), which will be carried forward into 2024/25 and allocated against approved
spending plans within Pharmacy, Frailty and District Nursing.


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As demand continues to rise, the costs of providing health and social care services across
Lanarkshire have also been increasing year on year. This table shows the cost of our
services incurred over the last three years, as presented in the Comprehensive Income and
Expenditure Statement.
8. Care Inspectorate Grades 2023/24
The Care Inspectorate provide an overall evaluation for each of the key questions that they
inspect using a six-point scale from unsatisfactory (1), to excellent (6). This will be taken
from the specific quality indicators that they inspect within a “key question”, which will inform
an overall evaluation (using the same scale) for that particular key question that the quality
indicators sit under.
NLC Care Homes
As of 31st March 2024, there were 27 care homes within North Lanarkshire. All 27 of the
care homes had been assessed by the Care Inspectorate against their key question of, ‘How
well do we support people’s wellbeing?’. None of the care homes assessed achieved the
highest grade of ‘Excellent’, however 11.1% of care homes achieved ‘Very Good’. The
majority of care homes were assessed as ‘Good’ or better against this question, totalling
66.7%.
The care homes who were assessed as ‘Very Good’ were Blair House, Kirknowe, and
Summerlee. Of the 27 care homes, 13 were assessed under the key question ‘How well is
care and support planned?’. Of the 13 that had been assessed, 69.2% received a grade of
‘Good’ or better.
During the reporting period Centenary House continued to be subject to a Large Scale
Investigation Notification, in place till 11th October 2023. An improvement notice was also
served by the Care Inspectorate to Centenary House on 12th July 2023. This was removed
in December 2023 following significant improvements having been made.
During the reporting period, six care homes were closed to admissions due to them agreeing
to a voluntary moratorium. One care home had an enforced moratorium placed upon them.
The reasons for the application of moratoriums were due to concerns around the quality of

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care being provided and also to allow care home providers the opportunity to make the
necessary improvements.
Other services
There are 50 commissioned services that have been inspected by the Care Inspectorate
under their new methodology framework. 
Forty-nine commissioned services were inspected against the key question ‘How well do we
support people’s wellbeing?’. One service received a grade of ‘Excellent’ for this key
question; this was Support for Ordinary Living (SOL).  A grade of ‘Very Good’ was received
by 55.1% of services and 87.8% of services inspected received grades of ‘Good’ or above. 
For the key question ‘How well do we support people’s wellbeing?’, 4% of services received
grades of ‘Weak’.  The two services were Cera Care and Care 1 Professional’ both of these
services continue subject to moratorium at the end of this reporting period.  The reasons for
the moratorium were due to the quality of care assessed by the Care Inspectorate.
Application of the moratorium is to support the provider to make the necessary
improvements required. 
Of the 50 commissioned services, 21 were inspected by the Care Inspectorate against the
key question ‘How well is care and support planned?’.  Of these, 33.3% received grades of
‘Very Good’ and 76.2% received grades of ‘Good’, or above.

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9. Strategic Planning
The overarching strategic vision and objectives of the IJB are detailed in the IJB Strategic
Commissioning Plan 2023/20261 which sets out the key outcomes the IJB is committed to
delivering with its partners.
Strategic Commissioning Launch 2023 - 2026 Event 
Health & Social Care North Lanarkshire launched its Strategic Commissioning Plan 2023-
2026 on Thursday, 05th October 2023, hosted by the staff and pupils at Coltness High
School. The opportunity to hold the launch at the school is in line with our ambition to
engage with people at a local level and the event was attended by service users, health and
social care professionals, voluntary sector partners, and stakeholders. In addition, Higher
Modern Studies students from the school were able to join delegates for the session
presented by the keynote speaker, Sir Harry Burns, professor of practice and special adviser
at the University of Strathclyde. Guests were treated to a musical performance by three of
the school’s singers, Isla McGowan, Freya McIntyre and Millie Costello, accompanied by
fellow pupil Kurtis Fang on the piano, which was a fantastic way to end the day and a
reminder of the talent and potential we have in North Lanarkshire. 
The feedback from the launch event was extremely positive, with many delegates providing
feedback on how inspired they were by the event, the quality of both the speakers and their
presentations and that it had provided a clear understanding of Health & Social Care North
Lanarkshire’s goals for the next three years, with a clear message that people are central to
everything that we do. The feedback clearly shows the strong foundations that are already in
place and our commitment to working with service users, patients, carers, families,
communities and partner organisations to improve the health and wellbeing of North
Lanarkshire residents. 
1 IJB Strategic Commissioning Plan 2023/2026

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56 
The Strategic Commissioning Plan 2023-2026 for North Lanarkshire sets out ambitious key
local priorities for health and social care services over the next three years to ensure people
are robustly supported to live in their own homes and lead independent lives in their
communities. It was developed through a collaborative process with people who use health
and social care services, partners, the public and partnership staff. Key priorities include: 
 Improving access to services
 Reducing health inequalities
 Delivering high-quality, person-centred care
 Promoting early intervention and prevention
 Empowering individuals and communities
 Fostering partnership working
 Contributing towards national health and wellbeing outcomes 
The chief executives of North Lanarkshire Council and NHS Lanarkshire set out in detail how
their respective organisational plans align, complement and support the Strategic
Commissioning Plan. Presentations were also delivered at the launch event on people-led
system transformation and human learning systems, which are approaches the partnership
are employing in bold and innovative new ways of delivering health and social care services
across North Lanarkshire. 
The plan reflects the feedback and input from people across North Lanarkshire to develop a
shared vision for local health and social care. It focuses on promoting early intervention,
empowering communities and fostering partnerships to ensure that our services meet the
needs of the population. The plan outlines our commitment to developing and delivering
services that provide support to individuals, families, and our wider communities to improve
their health, wellbeing, and overall quality of life. High quality community health and social
care services play a crucial role in supporting people to maintain a better level of health. This
is achieved through prevention, support and treatment to help people to live a better life at
home for as long as possible. 
The plan will be implemented over the next three years, with ongoing monitoring to ensure
that services continue to meet the needs and goals of local people. 
The Strategic Planning Group sets out the IJB’s approach to engage with stakeholders. 
Consultation on the future vision and activities of the IJB is undertaken with its Health
Services and Local Authority partners with a Programme of Work setting out in detail the
commitments that will be progressed over the next three years.

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The Medium-Term Financial Plan 2023/2026 outlines the financial challenges and
opportunities the HSCP faces over the next three years and provides a framework which will
support the HSCP to remain financially sustainable.  It complements the IJB Strategic
Commissioning Plan, highlighting how the financial plan will support the delivery of the IJB’s
strategic objectives and priorities. 
Our joint focus with all our partners and stakeholders, will be to ensure that all resources in
scope are maximised to their full potential and health and social care services are efficient,
effective and sustainable for the future. 
10. Looking Forward – Our Next Steps   
The North Lanarkshire HSCP Strategic Commissioning Plan 2023 – 2026 Programme of
work sets out in detail the key work Programmes that will be undertaken over the three-year
period to meet the key priorities within the Strategic Commissioning Plan. The Programme of
Work is aligned to the transformational change priorities for the partnership, reflects the
requirement to manage the interconnections and dependencies in a complex system, as well
as give clarity and structure to wider partners and stakeholders. 
The Plan sets out revised ambitions for the HSCP, which were agreed following consultation
with the public and other stakeholders: 
Do the right thing first time
Increased focus on prevention, early intervention and tackling inequalities by
working with communities and people
Develop and support a workforce for the future
Improve mental health and wellbeing
Support people through a whole family approach

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11. Appendices
Appendix 1 – Summary of Performance against Core Suite of Integration Indicators 
Indicator Title  NL
2015/16
NL
2017/18
NL
2019/20
NL
2021/22
NL
2023/24
NI -1 
Percentage of adults able to look
after their health very well or
quite well
91.70% 90.30% 90.50% 87.50% 87.41%
NI - 2
Percentage of adults supported at
home who agreed that they are
supported to live as independently
as possible    
77.60% 79.80% 67.74%
NI - 3
Percentage of adults supported at
home who agreed that they had a
say in how their help, care, or
support was provided    
71.20% 67.10% 57.11%
NI - 4
Percentage of adults supported at
home who agreed that their
health and social care services
seemed to be well co-ordinated    
70.20% 66.60% 56.04%
NI - 5
Percentage of adults receiving any
care or support who rate it as
excellent or good    
77.80% 74.00% 65.76%
NI - 6
Percentage of people with positive
experience of care at their GP
practice
79.30% 75.50% 68.30% 51.80% 52.80%
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    
75.70% 77.00% 67.70%
NI - 8
Percentage of carers who feel
supported to continue in their
caring role
41.20% 33.20% 32.60% 25.10% 28.46%
NI - 9 Percentage of adults supported at
home who agreed they felt safe     80.00% 79.80% 68.44%

