Combined Agenda Pack
North Lanarkshire Council · 22 June 2022
Back to Health and Social Care Integration Joint Board — 22 June 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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A meeting of the IJB will be held on Wednesday 22nd June 2022 at 2pm – 4.30pm via MS Meetings If anyone would like to join this meeting, please contact Stacey Connor on 01698 752594 or by email at Stacey.Connor@lanarkshire.scot.nhs.uk for the relevant information. Chair: Cllr Tracy Carragher AGENDA No Item Action Attachment Reporting Indicative Timings 1. Welcome and Apologies 2pm 2. Declaration of Interests Members are invited to declare any interest in relation to any of the agenda items Board Members 3. Minutes of the Meeting of the IJB held on 23.3.22 For Approval Attachment Chair 4. IJB Action Log For Approval Attachment Christine Jack PERFORMANCE & AUDIT 5. Unaudited Accounts For Noting Attachment Nicola Lynch 6. Finance Report – 2021/22 For Noting Attachment Ross McGuffie 7. Covid Update For Noting Attachment Ross McGuffie 8. Equalities Mainstreaming Report For Endorsement Attachment Morag Dendy GOVERNANCE 9. Risk Register For Approval Attachment Christine Jack 10. IJB Membership For Approval Attachment Christine Jack 11. Investment in IT Infrastructure to support care delivery For Approval Attachment Ross McGuffie STRATEGIC PLANNING 12. Strategic Commisioning Plan For Noting Attachment Morag Dendy 13. National Care Service – Progress Update For Noting Verbal Update Ross McGuffie
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2 14. Annual External Audit Plan For Approval Attachment Ross McGuffie 15. Risk Consider whether, from the business discussed, any new, emerging risks need to be added to the Risk Register, or whether the discussion materially alters the assessed level of risk/risk tolerance and/or the mitigating controls 16. Date of Next Meeting 21st Septemeber 2022 @2pm For Noting
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ITEM 3 Integration Joint Board Committee Minutes from a meeting held on Microsoft Teams on Wednesday 23rd March 2022 at 2pm-4pm Present: Voting Members: Ally Boyle NHS Lanarkshire Nominated Non Exec Director Councillor Paul Kelly (Chair) North Lanarkshire Council Nominated Councillor Councillor Jordan Linden North Lanarkshire Council Nominated Councillor Brian Moore NHS Lanarkshire Nominated Non Exec Director Non-Voting Members: Professional Advisors Alison Gordon Head of Children & Families & Justice Services CSWO of NLC Ross McGuffie Chief Officer, North Lanarkshire HSCP Marie Moy Section 95 Finance Officer Stakeholders Cathy McGinty Staff Side Representative NHSL Elizabeth Seaton Partnership for Change User Rep Harry Robertson Carer Representative John Watson Employee Representative NLC Unison Officer in Attendance: Nick Brown Senior Manager, Community Solutions Stacey Connor Minute Secretary Morag Dendy Head of Planning, Performance & Quality Christine Jack IJB Board Secretary Trudi Marshall Nurse Director NLHSCP Lucy Munro Medical Director NL Des Murray Chief Executive NLC Dr Tyra Smyth General Practitioner (GP) APOLOGIES: Dr Kenneth Dagg Secondary Care Medical Practitioner Mark Dell Communication Manager Euan Dickson Audit Scotland Neil Findlay NHS Lanarkshire Nominated Non Exec Director Maddie Halliday Chief Exec, VANL Third Sector Rep Heather Knox Chief Executive NHS Lanarkshire Councillor Jim Logue North Lanarkshire Council Nominated Councillor Councillor Sandy Watson North Lanarkshire Council Nominated Councillor
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ACTION 1. Welcome and Apologies The chair welcomed everyone to the meeting and introductions were made; apologies were as noted above. 2. Declaration of Interests There was no declaration of interest made. 3. Minutes of Special IJB on 16.2.22 The previous minutes were approved as an accurate reflection of the discussion. 4. Minutes of IJB 8.12.21 The previous minutes were approved as an accurate reflection of the discussion. Brain Moore drew note to item 7 within the minutes which refers to an IT pack coming to a future meeting, Christine Jack will add this to the action log for a future meeting. CJ 5. Minutes of Previous PFA 9.11.21 The previous minutes were agreed as an accurate reflection of the discussion. 6. Matters Arising/ IJB Action Log There were no matters arising. Christine Jack shared an updated action log to reflect the progression of work since the last committee. Some actions have been deferred to the PFA meeting but they will remain on the IJB action log until resolved. The following updates were noted by the committee: Item 9 PCIP– The engagement officer has been redeployed but is due to return to their post so the engagement events will be progressed then; this will be kept on the action log. Item 10 MH Continuing Care Contracted Beds- Linking in with National team and HIS to develop an engagement plan with an aim to complete over the next 3 months. Plan to bring a business case proposal to September IJBs for both North and South Lanarkshire.
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7. Finance Monitoring Report Marie Moy provided a report which provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2021 to 31 January 2022 (Health Care Services) and 4 February 2022 (Social Work and Housing Services). It was noted there is a net underspend of £7.818m on the core budgets within Health Care Services and there is a net underspend of £11.727m on the core budgets within Social Care and Housing Services. All covid 21/22 costs will be funded, uncommitted 21/22 covid funding will be transferred to a ring fenced reserve to meet 22/23 covid costs. Any proposed use of the Covid reserve to meet new expenditure next year that had not been funded this year will require the prior agreement of the Scottish Government in advance of the expenditure being incurred. At paragraph 8.1.3, the overspend on non-pay costs is mainly due to the payments in respect of the Strathcarron Hospice £0.474m. This has been addressed in the IJB Financial Plan 2022/2023. The Health Care underspend is £7.8m. 82% of this (£6.4m) is as a result of vacancies which were 7% at end of January 2022. It has improved slightly at the end of February 2022 – vacancies 5.8%. The significant overspend across the Immunisation Services which is £1.292m at 31 January 2022 has been reported throughout the year and is linked to 1st, 2nd and booster vaccines being rolled out. Costs are being recorded against the correct budget line to ensure fully reimbursed through the Covid funding received from Scottish Government. Harry Robertson queried what is the Scottish vacancy national average in comparison to the Lanarkshire vacancy level, rather than the funds going into reserves should we be looking at alternate models. Ross McGuffie advised it is a national wide issue in terms of recruitment challenges; smaller partnership areas are finding it more difficult. He could not advise the exact figure but advised it will never be a 0% position due to staff turnover. The Integration Joint Board committee noted the following recommendations: Note the contents of the report; Note the confirmation of the additional non-recurring Scottish Government funding to respond to the Covid-19 pandemic and to recover and remobilise health and social care services during 2021/2022; Endorse the principle that uncommitted 2021/2022 Covid-19 funding will be transferred to a ring-fenced reserve to address ongoing Covid- 19 costs in 2022/2023;
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Note that the projected outturn at 31 March 2022 is estimated to be an underspend of at least £23.242m (NHSL - £9.382m; NLC - £13.860m). This excludes the impact of further recruitment challenges and staff turnover associated with new Scottish Government funding; Note that, subject to IJB approval, the North Lanarkshire IJB Business Plan and the IJB Financial Plan 2022/2023 will each be dependent on the 2021/2022 underspend to manage on a non-recurring basis the double-running costs associated with the transformational change programme for a fixed term period and also the balance of unfunded cost pressures in 2022/2023; and Note that the IJB Financial Plan 2022/2023 is the subject of a separate report to the IJB on 23 March 2022. 8. IJB Financial Plan 2022/23 Marie Moy tabled a report which provides an update on the implications of the 2022/2023 grant settlement fop each partner and outlines the IJB Financial Plan for 2022/2023 including details of the budget pressures facing each partner, the key financial assumptions and key risks. It outlines the indicative 2022/2023 contributions from each partner and the proposed approach to address the funding gap. As highlighted at paragraph 6.4, costs are expected to increase by £56.9m. Additional funding totalling £51.396m is being received in 2021/2022. The funding gap is £5.505m. (NHSL - £2.241m; NLC - £3.264m). This will be addressed by: NLC Budget realignments (£3.264m) NHSL Prescribing efficiency savings (£0.387m) A projected recurring underspends across prescribing (£1.493m) Reliance on reserves (£0.361m). A balanced budget for 2022/2023 is therefore deliverable. The increase in cost does not include the Covid costs expected in 2022/2023. At paragraph 7.10, you will see I refer to the additional Scottish Government Covid funding of £32.102m which we are receiving in 2021/2022. Of this, we project £1.238m is required to meet the balance of the 2021/2022 costs. The remainder of the funding totalling £30.864m will be transferred to a ring-fenced reserve to meet 2022/2023 Covid costs. The recurring cost for the Strathcarron Hospice of £0.474m is accounted for. The IJB Financial Plan 2022/2023 highlights the reliance on reserves however it does not set out the complete IJB Reserves Strategy for 2022/2023. This is being prepared and will be finalised on completion of the financial year-end. Reserves are currently being updated by both partners
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and this will be reported in June 2022 and will include exit strategies as appropriate. Marie Moy acknowledged the cost pressures each partner requires to address across other services not delegated to the IJB. Notwithstanding this, both partners are continuing to support the IJB and will pass on all Scottish Government funding received for the services delegated to the IJB. The additional funding will therefore be additional and not substitutional for the services that are delegated to the IJB. Ally Boyle queried about the updated smoke alarm standard for Scotland, has this been included in the financial plan. Marie Moy advised there is not a specific budget for this project as would need to clarify who is responsible for this. Although there is funding available that could be directed to support this. Ross McGuffie advised an update for the digital work will be brought to a future committee which includes this. Brain Moore queried is the demographic growth realistic going forward if we do not utilise covid costs. There are amounts of funding to give some coverage but it is difficult to project demand in future. For covid funding we are holding the funding but need to follow Scottish government guidance when it is issued. The Integration Joint Board committee noted the following recommendations: Note the contents of the report and the cost pressures identified by North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) as set out at section 9; Note the contributions from NHSL and NLC to the IJB for the financial year 2022/2023 as detailed at section 10; Note the funding gap of 5.505mm (NLC - £3.264m; NHSL - £2.241m); Approve the financial strategy to address the funding gap of £5.505m as detailed at section 13; Approve the 2022/2023 notional set-aside budget offer as detailed at section 11; Endorse the budget transfer of £2.024m to the NLC partner in line with the third and final year of the previously agreed corporate savings programme recognising that the IJB will manage the 2022/2023 cost pressures in respect of the Adult Social Care and Housing Services; Approve the overall IJB Financial Plan for 2022/2023 as summarised at section 12; Accept the offer of the financial contributions from NLC and NHSL to the Integrated Joint Board (IJB) for the financial year 2022/2023 as set out at section 10; Note the significant financial risks as detailed at section 14 in particular the risk associated with the ongoing emergency response required to address the Covid-19 pandemic and the RMcG
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uncertainty in respect of the financial implications of the necessary actions being implemented by both partners in 2022/2023; Note that both partners will continue to monitor the financial position and regular reports will be provided by both partners to the IJB as appropriate; Note the requirement to update the IJB Medium to Long Term Financial Plan; Note the requirement to vary the directions to each partner in respect of the financial year 2022/2023 which is the subject of a separate report to the IJB; Note that a mid-year review of the 2022/2023 IJB Financial Plan will be undertaken by October 2022, in consultation with both partners, to test the original assumptions, projections and information for ongoing validity with a view to reprioritising where appropriate. Note the commitment on conclusion of the financial year 2021/2022 and pending IJB approval, to establish ring-fenced and earmarked reserves as appropriate to address projected cost commitments and to mitigate financial risks in 2022/2023; Note the ongoing review of the IJB Reserves Strategy in consultation with both partners; Approve the proposal to continue to adopt for 2022/2023 the current approach for the management of underspends or overspends by the lead partner for the Hosted Service; Note the option to jointly consider a pan-Lanarkshire approach to the establishment of reserves in respect of Hosted Services underspends on confirmation of the year-end outturns for each IJB; Note the ongoing implementation of the transformational change programme as set out in the North Lanarkshire Winter Planning and Enhanced Support Business Plan, and the commitment to ensure the actual costs of services delivered can be contained within the financial envelope available; Approve the delegation of authority to the IJB Chief Officer to finalise the 2022/2023 funding allocations as part of the budget process, in consultation with the NHSL Director of Finance and the NLC Head of Financial Solutions. This will ensure the funding received by each partner is aligned to the actual costs incurred either by the same partner or by the other partner as appropriate. 9. Covid Update Ross McGuffie provided the committee with an update on the current Covid situation for Lanarkshire to date. There are 299 in patients and 54 in off-site beds and 1 patient in level 3 ITU. There are 46 care homes with outbreaks and a further 12 care homes under going investigations. There have been very few admissions to hospital and deaths from care homes showing the vaccination programme is working.
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The figures for delayed discharges has increased with a number of patients awaiting care packages –there are 81 delays and 38 of these patients are awaiting a care home admission which is delayed due to the out breaks. The vaccination programme continues at pace for 5-11year olds roll out and the spring booster campaign has started in line with the national programme. The committee noted the report along with their thanks to all involved in supporting the response to the pandemic. 10. Chryston Business Case Ross McGuffie spoke to a paper which provide an update to the committee on the development of the Chryston community health clinic. From 1st April 2014, Health Board boundaries were realigned with those of the Local Authorities across Scotland, with the aim of reducing administrative barriers and ensuring full alignment with the integration of health and social care services as set out in the Public Bodies (Joint Working) (Scotland) Act. North Lanarkshire Council’s ‘The Plan for North Lanarkshire’ sets out an ambitious estates strategy that looks to develop Community Hubs / Campuses. Further to consideration of this approach, NHS Lanarkshire working in partnership with North Lanarkshire Council, invited hub South West Scotland to deliver a single campus for the replacement of Muirhead Community Health Clinic and Chryston Primary School. Since 14th May 2020 all parties have been involved with site identification, stakeholder engagement and design development of the new facility. In keeping with North Lanarkshire Council’s hub programme guiding principles, there will be two discreet facilities under one roof with the benefits of shared arrangements for car parking, amenities including waste yards, a suite of bookable rooms, staff accommodation that includes touchdown space for community based staff and outdoor space that can be enjoyed by the local community. The site identified was that of Lanrig Park, located in the Chryston area of North Lanarkshire. The Chryston area provides an ideal location for the facility, as it is central and provides the best public transport links to all areas of the Northern corridor. To support the smooth transition, clinical safety and continuity of care there will be an expectation of double running costs for a period of 3 months (£522k). This would equate to an increased cost of £212k for that quarter. In conclusion, this paper confirms that Chryston Community Health Centre has been commissioned by NHS Lanarkshire in partnership with North Lanarkshire Council and will become operationally available for service delivery in August 2023.
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IJB members are asked to support the additional recurring costs of £392k, plus one off double running costs of £212k to support service transfer. The IJB approved the following recommendation: 1) Note the active involvement with the delivery of this capital programme. 2) Note that H&SCNL is progressing with the repatriation of the clinical services from NHS Greater Glasgow & Clyde 3) Approve that the recurring financial gap be built into the future revenue plan for the IJB. 11. Risk Register Christine Jack spoke to a report which provides a summary to the Integration Joint Board on risk management activity and IJB risk register, noting any amendments or additions to the current risk register. There are currently two risks rated as Very High on the IJB risk register. ▪ IJB 08/21 – Financial Implications of Responding to Covid ▪ IJB 09/21 – Impact on the Strategic Plan due to Covid These risks have each been reviewed having regard to the overall financial position and the additional confirmed Covid funding. The risks remain as Very High due to the non-recurring status of the additional funding, the uncertainty in respect of the ongoing Covid-19 pandemic and the ongoing discussions with each partner about the allocation of the available funding to cost pressures. Section 5.5 outlines risks held by NLC and NHS. Particular attention was drawn to risk 2.115 which highlights the risk to the CAMHS service delivering clinical services due to vacancies within the service. The committee is asked to consider when reviewing item 17 if this risk should be added to the IJ register as well as the corporate risk register. This was noted. The IJB noted the following recommendations: The IJB is asked to note the contents of the report which includes; the latest version of the IJB risk register (Appendix 1) and a note of risks from partner agencies that impact upon delivery of IJB business. The IJB is asked to approve the updates and additions to the IJB Risk register as set out in Record of Change (Appendix 2) and noting that the Performance, Finance & Audit Committee (PF&A) reviewed the finance and performance risks contained within the IJB Risk Register at its last meeting in November 2021. The IJB is asked to support further planned developments in 2022 around risk management of IJB business as outlined in section 5.8 of this report.
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12. Ethical Commissioning Morag advised our approach in North Lanarkshire is clearly aligned to the recommendations around ethical commissioning as set out in the Independent Review of Adult Social Care. By reviewing our approach to commissioning services and exploring ways we can award contracts for Health and Social Care without the need for competition where justification exists, demonstrates our commitments to these principles. The majority of the commissioning work sits with NLC but a further report to health approaches can be brought to a future committee if required. Under section 5.3 the Review highlights the importance of personalisation, collaborative commissioning, service design and market sustainability across the sector. The approach has been to maintain a person-centred focus at the core and ensure high quality provision is available across North Lanarkshire. Quality of service delivery that focuses on outcomes for people and not price; fair work practices that demonstrate a valued workforce and consideration of community benefits that support the local economy are key factors in how we procure services. The Market facilitation plan included within the paper supports the work. Ally Boyle asked do we have capacity to ensure contractors are delivering on their promises and also to look at what the collective different of what contractors are delivering is. Also how do we present the difference made overall. Morag Dendy advised the market facilitation plan demonstrates the robustness and tangible ways for individuals and communities. Also working with the independent sector on how to demonstrate best value. The IJB noted the following recommendations: Seeking endorsement of our approach from IJB Seeking promotion of the approach by raising awareness of the position in North Lanarkshire across National networks 13. Model Code of Conduct The purpose of this report is to note the requirement for the Integration Joint Board (IJB) to revise its Code of Conduct in keeping with the new model Code of Conduct and submit the revised Code of Conduct to Scottish Ministers for approval. A revised version has been shared which is applicable to the committee if this approved today it will be submitted to the Scottish Government and the document will be shared with the committee for reference. There were no questions raised by the committee. The IJB noted the following recommendations: The IJB Committee is asked to note the contents of the report which sets out the requirement of the North Lanarkshire IJB to revise its Code of Conduct.
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The IJB is asked to approve its revised Code of Conduct for onward submission to Scottish Ministers for approval. 14. Chief Social Work Officer Report Alison Gordon advised the report shared is the annual report for 21/22 so it contains retrospective content within the report in relation to Adult social work. It has gone through the committee structures within the council and been approved. It provides a summary of the framework for the delivery of social work services, performance and the development activity that has been undertaken. It follows a set format on how we have adapted changes due to the changes in demands throughout the pandemic. In terms of governance it updates on how services are delivered within communities with the strengthening of services through community boards and our own structures. John Watson noted there is great difficulty in filling posts on a permanent basis, what plans are being put in place to address this in particular as we start to recover from the pandemic. Alison Gordon advised there is development of comprehensive strategic plans for the broader council planning inclusive of social care. The committee will have seen some of the work outlined within the business case. In terms of Social workers, looking at working environments and staff conditions to support staff to undertake a rewarding job as well as address contractual issues. There is a strong senior practitioner scheme to support and reward staff who achieve additional qualifications. Some of the developments have been supported by recurrent funding in adult services but this is not the case in children’s services, so work is being undertaking to support this. There are short term funding challenges within the justice services also. John Watson advised unison have been involved with Scottish Government in regard to the promises made. He asked is there any focus on the trauma experienced by frontline to enable managers to have more training. Alison Gordon advised there are trauma champions within the partnership. Brian Moore asked for an update on Mental Health Officers in particular how close we are in having the number of staff required in post. He also noted in relation to substance reviews what can be done to improve service delivery to support this. Alison Gordon advised have focused on trying to build MHO capacity through sessional contracts and the creation of trainee post, which in turn will support substance reviews. Ally Boyle how do we target toward more deprived communities with the most limited opportunities. Alison Gordon noted there are huge opportunities for communities and their carers, they can have in health and social care particularly linked to the care academy.
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The committee agreed the recommendations made. 15. Letters of Direction A report was shared which seeks the approval of the IJB for the issue of the directions to each partner for 2022/2023in line with the IJB Financial Plan 2022/2023. In accordance with the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the North Lanarkshire Integration Joint Board is required to issue a direction to Lanarkshire NHS Health Board and North Lanarkshire Council in respect of the delivery of integrated functions and how resources are to be allocated for the resultant services. Within annex 4 of each letter the financial information is included to back up the direction in totality, so able to set out within detail of the financial envelope in which we operate. The IJB agreed the following recommendations: (1) Approve the issue of the directions to North Lanarkshire Council for the financial year 2022/2023 attached at appendix 1; and (2) Approve the issue of the directions to Lanarkshire NHS Health Board for the financial year 2022/2023 attached at appendix 2. 16. Strategic Commissioning Plan Health and Social Care North Lanarkshire published its ten-year strategy Safer, Healthier, Independent Lives in 2016. Strategic Commissioning Plans (SCP) have been produced to outline the key intentions to be delivered, initially annually (2016-17, 2017-18, 2018-19, 2019-20) then a three-year plan for 2020 – 23. The 2023 – 2026 SCP will be the final plan within the ten- year strategy. The SCP is crucial to achieving the strategic ambitions for people in North Lanarkshire. There is wide engagement designed to really share, listen and act is needed in the complex whole system approach. Activities throughout 2022 will be undertaken in a co-ordinated and co-operative way, aspiring to be increasingly co-productive in the future. Appendix 1 within the report illustrates the development of the plan and outlines timelines. It is anticipated that the draft plan will come to the committee by December with final comments and submission to be approved in March 2023. Priorities of the plan will be influenced by what is currently going on. Ally Boyle questioned how do we ensure participants are not confused if asked similar questions at different times for different projects. Also how does consultation work with hosted services. Morag Dendy advised involve partners from the wider NHSL planning teams and colleagues in South to
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ensure engaging effectively to ensure it is done once rather than asking a number of similar questions at different occasions. The IJB agreed the following recommendations: 1. Seeking endorsement of our approach from IJB 2. Seeking promotion of the approach to encourage wide participation in the development of the 2023 – 2026 Strategic Commissioning Plan. 17. Mental Health & Wellbeing Strategy –Progress Update on CAMGS & Psychological Therapies The purpose of this report is to provide an update on progress with the implementation of the Mental Health & Wellbeing Strategy with a particular focus on; o Adult Psychological Services o Children & Adult Mental Health Services o Neuro Developmental services for Children (NDS) Ross McGuffie advised there are new national service specifications that need to be met by the services and the paper sets out the progress against these. The demand for Mental Health services has stayed static but have seen an increase in urgent demand particularity in psychological therapies. The RTT performance is positive which is different from reality. Seeing significant number of urgent cases which are seen within 48 hours which will artificially affect the figure. The wait times for the service remains high. As of March 2023 the waiting time target will be 100% which has never been met by Health Boards previously. Seen more demands than expected but starting to see recovery also. The lower tier interventions will be vital in terms of recovery, will use the capa model for CAMHS meaning any new referrals will be seen be a senior decision maker initially to allow them to be redirected quicker to appropriate services. Brian Moore asked is this new funding recurring for both CAMHS and psychological therapies. Ross McGuffie advised at present it is not recurrent but there has been letters from the Scottish Government that advise they are fully expecting it to become recurrent and they have advised to recruit to posts on a permanent basis. The IJB agreed the following recommendations: The IJB is asked to note the direction of travel in relation to the modernisation programme for CAMHS and implementation of national specification for NDS. The IJB is asked to note progress in recovery of waiting times for adult psychological therapies and plans in place to achieve performance objectives subject to successful recruitment.
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18. National Care Service-Progress Update The purpose of this report is provide IJB members with an overview of the Scottish Government’s published analysis of the responses to its consultation on A National Care Service for Scotland published on 10 February 2022; and raise awareness of the significance and scale of the proposals ahead of legislation being brought forward. It is likely will not receive any further information on the scope of the service until after the elections The primary legislation will be at a high level and the plan is to create secondary legislations to support this at a later date which is part of learning from the current model and will allow more flexibility. Des Murray noted the Scottish Government were going to announce this earlier but there is a debate around children services; if they should be within scope going forward. The deputy 1st Minister will be launching the implementation plan around the promise which will link to the National Care Service. Brian Moore noted little reference to linkages between partnerships and the acute sector. The IJB agreed the following recommendations: The IJB Committee is asked to note the contents of the report which sets out the requirement of the North Lanarkshire IJB to revise its Code of Conduct. The IJB is asked to approve its revised Code of Conduct for onward submission to Scottish Ministers for approval. 19. Community Solutions Strategy & Investment Plan 2022-25 The purpose of this report is to: present the Community Solutions Strategy and Investment Plan 2022-25 for review and approval. The plan is presented earlier than required but this has been brought forward due to the pandemic. The report looks at what has been delivered already summary on page 8 on the range of investment managed through the funds value of £.4.5m which is a combination of recurrent and non-recurrent sources. Have attracted significant match funding. Community Solutions is a successful, HSCNL cross-sector health and social care investment and improvement programme for North Lanarkshire, established in 2012, which is improving people’s health, wellbeing, quality of life and equality by investing in community-led initiatives which build community, family and individual strengths and resources - with a focus on prevention and early intervention.
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The new Community Solutions Strategy and Investment Plan provides the basis for strengthening and expanding the reach and the impact of the programme over the next three years, building on previous progress. Ally Boyle queried in section 5 under priority groups it states people effected by cancer effecting wider family network but next part refers to only the individual should there be a difference. Morgan Dendy and Nick Brown both advised it should be inclusive so may just require some final tweaks to the wording within the report. The IJB approved the Community Solutions Strategy and Investment Plan 2022-25. 20. Risk The chair proposed to the committee to add CAMHS recruitment to the IJB risk register in relation to today’s discussion and considering the risk already on the corporate register. The committee agreed this action, Christine Jack will update. CJ 21. Date of Next Meeting 22nd June 2022 @ 2pm
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ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 1. 30/10/18 Item 11 Reserves Strategy M Moy To develop a reserves strategy on receipt of national guidance on setting minimum levels of reserves. In the interim period a local reserves strategy will be progressed. Update September 2021: The IJB Reserves Strategy 2021/2022 was approved by the IJB on 22 June 2021. This report provided an update on the review of the existing IJB reserves and new reserves were established in line with planned commitments and Scottish Government guidance. Update on Exit strategies to be presented to PF& A in November 2021 8.12.22 Update provided within report Medium to Long Term Financial Planning. Further work being undertaken to confirm exit plans and ongoing areas of work. June 2021 November 2021 – deferred to IJB December 2021 Complete Ongoing
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March 2022 – Update provided within Financial Plan Report 2. 26.5.20 Item 10 Internal Audit Report – Due Diligence Review M Moy Further update on the disaggregation of the children, families and justice social work services budget to be presented to the IJB. Update September 2021: The progress in respect of this action is regularly reported to the IJB (Performance, Finance and Audit) Committee. The updated report to the IJB (Performance, Finance and Audit) Committee on 24 August 2021 advised that the budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Work is continuing to progress in respect of the hosting arrangements for cross-cutting and support services. The original timeline of March 2021 has therefore been extended to the revised timeline of September 2021. The Service Level Agreement for the future hosting arrangements and associated budgets will be presented to the IJB following consultation and endorsement by the NLC Adult Health and Social Care Committee and Education and Families Committee. A further report will therefore be presented to the next meeting of the IJB (Performance, Finance and Audit) Committee on 9 November 2021. September/December 2020 Deferred to March 2021 – deferred to September 2021 – deferred to November 2021 Update March 2022 - Further work required to conclude agreements around hosting arrangements. Original Action complete with further update on hosting arrangements presented to PF&A in November 2021. Ongoing – Update be provided by September 2022.
