Combined Pack - IJB PFA 27.08.2025
North Lanarkshire Council · 27 August 2025
Back to IJB Performance, Finance and Audit Committee — 27 August 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 27 August 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 (21 May 2025) For Approval Attachment Chair 4. Matters Arising For Noting Attachment Chair Performance & Finance 5. Financial Monitoring Report For Noting Attachment Nicola Scott 6. Q4 IJB Performance Report For Noting Attachment Morag Dendy 7. Internal Audit Progress Report 2024/25 and 2025/26 For Noting Attachment Jocelyn Lyall 8. Draft Internal Audit Charter For Approval Attachment Jocelyn Lyall Governance & Policy 9. Risk Report For Noting Attachment Kerry Taylor 10. IJB PFA Work Plan For Noting Attachment Kerry Taylor For Noting 11. 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 . Date of Next Meeting 22 October 2025, 14:00-16:30 For Noting
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Page 1 of 12 ITEM: 4 Integration Joint Board Performance, Finance & Audit Committee Minutes from the meeting held on Wednesday 21st May 2025, 14.00 – 16.30 via MS Teams PRESENT Voting Members: Cllr Claire Barclay NLC Nominated Councillor Cllr Bob Burgess NLC Nominated Councillor Phillip Couser 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: Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Margaret Flavell Senior Manager Adult Social Work Diane Fraser Head of Adult Social Care Jocelyn Lyall Chief Internal Auditor Ann Muir Chair of North Lanarkshire Disability Forum Lucy Munro Medical Director for Health & Social Care North Lanarkshire Claire Rae Chief Office NL HSCP Harry Robertson North Lanarkshire Carers Together / Carer Representative Marie Rooney Associate Nurse Director – Mental Health Fiona Sanderson Lead Pharmacist - Primary Care Nicola Scott Chief Finance Officer Francis Scott Chief Officer (Audit and Risk) Kerry Taylor Business Support Manager John Watson Employee Representative NLC David Wood Chief Executive Officer with VANL Dawn Wright (Minutes) Management Team Secretary Apologies: Nauman Dar NHS Lanarkshire Nominated Non-Executive Alison Gordon Head of Children’s, Families & Justice Services Joanne Jenkins Nurse Director NL HSCP / Nurse Representative Catherine McGinty Unison / Staff Side Representative (NHSL) Thomas Moan Senior Manager – Community Solutions VANL Maggs Thomson Head of Health North HSCP Rose Walker Governance Support Manager
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Page 2 of 12 1. Welcome and Apologies The chair welcomed everyone to the meeting and apologies were noted as above. The committee was advised that the "Tackling Poverty Team Report" and the "Lanarkshire Winter Plan Report" were deferred to a future IJB meeting. Brian Moore 2. Declaration of Interests No conflicts of interest were declared. All 3. Minutes IJB PFA (25th February) Councillor Claire Barclay requested a minor amendment to the previous minutes (25.02.25) to specify her full name, replacing "Councillor Claire" with "Councillor Claire Barclay" in order to clearly differentiate her from Claire Rae. The minutes, with above noted minor changes, were approved. Brian Moore 4. Matters Arising/ Rolling Action List John Watson raised concerns regarding the withdrawal of the Tackling Poverty Paper and the temporary contracts of Unison members in that team. Concerns were voiced about the sustainability of funding, given the team's success in securing significant funds. Claire Rae clarified that the paper was pulled to explore a more sustainable approach to tackling poverty, not due to funding issues, and reassured that trade unions would be involved. Brian Moore added that discussions have previously emphasised the need for an exit strategy and the requirement for sustainable funding, also noting the involvement of other funding partners. Claire Rae confirmed that the annual safe staffing report, required by Scottish Government under new legislation, is underway across Health and Social Care and will be brought back to a future IJB meeting. Brian Moore inquired about a previous query from John regarding the resourcing or training for age assessments in the context of the asylum seeking report. Claire Rae confirmed no response had been provided yet and this issue will be followed up. An update was requested on communications surrounding the CAMHS service, with Mark Dell confirming a communications plan is underway, including a scoping exercise to avoid duplication and engagement with key players. Councillor Claire Barclay requested a timeline for the communication rollout, highlighting that while improvements have been made, councillors still receive inquiries. Mark Dell assured the committee that the communication would be out soon and would include guidance for elected members. Claire Rae agreed to add a timeline to the action log. Philip Couser questioned the inclusion of general "business as usual" items (28, 29, and 30) on the action log, as they lacked specific outputs or dates. He also suggested a review of the long list of closed actions, some dating back to 2018, proposing a retention policy, e.g., two years. It was agreed that the action log be revised to remove "business as usual" items (28, 29, 30) and old completed actions to be deleted. Brian Moore
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Page 3 of 12 Strategic Planning & Development 5. Lanarkshire Winter Plan Debrief Deferred to future IJB meeting Performance & Finance 6. Chryston Hub Update Claire Rae provided an update on the Chryston Community Health Clinic, noting that all physical health services have been repatriated from NHS Greater Glasgow and Clyde (GGC), including Community Diabetic Service, Dietetics, Physiotherapy, and Sexual Health. Mental health and substance misuse services were not repatriated due to clinical safety concerns as the SLA did not include medical staffing and concerns about fragmentation of the Community Mental Health Team and Substance Misuse Team. Discussions are ongoing with GGC about using the clinic as a satellite clinic, with a visit scheduled for tomorrow. There are no associated cost implications of the transfer of services at this stage. Claire Rae proposed holding a future IJB meeting at the Chryston Community Hub during the school holidays to utilize the larger area and allow members to see the facility. Siobhan White inquired about the need for further public consultation since the original plan included mental health services, which are now excluded. Claire Rae clarified that consultation would not be required due to clinical safety decisions, but communications will be issued to the population explaining the changes and reasons. Philip Couser inquired about feedback from service users regarding the impact of the changes. Claire Rae stated that specific feedback hasn't been sought yet but will be in the future, as well as general feedback on the community hub model. Councillor Anne McCrory asked about the timeline for instigating satellite clinics if GGC decides to proceed. Lucy Munro, explained it would depend on the discipline, with some potentially happening more quickly than others due to existing clinic schedules. Recommendations: 1. The IJB PFA Committee noted the progress and current position of the repatriation of the clinical services from NHS Greater Glasgow & Clyde (NHSGG&C) 2. The IJB PFA Committee noted the change in provision for Mental Health and Substance Misuse Services. 3. The IJB PFA Committee noted the change in the financial position and work to date to progress towards final conclusion. Claire Rae
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Page 4 of 12 7. Prescribing: Sustainability and Value Programme Progress Update The report provided benchmarking information regarding the number of prescriptions per head of population by Board. Information on the cost and volume of prescriptions in North Lanarkshire was also provided. The report also set out the financial pressures and savings proposals within Lanarkshire at present. Despite pressures, Lanarkshire achieved its highest savings in 2025, with 80-90% of primary care prescribing deemed appropriate but within safe margins. The report set out the objectives of the Sustainability and Value Programme and the planned actions with an emphasis on the importance of changing prescribing culture. Active efforts are underway to reduce Medicines of Low Therapeutic Value and tackle polypharmacy in older, multi-morbid patients through pharmacist-led reviews and locality- specific plans. Practices are also addressing unique prescribing patterns and working with acute partners to limit costly catheter use. The Prescribing Change Scheme is under consideration to incentivise safe and effective prescribing adjustments, amid concerns about potential negative incentives. The overall program projects £8 million savings for the year and is currently on track. Councillor Claire Barclay inquired about any backlash from doctor's surgeries or patients. Lucy Munro noted that, although there is some dissatisfaction and concern expressed by GPs and pharmacists, these reactions are minimal and are not hindering the progress of the programme. Representatives from the GP sub and LMC on the Partnerships Medicines Management Board are largely positive about the need for the programme, and Fiona's team strives to make the process as easy as possible. Fiona Sanderson added that patient feedback from polypharmacy reviews will be collected automatically, building on a pilot of 50 patients which showed overwhelmingly positive responses from patients who appreciated the opportunity to review and adjust their medications. Siobhan White asked for clarification on where polypharmacy reviews are conducted (hospitals, practices, or both) and whether "Pharmacy First" prescriptions fall outside the control of the programme. Lucy Munro explained that polypharmacy reviews are practice-based and are linking with fieldwork and district nurses to identify patients, particularly those who have been at the front door of care but turned around in terms of frailty. Fiona Sanderson clarified that while some reviews start in the hospital, better outcomes are often achieved in primary care, with referrals made to primary care teams. Regarding Pharmacy First, the program monitors for unintended consequences where stopping one medication might lead to another being prescribed. New reports will analyse prescribing within "Pharmacy First" and "Pharmacy First Plus" (where community pharmacists are independent prescribers) to track changes across systems. She emphasised that Pharmacy First always involves a consultation with patients. Brian Moore noted the significant difference in value between "medicines of low therapeutic value" (£2 million) and "non-medicines" (£22 million). He questioned the alternatives for sourcing or funding non-medicines if they are not prescribed in the future. Lucy Munro
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Page 5 of 12 He also noted the potential saving of £1 million if switch to generic Sitagliptin. He welcomed the development of dashboards for better data reliance and which will provide evidence of the polypharmacy work's benefits. Lucy Munro stated that nicotine patches constitute the largest portion of low-value medicines, and savings from this are part of a wider strategy to improve chronic pain management. The £22 million non-medicine savings target is based on disparities, such as two suitable catheters costing £2.20 and £22, with hospitals often receiving free, more expensive options from pharmaceutical companies, influencing continued prescription. Fiona Sanderson stated a "non-medicines effective prescribing" subgroup collaborates with nurses and pharmacy to improve efficiency and quality. She highlighted that switching the DPP4 class drug Sitagliptin to a generic—already done elsewhere—could save £1.4 million without affecting safety, with the pharmacy team overseeing the process and patient follow-up. Recommendations: 1. The IJB PFA Committee noted the savings for the financial year 24/25 2. The IJB PFA Committee noted the project workstream activities planned for 25/26 8. Supporting Unpaid Carers & North Lanarkshire Carers Strategy Update Morag Dendy spoke to the submitted report. The report focused on the North Lanarkshire Carers Strategy, emphasising the importance of identifying unpaid carers early, providing timely support, and aligning with national policy drivers. The implementation of the Carers (Scotland) Act 2016 and the challenges in identifying and supporting hidden carers were discussed. The role of various partners, including the North Lanarkshire Carers Together Steering Group and the Carers Network, was highlighted. The importance of data collection to measure the impact of interventions for carers was emphasised. Concerns were raised about the decreasing number of carers assessments and the need to understand the reasons behind this trend. The committee requested information on supports available for carers during periods of crisis. Discussions included the difficulties in reaching "hidden carers" and the reliance on general practitioners for identification, with a need for broader outreach. The need for a robust communication strategy to identify and support carers was highlighted. Recommendations: 1. IJB PFA Committee endorse the approach to supporting Carers in North Lanarkshire. 2. IJB PFA Committee noted the range of supports to unpaid carers available locally. Morag Dendy
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Page 6 of 12 9. Financial Monitoring Nicola Scott presented the 2024-2025 financial report, showing a £10.716 million underspend, which became £10.1 million after accounting for ring-fenced funds of £614,000. Part of this underspend was due to reserve drawdowns that were later replenished. Employee costs had a £19 million underspend, mainly from a £6 million non-recurring saving on the Strathclyde pension fund, offset by a prescribing overspend. Closing reserves were reported at £64 million after drawdowns, before this year underspend allocation. The reserves report addresses prior IJB and PFA comments on long-held reserves. The savings strategy aimed for £29 million over two years, with £15.4 million achieved before the plan was reviewed rolling unachieved savings into the 2025-2026 Medium Term Financial Plan. The report also covered vacancies and digital projects. Councillor Bob Burgess inquired about Scottish Government allocations for diabetes technology and mental health funding. Lucy Munro explained diabetes technology relates to transformative closed-loop systems for type one diabetics, funded partly by the Scottish Government. Claire Rae added that mental health allocations are tied to Scottish Government service targets, with demand rising significantly. Siobhan White asked about 2025-2026 allocations and the lack of an inflationary rise in the 2024-2025 prescribing budget. Claire Rae confirmed ongoing allocations and mentioned that the Chief Officer Group raises concerns over the prescribing budget with policymakers. Nicola noted that the 2025-2026 Medium Term Financial Plan includes an inflationary increase for prescribing and outlined recurring costs for digital alarms that need future budget considerations. Brian Moore highlighted Appendix 6 on the savings program, calling for a development session to address a £20 million deficit. He queried the planned use of unscheduled care and CAMHS reserves. Nicola Scott clarified that the £14.7 million savings gap is not new unmet need but carries previous savings targets into the new plan, with reserves being ring-fenced funds meant for specific purposes. Claire Rae added that work on using the neurodevelopment service reserve will be proposed at the next IJB meeting, emphasizing that future discussions will focus on savings and risks related to social care budgets. Brian Moore briefly inquired about a £1.5 million allocation for mental health services, to which Nicola responded that it aims to support anticipated funding reductions from the Scottish Government using some of the underspend. Recommendations: 1. IJB PFA Committee acknowledged the year-end financial position of a £10.716m underspend. 2. IJB PFA Committee referred to the IJB Reserves Strategy report to approve the allocation of this underspend. Nicola Scott
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Page 7 of 12 10. IJB Reserves Strategy Nicola Scott presented the 2025-2026 reserves strategy, seeking approval for realignments in Appendix 1 and a contingency reserve percentage change. She corrected report date errors: Table 1 should start with 2024, Table 3 with 2025. Reserves began at £75.524m, now £64.8m after drawdowns, with a full review by Council and NHS finance teams. Proposed realignments: • Remove £2.2m surplus reserves • Allocate £128k to summer placements from social care demand risk • Increase risk and contingency reserves by £10.8m • Establish five new reserves totalling £2.183m Post-approval, opening reserves would be £75.553m, a minimal £30k net change indicating reserves are actively used but continue to grow. She also proposed reducing the contingency reserve target from 5% to 4% due to current financial constraints and ongoing reviews. Brian Moore queried Mental Health Officer funding; Diane Fraser explained it is Scottish Government support for training, with some underspends held in anticipation of future requests. Regarding summer placements, Nicola Scott detailed an annual program for S4–S6 students, with increased demand in social care. Morag Dendy highlighted the program’s success, offering paid placements that enhance young people's skills and employment prospects, with some choosing to stay in paid roles. The program now includes apprenticeships, with positive feedback from participants and staff. Councillor Anne McCrory asked about participation numbers, retention, and full-time stays; Morag Dendy confirmed some students have opted to stay employed rather than return to school, and interest continues to grow. She emphasised that placements develop practical skills and employability through community and virtual experiences, with partnerships across sectors supporting expanded opportunities. Councillor Claire Barclay inquired about Care Academy retention and understanding; Morag Dendy explained the program’s four work streams focusing on recruitment, pathways for youth and adults, and broader employment initiatives, aiming for more ambitious targets. Recommendations: 1. IJB PFA Committee acknowledged the contents of the report. 2. IJB PFA Committee approved the proposed realignments & new reserves detailed in Appendix 1. 3. IJB PFA Committee approved the change to the percentage of risk based & contingency reserves to be held as detailed in section 8. Nicola Scott
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Page 8 of 12 11. Q3 Performance Report Morag Dendy presented the Q3 Performance Report, noting monitoring of key areas within the health and social care partnership. Scrutiny panels support underperforming services. Highlights: • Alcohol Brief Interventions: Underreporting persists due to technical issues; a future report will cover the North Lanarkshire alcohol summit. • Cervical Screening: Targeted outreach aims to boost participation. • Immunisations & 6-8 Week Reviews: Supported by a working group, with ongoing monitoring. • Rehab/Re-ablement: Emphasis on early assessments and revised targets; progress made despite unmet goals. • Discharge Performance: 50-60 delayed discharges remain, showing improvement. • Mental Health: Recruitment challenges affect performance; innovative management approaches are being applied. • SLT & Dietetics: Learning from CAMHS to improve waiting list management. • Complaints: Staff capacity issues impact response times; 69% positive feedback. • Care Home Length of Stay: New models and initiatives are expected to gradually influence figures and costs. • Smoking Cessation: Increasing social media engagement for referrals. • Sickness Absence: Continues to be a key focus for the partnership. Siobhan White raised a procedural point about ensuring actions and recommendations from other committees (like population health, e.g., childhood immunisations, cervical screening) are captured in the same place as the Q3 report, to avoid governance overlap. Morag Dendy confirmed that they do join up information from different forums and scrutiny panels. Councillor Bob Burgess requested figures on long-term sickness within the system for the next meeting. Claire Rae agreed to break down absence figures in a deeper dive. Brian Moore noted that home assessment teams dropped considerably in January and the readmission rate remained at 14%, with work underway to understand this better. Paediatric SLT (Speech and Language Therapy) was highlighted as a continuing main concern due to poor performance. Claire Rae mentioned Forth Valley's integrated approach with education as a learning opportunity, and they are looking to implement similar strategies. Brian Moore suggested that given significant reserves, investment in this service might be considered, as there is no sense of progress and reputational issues remain a high concern. Claire Rae agreed to bring back proposals if reserves are to be used for this. A deeper dive into this area was also suggested. Recommendations: 1. IJB PFA Committee noted the contents of the report and the appendix. Morag Dendy
