2025 05 21 - Agenda Pack
North Lanarkshire Council · 21 May 2025
Back to IJB Performance, Finance and Audit Committee — 21 May 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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A meeting of the IJB PFA will be held on Wednesday 21st May 2025 at 2pm – 4.30pm via MS Meetings If anyone would like to join this meeting, please contact the governance team at NLHSCPGovernance@lanarkshire.scot.nhs.uk for the relevant information. Chair: Brian Moore AGENDA No. Item Action Attachment Reporting 1. Welcome & Apologies For Noting Chair 2. Declaration of Interests Members are invited to declare any interest in relation to agenda items Board Members 3. Minutes IJB PFA (25th February 2025) For Approval Attachment Chair 4. Matters Arising/ Rolling Action List For Noting Attachment Chair Strategic Planning & Development 5. Lanarkshire Winter Plan Debrief Annual Report Attachment Morag Dendy Performance & Finance 6. Chryston Hub Update Routine Report Attachment Maggs Thomson 7. Prescribing: Sustainability and Value Programme Progress Update SCP Update Attachment Lucy Munro 8. Supporting Unpaid Carers & North Lanarkshire Carers Strategy Update SCP Update Attachment Morag Dendy 9. Financial Monitoring Routine Report Attachment Nicola Scott 10. IJB Reserves Strategy For approval Attachment Nicola Scott 11. Q3 Performance Report Routine Report Attachment Morag Dendy/ Stephen Forrest 12. Cat 1 Responders Update Annual Report Attachment Margaret Flavell 13. Internal audit 2025/26 work plan Routine Report Attachment Jocelyn Lyall 13.1 Internal audit progress report 2024/25 Routine Report Attachment Jocelyn Lyall Governance & Policy 14. Risk Report Routine Report Attachment Morag Dendy For Noting 15. Risk Consider from the business discussed any new emerging risks to be added to risk register or whether the discussion materially alters the accessed levels of risk/risk tolerance or mitigating controls 16. Date of Next Meeting 27 August 2025, 14:00-16:30 For Noting
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Page 1 of 11 ITEM: 3 Integration Joint Board Performance, Finance & Audit Committee Minutes from the meeting held on Wednesday 25th February 2025, 11.00 – 13.30 via MS Teams PRESENT Voting Members: Cllr Claire Barclay NLC Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non-Executive Nauman Dar NHS Lanarkshire Nominated Non-Executive Cllr Paul Kelly NLC Nominated Councillor Cllr Anne McCrory NLC Nominated Councillor Brian Moore (Chair) NHS Lanarkshire Nominated Non-Executive Siobhan White NHS Lanarkshire Nominated Non-Executive Others In Attendance: John Boyd Audit Scotland Mark Dell Communications Manager Stephen Forrest Performance Manager Diane Fraser Head of Adult Social Care John Holleran Strategic Lead NLADP Joanne Jenkins Nurse Director NL HSCP / Nurse Representative Jocelyn Lyall Chief Internal Auditor Catherine McGinty Unison / Staff Side Representative (NHSL) David Meechan Audit Scotland Thomas Moan Senior Manager – Community Solutions VANL Claire Rae Chief Office NL HSCP Harry Robertson North Lanarkshire Carers Together / Carer Representative Nicola Scott Chief Finance Officer Francis Scott Maggs Thomson Head of Health North HSCP John Watson Employee Representative NLC Dawn Wright Management Team Secretary Apologies: Cllr Bob Burgess NLC Nominated Councillor Morag Dendy Head of Planning, Performance & Quality Alison Gordon Head of Children’s, Families & Justice Services Lucy Munro Medical Director for Health & Social Care North Lanarkshire Liz Seaton Partnership for Change / User Representative Rose Walker Governance Support Manager
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Page 2 of 11 1. Welcome and Apologies The chair welcomed everyone to the meeting; apologies were noted as above. Brian Moore 2. Declaration of Interests None Board Members 3. Minutes IJB PFA (23rd Oct 2024) The previous minutes were approved as an accurate reflection of the discussion. Siobhan White asked for her title to be added. Brian Moore 4. Matters Arising/ Rolling Action List Some issues Brian Moore wanted to highlight with the IJB members, were; • The agreed extension of the funding for the Cost of Living Helpline, ends July 2025. An updated report and exit strategy can be done and taken to the next IJB. • Quarterly Assurance Annual Report and Safe Staffing. As understood, the board is required to submit an initial report on the Health and Care of Safe Staffing Legislation. This will be coming to the next IJB PFA meeting for both sides of the business. • An update had been requested in relation to the Paediatric Modernisation Board and it is unclear when that's due to come back. One of the requests made was for a more detailed breakdown of the scope and range of services that fall under the board's oversight, as well as the modernisation of those services. Brian Moore Strategic Planning & Development 5. Resettlement Update Maggs Thomson presented the resettlement Update Paper and gave the following summary. The programme of work is ever changing and necessitates partnership and multidisciplinary working to ensure connectivity to support the transition and integration into main stream services. The work has had a profound impact on improving health outcomes and overall wellbeing of asylum seekers and refugees. A partnership approach has ensured that that the settling populations can easily access healthcare services, resulting in timely diagnosis, treatment and improved health outcomes. Through the support of the Health Improvement Manager, the wider team have empowered asylum seekers and refugees with the essential knowledge and skills to maintain and improve health, prevent ill health and navigate the health care system independently. The arrival of Ukrainian refugees to Lanarkshire has greatly decreased such that there are no hotels in Lanarkshire required to provide temporary accommodation. Additionally, there is currently one hotel hosting asylum seeking males. As part of the Widening Asylum Dispersal Strategy, Lanarkshire is now seeing people seeking asylum moving in to dispersal accommodation. At this time numbers have been low however it is difficult to estimate these numbers. The Mears Housing Group Maggs Thomson
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Page 3 of 11 procure accommodation for asylum seekers and the local authority resettlement teams will notify health of any new arrivals in to the area. The Mears Welfare Officers will support GP registrations as directed. Those male asylum seekers residing in the hotel accommodation are supported by one GP Practice as a Local Enhanced Service (LES) agreement. The numbers of people seeking asylum and refugees coming to and settling in Lanarkshire will continue to increase. By working together, we can ensure that refugees and asylum seekers in Lanarkshire have access to the health care services they require to live healthy, fulfilling lives and integrate into our community effectively. Siobhan White questioned how to address the potential shift to private accommodations in reporting, particularly regarding care responsibilities and the specific category of care. Maggs Thomson explained that the challenging aspect lies in identifying the specific category of the population in question. Asylum seekers typically integrate into mainstream healthcare; however, for any additional needs, there is supplementary funding available due to the understanding that these individuals often present with increased complexity. Phillip Couser reiterated that there is substantial work happening, particularly regarding funding for asylum seekers, which is a sensitive and politically charged area. Phillip posed the questions of whether we have a comprehensive understanding of whether the additional funding sufficiently addresses the associated costs, and how prepared we are to address potential inquiries about the impact on services for the broader population. Maggs Thomson answered by advising that it would depend on the volume that comes in. The higher the volume the more scalable that money will help. We are continuously learning and improving our approach. We believe the current model we have is effective, as it allows us to integrate personnel into local communities more rapidly. We also acknowledge the importance of collaborating with other services to ensure a swift response when necessary, and this understanding is reflected in our current agreement. Cllr Paul Kelly asked for clarity in the discussion regarding financial sustainability and if the capacity for continued support in light of potential increases in numbers has been addressed? Additionally, are we positioned to seek further financial packages to ensure comprehensive coverage? While I understand that asylum seekers receive some support, it may not fully cover all associated costs. Philip raises an important point about the current political landscape and the criticism we may face. It is crucial that we remain steadfast in our commitments and demonstrate leadership in supporting this vital work, which is essential for the individuals we serve. John Watson raised the question to Maggs asking if there is adequate support from the social work localities with regards to the unaccompanied children seeking asylum, particularly in relation to age assessments and other related matters? Maggs Thomson was unable to provide an answer at this time but assured that she would inquire further and respond to John Watson accordingly.
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Page 4 of 11 Brian Moore shared that the report highlights a strong emphasis on mental health and well-being in the needs assessment. One issue that arises, is access to mental health services, particularly for dispersed individuals or those in congregated settings. Are we aware of the level of need and the challenges in accessing these services? Maggs Thomson advised that a surge was initially expected in demand for mental health services due to trauma and set up robust support systems. However, the population has shown resilience, resulting in stable service demand. We integrate these individuals into our communities like others, but we should monitor young men at the Bruce Hotel for potential issues. Brian Moore suggested that this could be picked up further in the Chief Exec report at the next IJB. Claire Rae suggested linking in with Mark Dell in comms to get some patient stories, so that it's not just numbers we're seeing, it's what's the experience and outcome has been. IJB PFA Committee note and agreed the following recommendations: I. Acknowledge the contents of report. Future reports can be provided. Performance & Finance 6. Q2 Performance Report Stephen Forrest presented the Quarter 2 performance report and informed 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. The areas for improvement and corrective action are noted in 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. Siobhan White raised several questions regarding the sustainability of these improvements, particularly in relation to challenges pertaining to appointment uptake and staffing. Can we anticipate the continuation of this upward trend? Furthermore, it would be beneficial to analyse why we typically see an increase over a period of three to four quarters, especially considering the impact of the seasonal return to school in August on these trends. Any insights on sustainability and the factors contributing to this performance spike would be greatly appreciated. Claire Rae stated that the sustainability target was achieved in September and have maintained it, supported by NHS Lanarkshire's recurring funding for mental health. While we are successfully meeting the 18-week RTT, we must focus on the outcomes and experiences of children and families receiving our services. The progress made with the Kappa model can inform improvements in other areas, such as speech and language services, as highlighted by Steven Forrester. Stephen Forrest
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Page 5 of 11 Siobhan White responded by asking if we are effectively promoting access to appointments for children. Claire Rae replied to Siobhan’s question by advising that there are plans in place. Mark Dell from comms will share positive news about our CAMHS performance, including our success in meeting RTT targets. We aim to clarify misconceptions on social media and highlight the impact on families' experiences. It's in the works, but not fully implemented yet. Maggs Thomson added that Claire's update highlights the misconception that distressed young people always need CAMHS. In reality, they often require broader support for themselves and their families. Bringing them into the CAMHS environment isn’t always beneficial. KAPPA has helped clarify who truly needs CAMHS versus alternative supports. Effectively communicating that CAMHS isn't the universal solution, ensuring children receive appropriate support is what’s needed. Phillip Couser emphasised that the report presents concerning findings, particularly reflected in the red indicators. Although there are positive elements, it is essential for us to enhance our performance reporting to better illustrate the connection between inputs and outcomes. Furthermore, we must acknowledge that CAMHS may not be the sole solution; it is crucial to ensure that children receive the appropriate support tailored to their needs. Brian proposed that IJB consider utilising a liaison session to focus not on the performance metrics, but rather on the methodology for identifying outcomes from the various activities and processes we have implemented. Cllr Claire acknowledged CAMHS's progress but emphasised the need to clarify public perceptions. Despite improvements, the 18-week wait remains a concern. Communication should indicate that CAMHS isn't for everyone, especially those needing immediate help, and stress the importance of appropriate referrals to other services. We must highlight our successes while explaining the wait, demonstrating that the system is effectively supporting those in need. Mark Dell advised that comms are currently working on communications to explain the reasons behind waiting lists and our efforts to expedite the process. However, we need to be cautious; previous outreach has resulted in an overwhelming influx of people wanting to join another waiting list. We must carefully target our messaging to ensure inquiries are directed appropriately. Brian Moore suggested the based on the discussion, IJB could get an update on communication and the engagement approach regarding the new facility. It's important to celebrate the successes while enhancing understanding of alternatives to direct referrals to CAMHS. Maggs raised the question of whether IJB could leverage the upcoming design program for the northern capital changes, similar to the CAMHS South initiative at Udston, in order to strengthen our communications about the development of new facilities. Brian Moore raised some comments for future consideration; • The home assessment team's 14% readmission rate is high and warrants further investigation in future updates.
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Page 6 of 11 • We should analyse the impact of changes in psychiatric practices and recruitment challenges on adult mental health services, particularly for older adults, in a formal meeting. • It was highlighted that speech and language therapy services have not improved. The prior request for a report on improvement plans was useful, but the current 15% metric indicates workforce issues. We should review how other services are restructuring for better quality and prepare a dedicated report for our committee. • Despite positive national trends in smoking cessation, current figures remain below target, especially in deprived communities. We need to better understand the support offered under the Quit Your Way model and keep this issue on our agenda for future discussions. IJB PFA Committee note and agreed the following recommendations: I. Note the contents of the report and the appendix. 7. Internal Audit Progress Report Jocelyn Lyall gave overview to the Internal Audit Paper. The IJB approved the Internal Audit Plan 2024/2025 on 22 May 2024. A total of 60 days has been committed to undertake the IJB Internal Audit Plan, which has been designed to target the priority issues which have been aligned to strategic risks and reflect the evolving and complex challenges to service delivery. The Public Sector Internal Audit Standards (PSIAS) require that activity and performance relative to the approved annual plan is periodically reported to the Performance, Finance & Audit Committee (PF&A Committee). The Internal Audit Plan 2024/2025 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 2024/2025 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 for 2024/2025. The audit of operational activities is being undertaken under the auspices of the partner bodies. The IJB is asked to note that the outcomes of these operational audits are reported to the partner body Audit Committees and discussed with the IJB Chief Officer and IJB Chief Financial Officer. The assurances gained will be provided to the IJB as part of the overall assurances received from the partner body Audit Committees. The Internal Audit Plan 2024/2025 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. Brian Moore shared that he welcomed the approach. Siobhan White addressed a previous point about performance reporting, Jocelyn Lyall
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Page 7 of 11 particularly regarding a recommendation from August 2019 in Appendix 3. This highlights the ongoing concern for improved performance reporting, as evidenced by the revised timelines. Siobhan asked if the upcoming work would address these issues, in which Claire Rae confirmed yes. The performance framework will be looked at and will work through the recommendations. IJB PFA Committee note and agreed the following recommendations: I. the attached Progress Report at Appendix 1, the Summary of audits completed as part of the Internal Audit Plan 2023/24 at Appendix 2, the summary of relevant partner reports at Appendix 3 and note the final report on HSCP Governance Arrangements at Appendix 4. 8. Financial Monitoring Nicola Scott gave update to the financial monitoring position and advised that the primary purpose of this audit was to provide independent assurance on the adequacy and effectiveness of the processes in place to enable the North Lanarkshire Health and Social Care Partnership (HSCP) to review and assess its governance arrangements against expected good practice. As part of a review of the effectiveness of the governance arrangements in place, the North Lanarkshire HSCP have undertaken a self-assessment in respect of their compliance with the principles outlined in the CIPFA Delivering Good Governance in Local Government Framework (2016) (see Appendix 2). This Framework places a responsibility on an authority to ensure additional assurance on the overall adequacy and effectiveness of the framework of governance, risk management and control is provided by the internal auditor. The self-assessment was undertaken using a Governance Self-Assessment Checklist developed by the Chief Internal Auditor (NHS). This was based on professional judgement and relevant guidance, as well as the CIPFA Delivering Good Governance in Local Government Framework (2016). NLC Internal Audit thereafter undertook a high-level review of both the Governance Self-Assessment Checklist completed by the North Lanarkshire HSCP and the draft Annual Governance Statement for 2023-24, to identify areas where it is considered improvements could be made to strengthen the arrangements. This engagement has been conducted in accordance with the ‘Public Sector Internal Audit Standards’. The Internal Audit section reports formally on conformance with these standards to the Performance, Finance and Audit Committee. Siobhan White raised the question, if we contract for a specific number of care plans, which correlates to a certain number of beds, and we end up overspending, do we need to reassess our capacity for different contract amounts? Since they have the ability to take more, should we renegotiate the contracts if we consistently overspend? Claire Rae answered by advising that it’s about demand. There’s no fixed contract for beds; costs depend on capacity and individual assessments for care homes. This has led to overspending in both SDS and overtime for home support. Diane Fraser suggested further discussion on the care home contract with Excel Scotland may be beneficial due to ongoing negotiations and uncertainties. Nicola Scott
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Page 8 of 11 Nicola highlighted from Diane’s point, one risk in the medium-term financial plan, to be presented in March, is the ongoing negotiations for the National Care Home Contract rate. We don't have a confirmed figure yet and must estimate potential increases, particularly due to the impact of rising NI contributions. Siobhan White brought up the prescribing and overspends in which Claire Rae confirmed that all medication costs are increasing. Claire made a suggestion that Pharmacy Savings Approach could be brought back to IJB to get a restock of where things are and where they are going. Brian Moore commented that it's great to see our achievements, but we still need to secure £3,000,000 and address the outstanding items from the financial management vacancy review. I look forward to updates on this progress in future reports, especially with the financial year ending soon. We will be under pressure to deliver the remaining savings in the upcoming year. Claire Rae noted that there's a cultural shift and a change in approach, not a quick fix for funding. We're noticing increased demand for individual services, especially home support, which is leading to fewer delays. Now, we need to see similar improvements in the financial aspect regarding our savings target. Nicholas will address this later today and gather proposals. Nicola Scott advised that by March 31st, we will report on the final outcomes of our two-year savings plan and the current savings gap for 2025-2026. A final update on our achievements will likely be available in the May PFA. IJB PFA Committee note and agreed the following recommendations: I. Acknowledge the contents of the report; and II. Acknowledge the projected outturn for 2024/25 is an underspend of £1.454m 9. Alcohol & Drugs (ADP) John Holleran gave an overview of the Alcohol and Drugs Paper; advising North Lanarkshire Alcohol and Drug Partnership (NLADP) is a multi-agency strategic partnership focused on understanding and mitigating the impact of problematic alcohol and drug use in the local area. The purpose of the ADP is to co-ordinate and lead a collective response to tackle harms and improve the lives of people who used alcohol and drugs and those around them. The ADP is made up of key agencies and stakeholders with an interest in tackling harms and improving lives. This includes the wider community and those who have lived experience (including families). All sub-groups meet quarterly and report to the ADP Partnership Board. Each sub- group held a planning session in the first quarter of 2024 to map out areas of focus and further development for the next 12 months. Phillip Couser raised a concern regarding the understanding of the relationship between the inputs and the subsequent outcomes. While we evaluate activity based on these standards, meeting them does not necessarily ensure positive results. Phillip raised the question, are we adequately assessing which investments produce the most beneficial outcomes? John Holleran
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Page 9 of 11 John Holleran advised that the MAT standards allows us to monitor data related to interactions with our health and social care system, enhancing our processes where needed. We now have access to more data than ever, but it does not clarify what happens when individuals disengage. Currently, our focus is on opioid users, while other substances like stimulants and alcohol remain overlooked. This presents an opportunity to improve our services, but we must consider the available resources and capacity in North Lanarkshire to address these needs. Claire Rae noted that across all services, the performance metrics set by the Scottish Government, including those related to the ADP, are heavily performance- driven rather than outcome-focused. For instance, while we might report achieving 90% on 18-week RTT, it's crucial to question the actual impact on individual services. Similar issues arise with residential rehab, as discussed by John. We need to enhance our approach to measuring outcomes at both national and local levels, and influence the Scottish Government regarding the performance-driven targets assigned to boards and partnerships. Brian Moore provided several observations regarding our current initiatives. Reports indicate that 81% of drug-related fatalities occur in the most deprived areas according to the SIMD classifications one and two. It is essential that we evaluate the effectiveness of our resource allocation in these regions, as emphasised in the report. Furthermore, during our recent engagement with the addictions team, we identified a deficiency in Tier 3 alcohol detox services. Finally, the report references a forthcoming comprehensive service redesign; we require further clarity on the anticipated timeline and initial considerations for these changes. John Holleran responded by advising that a service redesign timeline is unclear and depends on involved parties. Currently, the system does not fully meet the needs of individuals seeking alcohol and drug support, as services have primarily focused on opiate interventions. The ADP is holding an alcohol summit to discuss necessary changes based on current experiences of service users and providers. There is strong support from Morag and others on the ADP board and subgroups for this initiative. Brian Moore asked if there any ongoing work to develop alcohol detox options, and is it deemed necessary? John Holleran advised that his understanding is that statutory limitations, specifically around medic prescribing and Home Office licence challenges, prevent widespread implementation across all six localities. A SWLG is focused on stabilising alcohol use and detox, especially for those distant from treatment. We’ve set up alcohol harm reduction cafes through our Commission services to address not only immediate needs but also holistic physical and mental health. IJB PFA Committee note and agreed the following recommendations: I. Note the content of the report; II. Acknowledge the progress made towards delivering the ADP strategic objectives and National Drug Mission priorities. III. Recognise the broad range of supports in place and the programme of work being delivered to reduce harms and prevent deaths from alcohol and other drugs
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Page 10 of 11 IV. Note the key developments in targeting resources in line with budgets for each priority area V. The MAT Standards is not covered in this report as a separate paper has been drafted and submitted for consideration. 10. MAT Standards John Holleran presented paper and informed that North Lanarkshire is on track to meet all MAT standards with the exception of MAT 7, which his provisional at Amber. This is due to constraints linked to delivery of MAT across Primary Care. North Lanarkshire is not unique in this. MAT 7 limitations have been acknowledged by the Scottish Government and Public Health Scotland as a national barrier with the majority of ADP areas unable to fully deliver on this standard, hybrid approaches are in place in many Board areas. A great deal of work has gone into achieving the standards across the whole system, this has been acknowledged by Public Health Scotland and the Scottish Government. North Lanarkshire is in a much stronger position to offer MAT as proposed with further improvement work in place to improve the quality and consistency of MAT standards delivery across all localities. The appropriate measures and plans are now in place to drive forward the additional improvements required to fully embed all standards across all localities in 2025. Brian Moore commented that while we may appear to be doing well on the surface, there are significant challenges, especially regarding drug-related deaths and their impact on communities. John Holleran commented that our next focus is linking MAT standards to a rights- based approach, considering the publication of the Charter of Rights. A key element will be incorporating lived experiences. We aim to implement follow-ups after appointments for both patients and their families to assess our effectiveness and identify any additional needs. However, we must ensure that the data we collect provides a comprehensive view; this may require deeper local consideration. IJB PFA Committee note and agreed the following recommendations: I. Note the content of the report; II. Acknowledge the significant progress made towards delivering the Medication Assisted Treatment Standards (MAT) throughout 2024. III. Note the current status of MAT Standards implementation and the position for this year’s national benchmarking report. John Holleran 11. External Audit Plan John Boyd shared the key points The audit plan for the fiscal year ending March 31, 2025, outlines our responsibilities regarding financial statements and broader audit dimensions, including financial management and sustainability, governance, and resource use. It highlights risk assessments related to financial statements and prioritises areas for audit, with a particular focus on financial sustainability for the IJB. This aligns with John Boyd
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Page 11 of 11 discussions on the IJB's role in the medium to long-term sustainability of services in collaboration with key partners. The audit is scheduled to start in July and August, with a sign-off by the end of September. Brian Moore asked the question, historically, organisations conducted best value audits for evidence, but is that still expected? John Boyd responded by advising that the IJB must evaluate whether it truly provides best value, despite relying on partner reports for performance and outcomes. We need to determine if this information is sufficient for the IJB to assess its overall performance rather than just individual partner contributions. This will be a key focus of our evaluation this year and is vital for the board's self-assessment. Governance & Policy 12. Risk Report Claire gave an update This paper outlines the IJB's highest scoring risks, highlighting three categorised as very high. We have discussed many of these, particularly regarding prescribing activity, financial challenges, and pharmacy pressures in the prison service. Each risk includes the current controls and actions being undertaken. There has been no progress on them at this moment in time. Claire Rae noted that the Risk Lead is still down as Amanda, and this will need to be amended. Claire noted for further discussion in terms of all overall risks that sit with IJB, it may potentially be a liaison session. No comments or questions raised by the board. Claire Rae For Noting 13. Risk Brian Moore noted that a number of issues were touched on, in terms of the finance position, care home contract and NI contributions. In addition, would be Speech & Language Therapy, CAMHS, communication and the performance framework 14. Date of next IJB PFA meeting: Wednesday 21st May 2025, 14:00-16:30, Via MS Teams
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 25. Future Meeting C Rae Host a future meeting face to face in Chryston hub 19.03.2025 – March date was cancelled new date to be re-arranged Dates set up for 2025 Walk rounds Ongoing 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 Ongoing Complete 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 Ongoing
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2 choices required to achieve financial sustainability. 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. Ongoing 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 the impact of preventative approaches. Ongoing 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. Ongoing 31. 25.02.25 Item 6 Q2 Performance Report Improved communication about progress and ensure a shared understanding of what CAMHs services can offer. 32. 25.02.25 Item 8 Financial Monitoring suggestion that Pharmacy Savings Approach could be brought back to IJB to
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3 get a restock of where things are and where they are going 33. 19.03.2025 Item 4 Matters Arising Learning Disability Workforce paper to be brought to PF&A 34. 35. 36.
