Agenda Document Pack - Moray Integration Joint Board - 26/03/2026
Moray Council · 26 March 2026
Back to Moray Integration Joint Board — 26 March 2026 and its agenda
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Moray Integration Joint Board Thursday, 26 March 2026 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, 26 March 2026 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 29 January 2026 5 - 10 4. Action Log of 29 January 2026 11 - 14 5. Minutes - for noting 5a. Minute of meeting Clinical and Care Governance Committee of 28 August 2025 15 - 18 5b. Minute of meeting Audit Performance and Risk Committee of 29 October 2025 19 - 24 6. Moray Integration Joint Board Draft Strategic Risk Register 25 - 54 7. Revenue Budget and Recovery Plan 2026/27 55 - 218 Page 1
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8. Medium Term Financial Framework 2026/27 - 2030/31 219 - 238 9. Membership of Board and Committees 239 - 244 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) Professor Duff Bruce (Non-Voting Member) Mrs Sheila Brumby (Non-Voting Member) Mr Sean Coady (Non-Voting Member) Ms Miriam Connor (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) Mrs Christine Stevens (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, 29 January 2026 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Councillor Peter Bloomfield, Professor Duff Bruce, Mrs Sheila Brumby, Mr Sean Coady, Ms Miriam Connor, Ms Sonya Duncan, Ms Jane Ewen, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Jim Lyon, Ms Aimee McIntosh, Mr Derick Murray, Councillor Bridget Mustard, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Mr Dennis Robertson, Ms Elizabeth Robinson, Mr Alex Stephen, Mrs Christine Stevens, Councillor Ben Williams APOLOGIES Ms Karen Greaves BEM, Mr Michael Ritchie, Ms Laura Skaife-Knight IN ATTENDANCE Deputy Head of Service, Chief Nurse - Moray and Caroline O'Connor, Committee Services Officer 1. Chair The meeting was chaired by Mr Dennis Robertson. 2. Declaration of Member's Interests Mr Riddell stated for transparency that he was Chair of the Mental Welfare Commission for Scotland. The Board noted there were no other declarations of member's interests. 3. Minute of meeting of 27 November 2025 The minute of meeting of 27 November 2025 was submitted. Item 3. Page 5
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Mr Riddell referred to the detailed record discussion of concerns raised in relation to the revenue budget however noted the same level of detail was not minuted in relation to concerns he had raised in relation to Item 10 "Mental Health Services and Pressures on Primary Care". In terms of any external scrutiny in relation to mental health services and to evidence the discussions and conclusions reached at the meeting, Mr Riddell asked the minute be amended to include the concerns he highlighted which were escalated from Clinical and Care Governance Committee to the Board relating to primary care accessing secondary care, issues in relation to Dr Grays and Cornhill Hospitals and setting out the detailed chronology of the last few years including his concerns about the time taken to action. The Chair agreed the minute should reflect the detailed discussion and asked the Clerk to amend the minute accordingly. Subject to the above amendments, the Board unanimously agreed the minute of the meeting. 4. Action Log of 27 November 2025 The Action Log of the meeting of 27 November 2025 was discussed and updated accordingly. During discussion Mr Riddell referenced Items 4 and 10 relating to mental health which were marked as closed and noted whilst the update column included details of planned actions, they should not be closed off and removed from the Action Log until the scheduled work/actions had been delivered. Councillor Mustard asked for an update on Item 12 in relation to the Children's Services Pressures Report, noting there was no update on the Action Log. In response to the first action, the Interim Chief Social Work Officer advised an amended version of the report approved by the Board in November 2025 would be prepared for Moray Council, given the joint budget responsibilities, setting out clearly the governance arrangements for the Board in relation of a costed action plan, which would then be reported to the Board. In relation to the second action, the Interim Chief Social Work Officer advised the action was now completed. 5. Minute of Special meeting of 30 October 2025 The Board noted the minute of the Special Meeting of the Board of 30 October 2025. 6. Revenue Budget Monitoring Quarter 3 for 2025-26 The meeting had before it a report by the Chief Financial Officer updated the Board of the current Revenue Budget reporting position as at 31 December 2025 for the MIJB budget. Ms Connor joined the meeting during discussing of this item. In response to a question from Councillor Bloomfield asking for an update on what work had been done to reduce the overspend of £2.5m as at 31 December 2025, the Chief Financial Officer advised the figure had been reduced by £0.5m as a result of the additional funding and efforts were being made to reduce the outturn to £7m in terms of grip and control measures previously reported and referred to earmarked reserves not used which may reduce the final figure, however that would not be known until Page 6
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March. The Chief Officer provided assurance that the grip and control measures remained in force with weekly meetings being held considering every aspect of expenditure through the health and social cart partnership including high-cost care packages, changes in care packages, vacancies, unintended spend and efforts had been made to slow as much as possible whilst maintaining service provision, noting how challenging it was to deliver savings while ensuring the safety of those provided with care in the community. In terms of the forthcoming year's budget, the measures in place would continue as savings proposals are developed however anticipated it would continue to be challenging as the areas where there is overspend tend to be demand led budgets relating to keeping vulnerable people safe. She confirmed the improved processes would be continued to maintain the focus and while there is evidence of slowing in overspend on a monthly basis, it was being outstripped by the level of demand. Councillor Mustard referred to the wording used in paragraph 4.1 of the report where stated that "cost reductions and savings required to ensure that the MIJB remains within the parameters of the partners provisions, which were set aside in their budgets against the risk of MIJB overspending" rather than the cost reductions being met within the MIJB budget. She expressed concern that the wording suggested an assumption that the monies set aside by both Moray Council and NHS Grampian would be used rather than savings being required to enable MIJB to remain within it's own budget and was not reliant on the extra provision. In response, the Chief Officer provided assurance the Senior Management Team's approach to managing the budget was not to assume the additional provision would be required and the aim was to remain within the MIJB budget however the paragraph was detailing that it was necessary to call on the provision this year to achieve a balance position year end. She further advised that messaging would need to be considered for the following year's budget setting as it was anticipated contributions from both partners would be required. Mr Murray referred to the reduction of £0.5m in the forecast outturn position from Quarter 2 to Quarter 3 in paragraphs 4.2 and 4.3 however noted this amounted to approximately the same amount of additional funding received which suggested additional grip and control measures in place were not having much of an impact. In response, the Chief Officer reiterated the additional measures in place as mentioned in her response to Councillor Bloomfield. She further advised, in terms of the forthcoming year, it was planned to hold further monthly service by service finance and performance meetings to provide scrutiny on spend, maintaining the budget oversight group and the governance in terms of delivery of savings for the Board to approve in March. Councillor Lawrence acknowledged the work undertaken by MIJB every year to set a savings plan to address the budget deficit however, whilst noting the progress made in last couple of years, recognised the recurrence of slippage on the savings plan by this period every year with the consequence that targets to close the deficit could not be achieved. He queried whether the current planning framework and effectiveness of the framework was sufficient or whether improvements could be made, specifically in relation to planning for demand-led services and unplanned pressures which were noted as constant and significant areas of overspend. In response, the Chief Financial Officer highlighted the reasons for the pressures set out in paragraph 4.1, confirming an element of growth was factored in when the savings plan was prepared at the beginning of the year however the unprecedented growth this year across the whole of Scotland had been far more that anyone had anticipated. She further advised some savings, to be Page 7
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classed as efficiencies, would enable the MIJB to deal better with growth and work differently with a reduced budget. The Chief Officer agreed while populations increases can be predicted, there was a need for transformation within the partnership in terms of proportionate care, anticipatory care, prevention, supporting use of technology, all of which take time to invest in. Recognising it had taken longer than hoped to reach that point and the importance of recognising the growth and demand, work would be undertaken to have services in place, deliver change and transform the partnership. Mr Stephen welcomed the progress made since the last meeting reformatting the report and, whilst noting it was work in progress, was pleased it would strengthen financial governance and how to move forward. He suggested a useful addition may be to include activity data to evidence the demand and challenges. Following lengthy consideration the Board unanimously agreed to:- i) Note the financial position of the Board as at 31 December 2025 is showing an overspend of £2,507,492 on core services; ii) Note the updated forecast position for 2025/26 of an overspend of £8,233,394 on total budget, a slightly improved position for total services since quarter 2; iii) Note the progress against the approved savings plan in paragraph 7, and Appendix 4; iv) Note the budget pressures and emerging budget pressure as detailed in paragraph 8; 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 October to 31 December 2025 as shown in Appendix 3. 7. Moray Integration Joint Board Strategic Risk Register - Risk 2 (Financial Sustainability) The meeting had before it a report by the Chief Officer presenting 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 which supports informed decision-making, strengthens strategic planning, and reinforces effective risk governance aligned with the Strategic Plan. Following consideration the Board unanimously agreed to:- i) note the updated Strategic Risk No 2 (Appendix 1); and ii) approve that the mitigating controls and assurance arrangements are adequate. 8. Reappointment of Chief Internal Auditor The meeting had before it a report by the Chief Officer asking the Board to approve the reappointment of the Chief Internal Auditor, whose current terms of appointment are due to expire on 31 March 2026. Page 8
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During discussion Mr Murray stated it was his understanding that five yearly external reviews of Internal Audit were to be undertaken and to his knowledge no such review had taken place since he had joined the Board. In response, the Chief Officer was unable to confirm but agreed to follow-up with the Chief Internal Auditor. Following consideration the Board unanimously agreed to appoint Dafydd Lewis, Service Manager Internal Audit and Risk, Moray Council, as the Chief Internal Auditor of the Moray Integration Joint Board, for a further period of two years to 31 March 2028. 9. Reappointment of Standards Officer and Depute Standards Officer The meeting had before it a report by the Chief Officer asking the Board to approve the nomination of its Standards Officer and one Depute, whose current terms of appointment are due to expire on 1 April 2026. Councillor Mustard noted recommendation (ii) did not state the role Aileen Scott was being appointed to and moved the recommendation be amended to include "as the Depute Standards Officer of the Moray Integration Board". Following consideration and there being no one otherwise minded, the Board unanimously agreed to:- i) formally nominate for approval by the Standards Commission, Alasdair McEachan, Chief Governance Officer (Monitoring Officer), Moray Council, as the Standards Officer of the Moray Integration Joint Board, for a further period of two years until 1 April 2028; ii) formally nominate for approval by the Standards Commission, Aileen Scott, Service Manager Legal Services, Moray Council, as the Depute Standards Officer of the Moray Integration Joint Board, for a further period of two years until 1 April 2028; iii) task the Chief Officer with writing to the Standards Commission with the relevant information; and iv) note that arrangements will be reviewed prior to April 2028. 10. Congratulations The Board joined the Chair in congratulating the Service Manager Provider Services and all staff for their hard work under pressures resulting in the positive Care at Home inspection report published by the Care Inspectorate following an unannounced inspection in late November 2025. Page 9
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MEETING OF MORAY INTEGRATION JOINT BOARD Thursday 29 January 2026 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 26 MARCH 2026 1. Chief Officer Report 29/05/25 Strategic awareness of unpaid carers capacity to be considered at next IJB Development Session. To be considered as part of development programme JP Topics for future development sessions being considered CLOSE ACTION 2. Moray Adult Mental Health Strategic Group Progress Report 29/05/25 Mental Health Services and Pressures on Primary Care 27/11/25 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. Progress report to be presented to MIJB to evidence changes delivered and improved performance. 2026 April 2026 IM/ER SMT The survey will be actioned later in the year. Progress report on Delivery Plan scheduled for MIJB Development Session in April and report to MIJB in June Item 4. Page 11
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 26 MARCH 2026 3. Revenue Budget Monitoring Quarter 2 for 2025-26 27/11/25 Chief Financial Officer to review report format in liaison with CFOs of Moray Council and NHS Grampian to improve assurance and accountability. Update 29/01/26: consider including activity data to evidence demand and challenges ASAP DO Report will be updated on a phased basis from Q3. Progressing. 4. Membership of Boards and Committees 27/11/25 Unpaid carers strategic updates are reported to Audit, Performance and Risk Committee therefore Unpaid Carer Reps are to be added to membership. Report to be prepared for Board approval of amended membership and remit. January 2026 SD/IW Being considered as part of wider review. CLOSE ACTION 5. Childrens Services Pressures Report 27/11/25 i) Clear outline of accountability and responsibilities of the Board to be circulated. ii) JL to provide explanation to DM of reasons for the actual spend being much lower than the available spend in Table 1. March 2026 JL JL Report being drafted for approval by Moray Council then to come to the Board. Completed. CLOSE ACTION Page 12
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 26 MARCH 2026 6. Reappointment of Chief Internal Auditor 29/01/26 Follow-up with Chief Internal Auditor position re five yearly external reviews of Internal Audit. March 2026 JP A five-yearly External Quality Assessment is required, and Moray Council’s Internal Audit Service was independently peer-reviewed in March 2024, achieving full conformance with standards. Reported to APR Cttee 26 September 2024. CLOSE ACTION Page 13
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MINUTE OF MEETING OF THE CLINICAL AND CARE GOVERNANCE COMMITTEE Thursday, 28 August 2025 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Councillor Peter Bloomfield, Ms Helen Chisholm, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Jim Lyon, Mr Derick Murray, Ms Deborah O'Shea, Ms Elizabeth Robinson, Mr Sandy Riddell APOLOGIES Mr Ivan Augustus, Professor Duff Bruce, Mrs Sheila Brumby, Mr Sean Coady, Ms Judith Proctor, Mr Alex Stephen IN ATTENDANCE Corporate Manager; Corporate Business Support Manager and Caroline O'Connor, Committee Services Officer. 1. Chair The meeting was chaired by Mr Derick Murray. 2. Declaration of Member's Interests There were no declarations of Member's interests in respect of any item on the agenda. 3. Minute of meeting of 27 February 2025 The minute of the meeting of 27 February was submitted and approved. 4. Action Log - 27 February 2025 The Action Log of the meeting of 27 February 2025 was discussed and updated accordingly. Item 5a. Page 15
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5. Health and Social Care Moray Clinical and Care Governance Group Escalation Report The meeting had before it a report by the Chief Nurse, Moray informing the Committee of progress and exceptions reported to the Clinical and Care Governance Group since the last report to Committee in February 2025. During discussion Councillor Lawrence expressed concern regarding the pressures on GPs in Moray in terms of direct clinical encounters being much higher than neighbouring authorities and the pressures were also impacted by gaps in mental health provision as outlined in Appendix 2. In response, the Chair confirmed he shared the concerns relating to the pressures on GPs and had shared the figures with the Chair of the NHS, the Council Leader, the Public Health Chair and the Interim Director of Public Health in NHS Grampian for consideration. Following consideration the Committee unanimously agreed to note the contents of the report. 6. Health and Social Care Moray Clinical Risk Management Terms of Reference The meeting had before it a report by the Chief Nurse, Moray informing the Committee of the updated Terms of Reference for the Health and Social Care Moray Clinical Risk Management Group and outlining it's purpose, remit and reporting arrangements. Following consideration the Committee unanimously agreed to:- (i) note the updated Terms of Reference for the Clinical Risk Management Group (Version 3.0, August 2025) which reflect current governance structures and professional leadership within Health and Social Care Moray; and (ii) endorse the continued role of the Clinical Risk Management Group in providing assurance on clinical risk and governance matters, and its reporting relationship to the Clinical and Care Governance Group and, where appropriate, to NHS Grampian. 7. Draft Health and Social Care Moray Annual Complaints Report 2024-25 The meeting had before it a report by the Chief Nurse, Moray providing the Committee with the Draft Health and Social Care Moray Annual Complaints Report for 2024/25. Following consideration the Committee unanimously agreed to:- (i) note the contents of the annual report; and (ii) request the annual report is submitted to Moray Integration Joint Board in September for approval prior to publication. 8. Items for Escalation to MIJB During discussion and following on from the concerns raised on the Health and Social Care Moray Clinical and Care Governance Group Escalation Report specifically relating to the pressures on GPs in Moray and the related gaps in mental health services, Page 16
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Councillor Lawrence suggested it may be appropriate to escalate the report to the next Moray Integration Joint Board meeting. Dr Lockhart advised it was intended to provide a more detailed report for the next meeting of this Committee however noted the next meeting was scheduled for February 2026 and there may be an increase in pressures during winter. Following consideration the Committee unanimously agreed the Health and Social Care Moray Clinical and Care Governance Group Escalation Report be escalated to the next meeting of Moray Integration Joint Board on 25 September 2025. Page 17
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MINUTE OF MEETING OF THE AUDIT, PERFORMANCE AND RISK COMMITTEE Wednesday, 29 October 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 Aimee McIntosh, Mr Michael Ritchie IN ATTENDANCE Corporate Programme Manager; Service Manager, Education and Social Care; Chief Internal Auditor; Service Manager, Provider Services; Self-Directed Support and Unpaid Carers Team Manager; Angela Pieri, Engagement Lead, Grant Thornton and Caroline O'Connor, Committee Services Officer ALSO IN ATTENDANCE Councillor Bridget Mustard 1. Chair The meeting was chaired by Councillor Ben Williams. 2. Declaration of Member's Interests Mr Murray stated for transparency, in relation to Item 11 "2024-25 Audited Annual Accounts", that he was Chair of the NHS Grampian Audit and Risk Committee. The Board noted there were no other declarations of member's interests. 3. Minute of meeting of 19 June 2025 The minute of the meeting of 19 June 2025 was submitted and approved. Item 5b. Page 19
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4. Action Log of 19 June 2025 The Action Log of the meeting of 27 March 2025 was discussed and updated accordingly. 5. Quarter 1 (April to June 2025) Performance Report - Adult Services The meeting had before it a report by the Corporate Programme Manager updating Committee on performance as at Quarter 1 2025 (April - June). Mr Riddell raised the importance of aligning insights between this report and the Children and Families and Social Work Services Performance Report also on the agenda, particularly in relation to mental health indicators. In response, the Chief Officer agreed the parallel reporting of performance does not make the connections, noting a joined-up approach was required to ensure a clear understanding of outcomes and impact and undertook to progress work to draw out the connections in order to provide assurance. Councillor Lawrence asked to what extent the current unmet need was related to insufficient recruitment and how much was due to broader pressures on the existing workforce. In response, the Chief Officer advised there were a combination of factors including complexity of care needs, workforce capacity and, although noting there had been improvements in recruitment in some areas, this resulted in increased delivery costs and resources strains. The Head of Service/Depute Chief Officer further advised there had been a significant reduction in waiting times however recognised the current reporting framework did not fully reflect the improvements. He confirmed work was ongoing with external providers to develop a collaborative model, the issues would be considered in more depth at a scheduled development session and offered to bring back a more detailed report on unmet need. Following consideration the Committee unanimously agreed to :- i) note the performance of local indicators for Quarter 1 (April to June 2025), against revised targets for 2025/26, 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 section 5; iii) note the commentary in section 6 and graphs for the National and Ministerial Steering Group indicators in Appendix 2; and iv) approve the revised list of local indicators for future quarterly reports included in paragraph 7.3 and the intention to provide deep dives into specific areas of interest through the year. 6. Quarter 1 (April to June 2025) Performance Report for Children and Families and Justice Social Work Page 20
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The meeting had before it a report by the Interim Chief Social Work Officer/Head of Service informing Committee on Children and Families and Justice Social Work Performance as at Quarter 1 (April to June 2025). Mr Riddell asked how the test of change to be taken forward by the Policy, Commissioning and Development Team referenced at paragraph 4.17 would be managed in terms of timescales and outputs. In response, the Service Manager Education and Social Care apologised the information was not detailed in the report but confirmed there was a clear schedule which would be provided to Committee. Following consideration the Committee unanimously agreed to note:- i) the performance of local indicators for Quarter 1 as presented in the Performance Report at Appendix 1; and ii) 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, with reference to the Chief Internal Auditor's decision to delay the review of Support for Carers to a future audit plan referred to in paragraph 4.1, noted there had been delays in implementation of the Strategy and suggested the review be carried out in the near future. In response, the Chief Internal Auditor agreed however noted his review would include the Strategy along with the arrangements and he would therefore want the Strategy to be implemented before undertaking a review. In response to a follow-up question from Mr Riddell asking for a definitive timescale in terms of there being an added incentive to ensure implementation of the Strategy was progressed, the Chief Internal Auditor confirmed it would be added to the Audit Plan for 2027/28 to review what had been implemented, what the intentions were and what had happened in practice. Following consideration the Committee unanimously agreed to note the audit update. 8. Internal Audit Section Completed Projects Report The meeting had before it a report by the Chief Internal Auditor providing Committee with an update on audit work completed since the last meeting of the Committee. In response to a concern raised by Mr Murray regarding the storage of records in officers homes referred to in Recommendation 3 of Appendix 2, the Chief Financial Officer provided assurance there was now a system in place meaning there was no longer an issue with file locations as all new files are being scanned into the system and backlog files are being processed through the mailroom. In order to provide further assurance, Councillor Lawrence confirmed similar reassurance had been provided to the last meeting of the Council's Audit and Scrutiny Committee. Following consideration the Committee unanimously agreed to note the audit update. Page 21
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9. Update on the Delivery of the Unpaid Carers Strategy The meeting had before it a report by the Service Manager Provider Services providing an update to Committee on the progress made in implementing the Moray Carers Strategy, with particular emphasis on key activities and developments over the reporting period. The Service Manager Provider Services noted at the time the report was prepared, the service was still in the process of putting arrangements in place and suggested the wording in recommendation ii) be changed to remove "Lead Officer" and substitute with "Strategy Group" to remove the responsibility from one individual person. Following a short discussion on the competency of there not being a singular person being accountable, the Chair suggested the wording of recommendation ii) be amended to "Lead Officer, supported by the Strategy Group". Following consideration and there being no one otherwise minded, the Committee unanimously agreed to:- i) note the progress made to date in delivering the objectives set out in the Carers Strategy; and ii) instruct the Lead Officer, supported by the Strategy Group, to provide quarterly progress reports to this Committee to support ongoing monitoring and scrutiny of the Strategy implementation. 10. External Auditors' Report to those charged with Governance The meeting had before it a report by the Chief Financial Officer asking Committee to consider the reports to those charged with governance from the Board's External Auditor for the year ended 31 March 2025. The Committee joined the Chair in thanking those involved in providing the External Auditor's Report and thereafter unanimously agreed to note the reports from the External Auditor as set out in Appendices 1 and 2 of the report and recommended them for approval by the Moray Integration Joint Board. 11. 2024-25 Audited Annual Accounts The meeting had before it a report by the Chief Financial Officer presenting to Committee the Audited Annual Accounts for the year then ended 31 March 2025. Following consideration the Committee unanimously agreed to note the Audited Annual Accounts for the financial year 2024/25 and the letter of Representation and recommended them to the Moray Integration Joint Board for approval. 12. Public Sector Internal Audit Standards - External Quality Assessment of the Internal Audit Section - Follow Up Review The meeting had before it a report by the Chief Internal Auditor providing an update on the implementation of recommendations detailed within the external quality assessment undertaken on the Council's Internal Audit Section. Page 22
