Agenda Document Pack - IJB Performance, Finance and Audit Committee - 20/05/2026
North Lanarkshire Council · 20 May 2026
Back to IJB Performance, Finance and Audit Committee — 20 May 2026 and its agenda
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14 May 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, 20 May 2026 at 09:30 AM 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 146
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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 the Integration Joint Board Performance Finance & Audit of 18 February 2026 Submit Minute of Previous Meeting of Integration Joint Board Performance, Finance & Audit held on 18 February 2026. 5 - 10 4 IJB Performance, Finance & Audit Rolling Action Log Submit report by the Chair. 11 - 22 5 Matters Arising Verbal Update by the Chair. Performance and Finance 6 Financial Monitoring Report 2025-26 Submit report by the Chief Financial Officer. 23 - 42 7 IJB Reserves Strategy 2026-27 Submit report by the Chief Financial Officer. 43 - 50 8 Performance Update – 1 October 2025 to 31 December 2025 - Quarter 3 2025/2026 Submit report by the Chief Officer (Planning, Performance & Quality Assurance). 51 - 80 Governance and Policy 9 Internal Audit Progress Report 2025-26 Submit report by Chief Officer (Audit & Risk) and Chief Internal Auditor. 81 - 96 10 Draft Internal Audit Plan 2026-27 Submit report by Chief Officer (Audit & Risk) and Chief Internal Auditor. 97 - 104 11 Chief Finance Officer Role Submit report by Chief Officer. 105 - 112 12 Annual Governance Statement – Action Plan Progress Submit report by Chief Financial Officer. 113 - 124 Page 3 of 146
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13 IJB Risk Register Submit report by the Business Support Manager. 125 - 142 14 IJB Performance, Finance and Audit Work Plan Submit report by the Business Support Manager. 143 - 146 For Noting 15 Risk Consider from the business discussed any new emerging risks to be added to the risk register or whether the discussion materially alters the accessed levels of risk/risk tolerance or mitigating controls. Page 4 of 146
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INTEGRATION JOINT BOARD (PERFORMANCE, FINANCE AND AUDIT) COMMITTEE – WEDNESDAY, 18 FEBRUARY 2026 AT 2PM PRESENT North Lanarkshire Council Councillors McCrory (Chair); Barclay and Baudo. NHS Lanarkshire Brian Moor (Vice-Chair); Philip Couser and Siobhan White. ALSO PRESENT Heath and Social Care Partnership: Claire Rae; Joanne Jenkins; Nicola Scott; Lucy Munro; and Kerry Taylor. NHS: Nauman Dar; Mark Dell; Jacqui Jones; Jocelyn Lyall; Maggs Thomson; and Siobhan White. North Lanarkshire Council: Diane Fraser; Francis Scott; Graeme Cowan and Clare Louise McDonald. Other Attendees Eilidh Montgomery – Audit Scotland Catherine McGinty and John Watson – Unison Thomas Moan and David Wood – Voluntary Action North Lanarkshire Ann Muir – North Lanarkshire Disability Forum APOLOGIES John Boyd and Callum Green (Audit Scotland); Morag Dendy (NLC); Harry Robertson (North Lanarkshire Carers Together/Carer Representative). WELCOME AND APOLOGIES 1. The Chair welcomed all attendee’s to the meeting and noted apologies. Decided: that apologies be noted. DECLARATIONS OF INTERESTS 2. The Committee noted that there were no declarations. Item 3 Page 5 of 146
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MINUTE OF INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT COMMITTEE – 22 OCTOBER 2025 3. There was submitted the minute of the meeting of the Integration Joint Board Performance, Finance and Audit Committee held on 22 October 2025 for approval. Decided: that the minute of the meeting of the Integration Joint Board Performance, Finance and Audit Committee held on 22 October 2025, be approved. INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT ROLLING ACTION LOG 4. There was submitted the rolling action log providing an update on a number of actions arising from previous meetings. Decided: that the update on the rolling action log be noted. MATTERS ARISING 5. The Chair sought any matters arising from the Action Log. Decided: that there were no matters arising from the Action Log be noted. FINANCIAL MONITORING REPORT 2025/26 6. There was submitted a report by the Chief Finance Officer, Health and Social Care Partnership: (1) summarising the financial performance of North Lanarkshire University Health and Social Care Partnership for the period 1 April to 30 November 2025; (2) detailing the projected outturn position for 2025/26 is an overspend of £1.915m; (3) informing that the detail within the report is based on the NHS Lanarkshire period 8 report, and the North Lanarkshire Council period 9 report; and (4) highlighting the key financial pressures on the budget. Arising from discussion, it was agreed that more information on the health underspend, offset by out of area and private health care etc be provided in the next report. Decided: (1) that the projected outturn for 2025/26 with an overspend of £1.915m be acknowledged; and (2) that the contents of the report be otherwise noted. IJB RESERVES STRATEGY 2026/27 Page 6 of 146
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7. There was submitted a report by the Chief Finance Officer, Health and Social Care Partnership: (1) providing an update on the review of the North Lanarkshire Integration Joint Board reserves; (2) setting out the strategic approach, through the Reserves Strategy; (3) informing that the projected reserves balance, as at 31 December 2025 had increased to £73.031m, arising from a review undertaken within Health Services; (4) intimating that a final review of the 2025/26 reserve balances, and the 2026/207 forecast would be completed following year end closure of the 2025/26 accounts; (5) summarising the requirement for realigning the Social Care Services reserve, to support transparency and ensure the remaining balance is held solely for risk-based purposes; and (6) seeking approval for the realignments, as detailed within section 6.4 of the report and to reduce the contingency reserve from 5% to 4%. Decided: (1) that the realignments outlined in section 6.4 of the report, be approved; (2) that the reduction of contingency reserve to 4%, be approved; and (3) that the contents of the report be otherwise noted. PERFORMANCE REPORT UPDATE – 1 JULY TO 30 SEPTEMBER 2025 QUARTER 2 2025/26 8. There was submitted a report by the Chief Officer (Planning, Performance and Quality Assurance), North Lanarkshire Council: (1) setting out an overview of performance of the Integration Joint Board for the period 1 July to 30 September 2025, Quarter 2; and (2) enclosing within the appendix to the report Areas for Improvement. Arising from discussion, it was agreed that the Chair and Vice Chair write to Alcohol Brief Interventions Services to congratulate the improvement work undertaken, on behalf of the Board which was agreed. During discussion on this matter, a question was asked in which officers committed to responding to outwith the meeting. “Is the issue with Alcohol Brief Interventions was a National issue, or more of a local issue?” Brian Moore. Decided: that the Performance Report Update, for the period 1 July to 30 September 2025, Quarter 2 and accompanying appendix, be noted. INTERNAL AUDIT PROGRESS REPORT 2024/25 AND 2025/26 9. There was submitted a report by the Chief Finance Officer: (1) setting out progress in respect of the Internal Audit work for 2024/25 and 2025/26; (2) informing that the 2024/25 Internal Audit Plan had been completed; (3) Page 7 of 146
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highlighting that the workplan had been agreed to ensure the Internal Audit Plan 2025/26 is delivered to inform the annual internal audit opinion; and (4) enclosing within the appendices to the report the Progress Report, a Summary of Relevant Partner Reports and the Final IJB Strategy Report. During discussion on this matter, a question was asked in which officers committed to responding to outwith the meeting. “Regarding the Review of NHS Lanarkshire resilience and business continuity, is there anything for implementation for IJB at this stage?” Brian Moore. Decided: that the Internal Audit Progress Report 2024/25 and 2025/26 be noted. NORTH LANARKSHIRE INTEGRATION JOINT BOARD – DRAFT ANNUAL AUDIT PLAN 2025/26 10. There was submitted a report by Audit Scotland providing the draft North Lanarkshire Integration Joint Board Annual Audit Plan 2025/26. Thereon, Eilidh Montgomery was heard in further explanation of the report, highlighting that the North Lanarkshire Integration Joint Board Annual Audit Plan 2025/26 was no longer in draft form and had now been finalised, with the only change being the removal of the word ‘draft’. Decided: that the North Lanarkshire Integration Joint Board Annual Audit Plan 2025/26 be noted. ANNUAL GOVERNANCE STATEMENT – ACTION PLAN PROGRESS 11. There was submitted a report by the Chief Financial Officer: (1) outlining the actions agreed with the External Auditor, Internal Auditor and Senior Management Team to further develop the IJB governance framework; and (2) summarising the Annual Governance Statement Action Plan progress. Thereon, the Chief Financial Officer was heard in further explanation of the report, highlighting continuing ongoing progress to complete the actions within the timeframe. Decided: that further progress reports, be presented to future meetings of the Committee in respect of the ongoing actions, be noted. NORTH LANARKSHIRE INTEGRATION JOINT BOARD GOVERNANCE LOG 12. There was submitted a report by the Business Support Manager detailing an overview of the governance issues identified. Decided: Page 8 of 146
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(1) that further progress reports, be presented to future meetings of the Committee in respect of the ongoing actions, be noted, and (2) that the contents of the report be otherwise noted. AUDIT SCOTLAND - COMMUNITY HEALTH & SOCIAL CARE: PERFORMANCE REPORT 2025 13. There was submitted a report by the Chief Officer (Planning, Performance and Quality Assurance): (1) providing an update on the publication of Audit Scotland’s report into Community Health and Social Care Performance 2025; and (2) outlining the key findings along with North Lanarkshire Council’s and Health and Social Care Partnership’s response. Decided: that 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, be endorsed. AUDIT SCOTLAND DELAYED DISCHARGES: A SYMPTOM OF THE CHALLENGES FACING HEALTH AND SOCIAL CARE 14. There was submitted a report by the Chief Officer (Planning, Performance and Quality Assurance): (1) providing an update on the publication of Audit Scotland’s report Delayed Discharged: A Symptom of Challenges facing Health and Social Care; and (2) outlining the key findings along with North Lanarkshire Council’s and Health and Social Care Partnership’s response. Decided: that the report be endorsed. NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN 15. There was submitted a report by the Business Support Manager detailing the Work Plan of the North Lanarkshire Integration Joint Board Performance, Finance and Audit Committee. Decided: that the updated Work Plan of the North Lanarkshire Integration Joint Board Performance, Finance and Audit Committee be noted. Page 9 of 146
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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 Item 4 Page 11 of 146
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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 12 of 146
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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 13 of 146
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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 14 of 146
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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 15 of 146
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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 16 of 146
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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 17 of 146
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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 18 of 146
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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 19 of 146
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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 20 of 146
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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 21 of 146
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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 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. 27.08.20 25 Item 4 Matters Arising Use of reserves (to be discussed under Finance) Complete – Paper on agenda for 18 Feb 2026 Page 22 of 146
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REPORT Item No: 06 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 31 March 2026 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 outturn for 2025/26 is a £30.511m underspend before the removal of £26.769m earmarked and ringfenced balances resulting in an underspend of £3.742m. 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: 20 May 2026 Yes No N/A Item 6 Page 23 of 146
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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 report uses outturn figures from NHSL and NLC. Although further movement is not expected, final adjustments may arise during year‑end close. As detailed in Table 1, the outturn position, prior to removal of ring-fenced / ear marked balances, is an underspend of £30.511m. Table 1 7.2 The majority of ring‑fenced and earmarked reserves are held within Health Services, reflecting funding received for commitments extending into 2026/27 as directed by NHSL and the Scottish Government. Key balances include £8.9m for ligature works, £2.0m of Marmot funding, £9.5m for unscheduled care, and £1.2m for medicines growth. These balances will be transferred to reserves and reflected in the opening balances within the separate Reserves Strategy report. 7.3 Excluding these balances, the IJB’s operating outturn represents an underspend of £3.742m. This variance reflects an underspend of £3.297m within services delegated to Health and £0.445m within services delegated to Social Care. Further detail is provided in Appendix 3. 7.4 An explanation of the significant projected variances within these delegated services are provided below: 7.4.1 Employee Costs (Pays) There is an underspend in this area of £3.688m. Recruitment and retention pressures continue across services, with a number of roles proving difficult to fill due to skills shortages and competition from other sectors. Section 10 outlines current vacancy levels and the resulting impact on agency, bank, and overtime expenditure. £m £m £m £m £m £m £m Health Care Services 631.633 -2.528 629.105 599.528 29.577 (26.280) 3.297 Social Care Services 279.068 -2.157 276.911 275.976 0.934 (0.489) 0.445 TOTAL 910.701 -4.685 906.016 875.504 30.511 (26.769) 3.742 Less Ring- Fenced / Ear Marked Underspend Revised Year End Variance 2024/25 Annual Budget 2025/26Care Group Projected Year End Variance 2025/26 Projected Year End Spend 2025/26 In Year Drawdown From Reserves Revised Budget 2025/26 Page 24 of 146
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Social Care Services 7.4.2 Excluding employee costs reported in section 7.2.1, the services delegated to Social Care are reporting a net overspend of £2.354m, which is represented by underspends within property costs, transport costs and supplies and services offset by overspends within admin costs and payment to other bodies (PTOB). 7.4.3 Expenditure within PTOB is predominantly associated with Care at Home and Independent Care Homes. The MTFP incorporated £7.548m of savings for 2025/26; the overspend reflects the shortfall in delivery against these targets. Further information is set out in Section 9. 7.4.4 The projections for independent care homes and care at home provision are demand led and the final position on these is as follows: Independent care homes have a yearly budget to fund 1,344 care plans however the actual care plans in place at the close of the year was 1,427 resulting in an overspend of £2.660m. Care at Home costs had an outturn overspend of £0.852m, the budget is based on funding 2,514 care plans however the actual plans in place were 2,880. Health Services 7.4.5 Excluding the ring fenced and ear marked balances, non pay costs are reporting a year end underspend of £0.470m. 7.4.6 Prescribing recorded an overspend of £4.757m in 2024/25. In recognition of ongoing pressures and anticipated growth, the budget was increased by £12.350m, resulting in a marginal underspend of £0.014m in the current year. Based on data to January 2026, with estimates for February and March, the average cost per item has risen to £10.31 (from £10.22), alongside a 1.24% increase in items dispensed compared to the same period last year. 7.4.6 Hosted Services led by North Lanarkshire IJB have reported an overall underspend of £3.603m. 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 Family Nurse Partnership, Learning Disability Services and Adult Psychiatry. Primary Care Improvement Fund 7.4.7 Previous reports advised of a projected overspend on the Primary Care Improvement Fund, hosted by South IJB. The final position is an overspend of £0.484m; however, in line with the treatment of all hosted services, the lead IJB manages any overspends and retains any underspends. There is therefore no financial impact on North IJB. 8. GENERAL RESERVES 8.1 Maintaining adequate reserves remains fundamental to the IJB’s long‑term financial resilience, ensuring capacity to respond to unforeseen pressures. This reflects statutory requirements and supports the broader framework for prudent financial management within section 106 bodies. 8.2 The opening reserve balance for 2025/26 was £75.554m. Following in‑year drawdowns, the revised balance is £70.869m, as summarised in Table 2. Page 25 of 146
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Table 2 8.3 A detailed list of all reserve movements during 2025/26 is detailed in appendix 5. 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. 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. 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 (0.607) 14.232 NLC/NHSL Earmarked Reserves 25.060 0.267 (3.701) 21.626 NLC/NHSL Risk-Based Reserves 21.536 (0.267) (0.377) 20.892 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 (4.685) 70.869Total LEAD SUMMARY Transfers To / From Reserves Drawdown from Reserves £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 26 of 146
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9.4 The year end IJB savings position, show total savings achieved of £9.107m (61%). This is summarised in chart 1 with more detail provided at Appendix 6. Chart 1 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. Establishment Actual Vacancies FTE FTE FTE North West Locality 384.82 360.78 24.04 North East Locality 322.37 294.20 28.17 Adult Services 294.41 267.90 26.51 Children Services 590.61 561.01 29.60 Mental Health 1,208.14 1,277.00 -68.86 Social Care Services 959.34 823.55 135.79 Home Support 971.07 901.13 69.94 Other 207.23 209.58 -2.35 TOTAL 4,937.99 4,695.15 242.84 Position as at 31 March Service Page 27 of 146
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Table 5 11. IMPLICATIONS 11.1 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 ☒ 11.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 11.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 11.4 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. Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.038 0.027 0.820 0.006 0.891 North East Locality 0.014 0.011 0.460 0.000 0.485 Adult Services 0.043 0.106 0.358 0.000 0.507 Children Services 0.094 0.088 0.912 0.185 1.278 Mental Health 0.322 0.071 5.118 4.188 9.700 Social Care Services 0.878 - - 0.046 0.924 Home Support 3.819 - - - 3.819 Other 0.009 0.014 0.071 - 0.094 TOTAL 5.217 0.317 7.738 4.424 17.697 SERVICE Costs as at 31 March 2026 Page 28 of 146
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Relevant Risk Register Details Current Risk Level Risk Owner Financial Sustainability – Short Term High Nicola Scott Financial Sustainability – Medium Term Very High Nicola Scott Financial Sustainability – LongTerm Very High Nicola Scott Governance Failure High Nicola Scott Failure to meet Legislative Requirements High Pauline Izat / Morag Dendy / Joanne Jenkins 11.5 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) 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. 11.6 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 29 of 146
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12. BACKGROUND PAPERS None. 13. 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 31 March 2026 Appendix 4.1 Hosted Services led by North Partnership to 31 March 2026 Appendix 4.2 Hosted Services led by South Partnership to 31 March 2026 Appendix 5 Movement in Reserves 2025/26 Appendix 6 Savings Progress to 31 March 2026 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 30 of 146
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Appendix 1 North Lanarkshire IJB Annual Budget 2025/26 Annual Budget 2025/26 £m Health Care Services Health Care 334.893 Hosted Services 216.815 Set-Aside Budget 77.397 Total Expenditure - NHSL 629.105 Social Care Services Social Care Services Gross Expenditure 280.206 Social Care Services Gross Income (5.869) Social Care Services Net Expenditure 274.337 Housing Revenue Account 2.573 Social Care, Housing and Transport Services Net Expenditure 276.911 Total Expenditure - NHSL and NLC 906.016 Annual Budget 2025/26 £m NHS Lanarkshire Funding (624.420) Social Care Funding (24.119) Resource Transfer (24.690) Commissioned Services (7.226) Transfer from Reserves (Approved) (2.528) Total Funding - NHSL (682.983) NLC Funding - Social Care Services (218.302) NLC Funding - Housing Services (2.573) Transfer from Reserves (Approved) (2.157) Total Funding - NLC (223.033) Total Funding - NHSL and NLC (906.016) Care Group Funded By: Page 31 of 146