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4 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 June 2021 November 2021 – deferred to IJB Complete Reserve strategy
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5 8.12.22 Update provided within report Medium to Long Term Financial Planning. Further work being undertaken to confirm exit plans and ongoing areas of work. 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 December 2021 deferred to March 2023. presented to IJB PFA on 16th Nov. 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 September/Dec ember 2020 Deferred to March 2021 – deferred to September 2021 Original Action complete with further update on hosting arrangements presented to
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6 IJB (Performance, Finance and Audit) Committee. The updated report to the IJB (Performance, Finance and Audit) Committee on 24 August 2021 advised that the budget disaggregation exercise has been concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Work is continuing to progress in respect of the hosting arrangements for cross-cutting and support services. The original timeline of March 2021 has therefore been extended to the revised timeline of September 2021. The Service Level Agreement for the future hosting arrangements and associated budgets will be presented to the IJB following consultation and endorsement by the NLC Adult Health and Social Care Committee and Education and Families Committee. A further report will therefore be presented to the next – deferred to November 2021 Update March 2022 - Further work required to conclude agreements around hosting arrangements. PF&A in November 2021. Complete – presented to IJB PFA on 16th Nov
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7 meeting of the IJB (Performance, Finance and Audit) Committee on 9 November 2021. 3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. 21.9.21 – Report presented setting out proposed use of a Change Fund. Progress reports on each element of the proposed plan to be presented to the PF&A February 2022 – update on progress noted with further updates to be presented March 2021 Deferred to September 2021 February 2022 Ongoing – delegated to PF&A to complete action. 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. June 2021 – deferred to September 2021 Complete
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8 21.9.21 – verbal update given – work ongoing to resolve accommodation issues. 2. Update requested on funding commitments. ADP strategy presented and approved at IJB on 21.9.21. Request for detail on commissioning of services, evidence of benefits and achievements and timelines for implementation of funding commitments to be brought back to IJB. 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives – deferred to PFA November 2021 – deferred to February 2022 September 2021 December 2021 August 2022 Ongoing updates on progress scheduled into forward plan for PFA MAT standards update given to Feb IJB PFA Further update on October PFA agenda
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9 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 21.6.22 – verbal update on progress noted 2. Memorandum of Understanding to be shared December 2021 Complete – update report to 16th Nov PFA Remove 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. June 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS around
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10 22.3.22 – Update provided on progress on engagement and development of business case September 2022 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 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 March 2022 June 2022 Complete
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11 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. 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 • Community Alarms (Analogue to digital) • National Care Service September 2022 Complete
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12 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
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13 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
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1 REPORT Item No: 6 SUBJECT: Progress Update: Development and Delivery of Chryston Community Health Clinic TO: IJB Performance, Finance & Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health Author(s) of Report Maggs Thomson, Head of Health DATE: 21st May 2025 1. PURPOSE OF REPORT This paper is coming to the IJB PFA to provide an update on the development and delivery of Chryston Community Health Clinic For approval For endorsement To note 2. ROUTE TO THE BOARD This paper has been: Prepared Reviewed Endorsed Prepared by Maggs Thomson, Head of Health in consultation with both Chryston Community Health Clinic Mobilisation Group and the Northern Corridor Service Repatriation Group. 3. RECOMMENDATIONS The IJB is asked to:. 1) Note the progress and current position of the repatriation of the clinical services from NHS Greater Glasgow & Clyde (NHSGG&C) and the associated Health and Social Care Partnerships (HSCP’s) 2) Note the change in provision for Mental Health and Substance Misuse Services
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2 3) Note the change in the financial position and reflect on work to date to progress towards final conclusion. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 From 1st April 2014, Health Board boundaries were realigned with those of the Local Authorities across Scotland, with the aim of reducing administrative barriers and ensuring full alignment with the integration of health and social care services as set out in the Public Bodies (Joint Working) (Scotland) Act. 5.1.2 This boundary change aimed to facilitate the development of integrated services across all areas of Scotland. The change resulted in the Northern Corridor (covering the areas of Moodiesburn, Muirhead, Chryston, Stepps, Gartcosh and Auchinloch) being transferred into the NHS Lanarkshire (NHSL) boundary. 5.1.3 This geographical area has one health facility located within Muirhead (Muirhead Clinic), which is small and at the time of transfer, dilapidated and not fit for function. The facility required backlog maintenance and asbestos work to be undertaken which was completed. 5.1.4 Despite the upgrade and refurbishment which improved compliance with healthcare standards, the facility could still not support the provision of all services for the local population. 5.1.5 Consideration was given to providing a new build facility on the existing site, however the footprint and parking limitations would not allow for the size of centre required to meet the clinical ask. 5.1.6 Due to the limited capacity of this facility, NHSL was unable to fully repatriate services from NHSGG&C, resulting in northern corridor residents having to travel significant distances across Glasgow to access some health services, with teams and clinics based in a range of areas including Shettleston, Kirkintilloch, Easterhouse and Bridgeton. 5.1.7 The services identified below continue to be delivered via a Service Level Agreement (SLA) with NHSGG&C and the associated HSCP’s. • Community Diabetic Service • Community Mental Health Teams • Dietetics • Physiotherapy Yes No N/A
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3 • Sexual and Reproductive Health Services • Substance Misuse 5.1.8 An opportunity emerged with the development of North Lanarkshire Council’s (NLC) ‘The Plan for North Lanarkshire’ which set out an ambitious estates strategy that looked to develop Community Hubs / Campuses. Further to consideration of this approach, NHSL working in partnership with NLC, invited hub South West Scotland to deliver a single campus for the replacement of Muirhead Community Health Clinic and Chryston Primary School. 5.1.9 There was extensive engagement with all stakeholders including NLC and NHSL project teams which resulted in the optimum design being developed to the satisfaction of all the stakeholders. The agreed design went through wide- ranging routes of engagement with key stakeholders including NHSL staff, H&SCP staff, teachers, support staff and pupils at Chryston Primary School. This process also included joint engagement with representatives of the Parent Council and elected members, culminating in an online public consultation to inform residents of the design outcome. 5.1.10 The business case for the Development of Chryston Community Health Clinic was considered by the NHSL Board on December 2021 at a cost of £3.65M and signed off with all legal agreements completed in January 2022. 5.1.11 The build programme began on Monday 14th February 2022 with a completion date of early August 2023 identified. 5.1.12 In tandem with the facility development, a process was initiated with NHSGG&C (and associated H&SCP’s) to begin the process of repatriation of the identified clinical services. 5.1.13 The Service Level Agreement (SLA) continued to be in place and as of 31st of July 2024 a notice of cessation was formally lodged with NHSGG&C. This exposed UH&SCNL to a £52.5k financial gap if services where to be delivered with the known funded establishment and skill mix of the NHS Lanarkshire service model. 5.1.14 This financial gap has been reducing over time as more certainty of funded establishment and service models developed. Update 5.2 Chryston Community Health Clinic 5.2.1 The clinic has now been open and receiving patients for 15 months.
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4 5.2.2 Over this timeframe all building snagging and revision has been completed 5.2.3 The operational policy has now been embedded and has had its first revision. 5.3 Repatriation of Services 5.3.1 This process proved challenging due initially to build delays, however agreements with NHSGG&C to repatriate services became the area of postponement which was in the main around safe transfer of care for mental health and substance misuse services. 5.3.2 All physical health services have now been repatriated and are being delivered in Chryston Community Health Clinic. This component of the SLA was signed off on 31st January 2025. 5.3.3 In relation mental health and substance misuse care our NHSGG&C and their H&SCP colleagues raised concerns regarding the clinical safety of separating component parts of both the Community Mental Health and the Substance Misuse teams. 5.3.4 The SLA for both service areas did not include medical staffing and over the timeframe of the SLA and Chryston development this workforce has become more scarce both locally and nationally. 5.3.5 The model of having psychiatry medics work across two CMHT’s, 2 health board areas and multiple sites was deemed too challenging in the current workforce climate. 5.3.6 At time of reporting it has been agreed not to repatriate mental health and substance misuse services from NHSGG&C. 5.3.7 The SLA for this component of service will remain with Glasgow and its associated H&SCP’s 5.3.8 There is ongoing discussion with NHSGG&C to consider the possibility of delivering some of the community mental health services as satellite clinics within Chryston. At time of reporting a date is being canvassed to facilitate a site visit for medical colleagues. 5.3.9 It is recognised that this proposed change in direction will need communicated with the local population and once final Glasgow position is known an engagement plan will be enacted.
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5 6. CONCLUSIONS 6.1.1 In conclusion, this paper confirms that Chryston Community Health Clinic was delivered for service provision from 18th December 2023. 6.1.2 All services have transferred from Muirhead Clinic and are being delivered in Chryston Community Health Clinic with the addition of Midwifery and CAMHS 6.1.3 All physical health services have been repatriated from NHSGG&C and are being delivered in Chryston Community Health Clinic. 6.1.4 Mental Health and Substance Misuse services will now not be repatriated and that component part of the SLA will remain in place. 6.1.5 Ongoing discussion regarding ability to deliver some elements of mental health and substance misuse services as outreach from Glasgow services 6.1.6 The revision of the arrangements with the SLA has resulted in a cost neutral position with no funding gap evident. 7. IMPLICATIONS Noted within the content of the paper 7.1 NATIONAL OUTCOMES The repatriation of services will support improvements in a range of service performance measures, particularly around mental health and substance misuse. 7.2 ASSOCIATED MEASURE(S) None. 7.3 FINANCIAL Yes No X N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Risks now shift from service delivery to community engagement in relation to the change in previously agreed service provision. 7.5 PEOPLE A significant programme of engagement has taken place as part of the development of the business case. This will need revisited in light the change in provision identified within the report. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY
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6 Yes No N/A Developed as part of the business case. 8. BACKGROUND PAPERS NHS Lanarkshire Chryston Community Health Clinic Business Case https://www.nhslanarkshire.scot.nhs.uk/download/2021-december-20-board- papers/ Maggs Thomson Head of Health Members seeking further information about any aspect of this report, please contact the following; Maggs Thomson, maggs.thomson@lanarkshire.scot.nhs.uk
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7
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1 REPORT Item No: 7 SUBJECT: Prescribing: Sustainability and Value Programme 2024/ 2025 Progress Update TO: IJB Performance, Finance & Audit Committee Lead Officer for Report: Lucy Munro, Medical Director NL HSCP Author(s) of Report Fiona Sanderson Lead Pharmacist Primary Care North Health & Social Care Partnership DATE: 21 May 2025 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: Fiona Sanderson Lead Pharmacist Primary Care North Health & Social Care Partnership ☒ Reviewed By: ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS The IJB PFA is asked to note the following: - [rec 1. The savings for the financial year 2024/2025 2. The project workstream activities planned for 2025/2026 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES • 5.1 Analysis published by Public Health Scotland for financial year 2023/24 shows that the total (net) cost for dispensing items and providing services in 2023/24 was £1.62 billion, increasing by 6.5% from £1.52 billion in 2022/23. This follows a period of largely rising cost, increasing by 35.3% over the last 10 years (Figure1). • The total number of items reimbursed between 2022/23 and 2023/24 increased by 3.7%, from 110.3 million to 114.4 million items. Over the last 10 years the total number of items reimbursed has increased by 13% from 101.2 million items in 2014/15. NHS Lanarkshire are the 3rd highest Board in terms of prescription items per head of population (excluding Western Islands & Shetland) Figure 1 - Total (Net) cost (£) in NHS Scotland: 2014/15 - 2023/24 (Public Health Scotland) Yes ☐ No ☒ N/A ☐
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3 5.1.1 Prescribing costs vary between different health board areas and are influenced by a variety of factors including population demographics, prescribing culture and the prevalence of chronic disease. Figure 1 - Average total (net) cost (£) per head of population by NHS Board: 2023/24 (Public Health Scotland) 5.1.2 Lanarkshire has consistently significantly higher costs per patient in most main therapeutic areas of prescribing compared to the Scottish average and is higher than some of the other Health Board areas in Scotland. The prescribing data generally
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4 follows the national trend but at a higher level. Previous work carried out by the Locality Quality Medicines Actions Groups and the Prescribing Quality and Efficiency Strategy achieved their targets however the trend is unchanged. 5.1.3 In 2023/24 both South and North Lanarkshire IJBs ended the year with a prescribing overspend of £8.482m: North Lanarkshire £1.781m; and South Lanarkshire £6.701m. This related to a total spend of £157.493m. The budget had received a 2% allocation uplift but the numbers of items dispensed had increased by 3.00% and the price per item had increased from an average of £9.93 per item to £10.17. 5.1.4 The total primary care prescribing budget for NHS Lanarkshire in 2024/25 was £141.6M. The North Lanarkshire HSCP share of this was £64.5M. There hasn’t been any inflationary increase added to 2024-25 annual budgets as the Board wont received the 2% allocation uplift this year from Scottish Government Health & Social Care Department (SGHSCD). Based on the data received to date the cost per item remains high and currently stands at £10.31 and the number of items being dispensed has increased by 3.40% based on the same period in 2023-24. 5.1.5 In North Lanarkshire, the prescribing overspend forecast for 2024/25 at January 2025 was £3.962M with South Lanarkshire having an overspend of £6.19m bringing the total overspend to £10.152m 5.1.6 Audit Scotland’s Integration Joint Boards Financial Analysis 2021/2022 report stated that IJBs have reached the point where ‘significant transformation will be needed to ensure the (1) long-term capacity, (2) financial sustainability and (3) quality of services individuals receive’. Audit Scotland have highlighted that there remains a significant overall and recurrent budget gap across all IJBs; and that failure to make the necessary changes to how public services are delivered will likely mean further budget pressures in the future. 5.1.7 The Sustainability and Value Programme 2024/5 included a Prescribing Services Efficiencies Plan with a view to bringing Lanarkshire’s prescribing levels closer to the level of a comparable health boards. This included reducing prescribing spending by £4.2m through 2024/25, noting that this would reduce the level of overspend but not eliminate it. The purpose of this plan was to further assess the causes for Lanarkshire’s high prescribing costs and to develop and implement change ideas with associated action plans. 5.1.8 The main areas of change which were required in order to achieve cost savings of this magnitude are themed below, with examples of some to the change ideas discussed below. 5.2 Objectives • Aim for a Pan Lanarkshire reduction in spending of £4.2M (with at least £2.280M of this in the North HSCP) in the financial year 2024/25.
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5 • Evaluate potential cost saving of individual proposed change measures identified in Prescribing Efficiencies Workshop and prioritise those with greatest recurring financial impact. • Effect cultural change by adopting a visible Pan Lanarkshire approach to efficiencies highlighting the responsibility of all stakeholders (including patients) to use resources responsibly. • Support and enable collaboration at the interface between primary and secondary care to achieve our shared aim of reducing waste and improving levels of formulary adherence. • Guidance and visible support for prescribers to implement and embed these changes i.e. clear and open communication with patients and their representatives that this is Lanarkshire wide guidance. 5.3 The following primary drivers were agreed: 5.3.1 Reduce waste inefficiencies and variation • Identify high spend medications where we are able to safely switch to an alternative on a pan Lanarkshire basis • Increase Formulary compliance by making the Preferred Formulary option the default setting on Vision • Examine Script Switch use and improve the acceptance rate • Resume project in Care Homes to test stock order of formulary wound dressings. • Test use of Script Switch in Pharmacotherapy hubs • Develop agreed process of medication ordering within Care Homes and standardize this pan-Lanarkshire • Collaborate with Care @ Home Service and DNs to develop and test and alert system to identify patients with high volumes of unused medications or who are not compliant with medications for review by practice pharmacist 5.3.2 Quality prescribing • Nursing are leading a review of ANP/DN/GPN prescribing • Address high volume continence and stoma prescribing; • Targeted delivery of PQES by Locality Prescribing Management Teams prioritizing practices with highest prescribing spend. • Develop and test MDT (Multidisciplinary team) models to increase polypharmacy reviews and de-prescribing
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6 5.3.3 Prescribing culture • Implement Health Board guidance for prescribers to avoid prescribing specific drugs of low therapeutic value. Lanarkshire’s guidance was updated in Dec 24 in line with the publication of the national guidance. Bespoke reports around monitoring of the MOLCV are in development both locally and nationally. • Refresh and promote GP (General Practitioner) locum- specific prescribing guidance • Develop and test a process for working across the Primary /Secondary Care interface to increase alignment to the NHS Lanarkshire Formulary • Improve signposting to alternative management options (Social Prescribing). The Lead Pharmacist Primary Care NHSCP is now a member of the Lanarkshire Green Health Partenership Strategic Group and joint projects are being discussed. • Facilitate improved communication with Community Pharmacy. The new Lead Pharmacist for Community Pharmacy Services is now in post. Appendix 1 outlines the project plan workstreams and their current status of activity. 5.4 2025/6 Plan 5.4.1 Addressing polypharmacy Looking ahead, cost reduction work in 2025/26 will continue to focus on polypharmacy reviews – i.e. consultations with people who are on multiple medications to determine whether they still need to be on all of them. A data-driven approach will be taken, to ensure that the resource is targeted in areas where the greatest yield will result however referrals from the wider MDTs are now being triaged and accepted by the team where resource allows this to happen. Past evidence shows that an average of £120 per reviewed patient per annum can be saved from annual prescribing costs. Polypharmacy reviews address the culture of prescribing and result in sustained change rather than relying on medication equivalent switches. Simulation training is an important tool in upskilling pharmacists to have complex risk/benefit-orientated conversations with patients. A significant number pharmacists have been trained in simulation facilitation and additional training for a smaller group in creating relevant scenarios. New polypharmacy dashboards have been developed and there will be a spotlight report regarding each locality progress to target on a monthly basis. This update will also be tabled at PMMB. The Lead Pharmacists for each Partnership will also have regular monthly updates from their locality leads around progress and any barriers or difficulties being faced.
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7 5.4.2 Targeted work In addition, targeted local work will take place, with bespoke reports created for each GP practice, highlighting where their prescribing varies from comparators and enabling conversations to take place between practice teams and locality prescribing advisors on how prescribing practice might change to reduce future prescribing costs. There has been a move away from traditional switch projects due to shortages and changes to prices in the Scottish Drug Tariff however it was highlighted that other Boards have successfully completed a switch from DPP4 inhibitors to generic Sitagliptin. The switch within Lanarkshire would release approx. £1million in savings. 5.4.3 Medications of low therapeutic value A list of medications of low therapeutic value has been launched. This is a range of medicines from which evidence suggests patients are unlikely to benefit and NHS Lanarkshire was the first Health Board in Scotland to implement such a list and with the publication of the national list, the Lanarkshire list has been updated to reflect any changes required. Reviews have taking place of patients already on these medications and they will be stopped where possible. Current data and graphs on use of MOLCV in Lanarkshire is suumarised below. Monitoring and changes to prescribing is noted at PMMB through the following graphs.
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8 5.4.4 Non medicines In 2024/25 the Non Medicines Effective Prescribing Group (NMEPG) was formed. This is representation from each of the specialties around non-medicines spend & the aim of the group is to review spend on each of the different areas with the wider teams, identify any outlier prescribing or quality & cost effective projects and feedback using a standard reporting template at the NMEPG. NHS Lanarkshire is working collaboratively with the national non medicines group to identify potential savings around non-medicines prescribing and there is also representation at the Effective Prescribing and Therapeutics group around the production of national indicators. Current spend for NHS Lanarkshire on non medicines is approx. £21.1m per annum. 5.4.5 Prescribing change schemes The concept of using change schemes to release efficiencies has been used in other Health Boards and palatability is being considered.
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9 It is becoming increasingly difficult to estimate future savings as work moves towards changing the overall trajectory of prescribing, rather than easily countable switches. This has been compounded by a delay in obtaining data due to a national issue with the Prescribing Information System for Scotland however this issue, has been, for the most part, resolved. For planning purposes, however, a savings target of £8.5M for Lanarkshire has been agreed and the main components of this final target are summarised below. 6. CONCLUSIONS All project workstreams aligned to reducing waste inefficiencies and variation, quality prescribing, and prescribing culture to aid cost savings were identified by the Prescribing Management Team in collaboration with the Primary Care Prescribing Efficiencies Operational Group. Total savings at the end of January 25 are £2.9M (Pan Lanarkshire) with £1.5M in the North. Predicted savings achieved are £0.556m below the planned level & this is due to a combination of polypharmacy reviews and medicines of low therapeutic value being slower than previously anticipated. However, savings achieved from practice and other switches are ahead of plan. As has been highlighted in finance monitoring reports to the IJB and the Performance and Audit Sub-Committee, prescribing volatility and uncertainty continues to represent a high-risk area within the IJB’s budget. 7. IMPLICATIONS Further work will be carried out for 2025/26, including - • Continue to move forward with polypharmacy reviews across localities
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10 • Complete Benefits mapping profiles and dashboard reporting system • As NMEPG becomes more established, it is hoped that quality and cost efficient projects will be highlighted within this group. • Continue with ongoing project workstreams • Continue to seek new workstreams. 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL Annual savings set at £4.2M pan Lanarkshire. The target for North was £2.3M and the South £1.9M. This paper has been reviewed by Finance: 7.4 RISK ASSESSMENT/RISK MANAGEMENT There is an operational risk register with mitigations which will be updated now that the 2024/25 workstreams are moving to polypharmacy reviews and drugs of low therapeutic value. Yes ☒ No ☐ N/A ☐
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11 The relevant IJB risk is; IJB06.21 – Prescribing Activity and Costs, Current Risk Level High. 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 Patient and Staff group involvement in all workstream activities ☒ Provide stakeholders with information on how to get involved Engagement opportunities available for any of the workstream activities, in particular the work on Guidance on Items that should no longer be prescribed ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs This is part of the Project Communications and Engagement Plan ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services This is part of the Communications and Engagement Plan ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Feedback from patient support groups fed into the Primary Care Prescribing Efficiencies Operational Group ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Opportunities available at governance group meetings as well as other meetings supporting the workstreams ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed and attached to report:
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12 EQIA added to website: 8. BACKGROUND PAPERS N/A 9. APPENDICES Appendix 1– North Lanarkshire Health and Social Care Partnership Primary Care Prescribing Efficiencies Project Summary of the Project Workstream Activities to date. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Dr Lucy Munro, Medical Director for Health and Social Care North Partnership, Lanarkshire Headquarters, Kirklands Hospital, Bothwell, 01698 752618 Lucy.Munro@lanarkshire.scot.nhs.uk Yes ☒ No ☐ N/A ☐ Yes / Date added ☒ No ☐ N/A ☐
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13 Appendix 1 North Lanarkshire Health and Social Care Partnership Primary Care Prescribing Efficiencies Project Summary of the Project Workstream Activities to date: Overall projected savings for North Lanarkshire to 31st March 2025 = £2.3Million (as of January 25 £1.6m has been released) Completed project workstreams: Ongoing project workstreams: • Increase number of polypharmacy reviews in practices (estimated savings £120 per review) • Care Homes Medicines Waste Policy – Scope to see if this can be rolled out further. • Care Homes Stock order test of change almost complete • Collaborate with Care@Home Service to develop and test an alert system to identify patients with high volumes of unused medications • Identify workstreams and quality and cost effective projects around non medicines • Review Formulary adherence and processes around prescribing on Vision/eMIS • Analyse pharmacist input to the test of change pilot within HMP Shotts. Main focus and plans for 2025/26 • Move forward intently with all polypharmacy reviews across localities & ensure that target number of reviews are being met. • Implement and evaluate the Benefits mapping profiles and dashboard reporting system • Continue with ongoing project workstreams
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1 REPORT Item No: 8 SUBJECT: Supporting Unpaid Carers and progress update on implementation of the North Lanarkshire Carers Strategy 2024 -2027 TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Maria Williamson, Senior Manager, Quality Assurance DATE: 21 May 2025 1. PURPOSE OF REPORT This report provides a progress update on the actions taken to support unpaid carers over the past year, following the launch of the North Lanarkshire Carers Strategy, in May 2024.The report seeks continuing committee support and endorsement of the approach taken to support unpaid carers locally. The intention set out in reporting to IJB in May 2024, on taking a “what might help?” approach to supporting unpaid carers has seen developments continue to be directly influenced and informed by carer feedback. The “what might help?” approach seeks to mitigate risk around any uncertainty as to what might otherwise constitute priority or eligible caring related need, as carer engagement identified many instances where carers had previously been informed that “their needs weren’t a priority”, or that they “were not eligible for support.” Such feedback made carers reluctant to seek support, until at absolute crisis point, resulting in missed opportunities to develop preventative and \ or participatory approaches, and a mistrust of services. Other carers cited a traumatizing impact, through being informed that their needs were not important enough, or significant enough to merit any consideration. Collectively across the wider carer support network, significant effort has been taking place to redress this, through “what might help?” focused conversations. A “what might help?” approach doesn’t seek to draw carers into statutory service provision, or “clientise” people. Rather, the approach can often be as straightforward as a supportive conversation, where the carer feels valued, respected, listened to and reassured, and does not require new, or significantly more resourcing.