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Following consideration the Committee unanimously agreed to note the report. 13. Health and Social Care Moray Strategic Delivery Plan 2025-2028 - Progress Update to 30 September 2025 The meeting had before it a report by the Corporate Programme Manager providing Committee with an update on progress to September 2025 of the implementation of the Strategic Delivery Plan. Following consideration the Committee unanimously agreed to:- i) note the progress to September 2025 of the Strategy Delivery Plan (2025-2028) attached at Appendix 1; ii) note the areas that are progressing well and those where adjustments to timescales are required as outlined in paragraphs 4.3 to 4.10; and iii) approved the amendment to the outcome identified in paragraph 4.11. 14. Items for Escalation to MIJB The Committee noted that there were no items for escalation to the Moray Integration Joint Board. 15. Internal Audit Section Follow Up Review - NHS Grampian [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 report. 16. Internal Audit Follow Up Reviews - Information, Communication and Technology [Para 6.2.5] The meeting had before it a report by the Chief Internal Auditor providing an update to Committee on the follow up reviews undertaken by the Internal Audit Section to evidence implementation of audit recommendations. Following consideration the Committee unanimously agreed to note the report. Page 23
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 26 MARCH 2026 SUBJECT: MORAY INTEGRATION JOINT BOARD DRAFT STRATEGIC RISK REGISTER BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To present the Strategic Risk Register to the Board for approval, following scrutiny by the Audit, Performance and Risk (APR) Committee at their meeting held on 26 February 2026. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) Approves the Board Strategic Risk Register included at Appendix 1, noting the current risk ratings, controls, assurances and areas of ongoing exposure; ii) Notes that future reports will reflect scrutiny and feedback provided by the Audit, Performance and Risk Committee on 26 February 2026; and iii) Agrees that a dedicated Board session be scheduled to review and refresh the Moray Integration Joint Board Risk Appetite Statement, including consideration of the relationship between risk ratings and the Board’s tolerance for risk. 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 6. Page 25
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3.3 As agreed at Audit, Performance and Risk Committee on 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 Chief Internal Auditor issued a ‘Limited Assurance’ rating for MIJB for 2024/25 to the meeting of Audit, Performance and Risk Committee on 19 June 2025 (para 8 of the minute refers), reflected within Strategic Risk 8. 3.5 As agreed at the MIJB meeting on 25 September 2025 (para 11 of minute refers), the Strategic Risk Register is subject to scrutiny by the Audit, Performance and Risk Committee, with escalation to the Board for oversight and approval. 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 Following scrutiny by the Audit, Performance and Risk Committee at their meeting on 26 February 2026 (para 10 of draft minute refers), a revised approach to identifying material changes within the Strategic Risk Register are proposed. From this reporting cycle onward, a ‘Change’ flag will be used within the summary table, supported by in-text ‘[Updated]’ markers where relevant, to more clearly identify material changes between formal reporting cycles and support focused scrutiny by members. 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 Page 26
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During scrutiny, the Audit, Performance and Risk Committee asked officers to consider whether the current financial risk rating continues to align with the Board’s agreed risk appetite. Officers note that risk rating and risk appetite are related but distinct. It is therefore proposed that the Risk Appetite Statement be reviewed in the round at a dedicated future Board session. (e) Staffing Implications There are no additional staffing implications arising from this report. However, further development of the workforce risk narrative will be taken forward in response to Audit, Performance and Risk Committee feedback. (f) Property There are no property implications arising from this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required, as 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 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 27
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IJB RISK REGISTER SUMMARY – March 2026 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! Reference 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 Very High January 2026 Very High 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 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 29
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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: The risk remains Medium because, although core governance elements (Integration Scheme, Governance Framework, Scheme of Administrations, Members Induction and Standards training) are in place and routinely used, the breadth of delegated functions and ongoing structural change still create exposure to governance variance across services. Risk scoring before mitigations/controls Mitigations / Current controls in place Risk scoring after mitigations/controls 4 5 20 1. Integration Scheme 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. 5. 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 2 3 6 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 30
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Assurances: • MIJB Scheme of Integration • Programme of Development Sessions held throughout the year with all MIJB members and Officers • 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: As part of HSCM structural review, mapping of the delegated Children’s, Families and Justice 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 and delivered in 2025/26. Further Controls Required Further Controls Owner Complete integration of Children’s, Families and Justice. Organisational Review and Change process underway. HoS/CO August 2026 6. Implementation of HSCM Internal Audit Process providing assurance and escalation process to SMT Target Date Page 31
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Review of MIJB Members Handbook Required – delayed from December 2025 due to competing priorities Corporate Manager/Legal Services April 2026 Page 32
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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: Very High January 2026 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 risk remains rated at Very High due to in year pressures, savings slippage and recurrent cost growth outpacing available funding, including high-cost care packages and demand growth in adults and children’s services. Prescribing movements, shortfalls (eNIC) and savings slippage underline uncertainty. While the grip/control, oversight and escalation processes are in place, residual exposure to overspend and delivery risk remains high. 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 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. Extended Resource Management Group – including financial recovery action plan. 8. SMT are actively monitoring and responding to the grip and control measures as they arise, ensuring robust oversight and challenge, ensuring that no critical issues are overlooked. 3 5 15 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 33
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Assurances: • Quarterly Budget monitoring reporting to MIJB • Financial Reporting through MIJB, NHS Grampian and Moray Council • The Project Management Office continues to support the Budget Savings Delivery as part of the budget setting for 2026/27 onwards. • Ongoing 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. • Finance workshops took place with Board members in December 2025 and Feb 2026. • Risk 2 presented to MIJB in January 2026 with Q3 report. Gaps in Assurance: • Slippage in savings programme for 2025/26 presented to MIJB January 2026. • Unprecedented growth and demand across adults and childrens services, adding significant pressure to all budgets and delivery of savings previously identified. 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. Quarter 2 budget monitoring reported presented to MIJB on 27 November 2025. Quarter 3 budget monitoring report planned for presenting to MIJB 29 January 2026. 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: Risk Rating: Medium 9. Financial pressures have been escalated to the Chief Executives of Moray Council and NHS Grampian, discussions continue as per the tri-partite arrangements. Page 34
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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 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 Rationale for Risk Rating: The risk remains Medium because recruitment and retention challenges, geography and housing constraints continue to affect capacity and service resilience. Residual risk remains until workforce plans are refreshed and resourced. 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 35
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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. • HSCM organisational review is cognisant of recruitment challenges and will be the consultation with staff will be key to developing any changes. 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. 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 – awaiting SG TBC TBC Review Date Review Notes / Decisions 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. Page 36
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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: The risk remains Medium because engagement and communications processes are variable across a complex landscape, and the current Communication & Engagement Strategy (2019) is being updated. Whilst SOCG locality work, and adoption of ‘Planning with People’ principles, and strengthened digital channels are in place, assurance on consistency and outcome capture needs to improve within the limited capacity. 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. • ‘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 37
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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. • The Programme Management Office ensures that all programmes of work incorporate appropriate engagement as standard business as usual practice. Gaps in Assurance: • Seek to improve the level of engagement across Moray. • Communication and Engagement Strategy was approved in 2019 and is currently being updated. • More systematic approach to stakeholder consultation required. • Establish a more robust process for youth representation pathways. 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: • Communications & Engagement will be factored into the ongoing structural review, providing a more systematic approach to engagement in localities. Further Controls Required Further Controls Owner Target Date Update Communication and Engagement Strategy Corporate Manager April 2026 Review Date Review Notes / Decisions Page 38
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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: The risk remains Medium as regulatory requirements span multiple domains (performance, finance, resilience, decision making), and system pressures raise the likelihood of standards not being met at times. Controls exist (learning loops, statutory reporting, resilience planning), but full assurance depends on Business Continuity planning being complete and visible across both parent bodies. Assurances: • Quarterly reporting to Clinical and Care Governance and Audit, Performance and Risk Committees Managing the risk - Current controls in place 5 5 25 1. Continuous emergency preparedness awareness with partners in Grampian Local Resilience Partnership (GLRP) – including exercises and debriefs. 2. 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. 3. HSCM Civil Contingencies group review specific risks and action plans to mitigate, developing plans and testing arrangements in partnership with NHSG and Council. 4. Annual review of internal resilience and emergency processes with Senior Managers on Call. 5. Timetable of statutory reporting across the financial year. 6. Implementation of regular progress reports on audit at OMT, with oversight at SMT. 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 39
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• 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. Audited annual accounts October 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. Implementation plan for new Scottish Government Resilience Standards will be required once received. Further Controls Required Further Controls Owner Target Date Business Continuity Planning Senior Management Team April 2026 Review Date Review Notes / Decisions Page 40
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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. Page 41
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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. 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: The risk remains at a Medium rating due to persistent system pressures, including high levels of unplanned admissions, delayed discharges, and constrained community capacity, all of which limit the Partnership’s ability to progress transformation at the intended pace. Significant financial constraints and limited workforce capacity continue to impact the feasibility and timing of redesign work. Public expectations also remain higher than what can be delivered within current resources. Although strong governance arrangements, performance oversight, and collaborative work across the pathway are in place, these structural challenges continue to create a sustained risk that the MIJB may be unable to deliver all strategic aspirations in a sustainable way. Managing the risk - Current controls in place 5 4 20 1. Clinical and Care Governance (CCG) oversight is provided through the CCG Committee, supported by the Clinical and Care Governance Group, Clinical Risk Management (CRM) and Practice Governance structures, ensuring professional standards are monitored and risks escalated appropriately. 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. Regular Internal and External scrutiny is provided through inspections. 5. Internal/External Inspection reports are scrutinised by appropriate operational groups with actions tracked and monitored through the appropriate governance groups. 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 42
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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 6. Care Home Collaborative Support Group provides oversight, ensuring risks in care homes are monitored and mitigated through partnership working. 7. Children and Adult Protection Committees provide specialist scrutiny and ensure statutory safeguarding duties are met. 8. Robust governance arrangements such as SMT, OMT and daily operational huddles ensure regular oversight, co- ordinated decision making and early escalation of system pressures. 9. Organisational Review of HSCM structures is underway to strengthen strategic capacity and ensure the organisation is equipped to deliver transformation and ability to respond to increasing demands across the system. Page 43
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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: The risk remains Medium because hosted services are subject to partner governance, financial constraints and workforce pressures outside MIJB’s direct control. The tri-partite working forums improve visibility and influence but cannot fully eliminate dependency risks. Parent organisations 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. 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 regard 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 44
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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. 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 45
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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 risk remains Medium because the 2024/25 Internal Audit Annual Report concluded ‘Limited Assurance’ with delays in recommendations and weaknesses noted in contract management, digital and tracking arrangements. Controls have strengthened (end to end audit tracking, SMT engagement, governance statement) but residual risk persists until audit actions are closed and key enablers are delivered. Assurances: • Internal Audit Annual Report presented to APR Committee (June 2025). • Internal Audit 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. ‘End to end’ process for agreeing, implementing and tracking audits is now established with regular OMT/SMT oversight. 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 46
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Gaps in Assurance: Delays previously experienced in implementing some audit recommendations. Updated Risk Policy framework is underway. 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 • HSCM Risk Framework (2022) being updated. CFO/HoS HoS SMT March 2027 March 2027 June 2026 Review Date Review Notes / Decisions Page 47
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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 Page 48
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• Low tolerance for activities that could undermine partnership working • Emphasis on transparent decision-making 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 49
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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 Page 50
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Injury /illness (physical and psychological) to patient/service user/visitor/staff/carer Adverse event leading to minor injury not requiring first aid Minor injury or illness, first aid treatment required Agency reportable, e.g. Police (violent and aggressive acts) Significant injury requiring medical treatment and/or counselling Major injuries/long term incapacity /disability (e.g. loss of limb), requiring, medical treatment and/or counselling Incident leading to death(s) or major permanent incapacity 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 Page 51
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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 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. Page 52
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Very High or High Requires monthly monitoring and updates. Medium Requires quarterly monitoring and updates. Low Requires 6 monthly monitoring and updates. Page 53
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 26 MARCH 2026 SUBJECT: REVENUE BUDGET AND RECOVERY PLAN 2026/27 BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To outline the budget allocations to the Moray Integration Joint Board (MIJB) and to consider the revenue budget for 2026/27, the estimated funding gap and the charges. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) notes the funding allocations proposed by NHS Grampian and Moray Council, detailed at 5.8; ii) notes the anticipated budget pressures detailed in 5.12; iii) approves the 2026/27 proposed savings plan at 5.27 and detailed in Appendix 2; iv) formally approves the Revenue Budget for 2026/27 as detailed in Appendix 1, following consideration on risks highlighted in 5.36; v) directs the Chief Officer to formally write to partners to request the additional in year funding, totalling £9m; vi) approves Directions for issue as set out at Appendix 5 to NHS Grampian and Moray Council, and vii) notes no amendments to the reserves policy, as detailed in Appendix 6. Item 7. Page 55
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3. BACKGROUND 3.1 On 13 January 2026 following the announcement of the Scottish Government’s indicative budget for 2026-27, the Cabinet Secretary for Finance and the Director of Health Finance and Governance wrote to Health Board Chief Executives providing details of the funding settlement for Health Boards. In Parliament on 13 January, the Cabinet Secretary set out that 2026/27 is expected to present a challenging fiscal environment across all public services. 3.2 The letter outlined that NHS payment uplifts to Integration Authorities for delegated health functions must deliver an uplift of 2% over the 2025/26 agreed recurring budgets. 3.3 In addition and separate to Health Board funding uplifts, the health and social care portfolio, will transfer additional funding of £160 million to Local Government for Adult services and £22 million for children’s services to support retention by beginning to embed improved pay and conditions for care workers, with Scottish Government considering that this funding requires local government to deliver a £13.45 minimum pay settlement for social care workers in commissioned services, in line with the equivalent commitment being made in the public sector pay policy. In addition to this further additional funding of £7 million will support the uprating of Free Personal and Nursing Care rates. 3.4 Scottish Government have stipulated that the funding allocation to Integration Authorities should be additional and not substitutional to each Council’s 2025/26 recurring budgets for adult social care services and therefore, Local Authority adult social care budgets for allocation to Integration Authorities should be £167 million greater than 2025/26. 4. KEY SUMMARY 4.1 The 2026/27 budget proposed is summarised in the table below. £m Anticipated spend (inc set aside) 233.766 Anticipated funding (219.048) Savings proposed (5.718) Gap 9.000 Met by deficit funding from partners (9.000) Balance 0 4.2 Anticipated spend is made up of recurring core budgets, budget pressures and recurring deficit from 2025/26 forecast position as at January 2026. Anticipated funding is made up of recurring funding from the partners, the passported funding received from Scottish Government and increases from the partners. Proposed savings are made up of carried forward savings that were identified in the prior year as part of a multi-year proposal and new savings identified for 2026/27. 4.3 This financial year the challenge of the recurring forecast position for 2025/26 and the size of the gap from pressures expected during the 2026/27 financial year, Page 56
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made balancing the budget very difficult. During 2025/26, the MIJB set a balanced budget however, risk was flagged to partners on the potential for the MIJB to deliver a deficit outturn given the scale of savings needed during the financial year. Both partners had included some provision in their financial plan for deficit support to the MIJB. This year, given the financial gap identified after savings, and the requirement for the MIJB to set a balanced budget, contributions towards deficit support will be requested from each partner at the start of the year. This will enable time for the implementation of savings at the pace required as well as supporting the service in identifying transformation opportunities that will allow Health and Social Care moray to be sustainable over time. 4.4 Work continues to produce a multi-year savings approach for the MIJB to achieve sustainability, for which the emphasis is on transformation. Savings will continue to be looked at continuously and will bring any potential new additional savings throughout the financial year for approval. 5. KEY MATTERS RELEVANT TO RECOMMENDATION Budget Overview 5.1 The MIJB Revenue Budget for 2026/27 is £233.766 million which includes £20.092 million Set Aside. The detail is provided in Appendix 1 and summarised below: Para ref £M BUDGET Recurring Budget 194.620 Inflationary and Demand Led Pressures 5.12 10.260 Recurring Deficit 5.12 4.393 SLW, FPNC & NCHC 5.12 4.400 Set Aside 5.11 20.092 TOTAL BUDGET 233.766 FUNDED BY NHS Grampian Recurring (exc. Set Aside) 5.8 102.088 NHS Grampian Set Aside 5.11 20.092 Moray Council (inc. Improvement Grants) 5.5 90.298 Scottish Government Additional Funding (£241.5m) 5.7 3.530 Moray Council additional funding towards RLW shortfall 5.5 0.200 Children’s & Justice services Additional Funding 5.7 0.186 NHS Grampian 2% Additional Funding 5.6 & 5.7 2.427 Scottish Government additional funding for pay award 5.5 0.227 Savings identified 5.5 5.718 Additional deficit funding from partners 4.3 9.000 TOTAL FUNDING 5.8 233.766 Page 57
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5.2 Earmarked reserves estimated to be carried forward into 2026/27 are £1.406 million, this includes reserves relating to Moray psychological facilities, Moray Winter fund Multi-Disciplinary Team (MDT), Moray Alcohol and Drug Partnership (MADP), plus others which are expected to be exhausted by the end of 2026/27. The balance on the remaining reserves will be reviewed after the 2026/27year end. MIJB Budget 5.3 The MIJB is required to consider its budget in the context of economic uncertainty in relation to the ongoing increase in the cost of living and high interest rates. It is fair to say that the impact of these circumstances remains a challenge and cannot yet be fully assessed. 5.4 Following the announcement of the Scottish Budget, NHS Grampian and Moray Council have notified the MIJB Chief Officer and Chief Financial Officer of the funding allocation for the forthcoming financial year. 5.5 On 25 February 2026, a Special Meeting of Moray Council agreed its 2026/27 budget for the forthcoming financial year (para 4 of draft minute refers). The Local Government settlement is for one year only, but the budget was set in the context of longer-term planning. The funding to the Council included £253 million for local priorities / to preserve the settlement in real terms. The paper presented referred to the Moray share of the additional funding that is required to be passed through from the Council to the MIJB. This is the share of the reported national investment in health and social care (adult and children’s services) of £160 million and £22 million respectively; £7 million relating to free nursing and personal care, the Moray share equates to a £3.256. Other funding approved relates to £0.186 million relating to Children and Young People for service development, £0.227 million for the additional cost of the pay award (share of the Scottish Government funding) and £0.200 million towards the shortfall on funding for the Real Living Wage (RLW) funding from Scottish Government, which is expected to be a pressure of £0.435 million. 5.6 The NHS Grampian budget setting process is based on the principle that funding allocations to the 3 Grampian IJB’s will be uplifted in line with the increase in baseline funding agreed through the Scottish Government budget settlement, with the total to each IJB being made on the National Resource Allocation Committee (NRAC) share. The draft Scottish Government budget was announced on 13 January 2026. It provides for a minimum baseline funding uplift of 2% for 2026/27. The 2% uplift provides MIJB with an increased funding allocation on the recurring budget of £1.679 million. In addition, there is an estimated additional funding of £0.748 million for the increase in pay award settlement above the 2%. Formal agreement of the 2026/27 NHS Grampian financial plan was sought at its Board on 19 March 2026. 5.7 The table below summarises the additional funding provided to Integration Authorities by Scottish Government that is passported through both Moray Council and NHS Grampian and additional partner allocations. Page 58
