Combined Pack - IJB PFA 22.10.2025
North Lanarkshire Council · 22 October 2025
Back to IJB Performance, Finance and Audit Committee — 22 October 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 22 October 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: Councillor Anne McCrory 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 (27 August 2025) For Approval Attachment Chair 4. IJB PFA Rolling Action Log For Noting Attachment Chair 5. Matters Arising For Noting Attachment Chair Performance & Finance 6. Financial Monitoring Report For Approval Attachment Nicola Scott 7. Q4 IJB Performance Report For Noting Attachment Morag Dendy Governance & Policy 8. Internal Audit Progress Report 2024/25 and 2025/26 For Noting Attachment Jocelyn Lyall 9. Annual Governance Statement Actions - Progress Update For Noting Attachment Nicola Scott 10. Risk Report For Noting Attachment Kerry Taylor 11. IJB PFA Work Plan For Noting Attachment Kerry Taylor For Noting 12. 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 18 February 2026, 14:00-16:30 For Noting
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Page 1 of 4 ITEM: Integration Joint Board Performance, Finance & Audit Committee Minutes from the meeting held on Wednesday 27th August 2025, 14.00 – 16.30 via MS Teams PRESENT Voting Members: Cllr Beth Baudo NLC Nominated Councillor Brian Moore (Vice -Chair) NHS Lanarkshire Nominated Non-Executive Siobhan White NHS Lanarkshire Nominated Non-Executive Others In Attendance: Mark Dell Communications Manager Morag Dendy Head of Planning, Performance & Quality Diane Fraser Head of Adult Social Care Joanne Jenkins Nurse Director North HSCP 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 Francis Scott Chief Officer (Audit and Risk) Kerry Taylor Business Support Manager Maggs Thomson Head of Health North HSCP John Watson Employee Representative NLC Apologies: Cllr Anne McCrory (Chair) NLC Nominated Councillor Cllr Claire Barclay NLC Nominated Councillor Phillip Couser NHS Lanarkshire Nominated Non-Executive Cllr Bob Burgess NLC Nominated Councillor Nauman Dar NHS Lanarkshire Nominated Non-Executive Alison Gordon Head of Children’s, Families & Justice Services Cllr Anne McCrory NLC Nominated Councillor Catherine McGinty Unison / Staff Side Representative (NHSL) Thomas Moan Senior Manager – Community Solutions VANL Harry Robertson North Lanarkshire Carers Together / Carer Representative Nicola Scott Chief Finance Officer David Wood Chief Executive Officer with VANL 1. Welcome and Apologies BM chairing on behalf of AM The Chair welcomed everyone to the meeting and apologies were noted as above. The Chair noted that as the meeting was not quorate, no decisions could be made during the meeting. Brian Moore 2. Declaration of Interests No declarations of interest were made. All
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Page 2 of 4 3. Minutes IJB PFA (21st May 2025) The minutes accepted as an accurate record. Noted the absence of an action log; agreed to implement a more robust action log process, as recommended by internal audit and previously requested by members. Brian Moore 4. Matters Arising Noted the absence of an action log; agreed to implement a more robust action log process, as recommended by internal audit and previously requested by members. Outstanding actions to be captured in the new action log include: Tackling Poverty Team report Safe Staffing report Information requests on age assessments and carers during crisis periods Use of reserves (to be discussed under Finance) No additional matters arising raised. Brian Moore Performance & Finance 5. Financial Monitoring Report Budget gap over three years: £51.85m; £14.9m for 2025/26. Projected year-end overspend £4.94m. Employee costs show an underspend; social care shows an overspend, mainly in payments to other bodies. Overspend in independent care homes and care at home due to higher-than- budgeted care plans. Prescribing budget increased to address overspend; aim to break even. Savings to date: £1.9m against a target of £14.9m. 289 WTE vacancies offset by agency/bank/overtime. Reserves: Opening balance £75.5m, revised to £72.5m. Concerns about the achievability of savings targets, especially in social care. Recruitment challenges and the need for innovative approaches. Demographic pressures and demand modelling for care home and home care services. Use and transparency of reserves, especially ring-fenced funds. Agency usage in mental health; ongoing efforts to reduce reliance. Detailed breakdown of reserves and agency usage to be provided at the November development session. Continued monitoring and reporting on savings and workforce. RECOMMENDATIONS i) IJB PFA acknowledge the contents of the report. ii) IJB PFA acknowledge the projected outturn for 2025/26 is an overspend of £4.945m Claire Rae 6. Q4 IJB Performance Report Alcohol Brief Interventions (ABIs): Additional work on alcohol harms; suggestion for a broader briefing on alcohol issues. Cervical Screening: Declining uptake; discussion on self-sampling and barriers. Childhood Immunisation: Focus on consistency and outreach; risk of falling rates to be considered for the risk register. Reablement & Rehab: Ongoing transformation; positive outcomes noted. Morag Dendy
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Page 3 of 4 Adult Mental Health: Significant psychiatry staffing vacancies; some improvement in stability. Speech & Language Therapy: Marked improvement in children’s SLT performance due to data system upgrades. Complaints: Need for better integration of health and social care learning; tracking of Ombudsman referrals. Smoking Cessation & Population Health: High smoking rates in North Lanarkshire; need for more intentional health improvement work. Sickness Absence: Early intervention and thematic analysis underway; home support workers have highest absence rates. Consider focused “spotlight” sessions on key performance areas in future meetings. Include neurodevelopment services in future performance reviews. Provide more detailed reporting on annual health checks for people with learning disabilities. RECOMMENDATIONS i) IJB PFA noted the contents of the report and the appendix. 7. Internal Audit Progress Report 2024/25 and 2025/26 Governance arrangements reviewed; found to be adequate. Some audit recommendations delayed due to National Care Service proposals and management changes. Improved tracking and reporting of outstanding actions agreed. Audit plan progress and partner organisation reports noted. Outstanding recommendations to be reviewed and closed where appropriate. Audit history to be included in future plans. RECOMMENDATIONS i) IJB PFA considered the attached Progress Report at Appendix 1 and the summary of relevant partner reports at Appendix 2. ii) IJB PFA noted that the GIAS development work continues. The draft Internal Audit Charter including the Mandate is at agenda item 8. Jocelyn Lyall 8. Draft Internal Audit Charter Charter aligns with global internal audit standards. Sets out mandate, roles, and responsibilities. Requires formal approval by Chair, Chief Officer, and Chief Finance Officer. Discussion: Importance of clear audit relationships and responsibilities noted. Charter to be finalised and signed off. RECOMMENDATIONS i) IJB PFA noted that this report provides assurance that the Internal Audit Charter complies with GIAS. ii) IJB PFA approved the Internal Audit Charter. Jocelyn Lyall Governance & Policy 9. Risk Report Highlight report on current IJB risks. SMT reviewed all risks, new risks to be proposed at the September development session. Ongoing work on a new IJB risk management strategy. Kerry Taylor
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Page 4 of 4 Revised risk register to be reviewed at the next development session. Consider adding childhood immunisation rates as a risk. RECOMMENDATIONS i) IJB PFA noted 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. 10. IJB PFA Work Plan Draft work plan presented; focus on performance, finance, audit, and risk. Plan is a live document; items can be added as needed. Streamlined agenda welcomed flexibility to add topics such as SLT improvements. Equivalent work plan for IJB Board to be developed. Kerry Taylor For Noting 11. Risk No new risks identified beyond those discussed. Noted that vaccination rates and related risks will be considered for inclusion. 12. AOCB Annual Health Checks for People with Learning Disabilities: Issue raised regarding reporting and data challenges; further detail to be provided in a future report. Anne Muir expected to chair next meeting. ALL Date of Next Meeting: 22 October 2025, 14:00-16:30
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1 ITEM 4 North Lanarkshire Integration Joint Board ROLLING ACTION LOG NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 27 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that the annual budgets and proposed savings are achievable and sustainable. The budget process should involve collaboration and clear conversations with IJB partners, workforce, people who use services and other stakeholders around the difficult choices required to achieve financial sustainability. Ongoing Proposal: Remove from PFA action log and add to governance tracker for PFA 28 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to systematically share learning to identify and develop: - Service redesign focused on early intervention and prevention. - Approaches focused on improving the recruitment and retention of the workforce. Ongoing Proposal: Remove from PFA action log and add to governance tracker for PFA 29 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Work collaboratively with other IJBs and partners to understand what data is available and how it can be developed and used to fully understand and improve outcomes for those using IJB commissioned services. This should include a consideration of gaps in data. It should also include consideration of measures to understand the impact of preventative approaches. Ongoing Proposal: Remove from PFA action log and add to governance tracker for PFA 30. 25.09.24 Item 9 Integration Joint Boards Finance C Rae Evaluate whether the local commissioning of care and support services, and the contracting Ongoing
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2 and Performance Report 2024 of these services, adheres to the ethical commissioning and procurement principles, improving outcomes for people. Proposal: Remove from PFA action log and add to governance tracker for PFA 32. 25.02.25 Item 8 Financial Monitoring Suggestion that Pharmacy Savings Approach could be brought back to IJB to get a restock of where things are and where they are going Ongoing 36. 27.08.2025 Item 4 Matters Arising Information request on age assessments and carers during crisis periods Ongoing – due to complete at PFA meeting on 22 Oct 2025 37. 27.08.2025 Item 4 Matters Arising Use of reserves (to be discussed under Finance) Ongoing – Reserves strategy included in PFA work plan for Feb 2026
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3 CLOSED ACTIONS NO DATE ITEM NO DESCRIPTION ACTION BY ACTION & PROGRESS DUE DATE COMPLETION STATUS 1. 30/10/18 Item 11 Reserves Strategy A Kilburn To develop a reserves strategy on receipt of national guidance on setting minimum levels of reserves. In the interim period a local reserves strategy will be progressed. Update September 2021: The IJB Reserves Strategy 2021/2022 was approved by the IJB on 22 June 2021. This report provided an update on the review of the existing IJB reserves and new reserves were established in line with planned commitments and Scottish Government guidance. Update on Exit strategies to be presented to PF& A in November 2021 8.12.22 Update provided within report Medium to Long Term Financial Planning. Further work being June 2021 November 2021 – deferred to IJB December 2021 Complete Reserve strategy presented to IJB PFA on 16th Nov.
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4 undertaken to confirm exit plans and ongoing areas of work. 23.3.22 – Update on Financial plan for 2022/23 presented that included update on reserves strategy but agreed at meeting to provide further more detailed update to include exit strategy for short term initiatives funded from reserves and conclusion of all other areas of reserve funding deferred to March 2023. Final version to March IJB alongside updated SCP Added to March 23 agenda- complete 2. 26.5.20 Item 10 Internal Audit Report – Due Diligence Review A Kilburn Further update on the disaggregation of the children, families and justice social work services budget to be presented to the IJB. Update September 2021: The progress in respect of this action is regularly reported to the IJB (Performance, Finance and Audit) Committee. The updated report to the IJB (Performance, Finance and Audit) Committee on 24 August 2021 advised that the budget disaggregation exercise has been September/Dece mber 2020 Deferred to March 2021 – deferred to September 2021 – deferred to November 2021 Original Action complete with further update on hosting arrangements presented to PF&A in November 2021.
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5 concluded. The revised IJB direction to NLC issued on 23 March 2021 excludes the total budget transfer in respect of Children, Families and Justice Services. Work is continuing to progress in respect of the hosting arrangements for cross-cutting and support services. The original timeline of March 2021 has therefore been extended to the revised timeline of September 2021. The Service Level Agreement for the future hosting arrangements and associated budgets will be presented to the IJB following consultation and endorsement by the NLC Adult Health and Social Care Committee and Education and Families Committee. A further report will therefore be presented to the next meeting of the IJB (Performance, Finance and Audit) Committee on 9 November 2021. Update March 2022 - Further work required to conclude agreements around hosting arrangements. Complete – presented to IJB PFA on 16th Nov 3. 22.9.20 Item 7 Recovery Process M Dendy IJB to receive an update on opportunities presented during recovery process. March 2021 Deferred to September 2021 Ongoing – delegated to PF&A to complete action.