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Page 9 of 12 12. Cat 1 Responders Update Margaret Flavell provided an update, highlighting its duties, responsibilities, and readiness under the Civil Contingencies Act 2021. The business continuity plan was reviewed late last year and will be reviewed again mid- year, with plans for a desktop scenario. The report aims to offer reassurance regarding their ability to put an appropriate response in place, with a focus on caring for people and ensuring a "people first" approach. Phillip Couser asked about the challenges of maintaining or sustaining capability in this area, referring to Section 7.18 of the report. Margaret Flavell responded that challenges were identified during a review of the business continuity plan and across health and social care localities, where there was a general understanding but a need to break it down into detailed responses. They are gathering information and looking at training support, noting a loss of involved people due to changes and departures. The main challenge is the lack of readily available information and knowledge. Brian Moore questioned the confidence in business continuity plans for commissioned services like care homes. Margaret Flavell confirmed strong links with commissioned services and providers, ensuring immediate contact if their business continuity plans are required. They work across the partnership to support them and will ensure these links are updated when their own business continuity plan is updated. Brian Moore inquired about the reflection of integrated arrangements within the report, specifically how the HSCP's is referenced in the North Lanarkshire Council Corporate Resilience Plan but no explicit link to the Health Board equivalent, Margaret Flavell acknowledged that it probably reads that way and committed to refreshing it with Kerry to ensure a full "whole system approach" across the partnership. Recommendations: 1. IJB PFA Committee noted the contents of the report 2. IJB PFA Committee understood the duties of a Category 1 responder 3. IJB PFA Committee are aware of the roles and responsibilities of a Category 1 responder 4. IJB PFA Committee have a knowledge of activities undertaken 5. IJB PFA Committee acknowledge the challenges and supports actions to address Margaret Flavell
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Page 10 of 12 13. Internal audit 2025/26 work plan Jocelyn Lyall presented the draft internal audit plan for 2025/2026, which aims to assess the adequacy and effectiveness of the IJB’S framework of Governance, risk management, and control for the year. The plan will be jointly delivered by North Lanarkshire Council and NHSL internal audit teams. The plan is designed to support the achievement of objectives and target priority issues, informed by a review of the risk register and consultation with the Chief Officer and Chief Finance Officer to ensure maximum value from audit assignments. Regular meetings are held every four to five weeks to discuss planning and progress. Jocelyn Lyall noted that Section 6 of the cover paper provides background on the planning process and sets out the requirements of the new global internal audit standards in relation to planning, which will be discussed further at the next agenda item. The proposed plan for 2025/2026 was set in Appendix 1. A total of 60 days are available for the audit, and the IJB will also benefit from assurances provided through partner organisation audits, which will be reported in each progress report. Of the 60 days, 27 are allocated to standard deliverables, including planning, audit management, general governance advice, production of the annual internal audit report, and the audit follow-up system. This leaves time for two full audits, which are proposed to be on financial sustainability and performance, and committee effectiveness. No questions were raised from the IJB PFA board members. Recommendations: 1. IJB PFA Committee approved the proposed Internal Audit Plan for 25/26 (Appendix 1) 2. IJB PFA Committee approved 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. 3. IJB PFA Committee approved 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 25/26 including the allocation of responsibilities for completion of assignments. Jocelyn Lyall
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Page 11 of 12 13.1 Internal audit progress report 2024/25 Jocelyn Lyall summarised the January 2024 global internal audit standards, effective from April 2024 in the public sector. Supplemented by UK-specific notes from CIPFA and the Scottish Government, these standards replace previous internal audit rules. They comprise 15 principles across five domains, with standards detailing requirements, implementation, and conformance evidence. While current practices largely align, departments will formalize evidence of compliance in 2025/26. Key changes include a mandated internal audit Charter, aligned audit strategy, enhanced ethics emphasising professional scepticism, and clarify roles for management and audit committees—who are also expected to champion the internal audit function. The 160-page document guides compliance, with revised policies forthcoming. Brian Moore welcomed the new standards, highlighting their role in clarifying the Audit and Risk Committee's purpose. He emphasised using the upcoming mandate to reaffirm this purpose. He supported the August audits and noted progress on completed Health Board audits. Additionally, he mentioned a minor issue from a recent NHSL ICE report regarding an outdated Integration Scheme on the HSCP website, which has now been resolved. Siobhan White inquired if the new mandate aligns with the Audit Committee's terms of reference. Jocelyn Lyall clarified that while terms of reference remain necessary, the mandate specifies legal authority per legislation, codes of practice, and the Scottish Public Finance Manual, and will complement internal arrangements. Siobhan White asked if Jocelyn would assist the committee in meeting new standards, including promoting internal audit. Jocelyn confirmed she would, emphasizing the relevance of the terms of reference and work plan, including private meetings. Jocelyn also announced a gap analysis-based improvement plan, to be reported to the NHS Lanarkshire Audit and Risk Committee, with updates provided at each meeting to ensure compliance. Francis Scott noted they are conducting a gap analysis. Full compliance is not required April 1st, but work is ongoing to embed the new standards. The new standards are more demanding and require greater demonstration. Originally designed by the IIA for private firms, they have been adapted for the public sector with extra documentation, necessitating time to adjust. Siobhan White requested that the internal audit plan include last audit dates to illustrate the audit history. Recommendations: 1. IJB PFA Committee reviewed the Progress Report and the summary of relevant partner reports. 2. IJB PFA Committee considered 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. Jocelyn Lyall
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Page 12 of 12 Governance & Policy 14. Risk Report Morag Dendy presented the Risk Report, noting that there were no significant changes since the last review. The primary change highlighted was the National Care Service risk, which has been reduced, reflecting its recording within each organization. Morag also mentioned that the strategic leadership team is exploring the approach to risk within NLC and NHSL. This will be further explored and refreshed during IJB development sessions likely in September, aiming to ensure the risk approach aligns with expectations. Phillip Couser questioned the medium risk rating for workforce, citing recruitment challenges and budget impact. He proposed separating immediate financial issues from longer-term risks in the register, akin to NHS Lanarkshire, to prevent persistent "red" ratings. He also emphasised defining risk appetite and establishing clear actions and timelines. Claire Rae concurred, noting she and Nicola Scott were reviewing risk articulation. She questioned the current risk level, considering turnover, and stressed the importance of understanding tolerable risk by September. She agreed the risk report needs restructuring for better clarity, discussion, and actionable insights. Recommendations: 1. IJB PFA Committee noted 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. 2. IJB PFA Committee noted 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. Morag Dendy For Noting 15. Risk Brian Moore noted the paediatric SLT risk and advised that it is important that the board review this in detail and consider including it in the risk register for further monitoring. 16. Date of next meeting: 27th August 2025, 14:00-16:30, Via MS Teams Claire Rae noted that Kerry Taylor is working on refining the agenda for future IJB PFA meetings to focus more on PFA, with the possibility of moving some reports to the main IJB meeting.
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REPORT Item No: 5 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee for: For approval For endorsement For noting 1.2 This report provides a summary of the North Lanarkshire University Health and Social Care Partnership (the Partnership) for the period 1 April 2025 to 30 June 2025 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the PFA Committee: (1) Acknowledge the contents of the report; and (2) Acknowledge the projected outturn for 2025/26 is an overspend of £4.945m 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND 5.1 In line with the integration scheme, North Lanarkshire IJB directs budget back to North Lanarkshire Council (NLC) and NHS Lanarkshire (NHSL), the partner organisations, who provide the associated services. 5.2 Direction Letters were approved by the IJB and issued to both NLC and NHSL in March 2025 to direct them to carry out the integrated functions delegated to the IJB and to confirm the resources to be allocated for the resultant services in the forthcoming year.1 As detailed within these, the focus for the year ahead will be on the implementation of the programme of work for the IJB’s Strategic Commissioning Plan 2023-26. 1 IJB Directions Letters SUBJECT: Financial Monitoring Report 2025/26 TO: Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 27 August 2025 Yes No N/A
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5.3 Both Partners provide the required information on operational budget performance from their respective financial systems. This information is then consolidated to provide reports to the Board on delegated health and social care services. Budget monitoring is undertaken by the finance teams within NLC and NHSL, overseen by the Chief Finance Officer. 6. 2025/26 BUDGET 6.1 The Medium Term Financial Plan (MTFP) for 2025/26 to 2027/28 was approved in March 2025 which identified a 3 year budget gap for the Partnership of £51.854m, of which £14.959m relates to 2025/26. The budget for the Partnership this year is £859.034m as detailed in Appendix 1. 6.2 Throughout the year, adjustments are made to the original budget due to additional budget allocations and budget transfers. Appendix 2 provides a reconciliation of the budget adjustments applied to date. 7. 2025/26 FINANCIAL PERFORMANCE 7.1 The information within this report is based on the NHSL month 3 report (to 30 June 2025) and NLC period 3 report (to 20 June 2025). This shows a projected year end overspend of £4.945m, assuming the current trajectory of spend continues throughout the financial year. Table 1 provides a summary of the Partnership’s position. Table 1 7.2 The projected year end variance can be attributed to £0.994m underspend in relation to the services delegated to health offset by a £5.939m overspend for services delegated to social care. Appendix 3 details the projected variances within each area. 7.3 An explanation of the significant operational projected variances within these delegated services are provided below: 7.3.1 Employee Costs (Pays) – underspend of £8.889m There continues to be challenges service wide in recruitment and retention. For a wide range of posts, recruitment has been unsuccessful due to the availability of the skill mix required or the competition being offered by other private and public sectors. Section 10 of this report provides further detail on vacancy levels and the impact these are having on agency, bank aide and overtime costs. Annual Projected Projected Budget Outturn Outturn Variance £m £m £m Core Delegated Services 576.007 584.343 (8.336) Hosted Services 205.629 202.238 3.392 Set Aside Services 77.397 77.397 0 Total 859.034 863.979 (4.945)
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Social Care Services 7.3.2 Excluding employee costs reported in section 7.2.1, the services delegated to Social Care are projecting an overspend of £6.716m, the majority of which is within Payment to Other Bodies. The costs reported within this area are predominantly Care at Home and Independent Care Homes. As part of the MTFP £7.548m was removed from these budgets to recognise the savings to be made in these areas throughout 2025/26. The overspend therefore recognises that most of these savings are yet to be achieved. More detail is provided on the savings achieved to date in section 9. 7.3.3 The projections for independent care homes and care at home provision are demand led and are based on the full year costs for both current clients and those anticipated, therefore projections will alter as the year progresses. The current projections are based on the following: • Independent care homes have a yearly budget to fund 1,344 care plans but at present the number of care plans is 1,451 resulting in an overspend of £4.210m. • Care at Home costs are projected to overspend by £2.907m, the budget is based on funding 2,514 care plans however the actual plans in place total 2,767. Health Services 7.3.4 Non pay costs have a year to date overspend of £1.799m resulting in the reported projected overspend of £7.1m. A decision was taken as part of the financial planning process to eliminate all historical cost pressures within non pay areas and instead report any financial gaps centrally. The intention is to generate savings through sustainability and value exercises to offset this overspend, if successful it will result in this outturn position improving over the coming months. 7.3.5 The year end overspend on prescribing for 2024/25 was £4.757m therefore to recognise historical pressures and anticipate a level of further growth the budget was increased by £12.350m. The impact of this is that a break even position is being projected this financial year. Based on data available to April 2025 and estimated data for May and June 2025 the cost per item has decreased to £10.23 from £10.37, and the number of items being dispensed has increased by 5.6% based on the same period last year. 7.3.6 Hosted Services are forecasting an overall underspend of £3.392m. There are a number of offsetting variances across this area however the most significant underspends are within Podiatry, CAMHS, Speech & Language Therapy and Psychological Therapies which are partially offset by overspends in Children’s Services and Learning Disability Services 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.
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8.2 The opening reserves balance for 2025/26 was £75.554m and the current IJB reserves position after adjustments for the drawdown of in-year reserves, is a revised balance of £72.556m and is summarised in table 2. Table 2 LEAD SUMMARY Opening Balance as at Transfers To / From Reserves Drawdown from Reserves Projected Balance as at 1st April 2025 31st March 2026 £m £m £m £m NHSL Ring-Fenced Reserves 14.839 0.000 -0.649 14.190 NLC/NHSL Earmarked Reserves 25.060 0.000 -2.349 22.711 NLC/NHSL Risk-Based Reserves 21.536 0.000 0.000 21.536 NHSL Contingency Reserves 14.119 0.000 0.000 14.119 NLC/NHSL Closed Reserves 0.000 0.000 0.000 0.000 Total 75.554 0.000 -2.998 72.556 8.3 A detailed list of all reserve movements during 2025/26 is detailed in appendix 5 including a key guidance table showing how the reserves are aligned to the five ambition statements detailed in the Strategic Commissioning Plan 2023-26. 8.4 Board Directors should note the transfer of £0.629m between Pharmacy Mental Health Recovery and School Nursing, this is simply the result of an error when the reserves were agreed at the start of the financial year. 9. SAVINGS 9.1 As detailed in section 6, the MTFP identified a budget gap for 2025/26 of £14.959m and the response to this was to develop service redesign and transformation actions. 9.2 These are summarised in Table 3. Table 3 SERVICE REDESIGN & TRANSFORMATION £m Social Care Services 10.386 Home Support 2.838 Independent Care Homes 4.710 Care at Home 2.838 Health Care Services 4.573 Budget Management Non Pays 0.247 Prescribing 4.326 TOTAL 14.959
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9.3 Savings are monitored monthly at the Senior Management Team Finance meeting. Progress is provided by the Senior Management Team on actions being taken against the service transformation work. This includes an update on the following work streams: • A poly pharmacy review • A review of non pay budgets • The roll out of “Getting it Right for Everyone” • Updates on the financial planning assumptions • Review of all vacant posts. 9.4 The current IJB savings position at the end of June 2025, show total savings achieved of £1.917m (13%). This is summarised in chart 1 with more detail provided at Appendix 6. Chart 1 9.5 The reserves strategy, as outlined in section 10 of the MTFP, recognises that savings plans can take time to implement and therefore the contingency and risk based reserves are being held to fund any savings gaps that cannot be met during the year. 10. VACANCY POSITION 2025/26 10.1 Table 4 shows the full time equivalent (FTE) vacancy numbers at 30 June 2025 within each service compared against their budgeted establishment. 14.959 1.917 1.131 0.786 Delivery Plan Target £m Total Savings Achieved £m Health Achieved to Date Social Care Achieved to Date 0.000 5.000 10.000 15.000 20.000 25.000 30.000 £m North Lanarkshire IJB Savings Delivery Plan
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Table 4 Service Position as at 30 June 2025 Establishment Actual Vacancies FTE FTE FTE North West Locality 391.78 367.39 24.39 North East Locality 331.25 318.36 12.89 Adult Services 288.44 267.89 20.55 Children Services 597.29 559.48 37.81 Mental Health 1,226.38 1,252.27 -25.89 Social Care Services 967.10 825.38 141.72 Home Support 996.57 930.45 66.12 Other 229.09 217.55 11.54 TOTAL 5,027.90 4,738.77 289.13 10.2 To help cover the vacant posts throughout the year, agency staff, bankaide, overtime and excess part time hours are used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 7 and summarised in Table 5. Table 5 SERVICE Costs As At 30 June 2025 Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.013 0.007 0.214 0.000 0.234 North East Locality 0.006 0.001 0.141 0.000 0.149 Adult Services 0.015 0.027 0.076 0.000 0.118 Children Services 0.009 0.024 0.239 0.046 0.317 Mental Health 0.075 0.018 1.224 0.606 1.923 Social Care Services 0.087 - - 0.000 0.087 Home Support 0.581 - - - 0.581 Other 0.004 0.003 0.018 - 0.025 TOTAL 0.789 0.080 1.912 0.652 3.434
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12. IMPLICATIONS 12.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 12.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 12.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken.
