04 - 2025-06-18 IJB - IJB PFA Minute 21.05.2025
North Lanarkshire Council · 18 June 2025
Back to Health and Social Care Integration Joint Board — 18 June 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Page 1 of 12 ITEM: 4 Integration Joint Board Performance, Finance & Audit Committee Minutes from the meeting held on Wednesday 21st May 2025, 14.00 – 16.30 via MS Teams PRESENT Voting Members: Cllr Claire Barclay NLC Nominated Councillor Cllr Bob Burgess NLC Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non-Executive Cllr Paul Kelly NLC Nominated Councillor Cllr Anne McCrory NLC Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non-Executive Siobhan White NHS Lanarkshire Nominated Non-Executive Others In Attendance: Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Margaret Flavell Senior Manager Adult Social Work Diane Fraser Head of Adult Social Care Jocelyn Lyall Chief Internal Auditor Ann Muir Chair of North Lanarkshire Disability Forum Lucy Munro Medical Director for Health & Social Care North Lanarkshire Claire Rae Chief Office NL HSCP Harry Robertson North Lanarkshire Carers Together / Carer Representative Marie Rooney Associate Nurse Director – Mental Health Fiona Sanderson Lead Pharmacist - Primary Care Nicola Scott Chief Finance Officer Francis Scott Chief Officer (Audit and Risk) Kerry Taylor Business Support Manager John Watson Employee Representative NLC David Wood Chief Executive Officer with VANL Dawn Wright (Minutes) Management Team Secretary Apologies: Nauman Dar NHS Lanarkshire Nominated Non-Executive Alison Gordon Head of Children’s, Families & Justice Services Joanne Jenkins Nurse Director NL HSCP / Nurse Representative Catherine McGinty Unison / Staff Side Representative (NHSL) Thomas Moan Senior Manager – Community Solutions VANL Maggs Thomson Head of Health North HSCP Rose Walker Governance Support Manager
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Page 2 of 12 1. Welcome and Apologies The chair welcomed everyone to the meeting and apologies were noted as above. The committee was advised that the "Tackling Poverty Team Report" and the "Lanarkshire Winter Plan Report" were deferred to a future IJB meeting. Brian Moore 2. Declaration of Interests No conflicts of interest were declared. All 3. Minutes IJB PFA (25th February) Councillor Claire Barclay requested a minor amendment to the previous minutes (25.02.25) to specify her full name, replacing "Councillor Claire" with "Councillor Claire Barclay" in order to clearly differentiate her from Claire Rae. The minutes, with above noted minor changes, were approved. Brian Moore 4. Matters Arising/ Rolling Action List John Watson raised concerns regarding the withdrawal of the Tackling Poverty Paper and the temporary contracts of Unison members in that team. Concerns were voiced about the sustainability of funding, given the team's success in securing significant funds. Claire Rae clarified that the paper was pulled to explore a more sustainable approach to tackling poverty, not due to funding issues, and reassured that trade unions would be involved. Brian Moore added that discussions have previously emphasised the need for an exit strategy and the requirement for sustainable funding, also noting the involvement of other funding partners. Claire Rae confirmed that the annual safe staffing report, required by Scottish Government under new legislation, is underway across Health and Social Care and will be brought back to a future IJB meeting. Brian Moore inquired about a previous query from John regarding the resourcing or training for age assessments in the context of the asylum seeking report. Claire Rae confirmed no response had been provided yet and this issue will be followed up. An update was requested on communications surrounding the CAMHS service, with Mark Dell confirming a communications plan is underway, including a scoping exercise to avoid duplication and engagement with key players. Councillor Claire Barclay requested a timeline for the communication rollout, highlighting that while improvements have been made, councillors still receive inquiries. Mark Dell assured the committee that the communication would be out soon and would include guidance for elected members. Claire Rae agreed to add a timeline to the action log. Philip Couser questioned the inclusion of general "business as usual" items (28, 29, and 30) on the action log, as they lacked specific outputs or dates. He also suggested a review of the long list of closed actions, some dating back to 2018, proposing a retention policy, e.g., two years. It was agreed that the action log be revised to remove "business as usual" items (28, 29, 30) and old completed actions to be deleted. Brian Moore
