Agenda Document Pack - IJB Performance, Finance and Audit Committee - 18/02/2026
North Lanarkshire Council · 18 February 2026
Back to IJB Performance, Finance and Audit Committee — 18 February 2026 and its agenda
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12 February 2026 Members of the IJB Performance, Finance and Audit Committee Chief Executive’s Office Claire Rae Chief Officer, North Lanarkshire Integration Joint Board Civic Centre, Windmill Street Motherwell ML1 1AB www.hscnl.org.uk Notice is given that a Meeting of the IJB Performance, Finance and Audit Committee is to be held on MS Teams on Wednesday, 18 February 2026 at 14:00 PM which you are requested to attend. The agenda of business is attached. Claire Rae Chief Officer, North Lanarkshire Integration Joint Board Members : Clerk Name: Committee Services Clerk Telephone: 07350435308 Clerk Email: committee@northlan.gov.uk C Barclay, B Baudo, B Burgess, P Couser, N Dar, D Henderson, A McCrory, B Moore. Page 1 of 208
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Agenda 1 Welcome and Apologies 2 Declarations of Interest In Terms of the Ethical Standards In Public Life Etc. (Scotland) Act 2000 3 Previous Minute from Integration Joint Board Performance, Finance & Audit Committee of 22 October 2025 Submit Minute of Previous Meeting of Integration Joint Board Performance, Finance & Audit held on 22 October 2025. 5 - 8 4 IJB Performance, Finance & Audit Rolling Action Log Submit report by the Chair 9 - 20 5 Matters Arising Verbal Update by the Chair Performance and Finance 6 Financial Monitoring Report 2025-26 Submit report by the Chief Officer 21 - 40 7 IJB Reserves Strategy 2026-27 Submit report by the Chief Finance Officer 41 - 48 8 Performance Update - 1 July 2025 to 30 September 2025 - Quarter 2 2025-26 Submit report by the Chief Officer (Planning, Performance & Quality Assurance) 49 - 72 Governance and Policy 9 Internal Audit Progress Report 2024-25 & 2025-26 Submit report by the Chief Finance Officer 73 - 98 10 North Lanarkshire Integration Joint Board External Audit Plan 2025-26 Submit report by Eilidh Montgomery 99 - 114 Page 3 of 208
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11 Annual Governance Statement - Action Plan Progress Submit report by the Chief Officer 115 - 120 12 North Lanarkshire Intergration Joint Board Governance Log Submit Report by the Chief Officer 121 - 130 13 Audit Scotland - Community Health & Social Care Performance 2025 Submit report by the Chief Officer (Planning, Performance & Quality Assurance) 131 - 154 14 Audit Scotland - Delayed Discharges Submit report by the Chief Officer (Planning, Performance & Quality Assurance) 155 - 204 15 North Lanarkshire Integration Joint Board Performance, Finance & Audit Work Plan Submit report by the Business Support Manager 205 - 208 Items for Noting 16 Risk Consider from the business discussed any new emerging risks to be added to risk register or whether the discussion materially alters the accessed levels of risk/risk tolerance or mitigating controls. Page 4 of 208
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Page 1 of 3 ITEM: Integration Joint Board Performance, Finance & Audit Committee Minutes from the meeting held on Wednesday 22nd October 2025, 09.30 – 12.00 via MS Teams PRESENT Voting Members: Cllr Claire Barclay NLC Nominated Councillor Cllr Beth Baudo NLC Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non-Executive Cllr Anne McCrory (Chair) NLC Nominated Councillor Brian Moore (Vice-Chair) NHS Lanarkshire Nominated Non-Executive Siobhan White NHS Lanarkshire Nominated Non-Executive Others In Attendance: Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Joanne Jenkins Nurse Director North HSCP Jocelyn Lyall Chief Internal Auditor Catherine McGinty Unison / Staff Side Representative (NHSL) Thomas Moan Senior Manager – Community Solutions VANL Ann Muir Chair of North Lanarkshire Disability Forum Lucy Munro Medical Director for Health & Social Care North Lanarkshire Claire Rae Chief Office NL HSCP Harry Robertson North Lanarkshire Carers Together / Carer Representative Francis Scott Chief Officer (Audit and Risk) Nicola Scott Chief Finance Officer Kerry Taylor Business Support Manager Maggs Thomson Head of Health North HSCP John Watson Employee Representative NLC Apologies: Cllr Bob Burgess NLC Nominated Councillor Nauman Dar NHS Lanarkshire Nominated Non-Executive Diane Fraser Head of Adult Social Care Alison Gordon Head of Children’s, Families & Justice Services Jacqui Jones Deputy Chief Executive and Director of Human Resources David Wood Chief Executive Officer with VANL Item 3 Page 5 of 208
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Page 2 of 3 1. Welcome and Apologies Cllr Anne McCrory welcomed everyone to the meeting and apologies were notes as above. Chair 2. Declaration of Interests No declarations of interest were made. Board Members 3. Minutes IJB PFA (27th August 2025) The minutes accepted as an accurate record. Chair 4. IJB PFA Rolling Action Log Items 27 to 30 are to be moved to the Governance Tracker. Item 32 (prescribing savings) to be brought to a future meeting. Item 36 Claire Rae to follow up directly with John Watson. Item 37 (use of reserves) scheduled for February IJB PFA meeting. Claire Rae and Kerry Taylor to review conventions on retention of closed actions and report back. Chair 5. Matters Arising No matters arising raised. Chair Performance & Finance 6. Financial Monitoring Report Report covered financial position to 31 August 2025. Projected year-end overspend of £4.226m. Key pressures: care at home, care homes, and healthcare non-pay costs. Request for approval to reinstate £260k organisational development reserve. Concerns raised about slow progress on savings and impact on performance. Discussion on Primary Care Improvement Fund (PCIF) overspend and evaluation. Polypharmacy savings and workforce vacancies discussed in detail. Approval granted to reinstate £260k organisational development reserve. Development session to be held to address savings challenges. Nicola Scott to include unachieved savings in December’s financial outlook. Claire Rae to follow up on workforce data and recruitment challenges. Nicola Scott to provide reserve establishment dates in future reporting. RECOMMENDATIONS i) IJB PFA acknowledge the contents of the report. ii) IJB PFA acknowledge the projected outturn for 2025/26 is an overspend of £4.226m iii) Approve the reinstatement of the £0.260m Organisational Development reserve. Nicola Scott 7. Q1 IJB Performance Report Alcohol Brief Interventions: under-recording identified. Cervical Screening: low uptake in 25–29 age group, data and access issues. Childhood Immunisations: national downward trend, local engagement ongoing. Mental Health: low outpatient consultation rates due to psychiatrist shortages. Speech & Language Therapy (SLT): significant improvement noted. Smoking Cessation: low referral and quit rates. Suggestion for future review. Sickness Absence: improving but still high. Staff wellbeing initiatives underway. Morag Dendy Page 6 of 208
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Page 3 of 3 Include SIMD and health inequalities data in future reports. Explore national initiatives on immunisation uptake. Include digital engagement data in performance reporting. Consider development session on smoking cessation strategy. Update risk registers to reflect polypharmacy and digital health innovations. RECOMMENDATIONS i) IJB PFA noted the contents of the report and the appendix. Governance & Policy 8. Internal Audit Progress Report 2024/25 and 2025/26 Strategy audit in progress; no major issues identified. 2025/26 audits (performance and financial sustainability) scheduled for early completion. Development of IJB internal audit strategy underway. No questions raised from this paper RECOMMENDATIONS i) IJB PFA noted the contents of the report. Jocelyn Lyall 9. Annual Governance Statement Actions - Progress Update Four actions remain outstanding; three are within timescales. No questions raised from this paper RECOMMENDATIONS i) IJB PFA noted the contents of the report. Nicola Scott 10. Risk Report Risks under review, new proposals to be presented in December IJB meeting. Discussion on inclusion of polypharmacy and digital health risks. Concern raised about community alarm systems in rural areas post-landline removal. RECOMMENDATIONS i) IJB PFA noted the contents of the report. Kerry Taylor 11. IJB PFA Work Plan The work plan is a live document. Members invited to suggest additional items. Kerry Taylor For Noting 12. Risk No risks identified beyond those discussed above. Date of Next Meeting: 18th February 2026, 14:00-16:30 Page 7 of 208
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 32. 25.02.25 Item 8 Financial Monitoring Suggestion that Pharmacy Savings Approach could be brought back to IJB to get a restock of where things are and where they are going Complete – Added to work plan for future meeting 37. 27.08.2025 Item 4 Matters Arising Use of reserves (to be discussed under Finance) Complete – Paper on agenda for 18 Feb 2026 Item 4 Page 9 of 208
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2 CLOSED ACTIONS NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 1. 30/10/18 Item 11 Reserves Strategy A Kilburn 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 June 2021 November 2021 – deferred to IJB December 2021 Complete Reserve strategy presented to IJB PFA on 16th Nov. Page 10 of 208
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3 undertaken to confirm exit plans and ongoing areas of work. 23.3.22 – Update on Financial plan for 2022/23 presented that included update on reserves strategy but agreed at meeting to provide further more detailed update to include exit strategy for short term initiatives funded from reserves and conclusion of all other areas of reserve funding deferred to March 2023. Final version to March IJB alongside updated SCP Added to March 23 agenda- complete 2. 26.5.20 Item 10 Internal Audit Report – Due Diligence Review A Kilburn 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 September/Dece mber 2020 Deferred to March 2021 – deferred to September 2021 – deferred to November 2021 Original Action complete with further update on hosting arrangements presented to PF&A in November 2021. Page 11 of 208
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4 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. Update March 2022 - Further work required to conclude agreements around hosting arrangements. Complete – presented to IJB PFA on 16th Nov 3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. March 2021 Deferred to September 2021 Ongoing – delegated to PF&A to complete action. Page 12 of 208
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5 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 February 2022 – update on progress noted with further updates to be presented February 2022 Ongoing Complete 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. June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 Complete Ongoing updates on progress scheduled into forward plan for PFA Page 13 of 208
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6 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives December 2021 August 2022 MAT standards update given to Feb IJB PFA Further update on October PFA agenda 5. 19/6/24 Item 6 Digital System Transformation M Dendy Delegate to the IJB PFA committee -To provide the IJB PFA with additional financial information relating to the programme Report provided to IJB PFA 21st August 2024 Complete 6. 19/6/24 Item 7 Mental Health & Wellbeing Delivery Plan R McGuffie Shared new action plan with the group in Sept/October Action Planned shared and stakeholder sign off currently underway. Complete 7. 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 December 2021 Complete – update report to 16th Nov PFA Remove Page 14 of 208
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7 21.6.22 – verbal update on progress noted 2. Memorandum of Understanding to be shared Complete 8. 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 Delayed following advice from HIS around engagement standards. Final business case to Dec IJB. Approved at NL IJB, SL IJB and NHS Board in December 2023. Complete 9. 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 Complete Page 15 of 208
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8 10. 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 21.6.22 – Update on recruitment of CFO provided 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 Complete 11. 22.6.22 Item 8 Financial Plan - Provision of smoke alarms R McGuffie Agreed that H&SC NL funding towards provision of smoke alarms to meet new standards would be included within future Digital Strategy report. March 2023 Update provided after year-end figures. Combined report linked to community alarms on August PFA agenda Complete 12. 22.6.22 Item 5 Unaudited Accounts R McG/NL Content of report to be amended to include more details around reason for significant underspend June 2022 Report updated accordingly. Complete 13. 22.6.22 Item 8 & Item 9 Equalities Mainstreaming Report & Risk Register R McG/CJ IJB members suggested additions to the IJB risk Register on following highlighted risks; Cost of Living Pressures Urgent/Unscheduled care September 2022 Complete Page 16 of 208
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9 Community Alarms (Analogue to digital) National Care Service 14. 22.6.22 Item 9 Equalities Mainstreaming Report M Dendy Progress updates on delivery of equality outcomes to be presented via Performance, Finance & Audit Committee May 2023 On agenda Tabled at June PFA 15. 22.6.22 Item 12 Strategic Commissioning Plan M Dendy/T Marshall Detailed report on community nursing to be brought back to future meeting and included within SCP On March 23 IJb agenda –IJB approved plan 16. 22.6.22 Item 4 Community Alarms R McG Provide the committee with an update on community alarms switching from analogue to digital and risk to service users Complete Update provided at 16th Nov PFA 17. 22.6.22 Item 14 Audited Accounts R McG Bring audited accounts to Sept committee Complete 19. 16.11.22 Item 5 Risk Management Strategy R McGuffie Reviewing risk management strategy which will be brought to the committee in due course. Reviewing a process to have shared risks between partnerships and acute and also review current risk register Update planned for March 2023 IJB Liaison session planned to review Complete 20 16.11.22 Item 6 Analogue to digital R McGuffie Share progress report on the work On April 2023 agenda Update on October agenda Complete 21. 14.2.23 Item 11 Performance Report R McGuffie Bring more information on OT Paediatrics and speech and language On April 2023 agenda Complete Page 17 of 208
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10 22. 14.2.23 Item 13 MH Strategy R McGuffie Consider dedicating liaison session for a more in-depth discussion Discuss wider thematic work with Brian Moore Topic at 8th Nov Liaison session Complete 23 18.10.23 Item 5 Risk Register R McGuffie Ross to provide briefing document to offer the committee assurance that risk are reviewed against other boards November 2023 Liaison Session Complete 24. 18.10.23 Item 10 Performance Report R McGuffie SWISS update Future report Tabled @ May PFA Complete 18. 31.8.22 Item 6 IJB Self- Assessment Report R McGuffie Consider hosting a development session to further explore the self-evaluation work Picked up at November Liaison Session Complete 25. Future Meeting C Rae Host a future meeting face to face in Chryston hub 19.03.2025 – March date was cancelled new date to be re-arranged Dates set up for 2025 Walk rounds Ongoing Complete – Chair & Vice-Chair invited to Chryston visit & dates sent of HSCP SMT walk rounds 26 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that their Medium-Term Financial Plans are up to date and reflect all current known and foreseeable costs to reflect short and longer-term financial sustainability challenges. 25.02.25 – Due to be discussed at the next IJB in March 19.03.2025 Discussed on agenda 19.03.25 Complete Page 18 of 208
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11 31. 25.02.25 Item 6 Q2 Performance Report Improved communication about progress and ensure a shared understanding of what CAMHs services can offer. Complete – updated provided in IJB action log 33. 19.03.20 25 Item 4 Matters Arising Learning Disability Workforce paper to be brought to PF&A Complete – paper presented to September IJB 34. 27.08.20 25 Item 4 Matters Arising Tackling Poverty Team report Complete – added to IJB work plan 35. 27.08.20 25 Item 4 Matters Arising Safe Staffing report Complete – added to IJB work plan 27 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability. Complete – Added to IJB PFA Governance Log 28 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to systematically share learning to identify and develop: - Service redesign focused on early intervention and prevention. - Approaches focused on improving the recruitment and retention of the workforce. Complete – Added to IJB PFA Governance Log 29 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully understand and improve outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand Complete – Added to IJB PFA Governance Log Page 19 of 208
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12 the impact of preventative approaches. 30. 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Evaluate whether the local commissioning of care and support services, and the contracting of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people. Complete – Added to IJB PFA Governance Log 36. 27.08.20 25 Item 4 Matters Arising Information request on age assessments and carers during crisis periods Complete – Discussion at PFA in October 2026 Page 20 of 208
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REPORT Item No: 6 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee for: For approval For endorsement For noting 1.2 This report provides a summary of the North Lanarkshire University Health and Social Care Partnership (the Partnership) for the period 1 April 2025 to 30 November 2025 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the PFA Committee: (1) Acknowledge the contents of the report. (2) Acknowledge the projected outturn for 2025/26 is an overspend of £1.915m 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND 5.1 In line with the integration scheme, North Lanarkshire IJB directs budget back to North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL), the partner organisations, who provide the associated services. 5.2 Direction Letters were approved by the IJB and issued to both NLC and NHSL in March 2025 to direct them to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year.1 As detailed within these, the focus for the year ahead will be on the implementation of the programme of work for the IJB’s Strategic Commissioning Plan 2023-26. 1 IJB Directions Letters SUBJECT: Financial Monitoring Report 2025/26 TO: Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 18 February 2026 Yes No N/A Item 6 Page 21 of 208
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5.3 Both Partners provide the required information on operational budget performance from their respective financial systems. This information is then consolidated to provide reports to the Board on delegated health and social care services. Budget monitoring is undertaken by the finance teams within NLC and NHSL, overseen by the Chief Finance Officer. 6. 2025/26 BUDGET 6.1 The Medium Term Financial Plan (MTFP) for 2025/26 to 2027/28 was approved in March 2025 which identified a 3 year budget gap for the Partnership of £51.854m, of which £14.959m relates to 2025/26. The budget for the Partnership this year is £867.391m as detailed in Appendix 1. 6.2 Throughout the year, adjustments are made to the original budget due to additional budget allocations and budget transfers. Appendix 2 provides a reconciliation of the budget adjustments applied to date. 7. 2025/26 FINANCIAL PERFORMANCE 7.1 The information within this report is based on the NHSL month 8 report (to 30 November 2025) and NLC period 9 report (to 5 December 2025). This shows a projected year end overspend of £1.915m, assuming the current trajectory of spend continues throughout the financial year. Table 1 provides a summary of the Partnership’s position. Table 1 7.2 The projected year end variance can be attributed to £0.630m underspend in relation to the services delegated to health offset by a £2.546m overspend for services delegated to social care. Appendix 3 details the projected variances within each area. 7.3 An explanation of the significant operational projected variances within these delegated services are provided below: 7.3.1 Employee Costs (Pays) – underspend of £5.119m There continues to be challenges service wide in recruitment and retention. For a wide range of posts, recruitment has been unsuccessful due to the availability of the skill mix required or the competition being offered by other private and public sectors. Section 10 of this report provides further detail on vacancy levels and the impact these are having on agency, bank aide and overtime costs. Annual Projected Projected Budget Outturn Outturn Variance £m £m £m Core Delegated Services 579.100 582.853 (3.753) Hosted Services 210.894 209.057 1.837 Set Aside Services 77.397 77.397 0 Total 867.391 869.307 (1.915) Page 22 of 208
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Social Care Services 7.3.2 Excluding employee costs reported in section 7.2.1, the services delegated to Social Care are projecting an overspend of £2.546m, the majority of which is within Payment to Other Bodies. The costs reported within this area are predominantly Care at Home and Independent Care Homes. As part of the MTFP £7.548m was removed from these budgets to recognise the savings to be made in these areas throughout 2025/26. The overspend therefore recognises that these savings are not anticipated to be fully achieved. More detail is provided on the savings achieved to date in section 9. 7.3.3 The projections for independent care homes and care at home provision are demand led and are based on the full year costs for both current clients and those anticipated, therefore projections will alter as the year progresses. The current projections are based on the following: Independent care homes have a yearly budget to fund 1,344 care plans but at present the number of care plans is 1,477 resulting in an overspend of £3.477m. Care at Home costs are projected to overspend by £1.888m, the budget is based on funding 2,514 care plans however the actual plans in place total 2,931. Health Services 7.3.4 Non pay costs have a year to date overspend of £2.082m resulting in the reported projected overspend of £3.237m. A decision was taken as part of the financial planning process to eliminate all historical cost pressures within non pay areas and instead report any financial gaps centrally. The intention was to generate savings through sustainability and value exercises to offset this overspend, as yet the full value of savings required have not been identified. 7.3.5 The year end overspend on prescribing for 2024/25 was £4.757m therefore to recognise historical pressures and anticipate a level of further growth the budget was increased by £12.350m. The impact of this is that a small underspend of £0.007m is being projected this financial year. Based on data available to September 2025 and estimated data for October and November 2025 the cost per item has increased to £10.41 from £10.31, and the number of items being dispensed has increased by 1.70% based on the same period last year. 7.3.6 Hosted Services led by North Lanarkshire IJB are forecasting an overall underspend of £1.837m. There are a number of offsetting variances across this area however the most significant underspends are within Speech & Language Therapy, CAMHS, Forensic Psychiatry and Psychological Therapies which are partially offset by overspends in Children’s Services, Immunisation Services, Learning Disability Services and Adult Psychotherapy. Primary Care Improvement Fund 7.3.7 The agreement in place in respect of hosted services is that the lead IJB will manage any overspends and will retain any underspends. The exception to this is the Primary Care Improvement Fund which is a hosted service led by the South Lanarkshire IJB. The PCIF underspends over previous years have been ring-fenced and retained for the PCIF activity across both the North and South Lanarkshire IJBs and have not been used to offset other South Lanarkshire IJB overspends. Page 23 of 208
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7.3.8 Board members should be aware that the 2025/2026 PCIF budget is £26.418m and a net overspend of £0.324m is reported as at 30 November 2025. Consistent with previous years, a break-even position requires to be achieved by 31 March 2026. 7.3.9 In order to ensure this position, grip-and-control actions have been implemented which include prioritising existing capacity within existing service budgets to safeguard patient safety and maintain required care standards. In parallel, an evaluation programme is on-going to ensure that available PCIF resources are used in the most effective and equitable way possible to support long-term service sustainability and effective care delivery. 7.3.10 Board members will continue to be updated on the actions being taken to achieve the break even position and any impact on North Lanarkshire IJB, should this not be achieved, will be reported at future meetings. 8. GENERAL RESERVES 8.1 It is important for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statute and is part of a range of measures in place to ensure that s106 public bodies do not over- commit themselves financially. 8.2 The opening reserves balance for 2025/26 was £75.554m and the current IJB reserves position after adjustments for the drawdown of in-year reserves, is a revised balance of £72.1114m and is summarised in table 2. Table 2 8.3 A detailed list of all reserve movements during 2025/26 is detailed in appendix 5 including a key guidance table showing how the reserves are aligned to the five ambition statements detailed in the Strategic Commissioning Plan 2023-26. 9. SAVINGS 9.1 As detailed in section 6, the MTFP identified a budget gap for 2025/26 of £14.959m and the response to this was to develop service redesign and transformation actions. Opening Balance As At Revised Balance As At 1st April 2025 31st March 2026 £m £m £m £m NHSL Ring-Fenced Reserves 14.839 0.000 -0.572 14.267 NLC/NHSL Earmarked Reserves 25.060 0.000 -2.618 22.442 NLC/NHSL Risk-Based Reserves 21.536 0.000 -0.250 21.286 NHSL Contingency Reserves 14.119 0.000 0.000 14.119 NLC/NHSL Closed Reserves 0.000 0.000 0.000 0.000 75.554 0.000 -3.440 72.114Total LEAD SUMMARY Transfers To / From Reserves Drawdown from Reserves Page 24 of 208
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9.2 These are summarised in Table 3. Table 3 9.3 Savings are monitored monthly at the Senior Management Team Finance meeting. Progress is provided by the Senior Management Team on actions being taken against the service transformation work. This includes an update on the following work streams: A poly pharmacy review A review of non pay budgets The roll out of “Getting it Right for Everyone” Updates on the financial planning assumptions Review of all vacant posts. 9.4 The current IJB savings position at the end of November 2025, show total savings achieved of £4.898m (33%). This is summarised in chart 1 with more detail provided at Appendix 6. Chart 1 £m Social Care Services 10.386 Home Support 2.838 Independent Care Homes 4.710 Care at Home 2.838 Health Care Services 4.573 Budget Management Non Pays 0.247 Prescribing 4.326 TOTAL 14.959 SERVICE REDESIGN & TRANSFORMATION Page 25 of 208
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9.5 The reserves strategy, as outlined in section 10 of the MTFP, recognises that savings plans can take time to implement and therefore the contingency and risk based reserves are being held to fund any savings gaps that cannot be met during the year. 10. VACANCY POSITION 2025/26 10.1 Table 4 shows the full time equivalent (FTE) vacancy numbers at 30 November 2025 within each service compared against their budgeted establishment. Table 4 10.2 To help cover the vacant posts throughout the year, agency staff, bankaide, overtime and excess part time hours are used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 7 and summarised in Table 5. Table 5 Establishment Actual Vacancies FTE FTE FTE North West Locality 385.97 354.73 19.94 North East Locality 323.83 293.93 15.07 Adult Services 293.59 263.27 36.57 Children Services 596.93 528.79 47.59 Mental Health 1,212.28 1,133.03 -54.12 Social Care Services 938.04 822.64 115.40 Home Support 971.07 919.68 51.39 Other 208.68 202.59 11.92 TOTAL 4,930.39 4,518.66 243.76 Position as at 30 November Service Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.029 0.018 0.577 0.003 0.626 North East Locality 0.014 0.006 0.363 0.000 0.382 Adult Services 0.034 0.080 0.251 0.000 0.365 Children Services 0.027 0.056 0.585 0.112 0.779 Mental Health 0.208 0.045 3.411 2.860 6.524 Social Care Services 0.465 - - 0.054 0.519 Home Support 2.466 - - - 2.466 Other 0.006 0.009 0.045 - 0.061 TOTAL 3.248 0.213 5.232 3.029 11.722 SERVICE Costs as at 30 November 2025 Page 26 of 208
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12. IMPLICATIONS 12.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 12.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 12.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Page 27 of 208
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Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance) within NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 12.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 13. BACKGROUND PAPERS None. 14. APPENDICES Appendix 1 North Lanarkshire IJB Annual Budget 2025/26 Appendix 2 IJB Budget Reconciliation 2025/26 Appendix 3 North Lanarkshire Revenue Budget Position to 30 November 2025 Appendix 4.1 Hosted Services led by North Partnership to 30 November 2025 Page 28 of 208
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Appendix 4.2 Hosted Services led by South Partnership to 30 November 2025 Appendix 5 Movement in Reserves 2025/26 Appendix 6 Savings Progress to 30 November 2025 Appendix 7 Analysis of Additional Employee Costs 2025/26 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07816 126362. Page 29 of 208
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Appendix 1 North Lanarkshire IJB Annual Budget 2025/26 Annual Budget 2025/26 £m Health Care Services Health Care 303.134 Hosted Services 210.894 Set-Aside Budget 77.397 Total Expenditure - NHSL 591.425 Social Care Services Social Care Services Gross Expenditure 279.287 Social Care Services Gross Income (5.894) Social Care Services Net Expenditure 273.393 Housing Revenue Account 2.573 Social Care, Housing and Transport Services Net Expenditure 275.966 Total Expenditure - NHSL and NLC 867.391 Annual Budget 2025/26 £m NHS Lanarkshire Funding (587.985) Social Care Funding (24.119) Resource Transfer (24.690) Commissioned Services (7.225) Transfer from Reserves (Approved) (3.440) Total Funding - NHSL (647.460) NLC Funding - Social Care Services (217.358) NLC Funding - Housing Services (2.573) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (219.931) Total Funding - NHSL and NLC (867.391) Care Group Funded By: Page 30 of 208
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Appendix 2 North Lanarkshire IJB Budget Reconciliation 2025/26 2025/26NHSL Financial Allocation to North Lanarkshire HSCP £m 2025/26 NLC Financial Allocation to North Lanarkshire HSCP £m 2025/26 North Lanarkshire HSCP Financial Allocation 274.566 2025/26 North Lanarkshire HSCP Financial Allocation 217.358 2025/26 Area Wide 8.021 NLC Funding - Housing Services 2.573 2025/26 Prescribing 86.525 NLC Financial Allocation at 20 June 2025 219.931 Set-Aside Budget 77.397 South Hosted @ 52% 43.332 Family Health Service South @ 52% 136.482 NHSL Financial Allocation at 31 May 2025 626.323 Budget Adjustments Posted in Month 3 12.779 NHSL Financial Allocation at 30 June 2025 639.102 Budget Adjustments Posted in Month 4 2.913 NHSL Financial Allocation at 31 July 2025 642.015 Budget Adjustments Posted in Month 5 (1.210) NHSL Financial Allocation at 31 August 2025 640.805 Budget Adjustments Posted in Month 6 5.876 NHSL Financial Allocation at 30 September 2025 646.681 Budget Adjustments Posted in Month 7 0.049 NHSL Financial Allocation at 31 October 2025 646.730 Budget Adjustments Posted in Month 8 North Income 0.600 Allocations 0.292 Area Wide 0.017 South Hosted Serv 52% (0.223) Family Health Service South @ 52% 0.000 South Transfer 0.045 NHSL Financial Allocation at 30 November 2025 647.461 Page 31 of 208
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Appendix 3 North Lanarkshire IJB Revenue Budget Position 1 April 2024 to 30th November 2025 Annual Year To Date Variance Projected Year End Outturn Budget Budget Actual Total Total 2025/26 November 2025 November 2025 November 2025 2025/26 £m £m £m £m £m Health Care Services Locality and Other Services 62.017 42.006 42.750 (0.743) (1.115) Addiction Services 4.459 2.923 2.923 0.000 0.000 Medical and Nursing Directorate 4.136 2.773 2.580 0.193 0.289 Prescribing 82.384 54.205 54.198 0.007 0.011 Out of Area Services 1.723 0.998 1.350 (0.351) (0.527) Area Wide Services 8.354 4.841 4.751 0.090 0.136 Family Health Services 140.062 96.764 96.764 0.000 0.000 Hosted Services 210.894 139.851 138.626 1.225 1.837 Set-Aside Budget 77.397 51.598 51.598 0.000 0.000 Total Expenditure - NHSL 591.425 395.960 395.540 0.420 0.630 Social Care Services Social Care Services Gross Expenditure 279.287 193.352 195.142 (1.789) (2.385) Social Care Services Gross Income (5.894) (4.080) (4.107) 0.027 0.039 Social Care Services Net Expenditure 273.393 189.272 191.034 (1.762) (2.346) Housing Revenue Account 2.573 1.782 1.643 (0.138) (0.200) Social Care, Housing and Transport Services Net Expenditure 275.966 191.053 192.677 (1.901) (2.546) Total Expenditure - NHSL and NLC 867.391 587.014 588.217 (1.481) (1.915) Care Group Year To Date Page 32 of 208
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Appendix 4.1 November 2025 November 2025 November 2025 November 2025 November 2025 November 2025 Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m Sexual Health Services 3.832 1.318 1.255 0.064 1.217 1.217 0.000 Continence Services 3.292 1.133 1.129 0.003 1.045 1.045 0.000 Immunisation Services 3.765 1.592 1.941 (0.349) 1.470 1.470 0.000 Speech and Language Therapy Services 7.641 2.552 2.280 0.272 2.356 2.356 0.000 Children and Adolescents Mental Health Services 16.814 5.477 4.153 1.323 5.055 5.055 0.000 Childrens Services 16.551 5.566 6.041 (0.475) 5.138 5.138 0.000 Integrated Equipment and Adaptations Store 0.817 0.283 0.275 0.008 0.262 0.262 0.000 Dietetics Services 4.773 1.639 1.680 (0.041) 1.513 1.513 0.000 Podiatry Services 5.019 1.670 1.557 0.113 1.541 1.541 0.000 Prisoner Healthcare Services 2.517 0.872 0.773 0.099 0.805 0.805 0.000 Blood Borne Viruses Services 1.886 0.662 0.515 0.146 0.611 0.611 0.000 Hospital at Home 3.345 1.205 1.221 (0.017) 1.112 1.112 0.000 Mental Health and Learning Disability Services 94.782 33.282 33.204 0.078 30.721 30.721 0.000 TOTAL 165.034 57.250 56.025 1.225 52.846 52.846 0.000 Year to Date North Lanarkshire IJB - 52% Share South Lanarkshire IJB - 48% Share Led by the North Partnership Annual Budget 2025/26 Year to Date Page 33 of 208
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Appendix 4.2 November 2025 November 2025 November 2025 November 2025 November 2025 November 2025 Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m Community Dental Services 8.274 2.834 2.834 0.000 2.616 2.534 0.082 Brain Injury Unit 2.682 0.930 0.930 0.000 0.858 0.844 0.014 Out of Hours Services 11.048 3.725 3.725 0.000 3.438 3.349 0.089 Palliative Care Services 8.951 3.254 3.254 0.000 3.004 2.919 0.085 Physiotherapy Services 12.551 4.265 4.265 0.000 3.937 4.034 (0.097) Primary Care Services 0.947 0.331 0.331 0.000 0.306 0.192 0.114 South Improving Cancer Journey 0.148 0.077 0.077 0.000 0.071 0.071 (0.000) Occupational Therapy Services 10.305 3.346 3.346 0.000 3.089 2.817 0.272 Diabetic Services 6.865 2.096 2.096 0.000 1.934 2.398 (0.463) Primary Care Improvement Fund 26.420 8.897 8.897 0.000 8.213 8.537 (0.324) Primary Care Transformation Fund 0.000 0.000 0.000 0.000 0.000 0.000 0.000 TOTAL 88.192 29.755 29.755 0.000 27.466 27.695 (0.229) North Lanarkshire IJB - 52% Share South Lanarkshire IJB - 48% Share Led by the South Partnership Annual Budget 2024/25 Year to Date Year to Date Page 34 of 208
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Appendix 5 MOVEMENT IN RESERVES Opening Balance as at Projected Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.681 3.681 0.000 2024/25 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Displaced Persons 0.123 (0.002) 0.121 (0.002) 2024/25 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.318 (0.045) 0.273 (0.045) 2024/25 1, 2, 4, 5 NHSL Community Living Change Fund 0.055 (0.011) 0.044 (0.011) 2023/24 1, 4, 5 NHSL District Nursing 0.373 0.373 0.000 2024/25 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.915 (0.144) 0.771 (0.144) 2024/25 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2023/24 2, 3 NHSL Long Covid Pathways 0.289 0.289 0.000 2023/24 2, 3, 4, 5 NHSL Mental Health Action 15 0.730 0.730 0.000 2023/24 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service Dementia Post 1.057 1.057 0.000 2024/25 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.221 (0.017) 0.204 (0.017) 2024/25 1, 2, 3, 4, 5 NHSL Mental Health Distress Brief Intervention 2.704 2.704 0.000 2024/25 1, 2, 4, 5 NHSL North Planning Band 2-4 Posts & Multi-Disciplinary Teams 2.719 (0.174) 2.545 (0.174) 2024/25 1, 2, 3, 4, 5 NHSL Pharmacy Mental Health Recovery & NES Training 0.800 (0.629) (0.171) 0.000 (0.800) 2024/25 1, 2, 3, 4, 5 NHSL School Nursing 0.274 0.629 0.903 0.629 2024/25 1, 2, 3, 4, 5 NHSL Third Sector Initiatives To Improve Health 0.075 0.075 0.000 2024/25 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 4 0.014 (0.008) 0.006 (0.008) 2024/25 3 14.839 0.000 0.572 14.267 0.572TOTAL RING-FENCED RESERVES LEAD RING-FENCED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Financial Year Reserve Established Ambition Statement & Performance Page 35 of 208
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Appendix 5 (Contd) Opening Balance as at Projected Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL MH Funding 1.500 1.500 0.000 2024/25 4 NHSL Children and Adolescent Mental Health Services 2.774 (0.172) 2.602 (0.172) 2022/23 1, 2, 4, 5 NHSL Frailty Nursing 1.715 (1.714) 0.001 (1.714) 2023/24 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 2.790 2.790 0.000 TBC 1, 2, 3, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 0.000 2022/23 1, 2, 4, 5 NHSL Adult Social Care Winter Preparedness Fund 1.000 1.000 0.000 TBC 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 (0.102) 0.152 (0.102) 2022/23 3 NHSL Minor Capital Works 1.027 1.027 0.000 2022/23 3 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.268 0.268 0.000 2024/25 4 NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000 2023/24 1, 5 NHSL Kylepark Works 0.134 0.134 0.000 2023/24 4, 5 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.087 0.087 0.000 2024/25 3 NHSL Breast Feeding Team (2 year funding) 0.345 (0.201) 0.144 (0.201) 2023/24 1, 2, 5 NHSL Dietetics Services - Double Running Costs 0.055 0.055 0.000 2022/23 0 NHSL Health Inequalities - Screening 0.016 (0.016) 0.000 (0.016) 2021/22 2 NHSL Health Visiting Students/Trainees 0.029 0.029 0.000 2023/24 3 NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000 2023/24 2, 4 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.293 (0.099) 0.194 (0.099) 2023/24 1, 2, 5 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.538 (0.009) 0.529 (0.009) 2022/23 1, 2, 3 NHSL Podiatry Services - Foot Screening 0.342 (0.004) 0.338 (0.004) 2022/23 1, 2 NHSL Scottish Clinical Leadership Fellowship 0.060 (0.011) 0.049 (0.011) TBC 3 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.297 0.297 0.000 2019/20 1, 2 Ambition Statement & Performance LEAD EARMARKED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Financial Year Reserve Established Page 36 of 208