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3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. 21.9.21 – Report presented setting out proposed use of a Change Fund. Progress reports on each element of the proposed plan to be presented to the PF&A March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action. Ongoing 4. 9.12.20 Item 6 & Item 11 Addictions services M Dendy 1. An update on accommodation issues affecting the delivery of the addiction services was requested. 21.9.21 – verbal update given – work ongoing to resolve accommodation issues. 2. Update requested on funding commitments. ADP strategy presented and approved at IJB on 21.9.21. Request for detail on commissioning of services, evidence of benefits and achievements and timelines for implementation of funding commitments to be brought back to IJB. 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 August 2022 Ongoing Ongoing- delegated to PFA to complete action 5. 9.12.20 Item 7 Category One Responders M Dendy An update on this issue was to be provided at the next meeting of the IJB following the completion of the consultation exercise and any further feedback from S Government. March 2021
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Update provided on 23.3.21 and a further update will be provided following completion of the engagement events with Chief Officers and IJB Chairs 21.9.21 – Update provided highlighting confirmation of named officers with lead responsibility. Further updates to be provided following anticipated national workshops. September 2021 December 2021 Item to remain on action log pending further guidance being issued by S.Govt. All other local actions completed. 6. 23.3.21 Item 6 Localising management of Community Mental Health services R McGuffie 1. Paper to be shared with SL H&SC Partnership 2. Following approval at SL IJB, directions to NHSL be updated & noted at NHSL Board meeting. Update September 2021: Paper was approved at South Lanarkshire IJB and details to be included within directions issued to NHSL Board by South Lanarkshire IJB. December 2021 - Advice being sought on any requirement to amend the Integration Scheme to note the revised hosting arrangements. April/May 2021 December 2021 March 2022 1. Complete 2. Complete 7. 22.6.21 Item 6 Whistleblowing R McGuffie An agreement with NLC was to be developed to ensure a clear process for all H&SC NL staff. An annual report to be provided to the IJB March 2022 – draft guidance shared with NLC and awaiting comment December 2021 September 2022 Ongoing 8. 21.9.21 Item 7 Finance Strategy - Strathcarron Hospice Update on future funding arrangements for Strathcarron Hospice to be to be presented within financial planning strategy. 8.12.21 - Update included in agenda item on Medium December 2021 Reference to funding included within IJB Financial Plan – March 2022 – Complete
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to Long Term Financial Plan and further update t be provided within IJB Financial plan in March 2022. 9. 21.9.21 Item 7 Primary Care Implementation Plan Dr L Munro 1. An update on planned engagement events with local people on the primary care implementation plan was requested. Update provided and noted at March 2022 IJB 2. Memorandum of Understanding to be shared December 2021 November 2021 Verbal update to be provided in June 2022 Complete 10. 22.9.20 Item 5 Mental Health Continuing Care Contracted Beds R McGuffie Issue not progressed as planned during 2020 as engagement process postponed due to lockdown impact on visits to care homes. 21.9.21 Business Case to be developed and presented to IJB, South Lanarkshire IJB and NHSL Board. 22.3.22 – Update provided on progress on engagement and development of business case June 2022 September 2022 Business case to be presented at IJB September 2022 11. 21.9.21 Item 16 Best Value Audit M Dendy An update on the Self Evaluation exercise is to be presented to the PF&A committee. February 2022 – deferred to August 2022 as engagement event took place after PF&A meeting Delegated to PF&A for completion – August/September 2022 14. 8.12.21 Item 14 Integration review - Chief Financial Officer R McGuffie Following approval to proceed from the IJB, reports were to be presented to NLC and NHSL Board to seek support for preferred option. 16.2.22 Update on progress provided at PF&A meeting. HR process being progressed 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. March 2022 June 2022 Ongoing – verbal update to be provided at IJB meeting in June 2022 ACTION LOG – ITEMS DEFERRED DUE TO COVID
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NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 2.1 24.9.19 Item 7 Primary Care Implementation/GP OOH L Munro 1. Updated report on GP OOH services to be provided that outlined options for a more sustainable two centre model. March 2020 (revised to December 2020) Deferred due to Covid – 19 Verbal Update on recent actions on GP OOH service to be provided at IJB in June 2022.
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Page | 1 REPORT Item No: 5 SUBJECT: Unaudited Annual Accounts 2021/2022 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie Chief Officer Author(s) of Report Nicola Lynch Business Finance Manager, NLC Fiona Porter Deputy Director Finance, NHSL DATE: 22nd June 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) for: For approval For endorsement To note 1.2 This report provides an overview of the unaudited IJB Annual Accounts for the financial year 2021/2022 in line with the legislative requirements. 2. ROUTE TO THE INTEGRATION JOINT BOARD: 2.1 This paper has been: Prepared By; Business Finance Manager, NLC Deputy Director Finance, NHSL Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) that the Annual Governance Statement and the continuous improvement actions included in the IJB Annual Accounts for 2021/2022 are endorsed; (2) that the unaudited IJB Annual Accounts for 2021/2022, as appended to this report, be noted; (3) that the arrangements for publication of the IJB Annual Accounts for 2021/2022 in line with the legislative requirements be noted; and (4) that authority is delegated to the Acting Chief Financial Officer to amend the IJB Annual Accounts for 2021/2022 before the publication date of 30 June 2022 to reflect feedback from the IJB.
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Page | 2 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Public Bodies (Joint Working) (Scotland) Act 2014 was passed by the Scottish Parliament on 25 February 2014 and received Royal Assent in April 2014. The IJB is a legal entity in its own right, created by Parliamentary Order, following Ministerial approval of the Integration Scheme. 5. BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.2 NHS Lanarkshire and North Lanarkshire Council have delegated functions to the IJB which has the responsibility for strategic planning, resourcing and ensuring delivery of all integrated services. 5.3 The IJB is specified in legislation as a “section 106” body under the terms of the Local Government Scotland Act 1973. It is therefore expected to prepare Annual Accounts in compliance with the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2016/2017 (the “Code of Practice”) and the International Financial Reporting Standard (IFRS). 6. CONCLUSIONS 6.1 This report provides the unaudited IJB Annual Accounts for the financial year 2020/2021 in line with the legislative requirements. 7. IJB ANNUAL ACCOUNTS 2021/2022 7.1 The unaudited IJB Annual Accounts 2021/2022 are attached as an appendix. The Annual Accounts have been prepared in line with proper accounting practice but remain subject to audit by Audit Scotland. 7.2 As prescribed by the Local Authority Accounts (Scotland) Regulations 2014 and in line with the previous year, the unaudited Annual Accounts will be available for public inspection in the Council Offices for a three week period from Friday 1 July 2022 until Friday 22 July 2022 inclusive. The Regulations also require publication of the Annual Accounts on the IJB’s website. The unaudited Annual Accounts are therefore available online from 1 July 2022 until the date the audited Annual Accounts are published. 7.3 Under normal circumstances, the IJB Annual Accounts 2021/2022 should be published by 31 October 2022 and any further reports by External Auditor by 31 December 2022. The Independent Auditor’s Report and the External Audit Annual Report will be available by 26 October 2022. Following completion of the external audit and having taken into consideration any findings reported by Audit Scotland, the audited IJB Annual Accounts 2021/2022 will be submitted to the IJB (Performance, Finance and Audit) Committee for approval in November 2022. The IJB Annual Accounts 2021/2022 will thereafter be available in both hard copy and on the website for at least five years, together with any further reports provided by the External Auditor that relates to the audited accounts. Yes No N/A
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Page | 3 7.4 The Acting Chief Financial Officer, supported by the Director of Finance of NHS Lanarkshire and the Head of Financial Solutions for North Lanarkshire Council, is following the Audit Scotland and LASAAC guidance and will make any further changes necessary in order to ensure compliance with best practice before publication. The IJB is asked to delegate authority to the Acting Chief Financial Officer to amend the IJB Annual Accounts for 2021/2022 before the publication date of 30 June 2022 to reflect feedback from the IJB. 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES This report relates to all national outcomes as effective governance arrangements will ensure that the IJB can fulfil its statutory duties. 8.2 ASSOCIATED MEASURE(S) None. 8. IMPLICATIONS (CONT.) 8.3 FINANCIAL 8.3.1 This paper has been reviewed by Finance: Yes No N/A 8.3.2 The main risk associated with the IJB is that one or both partners could overspend. The risk has been closely managed by each partner during the financial year under review. The budget monitoring arrangements in place ensured that corrective action could be taken including the use of the contingency reserve as appropriate to address increases in demand for health and social care services. 8.3.3 The Director of Finance of NHS Lanarkshire and the Head of Financial Solutions for North Lanarkshire Council were both consulted on the content of this report. 8.4 PEOPLE None 8.5 STAKEHOLDER ENGAGEMENT There has been consultation between the Chief Financial Officer and the External Auditor in respect of the External Audit Plan and the requirements to support the external audit within the agreed timeline. 8.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A
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Page | 4 8.7 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 9. BACKGROUND PAPERS None 10. APPENDICES Appendix 1: North Lanarkshire Integration Joint Board Annual Account 2021/2022 ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 5 NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS UNAUDITED 2021/2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 6 CONTENTS Management Commentary Page 3 Statement of Responsibilities 14 Remuneration Report 15 Annual Governance Statement 18 Comprehensive Income and Expenditure Statement 29 Movement in Reserves Statement 30 Balance Sheet 31 Notes to the Financial Statements 32 Audit Arrangements 44
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 7 MANAGEMENT COMMENTARY Introduction The North Lanarkshire Integration Joint Board (IJB), which was established as a body corporate by order of Scottish Ministers under the Public Bodies (Joint Working) (Scotland) Act 2014, became operational in June 2015 with integrated delivery of health and social care services commencing on 1 April 2016. The functions delegated by North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) to the IJB are detailed in the Integration Scheme. The North Lanarkshire Health and Social Care Partnership (HSCP) refers to the joint working arrangements between the partners NLC and NHSL. The IJB is a separate legal entity which is responsible for the strategic planning and commissioning of the wide range of health and social care services across North Lanarkshire. The partnership is responsible for the operational delivery of the IJB’s strategic directions. The purpose of the IJB is to improve the wellbeing of people who use health and social care services and their carers’ and to deliver on the nine national health and wellbeing outcomes. There are multifaceted factors which impact on the demand for health and social care services across North Lanarkshire which is the fourth largest and fifth most densely populated area in Scotland with a population of 341,140. The increase in the age group of people 65 years and over is projected to be 20.2% by 2028 and 39.6% by 2043. 110,563 residents live in the worst 20% datazones and it is estimated that 36% of North Lanarkshire residents have a limiting long-term illness. This management commentary provides an overview of the key outcomes relating to the objectives and strategy of the IJB. It considers our financial performance for the year ended 31st March 2022 and provides an indication of the issues and risks which may impact upon our finances in the future. The Role and Remit of the IJB The IJB has responsibility for the strategic planning and commissioning of the following services: accident and emergency services provided in a hospital; inpatient services related to general medicine, geriatric medicine, rehabilitation medicine, respiratory medicine and palliative care services in a hospital; community health services including Lanarkshire-wide (hosted) services; and social care services. The IJB is made up of eight voting members: four Elected Members appointed by NLC and four Non-Executive Directors appointed by NHSL. Non-voting members of the Board include the Chief Officer, the Chief Social Work Officer, the Nurse Advisor, the Medical Advisor, the Chief Financial Officer, the Registered Medical Practitioner and representatives for staff, the third sector, service users and carers. In March 2019, the IJB approved the Strategic Commissioning Framework1 for the period 2019 to 2022 and issued in March 2021 IJB Directions2 for 21/22 to each of the partners to achieve safer, healthier, independent lives for the residents of North Lanarkshire. The IJB’s Business Model and Strategy 1 https://mars.northlanarkshire.gov.uk/egenda/images/att90476.pdf 2 https://mars.northlanarkshire.gov.uk/egenda/images/att93865.pdf
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 8 The business model for the IJB is managed through key leadership groups which are aligned to both partners’ objectives. Front-line service delivery continues to be carried out by NLC and NHSL across six localities in line with the directions from the IJB. The directions from the IJB to NHSL and NLC outline what the IJB requires both bodies to do, the funding allocated to these functions, and the mechanisms through which the performance in delivering the directions will be monitored. Strong financial planning and management, the achievement of best value and the allocation of resources to support sustainable models of service delivery from a whole system perspective underpin everything that the IJB and the partners do to ensure our limited resources are targeted to achieve our outcomes.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 9 The IJB’s Outcomes for the Year The 2021/22 financial year was dominated by the response to the pandemic, though performance across all key HSCP areas continued to be reported to the IJB throughout the year as set out in pages 8 and 9. Some of the key outcomes for individuals in North Lanarkshire are summarised below: Following the World Health Organisation’s declaration of a Covid-19 pandemic on 12 March 2020, command structures were initiated in North Lanarkshire Council and NHS Lanarkshire, alongside those through the Lanarkshire Resilience Partnership. The IJB exercised agile governance principles and the Chief Officer participated as a full and active member of North Lanarkshire Council and NHS Lanarkshire’s Gold Command structures and the Lanarkshire Resilience Partnership. The IJB is now included as a Category 1 Responder. The delivery of the Covid-19 vaccination programme progressed at pace throughout 2021/22, reaching over 548k individuals in Lanarkshire and delivering over 1.5m doses in total by the end of the financial year. As part of the pandemic response, the partnership hosted a pan-Lanarkshire Care Home Assurance Group, bringing together key HSCP partners, NHSL/NLC/SCL service leads and the Care Inspectorate to provide additional support and assurance around the safe delivery of care within the Care Home sector. Similarly, a joint group was formed for Care at Home services. This led to a wide range of quality and assurance activities across both sectors, whilst enabling the sharing of best practice and implementation of consistent approaches across Lanarkshire as a whole. A whole system approach has been adopted to increase the resilience of community health and social care services including statutory services, independent providers and the third and voluntary sector through the redeployment of staff, increasing existing staff capacity and the reliance on volunteers. Partners and staff have embraced different ways of working and new technologies including remote service delivery and the use of telephone and Near Me (video) consultations to minimise footfall and enable face-to-face consultations for patients and service users who need it the most. In the latter months of the 21/22 year, restrictions have continued to ease, creating opportunities to increase footfall on sites and subsequently face to face consultation, though the focus has been on ensuring that the positive gains made during the pandemic around hybrid working are maintained. This will ensure we maintain flexible and adaptable models of service delivery for staff and our service users alike. Significant work has been undertaken to continue to align the Remobilisation Plan with the Strategic Commissioning Plan 2020-2023 ambitions and the Programme of Work. 53 service reviews have been undertaken to refresh the key priorities for 2021/2022 and to build on the recovery plans. Many aspects of the Programme of Work had moved forward more quickly due to the emergency response to the Covid-19 pandemic. Engagement continued with stakeholders to develop the detail of the plan. Response, Redesign and Recovery groups have been established to remobilise services. Remobilisation plans continued to be developed and updated throughout 2021/22, with some services significantly impacted by the ongoing pandemic response.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 10 Through clinical prioritisation, some community services were paused to free staff to support service delivery within the acute sector due to the overwhelming pressures being experienced. Waiting times have continued to prove challenging across a range of services and while we have seen strong recovery in services such as Psychological Therapies and Podiatry, others like CAMHS and Children and Young People’s Speech and Language Therapy continue to be areas of high risk. Remobilisation plans have been updated accordingly. In February 2022, the IJB approved the winter plan and enhanced support business case, which focused on prevention and early intervention, empowering individuals and communities and improving efficiency by working as a whole system. Key developments contained within included: o Creation of new Home Assessment teams in each Locality to support both earlier discharge and rapid community response to prevent admission o Expanded Integrated Rehabilitation Team and Reablement capacity to enable a greater local focus on maximising independence o Expanded capacity within the Equipment and Adaptation service to support rapid deployment of equipment to enable the safe roll out of the model described above o Expanded Home Support capacity to meet growing demand o Creation of new roles within Community Nursing teams to focus additional supports on the Care Managed Caseload (those at highest risk of hospital admission within the community) o Roll out of digital community alarms and the creation of a Technology Enabled Care team to support Localities to maximise the innovative use of TEC o Extended hours and service model to include both admission prevention and discharge support within Hospital at Home o Support for the Independent Sector SDS suppliers, including support at home. In line with North Lanarkshire Council’s Delivering for Communities report, the HSCP finalised its structural changes, ensuring strong and proactive systems and processes to maximise the use of the Community Boards as a key vehicle for participation and engagement. A wider review of participation and engagement was commissioned in 21/22, led independently via Voluntary Action North Lanarkshire, with the outputs and recommendations due to be reported to the IJB for implementation in 22/23. The mixed market of provision supports genuine choice and control for people. This has seen a significant investment in the relationship with the 19 independent sector providers on the Self-Directed Support Framework. This relationship offers greater flexibility to achieving outcomes, promotes inclusion and connection and incorporates digital responses. This requires trust, co-operation and a partnership approach between all stakeholders. The operating model supporting individual budgets has also developed to ensure financial stability for providers whilst ensuring
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 11 best value for people considering the use of their indicative budget. Choice and control are further promoted through the option of people receiving their individual budget as a direct payment. The Carers (Scotland) Act 2016 came into force on 1st April 2018. North Lanarkshire Carers Together is the overarching carer information service in North Lanarkshire, overseeing a range of information and advice services relevant to carers’ needs. They work in partnership with health and social care, community and voluntary sector colleagues to identify and to support hard to reach carers. North Lanarkshire Young Carers Project also supports young carers aged 8-18 (or age 18 and still at school). They raise awareness, identify and provide direct support to children and young people who look after or help to look after someone in their family who is unwell or disabled, including children caring for parents who have mental health or substance misuse problems. Mental Health and Learning Disability Services are a hosted service which is managed and strategically led within North Lanarkshire on behalf of both HSCPs. The Lanarkshire Mental Health and Wellbeing Strategy set in progress a range of service improvements for all age groups. Access to mental health services expanded in Accident and Emergency Departments, police custody suites and prisons as a result of the availability of Action 15 funding. Through the Mental Health Recovery and Renewal Funding, a range of service developments are underway, including: o Psychological Therapies: roll out of Assessment Plus (a guided self-help intervention delivered by a range of Psychologists); roll out of ACCEPT programme (delivered by Applied Psychologists to support those living with long term conditions in the community); Psychological supports for Adults living with Learning Disabilities; expended digital interventions; expanded Neuropsychology offering; expanded Eating Disorders provision; and expanded Psychological Therapies provision. o CAMHS: roll out of the Choices and Partnership Approach (rapid triage and collaborative consulting model); full implementation of the national service specification including expanded age range; creation of a new CAHMS facility in Udston Hospital, co-designed with those with lived experience; creation of the Neurodevelopmental Service. o Perinatal and Infant Mental Health: development of perinatal and infant mental health teams including recruitment of Multi-Disciplinary Teams (MDT), training etc, with services now open to referrals; development of Maternity and Neonatal Service embedded within Maternity services with MDT recruited and open for referrals. A wide range of stakeholder engagement was undertaken to support the Alcohol and Drug Partnership (ADP) to develop its Strategic Plan and associated Investment Plan in line with national evidence, regional scoping work and learning from commissioned services. Following an in-depth review of the governance structures, the IJB approved in September 2021 the new arrangements, including five subgroups that will support delivery on the Partnership Delivery Framework; National Mission - Rights Respect and Recovery; National Alcohol Framework; and the Ministerial priorities.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 12 The development of urgent care pathways continued in 21/22, with a new single point of access through NHS24 and the Flow Navigation Centre. Mental Health hubs were developed, greatly reducing the waiting times spent within ED departments. Through opening up direct access to MH services via police triage, the percentage of individuals maintained in the community has increased substantially from 28% in 2019 to 62.5% in 2021. The IJB participated fully in the consultations on the National Care Service, working collaboratively with North Lanarkshire Council and NHS Lanarkshire as part of the process. As part of the process, the HSCP undertook a self-assessment against all aspects of the report to support identification of any potential strengths and gaps for the future. This led to some more detailed areas of work, such as a review of ethical commissioning in North Lanarkshire, which was presented to the IJB in March 2022. The IJB undertook a Best Value Audit in conjunction with the Improvement Service, in advance of future formal IJB audits on Best Value being introduced in 2022/23, running through to 2026/27. Following the self-assessment exercise, an improvement plan has been developed and will be signed off by the IJB in 22/23. New whistleblowing standards were approved by the IJB, which bring a consistent approach to how the IJB alongside its NHSL and NLC partners will manage whistleblowing cases in future. The whole system approach undertaken included joint presentation to the IJB by the NHSL and NLC leads to ensure a once for North Lanarkshire approach. In June 2021, the IJB approved the roll out of the McMillan Cancer Support Improving Cancer Journey (ICJ) programme, bringing £2m of non-recurring funding into the two Lanarkshire partnerships to develop support over a five-year period for those affected by and recovering from a cancer diagnosis. Through the Community Solutions programme, a strategic funding programme for the community and voluntary sector managed by VANL, the third sector interface in North Lanarkshire, the partnership has invested in a number of condition specific, locality based services which offer information, activities and support to carers. The Community Solutions Programme (CSP) has made a significant contribution to supporting vulnerable groups and communities during the Covid-19 pandemic. The CSP utilises eleven project hosts to guide best practice (e.g. in physical activity; healthy eating; anticipatory planning; transport etc) and six locality host organisations to ensure a truly community led approach. Crucially, the IJB has confirmed recurring funding of £1.141m to the CSP to ensure stability and continued development with VANL as a key strategic partner. In collaboration with North Lanarkshire Council and NHS Lanarkshire, a new community campus in Chryston is now under construction, that will see primary education, community and health and social care facilities created in Chryston. This will support the repatriation of a number of community health services for the Northern Corridor area that are currently provided via SLA by NHS Greater Glasgow and Clyde, creating equitable service provision across the North Lanarkshire area.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 13 The IJB’s Financial Position at 31 March 2022 The delegated funds for the IJB come from NLC and NHSL. The level of funding available to the IJB is therefore heavily influenced by these organisations’ grant settlements from the Scottish Government. The IJB Financial Plan 2021/2022 was approved by the IJB on 23 March 2021. Demographic growth, inflationary cost pressures and national priorities were originally projected to increase costs by £20.426m in 2021/2022. Additional funding invested in the HSCP totalled £18.719m. The funding gap was therefore £1.707m. In order to address this, savings totalling £1.453m within NLC were approved and the remaining £0.254m was proposed to be addressed by the achievement of the Prescribing Quality and Efficiency Programme target. The actual expenditure incurred in 2021/2022 is detailed at note 4 on page 36 and is compared to the actual expenditure incurred in 2020/2021 and 2019/2020 in the graph below. The final year-end underspend at 31 March 2022 is £74.670m (NHSL - £58.697m; NLC - £15.973m). Expenditure incurred against reserves in 2021/2022 is £8.336m (NHSL - £7.564m; NLC - £0.772m). The surplus on the provision of services and total comprehensive income and expenditure in 2021/2022 is therefore £66.334m. Information on the significant variances across health and social care services are highlighted as follows:
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 14 Of the £58.697m NHSL underspend the most significant variances are within the hosted services led by the North Lanarkshire HSCP of £16.596m which includes underspends of £10.328m in Mental Health & Learning Disability Services and £5.285m in Children and Adolescents Mental Health Services. The IJB’s Financial Position at 31 March 2022 (CONTD.) There is also an underspend in Locality and Other services (£4.549m), Addiction Services (£2.336m), Prescribing (£1.500m) and Primary Care and Mental Health Transformation Fund and the Primary Care Improvement Fund (9.796m). Of the £15.973m NLC underspend £6.400m is in relation to the Scottish Government Funding for winter planning and £0.843M across carers budgets both of which will be carried forward to ring-fenced reserves. There is also a £7.987m underspend within the care at home sector predominantly relating to staff shortages. Covid-19 funding totalling £45.098m was received from the Scottish Government in 2021/22 of which £13.412m was incurred in 2021/2022 and £31.686m will be transferred to a ring-fenced reserve to meet ongoing Covid-19 costs in 2022/2023. The planned commitments in respect of the additional funding of £6.400m which was received in December 2021 from the Scottish Government for winter planning system pressures will be incurred in 2022/2023. Additional allocations received from Scottish Government which remain unspent at year end and will be added to IJB reserves for use in future years include the following main areas: - o ADP £1.931m o CAMHS £9.109m o Multi Disciplinary teams £1.160m o Additional healthcare support workers £0.634m o MH Action 15 £3.016m o Distress brief Interventions £1.444m o MH Recovery – Facilities £1.840m The total underspend of £74.670m represents approximately 9% of the total financial envelope available. The total savings target was £2.688m and the value of the savings target achieved was £2.554m (95%). The underachievement of savings totalling £0.134m (5%) was addressed by Scottish Government funding for proposals delayed as a consequence of the Covid-19 pandemic.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 15 Annual Accounts 2021/2022 The financial outturn for the year ended 31 March 2021 is therefore a surplus of £66.334m. This is highlighted on the Comprehensive Income and Expenditure Statement on page 29 and is also included in the Movement in Reserves Statement on page 30. The total movement on reserves at 31 March 2021 is a net increase of £66.334m. The final year-end underspend of £74.670m and the movement in reserves of £66.334m are reconciled in the table below. Financial Outturn 2020/2021 Movement In Reserves Reduction / (Increase) Returned to Partner £m £m £m NLC - General Underspend 15.973 (15.973) NLC -HRA Underspend 0.302 (0.302) NLC - Net Underspend 16.275 (15.973) (0.302) NHSL Underspend 58.697 (58.697) Total As At the 31 March 2021 74.972 (74.670) (0.302) Expenditure incurred against reserves in 2020/2021 8.336 Deficit or (surplus) on provision of services and total comprehensive (income) and expenditure (Page 29 and Page 41 Note 11) (66.334) The services which are hosted by the North Lanarkshire IJB on behalf of the South Lanarkshire IJB and the hosted services which are led by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB are detailed in note 10 on pages 39 to 40. In line with the Integrated Resource Advisory Group Finance Guidance, the lead partner for a hosted service is responsible for managing any overspends incurred. With the exception of ring-fenced funding, the lead partner can also retain any underspends which may be used to offset the overspends. This arrangement has been in place since 1 April 2016. The North Lanarkshire IJB and the South Lanarkshire IJB endorsed this principle in respect of 2021/2022.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 16 During the year, £8.336m was drawn from the IJB reserves. Of the total underspend of £74.670m reported at 31 March 2022, £31.686m (42%) was transferred to ring- fenced reserves, with the remainder of £42.984m (58%) being added to the earmarked reserve. The net transfer to reserves was therefore an increase of £66.334m. The balance on the IJB reserves at 31 March 2022 is £119.452m. The ring-fenced (£45.718m), earmarked (£70.050m) and contingency reserves (£3.684m) are detailed at note 11 on page 41. It is good financial management to maintain a contingency reserve. The contingency reserve represents 0.5% of the total IJB financial envelope. There continues to be a significant element of financial risk associated with the ongoing response to and consequences of the Covid-19 pandemic. The Chief Finance Officer and both partners will continue to confirm the Covid-19 pandemic costs which will require to be set against the remobilisation and recovery plan. In order to ensure financial sustainability during the pandemic and post-pandemic, the IJB Medium to Long Term Financial Plan will be updated. The North Lanarkshire IJB was established under the Public Bodies (Joint Working) (Scotland) Act 2014 and falls within section 106 of the Local Government (Scotland) Act 1973. The annual accounts are therefore prepared in accordance with the Local Authority Accounts (Scotland) Regulations 2014. Matters of Strategic Importance The IJB Financial Plan 2022/2023 was approved on 23 March 2022. Including the cost of the previously approved North Lanarkshire Winter Planning and Enhanced Supports Business Case, costs are projected to increase by a total of £56.901m and funding is projected to increase by £51.396m. The funding gap of £5.505m will be addressed by budget realignments (£3.264m), a projected recurring prescribing budget underspend (£1.493m), prescribing efficiency savings (£0.387m) and reliance on reserves (£0.361m). In respect of demographic growth and demand for services, research indicates that expenditure on healthcare would require to increase in real terms by an average of 3.3% per annum over the next 15 years to 2033 in order to maintain NHS provision at current levels. Social care funding would also require to increase by 3.9% per annum to meet the needs of the population living longer and an increasing number of younger adults living with disabilities. These projections do not take into account the impact of the Covid-19 pandemic including long-Covid, the financial cost of which continues to be uncertain but is expected to be significant. The impact of Covid-19 on health and social care services and the economy as a whole is unprecedented in recent times and has increased the risk of an overspend. Governance arrangements continue to be in place for the approval and monitoring of costs and regular updates are provided to the Scottish Government. Resilience is required within our health and social care system for the foreseeable future in response to Covid-19.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 17 The NLC and NHSL governance arrangements were reviewed and adapted as appropriate to support the response, recovery and redesign of services following the pandemic. The response, redesign and recovery of services is continuing. The aim of this next stage is to provide good corporate governance and oversight; seek out innovative solutions aligned to redesign for effectiveness and efficiencies; provide a safe working environment for essential services; and engage openly and constructively with all key stakeholders throughout the recovery planning. The IJB considers the innovative approaches and service alterations put in place out of necessity may present opportunities as we seek to re-start services within the new context in which health and social care services now need to be delivered. In doing so the IJB will continue to follow appropriate governance structures and consider equalities and human rights requirements to ensure that from the current crisis emerges a more efficient and effective health and social care system that delivers on the priorities set out in the SCP. The NLHSCP will actively seek to understand the impact of the measures implemented during the emergency response to the Covid-19 pandemic and also the remobilisation and recovery activity in order to agree which changes can be retained or adapted to improve services whilst still continuing to be person-centred and meet individual outcomes. A review will also be undertaken to identify key learning points and to share good practice.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 18 Key Strategic Risks and Uncertainties The IJB Risk Management Strategy complements the existing risk management processes within each partner. All three risk registers are reviewed regularly by the management team. It is important to note that some of the funding solutions in 2021/2022 were non- recurring and some cost pressures are expected to recur again in 2022/2023. The impact of the savings not achieved in full in 2021/2022 (£0.134m) will be taken into consideration during the review of the 2022/2023 Financial Plan. The notional set-aside budget aims to provide a mechanism for tracking the consumption of an element of hospital resources by North Lanarkshire residents. The budget for 2021/22 was agreed at £65.164m (2020/21 - £63.066m). The agreement currently in place with the NHS partner is that where a service change is agreed that alters the balance between hospital and community provision the impact of the specific change will be recosted and the set aside budget adjusted accordingly. There were no such changes in 2021/22. In the absence of changes, the agreement is that the services covered within the set aside arrangements will be provided for the agreed notional sum and that the risk of the cost of the directed services exceeding the agreed notional sum is borne by NHSL during the year. On that basis the expenditure recorded in the 2021/22 annual accounts equals the notional budget of £65.164m. This amount will be included in both the NHSL Health Board and IJB annual accounts. It is recognised that this will not necessarily reflect the actual usage of these hospital services by the IJB in 2021/2022 however it has been endorsed as an acceptable approach pending further updates from Public Health Scotland’s information services division. It is consistent with advice issued by the Scottish Government on how the sum set-aside should be recorded in the annual accounts. The complexities of this mechanism and actual information so far is explained in more detail at note 2.2 on pages 34 and 35. A whole system approach will continue to be adopted by the partners to support the use of set-aside resources. Conclusion Covid-19 has affected each and every member of our society and a robust response was implemented. Staff, partners and communities continue to work in partnership to ensure we respond effectively to this ongoing public health crisis, protect lives and keep people safe. In the face of this unprecedented challenge, partnership working continues to be critical to respond effectively to this national health and social care crisis. Available resources have, to date, been refocussed on the critical areas affected by the Covid-19 pandemic. However, our focus is increasingly moving towards recovery and remobilisation, but with the realisation that a ‘more of the same’ approach will not be sufficient. Services will require to create new and innovative solutions to support recovery, based on the new levels of demand created by the pandemic. A financial surplus totalling £66.334m was reported at 31 March 2022. This is mainly due to the additional funding received from the Scottish Government to address Covid- 19 expenditure and to take forward national and local priorities and also the essential and necessary changes across HSCP service delivery which released core funding. It
