Agenda Document Pack - Moray Integration Joint Board - 27/11/2025
Moray Council · 27 November 2025
Back to Moray Integration Joint Board — 27 November 2025 and its agenda
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Moray Integration Joint Board Thursday, 27 November 2025 Council Chambers NOTICE IS HEREBY GIVEN that a Meeting of the Moray Integration Joint Board, Council Chambers, Council Office, High Street, Elgin, IV30 1BX on Thursday, 27 November 2025 at 10:00 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Minute of meeting of 25 September 2025 5 - 10 4. Action Log of 25 September 2025 11 - 14 5. Minutes - for noting 5a Minute of meeting Audit Performance and Risk Committee of 19 June 2025 15 - 20 6. Chief Officer Report 21 - 28 7. Revenue Budget Monitoring Quarter 2 for 2025-26 29 - 50 8. Moray Integration Joint Board Strategic Risk Register Risk 2 (Financial Sustainability) and Risk 8 (Governance and Assurance) 51 - 82 Page 1
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9. Membership of Board and Committees 83 - 88 10. Mental Health Services and Pressures on Primary Care 89 - 94 11. Introduction to Moray Home Assessment Pathway 95 - 100 12. Childrens Services Pressures Report 101 - 120 13. Annual Report of the Chief Social Work Officer 2024-25 121 - 156 14. Public Sector Climate Change Duties Report Submission 2024-25 157 - 172 15. Moray Integration Joint Board Meeting Dates 2026-27 173 - 178 Item(s) which the Committee may wish to consider with the Press and Public excluded 16. CONFIDENTIAL Health and Social Care Moray Structure Review • 1. Information relating to a particular employee, former employee or applicant to become an employee of, or a particular office- holder, former office-holder or applicant to become an office- holder under, the authority. Watching the Meeting You can watch the webcast live by going to: http://www.moray.gov.uk/moray_standard/page_43661.html Webcasts are available to view for 1 year following the meeting. You can also attend the meeting in person. If you wish to attend in person, please come to the High Street entrance door and a member of staff will let you into the Chamber. Page 2
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MORAY INTEGRATION JOINT BOARD SEDERUNT Mr Dennis Robertson (Chair) Councillor Peter Bloomfield (Voting Member) Councillor Scott Lawrence (Voting Member) Mr Derick Murray (Voting Member) Councillor Bridget Mustard (Voting Member) Mr Sandy Riddell (Voting Member) Mr Alex Stephen (Voting Member) Councillor Ben Williams (Voting Member) Ms Karen Greaves BEM (Ex-Officio) Ms Laura Skaife-Knight (Ex-Officio) Mr Ivan Augustus (Non-Voting Member) Professor Duff Bruce (Non-Voting Member) Mrs Sheila Brumby (Non-Voting Member) Mr Sean Coady (Non-Voting Member) Ms Sonya Duncan (Non-Voting Member) Ms Jane Ewen (Non-Voting Member) Dr Robert Lockhart (Non-Voting Member) Mr Jim Lyon (Non-Voting Member) Ms Aimee McIntosh (Non-Voting Member) Ms Deborah O'Shea (Non-Voting Member) Ms Judith Proctor (Non-Voting Member) Mr Michael Ritchie (Non-Voting Member) Ms Elizabeth Robinson (Non-Voting Member) Clerk Name: Caroline O'Connor Clerk Telephone: 07779 999296 Clerk Email: committee.services@moray.gov.uk Page 3
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MINUTE OF MEETING OF THE MORAY INTEGRATION JOINT BOARD Thursday, 25 September 2025 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Councillor Peter Bloomfield, Mrs Sheila Brumby, Mr Sean Coady, Ms Sonya Duncan, Ms Jane Ewen, Councillor Scott Lawrence, Dr Robert Lockhart, Councillor Bridget Mustard, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Mr Michael Ritchie, Mr Dennis Robertson, Ms Elizabeth Robinson, Mr Alex Stephen, Councillor Ben Williams APOLOGIES Mr Ivan Augustus, Professor Duff Bruce, Dr Adam Coldwells, Ms Karen Greaves BEM, Mr Jim Lyon, Mr Derick Murray IN ATTENDANCE Chief Nurse - Moray; Janis Donaldson, UNISON (observer); Improvement Officer (Mental Wellbeing) and Caroline O'Connor, Committee Services Officer. ALSO IN ATTENDANCE Councillor Tracy Colyer, Councillor Sonya Warren 1. Chair The meeting was chaired by Councillor Bridget Mustard. 2. Welcome The Board joined the Chair in welcoming Mr Michael Ritchie as the new NHS Staff Partnership representative to his first meeting of the Board. 3. Declaration of Member's Interests Mr Riddell stated for transparency that he was Chair of the Mental Welfare Commission for Scotland. Item 3. Page 5
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The Board noted there were no other declarations of member's interests. 4. Minute of meeting of 19 June 2025 The minute of the meeting of 19 June 2025 was submitted and approved. 5. Action Log of 19 June 2025 The Action Log of the meeting of 19 June 2025 was discussed and updated accordingly. 6. Minute of meeting Clinical and Care Governance Committee of 27 February 2025 The Board noted the minute of the meeting of the Clinical and Care Governance Committee of 27 February 2025. 7. Minute of meeting Audit Performance and Risk Committee of 27 March 2025 The Board noted the minute of the meeting of the Audit, Performance and Risk Committee of 27 March 2025. 8. Membership of Board and Committees The meeting had before it a report by the Corporate Manager informing the Board of changes to membership of the Moray Integration Joint Board, Audit Performance and Risk Committee and Clinical and Care Governance Committee. The Corporate Manager provided an update in relation to recommendation 2.1(ii) that Councillor Ben Williams had been nominated for the position of Chair of Audit, Performance and Risk Committee and had accepted the position. In response to concerns raised by Ms Donaldson as to her role at the meeting given that paragraph 4.9 stated there was no agreed Moray Council staff representative, the Chief Officer advised whilst staff had previously been represented by UNISON, in terms of governance the Board required clarification which union would represent the Council staff working in health and social care. In the circumstances, Ms Donaldson asked it be noted that she was attending the meeting as an observer and anything agreed at the meeting must not stipulate in consultation with the Trade Unions. Following consideration the Board unanimously agreed to:- i) note the Chair and Vice Chair are due to rotate on 1 October 2025; ii) the appointment of Councillor Ben Williams as Chair of the Audit, Performance and Risk Committee; iii) note the update regarding vacancies in Unpaid Careers and Third Sector representative position; Page 6
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iv) note the appointment of Michael Ritchie as the new NHS Staff Partnership representative; and v) note the updated membership of the Board and Committees attached as Appendix 1. 9. Chief Officer Report The meeting had before it a report by the Chief Officer informing the Board of the Chief Officer activities that support the delivery against the Moray Integration Joint Board's (MIJB's) strategic priorities articulated in the Strategic Plan, and the delivery against the 9 Health and Wellbeing outcomes. Following consideration the Board unanimously agreed to:- i) note the contents of the report; and ii) agree that transforming services to meet the aspirations of the MIJB's Strategic Plan remains a priority. 10. Revenue Budget Monitoring Quarter 1 for 2025-26 The meeting had before it a report by the Chief Financial Officer updating the Board of the current Revenue Budget reporting position as at 30 June 2025 for the Moray Integration Joint Board budget. Following consideration the Board unanimously agreed to:- i) note the financial position of the MIJB as at 30 June 2025 is showing an overspend of £1,425,931 on core services; ii) approve the budget realignment as detailed in paragraph 5 and Appendix 3; iii) note the progress against the approved savings plan in paragraph 6 and Appendix 5; iv) note the budget pressures and emerging budget pressure as detailed in paragraph 7; and v) note the revisions to staffing arrangements dealt with under delegated powers and in accordance with financial regulations within the Council (MC) and NHS Grampian (NHSG) for the period 1 April to 30 June 2025 as shown in Appendix 4. 11. Moray Integration Joint Board Strategic Risk Register The meeting had before it a report by the Chief Officer presenting the Board with an updated Strategic Risk Register, providing a clear overview of current strategic risks, their assessments and mitigating actions. Ms Ewen left the meeting during discussion of this item. Page 7
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During discussion regarding reduction in risk ratings, Mr Robertson suggested the risk register be monitored by Audit, Performance and Risk (APR) Committee as a regular agenda item and any issues be escalated to the Board. In response Mr Riddell, as current Chair of APR, advised, while it would be appropriate for the Committee to focus on the detail in the register, the risk was owned by the Board and therefore scrutiny by the Board was important, specifically in relation to savings and timescales. The Chair moved an additional recommendation (iii) be added that "future updates of the Register be submitted in draft format to Audit, Performance and Risk Committee prior to submission to the Board for final approval". Following consideration and there being no one otherwise minded, the Board unanimously agreed:- i) to approve the updated Strategic Risk Register (Appendix 1), including the adequacy of the identified mitigating controls identified; ii) to approve the inclusion of a new risk related to the limited assurance position given by the Moray Integration Joint Board Auditor; and iii) future updates of the Register be submitted in draft format to Audit, Performance and Risk Committee prior to submission to the Board for final approval. 12. Childrens Services Plan 2023-26 - Year 2 Annual Report for Year 2024-25 The meeting had before it a report by the Interim Chief Social Work Officer presenting the 2024-25 Children Services Plan Annual Report to the Board. The Board joined the Chair in recognising the work undertaken by the service and commending them for the significant progress as highlighted in the report. Following consideration the Board unanimously agreed to approve the Children Services Plan 2024-25 Annual Report, attached as Appendix 1. 13. Health and Social Care Moray Annual Complaints Report 2024-25 The meeting had before it a report by the Chief Nurse, Moray providing the Board with the Health and Social Care Moray Annual Complaints Report for 2024/25. Following consideration the Board unanimously agreed to:- i) note the contents of the annual report; and ii) approve the publication of the annual report on the Health and Social Care Moray website. 14. Members Expenses The meeting had before it a report by the Chief Financial Officer informing the Board of amendments to the policy for reimbursement of expenditure incurred by individuals discharging their duties in relation to Moray Integration Joint Board. Page 8
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Following consideration the Board unanimously agreed to note the changes made to the Members' Expenses Policy (Appendix 1). Page 9
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MEETING OF MORAY INTEGRATION JOINT BOARD Thursday 25 September 2025 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 27 NOVEMBER 2025 1. Options for Ward 4 Inpatient Unit for Patients with Mental Illness Further development work to be undertaken in order to prepare a full detailed report which would be brought back to the Board for consideration in approximately 3 months. Update 28/11/24: Development session to be scheduled to be held before the strategic delivery plan progress update comes back to the Board in 6 months, to provide more details on progress and engage with members of the Board. Update 25/09/25: Briefing note to be circulated addressing specific issues escalated by CCG following their meeting on 28 August and report to be prepared for Board meeting on 27 November 2025 January 2026 TBC ASAP 27/11/2025 SC JP JP JP Options appraisal for Ward 4 will be concluded end of November 2025 and submitted to NHS Grampian Chief Executive Team on 9 December 2025 and to MIJB January 2026 Briefing circulated Report on today’s agenda Item 4. Page 11
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 27 NOVEMBER 2025 2. Chief Officer Report 29/05/25 i) Update report relating to the work being undertaken in relation to strategic change at Dr Grays to be prepared for future meeting of the Board. ii) Strategic awareness of unpaid carers capacity to be considered at next IJB Development Session. Early 2026 JP JP In progress Topics for future development sessions being considered 3. MIJB Strategic Risk Register 29/05/25 i) Youth representation – consideration to be given to a robust process to include youth representation. TBC JP/JL Considered the possibilities of someone from the Champions Board but have not identified anyone suitable. Liaising with Education Services to see if there is anyone who may be suitable – Youth Parliament or Debating Society. 4. Moray Adult Mental Health Strategic Group Progress Report 29/05/25 Mental Health Quality Standard 4: Workforce in Appendix 1, Outcome namely the workforce feels valued and respected, unpaid carers to be included in the workforce survey planned for later in the year. March 2026 IM/ER The survey will be actioned later in the year. Comprehensive progress report on Delivery Plan scheduled for March 2026 5. Membership of Board and Committees 25/09/25 Position regarding Moray Council staff representative on MIJB to be clarified. 27/11/25 SD Moray Council senior management taking forward. Page 12
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 27 NOVEMBER 2025 6. Chief Officer Report 25/09/25 i) Vaccination Centre, Beechbrae – issues with car parking, specifically white lines being painted for car parking spaces, to be resolved following extension of lease. ii) Palliative Care Review Report to be prepared for meeting of Board in November TBC 27/11/25 JP SC As the property is a temporary location for the Vaccination service there are no immediate plans to undertake additional spend. Report deferred to January 2026 7. Revenue Budget Monitoring Quarter 1 for 2025-26 25/09/25 Future monitoring reports to include more detailed information on work being undertaken by Budget Savings Oversight Group and monthly meetings between Finance Director NHSG and 95 Officer MC to address the savings to provide Board with assurance. Ongoing DO Report on today’s agenda Action Closed 8. HSCM Annual Complaints Report 2024/25 25/09/25 Future reports to include:- i) More detailed information on outcomes ii) Table 1a – clearer explanation of no value in table rather than with asterisks below iii) Benchmarking information in comparison to other areas iv) Update on how HSCM has changed processes / introduction of a single system Sep 2026 HC/IW In progress for next year’s report. Action Closed Page 13
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MINUTE OF MEETING OF THE AUDIT, PERFORMANCE AND RISK COMMITTEE Thursday, 19 June 2025 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Sean Coady, Ms Sonya Duncan, Councillor Scott Lawrence, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Councillor Ben Williams APOLOGIES Ms Deirdre McIntyre IN ATTENDANCE Interim Chief Social Work Officer/Head of Service; Chief Internal Auditor; Iain Macdonald, Deputy Head of Service; Corporate Programme Manager; Angela Pieri, Engagement Lead, Grant Thornton and Caroline O'Connor, Committee Services Officer ALSO IN ATTENDANCE Councillor Tracy Colyer 1. Chair The meeting was chaired by Mr Sandy Riddell. 2. Declaration of Member's Interests The Committee noted there were no declarations of member's interests. 3. Minute of meeting of 27 March 2025 The minute of the meeting of 27 March 2025 was submitted and approved. 4. Action Log of 27 March 2025 The Action Log of the meeting of 27 March 2025 was discussed and updated accordingly. Item 5a Page 15
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5. Quarter 4 (January - March 2025) Performance Report - Adult Services The meeting had before it a report by the Corporate Programme Manager updating the Committee on performance as at Quarter 4 2025 (January to March). With reference to the pressures outlined in paragraph 5.5 on adult mental health and primary care psychological therapies, Councillor Lawrence firstly asked for a breakdown of areas of pressures and whether issues such as the increasing numbers of adults waiting assessment for Attention Deficit Hyperactivity Disorder (ADHD) were contributing to the increased pressures; and secondly, what effect the Certificate of Equivalence for Specialist Registration (CESR) Fellowship was having to reduce waiting times. In response, the Deputy Head of Service advised currently the main pressure point was self referral into primary care however, as a result of targeted work undertaken over the last 6 months relating to referral routes and more appropriate signposting for people, the average wait time had reduced from 40 weeks to 20 weeks in the last quarter and was confident the adjustments would result in further improvements. He further advised the benefits in relation to CESR Fellowship were wide reaching across the whole system however there were significant benefits being realised within adult services. In response to a question from Councillor Lawrence asking whether long term vacancies were a factor in the staff sickness levels referenced in terms of increased pressure referred to in paragraphs 5.6 and 5.7, the Chief Officer confirmed this was a a contributing factor which management attempt to manage by reviewing processes and providing support within resources. She further advised of ongoing work within the partnership and Council on how to strengthen support for managers to proactively manage absence. In response to a question from Mr Riddell asking when it was anticipated the Mental Health Bed Based Review would be delivered noting the potential implications for Moray, the Deputy Chief advised Priority 6 of the review focusses on Moray and the first meeting of the Working Group relating to that priority was to be held later that day from which a timeline would be prepared on options, likely to take approximately 6 months, which would then be presented to the Moray Integration Joint Board for approval. Following consideration the Committee unanimously agreed to:- (i) note the performance of local indicators for Quarter 4 (January to March 2025) as presented in the Performance Report at Appendix 1; (ii) note the analysis of indicators that have been highlighted and actions being undertaken to address performance that is outside of acceptable target ranges as detailed in Appendix 1; (iii) note the revised format of this report, which will continue to evolve in future reporting periods noting that different service areas may be highlighted within each report, or as requested by the Board; and (iv) note the inclusion of supplementary service information in Appendix 1, which provides additional context and evidence to support the mitigations outlined in relation to the national outcomes. Page 16
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6. Quarter 4 (January to March 2025) Performance Report for Children and Families and Justice Social Work The meeting had before it a report by the Interim Chief Social Work Officer / Head of Service informing the Committee on Children and Families and Justice Social Work performance as at Quarter 4 (January to March 2025). Mr Murray asked for the reasons for the increase in numbers of Out of Area Placements referenced in Graph 20 of Appendix 1. In response, the Interim Chief Social Work Officer advised all attempts are made to keep families together and wherever possible this is facilitated within Moray however, internal foster care provision was at maximum capacity as a result of significant challenges with the permanence planning process. He further advised a range of measures were being considered including the potential for transitional funding to be agreed by the Council to address the particular issues. Following consideration the Committee unanimously agreed to:- (i) note the performance of local indicators for Quarter 4 as presented in the Performance Report at Appendix 1; and (ii) note the analysis of the local indicators as detailed in Appendix 1. 7. Internal Audit Section - Update Report The meeting had before it a report by the Chief Internal Auditor providing Committee with an update on the work of the Internal Audit Section. Mr Murray, appreciating the reasons provided by the Audit and Risk Manager in relation to his limited assurance opinion on the adequacy of the Board's governance arrangements, sought clarification how close the Board were to achieving reasonable assurance. In response, the Audit and Risk Manager advised his opinion was evidence based in respect of audit reviews undertaken and progression of audit recommendations by services. He confirmed the following years’ opinion would be based on the evidence at that time but stated work was required to ensure a closer working relationship within the NHS on what the Board feed back to NHS Grampian and their auditors to enable a more coordinated approach and allow an overarching view to be taken. In order to provide assurance, the Chief Officer confirmed the senior management team and operational management team were working to ensure there was clarity in terms of the reasons for incomplete audit actions and revised implementation deadlines. She confirmed the team would be working closely with Internal Audit to focus future audits on areas where there and challenges and to ensure recommendations were implementable in terms of both timescale and resource. Following consideration the Committee unanimously agreed to note the audit update. 8. Internal Audit Annual Report - 2024-25 The meeting had before it a report by the Chief Internal Auditor providing Committee with details of internal audit work undertaken relative to the Moray Integration Joint Board (MIJB) for the financial year ended 31 March 2025, and the assurances available on which to base the internal audit opinion on the adequacy of the MIJB's systems of internal control. Page 17
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Following consideration the Committee unanimously agreed to note the contents of the annual report given as Appendix 1. 9. Unaudited Annual Accounts The meeting had before it a report by the Chief Financial Officer informing the Committee of the Unaudited Annual Accounts of the Moray Integration Joint Board (MIJB) for the year ended 31 March 2025. In introducing the report, the Chief Financial Officer apologised for an error in paragraph 4.3 noting the figures in the paragraph had been amended to reflect the amended Asylum Seekers Grant of £701,000 which should have been classed as a grant carried forward rather than being included in ear marked reserves and, while the Reserves figure had been updated in the report, the sentence "this increase is primarily due to transfer of reserves from Moray Council to MIJB relating to Asylum Seekers granted during the year" should have been removed from the paragraph. Following consideration the Committee unanimously agreed to:- (i) note the unaudited Annual Accounts and recommend approval to the MIJB to be submitted to the external auditor, noting that all figures remain subject to audit, in Appendix 1; (ii) note the Annual Governance Statement contained within the unaudited Annual Accounts and in Appendix 3; (iii) note the accounting policies applied in the production of the unaudited Annual Accounts, pages 47 to 48 of the accounts; and (iv) approve the updated Local Code of Corporate Governance which supports the Annual Governance Statement, in Appendix 2. 10. Annual Performance Report 2024-25 The meeting had before it a report by the Chief Officer presenting the Committee with the draft Annual Performance Report 2024/25. Following consideration the Committee unanimously agreed to:- (i) note the draft Annual Performance Report 2024/25 at Appendix 1; (ii) note the national indicator 11-19 information will be updated and approved by the Chair and Vice Chair of the Board prior to publication; and (iii) recommend to the Moray Integration Joint Board for approval and publication of the Annual Performance Report 2024/25 by 31 July 2025. 11. Development Sessions in November 2024 for Children Families and Justice Social Work The meeting had before it a report by the Interim Chief Social Work Officer / Head of Service informing Committee of the Development Sessions undertaken by Children and Families and Justice Social Work in November 2024 and the resulting actions to address learning from social work practice. Page 18
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Following consideration the Committee unanimously agreed to:- (i) note the activity and outcomes related to the Development Sessions in 2024; (ii) note the content of the Improvement Plan at Appendix 3; and (iii) agree an update on progress of the Action Plan will be provided to a future Committee meeting. 12. Internal Audit Section Update Report - NHS Grampian Internal Audit Review [Para 6.2.5] The meeting had before it a report by the Chief Internal Auditor providing an update to Committee on the internal audit work completed on NHS Grampian systems and practices. Following consideration the Committee unanimously agreed to note the audit update. 13. Update on Improvement Plan for Adult Social Care Commissioning [Para 6.2.2] The meeting had before it a report by the Interim Chief Social Work Officer / Head of Service updating the Committee of progress on the Improvement Plan for Adult Social Care Commissioning. Following consideration the Committee unanimously agreed:- (i) to note the progress of the Improvement Plan attached at Appendix 1; (ii) to note the progress within this report as at the end of March 2025 regarding the recommendations detailed in the Improvement Plan; and (iii) that future reporting on this work will be submitted to the Moray Integration Joint Board annually, considering that there will be an internal reporting to evidence the implementation of the recommendations detailed within the KPMG Adult Social Care Commissioning review. Page 19
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: CHIEF OFFICER REPORT BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To inform the Board of activities underway that support the delivery against the Moray Integration Joint Board’s (MIJB’s) strategic priorities articulated in the Strategic Plan, and the delivery against the 9 Health and Wellbeing outcomes. 1.2 The focus on delivery of our Strategic plan objectives, through the implementation of the Delivery Plan will maintain a focus for transformational change of services to our community. We continue to experience significant financial challenges, alongside our two funding partners Moray Council and NHS Grampian, to deliver services within the budget, but remain committed to working in partnership to deliver within the resources we have available. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider and note the content of the report. ii) agree that transforming services to meet the aspirations of the MIJB’s Strategic Plan remains a priority. 3. BACKGROUND Home First/Discharge without Delay (DWD) 3.1 The average number of patients whose discharge is delayed has reduced during this reporting period, although this can be volatile. Innovative solutions implemented within the Homefirst work are starting to indicate positive impact on this and the impact of this will continue to be monitored. 3.2 Moray’s Home First Programme was re-launched on the 20 August 2025 with the aim of ensuring that all our teams consider a ‘Home First’ approach when supporting people who are facing challenges. This work was a focus of the MIJB development session on 30 October 2025. 3.3 The National DWD programme – which is a strand of work in HSCM’s overall Home First programme - is now fully established with teams representing Moray Item 6. Page 21
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within the four work streams (Planned Date of Discharge, Community Hospitals, Discharge to Assess (D2A) and Frailty at the Front Door), at National, Regional and Local levels. This programme is hosted by NHS Grampian, with local meetings taking place regularly to ensure Moray teams are updated with progress. Vaccination Programme – Autumn/Winter report 3.4 The autumn winter vaccination programme for flu and Covid is well under way. The full programme is rolled out over a number of months and is ongoing. National priority groups for Scotland are set by the Chief Medical Officer and time periods given for particular population cohorts to be offered vaccination are sequenced in response to this, to ensure those that are most at risk, receive the vaccine at the optimum time. The result of this is that different groups are called forward at different times. Residents can also change their appointments which is accommodated wherever possible. 3.5 Vaccination data for the autumn winter programme is updated and published weekly during the season. The team in Moray have administered 11,643 flu vaccines to eligible adult groups as of 26 October 2025. The current adult flu uptake is 28.1%, this is currently above Scotland’s average. If data looks low compared to other areas or to the national average, this could mean those cohorts have not been started yet, and once they are, uptake will begin to rise. Covid-19 vaccinations go on until the end of January 2026 and flu until the end of March 2026 with offers to the population at risk groups to be made before the second week in December 2025. Respiratory Syncytial virus (RSV) 3.6 The RSV vaccination programme to protect older adults was completed in the summer before the start of the autumn winter programme. National research completed following the first year of this programme showed a reduction in hospitalisation for severe RSV disease of 62% in the vaccinated age group (75- 79). This programme will be extended in 2026/27. A similar study done for the year-round maternity protecting infants’ cohort showed a reduction in hospitalisation in the vaccinated group of 80%. 3.7 These demonstrate that investing in vaccination is a proven way to reduce demand in the system. Because of its delivery model, Scotland was able to mobilise delivery of the RSV vaccine at scale to the 75-79 year-old population resulting in earlier benefits from RSV vaccination last autumn. Changes to Children’s Pre-School Vaccination Programme 3.8 There were minor changes in the children’s preschool vaccination programme which took place in the summer. Major changes will be taking place from January 2026. The main difference is an additional appointment at 18 months for the 4th primary vaccination course and the administration of the second Measles, Mumps & Rubella (MMR) vaccine will be brought forward from 3 years 4 months, facilitating the earlier protection of children. 3.9 At the same time, the current MMR vaccine will be substituted for MMRV. The additional V stands for Varicella, the virus that causes chickenpox. These Page 22
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changes will feed through from January 2026 and there will be a transitional period. Overall, these changes will protect children earlier and are a positive step. Moray Vaccination Centre 3.10 A permanent location has yet to be identified, and this remains a challenge for the Partnership. The service has undertaken a scoping exercise and reviewed both existing and future delivery models across the vaccination programme. As a result, the vaccination service has expanded their hub and spoke model across Moray however HSCM continue to scope suitable premises within the Elgin locality to deliver vaccination clinics to the Elgin populace. 3.11 HSCM have been diligent in their efforts to assess premises owned by both NHS Grampian (NHSG) and Moray Council and have not been able to identify suitable premises in the Elgin locality. The assessment of these premises included sole or split base occupancy as a vaccination clinic, for the staff and for the vaccination service as whole. However, these searches have not been successful. 3.12 As there is no available property available internally, the support of NHSG Property and Asset Development is required to source premises on the external market. This is being tabled at the NHSG Asset Management Group meeting on 29 October 2025. 3.13 Meantime the service continues to deliver from the Beechbrae location. Palliative Care Review 3.14 The review of palliative care services and pathways across Moray is concluded and a report will be taken to a future MIJB meeting. The report seeks to identify strengths and areas for further development. The report will also seek to demonstrate where provision can work seamlessly between primary and secondary care services giving a better experience for people who require support from Palliative Care services. The development of Community Appointment Days to allow outreach to more remote parts of Moray is already underway taking some of the opportunities available at The Oaks to local communities. This is one example of strength-based developments that the report will seek to highlight. The Strategic Palliative Care Group Moray is the forum established to monitor the delivery of palliative care services in Moray, drive forward new initiatives and ensure that HSCM are developing services in line with the Scottish Government Palliative Care Strategy: Palliative Care Matters for All. This forms the terms of reference for the future delivery of services. Within the project, budget savings will also be identified for consideration by the MIJB. Care at Home 3.15 Over the past three months, demand for Care at Home services in Moray has remained consistently high. The services continue to support older people, individuals with disabilities, and those requiring assistance following hospital discharge. There has been a slight increase in new referrals, particularly from Page 23
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hospital settings, reflecting seasonal pressures and a focus on preventing delayed discharges. 3.16 In relation to Staffing and Workforce, recruitment and retention of care staff remain ongoing priorities. During this period, targeted recruitment campaigns have resulted in a modest increase in the workforce, although vacancies persist for all providers, especially in rural areas. Staff training continues to focus on upskilling in areas such as dementia care, infection control, and the use of new digital care management tools. 3.17 Service performance has been monitored through regular reviews and feedback from those who use the service and their families. Key indicators such as the timeline of visits, continuity of care, and user satisfaction have remained stable. There have been some isolated incidents of delayed or missed visits, mostly attributable to staff shortages or adverse weather conditions, but these were addressed promptly. The Care Inspectorate have recently audited our START service and the outcome is awaited. 3.18 Looking ahead, the Care at Home Steering Group in Moray will continue to focus on the best Model of Care for Moray and will incorporate recruitment, digital innovation, and integrated care to meet growing demand and ensure high standards of care. Feedback from those who use the service and their families will guide ongoing improvements, and partnerships with local agencies will be strengthened to support people to live independently at home for as long as possible. This includes planned meetings with all agencies individually and collectively to share learning and plan the next steps. 3.19 Care at Home in Moray has made steady progress in maintaining service quality and adapting to ongoing challenges over the last three months. Efforts to recruit and retain staff, embrace digital solutions, and enhance integration with health services are central to sustaining and improving care delivery and the Steering group, as well as the Home First Programme will provide strategic guidance and development to allow this to progress, especially looking at the barriers and challenges that prevent access to services. Moray Unscheduled Care (USC) Plan Update 3.20 As part of the Unscheduled Care Improvement Programme, Moray was successful in securing funds to enhance the D2A and START services to provide a home assessment service. Working in collaboration with Dr Gray's and Primary Care Colleagues, this service will allow for expedited discharge from hospital, allowing for an intensive, multi-disciplinary, assessment that identifies needs and provides reablement and rehabilitation in the patient's own home. In addition to this, enhanced virtual ward capacity will allow HSCM to identify and monitor our most vulnerable cohort of patients, using all resources available, including professional, third sector and volunteer support. This programme is subject to enhanced reporting to the Scottish Government. Strategic Change Board Update 3.23 The MIJB approved partnership working across the North-East in relation to the Grampian Strategic Change Board (SCB) at its meeting on 30 January 2025 (para Page 24
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9 of minute refers). The Grampian SCB was established to drive transformational change across NHS Grampian and its partner IJBs, recognising the need for a shared approach to system-wide challenges and opportunities. 3.24 Over the past year, the SCB has evolved from a design and development space into a strategic enabler for change. It has supported the creation and testing of a shared model of change, which is now informing practical redesign efforts across the system. The SCB’s emerging role is to create the conditions for transformation, including shared principles, cultural shifts, and cross-system collaboration, operational teams to lead change locally. 3.25 The “Shifting the Balance of Care” workshop held on 12 September was a key milestone in this journey. It brought together partners from across health, social care, local authorities and the third sector to explore community-based options and test how the model of change can support locally led redesign. The workshop reinforced the importance of shared ownership and honest dialogue about what change means in practice. 3.26 The SCB is now entering a new phase focused on mainstreaming. This includes embedding the model of change into routine planning and decision-making, and supporting major change programmes to apply it in ways that reflect local context and priorities. An end-of-year report will be available in December 2025, consolidating learning from the SCB’s first year and setting out its future role in enabling transformation across the North-East system. Stakeholder Representation Update 3.27 It is pleasing to report that HSCM have successfully recruited to the Third Sector and Unpaid Carer stakeholder positions on the MIJB. These roles are essential in ensuring that a broad range of perspectives and lived experience inform the Board’s work. A standalone report providing full details is included on today’s agenda. Unfortunately, recruitment for the Moray Council staff representative position has not concluded, however HSCM remain committed to finalising this as soon as possible. Carefirst Replacement 3.28 Following evaluation of the submissions from the potential suppliers and feedback from site meetings with partnerships that are using the new systems a recommendation from the working group to the Project Board was accepted. Negotiations are underway with the preferred supplier, and it is anticipated that the contract will be signed, and implementation will commence immediately with a view to Go Live across Children and Families, Justice Services and Adult services by March 2027. A project team is being established to lead the development and implementation for HSCM, and senior management are fully aware of the significant staff resource that will be required across all Social Work and social care services to ensure that the system is designed to make our services more efficient and effective, data is migrated, staff are fully involved and trained in new processes and necessary testing and checks are undertaken. 4. KEY MATTERS RELEVANT TO RECOMMENDATION Page 25
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4.1 To support the acceleration of the MIJB ambitions set out in the Strategic Plan, the Delivery plan is currently being refreshed to support next steps. 4.2 The challenge of finance persists and there remains the need to address the underlying deficit in core services. The development of a Programme Management Office well progressed to support our financial savings. 5. SUMMARY OF IMPLICATIONS - (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” Working with our partners to support people so they can cope with, and where possible, overcome the health and wellbeing challenges they may face. Ensuring that the right care is provided at the right place at the right time when people are in need. Ensuring that our systems are as simple and efficient as possible. (b) Policy and Legal The Chief Officer continues to operate within the appropriate level of delegated authority, ensuring that the MIJB is sighted on key issues at the earliest opportunity, and continues to influence and agree the strategic direction. (c) Financial implications There are no financial implications arising directly from this report. The Chief Finance Officer continues to report regularly. There is an ongoing requirement to find efficiencies and to demonstrate best value for money. (d) Risk Implications and Mitigation The risk of not redesigning services will mean that HSCM cannot respond adequately to future demands. (e) Staffing Implications Staff remain the organisation’s greatest asset, and engagement with all sectors must continue to ensure full involvement, which will create the best solutions to the challenges faced. HSCM staff are facing continued pressures on a daily basis, and effort into ensuring staff well-being must continue. (f) Property There are no issues arising directly from this report. (g) Equalities/Socio Economic Impact Any proposed permanent change to service delivery will need to be impact assessed to ensure that HSCM are not disadvantaging any section of our community. Page 26