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2 “What might help?” could be: • conversations with carers recognising and affirming any capacity to self-help and self-care • income maximisation • wider family and \or community supports • enabling approaches • carer peer support • risk mitigation through identifying assistive technology solutions, • employer support • support through carer focused support organisations. Any or all the above, dependent on the individual carer situation, should be considered as a start point, prior to any supports provided by University Health and Social Care North Lanarkshire being considered, whether support be to the cared for person, the unpaid carer, or both. Existing, as well as new and innovative carer led and carer informed initiatives, such as an expanded Carer Breather programme and Carer Outcome grants have played a part in helping to meet carer outcomes over the past year. Quality Assurance’s role in committed partnership working with carer focused community and voluntary sector (CVS) organisations in engaging with unpaid carers, allied to demographic information, business intelligence and professional knowledge, seeks to ensure that we meet the statutory requirements set out in the: • Carers (Scotland) Act 2016 • Social Care (Self Directed Support) (Scotland) Act 2013 • Planning with People (Community engagement and participation guidance) (COSLA and Scottish Govt, 2021, updated 2024) Within this legislative context, we want to ensure that there is meaningful choice and control for carers (and supported people) locally, and that we meet the aspirations set out in the National Carers Strategy (Scottish Govt, Dec 2022) as well as the statements of strategic intent set out in the North Lanarkshire Carers Strategy 2024 -2027 (Appended) This paper is coming to the IJB PFA for: For approval For endorsement ☒ To note ☒
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3 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☒ Morris Howat, Service Manager, Quality Assurance Maria Williamson, Senior Manager, Quality Assurance Morag Dendy, Head of Planning, Performance and Quality Assurance 3. RECOMMENDATIONS It is recommended that the Integration Joint Board: (1) Endorse the approach to supporting Carers in North Lanarkshire (2) Note the range of supports to unpaid carers available locally. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☐ N/A ☒ 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 The background context remains consistent to that set out in previous reporting: Scotland’s national and local public bodies are committed to improving the ways individual people, and communities are engaged in decision-making that affects them. This is particularly relevant to the development of the health and social care services upon which we all rely. (Source: Planning with People; Community engagement and participation guidance. (Published by COSLA and The Scottish Government 2021) 5.2 North Lanarkshire continues to build and develop upon a long-standing positive record of engagement and participation and strong relationships with supported people, carers, and community organisations. This approach has ensured that the citizens of our area can continue to influence, inform, and have a role in shaping local policy, strategy, and services.
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4 5.3 The approach to engagement and participation continues to facilitate carers, supported people, and carer focused organisations, to influence and shape the range of carer supports set out within our local Carers Strategy 2024- 2027 5.4 Carers in North Lanarkshire are subject to the many challenges faced by unpaid carers nationally – around accessing breaks from caring, the hidden costs of caring, and issues accessing replacement care are widely known and recognised, but solutions can be harder to identify. National Census information confirms that more people are having to provide unpaid care, we are faced with an ageing population of unpaid carers, and resources are finite, whilst needs are infinite. However, the local carer experience continues to be significantly more positive than the findings and statistics reported nationally, as set out in previous reporting. Since last year we have continued to engage with unpaid carers and build on progress to date, and upon the intent set out in the North Lanarkshire Carers Strategy 2024-2027. Report 5.5 In the North Lanarkshire Carers Strategy 2024-2027, there were specific focus areas where we set out that we would: • Improve preventative approaches, anticipatory approaches, and future planning. • Improve communication with carers and their access to advice, information and support • Ensure that carers know their rights • Support carer health and well being • Ensure that carers can get a break from caring • Ensure that carers and the people being cared for, have their income maximized • Improve the carer experience around hospital discharge. • Improve awareness of, and access to, assistive technology • Offer specific support to young carers, Parent carers, Minority Ethnic carers, and LGBTQIA+ carers • Ensure that carers are at the heart of policy, strategy and support planning • Improve the carer experience around hospital discharge. The actions taken, and progress made in working to achieve these aims is set out below.
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5 5.6 In line with legislative requirements, a Procurement Exercise was undertaken in late 2024 to identify carer focused organisations who would work in close partnership with UHSCNL to meet the needs and outcomes of unpaid carers locally. The Whole Contract Value was £18 million, across a potential maximum six-year contract arrangement (three years, plus one year, plus one year, plus one year, subject to performance) and divided into five distinct Lots: • Adult Carer Support and Adult Carer Support Plans (Lot 1) • Carer Information, Advice, Campaigning, Engagement and Participation (Lot 2) • Dementia specific caring (Lot 3) • Hospital Discharge related caring (Lot 4) • Young Carers (Lot 5 The respective successful bidders were: Lanarkshire Carers (Lot 1) North Lanarkshire Carers Together (NLCT) (Lot 2) Alzheimer’s Scotland (Lot 3) Getting Better Together (Lot 4) Action for Children Young Carers Support Project (Lot 5) In addition to the commissioned organisations noted above, funding continued to be provided to: PAMIS (through a 2-year Proposal for Funding) – to offer a Family Support Service for families caring for individuals with profound, complex and multiple disabilities, where specialist knowledge is required, often beyond the scope of mainstream carer focused organisations. HOPE for Autism (through a 3-year Direct Award) – to support children, adults and family carers, where Autism or Neurodivergence is a feature. Further, North Lanarkshire Disability Forum (NLDF) were commissioned to deliver on the Engagement and Participation Strategy 2024 -2027, and within that, offer funding through a “growth pot”, aimed at organisations with a turnover of less than £50,000 a year – to promote engagement across seldom heard communities and organisations. Within this work, voices of previously “hidden” carers are also coming to the fore. NLDF also host a number of Community Connectors, whose remit is to ensure that where there is a risk of isolation or loneliness, that people, including carers, have an opportunity to be connected to their community, around their interests, hobbies and preferred activities. The wider Community Solutions programme, though Voluntary Action North Lanarkshire also provides opportunities for carers, through a diverse range of CVS organisations. The carer support landscape set out above offers a wide range of opportunities
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6 for carers, and work continues to ensure that any barriers to accessing such opportunities, such as replacement care, can be recognised and addressed. The Adult Carer Advocacy remit was re-aligned to an Advocacy provider organisation, having been previously hosted by NLCT, as part of the Tender exercise. Over and above the funding noted above, individual carer circumstances continued to be reflected in the adjustment of individual budgets to the cared for person, where deflators are generally applied to reflect that the person receiving a budget has unpaid carer support (rather than paid support) available, to meet outcomes. In circumstances where the carer support is limited, due to things such as multiple caring roles, carer ill health and so on, deflators can be adjusted, or in extreme circumstances, removed altogether. Accordingly, the total spend on carer support is far more than the amounts detailed within this report. 5.7 Relationships with the range of carer focused organisations outlined above in supporting and facilitating engagement and participation has been a significant factor in our collective approach to date. Input from carer focused organisations has proven invaluable generally, but particularly so regarding groups of carers from specific areas of caring, identified in the North Lanarkshire Carers Strategy 2024 -2027, particularly parent carers, carers from minority ethnic backgrounds and LGBTQI+ carers. 5.7.1 Last year, we reported on an innovative Hospital Discharge Payment Scheme for Carers offering a one-off payment of £1,000 to families to support their loved one for the first 6 weeks out of hospital. This was introduced to ensure people did not remain in hospital for any longer than needed to reduce the risk of delayed discharge arising from prolonged wait times for people who required support upon hospital discharge, but where social care provision could not be guaranteed due to difficulties arising from the pressures around social care recruitment, retention, and staffing. Initially introduced as a pilot \ demonstration scheme, ninety carers and ninety cared for people benefited from this scheme across 2023 -2024, at a cost of £90,000. That expenditure compared very favourably when set against both the financial and human costs of delayed discharge. 5.7.2 The Hospital Discharge Payment Scheme for Carers ended on 31st March 2024, with NLCT then undertaking further evaluation. (Report Appended.) It was evident from the Evaluation Report that carers valued the Hospital Discharge Carers Payment initiative. 5.7.3 Based on this positive feedback, we then incorporated the Hospital Discharge Payment Scheme for Carers into our much wider approach to Carer Outcome Grants – an initiative managed by Lanarkshire Carers on behalf of UHSCNL. The rationale for this was based on a range of considerations: the efficacy of Lanarkshire Carers conversation-based approach to supporting carers has been proven over time to be very successful in helping carers source solutions to caring related issues. Further, there can be caring related situations that require a “cash first” approach, and rather than carers having to be referred between agencies, it was recognised that Lanarkshire Carers being able to offer
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7 a discretionary payment of up to £1000, dependent on individual carer situations, helped alleviate otherwise difficult, protracted and stressful caring related circumstances. The third consideration was that carer feedback had demonstrated that even when the carer received a carer’s individual budget, following the progression of an Adult Carer Support Plan (ACSP), the time commitment and steps involved in setting up Direct Payment arrangements, often resulted in the “here and now” crisis” situation continuing for longer than was necessary. 5.7.4 Carer Outcome Grants are not advertised or publicised anywhere – as the main intention remains that a conversation-based approach helps identify carer strengths and solutions, and that the importance of the ACSP is the focus on both “what might help?” and on future planning, rather than as a form of “gateway to services” or money. The efficacy of the approach is demonstrated by the fact that through the conversation-based approach, only around 8% to 10% of carer referrals received by Lanarkshire Carers, result in an onward referral to Social Work. 62 Carer Outcome Grants, totaling £49,283.20 were made between April 2024 and March 2025, with none of these relating to Hospital Discharge. Whilst the initial Hospital Discharge Carers Payment Scheme. 5.7.5 Support for Carers involved in facilitating hospital discharge was further recognised and strengthened within the Carers Tender, through the inclusion of Lot 4, which had a specific focus on this area. Getting Better Together (GBT) were the successful bidder for Lot 4. The Tender also gave an opportunity to refine previous arrangements, where there had been a degree of drift around how long post discharge carer support should be in place for, as well as some concern regarding signposting and a risk of carers “falling through the cracks” in support arrangements. Refinements within the Tender specification stipulate a maximum 7-day period for GBT involvement, with a range of options thereafter, including, but not limited to, no further action needed, referral to community connectors, onward referral to carer focused support organisations for any ongoing caring related support and/or progression of an ACSP, or referral to Social Work, should that be required. 5.8 Further Expansion of Carer Breather. We reported last year on the expansion of Carer Breather Phase 2. Designed in partnership with carers in North Lanarkshire, Carer Breather is a pioneering initiative that not only supports carers to have time out, but also ensures carers have better access to their communities and works to reduce loneliness, isolation and foster friendships and relationships. The second round of funding for Carer Breather services was allocated to 11 organisations across North Lanarkshire. Funding is being used to provide breaks to carers from their caring roles in their local communities. 5.9 Through the opportunity created by the requirement to go to Tender, we sought bids in relation to Lot 2, where the successful bidder would expand Carer Breather still further. NLCT (the previous incumbent) was the successful bidder for Lot 2 of the Carers Tender, and Phase 3 of Carer Breather commenced in April 2025, with an expansion to 15 organisations: Bazooka Arts
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8 Central Scotland Adventures CACE (Cumbernauld) Glenboig Development Trust Health and Wellness Hub Lanarkshire Deaf Hub North Lanarkshire Disability Forum PAMIS PlayPeace Parkinsons Self Help Group The Haven VIP Pass Volunteering Matters Watch Us Grow YMCA Links to all the organisations can be found here: https://www.carerstogether.org/support-network/ Carer Breather enables carers to have time away from their caring role a few hours each week - to support carer wellbeing. Some services provide support for carers at the same time as providing support for the person they care for. This reflects requests from carers that they can access support that allows them to enjoy some joint time-out to relax in a community setting without having to worry about sourcing replacement care. Carers can self-refer to Carer Breather by contacting the organisations noted above directly. 5.9.1 The range of Carer Breather options sits within a much wider range of carer break options, with the Lanarkshire Carers Short Breaks Bureau, Time to Live Funding and individual Carer Budgets ensuring that carers can exercise choice and control in accessing the type of break most in keeping with their individual needs. Locally, we believe that we are already well placed to meet any requirements around the legal right to breaks from caring, as and when that is encompassed within an amendment to the Carers (Scotland) Act, as seems likely, following the shift away from the development of a national Care Service, where such a right was initially planned to be set out. The much wider context around affordability and sustainability regarding breaks from caring means that we must continue to focus on the key tenets of self-help, independence, empowerment and enablement, meaning that wherever possible, planning with carers can help identify how carers can self-manage breaks from caring, through options such as wider family, technology, family breaks together and identification of options that make sense to both the carer and the person/people being cared for. This reinforces the importance of progression Adult Carer Support Plans.
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9 5.9.2 We reported last year on increased funding to PAMIS to build capacity in the PAMIS Family Support Service, offering support to families caring for a family member with complex multiple disabilities. Around 160 families in North Lanarkshire are supported through this service. The nature of carer support goes beyond that offered by the main commissioned carer services as support around issues like postural drainage, daily stretching, physiotherapy, and specialist toileting techniques all require carers to have specialist knowledge. This increased funding is now coming to an end, and we are unable to offer funding for a third time through the Proposal for Funding option, which is limited to two years. Work is ongoing to consider whether a Direct Award should be offered. 5.9.3 PAMIS have also recently undertaken an audit of Changing Places Toilets across North Lanarkshire. Across Scotland there are around one million disabled people and, of that number, around 25,000 require access to larger sanitary facilities with specialist equipment such as: a hoist, adult sized changing bench, and a peninsular WC (toilet with a space either side for carers to assist). These larger sanitary facilities are known as ‘Changing Places Toilets’ (CPTs). Figures appear to vary, dependent upon which information source is accessed, but based on 2021 figures, throughout Scotland, there are around 250 CPT’s available. Without access to these facilities, families are sometimes forced to change loved ones on an unhygienic public toilet floor; clearly this is not acceptable. It can lead to people missing opportunities because there are no suitable sanitary facilities nearby. It can lead to social isolation as people are not confident that appropriate facilities will be available out-with the comfort of their own home. This not only affects the individual directly but can affect their friends and family as days out may have to be cut short—if they happen at all—due to the lack of suitable facilities. To facilitate the inclusion of all our citizens in community settings and local community life, CPT’s are required. 5.9.4 In summary, the audit of CPT’s highlighted an inconsistent picture, with the negative findings being that some facilities having no signage, staff being unaware that the building that they worked in had a CPT, equipment poorly maintained or not services, or the CPT being used as a store cupboard. More positively, other facilities were appropriately signed, staff were knowledgeable, and the facility was in good order. However, the positive feedback related to only 6 of the 16 CPT’s, so there is progress to be made. This is now being taken forward. 5.9.5 The number of citizens who require such facilities may never be significant in comparison those who could use mainstream public toilet provision. However, without CPT’s, the risk is that without adequately signed, clean, accessible, properly maintained, and appropriately equipped CPT’s, many families will simply opt to go elsewhere, meaning that wider community benefit is lost through families opting to go out with North Lanarkshire to spend their time and money. As demographic information highlights, the need for CPT’s is increasing, so the fundamental question is not whether we can afford to provide adequately resourced CPT’s, but whether we can afford note to, not just to meet
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10 legislative requirements, but to evidence that the needs of s our most disabled citizens are recognised and provided for. 5.9.6 We also reported last year on the introduction of support for carers supporting a family member with Dementia, through Alzheimer’s Scotland. This service provides holistic support to carers of people who have been diagnosed with dementia with a focus on meeting the needs and improve the quality of life, physical and mental wellbeing of carers of people with dementia to reduce stress and distress, maintain a healthy live/work balance and a reduction in the people with dementia being admitted to long term care. Alzheimer’s Scotland were the successful bidders for Lot 3 in the Carers Tender, and as a result, this service is being continued and further developed. Support for carers of people with dementia is further enhanced by the availability of a Care Academy (NHS Lanarkshire) where family members of people recently diagnosed with dementia can access a 2-day introductory course, and further Post Diagnostic Support (PDS) – where support must be available for a year, following a dementia diagnosis. The support for carers offered by Alzheimer’s Scotland is an essential element of carer support, alongside these two initiatives. 5.9.7 5.9.7 The extended 3-year contract for HOPE for Autism reported on last year, expired at the end of March 2025. A six-month extension to that contract is currently in place. Due to legal considerations around procurement, it is likely that there will be a requirement to go to Tender regarding this area of work in the near future. HOPE currently provides an all-age information and advice service for people with Autism, family members, carers, and professionals. Investment in practitioners from Autism Network to ensure that families have access to specialist knowledge locally around neurodivergence and the challenges that can arise around neurological conditions also came to and end during the past year, with sustainability being sought through training delivery and input to locality-based staff. 5.9.8 Support continued for Action for Children Young Carers Project who directly work with young carers to complete Young Carer Statements, assessments, reviews, and referrals for the young carer service. Action For Children were the successful bidder for Lot 5 within the Carer Tender 5.9.9 We have continued to offer development opportunities for Social Work staff around commissioned organisations, Adult Carer Support Plans, carer budget processes and Young Carer Statements. The commissioned carer focused organisations, and funded organisations have also accessed Trauma Informed Practice sessions, organized by North Lanarkshire Council, so that these principles can be embedded within day-to-day operational practice by these partner organisations. 5.10 Carer awareness events in tandem with the Assistive Technology team, have continued to take place both raising the awareness of, and promoting, assistive technology as a means of supporting both carers and those being cared for. It remains vital that this approach – to maximizing independence, minimizing risk, and encouraging a pro-active preventative approach is integral to assessment
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11 and planning, as often, carers only first present when already in crisis, resulting it being too late to benefit from preventative approaches. 5.10.1 As previously reported, the 2nd annual Commitment to Carers Event took place in Motherwell in May 2024, following on from the inaugural event in Bellshill in 2023. The event saw a number of carers and young carers delivering keynote addresses on various caring related topics. The event also served as the official launch of the North Lanarkshire Carers Strategy 2024 -2027. As part of the movement towards ever greater carer engagement and participation, responsibility for the annual Commitment to Carers Event has now passed from UHSCNL to NLCT, with the 3rd annual event continuing to have a focus on celebrating the impact of carer focused activity, and is scheduled for November 2025, at the Chryston Community Hub. 5.10.2 A range of engagement and participation activity aimed at all carers, but with a focus on underrepresented individuals, groups, or communities, including carers from minority ethnic communities and LGBTQI+ communities was evident throughout the year. Funding was made available for an Equalities post within NLCT, and this augments a similar existing post within Lanarkshire Carers. 5.10.3 Funding from a variety of sources, including Carer Breather, VANL Community Mental and Well Being Fund, NLDF Growth Pot, and NLC Grant Awards Programme was also successfully accessed by a range of organisations with a focus on underrepresented communities, and this route offers a further pathway for the carer voice to be heard. This range of CVS organisations, including those with an age related, or condition specific focus, continue to have a role in direct, or indirect, support to carers as well as supported people. Monitoring and quality evaluation regarding carer support across these organisations took place throughout the year to ensure that we continue to have a strong focus on approaches that are carer and supported people led. 5.10.4 Facilitating participation, notably with harder to reach groups and those who experience exclusion, continues to be progressed and achieved through making connections, and presenting opportunities. Investment continued around helpful networks, connecting people with shared experiences, identifying issues that are important to carers, supported people and communities and through delivering approaches to improve carer wellbeing. 5.10.5 There continues to be carer representation in governance structures and strategic forums, involvement in improvement areas, consultation, and co- production, with identified actions that further engagement and participation in our day-to-day practice. 5.10.6 Locally we want to ensure that we have the best possible approach to engagement with, and participation of, supported people and unpaid carers. One such approach, currently in development, is the introduction of “carer sounding boards” which will be facilitated by NLCT, but it is anticipated that all
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12 carer focused organisations locally can play a part in this work. Whilst all caring related roles have a degree of commonality, the variances of, for example, caring for a child with complex additional needs may be very different for caring for a parent living with dementia, or for someone with a physical disability, or enduring mental ill health. As such, we want to be sure that we have the right mechanisms and opportunities for carers to have their views heard, and where necessary, acted upon and carer sounding boards around specific areas of caring, will offer us this opportunity. 5.10.7 Carer Individual Budgets, where applicable, continue to be an option within the carer support toolbox. Most carers who are known to services are supported through the wider carer support infrastructure described in this report. In every situation where a cared for person is in receipt of an individual budget, the unpaid caring situation is also considered, and individual budgets are adjusted accordingly to take account of that. Following the progression of an ACSP, should a Carer Individual Budget be identified as being required, the 4 individual budget options outlined in the Self-Directed Support legislation, are available to carers. Most Carers in receipt of a Carer Individual Budget tend to opt for a Direct Payment. Across the year, there were 52 carers who received a Carer Individual Budget for the first time, with the maximum Carer Budget is £3000 in any one year. In situations where it is evident that the carer is already in crisis, there is discretion to agree a Carer Individual Budget in advance of the ACSP being progressed. 5.10.8 Further revision around the right to carer breaks, including an updated Short Breaks Statement was required, following changes to the proposed implementation of a National Care Service. A revised Short Breaks Statement will be published on the UHSCNL and partner organisation websites in the very near future. Our approach continues to be in line with the wider ethos of supporting and enabling self-help, enablement, and empowerment, so that wherever possible, carers use their own networks to facilitate breaks from caring, rather than rely on statutory services. 5.10.9 As previously reported, North Lanarkshire was a pathfinder area in the national Getting it Right for Everybody (GIRFE) approach, with a specific focus on ageing well and age-related frailty initially. Over the past year GIRFE has become further embedded in day-to-day practice across the adult age range. GIRFE has been largely synonymous with our local Back to Basics approach, with shared key aims of ensuring that people are heard, that if support is needed, that the right support is delivered at the right time and place, and that preventative, pro-active and innovative approaches are required, that no harm is done and that there is no need for people to have to relate their story multiple times. 5.11 NLCT recently undertook specific GIRFE related engagement activity with parent carers specifically, and findings are appended to this report. Ongoing engagement with people with lived experience will lead to further developments in our approach and help inform the type of opportunities and support that people value. Discussions with stakeholders around holding some form of
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13 parent carer summit, to help identify further approaches to “what might help” are at an early stage, with some form of event envisaged during the remainder of 2025. This is an example of the “carer sounding board” approach mentioned above. 5.12 Earmarked reserves from the allocated funding to support The Carers Act Implementation are noted below: EARMARKED RESERVES Opening Balance as at 1 April 2024 Projected Use Revised Balance as at 28 February 2025 £m £m £m Carers Act Support £2,595,745 £164,226 £2,431,519 These figures cover 01.04.24 to 31.03.25. This is the provisional outturn, but no change to these figures is anticipated. 5.13 Measures of Success Our measures of success have been jointly agreed with carers and care focused organisations, and as we enter Year 2 of the North Lanarkshire Carers Strategy 2024-2027, we will continue to engage with carers to ensure that these measures are being achieved, remain relevant and that in any areas across the measures, where more needs to be done, that there will be a focus on doing so. Carers are engaged, included, and represented to the extent they wish to be. Creation of better opportunities for under-represented and seldom heard carers to participate and have their voices heard. Improved opportunities for carers to influence, shape, co-produce and \ or co- design policy, strategy, and services. This goes beyond caring related policy or strategy, as through good design and engagement, the needs of carers and cared for people can be incorporated into wider policy and strategy. Provision of approaches which can be influenced and shaped by the engagement and participation activity set out above. Clear focus on the nine priority areas for action that carers have identified as a priority for them, as set out in the Carer Strategy 2024-2027. A reduction in the number of carers and \ or supported people first presenting whilst already in crisis – to be achieved through the promotion of ACSPs, advance planning, preventative, and/or anticipatory approaches. 6. CONCLUSIONS Our approach to both carer support and meeting the intent of the North Lanarkshire Carers Strategy 2024-2027 continue to be based predominantly on the principles of the
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14 Carers (Scotland) Act 2016 and Self-Directed Support (Scotland) Act 2013. Self- Directed Support (SDS) continues to be Scotland’s national Social Care policy, promoting a whole system approach that enables people to have more choice and control in their lives. SDS is based on enhancing the principles of participation, dignity, involvement, informed choice, and collaboration. Our aspiration remains unchanged - to offer a sustainable and innovative means to achieve the outcomes that carers, as well as supported people, identify as being important to them, that carers can lead full and meaningful lives, and that people can engage in, participate in, and contribute to the local economy and wider society, should that be their choice. We believe, and carers tell us, that when we get things right, the differences are meaningful, impactful and extremely positive. We must recognise that this is not, by any means, every carer’s experience. On that basis, we still have more to do, but the melding of carer lived experience, business intelligence and professional knowledge sees us on a path were hopefully, every carer can feel respected, valued, listened to, and well supported in their caring role, whatever form of support that may take. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Cross referencing with the Tackling Poverty paper to be finalised 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 ☒
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15 Yes No ☐ N/A ☐ Earmarked reserves and directed funding allocated for Carers support will be used to procure and deliver services that continue to support Carers across our communities. 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner n/a Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national Outcomes Through commissioned carer support organisations and other funded organisations with a carer remit locally. ☒ Provide stakeholders with information on how to get involved Through commissioned carer support organisations and other funded organisations with a carer remit locally ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Through commissioned carer support organisations and other funded organisations with a carer remit locally ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services Through carer participatory self- appraisal. Through commissioned carer support organisations and other funded organisations with a carer remit locally through monitoring and assurance. ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Through engagement and participation processes with commissioned carer support organisations locally, framework support provider organisations, governance groups.