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59 
Indicator Title NL 2017 NL 2018 NL 2019 NL 2020 NL 2021 NL 2022
NI -11
Premature mortality
rate per 100,000
persons
482 517 515 581 580 510        
Indicator Title NL
2018/19
NL
2019/20
NL
2020/21
NL
2021/22
NL
2022/23 NL 2023
NI -12
Emergency
admission rate (per
100,000 population)
15829 16280 13829 15122 15111 15396
NI – 13
Emergency bed day
rate (per 100,000
population)
120784 122569 107300 121842 126261 122120
NI – 14
Emergency
readmissions to
hospital within 28
days of discharge
(rate per 1,000
discharges)
101 106 123 115 117 116
NI - 15
Proportion of last 6
months of life spent
at home or in a
community setting
89% 89% 90% 90% 89% 89%
NI – 16 Falls rate per 1,000
population aged 65+ 23 21 19 21 20 21    
NL
2018/19
NL
2019/20
NL
2020/21
NL
2021/22
NL
2022/23
NL
2023/24
NI -17
Proportion of care
services graded
‘good’ (4) or better
in Care Inspectorate
inspections
76% 83% 80% 78% 77% 76%    
NL 
2018
NL 
2019
NL 
2020
NL 
2021 NL 2022 NL 2023
NI – 18
Percentage of adults
with intensive care
needs receiving care
at home
75% 74% 75% 75% 71% 70%    
NL
2018/19
NL
2019/20
NL
2020/21
NL
2021/22
NL
2022/23
NL
2023/24
NI – 19
Number of days
people spend in
hospital when they
are ready to be
discharged (per
1,000 population)
996 1109 781 821 970 973

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60 
Appendix 2 – HSCP Performance Dashboard 
Outcome 
(National
Health &
Wellbeing)
Ref
. 
KPI Target
2023-
24
2023/24
Q1
2023/24
Q2
2023/24
Q3
2023/24
Q4
Current
Performan
ce
1. People
are able to
look after
and improve
their own
health and
wellbeing
and live in
good health
longer
1.1 Alcohol Brief Interventions North  2883 718 790 772 598  
1.2 Alcohol Brief Interventions (all settings) NHSL  7381 1978 2040 1949 1806  
1.5 Cervical Screening   80% 72.3% 72.3% 71.8% 71.2%  
1.6 Immunisations – %s of 2 year olds   95% 94.8% 95.0% 95.1% 95.4%  
1.7 Immunisations – %s of 5 year olds   95% 91.4% 89.9% 90.6% 90.1%  
1.8 Addictions – Completed Waits 90% 90.1% 84.2% 87.8% 89.8%  
1.9 Addictions – Ongoing Waits  90% 86.6% 98.5% 91.8% 95.9%  
1.1
0 Addictions – Ongoing Waits NHSL   90% 86.1% 83.1% 82.3% 95.9%  
1.1
2
Percentage of people who have completed 6-8 week
review 90%
79.9% 81.3% Data not
available
Quarterly/
1 quarter
behind
...
2. People,
including
those with
disabilities
or long term
conditions,
or who are
frail, are
able to live,
as far as
reasonably
practicable,
2.4 Delayed discharge bed days - standard delays  31,796 8,438 16,110 24,098 31,405  
2.5 A&E Attendances - NL Residents 116,45
6 
30,637 30,044 29,292
Quarterly/
1 quarter
behind  
2.6 Emergency Admissions - NL Residents 
44,001 
10,834 11,055 9,401
Quarterly/
1 quarter
behind  
2.7 Unscheduled Bed Days - all specialties, NL residents  294,99
9 
66,941 77,508 67,694
Quarterly/
1 quarter
behind  
2.1
1 Inpatient Activity – Readmissions  7 days 8 5.75 5.90 5.65 5.67

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independent
ly and at
home or in a
homely
setting in
their
community.
2.1
3
Percentage of patients waiting less than 12 months to
begin PDS (waiting less than 12 months/total number
waiting) 70%
90.6% 86.2% 88.3% 83.9%  
2.1
4 Mental Health - bed occupancy rate  … 86.4% 87.5% 86.3% 86.2% ...
2.1
5
Assistive Technology - Number Of People With
Technology (0-17 yrs)
1,452
28 28 31 31  
2.1
6
Assistive Technology - Number Of People With
Technology (18-64yrs) 632 631 618 624
2.1
7
Assistive Technology - Number Of People With
Technology (65+) 818 825 856 858
2.1
8
Reablement - Number Of People Completing
Reablement Process
2000
(500
per
quarte
r) 
376 816 1355 2011  
2.1
9
Reablement - % Of New or Increased Home Support
Packages Which Are Reablement 70% 64.0% 70.3% 70.0% 60.8%  
2.2 Reablement - % Of People With No or Reduced Home
Support Service Required At End Of Process 70% 45.8% 48.0% 58.8% 58.5%  
2.2
1 Balance Of Care - % Of People (Age 65+) 45% 40.2% 36.7% 34.0% 36.4%  
2.2
2
IEAS - % Deliveries Achieved Within 7 Working Days
Quarterly 80% 47.5% 49.9% 53.5% 63.4%  
3. People
who use
health and
social care
services
have
3.1 18 Week RTT Performance – CAMHS NHSL (NORTH
HOSTED) 90% 28.1% 47.1% 72.6% 58.7%  
3.4 18 Week RTT Performance – Psychology (NHSL)
(NORTH HOSTED) 90% 81.7% 79.1% 82.5% 78.1%  
3.5 Consultant Outpatient WT - Adult Mental Health -
12wks (NHSL) (NORTH HOSTED) 90%* 57.4% 48.9% 40.4% 37.7%

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62 
positive
experiences
of those
services, and
have their
dignity
respected
3.6 Consultant Outpatient WT - Older Adult Psychiatry -
12wks (NHSL) (NORTH HOSTED)  90%* 81.9% 79.9% 77.8% 74.7%  
3.7 Consultant Outpatient WT - Learning Disability -
12wks (NHSL) (NORTH HOSTED) 90%* 100% 100% 100% 100%  
3.8 Medical Paediatrics WT - 12 wks (NHSL) (NORTH
HOSTED) 90%* 49.5% 56.1% 88.8% 88.2%  
3.9 Admission to MH Wards: Proportion NHSL Patients  >=95% 97.7% 98.5% 97.8% 98.8%  
3.1
1 MSK Podiatry - 12wks (NORTH HOSTED) 90%* 100% 100% 100% 100%  
3.1
2 Podiatry - 12wks (NORTH HOSTED) 90%* 96.6% 94.5% 99.0% 100%  
3.1
3 Podiatry - domiciliary visits - 12wks (NORTH HOSTED) 90%* 100% 100% 100% 100%  
3.1
4 SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 25.1% 18.3% 23.2% 21.2%  
3.1
5 SLT - Adult - 12wks (NORTH HOSTED)  90%* 81.4% 96.0% 90.0% 91.5%  
3.1
8 Dietetics - 12wks (NORTH HOSTED) 90%* 75.4% 69.1% 74.8% 74.1%  
4. Health
and social
care services
are centred
on helping
to maintain
or improve
the quality
of life of
people who
use those
services
4.3 Care Home Placements At End Of Quarter - Per 1000
Popn 65+ 24 21.7 22.0 21.9 22.0  
4.4 Care Home Placements At End Of Quarter - Per 1000
Popn 75+ 50 44.9 45.8 45.6 45.9  
4.5 Care Home - Average Length of Stay  865 832 891 835 834  
4.6 Number Of People With Self Directed Support  1,000 2070 2093 2092 2089  
4.7 Number Of People With A Direct Payment
240
329 342 357 379

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63 
5. Health
and social
care services
contribute
to reducing
health
inequalities
5.1
Sustain and embed successful smoking quits, at 12
weeks post quit, in 40% of SIMD areas. (AOP) (NORTH
HOSTED)
902
53 110
Quarterly/
2 quarters
behind
Quarterly/
2 quarters
behind  
6. People
who provide
unpaid care
are
supported to
look after
their own
health and
wellbeing,
including to
reduce any
negative
impact on
their caring
role on their
own health
and
wellbeing
6.1 Community Alarm Service Users 75 Years And Over
Per 1000 Population ... 191.8 193.9 196.5 195.8 …
7. People
who use
health and
social care
services are
7.6 Manual Handling Awareness 90% 94.9% 95.6% 94.8% 97.7%  
7.7 PAMOVA Training 90% 94.1% 96.5% 93.5% 98.1%  
7.8 Adult Basic Life Support 90% 84.3% 92.6% 90.3% 89.6%    
Paediatric Basic Life Support  90% 91.3% 92.9% 91.2% 86.7%  
7.9 Fire Safety Training 90% 94.6% 95.4% 95.2% 94.4%  
7.1 Hand Hygiene Training  90% 89.5% 94.1% 92.3% 95.1%

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64 
safe from
harm
7.1
1
Safe information Handling Training 
90% 92.3% 96.5% 95.2% 97.6%  
7.1
2
Child Protection Awareness Training 
90% 95.6% 97.7% 97.0% 98.5%  
7.1
4
Health and Safety Awareness Training
90% 94.2% 95.9% 95.9% 99.2%  
7.1
5
Occupational Health Service Awareness Training
90% 94.1% 95.9% 96.2% 99.6%  
7.1
6
Adult Support and Protection Awareness Training
90% 95.5% 92.6% 96.8% 99.3%  
7.2 % Of Adult Protection Referrals Passed To Care Team
For Investigation 20% 12.4% 14.8% 12.7% 20.1%  
7.2
1
% Of Adult Protection Investigations Going To Initial
Case Conference 20% 20.3% 10.4% 19.2% 11.9%  
7.2
2
Adult Protection - % Of Referrals With Decision
Within 5 Days 60% 76.6% 77.8% 76.3% 81.7%  
7.2
3
% of Adult Protection Referrals Which Did Not Go On
To Investigation Or Other Service 50% 76.6% 74.2% 75.9% 71.5%  
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,
8.1 TURAS compliance (NHSL, North)
>80%
68% 69% 65% 78%