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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 Additional NLC Conttribution - Pay Award 1.061 South Hosted @ 52% 43.332 NLC Financial Allocation at 30 January 2026 220.992 Family Health Service South @ 52% 136.482 Reduction for IFRS Adjustment -0.116 NHSL Financial Allocation at 31 May 2025 626.323 NLC Financial Allocation at 31 March 2026 220.876 NHSL Financial Allocation at 30 June 2025 639.102 NHSL Financial Allocation at 31 July 2025 642.015 NHSL Financial Allocation at 31 August 2025 640.805 NHSL Financial Allocation at 30 September 2025 646.681 NHSL Financial Allocation at 31 October 2025 646.730 NHSL Financial Allocation at 30 November 2025 647.461 NHSL Financial Allocation at 31 December 2025 653.276 NHSL Financial Allocation at 31 January 2026 654.837 NHSL Financial Allocation at 28 February 2026 667.314 Budget Adjustments Posted in Month 12 IJB Reserves North 0.079 North Income 0.767 Allocations 12.440 Financia MGT 2.548 Area Wide 1.054 Prescribing -0.145 South Hosted Serv 52% 0.321 FHS 0.761 NHSL Financial Allocation at 31 MARCH 2026 685.139 Page 32 of 146
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Appendix 3 North Lanarkshire IJB Revenue Budget Position 1 April 2025 to 31 March 2026 Annual Year To Date Variance Budget Budget Actual Total 2025/26 March 2026 March 2026 March 2026 £m £m £m £m Health Care Services Locality and Other Services 88.010 88.010 63.073 24.937 Addiction Services 4.460 4.460 4.010 0.450 Medical and Nursing Directorate 4.018 4.018 3.957 0.061 Prescribing 81.000 81.000 80.986 0.014 Out of Area Services 1.723 1.723 1.606 0.116 Area Wide Services 10.065 10.065 9.671 0.394 Family Health Services 145.617 145.617 145.617 0.000 Hosted Services 216.815 216.815 213.211 3.604 Set-Aside Budget 77.397 77.397 77.397 0.000 Total Expenditure - NHSL 629.105 629.105 599.528 29.577 Social Care Services Social Care Services Gross Expenditure 280.206 280.206 281.834 (1.628) Social Care Services Gross Income (5.869) (5.869) (8.295) 2.427 Social Care Services Net Expenditure 274.337 274.337 273.539 0.799 Housing Revenue Account 2.573 2.573 2.438 0.136 Social Care, Housing and Transport Services Net Expenditure 276.911 276.911 275.976 0.934 Total Expenditure - NHSL and NLC 906.016 906.016 875.505 30.511 Care Group Year To Date Page 33 of 146
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Appendix 4.1 HOSTED SERVICES March 2026 March 2026 March 2026 March 2026 March 2026 March 2026 Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m Sexual Health Services 3.833 1.993 1.848 0.145 1.840 1.840 0.000 Continence Services 3.292 1.712 1.691 0.021 1.580 1.580 0.000 Immunisation Services 5.425 2.821 2.970 (0.149) 2.604 2.604 0.000 Speech and Language Therapy Services 7.464 3.881 3.559 0.323 3.583 3.583 0.000 Children and Adolescents Mental Health Services 16.267 8.459 6.011 2.448 7.808 7.808 0.000 Childrens Services 17.155 8.921 8.893 0.028 8.235 8.235 0.000 Integrated Equipment and Adaptations Store 0.567 0.295 0.523 (0.228) 0.272 0.272 0.000 Dietetics Services 4.811 2.502 2.505 (0.003) 2.309 2.309 0.000 Podiatry Services 4.968 2.583 2.246 0.338 2.385 2.385 0.000 Prisoner Healthcare Services 2.579 1.341 1.094 0.247 1.238 1.238 0.000 Blood Borne Viruses Services 1.843 0.958 0.881 0.077 0.885 0.885 0.000 Hospital at Home 3.373 1.754 1.918 (0.164) 1.619 1.619 0.000 Mental Health and Learning Disability Services 97.921 50.919 50.397 0.521 47.002 47.002 0.000 TOTAL 169.498 88.139 84.535 3.604 81.359 81.359 0.000 Outturn North Lanarkshire IJB - 52% Share South Lanarkshire IJB - 48% Share Led by the North Partnership Annual Budget 2025/26 Outturn Page 34 of 146
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Appendix 4.2 HOSTED SERVICES March 2026 March 2026 March 2026 March 2026 March 2026 March 2026 Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m Community Dental Services 8.780 4.108 4.108 0.000 3.792 3.594 0.199 Brain Injury Unit 2.685 1.280 1.280 0.000 1.182 1.172 0.010 Out of Hours Services 10.872 5.141 5.141 0.000 4.745 4.698 0.048 Palliative Care Services 10.739 4.887 4.887 0.000 4.511 4.490 0.021 Physiotherapy Services 12.600 5.894 5.894 0.000 5.440 5.367 0.074 Primary Care Services 0.967 0.458 0.458 0.000 0.422 0.276 0.146 South Improving Cancer Journey 0.410 0.198 0.198 0.000 0.183 0.306 (0.124) Occupational Therapy Services 10.616 4.738 4.738 0.000 4.373 4.068 0.306 Diabetic Services 7.135 3.107 3.107 0.000 2.868 3.327 (0.459) Primary Care Improvement Fund 26.189 13.618 13.618 0.000 12.571 13.055 (0.484) Primary Care Transformation Fund 0.000 0.000 0.000 0.000 0.000 0.000 TOTAL 90.994 43.429 43.429 0.000 40.088 40.352 (0.264) North Lanarkshire IJB - 52% Share South Lanarkshire IJB - 48% Share Led by the South Partnership Annual Budget 2025/26 Outturn Outturn Page 35 of 146
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Appendix 5 MOVEMENT IN RESERVES 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 2024/25 NHSL Area Wide Services - Refugees and Displaced Persons 0.123 (0.002) 0.121 (0.002) 2024/25 2025/26 NHSL Blood-Borne Viruses Services 0.318 0.000 0.318 0.000 2023/24 26/27 proposed reduction NHSL Community Living Change Fund 0.055 (0.011) 0.044 (0.011) 2023/24 2025/26 NHSL District Nursing 0.373 0.373 0.000 2024/25 2024/25 NHSL Hospital at Home Services 0.915 (0.102) 0.813 (0.102) 2024/25 2025/26 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2022/23 Noy yet utilised NHSL Long Covid Pathways 0.289 (0.289) 0.000 (0.289) 2023/24 2025/26 NHSL Mental Health Action 15 0.730 0.730 0.000 2023/24 2024/25 NHSL Mental Health Diagnostic Support Service Dementia Post 1.057 1.057 0.000 2024/25 2024/25 NHSL Mental Health Digital Therapy Post 0.221 (0.000) 0.221 (0.000) 2024/25 2024/25 NHSL Mental Health Distress Brief Intervention 2.704 2.704 0.000 2024/25 2024/25 NHSL North Planning Band 2-4 Posts & Multi-Disciplinary Teams 2.719 (0.023) 2.696 (0.023) 2024/25 2025/26 NHSL Pharmacy Mental Health Recovery & NES Training 0.800 (0.629) (0.171) 0.000 (0.800) 2024/25 2025/26 NHSL School Nursing 0.274 0.629 0.903 0.629 2024/25 2024/25 NHSL Third Sector Initiatives To Improve Health 0.075 0.075 0.000 2024/25 2024/25 NHSL Upper GI Dietetics Band 4 0.014 (0.008) 0.006 (0.008) 2024/25 2025/26 14.839 0.000 0.607 14.232 0.607TOTAL RING-FENCED RESERVES LEAD RING-FENCED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Financial Year Reserve Established Financial Year Reserve Last Utlised Page 36 of 146
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Appendix 5 (Contd) 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 2025/26 Noy yet utilised NHSL Children and Adolescent Mental Health Services 2.774 0.000 2.774 0.000 2022/23 26/27 proposed reduction NHSL Frailty Nursing 1.715 (1.714) 0.001 (1.714) 2023/24 2025/26 NHSL Unscheduled Care Funding 2.790 2.790 0.000 2023/24 2023/24 NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 0.000 2022/23 2023/24 NHSL Adult Social Care Winter Preparedness Fund 1.000 1.000 0.000 2022/23 2023/24 NHSL Staff Wellbeing 0.254 0.000 0.254 0.000 2022/23 Noy yet utilised NHSL Minor Capital Works 1.027 (0.079) 0.948 (0.079) 2022/23 2025/26 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.268 0.268 0.000 2024/25 2024/25 NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000 2023/24 26/27 proposed reduction NHSL Kylepark Works 0.134 0.134 0.000 2023/24 Proposed Closure NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.087 0.087 0.000 2024/25 Proposed Closure NHSL Breast Feeding Team (2 year funding) 0.345 0.000 0.345 0.000 2023/24 26/27 proposed reduction NHSL Dietetics Services - Double Running Costs 0.055 0.055 0.000 2022/23 2024/25 NHSL Health Inequalities - Screening 0.016 (0.016) 0.000 (0.016) 2021/22 2025/26 NHSL Health Visiting Students/Trainees 0.029 0.029 0.000 2023/24 2024/25 NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000 2022/23 Noy yet utilised NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.293 (0.099) 0.194 (0.099) 2023/24 2025/26 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.538 (0.009) 0.529 (0.009) 2022/23 2025/26 NHSL Podiatry Services - Foot Screening 0.342 (0.004) 0.338 (0.004) 2022/23 2025/26 NHSL Scottish Clinical Leadership Fellowship 0.060 0.000 0.060 0.000 2022/23 2023/24 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.297 0.297 0.000 2019/20 26/27 proposed reduction Financial Year Reserve Last Utlised LEAD EARMARKED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Financial Year Reserve Established Page 37 of 146
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Appendix 5 (Contd) NHSL Staff Training Academy 0.335 0.000 0.335 0.000 2023/24 26/27 proposed reduction NHSL Vulnerable and Complex Cases - Test of Change 0.501 0.000 0.501 0.000 2023/24 26/27 proposed reduction NLC Business Case - Non-Recurring NLC Costs 0.309 0.065 (0.352) 0.022 (0.287) 2022/23 2025/26 NLC Carers Act 2018 - Support 2.604 (0.182) 2.422 (0.182) 2022/23 2025/26 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.230 (0.119) 0.111 (0.119) 2022/23 2025/26 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.332 (0.287) 3.045 (0.287) 2022/23 2025/26 NLC Digital and IT Strategy Technology Improvements - SWIS 0.084 (0.084) 0.000 (0.084) 2022/23 2025/26 NLC Home Support Resilience (2 year funding) 0.577 (0.090) 0.487 (0.090) 2023/24 2025/26 NLC IJB Helpline (2 years funding) 0.137 (0.137) 0.000 (0.137) 2022/23 2025/26 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.149 0.000 0.149 0.000 2022/23 2024/25 NLC Staff Training Academy 0.704 (0.278) 0.426 (0.278) 2022/23 2025/26 NLC MHO Capacity Funding 0.388 (0.097) 0.291 (0.097) 2025/26 2025/26 NLC Statutory Appropriate Adults 0.161 0.000 0.161 0.000 2025/26 Noy yet utilised NLC Participation & Engagement Locality 0.006 (0.006) 0.000 (0.006) 2025/26 2025/26 NLC Sessional - School summer placements 0.128 0.202 (0.148) 0.182 0.054 2025/26 2025/26 25.060 0.267 (3.701) 21.626 (3.434)TOTAL EARMARKED RESERVES Page 38 of 146
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Appendix 5 (Contd) Opening Balance as at Revised Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Prescribing Fund 5.066 5.066 0.000 2017/18 Noy yet utilised NLC Social Care Demand 16.470 (0.267) (0.377) 15.826 (0.644) 2021/22 2025/26 21.536 (0.267) (0.377) 20.892 (0.644) 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 (0.000) 14.119 0 2022/23 Noy yet utilised 14.119 0.000 (0.000) 14.119 0 75.554 0.000 (4.685) 70.869 (4.685) TOTAL CONTINGENCY FUND RESERVES TOTAL RESERVES LEAD CONTINGENCY FUND RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Financial Year Reserve Established Financial Year Reserve Last Utlised Financial Year Reserve Established Financial Year Reserve Last Utlised TOTAL RISK-BASED RESERVES LEAD RISK-BASED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Page 39 of 146
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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 0.224 2.614 - 0 2.614 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 2.049 2.661 - 0 2.661 Care at Home A review of the guided self-assessment process to align with a more strategic assessment and planning practice. 2.838 2.247 0.591 - 0 0.591 TOTAL SOCIAL CARE SERVICES 10.386 4.52 5.866 0 5.866 Budget Management Non Pays A review of budget lines including (but not limited to) travel, training and printing costs. 0.247 0.246 0.001 - 0 0.001 Prescribing A review of prescribing will be undertaken with a 5% savings target being applied. 4.326 4.341 -0.015 - 0 -0.015 TOTAL HEALTH CARE SERVICES 4.573 4.587 -0.014 0 -0.014 TOTAL HEALTH & SOCIAL CARE PARTNERSHIP 14.959 9.107 5.852 0 5.852 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 40 of 146
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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 72,607 48,337 22,545 90,803 384,899 3,492 622,683 2 71,418 41,152 29,022 80,792 379,200 7,439 609,024 3 77,695 42,872 20,265 77,774 415,502 7,207 641,315 4 81,834 58,168 38,071 59,872 461,851 7,115 706,911 5 71,192 47,421 34,659 47,566 467,144 7,003 674,985 6 72,699 39,771 27,262 77,790 449,717 3,924 671,163 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 9 65,107 44,527 33,415 90,786 395,917 7,466 637,218 10 40,866 24,562 36,474 69,457 438,949 6,943 617,251 11 62,528 4,960 22,228 74,613 353,269 5,420 523,018 12 74,096 22,630 14,203 92,115 519,218 5,232 727,493 TOTAL 819,827 459,769 358,011 911,841 5,118,377 70,604 7,738,429 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 9 0 0 0 6,608 367,934 0 374,543 10 1,074 0 0 3,355 264,358 0 268,788 11 479 0 0 19,814 310,844 3,717 334,854 12 1,348 0 0 43,205 384,382 9,903 438,838 13 -21,486 -21,486 TOTAL 5,522 - - 184,838 4,187,869 45,866 4,424,095 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 -90 1,945 2,852 3,850 32,470 72,573 292,877 232 406,709 10 1,644 754 2,335 10,076 27,419 82,917 213,306 1,607 340,057 11 5,538 -2,632 293 19,853 25,389 63,314 289,870 394 402,018 12 2,657 593 3,131 33,257 29,262 105,522 329,668 731 504,820 13 160,901 520,099 681,000 TOTAL 38,358 14,202 42,568 93,821 322,123 877,658 3,818,915 9,211 5,216,856 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 9 1,733 2,533 7,066 7,782 7,024 558 26,696 10 1,037 847 7,118 9,457 6,566 1,111 26,135 11 3,224 933 5,977 6,819 4,529 1,041 22,523 12 2,931 1,527 6,027 8,120 8,315 1,752 28,672 TOTAL 27,061 11,361 106,254 87,740 71,156 13,865 317,436 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 41 of 146
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REPORT Item No: 07 SUBJECT: IJB Reserves Strategy 2026/27 TO: Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 20 May 2026 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 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 PFA Committee: (1) Acknowledge the contents of the report. (2) Approve the proposed realignments and new reserves detailed in Appendix 1. (3) Approve the retention of the 4% target for risk‑based and contingency reserves, as detailed in section 7. 4. VARIATIONS TO DIRECTIONS 5. 2025/26 FINAL OUTTURN AND RESERVE ALLOCATION 5.1 Maintaining adequate financial reserves is critical to the IJB’s long-term stability and sustainability, providing capacity to respond to unforeseen financial pressures. The statutory importance of holding reserves forms part of the wider framework designed to ensure section 106 public bodies manage their finances responsibly. Yes No N/A Item 7 Page 43 of 146
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5.2 The Financial Monitoring report presented to the Committee confirms an underspend of £30.511m for 2025/26, including £26.769m of ring-fenced and ear marked funding for commitments and national priorities. The Partnership must now determine how this underspend is to be applied to reserve balances. 5.3 The IJB Reserves Strategy 2025/26 provides a framework to support this decision‑making and presents an opportunity to strengthen long‑term financial sustainability. It does so by reviewing all existing reserves to ensure they remain appropriate, necessary, and sufficient to meet ongoing and emerging financial pressures. Through the application of the Reserves Strategy, the IJB will be better positioned to balance current commitments while proactively planning for, and managing, future financial risks. 6. IJB RESERVES STRATEGY 2026/27 6.1 As set out in Table 1, reserve balances at 1 April 2026 totalled £75.554m. 6.2 In‑year drawdowns were applied against approved commitments funded from ring‑fenced and earmarked reserves. Following these movements, the Partnership’s closing reserves position was £70.869m. Further detail is provided in Appendix 5 of the Financial Monitoring report. 6.3 The closing balance comprises £14.232m of ring‑fenced reserves to support specific Scottish Government programmes, £21.626m of earmarked reserves for time‑limited commitments, and £35.011m of risk and contingency reserves. These uncommitted balances provide financial flexibility to respond to emerging pressures and risks. Table 1 6.4 As part of the year‑end process, a comprehensive review of all reserves was undertaken by both partners to confirm that balances held for 2025/26 remain appropriate and sufficient to address ongoing financial pressures. This review also incorporated the proposed allocation of the 2025/26 surplus. 6.5 Following this review, a revised reserves position has been developed and is detailed in Appendix 1 and summarised in Table 2. This includes: Allocation of the 2025/26 surplus Transfer of £0.304m from risk reserves to establish four new reserves within Social Care Creation of new reserves, primarily reflecting funding received from NHSL and the Scottish Government for specific commitments in 2026/27 Increases to existing reserves, largely driven by late‑year funding for 2026/27 commitments The closure or reduction of £2.225m of reserves, reallocated to general contingency and risk‑based reserves. Opening Balance as at Closing Balance as at 1st April 2025 31st March 2026 £m £m £m £m NHSL Ring-Fenced Reserves 14.839 0.000 (0.607) 14.232 NLC/NHSL Earmarked Reserves 25.060 0.267 (3.701) 21.626 NLC/NHSL Risk-Based Reserves 21.536 (0.267) (0.377) 20.892 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 (4.685) 70.869Total LEAD SUMMARY Transfers To / From Reserves Drawdown from Reserves Page 44 of 146
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Table 2 SUMMARY Proposed transfers from reserves New reserves awaiting IJB approval Proposed increase to reserves Proposed closure / reduction of reserves Net Movements £m £m £m £m £m Movements 0.000 19.431 13.332 (2.252) 30.511 6.6 The opening reserves for 2026/27 are summarised in Table 3. Table 3 7. RISK 7.1 In line with the Partnership’s Medium‑Term Financial Plan, risk‑based and contingency reserves continue to be maintained as a defined percentage of the core financial envelope. This approach provides a proportionate safeguard against financial uncertainty and supports the Partnership’s ability to manage emerging risks. 7.2 Members will recall approving a reduction in the target level for risk‑based and contingency reserves from 5% to 4% in May 2025, reflecting the significant financial challenges facing the Partnership at that time and the limited opportunity to generate underspends to support reserve growth. 7.3 The 2025/26 financial outturn has been more favourable than anticipated. Lower‑than‑expected drawdowns, the application of a £3.7m underspend, and the rationalisation of a number of existing reserves have enabled an increase in risk‑based and contingency reserves. As a result, these reserves now represent approximately 6% of the core financial envelope. 7.4 This position should be viewed as an over‑achievement against the agreed 4% target rather than a change in strategic intent. Given the scale of the forecast budget gap facing the Partnership and the lead‑in time required to deliver service transformation and savings plans, it is considered appropriate to retain the 4% target at this stage. Maintaining reserves above the target level provides additional short‑term resilience while avoiding the need for frequent revisions to agreed policy parameters. 7.5 The level of risk‑based and contingency reserves will continue to be reviewed as part of the annual financial planning and year‑end process, ensuring alignment with the Partnership’s risk profile, financial outlook, and medium‑term sustainability. Opening Balance As At 1st April 2026 £m NHSL Ring-Fenced Reserves 14.985 NLC/NHSL Earmarked Reserves 45.697 NLC/NHSL Risk-Based Reserves 21.574 NHSL Contingency Reserves 19.124 101.380Total PARTNER SUMMARY Page 45 of 146
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8. IMPLICATIONS 8.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 8.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 8.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register 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 Sustainability – Short Term High Nicola Scott Financial Sustainability – Medium Term Very High Nicola Scott Financial Sustainability – Long Term Very High Nicola Scott Governance Failure High Nicola Scott Failure to meet Legislative Requirements Medium Pauline Izat / Morag Dendy / Joanne Jenkins 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 finance teams of both Partners have been actively involved in the reserves review. Page 46 of 146
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☐ 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. 8.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 9. BACKGROUND PAPERS None. 10. APPENDICES HSCP Reserves Increases and Realignments Appendix 1 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07581 007187. Page 47 of 146