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Appendix 5 (Contd) NHSL Staff Training Academy 0.335 (0.218) 0.117 (0.218) 2023/24 3 NHSL Vulnerable and Complex Cases - Test of Change 0.501 (0.071) 0.430 (0.071) 2023/24 5 NLC Business Case - Non-Recurring NLC Costs 0.309 0.309 0.000 2022/23 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.604 2.604 0.000 2022/23 1, 2, 4, 5 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.230 0.230 0.000 2022/23 2, 3 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.332 3.332 0.000 2022/23 2, 3 NLC Digital and IT Strategy Technology Improvements - SWIS 0.084 0.084 0.000 2022/23 2, 3 NLC Home Support Resilience (2 year funding) 0.577 0.577 0.000 2023/24 3, 4 NLC IJB Helpline (2 years funding) 0.137 0.137 0.000 2022/23 1, 4, 5 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.149 0.149 0.000 2022/23 3, 4 NLC Staff Training Academy 0.704 0.704 0.000 2022/23 3 NLC MHO Capacity Funding 0.388 0.388 0.000 2025/26 4 NLC Statutory Appropriate Adults 0.161 0.161 0.000 2025/26 1, 2, 5 NLC Participation & Engagement Locality 0.006 0.006 0.000 2025/26 2 NLC Sessional - School summer placements 0.128 0.128 0.000 2025/26 3 25.060 0.000 (2.618) 22.442 (2.618)TOTAL EARMARKED RESERVES Page 37 of 208
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Appendix 5 (Contd) Opening Balance as at Projected Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Prescribing Fund 5.066 (0.250) 4.816 (0.250) 2017/18 2, 4 NLC Social Care Demand 16.470 16.470 0.000 2021/22 1, 2, 3, 4, 5 21.536 0.000 (0.250) 21.286 (0.250) Opening Balance as at Projected Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 14.119 14.119 0 2022/23 1, 2, 3, 4, 5 14.119 0.000 0.000 14.119 0 75.554 0.000 (3.440) 72.114 (3.440) KEY 1 2 3 4 5 Supporting people through a whole family approach. Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. Develop and support a workforce for the future. Improve mental health and wellbeing. TOTAL RESERVES Ambition Statement & Performance Do the right thing first time. Financial Year Reserve Established Ambition Statement & Performance TOTAL CONTINGENCY FUND RESERVES Financial Year Reserve Established Ambition Statement & Performance TOTAL RISK-BASED RESERVES LEAD CONTINGENCY FUND RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 LEAD RISK-BASED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Page 38 of 208
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Appendix 6 Description of Approved Saving Target Value Achieved to Date Savings Gap Description Value Budget Gap Commentary RAG Status £m £m £m £m £m Home Support Home Support re-design which will include the introduction of the dynamic scheduling tool to support the process of streamlining shift patterns alongside service provision. The re-design will further develop the enabling approach as the operating model. 2.838 0 2.838 - 0 2.838 Independent Care Homes Focus the strategic direction to reduce both the length of stay in care homes and the number of people being placed. 4.71 1.233 3.477 - 0 3.477 Care at Home A review of the guided self-assessment process to align with a more strategic assessment and planning practice. 2.838 0.684 2.154 - 0 2.154 TOTAL SOCIAL CARE SERVICES 10.386 1.917 8.469 0 8.469 Budget Management Non Pays A review of budget lines including (but not limited to) travel, training and printing costs. 0.247 0.165 0.082 - 0 0.082 Prescribing A review of prescribing will be undertaken with a 5% savings target being applied. 4.326 2.816 1.510 - 0 1.510 TOTAL HEALTH CARE SERVICES 4.573 2.981 1.592 0 1.592 TOTAL HEALTH & SOCIAL CARE PARTNERSHIP 14.959 4.898 10.061 0 10.061 RAG Status Key Saving achieved Saving partially achieved and has reached expected year to date target Saving not achieved to date HEALTH CARE SERVICES Any year end shortfall in savings will be met from reserves. Approved Savings Replacement Saving / Funding Source SOCIAL CARE SERVICES Any year end shortfall in savings will be met from reserves Page 39 of 208
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Appendix 7 ANALYSIS OF ADDITIONAL EMPLOYEE COSTS 2025/26 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 73,724 50,405 23,448 90,803 384,899 3,492 626,771 2 73,095 42,829 30,589 80,792 379,200 7,882 614,387 3 77,695 44,690 21,698 77,774 415,502 8,580 645,939 4 78,901 52,606 33,463 59,872 461,851 5,436 692,129 5 71,192 47,421 34,659 47,566 467,144 7,004 674,986 6 72,699 39,771 27,262 77,790 449,717 3,294 670,533 7 65,717 44,422 37,135 75,456 427,579 4,702 655,010 8 64,068 40,948 42,731 74,818 425,132 4,660 652,357 TOTAL 577,091 363,092 250,985 584,870 3,411,024 45,051 5,232,113 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 0 0 0 26,054 303,197 -52,687 276,564 2 0 0 0 20,182 373,625 52,462 446,269 3 475 0 0 18,789 383,482 0 402,746 4 477 0 0 22,984 319,872 0 343,333 5 235 0 0 5,668 330,604 28,875 365,382 6 476 0 0 4,671 453,163 25,082 483,392 7 479 0 0 22,128 293,388 0 315,995 8 479 0 0 -8,620 403,019 0 394,878 TOTAL 2,621 - - 111,856 2,860,350 53,732 3,028,558 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 3,378 3,213 6,503 3,183 32,198 -18,944 -68,736 2,540 -36,666 2 4,489 1,471 2,956 1,922 20,113 50,355 342,967 694 424,967 3 4,835 1,466 5,689 3,419 22,245 55,865 306,838 625 400,982 4 4,960 1,535 4,862 3,466 22,181 52,258 310,071 696 400,029 5 2,591 1,056 3,022 1,451 35,317 61,502 299,004 451 404,394 6 1,793 2,447 4,268 1,908 26,013 59,997 334,742 731 431,899 7 2,982 1,099 4,093 4,524 21,290 65,883 331,970 167 432,009 8 3,580 1,256 2,565 6,912 28,227 65,515 316,239 343 424,637 9 0 0 0 0 0 72,573 292,877 0 365,450 TOTAL 28,608 13,542 33,959 26,786 207,583 465,004 2,465,972 6,247 3,247,701 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 2,694 532 9,955 9,215 5,993 1,168 29,556 2 1,669 437 6,550 6,378 6,579 1,074 22,687 3 2,635 488 10,986 7,952 5,225 737 28,022 4 1,459 416 10,736 7,854 3,191 1,065 24,721 5 2,123 325 10,235 5,141 5,013 1,729 24,566 6 2,161 200 9,100 6,090 4,699 733 22,983 7 2,790 1,429 12,425 6,990 7,250 1,408 32,292 8 2,607 1,692 10,079 5,943 6,773 1,489 28,582 TOTAL 18,137 5,519 80,066 55,562 44,723 9,403 213,410 Period Period EXCESS PART TIME COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE Period BANKAIDE COSTS YEAR TO DATE Period AGENCY COSTS YEAR TO DATE Page 40 of 208
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REPORT Item No: 7 SUBJECT: IJB Reserves Strategy 2026/27 TO: Integration Joint Board Lead Officer for Report: Chief Finance Officer Author(s) of Report Chief Finance Officer DATE: 18 February 2026 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit Committee (PFAC) for: For approval For endorsement For noting 1.2 This report provides an update on the review of the North Lanarkshire Integration Joint Board (IJB) reserves. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the PFAC: (1) Acknowledge the contents of the report (2) Approve the realignments outlined in section 6.4 (3) Approve the contingency reserve of 4% 4. VARIATIONS TO DIRECTIONS 5. STRATEGIC APPROACH 5.1 Adequate reserves are critical to sustaining the IJB’s financial stability and enabling delivery of strategic priorities in the face of future pressures. Holding reserves supports long-term planning and mitigates financial risk, in line with statutory obligations for prudent financial management. 5.2 Through the Reserves Strategy, the IJB is taking a proactive approach to review existing reserves, ensuring they remain aligned with current and emerging priorities. Yes No N/A Item 7 Page 41 of 208
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This process balances immediate commitments with forward-looking risk management to strengthen financial sustainability. 6. RESERVES REVIEW AND OUTLOOK 6.1 The projected reserve balance as at 31 December is £73.031m, reflecting an update to the position reported in the most recent financial monitoring report, which was based on November balances. Health Services 6.2 The increase in the projected balance arises from a review undertaken within Health Services. This review identified £0.917m that could be returned to a number of ring-fenced and earmarked reserves, as planned expenditure can instead be met from in-year non-recurring underspends. This includes £0.250m being reinvested into contingency reserves. The reserves affected are as follows: Hospital at Home Services - £0.144m North Planning Band 2 – 4 Posts - £0.151m Children and Adolescent Mental Health Services - £0.172m Staff Wellbeing - £0.102 Neonatal & Paediatrics Dietetics Intervention – £0.098m Contingency - £0.250m 6.3 Appendix 1 details the updated reserves forecast based on these balances. Social Care Services 6.4 A review has been undertaken within Social Care Services, with a particular focus on the Social Care Demand Risk Reserve, to ensure that the balance reported reflects only genuine unallocated resources. Board Members are therefore asked to approve the following proposed reductions to this reserve, which will support transparency and ensure that the remaining balance is held solely for risk-based purposes: (1) The summer placement programme, which offers employment opportunities to S5 and S6 pupils, has continued to deliver strong outcomes. Participation in 2025 was higher than initially planned, resulting in additional expenditure of £19,942. (2) Following the success of the 2025 scheme, a notional allocation for the 2026 programme had been reserved. This has now been formally approved by the Senior Management Team (SMT). It is therefore proposed that £181,924 be transferred to support delivery of up to 60 summer placements and 6 internships in 2026. (3) An overspend of £64,719 has been identified in relation to posts previously approved under the Winter Planning Business Case. This variance is primarily attributable to the cumulative impact of recent pay awards. The posts were temporary in nature, and all post‑holders have now either left the service or moved into alternative roles; therefore, no further expenditure will arise. 6.5 In total, these adjustments represent a net reduction of £266,585 to the Social Care Demand Risk Reserve, with a corresponding increase to Earmarked Reserves. These movements reflect decisions previously delegated to SMT. The updated forecast position is shown in Table 1. Page 42 of 208
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Table 1 6.6 A final review of the 2025/26 reserve balances and the 2026/27 forecast will be completed following the year-end closure of the 2025/26 accounts. This review will focus on confirming that all earmarked reserves remain aligned to their original purpose. Where reserves are no longer required, they will be closed and the balances transferred to the Risk and Contingency Reserve. 7. 2026/27 RESERVES STRATEGY 7.1 In line with the Partnership’s Medium-Term Financial Plan, it is recommended that risk- based and contingency reserves be established as a defined percentage of the core financial envelope. This approach provides a structured and proportionate safeguard against financial uncertainty and strengthens the organisation’s capacity to manage future challenges effectively. 7.2 Members may recall approving a 4% target in May 2025 which was a reduction from the previous target of 5% taking cognisance of the current financial challenges facing the Partnership. 7.3 If the proposals in section 6 are approved for social care the forecast risk-based reserves would represent 3.5%. It is proposed to leave the target at 4% at this stage and undertake a further review at the Committee in May following the finalisation of the 2025/26 accounts. 8. IMPLICATIONS 8.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Opening Balance as at 31 March 2025 £m £m £m NHSL Ring-Fenced Reserves 14.839 (0.277) 14.562 NLC/NHSL Earmarked Reserves 25.060 (2.246) 0.267 23.081 NLC/NHSL Risk-Based Reserves 21.536 (0.267) 21.269 NHSL Contingency Reserves 14.119 14.119 NLC/NHSL Closed Reserves 0.000 0.000 75.554 (2.523) 0.000 73.031Total Revised Forecast as at 31 March 2026LEAD SUMMARY In year Draw Downs Proposed Transfers Page 43 of 208
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Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 8.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 8.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance) of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Page 44 of 208
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☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 8.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 9. BACKGROUND PAPERS IJB Reserves Strategy 2025-26 10. APPENDICES 2025/26 Reserves Forecast Appendix 1 Nicola Scott Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola on telephone number 07581 007187. Page 45 of 208
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Appendix 1 Opening Balance as at Revised Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.681 3.681 0.000 2024/25 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Displaced Persons 0.123 (0.002) 0.121 (0.002) 2024/25 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.318 (0.045) 0.273 (0.045) 2024/25 1, 2, 4, 5 NHSL Community Living Change Fund 0.055 (0.011) 0.044 (0.011) 2023/24 1, 4, 5 NHSL District Nursing 0.373 0.373 0.000 2024/25 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.915 0.000 0.915 0.000 2024/25 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2023/24 2, 3 NHSL Long Covid Pathways 0.289 0.289 0.000 2023/24 2, 3, 4, 5 NHSL Mental Health Action 15 0.730 0.730 0.000 2023/24 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service Dementia Post 1.057 1.057 0.000 2024/25 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.221 (0.017) 0.204 (0.017) 2024/25 1, 2, 3, 4, 5 NHSL Mental Health Distress Brief Intervention 2.704 2.704 0.000 2024/25 1, 2, 4, 5 NHSL North Planning Band 2-4 Posts & Multi-Disciplinary Teams 2.719 (0.023) 2.696 (0.023) 2024/25 1, 2, 3, 4, 5 NHSL Pharmacy Mental Health Recovery & NES Training 0.800 (0.629) (0.171) 0.000 (0.800) 2024/25 1, 2, 3, 4, 5 NHSL School Nursing 0.274 0.629 0.903 0.629 2024/25 1, 2, 3, 4, 5 NHSL Third Sector Initiatives To Improve Health 0.075 0.075 0.000 2024/25 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 4 0.014 (0.008) 0.006 (0.008) 2024/25 3 14.839 0.000 0.277 14.562 0.277 LEAD RING-FENCED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Financial Year Reserve Established Ambition Statement & Performance TOTAL RING-FENCED RESERVES Page 46 of 208
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Appendix 1 Opening Balance as at Revised Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL MH Funding 1.500 1.500 0.000 2024/25 4 NHSL Children and Adolescent Mental Health Services 2.774 0.000 2.774 0.000 2022/23 1, 2, 4, 5 NHSL Frailty Nursing 1.715 (1.714) 0.001 (1.714) 2023/24 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 2.790 2.790 0.000 TBC 1, 2, 3, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 0.000 2022/23 1, 2, 4, 5 NHSL Adult Social Care Winter Preparedness Fund 1.000 1.000 0.000 TBC 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 0.000 0.254 0.000 2022/23 3 NHSL Minor Capital Works 1.027 1.027 0.000 2022/23 3 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.268 0.268 0.000 2024/25 4 NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000 2023/24 1, 5 NHSL Kylepark Works 0.134 0.134 0.000 2023/24 4, 5 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.087 0.087 0.000 2024/25 3 NHSL Breast Feeding Team (2 year funding) 0.345 (0.201) 0.144 (0.201) 2023/24 1, 2, 5 NHSL Dietetics Services - Double Running Costs 0.055 0.055 0.000 2022/23 0 NHSL Health Inequalities - Screening 0.016 (0.016) 0.000 (0.016) 2021/22 2 NHSL Health Visiting Students/Trainees 0.029 0.029 0.000 2023/24 3 NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000 2023/24 2, 4 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.293 (0.001) 0.292 (0.001) 2023/24 1, 2, 5 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.538 (0.009) 0.529 (0.009) 2022/23 1, 2, 3 NHSL Podiatry Services - Foot Screening 0.342 (0.004) 0.338 (0.004) 2022/23 1, 2 NHSL Scottish Clinical Leadership Fellowship 0.060 (0.011) 0.049 (0.011) TBC 3 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.297 0.297 0.000 2019/20 1, 2 NHSL Staff Training Academy 0.335 (0.218) 0.117 (0.218) 2023/24 3 NHSL Vulnerable and Complex Cases - Test of Change 0.501 (0.071) 0.430 (0.071) 2023/24 5 NLC Business Case - Non-Recurring NLC Costs 0.309 0.309 0.000 2022/23 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.604 2.604 0.000 2022/23 1, 2, 4, 5 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.230 0.230 0.000 2022/23 2, 3 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.332 3.332 0.000 2022/23 2, 3 NLC Digital and IT Strategy Technology Improvements - SWIS 0.084 0.084 0.000 2022/23 2, 3 NLC Home Support Resilience (2 year funding) 0.577 0.577 0.000 2023/24 3, 4 NLC IJB Helpline (2 years funding) 0.137 0.137 0.000 2022/23 1, 4, 5 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.149 0.149 0.000 2022/23 3, 4 NLC Staff Training Academy 0.704 0.704 0.000 2022/23 3 NLC MHO Capacity Funding 0.388 0.388 0.000 2025/26 4 NLC Statutory Appropriate Adults 0.161 0.161 0.000 2025/26 1, 2, 5 NLC Participation & Engagement Locality 0.006 0.006 0.000 2025/26 2 NLC Sessional - School summer placements 0.128 0.128 0.000 2025/26 3 25.060 0.000 (2.245) 22.815 (2.245) LEAD EARMARKED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Financial Year Reserve Established Ambition Statement & Performance TOTAL EARMARKED RESERVES Page 47 of 208
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Appendix 1 Opening Balance as at Revised Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Prescribing Fund 5.066 (0.000) 5.066 (0.000) 2017/18 2, 4 NLC Social Care Demand 16.470 16.470 0.000 2021/22 1, 2, 3, 4, 5 21.536 0.000 (0.000) 21.536 (0.000) Opening Balance as at Revised Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 14.119 14.119 0 2022/23 1, 2, 3, 4, 5 14.119 0.000 0.000 14.119 0 75.554 0.000 (2.523) 73.031 (2.523) KEY 1 2 3 4 5 LEAD RISK-BASED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Financial Year Reserve Established Ambition Statement & Performance TOTAL RISK-BASED RESERVES Do the right thing first time. Financial Year Reserve Established Ambition Statement & Performance TOTAL CONTINGENCY FUND RESERVES LEAD CONTINGENCY FUND RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 TOTAL RESERVES Ambition Statement & Performance Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. Develop and support a workforce for the future. Improve mental health and wellbeing. Supporting people through a whole family approach. Page 48 of 208
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1 REPORT Item No: 8 SUBJECT: Performance Update – 01st July 2025 to 30th September 2025, Quarter 2 2025/26 TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest, Performance Manager DATE: 18 February 2026 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ Prepared by: Performance Manager Reviewed by: Senior Manager, Strategy & Performance Item 8 Page 49 of 208
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2 3. RECOMMENDATIONS It is recommended that the IJB/IJB PFA Committee: (1) Note the contents of the report and the appendix. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES The Chief Officer has joint quarterly performance review meetings with the Chief Executives of NHS Lanarkshire and North Lanarkshire Council. These meetings are supported by a Chief Executives Performance Framework comprising a range of performance measures taken from across both the health and social work systems, including relevant targets and trajectories for the measures presented. Each quarter there are areas for improvement identified within the performance framework; these are identified using a RAG rating and those measures that are flagged as Red or Amber are subject to improvement or corrective action. The performance review meetings are used as a means for jointly agreeing these actions. 6. CONCLUSIONS The areas for improvement and corrective action identified as RAG Red and Amber are attached as Appendix 1. The areas for improvement identified in Appendix 1 are being progressed as a matter of priority, and progress updates will be reported at future meetings of the Board and the Performance, Finance & Audit Committee. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ Yes ☐ No ☐ N/A ☒ Page 50 of 208
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3 People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) None. 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB 11.21 - Oversight of Performance Activity Low Claire Rae NLC RIA0000460 – Performance & planning High NLC – Social Work/Social care 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved Yes ☐ No ☐ N/A ☒ Page 51 of 208
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4 ☐ 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 The performance information, with the corresponding improvement and corrective actions will enable stakeholder representatives to participate in wider discussion about performance. ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership The performance information, with the corresponding improvement and corrective actions supports locality planning. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 8. BACKGROUND PAPERS Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒ Page 52 of 208
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5 None. 9. APPENDICES Appendix One - Areas for Improvement – 01st July 2025 to 30th September 2025, Quarter 2 2025/26 CHIEF ACCOUNTABLE OFFICER (or Depute) Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following; Stephen Forrest – Performance Manager Stephen.Forrest@lanarkshire.scot.nhs.uk Page 53 of 208
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6 1. Alcohol Brief Interventions Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 3047 *annualised 482 508 RED Alcohol Brief Interventions (all settings) NHSL 7381 *annualised 1518 1601 RED Narrative & Corrective Action Performance for Alcohol Brief Interventions in Q2 shows that there has been a modest increase in activity compared to Q1. Despite this improvement, overall delivery of ABI remains below the revised trajectory and continues to reflect a longer-term downward trend. Activity levels remain sensitive to wider system pressures, including workforce availability and competing clinical priorities; as such, delivery continues to vary across settings. Despite the slight improvement seen in Q2, there is no evidence of a sustained recovery. As noted in previous reporting, recording practices continue to influence reported performance. ABI activity is delivered across a range of services and there is evidence that not all interventions are consistently captured within core reporting systems. This limits the extent to which reported figures fully reflect activity undertaken in practice and remains an area for further improvement. The targeted engagement with delivery teams and reinforcement of ABI pathways within routine practice referenced in previous reporting remain ongoing. This includes senior managers directly engaging with services to raise awareness of ABI, particularly with newer colleagues. Senior managers also continue to raise awareness of ABI through their professional forums and at performance meetings. Given the preventative nature of ABI and the time lag between engagement activity and measurable impact, further improvement will be incremental and dependent on wider system capacity. Continued focus is required to translate this into sustained improvement. 2. Cervical Screening Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 69.7% 69.9% RED Narrative & Corrective Action Performance for Cervical Screening in Q2 shows improvement compared to Q1, with uptake increasing across all six localities. Despite this improvement, uptake remains below the 80% target in all areas and continues to reflect a longer-term year-on-year decline. Locality-level data shows that Q2 uptake ranged from 67.5% in Airdrie to 73.3% in North locality. All six localities improved compared to Q1, although the increases were modest and all areas remain below target. In addition, all six localities are lower than the same quarter in the previous year, with reductions ranging from 0.6% to 1.7%. NHS Lanarkshire overall uptake remains below target at 70.8%, with North H&SC at 69.9%. Page 54 of 208
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7 Cervical and wider screening work continues to be directed and monitored through the Lanarkshire-wide Inequalities in Screening Steering Group, providing a consistent framework for prioritisation and oversight. During Q2, Health Improvement teams across all localities continued to deliver engagement and awareness activity to support uptake, with cancer prevention featuring routinely in locality newsletters distributed across statutory, third sector and healthcare partnerships. This was supported by social media messaging shared through NHS Lanarkshire and Health Improvement channels. In the North East sector, a cervical screening action plan developed by Health Improvement continues to be progressed through Local Planning Groups. Activity during the quarter included coordinating use of digital waiting room screens in health centres, community centres and hubs to promote screening programmes, delivering awareness sessions with Health Visitors and Treatment Room staff and sharing quarterly locality-level data and narrative with GP Clinical Leads, Service Managers, Team Leaders and Local Planning Group members. The action plan has also been shared with the North West localities to support consistency of approach. Targeted locality activity has included cervical screening messaging within menopause awareness sessions, sharing of uptake data with Clinical Leads and the development and distribution of locally tailored materials. In Motherwell and Airdrie, a poster incorporating a QR code linking to lived-experience videos was produced and distributed across health centres and community venues, with the launch supported through engagement at the Lanarkshire Mosque Community Day. Further training for Health Visiting staff in Motherwell has been agreed for February 2026. In Wishaw, Treatment Room Chronic Disease Management teams have been trained to deliver cancer screening messages during clinics, resulting in 84 screening-related conversations during the quarter, including 20 focused on cervical screening. In the North West sector, cervical screening leaflets were distributed across all Early Years establishments, with awareness sessions routinely offered. Additional engagement activity took place through community events, treatment room clinics and women’s groups, with cervical screening messages integrated alongside wider cancer prevention and tobacco cessation advice. Work during Q2 has also strengthened links between cervical screening and the HPV immunisation programme. A pilot project of awareness sessions with the Wishaw and Shotts Health Visiting teams identified that the staff wanted more information on the protective role of HPV immunisation. Collaboration with the Schools Immunisation Team has since been incorporated into local presentations to support more informed conversations with families. A cervical screening self-sampling pilot (validated test) is also being explored, with Lanarkshire practices approached to participate and further detail expected by the next quarterly report. While this breadth of activity provides reassurance that cervical screening remains an active prevention priority, the impact on uptake is expected to be incremental due to the cyclical nature of screening and time lag between engagement and measurable change. Q2 performance therefore represents an encouraging early signal but overall uptake remains below target and continued focus is required to translate sustained engagement into longer-term recovery. Cervical Screening Uptake by Locality: Locality Uptake (%) Change from Q1 Airdrie 67.5 +0.7 Bellshill 69.0 +0.1 Coatbridge 68.0 +0.2 Motherwell 69.6 +0.3 North 73.3 +0.1 Page 55 of 208
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8 Wishaw 69.0 +0.2 NHS Lanarkshire 70.8 North HSCP 69.9 South HSCP 72.7 Nationally, there have been data quality issues with the cervical screening performance data, which is a significant factor in the national, benchmarkable data only being available several years in arrears. That data is only published at NHS Board level and local authority level data is only provided infrequently and upon request. The 24/25 financial year data, which was due to be published prior at the end of 2025, has been delayed with no timescale for publication. This is further complicated due to the move from a three, to five-year recall, which means that long-term trend analysis may now be difficult. The latest publication includes performance up to financial year 2021/22 and this data is presented in the Strategic Needs Assessments for both University North and South Lanarkshire Health and Social Care Partnerships. Percentage of cervical screening uptake for 25-49 year olds, by financial year Financial Year Percentage of cervical screening uptake for 50-64 year olds, by financial year Financial Year Area of Residence 2019/20 2020/21 2021/22 Area of Residence 2019/20 2020/21 2021/22 South Lanarkshire 73.5% 71.5% 70.9% South Lanarkshire 75.5% 74.0% 73.4% Scotland 68.5% 66.3% 65.7% Scotland 75.8% 74.4% 73.7% North Lanarkshire 72.1% 69.4% 69.5% North Lanarkshire 73.4% 72.1% 71.5% Airdrie 70.3% 66.6% 67.5% Airdrie 70.6% 69.2% 68.4% Bellshill 71.0% 68.2% 68.8% Bellshill 71.9% 70.4% 69.7% Coatbridge 71.8% 69.1% 69.1% Coatbridge 71.5% 70.5% 70.1% Motherwell 71.8% 69.1% 68.5% Motherwell 73.1% 71.0% 70.4% North Lanarkshire North 74.0% 72.5% 72.7% North Lanarkshire North 76.4% 75.3% 74.7% Wishaw 72.3% 68.9% 68.6% Wishaw 74.6% 73.7% 73.4% North Lanarkshire has had a higher cervical screening uptake rate among 25-49 year olds in comparison to the national rate from 2019/20 to 2021/22, with all six North Lanarkshire localities also having a higher uptake percentage than Scotland. North Lanarkshire North is consistently the locality with the highest uptake percentage and Airdrie consistently the lowest. Page 56 of 208
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9 The North Lanarkshire cervical screening uptake percentage among 50-64 year olds has been consistently lower than the national rate from 2019/20 to 2021/22. The uptake percentage has been decreasing for both North Lanarkshire and Scotland over the last three years of published national open data. North Lanarkshire North has consistently been the locality with the highest uptake percentage, Airdrie has been the locality with the lowest uptake percentage. 3. Childhood Immunisations Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 89.6% 89.5% RED Immunisations – %s of 2 year olds 95% 94.8% 94.4% AMBER Narrative & Corrective Action Performance for Childhood Immunisations shows a slight decline compared to Q1, continuing the downward movement reported previously. Uptake remains below the national target, reinforcing the longer-term trend observed across recent quarters. The Q2 position reflects a complex operational and behavioural context rather than any single underlying issue. Discussion at scrutiny meetings has highlighted a degree of uncertainty around primary vaccinations, influenced in part by vaccine hesitancy that emerged during the COVID-19 pandemic. This continues to affect uptake patterns and contributes to ongoing challenges in achieving sustained improvement. 69.0% 70.0% 71.0% 72.0% 73.0% 74.0% 75.0% 76.0% 77.0% 2019/20 2020/21 2021/22 Financial Year Percentage of cervical screening uptake for 50-64 year olds, by financial year South Lanarkshire Scotland North Lanarkshire 60.0% 62.0% 64.0% 66.0% 68.0% 70.0% 72.0% 74.0% 76.0% 2019/20 2020/21 2021/22 Financial Year Percentage of cervical screening uptake for 25-49 year olds, by financial year South Lanarkshire Scotland North Lanarkshire Page 57 of 208
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10 Alongside system-level development, locality-based work continues to support immunisation uptake. This includes targeted follow-up with families, additional clinic activity where required, and ongoing engagement by Health Visiting teams to reinforce vaccination messages during routine contacts. These actions remain important to stabilise performance at local level. Work is also underway in developing the vaccination service model to understand patterns, trends and themes among children who do not attend for vaccination. This includes analysis of DNA activity and more intensive follow-up with families. The scale of this work is significant and, in some cases, involves tracking families across the county to promote uptake and re-engagement with vaccination services. Further operational change is planned through the transition to a dedicated vaccination team. A paper has been developed to set out how service delivery will change as part of this transformation, including amendments to clinic arrangements and implications for locality and sector approaches. Recruitment to permanent posts is ongoing, with agreement that these roles will transfer to the future vaccination service, providing greater stability and capacity over time. In parallel, there is a review of the North Lanarkshire Council Programme of Work, which presents opportunities to strengthen multi-agency collaboration on vaccination uptake. This includes sharing information, raising awareness, and identifying practical ways in which partners can support families to access and engage with vaccination services. While this programme of work provides reassurance that childhood immunisations remain an active focus at both system and locality level, the preventative nature of the intervention and the behavioural factors involved mean that improvements are expected to be incremental rather than immediate. Short-term movements in performance should therefore be interpreted with caution; continued focus on locality delivery, service transformation and multi-agency working remain required to support recovery over future quarters. It should be noted however, that changes in operational delivery and the transition to a dedicated vaccination team is likely to result in some short-term volatility in the reported performance, with some decline expected in future quarters three and four whilst the new model is embedded. 4. 6 – 8 Week Reviews Target 2025/26 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of people who have completed 6-8 week review 90% 85.4% 84.4% ... RED Narrative & Corrective Action Performance for 6–8 Week Reviews, as reported on the scorecard, shows a very slight decline compared to the previous position. This movement should be interpreted with caution, as the indicator is reported two quarters in arrears and does not reflect activity undertaken during Q2 itself. It has now been clarified through recent discussion with services that the indicator historically reported as “6–8 Week Reviews” is not a true 8-week measure. The reporting standard was previously based on completion within 10 weeks and subsequently moved to a 12-week timescale in line with national reporting requirements. This definitional change was implemented in earlier quarters, however may not directly explain the scorecard movement. The change in timescale delivered an improvement in the reported performance, as the timeframe for compliant reviews had increased, however this indicator remains highly sensitive to administrative and recording processes. Reviews completed outside the intended 6–8 week period, including those undertaken at 10–12 weeks, are counted as compliant within the Page 58 of 208
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11 reported measure. Variability in the management and transfer of review forms influences reported performance, particularly where small numbers of late or incomplete reviews can have a disproportionate effect on percentages. Operational discussion through the Strategic Locality Working Group has highlighted that the principal challenge remains administration rather than clinical engagement. Quality improvement work is underway to document the end-to-end review process more clearly, improve handling of forms and strengthen consistency across local practice. Feedback from General Practice indicates that most babies are reviewed, but that a small number of delayed or incomplete reviews can materially affect the reported metric. As a benchmark, for the most recent reported quarter, Q4 of 2024/25, University South Lanarkshire HSCP reported 81.3%, which although slightly lower, is broadly comparable with performance in North Lanarkshire. Whilst the slight decline shown in the Q2 scorecard for North Lanarkshire should not necessarily be interpreted as strong evidence of worsening practice, equally given the reporting lag and sensitivity of the measure, it is not possible to draw firm conclusions about improvement. Further work to improve process clarity and administration is required before meaningful assessment of performance trends can be made. Action Timescale Expected Impact on Indicator Implement notification process for missing forms TBC Reduce incomplete records Test and evaluate Elsie App TBC Reduce DNAs, improve attendance recording Maintain GP practice engagement programme Ongoing Increase form return rates Embed SOP across all localities TBC Standardise processes, reduce variation Complete UHVP digital recording scoping TBC Improve timeliness and accuracy of reporting 5. Assistive Technology Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Assistive Technology - Number Of People With Technology (0-17 yrs) 1452 22 22 RED Assistive Technology - Number Of People With Technology (18-64yrs) 270 303 RED Assistive Technology - Number Of People With Technology (65+) 673 745 RED Narrative & Corrective Action Page 59 of 208
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12 Performance for Assistive Technology remains below target, continuing the position reported previously. Interpretation of the current position requires recognition that the reported performance now reflects improved data completeness following system changes, rather than a sudden reduction in activity or demand. Greater visibility of Assistive Technology through the analysis of ELMS2 and Mosaic data has resulted in a more accurate representation of the operational position. Comparisons with previous quarters are therefore difficult due to the significant change in the data. Demand for Assistive Technology remains high, driven by hospital discharge pressures and the wider shift towards supporting people to remain safely at home through Enabling approaches. Capacity constraints across assessment, installation and review functions continue to influence the throughput. Work is ongoing to stabilise delivery and improve flow through better alignment with Home Support and Reablement processes, clearer prioritisation linked to discharge and risk, alongside continued refinement of data quality to support performance monitoring. As this work progresses, consideration will be given to whether the existing targets remain appropriate and achievable in light of the current levels of demand and system design. A desktop exercise to review the indicators and targets set in the performance scorecard is planned to produce a refreshed scorecard for financial year 2026/27. Assistive Technology remains a key enabler of hospital discharge and community support; a continued focus on capacity, prioritisation and data maturity will be required to support recovery against the current targets. 6. Reablement and Rehabilitation Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 317 604 RED Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 62.4% 60.4% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 65.3% 56.8% RED IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 72.7% 79.2% AMBER Narrative & Corrective Action Performance for Reablement in Q2 remains below the expected level, with limited movement from the position reported previously. The proportion of new and increased Home Support cases routed through Reablement continues to fall short of the targeted level and the variation between localities remains largely unchanged. The scorecard position indicates that the number of people accepted for Reablement is persistently below the targeted level and suggests that, despite the intent that where possible, for all new or increased care packages to progress through Reablement, this does not happen consistently in practice. Capacity constraints, pathway complexity and local operational pressures continue to influence decision making in this area. Page 60 of 208
