2025-09-17 IJB - Combined Agenda and Papers
North Lanarkshire Council · 17 September 2025
Back to Health and Social Care Integration Joint Board — 17 September 2025 and its agenda
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1 A meeting of the IJB will be held on Wednesday 17 September 2025 at 9.30am – 12.00pm 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: Brian Moore AGENDA No. Item Action Attachment Reporting 1. Welcome & Apologies Chair 2. Declaration of Interests Members are invited to declare any interest in relation to agenda items Board Members 3. Minutes IJB (18th June 2025) For Approval Attachment Chair 4. Minutes IJB PFA (21st May 2025) For Noting Attachment Chair 5. Membership & Meeting Changes Consider any changes to be made to Board or Committee membership or amendments to meeting arrangements 6. Matters Arising/ Rolling Action Log For Noting Attachment Chair Standing Items 7. Chief Officer Report For Noting Attachment Claire Rae 8. Chief Finance Officer Report - Medium Term Financial Outlook 2026-2029 For Noting Attachment Nicola Scott Strategic Planning & Development 9. IJB Annual Performance Report For Approval Attachment x2 Morag Dendy 10. Strategic Commissioning Overview Plan Update For Noting Attachment Morag Dendy 11. Supporting Resilience For Noting Attachment Morag Dendy
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2 12. Quality Assurance Annual Report For Noting Attachment x2 Morag Dendy 13. Hospital @ Home For Noting Attachment Maggs Thomson 14. Home Support For Noting Attachment Diane Fraser 15. Learning Disabilities Unit Nursing Workforce For Noting Attachment Joanne Jenkins Performance & Finance 16. Internal Audit Annual Report 2024/25 For Approval Attachment Jocelyn Lyall 17 Audit Scotland - Final Audit Report 2024/25 For Approval Attachment x3 Nicola Scott 18. Audited Annual Accounts & Financial Statement 2024/2025 For Approval Attachment x2 Nicola Scott Governance & Policy 19. Self-Assessment Questionnaire Results For Noting Attachment x 2 Kerry Taylor 20. IJB Work Plan For Noting Attachment Kerry Taylor For Noting 21. 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 Date of Next Meeting 10 December 2025 9.30am-12pm
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Page 1 of 11 ITEM: Integration Joint Board Performance Minutes from the meeting held on Wednesday 18th June 2025, 09.30 – 12.00 via MS Teams PRESENT Voting Members: Cllr Claire Barclay NLC Nominated Councillor Cllr Bob Burgess NLC Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non-Executive Siobhan White NHS Lanarkshire Nominated Non-Executive Others In Attendance: Graeme Cowan Mark Dell Communications manager Diane Fraser Head of Adult Social Care Alison Gordon Head of Children & Families & Justice Services CSWO of NLC Joanne Jenkins Nurse Director NL HSCP / Nurse Representative Louise Long Chief Executive Jocelyn Lyall Chief Internal Auditor Catherine McGinty Unison / Staff Side Representative (NHSL) Thomas Moan Senior Manager – Community Solutions VANL Ann Muir Chair of North Lanarkshire Disability Forum Lucy Munro Medical Director for Health & Social Care North Lanarkshire Des Murray Fiona Owens Josephine Pravinkumar Director of Public Health and Health Policy Claire Rae Chief Office NL HSCP Roslyn Rafferty Head of Strategy & Performance Harry Robertson North Lanarkshire Carers Together / Carer Representative Mark Russell *left 10.09 Medical Director (South Lanarkshire HSCP/Primary Care) Fiona Sanderson Lead Pharmacist - Primary Care Nicola Scott Chief Finance Officer Francis Scott Chief Officer (Audit and Risk) Tyra Smyth GP Sub Secretary Kerry Taylor Business Support Manager David Wood Chief Executive Officer with VANL Dawn Wright (Minutes) Management Team Secretary Apologies: Nauman Dar NHS Lanarkshire Nominated Non-Executive Cllr Paul Kelly NLC Nominated Councillor Cllr Anne McCrory NLC Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non-Executive Morag Dendy Head of Planning, Performance & Quality John Watson Employee Representative NLC Peter McCrossan Director for AHPs Jackie Jones Deputy Chief Executive and Director of Human Resources
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Page 2 of 11 1. Welcome and Apologies The chair welcomed everyone to the meeting and apologies were noted as above. The chair also acknowledged the 10th anniversary of the IJB's establishment. Brian Moore 2. Declaration of Interests No declarations of interest were made. All 3. Minutes IJB (19th March 2025) The minutes were approved as an accurate record. Brian Moore 4. Minutes IJB PFA (21st May 2025) The minutes were approved as an accurate record. Brian Moore 5. Matters Arising/ Rolling Action List No issues were raised regarding matters arising. Rolling Actions: 25 - Dates still to be arranged. 27 - Ongoing. 31 - Communications to be out by the end of June. 32 - Complete, as Lucy brought it back to the IJB PFA meeting. 33 - To be taken back to the next IJB PFA meeting. Brian Moore /Claire Rae 6. Chief Officer Update Claire Rae provided an update on recent activities and developments. Louise Long started as the new Chief Executive of NHS Lanarkshire on 5th May, with positive feedback from visits to CAMHS service and Holdsworth Centre. More visits are planned. The Care Reform Bill, formerly the National Care Service, passed on June 10. Key provisions include "Anne's Law" (upholding rights of care home residents to see loved ones), strengthened support for unpaid carers (right to breaks, improved access to independent advocacy), and the establishment of a national chief social work advisor role. The Advisory Board is set to replace the interim board in May. The Population Health Framework and the Health and Social Care Renewal Framework (both 10-year plans) were published yesterday, jointly developed by COSLA and the Scottish Government. A development session for IJB will be arranged to discuss these in more detail. The assistive tech team was shortlisted for the Local Government Chronicle Awards, acknowledging their nomination, though unfortunately they did not win. Claire Rae
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Page 3 of 11 Chief officers met with Minister Mary Todd to extensively discuss the IJB's financial challenges. The first meeting of this board occurred last month, with a vision session scheduled for tomorrow. This will be brought back to the IJB for a detailed discussion on priorities. Brian Moore queried the need to review existing practices or policies in light of new carers legislation and short breaks. Claire Rae confirmed this would be examined and reported back within the context of the carer strategy. Strategic Planning & Development 7. PCIP Update Mark Russell highlighted that the action plan focuses on concrete changes, not just strategy. He outlined key challenges in Lanarkshire’s primary care, especially North Lanarkshire, due to limited resources, GP shortages, and high deprivation, which worsen the "inverse care law." The PCAP expands primary care to include all community health services beyond GPs, dentists, optometrists, and pharmacists. Its goal is to streamline access pathways, currently muddled by over 60 self-referral options, leading residents to rely mainly on GPs or A&E. The action plan focuses on three areas: 1. Developing meaningful alternatives to general practice: This includes optimising existing services (e.g., Community Treatment and Care, Pharmacotherapy) and developing new ones, such as encouraging direct contact with physiotherapy teams for musculoskeletal problems, rather than GPs. 2. Reshaping care pathways: This aims to reduce workload on general practice by diverting work from secondary care directly to appropriate services. 3. Refocusing practice capacity: Providing assets and support (e.g., digital tools) to practices to facilitate change and innovation, with a focus on a "once for Lanarkshire" approach for impact assessments. A work stream is assessing the impact of these changes on patients and general practice, with a summer project with Strathclyde University to gather effectiveness data. Additionally, NES and local digital teams will provide free digital services and communication tools to all 93 Lanarkshire general practices over nine months, extending to key community services. DPI assessments will be managed by the Health Board to ensure safe adoption. Siobhan White asked about the risk to the board’s ability to provide General Medical Services. Mark Russell explained that this risk is decreasing due to better locum GP availability, but this is driven by practices reducing discretionary sessions for financial reasons, likely decreasing overall GP access for patients. Councillor Claire Barclay emphasised the need for public communication to raise awareness of alternative care options, as many default to GPs or A&E. Mark Russell confirmed a social media campaign launching this summer to inform the public about service changes and vowed to arrange a liaison session on the digital front door once procurement progresses. Mark Russell
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Page 4 of 11 Councillor Bob Burgess questioned the adequacy of musculoskeletal clinics in Cumbernauld. Mark Russell confirmed that Community Appointment Days rotate throughout Lanarkshire and are now being expanded to weekly sessions, becoming a regional staple, with councils facilitating access through facilities like sports centres. Brian Moore asked about the benefits derived from the Primary Care Improvement Plan (PCIP) funding and Pharmacy Plus initiatives, as well as the current status of the GP contract. Mark Russell acknowledged PCIP’s contribution but stated it’s insufficient for systemic change. Impact assessment with Strathclyde University is ongoing. Pharmacotherapy has improved outcomes, with medicines reconciliation now managed by hubs, freeing GP time. National talks on the GP contract continue. The Scottish Government is creating a primary care roadmap and business case. PCIP was Phase 1 and Phase 2, boards covering non-clinical costs has stalled due to funding shortages, parallel to capital investment issues for GP premises. RECOMMENDATIONS The IJB committee noted the progress of the Primary Care Action Plan (PCAP) as the overarching delivery framework for Primary Care transformation The IJB committee noted the rationale for investing in a digital access platform to support both general practice and community service accessibility. The IJB committee noted the steps taken to enhance impact measurement and quality assurance alongside the development of a unified key performance indicator framework 8. Public Health Annual Report Josephine Pravinkumar gave an overview of the Public Heath Annual Report which focuses on the health of children, young people, and infants this year. The report highlights achievements, challenges, and future priorities in public health, with a strong emphasis on prevention, early intervention, and addressing inequalities. The 10-year plan for the population health framework has been published, and there are plans for a joint session to review its outputs. North Lanarkshire is well-positioned, having already aligned its strategic priorities with the framework. The report specifically focused on children, young people, and infants, with significant contributions from children in North Lanarkshire who influenced the report with their pictures, drawings, and comments on health and well-being. This focus aligns with the UNCRC. Good progress has been made on actions related to the "anchor" theme from the previous year's report, including successes in employability. There is a joint venture across the system to support young people and specific communities in their employment journeys, with a signed Memorandum of Understanding and a community wealth building statement. Josephine Pravinkumar
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Page 5 of 11 Opportunities are being explored through the Monkland project to look at community benefits and support the wider community. Excellent progress has been made in oral health, and North Lanarkshire is leading in breastfeeding initiatives. The region is performing well in pregnancy and new-born screening programmes. A number of challenges remain in child health, which are not a surprise to the committee. Concerns exist about not meeting child poverty targets, and this remains a key focus area in the new population health framework. While digital and innovative solutions are being used to support mental health, more work is needed, especially concerning issues like young people resorting to vaping and smoking due to stress and lack of resilience. There is a continued concern about widening inequalities across all areas, and the population health framework is expected to provide an additional lever to address this. The high smoking rates in North Lanarkshire (third highest in the UK) are a real concern, and a national tobacco and vaping framework is being used to take action against these issues, including new forms of tobacco products like pouches. There are disparities in maternal and childhood vaccination uptake across localities. Councillor Bob Burgess noted that 33% of young children in North Lanarkshire are diagnosed with ASN. Josephine Pravinkumar was unaware of this figure but will investigate and respond. Early identification is vital, but the root causes must be examined. Siobhan White highlighted the persistent gender gap in life expectancy across Scotland, including North Lanarkshire. Josephine Pravinkumar attributed this to factors such as early neurodevelopmental issues, maternal and childhood obesity, and low birth weight, which contribute to chronic diseases. Preventive measures, early intervention, and tackling socioeconomic factors like child poverty are essential. Claire Rae emphasised a whole-system approach, including housing and economic determinants, to address the gap. Brian Moore asked about targeting low vaccination areas. Josephine Pravinkumar confirmed public health is identifying uptake disparities, reviewing services, partnering with community and faith groups, and using the Scottish Vaccination Immunisation Framework for targeted actions. Lower uptake in some areas and ethnic groups is linked to misinformation, requiring more resources. The population health framework and an inequalities action plan will support these efforts. A briefing on the population health framework will be organised in the future. RECOMMENDATIONS
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Page 6 of 11 The IJB committee noted the contents of the report in particular the key priorities that need actioned to improve children’s and the wider population health. 9. NHS Lanarkshire Board - 2025-26 Delivery Plan – Delivering Our Health Together Roslyn Rafferty presented the "Delivering Our Health Together" plan, which outlines local actions and timelines aligned with the Scottish Government and NHS Lanarkshire's transformation and reform priorities. The plan was developed based on prescribed Scottish Government guidance issued in December, emphasizing a shift from recovery to transformation and reform, encompassing 13 delivery areas and 80 planning priorities. It ensures alignment with local finance, workforce, and quality plans, integrates new National Health and Social Care reform ambitions (launched in January), and aims to optimise service delivery, workforce, and financial resources. The plan's development involved the corporate management team and senior leaders from January to March. It was initially shared in draft form with the board in February and with the EDG in March, before being submitted to the Scottish Government. Subsequent updates incorporated successful bids for operational improvement plan funding, leading to approval for submission to the board in mid-May. Joanne Jenkins discussed the health visitor workforce, noting a decline in registrants, particularly for learning disabilities. The health visitor role remains attractive, and efforts are underway to plan workforce needs by predicting retirements and ensuring sufficient posts for trainees, while adhering to budget constraints. A paper was recently approved by SMT, and the situation will be re-evaluated in October. RECOMMENDATIONS The IJB committee noted the contents of the report. Roslyn Rafferty 10. Lanarkshire Winter Plan Debrief Graeme Cowan provided a debrief on its implementation and to outline key learnings for the 2025/2026 winter plan. The plan, which started in August 2024 in line with national guidance, focused on four main priorities: 1. Prioritising community care to enable people to live at home and avoid hospital stays. 2. Ensuring individuals receive appropriate care responses, with an emphasis on home-based or close-to-home services. 3. Maximising capacity within the health, social care, and social work systems, protecting planned care, and reducing long waits. 4. Focusing on the well-being of the workforce and acknowledging the commitment of unpaid carers. The 2024 plan covered several areas, including: Graeme Cowan
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Page 7 of 11 Expansion of the Flow Navigation Centre Plus in 2024/2025, detailed in Appendix 1. This included new virtual wards, increased multidisciplinary staff (like MSK physios and Scottish Ambulance Service), and enhanced nursing staff availability during peak periods. The HSCP focused on supporting hospital discharges through a home assessment approach in North Lanarkshire. Work was undertaken to maintain relationships with commissioned providers to ensure their ability to respond throughout the winter. Over two-thirds of GP practices in Lanarkshire were open during some public holidays over Christmas and New Year. Enhancements were made to primary care out-of-hours services using multidisciplinary teams, allowing more signposting away from A&E. Despite national coordination for flu and COVID-19 vaccinations, local efforts included extended use of pop-up clinics and community pharmacy appointments. However, overall uptake rates for the general population and staff were down in 2024/2025. Continued support was provided through commissioned carer organizations and enhanced assistance for carers helping people return home from hospital during winter. Enhanced messaging and communications aimed to increase awareness of staff health and well-being platforms. The debrief identified several learning points to be progressed for the 2025/2026 winter plan: Addressing vaccination uptake rates, including staff vaccination. Working with managers to minimise leave allocation during winter to ensure sufficient staff availability. Further learning points on operational flow and the Flow Navigation Centre are in Appendix 1. Continuing the "discharge without delay" approach, focusing on assessing people at home rather than in hospital. Moving into 2025/2026, the responsibility for winter planning will transfer from the South Lanarkshire-led group to NHS Lanarkshire's Planning Directorate. The IJB will be kept informed of future plans. Councillor Bob Burgess questioned who determines if a discharge package is adequate, citing issues like alarms and ramps. Graeme Cowan replied that it depends on the patient's circumstances, involving relevant professionals or a single coordinator to assess support needs and family input, and offered to review specific cases privately. Brian Moore asked if a different approach to staff vaccinations is needed due to declining uptake. Josephine Pravinkumar explained that targeted efforts, including peer support and vaccinators, are in place, with an action plan presented to the Population Health Committee. Claire Rae added that collaboration with the quality department involves safety cards to assess risks for staff and patients. A review of vaccination services, focusing on areas with low uptake, is ongoing, with a report due by September.
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Page 8 of 11 Brian Moore inquired about managing annual leave during peak times. Claire Rae confirmed existing targets and quotas across health and social care, managed within agreed parameters. She noted unplanned leave, like sickness, can affect this, especially at Christmas, but policies are established to address it. Brian Moore thanked Graeme Cowan for the report, noting that winter planning is now recognised as a year-round process and that learnings from the past winter have been identified. RECOMMENDATIONS The IJB committee noted the contents of the report. Performance & Finance 11. Unaudited North Lanarkshire IJB Annual Accounts 2024/2025 Nicola Scott presented the unaudited North Lanarkshire IJB annual accounts for 2024/25 for approval. Siobhan White asked about narrative categories in the income and expenditure statement. Nicola Scott said detailed breakdowns aren't required unless needed, noting external audits favour shorter, less operational accounts. She will discuss with Audit Scotland the option of adding a glossary for clarity. Siobhan White noted the different format of the balance sheet. Nicola Scott explained it's simpler because the IJB doesn't hold assets. Siobhan White asked about declarations regarding fraud, bribery, and corruption. Nicola Scott stated this would be part of the audit report, and the only required declaration from the IJB is within the statement of responsibilities on page 19. Brian Moore and Josephine Pravinkumar emphasised prioritising prevention and early intervention within the new population health framework, recognising challenges in measuring impact and budgeting, and anticipating national efforts to guide future strategies. Siobhan White asked about new accounting standards like IES 1 affecting account presentation. Nicola Scott is aware of meetings on this and will confirm the timeline. RECOMMENDATIONS The IJB committee approved the Annual Governance Statement and associated reports for inclusion in the statutory accounts. The IJB committee approved the unaudited North Lanarkshire IJB Annual Accounts 2024/25 at Appendix 1. The IJB committee approved the submission of the unaudited annual accounts to Audit Scotland. The IJB committee acknowledged the arrangements for publication of the North Lanarkshire IJB Annual Accounts 2024/25 in line with the legislative requirements. Nicola Scott 12. IJB Annual Performance Report Graeme Cowan explained that the IJB Annual Performance Report is required to be published by the end of July according to statutory regulations in the Public Bodies Act. Graeme Cowan
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Page 9 of 11 However, a significant constraint in meeting this deadline is the availability of national indicator data, which is not finalised until early July. To address this, the board were asked to approve the below recommendations. RECOMMENDATIONS The IJB committee agreed to delegate authority to the Chief Officer of North Lanarkshire HSCP to publish the draft version of the Annual Performance Report on the HSCP website by 31 July 2025. The IJB committee agreed to receive the finalised report at the next IJB meeting in September 2025 for approval. Governance & Policy 13. IJB Governance Overview Report Kerry Taylor presented the IJB governance overview report, detailing recent reviews of governance documents and reporting arrangements to ensure compliance with the Public Bodies Joint Working Act. The report encompasses the Code of Conduct, declaration of interests, board's directions, records management plan, standing orders, terms of reference, role descriptions, induction process for members, integration scheme, Annual Governance Statement, scheme of delegations, and membership updates. Due to a prolonged staff vacancy, there has been a delay in issuing declaration of interest forms to members. These forms will be issued following today's meeting. Brian Moore asked about standing order review. Kerry Taylor said it’s due for a three- year review but will likely be revisited early next year after other governance matters. It may be discussed at a development session before being presented to the IJB PFA or the full board, with the IJB PFA the probable first step. Brian Moore inquired about the record management plan timeline. Kerry Taylor confirmed National Records Scotland usually requests an update in August during the annual review. North Lanarkshire Council is reviewing it, with a target to present for approval at the September board meeting before submission. RECOMMENDATIONS The IJB committee agreed to review the updated IJB Governance Report. The IJB committee noted that the Code of Conduct and Declaration of Interest Forms will be issued to IJB members for completion for 2025- 2026. The IJB committee noted that the Records Management Plan will be presented to a future Board meeting. The IJB committee approved a review of the Standing Orders. The IJB committee approved a review of the roles and responsibilities for Board members alongside a new induction process. The IJB committee approved the development of North Lanarkshire IJB’s Scheme of Delegations. Kerry Taylor 14. Self-Assessment Questionnaire
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Page 10 of 11 The questionnaire will be distributed electronically next week and remain open until the end of August to allow members appropriate time to complete it, considering the summer holiday period. RECOMMENDATIONS The IJB committee considered carrying out a self-assessment of the Board’s effectiveness by the use of the questionnaire. The IJB committee approved the draft questionnaire at Appendix 1. The IJB committee approved the questionnaire being issued to Board members and the results reported to a future meeting. Kerry Taylor 15. Support Care and Clinical Governance Update The Bi-Monthly Support Care and Clinical Governance Update reports to the IJB, with discussions on quarterly meetings, but bi-monthly due to workload, aligned with other regions. It reports to the Healthcare Governance and Assurance Committees and aims to inform adult social care and social work structures. Key updates include enhanced governance in social work and social care, led by Diane Fraser, following Scottish Government guidance. In healthcare, focus has been on adverse events, themes, and quality improvement. The group’s chair ship is rotational; Lucy Munro has chaired for over 1.5 years, with her term extended to 2.5 years. Diane Fraser will take over as chair in April, with Joanne Jenkins as Vice Chair. Appendices require updating; Kerry Taylor will review them. The report remains high-level, confirming assurance without unnecessary duplication. Brian Moore shared that he found the report too high-level and lacked detail on key issues and SAERs related to the HSCP. He noted that while annual reports go to the healthcare committee, the IJB often doesn't receive papers on specific areas like learning disabilities or addictions, despite assurance statements. Brian Moore questioned whether stating "everything's OK" sufficed, emphasising the need for more concrete evidence to truly assure the IJB. Lucy Munro acknowledged Brian's concerns, explaining that reports are prepared for multiple committees, and the delegation scheme requires each organisation to manage its own affairs, making it difficult to determine the appropriate level of detail for the IJB. She offered to provide more detailed reports or discuss further in a separate session. Claire Rae said the issue was raised pre-agenda and will be addressed by SMT. She recommended summarising joint reports from governance groups for each partner and presenting them to the IJB—frequency to be decided—to highlight common SAER themes. Brian Moore stressed balancing detail to avoid overload, ensuring the IJB is informed of issues and can learn from them. RECOMMENDATIONS The IJB committee noted the update from the Support Care and Clinical Governance committee. Lucy Munro For Noting 16. Risk
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Page 11 of 11 None raised 17. Date of next IJB meeting: 17th September 2025, 9.30am –12pm, Via MS Teams
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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 lignocaine 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.
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 25. Future Meeting C Rae Host a future meeting face to face in Chryston hub 19.03.2025 – March date was cancelled new date to be re-arranged Dates set up for 2025 Walk rounds Ongoing 27 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability. Ongoing 31. 25.02.25 Item 6 Q2 Performance Report Improved communication about progress and ensure a shared understanding of what CAMHs services can offer. 21.05.25 - Mark Dell confirmed a communications plan is underway, including a scoping exercise to avoid duplication and engagement with key Complete
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2 players. Mark Dell assured the communication would be out soon and would include guidance for elected members. 04.06.2025 – Timeline agreed between MD & CR for end of June 2025. 08.09.2025 – MD updated that comms is due to launch on 11.09.2025 via GP’s and Health Visitors with further rollout following via HSCP and IJB 32. 25.02.25 Item 8 Financial Monitoring suggestion that Pharmacy Savings Approach could be brought back to IJB to get a restock of where things are and where they are going Ongoing 33. 19.03.2025 Item 4 Matters Arising Learning Disability Workforce paper to be brought to PF&A Update – report being presented to NL IJB on 18 June 2025 Complete 34. 35. 36. 37. 38. 39.
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3 40.
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4 CLOSED ACTIONS NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 5. 19.06.24 Item 6 Digital System Transformation M Dendy Delegate to the IJB PFA committee -To provide the IJB PFA with additional financial information relating to the programme Report provided to IJB PFA 21st August 2024 Complete 6. 19.06.24 Item 7 Mental Health & Wellbeing Delivery Plan R McGuffie Shared new action plan with the group in Sept/October Action Planned shared and stakeholder sign off currently underway. Complete 28 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to systematically share learning to identify and develop: - Service redesign focused on early intervention and prevention. - Approaches focused on improving the recruitment and retention of the workforce. “business as usual" item 29 25.09.24 Item 9 Integration Joint Boards Finance C Rae Work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully “business as usual" item
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5 and Performance Report 2024 understand and improve outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand the impact of preventative approaches. 30. 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Evaluate whether the local commissioning of care and support services, and the contracting of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people. “business as usual" item 26 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that their Medium-Term Financial Plans are up to date and reflect all current known and foreseeable costs to reflect short and longer-term financial sustainability challenges. 25.02.25 – Due to be discussed at the next IJB in March 19.03.2025 Discussed on agenda 19.03.25 Complete
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1 REPORT Item No: 7 SUBJECT: Chief Officer Report TO: Integration Joint Board Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Kerry Taylor, Business Support Manager DATE: 17 September 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Kerry Taylor, Business Support Manager ☒ Reviewed By: HSCP SMT 1 September 2025 ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS 3.1 It is recommended that the IJB Note and comment on the key areas of work and service developments that have been taking place within North Lanarkshire in relation to the work of the Integration Joint Board 4. CHIEF OFFICER REPORT 4.1 Care Reform Act The Scottish Government approved the Care Reform (Scotland) Bill on 10 June 2025 and received Royal Assent on 22 July 2025. Although more limited in scope than the original proposals for a National Care Service, the Bill introduces several key measures including: Enshrining Anne’s Law in legislation, securing the rights of adult care home residents to maintain contact with loved ones and designate an essential care supporter Strengthening support for unpaid carers by establishing a legal right to respite breaks. This follows the allocation of an additional £13 million to support up to 40,000 carers in accessing voluntary sector short breaks Enhancing access to care information and improves the flow of data across care settings, empowering individuals to make informed decisions Expanding access to independent advocacy to ensure people are heard and actively involved in decisions about their care. Establishing a National Chief Social Work Adviser to provide professional leadership and advocate for the social care sector, as part of wider plans for a new national framework Further information can be found here 4.2 Standards Commission for Scotland Following a period of consultation, the Commission has revised its Advice Note for Members of Health and Social Care Integration Joint Boards. The updated guidance outlines the responsibilities of IJB members under the ethical standards framework and aims to support them in identifying and managing potential conflicts of interest, thereby safeguarding effective governance and scrutiny processes. The Advice Note is available here
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3 4.3 Delayed Discharge In Figure 5.1 the national target performance in June (validated data) shows that North Lanarkshire HSCP has met the national target and is lower than the Scottish average (lower is better). Fortnightly Collaborative, Response and Assurance Group chaired by the Cabinet Secretary continues with a focus on Delayed Discharge performance, with the format of this meeting currently under review. 4.4 Freedom of Information Requests The Board is required to submit quarterly statistics on requests for information to the Office of the Scottish Information Commissioner (OSIC). Freedom of Information (Scotland) Act 2002 is an Act of the Scottish Parliament which gives everyone the right to ask for any information held by a Scottish public authority. During quarter 1 of 2025/2026, there were 3 information requests received. 4.5 National Records Scotland Data National Records of Scotland (NRS) publish national and local data each year for Probable Suicides and Alcohol Related Deaths. Due to the publication dates scheduled for September this year, these reports will be reported to the Integration Joint Board in December 2025.
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4 Drug Related Deaths Due to the date of publication of the following data, a more in-depth report will be presented to the IJB in December 2025. The national statistics on Drug Related Deaths are produced annually by the National Records Service (NRS) and the 2024 data was released on 2 September 2025. Across Scotland in 2025 there were 1,017 deaths due to the direct impact of drug misuse. This is a decrease of 155 deaths (13%) from 2023, and the lowest number of drug misuse deaths registered in any year since 2017. The rate of drug misuse deaths is still much higher than at the beginning of the series in 1996. The figure for 2024 in North Lanarkshire was 85, a decrease from the previous year where, 103 people died. Each and every death is one too many and we continue to work together alongside communities to improve our services and tackle the wider inequalities that lead to drug deaths. 4.6 Scotland’s Data Strategy for Health and Social Care – 2025 Update The Scottish Government and COSLA has released a progress update in the second year of Scotland’s first Data Strategy for Health and Social Care, Health and social care: data strategy - gov.scot published in February 2023. The strategy sets out the vision and ambitions for improving the use of health and social care data to deliver the best care possible for the people of Scotland. The strategy has three main ambitions: Empowering Individuals: Enable people in Scotland to access, manage, and contribute to their own health and social care data safely and appropriately Supporting Service Providers: Equip health and social care professionals with the tools and confidence to collect, use, and share data securely to improve services and outcomes Advancing Research and Innovation: Ensure secure access to high- quality data for planning, research, and innovation to enhance individual wellbeing and public health through improved care and new technologies The 2025 update sets out the progress made in 2024 and some priorities for 2025 and is based on regular discussions with delivery partners and stakeholders,
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5 reiterating the agreed approach in achieving the safe, secure and consistent use of data across Scotland’s health and care systems. Key successes include: Governance Structures Established: Formation of the Health and Social Care Data Board, along with two sub-boards—Data Delivery and Data Standards—to oversee implementation and ensure consistent data practices across the sector Improved Data Access and Use: Progress in enabling individuals to access and contribute to their own health and care data, and in supporting professionals to use data confidently and securely to improve services. Standardisation and Interoperability: Development of preferred data standards to promote consistency and interoperability across health and social care systems, facilitating better data sharing and integration. Further information on progress and future plans on the eight priority areas of the strategy can be found here 4.7 Jane Davies Award 2025 Motherwell District Nursing Team were awarded runners up for Person Centred Care. The Healthcare Improvement Scotland article states; “Motherwell Health Centre District Nursing team were recognised for their outstanding person- centred approach to an individual’s end-of-life care. Their support honoured the full identity of the individual, not just as a patient, but as, for example, a father, grandfather, footballer, gardener, and music lover. A family member described the experience as one of “care, compassion and laughter in our darkest days,” crediting the team with helping preserve joy, dignity and connection at the end of life.” 4.8 Review of Vaccination Service Delivery A review of Vaccination Service Delivery within Lanarkshire is underway. Updates will be provided to the Integration Joint Board at future meetings. 4.9 NHS Lanarkshire Recruitment
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6 Two NHS Lanarkshire Director positions have recently been advertised for recruitment as two members of staff move to other NHS Boards. An update will be provided after the positions of Acute Service Director and Executive Director of Finance have been appointed. 4.10 Meeting, Event and Media Updates The Chief Officer Group met with the Minister for Social Care and Mental Wellbeing in July 25. The discussion focused on reinforcing the financial challenge that IJB’s face alongside the demand faced NHS Lanarkshire’s Health Improvement Team in Wishaw organised a family-fun day ‘Tea in the Garden’ event at University Hospital Wishaw in July 2025 to raise awareness of services available to the local community A Winter Planning Event was held in August 2025 with South Lanarkshire HSCP, North Lanarkshire HSCP and NHS Lanarkshire to discuss the learnings from the previous winter period, with actions to follow A joint Community Planning Partnership event in scheduled for October 2025 with NHS Lanarkshire, South Lanarkshire Council and North Lanarkshire Council to focus on Population Health Framework A media article relating to Hospital Based Complex Clinical Care (HBCCC) was published in July 2025. This related to a national focus on Dementia services, however NHS Lanarkshire was mentioned due to recent changes to delivery of HBCCC within NHS Lanarkshire. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Kerry Taylor kerry.taylor@lanarkshire.scot.nhs.uk
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REPORT Item No: 8 SUBJECT: Medium Term Financial Outlook 2026-2029 TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 17 September 2025 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report advises the IJB of the medium term financial forecast position for 2026- 2029. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Acknowledge Medium Term Financial Outlook (MTFO) position for 2026/27 to 2027/29 (2) Acknowledge the forecast funding gap over the 3 year cycle (3) Recognise this outlook will be subject to ongoing review with an update reported in December before the Medium Term Financial Plan (MTFP) is presented to the Board for approval in March. (4) Acknowledge the forecast reserves position. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report provides an update on the MTFO for 2026/27 to 2028/29 and outlines the financial challenges the University Health & Social Care Partnership (the Partnership) faces over the coming three years. The assumptions reported within this outlook will continue to be reviewed and updated until the MTFP, for the three year period to 2028/29, is presented to the IJB in March 2026. 5.2 The MTFP 2025/26 – 2027/28 was approved on 19 March 2025 which indicated a 3 year budget gap of £51.854m (2025/26 £14.729m, 2026/27 £18.322 and 2027/28 Yes No N/A
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£18.804m). Taking this approved budget as the new baseline, this MTFO updates the financial planning assumptions and projected funding gap focussing on those factors which have the biggest impact on the Partnership. 5.3 This outlook assumes that the service redesign and transformation solutions approved within the MTFP in March 2025 are fully implemented to meet the 2025/26 budget gap. 6. FINANCIAL OUTLOOK 6.1 Health & Social Care Partnerships operate in a complex, challenging and changing environment where national issues can have an impact on what and how services are delivered along with the financial resources, they have available to meet this. 6.2 It is clear from the census information and the pressures being seen across all areas of health and social care in Scotland that demand continues to exceed funding available to the sector. It is also increasingly difficult to implement service redesign options which don’t directly impact on service users. However, it is essential that the Partnership maintains a service model which can be financially sustainable in the long term. 6.3 The Partnership’s financial planning arrangements remains subject to active review using a scenario-based approach in recognition of the significant uncertainty over rising costs and the scale of variability in the potential funding available to the Partnership in future years. 7. FORECAST ASSUMPTIONS 7.1 This MTFO focuses on the likely cost pressures that the Partnership can reasonably expect over the next three years. These assumptions have been informed by the local and national context within which the Partnership operates. Contractual Pressures 7.1.1 The National Care Home Rate will not be known until Spring 2026. An annual 10% increase was included in the current MTFP with the actual increase being 6.8%. For the financial outlook it is prudent to keep the envisaged increase at 10% which results in a provision of £4.893m for 2025/26 and £16.198m for the 3 year finance cycle. This will be reviewed as necessary throughout the year. 7.1.2 Contract inflation for Care at Home provision represents the increases to the Scottish Living Wage which is unknown at this stage, therefore the financial outlook includes an average of the weighted 2025/26 increase. This results in a provision of £6.596m for 2026/27 and £20.594m for the 3 years. 7.1.3 A provision of £2.969m has been included in the 2026/27 outlook for inflationary pressures across the Partnership. This is based on the OBR’s Economic and Fiscal Outlook as at March 2025. Demand Pressures – Social Care 7.1.4 Demand on social care services continues to increase which has been well reported through the 2022 census information. A provision of £19.228m has been included over the next 3 years which is based on an average 5% increase. The 2026/27 value is £1.193m which assumes the £10.686m savings are fully achieved in 2025/26.
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Pay Pressures 7.1.5 Employee costs represent 34% of the IJB net budgets therefore any increase in pay awards have a material impact on the forecast plan. 2025/26 Pay Award A pay offer has been agreed for NHS Agenda for Change staff at 4.25% in 2025/26 which is higher than the 3% included in the MTFP presented to the Board in March. The budgeted increase was based on the Scottish Government’ Public Sector Pay Policy of a 9% increase over 3 years. The expectation is that Scottish Government will provide the necessary funding to meet the 1.25% increased offer. The 2025/26 MTFP also includes a 3% increase for council services pay award, however an offer of 4% has been agreed. It is also anticipated that Scottish Government will fund the differential for Council staff therefore there is no change in relation to these cost projections. Pay Award – Future Years For future years the projected pay awards have been budgeted at 3% again reflecting the Public Sector Pay agenda. A total provision of £6.041m is estimated for 2026/27 and £18.287m for the 3 year planning period to 2028/29. These assumptions will remain under review as negotiations continue. Prescribing 7.1.6 In 2024/25 the cost of prescribing to the Partnership was £81.7m which represented an overspend of £4.757m and also a 4% increase on the 2023/24 position. The price of drugs is set nationally and influenced by factors such as supply and demand, currency movements and patents. Activity is a clinical decision, and demand is ever changing despite positive work being undertaken to reduce the number of drugs prescribed. The MTFP included a 10% increase for 2026/27 and 2027/28; based on current projections this remains unchanged for this financial outlook. The provision for 2026/27 is £8.534m with the total 3 year provision being £28.249m Reinstatement of Non Recurring Solutions 7.17 In 20254/25 and 2025/26 a number of non-recurring solutions were used to support the budget gaps and as yet recurring solutions have not been identified to replace these budgets therefore £16.260m has been included as a cost pressure to reinstate these. Funding 7.1.8 Funding contributions from both Partners are significantly influenced by the Scottish Government Finance Settlement which will remain unknown until December. The MTFP currently includes a 3% increase on Health Services and 5.23% for Council Services. These forecasts would generate recurring income of £20.610m in 2026/27 and £64.288m over the 3 years. 8. MEDIUM TERM FINANCIAL OUTLOOK SUMMARY 8.1 Using the financial planning assumptions detailed in section 7, a range of risk-based scenarios have been considered, resulting in envisaged, pessimistic and optimistic positions. 8.2 Table 1 provides a summary of these scenarios over the forthcoming 3 years.
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Table 1 Forecast Gap 2025/26 £000 2026/27 £000 2027/28 £000 Total £000 Envisaged £26,241 £17,727 £19,420 £63,388 Optimistic £24,855 £12,902 £13,813 £51,569 Pessimistic £35,997 £23,346 £25,972 £85,314 8.3 It is recommended that the IJB progresses with a financial strategy based on the envisaged scenario. This scenario projects an estimated budget gap of £63.388m over the 3-year planning period 2026/27 to 2028/29 of which £26.241m relates to 2026/27. 8.4 Over the coming months, savings options will be developed by the Senior Management Team and be presented at a future IJB Development Day for discussion ahead of being presented to the next IJB in December. A proposed timeline is presented in Table 2. Table 2: Budget Setting Timeline Date Meeting Purpose TBC - October IJB Development Day Discussion on savings proposals TBC - November IJB Development Day Discussion on savings proposals 3rd December 2025 Integrated Joint Board Medium Term Financial Outlook Update 2026/27 – 2028/29. TBC - January IJB Development Day Discussion on savings proposals 18th March 2026 Integrated Joint Board Approval of Medium Term Financial Plan 2026/27 – 2028/29 and Long Term Financial Outlook to 2036. 9. Reserves 9.1 As reported to the performance, Finance & Audit Committee in August, the year end reserves position is currently forecast as £72.556m as shown in Table 3. Table 3 Reserves £m Ring Fenced 14.190 Earmarked 22.711 Sub Total 36.901 Risk Based 21.536 Contingency 14.119 Sub Total 35.655 Total 72.556 9.2 Assuming all 2025/26 savings are achieved, and the Partnership closes the financial year with a break even position the level of useable reserves from this total will be £35.655m. Therefore, if savings are not identified to address the projected £26.241m budget gap in 2026/27, three quarters of these useable reserves will be utilised during next financial year.
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10. IMPLICATIONS 10.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 10.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 10.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 10.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated where necessary. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 10.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken.
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Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 10.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 11. BACKGROUND PAPERS None. 12. APPENDIX None Nicola Scott Chief Finance Officer Members seeking further information, please contact Nicola Scott on 07581 007187.
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1 REPORT Item No: 9 SUBJECT: Annual Performance Report 2024/25 – University Health & Social Care North Lanarkshire TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest, Performance Manager DATE: 17 September 2025 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. RECOMMENDATIONS It is recommended that the IJB: (1) Review the content of the draft Annual Performance Report 2024/25 – University Health & Social Care North Lanarkshire, which is appended to this report. (2) Approve for publication the content of the draft Annual Performance Report 2024/25 – University Health & Social Care North Lanarkshire. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES The Public Bodies (Joint Working) Regulations 2014 requires that North Lanarkshire IJB publish an Annual Performance Report by July 31st, every year. The content of the Annual Performance Report is focused on the National Integration Indicators (the Core Suite and Ministerial Steering Group indicators). The purpose of standardising Annual Performance Reports for Integration Authorities is to support consistency of reporting for these indicator sets, facilitate benchmarking and provide a suitable framework for understanding the performance of Health and Social Care services. The Annual Performance Report 2024/25 – University Health & Social Care North Lanarkshire (APR) presents our performance in relation to these metrics, performance information relating to inspections carried out by the Care Inspectorate, alongside additional local performance information in the form of the Chief Executive’s scorecard. Progress against the National Health & Wellbeing Outcomes is also described in the report. There is a dedicated section presenting and describing financial performance for 2024/25. 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 they do not publish until July 2025; the prior publications of the data set are for use as management information only. The APR document appended is a draft, pending approval. Members should note the most up-to-date available has been used in the report, however for many indicators this relates to previous years. The results of indicators NI1 – NI9 derive from the National Health and Care Experience Survey and for indicators NI2 – NI7 and NI9; the results are not comparable to previous years due to changes in the wording of the survey. For indicator NI11, data is only available up to calendar year 2023. For indicators NI12 – NI16 and NI18, we have presented the performance for calendar year 2024 per the instruction of Public Health Scotland, as the 2024/25 data for these indicators has not been validated for publication. Yes ☐ No ☐ N/A ☒
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3 6. CONCLUSIONS The Annual Performance Report 2024/25 – University Health & Social Care North Lanarkshire describes progress made in pursuit of the National Health & Wellbeing Outcomes against the challenging position for Health and Social Care nationally, reflected in the performance for some of the metrics presented in the report. Performance in North Lanarkshire is broadly comparable with similar authorities and the Scottish average in many areas; the Health and Social Care Partnership actively manages any areas requiring performance improvement through its established performance framework. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The content of the Annual Performance Report focusses on the National Integration Indicators (the Core Suite and Ministerial Steering Group indicators). A performance framework is in place within University Health and Social Care North Lanarkshire to ensure the continual monitoring of performance data and information, and any improvement actions associated with performance monitoring. 7.3 FINANCIAL This paper has been reviewed by Finance:
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4 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB 11.21 - Oversight of Performance Activity Low Claire Rae NLC RIA0000460 – Performance & planning High NLC – Social Work/Social care 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services The Annual Performance Report outlines the roles of our community stakeholders and highlights their active contribution to service delivery across North Lanarkshire. ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery The APR provides information on engagement with and participation of community stakeholders. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings The APR provides performance information that will enable stakeholder representatives to participate in wider discussions about performance. ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Yes ☐ No ☐ N/A ☒
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5 ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership The performance information included in the APR supports locality planning. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS The results for each General Practice, General Practice Cluster, Health and Social Care Partnership and NHS Board, as well as time series trends where applicable, are available via an online dashboard hosted by Public Health Scotland. 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 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-1-july- 2025/#:~:text=These%20indicators%20were%20developed%20to,services%20should%20m ake%20for%20people. 9. APPENDICES Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
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6 Appendix One – Annual Performance Report 2024/25 – University Health & Social Care North Lanarkshire CHIEF ACCOUNTABLE OFFICER (or Depute) Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following; Stephen Forrest – Performance Manager Stephen.Forrest@lanarkshire.scot.nhs.uk
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7 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Foreword As the new Chief Officer for University Health and Social Care North Lanarkshire, I’m proud to present our Annual Performance Report for 2024/25. This report reflects the dedication of our staff, collaboration as partners and the progress made across our partnership to improve the health and wellbeing of our communities. Over the past year, we’ve continued to strengthen our commitment to person-centred care, focusing on prevention, early intervention, and doing the right thing well, first time. Our work is shaped by a rights-based approach, delivered through a trauma-informed lens and driven by a shared goal to reduce inequalities. Engaging with communities and listening to what matters most to people is central to how we work. One of the most rewarding parts of my role is connecting with colleagues, partners, and people with lived experience; your insights and commitment are the foundation of our Whole System Approach to care. This report highlights key achievements, including progress in supporting older adults through our Frailty Strategy, improvements in mental health services and the development of innovative digital solutions that enhance access and integration. I’m also pleased to recognise the vital role of our community and voluntary partners in extending the reach and impact of our services. All of our work aligns with the wider ambitions of the “Plan for North Lanarkshire” and NHS Lanarkshire’s “Our Health Together” strategy. None of this would be possible without the dedication of our staff, partners, and volunteers. I’d also like to thank my predecessor, Ross McGuffie, for his leadership and contribution to University Health and Social Care North Lanarkshire. While challenges remain, we are committed to building on our successes through innovation and collaboration, delivering the right care, at the right time, to help people live healthier lives in the heart of their communities.
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Introduction Welcome to the 2024/25 Annual Performance Report for University Health and Social Care North Lanarkshire. We’re pleased to share this year’s Annual Performance Report, covering the period from April 2024 to March 2025. This report offers a comprehensive overview of how we’ve performed across key national and local indicators, including the National Health & Wellbeing Outcomes, Core Integration Indicators, Ministerial Strategic Group measures, and our own local benchmarks. Throughout the year, the Integration Joint Board has received regular updates on our progress, and you can explore these reports alongside previous Annual Performance Reports on our website: www.hscnl.org.uk. This report is more than just data, it’s a reflection of the dedication, collaboration, and innovation shown by our teams, partners and communities. It celebrates the achievements of our services and the people behind them, whilst also acknowledging the challenges we face and some of the work undertaken to address them. The first section focuses on statutory performance reporting, including national comparisons, benchmarking and trend analysis. In some cases, data limitations have impacted our ability to present a full picture; where this occurs, we’ve explained the reasons clearly. The remainder of the report dives deeper into each of the National Outcomes, showcasing the progress, improvements, and impact of our work throughout 2024/25.
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4 Executive Summary 2024/25 has been a year of transformation, innovation and collaboration for University Health and Social Care North Lanarkshire (UHSCNL). As we continue to recover from the long-term impacts of the COVID-19 pandemic and respond to increasing demand and complexity, our focus has remained firmly on delivering high-quality, person-centred care that supports people to live well in their communities. This year, we celebrated several key milestones: • The Home Assessment Team (HAT) supported its 3,000th person, enabling more people to return home safely from hospital with the right support at the right time. • The Chryston Community Hub officially opened, providing integrated health, education, and wellbeing services in a state-of-the-art facility. • We launched the Engagement and Participation Strategy 2024–2027, backed by the new Growth Pot Fund, to strengthen community voice and co-design. • The North Lanarkshire Carers Strategy 2024–2027 was launched at our second annual Commitment to Carers event, reinforcing our pledge to support unpaid carers. • Our Assistive Technology Team expanded its reach, embedding a “tech-first” approach across localities and reducing pressure on traditional services. • We achieved UNICEF Gold Baby Friendly Accreditation and surpassed 50% breastfeeding rates for the first time in North Lanarkshire. • The Care Academy continued to grow, offering structured vocational pathways and apprenticeships to support workforce sustainability. We also made significant progress in strategic planning and governance: • The Strategic Commissioning Plan 2023–2026 underwent a mid-cycle review in February 2025. Four of the five work streams were rated Green, with Community Engagement & Co-design rated Amber, reflecting our ongoing efforts to deepen participation. • The Integration Joint Board (IJB) approved a balanced budget for 2025/26, ensuring continued investment in prevention, early intervention, and community-based care. Our academic partnerships with the University of Strathclyde, Glasgow Caledonian University, and the University of the West of Scotland have flourished, positioning UHSCNL as a University-designated operating division and a national leader in research, innovation, and workforce development. As we look ahead, our priorities remain clear: to do the right thing first time, to support people and communities through prevention and early intervention, and to ensure that our workforce, systems, and services are equipped to meet the needs of today and tomorrow.
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5 Contents Foreword ...................................................................................................................................... 2 Introduction ................................................................................................................................... 3 Executive Summary ..................................................................................................................... 4 National Health and Wellbeing Outcomes .................................................................................... 7 National Health and Wellbeing Outcomes Framework ................................................................. 8 Performance Dashboard ........................................................................................................... 8 Scottish Health and Care Experience Survey ........................................................................... 9 National Outcome Indicators – Benchmarking – 2023/24 ....................................................... 10 Core Suite of Integration Indicators ........................................................................................ 11 National Integration Indicators – Benchmarking – 2023 ......................................................... 13 Measuring Performance Under Integration (MPUI) .................................................................... 14 Managing Performance Under Integration ................................................................................. 18 Community Solutions .............................................................................................................. 18 Digital Health Innovation: Mari One Pilot ................................................................................ 18 Frailty Strategy ........................................................................................................................ 19 Home Assessment Teams (HAT) and Home Support Redesign ............................................ 19 Assistive Technology - Embedding a “tech-first” approach in North Lanarkshire. ................... 20 “Our Health Together” Strategy .............................................................................................. 23 Community Nursing Review .................................................................................................... 23 Breastfeeding Milestones ........................................................................................................ 24 UNICEF Gold Baby Friendly Accreditation ............................................................................. 24 Breastfeeding Friendly Scotland ............................................................................................. 24 North Lanarkshire Carers Strategy 2024–2027 ...................................................................... 25 World Mental Health Day 2024 ............................................................................................... 26 Child and Adolescent Mental Health Service (CAMHS) .......................................................... 26 Psychiatric liaison nursing team win collaboration award for transforming mental health crisis care ......................................................................................................................................... 26 Academic Partnerships ........................................................................................................... 27 Care Academy & Apprenticeships .......................................................................................... 27 Summary of Financial Performance ........................................................................................... 28
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6 Care Inspectorate Grades 2024/25 ............................................................................................ 31 NLC Care Homes ................................................................................................................... 32 Other services ......................................................................................................................... 33 Strategic Planning ...................................................................................................................... 34 Strategic Commissioning Plan 2023–2026: Mid-Cycle Review ............................................... 34 Looking Forward – Our Next Steps ......................................................................................... 37 Development of a new Strategic Commissioning Plan ........................................................... 38 Appendices ................................................................................................................................. 39 Appendix 1 – Summary of Performance against Core Suite of Integration Indicators ............ 39 Appendix 2 – HSCP Performance Dashboard ........................................................................ 41 Appendix 3 – Inspection Findings 2024/25 ............................................................................. 44 Glossary of Terms ...................................................................................................................... 51
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7 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 who 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 who use 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
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8 National Health and Wellbeing Outcomes Framework Since 2016/17, Integration Authorities have been required by legislation to report on the Core Suite of Integration Indicators within their Annual Performance Reports. These indicators were developed to help Integration Authorities review their progress towards achieving each of the National Health and Wellbeing Outcomes, which focus on improving how services are provided and the difference that integrated health and social care services should make for people. The indicators were developed in consultation with a wide range of stakeholders and are intended for consideration within the wider context of health and social care. They help us, as a partnership, identify areas for improvement and assist us with planning for the future. Indicator values are derived from national data sources for each of the 23 indicators to enable comparability between local areas and with Scotland. There are 23 indicators in total, comprising nine indicators based on the Health and Care Experience Survey and ten other measures mainly using health activity, community and deaths information. The remaining four indicators cannot be reported on as national data is not available or there is not yet a nationally agreed definition. The nine indicators based on the Health and Care Experience Survey, which has been run every two years since 2009, detail people's experiences of accessing and using various services. The Health and Care Experience Survey (successor to the GP and Local NHS Services Patient Experience Survey) asks about people’s experiences of accessing and using their GP practice and Out of Hours services, aspects of care and support provided by local authorities and other organisations and caring responsibilities and related support: https://www.gov.scot/publications/national-health-wellbeing-outcomes-framework Performance Dashboard The Health & Social Care Partnership also has in place a corporate performance dashboard which is monitored and reported on a quarterly basis and is attached as Appendix 2. This comprises a range of performance metrics and Key Performance Indicators that are used to give the Strategic Leadership Team and Integration Joint Board an assurance of progress against key performance targets.
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9 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 91.68% 90.34% 90.49% 87.45% 87.41% 90.66% ⬇ ⬇ NI - 2 Percentage of adults supported at home who agreed that they are supported to live as independently as possible 82.99% 75.44% 77.55% 79.83% 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 75.44% 71.37% 71.18% 67.05% 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 73.35% 69.72% 70.21% 66.55% 56.04% 61.36% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 77.66% 75.43% 77.83% 74.02% 65.76% 70.02% NI - 6 Percentage of people with positive experience of care at their GP practice 79.32% 75.51% 68.34% 51.81% 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 83.80% 75.59% 75.71% 76.97% 67.70% 69.75% NI - 8 Percentage of carers who feel supported to continue in their caring role 41.18% 33.16% 32.58% 25.11% 28.46% 31.19% ⬆ ⬆ NI - 9 Percentage of adults supported at home who agreed they felt safe 83.70% 79.87% 79.98% 79.84% 68.44% 72.67% N.B. Please note results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years due to changes in survey wording. Also results for 2019/20 and 2021/22 for indicators 2, 3, 4, 5, 7 and 9 are comparable to each other, but not directly comparable to figures in previous years due to changes in survey wording and methodology.
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10 National Outcome Indicators – Benchmarking – 2023/24 Indicator Scotland North Lanarkshire East Ayrshire Eilean Siar Dundee City North Ayrshire Inverclyde West Dunbartonshire Glasgow City Percentage of adults able to look after their health very well or quite well 90.66% 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% 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.