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HSCM will continue to work closely with all our partners to ensure that we contribute to the health and well-being of the community. (h) Climate Change and Biodiversity Impacts Care closer to and at home, delivered by teams working on a locality basis, will reduce HSCM’s reliance on centralised fixed assets and their associated use of utilities. (i) Directions There are no directions arising from this report. (j) Consultations The Moray HSCP Senior Management Team, Senior Solicitor (Litigation and Social Care) and Caroline O’Connor, Committee Services Officer have been consulted in the drafting of this report. 6. CONCLUSION 6.1 The MIJB are asked to acknowledge the significant efforts of staff, across in- house providers, externally commissioned services, the Independent and Third Sector, who are supporting the response to the recovery, and the drive to create resilience and sustainability through positive change. 6.2 The size of the financial challenge facing the MIJB, and also its two funding partners, means that redesign and transformation is not an option but a necessity. HSCM’s approach will be to prioritise quality, safety and good outcomes in all service redesigns. Author of Report: Judith Proctor, Chief Officer, Moray HSCP Page 27
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DRAFT REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: REVENUE BUDGET MONITORING QUARTER 2 FOR 2025/26 BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To update the Moray Integration Joint Board (MIJB) of the current Revenue Budget reporting position as at 30 September 2025 for the MIJB budget. 2. RECOMMENDATIONS 2.1 It is recommended that the Board: i) Note the financial position of the Board as at 30 September 2025 is showing an overspend of £2,439,169 on core services; ii) Note the updated forecast position for 2025/26 of an overspend of £8,780,881 on total budget, a worsening position for total services since quarter 1; iii) Note the progress against the approved savings plan in paragraph 6, and Appendix 4; iv) Note the budget pressures and emerging budget pressure as detailed in paragraph 7; v) Note the recovery plan and actions put in place to reduce the year end position, as detailed in paragraph 9; vi) Agree to reverse the budget realignment adjustment for Care Services provided in house and Public Dental service, as detailed in paragraph 5, and vii) note the revisions to staffing arrangements dealt with under delegated powers and in accordance with financial regulations within the Council (MC)and NHS Grampian (NHSG) for the period 1 June to 30 September 2025 as shown in Appendix 3. Item 7. Page 29
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3. BACKGROUND 3.1 The financial position for the MIJB services at 30 September 2025 is shown at Appendix 1. The figures reflect the position in that the MIJB core services are currently overspent by £2,439,169. This is summarised in the table below: Annual Budget £ Budget to date £ Expenditure to date £ Variance to date £ MIJB Core Service 189,685,676 96,778,06 1 99,217,230 (2,439,169) MIJB Strategic Funds 7,187,063 2,162, 973 2,713,609 (550,636) Set Aside Budget 15,638,000 - - - Total MIJB Expenditure 212,510,739 98,941,034 101,930,839 (2,989,805) 3.2 The updated provisional forecast outturn to 31 March 2026 is included in Appendix 1. The figures reflect the overall position in that the MIJB core services are forecast to be overspent by £6,963,308 by the end of the financial year. This is summarised in the table below: Annual Budget £ Forecast expenditure to 31 Mar 26 £ Variance to 31 Mar 26 £ MIJB Core Service 189,685,676 196,648,984 (6,963,308) MIJB Strategic Funds 7,187,063 9,004,635 (1,817,573) Set Aside Budget 15,638,000 15,638,000 0 Total MIJB Expenditure 212,510,739 221,291,619 (8,780,880) 3.3 A list of services that are included in each budget heading are shown in Appendix 2 for information. 3.4 This is a worsening position than expected at quarter 1 of £4,685,331 and in excess of the £7m provision that is included in our partners’ accounts. The £8.8m position is due to movement in the following: £m Q1 Forecast position 4.7 Care services provided in house 1.1 Children services 1 Prescribing tariff reduction 0.8 High cost care packages 0.3 Shortfall in funding (pay award & eNIC) 0.7 Other 0.2 Q2 Forecast outturn 8.8 Measures have been put in place to reduce this position down as soon as possible; details are contained within paragraph 9. 4. KEY MATTERS/SIGNIFICANT VARIANCES FOR 2025/26 Page 30
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Mental Health 4.1 The mental health budget is overspent by £270,928 to 30 September 2025. This relates to staff overspend of £152,378 primarily due to the continuing use of locum consultants, overspend related to Mental Health Act activity including Admin, Occupational Therapy and Psychology and an overspend of £118,550 in Assessment and Care packages. 4.2 The CESR fellows were appointed in December 2024, however the CESR doctors have not provided a solution to service medical staffing challenges and as such have not allowed the expected financial savings to be fully implemented. One CESR fellow has left in July 2025 and a NHS locum is now in place. Alternatives are currently being investigated to reduce this cost down during the year. The centralisation of the Grampian mental health and learning disabilities medical budget, overseen by the medical director, will allow for greater oversight of the financial position and shared decision making in relation to future recruitment. 4.3 This budget is forecast to be £514,326 overspent by then end of the financial year, due to the above issues continuing. Older People and Physical Sensory Disability (Assessment & Care) 4.4 This budget is overspent by £915,705 to 30 September 2025. This primarily relates to overspend in permanent care of £417,106 due to most placements now being for nursing care charged at the higher rate rather than residential, and external care at home and short breaks £395,150 in the West and £102,849 in the East. There are also other minor variances of £600The variances within this overall budget heading reflect the shift in the balance of care to enable people to remain in their homes for longer. 4.5 External care purchasing remains a high cost due to serval operating factors including rising expenses for wages and energy and this impacts the overall cost of care. The population is aging and more people are living with complex needs leading to a higher number of individuals requiring care, and these requiring greater levels of care. 4.6 This budget is forecast to be £1,196,544 overspent by the end of the financial year, due to the above mentioned issues expected to continue to the end of the year. Intermediate Care & Occupational Therapy 4.7 This budget is overspent by £158,931 at the 30 September 2025. This is primarily due to purchase of equipment, aids and adaptions £160,775, with other minor variances totalling £1,844 underspend. This is a volatile budget as equipment is required to ensure that people can live as comfortably and independently at home following assessment and its use can prevent higher cost care packages. 4.8 The cost of equipment provision has increased in unit prices. The current contract remains to offer best value from available suppliers through the commissioned process. However, the complexities of individuals needs have also increased resulting in more expensive equipment in order to allow them to remain at home as independently as possible. An increased demand on the provision of moving and handling equipment is evident through the critical referrals being received into the service. This equipment is essential to support both the person and carers Page 31
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to ensure safe moving and handling. The robust authorising processes remain in place to ensure that scrutiny is applied to high-cost equipment provisions. 4.9 This budget is forecast to be £317,862 overspent by the end of the financial year due to the reasons mentioned above. Other Community Services 4.10 This budget is overspent by £245,570 at 30 September 2025. This is due to staffing in Physiotherapy AHP £86,581, dental £118,171 and realistic medicine £32,216. With other overspends totalling £8,602 relating to equipment. 4.11 This budget is forecast to be £534,731 due the above reasons mentioned above expecting to continue to the end of the financial year. Admin & Management 4.12 This budget is overspent by £164,046 at 30 September 2025, due to costs related to senior medical practitioner £59,829 providing clinical oversight and other management costs of £104,217. 4.13 This budget is forecast to be £919,844 overspent by the end of the financial year. This relates to overspends of £184,324 in staffing costs mentioned above, with a slight reduction for other management costs and an under achievement of the vacancy factor by £735,520. Hosted Services 4.14 The hosted budget is underspent by £37,038 to 30 September 2025, this position is based on four month’s actuals for April to July and an accrued position for August and September as information is received two months in arrears. 4.15 This budget is forecast to be £335,855 overspent by the end of the financial year for the Moray share on all hosted services. There are overspends across all areas and senior managers are aware and discussions are ongoing with partners to reduce these costs wherever possible. Childrens & Justice Services 4.16 This budget is overspent by £64,635 as at 30 September 2025. This relates primarily to an overspend on home to school transport of £56,000 and additional residential costs for a young person not attending school £23,000. This is reduced by income from adoption placements exceeding expenditure by £12,000. The balance of £2,365 is made up of minor under/overspends across the service. 4.17 This budget is forecast to be overspent by £1,069,000 at the end of the financial year. The Commissioning overspend of £276,000 is mainly due to two out of area placements continuing beyond the six months funding, additional costs for 2 other individuals. The area teams forecast overspend of £99,000 is mainly due to self directed support packages and home to school transport. The Corporate Parenting forecasted overspend of £671,000 is mainly due to continuing care residential placements and independent fostering placements reduced by an underspend in adoption placements with other local authorities. The continuing care placements overspend is due to out of area young people turning 18 while in their residential placement and the costs moving to continuing care. These young Page 32
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people will transition to the Learning Disability team. Staff savings from vacancies and appointment below top of scale are anticipated to not be achieved by £23,000, this is partly due to increased use of agency staff. 5. BUDGET REALIGNMENT 5.1 As agreed at the meeting of the Board on 25 September 2025, budget realignments based on recurring deficits and surplus were agreed (para 10 of the minute refers). This is the first time the Board have allocated out these budget movements and there was a risk at the time that not all surplus budgets would continue to be in surplus. 5.2 This is the first year we have attempted to do the budget realignment, as it was based on the position at a point in time, we knew that there would be further refinement needed. The rebasing was to allow for a true reflection of budgets for 2025/26 to allow budget managers to have a more meaningful budget to manage. The downside to this is that there are now movements in different budgets for different reasons/pressures. 5.3 Care services provided in-house have had challenges with recruitment for many years and since the regrading of staff at the end of last year, have found that this has impacted favourably on filling vacancies during this financial year. The services are now showing an overspend of £449,969 to 30 September 2025, with a forecast position of £1,113,658. This is due to the virement of the staffing underspends within provider services at 2024/25 year-end to external purchasing. With the demand on the service and safe staffing required for the challenging behaviour service, it is recommended that the forecast position of £1,113,658 is reversed and budget increased to reflect service requirements. Reversing this will not affect the bottom line forecast position but will provide a realistic budget for the service from which to work. 5.4 Moray public dental service (PDS) had significant recruitment challenges in 2024 and had been unable to recruit to senior positions, which resulted in the development of a prioritisation plan and a reduction in clinical services provided. In 2025 recruitment was successful and a full time senior dental officer and a full time replacement dental officer took up post. The service is now showing an overspend of £138,313 to 30 September 2025, with a forecast position of £258,000. This is due to the budget realignment made, the service has achieved savings during the year, but it is recommended that the forecast position of £258,000 is reversed and budget increased to reflect service requirements. Again, reversing this will not affect the bottom line forecast position but will provide a realistic budget for the service from which to work. 6. STRATEGIC FUNDS 6.1 Strategic Funds are additional funding for the MIJB, they include: • Additional funding received via NHS Grampian and Moray Council (this may not be fully utilised in the year resulting in a contribution to the overall MIJB financial position at year end which then needs to be earmarked as a commitment for the future year). Page 33
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• Provisions for earmarked reserves have been made to fund unutilised allocation for Primary Care Improvement Funds, additional investment funding and others in 2025/26, identified budget pressures, new burdens, savings and general reserve that were expected at the start of the year. 6.2 Within the strategic funds are earmarked reserves totalling £1,450,304. However, there will not be enough reserves to cover the overspend in total if the level of spend continues till the 31 March 2026. 6.3 Also within strategic funds are provisions for known budget pressures at the start of the financial year including a provision for recurring budget over and underspends totalling £18,416,862. 6.4 By the end of the financial year, the Strategic Funds will reduce as the commitments and provisions materialise and the core budgets will increase correspondingly. 7. PROGRESS AGAINST THE APPROVED SAVINGS PLAN 7.1 The Revenue Budget 2025/26 was presented to the Board on 27 March 2025 (para 11 of the minute refers). The paper presented a balanced budget through the identification of efficiencies through savings and the use of reserves. 7.2 The progress against the recovery plan is detailed in Appendix 4 and summarised in the table below and will continue to be reported to the Board during the 2025/26 financial year. The table details progress during the first two quarters against the original savings plan. A significant number relate to reductions in overspending rather than being actual savings to be taken. Efficiencies Para Ref Full Year Target Savings expected progress at 30 Sept 2025 Savings actual progress at 30 Sept 2025 Reduction in overspend expected at 30 Sept 2025 £’000 £’000 £’000 £’000 Building Resilience 7.3 2,626 453 374 860 Home first 7.4 1,445 239 139 484 Partners in Care 7.5 1,821 428 351 483 Already implemented 3,577 1,764 1,664 25 Total Projected Efficiencies 9,469 2,884 2,528 1,852 7.3 There are 8 projects under the heading of building resilience, of which 5 have been allocated and will be achieved in this financial year. Of the remaining 3 projects, 1 is expected to be achieved by the end of the financial year and the remaining 2 (review of care and review of care purchasing) relate to £1.7m savings of which not all are not expected to be achieved in this financial year. Page 34
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7.4 There are 4 projects under the heading for Home First, of which 2 have been allocated £0.477m and due to slippage only £0.277m is expected to be achieved. Of the remaining 2 projects, 1 has been reclassed as an efficiency rather than a saving (proportionate care £0.555m), with the other (Short breaks provision) being delayed until later in the year, reducing the saving in year to £0.213m. 7.5 There are 11 projects under the heading of partners in care, of which 7 have been allocated £0.855m and is expected to be achieved by £0.701m. 1 project relating to commissioning contracts has not yet been allocated but is expected to be achieved during the year of £0.350m. The final 3 projects although the right thing to do have been delayed until next financial year totalling £0.616m. 7.6 Projects are detailed in Appendix 4, all projects have been reviewed for progress and have been appropriately Red/Amber/Green (RAG) status for risk of achieving the savings on target. Updates on risk description in red for ease of reading. When the budget was set there was a risk of not achieving the savings within this financial year of £1.507m. At quarter 1, the potential risk of not achieving savings in this financial year was £2.6m and following an in-depth review there are savings totalling £3.039m that will not be achieved in this financial year. 7.7 Within the savings detailed above, 4 of them are non-recurring totalling £0.42m, which will be achieved, there is also a further £0.75m element of the budget cuts that are non-recurring, which is not expected to be achieved. 7.7 The Budget Savings Oversight Group continues to meet regularly to strengthen governance, provide support to the Senior Responsible Officers (SRO) and provide a project management approach. The Group is chaired by the Chief Officer and comprises of members of the Senior Management Team (SMT). Additional measures have also been put in place and are detailed in paragraph 9. 8. BUDGET PRESSURES 8.1 Budget pressures recognised when the budget was approved on 27 March 2025 are released when the pressure crystallises to the extent that it can be accurately quantified. Provisions to meet budget pressures totalling £4,335,595 have been released in quarter 2. 8.2 Provisions still held centrally at the end of quarter 2 total £4,335,595 and are detailed in the table below. Description Para Ref £’000 Pay inflation 8.4 78 Contractual inflation & Scottish Living Wage 8.3 1,129 Prescribing & Community Pharmacy 8.3 1,153 Balance of FPNC & NCHC 8.4 55 Learning Disability & Mental Health Clients 8.3 701 Occupational Therapy equipment 8.3 100 Hosted Services 8.3 122 Page 35
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eNIC 8.4 957 Other 8.3 41 TOTAL BUDGET PRESSURES 4,336 8.3 These budget pressures have not yet been drawn down as they have not yet materialised in the budgets. At this stage these are all intended to be fully required in this financial year. 8.4 These budget pressures have been partly drawn down in quarter 2. NHS and Council pay awards have been actioned, the free personal care, National Care Home Contract and the eNIC budget pressure has also been partly drawn down and the balance will be required over the rest of the financial year. 8.5 Emerging budget pressures have materialised since the budget was set and these are detailed in the table below: Description Para Ref £’000 High cost care packages 7.6 325 Total emerging budget pressures 325 8.6 Emerging budget pressures reported in quarter 1 were £61,641 with an additional £263,783 in quarter 2. Emerging budget pressure for high cost care packages relating to older people, learning disability and mental health, have been approved at the High Cost care packages meeting and Resource Management Group. These costs relate to 19 cases that 17 required an increase in packages and 2 reductions in costs agreed in quarter 1, which total £325,424 cumulatively up to quarter 2. All these packages will be reviewed regularly. 9. RECOVERY AND TRANSFORMATION PLAN 9.1 Once the forecast for quarter 2 of £8.8m was finalised urgent action was taken to put in place emergency measures to mitigate against this. 9.2 The forecast at quarter 1 was £4.7m is always just an early indicative figure using straight line extrapolation. The quarter 2 forecast of £8.8m is done in depth by the accountants in discussion with budget managers. The significant factors for this movement include: Care services provided in house recruitment which is showing as a £1.1m deficit; prescribing movement of £0.790m due to the prescribing tariff reduction by Scottish Government; unprecedented pressures on children and families budget following the number of large families coming into the service £1m; slippage in savings of £3.8m, of which £3.1m will be expected to be achieved in 2026/27 and £0.75 non-recurring saving will not be achieved; shortfall in funding, no funding has yet been received for the increase in pay award £0.429m and less than expected funding for eNIC pressure of £0.229m and high cost care packages of £0.325m as detailed in paragraph 8.6 above. 9.3 Health and Social Care Moray (HSCM) are facing increasing challenges with obstacles on the delivery of the savings program, the financial position of both of our partners, increasing referrals , the complexity of individuals are increasing, Page 36
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an increasing older population whilst dealing with a reducing population in the workforce age and extremely challenging new referrals in Children and Families. 9.4 A range of recovery measures have been put in place, and these are being regularly reviewed. They come under 2 headings: grip and control measures and additional in year recovery actions. 9.5 Grip and control measure in place include Budget Saving Oversight Group: weekly financial recovery meeting established with Chief Officer, Chief Finance Officer and Heads of Service and budget managers to provide confirmation to Head of Service on a regular basis. 9.6 Additional in year actions have also been agreed and include: • Enhanced budget monitoring • Targeted cost containment measures (review of non-essential spend, prioritising statutory and critical service delivery) • Rapid review of out of area placements • Workforce controls (all vacancies extra scrutiny, temporary controls on agency and overtime usage) • Acceleration of savings program delivery where possible • Service review and reconfiguration • Income maximisation 9.7 With all these measures put in place there is a degree of confidence that the forecast position will be reduced down to at least within the limits of the partners’ provisions. The impact of the above measures will be monitored on a monthly basis. 9.8 The current forecast position has been formally notified to the Chief Executives of both partners due to the implications of the increase in overspend having to be met at the year end under the arrangements in the Integration Scheme, as this will impact on the partners financial position for 2025/26. 10. CHANGES TO STAFFING ARRANGEMENTS 10.1 At the meeting of the Board on 30 November 2023, the Financial Regulations were approved (para 12 of the minute refers). All changes to staffing arrangements with financial implications and effects on establishment are to be advised to the Board. 10.2 Changes to staffing arrangements as dealt with under delegated powers through appropriate Council and NHS Grampian procedures for the period 1 July to 30 September 2025, are detailed in Appendix 3. 11. UPDATED BUDGET POSITION 11.1 During the financial year, budget adjustments arise relating in the main to the allocation of non-recurring funding that is received via NHS Grampian. In order to establish clarity of these budget allocations a summary reconciliation has been provided below. Page 37
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11.2 In addition, the MIJB, are still awaiting for some funding yet to come through that was included in the budget and that is reconciled at the bottom of the table below. £’s Approved Funding 27.3.25 187,737,377 Set Aside Funding 15,638,000 Balance of IJB reserves c/fwd to 25/26 1,187,022 Amendment to NHS Grampian core 1,245,457 Adjustments in Q1 4,302,519 Revised funding at the start of Qtr 2 210,110,375 Budget adjustments M04-M06 Action 15 590,784 Outcomes 681,486 MDT drawdown 727,589 B5-B6 10,959 Pay award 256,639 Thrombectomy drawdown 111,636 Blood plasma 2,316 Dementia drawdown 58,514 Prescribing tariff reduction (326,290) Open University 25,000 Hosted services recharge 15,930 eNIC 91,000 Fostering Allowance uplift 31,800 Joint OOH budget 123,000 Revised Funding to quarter 3 212,510,738 11.3 In accordance with the updated budget position, but due to funding not fully being received there will be no revised Directions issued this quarter. 12. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan ‘Partners in Care 2022 – 2032’ This report is consistent with the objectives of the Strategic Plan and includes budget information for services included in the MIJB Revenue Budget 2025/26. (b) Policy and Legal It is the responsibility of the organisation receiving the direction to work with the Chief Officer and Chief Financial Officer to deliver services within the resources identified. The Moray Integration Scheme (para 12.8 of the 2015 Integration Scheme) makes provision for dealing with in year variations to budget and forecast overspend by reference to agreed corrective action and recovery plans. It also makes provision for dealing with year-end actual overspend where such action and plans have been unsuccessful in balancing the relevant budget by reference to use of MIJB Page 38
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reserves and additional payments from NHS Grampian and Moray Council. (c) Financial implications The financial details are set out in sections 3-9 of this report and in Appendix 1. For the period to 30 September 2025, an overspend is reported to the Board of £2,989,805 in totality. An updated forecast to end March 2026 has been included in section 3 and Appendix 1, which gives the updated provisional year end position of £8,780,881. There is also the assumption at this stage that some savings RAG status of red will not be achieved within this financial year. The potential impact to the partners has been communicated however, the monitoring of the recovery plan will be brought to a future meetings of this Committee. The staffing changes detailed in paragraph 10 have already been incorporated in the figures reported. The movement in the 2025/26 budget as detailed in paragraph 11 have already been incorporated in the figures reported. (d) Risk Implications and Mitigations The most significant risk arising from this report is the control and management of expenditure to provide the Health and Social Care services required for the Moray Area, within budget. There are earmarked reserves brought forward in 2025/26. Additional savings continue to be sought and service redesign are under regular review. Progress reports will be presented to this Board throughout the year in order to address the financial implications the MIJB is facing. The level of reserves carried forward into 2025/26 was £1,450,304 of which £1,000,000 was used to balance the budget. As well as additional pressures arising from the cost of living crisis, increasing energy bills, emerging budget pressures and inflation puts a risk on the budget. The updated provisional forecast is a potential overspend position, this has been communicated to both partners and the recovery plan will be closely monitored as well as additional savings identified to counteract and reduce this position as both partners are under severe financial pressures. The Budget Saving Oversight group continues to support the delivery of projects and look at savings for the next financial year. There is a risk of the red RAG savings not achieving in this financial year, and work is already begun looking at savings for next year and mitigations for this current year. (e) Staffing Implications There are no direct implications in this report. Page 39
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(f) Property There are no direct implications in this report. (g) Equalities/Socio Economic Impact There are no direct equality/socio economic implications as there has been no change to policy. (h) Climate Change and Biodiversity Impacts There are no direct climate change and biodiversity implications as there has been no change to policy (i) Directions There are no amendments to Directions as part of this report. (j) Consultations The Chief Officer, the Health and Social Care Moray Senior Management Team and the Finance Officers from Health and Social Care Moray have been consulted and their comments have been incorporated in this report where appropriate. 13. CONCLUSION 13.1 The MIJB Budget to 30 September 2025 has an over spend of £2,439,169 on core services and £2,989,805 in totality. Senior Managers will continue to monitor the financial position closely and continue to report on the Recovery and Transformation Plan, as detailed in para 9. 13.2 The updated provisional financial position for the overall MIJB to 31 March 2025, is an overspend of £8,780,880. Author of Report: D O’Shea Chief Financial Officer Background Papers: Papers held by respective Accountancy teams Ref: Page 40
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MORAY INTEGRATION JOINT BOARD JOINT FINANCE REPORT APRIL 2025 - SEPT 2025 Para Annual Budget (Net) Actual Most recent Variance Forecast Ref Net Budget To Date To Date Variance Variance Forecast To Budget Variance £'s £'s £'s £'s % £'s £'s % 2025-26 2025-26 2025-26 2025-26 2025-26 2025-26 2025-26 2025-26 Community Hospitals 7,351,331 3,948,258 4,089,606 (141,348) (2) 7,538,507 (187,176) (3) Community Nursing 6,213,518 3,106,731 3,196,429 (89,698) (1) 6,392,859 (179,341) (3) Learning Disabilities 20,842,657 9,983,438 9,850,013 133,425 1 20,767,535 75,122 0 Mental Health 4.1 12,162,171 6,221,205 6,492,133 (270,928) (5) 12,676,497 (514,326) (4) Addictions 1,681,930 842,364 811,330 31,034 2 1,632,684 49,246 3 Adult Protection & Health Improvement 281,320 133,054 133,085 (31) (1) 280,212 1,108 0 Care Services provided in-house 5.3 23,682,819 11,772,674 12,222,643 (449,969) (2) 24,796,477 (1,113,658) (5) Older People & PSD Services 4.4 28,173,863 14,454,386 15,370,091 (915,705) (3) 29,370,407 (1,196,544) (4) Intermediate Care & OT 4.7 1,925,793 957,480 1,116,411 (158,931) (8) 2,243,655 (317,862) (17) Care Services provided by External Contractors 1,711,162 872,045 1,061,185 (189,140) (11) 2,118,961 (407,799) (24) Other Community Services 4.10 10,100,954 5,043,272 5,288,842 (245,570) (2) 10,635,685 (534,731) (5) Admin & Management 4.12 1,448,586 1,440,304 1,604,350 (164,046) (11) 2,368,430 (919,844) (63) Other Operational Services 1,490,477 745,238 756,369 (11,131) (1) 1,512,739 (22,262) (1) Primary Care Prescribing 21,392,216 10,684,559 10,618,113 66,446 0 21,691,216 (299,000) (1) Primary Care Services 21,314,118 10,657,059 10,779,163 (122,104) (1) 21,460,505 (146,387) (1) Hosted Services 4.14 5,824,638 2,996,554 2,959,516 37,038 1 6,160,493 (335,855) (6) Out of Area 1,780,000 838,237 790,466 47,771 3 1,675,000 105,000 0 Improvement Grants 1,060,200 514,697 446,344 68,353 6 1,010,200 50,000 5 Childrens & Justice Services 4.16 21,247,923 11,566,505 11,631,140 (64,635) (0) 22,316,923 (1,069,000) (5) Total Moray IJB Core 189,685,676 96,778,061 99,217,230 (2,439,169) (1) 196,648,984 (6,963,308) (4) Other non-recurring Strategic Funds in the ledger 5,859,607 3,336,925 2,969,871 367,054 0 4,990,218 869,389 15 Total Moray IJB Including Other Strategic funds in the ledger 195,545,283 100,114,986 102,187,101 (2,072,115) 201,639,202 (6,093,919) (3) Other resources not included in ledger under core and strategic: 6 1,327,456 (1,173,952) (346,637) (827,315) 0 4,014,417 (2,686,962) Total Moray IJB (incl. other strategic funds) and other costs not in ledger 196,872,739 98,941,034 101,840,465 (2,899,431) 0 205,653,619 (8,780,880) (4) Set Aside Budget 15,638,000 - 15,638,000 0 0 Overall Total Moray IJB 212,510,739 98,941,034 101,840,465 (2,899,431) ,0 221,291,619 (8,780,880) (4) Funded By: NHS Grampian 122,548,602 Moray Council funding 89,962,137 Total funding 212,510,739 APPENDIX 1 Page 41
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APPENDIX 2 Description of MIJB Core Services 1. Community Hospitals includes community hospitals, community administration and community Medical services in Moray. 2. Community Nursing related to Community Nursing services throughout Moray, including District Nurses and Health Visitors. 3. Learning Disabilities budget comprises of:- • Transitions, • Staff – social work and admin infrastructure, • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care, • Medical, Nursing, Allied Health Professionals and other staff. 4. Mental Health budget comprises of:- • Staff social work and admin infrastructure, • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care, • In patient accommodation in Buckie & Elgin. • Medical, Nursing, Allied Health Professionals and other staff. 5. Addictions budget comprises of:- • Staff – social work and admin infrastructure, • Medical and nursing staff • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care, • Moray Alcohol & Drugs Partnership. 6. Adult Protection and Health Improvement 7. Care Services provided in-house Services budget comprises of:- • Employment Support services, • Care at Home service/ re-ablement, • Integrated Day services (including Moray Resource Centre), • Supported Housing/Respite and • Occupational Therapy Equipment Store. 8. Older People & Physical Sensory Disability (PSD) budget comprises of:- • Staff – social work infrastructure (including access team and area teams), • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care and • Residential & Nursing Care home (permanent care), 9. Intermediate Care & Occupational Therapy budget includes:- • Staff – OT infrastructure • Occupational therapy equipment • Telecare/ Community Alarm equipment, • Blue Badge scheme Page 42
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10. Other Community Services budget comprises of:- • Community services for each locality (Allied Health Professionals (AHP’s), Dental services, Public Health, Pharmacy and other specialist nursing roles). 11. Admin & Management budget comprises of :- • Admin & Management staff infrastructure, • Commissioning and Performance team, • Carefirst team, • Older People development, • Community Care finance, • Self Directed support & Carers • Target for staffing efficiencies from vacancies 12. Other Operational Services - range of operational services including – • Community Response Team • Child Protection • Winter Pressures • Clinical Governance • International Normalised Ratio (INR) blood clotting test Training • Moray Alcohol and Drug Partnership (ADP) 13. Primary Care Prescribing includes cost of drugs prescribed in Moray. 14. Primary Care Services relate to General Practitioner GP services in Moray. 15. Hosted Services, comprises of a range of Grampian wide services. These services are hosted and managed by a specific IJB on a Grampian wide basis and costs are re-allocated to IJB budgets. These services include:- Moray IJB Hosted & Managed services: • GMED out of Hours service. • Primary Care Contracts Team Aberdeen City/Aberdeenshire IJB Hosted & Managed services: • Intermediate care of elderly & rehab. • Marie Curie Nursing Service – out of hours nursing service for end of life patients • Continence Service – provides advice on continence issues and runs continence clinics • Sexual Health service • Diabetes Development Funding – overseen by the diabetes Network. Also covers the retinal screening service • Chronic Oedema Service – provides specialist support to oedema patients • Heart Failure Service – provided specialist nursing support to patients suffering from heart failure. • Police Forensic Examiner Service • HMP Grampian – provision of healthcare to HMP Grampian. Page 43
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16. Out of Area Placements for a range of needs and conditions in accommodation out with Grampian. These are managed centrally within NHS Grampian and charged to IJB’s. 17. Improvement Grants managed by Council Housing Service, budget comprises of:- • Disabled adaptations • Private Sector Improvement grants • Grass cutting scheme 18. Children Services & Criminal Justice budget includes the following areas: a) Children Services area teams budget includes:- • Staff – social work (including access team, area teams, disability team, SCIM and Child Protection Unit) • Self directed support • Fostering home to school transport • Support to families b) Quality Assurance team budget includes:- • Staff – social work • Locality management groups funding c) Reviewing Team d) Commissioned Services budget includes:- • Commissioning team • Contracts for all services e) Corporate Parenting budget includes:- • Staff – social work (including fostering, adoption and throughcare/aftercare) • Continuing care payments, income maintenance, supported lodgings and throughcare/aftercare grants • Fostering/kinship fees and allowances. Placements with external fostering agencies. • Adoption allowances • Adoption fees to other local authorities f) Children Services Residential Unit - Cala g) Justice Services budget includes:- • Staff – social work • Youth Pod • Out of Hours team • Community Justice Reform • Criminal Justice Services h) Children Services Strategy and Support budget comprises of:- • Central management staffing • Trauma Informed Practice • Community Mental Health and Wellbeing Supports and Services • Target for staffing efficiencies from vacancies Page 44
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i) Additional grant funding • Unaccompanied asylum seeking children • Corra Foundation Other definitions: Tier 1- Help to help you (information and advice), universal services to the whole community and an emphasis on prevention. Tier 2- Help when you need it (immediate help in a crisis, re-ablement) and regaining independence. Tier 3- Ongoing support for those in need through the delivery of 1 or more self- directed support options. Page 45
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APPENDIX 3 HEALTH & SOCIAL CARE MORAY DELEGATED AUTHORITY REPORTS - PERIOD July to September 2025 Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding Performance Support Officer (temp 1 year) Create temporary performance support officer post 0.5 FTE Grade 7 Temporary 1 year As appointed Funding in place Artiquins - Burnie Care Assistant Post Transfer funding and care assistant position from Artiquins to Burnie Day Centre 1FTE Grade 4 Permanent N/A As appointed Funding in place Artiquins Relocation of Service Relocate staff and service users from Artiquins to Cedarwood All positions Permanent N/A ASAP Funding in place Temporary Social Worker Post for the Mental Health Social Work Team budget available from protected funds To employ a temporary social worker to work alongside the mental health social work team. 28 hours grade 9 Temporary 1 year As appointed Funding in place VMF – Residential Childcare Worker To fill 35 hour Grade 6 Childcare Worker vacancy at Cala. 35 hour Grade 6 Permanent As appointed Funding in place Youth Pod Project Worker To fill 36.25 hour Grade 7 Project Worker vacancy. 36.25 hour Grade 7 Permanent As appointed Funding in place Page 46
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MIJB Budget 2025/26 APPENDIX 4 MIJB proposed savings Ref Service Brief Description Full year effect £000s Saving expected for 2025/26 Saving likely to be achieved in 2025/26 Planned Implementation Date Risk Level Risk Description BR 1 Internal Care at Home review Review of Internal care at home including redesign 122.00 122.00 122.00 Apr 25 Red Timeline Continuation of 24/5 saving Scope needs to be reviewed, not likely to be achieved in 2025/26 BR 4 &5 Removal of locum / implement CESR Cease locum use - gradual & implement 2 CESR fellows 1,044.00 261.00 217.00 Jan-26 Amber Recruitment taking longer than expected and not both vacancies at the same time continuation of 24/5 saving 1 CESR left and additional locum required BR 6,7,8 GMED redesign Relocation from Health Village, redesign of clinical & admin staffing model, Ad astra Ehealth system 110.00 110.00 - Apr 25 Red Workforce Impact; Parking; Footfall dependent on location Delayed for 3 months Project further delayed and will not be achieved in 2025/26 BR 9 Pool car vs expenses review Review into all teams transport and expenses to evalaute best options 20.00 20.00 20.00 Apr-25 Green Time and capacity – will be spend to save in the first instance BR 10,12 Cessation of leases and relocation Southfield, Strathisla dental practice 63.00 63.00 57.00 Apr-25 Amber Lease cessation delayed by a month Strathisla cessation reliant upon NHS G - will not be achieved in 2025/26 BR 14 Review of Care spot purchasing & review care packages 1,000.00 1,000.00 250.00 Jan-26 Red Reviews commenced in Jan 2025 and this is the continuation of that work already started So far the level of savings are no where near the saving expected and as such the £1m unlikely to be realistic BR 15 Review of Care Purchasing 700.00 700.00 350.00 Oct-26 Red Reviews not achieving results expected, reviews broadened to now include Mental Health & Learning Disability BR 42 *new SDS recovery Review packages to increase recovery 350.00 350.00 350.00 Apr-25 Green Reviews are not completed timeously Recovery in excess of target as at Oct 2025 Page 47
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HF 16 Short Breaks provision Review into planned and emergency short breaks - change in model 413.00 413.00 213.00 Apr-25 Amber Time to implement fully Care home bed shortage Care Home Provider monopoly Competition from other boards Time heavy paperwork for care homes Saving slipped and will be over 2 financial years HF 17 Proportionate care Redesign model 555.00 555.00 - Apr-25 Red Time to fully implement Needs full EQIA Service user safety Internal progressing slower than expected and external delayed until next financial year HF 18 Night Time Responder (LD) Redesign LD nighttime model of care delivery 277.00 277.00 77.00 Apr-25 Red Organisational change More complex than expected and delayed from 24/25 Project support required and saving will now be achieved over 2 financial years HF 20 Community hospital redesign Redesign of inpatient services supporting Home First 200.00 200.00 200.00 Apr-25 Red Contentious – public opinion Reputational damage Impact on secondary care Progressing but other pressures on the budget Project to be rescoped, will not be achieved in 2025/26 PIC 23 Commissioning and contracts review Review of all contracts and redesign of provisions 350.00 350.00 350.00 Apr-25 Green Time and capacity, reputational damage Balance of needs versus costs Continuation of last years work with providers, will be achieved in 2025/26 PIC 21,24 Day Services review MRC catering & infrastructure 220.00 220.00 115.00 Apr-25 Amber Reputational damage Impact on Unpaid carers Downstream impact Impact on MH of service user Change management plan to be progressed saving will be made over 2 financial years PIC 25 Complex & challenging behaviour unit Review Review into Woodview and change management 657.00 159.00 159.00 Apr-25 Green Organisational change, continuation of 24/5 proposal PIC 26 Care home bed usage - LD review care home bed utilitsation 182.00 121.00 121.00 Apr-25 Amber Progressing slower than expected and need fair access policy updated Page 48