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65 
care and
treatment
they provide
9. Resources
are used
effectively
and
efficiently in
the
provision of
health and
social care
services
9.1 Breakeven Position - YTD Variance Including
Prescribing (NHSL) >=0
0.042m
Underspen
d
0.006m
Underspen
d
2.013m
Underspen
d
£15.379m
underspen
d
...
9.2 Breakeven Position - YTD Variance Excluding
Prescribing (NHSL)  >=0
1.392m
Underspen
d
2.346m
Underspen
d
2.631m
Underspen
d
£17.160m
underspen
d
...
9.5 Sickness Absence (NHSL, North)  4% 7.41% 6.88% 6.46% 6.88%  
9.6 Sickness Absence (NLC) - days lost per person
9.22
3.34 6.93 10.29 13.74

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66 
Appendix 3 – Inspection Findings 2022/23
Further information on 2023/24 inspection activity can be found in the HSCP Quality Assurance Annual Report, or more detailed information is available at
the Care Inspectorate website: Publications & Statistics (careinspectorate.com).   
Service Resource Name Service Group Date Last
Inspected
How well
do we
support
people's
wellbeing?
How well is
care and
support
planned?
How good
is our
setting?
How good
is our staff
team?
How good
is our
leadership?
Cumbernauld Locality Support Service 25/09/2023 Very Good Excellent Very Good Very Good Very Good
Coatbridge Locality Support Service 26/05/2023 Very Good Very Good Very Good Very Good Very Good
Wishaw Locality Support Service 12/06/2023 Very Good Very Good Good Very Good Very Good
Airdrie Locality Support Service 16/05/2023 Very Good Excellent Very Good Very Good Very Good
The New Harry Walker Integrated Day
Services Support Service 27/07/2023 Very Good Very Good Very Good Very Good Adequate
Bellshill Locality Support Service 23/06/2023 Very Good Very Good Very Good Very Good Very Good
Phew Care Home Service 29/02/2024 Good Good Good Good Adequate
Avondale Nursing Home Care Home Service 13/07/2023 Good Good Good Good Good
Craig En Goyne Care Home Service 21/04/2023 Good Good Very Good Good Good
Darroch Nursing Home Care Home Service 09/11/2023 Good Good Good Very Good Adequate
Rawyards House Care Home Care Home Service 06/11/2023 Good Adequate Good Adequate Good
Sir John Mann Integrated Day Service Support Service 12/01/2024 Very Good Good Good Very Good Very Good
Sinclair Integrated Day Service Support Service 14/04/2023 Very Good Good Very Good Very Good Good
Capability Scotland - North Lanarkshire
Services Support Service 17/04/2023 Very Good Good   Good Very Good
North Lanarkshire Supported Living
Service
Housing Support
Service 07/09/2023 Very Good Very Good   Very Good Good
East Dunbartonshire Phase 1
Housing Support
Service 01/06/2023 Very Good Very Good   Good Good

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67 
Service Resource Name Service Group Date Last
Inspected
How well
do we
support
people's
wellbeing?
How well is
care and
support
planned?
How good
is our
setting?
How good
is our staff
team?
How good
is our
leadership?
East Dunbartonshire Phase 2
Housing Support
Service 01/06/2023 Very Good Good   Good Good
East Dunbartonshire Phase 3
Housing Support
Service 06/06/2023 Good Good   Good Good
Enable Scotland (Leading the Way) -
Lanarkshire Services
Housing Support
Service 11/03/2024 Weak Weak   Weak Weak
Tenancy Support Service Cumbernauld
Housing Support
Service 03/10/2023 Very Good Very Good   Very Good Very Good
Potential Living
Housing Support
Service 17/04/2023 Very Good Excellent   Very Good Very Good
Potential Living Support Service 17/04/2023 Very Good Excellent   Very Good Very Good
Coatbridge Home Support Service
Housing Support
Service 24/05/2023 Weak Weak   Adequate Weak
Coatbridge Home Support Service Support Service 24/05/2023 Weak Weak   Adequate Weak
Cumbernauld Home Support Service
Housing Support
Service 17/08/2023 Weak Weak   Weak Weak
Cumbernauld Home Support Service Support Service 17/08/2023 Weak Weak   Weak Weak
Wishaw and Shotts Home Support
Service Support Service 21/02/2024 Adequate Adequate   Adequate Adequate
Airdrie Home Support Service
Housing Support
Service 28/09/2023 Weak Weak   Good Adequate
Airdrie Home Support Service Support Service 28/09/2023 Weak Weak   Good Adequate
Community Alarm Service
Housing Support
Service 26/04/2023 Very Good Adequate   Very Good Good
Community Alarm Service Support Service 26/04/2023 Very Good Adequate   Very Good Good
Motherwell Home Support Service Support Service 11/10/2023 Good Adequate   Adequate Good

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68 
Service Resource Name Service Group Date Last
Inspected
How well
do we
support
people's
wellbeing?
How well is
care and
support
planned?
How good
is our
setting?
How good
is our staff
team?
How good
is our
leadership?
Motherwell Home Support Service
Housing Support
Service 11/10/2023 Good Adequate   Adequate Good
Wishaw and Shotts Home Support
Service
Housing Support
Service 21/02/2024 Weak Weak   Weak Weak
Sciensus Pharma Services Limited Nurse Agency 17/07/2023 Very Good Very Good   Very Good Adequate
Blair House Care Home Care Home Service 28/03/2024 Very Good Good Good Good Very Good
Key Community Supports - North
Lanarkshire
Housing Support
Service 12/06/2023 Very Good Very Good   Good Very Good
East Dunbartonshire Phase 2 Support Service 01/06/2023 Good Good   Good Good
East Dunbartonshire Phase 1 Support Service 01/06/2023 Very Good Very Good   Good Good
East Dunbartonshire Phase 3 Support Service 06/06/2023 Good Good   Good Good
North Lanarkshire Supported Living
Service Support Service 07/09/2023 Very Good Very Good   Very Good Good
The View Park Project
Housing Support
Service 30/06/2023 Very Good Very Good   Good Very Good
Enable Scotland (Leading the Way) -
Lanarkshire Services Support Service 11/03/2024 Very Good Very Good   Very Good Very Good
Key Community Supports - North
Lanarkshire Support Service 12/06/2023 Very Good Good   Very Good Good
Elaina Nursing Home Care Home Service 21/02/2024 Good Good Good Adequate Adequate
Rosehall Manor Care Home Service 13/12/2023 Good Good Very Good Good Good
Morningside Care Home Care Home Service 18/01/2024 Adequate Adequate Adequate Adequate Adequate
Motherwell Locality Support Service
(Disability) Support Service 07/07/2023 Very Good Very Good Very Good Very Good Very Good

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69 
Service Resource Name Service Group Date Last
Inspected
How well
do we
support
people's
wellbeing?
How well is
care and
support
planned?
How good
is our
setting?
How good
is our staff
team?
How good
is our
leadership?
GMD Community Services
Housing Support
Service 31/07/2023 Very Good Very Good   Very Good Good
Rosepark Care Home Care Home Service 22/12/2023 Good Good Good Good Good
Summerlee House Ltd. Care Home Service 07/03/2024 Very Good Good Good Good Very Good
GMD Community Services Support Service 31/07/2023 Very Good Very Good   Very Good Good
Lanarkshire Care Partners
Housing Support
Service 14/07/2023 Good Good   Good Very Good
Partners in Play - Community Support Support Service 10/10/2023 Very Good Good Very Good Good Very Good
Carnbroe Care Centre Care Home Service 26/06/2023 Good Good Good Good Good
The Village Nursing Home Care Home Service 12/12/2023 Good Adequate Adequate Adequate Adequate
Lanarkshire Care Partners Support Service 14/07/2023 Good Good   Good Very Good
Wheatley Care Personalised and Self
Directed Support Services (North
Lanarkshire) Support Service 19/02/2024
Good Adequate   Good Good
Wheatley Care Personalised and Self
Directed Support Services (North
Lanarkshire)
Housing Support
Service 19/02/2024
Good Adequate   Good Good
Rannoch Lodge Care Home Care Home Service 17/08/2023 Good Good Good Good Good
Deanston House Nursing Home Care Home Service 04/12/2023 Good Good Very Good Good Good
Kirknowe Nursing Home Care Home Service 29/08/2023 Very Good Good Good Good Very Good
Local Lanarkshire Care
Housing Support
Service 21/07/2023 Very Good Very Good   Very Good Very Good
Local Lanarkshire Care Support Service 21/07/2023 Very Good Very Good   Very Good Very Good
Lochside Manor Care Home Service 21/08/2023 Good Good Good Good Good
Tezlom Nurse Agency 27/04/2023 Very Good       Very Good

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70 
Service Resource Name Service Group Date Last
Inspected
How well
do we
support
people's
wellbeing?
How well is
care and
support
planned?
How good
is our
setting?
How good
is our staff
team?
How good
is our
leadership?
SAMH North Lanarkshire Support Service Support Service 13/10/2023 Very Good Very Good   Very Good Very Good
SAMH North Lanarkshire Support Service
Housing Support
Service 13/10/2023 Very Good Very Good   Very Good Very Good
ION Care and Support Services (Care at
Home)(Lanarkshire) Support Service 07/04/2023 Very Good Good   Good Good
ION Care and Support Services (Housing
Support) (Lanarkshire)
Housing Support
Service 07/04/2023 Very Good Good   Good Good
Constance Care North Lanarkshire and
East Renfrewshire
Housing Support
Service 21/09/2023 Good Good   Very Good Very Good
Constance Care North Lanarkshire and
East Renfrewshire Support Service 21/09/2023 Good Good   Very Good Very Good
Beechwood Care Home Care Home Service 12/07/2023 Good Good Good Good Good
Bespoke Care Services Ltd Support Service 18/10/2023 Good Good   Good Good
Cornerstone Borders CS
Housing Support
Service 14/02/2024 Good Adequate   Good Good
Murdostoun Neurological Care Centre Care Home Service 22/09/2023 Adequate Adequate Adequate Good Adequate
Flexible Healthcare One Solutions Ltd Nurse Agency 17/05/2023 Good       Good
Centenary House Care Home Service 14/12/2023 Adequate Adequate Adequate Adequate Adequate

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71 
Glossary of Terms 
A&E Attendance  An A&E attendance is when a patient
attends an Accident & Emergency
department. 
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. 
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

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72 
 caring responsibilities and
related support 
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.
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.
Social Work Scotland (SWS)  Social Work Scotland is the professional
body for social work and social care
leaders.