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Appendix 1 2025/26 Closing Balance Proposed Transfers from Reserves New reserves Awaiting IJB Approval Proposed Increase to Reserves Proposed Closure / Reduction of Reserves 2026/27 Opening Balance £m £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding Increase 0.450 3.681 0.450 4.131 NHSL Area Wide Services - Refugees and Displaced Persons No change 0.000 0.121 0.121 NHSL Blood-Borne Viruses Services Partial Reduction (0.043) 0.318 (0.043) 0.275 NHSL Community Living Change Fund Closure (0.044) 0.044 (0.044) (0.000) NHSL District Nursing No change 0.000 0.373 0.373 NHSL Hospital at Home Services Increase 0.068 0.813 0.068 0.881 NHSL Learning Disabilities Health Checks No change 0.000 0.491 0.491 NHSL Mental Health Action 15 No change 0.000 0.730 0.730 NHSL Mental Health Diagnostic Support Service Dementia Post Increase 0.074 1.057 0.074 1.131 NHSL Mental Health Digital Therapy Post No change 0.000 0.221 0.221 NHSL Mental Health Distress Brief Intervention Increase 0.702 2.704 0.702 3.406 NHSL North Planning Band 2-4 Posts & Multi-Disciplinary Teams Partial Reduction (0.600) 2.696 (0.600) 2.096 NHSL Pharmacy Mental Health Recovery & NES Training New: 2026/27 0.146 0.000 0.146 0.146 NHSL School Nursing No change 0.000 0.903 0.903 NHSL Third Sector Initiatives To Improve Health No change 0.000 0.075 0.075 NHSL Upper GI Dietetics Band 4 No change 0.000 0.006 0.006 0.753 14.232 0.000 0.146 1.295 (0.687) 14.985 NHSL MH Funding No change 0.000 1.500 1.500 NHSL Children and Adolescent Mental Health Services Partial Reduction (0.172) 2.774 (0.172) 2.602 NHSL Frailty Nursing Closure (0.001) 0.001 (0.001) 0.000 NHSL Unscheduled Care: Contribution to Set Aside Increase 5.962 2.790 5.962 8.752 NHSL Unscheduled Care: Hospital at Home New: 2026/27 1.112 0.000 1.112 1.112 NHSL Unscheduled Care: Paediatrics New: 2026/27 0.982 0.000 0.982 0.982 NHSL Unscheduled Care: NLC Winter New: 2026/27 1.541 0.000 1.541 1.541 NHSL Unscheduled Care: General New: 2026/27 0.867 0.000 0.867 0.867 NHSL Mental Health Recovery Renewal - Facilities Projects No change 0.000 1.029 1.029 NHSL Adult Social Care Winter Preparedness Fund No change 0.000 1.000 1.000 NHSL Staff Wellbeing No change 0.000 0.254 0.254 NHSL Minor Capital Works Increase 0.003 0.948 0.003 0.951 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding No change 0.000 0.268 0.268 NHSL Development of Chryston Community Health Clinic Partial Reduction (0.078) 0.212 (0.078) 0.134 NHSL Kylepark Works Closure (0.134) 0.134 (0.134) 0.000 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) Closure (0.087) 0.087 (0.087) 0.000 NHSL Breast Feeding Team (2 year funding) Partial Reduction (0.291) 0.345 (0.291) 0.054 NHSL Dietetics Services - Double Running Costs No change 0.000 0.055 0.055 NHSL Health Visiting Students/Trainees No change 0.000 0.029 0.029 NHSL Mental Health Wards Window Replacement No change 0.000 0.650 0.650 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) Partial Reduction (0.115) 0.194 (0.115) 0.079 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff Partial Reduction (0.028) 0.529 (0.028) 0.501 NHSL Podiatry Services - Foot Screening No change 0.000 0.338 0.338 NHSL Scottish Clinical Leadership Fellowship No change 0.000 0.060 0.060 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) Partial Reduction (0.017) 0.297 (0.017) 0.280 TOTAL RING-FENCED RESERVES Partner HSCP RESERVES INCREASES AND REALIGNMENTS Action Net Movement £m Page 48 of 146
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Appendix 1 NHSL Staff Training Academy Partial Reduction (0.237) 0.335 0.050 (0.287) 0.098 NHSL Vulnerable and Complex Cases - Test of Change Partial Reduction (0.118) 0.501 (0.118) 0.383 NHSL Paediatric Acute Funding New: 2026/27 0.235 0.000 0.235 0.235 NHSL Ligature Spend New: 2026/27 8.886 0.000 8.886 8.886 NHSL MMRV Funding New: 2026/27 0.415 0.000 0.415 0.415 NHSL Mental Health Improvement Post (18 months) New: 2026/27 0.090 0.000 0.090 0.090 NHSL Neuro Psych New: 2026/27 0.264 0.000 0.264 0.264 NHSL Psychiatry Liaison New: 2026/27 0.611 0.000 0.611 0.611 NHSL GJ Coathill New: 2026/27 0.200 0.000 0.200 0.200 NHSL North IJB Staff Wellbeing New: 2026/27 0.254 0.000 0.254 0.254 NHSL Marmot monies New: 2026/27 2.000 0.000 2.000 2.000 NHSL Medicine Growth Fund New: 2026/27 0.620 0.000 0.620 0.620 NHSL Carehomes New: 2026/27 0.750 0.000 0.750 0.750 NLC Business Case - Non-Recurring NLC Costs No change 0.000 0.022 0.022 NLC Carers Act 2018 - Support Increase 0.017 2.422 0.017 2.439 NLC Digital and IT Strategy Technology Improvements - Community Alarms No change 0.000 0.111 0.111 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System No change 0.000 3.045 3.045 NLC Digital and IT Strategy Technology Improvements - SWIS No change 0.000 0.000 0.000 NLC Home Support Resilience (2 year funding) Partial Reduction (0.237) 0.487 (0.237) 0.250 NLC Mental Health Social Workers 2 x NL10 x 24 months No change 0.000 0.149 0.149 NLC Staff Training Academy No change 0.000 0.426 0.426 NLC MHO Capacity Funding No change 0.000 0.291 0.291 NLC Statutory Appropriate Adults Increase 0.014 0.161 0.014 0.175 NLC Sessional - School summer placements No change 0.000 0.182 0.182 NLC SDS Transformational Funding New: 2026/27 0.458 0.458 0.458 NLC FAI legal costs New: 2026/27 0.083 0.083 0.083 NLC Child and Adult Protection - resourcing multi agency reviews New: 2026/27 0.060 0.060 0.060 NLC MARR CHARTS / HOME SUPPORT New: 2026/27 0.110 0.110 0.110 NLC Pharmacy tech post New: 2026/27 0.050 0.050 0.050 24.071 21.626 0.304 19.286 6.046 (1.565) 45.697 NHSL Prescribing Fund No change 0.000 5.066 5.066 NLC Social Care Demand Increase 0.682 15.826 0.682 16.508 0.682 20.892 0.000 0.000 0.682 0.000 21.574 NHSL Contingency Balance Held By NHSL Increase 5.005 14.119 (0.304) 5.309 19.124 5.005 14.119 (0.304) 0.000 5.309 0.000 19.124 30.511 70.869 0.000 19.431 13.332 (2.252) 101.380 TOTAL EARMARKED RESERVES TOTAL RISK-BASED RESERVES TOTAL CONTINGENCY FUND RESERVES MOVEMENT Page 49 of 146
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1 REPORT Item No: 8 SUBJECT: Performance Update – 01st October 2025 to 31st December 2025, Quarter 3 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: 20 May 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 51 of 146
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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 52 of 146
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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 53 of 146
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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 54 of 146
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5 None. 9. APPENDICES Appendix One - Areas for Improvement – 01st October 2025 to 31st December 2025, Quarter 3 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 55 of 146
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6 1. Alcohol Brief Interventions Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 3047 *annualised 508 453 RED Alcohol Brief Interventions (all settings) NHSL 7381 *annualised 1601 1474 RED Narrative & Corrective Action Performance for Alcohol Brief Interventions in Q3 shows that there has been a reduction in activity when compared to Q2, with 453 interventions recorded across North Lanarkshire. Delivery therefore remains below the revised trajectory and continues to reflect the longer-term downward trend observed in recent reporting periods. As noted previously, ABI delivery remains sensitive to wider system pressures including workforce availability and competing clinical priorities. This continues to result in variation across the various delivery settings and limits the pace at which improvement can be realised. The Q3 position therefore does not yet suggest any sustained recovery in delivery levels. Recording practices also continue to influence reported performance. A range of services and settings deliver ABI and it is known that interventions are not recorded consistently within core reporting systems, meaning that not all activity is captured in the calculation for this performance indicator. This limits the extent to which reported figures fully reflect the activity undertaken in practice and remains an area for continued improvement. Engagement with delivery teams and the ongoing embedding of ABI pathways into routine practice continue to be key areas of focus. Given the preventative nature of the intervention and the time lag between engagement activity and measurable impact, improvement is expected to remain incremental and dependent on wider system capacity. 2. Cervical Screening Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 69.9% 69.8% RED Narrative & Corrective Action Performance for Cervical Screening in Q3 shows a slight decrease compared to the previous quarter, with uptake across North Lanarkshire recorded at 69.8%, compared to 69.9% in Q2. Uptake remains below the national target of 80% across all localities. Locality-level variation remains relatively modest. Airdrie showed a small improvement, while Motherwell and North localities remained broadly stable. Bellshill, Coatbridge and Wishaw recorded marginal reductions. Overall uptake therefore continues to reflect the longer-term decline seen across recent years. Page 56 of 146
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7 Uptake is lowest in the following age bands in Lanarkshire: 40-44 = 37.2% 45-49 = 34.0% 50-54 = 31.7% It is important to interpret the Q3 position within the wider national context. Recently published Scottish Cervical Screening Programme statistics indicate there has been a significant reduction in participation rates across Scotland and Lanarkshire. (7.9% decrease for Lanarkshire and an 8% decrease nationally). Analysis of the data by SIMD quintiles shows that there is a 13.8% difference between SIMD 1 and 5 for Lanarkshire, compared to a 9.2% difference across Scotland; inequality is greater across Lanarkshire, however Lanarkshire performs better across all SMID quintiles when compared to the overall Scottish position. In addition, the change to the screening recall interval from three to five years, for women aged 25–49, has influenced the way uptake is recorded within the national statistics and is expected to affect the reported figures for a transitional period. Work to improve our screening uptake continues to be coordinated through the Lanarkshire-wide Inequalities in Screening Steering Group. Activity during the quarter has included targeted engagement events, strengthened awareness activity in community settings and direct support to GP practices with lower uptake by using screening system data to identify and engage non-attenders. Further initiatives are planned to support improvement, including the introduction of patient navigators and participation in the HPV self-sampling pilot within several North Lanarkshire practices. This pilot aims to increase participation among individuals who are currently under- screened, particularly those living in areas of higher deprivation. A summary of the improvement activity is presented below: Pan-Lanarkshire Targeted Support to Lowest-Uptake Practices – Public Health QI team supporting practices to use SCRRS to proactively identify high-risk non-attenders. Short-Term Workforce Support – Two redeployed staff assisting practices to engage non-attenders. Patient Navigator Pilot (Starts March 2026) – SG-funded pilot introducing patient navigators and additional community clinics, aligned with HPV self-sampling work. Pregnancy Exclusion Audit – System Fix Required – Audit shows midwifery teams are not routinely notifying GPs of pregnancies, preventing appropriate application of pregnancy exclusion and timely post-birth invites. Public Health now engaging midwifery to implement consistent notifications. HPV Self-Sampling Pilot – North Lanarkshire Practices – Five participating practices (Airdrie Adam Ave, Airdrie Wellwynd, Coatbridge Waverly, Motherwell Orchard, Wishaw Logan). Evidence indicates significantly improved uptake in deprived/minoritised populations; national rollout expected in 2–3 years. Health Improvement Activity Across Localities Screening materials and QR posters distributed across all NL community hubs. Lived-experience video/podcast embedded in community conversations. Screening included in all menopause education sessions. Page 57 of 146
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8 Comms planning underway for Cervical Cancer Prevention Week 2026. Wishaw Locality 6-Week Post-Natal ‘One-Stop’ Pilot – Developing a combined post-natal check offering physical review, Edinburgh Depression Score and smear at one appointment. Digital Engagement – Text reminders now used to reduce DNAs for smear appointments. Professional Education Video – Health Improvement and Public Health producing a short video on benefits/risks of cervical screening; led by colposcopy clinical lead (in Comms production). HPV Self-Sampling Pilot – Logan Practice participating in the North Lanarkshire pilot targeting under-screened women in high-deprivation areas. Local Health Improvement Work Screening promotion across Wishaw community hubs and venues. Use of lived-experience materials and QR-coded resources in community engagements. Menopause sessions integrating cervical screening messaging. Joint working with Treatment Room staff to embed screening conversations into chronic disease clinics. Health Visitor awareness sessions delivered as part of locality action plan. Other locality-specific actions Airdrie/Coatbridge/North – Newsletters, Early Years distribution, routine awareness sessions. Coatbridge – Engagement with parents at school events. North – Outreach to community groups (e.g., seniors events). Bellshill/Motherwell/Wishaw – Digital screens in public venues, QR posters in health centres, Health Visitor awareness, Treatment Room staff training, quarterly Milan data sharing. While this range of activity demonstrates continued focus on improving uptake, the cyclical nature of screening programmes and the behavioural factors influencing engagement mean that improvement is expected to be gradual. Continued emphasis on community engagement, practice-level support and national programme development will therefore be required to support recovery in the level of performance toward the targeted level. Page 58 of 146
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9 3. Childhood Immunisations Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 89.5% 90.5% RED Immunisations – %s of 2 year olds 95% 94.4% 94.3% RED Narrative & Corrective Action Childhood immunisation uptake in North Lanarkshire has generally compared well with the national position. However, current rates for several key age groups remain below the 95% performance standard. This shortfall is concerning given the importance of maintaining high vaccination coverage to protect population health, prevent disease outbreaks, and sustain herd immunity. Uptake within the two-year-old immunisation programme continues to fall slightly short of the national target. Although the variation is small, the consistency of this downward trend means it requires close monitoring. For preschool aged children, uptake remains further from the 95% standard, although this quarter has shown a modest improvement of 0.9%. A range of factors appear to be contributing to the reduction in uptake. These include a gradual increase in vaccine hesitancy among a small but growing number of families, delays in providing consent, refusal of consent, challenges accessing clinics, and missed appointments. In addition, a notable proportion of families in each locality have actively withdrawn consent, as reflected in the table below. Locality % Opt out Airdrie 5.0% Bellshill 5.94% Coatbridge 5.8% Motherwell 7.42% North 5.5% Wishaw 6.8% All areas also report a substantial number of children transferring into the area, which further affects overall uptake figures. Workforce capacity continues to be a concern; the number of vacancies for Staff Nurses are a limiting factor on the service’s ability to maintain the existing immunisation schedule and place additional pressure on both delivery and follow-up activity. Page 59 of 146
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10 Vaccination Teams remain fully engaged in addressing these challenges. Ongoing improvement work includes strengthened reminder and recall processes, closer coordination with Health Visiting Teams to maximise every contact as an opportunity to promote vaccination and targeted outreach to families who do not attend. In addition, to counter the declining trend, Health Visiting Teams across NHS Lanarkshire have implemented a range of focused actions. Operational and Workforce Measures Streamlined Processes: In response to staffing instability within the North East Sector, a sector-wide model for clinic coverage was introduced to ensure safe delivery and prevent clinic cancellations. Standardised operating procedures (SOPs) were developed to support consistent, safe cross-cover arrangements. Improving Access and Reducing Backlogs Enhanced Monitoring of Q-Print: Backlogs were proactively reduced through additional clinics scheduled during the 5th week of the month, traditionally a non-clinic week. Home visits were also offered to improve accessibility for families experiencing barriers. Strengthened Engagement and Communication Enhanced Health Visitor Engagement: Vaccinations are routinely discussed during pathway visits, with targeted scripts used to ensure clear, consistent messaging that supports informed decision-making. Data-Driven Oversight and Governance Robust Review by AOVIC: The Area Oversight Vaccination and Immunisation Committee continues to lead detailed data analysis and identify systemic changes required to maintain uptake levels above 95%. Combined, these efforts reflect a sustained commitment to improving immunisation uptake, reducing inequality and preventing avoidable outbreaks to protect the health of children and families across Lanarkshire. Continued focus and cross-system collaboration will be essential to reverse the downward trajectory and consolidate the progress made in previous years. 4. Addictions Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Addictions – Ongoing Waits NHSL 90% 80.2% 59.4% RED Narrative & Corrective Action Medication Assisted Treatment (MAT) Standards continue to demonstrate that addictions services in North Lanarkshire are operating within a stable and well‑established clinical framework, with the majority of standards consistently met. This provides ongoing assurance regarding the quality, safety, and consistency of treatment and recovery pathways. Page 60 of 146
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11 However, the NHS Lanarkshire-wide ongoing waits indicator shows a significant decline in Q3. This movement reflects pressures across the wider system rather than a deterioration in North Lanarkshire service delivery. There have been some extended waits within the Airdrie locality, which were anticipated and directly attributable to short‑term staff absence. Despite this, local performance across North Lanarkshire remains comparatively stable, and treatment pathways continue to operate in line with national expectations. Work to address NHS Lanarkshire–wide waiting time pressures continues to be coordinated through corporate processes and sits outside the scope of the MAT Standards framework. The detail on MAT Standards below should therefore be read as a supplementary assurance measure rather than a proxy for wider addictions performance; focus remains appropriately directed towards addressing NHS Lanarkshire-wide access pressures. 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 5. 6 – 8 Week Reviews Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Page 61 of 146
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12 Percentage of people who have completed 6-8 week review 90% 84.4% 81.0% ... RED Narrative & Corrective Action The partnership continues to face challenges in achieving the 90% performance target for 6–8 week child health reviews. Although performance is relatively stable, it remains well below the required standard. Because of reporting time lags, the current data reflects activity prior to the full implementation of the new pathway developed by the 6–8 Week Review Sub-Group. During this quarter, the process documentation has been have been recirculated and Health Visiting (HV) Team Leads have reiterated the expectations on GP Practices and Clinical Leads for reviews, highlighting the specific detail on the responsibilities of GP within the process. Despite these actions, several recurring issues continue to limit the effectiveness of the pathway and, in turn, overall performance. Some practices continue to schedule appointments earlier than the recommended timeframe, typically at 5 weeks and 6 days, which delays the timely availability of HV forms. This leads to duplicate forms being generated, contrary to recommended guidance. Further concerns include GP submissions with missing information, particularly absent completion dates. In these instances, the date received by the Child Health department is recorded instead, frequently placing the review outside the required timescales. There also remains considerable variation in processes across GP practices, making it difficult to embed consistent improvement across North Lanarkshire. Engagement work has revealed that at least one practice had been waiting for the HV form before offering an appointment, causing avoidable delays; this practice has now agreed to schedule appointments from birth. In another locality, neither the practice, nor the wider team monitored the assessment form’s journey, making it difficult to track whether both HV and GP components were completed within the appropriate timeframe for those reviews. In addition, Child Health continues to experience issues issuing paperwork during the fifth week of certain months, further contributing to delays in arranging and completing appointments. Reviews for premature babies add further complexity, however many cases of missed reviews relate to parental choice or difficulty attending within the required window. The transition to digital CHSP forms is scheduled to go live in May. Initially, only the HV section will be digital. The system is currently undergoing testing and with most fields becoming mandatory, adherence to the process, and therefore performance, is expected to improve. Other improvement work will continue and the service recognises that a sustained and consistent effort will be required to return performance to the expected standard. 6. Assistive Technology Target 2025/26 2025/26 Q2 2025/26 Q3 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 25 RED Assistive Technology - Number Of People With Technology (18-64yrs) 303 348 RED Page 62 of 146