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11 Public Health Scotland Data 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. 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 2018 NL 2019 NL 2020 NL 2021 NL 2022 NL 2023 Scotland 2023 HSCNL Trend Scotland Trend NI -11 Premature mortality rate per 100,000 persons 515 513 578 575 507 545 442 ⬇ ⬇ Please note that only data from 2018 - 2023 is available for this indicator. Indicator Title NL 2019/20 NL 2020/21 NL 2021/22 NL 2022/23 NL 2023/24 NL 2024 Scotland 2024 HSCNL Trend Scotland Trend NI – 12 Emergency admission rate (per 100,000 population) 16280 13828 15120 15030 14615 12683 11559 ⬆ ⬆ Please note that only data from 2018/19 - 2023/24 and calendar year 2024 is available for these indicators. NI – 13 Emergency bed day rate (per 100,000 population) 124636 108735 124594 130646 128123 120763 113627 ⬆ ⬆ NI – 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 106 123 115 117 114 112 103 ⬆ ⬆
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12 NI – 15 Proportion of last 6 months of life spent at home or in a community setting 89.0% 90.3% 89.8% 89.0% 88.9% 88.9% 89.2% ⬌ ⬆ NI – 16 Falls rate per 1,000 population aged 65+ 21.2 19.1 20.5 19.7 21.1 22.1 22.5 ⬇ ⬆ Indicator Title NL 2019/20 NL 2020/21 NL 2021/22 NL 2022/23 NL 2023/24 NL 2024/25 Scotland 2024/25 HSCNL Trend Scotland Trend NI – 17 Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections 83.3% 80.1% 78.1% 77.0% 75.8% 77.5% 81.9% ⬆ ⬆ Indicator Title NL 2019 NL 2020 NL 2021 NL 2022 NL 2023 NL 2024 Scotland 2024 HSCNL Trend Scotland Trend NI – 18 Percentage of adults with intensive care needs receiving care at home 74.4% 75.1% 75.0% 71.5% 69.7% 65.6% 64.7% ⬇ ⬆ Please note that only data from 2018 - 2024 (calendar years) is available for this indicator. Indicator Title NL 2019/20 NL 2020/21 NL 2021/22 NL 2022/23 NL 2023/24 NL 2024/25 Scotland 2024/25 HSCNL Trend Scotland Trend NI – 19 Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) 1109 781 821 950 953 825 952 ⬆ ⬇
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13 National Integration Indicators – Benchmarking – 2023 Indicator Scotland North Lanarkshire East Ayrshire Western Isles Dundee City North Ayrshire Inverclyde West Dunbartonshire Glasgow City Latest data Premature mortality rate per 100,000 442 545 491 461 549 507 532 487 591 2023 Emergency admission rate per 100,000 11559 12683 14738 13005 15134 15142 12937 13628 11800 2024 Emergency bed day rate for adults per 100,000 113627 120763 125635 142814 105532 155896 146476 147797 129781 2024 Emergency readmission to hospital within 28 days of discharge (per 1,000 discharges) 103 112 111 87 139 106 83 85 92 2024 Proportion of last 6 months of life spent at home or in the community 89.2% 88.9% 89.3% 87.5% 90.9% 87.6% 88.2% 87.0% 87.6% 2024 Falls rate per population aged 65+ 22.5 22.1 21.3 23.8 34.0 23.0 24.1 22.2 28.9 2024 Proportion of care services graded ‘Good’ (4) / better in Care Inspectorate Inspections 81.9% 77.5% 88.1% 84.6% 82.6% 86.6% 83.6% 79.4% 89.6% 2024/25 Percentage of adults with intensive care needs receiving care at home 64.7% 65.6% 70.1% 54.3% 65.9% 77.0% 66.6% 70.1% 62.0% 2024 Number of days people aged 75+ spend in hospital when ready to be discharged, per 1,000 population 952 825 652 1848 245 1266 340 1022 1107 2024/25
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14 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 that we can improve across a range of areas. Measuring Performance Under Integration (MPUI) Emergency Admissions - Based on agreed trajectories, our objective for 2024/25 was to achieve a reduction in emergency admissions by March 2025. Performance throughout the year was generally positive; either in- line with, or positive when compared with the trajectory set. 0 1,000 2,000 3,000 4,000 5,000 North Lanarkshire Emergency Admissions April 2019 - March 2025 Performance Trajectory
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15 The agreed trajectory for 2024/25 was for a reduction in the number of A&E attendances and the level of performance delivered was generally positive when compared with the trajectory set. Unscheduled Bed Days - Based on agreed trajectories, our objective for 2024/25 was to achieve a reduction in the number of unscheduled bed days. The trajectory for the reduction in bed days reflected the ongoing work to reduce length of stay, including the development of the Target Operating Model, the Flow Navigation Centre and the continued work across all acute and community wards to improve efficiency and effectiveness. 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 Apr-19 Jul-19 Oct-19 Jan-20 Apr-20 Jul-20 Oct-20 Jan-21 Apr21 Jul21 Oct21 Jan22 Apr-22 Jul-22 Oct-22 Jan-23 Apr-23 Jul-23 Oct-23 Jan-24 Apr-24 Jul-24 Oct-24 Jan-25 North Lanarkshire A&E Attendances April 2019 - March 2025 Performance Trajectory 0 5,000 10,000 15,000 20,000 25,000 30,000 Apr-19 Jul-19 Oct-19 Jan-20 Apr-20 Jul-20 Oct-20 Jan-21 Apr21 Jul21 Oct21 Jan22 Apr-22 Jul-22 Oct-22 Jan-23 Apr-23 Jul-23 Oct-23 Jan-24 Apr-24 Jul-24 Oct-24 Jan-25 North Lanarkshire Unscheduled Care Bed Days Acute Specialties April 2019 - March 2025 Performance Trajectory
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16 Delayed Discharge - Based on agreed trajectories, our objective for 2024/25 was to reduce the number of occupied bed days due to standard delays. There was significant effort to improve our locality and community response to facilitating hospital discharges, including the development of Getting It Right for Everyone and our Enabling Approach, which contributed to a significant reduction in bed days. End of Life Care – The percentage of the last six months of life spent at home, or in community settings is high and remains above the targeted level, reflecting the positive balance of care and commitment to caring for people in their home, or a homely setting. 0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 Apr-19 Jul-19 Oct-19 Jan-20 Apr-20 Jul-20 Oct-20 Jan-21 Apr-21 Jul-21 Oct-21 Jan-22 Apr-22 Jul-22 Oct-22 Jan-23 Apr-23 Jul-23 Oct-23 Jan-24 Apr-24 Jul-24 Oct-24 Jan-25 Delayed Discharge Bed Days Standard Delays April 2019 - March 2025 Standard bed days Target Trajectory 81.0% 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 a community setting Community Community Target
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17 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 80.0% 82.0% 84.0% 86.0% 88.0% 90.0% Balance of Care Home (unsupported) 75+ Home (unsupported) Home (unsupport) Target
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18 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 Community Solutions The Community Solutions programme is a cornerstone of our preventative and early intervention approach. Hosted by Voluntary Action North Lanarkshire (VANL), the programme funds a wide range of community- led initiatives that improve health, wellbeing, and equality across North Lanarkshire. In 2024/25, the programme supported over 1,600 people through the Improving Lives Initiative and Improving Cancer Journeys (ILI/ICJ). Digital Health Innovation: Mari One Pilot In 2024/25, North Lanarkshire, in partnership with Strathclyde University and Mari One Ltd, supported the delivery of a remote health monitoring project. Mari One provide biometric sensing and intelligent software to monitor the health and wellbeing of people at home and in the community, as well as patients in hospital. The challenges associated with demographic change mean we have to think differently, understanding how to keep people healthy, active and shape our services and responses to support this. The project measures frailty on the Rockwood score using a wearable sensor to demonstrate the capabilities of digital health solutions and empowers those taking part by providing them with better understanding of their health. Participants actively involved in the co- designed Getting It Right For Everyone work volunteered to take part in the project and attend weekly drop ins at Newmains & St Brigid’s Community Hub.
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19 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 Frailty Strategy A “One Year On” event in November 2024 was held to mark the first full year of implementation of the Lanarkshire Strategy for Preventing and Managing Frailty 2023 – 2028. The event showcased progress in early identification, community engagement and acute-community interface working. It also reinforced the strong commitment of partners to the continued implementation of the strategy. In 2025/26, our efforts will focus on work to facilitate the earliest identification of frailty, allowing for the earliest access to preventative services. This work will involve engagement with our community partners to address any inequalities that might exist and how technology can be used to promote independent living. Work will also continue to refine frailty pathways within acute settings, while collaborating with community and interface teams to establish robust support systems that enable people living with frailty to remain in their homes. Home Assessment Teams (HAT) and Home Support Redesign Home Assessment Teams are now fully embedded across all localities. In August 2024, the service supported its 2,000th person to return home safely from hospital. The positive momentum has continued throughout 2024/25 and the 3000th person was supported in February 2025. In 2025/26, we will continue with our redesign of Home Support services to improve outcomes for the people using the service, ensuring that people receive a holistic assessment of their need and are provided with the most appropriate services to meet outcomes for individuals.
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20 Assistive Technology - Embedding a “tech-first” approach in North Lanarkshire. In 2024/25, the Assistive Technology Team significantly expanded its reach. The team was created to promote the use of technology to enhance the lives of North Lanarkshire's most vulnerable residents. Throughout the year, the team has strengthened connections and collaborative working across the partnership, reducing pressures on other services through the use of technology and encouraging a "tech first" mindset when assessing need and planning supports. Highlights include: • Deployment of Komp devices for medication support • Development of a cognitive kit for young people in transition • A high-demand Assistive Technology Flat showcasing digital solutions • Collaboration with DHI and CENSIS on fall prevention and self-assessment tools The Technology Team aim to increase the independence, safety, health, and wellbeing of those they support, reduce social isolation and alleviate carer stress. As part of our Enabling Approach, the team intervene earlier in care, diverting from services facing high demand, minimising unnecessary input and reducing waiting times. The team also provide North Lanarkshire’s assistive technology flat, which showcases a blend of equipment and mainstream technology. The team facilitates educational visits on the role of technology and the positive impacts that it can have on outcomes. The team have also expanded the use of Komp, a simple one-button computer designed for self-answering video calls to support individuals in safely managing their medication at home and maintaining their independence in this essential aspect of daily life.
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21 Technology Enabled Care – Digital Transformation Digital transformation is reshaping how we deliver services across University Health and Social Care North Lanarkshire, with Adult Social Work Services leading on a programme of technology- enabled change. These developments align with North Lanarkshire Council’s Digital Programme of Work and will modernise practice and improve outcomes for people and communities. Projects such as the new Mosaic Social Work case management system and the Dynamic Scheduling Tool for Home Support are enabling better access to information and a more efficient use of staff resources. Alongside this, the Assistive Technology Team is embedding a “tech-first” approach in everyday practice, ensuring that we consider digital solutions at every stage of care planning. Building on this foundation, dedicated programmes of work are advancing specific priorities in Technology Enabled Care. No Need to Fall The No Need to Fall project is a collaborative, technology-enabled initiative designed to reduce the risk of falls and improve responses when they occur. The approach is co-designed with people who have lived experience of falls, as well as professionals and carers. Two core components are in development: • A Personal Data Store (PDS), providing a secure digital space for individuals to hold and share personal information such as preferences, emergency contacts, and care networks • A Digital Front Door (DFD), a personalised online platform offering tailored access to information, guidance, and community supports. We are delivering the project in partnership with South Lanarkshire Health and Social Care Partnership, NHS Lanarkshire, the University of Strathclyde, the Digital Health & Care Innovation Centre, and third sector partners. The project is now in its third phase and is piloting the model more than 20 people in Lanarkshire. This work builds on Lanarkshire’s Falls Strategy (2020–2025) and has national support through the Health Foundation and the Digital Health & Care Innovation Centre.
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22 Analogue to Digital We continue to transition the community alarm service from analogue to digital to meet the retirement of analogue telephone networks by December 2025. The council will join the National Shared Alarm Receiving Centre (ARC), a digital, cloud-based solution that will replace the current analogue system. There is significant progress with device replacement; we have replaced over 3,400 analogue units, with approximately 3,000 still to complete. In addition, we have procured digital telecare peripherals to support people in the community. The Digital Office for Scottish Local Government formally recognised North Lanarkshire’s progress through the award of their Bronze Digital Telecare Implementation Award, reflecting the successful replacement of more than half of analogue devices to date. Broadband Connectivity Opportunities Building on the progress already made, North Lanarkshire Council’s long-term plan to deliver free internet access to over 36,000 council homes represents a significant step in addressing digital exclusion. The provision of an ultrafast, secure and reliable internet service will connect people and communities, broaden opportunities for education and employment, and provide the foundations for enhanced digital health and social care. Universal connectivity creates the conditions for a wider range of TEC solutions. These include smart-home models designed around individual needs, and supports digital telecare innovations, such as remote check-ins, video- observed medicines and automated reminders for daily routines. These innovations can improve safety, enhance independence, reduce carer stress and provide greater choice and control in how people interact with services. Connectivity at scale supports new approaches to service planning, improves data and strengthens prevention through early identification of risk. The provision of free broadband will unlock innovation, improve outcomes, reduce inequalities, and ensure services are equipped to meet future needs. Together, these initiatives reflect the scale of transformation underway and a strong commitment to leveraging digital innovation to deliver safer, more responsive and person- centred support.
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23 National Health and Wellbeing Outcome 3 People who use health and social care services have positive experiences of those services and have their dignity respected 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 “Our Health Together” Strategy In July 2024, NHS Lanarkshire approved its new healthcare strategy, “Our Health Together – Living Our Best Lives in Lanarkshire.” This seven-year plan sets the direction for redesigning acute and primary care services, with a strong focus on: • Improving access to services • Reducing health inequalities • Supporting staff wellbeing • Promoting health improvement and prevention The strategy was shaped by extensive engagement with patients, carers, staff, and communities, including children and young people. Community Nursing Review Following the 2023 Community Nursing Review, a new Vision & Model for Community Nursing was launched in October 2024. The model supports a shift from reactive to proactive care, with a focus on: - Direct nursing care - Health promotion and education - Future care planning - Supporting self-care and carers This work aligns with the principles of Healthy Ageing and the “Living Our Best Lives” vision.
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24 National Health and Wellbeing Outcome 5 Health and Social Care Services contribute to reducing health inequalities Breastfeeding Milestones North Lanarkshire achieved a major milestone in 2024/25, with breastfeeding rates exceeding 50% for the first time, reaching 50.7% at their highest. This reflects growing awareness and support for infant health across the area. UNICEF Gold Baby Friendly Accreditation Lanarkshire maternity services were awarded the prestigious UNICEF Gold Baby Friendly Accreditation in 2024/25, recognising excellence in supporting breastfeeding and mother-baby relationships. The award was presented at the 5th Annual Lanarkshire Breastfeeding Conference in September 2024. Breastfeeding Friendly Scotland A significant milestone was achieved with over 670 business across the area now signed up to The Breastfeeding Friendly Scotland Scheme. The scheme promotes positive experiences for breastfeeding mothers while they are out in public. It ensures that mothers feel comfortable and confident to feed their babies without interruption or judgement. This initiative is making a real difference by creating supportive, welcoming environments for breastfeeding mothers.
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25 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 North Lanarkshire Carers Strategy 2024–2027 North Lanarkshire has a strong history of engagement and participation. The partnership and the partner agencies have long-standing relationships with supported people, carers and community organisations. This approach has ensured that the citizens of our area influence, inform and shape our local policy, strategy, and services. This approach to engagement and participation has helped carers, supported people and carer focused organisations influence and shape the range of carer services described within our local Carers Strategy 2024 -2027. Launched at the second annual Commitment to Carers event in May 2024, the new Carers Strategy builds on North Lanarkshire’s strong history of engagement and co-design. The strategy was shaped by carers, supported people and carer-focused organisations. The strategy sets out a clear vision to improve outcomes for unpaid carers. Key achievements to support carers in 2024/25 have included: • Expansion of the Carer Breather programme to 15 community organisations, reducing isolation and fostering community connections. • Introduction of Carer Outcome Grants, offering financial support for immediate caring needs. • Increased funding to PAMIS, supporting 160 families caring for someone with profound and multiple disabilities. • New support initiatives for carers of people with dementia, delivered in partnership with Alzheimer Scotland. • Extended contracts and investment in HOPE for Autism, Lanarkshire Carers, and Action for Children Young Carers Project. • Joint awareness events with the Assistive Technology Team, promoting tech-enabled support for carers and those that they care for.
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26 National Health and Wellbeing Outcome 7 People using health and social care services are safe from harm World Mental Health Day 2024 To mark World Mental Health Day on 10 October 2024, UHSCNL hosted a vibrant community event at the newly opened King George V Community Garden at University Hospital Wishaw. The theme, “Workplace Mental Health,” highlighted the importance of supporting staff wellbeing and promoting positive mental health across all settings. The event featured practical activities and community engagement, reinforcing the link between green spaces, social connection, and mental wellbeing. Child and Adolescent Mental Health Service (CAMHS) The Child and Adolescent Mental Health Service (CAMHS) continued to embed the Choice and Partnership Approach (CAPA), improving access and reducing waiting times for young people. Throughout 2024/25, the service delivered improved waiting times performance in-line with the planned trajectory and had exceeded the performance target by March 2025. Psychiatric liaison nursing team win collaboration award for transforming mental health crisis care The psychiatric liaison nursing team received national recognition for their work in transforming mental health crisis care, winning the Collaboration Award at the 2024 NHS Staff Awards, in recognition of their exceptional work in transforming mental health crisis care and their outstanding partnerships with emergency services. The team has redefined how mental health emergencies are handled and have had a profound impact on reducing mental health- related presentations in Accident & Emergency Departments. The Scottish Government are exploring how this service could be expanded across other health boards, with the potential to transform mental health crisis care throughout Scotland.
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27 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 Academic Partnerships In 2024/25, University Health and Social Care North Lanarkshire continued to strengthen its academic partnerships with: - University of Strathclyde - Glasgow Caledonian University - University of the West of Scotland These partnerships have enabled collaborative research, innovation, and workforce development across a range of disciplines. A Memorandum of Understanding was signed by University of Strathclyde with North Lanarkshire Council, consolidating the status as a University-designated operating division of NHS Lanarkshire. “This renewal reinforces our commitment to translate our research and innovation into high-impact applications.” PROFESSOR SIR JIM MCDONALD, UNIVERSITY OF STRATHCLYDE Care Academy & Apprenticeships The Lanarkshire-wide Care Academy continues to grow, offering structured vocational pathways into health and social care. In 2024/25, the Academy: - Expanded its reach across both North and South Lanarkshire - Strengthened links with local schools, colleges, and universities - Supported new graduate apprenticeships and student placements - Promoted career pathways through the “Prepare to Care” platform The Academy plays a key role in addressing workforce challenges and supporting the ambitions of both new entrants and existing staff.
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28 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 challenges experienced in 2023/24 continued in 2024/25, with funding not keeping pace with increasing costs and demand. The savings plan put in place to ensure that the Partnership continued to meet its key ambitions was not fully realised, however the Partnership did deliver a year end underspend and underwent significant service transformation during this period to support the wider savings plan. The underspend in 2024/25 was achieved by: o flexible use of recurring and non-recurring funding o creation and use of reserves for specific commitments o delivery of approved savings through efficiency measures and redesign o focusing on workforce planning and the Strategic Commissioning Plan Programme of Work o effective governance and audit controls North Lanarkshire IJB delivers and commissions a range of health and social care services. The Board is responsible for the strategic planning of the functions delegated to it and for ensuring the delivery of its functions through the locally agreed operational arrangements set out within the integration scheme. To successfully discharge the operational delivery of services, funding is provided through budgets delegated from both NLC and NHSL. The level of funding available to the IJB is therefore heavily influenced by grant settlement from Scottish Government to the partner organisations. The total budget available to the IJB, inclusive of the Set Aside Budget and the budgets for a number of delegated services where South Lanarkshire IJB acts as lead host, was £861.652m. Included within this funding is a ‘Large Hospital Service’ (Set Aside) budget totalling £75.143m. 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. The table below provides a summary of the funding from each Partner over the last four financial years. Funding £m 2021/22 2022/23 2023/24 2024/25 North Lanarkshire Council (168.587) (188.180) (201.591) (208.025) NHS Lanarkshire (517.779) (482.813) (544.843) (555.622) Set Aside (65.164) (66.858) (74.575) (75.143) Total (751.530) (737.851) (821.009) (838.790) Annual (Increase) / Decrease £m (58.425) 13.679 (83.158) (17.781)
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29 The final outturn against this budget, after the use of reserves, is an underspend of £10.716m. This is in line with the monitoring position that has been reported to the IJB throughout the financial year 2024/25 and inclusive of the transfer of ring-fenced monies to reserves, in line with Scottish Government guidance. Annual Budget 2024/25 In Year Drawdown From Reserves Revised Budget 2024/25 Final Outturn 2024/25 Final Outturn Variance 2024/25 £m £m £m £m £m North Lanarkshire IJB 861.652 (10.686) 850.966 840.250 10.716 Note: The figures differ to that in the Comprehensive Income and Expenditure Statement (CIES) due to differences in the presentation of in year adjustments between the partners. This underspend is shown in the table below, split across each main service area within the Partnership. Care Group Annual Actual Variance Budget £m £m £m Health Care Services Locality and Other Services 70.116 64.937 5.179 Addiction Services 4.317 4.073 0.244 Medical and Nursing Directorate 4.607 4.105 0.502 Prescribing 76.952 81.709 (4.757) Out of Area Services 4.318 4.22 0.098 Area Wide Services 8.823 8.42 0.403 Hosted Services 203.408 200.543 2.865 Family Health Services 135.965 135.965 0 Set-Aside Budget 75.143 75.143 0 Total Expenditure - Health Care 583.649 579.115 4.534 Social Care Services Social Care Services 265.088 258.69 6.398 Housing Revenue Account 2.229 2.445 (0.216) Total Expenditure - Social Care 267.317 261.135 6.182 Total Expenditure 850.966 840.250 10.716
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30 Of this final outturn underspend, there are 4 key variances worthy of highlighting which are linked to the ambition statements of the Partnership. Delegated Service Variance £m Over / Underspend Reason Ambition Statement Employee Costs 19.219 Underspend The Partnership continues to encounter challenges in terms of recruitment and retention across all service areas which has led to spend below budget. This underspend is also inclusive of non- recurring savings on pension costs 3 Hosted Services 2.865 Underspend North Lanarkshire IJB commissions a number of services where North Lanarkshire is the host organisation for services carried out within South Lanarkshire. Overall, there was an underspend however there are some services which delivered over budget, which include continence services, children’s diabetic nursing and prisoner healthcare. 1, 2, 4, 5 Payments to Other Bodies (1.073) Overspend Integrated services provided by Social Care on behalf of the IJB includes Care at Home and Care Homes. A net overspend was reported within these areas which is representative of the increasing demand on these services. 1, 3, 5 Prescribing (4.757) Overspend A significant spend within the services delegated to the IJB from the Health Service is the cost of Prescribing. The overspend being reported in here is attributable to both the number of medicines being prescribed and dispensed alongside higher prices. 2, 4
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31 The year-end underspend of £10.716m included the drawdown of reserves of £10.686m in 2024/25, leaving a surplus on the provision of services of £0.030m. This surplus was transferred to the Partnership’s reserves giving a closing balance of £75.554m as shown below. North Lanarkshire Integration Joint Board Total Reserves General Fund £m Opening Balance at 1 April 2024 75.524 Total Comprehensive Income and Expenditure Increase in 2024/25 0.030 Closing Balance at 31 March 2025 75.554 Care Inspectorate Grades 2024/25 North Lanarkshire Council delivers a range of registered Adult Services, which are all subject to regulation by the Care Inspectorate. Below is a summary of care inspection activity relating to in- house services during 2024/25. The Care Inspectorate grade services against key questions and quality statements on a scale of Unsatisfactory (1), through to Excellent (6). Of the NLC in-house services, only Home Support Services were inspected in 2024/25. There are six in-house Home Support services across North Lanarkshire, one in each of the localities. • Airdrie Home Support were inspected three times in 2024/25, the last of these being on the 8th January 2025. The first two inspections resulted in recommendations and some areas of improvement being identified. On the last inspection, all areas were graded 3 (Adequate), reflecting the improvements made. • Bellshill Home Support were inspected on 18th April 2024 and were graded 4 (Good) in all areas assessed. The inspection highlighted that supervision and observations had improved. • Coatbridge Home Support were inspected on 27th September 2024 and were graded 3 (Adequate). This was an improvement since their last inspection. • Cumbernauld Home Support were inspected on 11th September 2024, receiving grades of 3 (Adequate). Two of the three requirements made following a prior inspection were met, recognising the improvements made in training, supervision, and audits of reviews. The outstanding requirement has been extended to 20th January 2026 to allow for improvements in personal support plans to be fully embedded into practice. • Motherwell Home Support was inspected on 26th March 2025; all areas were graded 3 (Adequate) and all outstanding requirements and areas for improvement were met.
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32 • Wishaw Home Support was inspected on 15th October 2024 and received grades of 4 (Good), recognising the quality of care and support provided and the good communication across the staff team. Home Support Services are subject to internal monitoring, with the Quality Assurance team providing guidance and support regarding improvement plans. Previous inspections had identified a need for improvements in care plans as a common theme across services with work undertaken to address this. These efforts are reflected in the improved grades. NLC Care Homes As of 31st March 2025, there were 27 care homes within North Lanarkshire. Of the care homes that had been assessed by the Care Inspectorate against, “How well do we support people’s wellbeing?”, 54% were graded as “Good” or better; 29% of those care homes were assessed as “Very Good”. During 2024/25, no care homes within North Lanarkshire were subject to a Large-Scale Investigation. Six had a voluntary moratorium applied to all new admissions, enabling the care homes to focus on progressing with required improvements. These were Avondale, Darroch, Carrickstone, Milbrae, Parksprings and Woodside. Other than Avondale, whose moratorium was applied due to a change in contract, the voluntary moratoriums were due to poor Care Inspectorate grades and concerns raised by monitoring carried out by our Quality Assurance team. The longest duration of these moratoriums was three months. Cumbernauld Care Home had an enforced moratorium due to poor Care Inspectorate grades, however improvements were made and the moratorium to new admissions was removed within three months. How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Very Good 7 4 4 1 0 Good 13 7 14 13 11 Adequate 4 7 3 2 4 Not assessed 3 9 6 11 12 7 4 4 1 0 13 7 14 13 11 4 7 3 2 43 9 6 11 12 Care Inspectorate Grades - Care Homes 2024/25 Very Good Good Adequate Not assessed
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33 Other services In 2024/25, 38 Care Inspections took place of services on the SDS Framework. No services were subject to a Large-Scale Investigation. Six services had a voluntary moratorium applied to supporting any new people. These were Aspire, Ayrshire Children’s Service, Cera Care, Enable, Invercare and Home Instead. Other than Home Instead, whose moratorium was applied due to a change in contract, the voluntary moratoriums applied were due to poor Care Inspectorate grades and concerns raised by monitoring carried out by our Quality Assurance team. Care 1 Professional had an enforced moratorium due to poor Care Inspectorate grades. How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? How well do we support Children and Young People's Rights and Well-Being Care and Support Environment Staffing Management and Leadership Excellent 3 0 2 0 0 0 0 0 0 0 Very Good 32 21 21 1 12 1 2 0 2 1 Good 12 15 10 1 10 1 0 0 0 0 Adequate 7 6 6 0 6 0 0 0 0 0 Weak 1 1 2 0 1 0 0 0 0 0 3 2 32 21 21 1 12 1 2 2 1 12 15 10 1 10 1 7 6 6 6 1 1 2 1 Care Inspectorate Grades - Self Directed Support including Care at Home 2024/25 Excellent Very Good Good Adequate Weak
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34 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. The Strategic Commissioning Plan 2023-2026 sets the local priorities for health and social care services. It was developed through a collaborative process with people who use health and social care services, our partners, members of the public and our staff colleagues who deliver those services. The plan 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. This is achieved through prevention, support, and treatment to help people to live a better life at home for as long as possible. To support and complement the Strategic Commissioning Plan, the Medium-Term Financial Plan 2023/2026 outlines the financial challenges and opportunities the HSCP faces over the three-year period of the plan and provides a framework that supports the HSCP to remain financially sustainable, highlighting how the financial plan will support the delivery of the IJB’s strategic objectives and priorities. Strategic Commissioning Plan 2023–2026: Mid-Cycle Review At the February 2025 meeting of the Integration Joint Board (IJB), the Chief Officer presented a mid-cycle review of the Strategic Commissioning Plan and its associated Programme of Work, providing a summary of the current position and a Red/Amber/Green status assessment. The review highlighted strong progress and achievements across key work streams and reaffirmed the partnership’s commitment to transformational change. Significant progress has been made and is documented in the table below. Further work will continue during 2025/26 to ensure momentum is sustained and key milestones continue to be delivered. Programme RAG Status Mid-cycle position Getting It Right For Everyone (GIRFE) ⬣Amber The GIRFE Pathfinder is embedding the co-designed prototypes into the Whole System Enabling Approach, focusing on person-centred tools like “My Plan” to reduce repetitive storytelling and improve continuity of care. The initiative promotes early intervention through multidisciplinary teams and introduces the “sticky person” concept; a consistent point of contact for individuals navigating services. Community hubs are being developed to 1 Strategic-Comm-Plan-23-26.pdf
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35 Programme RAG Status Mid-cycle position reflect local needs and dementia care competencies are under review. The transition from GIRFEC to GIRFE is also being explored to ensure seamless support for young people. Frailty Strategy ⬣Green The Lanarkshire Frailty Strategy (2023–2028) is being implemented with a strong emphasis on collaboration between acute and community teams. Frailty networks have been established to foster realistic, patient-centred care. Engagement with various stakeholders, including GPs and third-sector partners, has enhanced understanding of frailty management challenges and promoted integrated working across sectors. Home Support Redesign ⬣Amber This programme is transforming Home Support through the design of a new integrated Assessment and Planning Team, adoption of the Dynamic Scheduling Tool and workforce development. The Home Assessment Team is now well established and works closely with Reablement services to ensure timely, needs-based support. Staff training and engagement have been prioritised in the Programme. The redesign aims to deliver high-quality, person-centred care while improving operational efficiency. Carers Strategy ⬣Green The 2024–27 Carers Strategy is co-produced with carers and organisations, emphasizing choice, control, and sustainability. It aligns with GIRFE and Community Wealth Building principles, aiming to empower carers to lead fulfilling lives. The strategy builds on a robust local support infrastructure and seeks to enhance carers’ participation in the economy and society. Care Home Assurance Team ⬣Green This initiative supports the implementation of the national Healthcare Framework in care homes through collaborative working, training, and multidisciplinary team (MDT) involvement. Key areas include infection prevention, anticipatory care planning, and palliative care. The approach emphasises proactive, person-centred care and has improved staff engagement and training access. Hospital @ Home ⬣Green The service has undergone a phased expansion, enhancing access, diagnostics, and professional collaboration. Completed phases have shifted the model toward admission avoidance and medical oversight. The next phase focuses on workforce development, integration with locality teams, and governance. The service aims to provide hospital-level care at home, improving outcomes and reducing hospital admissions. Home Assessment Team (HAT) ⬣Green The HAT is now operational across all localities, supporting timely discharge and reablement. Standard procedures, data tracking, and recruitment efforts are in place. Weekly multidisciplinary meetings ensure coordinated care and that the approach is integrated with other key programmes like GIRFE and the Frailty Strategy, to enhance early intervention and community-based support. Self-Directed Support Transformation ⬣Green A refreshed learning plan supports practitioners and stakeholders in delivering flexible, person-centred care. Localities now have greater autonomy in budget decisions, accelerating support delivery and fostering innovation. The transformation emphasizes empowerment, responsiveness, and alignment with the enabling approach. Community Alarm Service ⬣Amber The service is transitioning to a fully digital model to replace outdated analogue systems. Over 3,000 alarms have been upgraded, with more planned. User feedback has been
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36 Programme RAG Status Mid-cycle position positive, and staff engagement has informed service improvements. A staffing review is underway to support the expanded digital infrastructure and ensure continued high- quality service. Community Nursing Review ⬣Green A new vision launched in October 2024 focuses on caseload complexity, care coordination, and workforce development. Frailty scoring and future care planning are being integrated into assessments. A centralised referral centre is expanding, and leadership training is addressing gaps. The review aims to enhance safety, efficiency, and patient outcomes. Alcohol & Drugs Partnership Strategy ⬣Green The ADP has commissioned key services aligned with national priorities and secured three-year funding for the stability of those services. Initiatives include early intervention, crisis response, and recovery support. Work to prevent drug-related deaths and reduce alcohol-related harm is ongoing, with all of the MAT standards almost met. Residential Rehab and Whole-Family Support are also being strengthened. Prisoner Healthcare ⬣Green A comprehensive review at HMP Shotts led to 31 recommendations, which have all now been implemented. Improvements include staffing, training, and patient-centred care. A Healthcare Improvement Scotland inspection confirmed compliance with their recommendations, with some pharmacy-related actions remaining as ongoing pieces of improvement work. The service now meets national standards and is set for its next review in 2027. Mental Health & Wellbeing Strategy ⬣Green Following the success of the 2019–24 strategy, a new Lanarkshire-wide Delivery Plan is being developed in alignment with national priorities. Stakeholder engagement has informed the plan and governance structures are being revised. The new plan will build on past achievements and ensure continued system-wide collaboration and improvement. Speech & Language Therapy ⬣Green A service improvement group has prioritised waiting list management, digital integration and workforce development for the service. Trakcare implementation is enhancing data collection and work to improve communications for the service is expanding to include adult services. Workforce and accommodation reviews are underway, with a focus on sustainable service delivery and training. CAMHS ⬣Green The six workstreams of the Programme have seen improvement in neurodevelopmental services, patient management and digital infrastructure. The CAPA model is now operational, and the RTT performance nearing national targets. The UCAMHS model supports crisis intervention and safe discharge. Continued funding and workforce stability are key to sustaining progress and meeting RTT goals. Paediatrics Review ⬣Amber Five working groups are addressing clinical challenges through a phased approach. Horizon 1 focuses on nursing care and continence services, while Horizon 2 addresses medical rota sustainability. Horizon 3 will develop a new clinical model. Staff wellbeing and capacity constraints are being managed to support ongoing transformation. Community Solutions ⬣Green This third-sector investment plan supports a wide range of community services, including mental health, transport and hospital discharge support. A pilot Community Connectors programme is helping people access local resources. Future funding reviews aim to enhance support for carers, physical activity and volunteer transport.
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37 Programme RAG Status Mid-cycle position Digital Technology & Systems ⬣Green Major digital projects like Mosaic and the Dynamic Scheduling Tool were nearing launch at the point of the mid- cycle update. These systems replace legacy platforms and improve data access, service delivery, and staff digital skills. A new Digital & Technology Group will oversee integration across programmes and ensure alignment with strategic goals. Engagement & Participation Strategy ⬣Green The refreshed 2024–27 strategy emphasises meaningful engagement, inclusivity, and two-way communication. It is embedded in our staff induction and supported by practical tools to amplify the voices of supported people. Locality Planning Groups are being aligned to ensure that the community input shapes our service development. Academic Partnerships ⬣Green Our strategic collaborations with local universities have led to formal agreements and university status for the partnership. These relationships support research, training, and innovation across health and social care. Ongoing work aims to deepen academic engagement and enhance service delivery through evidence-based practice. Looking Forward – Our Next Steps As we move into the final year of our current three-year Strategic Commissioning Plan and Programme of Work, our focus remains on the ambitions of that plan, to: Do the right thing, first time Increase our 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 These ambitions align with our Getting It Right for Everyone Programme and Enabling Approach, which focuses on doing the right thing the first time through early, proactive interventions. We are committed to delivering integrated support across our partner agencies, using a whole-family approach to meet people’s needs effectively. Our priorities for the final year of this Strategic Commissioning Plan include: • Expanding carer support and community-based services to strengthen local networks of care. • Developing a future-ready workforce by growing the Care Academy and deepening our academic partnerships. • Improving mental health and wellbeing through continued investment in CAMHS, crisis care and community mental health services.
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38 • Tackling inequalities with targeted investment, inclusive engagement, and innovative digital solutions. We will continue to align our efforts with the national priorities, including the evolving GIRFE framework, and local strategic plans such as the Lanarkshire Frailty Strategy and NHS Lanarkshire’s “Our Health Together” plan. Development of a new Strategic Commissioning Plan 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. Work to develop the new Strategic Commissioning Plan for 2026/27 and beyond will take place during 2025/26.
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39 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 91.68% 90.34% 90.49% 87.45% 87.41% NI - 2 Percentage of adults supported at home who agreed that they are supported to live as independently as possible 82.99% 75.44% 77.55% 79.83% 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 75.44% 71.37% 71.18% 67.05% 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 73.35% 69.72% 70.21% 66.55% 56.04% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 77.66% 75.43% 77.83% 74.02% 65.76% NI - 6 Percentage of people with positive experience of care at their GP practice 79.32% 75.51% 68.34% 51.81% 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 83.80% 75.59% 75.71% 76.97% 67.70% NI - 8 Percentage of carers who feel supported to continue in their caring role 41.18% 33.16% 32.58% 25.11% 28.46% NI - 9 Percentage of adults supported at home who agreed they felt safe 83.70% 79.87% 79.98% 79.84% 68.44%
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40 Indicator Title NL 2018 NL 2019 NL 2020 NL 2021 NL 2022 NL 2023 NI – 11 Premature mortality rate per 100,000 persons 515 513 578 575 507 545 Indicator Title NL 2019/20 NL 2020/21 NL 2021/22 NL 2022/23 NL 2023/24 NL 2024 NI – 12 Emergency admission rate (per 100,000 population) 16280 13828 15120 15030 14615 12683 NI – 13 Emergency bed day rate (per 100,000 population) 124636 108735 124594 130646 128123 120763 NI – 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 106 123 115 117 114 112 NI – 15 Proportion of last 6 months of life spent at home or in a community setting 89.0% 90.3% 89.8% 89.0% 88.9% 88.9% NI – 16 Falls rate per 1,000 population aged 65+ 21.2 19.1 20.5 19.7 21.1 22.1 Indicator Title NL 2019/20 NL 2020/21 NL 2021/22 NL 2022/23 NL 2023/24 NL 2024/25 NI – 17 Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections 83.3% 80.1% 78.1% 77.0% 75.8% 77.5% Indicator Title NL 2019 NL 2020 NL 2021 NL 2022 NL 2023 NL 2024 NI – 18 Percentage of adults with intensive care needs receiving care at home 74.4% 75.1% 75.0% 71.5% 69.7% 65.6% Indicator Title NL 2019/20 NL 2020/21 NL 2021/22 NL 2022/23 NL 2023/24 NL 2024/25 NI – 19 Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) 1109 781 821 950 953 825
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41 Appendix 2 – HSCP Performance Dashboard KPI Target Q1 Q2 Q3 Q4 RAG Alcohol Brief Interventions North 3047 539 705 583 501 Alcohol Brief Interventions (all settings) NHSL 7381 1556 2449 1751 1470 % breastfeeding attrition rate (% of mums who ever breastfed but stopped by 6-8 week review) 46.6% 42.3% 32.9% Quarterly / 2 quarters behind Quarterly / 2 quarters behind Cervical Screening 80% 71.0% 71.9% 70.0% 69.6% Immunisations – %s of 2 year olds 95% 95.1% 95.5% 94.9% 94.8% Immunisations – %s of 5 year olds 95% 90.4% 90.2% 89.0% 88.7% Addictions – Completed Waits 90% ... 97.4% 98.2% 99.3% Addictions – Ongoing Waits 90% ... 99.1% 100% 98.2% Addictions – Ongoing Waits NHSL 90% ... 85.0% 92.9% 94.4% Percentage of people who have completed 6-8 week review 90% 80.1% 83.4% Quarterly / 2 quarters behind Quarterly / 2 quarters behind ... Delayed discharge bed days - standard delays 31,796 6,060 13,048 20,558 27,160 A&E Attendances - NL Residents 116,45 6 31,435 30,446 30,541 Quarterly / 1 quarter behind Emergency Admissions - NL Residents 44,001 11,684 10,758 Quarterly / 2 quarters behind Quarterly / 2 quarters behind Unscheduled Bed Days - all specialties, NL residents 294,99 9 80,985 66,919 Quarterly / 2 quarters behind Quarterly / 2 quarters behind Inpatient Activity – Readmissions 7 days 8 5.17 5.64 6.49 6.49 Percentage of patients waiting less than 12 months to begin PDS (waiting less than 12 months/total number waiting) 70% 77.5% 71.5% 76.4% 83.5% Mental Health - bed occupancy rate ... 92.0% 94.1% 93.0% 94.0% ... Assistive Technology - Number Of People With Technology (0-17 yrs.) 1,452 35 36 34 33 Assistive Technology - Number Of People With Technology (18-64yrs) 632 617 627 622 Assistive Technology - Number Of People With Technology (65+) 905 860 893 912 Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 527 987 1387 1788
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42 KPI Target Q1 Q2 Q3 Q4 RAG Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 61.1% 57.1% 56.5% 63.0% Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 62.6% 58.1% 63.6% 62.5% IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 87.1% 65.8% 60.1% 73.4% 18 Week RTT Performance – CAMHS NHSL (NORTH HOSTED) 90% 57.6% 81.3% 90.5% 93.5% 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 76.0% 74.1% 72.3% 75.0% Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90%* 36.0% 30.5% 23.5% 21.8% Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90%* 69.4% 65.1% 61.9% 66.2% Consultant Outpatient WT - Learning Disability - 12wks (NHSL) (NORTH HOSTED) 90%* 100% 90% 100% 100% Medical Paediatrics WT - 12 wks. (NHSL) (NORTH HOSTED) 90%* 86.4% 90.3% 87.9% 80.3% Admission to MH Wards: Proportion NHSL Patients >=95% 99.1% 98.8% 98.4% 98.5% MSK Podiatry - 12wks (NORTH HOSTED) 90%* 100% 100% 100% 100% Podiatry - 12wks (NORTH HOSTED) 90%* 100% 99.8% 100% 100% Podiatry - domiciliary visits - 12wks (NORTH HOSTED) 90%* 100% 100% 100% 100% SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 15.8% 15.3% 16.0% 17.6% SLT - Adult - 12wks (NORTH HOSTED) 90%* 85.6% 74.3% 74.4% 79.2% Dietetics - 12wks (NORTH HOSTED) 90%* 64.8% 62.3% 65.5% 62.5% Care Home Placements At End Of Quarter - Per 1000 Popn 65+ 24 22.1 22.2 22.0 21.9 Care Home Placements At End Of Quarter - Per 1000 Popn 75+ 50 46.3 46.6 46.1 45.4 Care Home - Average Length of Stay 865 708 789 966 776 Number Of People With Self Directed Support 1,000 2054 2114 2119 2214 Number Of People With A Direct Payment 240 355 365 377 395 Sustain and embed successful smoking quits, at 12 weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 55 110 Quarterly / 2 quarters behind Quarterly / 2 quarters behind Manual Handling Awareness 90% 91.9% 92.5% 93.0% 92.3% PAMOVA Training 90% 94.0% 94.2% 94.6% 94.1% Adult Basic Life Support 90% 89.6% 91.3% 92.0% Paediatric Basic Life Support 90% 86.7% 88.1% 94.0% Fire Safety Training 90% 87.5% 88.8% 90.5% 90.0% Hand Hygiene Training 90% 85.4% 87.2% 88.9% 88.6% Safe information Handling Training 90% 91.6% 91.6% 92.6% 91.4% Child Protection Awareness Training 90% 94.0% 94.9% 95.2% 94.6% Mental Health & Suicide Prevention Training 90% Health and Safety Awareness Training 90% 95.8% 96.6% 96.9% 96.6% Occupational Health Service Awareness Training 90% 95.9% 96.5% 96.9% 96.6% Adult Support and Protection Awareness Training 90% 94.4% 94.8% 95.2% 95.2%
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43 KPI Target Q1 Q2 Q3 Q4 RAG % Of Adult Protection Referrals Passed To Care Team For Investigation 20% 24.7% 30.6% 34.7% 35.7% Adult Protection - % Of Referrals With Decision Within 5 Days 60% 80.3% 83.6% 82.5% 81.5% % of Adult Protection Referrals Which Did Not Go On To Investigation Or Other Service 50% 66.0% 57.4% 56.4% 53.4% TURAS compliance (NHSL, North) >80% 75% 71% 69% Breakeven Position - YTD Variance Including Prescribing (NHSL) >=0 £0.342m underspen d £0.088m underspen d £0.098m underspend £4.534M underspend (Q4 is the year end position) ... Breakeven Position - YTD Variance Excluding Prescribing (NHSL) >=0 £1.619m underspen d £3.262m underspen d £5.202m underspend 9.291M underspend (Q4 is the year end position) ... Sickness Absence (NHSL, North) 4% 7.49% 6.63% 8.10% Sickness Absence (NLC) - days lost per person 9.22 3.48 6.34 9.52 12.92
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44 Appendix 3 – Inspection Findings 2024/25 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? Summerlee House Ltd. Care Home Service 07/03/2024 Very Good Good Good Good Very Good Blair House Care Home Care Home Service 28/03/2024 Very Good Good Good Good Very Good Bellshill Home Support Service Housing Support Service 18/04/2024 Good Good Good Good Bellshill Home Support Service Support Service 18/04/2024 Good Good Good Good The Richmond Fellowship Scotland - North Lanarkshire Housing Support Service 23/04/2024 Very Good Good Very Good Very Good The Richmond Fellowship Scotland - North Lanarkshire - Care at Home Support Service 23/04/2024 Very Good Good Very Good Very Good Highgate Care Home Care Home Service 24/04/2024 Very Good Good Good Good Good Millbrae Care Home Care Home Service 02/05/2024 Weak Good Good Good Weak North Lanarkshire Intensive Housing Support Service Housing Support Service 03/05/2024 Very Good Excellent Very Good Very Good Cumbernauld Care Home Care Home Service 09/05/2024 Good Good Good Good Good Love @ Care-Lanarkshire Support Service 10/05/2024 Very Good Good Very Good Good
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45 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? Love Housing Support - Lanarkshire Housing Support Service 10/05/2024 Very Good Good Very Good Good Parksprings Care Home Care Home Service 16/05/2024 Weak Weak Good Good Weak Netherton Court Nursing Home Care Home Service 22/05/2024 Weak Good Good Good Weak Hatton Lea Nursing Home Care Home Service 24/05/2024 Good Good Weak Good Good Potential Living Housing Support Service 31/05/2024 Excellent Excellent Excellent Very Good Potential Living Support Service 31/05/2024 Excellent Excellent Excellent Very Good Cornerstone NLCS Airdrie & Coatbridge Support Service 13/06/2024 Very Good Very Good Very Good Very Good Cornerstone NLCS Airdrie & Coatbridge Housing Support Service 13/06/2024 Very Good Very Good Very Good Very Good Murdostoun Neurological Care Centre Care Home Service 19/06/2024 Good Good Good Very Good Very Good SAMH North Lanarkshire Support Service Support Service 28/06/2024 Very Good Very Good Very Good Very Good SAMH North Lanarkshire Support Service Housing Support Service 28/06/2024 Very Good Very Good Very Good Very Good Enable Scotland (Leading the Way) - Lanarkshire Services Housing Support Service 01/07/2024 Weak Weak Weak Weak Enable Scotland (Leading the Way) - Lanarkshire Services Support Service 01/07/2024 Weak Weak Weak Weak Cornerstone North Lanarkshire Supported Living 1 Housing Support Service 04/07/2024 Very Good Very Good Very Good Good
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46 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? Cornerstone North Lanarkshire Supported Living 1 Support Service 04/07/2024 Very Good Very Good Very Good Good Lochside Manor Care Home Service 17/07/2024 Good Good Good Good Good Mears Supported Living - North Lanarkshire Support Service 17/07/2024 Very Good Very Good Very Good Very Good Mears Supported Living - North Lanarkshire Housing Support Service 17/07/2024 Very Good Very Good Very Good Very Good Cornerstone NLCS Cumbernauld Housing Support Service 25/07/2024 Very Good Very Good Very Good Good Cornerstone NLCS Cumbernauld Support Service 25/07/2024 Very Good Very Good Very Good Good Carnbroe Care Centre Care Home Service 01/08/2024 Good Good Good Good Good Rawyards House Care Home Care Home Service 09/09/2024 Good Good Very Good Good Good Woodside Care Home Care Home Service 16/09/2024 Weak Good Weak Good Weak Darroch Nursing Home Care Home Service 18/09/2024 Very Good Good Good Very Good Good Kirknowe Nursing Home Care Home Service 18/09/2024 Very Good Good Good Very Good Very Good TACT Scotland Adult Placement Service Adult Placement Service 23/09/2024 Very Good Very Good CERA - Central Scotland Housing Support Service 01/10/2024 Weak Weak Weak Weak CERA - Central Scotland Support Service 01/10/2024 Weak Weak Weak Weak
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47 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? Wishaw and Shotts Home Support Service Support Service 15/10/2024 Good Good Good Good Wishaw and Shotts Home Support Service Housing Support Service 15/10/2024 Good Good Good Good The Village Nursing Home Care Home Service 16/10/2024 Good Good Good Good Good Wheatley Care Personalised and Self Directed Support Services (North Lanarkshire) Support Service 31/10/2024 Very Good Very Good Very Good Very Good Wheatley Care Personalised and Self Directed Support Services (North Lanarkshire) Housing Support Service 31/10/2024 Very Good Very Good Very Good Very Good The New Harry Walker Integrated Day Services Support Service 04/11/2024 Very Good Very Good Very Good Very Good Good Sciensus Pharma Services Limited Nurse Agency 07/11/2024 Excellent Very Good Very Good Very Good SAMH - Falkirk Support Service and Stirling Outreach Housing Support Service 07/11/2024 Good Very Good Very Good Very Good SAMH - Falkirk Support Service and Stirling Outreach Support Service 07/11/2024 Good Very Good Very Good Very Good Lanarkshire Association for Mental Health Individual Support Service Housing Support Service 08/11/2024 Very Good Very Good Very Good Very Good Lanarkshire Association for Mental Health Individual Support Service Support Service 08/11/2024 Very Good Very Good Very Good Very Good Enhance Living Support Services Support Service 12/11/2024 Very Good Very Good Very Good Good Rannoch Lodge Care Home Care Home Service 15/11/2024 Very Good Good Weak Good Good
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48 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? Support for Ordinary Living Housing Support Service 21/11/2024 Excellent Very Good Very Good Very Good Support for Ordinary Living Support Service 21/11/2024 Excellent Very Good Very Good Very Good Rosehall Manor Care Home Service 21/11/2024 Good Good Very Good Weak Good Cornerstone NLCS Motherwell and Wishaw Support Service 28/11/2024 Very Good Very Good Very Good Very Good Cornerstone NLCS Motherwell & Wishaw Housing Support Service 28/11/2024 Very Good Very Good Very Good Very Good Call-In Homecare - North Lanarkshire Support Service 02/12/2024 Good Weak Weak Weak Craig En Goyne Care Home Service 05/12/2024 Good Good Very Good Very Good Good Aspire Central Support Services Housing Support Service 05/12/2024 Good Weak Good Weak Aspire Central Support Services Support Service 05/12/2024 Good Weak Good Weak Equity of Services for All Support Service 05/12/2024 Weak Weak Weak Weak Elaina Nursing Home Care Home Service 19/12/2024 Good Good Good Good Weak Rosepark Care Home Care Home Service 20/12/2024 Very Good Good Good Good Good Airdrie Home Support Service Housing Support Service 08/01/2025 Weak Weak Weak Weak Airdrie Home Support Service Support Service 08/01/2025 Weak Weak Weak Weak Threshold Support Services - Community and Short Breaks Support Service 17/01/2025 Very Good Very Good Very Good Very Good Very Good
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49 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? Flexible Healthcare One Solutions Ltd Support Service 17/01/2025 Weak Good Weak Adequate Key Community Supports - North Lanarkshire Housing Support Service 20/01/2025 Very Good Good Very Good Good Key Community Supports - North Lanarkshire Support Service 20/01/2025 Very Good Good Very Good Good Home Instead North Lanarkshire & Glasgow East Support Service 20/01/2025 Very Good Very Good Very Good Good Cumbernauld Home Support Service Housing Support Service 27/01/2025 Weak Weak Weak Weak Cumbernauld Home Support Service Support Service 27/01/2025 Weak Weak Weak Weak Morningside Care Home Care Home Service 28/01/2025 Weak Weak Good Weak Weak Beechwood Care Home Care Home Service 30/01/2025 Good Good Good Good Good Coatbridge Home Support Service Housing Support Service 31/01/2025 Weak Weak Weak Weak Coatbridge Home Support Service Support Service 31/01/2025 Weak Weak Weak Weak Carrickstone Care Home Care Home Service 05/02/2025 Very Good Good Good Very Good Good Phew Care Home Service 06/02/2025 Very Good Good Good Good Good Keane Premier Support Services North Lanarkshire Housing Support Service 14/02/2025 Very Good Very Good Very Good Very Good Keane Premier Support Services North Lanarkshire Support Service 14/02/2025 Very Good Very Good Very Good Very Good Home Instead South Lanarkshire - Hamilton Support Service 21/02/2025 Very Good Very Good Very Good Very Good
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50 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? Aspire West Support Services Care at Home Support Service 24/02/2025 Adequate Adequate Adequate Adequate Invercare Services - North Lanarkshire & Glasgow Branch Support Service 05/03/2025 Weak Weak Weak Weak Invercare Services - North Lanarkshire & Glasgow Branch Housing Support Service 05/03/2025 Weak Weak Weak Weak Centenary House Care Home Care Home Service 05/03/2025 Good Weak Good Weak Weak Deanston House Nursing Home Care Home Service 19/03/2025 Weak Good Very Good Weak Good Motherwell Home Support Service Support Service 26/03/2025 Weak Adequate Adequate Adequate Motherwell Home Support Service Housing Support Service 26/03/2025 Weak Adequate Adequate Adequate
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51 Glossary of Terms ADP The Alcohol and Drug Partnership (ADP) is responsible for commissioning and developing local strategies for tackling problem alcohol and drug use and promoting recovery based on an assessment of local needs. Adult Protection Committee The Adult Protection Committee is a multi-agency committee which monitors and reviews what is happening locally to safeguard adults. It is made up of senior staff from many of the agencies involved in protecting adults who may be at risk. Adult Support & Protection (ASP) Adult Support and Protection relates to the protection of adults at risk of harm and the measures and duties within the Adult Support and Protection (Scotland) Act 2007. CAMHS The NHS Lanarkshire Child & Adolescent Mental Health Service (CAMHS) is a specialist service for infants, children and young people. Delayed Discharge A delayed discharge occurs when a patient is ready to leave a hospital or similar care provider but is still occupying a bed. Emergency Admission An emergency admission is one where a patient is admitted to hospital urgently and unexpectedly (i.e. the admission is unplanned). Health & Care Experience Survey The Health and Care Experience Survey is a national survey which asks about people’s experiences of accessing and using their GP practice and Out of Hours services • aspects of care and support provided by local authorities and other organisations • caring responsibilities and related support 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.