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PIC 27 LD review & review Internal review and redesign, review care home bed utilitsation 554.00 370.00 - Apr-25 Red need to carry forward to 26/27 - part duplication with commissioning saving above Any care package savings has implications for safety. Requires care home registration change and agreed costings . Continuation of 24/5 saving PIC 28 Review of step down building based facilities Review into model of care 118.00 69.00 20.00 Apr-25 Amber Lack of step down facility Impact on acute /secondary care/ primary care Continuation of 24/5 saving Due to current flow issues the rest of the beds will not be closed in 2025/26 PIC 30 Prescribing efficiencies -GP Medication cessatio,switches within GP services and work with Care Homes 669.00 100.00 100.00 Apr-25 Green Pan Grampian approach may take tme to implement Progressing but other pressures on the budget Continuation of 24/5 saving PIC 43*new Prescribing efficiencies -Care home 69.00 69.00 Apr-25 Green Pan Grampian approach may take tme to implement Progressing but other pressures on the budget PIC 31 Digital Support efficiencies - NO TEMPLATE REQUIRED As part of DHI (Moray Growth Deal and Analogue To Digital Proposal) 100.00 100.00 - Apr-25 Red Pan Grampian approach may take time to implement Strategy to be developed, will not be achieved in 2025/26 PIC 33 Transport contract Review fo how we contract for transport for childrens and adult services 292.00 146.00 146.00 Oct-25 Red Time and resources Contracts being reviewed but will not be in place until 2026/27 AI 44 *new Reduction in overtime reduce the amount spent on overtime during the year 200.00 200.00 - Apr-25 Red Recruitment levels Due to recruitment issues continuing will not be achieved in full 2025/26 PIC 46 *new Review of palliative care services Review of provision of palliative care in Moray to improve outcomes 117.00 117.00 117.00 Apr-25 Amber Contentious – public opinion Reputational damage Impact on secondary care Alternative plan to be worked up, will not be achieved in 2025/26 AI 38 No non-essential travel (I year) Non essential travel ban (out of area) 30.00 30.00 30.00 Apr-25 Green Impact on staff development Page 49
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AI 38 No non-essential training (I year) Non essential training ban (conference attendance etc) 20.00 20.00 20.00 Apr-25 Green Impact on staff development AI 41 *new Vacancy target NHS & increase on Council in line with pay award increase Already implemented 1,135.00 1,135.00 1,135.00 Apr-25 Green Use of agency staff will impact on the savings being made in 2025/26 AI 47* new Healthcare system reduced payment Refund due for system 20.00 20.00 20.00 Apr-25 Green Implemented - refund received AI 48* new 3.42% budget cut on other services not included above 3.42% reduction in expenditure across a variety of budget headings 2,172.00 2,172.00 2,172.00 Mar-25 Green Implemented TOTAL 11,690.00 9,469.00 6,430.00 KEY BR Building Resilience HF Home First PIC Partners in Care 3,039.00 AI Already implemented Page 50
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: MORAY INTEGRATION JOINT BOARD STRATEGIC RISK REGISTER – RISK 2 (FINANCIAL SUSTAINABILITY) AND RISK 8 (GOVERNANCE AND ASSURANCE) BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To present the Board with an update to Risks 2 and 8 of the Board Strategic Risk Register, providing a clear overview of current strategic risks, their assessments, and mitigating actions. This supports informed decision-making, strengthens strategic planning, and reinforces effective risk governance aligned with the Strategic Plan. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) scrutinise the updated Strategic Risks 2 and 8 (Appendix 1); ii) approve that the mitigating controls and assurance arrangements are adequate; and iii) note the improvement actions taken in relation to Risk 8 to embed risk governance and strengthen internal audit capacity. 3. BACKGROUND 3.1 The Risk Management Framework review was approved by the Moray Integration Joint Board (MIJB) at their meeting on 25 June 2020 (para 9 of the minute refers). Risk Appetite Statements are included in Appendix 1. 3.2 Risk scores are determined using the MIJB Risk Policy (Section 5), based on likelihood and impact. Item 8. Page 51
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3.3 As agreed at Audit, Performance and Risk Committee 26 October 2023 (para 8 of the minute refers), the reporting frequency was amended from quarterly to biannually unless significant changes arise. 3.4 The MIJB Internal Auditor issued a ‘Limited Assurance’ rating for MIJB to the meeting of Audit, Performance and Risk Committee on 19 June 2025 (para 8 of the minute refers). 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The updated Strategic Risk Register incorporates feedback from the October 2024 hybrid session with Board members, ensuring alignment with strategic priorities and operational realities. 4.2 The approved Risk Appetite Statements guide decision making and balance innovation with compliance and continuity. 4.3 This report presents changes to the following risks within the Board Risk Register: Risk 2 – Financial Sustainability: The ability of the MIJB to deliver services within available resources and achieve agreed savings targets. Risk 8 – Governance and Assurance: The effectiveness of governance arrangements and assurance processes across the partnership. Risk 2 4.4 The risk has increased from High to Very High, reflecting heightened exposure following the updated forecast at quarter 2 and the need for continued close monitoring, mitigation and recovery plan. The increase in risk is due to a variety of reasons including slippage in the identified savings plan for 2025/26 not being achieved in the timescales agreed. 4.5 An additional pressure is the presence of high cost care packages that currently have no allocated budget and unprecedented pressures on children and families budget as well as increasing demand on the service with more complex care requirements 4.6 Furthermore, Care at Home previously recorded an underspend year-on-year due to challenges in recruiting to its establishment. That underspend was identified as part of the budget realignment, however, following the introduction of more favourable terms, successful recruitment has now occurred. This has now resulted in an overspend. Risk 8 4.7 The overall risk grading remains unchanged. However, the scoring has been reduced slightly reflecting that the end to end process for managing the audit process is now embedded within the operational and governance structures. 4.8 Financial investment has strengthened internal audit capacity, enabling enhanced collaboration and regular engagement between the MIJB auditor and Page 52
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senior management. This supports early identification and discussion of issues or escalations. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-2032” The MIJB requires effective governance arrangements for those services and functions delegated to it and Risk Management systems are integral to this. (b) Policy and Legal As set out in the terms of reference, the Board has responsibility to provide assurance of the adequacy of the risk management framework. There are no legal implications arising from this report. (c) Financial implications There are no direct financial implications arising from this report however, the Board should note the failure to manage risks effectively could have a financial impact for the MIJB. (d) Risk Implications and Mitigation This report forms part of the governance arrangements for identifying and managing strategic risks of the MIJB. The risks are outlined in the body of the report in section 4. Without appropriate funding, the organisation may be required to reduce or discontinue services in Moray to meet financial targets. This could result in unmet community needs, reputational damage, and failure to deliver the strategic objectives set by the Board. (e) Staffing Implications There are no additional staffing implications arising from this report. (f) Property There are no property implications arising from this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required because there are no service, policy or organisational changes being proposed. However, Impact Assessments will be core to any decision making process. (h) Climate Change and Biodiversity Impacts There are no impacts arising from this report. (i) Directions None arising from this report. (j) Consultations Page 53
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Consultation on this report has taken place with the Board members, and Senior Management Team. 6. CONCLUSION 6.1 The updated Strategic Risk Register demonstrates a collaborative and embedded approach to risk management. It aligns with strategic priorities and operational realities. The Board is asked to approve the updated register, reaffirming its commitment to robust governance. Author of Report: Sonya Duncan, Corporate Manager Background Papers: held by HSCM Ref: Page 54
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IJB RISK REGISTER SUMMARY – November 2025 APPENDIX 1 Risk Assessment Table – Multiply likelihood score by impact score to determine the risk rating (score). Risk No Risk Risk Owner Previous Risk Rating Last Reviewed Change Current Rating 1 There is a risk that the MIJB does not function as set out within the Integration Scheme, Strategic Plan and in-line with its Governance Framework and fails to deliver its objectives or expected outcomes. Chief Officer Contributor: Senior Leadership Team Error! Referenc e source not found. September 2025 Medium 2 The MIJB must operate within the resources allocated to it by the partner bodies and it is good financial practice to set a balanced budget at the start of each financial year. There is a risk that Financial pressures being experienced by the funding partners will directly impact the MIJB’s strategic planning of services and its decision-making Chief Officer Contributor: Chief Finance Officer/ Heads of Service/ Chief Nurse High September 2025 Very High 3 There is a risk that the MIJB’s workforce strategy is not delivered, affecting the quality of paid and unpaid Health & Social Care. Chief Officer Contributor: Heads of Service/ Chief Nurse Medium September 2025 Medium 4 There is a risk that the MIJB is unable to operate effectively as a Public Body. Chief Officer Contributor: Corporate Manager/ Chief Finance Officer Medium September 2025 Medium 5 There is a risk that the MIJB does not comply with the necessary legislative and regulatory requirements in which it operates. Chief Officer Contributor: Senior Leadership Team Medium September 2025 Medium 6 There is a risk that the MIJB’s strategic aspirations are not sufficiently transformative and as a result, that it is unable to deliver outcomes for people in a sustainable way. Chief Officer Contributor: Senior Leadership Team Medium September 2025 Medium 7 There is a risk that the MIJB is unable to exert influence on services delegated but hosted within another organisation. Chief Officer Contributor: Heads of Service Medium September 2025 Medium Page 55
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8 There is a risk that the MIJB’s internal control and governance arrangements are not sufficiently robust, as evidenced by the 2024/25 Internal Audit opinion of ‘limited assurance’ Chief Officer Contributor: Senior Leadership Team Medium September 2025 Medium Page 56
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Risk 1: There is a risk that the MIJB does not function as set out within the Integration Scheme, Strategic Plan and in-line with its Governance Framework and fails to deliver its objectives or expected outcomes. Consequence: Legal and Regulatory Implications, Reputational Damage, Loss of Stakeholder Trust, Resource Challenges, Service Disruption, Failure to deliver Health Outcomes Risk Rating: Medium Risk Appetite: Moderate-High Risk Movement: Historical Risk Rating: Medium September 2025 Rationale for Risk Appetite as reflected by MIJB in Appendix 2: • Strategic Priorities require innovative approaches to integration that may involve governance development • Outcomes depend on our ability to make timely decisions through efficient governance structures • The board recognises that complete risk aversion would prevent necessary transformation of services • A Moderate appetite allows for controlled governance exploration while maintaining core statutory compliance Rationale for Risk Rating: MIJB is committed to maintaining appropriate standards of care and governance through: • Proactive regulatory compliance • Robust operational policies • Adaptive approach to emerging healthcare challenges MIJB will only accept regulatory risks after: • Thorough consultation with regulatory bodies • Comprehensive risk assessment • Development of clear mitigation strategies • Ensuring minimal potential for service disruption Risk scoring before mitigations/controls Mitigations / Current controls in place Risk scoring after mitigations/controls 4 5 20 1. Integration Scheme is in place, approved March 2023. 2. Consultation with legal representative for all reports to committees and attendance at committee for key reports. 3. Induction sessions are held for new MIJB members. 4. Conduct and Standards training held for MIJB Members in June 2022 and February 2024 provided by Legal Services. 2 3 6 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 57
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Assurances: • MIJB Scheme of Integration • Audit, Performance and Risk Committee (APR) provides quarterly scrutiny of governance compliance with minutes to the Board. • Internal Audit conducts reviews with formal recommendations and monitoring to APR • Budget Savings Oversight Group monitors financial governance monthly with escalation pathways to SMT and MIJB. • Service Reporting to Board for strategic decisions and updates. • The Moray Transformation Board and Strategic Planning and Commissioning Group provides oversight of planned business across HSCM. • Budget Savings Oversight Group on monthly basis. • Monthly Tri-partite partnership performance meetings with partner CEOs, Finance Directors and Chair/Vice Chair of MIJB • Care Inspectorate assessment of services, including governance impact on service delivery. • Annual governance statement for external audit. • Strategic Delivery Plan (approved June 2025) incorporates the work being driven across all areas of the MIJB’s Strategic Plan priorities and will be reported regularly to AP&R Committee Gaps in Assurance: Mapping of the recently delegated services will take place to ensure the statutory governance requirements and those of MIJB are robust. Current Performance: • The Scheme of Administration is updated as required. • The Governance Framework was approved by MIJB on 28 January 2021. • Re-appointment of Standards Officer agreed by MIJB 28 March 2024. • Members Handbook updated and circulated to 100% of members in June 2022 • Quarterly performance to APR including benchmarking and targets. • All committees submitted required reports on schedule in 2024/25 • 100% of new members received induction on appointment • Standards training was delivered to all members in February 2024 with an update during MIJB Development session in August 2025 • Development sessions: 5 planned for 2025/26, 3 completed to date, with the most recent in August 2025, next one scheduled for October 2025. 5. Programme of Development Sessions held throughout the year with all MIJB members and Officers 6. Regular Senior Management Team (SMT) and Operational Management Team (OMT) meetings to provide direction and support to managers and teams, with agreed focus and priorities aligned to the Strategic Delivery Plan 7. Implementation of HSCM Internal Audit Process providing assurance and escalation process to SMT Page 58
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Further Controls Required Further Controls Owner Full integration of Childrens, Families and Justice services to be realised HoS/CO To be agreed Review of MIJB Members Handbook Required – in progress Corporate Manager/Legal Services 30/12/25 Target Date Page 59
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Risk 2: The MIJB must operate within the resources allocated to it by the partner bodies and it is good financial practice to set a balanced budget at the start of each financial year. There is a risk that Financial pressures being experienced by the funding partners will directly impact the MIJB’s strategic planning of services and its decision-making Consequence: Inability to deliver strategic priorities, potential statutory service cuts. Reduced service capacity, financial instability, compromised care delivery Risk Rating: Very High Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: High September 2025 Rationale for Risk Appetite (as detailed in Appendix 2) • Willing to accept moderate financial risks in pursuit of strategic objectives • Conservative approach to core budget management • Higher tolerance for innovative projects with clear benefits • Low tolerance for financial decisions that could threaten long-term sustainability Rationale for Risk Rating: The Board’s financial risk management approach emphasises: • Absolute commitment to financial sustainability • Minimising wherever possible risk to essential service delivery • Protecting vulnerable persons using services Financial risks will only be tolerated when: • A comprehensive business case demonstrates clear, measureable benefits (i.e. spend to save initiatives) • The initiative directly supports long-term health and social care sustainability • Robust risk mitigation strategies are in place • Stakeholder consultation ensures transparency and collective understanding • Willing to accept moderate financial risks in pursuit of strategic objectives • Conservative approach to core budget management • Higher tolerance for innovative projects with clear benefits • Low tolerance for financial decisions that could threaten long-term sustainability Unprecedented financial pressures on public sector funding: • Challenging economic environment • Rapidly increasing service demand Strategic financial principles and prioritisation: • Sustainable Financial Planning • Develop robust, realistic financial plans • Align budgets with long term sustainability • Focus on highest and best value initiatives • Align financial decisions with strategic goals Comprehensive Risk Mitigation: • Implement proactive financial risk strategies • Protect critical service delivery Page 60
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Stakeholder Engagement: • Transparent financial communication • Collaborative decision making processes • MIJB Board Members Development Sessions • Forecast position for quarter 2 worse than expected including Financial savings projection, which is unlikely to be achieved (see Gaps in Assurance) Assurances: • Quarterly Budget monitoring reporting to MIJB • Financial Reporting through MIJB, NHS Grampian and Moray Council • The Project Management Office will support the Budget Savings Delivery as part of the budget setting for 2025/26 onwards. • Financial Development Sessions with MIJB members. • Internal Audit quarterly reporting to APR • External Audits presented to MIJB/ Committees as appropriate. • Six weekly Tri-partite partnership performance meetings with partner CEOs, Finance Directors and regular meetings with the Chair/Vice Chair of MIJB • Strategic Delivery Plan (approved June 2025) incorporates the work being driven across all areas of the MIJB’s Strategic Plan priorities and will be reported regularly to AP&R Committee. • Updated forecast for quarter 3. Gaps in Assurance: • Senior Management Team (SMT) continues to work to build further capacity within the current workforce to support the planning, consultation and implementation required to deliver the financial savings. Managing the risk - Current controls in place 5 5 25 1. Medium Term Financial Framework (MTFF) approved by MIJB on 30th March 2025. 2. Additional resource to support the Budget Savings Delivery was agreed until September 2025. This has been extended to March 2026. 3. Tri-partite partnership performance meetings with partner CEOs, Finance Directors and Chair/Vice Chair of MIJB. 4. Operational financial monitoring undertaken by Chief Finance Officer (CFO), Heads of Service (HOS) and Budget Managers. 5. Budget Savings Oversight Group chaired by Chief Officer, attended by HOS, CFO and Service Managers as appropriate. 6. Monitoring of MIJB Strategic Delivery Plan ensuring all projects are aligned with savings plans. 7. Finance workshop with partners and HSCM 27 October 2025. 8. Extended Resource Mangement Group – including financial recovery action plan. 9. Grip and control measures put in place. 10. Additional in year recovery actions commenced 3 5 15 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 61
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• Internal homecare previously had an underspend that was removed as part of the budget realignment, however, due to a successful recruitment campaign this has resulted in an overspend of £1.1m. • Children’s Services additional packages of care totalling £1m. • High cost care packages are always additional costs, outwith normal budgetary spends. • Prescribing movement of £0.79m due to prescribing tariff reduction. • Shortfall in funding for pay award increase greater than budget and less than expected funding for eNIC £0.658m. • Slippage in savings programme for 2025/26 of £3.8m. Current Performance: The Revenue Budget Outturn for 2024/25 was presented and a balanced budget for 2025/26 was agreed by MIJB on 27 March 2025 A Financial Savings Plan for 2025/26 was agreed by MIJB on 27 March 2025. Quarter 1 budget monitoring report presented to MIJB on 25 September 2025. Approved Audited accounts for 2024/25 presented and approved by APR committee 29 October 2025 and MIJB 30 October 2025. APR committee presented with biannual update on Strategic Delivery Plan October 2025. Comments: Further Controls Required Further Controls Owner Target Date Review Date Review Notes / Decisions Risk 3: There is a risk that the MIJB’s workforce strategy is not delivered impacting the quality of paid and unpaid Health & Social Care. Consequence: Service disruption and reduced capacity, Increased Workload and staff burnout, Significant Financial impact, Deteriorating Staff and Unpaid Carers Morale and Engagement, Compromised Patient Safety and Care Quality, Negative Public Perception and Reputation Damage Risk Rating: Medium Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) MIJB will only accept minimal risk to people accessing services, unpaid carers or staff when the comparative risk of doing nothing is higher than the risk of intervention. Safety risks inherent in Health and Social care services demand exceptional management and clinical care standards. The Board recognises that: • Individual safety is paramount • Person-centred care involves supporting informed decision-making, which may introduce nuanced risk scenarios A balanced approach is critical, considering both individual and community safety risks Page 62
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Rationale for Risk Rating: Recruitment Difficulties: • Persistent challenges in recruiting skilled professionals in critical areas: o Allied Health Professions o Social Work o Dental Services Pandemic-Induced Complications: • Reduced graduate numbers due to Covid-19 disruptions • Ongoing strain on partnership resources across frontline and support functions • Staffing Instability • High proportion of fixed term and seconded contracts due to financial constraints • Potential workforce instability as temporary contracts conclude • Need for significant organisational transformation • High proportion of an aging workforce by NHSG and MC is increasing with more staff opting to retire early or requests for reduced working hours. Geographical and Structural Barriers: • Lack of suitable housing for healthcare professionals in Moray • Challenges in Care Homes recruitment and retention Strategic Workforce Transformation: • Capacity constraints in delivering financial recovery initiatives • Potential requirement for internal role allocation • Alignment needed between workforce strategy and financial sustainability National Context: • Ongoing GP sustainability challenges Managing the risk - Current controls in place 5 5 25 1. Ongoing review of HSCM Structure to identify areas for consideration, development, reconfiguration 2. Moray Council conducted an assessment of needs, including people working in the Health and Care sector. 3. Staff wellbeing is a key focus and there are many initiatives across both parent organisations offering information, support and access to activities. 4. Collaborative approaches with educational institutions e.g. intakes and programmes for future workforce development. 5. Professional Development and retention programmes; Incentives have been secured to attract additional NHS dentists and dental practices to Moray. The Scottish Dental Access Initiative includes Moray, with grants of £50,000 and above available to allow dental practices to be established or extended, provided there is a seven- year commitment to providing NHS treatment. A recruitment and retention bonus is also being offered to eligible new dentists in Moray 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 63
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Assurances: • Operational oversight by Moray Workforce Forum. • The HSCM Response Group continues to focus on leadership around emerging issues and resolving them, including staffing. • The Carers Strategy extension was approved by MIJB June 2025, extending to March 2028. The focus is on developing support to the large, valued workforce of unpaid carers within Moray. • The Resource Management Group (RMG) considers all vacancies before being considered for external advertisement. Gaps in Assurance: • Further capacity will be required to develop and implement workforce plans to reflect updated delivery plans to reflect the financial savings required. • Due to the required scrutiny and control of financial spend, there continues to be a delay in recruitment processes often taking in excess of 8 weeks, which can cause additional pressure on staff and service delivery. • There can be a lack of suitable applicants for some posts, which affects the ability to appoint to some roles. • Current Performance: Comments: Staffing issues are monitored by the Operational Management Team (OMT) working collaboratively to seek opportunities to make jobs more attractive where it has proven difficult to recruit in the past. There is the risk that staff move from one position to another within HSCM, as in unintended consequence creating a vacancy elsewhere in the system. This needs to be considered when fixed term contracts and secondments are planned; consideration needs to be given to the whole of HSCM and not services in isolation. Many of our staff may have transferrable skills and experience. Further Controls Required Further Controls Owner Target Date Review and update of the Workforce Plan TBC TBC Review Date Review Notes / Decisions Sept 2025 The Public Dental Service have been successful in their recruitment drive and dentist numbers are now reasonably stable. 6. GP sustainability Group and Primary Care Vison for the Future Groups now progressing across Grampian. 7. iMatter reports are an opportunity for staff’s opinions on the MIJB and wider organisation. 8. Recruitment process underway for MIJB Unpaid Carer Representative. Page 64
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Risk 4: Inability to demonstrate effective governance and effective communication and engagement with stakeholders. Consequence: Suboptimal outcomes for people, Erosion of organisational trust and credibility, Increased legal and regulatory compliance risks Workforce demotivation and disengagement, missed strategic opportunities and collaborative potential, reduced organisational responsiveness and adaptability Risk Rating: Medium Risk Appetite: Low-Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) The Board acknowledges the critical importance of: • Robust stakeholder relationships • Effective collaboration and co-production • Adaptive partnership working • Recognising diverse stakeholder capacities and readiness for change Strategic principles guiding stakeholder engagement: • Maintaining constructive, transparent relationships • Balancing organisational objectives with collaborative dynamics • Ensuring inclusive and meaningful engagement processes • Protecting long-term partnership sustainability Continuous Improvement in communication processes Rationale for Risk Rating: Comprehensive Governance and Engagement Challenges: Stakeholder Feedback and Engagement Gaps • Potential weaknesses in: o Communication clarity issues o Engagement process inefficiencies o Unclear outcome expectations o Perceived disconnect between organisational intentions and practical implementation o Cost of living and digital exclusion are potentially additional barriers for engagement Governance and Communication Structural Challenges • Potential weaknesses in: o Interdepartmental communication channels – staff communications across two different parent organisations o Stakeholder consultation mechanisms o Transparent reporting and accountability processes o Strategic alignment communication Collaborative Partnership Dynamics o Varied stakeholder readiness and capacity for change o Potential misalignment of expectations o Complex interdependencies across different organisational contexts Risk of Disengagement • Inadequate communication may lead to: o Reduced stakeholder trust o Diminished collaborative potential Increased resistance to organisational initiatives Page 65
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Assurances: • Oversight and scrutiny by Clinical and Care Governance Committee, Audit Performance and Risk Committee and MIJB • Strategic Planning & Commissioning Group (SPCG) • MIJB Audit, Performance and Risk Committee • 3rd Sector and Stakeholder Representatives on MIJB and committees • Local Outcome Improvement Plan (LOIP). • Community Planning • ADP • Locality Reporting to MIJB • Stakeholder Representative on GP Vision Board • Summary reports of MIJB submitted to Moray Council and NHSG committees Gaps in Assurance: • Seek to improve the level of engagement across Moray • Communication and Engagement Strategy was approved in 2019 and is in the process of being updated. • More systematic approach to stakeholder consultation required. • Establish a more robust process for youth representation Current Performance: • SPCG meets quarterly • Locality Plans reviewed with the Strategic Delivery Plan • LOIP plans linked to MIJB Strategic Plan • Annual Performance Report for 2024/25 published in July 2025. • Community engagement in place for key projects areas such as Forres, Keith and Lossiemouth Comments: • A communication cell was established as part of the Local Resilience Partnership response. This forum provides assurance that messages to all stakeholders are consistent. • Early conversations are planned to discuss a Grampian partnership communications group to ensure consistent messaging regards service Managing the risk - Current controls in place 4 4 16 • Refocus of Strategic Planning & Commissioning Group (SPCG) to support locality engagement. • Continued working with Community Planning colleagues to oversee the development of locality planning. • Grampian Joint Strategic Needs Assessment Group, including participation from community groups. • Engagement with diverse groups across Moray e.g. Alcohol & Drug Partnership, School Nurses. • Continued development of HSCM/MIJB webpages and Facebook • ‘Planning with People’ principles adopted as per Healthcare Improvement Scotland (HIS) 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 66
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redesign and changes, ensuring a consistent message to all citizens of Grampian, in particular for area wide changes. Further Controls Required Further Controls Owner Target Date Update Communication and Engagement Strategy Improve Stakeholder Consultation Corporate Manager December 2025 Review Date Review Notes / Decisions Page 67
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Risk 5: There is a risk that the MIJB does not comply with the necessary legislative and regulatory requirements in which it operates. Consequence: Significant reputational impact and potential resource allocation challenge and possible financial and operational strain, potential impact on communities and staff, potential compromise of statutory Category One Response obligations, reduced organisational resilience Risk Rating: Medium Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) The MIJB has minimal tolerance of harm happening to people as a result of its actions, recognising the need to balance the risk of doing nothing and the risk of action or intervention. The Moray Integration Joint Board (MIJB) recognises the statutory obligations under the Civil Contingencies Act 2004, including Category 1 Responder responsibilities (since March 2021) Rationale for Risk Rating: Performance Indicators: There are a variety of performance standards set both by national and regulatory bodies as well as those determined locally and there are a range of factors which may impact on service performance against these. Poor performance will in turn impact both on the outcomes for people accessing services and on the reputation of the MIJB/partnership. Given current situation with increased demand and staffing pressures there might be times that the likelihood of services not meeting standards is possible. IJB works within a range of regulatory of frameworks and it is a legislative requirement to comply, non-compliance would potentially impact the following: 1. Annual Performance Reporting 2. Robust financial monitoring and compliance with standards 3. Delivery of key reporting requirements 4. Category One Responder Resilience Duties 5. Climate Change Reporting 6. Delivery of sound and robust decision making and scrutiny Therefore, there is a need to ensure requirements are in place and regularly monitored. Managing the risk - Current controls in place 5 5 25 1. NHS Grampian Resilience Standards Action Plan approved (3 year). Scottish Government is drafting new standards and these are expected in 2025 and will replace the current standards. 2. Continuous emergency preparedness awareness with partners in Grampian Local Resilience Partnership (GLRP) – including exercises and debriefs. 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 68
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Assurances: • Quarterly reporting to Clinical and Care Governance and Audit, Performance and Risk Committees • Annual Performance Report – published July 2025 • Chief Social Work Officer’s Report • Internal and External Audits • Senior Management Meetings fortnightly • Joint meeting of MIJB Chief Officer with two Partner Body Chief Executives. • Annual report on MIJB activity developed and reported to Moray Council and NHSG • All Inspection reports reported to APR Committee with action plans developed and monitored Gaps in Assurance: Business Continuity (BC) Planning – work is underway to ensure HSCM has a register of all plans and timescales – to be monitored by OMT and escalations to SMT. Current Performance: There are Resilience and Business Continuity processes in place and these are reviewed regularly. Annual Performance Report for 2024/25 was approved by the MIJB and published in July 2025. Unaudited annual accounts June 2025. Category One Responder duties incorporated in the role of Corporate Manager. Comments: Structure review of HSCM to mitigate the governance risk of services not meeting standards and adequate service delivery The Manchester Arena and Grenfell Inquiry has resulted in a focus on Category 1 responders’ responsibilities, together with an increase of additional policies/procedures to be developed, implemented and exercised with no additional resource. Further Controls Required Further Controls Owner Target Date Business Continuity Planning Corporate Manager December 2025 Review Date Review Notes / Decisions 3. Learning from Inspection Reports, Adverse Events, Complaints, actions plans and performance measures monitored by Clinical Risk Management (CRM), Clinical and Care Governance Group (CCGG) and Operational Management Team (OMT) with oversight by SMT. 4. HSCM Civil Contingencies group review specific risks and action plans to mitigate, developing plans and testing arrangements in partnership with NHSG and Council. 5. Annual review of internal resilience and emergency processes with Senior Managers on Call. 6. Timetable of statutory reporting across the financial year. 7. Implementation of regular progress reports on audit at OMT, with oversight at SMT. Page 69
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Risk 6: There is a risk that the MIJB’s strategic aspirations are not transformative and as a result, we are unable to deliver outcomes for people in a sustainable way. Consequence: Persistent health inequalities, erosion of public trust and organisational reputation, potential legal challenges, significant reputational damage to MIJB, potential long-term negative impacts on community health outcomes, reduced effectiveness of healthcare resource allocation Risk Rating: Medium Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) The Moray Integration Joint Board (MIJB) faces significant challenges in maintaining service delivery across its delegated services from NHS Grampian and Moray Council. These challenges stem from three key areas: Resource Constraints Budgetary pressures are leading to reduced staffing resources, affecting service delivery capacity and quality. This situation requires careful management to maintain essential services while operating within financial constraints. System Pressures The healthcare system continues to experience significant strain from high levels of unplanned admissions and delayed discharges. While teams across the care pathway are working collaboratively to address these issues, the complexity of the situation, combined with limited community care availability, makes sustainable improvement challenging. Service Redesign The financial recovery plan necessitates fundamental service redesign to deliver outcomes more efficiently. While the aim is to enhance service quality through these changes, public expectations may need to adjust to align with what is deliverable within budget constraints. This requires careful management of both service transformation and stakeholder expectations. The Moray Integration Joint Board (MIJB) is committed to: • Maintaining exemplary standards of governance • Balancing innovative approaches with robust regulatory compliance • Proactively managing emerging risks in a dynamic healthcare landscape • Prioritisation of Moray’s unique community needs Regulatory risks will only be considered with: 1. Comprehensive consultation with relevant regulatory bodies 2. Clearly defined and documented defensible risk mitigation strategies 3. Transparent decision-making processes 4. Thorough impact assessments MIJB will only take regulatory risks knowingly, following consultation with the relevant regulatory body and where we have clear risk mitigation in place. Potential impacts to the wide range of services in NHS Grampian and Moray Council commissioned by the MIJB arising from reductions in available staff resources as budgetary constraints impact. Unplanned admissions and delayed discharges place additional cost and capacity burdens on the service. Page 70
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The level of delayed discharges has remained challenging, reflecting the sustained pressure in the system and the lack of availability of care in the community. There are sustained focussed and collective efforts by all those working in the pathway. However, this is a complex area and will require continued effort to realise reductions and maintain them. The financial recovery plan will require some service redesign to meet outcomes in alternative ways. It is hoped that this will always provide an improved service but it must be recognised that public expectations may differ to what can be delivered within budget. The Moray Integration Joint Board (MIJB) faces significant challenges in maintaining service delivery across its commissioned services from NHS Grampian and Moray Council. Rationale for Risk Rating: Contributing Factors: • Systemic resource constraints across internal and external services • Complex regulatory environment • Increasing expectations from external inspection bodies • Rapid evolution of healthcare delivery models • Predicted demographic changes • Financial Challenges, including cost of living • Increasing demand and staffing challenges are likely to impact transformational projects and plans Mitigating Strategies: • Regular compliance audits • Continuous staff training on regulatory requirements • Robust documentation and decision-making frameworks • Proactive engagement with regulatory bodies • Risk reassessment Resources are stretched thin across all services, both internal and external, which may result in the inability to meet expected standards despite the best efforts of everyone involved. Managing the risk - Current controls in place 5 4 20 1. Clinical and Care Governance (CCG) Committee. Clinical Risk Management and Practice Governance group has oversight of their respective professional standards and links into Clinical and Care Governance Group, which escalates to CCG Committee as necessary. 2. HSCM Clinical Risk Management (CRM) Group and NHS Grampian CRM Group review High and Very High operational health service risks. 3. Annual Performance Reports 4. Internal and External Audit 5. Internal/External Inspection reports are scrutinised by appropriate operational groups and by exception to SMT 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 71