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Route Scotland Wide Allocation Moray IJB Share £m £m £13.45 – uplift for Adult Social Care Staff Council 160.0 2.927 £13.45 – uplift for Children’s Social Care Staff Council 22.0 0.201 Additional funding for RLW * Council 20 0.274 Free Personal & Nursing Care Council 7.0 0.128 Children’s social work Council 0.186 Moray Council additional funding for pay award Council 0.227 Moray Council pressure for RLW shortfall Council 0.200 NHS increase in base funding by 2% NHS 1.679 NHS additional funding for pay award NHS 0.748 Total Additional Allocation 6.570 * Scottish Government announced an extra £20m relating to RLW after the budget was set, in response to queries that the RLW funding was not sufficient and is estimated ( this also includes funding for early learning and childcare, which is not included in the moray figure above). MIJB Funding 2026/27 5.8 The MIJB has a responsibility under the Public Bodies (Joint Working) (Scotland) Act 2014 to set its revenue budget by 31 March each year. The funding of the MIJB revenue budget in support of the delivery of the Strategic Plan is delegated from NHS Grampian and Moray Council. The allocated funding is summarised below: £ M NHS Grampian (recurring 2025/26) 102.089 NHS Grampian – Set Aside Services 20.092 NHS Grampian – 2% increase in base 1.679 NHS Grampian – additional funding for pay award 0.748 Moray Council – Core ** 89.347 Moray Council Children’s Social Work – Service development 0.186 Moray Council - Budget pressure for RLW shortfall 0.200 Moray Council – Improvement Grants* 0.951 Moray Council – SG additional funding (share of £189m) 3.255 Moray Council – SG additional funding for pay award 0.227 Moray Council – SG additional RLW funding (share of £15m) 0.274 PARTNER MIJB FUNDING 2026/27 219.048 * Improvement Grants includes £0.451 million which requires to be ring-fenced as it relates to council house tenants. ** Children’s services includes £3.402 million which required to be ring-fenced as it relates to the joint Out of Area budget which remains in the Council. Page 59
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Hosted Services 5.9 Within the scope of services delegated to the MIJB are hosted services. Budgets for hosted services are primarily based on the National Resource Allocation Formula (NRAC). Hosted services are operated and managed on a Grampian-wide basis. Hosting arrangements mean that one IJB within the Grampian Health Board area would host the service on behalf of all 3 IJB’s. Strategic planning for the use of the hosted services is undertaken by the IJB’s for their respective populations. 5.10 The 2026/27 budget for Moray’s share of all hosted services is £5.801 million as detailed below. £ M Hosted by Aberdeen City IJB Intermediate Care 1.024 Sexual Health Services 0.591 Hosted by Aberdeenshire IJB Marie Curie Nursing 0.201 Heart Failure Service 0.073 Continence Service 0.153 Diabetes MCN including Retinal Screening 0.256 Chronic Oedema Service 0.049 HMP Grampian 0.624 Police Forensic Examiners 0.393 Hosted by Moray IJB GMED Out of Hours 2.312 Primary Care Contracts 0.125 TOTAL MORAY HOSTED SERVICES 5.801 Large Hospital Services (Set Aside) 5.11 Budgets for Large Hospital Services continue to be managed on a day-to-day basis by the NHS Grampian Acute Sector and Mental Health Service, however the MIJB has an allocated set aside budget, designed to represent the consumption of these services by the Moray population. The MIJB has a responsibility in the joint strategic planning of these services in partnership with the Acute Sector. £ M General Medicine 9,847 Geriatric Medicine 1,955 Rehabilitation Medicine 154 Respiratory Medicine 371 Palliative Care 196 A & E Inpatient 195 A & E Outpatient 5,344 Learning Disabilities 410 Psychiatry of Old Age 34 General Psychiatry 1,586 TOTAL SET ASIDE BUDGET 20,092 Page 60
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Budget Pressures 5.12 Budget pressures are a major consideration for the MIJB and are an intrinsic part of the budget setting process. The additional funding highlighted in the Scottish Government budget for health and social care is welcomed and will be required to support expected budget pressures arising for adult and children’s social care uplift of £13.45 for externally commissioned services and free personal and nursing care. In previous years, both Moray Council and NHS Grampian would have supported some elements of inflation through their budget setting process, taking cognisance of the budget setting protocol agreed by the MIJB on 14 December 2017 (para 15 of the minute refers). However, given the difficult budget settlement for Local Authorities, Moray Council are passporting through the Scottish Government additional investment funding and have agreed to fund the pay award over and above the 2% for adult social care as well as an extra £0.200 million funding for the shortfall in the RLW. For NHS Grampian, there is a Scottish Government requirement to increase base funding for pay and non pay inflation of 2% for the IJB. NHS Grampian are also funding the pay award over and above the 2%. There is also an expectation as we continue to re-mobilise and transform, that there will be budget pressures arising in relation to what is described as the recurring deficit. There will be budget pressures arising during the year that are not yet known and these will be reported and escalated once quantified. The identified cost pressures below are based on estimates and remains an ongoing consideration in the financial planning. The table below outlines the anticipated budget pressure the MIJB needs to address in the forthcoming financial year: £’M BUDGET PRESSURES Pay Inflation 3.265 Non Pay Inflation 1.698 Contractual Inflation & Scottish Living Wage 3.231 Prescribing & Community Pharmacy 1.708 Children in Transition 1.293 Mental Health complex clients 0.603 Recurring Deficit 4.394 Hosted services 0.067 National Care Home Contract (NCHC) uplift 1.095 Free Personal & Nursing Care (FPNC) uplift 0.075 Occupational therapy equipment 0.042 Physio costs 0.208 Continuing Care placements 1.257 Other 0.118 TOTAL BUDGET PRESSURES 19.054 5.13 In March 2024 following agreement at the Convention of Scottish Local Authorities (COSLA) Leaders, the Scottish Government wrote to Integration Authorities providing details of the pay uplift that would apply to staff providing direct care within Adult and Children’s Social Care in commissioned services. The Scottish Government settlement for 2026/27 includes funding to support retention and to continue to embed improved pay and conditions for care workers, requiring local Page 61
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government to deliver a £13.45 minimum pay settlement for adult and children social care workers in commissioned services. This will cost in the region of £3.563 million, Scottish Government funding does not fully cover this cost and Moray Council has allocated a £0.2 million pressure towards a gap of approx. £0.435 million. 5.14 £1.095 million is included as a budget pressure for the National Care Home Contract (NCHC), based on the Scottish Government and COSLA’s current proposal on the increase for 2026/27. This will be partly funded from the additional funding mentioned above for the £13.45 per hour, again noting that the funding allocated does not fully cover the cost. 5.15 Budget pressure for Free Personal Nursing Care (FPNC) is also to be funded from the Scottish Government as part of the £7 million additional funding agreed as part of the settlement for 2026/27. 5.16 With funding being provided by Scottish Government for some elements listed above, totalling £6.57 million, which gives a net budget pressure of £12.672 million. 5.17 Prescribing pressures continue to grow, with a current 11% increase in overall costs. Details of this budget for 2026/27 is attached at Appendix 3. Savings Plan 5.18 It is the Moray IJB strategy that sets out the programme of transformation and improvement. The vision for Moray IJB Strategy is that “we come together as equal and valued partners in care to achieve the best health and wellbeing possible for everyone in Moray throughout their lives. The 3 themes within the strategy are: • Homefirst – developing locality planning approach with the development of multidisciplinary teams and initiatives including discharge to assess, crises support, rehabilitation, re-ablement and recovery, housing, adaptations and technology. Building based to community services. • Building resilience – developing Making Every Opportunity Count, self management, prevention, personal responsibility, social prescribing. • Partners in care- developing care and support planning, support for unpaid carers, self directed support (SDS), realistic medicine, long term conditions, palliative/end of life, market – shaping strategies. 5.19 Our outcomes continue align with the National Health and Wellbeing Outcomes (9): • Lives are healthier • People live more independently • Experiences of services are positive • Quality of life is improved • Health inequalities are reduced • Carers are supported • People are safe Page 62
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• The workforce continually improves 5.20 The Moray Joint Strategic Needs Assessment (JSNA) was refreshed in 2024 to analyse the needs of the local population to inform and guide the commissioning of health, wellbeing and social care services within Moray. The main goal of the JSNA is to accurately assess the care needs of a local population in order to improve the physical, mental health and wellbeing of individuals and communities. 5.21 The Strategy understands that the building blocks of health and wellbeing include: employment, housing, education and skills, childhood experiences, economic stability, healthcare, social and community requirements. It also sets out that the MIJB are working within a context of competing priorities - cost savings, reducing demand on hospitals, better experiences and outcomes for people who use health and care services, improved service alignment/integration, developing population health and prevention at scale, including wellbeing and tackling inequalities. 5.22 A change in focus for Moray is required to deliver improved care and better outcomes, ensuring sustainability for the future, rather than to deliver cost savings only in the short term. The health and care system is often seen as hospital focused, however an integrated and holistic response is required that encompasses community assets. This requires a system with increased generalism and multidisciplinary teamworking, with practitioners able to hold risk and enable people to live healthily in their communities, with a focus on prevention and reablement. A community focused health and care system prioritised to local need and individualised support is most effective where that support maximises independence. 5.23 The budget setting for 2026/27 includes the continuation of the 2025/26 saving plan, which was initially set over 2 financial years, this gives a total of £3.760 million that is planned to be achieved in 2026/27. New savings proposals totalling £1.958m have been identified for being achievable in 2026/27. Ongoing meetings of the Chief Officer and the Senior Management Team, along with service managers have taken place, given savings identified to date, it remains extremely challenging to identify additional savings to support the 2026/27 budget setting process. The proposed savings being presented today are provided following discussion at the recent MIJB Development session on 18 February 2026. Given that each separate decision made when setting the budget may impact on the lives of people with protected characteristics, the importance of the cumulative impact on the decisions being taken is recognised, including the cumulative impact of service changes and unintended consequences on communities where multiple organisations might have reduced savings. 5.24 In addition to savings identified, 4 proposals have identified efficiencies totalling £1.085 million. These efficiencies will negate the additional growth and demand on current services. These proposals relate to review of short breaks, review of internal care at home services, enabling proportionate care and support and implementing medicines management. Page 63
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5.25 There is still a focus and commitment around identifying further in-year savings and savings for future years that will be brought back before the MIJB for approval to ensure future years budgeting is robust. MIJB and the Senior Management Team are acutely aware of the challenges they face surrounding both its people and financial resources which remains a focus within decision making. Financial and staffing impacts will be monitored on an individual savings basis and scrutiny will be provided through the agreed governance structure. The savings have been RAG-rated (i.e. provided with a Red, Amber, Green risk level) on the basis of the savings being achieved with particular reference to political environment; staff and changes in services; capacity; engagement and processes i.e. HR, procurement etc. With this in mind, 16 are green status, 14 are amber status and 4 are red status. 5.26 The table below summarises the progress made by the Health and Social Care Moray management team in identifying opportunities for efficiency/savings, which fall under the 3 themes of the MIJB strategy and a fourth heading of savings already implemented. Areas under each theme are detailed in Appendix 2. Close monitoring of progress will be undertaken via a range of operational financial governance controls, including the Budget Sustainability Oversight Group and will be reported on a quarterly basis during 2026/27. 5.27 Para Ref 2026/27 £ M Projected carried forward from 2025/26 Building resilience 5.28 1.504 Home first 5.29 0.270 Partners in care 5.30 0.651 Savings already implemented 5.31 1.335 Subtotal Projected Savings 3.760 Projected Savings 2026/27 Building resilience 5.32 0.453 Home first 5.33 0.009 Partners in care 5.34 0.546 Savings already implemented/enablers 5.35 0.950 Subtotal Projected Savings 1.958 Total Projected Savings 5.718 5.28 Building resilience covers 6 proposals, predominantly with a RAG status of green. These proposals cover review and redesign of services: GMED (hosted service for Grampian, led by Moray); SDS recovery; relocation/ reduction of lease of buildings and use of pool cars. There is 1 proposal that has a RAG status of red for the removal of locums and 1 proposal that has a RAG statue of amber for the review of care and care commissioning, this is reviewing all care packages and the use of spot purchasing. These proposals although challenging will be achievable, a total of £1.504 million is expected to be achievable in 2026/27. Of which £1.254 million is recurring and £0.250 million is non recurring. Page 64
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5.29 Home first covers 3 proposals; of these proposals 1 has a RAG status of green for community hospital redesign, to ensure services are fit for purpose and 2 have a RAG status of amber and relate to the review of respite provision and the review/redesign of the Learning disability nighttime model of care delivery and in conjunction with our home first priority to ensure people are looked after in their own homes as safely as possible. These proposals although challenging will be achievable, a total of £0.270 million recurring saving is the expectation this financial year. 5.30 Partners in care covers 6 proposals, 2 of which have a RAG status of green and relate to prescribing efficiencies and implementation of the review of the North East Sensory Service (NESS) contract. 4 proposals have a RAG status of amber relating to review of service for day services and adult services; review of step down building based facilities; review of the transport contract for children’s & justice service and adult services and review of palliative care services. These proposals although challenging will be achievable, a total of £0.651 million recurring saving is expected to be achieved in 2026/27. 5.31 There are 4 plans that have already been implemented and savings taken in 2026/27. 2 plans were for 1 year initially and have been reviewed for the next financial year to continue, which relate to no non-essential travel and no non- essential training and vacancy target. The other 2 plans are the reduction in overtime and vacancy target. These proposals total £1.335 million all achievable in 2026/27 ( £1.295 million recurring and £0.04 million non recurring). 5.32 Building resilience covers 3 proposals, 2 of which have a green RAG status and relate to the Children, Families and Justice review of service delivery and family contacts. 1 proposal is red for review of adults out of area and ordinary residence. These proposal totals £0.453 million recurring savings expected to be achieved in 2026/27. 5.33 Home first covers 1 proposal which has a green RAG status for the review of purchasing hospital beds for the community. This will achieve a recurring saving of £0.009 million in 2026/27. 5.34 Partners in care covers 8 proposals majority of which have a green RAG status, these relate to the nutritional prescribing, review of nursing equipment/stock, review of the skill mix in GMED, review of very sheltered housing provision and review of commissioned contract for children and families. There are 2 amber RAG status relating to the review of the clinical leadership provision and review of out of area care and return to local community (including emergency transport) arrangements for children, families and justice services. There is 1 red RAG status relating to the review of the provision of minor surgery service. These proposals total £0.546 million recurring savings. 5.35 Savings Already implemented/ enablers covers 2 proposals, 1 of which is amber RAG status that relates to the cessation of interim management arrangements and 1 which is red relating to the review of the contributions policy and income maximisation. These proposals total £0.950 million recurring savings and although challenging will be achieved in 2026/27. Page 65
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Financial Risks 5.36 The budget assumptions made within this report carry a degree of financial risk, meaning that variations that may arise will impact on financial performance. Acceptance of risk is a necessary part of the budget setting process. The main risks are summarised: • Financial Settlement – the 2026/27 financial settlement is for one year only and the increased level of funding is required to meet policy commitments as determined by Scottish Government. There is no inflationary increase for children’s or adult social care provided by Moray Council, but for NHS Grampian there is the agreement of a 2% increase in pay and non pay inflation. A provision has been made for Local Authority and NHS Grampian pay increases, as both the NHS Public Sector Pay Policy and Local Authority pay award increases were part of a two year deal , with additional funding being received for the percentage above 3% being passported through to the MIJB. Whilst the benefits of longer-term financial planning are well documented in assisting the delivery of strategic priorities, at this stage, financial planning is subject to continuous change and there is a need to adapt to the changing landscape. • The budget pressures identified in paragraph 5.12 are based on continued discussion and assessment and through monitoring, this process is reasonably accurate. However, there remains the risk in the event that inflationary increases and demand driven pressures may exceed the anticipated cost. There is no provision for increases over and above the SLW payments for providers. • Prescribing costs are a large and volatile part of the MIJB budget with demographic changes a material contributing factor. Whilst the decisions to prescribe are made locally, the costs of drugs and agreements to introduce new drugs are made on a national basis. Provision in the budget has been made based on analysis undertaken by NHS Grampian with a range of options provided from Best Case to Best Prediction and Worst- Case scenario. MIJB are proposing the inclusion of the Best Prediction scenario with the associated pressure of this option. There is a risk associated with this option and the IJB will closely monitor this budget through regular reporting to the IJB throughout financial year 2026/27 and appropriate action taken to mitigate the pressure in year through continued close working with NHS Grampian, this is being reviewed not only across Grampian but nationally. • Demographic changes - the demographic profile of Moray continues to show a general rise in population with a specific increase in the age profile of the population. The associated challenges of providing care for a rising population where people live with multiple conditions are well known. These challenges manifest themselves in a financial sense when we experience issues such as rising numbers for social care packages and Page 66
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rising demand for aids, adaptations, and equipment. The increasing level of complexity of need for some of our clients means that high-cost care packages may arise during the year for which we have not budgeted. The same applies to patients who need out of area care and where a clinical decision has been made that this is in their best interests. • In Primary Care there continues to be a number of continuing challenges around sustainability of some of our GP Practices with inability to recruit General Practitioners a common issue. This has necessitated the Partnership providing support and investment to maintain GP services in some parts of Moray. We will continue to use the Primary Care Improvement Fund and other funding streams to support General Practices and wider Primary Care teams across Moray. • The savings identified are challenging to achieve fully in the year - the risk of achieving the savings has been calculated based on the RAG status, with green assuming will be 90% achieved, amber 80% and red 70% respectively. Using this assumption the savings for 2026/27 could be £4.734 million, leaving a risk of a potential funding gap, which would have to be borne by the partners of £1.074 million. All endeavours will be undertaken to ensure delivery where possible, including identifying additional savings in year to ensure savings target is achieved. The Chief Officer and Chief Financial Officer will continue to work within the tri- partite approach with finance colleagues in both Moray Council and NHS Grampian. The implementation of savings also presents an opportunity to redesign services collaborating with staff and communities. 5.37 Accounts Commission have released an IJB Finance bulletin 2024/25 on 26 February 2026 which was prepared by Audit Scotland. This summarises the position for all the IJBs in Scotland and is attached at Appendix 4. This provides background information and clarification that the issues facing MIJB are affecting all IJBs. One of the key messages from this publication is around the need for IJB’s to make difficult decisions about how services are delivered, determine the appropriate level of services, and decide where to redesign, reduce or discontinue services. The funding gap in 2025/26 remains significant at £449 million for all IJB’s, IJB’s must work closely with partners to ensure budgets and savings plans are realistic and to identify solutions that will ensure services remain financially sustainable over the medium to long term. Reserves Policy 5.38 The MIJB has previously considered the purpose and use of reserves and approved its initial Reserves Policy at a meeting of the Board on 31 March 2016 (para 12 of the minute refers), updates being prepared for consideration and approval on 25 January 2018 (para 7 of the minute refers) and each year thereafter. A further review was due no later than March 2026. 5.39 The MIJB Reserves Policy has been reviewed and it remains extant with no requirement for any amendments at this current time and is presented as Appendix 6 to this report Page 67
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5.40 The Reserves Policy outlines the importance of holding reserves for the long term financial stability of the MIJB to manage pressures from year to year. The MIJB Integration Scheme highlights the process to be followed in circumstances where it is anticipating an overspend position in that uncommitted reserves would firstly be used to address any overspend. With the Scheme in mind, there has only been ear marked reserves by the end of the financial year as the MIJB has not held any uncommitted general reserves for a significant period. 5.41 Given the financial situation of the MIJB, it is unlikely it will give rise to any general reserves over the next few years. Whilst it is necessary to ensure that the reserves policy is kept under review, the next review will be no later than March 2028. 6. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan 2022 – 2032, ‘Partners in Care’ The approval of a balanced budget for the MIJB is key to the delivery of health and social care services in Moray in accordance with the Strategic Plan. (b) Policy and Legal In accordance with the Public Bodies (Joint Working) (Scotland) Act 2014, MIJB is subject to the audit and accounts regulations and legislation of a body under Section 106 of the Local Government (Scotland) Act 1973 and is classified as a local government body for accounts purposes by the Office for National Statistics. (c) Financial implications The 2026/27 revenue budget (excluding Set Aside) as detailed in Appendix 1 is £213.674 million. The funding allocated to the MIJB by Moray Council and NHS Grampian and through the Partner bodies from Scottish Government totals £198.956 million (excluding Set Aside). In addition, the indicative savings plan for the forthcoming year totals £5.718 million. The notional Set Aside budget for Moray’s share of the Large Hospital Services is currently £20.092 million. The Set Aside budget is provided by NHS Grampian. A balanced budget is presented with additional deficit funding from the partners of £9 million, this will need to be funded in 2026/27. (d) Risk Implications and Mitigation The revenue budget for 2026/27 is subject to the following risks: • GP Prescribing – represents around 11% of the MIJB core budget. It is well documented that the Prescribing budget can be extremely Page 68
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volatile in nature with volume and price increases potentially leading to substantial adverse variances. • Growth and demand in the system, together with service users with complex care needs are attracting additional financial challenge. These issues require to be managed within the overall resource of the MIJB. • The need to transform at pace and drive forward opportunities arising through changes to working practice experienced through the pandemic. The risk being the ability to capture and embed in a timely manner. • National Care Home Contract for 2026/27 has been proposed by COSLA and Scottish Government and whilst this will be partly funded from Scottish Government funding for the £13.45 per hour, this will not fully fund the increase once agreed. • The implications of the cost-of-living crisis and current levels of inflation, which although are now forecast to decrease continuing cost increases may mean the provision for inflation may not cover all the calls upon it. Price inflation may impact on areas where no provision has been made for inflationary increase and this will add pressure to budgets. Budget managers will need to control their expenditure to absorb such pressure if possible and may have to reduce service levels or identify further savings. • This report highlights the anticipated budget pressures at paragraph 5.12. It will be necessary to note that budget pressures may exceed allocation. This will be closely monitored and reported accordingly to the MIJB as part of the budget monitoring reports. • With the level of savings required to balance the budget there is a risk that the budget may not be achieved in line with expectations for 2026/27. Based on the rag status as in para 5.27, there is a risk of not achieving the savings in this financial year of £1.074 million, for which alternative savings in year will be identified to ensure there is no requirement for the deficit to be borne by the partners of the MIJB. (e) Staffing Implications There are no direct implications in this report. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact Integrated Impact Assessments relating to the new savings proposals as detailed in para 5.26 and Appendix 2, are attached in Appendix 2A. For proposals agreed at this meeting, these dynamic documents will be Page 69