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52 National Core Integration Indicators A core suite of indicators that Integration Authorities use to measure progress towards the National Health and Wellbeing Outcomes. National Health & Wellbeing Outcomes There are nine national health and wellbeing outcomes which apply to integrated health and social care. Health Boards, Local Authorities and Integration Authorities work together to ensure that these outcomes are meaningful to people in their area. Unscheduled Bed Day A bed-day is a day during which a person stays overnight in a hospital. An unscheduled bed day is where the patient’s admission was unplanned. 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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1 REPORT Item No: 10 SUBJECT: Strategic Commissioning Plan 2026 and beyond TO: Integration Joint Board Lead Officer for Report: Chief Officer, Planning, Performance & Quality Assurance Author(s) of Report Senior Manager, Strategy & Performance DATE: 17 September 2025 1. PURPOSE OF REPORT The purpose of the report is to provide the board with an update on the development of the new Strategic Commissioning Plan for 2026 and beyond. 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 the Chief Officer, Planning, Performance & Quality Assurance and has been reviewed by the Senior Management Team. 3. EXECUTIVE SUMMARY The current Strategic Commissioning Plan and Programme of Work (PoW) is due to expire in March 2026, and this report sets out arrangements for the development of a new Strategic Commissioning Plan and PoW. 4. RECOMMENDATIONS
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2 4.1 It is recommended that the IJB approve the arrangements set out in the report for the development of a new Strategic Commissioning Plan. 5. VARIATIONS TO DIRECTIONS? 6. BACKGROUND 6.1 The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) places a duty on Integration Authorities to develop a strategic plan, also known as a strategic commissioning plan, for integrated functions and budgets under their control and the Scottish Government has published guidance to support production of said plans: https://www.gov.scot/publications/strategic-commissioning-plans- guidance/pages/9/. 6.2 The Integration Joint Board approved the Strategic Commissioning Plan 2023- 2026 at its meeting on 22 March 2023, setting out how the Health & Social Care Partnerships plans and delivers services for North Lanarkshire over the medium term and how these arrangements help to contribute towards achieving the national health and wellbeing outcomes. 6.2 Subsequently, a more detailed Programme of Work was approved by the Board at its meeting on 27 September 2023, setting out in more detail the programmes and activities intended to help transform the health and social care system. 6.3 The current Strategic Commissioning Plan and Programme of Work is due to expire in March 2026, and this report sets out arrangements for the development of a new SCP and PoW. 7. SUMMARY OF KEY ISSUES 7.1 The development of a new Strategic Commissioning Plan is underway with a view to the new plan coming into effect from April 2026, upon expiry of the current Strategic Commissioning Plan 2023-2026. 7.2 An engagement and consultation process has been initiated to ensure a wide range of staff, people who use services, carers and partner organisations have an opportunity to participate in shaping the next commissioning plan. A number of events will be organised over the coming months to facilitate discussion in localities as well as targeted groups, Community Board members, elected members, Integration Joint Board members, and the Strategic Planning Group. 7.3 These events will seek to review the achievements and challenges of the past three years and use a range of information and intelligence to guide our conversations into the opportunities and challenges facing the partnership in the future. Yes ☐ No ☒ N/A ☐
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3 7.4 We will also consider the range of other national and local strategies, plans and policies to ensure our plan is consistent and aligned with the priorities of North Lanarkshire Council, NHS Lanarkshire, other community planning partners, and national priorities. 7.5 The development of the new plan will also consider the planned review arrangements for the Local Outcome Improvement Plans (LOIPs). The LOIPs are an articulation of the community planning priorities within each of the Community Board areas in North Lanarkshire and are due to expire in 2027. A full review of these plans is underway and the new Strategic Commissioning Plan will take account of these developments. 7.6 The Health and Social Care Renewal Framework 2025-35, recently published by the Scottish Government and COSLA, sets out a high level guide for change to ensure the sustainability, efficiency, quality, and accessibility of health and social services in Scotland. This framework will guide our work and we will use the key principles for renewal to frame our engagement and future plans. These principles are: 1. Prevention Principle: Prevention across the continuum of care 2. People Principle: Care designed around people rather than the ‘system’ or ‘services’ 3. Community Principle: More care in the community rather than a hospital- focused model 4. Population Principle: Population planning, rather than along boundaries 5. Digital Principle: Reflecting societal expectations and societal needs 7.7 Engagement will also focus on the development of a Joint Strategic Needs Assessment (JSNA). The purpose of a Joint Strategic Needs Assessment (JSNA) is to ensure that the Integration Joint Board’s strategic plans are based on robust understanding of the current and predicted future needs of local populations. The information from the JSNA will inform and guide the commissioning and delivery of health, wellbeing and social care services. We will work with colleagues from Public Health Scotland and across the Health and Social Care Partnership to produce information on North Lanarkshire’s demographics and population health and care needs. 7.8 As previously reported, the partnership has been adopting a learning as management strategy (also known as Human Learning System) approach, working with partners from Healthcare Improvement Scotland to make learning and experimentation the key force driving our work. We will ensure this approach and the work to date with Getting It Right For Everyone (GIRFE) continues to feed into our future direction and informs our strategic priorities. 7.9 A draft commissioning plan will be brought to a future meeting of the Board, with final approval required by March 2026. 8. CONCLUSIONS
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4 8.1 Work has commenced on the development of a new Strategic Commissioning Plan, focusing on our achievements to date, the current and future opportunities and challenges facing the Health and Social Care Partnerships, and our responses required to meet our communities and localities needs. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9.2 ASSOCIATED MEASURE(S) None 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.5 ENGAGEMENT & PARTICIPATION
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5 Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A
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6 The Strategic Commissioning Plan will be subject to an EQIA and will be reported at a future meeting of the IJB, 10. BACKGROUND PAPERS None. 11. APPENDICES None CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Graeme Cowan cowang@northlan.gov.uk
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1 REPORT Item No: 11 SUBJECT: Supporting Resilience Across our Communities TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Performance, Planning, and Quality Assurance Author(s) of Report Maria Barry, Senior Manager Quality Assurance DATE: 17 September 2025 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: ☒ North Lanarkshire Council’s Adult Care and Social Work Committee.
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2 3. RECOMMENDATIONS 3.1 It is recommended that the Integration Joint Board endorse the ongoing work to support resilient communities. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 We have an ongoing commitment to supporting resilience across our communities, unpaid carers and supported people. We have made significant efforts in developing and enhancing partnership working. We have commissioned community and voluntary sector organisations (CVS) to further this. These organisations have a key role in enabling and delivering a resilience-based approach, and in providing the supportive infrastructure that facilitates it. 5.2 Our local approach continues to be based on promoting resilience through independence, self-help, enablement, choice, and control, using an assets and strengths-based approach. 5.3 We also seek to ensure that a preventative approach is embedded, and that anticipatory and emergency planning has been considered. 5.4 The overall intent is that communities, unpaid carers and supported people are resilient, and can influence and shape decisions - from individual care planning to strategic decision making. 5.5 Our shared approach, involving lived experience, business intelligence and professional knowledge and expertise is a whole system approach to getting it right for everyone. Our approach incorporates the Scottish Government’s pathfinder work promoting a multi-agency approach to designing and delivering public services that focus on people’s needs, to make sure services work well for everyone who uses them. Background 5.6 In defining resilience as: the capacity to withstand or to recover quickly from difficulties, or as supporting individuals to overcome adversity and build resilience: there is recognition that engagement and participation activity is essential in helping define and inform what matters to people, and what support they may need to help withstand or overcome difficulty. Yes ☐ No ☒ N/A ☐
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3 5.6.1 Accordingly, supporting resilience involves: supporting engagement and participation, the provision of information, advice, signposting, or campaigning, help people to help themselves, providing support as a means of prevention or early intervention, facilitating anticipatory or emergency planning, thus lessening impact on statutory services. 5.7 This approach also helps meet statutory obligations set out in: The Carers (Scotland) Act 2016 (which increased carers rights and enshrined these in law.) The Social Care (Self Directed Support) Scotland Act 2013 (which gave people requiring support significantly greater choice and control around how they chose to be supported and the way in which support is delivered.) The Community Empowerment (Scotland) Act 2015 (which aimed to empower communities by giving them more control over local decisions, land, and resources, enhancing their ability to influence public services.) The Equality Act 2010 (specifically the public sector equality duty, where Scottish public authorities must have due regard to the need to: eliminate unlawful discrimination; advance equality of opportunity; foster good relations.) The Community Wealth Building Bill (aimed at ensuring that wealth is generated, retained, and circulated within communities) (Scottish Govt, March 2025) 5.8 Members will recall previously agreeing investment in CVS organisations at the Adult Care and Social Work Committee on 12 November 2024. These organisations, identified through procurement, has ensured that robust arrangements are in place to further the resilience of communities. Engagement and participation of communities, unpaid carers and supported people is well supported. 5.9 Five organisations were identified, through Tender, to support unpaid carers: Action For Children Young Carers Support Project Alzheimer’s Scotland (support around dementia related caring) Lanarkshire Carers (direct carer support, and Adult Carer Support plans Getting Better together (post discharge support) North Lanarkshire Carers Together (carer engagement, participation, and campaigning 5.10 A consortium led by North Lanarkshire Disability Forum (NLDF) and involving Lanarkshire Links and Voice of Experience was the successful bidder in the tender aimed at furthering the intent set out in the Engagement and Participation Strategy 2024- 2027.
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4 5.11 Voluntary Action North Lanarkshire (VANL) continue as the third sector interface across North Lanarkshire and manage the Community Solutions programme. Community Solutions has a focus on local activity, through the Community and Voluntary Sector (CVS), aimed at pro-active early interventions and preventative approaches, which in turn promote self-help, independence, choice, and control, and reduce demand and need for statutory service involvement. 5.12 Engagement and participation activity continues to support the development of plans and strategies, inform investment and contribute to supporting resilience, positively impacting on improving equity, reducing reliance and demand on statutory sector provision, and improving health outcomes across North Lanarkshire. 5.13 Alongside this, community hubs, in line with the Council’s approved strategy and programme of work function as a gateway, signposting (where appropriate) offering preventative approaches and facilitating early intervention and targeted approaches, based on local needs. 5.14 This report appraises Members on the current position, sets out anticipated challenges, and the suggested next steps and actions to ensure that there is equity of opportunity across the authority area. The report also appraises Members on the progress made on meeting the strategic intent set out in the: Engagement and Participation Strategy 2024-2027 North Lanarkshire Carers Strategy 2024 – 2027. 5.14.1 Both these strategies support a culture of engagement and participation with the people of North Lanarkshire and seek to ensure that this is embedded in all aspects of health and social care. The intent was to: • Improve communication and increase connections. • Increase awareness of what matters. • Build capacity for early intervention and prevention. Current Position. 5.15 Each of the commissioned organisations is working in partnership with council services, partners and communities, utilising engagement and participation activity to shape the delivery of a range of needs-based support, information, advice services and activities. 5.16 Carer focused initiatives are in place, including arrangements around Adult Carer Support Plans (ACSP) through Lanarkshire Carers, and Young Carer Statements, through Action for Children. There is a well-developed Carer Breaks service and an innovative Carer Breather programme, offering carers time away from the caring routine. Alongside existing engagement and participation opportunities, the first of a number of carers sounding boards has
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5 been established by NLCT, with a focus on parent carers, with other sounding boards to follow. 5.17 These are intended to ensure that the focus continues to be on what matters to carers. NLCT also facilitates and manages a much wider Carer Support Network (CSN) involving a diverse range of carer focused organisations. CSN raises awareness of caring related issues, community initiatives, offers a supportive network to carer focused practitioners, and opportunities to share information on best practice. Assurance and oversight are provided through a Carers Oversight Group, which involves representatives from UHSCNL, the commissioned carer organisations and Education and Families. A representative from Health has been identified and will join the group for future meetings. 5.18 Meaningful participation through mechanisms such as the Carer Forum(s), carer representation on the Integration Joint Board (IJB), collaboration with the wider Carer Support Network and through the range of funded Carer Breather and Time for Me organisations and groups, as well as the Public Partnership Forum, ensure that people, including carers, are supported to engage early, access the right information, and influence change. 5.19 Through awards made from a Growth Pot provided by UHSCNL, and managed by NLDF, significantly broadened reach has been achieved, and the voice of previously unheard communities has been amplified. Recipients of Growth Pot funding to date have included organisations facilitating engagement with Global Minority Ethnic communities, library projects, biodiversity and greenspace, food and fuel poverty, benefits advice, displaced communities, and age-related support organisations. 5.20 The Community Solutions Governance Group agreed to consult on a new funding model to allocate thematic funds to Community and Voluntary Sector (CVS) organisations. The intention was that funding was more dynamic and responsive to changing themes and priorities, on an annual basis, including the priorities of the Community Solutions Strategy and Investment Plan, the UHSCNL Strategic Commissioning Plan, Programme of Work, and public health priorities. Funding of £512,000 was disbursed and twenty projects were funded, covering each of the fund’s priority activities. 5.21 Paid support is delivered through in-house services, framework support provider organisations, or through a Direct Payment. Information on these arrangements is reported separately to committee. The majority of community- based support is facilitated through self-help and unpaid care, and within our approach to supporting resilience, UHSCNL continues to develop or enhance place-based initiatives. Two specific examples that serve to enhance community\place-based support are Neighbourhood Networks and Community Connectors. Neighbourhood Networks utilise a peer support approach which focuses on the development of natural networks with an emphasis on helping people achieve outcomes whilst reducing dependence on paid support. Its roots are in early intervention, prevention, and the development of communities in line with the principles first outlined in the Christie Report. Neighbourhood
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6 Networks has been delivering services in North Lanarkshire since 2003 and has adapted and flexed to meet local need over the past two decades. More recently, Community Connectors have been employed, managed by NLDF, to ensure that people, who may otherwise have had to access statutory supports can be connected, or re-connected to local community opportunities. 5.22 We have an effective and impactful engagement, participation, and support (if required) landscape in place through commissioned organisations, augmented by wider CVS organisations, to help promote and develop resilience across communities, carers, and supported people. This is further evidenced by the range and strength of involvement of people from these areas, whether around individual planning, policy, service design, or involvement in tender evaluation. Lived experience has become an increasingly influential and important element of the three-way partnership across business intelligence, professional knowledge, experience, and skill, allied to lived experience. 5.23 We can be confident that an infrastructure is in place to support and promote resilience, and effective early intervention, when required. Preventative, and anticipatory approaches are in place across communities, carers, and supported people, thus alleviating pressure and demand that would otherwise fall to statutory provision, for people aligned to services, whether statutory, or through CVS. 5.24 We are also confident that our approach assists with the requirements set out in the Community Wealth Building Bill (Scottish Govt, March 2025) aimed at ensuring that wealth is generated, retained, and circulated within communities. As an anchor organization, North Lanarkshire Council helps ensure that local employability options, consumer spend, and economic development can be prioritised and supported. This can be achieved by ensuring that local people continue to be consumers, citizens, and users of local services being helped to help themselves and if support is required, are supported by local people, local communities, and local organisations. Challenges 5.25 The landscape set out above helps promote and support resilience for those people currently known to services, whether statutory services, or CVS. Our investment further upstream demonstrates a strong return, irrespective of whether spending to save, deferred spend, or spend avoidance - all three hold true. 5.26 However, the National State of Caring, published March 2025, presents a concerning picture. Locally, NLCT were asked to engage with carers in our area, to get a sense of the local picture around caring, but also with a focus on resilience, inclusion, and any impacts of economic deprivation. Findings demonstrated that the local experience is more positive than the national picture but highlighted that we still have much to do.
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7 5.27 There is, therefore, a wider consideration around supporting resilience. There are many carers and supported people not currently aligned to any services. Demographic information from a range of sources, such as the national census, local carer engagement sessions and other means, all demonstrate the scale of challenge. North Lanarkshire has an ageing population, including unpaid carers, and estimates suggest that three in every four people will have an unpaid caring role at some point in their lives. Doing more of the same as we do now is not a sustainable approach to service delivery. The demographic challenge means that we need to broaden reach- to reach people that are not aligned to services and to identify any unmet need - through whole system efforts. Next Steps 5.28 The challenge we face is how to ensure that people and communities can, and do, make advance plans; to ensure that the needs of people currently unknown to services, do not become service reliant, but can instead continue to live as independently as possible, with the appropriate community infrastructure in place to facilitate and enable that, through the optimal combination of self-help, preventative approaches, and anticipatory planning. 5.29 It is often the case that people only first present to services when already in crisis, with the costs in financial terms, resources and most importantly, in human terms, then being significant. Often, crisis can be avoided, through the implementation of preventative or anticipatory actions or future planning. However, when the person, or situation, first presents when already in crisis, such opportunities are lost, as the window of opportunity for introducing, options such as enabling approaches, assistive technology, or advance planning, has passed. 5.30 Accordingly, there is a need to ensure that even earlier planning takes place across communities, carers and supported people, as well as across partner organisations. Promoting self-planning, thinking ahead and sustaining resilience will be key elements of our approach. Our aim is to not only get it right for everyone known to services, but to try and ensure that people do not need to become known to services, or, if or when they do, that advance plans, rather than crisis-lead responses, set out what should happen. 5.31 Our aim is also to ensure equitable provision across the authority area and redress any current service provision imbalance in an appropriate and sustainable way. We want to ensure that we maintain our focus on Getting it Right for Everyone, through prevention, early intervention and anticipatory planning, allied to tackling inequality, in a fair, equitable and sustainable way and to ensure that there is no postcode inequality in service provision. Action to rebalance support and services to reflect this will be progressed. Partnership work in this area has already commenced, following the shared VANL thematic review. 5.32 Wider service approaches such as income maximisation, assistive technology, community hubs, aging well initiatives and other work streams all have a continuing role to play in promoting and sustaining independence, self-help, and self-reliance and is supporting community wealth - to support resilient
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8 communities. UHSCNL and partner organisations all have a role and remit in promoting and supporting wider self-planning and individual approaches and solutions to the challenges described above. This will be the priority and area of focus moving forwards. 5.33 We will report to Committee in due course on progressing next steps. 6. CONCLUSIONS This report seeks to draw together a number of key strands of work to demonstrate the overall intent that communities, unpaid carers and supported people are resilient, and can influence and shape decisions, from individual care planning to strategic decision making. Through this shared approach, involving lived experience, business intelligence and professional knowledge and expertise a whole system approach to getting it right for everyone is realised. 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) 7.2.1 The measures of success have not fundamentally changed since previous reporting. 7.2.2 All care groups and communities are engaged, included, and represented to the extent they wish to be.
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9 7.2.3 Creation of better opportunities for under-represented and seldom heard people to participate and have their voices heard. 7.2.4 Improved opportunities to co-produce and co-design services, our Strategic Commissioning Plan and associated Programmes of Work and a better route to consult and seek feedback. 7.2.5 Provision of sector, locality and thematic forums that can be influenced and shaped by the engagement and participation activity set out above are delivered on an equitable basis, across the authority area. 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 ☐ 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 Yes ☐ No ☐ N/A ☐
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10 ☐ 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: 8. BACKGROUND PAPERS 9. APPENDICES Please include a glossary of terms if not already included. N/A Yes ☐ No ☐ N/A ☐ Yes / Date added ☐ No ☐ N/A ☐
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11 Morag Dendy CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following.
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12 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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13
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1 REPORT Item No: 12 SUBJECT: QUALITY ASSURANCE ANNUAL REPORT TO: JOINT INTEGRATION BOARD Lead Officer for Report: MORAG DENDY, CHIEF OFFICER, PLANNING, PERFORMANCE & QUALITY ASSURANCE Author(s) of Report MARIA BARRY, Senior Manager Quality Assurance DATE: 17 September 2025 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: ☒ North Lanarkshire Council’s Adult Care and Social Work Committee. 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: 1. Note and endorse the contents of the report
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2 4. EXECUTIVE SUMMARY / BACKGROUND 4.1 The role of Quality Assurance includes a broad spectrum of activity both internally across social work services, and, in partnership with our commissioned services. Assurance and Governance underpins our key functions whilst aligning our work to the Council’s Plan for North Lanarkshire and the five-year Programme of Work 2023-2028. 4.2 Throughout 2024/2025, the Quality Assurance Team have participated in Strategic Planning meetings, influencing and shaping future priorities and approaches aligned with the University Health & Social Care (UHSCNL) Strategic Commissioning Plan 2023 – 2026 and the priorities outlined within the associated Programme of Work. 4.3 The health and social care environment in which we operate remains challenging and sharing of best practice and solution focused ideas are integral to ensure the people of North Lanarkshire receive good quality support to help meet their outcomes. 4.4 Our commitment is to provide an annual report on activity carried out in the preceding year. 4.5 The purpose of this report is to update Committee on our Quality Assurance activity over the annual period of 1 April 24 to 31 March 25. 4.6 This report highlights Quality Assurance activity over the period 1 April 2024 to 31 March 2025. It outlines how work has progressed in areas which includes Contracts & Contract Management Framework, Procurement, Back to Basics – Getting it Right for Everyone, Safe Staffing, Market Facilitation, Review of Registered Social Landlords, Duty of Candour, In House Monitoring, Social Work Risk Management, ASW Governance Subgroup for Registered Managers, Participation & Engagement and Carers. 4.7 Full detail of these activities is included in Appendix One. 5. Report Contracts 5.1 The Quality Assurance Team are responsible for coordinating and facilitating all procurement activity across social work. This is in partnership with our corporate procurement colleagues, who provide the framework and legal basis to ensuring that decisions taken are in line with legislation including the Procurement Reform (Scotland) Act 2014. 5.2 Over the past year, Quality Assurance have continued to ensure consistency across purchased services and that contractual arrangements have clearly defined terms and conditions. This has ensured that expectations are clearly outlined and there is a basis for contract monitoring to take place. This enables the quality of services being provided to people to be evaluated. Arrangements
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3 range from national frameworks to Individual Placement Agreements which balance quality against cost to achieve overall best value for services purchased to support people. Contract Management Framework 5.3 Adherence with the contract management framework is an integral component of the processes in place to demonstrate commissioned services are adhering to terms and conditions and that outcomes and best value are achieved. Contract monitoring is a means to identify unmet need and inform future strategic planning and commissioning. 5.4 The Contract Management Framework was also the focus of a recent internal audit of Quality Assurance. Findings were positive, with only minor recommendations for improvement. As a result of the audit, feedback from stakeholders and new legislation, further enhancements have been made: Contract Management Framework process has been made clearer with roles & responsibilities outlined for both QA staff and providers Monitoring prioritisation assessment (MPA) modified to more clearly identify service-related risk Analysis of quarterly return submission documented, and feedback is now given to providers Closure date introduced for acceptance of quarterly & annual return submissions to enhance compliance Information added to capture the principles of safe staffing legislation 5.4.1 We reported last year that we planned to produce a Quarterly Commissioned Services Performance Report. This was implemented as of 1st April 2024, to provide useful information to operational colleagues to assist in supporting people to make a choice of care provider based on the available intelligence. The report also enables the Quality Assurance Team to monitor performance, patterns, themes and trends in relation to areas such as notifications of concern, engagement & participation, Care Inspectorate Grades, Tier Ratings and compliance with annual/quarterly provider returns. 5.4.2 During the reporting period we started to provide information which assists Locality Teams in supporting people to identify their choice of care provider. All providers on the SDS Framework are included within the Performance Benchmark Tool, as are up to date contact details. Alongside each provider on the SDS Framework, we have included performance information which gives indicators to the quality of care being provided to people. We strive to ensure information is up to date. Benchmarks include Care Inspectorate grades, contract monitoring Tier indicating associated risk level and evaluation score at the time of entering the framework.
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4 Procurement 5.5 Quality Assurance continued to lead on procurement activity for all social work services in collaboration with colleagues within Corporate Procurement, Service Leads and Locality Social Work Teams, to ensure joined up planning, clear procurement processes and subsequent contract monitoring arrangements. This ensured that all commissioned contract work delivered best value, in accordance with Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016. In House Monitoring Framework 5.6 Throughout 2024 a Test of Change for the newly developed In House Monitoring Framework continued within Home Support (Living Well at Home). The review and evaluation of the In-House Monitoring Framework commenced in December 2024 and those who had been involved in the development of this, and the participants of the Test of Change provided feedback on what worked well and what further developments could be embedded within the approach. Feedback consisted of individual meetings and group workshops. 5.7 The Senior Management Team have agreed the roll out of the revised In-House Monitoring Framework and a programme of activity will commence in April 2025. Market Facilitation 5.8 The health and social care sector continued to experience a variety of challenges. These challenges are expected to continue for some time. The Quality Assurance team continues to promote, stimulate and support market facilitation, and our approach is based on strategic intervention, relationship building, light touch intervention and supporting beneficial new relationships and activities that lead to resilient and sustainable approaches. In turn this leads to continuous improvement, improved ways of working and an active learning cycle, whereby planning impacts on delivery, review and learning. Engagement & Participation 5.9 In September 2024 the University Health and Social Care Engagement and Participation Strategy was launched alongside the Growth Pot Fund. Quality Assurance were involved in both the drafting of, and raising awareness of, the strategy and its ambitions. During the year work to collate examples of best practice to support staff across the service to further engage with those involved in services, was undertaken by Quality Assurance, in partnership with Planning and Performance colleagues. Back-to-basics to getting it right for everyone 5.10 Over the past year within Adult Health & Social Care Services, we have been working on the development of an enabling approach that supports the move from our work on back-to-basics to getting it right for everyone, as we recognise
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5 the landscape of health and social care is changing and services, supports and responses need to change to continue to improve the lives of people who live and work in North Lanarkshire. We have sought to adopt a human learning approach by trying different ways to focus more on people and less on systems and processes, and use resources to their best effect, to make the most positive impact on peoples’ lives. 5.11 Over the coming year we will further develop specific plans and service developments: as this is a whole system approach, we anticipate there will be a lot to focus on and much change across services, supports and responses that are needed to achieve and sustain change. Safe Staffing 5.12 The Health and Care (Staffing) (Scotland) Act 2019 (HCSA) came into effect on 1st April 2024. The purpose of this legislation is to establish a statutory framework to ensure appropriate staffing levels in health and care settings. North Lanarkshire Council have responsibilities as a provider of care and support and as a placing authority. 5.13 Quality Assurance supported both commissioned and in-house services with the implementation of the Act throughout the reporting period, by facilitating two dedicated working groups. 5.14 Quality Assurance have devised the Health and Care (Staffing) (Scotland) Act 2019 Annual Report for Social Work Services. Duty of Candour 5.15 All health and social care services in Scotland have an organisational duty of candour. This is a legal requirement which means that when certain types of incidents happen, the people affected understand what has happened, receive an apology, and the organisation learns how to improve for the future. 5.16 North Lanarkshire Council reviewed and modified its Duty of Candour reporting procedures during 2024/25. Throughout January, February & March 2025 Locality Social Work Managers, Senior Social Workers and Registered Managers participated in awareness raising sessions to enhance understanding of the circumstances when Duty of Candour would be considered; and the stages involved in the procedure. 5.17 The Duty of Candour notification procedure now includes two stages, which are: Part 1 Possible Duty of Candour incident (Initial Notification) Part 2 Managing the Duty of Candour Process 5.18 The intention underlying the introduction of the two-stage process is to enable internal monitoring and analysis of when Duty of Candour has been considered but not activated. It is envisaged that this data will contribute to organisational learning.
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6 Review of Registered Social Landlords 5.19 Since the summer of 2023, Quality Assurance has been leading on the review of five Registered Social Landlords who provided thirteen sheltered & very sheltered developments across North Lanarkshire. These services were funded to provide housing support, using Supporting People funding. This funding stream was discontinued around 2016/17, leading to mainstream social work funding being accessed pending review. This review has now concluded, and North Lanarkshire Council no longer commission or fund these Registered Social Landlords. Adult Social Work Subgroup – Registered Managers 5.20 An Adult Social Work Subgroup for Registered Managers was established in 2025. This group meet eight weekly, and the chair is the Quality Assurance Service Manager or delegated person. This group reports through the ASW Governance Group and its purpose is to ensure robust governance and oversight across Registered Services. Social Work Risk Management 5.21 Quality Assurance have oversight of the social work risk register and are responsible for quarterly & annual reporting, compliance audits and for the facilitation and coordination of the Social Work Risk Forums. Quality Assurance participate in Corporate Risk Management Team meetings, and cascade appropriate information through the correct forums. 5.22 Risk Champions and Facilitators act as points of contact for risk management matters within social work and promote risk awareness across the service. 6. IMPLICATIONS 6.1 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 ☐
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7 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 FINANCIAL This paper has been reviewed by Finance: 7.3 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 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 ☐ 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 Yes ☒ No ☐ N/A ☐
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8 ☐ 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 7.5 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. APPENDICES Appendix 1: Quality Assurance Annual Report 2024/25 Members seeking further information about any aspect of this report, please contact the following; Morag Dendy Chief Officer (Planning, Performance, and Quality Assurance) Yes ☐ No ☐ N/A ☐ Yes / Date added ☐ No ☐ N/A ☐
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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Quality Assurance Annual Report 2024/2025 APPENDIX 1
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1 1. Introduction The role of Quality Assurance includes a broad spectrum of activity both internally across social work services, and, in partnership with our commissioned services. Assurance and Governance underpins our key functions whilst aligning our work to the Council’s Plan for North Lanarkshire and the five-year Programme of Work 2023-2028. Throughout 2024/2025, the Quality Assurance Team have participated in Strategic Planning meetings, influencing and shaping future priorities and approaches aligned with the University Health & Social Care (UHSCNL) Strategic Commissioning Plan 2023 – 2026 and the priorities outlined within the associated Programme of Work. Quality Assurance have strengthened the governance structure and reporting arrangements around the Strategic Commissioning Plan Programme of Work. These sit alongside and compliment structures already in place across UHSCNL. The purpose of the structure is to ensure oversight of inter-related programmes, projects and activities. Last year we reported on the expanded remit of Quality Assurance and the additional staffing resource that had been aligned. We believe that we met our key deliverables. Our achievements include the evaluation of the In-House Monitoring Framework and subsequent roll out; a review of Duty of Candour Procedures and delivery of training across Locality Teams; completion of a review of Registered Social Landlords, collation of information for inclusion in the CSWO report; development of a care opinion newsletter; the launch of the Engagement & Participation Strategy; and the organisation of the annual Committed to Carers Event. The bigger part of our work focuses on social work procurement and contract monitoring. The range of contracts that have been procured, and further development of our contract management framework are detailed within this report. Some key functions of the Quality Assurance Team were subject to audit and the findings shared. We are delighted to report that the areas of work audited reflected compliance with good practice principles and defined expectations. Much of the focus of Quality Assurance during this reporting period has been supporting our Registered Services and an Adult Social Work Subgroup for Registered Managers commenced. A safe staffing working group continues to explore best practice and develop standardised tools to evidence compliance with the Guiding Principles of the newly implemented Health and Care (Staffing) (Scotland) Act 2019. The Quality Assurance Team supported Home Support (Living Well at Home) to introduce a performance monitoring framework to ensure accountability across all grades of staff. The team also facilitated workshops and briefings to assist in expanding the knowledge of Care Inspectorate Quality Frameworks and self-evaluation tools. In line with the principles of self-directed support, people can exercise as much choice and control as they wish, around their support arrangements. Quality Assurance support this through ensuring that teams are equipped to facilitate discussions around choice of support options. Performance is now being captured through the introduction of a Quarterly Performance Report and Benchmark Tool for commissioned services. We have progressed new social work induction processes, social work self-evaluation, the reframing of risks and policy development has commenced. Test of change sites have been identified for social work self-evaluation, prior to roll out.
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2 Extensive work was carried out in relation to new legislation around reporting requirements under the Health and Care (Staffing) (Scotland) Act 2019 Act. We also supported Housing and Early Years colleagues with the aim of ensuring a consistent approach across North Lanarkshire Council to safe staffing reporting. Over the past year Quality Assurance have supported the work around our transformational change programme, Phase One Back to Basics, which is now embedded across our locality teams. As we enter Phase 2 Getting it Right for Everyone, we remain engaged and connected to the principles underlying the approach. The activities reported in this annual report reflect our commitment to on-going improvement and that people can influence and shape decision making. 2. Contracts The Quality Assurance Team are responsible for coordinating and facilitating all procurement activity across social work. This is in partnership with our corporate procurement colleagues, who provide the framework and legal basis to ensuring that decisions taken are in line with legislation including the Procurement Reform (Scotland) Act 2014. Our approach to procurement activity reflects Scottish Government best practice guidance including Procurement of Care and Support Services, and the Public Procurement Strategy for Scotland 2023 to 2028. We seek to ensure that we are acting in accordance with the principles of ethical commissioning. As a learning organisation, we continue to modify and adapt our procurement journeys to inform and secure best value, to provide care and support to people across North Lanarkshire. Following the awarding of contracts throughout 2024/2025, our internal procurement end to end process has been revised and modified to reflect what worked well and what improvements and enhancements could be made to ensure that future services are influenced, shaped and aligned to the Plan for North Lanarkshire, the Strategic Commissioning Plan and other key health and social care priorities and ambitions. The Quality Assurance Team have participated in additional procurement awareness training during this reporting period and more bespoke training is planned for August 2025. An invite will be extended to operational colleagues to take part in this training, in response to feedback from previous tendering activity. It is envisaged that the modifications made to the end-to-end procurement journey and the involvement in bespoke procurement training will assist operational colleagues to devise service specifications, which describe the service required and the outcomes to be achieved. We continued to work closely with our partners at Scotland Excel. Through Scotland Excel, we operate the National Care Home Contract, the Children's Residential Care and Education including Short Break, Services and Fostering & Continuing Care contracts from Scotland Excel. Scotland Excel have committed to redesigning the National Care Home Contract, as since its development in 2013 there have been significant changes to the social care environment. It is envisaged that redesign will be more reflective of the current social care landscape, which includes challenges such as the inexperience of the workforce, staff recruitment and retention, cost of living impacts and changing demographics/more complex needs of the care home population at the time of admission.
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3 Over the past year, Quality Assurance have continued to try and ensure consistency across purchased services and that contractual arrangements have clearly defined terms and conditions. This has ensured that expectations are clearly outlined and there is a basis for contract monitoring to take place. This enables the quality of services being provided to people to be evaluated. Arrangements range from national frameworks to Individual Placement Agreements which balance quality against cost to achieve overall best value for services purchased to support people. Tables 2a and 2b below illustrate that as of 31 March 25, 98% of all social work spend had a formal contracting arrangement in place. This figure remained consistent with 2023/2024, when we reported 98%. Two organisations are currently out of contract and subject to review during the reporting period. The review findings are under consideration and previous funding agreements are being honoured during this time. Quality Assurance continue to progress with arrangements to ensure all spend has contractual and legal agreements in place; however, it should be noted that due to the fluidity of contracting and commissioning, achievement of 100% compliance may not always be possible. Table 2a 98% 2% No of Contracts 2024/2025 Contracts in Place In Development 98% 2% No of Contracts 2023/2024 Contracts in Place In Development
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4 Table 2b There are currently 310 contracted provider organisations, a decrease of seven from the figure reported last year and as highlighted above. The number of out of authority care homes being utilised has increased by 7 and it can be determined that this is not due to lack of availability within North Lanarkshire, as there have been no capacity issues throughout the reporting period. People accessing care homes out of authority are doing so due to their choice to locate close to family. There has been a reduction in the cross-border provider organisations we contract with. It can be seen from the graphs above that non framework self-directed support has increased, and non-traditional respite packages have decreased. 3rd sector and voluntary providers have increased by 1. We encourage these providers to join our SDS Framework. The number of care homes within North Lanarkshire we contract with remains unchanged since last year and this is also the case with Self Directed Support (SDS Framework). 10 4 27 12 141 3 10 2 7 4 9 9 4 61 0 20 40 60 80 100 120 140 160 3rd Sector / Voluntary Advocacy Care Home (NLC) Care Home Cross Border Care Home Out of Authority Carers Network Fostering & Continuing Care Mental Health Misc Non Framework Self Directed Support Non Traditional Respite Residential Schools Secure Services Self Directed Support Spread of Providers 2023/2024 11 4 27 3 148 10 10 2 7 5 8 10 4 61 0 20 40 60 80 100 120 140 160 3rd Sector / Voluntary Advocacy Care Home (NLC) Carers Network Care Home (Out of Authority) Care Home (Cross Border) Fostering & Continuing Care Mental Health Misc Non Framework Self Directed Support Non Traditional Respite Residential Schools Secure Services Self Directed Support Spread of Providers -2024/2025
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5 3. Contract Management Framework (CMF) The two most recent Quality Assurance Annual Reports (2022/23 & 2023/2024) provided updates on developments and enhancements to the contract management framework. From the cyclical changes implemented, and throughout the 2023/24 reporting period, the Quality Assurance team evaluated the impact of the changes. Various methods of evaluation were utilised, including an on-line meeting with commissioned services. Other methods included a Quality Assurance presentation at one of the SDS Provider Development Sessions, feedback from Internal Audit, on-going discussions at team meetings and through the findings of senior officers’ use of the framework, findings from service manager sampling and compliance checks. This approach reflects one of a learning organisation and focuses on our overarching aims, which include monitoring our commissioned services to enable effective partnership working, early intervention and the targeting of resources to improve the experience of people. Adherence with the contract management framework is an integral component of the processes in place to demonstrate commissioned services are adhering to terms and conditions and that outcomes and best value are achieved. Contract monitoring is a means to identify unmet need and inform future strategic planning and commissioning. The main changes made to the contract management framework and as highlighted in 2022/2023 & 2023/2024 annual reports are as follows: - - Introduction of an Engagement & Participation Toolkit - Quarterly & annual returns being specific to the model of service - Monitoring Visit report template introduced to improve on consistency and the impact from monitoring In January 2025 Quality Assurance arranged a feedback session focusing on the changes made to the contract management framework. Over 40 providers attended. Feedback was used to further build on developments to avoid duplication of reporting or collation of unnecessary information. The outcome was an improved and more relevant framework. In March 2025 Quality Assurance facilitated a further session on the contract management framework at one of the SDS Provider Development Days. Feedback was positive and promoted enhanced understanding and awareness. The Contract Management Framework was also the focus of a recent internal audit of Quality Assurance. Findings were positive, with only minor recommendations for improvement. As a result of the audit, feedback from stakeholders and new legislation, further enhancements have been made: • Contract Management Framework process has been made clearer with roles & responsibilities outlined for both QA staff and providers • Monitoring prioritisation assessment (MPA) modified to more clearly identify service-related risk • Analysis of quarterly return submission documented, and feedback is now given to providers • Closure date introduced for acceptance of quarterly & annual return submissions to enhance compliance • Information added to capture the principles of safe staffing legislation The revised MPA can be seen below in two parts (Table 3a & 3B) It is based on a confidence rating and focuses on assessment areas which indicate the potential risk of lower-than-
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6 expected standards of care and support being provided. Outcomes are nuanced and determined based on narrative provided by Senior Officers who have additional context as to circumstances, as well as established relationships with providers. This approach is balanced with an element of standardisation. Table 3a Table 3b
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7 The MPA outcome indicates the tier level and associated frequency of monitoring required by Quality Assurance Senior Officers. See below: - Each Tier suggests a minimum monitoring frequency as set out in Table 3c below Table 3c STATUS INDICATED MONITORING LEVEL Red Significant concerns in relation to service performance, contract compliance. TIER 4 Contract monitoring visit frequency – 1 to 4 weekly. Amber Moderate concerns in relation to service performance, contract Compliance TIER 3 Contract monitoring visit frequency – variable, at least quarterly but no more than monthly. Yellow Minor concerns identified in relation to service performance and contract compliance TIER 2 Contract monitoring visit frequency – variable, at least bi-annually but no more than quarterly. Green Service performance, contract compliance and engagement are satisfactory. TIER 1 Contract monitoring visit frequency – annually in most cases.
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8 Table 3c The on-going improvements to our contract management framework ensure that due diligence is consistently and clearly documented and decisions are based on facts and evidence. This safeguards North Lanarkshire Council from potential reputational or financial consequences. Table 3c highlights Tier Levels as reported at the end of 2023/2024 and for the same time in 2024/2025. Tier 4 services have increased in this reporting period from 0% to 5%. However, it is positive that the risks are known to the team, as this ensures these can be mitigated with the appropriate interventions. When comparing the lower tier ratings (1 & 2) across both reporting periods, there was a 3% reduction from 2023/2024 and for Tiers 3&4 there was a 2% increase from 2023/2024. Overall, most providers were tiered within the lower Tier rating categories. This is positive as the intensity and frequency of Care Inspections, and our monitoring activity has been enhanced. Quality Assurance are mindful of the challenges being experienced within the sector and are pleased to report that in spite of the challenges evidence highlights an improved quality of care from 2023/24. Tier 1 Tier 2 Tier 3 Tier 4 Q4 2024 to 2025 74% 16% 5% 5% Q4 2023 to 2024 68% 25% 8% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% Commissioned Services Q4 Tier Ratings 2023/2024 & 2024/2025 Q4 2024 to 2025 Q4 2023 to 2024
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9 Commissioned Services Quarterly Performance Report – We reported last year that we planned to produce a Quarterly Commissioned Services Performance Report. This was implemented as of 1st April 2024, and it is intended to provide useful information to operational colleagues to assist in supporting people to make a choice of care provider based on the available intelligence. The report also enables the Quality Assurance Team to monitor performance, patterns, themes and trends in relation to areas such as notifications of concern, engagement & participation, Care Inspectorate Grades, Tier Ratings and compliance with annual/quarterly provider returns. The format of the Commissioned Services Quarterly Performance Report has continued to change and develop in response to feedback from Localities. Feedback indicated it would be helpful for Localities to receive updates following submission of Notifications of Concern about provider performance. We introduced a feedback section within the Notification of Concern Form. We also track the timescales for feedback to be provided. Levels of Engagement and Participation have continuously increased. Over the reporting period we engaged with the following: Table 3d Supported people Staff Relatives/ carers Other Amount 146 276 134 48 0 50 100 150 200 250 300 No of people engaged with as at 31/03/2025 Supported people Staff Relatives/ carers Other Q1 3 11 2 0 Q2 43 80 32 18 Q3 68 109 60 20 Q4 32 76 40 10 0 20 40 60 80 100 120 No of people engaged with during each quarter 2024/2025
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10 We continue to measure the impact of this engagement. Some examples are shown below: - Table 3e GP is now based within the Care Home one day a week. Provider ensured consistency and improvement in staffing arrangements. Manager arranged a meeting with the family to outline the staffing arrangements and to provide reassurance around their concerns The need to provide information about people’s likes and dislikes in Agency staff induction and handovers was agreed. This has been added to the service development plan. Previous concerns around prearranged GP appointments. Discussed concerns with the management team Concerns around inadequate staffing levels at night raised by family Discussion took place with the manager who confirmed safe staffing levels were in place Some carers are better than others Senior Officer discussed with manager and asked for follow up Agency staff who do not know the residents Information relayed to the manager
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11 Performance Benchmark Tool – During the reporting period we started to provide information which we hope will assist Locality Teams in supporting people to identify their choice of care provider. All providers on the SDS Framework are included within the Performance Benchmark Tool, as are up to date contact details. Alongside each provider on the SDS Framework, we have included performance information which gives indicators to the quality of care being provided to people. We strive to ensure information is up to date. Benchmarks include Care Inspectorate grades, contract monitoring Tier indicating associated risk level and evaluation score at the time of entering the framework. 4. Regulatory Activity Table 4a below details an analysis of the key question “How well do we support people’s wellbeing?”. The data has been extracted from Tables 4b and 4c below. North Lanarkshire Care Homes performance measures lower than Scotland wide care homes, in that 72% of grades of 4 and above were awarded. Scotland wide care homes achieved 76.6% of grades of 4 and above. From the figures below it would appear that North Lanarkshire care homes seem to have an overall average of grades ranging between adequate and good. An improvement area would be to start to focus on why very few care homes are achieving good or above grades. 132 Scotland wide care inspections are reported below for the period 1st April 2024 – 31st March 2025. Please note some care homes have not been inspected or have not been inspected under this key question. Table 4a - Please note North Lanarkshire care homes are not included in the overall Scotland wide figures. How well do we support people’s wellbeing Number of Care Homes Assessed Grades Awarded Percentage North Lanarkshire Care Homes (Table 4b) 25 0 x Excellent 5 x Very Good 13 x Good 4 x Adequate 0 x Weak 0 x Unsatisfactory 3 x Not Assessed 0% 20% 52% 16% 0% 0% 12% Scotland Wide Care Homes (Table 4c) 107 3 x Excellent 38 x Very Good 41 x Good 17 x Adequate 1 x Weak 0 x Unsatisfactory 3% 35% 38% 16% 1% 0%
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12 7 x Not Assessed 7% Table 4b As of 31st March 2025, there were 27 care homes within North Lanarkshire. 24 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 29.1% of care homes achieved ‘Very Good’. How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Very Good 3 2 1 2 0 Good 15 13 9 6 9 Adequate 5 7 3 5 2 Weak 4 3 0 3 2 Unsatisfactory 0 1 1 0 0 0246810121416 Care Inspectorate Grades -North Lanarkshire based Care Home as at 31/03/2024 How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Very Good 7 4 4 1 0 Good 13 7 14 13 11 Adequate 4 7 3 2 4 Not assessed 3 9 6 11 12 0 2 4 6 8 10 12 14 16 Care Inspectorate Grades -North Lanarkshire based Care Home as at 31/03/2025
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13 The majority of care homes were assessed as ‘Good’ or better against this question, totalling 54.1%. It is positive to note that the number of care homes assessed as Very Good has increased from 11.1% in 2023/2024. The care homes who were assessed as ‘Very Good’ were Blair House, Carrickstone, Darroch, Highgate, Kirknowe, Rosepark and Summerlee. Of the 27 care homes within North Lanarkshire, 15 were assessed under key question ‘How well is care and support planned?’ Of the 15 assessed, 73% received a grade of ‘Good’. During the reporting period, no care homes within North Lanarkshire were subject to Large Scale Investigations. From 1st April 2024 to 31st March 2025 there were a total of six care homes within North Lanarkshire, who at periods, had a voluntary moratorium applied to all new admissions. These were Avondale, Darroch, Carrickstone, Milbrae, Parksprings and Woodside. Out with Avondale, whose moratorium was applied due to a change in contract, the remaining five care homes were for reasons of weak Care Inspectorate grades and the findings from monitoring carried out by Quality Assurance. The duration of these moratoriums was a maximum of three months with some being removed with one or two months. Cumbernauld Care Home had an enforced moratorium due to weak Care Inspectorate grades. Improvements were quickly embedded by the Provider and the moratorium to new admissions was removed within three months. It is important to note the application of a moratorium to new admissions is to enable the care homes to focus on progressing identified improvement areas.
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14 Table 4c Care Homes in Scotland (excluding North Lanarkshire): North Lanarkshire Council currently has 313 people placed within 122 care homes that are located elsewhere in Scotland. Contract Monitoring activity is carried out by the host authority where the care home is geographically located, although care management responsibilities remain with North Lanarkshire Council for the individuals placed. Individual Placement Agreements are implemented for individuals and these agreements detail the basis for care and support. North Lanarkshire Council are notified of any Large-Scale Investigation activity or potential scenarios which may lead to the closure of the home e.g. Care Inspection Enforcement Action, Liquidation etc. How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Excellent 0 1 0 1 0 Very Good 39 40 15 9 13 Good 56 44 34 37 38 Adequate 30 27 19 12 25 Weak 2 2 1 2 1 0 10 20 30 40 50 60 Care Inspectorate Grades -Care Home as at 31/03/2024 (excluding NLC) How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Excellent 4 2 0 1 0 Very Good 58 36 45 20 22 Good 58 44 50 49 41 Adequate 18 25 17 15 23 Weak 1 2 2 0 0 Not assessed 9 39 34 63 62 0 10 20 30 40 50 60 70 Care Inspectorate Grades -Care Home as at 31/03/2025 (excluding NLC)
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15 Table 4d How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? How well do we support Children and Young People's Rights and Well-Being Care and Support Environment Staffing Management and Leadership Excellent 3 0 2 0 0 0 0 0 0 0 Very Good 32 21 21 1 12 1 2 0 2 1 Good 12 15 10 1 10 1 0 0 0 1 Adequate 7 6 6 0 6 0 0 0 0 0 Weak 1 1 2 0 1 0 0 0 0 0 Not assessed 6 18 20 59 32 0 0 2 0 0 0 10 20 30 40 50 60 70 Care Inspectorate Grades -Self Directed Support including Care at Home as at 31/03/2025
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16 Table 4e Self-Directed Support (SDS) including Care at Home: Across the services on the SDS Framework a total of 38 Care Inspections took place using the current inspection methodology. There remain two services whose last inspections were carried out in accordance with a previous inspection approach. How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Excellent 1 0 0 0 0 Very Good 27 16 7 1 7 Good 16 20 9 2 9 Adequate 3 8 1 0 3 Weak 2 2 2 0 2 0 5 10 15 20 25 30 Care Inspectorate Grades -Self Directed Support including Care at Home as at 31/03/2024
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17 The table above outlines 61 services with their current grades under each Key Questions as of 31st March 2025. This table highlights that for Key Question 1 ‘How well do we support people’s wellbeing?’ Three services received a grade of ‘Excellent’. These services were Active Care and Support Services, Potential Living (VAMW) and Support for Ordinary Living (SOL). A grade of ‘Very Good’ was received by 58.1% of services and 21.8% of services inspected received grades of ‘Good’ or above. For the key question ‘How well do we support people’s wellbeing?’, one service received a grade of ‘Weak’. This service was Aspire West Support Service Care at Home. Of the 61 services, 29 were inspected by the Care Inspectorate against the key question ‘How well is care and support planned?’. Of these, 41.3% received grades of ‘Very Good’ and 34.5% received grades of ‘Good’, or above. It should however be taken into consideration that a further two services have grades of ‘Very Good’ under Quality of Care and Support from the previous Care Inspectorate approach. This means that 45.1% of services inspected received grades of ‘Very Good’. During the reporting period no SDS Framework services were subject to Large Scale Investigations. From 1st April 2024 to 31st March 2025 there were a total of six SDS Framework services within North Lanarkshire, at periods, that had a voluntary moratorium applied to supporting any new people. These were Aspire, Ayrshire Children’s Service, Cera Care, Enable, Invercare and Home Instead. Out with Home Instead, whose moratorium was applied due to a change in contract, the remaining five SDS Framework services were for reasons of weak Care Inspectorate grades and findings from monitoring carried out by Quality Assurance. Care 1 Professional had an enforced moratorium due to weak Care Inspectorate grades. When taking into consideration timescales for moratoriums being applied, SDS Framework services were in place for considerably longer than care homes with an average period being approximately six months.
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18 5. In-house Monitoring Framework Throughout 2024 a Test of Change for the newly developed In House Monitoring Framework continued within Home Support (Living Well at Home). The review and evaluation of the In-House Monitoring Framework commenced in December 2024 and those who had been involved in the development of this, and the participants of the Test of Change provided feedback on what worked well and what further developments could be embedded within the approach. Feedback consisted of individual meetings and group workshops. The evaluation highlighted the need for a greater focus on engaging with people to inform self-evaluation improvement plans during Stage One of the process. Furthermore, the timescales and documentation/tools have benefited from slight modifications in response to what people told us during the engagement and evaluation. The Senior Management Team have agreed the roll out of the revised In-House Monitoring Framework and a programme of activity will commence in April 2025. Prior to roll out, briefing sessions will be facilitated by Quality Assurance for Registered Managers and Service Managers/Locality Social Work Managers, who are scheduled to participate in the process throughout 2025/26. Services in scope are Locality Support Services, Integrated Day Services and the Children’s Residential Houses. Two localities from Home Support (Living Well at Home) will recommence the cycle as of April 2025 as they achieved Tier 1 status. The remaining four localities continue to engage with Quality Assurance six weekly, to monitor progress of improvement plans, due to them being assessed as Tier 2 status. Prior to roll out of the In-House Monitoring Framework, the Quality Assurance Team will facilitate Improvement workshops for Registered
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19 Managers and their teams, which will focus on self-evaluation, quality frameworks and the tools to assist in this process.