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13 Assistive Technology - Number Of People With Technology (65+) 745 879 RED Narrative & Corrective Action Performance for Assistive Technology remained below target during Q3. Interpretation of this position requires recognition that recent improvements to reporting through ELMS2 have significantly improved data completeness. As a result, the current figures provide a more accurate representation of operational activity and comparisons with earlier reporting periods should be made with caution. Demand for Assistive Technology is believed to be increasing, driven by hospital discharge pressures and the strategic emphasis on enabling individuals to remain safely at home wherever possible. Alongside core service delivery, the Tech team provides significant support to people in the community that is not captured within the scorecard indicators. This includes supporting individuals who are purchasing technology independently and providing advice and demonstrations through the Assistive Technology “Tech Flat”. While these activities are resource intensive, they are not reflected in the current performance metrics and therefore under-represent the overall level of activity undertaken in this area. The volume of Adult Social Care Assessments undertaken by the Tech team is significant, again without being directly captured within the current indicator set. Work continues to strengthen the role of Assistive Technology within assessment and discharge pathways, including closer alignment with Home Assessment Teams and Reablement services. This will support greater integration of technology-enabled care within community support pathways. Capacity constraints within the service, particularly related to staffing levels, continue to affect the pace at which assessments, installations and reviews can be completed. A desktop review of the Assistive Technology indicators and associated targets is planned ahead of the 2026/27 performance scorecard refresh. This review will consider improved data maturity, workforce capacity and the need to ensure indicators reflect the breadth of operational activity undertaken by the Tech team, as well as the number of people who use assistive technology. Linked to this activity, the Equipment and Adaptation Service continues to demonstrate improvement in operational delivery. Performance against the delivery time target has improved and is now slightly exceeding the 80% target following sustained work to strengthen operational processes. The service is focusing on improving stock management, recycling equipment and strengthening ordering processes through closer collaboration with NHS Lanarkshire and North Lanarkshire Council procurement teams. A service redesign review is also underway and is currently evaluating role profiles and operational arrangements to support further service improvement. 7. Reablement and Rehabilitation Target 2025/26 2025/26 Q2 2025/26 Q3 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) 604 940 RED Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 60.4% 66.9% RED Page 63 of 146
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14 Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 56.8% 51.1% RED Narrative & Corrective Action Performance for the Reablement indicators during Q3 reflects progress in embedding the revised operating model for assessment and support at home. During the quarter, more individuals were supported through the Reablement pathway than the previous quarter; however, this number remains below the quarterly target of 500. Although below the targeted level of performance, the proportion of new or increased Home Support packages delivered through Reablement has also improved, reflective of the continued focus on enabling approaches. This shift in practice is expected to continue supporting improvement in the proportion of individuals receiving Reablement prior to longer-term care decisions being made. However, the proportion of individuals requiring no or reduced Home Support following completion of Reablement has declined. This may reflect the increasing complexity of needs among individuals entering the pathway, including higher levels of frailty, comorbidity and age-related complexity. 8. Adult Protection Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status For Referrals in Period, Proportion Going to Case Conference From DTI With Investigatory Powers Within Timescale 60% 28.6% 22.2% ... RED Narrative & Corrective Action The majority of referrals where there is a Duty to Inquire are progressing to investigation and assessment within the required timescales, demonstrating that appropriate immediate safeguarding responses are being delivered in localities. North Lanarkshire Social Work Services received 875 ASP referrals in Quarter 3 2025/26, which is a 33% increase in comparison to Q3 last year when 658 referrals were received. The care home sector accounts for 25% (210) of all AP1 referrals received by social work; in comparison to Q3 last year, referrals from care homes have increased 26% (from 167 to 210). Page 64 of 146
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15 The data shows that Coatbridge, Cumbernauld and Wishaw interchange as the localities receiving the most ASP referrals in any quarter, likely linked to the higher populations of those localities. In addition, all localities in North Lanarkshire experience multiple areas of deprivation, which contributes to poorer health and wellbeing outcomes, and is a key factor driving ASP activity. Page 65 of 146
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16 Physical harm and emotional/psychological harm remain the primary harm type within ASP referrals and this is a consistent trend over time. Many physical harm referrals orginate from the care home sector, with a high number of referrals from care homes detailing falls, or altercations between residents. The volume of self-neglect referrals remain high and it is recognised as a harm type that requires a multi-agency response in order to mitigate the associated risks. It should also be noted that multiple harm types often impact on service users and this cannot always be reflected in the data. Harm types relating to suicidal ideation, online harm, hoarding and domestic abuse are new categories that we are now trackable with the implementation of Mosaic. Although the numbers for these harm types are low, they serve as a useful indicator of emerging harm types. The proportion of investigations progressing to case conference within the expected timescale is low for the Q3 reporting period. The position is influenced by ongoing recording and data quality issues. Work is underway with operational teams to review those recording practices and address data quality issues. Once resolved, the indicator is expected to more accurately reflect safeguarding activity. The high proportion of adult welfare concerns recorded as requiring no further action reflects the fact that many individuals are already receiving appropriate support from services or partner agencies. Internal audit work has confirmed that these cases frequently involve individuals who are already known to services or who are Page 66 of 146
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17 receiving support through alternative pathways. As such, the indicator does not necessarily indicate unmet need but rather reflects appropriate decision-making within our safeguarding processes. 9. Adult Mental Health Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 83.9% 81.2% RED Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 19.4% 18.4% RED Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 73.7% 75.4% RED Consultant Outpatient WT - Learning Disability - 12wks (NHSL) (NORTH HOSTED) 90% 100.0% 75.0% RED Narrative & Corrective Action 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) Page 67 of 146
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18 In Q3, 81.2% of patients commenced treatment within 18 weeks. Whilst this is a 2.7% decrease from the previous quarter, when compared to the same quarter in 2024 there is an overall improvement of 8.9%. Over the last 12 months, the number of patients waiting over 18 weeks has decreased by 4.7%. The number of patients waiting for treatment exceeds the expected trajectory, although it is still broadly in line with the trend. In December 2025, the waiting list reduced for the third consecutive month, since consecutive increases between May and September 2025. The average compliance with the 18-week referral to treatment target for 2025, for NHS Lanarkshire, was 78.9%, which is 3.8% more than for the calendar year in 2024. All over-52 week waits continue to be within Neuropsychology, where waits have grown in line with expected trajectory following changes to the referral criteria introduced in November 2023. Additional clinical resource will be provided to this service on a temporary basis during 2026 in order to address long waits and stabilise the system. This will happen whilst a review of the service delivery model is carried out to understand future sustainability. The PHS analyst is currently reviewing and updating the DCAQ trajectories to provide further detail on the anticipated impact of the reduced working week on clinical activity levels. Whilst not captured in performance reporting data, clinical activity is ongoing across the majority of Psychological Services to offer, where appropriate, early assessment appointment within 12 weeks of referral. In keeping with the expectations set out in SG's National Specification for the Delivery of Psychological Therapies and Interventions, this approach ensures patients can be appropriately directed to the service that best meets their clinical needs at the earliest point in time. Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) The current scorecard metric reflects the position of the waiting list, calculated as the proportion of patients waiting within 12 weeks (i.e., the number of people waiting ≤12 weeks, divided by the total number of people on the waiting list). This approach is consistent with the methodology traditionally used for many other partnership services and represents ongoing waits (rather than completed waits). These data are robust and long standing, having been used for many years by the partnership for performance reporting. They are not, however, directly comparable to other performance measures such as the RTT for Psychological Therapies or CAMHS. North HSCP now has an ambition to move towards all services using completed waits as a more consistent measure of performance. We will require to do this in a stepwise, considered fashion, with an action plan given that to be robust, data recording practices will need to be reviewed across a high number of disciplines. In the instance of General Adult Psychiatry, the service has already been developing more robust reporting data that will meet that ambition. Early indications are that for Q3 and the proportion of individuals actually seen within 12 weeks, 50.1% of patients were seen within the 12-week target. This metric is itself affected by ADHD waits and psychiatry vacancies. Clinical directors have been asked to meet with all consultants to review the numbers of people being seen in clinics and to discuss how they ensure that the data supplied is robust. Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) Performance for Older Adult Psychiatry outpatient waiting times improved during Q3 and continues to show a gradual upward trajectory when compared with earlier reporting periods. Page 68 of 146
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19 Despite this improvement, performance remains below the targeted level and continues to reflect the wider workforce and capacity pressures affecting specialist mental health services. Operational focus remains on maintaining service stability and improving access where possible within the available capacity. Consultant Outpatient WT - Learning Disability - 12wks (NHSL) (NORTH HOSTED) Performance for Learning Disability outpatient waiting times reduced during Q3, with 75.0% of patients commencing treatment within 12 weeks. This represents a change from the previous quarter, when performance was 100%, which was the level of performance reported consistently for a significant period of time. The change in performance reflects the impact of cancellation of offered and then subsequently declined appointments within a small specialist cohort. The data has been reviewed and per the recording rules, the recording practice is correct and reflects waits beyond the 12-week threshold at the end of the reporting period. Given the low volume of referrals within this specialist service, a small number of cases can have a disproportionate impact on the quarterly percentage reported and performance for this indicator can fluctuate significantly when individual cases fall outside the expected waiting time threshold. The current position should therefore be interpreted cautiously and does not reflect a broader deterioration in service performance. 10. Medical Paediatrics Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90%* 71.1% 77.2% RED Narrative & Corrective Action Medical Paediatrics has found delivery of 90% target challenging to deliver throughout 2025/26. Positively, the Q3 result of 77.2% represents a 6.1% improvement on the previous quarter and reverses the trend of a continued decline in the reported level of performance for this indicator. The challenges and issues experienced by the service that prevent compliance with the targeted level of performance are multi-factorial, including a significant volume of inappropriate referrals to specialist services and a reduced medical capacity due to absence. Despite the challenges and issues experienced by the service, local unvalidated data suggests that there is further improvement likely to be realised in Q4, with an expected result of over 80% for this performance indicator. However, there remains variance across areas and specialisms, which requires additional analysis. The service continues to engage positively in service improvement activity, including stringent vetting of referrals to the service and work with universal pathways to offer advice and support with earlier intervention alternatives to referral (sleep and toilet training). Page 69 of 146
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20 11. SLT Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 79.9% 87.8% … … RED Narrative & Corrective Action Performance for both Paediatric and Adult Speech and Language Therapy waits improved significantly during Q3. Paediatric waits performance of 87.8% represents a substantial improvement from the 16% reported in Q3 of 2024/25, demonstrating the impact of sustained service redesign and operational improvement work undertaken over the past two years. This improvement has been driven by targeted investment in service transformation and strong professional leadership across both universal and CYP pathways. The service reports that early Q4 operational data shows continued positive momentum, with unvalidated figures indicating performance exceeding the 90% target for the universal pathway. The service will now focus on sustaining this level of performance and strengthening the consistency and accuracy of activity recording across universal, targeted, and specialist pathways to ensure future reporting fully reflects delivery. Adult Speech and Language Therapy also demonstrated strong performance during Q3. Earlier challenges had been associated with staffing absences; however, with staffing levels now stabilised, performance has recovered. Early Q4 data indicates that this positive trajectory has been maintained, with the local data suggesting that the performance is currently around 94.3%. 12. Complaints Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days (NHSL) 50% 26.0% 37.0% RED Narrative & Corrective Action Performance for complaints processed within 20 working days remains below the 50% target for Q3. Analysis of complaints activity indicates that many complaints are now resolved at Stage 1, reflecting an increased emphasis on early resolution where appropriate. While this approach supports a more responsive service for individuals raising concerns, it can influence the overall performance indicator as the more complex complaints, where every effort has already been made to expedite a quick resolution, progress to Stage 2 investigations and by their nature will necessitate a more complex and resource intensive, response. Stage 2 complaints often involve multiple services or require detailed clinical review and therefore require more time to investigate and respond appropriately. This complexity contributes to extended response times. Page 70 of 146
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21 For North Lanarkshire, 37% of Stage 2 complaints were responded to within 20 working days. 48% (10/21) MH & LD 0% (0/1) Adult Services 33% (3/9) Specialist Children’s Services 0% (0/2) Prison 0% (0/2) Primary Care From the information available, 67% of delays were system related and 33% were justified. Receiving comments from relevant colleagues regarding the complaint continues to be the largest cause of delay (50%). Page 71 of 146
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22 Work continues to strengthen complaints processes and improve reporting through the development of enhanced digital tools and improved statement collection processes. This includes the introduction of a LanQip module to streamline statement collection and improve tracking of complaint investigations. Further improvement activity focuses on strengthening the quality of learning from complaints, improving thematic reporting and ensuring that identified improvement actions are monitored through governance structures. A pan Lanarkshire ‘Learning and Improvement from complaints’ update was presented to CMT 5 January 2026. As part of this work, a thematic analysis was carried out and found that between September – November 2025, across all complaint types, the top 5 pan-Lanarkshire themes that proceeded directly to Stage 2, given the severity of the issues raised or multiple issues spanning multiple services, relate to: Care Planning/Co-ordination Examination/monitoring Disrespect Communication – absent Safety – Error A learning actions dashboard has been developed on InPhase that tracks evidence of learning that has been communicated to complainants. To maximise impact of this dashboard, this development will require a refresh of processes and educational materials for colleagues to ensure that learning and root causes are actively identified, communicated and then recorded for follow-up. This will be a NHSL True North action for 2026/27. 13. Care Homes Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same RAG Status Page 72 of 146
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23 Quarter Previous Year Care Home - Average Length of Stay 865 26.0% 37.0% RED Narrative & Corrective Action The average length of stay in care homes increased during Q3 and remains above the target level. The length of stay in care homes is influenced by a range of structural factors including complexity of need, availability of community alternatives and wider system pressures affecting hospital discharge and community flow. As such, short- term movement in the indicator should be interpreted with caution. Current operational activity continues to focus on strengthening Home First approaches and supporting discharge pathways that enable individuals to return home wherever possible. Further analysis would be required to determine whether targeted interventions could meaningfully influence care home length of stay in future reporting periods. The number of care home placements per 1,000 population aged 65+ and 75+ reflects the continued emphasis within North Lanarkshire on supporting individuals to remain in their own homes wherever possible through community-based support and enabling approaches. The relatively low rate of care home placements aligns with the strategic direction of the Partnership’s balance of care approach, which prioritises independence and community-based care. 14. Smoking Cessation Target 2025/26 2024/25 Q4 2025/26 Q1 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) 545 *cumulative 239 for 2024/25 68 ... ... RED Narrative & Corrective Action Performance against the smoking cessation target remains below the expected trajectory. The indicator measures the cumulative number of individuals achieving a successful quit at 12 weeks within the most deprived communities. The data is presented two quarters in arrears. Activity remains affected by lower referral volumes and challenges associated with engagement within priority groups. Table 1: All - North locality data April to June 2025/26 Q1 (40% most deprived) Locality Number of QDS Number of 12 week quits Cumulative target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 40 8 22.8 -14.8 35% 20% 24% Coatbridge 50 9 22.8 -13.8 40% 18% 24% Page 73 of 146
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24 North 32 13 18.8 -5.8 69% 41% 24% Bellshill 37 5 15.8 -10.8 32% 14% 24% Motherwell 34 12 20.3 -8.3 59% 35% 24% Wishaw 59 14 20.5 -6.5 68% 24% 24% Please note: Table 1 includes both specialist and community pharmacy services Table 2: Specialist - North locality data April to June 2025/26 Q1 (40% most deprived) Locality Number of QDS Number of 12 week quits Cumulative target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 10 4 7 -3.0 57% 40% 57% Coatbridge 15 6 7 -1.0 86% 40% 57% North 3 3 5.8 -2.8 52% 100% 57% Bellshill 4 3 4.8 -1.8 63% 75% 57% Motherwell 11 6 6.3 -0.3 95% 55% 57% Wishaw 9 5 6.3 -1.3 79% 56% 57% Please note: Table 2 includes community, pregnancy and mental health only QYW Community Pharmacy Service In 2025/26 (Q1) for all pharmacies in North Lanarkshire there were a total of 346 quit dates set (QDS) (All SIMD areas) 108 clients (31%) had no smoking status recorded at their 4-week follow-up (i.e. blank follow-up). 15 clients (13%) who had a successful quit at their 4-week follow-up had no smoking status recorded at their 12-week follow-up (i.e. blank follow-up). Despite efforts made by the QYW Pharmacy Support Team to support community pharmacies there continues to be discrepancies in the completeness and accuracy of data entered into the PCR system. These gaps may be affecting the accuracy of performance reporting to Scottish Government. Table 3: Pharmacy - North locality data April to June 2025/26 Q1 (40% most deprived) Locality Number of QDS Number of 12 week quits Cumulative target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 30 4 15.8 -11.8 25% 13% 17% Coatbridge 35 3 15.8 -12.8 19% 9% 17% North 29 10 13.0 -3.0 77% 34% 17% Bellshill 33 2 11.0 -9.0 18% 6% 17% Page 74 of 146