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reviewed and any subsequent changes to policy arising from proposals made within this paper will be updated as appropriate. (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 Directions are detailed in para 5.1 above and in Appendix 5. (j) Consultations The Chief Officer, Health and Social Care Moray Senior Management Team, Operational Management Team, Corporate Manager, Chief Finance Officer (Moray Council), Director of Finance NHS Grampian, the finance teams of both Moray Council and NHS Grampian, and Caroline O’Connor, Committee Services Officer and any comments made been incorporated into the report. 7. CONCLUSION 7.1 Legislation requires the MIJB to set its Revenue Budget for the forthcoming year by 31 March each year. The budget displays a balanced position. The Section 95 Officer as Chief Financial Officer to the Board recommends the budget as presented at Appendix 1. 7.2 Close monitoring of the continuing effects of the increasing demands on services will be required in order to ensure the MIJB can remain within the funding allocation provided by NHS Grampian and Moray Council. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: with author Ref: Page 70
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APPENDIX 1MORAY INTEGRATION JOINT BOARD JOINT FINANCE REPORT APRIL 2026 -MARCH 2027 Para Approved Annual Ref Net Budget £'s 2026-27 Community Hospitals 7,024,088 Community Nursing 6,386,040 Learning Disabilities 21,049,105 Mental Health 12,297,203 Addictions 1,366,141 Adult Protection & Health Improvement 285,475 Care Services provided in-house 25,106,408 Older People & PSD Services 28,312,640 Intermediate Care & OT 1,988,554 Care Services provided by External Contractors 2,157,636 Other Community Services 10,356,678 Admin & Management 1,587,164 Other Operational Services 1,331,347 Primary Care Prescribing 21,392,216 Primary Care Services 22,462,218 Hosted Services 5,800,818 Out of Area 1,780,000 Improvement Grants 950,804 Childrens Services 21,196,964 Total Moray IJB Core 192,831,500 Other recurring Strategic Funds in the ledger 1,789,097 Total Moray IJB Including Other Strategic funds in the ledger 194,620,597 Other resources not included in ledger under core and strategic: 19,053,686 Total Moray IJB (incl. other strategic funds) and other costs not in ledger 213,674,283 Set Aside Budget 20,092,000 Overall Total Moray IJB 233,766,283 Funded By: NHS Grampian 129,377,763 Moray Council 98,670,520 Savings identified 5,718,000 Use of ear marked reserves 0 IJB FUNDING 233,766,283 Page 71
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APPENDIX 2 MIJB Budget 2026/25 MIJB proposed savings Ref Service Brief Description Full year effect £000s Saving expected for 2026/27 Saving likely to be achieved in 2026/27 Saving likely to be achieved in 2027/28 Saving likely to be achieved in 2028/29 Planned Implementation Date Risk Level BR 4 &5 Removal of locum costs Cease the use of locums 950.00 450.00 450.00 500.00 Oct-26 Red BR 8 GMED redesign GMED redesign of clinical & admin staffing model 110.00 28.00 28.00 82.00 Dec 26 Green 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-26 Green BR 10,12 Cessation of leases and relocation Cessation of Strathisla dental practice lease 6.00 6.00 6.00 Apr-26 Green BR 14 & 15 Review of Care and Care Commissioning spot purchasing & review care packages 750.00 750.00 750.00 Apr-26 Amber BR 42 SDS recovery (non recurring) Review packages to increase recovery 250.00 250.00 250.00 Apr-26 Green BR 53* New Redesign Complex & Challenging Behaviour Review of Adults Out of Area and Ordinary Residence 200.00 200.00 200.00 Apr-26 Red BR 61* new Children, Families and Justice review of service Redesign service delivery 223.00 223.00 223.00 Apr-26 Amber BR 62* new Children, Families and Justice review of service Review of family contacts 30.00 30.00 30.00 Apr-26 Amber HF 16 Short Breaks provision Review into planned and emergency short breaks - change in model 200.00 200.00 200.00 Apr-26 Amber HF 20 Community hospital redesign Redesign of inpatient services supporting Home First 50.00 50.00 50.00 50.00 700.00 Apr-26 Green HF 18 Night Time Responder (LD) Redesign LD nighttime model of care delivery 20.00 20.00 20.00 Apr-26 Amber HF 51* new Operational model redesign Review of purchasing end of life palliative care equipment 9.00 9.00 9.00 Apr-26 Green Page 73
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APPENDIX 2 PIC 21,24 Day Services review Review of day service provision 151.00 151.00 151.00 Apr-26 Amber PIC 28 Review of step down building based facilities Review into model of care 49.00 49.00 49.00 Apr-26 Amber PIC 30 Prescribing efficiencies -GP Medication cessation,switches within GP services and work with Care Homes 65.00 65.00 65.00 Apr-26 Green PIC 55*new Nutritional prescribing - dietetic led Transformation of oral nutrititional support (ONS) pathways in Moray 50.00 50.00 50.00 Apr-26 Green PIC 33 Transport contract Review contracts for transport for childrens and adult services 212.00 212.00 212.00 400.00 Apr-26 Amber PIC 46 Review of palliative care services Review of provision of palliative care in Moray to improve outcomes 44.00 44.00 44.00 44.00 Apr-26 Amber PIC 52* new Review of very sheltered housing Review of provision of very sheltered housing 153.00 153.00 153.00 Apr-26 Green PIC 50 Review of North East Sensory Services contract Bringing service in house 130.00 130.00 130.00 Apr-26 Green PIC 56* new Review of nursing equipment Review of Nursing equipment/stock to rationalise/centralise 100.00 100.00 100.00 Apr-26 Green PIC 57* new GMED skill mix review Review of skill mix within GMED 38.00 38.00 38.00 Apr-26 Green PIC 58* new Review of clinical leadership provision Review of provision 60.00 40.00 40.00 20.00 Aug-26 Amber PIC 59* new Minor Surgery Review of provision 70.00 70.00 70.00 Apr-26 Red PIC 60* new Redesign of Children, Families and Justice Review of Commissioned contracts 25.00 25.00 25.00 Apr-26 Green PIC 63* new Redesign of Children, Families and Justice Review of out of area care and return to local community including emergency transport arrangements 70.00 70.00 70.00 Apr-26 Amber AI 44 Reduction in overtime reduce the amount spent on overtime during the year 50.00 50.00 50.00 Apr-26 Amber AI 38 No non-essential travel (non recurring) Non essential travel ban (out of area) 30.00 30.00 30.00 Apr-26 Green AI 38 No non-essential training (non recurring) Non essential training ban (conference attendance etc) 10.00 10.00 10.00 Apr-26 Green AI 41 Vacancy target NHS & increase on Council in line with pay award increase Already implemented 1,245.00 1,245.00 1,245.00 Apr-26 Green Page 74
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APPENDIX 2 AI 64* new Cessation of interim placements Stop all interim arrangements and review staffing for integrated working 450.00 450.00 450.00 Apr-26 Amber AI 54* new Review of contributions policy & charges Review of policies & income maximisation 500.00 500.00 500.00 Apr-26 Red TOTAL 6,320.00 5,718.00 5,718.00 1,096.00 700.00 KEY BR BUILDING RESILIENCE 2,539.00 1,957.00 1,957.00 582.00 - HF HOME FIRST 279.00 279.00 279.00 50.00 700.00 PIC PARTNERS IN CARE 1,217.00 1,197.00 1,197.00 464.00 - AI ALREADY IMPLEMENTED 2,285.00 2,285.00 2,285.00 - - 6,320.00 5,718.00 5,718.00 1,096.00 700.00 ** ** Of which 3 proposals are non recurring, valuing £290,000 Page 75
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APPENDIX 2A TABLE OF CONTENTS 51. Change to procurement process for palliative care equipment ............................... 2 52. Cease Housing Support Payments for Very Sheltered Housing Services .................. 8 53. Review of Adult Out of Area and Ordinary Residence Packages ............................ 15 54.Review of contributions and charging policies for health and social care services . 23 55. Nutritional Prescribing ...................................................................................... 30 56. Supplies and Procurement ................................................................................ 42 57. GMED Skill Mix Review ...................................................................................... 48 58. Review of Clinical Leadership provision .............................................................. 53 59. HSCM Minor Surgery ......................................................................................... 58 60. Review of Commissioned contracts – Childrens services .................................... 65 61. Re-design of childcare social work teams: .......................................................... 70 62. Accommodation Review – Social Work Office Community Hub ............................ 75 63. Review of OOA Care and Return to Local Community .......................................... 83 64. Cessation of all interim management arrangements ........................................... 92 Page 77
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2 INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 10/03/26 First draft completed for proposed change to procurement route for end of life and palliative care equipment. 1.0 10/03/2026 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 51. Change to procurement process for palliative care equipment Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? X Budget proposal? X Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. X Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them X Does your proposal impact on the human rights of people? X Does your proposal impact on the rights of children and young people X Reasoning Briefly describe your reasoning for the responses given above: Page 78
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3 The changes to the procurement of profiling beds, mattresses and commodes achieves at least £9.3k per annum via Moray Council VAT reclaim. There is no change for the person receiving care so minimal consideration required for equalities, socio-economic and human rights. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Lesley Attridge Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Date 10/03/26 Page 79
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4 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: 2. Who are your main stakeholders? 3. What changes as a result of the proposals? Is the service reduced or removed? 4. How will this affect your customers? 5. Impact on staff providing the service 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race No. Disability No. Carers (for elderly, disabled or minors) No. Sex No. Pregnancy and maternity (including breastfeeding) No. Sexual orientation No. Age (include children, young people, midlife and older people) No. Religion, and or belief No. Gender reassignment No. Inequalities arising from socio-economic differences No. Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security N/A Article 6: Right to a fair trial N/A Article 8: Right to respect for private and family life, N/A Page 80
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5 List of convention rights Describe, where applicable, if and how specific rights are engaged correspondence and the home Article 10: Freedom of expression N/A Article 11: Freedom of assembly and association N/A Article 12: Right to marry N/A Article 14: Prohibition of discrimination (in relation to the convention rights) N/A Article 1 of Protocol 1: Protection of property N/A Article 2 of Protocol 1: Right to education N/A Article 3 of Protocol 1: Right to free elections by secret ballot N/A Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination N/A Article 12 – Respect of the views of the child N/A Article 3.1 – Best interest of the child N/A Article 6.2 – Right to survival and development N/A 7. Evidence. What information have you used to make your assessment? Performance data N/A Internal consultation N/A Consultation with affected groups N/A Local statistics N/A National statistics N/A Other Page 81
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6 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? Page 82
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7 SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child: 4. Negative impacts can be mitigated the proposals as outlined in question 9. 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. 7. It is advised not to go ahead with the proposals. Decision Date of Decision: Sign off and authorisation: Service Department Policy/activity subject to IIA Review of Palliative Care Services We have completed the integrated impact assessment for this policy/activity. Name: Lesley Attridge Position: Locality Manager Date: 10/03/26 Authorisation by head of service Name: Sean Coady Position: Head of Service Date: 10/3/26 Permission to publish on website - Page 83
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8 INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS Insert Date (e.g. 03/10/2023) Add brief notes/highlight which section amended (e.g. first draft of IIA completed and submitted to SFC 25/10/2023 for consideration; noting that further work on Stage 2 will be required). Insert (ShP) Version Info (when details have been agreed) (e.g. 5.0 03/10/2023 11:21 AMcL) STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 52. Cease Housing Support Payments for Very Sheltered Housing Services Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? X Budget proposal? X Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. X Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them X Does your proposal impact on the human rights of people? X Page 84
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9 Does your proposal impact on the rights of children and young people X Reasoning Briefly describe your reasoning for the responses given above: Ceasing the Housing Support Payment may affect how housing‑related support services are funded and delivered within very sheltered accommodation for older people. While no personal care is provided as part of this service, changes to service charges or communal and emergency support arrangements could disproportionately affect older and disabled tenants, many of whom may be on fixed incomes. These potential impacts are considered further at Stage 2. Children’s rights are not engaged, as the proposal relates solely to accommodation for older people. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Date Page 85
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10 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: The service relates to very sheltered housing accommodation for older people, providing housing‑related support through communal facilities, emergency response arrangements, and on‑site or telecare‑based support. The accommodation is designed to promote safety, independence and social connection for older tenants. No direct personal care is delivered as part of this service; care and support are provided separately based on assessed need by commissioned care providers. There is a 24hr community alarm in place. 2. Who are your main stakeholders? • People living as tenants in each complex • Unpaid carers; families; and those with a recognised right to represent a persons’ interests i.e. proxies, legal guardians, invoked power of attorneys, advocacy services • Hanover Scotland • Moray Local Authority • Health and Social Care Moray (including Self-Directed Support Service) • NHS Grampian and Allied Services 3. What changes as a result of the proposals? Is the service reduced or removed? The proposal would cease the Housing Support Payment to the landlord for very sheltered housing services. Responsibility for funding housing‑related services would rest with the landlord through existing rent and service charge arrangements. The Council would no longer make a direct financial contribution to these services. 4. How will this affect your customers? The proposal may result in changes to the way housing‑related services are funded or delivered within very sheltered accommodation. While the accommodation and separately commissioned care services will remain in place, any changes to service charges or communal services may affect some tenants depending on individual circumstances. Clear communication and appropriate mitigation will be required. 5. Impact on staff providing the service Page 86
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11 The landlord will review their service provision and determine how best to proceed to meet their duties. 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race Not specifically impacted Disability Tenants are predominantly older people, many of whom are disabled or have age‑related impairments. Any increase in service charges or reduction in housing‑related support may disproportionately affect disabled tenants, particularly those with limited income or mobility. Carers (for elderly, disabled or minors) Carers may be affected indirectly if changes to housing‑related services increase reliance on informal support. Any impacts will depend on individual circumstances. Sex Not specifically impacted Pregnancy and maternity (including breastfeeding) Not specifically impacted Sexual orientation Not specifically impacted Age (include children, young people, midlife and older people) The service primarily supports older people. Changes to housing‑related services or affordability may have a greater impact on tenants’ independence, wellbeing, and ability to remain living safely in their own homes. Religion, and or belief Not specifically impacted Gender reassignment Not specifically impacted Inequalities arising from socio- economic differences Many tenants may be on fixed or limited incomes. Increases in service charges could create financial pressure and affect affordability, which may disproportionately impact this group. Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Page 87
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12 List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security Not engaged Article 6: Right to a fair trial Not engaged Article 8: Right to respect for private and family life, correspondence and the home Engaged. The proposal may affect tenants’ enjoyment of their home if changes are made to housing‑related services or service charges. Any such impacts must be proportionate, justified, and mitigated to support older tenants to remain safely and securely in their accommodation. Article 10: Freedom of expression Not engaged Article 11: Freedom of assembly and association Not engaged Article 12: Right to marry Not engaged Article 14: Prohibition of discrimination (in relation to the convention rights) Engaged in relation to Article 8. The proposal must be implemented in a way that does not disproportionately disadvantage older or disabled tenants. Article 1 of Protocol 1: Protection of property Not engaged Article 2 of Protocol 1: Right to education Not engaged Article 3 of Protocol 1: Right to free elections by secret ballot Not engaged Children’s Rights and Wellbeing Relevant articles – UNCRC Children’s rights are not engaged, as the proposal relates solely to very sheltered housing services for older people. Article 2 – Non discrimination Article 12 – Respect of the views of the child Article 3.1 – Best interest of the child Article 6.2 – Right to survival and development 7. Evidence. What information have you used to make your assessment? Page 88
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13 Performance data Performance data available Internal consultation Budget setting process, OMT, workshops Consultation with affected groups Comms gone out re budget position via social media etc. Landlord consultation completed re what tenants feel about the services they receive Local statistics Performance data available National statistics Performance data available Other Meeting with Landlord has taken place Meeting with other Local Authority in similar situation have taken place 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? No 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain Potential impacts will be mitigated through engagement with the landlord to understand how housing‑related services will continue to be delivered and how any changes to service charges will be managed. Clear communication with tenants will be required, alongside consideration of affordability, equality impacts, and the availability of alternative support where appropriate. 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? The proposal should proceed. Ceasing the Housing Support Payment clarifies the landlord’s responsibility for housing‑related services within very sheltered accommodation. While potential impacts on older and disabled tenants have been identified, these are considered capable of mitigation through appropriate engagement, communication, and oversight. The proposal is assessed as proportionate, subject to implementation that fully considers equality and human rights impacts. Page 89
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14 SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. The impacts relate to: Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child X 4. Negative impacts can be mitigated the proposals as outlined in question 9. X 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: The proposal should proceed. Ceasing the Housing Support Payment clarifies the landlord’s responsibility for housing‑related services within very sheltered accommodation. While potential impacts on older and disabled tenants have been identified, these are considered capable of mitigation through appropriate engagement, communication, and oversight. The proposal is assessed as proportionate, subject to implementation that fully considers equality and human rights impacts. Date of Decision: 24/07/25 Sign off and authorisation: Page 90
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15 Service Health and Social Care Moray Department Commissioning and Social Work Policy/activity subject to IIA Ceasing of Financial Support to Hanover Very Sheltered Housing We have completed the integrated impact assessment for this policy/activity. Name: Lesley Attridge Position: Locality Manager Date: 12/03/26 Authorisation by head of service Name: Sean Coady Position: Head of Service Date: 12/03/26 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 10.3.26 Update to V0.1 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 53. Review of Adult Out of Area and Ordinary Residence Packages Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? x Budget proposal? Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. x Page 91
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16 Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them x Does your proposal impact on the human rights of people? x Does your proposal impact on the rights of children and young people x Reasoning Briefly describe your reasoning for the responses given above: This proposal is guided by the principles of fairness, transparency, and strong governance. It aims to ensure that decisions are made consistently and responsibly, balancing individual rights and preferences with the equitable use of public resources. In line with the Coming Home Framework, the review supports people, often with complex needs, to live closer to home where appropriate. While some out-of-area placements are necessary due to specialist requirements, these must be regularly reviewed to ensure they remain person-centred and proportionate. The process recognises that individuals and families may have differing views, and that legal, financial, and ethical considerations, particularly around ordinary residence, must be carefully balanced. This approach reflects national policy expectations for ethical commissioning, person-led planning, and financial accountability. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Business Manager – Adults Services Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Operational Management Team Page 92
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17 Date 06.03.2026 Page 93
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18 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: Adult Social Work Teams in Older adult, mental health and Learning Disability services work to support individuals in their own homes, supported accommodation and Care Homes throughout Moray to live an independent life. In some cases there is a requirement to place a person outside of Moray as provision cannot be sourced locally. These packages often come at significant costs, regular uplifts and bring into question ordinary residence policies with outgoing and receiving authorities. This is not a blanket repatriation exercise. Each case will be reviewed individually, with decisions based on the person’s needs, preferences, and the ability of local services to meet those needs. 2. Who are your main stakeholders? People living with a disability, mental health condition, or age-related frailty—many of whom may have complex or specialist care needs. This includes individuals who require tailored support due to the nature or severity of their condition, as well as their families, carers, and the professionals involved in their care planning and delivery. 3. What changes as a result of the proposals? Is the service reduced or removed? While financial sustainability is a consideration, the primary aim of the review process is to ensure that care arrangements remain appropriate, equitable, and aligned with the individual’s current needs and preferences. There is a need to continue with enhanced monitoring programme and regularly review ordinary residence status. This will mean some people are brought back to Moray with their outcomes met locally as provision becomes available and circumstances of the individual alter over time. Enhanced review process to encourage relationship building but that can also cause additional workload for staff. 4. How will this affect your customers? • Individuals may experience changes to their care arrangements as part of the review process, which could affect their routines, relationships, or sense of stability. • Some people may prefer to remain in their current placement, even if a suitable local option becomes available. In these cases, ordinary residence responsibilities will need to be carefully considered. • Families may have differing views, and there is a risk that individuals or carers could feel under pressure to accept a change. • Clear, compassionate communication will be essential to ensure that people understand their options and that any changes are made safely and in line with their needs and preferences. Page 94
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19 • Advocacy and support will be offered, where appropriate, to ensure individuals and families are fully informed and supported throughout the review process. 5. Impact on staff providing the service An increase in workload is anticipated, as the review process will require more frequent and detailed assessments. Staff will need to engage in robust monitoring, coordination with partner agencies, and sensitive communication with individuals and families. Appropriate support and supervision will be important to manage this additional demand and maintain staff wellbeing. 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race No specific impacts are anticipated but cultural and communication needs will be considered during reviews. Disability x Carers (for elderly, disabled or minors) x Sex No differential impacts identified at this stage Pregnancy and maternity (including breastfeeding) No impacts anticipated based on current scope of the proposal Sexual orientation No impacts identified. Age (include children, young people, midlife and older people) x Religion, and or belief No specific impacts are anticipated but cultural and communication needs will be considered during reviews. Gender reassignment No specific impacts identified at this stage, but inclusive practice will be maintained. Inequalities arising from socio- economic differences There may be both positive and negative impacts. Returning to Moray could reduce travel costs and improve access to local support networks for some families. However, for others, a move could increase travel time and expenses, particularly if their current placement is closer to family or more accessible. These factors will be considered during individual reviews, and support options will be explored where appropriate. Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Page 95
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20 List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security People may feel deprived of their liberty due to potential reduced ability to take part in the wider community and may struggle with the initial change in their package. Mitigation will be careful consideration of changes and requirements and ongoing reviews. Article 6: Right to a fair trial Not engaged Article 8: Right to respect for private and family life, correspondence and the home Some people may not choose to come back to Moray and may feel a closer connection to their out of area community than familial bonds in Moray. This may be in conflict with family wishes. Mitigation will be careful and sensitive review processes. Article 10: Freedom of expression Not engaged Article 11: Freedom of assembly and association Not engaged Article 12: Right to marry Not engaged Article 14: Prohibition of discrimination (in relation to the convention rights) Decisions will be made in a way that avoids discrimination and ensures equitable treatment, in line with Article 14. Article 1 of Protocol 1: Protection of property Not engaged Article 2 of Protocol 1: Right to education Not engaged Article 3 of Protocol 1: Right to free elections by secret ballot Not engaged Children’s Rights and Wellbeing Relevant articles – UNCRC While this proposal relates to adult services, any individuals transitioning from childrens services will be considered on a case by cases basis to ensure continuity of care and uphold their rights. Article 2 – Non discrimination Article 12 – Respect of the views of the child Article 3.1 – Best interest of the child Article 6.2 – Right to survival and development 7. Evidence. What information have you used to make your assessment? Performance data x Internal consultation x Page 96