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20 6. Market Facilitation The health and social care sector continued to experience a variety of challenges, which have been mentioned throughout this report. These challenges are expected to continue for some time. The Quality Assurance team continues to promote, stimulate and support market facilitation, and our approach is based on strategic intervention, relationship building, light touch intervention and supporting beneficial new relationships and activities that lead to resilient and sustainable approaches. In turn this leads to continuous improvement, improved ways of working and an active learning cycle, whereby planning impacts on delivery, review and learning. Work with Enterprise & Communities Team - The Quality Assurance Team continued to liaise with colleagues across the council to identify and support initiatives to assist providers to flourish, remain sustainable and deliver excellent care and support to people across North Lanarkshire. There is a plan for Quality Assurance and Enterprise & Communities to jointly visit a variety of care homes and SDS Framework providers supporting people at home. The aim of these visits will be to hear directly from providers what the challenges are and to identify ways in which the council can support long term sustainability and growth. A report will be made available following the programme of visits which will take place throughout 2025/26. Care Academy - Quality Assurance continued to participate in the work activity of the Care Academy which consists of representatives from North Lanarkshire Council, South Lanarkshire Council and NHS Lanarkshire. The overall vision for the Care Academy is to: Develop a robust, sustained, vibrant Care Academy attracting and developing a diverse workforce for health and care services in Lanarkshire and promoting the sector as a rewarding choice for careers. Increase awareness and engagement about the Care Academy across all partners and organisations, to support people from our communities, working in our communities. The aims of the Care Academy are to: 1. Create the health and social care workforce for the future that best serves the needs of people living in Lanarkshire. 2. Contribute to addressing deprivation and inequalities across Lanarkshire to help people live their lives to the fullest. 3. Provide pathways to fair work, meaningful employment, and progression across the breadth of health and social care.
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21 4. Build a strong talent pipeline to meet future demand and reduce skills shortages within the health and social care sector across Lanarkshire. Further Roll Out of Funding to Support Workplace Scheme- Quality Assurance are currently planning, through the Care Academy to further build on an initiative whereby funding was provided by North Lanarkshire Council to Lanarkshire Care Partners, who deliver care at home services to people across North Lanarkshire. This workplace scheme has already achieved the following: - • 8 North Lanarkshire jobseekers secured paid work. • Over 500 hours of work were paid at a rate above SLW. • Approx.152 CPD points accrued. • SCQF level 5 qualifications gained in Emergency First Aid at Work and Moving and Assisting People. • 7 people finished the placement scheme and are qualified to fill gaps in the Health and Social Care workforce. • 5 offers of employment were made by us to people who would not have been on our recruitment radar without the work-placement scheme. • Approximately £1000 increase in revenue to local businesses contracted to deliver some of the scheme training. Other Care Academy Priorities - Quality Assurance have also been involved in a variety of other deliverables identified by the Care Academy, including the development of micro businesses within Adult Health & Social Care, development of local market facilitation plans, engagement with the principles of the Community Wealth Building and exploring options for funding to support training and wellbeing across the sector Impact of Increase in Employer National Insurance Contributions - Adult service colleagues liaised with providers to consider individual, unique and collaborative ways of minimising the impact of the increase in employer national insurance contributions. Meetings have taken place to ensure a solution focused approach to this. Provider Capacity Portal – Last year we reported that we would be rolling out a new portal whereby SDS Framework Providers would be able to report their capacity to deliver work. This roll out took place following an initial test of change. Feedback has been positive from providers and locality teams, in that the original aim to minimise the time impact for all, has been achieved through this reporting system. 7. Carer and carer focused organisations The Quality Assurance team participated in a range of carer focused work over the year, including a large-scale procurement exercise, monitoring of the commissioned carer focused organisations, engagement and participation focused activity, involvement in Carers Week and development work with the wider carer support network. The second annual Commitment to Carers event in North Lanarkshire was also organised and
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22 facilitated by Quality Assurance and supported by the commissioned carer organisations, again demonstrating the excellent partnership ethos to support carers locally. The Quality Assurance team continued to be influential in ensuring that North Lanarkshire maintained and further developed the long-standing positive record of engagement and participation and strong relationships with carers, and carer focused organisations. Over the reporting year Quality Assurance continued to engage with unpaid carers and carer focused organisations, to build on progress to date, and upon the intent set out in both the national Carers Strategy and the North Lanarkshire Carers Strategy 2024-2027. Quality Assurance led in certain areas of this work, offered support and guidance in other areas, and had an assurance overview throughout. Carers in North Lanarkshire are subject to the many challenges faced by unpaid carers nationally – around accessing breaks from caring, the hidden costs of caring, and issues with accessing replacement care are widely known and recognised, but solutions can be harder to identify. National Census information confirms that more people are having to provide unpaid care. In North Lanarkshire there is an ageing population of unpaid carers, and resources remain limited, whilst needs are infinite. Quality Assurance were involved in influencing and shaping how to best meet these challenges in a sustainable and innovative way, and the local carer experience over the past year continues to be significantly more positive than the findings and statistics reported nationally. This was evidenced through Quality Assurance monitoring and engagement with carers. In line with legislative requirements, a Procurement Exercise, led by Quality Assurance took place in late 2024 to identify carer focused organisations who would work in close partnership with UHSCNL to meet the needs and outcomes of unpaid carers locally. The UHSCNL financial commitment to support carers within this Tender was £18 million and involved significant engagement with carers and other stakeholders, resulting in key areas identified as being: • Adult Carer Support and Adult Carer Support Plans • Carer Information, Advice, Campaigning, Engagement and Participation • Dementia specific caring • Hospital Discharge related caring. • Support for Young Carers The successful bidders were: • Lanarkshire Carers • North Lanarkshire Carers Together (NLCT)
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23 • Alzheimer’s Scotland • Getting Better Together • Action for Children Young Carers Support Project Funding was also provided for: PAMIS – to offer a Family Support Service for families caring for individuals with profound, complex, and multiple disabilities, where specialist knowledge was required. HOPE for Autism - to support children, adults, and family carers, where Autism or Neurodivergence is a feature. Quality Assurance monitoring ensured continued strategic fit, best value, positive impact, and an outcome focused approach. Quality Assurance were also involved in the commissioning of North Lanarkshire Disability Forum (NLDF) - to deliver on the Engagement and Participation Strategy 2024 -2027. Engagement across seldom heard communities and organisations resulted in the voices of previously “hidden” carers also coming to the fore. Through a separate Tender led by Quality Assurance, the Adult Carer Advocacy remit was re-aligned to an Advocacy provider organisation, having previously been hosted by NLCT. Quality Assurance continued to be involved in both governance and operational activity around the Community Solutions programme, facilitated by Voluntary Action North Lanarkshire (VANL). A range of engagement and participation activities aimed at all carers, but with a focus on underrepresented individuals, groups, or communities, including carers from minority ethnic communities and LGBTQI+ communities and involving Quality Assurance, was progressed throughout the year. Funding was made available by Quality Assurance, for an Equalities post within NLCT, and this augmented a similar existing post within Lanarkshire Carers. Quality Assurance were involved in assessing funding applications across a variety of funding streams, including Carer Breather, VANL Community Mental and Well Being Fund, NLDF Growth Pot, and NLC Grant Awards Programme. The range of CVS organisations, including those with an age-related, or condition specific focus, continue to have a role in direct, or indirect, support to carers as well as supported people. Monitoring and quality evaluation regarding carer support across these organisations took place throughout the year to ensure that we continue to have a strong focus on approaches that are carer and supported people led.
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24 Quality Assurance continued to be involved in governance structures and strategic forums, involvement in improvement areas, consultation, and co- production, with identified actions that further engagement and participation in our day-to-day practice. 8. Commitment to Carers Event The 2nd annual Commitment to Carers Event took place in Motherwell in May 2024, following on from the inaugural event in Bellshill in 2023. The event saw a number of carers and young carers delivering keynote addresses on various caring related topics. The event, hosted by UHSCNL also served as the official launch of the North Lanarkshire Carers Strategy 2024 -2027. As part of the movement towards ever greater carer engagement and participation, responsibility for the annual Commitment to Carers Event has now passed from UHSCNL to NLCT, with the 3rd annual event continuing to have a focus on celebrating the impact of caring and carer focused activity, and is scheduled for November 2025, at the Chryston Community Hub. 9. Participation and Engagement Quality Assurance were instrumental in the progress made over the year to increase the capacity to enhance engagement and participation, across our communities, and amongst supported people and unpaid carers. This work continued over the year, in line with Ambition Statement 19, in the Plan for North Lanarkshire (Improve engagement with communities and develop their capacity to help themselves.) This is also priority within UHSCNL Strategic Commissioning Plan and is critical to ensuring: • We involve people in the decisions that affect their wellbeing. • Improvement comes from feedback on the experiences of services and supports. • Our services and supports continue to be based on what matters to people. • We have a continued focus on person centred approaches to embed the wider approach to Getting it Right for Everyone. The key ambitions of our continued investment to engage supported people, unpaid carers and communities is to: • Improve communication and increase connections • Increase awareness of what matters to people
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25 • Increase capacity for early intervention and prevention During 2024-25 the investment and focus to ensure that the voices of supported people were strengthened, gathered pace. The consortium of North Lanarkshire Disability Forum (NLDF), Lanarkshire Links (LL) and Voice of Experience Forum (VoEF), worked together to engage with supported people and support active participation. To help facilitate this, Quality Assurance provided a Growth Pot managed by NLDF. Across 2024-25 there were two rounds of Growth Pot funding that generated 55 applications and 20 awards totalling just over £80,000 to community organisations. The fund reached minority ethnic groups, rural communities and those who experience disability, mental health issues and addictions. The North Public Partnership Forum comprises 3 local forums in North Lanarkshire: Cumbernauld; Kilsyth and Villages; Northern Corridor. During the calendar year the forum decided to change their name to Lanarkshire North Partnership Forum to better represent the areas in North Lanarkshire in which they operate and as part of a review of their core functions. Over the last 12 months the forum’s views have been sought on a range of topics from health colleagues including Effective Prescribing, Pharmacotherapy and Treatment Escalation Plans. Quality Assurance participated in the forum and acted as a conduit to help facilitate progress, resolve issues and link to operational colleagues. In September 2024 the University Health and Social Care Engagement and Participation Strategy was launched alongside the Growth Pot Fund mentioned above. Quality Assurance were involved in both the drafting of, and raising awareness of, the strategy and its ambitions. During the year work to collate examples of best practice to support staff across the service to further engagement with those involved in services and supports was undertaken by Quality Assurance, in partnership with Planning and Performance colleagues. The Strategy for Carers 2024 – 27 was developed with carers and carer organisations and led by Quality Assurance. Carer related work is reported on in a previous section. Similarly, Quality Assurance support to Voluntary Action North Lanarkshire, (VANL) who oversee the Community Solutions programme, and the Children, Young People and Family Network is contained in another section of this report. Quality Assurance helps facilitate a broader reach within communities and supports opportunities for people to engage in what matters to them in North Lanarkshire. Engagement with localities builds community capacity, through anchor organisations and Community Consortia provide leadership and co-ordination of activities. The commissioning of Care Opinion in adult health and social care sought to ensure that there were opportunities online for adults, children and young people to feedback on their experiences and raise any concerns across the commissioned and funded services in North Lanarkshire. Quality Assurance has a coordination role in relation to Care Opinion.
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26 Care Opinion - Care Opinion is an independent, non-profit, web-based feedback platform where people can submit their experiences of health and social care services whether positive or negative. Comments are moderated and forwarded to the relevant service who can respond directly. 2024/2025 saw the introduction of a Care Opinion Newsletter produced by Quality Assurance. This has enabled feedback to be shared across networks and promotes the use of Care Opinion. The Care Opinion Newsletter celebrates positive feedback, highlights any lessons learned and is published quarterly. 10. Communications Quality Assurance have a key function within the area of communication. This includes the following responsibilities: - • Overseeing and updating North Lanarkshire Council (Social Work) and UHSCNL websites • Governing social work resources, policies and procedures held on our SharePoint site • Owners and administrators of Viva Engage – which includes responding to queries and sharing updates in relation to Subject Access Requests and Resources, Policies & Procedures • Quality Assurance Newsletter • Care Opinion Newsletter and administration of the stories received by UHSCNL Quality Assurance Newsletter During the reporting period the newsletter was refreshed and published three times. Having reviewed our Quality Assurance communications and the number of views from social work staff it was decided that a Quarterly Commissioned Services Report would be published. More information is available about this report under Contract Management Framework. Social Work Induction Talent and Organisational Development (TOD) initially developed a Social Work Induction Platform. Quality Assurance have continued to expand this with a specific focus on how we practice within North Lanarkshire. Various social work representatives have contributed to the development of this. Quality Assurance will continue to host a forum for ensuring on-going review. The current Social Work Induction Platform has been shared with IT Leads who will update accordingly. This work will progress during 2025/26. The focus from Quality Assurance will be to develop a standardised and localised induction programme which will concentrate on learning, development and reflective practice at key points, following commencement in a new post.
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27 11. Information Governance Quality Assurance had oversight to ensure that information was dealt with to the highest standards, ensuring fairness, consistency, and security. The Information Governance Framework supports in fulfilling these responsibilities. The team coordinate: • Subject Access Requests (SARs), including reviews, complaints from the Information Commissioner’s Office (ICO). • Quarterly SAR statistics. • Freedom of Information (FOISA) requests, including reviews and complaints from the Scottish Information Commissioner. • Data Protection Impact Assessments (DPIAs). • Data Protection Act (DPA) or Schedule 2 requests. • Annual ICO statistics. • Quarterly Corporate Key Performance Indicators (KPIs). The benefits of Information Governance for the council includes but is not limited to, enhanced data security, regulatory compliance, improved data quality, risk management, cost reduction, efficiency and accountability. Quality Assurance consult with the Freedom of Information Team and Data Protection Team, who guide internal processes in accordance with legislation. There was a continued focus on coaching, mentoring and training of locality administrative staff and field workers, in relation to SARs and SARs recording. This followed from the review and update of SAR’s recording systems. SARS statistics 2024/2025 The upcoming focus and development within Social Work Information Governance will focus on monitoring and tracking across all social work teams. 114 63 290 341 208 0 50 100 150 200 250 300 350 400 CASES AT START OF APRIL 2024 CASES AT END OF FEBRUARY 2025 TOTAL NUMBER OF SARS RECEIVED: TOTAL NUMBER OF SARS CLOSED: TOTAL NUMBER CLOSED ON TIME: SAR Information as at 31/03/2025
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28 12. Procurement Quality Assurance continued to lead on procurement activity for all social work services in collaboration with colleagues within Corporate Procurement, Service Leads and Locality Social Work Teams, to ensure joined up planning, clear procurement processes and subsequent contract monitoring arrangements. This ensured that all commissioned contract work delivered best value, in accordance with Procurement Reform Scotland Act 2014 and the Procurement (Scotland) Regulations 2016. Quality Assurance support individual’s rights to determine the way they receive support, and this includes the right to select a provider who is not on any of our contract frameworks. On these occasions, and following due diligence checks of the preferred provider, Individual Placement Agreements (IPA’s) are created to ensure there is a shared basis between North Lanarkshire Council and the Provider for the delivery and manner of support. In the past year, 56 citizens of North Lanarkshire chose this route for support. Table 12a - Procurement activity for contracts under £50,000 undertaken in 2024/2025. Provider Contract Overview Service Area / Procurement Category Total Value of Contract (Excl VAT) Contract Start Date Contract End Date Commercial Strategy Sourcing Route Disabled Enabled Ltd: Access Panel North Lanarkshire Provision of advice and guidance in supporting and ensuring accessibility across North Lanarkshire buildings and the built environments Adult Social Work Services £4,684 01/04/2024 31/04/25 Re-Procurement Proposal for Funding SACRO Provision of an individual service using a mentoring Children, Families and Justice Social £49,995.00 01/06/2024 30/06/2025 Re-Procurement Proposal for Funding
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29 approach, which is a way of helping and supporting individuals with issues they might be facing both practically and emotionally. Work Services Ten for Zen Provision of the mindfulness sessions online and in person service users could develop skills, which is a way of helping and supporting individuals with issues they might be facing both practically and emotionally Children, Families and Justice Social Work Services £32,850.00 01/04/2024 31/03/2026 Re-Procurement Proposal for Funding Lanarkshire Counselling &CBT Centre (LCCC Scotland Ltd) Provision of counselling services, in person, virtually and by telephone, service users have the opportunity to Adult Social Work Services £33,600.00 01/04/2024 31/03/2025 New Requirement Proposal for Funding
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30 address problematic areas in their lives with a trained counselling professional. Yoga Through the provision of the yoga and breath work in person sessions, service users have the opportunity to reduce stress, improve mental and physical health and improve coping skills. Children, Families and Justice Social Work Services £5,190 01/04/2024 31/03/2025 New Requirement Proposal for Funding Wise Group An on-line service that assists people to develop life skills. It is a secure flexible service for people being supported by a range of Justice Services and can count Children, Families and Justice Social Work Services £31,506 01/04/2024 31/03/2025 Re-Procurement Proposal for Funding
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31 towards the other activity element of a community payback order Families Outside A support service for families in North Lanarkshire who are affected by imprisonment Children, Families and Justice Social Work Services £56,188 01/04/2024 31/03/2025 New Requirement Proposal for Funding PAMIS Family information, advice, and support service for families in situations where a family member has a significant level of disability - profound and multiple learning disability (PMLD). Adult Social Work Services £36,500.00 01/04/2024 31/03/2025 Re-Procurement Proposal for Funding Shelter Scotland Provision of Specialist Housing Advocacy Service Adult Social Work Services £25,000.00 01/07/2024 31/03/2025 Re-Procurement Proposal for Funding
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32 Improvement Service Provision of independent support from the improvement service to offer workshops, consultation and engagement to help direct a review of family support. Children, Families and Justice Social Work Services £5,000.00 09/09/2024 01/06/2026 New Requirement Proposal for Funding Deaf Services Lanarkshire Provision of support to reduce inequalities for people with a sensory impairment Adult Social Work Services £10,000 01/02/2025 31/07/2025 Re-Procurement Proposal for Funding Barnardo’s Scotland To provide a Missing Persons Service across the North Lanarkshire to children and young people who have been reported missing to Police Scotland. Children, Families and Justice Social Work Services £50,000 16/02/2024 15/02/2025 Re-Procurement Proposal for Funding
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33 Care Opinion The purpose of the Care Opinion Subscription is to: • Provide an innovative model which assists and enables the Subscriber to fulfil their public engagement involvement responsibilities; • Enables the Subscriber to compare feedback on the Care Opinion website across local services using alerts and push reporting to provide access to performance management information for staff, managers, partnership, elected officials and key Social Work £35,936 01/11/2024 31/10/2027 Re-Procurement SLA
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34 stakeholders including public partners; • Provide evidence about the quality of services provision which can be used to support relevant standards in relation to quality and participation of people who use services. Table 12b - Procurement activity for Contracts over £50,000 undertaken in 2024/2025. Contract Title Contract Overview Total Value of Contract (Excl VAT) Service Area Contract Start Date Contract End Date (Excl Extensions) Advocacy Services for Children & Young People Due to new legislation to be introduced by Scottish Government during the early part of 2025, it is necessary to grant a direct award for 12 months to the current provider. This will enable the service to develop and take cognisance of the new legislation. A subsequent open tender will take place in 2025/2026. Provision of advocacy services to children and young people is in support of their rights as individuals as set out in the United Nations Convention on the Rights of the Child (UNCRC), which aims to support children in all areas of their lives. £241,000.00 Children, Families and Justice Social Work Services 03/03/2025 28/02/2026
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35 Befriending Service The aim of this support is to provide additional resource to Children’s Services Planning Partnerships to provide the right support at the earliest time to children, young people and families. This also supports the ambitions of the Promise; to provide flexible and responsive support, enabling more children to remain loved and supported within their own families and develop resilience, self-esteem, address isolation and build effective relationships. £361,591.80 Children, Families and Justice Social Work Services 01/10/2024 30/09/2025 plus 2 one- year extensions available Community Alarm replacement - Analogue to Digital UHSCNL and NLC have invested significantly in early intervention and supported self-management for over a decade, with support for change and investment across all sectors which focus on wellbeing. The Community Alarm Service is a key part of supporting self-management with technological advancements creating the opportunity to move from a crisis response service to being more proactive and preventative. Telephone lines in the UK are being upgraded to digital technology. The process of migrating to digital telephone lines has already started. The rollout was scheduled to be completed by the end of 2025, when analogue telephone services in the UK will be switched off and replaced by digital systems using internet protocol (IP) technology £495,000.00 Social Work 17/02/2025 31/03/2025 Community Alarms Individuals who have been provided with telecare equipment from NLC, Social Work, such as community alarm and assistive technology must have their equipment updated to continue to receive a safe and reliable service. £249,970.00 Adult Social Work Services 20/05/2024 16/11/2024 Community Living Support The service helps to ensure those residents of North Lanarkshire, who require support to maintain their tenancy, are enabled to do so. The low-level support available contributes to good health and wellbeing and can reduce any need for higher level support. £1,209,960.00 Adult Social Work Services 01/06/2024 31/05/2027
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36 Direct Payment Support Services The service will provide independent support and advice for people wishing to consider or actively employ staff directly to meet their social work budget using a direct payment option 1. £415,788.00 Adult Social Work Services 06/01/2025 05/01/2028 Distress Brief Intervention (DBI) The overarching aim of the DBI service is to provide a framework for improved inter-agency co-ordination, collaboration and co-operation across a wide range of care, settings, interventions and community supports, towards the shared goal of providing a compassionate and effective response to people in distress improving experience and outcomes for those experiencing distress and those providing support. Pan Lanarkshire with North Lanarkshire as the lead procuring partner. £1,917,960.00 Adult Social Work Services 01/04/2024 31/03/2026 Domestic Abuse An inclusive domestic abuse service for any person affected by abuse aligned too Equally Safe £1,384,492.00 Social Work 01/06/2025 30/05/2029 Early Help & Family Support To provide early help and take a preventative approach to providing support to families who need it. This is an opportunity to connect services locally and improve access to family support through earlier and more effective response to need. £4,080,000.00 Education 01/04/2024 31/03/2026 plus 1 year extension available Flexible Framework for Self-Directed Support - Entry Point 4 Flexible Framework with Providers to support the critical Service Delivery to Children, Young People and Adults who have been assessed as requiring support to design, develop and achieve real lives in line with the Social Care (Self Directed Support) (Scotland) Act 2013 £820,000,000.00 Adult Social Work Services 01/04/2025 31/03/2031 Independent Advocacy Services (Adults) Independent advocacy supports people to have their voices heard and their rights and interests protected. Independent advocacy is a positive force in influencing social change, with the work and ethos of advocacy underpinned by a person-focused and human rights framework. The importance and benefits of independent advocacy are now widely recognised and woven into the fabric of health and social care provision and legislation in Scotland. Advocacy for carers and for people affected by drug and alcohol £3,507,405 Adult Social Work Services 01/03/2025 28/02/2028 plus 2 one- year extensions available
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37 misuse are now also incorporated into the requirements of the contract. Multi Agency Risk Assessment Conferences (MARAC) Provision of effective management, co-ordination and administration of Multi Agency Risk Assessment Conferences (MARAC), on behalf of North Lanarkshire Council and North Lanarkshire Health and Social Care Partnership £253,325.00 Children, Families and Justice Social Work Services 01/07/2024 30/06/2026 plus 2 one- year extensions available Mental Health Peer Support and Short-Term Mental Health Support Service Mental health and wellbeing service that provides support to residents of North Lanarkshire experiencing mental health challenges. Lot 1 – Peer Support Service with Info Service Lot 2 – Short-Term Support Service. £3,081,204 Adult Social Work Services 01/03/2025 28/02/2029 Support for Unpaid Carers and Young Carers To provide support to unpaid adult carers and \ or young carers, across North Lanarkshire. The service(s) procured will be instrumental in helping North Lanarkshire Council meet statutory requirements and duties as outlines in the Carers (Scotland) Act 2016 and Self-Directed Support (Scotland) Act 2013, specifically around support to carers. Lot 1: Direct Carer Support and breaks from caring, Lot 2: Carer Information, Advice and Campaigning Services and breaks from routine from routine, Lot 3: Condition specific Carer support (Dementia), Lot 4: Post Discharge Carer Support, Lot 5: Young Carers £16,380,000.00 Adult Social Work Services 01/03/2025 28/02/2028 plus 3 one- year extensions available. National Shared Alarm Receiving Centre (ARC) Framework is a single supplier framework and will provide the participating members a mechanism to procure a technology solution to contribute to a smooth transition from the current analogue connections to digital connections within their Alarm Receiving Centres. £412,183.00 03/03/2025 02/03/2027 plus 2 one- year extensions available
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38 Bairns Hoose Underpinned by the UNCRC, Bairns Hoose promotes a child-centred, trauma-informed and multi-agency approach that supports children recover from abuse. £102,640.00 Children, Families and Justice Social Work Services 01/10/2024 30/09/2025 Missing Persons To provide a Missing Persons Service across the North Lanarkshire to children and young people who have been reported missing to Police Scotland. £290,000 Children, Families and Justice Social Work Services 15/02/2025 14/02/2027 plus 2 one- year extensions available Provision of information and advice service for (Autism) To provide a bespoke service to persons, families, communities and professionals who are affected by or work with Autism. £62,500.00 Adult Social Work Services 01/04/2025 30/09/2025 Provision of support for people affected by Huntington’s Disease A bespoke service to persons, families, communities and professionals who are affected by or work with Huntington’s Disease. Tripartite agreement with North Lanarkshire Council, South Lanarkshire Council and NHS Lanarkshire. North Lanarkshire Council is the lead. £398,898 Adult Social Work Services 01/04/2025 31/03/2028
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39 13. Ethical Commissioning The Scottish Government’s Adult Social Care Ethical Commissioning policy team commissioned the Institute for Research and Innovation in Social Services (Iriss) to work with a range of partners, on developing an implementation plan with priorities, to ensure that ethical commissioning and procurement principles became a reality. One of the priorities identified by the group was for better support for commissioners and to work on developing training and a qualification for commissioners. As part of the project, Iriss ran an Action Learning Set for commissioners. The aim was to develop support for commissioners and others involved in implementing ethical commissioning and procurement. A group of 15 local authority commissioners were invited to meet monthly from August 2024 to January 2025 for discussions with input from expert speakers. Quality Assurance were part of this group. Local commissioners shared their experiences, challenges and priorities for support and any training needs. The group provided a space for learning, development and support with the move to ethical commissioning, and for commissioners to hear about current developments and improvements in commissioning policy and practice, working together on identifying priorities for future support. The outcomes were: • Commissioners have increased knowledge, skills and confidence in their commissioning practice. • The Scottish Government Adult Social Care Ethical Commissioning team and partners have a clearer sense of commissioning as a distinct profession and the skills and knowledge required to commission ethically. • Scottish Government and partners have a foundation on which to build future and more formalised training in partnership with larger training focussed organisations. Scottish Living Wage Last year we reported that most Providers had indicated they were either already accredited as or were willing to become Scottish Living Wage employers. This trend continues, with 96% of 96% 4% Providers Paying Scottish Living Wage at at 31/03/2025 YES % N/A % 96% 4% Providers Paying Scottish Living Wage as at 31/03/2024 YES % N/A %
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40 Providers who deliver a direct care & support service paying the Scottish Living Wage. The remaining 4% of Providers provide non-care related services (such as domestic & catering staff) or are within the cross-border category, whereby the Scottish Living Wage does not apply. 14. Adult Support & Protection (ASP) Quality Assurance have a remit across social work in supporting commissioned services to respond in accordance with Adult Support & Protection legislation and North Lanarkshire Council policies and procedures. Quality Assurance also have a role in the identification of any patterns and themes which may indicate wider systemic concern. As a direct link to commissioned services, Quality Assurance promote best practice in relation to Adult Support & Protection. Over the reporting period, Quality Assurance continued to maintain links with adult services colleagues to ensure ASP activity was considered in day-to-day practice. Quality Assurance continue to have representation in the following ASP forums and contribute to: • Learning & Development • Monitoring & Reporting • Lanarkshire Wide Care Home Task Force Group • Weekly Care Home ASP Review Quality Assurance were also involved in a National Learning Review involving the closure of a Care Home. Representation will continue within a focus group driving forward local recommendations that arose from the Learning Review. 15. Social Work Risk Management Quality Assurance have oversight of the social work risk register and are responsible for quarterly & annual reporting, compliance audits and for the facilitation and coordination of the Social Work Risk Forums. Quality Assurance participate in Corporate Risk Management Team meetings, and cascade appropriate information through the correct forums. Risk Champions and Facilitators act as points of contact for risk management matters within social work and promote risk awareness across the service. Representatives from the Quality Assurance Team participated in a two-day accredited Institute of Risk Management (IRM), Essentials of Enterprise Risk Management Course. Participation assisted Quality Assurance to continue to progress the reframing of social work risks, to ensure that these are fluid, dynamic, specific and relevant to the current environmental context. Risk Champions and Facilitators continue to engage with risk owners to provide awareness and support to reframe risks. This approach ensures that our work priorities are focused on the correct areas. Risk continues as a standing agenda item at the ASW Governance and Social Work Leadership meetings and there is a plan for live risks to be discussed and reviewed by leadership teams within these forums. 16. Registered Social Landlords Since the summer of 2023, Quality Assurance has been leading on the review of five Registered Social Landlords who provided thirteen sheltered & very sheltered developments across North Lanarkshire. These services were funded to provide housing support, using Supporting People
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41 funding. This funding stream was discontinued around 2016/17, leading to mainstream social work funding being accessed pending review. Quality Assurance engaged with all stakeholders during 2024/2025 to hear their views in relation to the proposal to discontinue housing support services and move to Retirement Housing. Advocacy were involved to ensure representation for those who required this. Following the engagement sessions, it was agreed that NLC would no longer commission or fund the staffing associated with the legacy model. This was to ensure that all those living within the services under consideration could have choice and control over who delivered their care and support in line with SDS principles. Two of the five Registered Social Landlords (RSL’s) involved transitioned from sheltered/very sheltered housing to other models in April and July 2024 respectively, and positive outcomes were reported following the change. The remaining three RSL’s continued to finalise their transition plans and in early 2025 one moved to a new model. For the remaining two RSL’s direct funding from NLC has ceased. However, one of these RSL’s elected to join NLC’s Self-Directed Support including Care at Home Framework to enable them to provide care and support utilising individual budgets should people chose them as a provider. We will continue to engage through monitoring activity. Following the conclusion of this review there is confidence that individuals are receiving the right support at the right time. 17. Care Home Governance & Assurance Following review of the enhanced clinical and care oversight arrangements for care homes reported last year, there has been continued support commissioned through the Care Home Assurance and Support Board and the Care Home Collaborative Group. The Collaborative Group combined what was previously two separate subgroups - the Care Home Governance Group and the Care Home Healthcare Framework Implementation Group. An initial gap analysis of the implementation of the Healthcare Framework and follow up review have been progressed meaning that the separate Implementation Group was disbanded. The Safety Huddle Multi-Disciplinary Forum which has continued to build on good practice embedded during the pandemic, has been further stepped down to fortnightly meetings. The focus of work has been reviewed and refined to include the ratings for each Care Home within North Lanarkshire. Adult Support and Protection escalations have also been included in discussions. These further enhancements maximise the effectiveness of the arrangements in place, to ensure systems and processes enable intelligence to be shared between agencies, to identify and allow support to be provided to care homes at risk. Actions are agreed collaboratively to provide an immediate response to safeguard residents. Quality Assurance participate in the Collaborative Group and the Safety Huddle and play a part in influencing the assurance and governance arrangements through a social work lens. Quality Assurance have been involved in the on-going review of the Healthcare Framework Gap Analysis, and it is envisaged that enhanced awareness raising across care homes of the framework and what providers and people can expect, will be a focus of activity throughout 2025/26. Quality Assurance introduced a working group with providers, to understand the Healthcare Framework. The meetings were initially beneficial, as historically Care home managers did not always engage with opportunities to participate in formal governance meetings. However, with consensus, these meetings have since been disbanded as the group felt it had achieved its purpose.
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42 18. Care Home Managers Meeting Quality Assurance continued to co-ordinate Care Home Managers Meetings as a support for Care Home Managers. Meetings, hosted in a local care home setting, have continued, with the aim to have them quarterly. The meetings give the opportunity to share ideas, good practice initiatives and common provider concerns. There is an ongoing input and update from a range of professionals involved in supporting care homes. Meetings over the reporting period have included topics such as Adult Support & Protection, promoting continence care, promotion and use of care opinion, pharmaceutical updates, the healthcare framework and safe staffing legislation. The Associate Medical Director, attended the meeting in August 2024 to brief the group on the Serious Adverse Event Review (SAER) 19. Complaints Quality Assurance retains an overview role in terms of complaints regarding Social Work service provision. Quarterly reports on complaints activity are reported through our governance structures. The annual summary and analysis of complaints received over the period 2024/2025 is attached as Appendix 1. 20. Duty of Candour All health and social care services in Scotland have an organisational duty of candour. This is a legal requirement which means that when certain types of incidents happen, the people affected understand what has happened, receive an apology, and the organisation learns how to improve for the future. An annual report capturing Duty of Candour activity is a requirement of the Council and the report for 2024/2025 is attached as Appendix 2. 21. Safe Staffing The Health and Care (Staffing) (Scotland) Act 2019 (HCSA) came into effect on 1st April 2024. The purpose of this legislation is to establish a statutory framework to ensure appropriate staffing levels in health and care settings. A review of procurement, contracts and contract monitoring processes took place prior to the implementation of the Act. There has been recognition from Scottish Government, Care Inspectorate and all Local Authorities that the reporting requirements for Local Authorities are currently vague and therefore in the lead up to the first annual report, there remained new and emerging guidance being shared. Reassurance has been provided, that due to the lack of clarity, the Care Inspectorate on behalf of the Scottish Government, will carry out an analysis of reports following receipt, with clearer guidance and a reporting template to be made available for annual reports due in 2026. Quality Assurance worked collaboratively with the Care Inspectorate throughout the year, participating in the HCSA Implementation Group, which is facilitated by the Safe Staffing Programme and was launched in August 2024. This group meets every two months and provides a forum for stakeholders to share experiences, good practices, and areas for improvement. Whilst the group is ongoing, discussions are underway about its future direction after the current reporting period.
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43 Quality Assurance continued to support both commissioned and in-house services with the implementation of the Act throughout the reporting period, by facilitating two dedicated working groups. North Lanarkshire Council have responsibilities as a provider of care and support and as a placing authority. • Commissioned Services Working Group This group was established prior to the Act’s implementation. Its aim was to share best practices and discuss potential risks. Feedback from participants indicated that attending the group was beneficial and helped them feel more prepared. Following the implementation of the Act, the group continued to meet for several months, creating a collaborative platform where services could share experiences, including examples of good practice and areas for improvement. • In-House Registered Services Working Group This group was formed in November 2024 and initially met monthly, before transitioning to a bi-monthly schedule. It continues to be well attended by registered managers, and feedback indicates that the group is valuable in supporting ongoing learning, knowledge exchange, and the sharing of best practices. • The group has developed an assurance tool which is based on the guiding principles of the Act, and it is intended to document evidence of how the principles of the Act influence staffing arrangements. This tool is being used across all NLC registered services. • Throughout 2025/2026 staffing contingency plans and staffing level tools will continue to be developed. The Health and Care (Staffing) (Scotland) Act 2019: Annual Report for Social Work Services is attached as Appendix 3. 22. North Lanarkshire Registered Services Care Inspectorate Activity: Annual Report 2024/2025 Quality Assurance have oversight of Care Inspectorate activity, and this enables the monitoring of individual services and organisational patterns, themes and trends. An annual report has been produced capturing findings over the reporting period see Appendix 4. 23. Getting it Right for Everyone (GIRFE) Quality Assurance were represented on the GIRFE Facilitation Group, which is tasked with ensuring that the wider principles of the national approach to GIRFE were embedded within day-to-day practice across North Lanarkshire. GIRFE is about providing a more personalised way to access help and support when it is needed. GIRFE places the person at the centre of all the decision making that affects them, with a joined-up consistent approach, regardless of the support needed at any stage of life. GIRFE is intended to inform the future practice model of all health, social care and public sector professionals, and shape the design and delivery of services, ensuring that people’s needs are met. Work to embed the 5 GIRFE principles, as noted below is ongoing and the GIRFE Facilitation Group had a lead role in raising awareness of these and seeking to ensure that these are reflected in operation day to day.
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44 • I have the information I need to make decisions about my life, in a way that works for me, and I am supported to understand what options are available to me, and trusted to know what is right for me • the people who support me take the time to listen and understand me as a person and we consider my whole life when making decisions about my life • I know that I can be clear about what matters to me, and I trust that my choices will be respected and understood by the people who support me • if I need to access services or support, I am treated with kindness, dignity and respect at all times. • the people I am involved with work together with me and each other to share information, in a way that is accessible to me and develop a clear understanding of how to support my wellbeing The GIRFE approach applies equally to existing supports and services, as well as to innovation, with some exciting innovations underway. A Getting it Right for Everyone Approach has now been embedded within North Lanarkshire as our local means of meeting the aspirations of the national approach. 24. Back-to-basics to getting it right for everyone Over the past year within Adult Health & Social Care Services, we have been working on the development of an enabling approach that supports the move from our work on back-to-basics to getting it right for everyone, as we recognise the landscape of health and social care is changing and services, supports and responses need to change to continue to improve the lives of people who live and work in North Lanarkshire. We have sought to adopt a human learning approach by trying different ways to focus more on people and less on systems and processes, and use resources to their best effect, to make the most positive impact on peoples’ lives. Through the learning as management strategy (also known as Human Learning System) approach, we have been working with academic and national partners, including Healthcare Improvement Scotland, to make learning and experimentation a key driver in our work. A key element of the learning approach has been the development of a Whole System Enabling Approach strongly embedded within each of the six localities, which supports a place-based model. Overarching this work has been making sure that when people contact our services the response is quick and effective, with a focus on helping people to help themselves first. Our Enabling Approach has helped us understand and consider how all parts of the Health & Social Care system interact and influence each other. Our desire is to continue to support people to thrive by providing targeted services that are tailored to reflect their diverse needs. Keeping people central to the decisions that affect them is key and has helped us plan actions that support positive outcomes for those who access our services. Over the coming year we will further develop specific plans and service developments: as this is a whole system approach, we anticipate there will be a lot to focus on and much change across services, supports and responses that are needed to achieve and sustain change. 25. Trauma Informed Practice There is a Scotland wide vision of a trauma informed and responsive workforce and services. This approach recognises the impact of trauma and adversity on individuals and seeks to prevent further harm, support recovery, address inequalities and improve life chances. Within
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45 North Lanarkshire, a Trauma Informed Practice Oversight Group was established, with representatives drawn from across the wider Health and Social Care service, including Quality Assurance. The remit of the group is focused on ensuring that the principles of Trauma Informed Practice are embedded in day-to-day practice, and that our buildings and spaces also reflect and support a Trauma informed approach. Examples of the role of Quality Assurance in supporting this approach include, but are not limited to: Three recently concluded adult Tenders (Adult Advocacy, Support for unpaid Carers, and Peer Support, Mental Health) were all developed in line with Trauma Informed Practice. The services commissioned through these Tenders, as well as other local CVS organisations who provide information\ advice \ support to citizens of North Lanarkshire, were, for the most part, involved in an initial Trauma Informed Awareness session, facilitated by the Trauma informed Practice Lead. The overall intention is that Trauma Informed Practice becomes embedded into everyday practice, not just within Health and Social Care, but across partner organisations also. The next step in this process will be to link with framework support provider organisations and promote the opportunity to participate in Trauma Informed Practice awareness raising sessions, again with the expectation, that Trauma Informed Practice is further embedded within these organisations also. Work will also continue to embed Trauma Informed Practice across the services delivered by UHSCNL. 26. Policies and Procedures Work has continued to progress in relation to Social Work Policies and Procedures. Quality Assurance are the SharePoint site owners for these, and editing rights are restricted to the team. During the reporting period there has been a Policies & Procedures Working Group established with representatives from across social work. The aim of this group was to agree the file path for central storage and easy access. Furthermore, policy control documents would be attached to ensure that policy owners, review dates and version control were available and up to date. Thereafter the plan was for Quality Assurance to host a Policy Review Group to ensure social work policies remain consistent with changes in legislation and practice. This work was paused due to a variety of findings which made it difficult to establish a suitable file path due to use of language and gaps and duplication in policies and procedures. Several discussions and presentations have taken place with the Senior Leadership Team and colleagues in Legal Services and Corporate and there is now a plan to progress with the devising and implementing of policy statements, rather than working directly from National Guidance. These policy statements will guide and govern all safe operating procedures for local services. This work will be carried out in phases commencing with Registered Services. 27. Care Home Physical Activity Initiative UHSCNL funded an initiative with the Burns Gym which has meant that over the reporting period, Burns Gym has successfully expanded and enhanced its virtual fitness programme, delivered weekly via Zoom, for care homes across North Lanarkshire. 23 out of 27 homes participated in this imitative. Joe and Tony Burns have effectively engaged residents, significantly improving their physical, social, and mental well-being. Participation has increased, and feedback continues to highlight the programme’s positive impact.
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46 From the latest evaluation report some of the key Statistics have been identified and these include: Physical Health Improvements: Mobility improved in 50% of participating homes. Strength and balance improved in 40% of homes. Falls reduced in 20% of homes. Social Engagement: 72% of homes reported increased social interactions. Emotional Well-being: Improved mood reported in 80% of homes. The link to the report is below for more information. NLC 12 Month Evaluation Report.docx 28. Adult Social Work Subgroup – Registered Managers An Adult Social Work Subgroup for Registered Managers was established in 2025. This group meet 8 weekly, and the chair is the Quality Assurance Service Manager or delegated person. This group reports through the ASW Governance Group and its purpose is to ensure robust governance and oversight across Registered Services. The group aims are to: • Ensure good governance and oversight across service delivery • Work collaboratively as registered managers team • Source/agree solutions that promote good outcomes • Identify and agree actions that improve the quality of care and support and reduce the risk of harm • Ensure robust systems and processes are in place to reporting through various governance routes • Support a culture of self-evaluation; refection; shared learning; improved practice • Plan and support the inspection process through the development of improvement plans Initial feedback is that this forum is well received and Registered Managers feels that it gives them focused time to discuss and plan improvement work with their peers. There are plans in place for Duty of Candour, Engagement & Participation & Infection Control to be future focus sessions. 29. Social Work Scotland Contracts & Commissioning Practice Network Quality Assurance participate in quarterly Social Work Scotland Contracts & Commissioning Practice Network. The team lead on a Care Home subgroup which explores some of the national issues, initiatives and best practice. This group feed back to the main membership.
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47 Quality Assurance also facilitated a session on VAT Holding Companies as requested by the Chair. 30. Quality Assurance Planned Developments This report has covered Quality Assurance activity undertaken during the period 1 April 2024 to 31 March 2025 and highlights progress made in key activities noted in the last reporting period. Several developments outlined below are in progress or planned for the period 2025/2026 and we will provide updates in future reports. Quality Assurance Planned Developments • Work with operational colleagues to influence and shape future procurement and service specifications • Establish clearer end to end procurement processes • Revamp contract mobilisation procedures • Working with commissioned services to support/mitigate the impact of the NI changes. • Finalise Social Work Induction • Further develop support for Carers • Progress with Policy Statements/ Policy Review Group/File Path • Roll out of Social Work Self Evaluation following test of change • Complete programme of In-House Monitoring • Build on engagement and participation toolkit to embed throughout all aspects of our work • Embed Programme of Work Governance Structure & Reporting Procedures • Oversight and support in relation to Care Inspectorate complaints for registered services • Sampling/Quality check/Feedback relating to Elected Members/Parliamentary enquiries • Complete reframing of risks on social work risk register. Change the ethos of review. • Participate in National Care Home Learning Review/Progress Recommendations for Quality Assurance • Establish quarterly reporting structure for expressions of dissatisfaction & Care Inspectorate activity for Registered Services • Progress Care Academy deliverables
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48 Annual Complaints Report 2024-2025 Social Work [Adults and Education, Families & Justice] Introduction This report provides an overview of Social Work’s performance in terms of handling complaints received between 1 April 2024 and 31 March 2025 which covers both Adults and Education, Families & Justice services. This report describes how complaints have been managed by social work services, details the number and nature of complaints received during the year and demonstrates our commitment to learning and improvement. Complaint Process We always aim to provide the highest possible quality of service to all members of our communities and are committed to ensuring accountability and transparency. We recognise there are times when we get things wrong and fail to meet the expectations of those who use our services. We welcome feedback as it provides information that helps us to learn from complaints and shape and improve the way services are delivered. Complaints are viewed as a positive communication tool and are actively encouraged. As per the Scottish Public Services Ombudsman [SPSO] definition, we regard a complaint as any expression of dissatisfaction, by one or more members of the public, about our action or lack of action, or about the standard of service provided by us or on our behalf. Anyone can make a complaint, either verbally or in writing, face to-face, by phone, letter or email. People are directed and encouraged to use the North Lanarkshire Council online portal to make a complaint but retain the right to use any of the aforesaid options. A two-stage statutory social work complaints process was introduced on 1 April 2017, which harmonised complaint handling processes across all council services. The process is as follows: • Stage one – ‘frontline resolution’: we will always try to resolve complaints quickly, within five working days, and in exceptional circumstances extend for a further five days. • Stage two – ‘investigation’: if people remain dissatisfied with our stage one response, they can escalate their complaint to stage two. Complaints that are complex or need detailed investigation from the outset can be looked at immediately at stage two. These complaints will be acknowledged within three working days and a written response provided within twenty working days; this can be extended in exceptional circumstances. Appendix 1
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49 Following completion of the complaints process, if the person remains dissatisfied, they can ask the SPSO to consider their complaint further. We always advise of this entitlement and provide contact details. Complaint activity [overall] Overall, 263 complaints were received in the reporting period, an increase of 58 [28%] from 2023-2024 when 205 complaints were recorded. Notably, 34% of all adult services complaints were in relation to home support services. A breakdown of locality complaints is undernoted: Education, Families & Justice 103 complaints were received in relation to Education, Families and Justice services across 2024-25, an increase of five [6%] from last year. The undernoted summarises locality complaint activity for Education, Families and Justice services across 2024-2025. Adult Social Work Services 160 complaints were received in relation to adult services across 2024-25, an increase of 59 [54%] from 2023-2024. The undernoted summarises locality complaint activity for Adult Social Work Services in 2024-25. 14 18 21 16 7 17 10 Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw H.Q. Education, Families & Justice Services 57 16 9 19 19 28 12 Airdrie Bellshill Coatbridge Cumbernauld Motherwell Wishaw H.Q. Adult Social Work Services
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50 All localities had increased complaint activity in the reporting period. However, Airdrie and Bellshill recorded notably high increases over 2024-2025 – Airdrie, a 62% increase, Bellshill, a 100% increase. Increased complaints were attributable to dissatisfaction about home support services in the areas. However, Bellshill complaints are still relatively low – they recorded eight in 2023-2024 and 16 2024-2025. Management actions were deployed to consider this increase more fully, and consequently, home support complaints decreased in quarter four. Performance Indicators The Complaints Standard Authority, in conjunction with the Scottish Public Services Ombudsman developed a suite of four mandatory performance indicators in association with the Local Authority Complaint Handlers Network on which we are represented. These indicators [undernoted] are a valuable source of information as they help to identify recurring or underlying issues, derive/drive learning from complaints and highlight potential areas for improvement. • Indicator One: the total number of complaints received. • Indicator Two: the number and percentage of complaints at each stage that were closed in full within the set timescales of five and 20 working days. • Indicator Three: the average time in working days for a full response to complaints at each stage. • Indicator Four: the outcome of complaints at each stage. Education, Families & Justice – Performance Information Indicator One - 103 complaints were received in relation to Education, Families and Justice services across 2024-25 Indicator Two/Three: Compliance with target statutory timeframes to complete complaint. Undernoted graphics depict adherance to statutory timeframes. At Stage 1, 57% were met within 5 working days, a further 38% were met with an agreed extension [within 10 working days], and 5% were outwith response target time. Average number of days to issue response: 6 working days. At Stage 2, 56% were met within 20 working days, a further 24% required an agreed extension, and 20% were outwith reponse target time. Average number of days to issue response: 34 working days.
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51 Indicator four - Complaint Outcomes “Outcome” refers to whether a complaint was upheld, not upheld, partially upheld or resolved. At Stage One, 33% of all complaints were not upheld, with the remaining 66% recording a positive outcome for the complainant. At Stage 2, 36% were not upheld, 64% recording a positive outcome. The volume of Education, Families and Justice complaints since 2020-2021 has remained stable, with little variation in the number of complaints between 2021-2022 and 2024-2025. Cause of Complaints [Stage 1 Cause of Complaints [Stage 2]
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52 Adult Social Work Services – Performance Information Indicator One - 160 complaints were received in relation to adult services across 2024-25. Indicator Two/Three - Compliance with target statutory timeframes to complete complaint. Undernoted graphic depicts adherance to statutory timeframes: At Stage 1, 53% met statutory response times, 26% met statutory timeframes within 10 days, 21% breached target timeframe. Average number of days to issue response: 6 working days. At Stage 2, 72% were met within 20 working days, a further 18% required an agreed extension, and 10% breached target timeframe. Average number of days to issue response: 23 working days. Indicator 4 - Complaint Outcomes “Outcome” refers to whether a complaint was upheld, not upheld, partially upheld or resolved. 54% of complaints at Stage 1 were not upheld, with the remaining 46% recording a positive outcome for the complainant. At Stage 2, 37% of complaints were not upheld, 63% had a positive outcome. 35 53 11 Stage 1 Upheld Not upheld Partially upheld 7 148 9 Stage 2 Upheld Not upheld
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53 Adult Social Work Service complaints show variation in the number received between 2021- 2022 and 2024-2025. The increase in complaints throughout 2024-2025 are commensurate with increased home support complaints. Cause of Complaints Stage 1 Stage 2 Learning from Complaints [Both Services] The learning from all social work complaints this year have highlighted: • The importance of good communication and mutually respectful interactions. • The need to ensuring that those who use our services and their carers have appropriate information. • Ensure that service quality is met. • The need to improve information and advice for those who need to contact and seek support from social work services. • Importance of reviews carried out regularly. • Ensure that we comply with Human Rights.
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54 • Update support plans accurately. • Confirm social work planned intervention with person. • Adherence to timeframes. • Assure that all staff are appraised of procedural/process change. Outcomes are often specific to the complaint and complainant, but when there are organisational learning points that influence policy or procedure, it is necessary to ensure that learning outcomes are cascaded and acted upon. Individual learning points are handled directly with the complainant and through supervision with members of staff. More general learning points are cascaded through supervision with team members and discussion at team meetings. 31% of all social work complaints indicated that there were no learning outcomes, whilst 34% were attributed to communication/staff attitude as the principal cause of complaints. 19% related to other issues as mentioned above, with 16% unrecorded on the system. 54 [34%] of Adult Social Work Services were in relation to home support services in this reporting period. We recognise the importance of learning from complaints and acknowledge that having a learning outcome recorded is an area that requires attention. We understand that complaints help organisations learn more about the experiences of people who use their services, and that complaints can be helpful to enable us to provide a person-focused service. While learning from complaints remains a non-mandatory performance indicator by the Scottish Public Services Ombudsman, they are interested in any systemic changes that are made following a complaint. Going forward, we will work directly with our locality teams to ensure that accurate recording and learning from complaints is embedded in practice to ensure quality services are delivered. Scottish Public Services Ombudsman The SPSO considered nine complaints throughout 2024-2025 six of which they decided not to follow up, with one complaint withdrawn by the complainant. One complaint awaits a decision, whilst the final complaint, the Council were instructed to issue a new stage two response. Child Friendly Complaints Procedure The SPSO launched the Child Friendly Complaints Procedure in July 2024. This procedure aims to ensure that children’s rights, under the United Nations on the Rights of the Child, [UNCRC] are met through a child-centred complaint process. Their principal aim was to co- 74, 34% 67, 31% 40, 19% 35, 16% Learning from Complaints Communication No learning Service Improvement Outcome unrecorded
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55 design this alongside children and young people and implement a public sector complaints procedure that meets children’s rights and needs. The SPSO continue to work in collaboration with local authorities to develop good practice guidance through the national complaint handlers’ group, of which officers from Quality Assurance are members. Within North Lanarkshire, a core group meets to co-design and trial our Child Friendly Complaint Process, which is modelled on national guidance. Quality Assurance officers have met with senior managers from Education, Families and Justice to discuss and to distribute draft guidance and FAQs from the SPSO. Care Opinion Care Opinion is a non-profit organisation, web-based feedback platform funded mainly through subscriptions from health and care organisations. At present, 500 health and social care organisations use Care Opinion across the UK. People submit stories to share their experiences of health and social care services. These can be both positive and negative, are moderated by Care Opinion staff, and quickly forwarded to the relevant area of service who can respond directly to the story. We recognise the importance of feedback; it is considered integral to quality improvement. For staff, it gives an opportunity to see the system and the service provided through the person’s eyes. Care Opinion – Key statistics • 471 stories were shared on Care Opinion 1 April 2024 – 31 March 2025 • 84% of stories received a response from the service within 7 working days, with circa 60% within one working day. • 80% of all stories shared have a zero-criticality rating, whilst 1% have a strongly critical rating. 18% have a low to moderate criticality rating. • Circa 83% of stories posted refer to NHS Lanarkshire services, whilst the remaining 17% refer to social care and third sector partners that are included in the UHSCPs subscription. To further support the use of Care Opinion as a vehicle to promote feedback on services, our revised Contract Management Framework asks all contracted providers, through their quarterly monitoring return, to report on their use and promotion of Care Opinion as a method of seeking feedback. We are also expanding the service tree to incorporate commissioned organisations if they wish to be included within the UHSCP subscription. Over the course of the past year, several third sector organisations, mainly those specific to our partnership with Voluntary Action North Lanarkshire, have been added to the subscription. Training Training on the system, where complaints are recorded continues to be delivered virtually through a video. This is a helpful aide memoire, but we recognise that additional support around recording and managing complaints is required and have agreed a programme of learning events to support locality teams to further enhance their approach to complaint handling.