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25 Motherwell 23 6 14.0 -8.0 43% 26% 17% Wishaw 50 9 14.3 -5.3 63% 18% 17% Operational work continues to strengthen referral pathways and improve engagement with communities experiencing the highest levels of deprivation. This includes strengthening links with primary care, pharmacies and community partners to increase awareness and referral to cessation services. This includes: A Stop Smoking clinic specifically for clients with mental health will be made available within the Newmains Community Hub. Immunisation teams in North Lanarkshire will receive brief intervention and carbon monoxide monitor training in January 2026. A SBAR is being developed and will be presented to the Community Pharmacy Contractors Committee in February 2026, highlighting QYW current performance and will provide recommendations for future improvement work. A test of change will be implemented within two community pharmacies located in North Lanarkshire. The QYW Pharmacy Support Team will provide behavioural support in addition to the support provided by the community pharmacies to improve the success of the client stopping smoking. Data recording processes are also being reviewed to ensure that the activity delivered through partner services is appropriately captured within the reporting system. While improvement initiatives continue, smoking cessation performance remains influenced by behavioural factors and engagement challenges that are likely to affect the pace of improvement. 15. Unscheduled Care Target 2025/26 2025/26 Q1 2025/26 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status A&E Attendances - NL Residents 116,456 30,588 30,616 … AMBER Emergency Admissions - NL Residents 44,001 11,750 Quarterly/ 2 quarters behind … AMBER Unscheduled Bed Days - all specialties, NL residents 294,999 82,077 Quarterly/ 2 quarters behind … AMBER Narrative & Corrective Action These indicators represent different stages of the unscheduled care pathway and must be interpreted with recognition of the reporting lags associated with the available data. A&E attendances are reported one quarter in arrears, while emergency admissions and unscheduled bed days are reported two quarters in arrears. As such, the scorecard position does not reflect activity occurring during Q3 itself. Page 75 of 146
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26 Operational intelligence derived from the yet to be validated Q3 data indicates that pressure across the unscheduled care system remains significant. NHS Lanarkshire’s compliance with the national 4-hour emergency department standard was 51.1% in December 2025, remaining below the Scottish average. Performance at site level was 50% at University Hospital Monklands and 54% at University Hospital Wishaw. Weekly performance during the period showed considerable variation, reflecting the impact of fluctuating operational pressures. Both acute sites experienced challenges affecting patient flow during the Q3 period, including Infection Prevention and Control restrictions, increased levels of seasonal illness including flu and norovirus and higher levels of bed occupancy. Overall hospital occupancy across NHS Lanarkshire was 99.5% during December 2025. These pressures contributed to longer lengths of stay, an increase in patients remaining in hospital for more than 14 days, and delays to admission and first clinical assessment. Workforce pressures also affected operational capacity, including a short-term increase in staff sickness absence. In response, winter operational arrangements were implemented, including the use of surge capacity and a system-wide command and control structure to manage emerging pressures. A number of improvement actions are underway across NHS Lanarkshire to support improvement in patient flow. These include continued use of surge areas, expansion of virtual ward capacity and testing of direct admission pathways to frailty services. Weekly Criteria to Reside audits continue to be undertaken collaboratively between acute services and the Health and Social Care Partnership. System-wide improvement continues through implementation of the Flow Foundation Bundle, the Target Operating Model and the Operation Flow improvement programme. The Health and Social Care Partnership has also developed updated Unscheduled Care Improvement and Implementation Plans for 2025/26, which are aligned to the Operation Flow strategy and informed by feedback from the Centre for Sustainable Delivery. A continued focus remains on discharge planning processes and reducing same-day cancellations of supported discharges. A revised standard operating procedure has been implemented in collaboration with the Flow Navigation Centre to address this issue and strengthen discharge planning arrangements. Work is also underway to improve operational reporting across acute and community services, including development of enhanced digital reporting through Milan to support improved oversight of discharge activity, social care referrals and discharge delays. Despite these ongoing improvement efforts, demand and system pressures remain high. Continued collaboration between the acute sector and Health and Social Care Partnerships is required to achieve sustained improvement in flow and system performance. 16. Training and Development Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 4% 7.05% 7.75% RED Sickness Absence (NLC) - days lost per person 9.22 8.15 12.99 RED Narrative & Corrective Action Page 76 of 146
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27 There was a slight increase in the level of sickness absence among NHS Lanarkshire staff within University North Lanarkshire HSCP during Q3. For 2025/26, the target for NHS Lanarkshire and University North Lanarkshire HSCP is to reduce sickness absence by 1%, bringing performance to 6% and moving closer to the national target of 4%. Sickness absence levels increased during December 2025, reaching 8.74%. Local intelligence indicates that seasonal illness contributed significantly to this increase. Absences related to colds, influenza and other respiratory illnesses were reported more frequently during December, which is consistent with patterns observed in previous years. Historically, sickness absence levels tend to increase during the winter period due to seasonal illness pressures affecting the workforce. Sickness absence continues to be monitored and managed in accordance with the relevant policies and procedures of each partner organisation. The NHS Lanarkshire Absence Management Escalation Framework, implemented in April 2025, provides a structured approach to supporting staff during periods of sickness absence and ensuring timely management intervention. The framework ensures that appropriate support is offered to staff at an early stage of absence, including proactive engagement from Human Resources and Occupational Health services. A range of contact methods are used to maintain engagement with staff during periods of absence, including written communication, direct contact and discussion through sickness absence governance meetings. Support mechanisms available to staff include occupational health assessment, counselling services and other wellbeing resources aimed at supporting staff recovery and facilitating a timely and sustainable return to work where appropriate. 17. Training and Development Target 2025/26 2025/26 Q2 2025/26 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Records and information management 80% 80.0% 79.6% AMBER Fire Safety Training 90% 87.6% 88.9% AMBER Hand Hygiene Training 90% 86.0% 87.5% AMBER TURAS compliance (NHSL, North) 80% 75% 74% RED Narrative & Corrective Action The majority of mandatory training indicators are assessed as RAG Green and targets are being met in most areas, however compliance with some mandatory training courses remains below the targeted level for Q3. Workforce pressures and competing operational priorities are likely impacting on compliance with mandatory training requirements. Local teams continue to encourage staff completion of mandatory training and monitor compliance. Work also continues at NHS Lanarkshire level to review training systems and support improved recording and reporting. TURAS appraisal data is visible at senior levels and is available to support proactive management of appraisal compliance Performance for the NLC Records and Information Management training reduced marginally during the quarter to 79.6%, falling just below the 80% compliance threshold. Compliance with mandatory training requirements continues to be monitored through Adult Social Work management arrangements, with services Page 77 of 146
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28 encouraged to prioritise completion of outstanding modules. Operational pressures and workforce availability continue to influence completion rates, particularly within front-line services where releasing staff for training can present challenges. Mandatory training and TURAS appraisal compliance remains an area of continued focus for operational managers and improvement activity will continue throughout the remainder of the financial year to support progress toward the required compliance thresholds. Page 78 of 146
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29 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 79 of 146
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1 REPORT Item No: 9 SUBJECT: Internal Audit Progress Report 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 DATE: 20 May 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 Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire) ☒ Reviewed By: Chief Finance Officer ☒ Endorsed By: Chief Officer ☒ Item 9 Page 81 of 146
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2 3. EXECUTIVE SUMMARY The progress in respect of the internal audit work for 2025/26 is summarised in Appendix 1. 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 Financial Sustainability 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 2025/2026 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. 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 Yes ☐ No ☒ N/A ☐ Page 82 of 146
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3 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 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 February 2026 Performance, Finance & Audit Committee: Internal Audit NL05-26 Financial Sustainability has been finalised and is appended at Appendix 3. Management has agreed to take action to address two findings in the following areas: o Reducing reliance on reserves through a robust governed savings framework o Improving financial reporting arrangements The scope for Internal Audit NL06-26 Governance & Committee Effectiveness has been agreed and work is in progress. The Chief Officer and Chief Finance Officer have agreed that the performance element of the original scope of the audit will be risk assessed for inclusion in future Internal Audit work and the 2025/26 audit will focus on governance and committee effectiveness. This reflects the content of the revised and updated risk register, within which risk NLIJBR05: Inadequate Performance Management is scored as medium and risk NLIJBR06: Governance Failure is scored as High. 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 the Chief Internal Auditors are progressing GIAS development work to build up conformance to GIAS. 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. Page 83 of 146
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4 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 84 of 146
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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 NLIJBR06: Governance Failure High Chief Finance Officer NLIJB-R01: Financial Sustainability – Short Term High Chief Finance Officer NLIJB-R02: Financial Sustainability – Medium Term Very High Chief Finance Officer NLIJB-R03: Financial Sustainability – Long Term Very High Chief Finance 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 85 of 146
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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 Report 2025/26 Appendix 2 Summary of Relevant NHS Lanarkshire and North Lanarkshire Council Reports issued. Appendix 3 IJB Financial Sustainability Report CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Chief Finance Officer Page 86 of 146
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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 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. June 2026 Page 87 of 146
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Appendix 1 8 NL05-26 Financial Sustainability Effective, efficient and economic use of resources to ensure financial sustainability, with a focus on transformation. May 2026 Reasonable Assurance NL06-26 Committee Effectiveness Accurate, relevant and reliable reporting to the Board, staff, the SGHSCD and the public. March 2026 June 2026 Page 88 of 146
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Appendix 2 9 The following relevant reports have been issued by NHS Lanarkshire: Report Audit Opinion Key findings L02/26 Internal Control Evaluation (ICE) Reasonable Assurance The 2025-2026 Internal Control Evaluation is a key piece of work within the Internal Audit Plan, and provides an interim position statement for NHS Lanarkshire, highlighting any concerns to allow remedial work to be undertaken by year end. Actions points have been noted in relation to the following:- Code of Corporate Governance Review (risk assessed as moderate) Monitoring and tracking of external reports (risk assessed as moderate) In-depth review of risk mitigating controls (risk assessed as merits attention) Updating of the Register of Interest (risk assessed as merits attention) Management have agreed appropriate action to address the findings from this audit. A follow-up of implementation of the agreed actions will be undertaken in accordance with the current audit reporting protocol within the agreed timescales. L05/26 Review of Risk Management Strategy, Standards and operations Reasonable Assurance Key findings: The Code of Corporate Governance (May 2024) and SFIs (April 2024) do not align with the Risk Management Strategy (March 2025) and Policy (November 2025) Data reported in risk reports presented to Assurance Committees is not taken from InPhase, the primary system for recording risks; risks are retrospectively approved after being created in InPhase More than half of the corporate risks are out with risk appetite. Assurance Committee minutes do not always provide a clear record of robust risk discussion and consideration of whether controls are operating as expected, and whether additional controls are required. Risks are not always reviewed in a timely manner. Use of the optimal and tolerable zones demonstrating whether a risk is within or out with the zone for risk appetite has not been reported consistently against the standard criteria The Audit and Assurance Committee Key Lines of Enquiry document (Annex F) has not been presented to the Audit & Risk Committee (ARC) since March 2024 Corporate Management Team (CMT) minutes and papers did not evidence horizon scanning There is no Standard Operating Procedure (SOP) for InPhase risk management processes. We have been informed this is a planned development. 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. Page 89 of 146
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Appendix 2 10 Report Audit Opinion Key findings Agreed Action: Management has agreed that relevant content will be aligned to ensure core governance documentation is consistent. Inphase process and reports will be revised to ensure that the reports presented are driven from the most recent Inphase update. Relevant discussion will be included in the minutes and action taken to ensure that risk reports are consistent. Annex F will be presented to the March 2026 ARC. A SOP will be developed which will cover the process highlighted in the findings. L06/26 Review of Staff & Patient Environment – Fire Safety Reasonable Assurance The audit reviewed compliance with DL (2024) 28 - 'Fire Safety Policy for NHS Scotland' and assessment of whether processes for fire risk assessment, fire safety control book audits and fire safety training comply with NHS Assure fire safety requirements. Key findings: Internal Audit identified potential enhancements to the assurance provided on compliance with fire safety duties, and assurances that there is no management contravention of the Fire (Scotland) Act 2005 and the Fire Safety (Scotland) Regulations 2006. The Quarter 1 2025/26 Fire Safety report was not presented to the Corporate Management Team. Quarter 2 2025/26 Fire Safety Report was presented to the 22 December 2025 CMT, following issue of this draft report. Agreed Actions: A Short Life Working Group will review Key Performance Indicators. Site Directors will be contacted to remind them of their statutory fire safety responsibilities and a system put in place via the Fire Safety Group secretariat to escalate on a quarterly basis when no report or information is submitted. Quarterly Fire Reports and ad hoc reports will be submitted to CMT and Finance & Resources Sub-Committee for discussion and action Page 90 of 146
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Appendix 2 11 Report Audit Opinion Key findings L12/26 Review of Whistleblowing Reasonable Assurance This audit reviewed systems designed to ensure compliance with National Whistleblowing Standards. Key findings: The Whistleblowing SOP was not reviewed and updated by the scheduled date of February 2025. The extant SOP does not contain sufficient information relating to the role of the Confidential Contacts and there is no separate SOP for Confidential Contacts. Agreed Action: The Whistleblowing SOP will be reviewed and will include more detailed information on the role of confidential contacts. The following relevant report has been issued by North Lanarkshire Council in this period. Report Audit Opinion Key findings 0150.2026.001 Self-Directed Support Limited Assurance This audit reviewed the Council’s arrangements for ensuring that SDS budgets are calculated fairly and consistently in line with guidance and are monitored to ensure that they are being used appropriately by service users. While we found strong financial oversight arrangements and no evidence of incorrect budgets or misuse of SDS funds, significant weaknesses were identified in the application of agreed procedures, the retention of key documentation and the consistency of Direct Payment (DP) monitoring. These weaknesses could lead to DP funds being misused without detection or not being used in line with assessed needs and agreed outcomes, potentially affecting the support being received by individual service users and exposing the Council to potential financial loss and reputational damage. Further areas for improvement were noted relating to the consistent application of DP management and monitoring procedures across all localities, updating the SDS Good Practice Guide, strengthening procedures for retaining key documentation and consistently applying agreed SDS procedures and establishing a formal training programme. Page 91 of 146
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Appendix 3 12 INTERNAL AUDIT REPORT IJB FINANCIAL SUSTAINABILITY Headlines The Integration Joint Board (IJB) continues to face a complex range of challenges and significant financial pressures arising from increasing demand for health and social care services, rising costs and limited options for generating additional income. The IJB is exposed to the financial pressures of NHS Lanarkshire and North Lanarkshire Council, as its financial position is directly shaped by the level of resources delegated by its partners and the cost pressures arising within delegated services. As a result, the IJB has limited flexibility in mitigating these pressures. Collectively, these factors make setting a balanced budget, while continuing to deliver statutory services, progressively more challenging. In February 2025, the Accounts Commission highlighted the critical financial position facing Scotland’s IJBs, noting that despite a real-terms increase in funding, rising cost pressures and diminishing reserves require decisive action and difficult choices on service delivery. The purpose of this audit was to provide assurance on the adequacy and robustness of the IJB’s approach to long-term financial sustainability. Based on the results of our work, we have categorised this audit as providing reasonable assurance. We were pleased to note that the IJB has an established financial planning framework in place, supported by a clear annual financial planning cycle. This includes the development of an annual Medium-Term Financial Plan (MTFP), underpinned by a Long-Term Financial Outlook that provides oversight of forecast financial pressures through to 2035. At the time of the audit for the 2025/26 financial year, the IJB was reliant on reserves and non-recurring budget to manage in-year financial pressures, which is not a sustainable long-term financial position. However, we recognise that significant progress has been made following approval of the MTFP in March 2026. In particular, the introduction of a formal Savings Programme, with robust savings identified to address the forecast budget gap. This has strengthened the IJB’s financial sustainability position by supporting a reduction in reliance on reserves to balance the budget. Despite these improvements, the IJB’s financial outlook remains uncertain, and it is essential that Board members and partners remain fully sighted on emerging financial pressures and continue to support active monitoring, regular review, and timely decision-making. This will be critical to ensuring that plans are developed and implemented effectively, enabling the IJB to progress towards long-term financial sustainability. We have highlighted some areas for improvement, which are detailed in section 3 of this report and include: A need to strengthen the IJBs financial sustainability by reducing reliance on reserves through a robust governed savings framework. Scope to improve financial reporting arrangements to enhance transparency and support informed decision making. Internal Audit Opinion Reasonable assurance Priority of Recommendations High Medium Low 0 1 1 Report status FINAL Audit ref 0500/2026/004 Date issued 28/04/2026 Audit Team Kimberley Hall and Lesley Armstrong Issued To Chief Finance Officer (NL HSCP) Copied To Chief Officer (NL HSCP) Page 92 of 146