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21 Consultation with affected groups x Local statistics x National statistics x Other 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? No 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain Careful and sensitive review processes can help mitigate risks and reduce unintended stress or disruption. The individual’s preferences will be fully considered as part of a structured, person-centred approach. Out-of-area placements are not always more expensive than local provision, as this depends on the complexity and acuity of the individual’s needs. All high-cost packages are reviewed regularly, and this approach reflects wider efforts across service areas to ensure consistency and equity in decision-making. Where appropriate, advocacy services will be offered to ensure individuals are supported to express their views and participate in decisions about their care. 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? This is not a cost-cutting exercise, but a governance-led review to ensure equity, sustainability, and person-centred care across all placements. There is a requirement to ensure equity across the social care system, however all out of area placements are considered on a case by case basis due to the complex nature of their situation and will continue as such. SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. The impacts relate to: x Page 97
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22 Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010. Promoting equality of opportunity x Fostering good relations x 3. The proposals interfere with human rights and/or the rights of the child x 4. Negative impacts can be mitigated the proposals as outlined in question 9. x 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. x 6. Further consultation with affected groups is needed. 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: Proceeding with the proposed actions will support more equitable and sustainable care arrangements. The potential impacts identified can be mitigated through structured, person- centred review processes. If the proposal does not proceed, the risk of inequity and unmanaged financial pressure across the system will increase. Date of Decision: 10.03.2026 Page 98
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23 Sign off and authorisation: Service Social Care - Adult Services Department Adult Social Work Policy/activity subject to IIA Review of Out of Area and Ordinary Residence. We have completed the integrated impact assessment for this policy/activity. Name: Sonya Duncan Position: Corporate Manager Date: 10.03.2026 Authorisation by head of service Name: Sean Coady Position: Head of Adult Services Date: 10.03.2026 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 9.03.26 Review of contributions policy, charges and income maximisation 1.0 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 54. Review of contributions and charging policies for health and social care services Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? x Budget proposal? x Duties: tick the boxes you think apply No Maybe Yes Page 99
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24 Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. X Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them X Does your proposal impact on the human rights of people? X Does your proposal impact on the rights of children and young people X Reasoning Briefly describe your reasoning for the responses given above: The proposal involves reviewing contributions and charging policies for health and social care services, including the timing and application of charges following financial assessment. Charging policies have the potential to impact people with protected characteristics, particularly disabled people, older people, and those on low or fixed incomes. The proposal may also engage socio‑economic considerations and aspects of human rights, including respect for private life and the protection of property. These impacts are considered further at Stage 2. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Deborah O’Shea Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Finance Council, finance, Community Care finance, Locality Managers, service managers Mental health and Learning Disabilities. Date 9.03.2026 Page 100
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25 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: The policy sets out how financial contributions towards care and support services are assessed, applied, and collected. It covers non‑residential social care services and related charges, including financial assessment processes, invoicing arrangements, and mechanisms for review, appeal, and income maximisation. 2. Who are your main stakeholders? • People who use Health and Social Care services in Moray • Finance • Community Care Finance • Moray Council 3. What changes as a result of the proposals? Is the service reduced or removed? As a result of the proposal, charging policies and procedures will be reviewed, including the timing of charges following financial assessment and the application of minimum contributions. Some people may be required to make a financial contribution towards their care, based on their assessed ability to pay. Changes to invoicing processes aim to ensure charges are applied in a timely and transparent way, reducing the risk of large retrospective charges while maintaining appropriate safeguards. 4. How will this affect your customers? People using services may experience changes to how and when financial contributions are applied following assessment. For some individuals, this may result in earlier notification of charges, while for others there may be no change to the level of contribution required. Any changes will be informed by financial assessment, with protections in place to ensure minimum income levels are maintained. Clear communication, access to advice, and opportunities to query or appeal decisions will be essential to support fairness and understanding. 5. Impact on staff providing the service Potential changes to policies and practice , all of which will require appropriate engagement, training and communication to ensure consistency of approach and implementation. Page 101
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26 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race No specific impacts identified at this stage Disability Disabled people are more likely to require care and support services and may therefore be disproportionately affected by charging policies. Impacts will depend on individual financial circumstances and will be mitigated through financial assessment, income protections, and appeal processes. Carers (for elderly, disabled or minors) No specific impacts identified at this stage Sex No specific impacts identified at this stage Pregnancy and maternity (including breastfeeding) No specific impacts identified at this stage Sexual orientation No specific impacts identified at this stage Age (include children, young people, midlife and older people) Older people are more likely to use chargeable care services. Changes to charging arrangements may therefore have a greater impact on this group, particularly those on fixed incomes. Religion, and or belief No specific impacts identified at this stage Gender reassignment No specific impacts identified at this stage Inequalities arising from socio- economic differences Charging policies directly affect people on low or fixed incomes. While financial assessments include safeguards, changes to charging arrangements may still create financial pressure for some individuals. Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security No differential impact identified Article 6: Right to a fair trial No differential impact identified Article 8: Right to respect for private and family life, correspondence and the home Engaged. Financial assessments require consideration of personal financial circumstances. Any interference will be proportionate, lawful, and Page 102
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27 List of convention rights Describe, where applicable, if and how specific rights are engaged accompanied by safeguards, transparency, and appeal mechanisms. Article 10: Freedom of expression No differential impact identified Article 11: Freedom of assembly and association No differential impact identified Article 12: Right to marry No differential impact identified Article 14: Prohibition of discrimination (in relation to the convention rights) Engaged. The policy will be applied consistently, with safeguards to avoid disproportionate impact on protected groups. Article 1 of Protocol 1: Protection of property Engaged. Charging policies affect individuals’ financial resources. The proposal is justified in the public interest and subject to clear rules, safeguards, and review processes. Article 2 of Protocol 1: Right to education Not engaged Article 3 of Protocol 1: Right to free elections by secret ballot Not engaged Children’s Rights and Wellbeing Relevant articles – UNCRC Children’s rights may be indirectly engaged where charging policies apply to families receiving services. Decisions will be informed by financial assessment and safeguards to protect household income and wellbeing. Article 2 – Non discrimination Not engaged Article 12 – Respect of the views of the child Not engaged Article 3.1 – Best interest of the child Not engaged Article 6.2 – Right to survival and development Not engaged 7. Evidence. What information have you used to make your assessment? Performance data Finance reports Page 103
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28 Internal consultation Initial discussions with finance, community care finance and service managers Consultation with affected groups To be progressed as part of the review Local statistics Finance (Council) National statistics Not relevant Other 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? As the review progresses, issues or considerations may become apparent that will need to be added to this EQIA. For this reason please note this EQIA is provisional and will be updated as the review progresses. . 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain: Potential impacts will be mitigated through comprehensive financial assessment, application of national charging guidance, clear communications, access to advice and formal appeal processes. 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? The proposal seeks to ensure that charging policies are applied fairly, transparently, and consistently, whilst maintaining financial sustainability for services. The approach aligns with statutory charging guidance and ensures that contriutions are based on assessed ability to pay, with appropriate safeguards. . Moray council sets charges so the IJB can only recommend to them for approval. Page 104
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29 SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. The impacts relate to: x Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child 4. Negative impacts can be mitigated the proposals as outlined in question 9. x 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. x 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: Proceed with options appraisal and development of revised charging policies. The IIA will continue to be developed prior to implementation of any specific changes to ensure that equality, socio economic and human rights impacts are fully considred. Date of Decision: Sign off and authorisation: Service HSCM Department Social Work and finance Policy/activity subject to IIA Page 105
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30 We have completed the integrated impact assessment for this policy/activity. Name: Deb O’Shea Position: Chief Finance Officer Date: 9.03.2026 Authorisation by head of service Name: Deb O’Shea Position: Chief Finance Officer Date: 9.03.2026 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 09/03/2026 Prescribing Efficiencies – Nutritional Prescribing (ONS & CMPA Baby Milks)This proposal requires a full Stage 2 IIA due to impacts on equalities, socio-economic factors, and children. V1.0 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 55. Nutritional Prescribing ONS & CMPA Baby Milks Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? X Budget proposal? Duties: tick the boxes you think apply No Maybe Yes Page 106
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31 Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. Yes Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them Yes Does your proposal impact on the human rights of people? Yes Does your proposal impact on the rights of children and young people Yes Reasoning Briefly describe your reasoning for the responses given above: Appropriate nutrition is fundamental to health, wellbeing and development. The proposed changes to prescribing arrangements for oral nutritional supplements (ONS) and specialist infant formula may have differential impacts on groups with protected characteristics, on people experiencing socio‑economic disadvantage, and on children and young people. Potential impacts include affordability, access to clinically required nutrition, and risks to health and development for vulnerable groups. These issues engage equality, human rights and children’s rights considerations and therefore require a full Stage 2 Integrated Impact Assessment. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Date STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: Page 107
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32 The service provides specialist nutritional products where nutritional needs cannot be met through normal diet alone. This includes: • Specialist infant formulas for Cow’s Milk Protein Allergy (CMPA) prescribed following clinical assessment to support safe feeding, growth and development. • Oral Nutritional Supplements (ONS) prescribed for adults and children at risk of malnutrition due to illness, disability, frailty or treatment. Prescribing is clinically guided and monitored by dietitians, GPs and specialist teams in line with national guidance. 2. Who are your main stakeholders? • Infants with CMPA and their families • Adults and children requiring ONS • Parents/carers • GPs and primary care teams • Paediatricians • Dietitians (community and acute) • Health Visitors, Midwives, FNP • Community pharmacies • Acute services at Dr Gray’s Hospital • Moray HSCP / NHS Grampian • Third-sector support (e.g., food banks) • Scottish Government (nutrition, allergy, paediatric and rights frameworks) 3. What changes as a result of the proposals? Is the service reduced or removed? The proposals introduce changes to prescribing thresholds and review arrangements rather than full removal of provision. This may include tighter diagnostic criteria, shorter prescribing periods, and increased emphasis on food‑based approaches prior to prescribing ONS or specialist formula. As a result, access to CMPA formulas and ONS may be reduced for some individuals, depending on clinical assessment and eligibility, with potential impacts on accessibility and continuity of support. 4. How will this affect your customers? Infants with CMPA • Increased risk of accidental exposure to cow’s milk protein • Potential allergic symptoms (GI, dermatological, respiratory) • Faltering growth if families cannot afford specialist formulas • Delays in diagnosis or management due to stricter eligibility Page 108
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33 Adults and children requiring ONS • Potential increased risk of malnutrition or deterioration where nutritional needs are not adequately met • Reduced functional ability, slower healing, reduced energy • Higher likelihood of hospital admissions or delayed recovery Families and low-income households • Potential financial pressure for families where clinically required products are no longer prescribed. • Potential for unsafe substitution practices (e.g., unsuitable formulas, diluting ONS) • Increased emotional stress, feeding anxiety, and difficulty managing conditions Health inequalities Those living in areas of deprivation and those with long‑term health conditions are more likely to require nutritional support. National and local evidence indicates that reduced access to clinically required nutrition may disproportionately affect these groups, with the potential to widen existing health inequalities. 5. Impact on staff providing the service • Increased clinical risk: staff must manage potential malnutrition, feeding issues or allergic reactions • Higher workload due to: o More assessments o Appeals or disputes around prescribing o Safeguarding concerns o Increased monitoring and documentation • Moral distress when families or patients cannot access products previously available • More referrals into dietetics, paediatrics, GPs, and acute care due to downstream effects • Increased complaints, patient dissatisfaction, and need for careful communication and justification Staff across dietetics, primary care, paediatrics and pharmacies will feel the cumulative impact. 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race No direct clinical link, but indirect impacts possible. Families from minority ethnic backgrounds may face language barriers, lower health literacy, or different cultural feeding practices, making reduced access to CMPA formulas or ONS more Page 109
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34 challenging. Risk of inequitable access without strong communication support. Disability High impact. Adults or children with physical, cognitive, neurological or developmental disabilities often rely on ONS due to feeding difficulties or increased nutritional needs. Reducing access may worsen health, function and independence. Parents or carers with disabilities may find it harder to navigate new pathways or self-fund specialist infant formulas. Carers (for elderly, disabled or minors) Some Impact Carers may face increased burden if ONS is restricted and nutritional needs cannot be met through diet alone. Families caring for infants with CMPA may experience greater stress, financial strain and safety concerns if specialist formula access is reduced. Front-line carers may need to spend more time managing symptoms or feeding issues. Sex No direct sex-related impact, but women are more commonly primary carers and therefore more likely to experience the practical and emotional impact of reduced access to CMPA formula or ONS. Pregnancy and maternity (including breastfeeding) Significant impact. Infant feeding is central to maternal wellbeing. Mothers who are breastfeeding may require support to maintain breastfeeding safely for infants with CMPA; where breastfeeding is not possible, specialist formula is essential. Reduced access could impact infant health and maternal mental health. Sexual orientation No direct impact expected. However, LGBTQ+ parents may already face barriers in accessing infant feeding or health services; clarity and sensitivity in communication will be essential to avoid inequitable access. Age (include children, young people, midlife and older people) High impact. CMPA affects infants exclusively, so reduced access to specialist formulas directly affects babies. Older adults and children with illness, frailty or disability frequently require ONS. Restricting provision may lead to malnutrition, reduced function, delayed recovery, or increased healthcare utilisation across these groups. Religion, and or belief Some families have specific dietary requirements (e.g., halal, kosher, or avoidance of certain ingredients). If formula or ONS choices are restricted, suitable alternatives may not always align with religious dietary rules. Gender reassignment No direct clinical link, but individuals undergoing gender-affirming care may experience increased nutritional needs or eating difficulties; reduced access to ONS could contribute to health inequalities. Page 110
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35 Inequalities arising from socio-economic differences Very significant impact. Both CMPA formula and ONS are expensive and cannot be easily replaced with cheaper alternatives. Families with low income or food insecurity are at highest risk. Reduced provision could: increase financial hardship, widen health inequalities, and lead to unsafe feeding practices (diluting formula, skipping meals, inappropriate substitution). Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security Not engaged. The proposal does not affect peoples freedom or personal safety. Article 6: Right to a fair trial Not engaged – the proposal does not involve legal or court based decisions. Article 8: Right to respect for private and family life, correspondence and the home Engaged. Infant feeding and nutritional care are central to family life. Reducing access to CMPA formula or essential ONS may affect a family’s ability to care for dependents safely, potentially impacting dignity, family functioning, and health-related decision-making. Article 10: Freedom of expression Not directly engaged, the proposal does not affect freedom of expression. Article 11: Freedom of assembly and association Not engaged – the proposal does not affect peoples ability to meet or associate. Article 12: Right to marry Not engaged – the proposal has no relevance to the right to marry. Article 14: Prohibition of discrimination (in relation to the convention rights) Engaged. There is a risk of indirect discrimination if groups with protected characteristics (e.g., disability, pregnancy/maternity, age) are disproportionately affected by reduced access to medically required nutrition. Article 1 of Protocol 1: Protection of property Not engaged. The proposals does not affect ownership of personal property. Article 2 of Protocol 1: Right to education Not engaged. The proposal does not affect the right to education. Article 3 of Protocol 1: Right to free elections by secret ballot Not engaged. The proposal does not affect electoral rights. Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination Engaged. Infants with CMPA and children at risk of malnutrition may be disproportionately affected by reductions in specialist formula Page 111
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36 access. Low-income families may also be disproportionately disadvantaged, raising equality concerns. Article 12 – Respect of the views of the child Engagement is limited due to age (especially infants), their views should be sought where appropriate in clinical decision-making. Article 3.1 – Best interest of the child Engaged. Adequate nutrition is fundamental to survival, health and development. Any changes to access may affect these outcomes if not carefully mitigated. Article 6.2 – Right to survival and development Engaged. Adequate nutrition is essential for survival, growth, neurodevelopment and immune function. Changes to access to CMPA formula for may affect these outcomes if not carefully mitigated and monitored. 7. Evidence. What information have you used to make your assessment? The assessment draws on local prescribing data, professional clinical expertise, service intelligence and relevant national guidance. Detailed evidence sources are summarised below: Performance data Performance Data • Local prescribing data for CMPA specialist formulas and ONS within Moray HSCP • Dietetic caseload data showing prevalence of malnutrition, growth concerns, and CMPA diagnoses • Trends in inappropriate prescribing, over-prescribing or gaps in provision • Clinical audit findings on ONS compliance and outcomes Internal consultation Internal Consultation • Discussions with Moray Dietetic Service (adult and paediatric) • Input from Health Visitors, GPs, paediatric teams and community pharmacy colleagues • Feedback from Moray HSCP professional leads and service managers • Review of local pathways and clinical guidance Consultation with affected groups Consultation With Affected Groups Page 112
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37 • Informal feedback from families of infants diagnosed with CMPA • Case examples from adults and children reliant on ONS for clinical reasons • Professional insights from staff working directly with vulnerable service users Local statistics • Moray prevalence of malnutrition risk in community and acute settings • Local CMPA incidence based on paediatric and dietetic assessment data • Socio-economic indicators in Moray, including levels of food insecurity • Local admissions data where malnutrition or feeding issues are contributing factors National statistics • Scottish national CMPA prevalence and infant feeding guidance • Scottish malnutrition prevalence data (e.g., MUST audit trends) • National ONS prescribing guidance and data from NES/PHS • National evidence on health inequalities and impact of food insecurity Other Clinical guidelines: • BSACI guidelines on CMPA • Scottish Government’s Infant Feeding and Allergy guidance • BDA “Food First” pathways and ONS guidelines • Scottish Government ONS Best Practice Statements • Research evidence on malnutrition outcomes, CMPA management, and the cost impacts of inadequate nutrition • NICE/HIS guidance on nutrition support for adults and children • UNCRC and Human Rights frameworks relevant to infant feeding and nutrition 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? Yes — several areas would benefit from further data to inform the full impact: Service-specific evidence gaps • Updated local prescribing data on CMPA formulas and ONS broken down by age, diagnosis and socio-economic status • More detailed cost–benefit analysis, including potential costs of complications arising from reduced access Page 113
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38 • Accurate estimates of demand in Moray for both CMPA formulas and ONS • Data on compliance and outcomes for patients currently prescribed ONS • Local data on current breastfeeding rates and how they intersect with CMPA management • Insight into family capacity to self-fund specialist formulas or supplements Engagement and lived-experience gaps • Formal consultation with parents of infants with CMPA • Patient and carer feedback from adults and children receiving ONS • Feedback from frontline staff on anticipated clinical risk and workload Wider system data gaps • Projected impact on dietetic services, paediatrics, GPs and acute admissions • National benchmarking data on CMPA prescribing changes and outcomes Addressing these gaps will strengthen implementation planning and inform monitoring arrangements should the proposal proceed. 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain Yes. Potential impacts can be mitigated, although not eliminated, through coordinated clinical, operational and communication measures across services. Key mitigating actions include For CMPA Specialist Infant Formula • Ensure clear, clinically robust criteria that avoid excluding infants with genuine CMPA • Provide rapid-access dietetic assessment to reduce delays in diagnosis • Offer enhanced breastfeeding support where breastfeeding is possible and safe • Maintain access to amino-acid formulas for infants with severe allergy, anaphylaxis, EoE or faltering growth • Develop clear communication materials to guide families safely through any changes • Ensure culturally appropriate alternatives where restriction of formula choice may impact religious dietary requirements For ONS (Adults and Children) • Strengthen the Food First pathway with more resources, training and support • Increase availability of food support resources (recipes, costed meal plans, fortified food guidance) • Provide early dietetic intervention for high-risk groups to avoid deterioration Page 114