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73 
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.
VANL  Voluntary Action North Lanarkshire is a
charitable organisation which provides
support to community and voluntary
organisations across the whole of North
Lanarkshire.

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74 
Appendix Three – Sample desktop published pages

Page 280

Page 281

REPORT 
Item No: 14 
SUBJECT: Risk Management Report
TO: Integration Joint Board Committee
Lead
Officer for
Report:
Ross McGuffie, NL HSCP Chief Officer
Author(s) of
Report
Stacey Anderson, Support Services Project Manager
DATE: 25th September 2024 
1. PURPOSE OF REPORT 
This paper is coming to the IJB for: 
For approval ☒ For endorsement ☐ To note ☐ 
The purpose of this report is to provide a summary to the IJB on risk management
activity, noting any amendments or additions to the current risk register. 
2. ROUTE TO THE BOARD 
This paper has been: 
Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ 
By: The Support Services, Project Manager and Chief Officer North HSCP. 
1

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3. RECOMMENDATIONS 
3.1 The IJB is asked to note 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. 
3.2 The IJB is asked to note the addition of a risk relating to the Speech and Language
Therapy Service to the IJB Risk Register following recent performance reports and
as agreed at the IJB PFA on the 21st August 2024. 
4. VARIATIONS TO DIRECTIONS? 
Yes ☐ No ☒ N/A ☐ 
5. BACKGROUND/SUMMARY OF KEY ISSUES 
5.1 From a good practice and sound governance perspective, all public bodies are
required to identify and take account of the impact of any potential risks in delivering
their business. 
5.2 The PFA Committee has delegated oversight and responsibility for financial and
performance risks associated with the remit of the Integration Joint Board. 
5.3 At the IJB PFA meeting on 21st August 2024, the following risk changes were
approved:
 Introduction of a risk relating to the performance of speech and language
therapy service following on from recent performance reporting that has
been presented to the IJB. 
5.4 There are currently two other risks rated as Very High on the IJB risk register.
 IJB 06/21 – Prescribing Activity and Costs
 IJB 01/21 – Financial Challenges 
5.5 There following risks are rated high on the IJB risk register. 
 IJB 04/21 - Notional Set Aside Budget
 IJB 12/21 - Staff Health & wellbeing
 IJB 15/22 – Cost of Living
 IJB 16/22 – National Care Service
 IJB 19/23 – Service Sustainability
 IJB 20/23 – Workforce Sustainability
 IJB 12/22 – Unscheduled Care
 IJB 23/24- Speech and Language Therapy

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5.6 There are several High/Very High rated operational risks that have been identified
as having or potentially having an impact on IJB objectives and/or delivery of
services and these are highlighted within the Risk Overview Dashboard that has
been presented to IJB PFA (Appendix 1) and Risk Register (Appendix 2). 
6. CONCLUSIONS 
6.1 The IJB currently has 19 risks identified on its IJB risk register with 11 risks rated as
high or very high. 
6.2 Risks identified by H&SC NL as potentially impacting on IJB business are
highlighted in the report. 
6.3 The inclusion of the Speech and Language Therapy Service Risk to the IJB risk
register as per approval at the recent IJB PFA meeting. 
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 centered 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
☒
7.1 ASSOCIATED MEASURE(S) 
7.2 FINANCIAL 
4

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This paper has been reviewed by Finance: 
Yes ☐ No ☒ N/A ☐ 
7.3 RISK ASSESSMENT/RISK MANAGEMENT 
Relevant Risk Register
Details
Current Risk Level Risk Owner
IJB Risk Register Choose an item. Multi 
7.4 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 
1. 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 
1. 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 
5

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7.5 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 /
Date
added
☐ No ☐ N/A ☒ 
8. BACKGROUND PAPERS
None.
9. APPENDICES
Appendix 1 – Risk Overview Dashboard
Appendix 2 – IJB Risk Register 
CHIEF ACCOUNTABLE OFFICER (or Depute) 
Members seeking further information about any aspect of this report, please contact
the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk 
6

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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 
7

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Appendix 1 
15 
Report Prepared by Stacey Anderson on behalf of the Chief Officer

Page 288

16 
Report Prepared by Stacey Anderson on behalf of the Chief Officer

Page 289

17 
Report Prepared by Stacey Anderson on behalf of the Chief Officer

Page 290

18 
Report Prepared by Stacey Anderson on behalf of the Chief Officer

Page 291

Appendix 2 IJB Risk Register
IJB ID Category
Open
ed Description of Risk
Risk
level Mitigating Controls
Risk
level
Risk
level
Ris
k Risk
Regist
er
Assuran
ce Next
Revie
w Clos
ed
IJB.01/ 21 Financi
al
Strategi
c
01/04/2021
Financial Challenges
There are a range of financial challenges which will impact on the
IJB's ability to deliver the Strategic Commissioning Plan
intentions within the financial envelope available. These include:
1. The absence of a unique IJB financial settlement from the
Scottish Government.
2. The IJB is dependent on funding from both partners.
3. Late Scottish Government financial settlement.
4. Budget reductions due to insufficient Scottish Government
financial settlements and/or partner contributions.
5. New Scottish Government policy commitments e.g. Carers
(Scotland) Act 2016.
6. Demographic growth.
7. Competing service priorities.
8. Conflicting partner efficiency savings programs which
adversely impact on the HSCP's ability to deliver services.
9. In‐year cost pressures emerging due to the underachievement
of planned savings, pandemics and other emerging risks which
may lead to an overspend.
10. Each partner may be unable to maintain their financial
contributions to the IJB in future years which would impact on
frontline health and social care services.
11. The agreed transformational plans and service redesigns
are not implemented in full and in line with the original
implementation plan and/or do not secure the intended
improvement outcomes in both performance standards and
financial efficiency targets.
12. Future savings targets will continue to be challenging and are
likely to impact on essential core services.
13. The IJB Financial Plan cannot be adhered to and budget
recovery plans fail to achieve financial balance for both
partners.
14. The continuing recovery from the pandemic on the financial
sustainability of external providers in particular social care
providers.
15. The financial implications of the continuing impact of the
pandemic on the workforce e.g. increase in sickness absence,
early retirement requests and recruitment challenges.
The above factors would lead to a failure to achieve the desired
strategic aims and would also impact on service delivery.
HIGH
CONTROLS
1. IJB PFA Committee.
2. IJB Chief Officer is a member of each partner's key decision‐making forums.
3. Effective joint working between North and South Chief Financial Officer and both
Council and NHS Finance Departments.
4. Regular budget meetings with Chief Executives and Directors of Finance.
5. Regular HSCP budget monitoring meetings across Senior Leadership Team.
6. The IJB Financial Plans have been agreed and are reviewed regularly.
7. IJB medium term financial plan 2023 ‐26 and reserves strategy 2023‐24 approved
at March 23 IJB
8. Capacity plans in place to maximise efficiency.
9. IJB Integration Scheme setting out the budget recovery processes.
10. IJB Financial Regulations and financial procedures.
11. Consultation and involvement with key stakeholders including service users and
carers.
12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support
monitoring groups are in place.
13. Joint Strategic Needs Assessment and ongoing move towards preventative and
anticipatory approaches.
13. Strategic Planning Group, Locality engagement sessions and Partnership Boards.
14. Effective and ongoing service user engagement, staff consultation and Trade
Union liaison at strategic and local levels.
ACTIONS
1. Annual budget setting processes within each of the partners.
2. HSCP participating in NHSL Sustainability and Value process
3. Partnership will also be connected to new national whole system groups around
budget
VERY HIGH
Medium
Amanda Kilburn
Amanda Kilburn
SLT, IJB
PFA, IJB
28.06.2024
Previously IJB2, IJB7, IJB10 and
IJB12.
Reviewed and Updated May
2023. Reviewed and Updated
Sept 2023.
Reviewed and updated Jan 2024.
Reviewed and updated March
2024.
Review and risk increased June
2024.
Reviewed and no changes Sept
2024
IJB02. 21 Financial
Reputationa
l
01/04/2021
Prevention and Detection of Fraud, Bribery and/or
Corruption There is a risk that the IJB is unable to prevent
and detect fraud and corruption within services because of
inadequate governance
arrangements and inadequate internal control systems which
could lead to financial and reputational damage.
LOW
CONTROLS
1. Fraud awareness e‐learning.
2. National Fraud initiative.
3. Locality/SW Enablement Groups.
4. Segregation of duties in relation to authorising and processing direct payments. 5
Whistle blowing policies.
6. Procurement processes and standing orders.
7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee.
8. Effective governance arrangements are in place and subject to internal and
external audit review.
9. IJB and IJB PFA meetings established ensuring effective oversight of financial
performance.
10. The IJB does not maintain its own policies relating to the prevention and detection of
fraud and error but instead depends on those in place at its partnerbodies. The IJB has a
Code of Conduct in place to which members subscribe and the Members’ Registers of
Interests are publicly available on the IJB’s website
LOW
LOW
Ross McGuffie
Amanda Kilburn
SLT, IJB
PFA, IJB
31.08.24
Previously IJB6. Reviewed
and updated on March
2023.
Reviewed and Updated Oct
2023, (previously title
ineffective governance
arrangements).
Reviewed May 2024
Reviewed and No changes Sept
2024