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 19 is important to note that we do not expect to receive any further Covid-19 expenditure, so the resource carried forward will require to support any future Covid-19 spend in 2022/23 and beyond. Although the current operational and financial challenges will inevitably drive the pace of change, improving outcomes for individuals will continue to underpin the IJB’s strategic commissioning intentions and the ongoing re-design and integration of health and social care services. We will do this by ensuring that we continue to adhere to sound governance arrangements and by exploring alternative pathways to divert people into more appropriate forms of support. Much of this will require a coordinated and consistent communications message to the public, together with concerted action planning with colleagues in acute services and also the third sector, independent providers and carers across the partnership. Support for all health and social care professionals, particularly those working in community settings, will be fundamental to managing service delivery while Covid-19 remains a risk. Maintaining the positive developments which have been rapidly stepped up in response to the crisis will be a priority during the recovery process. Ensuring health and social care resources are directed to best effect and achieving financial sustainability will be key to achieving this. Approved By Cllr Carragher Ross McGuffie Marie Moy Chair Chief Officer Chief Financial Officer Date Date Date
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 20 STATEMENT OF RESPONSIBILITIES Responsibilities of the North Lanarkshire Integration Joint Board The North Lanarkshire Integration Joint Board (IJB) is required to: make arrangements for the proper administration of its financial affairs and to secure that the proper officer of the IJB has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973; Coronavirus (Scotland) Act 2020). In this IJB, that officer is the Chief Financial 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 that legislation, in accordance with proper accounting practices (s12 of the Local Government in Scotland Act 2003). approve the Annual Accounts for signature. Responsibilities of the Chief Financial Officer As Chief Financial Officer I am responsible for the preparation of the IJB’s statement of accounts which, in terms of the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2021/2022 (the “Code of Practice”), as supported by the International Financial Reporting Standard (IFRS), is required to give a true and fair view of the financial position of the IJB at the financial year end and its income and expenditure for the year then ended. In preparing the Annual Accounts, I am responsible for: Selecting suitable accounting policies and applying them consistently; Making judgements and estimates that are reasonable and prudent; and Complying with the Code of Practice. I am also required to: Keep proper accounting records which are up to date; and Take reasonable steps to ensure the propriety and regularity of the finances of the IJB. 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 2022 and the transactions for the year then ended. Certified By Ross McGuffie Acting Chief Financial Officer Date: 24 June 2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 21 REMUNERATION REPORT 1 Introduction The Remuneration Report has been prepared in accordance with the Local Authority Accounts (Scotland) Regulations 2014 which requires, at least, disclosure about remuneration and pension benefits of any persons whose remuneration is £150,000 or more. The Regulations also require disclosure of remuneration information for ‘relevant’ persons. A ‘relevant person’ in relation to the Remuneration Report for a financial year 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. All information disclosed in the tables at sections 6 and 7 in this Remuneration Report is subject to audit by Audit Scotland. The other sections of the Remuneration Report will be reviewed by Audit Scotland to ensure that they are consistent with the financial statements. 2 Integration Joint Board The Standing Orders of the IJB, as prescribed by the Public Bodies (Joint Working) (Integration Joint Board) Order 2014, set out the detail regarding IJB membership, voting, calling of meetings and the quorum for meetings. The IJB comprises eight voting members, four of whom are Elected Members appointed by North Lanarkshire Council (NLC) and four of whom are Non-Executive Directors appointed by the NHS Lanarkshire (NHSL). The term of office of members is for a period of three years. There are also non-voting representatives on the IJB drawn from health and social care professionals, employees, the third sector, service users and carers. 3 Remuneration: IJB Chair and Vice Chair The Board Members do not currently 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 borne by the partner. During 2021/2022, the Chair of the IJB was Dr Avril Osborne and the Vice Chair was Councillor Paul Kelly. The details of the Chair and Vice Chair appointments held during 2021/2022are shown below. No taxable expenses were paid by the IJB inv2021/2022. Name Post Held Nominated by Dr. A.Osborne Chair (1 April 2021 to 31 March 2022) NHS Lanarkshire Cllr Paul Kelly Vice Chair North Lanarkshire Council
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 22 (1 April 2021 to 31 March 2022) The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlements of voting IJB members. Therefore no pension rights disclosures are provided for the Chair or the Vice Chair. REMUNERATION REPORT (Cont.) 4 Senior officers The Chief Officer is appointed by the North Lanarkshire IJB and is employed by North Lanarkshire Council. The Chief Officer is seconded to the IJB in line with the local arrangements. The Chief Financial Officer is appointed by the North Lanarkshire IJB and is employed by South Lanarkshire Council. The Chief Financial Officer is seconded to the IJB in line with the local arrangements. 5 Remuneration policy The remuneration of the Chief Officer is set with reference to national arrangements as well as local decisions on management structures and their associated remuneration levels. The Scottish Joint Negotiating Committee for Local Authority Services sets out the spinal column salary points for Chief Officers which can be utilised in setting salary levels for such posts. 6 Remuneration: Officers of the IJB The senior officers received the following remuneration in the period: Name Salary, Fees, Allowance s 2021/2022 Total Remuneration 2020/2021 Total Remuneration Ross McGuffie, Chief Officer (1 April 2021 to 31 March 2022) £102,352 £102,352 £101,601 Marie Moy, Chief Financial Officer (1 April 2021 to 31 March 2022) £36,631 £36,631 £36,224 The Chief Financial Officer is also appointed to the South Lanarkshire IJB. The remuneration disclosed in the table above is the proportion of remuneration received
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 23 in relation to the activity of the North Lanarkshire IJB during 2021/2022. The remuneration in respect of South Lanarkshire IJB is therefore shown separately in the South Lanarkshire IJB Annual Accounts 2021/2022 The IJB does not directly employ any Health or Social Care staff. They are employed by either NHSL or NLC and remuneration for staff is reported in the employing organisation. Pay band information is not separately provided as all staff pay information has been disclosed in the information above. 7 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 pensions liability reflected on the IJB balance sheet for the Chief Officer or any other officers. The IJB however, has responsibility for funding the employer contributions for the current year in respect of the officer time spent on fulfilling the responsibilities of their role on the IJB. The senior officers are members of the Strathclyde Pension Fund which is a Local Government Pension Scheme (LGPS). The LGPS is a defined benefit statutory scheme, administered in accordance with the Local Government Scheme Regulations 2014.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 24 REMUNERATION REPORT (Cont.) 7 Pension benefits (Cont.) Costs of the pension scheme contributions for the year to 31 March 2022 are shown in the table below: Name In-year pension contributions Accrued pension benefits To 31 March 2021 To 31 March 2022 As at 31 March 2021 Move ment In Year As at 31 March 2022 £000 £000 £000 Ross McGuffie Chief Officer £19,519 £21,291 Pensio n 8 2 10 Lump Sum Nil Nil Nil Marie Moy Chief Financial Officer £6,966 £7,058 Pensio n 15 1 16 Lump Sum 22 0 22 The pension benefits detailed in the table above relate to the proportion attributable to the activity of the North Lanarkshire IJB. In respect of the Chief Financial Officer, a pro-rata approach has been adopted for 2021/2022. Approved By Cllr Carragher Ross McGuffie Chair Chief Officer Date: Date:
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 25 ANNUAL GOVERNANCE STATEMENT Introduction The Annual Governance Statement explains how the North Lanarkshire Integration Joint Board (IJB) complies with the Code of Corporate Governance and meets the requirements of the Delivering Good Governance in Local Government Framework developed by CIPFA and SOLACE in 2016. This statement reports on the effectiveness of the IJB’s governance arrangements and system of internal control. Scope of Responsibility The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) sets out the legislative responsibilities for the delivery of integrated health and social care services. The original North Lanarkshire Health and Social Care Integration Scheme was approved by the Scottish Parliament in May 2015 and the IJB became a public sector organisation in June 2015. In April 2019, the Cabinet Secretary approved an updated Integration Scheme to reflect the transfer of the discretionary delegated functions for Children, Families and Justice Services from the IJB to the newly reshaped Education and Families Service in North Lanarkshire Council (NLC). The system of internal control is proportionate to the IJB’s strategic responsibility and reliance is placed on the NHS Lanarkshire (NHSL) and NLC systems of internal control. Within a strategic context, the IJB has a statutory duty of best value. The IJB is required to ensure that risk is effectively managed and public money is safeguarded and properly accounted for. The Governance Framework The terms of reference for the IJB are formally set out in the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 with particular reference to the Scottish Statutory Instruments 2014 No.285. This Order sets out provisions which apply in relation to the membership, proceedings and operation of all IJBs. Article 17 also confers powers on IJBs to establish committees and delegate functions to those committees. The roles and responsibilities of the IJB and the PFAC were originally set out in the Terms of Reference3. The IJB Code of Corporate Governance4 describes the IJB’s governance arrangements. The internal control system can only provide reasonable and not absolute assurance of effectiveness. The effective operation of each partner’s financial and corporate systems, processes and internal controls are key to achieving IJB outcomes. Review of Adequacy and Effectiveness The ongoing effectiveness of the IJB’s governance arrangements in 2021/2022 was reviewed in line with the Local Authority Accounts (Scotland) Regulations 2014. The review took into consideration the changes necessary to address the Covid-19 pandemic. Improvement actions continue to be implemented to further develop controls and to achieve integration outcomes. The review is also informed by cross- 3 https://mars.northlanarkshire.gov.uk/egenda/images/att87070.pdf 4 https://mars.northlanarkshire.gov.uk/egenda/images/att86221.pdf
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 26 assurances from each of the partners, NHSL and NLC, including consideration of their relevant internal audit and external audit reports and the governance arrangements implemented in response to the Covid-19 pandemic. Ongoing service sustainability is a key priority for the IJB and both partners.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 27 Assessment of Governance Arrangements The assessment of the IJB governance framework and internal control system confirmed that no significant control weaknesses or significant failures have arisen in the expected standards for good governance, risk management and internal control. Some areas for improvement have been identified and are detailed in the continuous improvement actions on page 25 and 26. The key conclusions which contributed to this overall assessment are detailed below. 1. Response to the Covid Pandemic 1.1 There was an immediate requirement to move quickly and decisively to manage the pressures on health and social care services across North Lanarkshire and to sustain this support throughout the duration of the pandemic. The governance context within which the IJB operates has been significantly impacted by the need to implement business continuity processes to respond to the national and international public health challenge presented by the Covid-19 pandemic. The IJB governance arrangements were therefore adapted to support the planning and delivery of health and social care services during the pandemic. 1.2 In response to the pandemic, IJB governance arrangements were amended, allowing special meetings to be convened if required, with regular meetings between the Chair, Vice Chair and Chief Officer maintained throughout. During 21/22, all meetings proceeded as planned, with special meetings called in September 21 and February 22. 1.3 The IJB, the Chief Officer and the Senior Leadership Team have been key active participants and stakeholders across the range of governance structures adopted to manage the impact of the pandemic. The NLHSCP implemented new service areas and service delivery models in response to the changing levels of need as a result of the pandemic. Examples included the following: The establishment of community assessment centres Delivery of the vaccination programme. The creation of a hub to support the distribution of personal protective equipment to health and social care staff, the third and independent sector, personal assistants and carers. The requirement for mental health assessment units. The adoption of social distancing requirements. Care Home Assurance Group arrangements Care at Home Assurance Group arrangements 2. IJB Governance Developments 2.1 The IJB has arrangements in place to deal with any conflicts of interest that may arise. It is the responsibility of IJB and PFA Members to declare any potential conflicts of interest and it is the responsibility of the Chair of the relevant IJB or PFA to ensure such declarations are appropriately considered and acted upon. The IJB arrangements continue to be regarded as fit for purpose in accordance with the governance framework. 2.2 The Scottish Government are legislating for IJBs to be included as Category 1 Responders under the Civil Contingencies Act 2004. The Scottish Government
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 28 believe this status will complement the work already conducted by all of the partners. In terms of resourcing, there should be limited additional activity associated with the requirement given local partners are already working with an integrated health and social care model. Some concerns were expressed locally during the consultation with regards to the strategic role of the IJB in the context of the NLHSCP’s operational role, governance, the role of the Chief Officer and that there were no additional formal resources to undertake this activity. 2.3 The following IJB responsibilities are standing items on the IJB and PFA agendas: Financial monitoring reports Performance monitoring reports Risk management update Progress report on agreed actions 3. IJB Strategic Commissioning Intentions 3.1 The three year Strategic Commissioning Plan 2020-20235 was approved by the IJB on 24 March 2020. In line with the Community Empowerment (Scotland) Act 2015, an extensive engagement process was undertaken involving a wide a range of staff, service users, carers and over 1,000 responses to an online questionnaire. This plan is underpinned by a Programme of Work to achieve the key ambitions which details the aims of each work programme, anticipated performance impact, key deliverables, approval routes and financial implications. In order to strengthen the links to addiction and mental health services, an integrated approach within justice services continues to be embedded. 3.2 The IJB is committed to ensuring stakeholders are fully engaged. A review of participation and engagement was commissioned during 2021/222 and the outputs and recommendations will be presented to the IJB in 2022/23. In addition, the IJB approved the developments around the Delivering for Communities strategy, which will see the use of Community Boards as a key pillar of engagement activity moving forwards. 3.3 As part of the HSCP structural review, the support arrangements around the Chief Finance Officer were reviewed in conjunction with colleagues in the South Lanarkshire HSCP, with approval granted to move to both IJBs having a 1WTE Chief Finance Officer from 2022/23 onwards. Recruitment to the additional post is already underway. Section 42 of the Public Bodies (Joint Working) (Scotland) Act 2014 requires that Annual Performance Reports (APRs) are prepared by IJBs. The 2014 Act obliges that the APR should cover the preceding year’s activity and be published four months after the end of that reporting year. The purpose of the APR is to ensure that performance is open and accountable, whilst at the same time providing an overall assessment of performance in relation to planning and carrying out integration functions. In line with paragraph 8 of Schedule 6 to the Coronavirus (Scotland) Act 2020, the publication of the final North Lanarkshire IJB Annual Performance Report 2020/2021 was rescheduled to September 2021. 3.4 A genuine integrated performance culture is embedded across the NLHSCP. The IJB and PFA continue to receive reports on service performance, despite 5 https://mars.northlanarkshire.gov.uk/egenda/images/att93862.pdf
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 29 some of the operational performance systems being delayed due to the pandemic response. A continuous improvement programme is in place which relies on performance data to drive further improvement and support informed decision making in respect of strategic planning and commissioning. 3.5 A particular measure of IJB and Scottish Government focus continues to be the number of delayed discharge bed days. This was of particular critical importance during the pandemic to improve bed capacity across Acute Services. In comparison to the same period last year, performance for the period from April to March is summarised as follows: A&E attendances down by 5.5% against 2019/20 (pre-pandemic) Emergency admissions down by 9% against 2019/20 (pre-pandemic) Unscheduled bed days (Acute) down by 4% against 2019/20 (pre- pandemic) Delayed discharge (standard delay) bed days down by 22% against 2019/20 (pre-pandemic) 3.6 The Discharge Without Delay programme commenced in 2021/22, with the aim of taking a whole system approach to reducing delayed discharge. This has included the introduction of Planned Date of Discharge across all acute sites, developing relationships and teams, having an understanding of the roles of individuals, consistency of personnel attending daily ward multi-disciplinary team meetings and improving access to systems including Near Me. 3.7 The management of ‘set-aside’ budgets totalling £65.164m in 2021/2022 continues to be complex however NHSL continue to maintain an appropriate mechanism for its operation. The overspend across the set-aside service has been managed by the health partner since 2016 and this approach was maintained in 2021/2022. As highlighted at note 2.2 on pages 36 and 37, the operation of the set-aside budget for unscheduled care services is a key area of uncertainty which has been further exacerbated by the Covid-19 pandemic. These challenges will continue during the post-pandemic period. Both hospital and community services must continue to operate together to maximise the efficacy of unscheduled care services and a whole system approach is being adopted by the partners. 4. Financial Governance 4.1 The IJB Financial Plan 2021/2022 was approved by the IJB on 23 March 2021 and set out the parameters to achieve a balanced budget by 31 March 2022. The financial position of the IJB for 2021/2022 is set out at pages 8 to 10 of the management commentary and also at pages 29 to 31. 4.2 The financial impact of implementing the emergency response to the Covid-19 pandemic was, and continues to be, significant. The Scottish Government established a process whereby the necessary activity and the additional costs incurred across health and social care services as a result of Covid-19 are reported through Mobilisation Plans. The expenditure incurred by both partners in response to the Covid-19 pandemic was fully funded by the Scottish Government in 2021/2022. A balance of funding received for 2021/2022 is being retained by the IJB in reserves to meet additional Covid-19 expenditure in
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 30 2022/23. 4.3 The IJB Financial Plan 2022/2023 was approved by the IJB on 23 March 2022 and set out the parameters to achieve a balanced budget by 31 March 2023. The financial strategy will require to be reviewed to reflect the ongoing impact of the Covid-19 pandemic on operational services. 5. Risk 5.1 There has been continued focus and development around the IJB Risk Register over the financial year, undertaken by the Chief Officer, IJB Section 95 officer and the Operational & Business Manager. In line with the findings of the table top review undertaken in 2020, new and emerging risks or changes in risk level are agreed at each meeting as appropriate. Each report gives due consideration to any risks associated with the subject matter. All risks identified relating to the functions delegated to the IJB are regularly reviewed and updated. 5.2 A table top review of the existing IJB Risk Management Strategy and the IJB Risk Register6 was undertaken by the Chief Officer, IJB Section 95 officer and the Operational & Business Manager in August 2020. Following this review, a number of risks were closed with the approval of the IJB on 22 September 2020. A proactive approach to risk management is being adopted. Confirmation of new emerging risks is agreed at each meeting as appropriate. Each report gives due consideration to any risks associated with the subject matter. All risks identified relating to the functions delegated to the IJB are regularly reviewed and updated. Internal Audit also recommended that mitigating controls be separated between controls and actions. This continuous improvement action will be completed in June 2021. 5.3 10 risks are recorded on the IJB Risk Register as follows: 5.4 The two very high risks relate to the impact of Covid on the IJBs Financial plan Strategic Plans. 6 https://mars.northlanarkshire.gov.uk/egenda/images/att96291.pdf Current Risk Level No. % Very High 2 15% High 4 31% Medium 4 31% Low 3 23% Total 13 100%
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 31 5.5 The following very high risks are also recorded on the NHSL partner’s risk register: The ability to maintain the existing General Medical Services across NHSL. Sustainability of the two-site model for the Out-of-Hours Service. Acute sector bed capacity linked to availability of beds in care homes affected by the Covid-19 pandemic. CAMHS performance and recovery Staff fatigue, resilience, wellbeing and safety following sustained pandemic response Impact of analogue to digital phone line transition on the Community Alarm Service Recovery of performance 2020/2021. 5.6 The Risk Management Update was reported to the IJB on 23 March 2022. The optimum management of risks by the IJB and both partners continues to be a priority. There is a significant element of financial risk associated with Covid-19 and service recovery. Sustainable financial strategies require to be developed to meet increased demand and to maintain the innovative and beneficial changes to service delivery which have been implemented. The IJB Reserves Strategy also requires to be reviewed in response to current circumstances. 6. Partner Assurances 6.1 In recognition of the Public Health emergency, in March 2020 both partners moved from normal operating arrangements into emergency response mode in order to react quickly and effectively to the evolving Covid-19 pandemic. Each partner adopted appropriate command and control structures and resilience arrangements as the mechanism for rapid decision making in line with their respective legislative responsibilities. Key meetings were held daily at the height of the pandemic to assess the situation and to take immediate decisions. Clear lines of reporting and escalation were in place to allow rapid assessment and resolution. Action logs and a separate Covid-19 risk register were maintained. Some services had to be stood down. Risks were assessed and consideration was given to the process for ensuring services were safely stood up once Covid- 19 numbers reduced. 6.2 The pandemic impacted on the way health and social care services were delivered over the last year with many staff redeployed to critical service areas. In recent months, staff have returned to their substantive posts, though the recovery and remobilisation efforts will continue for the foreseeable future. 6.3 Within NLHSCP, a Wellbeing Group has been established to focus on supporting and developing the strategy for Staff Health and Wellbeing across the Partnership area. Of critical importance is the co-production and collaboration with multi-agency partners, representative of residential care, third sector colleagues, psychology, spiritual care and Locality Management Teams. 6.4 Both partners provided assurance to the IJB that satisfactory controls are in operation in respect of the delivery of the IJB delegated functions. Notwithstanding the changes necessary to respond to the Public Health emergency, both partners provided assurance that the governance
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 32 arrangements remained appropriate and effective. 6.5 Both partners have well established stakeholder engagement mechanisms in place which were adjusted as appropriate during the pandemic. 6.6 During the Covid-19 pandemic elective activity was curtailed. At peak times it was suspended to allow all staffing resources to be diverted to treat the surge of Covid-19 patients but, even during periods of less demand, the need for additional physical distancing and infection control measures reduced the number of people who could be seen. Given the numbers waiting and the continued impact of working in an environment with Covid-19 present, the risk to getting back to normal waiting times performance is graded very high by the NHSL partner. To reduce harm, processes are in place for regularly reviewing the waiting lists and having a structured clinical prioritisation process to ensure the most urgent cases are seen first. This is combined with a review of very long waits over 52 weeks. Remobilisation plans continue to be developed and actioned. 6.7 Following the transfer of the discretionary Children, Families and Justice Services budgets from the IJB to NLC, a hosting arrangement was agreed in respect of the cross-cutting and support services which could not be allocated to either the IJB delegated services or to the discretionary functions transferred to NLC. This hosting arrangement is being implemented and monitored. 6.8 The sustainability of GP services in its current format across NHSL since being placed on an emergency footing remains a very high risk. The South Lanarkshire IJB is the lead partner for this hosted service. Practical measures to reduce the pressure on GP practices include additional pharmacists, the transition of responsibility of vaccinations to Health Board staff, the availability of video/telephone consultations to help GP practices to continue to safely provide support to patients and the progression of a rolling programme to transfer the property responsibility to the NHS Board where GPs feel the property burden is affecting the practice’s attractiveness. Learning will also be taken from the measures put in place over the pandemic about alternative ways of accessing practice services. 6.9 The Out of Hours Service is a hosted service led by the South Lanarkshire IJB. In June 2019, the Primary Care Out of Hours service became very fragile with the inability to cover every clinical session to sustain the two-site model leading to the frequent closure of the Airdrie site. The risk level was raised to very high and this has continued at this level ever since. Active daily management has been required and business continuity plans are in place with planned redirection to A&E, improved triaging jointly with NHS 24, plans for the further recruitment of salaried GPs, increased numbers of advanced Nurse practitioners and a communication & engagement strategy. 6.10 NLC has identified the transfer of phone lines from analogue to digital as a very high risk to the Community Alarm service. The current analogue alarms will not be able to work via a digital telephone line, but with no outward notification to the user that this is the case. Following being made aware of plans of a provider to