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13 Bellshill remains a minor outlier within the Reablement pathway; while intake levels in Bellshill are consistently closer to the expected threshold, outcomes for the other performance metrics are weaker than in other localities, with fewer hours saved and a higher proportion of cases requiring the same or increased levels of support. This pattern has been evident across multiple quarters and may indicate that higher compliance with intake (a greater proportion of new or increased care packages going through Reablement) does not necessarily result in an outcome of reduced levels of home support required at the end of the intervention. Across the wider system, the relationship between Reablement and mainstream Home Support is a key factor in interpreting performance. Pressure on Home Support capacity, combined with the need to prioritise urgent discharge and high-risk cases, continues to limit the extent to which Reablement is used as a proactive and preventative intervention. Service delivery continues to be constrained by system pressures and to some degree, variation in local practice. Further work is required to strengthen compliance, address any variation and ensure that Reablement is strengthened within the wider Home Support and discharge system. IEAS - % DELIVERIES ACHIEVED WITHIN 7 WORKING DAYS QUARTERLY Performance for IEAS deliveries within 7 working days in Q2 was 79.2%, remaining just below the 80% target. While the indicator is therefore assessed as RAG Amber, the Q2 position represents a significant improvement and reflects a sustained upward trajectory. The improvement seen in Q2 indicates increasing stability within the Equipment Store following earlier operational pressures. Clearer prioritisation, improved workflow and strengthened operational grip have contributed to more timely delivery of equipment, particularly for urgent and hospital discharge-related requests. The current position is notable given the wider system context. Demand for equipment remains high and closely linked to hospital discharge, reablement and community support pathways. Continued focus will be required to maintain this trajectory and meet, and then sustain the 80% target. Ongoing monitoring is required to reflect demand and seasonal pressures. 7. Adult Mental Health Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 75.6% 83.9% RED Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 20.8% 19.4% RED Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 71.5% 73.7% RED Narrative & Corrective Action 18 WEEK RTT PERFORMANCE – PSYCHOLOGY (NHSL) (NORTH HOSTED) Page 61 of 208
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14 Performance improved in Q2, with 83.9% of patients commencing treatment within 18 weeks, compared to 75.6% in Q1. This represents a notable improvement and indicates positive momentum within the service. The Q2 position is supported by the monthly position and the position now exceeds the Public Health Scotland Analyst’s predicted range of 70% to 80%. Over the last 12 months, the number of patients waiting over 18 weeks has reduced by 28%, indicating sustained progress in addressing long waits. Although the total waiting list remains slightly higher than the predicted trajectory, this is considered likely to be reflective of seasonal variation. Importantly, the overall number of patients waiting has reduced by 10.6% compared to the same period last year, providing further assurance of the underlying positive momentum. Longer waits over 52 weeks continue to be concentrated within Neuropsychology and the Neuropsychology waiting list has increased in line with predicted trajectory following changes to referral criteria introduced in November 2023. It is estimated that an additional 4.25 WTE clinical capacity would be required to meet RTT within this specialty, and this remains a key constraint on further improvement. The service continues to strengthen its improvement approach. Feedback from Scottish Government on the recently submitted improvement plan recognised it as comprehensive, with clear understanding of current challenges and appropriate actions in place. Work is also underway to articulate Neuropsychology waiting time risks through a structured SBAR, which will be considered through senior management and finance governance routes. In parallel, Psychological Services continue to align practice with the National Specification for the Delivery of Psychological Therapies and Interventions, supported by collaboration with academic partners. The recent multidisciplinary research conference hosted with Strathclyde University reflects a continued focus on innovation, workforce development and sustainable service improvement. CONSULTANT OUTPATIENT WT - ADULT MENTAL HEALTH - 12WKS (NHSL) (NORTH HOSTED) Performance against the 12-week standard for Adult Mental Health deteriorated further in Q2, with compliance reducing from 20.8% in Q1 to 19.4% in Q2 and remaining significantly off target. The Q2 position reflects sustained pressure across the Adult Mental Health pathway, driven by high demand, increasing clinical complexity and constrained consultant capacity. Workforce challenges remain the primary constraint on performance, particularly within General Adult Psychiatry (GAP). Persistent difficulties in recruitment, retention and workforce development continue to create a significant imbalance between demand and available capacity, directly limiting the service’s ability to improve waiting times. Review of the Clinical Director model has previously confirmed that GAP has been operating with vacancy levels of around 50%, illustrating the structural nature of the challenge. Operationally, the service continues to prioritise urgent and higher-risk referrals appropriately. However, this necessary focus has the effect of extending waits for routine outpatient appointments and further constraining overall performance. Workforce instability, including vacancies and sickness absence, continues to limit clinic availability and reduce flexibility to address backlog. As a North-hosted service operating within an NHS Lanarkshire-wide system, pressures beyond North Lanarkshire also influence performance, reflecting that this is not a short-term or localised issue. CONSULTANT OUTPATIENT WT - OLDER ADULT PSYCHIATRY - 12WKS (NHSL) (NORTH HOSTED) Page 62 of 208
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15 Performance against the 12-week standard for Older Adult Psychiatry improved in Q2 2025/26, continuing the positive trajectory observed over recent quarters. Compliance with the standard increased to 73.7% in the reporting period, indicating sustained progress, although performance does remain below the national standard. There remain ongoing pressures associated with clinical complexity, comorbidity and demographic change. As with other mental health services, the North-hosted Older Adult Psychiatry pathway operates within a wider NHS Lanarkshire system and performance is influenced by consultant availability. The service continues to prioritise urgent and higher-risk referrals appropriately, while working to reduce waits. 8. Medical Paediatrics Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90%* 76.0% 72.1% RED Narrative & Corrective Action Performance against the 12-week standard for Medical Paediatrics continued to decline in Q2. Demand for Medical Paediatrics remains high, with performance influenced by increasing complexity, capacity constraints and wider system pressures. Governance and oversight arrangements for Medical Paediatrics have been strengthened through active participation in the Acute Weekly Planned Care Group, with specific focus on the longest waits (over 52 weeks). Progress is tracked regularly, with reporting being extended to Chief Officer level. In parallel, the newly established Paediatric Service Improvement Group provides structured oversight through the Unit Performance Meeting and brings together medical, nursing and administrative leadership to drive improvement. The improvement focus is on addressing backlog, releasing capacity and improving pathway efficiency, including a review of new/return appointment balance, clinic configuration and DNA processes. Work is also underway to strengthen waiting list management, centralise booking, improve data quality and develop clear trajectories for Community Paediatrics. These actions are intended to stabilise performance and support a gradual recovery. 9. SLT Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 54.5% 85.9% RED SLT - Adult - 12wks (NORTH HOSTED) 90%* 82.8% 83.5% RED Narrative & Corrective Action Page 63 of 208
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16 Performance against the 12-week waiting time standard for Adult Speech and Language Therapy remained stable in Q2. Compliance increased marginally from 82.8% in Q1 to 83.5% in Q2, with no significant change in overall performance. While performance remains below the 12-week standard, service delivery is stable and demand/capacity broadly in balance. Performance against the 12-week waiting time standard for Paediatric SLT services improved significantly in Q2 2025/26. Compliance with the standard increased from 54.5% in Q1 to 85.9% in Q2, representing a substantial improvement within the quarter. The Q2 position aligns with the focused work undertaken through established SLT oversight and performance arrangements. This has included targeted review of long waits, a prioritisation of backlog cases and strengthened the grip on waiting list management. Better use of the available capacity has been achieved through improved differentiation between ongoing support and new referrals, alongside enhanced validation of waiting list data. The improvement in Q2 reflects the impact of concentrated activity and continued monitoring is required to embed changes into routine practice that will both sustain and continue to improve the level of performance. 10. Dietetics Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 69.8% 78.9% RED Narrative & Corrective Action Performance against the 12-week waiting time standard for Dietetics improved in Q2 2025/26, with compliance increasing from 69.8% in Q1 to 78.9% in Q2. The improvement in Q2 aligns with a structured improvement programme focused on strengthening waiting list management and service oversight. This has included validation of the waiting list, the introduction of a rolling validation process, and work to address data inaccuracies within TrakCare. Previously discontinued coordination practices have been reinstated, and standard operating procedures are in development to support consistency and sustainability. As these reinstated practices and improvements are embedded, there may be some short-term volatility in the reported performance and a slight decline expected to be reported in subsequent quarters whilst the service adapts to the change, however monitoring and analysis will support a more sustainable long-term model for the service. Targeted capacity measures have contributed to the improved position; a Waiting List Initiative has been introduced providing additional adult clinic appointments and domiciliary telephone consultations each week, alongside an expanded paediatric provision. These actions have supported increased throughput within the constraints of existing workforce capacity. Workforce resilience remains a risk given the specialised nature of the service. Work is underway to develop more flexible models of dietetic provision that enhance long- term resilience and sustainability. Page 64 of 208
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17 11. Complaints Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days (NHSL) 50% 31% 26% RED Narrative & Corrective Action Performance remains below target and continues a pattern observed across previous quarters. The Q2 position does not represent a material change in direction and indicates that timely handling of complaints remains a systemic challenge. As with previous quarters, performance should be interpreted in the context of sustained pressure on services, workforce capacity constraints and the complexity of cases being received. These factors continue to affect the ability to progress complaints through investigation, response drafting and approval within the required timescale. The position in Q2 aligns with intelligence from other performance reporting, which indicate that delays are not isolated to individual services or short-term operational issues. Rather, they reflect ongoing challenges in capacity, process and consistency across NHS Lanarkshire. Work continues to strengthen complaints handling processes and oversight; sustained action will be required to address the underlying drivers of delay and to achieve meaningful and lasting improvement in future quarters. 12. Smoking Cessation Target 2025/26 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sustain and embed successful smoking quits, at 12- weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 166 239 ... ... RED Narrative & Corrective Action Performance for sustained smoking quits at 12 weeks post quit in Q2 remains below the targeted level. The Q2 position reflects the continued challenge of achieving and sustaining quits within communities experiencing the greatest deprivation. The scorecard position should be interpreted in the context of the nature of the indicator, which measures sustained behaviour change rather than engagement or referral activity. As with other prevention measures, performance is sensitive to both service capacity and wider socio-economic factors. As such, improvements tend to be incremental rather than immediate. Table 1: All - North locality data April to March 2024/25 Q1 - 4 (40% most deprived) Page 65 of 208
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18 Locality Number of QDS Number of 12 week quits Cumulative target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 168 27 91 -64 30% 16% 22% Coatbridge 210 31 91 -60 34% 15% 22% North 159 52 75 -23 69% 33% 22% Bellshill 179 24 63 -39 38% 13% 22% Motherwell 158 42 81 -39 52% 27% 22% Wishaw 197 32 82 -50 39% 16% 22% Table 2: Specialist - North locality data April to March 2024/25 Q1 - 4 (40% most deprived) Locality Number of QDS Number of 12 week quits Cumulative target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 26 11 28 -17 39% 42% 55% Coatbridge 39 21 28 -7 75% 54% 55% North 16 9 23 -14 39% 56% 55% Bellshill 18 7 19 -12 37% 39% 55% Motherwell 33 16 25 -9 64% 49% 55% Wishaw 30 15 25 -10 60% 50% 55% Table 3: Pharmacy - North locality data April to March 2024/25 Q1 - 4 (40% most deprived) Locality Number of QDS Number of 12 week quits Cumulative target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 142 16 63 -47 25% 11% 15% Page 66 of 208
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19 Coatbridge 171 10 63 -53 16% 6% 15% North 143 43 52 -9 83% 30% 15% Bellshill 161 17 44 -27 39% 11% 15% Motherwell 125 26 56 -30 46% 21% 15% Wishaw 167 17 57 -40 30% 10% 15% A range of locality-based activity continues to be delivered to support smoking cessation in SIMD areas. This includes targeted engagement through community settings, integration of smoking cessation messaging within wider health improvement activity and close working with services such as treatment rooms and chronic disease management clinics to identify and support smokers at key points of contact. The service recognises the importance of aligning smoking cessation activity with other preventative interventions, including cancer screening and long-term condition management, to maximise reach and relevance. Work continues to refine referral pathways and strengthen follow-up support, reflecting that sustained quits are influenced by the intensity and continuity of engagement rather than initial contact alone. Despite this activity, the Q2 position reinforces that smoking cessation in SIMD areas remains a complex challenge; high levels of need, competing priorities and wider determinants of health continue to affect quit success and sustainability. Continued focus on locality delivery, pathway integration and sustained engagement will be required to support improvement over future quarters. 13. Addictions Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Addictions – Ongoing Waits NHSL 90% 89.7% 80.2% RED Narrative & Corrective Action Information on the implementation of the Medication Assisted Treatment (MAT) Standards are included in this report to provide assurance on the quality and consistency of addictions treatment delivery. The most recent MAT Standards update remains the primary reference point for this position and reflects an annual assessment rather than quarter-specific detail. The majority of Medication Assisted Treatment (MAT) Standards are met, providing assurance around access, choice, and quality of care. Performance against the MAT Standards in Q2 2025/26 is unchanged from the position reported previously and the RAG ratings indicate that the majority of standards are being met. The MAT Standards framework provides a qualitative assurance view of service delivery rather than a measure of activity or access pressures. This is particularly relevant given that the primary performance challenge within addictions services relates to waiting times reported at NHS Lanarkshire level, rather than performance specific to Page 67 of 208
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20 North Lanarkshire. Local access and delivery within North Lanarkshire remains comparatively stable and pressures elsewhere within the system mostly drive the position for overall waits. In this context, the MAT Standards should be read as a supplementary assurance measure rather than a proxy for wider addictions performance; MAT Standards confirm that treatment and recovery-focused services continue to operate within an established and stable framework. Focus remains appropriately directed towards addressing NHS Lanarkshire-wide access pressures, which sit outside the scope of the MAT Standards framework. RAGB Colour | Definition Colour Definition Red There is no or limited evidence of implementation of the standard in MAT services Provisional amber There is no or limited evidence of implementation of the standard in MAT services Amber There is evidence of partial implementation of the standard in MAT services including benefit to people Provisional green There is evidence of implementation and benefit to people, however, full implementation is not confirmed by all three evidence streams – usually the experiential stream is lacking Green There is evidence of full implementation and benefit to people in all unique combinations of setting and service that offer MAT and opioid substitution therapy (OST) across the ADP area ADP Reporting Year MAT 1 MAT 2 MAT 3 MAT 4 MAT 5 MAT 6 MAT 6 & 10 MAT 7 MAT 8 MAT 9 MAT 10 North Lanarkshire 2022 2023 2024 2025 14. Unscheduled Care Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status A&E Attendances - NL Residents 116,456 28,896 30,588 … AMBER Emergency Admissions - NL Residents 44,001 11,583 Quarterly/ 2 quarters behind … AMBER Page 68 of 208
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21 Unscheduled Bed Days - all specialties, NL residents 294,999 83,412 Quarterly/ 2 quarters behind … AMBER Narrative & Corrective Action These indicators reflect different stages of the same unscheduled care pathway; interpretation of the Q2 scorecard requires recognition of the reporting lags, with A&E attendances reported one quarter in arrears and emergency admissions and unscheduled bed days reported two quarters in arrears. As such, the scorecard does not reflect activity occurring during Q2 itself. The latest available data shows that A&E attendances among North Lanarkshire residents remain high and comparable with earlier peaks in 2024/25, indicating sustained front door pressure. Emergency admissions and unscheduled bed days show a slight reduction in the Q4 figure from the winter peak observed in Q3, however are elevated levels than that experienced in earlier quarters and may represent a higher baseline level of demand and occupancy. This position is consistent; pressure across unscheduled care continues to be driven by whole-system flow constraints, including delays to admission and first assessment, high numbers not meeting criteria to reside, longer lengths of stay, and workforce pressures affecting throughput and discharge. Operational information supports this interpretation, with emergency access performance remaining significantly off trajectory. Performance against the 4-hour standard continues to be well below target, with ongoing pressure evident across longer waits, reflecting the constrained bed availability and higher variation in the levels of delayed discharge, rather than changes in attendance behaviour alone. While some easing is visible in the more recent admissions and bed day data, demand and occupancy remain high and continue to constrain flow through the acute system. This reinforces the need for sustained focus on whole-system flow and discharge processes to assist in meaningful and lasting improvement for these indicators. 15. Training and Development Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Fire Safety Training 90% 89.6% 87.6% AMBER Hand Hygiene Training 90% 87.5% 86.0% AMBER TURAS compliance (NHSL, North) 80% 79% 75% RED Narrative & Corrective Action The Q2 position for TURAS appraisals and mandatory training is generally stable. The majority of mandatory training indicators are assessed as RAG Green and requirements are being met in most areas. Two indicators, Fire Safety and Hand Hygiene, remain Amber and require focused attention. Levels of compliance vary across services and teams. As with appraisal data, data quality and system configuration issues affect interpretation of training compliance. Manual maintenance of team hierarchies and staff allocation means that reported compliance can be distorted where records are out of date, particularly in areas that have experienced organisational change or staff movement. Page 69 of 208
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22 The Amber position for Fire Safety and Hand Hygiene reflects competing operational pressures and the timing of refresher requirements. Local Performance and Quality Coordinators provide targeted team-level analysis to highlight areas of low compliance and support remedial action. Managers continue to review compliance as part of routine performance discussions, with a focus on early escalation of risks and ensuring that new staff complete mandatory modules promptly during induction. More broadly, TURAS appraisal data is increasingly visible at senior levels and is available to support proactive management of appraisal and mandatory training compliance Page 70 of 208
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23 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed Page 71 of 208
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1 REPORT Item No: 9 SUBJECT: Internal Audit Progress Report 2024/25 & 2025/26 TO: Integration Joint Board Performance, Finance & Audit Committee. Lead Officer for Report: Nicola Scott, Chief Finance Officer Author(s) of Report Francis Scott, Chief Officer (Audit and Risk), North Lanarkshire Council Jocelyn Lyall, Chief Internal Auditor, NHS Lanarkshire Contact details for Author(s) of Report Francis Scott – ScottFr@northlan.gov.uk Jocelyn Lyall – Jocelyn.lyall2@nhs.scot DATE: 18 February 2026 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE PFA This paper has been: Prepared By: Chief Officer (Audit and Risk), North ☒ Reviewed By: Chief Finance Officer ☒ Endorsed By: Chief Officer ☒ Item 9 Page 73 of 208
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2 Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire) 3. EXECUTIVE SUMMARY The progress in respect of the Internal Audit work for 2024/25 and 2025/26 is summarised in Appendix 1. The 2024/25 Internal Audit Plan is complete and a workplan has been agreed to ensure the Internal Audit Plan 2025/26 is delivered to inform the annual internal audit opinion. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB Performance, Finance & Audit Committee: 1) Consider the attached Progress Report at Appendix 1, the summary of relevant partner reports at Appendix 2 and the final IJB Strategy report at Appendix 3. 5. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required. 6. BACKGROUND As stated in the Integrated Resources Advisory Group guidance, it is the responsibility of the Integration Joint Board (IJB) to establish an adequate and proportionate internal audit of the arrangements for risk management, governance and control of the delegated resources. The internal audit arrangements for the IJB are provided jointly by the internal audit teams of North Lanarkshire Council and NHS Lanarkshire. The IJB approved the Internal Audit Plan 2025/26 on 21 May 2025. A total of 60 days has been committed and the plan has been designed to target the priority issues which have been aligned to strategic risks, and to reflect the evolving and complex challenges to service delivery. Yes ☐ No ☒ N/A ☐ Page 74 of 208
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3 The Internal Audit Plan 2025/26 will provide sufficient evidence to form an Internal Audit Opinion on the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control arrangements. The Internal Audit Plan 2025/26 also takes account of assurances which will be provided to the IJB based on the work performed under the Internal Audit Plans of both North Lanarkshire Council and NHS Lanarkshire. The audit of operational activities is being undertaken under the auspices of the partner bodies. The IJB is asked to note that the outcomes of these operational audits are reported to the partner body Audit Committees and discussed with the IJB Chief Officer and IJB Chief Financial Officer. The assurances gained will be provided to the IJB as part of the overall assurances received from the partner body Audit Committees. We include a summary of relevant completed NHS Lanarkshire and North Lanarkshire Council reports at Appendix 2. 7. SUMMARY OF KEY ISSUES Completion of the 2024/2025 Internal Audit Plan and progress with the 2025/26 plan is set out at Appendix 1. The summary of relevant partner body reports is at Appendix 2. Progress since the October 2025 Performance, Finance & Audit Committee: The IJB Strategy audit report is appended at Appendix 3. The report provided Reasonable Assurance. Management has agreed to take action to address three findings in the following areas: o Elements that should be incorporated in to planning the next iteration of the Strategic Commissioning Plan (SCP) – risk assessed as Significant o Articulation of governance arrangements for development and monitoring of the next SCP – risk assessed as Moderate o Schedule of reporting on the Programme of Works to enable monitoring – risk assessed as Significant. From 1 April 2025, Public Sector Internal Audit Standards were replaced by the Global Internal Audit Standards (GIAS), supported by an ‘Application Note - Global Internal Audit Standards in the UK Public Sector’. Within the Local Government context application of GIAS is also supported by the CIPFA ‘Code of Practice for the Governance of Internal Audit in Local Government’ (The Code). Internal audit teams must work in accordance with the new standards from 1 April 2025 and by doing so will build up conformance to GIAS during 2025/26. Page 75 of 208
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4 The Chief Internal Auditors are progressing GIAS development work and the Internal Audit Charter, including the Mandate, was approved at the 27 August 2025 Performance, Finance & Audit Committee. 8. CONCLUSIONS The Internal Audit Plan 2025/26 is designed to target the priority issues and to provide sufficient evidence to form an Internal Audit Opinion on the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control arrangements. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer. ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected. ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services. ☐ Health and Social Care Services contribute to reducing health inequalities. ☐ People who use Health and Social Care Services are safe from harm. ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services. ☒ 9.2 ASSOCIATED MEASURE(S) Page 76 of 208
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5 9.3 FINANCIAL There are no financial impacts arising directly from this report. This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT The internal audit planning process which produced the Annual Internal Audit Plan considers the strategic risk profile of the organisation. Individual internal audit assignments identify the key risks at the planning stage and our work is designed to evaluate whether appropriate systems are in place and operating effectively to mitigate the risks identified. Legislative requirements are a core consideration in planning all internal audit reviews. Relevant Risk Register Details Current Risk Level Risk Owner Ineffective Governance Arrangements Low Chief Officer 9.5 ENGAGEMENT & PARTICIPATION The Chief Officer and the Chief Finance Officer have both been consulted in respect of the preparation of the Internal Audit progress report. 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY An EQIA & Fairer Scotland Impact Assessment Form is not required as there are no EQIA implications arising directly from this report. All internal audit reviews which involve review of policies and procedures will examine the way in which equality and diversity is incorporated within documentation. Page 77 of 208
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6 EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS N/A 11. APPENDICES Appendix 1 Internal Audit Progress – 2024/25 and 2025/26 Appendix 2 Summary of Relevant NHS Lanarkshire and North Lanarkshire Council Reports issued. Appendix 3 Internal Audit Report – IJB Strategy. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Chief Finance Officer Page 78 of 208
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Appendix 1 7 Ref Audit Indicative Scope Target Audit Committee Planning Stage Work in Progress Draft Issued Completed Grade Internal Audit Plan 2024/25 NL01-25 Audit Planning Agreeing audit universe and preparation of internal audit annual plan. May 2024 N/A NL02-25 Audit Management Liaison with management, liaison with Chief Finance Officer and attendance at Audit Committee. Ongoing N/A N/A N/A N/A N/A NL03-25 Audit Follow Up Review of progress made by management in implementing those actions committed to in response to previously agreed Internal Audit recommendations. August 2025 N/A NL04-25 Annual Report Preparation for Annual Report including assistance with completion of IJB governance self-assessment checklist. August 2024 Reasonable Page 79 of 208
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Appendix 1 8 NL05-25 Governance arrangements Review of governance arrangements with reference to the Blueprint for Good Governance in NHS Scotland. August 2025 Adequate NL06-25 Strategy Review of the content and implementation of the Strategic Commissioning Plan, including assessing the adequacy and effectiveness of arrangements for monitoring of delivery and performance reporting. August 2025 Reasonable Page 80 of 208
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Appendix 1 9 Ref Audit Indicative Scope Target Audit Committee Planning Stage Work in Progress Draft Issued Completed Grade Internal Audit Plan 2025/26 NL01-26 Audit Planning Agreeing audit universe and preparation of internal audit annual plan. May 2025 N/A NL02-26 Audit Management Liaison with management, liaison with Chief Finance Officer and attendance at Audit Committee. Ongoing N/A N/A N/A N/A N/A NL03-26 Audit Follow Up Review of progress made by management in implementing those actions committed to in response to previously agreed Internal Audit recommendations. August 2026 NL04-26 Annual Report Preparation for Annual Report including assistance with completion of IJB governance self-assessment checklist. August 2026 Page 81 of 208
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Appendix 1 10 NL05-26 Financial Sustainability Effective, efficient and economic use of resources to ensure financial sustainability, with a focus on transformation. May 2026 NL06-26 Performance / Committee Effectiveness Accurate, relevant and reliable reporting to the Board, staff, the SGHSCD and the public. March 2026 Page 82 of 208
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Appendix 2 11 The following relevant reports have been issued by NHS Lanarkshire: Report Audit Opinion Key findings L20A/26 Compliance with Core Financial Procedures – Banking Arrangements Reasonable Assurance While there was a good level of compliance, Internal Audit identified the following issues: Not all monthly reconciliations were completed in compliance with the established procedures No targets have been established for Key Performance Indicators (KPIs) and no analysis is completed on the ‘Faster Payments Possibly Resulting from Errors’ KPI. Agreed Action: Bank Reconciliations will be prepared and authorised in compliance with the desktop procedures. The Treasury team will discuss setting reasonable KPI targets to be collated into a performance report. L20B/26 Compliance with Core Financial Procedures – Payroll Substantial Assurance Desktop Procedures have not been reviewed, updated as appropriate and approved by the established Review Date, albeit no major changes to the Procedures have been required and they remain fit for purpose. Management will endeavour to have these updated by the end of the year. L16/26 Review of Supplementary Staffing Reasonable Assurance Controls to mitigate the risk were operating as expected. While recognising that DL(2024)04 - Supplementary staffing – Health Care Support Worker (HCSW) agency controls has been implemented, the use and cost of supplementary staffing has risen. If this continues there will be a considerable increase in cost during 2025/26. L07/26 Review of NHS Resilience Business Continuity & Emergency Planning Limited Assurance Whilst the Resilience Team have developed several draft resilience documents/processes, these have not been formally adopted, approved, published and disseminated throughout NHSL. The organisation’s register of Business Continuity Plans is not complete. The previous two internal audit reviews reported to the Audit and Risk Committee provided assurance that actions to address findings were being taken forward, however some key aspects have not been adequately progressed, for example, delivery of the improvement plan. Management has agreed that: Page 83 of 208
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Appendix 2 12 Report Audit Opinion Key findings The Resilience Management Systems (RMS) Policy has been agreed by Corporate Management Team and the Corporate Policy Team has been contacted to arrange publication. Planning Framework engagement is well underway and draft Framework consultation has commenced. Development work is ongoing for new systematic approaches. Existing documents remain extant as the current plans. These will be recorded and tracked in line with the compliance arrangements being put in place. The Register of Business Continuity Plans is at an advanced stage of development and ready to be tested with a view to implementation. The development of the RMS approach includes the reporting timeframes and links aspects of performance to KPIs. The establishment of a reconstituted Resilience Group provides the platform for assurance reporting. This format will be utilised for the annual 2025/26 PPRC update and also to establish a regular CMT update. Risk 1703 has been reviewed and updates are provided to the Chief Risk Officer on a regular basis. Work to manage the risk is taken via the Acute Major Incident Group. No relevant reports have been issued by North Lanarkshire Council in this period. Page 84 of 208
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Appendix 3 Internal Audit Consortium for NHS Fife, NHS Tayside and NHS Forth Valley FTF Internal Audit Service North Lanarkshire IJB Internal Audit Service IJB Strategy Issued to: C Rae, Chief Officer N Scott, Chief Finance Officer M Dendy, Head of Planning, Performance & Quality G Cowan, Senior Manager, Strategy & Performance North Lanarkshire Integration Joint Board External Audit Page 85 of 208
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FTF Internal Audit Service NL IJB Strategy Page 1 Contents Section Page Section 1 Executive Summary 2 Section 2 Issues and Actions 10 Section 3 Definitions of Assurance & Recommendation Priorities 12 Draft Report Issued 2 September 2025 Draft report reissued 22 December 2025 Management Responses Received 4 February 2026 Performance and Audit Sub-Committee 18 February 2026 Final Report Issued 9 February 2026 Page 86 of 208
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Section 1 Executive Summary FTF Internal Audit Service NL IJB Strategy Page 2 CONTEXT AND SCOPE 1. The North Lanarkshire HSCP Strategic Commissioning Plan (SCP) 2023-2026 was approved by the IJB Board on 23 March 2023. It sets out how the HSCP plans and delivers services over the medium term and how these arrangements help contribute towards achieving national health and wellbeing outcomes. 2. A Programme of Works was approved by the IJB Board on 27 September 2023 setting out in more detail the programme and activities intended to help transform the health and social care system. 3. On 4 December 2024, at the mid-point of the planning cycle, the IJB Board was provided with a report on progress to date, detailing the Red/Amber/Green (RAG) status of each item within the Programme of Works. 4. The key relevant risk is IJB.19/23 – Service Sustainability, described as ‘Due to competing service priorities and workforce/operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety’. The risk has a current risk rating of High and a target risk rating of Low. 5. Risk IJB.11/21 – Oversight of Performance Activity is also relevant to this review and is described as ‘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’. The current risk level is Low, which is also the target risk level. 6. This audit concluded on whether: The Strategic Commissioning Plan 2023-26: o Embedded appropriate project/programme management principles o Incorporated learning from post Covid remobilisation o Ensured genuine innovation incorporating transformation and achievement of efficiency savings o Identified overall population need and addresses health and care inequalities o Was congruent with partner bodies strategies o Identified staff, eHealth, Estates and other resource requirements and ensures these are embedded in the supporting strategies of the IJB and its partners. There is regular, appropriate and proportionate governance and performance reporting to the Board on the delivery of the Strategy. Arrangements are in progress to ensure the Board’s continued engagement in all key decisions and in setting the vision/direction for the next iteration of the SCP. Page 87 of 208