Page 292

ACTIONS
1. Continue to raise fraud awareness through teambriefings.
2. Annual planned Procurement and Standing Financial Instructions presentations.
3. Annual review of Code of Conduct
4. Review of how Members' Declaration of Interests are collated and reviewed.
5. IJB to request Fraud prevention and detection reports from both partners for oversight
at the IJB PFA.
IJB04. 21 Financi
al
Strategi
c
01/04/2021
Notional Set‐Aside Budget
There is a risk that resources will not be transferred from Acute
Services to the HSCP in line with the shift in the balance of care
from residential and acute settings to community based
alternatives as expected in terms of the notional set‐aside concept.
This includes the ongoing
development of locality pathways to support maintaining
people at home e.g. transitional care models.
VERY HIGH
CONTROLS
2. There is complete transparency and ongoing dialogue between the IJB and the Health
Board on the challenges associated with the implementation of the notional set‐aside
concept.
3. Bed modelling and capacity planning arrangements are in place.
4. Effective working relationships between both partners and the IJB have been
established.
5. Since the inception of the IJB, an agreement is in place whereby the NHSL Health
Board will manage the overspend or underspend across the notional set ‐aside budget.
This arrangement continues to be in place for 2022/23
ACTIONS
1. The Chief Officer and the Chief Financial Officer continue to raise this concern at a
national level.
HIGH
MEDIUM
Ross McGuffie
Amanda Kilburn
SLT, IJB
PFA, IJB
28.08.2024
Reviewed and Updated May 2023.
Reviewed Oct 2023.
Reviewed Jan 2024
Reviewed May 2024
Reviewed July 2024.
Reviewed Sept 2024
IJB05. 21 Financi
al
Strategi
c
01/04/2021
Hosted Services
There is a risk of dispute between the North Lanarkshire IJB and
the South Lanarkshire IJB in respect of the financial allocations
underpinning the Hosted Services particularly as a result of the
budget changes linked to the implementation of devolved locality
models. This could impact on the ability of each IJB to achieve its
commissioning intentions and may also have an adverse impact
on service users across Lanarkshire.
VERY HIGH
CONTROLS
1. North and South IJBs aim to co ‐operate to ensure a pan‐Lanarkshire approach is
achieved across all hosted services.
2. Financial and budgetary controls.
3. Performance reports on service delivery.
4. The Hosted Services principles in respect of the management of the
overspends and underspends are agreed for each financial year.
CONTROLS
1.. Prescribing Quality and Efficiency Programme.
2. Prescribing Management Board functions and membership.
3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team.
4. Locality Pharmacist input.
5. Earmarked reserve established to address prescribing costs.
6. Regular HSCP monitoring.In respect of the regulation of medicines and medical
devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became
the UK’s sovereign regulator.
7. The new trade deal contains specific clauses that mean both the UK and EEA states
formally recognise each other’s good practice in medicine manufacturing.
8. To reduce the risk of divergence from the EU rules, there are three interrelated
factors; the technical annexes of the new trade deal, the Northern Ireland protocol
and the UK Internal Market Act.
9. The effectiveness of the Border Operating Model to import and export goods to and
from the EEA, which was being implemented in stages from 2020 to minimise any risk of
disruption, is still being assessed. The risk of border delays is still evident. Other
measures were also implemented specifically to mitigate the risk of supplies of medicines
and medical devices being disrupted. In August 2020 the UK government instructed
medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first
three months of 2021. In addition, the Department of
MEDIUM
MEDIUM
Ross McGuffie
Amanda Kilburn
SLT, IJB
PFA, IJB
28.08.2024
Reviewed Jan 2024
Reviewed May 2024
Reviewed July 2024.
Reviewed Sept 2024
Prescribing Activity and Costs
The cost of prescribing is growing due to issues in supply chains
driving increased wholesaler cost of medicines, advance
treatment developments resulting in the need for more expensive
medications, aging population and increase in patients requiring
regular medication.
Medication availability has been impacted following the EU
withdrawal the UK 's membership of the common regulatory
bodies and EU agencies, such as the European Medicines
Agency, (EMA), European Centre for Disease Prevention and
Control and the European Atomic Energy Community. The risk is
that this could impact on the availability of medicines, healthcare
techniques and technology and in respect of the supply of
medicines and medical devices, additional checks are now
required at ports in the UK and the EEA before goods, including
IJB06. 21 Financial
Operationa
l
01/04/2021
Medium
VERY HIGH
LOW
Ross McGuffie
Amanda Kilburn
SLT, IJB
PFA, IJB
28.08.24
Previously IJB11. Reviewed
and updated June 2023.
Reviewed and Updated
(risk increased) October
2023.
Reviewed Jan 2024
Reviewed June 2024.
Reviewed July 2024.
Reviewed Sept 2024

Page 293

moving medicines between the EEA and the UK. Transport has secured additional freight capacity to bring medicines into the country via
other
routes.
ACTIONS
1. Review of Locality Prescribing Action Groups.
2. Prescribing part of NHSL Sustainability and Value structures
3. Continuation of Scriptswitch.
4. Prescribing updates being provided to IJB as per financial reports
IJB07. 21 Financi
al
Strategi
c
01/04/2021
Third and Voluntary Sector
There is a risk that Third Sector organisations in North
Lanarkshire are vulnerable because of the lack of certainty in
respect of long‐term funding security. This uncertainty has the
potential to lead to service instability, recruitment and retention
challenges and an increasing reliance on statutory services.
HIGH
CONTROLS
1. Third Sector Interface represented on key strategic groups.
2. Community capacity building and carer support infrastructure embedded across
North Lanarkshire.
3. Community capacity building is regularly reviewed.
4. Maximising funding opportunities for the third and voluntary sector will continue
to be progressed.
ACTIONS
1. The annual HSCP funding which is directed to the third sector is recurring funding.
Funding will be confirmed each year in line with the agreement of the IJB Financial Plan
and subject to the Scottish Government financial settlements for future years.
2. Updated SLA with VANL nearing completion
LOW
LOW
Ross McGuffie
Amanda Kilburn
SLT, IJB
PFA, IJB
30.06.24
Previously IJB16.
Reviewed April 2024.
Reviewed July 2024
Reviewed and no changes Sept
2024
IJB.10. 21 Financi
al
Strategi
c
01/04/2021
Ineffective Governance Arrangements
1. There is a risk that the intensity of the required response to
Covid ‐19
may have resulted in a failure of governance impacting on the
effectiveness of the IJB decision‐making, IJB directions to
partners and IJB oversight of operational service delivery.
Routine governance
2. New or amended legislation and Scottish and UK Government
guidance may not be adopted effectively and timeously.
3. There is no / limited public access to IJB and PFA meetings
during the period of the pandemic, in line with Public Health
advice.
4. Ineffective information governance controls could lead to
data breaches and an impact on the General Data Protection
Regulations.
5. Communications with employees, patients and service users
may be ineffective.
6. There will require to be changes to the working
environment including remote working and working from
home.
7. There is a reduced ability to protect the wellbeing of
employees, patients and service users.
8. There may be adverse media coverage locally, a loss of
public confidence and reputational damage.
MEDIUM
CONTROLS
1.N ational Networks are established which are providing the framework to support a
national approach where appropriate.
2 .Public Health advice and support is in place.
3 .Increased numbers of agile workers and increased number of laptops/tablets.
4 .Continued working from home arrangements supported by the roll out of MS Teams /
Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is
circulated. A blended approach to home/work ‐based working is being developed going
forward.
5.R isk registers are in place for the IJB and each partner. Each partner has a
speciﬁc HSCP Covid‐19 Risk Register in place.
6 .The IJB and both partners aim to comply with the European Working Time Directive
(WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular
front ‐line service delivery. As a result of the withdrawal from the European Union, the
WTD ceased to apply to the United Kingdom at the end of the transition period (31
December 2020). However, the UK's Working Time Regulations which implement the EU
Working Time Directive will continue to apply unless and until amended by UK law.
7 .Back to Basics exercise has helped to focus on the underpinning governance
requirements
across the whole HSCP
8. Staff health and wellbeing is a key priority for both partners and all key stakeholders.
The commitment to staff health and wellbeing is being actively promoted through all
available forums.
9. IJB Governance reporting reviewed and associated documents updated.
LOW
LOW
Ross McGuffie
Amanda Kilburn
SLT, IJB
PFA, IJB
30.10.24
Reviewed and updated June
2023.
Reviewed and updated Oct
2023.
Reviewed and updated Jan
2024.
Reviewed and Risk level
lowered June 2024.
Reviewed and no changes Sept
2024
IJB.11 21 Performanc
e
30/07/2021
Oversight of Performance Activity
There is a risk that the IJB is not provided with adequate or
sufficient performance information to enable it to discharge its
scrutiny and oversight role; make informed decisions and
recommend remedial actions to address any performance
concerns.
LOW
CONTROLS
Regular (quarterly) reports on the IJB performance framework, providing updates on
areas for improvement, remedial actions (and timescales) and updates on performance
issues previously reported.
Chief Executive Performance Review arrangements. Hosted Services
Performance Review arrangements. Sector/Locality Performance Review arrangements.
LOW
LOW
Ross McGuffie
Morag Dendy
SLT, IJB
PFA, IJB
31..10.24
Reviewed May 2024.
Reviewed June 2024.
Reviewed and no changes Sept
2024
Staff Health & Wellbeing CONTROLS Reviewed and Updated May