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39 • Implement structured review cycles to ensure patients who still have clinical need are not withdrawn prematurely • Work with third-sector partners to support households experiencing food insecurity Cross-cutting mitigations • Prioritise vulnerable groups, including low-income households, disabilities, frailty, complex medical needs and rural isolation • Monitor unintended consequences (A&E presentations, faltering growth, malnutrition rates) • Provide additional training and guidance for GPs, HVs and pharmacy teams to ensure consistent decision-making • Ensure appropriate signposting to welfare and financial support where needed Mitigation can reduce risk but cannot eliminate clinical and equality impacts entirely. 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? The assessment identifies significant potential impacts, particularly for infants with CMPA, people at risk of malnutrition, and those experiencing socio‑economic disadvantage. These impacts cannot be fully avoided; however, they may be mitigated through strengthened clinical pathways, protection for high‑risk groups, and robust monitoring. The justification for proceeding rests on the need to ensure sustainable prescribing practices, consistent application of evidence‑based guidance, and the ability to reinvest resources into preventative and early intervention support. Any decision to proceed must balance financial sustainability with the duty to protect equality, human rights and children’s wellbeing. Page 115
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40 SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. No 2. Some potential negative impacts have been identified. The impacts relate to: Yes Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 No Promoting equality of opportunity Yes Fostering good relations Potential 3. The proposals interfere with human rights and/or the rights of the child Yes 4. Negative impacts can be mitigated the proposals as outlined in question 9. Yes 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. Yes 6. Further consultation with affected groups is needed. Potentially 7. It is advised not to go ahead with the proposals. No Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: The assessment identifies clear potential negative impacts, particularly for infants with CMPA, individuals at risk of malnutrition, and households experiencing socio‑economic disadvantage. While these impacts cannot be fully mitigated, they may be reduced through strengthened clinical pathways, protection for those with the highest need, and ongoing monitoring. Any decision to proceed should be conditional on adequate dietetic capacity, clear mitigation actions, continued engagement with affected groups, and robust monitoring of unintended consequences. Page 116
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41 Date of Decision: 09/03/26 Page 117
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42 Sign off and authorisation: Service Health & Social Care Department AHP Policy/activity subject to IIA Prescribing Efficiencies – Nutritional Prescribing (ONS & CMPA Baby Milks We have completed the integrated impact assessment for this policy/activity. Name: Audrey Steele-Chalmers Position: AHP Professional/Sector lead - Moray Date: 16/3/26 Authorisation by head of service Name: Sean Coady Position: Head of Service Date: 16/3/26 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 10/3/26 First draft of IIA completed to support the Supplies and Procurement budget savings proposal for consideration by the Integration Joint Board. This assessment reflects an options appraisal and investigation stage only; further assessment will be required should specific service changes be progressed. Draft V1.0 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 56. Supplies and Procurement Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? X Budget proposal? X Page 118
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43 Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. X Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them X Does your proposal impact on the human rights of people? x Does your proposal impact on the rights of children and young people x Reasoning Briefly describe your reasoning for the responses given above: The proposal focuses on reviewing procurement, stock management, and distribution arrangements to identify efficiencies and potential budget savings. While no direct service reduction or withdrawal is proposed at this stage, changes to procurement arrangements could indirectly affect service delivery, access, or staff workflows. As such, potential impacts cannot be ruled out and a Stage 2 Integrated Impact Assessment is required. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Michelle Watson Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Date Page 119
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44 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: The proposal relates to the procurement, storage, and distribution of clinical and surgical supplies used by community hospitals, community nursing services, and multidisciplinary teams. 2. Who are your main stakeholders? Community hospitals; community nursing teams; multidisciplinary teams; procurement and stores staff; finance teams. 3. What changes as a result of the proposals? Is the service reduced or removed? No service is reduced or removed at this stage. The proposal seeks to investigate options for more efficient procurement, stock management, and distribution arrangements to evidence best value and identify potential savings. 4. How will this affect your customers? No direct impact on people using services is anticipated at this stage. Any future changes would be designed to maintain safe, timely, and effective access to clinical supplies. 5. Impact on staff providing the service Potential changes to ordering processes, stock management, or distribution arrangements may affect staff workflows. Any changes would require appropriate engagement, communication, and change management support. 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race No specific impacts identified at this stage. Disability Indirect impacts could arise if changes affect availability or timeliness of equipment; this would require mitigation. Carers (for elderly, disabled or minors) No specific impacts identified at this stage. Sex No specific impacts identified at this stage. Pregnancy and maternity (including breastfeeding) No specific impacts identified at this stage. Sexual orientation No specific impacts identified at this stage. Age (include children, young people, midlife and older people) Indirect impacts could arise if service delivery were affected; impacts would be monitored. Page 120
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45 Religion, and or belief No specific impacts identified at this stage. Gender reassignment No specific impacts identified at this stage. Inequalities arising from socio- economic differences Indirect impacts could arise if service efficiency were affected; proposal aims to improve value for money. Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security Not engaged Article 6: Right to a fair trial Not engaged Article 8: Right to respect for private and family life, correspondence and the home Potential indirect engagement if service delivery were affected; no direct impact anticipated at this stage. Article 10: Freedom of expression Not engaged Article 11: Freedom of assembly and association Not engaged Article 12: Right to marry Not engaged Article 14: Prohibition of discrimination (in relation to the convention rights) No discriminatory impacts identified at this stage. Article 1 of Protocol 1: Protection of property Not engaged Article 2 of Protocol 1: Right to education Not engaged Article 3 of Protocol 1: Right to free elections by secret ballot Not engaged Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination No direct impact identified. Article 12 – Respect of the views of the child Not engaged Article 3.1 – Best interest of the child Not engaged Article 6.2 – Right to survival and development Not engaged 7. Evidence. What information have you used to make your assessment? Performance data Internal procurement and financial data. Internal consultation Initial discussions with procurement, finance, and service leads. Page 121
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46 Consultation with affected groups Not undertaken at this stage – options appraisal phase. Local statistics Local operational and service data. National statistics Not applicable at this stage. Other Best value and efficiency principles. 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? Further information will be required once specific options are developed, including detailed operational impacts, staff feedback, and service-level implications. 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain Any potential impacts would be mitigated through phased implementation, staff engagement, monitoring of supply availability, and clear escalation routes for unintended consequences. 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? The proposal is driven by the requirement to evidence best value and support financial sustainability. Any future changes would only proceed where benefits outweigh risks and impacts can be appropriately mitigated. Page 122
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47 SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. The impacts relate to: x Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child 4. Negative impacts can be mitigated the proposals as outlined in question 9. x 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. x 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: Proceed with options appraisal and investigation. Further Integrated Impact Assessment will be undertaken prior to implementation of any specific changes. Date of Decision: To be confirmed. Page 123
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48 Sign off and authorisation: Service Finance and Procurement Department Nursing Policy/activity subject to IIA Supplies and Procurement – Budget Savings Proposal We have completed the integrated impact assessment for this policy/activity. Name: Michelle Watson Position: Date: 12/3/26 Authorisation by head of service Name: Sean Coady Position: Head of Service Date: 12/3/26 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 10/03/2026 First version created. IIA completed at stage 1 as IIA not required due to the project 1.0 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 57. GMED Skill Mix Review Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? x Budget proposal? Duties: tick the boxes you think apply No Maybe Yes Page 124
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49 Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. x Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them x Does your proposal impact on the human rights of people? x Does your proposal impact on the rights of children and young people x Reasoning Briefly describe your reasoning for the responses given above: The change to the existing process is an administrative one that does not impact on the clinical service delivery levels. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Martyna Chlost Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Magdalena Polcik-Miniach Date 10/03/2026 Page 125
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50 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: 2. Who are your main stakeholders? 3. What changes as a result of the proposals? Is the service reduced or removed? 4. How will this affect your customers? 5. Impact on staff providing the service 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race Disability Carers (for elderly, disabled or minors) Sex Pregnancy and maternity (including breastfeeding) Sexual orientation Age (include children, young people, midlife and older people) Religion, and or belief Gender reassignment Inequalities arising from socio-economic differences Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security Article 6: Right to a fair trial Article 8: Right to respect for private and family life, correspondence and the home Article 10: Freedom of expression Article 11: Freedom of assembly and association Page 126
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51 List of convention rights Describe, where applicable, if and how specific rights are engaged Article 12: Right to marry Article 14: Prohibition of discrimination (in relation to the convention rights) Article 1 of Protocol 1: Protection of property Article 2 of Protocol 1: Right to education Article 3 of Protocol 1: Right to free elections by secret ballot Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination Article 12 – Respect of the views of the child Article 3.1 – Best interest of the child Article 6.2 – Right to survival and development 7. Evidence. What information have you used to make your assessment? Performance data Internal consultation Consultation with affected groups Local statistics National statistics Other 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain 10. Justification Page 127
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52 If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. The impacts relate to: Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child 4. Negative impacts can be mitigated the proposals as outlined in question 9. 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: Date of Decision: Page 128
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53 Sign off and authorisation: Service Department Policy/activity subject to IIA We have completed the integrated impact assessment for this policy/activity. Name: Martyna Chlost Position: Date: 12/3/26 Authorisation by head of service Name: Sean Coady Position: Head of Service Date: 12/3/26 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 4.3.26 1st Draft of IIA – Review of Clinical Leadership V0.1 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 58. Review of Clinical Leadership provision Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? Budget proposal? X Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. X Page 129
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54 Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them X Does your proposal impact on the human rights of people? X Does your proposal impact on the rights of children and young people X Reasoning Briefly describe your reasoning for the responses given above: The proposal relates to a review of clinical leadership provision at an options‑appraisal stage. No specific changes to service delivery, staffing models, access to services, or clinical decision‑making are being proposed at this time. Also the review does not alter how people access services or receive care, no direct impacts on equality, socio‑economic circumstances, human rights, or children’s rights have been identified at this stage. This position will be kept under review and, should it change, a Stage 2 IIA will be undertaken. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract R V REEVE Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) NA Date 4/3/26 Page 130
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55 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: 2. Who are your main stakeholders? 3. What changes as a result of the proposals? Is the service reduced or removed? 4. How will this affect your customers? 5. Impact on staff providing the service 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race No Disability No Carers (for elderly, disabled or minors) No Sex No Pregnancy and maternity (including breastfeeding) No Sexual orientation No Age (include children, young people, midlife and older people) No Religion, and or belief No Gender reassignment No Inequalities arising from socio-economic differences No Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security NA Article 6: Right to a fair trial NA Article 8: Right to respect for private and family life, correspondence and the home NA Article 10: Freedom of expression NA Page 131
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56 List of convention rights Describe, where applicable, if and how specific rights are engaged Article 11: Freedom of assembly and association NA Article 12: Right to marry NA Article 14: Prohibition of discrimination (in relation to the convention rights) NA Article 1 of Protocol 1: Protection of property NA Article 2 of Protocol 1: Right to education NA Article 3 of Protocol 1: Right to free elections by secret ballot NA Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination NA Article 12 – Respect of the views of the child NA Article 3.1 – Best interest of the child NA Article 6.2 – Right to survival and development NA 7. Evidence. What information have you used to make your assessment? Performance data NA Internal consultation NA Consultation with affected groups NA Local statistics NA National statistics NA Other 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? SECTION 3 CONCLUDING THE IIA Concluding the IIA Page 132
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57 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified.The impacts relate to: Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child 4. Negative impacts can be mitigated the proposals as outlined in question 9. 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: Date of Decision: Sign off and authorisation: Service Department Policy/activity subject to IIA We have completed the integrated impact assessment for this policy/activity. Name: Rosemary Reeve Position: Interim Primary Care Development Manager Date: 12/3/26 Authorisation by head of service Name: Sean Coady Position: Head of Service Date: 12/3/26 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES Page 133
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58 • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 4.3.26 1ST Draft of IIA – HSCM Minor Surgery V0.1 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 59. HSCM Minor Surgery Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? X Budget proposal? X Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. X Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them X Does your proposal impact on the human rights of people? X Does your proposal impact on the rights of children and young people X Reasoning Briefly describe your reasoning for the responses given above: The proposal relates to a review of the Minor Surgery service, including consideration of funding responsibility and future delivery arrangements. At this stage, no final decision has been taken to reduce or cease the service; however, potential changes could affect access to treatment, waiting times, and travel requirements for patients. As such, potential impacts on equality, socio‑economic circumstances, and human rights cannot be ruled out at this stage, and a Stage 2 Integrated Impact Assessment is required. Page 134
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59 If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract R V REEVE Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) City & Aberdeenshire HSCPs Date 4/3/26 Page 135
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60 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: - Provides a day case surgical service under Primary Care management to undertake surgical procedures – vasectomies, lesions (skin) and carpal tunnel work not suitable to be undertaken in GP Practice and to relieve waiting list pressures in Secondary Care. - Provides the opportunity for GP Referral Surgeons (GPWSI’s ) to skill up in surgical assessment and procedures and to offer training and support to other GP Minor Surgeon colleagues in a community setting. - Offers basic training and support to medical students attached to surgical specialities at Dr Gray’s. - Offers a training program for trainee GPWSI’s through the GP Career Start Program. - Work in a Managed Clinical Network with other hospital based specialties including General Surgery, Dermatology, Plastic Surgery, and Orthopaedics. 2. Who are your main stakeholders? • Patients - referred by Primary Care and Secondary Care (dermatology, surgery, and orthopaedics) • GP (WSI) operating the service • Nursing staff operating the service • Bank staff operating the service • Admin staff managing the service • GP Practice’s • Secondary Care 3. What changes as a result of the proposals? Is the service reduced or removed? There is some uncertainty regarding the funding arrangements supporting this activity, and the current review is focused on clarifying funding responsibility and confirming sustainable arrangements for future delivery. The current review is therefore considering the sustainability of the existing arrangement, with a view to confirming appropriate and sustainable arrangements going forward. 4. How will this affect your customers? Local access to minor surgical procedures is currently provided through delivery within HSCM. Any potential changes to delivery arrangements would be subject to further consideration, with potential implications for access, waiting times or travel dependent on the option progressed and the final implementation arrangements. 5. Impact on staff providing the service There are no immediate workforce impacts arising from the review. Workforce considerations will be part of the overall assessment to ensure that any future delivery Page 136
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61 arrangements continue to support staff appropriately and are managed in accordance with relevant policies. 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race No differential impact identified Disability Disabled patients may be more sensitive to changes in access arrangements, particularly where this could involve additional travel or waiting times. Any such considerations would inform future decision‑making to minimise barriers to access. Carers (for elderly, disabled or minors) Changes to access arrangements could have implications for carers in supporting attendance at appointments, for example in relation to travel or time commitments. The extent of any impact would depend on the nature of any future delivery arrangements. Sex The service includes sex‑specific procedures, such as vasectomies. Any changes to delivery arrangements could affect how individuals access these procedures, including where travel or waiting times are impacted. Pregnancy and maternity (including breastfeeding) No differential impact identified Sexual orientation No differential impact identified Age (include children, young people, midlife and older people) Older people are more likely to access minor surgical procedures. Consideration would therefore be given to the potential effects of any future changes on this group, including accessibility and continuity of care. Religion, and or belief No differential impact identified Gender reassignment No differential impact identified Inequalities arising from socio- economic differences Any changes that affect travel requirements or waiting times could have a greater impact on people experiencing socio‑economic disadvantage. This would be a relevant consideration in assessing future delivery options. Human rights Page 137
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62 List of convention rights Describe, where applicable, if and how specific rights are engaged The following human rights considerations are identified as part of the review and would be relevant should future delivery arrangements change. No changes to service provision are proposed at this stage. Article 5: Right to liberty and security Not engaged. Article 6: Right to a fair trial Not engaged. Article 8: Right to respect for private and family life, correspondence and the home Potentially engaged. Any future changes to delivery arrangements could have implications for how patients access care, including considerations around convenience, travel and family circumstances. These factors would be considered as part of decision‑making to minimise any impact on patients. Article 10: Freedom of expression Not engaged. Article 11: Freedom of assembly and association Not engaged. Article 12: Right to marry Not engaged. Article 14: Prohibition of discrimination (in relation to the convention rights) Potentially engaged. Consideration would be given to whether any future changes could have differential effects on particular groups, including disabled or older patients, and to ensuring that equality of access is maintained. Article 1 of Protocol 1: Protection of property Not engaged Article 2 of Protocol 1: Right to education Not engaged Article 3 of Protocol 1: Right to free elections by secret ballot Not engaged Children’s Rights and Wellbeing Relevant articles – UNCRC The Minor Surgery service does not deliver surgical procedures for children or young people. As a result, no direct implications for children’s rights or wellbeing have been identified as part of this review. Article 2 – Non discrimination Not applicable. The service does not provide surgical procedures for children or young people. Article 12 – Respect of the views of the child Not applicable. No direct engagement with children or young people arises from this proposal. Page 138
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63 Article 3.1 – Best interest of the child Not applicable. No children’s surgical activity is delivered through this service. Article 6.2 – Right to survival and development Not applicable. The service does not deliver care to children or young people. 7. Evidence. What information have you used to make your assessment? Performance data Internal consultation Ongoing with Aberdeen City & Aberdeenshire HSCPs Consultation with affected groups NA Local statistics Yes – from all three HSCP National statistics NA Other Yes – from all three HSCP 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? We have yet to commence engagement with Secondary Care regarding the position. Plans for engagement are being progressed 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain Potential impacts will be mitigated through engagement with Secondary Care, consideration of alternative delivery arrangements, and careful planning to minimise disruption to patient access. Further mitigation will be developed once a preferred option is identified. 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? Any decision to change the delivery of the Minor Surgery service would be based on consideration of clinical safety, service sustainability, and value for money, alongside assessment of impacts on patient access and equality. Budgetary considerations would be balanced against these factors. SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. X Page 139
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64 The impacts relate to: Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child 4. Negative impacts can be mitigated the proposals as outlined in question 9. X 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. X 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: No decision has been taken at this stage. The review will continue, informed by further engagement and impact assessment, before any final decision is made. Date of Decision: Sign off and authorisation: Service Department Policy/activity subject to IIA We have completed the integrated impact assessment for this policy/activity. Name: Rosemary Reeve Position: Interim Primary Care Development Manager Date: 12/3/26 Authorisation by head of service Name: Sean Coady Position: Head of Service Date: 12/3/26 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO-ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 27/02/2026 First draft IIA completed to BSOG for noting of contract saving. V0.1 Page 140
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65 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 60. Review of Commissioned contracts – Childrens services Saving identified in reduction in commissioned external Functional Family Therapy (FFT) through Action for Children Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? Budget proposal? X Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. ✓ Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them ✓ Does your proposal impact on the human rights of people? ✓ Does your proposal impact on the rights of children and young people ✓ Reasoning Briefly describe your reasoning for the responses given above: The proposal relates to a reduction in commissioned staffing within the Functional Family Therapy (FFT) service delivered by Action for Children. The service has confirmed that the proposed reduction can be accommodated within the existing service model and will not result in a reduction in service availability, access, or quality of support provided to families. Families referred to FFT are already known to statutory social work services and remain on open caseloads, ensuring continued oversight, support and access to alternative or supplementary interventions where required. The proposal does not change eligibility criteria, referral pathways, or the way in which families with protected characteristics, socio‑economic disadvantage, or additional vulnerabilities access support. On this basis, no adverse impacts have been identified in relation to equalities, socio‑economic inequality, human rights, or the rights of children and young people at this stage. A Stage 2 Integrated Impact Assessment is therefore not required at this time Page 141