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Section 1 Executive Summary FTF Internal Audit Service NL IJB Strategy Page 3 AUDIT OPINION The Audit Opinion of the level of assurance is as follows: Level of Assurance System Adequacy Controls Reasonable Assurance There is a generally sound system of governance, risk management and control in place. Some issues, non- compliance or scope for improvement were identified which may put at risk the achievement of objectives in the area audited. Controls are applied frequently but with evidence of non- compliance. 7. We concluded positively on the content of the current SCP which is well constructed and provides a sound basis for the development of future strategic intentions. 8. While a Programme of Works to implement the Strategy is in place, there has only been one overarching report to the Board on the full programme, summarising elements of the programme reported through other committees. Individual elements are reported more frequently through individual papers to the IJB Board and the Performance, Finance & Audit Committee. Elements of the programme are also reported through the North Lanarkshire Council Adult Care and Social Work Committee and the NHS Lanarkshire Population Health Committee. 9. The findings within this report represent an opportunity to progress planning for development of the next iteration of the SCP and improve reporting of the Programme of Works to the IJB, with a focus on the role of the Board in contributing to the SCP and in monitoring progress. 10. Our main findings were: In developing the extant SCP there was a robust engagement process undertaken in line with the HSCP’s Engagement & Participation Strategy. Engagement is a key feature within the SCP. The extant SCP is congruent with partner organisation strategies and identifies the elements required to enable the plan. It incorporates elements such as innovation and learning, realistic medicine, service transformation and the need to maximise resources and adopt a whole system approach which is sustainable and operates efficiently and effectively. A mid-cycle progress update on the SCP Programme of Works, linked to the five key priorities of the SCP, was presented to the 4 December 2024 IJB and confirmed significant progress with the 21 items within the programme of works. Page 88 of 208
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Section 1 Executive Summary FTF Internal Audit Service NL IJB Strategy Page 4 The Strategic Planning Group (SPG) has a key role in developing the SCP to ensure it reflects the needs and expectations of the population. The Group continues to meet quarterly and development of the next iteration of the SCP was discussed at the April 2025 meeting, including the potential to align review dates with other key HSCP documents. In our view, the project plan, including the timetable to develop the SCP should as a priority, be formulated and agreed by the SPG, the Senior Management Team and the Board. Governance arrangements and the Board’s role in the development of the SCP and in monitoring implementation should be formally agreed and communicated. Risk Management Updates and the IJB risk register are presented to both the Board and the Performance, Finance & Audit Committee. There is scope to ensure all relevant risks are reflected in the new SCP and to incorporate enhanced risk reporting in IJB progress reports on implementation. Strategic Plan & Strategic Commissioning Plan 11. Health and Social Care North Lanarkshire published its ten-year strategy “Safer, Healthier, Independent Lives” in 2016, setting out the vision and priorities for the next ten years to achieve the national health and wellbeing outcomes prescribed in the Public Bodies (Scotland) Act 2014. 12. Annual SCPs were produced between 2016 and 2020, and a three-year plan covering the period 2020-23 was produced. The SCP 2023–2026 covers the final three years of the original ten-year strategy. 13. The Board approved the draft version of the extant SCP on 30 November 2022, subject to final consultation between December 2022 and February 2023. 14. The final SCP 2023-2026 was approved at the 22 March 2023 Board. Work programmes to meet the key priorities within the SCP were described and the paper stated that key deliverables and timescales would be further developed, with regular reports on progress to the Board and its Committees. 15. Development of the SCP considered the range of other national and local strategies, plans and policies to ensure SCP was consistent and aligned with the priorities of North Lanarkshire Council, NHS Lanarkshire, other community planning partners and national priorities. 16. The SCP 2023-2026 set out five key priorities: Increased focus on prevention, early intervention and tackling inequalities by working with people and communities Do the right thing first time Develop and support a workforce for the future Improve mental health and wellbeing, and Support people through a whole family approach. 17. Section 6 – ‘Enabling the Plan’ identifies the key plans required to implement the SCP as the: Medium Term Financial Plan Market Facilitation Plan Workforce Plan Housing Contribution Statement Transformation Plan Page 89 of 208
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Section 1 Executive Summary FTF Internal Audit Service NL IJB Strategy Page 5 Support, Care & Clinical Governance Framework. 18. Appendix 1 of the SCP sets out a table of engagement events and activities providing details of dates, forum and type of engagement. These were a mixture of online and in person events and included staff roadshows, stakeholder events in Northeast and Northwest Sectors. 19. The North IJB Engagement and Participation Strategy 2024-2027 is available on the North Lanarkshire HSCP website and was approved by the IJB Performance, Finance and Audit Committee on 22 May 2024. 20. Appendix 2 of the SCP sets out the full Strategic Needs Analysis, developed with support from the Public Health Scotland Local Intelligence Support Team. The Strategic Needs Analysis identifies population need to help ensure that services are designed and delivered in a way that meets the current and future needs of the population. Locality profiles for the six Health & Social Care Localities of North Lanarkshire provided population, life expectancy and poverty and deprivation data, as well as other key indicators. 21. The HSCP utilises a Human Learning System (Learning as Management Strategy approach), which is working with Health Improvement Scotland to make learning and experimentation the key force driving work. This approach drives continuous improvement as part of the SCP programme of works to drive improvement and transformation and allows learning to be implemented on an ongoing basis rather than waiting for expiry of a strategy or programme of works. This approach and work to date with Getting It Right For Everyone (GIRFE) continues to feed into the IJB’s future direction and inform strategic priorities. Governance and Performance Reporting 22. The SCP Programme of Work approved by the IJB on 23 September 2023 articulated the governance reporting route for each programme, as well as the programme duration and reporting frequency. 23. During the life of the Strategy, one overarching update paper was presented to the IJB on 4 December 2024. The paper described the programmes that are linked to the SCP five key priorities, with a table of reporting timescales for each programme from September 2023 to November 2025. 24. Internal Audit would suggest that progress updates on the entirety of the SCP should be reported with more frequency, to facilitate regular monitoring and early warning of any areas that are not on track, so that remedial action can be taken. We recommend reporting twice per annum as a minimum, with an update on each programme provided and any risks to completion highlighted, and exception reporting as necessary. 25. At the mid-point of the planning cycle, the 4 December 2024 Board meeting was provided with a report on progress to date, detailing the Red/Amber/Green status of each item within the Programme of Works. For the 21 programmes: 17 programmes were assessed as Green (Complete or on-track for completion against agreed timescales); and 4 programmes were assessed as Amber (Incomplete but within acceptable thresholds). 26. We would expect the Board to receive a final progress report on implementation of the extant SCP. Page 90 of 208
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Section 1 Executive Summary FTF Internal Audit Service NL IJB Strategy Page 6 27. A draft version of the Annual Performance Report was published on the North HSCP website on 31 July 2025 with approval expected at the IJB meeting on 17 September 2025, as agreed at the 18 June 2025 IJB. 28. The Annual Performance Report 2024/25 stated that at the mid-cycle review, four of the five work streams were rated Green, with Community Engagement & Co-design rated Amber, reflecting our ongoing efforts to deepen participation. 29. The Annual Performance Report 2024/25 described the priorities for the final year of the SCP as: Expanding carer support and community-based services to strengthen local networks of care. Developing a future-ready workforce by growing the Care Academy and deepening our academic partnerships. Improving mental health and wellbeing through continued investment in CAMHS, crisis care and community mental health services. Tackling inequalities with targeted investment, inclusive engagement, and innovative digital solutions. 30. Performance, Finance and Risk Reports are routinely presented to the Board and the Performance, Finance & Audit Committee. On 19 March 2025 the Board approved the Medium Term Financial Plan 2025-2028 and acknowledged the long term financial outlook for 2025-2035. The well-known issues of the challenging financial environment, the uncertainty of the scale of this and the need to ensure sufficient flexibility to manage in a sustainable manner over the coming years were clearly articulated, as was the greater risk that future uplifts in funding to the Partnership similar to that provided in previous years may not be deliverable. Next Iteration of the SCP 31. The North Lanarkshire HSCP SPG was established in 2015 and meets quarterly. Membership includes Health and Social Care professionals, providers of services, service users and their Carers, as well as third sector bodies and other partners. Commissioning Plan. Members responsibilities include taking an active role in the development of the SCP and ensuring it reflects the needs and expectations of their sector/communities. The SPG reports to the Senior Management Team but minutes are not reported to the Board. Management have informed us that reporting of key issues will be formalised through the Chief Officer’s report which provides an update on key areas of work and service developments. 32. The Annual Performance Report 2024/25 stated that ‘The Strategic Planning Group sets out the IJB’s approach to engage with stakeholders. Consultation on the future vision and activities of the IJB is undertaken with its Health Services and Local Authority partners. Work to develop the new Strategic Commissioning Plan for 2026/27 and beyond will take place during 2025/26’. 33. At the SPG meeting on 22 April 2025 the process for production of the next SCP was discussed, commencing with the agreement of the key group to implement the engagement programme. Other agreed key tasks were the drafting of a set of ambitions, priorities and the shape of the programme of work, and the development of the Strategic Needs Analysis. Page 91 of 208
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Section 1 Executive Summary FTF Internal Audit Service NL IJB Strategy Page 7 34. Part of the discussion focussed on aligning with the renewal of the Engagement & Participation Strategy, Carers Strategy, Community Boards and Local Outcome Improvement Plans, which are due to expire in 2027. This was to explore the potential reduction of continuously requesting engagement and feedback from the same stakeholders on cross-cutting topics. 35. Management has informed us that the aim is to ensure the SCP is balanced and brief but comprehensive, aligned to the Local Outcome Improvement Plans (LOIPs) with a sense of joined up engagement and clear responsibilities. 36. At its April and August 2025 meetings, the SPG focused on reviewing progress against the current SCP and taking stock of the current position, and considering emerging national priorities and principles expressed in the Scottish Government/COSLA Health and Social Care Renewal Framework 2025-35 and Scottish Government/COSLA Population Health Framework 2025-35. 37. The SPG met again on 26 November 2025 with the SCP priorities as the single item on the agenda. 38. The development of the new plan will consider the planned review arrangements for the LOIPs. The LOIPs are an articulation of the community planning priorities within each of the Community Board areas in North Lanarkshire and are due to expire in 2027. A full review of these plans is underway and the new SCP will take account of these developments. 39. A number of engagement events are planned over the coming months to facilitate discussion with targeted groups, Community Board members, elected members, Integration Joint Board members and members of staff. These meetings include but are not limited to: Staff roadshows; Community Board meetings; Locality Planning Group meetings. 40. These events will seek to review the achievements and challenges of the past three years and use a range of information and intelligence to guide conversations into the opportunities and challenges facing the partnership in the future. 41. Engagement will also focus on the development of a Joint Strategic Needs Assessment (JSNA), the purpose of which is to ensure that the IJB’s strategic plans are based on robust understanding of the current and predicted future needs of local populations. The JSNA will inform and guide the commissioning and delivery of health, wellbeing and social care services. The SPG has worked with colleagues from Public Health Scotland and across the Health and Social Care Partnership to produce a first draft JSNA. Look forward 42. The Chief Officer, Planning, Performance & Quality Assurance presented an update on the SCP 2026 and beyond to the Board on 17 September 2025, setting out sets out arrangements for the development of a new SCP and Programme of Work. The report confirmed arrangements for development of the new SCP, including: Initiation of the engagement and consultation process Consideration of national and local strategies, plans and policies to ensure the SCP is consistent and aligned with the priorities of North Lanarkshire Council, NHS Lanarkshire, other community planning partners, and national priorities. Consideration of the planned review arrangements for the LOIPs, due to expire in 2027. Page 92 of 208
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Section 1 Executive Summary FTF Internal Audit Service NL IJB Strategy Page 8 Key principles from the Health and Social Care Renewal Framework 2025-35 high level guide for change to ensure the sustainability, efficiency, quality, and accessibility of health and social services in Scotland. Development of a JSNA. 43. The development of the new SCP is underway and a draft commissioning plan will be brought to a future meeting of the Integration Joint Board, with final approval required by March 2026 and the new plan coming into effect from April 2026, upon expiry of the current SCP 2023-2026. 44. Robust assurance on progress with the new SCP should be provided to the IJB, including a project plan and timetable. 45. The process should clearly identify key responsibilities for individuals and group. There should be a strong focus on taking stock of transformative projects and articulating a clear link between strategy and ongoing service developments, to ensure future services are sustainable. 46. We suggest that the SCP should make overt linkage to realistic medicine, transformative programmes, efficiency savings and other initiatives, as well as an assessment of the risks to achievement and identification of mitigating controls. 47. There should be effective governance and oversight of this key area so that the Board can formally scrutinise the arrangements to develop the SCP and then regularly monitor implementation to gain assurance that progress is satisfactory and risks are being appropriately managed. The Board should be appropriately engaged in key decisions, and in setting the vision/ direction for the next iteration of the plan. 48. It is important that the Board agrees how it will be kept informed of progress and will be assured that SCP development is on track, and of key achievements, challenges and risks, and any significant implications for strategy and priorities. 49. Moving to the implementation stage, regular progress reporting to the Board will be required. The Board, having approved the plan, will need to continue to foster a culture which embraces change and innovation and supports officers making difficult choices. 50. Re-alignment of the SCP with other key North Lanarkshire HSCP documents expiring in 2027 is under consideration. Options to ensure alignment of key strategies, plans and frameworks should be articulated, including extending the current SCP for a further year. IJB Risks & Risk Register 51. Work is underway to review the reporting of IJB Risks, the Senior Management Team development session on 22 August 2025 focused on refreshing the approach to risk management, and a Risk Management Development Event for members took place in early September 2025. The North Lanarkshire Council fig tree system is now used to record risks to enable capture and review. 52. The North Lanarkshire Health and Social Care Partnership’s Business Support Manager is working with NHS Lanarkshire’s Chief Risk Officer to review the North Lanarkshire IJB Risk Management Strategy. 53. Risk Management Updates and the IJB risk register are presented to both the IJB and the Performance, Finance & Audit Committee. The Risk Management system continues to evolve. The update presented to the 22 October 2025 Performance, Finance & Audit Committee featured a review of the IJB’s highest rated risks and noted the operational risks highlighted by the North Lanarkshire HSCP that impact upon delivery of IJB business. Page 93 of 208
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Section 1 Executive Summary FTF Internal Audit Service NL IJB Strategy Page 9 54. In our opinion the format of the risk update reports is helpful in highlighting movement since the last report and presenting the current and target score for each risk. However, the risk profile is relatively static which may indicate that the effectiveness of each current control and required action should be revisited. 55. Appendix 1 focuses on the ‘Very High’ IJB risks and notes how many partner risks are recorded. It would be beneficial to include an appendix detailing the partner organisation risks, alongside the current and target scores, to provide a holistic view of risks across Lanarkshire. 56. The ‘Very High’ risks are: IJB 06/21 – Prescribing Activity and Costs IJB 01/21 – Financial Challenges IJB 21/24 – Pharmacy Pressures within Prison Services 57. Five low rated IJB risks are meeting their target rating and should be considered for removal or de-escalation from IJB risk register. In the May 2025 IJB risk register, risk IJB 17/22- ‘National Care Service’ was reviewed and reduced to Low with the mitigating actions noting that this risk in the North Lanarkshire Council risk register was closed in February 2025. Given that the National Care Service is no longer the direction of travel, this risk should either be removed from the risk register or reframed to ensure currency. 58. As a development the IJB should consider the application of risk tolerance and optimal risk appetite. ACTION 59. Internal Audit findings and Management Responses are at Section 2 of this report. A follow-up of implementation of the agreed actions will be undertaken in accordance with the audit follow up protocol. ACKNOWLEDGEMENT 60. We would like to thank all members of staff for the help and co-operation received during the course of the audit. Jocelyn Lyall BAcc CPFA Chief Internal Auditor Page 94 of 208
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Section 2 Issues and Actions FTF Internal Audit Service NL IJB Strategy Page 10 No. Audit Finding Assessment of Risk Management Response / Action Responsible Officer Action by date 1 Planning the next itera;on of the SCP The current SCP will expire in 2026 and the following elements require to be put in place as a priority: Stocktake and lessons learned from development and implementaJon of the extant SCP ConsideraJon of re-alignment of the SCP with other key North Lanarkshire HSCP documents expiring in 2027, including opJons to ensure alignment of key strategies, plans and frameworks, including extending the current SCP for a further year. OpJon appraisal for development of the SCP and alignment with the supporJng Strategies. To re-align the SCP with other key North Lanarkshire HSCP documents expiraJon in 2027 would require either the current SCP to be extended for a further year or to develop a one-year SCP, or other way of ensuring close alignment. Agreement of the process, project plan and Jmeline for development of the SCP. Agreement of the Board role in development of the SCP and monitoring progress with implementaJon on a regular basis. Agreement of overall governance arrangements for developing and monitoring implementaJon of the SCP. Significant The SCP will be presented to the IJB for approval reflecting the range of engagement and identification of key priorities. The role of the board in development is agreed and the role of the board in monitoring will be reported as part of the final approval of the SCP. Head of Planning, Performance & Quality Senior Manager, Strategy & Performance April 2026 Page 95 of 208
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Section 2 Issues and Actions FTF Internal Audit Service NL IJB Strategy Page 11 2 It is important that the governance arrangements for development and monitoring of the next SCP are clearly articulated and understood, including: Detailed scruJny arrangements for delivery and impact of the SCP with a focus on strategic prioriJes Project management governance Review of delivery of the acJons set out in the SCP The relaJonship with the risk register and risk appeJte Moderate Monitoring arrangements, performance management, and scrutiny arrangements will be defined, outlining programme and project management. Head of Planning, Performance & Quality Senior Manager, Strategy & Performance November 2026 3 The Programme of Works paper approved at the IJB Board on 27 September 2023 set out a table of reporting timescales for the various programme throughout the time period September 2023 to November 2025. At the mid-point of the planning cycle, the IJB Board at the 4 December 2024 meeting was provided with a report on progress to date, detailing the Red/Amber/Green status of each item within the Programme of Works. This frequency of reporting does not provide early warning of any programmes that are not on track so that remedial action can be taken and any risks to completion highlighted. A more frequent schedule of reporting would be beneficial e.g. bi-annual reporting and exception reporting as necessary. Significant Programme of reporting programme and projects across the partnership as well as overall SCP performance will be reported to the IJB on an agreed cycle to be agreed with the completion of the SCP. Head of Planning, Performance & Quality Senior Manager, Strategy & Performance November 2026 Page 96 of 208
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FTF Internal Audit Service NL IJB Strategy Page 12 Definition of Assurance To assist management in assessing the overall opinion of the area under review, we have assessed the system adequacy and control application, and categorised the opinion based on the following criteria: Level of Assurance System Adequacy Controls Substantial Assurance A sound system of governance, risk management and control exists, with internal controls operating effectively and being consistently applied to support the achievement of objectives in the area audited. Controls are applied continuously or with only minor lapses. Reasonable Assurance There is a generally sound system of governance, risk management and control in place. Some issues, non- compliance or scope for improvement were identified which may put at risk the achievement of objectives in the area audited. Controls are applied frequently but with evidence of non- compliance. Limited Assurance Significant gaps, weaknesses or non-compliance were identified. Improvement is required to the system of governance, risk management and control to effectively manage risks to the achievement of objectives in the area audited. Controls are applied but with some significant lapses. No Assurance Immediate action is required to address fundamental gaps, weaknesses or non- compliance identified. The system of governance, risk management and control is inadequate to effectively manage risks to the achievement of objectives in the area audited. Significant breakdown in the application of controls. Page 97 of 208
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FTF Internal Audit Service NL IJB Strategy Page 13 Assessment of Risk To assist management in assessing each audit finding and recommendation, we have assessed the risk of each of the weaknesses identified and categorised each finding according to the following criteria: Risk Assessment Definition Total Fundamental Non Compliance with key controls or evidence of material loss or error. Action is imperative to ensure that the objectives for the area under review are met. None Significant Weaknesses in design or implementation of key controls i.e. those which individually reduce the risk scores. Requires action to avoid exposure to significant risks to achieving the objectives for area under review. Two Moderate Weaknesses in design or implementation of controls which contribute to risk mitigation. Requires action to avoid exposure to moderate risks to achieving the objectives for area under review. One Merits attention There are generally areas of good practice. Action may be advised to enhance control or improve operational efficiency. None Page 98 of 208
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North Lanarkshire Integration Joint Board Annual Audit Plan 2025/26 - DRAFT Prepared for North Lanarkshire Integration Joint Board February 2026 Item 10 Page 99 of 208
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North Lanarkshire Integration Joint Board Annual Audit Plan | 2 Contents Introduction 3 Audit scope and responsibilities 4 Audit of the annual accounts 6 Wider scope and Best Value 9 Reporting arrangements, timetable and audit fee 11 Other matters 14 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility. Page 100 of 208
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Introduction | 3 Introduction Purpose of the Annual Audit Plan 1. The purpose of this Annual Audit Plan is to provide an overview of the planned scope and timing of the 2025/26 audit of North Lanarkshire Integration Joint Board’s (North Lanarkshire IJB’s) annual accounts. It outlines the audit work planned to meet the audit requirements set out in auditing standards and the Code of Audit Practice, including supplementary guidance. Appointed auditor and independence 2. John Boyd, of Audit Scotland, has been appointed by the Accounts Commission as external auditor of North Lanarkshire IJB for the period from 2022/23 until 2026/27. The 2025/26 financial year is therefore the fourth of the five-year audit appointment. 3. John Boyd and the audit team are independent of North Lanarkshire IJB in accordance with relevant ethical requirements, including the Financial Reporting Council’s Ethical Standard. This standard imposes stringent rules to ensure the independence and objectivity of auditors. Audit Scotland has robust arrangements in place to ensure compliance with ethical standards. The arrangements are overseen by the Executive Director of Innovation and Quality, who serves as Audit Scotland’s Ethics Partner. 4. The Ethical Standard requires auditors to communicate any relationships that may affect the independence and objectivity of the audit team. There are no such relationships pertaining to the audit of North Lanarkshire IJB to communicate. Page 101 of 208
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Audit scope and responsibilities | 4 Audit scope and responsibilities Scope of the audit 5. The audit is performed in accordance with the Code of Audit Practice, including supplementary guidance, International Standards on Auditing (UK), and relevant legislation. These set out the requirements for the scope of the audit which includes: • An audit of the financial statements and an opinion on whether they give a true and fair view and are free from material misstatement. • An opinion on statutory other information published with the financial statements in the annual accounts, namely the Management Commentary and the Annual Governance Statement. • An opinion on the audited part of the Remuneration Report. • Conclusions on North Lanarkshire IJB’s arrangements in relation to the wider scope areas: Financial Management, Financial Sustainability, Vision, Leadership, and Governance, and Use of Resources to Improve Outcomes. • Reporting on North Lanarkshire IJB’s arrangements for securing Best Value. • An Annual Audit Report setting out significant matters identified from the audit of the annual accounts and the wider scope areas specified in the Code of Audit Practice. Responsibilities 6. The Code of Audit Practice sets out the respective responsibilities of North Lanarkshire IJB and the auditor. A summary of the key responsibilities is outlined below. Auditor’s responsibilities 7. The responsibilities of auditors in the public sector are established in the Local Government (Scotland) Act 1973. These include providing an independent opinion on the financial statements and other information reported within the annual accounts, and concluding on the North Lanarkshire IJB’s arrangements in place for the wider scope areas. Page 102 of 208
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Audit scope and responsibilities | 5 North Lanarkshire IJB’s responsibilities 8. North Lanarkshire IJB has primary responsibility for ensuring proper financial stewardship of public funds, compliance with relevant legislation and establishing effective arrangements for governance, propriety and regularity that enables it to successfully deliver its objectives. The features of proper financial stewardship include: • Establishing arrangements to ensure the proper conduct of its affairs. • Preparation of annual accounts, comprising financial statements that give a true and fair view and other information. • Establishing arrangements for the prevention and detection of fraud, error and irregularities, and bribery and corruption. • Implementing arrangements to ensure its financial position is soundly based. • Making arrangements to secure Best Value. • Establishing an internal audit function. Page 103 of 208
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Audit of the annual accounts | 6 Audit of the annual accounts Introduction 9. The audit of the annual accounts is driven by materiality and the risks of material misstatement in the financial statements, with greater attention being given to the significant risks of material misstatement. This chapter outlines materiality, the significant risks of material misstatement that have been identified, and the impact these have on the planned audit procedures. Materiality 10. The concept of materiality is applied by auditors in planning and performing an audit, and in evaluating the effect of any uncorrected misstatements on the financial statements or other information reported in the annual accounts. 11. Broadly, the concept of materiality is to determine whether matters identified during the audit could reasonably be expected to influence the decisions of users of the financial statements. Auditors set a monetary threshold when determining materiality, although some issues may be considered material by their nature. Therefore, materiality is ultimately a matter of the auditor’s professional judgement. 12. The materiality levels determined for the audit of North Lanarkshire IJB are outlined in Exhibit 1. Exhibit 1 2025/26 Materiality levels for North Lanarkshire IJB Materiality North Lanarkshire IJB Materiality – based on an assessment of the needs of users of the financial statements and the nature of North Lanarkshire IJB operations, the benchmark used to determine materiality is gross expenditure based on the audited 2024/25 financial statements. Materiality has been set at 2% of the benchmark. £16.775 million Performance materiality – this acts as a trigger point. If the aggregate of misstatements identified during the audit exceeds performance materiality, this could indicate that further audit procedures are required. Using professional £12.581 million Page 104 of 208
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Audit of the annual accounts | 7 Materiality North Lanarkshire IJB judgement, performance materiality has been set at 75% of planning materiality. Reporting threshold – all misstatements greater than the reporting threshold will be reported. £0.839 million Source: Audit Scotland Significant risks of material misstatement to the financial statements 13. The risk assessment process draws on the audit team’s cumulative knowledge of North Lanarkshire IJB, including the nature of its operations and its significant transaction streams, the system of internal control, governance arrangements and processes, and developments that could impact on its financial reporting. 14. Based on the risk assessment process, significant risks of material misstatement to the financial statements have been identified and these are summarised in Exhibit 2, page 7. These are the risks which have the greatest impact on the planned audit approach, and the planned audit procedures in response to the risks are outlined in Exhibit 2. 15. The risk assessment process is an iterative and dynamic process. The assessment of risks set out in this Annual Audit Plan and Exhibit 2 may change as more information and evidence is obtained over the course of the audit. Where such changes occur, these will be reported to North Lanarkshire IJB and those charged with governance, where relevant. 16. North Lanarkshire IJB’s income comes directly from partner bodies, and their expenditure involves the commissioning of services also from partner bodies. Due to the nature of North Lanarkshire IJB’s income and expenditure, assurances over the accuracy and completeness of the IJB transactions will be obtained from the auditors of North Lanarkshire Council and NHS Lanarkshire. Exhibit 2 Significant risks of material misstatement to the financial statements Risk of material misstatement Planned audit response Fraud caused by management override of controls Management is in a unique position to perpetrate fraud because of management’s ability to override The audit team will: • Agree balances and transactions to North Lanarkshire Council and NHS Lanarkshire financial reports, ledgers and correspondence. Page 105 of 208
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Audit of the annual accounts | 8 Risk of material misstatement Planned audit response controls that otherwise appear to be operating effectively. • Assurances will be obtained from the auditors of North Lanarkshire Council and NHS Lanarkshire over the completeness, accuracy and allocation of income and expenditure. • Review of significant adjustments at year end where we consider there to be greatest risk of material misstatement through management override of controls. • Review of financial monitoring reports during the year. • Evaluate significant transactions outside the normal course of business. • Assess the adequacy of controls in place for identifying and disclosing related party relationships and transactions in the financial statements. Source: Audit Scotland Key audit matters 17. The Code of Audit Practice requires public sector auditors to communicate key audit matters. Key audit matters are those matters, that in the auditor’s professional judgement, are of most significance to the audit of the financial statements and require most attention when performing the audit. 18. In determining key audit matters, auditors consider: • Areas of higher or significant risk of material misstatement. • Areas where significant judgement is required, including accounting estimates that are subject to a high degree of estimation uncertainty. • Significant events or transactions that occurred during the year. 19. The matters determined to be key audit matters will be communicated in the Annual Audit Report. Exhibit 2 outlines the significant risks of material misstatement to the financial statements that have been identified, including those that have greatest impact on the planned audit procedures and require most attention when performing the audit. Page 106 of 208
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Wider scope and Best Value | 9 Wider scope and Best Value Introduction 20. Reflecting the fact that public money is involved, the Code of Audit Practice requires that public audit is planned and undertaken from a wider perspective than in the private sector. The wider scope audit set out by the Code of Audit Practice broadens the audit of the annual accounts to include consideration of additional aspects or risks in four wider scope areas, which are summarised below: • Financial Management – this means having sound budgetary processes. Factors that can impact on North Lanarkshire IJB being able to secure sound financial management include the strength of the financial management culture, accountability, and arrangements to prevent and detect fraud, error and other irregularities, bribery and corruption. • Financial Sustainability – this means looking forward over the medium and longer term in planning the services to be delivered and how they will be delivered effectively. This is assessed by considering North Lanarkshire IJB’s medium to longer-term planning for service delivery. • Vision, Leadership and Governance – this means having a clear vision and strategy, with set priorities within the vision and strategy. This is assessed by considering the clarity of plans in place to deliver the vision and strategy and the effectiveness of the governance arrangements to support delivery. • Use of Resources to Improve Outcomes – this means using resources to meet stated outcomes and improvement objectives through effective planning and working with partners and communities. This is assessed by considering North Lanarkshire IJB’s arrangements for ensuing resources are deployed to improve strategic outcomes, meet the needs of service users, and deliver continuous improvement. 21. A conclusion on the effectiveness and appropriateness of arrangements North Lanarkshire IJB has in place for each of the wider scope areas will be reported in the Annual Audit Report. Best Value 22. Under the Code of Audit Practice, the duty on auditors to consider the arrangements an audited body has in place to secure Best Value applies Page 107 of 208
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Wider scope and Best Value | 10 to audited bodies that fall within section 106 of the Local Government (Scotland) Act 1973, which North Lanarkshire IJB does. Consideration of the arrangements North Lanarkshire IJB has in place to secure Best Value will be carried out alongside the wider scope audit, and a conclusion on the arrangements North Lanarkshire IJB has in place will be reported in the Annual Audit Report. Significant wider scope and Best Value risks 23. The risk assessment process has identified significant risks in the wider scope areas and Best Value as outlined in Exhibit 3, and this includes the planned audit procedures in response to the risks. Exhibit 3 Significant wider scope and Best Value risks Description of risk Planned audit response Financial sustainability In recent years, North Lanarkshire IJB has been able to achieve financial balance. North Lanarkshire IJB faces significant financial challenges. The IJB has forecast a budget gap of £18.322 million for year ended 31 March 2027. North Lanarkshire IJB needs to ensure resources are allocated to areas of strategic priority and user need. North Lanarkshire IJB have established medium and longer-term financial plans. However, these should continue to be developed to ensure assumptions around funding and savings are incorporated. With the financial and operational challenges facing the IJB, it is important that the organisation work with partners to establish a financially sustainable operating model. The audit team will: • Establish the extent to which North Lanarkshire IJB’s financial plans have been developed to incorporate funding and savings assumptions in order to establish a financially sustainable operating model. • Review the plans in place to identify any budget gaps. • Review any other financial plans developed and assess the appropriateness of the financial plans and any assumptions made. • Review financial monitoring reports to assess the financial position, including progress of partner bodies in achieving planned savings. • Review controls in place and updates to financial plans to assess financial sustainability. Source: Audit Scotland Page 108 of 208