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6 21.9.21 – Report presented setting out proposed use of a Change Fund. Progress reports on each element of the proposed plan to be presented to the PF&A February 2022 – update on progress noted with further updates to be presented February 2022 Ongoing Complete 4. 9.12.20 Item 6 & Item 11 Addictions services M Dendy 1. An update on accommodation issues affecting the delivery of the addiction services was requested. 21.9.21 – verbal update given – work ongoing to resolve accommodation issues. 2. Update requested on funding commitments. ADP strategy presented and approved at IJB on 21.9.21. Request for detail on commissioning of services, evidence of benefits and achievements and timelines for implementation of funding commitments to be brought back to IJB. June 2021 – deferred to September 2021 – deferred to PFA November 2021 – deferred to February 2022 September 2021 Complete Ongoing updates on progress scheduled into forward plan for PFA
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7 16.2.22 PF&A – update noted at meeting with commitment to report back on specifics and performance objectives December 2021 August 2022 MAT standards update given to Feb IJB PFA Further update on October PFA agenda 5. 19/6/24 Item 6 Digital System Transformation M Dendy Delegate to the IJB PFA committee -To provide the IJB PFA with additional financial information relating to the programme Report provided to IJB PFA 21st August 2024 Complete 6. 19/6/24 Item 7 Mental Health & Wellbeing Delivery Plan R McGuffie Shared new action plan with the group in Sept/October Action Planned shared and stakeholder sign off currently underway. Complete 7. 21.9.21 Item 7 Primary Care Implementation Plan Dr L Munro 1. An update on planned engagement events with local people on the primary care implementation plan was requested. Update provided and noted at March 2022 IJB December 2021 Complete – update report to 16th Nov PFA Remove
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8 21.6.22 – verbal update on progress noted 2. Memorandum of Understanding to be shared Complete 8. 22.9.20 Item 5 Mental Health Continuing Care Contracted Beds R McGuffie Issue not progressed as planned during 2020 as engagement process postponed due to lockdown impact on visits to care homes. 21.9.21 Business Case to be developed and presented to IJB, South Lanarkshire IJB and NHSL Board. 22.3.22 – Update provided on progress on engagement and development of business case June 2022 September 2022 Business case to be presented at IJB September 2022 Delayed following advice from HIS around engagement standards. Final business case to Dec IJB. Approved at NL IJB, SL IJB and NHS Board in December 2023. Complete 9. 21.9.21 Item 16 Best Value Audit M Dendy An update on the Self Evaluation exercise is to be presented to the PF&A committee. February 2022 – deferred to August 2022 as engagement event took place after PF&A meeting Complete
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9 10. 8.12.21 Item 14 Integration review - Chief Financial Officer R McGuffie Following approval to proceed from the IJB, reports were to be presented to NLC and NHSL Board to seek support for preferred option. 16.2.22 Update on progress provided at PF&A meeting. HR process being progressed 21.6.22 – Update on recruitment of CFO provided 23.3.22 – Update provided to IJB to note that HR process has commenced and recruitment to additional post is underway. March 2022 June 2022 Complete 11. 22.6.22 Item 8 Financial Plan - Provision of smoke alarms R McGuffie Agreed that H&SC NL funding towards provision of smoke alarms to meet new standards would be included within future Digital Strategy report. March 2023 Update provided after year-end figures. Combined report linked to community alarms on August PFA agenda Complete 12. 22.6.22 Item 5 Unaudited Accounts R McG/NL Content of report to be amended to include more details around reason for significant underspend June 2022 Report updated accordingly. Complete 13. 22.6.22 Item 8 & Item 9 Equalities Mainstreaming Report & Risk Register R McG/CJ IJB members suggested additions to the IJB risk Register on following highlighted risks; Cost of Living Pressures Urgent/Unscheduled care September 2022 Complete
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10 Community Alarms (Analogue to digital) National Care Service 14. 22.6.22 Item 9 Equalities Mainstreaming Report M Dendy Progress updates on delivery of equality outcomes to be presented via Performance, Finance & Audit Committee May 2023 On agenda Tabled at June PFA 15. 22.6.22 Item 12 Strategic Commissioning Plan M Dendy/T Marshall Detailed report on community nursing to be brought back to future meeting and included within SCP On March 23 IJb agenda –IJB approved plan 16. 22.6.22 Item 4 Community Alarms R McG Provide the committee with an update on community alarms switching from analogue to digital and risk to service users Complete Update provided at 16th Nov PFA 17. 22.6.22 Item 14 Audited Accounts R McG Bring audited accounts to Sept committee Complete 19. 16.11.22 Item 5 Risk Management Strategy R McGuffie Reviewing risk management strategy which will be brought to the committee in due course. Reviewing a process to have shared risks between partnerships and acute and also review current risk register Update planned for March 2023 IJB Liaison session planned to review Complete 20 16.11.22 Item 6 Analogue to digital R McGuffie Share progress report on the work On April 2023 agenda Update on October agenda Complete 21. 14.2.23 Item 11 Performance Report R McGuffie Bring more information on OT Paediatrics and speech and language On April 2023 agenda Complete
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11 22. 14.2.23 Item 13 MH Strategy R McGuffie Consider dedicating liaison session for a more in-depth discussion Discuss wider thematic work with Brian Moore Topic at 8th Nov Liaison session Complete 23 18.10.23 Item 5 Risk Register R McGuffie Ross to provide briefing document to offer the committee assurance that risk are reviewed against other boards November 2023 Liaison Session Complete 24. 18.10.23 Item 10 Performance Report R McGuffie SWISS update Future report Tabled @ May PFA Complete 18. 31.8.22 Item 6 IJB Self- Assessment Report R McGuffie Consider hosting a development session to further explore the self-evaluation work Picked up at November Liaison Session Complete 25. Future Meeting C Rae Host a future meeting face to face in Chryston hub 19.03.2025 – March date was cancelled new date to be re-arranged Dates set up for 2025 Walk rounds Ongoing Complete – Chair & Vice-Chair invited to Chryston visit & dates sent of HSCP SMT walk rounds 26 25.09.24 Item 9 Integration Joint Boards Finance and Performance Report 2024 C Rae Ensure that their Medium-Term Financial Plans are up to date and reflect all current known and foreseeable costs to reflect short and longer-term financial sustainability challenges. 25.02.25 – Due to be discussed at the next IJB in March 19.03.2025 Discussed on agenda 19.03.25 Complete
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12 31. 25.02.25 Item 6 Q2 Performance Report Improved communication about progress and ensure a shared understanding of what CAMHs services can offer. Complete – updated provided in IJB action log 33. 19.03.20 25 Item 4 Matters Arising Learning Disability Workforce paper to be brought to PF&A Complete – paper presented to September IJB 34. 27.08.20 25 Item 4 Matters Arising Tackling Poverty Team report Complete – added to IJB work plan 35. 27.08.20 25 Item 4 Matters Arising Safe Staffing report Complete – added to IJB work plan
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REPORT Item No: 6 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee for: For approval For endorsement For noting 1.2 This report provides a summary of the North Lanarkshire University Health and Social Care Partnership (the Partnership) for the period 1 April 2025 to 31 August 2025 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the PFA Committee: (1) Acknowledge the contents of the report. (2) Acknowledge the projected outturn for 2025/26 is an overspend of £4.226m (3) Approve the reinstatement of the £0.260m Organisational Development reserve. 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 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: 22 October 2025 Yes No N/A
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the implementation of the programme of work for the IJB’s Strategic Commissioning Plan 2023-26. 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 £860.736m 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 5 report (to 31 August 2025) and NLC period 6 report (to 12 September 2025). This shows a projected year end overspend of £4.226m, 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 £0.748m underspend in relation to the services delegated to health offset by a £4.974m 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 £6.166m 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 574.620 581.328 (6.708) Hosted Services 208.719 206.237 2.482 Set Aside Services 77.397 77.397 0 Total 860.736 864.962 (4.226)
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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 £5.893m, 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 1,428 resulting in an overspend of £3.602m. Care at Home costs are projected to overspend by £3.222m, the budget is based on funding 2,514 care plans however the actual plans in place total 2,865. Health Services 7.3.4 Non pay costs have a year to date overspend of £1.879m resulting in the reported projected overspend of £4.509m. 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 small underspend of £0.007m is being projected this financial year. Based on data available to June 2025 and estimated data for July and August 2025 the cost per item has increased to £10.26 from £10.21, and the number of items being dispensed has increased by 0.38% based on the same period last year. 7.3.6 Hosted Services led by North Lanarkshire IJB are forecasting an overall underspend of £2.482m. There are a number of offsetting variances across this area however the most significant underspends are within Podiatry, CAMHS, Forensic Psychiatry and Psychological Therapies which are partially offset by overspends in Children’s Services, Learning Disability Services and Adult Psychotherapy. Primary Care Improvement Fund 7.3.7 The agreement in place in respect of hosted services is that the lead IJB will manage any overspends and will retain any underspends. The exception to this is the Primary Care Improvement Fund which is a hosted service led by the South Lanarkshire IJB. The PCIF underspends over previous years have been ring-fenced and retained for the PCIF activity across both the North and South Lanarkshire IJBs and have not been used to offset other South Lanarkshire IJB overspends.
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7.3.8 Board members should be aware that the 2025/2026 PCIF budget is £26.418m and a net overspend of £0.102m is reported as at 31 August 2025. Consistent with previous years, a break-even position requires to be achieved by 31 March 2026. 7.3.9 In order to ensure this position, grip-and-control actions have been implemented which include prioritising existing capacity within existing service budgets to safeguard patient safety and maintain required care standards. In parallel, an evaluation programme is on-going to ensure that available PCIF resources are used in the most effective and equitable way possible to support long-term service sustainability and effective care delivery. 7.3.10 Board members will continue to be updated on the actions being taken to achieve the break even position and any impact on North Lanarkshire IJB, should this not be achieved, will be reported at future meetings. 8. GENERAL RESERVES 8.1 It is important for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statute and is part of a range of measures in place to ensure that s106 public bodies do not over- commit themselves financially. 8.2 The opening reserves balance for 2025/26 was £75.554m and the current IJB reserves position after adjustments for the drawdown of in-year reserves, is a revised balance of £72.121m and is summarised in table 2. Table 2 8.3 A detailed list of all reserve movements during 2025/26 is detailed in appendix 5 including a key guidance table showing how the reserves are aligned to the five ambition statements detailed in the Strategic Commissioning Plan 2023-26. 8.4 Board Members are asked to approve the reinstatement of a £0.260m reserve for organisational development which was closed and moved to contingency at the financial year end. Following a further review and discussions with the Programme Manager there is further work to be undertaken across the Partnership in this area and therefore closing this was premature. Details of the key areas of spend planned are provided in Appendix 6. Opening Balance As At Revised Balance As At 1st April 2025 31st March 2026 £m £m £m £m NHSL Ring-Fenced Reserves 14.839 0.000 -0.627 14.212 NLC/NHSL Earmarked Reserves 25.060 0.000 -2.555 22.505 NLC/NHSL Risk-Based Reserves 21.536 0.000 -0.250 21.286 NHSL Contingency Reserves 14.119 0.000 0.000 14.119 NLC/NHSL Closed Reserves 0.000 0.000 0.000 0.000 75.554 0.000 -3.433 72.121Total LEAD SUMMARY Transfers To / From Reserves Drawdown from Reserves
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9. SAVINGS 9.1 As detailed in section 6, the MTFP identified a budget gap for 2025/26 of £14.959m and the response to this was to develop service redesign and transformation actions. 9.2 These are summarised in Table 3. Table 3 9.3 Savings are monitored monthly at the Senior Management Team Finance meeting. Progress is provided by the Senior Management Team on actions being taken against the service transformation work. This includes an update on the following work streams: A poly pharmacy review A review of non pay budgets The roll out of “Getting it Right for Everyone” Updates on the financial planning assumptions Review of all vacant posts. 9.4 The current IJB savings position at the end of June 2025, show total savings achieved of £1.917m (19%). This is summarised in chart 1 with more detail provided at Appendix 7. £m Social Care Services 10.386 Home Support 2.838 Independent Care Homes 4.710 Care at Home 2.838 Health Care Services 4.573 Budget Management Non Pays 0.247 Prescribing 4.326 TOTAL 14.959 SERVICE REDESIGN & TRANSFORMATION
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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 31 August 2025 within each service compared against their budgeted establishment. Table 4 10.2 To help cover the vacant posts throughout the year, agency staff, bankaide, overtime and excess part time hours are used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 8 and summarised in Table 5. Establishment Actual Vacancies FTE FTE FTE North West Locality 388.71 367.43 21.28 North East Locality 326.83 298.99 27.84 Adult Services 288.44 267.40 21.04 Children Services 597.69 547.63 50.06 Mental Health 1,212.80 1,235.94 -23.14 Social Care Services 967.13 832.55 134.58 Home Support 996.57 926.36 70.21 Other 232.61 216.32 16.29 TOTAL 5,010.78 4,692.62 318.16 Position as at 31 August Service
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Table 5 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. Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.020 0.011 0.375 0.001 0.407 North East Locality 0.009 0.002 0.238 0.000 0.249 Adult Services 0.023 0.048 0.144 0.000 0.215 Children Services 0.013 0.037 0.357 0.094 0.500 Mental Health 0.132 0.026 2.109 1.711 3.977 Social Care Services 0.261 - - 0.054 0.315 Home Support 1.525 - - - 1.525 Other 0.005 0.006 0.032 - 0.043 TOTAL 1.988 0.130 3.254 1.859 7.232 SERVICE Costs As At 31 August 2025
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Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 12.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Chief Officer (Finance) within NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny.