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Assurances: Audit, Performance and Risk and Clinical and Care Governance Sub- Committees oversight and scrutiny. The Clinical and Care Governance Framework was refreshed and presented to CCG Committee in November 2023. The Strategic Delivery Plan was approved by MIJB June 2025 Gaps in Assurance: Process for highlighting recurring themes or strategic expectations from external inspections requires further development to ensure Committee has sight of significant issues. Current Performance: External inspection reports are scrutinised and actions arising are allocated to responsible officers. A summary of inspections is included in the Annual Performance report. Risk Management session delivered for managers in HSCM in September 2023, by the NHSG Risk Advisor. Comments: No major concerns identified for HSCM services in any audits or inspections during 2023/24. An inspection of Childrens Services commenced in August 2023, the final report was presented to the board and a Service Improvement plan commenced and reported to APR on a quarterly cycle. The current financial pressures will impact HSCM’s ability to deliver on the priorities set out in the strategic plan and requires a level of transformation to match this. Further Controls Required Further Controls Owner Target Date Review Date Review Notes / Decisions for subsequent reporting to CCG or APR Committee as appropriate. 6. Care Home Collaborative Support Group meets to oversee and manage risks in care homes. 7. Children and Adult Protection services report to their respective committees. 8. Governance Structure and Process (Senior Management Team meetings, Operational Team Meetings, Daily Huddles) Page 72
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Risk 7: There is a risk that the MIJB is unable to exert influence on services delegated but hosted within another organisation. Consequence: Legal challenge from Moray citizens and staff, potential intervention or censure from Scottish Government, systemic service failures, particularly in areas such as IT, Human Resources, Legal and compliance services Risk Rating: Medium Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) Extremely low tolerance for: • Systemic support service failures • Potential compromise of organisational effectiveness • Risk of legal and regulatory non-compliance • Diminished service delivery capacity Low tolerance in relation to not meeting requirements. Rationale for Risk Rating: Parent organizations experiencing: • Significant financial constraints • Staffing challenges • Potential resource allocation limitations The projected overspend in hosted services sits within each MIJB and HSCM is one of the partners who can influence decisions. Assurances: These largely come from the systems, process and procedures put in place by NHS Grampian, which are still being operated, along with any new processes which are put in place by the lead MIJB. North East System Wide Transformation Group (Officers only) led by the 4 pan- Grampian chief executives. The aim of the group is to develop real top-level leadership to drive forward the change agenda, especially relating to the delegated hospital-based services. Both the CEO group and the Chairs & Vice Chairs group meet quarterly. The meetings are evenly staggered between groups, giving some six weeks between them, allowing progressive work / iterative work to be timely between the forums. The Portfolio approach and wider system approach demonstrates closer joint working across the 3 Health and Social Care Partnerships and the Acute Sector. Gaps in Assurance: Ongoing implementation of internal audit recommendations. Managing the risk - Current controls in place 5 4 20 1. Chief Officer regularly meets with Chief Officers of Aberdeen City Health and Social Care Partnership and Aberdeenshire Health and Social Care Partnership. 2. Significant changes to service delivery are discussed across all three HSCP’s 3. Agreement that proposals regards significant service changes are presented to all three MIJB’s for approval. 4. Internal Audit of MIJB Hosted Services 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 73
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Current Performance: Officers are currently implementing the recommendations from the Audit on Hosted Services. Standardised service templates have been implemented and sent to all hosted services and information is being gathered in preparation to presenting proposals to the Chief Officers, MIJB’s and NHS Grampian. Comments: Further Controls Required Further Controls Owner Target Date Review Date Review Notes / Decisions Page 74
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Risk 8: There is a risk that the MIJB’s internal control and governance arrangements are not sufficiently robust to provide full assurance, as evidenced by the 2024/25 Internal Audit opinion of ‘limited assurance’ Consequence: • Weaknesses in internal controls may lead to financial mismanagement, service delivery failures, reputational damage, and non-compliance with statutory duties. • Delays in implementing audit recommendations may result in prolonged exposure to known risks and inefficiencies. • A continued ‘limited assurance’ position may reduce stakeholder confidence in the MIJB’s governance and oversight arrangements. Risk Rating: Medium Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) • The MIJB recognises the importance of strong internal controls and governance to support safe, effective, and sustainable service delivery. • While some risk is accepted in the pursuit of transformation, assurance processes must be timely, transparent, and responsive to audit findings. Rationale for Risk Rating: • The 2024/25 Internal Audit Annual Report concluded with a ‘limited assurance’ opinion. • Several audits identified significant issues, including delays in implementing recommendations, weaknesses in contract management, and challenges in information governance and digital infrastructure. • The findings collectively indicates a measurable risk to the MIJB’s ability to demonstrate effective governance and assurance. Assurances: • Internal Audit Annual Report presented to APR Committee (June 2025). • Quarterly reporting of audit progress and follow-up to APR Committee. • Oversight by SMT. • Internal audit process implemented, providing operational assurance to SMT as per agreed timescales. Managing the risk - Current controls in place 4 5 20 1. Implementation of an ‘end to end’ process for agreeing, implementing and tracking audits is now established operationally with regular updates to OMT with escalations to SMT highlighting progress, challenges, and emerging risks and any escalations as required. 2. Governance statement prepared in line with CIPFA/SOLACE guidance 3. Internal audit attending regular SMT meetings to discuss audit plan work and any emerging risks. 4. Financial resource from HSCM to MIJB Internal Audit team to improve capacity for collaboration and oversight. 2 3 6 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 75
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Gaps in Assurance: Delays in implementing some audit recommendations. Current Performance: • Implementation of Adult Social Care Commissioning audit recommendations nearing completion. • Audit plan for 2025/26 includes follow-up reviews to verify progress. • Improved partnership working with Internal Audit and SMT. Comments: Further Controls Required Further Controls Owner Target Date • Continue to identify capacity to progress the Digital work stream, including digitalisation where possible • Progress development of unified case recording system CFO/HoS HoS March 2027 March 2027 Review Date Review Notes / Decisions Page 76
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MIJB Risk Appetite Statement The Moray MIJB recognizes that effective risk management is fundamental to achieving its strategic objectives in delivering integrated health and social care services. This statement defines the level and type of risk the MIJB is willing to accept in pursuit of achieving the outcomes defined in the strategic plan, Partners in Care 2022-2032. Moray MIJB adopts a balanced approach to risk-taking, acknowledging that transformation, innovation and service improvement often require managed risk-taking while ensuring the safety and wellbeing of its staff and the public remains paramount. Strategic Risk: MODERATE-HIGH • Higher appetite for strategic initiatives supporting integration • Willingness to innovate in service delivery • Acceptance of calculated risks in pursuit of transformation • Support for pilot projects with clear business case and evaluation criteria At this appetite level, the board is willing to accept some uncertainty in governance processes where: - Clear oversight mechanisms remain in place - Core statutory obligations continue to be met - Potential benefits to service delivery are significant - Learning opportunities from governance adjustments can be captured Financial Risk: MODERATE • Willing to accept moderate financial risks in pursuit of strategic objectives • Conservative approach to core budget management • Higher tolerance for innovative projects with clear benefits • Low tolerance for financial decisions that could threaten long-term sustainability Clinical Safety Risk: LOW • Minimal appetite for risks affecting patient/service user safety • Strong controls and monitoring required for all clinical activities • Zero tolerance for non-compliance with clinical governance standards • Comprehensive risk assessments required for any service changes • Operational Risk: MODERATE • Moderate tolerance for operational changes that improve efficiency • Willing to consider new service delivery models • Acceptance of short-term disruption for long-term benefits • Regular monitoring and review of operational changes Reputational Risk: LOW-MODERATE • Conservative approach to actions that could damage public trust • Proactive stakeholder engagement in major decisions • Low tolerance for activities that could undermine partnership working • Emphasis on transparent decision-making Page 77
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Workforce Risk: MODERATE • Moderate appetite for workforce development initiatives • Innovation in recruitment and retention strategies • Support for new ways of working • Low tolerance for risks affecting staff wellbeing Risk Governance • Regular review of risk appetite by the MIJB Board • Clear escalation procedures for risks exceeding appetite levels • Integration of risk appetite into decision-making processes • Regular reporting on risk profile against appetite Implementation • Risk appetite to be considered in all significant decisions • Regular training for staff on risk management • Clear communication of risk appetite across the organization • Annual review and update of risk appetite statement Monitoring and Review • Bi-annual review of risk register against appetite levels • Annual review of risk appetite statement • Regular reporting to Audit and Risk Committee • Adjustment of appetite levels based on changing context This statement will be reviewed annually and updated as required to reflect changes in the operating environment and strategic priorities. Page 78
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Likelihood – What is the likelihood of the risk occurring? Assess using the criteria below. Rare (1) Unlikely (2) Possible (3) Likely (4) Almost Certain (5) Don’t believe this event would happen Will only happen in exceptional circumstances Not expected to happen but definite potential exists Unlikely to occur May occur occasionally Has happened before on occasions Reasonable chance of occurring Strong possibility that this could occur Likely to occur This is expected to occur frequently/ in most circumstances more likely to occur than not Impact – What could happen if the risk occurred? Assess for each category and use the highest score identified. The impact scale is from an organisational level perspective. It reflects the key areas that if impacted could prevent the organisation achieving its priorities and objectives. The scale is a guide and cannot cover every type of impact therefore judgement is required. Category Negligible (1) Minor (2) Moderate (3) Major (4) Extreme (5) Patient or Service user Experience Reduced quality patient experience/clinical outcome not directly related to delivery of clinical care Unsatisfactory patient experience/clinical outcome directly related to care provision – readily resolvable Unsatisfactory patient experience/ clinical outcome, short term effects – expect recovery less than 1wk Unsatisfactory patient experience /clinical outcome, long term effects - expect recovery over more than 1week Unsatisfactory patient experience/clinical outcome, continued ongoing long term effects Objectives/ Project Barely noticeable reduction in scope/quality/ schedule Minor reduction in scope/quality/schedule Reduction in scope/quality/project objectives or schedule Significant project overrun Inability to meet project/corporate objectives, reputation of organisation seriously damaged Injury /illness (physical and psychological) to Adverse event leading to minor Minor injury or illness, first aid treatment required Agency reportable, e.g. Police (violent and aggressive acts) Major injuries/long term incapacity /disability (e.g. loss of limb), Incident leading to death(s) or major permanent incapacity Page 79
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patient/service user/visitor/staff/carer injury not requiring first aid Significant injury requiring medical treatment and/or counselling requiring, medical treatment and/or counselling Complaints/Claims Locally resolved verbal complaint Justified written complaint peripheral to clinical care Justified complaint involving lack of appropriate care Claim above excess level. Multiple justified complaints Multiple claims or single major claim Complex Justified complaint Service/ Business Interruption Interruption in a service which does not impact on the delivery of patient care or the ability to continue to provide service Short term disruption to service with minor impact on patient care/service provision Some disruption in service with unacceptable impact on patient care Temporary loss of ability to provide Service. Sustained loss of service which has serious impact on delivery of patient care resulting in major contingency plans being invoked Permanent loss of core service/ facility Disruption to facility leading to significant “knock on” effect -- to function Staffing and Competence Short term low staffing level temporarily reduces service quality (less than 1 day) Short term low staffing level (>1 day), where there is no disruption to patient care Ongoing low staffing level reduces service quality Minor error due to lack of/ ineffective training/ implementation of training Late delivery of key objective/service /care due to lack of staff Moderate error due to lack of/ ineffective training / implementation of training Ongoing problems with staffing levels Uncertain delivery of key objective/service/care due to lack of staff Major error due to lack of/ ineffective training / implementation of training Non-delivery of key objective/ service/care due to lack of staff. Loss of key staff Critical error due to lack of/ ineffective training/ implementation of training Financial (including Damage/Loss/Theft/ Fraud Negligible organisational/ personal financial loss up to £1k Minor organisational/ personal financial loss of £1-10K Significant organisational/personal financial loss of £10- 100k Major organisational/personal financial loss of £100k- 1m) Severe organisational financial loss of more than £1m Page 80
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Inspection/ Audit Small number of recommendations which focus on minor quality improvement issues Recommendations made which can be addressed by low level of management action Challenging recommendations that can be addressed with appropriate action plan Improvement Notice Enforcement/prohibition action Low Rating Critical report Prosecution Zero rating Severely critical report Adverse Publicity/ Reputation Rumours, no media coverage Little effect on staff morale Local media coverage – short term. Some public embarrassment Minor effect on staff morale/public attitudes Local media – long term adverse publicity Significant effect on staff morale/public perception of the organisation National media adverse publicity less than 3 days Public confidence in the organisation undermined Use of services affected National/International media/ adverse publicity, more than 3 days MSP/MP/SEHD concern (Questions in Parliament) Court Enforcement/Public Enquiry/FAI Risk Scoring Consequences/Impact Likelihood Negligible Minor Moderate Major Extreme Almost Certain Medium High High V High V High Likely Medium Medium High High V High Possible Low Medium Medium High High Unlikely Low Medium Medium Medium High Rare Low Low Low Medium Medium Review Timescales – When a risk rating has been assigned the criteria below should be used to assess the review timescales. Very High or High Requires monthly monitoring and updates. Medium Requires quarterly monitoring and updates. Low Requires 6 monthly monitoring and updates. Page 81
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: MEMBERSHIP OF BOARD AND COMMITTEES BY: CORPORATE MANAGER 1. REASON FOR REPORT 1.1 To inform the Board of changes to Membership of the Moray Integration Joint Board (MIJB), Audit, Performance and Risk (APR) Committee and Clinical and Care Governance (CCG) Committee. 2. RECOMMENDATION 2.1 It is recommended that the Moray Integration Board (MIJB): i) notes that Ivan Augustus will stand down as the Unpaid Carer Stakeholder member on 27 November 2025; ii) agrees to increase the non-voting stakeholder members from five to six, to enable the inclusion of two Unpaid Carer Stakeholder representatives on the MIJB membership from 28 November 2025; iii) notes the appointment of Aimee McIntosh as the new Third Sector representative, effective from 1 October 2025; and iv) notes the updated membership of the Board and its committees, attached at Appendix 1. 3. BACKGROUND 3.1 The Public Bodies Joint Working (Scotland) Act 2014 (“the Act”) and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (“the Order”) make provisions about various matters including the membership of the MIJB. As a minimum this must comprise voting members nominated from the NHS Board and Council; co-opted non-voting members who are holders of key posts with the NHS and Council or the MIJB; and co-opted non-voting members who are representatives of groups who have an interest in the MIJB. There is flexibility to appoint additional non-voting members as the Board sees fit. The Moray Health Item 9. Page 83
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and Social Care Integration Scheme (“Integration Scheme”) outlines certain agreed provisions re membership (and includes the specific provisions taken from the Act and the Order). 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Following engagement and interviews held on 26 September 2025, Aimee McIntosh was appointed as the Third Sector Stakeholder representative. 4.2 Following engagement and interviews conducted on 26 September 2025, the following individuals have been nominated for the position of Unpaid Carer Representative. These nominations have been submitted to the Chair and Vice- Chair of the MIJB: • Miriam Connor • Christine Nicoll 4.3 Subject to the MIJB’s approval of the recommendations to increase the number of non-voting stakeholder members from five to six, both nominees are to be appointed as Unpaid Carer Stakeholder representatives with effect from 28 November 2025. 4.4 Increasing the number of Unpaid Carer Representatives from one to two will bring a broader range of perspectives, reduce isolation within the position, and better reflect the diversity of carer experiences. The proposal supports the MIJB’s commitment to inclusive engagement and collaborative decision-making. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-2032” Effective governance arrangements support the development and delivery of priorities and plans. (b) Policy and Legal The Board, through its approved Standing Orders for Meetings, established under the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014, ensures that affairs are administered in accordance with the law, probity and proper standards. (c) Financial implications There are no financial implications arising as a direct result of this report. (d) Risk Implications and Mitigation There are no risk implications arising as a direct result of this report. (e) Staffing Implications There are no staffing implications arising as a direct result of this report. Page 84
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(f) Property There are no property implications arising as a direct result of this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required as the report is to inform the Board of changes required to membership of the Board and CCG Committee. (h) Climate Change and Biodiversity Impacts None arising from this report. (i) Directions None arising from this report. (j) Consultations Consultation on this report has taken place with Chief Officer – Health and Social Care Moray and Caroline O’Connor, Committee Services Officer, Moray Council, who are in agreement with the report. 6. CONCLUSION 6.1 This paper sets out the position in relation to the membership of MIJB. Author of Report: Isla Whyte, Corporate Business Support Manager, HSCM Background Papers: None Ref: Page 85
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APPENDIX 1 Moray Integration Joint Board – as at November 2025 Moray Integration Joint Board 4 Council voting members Bridget Mustard (Vice-Chair) Ben Williams Peter Bloomfield Scott Lawrence 4 NHS Grampian voting members Dennis Robertson (Chair) Derick Murray Sandy Riddell Alex Stephen Third Sector Stakeholder Aimee McIntosh NHS Grampian Staff Representative Stakeholder Member Michael Ritchie Unpaid Carer Stakeholders Ivan Augustus Miriam Connor Chrissie Nicoll (both from 28/11/25) User of Services Stakeholder Sheila Brumby Moray Council Staff Representative Vacant Chief Officer Professional Judith Proctor Chief Social Work Officer Jim Lyon (interim) Lead Nurse Jane Ewen GP Lead Dr Robert Lockhart Non Primary Medical Services Lead Mr Duff Bruce Additional Member Elizabeth Robinson Audit, Performance and Risk Members (note chair needs to be alternate partnership member to the Chair of MIJB) 2 Council voting members Ben Williams (Chair) Scott Lawrence 2 Health Board voting members Sandy Riddell Derick Murray Third Sector Stakeholder Aimee McIntosh NHS Grampian Staff Representative Stakeholder Member Michael Ritchie Clinical and Care Governance Members 2 Council voting member Cllr Peter Bloomfield Cllr Scott Lawrence 2 Health Board voting member (Chair) Derick Murray (Chair) Alex Stephen (Sandy Riddell 25/1/24 temporary) Unpaid Carer Stakeholders Ivan Augustus Miriam Connor Chrissie Nicoll (both from 28/11/25) Service User Stakeholder Sheila Brumby Third Sector Stakeholder Aimee McIntosh Page 86
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APPENDIX 1 Moray Council Staff Representative Vacant Chief Officer Professional Judith Proctor Chief Social Work Officer Jim Lyon (interim) Lead Nurse Jane Ewen GP Lead Dr Robert Lockhart Non Primary Medical Services Lead Prof Duff Bruce Additional Member Elizabeth Robinson Page 87
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: MENTAL HEALTH SERVICES AND PRESSURES ON PRIMARY CARE BY: DEPUTY HEAD OF SERVICE AND THE GP CLINICAL LEAD FOR MORAY 1. REASON FOR REPORT 1.1 To provide the Board with assurance regarding progress in the development of mental health service provision, with the specific aim of reducing pressures on primary care and improving patient outcomes. 2. RECOMMENDATION 2.1 It is recommended that the Board : i) note the progress made in developing mental health services aimed at reducing pressures on primary care; and ii) note that a more detailed report on the development of mental health services across the wider Moray health and social care system will be presented to the Board on 26 March 2026. 3. BACKGROUND 3.1 A Health and Social Care Moray (HSCM) Clinical Care and Governance Group Escalation Report was presented to the Moray Integration Joint Board (MIJB) Clinical and Care Governance Committee on 28 August 2025 (para 5 of the minute refers). Following discussion, Committee members agreed to escalate specific concerns to the next meeting of the MIJB (para 8 of the minute refers). These concerns related to mental health service provision and pressures on primary care, as outlined in Appendix 2, Section 5 of the report, report and appendices are linked as a background paper. 3.2 Appendix 2, Section 5 noted ‘Mental Health Service Gaps Access to consultant- led psychiatry services in Moray remains severely limited due to longstanding and unresolved staff shortages. Some areas of Moray have no consultant psychiatry Item 10. Page 89
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coverage at all. As a result, GPs are left managing complex adult and child mental health cases — including ADHD, autism, and self-harm — without adequate specialist support, increasing clinical risk and pressure on primary care.’ 3.3 The matter was duly escalated to the MIJB in the Chief Officer Report and discussed at the Board meeting on 25 September 2025 (para 9 of the draft minute refers). It was recognised that if not resolved then the issues escalated would have a potentially negative impact on the MIJB’s delivery of its strategic ambitions. It was therefore agreed that: • The specific issues escalated by the MIJB Clinical Care and Governance Committee should initially be responded to in a briefing note to MIJB members. • These issues should then be formally responded to in a report to the next meeting of the MIJB on 27 November 2025. 3.4 A briefing note was provided to the Moray Integration Joint Board members on 7 November 2025. 3.5 This report provides the formal response. 3.6 The Moray Mental Health and Wellbeing Strategic Group will present a comprehensive report outlining progress on the Moray Mental Health and Wellbeing Delivery Plan 2024–2026 to the MIJB meeting on 26 March 2026. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 There continue to be challenges in delivering mental health services across Community, Primary Care, and Secondary Care settings in Moray. These challenges include: • Recruitment and retention of staff • Financial constraints • Increasing numbers of individuals presenting with mental health and wellbeing conditions • Limited capacity to lead necessary changes while maintaining clinical service delivery 4.2 Many of these challenges are reflected across the wider Grampian area and nationally. In response, HSCM have engaged with other health and social care partnerships to share learning and best practices, which has positively influenced planning in Moray. 4.3 Within Moray a plan is in place to address the challenges faced in delivering mental health services within the Primary Care and Secondary care settings. Progress has been achieved over the past 12 months and key points are outlined in section 4.4 to 4.18 below. 4.4 A new Clinical Director for Moray Mental Health Services (Adult / Older Adult and Moray Integrated Drug and Alcohol Services) was appointed in June 2025 and has formally been in post from August 2025. Page 90
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4.5 The Clinical Director for Moray Mental Health and Drug and Alcohol Services is working closely with the General Practice Clinical Lead for Moray to develop the interface between Primary Care Services and Secondary Care. 4.6 Staffing vacancy and absence levels across Mental Health and Drug and Alcohol Services are now average or better compared to similar services across the Partnership. However, challenges remain in nursing vacancies within ward areas and in some medical posts. 4.7 Consultant Psychiatry cover for Adult and Older Adult Mental Health Services is now in place across all areas of Moray. Although there were disruptions during the early summer due to unexpected absences, the situation has stabilised. One of the two current Adult Mental Health locums has expressed a desire to stay within Moray and the job advert process is underway. 4.8 The Secondary Care Mental Health Service is aware of the impact that reduced consultant cover will have had on our colleagues in General Practice. The Clinical Director and Mental Health Team staff, alongside colleagues in Primary Care, are working through the remaining open patients, on a Practice by Practice basis, to assess ongoing need to remain in service, and if required arranging follow up. 4.9 The Clinical Director is currently in the process of developing a new protocol where GPs can access psychiatry advice via a specific email contact system therefore reducing unnecessary referrals and associated paperwork. 4.10 Mental health on call consultant cover was particularly stretched in the early part of the summer as a result of staff absence and vacancies. However, despite not being able to progress the move to a single Grampian consultant on call rota as part of the Grampian Mental Health Bed Base Review, support from Royal Cornhill colleagues has ensured continuous out-of-hours consultant cover for Moray. The situation has since improved significantly. 4.11 HSCM are increasing the presence of Consultant Psychiatrists and Community Mental Health Teams within Primary Care settings and within Primary Care Multi- Disciplinary Teams. The outcome of this is an increase in timely responses to primary care queries and an increase in face-to-face appointments. 4.12 Recruitment is underway for two Senior Advanced Nurse Practitioner posts — one for Adult and one for Older Adult Mental Health. These roles will enhance the Consultant-led model and strengthen Community Mental Health Team involvement in Primary Care settings, in line with other Health and Social Care Partnerships across Scotland. 4.13 In September 2025, 100% of Secondary Care Psychological Service referrals met national waiting time targets. However, only 15% of Primary Care Psychological Service referrals met these targets. While Moray’s waiting times and list sizes are better than neighbouring partnerships, significant improvement is still needed. The aim is to apply lessons learned from Secondary Care to improve Primary Care Page 91
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performance. Work is already underway to streamline pathways between these services. 4.14 The attention deficit hyperactivity disorder (ADHD) assessment waiting list is being reviewed in collaboration with Primary Care colleagues to ensure earlier support can be provided. In the meantime, individuals screened for ADHD with co-morbid mental illness continue to be prioritised within Secondary Care. 4.15 Mental Health and Wellbeing Practitioners are located in GP Practices throughout Moray funded through Primary Care Improvement Plan funding. In August 2025, they provided 255 appointments. Through discussion with GP colleagues, the role of these workers have evolved over the past few months to include, where requested, a focus on supporting the triaging of mental health referrals to allow earlier identification and response. This role will continue to evolve over the next few months. 4.16 The three Scottish Action for Mental Health (SAMH) commissioned contracts are now operational and fully staffed. • The Distress Brief Intervention Service predominantly receive referrals from GP colleagues. 75 out of a total 120 referrals received during Quarter 2 of the current financial year were from GPs. • The Intensive Recovery and Community Support Service. 82 referrals received during Quarter 2 of the current financial year • The Suicide Prevention Service offers community-based support and capacity-building activities, including a newly added bereavement support component. 4.17 Key service delivery challenges include: • Medical and social work cover within the Moray Integrated Drug and Alcohol Service. There are currently temporary medical cover arrangements in place, with plans to recruit to a specialty doctor from February 2026. • Reducing locum spend on consultant psychiatrist posts. • Primary Care Psychological Therapy waiting times. • ADHD pathway revision. 4.18 Staffing within Mental Health Services is stabilising, which is critical for delivering the developments outlined in the Mental Health Strategic Delivery Plan and achieving positive outcomes for individual receiving services. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The approach set out in this report is consistent with the MIJB Strategic Plan. (b) Policy and Legal Page 92
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There are no implications for policy or legal. (c) Financial implications None arising directly from this report. (d) Risk Implications and Mitigation Risks are recorded on the Health and Social Care Moray Risk Register; actions plans are in place and are routinely monitored. (e) Staffing Implications None arising directly from this report. (f) Property There are no implications on property provision. (g) Equalities/Socio Economic Impact None arising directly from this report. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions None arising from this report. (j) Consultations The following people were consulted during the writing of this report: Sean Coady, Head of Service, Health and Social Care Moray Jonathon Mann – Clinical Lead in Adult Mental Health and Addictions Lynne Clark - Service Manager, Moray Mental Health and Drug and Alcohol Services Kirsteen Pyett – Social Work Team Manager, Mental Health 6. CONCLUSION 6.1 The Board are asked to note the progress in relation to the development of mental health service provision to specifically reduce pressures within primary care and improve patient outcomes. Author of Report: Iain Macdonald: Deputy Head of Service Robert Lockhart: GP Clinical Lead for Moray Background Papers: Health and Social Care Moray Clinical and Care Governance Escalation Report – MIJB CCG Committee of 28/08/25 Page 93
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: INTRODUCTION TO MORAY HOME ASSESSMENT PATHWAY BY: HEAD OF SERVICE 1. REASON FOR REPORT 1.1 To inform the Board of the successful bid to implement a Moray Home Assessment Pathway and to highlight how it supports the delivery of Moray Integration Joint Board’s (MIJB’s) strategic priorities articulated in the Strategic Plan, and the delivery against the nine national Health and Wellbeing outcomes. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider and note the contents of this report; ii) note that funding has been made available to Health and Social Care Moray (HSCM) to implement a Home Assessment Pathway as part of a Grampian Unscheduled Care Improvement Programme; iii) acknowledge that NHS Grampian will hold the risk in relation to the funding as set out in paragraph 4.13; iv) agree to receive updates on the implementation and impact of the pathway as part of its regular performance reports to Audit, Performance and Risk Committee; and v) agree that the pathway meets the aspirations of the MIJB’s Strategic Plan and is aligned to the MIJB’s Strategic Delivery Plan. 3. BACKGROUND 3.1 In August 2025, HSCM submitted a successful bid to the Scottish Government (SG) to enhance and embed a home assessment pathway within HSCM’s existing START/Discharge to Assess (D2A), Care at Home, Community Response Team (CRT), and Primary Care pathways that enables people to leave hospital as soon as they are clinically able. The incorporation of a flexible, Item 11. Page 95
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dynamic, multi-disciplinary, collaborative service would allow for people to be assessed at home, in the environment they will continue to live in, looking at hazards and good practice that will ensure they are safe and as independent as possible, for as long as possible. 3.2 The SG is funding this work in order to accelerate NHS Grampian’s whole system Unscheduled Care Improvement Programme which has as its focus the aims of improving the patient experience in unscheduled care, reducing people delayed in their discharge from hospital and improving NHS Grampian’s (NHSG) overall performance relating to the 4-hour target for waits in the Emergency Department and the levels of Ambulance queuing that is being experienced by people at both Aberdeen Royal Infirmary and Dr Gray’s Hospital in Elgin. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Home Assessment Pathway aims to incorporate existing D2A, Care at Home, START Service, CRT and Primary Care pathways to: • Prevent future hospital admission by recognising persons in crisis • Reduce long term care dependency • Promote independence • Provide person centred care • Reduce length of stay in hospital • Manage co-morbidities and long term conditions better • Reduce level of care packages by assessing in a familiar and real environment • Involve unpaid carers and families in the decisions around care provision in a familiar location • Show progression in real time • Allow Moray’s community hospitals to be used for rehabilitation • Ensure people are receiving the right support under the right team (CRT, D2A or START) 4.2 Moray, with a population of approximately 96,400, faces increasing demands on its healthcare system due to an ageing demographic and rising levels of frailty. Direct investment in general practice to enhance multidisciplinary team (MDT) capacity is essential to improve care coordination, increase productivity, and achieve robust health outcomes. This successful bid thus advocated for the expansion of D2A, community nursing teams, CRT and Advanced Health Practitioner (AHP) services to support admission avoidance, frailty management, and facilitated discharge, aligning with the strategic priorities of the MIJB and the NHSG GP Vision programme. 4.3 The enhanced service will enable proactive interventions that prevent unnecessary hospital admissions, improve discharge planning, and ensure that frail and elderly patients receive the right care in the right setting. By strengthening primary and inpatient capacity, Moray can reduce pressure on secondary care services and deliver more efficient, patient-centred care. Page 96
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4.4 The model supports integration between general practice, community health services, and social care, ensuring a seamless healthcare experience for patients, underpinned by the Getting It Right for Everyone (GIRFE) principles, the NHSG GP Vision programme, supporting HSCM’s Discharge without Delay and Unscheduled Care Frameworks and reinforcing HSCM’s commitment to Home First. 4.5 The team, in collaboration with a full MDT, would assess over a two week period looking at all elements of support including medication prompts, care facilitation, telecare and technological aids, proportionate care, equipment and financial and social support, such as third sector befriending services, liaising with START and D2A teams and Care at Home services, who would then pick up the next period of care allowing for proper rehabilitation if it was needed. 4.6 The approach centres on collaboration and shared responsibility across MDTs, moving away from siloed, criteria-led practices. It promotes a patient-centred mindset, where staff see themselves as part of one unified service. A key cultural shift involves embracing home-based assessment as safe and effective, challenging the traditional belief that hospital is always best. This requires clear communication and reassurance for both staff and the public. The goal is to create a culture of risk enablement rather than risk avoidance, reducing delays and improving continuity of care. Virtual Wards 4.7 Virtual wards allow people to receive treatment and care where they live, rather than as a hospital inpatient, while still being in regular contact with health professionals. Virtual wards are used to avoid a hospital admission or to support early discharge from hospital. In some cases, virtual wards are supported by technologies that help people monitor their health at home and send information back to health care professionals, such as devices to track pulse, blood pressure, or oxygen levels. 4.8 Virtual wards will be established within a group of, or one chosen practice. The process used by Practices which have successfully implemented the virtual ward is detailed below. It is anticipated that this will be the process adopted by the majority of Practices undertaking the Service Level Agreement. It is recognised, however that the model may have to vary across parts of Moray, mostly for geographical reasons. Key Deliverables 4.9 The key operational delivery actions are: • Operational Home Assessment Pathway operationalised; • Virtual ward model in selected GP practices established; • Central referral and escalation system in place; • Training for support workers and volunteers put in place and • Communication strategy for public and staff agreed; Page 97
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Timescale 4.10 The timetable for implementation of the programme is set out in Table 1 below Table 1 – Implementation Timeline Phase 1 Launch January 2026 Phase 2 Expansion March 2026 KPI Review Quarterly Final Evaluation March 2027 Key Performance Indicators (KPIs) 4.11 A suite of performance and delivery indicators are being developed for the whole system Unscheduled Care Improvement Plan which will be overseen by the Unscheduled Care Improvement Board. This is a complex, multi-partner programme and to enable HSCM and MIJB to scrutinise the impact of local plans, the following KPIs have been agreed for the Home Assessment Pathway element. This will enable an understanding of local impact, as well as contribution to the impact of the overall programme: • ≥20% reduction in acute geriatric Length of Stay (LOS) by March 2026 • ≥20% reduction in community hospital LOS • ≥5 delayed discharges reduced monthly • 10% reduction in Emergency Department presentations (60–80 age group) • 240 patients assessed in first 12 months Budget and Risk 4.12 Funding for the programme has been provided to NHSG by SG to deliver improvement in Unscheduled Care. This funding is not being delegated to the Grampian IJBs but will be available to the Health and Social Care Partnerships for operational implementation. The aim of this work is very aligned to the MIJB’s strategic plan and strategic ambitions and given this, it is vital that the MIJB is both sighted on, and supportive of, this work. 4.13 The total estimated cost of delivery of the Moray element of the plan is £1,391,682, comprising staffing (£1.3M), equipment (£60K), and contingency (£100K). The full allocation has been provided to support implementation. The funding is recurring, based on performance and is subject to enhanced reporting to SG as part of the Unscheduled Care Improvement Programme. Given the Page 98