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 33 migrate over 1700 properties over onto a digital line, contingency plans were escalated including the purchase of new alarms that can work on both analogue and digital infrastructures and liaison with providers to delay implementation. 7. External and Internal Audit Arrangements 7.1 There are currently 9 external audit actions, with 2 complete, 4 ongoing and 3 delayed and overdue due to the pandemic response. However, work to progress to completion has re-started and aims to bring all outstanding to a quick conclusion. 7.2 The Internal Audit Plan 2021/2022 was presented to the PFA for approval on 25th May 2021, at an earlier stage than in previous years, providing greater opportunity for implementation in year. 7.3 During 2020/2021, the joint internal audit arrangements were reviewed by the IJB Chief Financial Officer in consultation with both partners. The review concluded that the current skills and expertise of each Internal Audit team are being deployed to best effect to provide the independent appraisal of the functions delegated to the IJB, assess the effective management of the strategic IJB risks, contribute positively to the strategic commissioning intentions of the IJB and provide an opinion on the overall governance arrangements of the IJB. The joint approach is efficient, cost effective, minimises the complexities of accessing data to complete audit assignments and avoids unnecessary disruption to the auditees. The IJB Chief Financial Officer’s recommendation to the IJB that the joint Internal Audit service continue up to 2022/2023 was therefore approved and remains extant.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 34 Overview of Control and Governance Improvements during 2021/2022 Improvement areas to further strengthen the IJB’s governance arrangements during 2021/2022were identified in the Annual Governance Statement included in the IJB Annual Accounts 2020/2021. A progress report in respect of these actions is detailed below. Re f. Improvement Area Action Undertaken 1 Completion of previous internal and external audit actions. Ongoing Some progress was made during 2021/22, notably through completion of major actions within the Integration Review including a review of financial support arrangements and formal consultation on the updated Integration Scheme. 2 Review of Recruitment and Retention Strategies Progressed Wide range of work undertaken to support improved recruitment and retention in 2021/22, including: Expansion of staff health and wellbeing activities including creation of local budgets for teams to access Refresh of the Care Academy approach Changes to post requirements such as removal of SVQ2 requirement in Home Support, with the service then supporting individuals to achieve the qualification at work Recruitment of additional HR supports to facilitate greater recruitment capacity with partner orgs Use of skill mix to support recruitment (e.g. new Nursing workforce within CAMHS) 3 Review of Set-Aside Concept Ongoing There have been no developments nationally on this. 4 Independent Review of Adult Social Care Services Progressed While the final form of the National Care Service remains unknown, the HSCP undertook a self-assessment exercise against the 53 recommendations of the Independent Review of Adult Social Care Services, which informed the IJB’s consultation responses.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 35 Overview of Control and Governance Improvements for 2022/2023 Following consideration of the internal review of the adequacy and effectiveness of the IJB governance arrangements, in addition to the ongoing continuous improvement actions from 2021/2022, further actions will be progressed in 2022/2023 to strengthen the good governance controls. These actions, including the timeline, are highlighted in the table below. Re f. Improvement Area Action Agreed Lead Officer Timeline 1 Completion of previous internal and external audit actions Although some progress was made during 2021/22, all previously agreed internal and external audit actions were not completed. Progress was reported to each meeting of the PFA throughout 21/22, with revised timescales agreed. Chief Financial Officer March 2023 2 National Care Service To develop a sound understanding of the impact for the NLHSCP of the outputs of the National Care Service legislation. Chief Officer March 2023 3 Implementation of improvement actions identified in the Best Value Self-Assessment exercise Following a self-assessment review assisted by the Improvement Service in February 2022, an action plan is being finalised to support the IJB in demonstrating Best Value, with actions to be completed throughout 2022/23. Chief Officer March 2023 4 Review the IJBs progress in In conjunction with the Local Resilience Partnership, undertake Chief Officer March 2023
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 36 becoming a Category 1 Responder as set out within the Civil Contingencies Act a self-assessment review against the seven duties, reporting progress to the West of Scotland Regional Resilience Partnership.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 37 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. This responsibility has continued throughout the Covid-19 pandemic and includes any changes to business processes that have been required throughout this period. Internal Audit monitor these changes. Overall, the results of all of the work undertaken by Internal Audit in 2021/2022, including shared system audits and the reports produced by External Audit, help to inform an opinion on whether the internal controls the NLHSCP has in place are adequate. The formal annual Internal Audit opinion on the soundness of the IJB’s internal control systems is presented jointly by the NLC Audit and Risk Manager and the NHSL Chief Internal Auditor. It was recognised that the IJB and both partners continue to function within a challenging environment. The additional challenges presented in 2021/2022 by the Covid-19 pandemic further increased the scale and complexity of issues. Internal Audit have a generally positive view of the IJB’s governance, internal control arrangements and progress to achieve previously agreed audit recommendations. Generally, across the IJB, there continues to be a strong recognition amongst management of the importance of appropriate governance arrangements and proportionate but effective internal controls. There are no matters that Internal Audit require to highlight in the Annual Governance Statement. Compliance with the requirements of the IJB corporate governance framework continues to be positive with no significant weaknesses, areas of concern, material frauds or irregularities resulting in financial loss to the IJB identified in 2021/2022. The joint Internal Audit opinion is therefore that reasonable assurance can be placed upon 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 2022. The Internal Audit work for 2022/2023 will continue to focus on key strategic and operational areas of risk for the IJB.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 38 Conclusion and Opinion on Assurance Throughout 2021/2022, in response to the Public Health emergency, the IJB and both partners revised their governance arrangements to support the most effective response to the Covid-19 pandemic. NLC and NHSL responded pro-actively to the Covid-19 pandemic and emergency arrangements were put in place to allow services to rapidly respond to each development. Normal business operations were impacted and some of the expected systems and controls have been subject to change. Risk assessments had to be updated and regularly reviewed. Against this unprecedented backdrop, the IJB has adhered to the stated principles of good governance, acted in the public interest and been committed to continuous improvement. The IJB continues to comply with the CIPFA statements on the role of the Chief Financial Officer and the practical guidance for audit committees. In respect of the role of the Head of Internal Audit and the management of fraud and corruption, the IJB continues to place reliance on the arrangements in place with each partner. The scrutiny and oversight of the North Lanarkshire IJB Performance, Finance and Audit Committee contributes effectively to these arrangements. There were no significant control weaknesses, issues or failures in the expected standards for good governance, risk management and internal control. Assurances that adequate and effective systems of internal control are in place have been exchanged between the IJB and each partner. The IJB governance arrangements are effective and consistent with the recommendations of the CIPFA/SOLACE Framework (2016). The IJB considers that review processes are in place and are effective. Making transformational change, at the same time as managing existing services and funding pressures, particularly during the Covid-19 pandemic, continues to be challenging. Both partners will experience significant challenges in recovering from the pandemic. There will be a significant backlog of activity to be addressed. Workforce and financial resources will be stretched. Response, recovery and remobilisation plans are being refreshed to ensure available resources are prioritised and new approaches, which have proven to be effective, continue to be implemented. While recognising that continuous improvement actions will be progressed during the sixth year of operation, it is the IJB’s opinion that reasonable and objective assurance can be placed upon the adequacy and effectiveness of the IJB’s governance arrangements and that any significant risks impacting on the IJB’s principal objectives will be identified and actions taken to avoid or mitigate their impact. This assurance is limited, however, to the work undertaken during the year, the assurances provided by each partner and the evidence available at the time of preparing this statement. In partnership with NHSL and NLC, the IJB continues to have effective and robust structures in place to deliver the commissioning intentions. The good governance arrangements across the NLHSCP also effectively contribute to the implementation of the objectives of both partners. Approved By
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 39 Cllr Carragher Ross McGuffie Chair Chief Officer Date: 24 June 2022 Date: 24 June 2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 40 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT FOR THE YEAR ENDED 31 MARCH 2022 This statement shows the actual cost of providing services in accordance with generally accepted accounting practices, the total funding contributions from the partners and the surplus on activities during the year. 2020/2021 2021/2022 Gross Expenditu re Gross Income Net Expenditu re Gross Expenditu re Gross Income Net Expenditu re £m £m £m £m £m £m 189.048 (1.226) 187.822 Social Care Services 202.610 (1.593) 201.017 105.773 0.000 105.773 Family Health Services 109.652 0.000 109.652 69.088 0.000 69.088 Prescribing Costs 68.739 0.000 68.739 141.034 0.000 141.034 Hosted Services (Note 10) 149.126 0.000 149.126 63.066 0.000 63.066 Hospital Acute Services (Notional Set Aside Budget) 65.164 0.000 65.164 65.557 0.000 65.557 Health Care Services 74.073 0.000 74.073 1.281 (1.281) 0.000 Housing Services 1.668 (1.668) 0.000 0.000 0.000 0.000 Transport Services 0.539 (0.539) 0.000 0.212 0.000 0.212 Corporate Services (Note 6) 0.214 0.000 0.214 21.342 0.000 21.342 Covid-19 Costs (Note 13) 13.412 0.000 13.412 656.401 (2.507) 653.894 Cost of Services 685.197 (3.800) 681.397 0.000 (666.99 1) (666.991) Taxation and Non- Specific Grant Income (Note 5) 0.000 (702.63 3) (702.633) 0.000 (23.607) (23.607) Covid-19 Funding (Note 13) 0.000 (45.098) (45.098) 656.401 (693.10 5) (36.704) Deficit or (surplus) on provision of services and total comprehensive (income) and expenditure 685.197 (751.53 1) (66.334)
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 41 (Note 4) The IJB was established on 27 June 2015. Integrated delivery of health and social care services commenced on 1 April 2016. 2021/2022 is the sixth year of operation for the IJB. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received by 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.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 42 MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the 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. Movements in Reserves General Fund Balance £m Total Reserves £m Opening balance at 1 April 2020 16.414 16.414 Total Comprehensive Income and Expenditure (36.704) (36.704) Increase or (decrease) in 2020/2021 36.704 36.704 Opening balance at 1 April 2021 53.118 53.118 Total Comprehensive Income and Expenditure (66.334) (66.334) Increase or (decrease) in 2021/2022 66.334 66.334 Closing balance at 31 March 2022 119.452 119.452
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 43 BALANCE SHEET AS AT 31 MARCH 2022 The balance sheet shows the value as at 31 March 2022 of the IJB’s assets and liabilities at the balance sheet date. The net assets of the IJB are matched by the reserves held by the IJB. Notes 31 March 2022 £m 31 March 2021 £m Current assets Short term debtors 7 119.452 53.118 Net assets / (liabilities) 119.452 53.118 Usable reserves 11 119.452 53.118 Total reserves 119.452 16.414 The Statement of Accounts present a true and fair view of the financial position of the North Lanarkshire Integration Joint Board as at 31 March 2022 and its income and expenditure for the year then ended. The unaudited accounts were authorised for issue on 24 June 2022. Authorised by Ross McGuffie Acting Chief Financial Officer Date: 24 June 2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 44 NOTES TO THE FINANCIAL STATEMENTS 1. Accounting policies 1.1 General principles The financial statements summarise the transactions of the IJB for the financial year 2021/2022and its position at the year end of 31 March 2022. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a section 106 body as defined in the Local Government (Scotland) Act 1973. It is a joint venture between North Lanarkshire Council and NHS Lanarkshire. The financial statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2021/2022, 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. 1.2 Going concern The annual accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future. 1.3 Accounting convention The annual accounts are prepared under the historical cost convention. 1.4 Accruals of income and expenditure Activity is accounted for in the year that it relates to and not simply when financial transactions are undertaken. 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 down. 1.5 Funding The IJB is primarily funded through funding contributions from the statutory funding partners, North Lanarkshire Council and NHS Lanarkshire, to fund its services. 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. 1.6 Cash and cash equivalents The IJB does not operate a bank account or hold cash. Transactions are settled on behalf of the IJB by the funding partners. Consequently, the IJB does not present a “cash and cash equivalent” figure on the balance sheet. There is
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 45 therefore no requirement for the IJB to prepare a cash flow statement. The funding balance due to or from each funding partner as at 31 March 2022 is represented as a debtor or creditor on the IJB’s balance sheet. 1.7 Employee benefits 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.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 46 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 1. Accounting policies (Cont.) 1.8 Corporate services The IJB has a legal responsibility to appoint a Chief Officer. A Chief Financial Officer has also been appointed to the IJB. The details in respect of these arrangements are outlined in the Remuneration Report. The charges from the employing partner are treated as employee costs within Corporate Services. The absence entitlement of both the Chief Officer and the Chief Financial Officer as at 31 March 2022 is not material and has therefore not been accrued. 1.9 Contingent Liability A contingent liability is a possible liability arising from events on or before 31 March 2022 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. 1.10 Indemnity Insurance The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding board member and officer responsibilities. NHS Lanarkshire and North Lanarkshire Council have responsibility for claims in respect of the services that they are statutory responsible for and that they provide. Unlike NHS Boards, the IJB does not have any “shared risk” exposure from participation in the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). The IJB participation in CNORIS is therefore analogous to normal insurance arrangements. 1.11 Debtors and creditors Where income and expenditure have been recognised but cash has not been received or paid, a debtor or creditor for the relevant amount is recorded in the balance sheet. Debtors have been analysed as short term debtors which is income receivable within one year on the basis that these reserves could be utilised at any time. A bad debt provision is not assessed as necessary as the debtor balances represent usable reserves held by each partner on behalf of the IJB. There are no creditor balances. 1.12 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 2022, the usable reserve balance totals £53.118million. There are no unusable reserves. 1.13 Specific Service Income
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 47 Income may be received from individuals as a contribution towards the cost of their social care services. The amount collected is allocated to the relevant expenditure category and the net cost is reported in the Comprehensive Income and Expenditure Statement. This is the basis upon which the 2021/2022annual accounts have been prepared.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 48 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 2. Critical judgements and estimation uncertainty The critical judgements made in the financial statements relating to complex transactions include the following: The accounting treatment of hosted services and the hospital acute services (set-aside). Expenditure in respect of these services is included in the financial statements on the basis of estimated figures. Estimates are made taking into account the best available information, however, actual results could be materially different from the assumptions and estimates used. This is further explained at notes 2.1 and 2.2. The financial implications of the transfer of the Children, Families and Justice Services budgets back to NLC are highlighted at note 2.3. 2.1 Hosted Services In applying the accounting policies set out above, the IJB has had to make a critical judgement relating to complex transactions in respect of values included for services hosted within North Lanarkshire IJB for South Lanarkshire IJB. Within Lanarkshire, each IJB has operational responsibility for the services which it hosts on behalf of the other IJB. In delivering these services the 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 now reflected within the annual accounts for the services it hosts. This is the basis upon which the 2021/2022 annual 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 51% of the total expenditure. 49% 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. 2.2 Hospital Acute Services (Set Aside) The legislation sets out that Integration Authorities are responsible for the strategic planning of hospital services most commonly associated with the emergency care pathway along with primary and community health care and social care services. As the emergency care services in large hospitals, both within Lanarkshire and out of region, are used by the residents of multiple IJBs and are delivered using resources shared with other hospital services,
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 49 estimating the resource used each year by each IJB involves a complex allocation methodology. This is enabled by a national NHS information services division , now under NHS Public Health Scotland and involves apportioning the hospital expenditure to individual patient episodes, separating out episodes for services delegated to the IJB from those that are not , and assigning these to the relevant IJBs based on postcode. NOTES TO THE FINANCIAL STATEMENTS (Cont.) 2. Critical judgements and estimation uncertainty (Cont.) 2.2 Hospital Acute Services (Set Aside) (Cont.) The complexity of this exercise means the results are produced at a time lag of over a year with the 2019/20 data expected to be available in 2021/22. Difficulties were experienced by PHS in completing the 2019/20 exercise so this resource review has still to take place. The latest available data remains 2018/19. The results of comparing the historic budget, as increased by funding uplifts and adjusted to reflect the impact of agreed service changes , with the costed patient activity produced by the national information services function are shown in the table below. In each of the 3 years for which data is available the estimated costs of providing the services exceeded the budget and that additional cost was borne by NHSL in each year rather than recharged to the IJB. Year Notional Budget £m Actual Cost £m Underspend/(Overspend) £m 2016/2017 57.250 57.444 (0.194) 2017/2018 56.719 58.373 (1.654) 2018/2019 58.103 58.693 (0.590) There have been no developments nationally during the year which offer a more timeous complete solution. Research reported by the NHS Finance Director has revealed that some Boards use preset apportionments of their ledger costs and discussions will continue as to whether a more timely but less precise methodology like that would have merit in future. 3. Events after the reporting period The Chief Financial Officer authorised the unaudited annual accounts for issue on 24 June 2022. There have been no other material events since the date of the balance sheet which require revision to the figures in the annual accounts.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 50 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 4. Expenditure and Income Analysis by Nature 2020/202 1 £m 2021/2022 £m 189.048 Social Care Services 202.610 105.773 Family Health Services 109.652 69.088 Prescribing Costs 68.739 110.374 Hosted Services - Led by the North IJB (Note 10) 114.573 30.660 Hosted Services - Led by the South IJB 34.553 141.034 Hosted Services – Total 149.126 63.066 Hospital Acute Services (Notional Set Aside Budget) 65.164 52.430 Health Care Services – Localities 58.073 8.648 Health Care Services - Area Wide 11.010 4.480 Health Care Services - Out-of Area 4.990 65.558 Health Care Services – Total 74.073 0.741 Housing Services - Housing Revenue Account 1.183 0.540 Housing Services - General Fund 0.485 1.281 Housing Services – Total 1.668 0.000 Transport Services 0.539 0.212 Corporate Services 0.214 21.342 Covid-19 Costs 13.412 656.401 Total Gross Expenditure 685.197 (518.560) Funding Contribution - NHS Lanarkshire (537.84 5) (148.431) Funding Contribution - North Lanarkshire Council (164.78 8) (2.507) Specific Service Income (3.800) (23.607) Covid-19 Funding (45.098 )
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 51 (693.105) Total (Income) (751.53 1) (36.704) Deficit or (surplus) on the provision of services (66.334 ) NOTES TO THE FINANCIAL STATEMENTS (Cont.) 5. Taxation and Non-Specific Grant Income 2020/2021 £m 2021/202 2 £m (518.560) Funding Contribution from NHS Lanarkshire (537.845) (148.431) Funding Contribution from North Lanarkshire Council (164.788) (666.991) Total (702.633) The funding contribution from the NHS Board shown above includes £65.164m in respect of the “set aside” resources relating to acute hospital and other resources. These are provided by NHS Lanarkshire which retains responsibility for managing the costs of providing these services. The IJB however, has responsibility for the consumption of, and level of demand placed on, these resources. The funding contributions from the partners shown above exclude any funding which is ring-fenced for the provision of specific services. Such ring-fenced funding is presented as income in the Cost of Services in the Comprehensive Income and Expenditure Statement. The ring fenced contributions received by the North Lanarkshire IJB are detailed as follows: 2020/2021 £m 2021/202 2 £m (0.741) Housing Revenue Account (1.183) (0.540) Garden Assistance Scheme Income (0.485)
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 52 (1.281) Housing Services Total (1.668) The funding contributions from the partners shown above also exclude specific service income contributions from individuals towards the cost of their social care services. In 2021/2022 this income totalled £1.592m and is presented as income in the Cost of Services in the Comprehensive Income and Expenditure Statement on page 31. There are no other non-ring fenced grants or contributions. 6. Corporate Services 31 March 2021 £m 31 March 2022 £m 0.182 Staff Costs 0.183 0.027 External Audit Fee 0.028 0.003 Administration Costs 0.003 0.212 Total 0.214 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 7. Short Term Debtors 31 March 2021 £m 31 March 2022 £m 36.400 NHS Lanarkshire 87.533 16.718 North Lanarkshire Council 31.919 53.118 Total 114.452 All balances due to the IJB from the partner bodies have been classified as short term debtors on the basis that these reserves could be utilised at any time. 8. Contingent Liabilities The IJB is unaware of any material contingent liability as at 31 March 2022. Contingent liabilities represent items that at 31 March 2022 are not recognised in the IJB’s annual accounts because there is significant uncertainty at that date as to the necessity of the partner or IJB to make payments in respect of them. 9. VAT The IJB is not VAT registered and as such the VAT is settled or recovered by the partner agencies. The VAT treatment of expenditure in the IJB’s annual
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 53 accounts depends on which of the partner agencies is providing the service as these are treated differently for VAT purposes. Where North Lanarkshire Council is the provider, income and expenditure excludes any amounts related to VAT, as collected VAT is payable to HM Revenue & Customs and all VAT paid is recoverable from it. North Lanarkshire Council is not entitled to fully recover VAT paid on a very limited number of items of expenditure and for these items the cost of VAT paid is included within service expenditure to the extent that it is irrecoverable from HM Revenue & Customs. Where NHS Lanarkshire is the provider, expenditure incurred will include irrecoverable VAT as, generally, NHS Lanarkshire cannot recover VAT paid as input tax and will seek to recover its full cost as income from the IJB. 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.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 54 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 10. Hosted Services - Principal Income and Expenditure On behalf of the South Lanarkshire IJB within the NHS Lanarkshire area, the North Lanarkshire IJB acts as the lead for a number of delegated services. It therefore commissions services on behalf of the South Lanarkshire IJB and reclaims the costs involved. The payments that are made on behalf of the South Lanarkshire IJB, and the consequential reimbursement, are included in the Comprehensive Income and Expenditure Statement, since the North Lanarkshire IJB is acting as principal in these transactions. The net amount of expenditure and income relating to these principal arrangements is shown below: 2020/2021 Delegated Services - Services hosted by the North Lanarkshire IJB On behalf of the South Lanarkshire IJB 2021/2022 Expenditure on hosted services Income from hosted services Net Expenditure Expenditure on hosted services Income from hosted services Net Expenditure £m £m £m £m £m £m 1.360 (1.360) 0.000 Sexual Health Services 1.442 (1.442) 0.000 1.057 (1.057) 0.000 Continence Services 1.099 (1.099) 0.000 0.908 (0.908) 0.000 Immunisation Services 1.077 (1.077) 0.000 2.862 (2.862) 0.000 Speech and Language Therapy Services 2.962 (2.962) 0.000 3.930 (3.930) 0.000 Children and Adult Mental Health Services 6.097 (6.097) 0.000 5.591 (5.591) 0.000 Children’s Services 5.619 (5.619) 0.000 0.253 (0.253) 0.000 Integrated Equipment and Adaptation Service 0.278 (0.278) 0.000 1.854 (1.854) 0.000 Dietetics Services 1.864 (1.864) 0.000 2.081 (2.081) 0.000 Podiatry Services 2.119 (2.119) 0.000 0.848 (0.848) 0.000 Prisoner Healthcare Services 0.984 (0.984) 0.000 0.703 (0.703) 0.000 Blood Borne Virus Services 0.739 (0.739) 0.000 1.062 (1.062) 0.000 Hospital at Home Services 1.264 (1.264) 0.000 34.988 (34.988) 0.000 Mental Health Services 38.312 (38.312) 0.000
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 55 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 10. Hosted Services - Principal Income and Expenditure (Cont.) Similarly, the South Lanarkshire IJB within the NHS Lanarkshire area acts as the lead for a number of delegated services on behalf of the North Lanarkshire IJB. The payments that are made by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB, and the consequential reimbursement, are included in the Comprehensive Income and Expenditure Statement, since this expenditure is incurred for the residents of North Lanarkshire. The net amount of expenditure and income relating to those principal arrangements hosted by the South Lanarkshire IJB is shown below: 2020/2021 Delegated Services - Hosted Services 2021/2022 Expenditure on hosted services Income from hosted services Net Expenditure Expenditure on hosted services Income from hosted services Net Expenditure £m £m £m £m £m £m 7.373 (7.373) 0.000 Primary Care Improvement Fund 8.870 (8.870) 0.000 3.325 (3.325) 0.000 Community Dental Services 3.758 (3.758) 0.000 4.255 (4.255) 0.000 Out of Hours Services 4.509 (4.509) 0.000 2.211 (2.211) 0.000 Diabetic Services 2.929 (2.929) 0.000 4.565 (4.565) 0.000 Occupational Therapy Services 5.180 (5.180) 0.000 3.636 (3.636) 0.000 Palliative Care Services 3.770 (3.770) 0.000 0.378 (0.378) 0.000 Primary Care Services 0.389 (0.389) 0.000 4.917 (4.917) 0.000 Physiotherapy Services 5.149 (5.149) 0.000 57.497 (57.497) 0.000 South Lanarkshire IJB Total 63.855 (63.855) 0.000 52.877 (59.843) (6.966) North Lanarkshire IJB Total 50.718 (65.994) (15.276) 110.374 (117.340) (6.966) Total services hosted by the North Lanarkshire IJB (Note 4) 114.573 (129.849) (15.276)
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 56 30.660 (30.660) 0.000 Services hosted by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB (Note 4) 34.554 (34.554) 0.000
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 57 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 11. Usable Reserve: General Fund The purposes of the General Fund are detailed in the IJB Reserves Policy7. 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. This is a key part of the risk management strategy. The table below shows the movements on the General Fund balance, analysed between these purposes and the amount held as a general contingency. 7 https://mars.northlanarkshire.gov.uk/egenda/images/att91214.pdf
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 58 Balance As At 1 April 2020 Transfers Out Transfers In Balance As At 31 March 2021 Useable Reserve Transfers Out Transfers In Balance As At 31 March 2022 £m £m £m £m Ring-Fenced Reserves £m £m £m 0.000 0.000 6.076 6.076 Integrated Authority Support 0.000 0.000 6.076 0.086 (0.086) 2.358 2.358 Mental Health and Learning Disability Services - Action 15 Funding (2.355) 0.000 0.003 0.000 0.000 2.265 2.265 Covid-19 Funding (2.265) 31.686 31.686 0.000 0.000 1.941 1.941 Winter Adult Social Care Preparedness Fund 0.000 0.000 1.941 0.000 0.000 1.298 1.298 Community Living Change Fund 0.000 0.000 1.298 0.313 0.000 0.964 1.277 Alcohol and Drug Partnership Funding (0.135) 0.000 1.142 0.000 0.000 0.900 0.900 Children and Adolescent Mental Health Services Funding 0.000 0.000 0.900 0.647 (0.127) 0.300 0.820 Mental Health and Learning Disability Services - Distress Brief Intervention (0.712) 0.000 0.108 1.290 (0.271) 2.748 3.767 Ring-fenced Reserves - Other Services (1.203) 0.000 2.564 2.336 (0.484) 18.850 20.702 Ring-Fenced Reserves Total (6.670) 31.686 45.718 Earmarked Reserves 0.000 0.000 3.988 3.988 Social Care Services (Risk Based Reserve) 0.000 0.000 3.988 3.214 (3.214) 0.000 0.000 Self Directed Support Strategy (Risk Based Reserve) 0.000 0.000 0.000 3.786 0.000 0.575 4.361 Prescribing Fund (Risk Based Reserve) 0.000 0.000 4.361 0.384 0.000 6.188 6.572 IJB Financial Plan 2022/2023 (NLC) 0.000 0.000 6.572 0.000 0.000 3.000 3.000 Long Covid Contingency (Risk Based Reserve) 0.000 0.000 3.000 0.000 0.000 1.500 1.500 Minor Capital Works (0.113) 0.000 1.387 0.000 0.000 0.807 0.807 Speech, Language and Therapy Services 0.000 0.000 0.807 0.000 0.000 0.717 0.717 Children and Adolescent Mental Health Services Funding 0.000 0.000 0.717 0.000 0.000 0.600 0.600 Digital and IT Strategy Technology Improvements Funding (0.034) 0.000 0.566 0.580 0.000 0.000 0.580 Carers Act 2018 0.000 0.000 0.580 0.000 0.000 0.000 0.000 Earmarked Reserves 2021/2022 0.000 42.984 42.984 2.430 (0.492) 4.669 6.607 Earmarked Reserves - Other Services (1.519) 0.000 5.088 10.394 (3.706) 22.044 28.732 Earmarked Reserves Total (1.666) 42.984 70.050 3.684 0.000 0.000 3.684 Contingency Reserve Total 0.000 0.000 3.684 16.414 (4.190) 40.894 53.118 General Fund Total (8.336) 74.670 119.452 0.000 3.214 (3.214) 0.000 Transfer Between Reserves 0.000 0.000 0.000 16.414 (0.976) 37.680 53.118 Movement In Reserves (Decrease)/Increase (8.336) 74.670 119.452 2020/2021 2021/2022
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 59 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 12. Related Party Transactions The IJB has related party transactions with NHS Lanarkshire and North Lanarkshire Council. In particular, the nature of the partnership means that the IJB may influence, and be influenced by, its partners. The following transactions and balances included in the IJB’s annual accounts are presented to provide additional information on the relationships. 2020/202 1 £m Transactions with NHS Lanarkshire 2021/2022 £m (518.560) Funding Contributions received from NHS Lanarkshire (537.845) (23.607) Covid-19 Funding (45.098) 444.518 Expenditure on Services Provided by NHS Lanarkshire 466.753 6.145 Covid-19 Costs 5.347 0.030 Support Services 0.031 (91.474) Net Transactions with NHS Lanarkshire (110.812) Key Management Personnel: The non-voting Board members are not directly employed by NHS Lanarkshire however a contribution of 50% of the cost of the Chief Officer and the Chief Financial Officer is made by NHS Lanarkshire. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. Details of the remuneration of these post holders is included in the Remuneration Report. NHS Lanarkshire provide a range of support services for the IJB including finance services, personnel services, planning services, audit services, payroll services and creditor services. There is no charge from NHS Lanarkshire to the IJB for these support services. 31 March 2021 £m Balances with NHS Lanarkshire 31 March 2022 £m 36.400 Debtor balances: Amounts due from NHS Lanarkshire 87.533 36.400 Net Balance with NHS Lanarkshire 87.533 2020/202 1 £m Transactions with North Lanarkshire Council 2021/202 2 £m (148.431) Funding Contributions received from North Lanarkshire Council (164.787)
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 60 (2.507) Service Income received from North Lanarkshire Council (3.800) 0.000 Covid-19 Funding 0.000 190.329 Expenditure on Services Provided by North Lanarkshire Council 204.817 15.197 Covid-19 Costs 8.065 0.182 Key Management Personnel: Non-Voting Board Members 0.183 54.770 Net Transactions with North Lanarkshire Council 44.478
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 61 NOTES TO THE FINANCIAL STATEMENTS (Cont.) 12. Related Party Transactions (Cont.) Key Management Personnel: The Chief Officer is a non-voting Board member and is directly employed by North Lanarkshire Council. The Chief Financial Officer is also a non-voting Board member and is directly employed by South Lanarkshire Council. The cost of the Chief Financial Officer post is shared equally between North Lanarkshire and South Lanarkshire Council. The total cost of the Chief Officer and the Chief Financial Officer is paid by North Lanarkshire Council. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. A contribution of 50% of this cost is met by NHS Lanarkshire. Details of the remuneration of these post holders is included in the Remuneration Report. North Lanarkshire Council also provide a range of support services for the IJB including finance services, personnel services, planning services, legal services, audit services, payroll services and creditor services. There is no charge from North Lanarkshire Council to the IJB for these support services. 31 March 2021 £m Balances with North Lanarkshire Council 31 March 2022 £m 16.718 Debtor balances: Amounts due from North Lanarkshire Council 31.919 16.718 Net Balance with North Lanarkshire Council 31.919 The financial information contained in the IJB annual accounts excludes any values associated with transactions between each of the partners. This has been removed to prevent double counting. 13. Covid-19 Costs and Funding Additional funding was provided by the Scottish Government to respond to the Covid-19 pandemic and to support the remobilisation of services. The Covid- 19 funding and Covid-19 costs are summarised as follows: 2020/2021 Description 2021/2022 £m £m 23.607 Covid-19 Funding Total (45.098) 6.145 Allocated To NHSL Costs 5.347 15.197 Allocated To NLC Costs 8.065 21.342 Covid-19 Costs Total 13.412 2.265 Remobilisation Funding Transferred To Reserves (31.686) 14. New standards issued but not yet adopted
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 62 The Code requires the disclosure of information relating to the impact of an accounting change that will be required by a new standard that has been issued but not yet adopted. The IJB considers that there are no such standards which would have significant impact on its annual accounts.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2021/2022 Page | 63 Audit Arrangements Under the arrangements approved by the Commission for Local Authority Accounts in Scotland (“The Accounts Commission”), the auditor with overall responsibility for the audit of the accounts of the North Lanarkshire IJB for the year ended 31 March 2022 is Audit Scotland, 4th Floor, 102 West Port, Edinburgh, EH3 9DN.