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66 If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Name: Dawn Mylchreest Position: Senior Commissioning Officer Date: 27/02/2026 Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Date Page 142
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67 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: 2. Who are your main stakeholders? 3. What changes as a result of the proposals? Is the service reduced or removed? 4. How will this affect your customers? 5. Impact on staff providing the service . 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race Disability Carers (for elderly, disabled or minors) Sex Pregnancy and maternity (including breastfeeding) Sexual orientation Age (include children, young people, midlife and older people) Religion, and or belief Gender reassignment Inequalities arising from socio-economic differences Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security Article 6: Right to a fair trial Article 8: Right to respect for private and family life, correspondence and the home Article 10: Freedom of expression Article 11: Freedom of assembly and association Article 12: Right to marry Article 14: Prohibition of discrimination (in relation to the convention rights) Page 143
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68 List of convention rights Describe, where applicable, if and how specific rights are engaged Article 1 of Protocol 1: Protection of property Article 2 of Protocol 1: Right to education Article 3 of Protocol 1: Right to free elections by secret ballot Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination Article 12 – Respect of the views of the child Article 3.1 – Best interest of the child Article 6.2 – Right to survival and development 7. Evidence. What information have you used to make your assessment? Performance data Internal consultation Consultation with affected groups Local statistics National statistics Other 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? No 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? SECTION 3 CONCLUDING THE IIA Concluding the IIA Page 144
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69 1. No potential negative impacts on any of the protected groups were found. ✓ 2. Some potential negative impacts have been identified. The impacts relate to: Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child 4. Negative impacts can be mitigated the proposals as outlined in Q9. 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: Date of Decision: Sign off and authorisation: Service Children, Families and Justice Department Social Work Policy/activity subject to IIA Reduction in commissioned external Functional Family Therapy We have completed the integrated impact assessment for this policy/activity. Name: Lizette Van Zyl Position: Social Work Service Manager Date: 16/3/26 Authorisation by head of service Name: Jim Lyon Position: Head of Service Date:16/3/26 Permission to publish on website INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS Page 145
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70 3/3/2026 First draft of IIA completed and submitted for authorisation and further consideration 1.0, 03/3/2026 (JM) 16/3/2026 Final draft completed subject to authorisation 2.0, 16/3/2026 (JM) STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 61. Re-design of childcare social work teams: Merger of Access to create Locality teams East and West (Access) Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? x Budget proposal? x Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. X Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them X Does your proposal impact on the human rights of people? X Does your proposal impact on the rights of children and young people X Reasoning Briefly describe your reasoning for the responses given above: Stage 1 screening has been undertaken to consider potential impacts on equalities, socio‑economic disadvantage, human rights and the rights of children and young people. The assessment has not identified any adverse, differential or disproportionate impacts arising from the proposal. While the proposal is expected to support and reinforce existing good practice and statutory duties, it does not introduce changes that materially alter access to services, eligibility, decision‑making processes or outcomes for specific groups. Any anticipated benefits are Page 146
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71 indirect and apply consistently across the population rather than creating new or distinct impacts. On this basis, it is considered that there are no material impacts requiring further exploration, and that completion of a Stage 2 Integrated Impact Assessment would not be proportionate. The proposal will continue to be implemented in line with existing equality, human rights and children’s rights duties. The position will be kept under review, and a further impact assessment undertaken should the scope or implementation of the proposal change in a way that could give rise to material impacts. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Jean Massie (Interim Service Manager) Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Initial consultation with peer managers for Area Teams, Justice Services and Corporate Parent responsibility. Date 4/3/2026 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: 2. Who are your main stakeholders? 3. What changes as a result of the proposals? Is the service reduced or removed? 4. How will this affect your customers? 5. Impact on staff providing the service 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race Page 147
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72 Disability Carers (for elderly, disabled or minors) Sex Pregnancy and maternity (including breastfeeding) Sexual orientation Age (include children, young people, midlife and older people) Religion, and or belief Gender reassignment Inequalities arising from socio- economic differences Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security Article 6: Right to a fair trial Article 8: Right to respect for private and family life, correspondence and the home Article 10: Freedom of expression Article 11: Freedom of assembly and association Article 12: Right to marry Article 14: Prohibition of discrimination (in relation to the convention rights) Article 1 of Protocol 1: Protection of property Article 2 of Protocol 1: Right to education Article 3 of Protocol 1: Right to free elections by secret ballot Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination Article 12 – Respect of the views of the child Article 3.1 – Best interest of the child Article 6.2 – Right to survival and development Page 148
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73 7. Evidence. What information have you used to make your assessment? Performance data Internal consultation Consultation with affected groups Local statistics National statistics Other 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? Page 149
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74 SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. The impacts relate to: Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child 4. Negative impacts can be mitigated the proposals as outlined in question 9. 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: Date of Decision: Sign off and authorisation: Service Health and Social Care Department Children and Families and Justice Services Policy/activity subject to IIA We have completed the integrated impact assessment for this policy/activity. Name: Jean Massie Position: Interim Service Manager Date: 16/3/2026 Authorisation by head of service Name: Jim Lyon Position: Head of Service Date: 16/3/26 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD Page 150
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75 DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 3/3/2026 First draft of IIA completed and submitted for authorisation and further consideration 1.0, 05/3/2026 (JM) STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 62. Accommodation Review – Social Work Office Community Hub Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? x Budget proposal? x Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. X Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them X Does your proposal impact on the human rights of people? X Does your proposal impact on the rights of children and young people X Reasoning Briefly describe your reasoning for the responses given above: Page 151
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76 Access to statutory services and supervised family contact may engage human rights and children’s rights considerations, particularly where changes to location are proposed. These impacts are considered further at Stage 2. All families working with statutory social work and will continue to have access to appropriate facilities in other areas. All children who have family time with parents and care givers will continue to have access to appropriate facilities in other areas. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Jean Massie (Interim Service Manager) Pam Urquhart Date: 04/03/2026 Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Initial consultation with peer managers Date 4/3/2026 Page 152
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77 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: The premises offers office space where social work staff can base themselves and contact rooms, for family time. The focus of the work is to: • Work with families where they require long term social work support • Support children and young people in need of care and protection • Support children and young people who require permanent alternative care away from their families • Undertake assessment of need and risk following legislated for procedure and process. • Lead on assessment and planning for children and young people • Work with and engage family in the support of their children • Support and supervise contact between children and their families • Engage with partners to children’s plans within their local and school communities 2. Who are your main stakeholders? Children and families, members of our communities, partners (Police, Health, Education and 3rd Sector). Employees of the children and families social work teams and admin support. 3. What changes as a result of the proposals? Is the service reduced or removed? The proposal would remove the use of rented office and contact room accommodation for the Children & Families teams. Statutory work would continue, with appointments and supervised family time delivered from alternative locations. 4. How will this affect your customers? Some children and families may experience increased travel time and changes to the location of appointments or supervised family time. The extent of impact will vary depending on individual circumstances, including the child’s needs, family circumstances, and accessibility requirements. 5. Impact on staff providing the service No change to service function is anticipated; however, some staff may experience additional travel depending on home location and deployment arrangements. This will be managed through workforce planning and policies. It should also be noted for some staff it may result in reduced travel time as not all staff live where they work. Page 153
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78 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race No. No differential impact identified. The proposal applies equally to all individuals regardless of race or ethnicity. Disability The closure of a locality base may result in additional travel for some disabled people, which could present challenges where mobility, access to transport, or reliance on public transport is a factor. These impacts can be mitigated through the continued use of alternative suitable venues, flexible meeting arrangements, and home visits where required. Carers (for elderly, disabled or minors) Unpaid carers may experience increased travel time associated with attending meetings or contact arrangements away from their local community. Mitigation includes the use of alternative local facilities, flexible scheduling, and continued home‑based or community‑based engagement where appropriate. Sex No differential impact identified. The proposal does not affect people differently on the basis of sex. Pregnancy and maternity (including breastfeeding) No specific impacts identified. Existing arrangements to support pregnant people and those who are breastfeeding will continue to apply, including the use of appropriate and accessible venues. Sexual orientation No differential impact identified. The proposal applies equally and does not affect people differently on the basis of sexual orientation. Age (include children, young people, midlife and older people) Some children and young people, and their families, may be required to travel further for meetings or supervised contact as a result of the closure of the locality base. However, responses to immediate need will continue to be supported through locality‑based social work practice, including timely home visits and the use of alternative local venues where appropriate. Page 154
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79 Religion, and or belief No differential impact identified. The proposal does not restrict the ability to observe religious or belief practices. Gender reassignment No differential impact identified. The proposal applies equally and does not affect people differently on the basis of gender reassignment. Inequalities arising from socio- economic differences Additional travel requirements may have a greater impact on individuals and families experiencing socio‑economic disadvantage. These impacts can be mitigated through careful consideration of location, use of accessible community facilities, and maintaining a locality‑based approach to service delivery. Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security Not engaged – the proposal does not affect people’s freedom or personal safety Article 6: Right to a fair trial Not engaged - the proposal does not involve legal or court based decision making Article 8: Right to respect for private and family life, correspondence and the home Engaged - Appointments and supervised family time engage Article 8. Any change of venue will be managed to support continued family contact where it is assessed as safe and in the child’s best interests, with planning to minimise disruption and ensure privacy and dignity in facilities used. Article 10: Freedom of expression Not engaged – the proposal does not restrict or interfere with individuals’ ability to express views or opinions. Article 11: Freedom of assembly and association Not engaged – the proposal does not affect people’s ability to meet, gather, or take part in groups or organisations. Article 12: Right to marry Not engaged – the proposal has no relevance to marital status or the right to marry. Page 155
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80 List of convention rights Describe, where applicable, if and how specific rights are engaged Article 14: Prohibition of discrimination (in relation to the convention rights) Potential differential impact through travel/access will be mitigated via reasonable adjustments, travel support, and alternative venues where needed. Article 1 of Protocol 1: Protection of property Not engaged – the proposal does not affect ownership or use of property. Article 2 of Protocol 1: Right to education Not engaged – the proposal does not affect access to education. Article 3 of Protocol 1: Right to free elections by secret ballot Not engaged – the proposal does not affect access to education. Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination Considered - Individual barriers to access will be addressed through adjustments and support. Article 12 – Respect of the views of the child Considered - where appropriate, children’s views will inform planning of contact arrangements. Article 3.1 – Best interest of the child Engaged - decisions about contact arrangements and venues will continue to be made on a child‑centred basis. Article 6.2 – Right to survival and development Engaged – while the proposal does not direct affect survival, changes to contact arrangements and travel may have an indirect impact on children’s wellbeing, which will be considered and mitigated through individual planning. 7. Evidence. What information have you used to make your assessment? Performance data Internal consultation Available performance data information indicates that the Social Work contact rooms area used by a relatively small number of families. Most supervised family contact for families is currently taking place in other areas, which has resulted contributed to lower utilisation of the premises. This data suggests that the contact rooms are not being used to their full potential capacity and provides context to review how effectively the premises meets current service needs Page 156
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81 Consultation with affected groups Not at this stage. Local statistics National statistics The Promise (Care Review) GIRFEC Refresh Other 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? Current usage information indicates the contact rooms are used by a limited number of families, with the majority of supervised contact currently occurring in other bases. Operational steps have been taken to maintain the space within available resources. Usage and feedback will continue to be monitored to inform any implementation decision. 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain Yes. The potential impacts can be mitigated through the continued use of appropriate alternative facilities for meetings and supervised family contact, together with financial support for travel where required. Individual arrangements will be planned on a case‑by‑case basis, taking account of accessibility needs and any protected characteristics, and alternative local venues will be considered where travel to another centre would present a barrier. These arrangements will be kept under review. 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? While some potential negative impacts have been identified, these are considered capable of being mitigated through the actions set out in this assessment. The proposal does not remove access to statutory services or supervised family contact; rather, it changes the location from which some elements of the service are delivered. Appropriate alternative facilities will remain available, and individual arrangements will be made to ensure accessibility and protect children’s rights. No impacts have been identified that cannot be reasonably mitigated. On this basis, the proposal is considered justified and proportionate. Page 157
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82 SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. The impacts relate to: Geographic factors and travel distance for some families and staff. X Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child X 4. Negative impacts can be mitigated the proposals as outlined in question 9. X 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. X 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: On the evidence available at this stage, the proposal appears capable of being implemented with appropriate mitigations to maintain access for children and families. It is recommended that any final decision is taken subject to assurance that equality, human rights and children’s rights considerations have been addressed, and that engagement with affected stakeholders has informed the final implementation approach. Date of Decision: 5/3/2026 Sign off and authorisation: Service Children, families and justice Department Social Work Policy/activity subject to IIA Accommodation Review – Social Work Office Community Hub We have completed the integrated impact assessment for this policy/activity. Name: Jean Massie & Pam Urquhart Position: interim service managers Page 158
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83 Date: 16/3/26 Authorisation by head of service Name: Jim Lyon Position: Head of Service Date:16/3/26 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 06/03/2026 This is the first version of the IIA Version 1 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 63. Review of OOA Care and Return to Local Community Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? Budget proposal? x Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. x Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them x Does your proposal impact on the human rights of people? x Page 159
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84 Does your proposal impact on the rights of children and young people x Reasoning Briefly describe your reasoning for the responses given above: The overarching aim is to support children and young people to remain within, or as close as possible to, their home community wherever it is safe and appropriate to do so. Local care and support options are always considered as the starting point for planning, recognising the importance of stability, continuity of relationships, and connection to family and community. It is acknowledged that there will be circumstances where suitable care cannot be provided within the local area due to the assessed needs of the child or young person, safeguarding considerations, or the availability of appropriate provision. In such cases, Out of Area (OOA) care may be required to ensure that the child or young person receives the right care at the right time, in line with their best interests. OOA care is not intended to be a default or permanent solution. Where an OOA placement is necessary, it will be subject to ongoing review, with active consideration given to opportunities for the child or young person to return closer to home when it is safe and appropriate to do so. In some cases, the duration or nature of an OOA placement may be influenced by statutory or legal requirements, including court orders or decisions of the Children’s Hearing System. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Lead Officer for developing the contract Kristen Duncan Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Virtual Head Teacher Principal Educational Psychologist Senior Commissioning Officer Interim Service Managers Date 06/03/2026 Page 160
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85 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 1. Describe what the service does: Review and monitor use of Out of Area Alternative Care and options for a Return to Local to internal alternative care options within own community • Increase alternative care options within the Moray Area and prevent children and young people having to be cared for out with their communities. • Prevent children and young people from requiring alternative care arrangements by utilising home/community-based supports at an early stage. • Maximising use of kinship options • Children and young people who are currently out with their community in alternative care arrangements to return to internal care arrangements within their own community. • Reduce the cost of transport for children and young people in OOA alternative care options required to maintain links with their families and local community is costly. 2. Who are your main stakeholders? Children, families and Justice Social Work, Education and Commissioning Services 2. What changes as a result of the proposals? Is the service reduced or removed? As a result of the proposal, there will be increased oversight and review of Out of Area (OOA) alternative care arrangements to ensure they are used only where suitable care cannot be provided locally. The review will strengthen the focus on: • Increase alternative care options within the Moray Area and prevent children and young people having to be cared for out with their communities. • Prevent children and young people from requiring alternative care arrangements by utilising home/community-based supports at a n early stage. • Maximising use of kinship options • Children and young people who are currently out with their community in alternative care arrangements to return to internal care arrangements within their own community. Page 161
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86 • Reduce the cost of transport for children and young people in OOA alternative care options required to maintain links with their families and local community is costly. The proposal does not remove or reduce services, but reinforces a consistent, rights‑based approach to placement decision‑making. As part of the review, increased attention will be given to the wider impacts arising from OOA care arrangements, including situations where children and young people placed out of area continue to attend education provision within Moray. These arrangements can result in significant travel time for the child and associated transport costs, reinforcing the importance of ensuring that OOA care is used only where local provision cannot meet assessed need. 4. How will this affect your customers? For children and young people, the proposal supports greater stability, continuity of relationships, and connection to family and community by prioritising local care arrangements wherever possible. For those currently placed out of area, the review provides an opportunity for ongoing consideration of whether their needs could be met closer to home, while recognising that OOA care will continue to be necessary for some children and young people. Families may benefit from increased proximity and involvement where children are able to remain locally or return closer to home, while continuing to be supported where OOA placements remain appropriate. For some children and young people, OOA placements combined with attendance at education provision within their home area can result in extended daily travel. This may have a negative impact on wellbeing, including increased fatigue and reduced time for rest, family life and social activity. Strengthening oversight of OOA arrangements supports consideration of these impacts as part of placement planning and review. 5. Impact on staff providing the service The proposal supports staff by providing clearer oversight and shared expectations regarding the use of OOA care. Strengthened review arrangements promote consistent decision‑making, improved multi‑agency planning, and clearer pathways for reviewing and, where appropriate, transitioning children back to local care arrangements. The proposal does not change statutory responsibilities or operational roles but supports more coordinated and planned use of alternative care. 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Page 162
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87 Race No differential impact identified. Decisions about OOA care are based on assessed need and are applied consistently regardless of race or ethnicity. Disability Some children and young people with disabilities may require specialist provision that is not available locally, increasing the likelihood of OOA placement. Individual care planning will continue to consider reasonable adjustments and appropriate support. Carers (for elderly, disabled or minors) Families and carers may experience increased distance from the child or young person when OOA placements are required. Efforts will be made, where appropriate, to support ongoing contact and involvement. Sex No differential impact identified. Pregnancy and maternity (including breastfeeding) No specific impacts identified. Sexual orientation No differential impact identified. Age (include children, young people, midlife and older people) The proposal directly affects children and young people. OOA placements will be used only where necessary, with decisions informed by individual assessment and care planning. Extended travel associated with some OOA care arrangements may disproportionately affect children and young people. Religion, and or belief No differential impact identified. Cultural or religious needs will continue to be considered through placement planning. Gender reassignment No differential impact identified. Individual identity and wellbeing considerations will continue to inform care planning. Inequalities arising from socio- economic differences OOA placements may increase pressures on families experiencing socio‑economic disadvantage due to distance and reduced accessibility. These factors will be considered when planning and reviewing placements. Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security Not engaged. The proposal does not involve detention or deprivation of liberty beyond existing lawful care arrangements. Article 6: Right to a fair trial Not engaged. The proposal does not relate to judicial or quasi‑judicial proceedings. Page 163