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Appendix 3 13 1. Executive Summary Objectives The audit sought to provide assurance on the following areas: There are robust financial planning processes in place, aligning strategic objectives to a medium to long term financial strategy. Key assumptions, risk and uncertainties are clearly stated and appear reasonable. There are appropriate oversight and accountability for financial decisions, with board members, senior officers and other stakeholders receiving timely and relevant financial information and being engaged in financial planning processes decision making. Progress against identified savings options is monitored, reported and followed up where required and is there a strategy in place to manage the use of reserves. Work undertaken by NLC Internal Audit included obtaining appropriate evidence, holding discussions with relevant officers, and reviewing the IJB’s approach to long‑term financial sustainability to determine whether it is adequate and robust. This engagement has been conducted in accordance with the Global Internal Audit Standards. We would like to thank officers involved in this audit for their cooperation and assistance. 2. Findings and Recommendations Good practice identified We noted the following areas of good practice during the audit: The IJB has an established financial planning cycle, with an annual Medium‑Term Financial Plan (MTFP) supported by a Long‑Term Financial Outlook (LTFO) providing visibility of financial pressures up to 2035. The introduction of updated Medium‑Term Financial Outlook (MTFO) reports in September and December ensures emerging pressures are identified early and reflected in financial planning ahead of the formal March budget‑setting cycle. The long-term financial planning aligns the MTFP and LTFO with the Strategic Commissioning Plan, ensuring resources support key priorities. The IJB has introduced a formal Savings Programme as part of the MTFP. This includes, for each proposed saving, a risk rating, risks and impacts, forecast savings, and alignment to the Strategic Commissioning Plan. Quarterly budget monitoring reports are presented the IJB providing timely updates on outturns, variances, financial risks, savings delivery and reserves. The Chief Finance Officer holds regular Senior Management Team meetings with finance colleagues from both NLC and NHSL to discuss emerging financial risks, with any significant issues escalated promptly. These discussions feed into the quarterly financial monitoring reports, ensuring senior officers and Board members are kept informed. Budget liaison sessions are held with board members prior to setting the MTFP in March, ensuring members receive timely and relevant financial information to make informed decisions and set a balanced budget. Key areas requiring management action (High) No key areas requiring urgent management action have been identified. Other areas for improvement (Medium) One area for improvement was identified: There is a need to strengthen the IJBs financial sustainability by reducing reliance on reserves through a robust governed savings framework. Page 93 of 146
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Appendix 3 14 3. Action Plan IJB FINANCIAL SUSTAINABILITY 0500/2026/004 Ref Finding 1 There is a need to strengthen the IJB’s financial sustainability by reducing reliance on reserves through a robust governed savings framework. Financial performance reported to the Performance, Finance and Audit (PF&A) Committee in 2025/26 shows a continued reliance on reserves and non-recurring budget measures to support the IJBs financial position. The February 2026 report forecasts a £14.9m budget gap, with only £4.9m of approved savings expected to be delivered. Non‑recurring budget measures are being used to offset most of this pressure, reducing the projected year‑end overspend to £1.9m. This demonstrates the IJBs reliance on one-off measures to bring the financial position to a manageable level. The MTFO report, which was reported to the IJB in December 2025 provides an in-year update on the MTFP. The report projects a three-year cumulative gap of £80.905m, including a gap of £38.177m for 2026/27. The IJB useable reserves balance at the time of the report was £36.560m lower than the projected deficit for 2026/27, demonstrating that the IJB does not hold sufficient reserves to manage the level of financial pressures it faces. The 2026/27 MTFP presented to the IJB in March 2026 provided a more positive outlook, with the updated total three year forecasted budget gap of £67.464m, down £13.441 from the December. The reduction was as a result of increased grant-aided expenditure from NLC, indicating that the IJB is reliant on partnership additional funding and/or reserves to balance the budget. The MTFP sets out that any in-year shortfalls in savings delivery will be managed through the prudent use of contingency and risk‑based reserves and confirms that reserves will be used to support project management capacity to deliver transformation and the approved savings programme. This demonstrates a strategic but increasing reliance on reserves, both to address immediate financial pressures and to facilitate the redesign needed to achieve future savings. While this approach provides short-term stability, it also highlights that the IJB’s ability to deliver longer-term financial sustainability and transformation is partly dependant on reserves, reinforcing the need for close monitoring and prudent reserve management. Review of the approved 2025/26 MTFP identified that information on savings and service redesign was limited and lacked transparency, providing only a brief description and overall high- level totals with no detail on what makes up the savings proposal, risks, or what underpins the savings. It was confirmed that the IJB historically operated with no formal savings process, contributing to the limited clarity. We recognise recent improvements in this area, including the introduction of a standardised savings template and monthly SMT and budget liaison sessions, which provide IJB Board members with opportunities to discuss savings proposals. There has also been the integration of the new savings programme, which uses a risk-based approach to develop recurring savings options. The new approach allows for each saving option to set out the risk rating, scope of saving, risks, alignment to the Strategic Commissioning Plan, forecast savings amount and mitigations, this standardised approach which has been adopted allows for enhanced transparency. The MTFP for 2026/27 proposes the establishment of a dedicated Savings Board, chaired by the Chief Officer, to strengthen oversight through monthly monitoring and early identification of undeliverable savings, with progress also reported quarterly to the PF&A Committee. However, these arrangements are still at an early stage, and do not yet provide a robust structure for effective scrutiny or challenge. Given the IJB’s continued reliance on reserves and non-recurring budget, there is an increasing need for recurring savings that are realistic, deliverable and clearly justified. At present, when approved savings become unachievable, the shortfall is met through drawdown of reserves or other one-off measures. This approach is not sustainable, and it is important that the IJB identifies alternative recurring savings where proposals cannot be delivered, to reduce reliance on reserves to manage in-year pressures. Implication Recommendation Priority Management response Implementation Date The IJB may be unable to maintain financial sustainability due to over-reliance on reserves and non-recurring measures and insufficient recurring savings increases the risk of future overspends and limits the IJB’s ability to manage significant financial pressures. The Chief Finance Officer (NL HSCP) should: (1) Progress with the development of a sustainable longer-term financial strategy underpinned by recurring savings and reduced reliance on non-recurring budget and reserves, including a process to identify alternative recurring savings where approved proposals become unachievable. (2) Progress with establishing a dedicated Savings Board to strengthen governance and transparency of savings. Medium Agree – Nicola Scott, Chief Finance Officer The 2026/27 budget gap is fully met by a programme of savings approved at the IJB in March 2026 without reliance on reserves. A Savings and Value Board has been established, with the first meeting scheduled for 28th April to agree the documented Terms of Reference. The meetings will take place monthly with the main focus being to monitor progress against the approved savings. If these cannot be achieved, Senior Managers will need to identify and approve alternatives which will be reported to the IJB. 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Appendix 3 15 3. Action Plan IJB FINANCIAL SUSTAINABILITY 0500/2026/004 Ref Finding 2 There is scope to improve financial reporting arrangements to enhance transparency and support informed decision making. The MTFP workings are based on a range of risk-based scenarios, envisaged, pessimistic and optimistic over a three-year planning period. While the envisaged scenario includes a full breakdown of pressures, recurring and non-recurring funding and the resulting funding gap, the pessimistic and optimistic scenarios are presented only as headline budget-gap figures with no supporting detail. The lack of transparency over the underpinning assumptions and components of these scenarios limits Board members’ ability to understand the scale and drivers of the projected budget gaps, reduces insight into the financial implications of alternative scenarios, and restricts informed decision‑making by weakening scrutiny of the underlying assumptions and risks. We also noted that the MTFP that is reported and approved annually, and the MTFO reported in September and December, do not present the overall financial position in a single consolidated view. Instead, information on pressures, savings, reserves and outturn position are reported across different sections of the reports, making it more difficult for Board members and stakeholders to clearly understand the full finance forecast and drivers influencing the projected outturn position. Implication Recommendation Priority Management response Implementation Date The IJB may not have a complete or fully informed understanding of the IJB’s financial position due to the lack of scenario detail, increasing the likelihood of ineffective decision making. The Chief Officer (NL HSCP) should consider: (1) Providing full supporting detail for all three risk-based scenarios to enable effective scrutiny. (2) Improving the clarity and transparency of financial reporting, with consideration being given to a single consolidated financial overview. Low Agree – Nicola Scott, Chief Finance Officer The financial outlook which will be prepared for IJB in September will incorporate these recommendations. September 2026 Page 95 of 146
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Appendix 3 16 APPENDIX 1 – Audit Grading Audit reports are graded with an overall assurance opinion, and any issues and associated recommendations are classified individually to denote their relative importance, in accordance with the definitions in the tables below. Definition of audit assurance and recommendation categories Assurance Confidence based on sufficient evidence that internal controls are in place, operating effectively and objectives are being achieved. Assurance opinion definitions 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. 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. 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. 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. Recommendation priority definitions High Significant control failure or weakness that, if not addressed, may lead to a major financial, operational or reputational risk to the organisation and/or significantly impact the successful delivery and achievement of the objectives of the area under review. Urgent/Immediate action is required. Medium Control failure or weakness that, if not addressed, may lead to a moderate financial, operational or reputational risk to the organisation. Weakness may be individually significant but is unlikely to affect the successful delivery and achievement of the overall objectives of the area under review. The risk of error would, however, be significantly reduced if corrective action was taken. Prompt action is required. Low Control failure or weakness that may lead to a minor financial, operational or reputational risk to the organisation. Weakness does not appear to significantly affect the ability to meet objectives. Minor issue raised to improve the efficiency and effectiveness of controls. Page 96 of 146
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1 REPORT Item No: 10 SUBJECT: Draft Internal Audit Plan 2026/27 TO: Integration Joint Board Performance, Finance & Audit Committee. Lead Officer for Report: Claire Ray, Chief Officer Author(s) of Report Francis Scott, Chief Officer (Audit and Risk), North Lanarkshire Council Jocelyn Lyall, Chief Internal Auditor, NHS Lanarkshire DATE: 20 May 2026 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: For Approval: ☒ For Endorsement: ☐ To Note: ☐ Item 10 Page 97 of 146
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2 2. ROUTE TO THE BOARD This paper has been: Prepared By: Chief Officer (Audit and Risk), North Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire) ☒ Reviewed By: Chief Finance Officer ☒ Endorsed By: Chief Officer ☒ 3. EXECUTIVE SUMMARY The Internal Audit Plan 2026/27 is designed to provide sufficient evidence to form an assessment of the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control arrangements. The planning process for 2026/2027 has taken cognisance of the Global Internal Audit Standards, which require an internal audit plan that supports achievement of the organisation’s objectives. The proposed Internal Audit Plan for 2026/2027 has been designed to target the priority issues. It seeks to align to strategic risks and 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 for 2026/2027. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB Performance, Finance & Audit Committee: (1) Approve the proposed Internal Audit Plan for 2026/2027 (Appendix 1); (2) Approve the recommendation by the Chief Financial Officer that the joint working arrangements between the North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL) Internal Audit teams continue in order to deliver the IJB Internal Audit Service; and (3) Approve the delegation of authority to the Chief Finance Officer to agree with the Chief Officer (Audit and Risk) (NLC) and the Chief Internal Auditor (NHSL) the scope of the audit assignments in the Internal Audit Plan for 2026/2027 including the allocation of responsibilities for completion of assignments. Page 98 of 146
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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 Standard 9.4 of the Global Internal Audit Standards (GIAS) set out the need to create an internal audit plan that supports achievement of the organisation’s objectives. GIAS Standard 9.4 states that ‘the Chief Audit Executive must base the internal audit plan on a documented assessment of the organisation’s strategies, objectives and risks. This assessment must be informed by input from the board and senior management, as well as the chief audit executive’s understanding of the organisation’s governance, risk management and control processes’. The internal audit plan must: Consider the internal audit mandate and the full range of agreed to internal audit services Specify internal audit services that support the evaluation and improvement of the organisation’s governance, risk management and control processes Consider coverage of information technology governance, fraud risk, the effectiveness of the organisation’s compliance and ethics programmes, and other high risk areas Identify the necessary human, financial and technological resources necessary to complete the plan Be dynamic and updated timely in response to changes in the organisation’s business, risks, operations, programmes, systems, controls and organisational culture. The Chief Audit Executive must review and revise the internal audit plan as necessary and communicate timely to the board and senior management: The impact of any resource limitations no internal audit coverage The rationale for not including an assurance engagement in a high risk area or activity in the plan 7. SUMMARY OF KEY ISSUES The Internal Audit Plan is designed to provide the Chief Officer (Audit and Risk) of North Lanarkshire Council (NLC) and the Chief Internal Auditor of NHS Lanarkshire (NHSL) with sufficient evidence to form an overall independent and objective annual conclusion on the organisation’s governance, risk management, and control. It therefore includes the delivery of standard products required each year and is based on professional judgement of audit need based on the IJB’s risk environment. Yes ☐ No ☒ N/A ☐ Page 99 of 146
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4 In addition, account is taken of assurance which can be provided to the IJB based on work performed under the Internal Audit Plans of both parties. The Internal Audit Plan describes how the available resources will be utilised during the year. Integrated Resource Advisory Group (IRAG) Finance Guidance states that it is the responsibility of the IJB to establish adequate and proportionate internal audit arrangements. This will include a review of the adequacy of the arrangements for risk management, governance, and control of the delegated resources. A joint internal audit arrangement is in place for the North Lanarkshire IJB with input from Internal Audit teams at both NLC and NHSL. The internal audit programme of work and the annual Internal Audit opinion are therefore delivered jointly by the Chief Officer (Audit and Risk) of NLC and the Chief Internal Auditor of NHSL. 8. CONCLUSIONS The proposed Internal Audit Plan for 2026/2027 is attached at Appendix 1 for consideration and approval. The Committee is asked to delegate authority to the Chief Financial Officer to agree with the Chief Officer (Audit and Risk) of NLC and the Chief Internal Auditor of NHSL the scope of the audit assignments in the Internal Audit Plan for 2026/2027 including the allocation of responsibilities for the completion of assignments. The Chief Officer and the Chief Financial Officer will consult with both partners. Internal Audit Plan 2026/2027 The proposed Internal Audit Plan for 2026/2027 totals 60 days and is attached as an appendix for approval. We have reviewed the extant risk register of the organisation and we have consulted the Chief Officer and Chief Finance Officer to ensure the substantive audit assignment in 2026/27 adds maximum value. The IJB’s Internal Auditors will flexibly adjust the plan as required if risks change throughout the year. Of the 60 days available, 27 days relate to standard audit deliverables of audit planning, audit management, the provision of the annual internal audit report and the follow-up of previously agreed actions. Progress reports will be presented to the Performance, Finance & Audit Committee during the year. 40 days have been allocated to assess workforce planning arrangements including: workforce planning to ensure alignment to service delivery; adequacy of workforce resilience; and review of arrangements to ensure compliance with the Health and Care (Staffing) (Scotland) Act 2019. This work will be undertaken jointly by the North Lanarkshire Council and NHS Lanarkshire Internal Audit teams. Page 100 of 146
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5 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL This paper has been reviewed by Finance: Yes X No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner NLIJ-R06: Governance Failure High (12) Chief Finance Officer NLIJB-R08: Workforce Availability and Capacity Medium (8) Head of Health / Head of Adult Social Work / Nursing Director Page 101 of 146
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6 The management of risk is an integral part of the development of the Internal Audit Plan. The Internal Audit Plan 2026/2027 has also been informed by the draft Internal Audit Opinion 2025/2026 and an assessment of current and ongoing risks. 9.5 ENGAGEMENT & PARTICIPATION The Chief Officer and the Chief Financial Officer have both been consulted in respect of the preparation of the Internal Audit Plan 2026/2027. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes N/A ☐ Provide stakeholders with information on how to get involved N/A ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs N/A ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services N/A ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery N/A ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings N/A ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff N/A ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership N/A Page 102 of 146
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7 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A X EQIA added to website: Yes No N/A X 10. BACKGROUND PAPERS N/A 11. APPENDICES Appendix 1 – Draft internal audit plan 2026/27 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Francis Scott, Chief Officer (Audit and Risk), North Lanarkshire Council) – Scott Fr@northlan.gov.uk Jocelyn Lyall, Chief Internal Auditor (NHS Lanarkshire) – Jocelyn.lyall2@nhs.scot Page 103 of 146