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16 ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Through commissioned carer support organisations locally. Through Advocacy Through individual support. Through carer development programmes, such as Recognition to Rights. ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Through the Engagement and Participation Strategy, NLDF, and through co- production with stakeholders. ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership Through the Engagement and Participation Strategy, NLDF, and through co- production with stakeholders. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A X (Undertaken previously prior to Procurement and launch of Carer Strategy 2024 - 2027) EQIA added to website: Yes / Date added ☐ No N/A ☐ 8 BACKGROUND PAPERS N/A 9 APPENDICES 9.1 North Lanarkshire Carers Strategy 2024-2027 9.2 TBC 9.3 TBC 9.4 TBC
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17 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Maria Williamson, Senior Manager, Quality Assurance, WilliamsonM@northlan.gov.uk
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REPORT Item No: 9 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 (UHSCNL) for the period 1 April 2024 to 31 March 2025 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA Committee: (1) Acknowledge the year end financial position of a £10.716m underspend. (2) Refer to the IJB Reserves Strategy report to approve the allocation of this underspend. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from NHS Lanarkshire Director of Finance and North Lanarkshire Council Chief Officer (Finance). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 As detailed in Table 1, the IJB final outturn position, prior to removal of ring-fenced funding, is an underspend of £10.716m. SUBJECT: Financial Monitoring Report 2024/25 TO: Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 21 May 2025 Yes No N/A
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6.2 Once the ring-fenced balances have been transferred to the relevant reserve in line with Scottish Government guidance, the revised outturn was an underspend of £10.102m. Table 1 6.3 Subject to PFA approval of the Reserves Strategy report, this underspend will be allocated to manage earmarked commitments, any funding gap which has been highlighted in the Medium Term Financial Plan 2025/26 – 2027/28 and to augment the amounts held in contingency. 6.4 Appendices 1 to 3 show a detailed revenue budget position for each care group above. 7. 2024/25 FINANCIAL PERFORMANCE 7.1 Thie final outturn underspend for 2024/25 is an underspend of £10.716m relating to various under and overspends across the whole integrated budget. A summary of the main variances including financial challenges and key pressures are highlighted below: 7.1.1 Employee Costs – underspend of £19.219m As highlighted throughout 2024/25, there are continuing challenges in terms of recruitment and retention across all service areas. For a wide range of posts recruitment has been unsuccessful due to the availability of the skill mix required or the competition being offered by other private and public sectors. Included in this underspend is £6.961m relating to a non-recurring reduction in pension contributions within Social Care. 7.1.2 Payments to Other Bodies (PTOB) – overspend of £1.073m This overspend is primarily in relation to anticipated spend in Independent Care Homes and also within ‘Care at Home’ through self-directed support (SDS) plans. These projections are demand led and are based on full year costs for both current clients and those anticipated. 7.1.3 Transport – overspend of £0.418k The overspend is attributed to an increase in running costs associated with the home support additional pool cars that were purchased during 2024/25 along with an increase in staff mileage claims. 7.1.4 Prescribing – overspend of £4.757m This overspend is based on actual prescribing data available to January 2025 and estimated data for February and March 2025. Based on data received to date the cost per item has increased to £10.33, and the number of items being dispensed has reduced by 0.02% based on the same period in 2023-24. Therefore, the overspends is attributable to both the number of medicines being prescribed and dispensed in community pharmacies remaining at high levels alongside higher prices. This is exacerbated by the fact that there hasn’t been an inflationary increase added to 2024-25 annual budget. £m £m £m £m £m £m £m Health Care Services 588.021 (4.978) 583.043 578.509 4.534 (0.614) 3.920 Social Care Services 273.025 (5.708) 267.317 261.135 6.182 0.000 6.182 TOTAL 861.046 (10.686) 850.360 839.644 10.716 (0.614) 10.102 Less Ring- Fenced Underspend Revised Final Outturn Variance 2024/25 Annual Budget 2024/25Care Group Final Outturn Variance 2024/25 Final Outturn 2024/25 In Year Drawdown From Reserves Revised Budget 2024/25
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7.1.5 North Lanarkshire Hosted Services – projected underspend of £2.865m The main areas reporting an underspend within hosted services include speech and language therapy, children and adolescent mental health services, podiatry services and mental health and learning disability services. The underspends in this area are partially offset by the following areas of concern: • Continence Services – overspend of £0.683m which is related to product costs within both the care home environment and within the community. • Children Services Diabetic Nursing – overspend of £2.221m which is mainly due to additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. • Prisoner Healthcare – overspend of £0.204m due to the increase in costs linked to the delivery of the new pharmacy contract and drug prices associated with prescribing. 7.2 Throughout the year, adjustments are made to the original budget due to additional budget allocations and budget transfers. Appendix 4 provides a reconciliation of the main budget adjustments applied this financial year and table 2 shows the current funding allocation received from Scottish Government during 2024/25. Table 2 Scottish Government Allocations as at 31 March 2025 £m Action 15 mental Health Strategy 1.478 Additional Band 2-4 Staffing 1.276 Alcohol and Drug Partnership Funding 3.179 DBI national Pathways 0.075 Mental Health Outcomes Framework 11.592 Multi Disciplinary Teams 2.309 Outcomes Framework (exc Mental Health) 1.865 School Nursing 0.840 Specialist Community Perinatal, Infant and Maternity Mental Health 1.084 District Nursing 0.683 Long Covid Support Fund 0.320 Distress Brief Intervention 2.780 Digital Mental Health Licences 0.120 Band 7 OPAT Post 0.069 Hospital at Home 0.276 V1P & ICU Funding 0.170 Dementia Post 0.441 Meningitis C 0.106 Specialty and Specialist Doctors Contract 0.194 National Diabetes Technology 0.212 Seasonal Vaccines 4.013 Operation Flow 1.871 Other 1.810 TOTAL 36.763
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8. GENERAL RESERVES 8.1 It is important for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statute and is part of a range of measures in place to ensure that s106 public bodies do not over- commit themselves financially. 8.2 The closing IJB reserves position for 2024/25 after adjustments for the drawdown of in-year reserves, is a revised balance of £64.386 and is summarised in table 4. Table 4 8.3 A detailed list of all reserve movement during 2024/25 is at appendix 5 including a key guidance table showing how the reserves are aligned to our five ambition statements detailed in the Strategic Commissioning Plan 2023-26. 8.4 The reserves Strategy report for 2025/26 is also being reported to PFA this cycle which requests approval for the allocation of the 2024/25 surplus and also provides a detailed list of the opening reserves should these approvals be granted. 9. SAVINGS 9.1 The saving delivery plan commenced in April 2024 with a target of £29.093m over financial years 2024/25 and 2025/26. 9.2 The Senior Management Team alongside various sustainability and value workshops met on a regular basis to discuss and monitor the management actions reported in the financial plans to progress savings and redesign of services to help support future years budget planning. This includes the following areas of work: • Review of financial planning assumptions for 2024/25. • Review of all current vacancies including length of time left vacant. • Review of discretionary spend and supplementary staffing. • Updates on saving planning in significant areas of budget pressures. • Various service reviews across the partnership. • Collaboration with South UHSCP Management Team primarily to review hosted services and joint working arrangements across Lanarkshire. 9.3 The final IJB savings position show total savings achieved of £15.437m and is summarised in chart 1. Opening Balance As At 1 April 2024 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2025 £m £m £m £m NHSL Ring-Fenced Reserves 24.114 9.060 (11.599) 21.575 NLC/NHSL Earmarked Reserves 20.975 0.000 (5.131) 15.843 NLC/NHSL Risk-Based Reserves 17.045 0.000 (2.731) 14.314 NHSL Contingency Reserves 13.390 0.000 (0.286) 13.104 NLC/NHSL Closed Reserves 0.000 0.000 0.000 0.000 75.524 9.060 (19.748) 64.836Total LEAD SUMMARY
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Chart 1 9.4 Appendix 6 shows a detailed list, including target value, of all IJB approved saving plans. Directors should note the unachieved savings from this 2 year plan have been absorbed into the Medium Term Financial Plan 2025/26 and form part of the new savings plan for 2025/26. 10. VACANCY POSITION 2024/25 10.1 Table 5 shows the full time equivalent (FTE) vacancy numbers at 31 March 2025 within each service compared against their budgeted establishment. Table 5 10.2 To help cover the vacant posts throughout the year, agency staff, bankaide, overtime and excess part time hours is 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 6. Establishment Actual Vacancies FTE FTE FTE North West Locality 393.28 373.55 19.73 North East Locality 331.46 315.87 15.59 Adult Services 295.44 267.42 28.02 Children Services 602.67 544.70 57.97 Mental Health 1,196.62 1,246.28 -49.66 Social Care Services 989.30 838.24 151.06 Home Support 996.57 927.23 69.34 Other 233.36 231.96 1.40 TOTAL 5,038.70 4,745.25 293.45 Position as at 31 March 2025 Service
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Table 6 11. DIGITAL FINANCE POSITION 2024/25 11.1 Below is a summary of the current North Lanarkshire IJB digital programmes of work and the agreed funding associated with each: Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.080 0.031 0.696 0.013 0.820 North East Locality 0.043 0.017 0.434 0.000 0.494 Adult Services 0.056 0.073 0.322 0.007 0.459 Children Services 0.122 0.045 0.735 0.268 1.170 Mental Health 0.336 0.077 4.266 4.453 9.132 Social Care Services 0.777 - - 0.111 0.888 Home Support 4.437 - - - 4.437 Other 0.014 0.014 0.051 - 0.078 TOTAL 5.864 0.257 6.504 4.853 17.478 SERVICE Costs As At 31 March 2025 Home Support Scheduling System (ACCESS) COST £m FUNDING £m Year 1 (23/24) 0.521 Year 2 (24/25) 0.610 Year 3 (25/26) 0.547 Year 4 (26/27) 0.312 Year 5 (27/28) 0.326 Year 6 (28/29) 0.340 TOTAL COST OF PROGRAMME 2.656 Recurring Revenue Budget (0.224) Earmarked Reserve (2.432) TOTAL FUNDING AVAILABLE (2.656) Community Alarms Analogue to Digital COST £m FUNDING £m Year 1 (24/25) 0.399 Year 2 (25/26) 0.229 Year 3 (26/27) 0.279 TOTAL COST OF PROGRAMME 0.907 Capital Budget (0.087) Recurring Revenue Budget (0.135) Earmarked Reserve (0.465) TOTAL FUNDING AVAILABLE (0.687) Recurring Funding Gap From Year 3 (26/27) 0.220
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11.2 Currently two of the three programmes are progressing within their allocated funding however, Community Alarms envisage a gap in recurring funding from 2026/27 onwards. To ensure future financial transparency, the Medium Term Financial Plan has been updated to reflect this additional pressure. 12. IMPLICATIONS 12.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A Social Work Case Management System (MOSAIC COST £m FUNDING £m Year 1 (23/24) 0.213 Year 2 (24/25) 0.174 Year 3 (25/26) 0.114 Year 4 (26/27) 0.114 Year 5 (27/28) 0.114 Year 6 (28/29) 0.114 Year 7 (29/30) 0.114 TOTAL COST OF PROGRAMME 0.957 Capital Budget (0.157) Non-Recurring Funding (0.100) Earmarked Reserve (0.700) TOTAL FUNDING AVAILABLE (0.957)
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12.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service Very High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 12.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. 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.
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12.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 13. BACKGROUND PAPERS None. 14. APPENDICES Appendix 1 - North Lanarkshire IJB 2024/25 Budget Appendix 2 - Hosted Services Led by North Lanarkshire Appendix 3 - Hosted Services Led by South Lanarkshire Appendix 4 - North Lanarkshire IJB Budget Reconciliation 2024/25 Appendix 5 – North Lanarkshire IJB Movement on Reserves Appendix 6 – North Lanarkshire IJB 2 Year Savings Delivery Plan Appendix 7 - Analysis of Additional Employee Costs 2024/25 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07816 126362.
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North Lanarkshire IJB Revenue Budget Position 1 April 2024 to 31 March 2025 Appendix 1 Annual Final Year End Actual Final Year End Variance Budget Total Total 2024/25 2024/25 2024/25 £m £m £m Health Care Services Locality and Other Services 70.116 64.937 5.179 Addiction Services 4.317 4.073 0.244 Medical and Nursing Directorate 4.607 4.105 0.502 Prescribing 76.952 81.709 (4.757) Out of Area Services 4.318 4.220 0.098 Area Wide Services 8.823 8.420 0.403 Hosted Services 203.408 200.543 2.865 Family Health Services 135.965 135.965 0.000 Set-Aside Budget 74.537 74.537 0.000 Total Expenditure - NHSL 583.043 578.509 4.534 Social Care Services Social Care Services Gross Expenditure 272.233 265.631 6.602 Social Care Services Gross Income (7.146) (6.942) (0.204) Social Care Services Net Expenditure 265.087 258.689 6.398 Housing Revenue Account 2.229 2.445 (0.216) Social Care, Housing and Transport Services Net Expenditure 267.316 261.134 6.182 Total Expenditure - NHSL and NLC 850.360 839.643 10.716 Annual Budget 2024/25 £m NHS Lanarkshire Funding (578.065) Social Care Funding (23.417) Resource Transfer (23.975) Commissioned Services (6.965) Transfer from Reserves (Approved) (4.978) Total Funding - NHSL (637.401) NLC Funding - Social Care Services (208.024) NLC Funding - Housing Services (2.229) Transfer from Reserves (Approved) (2.706) Total Funding - NLC (212.959) Total Funding - NHSL and NLC (850.360) Care Group Funded By:
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Hosted Services Appendix 2 March 2025 March 2025 March 2025 March 2025 March 2025 March 2025 March 2025 March 2025 March 2025 Budget Actual Variance Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m £m £m £m £m £m Sexual Health Services 3.852 3.852 3.819 0.033 2.003 2.003 1.970 0.033 1.849 1.849 1.849 0.000 Continence Services 2.527 2.527 3.210 (0.683) 1.314 1.314 1.997 (0.683) 1.213 1.213 1.213 0.000 Immunisation Services 6.231 6.231 4.925 1.306 3.240 3.240 1.934 1.306 2.991 2.991 2.991 0.000 Speech and Language Therapy Services 7.514 7.514 6.678 0.837 3.907 3.907 3.071 0.837 3.607 3.607 3.607 0.000 Children and Adolescents Mental Health Services 14.376 14.376 13.683 0.694 7.476 7.476 6.782 0.694 6.901 6.901 6.901 0.000 Childrens Services 14.336 14.336 16.556 (2.221) 7.455 7.455 9.675 (2.221) 6.881 6.881 6.881 0.000 Integrated Equipment and Adaptations Store 0.817 0.817 0.817 0.000 0.425 0.425 0.425 0.000 0.392 0.392 0.392 0.000 Dietetics Services 4.609 4.609 4.339 0.269 2.396 2.396 2.127 0.269 2.212 2.212 2.212 0.000 Podiatry Services 5.167 5.167 4.627 0.540 2.687 2.687 2.147 0.540 2.480 2.480 2.480 0.000 Prisoner Healthcare Services 2.122 2.122 2.327 (0.204) 1.104 1.104 1.308 (0.204) 1.019 1.019 1.019 0.000 Blood Borne Viruses Services 1.830 1.830 1.667 0.163 0.952 0.952 0.789 0.163 0.879 0.879 0.879 0.000 Hospital at Home 3.048 3.048 3.048 0.001 1.585 1.585 1.584 0.001 1.463 1.463 1.463 0.000 Mental Health and Learning Disability Services 93.071 93.071 90.942 2.130 48.397 48.397 46.267 2.130 44.674 44.674 44.674 0.000 TOTAL 159.501 159.501 156.637 2.864 82.941 82.941 80.076 2.864 76.561 76.561 76.561 0.000 Led by the North Partnership South Lanarkshire IJB - 48% Share Final OutturnAnnual Budget 2024/25 Annual Budget 2024/25 Final Outturn North Lanarkshire IJB - 52% ShareFinal OutturnAnnual Budget 2024/25 Hosted Services Appendix 3 March 25 March 25 March 25 March 25 March 25 March 25 March 25 March 25 March 25 Budget Actual Variance Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 8.710 8.710 7.687 1.023 4.529 4.529 4.529 0.000 4.181 4.181 3.158 1.023 Brain Injury Unit 2.504 2.504 2.455 0.049 1.302 1.302 1.302 0.000 1.202 1.202 1.153 0.049 Out of Hours Services 10.703 10.703 10.103 0.600 5.565 5.565 5.565 0.000 5.137 5.137 4.537 0.600 Palliative Care Services 9.801 9.801 7.707 2.094 5.097 5.097 5.097 0.000 4.705 4.705 2.611 2.094 Physiotherapy Services 12.320 12.320 10.959 1.361 6.407 6.407 6.407 0.000 5.914 5.914 4.553 1.361 Primary Care Services 0.916 0.916 0.762 0.154 0.476 0.476 0.476 0.000 0.440 0.440 0.286 0.154 South Improving Cancer Journey 0.470 0.470 0.638 (0.168) 0.244 0.244 0.244 0.000 0.226 0.226 0.394 (0.168) Occupational Therapy Services 9.061 9.061 8.460 0.601 4.712 4.712 4.712 0.000 4.349 4.349 3.748 0.601 Diabetic Services 5.024 5.024 6.200 (1.176) 2.613 2.613 2.613 0.000 2.412 2.412 3.588 (1.176) Primary Care Improvement Fund 24.928 24.928 24.927 0.001 12.962 12.962 12.962 0.000 11.965 11.965 11.965 0.001 TOTAL 84.436 84.436 79.899 4.537 43.907 43.907 43.907 0.000 40.529 40.529 35.993 4.537 Annual Budget 2024/25 Year to Date South Lanarkshire IJB - 48% Share Led by the South Partnership Annual Budget 2024/25 Final Outturn Annual Budget 2024/25 Year to Date North Lanarkshire IJB - 52% Share
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North Lanarkshire IJB Budget Reconciliation 2024/25 Appendix 4 2024/25 NHSL Financial Allocation to North Lanarkshire HSCP £m 2024/25 NLC Financial Allocation to North Lanarkshire HSCP £m 2024/25 North Lanarkshire HSCP Financial Allocation 338.816 2024/25 North Lanarkshire HSCP Financial Allocation 206.811 Set-Aside Budget 74.537 NLC Funding - Housing Services 2.229 South Hosted @ 52% 39.188 NLC Financial Allocation at 11 October 2024 209.040 Family Health Service South @ 52% 124.475 Budget Adjustments Posted in Month 5 NHSL Financial Allocation at 31 May 2024 577.016 Transfer Scottish Living Wage budget to Housing -0.023 NLC Financial Allocation at 23 August 2024 209.017 Budget Adjustments Posted in Month 3 Budget Adjustments Posted in Month 6 Draw Down From Reserves 1.747 Scottish Living Wage for Childrens Services 0.500 Increase in ERS Usage 1.943 NLC Financial Allocation at 11 October 2024 209.517 Long Covid, ADP, Men C Funding 0.387 Budget Adjustments Posted in Month xx Budget Realignment 0.981 0.736 Increase in Hosted Services Led by South 1.358 Budgeted Use of Rserves 2.706 Increase in Area Wide Services 0.072 NLC Financial Allocation at 31 March 2025 212.959 Other Budget Adjustments 0.273 NHSL Financial Allocation at 30 June 2024 583.777 Budget Adjustments Posted in Month 4 Draw Down From Reserves 1.626 Non Recurring Funding Hospital at Home 0.442 Other Budget Adjustments 0.084 NHSL Financial Allocation at 31 July 2024 585.929 Budget Adjustments Posted in Month 5 Draw Down From Reserves 2.935 Increase in Hosted Services Led by South 0.087 Veterans 1st Point Funding 0.126 Other Budget Adjustments 0.886 NHSL Financial Allocation at 31 August 2024 589.963 Budget Adjustments Posted in Month 6 Draw Down From Reserves 0.846 Increased income 0.099 Increase in Hosted Services Led by South 5.734 Prescribing adjustments 1.144 Other budget adjustments 0.187 NHSL Financial Allocation at 31 September 2024 597.973 Budget Adjustments Posted in Month 7 Draw Down From Reserves 0.691 Increased income 0.554 Increase in Hosted Services Led by South 1.727 Prescribing adjustments 0.400 AW 0.354 Other budget adjustments 8.019 NHSL Financial Allocation at 31 October 2024 609.718 Budget Adjustments Posted in Month 8 Draw Down From Reserves 0.886 Increased income 0.654 Increase in Hosted Services Led by South 0.465 AW 0.163 Prescribing adjustments 0.520 Other budget adjustments 0.342 NHSL Financial Allocation at 30 November 2024 612.748 Budget Adjustments Posted in Month 9 SG Allocations/PC Reserves 6.965 Medical Pay Award 2.132 Income 1.693 Prescribing adjustments 0.250 AW 0.397 NHSL Financial Allocation at 30 December 2024 624.185 Budget Adjustments Posted in Month 10 Prescribing 1.973 SG Allocations/PC Reserves 2.310 IJB Reserves hand back -10.881 Income 1.240 AW -0.144 South Hosted Serv 4.508 NHSL Financial Allocation at 31 January 2025 623.191 Budget Adjustments Posted in Month 11 SG Allocations/PC Reserves 2.104 IJB Reserves 2.430 Income 0.833 Prescribing 0.206 AW 0.029 South Hosted Serv 2.974 NHSL Financial Allocation at 28 February 2025 631.767 Budget Adjustments Posted in Month 12 SG Allocations/PC Reserves 0.741 IJB Reserves 4.996 Income 0.892 Prescribing 0.164 AW 0.073 South Hosted Serv -1.232 NHSL Financial Allocation at 31 March 2025 637.401
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North Lanarkshire IJB Movement on Reserves Audit Trail NHSL & NCL Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2025 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.597 0.860 (1.021) 3.436 (0.161) 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Dis 0.106 (0.029) 0.077 (0.029) 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.194 (0.039) 0.155 (0.039) 1, 2, 4, 5 NHSL Children and Adolescent Mental Health 2.849 (0.075) 2.774 (0.075) 1, 2, 4, 5 NHSL Community Living Change Fund 1.164 (1.110) 0.055 (1.110) 1, 4, 5 NHSL District Nursing 0.292 0.373 (0.292) 0.373 0.081 1, 2, 3, 4, 5 NHSL Family Nurse Practitioner Funding 0.072 0.072 0.000 1, 2, 3, 4, 5 NHSL Frailty Nursing 0.401 (0.400) 0.001 (0.400) 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.962 0.276 (0.322) 0.915 (0.046) 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2, 3 NHSL Long Covid Pathways 0.234 0.289 (0.233) 0.289 0.056 2, 3, 4, 5 NHSL Mental Health Action 15 0.729 0.730 (0.730) 0.730 0.000 1, 2, 4, 5 NHSL Mental Health Covid Clinicians 0.052 0.052 0.000 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service Dementia Post 0.972 0.359 (0.274) 1.057 0.086 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.111 0.110 0.221 0.110 1, 2, 3, 4, 5 NHSL Mental Health Distress Brief Intervention 3.396 2.704 (3.396) 2.704 (0.692) 1, 2, 4, 5 NHSL Mental Health Eating Disorders 0.036 0.036 0.000 1, 2, 4, 5 NHSL Mental Health Neurodevelopmental Pathways 0.074 (0.074) 0.000 (0.074) 1, 2, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 0.000 1, 2, 4, 5 NHSL Mental Health Wellbeing in Primary 0.148 0.148 0.000 1, 2, 4, 5 NHSL North Planning Band 2-4 Posts & Multi-D 2.719 2.719 (2.719) 2.719 0.000 1, 2, 3, 4, 5 NHSL PCR Prison Care Network Transforming 0.013 (0.012) 0.001 (0.012) 1, 2, 3, 4, 5 NHSL Pharmacy Mental Health Recovery & NE 0.341 0.640 (0.341) 0.640 0.299 1, 2, 3, 4, 5 NHSL School Nursing 0.622 (0.348) 0.274 (0.348) 1, 2, 3, 4, 5 NHSL Specialist Doctor Contracts 0.194 0.194 0.000 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 0.254 0.000 3 NHSL Third Sector Initiatives To Improve 0.247 (0.172) 0.075 (0.172) 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 2.790 2.790 0.000 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 4 0.027 (0.013) 0.014 (0.013) 3 24.114 9.060 (11.599) 21.575 (2.539) Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2025 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Adult Social Care Winter Preparedness F 1.000 1.000 0.000 1, 2, 3, 4, 5 NLC Adaptations Fund 0.308 (0.185) 0.123 (0.185) 2, 4 NLC Adult Protection (share with C&F and 0.050 (0.040) 0.010 (0.040) 1, 2, 4, 5 NLC Advocacy Services 0.065 (0.046) 0.019 (0.046) 1, 2, 4, 5 NHSL Breast Feeding Team (2 year funding) 0.705 (0.360) 0.345 (0.360) 1, 2, 5 NLC Business Case - Non-Recurring NLC 1.319 (1.010) 0.309 (1.010) 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.596 (0.170) 2.426 (0.170) 1, 2, 4, 5 NHSL Children and Adolescent Mental Health 0.268 0.268 0.000 4 NHSL Childrens Services - Paediatric Band 7, 0.107 (0.107) 0.000 (0.107) 3 NHSL Development of Chryston Community 0.212 0.212 0.000 1, 5 NHSL Dietetics Services - Double Running 0.064 (0.009) 0.055 (0.009) NLC Digital and IT Strategy Technology 0.465 (0.235) 0.230 (0.235) 2, 3 NLC Digital and IT Strategy Technology 3.699 (0.367) 3.332 (0.367) 2, 3 NLC Digital and IT Strategy Technology 0.389 (0.075) 0.314 (0.075) 2, 3 NLC Digital and IT Strategy Technology 0.700 (0.045) 0.655 (0.045) 2, 3 NLC Financial Strategy - Changes to LA 0.027 (0.009) 0.018 (0.009) NHSL Health Inequalities - Screening 0.044 (0.028) 0.016 (0.028) 2 NHSL Health Visiting Students/Trainees 0.311 (0.282) 0.029 (0.282) 3 NLC Home Support Resilience (2 year 0.656 (0.079) 0.577 (0.079) 3, 4 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.087 0.087 0.000 3 NLC IJB Helpline (2 years funding) 0.360 (0.223) 0.137 (0.223) 1, 4, 5 NHSL Kylepark Works 0.134 0.134 0.000 4, 5 NLC Mental Health Social Workers 2 x NL10 0.162 (0.013) 0.149 (0.013) 3, 4 NHSL Mental Health Wards Window 0.650 0.650 0.000 2, 4 NHSL Minor Capital Works 1.027 1.027 0.000 3 NHSL Neonatal & Paediatrics Dieteics 0.450 (0.157) 0.293 (0.157) 1, 2, 5 NHSL Organisational Development Fund 0.260 0.260 0.000 3 NHSL Paediatric Diabetes Insulin Pumps and 0.569 (0.031) 0.538 (0.031) 1, 2, 3 NLC Planned Date of Discharge - Discharge 0.109 (0.057) 0.052 (0.057) 1, 5 NHSL Podiatry Services - Foot Screening 0.350 (0.008) 0.342 (0.008) 1, 2 NHSL Prisioner Healthcare - Transitional 0.020 (0.019) 0.001 (0.019) 3 NHSL Regrading of Posts Including Backpay 0.250 0.250 0.000 3 NHSL Scottish Clinical Leadership Fellowship 0.060 0.000 0.060 0.000 3 NHSL Sexual Health Services - Forensic 0.152 (0.152) 0.000 (0.152) 1, 2 NHSL Sexual Health Services - Long-Acting 0.404 (0.107) 0.297 (0.107) 1, 2 NLC Social Care Contracting Staff within 0.087 0.000 0.087 0.000 NLC/NHSL Staff Training Academy 2.042 (1.003) 1.039 (1.003) 3 NHSL Vulnerable and Complex Cases - Test 0.816 (0.315) 0.501 (0.315) 5 20.975 0.000 (5.131) 15.843 (5.131) Ambition Statement & Performance APPENDIX 5 Ambition Statement & Performance To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ongoing TOTAL RING-FENCED RESERVES LEAD EARMARKED RESERVES TOTAL EARMARKED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 LEAD RING-FENCED RESERVES
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Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2025 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Prescribing Fund 4.361 4.361 0.000 2, 4 NLC Social Care Demand 12.684 (2.731) 9.953 (2.731) 2, 4 17.045 0.000 (2.731) 14.314 (2.731) Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2025 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 13.390 (0.286) 13.104 (0.286) 13.390 0.000 (0.286) 13.104 (0.286) 75.524 9.060 (19.748) 64.836 (10.687) KEY 1 2 3 4 5 Develop and support a workforce for the future. Improve mental health and wellbeing. Supporting people through a whole family approach. Ambition Statement & Performance Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. Ambition Statement & Performance Do the right thing first time. TOTAL CONTINGENCY FUND RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ambition Statement & Performance TOTAL RESERVES LEAD RISK-BASED RESERVES TOTAL RISK-BASED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing LEAD CONTINGENCY FUND RESERVES
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APPENDIX 6 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 1 Ongoing Prescribing Savings 2.280 1.746 1.746 0.534 2 Financial Management - North Consequential Funding 3.446 3.446 3.446 0.000 3 Service Redesign: Mental Health Hospital Based Complex Care Contracted Beds 2.600 0.905 0.905 1.695 4 Review of Discretionary Spend 2.188 0 0.000 2.188 5 Review of Supplementary Staffing 0.982 0.787 0.787 0.195 6 Workforce Management and Service Redesign 4.699 2.786 2.786 1.913 7 Financial Management - Support Costs and Vacancy Review 1.486 1.614 1.614 (0.128) 17.681 11.284 0.000 11.284 6.397 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 8 Financial Management - Overspends 4.827 0.426 0.426 4.401 9 Service Redesign: Review of Provision of Registered Social Landlords 0.600 0.296 0.488 0.784 (0.184) 10 Review of Supplementary Staffing 0.750 0.75 0.750 0.000 11 Service Redesign and Contract Review 0.400 0.517 0.326 0.843 (0.443) 12 Review of Operating Model Supporting Back to Basics 3.825 0.3 0.300 3.525 13 Financial Management - Vacancy Review 1.000 1.05 1.050 (0.050) 11.402 3.339 0.814 4.153 7.249 29.083 14.623 0.814 15.437 13.646 Reference 1 2 3 4 5 6 7 8 Reference 8 9 10 11 12 13 Health Care Services Savings Delivery Plan Review all areas of discretionary spend including postage, stationery and printing, staff travel and subsistence, domestic supplies, subscriptions and licenses and hospitality. Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review. The prescribing efficiency programme will continue. This will include additional efficiencies around medicines of low clinical value, drug patent expiry list, product switches, complex rebates and prescribing waste. Reducing current overspends to align with allocated budgets. For 2024/25, this is being off set by non-recurring consequential funding from Scottish Government. Additional non-recurring funding received in year from Scottish Government. This will be used in 2024/25. Outstanding Target to Date 2 Year Savings Delivery Plan (Target = £17.681m) Plan Total Achieved 2 Year Savings Delivery Plan (Target = £11.402m) Plan The current model of HBCCC is being reviewed with a view of moving patients into a more suitable and homely environment, such as a mainstream care home which would be a less intensive setting whilst also improving the quality of life of the individual. Total Adult Social Care Services TOTAL Total Achieved Review of all unfunded posts (£4.324m). Redesign of Continence Service delivery schedule and products (£0.375m). Review of all vacant posts and realignment of support costs to all funding streams to show true cost of each service. Health Care Services RAG Rating Adult Social Care Services RAG Rating North Lanarkshire IJB 2024/25 & 2025/26 - 2 Year Savings Delivery Plan Total Health Care Services Reference Reference Outstanding Target to Date Adult Social Care Services Savings Delivery Plan Review of non traditional respite, advocacy and community services. Review of whole system approach to ensure that when people contact our services the response is quick and effective, with a focus on helping people to help themselves first. Review of all vacant posts. Reducing current overspends to align with allocated budgets. (IEAS, Independent Care Homes, SDS, Private Sector Housing Grants) Review of all Registered Social Landlords services in North Lanarkshire keeping with the approach taken by other local authorities by opting to reconfigure some existing sheltered/very sheltered housing to retirement models. Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review.