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56 Quality Assurance Quality Assurance senior officers provide training and support to social work managers and teams in relation to the complaint handling process. A suite of letter templates is available, which provide guidance on model answers, trauma informed and best practice when engaging with complainants. Complaints are often routed directly through the Quality Assurance team who acknowledge receipt and assign complaints to the relevant service manager. New guidance was recently issued that instructs that all Stage 2 responses are routed through the social work complaints mailbox prior to issue, with all being sense checked by the Quality Assurance Senior Officer. In doing so, we ensure that all stage 2 complaints are compliant with the Complaint Handling Procedure. A single agency learning review was commissioned to consider a serious complaint. The outcome and findings are still be determined. Complaints that relate to both health and social work/social care services are routed through the relevant lead organisations complaints process, but there is an integrated approach to resolution and any joint learning outcomes are shared. Conclusion The principal cause of complaints continues to identify poor staff communication, staff attitudes and quality of service. This is further reflected within the learning outcomes, which indicate the need to improve communication, practice and approach to those using social work services. As a service we are committed to improving learning from complaints, which is also one of the key performance indicators, which in the future may be reportable to the SPSO. We will place further emphasis on the need to ensure that all complaints are dealt within identified timeframes, with clear communication of outcomes. Although 100% of complaints that were sent directly to social work were acknowledged by the due dates, only 58% overall were completed within statutory timeframes, with no need for an extension. Complexity of issues, new processes, staffing, IT systems and very tight time frames for resolution were the contributory factors in failure to complete all complaints within time. Improvement in these areas is expected in 2025-2026. Further actions – 2025-2026 Several key actions have been identified to strengthen our approach whilst dealing with complaints including using the learning to improve the quality of experience for those who use our services. Many are continuing or legacy commitments made in former years but remain valid objectives. The key actions are: 1. We will, over the course of 2025 -2026, sense check and proof-read all stage 2 complaints to ensure that the procedures are understood and followed. Legacy action that is on-going. 2. We aspire to ensure that logging actions and learning from complaints is done consistently to support the improvement of services that support people across our communities. 3. We develop a programme of reflective learning sessions across teams - Complaint activity and learning remain an agenda item in team meetings and links across services and localities are maintained with Quality Assurance who will review complaint activity as required. Learning sessions were delivered as requested in 2024-2025 and will continue in 2025-2026.
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57 4. We will continue to promote Care Opinion as one of the key mechanisms for engaging with members of the public and to generate meaningful feedback. Further resources have been deployed to assist with this activity – a one-page newsletter/precis of Care Opinion will be drafted and circulated to all social work staff to support further usage and promotion of Care Opinion. 5. Where possible, we will secure system training to all members of management support teams who now have responsibility for logging and tracking complaints. 6. We will offer complaint handling training as a refresher session, or for training for new staff. Training sessions are offered on an ad hoc basis, and as required by individual teams. 7. A further legacy action from 2023-2024 is the roll out and implementation of Child Friendly Complaints Handling Procedures. The SPSO have now indicated that Child Friendly Complaint Handling will not be a separate procedure, but practice guidance is necessary to ensure that the rights of children and young people, conferred by the UNCRC, are protected.
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58 Duty of Candour Report: 2024-2025 All health and social care services in Scotland have an organisational duty of candour. This is a legal requirement which means that when certain types of incidents happen, the people affected understand what has happened, receive an apology, and the organisation learns how to improve for the future. An important part of this duty is that we provide an annual report about the organisational duty of candour in our services. This report describes how our organisation, North Lanarkshire Council, has operated the organisational Duty of Candour during the time between 01 April 2024 and 31 March 2025. If you have any questions or would like more information about North Lanarkshire Council, please feel free to contact us at: barrym@northlan.gov.uk When Must Duty of Candour be Activated? Duty of Candour must be activated as soon as reasonably practicable after becoming aware that an unintended or unexpected incident occurred in the provision of the health, care or social work service were, in the reasonable opinion of a registered health professional (not involved in the incident) that: (a) the incident appears to have resulted in or could result in any of the outcomes mentioned below (b) the outcome relates directly to the incident rather than to the natural course of the person’s illness or underlying condition. The relevant outcomes are as follows: • the death of the person. • permanent lessening of bodily, sensory, motor, physiologic or intellectual functions(including removal of the wrong limb or organ or brain damage) (“severe harm”). Harm which is not severe harm, but which results in one or more of the following: • an increase in the person’s treatment. • changes to the structure of the person’s body. • the shortening of the life expectancy of the person. • an impairment of the sensory, motor, or intellectual functions of the person which has lasted, or is likely to last, for a continuous period of at least 28 days. • the person experiencing pain or psychological harm which has been, or is likely to be, experienced by the person for a continuous period of at least 28 days. The person requires treatment by a registered health professional to prevent: Appendix 2
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59 • the death of the person. • any injury to the person which, if left untreated, would lead to one or more of the outcomes mentioned above. How many incidents happened to which the organisational duty of candour applies? In the last year, there have been no incidents notified to Quality Assurance, where the organisational duty of candour applied. Information About Our Policies and Procedures North Lanarkshire Council reviewed and modified its Duty of Candour reporting procedures during 2024/25. Throughout January, February & March 2025 Locality Social Work Managers, Senior Social Workers and Registered Managers participated in awareness raising sessions to enhance understanding of the circumstances when Duty of Candour would be considered; and the stages involved in the procedure. The Duty of Candour notification procedure now includes two stages, which are: / Part 1 Possible Duty of Candour incident (Initial Notification) / Part 2 Managing the Duty of Candour Process The intention underlying the introduction of the two-stage process is to enable internal monitoring and analysis of when Duty of Candour has been considered but not activated. It is envisaged that this data will contribute to organisational learning. Duty of Candour Reporting procedures and awareness raising sessions have been added to the North Lanarkshire Council Social Work Induction that all social work staff complete within the first four weeks of employment. Duty of Candour training and information is available to North Lanarkshire Council staff on-line at Duty of candour | Turas | Learn Where something has happened that may trigger the organisational Duty of Candour, our staff report this to Social Work Quality Assurance. Quality Assurance initiate contact with the reporter to plan, guide and support the process Duty of Candour Procedure. What have we learned? Duty of Candour discussions and reflections have taken place during the awareness raising sessions and have demonstrated the benefits of interactive learning and peer discussion when considering whether the Duty of Candour criteria has been met. North Lanarkshire Council Social Work will embed a refresher Duty of Candour training programme utilising this method, in turn complementing and enhancing e-learning. We believe that our modified Duty of Candour reporting process provides operational social work staff with the opportunity to explore and consider in full, improvement actions from unintended incidents. Furthermore, it enables North Lanarkshire Council Senior Managers to have confidence that we are fulfilling our legal and morale responsibilities as defined within the Health (Tobacco, Nicotine etc. and Care) (Scotland) Act 2016 (The Act) and The Duty of Candour Procedure (Scotland) Regulations 2018. Training and Support for staff All new social work & social care staff within North Lanarkshire Council learn about the organisational Duty of Candour at induction and subsequent refresher sessions.
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60 We know that serious mistakes can be distressing for staff as well as people who receive care and support and their families. We therefore promote access to North Lanarkshire Council Employee Assistance Programme for those who have been affected by an organisational Duty of Candour incident. Support for relevant persons Where a relevant person (i.e., children, adults, families, etc.) is affected by the incident that activated the organisational duty of candour, we provide links to wellbeing support services.
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61 Appendix 3 Health and Care (Staffing) (Scotland) Act 2019: Annual Report for Social Work Services Under section 3(2) of the Health and Care (Staffing) (Scotland) Act 2019 (“the Act”), every local authority and integration authority must have regard to a number of listed factors when planning or securing the provision of a care service from a third party: • the guiding principles in the Act (section 1 of the Act); • the requirement on care service providers to have regard to the guiding principles (section 3(1) of the Act); • the duty on care service providers to ensure appropriate staffing (section 7 of the Act); • the requirement on care service providers with regard to training of staff (section 8 of the Act); • the requirement on care service providers to have regard to guidance issued by the Scottish Ministers (section 10 of the Act); • the duties on care service providers under Chapter 3 of Part 5 of the Public Services Reform (Scotland) Act 2010, for example with regard to registration of care services; and • the duties on care service providers under Chapter 3A of Part 5 of the Public Services Reform (Scotland) Act 2010, for example with regard to the use of any prescribed staffing methods or staffing tools. Note that the Health and Care (Staffing) (Scotland) Act 2019 inserted chapter 3A into the Public Services Reform (Scotland) Act. Section 3(6) of the Act states that relevant organisations must publish information annually on the steps they have taken to comply with the requirement in section 3(2) regarding the planning and securing of care services and any ongoing risks that may affect their ability to comply with this requirement. The information in this report relates to the financial year, 01 April 24 to 31 March 25, and will be published by 30 June 25.
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62 To enable the collation of the information published, a copy of the report has been sent to the Scottish Government hcsa@gov.scot.
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63 Declaration Name of local authority / integration authority: North Lanarkshire Council Report authorised by: Name Alison Gordon Designation Chief Social Work Officer (Children, Families, Justice and Integrated Services) Date: 23 June 2025 Details of where the report will be published: NLC and UHSCP website(s). Information Required 1. Please detail the steps you have taken as an organisation to comply with section 3(2) of the Health and Care (Staffing) (Scotland) Act 2019: 3(2) In planning or securing the provision of a care service from another person under a contract, agreement or other arrangements, every local authority and every integration authority (within the meaning of section 59 of the Public Bodies (Joint Working) (Scotland) Act 2014) must have regard to— (a) the guiding principles for health and care staffing, and (b) the duties relating to staffing imposed on persons who provide care services— (i) by virtue of subsection (1) and sections 7 to 10, and (ii) by virtue of Chapters 3 and 3A of Part 5 of the Public Services Reform (Scotland) Act 2010. To comply with section 3 (2) of the Health and Care (Staffing) (Scotland) Act 2019 North Lanarkshire Council worked closely with the Care Inspectorate, the Scottish Government, our commissioned Registered Services and key social work staff. Education, training, scoping roles & responsibilities Prior to the enactment of the legislation in April 2024 our Social Work Quality Assurance team led on the research around the requirements of the act, focusing on the impact to Commissioned Services and to North Lanarkshire Council in meeting the responsibilities outlined for Local Authorities. Our engagement activities included:
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64 - North Lanarkshire were one of ten authorities involved in the Scottish Government pilot – HSCP Chapter Testing Summary Report - Focus Groups & Peer Learning for Commissioned Registered Services. Sessions included education and the sharing of best practice evidence sources surrounding the 8 Guiding Principles, wellbeing of staff, staff training and the Staffing Method Framework. - Hosted Care Inspectorate Face to Face & On-line Education Sessions for Social Work staff. This raised awareness of the act to ensure social work staff were aware of the responsibilities of providers and Local Authorities. - Introduced as a standing agenda item at Adult Social Work Governance, Senior and Social Work Leadership Team Meetings and our (cross care group) Social Work Workforce Meeting. In doing so preparation and implementation of the legislation was given strategic priority. - Quality Assurance Newsletter. Quarterly updates were provided across social work in relation to the new legislation and how we were preparing for its implementation. Links to the Care Inspectorate Safer Staffing Hub were shared as was training available through the SSSC Open Badge route or alternatively Turas. Procurement & Contracting Our Social Work Quality Assurance Team, in partnership with operational colleagues, are responsible for procuring and contracting of Registered Commissioned Services. Prior to 1st April 2024 they liaised with our Corporate Procurement Team to review contracts which for Registered Services includes: - National Care Home Contract (NCHC) – 25 Care Homes with nursing and 1 Care Home Residential are commissioned within North Lanarkshire. Scotland Excel own and manage this contract through the National Care Home Contract. - North Lanarkshire Council did not plan or secure care homes between 1st April 2024 to 31st March 2025. - Self-Directed Support (SDS) Framework including Care at Home Services – This framework is owned by North Lanarkshire Council. It is a ten-year framework effective from 2021, and it will expire in 2031. There are annual entry points for tender submissions from organisations meeting the criteria however in 2024 tender submissions were invited from December 2024 with the contract being effective as of 1st April 2025. We will report on new services added to the SDS Framework in 2025/2026.
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65 - As of 31st March 2025, the SDS Framework for Care at Home Services included 58 services. These services are accessed by Adult Health & Social Care, Children & Families & Justice. Breakdown below of the number of services available to support adults, children and older adults. Adults Children Older Adults 49 19 38 - Children's Residential Care and Education, including Short Break, Services – 2 different organisations from the framework are provide services within North Lanarkshire. This contract is owned and managed by Scotland Excel. - North Lanarkshire Council did not plan or secure any services under this contract between 1st April 2024 to 31st March 2025. - Fostering and continuing Care - 2 services are commissioned within North Lanarkshire. This contract is owned and managed by Scotland Excel. - North Lanarkshire Council did not plan or secure any services under this contract between 1st April 2024 to 31st March 2025. - Individual Placement Agreements – Where an individual chooses to be supported by a non-commissioned service or out of authority/cross borders, placements are agreed through North Lanarkshire Council by utilising an Individual Placement Agreement. The findings from the review of the National Care Home Contract, the SDS Framework for Care at Home services and Individual Placement Agreements, all of which are utilised when planning and securing services, confirmed that no modifications were required to legislative requirements. This was due to the Health and Care (Staffing) (Scotland) Act 2019 legislation/guidance stating that there is no requirement to stipulate the actual name of the legislation. The need to comply with the Care Inspectorate Standards and all legislation relevant to social care form part of our contract monitoring approach. As part of the procurement journey and overall evaluations the guiding principles of the act and person specific training plans are considered in reference to meeting people’s unique outcomes. Care Inspectorate registration details and current grades awarded for each of the Key Questions are also taken into consideration. Contract Monitoring The Social Work Quality Assurance Team have oversight of all commissioned Registered Services for Adult Social Work, Children & Families and Justice services.
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66 Monitoring arrangements are in place, and these have been modified to include information around staffing arrangements and the key components of the staffing method framework, the guiding principles of the act including staff wellbeing and stakeholder feedback. During monitoring visits, the Quality Assurance Team engage directly with stakeholders to ensure that their views are being taken into consideration when decisions are made about staffing. A request is made to the Care Inspectorate to extend an invitation to a representative from the Quality Assurance Team to enable them to participate in the feedback session. This approach ensures information about staffing is known timeously. Care Inspectorate grades, requirements and areas for improvement are monitored and taken into consideration when risk assessing the commissioned services and the level of monitoring required. When a placement is being made in a non-commissioned service including out of authority and cross borders, due diligence processes are in place that includes liaison with the host authority and the appropriate regulator e.g. Care Inspectorate. This enables oversight of safer staffing compliance issues. 2. Please detail any ongoing risks that may affect your ability to comply with the duty set out in section 3(2). North Lanarkshire Council have a Self-Directed Support (SDS) Framework including Care at Home Services. This is a 10-year framework with annual entry points, as referenced above. This framework has been live since 2021 and will continue until 2031. Exploration and consideration are in process to make changes to the tendering evaluation process to evidence inclusion of the provider’s responsibilities under the Act. This will feature within future entry points. Subsequent modifications arising will be informed in collaboration with procurement legislation and best practice, which may result in limitations to the scope of change applied throughout this period. The Care Inspectorate do not define training requirements for a provider at the time of registration. Staff training is determined by the needs of the people being supported which is a fluid and dynamic process. To include training requirements as part of any competitive tendering process may not achieve the desired outcome as a result. North Lanarkshire Council take a person-centered approach to the expectations of providers to update their training plans as and when the needs and aspirations or people change. Monitoring visits carried out by our Social Work Quality Assurance Team capture any gaps as defined by the population at that time.
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67 North Lanarkshire Registered Services Care Inspectorate Activity: Annual Report 2024/2025 Appendix 4
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68 Annual Report for North Lanarkshire Adult Services Care Inspectorate Activity for 2024/2025 Introduction North Lanarkshire Council currently operate a range of registered services, namely Locality Support Service (Disability), Home Support Service and Integrated Day Services and Residential Children’s Houses. All are delivered over the six localities: Motherwell, Wishaw, Coatbridge, Airdrie, Bellshill and Cumbernauld. These services are regulated by the Care Inspectorate and inspection frequency is determined by risk rating based on the Care Inspectorate scrutiny tool. Purpose of Report The purpose of this report is to provide an overview of care inspection activity for NLC in- house services during the reporting period 1st April 2024 and 31st March 2025. This report provides details of the most recent care inspection activity, including grades awarded, requirements, areas for improvement, areas of strength and good practice and highlights any patterns or themes emerging. Care Inspectorate Grading System The table below outlines the grading system used by the Care Inspectorate to determine grades for each of the key questions and quality statements. Grades range from unsatisfactory (1) through to excellent (6). The In-House Services being reported on fall under three different quality frameworks which are as follows: - Locality Support Services & Integrated Day Services – A quality framework for support services (not care at home) - Home Support Service & Community Alarms – A quality framework for support services (care at home including supported living models) Key Question 4 as stated below is not assessed for this service type. EXCELENT 06 VERY GOOD 05 GOOD 04 ADEQUATE 03 WEAK 02 UNSATISFACTORY 01 OUTSTANDING OR SECTOR LEADING MAJOR STRENGTHS IMPORTANT STRENGTHS, WITH SOME AREAS FOR IMPROVEMENT STRENGTHS JUST OUTWEIGH WEAKNESSES IMPORTANT WEAKNESSES – PRIORITY ACTION REQUIRED MAJOR WEAKNESSES – URGENT REMEDIAL ACTION REQUIRED An evaluation of excellent describes performance which is sector leading and supports experiences and outcomes for people which are outstandingly high quality. This is a demonstrable track record of innovation, effective practice and/or very high- quality performance across a wide range of its activities and from which others could learn. We can be confident that excellent performance is sustainable and that it will be maintained. An evaluation of very good will apply to performance that demonstrates major strengths in supporting positive outcomes for people. There are very few areas for improvement. Those that do exist will have minimal impact on people’s experiences and outcomes. While opportunities are taken to strive for excellence within a culture of continuous improvement, performance evaluated as very good does not require significant adjustment. An evaluation of good applies to performance where there is a number of important strengths which, taken together, clearly outweigh areas for improvement. The strengths will have a significant positive impact on people’s experience and outcomes. However improvement are requirement to maximise wellbeing and ensure that people consistently have experiences and outcomes which are as positive as possible. An evaluation of adequate applicates where there are some strengths, but these just outweigh weaknesses. Strengths may still have a positive impact by the likelihood of achieving positive experiences and outcomes for people is reduced significantly because key areas of performance need to improve. Performance which is evaluated as adequate may be tolerable in particular circumstances, such as where a service or partnership is not yet fully established, or in the midst of major transition. However, continues performance at adequate level is not acceptable. Improvements must be made by building on strengths while addressing those elements that are not contributing to positive experiences and outcomes for people. An evaluation of weak will apply to performance in which strengths can be identified but these are outweighed or compromised by significant weaknesses. The weaknesses, either individually or when added together, substantially affect peoples’ experiences or outcomes. Without improvement as a matter of priority, the welfare or safety of people may be compromised, or their critical needs not met. Weak performance requires action in the form of structured and planned improvement by the provider or partnership with a mechanism to demonstrate clearly that sustainable improvements have been made. An evaluation of unsatisfactory will apply when there are major weaknesses in critical aspects of performance which require immediate remedial action to improve experiences and outcomes for people. It is likely that people’s welfare or safety will be compromised by risks which cannot be tolerated. Those accountable for carrying out the necessary actions for improvement must do so as a matter of urgency, to ensure that people are protected, and their wellbeing improves without delay.
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69 - Residential Children’s Houses – A quality framework for care homes for children and young people and school care accommodation (special residential schools) Care Inspectorate Activity Locality Support Services Locality Support Service is a service for adults aged 16-65 with a learning disability, physical disability or long-term condition who require support to achieve their identified goals or outcomes, build confidence or maximise independence to lead healthier, safer, happier lives. This service is well connected and can support and signpost people to access services within their community including employment/voluntary opportunities, health improvement groups and further education courses. There were no care inspections within Locality Support Services during the reporting period. For details of grades and last inspection dates please refer to Table Appendix A. Integrated Day Services Integrated Day Services provide support for adults over 65, who often have complex and overlapping needs that require support from both health staff and social care staff. Support is offered either through the outreach, respite at home service, or support within the Integrated Day Service. The service is provided by both Social Work and Health staff, who work in partnership to ensure good quality support is provided. There were no care inspections within Integrated Day Services during the reporting period. Dates of the last inspections can be seen in the table Appendix B.
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70 Community Alarm Service The community alarm service provides urgent assistance to people living within their own homes who experience emergencies like taking ill or falling. People who choose to have the service are provided with an alarm unit connected to their phone system. When activated, a call is automatically made to the response centre where the staff will clarify the nature of the emergency. Staff will then alert family members or send trained community alarm staff or contact emergency services. This service operates 24-hours a day, 365 days a year, for people who are resident within North Lanarkshire area. There is currently a small charge for this service. Within the reporting period there were no inspections for this service. The table in Appendix C, highlights the core information in relation to the Community Alarm Service. Home Support Services Home Support is a service for individuals with complex health and care needs who require support to be as independent as they can be within their own homes. There are six In-House Home Support services across North Lanarkshire - Wishaw, Motherwell, Bellshill, Coatbridge, Airdrie and Cumbernauld. Airdrie Home Support were inspected three times during the reporting period. August 2024, 13 November 2024 and again on the 8 January 2025. On the 9 August 2024 the inspection focussed on 4 key questions: “How well do we support people’s wellbeing?” “How good is our leadership?” “How good is our staff team?” “How well is care and support planned?” All four key questions were awarded grades of weak (2) From this inspection requirements and areas of improvement included: Improvement and management of missed visits, reviews to be held no later than six monthly and support plans to be updated following reviews, to ensure that visits take place at the times specified, support plans reflect good practice, are person centred and outcome focussed. (see table on Appendix D) A further inspection took place on 13 November 2024 which focussed on two of the four requirements which were made on 28 September 2023. These were missed visits and reviews. It was evident that there were improvements in the number of reviews being carried out and systems had been implemented to ensure visits took place as scheduled. These requirements were then recorded as being met. The remaining two requirements from 28 September 2023 were then extended further to 6 January 2025. On the 8 January 2025 a further inspection focussed on the two outstanding requirements wand the following key questions: “How well do we support people's wellbeing” “How good is our leadership” “How well is our care and support planned”
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71 The requirements were met at this inspection and the 3 key questions above were graded adequate (3). This highlighted improvement particularly around care planning and consistent, organised visits. Bellshill Home Support were inspected on 18 April 2024 with four key questions being assessed. “How well do we support people’s wellbeing?” “How good is our leadership?” “How good is our staff team?” “How well is care and support planned?” All questions were graded Good (4) which highlighted an overall improvement in the grades from the previous inspection where grades of Adequate (3) were awarded for all key questions. Feedback reflected improvements to supervision frequency, observational monitoring and staff training. Coatbridge Home Support were inspected on 27 September 2024 with four key questions being assessed. “How well do we support people’s wellbeing?” “How good is our leadership?” “How good is our staff team?” “How well is care and support planned?” All questions were graded Adequate (3). This was an improvement on the grades awarded at the last inspection where three key questions (KQ 1, 2 and 5) were graded weak (2). Some progress was recognised from the last inspection. However there remained two of the three requirements which had not been met. These were: care plans to be person centred and outcome focussed and reviews to be carried out 6 monthly. During this inspection four of the eleven previous areas for improvement were noted as having been met. Some other areas were consolidated into new areas of improvement. These were to ensure that all staff, including management, access the relevant training appropriate to their role and apply this training in practice. A robust system was to be developed for managing complaints and to ensure that people are involved in contributing to their reviews. (See Appendix D) Feedback reflected that the staff induction process was thorough and had been developed, direct observations were taking place and staff received feedback. Supervision was taking place, recorded with follow up action and the training matrix was up to date and noted when refresher training was due. Cumbernauld Home Support was inspected on 11 September 2024 with four key questions being assessed. “How well do we support people’s wellbeing?” “How good is our leadership?” “How good is our staff team?” “How well is care and support planned?”
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72 Although two of the three requirements had been met since the last inspection no regrading took place. Therefore, grades of Adequate (3) remained for all four key questions. Feedback reflected improvements in training, supervision and audits of support reviews. A follow up inspection on 27 January 2025 focused on outstanding requirements and areas for improvement. The requirement for personal support plans being up to date, accurate, and reflective of good practice remained unmet. Additionally, there remained an area for improvement around action plans and supervision records as these had not been fully addressed. More time was required for the improvements that had been made to be embedded in practice. Feedback reflected that the care and support provided was good and positive changes continued to be implemented by the management team. Motherwell Home Support was inspected on 15 August 2024 with four key questions being assessed. “How well do we support people’s wellbeing?” “How good is our leadership?” “How good is our staff team?” “How well is care and support planned?” Three key questions were awarded grades of weak (2) however the key question “How well do we support people’s wellbeing?” was graded adequate (3). These grades were lower than those awarded previously. Requirements and areas for improvement were made. (See table Appendix D) A follow up inspection took place on 26 March 2025 and improvements had been noted. Three key questions were assessed. “How good is our leadership”, “How good is our staff team” and “How well is care and support planned” All three key questions were regraded to adequate (3). All requirements and areas for improvement had been met highlighting progress in these areas. Wishaw Home Support was inspected on 15 October 2024 with four key questions being assessed. “How well do we support people’s wellbeing?” “How good is our leadership?” “How good is our staff team?” “How well is care and support planned?” Grades of good (4) were awarded for all four key questions. The three areas noted for improvement at the last inspection were assessed during the October 2024 inspection and all three had been met. These included: improving the quality of care plans: the management of falls: ensuring prompt referrals to the appropriate professionals, when required. Areas of improvement from the October 2024 inspection included ensuring that action plans were fit for purpose and SMART (specific, measurable, achievable, realistic and time-bound)
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73 and focused to ensure a culture of continuous improvement. Review reports were to be shared with the appropriate people. Feedback reflected that there is good communication across the staff team, good management oversight and staff are supported within the workplace. Residential Children’s Houses North Lanarkshire Council Residential Children’s houses offer accommodation, care and protection to children and young people generally aged 12 to 18, who cannot, for a variety of reasons, live in the community with their parents, extended family or substitute families. There are currently 5 North Lanarkshire Residential Houses in 5 areas within North Lanarkshire: Buchanan Street, Fort Street, Cambusnethan, Forrest Street, Fort Street and Main Street. All 5 residential houses were inspected within the reporting period. More detail can be found in Appendix E. Buchanan Street Residential House was inspected during the reporting period on 5th December 2024. One key question was inspected: “How well do we support children and young people's rights and wellbeing?” This key question was graded adequate (3). An area for improvement included development of staff practice, particularly around trauma informed practice. A further area for development noted the need for collective discussions and decision-making forums to be developed with young people. The management of medication and associated procedures were an area for improvement and management meetings were to be held, to continue to develop the service. The two requirements made from the previous inspection were both met within the timescales highlighting improvements in the quality assurance processes, incident reports were recorded accurately and risk assessments and safe plans for young people were detailed. More detail can be found in Appendix E. Feedback reflected that young people felt well cared for, there was good oversight of risk for young people and personal plans were outcome focused. Cambusnethan Residential House was inspected during the reporting period on 12th June 2024. One key question was inspected: “How well do we support children and young people's rights and wellbeing?” This key question was graded adequate (3) The previous requirement made at the last inspection was met within the timescales. This highlighted improvement with the admissions and matching procedures. Three previous areas for improvements from the last inspection were also met. Three new areas for improvement were made in the inspection of 12th June 2024. These included the need for improvement in staff training in relation to children’s specific needs, to develop child friendly and SMART personal plans and to continue to review staffing levels. Feedback reflected that the home worked well with partner agencies to support young people, there were some positive outcomes for young people and support for families was very good.
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74 Forrest Street Residential House was inspected during the reporting period on 18 August 2024. One key question was inspected: “How well do we support children and young people's rights and wellbeing?” This key question was graded good (4). The areas of improvement made from the previous inspection were met at this inspection and three new areas for improvement were made at the inspection of 18 August 2024. More detail can be found in Appendix E. Feedback reflected that risk was reduced for most young people, the staff group were skilled and experienced, and all young people had personal plans which detailed their needs and wishes. Fort Street Residential House was inspected during the reporting period on 25 February 2025. One key question was inspected: “How well do we support children and young people's rights and wellbeing?” This was graded 4 (good). There was one area of improvement made at this inspection suggesting personal plans should be SMART (specific, measurable, achievable, realistic and timebound). Feedback reflected that young people had meaningful relationships with staff and managers. Additionally, it was noted that staff worked proactively to support young people, relationships with family and friends were actively promoted and young people were supported and enabled to make informed choices and decisions for themselves. A previous area of improvement made was met at this inspection as there was evidence that action was taken to improve incident records ensuring that they held accurate information and good evidence of debriefs. The de-briefs were proactively undertaken by the manager, who sought to explore and understand learning for all involved. Main Street Residential House was inspected during the reporting period on 31 January 2025 with one key question inspected “How well do we support children and young people's rights and wellbeing?” This key question was graded good (4). There was one area of improvement made suggesting that personal plans should be SMART (specific, measurable, achievable, realistic and timebound). The previous four requirements made were all met at this inspection. Conclusion From carrying out an analysis of recent inspection activity across Registered In-House services, 15 inspections are noted to have been carried out between 1 April 2024 to 31 March 2025. From the 24 services reported on, 6 home support and 5 residential children’s houses services have been inspected.
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75 From the inspections carried out during the reporting period a common theme identified for all home support services, was the need for care plans to be developed, ensuring that they were person centred, and outcome focussed. Another common theme identified was to ensure that reviews were taking place 6 monthly. Themes emerging from the 5 children’s residential houses were staff training, specifically focusing on children’s needs and ensuring that personal plans were SMART. Further information can be found in the appendices below.
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Appendix A Locality Support Services CI Status 76 Locality Support Service Date Inspection Took Place How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Overall Grade Awarded Requirements Areas for Improvement Areas of Strength Airdrie 16/05/2023 VERY GOOD - 5 VERY GOOD - 5 NOT ASSESSED NOT ASSESSED NOT ASSESSED VERY GOOD - 5 None None Support is consistent by high quality staff ensuring positive experiences and outcomes Bellshill 23/06/2023 VERY GOOD - 5 VERY GOOD - 5 NOT ASSESSED NOT ASSESSED NOT ASSESSED VERY GOOD - 5 None None Good planning with people to ensure support is person centred. Good joint working with partnership agencies and skilled staff. Coatbridge 26/05/2023 VERY GOOD - 5 VERY GOOD - 5 VERY GOOD - 5 NOT ASSESSED VERY GOOD - 5 VERY GOOD - 5 None None People are supported well to build friendships and community links with good high-quality support provided. Cumbernauld 25/09/2023 VERY GOOD - 5 VERY GOOD - 5 NOT ASSESSED NOT ASSESSED NOT ASSESSED VERY GOOD - 5 None None Support is consistent by high quality staff ensuring positive experiences and outcomes. Motherwell 07/07/2023 VERY GOOD - 5 VERY GOOD - 5 NOT ASSESSED NOT ASSESSED NOT ASSESSED VERY GOOD - 5 None None People are well supported with experienced staff and Good supportive management team. Wishaw 12/06/2023 VERY GOOD - 5 VERY GOOD - 5 NOT ASSESSED NOT ASSESSED NOT ASSESSED VERY GOOD - 5 None None Good communication between people, families and the service. People are supported to have high quality positive experiences and outcomes.
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Appendix B Integrated Day Services CI Status 77 Integrated Day Service Date Inspection Took Place How well do we support people's wellbeing? How good is our leadership ? How good is our staff team? How good is our setting? How well is care and support planned? Overall Grade Awarded Key Questions Inspected outwith New Framework Requirements Areas for Improvement Areas of Strength Harry Walker - Airdrie 27/07/2023 VERY GOOD - 5 ADEQUATE - 3 VERY GOOD - 5 VERY GOOD - 5 VERY GOOD - 5 N/A By the closing date, which will be notified by the Care Inspectorate in 2024, the provider must comply with their legislative responsibility to submit an annual return. To ensure continuous improvements the provider should develop an improvement plan. Sir John Mann - Bellshill 12/01/2024 VERY GOOD - 5 VERY GOOD - 5 VERY GOOD - 5 NOT ASSESSED GOOD - 4 GOOD - 4 N/A None People should be supported to gain and maintain their independence to ensure people feel empowered and in control. This is to ensure that care and support is consistent with the Health and Social Care Standards (HSCS) which state that: 'I am empowered and enabled to be as independent and as in control of my life as I want and can be.' (HSCS 2.2).This area for improvement was made on 30 January 2024. • People were supported by long term staff who knew them well • People enjoyed attending the service and talking to staff and peers • Various activities were on offer everyday to stimulate people both physically and mentally • Both hot and cold nutritious meals on offer everyday. Coatbridge 14/04/2024 VERY GOOD - 5 GOOD - 4 VERY GOOD - 5 GOOD - 4 GOOD - 4 N/A There were no requirements 1. To develop an improvement plan 2. Carry out regular audits to ensure robust and transparent quality assurance processes 3. To provide detailed guidance for staff, care plans need to be developed * Good communication and participation from service users * Good relationships and friendships maintained which supported positive outcomes and reduced social isolation * Well trained and knowledgable staff who were supportive of each other encouraging good teamwork Cumbernauld & Kilsyth 14/06/2019 VERY GOOD - 5 VERY GOOD - 5 VERY GOOD - 5 VERY GOOD - 5 VERY GOOD - 5 VERY GOOD - 5 N/A None None The setting is very good at promoting and enabling independence. Care and support is planned and recorded very well. Staff were organised and well trained and reviews and care plans were carried out within the timescales. Motherwell 16/11/2015 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED VERY GOOD - 5 1. Quality of Care and Support (5) 2. Quality of Staff (5) 3. Quality of Environment (5) 4 Quality of Management & Leadership (5) Areas for improvement were not part of this inspection methodology as it was prior to the introduction of the new quality frameworks when recommendations were still in force. None * The performance of the service was excellent * Good engagement with service users, relatives and staff * The manager was supportive and approachable * Service Users were supported in a respectful way esuring privacy, dignity and respect Wishaw 24/03/2017 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED GOOD - 4 1. Quality of Care and Support (4) 4 Quality of Management & Leadership (4) Areas for improvement were not part of this inspection methodology as it was prior to the introduction of the new quality frameworks when None Support Plans were person centred and individual to each person Staff provided good care and support resulting in good outcomes for people
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Appendix C – Community Alarm CI Status 78 community Alarm Service Date Inspection Took Place How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Overall Grade Awarded Requirements Areas for Improvement Areas of Strength Covers All 6 Localities 26/03/2023 VERY GOOD - 5 GOOD - 4 VERY GOOD - 5 VERY GOOD - 5 None The service should introduce an improvement plan which includes its aims and objectives. The plan should detail challenges and goals in improving outcomes for people. The improvement plan should follow SMART principles and include timescales, progress towards goals and names staff responsible in each area. * Staff were well trained *Good hygiene levels and infection prevention and control * Staff were supported well with regular supervision and meetings
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Appendix D – Home Support CI Status 79 Home Support Service Date Inspection Took Place Date Draft Inspection Became Available Via Eforms Date Final Report became available via eforms How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? Overall Grade Awarded Requirements Areas for Improvement Areas of Strength Airdrie 09/08/2024 17/09/2024 01/10/2024 WEAK - 2 WEAK - 2 ADEQUATE - 3 WEAK - 2 WEAK - 2 (1) By 8 April 2024, the provider must ensure the support provided to people promotes and their health and wellbeing. To achieve this the provider must: Take action reduce the number of missed visits. This should include: a) Introduce systems that further develop existing ones to reduce the likelihood of missed visits. b) Further develop existing contingencies to respond quickly to actual missed visits to ensure people receive the care and support they require (2) By 8 April 2024, the provider must ensure the support provided to people promotes and their health and wellbeing. To achieve this the provider must: a) Ensure support visits are organised to provide sufficient time and staffing to provide the assessed support at each visit.b) Ensure support visits take place, as far as possible, at the times notified to people.c) Ensure sufficient time is allowed for all support needs to be met at each visit.d) Ensure schedules are accurate and received in advance of the start of the planned supports with details of times and named staff. To support positive outcomes for people experiencing care and support, the provider should inform people of significant changes. This should include, but is not limited to, changes made to their staff team and visiting times, including when changes occur at short notice if possible. (2) To support people's health and wellbeing, the provider should ensure that requests for specified times to meet medical appointments are kept. This should include, but is not limited to, agreeing how they will support people when reasonable notice has been given. Airdrie 13/11/2024 10/12/2024 06/01/2025 WEAK - 2 (1) By 8 April 2024, the provider must ensure the support provided to people promotes and their health and wellbeing. To achieve this the provider must: Take action reduce the number of missed visits. This should include: a) Introduce systems that further develop existing ones to reduce the likelihood of missed visits. b) Further develop existing contingencies to respond quickly to actual missed visits to ensure people receive the care and support they require. MET (2) To ensure people receive appropriate supports to maintain and enhance their well-being and achieve their outcomes, the provider must: a) Have system in place to ensure reviews of people's care and support take place not less than six-monthly. b) Ensure that care plans are reviewed more regularly when a person's needs change. c) Audit the quality of reviews to ensure consistency and quality. MET (3)The provider must ensure the support provided to people promotes and their health and wellbeing. To achieve this the provider must a) Ensure support visits are organised to provide sufficient time and staffing to provide the assessed support at each visit. b) Ensure support visits take place, as far as possible, at the times notified to people. c) Ensure sufficient time is allowed for all support needs to be met at each visit. (d) Ensure schedules are accurate and received in advance of the start of the planned supports with details of times and named staff NOT ASSSESSED AT THIS INSPECTION (4) The provider must ensure service users experience care and support which is consistent, safe, and meets their needs. To do this the provider must, at a minimum, ensure that service users' personal plans: a) are current, accurate, reflect good practice in being person-centred and outcome focussed. b) have sufficient detail in them to ensure people's individualised support needs and outcomes are met. c) are subject to regular evaluation and audit to monitor quality and effectiveness. In addition, the provider must, a) ensure each person supported is provided with a copy of their care plan b) ensure all care plans are available on request for the Care Inspectorate NOT ASSESSED AT THIS INSPECTION To support positive outcomes for people experiencing care and support, the provider should inform people of significant changes. This should include, but is not limited to, changes made to their staff team and visiting times, including when changes occur at short notice if possible. MET (2) To support people's health and wellbeing, the provider should ensure that requests for specified times to meet medical appointments are kept. This should include, but is not limited to, agreeing how they will support people when reasonable notice has been given. MET During this period service management have worked hard to reduce the number of missed visits. Daily checks were introduced to provide alerts. Positive work carried out to ensure no care reviews were overdue and that management had overview of the quality of the reviews. Airdrie 08/01/2025 28/01/2025 12/02/2025 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3 Previous two (3) and (4) requirements were assessed at this visit and MET - OUTWITH THE TIMESCALES NONE The service continue to ensure staff are properly supported and trained. The quality of support plans had improved. Bellshill 18/04/2024 30/04/2024 14/05/2024 GOOD - 4 GOOD - 4 GOOD - 4 GOOD - 4 GOOD - 4 None To improve staff support the provider should ensure their policy regarding patch meetings is followed. Supervision and observation targets had improved, good quality assurance tools for observations, staff well trained Coatbridge 27/09/2024 04/11/2024 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3 By 30 November 2023, the provider must ensure that care plans are reviewed on a six-monthly basis as a minimum, in line with current legislation. To do this, the provider must, at a minimum, ensure: a) people are supported to understand and be included within their care review b) they collaborate with people and others involved with their care to gather their views on what is working well with their care and support. This includes but is not limited to reviewing health and safety risk assessments and needs assessments c) ensure that any agreed actions are completed and reviewed regularly to ensure they remain effective. Completed actions to be carried forward to the next agreed review date d) people and their representatives (where appropriate) have read over and are happy with the record of their review e) managers are involved in the monitoring and the audit of people's reviews. By 30 November 2023, the provider must ensure service users experience care and support which is consistent, safe, and meets their needs. To do this the provider must, at a minimum, ensure that service users' personal plans: a) are current, accurate, reflect good practice in being person-centred and outcome focussed b) have sufficient detail in them to ensure people's individualised support needs and outcomes are met c) are subject to regular evaluation and audit to monitor quality and effectiveness.
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Appendix D – Home Support CI Status 80 Cumbernauld 27/01/2025 04/02/2025 27/02/2025 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3ADEQUATE - 3 By 30 June 2023, the provider must ensure service users experience care and support which is consistent, safe, and meets their needs. To do this the provider must, at a minimum, ensure that service users' personal support plans are: a) Up-to-date, accurate, reflect good practice in being person-centred and outcome focussed b) Detailed enough to provide guidance to staff on how to support people, including risk assessments. c) Regularly audited to ensure consistency and quality. This has been extended to 30 April 2025 To ensure people are being supported by a competent workforce, the provider should ensure action plans generated from supervisions are completed and supervision records are regularly audited.This area for improvement has not been assessed and remains in place Cumbernauld 11/09/2024 02/10/2024 08/10/2024 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3ADEQUATE - 3 By 30 June 2023, the provider must ensure service users experience care and support which is consistent, safe, and meets their needs. Support plans require to be: a) Up-to-date, accurate, reflect good practice in being person-centred and outcome focussed b) Detailed enough to provide guidance to staff on how to support people, including risk assessments. c) Regularly audited to ensure consistency and quality. . To ensure people are being supported by a competent workforce, the provider should ensure action plans generated from supervisions are completed and supervision records are regularly audited. 2 of the 3 requirements have been met. Improvements made with training, supervision and audits of reviews. Motherwell 15/08/2024 09/09/2024 02/10/2024 ADEQUATE - 3 WEAK - 2 WEAK - 2 WEAK - 2 WEAK - 2 By 31 December 2024, the provider must provide the service in a manner which promotes quality and safety and respects the independence of service users and affords them the choice in the way in which the service is provided to them. To do this the provider must, at a minimum: -implement a SMART short focused improvement plan which is updated regularly by service -record and monitor visits completed by family members as part of their contingency planning -ensure people receive their assessed time at each visit. 1. By 31 December 2024, to ensure that people’s care and support needs are met effectively, the provider must ensure staffing arrangements are safe. To do this, the provider must, at a minimum: regularly assess and review people’s care and support needs clear systems that identify the current support needs for people experiencing care relevant training is provided to all staff to ensure their competency in all aspects of their role which must include direct observations provide regular support for staff which includes supervision and appraisal develop a long term strategy for recruitment, retention and wellbeing of staff Adult Support and Protection incidents were generally well recorded and reported to the Care Inspectorate. We could see appropriate actions had been taken. However there were delays between the incidents and when they were notified to the Care Inspectorate, some by more than a couple of weeks. Notifications should be made in the timescales identified in the Care Inspectorate guidance for notification reporting. To ensure notifiable events are reported to the Care Inspectorate in a timely manner the service should comply with the Care Inspectorate guidance for notification reporting. Motherwell 26/03/2025 01/04/2025 16/04/2025 ADEQUATE - 3 ADEQUATE - 3 ADEQUATE - 3ADEQUATE - 3 All requirements were met All previous areas of improvement were met - 2 new areas for improvement was made: To ensure a confident well trained staff team the service should ensure schedulers have the training, mentoring and support they need. 2. To ensure there is clear evidence staff support is taking place the service should develop a robust monitoring system. Wishaw 15/10/2024 22/10/2024 28/10/2024 GOOD - 4 GOOD - 4 GOOD - 4 GOOD - 4 GOOD - 4 No requirements All 3 previous areas for improvement met. Further areas of improvements as below: To support a culture of continuous improvement, the provider should ensure that all action plans are fit for purpose and SMART (specific, measurable, achievable, realistic and time-bound) focused. To ensure that people are fully involved in developing and reviewing their care plan, the provider should ensure that review records are shared with them. The care and support that people experienced was right for them. Good communication across the staff team.
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Appendix D – Home Support CI Status 81 Childrens Residential Children's House Date Inspection Took Place How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? How well do we support children and young people's rights and wellbeing? Overall Grade Awarded Requirements Areas for Improvement Areas of Strength Buchanan Street 05/12/2024 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED ADEQUATE - 3 ADEQUATE - 3 None 1. To ensure that all young people consistently experience trauma informed responses to their care and support needs, the provider should continue to develop staff practice which is based on the principles of relational practice. The expected impact of any natural consequences should be carefully considered prior to being implemented. 2. To ensure that all young people's care and support needs are met by a staff team that works well together, the provider should maintain regular opportunities for collective discussion and decision making forums, to enable and promote agreed ways of working with young people. 3.To ensure the safety and wellbeing of all young people, the provider should provide closer monitoring of medication procedures to minimise the likelihood of errors occurring in practice. 4. To ensure that all young people receive high quality care and support, the provider should commit to regular, effective staff supervision for all members of staff, in line with their policy. 5. To ensure that all young people receive high quality care and support, the provider should undertake analysis, to determine the training and development needs of staff to promote professional growth. 6. To ensure that all young people receive high quality care and support from a service which is well led and managed, the provider should enable regular i d h i i Young people felt well cared for. There was good oversight of risk for young people. Personal plans were outcome focused. Cambusnethan 12/06/2024 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED ADEQUATE - 3 ADEQUATE - 3 None 1. To ensure that young people's needs are met, the provider should source and implement staff training relating to the specific needs of all young people 2. To ensure that young people's needs and wishes inform their care and support, the provider should develop SMART personal plans which are informed by young people and are written in a child friendly style 3.To ensure young people's needs are met, the provider should keep staffing levels under review to ensure the correct number of staff are always available to meet the needs of children and young people. Cambusnethan worked well with partner agencies to support young people. There were some positive outcomes for young people and support for families was very good. Forest Street 08/08/2024 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED GOOD - 4 GOOD - 4 None 1. To ensure that young people can assess their achievements, the provider should ensure that personal plans adequately document young people's progress toward good outcomes 2. To ensure the safety and wellbeing of all young people living at Forrest Street Residential Children's House, the provider should ensure that in each instance, admissions and matching assessments include assessment of the needs of young people already living in the house. The management team at Forrest Street Residential Children's House should inform decisions. 3. To ensure that young people help to inform improvement planning and continue to contribute to evaluations of progress toward identified outcomes, the provider should create a more streamlined approach to this process Risk was reduced for most young people and Leaders worked effectively with partners Fort Street 25/02/2025 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED GOOD - 4 GOOD - 4 None 1. To ensure that young people achieve positive outcomes which are specific to them as individuals, personal plans should be SMART (specific, measurable, achievable, realistic and timebound.) Young people had meaningful relationships with staff. Partners felt that managers and staff worked proactively with them to support young people. Relationships with family and friends were actively promoted. The quality of the environment was very good. Young people were supported and enabled to make informed choices and decisions for themselves. The house provided a safe place for young people Main Street 31/01/2025 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED GOOD - 4 GOOD - 4 None 1. To ensure effective oversight and governance of experiences and outcomes for young people, the provider should continue to improve quality assurance processes. 2. To ensure effective involvement of young people and their progress towards identified outcomes, personal plans should be SMART (specific, measurable, achievable, realistic and timebound) Most young people thrived, enjoying positive relationships with staff. The provider was responsive to risk impacting young people's safety and wellbeing. Education and employment was the norm for most young people. Some young people felt a strong sense of belonging. Interests and aspirations were fully supported. Personal plans should be SMART (specific, measurable, achievable, realistic and timebound). Leadership was positive and enabling.
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Appendix E – Children’s Houses CI Status 82 Childrens Residential Children's House Date Inspection Took Place How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is care and support planned? How well do we support children and young people's rights and wellbeing? Overall Grade Awarded Requirements Areas for Improvement Areas of Strength Buchanan Street 05/12/2024 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED ADEQUATE - 3 ADEQUATE - 3 None 1. To ensure that all young people consistently experience trauma informed responses to their care and support needs, the provider should continue to develop staff practice which is based on the principles of relational practice. The expected impact of any natural consequences should be carefully considered prior to being implemented. 2. To ensure that all young people's care and support needs are met by a staff team that works well together, the provider should maintain regular opportunities for collective discussion and decision making forums, to enable and promote agreed ways of working with young people. 3.To ensure the safety and wellbeing of all young people, the provider should provide closer monitoring of medication procedures to minimise the likelihood of errors occurring in practice. 4. To ensure that all young people receive high quality care and support, the provider should commit to regular, effective staff supervision for all members of staff, in line with their policy. 5. To ensure that all young people receive high quality care and support, the provider should undertake analysis, to determine the training and development needs of staff to promote professional growth. 6. To ensure that all young people receive high quality care and support from a service which is well led and managed, the provider should enable regular management meetings and other opportunities to develop the service. Young people felt well cared for. There was good oversight of risk for young people. Personal plans were outcome focused. Cambusnethan 12/06/2024 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSEDADEQUATE - ADEQUATE - 3 None 1. To ensure that young people's needs are met, the provider should source and implement staff training relating to the specific needs of all young people 2. To ensure that young people's needs and wishes inform their care and support, the provider should develop SMART personal plans which are informed by young people and are written in a child friendly style 3.To ensure young people's needs are met, the provider should keep staffing levels under review to ensure the correct number of staff are always available to meet the needs of children and young people. Cambusnethan worked well with partner agencies to support young people. There were some positive outcomes for young people and support for families was very good. Forest Street 08/08/2024 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSEDGOOD - 4 GOOD - 4 None 1. To ensure that young people can assess their achievements, the provider should ensure that personal plans adequately document young people's progress toward good outcomes 2. To ensure the safety and wellbeing of all young people living at Forrest Street Residential Children's House, the provider should ensure that in each instance, admissions and matching assessments include assessment of the needs of young people already living in the house. The management team at Forrest Street Residential Children's House should inform decisions. 3. To ensure that young people help to inform improvement planning and continue to contribute to evaluations of progress toward identified outcomes, the provider should create a more streamlined approach to this process Risk was reduced for most young people and Leaders worked effectively with partners Fort Street 25/02/2025 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSEDGOOD - 4 GOOD - 4 None 1. To ensure that young people achieve positive outcomes which are specific to them as individuals, personal plans should be SMART (specific, measurable, achievable, realistic and timebound.) Young people had meaningful relationships with staff. Partners felt that managers and staff worked proactively with them to support young people. Relationships with family and friends were actively promoted. The quality of the environment was very good. Young people were supported and enabled to make informed choices and decisions for themselves. The house provided a safe place for young people Main Street 31/01/2025 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSEDGOOD - 4 GOOD - 4 None 1. To ensure effective oversight and governance of experiences and outcomes for young people, the provider should continue to improve quality assurance processes. 2. To ensure effective involvement of young people and their progress towards identified outcomes, personal plans should be SMART (specific, measurable, achievable, realistic and timebound) Most young people thrived, enjoying positive relationships with staff. The provider was responsive to risk impacting young people's safety and wellbeing. Education and employment was the norm for most young people. Some young people felt a strong sense of belonging. Interests and aspirations were fully supported. Personal plans should be SMART (specific, measurable, achievable, realistic and timebound). Leadership was positive and enabling.
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Appendix E – Children’s Houses CI Status 83 Childrens Residential Children's House Date Inspection Took Place How well do we support people's wellbeing ? How good is our leadership ? How good is our staff team? How good is our setting? How well is care and support planned? How well do we support children and young people's rights and wellbeing? Overall Grade Awarded Requireme nts Areas for Improvement Areas of Strength Buchanan Street 05/12/2024 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED ADEQUATE - 3 ADEQUATE - 3 None 1. To ensure that all young people consistently experience trauma informed responses to their care and support needs, the provider should continue to develop staff practice which is based on the principles of relational practice. The expected impact of any natural consequences should be carefully considered prior to being implemented. 2. To ensure that all young people's care and support needs are met by a staff team that works well together, the provider should maintain regular opportunities for collective discussion and decision making forums, to enable and promote agreed ways of working with young people. 3.To ensure the safety and wellbeing of all young people, the provider should provide closer monitoring of medication procedures to minimise the likelihood of errors occurring in practice. 4. To ensure that all young people receive high quality care and support, the provider should commit to regular, effective staff supervision for all members of staff, in line with their policy. 5. To ensure that all young people receive high quality care and support, the provider should Young people felt well cared for. There was good oversight of risk for young people. Personal plans were outcome focused.