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Reporting arrangements, timetable and audit fee | 11 Reporting arrangements, timetable and audit fee Audit outputs 24. The outputs from the 2025/26 audit include: • This Annual Audit Plan. • An Independent Auditor’s Report to North Lanarkshire IJB and the Accounts Commission setting out opinions on the annual accounts • An Annual Audit Report to North Lanarkshire IJB and the Accounts Commission setting out significant matters identified from the audit of the annual accounts, conclusions from the wider scope and Best Value audit, recommendations, where required, and any good practice identified. 25. The matters to be reported in the outputs will be discussed with North Lanarkshire IJB for factual accuracy before they are issued. All outputs from the audit will be published on Audit Scotland’s website, apart from the Independent Auditor’s Report, which is included in the audited annual accounts. 26. Target dates for the audit outputs are set by the Accounts Commission. In setting the target dates for the audit outputs, consideration is given to the statutory date for approving the annual accounts, which is 30 September 2026 for local government bodies. 27. The Independent Auditor’s Report and Annual Audit Report are planned to be issued by the target date of 30 September 2026. Audit timetable 28. Achieving the timetable for production of the annual accounts, supported by complete and accurate working papers, is critical to delivery of the audit to agreed target dates. Exhibit 4 includes a timetable for the audit, which has been agreed with management. Agreed target dates will be kept under review as the audit progresses, and any changes required, and their potential impact, will be discussed with North Lanarkshire IJB and reported to those charged with governance, where required. Page 109 of 208
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Reporting arrangements, timetable and audit fee | 12 Exhibit 4 2025/26 audit timetable Audit activity North Lanarkshire IJB target date Audit team target date Relevant committee date Issue of Annual Audit Plan N/A 4 February 2026 18 February 2026 Annual accounts: • Consideration of unaudited annual accounts by those charged with governance 30 June 2026 N/A 17 June 2026 • Submission of unaudited annual accounts and all working papers to audit team 30 June 2026 N/A N/A • Latest date for audit clearance meeting 31 August 2026 31 August 2026 N/A • Issue of draft Letter of Representation, proposed Independent Auditor’s Report, and proposed Annual Audit Report N/A 4 September 2026 16 September 2026 • Agreement of audited and unsigned annual accounts N/A 11 September 2026 16 September 2026 • Approval by those charged with governance and signing of audited annual accounts 16 September 2026 N/A 16 September 2026 • Signing of Independent Auditor’s Report and issue of Annual Audit Report N/A 30 September 2026 N/A Source: Audit Scotland Audit fee 29. North Lanarkshire IJB’s audit fee is determined in line with Audit Scotland’s fee setting arrangements. The agreed audit fee for the 2025/26 audit is set out in Exhibit 5. 30. In setting the audit fee, it is assumed that North Lanarkshire IJB has effective governance arrangements in place and the complete annual accounts will be provided for audit in line with the agreed timetable. The audit fee assumes there will be no significant changes to the planned scope of the audit. Where the audit cannot proceed as planned, for Page 110 of 208
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Reporting arrangements, timetable and audit fee | 13 example, due to incomplete or inadequate working papers, the audit fee may need to be increased. Exhibit 5 Audit fee Fee component1 Fee (£) External auditor remuneration, limited to sectoral cap increase 26,960 Pooled costs, such as travel and subsistence costs 1,330 Contribution to the performance audit programme 7,190 Total 2025/26 fee 35,480 Source: Audit Scotland 1 Information on the components that make up the total fee can be found in Audit Scotland’s Audit management and quality guidance. Page 111 of 208
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Other matters | 14 Other matters Internal audit 31. North Lanarkshire IJB’s internal audit function is provided jointly by the internal audit teams of NHS Lanarkshire and North Lanarkshire Council. 32. While we are not planning to place formal reliance on the work of internal audit in 2025/26, we may consider aspects of internal audit’s work in respect of our wider audit dimension responsibilities. Audit quality 33. Audit Scotland is committed to the consistent delivery of high-quality audit. Audit quality requires ongoing attention and improvement to keep pace with external and internal changes. Details of the arrangements in place for the delivery of high-quality audits is available from the Audit Scotland website. 34. The International Standards on Quality Management (ISQM) applicable to Audit Scotland for 2025/26 audits are: • ISQM (UK) 1, which deals with an audit organisation’s responsibilities to design, implement, and operate a system of quality management (SoQM) for audits. Audit Scotland’s SoQM consists of a variety of components, such as governance arrangements and culture to support audit quality, compliance with ethical requirements, ensuring Audit Scotland is dedicated to high- quality audit through engagement performance and resourcing arrangements, and ensuring there are robust quality monitoring arrangements in place. Audit Scotland carries out an annual evaluation of its SoQM and has concluded it complies with this standard. • ISQM (UK) 2, which sets out arrangements for conducting engagement quality reviews, which are performed by senior management not involved in an audit, to review significant judgements and conclusions reached by the audit team, and the appropriateness of proposed audit opinions on high-risk audits. 35. To monitor quality at an individual audit level, Audit Scotland carries out internal quality reviews on a sample of audits. Additionally, the Institute of Chartered Accountants of England and Wales (ICAEW) carries out independent quality reviews on a sample of audits. Page 112 of 208
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Other matters | 15 36. Actions to address deficiencies identified by internal and external quality reviews are included in a rolling Quality Improvement Action Plan, which is used to support continuous improvement. Progress with implementing planned actions is monitors on a regular basis by Audit Scotland’s Quality and Ethics Committee. 37. Audit Scotland may periodically seek the views of North Lanarkshire IJB on the quality of audit services provided. The audit team would also welcome feedback at any time. Page 113 of 208
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North Lanarkshire IJB Annual Audit Plan 2025/26 - DRAFT - DRAFT Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 www.audit.scot AS.5.0 Page 114 of 208
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REPORT Item No: 11 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee: For approval For endorsement For noting 1.2 This report provides an outline of the actions agreed with the External Auditor, Internal Auditor, and the Senior Management Team to further develop the IJB governance framework. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the PFA Committee: (1) Acknowledge the contents of the report; and (2) Agree that further progress reports will be presented to future meetings of the PFA Committee in respect of the ongoing actions. 4. VARIATIONS TO DIRECTIONS 5. ANNUAL GOVERNANCE STATEMENT ACTION PLAN 5.1 As part of the statutory annual accounts, an Annual Governance Statement is included which reports on the effectiveness of the IJB’s governance arrangements and system of internal control and explains how the IJB complies with the Code of Corporate Governance and meets the requirements of ‘Delivering Good Governance in Local Government’ framework developed by CIPFA and SOLACE in 2016. 5.2 To ensure continual improvement of the IJB’s governance arrangements, an action plan is included within the Annual Governance Statement which was approved at the IJB in June 2025. Included within this are improvement areas identified by Audit Scotland within their Annual Audit report, Internal Audit as part of their annual audit SUBJECT: Annual Governance Statement – Action Plan Progress TO: Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Financial Officer DATE: 18 February 2026 Yes No N/A Item 11 Page 115 of 208
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work as well as improvements highlighted as part of the IJB self-assessment process. 5.3 Following conclusion of the 2024/25 External Audit, the Annual Audit Report identified 1 recommendation with regards to financial sustainability therefore this has been added to the action plan. 6 ACTION PLAN PROGRESS 6.1 Appendix 1 details the actions as well as progress against these actions. For audit purposes, all actions will remain on the plan for a full financial year however those completed during the year will be removed for the first report after April 1st each year. Table 1 provides a summary of the status of the actions. Table 1 Year the action was identified Total Actions Completed Actions Ongoing Actions 2022/23 2 1 1 2023/24 5 4 1 2024/25 3 1 2 2025/26 1 1 0 TOTAL 11 7 4 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The implementation of agreed actions will contribute to the ongoing development of the internal control framework and will also inform the Annual Governance Statement for 2025/26. Page 116 of 208
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7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Ineffective Governance Arrangements Low Claire Rae 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes This report includes all engagement and participation objectives as effective governance arrangements ensure the IJB can fulfil its statutory duties. Good governance enables the IJB to pursue its vision effectively as well as underpinning that vision with mechanisms for control and management of risk. ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A Page 117 of 208
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8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Annual Governance Statement – Action Plan Progress Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07581 007187. Page 118 of 208
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Appendix 1 Annual Government Statement - Action Plan Progress Reference Improvement Area Agreed Action Responsible Person Projected Completion Date Current Status Ongoing / Complete 2022/23: 1 Service Level Agreement (SLA) To agree an SLA with Children, Families and Justice for future hosting arrangements following the budget disaggregation exercise. Work is currently underway to agree, approve and implement the new SLA in partnership with Children, Families and Justice Services. Chief Officer Claire Rae September 2025 Work on this is progressing. The budget data has been gathered to inform the arrangements, key points for consideration are being collated, and the final task will be for all relevant chief officers to meet and finalise this SLA. The current timeline for completion is no later than 31st March 2026. Ongoing 2022/23: 2 National Care Service To develop a sound understanding of the impact for the Partnership of the National Care Service legislation. Paper presented to the IJB in January 24 giving an update on timescales for implementation. Further updates will be presented to the board as details are released. Chief Officer Claire Rae September 2025 This action is no longer relevant given the changes from the proposed NCS to the Care Reform Bill. The Senior Management Team will keep abreast of ongoing developments and report to the IJB as necessary. Complete. 2023/24: 1 2023/24 Self- Assessment Agreed actions 1. Development of a revised framework for North Lanarkshire which will ensure engagement and participation in the development of the Strategic Commissioning Plan across the entire health and social care system. Chief Officer Claire Rae December 2025 The development of a new Strategic Commissioning Plan is underway with a view to the new plan coming into effect from April 2026, upon expiry of the current Strategic Commissioning Plan 2023-2026. An engagement and consultation process has been initiated to ensure a wide range of staff, people who use services, carers and partner organisations have an opportunity to participate in shaping the next commissioning plan. This was reported to the IJB on 17th September 2025 Strategic Commissioning Plan 2026 and Beyond Complete 2. Undertake an exercise to review performance output and associated data from other Health Boards and Local Authorities. Chief Officer Claire Rae December 2025 Benchmarking is undertaken within our family group of local authorities against all national performance indicators and reported within the Annual performance report. Annual Performance Report 2024/25 - DRAFT Complete 3. Recognition that there is a formalised risk sharing agreement in place with NHSL, NLC and SL IJB within the risk management strategy but no reference to similar in relation to performance and finance. Chief Officer Claire Rae December 2025 This remains under review to consider whether a formalised agreement is required and what this would consist of. A decision will be taken by the end of this financial year. Ongoing 2023/24: 2 Presentation of financial and non- financial information in the annual accounts In the production of future accounts, the IJB should review the presentation of both financial and non-financial information to ensure this reflects the organisation’s role as a strategic commissioning body. Chief Finance Officer Nicola Scott September 2025 A review of other IJB’s accounts was undertaken to ascertain the style and content of their Annual Reports. Using this, the format of the 2024/25 Annual Report was updated which has been accepted by Audit Scotland. Complete 2023/24: 3 Presentation of financial and non- financial information in the financial performance reports The financial reports will be further defined to give an overview in the delivery of services against the overall funding aligned to the Strategic Commissioning Plan and Medium- Term Financial Plan/Long Term Financial Plan including earmarked reserves. Chief Finance Officer Nicola Scott September 2025 An updated report, taking into account Audit Scotland’s recommendations, has been prepared for the first quarter. This was presented to PFA in August 2025 and has been accepted by Audit Scotland as part of their 2024/25 External Audit. Complete Page 119 of 208
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Appendix 1 Reference Improvement Area Agreed Action Responsible Person Projected Completion Date Current Status Ongoing / Complete 2024/25: 1 2024/25 Self- Assessment Agreed actions 1. Holding to Account - effective scrutiny, challenge and support of services by the Management Team and IJB members when reviewing presented papers. Chief Officer Claire Rae December 2025 Work on this will be undertaken as part of updating the standing orders in Q1 2026. Ongoing 2. Vision for IJB should be clear and ambitious with membership being diverse and engaged. Management team to review induction process and liaison sessions. Chief Officer Claire Rae December 2025 Work on this is underway and will be finalised along with the renewal of the Strategic Commissioning Plan in April 2026. Ongoing 3. Review what goes to IJB and PFA and ensure there are appropriate development sessions to support the financial picture. Chief Officer Claire Rae December 2025 A workplan has been prepared for 12months for both PFA and IJB and presented to both for approval. This is a live document that can be added to as necessary. There has also been a series of IJB Development Sessions scheduled for the remainder of 2025 and Q1 2026 with specific topics allocated including Finance and Risk. Complete 2025/26 Financial Sustainability The IJB should continue to: Develop and refine the arrangements it has in place for securing financial sustainability, including its medium and long term financial plans and savings plans. Work effectively in partnership with the local council and the health board on service transformation. Apply its reserves strategy to effectively manage the use of reserves to supplement savings and efficiencies when required. Chief Finance Officer Nicola Scott Ongoing It was agreed with the Audit Director that this action will remain ongoing as there is no end date to this. The management response provided and included in the Final Audit Report was as follows: A financial outlook for the 3 year period has been prepared and is being presented to Board Members on 17th September 2025. This outlines the forecast budget gaps for the next 3 years and will lead into Board Development sessions where savings will be discussed for approval at a later Board. The outlook clearly identifies the current reserves position and the impact non achievement on savings will have on reserves. Discussions have taken place with both NLC & NHSL on the forecast position and an Elected Members briefing session within NLC was undertaken in June this year with another scheduled in the Autumn to ensure all relevant parties are aware of the forecast. The medium term and long term outlooks will continue to be reviewed throughout the year with budget setting for 2026/27 set for March 2026. Complete There will be ongoing review as part of the annual financial planning arrangements. Key Complete Ongoing – within projected completion timescale Ongoing – has exceeded projected completion date Page 120 of 208
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1 REPORT Item No: 12 SUBJECT: North Lanarkshire Integration Joint Board Governance Log TO: North Lanarkshire Integration Joint Board, Performance Finance and Audit Committee Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Kerry Taylor, Business Support Manager DATE: 18 February 2026 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: For Approval: ☐ For Endorsement: ☒ To Note: ☐ This report provides the Performance, Finance and Audit Committee an overview of the governance issues identified. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE Prepared By: Kerry Taylor, Business Support Manager ☒ Reviewed By: Claire Rae, Chief Officer Nicola Scott, Chief Finance Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS Item 12 Page 121 of 208
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2 3.1 It is recommended that the IJB PFA: 1. Note the contents of this report; and 2. Agree that further progress reports will be presented to future meetings of the PFA Committee in respect of the ongoing actions. 4. VARIATIONS TO DIRECTIONS This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND 5.1 The Board is committed to meeting good standards of corporate governance. Compliance is the responsibility of all Board members. Providing evidence and assurance to Board members is the responsibility of officers. This report, in conjunction with other reports on the same agenda, are designed to give members that assurance and allow members to scrutinise the basis of it. 5.2 This report follows on from the Annual Governance Report at agenda item 10. Annual governance statements have identified areas of concern and actions that should be taken. Those have been reported at each year end and, latterly, through half-yearly updates on progress to the committee. 5.3 Appendix 1 details a list of governance issues identified for North Lanarkshire Integration Joint Board. The first four actions are detailed in the Annual Governance Statement, with the remaining actions identified through review of IJB documents and processes and following a Governance Update report to the Integration Joint Board in June 2025. 5.4 It is proposed that a bi-annual update on progress against actions will be reported to the Performance Finance and Audit Committee. 6. IMPLICATIONS 6.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ Yes ☐ No ☐ N/A ☒ Page 122 of 208
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3 People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 6.2 ASSOCIATED MEASURE(S) 6.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 6.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Ineffective Governance Arrangements Low Claire Rae 6.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes This report includes all engagement and participation objectives as effective governance arrangements Page 123 of 208
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4 ☒ Provide stakeholders with information on how to get involved ensure the IJB can fulfil its statutory duties. Good governance enables the IJB to pursue its vision effectively as well as underpinning that vision with mechanisms for control and management of risk. ☒ 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 6.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A Page 124 of 208
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5 7. BACKGROUND PAPERS N/A 8. APPENDICES Appendix 1 – NL IJB PFA Governance Log Claire Rae CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Kerry Taylor, Business Support Manager Kerry.Taylor@lanarkshire.scot.nhs.uk Page 125 of 208
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT – GOVERNANCE LOG Item Area & Action(s) Status Update - February 2026 PFA-Gov-01 Service Level Agreement (SLA) To agree an SLA with Children, Families and Justice for future hosting arrangements following the budget disaggregation exercise. Work is currently underway to agree, approve and implement the new SLA in partnership with Children, Families and Justice Services. Ongoing Added to IJB PFA Governance Log – item from Annual Governance Statement Log PFA-Gov-02 2023/24 Self-Assessment Agreed Actions Recognition that there is a formalised risk sharing agreement in place with NHSL, NLC and SL IJB within the risk management strategy but no reference to similar in relation to performance and finance. Ongoing Added to IJB PFA Governance Log – item from Annual Governance Statement Log PFA-Gov-03 2024/25 Self-Assessment Agreed Actions Holding to Account - effective scrutiny, challenge and support of services by the Management Team and IJB members when reviewing presented papers Vision for IJB should be clear and ambitious with membership being diverse and engaged. Management team to review induction process and liaison sessions. Ongoing Added to IJB PFA Governance Log – item from Annual Governance Statement Log PFA-Gov-04 Integration Joint Boards Finance and Performance Report 2024 Ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability Ongoing Added to IJB PFA Governance Log – moved from IJB PFA & IJB action logs (originally added September 2024) Page 126 of 208
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT – GOVERNANCE LOG Item Area & Action(s) Status Update - February 2026 Work collaboratively with other IJBs and partners to systematically share learning to identify and develop: o Service redesign focused on early intervention and prevention. o Approaches focused on improving the recruitment and retention of the workforce. Work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully understand and improve outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand the impact of preventative approaches Evaluate whether the local commissioning of care and support services, and the contracting of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people PFA-Gov-05 IJB Standing Orders Review The Board is required by legislation to make Standing Orders. Some of the content of those Standing Orders is set by legislation, such as the quorum requirement and the Chair not having a casting vote. In other aspects, the Board has flexibility to set its own procedural rules, subject to good governance standard North Lanarkshire IJB’s Standing Orders are due for review New Added to IJB PFA Governance Log – The board agreed for a review to be undertaken of the Standing Orders in June 2025. Work is ongoing to present the review of the Standing Orders to a future meeting of the IJB, alongside the action PFA-Gov-06 PFA-Gov-06 Board Member Role Descriptions & Induction In 2015, Board Member Role Descriptions were approved, with the document setting out the responsibilities that members of the North Lanarkshire Joint Integration Board have. It advises that it should be New Added to IJB PFA Governance Log – The board agreed for a review to be undertaken of the role descriptions, alongside a new induction process for Board members in June 2025. Page 127 of 208
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT – GOVERNANCE LOG Item Area & Action(s) Status Update - February 2026 read in conjunction with the Standing Orders which set out the process and procedures that Board members must adhere to as they conduct the business of the Board North Lanarkshire IJB’s role descriptions and induction processes are due to review Work is ongoing to present the review to a future meeting of the IJB, alongside the action PFA-Gov-05. PFA-Gov-07 Scheme of Delegations There is no statutory requirement for there to be a Scheme of Delegations. It is considered good practice to show the powers delegated and to define the areas of accountability of its officers. It is a key document in governance and decision-making terms. As the Integration Scheme is now in place, a Scheme of Delegations will be developed New Added to IJB PFA Governance Log – The board agreed for a Scheme of Delegations to be developed in June 2025. PFA-Gov-08 Review of North Lanarkshire Integration Joint Board Performance, Finance and Audit Committee Discussion at IJB Development session to undertake review of the IJB PFA Committee including membership and remit New Added to IJB PFA Governance Log – Review ongoing, with new work plan in place PFA-Gov-09 UN Convention on Rights of the Child Implement appropriate procedures for compliance with statutory duties arising from the incorporation the UN Convention on the Rights of the Child into Scots law New Added to IJB PFA Governance Log – Colleagues from both NLC and NHSL attended a Board development session to give an overview of UNCRC in June 2025. A working group is attended by the Business Support Manager to work Page 128 of 208
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT – GOVERNANCE LOG Item Area & Action(s) Status Update - February 2026 with colleagues to ensure compliance with statutory duties. A report will be presented to a future Board meeting. Page 129 of 208
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1 REPORT Item No: SUBJECT: Audit Scotland’s report into Community Health and Social Care: Performance 2025 TO: Integration Joint Board – Performance Finance & Audit Lead Officer for Report: Morag Dendy, Chief Officer (Performance, Planning & Quality Assurance) Author(s) of Report Morag Dendy DATE: 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☒ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Item 13 Page 131 of 208
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2 3. RECOMMENDATIONS It is recommended that the Committee: I. Endorse the approach to continue to use the Audit Scotland interactive data tool to compare performance with other areas to understand and explain relative performance in terms of local context, priorities, policy and operational decisions; and to analyse performance alongside local data to support benchmarking, self-assessment and the development of improvement plans; II. Otherwise, note the contents of the report 4. VARIATIONS TO DIRECTIONS? 4.1 This paper will be presented to North Lanarkshire Council’s Adult Health and Social Work Committee on 24th February 2026. 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 In January 2026, Audit Scotland published its report Community Health and Social Care: Performance 2025, which provides a detailed assessment of how Integration Authorities (IAs) and Health & Social Care Partnerships are performing across Scotland. 5.2 The report identifies significant issues with data, demand pressures, and slow progress on long-standing reform goals, making it difficult to fully assess—and improve—system performance. 5.3 The central message within Audit Scotland’s report Community Health and Social Care: Performance 2025 is that Scotland lacks comprehensive and consistent national performance information regarding health and social care, and particularly around: • Service demand • Workload • Quality of care • Outcomes 5.4 This information gap hampers performance assessment, benchmarking, transparency, and effective decision-making. Yes ☒ No ☐ N/A ☐ Page 132 of 208
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3 5.5 The report identifies a long-term decline in performance and public satisfaction, driven by: • Rising demand across the system • Difficulty shifting care from hospitals to community and preventive services • Persistent variability in service users’ choice and control • A continuing gap between ambitions to reduce health inequalities and actual progress 5.6 The report notes that Integration Authorities and Health & Social Care Partnerships continue to face difficulties in: • Progressing service redesign • Implementing integration consistently • Accessing reliable performance information to support improvement 5.7 The report stresses that integration is not delivering its full potential, due in large part to the data gaps and inconsistent reporting frameworks 5.8 Alongside the report, Audit Scotland has released a performance tool that allows users to explore national and local performance and compare the performance of individual HSCPs in an accessible way, setting out national and local trends. The report summarises the main observations from an analysis of data in Audit Scotland’s performance tool and provides findings based on three key themes: • Theme 1: Prevention and early intervention and shifting the balance of care • Theme 2: Person centred and accessible care • Theme 3: Reducing inequalities 5.9 Theme 1: Prevention and early intervention and shifting the balance of care The report suggests that progress in shifting the balance of care from actual hospitals and reactive services to community-based preventative and early intervention has been slow. Using a range of proxy indicators from the Audit Scotland performance tool, the report suggests that more progress is needed. 5.10 Falls rate – the rate of falls for individuals over 65 has remained consistent at a national level for a number of years. The North Lanarkshire falls rate continues to remain below the national average, despite small increases in recent years. 5.11 Delayed discharge – at a national level, when comparing the 20245/25 position to the 2018/19 pre-pandemic levels, there has been an overall 20.1% increase in the number of days people aged 75+ spent in hospital when they are ready to be discharged (per 1,000 population). In North Lanarkshire, when comparing the same period, there has been a 17.2% reduction in the number of days people aged 75+ spent in hospital when they are ready to be discharged (per 1,000 population). Page 133 of 208
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4 5.12 Emergency admissions – at a national level, the rate of emergency admissions is slightly below pre-pandemic levels but there were recent increases across the majority of local authority areas. The emergency admission rate in North Lanarkshire remains higher than the national average, however, was 7.7% lower in 23/24 than it was in 18/19. 5.13 Intensive care needs – the report notes that progress to increase the percentage of adults with intensive care needs receiving care at home is limited. Since 2018, the national level has increased 2.5 percentage points to 64.7 per cent in 2024. In North Lanarkshire, 65.6% of individuals with intensive care needs were receiving care at home in 2024. However, this metric does not recognise the number of people who have their needs met by directing their own support through an individual budget. 5.14 Theme 2: Person centred and accessible care In relation to the number of people directing their own support, the report refers to variation in practice and numbers across different council areas. However, in North Lanarkshire the number of people directing their own support through the use of individual budgets continues to increase year-on- year. We are currently unable to meaningfully benchmark with other local authorities due to the lack of published data. 5.15 The Audit Scotland report also refers to a range of experiential indicators related to people’s experience of health and care services and supports. Sourced from the Health and Care Experience Survey, the reports notes a consistent reduction in satisfaction levels across several indicators for Scotland. The North Lanarkshire position on all of these indicators is consistent with these national trends. 5.16 Theme 3: Reducing inequalities The report notes a gap between the ambitions to address health inequalities and progress with improvement, both nationally and across Health & Social Care Partnerships. The inequality gap across a range of indicators is challenging from a North Lanarkshire perspective, particularly when comparing performance across our most and least deprived areas. 5.17 The report recommends that Public Health Scotland lead a programme to assess and review the current measures for monitoring performance and agree a comprehensive suite of indicators. 5.18 Audit Scotland expects Health & Social Care Partnerships to use the tool to compare their performance with other areas and assure themselves that they understand and can explain their performance in terms of local context and priorities. I.e. how performance is helping deliver local outcomes, as set out in their Strategic Commissioning Plans. This work has already commenced. 7.1 NATIONAL OUTCOMES Page 134 of 208
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5 Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Yes ☐ No ☐ N/A ☒ Page 135 of 208
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6 Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: Yes ☐ No ☐ N/A ☒ Page 136 of 208
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7 8. BACKGROUND PAPERS 9. APPENDICES 9.1 Appendix 1 - Community Health and Social Care: Performance 2025 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Morag Dendy, DendyM@northlan.gov.uk Yes / Date added ☐ No ☐ N/A ☐ Page 137 of 208
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8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed Page 138 of 208
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Community health and social care Performance 2025 Prepared by Audit Scotland January 2026 APPENDIX 1 Page 140 of 208
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2Community health and social care: Performance 2025 Contents Key messages 3 Recommendations 4 Introduction 5 Community health and 7 social care performance Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility. Page 141 of 208
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3Key messages Key messages Key messages Key messages 1 Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) need to ensure that they have good quality information to fully understand their performance, support effective decision-making, benchmark against others and provide transparent public performance reporting. However, there is a lack of comprehensive and consistent national performance information about community health and social care demand, workload, quality of care and outcomes. 2 The limitations of the performance information make it difficult to fully assess the performance and progress of IAs and HSCPs towards improving the quality of life for people using health and social care services. To support IAs and HSCPs to use the data and indirect measures that are currently available, we have developed an interactive data tool to allow comparisons to be made. 3 From this data, we have found a general long-term picture of declining performance and satisfaction: • IAs and HSCPs are struggling to keep up with increasing demand across the health and social care system • more progress is needed with shifting the balance of care to the community and to prevention • the amount of choice and control service users feel they have remains variable • there is a gap between the ambitions to address health inequalities and progress with improvement.Page 142 of 208
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4RecommendationsRecommendations Recommendations Integration Authorities (IAs) and Health and Social Care Partnership (HSCP) leaders need the support of councils, health boards, the Scottish Government and other partners to make more progress with integration, service redesign, and ensuring they have the information needed to plan and make effective decisions. Public Health Scotland should: • Over the next year, through consultation with IAs, HSCPs and other stakeholders, such as the Care Inspectorate, Health Improvement Scotland and the Improvement Service, agree and roll out a programme to: – assess the current measures for monitoring performance across community health and social care and agree a comprehensive suite of indicators that draws on and modifies existing measures as appropriate and addresses current gaps in information. The suite should support performance monitoring and decision- making at a national and local level – centrally manage the collection, cleansing and management of the data – organise the performance information into a publicly accessible dashboard that is maintained on an ongoing basis to support national or local evaluation of performance information. • The suite of indicators should be annually reviewed to ensure the measures and the definitions of each remain relevant to supporting planning, monitoring and evaluation of delivery (paragraphs 12–17). IAs and HSCPs should: • Over the next six months, use the interactive data tool to compare performance with other areas to: – understand and explain in public reports their relative performance in terms of local context, priorities, policy and operational decisions – analyse performance alongside local data to support benchmarking, self- assessment and the development of improvement plans (paragraph 6).Page 143 of 208