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Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance) within NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 12.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 13. BACKGROUND PAPERS None. 14. APPENDICES Appendix 1 North Lanarkshire IJB Annual Budget 2025/26 Appendix 2 IJB Budget Reconciliation 2025/26 Appendix 3 North Lanarkshire Revenue Budget Position to 30 June 2025 Appendix 4.1 Hosted Services led by North Partnership to 30 June 2025 Appendix 4.2 Hosted Services led by South Partnership to 30 June 2025 Appendix 5 Movement in Reserves 2025/26 Appendix 6 Savings Progress to 30 June 2025 Appendix 7 Analysis of Additional Employee Costs 2025/26
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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 North Lanarkshire IJB Annual Budget 2025/26 Care Group Annual Budget £m 2025/26 Health Care Services Health Care 300.041 Hosted Services 205.629 Set-Aside Budget 77.397 Total Expenditure - NHSL 583.068 Social Care Services Social Care Services Gross Expenditure 279.204 Social Care Services Gross Income (5.811) Social Care Services Net Expenditure 273.393 Housing Revenue Account 2.573 Social Care, Housing and Transport Services Net Expenditure 275.966 Total Expenditure - NHSL and NLC 859.034 Funded By: £m NHS Lanarkshire Funding (580.070) Social Care Funding (24.119) Resource Transfer (24.690) Commissioned Services (7.225) Transfer from Reserves (Approved) (2.998) Total Funding - NHSL (639.103) NLC Funding - Social Care Services (217.358) NLC Funding - Housing Services (2.573) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (219.931) Total Funding - NHSL and NLC (859.034)
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Appendix 2 North Lanarkshire IJB Budget Reconciliation 2025/26 2025/26NHSL Financial Allocation to North Lanarkshire HSCP £m 2025/26 NLC Financial Allocation to North Lanarkshire HSCP £m 2025/26 North Lanarkshire HSCP Financial Allocation 274.566 2025/26 North Lanarkshire HSCP Financial Allocation 217.358 2025/26 Area Wide 8.021 NLC Funding - Housing Services 2.573 2025/26 Prescribing 86.525 NLC Financial Allocation at 20 June 2025 219.931 Set-Aside Budget 77.397 South Hosted @ 52% 43.332 Family Health Service South @ 52% 136.482 NHSL Financial Allocation at 31 May 2025 626.323 Budget Adjustments Posted in Month 3 IJB Reserves North 0.550 Income North 1.275 Allocations 0.911 Pay Award 6.554 SLA Uplift 1.676 Area Wide Increase 0.243 South Hosted @ 52% 1.497 Family Health Service South @ 52% 0.074 NHSL Financial Allocation at 30 June 2025 639.102
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Appendix 3 North Lanarkshire IJB Revenue Budget Position 1 April 2024 to 30 June 2025 Annual Year To Date Variance Projected Year End Outturn Budget Budget Actual Total Total 2025/26 June 2025 June 2025 June 2025 2025/26 £m £m £m £m £m Health Care Services Locality and Other Services 59.501 15.444 16.049 (0.605) (2.419) Addiction Services 4.433 1.122 1.122 0.000 0.001 Medical and Nursing Directorate 4.106 0.958 0.911 0.047 0.187 Prescribing 85.457 20.564 20.564 0.000 0.000 Out of Area Services 1.723 0.431 0.492 (0.061) (0.243) Area Wide Services 8.264 1.759 1.740 0.019 0.077 Family Health Services 136.556 35.264 35.264 0.000 0.000 Hosted Services 205.629 50.814 49.967 0.847 3.392 Set-Aside Budget 77.397 19.349 19.349 0.000 0.000 Total Expenditure - NHSL 583.068 145.704 145.457 0.247 0.994 Social Care Services Social Care Services Gross Expenditure 279.204 64.432 65.779 (1.348) (5.839) Social Care Services Gross Income (5.811) (1.341) (1.318) (0.023) (0.100) Social Care Services Net Expenditure 273.393 63.091 64.461 (1.371) (5.939) Housing Revenue Account 2.573 0.594 0.594 0.000 0.000 Social Care, Housing and Transport Services Net Expenditure 275.966 63.684 65.055 (1.371) (5.939) Total Expenditure - NHSL and NLC 859.034 209.389 210.512 (1.123) (4.945) Care Group Year To Date
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Appendix 4.1 Hosted Services Led by the North Partnership Annual Budget 2025/26 Year to Date Year to Date North Lanarkshire IJB - 52% Share South Lanarkshire IJB - 48% Share June 2025 June 2025 June 2025 June 2025 June 2025 June 2025 Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m Sexual Health Services 3.895 0.521 0.442 0.079 0.481 0.481 0.000 Continence Services 3.342 0.432 0.397 0.034 0.399 0.399 0.000 Immunisation Services 2.704 0.572 0.570 0.002 0.528 0.528 0.000 Speech and Language Therapy Services 7.906 1.004 0.781 0.223 0.926 0.926 0.000 Children and Adolescents Mental Health Services 16.926 1.911 1.646 0.264 1.764 1.764 0.000 Children’s Services 15.432 1.979 2.133 (0.154) 1.826 1.826 0.000 Integrated Equipment and Adaptations Store 0.567 0.074 0.071 0.003 0.068 0.068 0.000 Dietetics Services 4.775 0.631 0.545 0.086 0.582 0.582 0.000 Podiatry Services 5.372 0.682 0.527 0.156 0.630 0.630 0.000 Prisoner Healthcare Services 2.508 0.321 0.312 0.009 0.296 0.296 0.000 Blood Borne Viruses Services 1.878 0.234 0.234 0.000 0.216 0.216 0.000 Hospital at Home 2.919 0.418 0.421 (0.004) 0.386 0.386 0.000 Mental Health and Learning Disability Services 92.577 11.982 11.834 0.148 11.060 11.060 0.000 TOTAL 160.800 20.759 19.912 0.847 19.162 19.162 0.000
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Appendix 4.2 Led by the South Partnership Annual Budget 2025/26 Year to Date Year to Date North Lanarkshire IJB - 52% Share South Lanarkshire IJB - 48% Share June 2025 June 2025 June 2025 June 2025 June 2025 June 2025 Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m Community Dental Services 8.363 1.053 1.053 0.000 0.972 0.811 0.161 Brain Injury Unit 2.725 0.336 0.336 0.000 0.310 0.209 0.101 Out of Hours Services 11.112 1.375 1.375 0.000 1.269 1.269 0.000 Palliative Care Services 8.080 1.066 1.066 0.000 0.984 0.952 0.033 Physiotherapy Services 13.015 1.648 1.648 0.000 1.521 1.423 0.097 Primary Care Services 0.930 0.118 0.118 0.000 0.109 0.076 0.033 South Improving Cancer Journey 0.084 0.044 0.044 0.000 0.040 0.040 (0.000) Occupational Therapy Services 9.439 1.195 1.195 0.000 1.103 0.980 0.123 Diabetic Services 6.043 0.774 0.774 0.000 0.714 0.705 0.009 Primary Care Improvement Fund 26.418 3.283 3.283 0.000 3.031 3.131 (0.100) Primary Care Transformation Fund 0.000 0.000 0.000 0.000 0.000 0.000 0.000 TOTAL 86.210 10.892 10.892 0.000 10.054 9.596 0.458
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Appendix 5 MOVEMENT IN RESERVES LEAD RING-FENCED RESERVES Opening Balance as at Transfers To / From Reserves Drawdown from Reserves Revised Balance as at Movement in Reserves 2025/26 Ambition Statement & Performance 1st April 2025 31st March 2026 £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 (0.001) 0.122 (0.001) 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.318 (0.045) 0.273 (0.045) 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 (0.032) 0.883 (0.032) 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 MH Diagnostic Support Service Dementia Post 1.057 1.057 0.000 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.221 (0.017) 0.204 (0.017) 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 (0.375) 2.344 (0.375) 1, 2, 3, 4, 5 NHSL Pharmacy Mental Health Recovery & NES Training 0.800 (0.629) (0.171) 0.000 (0.800) 1, 2, 3, 4, 5 NHSL School Nursing 0.274 0.629 0.903 0.629 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 (0.008) 0.006 (0.008) 3 TOTAL RING-FENCED RESERVES 14.839 0.000 0.649 14.190 0.649
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Appendix 5 (Contd) LEAD EARMARKED RESERVES Opening Balance as at Transfers To / From Reserves Drawdown from Reserves Revised Balance as at Movement in Reserves 2025/26 Ambition Statement & Performance 1st April 2025 31st March 2026 £m £m £m £m £m NHSL MH Funding 1.500 1.500 0.000 4 NHSL Children and Adolescent Mental Health Services 2.774 (0.172) 2.602 (0.172) 1, 2, 4, 5 NHSL Frailty Nursing 1.715 (1.714) 0.001 (1.714) 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 (0.102) 0.152 (0.102) 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 0.087 0.087 0.000 3 NHSL Breast Feeding Team (2 year funding) 0.345 (0.116) 0.229 (0.116) 1, 2, 5 NHSL Dietetics Services - Double Running Costs 0.055 0.055 0.000 0 NHSL Health Inequalities - Screening 0.016 (0.008) 0.008 (0.008) 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 0.293 (0.048) 0.245 (0.048) 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 (0.003) 0.339 (0.003) 1, 2 NHSL Scottish Clinical Leadership Fellowship 0.060 (0.011) 0.049 (0.011) 3
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Appendix 5 (Contd) NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.297 0.297 0.000 1, 2 NHSL Staff Training Academy 0.335 (0.140) 0.195 (0.140) 3 NHSL Vulnerable and Complex Cases - Test of Change 0.501 (0.034) 0.467 (0.034) 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 Home Support Scheduling System 3.332 3.332 0.000 2, 3 NLC Digital - 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 TOTAL EARMARKED RESERVES 25.060 0.000 (2.349) 22.711 (2.349)
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Appendix 5 (Contd) LEAD RISK-BASED RESERVES Opening Balance as at Transfers To / From Reserves Drawdown from Reserves Revised Balance as at Movement in Reserves 2025/26 Ambition Statement & Performance 1st April 2025 31st March 2026 £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 TOTAL RISK-BASED RESERVES 21.536 0.000 0.000 21.536 0.000 LEAD CONTINGENCY FUND RESERVES Opening Balance as at Transfers To / From Reserves Drawdown from Reserves Revised Balance as at Movement in Reserves 2025/26 Ambition Statement & Performance 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 14.119 14.119 0 1, 2, 3, 4, 5 TOTAL CONTINGENCY FUND RESERVES 14.119 0.000 0.000 14.119 0 TOTAL RESERVES 75.554 0.000 (2.998) 72.556 (2.998) KEY Ambition Statement & Performance 1 Do the right thing first time. 2 Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. 3 Develop and support a workforce for the future. 4 Improve mental health and wellbeing. 5 Supporting people through a whole family approach.