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Appendix E – Children’s Houses CI Status 84 undertake analysis, to determine the training and development needs of staff to promote professional growth. 6. To ensure that all young people receive high quality care and support from a service which is well led and managed, the provider should enable regular management meetings and other opportunities to develop the service. Cambusneth an 12/06/2024 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED ADEQUATE - 3 ADEQUATE - 3 None 1. To ensure that young people's needs are met, the provider should source and implement staff training relating to the specific needs of all young people 2. To ensure that young people's needs and wishes inform their care and support, the provider should develop SMART personal plans which are informed by young people and are written in a child friendly style 3.To ensure young people's needs are met, the provider should keep staffing levels under review to ensure the correct number of staff are always available to meet the needs of children and young people. Cambusnethan worked well with partner agencies to support young people. There were some positive outcomes for young people and support for families was very good.
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Appendix E – Children’s Houses CI Status 85 Forrest Street 08/08/2024 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED GOOD - 4 GOOD - 4 None 1. To ensure that young people can assess their achievements, the provider should ensure that personal plans adequately document young people's progress toward good outcomes2. To ensure the safety and wellbeing of all young people living at Forrest Street Residential Children's House, the provider should ensure that in each instance, admissions and matching assessments include assessment of the needs of young people already living in the house. The management team at Forrest Street Residential Children's House should inform decisions.3. To ensure that young people help to inform improvement planning and continue to contribute to evaluations of progress toward identified outcomes, the provider should create a more streamlined approach to this process Risk was reduced for most young people and Leaders worked effectively with partners Fort Street 25/02/2025 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED GOOD - 4 GOOD - 4 None 1. To ensure that young people achieve positive outcomes which are specific to them as individuals, personal plans should be SMART (specific, measurable, achievable, realistic and timebound.) Young people had meaningful relationships with staff. Partners felt that managers and staff worked proactively with them to support young people. Relationships with family and friends were actively promoted. The quality of the environment was very good. Young people were supported and enabled to make informed choices and decisions for themselves. The house provided a safe place for young people
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Appendix E – Children’s Houses CI Status 86 Main Street 31/01/2025 NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED NOT ASSESSED GOOD - 4 GOOD - 4 None 1. To ensure effective oversight and governance of experiences and outcomes for young people, the provider should continue to improve quality assurance processes. 2. To ensure effective involvement of young people and their progress towards identified outcomes, personal plans should be SMART (specific, measurable, achievable, realistic and timebound) Most young people thrived, enjoying positive relationships with staff. The provider was responsive to risk impacting young people's safety and wellbeing. Education and employment was the norm for most young people. Some young people felt a strong sense of belonging. Interests and aspirations were fully supported. Personal plans should be SMART (specific, measurable, achievable, realistic and timebound). Leadership was positive and enabling.
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1 REPORT Item No: 13 SUBJECT: Hospital at Home TO: IJB Performance Finance Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health, NL HSCP Author(s) of Report Nicola Kelly, Interim Service Manager Contributor, Dr Claire Steel, Clinical Lead Hospital at Home DATE: 17 September 2025 1. PURPOSE OF REPORT This paper outlines the current provision of the Hospital at Home (H@H) service within Lanarkshire, the service expansion updates, and the strategic risks to the longevity of maintaining increased performance. 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 Nicola Kelly, Interim Service Manager and reviewed by Lorraine Smith, Interim General Manager and Maggs Thomson, Head of Health, NHSCP. Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ 3. RECOMMENDATIONS
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2 It is recommended that the IJB note that in line with the Board’s Unscheduled Care strategy, that work is underway within the H@H service with the aim to expand the virtual bed capacity and equity of services with the roll out of provision to Cambuslang/Rutherglen locality. 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 The Hospital at Home (H@H) service in Lanarkshire has been operational for over 12 years and was the first established service in Scotland. Currently there are 103 virtual beds and with expansion, the plan is to increase this to 125 virtual beds. It continues to be the largest H@H service, consisting of four hubs across Lanarkshire with links to each of the three acute hospitals, this would increase to 5 hubs and extend links to GG&C hospitals for patients accessing Hospitals in Glasgow from Cambuslang and Rutherglen. The service has expanded from its original admission avoidance to include step-down support following inpatient admission. Crucially, the H@H service is a key part of the Board’s health and social care strategy “Our Health Together 2024- 2031” to keep people well at home and to deliver better care by maximising care delivered in the community closer to patients’ homes. North Health and Social Care Partnership have received funding from Scottish Government to deliver whole-system and sustainable improvement through the existing Unscheduled Care for 2025/26. The additional funding for H@H service is £1.2m to scale up capacity and equity of services across the Partnerships. This is in addition to the annual Budget of £3,965,945. Both North and South Health and Social care Partnerships in addition to the Scottish Government funding arrangements jointly fund this annual budget. This new initiative gives an additional £1.2 million to continue to fund the service within the Clydesdale Locality and to develop a new service within the Cambuslang/Rutherglen area and development of a pharmacy support team. 5.1 WORKFORCE The service is currently Medically (Consultant) led and each of the 3 original Hubs are supported by Consultant Geriatricians from the associated Acute Yes ☐ No ☒ N/A ☐
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3 Hospital Site. Non-recurring funding has resulted in recruitment challenges with staff facing redeployment and an inability to recruit to vacancies, as posts are not on a permanent basis. The core budget for the service is £3,285,182 this is supplemented by non-recurring funding from Healthcare Improvement Scotland (HIS) £356,689 and South Health Social Care Partnership funding of £324,074. Replicating the original operating model into Clydesdale provided challenges due to the lack of available Consultant Geriatricians within the recruitment market. This meant a Consultant led model was not possible. As an alternative, the introduction of Advanced Nurse Practitioners and Advanced Practitioners (ANPs & APs) into the H@H model was developed. In principle, qualified and experienced Advanced Practitioners could work autonomously as a clinical decision maker working in collaboration with Consultant Geriatricians. To support this model, a Specialty Doctor was recruited for the Wishaw Hub to support the expansion into Clydesdale. This year has seen qualified ANPs increase to five. There are a further three Trainees currently being supported by a Senior ANP, Team Leaders and Practice Development. One of the remaining trainees is due to complete training by March 2026 with the remaining two Trainees expected late 2026. Further expansion into the team, has seen the introduction of GP Trainees, with seven GP Trainees having worked within the Service since August 2024. The recruitment process is underway to develop H@H services within Cambuslang & Rutherglen. Approval to recruit to posts has been agreed until 31st March 2026. 5.2 PERFORMANCE Admissions to H@H are a vital alternative to hospital admission as well as providing step down care for patients discharged from hospital who would benefit from ongoing medical intervention. On average 80% of patients within the service, are for admission avoidance and 20% are step down patients. From January to July 2025, there have been 2508 patients’ referred into the service. The breakdown is noted below: Location Admission avoidance Stepdown Total
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4 UHM 753 214 (22%) 967 UHH 559 101 (15%) 660 UHW 588 96 (14%) 684 Clydesdale 156 41 (20%) 197 Total 2056 452 (18%) 2508 On average, there are 358 patients per month referred to H@H. This is an increase from 2023 which saw an average of 260 patients per month. The average length of stay figures for each Hub are noted below: 2021/2022 2022/2023 2023/2024 2024/2025 UHM 6.01 5.7 4.55 4.87 UHH 8.02 7.4 7.5 6.5 UHW 10.48 9.3 7.77 6.14 Clydesdale x x 8.4 10 Total 8.17 7.46 7.05 6.87 The average length of stay in Clydesdale is greater than all other Hubs. This may be reflective of the nurse led model and has influenced proposals for the Cambuslang & Rutherglen model. 5.3 FINANCE The annual budget for H@H is £3,965,945. This includes pays and non pays. The budget is made up of substantive and yearly allocations from Health improvement Scotland, Scottish Government and NHS Lanarkshire.
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5 The financial position as at Month 4 2025/2026 financial year is as follows: The Pays budget is reviewed/scrutinised/managed accordingly in-line with allocated funds. 5.3 TECHNOLOGY Remote Patient Monitoring (DOCCLA) The introduction of DOCCLA into the service has facilitated remote monitoring of patients vital signs in real time, leading to improved patient outcomes and improving continuous patient engagement. The system also supports video calling potentially reducing face-to-face visits, a more responsive consultation time and overall efficiencies within the service. Although within its infancy, we are promoting DOCCLA with all new patients, particularly those within the Care Home setting. From July 2025, the service has used DOCCLA monitoring on 142 patients. Point Of Care Testing (POCT) POCT allows the testing of certain bloods within the patient’s home. This enables rapid diagnostic results on site. POCT could also enable healthcare professionals to provide diagnosis, monitoring and treatment without the need for the patient to visit the hospital. The service is evolving and developing each year with a recent expansion into a large, rural part of the county, Clydesdale. In 2024, the service decided to trial the use of point of care blood testing to address the need for new ways of working to overcome challenges in providing remote H@H care. Efficiency Core Budget 2,803,445 Clydesdale 324,074 Non recurring for 1 year HIS 356,689 Funding until 31/12/2027 Step Down 481,737 Non recurring funding via Scottish Government Total £3,965,945
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6 • In 54% of cases, point of care testing enabled a quicker decision to be made about a patient’s care. • In 35% of cases, the patient started treatment earlier than if a decision relied on a traditional laboratory route for blood results. • 21% of cases where POCT was used resulted in fewer visits to the patient’s home because blood results were known during the first visit. This had a positive impact on capacity and initiation of treatment plans in a timely manner. Point of Care Ultrasound (POCUS) Similarly, the introduction of POCUS would provide additional investigations within the patient’s home. Funding was included within the Scottish Government bid to purchase the necessary equipment. The service are currently undergoing training to progress roll out across the localities. 5.4 PHARMACY H@H received temporary pharmacy funding from Healthcare Improvement Scotland (HIS) for 2 years. This input has demonstrated significant value to the service, helped to mitigate (in part) risks previously identified in relation to medicines governance, as well as support the wider expansion of the H@H service. Benefits to the service include: Pharmacy expertise at ward rounds Poly pharmacy reviews undertaken Better communication between all interfaces Efficient co-ordination of medication changes Protecting safety of patients Protecting and supporting staff Facilitating staff training Free up time for current clinical team to optimize clinical capacity The lack of substantively funded pharmacy input to H@H presents a risk to the safe, effective and person-centered use of medicines as well as medicines governance within the service. 5.5 ASSOCIATED RISKS Risk factors to future expansions include non-recurring funding streams resulting
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7 in fixed term contracts, which are difficult to recruit to due to the lack of stability for staff. Qualified ANPs and Specialty Doctors are a highly sought after workforce making it challenging to recruit appropriately qualified staff. The service is not able to embrace innovation due to the strain on current resources. Sub optimum level of Multi-disciplinary input to care plans particularly the pharmacist role. Areas of NHS Lanarkshire will not be able to access the H@H service. Increase in admissions to hospital for patients who could be cared for at home. Organisational reputation of the H@H Service as it is held in high regards across Boards in NHS Scotland. 6. NEXT STEPS Liaise with South Health and Social Care Partnership regarding roll out of H@H services to Cambuslang/Rutherglen area and continued provision of service within the Clydesdale Locality. Recruitment drive for Cambuslang/Rutherglen Locality and Pharmacy staff to support the service as a whole. Monitor and review service impact, developments and data to assist with adaptations/expansion as required. All clinical, financial and staff governance will be governed appropriately under current arrangements within AHSU & North Health and Social Care Partnership. Expand the use of technology to enhance service provision. 7. CONCLUSIONS H@H services in NHSL has continuously increased virtual bed capacity every year since 2019 via expansion programmes and pilots. As a service, we are keen to continue to develop and expand the service into the Cambuslang/Rutherglen locality as well as continued provision to Clydesdale locality. 8. IMPLICATIONS As previous mentioned, the non-recurring funding to H@H services, could result in the inability to provide a H@H service within the Cambuslang/Rutherglen locality and the continued resource within the Clydesdale locality.
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8 8.1 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 ☒ 8.2 ASSOCIATED MEASURE(S) 8.3 FINANCIAL This paper has not been reviewed by Finance however funding information has been confirmed and agreed: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Workforce – Recruitment & Retention High AHSU Management Team Inequity of service provision across NHSL High AHSU Management Team Unnecessary admissions to Hospital for Frail Elderly patients High AHSU Management Team
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9 8.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Locality management team, GPs, staff and patients. ☒ 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 Monthly meetings with Locality team with expansion of participants. ☐ 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 8.6 INEQUALITIES & FAIRER SCOTLAND DUTY Yes No x N/A EQIA added to website:
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10 Yes No x N/A 9. BACKGROUND PAPERS Further data available on request. 10. APPENDICES Nil Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Nicola.kelly@lanarkshire.scot.nhs.uk Lorraine.Smith4@lanarkshire.scot.nhs.uk
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11 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
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12 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 14 SUBJECT: HOME SUPPORT TO: INTEGRATION JOINT BOARD Lead Officer for Report: Diane Fraser, Chief Officer (Adult Social Work Services) Author(s) of Report Margaret Flavell DATE: 17 September 2025 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: M Flavell ☒ Reviewed By: ☐ Endorsed By: D Fraser ☒ NLC - Adult Care and Social Work Committee
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2 3. RECOMMENDATIONS It is recommended that the Integration Joint Board acknowledge the developments within Home Support Service and the progress being made to implement the approved operating model. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Health and Social Care Partnership remain committed to providing services at the right time and place, leveraging a personalised, choice-driven model that enhances wellbeing and independence. 5.2 The plan for the new operating model to deliver Home Support was agreed by the IJB in March 2018. The model was based on the outputs of the Cross−Party Working Group, the advice from support officers and wider officer research, the proposed 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) 5.3 There has been considerable work undertaken to implement a functional model —through assessment and planning and delivering long-term support via Living Well at Home which is outlined in the Home Support Service report that was presented to IJB Performance and Audit Committee 21st August 2024.This is now in the final stages of implementation. 5.4 It is widely recognised that robust assessment at home which includes direct support can determine more accurately what supports an individual may require longer term. The home support workforce is key to maximising an individual’s independence through practical tasks as well as following a rehabilitation programme to work on specific tasks and confidence. Generally, home support staff will work closely with other members of the multi- disciplinary team such as Occupational Therapists, Physiotherapists and Social Workers and families. The Home Assessment, Reablement, Integrated Rehabilitation and Intensive Yes ☐ No ☒ N/A ☐
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3 Teams can support individuals to ensure a thorough assessment is complete to inform any decisions regarding longer term support. This should assist in managing demand and directing resources to those most in need. 5.5 North Lanarkshire continue to have a positive balance of care, a term which is used to refer to the balance of support and care available within the community - based settings compared with support within residential settings. This is supported by the continued investment in community – based supports and a long-standing commitment to self-directed support. This is underpinned by community support which is codesigned with individuals and their carers/ families. This approach has resulted in a high proportion of individuals remaining at home. The model will support more people being assessed at home and supported to be as independent as possible. This will ensure that people who need short term reablement to reach their full potential receive this. 5.6 This approach is necessary to address the demographic changes and increasing pressure on financial resources including the impact of changes in the cost of living, which means that “more of the same” is not the right response. The 2022 census demonstrates the potential demographic change which supports the case for change. Between 2011 and 2022 the 25 to 44 age group saw a percentage decrease (- 7.3%), in contrast the 75 and over age group saw a percentage increase (+21%) Although the population is projected to decrease from 2028 to 2043 by 1.2% there is a forecast increase of 71.4% in the age group 75 years and over across the same timescale 20% of North Lanarkshire data zones are within the 20% most deprived in Scotland Individuals who reported themselves ‘in fairly good health’ as opposed to ‘good health’ has grown by 15% (+7036). Individuals who reported themselves as having ‘long term health conditions’ has grown by 30.6% (+43,943). Individuals self-reporting mental health issues has grown by 158.6% (+24,903) Individuals self-reporting as providing informal / unpaid care has grown by 31.6% (+10,877). 5.7 The delivery model required for assessment and planning and Living Well has had to align with the new operating model for the Health and Social Care Partnership which is outlined in the report Back to Basics to Getting it Right for Everyone presented to Adult Care and Social Work Committee in May 2025. There has been considerable work to embed the values and principles of Getting it Right for Everyone and an enabling approach into the home support workforce. 5.8 This report will outline the progress that has been made over the past 12 months in four key areas; embedding an enabling approach, realigning and preparing
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4 the workforce to focus on home first and ongoing paid support, implement a dynamic scheduling tool and continue with the transition of analogue to digital to ensure continuity through community alarms whilst maintaining quality service. Overall, the report confirms our capacity to deliver a flexible and efficient operating model for North Lanarkshire. Embedding an enabling approach 5.9 The enabling approach that has been adopted in each locality promotes the following principles: Do no harm Home First Empower People Focus on prevention Whole system approach No waits 5.10 The learning through the Back-to-Basics programme has influenced the home support redesign and staff have been involved in the range of work that has supported new practice and processes to ensure that we can provide a quick and effective response whilst retaining a focus on one of our key principles helping people to help themselves. The delivery model relies on organising the home support workforce to be able to support assessment and planning to identify what long term support is required as well as provide ongoing paid support. The Living Well Service will provide ongoing support. This model promotes the key tasks of assess, plan, intervene and review. 5.11 We have introduced this approach in all six localities however we started the learning process in Wishaw with a focus on all referrals being directed through Home Assessment Team and Reablement. The performance in this area improved and was evidenced through improved waiting times, as outlined below, and importantly feedback from individuals and their families was positive. They reported feeling more included, information and processes were clear, they felt respected and empowered. Professionals also reported feeling optimistic, safe, motivated, and inspired. March 2025 March 2024
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5 5.12 Home support staff have played an important role to proactively supporting a home first ethos. They have supported this by committing to adopting an outcome focused approach to their intervention. There will be ongoing training to refresh the assessment and planning activity undertaken. Through the assessment phase people will receive a period of reablement/ rehabilitation to support their recovery. It is important that longer term support is not decided in environments such as hospital unless in exceptional circumstances. To support this, we have worked closely with NHS Lanarkshire colleagues to develop a process to request for assistance. Through an enabling approach staff will work on the principles of early intervention and prevention and ensure that people are provided with information, advice, and signposting relevant to their ongoing assessment. Planned interventions will include carers support, use of technology enabled care, as well as being able to use their own resources. Our staff undertaking assessments and providing support and care which promotes self-management and slow stream rehabilitation. 5.13 The ethos of Home First is currently being promoted and whilst this approach is not exclusive to HAT the performance of the team, provides an indicator of the outcomes for people. Key indicators show consistent improvements in response times and service user satisfaction. Staff feedback highlights growing confidence in applying the enabling approach and working across disciplines. These successes have contributed to timely hospital discharges, supported community resilience, and informed best practice. 5.14 The existing Home Assessment Team has supported around 3700 people since its inception, with the ongoing strong focus on rehabilitation and assessment the service continues to deliver strong results as evidenced below. 5.15 Service Users with no ongoing Home Support Needs following HAT Assessment 0 5 10 15 Jan 2024 Jan 2025 Wishaw HAT Completions July 24 v 25 Ongoing Service Req. No further service req. Readmission to hospital SU refused futher service Death
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6 5.16 The table above identifies that: 45% of individuals required immediate support from hospital but with support did not require longer term intervention. 37% of individuals required ongoing service, a high proportion of these individuals were assessed as benefiting from a community alarm hence this being recorded as ongoing service, however, crucially this does not involve ongoing paid supports at home. 14% of individuals readmitted into hospital. 5.17 Readmission rates appear to be high and relate to premature discharge, general decline in health and new acute episode. This also needs to be considered against the age profile of the service users that are being supported. However, with the focus of early intervention and discharge 86% of those being supported via HAT are not being readmitted. 5.18 The model will support hospital discharge flow, allow early planning, and facilitate a smoother transition from acute care settings to community-based support. Coordination will involve locality-based decision-making, informed by real-time scheduling data. Over the past 6 months there has been an improvement in the number of delays and have consistently remained below target as demonstrated below. However, by improving flow with the new delivery model, Home Support staff will work within a multi-disciplinary way to
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7 respond to surges within the system. This will be dependent on a whole system response to improving the persons journey in hospital. 5.19 This new way of working reflects the strategic ambition set out in previous committee reports under the Back-to-Basics programme which has evolved into the Getting It Right for Everyone programme. A particular focus will be placed on improving evening and out-of-hours support, recognising historic service gaps identified through consultation and service performance reviews. The aim is to ensure a balanced and resilient service which can respond to both planned and unplanned care needs at all times of day. 5.20 The Living Well at Home service continues to be locality-based, allowing responsive, integrated care aligned to the needs of communities. A new service descriptor for this service has been devised setting out what the service will provide moving forward. 5.21 The aim of the Living Well at Home service is to promote independent living, choice and control, social inclusion, and wellbeing for the adults that it supports. Living Well at Home will do this by providing personalised assistance to meet individual’s identified outcomes.
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8 5.22 The primary focus will be to support individuals where there is significant complexity of need. This may be complex physical and/or complex social need including where there may be public protection issues. Acknowledging that levels of complexity can be difficult to quantify, decision making around this will be determined in line with the outcome of a person’s assessment and a multi- disciplinary team approach to support. Workforce 5.23 The workforce is key to implementing the new delivery model for assessment and planning and Living Well. Staff have participated in a range of engagement sessions and are supportive of change that will lead to an improved quality of service for people who receive support as well as benefit the workforce. There are 1235 Home Support Workers employed in the Service across Reablement, Home Assessment Team, Intensive, Community Alarm and Living Well Service. The worker profile is made up of 94% female and 6% male with over 60% of our workforce over age 50. The management and support roles were previously reviewed. These roles support with scheduling visits, carrying out reviews, supervision, and training. There is no other employment change proposed at the moment other than the Senior Home Support Managers and Service Delivery Manager with the other aligned staff. However, future practice with consideration of demand and capacity could indicate potential further movement required. 5.24 Significant progress has been made in aligning the operational level of the workforce structure to support the assessment and care delivery. Frontline and supervisory roles, including Home Support Workers, Schedulers, and Team Leaders, have now been aligned to the appropriate service and this will be seamless in supporting the models of delivery. 5.25 To fully implement the model and to maximise flow it will be necessary to align key management posts. The proposed management and supervisory structure include Service Delivery Managers and Senior Home Support Manager roles within both Assessment and Planning and Living Well at Home need to be finalised. There will be an HR process to follow, working with the services HR Business Partner. 5.26 The recruitment and retention of Home Support Workers remain a priority for the service. Between Jan 2024 and May 2025, a total of 55.62 fte (75 head count) new recruits have started since January 2024 however this has been offset against the leavers of 81.82fte (117 headcount) employees within the same period. These figures are reflective of the aging workforce with the service seeing an increase, in retirement and termination through capability. 5.27 To improve this position there have been changes to recruitment practices to attract new people into social care with the format of the interviews taking a value-based approach. This has allowed a wider pool of staff to be recruited
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9 successfully allowing investment in those individuals looking for a career change. The latest recruitment campaign seen an increase in the number of successful applicants. 5.28 Participation within the Council’s summer programme has also seen several young people come forward with an interest in working in care. This has given us the opportunity to work with these young people to help them achieve their goals through modern apprenticeships in care as well as securing sessional post for those young people still in full time education. 5.29 The model of delivery will provide clearer roles and improved career paths. This will provide staff opportunities to develop skills and confidence in specific elements. With the intention of increasing the retention of staff. For example, staff will have the opportunity to work closely with Allied Health Professionals, Social Workers and nursing staff providing intervention based on rehabilitation. In addition, to focusing on recruitment and retention there has been considerable work undertaken to provide training to ensuring that we have a competent, confident workforce as we move into a new delivery model. With support from Learning and Development there has been a targeted approach to ensure staff have appropriate training. Dynamic Scheduling System 5.30 The service has undergone two significant system changes in the past 6 months which have included the introduction of the dynamic scheduling tool and Mosaic the client information system for Social Work. The dynamic scheduling tool will offer a wider range of benefits to service users and staff by improving consistency, reducing missed visits, and incorporating travel time accurately. For the first time, the service will be able to monitor care delivery in real-time as well as improve quality of service which in turn improves the experience for people who receive support. It also can produce accurate reports which will help to inform future demand upon the service. 5.31 A revised project timeline was devised for the roll out to Home Support Teams and at present Bellshill, Wishaw, Airdrie and Motherwell Home Support Teams are using the new system. There has been significant work undertaken to maintain service delivery whilst implementing a new system. It has been challenging for staff who have gone above and beyond and shown incredible dedication. The project team have worked closely with the provider to deliver this with minimal disruption. The programme for the project is outlined below with a completion date of 31st September 2025. Systems will require to be updated until the interface between Mosaic and the scheduling tool. The service is also preparing for the implementation of the Council’s new telephony system.
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10 Home Support Team Back Office Go Live Date Full Go Live Date Bellshill 17/03/2025 24/03/2024 Wishaw 26/05/2025 02/06/2025 Motherwell 23/06/2025 30/06/2025 Airdrie 14/07/2025 21/07/2025 5.32 Service users and their families are registering for the new Client Portal, which will allow service users and/or their family members to view scheduled care visits, including the times and names of Home Support Workers who will be delivered the care and support. The website is being updated to provide users and carers with information on how to register. 5.33 Staff have embraced the new system and are using basic functions to facilitate the implementation across the Home Support Service within a tight timescale. The go live is not the end of the journey; it is only the beginning in terms of introducing the full capabilities of the system and reviewing the information now available on supports being delivered to ensure the right support is being provided to service users at the right time. Community Alarms Update 5.34 The Community Alarm Service currently provides support to 7,859 people in North Lanarkshire with the confidence that they can call for help at any time of the day or night, every day of the year and is an essential service when people experience difficulties such as a fall or sudden illness. Of these individuals, 6,306 people are using dispersed analogue and or digital community alarms and 1,553 people are within sheltered accommodation. The Community Alarm staffing structure is being reviewed to support the outlined changes in the wider service. Improving Quality 5.35 The work that has been undertaken to embed Getting it Right for Everyone has led to improvements in the quality of service being provided. This has been achieved working closely with the Care Inspectorate to address areas identified for improvement through inspection. Staff absence, workforce availability, and recruitment of skilled professionals have previously impacted service consistency, but recent trends indicate a positive shift in performance across all locality teams.
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11 5.36 Significant improvement planning has been developed across localities and is actively monitored by the Senior Manager Adult Social Work, in conjunction with Care Inspectorate input and support. 5.37 The Service has been advised that only registered services who are rated 3/ adequate or below will receive a full inspection in the inspection year which commenced April 25. Services sitting on 4/ good or above will be chosen on a random basis to ensure quality grades are maintained. The Airdrie Home Support Team were the first team to receive their full inspection (July 2025) which resulted in an improved grade for the staff team and identified the need for improvement in key performance areas of the job role undertaken by Home Support Team Leaders. 5.38 Monthly improvement plans, and performance data are collated and reviewed for each Home Support Team by the Service Managers and Senior Manager. This supports the registered managers to focus on providing the best quality service. This ensure that any outstanding statutory work required for inspection and provides senior managers with a clear position on the strengths and areas of development within each of the teams. Quality Assurance colleagues have been working with the service to undertake self-evaluation to highlight areas that need immediate improvements to satisfy the regulator and improve outcomes for people. 5.39 Whilst the Service has continued to work in partnership with both the Care Inspectorate and Quality Assurance Team to deliver improvements within the service it should be noted that significant work remains to restore the previously high-level grades. Next Steps 5.40 To operationalise the new operating model there is a need to finalise the management structure. Benchmarking and learning visits to other areas have
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12 taken place and the workforce are kept informed throughout the process through regular consultation and updates. 5.41 Working towards full implementation of the new operating model for assessment and planning with Home Support staff already aligned will support the transition to the new way of working. There will be a communication plan and training programme in place over the next 6 -12 months. The progress will be reviewed and evaluated in conjunction with the wider programme of work, Getting it Right for Everyone. 5.42 The dynamic scheduling tool implementation will be complete by September 2025 and will be evaluated. Once this is complete it will be possible to use the data to make further improvements. 6. CONCLUSIONS 6.1 The report demonstrates significant progress in transforming the Home Support Service in North Lanarkshire, aligning with the strategic objectives of delivering high-quality, person-centred care. 6.2 The clear functional separation of Assessment and Planning from Living Well at Home marks a pivotal development phase, allowing targeted service delivery and efficiencies. 6.3 Multi-disciplinary Home First Assessment Teams (HATs) have had a measurable positive impact, with the alignment of reablement and intensive support this impact will continue at pace. 6.4 Implementation of the dynamic scheduling system (Access CM) has improved data accuracy, scheduling, and real-time monitoring, though challenges remain regarding system performance and workforce resource demands. 6.5 Note the updated position within the Community Alarm Service as it transitions from analogue to digital and progress made to date. 6.6 Locality-specific improvement plans, and quality assurance processes have contributed to more consistent service quality, with several localities achieving 'Good' inspection ratings. 6.7 The transition plan for full rollout by the end of 2025 is well-structured and supported by training, communication, and workforce engagement. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes
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13 People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The following measures of success have been identified: Improved wellbeing of supported peoples’ outcomes. Service Quality Improvements - Inspection ratings increased across all localities. Technological Integration of the Access CM dynamic scheduling system. The technological integration of the digital ARC within the Community Alarms Service. The Home First Assessment Model to be implemented across all six localities by 31stOctober 2025. Improved discharge response from Lanarkshire and Glasgow Hospitals. Living Well at Home will prioritise ongoing longer-term support. Workforce Stability and Engagement. Ensure a sustainable financial model. 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 Key risks is the delivery of the project; ongoing service risks relate to training and Medium Diane Fraser Yes ☒ No ☐ N/A ☐
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14 workforce availability to the transferring of information to the DRS. Risks are recorded on the Corporate risk register and project risk register 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 plan ☒ Provide stakeholders with information on how to get involved Family feedback encouraged in every review ☒ 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 Through oversight group in structure ☒ 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 Locality Action Plans ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Communicaton Plan being updated ☒ 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
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15 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS 9. APPENDICES Please include a glossary of terms if not already included. N/A Diane Fraser, Chief Officer (Adult Social Work Services) CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Margaret Flavell Yes ☐ No ☒ N/A ☐ Yes / Date added ☐ No ☒ N/A ☐
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16 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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17
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1 REPORT Item No: 15 SUBJECT: Learning Disabilities Unit Nursing Workforce TO: Lead Officer for Report: Joanne Jenkins North HSCP Nurse Director Author(s) of Report Marie Rooney North HSCP Associate Nurse Director, Mental Health Learning Disabilities and Addictions DATE: 17 September 2025 1. PURPOSE OF REPORT Update the IJB to an increase in the funded establishment of Kylepark Learning Disability Assessment and Treatment Unit, based in Kylepark on the Kirklands site. This request is the result of concerted work to reduce reliance on supplementary staffing and in the context of a national shortage of Learning Disability Nurses and projected reliance on supplementary staff, in the absence of additional investment. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been through Senior Management Team Finance for approval. Prepared By: ☐ Reviewed By: ☐ Endorsed By: ☒ 3. EXECUTIVE SUMMARY Kylepark, NHS Lanarkshire’s inpatient Learning Disability (LD) assessment and treatment centre, has faced critical nursing staffing challenges that compromise care quality, staff wellbeing, and financial sustainability. Despite targeted recruitment
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2 efforts, the unit has remained heavily reliant on supplementary staffing, including agency Health Care Support Workers (HCSWs), which contravenes national policy and incurs significant overspend. The current staffing model is under review. This proposal aimed to increase the funded establishment of Registered Learning Disability Nurses (RNMD) and Health Care Support Workers (HCSW), alongside initiatives to develop internal talent pipelines and improve retention. This strategic investment aims to: Enhance continuity and quality of care Reduce reliance on costly supplementary staffing Improve staff wellbeing and retention Align Kylepark Learning Disabilities in-patient unit with similar areas. There will continuous review to ensure future workforce planning 4. RECOMMENDATIONS 4.1 Note the contents of this report 5. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 6. BACKGROUND 6.1 Kylepark is a 12-bedded standalone unit on the Kirklands site, providing specialist care for individuals with learning disabilities and co-morbid mental illness. One individual with complex autism requiring intensive 4:1 nursing support. Plans to support this patient have been delayed due to lack of a suitable community placement meaning ongoing supplementary staffing costs to the unit. 6.2 There are also other delays within the unit, due to deficits in Social Care provision. These can and have resulted in patients who are well enough for discharge being delayed. We are also working within Mental Health and Learning Disability services to support people with Learning Disabilities to be looked after in their own Communities, in keeping with Scottish Governments Yes ☐ No ☐ N/A ☒
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3 Coming Home Implementation report (2022). This work is being progressed by a refreshed Out- of Area Group, chaired by a Clinical Director in North HSCP. 6.3 A more detailed update on the progress of this group will be brought to a future IJB. There are currently 7 delayed discharges within the Learning Disabilities in-patient unit, which increases our supplementary staffing usage due to the level of care and complexity of interventions required. 6.4 The unit faces persistent staffing challenges due to; National shortage of Registered Learning Disability Nurses, (23.9% drop in student intake from 2015–2023) Decline in Health Care Support Workers entering LD services (20.6% reduction) High levels of patient acuity requiring intensive observation ratios (1:1 to 3:1) Delayed discharges due to lack of community based Learning Disability care. These factors have led to a cycle of supplementary staffing, poor continuity of care, and staff burnout. 6.5 Actions Taken Shift pattern adjustments to support work-life balance Recruitment campaigns targeting Registered LD Nurses and experienced HCSWs Reduced agency use where possible However, despite these efforts, staffing gaps persist due to the complexity and acuity of the patient group. Analysis, over a 5-year period, by NHS Workforce colleagues, has demonstrated a deficit of on average 15 whole time equivalents within Kylepark, for the level of complexity and acuity, when compared to other NHS Boards. Following the recent Agenda for Change pay deal NHS boards are required to offset the impact of the reduced working week which will be implemented in May 2026. This will result in net loss of hours equivalent to 2.5 whole time equivalents for the LD in-patient unit. Taking all of these points into consideration, the following actions have been taken forward. Increase funded establishment Develop succession planning: o Support HCSWs to train as Nursing Associates (Band 4). o Participate in Glasgow Caledonian University’s “Earn-as-you-learn” RNLD initiative (2 candidates identified). Improve retention:
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4 o Enhance e-rostering and skill mix. o Promote work-life balance and wellbeing. There will be ongoing monitoring and review of supplementary staffing to ensure that we have the correct workforce model going forward 6.6 Strategic Impact Reduces reliance on agency staff and associated costs Improves continuity and quality of care Supports national workforce development goals Align LD Nursing workforce in Kylepark with best practice across Scottish Boards 6.7 Further Information The Annual Health Checks for People with Learning Disabilities (Scotland) Directions 2023 provide the legal basis for these checks: Eligibility: All individuals aged 16 and over with a learning disability must be offered an annual health check, this includes those who self-identify, regardless of formal diagnosis or severity. Responsibility: Health Boards must take all reasonable steps to identify eligible individuals and ensure they are offered a physical health check. Delivery: a Registered Nurse or Medical Practitioner must carry out physical Health checks. Data Reporting: Boards are required to submit relevant data to the Scottish Ministers. The Scottish Government committed recurring funding in January 2025 and issued guidance to support health checks. Recruitment has been completed and 3 members of staff are now in post. There are currently 2000 patients currently known to Learning Disabilities specialist services. The physical Clinics will commence in early October and 240 appointments have been offered, at the time of writing 48 appointments are confirmed. 7. SUMMARY OF KEY ISSUES 1. National shortage of Learning Disability Nurses
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5 2. Ongoing complexity and acuity in the patient group: requirement for continuity of care and workforce stability. 3. Financially unsustainable reliance on supplementary staffing and contravention of Scottish Government directive, making the Board an outlier. 8.CONCLUSIONS To ensure good financial governance, and a stable and suitably skilled workforce, we have secured an increase in the funded establishment as detailed above. However, this is currently under further review due to patient complexity and interventions required to ensure safe care delivery. The additional staffing will offer improved continuity of care for patients with complex needs. It will begin to bring NHS Lanarkshire into alignment with equivalent services in other Board areas, meaning that we are no longer in breach of Scottish Government directives, in relation to the use of non-registered Agency staff. 9.IMPLICATIONS This paper is primarily an overview of nursing workforce within the in patient Learning Disability workforce for noting, and is a spend to save in the longer term. This will mean a move from excess spending on supplementary staffing, to a stabilised workforce and improve the service for the residents of NHS Lanarkshire. 9.1NATIONAL 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 ☒
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6 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner NHS Lanarkshire Corporate Risk Register High Trudi Marshall 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings
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7 ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS 11. APPENDICES Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute)
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8 Members seeking further information about any aspect of this report, please contact the following; Marie Rooney, Associate Nurse Director marie.rooney2@lanarkshire.scot.nhs.uk
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction
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10 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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REPORT Item No: 16 SUBJECT: Internal Audit Annual Audit Report 2024/2025 TO: Integration Joint Board Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Officer (Audit and Risk), North Lanarkshire Council Chief Internal Auditor, NHS Lanarkshire DATE: 17 September 2025 1. PURPOSE OF REPORT 1.1 This paper is coming to the IJB Committee: For approval For endorsement To note 2. ROUTE TO THE BOARD 2.1 This paper has been: Prepared By: Chief Officer (Audit and Risk), North Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire. ☒ Reviewed By: Chief Finance Officer ☒ Endorsed By: Chief Officer ☒ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFAC: (1) 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 2025. 4. VARIATIONS TO DIRECTIONS Yes No N/A
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5. BACKGROUND/SUMMARY OF KEY ISSUES The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to comply with the accounts and audit regulations and legislation under section 106 of the Local Government (Scotland) Act 1973. The Integrated Resources Advisory Group (IRAG) guidance sets out that IJBs should make appropriate and proportionate arrangements for audit provision, including arrangements to review risk management, governance, and control of delegated resources. A professional and objective joint internal audit service has been established in accordance with recognised internal audit standards and practices as laid out in the revised Public Sector Internal Audit Standards (PSIAS), in order to comply with article 7 of the Local Authority Accounts (Scotland) Regulations 2014. The internal audit arrangements for the IJB are provided jointly by the internal audit teams of North Lanarkshire Council and NHS Lanarkshire. Appendix 1 is the IJB Internal Auditors’ 2024/25 Annual Internal Audit Report. This report is produced annually to provide the IJB with an independent view of the overall adequacy and effectiveness of the framework of governance, risk management, and control within the IJB. In turn, this informs the compilation of the IJB’s draft Annual Governance Statement, which forms part of the IJB’s Annual Accounts. 5.1 The Internal Audit Annual Audit Report 2024/2025 is based on the outcomes of the internal audit reviews of North Lanarkshire IJB Governance Arrangements and Strategy (draft report), the assessment of action taken to address previous internal audit actions, issued on 26 June 2025, review of the IJB draft Governance Statement and relevant reviews contained within the partner organisation Internal Audit Plans for 2024/2025. 6. CONCLUSIONS 6.1 The Internal Audit Annual Audit Report for 2024/2025 provides a high-level overview of the activity undertaken by the Internal Audit teams during the year, as reflected in the annual opinion. 6.2 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 provided on the adequacy and effectiveness of the IJB’s framework of governance, risk management, and internal controls for the year ending 31 March 2025. 6.3 Internal Audit will, as part of the agreed 2025/2026 workplan, 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 2025/2026. 7. IMPLICATIONS 7.1 National Outcomes Link(s) to National Health and Wellbeing Outcomes:
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People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 Associated Measure(s) The PFAC and both partners are required to ensure effective governance arrangements are in place. 7.3 Financial There was no charge for the provision of internal audit work as joint working arrangements have been developed to deliver this service. This paper has been reviewed by Finance: Yes No N/A 7.4 Risk Assessment/Risk Management The management of risk is an integral part of the development of the Internal Audit Plan. The IJB risk register was reviewed as part of year end assurance work. The ‘Ineffective Governance arrangements’ risk is scored as Low. Mitigating controls include the review of IJB governance arrangements and update of associated documents and the review of Internal Audit team programme of work and participation in the IJB. 7.5 Engagement & Participation The Chief Officer and the Chief Financial Officer have both been consulted on the content of the Internal Audit Annual Report 2024/2025. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes N/A ☐ Provide stakeholders with information on how to get involved N/A ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs N/A
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☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services N/A ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery N/A ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings N/A ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff N/A ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership N/A 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: Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Internal Audit Annual Report 2024/2025 ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Francis Scott, Chief Officer Audit and Risk, North Lanarkshire Council: ScottFr@northlan.gov.uk Jocelyn Lyall, Chief Internal Auditor, NHS Lanarkshire: Jocelyn.lyall2@nhs.scot
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INTERNAL AUDIT ANNUAL REPORT 2024/2025 Appendix 1 1 Purpose of Report 1.1 To report the activities undertaken by Internal Audit on behalf of the IJB for the year 2024/2025, and to present an independent annual opinion on the adequacy and effectiveness of the IJB’s internal controls based on the work undertaken during the year. 2 Background 2.1 Internal Audit is an independent and objective assurance function designed to add value and improve the IJB’s operations. It helps the IJB accomplish its objectives by bringing a systematic, disciplined approach to evaluate and improve the effectiveness of the IJB’s risk management, internal control and governance processes thereby assisting the IJB, the Performance, Finance and Audit Committee (PFAC), and the Senior Management Team to effectively discharge their role and responsibilities. 2.2 Internal Audit reports to the PFAC which also approves the Internal Audit annual audit plan and monitors the performance of the function. 2.3 Internal audit activity is planned to enable an independent annual opinion to be given by the Chief Internal Auditors on the adequacy and effectiveness of internal controls within the IJB, including the systems that achieve the corporate objectives of the IJB, and those that manage the material risks they face. It should be noted, however, that the presence of an effective internal audit function contributes towards, but is not a substitute for, effective control. It is primarily the responsibility of management to establish internal controls so that the IJB’s activities are conducted in an efficient and well-ordered manner, to ensure that management policies and directives are adhered to, and that any relevant assets and records are safeguarded. 3 High level overview of Internal Audit activity during 2023/2024 3.1 Both internal audit functions operated throughout 2024/2025 in accordance with the Public Sector Internal Audit Standards (PSIAS). 3.2 The 2024/25 Internal Audit Annual Plan included two audits in the areas of Governance and Strategy. 3.3 For the audit of Governance, Internal Audit was satisfied that the governance structures in place within the IJB provide effective oversight, challenge and direction, and are consistent with the Scottish Government guidance document “The Blueprint for Good Governance in NHS Scotland”, and the audit was therefore deemed to provide Adequate Assurance. The main finding from the audit work was for management to implement enhanced monitoring and reporting of previously agreed audit recommendations, to ensure the resulting actions are implemented within a reasonable timescale. 3.4 Internal Audit also completed a review of the content of the Strategic Commissioning Plan 2023-26, the associated governance and performance reporting arrangements for delivery of the Strategy and arrangements for the next iteration of the Strategy. The draft report was issued on 2 September and is currently with Management for factual accuracy check and response. Internal Audit provided ‘Reasonable Assurance’ and concluded positively on the content of the extant Strategic Commissioning Plan and noted that reporting on the Programme of Works to implement the Strategy could be enhanced. The report provided suggestions to further develop plans for the next iteration of the Strategic Commissioning Plan with a focus on the role of the Board in contributing to development of the Strategic Commissioning Plan and in monitoring progress. 4.2 In addition, the North Lanarkshire Council and NHS Lanarkshire internal audit teams undertook a range of audit work within their respective organisations. 4.3 For North Lanarkshire Council this included a review of the quality assurance arrangements for social work and social care, which included monitoring of external care providers and
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compliance with the contract management framework. Further audit work was undertaken on a range of systems and activities in the areas of corporate governance, performance management, cyber security, business continuity planning, project management and payroll which also provide general assurance in respect of North Lanarkshire Council operations for which the IJB has delegated responsibility. The Council’s Internal Audit Annual Report for 2024/25 provided an overall annual opinion of Reasonable Assurance in relation to governance, risk management and internal control. 4.4 Of note for NHS Lanarkshire were the Internal Control Evaluation and Annual Internal Audit Report 2024/25, both of which provided a holistic view of the adequacy and effectiveness of Internal Controls across NHS Lanarkshire, including delegated functions. In the 2024/25 Annual Report the Chief Internal Auditor concluded that NHS Lanarkshire Board has adequate and effective governance, risk management and internal control arrangements in place and the Accountable Officer had implemented a governance framework in line with required guidance sufficient to discharge the responsibilities of this role. Internal Audit identified three significant and one moderate action points in the areas of: governance of the Performance, Planning and Resources Committee; timing of production and presentation of Annual Reports to provide year end assurances; performance reporting highlighting key performance issues and clearly linking performance to risk; the risk associated with Artificial Intelligence. 4.5 Other relevant NHS Lanarkshire 2024/25 audits included reviews of Requisitioning, Order and Receipt, Financial Planning, Financial Management, Clinical Governance, Cyber Resilience / Information Security, Board & Operational Committees, Risk Management, Strategic Planning, Review of Delayed Discharge & Data and Waiting Times. 4.6 Audit work undertaken within North Lanarkshire Council and NHS Lanarkshire support a generally positive view of the IJB’s governance and internal control arrangements. 4.7 In addition, we confirmed consistency of the draft IJB Annual Governance Statement with information that we are aware of from our work. 4.8 The results from our work suggest that there are no matters that we require to highlight. No significant weaknesses and no material frauds or irregularities resulting in financial loss to the IJB were identified in 2024/2025 that require to be brought to your attention. 4 Annual Internal Audit Opinion 5.1 There is a formal requirement for the Chief Internal Auditors to prepare an annual opinion on the organisation’s internal control system. The opinion is presented to members of the IJB Committee and the Chief Officer, North Lanarkshire Health and Social Care Partnership and is intended to provide independent and objective assurance to these different stakeholders as to the adequacy and effectiveness of internal controls within the IJB. 5.2 The evaluation of the control environment is informed by a number of sources. In bringing these together, consideration has been given to whether there is evidence that any key controls are absent, inadequate or ineffective and whether the existence of any weaknesses identified, taken independently or with other findings, significantly impairs the IJB’s overall systems of internal control. Wider issues relating to the IJB’s corporate governance and risk management arrangements have also been considered. 5.3 We would like to thank all IJB staff who have assisted Internal Audit during the course of our work throughout 2024/2025. Basis of Opinion 5.4 The evaluation of the control environment is informed by: The internal audit review of Governance Arrangements. The internal audit review of Strategy (issued in draft on 2 September 2025) Progress with the delivery of previous internal audit action points. Review of the IJB draft Governance Statement 2024/25 Our wider knowledge of the IJB’s corporate governance, risk management and
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performance management arrangements. Relevant reports issued by NHS Lanarkshire and North Lanarkshire Council Internal Audit teams during 2024/2025.Opinion It is our opinion that we can provide reasonable assurance on the adequacy and effectiveness of the North Lanarkshire Health and Social Care Integration Joint Board’s framework of governance, risk management, and internal control for the year ended 31 March 2025.
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LEVEL OF ASSURANCE DEFINITION North Lanarkshire Council Audit reports are graded with an overall assurance opinion, and any issues and associated recommendations are classified individually to denote their relative importance, in accordance with the definitions in the tables below. Definition of audit assurance and recommendation categories Assurance Confidence based on sufficient evidence that internal controls are in place, operating effectively and objectives are being achieved. Assurance opinion Substantial assurance Sound systems for risk, control and governance are in place and should be effective in mitigating risks to the achievement of business and control objectives. Some minor improvements to existing controls in a few areas may be required. Reasonable assurance The systems for risk, control and governance are largely satisfactory, but there is some scope for improvement as the present arrangements could undermine the achievement of business and/or control objectives and/or leave them vulnerable to some risk of error/abuse. Limited assurance The systems for risk, control and governance have some satisfactory aspects, but contain a number of significant weaknesses that are likely to undermine the achievement of business and/or control objectives and leave them vulnerable to an unacceptable risk of error or abuse.
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NHS Lanarkshire Internal Audit Objective To assist management in assessing the overall opinion of the area under review, Internal Audit has assessed the system adequacy and control application, and categorised the opinion based on the following criteria. Level of Assurance System Adequacy Controls Substantial A sound system of governance, risk management and control exists, with internal controls operating effectively and being consistently applied to support the achievement of objectives in the area audited. Controls are applied continuously or with minor lapses. Reasonable There is a generally sound system of governance, risk management and control in place. Some issues, non-compliance or scope for improvement were identified which may put at risk the achievement of objectives in the area audited. Controls are applied frequently but with evidence of non-compliance. Limited Significant, gaps, weaknesses or non-compliance were identified. Improvement is required to the system of governance, risk management and control to effectively manage risks to the achievement of objectives in the area audited Controls are applied but with some significant lapses. No Assurance Immediate action is required to address fundamental gaps, weaknesses or non-compliance identified. The system of governance, risk management and control is inadequate to effectively manage risks to the achievement of objectives in the area audited. High risk of objectives not being achieved due to the absence of key internal controls. Significant breakdown in the application of controls.
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REPORT Item No: 17 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 the outcomes of the annual audit and the proposed management response to the action points detailed in the Audit Scotland Annual Audit Report (AAR). 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 Audit Scotland AAR in advance of the approval of the IJB Annual Accounts 2024/25. (2) Approve the management response to the action points which is highlighted at pages 19 to 21 of the annual audit report, attached at appendix 2. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Following the publication of the Local Authority Accounts (Scotland) Regulations 2014, the members of the IJB have to meet to consider whether to approve the audited IJB Annual Accounts 2024/25 for signature. The members should therefore consider any report made or advice provided by the External Auditor. 5.2 The IJB’s appointed External Auditor, Audit Scotland, is required to supply an audit certificate outlining the findings of the audit process undertaken in relation to the IJB Annual Accounts 2024/25. 5.3 Attached at appendix 1 is a letter setting out their responsibilities together with a letter of representation from the Chief Finance Officer. The findings are detailed in Audit Scotland AAR at appendix 2. SUBJECT: Audit Scotland Annual Audit Report 2024/25 TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 17 September 2025 Yes No N/A
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6. CONCLUSIONS 6.1 Audit Scotland AAR on the IJB Annual Accounts extends across several subjects, as follows: IJB Annual Accounts 2024/25 Financial management and sustainability Governance, transparency, and best value 6.2 The External Auditor has concluded that the financial statements of the North Lanarkshire IJB for 2024/25 give a true and fair view of the net expenditure for the year and have therefore issued an unmodified independent report. 6.3 This report includes the key messages at page 3 and an action plan on pages 19 to 21 which have been agreed by both the Chief Officer and the Chief Finance Officer. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The IJB, PFA and both partners are required to ensure effective governance arrangements are in place. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB.
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Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service Very High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny.
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7.6 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 8. BACKGROUND PAPERS IJB 18 June 2025 Unaudited IJB Annual Accounts 2024/25. 9. APPENDICES Appendix 1 – External Auditor’s Letter to the IJB 2024/25 Appendix 2 – Audit Scotland AAR 2024/25 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07581007187.
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APPENDIX 1 Independent auditor’s report to the members of North Lanarkshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2024 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2023/24 (the 2023/24 Code). In my opinion the accompanying financial statements: give a true and fair view of the state of affairs of the North Lanarkshire Integration Joint Board as at 31 March 2024 and of its income and expenditure for the year then ended; have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2023/24 Code; and have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 2 December 2022. My period of appointment is five years, covering 2022/23 to 2026/27. I am independent of the North Lanarkshire Integration Joint Board in accordance with the ethical requirements
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that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the North Lanarkshire Integration Joint Board. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the North Lanarkshire Integration Joint Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on North Lanarkshire Integration Joint Board’s current or future financial sustainability. However, I report on the North Lanarkshire Integration Joint Board’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Finance Officer and North Lanarkshire Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Finance Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Finance Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Finance Officer is responsible for assessing the North Lanarkshire Integration Joint Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the North Lanarkshire Integration Joint Board’s operations. The North Lanarkshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise
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from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: using my understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the North Lanarkshire Integration Joint Board; inquiring of the Chief Finance Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the North Lanarkshire Integration Joint Board; inquiring of the Chief Finance Officer concerning the North Lanarkshire Integration Joint Board’s policies and procedures regarding compliance with the applicable legal and regulatory framework; discussions among my audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the North Lanarkshire Integration Joint Board’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report.