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12.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 13. BACKGROUND PAPERS None. 14. APPENDICES Appendix 1 North Lanarkshire IJB Annual Budget 2025/26 Appendix 2 IJB Budget Reconciliation 2025/26 Appendix 3 North Lanarkshire Revenue Budget Position to 31 August 2025 Appendix 4.1 Hosted Services led by North Partnership to 31 August 2025 Appendix 4.2 Hosted Services led by South Partnership to 31 August 2025 Appendix 5 Movement in Reserves 2025/26 Appendix 6 Organisation Development Reserve – Key areas of spend Appendix 7 Savings Progress to 31 August 2025 Appendix 8 Analysis of Additional Employee Costs 2025/26 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07816 126362.
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Appendix 1 North Lanarkshire IJB Annual Budget 2025/26 Annual Budget 2025/26 £m Health Care Services Health Care 298.654 Hosted Services 208.719 Set-Aside Budget 77.397 Total Expenditure - NHSL 584.770 Social Care Services Social Care Services Gross Expenditure 279.366 Social Care Services Gross Income (5.973) 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 860.736 Annual Budget 2025/26 £m NHS Lanarkshire Funding (581.337) Social Care Funding (24.119) Resource Transfer (24.690) Commissioned Services (7.225) Transfer from Reserves (Approved) (3.433) Total Funding - NHSL (640.805) 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 (860.736) Care Group Funded By:
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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 Incease 0.243 South Hosted @ 52% 1.497 Family Health Service South @ 52% 0.074 NHSL Financial Allocation at 30 June 2025 639.102 Budget Adjustments Posted in Month 4 IJB Reserves North 0.226 North Income 0.684 Allocations 0.093 Pay Award 1.049 Area Wide 0.044 South Hosted Serv 52% 0.757 Family Health Service South @ 52% 0.060 NHSL Financial Allocation at 31 July 2025 642.015 Budget Adjustments Posted in Month 5 IJB Reserves North 0.221 North Income 0.731 Allocations 0.117 Area Wide 0.005 South Hosted Serv 52% 0.046 Prescribing (1.326) Family Health Service South @ 52% (1.004) NHSL Financial Allocation at 31 August 2025 640.805
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Appendix 3 North Lanarkshire IJB Revenue Budget Position 1 April 2024 to 31 August 2025 Annual Year To Date Variance Projected Year End Outturn Budget Budget Actual Total Total 2025/26 August 2025 August 2025 August 2025 2025/26 £m £m £m £m £m Health Care Services Locality and Other Services 60.903 26.497 27.345 (0.849) (2.037) Addiction Services 4.459 1.773 1.773 (0.000) (0.000) Medical and Nursing Directorate 4.171 1.785 1.584 0.201 0.483 Prescribing 83.474 34.161 34.158 0.003 0.007 Out of Area Services 1.723 0.718 0.826 (0.108) (0.259) Area Wide Services 8.312 2.987 2.957 0.030 0.072 Family Health Services 135.612 60.002 60.002 0.000 0.000 Hosted Services 208.719 86.747 85.714 1.033 2.482 Set-Aside Budget 77.397 32.249 32.249 0.000 0.000 Total Expenditure - NHSL 584.770 246.918 246.608 0.311 0.748 Social Care Services Social Care Services Gross Expenditure 279.366 128.938 131.225 (2.287) (4.954) Social Care Services Gross Income (5.973) (2.757) (2.748) (0.009) (0.019) Social Care Services Net Expenditure 273.393 126.181 128.477 (2.296) (4.974) Housing Revenue Account 2.573 1.188 1.188 0.000 0.000 Social Care, Housing and Transport Services Net Expenditure 275.966 127.369 129.665 (2.296) (4.974) Total Expenditure - NHSL and NLC 860.736 374.287 376.272 (1.985) (4.226) Care Group Year To Date
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Appendix 4.1 August 2025 August 2025 August 2025 August 2025 August 2025 August 2025 Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m Sexual Health Services 3.874 0.834 0.791 0.043 0.770 0.770 0.000 Continence Services 3.342 0.724 0.702 0.022 0.668 0.668 0.000 Immunisation Services 3.748 1.050 1.044 0.007 0.970 0.970 0.000 Speech and Language Therapy Services 7.724 1.621 1.424 0.197 1.496 1.496 0.000 Children and Adolescents Mental Health Services 17.026 3.268 2.813 0.456 3.017 3.017 0.000 Childrens Services 15.920 3.477 3.635 (0.158) 3.210 3.210 0.000 Integrated Equipment and Adaptations Store 0.817 0.177 0.172 0.005 0.163 0.163 0.000 Dietetics Services 4.762 1.046 0.990 0.056 0.965 0.965 0.000 Podiatry Services 5.177 1.059 0.984 0.076 0.978 0.978 0.000 Prisoner Healthcare Services 2.517 0.545 0.554 (0.009) 0.503 0.503 0.000 Blood Borne Viruses Services 1.886 0.422 0.339 0.084 0.390 0.390 0.000 Hospital at Home 3.059 0.731 0.707 0.024 0.675 0.675 0.000 Mental Health and Learning Disability Services 93.234 20.555 20.323 0.231 18.974 18.974 0.000 TOTAL 163.087 35.511 34.478 1.033 32.779 32.779 0.000 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
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Appendix 4.2
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Appendix 5 MOVEMENT IN RESERVES Opening Balance as at Revised Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.681 3.681 0.000 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 (0.011) 0.044 (0.011) 1, 4, 5 NHSL District Nursing 0.373 0.373 0.000 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.915 (0.131) 0.784 (0.131) 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2, 3 NHSL Long Covid Pathways 0.289 0.289 0.000 2, 3, 4, 5 NHSL Mental Health Action 15 0.730 0.730 0.000 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service Dementia Post 1.057 1.057 0.000 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.221 (0.017) 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 (0.243) 2.476 (0.243) 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 14.839 0.000 0.627 14.212 0.627 LEAD RING-FENCED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Ambition Statement & Performance TOTAL RING-FENCED RESERVES
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Appendix 5 (Contd) Opening Balance as at Revised Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL MH Funding 1.500 1.500 0.000 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 Top Up Funding 0.268 0.268 0.000 4 NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000 1, 5 NHSL Kylepark Works 0.134 0.134 0.000 4, 5 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.087 0.087 0.000 3 NHSL Breast Feeding Team (2 year funding) 0.345 (0.186) 0.159 (0.186) 1, 2, 5 NHSL Dietetics Services - Double Running Costs 0.055 0.055 0.000 0 NHSL Health Inequalities - Screening 0.016 (0.014) 0.002 (0.014) 2 NHSL Health Visiting Students/Trainees 0.029 0.029 0.000 3 NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000 2, 4 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.293 (0.082) 0.211 (0.082) 1, 2, 5 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.538 (0.005) 0.533 (0.005) 1, 2, 3 NHSL Podiatry Services - Foot Screening 0.342 (0.004) 0.338 (0.004) 1, 2 NHSL Scottish Clinical Leadership Fellowship 0.060 (0.011) 0.049 (0.011) 3 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.297 0.297 0.000 1, 2 LEAD EARMARKED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Ambition Statement & Performance
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Appendix 5 (Contd) NHSL Staff Training Academy 0.335 (0.206) 0.129 (0.206) 3 NHSL Vulnerable and Complex Cases - Test of Change 0.501 (0.059) 0.442 (0.059) 5 NLC Business Case - Non-Recurring NLC Costs 0.309 0.309 0.000 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.604 2.604 0.000 1, 2, 4, 5 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.230 0.230 0.000 2, 3 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.332 3.332 0.000 2, 3 NLC Digital and IT Strategy Technology Improvements - SWIS 0.084 0.084 0.000 2, 3 NLC Home Support Resilience (2 year funding) 0.577 0.577 0.000 3, 4 NLC IJB Helpline (2 years funding) 0.137 0.137 0.000 1, 4, 5 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.149 0.149 0.000 3, 4 NLC Staff Training Academy 0.704 0.704 0.000 3 NLC MHO Capacity Funding 0.388 0.388 0.000 4 NLC Statutory Appropriate Adults 0.161 0.161 0.000 1, 2, 5 NLC Participation & Engagement Locality 0.006 0.006 0.000 2 NLC Sessional - School summer placements 0.128 0.128 0.000 3 25.060 0.000 (2.555) 22.505 (2.555)TOTAL EARMARKED RESERVES
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Appendix 5 (Contd) Opening Balance as at Revised Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Prescribing Fund 5.066 (0.250) 4.816 (0.250) 2, 4 NLC Social Care Demand 16.470 16.470 0.000 1, 2, 3, 4, 5 21.536 0.000 (0.250) 21.286 (0.250) Opening Balance as at Revised Balance as at 1st April 2025 31st March 2026 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 14.119 14.119 0 1, 2, 3, 4, 5 14.119 0.000 0.000 14.119 0 75.554 0.000 (3.433) 72.121 (3.433) KEY 1 2 3 4 5 LEAD RISK-BASED RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Ambition Statement & Performance TOTAL RISK-BASED RESERVES LEAD CONTINGENCY FUND RESERVES Transfers To / From Reserves Drawdown from Reserves Movement in Reserves 2025/26 Ambition Statement & Performance TOTAL CONTINGENCY FUND RESERVES TOTAL RESERVES Ambition Statement & Performance Do the right thing first time. Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. Develop and support a workforce for the future. Improve mental health and wellbeing. Supporting people through a whole family approach.