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1 REPORT Item No: 6 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 a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2021 to 31 March 2022. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By; Chief Financial Officer Reviewed By; Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Note the contents of the report; (2) Note the confirmation of the additional non-recurring Scottish Government funding to respond to the Covid-19 pandemic and to recover and remobilise health and social care services during 2021/2022; (3) Endorse the principle that uncommitted 2021/2022 Covid-19 funding will be transferred to a ring-fenced reserve to address ongoing Covid-19 costs in 2022/2023; (4) Note that the financial outturn at 31 March 2022 is an underspend of £74.670m (NHSL - £58.697m; NLC - £15.973m). 4. VARIATIONS TO DIRECTIONS SUBJECT: Financial Monitoring Report 2021/2022 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie Chief Officer Author(s) of Report Marie Moy Chief Financial Officer DATE: 22nd June 2022 Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from the Director of Finance of NHS Lanarkshire (NHSL) and the Head of Financial Solutions of North Lanarkshire Council (NLC). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. This is the final financial monitoring report presented in respect of the financial year 2021/2022. 6. CONCLUSIONS 6.1 The financial position as at 31 March 2022 is summarised as follows: there is a net underspend of £58.697m on the core budgets within Health Care Services; details of which are provided at Appendix 1. there is a net underspend of £15.973 on the core budgets within Social Care and Housing Services; details of which are provided at Appendix 2 The total underspend of £74.670m represents approximately 12% of the total financial envelope available. 6.2 The Covid-19 pandemic has created significant financial management and financial planning challenges for both partners and the IJB. These challenges have centred around the difficulties in predicting the costs associated with the response to and recovery from the Covid-19 pandemic and the constantly evolving funding allocations from the Scottish Government. 6.3 Additional Scottish Government funding was confirmed on 25 February 2022 which meets in full the 2021/2022 Covid-19 costs included in the Lanarkshire Remobilisation Plan for both partners. 6.4 The underspends detailed in section 6.1 include the spend against covid-19 funding; during 2021/2022 the spend amounted to £13.412m (NHSL £5.347m) and (NLC £8.065m). This left a balance of £31.686m uncommitted at the 31 March 2022, which has been transferred to a ring-fenced reserve to address ongoing Covid-19 costs in 2022/2023. This funding is to be used before further funding is requested through the Local Mobilisation Planning process in 2022/2023. 6.5 The Covid-19 funding transferred to the ring-fenced reserve can be used to support continuation of costs which were funded in 2021/2022 as a direct result of Covid-19. The use of these allocations to meet Covid-19 expenditure must be agreed by the IJB Chief Finance Officer and the NHS Board Director of Finance. It is important to note that the funding should be targeted at meeting all additional costs of responding to the Covid-19 pandemic in the Integration Authority as well as the NHS Board. 6.6 Any proposed utilisation of the earmarked reserves to meet new expenditure that had not been funded in 2021/2022 will require the prior agreement of the Scottish Government in advance of the expenditure being incurred. It also remains important that reserves are not used to fund recurring expenditure, given the non- recurring nature of Covid-19 funding. The Covid-19 financial position is being closely monitored.
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3 6.7 The main factors contributing to the financial position are summarised at sections 7 and 8. 7. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES 7.1 Locality and Other Services 7.1.1 There is a net underspend of £4.549m. 7.1.2 The net underspend on pay costs totals £4.733m and is mainly due to vacancies across Nursing Services and Administration and Clerical staff within the localities totalling 64.30 WTE. There are incremental pay increases and unfunded enhancements across many services however these cost pressures are being offset in-year by the vacancies. 7.1.3 In respect of non-pay costs, there is a net overspend totalling £0.184m. The overspend is mainly due to payments in respect of Strathcarron Hospice (£0.568m). This cost is being managed on a non-recurring basis. A recurring funding solution requires to be identified. The overspend across non-pay costs is partly offset by underspends in respect of drug and travel costs. 7.2 Addiction Services 7.2.1 There is an underspend of £2.336m. 7.2.2 The underspend across pay costs is £0.386m. An underspend of £1.950m is reported in respect of non-pay costs. 7.3 Medical and Nursing Directorate 7.3.1 There is a net underspend of £0.758m. 7.3.2 An underspend of £0.076m is being reported in respect of the medical directorate. There is an overspend across pay costs of £0.011m which is offset by an underspend of £0.087m in respect of non-pay costs. 7.3.3 The nursing directorate is underspent by £0.682m. There is an underspend across pay costs of £0.658m and an underspend of £0.024m in respect of non-pay costs. 7.4 Prescribing 7.4.1 An underspend of £1.500m has been reported. 7.4.2 The prescribing budget has reduced by £1.349m since 31 March 2021. The majority of the budget reduction relates to the savings target of £1.186m which has been removed from the budget. The non-recurring funding of £0.978m received from the Scottish Government last year to address the price increases in two drugs and Flu costs has also been removed. The budget reductions have been partly offset by uplifts in-year to cover inflation. 7.4.3 Prescribing activity figures for the period from April 2021 to January 2021 have been received. Prescribing activity is 1.70% higher when compared to the same period last year. The cost per item remains at a high level. There continue to be significant risks in respect of prescribing activity and the costs as a result of both
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4 the Covid-19 pandemic and also the withdrawal from the European Union. Work is continuing to implement the planned prescribing savings targets. Prescribing costs will continue to be closely monitored. 7.5 Out of Area Services 7.5.1 There is a net overspend of £0.404m across non-pay costs. 7. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES (CONT.) 7.6 Area Wide Services 7.6.1 There is a net underspend of £1.676m mainly in respect of support for Refugees and Displaced People (£0.400m), Health Improvement Services (£0.030m) and Pharmacy Services (£1.391m). The funding for Refugees and Displaced People was received in December 2021. 7.6.2 Area Wide Services include central nursing services, corporate services, health promotion services, pharmacy services and winter planning services. The underspend comprises of an underspend of £1.439m across pay costs and an underspend of £0.237m across non-pay costs. 7.7 Hosted Services Led By North Lanarkshire 7.7.1 There is a net underspend in the hosted services which are led by the North Lanarkshire HSCP. The net underspend is £16.596m which includes the following significant variances: Mental Health and Learning Disability Services £10.328m underspend Children and Adolescents Mental Health Services £5.285m underspend Podiatry Services £0.280m underspend Speech and Language Therapy Services £0.405m underspend Dietetics Services £0.285m underspend Sexual Health Services £0.134m underspend Immunisation Service (£1.367m) overspend 7.7.2 The net underspend on Mental Health and Learning Disability Services is £10.328m. There is a net underspend across pay costs of £1.427m. This is due to 51.25 WTE vacancies mainly in nursing posts with some vacancies in psychology posts and administration posts (£2.133m). The underspend has been partly offset by overspends totalling £0.706m. This includes locum costs across Medical Services (£0.568m) and other overspends totalling £0.138m which include the use of bankaide across the inpatient areas and incremental increases within the community areas. There is a net underspend across non-pay costs of £8.901m. The total underspend to date is £9.085m however this is offset by overspends totalling £0.111m. The overspend relates to the Forensic Psychiatry Services (£0.083m) and Adult Psychotherapy (£0.028m). This position also includes additional allocations from Scottish Government in year.
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5 7.7.3 The net underspend within Children and Adolescents Mental Health Services is £5.285m and is due to vacancies (£5.443m) across nursing and administration posts (49.48 WTE) as well as additional new monies received in year from Scottish Government remaining unspent at year end. There is also an overspend on non-pay costs (£0.158m). 7.7.4 There is an underspend of £0.280m within Podiatry Services which is mainly due to 8.57 WTE podiatrist vacancies (£0.269m) and an underspend across non-pay costs of £0.011m. 7.7.5 There is an underspend of £0.405m within Speech and Language Therapy Services which is mainly due to 14.59 WTE posts (£0.311m) and an underspend across non-pay costs of £0.094m. 7.7.6 There is an underspend of £0.285m within Dietetics Services which is mainly due to 4.26 WTE vacancies across dietician, admin and clerical posts (£0.175m) and an underspend across non-pay costs of £0.110m. 7.7.7 There is an underspend of £0.134m within Sexual Health Services which is mainly due to 1.58 WTE medical, nursing, admin and clerical vacancies (£0.088m) and an underspend across non-pay costs of £0.046m. 7. REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES (CONT.) 7.7 Hosted Services Led By North Lanarkshire (Cont.) 7.7.8 There is an overspend within Immunisation Services of £1.367m which is partly due to an overspend on pay costs (£0.063m) but mainly due to an overspend on non-pay costs in respect of the cost of drugs (£1.304m). 7.7.9 In line with the Integrated Resource Advisory Group Finance Guidance, the lead partner for a hosted service is responsible for managing any overspends incurred. With the exception of ring-fenced funding, the lead partner can also retain any underspends which may be used to offset the overspends. This arrangement has been in place since 1 April 2016. 7.7.10 The IJB was previously advised that the hosted services principal is currently being reviewed. The outcome of the review will be reported to future meetings of both the North Lanarkshire IJB and the South Lanarkshire IJB for approval. 7.8 Hosted Services Led By South Lanarkshire 7.8.1 The hosted services which are led by the South Lanarkshire HSCP, in-line with the hosted services agreement, a break-even position is reported. 7.8.2 Primary Care Services are a hosted service which is led by the South Lanarkshire IJB. The Primary Care and Mental Health Transformation Fund and the Primary Care Improvement Fund are ring-fenced funding allocations. Any underspend is therefore retained for use across Lanarkshire and is not used to offset other overspends incurred by the South Lanarkshire IJB. 7.8.3 An underspend position of £9.796m is reported in respect of the Primary Care and Mental Health Transformation Fund and the Primary Care Improvement Fund. This is due to funding allocated by Scottish Government in year which will be utilised during future years.
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6 7.9 Covid-19 Pandemic – Additional Health and Social Care Costs 7.9.1 The additional costs which have been incurred in response to the Covid-19 pandemic continued to be reported to the Scottish Government through the Lanarkshire Mobilisation Plan. The actual costs incurred for Covid-19 for 2021/2022 total £13.412m. These have been met from existing IJB Covid-19 reserve (£2.265m) with the balance(£11.147m) being met by the additional Scottish Government funding announced on 25 February 2022. As highlighted at 6.4, uncommitted 2021/2022 Covid-19 funding at 31 March 2022 of £31.686m will be transferred to a ring-fenced reserve to meet ongoing 2022/2023 Covid-19 costs. 7.10 Average Vacancy Factor 7.10.1 The vacancy position against the funded establishment at 31 March 2022 is summarised as follows: Establishment Actual Variance 2,825 WTE 2,665 WTE 160 WTE vacancies 100% 93% 6% 7.10.2 The staff resource is 160 WTE (6%) under-established over the year. Additional hours are worked through bank aide, overtime and excess part time hours, the cost of which is included within the financial position reported and these are included in the final figure. 7 REASONS FOR MAJOR VARIANCES – HEALTH CARE SERVICES (CONT.) 7.11 Notional Set-Aside Allocation 7.11.1 The set-aside budget is a notional budget which represents the consumption of hospital resources by North Lanarkshire residents. The opening budget each year is increased by any relevant SG funding uplifts and modified to reflect any agreed changes to the specific delegated hospital services that shift the balance between hospital and community care. There were no agreed shifts during 2021/22 so the closing budget of £65.164m represents the impact of the 1.5% NHS allocation uplift and pay funding of £1.152m on opening budget of £63.066m. 7.11.2 In respect of the financial year 2021/2022, the notional set-aside budget is restated to reflect the 1.5% inflationary uplift on the recurring baseline (£0.946m) and also the 1.8% pay uplift (£1.152m). The notional set-aside budget for 2021/2022 is therefore £65.154m. 7.11.3 The 2019/2020 activity data from the Information Services Division (ISD) is not yet available. As highlighted at the North Lanarkshire IJB (Performance, Finance and Audit) Committee on 25 May 2021, the complexity in allocating costs contributes to a time lag. There is also a further delay in receiving the activity data as a result of the Covid-19 pandemic. A local pilot was being progressed within NHSL to ascertain if reliance could be placed on more current activity information linked to the NHSL financial ledger prior to being validated by the ISD. The outcome of this work however was impacted on by the Covid-19 pandemic both in terms of resource capacity to undertake the work and the relevance of the outcomes during the period of the pandemic. The time lag and complexities of this exercise are not however a barrier to progressing local plans. These are costed by adopting a “bottom up” approach.
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7 7.11.4 In line with the accounting policy previously agreed, this notional set-aside budget will be included in the IJB Annual Accounts 2021/2022 as an estimate of expenditure. It is recognised that this will not necessarily reflect the actual usage of these hospital services by the IJB however it has been endorsed as an acceptable approach pending further updates from ISD. It is also recognised that, in the future, the 2020/2021 and the 2021/2022 activity levels will not be representative of previous normal activity levels due to the impact of the Covid-19 pandemic. This will require to be taken into consideration. 7.11.5 The calculation of the notional set-aside allocation and the confirmation of actual activity levels is a complex accounting process. The NHSL Director of Finance, in consultation with the IJB Chief Financial Officer, continues to develop the monitoring arrangements for the Hospital Acute Services. 8. REASONS FOR MAJOR VARIANCES – SOCIAL CARE SERVICES 8.1 A net underspend of £15.793m is reported as at 31 March 2022. This is an increase of £4.246m since the net underspend of £11.727m which was reported as at 4 February 2022. The main factors contributing to this year-to-date financial position are highlighted below. 8.2 A net underspend of £0.093M is reported within employee cots which relates to vacancy management across the Service, partly offset by cost pressures resulting from demand within home support. 8.3 An underspend of £0.324m is reported within property costs which reflects lower than anticipated demand for housing adaptations within Council houses of £0.302m, this underspend will be retained within the Housing Revenue Account. 8.4 An underspend of £0.696m is reported in respect of supplies and services. Expenditure on supplies for client’s budgets and demand for equipment and adaptations are less than anticipated. The additional costs being incurred in respect of the provision of PPE to protect staff and service users against the Covid-19 virus will be offset by Covid-19 funding. 8. REASONS FOR MAJOR VARIANCES – SOCIAL CARE SERVICES (CONT.) 8.5 An underspend of £0.374m is reported in respect of transport and plant costs. This is due to lower than anticipated staff mileage costs coupled with lower than anticipated costs on vehicle contract hire within Integrated Day Services and Locality Support Services. 8.6 An underspend of £7.164m is reported in respect of administration costs. 8.6.1 The underspend is mainly due to the additional funding (£6.400m) received from the Scottish Government for winter planning systems pressures in 2021/2022 and also to facilitate longer term improvement in service capacity across health and social care services. The NLC partner will submit a request to the IJB to ring-fence the underspend from the winter pressures funding as a reserve to ensure it is available to support the transformational change programme as set out in the North Lanarkshire IJB Business Plan.
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8 8.6.2 An underspend of £0.843m across the carers budget in 2021/2022 is also reported. Social Care Services have recently reviewed all carer provision and budget allocations. The anticipated underspend across the carers budget is reflective of the part-year implementation of contracts. The NLC partner will submit a request to the IJB to earmark the underspend across the carers budget as a reserve to ensure it is utilised solely for carer provision in future years. 8.7 There is an underspend of £7.987m across payments to other bodies. The underspend is primarily due to the staff shortages and vacancies within the Care at Home sector who provide services to individuals via the Self-Directed Support commissioning framework. It is anticipated that these are in-year underspends only and these budgets will be required in full in 2022/2023. 8.8 Income is under-recovered by £0.744m, which is an adverse variance. This is partly due to the under-recovery of income from the community alarm charge, Home Support Services and Integrated Day Care Services which is lower than anticipated as a result of the Covid-19 pandemic. The implementation of the charge for community alarms was delayed due to the impact of the Covid-19 pandemic. The charge is now in place. Social Care Services continue to closely monitor the changes in the uptake of this essential service and are pro-actively responding to enquiries. The previously agreed NHS Lanarkshire partner contribution to the Integrated Equipment and Adaptations Service is also less than the actual cost of the service. This is currently being monitored. 8.9 The additional social care costs which have been incurred in response to the Covid-19 pandemic are also continuing to be reported to the Scottish Government through the 2021/2022 Lanarkshire Mobilisation Plan. 8.10 The projected Covid-19 costs for 2021/2022 will be met by Scottish Government funding. As highlighted at 6.4, uncommitted 2021/2022 Covid-19 funding at 31 March 2022 will be transferred to a ring-fenced reserve to meet ongoing 2022/2023 Covid-19 costs. 9. 2021/2022 SAVINGS 9.1 Financial Strategy 2021/2022 9.1.1 On 23 March 2021, the IJB approved the financial strategy to address the projected funding gap in 2021/2022 totalling £2.485m (NHSL - £1.032m; NLC - £1.453). 9.2 Health Care Savings 9.2.1 On 23 March 2021, the IJB approved total prescribing efficiencies of £1.632m. The prescribing budget was reduced by £1.186m, which represents 73% of the original target of £1.632m. The decision to reduce the prescribing budget by £1.186m instead of £1.632m was based on the financial information available at the start of the financial year taking into consideration projected prescribing activity
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9 levels and anticipated prices in 2021/2022. Further prescribing efficiencies would be progressed in 2022/2023. 9.2.2 As at 31 March 2022, an underspend position of £1.500m is reported in respect of the prescribing budget. This includes achievement of prescribing efficiencies of £1.234m. 9.3 Social Care Savings 9.3.1 This financial year 2021/2022 is the second year of the three-year Efficiency Programme approved by the IJB and the NLC partner in March 2020. The gross savings target is £1.453m. The NLC partner is therefore progressing the previously agreed savings plans. 9.3.2 The Service uses a variety of information, records and processes to monitor achievement of its approved budget savings; the service delivered £1.368m (94%) of the savings target. The budget gap of £0.086m was addressed during the year by the additional non-recurring 2021/2022 Scottish Government Covid-19 funding confirmed on 25 February 2022. 10. RESERVES 10.1 During 2021/2022 a total of £8.336m was drawn down from reserves (NHSL - £7.564m; NLC - £0.772m) and the surplus of £74.670m was added (NHSL - £58.697m; NLC - £15.973m). The reserves balance as at 31 March 2022 is therefore as follows: £m % Ring-fenced reserves 45.718 38% Ear-marked reserves 70.050 59% Contingency reserves 3.684 3% Total 119.452 100% 10.2 The 2021/2022 IJB Reserves Strategy continues to be monitored in consultation with the Director of Finance of NHSL and the Head of Financial Solutions of NLC. 11. RISK 11.1 Risk management arrangements are in place for the IJB and each partner. The IJB risk register has been reviewed and updated. The main risk associated with the in- scope budget during 2021/22 was that either or both partners would overspend. However as detailed within this report the financial outturn for the year was an underspend 11.2 The financial years 2020/2021 and 2021/2022 have been unprecedented. The emergency response to the Covid-19 pandemic has had a significant operational and financial impact on service delivery, the achievement of the Strategic Commissioning Plan and the financial planning assumptions of the original IJB Financial Plans.
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10 11. RISK (CONT.) 11.3 Although a non-recurring underspend has been reported, health and social care services continue to face demand pressures including home support, self-directed support, direct payments, independent care home placements, hospice care and health care services recovery plans. 11.4 The operational and financial impact of the response to the Covid-19 pandemic continues to be monitored by the IJB and both partners in line with their agreed emergency response arrangements and also the recovery, redesign and remobilisation work to reinstate services. The whole system approach continues to be adopted by NHSL, NLC and South Lanarkshire Council. 11.5 Additional non-recurring Scottish Government funding for Covid-19 and Remobilisation costs in 2021/2022 was confirmed on 25 February 2022. Although the risk in 2021/2022 of an overspend as a result of the Covid-19 pandemic has now been removed, the risk that the health and social care Covid-19 and Remobilisation costs in 2022/2023 and beyond will exceed the funding available continues to be assessed as high-risk. 11.6 Risk management arrangements are in place for the IJB and each partner. The respective risks are managed by both NHSL and NLC through their detailed budget management processes. In addition to these mitigating actions, the IJB Financial Plan 2021/2022 is closely monitored and the IJB Medium to Long Term Financial Pan is being updated. 12. IMPLICATIONS 12.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. The IJB Financial Plan 2021/2022 is currently being reviewed. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 12.4 RISK ASSESSMENT/RISK MANAGEMENT The financial risks are detailed at section 15. The strategic financial risks detailed in the IJB Risk Register have also been updated and are included in a separate report to the IJB. 12.5 PEOPLE None 12.6 STAKEHOLDER ENGAGEMENT The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the financial position of the North Lanarkshire IJB.
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11 12.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 12. IMPLICATIONS (CONT.) 12.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 13. BACKGROUND PAPERS None. 14. Appendices North Lanarkshire Health Care Services Financial Outturn 2021/2022 Appendix 1 North Lanarkshire Social Care Services Financial Outturn 2021/2022 Appendix 2 ........................................... CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Marie Moy on telephone number 01698 453709
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Appendix 1 12 North Lanarkshire Health Care Services Financial Outturn 2021/2022
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Appendix 2 13 North Lanarkshire Social Work Services Financial Outturn 2021/2022 CATEGORY ANNUAL PROJECTED OUTTURN BUDGET OUTTURN VARIANCE EMPLOYEE COSTS 75,548,757 75,454,912 93,845 PROPERTY COSTS 2,878,181 2,553,735 324,446 SUPPLIES & SERVICES 5,471,562 4,775,144 696,418 TRANSPORT & PLANT 1,681,395 1,306,497 374,898 ADMINISTRATION COSTS 7,646,825 481,935 7,164,890 PAYMENTS TO OTHER BODIES 137,124,820 129,137,351 7,987,469 OTHER EXPENDITURE 38,856 5,067 33,789 TOTAL EXPENDITURE 230,390,396 213,714,641 16,675,755 NLC CONTRIBUTION 164,787,426 164,787,426 0 NLC CONTRIBUTION - HOUSING 1,970,000 1,668,368 (301,632) NLC CONTRIBUTION - TRANSPORT 550,737 539,200 (11,537) INCOME FROM HEALTH 53,121,607 53,076,154 (45,453) INCOME FROM HEALTH - COVID FUNDING 8,065,089 8,065,089 0 FEES AND CHARGES 1,553,309 1,122,748 (430,561) OTHER LOCAL AUTHORITIES 30,000 32,475 2,475 USE OF IJB RESERVES 0 0 0 OTHER INCOME 312,228 396,198 83,970 TOTAL INCOME 230,390,396 229,687,658 (702,738) NET EXPENDITURE 0 (15,973,017) 15,973,017
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1 REPORT Item No: 7 SUBJECT: Covid-19 Update TO: Integration Joint Board Lead Officer for Report: Ross McGuffie Chief Officer Author(s) of Report Ross McGuffie Chief Officer DATE: 22nd June 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the IJB: For approval For endorsement To note 1.2 This paper sets out the actions taken to date during the pandemic response. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared Reviewed Endorsed By the command structure in the Health and Social Care Partnership. 3. RECOMMENDATIONS 3.1 The IJB is asked to: (1) Note progress made during the pandemic response (2) Request that future updates move to focus on recovery and remobilisation, unless the command structure is reinstated due to further significant waves. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 COVID-19 was declared a pandemic by the World Health Organisation on 12 March 2020, with spread of COVID-19 within all communities in the UK in the intervening period. 5.1.2 Command structures were immediately put in place in both North Lanarkshire Council and NHS Lanarkshire, with the Health and Social Care Partnership fully participating in both. In addition, the pan Lanarkshire Resilience Partnership has supported cross-agency developments. Yes No N/A
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2 5.1.3 An overview of the current developments around Covid-19 is included below: 5.2 Update on Numbers 5.2.1 As at 8th June, the seven-day case rate within North Lanarkshire is 103 per 100k population, which is a significant decrease to the figures last presented to the IJB PFA on 15th March when it was 1,334 per 100k. 5.2.2 Through the first Omicron wave, the peak on the acute sites was on 14th January 2022 when there were 192 covid positive inpatients, however, following a steady reduction through the first half of February the second wave of Omicron hit, with a peak of 322 covid positive inpatients on 28th March, with a further 63 in off-site facilities. 5.2.3 On 4th May, NHS Lanarkshire moved out of black status back to red, with the supporting command structure stood down. This has been replaced with a Service Remobilisation and Oversight Group, with the aim of: Overseeing service remobilisation approaches Identifying unintended consequences of service recovery and remodelling Taking a whole system approach to the resolution of issues Providing assurance on progress 5.3 Care Homes 5.3.1 One of the greatest areas of focus has been around supporting the Care Home sector, covering key areas of work such as: Testing, outbreak management and ongoing surveillance Infection, prevention and control including PPE and cleaning requirements Education and training Supportive reviews and visits. Workforce requirements and supply of mutual aid 5.3.2 Across Lanarkshire, work began to strengthen the management and oversight of outbreaks in care homes in March 2020, enhancing the supports we had offered routinely up until then. This included: Social Work Quality Assurance Section – existing contact Care home Liaison Team Support – existing weekly contact HPT Management of outbreaks – daily contact during outbreaks Weekly conference calls with sector by HSCP, established March 2020 Established early contact with Care Inspectorate Care home Assurance Group, meets daily, established 23rd April 2020 Bronze care home sub group, meeting twice weekly, established 24th April 2020 Development of Care Home Strategy 23rd April 2020 Access to staff bank to enable sustainable rotas with supporting governance framework Enhanced PPE recommendations that sector move to table 4 on 1st May 2020 Prioritised programme of testing for care homes commenced 5th May 2020 Workforce group established to support screening programme established 14th May 2020 Additional support arrangements for Care Homes confirmed until June 2022, with £1,326,353 allocated as part of the Remobilisation Plan funding in June 2021.