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Page 3 of 12 Strategic Planning & Development 5. Lanarkshire Winter Plan Debrief Deferred to future IJB meeting Performance & Finance 6. Chryston Hub Update Claire Rae provided an update on the Chryston Community Health Clinic, noting that all physical health services have been repatriated from NHS Greater Glasgow and Clyde (GGC), including Community Diabetic Service, Dietetics, Physiotherapy, and Sexual Health. Mental health and substance misuse services were not repatriated due to clinical safety concerns as the SLA did not include medical staffing and concerns about fragmentation of the Community Mental Health Team and Substance Misuse Team. Discussions are ongoing with GGC about using the clinic as a satellite clinic, with a visit scheduled for tomorrow. There are no associated cost implications of the transfer of services at this stage. Claire Rae proposed holding a future IJB meeting at the Chryston Community Hub during the school holidays to utilize the larger area and allow members to see the facility. Siobhan White inquired about the need for further public consultation since the original plan included mental health services, which are now excluded. Claire Rae clarified that consultation would not be required due to clinical safety decisions, but communications will be issued to the population explaining the changes and reasons. Philip Couser inquired about feedback from service users regarding the impact of the changes. Claire Rae stated that specific feedback hasn't been sought yet but will be in the future, as well as general feedback on the community hub model. Councillor Anne McCrory asked about the timeline for instigating satellite clinics if GGC decides to proceed. Lucy Munro, explained it would depend on the discipline, with some potentially happening more quickly than others due to existing clinic schedules. Recommendations: 1. The IJB PFA Committee noted the progress and current position of the repatriation of the clinical services from NHS Greater Glasgow & Clyde (NHSGG&C) 2. The IJB PFA Committee noted the change in provision for Mental Health and Substance Misuse Services. 3. The IJB PFA Committee noted the change in the financial position and work to date to progress towards final conclusion. Claire Rae
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Page 4 of 12 7. Prescribing: Sustainability and Value Programme Progress Update The report provided benchmarking information regarding the number of prescriptions per head of population by Board. Information on the cost and volume of prescriptions in North Lanarkshire was also provided. The report also set out the financial pressures and savings proposals within Lanarkshire at present. Despite pressures, Lanarkshire achieved its highest savings in 2025, with 80-90% of primary care prescribing deemed appropriate but within safe margins. The report set out the objectives of the Sustainability and Value Programme and the planned actions with an emphasis on the importance of changing prescribing culture. Active efforts are underway to reduce Medicines of Low Therapeutic Value and tackle polypharmacy in older, multi-morbid patients through pharmacist-led reviews and locality- specific plans. Practices are also addressing unique prescribing patterns and working with acute partners to limit costly catheter use. The Prescribing Change Scheme is under consideration to incentivise safe and effective prescribing adjustments, amid concerns about potential negative incentives. The overall program projects £8 million savings for the year and is currently on track. Councillor Claire Barclay inquired about any backlash from doctor's surgeries or patients. Lucy Munro noted that, although there is some dissatisfaction and concern expressed by GPs and pharmacists, these reactions are minimal and are not hindering the progress of the programme. Representatives from the GP sub and LMC on the Partnerships Medicines Management Board are largely positive about the need for the programme, and Fiona's team strives to make the process as easy as possible. Fiona Sanderson added that patient feedback from polypharmacy reviews will be collected automatically, building on a pilot of 50 patients which showed overwhelmingly positive responses from patients who appreciated the opportunity to review and adjust their medications. Siobhan White asked for clarification on where polypharmacy reviews are conducted (hospitals, practices, or both) and whether "Pharmacy First" prescriptions fall outside the control of the programme. Lucy Munro explained that polypharmacy reviews are practice-based and are linking with fieldwork and district nurses to identify patients, particularly those who have been at the front door of care but turned around in terms of frailty. Fiona Sanderson clarified that while some reviews start in the hospital, better outcomes are often achieved in primary care, with referrals made to primary care teams. Regarding Pharmacy First, the program monitors for unintended consequences where stopping one medication might lead to another being prescribed. New reports will analyse prescribing within "Pharmacy First" and "Pharmacy First Plus" (where community pharmacists are independent prescribers) to track changes across systems. She emphasised that Pharmacy First always involves a consultation with patients. Brian Moore noted the significant difference in value between "medicines of low therapeutic value" (£2 million) and "non-medicines" (£22 million). He questioned the alternatives for sourcing or funding non-medicines if they are not prescribed in the future. Lucy Munro