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Appendix 6 ORGANISATIONAL DEVELOPMENT RESERVE £0.260m Key areas of proposed spend: Leadership Development for key groups of management staff to support performance and positive working relationships Leadership Development to support succession planning Change Management development Mediation / arbitration skills development (or external engagement of mediation in complex cases) Complex organisational development / facilitation work Executive coaching and development for SMT Culture development work
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Appendix 7 SAVINGS PROGRESS Description of Approved Saving Target Value Achieved to Date Savings Gap Description Value Budget Gap Commentary RAG Status £m £m £m £m £m Home Support Home Support re-design which will include the introduction of the dynamic scheduling tool to support the process of streamlining shift patterns alongside service provision. The re-design will further develop the enabling approach as the operating model. 2.838 0 2.838 - 0 2.838 Independent Care Homes Focus the strategic direction to reduce both the length of stay in care homes and the number of people being placed. 4.71 1.107 3.603 - 0 3.603 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 - 0 2.838 TOTAL SOCIAL CARE SERVICES 10.386 1.107 9.279 0 9.279 Budget Management Non Pays A review of budget lines including (but not limited to) travel, training and printing costs. 0.247 0.085 0.162 - 0 0.162 Prescribing A review of prescribing will be undertaken with a 5% savings target being applied. 4.326 1.725 2.601 - 0 2.601 TOTAL HEALTH CARE SERVICES 4.573 1.81 2.763 0 2.763 TOTAL HEALTH & SOCIAL CARE PARTNERSHIP 14.959 2.917 12.042 0 12.042 0 RAG Status Key Saving achieved Saving partially achieved and has reached expected year to date target Saving not achieved to date HEALTH CARE SERVICES Any year end shortfall in savings will be met from reserves. Approved Savings Replacement Saving / Funding Source SOCIAL CARE SERVICES Any year end shortfall in savings will be met from reserves
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Appendix 8 ANALYSIS OF ADDITIONAL EMPLOYEE COSTS 2025/26 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 73,724 50,405 23,448 90,803 384,899 3,492 626,771 2 73,095 42,829 30,589 80,792 379,200 7,882 614,387 3 77,695 44,690 21,698 77,774 415,502 8,580 645,939 4 78,901 52,606 33,463 59,872 461,851 5,436 692,129 5 71,192 47,421 34,659 47,566 467,144 7,004 674,986 TOTAL 374,607 237,951 143,857 356,807 2,108,596 32,394 3,254,212 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 0 0 0 26,054 303,197 -52,687 276,564 2 0 0 0 20,182 373,625 52,462 446,269 3 475 0 0 18,789 383,482 0 402,746 4 477 0 0 22,984 319,872 0 343,333 5 235 0 0 5,668 330,604 28,875 365,382 6 25,082 25,082 TOTAL 1,187 - - 93,677 1,710,780 53,732 1,859,376 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 3,378 3,213 6,503 3,183 32,198 -18,944 -68,736 2,540 -36,666 2 4,489 1,471 2,956 1,922 20,113 50,355 342,967 694 424,967 3 4,835 1,466 5,689 3,419 22,245 55,865 306,838 625 400,982 4 4,960 1,535 4,862 3,466 22,181 52,258 310,071 696 400,029 5 2,591 1,056 3,022 1,451 35,317 61,502 299,004 451 404,394 6 59,997 334,742 394,739 TOTAL 20,253 8,741 23,032 13,441 132,053 261,033 1,524,886 5,006 1,988,445 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 2,694 532 9,955 9,215 5,993 1,168 29,556 2 1,669 437 6,550 6,378 6,579 1,074 22,687 3 2,635 488 10,986 7,952 5,225 737 28,022 4 1,459 416 10,736 7,854 3,191 1,065 24,721 5 2,123 325 10,235 5,141 5,013 1,729 24,566 TOTAL 10,580 2,198 48,462 36,539 26,001 5,773 129,553 Period BANKAIDE COSTS YEAR TO DATE Period AGENCY COSTS YEAR TO DATE Period Period EXCESS PART TIME COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE
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1 REPORT Item No: 7 SUBJECT: Performance Update – 01st April 2025 to 30th June 2025, Quarter 1 2025/26 TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Morag Dendy, Head of Planning, Performance and Quality Assurance Author(s) of Report Stephen Forrest, Performance Manager DATE: 22 October 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 identified as RAG Red and Amber are attached as Appendix 1. The areas for improvement identified in Appendix 1 are being progressed as a matter of priority, and progress updates will be reported at future meetings of the Board and the Performance, Finance & Audit Committee. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ Yes ☐ No ☐ N/A ☒
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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 April 2025 to 30th June 2025, Quarter 1 2025/26 CHIEF ACCOUNTABLE OFFICER (or Depute) Head of Planning, Performance and Quality Assurance Members seeking further information about any aspect of this report, please contact the following; Stephen Forrest – Performance Manager Stephen.Forrest@lanarkshire.scot.nhs.uk
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6 1. Alcohol Brief Interventions Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Alcohol Brief Interventions North 3047 *annualised 501 482 RED Narrative & Corrective Action The overall Lanarkshire position remains on trajectory to meet annual delivery expectations but performance in North continues to fall short of the targeted level. Four hundred and eighty-two (482) ABI were delivered in Q1, reflecting the ongoing challenges with both activity levels and data capture. A significant difficulty is inconsistent recording across different systems and services. The lack of a single, reliable method of logging activity means that reported figures are almost certainly an undercount. Internal discussions have highlighted the need to improve alignment of reporting processes. At the same time, there is recognition that the overall prevalence of hazardous or harmful drinking has declined at population level and that this is likely to manifest in reduced opportunities to deliver ABIs. While this contextualises the downward trend, it does not negate the need for accurate, consistent data to demonstrate the current level of delivery. Work will therefore continue through Q2 to see how a more robust recording approach can be developed, linking with the national guidance for ABI. 2. Cervical Screening Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Cervical Screening 80% 69.6% 69.7% RED Narrative & Corrective Action Performance remains well below target in all localities and not achieved nationally, which has been the position for several years. Barriers include limited appointment availability, system recording discrepancies between SCCRS and GP systems, and persistent non-attendance. The Inequalities in Screening Steering Group continues to lead improvement work, with targeted awareness events, training for staff, and expanded engagement in early years and community settings. Cervical screening uptake continues to fall short of the national target across all six North Lanarkshire localities. While Airdrie, Bellshill, and Coatbridge demonstrated marginal improvements in Quarter 1, North and Wishaw maintained previous levels, and Motherwell experienced a slight decline. These figures reflect broader national trends, as outlined in the recent Public Health Scotland annual update. Locality Uptake Rate Change from Previous Quarter Airdrie 66.8% ↑ 0.3% Bellshill 68.9% ↑ 0.1%
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7 Coatbridge 67.8% ↑ 0.1% Motherwell 69.6% ↓ 0.2% North 73.2% ↔ No change Wishaw 68.8% ↔ No change The Scottish Cervical Screening Programme Annual Update (published 29 July 2025) confirms a sustained national decline in screening coverage. Scotland-wide coverage has dropped to 63.3% in 2023/24, down from 72% in 2016/17. Lanarkshire mirrors this trend, with coverage falling to 66.4% from 73% over the same period. Key concerns include: A 16% disparity in coverage between the most and least deprived SIMD areas in Lanarkshire. Low engagement among 25–29-year-olds, with uptake at 48.4% in Lanarkshire and 38.2% nationally. Milan data for 2024/25 indicates average uptake of 70% in North Lanarkshire and 72.7% in South Lanarkshire, though variation persists across localities. These figures reinforce the need for sustained, system-wide efforts to improve uptake, particularly among younger and more deprived populations. Locality-Level Improvement Activity A range of initiatives were delivered during Quarter 1 to support cervical screening engagement: In Bellshill, Motherwell & Wishaw/Shotts, Health Improvement teams developed locality-specific action plans, delivered via LPGs. Key actions included: Use of digital screens in public venues to promote screening programmes. Training for Health Visitors using culturally informed resources. Treatment Room staff trained to deliver screening messages. Quarterly data shared with clinical and operational leads. Airdrie locality delivered a coordinated programme of activity during Cervical Screening Awareness Week (19–24 June), which included: Dissemination of information via newsletters and social media. Inclusion of screening materials in “Condoms by Post” packs. Delivery of inequalities training to seven participants. Bellshill locality delivered targeted engagement activity to support cervical screening awareness including: • Submission of the Culture Junction Project resource to Public Health for inclusion in the Scottish Government’s Cervical Cancer Elimination Plan. • Promotion of screening information during the NHSL staff Health and Wellbeing event at the Coddington site. Coatbridge locality implemented a series of communication and outreach initiatives to promote cervical screening: Inclusion of cervical screening messaging in Health Improvement newsletters and delivery of community workshops.
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8 Engagement with CLD groups and Dunbeth Family Learning Centre to share resources and raise awareness. Support for Treatment Room staff to embed screening conversations into chronic disease clinics, resulting in engagement with nearly 40 patients since May. Motherwell & Airdrie localities delivered a coordinated programme of culturally tailored engagement activity to support cervical screening awareness. Initiatives included: Launch of a suite of three educational videos at Bellshill Central Mosque during Cervical Screening Awareness Week (Thursday 26 June), attended by over 70 women. Development of the video resources in partnership with NHS Lanarkshire Public Health, Health Improvement teams, and diverse South Asian communities from Airdrie and Motherwell. Inclusion of cancer screening information at the Motherwell Locality Wellbeing Event on 8 May, hosted at Forgewood Community Centre. The event brought together residents from Motherwell and wider North Lanarkshire to promote positive engagement with health and social care services and was supported by the Airdrie Health Improvement Senior. Wishaw locality focused on embedding screening conversations into routine clinical practice: • Training of the Chronic Disease Management team to deliver cancer screening messages during patient consultations. • A total of 130 screening-related conversations were held this quarter, including 34 specifically focused on cervical screening. Performance Reporting and System Integration Clarification of cervical screening performance reporting continues to be a national discussion point, particularly regarding discrepancies between multiple data recording systems. This issue was raised with Consultant in Public Health for Cancer Screening, who supported the proposal for a single percentage achievement rate that excludes all but defaulters. It was agreed that this recommendation should be escalated nationally to determine whether an existing report could meet this need or if a bespoke report could be developed. Feedback from the SCCRS Senior Programme Manager and National SCCRS Lead confirmed that while the issue has been recognised for several years, system changes are costly and constrained by existing contractual arrangements. The SCCRS system contract is due for review in 2027, at which point this recommendation may be considered. In the interim, Lanarkshire Public Health continues to support practices with lower uptake rates by promoting effective use of defaulter lists. A practical guide has been developed and shared to assist other practices in implementing this approach. HPV Immunisation Programme – Protective Impact Scotland’s national HPV Immunisation Programme, introduced in 2008 and offered to all 12- and 13-year-olds, continues to demonstrate strong protective benefits. A recent study has shown that no cases of cervical cancer have been detected among fully vaccinated women, reinforcing the long-term value of early immunisation. 3. Childhood Immunisations Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same RAG Status
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9 Quarter Previous Year Immunisations – %s of 5 year olds 95% 88.7% 89.6% RED Immunisations – %s of 2 year olds 95% 94.8% 94.8% AMBER Narrative & Corrective Action Uptake of childhood immunisations in North Lanarkshire has historically compared well to the national position, however both immunisation rates are below the performance standard, reflecting a wider downward trend across Scotland. The Q1 results reflect the gradual but sustained fall in uptake. Whilst the result for the 2-year old immunisations metric is below target, there is evidence of sustained performance at the targeted level in the recent past. This position is concerning given the importance of maintaining high coverage to protect population health and ensure herd immunity. The decline is attributable to a combination of factors, including persistent vaccine hesitancy among a small minority of families, access issues linked to missed appointments, and the lasting impact of pandemic-related disruption on routine contact with services. Community vaccination teams continue to work intensively to address the shortfall. Improvement actions include strengthening reminder and recall systems, improving coordination with health visiting teams to promote vaccination at every opportunity, and targeted outreach to families who have not attended. Tailored communication for communities where uptake is lower, with additional support offered to address barriers should also help to improve the position. Sustained effort will be required to reverse the downward trajectory and safeguard the progress made over previous years. To combat the declining trend, NHS Lanarkshire has undertaken the following actions: Streamlined Process: The North East Sector pilot to streamline appointment times and improve cross-cover arrangements. Targeted Clinics: Additional vaccination clinics, including home visits 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%. 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 2025/26 2024/25 Q2 2024/25 Q3 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% 83.4% 85.4% ... RED
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10 Narrative & Corrective Action Please note that the data for this metric is presented in arrears, two quarters behind. Performance for 6-8 week child health faces continued challenges in meeting the target of 90%. Whilst there appears to be some stability in the level of performance, it is significantly below the consistently high levels achieved pre-pandemic. The main pressures continue to be capacity within health visiting services, alongside the complexity of engaging families who face socio-economic barriers. Some missed reviews also relate to parental choice or difficulties in arranging attendance within the required timeframe. In response, services have focused on strengthening recall and follow-up processes, with local teams undertaking more proactive contact with families to encourage engagement. Targeted support in areas of lower uptake, in the form of community-based interventions designed to make access easier and reduce non-attendance, is ongoing. Recruitment and retention of health visitors also remain a priority, with efforts continuing to stabilise the workforce and support delivery capacity. Improvement work will continue during Q2, with an expectation that a combination of enhanced recall systems, workforce stabilisation, and stronger community engagement will lead to some incremental gains. However, the service acknowledges that sustained effort will be required to restore performance to the standards targeted. Action Timescale Expected Impact on Indicator Implement notification process for missing forms TBC Reduce incomplete records Test and evaluate Elsie App TBC Reduce DNAs, improve attendance recording Maintain GP practice engagement programme Ongoing Increase form return rates Embed SOP across all localities TBC Standardise processes, reduce variation Complete UHVP digital recording scoping TBC Improve timeliness and accuracy of reporting 5. Assistive Technology Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status
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11 Assistive Technology - Number Of People With Technology (0-17 yrs) 1452 33 22 RED Assistive Technology - Number Of People With Technology (18-64yrs) 622 270 RED Assistive Technology - Number Of People With Technology (65+) 912 673 RED Narrative & Corrective Action This indicator is currently RAG-rated red. However, the significant decrease in the reported number of individuals with Assistive Technology does not reflect an actual reduction in provision. Instead, it is due to a substantial change in how the data is recorded. Previously, the figure of approximately 1,500 recipients was derived using a methodology developed several years ago. With the transition to using ELMS2 and Mosaic, this legacy method is no longer appropriate, as it does not align with current data recording practices. While ELMS2 is now the primary data source, it must be linked with data held in Mosaic for reporting purposes. Additionally, historical data remains in legacy systems such as SWIS and MICES. Our initial analysis revealed that not all recipients of Assistive Technology are captured in the ELMS2 data, and several cases have been identified where individuals receiving Assistive Technology are missing from ELMS2. It is unclear whether this is due to issues with data migration, and further work is underway to assess the scale of the problem. We have also identified that individuals receiving Assistive Technology through Self-Directed Support (SDS) budgets are unlikely to be recorded in ELMS2, despite receiving equipment. For internal reporting, the legacy methodology consistently identified around 1,500 recipients. A new method has now been developed to interpret ELMS2 data, resulting in a revised figure of approximately 970. This new approach excludes deceased individuals and care home residents; groups that could not be reliably excluded using the legacy data. However, this introduces challenges in terms of comparability and accuracy, as we know that some recipients are still not captured in the data. To improve the reliability and completeness of reporting, several actions are required. A priority action is to ensure that IEAS records include either the SWIS/Mosaic number or CHI as a mandatory data field. External reporting requires the ability to index and match individuals across multiple services, which depends on a unique identifier. Currently, ELMS2 does not mandate inclusion of SWIS/Mosaic or CHI numbers, and addressing this gap is essential. Further work is also needed to understand how Assistive Technology provided through SDS is recorded internally, and to clarify what should be included or excluded in future reporting. 6. Reablement and Rehabilitation Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same RAG Status
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12 Quarter Previous Year Reablement - Number Of People Completing Reablement Process 2000 (500 per quarter) 1788 317 ... RED Reablement - % Of New or Increased Home Support Packages Which Are Reablement 70% 63.0% 62.4% RED Reablement - % Of People With No or Reduced Home Support Service Required At End Of Process 70% 62.5% 65.3% RED IEAS - % Deliveries Achieved Within 7 Working Days Quarterly 80% 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. 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. IEAS - % Deliveries Achieved Within 7 Working Days Quarterly Performance improved in Q4, rising to 73.4% from 60.1% in Q3. While this marks a positive trend, it remains below the 80% target. The improvement reflects ongoing efforts to embed service transformation and fully implement the new priority-based delivery framework. Since December 2024, the service has operated under a four-level prioritisation model, which has shifted focus toward higher-priority deliveries (P1 and P2). Consequently, P3 orders have significantly reduced, and backlogs in lower-priority categories are now being addressed in a more structured and consistent manner. The service continues to engage with teams to support appropriate ordering and effective signposting. Service capacity remains under pressure due to vacancies, absence and holiday cover, impacting on the ability to process new orders. Despite these operational challenges, the service continues to advance its transformational agenda. ELMS2 is now live and in use, however there are ongoing refinements in process aimed at improving reporting capabilities and system integration. The availability of ELMS2 data supports the development of new KPIs that align with the priority model. However, as noted in the earlier commentary on Assistive Technology, significant work is still required to ensure that data recording processes enable linked reporting across systems, particularly the recording of a Mosaic ID, or CHI as a unique reference for index/match of data across systems.