Page 294

IJB.12. 21  Performanc
e
30/08/2021 
There is a risk to the delivery of the Strategic Commissioning
Plan as a result of sustained pressures on staff availability due to
additional pressures associated with Covid 19, current sickness
absence levels and potential for further staff redeployment due to
winter planning contingency  arrangements.   
MEDIUM 
Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL
corporate management  teams. 
Range of support services available both nationally and locally e.g Occupational Health,
Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk).
Rest & Recuperation areas
identified. Peer Support Networks
established
Well established Occupational Health supports available to support staff sickness. 
ACTIONS
Short Life Working Group for wellbeing with targeted approach for immediate actions
including Staff Health & Wellbeing Champions, access to online supports, access to
Occupational Health Services, helpline established and dedicated resource identified for
wellbeing officers to be recruited.
Funding received by Scottish Government specifically targeting staff wellbeing
programmes and supports. Local plans for use of funding being developed.
Managers supporting & encouraging staff to take planned leave/use full leave allocation  
HIGH   
low 
Ross McGuffie   
Ross McGuffie  
SLT, IJB
PFA, IJB, SC&CG, AH&SC   
28.08.24   
Reviewed and updated Dec 2023. 
Reviewed May 2024. 
Reviewed Sept 2024 
IJB.1
3.
2021 
Performanc
e
30.08.21
Care Homes 
Inability of care homes to sustain service due to staffing and cost
pressures resulting in closure to new placement and closure of
care homes. This may increase delayed discharge numbers
putting additional pressure on acute site capacity and impacting
on recovery.   
HIGH
CONTROLS 
Establishment of Care Home Assurance Team. 
Escalation Process in place.
National protocol to support discharge of Covid 19 patients in place. 
ACTIONS
Public Health teams providing guidance on infection control.
Care Home assurance team undertaking support visits to all care homes & action plans in
place for each care home.
All care homes advised to use PPE in line with national addendum.
Development day on 12th May 23 to agree structures and approach for year ahead  
medium   
medium 
Ross McGuffie   
Sharon Murphy  
IJB, PF&A, SLT, SC&SC, A
H
&SC   
28.08.24   
Reviewed and updated Oct 2023 
Reviewed May
2024. . Reviewed
Sept 2024 
IJB.1
4.
2022 
Strategic &
Performanc
e
30.04.22
CAMHS 
There is a risk that the CAMHS service cannot meet the increasing
clinical demands due to a significantly high number of cumulative
staff vacancies for both clinical and non ‐clinical posts and
challenges recruiting to new posts identified through the national
recovery and renewal fund. This is impacting on community, in‐
patient and out‐ patient care with the potential to adversely affect
response time to referrals; longer waiting times; poorer outcomes;
delays in redesign and reputation of the IJB.   
VERY HIGH
CONTROLS 
Prioritisation of referrals; all referrals vetted daily with urgent referrals prioritised
Commenced programme of work and implementation of a more structured partnership
approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2
referred through 3rd sector and interfacing with North & South Education Departments
Secured significant national investment to fully implement new service model
Active review of skill mix to utilise medical staff only when required for highly complex
patients
Vacancy gap analysis with active recruitment commenced. Expected to have recruited
75% of gap by end of May 2023
Continuous review and validation of the waiting list
Waiting list validation exercise completed in April 2022 with reduction in list by 16% 
CAPA appointments begin on 1st May 2023 ‐ first cycle (16wks) nearing
completion Monthly monitoring at board
Incremental implementation of the new service
model Performance monitoring through the
programme board
CAHMS IT Board in train to plan and oversee implementation of SCI gateway for
referrals Waiting list initiative commenced
Udston opened for patients September 2022
Upgrade to North physical infrastructure agreed.
Close working with health improvement and GP
reps  
Medium   
Medium 
Ross McGuffie   
Morag Dendy  
IJB,PF&A, SLT   
28.02.2024 
Reviewed and Updated May
2023. 
Reviewed and updated Dec
2023. 
Reviewed and risk level lowered
May 2024. 
Reviewed and no changes Sept
2024   
Cost of Living  CONTROLS

Page 295

IJB.1
5.
2022 
Strategic &
Performanc
e
05.09.22 
There is a risk that the IJB's Strategic Commissioning Plan will be
unable to be delivered or not have the desired impact due to the
cost of living rises being faced by residents across North
Lanarkshire, leading to a further widening of the inequality gap,
reduced quality of life and increased health and social care
demand due to individuals and families having insufficient funds to
support basic requirements such as food and heating.   
HIGH 
NLC Silver command group stood up focused on cost of living 
NHSL commenced review through CMT
Population Health Committee to review activity around cost of
living NLC approved cost of living contract increases in May
2023 
ACTIONS
Survey of NLC hybrid workers to see if home working remains financially viable
Business case being developed to expand 'support for people' arrangements used in
pandemic to support resident access to welfare rights and other supports
3% increase in individual budgets to support service users to maintain current levels of
supports at higher cost 
Recommendation from adult social work, care and wellbeing committee to review all
charges to service users and wider cost.  
High   
Medium 
Ross McGuffie   
Ross McGuffie  
SLT, IJB   
30.08.2024 
Reviewed and Updated May 2023. 
Reviewed Oct 2023. 
Reviewed May 2024. 
Reviewed Sept 2024 
IJB.1
6.
2022 
Strategic    
05.09.22
National Care Service 
There is a risk that the ongoing work around a National Care
Service could destabilise current service delivery due to
significant change activity, time demands around the co‐design
process, staff uncertainty and partner organisations having to
focus inwardly due to the impact of change leading to an impact
on the ability to deliver the significant ongoing change
programmes already approved by the IJB and the Strategic
Commissioning Plan for 2023‐26.   
HIGH
CONTROLS
NLC establishing NCS working groups
Key HSCP leads involved in national
developments Ongoing progress updates to
IJB and IJB PFA 
ACTIONS
IJB response submitted on proposed Bill
Strong partnership links into working groups at Chief Officers, Chief Finance Officers
and Social Work Scotland groups           
High   
Low 
Diane Fraser   
Ross McGuffie  
SLT, IJB
PFA, IJB, 
31.08.24 
Reviewed and Updated May
2023. Reviewed and Updated
Oct 2023. 
Reviewed and Updated May
2024 Reviewed Sept 2024 
IJB.1
7.
2022 
Strategic &
Performanc
e
05.09.22
Unscheduled Care 
There is a risk that we cannot sustain whole system patient flow
through peak winter pressures due to increased front door
demand; hospital workforce capacity; delays in onward movement
of patients due to care home capacity/outbreaks and care at home
capacity; and community health and social care workforce
capacity leading to reduced ability to meet 'routine' and increasing
bed demand for more unwell patients, deteriorating delayed
discharge performance and an inability to recover services.   
Very High
CONTROLS 
Care Home Assurance Group and associated supports for care homes through liaison
service, IPC advice and support, risk assessment for onward movement of patients etc.
Care at Home Assurance group and associated activity to try to support and sustain
independent sector provision
NHS CMT and Covid response group oversight of performance
Daily PDD meetings to review every planned supported discharge and delayed discharge 
Operation Flow now underway to ensure whole system approach to unscheduled
care/delayed discharge  challenges 
Expansion of Home Support service
Roll out of Home Assessment Teams across all 6 Localities
New CSW roles in District Nursing teams to proactively support Care Managed
patients Additional Nursing capacity in District Nursing Teams
Expansion of Equipment and Adaptation Service to support rapid access in community
Expansion of H@H service (hours of provision as well as moving to support discharges
as well as admission  prevention)
Expansion of Integrated Rehabilitation Teams in all six Localities to support
rehab in the community and reduce long‐term service demand
Regular Firebreaks across the system
Task and Finish groups now established to roll out the key actions agreed through the
Operation Flow programme (Phase 2 to be completed by Sept 23)  
High   
Medium 
Ross McGuffie   
Ross McGuffie  
SLT, IJB
PFA, IJB   
28.08.24  
Reviewed and Updated in June
2023. 
Reviewed Oct 2023 
Reviewed Jan 2024. 
Reviewed and risk level reduced
May 2024. 
Reviewed Sept 2024 
IJB.1
8.
2022 
Strategic
and
Performanc
e
05.09.22
Community  Alarms 
There is a risk that the community alarm system will be
destabilised due to the national change from analogue to digital
telephony by 2025, leading to community alarm users not getting a
response when required.   
HIGH
CONTROLS 
Working group established to coordinate all
activity Oversight through Home Support
Programme Board
Reporting to Adult Social Work, Care and Wellbeing Committee
Reporting to IJB 
ACTIONS
NLC Committee approval to purchase 1000 digital alarms so the service can support any
imminent changes over to digital in individual areas
NLC part of SG once for Scotland procurement process for a new digital alarm receiving 
Medium   
Low 
Diane Fraser   
Ross McGuffie  
SLT, IJB
PFA, IJB, 
28.07.2024  
Reviewed and updated June
2023. 
Reviewed Oct 2023. 
Reviewed Jan 2024.
Reviewed April 2024.
Reviewed Sept 2024

