Item 3 (M) IJB Pfa 25.02.2025
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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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