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Appendix 6 SAVINGS PROGRESS 2025/26 Description of Approved Saving Target Value Achieved to Date Savings Gap Commentary RAG Status £m £m £m Home Support Home Support re-design which will include the introduction of the dynamic scheduling tool to support the process of streamlining shift patterns alongside service provision. The re-design will further develop the enabling approach as the operating model. 2.838 0.278 2.560 Independent Care Homes Focus the strategic direction to reduce both the length of stay in care homes and the number of people being placed. 4.71 0.508 4.202 Care at Home A review of the guided self-assessment process to align with a more strategic assessment and planning practice. 2.838 0 2.838 TOTAL SOCIAL CARE SERVICES 10.386 0.786 9.600 Budget Management Non Pays A review of budget lines including (but not limited to) travel, training and printing costs. 0.247 0.063 0.184 Prescribing A review of prescribing will be undertaken with a 5% savings target being applied. 4.326 1.068 3.258 TOTAL HEALTH CARE SERVICES 4.573 1.131 3.442 TOTAL HEALTH & SOCIAL CARE PARTNERSHIP 14.959 1.917 13.042 RAG Status Key Saving achieved Saving partially achieved and has reached expected year to date target Saving not achieved to date HEALTH CARE SERVICES Any year end shortfall in savings will be met from reserves. Approved Savings SOCIAL CARE SERVICES Any year end shortfall in savings will be met from reserves
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Appendix 7 ANALYSIS OF ADDITIONAL EMPLOYEE COSTS 2025/26 Period BANKAIDE COSTS YEAR TO DATE North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 60,410 40,242 22,805 78,946 394,171 4,388 600,961 2 83,505 51,595 29,001 91,869 445,963 6,913 708,846 3 70,210 49,172 23,974 68,265 383,680 6,775 602,075 TOTAL 214,125 141,008 75,780 239,080 1,223,814 18,076 1,911,883 Period AGENCY COSTS YEAR TO DATE North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 0 0 0 26,054 303,197 -52,687 276,564 2 0 0 0 20,267 303,197 52,426 375,889 3 0 0 0 0 0 0 0 TOTAL 0 0 0 46,320 606,394 -261 652,453 Period OVERTIME COSTS YEAR TO DATE North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 3,378 3,213 6,503 3,183 32,198 -18,944 -68,736 2,540 -36,666 2 4,489 1,471 2,956 1,922 20,113 50,355 342,967 694 424,967 3 4,835 1,466 5,689 3,419 22,245 55,865 306,838 625 400,982 TOTAL 12,702 6,150 15,148 8,524 74,555 87,276 581,069 3,859 789,283 Period EXCESS PART TIME COSTS YEAR TO DATE North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 2,694 532 9,955 9,215 5,993 1,168 29,556 2 1,669 437 6,550 6,378 6,579 1,074 22,687 3 2,635 488 10,986 7,952 5,225 737 28,022 TOTAL 6,998 1,457 27,491 23,544 17,797 2,979 80,266
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1 Item No: 6 SUBJECT: Performance Update – 01st January 2025 to 31st March 2025, Quarter 4 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: 27 August 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☐ For endorsement ☐ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ Prepared by: Performance Manager Reviewed by: Senior Manager, Strategy & Performance
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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 January 2025 to 31st March 2025, Quarter 4 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 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 3047 583 501 RED Alcohol Brief Interventions (all settings) NHSL 7381 1751 1470 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 provide ABI training to locality staff to ensure there is capacity across all teams that contribute to the target. Health Improvement also contribute to wider work supporting the reduction of alcohol misuse in North Lanarkshire. A short life working group has been established to consider the specific needs of older adults in relation to alcohol use; what support is currently in place, to identify any gaps in provision, as well as promoting the services that are available to them. A similar short-life working group has also been established to examine multi-risk-taking behaviours among young people, focusing on the support currently available to them and identifying any gaps in existing services. Additional work is being planned with parents, including consultations through focus groups, to explore their needs and how best to support them in effectively engaging with their children and young people around issues such as alcohol and other harmful substances. 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 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 70.0% 69.6% RED Narrative & Corrective Action
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7 The overall trend is for a slow and gradual decrease in the level of performance and it has been several years since the targeted level of performance was achieved. Location Quarter 1 (Apr–Jun) Quarter 2 (Jul–Sep) Quarter 3 (Oct–Dec) Quarter 4 (Jan–Mar) Target Airdrie 67.8% 68.1% 67.2% 66.5% 80.0% Bellshill 69.5% 69.7% 68.9% 68.8% 80.0% Coatbridge 69.6% 68.9% 68.0% 67.7% 80.0% Motherwell 71.4% 71.6% 70.4% 69.8% 80.0% North 74.9% 74.6% 73.6% 73.2% 80.0% Wishaw 70.2% 70.0% 68.9% 68.8% 80.0%
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8 Wider screening work is directed and monitored by the Inequalities in Screening Steering Group, which is considering a number of contributory factors to the level of performance, with access to appointments a key issue identified as impacting on screening attendance. Training, engagement with the wider organisation and leveraging wider patient contact as a means to engage regarding screening, are other key areas of interest for the steering group to develop improvement plans. Health Improvement (HI), Place-based Activity Jan – Mar 2025 Cervical Cancer Prevention features in all HI newsletters and social media across North Lanarkshire. These communications are distributed across our statutory, third sector and healthcare partnerships. Cervical Cancer Prevention Week - January 2025 Cervical Screening Pop up in ASDA – Coatbridge Locality This awareness session was attended by in excess of 50 women aged 25-64. Outcomes: Increased awareness of and reduced barriers to cervical screening (signs and symptoms) through direct engagement and information sharing with 50 customers and staff, who were within the 25-64 age range. Undertook brief intervention with those women identified from the direct engagement that had not attended their cervical screening appointment. Cervical screening information provided to be displayed and distributed in the ASDA store staff rest areas. Offered training opportunities for staff to raise awareness of cervical screening. Whilst community engagement and awareness activity is strategic and targeted at the widest audience possible it is important for the service to see the impact of their work, which is being captured through Personal Stories, with a notable example from this exercise below: “We spoke to one lady, in her 40s, who had 10 years previously received treatment for high grade CIN changes & she then went on to have children but was now too scared to attend her screening invites. We spent time with her, listening to her fears and provided her with an information leaflet for her to take home – she said she really would read this at home in her own time and we hoped that this would ‘plant a seed’ and encourage her to make a screening appointment in the future”. A similar Pop-up event was held in the atrium of Houldsworth Centre, Wishaw with a stall in place to raise awareness of the importance of cervical cancer screening. Health Improvement staff and Practice Nurses were available and spoke with in-excess of 50 women. A physical display was available for women to see equipment such as speculums, cyto-brushes and sample pots, along with a video clip giving information on HPV, with the aim of reducing fear of cervical screening and increasing awareness and understanding of the screening process. Training Opportunities
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9 Health Improvement Teams across North Lanarkshire continue to offer Screening and Inequalities training to all Health and Social Care staff and Community Voluntary Sector partners. The training available is advertised on the Health Improvement Training Calendar, which can be accessed using the QR code, below. Scan the below QR code to access our Health Improvement Training Calendar. Cervical Screening awareness in Early Years Establishments Cervical Screening leaflets were provided to Dunbeth Family Learning Centre, with the leaflets prominently on display in both the reception and the staff room, with posters on display in the staff room for increased visibility. Staff were briefed on the content and provided with information, with the view that this information and knowledge could be cascaded to users of the centre and raise awareness of Cervical Screening. There are plans to extend this to other early years settings in the future. Similar information was shared with the Young Parents Group in Cumbernauld and Routine Enquiry will continue with this group on cervical screening, as well as other health and wellbeing topics. Routine Enquiry – Brief Interventions The Treatment Room in Wishaw Locality continue to deliver cancer screening conversations as Routine Enquiry. From January to March 2025, Treatment Room staff undertook 215 cancer screening conversations, with 69 of those specifically focussed on Cervical Screening. Cervical Screening Awareness is a Wishaw Locality Planning Group (LPG) Priority Cervical Screening Awareness will be the focus of the Wishaw LPG as part of their work to address Poverty and Inequalities. A Cervical Screening Awareness sub-group, led by Health Improvement colleagues, has been formed and an Action Plan is currently in development to provide structure for this work. Clarification of performance reporting from multiple Cervical Screening Data Recording Systems Recent scrutiny of Cervical Screening performance has highlighted a need to increase awareness and understanding of the two separate data recording systems for Cervical Screening. Possible misunderstanding, or lack of knowledge and awareness of how the data recording systems are managed may be a systemic contributor to performance levels and requires further consideration. The discrepancies between the two systems in use (Scottish Cervical Call Recall Service (SCCRS) / GP recording system and the Public Health Morse data) have been escalated to the Public Health Consultant for Screening, who has agreed to raise the issue at a national level. The Scottish Cervical Call Recall Service (SCCRS) /GP recording system rules state that, after sending three invitations and recording 3 DNA, the practice is paid (so as not to cause disadvantage to them), meaning these women are considered as ‘screened’ and so removed as defaulters from that system. However, the Public Health/Milan
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10 system does not remove defaulters from their denominator. This results in the data held by GP practices reporting a higher percentage of women screened than the reporting derived from the Public Health data, which does not discount defaulters from the calculation. It is hoped that raising this issue nationally will highlight the need for improved recording and reporting of Cervical Screening uptake and potentially influence our national partners to expedite improvements at that level. 3. Childhood Immunisations Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Immunisations – %s of 5 year olds 95% 89.0% 88.7% RED Narrative & Corrective Action The long-term trend for the 5-year old immunisations metric is for a sustained decline in the level of performance over several years; the last time that the targeted level of performance was achieved was in Q1 of 2021/22. Whilst the result for the 2-year old immunisations metric is below target for Q4, historically the target has been achieved and there is evidence of sustained performance at the targeted level in the recent past. It should be noted that families who actively decline their children to be vaccinated, as well as children who no longer live in Lanarkshire (or in some cases no longer reside in the UK) but remain on GP lists, are still included within the denominator, which impacts on the performance figure. 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. All efforts are made with families who actively decline their children to be vaccinated, however repeat unwanted contact with those families where the position has been clarified as declining vaccination, is minimised. Staff nurses continue to offer immunisations within the clinic and at 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. The NW Sector also utilise cross-cover arrangements, with a sector approach to manage and maximise capacity within those three localities. To combat the declining trend, NHS Lanarkshire has undertaken the following actions: · 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.
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11 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% 83.4% ... RED Narrative & Corrective Action Please note that this performance measure is reported two quarters in arrears. 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. 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 is introduced, as the approach to this is not standard across teams.
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12 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 Q3 2024/25 Q4 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) 1387 1788 ... RED Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 56.5% 63.0% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 63.6% 62.5% RED IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 60.1% 73.4% RED Narrative & Corrective Action 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 Home Support packages that are Reablement is relatively stable in a range, 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 The most recent HAT reporting covers a period beyond Q4 2024/25 and extends to May 2025. This reporting notes that since the beginning of the service, 3,496 referrals were accepted by HAT. Since the start of the service, referrals that were not accepted grew in volume up until May 2024, however this trend then reversed, with very few
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13 referrals not accepted (21 in March 2025 and 12 in April). Over the last year, 369 referrals were not accepted; 66% of referrals that were not accepted over the past year were from UH Wishaw. May 2025 was the thirteenth consecutive month where the volume of referrals exceeded 100. The average number of total monthly referrals over the past year was 127. The monthly referral distribution across the localities has been relatively stable over the past year: • Wishaw: 350 (21%) • Cumbernauld: 327 (20%) • Airdrie: 294 (18%) • Motherwell: 261 (16%) • Coatbridge: 226 (14%) • Bellshill: 181 (11%) Referral Sources There is very little difference in percentage terms from previous reporting regarding the HAT referrals by hospital of origin. However, it is notable this is the first reporting period where UH Monklands has overtaken UH Wishaw and it has now accepted 85 more referrals than UHW since the start of HAT.
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14 • UH Monklands: 1,731 – 50% • UH Wishaw: 1,646 – 47% • Other: 119 – 3% (includes older referrals with no source recorded) HAT Inputs The average number of input services for HAT cases has increased over time. The data on input services continues to reflect the expanding scope and complexity of support provided by HAT. Of the total referrals, only 1% (41 individuals) had no input services recorded, likely representing older cases, while 53% received one or two services. Notably, the proportion of individuals receiving three or more services has risen slightly and the average number of input services per referral has gradually increased; assuming that input services is a proxy of the intensity of support needs among service users, this may be an early indication that the HAT service is dealing with more complexity over time. Home Support remains the most frequently provided input service, involved in 87% of referrals, which is consistent with previous reporting. The volume of referrals where Occupational Therapy and Physiotherapy are input services has grown. HAT Outputs Around 96% of all referrals, or 3,349 individuals have completed the HAT service since its inception. Of those who completed the process, 14% (466 people) were re- admitted to hospital and 37% (1,238 individuals) were identified as needing further services; these proportions appear to be consistent over time.
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15 At the point of completion, 63% of individuals required no further support, while 37% were recorded as needing at least one service. Of those, the majority (73%) required only one service, with the remainder needing two or more. The most frequently provided services were IRT (Physiotherapy) and Reablement, each accounting for 14% of completions, followed by IRT (Occupational Therapy) and mainstream Home Support each accounting for 10%. 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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16 The overall number of waits has decreased in-line with the decrease in referrals; the number of people waiting for IRT Reablement allocation in Q4 was the lowest level experienced in financial year 2024/25. 35 30 36 27 15 25 11 13 9 8 14 4 13 0 5 10 15 20 25 30 35 40 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 No. of referrals - May-24 to May-25
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17 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. 15 12 18 13 6 13 5 5 6 8 5 3 6 0 2 4 6 8 10 12 14 16 18 20 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 No. waiting on allocation on last day of month - May-24 to May-25
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18 HOME SUPPORT REDESIGN The Home Support Redesign Programme 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. It is supported by several products that have been produced to progress the work, including service specifications, a workforce profile and an analysis of demand/capacity data. 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. 6. Adult Mental Health Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 72.3% 75.0% RED 0 10 20 30 40 50 60 aaNew Visit aaTelephone Assessment aClosing Summary Duty Repeat Visit Screening Telephone Calls zDiscussed with OT/PT zDiscussed with Senior/Team Leader zEmails Contact activity by contact type - Mar 2025 Airdrie Bellshill Coatbridge Cumbernauld Motherwell
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19 Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 23.5% 21.8% RED Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 61.9% 66.2% RED Narrative & Corrective Action 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) Although the targeted level of performance has not been met for some time, there were improvements in the monthly and quarterly results for this indicator. The current performance is consistent with the DCAQ modelling produced by the PHS Analyst; the current modelling suggests that the RTT position will be within a range of between 70% and 80%, based on the overall position for the service. The total number of patients waiting over 18 weeks has decreased significantly; over the last 12 months the number of patients waiting over 18 weeks has decreased by 29.8%. The total queue is less that the anticipated trajectory, indicating that there has been sustained progress in reducing the waiting list, which is at the lowest level experienced since October 2022; there is a 22.9% reduction at end of March 2025 when compared with March 2024.
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20 The referral criteria for Neuropsychology changed in November 2023. Our analysis shows that referrals have increased by 64.3% since this change. Modelling conducted within the service indicates that, if current trends continue, the volume of referrals will result in the waiting list reaching 175.1% of its current size by November 2026. To meet the RTT (Referral to Treatment Time) target under these conditions, an additional 4.25 WTE (Whole Time Equivalent) clinician capacity would be required. An SBAR detailing potential options and the management of risk in this area has been escalated through governance structures. The waiting list reduction initiative, led by Psychological Services to reduce the longest waits within the Lanarkshire Weight Management Service (LWMS), is now complete. During the three-month period of this initiative, the waiting list for LWMS has reduced from 68 to 7. With the exception of one outlier, at the end of March 2024 all patients waiting were within the 18 week RTT. Close monitoring of waiting times within this service will continue beyond the initiative to ensure that there is a sustained improvement. As part of ongoing work relating to the Implementation of the National Specification of Delivery of Psychological Therapies and Interventions, Psychological Services have now completed a Self-Assessment against the PT Specification. Actions resulting from this will be incorporated within service work plans. The Addiction Psychology Service (APS) continues to take a lead role in supporting the implementation of Medication Assisted Treatment (MAT) standards 6 & 10. The 2024/2025 reporting for MAT standards has recently been submitted, including an overarching plan for the delivery of ‘Psychologically and Trauma Informed Care’ across addiction services. The Addiction Psychology Service lead on workforce development in relation to psychologically and trauma informed care for all staff, including those who working within both statutory and third sector addiction services in Lanarkshire. As requested by Scottish Government (SG), whole-service aggregate level trajectories against the PT waiting times standards were produced up to the end of March 2026 and recently submitted to the SG. The embedded PHS analyst is now analysing those updated trajectories using the most recent data, starting from January 2025 and as more data is available, these trajectories will be updated accordingly. In the longer-term, to support staff development, recruitment and retention, a second MDT Research conference in collaboration with University partners, which is to be held at Strathclyde University with the theme of: Research and Innovation really matters: The next generation is currently being developed, to be held on 3rd October 2025. In addition, a Psychological Services 3-year Training Plan 2025-2028 is in development. 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.
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21 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. • 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.
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22 • 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. Medical Paediatrics Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90%* 87.9% 80.3% RED Narrative & Corrective Action Due to significant levels of acuity within the acute wards, there was a redirection of clinical capacity to support acute colleagues. In addition to this, the service experienced short term sickness absence within the group of Consultants. This was experienced in quarters three and four, however the position was improved toward the end of March, with some recovery expected in subsequent quarters. These factors led to slight decreases in capacity and cumulatively are likely to be responsible for the negative impact on performance in quarter four. The majority of children and young people on the waiting list are being seen within 4 weeks and there is continued and detailed monitoring of the waiting list by the Unit Performance Meeting. Preliminary analysis indicates that the impact has been more pronounced in certain sub-specialties within Medical Paediatrics, particularly in the Allergy specialty, which has seen a notable increase in waiting list numbers. At the time of writing, there are live adverts and interviews planned for additional Consultant staff; once recruited to, these posts will provide resilience and capacity, with an associated increase in RTT performance expected. 8. SLT Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status
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23 SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 16.0% 17.6% RED SLT - Adult - 12wks (NORTH HOSTED) 90%* 74.4% 79.2% RED Narrative & Corrective Action SLT - Adult - 12wks (NORTH HOSTED) Performance for Q4 improved slightly from the previous quarter (rising to 79.2%) but remains below the 90% target and significantly lower than the same quarter in the previous year. As previously reported, the end of post-COVID recovery funding continues to have an impact. Although no posts were lost, due to recruitment challenges overall staffing levels in the Adult Acquired service remain reduced by 7.4% compared to the previous year. The service continues to experience long-term sickness absence, further constraining capacity. However, these cases are being managed through ongoing HR-supported absence management processes, with monthly oversight from the management team. Despite these pressures, referral demand remains elevated, with a 4% rise in monthly referrals and high levels of referral demand sustained for several quarters. Recruitment efforts are progressing, with a focus on restoring lost capacity. Opportunities for longer-term system improvement, such as the administrative skills matrix and digital system alignment (notably Trakcare), are being actively explored, in line with broader SLT transformation work. SLT - Paediatrics - 12wks (NORTH HOSTED) Performance for Q4 has shown a modest improvement from Q3 (rising to 17.6%), though it remains significantly below the 90% target and lower than the same quarter in the previous year. The long-standing performance challenges reflect ongoing capacity constraints and structural workforce issues. As a result, the service will deliver a modernisation programme to deliver sustainable change. The SLT CYP Service Improvement Programme is now well established, with multiple work streams in place to address equity, efficiency, and quality of care. A key milestone was the Trakcare system go-live in September 2024, which has enabled more robust reporting across the universal, targeted, and specialist pathways. This has allowed better tracking of activity, particularly universal contact, which was previously underrepresented in reporting. Modernisation efforts are supported by several dedicated sub-groups: • Digital – developing e-referral processes, improved clinical documentation, and text-based communication with families to reduce DNAs and improve access. • Waiting List – reviewing and amalgamating lists, standardising pathways, and ensuring that children and young people (CYP) receive universal input while waiting for targeted or specialist input. • Workforce & HR – aligning job plans and skill mix, supporting a confident, skilled workforce through structured learning plans. • Administration – this work stream has completed a skills matrix and implemented targeted training, with Admin now integrated into the other improvement groups. • Communication – supporting the production of a Communication and Engagement Strategy and Equalities Impact Assessment to underpin change. These efforts are designed to release clinical capacity, strengthen data quality, and ensure a consistent, evidence-based approach to care delivery. Importantly, the revised model reflects a broader ambition to reconfigure teams across North and South Lanarkshire, reduce variation, and improve the responsiveness of the service.