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Page 5 of 12 He also noted the potential saving of £1 million if switch to generic Sitagliptin. He welcomed the development of dashboards for better data reliance and which will provide evidence of the polypharmacy work's benefits. Lucy Munro stated that nicotine patches constitute the largest portion of low-value medicines, and savings from this are part of a wider strategy to improve chronic pain management. The £22 million non-medicine savings target is based on disparities, such as two suitable catheters costing £2.20 and £22, with hospitals often receiving free, more expensive options from pharmaceutical companies, influencing continued prescription. Fiona Sanderson stated a "non-medicines effective prescribing" subgroup collaborates with nurses and pharmacy to improve efficiency and quality. She highlighted that switching the DPP4 class drug Sitagliptin to a generic—already done elsewhere—could save £1.4 million without affecting safety, with the pharmacy team overseeing the process and patient follow-up. Recommendations: 1. The IJB PFA Committee noted the savings for the financial year 24/25 2. The IJB PFA Committee noted the project workstream activities planned for 25/26 8. Supporting Unpaid Carers & North Lanarkshire Carers Strategy Update Morag Dendy spoke to the submitted report. The report focused on the North Lanarkshire Carers Strategy, emphasising the importance of identifying unpaid carers early, providing timely support, and aligning with national policy drivers. The implementation of the Carers (Scotland) Act 2016 and the challenges in identifying and supporting hidden carers were discussed. The role of various partners, including the North Lanarkshire Carers Together Steering Group and the Carers Network, was highlighted. The importance of data collection to measure the impact of interventions for carers was emphasised. Concerns were raised about the decreasing number of carers assessments and the need to understand the reasons behind this trend. The committee requested information on supports available for carers during periods of crisis. Discussions included the difficulties in reaching "hidden carers" and the reliance on general practitioners for identification, with a need for broader outreach. The need for a robust communication strategy to identify and support carers was highlighted. Recommendations: 1. IJB PFA Committee endorse the approach to supporting Carers in North Lanarkshire. 2. IJB PFA Committee noted the range of supports to unpaid carers available locally. Morag Dendy
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Page 6 of 12 9. Financial Monitoring Nicola Scott presented the 2024-2025 financial report, showing a £10.716 million underspend, which became £10.1 million after accounting for ring-fenced funds of £614,000. Part of this underspend was due to reserve drawdowns that were later replenished. Employee costs had a £19 million underspend, mainly from a £6 million non-recurring saving on the Strathclyde pension fund, offset by a prescribing overspend. Closing reserves were reported at £64 million after drawdowns, before this year underspend allocation. The reserves report addresses prior IJB and PFA comments on long-held reserves. The savings strategy aimed for £29 million over two years, with £15.4 million achieved before the plan was reviewed rolling unachieved savings into the 2025-2026 Medium Term Financial Plan. The report also covered vacancies and digital projects. Councillor Bob Burgess inquired about Scottish Government allocations for diabetes technology and mental health funding. Lucy Munro explained diabetes technology relates to transformative closed-loop systems for type one diabetics, funded partly by the Scottish Government. Claire Rae added that mental health allocations are tied to Scottish Government service targets, with demand rising significantly. Siobhan White asked about 2025-2026 allocations and the lack of an inflationary rise in the 2024-2025 prescribing budget. Claire Rae confirmed ongoing allocations and mentioned that the Chief Officer Group raises concerns over the prescribing budget with policymakers. Nicola noted that the 2025-2026 Medium Term Financial Plan includes an inflationary increase for prescribing and outlined recurring costs for digital alarms that need future budget considerations. Brian Moore highlighted Appendix 6 on the savings program, calling for a development session to address a £20 million deficit. He queried the planned use of unscheduled care and CAMHS reserves. Nicola Scott clarified that the £14.7 million savings gap is not new unmet need but carries previous savings targets into the new plan, with reserves being ring-fenced funds meant for specific purposes. Claire Rae added that work on using the neurodevelopment service reserve will be proposed at the next IJB meeting, emphasizing that future discussions will focus on savings and risks related to social care budgets. Brian Moore briefly inquired about a £1.5 million allocation for mental health services, to which Nicola responded that it aims to support anticipated funding reductions from the Scottish Government using some of the underspend. Recommendations: 1. IJB PFA Committee acknowledged the year-end financial position of a £10.716m underspend. 2. IJB PFA Committee referred to the IJB Reserves Strategy report to approve the allocation of this underspend. Nicola Scott