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Analysis of Additional Employee Costs 2024/25 Appendix 7 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 50,169 38,615 22,052 56,191 305,642 4,702 477,371 2 41,325 32,875 23,320 46,102 264,497 7,042 415,161 3 51,328 40,468 21,249 52,407 367,143 3,350 535,945 4 58,802 28,506 17,872 45,313 315,928 4,243 470,664 5 61,261 31,359 29,225 52,339 399,493 4,356 578,033 6 49,005 24,134 22,906 47,399 332,879 3,695 480,018 7 60,542 27,518 26,314 48,610 346,546 4,197 513,726 8 81,265 47,032 47,065 94,164 482,507 5,357 757,389 9 54,221 33,349 33,189 69,882 311,645 3,864 506,150 10 61,292 37,435 26,554 66,299 309,943 2,679 504,201 11 55,522 38,627 28,189 67,943 383,477 3,695 577,453 12 71,448 54,317 24,117 87,926 446,202 3,428 687,438 TOTAL 696,180 434,234 322,052 734,575 4,265,902 50,607 6,503,550 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 6,112 -1,743 -17 - 286,364 - 290,716 2 - - 606 -80 569,840 - 570,366 3 1,526 - 1,229 - 337,115 - 339,870 4 1,280 - 51,839 - 335,537 - 388,656 5 528 - -33,399 - 351,443 2,311 320,883 6 1,352 0 606 0 290,147 0 292,105 7 0 -428 -11,959 4,286 282,409 0 274,308 8 569 0 -1,096 167,781 291,259 5,732 464,245 9 1,132 2,171 -535 14,802 446,221 2,626 466,416 10 347 0 122 43,878 391,594 20,373 456,314 11 71 0 0 21,229 529,862 22,197 573,359 12 0 0 -121 16,128 341,553 5,298 362,859 13 52,687 52,687 TOTAL 12,917 0 7,275 268,024 4,453,344 111,224 4,852,784 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 7,896 6,109 4,121 14,860 30,578 -5,031 -36,239 737 23,031 2 11,173 8,470 4,855 17,042 30,317 84,416 341,911 2,508 500,692 3 7,738 7,429 5,896 10,311 21,831 65,331 331,451 1,247 451,234 4 7,253 5,666 3,373 17,206 29,554 48,786 385,446 1,407 498,691 5 6,018 1,257 7,614 10,756 19,232 40,111 412,126 253 497,367 6 7,059 714 5,354 12,415 30,811 60,954 400,282 490 518,079 7 4,767 2,620 3,308 13,841 24,698 63,268 360,760 2,293 475,555 8 6,319 1,819 2,563 10,898 27,613 80,104 408,207 1,451 538,974 9 4,406 3,456 5,223 6,404 30,771 77,587 412,013 536 540,396 10 4,810 2,039 3,232 3,135 25,246 77,353 235,019 783 351,616 11 7,483 1,061 5,641 2,516 31,655 35,152 328,589 543 412,641 12 4,822 2,051 5,132 2,267 33,597 72,952 303,962 1,520 426,302 13 75,873 553,455 629,327 TOTAL 79,743 42,691 56,312 121,652 335,902 776,856 4,436,982 13,767 5,863,905 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 4,408 2,005 7,033 9,061 9,873 1,559 33,939 2 2,745 3,160 4,339 3,462 5,718 1,250 20,674 3 1,508 1,689 4,890 850 6,956 776 16,669 4 2,606 991 5,042 3,474 5,352 1,315 18,780 5 1,732 2,785 5,716 1,863 6,623 966 19,685 6 2,353 632 7,455 1,266 7,388 554 19,648 7 3,283 307 8,342 4,200 6,327 1,087 23,546 8 3,199 1,606 5,031 2,974 6,134 1,246 20,190 9 2,411 1,403 6,968 4,406 7,091 316 22,594 10 1,590 1,635 6,561 3,101 3,969 1,633 18,489 11 2,839 341 4,517 4,556 6,343 1,082 19,678 12 2,516 794 7,443 6,178 4,776 1,844 23,550 TOTAL 31,190 17,348 73,336 45,390 76,550 13,628 257,441 BANKAIDE COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE EXCESS PART TIME COSTS YEAR TO DATE Period Period Period Period AGENCY COSTS YEAR TO DATE
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REPORT Item No: 10 SUBJECT: IJB Reserves Strategy 2025/26 TO: Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 21 May 2025 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 IJB PFA Committee: (1) Acknowledge the contents of the report. (2) Approve the proposed realignments and new reserves detailed in Appendix 1. (3) Approve the change to the percentage of risk based and contingency reserves to be held as detailed in section 8. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 It is essential for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statute and is part of a range of measures in place to ensure that section 106 public bodies do not over- commit themselves financially. Yes No N/A
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5.2 As detailed in the Financial Monitoring report being presented to this committee, the final outturn position for the Partnership for 2024/25 is an underspend of £10.716m which is inclusive of ring-fenced funding from Scottish Government of £0.614 to progress policy commitments and national priorities. It is therefore the responsibility of the Partnership to identify how this underspend should be utilised and allocated to reserve balances. 6. CONCLUSIONS 6.1 The IJB Reserves Strategy 2025/26 provides an opportunity to strengthen long-term financial sustainability by considering all current reserves to ensure those held are still required and sufficient to meet on-going pressures. The IJB Reserves Strategy 2025/26 will enable the IJB to balance current commitments whilst planning and addressing financial risks. 7. IJB RESERVES STRATEGY 2025/26 7.1 As detailed in the Table 1, the reserve balances as at 1 April 2025 were £75.524m. 7.2 In line with previous year practice, Health Services carried out a number of in year draw downs from reserves which resulted in a closing reserve balance of £64.386m. Full details of these are provided at Appendix 5 of the Financial Monitoring report being presented to this committee. 7.3 This closing position comprised £21.575m ring-fenced monies to enable the IJB to deliver on specific Scottish Government funded programmes, £15.843m earmarked reserves to support the delivery of projects which span financial years and the remaining balance of £27,418m, are risk-based and contingency reserves which are not held to meet any specific liability and offer the IJB some flexibility to deal with unforeseen events or emergencies. Table 1 LEAD SUMMARY Opening Balance as at 1 April 2025 Net Transfer from Reserves Revised Balance as at 31 March 2025 £m £m £m NHSL Ring-Fenced Reserves 24.114 (2.539) 21.575 NLC/NHSL Earmarked Reserves 20.975 (5.131) 15.843 NLC/NHSL Risk-Based Reserves 17.045 (2.731) 14.314 NHSL Contingency Reserves 13.390 (0.286) 13.104 Total 75.524 (10.687) 64.836 7.4 As part of the financial year end process a full review of all reserves held was completed by both partners to ensure the reserves held in 2025/26 are still required and sufficient to meet on-going pressures. 7.5 The purpose of this review was to: (i) draw down approved reserves to fund in year spend within social care services as agreed as part of the 2024/25 medium term financial plan. (ii) review all 2024/25 reserves to determine if they are still required for their original purpose. (iii) allocate the 2024/25 surplus.
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7.6 Following this review, a proposed realignment of reserves has been determined and is provided at Appendix 1 and summarised in Table 2. This includes the closure of £2.208m reserves which have been moved to contingency and risk based reserves, a transfer of £0.128m from contingency to create a new reserve within social care for school summer placements, an increase to previously created reserves of £10.869m, which includes augmenting the contingency and risk reserves, and the creation of 5 new reserves totalling £2.183m. Table 2 SUMMARY Proposed transfers from reserves New reserves awaiting IJB approval Proposed closure of reserves Proposed increase to reserves Total Movements £m £m £m £m £m Movements (0.128) 2.183 (2.208) 10.869 10.716 7.7 Of the £2.183m proposed new reserves, Health Services are requesting approval for £1.5m for mental health services and Social Care are requesting approval for £0.683m as follows: MHO Capacity Funding £0.388m Statutory Appropriate Adults £0.161m Participation & Engagement £0.006m Summer Placements £0.128m (this is a transfer from demand risk) 7.8 The revised structure of the reserves will continue to enable the IJB to meet its agreed strategic objectives and Scottish Government policy requirements. 7.9 The opening reserves for 2025/26 are summarised in Table 3 and included in detail at Appendix 2. Table 3 LEAD SUMMARY Opening Balance As At 1 April 2024 £m NHSL Ring-Fenced Reserves 14.838 NLC/NHSL Earmarked Reserves 25.060 NLC/NHSL Risk-Based Reserves 21.536 NHSL Contingency Reserves 14.119 NLC/NHSL Closed Reserves 0.000 Total 75.553
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8. RISK 8.1 In 2022/23, as part of the development of the financial plan and in line with the North Lanarkshire IJB Financial Plans it was approved that the risk-based and contingency reserves be established as a percentage of the mainstream financial envelope as follows: Year 2022/2023 2023 to 2030 Contingency Reserve % 3% 5% 8.2 However, given the financial challenges faced by the Partnership it is unlikely that underspends will be achieved in the coming years which would allow these reserves to grow to 5%. The opening balance represents 3.6%. It is therefore proposed to reduce the 5% target to 4% for the current financial planning period 2025/26 to 2027/28. Members should note that total reserves, inclusive of ringfenced and earmarked are 8% of the total financial envelope. 9. IMPLICATIONS 9.1 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 ☒ 9.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 9.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB.
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Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service Very High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The finance teams of both Partners have been actively involved in the reserves review. ☐ 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. 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed:
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Yes No N/A 10. BACKGROUND PAPERS None. 11. APPENDICES HSCP Reserves Realignment Appendix 1 Opening Reserves at 1 April 2025 Appendix 2 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07581 007187.
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Appendix 1 HSCP RESERVES INCREASES AND REALIGNMENTS Net Movement Original Value Proposed Transfers from Reserves New reserves Awaiting IJB Approval Proposed Closure of Reserves Proposed Increase to Reserves Closing Value Comments £m £m £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.436 0.245 3.681 NHSL Area Wide Services - Refugees and Displaced Persons 0.077 0.046 0.123 NHSL Blood-Borne Viruses Services 0.155 0.163 0.318 NHSL Pharmacy Mental Health Recovery & NES Training 0.640 0.160 0.800 NHSL Frailty Nursing 0.001 1.714 1.715 NLC Carers Act 2018 - Support 2.426 0.178 2.604 NHSL Prescribing Fund 4.361 0.705 5.066 NHSL Contingency Balance Held By NHSL 13.104 1.012 14.116 NLC Social Care Demand 9.953 (0.128) 6.646 16.471 Move to school summer placements NHSL MH Funding 0.000 1.500 1.500 NLC MHO Capacity Funding 0.000 0.388 0.388 NLC Statutory Appropriate Adults 0.000 0.161 0.161 NLC Participation & Engagement Locality 0.000 0.006 0.006 NLC Sessional - School summer placements 0.000 0.128 0.128 Move from social care demand NHSL Children and Adolescent Mental Health Services 2.774 2.774 Move from ringfenced to earmarked NHSL Unscheduled Care Funding 2.790 2.790 Move from ringfenced to earmarked NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 Move from ringfenced to earmarked NHSL Staff Wellbeing 0.254 0.254 Move from ringfenced to earmarked NLC Digital and IT Strategy Technology Improvements - SWIS 0.655 (0.571) 0.084 Partial closure NHSL Family Nurse Practitioner Funding 0.072 (0.072) 0.000 Close & move to contingency NHSL Mental Health Covid Clinicians (Cossette) 0.052 (0.052) (0.000) Close & move to contingency NHSL Mental Health Eating Disorders 0.036 (0.036) (0.000) Close & move to contingency NHSL Mental Health Wellbeing in Primary Care Services 0.148 (0.148) 0.000 Close & move to contingency NHSL PCR Prison Care Network Transforming Nursing Rolls 0.001 (0.001) 0.000 Close & move to contingency NHSL Specialist Doctor Contracts 0.194 (0.194) 0.000 Close & move to contingency NHSL Organisational Development Fund 0.260 (0.260) 0.000 Close & move to contingency NHSL Prisioner Healthcare - Transitional Project Band 8A 0.001 (0.001) (0.000) Close & move to contingency NHSL Regrading of Posts Including Backpay 0.250 (0.250) 0.000 Close & move to contingency NLC Social Care Contracting Staff within Quality Assurance 0.087 (0.087) (0.000) Close & move to social care demand risk NLC Financial Strategy - Changes to LA Services Muirpark 0.018 (0.018) 0.000 Close & move to social care demand risk NLC Digital and IT Strategy Technology Improvements - Other 0.314 (0.314) 0.000 Close & move to social care demand risk NLC Advocacy Services 0.019 (0.019) 0.000 Close & move to social care demand risk NLC Planned Date of Discharge - Discharge To Assess 0.052 (0.052) (0.000) Close & move to social care demand risk NLC Adaptations Fund 0.123 (0.123) 0.000 Close & move to social care demand risk NLC Adult Protection (share with C&F and NHSL) 0.010 (0.010) 0.000 Close & move to social care demand risk Movements (0.128) 2.183 (2.208) 10.869 Net Transfers & Increases 10.716
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Appendix 2 North Lanarkshire IJB Movement on Reserves Audit Trail NHSL & NLC Opening Balance As At 1 April 2025 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2026 Movement in Reserves 2025/26 £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.681 3.681 0.000 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Displaced Persons 0.123 0.123 0.000 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.318 0.318 0.000 1, 2, 4, 5 NHSL Community Living Change Fund 0.055 0.055 0.000 1, 4, 5 NHSL District Nursing 0.373 0.373 0.000 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.915 0.915 0.000 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2, 3 NHSL Long Covid Pathways 0.289 0.289 0.000 2, 3, 4, 5 NHSL Mental Health Action 15 0.730 0.730 0.000 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service Dementia Post 1.057 1.057 0.000 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.221 0.221 0.000 1, 2, 3, 4, 5 NHSL Mental Health Distress Brief Intervention 2.704 2.704 0.000 1, 2, 4, 5 NHSL North Planning Band 2-4 Posts & Multi-Disciplinary Teams 2.719 2.719 0.000 1, 2, 3, 4, 5 NHSL Pharmacy Mental Health Recovery & NES Training 0.800 0.800 0.000 1, 2, 3, 4, 5 NHSL School Nursing 0.274 0.274 0.000 1, 2, 3, 4, 5 NHSL Third Sector Initiatives To Improve Health 0.075 0.075 0.000 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 4 0.014 0.014 0.000 3 14.838 0.000 0.000 14.838 0.000 Opening Balance As At 1 April 2025 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2026 Movement in Reserves 2025/26 £m £m £m £m £m NHSL MH Funding 1.500 1.500 0.000 4 NHSL Children and Adolescent Mental Health Services 2.774 2.774 0.000 1, 2, 4, 5 NHSL Frailty Nursing 1.715 1.715 0.000 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 2.790 2.790 0.000 1, 2, 3, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 0.000 1, 2, 4, 5 NHSL Adult Social Care Winter Preparedness Fund 1.000 1.000 0.000 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 0.254 0.000 3 NHSL Minor Capital Works 1.027 1.027 0.000 3 NHSL Children and Adolescent Mental Health Services - Udston 0.268 0.268 0.000 4 NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000 1, 5 NHSL Kylepark Works 0.134 0.134 0.000 4, 5 NHSL HR Employability Team (2 year funding, 50:50 split between 0.087 0.087 0.000 3 NHSL Breast Feeding Team (2 year funding) 0.345 0.345 0.000 1, 2, 5 NHSL Dietetics Services - Double Running Costs 0.055 0.055 0.000 0 NHSL Health Inequalities - Screening 0.016 0.016 0.000 2 NHSL Health Visiting Students/Trainees 0.029 0.029 0.000 3 NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000 2, 4 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.293 0.293 0.000 1, 2, 5 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.538 0.538 0.000 1, 2, 3 NHSL Podiatry Services - Foot Screening 0.342 0.342 0.000 1, 2 NHSL Scottish Clinical Leadership Fellowship 0.060 0.060 0.000 3 NHSL Sexual Health Services - Long-Acting Reversible 0.297 0.297 0.000 1, 2 NHSL Staff Training Academy 0.335 0.335 0.000 3 NHSL Vulnerable and Complex Cases - Test of Change 0.501 0.501 0.000 5 NLC Business Case - Non-Recurring NLC Costs 0.309 0.309 0.000 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.604 2.604 0.000 1, 2, 4, 5 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.230 0.230 0.000 2, 3 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.332 3.332 0.000 2, 3 NLC Digital and IT Strategy Technology Improvements - SWIS 0.084 0.084 0.000 2, 3 NLC Home Support Resilience (2 year funding) 0.577 0.577 0.000 3, 4 NLC IJB Helpline (2 years funding) 0.137 0.137 0.000 1, 4, 5 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.149 0.149 0.000 3, 4 NLC Staff Training Academy 0.704 0.704 0.000 3 NLC MHO Capacity Funding 0.388 0.388 0.000 4 NLC Statutory Appropriate Adults 0.161 0.161 0.000 1, 2, 5 NLC Participation & Engagement Locality 0.006 0.006 0.000 2 NLC Sessional - School summer placements 0.128 0.128 0.000 3 25.060 0.000 0.000 25.060 0.000 LEAD RING-FENCED RESERVES Ambition Statement & Performance TOTAL RING-FENCED RESERVES LEAD EARMARKED RESERVES Ambition Statement & Performance TOTAL EARMARKED RESERVES
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Appendix 2 Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2026 Movement in Reserves 2025/26 £m £m £m £m £m NHSL Prescribing Fund 5.066 5.066 0.000 2, 4 NLC Social Care Demand 16.470 16.470 0.000 1, 2, 3, 4, 5 21.536 0.000 0.000 21.536 0.000 Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2026 Movement in Reserves 2025/26 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 14.119 14.119 0.000 1, 2, 3, 4, 5 14.119 0.000 0.000 14.119 0.000 75.553 0.000 0.000 75.553 0.000 KEY 1 2 3 4 5 RISK-BASED RESERVES Ambition Statement & Performance TOTAL RESERVES Ambition Statement & Performance Do the right thing first time. Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. Develop and support a workforce for the future. Ambition Statement & Performance TOTAL CONTINGENCY FUND RESERVES TOTAL RISK-BASED RESERVES LEAD CONTINGENCY FUND RESERVES LEAD Improve mental health and wellbeing. Supporting people through a whole family approach.