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5Introduction Introduction About health and social care integration 1. The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) requires councils and territorial NHS boards to work together in partnerships, known as Integration Authorities (IAs). As part of the Act, new bodies were created – Integration Joint Boards (IJBs). An IJB is a separate legal entity, responsible for the strategic planning and commissioning of a wide range of health and social care services across a partnership area. 2. Of the 31 IAs in Scotland, 30 are IJBs. Stirling and Clackmannanshire councils have formed a single partnership with NHS Forth Valley. Highland currently follows a lead agency model where a Joint Monitoring Committee takes a similar strategic oversight role of adult community health and social care. Each IA is supported by an operational delivery partnership – the Health and Social Care Partnership (HSCP) that manages the delivery of the services. The HSCP staff remain employees of the NHS or the council, depending on their role. More detail about integration can be found in our short guide – What is integration? 3. In December 2024, members of the Highland Council and NHS Highland Joint Monitoring Committee agreed to move from the lead agency model of integration to the IJB model. Both organisations agreed that moving away from the lead agency model would increase the pace of change towards an improved partnership culture and a more responsive system of care. The planning for transition is under way and a timeline for the full implementation is being developed. 4. The range of services each IA and HSCP are responsible for varies. In this briefing, for simplicity, we refer to ‘community health and social care’ to refer to the broad range of core services IAs and HSCPs cover, including primary care services and adult social care services, as well as unplanned health care, eg emergency admissions to hospitals. What is integration? A short guide to the integration of health and social care services in Scotland April 2018 Page 144 of 208
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Introduction 6 About the bulletin The data tool 5. In March 2025, we published a data tool that sets out financial data in an interactive way so that members of the public and in particular IJB members and other stakeholders could view the data and compare financial performance across the 30 IJBs in one location. We have now added a range of publicly available national performance data, including the national core suite of integration indicators to this data tool. This allows users to also explore national and local performance, as well as compare the performance of individual IAs and HSCPs in an easily accessible way. The tool sets out national and local trends, charts that show performance by authority, and provides some contextual information. 6. We expect IAs and HSCPs to use the tool to compare their performance with other areas and assure themselves that they understand and can explain their performance in terms of local context and priorities. We anticipate other stakeholders, such as the Care Inspectorate, Healthcare Improvement Scotland and third-sector organisations might also find this tool useful. 7. The range of publicly available national data is limited and does not provide a full picture of the performance of services or the outcomes for people. IAs and HSCPs should use the tool alongside other local data available to them, to support benchmarking, self-assessment, and the development of improvement plans. 8. Guidance on how to use the online tool is available on the Audit Scotland website. Within this briefing there are links to the relevant data in the tool, enabling access to a breakdown of the referenced indicator. This briefing 9. This briefing accompanies our interactive online data tool. It summarises the main findings from our analysis set out in the tool, sets out how we expect the data tool to be used by IAs and HSCPs, as well as the limitations of the available data. It challenges members of IAs and the leadership of the HSCPs to consider how they can better use data to support planning, decision-making, improvement and public reporting of performance. It also prompts the wider sector, including the Scottish Government, COSLA and NHS boards and councils, to consider their key role in supporting progress with addressing the challenges in community health and social care, including the collation of national data through Public Health Scotland. Integration Joint Boards Finance bulletin 2023/24 March Page 145 of 208
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7 Community health and social care performance IAs and HSCPs are struggling to keep up with increasing demand across the health and social care system. Long- term performance trends show an overall decline although there are some signs of improvement. Community health and social care services continue to face significant challenges 10. The community health and social care sector plays a vital role in our health and wellbeing, keeping people at home and cared for out of hospital. Over the years we have highlighted in our national and local audit work the increasing pressures facing the sector including significant financial constraints, rising public and political expectations, workforce challenges including difficulties with recruitment and retention, widening health inequalities and the increasing demand of an ageing population. Some of the many reports where we have set out the range of pressures and challenges for the health and social care sector include: IJB Finance and performance 2024 and IJBs’ Finance bulletin 2023/24 NHS in Scotland 2024 and NHS in Scotland 2025 Adult mental health, 2023 General practice: Progress since the 2018 General Medical Services contract, 2025 Improving care experience – Delivering The Promise, 2025 Delayed discharges, 2026 Demand pressures continue to rise 11. Unlike secondary care, where waiting lists and times are regularly monitored nationally, it is not easy to define or measure demand for community health and social care. However, there are proxy measures that clearly indicate that pressure on services has increased. These include an ageing population, growing numbers of people with one or more health conditions, an increased impact of long-term conditions on the population, and widening health inequalities (Exhibit 1, page 8). A proxy measure is a strongly-related indicator used to help quantify a point that is otherwise difficult to measure directly or that there are no direct measures for. Community health and social care performance Page 146 of 208
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Community health and social care performance 8 Exhibit 1. Indicators of increased pressure on community health and social care Proxy measures clearly indicate that demand pressure on community health and social care has increased and may continue to increase. Notes: Long-term illness, disease or condition includes a range of conditions such as arthritis, cancer, diabetes and epilepsy. The disease burden forecast calculates the impact of health loss across the population due to living with and dying from causes of injury or disease in terms of years of life lost – Scottish Burden of Disease study, Public Health Scotland, November 2022. Source: Audit Scotland, National Records of Scotland, Public Health Scotland data (at 1 July 2025) Indicator of increased demand Growing population 2014–24: Scottish population increased by 4 per cent. Ageing population 2014–24: Proportion of people in Scotland aged 65 and over increased from 18.2 per cent to 20.5 per cent. More unpaid carers 2011–22: Proportion of people that are unpaid carers increased from 9.4 per cent to 12 per cent in 2022. Of these, 59 per cent were female and 41 per cent were male. More people with long-term health conditions and mental health issues 2011–22: Proportion of people reporting a long-term illness, disease or condition increased from 18.7 per cent to 21.4 per cent. 2011–22: Proportion of people reporting a mental health condition increased from 4.4 per cent to 11.3 per cent. Increased impact of disease on the population Annual disease burden forecast to increase by 21 per cent by 2043. Enduring and widening health inequalities 2019–21: In the most deprived areas, people spend more than a third of their life in poor health compared to around 15 per cent in the least deprived areas. Longer waiting times for secondary care By the end of June 2025 there were 36,694 ongoing waits of more than a year for inpatient or day case treatment. Before Covid-19 (September 2019) there were around 1,640. This increases the demand for primary health and social care services. Page 147 of 208
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Community health and social care performance 9 There remains a lack of comprehensive and consistent performance information to fully assess the performance of IAs and their service delivery partners 12. The lack of relevant data, or analysis of community health and social care data, has been a common theme across a range of our reports. Most recently, the Auditor General concluded in his report on general practice, that the data needed by the Scottish Government to make informed decisions on planning and investment across general practice is inadequate. There remains a lack of robust information about general practice demand, workload, workforce and quality of care. 13. In the Integration Joint Boards (IJBs): Finance and performance 2024 briefing, the Accounts Commission concluded that ‘data quality and availability is insufficient to fully assess the performance of IJBs and inform how to improve outcomes for people who use services with a lack of joint data sharing’. This continues to be the case and the following examples must be addressed: • a consistent method for recording unmet need • data about the impact and use of eligibility criteria for social care services across the country • the impact of muti-disciplinary teams in primary care • the quality of data on levels of self-directed support • a coordinated approach to anticipating future demand for and costs of delivering services • value for money assessments of local and national initiatives. 14. The lack of an individual social care record, in the same way that each member of society has an NHS record, puts limitations on the ease of gathering and processing information across all areas. Multiple IT systems across partner organisations and general practice, poor data quality, limited digital infrastructure to gather data from small independent and third-sector service providers and inconsistent recording, also remain barriers. This makes it difficult to gather the comprehensive and consistent information needed to fully assess performance across the country. 15. The Scottish Government, alongside COSLA, have committed to address this as part of a wider programme to improve health and social care data and to digitalise access to health and social care services. The Health and Social Care Service Renewal Framework launched in June 2025, states that ‘We will build on the work already undertaken to identify gaps in our data landscape and make improvements’. It also states ‘We will work with partners across Local Government and more widely to adopt the use of CHI [Community Health Index] in Local Government, ensuring that there is a common identifier for verification and data matching to support better information sharing across organisations’. This is a welcome development, however the timeline for full implementation is unclear and it is a long-term programme that will take many years to fully roll out across community health and social care services. Page 148 of 208
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Community health and social care performance 10 16. Good quality information to understand performance across health and social care is needed at a national level to support planning and evaluation of national health and social care initiatives and strategies. At a local level, IAs and HSCPs should ensure that they have good quality information to fully understand their performance, support effective decision-making, benchmark against others and provide transparent public performance reporting. 17. As a matter of urgency, PHS should lead the development and maintenance of a centralised suite of indicators, that draws on and modifies existing measures as appropriate and addresses current gaps in information. This should involve working collaboratively with IAs and HSCPs as well as other sector stakeholders including the Care Inspectorate, Health Improvement Scotland and the Improvement Service. Local public performance reporting does not explain significant performance variation across Scotland 18. Our analysis of the data set out in our data tool, shows considerable variation in performance across IAs and HSCPs for many of the indicators. This significant variation cannot be fully explained by local contextual differences nor is it explored in local performance reports. 19. IAs and HSCPs should report publicly on their relative performance, including the impact of local priorities, policy, and operational decisions. There is a long-term picture of generally declining performance and satisfaction In this section we summarise the main observations from our analysis of data in the performance tool. Collectively, the data shows that in a challenging context, there is a long-term picture of declining performance and satisfaction, with a growing expectation gap, but there are some signs of improvement. Theme 1: Prevention and early intervention and shifting the balance of care 20. Shifting investment from acute hospitals and reactive services to preventative and early intervention services, has been the sector’s ambition for a number of years. The Public Bodies (Joint Working) (Scotland) Act, 2014 (the Act) was intended to ensure health and social care services were well integrated, so that people receive the care they need at the right time and in the right setting, with a focus on community-based care. The range of proxy indicators in the data tool suggest progress in shifting the balance of care to the community and to prevention is slow and more progress is needed (Exhibit 2, page 11). Page 149 of 208
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Community health and social care performance 11 Exhibit 2. Prevention, early intervention and shifting the balance of care More progress is needed with shifting the balance of care to the community and to prevention Note 1. This is defined as the number of adults (18+) receiving personal care at home or direct payments for personal care, as a percentage of the total number of adults needing care. Source: Audit Scotland, Public Health Scotland data (at 1 July 2025) Performance illustrated in the data tool The rate of falls for individuals over 65 has remained generally consistent nationally since 2018/19 but the rate varies significantly across the country from 33.6 falls per 1,000 people over 65 years in Dundee compared to 14.8 in Highland. The number of individuals receiving community alarms and/or telecare is lower than the position prior to the pandemic. At the end of 2023/24 there were an estimated 131,560 people receiving community alarms and/or telecare, down from a high point of 136,900 in 2018/19. The rate of emergency admissions is slightly below pre-pandemic levels but there were recent increases across the majority of IA areas. There is notable variation across the country ranging from just under 15,000 emergency admissions per 100,000 adults in Falkirk to 8,300 in Edinburgh in 2023/24. The level of delayed discharges from hospital has remained challenging. Comparing the 2024/25 position to the 2018/19 pre-pandemic levels, there has been an overall 20.1 per cent increase in the number of days people aged 75+ spent in hospital when they are ready to be discharged (per 1,000 population). The data suggests that between April 2024 and the end of March 2025, the number of individuals waiting for a social care assessment and those waiting to receive a care at home package reduced. Alongside this progress, the estimated total number of hours of care at home yet to be provided for assessed individuals also improved. Progress to increase the percentage of adults with intensive care needs1 receiving care at home is limited. Since 2018, the level has increased by only 2.5 percentage points to 64.7 per cent in 2024. There is significant variation across the country ranging from 77 per cent in North Ayrshire to 54.3 per cent in Eilean Siar. A significant proportion of the last six months of life is spent either at home or in a community setting. In 2023/24, an estimated 88.9 per cent of the last six months of peoples’ lives were spent either at home or in a community setting. There has been a small (0.9 percentage point) increase since 2018/19. Page 150 of 208
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Community health and social care performance 12 21. There is a clear focus on prevention and shifting the balance of care in the Scottish Government and COSLA’s joint Population Health Framework (PHF) and Health and Social Care Service Renewal Framework (SRF). To progress these ambitions, IAs and HSCPs, responsible for so many of the services underpinning health and social care, need to be at the forefront of implementation planning to achieve the aims of the PHF and SRF. More detail about delayed discharge performance across IAs and HSCPs is set out in our performance audit report Delayed discharges: A symptom of the challenges facing health and social care, January 2026. Theme 2: Person centred and accessible care 22. Accessible care that is tailored to the needs and preferences of individuals and carers helps to promote independent living and better outcomes. The Social Care (Self-directed Support) (Scotland) Act 2013 set out how councils should offer people options for how their social care is managed. The latest data available1 shows that the percentage of people who have a choice of how they receive social care services and support, through self-directed support options, is increasing – estimated at 88.5 per cent in 2021/22, up from 77.1 per cent in 2017/18 – but the levels are variable across the country. Public Health Scotland state on their website that the publication of the 2022/23 Self-directed support information is delayed while further investigations are undertaken regarding the quality of the data. Other national indicators also suggest the amount of choice and control service users feel they have remains variable (Exhibit 3, page 13). More details about general practice performance are available in the Auditor General’s General practice: Progress since the 2018 General Medical Services contract, March 2025. 1 Public Health Scotland state on their website that the publication of the 2022/23 Self-directed support information is delayed while further investigations are undertaken regarding the quality of the data. Page 151 of 208
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Community health and social care performance 13 Exhibit 3. Person centred and accessible care The amount of choice and control service users feel they have remains variable Source: Audit Scotland, Public Health Scotland data (at 1 July 2025) Performance illustrated in the data tool In 2023/24, 60 per cent of adults supported at home agreed that they had a say in how their help, care or support was provided, leaving two in five adults feeling they had less influence. This varies across Scotland from 75 per cent in East Renfrewshire to 50.6 per cent in North Ayrshire. The proportion of respondents to the Health and Care Experience Survey indicating it is easy to contact their general practice has dropped from 87 per cent in 2017/18 to 76 per cent in 2023/24. This satisfaction measure varies across the country with for example, in 2023/24, 97 per cent of respondents in Orkney who found it easy to contact their GP practice compared to 57 per cent in North Lanarkshire. Satisfaction with the care that people receive from their general practices has decreased compared with 2017/18. In 2023/24, 69 per cent of survey respondents said the care was excellent or good, but this is 14 percentage points lower than in 2017/18. The proportion of people provided with advanced booking of a GP appointment (three or more working days in advance) has decreased by 18 percentage points compared to pre-pandemic levels. There are signs of improvement with an increase of two percentage points from 2021/22 to 2023/24. There is wide variation across the country from 82 per cent in the Orkney Islands to 30 per cent in North Ayrshire. The proportion of people that agreed they were given enough time at their GP practice has increased by two percentage points between 2021/22 to 2023/24 but remains below pre-pandemic levels. The majority of carers do not feel supported to continue in their caring role. The proportion that feel supported has increased very slightly between 2021/22 and 2023/24 (two percentage points) but overall has decreased by over five percentage points to 31.2 per cent of respondents in comparison to 36.6 per cent prior to the pandemic. Page 152 of 208
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Community health and social care performance 14 Theme 3: Reducing inequalities 23. IAs and the HSCPs have a key role to play in helping address health inequalities. There is a gap between the national policy ambitions to address health inequalities and progress with improvement. Analysis using the data tool highlights some key findings (Exhibit 4). Exhibit 4. Reducing inequalities There is a gap between the ambitions to address health inequalities and progress with improvement Source: Audit Scotland, Public Health Scotland data (at 1 July 2025), Scotland’s Census 2022 There is a significant health inequality gap in the total life expectancy between Scotland’s most and least deprived areas. There is a strong statistical correlation between deprivation and the rate of premature mortality. The female life expectancy in the most deprived areas of Scotland was 10.5 years lower than in the least deprived areas in 2021- 2023. There was a 13.2 year difference for males. More densely populated areas are also more likely to experience higher premature mortality. There is a clear relationship between the emergency bed day rate and deprivation. Using the Improvement Service’s family groupings of IA areas shows that areas with higher levels of deprivation are more likely to have higher levels of emergency bed day rates than areas that are more affluent. More densely populated areas are more likely to have a higher premature mortality rate and they are more likely to have a higher rate of slips, trips and falls for those aged 65 and over. Areas that reported a higher percentage of the population that provide unpaid care were more likely to observe higher rates of emergency admissions and emergency bed days. Page 153 of 208
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Community health and social care Performance 2025 Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 www.audit.scot ISBN 978 1 915839 96 1 AGS/2026/2 Page 154 of 208
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1 REPORT Item No: SUBJECT: Audit Scotland’s report Delayed Discharges: A symptom of the challenges facing health and social care TO: Integration Joint Board – Performance Finance and Audit Lead Officer for Report: Morag Dendy, Chief Officer (Performance, Planning & Quality Assurance) Author(s) of Report Morag Dendy DATE: 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ Item 14 Page 155 of 208
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2 3. RECOMMENDATIONS It is recommended that the Committee: 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 In January 2026, Audit Scotland published its report, Delayed Discharges: a symptom of the challenges facing health and social care which seeks to assess how well the challenge of reducing hospital delayed discharges is being addressed in Scotland. 5.2 The report identifies the key factors that contribute to people’s discharge from hospital being delayed and analyses the impact of initiatives that have been implemented in an attempt to address them. 5.3 Individuals who remain in hospital longer than required are at risk of deconditioning and loss of mobility, loss of independence and potentially requiring a higher level of support upon discharge. It is imperative that the whole health and social care system is able to support people’s discharge in a timely and effective manner. 5.4 In Scotland, the number of people experiencing a delayed discharge at the monthly census point remains above pre-pandemic levels. However, despite continuing and ongoing challenges, the number of people experiencing a delayed discharge in North Lanarkshire is lower than pre-pandemic levels. 5.5 The report sets out a range of challenges both nationally and locally: • Critical financial challenges • Complicated governance arrangement making partnership working complex It is recommended that the Committee: i) Endorse the contents of the report ii) Otherwise, note the contents of the report Yes ☐ No ☐ N/A ☐ Page 156 of 208
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3 • Increasing demands on health and social care services • Workforce recruitment and retention • Delays related to Power of Attorney and Guardianship Orders 5.6 The report sets out a range of national and local initiatives, many of which North Lanarkshire’s Health & Social Partnership is engaged in. • Discharge without Delay / Home First / Home Assessment Focusing on discharge to assess, with assessments taking place post discharge enabling people to return home without delay. • Expansion of Hospital at Home • Frailty Strategy - focus on early frailty identification and assessment; and front door frailty pathways • Engagement with third sector – including carers organisations • Lanarkshire Flow Navigation Centre • Getting It Right For Everyone 5.7 The report notes Scotland’s new Population Health Framework which focuses on population-level prevention and reducing inequalities across Scotland. However, the report notes the lack of clarity on how this will be taken forward with shared accountability and decision making and also notes the limited reflection of the role of social care. 5.8 The report also notes the Health and Social Care Service Renewal Framework as an opportunity for progress to be made with health and social care reform. However, the report also identifies that Integration Joint Boards and social care, more generally, need to be more central to the arrangements. 5.9 North Lanarkshire Health & Social Care Partnership and Integration Joint Board will work with the Scottish Government and partners to support the delivery of the report’s recommendations: • Over the next 12 months, develop a consistent approach to evaluating and reporting on initiatives to improve delayed discharges, such as discharge without delay and the Lothian Partnership, and sharing best practice and areas for improvement. Evaluation should be reported annually and include assessing effectiveness, value for money, and whether the initiatives are improving the balance of care. This evaluation should be used to update current discharge planning guidance. • In the next six months, publish guidance to clarify and strengthen the role of integration joint boards and health and social care partnerships in the governance and delivery of the health and social care service renewal framework. • Over the next 12 months, provide guidance on, and better promote public awareness of the benefits of, establishing a power of attorney or a guardianship order. • Over the next 12 months, work together to develop and action an implementation plan to share learning and practice from digital solutions used for tackling delayed discharges, early intervention and prevention. Page 157 of 208
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4 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. Yes ☐ No ☐ N/A ☐ Page 158 of 208
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5 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: Yes ☐ No ☐ N/A ☐ Page 159 of 208
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6 8. BACKGROUND PAPERS 9. APPENDICE 9.1 Appendix 1 – Delayed Discharge a symptom of the challenges facing health and social care Morag Dendy CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Morag Dendy, DendyM@northlan.gov.uk Yes / Date added ☐ No ☐ N/A ☐ Page 160 of 208
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7 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed Page 161 of 208
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Prepared by Audit Scotland January 2026 Delayed discharges A symptom of the challenges facing health and social care APPENDIX 2 Page 162 of 208
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2Delayed discharges Contents Key facts 3 Key messages 4 Recommendations 6 Introduction 8 1. Delayed discharges – what’s the problem 10 2. Delayed discharges – what’s happening 18 3. Delayed discharges – what needs to happen 34 Endnotes 39 Appendix 41 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility. Audit team The core audit team consisted of: Kathrine Sibbald, Adam Bullough, Naomi Ness, Nathalie Cornish and Lindsay Stother, under the direction of Carol Calder. Page 163 of 208
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3Key facts Key facts 17,915 Number of times people experienced a delayed discharge in 2024/25 720,119 days The number of hospital bed days lost due to delayed discharges in 2024/25 1 in 9 Proportion of beds occupied due to delayed discharges in 2024/25 3.2% Delayed discharges as a proportion of adult inpatient discharges in 2024/25 The percentage of all delayed discharge bed days occupied in 2024/25 by people aged: 66% 34% 75 years and above 18 to 74 years Page 164 of 208
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4Key messages Key messages 1 A delayed discharge is when someone remains in hospital despite being medically ready to leave. During the month of October 2024, Public Health Scotland reported the highest number (2,030) of people experiencing a delayed discharge at the monthly census point. The number of delayed patients has decreased slightly since the peak levels in October 2024, but numbers remain well above pre-pandemic levels and are rising again. In 2024/25, people delayed from being discharged spent 720,119 clinically unnecessary days in hospital. While the full costs to the health and social care system are likely to be much higher, we estimate the cost of hospital days alone to be over £440 million a year. 2 Despite only around three per cent of all people discharged from hospital experiencing a delay, each delay has a detrimental effect on the individual’s physical and mental wellbeing. This includes increased risk of infections, reduced mobility and independence and can result in higher social care needs upon discharge. Delays also impact the flow of patients through hospitals, reducing staffing availability and capacity for other patients, and in 2024/25 resulted in 11.7 per cent of hospital beds being unnecessarily occupied. This means that the system cannot function as intended, and it will be challenging to meet the projected increase in demand if delayed discharges are not reduced. 3 While the reasons behind delayed discharges are complex and vary significantly by area, hospital and each patient, it is a symptom of much wider challenges across the health and social care system. NHS Scotland, councils, integration authorities, Page 165 of 208
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Key messages 5 as well as the third sector and independent providers, all face significant financial challenges. Demand for health and social care services continues to rise. Capacity across the system is constrained by workforce recruitment and retention problems, which are particularly acute for rural and remote areas. The priorities, strategies, cultures and systems of the many national and local bodies involved vary, creating complicated governance, planning and delivery arrangements, which can affect how efficiently patients can be discharged once they are well enough. 4 The Scottish Government, integration authorities and their partners, the NHS boards and councils, have actively targeted delayed discharges as an issue. This has led to some improvements, but this varies across the country. The lack of a consistent approach to evaluating initiatives makes it very difficult to understand their impact. Better analysis and transparency are needed to understand both the costs and impacts of delayed discharges, what is providing better quality of outcomes for individuals and value for money for public spending. 5 Limited progress with addressing the wider challenges in the health and social care sector restricts further progress with reducing delays. Scotland’s population health framework, the health and social care service renewal framework and the NHS operational improvement plan, offer an opportunity to make progress, with a common focus on prevention. But it’s not clear how shared accountability and joint decision-making will be achieved, particularly given there is limited reflection of the critical role of social care, and of integration joint boards and health and social care partnerships in the arrangements. Page 166 of 208
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Recommendations 6 Jointly, the Scottish Government, NHS Scotland, the Convention of Scottish Local Authorities (COSLA), Healthcare Improvement Scotland, integration authorities and their partner NHS boards and councils, should: • Over the next 12 months, develop a consistent approach to evaluating and reporting on initiatives to improve delayed discharges, such as discharge without delay and the Lothian Partnership, and sharing best practice and areas for improvement. Evaluation should be reported annually and include assessing effectiveness, value for money, and whether the initiatives are improving the balance of care. This evaluation should be used to update current discharge planning guidance (paragraph 109). • In the next six months, publish guidance to clarify and strengthen the role of integration joint boards and health and social care partnerships in the governance and delivery of the health and social care service renewal framework (paragraph 106). • Over the next 12 months, provide guidance on, and better promote public awareness of the benefits of, establishing a power of attorney or a guardianship order (paragraph 84). • Over the next 12 months, work together to develop and action an implementation plan to share learning and practice from digital solutions used for tackling delayed discharges, early intervention and prevention (paragraph 95). Jointly, the Scottish Government and Public Health Scotland should: • Produce a clear estimate of the total costs of delayed discharges and the savings being made through initiatives to reduce delayed discharges. This should be completed within the next 12 months, updated regularly and reported in the annual analysis of delayed discharge performance (paragraph 111). Recommendations Page 167 of 208
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Recommendations 7 The Scottish Government should: • Assess the current measures for monitoring performance in reducing delays and establish a suite of key indicators. These should be agreed by working in consultation with NHS boards and integration authorities to ensure indicators are both evidence-based and relevant to local circumstances, while focused on improving hospital flow and clearly linked to improving outcomes. This should be completed within the next 12 months, regularly reviewed and reported in the annual analysis of delayed discharge performance (paragraph 114). Jointly, integration authorities and their partner NHS boards and councils should: • In the next six months, ensure they fully implement the Carers (Scotland) Act 2016 by understanding the point of the discharge planning process where this is failing to happen, intervening with support for local areas to improve their processes for carers to be involved in discharge planning from the point of admission (paragraph 71). Page 168 of 208
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8Introduction Introduction Background 1. Most patients in Scotland’s hospitals are discharged promptly. In December 2025, Public Health Scotland (PHS) reported that in 2024/25, 97 per cent of adult inpatients were discharged without delay. In three per cent of adult inpatient stays, or 17,915 inpatient stays, the patient experienced a delayed discharge, meaning they remained in hospital beyond the point they were medically ready to leave.1 This could be, for example, due to a lack of available home care services, delays in securing a care home place, or waiting for adaptations to be made to their home. 2. Delayed discharge has significant implications for an individual’s wellbeing. Staying in a hospital longer than necessary can lead to deconditioning (deterioration of a person’s physical/mental health), loss of independence, and a higher risk of infections. 3. Delayed discharges pose significant challenges in the health and social care systems. Prolonged hospital stays add to the cost of providing health and social care services, they contribute to bed shortages and make it harder for new people to be admitted, including those needing emergency care. Staff resources are stretched as hospitals must care for patients who no longer require acute medical care. It can also mean an increased need for social care support on discharge due to the detrimental impact on the person’s wellbeing. Health and social care were integrated to improve care and support for people and address issues such as delayed discharges 4. The health and social care sector involves a wide array of national and local bodies from the public, third and the independent sectors. Priorities, strategies and cultures vary making coordinating and leading change across the sector complex. 5. In 2016, the Scottish Government legislated under the Public Bodies (Joint Working) (Scotland) Act 2014 to bring together health and social care into an integrated system to improve care and support for people who use services, their carers, and their families. This included addressing whole-system issues such as delayed discharges. This led to 31 integration authorities (IAs) being created in Scotland that are responsible for strategic planning of designing, delivering, and coordinating health and social care services and have a key role in reducing delays in discharge. Page 169 of 208
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Introduction 9 6. The size of IAs varies depending on council boundaries. Most NHS boards have two or more IAs within their boundary, but the number ranges from one to six IAs in others. 7. IAs are currently structured in two ways, either through an integration joint board (IJB) or using a lead agency model. You can find more information about integration arrangements in our short guide. All areas except Highland elected to adopt the IJB model. Clackmannanshire and Stirling decided to form a single IA to service the needs of both areas. In December 2024, members of the Highland Council and NHS Highland Joint Monitoring Committee agreed to move from the lead agency model of integration to the IJB model. About this audit 8. This performance audit aims to assess how well the challenge of reducing hospital delayed discharges is being addressed in Scotland. The audit provides oversight of the factors that contribute to delays and analyses the impact of initiatives put in place to address them. 9. Our findings and recommendations in this report are based on evidence gathered through document review, data analysis and interviews. To better understand how local pressures and challenges are being addressed, our work focused on three IAs – Dundee City, East Ayrshire and Highland, engaging with IA officers and those within the NHS board and council partner bodies. In the report, we include examples from these sample areas. These are not necessarily examples of best practice or the only approaches being taken across the country. We also engaged with Scottish Government policy leads, chief officers of integration authorities, chairs of IJBs and a range of national organisations across the public and third sector. 10. The scope of our audit focused on the reasons for, and implications of, delayed discharges and the actions taken to reduce them. The audit has looked at the impact of delayed discharges on people through secondary evidence and engagement with external stakeholders. 11. This report is accompanied by an online interactive delayed discharges tool that allows users to explore the national and local performance of IAs. The tool also includes local and national contextual data from the 2022 census that illustrates the increasing population pressures nationally and the significant variation across Scotland. Page 170 of 208