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Page 7 of 12 10. IJB Reserves Strategy Nicola Scott presented the 2025-2026 reserves strategy, seeking approval for realignments in Appendix 1 and a contingency reserve percentage change. She corrected report date errors: Table 1 should start with 2024, Table 3 with 2025. Reserves began at £75.524m, now £64.8m after drawdowns, with a full review by Council and NHS finance teams. Proposed realignments: • Remove £2.2m surplus reserves • Allocate £128k to summer placements from social care demand risk • Increase risk and contingency reserves by £10.8m • Establish five new reserves totalling £2.183m Post-approval, opening reserves would be £75.553m, a minimal £30k net change indicating reserves are actively used but continue to grow. She also proposed reducing the contingency reserve target from 5% to 4% due to current financial constraints and ongoing reviews. Brian Moore queried Mental Health Officer funding; Diane Fraser explained it is Scottish Government support for training, with some underspends held in anticipation of future requests. Regarding summer placements, Nicola Scott detailed an annual program for S4–S6 students, with increased demand in social care. Morag Dendy highlighted the program’s success, offering paid placements that enhance young people's skills and employment prospects, with some choosing to stay in paid roles. The program now includes apprenticeships, with positive feedback from participants and staff. Councillor Anne McCrory asked about participation numbers, retention, and full-time stays; Morag Dendy confirmed some students have opted to stay employed rather than return to school, and interest continues to grow. She emphasised that placements develop practical skills and employability through community and virtual experiences, with partnerships across sectors supporting expanded opportunities. Councillor Claire Barclay inquired about Care Academy retention and understanding; Morag Dendy explained the program’s four work streams focusing on recruitment, pathways for youth and adults, and broader employment initiatives, aiming for more ambitious targets. Recommendations: 1. IJB PFA Committee acknowledged the contents of the report. 2. IJB PFA Committee approved the proposed realignments & new reserves detailed in Appendix 1. 3. IJB PFA Committee approved the change to the percentage of risk based & contingency reserves to be held as detailed in section 8. Nicola Scott
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Page 8 of 12 11. Q3 Performance Report Morag Dendy presented the Q3 Performance Report, noting monitoring of key areas within the health and social care partnership. Scrutiny panels support underperforming services. Highlights: • Alcohol Brief Interventions: Underreporting persists due to technical issues; a future report will cover the North Lanarkshire alcohol summit. • Cervical Screening: Targeted outreach aims to boost participation. • Immunisations & 6-8 Week Reviews: Supported by a working group, with ongoing monitoring. • Rehab/Re-ablement: Emphasis on early assessments and revised targets; progress made despite unmet goals. • Discharge Performance: 50-60 delayed discharges remain, showing improvement. • Mental Health: Recruitment challenges affect performance; innovative management approaches are being applied. • SLT & Dietetics: Learning from CAMHS to improve waiting list management. • Complaints: Staff capacity issues impact response times; 69% positive feedback. • Care Home Length of Stay: New models and initiatives are expected to gradually influence figures and costs. • Smoking Cessation: Increasing social media engagement for referrals. • Sickness Absence: Continues to be a key focus for the partnership. Siobhan White raised a procedural point about ensuring actions and recommendations from other committees (like population health, e.g., childhood immunisations, cervical screening) are captured in the same place as the Q3 report, to avoid governance overlap. Morag Dendy confirmed that they do join up information from different forums and scrutiny panels. Councillor Bob Burgess requested figures on long-term sickness within the system for the next meeting. Claire Rae agreed to break down absence figures in a deeper dive. Brian Moore noted that home assessment teams dropped considerably in January and the readmission rate remained at 14%, with work underway to understand this better. Paediatric SLT (Speech and Language Therapy) was highlighted as a continuing main concern due to poor performance. Claire Rae mentioned Forth Valley's integrated approach with education as a learning opportunity, and they are looking to implement similar strategies. Brian Moore suggested that given significant reserves, investment in this service might be considered, as there is no sense of progress and reputational issues remain a high concern. Claire Rae agreed to bring back proposals if reserves are to be used for this. A deeper dive into this area was also suggested. Recommendations: 1. IJB PFA Committee noted the contents of the report and the appendix. Morag Dendy