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Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report I have audited the parts of the Remuneration Report described as audited. In my opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Finance Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: adequate accounting records have not been kept; or the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or
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I have not received all the information and explanations I require for my audit. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. John Boyd FCPFA Audit Scotland 8 Nelson Mandela Place Glasgow G1 2BT
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102 West Port Edinburgh EH3 9DN 8 Nelson Mandela Place Glasgow G2 1BT The Green House Beechwood Business Park North Inverness IV2 3BL T: 0131 625 1500 E: info@audit-scotland.gov.uk www.audit-scotland.gov.uk APPENDIX 1 17 September 2025 NORTH LANARKSHIRE INTEGRATION JOINT BOARD Audit of 2024/25 annual accounts Independent auditor's report 1. My audit work on the 2024/25 annual accounts is now complete. Subject to receipt of a revised set of annual accounts for final review, I anticipate being able to issue unmodified audit opinions in the independent auditor's report following approval of the annual accounts by the North Lanarkshire IJB on 17 September 2025 (the proposed report is attached at Appendix A). Annual Audit Report 2. Under International Standards on Auditing in the UK, I report specific matters arising from the audit of the annual accounts to those charged with governance of North Lanarkshire IJB in sufficient time to enable appropriate action. For North Lanarkshire IJB, those charged with governance is the Board. I present for the Board’s consideration my draft Annual Audit Report on the 2024/25 audit. The section headed "Significant findings and key audit matters" sets out the issues identified in respect of the annual accounts. 3. The report also sets out conclusions on the wider scope areas that frame public audit as set out in the Code of Audit Practice. 4. This report will be issued in final form after the audit of the annual accounts has been completed. Unadjusted misstatements 5. I also report to those charged with governance all unadjusted misstatements in the annual accounts which I have identified during the course of my audit, other than those of a trivial nature, and request that these misstatements be corrected. 6. I have no unadjusted misstatements to be corrected. Fraud, subsequent events, and compliance with laws and regulations 7. In presenting this report to the Board I seek confirmation from those charged with governance of any instances of any actual, suspected, or alleged fraud; any subsequent events that have occurred since the date of the financial statements; or material non-compliance with laws and regulations affecting North Lanarkshire IJB that should be brought to my attention. Representations from Section 95 Officer 8. As part of the completion of our audit, I am seeking written representations from the Chief Finance Officer, who is the Section 95 Officer, on aspects of the annual accounts, including the judgements and estimates made.
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9. A draft letter of representation is attached at Appendix B. This should be signed and returned to me by the Section 95 Officer with the signed annual accounts prior to the independent auditor’s report being certified. John Boyd CPFA Audit Director Audit Scotland 4th Floor, The Athenaeum Building 8 Nelson Mandela Place Glasgow, G2 1BT
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Appendix A: Proposed Independent Auditor’s Report Independent auditor’s report to the members of North Lanarkshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2025 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25 (the 2024/25 Code). In my opinion the accompanying financial statements: • give a true and fair view of the state of affairs of the North Lanarkshire Integration Joint Board as at 31 March 2025 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2024/25 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 2 December 2022. My period of appointment is five years, covering 2022/23 to 2026/27. I am independent of the North Lanarkshire Integration Joint Board in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the North Lanarkshire Integration Joint Board. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the North
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Lanarkshire Integration Joint Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on North Lanarkshire Integration Joint Board’s current or future financial sustainability. However, I report on the North Lanarkshire Integration Joint Board’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Finance Officer and North Lanarkshire Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Finance Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Finance Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Finance Officer is responsible for assessing the North Lanarkshire Integration Joint Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the North Lanarkshire Integration Joint Board’s operations. The North Lanarkshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using my understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the North Lanarkshire Integration Joint Board; • inquiring of the Chief Finance Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the North Lanarkshire Integration Joint Board;
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• inquiring of the Chief Finance Officer concerning the North Lanarkshire Integration Joint Board’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among my audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the North Lanarkshire Integration Joint Board’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report I have audited the parts of the Remuneration Report described as audited. In my opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Finance Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission.
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Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • I have not received all the information and explanations I require for my audit. I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. John Boyd FCPFA Audit Scotland 8 Nelson Mandela Place Glasgow G1 2BT
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Appendix B: Letter of Representation (ISA 580) - to be reproduced on client's letterhead John Boyd, Audit Director Audit Scotland 4th Floor 8 Nelson Mandela Place Glasgow G2 1BT Dear John North Lanarkshire Integration Joint Board Annual Accounts 2024/25 1. This representation letter is provided in connection with your audit of the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2025 for the purpose of expressing an opinion as to whether the financial statements give a true and fair view and have been properly prepared, and for expressing other opinions on the Remuneration Report, Management Commentary, and Annual Governance Statement. 2. I confirm to the best of my knowledge and belief and having made appropriate enquiries of the Joint Board, North Lanarkshire Council and NHS Lanarkshire, the following representations given to you in connection with your audit of North Lanarkshire Integration Joint Board’s annual accounts for the year ended 31 March 2025. General 3. North Lanarkshire Integration Joint Board and I have fulfilled our statutory responsibilities for the preparation of the 2024/25 annual accounts. All the accounting records, documentation, and other matters which I am aware are relevant to the preparation of the annual accounts have been made available to you for the purposes of your audit. All transactions undertaken by North Lanarkshire Integration Joint Board have been recorded in the accounting records and are properly reflected in the financial statements. 4. I confirm that the effects of uncorrected misstatements are immaterial, individually and in aggregate, to the financial statements as a whole. I am not aware of any uncorrected misstatements other than those reported by you. Financial Reporting Framework 5. The annual accounts have been prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25 (2024/25 accounting code), mandatory guidance from LASAAC, and the requirements of the Local Government (Scotland) Act 1973, the Local Government in Scotland Act 2003, and The Local Authority Accounts (Scotland) Regulations 2014. 6. In accordance with the 2014 Regulations, I have ensured that the financial statements give a true and fair view of the financial position of the North Lanarkshire Integration Joint Board at 31 March 2025 and the transactions for 2024/25. Accounting Policies and Estimates 7. All material accounting policies applied are as shown in the notes to the financial statements. The accounting policies are determined by the 2024/25 accounting code, where applicable. Where the accounting code does not specifically apply, I have used judgement in developing
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and applying an accounting policy that results in information that is relevant and reliable. All accounting policies applied are appropriate to North Lanarkshire Integration Joint Board circumstances and have been consistently applied. 8. The significant assumptions used in making accounting estimates are reasonable and properly reflected in the financial statements. Judgements used in making estimates have been based on the latest available, reliable information. Estimates have been revised where there are changes in the circumstances on which the original estimate was based or as a result of new information or experience. Going Concern Basis of Accounting 9. I have assessed North Lanarkshire Integration Joint Board’s ability to continue to use the going concern basis of accounting and have concluded that it is appropriate. I am not aware of any material uncertainties that may cast significant doubt on North Lanarkshire Integration Joint Board’s ability to continue to adopt the going concern basis of accounting. Assets 10. All assets at 31 March 2025 of which I am aware have been recognised in the annual accounts in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25. There are no plans or intentions that are likely to affect the carrying value or classification of the assets recognised in the financial statements Liabilities 11. All liabilities at 31 March 2025 of which I am aware have been reported in the financial statements. 12. There are no plans or intentions that are likely to affect the carrying value or classification of the liabilities recognised in the financial statements. Fraud 13. I understand my responsibilities for the design, implementation, and maintenance of internal control to prevent fraud and I believe I have appropriately fulfilled those responsibilities. 14. I have provided you with all information in relation to • my assessment of the risk that the financial statements may be materially misstated as a result of fraud, • any allegations of fraud or suspected fraud affecting the financial statements, and • fraud or suspected fraud that I am aware of involving management, employees who have a significant role in internal control, or others that could have a material effect on the financial statements. Laws and Regulations 15. I have disclosed to you all known instances of non-compliance or suspected non- compliance with laws and regulations whose effects should be considered when preparing financial statements. Related Party Transactions 16. All material transactions with related parties have been appropriately accounted for and disclosed in the financial statements in accordance with the 2024/25 accounting code. I have
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made available to you the identity of all the North Lanarkshire Integration Joint Board’s related parties and all the related party relationships and transactions of which I am aware. Remuneration Report 17. The Remuneration Report has been prepared in accordance with the Local Authority Accounts (Scotland) Regulations 2014, and all required information of which I am aware has been provided to you. Management Commentary 18. I confirm that the Management Commentary has been prepared in accordance with the statutory guidance and the information is consistent with the financial statements. Corporate Governance 19. I confirm that the North Lanarkshire Integration Joint Board has undertaken a review of the system of internal control during 2024/25 to establish the extent to which it complies with proper practices set out in the Delivering Good Governance in Local Government: Framework 2016. I have disclosed to you all deficiencies in internal control identified from this review or of which I am otherwise aware. 20. I confirm that the Annual Governance Statement has been prepared in accordance with the Delivering Good Governance in Local Government: Framework 2016 and the information is consistent with the financial statements. There have been no changes in the corporate governance arrangements or issues identified, since 31 March 2025, which require to be reflected. Events Subsequent to the Date of the Balance Sheet 21. All events subsequent to 31 March 2025 for which the 2024/25 accounting code requires adjustment or disclosure have been adjusted or disclosed. Yours sincerely Nicola Scott CPFA Chief Finance Officer
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North Lanarkshire Integration Joint Board 2024/25 Annual Audit Report - Draft Prepared for North Lanarkshire Integration Joint Board and the Controller of Audit September 2025
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North Lanarkshire Integration Joint Board: 2024/25 Annual Audit Report - Draft | 2 Contents Key messages 3 Introduction 4 Audit scope and responsibilities 5 Audit of the annual accounts 7 Wider scope and Best Value audit 11 Appendix 1 19 Appendix 2 22 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility.
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Key messages | 3 Key messages Audit of the annual accounts 1 The annual report and accounts contain an unqualified audit opinion providing reasonable assurance that the annual accounts were free from material misstatement. 2 There were no significant findings or key audit matters to report. Wider scope and Best Value audit 3 North Lanarkshire Integration Joint Board has effective and appropriate arrangements in place for Financial Management; Financial Sustainability; Vision, Leadership and Governance; and Use of Resources to Improve Outcomes. 4 North Lanarkshire Integration Joint Board has effective and appropriate arrangements in place for securing Best Value.
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Introduction | 4 Introduction Purpose of the Annual Audit Report 1. The purpose of this Annual Audit Report is to report the significant matters identified from the 2024/25 audit of North Lanarkshire Integration Joint Board (the IJB) annual accounts and the wider scope areas specified in the Code of Audit Practice (2021). 2. The Annual Audit Report is addressed to North Lanarkshire Integration Joint Board, hereafter referred to as ‘the body’ and the Controller of Audit, and will be published on Audit Scotland’s website in due course. Appointed auditor and independence 3. John Boyd, of Audit Scotland, has been appointed as external auditor of the body for the period from 2022/23 until 2026/27. As reported in the Annual Audit Plan, John Boyd as engagement lead and the audit team are independent of the body in accordance with relevant ethical requirements, including the Financial Reporting Council’s Ethical Standard. There have been no developments since the issue of the Annual Audit Plan that impact on the continued independence of the engagement lead or the rest of the audit team from the body, including no provision of non-audit services. Acknowledgements 4. We would like to thank the body and its staff, particularly those involved in preparation of the annual accounts, for their cooperation and assistance during the audit. We look forward to working together constructively over the remainder of the five-year audit appointment.
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Audit scope and responsibilities | 5 Audit scope and responsibilities Scope of the audit 5. The audit is performed in accordance with the Code of Audit Practice, including supplementary guidance, International Standards on Auditing (ISA) (UK), and relevant legislation. These set out the requirements for the scope of the audit which includes: • An audit of the financial statements and an opinion on whether they give a true and fair view and are free from material misstatement. • An opinion on statutory other information published with the financial statements in the annual accounts, namely the Management Commentary and Annual Governance Statement. • An opinion on the audited part of the Remuneration Report. • Conclusions on the body’s arrangements in relation to the wider scope areas: Financial Management; Financial Sustainability; Vision, Leadership and Governance; and Use of Resources to Improve Outcomes. • Reporting on the body’s arrangements for securing Best Value. • Provision of this Annual Audit Report. Responsibilities and reporting 6. The Code of Audit Practice sets out the respective responsibilities of the body and the auditor. A summary of the key responsibilities is outlined below. Auditor’s responsibilities 7. The responsibilities of auditors in the public sector are established in the Local Government (Scotland) Act 1973. These include providing an independent opinion on the financial statements and other information reported within the annual accounts, and concluding on the body’s arrangements in place for the wider scope areas and Best Value. 8. The matters reported in the Annual Audit Report are only those that have been identified by the audit team during normal audit work and may not be all that exist. Communicating these does not absolve the body from its responsibilities outlined below.
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Audit scope and responsibilities | 6 9. The Annual Audit Report includes an agreed action plan at Appendix 1 setting out specific recommendations to address matters identified and includes details of the responsible officer and dates for implementation. The body’s responsibilities 10. The body has primary responsibility for ensuring proper financial stewardship of public funds, compliance with relevant legislation and establishing effective arrangements for governance, propriety, and regularity that enables it to successfully deliver its objectives. The features of proper financial stewardship include: • Establishing arrangements to ensure the proper conduct of its affairs. • Preparation of annual accounts, comprising financial statements for the body that gives a true and fair view and other specified information. • Establishing arrangements for the prevention and detection of fraud, error and irregularities, and bribery and corruption. • Implementing arrangements to ensure its financial position is soundly based. • Making arrangements to secure Best Value. • Establishing an internal audit function. National performance audit reporting 11. The Auditor General for Scotland and the Accounts Commission regularly publish performance audit reports. These cover a range of matters, many of which may be of interest to the body and its Performance, Finance & Audit Committee. Details of national and performance audit reports published over the last year can be seen in Appendix 2.
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Audit of the annual accounts | 7 Audit of the annual accounts Main judgements The annual report and accounts contain an unqualified audit opinion providing reasonable assurance that the annual accounts were free from material misstatement. There were no significant findings or key audit matters to report. Audit opinions on the annual accounts 12. The body’s annual accounts were approved by the board on 17 September 2025 and certified by the appointed auditor on 17 September 2025. The Independent Auditor’s Report is included in the body’s annual accounts, and this reports that, in the appointed auditor’s opinion, these were free from material misstatement. Audit timetable 13. The unaudited annual accounts were received on 19 June 2025 in accordance with the agreed audit timetable. Audit Fee 14. The audit fee for the 2024/25 audit was reported in the Annual Audit Plan and was set at £34,000 . There have been no developments that impact on planned audit work required, therefore the audit fee reported in the Annual Audit Plan remains unchanged. Materiality 15. The concept of materiality is applied by auditors in planning and performing an audit, and in evaluating the effect of any uncorrected misstatements on the financial statements or other information reported in the annual accounts. 16. Broadly, the concept of materiality is to determine whether misstatements identified during the audit could reasonably be expected to influence the decisions of users of the annual accounts. Auditors set a monetary threshold when determining materiality, although some issues may be considered material by their nature. Therefore, materiality is ultimately a matter of the auditor’s professional judgement.
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Audit of the annual accounts | 8 17. Materiality levels for the audit of the body were determined at the risk assessment phase of the audit and were reported in the Annual Audit Plan, which also reported the judgements made in determining materiality levels. These were reassessed on receipt of the unaudited annual accounts. Materiality levels were updated and these can be seen in Exhibit 1. Exhibit 1 2024/25 Materiality levels for the body Materiality The body Materiality – set at 2% of gross expenditure £16.763 million Performance materiality – set at 75% of materiality. As outlined in the Annual Audit Plan, this acts as a trigger point. If the aggregate of misstatements identified during the audit exceeds performance materiality, this could indicate further audit procedures are required. £12.572 million Reporting threshold – set at 5% of materiality. £0.838 million Source: Audit Scotland Significant findings and key audit matters 18. ISA (UK) 260 requires auditors to communicate significant findings from the audit to those charged with governance, which for the body is the Performance, Finance & Audit Committee. 19. The Code of Audit Practice also requires public sector auditors to communicate key audit matters. These are the matters that, in the auditor’s professional judgement, are of most significance to the audit of the financial statements and require most attention when performing the audit. 20. In determining key audit matters, auditors consider: • Areas of higher or significant risk of material misstatement. • Areas where significant judgement is required, including accounting estimates that are subject to a high degree of estimation uncertainty. • Significant events or transactions that occurred during the year. 21. There are no significant findings or key audit matters to report.
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Audit of the annual accounts | 9 Qualitative aspects of accounting practices 22. ISA (UK) 260 also requires auditors to communicate their view about qualitative aspects of the body’s accounting practices, including accounting policies, accounting estimates, and disclosures in the financial statements. Accounting policies 23. The appropriateness of accounting policies adopted by the body was assessed as part of the audit. These were considered to be appropriate to the circumstances of the body, and there were no significant departures from the accounting policies set out in the Code of Practice on Local Authority Accounting in the United Kingdom (the Code). Accounting estimates 24. No significant accounting estimates were identified as having been employed by management in preparing the financial statements. Disclosures in the financial statements 25. The adequacy of disclosures in the financial statements was assessed as part of the audit. The quality of disclosures was adequate, with additional levels of detail provided for disclosures around areas of greater sensitivity, such as related party transactions. Significant matters discussed with management 26. All significant matters identified during the audit and discussed with the body’s management have been reported in the Annual Audit Report. Audit adjustments 27. There were no adjusted or unadjusted audit misstatements required to the financial statements greater than the reporting threshold of £0.838 million. Significant risks of material misstatement identified in the Annual Audit Plan 28. Audit work has been performed in response to the significant risks of material misstatement identified in the Annual Audit Plan. The outcome of audit work performed is summarised in Exhibit 2.
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Audit of the annual accounts | 10 Exhibit 2 Significant risk of material misstatement in the financial statements Risk of material misstatement Planned audit response Outcome of audit work Fraud caused by management override of controls Management is in a unique position to perpetrate fraud because of management’s ability to override controls that otherwise appear to be operating effectively. The audit team will: • Agree balances and transactions to North Lanarkshire Council and NHS Lanarkshire financial reports/ledger/correspondence. • Assurances will be obtained from the auditors of North Lanarkshire Council and NHS Lanarkshire over the completeness, accuracy and allocation of income and expenditure. • Review of significant adjustments at year end where we consider there to be greatest risk of material misstatement through management override of controls. • Review of financial monitoring reports during the year. • Evaluate significant transactions outside the normal course of business. • Assess the adequacy of controls in place for identifying and disclosing related party relationships and transactions in the financial statements. From carrying out the planned audit procedures, we have not identified any indication of material misstatement in the financial statements through fraud or error caused by management override of controls. Source: Audit Scotland Prior year recommendations 29. The body has made good progress in implementing the agreed prior year audit recommendations. For actions not yet implemented, revised responses and timescales have been agreed with the body and are outlined in Appendix 1.
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Wider scope and Best Value audit | 11 Wider scope and Best Value audit Conclusion The body has effective and appropriate arrangements in place for Financial Management; Financial Sustainability, Vision, Leadership and Governance; and Use of Resources to Improve Outcomes. The body has effective and appropriate arrangements in place for securing Best Value. Audit approach to wider scope and Best Value Wider scope 30. As reported in the Annual Audit Plan, the wider scope audit areas are: • Financial Management. • Financial Sustainability. • Vision, Leadership and Governance. • Use of Resources to Improve Outcomes. 31. Audit work is performed on these four areas and a conclusion on the effectiveness and appropriateness of arrangements the body has in place for each of these is reported in this chapter. Best Value 32. The duty on auditors to consider the arrangements in place to secure Best Value applies to the body as it falls within section 106 of the Local Government (Scotland) Act 1973. 33. Consideration of the arrangements the body has in place to secure Best Value has been carried out alongside the wider scope audit. Significant wider scope and Best Value risks 34. Audit work has been performed in response to the significant wider scope and Best Value risks identified in the Annual Audit Plan. The outcome of audit work performed is summarised in Exhibit 3.
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Wider scope and Best Value audit | 12 Exhibit 3 Significant wider scope and Best Value risks Significant risk Planned audit response Outcome of audit work Financial sustainability In recent years North Lanarkshire IJB has achieved short term financial balance. However, it continues to be faced with significant financial challenges and difficult decisions to ensure resources are allocated to areas of strategic priority and user need. Further work is required to ensure sustainable financial balance is maintained. The audit team will: • Review financial plans developed and assess the appropriateness of the financial plans and any assumptions made. • Assess if financial plans developed are aligned to North Lanarkshire IJB’s strategic priorities. • Review financial monitoring reports to assess the financial position, including progress of partner bodies in achieving planned savings. • Review controls in place and updates to financial plans to assess financial sustainability. Audit work performed found: • The body has developed medium and longer-term financial plans which are appropriate to its circumstances. • The assumptions made in the financial plans are reasonable, however, due to uncertainty over funding beyond the 3 year medium term, no assumptions were made regarding likely income, nor any financial strategy recognised to address the cost/demand pressures eg recurring savings plans. • The financial plans developed are aligned to the body’s Strategic Commissioning Plan and priorities. Conclusion: The body has made appropriate arrangements to develop and implement medium and longer-term financial plans which are linked to its Strategic Commissioning Plan and priorities, however, these require to be developed further to incorporate assumptions around funding and savings. Source: Audit Scotland
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Wider scope and Best Value audit | 13 Conclusions on wider scope audit Financial Management 35. The audit work performed on the arrangements the body has in place for securing sound financial management found that these were effective and appropriate. This judgement is evidenced by the body: • having clear and up-to-date policies and procedures, for example, financial regulations and scheme of delegation, in place that ensure effective financial management. • having suitably qualified and experienced staff leading the finance function, with sufficient skills, capacity, and capability to effectively fulfil its role. • having effective arrangements in place for the scrutiny of arrangements that support sound financial management, and effective scrutiny and challenge provided by the Performance, Finance & Audit Committee. 36. The IJB approved its 2024/25 budget in March 2024. The initial budget for 2024/25 was £757.520 million, being £549.026 million of funding from NHS Lanarkshire including set aside and hosted services and £208.494 million from North Lanarkshire Council. The long term financial plan had estimated recurring funding pressures of around £23 million for 2024/25 and a two year savings target was introduced to address these pressures by reducing costs through a mixture of efficiencies, redesign and management actions. 37. The IJB does not directly incur expenditure or employ staff, other than the Chief Officer and Chief Finance Officer. All funding and expenditure for the IJB is provided or incurred by partner bodies and process in their accounting records. 38. The IJB reported a surplus on the provision of services of £0.030 million. This reflected an underspend against 2024/25 budgeted expenditure of £10.716 million set against expenditure of £10.686 million on specific projects or other areas of expenditure agreed to be funded from earmarked or ring fenced reserves. 39. The IJB’s reserves increased by £0.030 million as a result of the surplus for the year, increasing overall reserves to £75.554 million (2024: £75.524 million). The net movement reflected the application of £9.277 million of ring fenced reserves in year, an increase of £4.792 million to earmarked reserves and an increase of £4.515 million to contingency reserve, increasing the IJB’s resources for responding to unforeseen costs from £26.074 million to £30.589 million. Movements in reserves were in line with the IJB’s reserves policy and financial strategy.
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Wider scope and Best Value audit | 14 40. Detailed budget monitoring reports were submitted to the IJB throughout the year. The outturn to date and projected year end outturn position were clearly stated in these reports , including regular updates highlighting any significant movements during the year. 41. North Lanarkshire IJB does not have its own financial systems but instead relies on information compiled from partner bodies’ financial systems, therefore processing of underlying financial transactions is subject to partner bodies’ internal controls. 42. As part of our audit approach, we sought assurances from the external auditor of NHS Lanarkshire and North Lanarkshire Council. Neither the health board nor council auditor reported any significant weaknesses that could result in a risk of misstatement in the annual accounts of the IJB. 43. Internal audit provides the Joint Board with independent assurance on risk management, internal control and corporate governance processes. North Lanarkshire IJB’s internal audit function is carried out on a joint basis by the Chief Auditors of NHS Lanarkshire and North Lanarkshire Council, who have now completed their 2024/25 audit work. 44. Based on the audit work undertaken directly on behalf of the IJB, and being informed by internal audit work undertaken independently by each respective internal audit function for North Lanarkshire Council and NHS Lanarkshire, the NHS Lanarkshire Chief Internal Auditor and the North Lanarkshire Council Chief Officer (Audit and Risk) are able to conclude that a reasonable level of assurance can be placed upon the adequacy and effectiveness of the North Lanarkshire IJB’s framework of governance, risk management and internal control. 45. In the public sector there are specific fraud risks, including those relating to payments and other claims made by individuals and organisations. Public sector bodies are responsible for implementing effective systems of internal control, including internal audit, which safeguard public assets and prevent and detect fraud, error and irregularities, bribery, and corruption. 46. The IJB has adequate arrangements in place to prevent and detect fraud or other irregularities. 47. Appropriate arrangements are in place for the prevention and detection of fraud and error. We are not aware of any specific issues we require to bring to your attention. Financial Sustainability 48. The audit work performed on the arrangements the body has in place for securing financial sustainability found that these were effective and appropriate. This judgement is evidenced by the body:
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Wider scope and Best Value audit | 15 • making appropriate arrangements to develop medium and longer- term financial plans and linking these to its Strategic Commissioning Plan and priorities. • having effective arrangements in place for identifying risks to financial sustainability over the medium and longer-term, and understanding medium and longer-term demand pressures that could impact on available resources. • having savings plans in place to manage forecast budget deficits, and a reserves strategy in place to manage the use of reserves if the required level of savings cannot be met. 49. An update to the Medium Term Financial Plan (incorporating the Long Term Financial Outlook) was approved by the Board 15 March 2025, and estimated a funding gap of £51.854 million over the 3 year planning period 2025/26 to 2027/28, of which £14.729 million related to 2025/26. 50. The long term financial outlook for years 7 -10 identified cost pressures in 2028/29 of £40.020 million rising to £58.075 million in 2034/35. Due to uncertainty over funding beyond the 3 year medium term, no assumptions were made regarding likely income, nor any financial strategy recognised to address the cost/demand pressures eg recurring savings plans. 51. A Reserves Strategy 2025-26, realigning the IJB’s reserves as at 31 March 2025, was approved by the Performance, Finance and Audit Committee in May 2025. This was designed to strengthen long-term financial sustainability by considering all current reserves, and whether they are still required and sufficient to meet on going pressures. The revised structure is considered by the IJB to be more appropriate for enabling the organisation to meet its agreed strategic objectives and Scottish Government policy requirements. 52. Based on the above, the following recommendation has been made, with further details outlined in Appendix 1. Recommendation 1 Financial Sustainability The IJB should continue to: - develop and refine its arrangements for securing financial sustainability, including its medium and long term financial plan and savings plans - work effectively in partnership with the local council and the health board on service transformation - apply its reserves strategy to effectively manage the use of reserves to supplement savings and efficiencies when required.
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Wider scope and Best Value audit | 16 Vision, Leadership and Governance 53. The audit work performed on the arrangements the body has in place around its Vision, Leadership and Governance found that these were effective and appropriate. 54. Well established governance arrangements are in place, as reflected in the Annual Governance Statement included in the accounts, with the Board supported through the Performance, Finance and Audit Committee. 55. From review of committee and Board papers and through attendance at committee meetings throughout the year we have found that these are conducted in a professional manner with a good degree of scrutiny and challenge by members. 56. The IJB’s Strategic Plan defines its vision and the Strategic Commissioning Plan (SCP) clearly outlines its priorities and strategy for delivering the Strategic Plan. 57. The long term vision for North Lanarkshire HSCP was set out in the original Strategic Plan 2016/2026. The current SCP 2023/26 complements this, setting out the IJB’s commitment to achieving long term ambitions. The SCP recognises the importance of partnership working to support the transformational change necessary for the improvement of health and wellbeing in the area. 58. The Strategic Commissioning Plan is underpinned by the IJB’s Medium and Longer Term Financial Plans, by having clear financial and performance reporting in place and from effective scrutiny and challenge of performance provided by the Performance, Finance & Audit Committee. Use of Resources to Improve Outcomes 59. The audit work performed on the arrangements the body has in place around its Use of Resources to Improve Outcomes found that these were effective and appropriate. This judgement is evidenced by the body: • being able to demonstrate a clear link between the use of resources and delivery of its priorities. • having arrangements in place to benchmark its performance to identify areas of improvement. • being able to demonstrate improvements in performance against benchmarks and relative to other comparable organisations. 60. The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to produce an annual performance report covering areas such as assessing performance in relation to national health and wellbeing outcomes, financial performance and best value, reporting on localities, and the inspection of services.
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Wider scope and Best Value audit | 17 61. The IJB’s Annual Performance Report 2023/24 was published in September 2024, and acknowledged the ongoing collaborative work undertaken with service users, carers, families, and communities to improve on performance, and recognised the significant challenges facing the IJB. 62. Performance reports cover the six ministerial steering group performance measures. As noted in our 2023/24 Annual Audit Report, performance in 2023/24 against these measures was mixed. Areas of performance improvement included emergency admission and readmission (within 28 days of discharge) rates. However, the report highlighted areas where performance had declined including delayed discharge rates and the proportion of care services graded “good” or “better” in Care Inspectorate reviews. 63. The IJB has continued to monitor key performance targets of the HSCP throughout 2024/25, with the 24/25 Annual Performance Report scheduled to be taken to the 17 September 2025 Board meeting. 64. The IJB continues to work with NHS Lanarkshire and North Lanarkshire Council to ensure resources are focused on addressing areas of underperformance in the context of local and national financial and non- financial challenges. Conclusions on Best Value 65. Integration Joint Boards have a statutory duty to have arrangements to secure Best Value. To achieve this, IJBs should have effective processes for scrutinising performance, monitoring progress towards their strategic objectives and holding partners to account. The audit work performed on the arrangements the body has in place for securing Best Value found these were effective and appropriate. 66. The IJB’s Strategic Commissioning Plan 2023-26 (SCP) sets out the organisation’s five key priorities: • Do the right thing first time • Increased focus on prevention, early intervention and tackling inequalities • Improve mental health and well being • Develop and support a workforce for the future and • Support people through a whole family approach. 67. The IJB’s programme of Works links to the SCP priorities, and has been compiled following consultation and engagement with stakeholders including NLC and NHSL to ensure alignment with partner organisations’ strategic plans.
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Wider scope and Best Value audit | 18 68. Progress made by the health and social care partnership on the key strategic commissioning intentions and the key performance indicators are reported regularly to the IJB. 69. The arrangements the body has in place around the four wider scope audit areas, which are effective and appropriate, contribute to it being able to secure Best Value.
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Appendix 1 | 19 Appendix 1 Action plan 2024/25 2024/25 recommendations Matter giving rise to recommendation Recommendation Agreed action, officer and timing 1. Financial Sustainability In recent years North Lanarkshire IJB has been successful in achieving short term financial balance. However, it still faces significant financial challenges and difficult decisions in ensuring resources are allocated to areas of strategic priority and user demand. Current Medium Term Financial Plan is estimating a funding gap of £51.8m over the three years to 2027/28, and the Long Term Financial Outlook identifies cost pressures in 2028/29 of £40m rising to £58m in 2034/35. Risk – the IJB does not have sufficient reserves to fund its projected future net expenditure. The IJB should continue to: • develop and refine the arrangements it has in place for securing financial sustainability, including its medium and long term financial plans and savings plans • work effectively in partnership with the local council and the health board on service transformation • apply its reserves strategy to effectively manage the use of reserves to supplement savings and efficiencies when required. A financial outlook for the 3 year period has been prepared and is being presented to Board Members on 17th September 2025. This outlines the forecast budget gaps for the next 3 years and will lead into Board Development sessions where savings will be discussed for approval at a later Board. The outlook clearly identifies the current reserves position and the impact non achievement on savings will have on reserves. Discussions have taken place with both NLC & NHSL on the forecast position and an Elected Members briefing session within NLC was undertaken in June this year with another scheduled in the Autumn to ensure all relevant parties are aware of the forecast. The medium term and long term outlooks will continue to be reviewed throughout the year with budget setting for 2026/27 set for March 2026. Chief Finance Officer/Chief Officer Ongoing
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Appendix 1 | 20 Follow-up of prior year recommendations Matter giving rise to recommendation Recommendation, agreed action, officer and timing Update b/f 1. Presentation of financial and non- financial information in the annual accounts [2023/24 AAR] In the unaudited accounts, the Management Commentary and financial statements contained information on the operational activity of the health and social care partnership rather than that of the strategic commissioning activity of the IJB. Risk – There is a risk that the Management Commentary and notes to the accounts do not reflect the functions and activities of the IJB as a strategic commissioning body. While the 2023/24 annual report and accounts have been updated to reflect ensure focus of the activities of the IJB and ensure they are free from material misstatements, during the production of future accounts, the IJB should review the presentation of both financial and non-financial information to ensure this reflects the organisation’s role as a strategic commissioning body. Recommendation will be taken forward and reflected in 2024/25 annual accounts. Chief Finance Officer June 2025 The 2024/25 Annual Accounts were altered to take account of this recommendation. A review of other IJBs reports was undertaken and NL now follows a similar pattern to these. This recommendation has therefore been implemented.
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Appendix 1 | 21 Matter giving rise to recommendation Recommendation, agreed action, officer and timing Update b/f 2 Financial performance reports [2022/23 AAR] The IJB performance monitoring reports provide detailed operational financial performance information over IJB activity at North Lanarkshire Council and NHS Lanarkshire. However, there is an opportunity to enhance the current financial reporting to provide an overview of the overarching IJB performance. Risk – There is a risk that budget monitoring reports focus on operational financial challenges and lose focus on wider overarching financial performance of the IJB. As a Strategic commissioning body the IJB should ensure that its financial performance reports retain a holistic view of the IJBs financial performance as a whole and continue to align to the reserves strategy and financial strategy. Agreed action: The IJB have revised financial monitoring reports to provide an overview of the delivery of services and overall funding aligned to the Strategic Commissioning Plan and Medium Term Financial Plan. However, as reflected in the unaudited accounts (see recommendation b/f 1) the reports provide detail around the financial and operational performances of each of the partner bodies in the delivery of the underlying services. There is an opportunity to further develop the reporting and scrutiny to reflect the overarching strategic role of the IJB as a commissioning body rather than the operational focus of the partners in delivery of health and social care partnership activity. Chief Finance Officer March 2025 From period end June 2025 the format and content of Financial Monitoring Reporting has been modified to make clearer the strategic aspects of the IJB’s financial performance. As this is a quarterly report there will be constant review of the contents however the b/f recommendation is complete. Chief Finance Officer
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Appendix 2 | 22 Appendix 2 Supporting national and performance audit reports Report name Date published Local government budgets 2024/25 15 May 2024 Integration Joint Boards: Finance and performance 2024 25 July 2024 Transformation in councils 1 October 2024 Alcohol and drug services 31 October 2024 Fiscal sustainability and reform in Scotland 21 November 2024 Public service reform in Scotland: how do we turn rhetoric into reality? 26 November 2024 NHS in Scotland 2024: Finance and performance 3 December 2024 Auditing climate change 7 January 2025 Local government in Scotland: Financial bulletin 2023/24 28 January 2025 Transparency, transformation and the sustainability of council services 28 January 2025 Sustainable transport 30 January 2025 Integration Joint Boards: Finance bulletin 2023/24 6 March 2025 Integration Joint Boards finances continue to be precarious 6 March 2025 General practise: Progress since the 2018 General Medical Services contract 27 March 2025
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North Lanarkshire Integration Joint Board 2024/25 Annual Audit Report - Draft Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit.scot www.audit.scot AS.5.0
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REPORT Item No: 18 SUBJECT: Audited North Lanarkshire IJB Annual Accounts 2024/25 TO: Integration Joint Board Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 17 September 2025 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) For approval For endorsement For noting 1.2 This report provides an overview of the unaudited North Lanarkshire IJB Annual Accounts for the financial year 2024/25, in line with the legislative requirements. 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 External Auditor’s opinion. (2) Approve the North Lanarkshire IJB Annual Accounts 2024/25 for signature. (3) Acknowledge that the signed audited IJB Accounts will be available to view electronically on the HSCP website. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Following the publication of the Local Authority Accounts (Scotland) Regulations 2014, the members of the IJB have to meet to consider whether to approve the audited IJB Annual Accounts 2024/25 for signature. 6. CONCLUSIONS 6.1 This report provides an overview of the unsigned audited IJB Annual Accounts for the financial year 2024/25 in line with legislative requirements. Yes No N/A
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7. NORTH LANARKSHIRE IJB ANNUAL ACCOUNTS 2024/25 7.1 The IJB Annual Accounts 2024/25 were prepared in accordance with the requirements of the Local Government (Scotland) Act 1973 and the Local Government in Scotland Act 2003. This means that suitable accounting policies were selected and applied consistently, reasonable, and prudent judgement were made, and proper accounting records were maintained. The preparation of the unaudited annual accounts also met the statutory deadline of 30 June 2025. 7.2 The unsigned audited IJB Annual Accounts 2024/25 are attached at appendix 1. 7.3 The External Auditor has concluded that the 2024/25 financial statements of the North Lanarkshire IJB give a true and fair view of its net expenditure for the year and have therefore issued an unqualified independent audit report. 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 8.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB.
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Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service Very High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 8.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance and Technology) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny.
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8.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 9. BACKGROUND PAPERS None. 10. APPENDICES Appendix 1 – Audited North Lanarkshire IJB Annual Accounts 2024/25 Chief Finance Officer Members seeking further information, please contact Nicola Scott on 07581007187.
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Appendix 1 AUDITED ANNUAL ACCOUNTS For the Year Ended 31 March 2025
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1 | P a g e CONTENTS Introduction 2 Management Commentary 3 Role of the IJB 3 National Health & Wellbeing Outcomes 4 A profile of North Lanarkshire 5 University Health & Social Care Partnership 6 2024/25 Achievements 7 Measuring Performance Under Integration 10 Key Risks, Uncertainties & Challenges 12 Financial Performance 2024/25 16 Reserves Strategy 19 Acknowledgements 20 Statement of Responsibilities 21 Remuneration Report 23 Annual Governance Statement 26 Independent Auditors Report 34 Comprehensive Income and Expenditure Statement 39 Movement in Reserves Statement 40 Balance Sheet 41 Notes to the Financial Statements 42 Note 1. Significant Accounting Policies 42 Note 2. Events After the Balance Sheet Date 44 Note 3. Expenditure and Funding Analysis by Nature 45 Note 4. Taxation and Non-Specific Grant Income 45 Note 5. Corporate Services 46 Note 6. Short Term Debtors and Creditors 46 Note 7. Useable Reserves: General Fund 46 Note 8. Related Party Transactions 47 Note 9. Hosted Services 48 Note 10. VAT 50 Note 11. External Audit Costs 50
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2 | P a g e Introduction This publication contains the annual report and financial statements of the North Lanarkshire Integration Joint Board (IJB) for the year ending 31 March 2025. The management commentary provides an overview of the key outcomes relating to the objectives and strategy of the IJB. It considers the financial performance for the year 2024/25 and looks forward, outlining future plans, challenges and risks that will be faced as the Board strives to meet the needs of the people of North Lanarkshire.
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3 | P a g e Management Commentary Role of the IJB The IJB was established as a corporate body by Scottish Government and became operational in June 2015 with integrated delivery of health and social care services commencing on 1 April 2016. It is a joint venture between NHS Lanarkshire (NHSL) and North Lanarkshire Council (NLC). The functions delegated to the IJB, under the Public Bodies (Joint Working) (Scotland) Act 2014, are detailed in the formal partnership agreement between the two partner organisations, NLC and NHSL referred to as the Integration Scheme.1 The IJB’s primary purpose is to set the strategic direction for the delegated functions through its Strategic Commissioning Plan2 with NHSL and NLC being responsible for the operational delivery of those strategic directions which include: • Accident and emergency services provided in a hospital • Inpatient services related to general, respiratory and rehabilitation medicine • Palliative care services • Community health services including Lanarkshire wide hosted services • Social care services. The IJB comprises of eight voting members, made up of four Elected Members appointed by NLC and four Non-Executive Directors appointed by NHSL. Non-voting members include the Chief Officer, Chief Finance Officer, service professionals, third sector, service users, carers, and staff representatives. 1 NL IJB Integration Scheme 2025 2 Strategic Commissioning Plan 2023-26
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4 | P a g e National Health & Wellbeing Outcomes While the IJB has overall responsibility for planning health and social care services within the area, consideration has to be given to the range of other local and national strategies to ensure the Strategic Commissioning Plan aligns with these. The outcomes that pull all the strategic and planning strands together are reflected in an agreed set of nine national Health and Wellbeing Outcomes which the IJB has a duty to deliver. Outcome 1 People are able to look after and improve their own health and wellbeing and live in good health for longer Outcome 2 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community Outcome 3 People who use health and social care services have positive experiences of those services and have their dignity respected. Outcome 4 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Outcome 5 Health and social care services contribute to reducing health inequalities. Outcome 6 People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing. Outcome 7 People using health and social care services are safe from harm. Outcome 8 People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. Outcome 9 Resources are used effectively and efficiently in the provision of health and social care services. Whilst many older people are expected to enjoy better health than their predecessors did at an equivalent age, they will still have significant health needs, living with potentially multiple complex conditions. The impact of this will be a steadily increasing demand on health and social care services, including home support, care homes, increases in demand for community-based healthcare, equipment and adaptations and an increased demand for GP services and medication. This is supported by the statistics outlined in the next section.
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5 | P a g e A profile of North Lanarkshire The 2022 census provided a number of updated statistics pertaining to the population of North Lanarkshire. The diagram below shows the percentage movements in each category since the 2011 census. Population 341,890 4th largest area in Scotland and the 5th most populated Population Trends 2011 – 2022 25 to 44 age group 7.3% Over 75’s 21% Population Projections to 2043 Population 1.2% Over 75’s 71.4% Unemployment 3.3% = lowest since 2005 Long Term sick or disabled 6% Health Comparisons 2011 – 2022 Individuals self-reporting as “not in good health”. 24.6% (+6039) Individuals self-reporting as in “fairly good health”. 15% (+7036) Individuals self-reporting with ‘long term health conditions’ 30.6% (+43,943) Individuals self-reporting mental health issues 158.6% (+24,903) Individuals self-reporting as providing informal / unpaid care 31.6% (+10,877)
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6 | P a g e University Health & Social Care Partnership Within North Lanarkshire, NHSL and NLC deliver integrated services as the Partnership therefore it is essentially staff from both organisations working together to plan and deliver services under the direction of the IJB. Purpose The long-term vision for the Partnership was set out in the original Strategic Plan 2016- 2026 and continues as the over-arching vision of the Strategic Commissioning Plan 2023-26. This states that the people of North Lanarkshire will achieve their full potential through: Ambitions To implement the vision, the Partnership has 6 key ambitions which were revised in 2023, following engagement with stakeholders, taking experience gained since 2016 and looking at the current and future challenges facing the Partnership. • Living safe, healthy and independent lives in their communities. • Receiving the information, support and care they need, efficiently and effectively, at the right time, in the right place and in the right way. • Ensuring North Lanarkshire is the best place in Scotland to grow up. KEY AMBITIONS 1. Do the right thing first time 2. Increased focus on prevention, early intervention and tackling inequalities by working with communities and people 3. Develop and support a workforce for the future 4. Improve mental health and wellbeing 5. Support people through a whole family approach
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7 | P a g e 2024/25 Achievements The progress made by the Partnership on the key strategic commissioning intentions and the key performance indicators are reported regularly to the IJB. The Strategic Commissioning Plan 2023-26 and Programme of Work Update Report 3 reflects on the achievements made throughout the year. There has been significant work completed in 2024/25 which continues to meet the key ambitions of the partnership, some of which are detailed below, with full detail included in the update report: Do the right thing first time The Partnership is a Pathfinder initiative for the national ‘Getting it Right for Everyone’ work led by the Scottish Government. This work is built on strong co-design routes to which has led to the development of prototypes to focus on My Plan and My Team. These developments are fully embedded within the whole system enabling approach being adopted to ensure Getting it Right for Everyone. The approach to improving the co-ordination of people’s support involves a ‘sticky person’ as a trusted point of contact who supports people with the coordination of their plan and appointments as an integrated member of a multi-disciplinary team, including when someone receives support from a variety of teams. Areas for further development and design include determining how the sticky person for each individual is allocated routinely across the Partnership operates and how the role might be undertaken by a family member, the wider community or the voluntary sector colleague. Getting it Right for Everyone includes the development of community hubs to ensure that individuals can connect with public services and with local people involved in supporting. This approach is building on the active work being undertaken in Newmains and St Brigid’s Community Hub, Riverbank and Chryston community hubs. Increased focus on prevention, early intervention and tackling inequalities The Lanarkshire Strategy for Preventing and Managing Frailty 2023 – 2028 was approved in November 2023. The implementation of the strategy is ongoing with a particular focus on strengthening frailty networks, with the aim of providing a collaboration between the multi- disciplinary teams on the acute sites and the partnerships who have experience in frailty work. This has led to richly informed conversations which has been at the forefront of driving realistic and patient-centred change for the people living in North Lanarkshire. Develop and support a workforce for the future There has been a significant development in the strategic academic collaborations within the Lanarkshire system. Both Lanarkshire Health and Social Care Partnerships have now been granted University Status with Glasgow Caledonian University. Work continues to develop the strategic academic approach with Strathclyde University and the University of the West of Scotland. 3 Strategic Commissioning Plan 2023-26 and Programme of Work Update
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8 | P a g e There has been an expansion not only in the volume of collaborative work undertaken but also in the complexity of projects and in the increasing diversity of links between NHSL and multiple departments and individuals across our strategic partnerships. The Care Academy is a collaborative initiative between NHSL, NLC and South Lanarkshire Council (SLC). The Academy is authorised to work with partners such as local councils, education departments, colleges, universities, the independent sector and third-sector organisations to attract and recruit staff to the health and social care workforce in Lanarkshire. Four workstreams have been established: • a focus on attraction, recruitment, retention and wellbeing • pathways for young people • adult pathways to care Improving prospects for working-age adults • funding, procurement, community wealth building and entrepreneurship. Improve mental health and wellbeing There have been 6 work streams supporting mental health and wellbeing that have all either been fully completed or are well progressed to a business-as-usual model of operational delivery: • Neurodevelopmental Service (NDS) All neurodevelopmental requests for assistance are now channelled via the established NDS. This combined three previous waiting lists (Child and Adolescent Mental Health Services (CAMHS), NDS and Paediatrics) and provided transparency of referral pathway, consistency of response and quality assurance of assessment. • Choices & Partnership Approach (CAPA) This new model of patient management has been operational since May 2023. It can now provide robust data capable of assuring planning of service capacity and informing trajectories over a longer time period. • HR & Workforce A full review of workforce in line with CAMHS and NDS specifications was undertaken and professional and support staff gaps addressed. • Communication and Engagement An Engagement Officer role has established a process that facilitates consultation with children, young people and their families. This provides assurance that the child’s voice is represented in our strategic planning and individual care planning. A website has been established and design of CAMHS and NDS logos were undertaken in partnership with New College Lanarkshire and decided by public vote. • eHealth Trakcare build completed to facilitate delivery of CAPA Model. Electronic case record now in place across whole service.
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9 | P a g e • Capital/Strategic Planning Large scale refurbishment delivered in South Lanarkshire. Work ongoing across 3 sites in North Lanarkshire to deliver the same. The objectives initially set by Programme Board have been realised and have now progressed to a stage of sustainability of performance and quality assurance that is aligned with national specification. Support people through a whole family approach The partnership’s Carers Strategy 2024-27 was approved and published in May 2024 and the approach continues to be based on the principles of the Carers (Scotland) Act 2016 and Self- Directed Support (Scotland) Act 2013, promoting a whole system approach that enables people to have more choice and control in their lives. The development of the Carers Strategy was developed through engagement and participation activity with carers and supported people. This has resulted in a carer led and carer informed strategy, co-produced with carers and carer organisations locally. The sense of joint ownership that has emerged is something that carers, carer organisations and the Partnership can be proud of. A focused effort has been directed towards refreshing the Engagement & Participation Strategy that will serve as the foundation across all areas of our work. The final version of the Engagement & Participation Strategy 2024-27 was approved in May 20244. In the development of the Strategy, the Partnership actively engaged with stakeholders, representatives of community-based organisations, supported people, carers, and staff teams. Learning from these sessions has highlighted what is considered good engagement and participation. 4 Engagement and Participation Strategy 2024-2027
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10 | P a g e Measuring Performance Under Integration The Annual Performance Report for 2023/245 was published in September 2024 and provides an opportunity to reflect on the past year and celebrate the accomplishments of the Partnership, its employees and partners. It acknowledges the ongoing collaborative work undertaken and recognises the existing and future challenges that the Partnership faces, many of which are influenced by the long-lasting effects of the pandemic. The report shows that over the last year the Partnership has continued to make significant strides in enhancing the well-being and quality of life for individuals across communities. 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, several commendable accomplishments have been made that highlight commitment to excellence in care delivery. One of the key successes of the past year has been the dedication to person centred care. There has been a focus on innovation and service improvement which has led to the implementation of several initiatives aimed at enhancing the efficiency and effectiveness of the delivery model. Since 2016, IJBs have been required by legislation to report on the Core Suite of Integration Indicators. These indicators were developed to help IJBs review their progress towards achieving each of the National Health and Wellbeing Outcomes, which focus on improving how services are provided, and the difference health and social care services should make for individuals. The most recent reporting period available is 2023/24; this ensures that the findings are based on the most complete and robust data currently available. The table below provides information on how North Lanarkshire is performing compared to the Scottish trend. The performance decline in some areas largely results from long-term demographic and public health pressures, including an ageing population, rising levels of chronic disease, and the impact of deprivation in North Lanarkshire. These factors contribute to increased demand on services, such as a higher falls rate among older adults and reduced capacity to deliver intensive care at home. Community-based services are under strain, particularly due to workforce recruitment and retention challenges. In response, the Partnership are developing targeted public health initiatives, such as Healthy Schools and breastfeeding support, alongside the introduction of new roles such as Community Connectors to strengthen local support networks. Despite these challenges, several indicators show positive or stable performance, reflecting the impact of strategic initiatives. The Hospital at Home programme continues to reduce emergency bed days and readmissions, offering acute care in people’s homes with high patient satisfaction. Integrated rehabilitation teams and a “Home First” ethos are helping people remain at home with the right support. Service redesigns, including the Enabling Approach and Home Support Redesign, are simplifying care pathways and empowering staff to deliver person- centred care. Investment in palliative and community services has also helped maintain stability in end-of-life care indicators. 5 Annual Performance Report 2023/24
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11 | P a g e Overall progress has been made in pursuit of the National Health & Wellbeing outcomes and is comparable with similar authorities and the Scottish average in many areas. There are improvements required which are highlighted in the performance report and these are managed through the performance framework. Core Suite of Integration Indicators Title North Lanarkshire Scotland UHSCNL Trend Scotland Trend Premature mortality rate (per 100,000 persons) 510 442 BETTER BETTER Emergency Admission Rate (per 100,000 of population) 15,396 11,707 WORSE WORSE Emergency Bed Day Rate (per 100,000 of population) 122,120 112,883 BETTER BETTER Emergency re-admission to hospital within 28 days of discharge (per 1,000 of discharges) 116 104 BETTER WORSE Proportion of last 6 months of life spent at home or in a community setting 89% 89% BETTER BETTER Falls rate per 1,000 population aged 65+ 21 23 WORSE WORSE Proportion of care services graded ‘good’ (4) or better in Care Inspectorate inspections 76% 77% WORSE BETTER Percentage of adults with intensive care needs receiving care at home 70% 65% WORSE BETTER Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) 973 902 WORSE BETTER Performance is better than previous reporting period Performance is worse than previous reporting period
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12 | P a g e Key Risks, Uncertainties & Challenges Given the current political climate and the associated economic uncertainty, the Partnership faces significant risks, uncertainties and challenges. These include but are not limited to: Financial Risks & Uncertainties • Future funding levels from partner organisations and Scottish Government. • Continued increasing costs and raising inflation including future pay awards. • Increasing costs of equipment and adaptations • The outcome of the negotiations for the national care home rate • The impact of the increase to national insurance contributions for both direct staff and commissioned services and the potential lack of additional funding to support these • Impact of rising costs of commissioned services with providers outwith the national frameworks asking for significantly above inflation increases. • The level of non-recurring solutions included to meet the 2025/26 cost pressures. Operational Risks & Uncertainties • Impact of proposed savings options which could include an increase to delayed discharge figures and bed delays. • The ability to recruit and retain quality staff to continue to deliver services and manage increasing demand. • Unexpected shortage of supplies and materials. • Increasing level of complex care packages materialising that are currently unknown. • Volatility of the external care market and the support required in order to provide stability. • Increased numbers of providers seeking to set up separate companies and exit the National Care Home Contract which would lead to individual placement and price negotiations. • Operational impact of the increased contract prices from providers leading to issues with placement of individuals. • Changing political factors which influence the UK and Scottish Government priorities and policy initiatives. These were highlighted to the IJB as part of the Medium Term Financial plan and they will be monitored through the Partnership’s risk management process as detailed in the next section.