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3 5.3.3 Following communication from the Cabinet Secretary on 17th May 2021, which outlined the additional requirements regarding accountability for provision of nursing leadership; professional oversight; implementation of infection prevention control measures; use of PPE; and quality of care; we have undertaken significant work to map our current provision of support and ongoing workforce and resource requirements to deliver this new request: Care Home Assurance Group – initially established on 23rd April 2021, group was expanded to include Chief Social Work Officers, Chief Officers and the Medical Directors. The group has also undertaken a thematic analysis of Care Homes, identifying support needs around access to updated HPS guidance; management of outbreaks; standard infection prevention and control measures; and staff support around mental health and wellbeing. Huddle - All 93 care homes in Lanarkshire have registered to use the national safety huddle template hosted on TURAS. There is a daily safety huddle meeting involving social work, care inspectorate, health protection team and nursing staff where they review this information and respond to any escalations or concern’s raised. Work continues with the Care Homes to improve completion rates, particularly at weekends. Enhanced support from Social Work Quality Assurance – including coordinated timetable of audits for each Care Home; supporting action plan development; coordinating links with colleagues in Care Home Liaison, Infection Prevention and Control, Care Inspectorate etc; and support for Homes to claim financial assistance where appropriate. Care Home Liaison – establishment increased by 0.8wte B7 and 3.4wte B6 to move to a 7 day service and enhance contact with each home in Lanarkshire. The team have undertaken visits; managed daily data returns; acted as an escalation point for PPE issues; and participated in the prioritised engagement visits as required. Health Protection Team – To enhance the outbreak management and screening testing in Care Homes, an additional 0.6wte B7, 3wte B5, 1wte B4 and 3wte B2 staff have been brought into the team. Testing – All staff continue have access to weekly asymptomatic PCR staff testing through either the social care portal or NHS laboratory testing. In addition to weekly PCR testing care home staff are now also requested to undertake twice weekly Lateral Flow Testing. Infection, Prevention and Control – In conjunction with Care Home Liaison, the IPC team provide advice and support covering virtual visits, attendance at Care Inspectorate unannounced inspections and providing support to Homes as required. Senior Nursing Leadership – a team is being developed under the leadership of a Deputy Chief Nurse to provide an immediate response during early stages of an outbreak similar to acute care setting where the focus is on early containment. This team would build on the existing care home liaison team and would have additional workforce requirements as detailed below, including IPC expertise. The outbreak testing team would be embedded within the team. 5.3.4 In November 2020 a Care Home Outbreak Oversight Group was established, chaired by a Public Health Consultant, to provide oversight of all active outbreaks. To date, Fifty-six care home outbreaks have been recorded and 37 IPC outbreak supportive visits have been undertaken by IPC specialist nurses. As an outbreak is declared the care home assurance team deploy an IPC nurse to support the care
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4 home manager to review practice and identify any immediate issues. This is in addition to routine IPC audits and support visits. Feedback from these outbreak visits is provided to the Oversight Group and common themes recorded. This supports the targeting of messaging, education and support for care homes. 5.3.5 As at 6th June, there are 3 outbreaks ongoing in Care Homes, affecting 7 residents and 8 members of staff cumulatively. 5.3.6 This is a significantly improved position from the peaks of the second Omicron wave at the end of March, when we saw 42 Care Home outbreaks affecting 536 residents and 591 staff. It is important to note that despite the scale of outbreaks in Care Homes, the vaccination programme proved to be very successful with very few hospitalisations due to covid. 5.4 Personal Protective Equipment (PPE) 5.4.1 One of the biggest challenges during the early phases of the pandemic was the supply of PPE to frontline staff. The national PPE guidance has evolved over time, but overall the service has been able to maintain supplies to frontline staff in line with guidance. 5.4.2 There are no ongoing issues to report. 5.5 Delayed Discharge/System Pressures/Home Support 5.5.1 Following the first wave of Omicron, delayed discharge performance improved significantly and in early February has gone back down to 50s and 60s, as it had been in October and November. However, the second Omicron wave created significant challenges across the system, with delays returning to the 70s and 80s. 5.5.2 While being significantly higher than we would aspire, it is important to note this was still significantly better than the 125 delays seen in March 2019 before the roll out of Planned Date of Discharge. 5.5.3 As at 6th June, delays are 58, showing a steady improvement over the last 4 weeks. National comparative data shows that the partnership is now in the bottom half in rates of delay, which is a considerable improvement from pre-pandemic where the partnership was consistently in the top 4. 5.5.4 The winter business case was approved at a special meeting of the IJB on 16th February 2022, with recruitment underway to support the development of the new models proposed, including:
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5 Home Assessment Teams in each Locality to support early discharge as well as admission prevention Expanded Home Support and Reablement capacity in each Locality New resource in District Nursing teams to proactively support Care Managed patients (those identified as being at the highest risk of admission) Expanded Integrated Rehabilitation Teams to create additional rehabilitation capacity for both discharge support and admission prevention 5.6 Testing 5.6.1 Staff testing has continually evolved in line with the Scottish Government guidance throughout the pandemic. We have seen a gradual reduction in testing requirements over recent months and continue to follow the national guidance in full. 5.7 Covid Vaccination 5..1 The Covid vaccination programme continues at pace, with uptake as at 6th June as follows: Total doses administered 1,564,889 Individuals with at least 1 dose 554,132 Partially vaccinated 34,139 Fully vaccinated 93,424 Boosters 426,569 5.7.2 The vaccination programme continued with the announcement of the spring programme running concurrently with the roll out for all 5 to 11 year olds: 5 to 11 year olds o Commenced 25th March Spring booster programme o Care Homes o Over 75s o Outreach visits o Severely immunosuppressed 2nd booster o Immunosuppressed >12s 2nd booster o House calls for all who are eligible, though recognising maximum efficiency is achieved by clinic attendance 5.7.3 We await JCVI guidance on the next stages of the programme, expected to commence in Autumn 2022. 6. CONCLUSIONS 6.1 There has been a tremendous effort across the whole system (including third and independent sectors, communities and public partners) in building our response to the pandemic. 6.2 The dedication, bravery and commitment of all of our frontline staff should be commended in supporting us to continue to deliver a strong service to our residents in North Lanarkshire.
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6 6.3 The delivery of the Covid Vaccination campaign is now at an advanced stage, with Lanarkshire comparing very positively against the Scottish averages. 6.4 NHS Lanarkshire moved out of black status on 4th May and the command structure was stood down accordingly. Future update papers should now focus on recovery and remobilisation, unless future waves require the command structure to reconvene. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This relates to all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) A weekly performance framework has been developed to track progress. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB 09/21 sets out the impact of Covid on the roll out of the IJB’s Strategic Plan and is currently rated at very high. 7.5 PEOPLE The Strategic Planning Group has increased in frequency to quarterly throughout the pandemic to support engagement with staff, service users and carers and staff roadshows have also recommenced on a quarterly basis. 7.6 INEQUALITY & FAIRER SCOTLAND DUTY Yes No N/A 8. BACKGROUND PAPERS None. 9. APPENDICES None. ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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1 REPORT Item No: 8 SUBJECT: Equality Act 2010 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie Chief Accountable Officer Author(s) of Report Morag Dendy Head of Planning, Performance and Quality Assurance DATE: 22nd June 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note This paper will set out the IJB’s requirements against the Equality Act 2010 and will seek endorsement of the second mainstreaming report and equality outcomes stipulated by the Act. 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By Head of Planning, Performance and Quality Assurance. 3. RECOMMENDATIONS 3.1 The IJB is asked to: Endorse the Mainstreaming Report Endorse the equality outcomes as agreed by the partner organisations Request progress updates via the Performance, Finance and Audit Committee Note the requirement to meet the 2 year cycle for future Mainstreaming Reports 4. VARIATIONS TO DIRECTIONS Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Equality Act 2010 stipulates that all public bodies across Scotland are required to produce and deliver a set of equality outcomes to further one or more of the three needs of the Public Sector Equality Duty (PSED/also known as General Duty). 5.2 The duty has two parts – a General Duty and Specific Duties. The General Duty came into force in April 2011 and applies to any organisation which carries out a public function, requiring due regard to be given to the need to: Eliminate discrimination, harassment, victimisation and any other conduct that is prohibited under this Act Advance equality of opportunity between persons who share a relevant characteristic and persons who do not Foster good relations between people who share a protected characteristic and those who do not 5.3 The purpose of the general Equality Duty is to ensure that all public bodies mainstream equality into their day to day business by proactively advancing equality, encouraging good community relations and addressing discrimination. The current duty requires equality to be considered in relation to key functions including the development of internal and external policies, decision-making processes, procurement, service delivery and improving outcomes for service users. 5.4 In May 2012, further Specific duties came into force to support public bodies in their performance of the general equality duty. This places a statutory duty on designated public bodies to: Report progress on mainstreaming the public sector equality duty Publish equality outcomes and report progress Assess and review policies and practices (impact assessment) Consider award criteria and conditions in relation to public procurement Publish in a manner that is accessible. 5.5 The IJB does not directly employ any staff and with the HSCP being a joint delivery vehicle between the two partner organisations of North Lanarkshire Council and NHS Lanarkshire, links have been made with the equality leads in each organisation to ensure alignment. 5.6 A mainstreaming report has been created (see appendix 1), with equality outcomes that are based on the commissioning intentions of the 2020-23 strategic commissioning plan. With the participation and engagement work already commencing around the next 2023-26 Strategic Commissioning Plan, it will be important to ensure the mainstreaming report is updated accordingly as our new commissioning intentions become clear. 5.7 Progress against the equality outcomes will be monitored via the Performance, Finance and Audit sub-committee.
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3 6. CONCLUSIONS 6.1 The Strategic Commissioning Plan 2020-23 set out the IJBs priorities in creating integrated health and social care supports and services for the people of North Lanarkshire; service users; carers; the public; independent and third sectors; and practitioners. 6.2 To ensure successful delivery of the plan, it is vital that the IJB is fully committed to the values and ethos placed upon it by the Equality Act 2010, ensuring equality is mainstreamed in business and that everyone in North Lanarkshire has equal opportunities regardless of their age, ability, gender, sexual orientation, race, belief, childbearing or marital status. 6.3 It is widely documented that the Covid-19 pandemic has further exacerbated inequalities across our communities, making it ever more vital that the IJB has an active sight on the Equality Act and its impact on our local residents. 6.4 Work is ongoing with both partners to review the Equality Impact Assessment documentation. As part of the winter business case approved by the IJB in February 2022, work is continuing to explore the potential of creating a whole-system support team to help facilitate proactive impact assessments across key decisions. The aim of this is not to remove the responsibility from existing staff and services, but instead to provide support and advice to allow us to maximise the potential impact of the process. 6.5 Recent examples around the creation of the new Monklands Hospital and Covid-19 Vaccination Programme highlight the positive influence that the impact assessments process can have on programme development. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This will support the delivery of all nine health and wellbeing outcomes. 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL It is unlikely there will be significant financial costs arising from this work. This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk IJB 09/21 sets out the impact of Covid on the roll out of the IJB’s Strategic Plan and widening inequality and is currently rated at very high. 7.5 PEOPLE The Act provides specific protection to people who are discriminated against on the basis of a defined set of nine “protected characteristics”. The nine protected characteristics are:
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4 1. Age 2. Disability 3. Gender reassignment 4. Marriage and civil partnership 5. Pregnancy and maternity 6. Race 7. Religion and belief 8. Sex 9. Sexual orientation 7.6 STAKEHOLDER ENGAGEMENT Through the creation of the Strategic Commissioning Plan, a wide ranging consultation exercise was conducted to identify the key priorities for North Lanarkshire. In addition, the Strategic Planning Group, staff roadshows and Strategic Commissioning Plan Programme Board have supported the ongoing planning and delivery around key Commissioning Plan outcomes. 7.5 INEQUALITy & FAIRER SCOTLAND DUTY As discussed throughout this paper. EQIA Completed: Yes No N/A 8. BACKGROUND PAPERS None 9. APPENDICES Appendix 1: Mainstreaming Report and Equality Outcomes ............................................................................. CHIEF OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752591
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5 Appendix 1 Equality Outcomes and Mainstreaming Report 2022-24
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6 CONTENTS Page No Foreword 3 1 Introduction to Mainstreaming Report and Equality Outcomes 4 2 Legislative Context 4 2.1 The Equality Act (2010) 4 2.2 Public Sector General Equality Duty 4 2.3 Specific Duties 5 3 Operational Context 5 4 Mainstreaming Equality: Benefits 5 5. Mainstraming Equality: Our Approach 6 5.1 Leadership and Corporate Commitment 6 5.2 Workforce and Workforce Development 6 5.3 Impact Assessment 7 5.4 Participation and Engagement 7 5.5 Commissioning 8 5.6 Monitoring, Reporting and Publication 8 6. Mainstreaming Equality: Equality Outcomes 9 Appendix One: NHS Lanarkshire and North Lanarkshire Council Equality Outcomes Appendix Two: North Lanarkshire IJB Equality Outcomes 11 12
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7 Foreword This is the second equalities mainstreaming report for Health and Social Care North Lanarkshire. The Covid-19 pandemic has been a challenging time for all of our community, but we know that it has impacted on some more than others, with a growing evidence base highlighting the significant effect on equality, examples including adverse health outcomes in BME communities; the interruption of services for disabled children and adults; day service interruption for older people; increased violence against women and girls; loss of income for people in precarious work, who are disproportionately likely to be from certain ethnic minority groups; and a widening of the gender pay gap. Our vision is to place individuals and communities at the centre of our service planning and delivery in order to deliver locality based, person-centred outcomes. Our aim is to ensure the people of North Lanarkshire receive fair, consistent and non-discriminatory decisions and services from Health and Social Care North Lanarkshire, irrespective of their origin, protected characteristics and background, and that equality is mainstreamed into all that we do.
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8 1. Introduction to Mainstreaming Report and Equality Outcomes 1.1 The North Lanarkshire Integration Board is now in its sixth year and is fully committed to the values and ethos placed upon it by the Equality Act 2010, ensuring equality is mainstreamed in business and that everyone in North Lanarkshire has equal opportunities regardless of their age, ability, gender, sexual orientation, race, belief, childbearing or marital status. 1.4 The Integration Joint Board recognises individuals, groups and communities who routinely face such disadvantages and inequalities in how they access and experience health and social care services. The Integration Joint Board is committed to making a real and lasting contribution to creating a fairer North Lanarkshire, and to reducing inequalities in health, access and opportunity for the whole population. 2. Legislative Context 2.0.1 All public bodies across Scotland are required to comply with the three aims of the Public Sector General Duty, Equality Act (2010) and (Specific Duties) (Scotland) Regulations 2012. 2.1 The Equality Act (2010) 2.1.1 In 2010, the Equality Act came into force, with the aim of consolidating and harmonising existing equalities legislation and strengthening the law to support equal opportunities in the workplace and in wider society. The Act provides specific protection to people who are discriminated against on the basis of a defined set of nine “protected characteristics”. The nine protected characteristics are: 1. Age 2. Disability 3. Gender reassignment 4. Marriage and civil partnership 5. Pregnancy and maternity 6. Race 7. Religion and belief 8. Sex 9. Sexual orientation 2.2 Public Sector General Equality Duty 2.2.1 On 5th November 2011, the Equality Act 2010 introduced a new public sector equality duty requiring public authorities, in the exercise of their functions, to have due regard to the need to: Eliminate discrimination, harassment, victimisation and any other conduct that is prohibited under this Act Advance equality of opportunity between persons who share a relevant characteristic and persons who do not Foster good relations between people who share a protected characteristic and those who do not
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9 2.2.2 The Public Sector General Equality Duty replaces the previous Race Equality Duty (2002), the Disability Equality Duty (2006) and the Gender Equality Duty (2007). 2.2.3 The purpose of the general Equality Duty is to ensure that all public bodies mainstream equality into their day to day business by proactively advancing equality, encouraging good community relations and addressing discrimination. The current duty requires equality to be considered in relation to key functions including the development of internal and external policies, decision-making processes, procurement, service delivery and improving outcomes for service users. 2.3 Specific Duties 2.3.1 On 27th May 2012, the Equality Act (2010) (Specific Duties) (Scotland) Regulations 2012, came into force, to support public bodies in their performance of the general equality duty. This places a statutory duty on designated public bodies to: Report progress on mainstreaming the public sector equality duty Publish equality outcomes and report progress Assess and review policies and practices (impact assessment) Consider award criteria and conditions in relation to public procurement Publish in a manner that is accessible. 2.3.2 In April 2015 the Scottish Government added Integrated Joint Boards to Schedule 19 of the Equality Act 2010 and to The Equality Act 2010 (Specific Duties) (Scotland) Amendment Regulations 2015. 3. Operational Context 3.1 From 1st April 2016, the Integration Joint Board assumed responsibility for planning, commissioning and overseeing the delivery of integrated health and social care provision, covering adult and child community and unplanned hospital healthcare and adult social work in North Lanarkshire. 3.2 The legislation sets out that the Integrated Joint Board must contribute to the delivery of nine national health and wellbeing outcomes for integration: 1. People are able to look after and improve their own health and wellbeing and live in good health for longer. 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. 3. People who use health and social care services have positive experiences of those services, and have their dignity respected. 4. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. 5. Health and social care services contribute to reducing health inequalities. 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 well-being. 7. People using health and social care services are safe from harm.
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10 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. 9. Resources are used effectively and efficiently in the provision of health and social care services. 3.3 The Integration Joint Board publishes a detailed Annual Performance Report on progress to achieve each Outcome, as well as on twenty-three pre-determined National Performance Indicators set by the Scottish Government. In addition, locally derived performance indicators have also been developed to ensure information is tailored to North Lanarkshire’s circumstances. 4. Mainstreaming Equality: Benefits 4.1 Mainstreaming equality means integrating equality and diversity into day-to-day activity, by taking equality into account as part of the process of planning, commissioning and delivering health and social care services for the people of North Lanarkshire. Ongoing stakeholder engagement and collaboration are critical to the delivery of equality mainstreaming, activities that the Joint Integrated Board is committed to engage in to provide the best quality supports and services and deliver on the goals of integration. 4.2 Mainstreaming equality has a number of benefits including: Ensuring equality becomes part of the culture, structures and behaviours of the partnership Helping to ensure that services are fit for purpose and meet the needs of our community Attracting and retaining a productive workforce, rich in diverse skills and talents Contributing to continuous improvement, better performance and best value. 5. Mainstreaming Equality: Our Approach 5.1 Leadership and Corporate Commitment 5.1.1 Mainstreaming the Equality Duty is an organisational responsibility to which the Integrated Joint Board is fully committed. There is a commitment to see regular reporting to the Board through its governance structures. 5.1.2 The Integration Joint Board will ensure that clear and consistent messages are given to senior officers about the importance of meeting the equality needs of service users, their carers and employees. 5.1.3 Integration Joint Board members are committed to undertaking training to ensure a clearer understanding of the main requirements of the Equality Act, including: Defined roles and responsibilities in ensuring compliance Identifying a number of actions to be taken forward by senior officers Able to use the Equality Impact Assessment (EQIA) guide to inform and support them in understanding the role of EQIA in their decision making process.
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11 5.2 Workforce and Workforce Development 5.2.1 Whilst the staff within Health and Social Care North Lanarkshire continue to be employed by NHS Lanarkshire and North Lanarkshire Council, rather than by the Integrated Joint Board, the importance of valuing employees and supporting their development is still understood. 5.2.2 Through the Strategic Planning Process, a lot of work was undertaken in partnership with staff to agree values for staff working in North Lanarkshire, with the aim of creating a positive culture where staff are valued and fully involved in decision making. 5.2.3 Staff training on Equality and Diversity is strongly championed in both NHS Lanarkshire and North Lanarkshire Council, with Health and Social Care North Lanarkshire keen to maintain this focus with all staff. Other training and courses to support a better work-life balance and improved health and well-being can be applied to everyday personal and professional interactions and understanding, reinforcing the culture and environment we wish to engender. 5.2.4 Publication of equal pay and gender pay analysis will be undertaken by NHS Lanarkshire and North Lanarkshire Council as the employing bodies. 5.3 Impact Assessments 5.3.1 We are committed to carrying out Equality Impact Assessments on our strategies, policies and services to ensure there is no unlawful discrimination in the way that they are designed, developed or delivered and that, wherever possible, equality is promoted. 5.3.2 In meeting this commitment, we will ensure that: Equality Impact Assessments will be carried out on all relevant strategies, policies and service re-designs Equality Impact Assessments will be undertaken on any potential budget savings 5.3.3 Completed Equality Impact Assessments will be electronically accessible via the Integration Joint Board website. 5.3.4 All Committee and Board meeting paper templates have been updated to include a section on Equality Impact Assessments to ensure a strong focus throughout the structure. 5.4. Participation and Engagement 5.4.1 The Integration Joint Board recognises the value of engaging with Equality Groups and with people who experience prejudice and discrimination as a result of protected characteristics.
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12 5.4.2 The Participation and Engagement strategy aims to strengthen this dialogue and build a good understanding of the range of complexity of risk and needs in communities (both geographical and communities of interest). 5.4.3 The Integration Joint Board recognises the importance of ensuring that the services it provides are responsive to the needs of the whole population and specifically, the protected characteristic groups that are served. The opportunity to mainstream equalities within all activities and services delivered is welcomed, as this is essential to the successful delivery of quality, person-centred and effective health and social care supports are services for the people of North Lanarkshire. 5.4.4 The engagement and participation principles agreed by Health and Social Care North Lanarkshire are: Services are planned and developed in a way which actively and systematically engages with the community and local professionals All stakeholders are treated fairly, equally and with respect Engagement opportunities should be accessible and engagement materials offered in accessible formats All health and social care staff have a role to play in supporting engagement and participation A commitment to learning and continuous improvement 5.4.5 The engagement and participation objectives agreed by Health and Social Care North Lanarkshire are: 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 5.4.3 Through strong partnership working, Health and Social Care North Lanarkshire will utilise a number of different existing forums and groups already engaged in work with NHS Lanarkshire and North Lanarkshire Council. This has been an area of significant development over the course of the Strategic Commissioning Plan and now includes a wide range of groups including: NLC Disability Monitoring and Review Group Community Groups and Community Councils Lanarkshire Ethnic Minority Action Group Lanarkshire Carers’ Centre
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13 Mosques Citizen’s Panel Locality Planning Groups Locality Youth Forums Partnership Boards Partnership for Change User and Carer Engagement and Representation Forum Community Solutions Locality Consortia North Lanarkshire Public Partnership Forum North Lanarkshire Youth Forum Employee Groups Regional and National Groups such as Stonewall Scotland, Terrence Higgins Trust, Scottish Government, Equality and Human Rights Commission and Scottish Councils Equality Network 5.4.4 A wide range of networks and groups exist across North Lanarkshire and the Health and Social Care Partnership is keen to explore alternative means of engagement, such as focus groups for specific topics, rather than relying on only existing mechanisms. 5.5 Commissioning 5.5.1 As part of the Public Bodies Act, the Integrated Joint Board develops Strategic Commissioning Plans on a three yearly cycle. Strategic commissioning is the term used for all the activities involved in assessing and forecasting needs, linking investment to agreed outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place. 5.5.2 The equality outcomes listed in section 6 were developed as part of the commissioning process, to ensure the commissioning intentions fully consider equalities. 5.5.3 Procurement of services will take place via NHS Lanarkshire and North Lanarkshire Council, with relevant staff fully aware of the duties and responsibilities for Equality and Diversity legislation. 5.6 Monitoring, Reporting and Publishing 5.6.1 Monitoring will be an important aspect of the Integrated Joint Board’s commitment to equality, diversity and inclusion. The collection and analysis of equality data enables the recognition of trends and identification of any barriers facing specific equality groups. The use of equality data collection is embedded into service delivery and design to ensure that services are reflective of the needs of the wider population and target groups. 5.6.2 The Strategic Needs Assessment process which forms part of the Commissioning process is crucial in undertaking this role to support the development of the plan. 5.6.3 National and local systems will be used to ensure accurate data is utilised as part of this process. For example, national data capture through Information Services Division provides a useful repository of data around acute inpatients and day cases,
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14 whilst local service data can also provide a useful breakdown of characteristics such as age and sex. 5.6.4 Reporting against the Equality Outcomes will be a formal task of the Integrated Joint Board’s Performance, Finance and Audit Sub-Committee and progress will be included in the Board’s annual report. 6. Mainstreaming Equality: Equality Outcomes 6.1 An equality outcome is the desired aim to further one or more of the general equality duties; eliminate discrimination, advance equality of opportunity and foster good relations. By focusing on outcomes rather than objectives or outputs, it is possible to bring practical improvements in the lives of those experiencing unlawful discrimination or disadvantage. 6.2 Outcomes are changes that result for individuals, communities, organisations or society as a consequence of action taken. Outcomes include short-term benefits such as changes in awareness, knowledge, skills and attitudes, and long-term benefits such as changes in behaviours, decision-making, or social or environmental conditions. 6.3 NHS Lanarkshire and North Lanarkshire Council have published existing equality outcomes and they are outlined in Appendix 1. 6.4 Based on the Strategic Commissioning Plan intentions, the equality outcomes for the Integration Joint Board are as follows, with detailed action plans outlined in Appendix 2: 1. Inequalities in North Lanarkshire have been further exacerbated by the Covid- 19 pandemic. Through targeted interventions, people with a protected characteristic(s) will be supported to maximise their health and wellbeing through the pandemic recovery. 2. Through development of our first responses, we will make services and supports more accessible to meet the needs of people with a protected characteristic(s) to maximise independence and connectedness. 3. The HSCPs Engagement and Participation Strategy will ensure that we are able to actively engage with a much wider range of individuals in North Lanarkshire, including those from seldom heard groups, supporting people with a protected characteristic(s) to be engaged in the design and delivery of services 4. Through proactive engagement and Market Facilitation, the HSCP will support the Independent Sector to flourish, creating varied and person-centred supports for individuals including those with disabilities, long term conditions, or who are frail; supporting individuals to have greater choice and control over their care; and creating sustained employment opportunities within the North Lanarkshire area 5. Through the development of Technology Enable Care, individuals including children and young people, those with disabilities, long term conditions, or who are frail will have alternative methods to engage with services and more innovative solutions to remain living independently, connected in their own community.
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15 6.5 Progress against the outcomes will be monitored on a bi-annual basis at the Performance, Scrutiny and Assurance Sub-Committee of the Integrated Joint Board.