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13 7. Adult Mental Health Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED) 90% 75.0% 75.6% RED Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) 90% 21.8% 20.8% RED Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) 90% 66.2% 71.5% RED Narrative & Corrective Action 18 Week RTT Performance – Psychology (NHSL) (NORTH HOSTED)
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14 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 RTT performance reflects the refreshed criteria, with self-referral digital interventions now excluded from the calculation. Were digital therapies to be included, an approximate 10% increase in performance would be realised. The total number of patients waiting over 18 weeks has decreased significantly over the last 12 months (there has been a 22% reduction in the total waiting list and 37.2% reduction in over 18 week waits). The total queue is less that the anticipated trajectory, indicating sustained progress in reducing the waiting. Referrals for Neuropsychology continue to increase; our modelling 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 is in escalation through the appropriate governance structures. Consultant Outpatient WT - Older Adult Psychiatry - 12wks (NHSL) (NORTH HOSTED) Since August 2023, the service has been operating with limited Consultant capacity in Older Adult Psychiatry. This is due to maternity leave and vacancies across the team. Recruitment to Specialty Doctor posts is a significant challenge, despite persistent effort to fill these roles. Whilst vacancies remain, existing staff continue to providing best cover for rota sessions to maintain service continuity.
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15 To reflect the reduced availability of Community Consultants for routine outpatient work, the service made a series of internal rota adjustments. These changes have contributed to longer patient waiting times, as Consultants have necessarily had to scale back community clinical activity to support rota coverage for vacant posts. Increased demand; driven by changing community demographics, impacts on the service’s ability to meet targets. However, as staffing capacity improves, waiting times should improve in-line with the increased capacity. To help manage current pressures, local teams are running closely monitored ad-hoc clinics to ensure the best possible balance between demand and available capacity. Consultant Outpatient WT - Adult Mental Health - 12wks (NHSL) (NORTH HOSTED) Staff recruitment, retention, and development continue to present the most significant challenges for the Adult Mental Health service, particularly within General Adult Psychiatry (GAP). The ongoing imbalance between demand and capacity, alongside staffing instability, severely affects the service’s ability to meet waiting time targets. As noted in previous reporting, a review of the Clinical Director model highlighted that General Adult Psychiatry (GAP) has been operating with an approximate 50% vacancy rate, demonstrating the scale of the challenge. 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
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16 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. The service has written an Options Appraisal (OA) to guide the future direction of General Adult Psychiatry Services. The OA paper offers various solutions that can be adapted based on integrated, cross-disciplinary tests of change and outlines six key recommendations to drive service transformation: Formation of a Programme Board to review the GAP service model and develop a sustainable, cross-discipline workforce aligned with the Scottish Government’s Adult Secondary Mental Health Services Quality Standards. Maximisation of recruitment and retention efforts by supporting the current workforce and absorbing high-cost locums into permanent NHS roles. A comprehensive workforce review across all disciplines within GAP services, including expansion of the ANP pilot into CMHTs and a review of Psychological Therapy Teams. Engaging with referrers, patients, and carers to ensure appropriate access to services. Creation of clear guidance for transitions between primary and secondary care GAP services, and between different sub-specialities within Mental Health & Learning Disability Services. Reliable statistical modelling to support longer-term workforce planning to ensure services meet population demand. In parallel, the General Manager is working closely with the Clinical Directors on a focused piece of work to assess Demand, Capacity, Activity, and Queue (DCAQ) within GAP and Older Adults Psychiatry. 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
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17 role, improving service efficiency. As the OA is still under review, these recommendations may evolve, however the service will communicate the development of this widely with stakeholders as the work progresses. 8. Medical Paediatrics Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Medical Paediatrics WT - 12 wks (NHSL) (NORTH HOSTED) 90%* 80.3% 76.0% RED Narrative & Corrective Action The SCHSU Service Manager represents the unit at the Acute Weekly Planned Care Group that has a focus on longest waits (more than 52 weeks). A Plan on a Page Report is updated weekly to reflect progress to date. Going forward, this will be shared with Chief Officer. This is complemented by the SCHSU’s newly established Paediatric Service Improvement Group that reports into the Unit Performance Meeting. This group has representation from medical, professional nursing leadership and admin colleagues. It will be responsible for the delivering improvements in performance. The service improvement group has identified several areas of focus that should collectively expedite process. These include: Clearance of backlogs –Support to discharge for identified groups (melatonin, 16). Release capacity for T21 annual reviews, neonatal transfers. Review ratios of new: return patients including a review of Registrar Clinic (increase of new apt capacity with supervisory oversight from Consultant) Review of Registrar clinic. Review of Child not Brought Policy – Offer Tel Triage post first non-attendance. Only rebook if family engages and/or there is another identified vulnerability. Clarity and consistency in vetting process. To support this: Booking to be centralised to SCHSU Waiting List Team- additional scheduler will be required for delivery of ToC. Good housekeeping/reporting via WL Team/Weekly planned care meeting and Unit Performance Management meeting. Trakcare build – WLI. Trajectories for Community Paeds in progress of being built to evidence delivery of new process model. Validation process planned for September 2025. Professional Support required to:
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18 Identify scope and span of new roles that will support wider changes to model (in particular for continence and sleep referrals). Consultants reviewing current capacity against job plan. Review of apt times and length for new and return patients. 9. SLT Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status SLT - Paediatrics - 12wks (NORTH HOSTED) 90%* 17.6% 42.7% RED SLT - Adult - 12wks (NORTH HOSTED) 90%* 79.2% 82.8% RED Narrative & Corrective Action SLT - Adult - 12wks (NORTH HOSTED) Performance for Q4 again improved from the previous quarter (rising to 82.8%) but remains below the 90% target. 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 compared to the previous year. The service continues to experience long-term sickness absence, further constraining capacity. Referral demand remains elevated, with 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 progressing in line with broader SLT transformation work. SLT - Paediatrics - 12wks (NORTH HOSTED) Although the performance remains significantly below the 90% target, in Q1 of 2025/25 there was a significant improvement, with compliance with the twelve-week standard increasing from 17.6% to 42.7%. 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 well-established SLT CYP Service Improvement Programme has multiple work streams in place to address equity, efficiency, and quality of care: 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.
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19 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. Recruitment and retention remain critical to delivery, however activity continues to impact positively on vacancy management and contributes to the improvements in performance for this quarter. The service is also preparing trajectory-based forecasts for each tier of intervention to support planning and demonstrate progress toward the 90% target. 10. Dietetics Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Dietetics - 12wks (NORTH HOSTED) 90%* 62.5% 69.8% RED Narrative & Corrective Action A structured improvement programme is now underway to enhance service delivery and waiting list management. This includes a recent waiting list validation exercise, followed by the implementation of a rolling three-monthly validation process to ensure ongoing accuracy and a more effective oversight of the waits. The service is actively addressing data inaccuracies within TrakCare, and previously discontinued waiting list coordination practices have been reinstated. Standard Operating Procedures (SOPs) are currently in development, with staff training planned to support the implementation of these changes. To increase capacity, a Waiting List Initiative has been introduced, providing an additional 12 adult clinic appointments and 8 domiciliary telephone consultations per week. This is complemented by an expanded paediatric provision. In parallel, the service is progressing a broader transformation agenda, which includes: Modernising systems and processes Streamlining referral pathways Embedding new ways of working to support sustainable service delivery
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20 An interim target of seeing 70% of patients within 12 weeks was set for June 2025 and was almost achieved (69.8%). However, workforce resilience remains a key risk, with the service’s highly specialised configuration vulnerable to staff turnover. To support long-term sustainability, work is ongoing to explore the potential of a more generalist model of dietetic provision, which may offer greater flexibility and resilience across the service. 11. Complaints Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Complaints Processed 20 Working Days (NHSL) 50% 38% 34% RED Narrative & Corrective Action As previously reported, the performance targets for processing complaints have been revised for both Stage 1 and Stage 2 complaints. While the response timescales remain unchanged, the compliance targets have been adjusted. Specifically, the new target for Stage 2 complaints is for 50% of them to be responded to within 20 working days. As performance is measured as a percentage compliance metric, it can be significantly impacted by a small number of complex or non-compliant cases. For NHS Lanarkshire overall, performance has improved but remains below the 50% target. The majority of delays are attributed to system-related issues, with the late receipt of statements being the most significant contributing factor. To support improvement, additional permanent resource has been added to the NHSL Patient Affairs team as of June 2025, which is expected to enhance response times in future quarters. Within the partnership, the Senior Management Team continues to promote early resolution of complaints at Stage 1. Stage 2 delays are actively monitored, with escalation triggered where necessary. As a balancing measure, University Health and Social Care North Lanarkshire published 46 patient stories in May 2025, of which 38 (83%) reflected a positive experience. 12. Smoking Cessation Target 2025/26 2024/25 Q2 2024/25 Q3 Performance Compared to Previous Quarter Performance Compared to Same RAG Status
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21 Quarter Previous Year Sustain and embed successful smoking quits, at 12- weeks post quit, in 40% of SIMD areas. (AOP) (NORTH HOSTED) 902 110 166 ... ... RED Narrative & Corrective Action Please note that the data for this metric is presented in arrears, two quarters behind. All - North locality data April to December 2024/25 Q1-3 (40% most deprived) Locality Number of Quit Date Set (QDS) Number of 12 week quits 9 month target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 118 16 68.3 -52.3 23% 14% 22% Coatbridge 120 40 56.3 -16.3 71% 33% 22% North 102 24 60.8 -36.8 40% 24% 22% Bellshill 146 20 68.3 -48.3 29% 14% 22% Motherwell 132 18 47.3 -29.3 38% 14% 22% Wishaw 132 22 61.5 -39.5 36% 17% 22% Please note: Table 1 includes both specialist and community pharmacy services The table above shows the number of successful 12 week quits against the target for North localities. A six-month time lag is present, per the reporting schedule. Based on the most recent data, NHS Lanarkshire as a whole is projected to achieve 49% of its Local Delivery Plan (LDP) target set by Scottish Government (438 of 902 successful 12 week quits). Specialist - North locality data April to December 2024/25 Q1-3 (40% most deprived) Locality Number of Quit Date Set (QDS) Number of 12 week quits 9 month target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 20 9 21 -12.0 43% 45% 53%