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Appendix 1 Internal Audit Plan 2026/27 8 Ref Audit Indicative Scope Strategic risk Days NL01-27 Audit Planning Preparation of internal audit annual plan 2026/27. Full IJB risk register considered 1 NL02-27 Audit Management Liaison with management and external audit, liaison with Chief Finance Officer and attendance at Audit Committee. N/A 7 NL03-27 Audit Follow Up Review of progress made by management in implementing those actions committed to in response to previously agreed Internal Audit recommendations. N/A 5 NL04-27 Annual Report Prepare and present an annual report containing the Annual Internal Audit Opinion for 2026/2027. Full IJB risk register considered 7 NL05-27 Workforce Assessment of the design and effectiveness of workforce planning arrangements including: ensuring alignment to service delivery; adequacy of workforce resilience; and review of arrangements to ensure compliance with the Health and Care (Staffing) (Scotland) Act 2019. NLIJB-R08: Workforce Availability and Capacity 40 Page 104 of 146
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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 The purpose of this report is to seek approval of proposed changes to the Chief Finance Officer (CFO) role, which are intended to strengthen financial governance, resilience and workforce planning arrangements for the Integration Joint Board. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By: Chief Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the PFA Committee: (1) Acknowledge the contents of this report and the rationale for the proposed changes to the CFO role. (2) Approve the proposed changes to the CFO role, as set out in this report, recognising the additional support being provided by North Lanarkshire Council. (3) Note that the proposed arrangements are designed to strengthen governance, reduce single‑point‑of‑failure risk, and improve workforce and succession planning, with no reduction in service to the Integration Joint Board (IJB). 4. VARIATIONS TO DIRECTIONS 5. Background 5.1 The IJB continues to operate in a highly challenging financial environment, with increasing demand pressures and significant financial risk concentrated largely within adult social care. The scale and complexity of these pressures require strong, resilient and well-integrated financial leadership. SUBJECT: Chief Finance Officer Role TO: Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Officer DATE: 20 May 2026 Yes No N/A Item 11 Page 105 of 146
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5.2 The CFO role is a statutory post under section 95 of the Local Government (Scotland) Act 1973 and is central to good governance, financial stewardship and strategic planning. Recent national audit findings have highlighted the increased vulnerability of IJBs where there is insufficient resilience around statutory financial roles, particularly in the context of workforce shortages and recruitment challenges at senior levels. 5.3 In parallel, North Lanarkshire Council is reviewing its wider finance arrangements, providing an opportunity to strengthen integration, improve resilience and align financial leadership across the system while protecting the independence of statutory advice provided to the IJB. 6 PROPOSAL 6.1 It is proposed that the IJB CFO role be adapted to operate as a dual role, combining the statutory CFO responsibilities for the IJB with a substantive role within the Finance Management Team of North Lanarkshire Council. 6.2 Under this arrangement: The CFO will remain the statutory section 95 officer to the IJB and a full member of the Partnership Senior Management Team. The CFO will also be embedded within the Council’s senior finance leadership structure, improving alignment with council-wide budget setting, medium-term financial planning and risk management. Responsibility for the Adult Social Care finance team within the Council will transfer into the remit of the dual role. Certain operational duties will be delegated to appropriately qualified finance managers and accountants, supported by a clear governance and delegation framework. 6.3 North Lanarkshire Council will provide additional capacity and support to ensure that the IJB continues to receive a full and effective finance service, with no detriment to service delivery. 7. RATIONALE 7.1 The proposed changes are intended to deliver clear and measurable benefits: Avoidance of single point of failure The current model places significant reliance on a single individual for statutory, strategic and operational finance responsibilities. The dual-role approach increases resilience by embedding the CFO within a broader finance leadership team and enabling effective delegation and cover arrangements. Improved workforce and succession planning The changes support more sustainable workforce planning by widening access to finance expertise, reducing over-reliance on one postholder and creating clearer succession and contingency arrangements. Stronger integration and governance Closer alignment with council financial leadership strengthens whole-system planning, enhances governance and provides earlier visibility of risks and pressures. Page 106 of 146
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Enhanced strategic capacity Delegating routine operational tasks allows the CFO to focus on strategic leadership, financial sustainability, transformation and assurance areas of increasing importance given the financial outlook. 8. IMPACT 8.1 The proposed changes to the CFO role are designed to strengthen resilience and governance arrangements while maintaining, and in some areas enhancing, the level of financial support provided to the IJB. 8.2 Impact on the IJB There will be no reduction in the capacity or quality of financial support provided to the IJB. The CFO will continue to operate independently in their statutory role, providing objective advice and assurance to the Board. 8.3 Impact on partnership working Relationships with NHS Lanarkshire Finance and Management Teams will remain unchanged and will continue to be supported through regular senior-level engagement. The proposals are expected to further strengthen partnership working across finance teams. 8.4 Financial impact The dual-role arrangement will result in a partial sharing of salary costs with North Lanarkshire Council. While the precise value is still to be finalised, an indicative saving to the IJB of approximately 25% of salary costs has been identified, with no associated service reduction. 9. LEARNING FROM THE ACCOUNTS COMMISSION REPORT 9.1 The Accounts Commission’s report on Clackmannanshire and Stirling Integration Joint Board (March 2026) provides an important national case study on the risks associated with insufficient resilience around the statutory CFO (section 95 officer) role. 9.2 In that case, the IJB’s substantive CFO resigned in August 2025 and left post in October 2025. Despite collaborative and well‑intentioned support from partner organisations’ finance leads, the IJB operated for approximately nine weeks without a formally appointed section 95 officer. During this period, financial management functions continued and partnership working remained strong; however, no individual was formally designated to discharge the statutory responsibilities of the role. 9.3 The Accounts Commission concluded that, while day-to-day financial administration was maintained, the legal requirement to appoint a section 95 officer was not met. The Commission described this as a serious governance failure by the IJB and its partners, particularly given explicit warnings raised at an IJB meeting during the period of vacancy. Of specific concern was the absence of formal contingency arrangements and the provision of assurance to Board members that statutory requirements were being met when this was not the case. As a result, the Controller of Audit exercised statutory reporting powers to draw the matter to the Accounts Commission’s attention. Page 107 of 146
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9.4 Therefore the proposed changes to the CFO role directly reflect these national findings and expectations. By strengthening resilience, reducing reliance on a single postholder, embedding clearer delegation and governance arrangements, and aligning the CFO role more closely with a wider finance leadership structure, the IJB is proactively addressing the risks highlighted by the Accounts Commission. These changes are intended to ensure statutory compliance is maintained at all times, even during periods of staff turnover or absence, while improving workforce planning and long-term sustainability. 10. ASSURANCE 10.1 The Committee can be assured that the proposed changes to the CFO role have been explicitly designed to address the risks and lessons identified by the Accounts Commission. The arrangements strengthen compliance with statutory requirements, improve resilience and continuity for the section 95 officer role, and provide clear, formal governance, delegation and contingency arrangements. 10.2 The proposals have been reviewed and approved by the Chief Executive of North Lanarkshire Council and are supported by the Chair and Vice Chair of the IJB, providing further assurance of their robustness and alignment with best practice. In addition, the enhanced support being provided by North Lanarkshire Council ensures that there will be no reduction in the level or quality of financial support to the IJB, while improving workforce planning and reducing reliance on a single postholder. 10.3 Taken together, these measures position the IJB strongly to meet current and future financial challenges and to avoid the governance risks experienced elsewhere in the sector. 11. NEXT STEPS 11.1 Subject to Committee approval: i. Revised role descriptions, delegation arrangements and governance documentation will be developed in conjunction with HR. ii. Clear reporting lines and accountability arrangements will be formally documented to ensure transparency and independence of the CFO’s statutory role. iii. North Lanarkshire Council will complete a capacity review of the relevant finance teams. 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 ☐ Page 108 of 146
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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) The implementation of agreed actions will strengthen financial governance, resilience and workforce planning arrangements 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 Sustainability – Short Term High Nicola Scott Financial Sustainability – Medium Term Very High Nicola Scott Financial Sustainability – LongTerm Very High Nicola Scott Governance Failure High Nicola Scott Failure to meet Legislative Requirements High Pauline Izat / Morag Dendy / Joanne Jenkins 12.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☒ 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 Page 109 of 146
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☒ 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 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 None Chief Officer Members seeking further information about any aspect of this report, please contact Claire Rae Page 110 of 146
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REPORT Item No: 12 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: 20 May 2026 Yes No N/A Item 12 Page 113 of 146
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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 2 0 2023/24 5 4 1 2024/25 3 1 2 2025/26 1 1 0 TOTAL 11 8 3 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 114 of 146
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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 Governance Failure Low Pauline Izat/Morag Dendy/Joanne Jenkins 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 115 of 146
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8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Annual Governance Statement – Action Plan Progress Appendix 2 Briefing Note – Outstanding Audit Action – Hosted Services Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07581 007187. Page 116 of 146
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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 Following a full review with Senior Managers within Finance, Adults Social Care and Education and Families a robust framework for financial governance of hosted services has been agreed. This will see the development of a combined Revenue Budget Monitoring Report specifically for hosted services as well as the introduction of budget governance meetings. A briefing note outlining the proposal which has been agreed by Chief Officers is included at Appendix 2 for information. Complete 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 117 of 146
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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 Q2 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 June 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 118 of 146
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Appendix 2 Page 1 of 6 Briefing Note Subject: Outstanding audit action - Hosted Services Prepared By: Paula Hendry and Scott McCrossan (Business Finance Managers) For: E&F - Alison Gordon (Chief Social Work Officer – Children, Families, Justice, and Integrated Practice) ASC - Claire Rae (Chief Officer – North Lanarkshire HSCP), Morag Dendy (Chief Officer – Planning, Performance, and Quality Assurance), Diane Fraser (Chief Officer – Adult Social Work Services) Date: 9 March 2026 Background At its meeting on 27 September 2018, the Policy and Resources Committee approved a revised organisational structure, as set out in the Chief Executive’s report “We ASPIRE – A Shared Ambition for North Lanarkshire.” This restructure introduced substantial changes to the Council’s management arrangements at that time. A key implication for the Health and Social Care service related to the realignment of ‘Children, Families and Justice Services’. The associated budgets were to be transferred from ‘Health and Social Care’ and incorporated within the newly established ‘Education and Families’ Service. Consequently, the ‘Health and Social Care’ Service was redesignated as ‘Adult Health and Social Care’. Following approval of the restructure, Finance prepared a series of discussion papers for the relevant Chief Officers. These papers supported the detailed consideration and agreement of the budget lines to be transferred to Education and Families and those to be retained within Adult Health and Social Care. The budget transfers completed during 2019/20 and 2020/21. During these deliberations, it was recognised that a complete and distinct separation of all budget areas was operationally impracticable. As a result, certain budgets transferred to Education and Families to continue to support both Services and were therefore “hosted” within Education and Families. Likewise, some budgets retained within Adult Health and Social Care also supported both Services and continued to be “hosted” within that Service. Outstanding Audit Action Following the disaggregation, recommendations were raised by Internal Audit (Financial Due Diligence Report, May 2020) and External Audit (Annual Audit Report 2019/20, September 2020) requiring the finalisation and implementation of hosting arrangements for budgets relating to cross-cutting services associated with this disaggregation. This requirement has also been captured as an improvement action within the IJB’s Annual Governance Statement (AGS). Internal Audit has monitored progress on this action since 2020 through formal follow-up processes. In parallel, the IJB Chief Finance Officer has provided periodic progress updates to the IJB Performance, Finance and Audit Committee as part of routine AGS action plan reporting. Management previously advised that progression of this audit action had been paused pending further clarity on the Scottish Government’s proposals for a National Care Service. Appendix 1 sets out extracts from the relevant audit reports alongside a summary of the position as reported in the Internal Audit follow-up reports since the recommendation was made along with the most recent progress update for the AGS action plan. Page 119 of 146
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Appendix 2 Page 2 of 6 Budget Composition 2025/26 For the 2025/26 financial year, the overall budget associated with North Lanarkshire’s Social Work hosted services equates to c. £115.290m which has c. £6.143m and £109.147m hosted within the Council’s Education and Families Service (General Fund) and Adult Social Care Service (Integrated Joint Boad) respectively. Appendix 2 provides a high-level, functional breakdown of this budget for reference. There is a long-established practice within the respective Finance Teams and across the relevant Services to ensure that associated budget areas are clearly identified and well understood. However, it is acknowledged that, in light of the outstanding audit action, overall governance relating to how these budgets are utilised requires greater visibility and improved oversight. Financial Governance and Reporting To enhance financial governance and strengthen oversight across Social Work Hosted Services, it is proposed that the Finance Team develop a combined Revenue Budget Monitoring Report specifically for these hosted services. This report will present a clear and comprehensive financial position, drawing together all relevant budget information into a single monitoring framework. It is intended that the report be issued to the designated Chief Officers on a bi-annual basis, aligned with Period 6 and the Final Outturn. From a wider financial governance perspective, it is proposed that budget governance meetings be convened on an as-required basis to provide a formal mechanism for cross-service consideration of financial matters relating to the hosted budgets. These meetings would support scrutiny and agreement on issues such as: requests for, and approval of, the utilisation of specific budgets outlined in Appendix 2 (e.g. training allocations); project-related funding requirements; emerging cost pressures; and savings reviews and associated financial planning implications. Any decisions relating to these matters will require discussion and endorsement by the relevant Chief Officers. To ensure robust oversight, attendance should ideally include the aligned Business Finance Managers together with all associated Chief Officers. However, where timely decision-making is required, a minimum quorum of one Chief Officer from each service area and one Business Finance Manager would be sufficient to ensure governance standards are maintained while enabling prompt and co-ordinated action. Conclusion The proposal outlined above establishes a proportionate and robust framework for the financial governance of hosted services supporting North Lanarkshire’s social work functions. Finance is of the view that implementing these arrangements will address, and enable closure of, the outstanding audit action. The introduction of a bi-annual Revenue Budget Monitoring Report, providing a consolidated financial position for Social Work Hosted Services, together with the proposed budget governance meetings, will ensure that Chief Officers receive tailored, timely and comprehensive financial and management information. This enhanced reporting and oversight structure will support cohesive, well-informed decision-making and strengthen assurance over the effective use of hosted service budgets. Page 120 of 146
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Page 3 of 6 Appendix 1: Social Work Hosted Services – Audit Recommendation and Management Response Extracts Internal Audit: Financial Due Diligence, May 2020 Page 121 of 146
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Page 4 of 6 Appendix 1: Social Work Hosted Services – Audit Recommendation and Management Response Extracts External Audit: Annual Report 2019/20, September 2020 Page 122 of 146
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Page 5 of 6 Appendix 1 (cont): Social Work Hosted Services – Audit Recommendation and Management Response Extracts Update Position on status of Audit recommendations as reported to IJB via Internal Audit Follow-Up Reports Position as at Apr 2021 Position as at Feb 2022 Position as at Apr 2023 Position as at June 2024 Position as at June 2025 The SLA for future hosting arrangements and associated budgets had not yet been presented to the IJB, Adult Health and Social Care Committee, or Education and Families Committee. Work was underway and expected to conclude by the end of April 2021. Complete – the budget disaggregation exercise was concluded. The revised IJB direction to NLC (23 March 2021) excluded the total budget transfer for Children, Families & Justice Services. Ongoing – SLA finalisation overdue. Revised Timeline: June 2022. Complete – The budget disaggregation exercise remained concluded. Ongoing – SLA overdue and paused pending clarity around what services will be part of the new National Care Service (NCS). Revised Timeline: TBC. Complete – Budget disaggregation concluded. Ongoing – SLA overdue. NCS timeframe delayed further than intended by Scottish Government. IJB will now consider creating its own SLA with Children Families and Justice. Revised Timeline: TBC. Budget disaggregation complete. SLA still overdue with limited progress due to a change in the SMT. Action included in Governance Statement with new timescale to review and finalise. Revised Timeline: September 2025. Latest update position as reported to IJB at Performance, Finance and Audit Committee on 18 February 2026 Page 123 of 146
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Page 6 of 6 Appendix 2: Social Work Hosted Services Budget Composition (2025/26) Hosted by Education and Families (General Fund) Category No. of Cost Centres 2025/26 Budget Admin 7 £5.287m Locality running costs 6 £0.513m Specific (Training – SW Secondment Scheme) 2 £0.342m TOTAL 16 £6.143m Hosted by Adult Social Care (IJB) Category No. of Cost Centres 2025/26 Budget SDS 83 £106.801m Planning & Quality Assurance (P&QA) 12 £1.597m Business Process Change & Improvement (BPC&I) 1 £0.636m Equipment & Adaptation Service (EAS) 3 £5.886m Specific (includes MIST – Emergency Planning & Grounds) 2 £0.112m TOTAL 101 £109.148m Following the conclusion of the Council’s 2026/27 Budget Master Process (c. June 2026), updated budgetary information will be provided to the respective Chief Officers. Page 124 of 146