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funding is not delegated, NHSG has agreed to own any risk that funding is decreased or withdrawn. 4.14 Other project risks are set out in Table 2 below: Table 2 – Project Risks Risk Mitigation Recruitment challenges Flexible funding and service redesign, delays in systems Service saturation Strict governance and monitoring Collaboration issues Culture shift and communication System escalation Business resilience planning Governance 4.15 Governance and oversight is in place both at Moray and Grampian levels which enables HSCM to monitor implementation and impact as part of the Home First Strand of the Strategic Plan, and at a Grampian level in terms of the Moray contribution to the overall Unscheduled Care Improvement Programme. 5. SUMMARY OF IMPLICATIONS a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-2032”. This report supports the strategic objectives set out in the MIJB’s Strategic Plan. b) Policy and Legal There are no new policy or legal implications arising directly from this report. The report is consistent with existing statutory duties and governance arrangements. c) Financial implications There are no direct financial implications associated with this report. However, performance insights may inform future resource planning and monies received from SG. d) Risk Implications and Mitigation While there are no immediate risks arising from this report, at present, please note the risks listed in paragraph 4.14. If performance is not met, SG will reduce or remove funding and the permanent staff will be at the expense of NHSG. NHSG have recognised this risk. e) Staffing Implications Page 99
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While there are no direct staffing implications arising from this report, it is important to acknowledge the ongoing challenges with recruitment across health and social care services. This new pathway aims to maintain a focus on transformational change to deliver services to our community. f) Property There are no property implications directly associated with this report. g) Equalities/Socio Economic Impact An Equality Impact Assessment (EIA) is not required for this report, as it does not introduce or amend any policy or service that would directly affect individuals with protected characteristics. However, performance data may be used to inform future service improvements that promote equity and inclusion. h) Climate Change and Biodiversity Impacts There are no direct climate or biodiversity implications arising from this report. However, it is recognised that extreme weather events and rising energy costs may increasingly impact service delivery, particularly in rural areas. These factors will be considered in future strategic planning. i) Directions No new directions are required as a result of this report. j) Consultations This report was in collaboration with the home assessment oversight group. 6. CONCLUSION 6.1 The Board is asked to note the report, acknowledge funding and associated risk, confirm alignment with strategic plans, and agree to receive regular updates on the Home Assessment Pathway’s implementation and impact. Author of Report: Sean Coady, Deputy Chief Officer, Moray HSCP Background papers – on request Page 100
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: CHILDRENS SERVICES PRESSURES REPORT BY: INTERIM CHIEF SOCIAL WORK OFFICER/HEAD OF SERVICE 1. REASON FOR REPORT 1.1 To inform the Board of the significant and sustained pressures, experienced by Children’s Services, notably with the increased flow-into care, the permanence backlog, resulting budgetary constraints, and uncertainties surrounding the sustainability of funding streams such as the Whole Family Wellbeing Fund (WFWF), and rising costs of residential care. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider the contents of this report; and ii) approve the strategic direction set out in Appendix 1 to address both the immediate pressures and the longer term sustainability of these services. 3. BACKGROUND 3.1 There is no one factor which can predict child abuse or neglect. However, it is known that children growing up in homes where there is poverty, domestic abuse, substance use, or mental health problems, are at a higher risk. When these risks are combined with the existing strain on local services (Audit Scotland reports 2024 and 2025), the implications for children are significant. The landscape of safeguarding and child protection is changing and although practice is improving in some areas, statutory funding is stretched to keep up with increased demand. 3.2 In Moray the flow-into care during the last two financial years has been higher than in preceding years resulting in internal resources being exhausted and severe budgetary pressures. 3.3 Nationally it has been difficult to access out of area (OOA) care, and costs range from £5.5K to £7.5K per week, excluding travel and time, to keep children in contact with their families. The current average cost of OOA care per child per week is £5,612 which is £291,824 per annum per child. 4. KEY MATTERS RELEVANT TO RECOMMENDATION Item 12. Page 101
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4.1 The report highlights the significant pressures on children’s services and actions being taken to address these. Consideration has been given to maximising the impact of current resources including the WFWF as noted in Appendix 1. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” This report is in line with the Moray 2026 Plan – healthier citizens, ambitious and confident young people, adults living healthier, sustainable independent lives safeguarded from harm and Council priority 4 – More of our children have a better start in life and are ready to succeed. (b) Policy and Legal The services referred to in this report fall within the scope of several important pieces of legislation including: • Social Work (Scotland) Act 1968 • The Children (Scotland) Act 1995 • The Joint Inspection of Children’s Services & Inspection of Social Work Services (Scotland) Act 2006 • Adoption and Children (Scotland) Act 2007 • Looked After Children (Scotland) Regulations 2009 • Children & Young People (Scotland) Act 2014 (c) Financial implications There are financial risks in all of the above which test the organisational financial risk appetite including doing nothing and doing something. This is set against the need to keep children safe and together, wherever possible, and the costs and sustainability of creating internal resources noted in Appendix 1. (d) Risk Implications and Mitigation There are no risk implications associated with or arising from this report. (e) Staffing Implications There are no staffing implications directly relating to this report. (f) Property There are no property implications arising from this report. (g) Equalities/Socio Economic Impact There are no issues directly arising from this report. (h) Climate Change and Biodiversity Impacts There are no issues directly arising from this report. (i) Directions There are none arising from this report. (j) Consultations Page 102
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HSCM Senior Management Team 6. CONCLUSION 6.1 This report shows pressures experienced by children’s services. Author of Report: Jim Lyon, Interim Chief Social Work Officer/Head of Service Background Papers: Attached Ref: Page 103
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APPENDIX 1 Strategy to Address Pressures in Moray Children’s Services A Strategic Approach to Sustainable Children’s Care and Support 1. Introduction Moray Children’s Services are currently experiencing significant and sustained pressures, notably with the increased flow-into care, the permanence backlog, resulting budgetary constraints, and uncertainties surrounding the sustainability of funding streams such as the Whole Family Wellbeing Fund (WFWF), and rising costs of residential care. 2. Background There is no one factor which can predict child abuse or neglect. However, we know that children growing up in homes where there is poverty, domestic abuse, substance use, or mental health problems, are at a higher risk. When these risks are combined with the existing strain on local services (Audit Scotland reports 2024 and 2025), the implications for children are significant. The landscape of safeguarding and child protection is changing and although practice is improving in some areas, statutory funding is stretched to keep up with increased demand In Moray the flow-into care during the last two financial years has been higher than in preceding years resulting in internal resources being exhausted and severe budgetary pressures. Nationally it has been difficult to access out of area (OOA) care, and costs range from £5.5K to £7.5K per week, excluding travel and time, to keep children in contact with their families. The current average cost of OOA care per child per week is £5,612 which is £291,824 per annum per child. 3. Immediate and Longer-term Strategic Planning To ensure continued wellbeing and safety of children, while maintaining financial sustainability and statutory obligations, a clear and coherent strategic response is essential. This report outlines a strategy to address these multifaceted pressures, ensuring children’s rights, safety, and family integrity remain central in planning and decision-making. It sets out immediate opportunities which support longer-term ambitions and makes recommendations for investment in transformation. This report highlights the different available funding streams for this work and will be accompanied by a costed implementation plan. 4. Strategic Objectives These include immediate actions to safeguard children and young people from imminent harm and neglect, and longer-term planning for future sustainability and prevention: • Reducing the number of children entering care through early support, diversion, and prevention • Reducing time where possible in care particularly OOA care Page 104
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• Increasing capacity and enhancing care arrangements for stability and improved outcomes for children • Sustaining and diversifying funding sources to unify and expand family support services • Strengthening governance and accountability across the children’s services partnership • Developing innovative, community-based alternatives to mainstream care models While there are two distinct strands to the overall strategy, longer-term sustainability and immediate need, several actions fall under both strands. Several actions have already been initiated, for example, in the Children’s Services Plan and in children, families and justice services. Longer-term Planning for Future Sustainability: 5. Early Support and Prevention Moray GIRFEC Leadership group (GLG) was established to create a roadmap for the realisation in Moray of the Scottish Government’s vision of a single system of children’s services for holistic family support through Children’s Services Planning Partnerships (CSPPs) as detailed in Appendix A. Funding is provided by the WFWF, through the Council’s General Revenue Grant, so families receive support at the right time, to fulfil children’s rights to be raised safely in their own families whatever the nature of their family composition. The funding supports the eradication of child poverty and keeping The Promise by investment in early intervention and prevention, ensuring families access support before crisis point. The Scottish Government’s 5% funding requirement aims to ensure that by 2030, at least 5% of community-based health and social care spending is directed toward preventative whole family support. A significant challenge within the funding requirements is sustainability – the funding is annual and there is no guarantee beyond financial year 2026/27. Funding for 2025/26 and 2026/27 is £619,000 for each year. 6. Strengthening Universal Services This involves reinforcing universal services including health, education, third sector, and community resources to identify and address family needs at the earliest opportunity including: • Implementing effective screening and referral pathways within schools, children’s health services, and community hubs • Enhancing the capacity of early years services to provide support before crisis points are reached • Effective implementation of the GIRFEC national model with refresher training, development, and evaluative review • Early identification of risk Page 105
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7. Targeted Family Support Targeted support for families at risk of breakdown or requiring additional assistance, coordinated through use of the WFWF where priorities include: • Rapid response outreach teams to provide intensive family support at home, in evenings and weekends as required • Access to therapeutic services and parenting programmes for high-risk families • Flexible, needs-led financial and practical support to address specific stressors e.g. housing instability, mental health, neglect, substance use and domestic abuse 8. Partnership and Community Capacity Building This involves public services working closely with third sector, community, and voluntary organisations to build local capacity, ensuring families have access to a wide range of support services in their communities. Actions include: • Grant schemes for community-led early support initiatives • Support for peer-led family networks and advocacy groups • Youth work and youth services • Effective systems for tackling local anti-social behaviour, links to wider “organised crime”, and parents with addictions, poor mental health, and those involved in drugs 9. Enhancing Care Arrangements and Pathways Most accessible specialist residential care services are in central belt Scotland presenting significant infrastructure challenges for local authorities and H&SCPs in highland, island and rural locations. For decades, local authorities in the North East and wider, have been placing children in central belt locations due to a lack of accessible specialist provision, for example, in Grampian. Actions include: • Mapping need including trends in the flow-into care • Profiling the children and young people being accommodated and the underlying reasons - poverty • Identifying and targeting support services to meet the needs of parents including adult addictions, mental health and learning difficulties • Rethinking the “access” process for children and families’ services to be built around the needs of people as opposed to fitting people around internal structures, as part of the structural review, to have consistent, relational, social work from the outset • Exploration of joint commissioning of need and appetite across Grampian for commissioned shared specialist resource in the North East Initial exploratory discussions with CSWOs in Grampian indicate shared experience of children’s services pressures and a willingness for further exploratory work. Any future agreed initiatives will take considerable time, up to five years, in planning and commissioning but promises great potential benefits, therefore, exploration must start now. Profile work undertaken in Moray on the intake of accommodated children (more prominent for teenagers) in 2025/26 highlights exclusion from school, reduced Page 106
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timetables, and non-attendance, amongst other things, as significant factors contributing to them being accommodated in OOA care. There are opportunities to: • Develop with partners the Pinefield Park education provision into an education, care and support resource, to address the needs of young people requiring greater structure and multi-agency support on site to sustain school and education 10. Immediate Need Evidence informs that a significant number of children accommodated over the last two financial years, including large families, should have been accommodated sooner. There are various reasons for this including the after effect of Covid lockdown measures where children were isolated at home and not always visible to services, failure to identify serious neglect early enough, lack of coordinated early support and diversion, and OOA budget savings based on previous lower rates of accommodation. The process for accommodating and looking after children away from home (legal drivers) are contained in Appendix B. 11. Children and Families Centre: Hub and Spoke The Munro Report 2011 informs that early year’s services, attachment-informed care, and responsive parenting support are essential for long-term prevention of harm. Children & Families Centres, recognised in the research, can support families in ways which are: • Non-threatening and non-stigmatising • Open and accessible • Responsive and friendly • Holistic and coordinated • Mutually supportive and relational • Community, family based and trauma informed The GLG, in its children’s services planning partnership capacity, has committed to investing funding in the provision of a children and families centre in Moray, by a hub and spoke model, funded by the WFWF. The model includes a centre in Elgin and hubs in rural and coastal areas across Moray, connected to each other, embedded in the community, supported by services including community capacity building. Scoping and modelling work has been undertaken; a draft lease and small staff team was devised with options and costs amounting from lowest £277,254 to highest, £315,133 per annum, excluding any required refurbishment costs. Sustainability would come from the reduction of OOA care costs on impact of the strategy. We have established regular engagement forums, such as the Champion’s Board with care experienced young people, involvement with carers through Barnardos, and with operational staff to ensure lived experience informs strategic priorities and service design. Improvement actions include: • Creating a cross IJB and Council Corporate Parenting Group to better inform Board Members and Councillors of their corporate parenting roles and responsibilities, the complexities of service provision, and legal requirements • Creation of tools to assist the “voice of the child” with further need to evidence the key messages and what we are doing about it • Supporting family hubs and strengthening third sector participation in identify need and working towards prevention and diversion Page 107
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12. Permanency Planning Work has been progressing, as a service priority, over the last year to ensure all children requiring lifelong alternative family care, have evidenced based plans to progress adoption, permanence orders, or kinship care. Actions include: • Management prioritisation and overview, regular review of permanence plans, and development of a “whole service” approach to family finding • Consecutive planning (concurrent planning) to ensure best outcomes for children by planning for possible return to their parents or being adopted by their concurrent carers (duel registered foster and adoptive carers) • Joint child profiling with fostering and localities teams and improved working between the two – child at centre • Improved monitoring of commissioned services designed to support family decision making • Improved Kinship searching, streamlined assessments, and clarity on “good enough care” • Review of the Kinship Team – increase resource to meet increased demand • Work on policies, procedures (including a Team Around the Child Procedure) and a specialist permanence training programme (not yet rolled out) Delays in expediting permanence plans cause a “bottleneck” effect in internal foster care resources which need to be freed for newly accommodated children to avoid OOA care: • Work is developing with legal services to most effectively progress legal remedies and management of the backlog of permanence • Creation of a “test of change” Specialist Permanence Team • Early identification and tackling neglect with partners The permanence specialist team has been set up temporarily to manage the backlog, including an increase in the accommodation of babies with associated parental mental health and substance use issues impacting on parental care. It contains experienced social workers in permanence with accompanying family support workers and developing links with legal services. Once evaluated its status can be decided thereafter. Better alignment of children’s health (Health Visiting and School Nursing) and localities social work services can lead to improved joint working, early identification of neglect and other family health and social concerns, actions include: • Consideration of colocation opportunities • Increased joint learning and development approaches • Targeted service input to locations with high and concentrated joint support needs – improved management information and information sharing 13. Increased Internal Capacity Work is underway to ensure every child’s care plan prioritises permanency and stability, reducing the need for moves between care settings and associated trauma with key actions including: • Support and training for Independent Review Officers (IROs) for effective scrutiny, drive, and completion of children’s plans timeously Page 108
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• Development of “Family Finding” approaches to match children quickly and effectively with permanent carers • Enhanced support to foster carers (training, short-breaks, financial allowances) to improve retention and care stability – this depends on having the physical room and appropriate skills, building in training, and flexible support when needed i.e. evenings and weekends • Ensuring effective management overview of the flow-out of care including young people supported to move out of children’s houses internally and externally by individualised transition planning, started well in advance of leaving care • Partnerships with local employers, housing providers, and further education institutions • Unblocking children “stuck” in temporary foster care by improved permanence planning, working closely with housing services to maximise use and support of local housing provision 14. Improved Management Information Previously there was underutilised use of trend information, profiling, and information sharing which has been developed in the past year. For example, Five- and ten-year trends in the flow-into care and child protection registration rates are crucial in helping to plan for future need, and targeted resource allocation. The Care First management information system is a legacy system which needs replaced. The new system shall, along with strategic leadership, provide better data collection, analysis, and forecasting to better understand trends in demand such as our Critical Mass, predict future pressures, and evaluate the impact of interventions. Work is underway in GLG to streamline reporting, reduce actions, focus on outcomes and improve measurements of success. A long-term service manager gap has recently been filled bringing new strategic leadership, benchmark experience, and renewed energy to help drive the children’s services partnership. This assists commitment to regular review of strategy implementation, adapting actions in response to changing circumstances, emerging evidence, and feedback from stakeholders. 15. Small Group Family Living Models Work has been started to promote the establishment of internal small (four to six children - more if keeping a larger family together) group family living models as alternatives to external care, focusing on nurturing, homely environments. To increase internal capacity there are options to convert one or two large Moray Council housing properties which could create up to twelve care places for accommodated children. Actions include: • Pilot projects for small group homes within communities, drawing on best practice from successful models • Investment in recruitment, training, and ongoing support for staff and carers in such settings • Strengthened partnership working with specialist health and education services • Building community support and dialogue Page 109
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Initial staffing and funding estimates, with a trusted care provider, for two Housing Services properties to meet the needs of two large families accommodated in the current and previous financial year, are ironically higher than current OOA care costs. However, the model has “The Promise” advantage of keeping the children together in their family should this be in their assessed best interests. The larger of the two housing properties would cost £125,000 for renovation to make it habitable and fit for purpose. The smaller of the two has not yet been costed and will be completed and included in the implementation plan as with the larger house including staff and lease costs. There are also significant challenges in working through Care Inspectorate registration requirements which are time consuming, rigid, and at times uncompromising. Efforts to engage the Care Inspectorate in reflective conversation on the prospects of such provision being potential sector leading (given the size of the families – no children’s house in Scotland could accommodate together by existing resources) have met with a standard bureaucratic response – begin the registration paperwork on-line! 16. Financial Sustainability and Funding Diversification There are financial risks in all the above which test the organisational financial risk appetite including doing nothing and doing something: • The forecasted overspend in OOA care is £1,241,000 • If four care packages are extended until the end of the financial year this will increase the overspend to £1,625,000 • This excludes this year’s price increase for Scotland Excel contracts (in negotiation), with estimated cost of a further £100,000 • There may be more need to accommodate children before the end of the financial year – another large family is on the edge of breakdown and other young people could be accommodated by the Children’s Hearing system over which we have no control legally • We are legally and duty bound to investigate the circumstances of children in need and those at risk of harm, once we act, for example, taking Child Protection Orders, the Children’s Hearing system comes into effect, and we are not in control of its decision making This is set against the need to keep children safe and together, wherever possible, and the costs and sustainability of creating internal resources: • The cost of not accommodating children who are being neglected and abused in their families • The risk of these children being left too long in the community and reputational damage from child protection Care Inspections • Sustainability of costs to create internal resources, beyond their expected life span e.g. staff redeployment or redundancy • The continued and growing cost of OOA care 17. Optimising Use of Existing Funds Consideration has been given to maximising the impact of current resources, including the WFWF, through: Page 110
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• Creating a Children and Families Centre providing early support and diversion before crisis point – benefits will take time to be realised and decrease the flow-into care • Regular review and reallocation of resources to interventions with the strongest evidence of effectiveness – reinvigorate the focus of the GLG and children’s services partnership under the above heading - Partnership and Community Capacity Building • Robust contract management with external providers to ensure value for money – actions are underway, but the market is tough with demand exceeding availability. A recent Social Work Scotland benchmark noted a CSWO was quoted £10,000 per week for OOA care for a child • Funding efforts to keep large families together (OOA care) while recognising the sustainability challenge – how would this be funded if the WFWF ceases and would enough funds be left to develop holistic family support before crisis point. This would require organisational approval and governance which needs work 18. Governance, Integration, and Accountability There are complicated governance and reporting arrangements for OOA spend now Children, Families and Justice Services have joined the Health and Social Care Partnership. The needs of children have been delineated into categories including children with disabilities, children who require residential care on care grounds alone, and children who require residential care on care and education grounds – the latter rests with the Council ECLS Committee jointly with the Integration Joint Board (IJB), while the former rest solely with the IJB. There is need to clarify and streamline existing governance arrangements, including lines of accountability between the IJB, ECLS Committee, and Moray Council which involves: • Regular, transparent reporting on budget, activity, and outcomes to all governance bodies • Clear delineation of responsibilities and escalation routes for strategic decisions affecting children’s services 19. Innovation and System Change Over the past 18 months the GLG has had a change in strategic leadership, various personnel changes, deletion of posts due to temporary national funding endings, and a prolonged key service management gap. This has had significant impact on its ability to establish a single children’s services system across the CSPP to achieve attachment- informed care, responsive parenting support, and prevention. Review of existing plans found significant progress had been made on a range of actions as outlined in the Children’s Services Annual reports for 2024 and 2025. However, new direction was needed to tackle the rising flow-into care, increased costs of care, savings requirements, all of which increase the challenge of sustainability. The development of a hub and spoke Children & Families Centre, and systems change to early support and prevention with evidence-based data, must be the directional thrust within an agreed governance structure to avoid further delay. Page 111
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20. Monitoring, Evaluation, and Continuous Improvement A “self-evaluation and continual improvement” model has been introduced across the CSPP which takes time to embed and establish operationally. Delays and leadership changes have hindered progress while significant progress has been achieved across a range of children, families, and justice services learning and development requirements as reported to the IJB on 19 June 2025. Service priorities have been identified with clear outcomes to: • Reduce the flow-into care • Improve kinship care • Develop and streamline permanence planning • Improve stability of care – reduce care moves for children • Achieve savings and achieve budget alignment This involves commitment to regular strategic review, flexibility to adapt to changing circumstances, and refining actions to maximise outcomes based on emerging evidence, and feedback from stakeholders. 21. Summary As set out herein, there are immediate emerging pressures in the need to accommodate and support a large family of children subject to legal and child protection measures. Care provision involves different internal and OOA fostering and specialist residential care, the current cost of which is forecast at £250k per quarter. This is an unbudgeted pressure which if unaddressed will further increase the HSCP’s overspend and potentially require further (unbudgeted) financial support from our partners. A range of options are now required within C&FS to identify balancing efficiencies, or set out options for bringing the level of support for this family to within available budget parameters, through more affordable, and equally safe and effective models of care and support, or through the swift creation of a whole family service which can be delivered at a lower cost. Actions in place include: • Regular review of OOA care with planning to return children to Moray wherever possible • Regular review of the planned flow-out of care while matching the needs of children in OOA care for internal provision when vacancies arise • Prioritisation of permanence children to secure their lifelong alternative care and free up internal foster care resources (bottleneck) • Increased support for and recruitment of foster carers (national shortage) • Working with Housing Services to identify local provision to assist the appropriate flow-out of care while balancing legal responsibilities for Continued Care (same or similar care till age 21 years) • Focussed commissioning activity on the most expensive care providers for reductions and negotiated costs • Developing partnership approaches to the prioritisation of children on the edge of care in need of additional health care, education support, police disruption activities, diversion from offending, mentoring and befriending Page 112
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• Development of better coordination of services for parents with addiction, mental health, learning difficulties and other support needs • Exploration of additional out of hours approaches (rapid response) 22. Conclusion Addressing the current and future pressures on Moray Children’s Services requires a bold, collaborative, and flexible approach. By focusing on prevention, enhancing care pathways, ensuring financial sustainability, and fostering innovation and accountability, the partnership can ensure every child and family has access to the support they need—now and for years to come. Moreover, there is need to address the Scottish Government’s 5% funding requirement which aims to ensure that by 2030, at least 5% of community-based health and social care spending is directed toward preventative whole family support. Author: Jim Lyon, Interim Head of Service/CSWO. Date: 12 November 2025 Page 113
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APPENDIX A Governance and Strategy The Children’s Service Plan links to the Council’s Corporate Plan priorities: Tackling poverty and inequality and building thriving, resilient, empowered communities. Also, the Local Outcomes Improvement Plan (LOIP) priorities: Building a better future for our children and young people in Moray and empowering and connecting communities. Moray Community Planning Partnership has devolved responsibility to deliver Moray’s Children’s Service Plan to the GIRFEC Leadership Group (GLG). The GLG includes senior decision makers, including directorate level, from the public and 3rd sector remitted to work together to improve the lives of children and young people across Moray. The group is chaired by the Chief Social Work officer and Head of Service. The current GIRFEC Leadership Group TOR & Membership requires updated to reflect the current model and governance arrangements. Strategic groups across the Children's Services partnership have oversight responsibility for the delivery of each of the action plans with subgroups ensuring data underpins the transformational change activity. Chairs meet regularly to coordinate improvement activity with progress reported quarterly to GLG. Locality Networks of practitioners and community organisations ensure the voices of those living and working in localities underpins strategic decision making. The number of Children’s Service Planning strategic groups was streamlined in September 2025 to focus on: • Family Support • Voice (youth advisory group) • Participation (Team around the Child) Moray’s Corporate Parenting Strategic Group has been realigned to ensure parity with the Child Protection Committee in recognition of the significance of Moray’s commitment to #KeepthePromise: Community Planning Board Page 114
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Whole Family Wellbeing Fund (WFWF) The Scottish Government’s Programme for Government 2021-22 committed to invest £500 million in Whole Family Wellbeing Funding (WFWF) over parliament 2022-2026 to transform family support so families get the help they need, where and when they need it. The programme supports: • Expanding successful support offers in local communities, like family support hubs or services for parents and carers dealing with mental health or substance use • Improving the co-ordination and delivery of support, investing in staff to deliver high- quality services and providing leadership support • Sharing learning across the country through a Learning into Action Network Moray’s allocation of the funding was £564k per annum increased to £619,000 for 2025/26 and 2026/27. Funding can be carried forward each year, and the Scottish Government extended the timeframe of the programme until March 2027. The Children’s Services Partnership is required to report progress on an annual basis to the Scottish Government - to date 3 Moray progress reports have been presented to the Scottish government with proposals aligning with locally identified needs. Following a workshop with key Children’s Services partners in October 2022 the GLG agreed to prioritise: • Investing capacity within ‘the system’ to design and deliver holistic family support • Building on the success of the locality planning model, as identified through external evaluation Over the period 2023-25 monitoring has included: • Regular progress reports detailing activities, outputs, and outcomes • Regular Financial reporting to ensure transparency and accountability • End-of-project evaluation to measure impact against WFWF priorities Budget Spend 2023-October 2025 Table 1 outlines the allocation of WFWF from 2022 to 30 October 2025: Table 1: Allocation of WFWF from 2022 to 30 October 2025. Year Allocation Carried forward Available to spend Actual Spend 2022-23 £546,000 n/a year 1 £546,000 £36,949 2023/24 £545,000 £509,051 £1,054,051 £264,045 2024/25 £524,000 £790,006 £1,314,006 £349,963 2025/26 £619,000 £964,043 £1,583,043 £530,390.71 as of 30/10/25 Page 115
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Initiatives currently funded by WFWF are outlined in Table 2 below: Table 2: Actual spend at 30 October and projection until 31 March 2026 Item funded Amount spent at 30/10/25 Projection until 31/03/26 Wellbeing Co-Ordinators x2 £64,739.79 £63,828 Learning Co-ordinator £28,704.20 £28,836 Mentoring Young Talent Co-ordinators £42,688.39 £45,008 Chairs of Locality Network £8,281.82 £0.00 Moray PEEP programme Development and Delivery £45,000 £46,800 Operational Budget for Virtual HT £821.46 £19,178.54 Daniel Spargo Mabbs Foundation £4,930.00 £25,070 Moray Parent Project £23,575.00 £36,425 Misc Staff Travel (Booking Service) £93.40 £0.00 YP Zone funding (Aberlour) £30,000 £12,500 Test of foster care keeping families together approach £281,556.65 £0.00 Total spend at 30 October 2025 £530,390.71 Additional projected spend until 31 March 2026 £277,645.54 Children and Families Centre: Hub and Spoke For reasons outlined in the body of this report GLG has committed to investing in the provision of a children and families centre in Moray. This is a spend to save approach and it is anticipated that sustainability will come from the reduction of out of OOA care costs which result as an impact of the successful implementation of the family centre and supporting services. Scoping and modelling work has been undertaken; options and costs to operate the family Centre hub and spoke model range from lowest £277,000 to highest, £315,000 per annum, excluding any required refurbishment costs. Whole Family Wellbeing Governance beyond March 2025 All WFWF funded projects are required to participate in a structured monitoring and evaluation process to assess impact and inform future funding decisions. A robust monitoring and evaluation framework will be developed between November 2025 – January Page 116
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2026 which aligns with the devolved responsibility given from to the GLG to deliver the Children’s Service Plan. This will include where solutions need to be made at a strategic level, for example, if additional resources are required or if there is a change in how resources are prioritised and allocated. Governance Structure Governance of the WFWF is overseen by a multi-agency steering group comprising representatives from local authorities, health services, and third sector organisations. This structure ensures accountability, strategic oversight, and collaborative decision- making. Funding Allocation and Spend Funding has been allocated across a range of initiatives targeting family wellbeing. Spend analysis indicates a focus on capacity building, service integration, and community-based support. Monitoring mechanisms are in place to track expenditure and assess value for money. Project Outcomes Funded projects have reported positive outcomes including increased access to support services, improved family resilience, and enhanced child development. Evaluation frameworks are used to measure impact and inform continuous improvement. Future Planning Future planning includes the development of a Whole Family Wellbeing Programme funding and capacity buildings for Morays Third Sector. Page 117
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APPENDIX B Flow-into Care, Legal Drivers and Budgets Looked After Children Requiring Alternative Care (1 April 2024 – 31 October 2025) During the previous 18 months, 45 children have become Looked After, (away from home), equating to 40 families. In 2024, 14 children were accommodated which represents 13 families, (1 family group of 3). The age range of these children were: • 7 aged 12 -16 • 2 aged 6-11 • 4 aged 3-5 • aged 0-2 In 2025, 31 children were accommodated representing 27 families, (4 family groups including large family groups). The age range of these children were: • 9 aged 12-16 • 8 aged 6-11 • 6 aged 3-5 • 8 aged 0-2 Of the 45 children, 38 were known to Children’s Social Work Services and had an allocated social worker who coordinated a multi-agency support plan. These children had been subject to proportionate safeguarding measures such as Child Protection Registration and Compulsory Measures of Care through the Children’s Hearing system prior to becoming Looked After away from home. Eight children were accommodated directly by a Children’s Hearing decision, and 14 children were subject of emergency Child Protection Orders. The large family groups were not all known to Children’s Social Work Services at the point of accommodation. Key themes across the children becoming looked after away from home were: • Neglect • Child Exploitation • Sexual Abuse • Lack of Parental Supervision Risk factors and background pressures included: • Parental Mental Health • Domestic Violence • Parental Substance Use • Fabricated and Induced Harm Of the 45 children, 41 were affected by 3 or more risk factors, which significantly increased their vulnerability to harm. A significant number were either attending school sporadically or were not engaged in Education at all. A small number were receiving CAHMS support. The legal status of the 45 children was: • S25 (voluntary basis) 6 children • CSO (Compulsory Supervision Orders) 32 children • Bail Conditions (parental) 7 children Page 118