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16 Appendix One North Lanarkshire Council 1. To know and understand all our communities 2. To involve our communities effectively 3. To demonstrate leadership in equalities and human rights, both within the council and amongst partners, and organisational commitment to excellence 4. To ensure that local public services are responsive to different needs and treat users with dignity and respect 5. To develop and sustain a skilled and committed workforce able to meet the needs of all local people. The North Lanarkshire Council Equality Strategy can be accessed at https://www.northlanarkshire.gov.uk/sites/default/files/2020-06/Equality%20Strategy.pdf NHS Lanarkshire 1. Near Me: To provide an alternative method of patient care that increases the ease of access for all patients in Lanarkshire. 2. Staff Equality Networks: To provide a safe and supportive environment for staff to discuss issues relating to a particular protected characteristic. Further equality outcomes will be developed in 2023 to complement EHRC reporting cycle. The NHS Lanarkshire Equality Mainstreaming Report can be accessed at https://www.nhslanarkshire.scot.nhs.uk/download/equality-mainstreaming-report/
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17 Appendix Two Equality Outcome Protected Characteristics Actions Lead Inequalities in North Lanarkshire have been further exacerbated by the Covid-19 pandemic. Through targeted interventions, people with a protected characteristic(s) will be supported to maximise their health and wellbeing through the pandemic recovery. Creation of Long Covid AHP Team to provide proactive supports to those with lasting effects from Covid. Development of anti-viral pathway to support those most at risk of complications from Covid Targeted role out of Covid-19 vaccination programme, including proactive use of home visits and clinics supporting identified groups. Use of Keep Well to provide practical supports to key communities such as Gypsy Travellers and Homeless. Utilise Covid Community Champions group to proactively engage with seldom heard groups. Head of Health Medical Director Head of Health Improvement Through development of our first responses, we will make services and supports more accessible to meet the needs of people with a protected characteristic(s) to maximise independence and connectedness. 1,2,3,4,5,6,7,8,9 Development of Home Assessment Teams in each Locality to provide rapid response at home for those that require it and faster discharge from hospital. Development of CAPA model to support faster and effective access to mental health and wellbeing supports for children and young people. Development of Mental Health in Primary Care teams to create rapid access to appropriate level mental health and wellbeing supports for adults Creation of Community Connectors in the third sector, providing proactive support to access a wide range of community based supports, including mental health and wellbeing, for all ages in North Lanarkshire Head of Health Head of Adult SW Head of Planning
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18 Equality Outcome Protected Characteristics Actions Lead The HSCPs Engagement and Participation Strategy will ensure that we are able to actively engage with a much wider range of individuals in North Lanarkshire, including those from seldom heard groups, supporting people with a protected characteristic(s) to be engaged in the design and delivery of services 1,2,3,4,5,6,7,8,9 Develop Locality Profiles to fully understand the needs of each Locality area. Create a diverse range of engagement and participation opportunities to suit different needs Provide support to enable stakeholder representatives to participate meaningfully Development of Locality Planning Group structures to support proactive engagement at a local level Expansion of the IJBs Strategic Planning Group to widen patient, service user and carer representation Head of Planning Manager Adults – Planning OD Manager Through proactive engagement and Market Facilitation, the HSCP will support the Independent Sector to flourish, creating varied and person-centred supports for individuals including those with disabilities, long term conditions, or who are frail; supporting individuals to have greater choice and control over their care; and creating sustained employment opportunities within the North Lanarkshire area 1,2,3,4,5,6,7,8,9 Development of the partnership’s Market Facilitation Plan to reflect pandemic recovery Creative use of independent sector sustainability payments to support local providers Development of regular provider support calls for Care at Home and Care Homes, creating the opportunity for ongoing dialogue, peer support and collaboration Continued development of Self- Directed Support to ensure people, including those with physical or learning disabilities, long term conditions, mental health problems and frailty are able to exercise choice and control over their care. Head of Planning Head of Adult SW Manager Adults – QA Manager Adults – younger adults Through the development of Technology Enable Care, individuals including children and young people, those with disabilities, long term conditions, or who are frail 1,2,3,4,5,6,7,8,9 Sustained roll out and use of Near Me across community health and social care services to provide alternative means of engagement Development of the TEC Flat in Allershaw Tower to support staff Head of Health Head of Adult SW Head of Planning
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19 Equality Outcome Protected Characteristics Actions Lead will have alternative methods to engage with services and more innovative solutions to remain living independently, connected in their own community. and service users/carers to see TEC in action and enable innovative solutions to retain independent living Continued expansion of the Making Life Easier website to support self-management, assessment and access to simple equipment Roll out of a wide range of online Mental Health resources 1. Age 2. Disability 3. Gender reassignment 4. Marriage and civil partnership 5. Pregnancy and maternity 6. Race 7. Religion and belief 8. Sex 9. Sexual orientation
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1 REPORT Item No: 9 1. PURPOSE OF REPORT This paper is coming to the IJB; The purpose of this report is to provide a summary to the Integration Joint board (IJB) on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed By: The Operational & Business Manager and Chief Officer for H& SC NL. 3. RECOMMENDATIONS 3.1 The IJB Committee is asked to note the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. SUBJECT: Risk Management: IJB Risk Register TO: Integration Joint Board Committee Lead Officer for Report: Christine Jack Operational & Business Manager Author(s) of Report Christine Jack, Operational & Business Manager DATE: 22nd June 2022 For approval For endorsement To note Yes No N/A
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2 BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.2 The PF&A Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board and the PF&A committee considered the finance and performance risks at its last meeting on 16th February 2022. No changes to the risk rating were recommended at that meeting however the actions associated with each risk have been updated. 5.3 There are currently three risks rated as Very High on the IJB risk register. IJB 08/21 – Financial Implications of Responding to Covid IJB 09/21 – Impact on the Strategic Plan due to Covid IJB 14/22 – Children and Adolescent Mental Health Services (CAMHS) and ability to recruit to service vacancies following investment in funding. These risks were reviewed in March 2022 having regard to the overall financial position and the additional confirmed Covid funding. At that point, it was agreed that the risks should remain as Very High due to the non-recurring status of the additional funding, the uncertainty in respect of the ongoing Covid-19 pandemic and the ongoing discussions with each partner about the allocation of the available funding to cost pressures. The risks will be reviewed as part of the financial planning exercise for 2022/23 with the new IJB Chief Financial Officer. 5.4 There are four high rated risks on the IJB risk register. IJB 01/21 - Financial Challenges IJB 04/21 - Notional Set Aside Budget IJB 13/21 - Impact on discharge performance linked to care homes. IJB 12/21- Staff Health & wellbeing 5.5 One new risk has been added to the IJB Risk Register (IJB14.2022 – CAMHS service) following discussion at the last IJB meeting held in March 2022. 5.5 There are a number of high/very high rated operational risks recorded on NHSL and NLC risk systems that have been identified as having or potentially having an impact on IJB objectives and/or delivery of services. A new risk around sustaining whole system patient flow (ref 2129) was added recently by NHS Lanarkshire. Other relevant risks are highlighted below; No/Ref Risk Risk Rating Lead Organisation/Area 2115 CAMHS Service - 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 Very High NHSL Corporate
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3 non-clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in- patient and out- patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of NHSL 1710 Public Protection: There is a risk that NHSL could fail to identify harm to any vulnerable person, child or adult, or prevent harm to others resulting from the complexities of opportunity lost due to the current reprioritising of services in response to COVID-19. High NHSL Corporate 2039 Staff Fatigue, Resilience, Wellbeing & Safety – Effects of prolonged Covid response is adversely impacting on staff, increasing staff absence and consequently reducing workforce capacity. Very High NHSL Corporate 2126 Sustaining Out of Hours Primary Care Service Very High NHSL Corporate 2086 Sustaining GP Services Very High NHSL Corporate 2129 Sustaining Whole System Patient Flow Very High NHSL – Corporate NLC RIA0000446 Unable to deliver services due to funding issues Very High NLC - Social Care/Social Work NLC RIA0000448 Availability of workforce to deliver services within legislative and regulatory compliance requirements. High NLC – Social Care/Social Work NLC RIA0000449 Information & Data Protection – non-compliance with information governance legislation, standards and processes and data security and inability to retrieve relevant data with deadlines High NLC – Social Care/Social Work NLC RIA0000450 Health & Safety of staff in SW & partnership companies – failure to ensure the health safety and welfare at work of the service, employees, partners and provider agencies High NLC – Social Care/Social Work NLC RIA0000453 Supplier failure or services not provided to required standard. Insufficient number of providers. High NLC – Social Care/Social Work NLC Inadequate supervision, High NLC – Social
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4 RIA0000457 governance and monitoring across professional workforce Work/Social care NLC RIA0000458 IT system not fit for purpose High NLC – Social Work/Social care NLC RIA0000459 Integration – there is a risk that services and not integrated effectively thus impacting on improving the outcomes for individuals receiving care and support High NLC – Social Work/Social care NLC RIA0000460 Performance & planning – increasing expectations and changing performance demands will result in a failure to provide performance information internal, external and including S Govt, High NLC – Social Work/Social care NLC RIS0000414 Community alarm and assistive technology – unable to continue to support people with a community alarm system and develop use of assistive technology Very High NLC – Social Work/Social care NLC RIS0000415 Mental Health Officers – Failure to comply with legal obligations High NLC – Social Work/Social care NLC RIS0000417 Communications strategies and engagement plans – Inadequate strategies not aligned with strategic objectives High NLC – Social Work/Social care NLC RIS000419 Non- compliance with Information Governance & Data Protection High NLC – Social Work/Social care NLC RIS000426 Analogue to digital transition & ability to provide a working community alarm service High NLC – Social Work/Social care 6. CONCLUSIONS 6.1 The IJB currently has 14 risks identified on its IJB risk register with 7 risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES N/A 7.2 ASSOCIATED MEASURE(S) N/A 7.3 FINANCIAL This paper has been reviewed by Finance:
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5 Yes No N/A Financial risks are identified in the risk register. 7.4 RISK ASSESSMENT/RISK MANAGEMENT This report sets out the IJB risk register and risk assurance process for the IJB 7.5 PEOPLE N/A 7.6 STAKEHOLDER ENGAGEMENT Stakeholders are represented at the IJB and the IJB PFA Committee and fully contribute to approval and amendments to the IJB risk register. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Yes No N/A 8. BACKGROUND PAPER None 9. APPENDICES IJB Risk Register Appendix 1 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Christine Jack on telephone number 01698 752590.
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/04/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB02. 21 Financial Reputational 01/04/2021 Ineffective Governance Arrangements There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW CONTROLS 1. Fraud awareness e‐learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. ACTIONS 1. Continue to raise fraud awareness through team briefings. 2. Planned Procurement and Standing Financial Instructions presentations at Extended SLT by 31 March 2022. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 Previously IJB6. Reviewed and updated on 15 May 21. Previously IJB2, IJB7, IJB10 and IJB12. HIGH M EDIUM M arie M oy M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programmes which adversely impact on the HSCP's ability to deliver services. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. The impact of the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. 16. Additional Scottish Government funding to address Covid‐19 costs and to progress the Remobilisation and Recovery Plan in 2021/2022 is not sufficient. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 3. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plan 2021/2022 has been agreed and is being reviewed regularly. The IJB Financial plan 2022/23 is being developed. 7. Capacity plans in place to maximise efficiency. 8. IJB Integration Scheme setting out the budget recovery processes. 9. IJB Financial Regulations and financial procedures. 10. Consultation and involvement with key stakeholders including service users and carers. 11. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 12. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. 15. Financial sustainability payment arrangements in place to 30 June 2022 to support external social care providers. 16. A Change Fund of £6.076m has been agreed with the Scottish Government. 17. The Scottish Government announced on 5 October 2021 an additional £300m for winter health and social care pressures. 18. The Scottish Government announced on 9 December 2021 the indicative Scottish Budget 2022/2023. Work is ongoing to confirm recurring and non‐recurring funding allocations. 19. Lanarkshire Mobilisation Plan 2021/2022 Funding has been confirmed which meets the additional costs of the Covid‐19 pandemic, including the underachievement of savings. The cost of the recovery and remobilisation of health and social care services in 2022/2023 continues to be monitored. ACTIONS 1. Annual budget setting processes within each of the partners. 2. The development of the IJB Reserves Strategy 2022/2023 is being progressed. 3. The review and update of the IJB Medium to Long Term Financial Plan is ongoing. 4. The Business Case to take forward the remobilisation and recovery of services and also transformational changes is being developed. 5. The Lanarkshire Mobilisation Plan 2021/2022 costs for quarter 3 were submitted to the Scottish Government on 31 January 2022. 6. Confirmation was received on 25 February 2022 of the additional funding for 2021/2022 to address the costs incurred in 2021/2022 in respect of the Covid‐19 pandemic and also the remobilisation and recovery of services. On conclusion of the financial year 2021/2022, any uncommitted funding will be ring‐fenced as an IJB reserve to meet Covid costs in 2022/2023. The financial implications of this are being monitored. 7. Ongoing consultation with the Scottish Government in respect of the IJB Reserves Strategy 2022/2023 and the anticipated additional costs in 2022/2023 will be progressed by the IJB Chief Financial Officer. 8. The implementation of the approved Business Case to invest the Change Fund and the 2022/2023 recurring Scottish Government funding to maximum effect over the following 2 to 3 year period. HIGH Report Prepared by Christine Jack on behalf of the Chief Officer Page 1 of 4
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/04/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB04. 21 Financial Strategic 01/04/2021 Notional Set‐Aside Budget There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set‐aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. VERY HIGH CONTROLS 1.There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set‐aside concept. 2. Bed modelling and capacity planning arrangements are in place. 3. Effective working relationships between both partners and the IJB have been established. 4. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set‐aside budget. This arrangement continues to be in place for 2021/2022. ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB05. 21 Financial Strategic 01/04/2021 Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH CONTROLS 1. North and South IJBs aim to co‐operate to ensure a pan‐Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. ACTIONS 1. North and South IJBs will undertake a review the financial principles in respect of the hosted services to further develop the current arrangements in line with emerging good practice and guidance. M EDIUM M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs Prescribing costs may escalate due to increases in prescribing activity and increasing price volatility, new drugs becoming available, the response to the Covid‐19 pandemic and the impact of EU withdrawal. M edium CONTROLS 1.. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. ACTIONS 1.. Locality Prescribing Action Groups. 2. Continuation of Scriptswitch. M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 Previously IJB11. Previously IJB20.M edium LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB03. 21 Financial Strategic 01/04/2021 Impact of European Union Withdrawal There is a risk that the IJB is unable to implement the Strategic Plan because of the operational and financial challenges posed by European Union (EU) withdrawal leading to a failure to achieve the desired strategic aims and an adverse impact on both operational service delivery and the achievement of financial balance. The impact on health and social care services of leaving the EU continues to be difficult to forecast. The following significant risks continue to be monitored at a national level. (1) The UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology. (2) In respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. (3) There is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non‐EEA countries are subject to the same immigration rules. The new points‐based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast‐track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. (4) The Mutual Recognition of Professional Qualifications Directive is an EU‐wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. (5) There continues to be a risk of disruption to the supply chains, part of the risk in respect of which was minimised with mitigating actions such as stockpiling. (6) The future of Scottish patients' healthcare in other European countries and the impact of reciprocal healthcare and the free movement of healthcare including the impact of the changes to the European Health Insurance Card (EHIC). M edium CONTROLS 1. Silver command' group formed for HSCP. 2. On 24 December 2020 a new EU‐UK trade and co‐operation deal was agreed. 3. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 4. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 5. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 6. All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one‐off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co‐ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. 7. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. 8. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in 3 stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. 9. Reciprocal health care is subject to the Withdrawal Agreement, the collection of guidance outlining the rules in each state, the completion of relevant visa applications and the payment of the Immigration Health Surcharge in order to access NHS services (where applicable). The rights of access for EU citizens who need work or study in the UK for less than six months was still being decided. Global Health Insurance Cards have been implemented to cover both urgent and routine medical treatment. 10. In respect of reciprocal health care, the rights of access to health care for UK citizens who move to the EEA after the transition period is being decided independently by each member state and will differ substantially between them. ACTIONS 1.HSCP fully participates in the NLC and NHSL resilience arrangements. 2.HSCP workshops undertaken. 3. Business Continuity Plans revisited and updated for all services and sites. Report Prepared by Christine Jack on behalf of the Chief Officer Page 2 of 4
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/04/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long‐term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH CONTROLS 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. ACTIONS 1.The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years. LOW LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 Previously IJB16. IJB08. 21 Financial Strategic 01/04/2021 Financial Implications of Responding to and Recovering from the Covid‐19 Pandemic There are a range of IJB risks associated with the response to and recovery from the Covid‐19 pandemic. Additional funding was received from the Scottish Government in 2020/2021 to meet the additional costs of the Covid‐19 pandemic. Further funding for 2021/2022 has been confirmed by the Scottish Government to meet the additional costs of responding to and recovering from the Covid‐19 pandemic. The IJB projected out turn 2021/2022 is not available to meet the 2021/2022 Covid‐19 costs. The projected underspend requires to be retained to implement the Business Case and to recover and redesign health and social care services. Insufficient reimbursement of funding from the Scottish Government would impact on the implementation of the Response, Recovery and Redesign Plans in 2022/23. The 2022/2023 Savings Plans may also not be achieved in part or in full due to key resources continuing to be diverted to respond to the Covid‐19 pandemic. This risk could lead to significant operational, financial, legal and/or reputational harm to the HSCP and also adversely impact on the Strategic Plan outcomes. VERY HIGH CONTROLS 1.Governance arrangements are in place in respect of the approval and monitoring of additional Covid‐19 costs and the recovery and redesign plans. 2 Delivery of savings will continue to be tracked and monitored. 3.The financial position is being monitored on an ongoing basis by SLT, IJB PFA and IJB. 4. The IJB Chief Officer and the Chief Financial Officer are actively engaging with the Scottish Government and other Networks and providing regular updates on the mobilisation and remobilisation plans and the associated costs. ACTIONS 1. All costs associated with responding to the Covid‐19 pandemic are being tracked and reported to the Scottish Government through the completion of the Remobilisation Plan Financial Returns. 2. A financial tracker on Covid‐19 related expenditure (as part of the Local Remobilisation Plan) is updated on a 4 weekly basis. Quarterly updates are submitted to the Scottish Government. 3. The IJB Reserves Strategy 2021/2022 has been discussed with the Scottish Government Officers. 4. The IJB Reserves Strategy 2021/2022 is being implemented. The IJB Reserves Strategy 2022/2023 is being developed. VERY HIGH M EDIUM Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB09. 21 Financial Strategic 01/04/2021 Impact on the Strategic Plan Due to the Covid‐19 Pandemic 1. Social Care providers continue to be significantly impacted by the Covid‐19 pandemic. There are risks associated with the ongoing financial stability of providers during the Covid‐19 pandemic and some external providers may be unable to continue operating without ongoing financial and operational support. If providers are unable to safely staff services, there could be a risk of harm to service users and failure of the provider. 2. Providers are operating under unique and significantly detrimental conditions including continuity of service being disrupted due to the requirement to focus on priority services only, increased infection control measures and associated costs, increased staff absence and associated costs, reduced availability of back‐up staff and social distancing requirements. Premises may not be suitable to deliver services in these circumstances. 3. Increased reporting requirements to provide data to regulatory bodies are stretching limited resources. 4. Sufficient emergency/additional services to continue to respond to the Covid‐19 pandemic may not be available. Hospital admissions may not be avoided and discharges from hospital may be delayed. General Medical Services may not be sustainable. There are whole system capacity constraints across primary care services impacting on Acute Services. 5. Discharges from hospital may impact on care at home, residential care, nursing care and respite provision. 6. There is an increase in demand for a range of health and social care services as a result of the Covid‐19 pandemic. There is insufficient workforce capacity and there is a risk the Working Time Directive may be breached. There is insufficient equipment for key areas e.g. ventilators, pumps, etc. Personal Protective Equipment and supplies may be limited. The required service specification and standard may not be procured. There may be insufficient mobile IT devices. 7. There may be constraints in respect of the supply of vaccinations. 8. There are significant risks associated with the mutation of the Covid‐19 virus and the new variants. 9. There is an adverse impact on the progress of transformation service redesign opportunities including implementing agreed efficiency savings. 10. Prioritising the impact of the response to the Covid‐19 pandemic may divert limited resources away from key essential services which may lead to additional resource requirements and costs over the medium to longer term. 11. There may be a lack of HSCP management capacity and resilience to co‐ordinate the response to the pandemic. This may lead to an adverse impact on service delivery and financial overspends. 12. The risk status across NHS Lanarkshire has been moved to 'Black', the highest risk level. VERY HIGH CONTROLS 1. Scottish Government and COSLA guidance is being complied with. 2. NHS National Services Scotland are supporting primary care and social care services. PPE is available in line with Health Protection Scotland guidance. 3. Chief Medical Officer guidance as adopted by the four nations has been published, put into effect and endorsed by the Scottish Government/COSLA. Updates are also adopted. 4. Scottish Government are focusing on the care home sector to support continuity of service delivery. A national protocol to support discharge of Covid‐19 patients is in place. Care home liaison nurses are in place. 5. Remote working and flexible working arrangements are also in place. There is an increase in the number of agile workers and an increase in the number of laptops/tablets provided. A blended approach to home/work‐based working is being developed going forward. 6. Arrangements are in place across the partnership to review service user and carer prioritisation in terms of accessing service and support. Resources are targeted to those with critical or substantial needs. 7. Arrangements are in place to support carers in their caring role, working in partnership with voluntary organisations to provide early intervention and preventative supports. 8. Reliance is being placed on the Social Care Sustainability Payments by External Social Care Providers up to 30 June 2022. The HSCP continues to liaise and support providers to ensure there is early identification of problems and early intervention if necessary. 9. The Response, Recovery and Redesign Remobilisation Plan has been developed and is regularly updated. Response, Recovery and Redesign Plans are in place across the IJB and both partners. 10. Safe systems of working have been adopted. Regular cleaning regime is in place across all premises. All workplace appropriate social distance signage is in place. 11. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 12. The Scottish Government is taking appropriate action to mitigate the impact of the variants of the Covid‐19 virus as far as possible. ACTIONS 1. Emergency Command and Control structures have been established by each partner. Infection Prevention Control and Social Distancing requirements are being complied with. 2.Up‐to‐date information is disseminated to all staff across the HSCP as the situation develops and a consistent communication strategy is in place with employees across IJB, NHSL and NLC websites 3.IJB and partner business continuity plans are being regularly reviewed. 4.The HSCP is actively engaging with the third and independent sector in relation to service opportunities to meet the low/moderate needs of service users/patients and their associated costs. 5. Additional funding for 2021/2022 and 2022/2023 has been announced by the Scottish Government. Further Covid‐19 funding was confirmed on 25 February 2022. 6. The vaccination programme is continuing to be rolled out. 7. Having regard to the assessment of risk across NHS Lanarkshire as 'Black', action is being taken to mitigate the impact of the Covid‐19 pandemic over the winter period and COP26 in consultation with the Scottish Government. The position is being closely monitored. VERY HIGH M EDIUM Report Prepared by Christine Jack on behalf of the Chief Officer Page 3 of 4
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Appendix 1 North Lanarkshire Integrated Joint Board Risk Register (Accurate as 30/04/22) IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Review Date Closed Date Risk Closed ‐ Changes By MM IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements Due To the Covid‐19 Pandemic 1. 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, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended Covid‐19 legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. 6. There will require to be changes to the working environment including remote working and working from home. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. M EDIUM CONTROLS 1. National Networks are established which are providing the framework to support a national approach where appropriate. 2. Public Health advice and support is in place. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 6. The IJB and both partners aim to comply with the European Working Time Directive (WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular front‐line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply unless and until amended by UK law. ACTIONS 1. Staff health and well being is a key priority for both partners and all key stakeholders. The commitment to staff health and well being is being actively promoted through all available forums. M EDIUM LOW Ross M cGuffie M arie M oy SLT, IJB PFA, IJB 30.06.22 IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW CONTROLS 1. Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. 2. Chief Executive Performance Review arrangements. 3. Hosted Services Performance Review arrangements. 4. Sector/Locality Performance Review arrangements. ACTIONS 1. Request detailed topic based performance reports on specific areas of concern e.g. CAMHS & Psychological Therapies. low LOW Ross M cGuffie M orag Dendy SLT, IJB PFA, IJB 30.06.22 IJB.12. 21 Performance 30/08/2021 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 Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. medium Controls 1. Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. 2. Range of support services available both nationally and locally e.g. Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). 3. Rest & Recuperation areas identified. 4. Peer Support Networks established 5. Well established Occupational Health supports available to support staff sickness. Actions 1. Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. 2. Funding received by Scottish Government specifically targeting staff well‐ being programmes and supports. Local plans for use of funding being developed. 3. Managers supporting & encouraging staff to take planned leave/use full leave allocation. 4. Staff being encouraged to submit proposals for use of targeted funding & some programmes already in place. HIGH low Ross M cGuffie Ross M cGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 30.06.22 IJB.13. 2021 Performance 30.08.21 Care Homes Inability of care homes to sustain service due to staffing or Covid outbreaks resulting in closure to new placements. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. The financial support for social care providers during the Covid‐19 pandemic is being reviewed. Payments in respect of under‐occupancy in care homes were extended to 30th June 2022. High Controls 1. Establishment of Care Home Assurance Team. 2. Escalation Process in place. 3. National protocol to support discharge of Covid 19 patients in place. Actions 1. Public Health teams providing guidance on infection control. 2. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. 3. Staff and visitor testing in place. 4. All care homes advised to use PPE in line with national addendum. High medium Ross M cGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 30/06/2022 Report Prepared by Christine Jack on behalf of the Chief Officer Page 4 of 4
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1 REPORT Item No: 10 SUBJECT: IJB Membership TO: Integration Joint Board Lead Officer for Report: Christine Jack Operational & Business Manager Author(s) of Report Christine Jack Operational & Business Manager DATE: 22nd June 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been; Prepared Reviewed Endorsed Prepared on behalf of the Chair and Chief Officer. 3. RECOMMENDATIONS The Integration Joint Board (IJB) is asked to; 3.2 Note the handover of the IJB Chair from NHS Lanarkshire Board to North Lanarkshire Council from June 2022. 3.3 Note the revised membership of the voting members of the IJB from June 2022. 3.4 Approve the recommendations for Chair & Vice Chair of the Performance, Finance & Audit Committee (P, F&A). 4. VARIATIONS TO DIRECTIONS?
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The rules about IJB membership are contained in statutory instruments and reflected in the Integration Scheme and Standing Orders. These state that Board members are appointed for three years unless their membership is terminated earlier. Membership can be renewed for further periods of three years at a time or a new member appointed. When a member resigns or otherwise ceases to hold office, the person shall be appointed for the unexpired term of the person being replaced. 5.2 The Chair of the IJB should alternate between the voting representatives of North Lanarkshire Council and NHS Lanarkshire. Since 2019, the Chair has been nominated from NHS Lanarkshire from the cohort of Non-Executive Director members of the IJB. From June 2022 the chair of the IJB should be nominated from North Lanarkshire Council. 5.3 The rules around IJB membership applies to all members with the exception of the Chief Accountable Officer, Financial Officer and the Chief Social Work Officer who remain on the Board as long as they hold their respective posts. Therefore, all members of the IJB require to be renewed in 2022. An established process is in place to seek nominations for stakeholder members. 5.4 The Voting members of the IJB and PF&A have been nominated by their respective bodies and are noted as follows; Cllr Tracy Carragher – Deputy Leader of North Lanarkshire IJB Chair Cllr Jordan Linden – Leader of North Lanarkshire Council – Council Cllr Kirsten Larson – Elected member, North Lanarkshire Council TBC – Elected member, North Lanarkshire Council Mr Brian Moore, Non-Executive Director, NHS Lanarkshire Board – Deputy Chair IJB Mr Ally Boyle - Non-Executive Director, NHS Lanarkshire Board Mr Neil Findlay, Non-Executive Director, NHS Lanarkshire Board Mr James Muir, Non- Executive Director, NHS Lanarkshire Board 5.5. The proposals for the Chair and Vice Chair of the PF&A committee are as follows; Chair: Mr Brian Moore, Non-Executive Director, NHS Lanarkshire Board Vice Chair: Cllr Tracy Carragher, Elected Member, North Lanarkshire Council Yes No N/A
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3 6. CONCLUSIONS 6.1 The Chair of the IJB alternates between North Lanarkshire Council and NHS Lanarkshire. From June 2022, chairmanship of the IJB will handover to North Lanarkshire Council for a three-year period (to 2025). 6.2 Membership of the IJB requires to be updated following a 3-year period of current members. Individual membership can be renewed for further periods of three years at a time or a new member appointed. 6.3 Following the recent local authority elections and recruitment to non- executive vacancies, a number of new voting members have joined the membership of the IJB and the PF&A committees. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES N/A 7.2 ASSOCIATED MEASURE(S) N/A 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT No risks have been identified in relation to the content of this report. 7.5 PEOPLE N/A 7.6 STAKEHOLDER ENGAGEMENT (Detail below any stakeholder engagement that has taken place). Stakeholder representation is embedded within the membership of the IJB. 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A
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4 7.8 CARBON MANAGEMENT IMPLICATIONS Committee meetings will continue to be held remotely via MS meetings thereby reducing the need for travel for committee members. Papers will be issued via mail reducing the need where possible for printed copies. 8. BACKGROUND PAPERS None. 9. APPENDICES None. ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Christine Jack on telephone number 01698 752590.
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1 REPORT Item No: 11 SUBJECT: Investment in IT Infrastructure to support care delivery TO: Integrated Joint Board Lead Officer for Report: Ross McGuffie Chief Officer Author(s) of Report Mark Russell Associate Medical Director DATE: 22nd June 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared By: Associate Medical Director, North Lanarkshire HSCP Reviewed By: Chief Officer Endorsed: 3. RECOMMENDATIONS Note the progress which has been made in procuring a reprovisioned IT system for General Practice and the opportunity this provides for providing an infrastructure for the work of integrated teams Note the opportunity to improve the quality and co-ordination of care by further investment in broader IT infrastructure That a ring-fenced reserve is created of £1.5m, including 0.301m to fund shared services linked to General Practice IT systems until 2029/30 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background to GP IT Reprovisioning 5.1.1. Contracts for the supply and support of GP Clinical Systems within Scotland are currently held separately by each territorial NHS Board. These are coming to end of life and in NHS Lanarkshire began to expire in May 2019. 5.1.2. In the meantime, a National procurement/re-provisioning exercise has been undertaken with representatives from Scottish Health Boards. As a result, NHS Scotland has put in place a National GP IT Managed Services contract, signed and managed by NSS on behalf of the NHS Boards. This Multi- Supplier Framework Contract, which will replace the existing individual NHS Board contracts, was signed on 1st February 2019. Three suppliers, EMIS, Cegedim (Vision) and Eva Health Technologies were appointed to this framework. There have been significant delays and Eva have withdrawn from the framework, with a system from Emis not being available for at least another year. 5.1.3. The current system poses significant challenges for the development of primary care services; in particular, the challenges of shared access to GP clinical systems has acted as a rate limiter on the implementation of the Primary Care Improvement Programme and remote access to GP clinical systems requires the exclusive use of a physical desktop PC in the practice, making efficient use of estate challenging. A process was therefore initiated in Lanarkshire in June 2021 to examine the feasibility of a Direct Award to Cegedim as soon as their system was available in Spring 2022 and a cohort of GP practices formed. All except two practices have agreed to join this cohort, which covers 99.5% of Lanarkshire’s population 5.2. Current position 5.2.1. Significant work has been undertaken over the last 6 months: An accelerated rollout has been planned, with all cohort practices to be completed by the end of the financial year and the rollout of key features such as those to improve prescribing efficiency and safety by the end of November Planning for the use of shared services infrastructure by vaccinations and treatment rooms by the end of July Implementation groups have been set up to cover technical, pharmacy and primary care improvement plan issues. A further group is proposed to deal with deployment in integrated services A Request for Proposal has been made to Cegedim, and groups have scrutinised the financial, interfacing, and technical aspects of the response. In addition, a group representing the cohort practices has examined the response 5.2.2. The Direct Award assessment process has identified a number of benefits of moving forward immediately:
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3 Primary Care – delivery of the GP contract through allowing access to GP records which will facilitate collaboration, and more broadly, enable closer working between GPs and other professionals Clinical Infrastructure – currently community services lack a booking and communication platform, which the Vision Anywhere application would provide. Infrastructure for Integrated Services –Vision Tasks is a standalone application which could be used for communication between (for example) social work and district nursing teams Population Level Planning – Cegedim have asked Lanarkshire to consider forming a strategic partnership with them, to further develop their Outcomes Manager product to integrate both primary and secondary care data. Subject to extension of existing Data Sharing Agreements with practices, this would significantly enhance the population health and planning abilities of the Health and Social Care Partnership 5.2.3. The group representing the cohort practices is content that the product is fit for purpose but was clear that the rationale for moving forward immediately is dependent on the Shared Services and Outcomes Manager features, which are prerequisites for delivering the benefits above, and require investment from NHS Lanarkshire and North and South Lanarkshire HSCPs in addition to the core funding provided by Scottish Government. 5.3. Future investment in other care critical IT services 5.3.1. A number of other partnership programmes will require further investment to maximise their capabilities for assisting with the delivery of safe and high quality care: Replacement of SWIS in Social Work and development of dynamic scheduling Extension of deployment of Morse to CAMHS and purchased and deployment of scheduling component Further development of TrakCare within managed services to enable Electronic Medical Record capabilities Deployment of Hepma to Paediatrics and Hospital at Home 5.3.2. These developments are expected to take place over the next 5-8 years and it is proposed that reserves are set aside to fund this. 6. CONCLUSIONS 6.1. The IJB is asked to note the work that has been undertaken to improve the IT infrastructure available to ensure the availability of information to staff to promote the delivery of high quality care and facilitate inter-professional working.