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1 REPORT Item No: 11 SUBJECT: Q3 Performance Update – 01st October 2024 to 31st December 2024, 2024/25 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: 21 May 2025 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: ☒ Reviewed By: ☒ Endorsed By: ☐ Prepared by: Performance Manager Reviewed by: Senior Manager, Strategy & Performance
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2 3. RECOMMENDATIONS It is recommended that the IJB/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 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 ☒
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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 ☒
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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 ☒
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5 None. 9. APPENDICES Appendix One - Areas for Improvement 01st October 2024 to 31st December 2024, Quarter 3 2024/25 CHIEF ACCOUNTABLE OFFICER (or Depute) Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following; Stephen Forrest – Performance Manager Stephen.Forrest@lanarkshire.scot.nhs.uk
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6 1. Alcohol Brief Interventions Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 3047 705 583 RED Alcohol Brief Interventions (all settings) NHSL 7381 2449 1751 RED Narrative & Corrective Action Whilst Public Health Scotland’s (PHS) data collection for Alcohol Brief Interventions (ABI) across all settings has been temporarily suspended and the submission of screening and intervention data is no longer required during this period, NHS Lanarkshire and the HSCP remain committed to maintaining ABI delivery and internal performance reporting, hence the metrics continuing to feature in local reviews. Locality-level ABI targets, introduced earlier this year, remain in place and team-level targets are being developed by IM to further enhance performance management. The initial review of performance at the level of individual teams has highlighted variance amongst professional groups; efforts to harmonise this will require support from service managers. Despite efforts to address previous reporting challenges, the current reported performance is below expected levels, suggesting that there are ongoing issues with data accuracy or completeness. Investigations are continuing to resolve these discrepancies, including the planned monthly transfer of paper forms to Morse. The Health Improvement Team continue to contribute to wider work supporting the reduction of alcohol misuse in North Lanarkshire. A short life working group has been established to look at alcohol & older adults; the group will consult with older adults across Lanarkshire to understand their current awareness of local services. The team offer training in partnership with locality staff and this is available through the HI Training Calendar. Dedicated Alcohol & Employment training is also delivered, in partnership with Healthy Working Lives. 2. Cervical Screening Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 71.9% 70.0% RED Narrative & Corrective Action Whilst there has been a decrease in performance from the previous quarter (Q2 - 71.9%, Q3 - 70%), there remains a focus on communications and improvement activity in order to address inequality and other challenges to the cervical screening uptake. In Q3, none of the 6 localities achieved the 80% target and all uptake for all localities was down from the previous quarter. Only one practice, in the North locality, met the targeted level; that practice achieved 84.4%. Although North Lanarkshire has not achieved the 80% target, it is of note than no board in Scotland has met the 80% target. • Airdrie: Uptake 67.2% (range: 59.3% - 72.2%) • Bellshill: Uptake 68.9% (range: 64.0% - 71.9%) • Coatbridge: Uptake 68.0% (range: 62.8% - 73.6%)
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7 • Motherwell: Uptake 70.4% (range: 65.5% - 78.4%) • North: Uptake 73.6% (range: 68.9% - 84.4%) • Wishaw: Uptake 68.9% (range: 58.4% - 72.5%) Efforts to strengthen the communication between the Health & Social Care Partnership (HSCP) and General Practices are ongoing and include: • Regular inclusion of cervical screening data and updates as standing agenda items at relevant forums • Health Improvement teams sharing quarterly locality-level data and narratives with GP Clinical Leads and Service Managers • Co-ordinating the innovative use of waiting room digital screens to promote cervical screening • Planning work in progress to use two new resources, listed below, as part of staff training to raise awareness and promote patient-centred approach to cervical screening: - - A multilingual video focusing on the experiences of South Asian women, aimed at raising awareness and improving cultural inclusivity in cervical screening initiatives. - A training guide informed by consultations with local women, addressing barriers and promoting a patient-centred approach. • As surveys have identified appointment accessibility as a recurring issue, focussed work on improving access through telephony and digital developments is underway Feedback from these activities will inform the Inequalities in Screening Steering Group, where wider screening work is directed and monitored. The steering group are considering a number of other factors, with access to appointments a key issue identified as impacting on screening performance more generally. Training, engagement with the wider organisation and leveraging wider patient contact as a means to engage regarding screening are other key areas of interest that the steering group are developing further. 3. Childhood Immunisations Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 90.2% 89.0% RED Narrative & Corrective Action The holiday period during Q3 is an expected seasonal impact on immunisation uptake. In order to mitigate for this, additional clinics were offered and there was a continued focus on ensuring that immunisations are a point of discussion at UHVP visits and home visits were available for hard to reach children and their families. The local position remains that all holds have been removed from the system, with the exception of those families that have refused all immunisations and do not wish a recall. Staff nurses continue to offer immunisations within the clinic and home to maximise accessibility and uptake. In North East sector, a pilot initiative has commenced to streamline appointment times and improve cross-cover arrangements with a sector wide approach to managing capacity and a revised protocol for any non-attenders. To combat the declining trend, NHS Lanarkshire has undertaken the following actions:
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8 • Streamlined Process: The North East Sector pilot mentioned above to streamline appointment times and improve cross-cover arrangements. • Targeted Clinics: Additional vaccination clinics, including home visits, are being scheduled to address accessibility issues. • Enhanced Engagement: Health visitors actively discuss vaccinations during pathway visits and use targeted scripts to support consistent messaging. • Data Analysis and Oversight: The newly established Area Oversight Vaccination and Immunisation Committee (AOVIC) is conducting comprehensive data reviews and identifying systemic changes required to maintain uptake above 95%. • Support for Children with Additional Needs: Challenges in ASN schools have been noted, particularly for children with sensory difficulties or behavioural needs. A new MS Form has been developed to capture children’s voices during the flu campaign to improve approaches. Preparing for Future Risks In response to recent measles outbreaks in Europe and concerns about whooping cough, NHS Lanarkshire is strengthening its workforce readiness by: • Recording staff vaccination statuses and conducting immunity testing. • Expanding collaboration with GP, primary care, and social care partners to ensure a whole-system approach to immunisation. These efforts reflect a continued focus on improving immunisation uptake, reducing inequalities, and preventing outbreaks to safeguard the health of Lanarkshire’s population. 4. 6 – 8 Week Reviews Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Percentage of people who have completed 6-8 week review 90% 80.1% Quarterly/ 2 quarters behind ... RED... Narrative & Corrective Action Following extended discussion regarding the performance reporting of 6-8 week reviews, which continues to report performance below the targeted level, Pan- Lanarkshire work is now complete to improve the current processes for managing data and reporting. As the national reporting requirement has an extended timeframe when compared with the local process (12 weeks vs. 10 weeks), this allows for more time to collect the relevant data and a significant improvement is seen when compared with local reporting. It is believed that the extended timeframe results in a more accurate position being reported. Both South and North Lanarkshire HSCP have agreed that for performance reporting purposes that they will amend their reporting to the longer timeframe (i.e. 12 weeks) and report two quarters in arrears.
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9 The Q1 data has been refreshed and is now reported in the scorecard using the new method. North HSCP for Q1 was previously reported as 73.5% at 10 weeks and is now 80.1% at 12 weeks. Although this is still below the targeted level of 90%, allowing for the data to be extracted later allows more time for the paperwork to be collated and the increase in performance is most likely attributable to this change in practice. The data will be reviewed to ensure any change in reporting does not have an adverse consequence elsewhere in the system. Given the importance of this performance measure; assuring us that children are getting this crucial assessment we can only move to a 12-week reporting cycle if we are also assured that the wider system allows practitioners to manage cases effectively. To support the improvement, it is suggested that a mechanism for notifying teams about missing forms will be introduced, as the approach to this is not standard across teams. Work continues to prioritise the Universal Home Visiting Pathway (UHVP) as an area of need and risk for Morse implementation. This aligns with broader national engagement to support a digital recording solution. Additionally, scoping work continues around the Elsie App, which has been used in other healthcare settings to reduce Did Not Attend (DNA) rates by improving communication and reducing manual processes. Further updates will be provided as discussions progress with stakeholders on the SBAR proposal for introducing the Elsie App. Efforts are ongoing with NHS Lanarkshire-wide GP practices to support the completion and return of forms, ensuring regular engagement of GP practices on the importance of reporting non-attendance. A Lanarkshire wide SLWG with representation from operational, nursing and medical colleagues is considering improvement and change within UHVP and has designed a Standard Operating Procedure. This has previously been tested and evaluated positively in a locality in South HSCP and the process is currently being tested NHS Lanarkshire wide. Although progressing, the impact of the work from the SLWG has yet to be fully understood, however there are early indications that an improvement in recording compliance has been realised, with evidence that both GP and HV records are being completed for more reviews. 5. Reablement and Rehabilitation Target 2024/25 2024/25 Q2 2024/25 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) 987 1387 RED Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 57.1% 56.5% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 58.1% 63.6% RED IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 65.8% 60.1% RED Narrative & Corrective Action
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10 The indicators for Reablement presented in the CE Scorecard have not met the targeted levels of performance. During 2023/24, the number of people completing the Reablement process increased, however in 2024/25 there has been a reversal of this trend. The percentage of new or increased HS packages that are Reablement is relatively stable around but below the targeted level of 70%. However, the percentage of people with no, or reduced Home Support at the end of the Reablement process has failed to meet the targeted level of performance for some time. Additional data/information on Reablement is available from the HAT and IRT datasets. Home Assessment Team Since its inception, the HAT service has accepted a total of 2902 referrals. During Q3, 123 referrals were accepted in December, which was an increase from November when 110 were accepted. The highest number of referrals in Q3 was in October, when 147 were accepted. December was the eleventh consecutive month were more than 100 referrals were accepted. Referrals by Locality and Source • Wishaw: Accepted an average of 27 referrals per month in the past year, accounting for 22% of the total referrals. • Motherwell: Accepted an average of 22 referrals per month, accounting for 18% of the total referrals. • Cumbernauld: 21% of the total referrals. • Airdrie: 17% of the total referrals. • Bellshill: 9% of the total referrals and this has remained stable over time. • Coatbridge: 14% of total referrals and this has remained stable over time.
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11 Referral Sources • UH Wishaw: 1428 referrals (49%) • UH Monklands: 1379 referrals (48%) HAT Input and Output Services The average number of input services for HAT cases has increased over time. It is recorded that 14% of people completing the HAT process were re-admitted to hospital at the end of the process; this is a significant proportion of those completing HAT and further investigation is required to understand how best this cohort of people can be supported. For those people who were recorded as having completed the HAT process, 64% required no further service with 36% noted as having at least 1 service delivered.
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12 IRT Reablement Throughout 2024/25, the overall number of IRT/Reablement referrals has decreased, however it should be noted that this decrease follows a notable and significant increase in the volume of referrals at the start of the financial year. There is no target set for this metric, however it complements the Reablement information presented above and should be considered in the context of a wider system of Reablement, Rehabilitation and Home Support.
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13
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14 The overall number of waits has decreased in-line with the decrease in referrals; the number of people waiting for IRT Reablement allocation is at the lowest level experienced in financial year 2024/25. Detailed activity information is available in the IRT dataset. The contact activity for IRT Reablement in February 2025 presented below shows that the most prevalent contact type is telephone call. Home Support Redesign Several products have been produced in support of the Home Support Redesign Programme. Service Specifications and a Workforce Profile have been produced, with Demand/Capacity data modelling also provided to support decision making and service design. The redesign is focussed on Home Support that achieves individual outcomes for people using the service and their families. The redesign is based on core principles that are aligned with B2B, SDS and developments in Hospital Flow. The proposal is for a “Living Well” service that provides Home Support to achieve individual outcomes for the people using the service and a distinct “Assessment & Planning” service, to include Rehabilitation and Reablement services, ensuring that people receive a holistic assessment of their need and are provided with the most appropriate services to meet the individual outcomes.
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15 IEAS - % Deliveries Achieved Within 7 Working Days Quarterly Change and Improvement work within the Equipment & Adaptation Service is governed by the Equipment & Adaptation Service (EAS) Governance Board. This ensures coordinated planning and communication, particularly in relation to performance management. The “Lanarkshire Equipment Ordering Service” (ELMS2) is now live and has replaced the MICES system. Whilst the system is live and in active use, continuous improvements in the configuration and reporting are being made to facilitate improved management and performance information and easier integration of data with wider partnership systems. New performance indicators are in development that better reflect the four level priority system used in the service, however further work is required to facilitate reporting in this way. 6. Adult Mental Health Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 74.1% 72.3% RED Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 30.5% 23.5% RED Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 65.1% 61.9% RED Narrative & Corrective Action The RTT Performance remains below both the targeted level and the Scottish average.
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16 There is notable pressure within the Lanarkshire Weight Management Service (LWMS). A dedicated short-life working group has been commissioned to address waits for Psychological Services within the Weight Management Service. Work to target the longest waits is in progress, with additional temporary resource being provided by Psychological Services, however it should be noted that the LWMS service is not operationally managed within Psychological Services. The short-life working group ends at the end of March 2025. Adult Psychology teams are working to increase the provision of group work, which is having a positive effect on waiting lists within the service. The service continues to implement quality improvement projects focused on reducing longest waits. Recent analysis of waiting times data indicates significant progress has been made in relation to reducing the waiting list size; there has been a 18% reduction in the total numbers waiting over 18 weeks in the reporting period as compared with the previous quarter. A self-assessment of local implementation of the Scottish Government National Specification of Delivery of Psychological Therapies and Intervention has been completed and will be submitted, which crosses the delivery of Psychological Therapies across all ages. An associated improvement plan has been included, which will be completed for adult services in the first instance.
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17 The service continues to engage with the Enhanced Support provided by the Scottish Government, with detailed discussions having taken place to better understand the impact of reporting guidance in relation to the inclusion of CAMHS Psychological Therapies data. Recent discussions with SG have highlighted there are differences across Boards in relation to data included in RTT reporting. As such, comparisons against the national average should be treated with caution. The date for a second MDT Research conference in collaboration with University partners at University of Strathclyde has been set for October 3rd 2025.The conference theme is Research and Innovation, with the intention of raising the profile of such activity in NHS Lanarkshire Psychological Services and in addition, promoting employment and development opportunities within Lanarkshire. To further support recruitment and retention, the Psychological Services 3-year Training Plan 2025-2028 has been developed, with continued investment in building internal capacity for supervision and live training needs analysis. Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) The service has been dealing with limited Consultant capacity within Older Adult Psychiatry since August 2023 due to maternity leave, which is compounded by other vacancies within the service. The service faces a continued challenge in recruiting to Specialty Doctor posts. The service is still actively recruiting to posts, however the current position requires staff to provide cover for the rota sessions. A series of internal modifications to the rota to reflect the reduced capacity of Community Consultants to attend to routine outpatient work has contributed to longer waiting times for patients, as consultants reduce community clinical activity in order to participate in a rota to cover consultant vacancy; the changing demographics of communities have also increased demand on the service, affecting the ability to reach targets. As capacity increases, it is hoped that a positive impact will be seen in the waiting times. To manage increased waiting times, local teams are running ad-hoc clinics, and these are being monitored closely to ensure the best possible balance between demand and capacity. Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) Staff recruitment, retention, and development continue to present the most significant challenges for the Adult Mental Health service, particularly within General Adult Psychiatry (GAP). The ongoing imbalance between demand and capacity, alongside staffing instability, severely impacts the service’s ability to meet waiting time targets. The Programme Board for Mental Health, Learning Disabilities & Addictions (MHLD&A) services is actively working on addressing medical staffing shortages while simultaneously considering changes to traditional psychiatry working practices. This includes exploring new models of practice such as the introduction of Advanced Nurse Practitioner (ANP) roles within the community to support Community Mental Health Teams (CMHTs) and reduce reliance on medical staff. While the primary focus remains on tackling staffing gaps, these innovative approaches could also help attract new talent to the service. Several initiatives are underway to address these staffing challenges, including: • Ongoing recruitment efforts in partnership with HR and wider advertising for vacant posts. • Collaborations with the Centre for Workforce Supply in Scotland, recruitment agencies, and exploration of pathways for International Medical Graduates (IMGs), alongside novel marketing strategies. • Discussions with Medical Education regarding additional higher trainee placements.
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18 • Increased use of Extra Planned Activities to enable current staff to cover service gaps. However, given the current workforce situation, most of these initiatives are expected to produce medium to long-term improvements rather than immediate results. These actions are crucial for ensuring the future stability of the service. Additionally, an Options Appraisal (OA) has been developed to guide the future direction of General Adult Psychiatry Services. The OA, which is yet to be finalised, offers various solutions that can be adapted based on integrated, cross-disciplinary tests of change. The paper outlines six key recommendations to drive service transformation: • Formation of a Programme Board to review the GAP service model and develop a sustainable, cross-discipline workforce aligned with the Scottish Government’s Adult Secondary Mental Health Services Quality Standards. • Maximisation of recruitment and retention efforts by supporting the current workforce and absorbing high-cost locums into permanent NHS roles. • A comprehensive workforce review across all disciplines within GAP services, including expansion of the ANP pilot into CMHTs and a review of Psychological Therapy Teams. • Engaging with referrers, patients, and carers to ensure appropriate access to services. • Creation of clear guidance for transitions between primary and secondary care GAP services, and between different sub-specialities within Mental Health & Learning Disability Services. • Reliable statistical modelling to support longer-term workforce planning to ensure services meet population demand. The preferred model for GAP services in North Lanarkshire involves a functional split between inpatient and outpatient care, with dedicated consultants for each ward. This model, which is favoured by stakeholders and aligns with broader trends in Scotland, aims to provide psychiatrists with protected time to focus on either inpatient or CMHT responsibilities, improving consistency, responsiveness, and stability within these services. It also simplifies job planning and reduces the need for the Duty AMP role, improving service efficiency. As the OA is still under review, these recommendations may evolve, and any developments will be communicated widely with stakeholders. 7. SLT Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 15.3% 16.0% RED SLT - Adult - 12wks (NORTH HOSTED) 90%* 74.3% 74.4% RED Narrative & Corrective Action
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19 SLT - Adult - 12wks (NORTH HOSTED) For Q3, Adult SLT services have reported performance below the targeted level. This is due, in part, to the end of funding that the service was in receipt of for post-COVID recovery. No posts have been lost, as the service was unable to recruit to the number of posts matched to the additional funding that was provided. However, staffing for the Adult Acquired service has reduced by 7.4% between September 2023 and September 2024. The impact of the loss of posts has been compounded by an increase in the average number of referrals received per month, which have increased by 4%. The team has also experienced significant long-term sickness absence; the long-term absences are being managed and monitored appropriately, with additional assurance provided by monthly sickness absence meetings that are supported by colleagues from HR. All vacancies in the service are being progressed through the HSCP vacancy panel process. SLT - Paediatrics - 12wks (NORTH HOSTED) Despite a slight improvement in the performance for Q3, the long-term trend is for a decline in the level of performance, which remains significantly apart from the targeted level. The service continues with its modernisation programme; unfortunately, progress in recent months has been challenging due to the long-term absence of colleagues who had been progressing the work, which was in addition to their substantive role when the centrally provided Project Team support was removed. Capacity to progress this work is further challenged as the hours provided to support service improvement within SLT via the service improvement board are no longer available, as the colleague in question has moved on from that post. The General Manager and Professional Lead are actively working to release capacity within the budgetary envelope to provide support for the modernisation programme. The data generated by Trakcare reporting and analysis of that data will allow performance to be measured and reported in line with the national service model. The previous waiting times measure only reported waits for specialist assessments, however Trakcare will now allow a measure linked to Targeted Support (OPWL) and Specialist Assessment (PRL). This will mean that the service can evidence improvements in waiting times linked to targeted support (OPWL); the data collected manually in the service can now be validated by the reporting generated by Trakcare to ensure that the outcomes on the system reflect the clinical activity. There is also evidence to show the numbers of children and young people waiting for Specialist Assessment (PRL) is reducing and it is anticipated that in the next six months this will be reflected in a reduction in the longest waits for a specialist assessment, although this is dependent on maintaining the staffing position within the service. To deliver this, our Waiting List Team Coordinators are undertaking a cleanse of the Targeted and Specialist PRL; this will ensure that we recognise and better manage cases where universal work has been carried out with children and young people who are waiting for targeted and specialist input. The local data that is available suggests that the service is in contact with all universal referrals within 2 weeks, however at this time, this is not reflected on Trakcare and dependent on a manual count. The current planned actions are: - • Amalgamation of waiting lists – In progress • Work on the targeted and specialist lists in order that the service can be assured that all CYP waiting on have been provided with a universal contact appointment and that this is reflected in Trakcare to facilitate better reporting against the target for 90% of patients to be seen within 2 weeks of referral – In progress, however further improvement activity will follow, informed by the findings of the initial work • Work involving the North and South senior leads with locality colleagues in order to be assured that robust job plans are in place for all practitioners – This work is planned and currently being developed
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20 • Additional Hours offered to all staff for the specific purpose of addressing and appropriately recording universal waits, to assist in better management of the longest waits for CYP whilst they await specialist support; this will create additional capacity to release flow of patients through the service – In progress • Development of three trajectories for each of the waiting lists, showing them individually and providing better management information (the focus of 12 week RTT is the universal appointment pathway). This will provide additional clarity for the senior leadership team and better demonstrate how the service will achieve the targeted level of performance and how this is reflected in Job Plans and the overall capacity model for the service – In Progress. • SLT included in the monthly performance meeting within Childrens Services unit – Ongoing • Focussed work by the General Manager and Professional Lead with colleagues on delivery of the RTT, including weekly management of the longest waits on PRL that negatively impact RTT – Ongoing All SLT funding attributed to support for children and young people is not provided by NHSL. A significant contribution is made by both local authorities and each have an aligned historical SLA. This reduces the flexibility and agility of the team response as, for example, the SLA’s do not reflect the current Terms and Conditions of staff who are aligned to these posts. In effect this means that NHSL are providing the same number of sessions to schools originally agreed many years ago, however the cost to the service is greatly increased due to: - • The reduced working week • Nationally agreed pay rises • The protected learning time required for the staff in question • Carers/Special leave arrangements that were not considered at the time the SLA was agreed • NHS staff are not employed on a term time basis and there is an associated inefficiency Schools only recognise targeted and specialist work, therefore no time is formally allocated from these contracts to the universal pathway, which affects the RTT. The SLA have been reviewed by NHSL and plans are in place to meet with both educational partners to see if some other arrangements can be made. Recruitment and retention of staff remains a challenge for the service; the vacancy rate in December 2024 was 13%/16.87 WTE. At the time of writing, there are establishment vacancies currently advertised and it is hoped that a positive response will be received. Recruitment and retention will continue to be a focus of service improvement work and will include engagement with our network of higher education and academic partners. 8. Dietetics Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 62.3% 65.5% RED Narrative & Corrective Action An initial analysis of data held by the service has highlighted a significant volume of cases that have not been closed correctly. As a result, there is likely to be some level of error in the metric as reported. The management team are looking at how admin staff are deployed and whether a more efficient use of this resource could facilitate a
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21 data cleansing exercise and improve process to prevent a recurrence. Additional hours have been authorised in short-term to cleanse the data, however in the longer term, it is acknowledged that additional work is required to improve the process. A number of areas are planned for improvement activity, including a focussed project with Domiciliary teams to ensure that appropriate levels and durations of support are being provided for patients and regularly reviewed as to the level of support provided. In addition, work to understand how digital solutions, particularly the use of Near Me, might be leveraged for improvement. As with many services, recruitment and retention is challenging. As it is a small service, configured in multiple specialisms, the loss of one member of staff results in a loss of a specialism entirely. The national position is similarly challenging; some Dietetics undergraduate programmes are at risk of deletion. Initial discussions with our academic partners are planned to fully understand the wider context for Dietetics, however in the short-term, the role and concept of a generic dietician and how the service model might accommodate a more generalised approach is a focus of the improvement work. 9. Complaints Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days(NHSL) 100% 21% 15% RED Narrative & Corrective Action It is likely that current clinical pressures and the reduced availability of clinical staff to address complaints has impacted on the ability to resolve them within the targeted timescales. The transition to the InPhase system has continued to present challenges, particularly in the development and validation of its reporting function. There is ongoing work to develop the internal reporting for complaints to identify where process improvements might be found. The direction from NHS Lanarkshire is for a focus on learning, improvement and a person-centred approach to complaint handling. This supports a listening and learning culture for both complainants and staff, in order to achieve a high quality response to complaints, whilst also maximising delivery of the time-based performance indicators. NHSL continue to encourage resolution of complaints at Stage 1, promoting a resolution-based approach for the benefit of complainant, organisation and staff involved, thus avoiding a lengthy and potentially protracted Stage 2 investigation wherever possible. A specific approach to identifying whether Stage 2 delays are justified/legitimate, or system related has been developed to provide additional context for the level of performance. This aligns with the recent Scottish Public Services Ombudsman (SPSO) consultation on complaint handling principles that states the “quality and thoroughness of investigation should not be compromised by attempts to meet timescales”. To support the learning from complaints, the partnership monitors the output from Care Opinion; in December 2024, 69% of stories recorded were positive. 62% of all stories received a response.