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1 REPORT Item No: 13 SUBJECT: IJB Risk Register TO: North Lanarkshire Integration Joint Board Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Kerry Taylor, Business Support Manager DATE: 20 May 2026 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Kerry Taylor, Business Support Manager ☒ Reviewed By: Claire Rae, Chief Officer ☒ Endorsed By: ☐ Item 13 Page 125 of 146
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2 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA: (1) considers the risks identified, the control measures in place, and the risk actions in progress to mitigate their impact; (2) makes recommendations it thinks appropriate to the Chief Officer in relation to those risks, controls and 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 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. The IJB PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. A new risk register was presented and approved at North Lanarkshire Integration Joint Board in March 2026. NORTH LANARKSHIRE INTEGRATION JOINT BOARD RISK OVERVIEW Risks scoring between 16-25 are considered Very High, with two risks within this category: NLIJB-R02: Financial Sustainability - Medium Term – Risk Score 20 NLIJB-R03: Financial Sustainability - Long Term – Risk Score 16 Risks scoring between 10-15 are considered High, with three proposed risks within this category: NLIJB-R01: Financial Sustainability - Short Term – Risk Score 12 NLIJB-R06: Governance Failure – Risk Score 12 NLIJB-R09: Delayed Discharge – Risk Score 12 Yes ☐ No ☐ N/A ☒ Page 126 of 146
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3 Risks scoring between 5-9 are considered Medium, with four proposed risks within this category: NLIJB-R04: Performance Delivery – Risk Score 8 NLIJB-R05: Inadequate Performance Management – Risk Score 6 NLIJB-R07: Failure to Meet Legislative Requirements – Risk Score 7 NLIJB-R08: Workforce Availability and Capacity – Risk Score 9 NEXT STEPS Members of North Lanarkshire Integration Joint Board are invited to discuss the proposed risks, and if deemed appropriate to approve the new risk register. Work is ongoing to develop a new risk management strategy in partnership with NHS Lanarkshire and North Lanarkshire Council. This strategy has now been drafted, with final amendments being made. This will be presented to the IJB PFA in August 2026. It has been agreed for the North IJB risks to be recorded on the NHS Lanarkshire risk recording system InPhase. The risks are currently in progress of being added to InPhase. 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner New IJB Risk Register Proposed Choose an item. 10. BACKGROUND PAPERS Page 127 of 146
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4 11. APPENDICES Appendix 1 – IJB Risk Dashboard (May) CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Kerry Taylor kerry.taylor@lanarkshire.scot.nhs.uk Page 128 of 146
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5 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 Page 129 of 146
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6 10 Performance Management / Governance arrangements 11 Date direction will be reviewed Page 130 of 146
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Executive Summary • New risk register presented and approved at North Lanarkshire Integration Joint Board on 18 March 2026 • Work is ongoing in partnership with NHSL and NLC to develop new Risk Management Strategy North Lanarkshire IJB Risks Dashboard – May 2026 Number of RisksRisk Register 9 North Lanarkshire Integration Joint Board Risk Movement Since Last Report EscalatedNewDe-escalatedClosedDecreaseIncreaseNo Change ------9 NL IJB Risk Heat Map 0 1 2 3 4 5 6 Within Optimal Zone Within Tolerable Zone Out with Tolerable Zone IJB Risks IJB Risk Appetite 0 111 2 21 4 5 Number of RisksRisk Register Overview 2Very High (16-25) 3High (10-15) 4Medium (5-9) 0 Low (1-4) 1 Page 131 of 146
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Accountable Officer Risk OwnerCurrent Risk Score Tolerable Zone Optimal Zone Date Opened RiskRisk Ref Chief OfficerChief Finance Officer125-91-418 March 2026 Financial Sustainability – Short Term NLIJB- R01 Chief OfficerChief Finance Officer2010-155-918 March 2026 Financial Sustainability – Medium Term NLIJB- R02 Chief OfficerChief Finance Officer1610-155-918 March 2026 Financial Sustainability – Long Term NLIJB- R03 Chief OfficerHead of Planning, Performance and Quality Assurance 85-91-418 March 2026 Performance DeliveryNLIJB- R04 Chief OfficerHead of Planning, Performance and Quality Assurance 65-91-418 March 2026 Inadequate Performance Management NLIJB- R05 Chief OfficerChief Finance Officer125-91-418 March 2026 Governance FailureNLIJB- R06 Chief OfficerHead of Health / Head of Adult Social Work / Nursing Director 65-91-418 March 2026 Failure to Meet Legislative Requirements NLIJB- R07 Chief OfficerHead of Health / Head of Adult Social Work / Nursing Director 95-91-418 March 2026 Workforce Availability and Capacity NLIJB- R08 Chief OfficerHead of Health / Head of Adult Social Work 125-91-418 March 2026 Delayed DischargeNLIJB- R09 North Lanarkshire IJB Risks Overview – March 2026 Page 132 of 146
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NLIJB-R01: Financial Sustainability - Short Term Accountable Officer Risk OwnerRisk Description Chief OfficerChief Finance Officer The Public Bodies (Joint Working) (Scotland) Act 2014 requires IJB’s to set a balanced budget as part of their strategic planning. This is essential for delivering integrated functions and budgets under IJB’s control, as outlined in the Act’s statutory guidance. There is a risk of North Lanarkshire Integration Joint Board not achieving a balanced budget within the current year as approved by the IJB annually in March. Current Controls • Chief Finance Officer (S95 officer) • Due diligence by S95 officer on budget contributions from partner bodies each year as part of annual budget process • Financial position monitored on ongoing basis by SMT, IJB Performance, Finance and Audit Committee and full IJB, underpinned by a strong system of internal financial control and governance • Financial position reported to NHSL Board and NLC Adult Care & Social Work Committee quarterly • Monthly savings Board being introduced in 2026 to monitor progress against annual savings targets • Financial Regulations in place • NL Integration Scheme – agreed financial and budgetary responsibilities including for overspends against delegated IJB functions • Ongoing monitoring of in year budget and key risk areas regularly reported to the Board • Reserves strategy & policy in place Actions • Agree 2026/2027 budget and Medium-Term Financial Plan on 18 March 2026 - complete • Continue to report financial position via SMT, IJB Performance, Finance and Audit Committee and full IJB • Continue monthly meetings between Partner finance teams and budget managers to ensure variances are reported timeously Risk Update May 2026 – Risk approved on 18 March 2026 at the North IJB. Risk reviewed, one action to be closed. New risk created on North HSCP L2 risk register (NHSL) – ‘North HSCP Financial Sustainability’ Is current assessment within Risk Appetite? No1-4Risk Appetite: Optimal Zone No5-9Risk Appetite: Tolerable Zone 12 Page 133 of 146
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NLIJB-R02: Financial Sustainability - Medium Term Accountable Officer Risk OwnerRisk Description Chief OfficerChief Finance Officer The Public Bodies (Joint Working) (Scotland) Act 2014 requires IJB’s to set a balanced budget as part of their strategic planning. This is essential for delivering integrated functions and budgets under IJB’s control, as outlined in the Act’s statutory guidance. There is a risk of North Lanarkshire Integration Joint Board failing meet this statutory duty by not delivering financial balance over the medium three year financial planning cycle due to income levels not keeping pace with increasing demand and costs pressures. Current Controls • Chief Finance Officer (S95 officer) • Due diligence by S95 officer on budget contributions from partner bodies each year as part of annual budget process • Medium Term Financial Outlook prepared and reported to IJB and Partners annually in September and December • Medium term financial plan prepared annually as part of the annual budget setting process and approved by IJB each March • Financial position monitored on ongoing basis by SMT, IJB Performance, Finance and Audit Committee and full IJB, underpinned by a strong system of internal financial control and governance • Monthly savings Board being introduced in 2026 to monitor progress against annual savings targets • Financial Regulations in place • NL Integration Scheme – agreed financial and budgetary responsibilities including for overspends against delegated IJB functions • Reserves strategy and policy in place Actions • Agree 2026/2027 budget and Medium-Term Financial Plan on 18 March 2026 - complete • Continue to report financial position via SMT, IJB Performance, Finance and Audit Committee and full IJB • Savings proposals to be presented to IJB members early to allow full consideration before the budget is set in March • Regular review of reserves to maximise funds that can be held in contingency to meet budget gaps Risk Update May 2026 – Risk approved on 18 March 2026 at the North IJB. Risk reviewed, one action to be closed. New risk created on North HSCP L2 risk register (NHSL) – ‘North HSCP Financial Sustainability’ Is current assessment within Risk Appetite? No5-9Risk Appetite: Optimal Zone No10-15Risk Appetite: Tolerable Zone 20 Page 134 of 146
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NLIJB-R03: Financial Sustainability - Long Term Accountable Officer Risk OwnerRisk Description Chief OfficerChief Finance Officer Forecasting over an extended period remains inherently uncertain, particularly given the potential for policy change, economic volatility and wider system pressures. Despite this uncertainty, it is essential that the IJB adopts a long-term perspective to ensure it can identify emerging risks early and take proactive steps to safeguard financial sustainability. There is a risk of North Lanarkshire Integration Joint Board not forecasting the long-term factors appropriately resulting in being unable to achieve a balanced budget over the 10-year forecasting timeline. Current Controls • Chief Finance Officer (S95 officer) • Due diligence by S95 officer on budget contributions from partner bodies each year as part of annual budget process • Long term financial outlook is presented alongside the Medium term financial plan annually • Financial position monitored on ongoing basis by SMT, IJB Performance, Finance and Audit Committee and full IJB, underpinned by a strong system of internal financial control and governance. • Financial Regulations in place • NL Integration Scheme – agreed financial and budgetary responsibilities including for overspends against delegated IJB functions • Key risk areas regularly reported to the Board • Reserves strategy and policy in place Actions • Continue to report financial position via SMT, IJB Performance, Finance and Audit Committee and full IJB • Savings proposals to be presented to IJB members early to allow full consideration before the budget is set in March • Regular review of reserves to maximise funds that can be held in contingency to meet budget gaps • Long Term Financial Forecast to be presented to IJB in March each year along with the Medum Term Financial Plan • Assumptions are updated annually using census date, OBR forecasts and demand forecasts from Partners Risk Update May 2026 – Risk approved on 18 March 2026 at the North IJB. Risk reviewed, no proposed changes. New risk created on North HSCP L2 risk register (NHSL) – ‘North HSCP Financial Sustainability’ Is current assessment within Risk Appetite? No5-9Risk Appetite: Optimal Zone No10-15Risk Appetite: Tolerable Zone 16 Page 135 of 146
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NLIJB-R04: Performance Delivery Accountable Officer Risk OwnerRisk Description Chief Officer Head of Planning, Performance and Quality Assurance There is a risk of deterioration in performance delivery of the priorities and outcomes of the Strategic Commissioning Plan due to required expenditure reduction, workforce supply challenges and service demands resulting in North Lanarkshire Integration Joint Board not meeting its statutory duty. Current Controls • Quarterly Performance reviews • Benchmarking against national comparators • Medium term and long-term financial forecasting in place • Service redesign and innovation to progress implementation of the Strategic Commissioning Plan • Regular reporting to IJB Performance, Finance and Audit Committee Actions • Draft Strategic Commissioning Plan for 2026-2029 to be presented to IJB in March 2026 - complete • Final SCP to be presented in June 2026 Risk Update May 2026 – Risk approved on 18 March 2026 at the North IJB. Risk reviewed, one action to be closed. New risk created on North HSCP L2 risk register (NHSL) – ‘Performance Delivery’ Is current assessment within Risk Appetite? No1-4Risk Appetite: Optimal Zone Yes5-9Risk Appetite: Tolerable Zone 8 Page 136 of 146
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NLIJB-R05: Inadequate Performance Management Accountable Officer Risk OwnerRisk Description Chief Officer Head of Planning, Performance and Quality Assurance There is a risk that achieve key objectives will not be achieved due to processes for the review and scrutiny of health and council performance either not being in place or are ineffective, resulting in less than robust scrutiny arrangements, and failure to identify, challenge, or rectify poor performance. Current Controls • Regular reporting to IJB Performance, Finance and Audit Committee • Agreed outcomes / performance measures • Robust performance management within NLC / NHSL • Regular monitoring by IJB and SMT • Annual performance report Actions • Draft Strategic Commissioning Plan for 2026-2029 to be presented to IJB in March 2026 - complete • Final SCP to be presented in June 2026 Risk Update May 2026 – Risk approved on 18 March 2026 at the North IJB. Risk reviewed, one action to be closed. New risk created on North HSCP L2 risk register (NHSL) – ‘Performance Delivery’ Is current assessment within Risk Appetite? No1-4Risk Appetite: Optimal Zone Yes5-9Risk Appetite: Tolerable Zone 6 Page 137 of 146
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NLIJB-R06: Governance Failure Accountable Officer Risk OwnerRisk Description Chief OfficerChief Finance Officer There is a risk that less than robust scrutiny arrangements and appropriate internal processes and procedures are either not in place or are ineffective, leading to a lack of leadership, accountability or scrutiny, resulting in a failure to meet key objectives, financial overspends or reputational damage. Current Controls • Chief Officer • Chief Finance Officer (S95 officer) • Standing Orders • Financial Regulations • Code of Conduct • Local Code of Corporate Governance, Annual Governance Statement and Governance Issues Log • Performance, Finance and Audit Committee • Internal auditor, annual audit plan and internal audit annual report • IJB Development sessions Actions • Appoint Standards Officer • New Risk Management Strategy in progress – strategy has been drafted • Review of IJB constitutional documents • Timetable of future development sessions / training for IJB members • New induction pack for IJB members Risk Update May 2026 – Risk approved on 18 March 2026 at the North IJB. Risk reviewed, no proposed changes. Is current assessment within Risk Appetite? No1-4Risk Appetite: Optimal Zone No5-9Risk Appetite: Tolerable Zone 12 Page 138 of 146
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NLIJB-R07: Failure to Meet Legislative Requirements Accountable Officer Risk OwnerRisk Description Chief Officer Head of Health / Head of Adult Social Work / Nursing Director There is a risk that the IJB has limited ability to commission services efficiently due to financial and workforce instability alongside demand pressures sufficiently resulting in failure to meet legislative requirements (including safe staffing). Current Controls • Financial and performance monitoring reports to the IJB and IJB PFA • Further information to be added Actions • Ongoing collaborative working with partners to deliver requirements under Health & Care Staffing Act, and escalation of arising Risk Update May 2026 – Risk approved on 18 March 2026 at the North IJB. Risk reviewed, no proposed changes at present. Further review from SMT required. Is current assessment within Risk Appetite? No1-4Risk Appetite: Optimal Zone Yes5-9Risk Appetite: Tolerable Zone 6 Page 139 of 146
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NLIJB-R08: Workforce Availability and Capacity Accountable Officer Risk OwnerRisk Description Chief Officer Head of Health / Head of Adult Social Work / Nursing Director There is a risk that full implementation of workforce plans can not be achieved due to financial and demand pressures which could lead to longer term workforce difficulties, shortages in some skill sets, negatively impacting on service delivery and the IJB’s ability to deliver the strategic plan. Current Controls • Lanarkshire Health and Social Care Workforce Plan 2025 – 2028 in progress • NLC Workforce Plan • Service transformation, including redesign/review of services • Regular workforce monitoring • Partnership working between NHSL and NLC HR Services with workforce reports presented to the HSCP SMT Actions • Ongoing collaborative working with partners to deliver requirements under Health & Care Staffing Act, and escalation of arising Risk Update May 2026 – Risk approved on 18 March 2026 at the North IJB. Risk reviewed, no proposed changes at present. Further review from SMT required. Is current assessment within Risk Appetite? No1-4Risk Appetite: Optimal Zone Yes5-9Risk Appetite: Tolerable Zone 9 Page 140 of 146
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NLIJB-R09: Delayed Discharge Accountable Officer Risk OwnerRisk Description Chief Officer Head of Health / Head of Adult Social Work There is a risk that patients are not being discharged in a timely manner resulting in suboptimal patient flow, impacting on poor patient and staff experience and poorer outcomes of care. Current Controls • Daily enabling hubs • Senior decision makers within team to oversee • Daily reporting of delays • Home Assessment Model • Home Care Redesign • Escalation process in place • weekly scrutiny meeting with HSCP senior managers present • Weekly oversight meetings with whole system representation • Agreed Target Operating Model implementation • Close working with Acute Colleagues • Criteria to Reside Audits • Daily Dynamic Scheduling tool implemented within home care Actions • Deep Dive into current performance inclusive of daily meetings with Senior staff • Home care redesign roll out/completion Risk Update May 2026 – Risk approved on 18 March 2026 at the North IJB. Risk reviewed, no proposed changes at present. Further review from SMT required. Is current assessment within Risk Appetite? No1-4Risk Appetite: Optimal Zone No5-9Risk Appetite: Tolerable Zone 12 Page 141 of 146
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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 20 May 2026 Financial Monitoring - Final Outturn Chief Finance Oicer 20 May 2026 Quarterly Reserves Update Chief Finance Oicer 20 May 2026 Annual Governance Statement Actions - Progress Update Chief Finance Oicer 20 May 2026 IJB Performance Report (Q3) Head of Planning, Performance & Quality Assurance 20 May 2026 Quarterly Internal Audit Plan 2026/2027 Chief Oicer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 20 May 2026 Annual Internal Audit Progress Report 2025/2026 Chief Oicer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 20 May 2026 Quarterly IJB Risk Report Chief Oicer 20 May 2026 Quarterly Wednesday 19 August 2026 Financial Monitoring - Month 4 & Period 4 (July) Chief Finance Oicer 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 Oicer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 19 August 2026 Quarterly IJB Risk Management Strategy Business Support Manager 19 August 2026 Annual New Strategy for approval Item 14 Page 143 of 146
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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 Oicer 19 August 2026 Quarterly Wednesday 21 October 2026 Financial Monitoring - Month 6 & Period 6 (September) Chief Finance Oicer 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 Oicer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 21 October 2026 Quarterly IJB Risk Report Chief Oicer 21 October 2026 Quarterly Feb 2027 Financial Monitoring - Month 8 & Period 9 (December) Chief Finance Oicer 18 February 2026 Quarterly Reserves Strategy 2026/27 Chief Finance Oicer 18 February 2026 Annual Annual Governance Statement Actions - Progress Update Chief Finance Oicer 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 Oicer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 18 February 2026 Quarterly External Audit Report Chief Finance Oicer 18 February 2026 Annual Governance Log Chief Oicer 18 February 2026 Biannual Financial Regulations Chief Finance Oicer 18 February 2026 Annual Page 144 of 146
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead O icer Meeting Date Recurrence Reason / Notes Future Reports Integration Joint Boards: Finance and Performance 2025 Chief Finance Oicer TBC Annual Meeting date dependant on publishing from Audit Scotland Best Value Framework Chief Finance Oicer TBC Triennial Best Value – Annual Statement of Compliance Chief Finance Oicer 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 145 of 146
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