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13 | P a g e Risk Management The IJB Risk Management Strategy complements the existing risk management processes within each partner by ensuring risk reports form a substantial item of business at all IJB and Performance, Finance and Audit (PFA) Committee meetings. There are three main risk registers across the Partnership: • IJB risk register outlining the strategic risks to the IJB; • Health operational risk register, hosted within the NHSL system; and • Social Work operational risk register, hosted within NLC system. Strong ties have been maintained with the corporate risk managers in both partner organisations and the IJB Risk Management Strategy, has been developed in conjunction with these leads, linking closely to both the NLC and NHSL Risk Management Strategies. At time of writing, there are currently nineteen open risks identified within the North Lanarkshire IJB Risk Register with ten of these risks rated as very high or high. The table below shows a summary of these: Current Risk Level Category Summary of Risk Financial Strategic Financial Challenges: There are a range of financial challenges which will impact on the IJB’s ability to deliver the Strategic Commissioning Plan with the financial envelope available. Very High Financial Reputational 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 internal controls. Low Financial Strategic Set-Aside Budget: There is a risk that the resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care. High Financial Strategic Hosted Services: There is a risk of dispute between the North and South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services budgets. Medium
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14 | P a g e Current Risk Level Category Summary of Risk (continued) Financial Operational Prescribing Activity and Costs: The risk is cost of prescribing could impact on the availability of medicines, healthcare techniques and technology and in respect of supply of medicines and medical devices, additional checks are now required at ports and EEA before goods can cross the border. Very High Financial Operational Pharmacy Pressures within Prison Service: Pharmacy costs have traditionally been the highest area of non-pay spend nationally in all prisons. There is currently a large overspend for the actual drugs brought associated with the management fees for the contract. Very High Financial Strategic Ineffective Governance Arrangements: There is a risk that the intensity of the required response to Covid-19 could result in a failure of governance impacting on the effectiveness of the IJB decision-making. Low Performance Oversight of Performance Activity: There is a risk the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role. Low Performance Staff Health & Wellbeing: 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 sickness absence, and redeployment. High Performance Care Homes: Inability of care homes to sustain service due to staffing and cost pressures resulting in closure to new placements and closure of care homes. Medium Strategic & Performance 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 post and challenges recruiting. Medium Strategic & Performance Cost of Living: 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. High
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15 | P a g e Current Risk Level Category Summary of Risk (continued) Strategic 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 on the impact of change. Low Strategic & Performance Unscheduled Care: There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand, workforce capacity, delays in onward movement of patients and care at home capacity. High Strategic & Performance 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. Medium Performance Service Sustainability: Due to competing service priorities and workforce and financial challenges, there is a risk that the IJB will be unable to implement the strategic plans. High Performance Workforce Sustainability: It is becoming increasingly difficult to recruit to particular roles across Health and Social Care as gaps in the workforce can result in reduction of service provision, increase in staff workload and inability to deliver the strategic plan. High Performance Speech and Language Therapy Service: 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 recruitment and retention of new colleagues, funding streams from Local Authority being reduce therefore reducing staff WTE High
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16 | P a g e Financial Performance 2024/25 As outlined on page 3 of this Annual report, North Lanarkshire IJB delivers and commissions a range of health and social care services to the local population. The Board is responsible for the strategic planning of the functions delegated to it and for ensuring the delivery of its functions through the locally agreed operational arrangements set out within the integration scheme. To successfully discharge the operational delivery of services, funding is provided through budgets delegated from both NLC and NHSL. The level of funding available to the IJB is therefore heavily influenced by these organisations’ grant settlement from Scottish Government. On 27th March 2024 the IJB agreed to accept the delegated budgets from NLC for Social Care and NHSL for Health Services which amounted to £208.494m and £385.363m respectively. In addition to the contributions from NHS Lanarkshire the Health budgets were supplemented further by £163.663m for services where South Lanarkshire IJB acts as the lead host. Therefore, the total opening budget available to the IJB was £757.520m. During 2024/25 this budget increased to account for additional Scottish Government funding received for areas including, but not limited to, Scottish Living Wage, Mental Health, Nursing, Hospital at Home and Operation flow. There was also an increase in relation to the budgeted use of reserves which resulted in a closing budget of £850.360m. North Lanarkshire IJB Budget 2024/25 £m Social Care Services Original Allocation 208.494 Scottish Government Additional Funding relating to Scottish Living Wage 1.759 Budgeted Use of Reserves 2.706 Closing Budget 212.959 Health Care Services Original Allocation including set aside and hosted services 549.026 Scottish Government additional allocations 83.397 Budgeted Use of Reserves 4.978 Closing Budget 637.401 Total Budget 2024/25 850.360 The challenges seen in 2023/24 continued to be seen in 2024/25 with funding not keeping pace with increasing costs and demand. The savings plan put in place to ensure the Partnership continued to meet its key ambitions, while undertaking service transformation, was not fully realised however the Partnership did deliver a year end underspend.
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17 | P a g e This underspend was achieved by: o flexible use of recurring and non-recurring funding o creation and use of reserves for specific commitments o delivery of approved savings through efficiency measures and redesign o focusing on workforce planning and the Strategic Commissioning Plan Programme of Work o effective governance and audit controls The final outturn expenditure of £839.644m included spend against recurring budget as well as spend relating to both the budgeted use of reserves show on page 16 of £7.684m and the utilisation of non-budgeted ear marked reserves of £3.002m within social care services. Annual Budget 2024/25 Debit to Reserves Budget after approved transfer from reserves 2024/25 Final Outturn 2024/25 Final Outturn Variance 2024/25 £m £m £m £m £m North Lanarkshire IJB 861.046 (10.686) 850.360 839.644 10.716 Note: The figures differ to that in the Comprehensive Income and Expenditure Statement (CIES) due to differences in the presentation of in year adjustments between the partners.
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18 | P a g e The final outturn variance is across a number of integrated services however there are 4 key variances worthy of highlighting: Delegated Service Variance £m Over / Underspend Reason Ambition Statement Employee Costs 19.219 Underspend The Partnership continues to encounter challenges in terms of recruitment and retention across all service areas which has led to spend below budget. This underspend is also inclusive of non-recurring savings on pension costs 3 Hosted Services 2.865 Underspend North Lanarkshire IJB commissions a number of services where North Lanarkshire is the host organisation for services carried out within South Lanarkshire. Overall, there was an underspend however there are some services which delivered over budget, which include continence services, children’s diabetic nursing and prisoner healthcare. 1, 2, 4, 5 Payments to Other Bodies (1.073) Overspend Integrated services provided by Social Care on behalf of the IJB includes Care at Home and Care Homes. A net overspend was reported within these areas which is representative of the increasing demand on these services. 1, 3, 5 Prescribing (4.757) Overspend A significant spend within the services delegated to the IJB from the Health Service is the cost of Prescribing. The overspend being reported in here is attributable to both the number of medicines being prescribed and dispensed alongside higher prices. 2, 4 The year end underspend totalled £10.716m which included the drawdown of reserves in 2024/25 of £10.686m leaving a surplus on the provision of services of £0.030m as shown in the CIES on page 38 and Movement in Reserves on page 39. North Lanarkshire IJB Financial Outturn 2024/25 £m Underspend as at 31 March 2025 10.716 Use of Reserves In-Year (10.686) Surplus on Provision of Services (Page 38) Movement in Reserves (Page 39) 0.030
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19 | P a g e Reserves Strategy The IJB has the same legal status as a local authority and is therefore able to hold reserves under section 106 of the Local Government (Scotland) Act 1973. A reserve strategy was developed to provide security against unexpected cost pressures and to aid financial stability. The IJB Reserves Strategy 2024/25 allows for the flexibility in terms of potential fluctuations. This allows the IJB to increase contingency reserve balances where resources permit, providing future financial resilience for those years where the level of resources available to the IJB may be significantly constrained and will require a drawdown from these reserves in order to deliver financial balance. To protect the financial resilience of the IJB in the context of an increased financial risk profile, the total contingency reserve is 3.6% of the mainstream financial envelope. The IJB has also committed actions attached to the Strategic Commissioning Plan Programme of Works and funding is therefore earmarked to specific projects to allow spend to be managed in a way that represents best value for the IJB to achieve its national outcomes. It is also important that in year funding available from government priorities are able to be ring-fenced and carried forward into the following financial year. As these funding allocations are to meet specific commitments, they must be carried forward to meet the conditions attached to their receipt. The table below shows the breakdown of the underspend transferred to reserves at year end: Analysis of Underspend Transferred to IJB Reserves at Year End 2024/25 £m Ring Fenced Reserves 0.614 Earmarked Reserves 10.102 Total Underspend Transferred to Reserves 10.716
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20 | P a g e Acknowledgements We would like to acknowledge the significant effort required to both produce the annual accounts and successfully manage the finances of the IJB and to record our thanks to the Finance teams in both NLC and NHSL and colleagues in other services for their continued hard work and support. Brian Moore Chair Date: Claire Rae Chief Officer Date: Nicola Scott CPFA Chief Finance Officer Date:
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21 | P a g e Statement of Responsibilities Responsibilities of the North Lanarkshire Integration Joint Board The North Lanarkshire IJB is required to: • Make arrangements for the proper administration of its financial affairs and to ensure that the proper officer of the board has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this IJB, that officer is the Chief Finance Officer. • Manage its affairs to secure economic, efficient, and effective use of resources and safeguard its assets. • Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far, as is compatible with the legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003). • Approve the Annual Accounts for signature. I confirm that these Annual Accounts were approved for signature at a meeting of the North Lanarkshire Integration Joint Board on 17th September 2025. Signed on behalf of the North Lanarkshire Integration Joint Board Brian Moore Chair Date:
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22 | P a g e Responsibilities of the Chief Finance Officer The Chief Finance Officer is responsible for the preparation of the Integration Joint Board’s Annual Accounts in accordance with proper practices as required by legislation and as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (Accounting Code). In preparing the Annual Accounts, the Chief Finance Officer has: • Selected suitable accounting policies and then applied them consistently. • Made judgements and estimates that were reasonable and prudent. • Complied with legislation. • Complied with the Local Authority Code (in so far as it is compatible with legislation). The Chief Finance Officer has also: • Kept proper accounting records which were up-to-date. • Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that these Annual Accounts present a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2025 and the transactions for the year then ended. Nicola Scott CPFA Chief Finance Officer Date:
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23 | P a g e Remuneration Report The Local Authority Accounts (Scotland) Regulations 2014 (SSI No.201/200) require local authorities and IJB’s in Scotland to prepare a Remuneration Report as part of the annual statutory accounts. The information in the tables below is subject to external audit. The explanatory text in the Remuneration Report is reviewed by Audit Scotland to ensure it is consistent with the financial statements. Voting Board Members Voting IJB members constitute councillors nominated as board members by constituent authorities and NHS representatives nominated by the NHS Board. The voting members of North Lanarkshire IJB were appointed through nomination by NLC and NHSL. The regulations require disclosure of remuneration information for ‘relevant’ persons. A ‘relevant’ person in relation to the Remuneration Report includes a senior officer holding office with associated authority, whether on a permanent or temporary basis, in the financial year to which that Remuneration Report relates. The Board Members do not receive remuneration or expenses directly from the IJB. Any remuneration or reimbursement of expenses for voting board members is governed by the relevant IJB partner organisation. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting member costs by the partner. The details of the Chair and Vice Chair appointments held during 2024/25 are outlined in the table below: The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlement of voting IJB members. Therefore, no pension rights disclosures are provided for the Chair or the Vice Chair. There were no exit packages payable during the financial year. Name Post Held Nominated by Cllr Michael McBride IJB Chair (1 April 2024 - 27 April 2024) North Lanarkshire Council Cllr Anne McCrory IJB Chair ( 28 April 2024 - 31 March 2025) North Lanarkshire Council Brian Moore IJB Vice Chair ( 1 April 2024 - 31 March 2025) NHS Lanarkshire
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24 | P a g e Officers of the IJB The IJB does not directly employ any staff in its own right, however specific post-holding officers are nonvoting members of the Board. The Chief Officer and the Chief Finance Officer are appointed by the North Lanarkshire IJB and employed by NLC. Both posts are seconded to the IJB in line with the local arrangements. The Chief Officers received the following remuneration in the period: Total Earnings Name and Post Title Total Earnings 2023/24 2024/25 £ £ 124,425 Ross McGuffie 62,333 Chief Officer (FYE 124,325) 1 April 2024 - 30 September 2024 81,854 Amanda Kilburn 43,960 Chief Finance Officer (FYE 83,570) 1 April 2024 - 9 October 2024 - Claire Rae 62,466 Chief Officer (FYE 125,275) 1 October 2024 - 31 March 2025 - Nicola Scott 31,249 Chief Finance Officer (FYE 85,118) 18 November 2024 - 31 March 2025 Pay band information is not separately provided as all staff pay information has been disclosed in the information above. Pension Benefits In respect of officers’ pension benefits the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis, there is no pension liability reflected on the IJB balance sheet for the Chief Officer or the Chief Finance Officer. The IJB however, has responsibility for funding the employer contributions for the current year in respect of the officer time spent fulfilling the responsibilities of their role on the IJB. The following table shows the IJB’s funding during the year to support officers’ pension benefits. The table also shows the total value of the accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions.
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25 | P a g e Name and Post Title In Year Pension Contribution Accrued Pension Benefits For Year to For Year to For Year to For Year to 31/03/2024 31/03/2025 Description 31/03/2024 31/03/2025 £ £ £ £ Ross McGuffie 24,014 4,311 Pension 16,236 18,554 Chief Officer Lump Sum - - Amanda Kilburn 15,798 3,030 Pension 16,902 8,209 Chief Finance Officer Lump Sum - - Claire Rae - 4,060 Pension - 1,310 Chief Officer Lump Sum - Nicola Scott - 2,031 Pension - 13,050 Chief Finance Officer Lump Sum - 13,180 Brian Moore Chair Date: Claire Rae Chief Officer Date:
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26 | P a g e Annual Governance Statement The Annual Governance Statement reports on the effectiveness of the IJB’s governance arrangements and system of internal control and explains how the IJB complies with the Code of Corporate Governance6 and meets the requirements of the ‘Delivering Good Governance in Local Government’ framework developed by CIPFA and SOLACE in 2016. Scope of Responsibility The IJB is responsible for ensuring that its business is conducted in accordance with the law and appropriate standards, that public money is safeguarded, properly accounted for, and used economically, efficiently, and effectively. The IJB also aims to foster a culture of continuous improvement in the performance of the IJB’s functions and to make arrangements to secure best value. To meet this responsibility, the IJB has established arrangements for governance which includes a system of internal controls. The system is intended to manage risk to support the achievement of the IJB’s policies, aims and objectives. Reliance is also placed on the NLC and NHSL systems of internal control which support compliance with both organisations’ policies and promotes achievement of each organisations aims and objectives, as well as those of the IJB. This system can only provide reasonable and not absolute assurance of effectiveness. Purpose of the Governance Framework The governance framework comprises the systems and processes, and culture and values, by which the IJB is directed and controlled. It enables the IJB to monitor the achievement of the objectives set out in the IJB’s Strategic Commissioning Plan. The governance framework is continually updated to reflect best practises, new legislative requirements, and the expectations of stakeholders. The system of internal control is based on an ongoing process designed to identify and prioritise the risks in the achievement of the IJB’s objectives, to evaluate the likelihood of those risks being realised, the impact should they be realised, and to manage them effectively. Governance Framework and Internal Control System The IJB comprises of eight voting members, with one from each partner organisation assuming the role of Chair and Vice Chair. Four are Council Members nominated by NLC and four are Non- Executive Members appointed by NHSL. The term of office is for a period of three years. There are also a number of non-voting professional and stakeholder members on the IJB board. Stakeholder members currently include third sector, carers, staff representatives, service users and professional members including the Chief Officer and Chief Finance Officer. The IJB, via a process of delegation from NLC and NHSL, has responsibility for the planning, resourcing and operational delivery of all delegated health and social care within its geographical area. The main features of the governance framework are: 6 Code of Corporate Governance
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27 | P a g e Principles ▪ The IJB follows the principles set out in the Convention of Scottish Local Authorities (COSLA) and the Accounts Commission in 1996 Code of Guidance on Funding External Bodies and Following the Public Pound for both resources delegated to the IJB, and resources paid to its Local Authority and Health Service partners. Formal Frameworks ▪ The IJB is formally constituted through the Integration Scheme agreed by NLC and NHSL and approved by Scottish Ministers. ▪ The IJB operates within an established procedural framework. The roles and responsibilities of board members and officers are defined within standing orders, scheme of delegation and financial governance arrangements which are subject to regular review. The IJB Code of Corporate Governance was approved by the IJB on 18 July 2017 and is subject to ongoing updates as required. Board members adhere to an established Code of Conduct and are supported by induction and ongoing training and development. ▪ The Partnership has robust structures in place with our partners, which are based on service delivery, care and interventions that are person centred, timely, outcome focused, equitable, safe, efficient, and effective. Reports are presented to the IJB throughout the year which provides evidence to demonstrate the delivery of our core components within our framework and the Clinical and Care Governance principles specified by Scottish Government. Strategic Planning ▪ The overarching strategic vision and objectives of the IJB are detailed in the IJB Strategic Commissioning Plan which sets out the key outcomes that the IJB is committed to delivering with its partners. ▪ The Strategic Commissioning Plan Board sets out the IJB’s approach to engage with stakeholders. Consultations on the future vision and activities of the IJB is undertaken with its Local Authority, Health Service partners and stakeholders. The IJB regularly publishes information regarding its performance. ▪ The financial plans outline the financial challenges and opportunities the Partnership faces in the medium to long term and provides a framework which will support the IJB to remain financially sustainable. It complements the IJB Strategic Commissioning Plan, highlighting how the financial plans will support the delivery of the IJB’s strategic objectives and priorities. Oversight ▪ Effective scrutiny and service improvement activities are supported by the formal submissions of reports, findings and recommendations by Inspectorates and the appointed Internal Audit Service to the Partnership’s Senior Management Team, the main IJB board and the Performance, Finance and Audit Committee, as appropriate.
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28 | P a g e ▪ Performance management, monitoring of service delivery and financial governance is provided by the Partnership to the IJB, who are accountable to both the Local Authority and the Health Board. It reviews reports on the effectiveness of the integrated arrangements including the financial management of the integrated budget. This ensures there is a regular scrutiny at senior management, committee, and board level. Information on performance can be found in the Annual Performance Report published on the Partnership’s website7. Risk Management ▪ In line with the continued and ongoing review of the IJB Risk Register, new and emerging risks or changes in risk level are agreed at each Senior Management Team, IJB and PFA meeting as appropriate. The current risks at time of writing are summarised in the Management Commentary. Financial Control ▪ The Board’s CFO has designated responsibility for the administration of the Board’s financial affairs. The CFO is responsible for advising the Board on all financial matters and for monitoring and reporting on the Boards financial performance and position. The CFO will also oversee the development and implementation of appropriate strategies to manage risk, control the delegated resources and comply with governance standards. NHSL and NLC remain fully accountable for the financial performance of their service area against the budget allocated. Transformational Change ▪ The IJB financial plans and the Strategic Commissioning Plan recognises the need to transform the way in which the UHSCNL delivers services to ensure the sustainability of health and social care services going forward. Together with the IJB Reserves Strategy, these plans are regularly reviewed over their lifespan and amended as necessary to reflect the current challenges and pressures the Partnership face. Review of Adequacy and Effectiveness ▪ Due to the nature of the IJB membership, a conflict of interest can arise between individual board and committee members and the responsibilities they have to the IJB. It is the responsibility of board and committee members to declare any potential conflicts of interest, and it is the responsibility of the Chair of the relevant board or committee to ensure sure declarations are appropriately considered and acted upon. ▪ The IJB has responsibility for conducting an annual review of the effectiveness of the system of internal control and the quality of data used throughout the organisation. The review is informed by the work of the Senior Management Team, who have the responsibility for the development and maintenance of the internal control framework, the work of the internal and external audit teams and other independent inspectorates. ▪ Internal Audit undertake an annual programme following an assessment of risk completed during the strategic audit planning process. The appointed NHSL Chief Internal Auditor in 7 UHSCNL Website
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29 | P a g e conjunction with the NLC Chief Officer (Audit and Risk), provide an annual report to the IJB PFA Committee giving an independent opinion of the adequacy and effectiveness of the governance framework, risk management and internal controls. ▪ Based on the audit work undertaken directly on behalf of the IJB and being informed by internal audit, work undertaken independently by each respective internal audit function within NLC and NHSL, the NHSL Chief Internal Auditor and the NLC Chief Officer (Audit and Risk) are able to conclude that a reasonable level of assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal controls. Roles and Responsibilities The Chief Officer is the Accountable Officer for the Partnership and has day to day operational responsibility to monitor delivery of integrated services, with oversight from the IJB. The IJB complies with the CIPFA statement on ‘The Role of the Chief Finance Officer in Local Government 2014’. The IJB Chief Finance Officer (CFO) has responsibility for the Partnership’s financial arrangements and is professionally qualified and suitably experienced to lead and advise the IJB finance functions. The IJB complies with the requirements of the Public Sector Internal Audit Standards and the approved Internal Audit Charter for the IJB. The appointed NHSL Chief Internal Auditor has responsibility for the IJB internal audit functions and is professionally qualified and suitably experienced to lead and direct internal audit staff. The Internal Audit Service operates in accordance with the CIPFA ‘Public Sector Internal Audit Standards 2017’. Board members and officers of the IJB are committed to the concept of sound internal control and effective delivery of health and social care services. The IJB PFA Committee operates in accordance with CIPFA ‘Audit Committee Principles in Local Authorities in Scotland and Audit Committees Practical Guidance for Local Authorities’. The committee core function is to provide the IJB with independent assurance on the adequacy of the risk management framework, the internal control environment, the integrity of the financial reporting and governance arrangements.
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30 | P a g e Action Plan To ensure continual improvement of the IJB’s governance arrangements, the following action plan has been agreed. Included within this are improvements highlighted as part of the IJB self- assessment process as well as improvement areas identified by Audit Scotland within their Annual Audit Report. Regular updates on progress of the agreed actions will be presented to and monitored by the IJB PFA. 2022/23 Ref Improvement Area Agreed Action Responsible Person Date 1 Service Level Agreement (SLA) To agree an SLA with Children, Families and Justice for future hosting arrangements following the budget disaggregation exercise. Work is currently underway to agree, approve and implement the new SLA in partnership with Children, Families and Justice Services. Chief Officer September 2025 2 National Care Service To develop a sound understanding of the impact for the Partnership of the National Care Service legislation. Paper presented to the IJB in January 24 giving an update on timescales for implementation. Further updates will be presented to the board as details are released. Chief Officer September 2025
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31 | P a g e 2023/24 Ref Improvement Area Agreed Action Responsible Person Date 1 2023/24 Self- Assessment Agreed actions 1. Development of a revised framework for North Lanarkshire which will ensure engagement and participation in the development of the Strategic Commissioning Plan across the entire health and social care system. Chief Officer December 2025 2. Undertake an exercise to review performance output and associated data from other Health Boards and Local Authorities. 3. Recognition that there is a formalised risk sharing agreement in place with NHSL, NLC and SL IJB within the risk management strategy but no reference to similar in relation to performance and finance. 2 Presentation of financial and non- financial information in the annual accounts In the production of future accounts, the IJB should review the presentation of both financial and non-financial information to ensure this reflects the organisation’s role as a strategic commissioning body. Chief Finance Officer September 2025 3 Presentation of financial and non- financial information in the financial performance reports The financial reports will be further defined to give an overview in the delivery of services against the overall funding aligned to the Strategic Commissioning Plan and Medium- Term Financial Plan/Long Term Financial Plan including earmarked reserves. Chief Finance Officer September 2025
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32 | P a g e 2024/25 Ref Improvement Area Agreed Action Responsible Person Date 1 2024/25 Self- Assessment Agreed actions 1. Holding to Account - effective scrutiny, challenge and support of services by the Management Team and also by IJB members when reviewing presented papers. Chief Officer December 2025 2. Vision for IJB should be clear and ambitious with membership being diverse and engaged. Management team to review induction process and liaison sessions 3. Review what goes to IJB and PFA and ensure there are appropriate development sessions to support the financial picture. Internal Audit Opinion Internal control remains, primarily, a management responsibility to ensure that the partnership conducts its business in a manner that has due regard to the principles of good governance. Overall, the results of work undertaken to provide assurance include reports produced by Audit Scotland and a range of governance reports undertaken jointly with the partner organisations to help to inform an opinion on whether the internal controls for the Partnership have in place are adequate. The joint internal audit opinion is that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s framework of governance, risk management and internal control. Conclusion and Opinion on Assurance It is our opinion that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s governance arrangements. The IJB has adhered to the stated principles of good governance, acted in the public interest, and been committed to continuous improvement. The scrutiny and oversight of the IJB PFA Committee contributes effectively to these arrangements. There were no significant control weaknesses, issues, or failure in the expected standards for good governance, risk management and internal control. We consider that the internal control environment provides reasonable and objective assurance that any significant risks impacting on the IJB’s principal objectives will be identified, actions taken to avoid or mitigate their impact and are consistent with the recommendations of the CIPFA/SOLACE Framework (2016).
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33 | P a g e Claire Rae Chief Officer Date: Brian Moore Chair Date:
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34 | P a g e Independent Auditors Report Independent auditor’s report to the members of North Lanarkshire Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of North Lanarkshire Integration Joint Board for the year ended 31 March 2025 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet, and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25 (the 2024/25 Code). In my opinion the accompanying financial statements: • give a true and fair view of the state of affairs of the body as at 31 March 2025 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2024/25 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I was appointed by the Accounts Commission on 2 December 2022. My period of appointment is five years, covering 2022/23 to 2026/27. I am independent of the body in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the body. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion.
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35 | P a g e Conclusions relating to going concern basis of accounting I have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work I have performed, I have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the body’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on the body’s current or future financial sustainability. However, I report on the body’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement I report in my Annual Audit Report the most significant assessed risks of material misstatement that I identified and my judgements thereon. Responsibilities of the Chief Finance Officer and North Lanarkshire Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Finance Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Finance Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Finance Officer is responsible for assessing the body’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the body’s operations. North Lanarkshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. I design procedures in line with my responsibilities outlined above to
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36 | P a g e detect material misstatements in respect of irregularities, including fraud. Procedures include: • using my understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the body; • inquiring of the Chief Finance Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the body; • inquiring of the Chief Finance Officer concerning the body’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among my audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which my procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the body’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report I have audited the parts of the Remuneration Report described as audited. In my opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014.
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37 | P a g e Other information The Chief Finance Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. My responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In my opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • I have not received all the information and explanations I require for my audit.
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38 | P a g e I have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to my responsibilities for the annual accounts, my conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in my Annual Audit Report. Use of my report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. John Boyd FCPFA Audit Scotland 8 Nelson Mandela Place Glasgow G2 1BT
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39 | P a g e Comprehensive Income and Expenditure Statement This statement shows the actual cost of providing services in accordance with generally accepted accounting practices. It includes, on an accrual basis, all expenses and related income. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received from partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts. 2023/24 North Lanarkshire Integration Joint Board Note 2024/25 Gross Expenditure Gross Income Net Expenditure Gross Expenditure Gross Income Net Expenditure £m £m £m £m £m £m 259.695 259.695 Social Care Services 263.773 263.773 78.950 78.950 Health Care Services 83.086 83.086 126.015 126.015 Family Health Services 135.965 135.965 189.595 189.595 Hosted Services 9 199.089 199.089 0.308 0.308 Corporate Services 5 0.278 0.278 78.442 78.442 Prescribing 81.709 81.709 74.575 74.575 Set Aside for Hospital Acute Services 75.143 75.143 0.227 0.227 Covid-19 Costs (0.283) (0.283) 807.807 0.000 807.807 Total Cost of Services 838.760 0.000 838.760 (785.385) (785.385) Taxation and Non-Specific Grant Income 4 (838.790) (838.790) 807.807 (785.385) 22.422 (Surplus) or Deficit on Provisions of Services (Movement in Reserves) 838.760 (838.790) (0.030)
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40 | P a g e Movement in Reserves Statement This statement shows the movement in year on the IJB’s reserves. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices. North Lanarkshire Integration Joint Board Total Reserves General Fund £m Movement in Reserves during 2023/24: Opening Balance at 1 April 2023 (97.946) Total Comprehensive Income and Expenditure (Increase) or decrease in 2023/24 22.422 Closing Balance at 31 March 2024 (75.524) Movement in Reserves during 2024/25: Opening Balance at 1 April 2024 (75.524) Total Comprehensive Income and Expenditure (Increase) or decrease in 2024/25 (0.030) Closing Balance at 31 March 2025 (75.554)
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41 | P a g e Balance Sheet The balance sheet shows the value of the IJB’s assets and liabilities as at 31 March 2024. The net assets of the IJB (assets less liabilities) are matched by the reserves held by the IJB. 31 March 2024 North Lanarkshire Integration Joint Board Notes 31 March 2025 £m £m 75.524 Current Assets 6 75.554 Short Term Debtors 0.000 Current Liabilities 6 0.000 Short Term Creditors 75.524 Net Assets 75.554 75.524 Usable Reserves: General Fund 7 75.554 75.524 Total Reserves 75.554 The Statement of Accounts presents a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2025 and its income and expenditure for the year then ended. Notes to the Financial Statements numbers 1 to 11 found on pages 34 - 42, form part of the financial statements. The audited accounts were authorised for issue on 17 September 2025. Balance Sheet signed by: Nicola Scott CPFA Chief Finance Officer Date:
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42 | P a g e Notes to the Financial Statements Note 1. Significant Accounting Policies General Principles The financial statements summarise the transactions of the IJB for the financial year 2024/25 and its position at 31 March 2025. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. It is a joint venture between NLC and NHSL. The financial statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25, supported by the International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. Each partner complies with their accounting policies as appropriate. The accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: • Expenditure is recognised when goods or services are received, and their benefits are used by the IJB. • Income is recognised when the IJB has a right to the income, for instance, by meeting any terms and conditions required to earn the income and receipt of the income is probable. • Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the balance sheet. • Where debts may not be received, the balance of debtors is written off. Funding The IJB is primarily funded through contributions from its statutory funding partners, NLC and NHSL. Expenditure is incurred as the IJB commissions specified health and social care services from the funding partners for the benefit of service recipients in North Lanarkshire and service recipients in South Lanarkshire for services that are delivered under hosted arrangements and on a pan-Lanarkshire basis. The funding relating to the year under review is recognised as income in the CIES and will normally be income added to the General Fund. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received from partners. The movement in General Fund balance is therefore solely due to the transactions shown in the CIES.
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43 | P a g e Cash and Cash Equivalents The IJB does not operate a bank account or hold cash. All transactions are settled on behalf of the IJB by the funding partner. Consequently, the IJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. There is therefore no requirement for the IJB to produce a cash flow statement. The funding balance due from and to each funding partner as at 31 March 2025 is represented as a debtor or creditor on the IJB’s balance sheet. Employee Benefit The IJB does not directly employ staff. Staff are formally employed by the funding partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a Pensions Liability on its balance sheet. The IJB has a legal responsibility to appoint a Chief Officer. A Chief Finance Officer has also been appointed to the IJB. More details on these arrangements are provided in the remuneration report. The charges for the employing partners are treated as employee costs. Where material, the absence entitlement at 31 March is accrued, for example in relation to annual leave earned but not yet taken. In the case of North Lanarkshire IJB any annual leave earned by the Chief Officer and Chief Finance Officer, but not yet taken is not considered to be material. Provisions, Contingent Liabilities and Contingent Assets Provisions are liabilities of uncertain timing or amount. A provision is recognised as a liability on the balance sheet when there is an obligation on 31 March due to a past event, settlement of the obligation is probable, and a reliable estimate of the amount can be made. Recognition of a provision will result in expenditure being charged to the CIES and will normally be a charge to the General Fund. A contingent liability is a possible liability arising from events on or before 31 March, whose existence will only be confirmed by later events. A provision that cannot be reasonably estimated, or where settlement is not probable, is treated as a contingent liability. A contingent liability is not recognised in the IJB’s balance sheet but is disclosed in a note where it is material. A contingent asset is a possible asset arising from events on or before 31 March, whose existence will only be confirmed by later events. A contingent asset is not recognised in the IJB’s balance sheet but is disclosed in a note only if it is probable to arise and can be reliably measured. Indemnity Insurance / Clinical and Medical Negligence The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding board member and officer responsibilities through the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). NLC and NHSL have responsibility for claims in respect of the services for which they are statutorily responsible for and that they provide. Unlike NHS Boards, the IJB does not have any ‘shared risk’ exposure from participation in CNORIS. The IJB participation in the scheme is therefore comparable to normal insurance arrangements.
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44 | P a g e Known claims are assessed as to the value and probability of settlement. Where it is material, the overall expected value of known claims taking probability of settlement into consideration, is provided for in the IJB balance sheet. The likelihood of receipt of an insurance settlement to cover any claims is separately assessed and where material, presented as either a debtor or disclosed as a contingent asset. Debtors and Creditors Financial instruments are recognised in the balance sheet when an obligation is identified and released as that obligation is fulfilled. Debtors are held at fair value and represent funding due from partner bodies that was not utilised in year. There are no creditor balances. Reserves A reserve is the accumulation of surpluses, deficits, and appropriation over a number of years. Reserves of a revenue nature are available and can be spent or earmarked at the discretion of the IJB. Reserves should be split between usable and unusable on the balance sheet. As at 31 March 2025, the usable reserve balance totals £75.554m. There are no unusable reserves. Hosted Services Within Lanarkshire, each IJB has operational responsibility for the service which it hosts on behalf of the other IJB. In delivering these services each IJB has primary responsibility for the provision of the services and bears the risk and reward associated with this service delivery in terms of demand and the financial resources required. As such the IJB is considered to be acting as ‘principal’, and the full costs are reflected within the annual accounts for the services which it hosts. This is the basis on which North Lanarkshire IJB accounts have been prepared. The relevant share of the pan Lanarkshire and area wide service expenditure is therefore included in the North Lanarkshire IJB on the basis of 52% of the total expenditure, 48% of the services relating to the South Lanarkshire IJB are also included as the North Lanarkshire IJB is acting as the principal for the delivery of these services. In line with the Integrated Resource Advisory Group Guidance, the IJB responsible for the management of the hosted service is also responsible for managing overspends. As a result, these are accounted for within the Annual Accounts of the lead IJB. The same accounting treatment was adopted where an underspend arose in respect of a hosted service. Note 2. Events After the Balance Sheet Date The Chief Finance Officer authorised the unaudited annual accounts for issue on 18 June 2025. Events after the balance sheet date are those events that occur between the end of the reporting period and the date when the statements are authorised for issue. Where events take place before the date of authorisation and provide information about conditions existing as at 31 March 2025, the figures in the financial statements and notes would be adjusted in all material aspects to reflect the impact of this information. There have been no material events since the date of the balance sheet which require revision to the figures in the Annual Accounts.
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45 | P a g e Note 3. Expenditure and Funding Analysis by Nature The following table shows the gross expenditure and funding for North Lanarkshire IJB against subjective headings: Expenditure and Funding Analysis by Nature 2023/24 2024/25 £m £m Social Care Services 259.695 263.773 Health Care Services - Localities 66.933 70.341 Health Care Services - Area Wide 7.621 8.420 Health Care Services - Out of Area 4.396 4.041 Family Health Services 126.015 135.965 Hosted Services - Led by North IJB 148.954 155.183 Hosted Services - Led by South IJB 40.641 43.907 IJB Operating Costs 0.308 0.278 Prescribing Costs 78.442 81.709 Covid-19 Costs 0.227 0.000 Set Aside 74.575 75.143 Total Cost of Services 807.807 838.760 Partners Funding Contributions and Non-Specific Grant Income (785.385) (838.790) (Surplus)/Deficit on Provision of Services 22.422 (0.030) Note 4. Taxation and Non-Specific Grant Income The following table shows the funding contribution from the two partner organisations: Taxation and Non-Specific Grant Income 2023/24 2024/25 £m £m Funding Contribution from NHS Lanarkshire (590.418) (630.765) Funding Contribution from North Lanarkshire Council (194.967) (208.025) Total (785.385) (838.790) The funding contribution from the NHSL Board shown above includes £75.143m in respect of ‘Set Aside’ resources relating to acute hospital services. These are provided by NHSL which retains responsibility for managing the costs of providing these services. The IJB however has responsibility for the consumption and level of demand placed on these resources.
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46 | P a g e Note 5. Corporate Services NLC and NHSL provide a range of support services for the IJB including finance, personnel, planning, audit, payroll, debtor, and creditor services. There is no charge to the IJB for these support services. The costs associated with running the IJB are shown in the following table: IJB Operating Costs (Corporate Services) 2023/24 2024/25 £m £m Staff Costs 0.272 0.240 Audit Fees 0.033 0.035 Administration Costs 0.003 0.003 Total 0.308 0.278 Note 6. Short Term Debtors and Creditors Short Term Debtors 2023/24 2024/25 £m £m NHS Lanarkshire 50.719 50.276 North Lanarkshire Council 24.805 25.278 Total 75.524 75.554 Short Term Creditors 2023/24 2024/25 £m £m NHS Lanarkshire - - North Lanarkshire Council - - Total - - Note 7. Useable Reserves: General Fund The purpose of the General Fund is detailed in the IJB Reserves Policy and summarised below: • Funding received for a specific purpose and not yet spent will be allocated to a ring-fenced reserve. • Funding for future expenditure needs and key financial risks will be allocated to earmarked reserves. • A contingency reserve is required to cushion the impact of unexpected events or emergencies. At 31 March 2025 the IJB transferred funding to ring-fenced reserves to enable the IJB to deliver on specific Scottish Government funded programmes and earmarked reserves to support the delivery of programme of works. In addition, the contingency reserve has been increased as part of the IJB financial strategy. This will be used to manage the risk of any future unanticipated events and support service provision that may materially impact on the financial position of the IJB in later years. The following table shows the movement of reserves during 2024/25:
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47 | P a g e USEABLE RESERVES Balance as at 31 March 2024 Net Transfers during 2024/25 Balance as at 31 March 2025 £m £m £m Alcohol and Drug Partnership Funding 3.597 0.084 3.681 Blood-Borne Viruses Services 0.194 0.124 0.318 Children and Adolescent Mental Health Services 2.849 (2.849) 0.000 Community Living Change Fund 1.164 (1.110) 0.054 Long Covid Pathways Funding 0.234 0.055 0.289 Hospital at Home Services 0.962 (0.047) 0.915 Mental Health and Learning Disability Services 7.038 (1.835) 5.203 North Planning Band 2-4 Posts & Pharmacy Training 2.892 0.173 3.065 Nursing Funding 1.386 (0.740) 0.646 Ring-Fenced Reserves - Other Services 3.798 (3.132) 0.666 Total Ring-Fenced Reserves 24.114 (9.277) 14.837 Adult Social Care Winter Preparedness Fund 1.000 0.000 1.000 Carers Act Support 2.596 0.008 2.604 Children and Adolescent Mental Health Services 0.268 2.774 3.042 Digital and IT Strategy 5.253 (1.607) 3.646 Earmarked Reserves - Other Services 2.591 3.633 6.224 Home Support Resilience 0.656 (0.079) 0.577 IJB Financial Plan 2023/2026 4.672 (2.056) 2.616 Mental Health 0.000 2.917 2.917 Minor Repair and Replacement Programme of Works 1.811 0.000 1.811 Prescribing Fund 4.361 0.705 5.066 Social Care Services 0.809 (0.493) 0.316 Winter Funding Business Case 1.319 (1.010) 0.309 Total Earmarked Reserves 25.336 4.792 30.128 Total Contingency Reserve 26.074 4.515 30.589 TOTAL USEABLE RESERVES 75.524 0.030 75.554 Note 8. Related Party Transactions The IJB has related party transactions with NLC and NHSL. In particular the nature of the partnership means that the IJB may influence and be influenced by its partners. Non-voting board members are not directly employed by NHSL however, a contribution of 50% of the cost of the Chief Officer is made by NHSL along with the full cost of the CFO. This payment is included in the IJB Operating Costs (Corporate Services) in the CIES and detailed at Note 5. The following transactions and balances included in the IJB Annual Accounts are presented to provide additional information on related party relationships.
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48 | P a g e There are elements of expenditure which are shown against NLC but where the resource is provided by NHSL. Resource Transfer which includes the Social Care Fund are therefore part of the NHSL budget but are used to deliver social care services supplied by NLC. Expenditure on Services Provided 2023/24 2024/25 £m £m NHS Lanarkshire 547.613 574.747 Resource Transfer to North Lanarkshire Council 54.266 56.462 NHS Lanarkshire Total 601.879 631.209 North Lanarkshire Council 260.193 264.013 Resource Transfer from NHS Lanarkshire (54.266) (56.462) North Lanarkshire Council Total 205.927 207.551 Funding Contributions Received 2023/24 2024/25 £m £m NHS Lanarkshire (590.418) (630.765) North Lanarkshire Council (194.967) (208.025) Total (785.385) (838.790) Debtors 2023/24 2024/25 £m £m NHS Lanarkshire 50.719 50.276 North Lanarkshire Council 24.805 25.278 Total 75.524 75.554 Note 9. Hosted Services North Lanarkshire IJB act as the lead for a number of delegated services on behalf of South Lanarkshire IJB. It therefore commissions services on behalf of South Lanarkshire IJB and reclaims the costs involved. Since North Lanarkshire IJB is acting as ‘principal’ in these transactions, the total gross expenditure and the consequential reimbursement is included in the CIES even though 48% of the hosted budget is consumed by South Lanarkshire.
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49 | P a g e Host: North Lanarkshire North Lanarkshire Services 2023/24 Consumed by South Lanarkshire 2023/24 Service North Lanarkshire Services 2024/25 Consumed by South Lanarkshire 2024/25 £m £m £m £m 1.667 0.833 Blood Borne Virus Services 1.667 0.879 13.648 6.975 Children and Adolescents Mental Health Services 13.683 6.901 14.482 6.410 Children’s Services 16.556 6.881 3.465 1.187 Continence Services 3.210 1.213 4.152 2.115 Dietetics Services 4.339 2.212 3.367 1.773 Hospital at Home 3.046 1.463 5.815 2.721 Immunisation Services 4.925 2.991 - 0.272 Integrated Equipment and Adaptation Store 0.000 0.392 84.074 43.706 Mental Health and Learning Disability Services 90.305 44.674 4.873 2.405 Podiatry Services 4.627 2.480 3.047 0.982 Prisoner Healthcare Services 2.327 1.019 3.569 1.661 Sexual Health Services 3.819 1.849 6.796 3.426 Speech and Language Therapy Services 6.678 3.607 148.954 74.466 Total Services Hosted by North Lanarkshire IJB 155.182 76.561 Similarly, South Lanarkshire IJB acts as the lead for a number of delegated services on behalf of North Lanarkshire IJB. The value consumed by North Lanarkshire equates to 52% of South Lanarkshire IJB hosted budget. As this expenditure is incurred for the residents of North Lanarkshire, it is included in the CIES. Host: South Lanarkshire Consumed by North Lanarkshire 2023/24 South Lanarkshire Services 2023/24 Service Consumed by North Lanarkshire 2024/25 South Lanarkshire Services 2024/25 £m £m £m £m 4.288 7.422 Community Dental Services 4.529 7.687 1.477 2.773 Brain Injury Unit 1.302 2.455 2.395 4.633 Diabetic Services 2.613 6.200 - - Improving Cancer Journey 0.244 0.638 4.669 8.739 Occupational Therapy Services 4.712 8.460 5.227 9.991 Out of Hours Services 5.565 10.103 3.941 7.507 Palliative Care Services 5.097 7.707 6.103 11.581 Physiotherapy Services 6.407 10.959 - - Telehealth - - 0.467 0.790 Primary Care Services 0.476 0.762 12.074 23.220 Primary Care Improvement Fund 12.962 24.927 40.641 76.656 Total Services Hosted by South Lanarkshire IJB 43.907 79.898
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50 | P a g e The table below shows the total of hosted serviced included in the CIES: 2023/24 Hosted Services 2024/25 £m £m 148.954 Total Services Hosted by North Lanarkshire IJB 155.182 40.641 Total Services Hosted by South Lanarkshire IJB and Consumed by North 43.907 189.595 Total Included in Comprehensive Income and Expenditure Statement 199.089 Note 10. VAT The IJB is not VAT registered and does not charge or recover VAT on its functions. The VAT treatment of expenditure and income within the accounts depends on which of the partners is providing the service as these bodies are treated differently for VAT purposes: • Where NLC is the provider, income and expenditure exclude any amounts related to VAT, as collected VAT is payable to HM Revenue & Customs and all VAT paid is recoverable from it. On a very limited number of items that NLC are not entitled to fully recover VAT, expenditure for these specific items will include the full cost to the IJB. • Where NHSL is the provider, expenditure will include the full cost to the IJB as generally, NHSL cannot recover VAT. The services provided by the Chief Officer to the IJB are outside the scope of VAT as they are undertaken under a specific legal regime. Note 11. External Audit Costs Fees payable to Audit Scotland in respect of external audit services undertaken in accordance with Audit Scotland's Code of Audit Practice in 2024/25 were £35,180 (2023/24 £33,360). Audit Scotland did not undertake any non-audit services.
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1 REPORT Item No: 19 SUBJECT: Self-Assessment Questionnaire TO: Integration Joint Board Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Kerry Taylor, Business Support Manager DATE: 17 September 2025 1. PURPOSE OF REPORT The purpose of this report is to inform the Board of the results of the self-assessment survey of the Board’s administrative arrangements and activity. The Board is invited to discuss the results and identify any action required. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Kerry Taylor, Business Support Manager ☒ Reviewed By: HSCP SMT 1 September 2025 ☐ Endorsed By: ☐
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2 3. RECOMMENDATIONS 3.1 It is recommended that the IJB Notes the results of the self-assessment survey; and Discuss if any actions should arise from the results 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND 5.1 The Chartered Institute of Public Finance and Accountancy (CIPFA) Framework suggests that committees involved in scrutiny and internal control should periodically conduct a self-assessment of their effectiveness and operation. The aim is to involve members in close consideration of the role of the committee and its members, its administrative arrangements and the context in which it operates. 5.2 A questionnaire was developed and approved by North Lanarkshire Integration Joint Board on 18 June 2025. 5.3 The self-assessment was circulated to all Board members on 26 June 2025 and was open for completion until Thursday 14 August 2025. Eight board members completed the questionnaire, with the anonymised results appended to this report at Appendix 1 for discussion. 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ 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 ☐ Yes ☐ No ☐ N/A ☒
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3 Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 9.5 ENGAGEMENT & PARTICIPATION The development of the proposed self-assessment questionnaire was presented during an IJB Development session in June 2025. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ 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
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4 and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS N/A 11. APPENDICES
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5 Appendix 1 –North Lanarkshire Integration Joint Board Self-Assessment Questionnaire Results 2025 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Kerry Taylor kerry.taylor@lanarkshire.scot.nhs.uk
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Oicer Meeting Date Recurrence Reason / Notes Wednesday 17 September 2025 Chief Oicer Report Chief Oicer 17 September 2025 Standing Item Chief Finance Oicer Report - Medium Term Financial Outlook 2026-2029 Chief Finance Oicer 17 September 2025 Standing Item IJB Annual Performance Report Head of Planning, Performance & Quality Assurance 17 September 2025 Annual APR must be published online by 31 July each year – presented to September Board due to date of data publication Audited Annual Accounts Report & Financial Statement 2024/25 Chief Finance Oicer 17 September 2025 Annual Audited Annual Accounts must be presented to Board and published online by 30 September each year Strategic Commissioning Overview Plan Update Head of Planning, Performance & Quality Assurance 17 September 2025 Biannual Supporting Resilience Head of Planning, Performance & Quality Assurance 17 September 2025 Annual Replacing ‘Engagement & Participation Strategy Update’ as approved in the Programme of Work at IJB in Sept 23 Quality Assurance Annual Report Head of Planning, Performance & Quality Assurance 17 September 2025 Annual
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Oicer Meeting Date Recurrence Reason / Notes Hospital @ Home Head of Health 17 September 2025 Biannual As approved in the Programme of Work at IJB in Sept 23 Home Support Head of Adult Social Work 17 September 2025 Biannual As approved in the Programme of Work at IJB in Sept 23 LD Workforce Report Nursing Director 17 September Annual Audit Scotland - Final Audit Report 2024/25 Chief Finance Oicer 17 September 2025 Annual Self-Assessment Questionnaire Results Business Support Manager 17 September 2025 Annual IJB SAQ approved at IJB in June 2025 Freedom of Information Requests Business Support Manager 17 September 2025 Quarterly To be included in the Chief Oicer Report. Quarterly reporting submitted to Scottish Information Commissioner. Wednesday 10 December 2025 Chief Oicer Report Chief Oicer 10 December 2025 Standing Item Chief Finance Oicer Report Chief Finance Oicer 10 December 2025 Standing Item Review of IJB Performance, Finance and Audit Committee Business Support Manager 10 December 2025 CAMHS Recovery & Renewal Head of Health 10 December 2025 Annual As approved in the Programme of Work at IJB in Sept 23
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Oicer Meeting Date Recurrence Reason / Notes Paediatric Modernisation Head of Health 10 December 2025 Annual As approved in the Programme of Work at IJB in Sept 23 SLT Improvement Head of Health 10 December 2025 Annual As approved in the Programme of Work at IJB in Sept 23 Trauma Informed Practice TBC 10 December 2025 Annual As approved in the Programme of Work at IJB in Sept 23 Care Academy TBC 10 December 2025 Annual As approved in the Programme of Work at IJB in Sept 23 Probable Suicide 2024 Report TBC 10 December 2025 Annual Moved from September 2025 due to publishing dates from National Records Scotland (NRS) Alcohol Related Deaths 2024 Report Head of Planning, Performance & Quality Assurance 10 December 2025 Annual Moved from September 2025 due to publishing dates from National Records Scotland (NRS) Drug Related Deaths 2024 Report Head of Planning, Performance & Quality Assurance 10 December 2025 Annual Moved from September 2025 due to publishing dates from National Records Scotland (NRS) Coming Home Report – Dynamic Support Register Head of Adult Social Work 10 December 2025 Biannual Freedom of Information Requests Business Support Manager 10 December 2025 Quarterly To be included in the Chief Oicer Report.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Oicer Meeting Date Recurrence Reason / Notes Quarterly reporting submitted to Scottish Information Commissioner. Wednesday 21 January 2026 Chief Oicer Report Chief Oicer 21 January 2026 Standing Item Chief Finance Oicer Report Chief Finance Oicer 21 January 2026 Standing Item Chief Social Work Oicer Report Chief Social Work Oicer 21 January 2026 Annual Wednesday 18 March 2026 Chief Oicer Report Chief Oicer 18 March 2026 Standing Item Chief Finance Oicer Report Chief Finance Oicer 18 March 2026 Standing Item IJB Budget – Medium Term Financial Plan Chief Finance Oicer 18 March 2026 Annual Strategic Commissioning Plan 2026 Head of Planning, Performance & Quality Assurance 18 March 2026 Freedom of Information Requests Business Support Manager 18 March 2026 Quarterly To be included in the Chief Oicer Report. Quarterly reporting submitted to Scottish Information Commissioner.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Oicer Meeting Date Recurrence Reason / Notes Wednesday 17 June 2026 Chief Oicer Report Chief Oicer 17 June 2026 Standing Item Chief Finance Oicer Report Chief Finance Oicer 17 June 2026 Standing Item Unaudited Annual Accounts Report Chief Finance Oicer 17 June 2026 Annual IJB Annual Performance Report Head of Planning, Performance & Quality Assurance 17 June 2026 Annual APR must be published online by 31 July each year Primary Care Improvement Plan (PCIP) Update Chief Oicer / Medical Director 17 June 2026 Annual Public Health Annual Report Director of Public Health 17 June 2026 Annual IJB Self-Assessment Questionnaire (Issue) Business Support Manager 17 June 2026 Annual IJB SAQ approved at IJB in June 2025 to be issued annually Coming Home Report – Dynamic Support Register Head of Adult Social Work 17 June 2026 Biannual Freedom of Information Requests Business Support Manager 17 June 2026 Quarterly To be included in the Chief Oicer Report. Quarterly reporting submitted to Scottish Information Commissioner. Wednesday 16 September 2026 Chief Oicer Report Chief Oicer 16 September 2026 Standing Item Chief Finance Oicer Report Chief Finance Oicer 16 September 2026 Standing Item
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Oicer Meeting Date Recurrence Reason / Notes Audited Annual Report & Financial Statement 2024/25 Chief Finance Oicer 16 September 2026 Annual Audited Annual Accounts must be presented to Board and published online by 30 September each year Audit Scotland - Final Audit Report 2025/26 Chief Finance Oicer 16 September 2026 Annual IJB Self-Assessment Questionnaire (Results) Business Support Manager 16 September 2026 Annual IJB SAQ approved at IJB in June 2025 to be issued annually Probable Suicide 2024 Report TBC 26 September 2026 Annual To be reported annually – date dependant on publishing dates from National Records Scotland (NRS) Alcohol Related Deaths 2024 Report Head of Planning, Performance & Quality Assurance 26 September 2026 Annual To be reported annually – date dependant on publishing dates from National Records Scotland (NRS) Drug Related Deaths 2024 Report Head of Planning, Performance & Quality Assurance 26 September 2026 Annual To be reported annually – date dependant on publishing dates from National Records Scotland (NRS) Wednesday 16 December 2026 Chief Oicer Report Chief Oicer 16 December 2026 Standing Item Chief Finance Oicer Report Chief Finance Oicer 16 December 2026 Standing Item
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD WORK PLAN Item Lead Oicer Meeting Date Recurrence Reason / Notes 16 December 2026 Coming Home Report – Dynamic Support Register Head of Adult Social Work 16 December 2026 Biannual Freedom of Information Requests Business Support Manager 16 December 2026 Quarterly To be included in the Chief Oicer Report. Quarterly reporting submitted to Scottish Information Commissioner. Future Reports