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22 10. Care Homes Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Care Home - Average Length of Stay 865 789 966 RED Narrative & Corrective Action North Lanarkshire HSCP is committed to ensuring that people receive timely and effective care that enables them to live in a home, or homely setting. Associated with this commitment, is a clear target for the length of stay that people have in Care Homes, with the aim to keep the length of stay in such settings as short as possible and for only those people for whom other options are not appropriate. Significant work has taken place as part of the Back 2 Basics and TOM to ensure appropriate assessment for people; this has involved significant levels of engagement with both Acute and Locality colleagues to improve the quality and timeliness of information gathered and recorded to facilitate an assessment of need and make informed decisions for people who may require more intensive support. The North Lanarkshire Strategy for Preventing and Managing Frailty (2024 – 2029) outlines several initiatives aimed at addressing the wider challenge in North Lanarkshire. Frailty affects a significant portion of our elderly population, particularly those in care homes. Our vision is to support every older person in Lanarkshire with, or at risk of, frailty to be healthier, remain independent for longer, and live their best lives. We have implemented a range of measures to enhance support in care homes, including the establishment of a Care Home Assurance Team and expanding the number of Care Home Liaison nurses. The Care Home Assurance Team is intended to evolve to a wider supporting team, reflecting a shift from inspection to a model of assurance based on appreciative inquiry and clinical support. The appointment of a Practice Development Educator for care homes to deliver an initial six-month education programme for care home staff will further enhance the quality of care provided. A multi-disciplinary approach is being encouraged, with a model for Frailty MDT meetings in care homes piloted and further developed. This pilot project will inform the expansion of the Care Home MDT model, with the aim to expand to 24 care homes across North Lanarkshire. Additional AHP support, including care home pharmacist sessions to review and optimise polypharmacy, reducing the use of medicines associated with falls and harm, are being introduced with the aim of moving toward the recruitment of dedicated care home pharmacists providing a realistic medicine approach for all new residents While we have made significant strides in enhancing care home support, we acknowledge that more work is needed to meet our target for reducing the length of stay. Our ongoing and future initiatives are designed to address this challenge, ensuring that residents receive the highest quality of care and support to return to their homes or community settings as swiftly as possible. 11. Smoking Cessation Target 2024/25 2024/25 Q1 2024/25 Q2 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status
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23 Sustain and embed successful smoking quits, at 12 weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 55 Quarterly/ 2 quarters behind ... ... RED Narrative & Corrective Action Whilst the wider Health Improvement team widely promote the Quit Your Way (QYW) services, dedicated work is planned for Smoking Cessation workers to link directly with Locality Health Improvement Team Leads to understand if better engagement and communication can be facilitated through Community Boards and alignment with existing LOIP. A number of priority groups exist and SIMD is a proxy for these in the context of this indicator, which is for all quits. The performance for the metric is below target and the current trajectory suggests that long-term targets, including the 2034 target, will not be met. Service redesign has been planned and delivered within the service, including the development of pathways; it is intended that improvements can be realised in the next financial year. However, it should be noted that the level of referrals to the service from localities is particularly low. Additional research and engagement is requirement with locality colleagues to understand historic and current referral patterns and how improvements can be made. It is acknowledged that the impact and legacy of C19, combined with system pressures has reduced the volume of referrals from GP and District Nurses, and it is likely that this is more widespread. However, information and access for the public has improved greatly, particularly digital solutions and use of social media as a communication method. A development session is planned in the North East Sector, facilitated by QYW services alongside colleagues promoting wider screening initiatives. Both this particular performance indicator and smoking cessation more generally will be an area of focus for locality/sector performance reviews following Q4. 12. Sickness Absence Target 2024/25 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 4% 6.63% 8.10% RED Sickness Absence (NLC) - days lost per person 9.22 6.34 9.52 RED Narrative & Corrective Action The Partnership continues to work towards reducing sickness absence rates as part of the Adult Social Care Services Savings Delivery Plan and the Health Care Services Savings Delivery Plan. These reviews, which began in April 2024, will run through the 2024/25 and 2025/26 financial years. Despite ongoing efforts, sickness absence remains an issue, and actions are being taken to reduce the rate. The wider NHSL Board remains above the national average for this metric. A dedicated work stream within the Sustainability and Value Workforce Optimisation Group is focusing on reducing sickness absence. Within the partnership, long and short-term sickness absence continues to be managed in accordance with the relevant organisational policies and monitored at service level. Attendance Management Reviews are taking place as required and local General Managers are complying with the requirements of the policy. Managers are focussing on cases that have breached sickness absence triggers and other long-term absences, whilst there remains a wider focus on the Health and Wellbeing of staff as a key contributing factor to levels of sickness absence.
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24 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 IJB Reporting Template REPORT Item No:12 SUBJECT: Category 1 Responder update TO: IJB Performance, Finance & Audit Committee Lead Officer for Report: Diane Fraser Chief Officer Adult Social Work Author(s) of Report Margaret Flavell Senior Manager Adult Social Work Contact details for Author(s) of Report Flavellm@northlan.gov.uk Mobile:07939284700 DATE: 21 May 2025 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:
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2 Prepared By: Margaret Flavell Senior Manager Adult Social Work ☒ Reviewed By: Diane Fraser Chief Officer Adult Social Work ☒ Endorsed By: Claire Rae Chief Officer HSCP ☒ 3. EXECUTIVE SUMMARY This report provides a summary of North Lanarkshire Integration Joint Board as a Category 1 responder as required by the Civil Contingencies Act 2004. It highlights the duties, responsibilities, explains our preparedness to fulfil the role and notes activities undertaken to date. 4. RECOMMENDATIONS 4.1 The IJB PFA note the contents of the report. 4.2 The IJB PFA understand the duties of a Category 1 responder. 4.3 The IJB PFA is aware of the role and responsibilities of a Category 1 responder. 4.4 The IJB PFA has a knowledge of activities undertaken. 4.5 The IJB PFA acknowledges the challenges and supports actions to address. 5. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 6. BACKGROUND 6.1 The Civil Contingencies Act 2004 (CCA) has legislated that organisations in the UK are categorised as responders outlined in their role and responsibilities in Civil Protection and Emergency Management. 6.2 The Act puts in place a framework for ensuring public bodies and key utility providers work together in emergency situations. The Act’s concern is how to Yes ☐ No ☐ N/A ☒
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3 deal with the consequences of emergencies, which it defines as events or situations that threaten serious damage to human welfare, the environment or the security of the UK. 6.3 The Act defines two categories of responders and outlines roles and responsibilities in maintaining public safety and resilience in emergency situations 6.3.1 Category 1 responders are public bodies and include Local Authorities, Health Boards, Emergency Services, Scottish Environment Protection Agency (SEPA), and now IJBs. 6.3.2 Category 2 responders include strategic health agencies, transport bodies, utility providers, the Health and Safety Executive and port authorities. 6.4 The Civil Contingencies Act 2004 sets out the responsibilities of each category in an emergency. In March 2021 the Act was amended to include Integrated Joint Boards as a Category 1 responder therefore North Lanarkshire IJB has been designated as a Category 1 Responder due to its priority role in the provision of health and social care services. This includes key duties working alongside the North Lanarkshire local authority, Lanarkshire Health Board and the emergency services. 6.5 The Health and Social Care Partnership (HSCP) is part of the Lanarkshire Local Resilience Partnership (LLRP). The LLRP have a workplan based on risks identified in the Scottish risk assessment and risk preparedness assessment. HSCP is referenced in the NL Council Corporate Resilience Plan and has representation on the Corporate Resilience Management Team (CRMT). 6.6 The response to an emergency is that we focus on the consequence and not the cause. Our main role in an incident is to Care for People. We lead on recovery. 7. SUMMARY OF KEY ISSUES Duties 7.1 The Civil Contingencies Act places legal duties upon a Category 1 responder. These legal duties are: • Duty to assess risk • Duty to maintain emergency plans • Duty to maintain Business Continuity Plans • Duty to promote business continuity • Duty to communicate with the public • Duty to share information • Duty to cooperate • The core duties are set out in Section 2 of the Act and highlight four main areas of responsibility:
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4 • The responsibility for Business Continuity Planning • The responsibility for Emergency Planning • The responsibility to engage with the public responders either locally, regionally or nationally. • The duties are coordinated through a resilience planning group and ensure it monitors the HSCP IJB Category 1 function as required under the Act. Role of Category 1 responder 7.2 The designation is a major responsibility that highlights the role in ensuring that during emergency North Lanarkshire citizens are safe. 7.3 To maintain a comprehensive Business Continuity Plan. 7.4 To uphold a variety of plans to ensure that they can continue to undertake their functions in the event of an emergency. 7.3 To keep crisis response capabilities going. 7.4 To be able to continue to deliver essential aspects of day-to-day service delivery in an emergency. 7.5 To consider resilience of internal services, supports and processes. 7.6 To consider external resilience of partners and organisations that are relied upon through delivering service for us. 7.7 To assist and help others in the event of an emergency. Duties, Risk Assessment and preparedness 7.8 Social Work and HSCP retains responsibility for preparing, reviewing, testing and documenting their resilience risk assessment and Business Continuity arrangements. Staff should be familiar with Business Continuity arrangements and plan which highlights priority activities, systems/processes, key people and dependencies. There requires some work to ensure that arrangements are understood across the workforce and information of priority people/patients is accessible and easily shared during an emergency. 7.9 At the beginning of an incident an assessment is undertaken to determine if service disruption can be managed internally (through social work and the HSCP) or requires escalation for a further corporate response. 7.10 During the incident there are clear expectations of communication with service updates, maintaining service delivery in priority critical areas, ongoing assessment of operational activity, staffing impact, and relocation consideration if required. 7.11 Finally, there is the stand down period of the Business Continuity arrangements whereby there is communication to all staff and normal service resumes. Also,
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5 at this point consideration is given to recovery and any lessons identified and then the Business Continuity Plan is updated as required including any lessons learned. Activities to date 7.12 Plan maintenance: Emergency and Business Continuity Plans 7.13 Communication with staff, partners and the public as required 7.14 Share information with other responders 7.15 Cooperate with other responders 7.16 HSCP role: attend CRMT meetings, aware of current issues, planning, exercises undertaken, current resilient issues, discussion, info sharing and learning 7.17 2024/2025 diary: Business Continuity Plan April 2024, HSCP Desk top scenario September 2024, Airport familiarisation exercise 24/9/24, Winter breach exercise14/11/24, Storm Eowyn 24/1/25, Allershaw Towers exercise February 2025, SLT Category 1Responder presentation 25/2/25, Cyber incident attack exercise 26/2/25, Winter planning meetings and debrief 6/3/25, Grenfell Towers learning recommendations March 2025, Risk Assessment update 3/25, Business Continuity Plan Review March – June 2025, plan to increase Business Continuity Plan Champions to represent localities ( 1 per sector), Challenges 7.18 As outlined in this report arrangements to support the IJB as a Category 1 responder is developing. Whilst progress has been achieved to ensure ongoing development some challenges require to be considered: sufficient resources to maintain response capabilities (refresh Major Incident Support Team), regular training for staff skill development to support preparedness and response capabilities in an emergency and update workforce knowledge and information regarding people/patients’ information being accessible during an emergency. 8. CONCLUSIONS 8.1 Throughout resilience planning as outlined above it is essential for designated representatives to attend resilience meetings, to ensure a risk assessment process is in place and to develop, implement, test and review the Business Continuity Plan and to share as required for a fuller understanding. 8.2 It is essential that communication and collaboration as a Category 1 responder is effective and offers reassurance to the IJB. 8.3 It is important the Category 1 responder duties are explained and understood.
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6 8.4 It is important the Category 1 responder role and responsibilities are known 8.5 The 2024/2025 diary of recent activities demonstrate practice in this area to support the IJB as a Category 1 responder. 8.6 By addressing the challenges outlined in the report we will meet the expectations and increase operational capacity. This will ensure that the IJB continues to meet the legal obligations of a Category 1 responder to support and strengthen resilience in North Lanarkshire. 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 No N/A There are no financial implications arising directly from this report. 9.4 RISK ASSESSMENT/RISK MANAGEMENT
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7 Relevant Risk Register Details Current Risk Level Risk Owner HSCP Service risk Low Claire Rae 9.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report:
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8 Yes No N/A EQIA added to website: Yes No N/A 10. BACKGROUND PAPERS Business Continuity Plan 11. APPENDICES Please include a glossary of terms if not already included. . CHIEF ACCOUNTABLE OFFICER (or Depute) Diane Fraser, Chief Officer Adult Social Work Members seeking further information about any aspect of this report, please contact the following: Margaret Flavell, Senior Manager Adult Social Work Flavellm@northlan.gov.uk
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9 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction
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10 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 IJB Reporting Template REPORT Item No: 13 SUBJECT: Draft Internal Audit Plan 2025/26 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 Contact details for Author(s) of Report Scott Fr@northlan.gov.uk Jocelyn.lyall2@nhs.scot DATE: 21 May 2025 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: ☒ Reviewed By: ☒ Endorsed By: ☒
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2 Chief Officer (Audit and Risk), North Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire) Chief Finance Officer Chief Officer 3. EXECUTIVE SUMMARY The Internal Audit Plan 2025/26 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 2025/2026 has taken cognisance of the Global Internal Audit Standards applicable from 1 April 2025, which require an internal audit plan that supports achievement of the organisation’s objectives. The proposed Internal Audit Plan for 2025/2026, has been designed to target the priority issues. It seeks to align to strategic risks and to reflect the evolving and complex challenges to service delivery. The Internal Audit Plan 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 for 2025/2026. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB PFA Committee: (1) Approve the proposed Internal Audit Plan for 2025/2026 (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 2025/2026 including the allocation of responsibilities for completion of assignments. 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
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3 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. 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. Yes ☐ No ☒ N/A ☐
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4 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 2025/2026 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 2024/2025 including the allocation of responsibilities for the completion of assignments. Internal Audit Plan 2025/2026 The Internal Audit Plan aims to reflect the key objective of the Internal Audit service to deliver a programme of work that informs the annual Internal Audit opinion on the overall adequacy and effectiveness of an organisation’s framework of governance, risk management and control arrangements. The Internal Audit Plan also takes account of assurances which will be provided to the IJB based on work performed under the Internal Audit Plans of both NLC and NHSL for 2024/2025. The proposed Internal Audit Plan for 2025/2026, which totals 60 days, is attached as an appendix for approval. We have reviewed the extant strategic risks of the organisation and we have consulted the Chief Officer and Chief Finance Officer to ensure the substantive audit assignments in 2025/26 add 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 namely 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 PFA Committee during the year. The Committee is asked to delegate authority to the Chief Financial Officer to finalise the Internal Audit Plan for 2025/2026, including the scope of the proposed internal audit reviews and the allocation of responsibilities for completion of assignments. The Chief Officer and the Chief Financial Officer will consult with both partners.
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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 IJB 19/23 – Service Sustainability High Chief Officer IJB01/21 – Financial Challenges Very High Chief Finance Officer IJB04/21 – National set aside budget High Chief Finance Officer
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6 IJB10/21 – Ineffective Governance Arrangements Low Chief Officer Risk IJB 11/21 – Oversight of performance activity Low Chief Officer The management of risk is an integral part of the development of the Internal Audit Plan. The Internal Audit Plan 2025/2026 has also been informed by the draft Internal Audit Opinion 2024/2025 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 2025/2026. 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
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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 2025/26 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
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Appendix 1 Internal Audit Plan 2025/26 8 Ref Audit Indicative Scope Strategic risk Days NL01-26 Audit Planning Preparation of internal audit annual plan 2025/26. Full IJB risk register considered 1 NL02-26 Audit Management Liaison with management and external audit, liaison with Chief Finance Officer and attendance at Audit Committee. N/A 7 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. N/A 5 NL04-26 Annual Report Prepare and present an annual report containing the Annual Internal Audit Opinion for 2025/2026. Full IJB risk register considered 7 NL05-26 Financial Sustainability Effective, efficient and economic use of resources to ensure financial sustainability, with a focus on transformation. Risk IJB01/21 – Financial Challenges Risk IJB04/21 – National set aside budget 20 NL06-26 Performance / Committee Effectiveness Accurate, relevant and reliable reporting to the Board, staff, the SGHSCD and the public. Risk IJB 11/21 – Oversight of performance activity Risk IJB10/21 – Ineffective Governance Arrangements 20
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Appendix 1 1 IJB Reporting Template REPORT Item No: 13.1 SUBJECT: Internal Audit Progress Report 2024/25 TO: Integration Joint Board Performance, Finance & Audit Committee. Lead Officer for Report: Nicola Scott, Chief Finance Officer Author(s) of Report Francis Scott, Chief Officer (Audit and Risk), North Lanarkshire Council Jocelyn Lyall, Chief Internal Auditor, NHS Lanarkshire Contact details for Author(s) of Report Francis Scott – ScottFr@northlan.gov.uk Jocelyn Lyall – Jocelyn.lyall2@nhs.scot DATE: 21 May 2025 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE PFA This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☒
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Appendix 1 2 Chief Officer (Audit and Risk), North Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire) Chief Finance Officer Chief Officer 3. EXECUTIVE SUMMARY The progress in respect of the Internal Audit Plan 2024/2025 is summarised in Appendix 1. A workplan has been agreed to ensure the Internal Audit Plan 2024/2025 is delivered to inform the internal audit opinion for 2024/25. 4. RECOMMENDATIONS 4.1 It is recommended that the IJB Performance, Finance & Audit Committee: 1) Consider the attached Progress Report at Appendix 1 and the summary of relevant partner reports at Appendix 2. 2) Consider the changes arising from the new Global Internal Audit Standards (GIAS) and the implications for the Internal Audit Service and the Performance, Finance and Audit Committee. 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 2024/2025 on 22 May 2024. A total of 60 days has been committed to undertake the IJB Internal Audit Plan, which Yes ☐ No ☒ N/A ☐
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Appendix 1 3 has been designed to target the priority issues which have been aligned to strategic risks and reflect the evolving and complex challenges to service delivery. The Internal Audit Plan 2024/2025 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 2024/2025 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 for 2024/2025. The audit of operational activities is being undertaken under the auspices of the partner bodies. The IJB is asked to note that the outcomes of these operational audits are reported to the partner body Audit Committees and discussed with the IJB Chief Officer and IJB Chief Financial Officer. The assurances gained will be provided to the IJB as part of the overall assurances received from the partner body Audit Committees. We include a summary of relevant completed NHS Lanarkshire and North Lanarkshire Council reports at Appendix 2. 7. SUMMARY OF KEY ISSUES Progress on the Internal Audit Plan i2024/25 is at Appendix 1. The Summary of relevant partner body reports is at Appendix 2. From 1 April 2025, Public Sector Internal Audit Standards were replaced by the GIAS supported by an ‘Application Note - Global Internal Audit Standards in the UK Public Sector’. The Application Note “provides a framework for the practice of internal audit in the UK public sector when taken together with the Global Internal Audit Standards (GIAS) issued by the Institute of Internal Auditors (IIA). It sets out interpretations and requirements which need to be applied to the GIAS requirements, in order that these form a suitable basis for internal audit practice 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). The Code addresses the responsibilities of senior management and the Audit Committee towards Internal Audit to ensure that Internal Audit services delivered have the necessary authority, support and oversight of the organisation. The Code provides a link between the recommended practices in GIAS and established governance arrangements of local government bodies and reflects the legislation and practices of local government bodies. GIAS consists of 5 domains which are supported by 15 principles: • Purpose of Internal Auditing • Ethics and Professionalism (principles 1-5)
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Appendix 1 4 • Governing the Internal Audit Function (principles 6-8) • Managing the Internal Audit Function (principles 9-12) • Performing Internal Audit Services (principles 13-15) The main changes under GIAS include: • a new Purpose Statement • a requirement for internal auditors to demonstrate ‘professional scepticism’ • clearer roles and responsibilities for senior management and the Audit Committee • development and approval of an Internal Audit Mandate and Charter • development and implementation of an Audit Strategy • oversight of wider assurance sources • development of skills and technology within the function to ensure delivery of an effective internal audit service • a requirement to report where recommendations are not agreed • a requirement for formal review processes Internal audit teams are not expected to demonstrate full conformance with GIAS on 1 April 2025 but must work in accordance with the new standards from this date, and by doing so will build up conformance to GIAS during 2025/26. While much of the day-to-day internal audit practice of undertaking audit engagements will not change, it is recognised that time will be needed to make the transition to GIAS. Nationally, internal audit functions are reviewing current audit processes and an improvement plan to ensure GIAS compliance is being developed. The role of the Audit Committee is set out in some detail in GIAS Domain III “Governing the Internal Audit Function”. Whilst many of these are already in place, the main elements emphasised in GIAS are to: • Provide the mandate setting out the authority, role and responsibilities under which the Internal Audit service operates. • Review and approve the Internal Audit Charter as reflecting the Audit Committee’s expectations of the Internal Audit service that will be delivered to the IJB. • Meet with the Chief Internal Auditor on a periodic basis. • ‘Champion’ and demonstrate support for Internal Audit • Review the governance, management and reporting arrangements of the Internal Audit service. • Assist with setting audit priorities. • Review and approve arrangements for the external assessment of Internal Audit. The Chief Internal Auditors are progressing GIAS development work and the intention is to present a revised Internal Audit Charter, including the Mandate, and the Internal Audit Strategy to the next meeting of this Committee.
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Appendix 1 5 8. CONCLUSIONS The Internal Audit Plan 2024/2025 is designed to target the priority issues and to provide sufficient evidence to form an Internal Audit Opinion on the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control arrangements. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer. ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected. ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services. ☐ Health and Social Care Services contribute to reducing health inequalities. ☐ People who use Health and Social Care Services are safe from harm. ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services. ☒ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL There are no financial impacts arising directly from this report. This paper has been reviewed by Finance: Yes X No N/A
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Appendix 1 6 9.4 RISK ASSESSMENT/RISK MANAGEMENT The internal audit planning process which produced the Annual Internal Audit Plan considers the strategic risk profile of the organisation. Individual internal audit assignments identify the key risks at the planning stage and our work is designed to evaluate whether appropriate systems are in place and operating effectively to mitigate the risks identified. Legislative requirements are a core consideration in planning all internal audit reviews. Relevant Risk Register Details Current Risk Level Risk Owner Ineffective Governance Arrangements Low Chief Officer
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Appendix 1 7 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. EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No X N/A EQIA added to website: Yes No X N/A 10. BACKGROUND PAPERS N/A 11. APPENDICES Appendix 1 2024/25 Internal Audit Progress Report Appendix 2 Summary of Relevant NHS Lanarkshire and North Lanarkshire Council Reports issued.
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Appendix 1 8 CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Chief Finance Officer Nicola Scott ScottN@northlan.gov.uk
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Appendix 1 9 Ref Audit Indicative Scope Target Audit Committee Planning Stage Work in Progress Draft Issued Completed Grade Internal Audit Plan 2024/25 NL01-25 Audit Planning Agreeing audit universe and preparation of internal audit annual plan. May 2024 N/A NL02-25 Audit Management Liaison with management, liaison with Chief Finance Officer and attendance at Audit Committee. Ongoing N/A N/A N/A N/A N/A NL03-25 Audit Follow Up Review of progress made by management in implementing those actions committed to in response to previously agreed Internal Audit recommendations. August 2025 N/A NL04-25 Annual Report Preparation for Annual Report including assistance with completion of IJB governance self-assessment checklist. August 2024 Reasonable
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Appendix 1 10 NL05-25 Governance arrangements Review of governance arrangements with reference to the Blueprint for Good Governance in NHS Scotland. August 2025 NL06-25 Strategy Review of the content and implementation of the Strategic Commissioning Plan, including assessing the adequacy and effectiveness of arrangements for monitoring of delivery and performance reporting. August 2025
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Appendix 2 11 The following relevant reports have been issued by NHS Lanarkshire: Report Audit Opinion Key findings L02/25 Internal Control Evaluation Reasonable Assurance This audit covered the totality of the internal control environment which impacts on all of NHS Lanarkshire’s s corporate risks and aimed to provide early warning of any significant issues that may affect the Governance Statement. Key Themes: • As previously reported by internal audit, financial sustainability must underpin all decision making and service transformation must be realistic, effective, and make the best use of resources. The challenge is in identifying achievable recurring savings targets and reducing reliance on non-recurring savings. • There must be an impetus to ‘do things differently’ and to prioritise in line with a clearly communicated, realistic and coherent, integrated Lanarkshire wide strategic direction for transformation, within the available financial and staffing envelope. • The NHS in Scotland 2024 report also highlighted that effective leadership and collaboration are essential, and that senior leaders must have a clear vision and strategic direction for reform. This will of course include working collaboratively with partners. • The Workforce Plan is key in identifying the future availability of staff and where those staff are needed. The report reflected numerous key developments, evidencing continuous improvement and ongoing development of governance and assurance structures. Internal Audit confirmed that Management continued to respond positively to internal audit findings and there was a clear focus on achieving actions in response to our ICE and other reports, as it evidenced though regular Audit Follow up reporting. Internal Audit made seven recommendations (one ‘significant’, and six ‘moderate’) are aimed at ensuring coherence between Governance Structures, Performance Management, Risk Management and Assurance.