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The Scottish legislative framework, including the Children’s Hearings (Scotland) Act 2011 and the Children (Scotland) Act 1995, sets out the statutory duties of the local authority in relation to Looked After Children. The Chief Social Work Officer (CSWO) is responsible for ensuring all children subject to legal orders such as Compulsory Supervision Orders (CSOs) Children’s Hearings (Scotland) Act 2011 are implemented in full. In practice this means the: • Local Authority arranging and funding Looked After care • Local Authority providing support services • Local Authority supporting the children’s welfare • Legal Orders are the decision of a Children’s Hearing • CSWO is legally required to implement legal measures stipulated Failure to implement a legal measure can result in legal challenge and potential reputational damage. Once the Local Authority acts to safeguard a child, for example, seeking a Child Protection Order the wider legal system is automatically triggered and legal processes and timescales are required mainly via the Children’s Hearing system. On occasion it is not safe for children to remain at home and in these situations all community-based supports have been exhausted. In this scenario the lead professional completes an assessment of the child’s needs, which is recorded within the child’s plan and submitted to the relevant Social Work Service Manager and Education for endorsement prior to being heard at the High-Cost Care Panel. Approval for all joint Education and Social Work Residential Resources and OOA care, is contingent upon the Panel’s collective agreement, following comprehensive multi- agency assessment. There are instances where children have not received prior approval from the High-Cost Care Panel which typically involve children appearing before a Children’s Hearing, resulting in a place of safety warrant. In such circumstances, the Local Authority is required to implement the legal order as directed, without delay. Additionally, there are situations where children must be accommodated urgently due to significant harm, leaving insufficient time to obtain panel approval in advance. In these cases, retrospective approval is sought following the emergency arrangement. Out of Area Budget (OOA) The OOA budget comprises residential, foster, and secure care, provided by external agencies, subject to individual or spot purchased contracts, rather than in-house or contracted providers. The budget previously sat in Moray Council and since the move of Children, Families and Justice Social Work (CFJSW) to Health and Social Care Moray, under the Integration Joint Board (IJB), in 2023/24 (shadow year) the budget and cost pressures (without allocated budget) has been separated into 5 different elements outlined in Table 1 below: Page 119
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Table 1: Care Elements, Budget and Responsibilities for External Care Care Elements Budget Responsibility Education Joint Social Work/Education (Residential and Foster Care) Out of Area Moray Council Included Social Work only Residential Care Social Work only Residential Care IJB Not Included Social Work only Disability Social Work only Disability IJB Not Included Social Work only Foster Care Social Work only Foster Care IJB Not Included Continuing Care (Residential and Foster Care) Continuing Care IJB Not Included The Continuing Care budget comprises internal and external care costs. As such, the OOA cost is an element within the wider Continuing Care budget. Continuing Care allows children to remain in their accommodation till their 21st birthday to provide continuity and stability of care which is a legislative requirement. When CFJSW moved to the partnership in 2023/24 the complexity of the budget provision was not fully appreciated, and it was decided the budget would remain in the council as a joint responsibility of Education Services and CFJSW. It did not take account of all care areas which resulted in an arbitrary budgetary separation between the social work and educational needs of children. Consequently, at the start of 2024/25 there was no clarity regarding budget setting for the Social Work only budgets for that need which was primarily care driven and where education could be provided in Moray. At the start of the financial year there was no budget provision for Residential Care and Continuing Care but some budget for Disability and Foster Care. Thus, Residential Care and Continuing Care had no budget and became a financial pressure for the partnership outlined in Table 2 below: Table 2: Social Work Only Budgets – Start of 2024/25 Budget Area Budget Amount Status of Funding Social Work only Residential Care 0 N/A Social Work only Disability 428,500 Recurring Social Work only Foster Care 400,649 Recurring Continuing Care (Residential and Foster Care) 0 N/A Page 120
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: ANNUAL REPORT OF THE CHIEF SOCIAL WORK OFFICER 2024/25 BY: INTERIM CHIEF SOCIAL WORK OFFICER/HEAD OF SERVICE 1. REASON FOR REPORT 1.1 To inform the Board of the annual report of the Chief Social Work Officer (CSWO) on the statutory work undertaken on the Council’s behalf during the period 1 April 2024 to 31 March 2025. 2. RECOMMENDATION 2.1 It is recommended that the Moray Integration Joint Board (MIJB) consider and note the contents of this report. 3. BACKGROUND 3.1 In compliance with their statutory functions under the Social Work (Scotland) Act 1968, all local authorities have a CSWO. For several years CSWOs have produced Annual Reports on the provision of social work services which are provided for relevant committees, Moray Council and Integration Joint Boards. 3.2 The Office of the Chief Social Work Adviser in the Scottish Government (OCSWA) collates an overview Summary Report based on the key content of the reports from all local authorities in Scotland. This summary would: • Be of value to CSWOs and support the CSWA in their role of raising the profile highlighting the value and contribution of social work services nationally; and • Be a useful addition to the set of information available to aid understanding of quality and performance in social work services across Scotland. 3.3 The Council’s Social Work Services require to support and protect people of all ages as well as contributing to community safety (public protection) by reducing offending and managing the risk posed by known offenders. Social Work services manage this together with implications of significant demographic change and financial constraint whilst fulfilling a widening array of legal obligations and duties. 3.4 The annual report is attached at Appendix 1. This report was completed and is presented to the Board by the Interim Chief Social Work Officer. Item 13. Page 121
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4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The report highlights that a huge amount of work was undertaken during the reporting period with significant areas of improvement and delivery of key services in a context of external environmental restraints including complexity and rising need, savings required, and staffing challenges. It highlights the positive working relationships between Councillors, IJB members, officers and the community planning partnerships in adult and child services, aimed at providing good quality social work and social care and health services in Moray. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” This report is in line with the Moray 2026 Plan – healthier citizens, ambitious and confident young people, adults living healthier, sustainable independent lives safeguarded from harm and Council priority 4 – More of our children have a better start in life and are ready to succeed. (b) Policy and Legal The service referred to in this report fall within the scope of several important pieces of legislation including: • Social Work (Scotland) Act 1968 • The Adult Support & Protection (Scotland) Act 2007 • The Community Care & Health (Scotland) Act 2002 • The Children (Scotland) Act 1995 • The Joint Inspection of Children’s Services & Inspection of Social Work Services (Scotland) Act 2006 • Adoption and Children (Scotland) Act 2007 • Looked After Children (Scotland) Regulations 2009 • The Public Bodies (Joint Working) (Scotland) Act 2014 • Children & Young People (Scotland) Act 2014 Significant policies and white papers that relate to these services include: • Changing Lives, the Future of Unpaid Care in Scotland (2006) • Delivery for Health (2005) • All our Futures: Planning for a Scotland with an Ageing Population (2007) • Better Health, Better Care: Action Plan for a Healthier Scotland (2007) • Better Outcomes for Older People: Framework for Joint Services (2005) • National Guidance for Child Protection in Scotland, The Scottish Government 2014 (c) Financial implications Page 122
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There are no direct financial implications arising from this report. Future priorities will be addressed within the context of the financial planning process. (d) Risk Implications and Mitigation There are no risk implications associated with or arising from this report. (e) Staffing Implications There are no staffing implications directly relating to this report. (f) Property There are no property implications arising from this report. (g) Equalities/Socio Economic Impact There are no issues directly arising from this report. (h) Climate Change and Biodiversity Impacts There are no issues directly arising from this report. (i) Directions There are none arising from this report. (j) Consultations HSCM Operational Management Team 6. CONCLUSION 6.1 This report shows that Social Work, like other areas of health and social care, are experiencing pressures. Author of Report: Jim Lyon, Interim Chief Social Work Officer/Head of Service Background Papers: Ref: Page 123
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APPENDIX 1 Chief Social Work Officer Annual Report 2024/25 Jim Lyon, Interim Chief Social Work Officer, Moray Council Page 124
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Page 2 of 32 Table of Contents Welcome and Introduction .................................................................. 2 1. Governance, Accountability, and Statutory Functions .................... 2 2. Service Quality and Performance ................................................. 6 Children and Families ...................................................................... 6 Adults .............................................................................................. 12 Community Justice ......................................................................... 27 3. Resources ................................................................................ 29 4. Workforce ................................................................................ 30 5. Looking Ahead .......................................................................... 31 Welcome and Introduction Welcome to the Chief Social Work Officer’s (CSWO) annual report for 1 April 2024 to 31 March 2025. This is my first annual report in Moray as Interim CSWO and Head of Children, Families and Justice Services, having taken up post on 3 June 2024. I very much welcome the opportunity which is a privilege and honour. Given the timing of annual reports, there are significant developments beyond the end date sighted for development in the next reporting period. Social work services face significant pressures from wider social, economic, and political factors, Audit Scotland Report, July 2024. Over the last year, like many areas in Scotland, there have been persistent pressures in Moray, including: • An ageing population and increasing demand for services • Rising complexity of need across the population and increased care costs • Workforce shortages and recruitment challenges • Significant developments in policy and legislation • Continuing effects of the pandemic most notably in children’s services • The cost-of-living crisis • Public service savings, and challenges of providing public services in areas with rural communities Despite these challenges, we continue to deliver high quality services through the commitment and diligence of our dedicated social work and social care workforce who demonstrate unshakable determination to support and protect our citizens. The scale of the challenge is considerable requiring a cross-Moray Council and Moray Integration Joint Board (MIJB) approach to supporting our people and communities. 1. Governance, Accountability, and Statutory Functions We enjoy strong governance and leadership arrangements in MIJB and Moray Council helping and supporting the rationale and transparency of decision making and risk Page 125
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Page 3 of 32 management. We have close working relationships between officers, MIJB members and our elected Councillors, demonstrating a clear desire for strong working relationships to deliver effective services to our people. Over the last year in Moray, we have had changes in social work leadership and other senior leadership roles most notably the appointment of our Health and Social Care Moray (HSCM), Chief Officer, Judith Proctor. Judith joined us on an interim basis on 15 July 2024 and was appointed substantively on 21 November 2024. Judith brings a wealth of experience and leadership to the role and has helped galvanise our direction of travel and culture of partnership working across the, at times, complicated landscape of public bodies interworking and integration. In Moray Council, there has been a change at Chief Executive level with the appointment of Karen Greaves, BEM, on 17 March 2025, who took over from John Mundell, OBE, Interim Chief Executive, who left on 17 April 2025 following handover. Karen brings a wealth of experience and leadership in senior roles in local authority work and from her appointment in March, she has presided over the final stages of the Council’s restructure process. MIJB brings together Moray Council and NHS Grampian staff to jointly deliver a wide range of community health and social care services under the direction of the integration joint board, formally established in April 2016. The Council and NHS Grampian have delegated statutory functions to MIJB through an Integration Scheme approved by the Scottish Government. Functions delegated by the Council are social care services, fostering and adoption services, child protection, and justice services. Council and MIJB aims are aligned in the 10 years Local Outcomes Improvement Plan (LOIP) agreed by Moray Community Planning Partnership (MCPP). Outcomes are delivered through partnership working focusing on four agreed strategic objectives: developing a diverse, inclusive and sustainable economy; building a better future for our children and young people; empowering and connecting communities; and improving the wellbeing of our population. The HSCM Clinical and Care Governance Group (CCGG) is responsible for ensuring robust systems and processes are in place across all service areas within HSCM to support clinical and care governance. The group provides assurance to the HSCM Senior Management Team (SMT) and the Moray Integration Joint Board (MIJB) Clinical and Care Governance Committee that these systems are operating effectively to support the safe and effective delivery of care and maintain service quality. A review of all strategic Board-level risks has been completed, with new clear ownership, mitigations, and monitoring arrangements in place. The Audit, Performance and Risk Committee, brings oversight with exception reporting escalated to the Board. Work is continuing to review and strengthen the operational and corporate risk frameworks within HSCM, ensuring alignment with the Board’s Strategic Risk Register. This integrated approach supports more effective risk management across the system. The Role of the CSWO Section 3(1) of the Social Work (Scotland) Act 1968 requires Local Authorities to appoint a CSWO, with a requirement to publish an annual report on their professional Page 126
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Page 4 of 32 leadership, oversight of practice, governance, values, and standards as described in national guidance. It covers the areas of decision-making and practice where legislation confers functions directly on the CSWO mainly relating to public protection and the restriction of an individual’s freedom. The report may be cross referenced to specific performance reports including HSCM Annual Performance Report 2024/25 and NHS Grampian Clinical and Care Governance Committee Annual Report. Overall governance of social work services in Moray rests with the CSWO, who is also the Head of Children, Families and Justice Services, as laid out in the framework for Professional Social Work and Social Care Practice Governance in Moray Council and Health and Social Care Moray (the professional governance framework). CSWOs provide professional advice in the discharge of a Local Authority’s statutory social work functions including those delegated to H&SCPs. The CSWO is a ‘proper officer’ re social work functions: an officer given responsibility on behalf of a Local Authority, where the law requires the function to be discharged by a specified post holder. The CSWO is a non-voting member of MIJB and a member of MIJB Audit, Performance and Risk Committee, responsible for supporting and scrutinising delivery of integrated adult’s and children’s care services. The CSWO attends Moray Council Committee, and the Education, Children’s and Leisure Services (ECLS) Committee, the latter having a shared responsibility with MIJB for funding out of area (OOA) residential care for children with specialist care and education needs. Responsibilities of the CSWO Entail accountability to the Chief Executive of the Local Authority, Councillors, MIJB, and reporting to the Chief Officer, HSCM. Professional advice from the role includes the safety of vulnerable people, the impact of social work service, and the findings of quality and performance reports, setting out the implications for the delivery of national and local outcomes, proposals for remedial action, good practice and learning, and reporting arrangements for identified improvement activity. The CSWO has a direct line to the Chief Executive and Moray Councillors, ensuring Councillors are provided with reports on relevant developments and required decisions. The Council’s Chief Governance Officer (Monitoring Officer) offers crucial support to the CSWO in the effective discharge of duties through the provision of advice, guidance, and support with service delegation and other relevant matters associated with the role. Through engagement in these arrangements, the CSWO is satisfied the practice governance arrangements in place are appropriate and proportionate, and practice standards are being met with required improvement plans in place, subject of review. Moray Public Protection Chief Officers Group (MPP COG): This is the most senior group with strategic and governance for public protection in Moray. The Adult Support and Protection (Scotland) Act, Code of Practice (Revised 2022) and National Guidance for Child Protection in Scotland (Revised 2021) outlines their responsibilities including maximising the involvement of services not directly under their control: Scottish Children’s Reporter Administration, Crown Office, and Procurator Fiscal Services. It provides strategic leadership and scrutiny for the public protection work of their respective agencies and inter-agency work. Chief Officers are Page 127
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Page 5 of 32 individually and collectively responsible for the leadership, direction and scrutiny, of the Public Protection Committees, and linked public protection groups. Moray Chief Officers recognise strong leadership and a competent and confident workforce play a critical role in public protection with continued focus on supporting improved outcomes for vulnerable people across the diverse communities of Moray. Supporting effective inter-agency work is central in providing excellent public protection services in Moray. The Chief Officers involved include the senior leaders, at chief executive and chief officer level, CSWO and other representatives as required to address specific matters across the public protection partnership. Chief Officers are responsible for overseeing the commissioning of all public protection services and are accountable for this work and its effectiveness. They are individually responsible for promoting Child Protection, Adult Support & Protection, Alcohol & Drug, Violence Against Women, MAPPA and the wider public protection agenda across their individual services and agencies to ensure a corporate approach to protection. They identify successes, best practice and areas for improvement to learn from experience, monitor trends and examine outcomes for children, young people and adults receiving services. The main areas overseen by Moray Public Protection Chief Officers Group are Child Protection, Adult Support & Protection, Alcohol & Drugs, Violence Against Women including Multi-Agency Risk Assessment Conferences (MARAC), Multi-Agency Public Protection Arrangements (MAPPA) and Offenders Management, Community Justice, Prevent Multi-Agency Panel (PMAP), and Suicide Prevention. Moray Profile Moray is situated in the northeast of Scotland, bordered by Inverness and the Highlands to the west and Aberdeen and Aberdeenshire to the east. It covers an area of 864 square miles, making it the eighth largest council area in Scotland. Most of Moray’s population of 96,000 people reside in and around Elgin, Forres, Keith, Buckie, Dufftown, and Lossiemouth, each town with its distinct local identity. There are good transport links, with Inverness and Aberdeen, and Glasgow and Edinburgh are three and a half hours away. The presence of Army and RAF personnel in Kinloss Barracks and RAF Lossiemouth positively impacts the local economy and culture. With relatively low unemployment and an appealing natural environment, Moray is a desirable place to live. Low crime rates and good public services add to its appeal. Moray faces pockets of inequality and deprivation, and its rural profile can create difficulties in accessing services and economic opportunities, as well as isolation. Considering Moray’s higher-than-average proportion of older people, particularly in rural and coastal areas, providing high-quality public services can be complex and more expensive. HSCM and Moray Council’s Corporate Plan sets the strategic priorities between now and 2029. The vision is for Moray to be a place where people prosper, free from poverty and inequality, which means our: • Young people grow up safe, well-educated and reach their full potential • People lead healthy lives and have access to quality care when needed • Businesses and communities prosper Page 128
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Page 6 of 32 • Natural environment thrives for the betterment of all To make this vision a reality, three core strategic priorities have been identified on which the Council, and MIJB, work to tackle poverty and inequality, build a stronger, greener, vibrant economy, and build thriving, resilient, empowered communities. With a population of 95,520, Moray is one of Scotland’s smaller councils, although the 8th largest by geographic area. There are over 5,000 council employees (approx. 3,800 Full Time Equivalent) located throughout the region. 2. Service Quality and Performance Children and Families Localities Social Work This comprises an Access Team, and two Locality Teams, in East and West. The Access service is the initial point of contact for referrals on children not already being supported by social work services. It prioritises enquiries and child protection referrals acting as a feed to the longer-term Localities Teams where continual support is required. Effective access is critical for facilitating a prompt social work service, signposting to other services, and supporting families on a short-term basis or in preparation for transfer to the East and West Teams based on assessed need. Corporate Parenting “One of our care experienced adults, just graduated with a BA Hons and is flying to Australia this week for up to one year for an exciting travelling year”. As a corporate parent, such examples are always a pleasure to share highlighting the huge potential of our care experienced children and young people. Moray Community Planning Partnership has devolved responsibility to produce and deliver the Children’s Service Plan to the GIRFEC Leadership Group (GLG). The GLG includes senior decision makers from the public and 3rd sector working together to improve the lives of children and young people across Moray. The group is chaired by the CSWO, with Head of Education, vice chair. Strategic Children's Services partnership groups have oversight for the delivery of each of the action plans with subgroups using data to underpin transformational change activity. Chairs meet regularly to coordinate improvement activity with progress reported quarterly to GLG. Locality Networks comprise direct service delivery practitioners and community organisations. To ensure the voices of those living and working in localities underpin decision making. Strategic groups shall be streamlined to focus on Family Support, Voice (youth advisory group) and participation (Team around the Child). Moray Champion’s Board This is a group of care-experienced young people, meeting fortnightly, to share their views, speak up about what matters to them, and work with adults in power to make real change. It provides a space for young people who care about youth voice and want Page 129
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Page 7 of 32 to make a difference, whether by shaping services, leading campaigns or supporting others with similar experiences. At its heart, is connection, influence, and creating a better future. Led by young people, for young people. Current campaigns include ‘THE ROAD DOESN’T END AT 21!’, Moray Champion’s Board is campaigning for free bus travel to be extended to age 26 for care-experienced young people. The Board has produced a podcast under Moray’s Maintaining Relationships Project, a bold and compassionate initiative placing relationships at the heart of care. The Project is part of Moray’s commitment to Keep The Promise. It challenges traditional boundaries asking us to follow relationships, not job roles. It demands cultural change, risk reframing, and system-wide transformation! Of course, the role of corporate parent applies to children looked after at home, those accommodated, and those with care experience. The corporate parenting role is often initiated when child protection and alternative care is required or young people conflict with the law. During the reporting period the number of children looked after at home and away from home, has fluctuated at times but has levelled out over the year as seen in Graph 1 below: Graph 1: Looked After Children – At Home and Away from Home The number of children accommodated during the reporting period has been higher than in previous years. Reasons include the after effect of Covid lockdown measures with children isolated at home and not seen by services, failure to identify serious neglect soon enough, and lack of sufficiently coordinated early support & diversion. The number of children on the child protection register has fallen over the year mainly because the number of children accommodated has risen due to significant levels of increased need including neglect and other forms of harm. Details of registration and de-registration are provided in Graph 2 below: Graph 2: Child Protection Register 172 177 179 175 173 175 177 176 175 180 178 171 160 170 180 190 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 LAC - At Home & Away from Home - 2024 - 25 Page 130
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Page 8 of 32 The number of Initial Referral Discussion (IRDs), the mechanism for multi-agency information sharing and planning child protection actions, has fallen from a peak in May 2024. Multiagency working arrangements have tightened arrangements for ensuring IRDs are required and routine working together means effective information sharing for children and families already known to services. The number of IRDs and children are contained in Graph 3 below: Graph 3: Number of IRDs and Children Care Settings During the last two CSWO reporting periods, Care Inspection grades for fostering, adoption and adult placement services have been consistently good on how well we support people, leadership, staff, and care planning. Our children’s services partnership joint inspection of services for children and young people at risk of harm in Moray of January 2024 was adequate from which we have been delivering an Improvement Plan as set out below. 67 68 66 66 65 65 69 69 64 60 64 48 2 7 2 0 6 4 12 5 4 1 5 46 9 4 0 7 4 8 4 10 5 1 20 0 10 20 30 40 50 60 70 80 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Child Protection Register - 2024 to 2025 Number on Register Number of Registrations Number of De-Registrations 0 5 10 15 20 25 30 35 40 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 18 9 6 9 4 6 5 14 2 8 6 1 36 40 22 23 16 12 20 33 10 24 13 11 No of IRDs & Children 2024-25 No. of IRDs No. of Children Page 131
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Page 9 of 32 Our grades for Supported Lodgings in May 2024 were mixed (overall adequate) as outlined in Table 1 below: Table 1: Care Inspection Grades from July 2023 to March 2025 Service Completed Area inspected Grade Fostering 06-07-23 How well do we support people’s wellbeing? How good is our leadership? How good is our staff team? How well is our care and support planned? 4 – Good 4 – Good 4 – Good 4 – Good Adoption 06-07-23 How well do we support people’s wellbeing? How good is our leadership? How good is our staff team? How well is our care and support planned? 4 – Good 4 – Good 4 – Good 4 – Good Adult Placement Service (Continuing Care) 06-07-23 How well do we support people’s wellbeing? How good is our leadership? How good is our staff team? How well is our care and support planned? 4 – Good 4 – Good 4 – Good 4 – Good Partnership 23-01-24 Report of joint inspection of services for children and young people at risk of harm in Moray community planning partnership Adequate Moray Supported Lodgings 29-05-24 How well do we support people’s wellbeing? How good is our leadership? How good is our staff team? How well is our care and support planned? 3 – Adequate 3 – Adequate 2 – Weak 4 – Good In July 2024 work was undertaken on learning from complaints and five themes were identified: communication, timely actions, process and procedure, the voice of the child, and addressing power imbalance. The work demonstrated the themes were relevant to all the teams across children and families and justice services and two Learning from Practice development sessions were held on 14 and 27 November 2024, attended by 111 staff with good representation from all teams. An action plan was implemented which, at the end of the reporting period, evidenced significant progress in all areas and will be reported to MIJB in the next reporting period. Follow up activity including further development sessions are planned as we embed our culture of learning and development throughout the service. Children and Young People at Risk of Harm Page 132
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Page 10 of 32 Based on external inspection, January 2024, improvement activity has focused on three key areas to ensure: • Children and young people at risk of harm influence service planning and improvement • Children and young people at risk of harm benefit from independent advocacy • The support and protection of young people at risk of harm from themselves or to others, or from risk in the community We have produced a, self-evaluation and continual improvement approach, introduced in the children’s services community planning partnership, including the third sector, supported by Moray Child Protection Committee. It has a programme of case file audits in children and justice services, learning from complaints findings, and single and multi-agency learning and development activities, moving to include partner services. It has a learning funnel to review and evaluate improvement requirements from various learning opportunities such as findings from complaints. The model will be rolled out across the whole social work and social care service once we have embedded the working mechanisms, and developed the key principles, and lessons from its introduction in children and justice services. Improvements in the participation of children and young people at risk of harm include: • Quarriers Moray Children’s Rights Service through a relational approach, promotes, protects, and upholds the rights of young people, ensuring their voices are heard and respected. Their contract has expanded to include independent advocacy for parents and carers. Compared to the previous contract, referrals for young people have increased by 290%, alongside 143 new referrals for parents and carers demonstrating their positive work and ability to meet demand. • They supported young people in 116 professional meetings, a 190% increase and provided advocacy for parents and carers in 90 meetings, ensuring their voices and rights are represented in key decision-making processes. They prioritise referrals from young people, parents, and carers subject to child protection measures and those looked after, offering immediate support. • A multiagency communication and engagement strategy, developed with children, young people and practitioners, February 2025, to increase awareness of the role and contribution of Moray Child Protection Committee (MCPC). • A draft multiagency practitioner toolkit for gathering the voice of the child Improvements in the support and protection of young people at risk of harm from themselves or to others, or risk in the community include: • A Protection from Serious Harm (PSH) process, from revised multiagency child protection procedures for coordinating multi-agency responses to safeguard children and young people from serious harm, exploitation, abuse, or criminal activity, creating safety plans and implementing protective measures. Page 133
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Page 11 of 32 The first PSH meeting, October 2024, saw 60% of young people referred with a plan to reduce risk. Concerns for young people were shared early and support and planning put in place. Resultantly, well over 50% of plans have been stepped down due to a reduction in the potential for serious harm from collaboration with young people, their families, and partners. From evaluation, the process will be developed in the next reporting period, to further embed and improve the process, and the procedure will be updated accordingly. • Exploration of Contextual Safeguarding for young people at risk of harm from the community by shifting focus from the individual and family to environmental risks, promoting earlier support in harmful situations with effective responses. We have delivered initial awareness training sessions, with participants feeling more informed and having a better understanding of the approach. Since introducing contextual safeguarding, professionals, especially in police, social work, and education, have begun to view environments as sources of risk, fostering a more collaborative approach to addressing concerns. Several multi- agency discussions, led to active mapping of environmental risk and exploration of ways to reduce or disrupt those risks. Benchmarking has helped production of a draft partnership procedure. Scottish Child Interview Model (SCIM) SCIM focuses on gathering information sensitively from children in investigations, while prioritising their wellbeing. Child-centred, trauma-informed approaches, ensure children feel heard, validated, and secure. Interviewers are trained to build rapport, use age-appropriate communication, and employ supportive techniques. SCIM is fully implemented with regular reports via the national SCIM quality assurance and data framework. Between 1 April 2024 and 31 March 2025, 101 joint investigative interviews were held in Moray all conducted by the SCIM team with disclosures made by children in 89% of the interviews. Feedback is sought from children, where appropriate, for SCIM evaluation, from 1 April to 30 September 2024, the views of 14 younger children, up to 12yrs, and 17 older children, 13yrs and over, were gathered across the North East SCIM Team (Aberdeen City, Moray, and Aberdeenshire). Table 2 below provides important feedback themes from children involved (figures have not been broken down by authority due to low numbers for preservation of confidentiality) as follows: Table 2: SCIM Feedback from April to September 2024 SCIM Feedback: 1 April to 30 September 2024 Children 13 yrs and over Children 12 yrs & under ➢ 100% stated interviewers worked together with them ➢ 100% felt they had a choice with the interviewers ➢ 100% felt safe with the interviewers ➢ 100% felt they could trust what the interviewers said to them ➢ 100% felt the interviewers helped them to tell their story ➢ 72% were happy with how the interview process was explained, 21% were ok with the explanation ➢ 79% felt happy about speaking with the interviewers with the remaining 21% feeling ok ➢ 100% felt safe or happy in the room ➢ 100% would speak to the interviewers again Page 134
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Page 12 of 32 ➢ 94% said they would be happy to talk to the interviewers again if needed Moray Bairns’ Hoose Partnership The successful application for 2025/26 Bairns’ Hoose Development funding was completed, February 2025, in collaboration with Police, Health, Social Work and Quarriers our commissioned children’s rights service provider. The application builds on learning from pathfinder sites and includes a test of change to align with Aberdeen City and Aberdeenshire project plans in 2025/26. The main project, awarded through the fund, focuses on establishing governance arrangements, conducting self-assessment against the Bairns’ Hoose Standards, and agreeing a long-term vision and delivery. It includes the installation of new fixed site Visual Recorded Interview (VRI) equipment for the Joint Child Protection Unit and a mobile VRI unit for joint investigative interviews offsite. To support service delivery, the application includes resources to supervise the existing SCIM team and enable coordination of trauma responsive plans for children to support their journey through the care, protection, and justice system. Moray also applied for 2025/26 Bairns’ Hoose Test of Change funding in February 2025 to include a Health Coordinator post and specialist Speech and Language service provision. Based on learning from other pathfinder sites, proposals were initially developed by NHS Grampian for Aberdeen City and Aberdeenshire. The successful Moray application will enable alignment and consistency for the SCIM team in all three authority areas and ensure equity of healthcare coordination and specialist SLT service provision for children and young people in Moray. Adults Localities Social Work Services East and West Community Care Teams support older people and those with physical and sensory disabilities. The teams provide longer term support including Adult Support and Protection (ASP) where a person is already known. They have a duty system for responding to people known to them in crisis, helping stabilise their situation, often related to ASP. They undertake care reviews to deliver outcomes and required changes in support are implemented. The Access Care Team receives referrals for people not already know to a social work team, including ASP, Police Concern Reports, NHS Public Protection Referrals, Scottish Ambulance Service, Scottish Fire and Rescue Service and the public. It filters referrals to the Care Teams who undertake inquiries, supporting people requiring short term support, perhaps in crisis. The Hospital Discharge Team supports people who require return home from hospital or a homely setting of their choice supported by social work services. The team supports ASP issues surfaced when people are in hospital. They consider community resources to support people home therefore, not relying solely on commissioned services. Housing Support (Care at Home) Page 135
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Page 13 of 32 Moray has two “care at home” housing support services for adults with complex needs: Barlink House of Multiple Occupation, for four adults with learning disabilities and complex needs, and Woodview, purpose-built accommodation, providing care and support to 15 adults and one younger adult with complex needs, learning disabilities and autism. Staff also support people in their own tenancies in Elgin, Lossiemouth, Buckie and Burghead. The Care Inspectorate reviewed Woodview in October 2024 as outlined in Table 3 below: Table 3: Care Inspection Grades from October 2024 Service Completed Areas inspected Grades Woodview Housing Support 24-10-24 How well do we support people’s wellbeing? How good is our staff team? 5 - very good 4 - good Care at Home Provides personal care for people to live independently in their homes. It operates in an increasingly challenging environment, with high demand, a complex mix of needs, and recruitment pressures. Self-Directed Support (SDS) remains at the centre of how support is delivered, ensuring people have real choice and control over their care. In Moray, option 3 services were delivered by the in-house Care at Home team and by our partner provider, Care Quality Scotland (CQS). Weekly monitoring of unmet need continued to help us plan and prioritise, while the Strategic Care at Home Steering Group and Care at Home Review focused on sustainability, improvement, and closer alignment with the reablement pathway and setting up a Framework, supported by Scotland Excel. Table 4 below shows the service positions from February 2024 to February 2025: Table 4: Service Position February 2024 to February 2025 Provider Planned Weekly Hours Feb 2024 Planned Weekly Hours Feb 2025 Change % Internal Care at Home 3,871 3,819 −52 −1.3% Partner Provider 881 693 −188 −21.3% Total 4,752 4,512 −240 −5.1% Internal delivery remained broadly stable, supported by sustained recruitment and a stronger focus on retention. Partner provider hours reduced further due to staffing and operational pressures, but this continued to be closely monitored through weekly Care at Home Hub meetings. Quality and Improvement There was no Care Inspectorate inspection during 2024/25. To maintain the standards achieved previously, Area Managers carried out an internal review against the four Care Inspectorate themes: • How well we support people’s wellbeing • The quality of leadership • The strength of our staff team • How well care and support are planned Page 136