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24 Recruitment and retention remain critical to delivery, with a 13% vacancy rate recorded in December 2024, though further recruitment is underway. The service is also preparing trajectory-based forecasts for each tier of intervention to support planning and demonstrate progress toward the 90% target. 9. Dietetics Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 65.5% 62.5% RED Narrative & Corrective Action Performance remains significantly below target, with 62.5% of patients seen within 12 weeks. A structured improvement programme is now underway. This includes a recent waiting list validation exercise targeting 100 long-wait patients, achieving a 90% removal rate from the waiting list. A rolling three-monthly validation process will be put in place to ensure more effective management of the waiting list. Inaccuracies within TrakCare, where patients had been seen but not removed, are being addressed. Some waiting list co-ordination practices, which were historically in place but had lapsed, are also being reinstated. SOPs are being developed to support more consistent processes, with staff training planned to support the implementation of these changes. To increase capacity, the service introduced a Waiting List Initiative that delivers an additional 12 adult clinic appointments and 8 domiciliary telephone consultations each week, alongside an expanded paediatric provision. In parallel, the service is progressing a broader transformation agenda. This includes modernising systems and processes, streamlining referral pathways, and embedding new ways of working that support more sustainable service delivery. Digital tools are being explored to improve patient flow and support flexible consultation formats, with Near Me and other virtual options under consideration. An interim target of 70% of patients seen within 12 weeks has been set for June 2025, with gradual recovery anticipated as improvement actions take effect. Workforce resilience remains a risk, with the service’s highly specialised configuration continuing to be vulnerable to staff turnover. Work is ongoing to explore how a more generalist model of dietetic provision could support longer-term sustainability. 10. Complaints Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days (NHSL) 50% 13% 38% RED
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25 Complaints Processed Within Timescale (NLC) 85% 90.3% (Stage 1) 71.4% (Stage 2) 60.0% (Stage 1) 76.9% (Stage 2) RED Narrative & Corrective Action The performance targets for processing complaints has been changed for both Stage 1 and Stage 2 complaints. The timescales for response remain the same, however the percentage compliance target with those response times has changed for both metrics. These reset targets reflect the national position, recognising that across Scotland, NHS Boards are consistently failing to meet the targeted level of performance. NHS Scotland complaints performance data for 2023-2024 was published in January 2025. The national average for this performance metric in 2023-2024 was for 41% of Stage 2 complaints to be closed within 20 days. The target was reviewed by the Executive Director Group in April 2025. The reset targets will now be consistent across all Lanarkshire performance reporting, including the IPQR and monthly complaints reporting. Stage 1 • Retain 65% (or more) complaints to be closed as a Stage 1. Stage 2 • 50% Stage 2 complaints responded to within 20 working days • 70% Stage 2 complaints responded to within 30 working days • 85% Stage 2 complaints responded to within 40 working days The performance will be closely monitored and revised stretch targets introduced, as appropriate. For Q4 in North Lanarkshire, 38% (18/48) of Stage 2 North Lanarkshire complaints were closed within 20 days: • 33% (6/18) MH&LD • 33% (1/3) Adult Services • 22% (2/9) Specialist Children’s Services • 53% (9/17) Prison • 0% (0/1) Primary Care For Stage 2 complaints, the average response time was 38 days • 46 days – MH&LD • 45 days – Adult Services
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26 • 35 days – Specialist Children’s Services • 29 days – Prison • 47 days – Primary Care At the time of writing, ten Stage 2 complaints remain open in North Lanarkshire. The longest wait for resolution is 37 days, which is a complex case awaiting final review and signature. As performance in this area is described by a percentage compliance metric, the performance can be significantly affected by a relatively small number of non-compliant and complex cases. As a balancing measure, University Health and Social Care North Lanarkshire had a total of 49 stories published on Care Opinion during February 2025; 90% of those were positive of their experience. A number of actions are in place to improve complaints performance. Within Patient Affairs, a recruitment process is underway to recruit additional resource to support the central processing of complaints. Within the partnership, the Senior Management Team continue to promote the early resolution of complaints at Stage 1 and any Stage 2 delays are monitored, with any escalation triggered as required. All NLC complaints are collated via one centralised, customer service portal, logged centrally and monitored through the relevant NLC governance process. A detailed dashboard provides live management and performance information. As the cost of a licence for the system increased substantially from April 2023, the number of licences allocated to SW services has been reduced and consequently, only members of management support and complaint administrators have been granted a licence. The rationalisation of licence permissions ensures confidentiality for social work complaints. Within Adult SW Services, in-house monitoring by the Quality Assurance team has been introduced to support improvements in managing complaints. 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 Sustain and embed successful smoking quits, at 12- weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 55 110 ... RED Narrative & Corrective Action Please note that this performance measure is reported two quarters in arrears.
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27 The table below presents the Q1-2 data for North localities (April to September 2024/2025), for the number of successful 12-week quits and the targeted level of performance for those localities. There is a 6-month time lag for the data, per the reporting schedule. Locality Number of Quit Date Set (QDS) Number of 12 week quits 6 month target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 86 10 45.5 -35.5 22% 12% 23% Bellshill 93 14 31.5 -17.5 44% 15% 23% Coatbridge 111 12 45.5 -33.5 26% 11% 23% Motherwell 67 14 40.5 -26.5 35% 21% 23% North 82 28 37.5 -9.5 75% 34% 23% Wishaw 86 14 41.0 -27.0 34% 16% 23% Based on the most recent data, NHS Lanarkshire as a whole is projected to achieve 48% of the Local Delivery Plan (LDP) target set by Scottish Government (431 of 902 successful 12 week quits). QYW Stop Smoking Service During Q4 there has been a significant reduction in staff capacity due to high levels of both short and long-term sickness absence. Both the number of referrals into the QYW service and the number of those who then go on to set a quit date remain low. North Lanarkshire localities have seen a 35% drop in referrals for Q4; in 2023/24 the number of referrals was 164, however this has dropped to 106 in 2024/25. QYW Community Pharmacy Service Data analysis has highlighted discrepancies in both the completeness and accuracy of data entered into the Patient Care Record (PCR) community pharmacy system. Key Actions for Q1 of 2025/2026 QYW Stop Smoking Service • The Lanarkshire Tobacco and Vaping Programme Plan (2024-2026) will be implemented from 1st April 2025. Tobacco and Vaping Action Plans will be developed to support the Lanarkshire Tobacco and Vaping Programme Plan (2024-2026). Priority areas include: Pregnancy, Secondary Care, Mental Health and the 40% most deprived SIMD data zones (community). • Implementation of the QYW service redesign commenced on 13th January 2025 and is expected to be completed by 1st April 2025.
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28 • From 1st April 2025 all colleagues working in service delivery positions will adhere to 80/20 hybrid working pattern; this supports a balance between the requirements of service delivery and flexibility for staff. This approach will enable the QYW service to effectively address the volume of demand, given Lanarkshire’s significant percentage of people who smoke, with a particular focus on priority clients, as recommended in the Scottish Government Tobacco and Vaping Framework: Roadmap to 2034. • A protocol for non-clinical staff to provide behavioural support and supply Nicotine Replacement Therapy (NRT) to clients, will be implemented by QYW staff who have attended the National Centre for Smoking Cessation and Training (NCSCT) training and have also completed the mentoring programme. This will increase capacity to support people who are motivated to stop smoking. • Increased visibility of Health Improvement staff across the three secondary care sites to promote the Quit Your Way (QYW) service. This includes assessing and providing behavioral support to patients prior to and then following discharge. The team will also work in partnership with the Lung Cancer Specialist Practitioners in both University Hospital Monklands and University Hospital Wishaw, to ensure that patients who smoke and have been diagnosed with lung cancer will be offered direct support to stop smoking. • NHS Lanarkshire staff who smoke will be given the opportunity to access a Smoke-free mobile App for behavioral support and will receive a supply of NRT from the QYW service, should they wish to participate. Encouraging NHS Lanarkshire staff to stop smoking not only improves their personal health but also sets a positive example and as a result, it is believed that staff may be more likely to promote smoking cessation to their patients. • A meeting with HSCP colleagues took place on 17th April 2025 to discuss opportunities to increase referrals to the Quit Your Way service from Allied Health Professionals working in North Lanarkshire. QYW Community Pharmacy Service • In Q1, the QYW Pharmacy Support Team will carry out support visits to community pharmacies across Lanarkshire to improve data recording and service performance across the QYW Community Pharmacy Service. Visits will be prioritised for those community pharmacies where our data analysis has highlighted that performance could be improved. A procurement process will be undertaken to commission an external, independent organisation to carry out an in-depth analysis of current practice in community pharmacies delivering QYW services. 12. Sickness Absence Target 2024/25 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 4% 8.10% Not available RED Sickness Absence (NLC) - days lost per person 9.22 9.52 12.92 RED Narrative & Corrective Action
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29 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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30 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 Item No: 7 SUBJECT: Internal Audit Progress Report 2024/25 and 2025/26 TO: Integration Joint Board Performance, Finance & Audit Committee. Lead Officer for Report: Nicola Scott, Chief Finance Officer Author(s) of Report Francis Scott, Chief Officer (Audit and Risk), North Lanarkshire Council Jocelyn Lyall, Chief Internal Auditor, NHS Lanarkshire Contact details for Author(s) of Report Francis Scott – ScottFr@northlan.gov.uk Jocelyn Lyall – Jocelyn.lyall2@nhs.scot DATE: 27 August 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE PFA This paper has been: Prepared By: Chief Officer (Audit and Risk), North Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire) ☒ Reviewed By: Chief Finance Officer ☒ Endorsed By: Chief Officer ☒
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2 3. EXECUTIVE SUMMARY The progress in respect of the Internal Audit Plans for 2024/2025 and 2025/26 is summarised in Appendix 1. A workplan has been agreed to ensure the Internal Audit Plans 2024/2025 and 2025/26 are delivered to inform the annual internal audit opinion for 2024/25 and 2025/26. 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) Note that the GIAS development work continues. The draft Internal Audit Charter including the Mandate is at agenda item 8. 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 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 are 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 Yes ☐ No ☒ N/A ☐
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3 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. Appendix 1 provides an update on progress with the 2024/25 and 2025/26 Internal Audit Plans. Appendix 1 also includes a summary of key findings from the completed 2024/25 internal audit of Governance Arrangements. The full report is at Appendix 3. We include a summary of relevant completed NHS Lanarkshire and North Lanarkshire Council reports at Appendix 2. The North Lanarkshire Council and NHS Lanarkshire audit grading descriptions are set out at Appendix 4. 2025/26 Plan The IJB approved the Internal Audit Plan 2025/26 on 21 May 2025. A total of 60 days has been committed to undertake the IJB Internal Audit Plan. As in previous years, the Internal Audit Plan 2025/2026 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. 7. SUMMARY OF KEY ISSUES Progress on the Internal Audit Plan 2024/25 is at Appendix 1. The Summary of relevant partner body reports is at Appendix 2. Progress since the May 2025 Performance, Finance & Audit Committee: • Governance arrangements o Complete – key findings are summarised at Appendix 1 and the full report is appended at Appendix 3 • Strategy o Commencement of the audit was delayed due to annual leave and prioritisation of the North Lanarkshire Health and Social Care Conference. Fieldwork is currently underway and it is anticipated that the draft report will be issued by mid-August. • Annual Report 2024/25 o Draft report to be issued by end of August. The Chief Internal Auditors are progressing Global Internal Audit Standards
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4 development work. The NHS Lanarkshire Internal Audit Charter and the NHS Lanarkshire Internal Audit Improvement Action Plan, to ensure GIAS compliance, were approved at the NHS Lanarkshire 4 June 2025 Audit and Risk Committee. The Internal Audit Charter for North Lanarkshire Council was approved by the Audit and Scrutiny Panel on 8 May 2025. 8. CONCLUSIONS The Internal Audit Plans 2024/2025 and 2025/26 are 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:
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5 Yes No N/A 9.4 RISK ASSESSMENT/RISK MANAGEMENT The internal audit planning process which produced the Annual Internal Audit Plan considers the strategic risk profile of the organisation. Individual internal audit assignments identify the key risks at the planning stage and our work is designed to evaluate whether appropriate systems are in place and operating effectively to mitigate the risks identified. Legislative requirements are a core consideration in planning all internal audit reviews. Relevant Risk Register Details Current Risk Level Risk Owner Ineffective Governance Arrangements Low Chief Officer 9.5 ENGAGEMENT & PARTICIPATION The Chief Officer and the Chief Finance Officer have both been consulted in respect of the preparation of the Internal Audit progress report. 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY An EQIA & Fairer Scotland Impact Assessment Form is not required as there are no EQIA implications arising directly from this report. All internal audit reviews which involve review of policies and procedures will examine the way in which equality and diversity is incorporated within documentation. EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website:
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6 Yes No N/A 10. BACKGROUND PAPERS N/A 11. APPENDICES Appendix 1 2024/25 and 2025/26 Internal Audit Progress Report and key findings from the 2024/25 internal audit of Governance Arrangements. Appendix 2 Summary of Relevant NHS Lanarkshire and North Lanarkshire Council Reports issued. Appendix 3 Internal Audit Report - Governance Arrangements. Appendix 4 Internal Audit Gradings Description CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Chief Finance Officer
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Appendix 1 7 Ref Audit Indicative Scope Target Audit Committee Planning Stage Work in Progress Draft Issued Completed Grade Internal Audit Plan 2024/25 NL01-25 Audit Planning Agreeing audit universe and preparation of internal audit annual plan. May 2024 N/A NL02-25 Audit Management Liaison with management, liaison with Chief Finance Officer and attendance at Audit Committee. Ongoing N/A N/A N/A N/A 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. (included in the update on the audit of Governance Arrangements below) 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 8 NL05-25 Governance arrangements Review of governance arrangements with reference to the Blueprint for Good Governance in NHS Scotland. August 2025 Adequate NL06-25 Strategy Review of the content and implementation of the Strategic Commissioning Plan, including assessing the adequacy and effectiveness of arrangements for monitoring of delivery and performance reporting. August 2025
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Appendix 1 9 Summary of IJB Audits 2024/25 Ref Audit Opinion Key Findings NL05- 25 Governance Arrangements Adequate Assurance This audit sought to determine whether North Lanarkshire Health and Social Care Partnership (NL HSCP) has effective governance structures in place that provide effective oversight, challenge and direction in line with the Scottish Government document, ‘The Blueprint for Good Governance in NHS Scotland’ (the Blueprint). The audit also considered the progress in implementing previously agreed audit recommendations. NL HSCP has self-assessed compliance with the Blueprint and identified improvement actions which were grouped together for inclusion in the Action Plan included in NL HSCP’s Annual Governance Statement for 2024-25. We consider that the governance structures in place within NL HSCP generally provide effective oversight, challenge and direction and are generally consistent with the Blueprint. Of the 13 recommendations and actions made (some of which have been outstanding for a number of years), three were fully implemented, three were not yet due and seven were partially implemented. The progression of the majority of these actions has been hampered by a combination of awaiting the outcome of the Scottish Government’s National Care Standards proposals and the significant changes in the Senior Management Team of NL HSCP in the last 12 months. Areas for improvement relating to the implementation of previous recommendations and the preparation of an NL HSCP Internal Audit Charter were agreed by management, and progress on these will be reported to future meetings of PFAC.