Page 296

Communication out to all community alarm service users
Instructions issued to all community alarm service users on how to do test calls to
ensure alarms are operational
Engagement with telecommunication suppliers to ensure sight of roll out plans across NL
IJB.1
9.
2023
Performanc
e
27/02/2023
Service Sustainability
Due to competing service priorities and workforce/ operational
and financial challenges there is a risk that the IJB will be
unable to implement the strategic plan/commission plan.
Failure to achieve the desired strategic aims of the IJB poses a
risk on operational service delivery and the achievement of
financial balance and patient safety
High
CONTROLS
IJB PFA Committee.
IJB Chief Officer is a member of each partner's key decision‐making forums.
Effective joint working between Chief Financial Officer and both Council and NHS
Finance Departments.
Regular budget meetings with Chief Executives and Directors of
Finance. Regular HSCP budget monitoring meetings across Senior
Leadership Team. The IJB Financial Plan is regularly reviewed and
agreed.
Capacity plans in place to maximize efficiency.
Consultation and involvement with key stakeholders including service users and
carers. Joint Strategic Needs Assessment and ongoing move towards preventative
and anticipatory approaches.
Strategic Planning Group, Locality engagement sessions and Partnership Boards.
Effective and ongoing service user engagement, staff consultation and Trade Union
liaison at strategic and local levels.
ACTIONS
Sustainability plans to be reviewed
regularly Re‐introduction of scrutiny
panels
Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure
areas of
concern are identified and reviewed regularly.
Review of reporting process into IJB to ensure continuous review of services/
service developments.
Development of the programme of work to ensure regular reporting structure in place for
service review.
Operation Flow Task and Finish Groups analyzing service challenges and
winter
High
Low
Ross McGuffie
Ross McGuffie
SLT, IJB
PFA, IJB
28.02.2024
Reviewed and Updated May 2023
Reviewed and Updated Oct
2023. Reviewed and updated
Jan 2024.
Reviewed April 2024.
Reviewed Sept 2024
IJB.2
0.
2023
Workforce Sustainability
It is becoming increasingly difficult to recruit to particular roles
across Health and Social Care. Gaps in the workforce can result in
reduction of service provision, increase in staff workload and
inability to deliver the strategic plan. Following EU withdrawal there
is no longer the free movement of labour between the UK and EEA
countries. All workers arriving from the EEA and non‐EEA
countries are subject to the same immigration rules.The new
points‐based immigration system makes exceptions for the
majority of health care professionals with an NHS job offer and for
qualified social workers via a new fast ‐track visa route, known as
the Health and Care Worker Visa. There are however no
exceptions made for other social care roles, such as care
workers.The Mutual Recognition of Professional Qualifications
Directive is an EU ‐wide directive that allows professional
regulators in all member states to automatically recognise
professional qualifications. The UK government has decided to
continue recognising qualifications gained in the EEA for at least
two years after the transition period ends. This however is not a
reciprocal and there is no guarantee that qualifications gained in
the UK will be accepted by professional regulators in EEA nations.
HIGH
CONTROLS
All successful Health and Care Worker Visa applicants are exempt from the Immigration
Health Surcharge, a one‐off charge levied against arriving migrant workers as part of the
visa application process. The system has been designed to make international
recruitment into health and social care roles more straightforward for employers and
employees alike. These changes to immigration rules are in law as part of the
Immigration and Social Security Co ‐ordination (EU Withdrawal) Act 2020. As such, from
1 January 2021, they apply to all workers arriving to work in the NHS or adult social care.
All workers from EEA nations who are already resident in the UK had until 30 June 2021
to apply for the EU Settlement Scheme which will guarantee their right to work in the UK
indefinitely.
In respect of the mutual recognition of professional qualifications, professional regulatory
bodies are working with the UK government to review future registration requirements for
those with qualifications gained in the EEA and decide what they will be from January
2023.
Development of the Care Academy
Dedicated HR support identified in NHSL and NLC to support key priority areas of
recruitment such as Mental Health and Home Support
ACTIONS
Annual workforce plan being prepared
NHSL programme underway to support international
recruitment On the day recruitment events being trialed in
Home Support
Use of university status being explored following positive gains in Podiatry and
Psychological
Therapies recruitment
High
Medium
Ross McGuffie
Ross McGuffie
SLT, IJB
PFA, IJB
28.07.24
Updated May 2023
Reviewed and updated Oct 2023.
Reviewed and updated Jan 24
Reviewed April 2024.
Reviewed Sept 2024
IJB21.24 Financial Jun‐2
4
Pharmacy Pressures within Prison Service
Pharmacy costs have traditionally been the highest area of non
‐pay spend nationally in all prisons. The nature of the patient cohort
results in high volumes of prescribed medication for Mental Health,
Pain, & Addictions purposes. There is currently a large overspend
High
CONTROLS
Review of the dispense processes within the
prison Implementation of guidelines
Improved communication with pharmacy provider High
Low
Ross
Ross
IJB 30.07. Added to register June 2024.

Page 297

May 2024) for the actual drugs bought and £246K associated
with the management fees for the contract.
ACTIONS
Prescribing Action Group re‐established to try and manage the number of items
prescribed Development of pain and medicine management pathways
Review of prescribing habits
uffie
uffie
IJB 4
IJB23.2
4
Performanc
e
Speech and Language Therapy (SLT) Service
High
CONTROLS
1. Good communication processes, and the sharing of information and practical learning
online have been established and will be further developed as service improvement
work progresses.
2. Service model review to ensure that future TrakCare builds on local learning and
builds on organisational learning from other builds. Forward planning for inclusion in the
AHP Hub model will proceed in parallel to these TrakCare developments.
3. Revised workforce planning, incorporating the best‐practice and learning from other
areas who have specialist children’s health services units.
4. The professional relationships between service and university have already been
improved and we have academic representation that actively contributes to both our
Workforce Planning and Service Improvement Steering Group.
ACTIONS
1. Working with university colleagues to identify new practitioners who have
expressed their desire to work in Lanarkshire on registration. This allows us to
maximise and enhance opportunities for placement, improvement projects and
induction planning, ensuring that we present ourselves as an area that is not only
welcoming but committed to the ongoing development of individuals and the service
2. Work with professional colleagues to ensure that all activity is aligned to direct and/or
indirect pursuit of meeting the SLT waiting time target.
3. Transition from restrictive locality models for managing the waiting list.
High
Low
Ross McGuffie
Ross McGuffie
IJB
PFA, IJB
30.07.25
Added to the register August
2024.
Jul‐24
There is a risk that the SLT service cannot meet the increasing
clinical demands with variance in waiting list length by area,
continued challenges around the recrutiment and retention of
new colleagues, funding streams from Local Authority being
reduce therefore reducing staff WTE.

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1 
REPORT 
Item No: 15 
SUBJECT: Review of Commissioned Registered Social Landlord Provision
TO: Integrated Joint Board Committee
Lead
Officer for
Report:
Morag Dendy, Chief Officer – Performance, Planning & Quality
Assurance 
Author(s) of
Report
Maria Williamson, Senior Manager Quality Assurance 
DATE: 25 September 2024 
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 Maria Williamson (Senior Manager Quality
Assurance) and reviewed and endorsed by Morag Dendy, Chief Officer –
Performance, Planning & Quality Assurance. 
Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☒          
3. RECOMMENDATIONS 
(1) It is recommended that the IJB recognises the progress of this review, which
when completed will further embed the principles of Self-Directed Support – Social
Care (Self Directed Support) (Scotland) Act 2013.

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2 
(2) It is recommended that the IJB acknowledge the change in provision delivered by
both Link Housing Association and Blackwood and note a review of this provision is
no longer required.
(3) It is recommended that the IJB acknowledge the concerns raised by Trust and
their representatives and note agreement has been reached following a positive
meeting between North Lanarkshire Council and Trust Housing Representatives.
(4) It is recommended that the IJB acknowledge the approval by Aspire management
committee to progress to a Retirement Housing model at, Law View Housing
development.
(5) It is recommended that the IJB note the delay in progressing the review with
Hanover Scotland due to fire safety concerns and following an independent fire
audit, endorse the recommencement of that review. 
(6) It is recommended that the IJB agree a notice period to 31 March 2025 to enable
transition planning with providers and individual tenants. 
4.  VARIATIONS TO DIRECTIONS?
4.1 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/SUMMARY OF KEY ISSUES
5.1 The contracts with Registered Social Landlords (RSLs) expired in 2016/17,
prompting a review of the services being provided. The review has been
significantly delayed due to the impact of the  Covid-19 pandemic.
5.2 The purpose of review was to ensure that people had the freedom to choose
who provides the care and support they receive. We recognise it is vital that
any support tenants receive are focused on their needs and are unique to them.
5.3 The decision to remodel Registered Social Landlord Provision (RSLs) was
approved within the March 2020 IJB financial plan, which received cross party
support. The plan detailed that the current RSL services would transition to
become Retirement Housing in line with the council’s in-house model. It was
noted that this change would result in future support costs being absorbed by
housing benefit. 
5.4 This current review commenced in June 2023. Following discussions with
providers and the collation of data and impact assessments outlining the needs
of tenants, North Lanarkshire Council informed all providers within the scope of
the review of the initial proposal to withdraw all housing support funding. 
Yes ☒ No ☐ N/A ☐