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Page 9 of 12 12. Cat 1 Responders Update Margaret Flavell provided an update, highlighting its duties, responsibilities, and readiness under the Civil Contingencies Act 2021. The business continuity plan was reviewed late last year and will be reviewed again mid- year, with plans for a desktop scenario. The report aims to offer reassurance regarding their ability to put an appropriate response in place, with a focus on caring for people and ensuring a "people first" approach. Phillip Couser asked about the challenges of maintaining or sustaining capability in this area, referring to Section 7.18 of the report. Margaret Flavell responded that challenges were identified during a review of the business continuity plan and across health and social care localities, where there was a general understanding but a need to break it down into detailed responses. They are gathering information and looking at training support, noting a loss of involved people due to changes and departures. The main challenge is the lack of readily available information and knowledge. Brian Moore questioned the confidence in business continuity plans for commissioned services like care homes. Margaret Flavell confirmed strong links with commissioned services and providers, ensuring immediate contact if their business continuity plans are required. They work across the partnership to support them and will ensure these links are updated when their own business continuity plan is updated. Brian Moore inquired about the reflection of integrated arrangements within the report, specifically how the HSCP's is referenced in the North Lanarkshire Council Corporate Resilience Plan but no explicit link to the Health Board equivalent, Margaret Flavell acknowledged that it probably reads that way and committed to refreshing it with Kerry to ensure a full "whole system approach" across the partnership. Recommendations: 1. IJB PFA Committee noted the contents of the report 2. IJB PFA Committee understood the duties of a Category 1 responder 3. IJB PFA Committee are aware of the roles and responsibilities of a Category 1 responder 4. IJB PFA Committee have a knowledge of activities undertaken 5. IJB PFA Committee acknowledge the challenges and supports actions to address Margaret Flavell
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Page 10 of 12 13. Internal audit 2025/26 work plan Jocelyn Lyall presented the draft internal audit plan for 2025/2026, which aims to assess the adequacy and effectiveness of the IJB’S framework of Governance, risk management, and control for the year. The plan will be jointly delivered by North Lanarkshire Council and NHSL internal audit teams. The plan is designed to support the achievement of objectives and target priority issues, informed by a review of the risk register and consultation with the Chief Officer and Chief Finance Officer to ensure maximum value from audit assignments. Regular meetings are held every four to five weeks to discuss planning and progress. Jocelyn Lyall noted that Section 6 of the cover paper provides background on the planning process and sets out the requirements of the new global internal audit standards in relation to planning, which will be discussed further at the next agenda item. The proposed plan for 2025/2026 was set in Appendix 1. A total of 60 days are available for the audit, and the IJB will also benefit from assurances provided through partner organisation audits, which will be reported in each progress report. Of the 60 days, 27 are allocated to standard deliverables, including planning, audit management, general governance advice, production of the annual internal audit report, and the audit follow-up system. This leaves time for two full audits, which are proposed to be on financial sustainability and performance, and committee effectiveness. No questions were raised from the IJB PFA board members. Recommendations: 1. IJB PFA Committee approved the proposed Internal Audit Plan for 25/26 (Appendix 1) 2. IJB PFA Committee approved the recommendation by the Chief Financial Officer that the joint working arrangements between the North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) Internal Audit teams continue in order to deliver the IJB Internal Audit Service. 3. IJB PFA Committee approved the delegation of authority to the Chief Finance Officer to agree with the Chief Officer (Audit and Risk) (NLC) and the Chief Internal Auditor (NHSL) the scope of the audit assignments in the Internal Audit Plan for 25/26 including the allocation of responsibilities for completion of assignments. Jocelyn Lyall