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Appendix 1 10 Ref Audit Indicative Scope Target Audit Committee Planning Stage Work in Progress Draft Issued Completed Grade Internal Audit Plan 2025/26 NL01-26 Audit Planning Preparation of internal audit annual plan 2025/26. May 2024 N/A NL02-26 Audit Management Liaison with management, liaison with Chief Finance Officer and attendance at Audit Committee. Ongoing N/A NL03-26 Audit Follow Up Review of progress made by management in implementing those actions committed to in response to previously agreed Internal Audit recommendations. August 2026 NL04-26 Annual Report Prepare and present an annual report containing the Annual Internal Audit Opinion for 2024/2025. November 2025
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Appendix 1 11 NL05-26 Financial Sustainability Effective, efficient and economic use of resources to ensure financial sustainability, with a focus on transformation. May 2026 NL06-26 Performance / Committee Effectiveness Accurate, relevant and reliable reporting to the Board, staff, the SGHSCD and the public. March 2026
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Appendix 2 12 The following relevant reports have been issued by NHS Lanarkshire: Report Audit Opinion Key findings L01/26 Internal Audit Annual Report 202425 Reasonable Assurance This Annual Report provided an overview of the outcomes of the 2024/25 internal audit programme and the Chief Internal Auditor’s opinion on NHS Lanarkshire’s internal control framework for the 2024/25 financial year. The Chief Internal Auditor concluded that in 2024/25 the Board has adequate and effective governance, risk management and internal control arrangements in place and the Accountable Officer had implemented a governance framework in line with required guidance sufficient to discharge the responsibilities of this role. Key themes included: • National developments including the renewed approach to population-based planning and collaborative working, and the NHS Scotland Operational Improvement Plan, published on 31 March 2025. • The work of the Interface Directorate, which aims to drive and influence improvements, collaboration, cohesion and communication. • Performance remains variable for NHSL and to drive improve, the focus is on four key priority areas. • Governance Structures continue to bed in and a new Board Secretary is post. Internal Audit would anticipate that development of the Board Assurance Framework (BAF) and application of Committee Assurance Principles will be a priority going in to 2025/26. There had also been significant development of risk management arrangements during the year. • The 2024/2025 financial plan supported financial sustainability, with well managed controls, but Internal Audit did highlight the challenges for all Health Boards, and the importance of sustainable cost improvement and enhanced financial controls. Key developments included: • Board agreement of Corporate Objectives for the year, with mid-year assurance reported through governance structures. • Approval of the Risk Management Strategy and Risk Appetite Statement
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Appendix 2 13 Report Audit Opinion Key findings • Development of a Business Case to support the Interface Division in providing alternatives to hospital based care and emergency department admissions. Internal Audit identified three significant and one moderate action points in the areas of: • Governance around the Performance, Planning and Resources Committee, to be reviewed as part of the wider governance review. • Timing of production and presentation of Annual Reports to provide year end assurances. As part of the ongoing review of Governance a review of the remit and purpose of the PPRC together with that of the sub committees will be undertaken to ensure that any gaps in the process are mitigated. • Performance Reporting and provision of a cover for the Integrated Performance and Quality Report, highlighting key performance issues, clearly linking performance to risk and highlighting where improvement is required. • The risk associated with Artificial Intelligence. It was agreed that an AI risk assessment will be undertaken. L22/25 Review of Requisitioning, Order and Receipt Substantial Assurance NHS Lanarkshire has well established systems for requisitioning, ordering receipting and invoicing which are built into the national Pecos and efinancial systems. Internal Audit identified the following issues: • The size of the Invoice Register continues to increase in both volume and value • If the end-user does not enter the number of units when receipting an order on Pecos, they are not alerted to the issue by the Pecos system. The order does not interface with the eFinancial system, resulting in a delay in paying the invoice as the order is not marked as goods received • Not all of the invoices we reviewed were paid within the credit terms of 30 days • The P2P Group has not met since 14 December 2023. The group does not have formal Terms of Reference and there are no minutes’/action notes recorded from any of the meetings • None of the 11 Accounts Payable Policies/Procedures have been reviewed by their scheduled review date of October 2024 • The 'Business Continuity Plan - Procurement & Logistics' document was last refreshed in June 2022 and has no scheduled review date recorded on the document. The Pecos guide does not cover the most recent version of Pecos
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Appendix 2 14 Report Audit Opinion Key findings Agreed Action: Work has already started on review of historical items in the invoice register. Numbers are consistently reducing and this will be monitored on a monthly basis. The order receipting guidance will be updated to reflect the most recent version of PECOS system and will be communicated to users. Supplier statement reconciliations have now recommenced and the top 30 suppliers on quantity and volume of invoices are reconciled on a quarterly basis which should lead to a positive impact on payment terms this will be monitored and progressed by the Accounts Payable Manager. The P2P meetings will recommence from March 2025 and quarterly going forward. Minutes and action notes will be maintained for all future meetings. Policies and procedures in relation to payment of goods and services will be reviewed by financial year end and will be made available to staff. The Procurement & Logistics Business Continuity Plan will be reviewed by June 2025 and a scheduled review date will be recorded. The Pecos guide will be updated to reflect the most recent version of PECOS. L18/25 Review of Financial Planning Substantial This review considered whether there was robust strategic financial planning and prioritisation to support corporate strategies and priorities for the 2025-2026 Financial Plan. The Substantial Assurance opinion was provided on the basis that the 2025/2026 – 2027/28 financial plan supports financial sustainability and the risks are well managed. Existing controls were likely to achieve and maintain financial sustainability in 2025/26. In 2025/26 brokerage will no longer be available and all NHS Boards must work towards break-even with historic outstanding brokerage to be re-paid when the Board return to financial balance. However, financial sustainability remains a significant and enduring risk for all Health Boards and financial and service challenges across health and social care will require continued joint working across Lanarkshire, with a focus on transformation. Delivering the required level of recurrent savings in years 2 and 3 will be extremely challenging and there will be a continued requirement for financial sustainability to underpin all decisions taken by the NHS Board and by Officers, and for sustainability to be given appropriate priority. There were no recommendations from this review.
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Appendix 2 15 Relevant reports issued by North Lanarkshire Council Report Audit Opinion Key findings Internal Audit Annual Report and Opinion 2024-25 Reasonable Assurance This report provided an annual summary of the work undertaken by Internal Audit and allowed the Chief Officer (Audit and Risk) to provide an independent opinion on the Council’s control environment. The annual opinion for 2024/25 is unqualified and states that reasonable assurance can be placed on the Council’s governance, risk management and internal control arrangements. While some audit issues were noted during the year, there were no key points relating to NL HSCP of the Council’s provision of social care.
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Appendix 3 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 16 INTERNAL AUDIT REPORT REVIEW OF NORTH LANARKSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP GOVERNANCE ARRANGEMENTS Headlines This audit sought to determine whether North Lanarkshire Health and Social Care Partnership (NL HSCP) has effective governance structures in place that provide effective oversight, challenge and direction in line with expected good practice. The audit also considered the progress in implementing previously agreed audit recommendations. NL HSCP has self-assessed compliance with the Scottish Government document, ‘The Blueprint for Good Governance in NHS Scotland’ (the Blueprint), which provides guidance on how to deliver and sustain good corporate governance in the healthcare sector. This self-assessment identified improvement actions which were grouped together for inclusion in the Action Plan included in NL HSCP’s Annual Governance Statement (AGS) for 2024/25. NLC Internal Audit thereafter undertook a high-level review of NL HSCP’s arrangements against the Blueprint to identify areas where improvements could be made to strengthen the governance arrangements. Generally, we concurred with the observations and improvement actions identified from the self-assessment. We have, therefore, categorised this audit as providing adequate assurance meaning that we consider that the governance structures in place within NL HSCP generally provide effective oversight, challenge and direction and are generally consistent with the Blueprint. Work undertaken by NLC Internal Audit to assess management progress in implementing previously agreed audit recommendations and improvement actions identified from the self- assessments, identified that of the 13 recommendations and actions made (some of which have been outstanding for a number of years), three were fully implemented, three were not yet due and seven were partially implemented. The progression of the majority of these actions has been hampered by a combination of awaiting the outcome of the Scottish Government’s National Care Standards proposals and the significant changes in the Senior Management Team of NL HSCP in the last 12 months, with a new Chief Officer, Chief Finance Officer and Business Support Manager being appointed during this time. Whilst the IJB and the Performance, Finance and Audit Committee (PFAC) meetings were held as scheduled, and the majority of key matters were addressed, there were no reports on the progress of implementation of previously agreed actions. Further details on this finding and the associated recommendations made by NLC Internal Audit are included in the action plan at section 3 of this report. Assurance Opinion Adequate assurance
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Appendix 3 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 17 Priority of Recommendations High Medium Low 0 1 1 Report status FINAL Audit ref 0500/2025/004 Date issued 26/06/2025 Audit Team Elaine MacDonald, Lynn McCrum and Lesley Armstrong Issued To Chief Officer (NL HSCP) Copied To Chief Finance Officer (NL HSCP)
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Appendix 3 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 18 1. Executive Summary Objectives The purpose of this audit was to determine, and provide independent assurance, on the following areas: • Are there effective governance structures that provide effective oversight, challenge and direction, in line with guidance issued by the Scottish Government? • Has sufficient progress been made in implementing audit recommendations, with specific reference to long-standing actions? Work undertaken by NLC Internal Audit included gathering appropriate evidence and undertaking a high-level review of the governance arrangements in place in NL HSCP against the Blueprint as well as obtaining evidence and having discussions with relevant officers to ascertain the current position of outstanding recommendations. This engagement has been conducted in accordance with the Global Internal Audit Standards. The Internal Audit section reports formally on conformance with these standards to the PFAC. We would like to thank officers involved in this audit for their cooperation and assistance. 2. Findings and Recommendations Key areas requiring management action (High) There were no areas requiring urgent management attention identified. Good practice identified We noted the following areas of good practice during the audit: • NL HSCP includes an AGS in their Annual Accounts. The AGS provides an assessment of the adequacy and effectiveness of NL HSCP’s governance arrangements and system of internal control and provides an explanation as to how NL HSCP complies with the Code of Corporate Governance and meets the requirements of the CIPFA Delivering Good Governance in Local Government Framework (2016). • The AGS also includes an update on how continuous improvement actions identified in previous years in respect of internal controls, risk management and other governance arrangements have been/are being progressed. • NL HSCP has undertaken a self-assessment in respect of their compliance with the Scottish Government guidance document ‘The Blueprint for Good Governance in NHS Scotland’. Other areas for improvement (Medium) One other area for improvement was identified: • Appropriate and timely action is required to progress previously agreed outstanding audit recommendations and improvement actions identified during NL HSCP’s self-assessment of governance arrangements.
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Appendix 3 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 19 3. Action Plan Review of NL HSCP Governance Arrangements 0500/2025/004 Ref Finding 1 Appropriate and timely action is required to progress both previously agreed outstanding audit recommendations and improvement actions identified during NL HSCP’s self-assessment of governance arrangements. All Internal and External Audit reports contain management responses to audit recommendations which generally include a commitment to specific actions by a stated timescale. NLC Internal Audit reviewed the extent to which management have implemented previously agreed Internal and External Audit recommendations and improvement actions identified by management in both the current and previous years’ self-assessment exercises. Across the three sources, there were 13 actions and progress of these actions is detailed in the table below. Source Complete Partially implemented Not yet due Total Internal Audit reports 3 3 0 6 External Audit reports 0 2 1 3 Self-assessments 0 2 2 4 TOTAL 3 7 3 13 Seven of the previously agreed actions have not been progressed as expected and, as such, have only been partially implemented. Six of these were not tracked or monitored during the year, primarily due to significant changes in the Senior Management Team in the last 12 months, however, we were pleased to note that the Chief Finance Officer has already addressed this by including the outstanding action, with revised timescales, on an action plan in the AGS and has committed to ensuring that these are regularly tracked and monitored through their inclusion as a standing agenda item in future meetings of the PFAC. The remaining action relates to the review and update of NL HSCP Audit Charter. The delay in implementation of this action is largely due to the recent introduction of the Global Internal Audit Standards, effective from 1 April 2025, and this action is being progressed by the Chief Officer (Audit and Risk) and Chief Auditor (NHS Lanarkshire). Further details of these outstanding actions are included at Appendix 2. Implication Recommendation Priority Management response Implementation Date Risks previously identified may not be appropriately mitigated, exposing the HSCP to these risks and leaving them vulnerable. The Chief Internal Auditors may not be in a position to conclude on the level of assurance that can be placed upon the overall adequacy and effectiveness of the HSCP’s framework of governance, risk (1) The Chief Officer (NL HSCP) should ensure that appropriate and timely action is taken to fully address the previously agreed audit recommendations in line with timescales detailed in the Action Plan contained within the AGS and that the actions are regularly monitored with progress reported at each meeting of the PFAC. (2) The Chief Officer (Audit and Risk) and the Chief Internal Auditor (NHS Lanarkshire) should ensure that NL HSCP Audit Charter is updated and reviewed to reflect the current environment and Medium (1) Agree Claire Rae, Chief Officer (NL HSCP) The Annual Governance Statement, prepared as part of the 2024-25 Annual Report, includes details of all previous audit recommendations with timescales for action provided. These timescales will be monitored through a progress report presented to each PFAC, with the first report going to the October meeting. (2) Agree December 2025
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Appendix 3 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 20 management and internal control arrangements. working arrangements whilst taking account of the Global Internal Audit Standards. Francis Scott, Chief Officer (Audit and Risk) and Jocelyn Lyall, Chief Internal Auditor (NHS Lanarkshire) September 2025 3. Action Plan Review of NL HSCP Governance Arrangements 0500/2025/004 Ref Finding 2 Rolling Action Logs, discussed at meetings of the IJB and PFAC, are not always fully populated. A standing agenda item at meetings of both the IJB and the PFAC is the Rolling Action Log. This document comprises of actions discussed and agreed to be taken forward at the Board/Committee meetings and requires details to be added with regards to whom the action has been allocated to, action taken/progress made, the due date and completion status. From our review of the Rolling Action Log, we noted that it was not always fully completed, often with detail in respect of the due date and completion status being omitted. We understand that the remit of the newly appointed Business Support Manager will include overseeing the Rolling Action Log and ensuring that it is fully populated. Implication Recommendation Priority Management response Implementation Date If actions are not properly recorded and tracked, it may be difficult to determine the status of the actions and whether these are being addressed timeously. The Chief Officer (NL HSCP) should ensure that the Rolling Action Log presented to each IJB and PFAC is fully completed following each meeting, with details of discussions and/or decisions regarding actions required, progress to date, proposed completion dates and completion status. Low Agree Claire Rae, Chief Officer (NL HSCP) The new Business Support Manager will ensure the action logs for both meetings are completed and monitored appropriately. August 2025
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Appendix 3 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 21 APPENDIX 1 – Audit Grading Audit reports are graded with an overall assurance opinion, and any issues and associated recommendations are classified individually to denote their relative importance, in accordance with the definitions in the tables below. Definition of audit assurance and recommendation categories Assurance Confidence based on sufficient evidence that internal controls are in place, operating effectively and objectives are being achieved. Assurance opinion definitions Substantial Assurance Sound systems for risk, control and governance are in place and should be effective in mitigating risks to the achievement of business and control objectives. Some minor improvements to existing controls in a few areas may be required. Adequate Assurance The systems for risk, control and governance are largely satisfactory, but there is some scope for improvement as the present arrangements could undermine the achievement of business and/or control objectives and/or leave them vulnerable to some risk of error/abuse. Limited Assurance The systems for risk, control and governance have some satisfactory aspects but contain a number of significant weaknesses that are likely to undermine the achievement of business and/or control objectives and leave them vulnerable to an unacceptable risk of error or abuse. Recommendation priority definitions High Significant weaknesses which management needs to address to achieve objectives. Medium Weaknesses which require prompt action to avoid exposure to risks in achieving objectives. Low Action advised/area for improvement to enhance control or improve efficiency.