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Page 14 of 32 This process led to improvements in care planning, induction evaluation, staff engagement, and resilience support. A new Wellbeing and Resilience Training course was introduced to help staff reflect on their own resilience, understand how it impacts their work, and build confidence in supporting individuals with traumatic behaviour. The supervision template was updated to ensure wellbeing discussions form a routine part of supervision. Behaviour Support Training was replaced with a more relevant course, Challenging Situations and Lone Working, focusing on de-escalation, empathy, communication, and safety when working alone. Proportionate Care (training and use of equipment) was explored allowing more tasks to be completed safely by a single carer, helping more efficient scheduling and care more person-centred care. Performance Weekly Care at Home Hub meetings and daily hospital discharge huddles continue to provide oversight of capacity, help manage risk, and support timely discharge from hospital. Internal services have worked closely with the external partner to stabilise provision and increase capacity where possible. Unmet need represents hours of assessed care not yet provided due to capacity limitations. Overall, unmet hours have fallen from peaks of 1,700 hours per week in mid-2023 to 1,200 hours by early 2025. This reflects improvements in workforce stability, better co-ordination through the Care at Home Hub, and more targeted deployment of resources. Summary • Internal delivery remained steady despite ongoing system pressures • Retention improved • Partner capacity reduced but continued to be closely managed • Quality assurance and staff wellbeing remained key priorities Community Learning Disability Moray Council continues to make significant progress in delivering housing solutions for people with learning disabilities, aligned with the Strategic Housing Investment Plan (SHIP) 2025/26–2029/30. The Council has prioritised the development of specialist housing, including supported accommodation tailored to the needs of people with learning disabilities, as part of its broader commitment to inclusive and sustainable communities. In 2024/25, new learning disabilities housing developments have been advanced in partnership with HSCM, with a focus on community-based living and reducing reliance on OOA care and accommodation. These projects are designed to support individuals to live independently or with tailored support, close to family and social networks. The SHIP outlines a five-year investment programme, with dedicated funding streams from the Scottish Government and local resources to support delivery. Key achievements include: • Completion of new supported living accommodation in Elgin, designed for accessibility and person-centred care Page 137
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Page 15 of 32 • A reduction in the number of individuals with learning disabilities placed in OOA accommodation, reflecting successful transitions back into Moray-based housing • Increased collaboration between housing, social work, and health teams ensuring effective oversight and planning • Integration of learning disabilities housing priorities into the Local Housing Strategy 2025–2030, with a focus on specialist provision, energy efficiency, and long-term sustainability These developments reflect commitment to delivering high-quality, inclusive housing supporting independence, wellbeing, and community connection for people with learning disabilities. Over the past year, significant progress has been made on the new Western Village housing development bringing the total number of learning disability support accommodation services in Moray to 21. Phase one of the project, comprising four bungalows, is now partially complete. Some people have successfully transitioned into their new homes, with other transitions scheduled to be completed in the coming months of the next reporting period. As part of phase one, the Community Learning Disability Team (CLDT) has worked in close partnership with the on-site care provider, Community Integrated Care, and the Digital Health & Care Innovation Centre (DHI) to embed Technology Enabled Care (TEC) in the service. Western Village is piloting the Arcangel system as part of a wider innovation project, aiming to enhance independence and safety through responsive, person-centred technology. This reflects commitment to digital transformation in social care, leveraging cutting-edge tools to personalise support, promote autonomy, and ensure real-time responsiveness to individual need. Phase two, a communal block of 13 flats, is expected to be completed by Spring 2026, with further transitions planned thereafter. Annual Health Checks for Adults with Learning Disabilities Delivery of Annual Health Checks for adults with learning disabilities continued to progress throughout the reporting period. In January 2025, a part-time nurse was appointed to lead this work, funded through government monies ringfenced for this purpose. Standard operating procedures and easy-read information have been developed to support understanding and encourage uptake among individuals. Working in partnership with administrative staff, the nurse liaised closely with GP practices to coordinate and deliver health check clinics within individuals registered surgeries, ensuring accessibility and continuity of care. Progress updates are routinely shared at local Clinical Care Governance meetings, and 32 health checks were successfully completed and 13 individuals were offered a health check but chose to decline; follow- up advice was provided, within the timeframe. Due to planning for new services, there has been a slow start; however, full implementation is expected in the coming months. Anticipated outcomes include improved health monitoring and early intervention, bringing excellent benefits for the people we support. Annual Health Checks are a key component in reducing health inequalities and ensuring equitable access to preventative care for adults with learning disabilities. Data Page 138
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Page 16 of 32 gathered from these checks will inform future service planning and help shape targeted interventions to meet the evolving health needs of this population. Commissioning and Tendering Early in the next reporting period, two care contracts will be issued for tender: the Western Village and Greyfriars Close service. A key priority has been to strengthen the involvement of people and their families in decision-making. In line with best practice, co-production and inclusive procurement, individuals and their families were actively involved in evaluating service presentations and shaping the outcome. In September 2024 as part of the re-tendering process for an existing service, and in January 2025, as part of tendering for a new service, supported people and their families were invited to be part of the respective evaluation panel. Engagement was strong, with many family members involved in the tender processes. Feedback from participants was overwhelmingly positive, highlighting the value of inclusive commissioning practices and the importance of embedding lived experience into service design and selection. We shall develop this further with continued and greater representation of people receiving services in the future. Dynamic Support Register Moray Dynamic Support Register (DSR) is a proactive tool to identify and support people with complex needs who do not meet Adult Support and Protection (ASP) criteria but are at risk of support arrangements breaking down, hospital admission, or inappropriate OOA care. It enables early support and helps coordination of planning across agencies. The DSR has been embedded as a core process in the CLDT, with regular oversight through Resource Allocation Meetings (RMG), the CCGG and the Learning Disability Clinical and Care Group (LDCCG). This has led to more effective risk management and person-centered planning, reflecting Moray’s commitment to trauma-informed practice, defensible decision-making, and collaborative care. The register supports strategic commissioning and service improvement, ensuring individuals receive the right support at the right time. Between January and March 2025, a comprehensive review of the DSR procedure was undertaken, resulting in the development of a Moray-specific operational protocol. Work was informed by staff consultation across the Integrated Team and insights from the National DSR Peer Network. The DSR continues to be a vital tool in identifying and supporting individuals at risk of hospital admission OOA care. During this reporting period we have: • Supported people to return to Moray from OOA • Facilitated discharge of individuals from learning disability hospitals with enhanced monitoring to prevent readmission • Enabled people to achieve stability and positive outcomes while remaining in their communities Page 139
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Page 17 of 32 Currently, the number of individuals actively supported through the DSR is low, testament to the achievements of the multi-disciplinary teams. Numbers should continue to be reduced as we progress the housing projects noted above. Budget Pressures and Efficiencies In response to ongoing financial pressures, we have worked collaboratively with commissioning colleagues and service providers to identify efficiencies and reduce costs where possible. Efforts are carefully balanced to minimise any adverse impact on people, ensuring quality of care remains a priority. Transformation includes: • Reviewing day services contracts • Increasing block contracts for clearer forecasting of expenses and payments • Increased expectations on day service providers to deliver more within constrained budgets As part of our review process, people have experienced reductions in care hours; implemented strategically benefiting from economies of scale in care and day service provision. Looking ahead, we will be exploring further changes in day service and transport provision, as well as overnight care models, to ensure sustainability and continued support for those with learning disabilities. Guardianship and Appointees Social workers in the CLDT act as delegated Welfare Guardian on behalf of the CSWO for 24 individuals, with a further 9 applications in progress, not counting renewals between 1 April 2024 and 31 March 2025. This represents a 22% increase of cases in progress from the previous year 2023/24, reflecting growing demand and complexity which has impacted the capacity available, as per below, for other statutory duties, such as care and guardianship reviews. The team serves as Department of Works and Pensions appointees for 28 people, who lack capacity to manage their finances with no alternative support, ensuring financial safeguarding for them. Short breaks Provision Unpaid carers in a learning disability context continue to play a vital and irreplaceable role in supporting people with learning disabilities. In recognition of their contribution, we remain firmly committed to upholding carers’ rights and ensuring they receive the necessary support to sustain their caring role. In 2024/25, our commissioned learning disability residential short breaks service delivered (estimated unpaid carers/known to service 401): • 712 nights of planned breaks • 238 nights of emergency breaks Individual carers also accessed a range of alternative short breaks through Self- Directed Support (Options 1 and 2), including support provided within the family home. Social Work Audit Process and Tool Page 140
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Page 18 of 32 In the next reporting period there are plans for a new audit process tool and calendar which will support people receiving services and their families to provide direct feedback to the audit team on their experience of social work involvement. Appropriate Adult Service Moray Council’s Appropriate Adult Service has transformed into its statutory requirement with no change in the model of delivery. There are 28 Appropriate Adults practicing who are social workers, day center officers, or support workers employed throughout the social work service, including the three Out of Hours social workers. The service is managed by the Access Care Team, the point of referral, with an On-call Rota, for office hours with out-of-hour social workers available. The service is supported by a Consultant Practitioner in the Adult Protection Team with governance by the Practice Governance Board. A working partnership with Aberdeen City and Aberdeenshire has been a highlight of this reporting year with the Grampian network firmly established benefiting Moray given our size and capacity. Developments can be undertaken jointly to mutual benefit by shared resources and learning and development opportunities. This year there has been a recruitment focus and refreshed joint training with the Grampian network. Consequently, having trained 22 new Appropriate Adults, we significantly increased the pool on the rota. We established an Appropriate Adult Forum with the Grampian network to support learning and improve retention. Quality Assurance The Care Inspectorate required all local authorities to submit core assurances which was helpful in focussing wider than direct day to day service provision. An Improvement plan has been developed with progress being reported to the Practice Governance Board. Improvement work will focus on the following in the coming year: • Feedback from people who received the service • Feedback from Appropriate Adults • Local policy developments from new statutory guidance Provision of an Appropriate Adult Requests in 2024/25 were positively met with 113 requests for 109 people. Most people requiring support were white; male (61) female (42) and transgender (2); most had a learning disability or a learning disability and mental health conditions; 14% had a combination of types of mental disorder. Police procedures prompting requests for an Appropriate Adult were mainly for interviews (not officially accused) or statements from victims or witnesses, which combined, amounted to 46 people, with 26 people subjects of multiple procedures (almost a quarter) which may have included cautions and charges, and a small number for DNA/Fingerprints/photographs and other matters. Adults with Incapacity Some adults need help making decisions because of a mental health condition or because they cannot communicate their wishes. The Adults with Incapacity (Scotland) Act 2000 protects people in these circumstances. Guardianship arrangements can be Page 141
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Page 19 of 32 sought allowing another person to make decisions on behalf of an adult with incapacity ensuring their welfare and financial matters are managed. In 2023/24 Guardianship referrals decreased to 62 after a 3-year trend of increasing rates, a decrease of 27%. In 2024/25 requests numbered 61 including 38 Private applications and 23 referrals for Local Authority Applications. In 2025 there are 284 existing private welfare guardianships in Moray, 71% (170) of which sit within the category of Learning Disability. Pie Chart 1 below shows Private Welfare Guardianship categories: Pie Chart 1: Private Welfare Guardianships by Category There are 45 CSWO welfare guardianships in existence, each overseen by a delegated guardian with 56% (25) managed in the Learning Disability Service. Pie Chart 2 below shows the categories of Local Authority Welfare Guardianship: Pie Chart 2: Local Authority Welfare Guardianship Categories Number of Private Welfare Guardianships by category Learning Disability 16-17year olds community care Mental Health Number of Local Authority Welfare Guardianships by category Learning Disability 16-17 year olds Community Care Mental Health Substance Misuse Page 142
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Page 20 of 32 In 2025 a change in policy was agreed at Practice Governance Board to cease or vary S10 supervision as per regulations (2014). Previous policy had been to strive for best practice and to supervise all welfare guardians on a yearly basis, which has been unachievable. The policy change, new process, and S10 guidance, allows prioritisation of guardians requiring more frequent supervision ensuring best practice prevails. Mental Health Orders Are governed by the Mental Health (Care and Treatment) (Scotland) Act 2003, which provides the framework for compulsory treatment and the rights of individuals with men tal health conditions. Table 4 below shows the range of mental health orders and the trend in Moray from 2021/22 to 2024/25: Table 4: Mental Health Orders Trend from 2021/22 to 2024/25 Mental Health Order 2021/22 2022/23 2023/24 2024/25 Emergency Detention Certificates (Numbers of EDCs in brackets show no MHO consent) 17(8) 23(10) 21(8) 14(11) Short Term Detention Certificates (STDC) 66 60 85 74 Compulsory Treatment Orders (CTO) 18 11 26 28 Compulsion Orders (CO) 2 1 0 0 There was an upward trend in STDCs in 2023/24 and a decrease in 2024/25, still higher than previous years. Positively, there was a decrease in EDCs, given best practice for a more planned approach when using compulsion in emergencies. There continues to be an increase in CTOs from which it is not possible to draw definitive conclusions given annual fluctuations and the small numbers involved. Data collection and reporting are improvement areas in collaboration with partners to address areas where a deeper dive is required. Audit, Quality Assurance and Improvement Activities The gateway to mental health compulsory treatment is expected to be through Short Term Detention Certificates rather than Emergency Detention Certificates. In 2024/25 there were 14 EDCs, 11 with no MHO consent. For 6 of those without consent, there was opportunity to have involved an MHO in the assessment. The EDCs were all out-of- hours, and two Moray-based individuals were assessed at Aberdeen Royal Infirmary. Grampian wide collaborative work was undertaken to reduce EDCs without MHO consent, outlined in Improvement Area 1 below: Improvement Area 1: MHO Developments • Updated mandatory training including guidance on the role of MHOs • Revised Guidance for GPs • Mental Health Act Status alerts now used consistently across all sites • Det1 forms now routinely shared with relevant Local Authorities by the Records Department • Recording systems better utilised in Aberdeen City to record EDCs without MHO consultation, supported by updated staff guidance Page 143
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Page 21 of 32 To support improvement and practice development the MHO workforce is planning a peer audit of Adults with Incapacity reports in the next reporting period. This will support consistency, maintain best practice, and contribute evidence to continued MHO professional case discussions. Since 2023/24 an MHO Service Improvement Plan has been in place to focus activity, define, and capture progress. To date, a range of positive actions have been achieved as outlined in Improvement Area 2 below: Improvement Area 2: MHO Improvement Plan Outcomes • An improved standard template for SCRs • A successful MHO Development Day • Advent of MHO Peer Groups now meeting regularly to discuss practice issues • Improved Mental Health Act performance data • Improved AWI case recording utilising innovative recording systems • Agreed governance arrangements for MHO service through Practice Governance Board • Revision of the MHO delivery model freeing up capacity • Work to increase the number of statutory reports for Relevant Events and reduce the number of “missing” reports • Implementation of policy and guidance for S10 supervision Self-directed Support SDS allows individuals maximum choice and control over how their support is planned and provided within a legal framework. There are four main options: • Option 1 - Direct Payment - the individual receives money from the local authority to arrange and pay for their own support, being in control of how the budget is spent • Option 2 - the individual chooses the support they want to meet their outcomes, and the local authority manages the budget on their behalf, offering flexibility without their need to manage the funds directly • Option 3 - the local authority arranges the support and services on behalf of the individual, suitable for individuals preferring not to manage their own care arrangements • Option 4 - the individual combines any of the options above to meet their care and support needs Option 1: Direct Payments Approximately 270 people have chosen this option, with many employing one or more of the 480 Personal Assistants (PAs) working in adult and children services. This regularly means being supported by someone they know and trust, fitting their routines and preferences, in a range of social, care, and practical areas of need. Others utilise Direct Payment in flexible ways to support independence and wellbeing by purchasing equipment, commissioning care from providers, arranging befriending support, or funding activities which help them stay active and included in community life. We are working closely with the National PA Programme Board to strengthen the role of PAs and ensure they feel supported and valued. Involvement in subgroups focus on wellbeing, recruitment, and training, as well as updating the PA Handbook and preparing for new PVG guidance, April 2025. Aims are to create the right conditions for Page 144
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Page 22 of 32 PAs to thrive, so the people they support continue to benefit from consistent, high- quality relationships. Option 2 & 3 We are developing a Community Asset Flexible Framework to make it easier for people to access a wide range of local supports and services. By embedding the National SDS Standards, this approach aims to expand the options available in Moray and give people even greater choice and control in how they shape their care. Day Opportunities Work of the Day Opportunities Team continues to complement SDS by working alongside individuals, families, and unpaid carers through a strength- and asset-based approach. Focus is on helping people to reconnect with their communities, build on existing strengths, and access more formal supports. The team supports the provision of regular short breaks for unpaid carers, recognising their crucial role and the importance of sustaining their own wellbeing. Unpaid Carers Play a vital role across Moray, providing essential day-to-day care and support to family members, friends, and neighbours. Their contribution enables people to remain at home, prevent avoidable hospital admissions, the cornerstone of the local health and social care system. We remain committed to ensuring carers are recognised, valued, and supported, with timely access to appropriate support in line with the priorities set out in Moray’s Carer Strategy 2023–2026. As of 31 March 2025, the commissioned carer support service, Quarriers, had a total of 1,188 adult carers and 198 young carers registered. During the reporting period of January to March 2025, they received 84 referrals for adult carers, including 58 new registrations. In the same period, 118 young carers were referred, with 45 newly registered for support. Throughout 2024/25, we have continued to work collaboratively with carers, families, and community organisations to enhance support in alignment with the Carers (Scotland) Act 2016 and our local strategy. Key developments include: • Revision of the Adult Carer Support Plan (ACSP): Work is underway to redesign the ACSP to adopt a more holistic, relationship-based, conversational approach, moving away from a perceived “tick-box” format, to better reflect carers’ lived experiences • Amendment to the Commissioned Carer Support Contract: Following comprehensive evaluation, the contract with Quarriers was amended in January 2025. HSCM now holds responsibility for the completion of ACSPs and Young Carer Statements (YCS), enabling more timely and parallel support. Resultantly carers feel more recognised, valued, and supported. • Awareness Raising Initiatives: The Unpaid Carers Team has partnered with Elgin Health Centre to improve identification and support of unpaid carers. This included staff training, revised recording practices, and increased visibility of available supports. Work has commenced on developing a distinct Carer Aware branding campaign to raise awareness of unpaid carers across Moray. Short Breaks for Unpaid Carers Page 145
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Page 23 of 32 A total of 126 unpaid carers (109 adults, including 49 parent carers; and a further 17 young carers) were supported to access a short break through the Time to Live awards administered by Shared Care Scotland, funded through the Scottish Government. Other short breaks included: • 7 adult carers and 1 young carer enjoying “Respitality Breaks” supported by Shared Care Scotland • 50 unpaid carers accessing sound bath sessions supporting their wellbeing • 34 unpaid carers accessing therapy sessions at a minimal fee • 12 young carers enjoying a Hopscotch funded residential break with the William Grant Foundation funding meals and extra clothing requirements, and Quarriers Children’s Fund paying for rucksacks, and Moray Council contract funding staff and volunteers • 5 young carers attending the Scottish Young Carer’s Festival • 22 young carers enjoying activities enabling a break from their caring role funded by donations • 12 young cares enjoyed a trip to the pantomime in December 2024 • 9 young carers attended the Carers Trust Young Carer Action Day consisting of a 3- day art workshop Adult Support and Protection Data and Performance In 2024/25 the ASP Data and Performance Subgroup, led by Social Work Services, including colleagues from across the ASP partnership, had oversight of data. Focus was on embedding robust recording systems to ensure the mandatory ASP National Data Set requirement. Quarterly data analysis is undertaken for reporting to the Adult Protection Committee (APC) which agrees exploratory and analytical work as required. The Subgroup has oversight of quality assurance activity including single agency scrutiny, referral audits, ‘screening’ activities, and multi-agency audits of Initial Referral Discussions (IRDs) and ASP Conferences. The Access Care Team, single point of contact for all ASP referrals, received 971 referrals in 2024/25, a 5% increase from 2023/24. Due to improvement work, there has been an increase in referrals from 2021/22 to the current reporting year. With the advent of the National Data Set we have compared data with other local authorities, however, nationally there are some differences in how the data is collated locally within ASP partnerships. The ASP upward referral trend is shown in graph 4 below: Graph 4: ASP Referrals trend from 2021/22 to 2024/25 Page 146
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Page 24 of 32 Referral and inquiry rates have increased in this reporting period, with a decrease in Case Conferences and Reviews as adults are not subject to ASP processes for longer than they need to be. IRDs are fully embedded in practice as sighted as a national exemplar in our Care Inspectorate ASP Progress Review. Published on 29 October 2024, the review evidenced substantial improvement in supporting and protecting adults at risk of harm. Our improved performance has resulted in clear protection planning and risk reduction to support adults, diverting them from formal ASP process, showing our work supports the least restrictive principle. The ASP activity percentage changes, plus or minus, over the last two years are shown in Table 5 below: Table 5: ASP activity from 2023/24 to 2024/25 Adult Suport and Protection 2023/24 2024/25 Percentage Change % ASP Referrals 923 971 Plus 5% ASP Intial Referral Discussions 127 148 Plus 14% ASP Investigations 70 74 Plus 5% ASP Case Conferences 38 33 Minus 13% ASP Case Conference Reviews 69 67 Minus 3% Quality Assurance, Self Evaluation and Improvement Activity To support ASP investigatory processes our Grampian partnership, introduced a Capacity Pathway for Protection Based Decisions. This was fully supported by the Moray Adult Protection Committee with the work integrated into the ASP multi-agency improvement plan. It provides clarity of practice for those requesting capacity assessment and those completing them, alongside the established Grampian Decision Specific Capacity Screening Tool, fully refreshed and reviewed in June 2024. Implementation has included ‘on demand’ video briefings, and changes to core ASP training for partners. We introduced a Multi-Agency Chronology Template for investigative processes, a catalyst for further improvement activity of chronologies, as outlined in Improvement Area 3 below: 0 20 40 60 80 100 120 April May June July August Sep Oct Nov Dec Jan Feb March ASP Referrals trend from 2021 to 2025 2021/22 2022/23 2023/24 2024/25 Page 147
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Page 25 of 32 Improvement Area 3: Chronologies Improvement Activity • Cross-referencing chronologies in Investigative documentation templates – further setting out the clear expectation chronologies are a core component of ASP practice • Formalising discussion on chronologies in ASP Case Conference agendas – setting expectation in our systems that chronologies are standard practice • New practice where completed chronologies are updated/refreshed as part of our ‘core group’ meetings. This ensures that chronologies are a dynamic and live document through the life of an adult at risk’s ASP journey. • Specific learning sessions held as part of the ASP Forum calendar of events – supporting staff to effectively complete chronologies. Moray ASP Lead Officer is chair of the National Chronologies Group. As national work in this area comes ‘on stream’, Moray is well-equipped to integrate these developments into local practice. Significant work was undertaken to improve the consistency and quality of our risk assessments in ASP practice as detailed in Improvement Area 4 below: Improvement Area 4: Risk Assessment Improvement Activity • Integration of risk identification and control measures in the body of our investigatory paperwork • Completion of a multi-agency risk assessment formally discussed and then finalised in the ASP Case Conference • Risk assessment reviews in Case Conference Reviews, and ‘between’ such formal meetings, via ‘core group’ arrangements • Introduction of (as part of Grampian wide work) a Multiagency Risk Assessment Training Workshop. This popular and well evaluated course allows police, health and social work staff to learn and share risk assessment practice collaboratively. We have created a clear, accessible protection and action plan for adults deliberately written in accessible language. As outlined in Improvement Area 5 below, Protection Plans within Moray are now: Improvement Area 5: Protection Plans Improvement Activity • Fully discussed and agreed at ASP Case Conferences multiagency wise • Discussed and agreed with the adult at risk • Updated regularly in ‘core groups’ so they remain relevant and up to date These improvements have also been seen and experienced by our practitioners and the people we support. During consultation we received very positive feedback from parents and Council Officers. Moreover, the Progress Review found Moray had made significant progress in all seven areas recommended in the 2022 joint inspection. Key findings included: • Consistent application and delivery of key processes. Practitioners were noted to be confident and highly professional and followed the multi-agency adult support and protection procedures meticulously Page 148
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Page 26 of 32 • Investigations were carried out for all adults at risk who required them. Almost all Investigations were rated good or better (85%) • Adults at risk of harm had in place a Chronology. 80% of Chronologies were rated good or better, which is a significant improvement from 39% in 2022 • The Quality of Risk Assessments and Protection Plans had improvement significantly • Case Conferences were found to be carried out effectively. The right people from partner agencies prioritised attendance. Almost all Case Conferences were rated good or better for quality • Initial Referral Discussions (IRDs) were found to be of an exemplar for the sector • The Adult Protection Committee (APC) and Chief Officers Group (COG) exercised sound and effective multi-agency governance over the delivery of improvements to adult support and protection • The partnership had a cohesive programme of multi-agency audits and quality assurance activities. These included involvement from front line practitioners. The Progress Review highlighted areas of further improvement with progress noted in our ASP multiagency improvement plan. Moray’s Interagency Vulnerable Adults Process (MIVA) initiated in 2022, has been implemented. MIVA is a supportive, collaborative framework involving adults in a person-centred process. Resultantly there has been a significant decrease in Police Concern Reports for adults involved, which features in collaborative Workstream 4 led by the Joint Care Inspection Team. Following expression of interest, we were invited to undertake a piece of supported self-evaluation using the ASP Quality Indicator Framework S5.7: “Effective support & early intervention for adults with escalating risks for whom a straightforward application of the three-point criteria is difficult to apply” In 2024 a new Quality Assurance Audit Tool: the Adult’s Journey, was developed for better analysis of data over the entire ASP process helping the reviewer consider the adult’s whole experience. The Consultant Practitioner Team is testing the tool in practice to make further improvements from ‘live’ feedback and practical usage. Learning and Development in ASP We have refreshed the Council Officer training across Grampian with revised codes of practice in the training calendar delivering various training initiatives internally and externally including Eventbrite for participants all supporting improvement work. Feedback has been positive e.g. our Self-Neglect and Hoarding session led to a Short Life Working Group to produce practitioner guidance. The new Moray ASP Learning and Development Subgroup progresses multiagency learning needs, the ASP forum meet 6-weekly, re collaborative practice, training and awareness raising activities. ASP Referrals We have experienced a significant increase in the volume of ASP referrals and across Grampian, developed a ‘Response to the Increase in ASP Reporting’, to manage the increase. This led to a full refresh of the Multiagency Thresholds Guidance, approved by the APC in June 2024, supporting practitioner’s judgements on what type and nature of Page 149
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Page 27 of 32 incidents should be subject to ASP reporting including guidance on actions to support vulnerable adults and reduce risk. Anti-racism We have been working closely with the police to support communities when introducing New Scots who have been well received, and many have been embraced by our care experience community. Any specific issues of racism affecting children and adults would be addressed in their support and care arrangements. There have been two minor incidents of racial behaviour in 4 years regarding our New Scots which happened in school. Through work with the respective schools, matters were addressed directly with the young people who made the comments, their parents were made aware, and such behaviour was robustly challenged in the school assembly. Community Justice Justice Services Deliver services, including statutory Justice Social Work functions for support and supervision of people who have committed offences and are involved in the Court or prison system. The governance of Justice Social Work in Scotland is a multi-layered system involving local and national bodies. Locally the Community Justice Partnership co-ordinates a plan to reduce reoffending in which the local authority plays a key role in delivering. Moray’s Community Justice Outcome Improvement Plan (CJOIP) 2024-2029 was launched in 2025 with attendance and presentations by people with justice system lived experience. Nationally, Community Justice Scotland is the leadership body which oversees local performance, reports can be accessed by the public alongside Moray’s annual report which is published locally. Relationships between Justice Social Work and the local Sheriff Court continue to be strong with good communication and regular meetings to identify and resolve issues. A Court pack is in development to provide an overview of the services provided by the local team and local updates. This will be available electronically on the Moray Protects website Moray-Court Information Pack in the next reporting period. In many cases prior to sentencing, the Courts will request a Justice Social Work Report to assess risk, identify interventions required and detail potential disposals. In 2024/25 there was a slight increase of 7% in the number of reports being requested. Of these reports there were 634 Community Payback Orders (CPO) imposed which is a 12% increase from 561 in 2023/24. In 2024/25 there were 10 Drug Treatment Testing Orders (DTTO) imposed, more than double the year prior. There is close working links between Moray Integrated Drug and Alcohol Team and Arrows, a third sector support service, to provide comprehensive support to individuals subject to a DTTO. The unpaid work service currently runs six days per week, with an increasing demand noted over this year for Saturdays. In addition to group work provision there has been a drive to increase the individual placement availability and at the end of March 2025 there were opportunities available in 9 third sector and charity agencies across Moray. Page 150
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Page 28 of 32 A female only group has been further developed which supported individuals to identify and reach specific goals during their time on unpaid work as well as benefit local communities. We continue to work in partnership with Moray Food Plus in growing and distributing produce from our polytunnel site with the space used for group activities outside the winter months. There are two group opportunities for individuals in the service, the Women’s (RISE) and Men’s (SWITCH) groups. These are community justice-focused, trauma informed, and person-centred to effectively address individual needs while promoting rehabilitation and enhancing community safety. This approach benefits participants by creating trust, reducing reoffending and supporting long-term positive change. Participation is voluntary and is available to people at any stage of their journey within the justice service. It involves a range of community partners to enhance the support available out with the justice system. There has been an increase in work undertaken on bail supervision which created higher workloads. In 2024/25 there were 218 bail assessment suitability reports completed which converted into 56 bail supervision requirements being imposed. This is a significant increase from 2023/24 where 128 assessments were completed, and 29 bail supervision requirements were imposed. Reflective engagement with the local Court and Procurator Fiscal is aimed to improve early identification of assessments being required to allow the Court to be advised of key information in a timely manner. Work will be developed in the next reporting period. Service improvements have included developing partnership approaches to support women and men in the Justice system. A pilot funded with third sector ring fenced funding, involved direct access to counselling via referrals from the Justice Social Work team to Crossreach Counselling. Evaluation was completed with agreement for three further counselling blocks where up to 5 individuals can be referred at a time. For men who commit sexual offences, we can deliver the Moving Forward to Change programme. During 2024/25 the number of individuals subject to Multi Agency Public Protection Arrangements (MAPPA) has remained consistent with the previous year with Justice Social work being lead agency for approximately 25%. There have been no under 18’s subject to MAPPA, with most individuals being aged 31-40. Together with our neighbouring local authorities there has been attention paid to the over 70 age range linking with adult services to ensure safe and appropriate arrangements of care and support when required. The team has undertaken the screening and essential training for the delivery of the Caledonian System. Specific training for the women’s social worker and children’s social worker is due to run later in the next reporting period given recruitment to these posts was successful. Youth Justice The team supports 16 and 17 year-olds, for diversion from prosecution, those appearing in Court and remanded or sentenced to secure care. Staff assess and Page 151
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Page 29 of 32 support families where the child has, or is at risk of, coming into conflict with the law. In the early part of the reporting period, we had had one young person in secure care provision, as a direct alternative to prison, and we now have no one in secure provision. The Youth Justice team has undertaken new and refresher training during 2024/25 for the START:AV and AIMs-3 assessment models. In addition to this they continue to work closely with the Children and Young People Centre for Justice (CYCJ) and have benefited from an in-person team development session aimed at identifying strengths and areas of improvement, taking into consideration the content of the Children’s Care and Justice Bill. During 2024/25 an average of 30% of young people in Youth Justice were identified as care experienced. There remains a continued commitment to reducing this number through early intervention and partnership working. Close links are in place with and between our local children’s houses and the Social, Emotion and Behavioural Needs Service provided by education. There have been 52 children and young people referred to the Scottish Children’s Reporter Administration (SCRA) during 2024/25 on offence grounds, a slight reduction from 2023/24. 17% of those were females showing it continues to be young males who require the highest level of support in respect of conflicting with the law. The most common offence reported over 2024/25 continues to be vandalism, followed by assault and theft by shoplifting. 3. Resources Financial Resources Year 2024/25: Adult Social Work and Social Care = total: £67.6M Children and Families (inc. Youth Justice) Social Work = total: £17.134M Justice Services Social Work = total: £1.435M (Justice social work services are funded through Scottish Government ring-fenced grant in line with Section 27 of the Social Work (Scotland) Act 1968, as amended). Whole Family Wellbeing Fund for children’s services community planning partnership = total: £524 for 2024/25 and £619K which has increased for financial year 2025/26. The number of families supported by social work services are contained in Table 6 below: Table 6: Open Cases Open Cases as at 31 March 2025 Team Caseloads Children’s Access Team 114 Children and Families West Team 201 Children and Families East Team 102 Youth Justice 43 Throughcare and Aftercare 69 Children’s Disability Team 80 Justice Services 496 Access Community Care Team 98 Community Care Team East 662 Page 152