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Page 11 of 12 13.1 Internal audit progress report 2024/25 Jocelyn Lyall summarised the January 2024 global internal audit standards, effective from April 2024 in the public sector. Supplemented by UK-specific notes from CIPFA and the Scottish Government, these standards replace previous internal audit rules. They comprise 15 principles across five domains, with standards detailing requirements, implementation, and conformance evidence. While current practices largely align, departments will formalize evidence of compliance in 2025/26. Key changes include a mandated internal audit Charter, aligned audit strategy, enhanced ethics emphasising professional scepticism, and clarify roles for management and audit committees—who are also expected to champion the internal audit function. The 160-page document guides compliance, with revised policies forthcoming. Brian Moore welcomed the new standards, highlighting their role in clarifying the Audit and Risk Committee's purpose. He emphasised using the upcoming mandate to reaffirm this purpose. He supported the August audits and noted progress on completed Health Board audits. Additionally, he mentioned a minor issue from a recent NHSL ICE report regarding an outdated Integration Scheme on the HSCP website, which has now been resolved. Siobhan White inquired if the new mandate aligns with the Audit Committee's terms of reference. Jocelyn Lyall clarified that while terms of reference remain necessary, the mandate specifies legal authority per legislation, codes of practice, and the Scottish Public Finance Manual, and will complement internal arrangements. Siobhan White asked if Jocelyn would assist the committee in meeting new standards, including promoting internal audit. Jocelyn confirmed she would, emphasizing the relevance of the terms of reference and work plan, including private meetings. Jocelyn also announced a gap analysis-based improvement plan, to be reported to the NHS Lanarkshire Audit and Risk Committee, with updates provided at each meeting to ensure compliance. Francis Scott noted they are conducting a gap analysis. Full compliance is not required April 1st, but work is ongoing to embed the new standards. The new standards are more demanding and require greater demonstration. Originally designed by the IIA for private firms, they have been adapted for the public sector with extra documentation, necessitating time to adjust. Siobhan White requested that the internal audit plan include last audit dates to illustrate the audit history. Recommendations: 1. IJB PFA Committee reviewed the Progress Report and the summary of relevant partner reports. 2. IJB PFA Committee considered the changes arising from the new Global Internal Audit Standards (GIAS) and the implications for the Internal Audit Service and the Performance, Finance and Audit Committee. Jocelyn Lyall
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Page 12 of 12 Governance & Policy 14. Risk Report Morag Dendy presented the Risk Report, noting that there were no significant changes since the last review. The primary change highlighted was the National Care Service risk, which has been reduced, reflecting its recording within each organization. Morag also mentioned that the strategic leadership team is exploring the approach to risk within NLC and NHSL. This will be further explored and refreshed during IJB development sessions likely in September, aiming to ensure the risk approach aligns with expectations. Phillip Couser questioned the medium risk rating for workforce, citing recruitment challenges and budget impact. He proposed separating immediate financial issues from longer-term risks in the register, akin to NHS Lanarkshire, to prevent persistent "red" ratings. He also emphasised defining risk appetite and establishing clear actions and timelines. Claire Rae concurred, noting she and Nicola Scott were reviewing risk articulation. She questioned the current risk level, considering turnover, and stressed the importance of understanding tolerable risk by September. She agreed the risk report needs restructuring for better clarity, discussion, and actionable insights. Recommendations: 1. IJB PFA Committee 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. 2. IJB PFA Committee noted that an IJB Liaison session will be focused on risk to take account of and strengthen the consideration of risk through the IJB taking account of the revised approaches to risk within NHS Lanarkshire and NLC; and the refreshed governance arrangements within the UHSCP. Morag Dendy For Noting 15. Risk Brian Moore noted the paediatric SLT risk and advised that it is important that the board review this in detail and consider including it in the risk register for further monitoring. 16. Date of next meeting: 27th August 2025, 14:00-16:30, Via MS Teams Claire Rae noted that Kerry Taylor is working on refining the agenda for future IJB PFA meetings to focus more on PFA, with the possibility of moving some reports to the main IJB meeting.