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Appendix 3 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 22 APPENDIX 2 – Outstanding Management Actions Report Details Recommendation Management Update Original and Revised Timescales INTERNAL AUDIT Financial Due Diligence (May 2020) EXTERNAL AUDIT Annual Audit Report 2019/20 ANNUAL GOVERNANCE STATEMENT Continuous improvement actions for 2019/20 Each of the reports listed contained similar recommendations (four in total) in respect of the disaggregation of Children, Families and Justice Social Work Services and need for hosting arrangements to be finalised for cross- cutting services. The budget disaggregation exercise has been concluded and the revised IJB direction to NLC issued in March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Management recognises that the finalisation of the Service Level Agreement (SLA) for future hosting arrangements and associated budgets is overdue. Once finalised, the SLA will be presented to a future meeting of the NLC Adult Health and Social Care Committee, the NLC Education and Families Committee and the IJB for approval. Previously, as the Scottish Government advising that the timeframe around the National Care Service had slipped further than intended, the Service advised that they would consider creating their own Service Level Agreement between Children, Families and Justice Services. There has been very little action taken in the last year with regards to this action. This is primarily due to a change in the Senior Management Team. This action has been included in the Action Plan within the draft Annual Governance Statement. The Senior Management Team have committed to reviewing this action over the Summer and providing an update on the position at the next meeting of the PFAC in August 2025. March 2021 September 2021 June 2022 March 2025 September 2025 ANNUAL GOVERNANCE STATEMENT Continuous improvement actions for 2021/22 To develop a sound understanding of the impact for the North Lanarkshire Health and Social Care Partnership (NLHSCP) of the outputs of the National Care Service legislation. There has been very little action taken to date with regards to this action. This is primarily due to both a change in the Senior Management Team and changes to the proposals for the National Care Service with the Scottish Government having concluded that they are not taking forward the legislative component of the National Care Service Bill. This action has been included in the Action Plan within the draft Annual Governance Statement and will now be tracked and monitored with progress thereafter reported at each meeting of the PFAC (from meeting scheduled for 27 August 2025 onwards). The Chief Finance Officer is liaising with the newly appointed Business Support Manager with regards to this. March 2023 March 2025 September 2025
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Appendix 3 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 23 Report Details Recommendation Management Update Original and Revised Timescales INTERNAL AUDIT Review of NL Health and Social Care Partnership Governance Arrangements 2023/24 The Chief Officer (North Lanarkshire HSCP) should liaise with the Chief Officer (Audit and Risk) to ensure that the North Lanarkshire HSCP Audit Charter is reviewed and updated as necessary. The Chief Officer (NL HSCP) instructed the Chief Officer (Audit and Risk) and the Chief Auditor (NHS Lanarkshire) to undertake a review of NL HSCP Audit Charter, however the revision of the audit charter was put on hold to take account of the introduction of the Global Internal Audit Standards, effective from 1 April 2025. The Chief Officer (Audit and Risk) and the Chief Internal Auditor (NHS Lanarkshire) have agreed that they will now review and update the Charter and submit it to the next meeting of the PFAC scheduled for 27 August 2025. March 2024 March 2025 September 2025 EXTERNAL AUDIT Annual Audit Report 2023/24 As a strategic commissioning body, the IJB should ensure that its financial performance reports retain a holistic view of the IJBs financial performance as a whole and continue to align to the reserves strategy and financial strategy. The IJB have revised financial monitoring reports to provide an overview of the delivery of services and overall funding aligned to the Strategic Commissioning Plan and Medium-Term Financial Plan. However, as reflected in the unaudited accounts, the reports provide detail around the financial and operational performances of each of the partner bodies in the delivery of the underlying services. The financial reports will be further defined to give an overview in the delivery of services against the overall funding aligned to the Strategic Commissioning Plan and Medium- Term Financial Plan/Long Term Financial Plan including earmarked reserves. This action will be tracked and monitored with progress thereafter reported at each meeting of the PFAC (from meeting scheduled for 27 August 2025 onwards). The Chief Finance Officer is liaising with the newly appointed Business Support Manager with regards to this. March 2024 March 2025 September 2025
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Appendix 4 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 24 North Lanarkshire Council Audit Gradings Audit reports are graded with an overall assurance opinion, and any issues and associated recommendations are classified individually to denote their relative importance, in accordance with the definitions in the tables below. Definition of audit assurance and recommendation categories Assurance Confidence based on sufficient evidence that internal controls are in place, operating effectively and objectives are being achieved. Assurance opinion definitions Substantial Assurance Sound systems for risk, control and governance are in place and should be effective in mitigating risks to the achievement of business and control objectives. Some minor improvements to existing controls in a few areas may be required. Adequate Assurance The systems for risk, control and governance are largely satisfactory, but there is some scope for improvement as the present arrangements could undermine the achievement of business and/or control objectives and/or leave them vulnerable to some risk of error/abuse. Limited Assurance The systems for risk, control and governance have some satisfactory aspects but contain a number of significant weaknesses that are likely to undermine the achievement of business and/or control objectives and leave them vulnerable to an unacceptable risk of error or abuse. Recommendation priority definitions High Significant weaknesses which management needs to address to achieve objectives. Medium Weaknesses which require prompt action to avoid exposure to risks in achieving objectives. Low Action advised/area for improvement to enhance control or improve efficiency.
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Appendix 4 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 25 NHS Lanarkshire Audit gradings: Internal Audit Objective To assist management in assessing the overall opinion of the area under review, Internal Audit has assessed the system adequacy and control application, and categorised the opinion based on the following criteria. Level of Assurance System Adequacy Controls Substantial A sound system of governance, risk management and control exists, with internal controls operating effectively and being consistently applied to support the achievement of objectives in the area audited. Controls are applied continuously or with minor lapses. Reasonable There is a generally sound system of governance, risk management and control in place. Some issues, non-compliance or scope for improvement were identified which may put at risk the achievement of objectives in the area audited. Controls are applied frequently but with evidence of non-compliance. Limited Significant, gaps, weaknesses or non-compliance were identified. Improvement is required to the system of governance, risk management and control to effectively manage risks to the achievement of objectives in the area audited Controls are applied but with some significant lapses. No Assurance Immediate action is required to address fundamental gaps, weaknesses or non-compliance identified. The system of governance, risk management and control is inadequate to effectively manage risks to the achievement of objectives in the area audited. High risk of objectives not being achieved due to the absence of key internal controls. Significant breakdown in the application of controls.
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Appendix 4 R:\Corporate\NL Health and Social Care Partnership\Business Support\IJB Committees\IJB PFA\2025\3. 27 August 2025\Final Word Papers\07 - 2025-08-27 IJB PFA - IJB Internal Audit Progress Report.docx 26 To assist management in assessing each audit finding and recommendation, Internal Audit has assessed the risk to the organisation of each of the weaknesses identified and categorised each finding according to the following criteria. Risk Assessment Definition Findings Fundamental Non-compliance with key controls or evidence of material loss or error. Action is imperative to ensure that the objectives for the area under review are met Significant Weaknesses in design or implementation of key controls i.e. those which individually reduce the risk scores. Requires action to avoid exposure to significant risks in achieving the objectives for the area under review. Moderate Weakness in design or implementation of controls which contribute to risk mitigation. Requires action to avoid exposure to moderate risk to achieving the objectives for area under review. Merits Attention These are generally areas of good practice. Action may be advised to enhance control or improve operational efficiency. 0
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Page 1 of 18 Item No: 8 SUBJECT: Draft Internal Audit Charter TO: Integration Joint Board Performance, Finance & Audit Committee. Lead Officer for Report: Claire Rae, 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: 27 August 2025 1. PURPOSE OF REPORT The purpose of this report is to provide the Performance, Finance & Audit Committee with assurance that the Internal Audit Charter complies with the Global Internal Audit Standards (GIAS) requirements and to seek approval of the Internal Audit Charter. This Charter is complementary to the relevant provisions included in the Code of Corporate Governance. This paper is coming to the IJB for: For Approval: ☒ For Endorsement: ☐ To Note: ☐ 2. ROUTE TO THE BOARD This paper has been:
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Page 2 of 18 Prepared By: Chief Officer (Audit and Risk), North Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire) ☒ Reviewed By: Chief Finance Officer ☒ Endorsed By: ☐ 3. EXECUTIVE SUMMARY 4. RECOMMENDATIONS 4.1 It is recommended that the IJB PFA note the contents of the report. • (1) Note that this report provides assurance that the Internal Audit Charter complies with GIAS • (2) Approve the Internal Audit Charter. 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 The Internal Audit Charter will be presented to the Performance, Finance & Audit Committee annually for approval. This August 2025 version has been drafted to ensure the Charter fully complies with the Institute of Internal Auditors (IIA) Global Internal Audit Standards (GIAS) and the Application Note: GIAS in the UK Public Sector, applicable from 1 April 2025. The Audit Charter is based on the Institute of Internal Auditors (IIA) template to ensure it fully complies with the requirements of GIAS. GIAS require each organisation to agree an Internal Audit Charter, which is a formal document that includes the internal audit function’s mandate, organisational position, reporting relationships, scope of work, types of services, and other specifications. The Internal Audit Mandate forms part of the Internal Audit Charter and sets out the internal audit function’s authority, role, and responsibilities, which may be granted by the Performance, Finance & Audit Committee and/or laws and regulations. Yes ☐ No ☐ N/A ☒
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Page 3 of 18 The Internal Audit Charter is complementary to the relevant provisions included in the Code of Corporate Governance. 7. SUMMARY OF KEY ISSUES The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to comply with the accounts and audit regulations and legislation under section 106 of the Local Government (Scotland) Act 1973. A professional and objective Internal Audit Service arrangement has been established in accordance with recognised Internal Audit standards and practices as laid out in the Public Sector Internal Audit Standards, in order to comply with article 7 of the Local Authority Accounts (Scotland) Regulations 2014. The Integrated Resources Advisory Group also issued guidance which set out the IJB’s responsibility to establish adequate and proportionate Internal Audit arrangements for risk management, governance and control of delegated resources. The guidance further advised that IJBs should make appropriate and proportionate arrangements for the consideration of the audit provision. To comply with GIAS the Charter includes the following key elements: • Reference to Internal Audit’s commitment to complying with Global Internal Audit Standards • Inclusion of the Internal Audit Mandate • Clarification of the Performance, Finance and Audit Committee oversight role • Clarification of the Chief Internal Auditors’ role • Inclusion of the requirement for a Quality Assurance and Improvement Program • Requirement for formal approval by the Chair of the Performance, Finance and Audit Committee and Chief Officer, in addition to approval by the Chief Finance Officer. 8. CONCLUSIONS GIAS Standard 8.3 Quality requires that the Chief Internal Auditor develops, implements and maintains a quality assurance and improvement program that covers all aspects of the internal audit function. The program includes external and internal assessments. When expressing conformance with standards, auditors must be clear that they are conforming to the GIAS subject to the Application Note and must refer to this as conformance with Global Internal Audit Standards in the UK Public Sector. The Internal Audit Charter reflects the Chief Internal Auditor’s responsibility to develop, implement, and maintain a quality assurance and improvement program that covers all aspects of the internal audit function, to be reported to Performance, Finance and Audit Committee. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES
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Page 4 of 18 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 9.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB10/21 – Ineffective Governance Arrangements Low Chief Officer 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.
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Page 5 of 18 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 9.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A
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Page 6 of 18 10. BACKGROUND PAPERS N/A 11. APPENDICES Appendix 1 – Draft Internal Audit Charter 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 Page 7 of 18 Internal Audit Charter Version: August 2025 Update: August 2026
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Appendix 1 Page 8 of 18 1. Purpose 1.1 The purpose of the internal audit function is to strengthen North Lanarkshire IJB’s ability to create, protect, and sustain value by providing the Performance, Finance and Audit Committee and management with independent, risk-based, and objective assurance, advice, insight, and foresight. The internal audit function enhances North Lanarkshire IJB’s: • Successful achievement of its objectives. • Governance, risk management, and control processes. • Decision-making and oversight. • Reputation and credibility with its stakeholders. • Ability to serve the public interest. North Lanarkshire IJB’s internal audit function is most effective when: • Internal auditing is performed by competent professionals in conformance with The Institute of Internal Auditor’s (IIA’s) Global Internal Audit Standards, which are set in the public interest. • The internal audit function is independently positioned with direct accountability to the Performance, Finance and Audit Committee. • Internal auditors are free from undue influence and committed to making objective assessments. 1.2 Commitment to Adhering to the Global Internal Audit Standards in the UK Public Sector North Lanarkshire IJB’s internal audit function will adhere to the mandatory elements of The Institute of Internal Auditors' International Professional Practices Framework, which are the Global Internal Audit Standards and Topical Requirements. The Chief Internal Auditors (CIAs) will report to each meeting of the Performance, Finance and Audit Committee and senior management regarding the internal audit function’s conformance with the Standards, which will be assessed through a quality assurance and improvement programme. The Application Note: GIAS in the UK Public Sector provides UK public sector-specific context, interpretations of GIAS requirements in the specific circumstances expected to apply across the UK public sector and some additional requirements which the Relevant Internal Audit Standard Setters consider essential for the practice of internal audit in the UK public sector.
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Appendix 1 Page 9 of 18 2. Mandate 2.1 The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to comply with the accounts and audit regulations and legislation under section 106 of the Local Government (Scotland) Act 1973. A professional and objective Internal Audit Service arrangement has been established in accordance with recognised Internal Audit standards and practices as laid out in the Public Sector Internal Audit Standards, in order to comply with article 7 of the Local Authority Accounts (Scotland) Regulations 2014. The Integrated Resources Advisory Group also issued guidance which set out the IJB’s responsibility to establish adequate and proportionate Internal Audit arrangements for risk management, governance and control of delegated resources. The guidance further advised that IJBs should make appropriate and proportionate arrangements for the consideration of the audit provision. The Performance, Finance and Audit Committee grants the internal audit service the mandate to provide the Performance, Finance and Audit Committee and senior management with objective assurance, advice, insight and foresight. 2.2 Authority Internal Audit derives its authority from the Integrated Joint Board, the Chief Officer, the Performance, Finance and Audit Committee and the relevant provisions included in the organisation’s Code of Corporate Governance. The internal audit function’s authority is created by its direct reporting relationship to the Performance, Finance and Audit Committee. Such authority allows for unrestricted access to the Performance, Finance and Audit Committee. The Chief Internal Auditors report on a functional basis to the Chief Officer and to the Performance, Finance and Audit Committee on behalf of the Board. The Performance, Finance and Audit Committee authorises the internal audit function to: • Have full and unrestricted access to all functions, data, records, information, physical property, and personnel pertinent to carrying out internal audit responsibilities. Internal auditors are accountable for confidentiality and safeguarding records and information. • Allocate resources, set frequencies, select subjects, determine scopes of work, apply techniques, and issue communications to accomplish the function’s objectives. • Obtain assistance from the necessary personnel of North Lanarkshire Health and Social Care Partnrtship (HSCP) and other specialised services from within or outside North Lanarkshire HSCP to complete internal audit services.
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Appendix 1 Page 10 of 18 2.3 Independence, Organisational Position, and Reporting Relationships The CIAs will be positioned at a level in the organisation that enables internal audit services and responsibilities to be performed without interference from management, thereby establishing the independence of the internal audit function. (See “Mandate” section.) The CIAs will report functionally to the Performance, Finance and Audit Committee and administratively (for example, day-to-day operations) to the Chief Finance Officer. This positioning provides the organisational authority and status to bring matters directly to senior management and escalate matters to the Performance, Finance and Audit Committee, when necessary, without interference and supports the internal auditors’ ability to maintain objectivity. In addition, the shared service model of Internal Audit provision allows further organisational independence. The CIAs will confirm to the Performance, Finance and Audit Committee, at least annually, the organisational independence of the internal audit function. If the governance structure does not support organisational independence, the CIAs will document the characteristics of the governance structure limiting independence and any safeguards employed to achieve the principle of independence. The CIAs will disclose to the Performance, Finance and Audit Committee any interference internal auditors encounter related to the scope, performance, or communication of internal audit work and results. The disclosure will include communicating the implications of such interference on the internal audit function’s effectiveness and ability to fulfill its mandate. 2.4 Changes to the Mandate and Charter Circumstances may justify a follow-up discussion between the CIAs, Performance, Finance and Audit Committee, and senior management on the internal audit mandate or other aspects of the internal audit charter. Such circumstances may include but are not limited to: • A significant change in the Global Internal Audit Standards. • A significant reorganisation within the HSCP. • Significant changes in the CIAs, Performance, Finance and Audit Committee and/or senior management. • Significant changes to the organisation’s strategies, objectives, risk profile, or the environment in which the organisation operates. • New laws or regulations that may affect the nature and/or scope of internal audit services. 3. Performance, Finance and Audit Committee Oversight 3.1 To establish, maintain, and ensure that North Lanarkshire IJB’s internal audit function has sufficient authority to fulfill its duties, the Director of Finance will:
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Appendix 1 Page 11 of 18 • Discuss with the CIAs and senior management the appropriate authority, role, responsibilities, scope, and services (assurance and/or advisory) of the internal audit function. • Ensure the CIAs have unrestricted access to and communicates and interacts directly with the Performance, Finance and Audit Committee, including in private meetings without senior management present. • Discuss with the CIAs and senior management other topics that should be included in the internal audit charter. • Participate in discussions with the CIAs and senior management about the “essential conditions,” described in the Global Internal Audit Standards, which establish the foundation that enables an effective internal audit function. • Approve the internal audit function’s charter, which includes the internal audit mandate and the scope and types of internal audit services. • Review the internal audit charter annually with the CIAs to consider changes affecting the organisation, such as the employment of new CIAs or changes in the type, severity, and interdependencies of risks to the organisation; and approve the internal audit charter annually. • Endorse the risk-based internal audit plan, prior to Performance, Finance and Audit Committee approval. • Provide input to the internal audit function’s human resources administration and budgets. • Ensure sufficient budget and resources to allow the internal audit function to fulfil its mandate and accomplish its audit plan. • Receive communications from the CIAs about the internal audit function including its performance relative to its plan. • Ensure a quality assurance and improvement program has been established and review the results annually. Make appropriate inquiries of senior management and the CIAs to determine whether scope or resource limitations are inappropriate. 4. CIA Roles and Responsibilities 4.1 The CIAs will hold membership of the CCAB Institute, or equivalent or CMIIA with experience equivalent to at least five years post-qualification experience and at least three years of audit. 4.2 Ethics and Professionalism
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Appendix 1 Page 12 of 18 The CIAs will ensure that internal auditors: • Conform with the Global Internal Audit Standards, including the principles of Ethics and Professionalism: integrity, objectivity, competency, due professional care, and confidentiality. • Conform with the Seven Principles of Public Life (the Nolan Principles) • Understand, respect, meet, and contribute to the legitimate and ethical expectations of the organisation and be able to recognise conduct that is contrary to those expectations. • Encourage and promote an ethics-based culture in the organisation. • Report organisational behavior that is inconsistent with the organisation’s ethical expectations, as described in applicable policies and procedures. 4.3 Objectivity The CIAs will ensure that the internal audit function remains free from all conditions that threaten the ability of internal auditors to carry out their responsibilities in an unbiased manner, including matters of engagement selection, scope, procedures, frequency, timing, and communication. If the CIAs determine that objectivity may be impaired in fact or appearance, the details of the impairment will be disclosed to appropriate parties. Internal auditors will maintain an unbiased mental attitude that allows them to perform engagements objectively such that they believe in their work product, do not compromise quality, and do not subordinate their judgment on audit matters to others, either in fact or appearance. Internal auditors will have no direct operational responsibility or authority over any of the activities they review. Accordingly, internal auditors will not implement internal controls, develop procedures, install systems, or engage in other activities that may impair their judgment, including: • Assessing specific operations for which they had responsibility within the previous year. • Performing operational duties for North Lanarkshire IJB or its affiliates. • Initiating or approving transactions external to the internal audit function. • Directing the activities of any North Lanarkshire IJB employee that is not employed by the internal audit function, except to the extent that such employees have been appropriately assigned to internal audit teams or to assist internal auditors.