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101. Delayed discharges – what’s the problem 1. Delayed discharges – what’s the problem Delayed discharges have a detrimental impact on the people affected and on the wider health system. They are a symptom of the many demographic, population health, workforce, governance and financial challenges faced by the health and social care sector. The number of people delayed in hospital has decreased slightly from the peak levels in October 2024, but numbers remain well above pre-pandemic levels and are rising again 12. Public Health Scotland (PHS) collects, analyses and publishes data on delayed discharges. In the financial year ending 31 March 2025, PHS reported that people who were delayed from being discharged spent 720,119 days in hospital, marking the highest annual figure reported since current recording guidelines were introduced in July 2016.2 This was an increase of almost 33 per cent from the financial year prior to the Covid-19 pandemic, where the total days delayed patients spent in hospital was 542,204. The number of people delayed from being discharged at the monthly census point peaked in October 2024 at 2,030 (Exhibit 1, page 11). 13. Of the 720,119 bed days occupied by people delayed in their discharge in 2024/25, 66 per cent were occupied by people aged 75 and over. 14. Following this peak in October 2024, the number of people experiencing delays each month started to slowly decrease, to 1,840 in May 2025. However, delays at the monthly census point have risen again. The most recent data, to October 2025, shows a 3.3 per cent reduction from October 2024, with 1,962 people delayed from being discharged.3 Page 171 of 208
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1. Delayed discharges – what’s the problem 11 0 500 1,000 1,500 2,000 2,500 Sep M ay Jan Sep M ay Jan Sep M ay Jan Sep M ay Jan Sep M ay Jan Sep M ay Jan Sep M ay JanJan Jan Jan Jan Jan Jan Jan Oct 2019 20212020 2022 2023 2024 2025 Exhibit 1. Total number of delayed discharges in Scotland at the monthly census point, between January 2019 and October 2025 The total number of delayed discharges in Scotland at the monthly census point have risen substantially since 2020 and short-term reductions in the numbers have not been sustained. Note: The large drop in early 2020 reflects the impact of special measures undertaken due to Covid-19. Source: Delayed discharges in NHS Scotland monthly, figures for October 2025, Public Health Scotland, December 2025 Number of delayed discharges Scotland 15. At a local level, there is significant variation in the trends of the numbers of delayed discharges between IAs. This reflects the varying contexts, needs and challenges of different areas. Between October 2024 and October 2025, delays at the monthly census point have ranged between 3.9 per 100,000 population in Renfrewshire (September 2025) and 152.5 per 100,000 population in Eilean Siar (March 2025).4 Between October 2024 and October 2025, 17 IAs have reduced their level of delayed discharges, while in 14 IAs, delayed discharges have increased. The Appendix contains a table of all IAs’ performance (number and rate of delays at the monthly census point) between October 2024 and October 2025. Page 172 of 208
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1. Delayed discharges – what’s the problem 12 Delayed discharges have a detrimental impact on the people affected Staying in a hospital longer than necessary can lead to deconditioning, loss of independence and a higher risk of infections 16. Delays in discharge negatively impact patients, leading to deconditioning, higher infection risks, and reduced mobility, especially in older or frail individuals. Frailty is common among those over 65 and affects over half of adults in hospitals or care homes.5 People with dementia and/or frailty often have longer hospital stays, worsening their symptoms and physical health. Just 24 hours in bed can reduce muscle power by two to five per cent, and up to 20 per cent in seven days, increasing fall risks and care needs.6 Lack of physical activity can lead to dependency and demotivation, while bright, noisy wards may cause stress and confusion. Longer delays, typically faced by adults with incapacity, have profound impacts on the individuals and their families 17. Adults with incapacity are people aged 16 or over who lack capacity to make some or all decisions due to mental illness, learning disability, dementia or a related condition, or an inability to communicate. Adults with incapacity face risks of their human rights not being met. Their right to independent living can be affected by long stays, leading to a disconnection from family, friends and community, institutionalisation and a deterioration of mental as well as physical health. 18. Adults with incapacity generally have a longer length of delay in hospital. Patients delayed in their discharge for standard, non-complex reasons in 2024/25 experienced an average delay of ten days.7 In 2024/25, there have been between 146 and 180 patients at each monthly census point who have experienced a delay of over 12 weeks because of incapacity.8 Of these, between 35 and 65 people each month have been delayed more than six months. Delays in securing legal mechanisms like power of attorney and guardianship orders are a significant barrier to timely discharge. 19. Addressing these delays requires close collaboration between health, legal, and social care systems to ensure timely and appropriate discharge planning. Patients with a long length of stay in hospital (considered three weeks or more) tend to be in poorer health and may require more support upon discharge. They also face a higher risk of re-admission. 20. Complex and lengthy legal processes can conflict with a person- centred, human rights-based approach to care that seeks to support adults with incapacity and their carers with shared decision-making. Waiting for guardianship orders to be processed and approved by the court before more suitable accommodation and/or care arrangements are found can lead to lengthy delays. According to a 2024 Mental Welfare Commission report, the number of existing guardianship orders has more than doubled in the last ten years.9 Deconditioning is the gradual decline in physical, psychological, and functional capacity due to reduced activity or prolonged immobility. Power of attorney is a written document giving someone else authority to take actions or make decisions on your behalf. The power of attorney details the names of the people, known as attorneys, who you want to help you and lists the individual powers that you want them to have. Guardianship order is a court appointment which authorises a person to act and make decisions on behalf of an adult with incapacity. Anyone with an interest can make an application for a guardianship order. Page 173 of 208
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1. Delayed discharges – what’s the problem 13 21. In February 2025, NHS Greater Glasgow and Clyde reported that they had over 100 people delayed due to a lack of a power of attorney, roughly equivalent to four acute inpatient wards.10 It highlighted that around a third of patients were delayed from being discharged from hospital because they did not have a power of attorney in place. Delayed discharges increase pressures on the wider health system 22. People who are delayed in their discharge occupied approximately one in nine hospital beds in Scotland in 2024/25, considerably reducing the beds available for incoming emergency and planned patients.11 This adds to existing pressures in the health system, making it more difficult to admit patients, contributing to overcrowding in emergency and assessment units and increasing planned care waiting lists. 23. A lack of available beds also exacerbates pressure across ambulance services and increases stress on the workforce. These impacts have been highlighted in our NHS in Scotland 2023 report and again more recently in our NHS in Scotland 2024 report. 24. It will be challenging for health boards to increase acute hospital capacity to meet the projected increase in demand if IAs and their partners are not able to reduce delayed discharges. This will place even more pressure on limited hospital beds and may pose risks to patient safety if there is not the capacity to meet patient needs. The cost of delayed discharges is unknown, but in 2024/25, the total estimated cost of the 720,119 bed days occupied by delayed discharges alone was over £440 million 25. There has been no published information on the costs of delayed discharges since 2019/20. PHS advises this is due to challenges in receiving patient level costs from NHS boards since the Covid-19 pandemic. In the absence of up-to-date costs relating to delayed discharges, we have used the NHS cost book to calculate the approximate cost of providing the type of hospital care a person experiencing delayed discharge may receive. 26. Based on 2023/24 costs, the average daily net cost of a hospital bed in Scotland where a patient receives nursing, allied health professional (AHP) and other direct patient care (excluding medical, pharmacy, laboratory and operating theatre-related care) is estimated at £618.12 This compares with £144.72 per day for a publicly funded care home placement with nursing, and £126 per day for a publicly funded residential care home placement.13 27. Assuming a daily cost of £618 for a hospital bed, in 2024/25 the total estimated cost of the 720,119 bed days occupied by delayed discharges alone was over £440 million. This is a minimum estimated cost as it does not include wider costs across the health and social care system resulting Page 174 of 208
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1. Delayed discharges – what’s the problem 14 from delayed discharges. For example, opportunity costs associated with the reduced capacity for planned care, and the potential costs of additional care required post-discharge due to deconditioning experienced during an extended hospital stay. 28. Reducing delayed discharges would not directly generate a cash saving as it would transfer the costs to other parts of health and social care, and the hospital beds would be occupied by others in need of care. However, ensuring that a person is cared for in the most appropriate place for them may be more cost effective. The Scottish Government needs to be able to understand the true costs of patients’ delayed discharge from hospital and the savings and individual benefits being made through initiatives to reduce delayed discharges (paragraph 111). Delayed discharges occur for many different reasons Most delayed discharges happen as a result of trying to ensure that appropriate care arrangements are in place 29. Once someone is medically ready to be discharged from hospital, there are a range of reasons why their discharge might be delayed and they are kept in hospital. 30. Exhibit 2 (page 15) shows the proportion of delayed discharges by reason for delay in 2024/25, of the average 1,967 people delayed in their discharge recorded at each monthly census in 2024/25. Page 175 of 208
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1. Delayed discharges – what’s the problem 15 Exhibit 2. Percentage of delayed discharge reasons, average number across monthly censuses between April 2024 and March 2025 Source: Delayed Discharges in NHS Scotland, Annual summary of occupied bed days and census figures: Data to March 2025, Public Health Scotland, June 2025 28% Awaiting place availability: for example, waiting for a care home place. 27% Complex delays: people delayed due to awaiting place availability in a high-level needs specialist facility, and where an interim option is not appropriate or where an adult may lack capacity. 27% Awaiting completion of care arrangements: for example, people waiting on a care package (eg, home care, equipment support services). 14% Awaiting community care assessment: for example, people waiting for a formal evaluation of their care needs by community-based professionals (eg, social workers, occupational therapists, or other adult social care staff). 4% Other reasons: includes patient and family-related delays, awaiting funding and transport. 28% 27% 27% 14% 4% Delayed discharges are a symptom of the many challenges faced by the health and social care sector 31. NHS Scotland, councils, integration authorities, as well as the third sector and independent providers, all face significant challenges (Exhibit 3, page 16). Page 176 of 208
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1. Delayed discharges – what’s the problem 16 Exhibit 3. Delayed discharges are a symptom of the many challenges faced by the health and social care sector Challenge area Key issues The financial challenges facing health and social care services are critical The NHS in Scotland is experiencing immediate financial pressures, as noted in the NHS in Scotland 2025: Finance and performance report. Scotland's councils continue to face severe financial pressures, as highlighted in the Local government in Scotland: Financial bulletin 2023/24. In our Integration Joint Boards: Finance bulletin 2023/24, we reported that 24 Integration Joint Boards (IJBs) reported a financial deficit in 2023/24, with the projected funding gap for IJBs worsening to £457 million for 2024/25. IJBs are making difficult decisions about funding and providing services, often relying on dwindling financial reserves and non- recurring savings, which is not sustainable long-term. Health and social care governance is complicated, and arrangements vary making partnership working and delivery complex Different priorities, strategies, and cultures among the national and local bodies involved in community health and social care, create a web of shared responsibility, complicating decision-making, governance, planning, and operational activities as we highlighted in the Integration Joint Boards: Finance and performance 2024 report. The NHS in Scotland: Spotlight on governance highlighted some NHS boards have created strong relationships to support better planning and decision-making, but others struggle with limited control or influence over IJB decisions. The demand for health and social care services continue to grow with the needs of an ageing population Rising demand and budget pressures mean Integration Authorities face challenges in providing services that fully meet the care needs of their populations. Health inequalities are widening, with a focus on crisis medical treatment rather than preventative measures to maintain good health and wellbeing in the community. Pressure on hospital bed capacity is likely to grow, with unplanned acute inpatient hospital admissions in Scotland projected to increase by 11.8 per cent from 2024 to 2034. Cont. Page 177 of 208
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1. Delayed discharges – what’s the problem 17 Challenge area Key issues Significant workforce recruitment and retention challenges impact on the capacity to deliver services Workforce shortages, high vacancy rates and challenges with staff retention have resulted in gaps in social work, social care services, allied health professionals, nursing, and general practice. Recruitment and retention are particularly problematic in rural and remote areas. These challenges have been worsened by the impacts of Covid-19, EU withdrawal, increases in national insurance contributions and changes to UK-wide immigration policy. A lack of suitable housing makes it harder to provide care, particularly in more remote and rural areas There is a lack of planning for the future housing needs of an ageing population. Most housing stock is not built with people's longer-term care needs in mind. A shortage of suitable, affordable homes impacts key worker recruitment and retention. Delays in housing adaptations for people with learning disabilities and complex needs result in a lack of access to independent living options and prolonged stays in unsuitable accommodation or hospital. Limited housing options for staff make increasing or maintaining service capacity difficult in some areas. Source: Audit Scotland Page 178 of 208
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182. Delayed discharges – what’s happening 2. Delayed discharges – what’s happening There is significant activity to reduce delayed discharge, with examples of good practice, but a lack of evaluation means it is difficult to understand the overall impact. The Scottish Government, integration authorities and their partners have actively targeted delayed discharges, but more needs to be done to effectively measure the impact and value of approaches 32. Many of the national and local initiatives to reduce delayed discharges are still at an early stage and are too recent to assess impact and effectiveness. Some initiatives lack outcome measures or published outcomes, making it difficult to make judgements of the overall impact in reducing delays and whether they are delivering value for money. Reducing delayed discharges is a priority for the Scottish Government, with a focus on preventative actions 33. The Scottish Government’s 2024/25 Programme for Government14 reiterated its commitment to reducing delayed discharges and the variation in practice across Scotland. It outlined activities such as ensuring that partners work together to support effective discharge and reducing hospital admissions by providing the right care in the right setting. 34. The most recent Programme for Government, published in May 2025, and the NHS Scotland operational improvement plan,15 published in March 2025, emphasise a focus on prevention, through ensuring more people can be cared for at home and reducing pressures in hospitals. This will be achieved by expanding the number of Hospital at Home (H@H) beds to at least 2,000 by December 2026. It also commits to ensuring frail patients with complex needs receive the wrap-around care they need to return home or into a care setting as soon as possible, improving hospital discharges.16 The Scottish Government and COSLA have a structured approach to tackling delayed discharges through regular monitoring, collaboration and targeted support, but this lacks transparency 35. The Scottish Government and COSLA place a significant emphasis on performance management and monitor the numbers of delayed discharges nationally and in each IA, engaging with local health systems to understand performance fluctuations. Hospital at Home (H@H) provides urgent short-term hospital level care at home. This may range from one day to several weeks which would otherwise be spent in hospital. Page 179 of 208
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2. Delayed discharges – what’s happening 19 36. The Scottish Government and COSLA gain assurance over the performance of IAs through review of weekly management information on the number of delays, alongside discussions with HSCP leaders to understand the reasons behind performance, challenges and mitigations being put in place. This intelligence is shared with other leaders within the health and social care system, and performance is monitored by the First Minister and the cabinet. 37. The Collaborative Response and Assurance Group (CRAG) is a key part of the approach. It is co-chaired by the Cabinet Secretary for health and social care and COSLA health and social care spokesperson. It brings together leaders from across health and social care to coordinate responses and ensure the delivery of effective services. It focuses on areas of concern, such as delayed discharges from hospitals, by holding regular meetings to monitor performance and implement improvement strategies. 38. The Scottish Government and COSLA intended CRAG meetings to provide local oversight and consider the reasons behind high levels of delayed discharges and why the number of delays were not improving. This was difficult for some local areas for often multiple and complex reasons. Three working groups were established: • Working Group 1: A targeted performance and support work group – Rapid Peer Review and Support Team (RPRST) has engaged directly with the local systems and worked locally to improve performance (paragraph 48). • Working Group 2: Focuses on delays related to learning disabilities and mental health, including adults with incapacity. The group allows for more intensive work in these areas. • Working Group 3: Designed to look at national issues. Chaired by COSLA. It identified local case studies to highlight good practice. 39. There have been tensions with CRAG’s directional approach and how data is presented. The approach to meetings has developed over time, and general feedback is that meetings have evolved into a more collaborative space that offers a forum for sharing best practices. But there is a lack of transparency outside of the group. The Scottish Government and COSLA intend to review the remit and focus of CRAG to ensure it aligns with NHS board operational planning processes and the remit of the National Care Service (NCS) Interim Advisory Board. 40. While CRAG has established a structured approach to tackling delayed discharges through regular collaboration and targeted support, the persistence of high delayed discharge figures and significant variation in certain regions indicates that further efforts, with better analysis and evaluation of what is providing better quality outcomes for individuals, are necessary to achieve significant and consistent reductions across Scotland. Page 180 of 208
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2. Delayed discharges – what’s happening 20 In June 2025, the Scottish Government allocated additional funding of £92 million to NHS boards to improve unscheduled care services and to support the delivery of the NHS Scotland operational improvement plan 41. Reducing delayed discharges is a national priority for the Scottish Government, COSLA and IAs. In February 2025, the Scottish Government invited all NHS boards to bid for additional funding to improve unscheduled care services, supporting the delivery of the NHS Scotland operational improvement plan.17 The Scottish Government was unable to approve the entirety of each NHS board’s plans because these exceeded the total additional funding available. Ultimately, the additional urgent and unscheduled care funding for 2025/26 were made up of: • Hospital at Home funding – £21.3 million • improving flow, discharge without delay, and frailty services – £39.7 million • core unscheduled care funding – £29.8 million • mental health/adults with incapacity/learning disabilities – £824,000. 42. The Scottish Government has set out that it expects NHS boards to consider how they use the additional funding to redesign services and realign existing budgets to fully deliver on their proposals. The allocation of this additional funding is conditional on the delivery of these outcomes. The Scottish Government has set out that it will monitor progress and identify any slippages. It is the intention for the funding for future years to be made recurrent based on activity, actual spend, and evidence of delivery of outcomes required. As not all plans or initiatives have been fully funded, NHS boards will need to consider how existing budgets can be used to support their proposals. 43. The Scottish Government has a long-standing commitment to shift the balance of care from secondary, acute health services to primary and community services. Our 2016 report on Changing models of health and social care noted that the continued focus on challenging secondary care targets and short-term funding was making shifting the balance of care difficult. These issues remain, and the Scottish Government has recognised the continued need to make a long-term shift in the balance of care in its health and social care service renewal framework.18 It aims to do this by focusing new resources on building capacity and service improvement in primary and community care, leading to community services receiving an increasing share of investment over time. 44. Within IAs, there are opportunities to maximise the impact of financial resources by organising services around people’s needs, rather than traditional service/professional boundaries. However, current financial challenges make this difficult and it requires collaborative leadership. Page 181 of 208
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2. Delayed discharges – what’s happening 21 The National Care Service (NCS) Advisory Board has a remit to provide advice and suggest where improvements can be made to social care, social work and community health services. Hence it has a key role in supporting the sector to reduce delayed discharges 45. The NCS interim advisory board was set up in May 2025 to provide advice and suggest where improvements can be made to social care, social work and community health services. The aim of the interim board is to help ensure services are consistent, fair and high-quality across Scotland hence it has a key role in supporting the sector to reduce delayed discharges. The board includes people with personal experience of accessing and delivering social care, social work and community health services. It is important that the NCS advisory board is aligned with the existing groups and adds value by advising on embedding lived experience into system design, strengthening collaborative governance, developing approaches for wider participation and providing agile, evidence informed advice, rather than adding a further layer of governance, which could result in further complexity, lack of transparency, and unclear accountabilities. The Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan has encouraged local areas to focus on adopting best practice, with 11 boards embedding discharge without delay 46. The Scottish Government’s Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan (the Plan) was introduced in March 2023. It builds on the principles of its best practice discussion paper, transforming urgent and unscheduled care – optimising flow – discharge without delay, published in August 2021, and aimed to promote known good practice in terms of discharge planning and whole-system working (Exhibit 4, page 22). 47. IAs are required to complete annual self-assessments against the Plan and submit these to the Scottish Government. IAs are now on their third iteration of self-assessment. Some IAs have reported action plans against these self-assessments, but the Scottish Government has not finalised an overall summary of these self-assessments or detailed how IAs are progressing against the Plan, which makes it difficult to evidence whether the self-assessments are driving improvement. Page 182 of 208
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2. Delayed discharges – what’s happening 22 Exhibit 4. Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan delivery actions Source: Audit Scotland The Plan focuses on three delivery actions: 1. Good practice Has focused on ‘getting the basics right’ by using the Discharge without Delay (DwD) programme, see Case study 3 (page 31). The DwD collaborative has developed guiding principles for boards to follow, and there are now 11 boards signed up that are at varying stages of embedding the DwD programme. 2. Data Management A Whole System Pressures Dashboard has been developed through a collaboration between NHS National Services Scotland, Public Health Scotland and the Scottish Government. It provides a weekly summary of current pressures across the health and care system, with the aim of supporting strategic decision making. The data includes weekly discharge data, summary counts of people delayed by Health and Social Care Partnership, split by delay reasons. It also includes other data related to planned care, unscheduled care, the Scottish Ambulance Service (SAS), and other parts of the system. The usage of the dashboard can be tracked, and over 800 users have access to the dashboard. What is not clear is how individual IAs are using this data, and it is difficult to assess, as they all have different processes for analysing performance. 3. Workforce Has looked at addressing labour shortages in social care through recruitment campaigns such as ‘There’s More to Care than Caring’ and ‘You Can Make a Difference’. But challenges remain with the workforce, and many IAs and independent care providers still face recruitment challenges across the health and social care sector in Scotland, see Exhibit 3. The Rapid Peer Response and Support Team has provided targeted support to IAs struggling with persistent delayed discharge pressures, and has been positively received, but lacks evaluation to understand the overall impact 48. The Rapid Peer Response and Support Team (RPRST), initiated by the Scottish Government, has provided tailored support to NHS boards and IAs that have faced challenges in reducing delayed discharges. They collaborate with IAs to identify issues and share best practices to improve performance in reducing delayed discharges. Page 183 of 208
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2. Delayed discharges – what’s happening 23 49. The RPRST has worked closely with a variety of HSCPs to scope out bespoke packages of support. It focuses on problem identification and solving, encouraging peer support, and avoiding duplication and unnecessary bureaucracy. Some examples include: • The Aberdeenshire HSCP worked with the RPRST to map patient pathways following discharge from hospital. Following the mapping exercise, the RPRST has worked with the Aberdeenshire HSCP to develop a Standard Operating Procedure (SOP) for facilitating the discharge of patients from Aberdeen Royal Infirmary to home or via community hospitals in Aberdeenshire to home or a homely setting. The Aberdeenshire HSCP is currently working with the RPRST on implementation of the SOP. • With South Ayrshire HSCP, the RPRST helped scope Local Support Intelligence Team support from Public Health Scotland, which has enabled South Ayrshire to access data on the most frequent A&E attenders and updated trend analysis on single- and double- handed care. 50. The RPRST shares local intelligence and learning with CRAG and escalates any barriers or issues that cannot be resolved by the local area and RPRST. It maintains a network of peers to provide peer support. There has been positive feedback from boards that have been involved with the team, but there has not been any evaluation to assess the success of these initiatives and the direct impact they have had on improving performance in reducing delayed discharges. Hospital at home is a nationally supported model that can prevent hospital admissions, but there is no analysis of its cost- effectiveness in relation to other models of community or home- based care 51. The Hospital at Home (H@H) programme has been implemented as a strategic response to alleviate delayed discharges by providing acute-level care in patients’ homes. This initiative aims to reduce hospital stays, free up bed capacity, and enhance patient outcomes. 52. H@H has prevented an estimated 15,811 hospital admissions from April 2024 to March 2025, representing a ten per cent increase in the number of patients managed by H@H between April 2023 and March 2024.19 53. The 2025/26 Scottish Budget included a £100 million fund to support various reform and improvement measures, including reducing delayed discharges and expanding the capacity of H@H.20 Some of this £100 million has already been earmarked for other purposes, such as a new cardiovascular service in general practice. In June 2025, the Scottish Government informed NHS boards of the funding arrangements for H@H, allocating £21.3 million for 2025/26, and confirmed the funding for future years will be made recurrent based on activity and actual spend incurred and evidence of delivery of outcomes required. Page 184 of 208
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2. Delayed discharges – what’s happening 24 54. Health boards have highlighted that the requirement for H@H to be a secondary care consultant-led service can make it unaffordable. There is also a risk that finite resources are taken away from other areas, putting an additional burden on carers. While there is some evidence that H@H can be more cost-effective than hospital-based care, the Scottish Government or HIS have not completed a full assessment to analyse the cost-effectiveness of H@H in relation to other models of community or home-based care. 55. The Scottish Government has commissioned PHS to develop consistent national data on H@H activity. PHS plan to publish statistics quarterly from spring 2026 alongside updates by HIS on H@H improvement work. HIS and PHS should consider including metrics on the costs of H@H services, to allow assessments on the cost- effectiveness, relative to other models of care. Flow Navigations Centres, Integrated Clinical Hubs and Pathways Hubs are virtual assessment hubs that help direct patients more efficiently and effectively Flow Navigation Centres (FNCs) 56. FNCs are part of the Scottish Government’s national initiative to improve access to urgent and unscheduled care by ensuring patients receive the right care, in the right place. They offer an opportunity for professional-to-professional advice with direct referrals from primary care, NHS24 and SAS with an aim to improve coordination of patient flow. This can contribute to reducing the number of people requiring hospital care by identifying alternatives to hospital admission, such as community- based care, specialist outpatient services, home treatment options and hospital at home services. Examples of the use of FNCs: • NHS Lothian – With funding from the Scottish Government, NHS Lothian enhanced its flow navigation service by directing provision to consultant-led flow centres. The service has 11 consultants from acute medical and emergency medicine, offering a Monday to Friday 9am-6pm referral service. The new model aims to minimise the need for transfers to hospital, identify unmet need within the system and protect any one part of the system from becoming overburdened. Funding constraints means they are not currently able to operate a 24-hours-a-day, seven-day-a-week service. • NHS Greater Glasgow and Clyde – Operate an enhanced FNC+ model, bringing together a multidisciplinary team to provide assessments and navigate patients to access alternatives to hospital admission when appropriate. Central to this development is the creation of a virtual hospital, which will provide 1,000 ‘virtual beds’ across NHSGGC. Patients suitable for this model of care will be supported at home using remote monitoring technology and clinician-led interventions, allowing hospital-level care to be delivered without the need for a hospital stay. Page 185 of 208
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2. Delayed discharges – what’s happening 25 57. FNC models and levels of expertise vary across Scotland, and it can be difficult to replicate for smaller boards who may have less resource to staff FNCs as well as access and capacity in the community. There is also no unified data set collected by PHS, which makes it difficult to compare activities and outcomes. Integrated Clinical Hubs and Pathways Hubs 58. Scottish Ambulance Service (SAS) Integrated Clinical Hubs allow SAS to remotely assess and consult with patients avoiding unnecessary ambulance dispatch and hospital admissions and readmissions. The Pathways Hub is a single point of contact for SAS clinicians to access a range of proactive and preventative pathways. 59. The Integrated Clinical Hub has a remote multidisciplinary team of clinical advisers, advanced practitioners and GPs who engage with patients that would benefit from clinical assessment and review. The Pathways Hub provides pathways for those not requiring urgent or emergency care into preventative services such as falls prevention, alcohol and drug services, Distress Brief Intervention or social services, or refers patients to third sector providers that can best suit their specific needs. 60. Through the introduction of Integrated Clinical Hubs and Pathways Hubs, SAS manages around 50 per cent of emergency calls outwith acute emergency hospital settings. Patients can be supported at the point of call or by SAS clinicians on scene, reducing the need for hospital conveyance and potential admission. In June 2025, SAS highlighted that over 175,000 patients have been supported through the Hub, with more than 55,000 ambulance journeys being avoided.21 There is a focus on early identification, assessment, and management of frailty 61. Early identification and management of frailty through the provision of community frailty services is important to allow people to live as independently as possible, avoid unnecessary hospital admissions, readmissions, and reduce length of stay, if hospital admission is required. 62. Having a clinical focus on frailty at the ‘front door’ (the part of the hospital where patients initially present when unwell, such as an emergency department) and early comprehensive geriatric assessments can ensure that patients are supported by the most appropriate services. 63. The Scottish Government has set a target for every emergency department in Scotland to have direct access to specialised frailty teams by summer 2025, to support early identification, assessment and management of frailty at the hospital front door.22 HIS has developed ageing and frailty standards and set foundations for front door frailty, which sits alongside its foundations for community frailty services and key steps to setting up a front door frailty service to help organisations implement the ageing frailty standards.Page 186 of 208
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2. Delayed discharges – what’s happening 26 Getting it Right for Everyone principles have been developed to promote effective discharge planning and help prevent delayed discharges 64. Getting it right for everyone, or GIRFE, launched in May 2025, is a Scottish Government multi-agency approach to care that focuses on working together around the person. It responds to frustrations people have with the current system, such as repeating their story multiple times, navigating complex information and attending multiple appointments with different professionals. The Scottish Government worked with nine pathfinder health and social care partnerships, professionals and individuals receiving and providing care between 2022 and 2024 to develop the GIRFE approach. 65. A GIRFE toolkit has been developed to help practitioners apply a more personalised and preventative approach to care. The core principles focus on person-centred discharge planning, multi-agency coordination and, taking a consistent and ‘whole-life’ approach to ensuring an individual’s needs are considered and necessary support is in place before discharge. Discharge planning and processes vary across the country with many improvement programmes and initiatives evident 66. When a person attends a hospital for clinical care, an initial assessment should be completed to determine if their care needs can be properly met in any setting other than a hospital. The assessment should establish the best place for the person to have their clinical healthcare needs met. Where appropriate, they should be discharged to a suitable community setting, home with no ongoing support, home with support, a care home or supported accommodation. 67. If a person is admitted to a hospital, the discharge planning process should start immediately, to ensure the right care is available in the community at the time of discharge. This discharge planning process should be carried out by the responsible consultant, informed by the multi-disciplinary team (MDT), in partnership with the patient, family or carer, with their views and wishes being considered. 68. The approach to discharge planning varies across the 31 IAs. Some areas have embedded good practice involving collaboration of MDT, while others face challenges due to workforce shortages, limited resources and varying levels of cooperation and joint working Unpaid carers are often involved too late in the discharge process 69. With an ageing population, people living longer with multiple complex health conditions, and care being brought closer to home, caring is likely to be a feature of most people’s lives in the future.23 Page 187 of 208