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Appendix 2 12 Report Audit Opinion Key findings L11/25 Review of Clinical Governance Reasonable Internal Audit concluded that while there were regular updates on the Quality Strategy 2023-2029 reported through governance structures and that the 2024/2025 True North Action Plans have been formally approved, reporting on implementation of True North Action Statements could be improved through standardisation of reporting and through more timely reporting. Management have agreed that True North updates will continue to be reported to the committees that are assigned True North actions, and that they will strive to ensure completion in a timely manner. A 2024/25 end of year report on outcomes of the Quality Strategy 2023-2029 will be produced. L19/25 Financial Management Reasonable The NHS Lanarkshire Financial and Transformation Plan 2024/2025 aligns the Annual Delivery Plan and regular finance reports were presented to NHS Lanarkshire Board and the Planning, Performance and Resources Committee for awareness, discussion, and assurance. Internal Audit confirmed that relevant, reliable and meaningful monthly budget reports are distributed with support and training provided for budget holders. Management have agreed that: • Where budgets are widely different from actuals in year, each division will review variances to determine if these have been created from one-off cost pressures or a substantive change; a business case would be expected before adjusting budgets. • Finance will continue to set, review and report on all budget areas within the current funding envelope and would propose a budget “rewash” exercise be progressed where areas of expenditure reporting recurring reductions be reinvested across areas experiencing higher levels of expenditure/activity. • Consideration will be given to the process around escalating budget management concerns and the team will work towards the implementation of a procedure which will aid management control and reporting as well as escalating areas of concern.
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Appendix 2 13 Report Audit Opinion Key findings L24/25 Cyber Resilience / Information Security Framework Reasonable The NHSL Digital Plan 2023-2028 is aligned to the Cyber Resilience Framework. The NHS Lanarkshire Network & Information Systems (NIS) Audit Programme 2024 Progress Review Interim Report was published on 29 November 2024 and concluded positively on compliance with asset management aspects of the Cyber Resilience Framework. The aim of 100% implementation of security patches (software and operating system updates that aim to fix security vulnerabilities) within 14 days of release has been achieved in 5 months of the 14-month period from November 2023 – December 2024. Management have active reporting implemented to identify any non-compliance with the 14-day target for security patches. There are significant business challenges involved with some Application Owners unable to agree the required downtime to apply the patches and this issue was escalated to the March 2025 Cyber Security Group. Risk record (83) - Asset Management process and controls will be reviewed and updated to ensure that the risk and potential impact is clearly described, and all current controls documented. Planned mitigating actions along with target dates will also be added. No relevant reports have been issued by North Lanarkshire Council
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REPORT Item No: Item 14. SUBJECT: Risk Management Report TO: Integration Joint Board, Performance, Finance and Audit Committee Lead Officer for Report: Claire Rae, NL HSCP Chief Officer Author(s) of Report Morag Dendy, Chief Officer / Head of Service (Performance, Planning, and Quality Assurance) DATE: 21 May 2025 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: ☒ Reviewed By: ☐ Endorsed By: ☐ Morag Dendy, Chief Officer / Head of Service (Performance, Planning and Quality Assurance) 1
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3. RECOMMENDATIONS 3.1 The IJB, PFA is asked to note the contents of the presentation which includes a review of the highest rated risks within the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 3.2 The IJB, PFA is also asked to note that an IJB Liaison session will be focused on risk to take account of and strengthen the consideration of risk through the IJB taking account of the revised approaches to risk within NHS Lanarkshire and NLC; and the refreshed governance arrangements within the UHSCP. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. 5.2 The IJB PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 5.3 The following risk are currently rated as Very High on the IJB risk register. • IJB 06/21 – Prescribing Activity and Costs • IJB 01/21 – Financial Challenges • IJB 21/24- Pharmacy Pressures within Prison Services 5.4 The following risks are rated high on the IJB risk register. • IJB 04/21 - Notional Set Aside Budget • IJB 12/21 - Staff Health & wellbeing • IJB 15/22 – Cost of Living • IJB 19/23 – Service Sustainability • IJB 20/23 – Workforce Sustainability • IJB 12/22 – Unscheduled Care 2
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• IJB 23/24- Speech and Language Therapy 5.5 The High/Very High rated operational risks that have been identified as having or potentially having an impact on IJB objectives and/or delivery of services are highlighted within the Risk Overview Dashboard (Appendix 1) and Risk Register (Appendix 2). 6. CONCLUSIONS 6.1 The IJB currently has 19 risks identified on its IJB risk register with 10 risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 7.2 ASSOCIATED MEASURE(S) 3
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7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☒ No ☐ N/A ☐ 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ 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 4
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☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☐ N/A ☒ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 – Risk Overview Dashboard Appendix 2 – Risk Register . 5
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CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; 6
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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 7
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NL H&SCP Risk Overview Report Meeting Name – IJB, PFA Reporting Period: IJB Risk Register – May 2025
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NL HSCP IJB Risk – Dashboard March 2025 Executive Summary Risk movement since last report No Change Increase Decrease New Closed Risks with updated actions 18 1 0 19 IJB Highest Scoring Risks Risk Register Number of Risks IJB 19 NL Council 21 NHS Lanarkshire 21 NL H&SCP Risks Reported to Assurance Committees Service risks- Service level Level 3- North Health Professional/ Operational Group and Support Care and Clinical Governance Risk Overview Process NL H&SCP IJB Risk Register – IJB and IJB PFA Level 2- Core VH Pharmacy Pressures within Prison Service IJB.21/24 VH Financial Challenges IJB.01/21 VH Prescribing Activity and Costs IJB 06/21 Trend Score Risk
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Current – Veru High Target‐ Low Risk in Focus – Pharmacy Pressures within Prison Service Risk Trend Following the Prisoner Healthcare Report presented to IJB PFA on the 22nd May 2024. The IJB PFA recommended that a Pharmacy Pressure within Prison Service Risk was added to the risk register. Risk Description Risk Owner Risk Lead Pharmacy costs have traditionally been the highest area of non-pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. There is currently a large overspend (559K reported May 2024) for the actual drugs bought and £246K associated with the management fees for the contract. MT CR Current Controls CONTROLS • Review of the dispense processes within the prison • Implementation of guidelines • Improved communication with pharmacy provider Actions ACTIONS • Prescribing Action Group re‐established to try and manage the number of items prescribed • Developmentof pain and medicine management pathways • Review of prescribing habits
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Current – Very High Target‐ Medium Risk in Focus – Financial Challenges Risk Trend No Movement Increasing financial pressures have resulted in no movement of the risk rating for this risk. Further controls and actions are currently being reviewed Risk Description Risk Owner Risk Lead Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: NS NS Current Controls CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision-making forums. 3. Effective joint working between North and South Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plans have been agreed and are reviewed regularly. 7. IJB medium term financial plan 2023-26 and reserves strategy 2023-24 approved at March 23 IJB 8. Capacity plans in place to maximise efficiency. 9. IJB Integration Scheme setting out the budget recovery processes. 10. IJB Financial Regulations and financial procedures. 11. Consultation and involvement with key stakeholders including service users and carers. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. 15. IJB medium term financial plan 2024-2028 including the long term outlook 2025 – 2035 approved by the IJB in March 2025. Actions ACTIONS 1. Annual budget setting processes within each of the partners. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget
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Current – Very High Target‐ Low Risk in Focus – Prescribing Activity and Costs Risk Trend No movement Consider any still ongoing, however good progress has been made regarding achievement of the prescribing target for 2024-25 Risk Description Risk Owner Risk Lead The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. CR NS Current Controls 1. Prescribing Quality and Efficiency Programme. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. 6. Regular HSCP monitoring. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 7. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 8. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 9. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes Actions 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch. 4. Prescribing updates being provided to IJB as per financial reports
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IJB ID Category Opened Date Description of Risk Risk level (Initial) Mitigating Controls Risk level (Current Risk level (Target) Risk Owner Risk Register Lead ce Source Next Review Date Closed Date 01/04/2021 Financial Challenges HIGH CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision-making forums. 3. Effective joint working between North and South Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plans have been agreed and are reviewed regularly. 7. IJB medium term financial plan 2023-26 and reserves strategy 2023-24 approved at March 23 IJB 8. Capacity plans in place to maximise efficiency. 9. IJB Integration Scheme setting out the budget recovery processes. 10. IJB Financial Regulations and financial procedures. 11. Consultation and involvement with key stakeholders including service users and carers. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. ACTIONS 1. Annual budget setting processes within each of the partners. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget 4. Review the Audit Scotland Bulletin released on the 6 March 2025 VERY HIGH Medium Nicola Scott Nicola Scott SLT, IJB PFA, IJB 31.01.2024 Previously IJB2, IJB7, IJB10 and IJB12. There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. Reviewed and updated Jan 2024. 3. Late Scottish Government financial settlement. Reviewed and updated March 2024. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. Review and risk increased June 2024. 7. Competing service priorities. Reviewed and no changes Sept 2024 IJB.01/ 21 Financial Strategic 8. Conflicting partner efficiency savings programs which adversely impact on the HSCP's ability to deliver services. 9. In-year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. Review and updated Oct 2024 Reviewed and no changes March 2025 Reviewed and no changes May 2025 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. The continuing recovery from the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the continuing impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. Prevention and Detection of Fraud, Bribery and/or Corruption There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW CONTROLS 1. Fraud awareness e-learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. Previously IJB6. Reviewed and updated on March 2023. Reviewed and Updated Oct 2023, (previously title ineffective governance arrangements).
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IJB02. 21 Financial Reputational 01/04/2021 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partnerbodies. The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website ACTIONS 1. Continue to raise fraud awareness through teambriefings. 2. Annual planned Procurement and Standing Financial Instructions presentations. 3. Annual review of Code of Conduct 4. Review of how Members' Declaration of Interests are collated and reviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA. LOW LOW Claire Rae Nicola Scott SLT, IJB PFA, IJB 31.01.2025 Reviewed May 2024 Reviewed and No changes Sept 2024 Reviewed and no changes Oct 2024 Reviewed and no changes March 2025 Reviewed and no changes May 2025 01/04/2021 Notional Set‐Aside Budget VERY HIGH CONTROLS HIGH MEDIUM Claire Rae Nicola Scott SLT, IJB PFA, IJB 31.01.2025 2.There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set-aside concept. Reviewed and Updated May 2023. 3. Bed modelling and capacity planning arrangements are in place. 4. Effective working relationships between both partners and the IJB have been established. Reviewed Oct 2023. IJB04. 21 Financial Strategic There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set-aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. 5. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set-aside budget. This arrangement continues to be in place for 2022/23 ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. Reviewed Jan 2024 Reviewed May 2024 Reviewed July 2024. Reviewed Sept 2024 Reviewed Oct 2024 and no changes (awaiting SG info) Reviewed March 2025 Reviewed and no changes May 2025 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and budget for 2024/25 IJB05. 21 Financial Strategic 01/04/2021 Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH CONTROLS 1. North and South IJBs aim to co-operate to ensure a pan-Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. MEDIUM MEDIUM Claire Rae Nicola Scott SLT, IJB PFA, IJB 31.01.2025 Reviewed May 2024 Reviewed July 2024 Reviewed Sept 2024 Reviewed Oct 2024 and no updates Reviewed March 2025 Reviewed and no changes May 2025
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01/04/2021 Prescribing Activity and Costs CONTROLS 01/04/2021 Medium VERY HIGH LOW Claire Rae Nicola Scott SLT, IJB PFA, IJB 31.01.2025 Previously IJB11. Reviewed and updated June 2023. 1.. Prescribing Quality and Efficiency Programme. IJB06. 21 Financial Operational The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. 2. Prescribing Management Board functions and membership. 3. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 4. Locality Pharmacist input. 5. Earmarked reserve established to address prescribing costs. 6. Regular HSCP monitoring.In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 7. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 8. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 9. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. Reviewed and Updated (risk increased) October 2023. Reviewed Jan 2024 Reviewed June 2024. Reviewed July 2024. Reviewed Sept 2024 Reviewed October 2024 no changes Reviewed March 2025 Reviewed and no changes May 2025 ACTIONS 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch. 4. Prescribing updates being provided to IJB as per financial reports IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long-term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH CONTROLS 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. ACTIONS 1. The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years. 2. Updated SLA with VANL nearing completion LOW LOW Claire Rae Nicola Scott SLT, IJB PFA, IJB 31.01.2025 Previously IJB16. Reviewed April 2024. Reviewed July 2024 Reviewed and no changes Sept 2024 Reviewed March 2025 Reviewed and no changes May 2025
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20 c IJB.10. 21 Financial Strategic 01/04/2 Ineffective Governance Arrangements 1. There is a risk that the intensity of the required response to Covid-19 may have resulted in a failure of governance impacting on the effectiveness of the IJB decision-making, IJB directions to partners and IJB oversight of operational service delivery Routine governance processes 2. New or amended legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. MEDIUM CONTROLS 1. National Networks are established which are providing the framework to support a national approach where appropriate. 2. Public Health advice and support is in place. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work-based working is being developed going forward. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid-19 Risk Register in place. LOW LOW Claire R Nicola S SLT, IJB PF 31.01. Reviewed and updated June 2023. Reviewed and updated Oct 2023. Reviewed and updated Jan 2024. 6. There will require to be changes to the working environment including remote working and working from home. 6.The IJB and both partners aim to comply with the European Working Time Directive (WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular front-line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply ae ott A, IJB 25 Reviewed and Risk level lowered June 2024. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. 7. Back to Basics exercise has helped to focus on the underpinning governance requirements across the whole HSCP 8. Staff health and wellbeing is a key priority for both partners and all key stakeholders. The commitment to staff health and wellbeing is being actively promoted through all available forums. Reviewed and no changes Sept 2024 9. IJB Governance reporting reviewed and associated documents updated. 10. Recent review of Internal Audit team programme of work and participation in the IJB. 11. Review of IJB / PFA self assessment session Review March 2025 Reviewed and no changes May 2025 IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW CONTROLS Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. Chief Executive Performance Review arrangements. Hosted Services Performance Review arrangements. Sector/Locality Performance Review arrangements. LOW LOW Claire Rae Morag Dendy SLT, IJB PFA, IJB 31.01.2025 Reviewed May 2024. Reviewed June 2024. Reviewed and no changes Sept 2024 Review March 2025 Reviewed and no changes May 2025 IJB.12. 21 Performance 30/08/2021 Staff Health & Wellbeing There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. MEDIUM CONTROLS Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. Range of support services available both nationally and locally e.g Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). Rest & Recuperation areas identified. Peer Support Networks established Well established Occupational Health supports available to support staff sickness. ACTIONS Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. Funding received by Scottish Government specifically targeting staff wellbeing programmes and supports. Local plans for use of funding being developed. Managers supporting & encouraging staff to take planned leave/use full leave allocation HIGH low Claire Rae Claire Rae SLT, IJB PFA, IJB, SC&CG, AH&SC 31.01.2025 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed May 2024. Reviewed Sept 2024 Review March 2025 Reviewed and no changes May 2025
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021 30.08.21 Care Homes HIGH CONTROLS medium medium Claire Rae Joanne Jenkins IJB, PF&A, SLT, SC&SC, A H &SC 31.01.2025 Reviewed and updated Oct 2023 Establishment of Care Home Assurance Team. IJB.13. 2021 Performance Inability of care homes to sustain service due to staffing and cost pressures resulting in closure to new placement and closure of care homes. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. Escalation Process in place. National protocol to support discharge of Covid 19 patients in place. ACTIONS Public Health teams providing guidance on infection control. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. All care homes advised to use PPE in line with national addendum. Development day on 12th May 23 to agree structures and approach for year ahead Reviewed May 2024. . Reviewed Sept 2024 Review March 2025 Reviewed and no changes May 2025 CAMHS CONTROLS Prioritisation of referrals; all referrals vetted daily with urgent referrals prioritised Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments Secured significant national investment to fully implement new service model Active review of skill mix to utilise medical staff only when required for highly complex patients Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed and risk level lowered May IJB.14. 2022 Strategic & Performance 30.04.22 There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non-clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in- patient and out- patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. VERY HIGH Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023 Continuous review and validation of the waiting list Waiting list validation exercise completed in April 2022 with reduction in list by 16% CAPA appointments begin on 1st May 2023 - first cycle (16wks) nearing completion Monthly monitoring at board Incremental implementation of the new service model Performance monitoring through the programme board CAHMS IT Board in train to plan and oversee implementation of SCI gateway for referrals Waiting list initiative commenced Udston opened for patients September 2022 Upgrade to North physical infrastructure agreed. Close working with health improvement and GP reps Medium Medium Claire Rae Morag Dendy IJB,PF&A, SLT 31.01.2025 2024. Reviewed and no changes Sept 2024 Reviewed and no change March 2025 Reviewed and no changes May 2025 05.09.22 Cost of Living HIGH CONTROLS High Medium Claire Rae Claire Rae SLT, IJB 31.01.2025 Reviewed and Updated May 2023. NLC Silver command group stood up focused on cost of living IJB.15. 2022 Strategic & Performance There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such as food and heating. NHSL commenced review through CMT Population Health Committee to review activity around cost of living NLC approved cost of living contract increases in May 2023 ACTIONS Survey of NLC hybrid workers to see if home working remains financially viable Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost Reviewed Oct 2023. Reviewed May 2024. Reviewed Sept 2024 Reviewed March 2025 Reviewed and no changes May 2025 Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost. 05.09.22 National Care Service HIGH CONTROLS Low Low Diane Fraser Claire Rae SLT, IJB PFA, IJB, ASW C&W B 31.01.2025 Reviewed and Updated May 2023. IJB.16. 2022 Strategic There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co-design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023-26. NLC establishing NCS working groups Key HSCP leads involved in national developments Ongoing progress updates to IJB and IJB PFA ACTIONS IJB response submitted on proposed Bill Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups SG/COSLA working groups being established - local reps nominated for each National Advisory Group being established. Reviewed and Updated Oct 2023. Reviewed and Updated May 2024 Reviewed Sept 2024 Reviewed Oct 2024 no changes Reviewed March 2025
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Risk in the NLC risk register closed in February 2025 Reviewed in May 2025 and current risk reduced to LOW 05.09.22 Unscheduled Care Very High CONTROLS High Medium Claire Rae Claire Rae SLT, IJB PFA, IJB 31.01.2025 Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. Reviewed and Updated in June 2023. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision NHS CMT and Covid response group oversight of performance Reviewed Oct 2023 Daily PDD meetings to review every planned supported discharge and delayed discharge Reviewed Jan 2024. IJB.17. 2022 Strategic & Performance There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges Expansion of Home Support service Roll out of Home Assessment Teams across all 6 Localities New CSW roles in District Nursing teams to proactively support Care Managed patients Additional Nursing capacity in District Nursing Teams Expansion of Equipment and Adaptation Service to support rapid access in community Reviewed and risk level reduced May 2024. Reviewed Sept 2024 Reviewed Oct 2024, no changes Reviewed March 2025 Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long-term service demand Regular Firebreaks across the system Task and Finish groups now established to roll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) Reviewed and no changes May 2025 05.09.22 Community Alarms There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. HIGH CONTROLS Medium Low Diane Fraser Claire Rae SLT, IJB PFA, IJB, ASW C&W B 31.01.2025 Reviewed and updated June 2023. Working group established to coordinate all activity Oversight through Home Support Programme Board Reporting to Adult Social Work, Care and Wellbeing Committee Reporting to IJB Reviewed Oct 2023. Reviewed Jan 2024. IJB.18. 2022 Strategic and Performance ACTIONS NLC Committee approval to purchase 1000 digital alarms so the service can support any imminent changes over to digital in individual areas Reviewed April 2024. Reviewed Sept 2024 Reviewed Oct 2024 NLC part of SG once for Scotland procurement process for a new digital alarm receiving center Reviewed March 2025 Communication out to all community alarm service users Instructions issued to all community alarm service users on how to do test calls to ensure alarms are operational Reviewed and no changes May 2025 Engagement with telecommunication suppliers to ensure sight of roll out plans across NL Call-off direct award using third party Framework for Digital ARC and purchase of digital dispersed alarm units agreed at Adult Care and Social Work Committee in May 2025
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27/02/2023 Service Sustainability High CONTROLS High Low Claire Rae Claire Rae SLT, IJB PFA, IJB 31.01.2025 Reviewed and Updated May 2023 IJB PFA Committee. IJB.19. 2023 Performance Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety IJB Chief Officer is a member of each partner's key decision-making forums. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. Regular budget meetings with Chief Executives and Directors of Finance. Regular HSCP budget monitoring meetings across Senior Leadership Team. The IJB Financial Plan is regularly reviewed and agreed. Capacity plans in place to maximize efficiency. Consultation and involvement with key stakeholders including service users and carers. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. Strategic Planning Group, Locality engagement sessions and Partnership Boards. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Reviewed and Updated Oct 2023. Reviewed and updated Jan 2024. Reviewed April 2024. Reviewed Sept 2024 Reviewed Oct 2024 Reviewed March 2025 Reviewed and no changes May 2025 ACTIONS Sustainability plans to be reviewed regularly Re-introduction of scrutiny panels Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. Review of reporting process into IJB to ensure continuous review of services/ service developments. Development of the programme of work to ensure regular reporting structure in place for service review. Operation Flow Task and Finish Groups analyzing service challenges and implementing phased changes to support winter pressures and beyond. IJB.20. 2023 Workforce Sustainability It is becoming increasingly difficult to recruit to particular roles across Health and Social Care. Gaps in the workforce can result in reduction of service provision, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawal there is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non-EEA countries are subject to the same immigration rules.The new points-based immigration system makes exceptions for the majority of health care professionals with an NHS job High CONTROLS All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one-off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co-ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. High Medium Claire Rae Claire Rae SLT, PFA, IJB 31.01.2025 Updated May 2023 Reviewed and updated Oct 2023.
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GH offer and for qualified social workers via a new fast-track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers.The Mutual Recognition of Professional Qualifications Directive is an EU-wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. Development of the Care Academy Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support ACTIONS Annual workforce plan being prepared NHSL programme underway to support international recruitment On the day recruitment events being trialed in Home Support Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment Recruitment of 15 Modern Apprenticeships within the H&SCP working within Business Admin, Comms and Health Care Support. Reviewed and updated Jan 24 Reviewed April 2024. Reviewed Sept 2024 Reviewed March 2025 Reviewed and no changes May 2025 IJB21.24 Financial Jun-24 Pharmacy Pressures within Prison Service Pharmacy costs have traditionally been the highest area of non-pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. There is currently a large overspend (559K reported May 2024) for the actual drugs bought and £246K associated with the management fees for the contract. High CONTROLS Review of the dispense processes within the prison Implementation of guidelines Improved communication with pharmacy provider ACTIONS Prescribing Action Group re-established to try and manage the number of items prescribed Development of pain and medicine management pathways Review of prescribing habits Very High Low Claire Rae Claire Rae IJB PFA, IJB 31.01.2025 Added to register June 2024 and reviewed Sept 2024 Reviewed March 2025 Reviewed and no changes May 2025 IJB23.24 Performance Speech and Language Therapy (SLT) Service High CONTROLS 1. Good communication processes, and the sharing of information and practical learning online have been established and will be further developed as service improvement work progresses. 2. Service model review to ensure that future TrakCare builds on local learning and builds on organisational learning from other builds. Forward planning for inclusion in the AHP Hub model will proceed in parallel to these TrakCare developments. 3. Revised workforce planning, incorporating the best-practice and learning from other areas who have specialist children’s health services units. 4. The professional relationships between service and university have already been improved and we have academic representation that actively contributes to both our Workforce Planning and Service Improvement Steering Group. ACTIONS 1. Working with university colleagues to identify new practitioners who have expressed their desire to work in Lanarkshire on registration. This allows us to maximise and enhance opportunities for placement, improvement projects and induction planning, ensuring that we present ourselves as an area that is not only welcoming but committed to the ongoing development of individuals and the service 2. Work with professional colleagues to ensure that all activity is aligned to direct and/or indirect pursuit of meeting the SLT waiting time target. 3. Transition from restrictive locality models for managing the waiting list. High Low Claire Rae Claire Rae IJB PFA, IJB 31.01.2025 Added to the register August 2024. Reviewed Oct 2024 Reviewed March 2025 Reviewed and no changes May 2025 Jul-24 There is a risk that the SLT service cannot meet the increasing clinical demands with variance in waiting list length by area, continued challenges around the recrutiment and retention of new colleagues, funding streams from Local Authority being reduce therefore reducing staff WTE.