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Appendix 1 Page 13 of 18 Internal auditors will: • Disclose impairments of independence or objectivity, in fact or appearance, to appropriate parties and at least annually, such as the CIAs, Performance, Finance and Audit Committee, management, or others. • Exhibit professional objectivity in gathering, evaluating, and communicating information. • Make balanced assessments of all available and relevant facts and circumstances. • Take necessary precautions to avoid conflicts of interest, bias, and undue influence. 4.4 Managing the Internal Audit Function The CIAs have the responsibility to: • At least annually, develop a risk-based internal audit plan that considers the input of the Performance, Finance and Audit Committee and senior management. Discuss the plan with the Performance, Finance and Audit Committee and senior management and submit the plan to the Performance, Finance and Audit Committee for review and approval. • Communicate the impact of resource limitations on the internal audit plan to the Performance, Finance and Audit Committee and senior management. • Review and adjust the internal audit plan, as necessary, in response to changes in North Lanarkshire IJB’s business, risks, operations, programs, systems, and controls. • Communicate with the Performance, Finance and Audit Committee and senior management if there are significant interim changes to the internal audit plan. • Ensure internal audit engagements are performed, documented, and communicated in accordance with the Global Internal Audit Standards and laws and/or regulations. • Follow up on engagement findings and confirm the implementation of recommendations or action plans and communicate the results of internal audit services to meetings of the Performance, Finance and Audit Committee and senior management and for each engagement as appropriate. • Ensure the internal audit function collectively possesses or obtains the knowledge, skills, and other competencies and qualifications
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Appendix 1 Page 14 of 18 needed to meet the requirements of the Global Internal Audit Standards and fulfill the internal audit mandate. • Identify and consider trends and emerging issues that could impact North Lanarkshire IJB and communicate to the Performance, Finance and Audit Committee and senior management as appropriate. • Consider emerging trends and successful practices in internal auditing. • Establish and ensure adherence to methodologies designed to guide the internal audit function. • Ensure adherence to North Lanarkshire IJB’s relevant policies and procedures unless such policies and procedures conflict with the internal audit charter or the Global Internal Audit Standards. Any such conflicts will be resolved or documented and communicated to the Performance, Finance and Audit Committee and senior management. • Obtain an understanding of the organisation and its activities, encourage two-way communications between internal audit and operational staff, discuss the audit approach and seek feedback on work undertaken. • Coordinate activities and consider relying upon the work of other internal and external providers of assurance and advisory services. If the CIAs cannot achieve an appropriate level of coordination, the issue must be communicated to senior management and if necessary escalated to the Performance, Finance and Audit Committee. 4.5 Communication with the Performance, Finance and Audit Committee and Senior Management The CIAs will report annually to the Performance, Finance and Audit Committee and senior management regarding: • The internal audit function’s mandate. • The internal audit plan and performance relative to its plan. • Significant revisions to the internal audit plan. • Potential impairments to independence, including relevant disclosures as applicable. • Results from the quality assurance and improvement program, which include the internal audit function’s conformance with the IIA’s Global Internal Audit Standards and action plans to address the internal audit function’s deficiencies and opportunities for improvement. • Significant risk exposures and control issues, including fraud risks, governance issues, and other areas of focus for the Performance, Finance and Audit Committee that could interfere with the achievement of North Lanarkshire IJB’s strategic objectives.
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Appendix 1 Page 15 of 18 • Results of assurance and advisory services. • Human resource requirements. • Management’s responses to risk that the internal audit function determines may be unacceptable or acceptance of a risk that is beyond North Lanarkshire IJB’s risk appetite. 4.6 Quality Assurance and Improvement Programme The CIAs will develop, implement, and maintain a quality assurance and improvement program that covers all aspects of the internal audit function. The program will include external and internal assessments of the internal audit function’s conformance with the Global Internal Audit Standards, as well as performance measurement to assess the internal audit function’s progress toward the achievement of its objectives and promotion of continuous improvement. The program also will assess, if applicable, compliance with laws and/or regulations relevant to internal auditing. Also, if applicable, the assessment will include plans to address the internal audit function’s deficiencies and opportunities for improvement. The CIAs will regularly communicate with the Performance, Finance and Audit Committee and senior management about the internal audit function’s quality assurance and improvement program, including the results of internal assessments (ongoing monitoring and periodic self-assessments) and external assessments. The North Lanarkshire Council and NHS Lanarkshire audit teams are subject to external assessment at least once every five years by a qualified, independent assessor or assessment team; qualifications must include at least one assessor holding a CCAB Institute, or equivalent or CMIIA qualification, and Public Sector competencies and knowledge. 5. Scope and Types of Internal Audit Services 5.1 The scope of internal audit services covers the entire breadth of the organisation as set out in the audit universe, including all North Lanarkshire IJB’s activities, assets, and personnel. The scope of internal audit activities also encompasses, but is not limited to, objective examinations of evidence to provide independent assurance and advisory services to the Performance, Finance and Audit Committee and management on the adequacy and effectiveness of governance, risk management, and control processes for North Lanarkshire IJB. 5.2 Annual Report The principal report to be produced by Internal Audit will be the Annual Audit Report for each audit year. This requires to be prepared in time for submission to the Performance, Finance and Audit Committee no later than the agreed target date, in order to provide the assurance required in considering the Board’s Annual Accounts.
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Appendix 1 Page 16 of 18 The Annual Audit Report should contain: • An opinion on whether: Based on the work undertaken, there were adequate and effective internal control, risk management and governance arrangements in place throughout the year. The Accountable Officer has implemented a governance framework in line with required guidance sufficient to discharge the responsibilities of this role. • analysis of any changes in control requirements during the year. • comment on the key elements of the control environment. • summary of Internal Audit performance. • progress in delivering the Quality Assurance Improvement Programme. 5.3 Risk Management Through specific, periodic audits, internal audit will review the risk management systems, associated controls, assurance processes and functions, and test the operation of controls. Appropriate communication with the risk management function will be maintained, including provision of all audit reports and regular meetings with risk managers. 5.4 Advisory Services Internal Audit may be called upon to provide advice on controls and related matters, subject to the need to maintain objectivity. Normally Internal Audit will have no executive role, nor will it have any responsibility for the development, implementation or operation of systems. The nature and scope of advisory services will be agreed and set out in an assignment plan. Opportunities for improving the efficiency of governance, risk management, and control processes may be identified during advisory engagements. These opportunities will be communicated to the appropriate level of management. Internal audit engagements may include evaluating whether: • Risks relating to the achievement of North Lanarkshire IJB’s corporate objectives are appropriately identified and managed. • The actions of North Lanarkshire IJB’s officers, directors, management, employees, and contractors or other relevant parties comply with North Lanarkshire IJB’s policies, procedures, and applicable laws, regulations, and governance standards. • The results of operations and programs are consistent with established goals and objectives.
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Appendix 1 Page 17 of 18 • Operations and programs are being carried out effectively, efficiently, ethically, and equitably. • Established processes and systems enable compliance with the policies, procedures, laws, and regulations that could significantly impact North Lanarkshire IJB. • The integrity of information and the means used to identify, measure, analyse, classify, and report such information is reliable. • Resources and assets are acquired economically, used efficiently and sustainably, and protected adequately. Advisory engagements may include: • Attendance at governance forums in an independent capacity • Provision of controls and assurance expertise • Review of draft strategic and corporate documentation • Input into Board and Senior Management team development events • Independent validation of self-assessments The Performance, Finance and Audit Committee is the final reporting line for all audit reports and where it is appropriate for a report to be shared with another Committee, this will be included in the audit final audit report.
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Appendix 1 Page 18 of 18 Approved by the Performance, Finance and Audit Committee at its meeting on [date]. Acknowledgments/Signatures _________________________________ _________________ CIAs Date _________________________________ _________________ Performance, Finance and Audit Committee Chair Date _________________________________ _________________ Chief Officer Date _________________________________ _________________ Chief Finance Officer Date
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REPORT Item No: Item 9 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 Kerry Taylor, Business Support Manager DATE: 27 August 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: Kerry Taylor, Business Support Manager ☒ Reviewed By: NL HSCP SMT – 11 Aug 2025 ☒ Endorsed By: ☐ 1
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3. RECOMMENDATIONS 3.1 The IJB, PFA is asked to note the contents of this report which includes a review of the highest rated risks within the IJB risk register and a note of those operational risks highlighted by the North Lanarkshire Health and Social Care Partnership that impact upon delivery of IJB business. 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. NEXT STEPS 6.1 Work is underway to review the reporting of IJB Risks, North Lanarkshire Health and Social Care Partnership’s Business Support Manager is working with NHS Lanarkshire’s Chief Risk Officer to review the NL IJB Risk Management Strategy. 6.2 At the time of writing, NL HSCP’s Senior Management Team were due to attend a development session on 22 August 2025, part of which will focus on IJB Risks. A verbal update will be provided during the IJB PFA Meeting on 27 August 2025. 6.3 The next scheduled IJB Development Session for Board Members on 10 September 2025 will include a focus on IJB Risks. 7. CONCLUSIONS 7.1 The IJB currently has 19 risks identified on its IJB risk register with 10 risks rated as high or very high. 7.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 8. IMPLICATIONS 8.1 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 ☐
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Resources are used effectively and efficiently in the provision of Health and Social Care Services ☐ 8.2 ASSOCIATED MEASURE(S) 8.3 FINANCIAL This paper has been reviewed by Finance: Yes ☒ No ☐ N/A ☐ 8.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 8.5 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
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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 8.6 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 ☒ 9. BACKGROUND PAPERS 10. 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; Kerry Taylor, Business Support Manager – Kerry.Taylor@lanarkshire.scot.nhs.uk 6
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NL H&SCP Risk Overview Report Meeting Name – IJB, PFA Reporting Period: IJB Risk Register – August 2025
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NL HSCP IJB Risk – Dashboard August 2025 Executive Summary Risk movement since last report No Change Increase Decrease New Closed Risks with updated actions 19 0 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. I�ncreased 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. R�isk 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.T�he 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 31012025 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 31012025 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.
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead Officer Meeting Date Recurrence Reason / Notes Wednesday 27 August 2025 Financial Monitoring - Month 4 & Period 4 (July) Chief Finance Officer 27 August 2025 Quarterly IJB Performance Report (Q4) Head of Planning, Performance & Quality Assurance 27 August 2025 Quarterly Internal Audit Progress Report 2025/2026 Chief Officer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 27 August 2025 Quarterly Draft Internal Audit Charter Chief Officer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 27 August 2025 Annual Added August 2025 IJB Risk Report Chief Officer 27 August 2025 Quarterly Wednesday 22 October 2025 Financial Monitoring - Month 6 & Period 6 (September) Chief Finance Officer 22 October 2025 Quarterly Annual Governance Statement Actions - Progress Update Chief Finance Officer 22 October 2025 IJB Performance Report (Q1) Head of Planning, Performance & Quality Assurance 22 October 2025 Quarterly Quality Assurance Annual Report Head of Planning, Performance & Quality Assurance 22 October 2025 Annual Internal Audit Progress Report 2025/2026 Chief Officer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 22 October 2025 Quarterly IJB Risk Report Chief Officer 22 October 2025 Quarterly
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead Officer Meeting Date Recurrence Reason / Notes Integration Joint Boards: Finance and Performance 2025 Chief Finance Officer 22 October 2025 Annual Meeting date dependant on publishing from Audit Scotland Wednesday 18 February 2026 Financial Monitoring - Month 8 & Period 9 (December) Chief Finance Officer 18 February 2026 Quarterly Reserves Strategy 2026/27 Chief Finance Officer 18 February 2026 Annual Governance Statement Actions - Progress Update Chief Finance Officer 18 February 2026 IJB Performance Report (Q2) Head of Planning, Performance & Quality Assurance 18 February 2026 Quarterly Internal Audit Progress Report 2025/2026 Chief Officer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 18 February 2026 Quarterly IJB Risk Report Chief Officer 18 February 2026 Quarterly Financial Regulations Chief Finance Officer 18 February 2026 Annual Wednesday 20 May 2026 Financial Monitoring - Final Outturn Chief Finance Officer 20 May 2026 Quarterly IJB Performance Report (Q3) Head of Planning, Performance & Quality Assurance 20 May 2026 Quarterly Internal Audit Plan 2026/2027 Chief Officer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 20 May 2026 Annual Internal Audit Progress Report 2025/2026 Chief Officer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 20 May 2026 Quarterly
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead Officer Meeting Date Recurrence Reason / Notes IJB Risk Report Chief Officer 20 May 2026 Quarterly Wednesday 19 August 2026 Financial Monitoring - Month 4 & Period 4 (July) Chief Finance Officer 19 August 2026 Quarterly IJB Performance Report (Q4) Head of Planning, Performance & Quality Assurance 19 August 2026 Quarterly Internal Audit Progress Report 2025/2026 Chief Officer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 19 August 2026 Quarterly IJB Risk Report Chief Officer 19 August 2026 Quarterly Wednesday 21 October 2026 Financial Monitoring - Month 6 & Period 6 (September) Chief Finance Officer 21 October 2026 Quarterly IJB Performance Report (Q1) Head of Planning, Performance & Quality Assurance 21 October 2026 Quarterly Internal Audit Progress Report 2025/2026 Chief Officer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 21 October 2026 Quarterly IJB Risk Report Chief Officer 21 October 2026 Quarterly Future Reports Best Value Framework Chief Finance Officer TBC Triennial Best Value – Annual Statement of Compliance Chief Finance Officer TBC Annual Accounts Commission Reporting TBC TBC As and when publications released
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead Officer Meeting Date Recurrence Reason / Notes from Accounts Commission Local Code of Corporate Governance TBC TBC Annual Governance Issues Business Support Manager TBC Biannual Risk Management Strategy Business Support Manager TBC Triennial Risk Management Annual Report Business Support Manager TBC Annual External Audit Report Chief Finance Officer TBC Annual