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22 Coatbridge 28 17 21 -4.0 81% 61% 53% North 14 8 17.3 -9.3 46% 57% 53% Bellshill 16 6 14.3 -8.3 42% 38% 53% Motherwell 21 11 18.8 -7.8 59% 52% 53% Wishaw 22 13 18.8 -5.8 69% 59% 53% Please note: Table 2 includes community, pregnancy and mental health only The Specialist table above shows the number of successful 12 week quits against the target for the QYW Specialist service only. Again, a six-month time lag is present, per the reporting schedule. Table 3: Pharmacy - North locality data April to December 2024/25 Q1-3 (40% most deprived) Locality Number of Quit Date Set (QDS) Number of 12 week quits 9 month target +/- RAG on Target % 12 week quit success % Lanarkshire rate Airdrie 98 7 47.3 -40.3 15% 7% 15% Coatbridge 118 3 47.3 -44.3 6% 3% 15% North 106 32 39.0 -7.0 82% 30% 15% Bellshill 116 12 33.0 -21.0 36% 10% 15% Motherwell 81 13 42.0 -29.0 31% 16% 15% Wishaw 110 9 42.8 -33.8 21% 8% 15% Key Issues for Q1 2025/2026 QYW Stop Smoking Service In Q1, significant reduction in staff capacity due to high levels of both short and long-term sickness absence continued, which has affected the completion of the mentoring programme intended to increase service delivery capacity. The number of referrals into the Specialist Community QYW service remains low and of those referred, the number of those that then go onto set a quit date, is also low. North Lanarkshire localities have seen a 12.9% drop in referrals (excluding self-referrals) for Q1, Q1 2024/25 (139) vs Q1 2025/26 (121). QYW Community Pharmacy Service
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23 The main issues identified from visits by the pharmacy support team to community pharmacists during Q1 concern Patient Care Record (PCR) entries and logins, staff training and Nicotine Replacement Therapy product (NRT) queries. There are discrepancies in the completeness and accuracy of data entered into the PCR system and these gaps may be affecting the accuracy of performance reporting submitted to the Scottish Government. In 2024/25 (Q1-3), for all pharmacies residing in North localities, there were 1047 QDS (All SIMD): Four-hundred and ninety-four - (494) clients (63%) had no smoking status recorded at their 4-week follow-up (i.e., a blank follow-up). Seventy - (70) clients (23%) who had a successful quit at their 4-week follow-up had no smoking status recorded at their 12-week follow-up (i.e., blank follow- up). Key Actions for Q2 2025/26 QYW Stop Smoking Service- The Lanarkshire’s Tobacco and Vaping Programme Plan (2024–2026), starting on 1st April 2025, is supported by detailed Tobacco and Vaping Action Plans. The priority areas including: Pregnancy, Secondary Care, Mental Health and communities within the 40% most deprived areas. The Tobacco and Vaping Steering Group have reviewed the content of the plans. The redesigned Quit Your Way (QYW) went live on 1st April 2025. The services has approval to recruit two full-time, fixed-term Health Improvement Practitioner posts for a duration of 23 months. These posts will focus on supporting inpatients and individuals living in the 40% most deprived areas of Lanarkshire. Health Improvement staff continue to maintain a visible presence across the three secondary care sites. This has contributed to an increase in the conversion rate from referrals, to patients setting a quit date while in hospital, compared to quarter one of the previous year. Uptake of the Smoke-free app by staff remains low. However, promotional efforts are ongoing and the opportunity to engage with the app remains available. A productive meeting with Health and Social Care Partnership (HSCP) colleagues took place on 17th April 2025 to explore ways to increase referrals to the QYW service from Allied Health Professionals in North Lanarkshire. As a result, further meetings with Integrated Rehab Teams and Service Manager Team Meetings in Wishaw and Coatbridge will take place. These meetings aim to raise awareness of the QYW service, clarify referral pathways and identify training needs. QYW Community Pharmacy Service
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24 QYW Pharmacy Support Team will continue to carry out visits to community pharmacies across Lanarkshire to improve data recording and service performance across the QYW Community Pharmacy Service. The service prioritises visits to Community pharmacies where our data analysis has highlighted poor performance. Following a successful commissioning process, JRS, a research consortium comprising Jump Research, RedTree Research, and the Social Marketing Gateway, secured funding to lead a research project that includes a desktop review and the development of research tools. The project will launch in partnership with community pharmacies in August 2025. A briefing document is being finalised to serve as an internal briefing to direct consultation with clients who have used the QYW Pharmacy service in order to understand when, why and how clients use pharmacies to quit, and their expectations and experiences of the service. Discussions will continue to take place with the Community Pharmacy Lead in relation to a shared care agreement between Community Pharmacy and NHS Lanarkshire QYW specialist services. 13. Sickness Absence Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Sickness Absence (NHSL, North) 4% 7.45% 7.09% RED Narrative & Corrective Action Despite ongoing efforts, sickness absence remains an issue and the wider NHSL Board remains above the national average for this metric. Sickness absence remains above the 4% standard, consistent with wider national pressures across the health system. The main drivers continue to be musculoskeletal conditions and stress-related absence, both of which likely reflect the sustained operational pressures faced by frontline services. Improvement activity during Q1 centred on supporting early interventions and return-to-work processes. Managers are encouraged to use occupational health services proactively and ensure early referral where appropriate. Targeted wellbeing initiatives also remain in place, with ongoing promotion of resources such as the Staff Wellbeing Hub and psychological support services. While improvement will be gradual, the Partnership will continue to prioritise sickness absence reduction through enhanced management action, robust monitoring, and targeted interventions.
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25 14. Addictions Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Addictions – Ongoing Waits NHSL 90% 94.4% 89.7% … AMBER Narrative & Corrective Action In May 2021, the Drug Deaths Taskforce introduced ten standards of care for Medication Assisted Treatment (MAT), forming the foundation for Scotland’s National Mission on Drugs (2022) and the National Strategy for Community Justice (2022). A national benchmarking report published by Public Health Scotland tracks progress across all 29 Alcohol and Drug Partnership (ADP) areas as of April 2025.A DPs submitted evidence across process, numerical, and experiential domains, which informed a composite RAGB (Red, Amber, Green, Blue) rating. The 2024/25 report shows continued national improvement: 91% of ADPs fully implemented MAT standards 1–5 (up from 17% in 2021/22) 75% achieved full implementation of standards 6–10, with 16% nearing completion. This reflects a strong national commitment to innovation, collaboration, and continuous improvement. RAGB Colour | Definition Colour Definition Red There is no or limited evidence of implementation of the standard in MAT services Provisional amber There is no or limited evidence of implementation of the standard in MAT services Amber There is evidence of partial implementation of the standard in MAT services including benefit to people Provisional green There is evidence of implementation and benefit to people, however, full implementation is not confirmed by all three evidence streams – usually the experiential stream is lacking Green There is evidence of full implementation and benefit to people in all unique combinations of setting and service that offer MAT and opioid substitution therapy (OST) across the ADP area
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26 ADP Reporting Year MAT 1 MAT 2 MAT 3 MAT 4 MAT 5 MAT 6 MAT 6 & 10 MAT 7 MAT 8 MAT 9 MAT 10 North Lanarkshire 2022 2023 2024 2025 North Lanarkshire has made significant strides in delivering effective Medication Assisted Treatment (MAT). The Urgent Response Team has enabled rapid access to care, with 81% of referrals assessed and prescribed within 24 hours, surpassing national benchmarks. Treatment options have diversified, with a notable reduction in methadone and oral Buprenorphine prescribing, and a 27% increase in long-acting injectable Buprenorphine, reflecting a more patient-centred approach. Assertive outreach, led by Turning Point Scotland, has been particularly impactful, with 341 crisis interventions - the highest in Scotland, meeting national standards. Harm reduction efforts have also expanded, with over 4,000 interventions recorded using a bespoke tool that allows for locality-specific service tailoring. Retention in care is another area of strength, with 94% of Alcohol Response Team (ART) service users remaining engaged for over six months, supported by the NEO system for pharmacy monitoring. Psychological and trauma-informed care is well embedded, with clear implementation plans and comprehensive training across commissioned services and ART teams that exceed national expectations. Advocacy and social support have been enhanced through increased team awareness and expanded service capacity, contributing to a more holistic support system. However, challenges remain. Integration with primary care is limited, as no OST prescriptions have been issued through general practice, unchanged from the previous year, restricting access to MAT via general health services. Mental health support is available only to a small cohort, and joint care pathways are still under development by a Pan-Lanarkshire steering group. The sharp rise in long-acting Buprenorphine prescribing, while beneficial, may place strain on resources and requires strategic planning to ensure sustainability. Additionally, the absence of a formal system to record when advocacy is offered limits visibility into service uptake and impact, highlighting the need for improved data capture mechanisms. The true impact of ongoing implementation will be demonstrated through measurable outcomes. Encouragingly, a reduction in drug-related deaths has already been observed this year. These figures will be reflected next year as we always report a year behind. The data presented at 1.10 reflects a pan-Lanarkshire overview, which indicates that regional services are currently falling short of meeting the prescribed waiting time targets. However, a more focused analysis of North Lanarkshire, specifically the Alcohol Response Team (ART), reveals a markedly different picture. Drawing on performance data from IM and DAISy (1.9), North Lanarkshire has consistently exceeded the 90% compliance threshold for waiting times. This success is underpinned by a revised engagement strategy, which includes a clinic-based service delivery model and the introduction of weekly audits to monitor adherence to the 21-day standard across all teams.
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27 15. Unscheduled Care Target 2025/26 2024/25 Q3 2024/25 Q4 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status A&E Attendances - NL Residents 116,456 30,541 28,896 … AMBER Emergency Admissions - NL Residents 44,001 11,974 Quarterly/ 2 quarters behind … AMBER Narrative & Corrective Action Please note that the data is presented in arrears; for A&E Attendances, one quarter behind and Emergency Admissions, two quarters behind. Both UHM and UHW continue to experience challenges that impact on length of stay, delays to admission and delays to first assessment. The issues include a high number of patients not meeting the criteria to reside, a high volume of patients with a length of stay in excess of 14 days, a continued reduction in bank and agency fill rates and unplanned staff sickness absence. Performance against the targets for the four, eight and twelve hour breaches remain below the local improvement trajectory and the national targets for these metrics. A number of actions are either complete, or work in progress to improve the overall position for A&E and wider capacity and flow. Surge capacity is now in use at all three acute sites. Criteria to Reside Audits, Flow navigation, oversight and virtual ward pathways are in place to support a more consistent delivery of the Target Operating Model. The significant reduction in homecare delays and general improvement in both discharge processes and flow have contributed to an overall reduction in occupied bed days and number of patients over 14 days. 16. Training and Development Target 2025/26 2024/25 Q4 2025/26 Q1 Performance Compared to Previous Quarter Performance Compared to Same Quarter Previous Year RAG Status Employee Code of Conduct 80% 84.5% 78.4% AMBER Introduction to Risk Management 80% 82.2% 79.2% AMBER Prevent 80% 82.1% 79.8% AMBER
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28 Records and information management 80% 79.3% 75.8% AMBER Fire Safety Training 90% 90.0% 89.6% AMBER Hand Hygiene Training 90% 88.6% 87.5% AMBER TURAS compliance (NHSL, North) 80% 71% 79% AMBER Narrative & Corrective Action Mandatory training and TURAS compliance remain a priority across the Partnership, with continued close monitoring at SMT level and monthly circulation of management data to identify individuals requiring additional support. Improvement efforts remain focused on enhancing access to e-learning and in-person training opportunities, with particular emphasis on LearnPro modules where uptake continues to lag. During Q1, local Performance and Quality Coordinators provided targeted team-level analysis to highlight areas of low compliance and support remedial action. Managers continue to review compliance as part of routine performance discussions, with a focus on early escalation of risks and ensuring that new staff complete mandatory modules promptly during their induction period. The emphasis for 2025/26 is on embedding a more proactive approach to appraisal planning, ensuring appraisals take place throughout the year to avoid a spike in activity at year-end. Preparatory work has begun on developing standardised objectives tailored to role and level, to improve consistency across appraisals and strengthen alignment to the service priorities. Next steps include further development of the management information system to improve accessibility of compliance data, alongside continued partnership with OD and training colleagues to ensure adequate opportunities for staff to complete required learning.