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3 
5.5 As the review has progressed, we have provided updates via Elected Member
briefings, FAQ documents and engagement sessions with Providers, residents
and stakeholders. 
5.6 Registered Social Landlords provide a range of different support arrangements
across North Lanarkshire.  Prior to 1st April 2024 these RSLs, who ran 12
complexes, were: -
 Trust Housing Association
 Hanover Housing Association
 Link Housing Association
 Aspire
 Blackwood
5.7 The services the RSLs provide primarily take the form of sheltered, very
sheltered, and supported housing. North Lanarkshire Council currently provide
funding that is used for on-site staff to provide a housing support service to
tenants in each of the complexes.  
5.8 RSL providers have been aware of the outstanding review of these services
since approximately 2016/17. They have engaged with some other Local
Authorities who carried out the review of this legacy funding stream, some as
far back as 2016/17. Other Local Authorities have either discontinued funding
or redesigned to models which include retirement housing, housing with care,
amenity housing or a continuation of sheltered/very sheltered housing. 
5.9 Local Authorities who have not yet carried out reviews of RSL provision have
indicated plans to do so. Some authorities have noted that providers have
decided to redesign of their own initiative to make them suitable to the current
housing and care needs of a changing population whilst remaining financially
sustainable. 
5.10 Equals Advocacy were commissioned to ensure an independent voice for
tenants. They attended all engagement sessions and met separately with
individuals and groups at later dates where this support was requested.
5.11 Tenant care and support needs are addressed by social work through individual
packages of tailored care. A mix of our Homecare service and independent
providers are delivering these bespoke packages in line with the ethos of Self-
Directed Support (SDS). 
5.12 RSLs have been using North Lanarkshire Council funding to pay for various
levels of on-site staffing. However, over time the roles and responsibilities of
staff within developments appears to have become unclear with possible unmet
tenant needs and duplication of provision, suggesting streamlining of care and
support would achieve better individual choice and outcomes for tenants.
5.13 North Lanarkshire Council funds a wealth of community resources, however
tenant feedback through the engagement sessions suggested these were not
being accessed by tenants within sheltered housing/very sheltered housing,

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4 
with reliance for social stimulation being directed to the in-house warden
service. This limits choice and participation in a wide range of unique and
diverse activities to enhance overall sense of purpose, identity and holistic well-
being. 
5.14 On the 1 April 2024, Link Housing Association decided to implement their new
Retirement Housing model across their three North Lanarkshire Sheltered
Housing services. This decision was despite not having concluded the review,
rather it was based on Link’s experience of the outcomes in similar reviews that
have been carried out by a number of Scottish Local Authorities. This model
meant the de-registering of the services with the Care Inspectorate as housing
support was no longer a feature of the services. Furthermore, it meant a
reduction from 35 hours weekly staffing to 25 hours weekly staffing in each
service.
5.15 As of 16 July 2024, Blackwood implemented its new Retirement Housing with
meals model within Buchanan House, which was previously a Very Sheltered
Housing service. Buchanan House is no longer registered with the Care
Inspectorate as housing support is no longer delivered. 53 hours on-site staffing
weekly is now included within the service model as opposed to 70 hours weekly
previously. To enable this creative and dynamic model Blackwood carried out
a consultation and restructure with their employees to reflect the more practical
nature of the new model. 
5.16 Both Link and Blackwood now no longer receive legacy housing support
funding from North Lanarkshire Council.  It is important to note that
commissioned Advocacy services have reported positive outcomes since the
changes have been made, which mirrors feedback received from North
Lanarkshire Council Housing colleagues as a result of the redesign of  the
Council’s Sheltered Housing to Retirement Housing. 
Hanover Scotland
5.17 Throughout the review period Hanover Scotland has always advised that
without staff on-site, including night cover at MacAlpine Court, they would not
be safe to operate due to the structure of the building and the associated fire
risks. Funding which is the subject of this review currently pays for the costs of
one on-site housing support worker seven days per week, twenty-four hours
per day. 
5.18 Sleepover funding was agreed on a temporary basis approximately two years
ago, pending this review. Hanover Scotland approached North Lanarkshire
Council at this time to request funding for night cover due to the change for a
standard night payment to an hourly rate for sleepover workers. Prior to this
change, tenants had funded the sleepover as they benefited from the sense of
security this brought them.
5.19 As part of the review of McAlpine Court, an independent assessment was
commissioned by North Lanarkshire Council to review the fire evacuation
measures deployed by Hanover Scotland and a number of recommendations

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5 
have been made to safeguard tenants residing there.  The aims of the
recommendations would be to either: - 
o Upgrade fire protection measures to allow a stay put policy.
o Deploy sufficient staffing to enable a simultaneous evacuation.
o Assess the needs of tenants living within McAlpine Court to determine
whether the accommodation is suitable due to dependency levels.
5.20 Hanover Scotland have always communicated that without on-site staffing a
number of residents would need to move to a care home environment. As there
is currently one member of staff on shift it is felt that reviews of tenants open to
social work must take place to ensure that their needs are being fully met at this
time.
5.21 The review was paused on 18 July 2024 due to safety concerns relating to the
management of fire within MacAlpine Court. We continue to discuss with
Hanover the findings of our independent fire consultant in relation to their
current evacuation strategy and risks posed by this. A range of options have
been suggested for Hanover to consider in their role as landlord and
responsible persons for having suitable and sufficient fire measures in place. It
is our intention to recommence the review in the coming weeks. 
Aspire 
5.22 Aspire currently delivers a housing support service funded by North Lanarkshire
Council to tenants residing in Law View Housing Development. The landlords
are Garrion and Forgewood Housing Associations. A new model of Retirement
Housing which provides housing management services has been approved by
the respective management committees and we have been advised that
engagement with tenants will commence imminently. 
5.23 The Housing Associations continue to liaise with North Lanarkshire Council
about maximisation of housing benefit/service charges. North Lanarkshire
Council will continue to provide support ensure a seamless transition to the new
service model. It is anticipated that the housing support service will end as of
31 March 2025.
Trust Housing Association 
5.24 Following the proposal to withdraw all housing support funding, Trust advised
it would redesign their six services to a range of retirement and amenity
housing. Trust identified the models for each service. Arrangements included
very sheltered complexes moving to amenity housing.
5.25 Trust advised concerns raised related specifically to 3 very sheltered
complexes, proposing these complexes changed to a Housing with Care model
on a revised block grant funding arrangement. Trust confirmed the 3 remaining
sheltered complexes could easily change to a Retirement Housing model. 
Trust advised that they deliver a Housing with Care model in several other local
authority areas and were keen to explore this as an option in North Lanarkshire.

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6 
5.26 To fully meet the principles of self-directed support legislation, our approach is
to ensure that housing and care/support needs are separate and unique to
everyone. 
5.27 This is instead of a block of support being available as part of the overall
accommodation and accessible to the group of tenants as a whole. This may
not be the right support for all tenants and prevents them being involved in
choosing the care provider that’s right for each person’s individual needs and
situation.
5.28 At the centre of all considerations regarding the housing with care model was
the vision to embrace the principles of choice and control for all current or
potential future tenants living at these services.
5.29 Ongoing engagement with Trust has been maintained and during a meeting on
19 August, Trust and the council reached agreement.  Trust will transition its
six complexes to a combination of Retirement Housing and Retirement Housing
with meals. Trust will also tender to be included as a care and support provider
on the North Lanarkshire Self Directed Support Framework, which will open for
entry point 5 later this year. This approach means that tenants will have the
choice to choose Trust to provide their care and support. 
5.30 We will work with Trust to transition from the current arrangements to the new.
This move will align the end of existing arrangements with the implementation
of Retirement Housing/Retirement Housing with meals. New providers will be
operational and able to deliver packages of care from 1 April 2025, which will
mean the current arrangements will end on 31 March 2025. 
6. CONCLUSIONS
6.1 The review of Registered Social Landlord provision will be completed, with all
new arrangements in place by 01 April 2025. 
6.2 We will continue to engage with Trust as we transfer to the new arrangements.
6.3 We will continue to engage with Hanover Scotland re implementing the
recommendations made following the independent review of the fire evacuation
strategy.
6.4 We will recommence the review of Hanover Scotland. 
6.5 Completion of this review will achieve the intentions as set out in the March
2020 IJB financial plan. 
7. IMPLICATIONS
7.1 NATIONAL OUTCOMES
Link(s) to National Health and Wellbeing Outcomes

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7 
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) 
7.3 FINANCIAL
7.3.1 Link - 24/25 Budget £46,651.  Ceased 31/3/24. 
7.3.2 Blackwood - 24/25 Budget £27,208.  Ceased 16/7/24.
7.3.3 Aspire -  24/25 Budget £22,607. 
7.3.4 Hanover -. 24/25 Budget £133,618.  This includes a sleepover which has
been funded for approximately two years and was agreed on an interim basis
pending the review of Registered Social landlords. 
7.3.5 Trust operates six services across North Lanarkshire - 24/25 Budget
£327,442.
This paper has been reviewed by Finance:
Yes    No  N/A 
7.4 RISK ASSESSMENT/RISK MANAGEMENT 
Relevant Risk Register
Details 
Current Risk Level  Risk Owner 
Service Risk Register Medium Chief Officer, Adult
Social Work

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8 
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 
☐ Provide stakeholders with information on
how to get involved 
X Ensure a diverse range of engagement
and participation and opportunities are in 
place to suit different needs 
Engagement sessions took place,
written information was provided,
and advocacy were commissioned
to ensure representation as a group
and individually.
☐ 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 
X Provide support to enable stakeholder
representatives to participate meaningfully
and confidently at meetings
Advocacy and carers were
involved.
☐ 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: 
Yes  No  N/A 
EQIA added to website:

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9 
Yes ☒ No ☐ N/A ☐ 
8. BACKGROUND PAPERS
8.1 Document.ashx (cmis.uk.com)  IJB Financial Plan 2020/2021 
9. APPENDICES 
None. 
Morag Dendy, Chief Officer – Performance, Planning & Quality Assurance
CHIEF ACCOUNTABLE OFFICER (or Depute)  
Members seeking further information about any aspect of this report, please contact
the following;
Elaine McIntyre, Service Manager Quality Assurance
mcintyree@northlan.gov.uk   
Maria Williamson, Senior Manager Quality Assurance
WilliamsonM@north.gov.uk

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10 
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