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Page 30 of 32 Community Care Team West 1049 Hospital Discharge Team 120 Community Learning Disability Team 419 Mental Health Team 288 TOTAL 3741 4. Workforce There is a national shortage of qualified social workers in Scotland impacting service delivery in Moray with vacancies in Localities Social Work, notably in Children & Families. Social Care staff are also in demand with statutory, private and third sector providers in Scotland reporting significant recruitment issues. Number of operational social work posts: Adult Services: 45.29 Whole Time Equivalent (WTE) Children and Families: 63.33 WTE Justice: 13.4 WTE Out of Hours: 2.75 WTE In 2024, Moray Council launched a new Social Worker in Training (SWiT) Scheme with MHSC and Robert Gordon’s University, to “grow our own” by converting vacant social worker posts into fully funded training opportunities. Successful candidates receive Grade 7 salary, and full university fees, while completing their Honours Degree by distance learning. This year, 2024/25, we have successfully recruited six SWiT into previously hard-to-fill vacancies. Supporting Newly Qualified Social Workers (NQSW) Definitions of employer support is mandatory, to create a framework from qualifying education to advanced practice for all social workers and social work employers in Scotland. The Supported Year provides an infrastructure for social worker employer support from education to work. Work is advanced for structured support early in the next reporting period. During 2024/25, training sessions and workshops on the 4x4x4 supervision model were delivered to all adult social work teams, adult day services, social care teams and the occupational therapy team. A total of 168 practitioners undertook the training with surveys showing the model is generally well understood and valued. In Scotland there are challenges in growing the Mental Health Officer (MHO) workforce to meet demand. There are 15.3 WTE practising MHOs in Moray (only 1 WTE MHO has a dedicated post). It is approximated for WTE capacity in a week, Moray has 3.06 WTE MHO undertaking dedicated MHO work. Moray will continue to support up to two MHO candidates. It is likely retirement will reduce the workforce soon given the age profile of MHOs, with 7 being over the age of 60. Plans have been developed for a test of change to increase capacity in the next reporting period using underspend on the remaining MHO capacity fund provided by Scottish Government to increase capacity Page 153
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Page 31 of 32 Between April 2024 and March 2025, 50 new staff joined the Care at Home service and 49 staff left. The overall retention rate for the year was 82%, an improvement from 79% the previous year. The reasons for staff leaving are contained below in Graph 5: Graph 5: Reasons for leaving The main reasons for leaving were family or personal circumstances (21), new jobs (14), and retirement (10). Recruitment activity has continued throughout the year, with regular induction programmes held every two months. 5. Looking Ahead Moving into the next reporting year, the external environment will continue to place a strain on resources and increased demand is likely to continue. We know that children growing up in homes where there is poverty, domestic abuse, substance use, or mental health problems, are at a higher risk. When combined with the existing strain on local services (Audit Scotland on IJBs, 2024), the implications for children are significant. The landscape of safeguarding and child protection is changing and although practice is improving in some areas, statutory funding is stretched to keep up with increased demand. There is a national shortage of foster carers, rural care at home provision and complex learning disability living resources, which will continue to impact budget, pressure on staff, individuals and families. Developments detailed above will contribute to a solution. Kinship Care figures have been like those for 2023/24 although we aim to increase this as part of the work to keep children at home with their families. In the movement of kinship carers arriving and departing in 2024/25 by the end of the year, there were larger groups of brother and sisters in kinship care with fewer households, meaning the number of children in Kinship care was only one less than in 2023/24 = 39 compared to 40. In the next reporting period, we shall review our health and social care partnership structure to ensure effective management and structural arrangements, within our resource capacity. To operate in the most efficient manner possible seeking flexibility and agility, in functioning within the current public services landscape. 0 5 10 15 20 25 Family/Personal New Job Retirement Other Dismissal 21 14 10 2 2 Reasons Employees Have Left Care at Home Service 24/25 Page 154
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Page 32 of 32 Our services access arrangements require examination, as part of the above structural review, to ensure services are built around the needs of people as opposed to people being processed around the needs of the structure. Taking account of the importance of relational social work, continuity of service from the outset, early diversion and prevention. Moving into the next year, we are building on the findings of the social work governance national thematic inspection, Care Inspectorate, June 2025. More specifically, the social work and social care governance framework we have introduced across the workforce. We are embedding this work with review to demonstrate the effectiveness of our arrangements. In 2024/2025, the Commissioning Team focused on embedding the improvements identified in the external audit conducted by KPMG in February 2023. The focus was ensuring each contract received consistent scrutiny and follows a standard process, as well as supporting operational staff in better understanding commissioning policies and procedures. The team has also fostered an inclusive culture in commissioning, whereby individuals who will receive services are included on the Tender Panel and are responsible for scoring the presentation element. This supports Moray’s aim of achieving ethical commissioning practices. The Commissioning Team has ensured that 90% of contracts are reviewed, current, and signed. The remaining contracts are undergoing thorough reviews, with decisions being carefully considered to ensure alignment with HSCM’s strategic aims. In the coming year, the Commissioning Team will be developing a Community Asset Framework to enable providers, from sole traders to large service providers, to offer services which meets individual outcomes in more imaginative ways. This initiative supports HSCM’s goal of empowering communities and reducing reliance on traditional services. Functional Family Therapy (FFT) continued to be embedded within the Children and Families services throughout 2024/25, during which 32 referrals were received. It was previously identified that younger children could benefit from the service. As a result, referrals are now accepted for children aged 8 and above, whereas previously the minimum age was 11. The Commissioning Team is actively monitoring families who have completed the programme at regular intervals to assess whether the service is achieving its core aim: supporting families to remain together. Outcomes for families who receive the service are generally positive. However, in some cases, referrals were made when families were already at crisis point, which reduced the effectiveness of the service. The service is currently operating under capacity, with immediate availability for new referrals. Commissioning has noted 12 unplanned exits from the programme, while 20 families have completed the programme successfully. A review of all family support services is underway, with a view to introducing new services from April 2027. Page 155
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: PUBLIC SECTOR CLIMATE CHANGE DUTIES REPORTING SUBMISSION 2024/25 BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To present to the Board the Climate Change Duties Report submission for the reporting year 2024/25, in line with statutory requirements under the Climate Change (Scotland) Act 2009. 2. RECOMMENDATION 2.1 It is recommended that the Board consider and approve the draft Public Sector Climate Change submission to Sustainable Scotland Network (Appendix 1) for the reporting year 2024/25. 3. BACKGROUND 3.1 The Climate Change (Scotland) Act 2009 introduced targets and legislation to reduce Scotland’s emissions by at least 80% by 2025. It subsequently set a target date for net zero emissions of all greenhouse gases by 2045. 3.2 Section 44 of the Act places duties on public bodies relating to climate change and requires them to; ➢ Contribute to the delivery of the Act’s emissions reduction targets ➢ Contribute to climate change adaptation, and ➢ Act sustainably 3.3 Following public consultation and parliamentary scrutiny, a Statutory Order under section 46 of the Act came into force in November 2015. This Order contains a list of public bodies required to annually report on compliance with the climate change duties. These ‘major players’ listed in the Order were expected to submit their reports to the Scottish Government for 1 April 2015, 31 March 2016, 30 November 2016 and annually thereafter. Item 14. Page 157
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3.4 Integration Authorities were required to provide annual reports for the first time in November 2017, and annually thereafter. These annual reports require approval by the Board prior to submission to Sustainable Scotland Network. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The report attached (Appendix 1) requires to be submitted to the Scottish Government by 30 November 2025. 4.2 As Moray Integration Joint Board (MIJB) does not own any property or vehicles, nor develop policies on fuel, procurement, transport, energy, waste, ICT or infrastructure, the content of this report is limited. 4.3 The MIJB and its management primarily influence environmental awareness and policy adherence within the employing organisations, NHS Grampian and Moray Council. The key areas where MIJB can make an impact on climate change and sustainability are: ➢ Ensuring climate change and sustainability implications are factored into all new business decisions and changes to current practices. ➢ Reducing travelling time to meetings and visits where possible, continuing to promote the use of video conferencing and hybrid working to minimise staff travel time and emissions. ➢ Continued use of existing ICT applications like Attend Anywhere, reducing travel for staff, patients and people accessing services across Moray. ➢ Promoting the use of recycling bins and appropriate waste management practices to reduce the overall waste footprint. ➢ Offering hybrid-working arrangements for vacancies where feasible, allowing staff to work remotely and reduce travel costs and travel related emissions. 4.4 Through these efforts, the MIJB aims to foster a culture of environmental awareness and responsibility, while supporting NHS Grampian and Moray Council policies and initiatives to address climate change. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” Supports the values and strategic aims outlined in the Moray Integration Joint Board Strategic Plan ‘Partners in Care 2022-32’ and contributes to the Local Outcomes Improvement Plan (LOIP) through sustainable practice. (b) Policy and Legal Page 158
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None directly associated with this report. The report supports compliance with statutory reporting duties under the Climate Change (Scotland) Act 2009. (c) Financial implications None directly associated with this report. Any future financial implications arising from sustainability initiatives would be considered through separate business cases. (d) Risk Implications and Mitigation None directly associated with this report. Continued engagement with sustainability reporting helps mitigate reputational and compliance risks. (e) Staffing Implications None directly associated with this report. Hybrid working arrangements referenced in the report may support staff wellbeing and retention. (f) Property None directly associated with the report as MIJB does not own or manage property assets. (g) Equalities/Socio Economic Impact As this is a performance monitoring report, an Equality Impact Assessment is not required. This report does not propose actions that would adversely affect groups with protected characteristics. (h) Climate Change and Biodiversity Impacts Impacts are detailed in section 4.3 and Appendix 1. The report supports MIJB’s contribution to national climate targets and promotes sustainable working practices. (i) Directions None directly associated with the report. (j) Consultations Consultation has taken place with the Senior Management Team, who are in agreement with the content of this report. 6. CONCLUSION 6.1 This report recommends that the Board consider and approve the submission (Appendix 1) to the Sustainable Scotland Network for the 2024/25 reporting year. Author of Report: Sonya Duncan, Interim Corporate Manager Background Papers: held be the author Ref: Page 159
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APPENDIX 1 Public Sector Report on Compliance with Climate Change Duties 2025 PART 1 Profile of Reporting Body 1a Name of reporting body Provide the name of the listed body (the "body") which prepared this report. Moray Integration Joint Board 1b Type of body Select from the options below Integration Joint Boards 1c Highest number of full-time equivalent staff in the body during the report year 2 1d Metrics used by the body Specify the metrics that the body uses to assess its performance in relation to climate change and sustainability. Metric Units Value Comments Please select from drop down box n/a n/a n/a Please select from drop down box Please select from drop down box 1e Overall budget of the body Specify approximate £/annum for the report year. Budget: £ 213,843,240 Budget Comments: Funding is provided by NHS Grampian and Moray Council. Staff of Health and Social Care Moray (circa 1,850) are employed by NHS Grampian or Moray Council 1f Report type Page 160
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Check the report year type is correct. The alternative template must be used for academic year reporting. Reporting type Report year comments Financial/Calendar/Other - financial 1g Context Provide a summary of the body's nature and functions that are relevant to climate change reporting. The Moray Integration Joint Board (MIJB) oversees services delegated by NHS Grampian and Moray Council, as outlined in the Integration Scheme. Staff operate from premises owned or leased by NHS Grampian or Moray Council, with energy use, emissions, and waste data reported through those organisations. Work related travel, including pool car usage, is similarly accounted for in their respective returns. Staff follow employer policies on property, infrastructure, waste, fuel, procurement and travel. That includes the two employees of the MIJB. PART 2 - Governance, Management and Strategy Governance and management 2a How is climate change governed in the body? Provide a summary of the roles performed by the body’s governance bodies and members in relation to climate change. If any of the body’s activities in relation to climate change sit outside its own governance arrangements (in relation to, for example, land use, adaptation, transport, business travel, waste, information and communication technology, procurement or behaviour change), identify these activities and the governance arrangements. Provide a diagram / chart to outline the governance structure within the body. Moray Integration Joint Board does not own physical assets and has only statutory officers, the Chief Officer and the Chief Finance Officer, seconded from NHS Grampian and Moray Council. Staff delivering services directed by MIJB are employed by NHS Grampian or Moray Council and work from their premises or a hybrid model. Responsibility for climate change governance, including emissions, energy use, and sustainability measures lies primarily with these statutory partners. Relevant data and reporting are included in their respective Climate Change Duty reports. While MIJB does not directly manage assets or infrastructure, it recognises its role in supporting Scotland's net zero and climate adaptation goals through strategic planning and service delivery. Page 161
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2b How is climate change action managed and embedded in the body? Provide a summary of how decision-making in relation to climate change action by the body is managed and how responsibility is allocated to the body’s senior staff, departmental heads etc. If any such decision-making sits outside the body’s own governance arrangements (in relation to, for example, land use, adaptation, transport, business travel, waste, information and communication technology, procurement or behaviour change), identify how this is managed and how responsibility is allocated outside the body. Provide a diagram to show how responsibility is allocated to the body’s senior staff, departmental heads etc. All business considerations, including service changes and new initiatives, must be accompanied by an Integrated Impact Assessment (IIA)/Equality Impact Assessment (EIA), which includes consideration of climate change and sustainability impacts. Health and Social Care Moray also supports and participates in sustainability initiatives led by NHS Grampian and Moray Council. Additionally, all papers submitted to the Board must assess any potential climate impact arising from their content. Strategy 2c Does the body have specific climate change mitigation and adaptation objectives in its corporate plan or similar document? Provide a brief summary of objectives if they exist. Wording of objective Name of document Document Link Locality Planning - identifying local needs and local outcomes MIJB Strategic Plan - Partners in Care 2022- 2032 https://hscmoray.co.uk/uploads/1/0/8/1/108104703/hscm_strategyfinal_march_202 3.pdf 2d Does the body have a climate change plan or strategy? If yes, provide the name of any such document and details of where a copy of the document may be obtained or accessed. MIJB does not have a specific plan or strategy relating to climate change but is fully committed to those of its partners, NHSG and Moray Council. Page 162
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2e Does the body have any plans or strategies covering the following areas that include climate change? Provide the name of any such document and the timeframe covered. Topic area Name of document Link Time period covered Comments Adaptation n/a Business travel n/a Staff Travel n/a Energy efficiency n/a Fleet transport n/a ICT n/a Renewable energy n/a Sustainable/renewable heat n/a Waste management n/a Water and sewerage n/a Land Use n/a Other (please specify in comments) n/a 2f What are the body’s top 5 priorities for climate change governance, management and strategy for the year ahead? Provide a brief summary of the body’s areas and activities of focus for the year ahead. Continue aligning MIJB's planning and decision making with the strategies of our partners, recognising their lead role in asset management, emissions reporting, and sustainability governance. Ensure all papers presented to the Board include an assessment of potential climate impacts, reinforcing the Board's commitment to sustainability. Support hybrid and remote working arrangements to reduce travel-related emissions, and encourage the use of digital collaboration tools across HSCM. Page 163
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Ensure climate and sustainability considerations are embedded in all business cases and IIAs for new initiatives or service changes. Actively participate in campaigns and programmes led by our partners which are aimed at reducing waste, improving energy efficiencies, and supporting Scotland’s net zero targets. 2g Has the body used the Climate Change Assessment Tool (a) or equivalent tool to self-assess its capability / performance? If yes, please provide details of the key findings and resultant action taken. (a) This refers to the tool developed by Resource Efficient Scotland for self-assessing an organisation’s capability / performance in relation to climate change. No, the MIJB has not used the Climate Change Assessment Tool or equivalent but continues to collaborate with partners. Further Information 2h Supporting information and best practice Provide any other relevant supporting information and any examples of best practice by the body in relation to governance, management and strategy. MIJB and HSCM recognise their role in contributing to Scotland's Net Zero ambitions. MIJB continues to support and align with the sustainability programmes and reporting mechanisms of its statutory partners, NHS Grampian and Moray Council. PART 3 Corporate Emissions, Targets and Project Data Emissions 3a Emissions from the start of the year which the body uses as a baseline (for its carbon footprint) to the end of the report year Complete the following table using the greenhouse gas emissions total for the body calculated on the same basis as for its annual carbon footprint / management reporting or, where applicable, its sustainability reporting. Include greenhouse gas emissions from the body’s estate and operations (a) (measured and reported in accordance with Scopes 1 & 2 and, to the extent Page 164
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applicable, selected Scope 3 of the Greenhouse Gas Protocol (b). If data is not available for any year from the start of the baseline year to the end of the report year, provide an explanation in the comments column. (a) No information is required on the effect of the body on emissions which are not from its estate and operations. (b) This refers to “The greenhouse gas protocol. A corporate accounting and reporting standard (revised edition)”, World Business Council for Sustainable Development, Geneva, Switzerland / World Resources Institute, Washington DC, USA (2004), ISBN: 1-56973-568-9. N/A – HSCM/MIJB has no estate. 3b Breakdown of emissions sources Please refrain from deleting rows or columns anywhere in this template. This workbook is password protected to prevent this and should not be unlocked. Complete the following table with the breakdown of emission sources from the body’s most recent carbon footprint (greenhouse gas inventory); this should correspond to the last entry in the table in 3(a) above. Use the ‘Comments’ column to explain what is included within each category of emission source entered in the first column. If there is no data consumption available for an emission source enter the emissions in kgCO2e in the ‘Consumption’ column of one of the “Other” rows and assign the scope and an emission factor of 1. (a) Emissions factors are published annually by the UK Department for Energy Security & Net Zero Emission Factor Year 2023 You can filter emission sources by "type" in column C to enable quicker selection of emission source in column D. See the list in the Emissions Tab. User defined emission sources can be entered in rows 131 onwards. Please only use these if you cannot find a relevant emission source in the dropdown list or you have a bespoke emission factor or non-standard derivation of emissions e.g. based on a survey/consumption data. If you require extra rows in the table please send the template to ccreporting@ed.ac.uk. N/A - submitted by parent organisations NHS Grampian and Moray Council 3c Generation, consumption and export of renewable energy Provide a summary of the body’s annual renewable generation (if any), and whether it is used or exported by the body. N/A Page 165
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Targets 3d Organisational targets List all of the body’s targets of relevance to its climate change duties. Where applicable, targets for reducing indirect emissions of greenhouse gases, overall carbon targets and any separate land use, energy efficiency, waste, water, information and communication technology, transport, travel and heat targets should be included. Where applicable, you should also provide the body’s target date for achieving zero direct emissions of greenhouse gases, or such other targets that demonstrate how the body is contributing to Scotland achieving its emissions reduction targets. Not applicable. 3da How will the body align its spending plans and use of resources to contribute to reducing emissions and delivering its emission reduction targets? Provide any relevant supporting information that is not already included elsewhere in this report. MIJB maintains a comprehensive financial planning process focused on service sustainability and recovery. While specific emissions reduction targets are not currently embedded within spending plans, the potential impact on climate change is considered during the development of business cases and service proposals. MIJB continues to work within the frameworks of its statutory partners, NHS Grampian and Moray Council, whose climate strategies guide operational decisions and resource use. 3db How will the body publish, or otherwise make available, its progress towards achieving its emissions reduction targets? Provide any other relevant supporting information. In the event that the body wishes to refer to information already published, provide information about where the publication can be accessed. Simply referencing this report or it's availability on the SSN website is insufficient information. All MIJB reports and decisions are public available via the Moray Council Committee Portal; MIJB Committee Papers (https://moray.cmis.uk.com/moray/CouncilandGovernance/Committees.aspx) and all board reports are published on the HSCM website (https://hscmoray.co.uk) Projects and changes Page 166
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3e Estimated total annual carbon savings from all projects implemented by the body in the report year If no projects were implemented against an emissions source, enter ""0"". If the body does not have any information for an emissions source, enter “Unknown”. If the body does not include the emissions source in its carbon footprint, enter “N/A”. Not applicable. 3f Detail the top 10 carbon reduction projects to be carried out by the body in the report year Provide details of the projects that are estimated to achieve the highest carbon savings during report year. Not Applicable. 3g Estimated decrease or increase in the body’s emissions attributed to factors (not reported elsewhere in this form) in the report year If the emissions increased or decreased due to any such factor in the report year, provide an estimate of the amount and direction Not applicable. 3h Anticipated annual carbon savings from all projects implemented by the body in the year ahead If no projects are expected to be implemented against an emissions source, enter “0”. If the organisation does not have any information for an emissions source, enter “Unknown”. If the organisation does not include the emissions source in its carbon footprint, enter “N/A”. N/A 3i Estimated decrease or increase in emissions from other sources in the year ahead If the body’s corporate emissions are likely to increase or decrease for any other reason in the year ahead, provide an estimate of the amount and direction. N/A Page 167
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3j Total carbon reduction project savings since the start of the year which the body used as a baseline for its carbon
footprint
If the body has data available, estimate the total emissions savings made from projects since the start of that year ("the baseline
year").
N/A
Further Information
3k Supporting information and best practice
Provide any other relevant supporting information and any examples of best practice by the body in relation to corporate
emissions, targets and projects.
N/A
PART 4 Adaptation - please do not include information in this part on measures that solely reduce
emissions with no implications for climate adaptation. These are climate mitigation measures which
should be reported in the Emissions tab.
Assessing and managing risk
4a Has the body assessed current and future climate-related risks?
If yes, provide a reference or link to any such risk assessment(s).
None identified currently.
4b What arrangements does the body have in place to manage climate-related risks?
Provide details of any climate change adaptation strategies, action plans and risk management procedures, and any climate
change adaptation policies which apply across the body.
Climate related risks are assessed by MIJB's statutory partners, NHS Grampian and Moray Council, through their respective risk
management frameworks. Where relevant, identified risks are incorporated into MIJB's risk register and HSCM's operational and strategic
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risk registers. The MIJB works collaboratively with both organisations to ensure alignment and to identify cross cutting risks that may impact the delivery of integrated health & social care services. Taking Action 4c What action has the body taken to adapt to climate change? Include details of work to increase awareness of the need to adapt to climate change and build the capacity of staff and stakeholders to assess risk and implement action. The body may wish to make reference to the Scottish Climate Change Adaptation Programme (“the Programme”). MIJB's strategic plan, Partners in Care 2022-2032, recognises the importance of building resilience across communities to address the wider determinants of health and reduce inequalities in access to care. The plan promotes delivering the right care in the right place, as close to home as possible, supporting adaptation to climate related challenges. While there is no formal climate adaptation training, the Board and HSCM works in alignment with its statutory partners whose climate strategies and engagement activities contribute to raising awareness and building capacity. Future work will consider alignment with the Scottish Climate Change Adaptation Programme. 4d Where applicable, what contribution has the body made to helping deliver the Programme? Provide any other relevant supporting information n/a Review, monitoring and evaluation 4e What arrangements does the body have in place to review current and future climate risks? Provide details of arrangements to review current and future climate risks, for example, what timescales are in place to review the climate change risk assessments referred to in Question 4(a) and adaptation strategies, action plans, procedures and policies in Question 4(b). Climate related risks are assessed by MIJB's statutory partners, NHS Grampian and Moray Council, through their respective risk management processes. MIJB continues to integrate relevant climate risks into its risk register and HSCM's operational and strategic risk registers. 4f What arrangements does the body have in place to monitor and evaluate the impact of the adaptation actions? Page 169
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Please provide details of monitoring and evaluation criteria and adaptation indicators used to assess the effectiveness of actions detailed under Question 4(c) and Question 4(d). MIJB includes climate change adaptation and mitigation impact statements in Board and committee reporting, where relevant. These statements support consistent monitoring of climate related considerations across decision making processes. MIJB continues to work with its statutory partners to align with their monitoring frameworks. Future priorities for adaptation 4g What are the body’s top 5 climate change adaptation priorities for the year ahead? Provide a summary of the areas and activities of focus for the year ahead. As a strategic planning body with no direct infrastructure and minimal employed workforce, MIJB focuses its climate change adaptation priorities on governance, decision making and collaboration with its statutory partners. The top priorities are: Embed climate change considerations into strategic planning Mandate climate impact statements in all board reports Integrate climate related risks into MIJB risk register where appropriate Strengthen collaboration with statutory partners Support awareness and capacity building through engagement with partner led initiatives Further Information 4h Supporting information and best practice Provide any other relevant supporting information and any examples of best practice by the body in relation to adaption. N/A Procurement 5a How have procurement policies contributed to compliance with climate change duties? Provide information relating to how the procurement policies of the body have contributed to its compliance with climate changes duties. Page 170
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MIJB does not hold direct procurement responsibilities, as commissioning and procurement activities are carried out by its statutory partners, NHS Grampian and Moray Council. Whilst MIJB does not currently have climate specific policies, climate considerations are integrated into commissioning practices. The Moray Council Procurement strategy 2023-2026 includes commitments to embedding community benefits and climate focused criteria in procurement processes. Senior Commissioning Officers supporting the work of HSCM and MIJB have completed relevant procurement and carbon literacy training, and work closely with procurement colleagues to ensure service specifications reflect sustainability priorities where applicable. 5b How has procurement activity contributed to compliance with climate change duties? Provide information relating to how procurement activity by the body has contributed to its compliance with climate changes duties. n/a Further Information 5c Supporting information and best practice Provide any other relevant supporting information and any examples of best practice by the body in relation to procurement. MIJB recognises its responsibilities under climate change legislation and is committed to supporting sustainable practices through its commissioning and procurement activities, within the scope of its strategic influence. The MIJB does not directly procure services but sets the strategic direction for commissioning through its Strategic Plan (2022-2032). The MIJB encourages adoption of sustainable procurement practices by supporting the prioritisation of suppliers with strong environmental credentials, where feasible. However, the rural nature of Moray presents limitations in supplier availability, which can impact the ability to consistently apply these preferences. The MIJB acknowledges that most resources are sourced via NHS Grampian or Moray Council approved suppliers and contracts. These arrangements are outside the direct control of MIJB, which limits its ability to enforce climate specific procurement standards. In line with MIJB's strategic commitment to sustainability, contract meetings are routinely held via Microsoft Teams. This reduces travel requirements for both providers and staff, contributing to lower carbon emissions. Validation and Declaration 6a Internal validation process Briefly describe the body’s internal validation process, if any, of the data or information contained within this report. Page 171
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This report has been approved by HSCM's Senior Management Team on Wednesday 29 October 2025, and then approved by Moray Integration Joint Board on Thursday 27 November 2025, prior to submission to Sustainable Scotland Network on Friday 28 November 2025. 6b Peer validation process Briefly describe the body’s peer validation process, if any, of the data or information contained within this report. The content of this report was prepared by the Corporate Manager and Chief Finance Officer. It was formally approved by the HSCM Senior Management Team prior to presentation to the MIJB. 6c External validation process Briefly describe the body’s external validation process, if any, of the data or information contained within this report. N/A 6d No Validation Process If any information provided in this report has not been validated, identify the information in question and explain why it has not been validated. N/A 6e Declaration I confirm that the information in this report is accurate and provides a fair representation of the body’s performance in relation to climate change. Name: Judith Proctor Role in the body: Chief Officer, HSCM Date: 29/10/2025 Page 172
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 NOVEMBER 2025 SUBJECT: MORAY INTEGRATION JOINT BOARD MEETINGS 2026/27 BY: CORPORATE MANAGER 1. REASON FOR REPORT 1.1 To ask the Board to agree the meeting dates for 2026/27. 2. RECOMMENDATION 2.1 It is recommended the Board endorses the schedule of meetings for the Moray Integration Joint Board (MIJB), the Audit, Performance and Risk (APR) Committee and the Clinical and Care Governance (CCG) Committee for 2026/27. 3. BACKGROUND 3.1 Following the Covid-19 pandemic, meetings of the MIJB, APR Committee and CCG Committee have been a hybrid model of, in person and remote attendance. Also, the Council’s committee meeting system, Connect Remote, allows the meetings to be webcast live to members of the public, also allowing members to watch the meeting at a later date if required. There have been no requests to change this system. This hybrid system supports sustainability, reduces costs, and travel time for staff and members of the public who may need to travel to attend the meetings. 3.2 At their meeting on 19 June 2025 (para 7 of minute refers) the MIJB approved the proposed reduction in the number of formal meetings from 18 to 15 per year, and agreed to meetings starting at 1000hrs on days where only one meeting is being held. 3.3 To enable APR Committee to recommend the submission of the unaudited annual accounts and audited annual accounts to MIJB for approval, the June and September APR Committee meetings take place in the morning and the MIJB in the afternoon. 4. KEY MATTERS RELEVANT TO RECOMMENDATIONS Item 15. Page 173
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4.1 A proposed timetable of Board and Committee meetings for 2026/27 including MIJB development sessions is attached at Appendix 1. 4.2 The meeting schedule is established with the intention to ensure key dates for formal business are accounted for and to avoid the creation of Special meetings and conducting formal business during development sessions. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The scheduling of appropriate meetings facilitates good governance arrangements and supports the delivery of the Strategic Plan. The proposal demonstrates a proactive approach to governance improvement, supporting transparency, efficiency and member wellbeing. (b) Policy and Legal In terms of the Standing Orders section 4.1, approved by the Board at its meeting on 28 June 2018 (para 5 of the Minute refers), the Board is to approve annually a forward schedule of meeting dates for the following year. (c) Financial implications There may be minor savings realised through reduced administrative and operational costs associated with fewer meetings. There may also be minor savings realised through fewer travel expenses. (d) Risk Implications and Mitigation The revised schedule maintains statutory compliance and ensures that key reporting deadlines are met. The provision for special Board meetings remains within the Standing Orders. (e) Staffing Implications Reduced meeting frequency will ease administrative and preparatory work for officers and committee support staff. The reduced frequency will also allow for improved planning for officers. (f) Property There are no implications in terms of Council or NHS property directly arising from this report. (g) Equalities/Socio Economic Impact There is no negative impact identified as a result of this report. The revised schedule continues to support inclusive participation and accessibility. The hybrid facility will remain for all formal meetings. (h) Climate Change and Biodiversity Impacts Page 174
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The hybrid system supports sustainability, reduces costs, and travel time for staff and members of the public who may need to travel to attend the meetings. (i) Directions None directly arising from this report. (j) Consultations Consultations have been undertaken with the following who agree with the content of this report where it relates to their area of responsibility: • Corporate Manager • Chief Officer • Chief Financial Officer • Caroline O’Connor, Committee Services Officer • MIJB Internal Auditor 6. CONCLUSION 6.1 The MIJB is asked to endorse the timetable of meetings, as attached at Appendix 1. Authors of Report: Isla Whyte, Corporate Business Support Manager, HSCM Background Papers: Ref: Page 175
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Proposed Meeting Dates 2026/27 DATE MEETING TYPE TIMES 30 April 2026 Moray Integration Joint Board Development Session 10:00 to 12:00 28 May 2026 Clinical & Care Governance Committee 10:00 to 12:30 25 June 2026 Audit, Performance and Risk Committee 09:30 to 12:00 25 June 2026 Moray Integration Joint Board 13:30 to 16:00 20 August 2026 Moray Integration Joint Board Development Session 10:00 to 12:30 27 August 2026 Clinical & Care Governance Committee 10:00 to 12:30 24 September 2026 Audit, Performance and Risk Committee 09:30 to 12:00 24 September 2026 Moray Integration Joint Board 13:30 to 16:00 28 October 2026 Moray Integration Joint Board 10:00 to 12:30 26 November 2026 Moray Integration Joint Board Development Session 10:00 to 12:30 28 January 2027 Moray Integration Joint Board 10:00 to 12:30 18 February 2027 Moray Integration Joint Board Development Session 10:00 to 12:30 25 February 2027 Audit, Performance and Risk Committee 09.30-12:00 APPENDIX 1 Page 176
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25 February 2027 Clinical & Care Governance Committee 13:30 to 16:00 25 March 2027 Moray Integration Joint Board 10:00 to 12:30 Page 177
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