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4 6.2. It is asked to approve the creation of a reserve to fund the above and other key IT developments over the next 8 years 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Improving the IT infrastructure and connectivity will impact on all nine health and wellbeing outcomes by improving service efficiency and multi-disciplinary working. 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL The Scottish Government has agreed to fund the gap between the current annual costs for GP IT and the higher costs that will be incurred under new arrangements. It will also fund central costs over the implementation period and the ongoing contract and service management costs of GP IT. However, these ‘Core’ costs do not include local deployment, training or interface costs, or the costs for shared services. £3.03m is required to implement the system and cover costs beyond those covered by Scottish Government until the anticipated end of this procurement in 2029/30. £0.935m can be met by redirecting existing NHS Lanarkshire eHealth funding streams, and South Lanarkshire IJB has previously set aside reserves of £1.5m to cover initial deployment and training. Negotiations with Cegedim has delivered significant reduction in costs, however a funding gap of £0.602m remains. Given the potential for this investment facilitating transformative change in community health and broader integrated services across both North and South Lanarkshire HSCPs, it is suggested that this gap should be funded by both IJBs setting aside a reserve of £0.301m. It should be noted that this is a maximum cost; in negotiations, Cegedim have committed to remove all costs for Shared Services share (which would eliminate this funding gap) should they reach a 55% national population share. Their current share is 48%. In addition, negotiations are ongoing with regard to the terms of a potential strategic partnership for Population Health features and this may yield further savings. This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risk 2086 – GP sustainability sits as a Very High risk on the NHSL Corporate Risk Register. 7.5 PEOPLE
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5 The potential for improved information sharing between services could positively impact the integration and seamless delivery of services for NL residents. 7.6 STAKEHOLDER ENGAGEMENT (Detail below any stakeholder engagement that has taken place). Key stakeholders in the development of the Health and Wellbeing work are staff across health and social care employed through NHSL, NLC as well as all third and independent sector providers. Wide engagement has been maintained to ensure wide benefit and uptake of the approach described in the report. 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.8 CARBON MANAGEMENT IMPLICATIONS No negative impacts identified. 8. BACKGROUND PAPERS 9. APPENDICES ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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1 REPORT Item No: 12 SUBJECT: Strategic Commissioning Plan 2023-2026 TO: North Integration Joint Board Lead Officer for Report: Ross McGuffie Chief officer Author(s) of Report Morag Dendy Head of Planning, Performance and Quality Assurance DATE: 22nd June 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared By: Head of Planning, Performance and Quality Assurance Reviewed By: Chief Officer Endorsed By: Strategic Leadership Team 3. RECOMMENDATIONS 3.1 1. Seeking endorsement of our approach from IJB 2. Seeking promotion of the approach to encourage wide participation in the development of the 2023 – 2026 Strategic Commissioning Plan 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.2 Health and Social Care North Lanarkshire published its ten-year strategy Safer, Healthier, Independent Lives, in 2016. Strategic Commissioning Plans (SCP) which are a statutory requirement, have been produced to outline the key intentions to be delivered, initially annually (2016-17, 2017-18, 2018-19, 2019-20) then a three-year plan for 2020 – 23. The 2023 – 2026 SCP will be the final plan within the ten-year strategy. 5.3 Along with Safer, Heathier, Independent Lives 2016 – 2026, The Plan for North Lanarkshire and Achieving Excellence which is currently being refreshed all shape the Strategic Commissioning Plans for North Lanarkshire Health and Social Care. 5.4 The SCP is further underpinned by key strategies and plans including but not limited to: a) Community Solutions Strategy and investment Plan b) Mental Health and Wellbeing Strategy for Lanarkshire c) North Lanarkshire Children’s Services Plan d) Alcohol and Drug Partnership Strategic Plan e) Tackling Poverty Strategy f) Engagement and Participation Strategy g) Market Facilitation Plan h) North Lanarkshire Strategy for Adult Carers and Young Carers i) Lanarkshire Advocacy Plan j) Lanarkshire Healthy Weight Strategy k) Digital and IT Strategy 5.5 The 9 Local Outcome Improvement Plans developed through each of the Community Boards capture local priorities and actions (noted below) which both inform and are informed by the work of the Health and Social Care Partnership and shape the Strategic Planning process. Mental Health and Wellbeing Public and community transport Tackling poverty and inequalities Community Safety Health inequalities Greenspace maintenance and environmental quality Food inequality Digital Inclusion Covid 19 recovery Youth engagement and consultation Community Engagement Social interaction and inclusion Town centre and hub development 5.7 Summary of Key Issues The development of the Strategic Commissioning Plan 2023 – 26 is underway with discussions across a range of important forum, including Strategic Leadership Team, Strategic Planning Group, Chairs and Co-chairs of Locality Planning Groups and Partnership Boards, as well as discussion with key partner organisations and engagement forums. These discussions have helped on shaping the next steps of engagement and participation in the Strategic
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3 Commissioning Planning process as well as draw a range of related activities together to refresh how they are undertaken and aligned to use resources smartly. 5.8 Further embedding a Whole System Approach The Health and Social Care Partnership has long been committed to a whole system approach, recognising the co-dependencies. Building performance frameworks across the whole system will involve understanding activities across: Communities Proactive and preventative activity First or initial responses Change services such as rehabilitation, recovery, treatment and reablement Ongoing interventions Complex and statutory interventions Acute or in-patient responses 5.9 Strengthening engagement and participation 5.10 The Engagement and Participation Strategy, Framework and Principles 2021-24 clearly outlines the importance of, and the approach to, ensuring strong voices inform and shape the work undertaken through the Health and Social Care Partnership. 5.11 Whilst significant progress has been made in engagement and participation, in aspiring a more co-productive approach, there is more to be done. The voice of communities is embedded through Community Solutions supporting local consortia who have a broad and wide reach. The voice of carers is well represented through North Lanarkshire Carers Together. Good progress has been made in representing the voice of people with lived experience, discussions are being undertaken to invest in future approaches which robustly enhance this to increase the focus on underrepresented groups. 5.12 Frontline staff and wider stakeholders are also important in wider engagement and participation. Quarterly staff roadshows augment local arrangements and facilitate easier information sharing and participation. 5.13 Delivering on major change as well as business as usual 5.14 The 6 key ambitions of the SCP 2020-23 is achieved through 41 programmes of work, previously noted through IJB meetings relating to the DELIVERY of services and supports, ENABLING, SUPPORTING and GOVERNING factors. It is also worthy of note however that there are a number of transformational change programmes being supported simultaneously, in particular: a) Child and Adolescent Mental Health Service change b) Community Nursing Review c) Development of Mental Health in Primary Care Services d) Development of Home First approach incorporating Home Assessment Teams, Integrated Rehabilitation Teams and modernisation of Home Support Services
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4 e) Development of Alcohol, Drugs and Mental Health Services The learning and development achieved through these programmes of change need to feed into the SCP 2023-26. 5.15 Active governance and refresh of performance 5.16 Developing the Whole System Approach described at 5.8 above work is underway to revise performance reviews to promote active governance. Increasingly data will be used to assure, anticipate and prioritise, within the Health and Social Care Partnership, with key partners and through the role governance committees play in scrutinising data in detail. 5.17 The construction of performance reviews will develop the revised structures within the Health and Social Care Partnership, using the two Sector and 3 main Area Wide constructs to promote integrated approaches, cross cutting learning and shared ambition. The review groupings then become: North West Sector (including Airdrie, Coatbridge and North Localities); North East Sector (including Bellshill, Motherwell and Wishaw localities); Children’s health services; Addiction, Learning Disability and Mental Health Services across health and social care; and area wide health services along with area wide social work services. 5.18 Proposals to introduce a whole system performance review are being developed to more actively include the voice of communities, the voice of carers, the voice of people with lived experience, representation of the independent sector, colleagues from acute services. Representing South H&SCP hosted services and the North Core Team. 5.19 Bringing the key considerations together, dates are being identified to facilitate 5 key engagement sessions to analyse and discuss the Strategic Needs Assessments and Local Outcome Improvement Plans for each locality and area wide services. These sessions will be held in August and will inform both the development of the SCP 2023-26 and establish the revised performance review groups. Invitation will be made to IJB members to participate in events. 6. CONCLUSIONS 6.1 The SCP is crucial to achieving the strategic ambitions for people in North Lanarkshire. Wide engagement which brings together Strategic Needs Assessments, Locality Outcome Improvement Plans, national and local strategies and plans, as well as learning and lessons from the transformational change agendas is being planned and developed for late August 2022. The engagement sessions, and others to be agreed with stakeholders will be designed to really share, listen and act in the complex whole system approach. A draft SCP will be brought to the IJB in late 2022. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES
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5 This paper covers all nine national health and wellbeing outcomes, but particularly outcomes one and two. 7.2.1 ASSOCIATED MEASURE(S) The range of associated performance measures within both the national outcome indicators and our own local performance framework will be refreshed alongside the development of the SCP 2023-26 and continued development of the Programme of Work. 7.3 FINANCIAL Financial Planning will be an important element of the SCP 2023-26 This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Consideration of risk is key to the overall plan and within each Programme of Work. 7.5 PEOPLE Residents across North Lanarkshire, third and independent providers operating in North Lanarkshire and wider stakeholders with a link to North Lanarkshire will be involved in the development of the SCP 2023- 26. 7.6 STAKEHOLDER ENGAGEMENT (Detail below any stakeholder engagement that has taken place). 7.6.1 Discussion at the Strategic Planning Group and Strategic Leadership Meeting has informed the paper. 7.6.2 The need for and quality of stakeholder engagement is recognised as the most significant key factor in developing a meaningful SCP for North Lanarkshire 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY The approach outlined in the report will seek to address inequalities and promote fair work practices by creating opportunities to engage and participate in the development HSCNL key priorities and strategic direction. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.8 CARBON MANAGEMENT IMPLICATIONS N/A 8. BACKGROUND PAPERS# 8.1 This content in this paper links directly to the following:
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6 • Strategic Commissioning plan 20-2023 https://www.hscnorthlan.scot/wpcontent/uploads/2020/07/Strategic- Comm-Plan-20-23-FINAL.pd 9. APPENDICES None. ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy on telephone number 01698 332000.
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1 REPORT Item No: 14 SUBJECT: Annual External Audit Plan TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer H&SC NL Author(s) of Report Ross McGuffie, Chief Officer H&SC NL Audit Scotland DATE: 22nd June 2022 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board: For approval For endorsement For noting 1.2 This report: - (1) Provides details of the External Auditor’s Annual Audit Plan for 2021/22 (2) Provides details of the External Auditors Annual Fee 2. ROUTE TO THE INTEGRATION JOINT BOARD : 2.1 This paper has been: Prepared By; Audit Scotland Reviewed By; Chief Officer 3. RECOMMENDATIONS The IJB Committee is asked to agree the following recommendations: (1) That the content of the report is noted; (2) That the proposed revised timescale for annual accounts is noted as referenced in page 11, paragraphs 29-31. (3) That the audit fee of £27,960 is approved. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Public Bodies (Joint Working) (Scotland Act) 2014 established the framework for health and social care in Scotland and the formation of Integration Joint Boards (IJBs). Each IJB is required to prepare annual accounts and have them audited in accordance with Part VII of the Local Government (Scotland) Act 1973. Ye s No N/A
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2 5.2 Audit Scotland was appointed by the Accounts Commission and the Auditor General as the external auditors of the North Lanarkshire IJB. 6. CONCLUSIONS 6.1 The External Audit Plan for 2021/22 has been discussed and agreed with both the Chief Officer and the Chief Financial Officer. 6.2 The External Auditor has provided an overview of the planned scope and timing of their audit work and this is set out in the attached appendix for information. 6.3 The annual Audit Fee for 2021/22 will be £27,960. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Sound governance and financial sustainability are integral to the achievement of the nine health and wellbeing outcomes. 7.2 ASSOCIATED MEASURE(S) None. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A The cost of the proposed external audit fee will be met from within existing resources as previously agreed. 7.4 PEOPLE None. 7.5 INEQUALITIES EQIA Completed: Yes No N/A 7.6 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 8. BACKGROUND PAPERS None.
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3 9. APPENDICES North Lanarkshire Integration Joint Board – Annual Audit Plan 2021/22 ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Ross McGuffie on telephone number 01698 752 591.
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Prepared for North Lanarkshire Integration Joint Board 8 April 2022 North Lanarkshire Integration Joint Board Annual Audit Plan 2021/22 Appendix
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North Lanarkshire Integration Joint Board Annual Audit Plan 2021/22 | 2 Contents Introduction 3 Annual accounts audit planning 5 Audit dimensions and Best Value 8 Reporting arrangements, timetable, and audit fee 10 Other matters 13
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Introduction | 3 Introduction Summary of planned audit work 1. This document summarises the work planned for our 2021/22 external audit of North Lanarkshire Integration Joint Board (the IJB). The main elements of our work include: • an audit of the 2021/22 annual accounts to support our opinions on the financial statements • work to support our opinions on the other statutory information published within the annual accounts including the Management Commentary, the Governance Statement, and the Remuneration Report • consideration of the arrangements in relation to the four audit dimensions that frame the wider scope of public sector audit: financial management, financial sustainability, governance and transparency and value for money • consideration of the Best Value arrangements • review the IJB’s arrangements for preparing and publishing its Annual Performance Report Impact of Covid-19 2. The coronavirus (Covid-19) pandemic has had a significant impact on public services and public finances, and the effects will be felt well into the future. 3. The Auditor General for Scotland, the Accounts Commission and Audit Scotland continue to assess the risks to public services and finances from Covid- 19 across the full range of our audit work, including annual audits and the programme of performance audits. The well-being of audit teams and the delivery of high-quality audits remain paramount. Changes in our approach may be necessary during 2022 and where this impacts on annual audits, revisions to this Annual Audit Plan may be required. Adding value 4. We aim to add value to the IJB through our external audit work by being constructive and forward looking, by identifying areas for improvement and by recommending and encouraging good practice. In so doing, we will help the IJB promote improved standards of governance, better management and decision making and more effective use of resources. We also attend meetings of Integration Joint Board and the Performance, Finance and Audit Committee and actively participate in discussions where appropriate.
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Introduction | 4 Respective responsibilities 5. The Code of Audit Practice (2016) sets out in detail the respective responsibilities of the auditor and the IJB. Key responsibilities are summarised below. Auditor responsibilities 6. Our responsibilities as independent auditors are established by the Local Government (Scotland) Act 1973 and the Code of Audit Practice (including supplementary guidance) and guided by the Financial Reporting Council’s Ethical Standard. 7. Auditors in the public sector give an independent opinion on the financial statements and other information within the annual accounts. We also review and report on the arrangements within the Joint Board to manage its performance and use of resources. In doing this, we aim to support improvement and accountability. The Integration Joint Board and Chief Officer responsibilities 8. The IJB is responsible for maintaining accounting records and preparing annual accounts that give a true and fair view. 9. Also, the IJB has the primary responsibility for ensuring the proper financial stewardship of public funds, compliance with relevant legislation and establishing effective arrangements for governance and propriety that enable them to deliver their objectives. 10. The audit of the annual accounts does not relieve management or the Joint Board of their responsibilities. Managing the transition to 2022/23 audits 11. Audit appointments are usually for five years but were extended to six years due to Covid-19. 2021/22 is the final year of the current appointment and we will work closely with our successors to ensure a well-managed transition.
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Annual accounts audit planning | 5 Annual accounts audit planning Materiality 12. Materiality is an expression of the relative significance of a matter in the context of the annual accounts. We are required to plan our audit to determine with reasonable confidence whether the annual accounts are free from material misstatement. The assessment of what is material is a matter of professional judgement over both the amount and the nature of the misstatement. Materiality values for the 2021/22 audit 13. The materiality values for the IJB are set out in exhibit 1. Exhibit 1 2021/22 materiality values for North Lanarkshire Integration Joint Board Materiality Amount Planning materiality – This is the figure we calculate to assess the overall impact of audit adjustments on the financial statements. It has been set at 1% of gross expenditure from the 2020/21 audited financial statements. £6.5 million Performance materiality – This acts as a trigger point. If the aggregate of errors identified during the financial statements audit exceeds performance materiality, this would indicate that further audit procedures should be considered. Using our professional judgement, we have assessed performance materiality at 75% of planning materiality. £4.8 million Reporting threshold – We are required to report to those charged with governance on all unadjusted misstatements more than the ‘reporting threshold' amount. £0.2 million Source: Audit Scotland Significant risk of material misstatement to the annual accounts 14. Our risk assessment draws on our cumulative knowledge of the IJB, its major transaction streams, key systems of internal control and risk management processes. It is also informed by our discussions with management, meetings with internal audit, attendance at committees and a review of other relevant information. 15. Based on our risk assessment process, we identified the following significant risk of material misstatement to the annual accounts. This risk has the greatest impact on our planned audit procedures. Exhibit 2 summarises the nature of the
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Annual accounts audit planning | 6 risk, the sources of assurance from management arrangements and the further audit procedures we plan to perform to gain assurance over the risk. Exhibit 2 2021/22 significant risk of material misstatement to the annual accounts Significant risk of material misstatement Sources of management assurance Planned audit response 1. Risk of management override of controls International Auditing Standards require that audits are planned to consider the risk of fraud, which is presumed to be a significant risk in any audit. This includes the risk of fraud due to the management override of controls. Owing to the nature of this risk, assurances from management are not applicable in this instance • Agreement of balances and transactions to North Lanarkshire Council and NHS Lanarkshire financial reports / ledger / correspondence. • Assurances will be obtained from the auditors of NHS Lanarkshire and North Lanarkshire Council over the completeness, accuracy and allocation of income and expenditure. • Review of significant adjustments at year- end. • Review of financial monitoring reports during the year. Source: Audit Scotland Consideration of the risks of fraud in the recognition of income and expenditure 16. As set out in International Standard on Auditing (UK) 240: The auditor’s responsibilities relating to fraud in an audit of financial statement, there is a presumed risk of fraud over the recognition of income. There is a risk that income may be misstated resulting in a material misstatement in the annual accounts. The Joint Board is wholly funded by NHS Lanarkshire and North Lanarkshire Council. We assess that the risk of material misstatement arising from fraud over income is limited. This limitation is to such an extent that we have excluded the risk of fraud over income from our significant audit risks.
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Annual accounts audit planning | 7 17. In line with Practice Note 10: Audit of financial statements and regularity of public sector bodies in the United Kingdom, as most public-sector bodies are net expenditure bodies, the risk of fraud is more likely to occur in expenditure. We have rebutted the risk of material misstatement caused by fraud in expenditure in 2021/22 as we do not consider this to be a significant risk for the Joint Board. This is on the basis that all transactions are processed by the partner bodies rather than the Joint Board directly and that all expenditure is undertaken by the partners who are public sector bodies. 18. We have not, therefore, incorporated specific work into our audit plan in these areas over and above our standard audit procedures. Our audit testing will maintain an oversight of any unusual transactions or accounting entries. Audit risk assessment process 19. Audit risk assessment is an iterative and dynamic process. Our assessment of risks set out in this plan may change as more information and evidence becomes available during the progress of the audit. Where such changes occur, we will advise management and where relevant, report them to those charged with governance.
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Audit dimensions and Best Value | 8 Audit dimensions and Best Value Introduction 20. The Code of Audit Practice sets out the four dimensions that frame the wider scope of public sector audit. The Code of Audit Practice requires auditors to consider the adequacy of the arrangements in place for the audit dimensions in audited bodies. Audit dimensions 21. The four dimensions that frame our audit work are shown in exhibit 3. Exhibit 3 Audit dimensions Source: Code of Audit Practice 22. In summary, the four dimensions cover the following: • Financial management – financial management is concerned with financial capacity, sound budgetary processes and whether the control environment and internal controls are operating effectively. • Financial sustainability – as auditors, we consider the appropriateness of the use of the going concern basis of accounting as part of the annual audit. We will also comment on financial sustainability in the longer term. We define this as medium term (two to five years) and longer term (longer than five years).
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Audit dimensions and Best Value | 9 • Governance and transparency – governance and transparency is concerned with the effectiveness of scrutiny and governance arrangements, leadership, and decision-making and transparent reporting of financial and performance information. • Value for money – value for money refers to using resources effectively and continually improving services. Best value 23. Integration Joint Boards have a statutory duty to make arrangements to secure best value. We will consider and report, where necessary, on these arrangements. Audit dimension risks 24. No new audit dimension risks were identified for the IJB in 2021/22. Progress on the audit dimension risks identified in the prior year will be followed-up with management during the course of the 2021/22 audit.
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Reporting arrangements, timetable, and audit fee | 10 Reporting arrangements, timetable, and audit fee Reporting arrangements 25. Audit reporting is the visible output for the annual audit. All Annual Audit Plans and the outputs, as detailed in exhibit 5, and any other outputs on matters of public interest will be published on our website: www.audit-scotland.gov.uk. 26. Matters arising from our audit will be reported on a timely basis and will include agreed action plans. Draft management reports will be issued to the relevant officers to confirm factual accuracy. 27. We will provide an independent auditor’s report to the Joint Board and the Accounts Commission setting out our opinions on the annual accounts. We will provide the IJB and the Accounts Commission with an annual report on the audit containing observations and recommendations on significant matters which have arisen during the audit. 28. Exhibit 5 outlines the target dates for our audit outputs, and we aim to issue the independent auditor’s report by the statutory deadline of 31 October 2022. We acknowledge this will be challenging due to the ongoing pressures and uncertainties caused by Covid-19. Integration Joint Board and Performance, Finance and Audit Committee meeting dates for later in the 2022 year have yet to be confirmed. Exhibit 5 2021/22 audit outputs Audit Output Target date Committee Date Annual Audit Plan 31 March 2022 22 June 2022 Independent Auditor's Report 31 October 2022 TBC Annual Audit Report 31 October 2022 TBC Source: Audit Scotland
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Reporting arrangements, timetable, and audit fee | 11 Timetable 29. To support an efficient audit, it is critical that the timetable for producing the annual accounts for audit is achieved. We have included a proposed timetable for the audit at exhibit 6 that has been discussed with management. 30. Covid-19 has had a considerable impact on the conduct and timeliness of the audit. We recognise that it is in the best interests of public accountability to get the reporting of audited accounts back to pre-pandemic timelines. To this end, 2021/22 is a transition year with the reporting deadline brought forward by three and a half months relative to the prior year sign-off. We are identifying ways to work more efficiently to expedite the 2021/22 audits whilst at the same time maintaining high standards of quality. 31. We will continue to work in close partnership with management with clarity over timescales and the requirement for high quality unaudited accounts and supporting working papers. Progress will be discussed with management over the course of the audit. Exhibit 6 Proposed annual accounts timetable Key stage Provisional Date Consideration of the unaudited annual report and accounts by those charged with governance 22 June 2022 Latest submission date for the receipt of the unaudited annual report and accounts with complete working papers package. 22 June 2022 Latest date for final clearance meeting with the Chief Financial Officer 30 November 2022 Latest date Letter of Representation and proposed Independent Auditor’s Report will be issued 30 November 2022 Latest date for agreement of audited and unsigned annual accounts 30 November 2022 Latest date Annual Audit Report will be issued to those charged with governance 30 November 2022 Latest date Independent Auditor’s Report will be signed 30 November 2022 Source: Audit Scotland
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Reporting arrangements, timetable, and audit fee | 12 Audit fee 32. The agreed audit fee for the 2021/22 audit of the Joint Board is £27,960 (2020/21: £27,330). In determining the audit fee, we have taken account of the risk exposure of the Joint Board, the planned management assurances in place and the level of reliance we plan to take from the work of internal audit. 33. Where our audit cannot proceed as planned through, for example, late receipt of unaudited annual accounts, the absence of adequate supporting working papers or being unable to take planned reliance from the work of internal audit, a supplementary fee may be levied. An additional fee may also be required in relation to any work or other significant exercises out with our planned audit activity.
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Other matters | 13 Other matters Internal audit 34. International standards on Auditing (UK) 610: Considering the work of internal audit requires us to: • consider the activities of internal audit and their effect on external audit procedures. • obtain an understanding of internal audit activities to inform our planning and develop an effective audit approach that avoids duplication of effort. • perform a preliminary assessment of the internal audit function when there is scope for relying on internal audit work which is relevant to our financial statements' responsibilities; and • evaluate and test the work of internal audit, where use is made of that work for our financial statements responsibilities to confirm its adequacy for our purposes. 35. The IJBs internal audit function is provided jointly by the internal audit teams of NHS Lanarkshire and North Lanarkshire Council. 36. From our initial review of the internal audit plan, we do not plan to place formal reliance on internal audit’s work for our financial statements' responsibilities. We may consider aspects of internal audit’s work in respect of our wider audit dimension responsibilities Independence and objectivity 37. Auditors appointed by the Auditor General for Scotland or Accounts Commission must comply with the Code of Audit Practice and relevant supporting guidance. When auditing the annual accounts, auditors must also comply with professional standards issued by the Financial Reporting Council and those of the professional accountancy bodies. These standards impose stringent rules to ensure the independence and objectivity of auditors. Audit Scotland has robust arrangements in place to ensure compliance with these standards including an annual ‘fit and proper’ declaration for all members of staff. The arrangements are overseen by the Director of Audit Services, who serves as Audit Scotland’s Ethics Partner. 38. The engagement lead (i.e., appointed auditor) for the IJB is Brian Howarth, Audit Director. Auditing and ethical standards require the appointed auditor to communicate any relationships that may affect the independence and objectivity of audit staff. We are not aware of any such relationships pertaining to the audit of the IJB.
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Other matters | 14 Quality control 39. International Standard on Quality Control (UK) 1 (ISQC1) requires a system of quality control to be established, as part of financial audit procedures, to provide reasonable assurance that professional standards and regulatory and legal requirements are being complied with and that the independent auditor’s report or opinion is appropriate in the circumstances. 40. The foundation of our quality framework is our Audit Guide, which incorporates the application of professional auditing, quality and ethical standards and the Code of Audit Practice (and supporting guidance) issued by Audit Scotland and approved by the Auditor General for Scotland. To ensure that we achieve the required quality standards, Audit Scotland conducts peer reviews and internal quality reviews. Additionally, the Institute of Chartered Accountants of Scotland (ICAS) have been commissioned to carry out external quality reviews. 41. As part of our commitment to quality and continuous improvement, Audit Scotland will periodically seek your views on the quality of our service provision. We welcome feedback at any time, and this may be directed to the engagement lead.
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Other matters | 15 North Lanarkshire Integration Joint Board Annual Audit Plan 2021/22 Audit Scotland’s published material is available for download on the website in a number of formats. For information on our accessibility principles, please visit: www.audit-scotland.gov.uk/accessibility For the latest news follow us on social media or subscribe to our email alerts. Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit-scotland.gov.uk www.audit-scotland.gov.uk AS.4.0