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29 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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1 REPORT Item No: 8 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: 22 October 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 ☒ Reviewed By: Chief Finance Officer ☒ Endorsed By: Chief Officer ☒
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2 Lanarkshire Council and Chief Internal Auditor, NHS Lanarkshire) 3. EXECUTIVE SUMMARY The progress in respect of the Internal Audit work for 2024/2025 and 2025/2026 is summarised in Appendix 1. The internal audit annual report and opinion for 2024/2025 was presented to the North Lanarkshire Integrated Joint Board meeting on 17 September 2025. A workplan has been agreed to ensure the Internal Audit Plan 2025/2026 is delivered to inform the internal audit opinion for 2025/2026. 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. 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. Fieldwork arising from the Internal Audit Plan 2024/2025 has been completed. The 2024/25 Strategy report has been issued and is with Management for their response. As part of the approval of the annual accounts, the Internal Audit Annual Report and Opinion 2024/2025 was presented to the North Lanarkshire Integrated Joint Board on 17 September 2025. The opinion provided reasonable assurance on the adequacy and effectiveness of the IJB’s Yes ☐ No ☒ N/A ☐
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3 framework of governance, risk management and internal controls for the year ended 31 March 2025. The IJB approved the Internal Audit Plan 2025/2026 on 21 May 2025. 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 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. The Internal Audit Plan 2025/2026 also takes account of assurances which will be provided to the IJB based on the work performed under the Internal Audit Plans of both North Lanarkshire Council and NHS Lanarkshire for 2025/2026. The audit of operational activities is being undertaken under the auspices of the partner bodies. The IJB is asked to note that the outcomes of these operational audits are reported to the partner body Audit Committees and discussed with the IJB Chief Officer and IJB Chief Financial Officer. The assurances gained will be provided to the IJB as part of the overall assurances received from the partner body Audit Committees. We include a summary of relevant completed NHS Lanarkshire and North Lanarkshire Council reports at Appendix 2. 7. SUMMARY OF KEY ISSUES Progress on the Internal Audit Plans for 2024/25 and 2025/26 is at Appendix 1. The summary of relevant partner body reports is at Appendix 2. Progress since the August 2025 Performance, Finance & Audit Committee: Annual Report 2024/25 presented to the North Lanarkshire Integrated Joint Board on 17 September 2025 Strategy: Fieldwork is complete and the draft report is with Management. From 1 April 2025, Public Sector Internal Audit Standards were replaced by the GIAS supported by an ‘Application Note - Global Internal Audit Standards in the UK Public Sector’. Within the Local Government context application of GIAS is also supported by the CIPFA ‘Code of Practice for the Governance of Internal Audit in Local Government’ (The Code). Internal audit teams must work in accordance with the new standards from 1 April 2025 and by doing so will build up conformance to GIAS during 2025/2026. The Chief Internal Auditors are progressing GIAS development work and the Internal Audit Charter, including the Mandate, was approved at the 27 August 2025 Performance, Finance & Audit Committee.
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4 8. CONCLUSIONS The Internal Audit Plan 2025/2026 is designed to target the priority issues and to provide sufficient evidence to form an Internal Audit Opinion on the overall adequacy and effectiveness of the IJB’s framework of governance, risk management and control arrangements. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer. ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected. ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services. ☐ Health and Social Care Services contribute to reducing health inequalities. ☐ People who use Health and Social Care Services are safe from harm. ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services. ☒ 9.2 ASSOCIATED MEASURE(S) 9.3 FINANCIAL There are no financial impacts arising directly from this report. This paper has been reviewed by Finance: Yes No N/A
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5 9.4 RISK ASSESSMENT/RISK MANAGEMENT The internal audit planning process which produced the Annual Internal Audit Plan considers the strategic risk profile of the organisation. Individual internal audit assignments identify the key risks at the planning stage and our work is designed to evaluate whether appropriate systems are in place and operating effectively to mitigate the risks identified. Legislative requirements are a core consideration in planning all internal audit reviews. Relevant Risk Register Details Current Risk Level Risk Owner Ineffective Governance Arrangements Low Chief Officer
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6 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: Yes No N/A 10. BACKGROUND PAPERS N/A 11. APPENDICES Appendix 1 Internal Audit Progress – 2024/2025 and 2025/2026 Appendix 2 Summary of Relevant NHS Lanarkshire and North Lanarkshire Council Reports issued.
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7 Chief Finance Officer CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following:
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Appendix 1 8 Ref Audit Indicative Scope Target Audit Committee Planning Stage Work in Progress Draft Issued Completed Grade Internal Audit Plan 2024/25 NL01-25 Audit Planning Agreeing audit universe and preparation of internal audit annual plan. May 2024 N/A NL02-25 Audit Management Liaison with management, liaison with Chief Finance Officer and attendance at Audit Committee. Ongoing N/A N/A N/A N/A N/A NL03-25 Audit Follow Up Review of progress made by management in implementing those actions committed to in response to previously agreed Internal Audit recommendations. August 2025 N/A NL04-25 Annual Report Preparation for Annual Report including assistance with completion of IJB governance self-assessment checklist. August 2024 Reasonable
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Appendix 1 9 NL05-25 Governance arrangements Review of governance arrangements with reference to the Blueprint for Good Governance in NHS Scotland. August 2025 Adequate NL06-25 Strategy Review of the content and implementation of the Strategic Commissioning Plan, including assessing the adequacy and effectiveness of arrangements for monitoring of delivery and performance reporting. August 2025 Reasonable
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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 Agreeing audit universe and preparation of internal audit annual plan. May 2025 N/A NL02-26 Audit Management Liaison with management, liaison with Chief Finance Officer and attendance at Audit Committee. Ongoing N/A N/A N/A N/A N/A NL03-26 Audit Follow Up Review of progress made by management in implementing those actions committed to in response to previously agreed Internal Audit recommendations. August 2026 NL04-26 Annual Report Preparation for Annual Report including assistance with completion of IJB governance self-assessment checklist. August 2026
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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 L02/25 Internal Control Evaluation Reasonable Assurance This audit covered the totality of the internal control environment which impacts on all of NHS Lanarkshire’s corporate risks and aimed to provide early warning of any significant issues that may affect the Governance Statement. Key Themes: As previously reported by internal audit, financial sustainability must underpin all decision making and service transformation must be realistic, effective, and make the best use of resources. The challenge is in identifying achievable recurring savings targets and reducing reliance on non- recurring savings. There must be an impetus to ‘do things differently’ and to prioritise in line with a clearly communicated, realistic and coherent, integrated Lanarkshire wide strategic direction for transformation, within the available financial and staffing envelope. The NHS in Scotland 2024 report also highlighted that effective leadership and collaboration are essential, and that senior leaders must have a clear vision and strategic direction for reform. This will of course include working collaboratively with partners. The Workforce Plan is key in identifying the future availability of staff and where those staff are needed. The report reflected numerous key developments, evidencing continuous improvement and ongoing development of governance and assurance structures. Internal Audit confirmed that Management continued to respond positively to internal audit findings and there was a clear focus on achieving actions in response to our ICE and other reports, as it evidenced though regular Audit Follow up reporting. Internal Audit made seven recommendations (one ‘significant’, and six ‘moderate’) are aimed at ensuring coherence between Governance Structures, Performance Management, Risk Management and Assurance.
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Appendix 2 13 Report Audit Opinion Key findings L11/25 Review of Clinical Governance Reasonable Assurance Internal Audit concluded that while there were regular updates on the Quality Strategy 2023-2029 reported through governance structures and that the 2024/2025 True North Action Plans have been formally approved, reporting on implementation of True North Action Statements could be improved through standardisation of reporting and through more timely reporting. Management have agreed that True North updates will continue to be reported to the committees that are assigned True North actions, and that they will strive to ensure completion in a timely manner. A 2024/25 end of year report on outcomes of the Quality Strategy 2023-2029 will be produced. L19/25 Financial Management Reasonable Assurance The NHS Lanarkshire Financial and Transformation Plan 2024/2025 aligns the Annual Delivery Plan and regular finance reports were presented to NHS Lanarkshire Board and the Planning, Performance and Resources Committee for awareness, discussion, and assurance. Internal Audit confirmed that relevant, reliable and meaningful monthly budget reports are distributed with support and training provided for budget holders. Management have agreed that: Where budgets are widely different from actuals in year, each division will review variances to determine if these have been created from one-off cost pressures or a substantive change; a business case would be expected before adjusting budgets. Finance will continue to set, review and report on all budget areas within the current funding envelope and would propose a budget “rewash” exercise be progressed where areas of expenditure reporting recurring reductions be reinvested across areas experiencing higher levels of expenditure/activity. Consideration will be given to the process around escalating budget management concerns and the team will work towards the implementation of a procedure which will aid management control and reporting as well as escalating areas of concern.
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Appendix 2 14 Report Audit Opinion Key findings L20/25 Review of Property Management Strategy Substantial Assurance Based on examination of the control structure and the procedures in place, we confirmed that objectives were met for the submission of the Business Continuity Investment Plan in compliance with DL (2024) 02. NHS Lanarkshire's Business Continuity & Essential Investment Infrastructure Plan was endorsed at the 14 January 2025 Finance & Resources Sub-Committee and approved by the Planning, Performance & Resources Committee (PPRC) before submission to the Scottish Government by 31 January 2025. We concluded that the project governance groups fulfilled their remits of co-ordinating activity, overseeing development of the Business Continuity & Essential Investment Plan and its approval through NHS Lanarkshire’s governance structures. L24/25 Cyber Resilience / Information Security Framework Reasonable Assurance The NHSL Digital Plan 2023-2028 is aligned to the Cyber Resilience Framework. The NHS Lanarkshire Network & Information Systems (NIS) Audit Programme 2024 Progress Review Interim Report was published on 29 November 2024 and concluded positively on compliance with asset management aspects of the Cyber Resilience Framework. The aim of 100% implementation of security patches (software and operating system updates that aim to fix security vulnerabilities) within 14 days of release has been achieved in 5 months of the 14-month period from November 2023 – December 2024. Management have active reporting implemented to identify any non-compliance with the 14-day target for security patches. There are significant business challenges involved with some Application Owners unable to agree the required downtime to apply the patches and this issue was escalated to the March 2025 Cyber Security Group. Risk record (83) - Asset Management process and controls will be reviewed and updated to ensure that the risk and potential impact is clearly described, and all current controls documented. Planned mitigating actions along with target dates will also be added. No relevant reports have been issued by North Lanarkshire Council in this period.
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REPORT Item No: 9 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee: For approval For endorsement For noting 1.2 This report provides an outline of the actions agreed with the External Auditor, Internal Auditor, and the Senior Management Team to further develop the IJB governance framework. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the PFA Committee: (1) Acknowledge the contents of the report; and (2) Agree that further progress reports will be presented to future meetings of the PFA Committee in respect of the ongoing actions. 4. VARIATIONS TO DIRECTIONS 5. ANNUAL GOVERNANCE STATEMENT ACTION PLAN 5.1 As part of the statutory annual accounts, an Annual Governance Statement is included which reports on the effectiveness of the IJB’s governance arrangements and system of internal control and explains how the IJB complies with the Code of Corporate Governance and meets the requirements of ‘Delivering Good Governance in Local Government’ framework developed by CIPFA and SOLACE in 2016. 5.2 To ensure continual improvement of the IJB’s governance arrangements, an action plan is included within the Annual Governance Statement which was approved at the IJB in June 2025. Included within this are improvement areas identified by Audit Scotland within their Annual Audit report, Internal Audit as part of their annual audit SUBJECT: Annual Governance Statement – Action Plan Progress TO: Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Financial Officer DATE: 22 October 2025 Yes No N/A
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work as well as improvements highlighted as part of the IJB self-assessment process. 5.3 Following conclusion of the 2024/25 External Audit, the Annual Audit Report identified 1 recommendation with regards to financial sustainability therefore this has been added to the action plan. 6 ACTION PLAN PROGRESS 6.1 Appendix 1 details the actions as well as progress against these actions. For audit purposes, all actions will remain on the plan for a full financial year however those completed during the year will be removed for the first report after April 1st each year. Table 1 provides a summary of the status of the actions. Table 1 Year the action was identified Total Actions Completed Actions Ongoing Actions 2022/23 2 1 1 2023/24 5 4 1 2024/25 3 1 2 2025/26 1 1 0 TOTAL 11 7 4 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The implementation of agreed actions will contribute to the ongoing development of the internal control framework and will also inform the Annual Governance Statement for 2025/26.
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7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Ineffective Governance Arrangements Low Claire Rae 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes This report includes all engagement and participation objectives as effective governance arrangements ensure the IJB can fulfil its statutory duties. Good governance enables the IJB to pursue its vision effectively as well as underpinning that vision with mechanisms for control and management of risk. ☒ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☒ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A
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8. BACKGROUND PAPERS None. 9. APPENDICES Appendix 1 Annual Governance Statement – Action Plan Progress Chief Finance Officer Members seeking further information about any aspect of this report, please contact Nicola Scott on telephone number 07581 007187.