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2. Delayed discharges – what’s happening 27 70. The Carers (Scotland) Act 2016 was introduced to provide carers in Scotland with additional rights. Part 4, section 28 of the Act provides unpaid carers the right to be involved in planning for discharge when the cared for person is admitted to hospital. In 2019, Health and Social Care Scotland published a practical guide for health and social care practitioners involved in discharge planning from hospitals.24 71. Involving carers early in the discharge planning process leads to smoother discharge and reduced delays. Readmissions are less likely as carers are better equipped to provide ongoing support, and their involvement leads to better informed care assessments. Despite this, there is still a lack of communication with carers, leading to assumptions around what support is or is not needed, and carers being often involved too late during the discharge process. 72. IAs are having to make difficult decisions on how to allocate limited budgets, and as a result some services are increasingly having to tighten eligibility criteria, such as for packages of home care. This means that people may have to rely more on family support and unpaid care. 73. An example of effectively involving carers as part of the discharge planning process is the collaboration between East Ayrshire HSCP and East Ayrshire Carers Centre. 74. East Ayrshire Carers Centre supports carers of all ages and recognises the need to involve families and carers from admission. They currently have two hospital discharge carer link workers based in University Hospital Crosshouse and University Hospital Ayr, as well as linking in with East Ayrshire Community Hospital and Biggart Hospital, working closely with the discharge without delay teams. They advise and support unpaid carers through the hospital discharge process and help identify what support they may require to continue to provide care and support for their loved ones after discharge, giving a more accurate picture of the patient’s needs and available support. Care packages are commonly cancelled on admission; changing this can reduce delays to discharge but is challenging to do 75. When someone is admitted to hospital, any existing care at home package will likely be cancelled as not being required, during the period of inpatient stay and restarted, if required, on discharge. This can save on costs and resources but impacts the continuity of care. 76. Keeping care packages open can speed up discharge. For example, in East Ayrshire IA, they try to keep care packages open for up to four weeks; this allows the continuity of care to be maintained, and it is less likely that this becomes a reason for a delayed discharge, but because of financial constraints and increasing demand, this is becoming more difficult. However, when care packages are kept open while an individual is in hospital, if demand for care packages exceeds capacity, this could mean that someone could be awaiting services in the community, so there is a delicate balance that needs to be managed. Page 188 of 208
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2. Delayed discharges – what’s happening 28 Some IAs have used financial reserves to address delayed discharges in the short term, but this is not a sustainable option 77. Using reserves to address challenges such as delayed discharges, for example, to pay for interim care placements or boosting social care capacity during peak times, can have a positive impact on performance, but this is not sustainable. 78. In our Financial bulletin on IJB finances 2023/24, we reported that IJB reserves decreased by 36 per cent in real terms (adjusting for inflation) between 2022/23 and 2023/24. Contingency reserves, which are not earmarked for a specific purpose, decreased by 49 per cent in real terms. Some IJBs have used reserves to improve performance in reducing delays (Case study 1). Case study 1. Focusing on finances and reserves for reducing delays Falkirk IA has experienced an increasing number of delayed discharges and struggled to maintain short-term improvements in performance. In 2023, Falkirk sought to understand the reasons behind increases in delays. The findings highlighted a lot of care at home waits, so the Health and Social Care Partnership focused on targeting specific blockages within the care at home service, using reserves to invest in care services to bring down delays. This resulted in an improvement from 87 delays at the April 2024 census point to 65 delays at the October 2024 census point, but the increased focus and spending resulted in a budget overspend. Falkirk quickly introduced control measures to reduce spending, and the number of delays increased. Part of the control measures were to have two people come out of a care home bed before one person could go in, and a limit on care at home hours. Analysis of care at home demand showed that the investment resulted in the lowest level of unmet demand in the community in Scotland, essentially meeting all care needs. However, as reserves were utilised and with control measures in place, delays again increased. Source: Falkirk Integration Authority Page 189 of 208
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2. Delayed discharges – what’s happening 29 Local whole-system and multidisciplinary approaches reflect the complexity of delayed discharges 79. Individual approaches may improve specific aspects of the discharge process locally and have a positive impact on the levels of delayed discharge. However, as set out in Part 1, delayed discharges are a symptom of wider challenges within the health and care system, involving many different factors, services and professions. To have a significant lasting impact on the level of delayed discharges requires shared accountability and a collaborative approach from all stakeholders, at all levels, which is built on evaluation and uses data to support decision-making. 80. There are some examples of whole-system and multidisciplinary team initiatives which have had a positive impact on delayed discharges. For example, the Lothian Partnership unscheduled care improvement programme is a local application of a whole-system approach. This aimed to enable transformation of models of care to ensure long-term sustainability and has resulted in reducing delays (Case study 2). Case study 2. Lothian Partnership – unscheduled care improvement programme In autumn 2024, there was a wider concern about the level of pressure across the whole system in NHS Lothian, with high hospital occupancy levels, especially in acute hospitals, and accident and emergency delays were very high. This was caused by several factors, including delayed discharges. The Scottish Government approached NHS Lothian to explore options to improve unscheduled care (USC) performance. The programme initially focused on the Royal Infirmary of Edinburgh and aimed to create a whole-system approach to enable the transformation of care models, ensuring long-term sustainability. The programme looked to move towards better partnership working, home-first approaches and a seven-day USC staffing model. This included discharging patients every day of the week and shifting care from acute to community services. The programme goals included reducing attendances, admissions, bed occupancy and length of stay in hospital, with data being used to support accountability and decision-making. It provided several benefits in respect of patient flow through the hospital, and although there was no focus or specific targets on delayed discharges, at the end of the 2024/25 financial year, NHS Lothian reported a reduction in delayed discharges at the Royal Infirmary of Edinburgh by 17 per cent and Western General Hospital by 32 per cent. Staff morale has improved, along with collaborative leadership and a belief in a whole-system approach. Source: NHS Lothian A whole-system approach looks at all aspects of how a system operates, the role of each part within the system, and how they are connected. This can help understand how things can be done differently to improve systems. Page 190 of 208
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2. Delayed discharges – what’s happening 30 Case study 3. Discharge without Delay (DwD) programme The DwD programme was built on principles developed in Tayside and is a whole-system initiative designed for frail older people currently accessing hospitals in Scotland. It integrates best practices, individual services, and care pathways into a model that prioritises delivering a comprehensive geriatric assessment of the patient promptly, ensuring that patients experience no negative consequences from their hospital stay, while facilitating a smoother transition from hospital to home. The DwD programme has four key integrated workstreams: • Planned Date of Discharge (PDD) and Integrated Discharge Hubs Workstream – A single point of referral for complex discharges, setting a realistic planned date of discharge, supported by a MDT approach. • Discharge to Assess (D2A)/Home First Workstream – The completion of social care assessment post discharge. Enabling people to return home without delay, through services that offer responsive community-based home care support. • Community Hospital and Step-Down Rehabilitation Units Workstream – Enhanced use of these facilities to care for frail individuals requiring rehabilitation and extended assessments. • Acute Frailty Unit Workstream – Frailty units early in the admission process in acute hospitals provide early comprehensive geriatric assessments for frail older people. The DwD collaborative meets fortnightly and now has over 50 members across 11 boards in Scotland. All boards in the DwD group have undertaken a needs assessment aligned to the guiding principles set out by the DwD collaborative that will support the development of a comprehensive action plan to guide service, workforce, and budget planning for the year ahead and inform the respective annual delivery plan 2025/26. 81. Multidisciplinary team (MDT) collaboration brings together health services, social care, housing, and community providers to coordinate care, share information, and streamline patient transitions. When these partners work closely, they can identify and resolve barriers more quickly, ensure appropriate support is in place post-discharge, and improve outcomes for patients. Strong, sustained collaboration fosters a more integrated system, reducing delays and improving overall efficiency. The Discharge without Delay (DwD) programme is another example of a collaborative, multidisciplinary, whole-system approach (Case study 3). Page 191 of 208
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2. Delayed discharges – what’s happening 31 Power of attorney and guardianship orders can be a lengthy, complicated process with long waits for legal aid 82. In December 2024, Health and Social Care Scotland funded the development of a power of attorney stakeholder toolkit and associated media campaign around a national power of attorney day to raise awareness of the importance of having a power of attorney in place. 25 As for many, especially those on lower incomes, having a power of attorney in place is not considered a priority. In more rural areas, this can be challenging, for example, in Highland, there are very few solicitors who accept legal aid due to capacity. According to the Scottish Legal Aid Board (SLAB), in 2024–25, adults with incapacity cases accounted for 47 per cent of all grants, up from just two per cent in 2005–06.26 83. There may be opportunities for IAs to target proactive support for patients who are most likely to require a power of attorney. For example, East Ayrshire HSCP has been supporting dementia patients to set up a power of attorney. Working with Alzheimer’s Scotland, they are supporting individuals and their families to put in place a power of attorney during dementia post-diagnostic support, while they still have capacity. A range of teams across the HSCP are engaged in supporting power of attorney discussions at the earliest opportunity across the wider population. Work is under way to ensure there is a shared approach to identification, promotion, and provision of power of attorney, including market testing to explore improved access to quality assured legal partners. 84. Our stakeholder engagement has highlighted that better public awareness of power of attorney and guardianship orders is needed, and support for those on lower incomes may be useful to ensure families have them in place before they are admitted to hospital. 85. The Scottish Government is considering changes to the Adults with Incapacity (Scotland) Act 2000 to better protect people’s rights and dignity, and the 2024/25 Programme for Government, published in September 2024, committed to bringing forward a Bill amending the Adults with Incapacity legislation. Between July and October 2024, the Scottish Government carried out a consultation on its proposals, publishing analysis from these consultations in January 2025.27 The responses to the consultation will inform the development of that legislation and the accompanying guidance and revised codes of practice. The DwD collaborative has agreed on four key targets to reduce delayed discharges and their impact (detailed in paragraph 115). There are early signs that the DwD programme is now having an impact in reducing delays across some boards that have implemented the new principles, but boards are at varying stages of implementing service changes, and the principles will take time to fully embed. Source: Discharge without delay collaborative Page 192 of 208
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2. Delayed discharges – what’s happening 32 The third sector is a key partner in tackling delayed discharges, especially in community-based interventions and carer support 86. Many IAs rely on third sector organisations to deliver social care services, including care home and care at home services. They also rely on the third sector to deliver services that enable timely discharge, such as housing support, befriending, and palliative care. 87. For example, the British Red Cross (BRC) supports health and social care across the UK, providing services in hospitals, primary care, social care and in the community. Their services include home from hospital support, assisted discharge, reablement, patient transport and discharge to assess, enabling faster, safer discharges and reducing the likelihood of readmission: • In East Ayrshire, the BRC is a key delivery partner offering assisted discharge, transports such as oxygen and stretcher transport, and non-regulated support services such as practical and emotional support to people for up to 12 weeks after discharge. • In partnership with Ninewells Hospital and Dundee HSCP, the BRC has co-developed a D2A model. Assessments are done in the person’s own home, and the Red Cross can provide wrap-around care and support during the assessment process for up to 21 days. 88. The Health and Social Care Alliance Scotland (the ALLIANCE) reported in April 2025,28 that overall, there had been local examples of good practice with health and social care integration across IAs, but these are yet to be adapted and implemented at scale. The ALLIANCE further reported that effective partnership working and collaboration between the third and public sector are undermined by financial challenges, negative attitudes toward the third sector, and complex organisational processes. 89. As significant contributors in the delivery of community health and social care services, the third sector and, where appropriate, the independent sector, should be involved in developing approaches to whole-system change. Digital solutions are playing an increasingly vital role in tackling delayed discharges 90. The use of artificial intelligence (AI) and digital technology is a powerful tool that can transform access to healthcare, improve efficiency and support long-term savings and better integration: • Remote and virtual care with enhanced online accessibility reduces the need to travel and virtual assistants can provide health advice, triage symptoms, and guide patients to appropriate care 24/7. Page 193 of 208
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2. Delayed discharges – what’s happening 33 • AI can help hospitals and health professionals allocate resources more efficiently and streamline administrative tasks. Our Tackling digital exclusion report gives examples of how digital options can improve access to services and help save money, such as the Near Me video consulting service. 91. An example of where digital technology has improved efficiency and supported better discharge planning by improving the interface between acute and community teams has been the launch by NHS Highland of a dynamic discharge app. 92. It follows the planned date of discharge principle of discharge without delay. The app links together multidisciplinary decision-making teams in both acute and community settings, improving communication to help ensure patients are put on the correct pathway as early in the process as possible. Upgrades to the app have included a clinical frailty scale, and a chat function to improve real-time communication to support the flow of patients through the hospital. 93. There is potential for AI and technology-enabled care (TEC) to support people to live more independently at home, including supporting the elderly and those living with dementia. Digital connections form part of East Ayrshire HSCP’s longer-term strategic plan to align the Home First model of care to a Digital First principle promoting the use of TEC for independent living.29 Recent innovations include the East Ayrshire smart hub which showcases different smart home technologies and is part of the Smart Supports initiative, using technology to provide services which can help people live independently within their homes and communities. 94. In our Community health and social care performance report, published in January 2026, we note that the Scottish Government has encouraged, through a number of workstreams, the growth of TEC. Although preventative initiatives to keep individuals in the community, such as the use of community alarms and telecare, have been used across IAs, the estimated number of people receiving community alarms and/or telecare is relatively static. 95. With the growing challenge of an ageing population, workforce shortages and rising costs, IAs should work together to share learning and best practice from these digital initiatives, as digital technology and digital innovations will be an important consideration in early intervention and prevention strategies. Page 194 of 208
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343. Delayed discharges – what needs to happen 3. Delayed discharges – what needs to happen Scotland’s Population Health Framework and the Health and Social Care Service Renewal Framework offer an opportunity for a common focus on prevention across health and social care. But it is not clear how the shared accountability and joint decision-making needed across all stakeholders will be achieved and how the underlying challenges in the social care sector will be addressed. The lack of a consistent approach to evaluating initiatives makes it very difficult to understand their impact. More needs to be done to understand the true costs of delays, what actions and initiatives are providing better quality of outcomes for individuals, and which approaches represent value for money for public spending. There is a long-term recognition of the need for extensive change in the health and social care sector to improve outcomes, including a focus on prevention, shifting the balance of funding and better collaborative working across sectors and organisations 96. In 2005, we published Moving on? An overview of delayed discharges in Scotland. In this report, we highlighted that solving the problem of delayed discharges needs action across all parts of the health and care system. In our Health and social care integration: Update on progress report, published in November 2018, we reported that significant changes are required in the way that health and care services are delivered, and highlighted: • appropriate leadership capacity must be in place • all partners need to be signed up to and engaged with the reforms Page 195 of 208
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3. Delayed discharges – what needs to happen 35 • partners also need to improve how they share learning • change cannot happen without meaningful engagement with staff, communities and politicians. 97. At both a national and local level, all partners need to work together to be more honest and open about the changes that are needed to sustain health and care services in Scotland. 98. These messages were reiterated in our Integration Joint Boards: Finance and performance report, published in July 2024. It highlighted that we still have not seen significant evidence of the shift in the balance of care from hospitals to the community intended by the creation of IJBs. It also noted there is a lack of collaboration and systematic shared learning. Scotland’s population health framework and the health and social care service renewal framework provide high-level guidance for change, but more clarity is needed on how these ambitions will be achieved 99. In June 2025, the Scottish Government and COSLA launched Scotland’s Population Health Framework 2025–2035 (PHF) and the Health and Social Care Service Renewal Framework (SRF). Both frameworks are a welcome development, recognising the need for a cross- sector approach to address the challenges of health and social care, with a focus on prevention at the core. Scotland’s population health framework provides a common vision, but it is not clear how shared accountability and joint decision- making will be achieved and there is limited reflection of the role of social care 100. The PHF sets out at a high level ‘a ten-year approach to improving health and wellbeing in Scotland’. It focuses on population-level prevention by improving health outcomes and reducing inequalities across Scotland. It clearly recognises the need to engage across public, private and third sector bodies to have a meaningful impact on public health and wellbeing and address these inequalities. 101. Although delayed discharges are not a central theme, the scope of the framework, which includes a cross-sector approach focusing on prevention drivers of health and wellbeing, supports actions to indirectly address delayed discharges. Importantly, the role of social care, as a critical element in the infrastructure for public health, is not fully recognised. The framework largely reflects the issues from an NHS perspective. This imbalance risks the achievement of the aims of this framework, including improving outcomes such as reducing delayed discharges. 102. The framework is a positive step towards having common aims to achieve long-term improvement of outcomes, although it is not clear how the shared accountability and joint decision-making needed across all stakeholders will be achieved, and it remains to be seen whether the required cross-sector buy-in can be achieved. Page 196 of 208
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3. Delayed discharges – what needs to happen 36 The Health and Social Care Service Renewal Framework is an opportunity for progress to be made with health and social care reform but IJBs and social care need to be more central to the arrangements, and it is not clear how the framework approach will address the leadership, cultural, financial and governance barriers that integration has not managed to overcome over the past ten years 103. The SRF provides a high-level guide for change, to ensure the sustainability, efficiency, quality and accessibility of health and social care services in Scotland. It sets out a shift towards a community-orientated approach to health and social care which, in turn, will contribute to better integration of services to meet individuals’ and families’ needs. 104. The SRF aims to ‘progress reform to ensure long-term financial sustainability, reduce health and care inequalities, further harness the benefits of digital technology, and improve health outcomes for people in Scotland’. The framework has the potential to reduce delayed discharges, improve workforce sustainability, and enhance patient outcomes, but only if it is implemented effectively and underpinned by genuine collaboration. 105. The SRF offers an opportunity to make the progress needed in the integration of health and social care. However, as with the PHF, there is limited reflection of social care or the role of IJBs. The Public Bodies (Joint Working) (Scotland) Act, 2014 (the Act) was intended to ensure that health and social care services were well integrated, that people receive the care they need at the right time and in the right setting, with a focus on community-based, preventative care. However, Scotland is yet to achieve this shift in the balance of care. The underlying challenges in the social care sector remain. It is not clear how the SRF approach will address the leadership, cultural, financial and governance barriers that integration has not managed to overcome over the past ten years. 106. Without IJBs and HSCPs being at the centre of the planning and decision-making about service renewal it is unlikely this framework will achieve the engagement and affect the change intended. In developing the plans to support this framework, more consideration is required of what this will mean for social care and social work services. The NHS Scotland operational improvement plan looks to address delayed discharges through reducing the pressure in hospitals and by shifting the balance of care 107. The NHS Scotland operational improvement plan (2025–2026),30 published in March 2025, is the Scottish Government’s short-term plan that sets out actions that are intended to progress reform and enhance NHS delivery. The plan is a useful summary of current key initiatives and commitments but does not set out specific actions in any detail. It looks to address delayed discharges and the pressures on hospitals through Page 197 of 208
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3. Delayed discharges – what needs to happen 37 programmes such as H@H, approaches to manage frailty, including specialist frailty services and managing frailty at A&Es and access to GPs and primary health care. 108. As highlighted in relation to the PHF and SRF, these approaches cannot be achieved in isolation and need to be planned and progressed in partnership with the social care sector, primarily through the IAs and HSCPs. In isolation, the NHS is limited in how effectively it can achieve the aims set out in this plan. The lack of a consistent approach to evaluating initiatives makes it very difficult to understand their impact and assess value for money 109. There has been significant work by the Scottish Government, integration authorities and their partners to reduce delays. Some regional areas are showing improved performance, but there has not been an overall assessment of the impact of these initiatives. Having a consistent approach to evaluating national initiatives for reducing delayed discharges and preventing hospital admissions would improve transparency of their effectiveness, if they are delivering value for money and if they are improving the balance of care which would help inform future resource allocation decisions. The Scottish Government does not measure the total costs associated with delayed discharges 110. As of October 2021, PHS stopped reporting the underlying costs of beds associated with delayed discharges, which was due to metrics being out of date and likely an underestimate of the true cost. 111. At present, the Scottish Government does not measure the total costs associated with delayed discharges. The Scottish Government recognises this as a gap in its data, but given the priority and investment in reducing delays, the Scottish Government needs to be able to understand the true costs of delays and the savings made through initiatives to reduce delayed discharges. In a system under extreme financial pressure, it is essential that the Scottish Government can identify the cost of delayed discharges and take targeted action to reduce them, enabling more effective and productive use of resources. The Scottish Government and COSLA do not have targets to monitor performance in reducing delays 112. The national mission to reduce delayed discharges was jointly agreed by the Scottish Government and COSLA, and between July 2024 and October 2024, the Scottish Government and COSLA assessed IAs performance against a national target of 34.6 delays per 100,000 population, based on a pre-pandemic rate, with each IA having to bring Page 198 of 208
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3. Delayed discharges – what needs to happen 38 down delays to a specific level to contribute to this national target. This was a time-bound target up to October 2024. By October 2024, the target was not met, with national performance at 44.8 delays per 100,000 population. A new target was not introduced. 113. The Scottish Government and COSLA now monitor IA performance based on the trajectories of the numbers of people delayed, outliers, and comparison with the Scottish average. At a national level, the delayed discharge rate has remained above 40 delays per 100,000 population, peaking at 44.8 in October 2024. 114. The Scottish Government, along with feedback from delivery partners and COSLA, advises that setting a single national target for delays may narrow focus and divert resources from community-based activities. While national targets can highlight key areas for improvement, they may not address the complexity of local issues. Measures should be set in consultation with partners to ensure they are evidence-based, sensitive to local circumstances, and linked to improved outcomes. Many local service providers prefer the indicators developed by the DwD collaborative, which considers the number of delays as one of several performance indicators. 115. Locally driven targets can help focus efforts to reduce delays where they will make the most impact. Analysis of local data on the processes and barriers faced in their local context has allowed some IAs to target investment and implement service changes that have resulted in reductions in delayed discharges. IAs involved in the DwD programme (Case study 3) have agreed four key targets to improve system flow, reduce delayed discharges and ensure actions put in place are achieving the intended impact: • Reduce acute geriatric length of stay by more than 20 per cent compared to March 2024 levels, by the end of March 2026. • Reduce community hospital and step-down care length of stay by more than 20 per cent compared to March 2024 levels, by the end of March 2026. • Reduce respective HSCP delayed discharges by more than 20 per cent compared to March 2024 levels, by end of March 2026, because of improved flow. • Less than 25 per cent of total delayed discharges in acute hospitals by December 2025. 116. The Scottish Government is working with the DwD group to ensure that all data reporting requirements and measures for monitoring are aligned. Page 199 of 208
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39EndnotesEndnotes Endnotes 1 Delayed discharges in NHS Scotland, annual summary of occupied bed days and census figures, data to March 2025 (planned revision), Public Health Scotland, December 2025. 2 Delayed discharges in NHS Scotland, annual summary of occupied bed days and census figures, data to March 2025, Public Health Scotland, June 2025. 3 Delayed discharges in NHS Scotland monthly, All delay reasons summary tables to October 2025, Public Health Scotland, December 2025. 4 Delayed discharges in NHS Scotland monthly, All delay reasons summary tables to October 2025, Public Health Scotland, December 2025; Mid-year population estimates for Scotland time series data, National Records of Scotland, August 2025. 5 Frailty Briefing, British Geriatrics Society, February 2025. 6 Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan, Scottish Government, March 2023. 7 Median length of delays at point of discharge, Standard delays tables to June 2025, Delayed Discharges in NHS Scotland monthly, Public Health Scotland, August 2025. 8 Code 9 delays tables to June 2025, Delayed Discharges in NHS Scotland monthly, Public Health Scotland, August 2025. 9 Adults with Incapacity Act Monitoring Report 2023-24, Mental Welfare Commission, September 2024. 10 Your future in your hands with Power of Attorney, NHS Greater Glasgow and Clyde, February 2025. 11 Delayed discharges in NHS Scotland, annual summary of occupied bed days and census figures, data to March 2025 (planned revision), Public Health Scotland, December 2025. 12 Hospital cost breakdown, specialty cost and activity – inpatients in all specialties (excluding long stay) (R040), Scottish Health Service Costs 2023/24, Public Health Scotland, February 2025. 13 National Care Home Contract (NCHC) Fee Negotiation 2025/25 Offer Letter to Scottish Care, Scotland Excel, March 2025. 14 Programme for Government 2024-25, Serving Scotland, the Scottish Government, September 2024. 15 NHS Scotland operational improvement plan, the Scottish Government, March 2025. 16 Programme for Government 2025-26, Building the Best Future for Scotland, the Scottish Government, May 2025. 17 NHS Scotland operational improvement plan, the Scottish Government, March 2025. 18 Health and Social Care Service Renewal Framework 2025-2035, Scottish Government and COSLA, June 2025. 19 Hospital at Home Programme progress update, Healthcare Improvement Scotland, May 2025. 20 Scottish Budget 2025 to 2026, the Scottish Government, December 2024. 21 Integrated Clinical Hub – the Scottish Ambulance Service Evolution, the Scottish Ambulance Service, June 2025. Page 200 of 208
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Endnotes 40 22 NHS Scotland Operational Improvement Plan, Scottish Government, March 2025. 23 Scotland Briefing Caring About Equality, Carers Week 2025. 24 Involving Carers in Discharge Planning, Health and Social Care Scotland, March 2019. 25 Power of Attorney – stakeholder toolkit, Health and Social Care Scotland, December 2024. 26 Legal Aid Enquiry, Scottish Legal Aid Board, April 2025. 27 Adults With Incapacity Amendment Act Summary and Analysis of Response to Consultation, the Scottish Government, January 2025. 28 The Integration Journey: Celebrating a decade of health and social care, the ALLIANCE, April 2025. 29 Strategic Plan 2021-2023, 2024-2027 update, East Ayrshire Health and Social Care Partnership, June 2025. 30 NHS Scotland operational improvement plan, the Scottish Government, March 2025. Page 201 of 208
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41Appendix Appendix Integration authorities’ performance (number and rate of delays at the monthly census point) between October 2024 and October 2025 October 2024 October 2025 Percentage change Delays at monthly census point Delays at monthly census point per 100,000 population Delays at monthly census point Delays at monthly census point per 100,000 population Aberdeen City 64 33.8 49 25.9 -23.4% Aberdeenshire 84 39.8 80 37.9 -4.8% Angus 30 31.8 17 18.0 -43.3% Argyll and Bute 33 44.8 53 71.9 60.6% Clackmannanshire and Stirling 54 45.2 45 37.7 -16.7% Dumfries and Galloway 79 65.3 101 83.5 27.8% Dundee City 25 20.4 23 18.8 -8.0% East Ayrshire 28 28.4 34 34.5 21.4% East Dunbartonshire 27 30.7 24 27.3 -11.1% East Lothian 38 41.2 31 33.6 -18.4% East Renfrewshire 12 15.6 17 22.0 41.7% Edinburgh 192 43.2 121 27.2 -37.0% Eilean Siar 16 73.9 25 115.5 56.3% Falkirk 65 50.2 68 52.5 4.6% Fife 128 41.9 113 37.0 -11.7% Glasgow City 231 42.8 252 46.7 9.1% Cont. Page 202 of 208
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Appendix 42 Integration authorities’ performance (number and rate of delays at the monthly census point) between October 2024 and October 2025 October 2024 October 2025 Percentage change Delays at monthly census point Delays at monthly census point per 100,000 population Delays at monthly census point Delays at monthly census point per 100,000 population Highland 223 114.2 215 110.1 -3.6% Inverclyde 7 10.8 13 20.0 85.7% Midlothian 32 40.5 20 25.3 -37.5% Moray 33 42.7 38 49.2 15.2% North Ayrshire 74 67.2 104 94.5 40.5% North Lanarkshire 106 38.4 103 37.3 -2.8% Orkney 7 38.7 15 82.9 114.3% Perth and Kinross 47 37.1 46 36.3 -2.1% Renfrewshire 20 13.0 9 5.8 -55.0% Scottish Borders 84 86.9 43 44.5 -44.8% Shetland 11 59.1 12 64.5 9.1% South Ayrshire 79 84.8 88 94.5 11.4% South Lanarkshire 124 45.9 107 39.6 -13.7% West Dunbartonshire 24 33.3 53 73.5 120.8% West Lothian 51 34.6 40 27.2 -21.6% Scotland 2030 44.8 1962 43.3 -3.3% Sources: Delayed discharges in NHS Scotland monthly, All delay reasons summary tables to October 2025, Public Health Scotland, December 2025. Mid-year population estimates for Scotland time series data, National Records of Scotland, August 2025 Page 203 of 208
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Delayed discharges A symptom of the challenges facing health and social care Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 www.audit.scot ISBN 978 1 915839 95 4 AGS: AGS/2026/1 Page 204 of 208
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead O icer Meeting Date Recurrence Reason / Notes Wednesday 18 February 2026 Financial Monitoring - Month 8 & Period 9 (December) Chief Finance O icer 18 February 2026 Quarterly Reserves Strategy 2026/27 Chief Finance O icer 18 February 2026 Annual Annual Governance Statement Actions - Progress Update Chief Finance O icer 18 February 2026 Biannual IJB Performance Report (Q2) Head of Planning, Performance & Quality Assurance 18 February 2026 Quarterly Internal Audit Progress Report 2025/2026 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 18 February 2026 Quarterly External Audit Report Chief Finance O icer 18 February 2026 Annual Governance Log Chief O icer 18 February 2026 Biannual Financial Regulations Chief Finance O icer 18 February 2026 Annual Wednesday 20 May 2026 Financial Monitoring - Final Outturn Chief Finance O icer 20 May 2026 Quarterly IJB Performance Report (Q3) Head of Planning, Performance & Quality Assurance 20 May 2026 Quarterly Internal Audit Plan 2026/2027 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 20 May 2026 Annual Internal Audit Progress Report 2025/2026 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 20 May 2026 Quarterly Item 15 Page 205 of 208
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead O icer Meeting Date Recurrence Reason / Notes IJB Risk Report Chief O icer 20 May 2026 Quarterly Wednesday 19 August 2026 Financial Monitoring - Month 4 & Period 4 (July) Chief Finance O icer 19 August 2026 Quarterly IJB Performance Report (Q4) Head of Planning, Performance & Quality Assurance 19 August 2026 Quarterly Internal Audit Progress Report 2025/2026 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 19 August 2026 Quarterly IJB Risk Report Chief O icer 19 August 2026 Quarterly Wednesday 21 October 2026 Financial Monitoring - Month 6 & Period 6 (September) Chief Finance O icer 21 October 2026 Quarterly IJB Performance Report (Q1) Head of Planning, Performance & Quality Assurance 21 October 2026 Quarterly Internal Audit Progress Report 2025/2026 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 21 October 2026 Quarterly IJB Risk Report Chief O icer 21 October 2026 Quarterly Future Reports Integration Joint Boards: Finance and Performance 2025 Chief Finance O icer TBC Annual Meeting date dependant on publishing from Audit Scotland Page 206 of 208
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead O icer Meeting Date Recurrence Reason / Notes Best Value Framework Chief Finance O icer TBC Triennial Best Value – Annual Statement of Compliance Chief Finance O icer TBC Annual Accounts Commission Reporting TBC TBC As and when publications released from Accounts Commission Local Code of Corporate Governance TBC TBC Annual Risk Management Strategy Business Support Manager TBC Triennial Risk Management Annual Report Business Support Manager TBC Annual Pharmacy Savings Approach TBC TBC Added to work plan from PFA rolling action log Page 207 of 208
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