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Appendix 1 Annual Government Statement - Action Plan Progress Reference Improvement Area Agreed Action Responsible Person Projected Completion Date Current Status Ongoing / Complete 2022/23: 1 Service Level Agreement (SLA) To agree an SLA with Children, Families and Justice for future hosting arrangements following the budget disaggregation exercise. Work is currently underway to agree, approve and implement the new SLA in partnership with Children, Families and Justice Services. Chief Officer Claire Rae September 2025 Work on this is progressing. The budget data has been gathered to inform the arrangements, key points for consideration are being collated, and the final task will be for all relevant chief officers to meet and finalise this SLA. The current timeline for completion is no later than 31st March 2026. Ongoing 2022/23: 2 National Care Service To develop a sound understanding of the impact for the Partnership of the National Care Service legislation. Paper presented to the IJB in January 24 giving an update on timescales for implementation. Further updates will be presented to the board as details are released. Chief Officer Claire Rae September 2025 This action is no longer relevant given the changes from the proposed NCS to the Care Reform Bill. The Senior Management Team will keep abreast of ongoing developments and report to the IJB as necessary. Complete. 2023/24: 1 2023/24 Self- Assessment Agreed actions 1. Development of a revised framework for North Lanarkshire which will ensure engagement and participation in the development of the Strategic Commissioning Plan across the entire health and social care system. Chief Officer Claire Rae December 2025 The development of a new Strategic Commissioning Plan is underway with a view to the new plan coming into effect from April 2026, upon expiry of the current Strategic Commissioning Plan 2023-2026. An engagement and consultation process has been initiated to ensure a wide range of staff, people who use services, carers and partner organisations have an opportunity to participate in shaping the next commissioning plan. This was reported to the IJB on 17th September 2025 Strategic Commissioning Plan 2026 and Beyond Complete 2. Undertake an exercise to review performance output and associated data from other Health Boards and Local Authorities. Chief Officer Claire Rae December 2025 Benchmarking is undertaken within our family group of local authorities against all national performance indicators and reported within the Annual performance report. Annual Performance Report 2024/25 - DRAFT Complete 3. Recognition that there is a formalised risk sharing agreement in place with NHSL, NLC and SL IJB within the risk management strategy but no reference to similar in relation to performance and finance. Chief Officer Claire Rae December 2025 This is currently under review to consider whether a formalised agreement is required and what this would consist of. Ongoing 2023/24: 2 Presentation of financial and non- financial information in the annual accounts In the production of future accounts, the IJB should review the presentation of both financial and non-financial information to ensure this reflects the organisation’s role as a strategic commissioning body. Chief Finance Officer Nicola Scott September 2025 A review of other IJB’s accounts was undertaken to ascertain the style and content of their Annual Reports. Using this, the format of the 2024/25 Annual Report was updated which has been accepted by Audit Scotland. Complete 2023/24: 3 Presentation of financial and non- financial information in the financial performance reports The financial reports will be further defined to give an overview in the delivery of services against the overall funding aligned to the Strategic Commissioning Plan and Medium- Term Financial Plan/Long Term Financial Plan including earmarked reserves. Chief Finance Officer Nicola Scott September 2025 An updated report, taking into account Audit Scotland’s recommendations, has been prepared for the first quarter. This was presented to PFA in August 2025 and has been accepted by Audit Scotland as part of their 2024/25 External Audit. Complete
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Appendix 1 Reference Improvement Area Agreed Action Responsible Person Projected Completion Date Current Status Ongoing / Complete 2024/25: 1 2024/25 Self- Assessment Agreed actions 1. Holding to Account - effective scrutiny, challenge and support of services by the Management Team and IJB members when reviewing presented papers. Chief Officer Claire Rae December 2025 Work on this will be undertaken as part of updating the standing orders in Q1 2026. Ongoing 2. Vision for IJB should be clear and ambitious with membership being diverse and engaged. Management team to review induction process and liaison sessions. Chief Officer Claire Rae December 2025 This is under review and will be updated along with the renewal of the Strategic Commissioning Plan in April 2026. Ongoing 3. Review what goes to IJB and PFA and ensure there are appropriate development sessions to support the financial picture. Chief Officer Claire Rae December 2025 A workplan has been prepared for 12months for both PFA and IJB and presented to both for approval. This is a live document that can be added to as necessary. There has also been a series of IJB Development Sessions scheduled for the remainder of 2025 and Q1 2026 with specific topics allocated including Finance and Risk. Complete 2025/26 Financial Sustainability The IJB should continue to: Develop and refine the arrangements it has in place for securing financial sustainability, including its medium and long term financial plans and savings plans. Work effectively in partnership with the local council and the health board on service transformation. Apply its reserves strategy to effectively manage the use of reserves to supplement savings and efficiencies when required. Chief Finance Officer Nicola Scott Ongoing It was agreed with the Audit Director that this action will remain ongoing as there is no end date to this. The management response provided and included in the Final Audit Report was as follows: A financial outlook for the 3 year period has been prepared and is being presented to Board Members on 17th September 2025. This outlines the forecast budget gaps for the next 3 years and will lead into Board Development sessions where savings will be discussed for approval at a later Board. The outlook clearly identifies the current reserves position and the impact non achievement on savings will have on reserves. Discussions have taken place with both NLC & NHSL on the forecast position and an Elected Members briefing session within NLC was undertaken in June this year with another scheduled in the Autumn to ensure all relevant parties are aware of the forecast. The medium term and long term outlooks will continue to be reviewed throughout the year with budget setting for 2026/27 set for March 2026. Complete There will be ongoing review as part of the annual financial planning arrangements. Key Complete Ongoing – within projected completion timescale Ongoing – has exceeded projected completion date
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REPORT Item No: 10 SUBJECT: Risk Management Report TO: Integration Joint Board, Performance, Finance and Audit Committee Lead Officer for Report: Claire Rae, Chief Officer Author(s) of Report Kerry Taylor, Business Support Manager DATE: 22 October 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 ☒ 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 At the IJB Development session on 10 September 2025 a presentation and discussion took place on the work underway to review and redevelop the IJB risk register. 5.4 It is proposed that the current risks will be closed, with new risks being presented to the IJB in December 2025 for approval. The discussion took place around the proposed themes of risks including financial risks, governance risks, performance risks and work force risks. 5.5 Work is ongoing to develop these risks with associated controls and actions. These will be discussed with both NHS Lanarkshire and North Lanarkshire Council colleagues before being presented to the Board. 6. Current Very High and High IJB Risks 6.1 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 6.2 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
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• IJB 19/23 – Service Sustainability • IJB 20/23 – Workforce Sustainability • IJB 12/22 – Unscheduled Care • IJB 23/24- Speech and Language Therapy 6.3 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). 7. NEXT STEPS 7.1 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. 7.2 A report will be presented to the IJB in December 2025 with the new proposed risk register for approval from the Board. 8. CONCLUSIONS 8.1 The IJB currently has 19 risks identified on its IJB risk register with 10 risks rated as high or very high. 8.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 9. IMPLICATIONS 9.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐
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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 Choose an item. 9.5 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 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 / Date added ☐ No ☐ N/A ☒ 10. BACKGROUND PAPERS 11. 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 October 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. Under review – October 2025 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 Under review – October 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 Under review – October 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 Under review – October 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 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 Under review – October 2025 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. J National Networks are established which are providing the framework to support a national approach where appropriate. 2. J Public Health advice and support is in place. 3. IJ ncreased numbers of agile workers and increased number of laptops/tablets. 4. J 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. RJ 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.TJ 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. J 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 Under review – October 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 Under review – October 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 Under review – October 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 Under review – October 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 Under review – October 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. Under review – October 2025 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 Under review – October 2025 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 Under review – October 2025 05.09.22 Community Alarms There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. HIGH CONTROLS Medium Low Diane Fraser Claire Rae SLT, IJB PFA, IJB, ASW C&W B 31.01.2025 Reviewed and updated June 2023. Working group established to coordinate all activity Oversight through Home Support Programme Board Reporting to Adult Social Work, Care and Wellbeing Committee Reporting to IJB Reviewed Oct 2023. Reviewed Jan 2024. IJB.18. 2022 Strategic and Performance ACTIONS NLC Committee approval to purchase 1000 digital alarms so the service can support any imminent changes over to digital in individual areas Reviewed April 2024. Reviewed Sept 2024 Reviewed Oct 2024 NLC part of SG once for Scotland procurement process for a new digital alarm receiving center Reviewed March 2025 Communication out to all community alarm service users Instructions issued to all community alarm service users on how to do test calls to ensure alarms are operational Reviewed and no changes May 2025 Engagement with telecommunication suppliers to ensure sight of roll out plans across NL Call-off direct award using third party Framework for Digital ARC and purchase of digital dispersed alarm units agreed at Adult Care and Social Work Committee in May 2025 Under review – October 2025
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27/02/2023 Service Sustainability High CONTROLS High Low Claire Rae Claire Rae SLT, IJB PFA, IJB 31.01.2025 Reviewed and Updated May 2023 IJB PFA Committee. IJB.19. 2023 Performance Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety IJB Chief Officer is a member of each partner's key decision-making forums. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. Regular budget meetings with Chief Executives and Directors of Finance. Regular HSCP budget monitoring meetings across Senior Leadership Team. The IJB Financial Plan is regularly reviewed and agreed. Capacity plans in place to maximize efficiency. Consultation and involvement with key stakeholders including service users and carers. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. Strategic Planning Group, Locality engagement sessions and Partnership Boards. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Reviewed and Updated Oct 2023. Reviewed and updated Jan 2024. Reviewed April 2024. Reviewed Sept 2024 Reviewed Oct 2024 Reviewed March 2025 Reviewed and no changes May 2025 Under review – October 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 Under review – October 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 Under review – October 2025 IJB23.24 Performance Speech and Language Therapy (SLT) Service High CONTROLS 1. J 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 Under review – October 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 O icer Meeting Date Recurrence Reason / Notes Wednesday 22 October 2025 Financial Monitoring - Month 6 & Period 6 (September) Chief Finance O icer 22 October 2025 Quarterly Annual Governance Statement Actions - Progress Update Chief Finance O icer 22 October 2025 IJB Performance Report (Q1) Head of Planning, Performance & Quality Assurance 22 October 2025 Quarterly Internal Audit Progress Report 2025/2026 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 22 October 2025 Quarterly IJB Risk Report Chief O icer 22 October 2025 Quarterly Wednesday 18 February 2026 Financial Monitoring - Month 8 & Period 9 (December) Chief Finance O icer 18 February 2026 Quarterly Reserves Strategy 2026/27 Chief Finance O icer 18 February 2026 Annual Governance Statement Actions - Progress Update Chief Finance O icer 18 February 2026 IJB Performance Report (Q2) Head of Planning, Performance & Quality Assurance 18 February 2026 Quarterly Internal Audit Progress Report 2025/2026 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 18 February 2026 Quarterly IJB Risk Report Chief O icer 18 February 2026 Quarterly
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead O icer Meeting Date Recurrence Reason / Notes Financial Regulations Chief Finance O icer 18 February 2026 Annual Wednesday 20 May 2026 Financial Monitoring - Final Outturn Chief Finance O icer 20 May 2026 Quarterly IJB Performance Report (Q3) Head of Planning, Performance & Quality Assurance 20 May 2026 Quarterly Internal Audit Plan 2026/2027 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 20 May 2026 Annual Internal Audit Progress Report 2025/2026 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 20 May 2026 Quarterly IJB Risk Report Chief O icer 20 May 2026 Quarterly Wednesday 19 August 2026 Financial Monitoring - Month 4 & Period 4 (July) Chief Finance O icer 19 August 2026 Quarterly IJB Performance Report (Q4) Head of Planning, Performance & Quality Assurance 19 August 2026 Quarterly Internal Audit Progress Report 2025/2026 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 19 August 2026 Quarterly IJB Risk Report Chief O icer 19 August 2026 Quarterly Wednesday 21 October 2026
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN Item Lead O icer Meeting Date Recurrence Reason / Notes Financial Monitoring - Month 6 & Period 6 (September) Chief Finance O icer 21 October 2026 Quarterly IJB Performance Report (Q1) Head of Planning, Performance & Quality Assurance 21 October 2026 Quarterly Internal Audit Progress Report 2025/2026 Chief O icer – Audit and Risk (NLC) / Chief Internal Auditor (NHS) 21 October 2026 Quarterly IJB Risk Report Chief O icer 21 October 2026 Quarterly Future Reports Integration Joint Boards: Finance and Performance 2025 Chief Finance O icer TBC Annual Meeting date dependant on publishing from Audit Scotland Best Value Framework Chief Finance O icer TBC Triennial Best Value – Annual Statement of Compliance Chief Finance O icer TBC Annual Accounts Commission Reporting TBC TBC As and when publications released from Accounts Commission Local Code of Corporate Governance TBC TBC Annual 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 O icer TBC Annual
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NORTH LANARKSHIRE INTEGRATION JOINT BOARD PERFORMANCE, FINANCE AND AUDIT WORK PLAN