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88 List of convention rights Describe, where applicable, if and how specific rights are engaged Article 8: Right to respect for private and family life, correspondence and the home Engaged. OOA placements may affect family life due to distance from home. Decisions will be made on the basis of individual need, with consideration given to maintaining family relationships where appropriate. Article 10: Freedom of expression Engaged. Children, young people and families will be supported to express their views as part of care planning and review processes. Article 11: Freedom of assembly and association Not engaged. Article 12: Right to marry Not engaged. Article 14: Prohibition of discrimination (in relation to the convention rights) Engaged in relation to Article 8. Placement decisions will be made consistently and based on assessed need. Article 1 of Protocol 1: Protection of property Not engaged. Article 2 of Protocol 1: Right to education Engaged. Education needs will be considered as part of placement planning, including where OOA provision is required. Article 3 of Protocol 1: Right to free elections by secret ballot Not engaged. Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination Placement decisions will be made without discrimination and based on individual assessed need. Article 12 – Respect of the views of the child The views of the child will be sought and considered at all stages of the planning Article 3.1 – Best interest of the child This will be a primary consideration in all decisions regarding OOA placements Article 6.2 – Right to survival and development This will be considered through thorough ongoing assessment and collaborative planning Page 164
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89 7. Evidence. What information have you used to make your assessment? Performance data Internal consultation Consultation with colleagues involved in project Consultation with colleagues in alternative care services Consultation with colleagues in commissioning services Consultation with Accountancy Consultation with affected groups Local statistics National statistics Other - Consideration of the need to identify OOA alternative care for children and young people due to a lack of internal resources. - Consideration to the distances and cost of taxis to travel to an educational setting following access to alternative care ooa. - Corporate budget overspend 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? No 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain Potential impacts associated with OOA care will be mitigated through strengthened oversight, regular review of placements, and continued development of local care options. Early intervention and use of community‑based supports will continue to be promoted to prevent the need for alternative care where appropriate. Where OOA placements are required, planning will focus on stability, wellbeing, and maintaining family connections, with active consideration of opportunities to return closer to home when this meets assessed need. Strengthened oversight and review of OOA care arrangements will support earlier identification of opportunities to reduce extended travel associated with education attendance, where this aligns with the child or young person’s best interests. This may also reduce associated transport costs arising as a consequence of reducing OOA placements. 10. Justification Page 165
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90 If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? Where OOA care continues to be required, this is justified on the basis that suitable care cannot be provided locally and that the placement is necessary to meet the assessed needs and best interests of the child or young person. Such placements will remain under regular review and will not be maintained as a default position. Extended travel to education provision is recognised as a potential consequence of some OOA care arrangements and may impact on children’s wellbeing as well as generating additional costs, reinforcing the importance of ensuring OOA placements are necessary, proportionate and regularly reviewed. Page 166
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91 SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. x 2. Some potential negative impacts have been identified. The impacts relate to: Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity x Fostering good relations x 3. The proposals interfere with human rights and/or the rights of the child 4. Negative impacts can be mitigated the proposals as outlined in question 9. x 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. 7. It is advised not to go ahead with the proposals. Decision Set out the rationale for deciding whether or not to proceed with the proposed actions: The proposal should proceed. Strengthening oversight of OOA care arrangements supports a consistent, rights‑based approach to placement decision‑making, reinforces local care as the default where possible, and ensures that OOA care is used only where necessary and for no longer than required. This approach also supports improved wellbeing for children and young people by reducing unnecessary extended travel associated with some OOA arrangements and may, as a consequence, reduce associated transport costs arising from education and care continuity. Date of Decision: Page 167
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92 Sign off and authorisation: Service Children, families and justice Department Social work Policy/activity subject to IIA Review of OOA Care and Return to Local Community We have completed the integrated impact assessment for this policy/activity. Name: Jean Massie & Pam Urquhart Position: Interim service managers Date: 16/3/26 Authorisation by head of service Name: Jim Lyon Position: Head of Service Date:16/3/26 Permission to publish on website - INTEGRATED IMPACT ASSESSMENT COVERING • EQUALITIES & SOCIO ECONOMIC DUTIES • HUMAN RIGHTS AND RIGHTS OF THE CHILD DATE UPDATES/EXECUTIVE SUMMARY VERSION DETAILS 9.03.26 Cessation of all interim management arrangements and review of staffing for integrated working 1.0 STAGE 1 - DO I NEED AN INTEGRATED IMPACT ASSESSMENT? Name of policy or proposal: 64. Cessation of all interim management arrangements and review of staffing for integrated working Is this a Mark X below New activity, programme or policy? Change to an existing activity, programme or policy? x Budget proposal? x Page 168
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93 Duties: tick the boxes you think apply No Maybe Yes Equalities: Will your proposal have an impact on groups with protected characteristics? Consider the impact of your proposal on people and how they access your services and information without barriers. x Socio-economic Not every person/family has access to regular income or savings. Will your proposal have an adverse impact on them x Does your proposal impact on the human rights of people? x Does your proposal impact on the rights of children and young people x Reasoning Briefly describe your reasoning for the responses given above: The proposal relates to the cessation of interim management arrangements and a review of staffing structures to support integrated working. There is no intention to reduce services or alter access for people who use services, and no changes to eligibility or service delivery models are proposed. While the implementation of HR processes (including redeployment and organisational change) may result in some posts being vacant for a temporary period, these arrangements will be managed in line with established workforce policies and are not assessed as giving rise to adverse impacts on people with protected characteristics, socio‑economic disadvantage, human rights, or children’s rights. Service continuity will be monitored throughout implementation, and any emerging impacts will be addressed through operational management. If you have answered “maybe” or “yes” to any of the Stage 1 questions above then proceed to complete the Stage 2 Integrated Impact Assessment questions below. If you have answered “no” to the Stage 1 questions above then provide the details below and submit to [email] Currently HSCM have a number of interim management arrangements. Once the current staffing structure review is completed, roles and responsibilities will be clarified for integrated working across adult and children services and the interim arrangements and associated costs will cease. Page 169
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94 Lead Officer for developing the contract Deborah O’Shea Other people involved in the screening (this may be council staff, partners or others i.e. contractor or community) Finance, Heads of Service, Chief Officer and HR. Date 9.03.2026 Page 170
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95 STAGE 2: INTEGRATED IMPACT ASSESSMENT Brief description of the affected service 2. Describe what the service does: 2. Who are your main stakeholders? 3. What changes as a result of the proposals? Is the service reduced or removed? 4. How will this affect your customers? 5. Impact on staff providing the service 6. Please indicate if these apply to any of the protected characteristics Protected groups Potential impacts and considerations Race Disability Carers (for elderly, disabled or minors) Sex Pregnancy and maternity (including breastfeeding) Sexual orientation Age (include children, young people, midlife and older people) Religion, and or belief Gender reassignment Inequalities arising from socio- economic differences Human rights List of convention rights Describe, where applicable, if and how specific rights are engaged Article 5: Right to liberty and security Article 6: Right to a fair trial Page 171
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96 List of convention rights Describe, where applicable, if and how specific rights are engaged Article 8: Right to respect for private and family life, correspondence and the home Article 10: Freedom of expression Article 11: Freedom of assembly and association Article 12: Right to marry Article 14: Prohibition of discrimination (in relation to the convention rights) Article 1 of Protocol 1: Protection of property Article 2 of Protocol 1: Right to education Article 3 of Protocol 1: Right to free elections by secret ballot Children’s Rights and Wellbeing Relevant articles – UNCRC Article 2 – Non discrimination Article 12 – Respect of the views of the child Article 3.1 – Best interest of the child Article 6.2 – Right to survival and development 7. Evidence. What information have you used to make your assessment? Performance data Internal consultation Consultation with affected groups Local statistics National statistics Other 8. Evidence gaps Do you need additional information in order to complete the information in the previous questions? Page 172
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97 9. Mitigating action Can the impact of the proposed policy/activity be mitigated? Please explain: 10. Justification If nothing can be done to reduce the negative impact(s) but the proposed policy/activity must go ahead, what justification is there to continue with the change? SECTION 3 CONCLUDING THE IIA Concluding the IIA 1. No potential negative impacts on any of the protected groups were found. 2. Some potential negative impacts have been identified. The impacts relate to: Reducing discrimination, harassment, victimisation or other conduct prohibited under the Equality Act 2010 Promoting equality of opportunity Fostering good relations 3. The proposals interfere with human rights and/or the rights of the child 4. Negative impacts can be mitigated the proposals as outlined in question 9. 5. The negative impacts cannot be fully mitigated but are justified as outlined in question 10. 6. Further consultation with affected groups is needed. 7. It is advised not to go ahead with the proposals. Decision Date of Decision: Sign off and authorisation: Page 173
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98 Service HSCM Department Social Work and finance Policy/activity subject to IIA We have completed the integrated impact assessment for this policy/activity. Name: Deb O’Shea Position: Chief Finance Officer Date: 9.03.2026 Authorisation by head of service Name: Deb O’Shea Position: Chief Finance Officer Date: 9.03.2026 Permission to publish on website - Page 174
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APPENDIX 3 Predicted Prescribing Budget Resource Requirements 2026-2027 Prescribing pressures continue to grow and there is a net predicted need for a budget resource of £23,191,000, for 2026-27. This paper provides information on the predicted prescribing budget resource requirements for 2026-2027, alongside key drivers of growth and mitigations regarding costs. Current forecasting indicates that Moray will end the 2025-2026 year with a prescribing deficit of -£182,000 which will be further affected by identified factors and estimates for these factors. Historic limited budget uplifts have resulted in significant historic overspends, however, recent uplift has significantly reduced the overspend predicted for 2025-2026. Appendix A highlights a trend of increasing void between actual budget and actual spend. 2025-2026 spend does more accurately reflect estimates due to factors such as stabilisation of growth, continued prescribing efficiency work and price changes. Medicines shortages present unpredictable risk to expenditure estimates and cannot be mitigated for. There has been a continued growth in items and costs across all boards in Scotland (Appendix B) since 2021 but NHS Grampian shows a lower percentage item growth compared to the Scottish average and Moray’s growth has mirrored the NHS Grampian average for the last 2 financial years. This has been further impacted also by the increase in acute prescription requests by patients. There are wide ranging factors affecting performance. Resource assessment for prescribing has been undertaken for 2026-27. This was done using the approach adopted in previous years, which estimates growth in volume and spend in the coming year, and also offsets these with generic savings and approved efficiency plans. The key themes and data presented here are taken from the more comprehensive ‘Health and Social Care Prescribing Budget Supporting Information and Data for 2026-2027’, which has been scrutinised and approved by the multidisciplinary / cross sector Grampian Area Drug and Therapeutics Committee (GADTC) and NHS Grampian Primary Care Prescribing Group. A breakdown of the components of the Moray requested budget for 2026-27 is provided in Appendix C. A growing and ageing population demographic has had an effect on prescribing volumes and subsequent costs as cost per patient rises with age: NRS figures now show that 23.5% of Moray population are now over age 65 which carries much higher cost per patient. Mitigation is to offer Primary and continue to offer Secondary prevention and adopt Realistic Medicine approaches to care. Page 175
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APPENDIX 3 Volume growth for 2025-2026 was still highly variable due to multiple factors out with our control, including changes in volumes and treatments and continuing post-Covid variation in operating levels across Primary and Secondary care. However, in the first 6 months of 2025-2026, NHS Grampian rates of growth for both items and cost was lower than the previous two financial years (Appendix D). The following are the main financial risks: Scottish Drug Tariff Pricing and Medicine Shortages: Volatility within pricing of several widely used medications means that prices are likely to remain high in 2025-26. There remains scope to ensure that all new medicines are prescribed generically even before generic availability to ensure smooth transition and cost effectiveness. There is a risk in that the future prices for generic medicines, and associated reimbursement levels set within the Scottish Drug tariff, remain high and difficult to predict. The Scottish Government sets the Scottish tariff prices. They are committed to rebalancing Community Pharmacy contractor payments by reducing the emphasis on margin share and moving these payments to within the guaranteed global sum. In July 2025, the clawback rate, part 11 of the Scottish Drug Tariff, was set to 0% (from 3.62%) meaning that previous monies generated via clawback rate were no longer available – generating risk to health board budgets. This is anticipated to be introduced, but there is uncertainty regarding when this will occur and the impact it will have. In 2024/2025 positive impact of the discount was £1.2 million for NHS Grampian. Generic shortages arise from increase in demand, lack of active ingredient, quality control and manufacturing delay, etc. These result in more costly prescribing e.g. more expensive sometimes unlicensed medication choices, as well as impacting pharmacy admin and clinician time required. The global supply chain of medication remaining fragile continues to be a significant sourcing problem for Community Pharmacy within a wide range of medicines for a variety of conditions. Such shortages can lead to unpredictability in the cost per item during the year. The growth in consumption of medicines, strengthened approaches to medication review and associated reductions in polypharmacy. The variations in volume are partially related to changes in patient behaviours, as well as changes in capacity within Primary Care. Repeat prescribing increase has continued, and acute prescribing and outpatient/medication requests are variable corresponding to service provision and patient flow. In terms of Primary Care rebates, a patient access scheme system provides the NHS in Scotland with post-use discounts on spend on specific medicines has remained generally stable, but there remains a risk that these rebates may change or be removed. N.B. these discounts accrue to the individual Health and Social Care Partnerships (HSCPs) based on spend and so are offset within prescribing expenditure estimates. Sustained and increased pressures within GP practices and requirement of Pharmacotherapy teams to deliver Pharmacotherapy Memorandum of Understanding (MOU) work has reduced time availability for medicines management cost efficiency work by Pharmacists and GPs. Page 176
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APPENDIX 3 National/international research, change to evidence based guidance or change to government policy. Many new medicines and new indications/licensing change for existing medications, from new protocols, are likely to have a significant clinical and subsequent financial impact e.g. Rimegepant in management and prevention of Migraine, and Attention Deficit Hyperactivity Disorder (ADHD ) treatment in adults. Appendix E highlights examples of medicines predicted to cause significant cost impact in Grampian. The list is not exhaustive and difficult to predict so will continue to be monitored. Changes in delivery of local services and patient pathways, have the potential to affect medicine use e.g. transfer of prescribing from secondary care to primary care has a financial impact. Extended hospital procedure waiting lists also requires extended prescribing time and increased prescribing costs while patients are on the waiting list. Summary of Risk Mitigation Patent Expiry On expiry of a drug patent, increasing competition can drive down market prices where there are alternative manufacturers’ competition. This relies on manufacturers to manufacture the newly off patent medicine. On patent expiry there is also opportunity to review the preparation prescribed and change to generic or more cost effective drug. Prescribing Cost Efficiencies and Cost Avoidance There is an urgent need and opportunity to deliver several cost efficiencies. An actionable tracker (in line with Grampian Primary Care Prescribing Group) holds some appropriate cost efficiency work for the pharmacy team to complete. Moray Pharmacotherapy staff annotate work when completed. This work has been challenging in terms of workforce capacity and workload pressures. Spend to Save Initiative Considerable cost savings work has now been undertaken in 2025-26 under a Moray Pharmacy Spend to Save Prescribing Cost Effectiveness Strategy. This involved some GP practice Clinician collaboration as well as seconded Specialised Pharmacy Technician input to drive progress. Recent program of cost efficiency work from April 2025 to end January 2026 has provided annualised prescribing savings of £321,097. The work involved visits to GP practices and also some secondary care discussions and managed interventions via dedicated focused work. Prescribing reports were utilised. As well as therapeutic switches, prescribing of non-formulary and low clinical value items was scrutinised and discussions were had with GPs, practice clinicians and patients. From discussions with prescribing staff within practice and secondary care indirect Page 177
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APPENDIX 3 savings were achieved by changing prescribing processes. Reducing over ordering and medicines wastage also helped maximise prescribing cost efficiency. A Grampian primary care prescribing efficiencies agreement was also put in place for GPs with the aim of medication review interventions involving drug therapeutic switches and generic switches. There were 3 levels of work stream and GPs suitably actioned some level 3 aspects. Medicines management team have provided guidance and support for prescribers re delivery of cost efficient prescribing in GP practices which has been a huge benefit to our intervention also. A Grampian Primary Care Prescribing group workbook has been developed which details information to guide efficiency, generic, preferred brand switches and a stop list with or without alternative re low clinical value prescribing. Following the successful spend to save initiative, a permanently funded post of Specialist Prescribing Efficiency Pharmacy Technician has been approved. This post will continue the work of the spend to save initiative but will also look at prescribing habits across Moray to ensure equitability for patients across Primary Care as well as highlight outliers, challenge prescribing and continue to reduce overall spend. Scriptswitch This is a communication tool providing electronic advice messages to the prescriber. We continually review these messages to ensure that Scriptswitch underpins and delivers many cost saving initiatives. This can be in the form of a targeted therapeutic drug switch, reducing waste by dose optimising, as well as safety alerts and influences prescribing for future. Generic Savings Work On our actionable tracker, we include work from the Practice Generic Savings Quarterly Report, and all teams are given details on medications not prescribed generically and the costs involved, although admittedly this is less than previous impact. The teams are requested to review and annotate changes made. Extraordinary Prescribing Report Moray Pharmacotherapy Team Management check reports and request copies of prescriptions in order to identify where pricing and reimbursement overpayments may require to be claimed. This can be from specials medications or normal prescribing and is provided through the Payment Verification process. Tighter Control of Specials Items Automatic authorisation of specials items of £100 or less has been removed to allow more scrutiny of the specials prescribing and payments, this service is hosted my Aberdeenshire HSCP working with the Pharmacotherapy Team in each HSCP. Page 178
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APPENDIX 3 Medicine Care and Review – Serial Prescribing Use of this serial prescription service, and now also in care homes, has the potential to reduce wastage as prescriptions are issued at correct intervals, which prevents any unnecessary stock piling. A review of this process with Community Pharmacy colleagues is required to ensure there is no stock piling or over ordering of medication. The Grampian Formulary A Grampian Formulary tool is installed in all Moray GP Practices to steer the appropriate cost-effective prescribing choices, this is maintained and managed by the Pharmacotherapy teams to ensure it is up to date when formulary changes occur. There remains opportunity to identify and amend non formulary prescribing. Page 179
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APPENDIX 3 Appendix A – Moray Budget Predictions, Budget Allocation and Actual Spend Page 180
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APPENDIX 3 Appendix B – Prescribed items % Growth from Previous Year Page 181
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APPENDIX 3 Appendix B – Prescribed Cost % Growth from Previous Year Page 182
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APPENDIX 3 Appendix C – Moray Health and Social Care Partnership: Summary and Budget Estimates Tables A and B: Estimates for Prescribing Moray Table A – Growth, Expenditure and Savings – Primary Care Prescribing Moray Table B - Overall Moray HSCP Suggested Primary Care Prescribing Budget Requirement 2026/2027 Moray Table C – Core Services Prescribing Budget Requirements Page 183
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APPENDIX 3 Moray Table D – Hosted services impact by IJB Page 184
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APPENDIX 3 Appendix D – NHS Grampian items, cost and % growth Q1 & Q2 comparison per financial year Notes for consideration:- • Increase in volumes due to aging population and increasing burden of disease • Price has decreased this year due to tariff adjustments, branded to generic impact and aggressive market conditions, which may not be sustainable. • There is no adjustments made for weight management drugs through Primary Care. Boards will need to make local assessment for this. Page 185
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APPENDIX 3 Appendix E – Primary Care Growth of Medicines Predictions (existing and new medicines) GLP-1 medicines: Type 2 Diabetes only (Dulaglutide, Exenatide, Liraglutide, Lixisenatide, Semaglutide) Page 186
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APPENDIX 3 Calcitonin Gene-related Peptide Receptor Antagonist (rimegepant & atogepant) Page 188
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APPENDIX 3 Methenamine Hippurate Page 190
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APPENDIX 3 ADHD Medication Page 191
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Integration Joint Boards Financial bulletin 2024/25 Prepared by Audit Scotland February 2026 APPENDIX 4 Page 195
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2Integration Joint Boards Contents Key facts 3 Key messages 4 Recommendations 6 Introduction 7 Context 9 Financial performance 11 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility. Audit team The core audit team consisted of: Christopher McClelland, Christopher Holgate and Kathrine Sibbald, under the direction of Blyth Deans. Page 196
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3Key facts Key facts 2.3% Real-terms increase in IJB funding between 2023/24 and 2024/25 £12.5 billion Net cost of services for IJBs in 2024/25 78% Proportion of planned savings achieved by IJBs in 2024/25 12% Reduction in total reserves since 2023/24 £404 million Total IJB reserves remaining at the end of 2024/25, £316 million of which is earmarked £449 million The budget gap at the time of budget setting for 2025/26 Page 197
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4Key messages Key messages Key messages Key messages Despite a real-terms increase in funding, Scotland’s Integration Joint Boards (IJBs) are in a critical financial position. With increasing cost pressures and the total level of reserves now lower than the budget gap forecast, IJBs need to take decisive action and make difficult decisions about services. 1 Despite a real-terms increase in funding between 2023/24 and 2024/25 of 2.3 per cent, the financial position of IJBs has become increasingly concerning. Financial pressures and demands on services continue to grow, outstripping increased funding and savings made, raising concerns around IJBs’ financial sustainability. IJBs must make difficult decisions about how services are delivered, determine the appropriate level of services, and decide where to redesign, reduce or discontinue services. They must be transparent with service users and the public about the potential impact of these changes on service performance and outcomes. 2 Total reserve levels continue to fall across IJBs. Almost half of IJBs no longer hold any contingency reserves. The total level of reserves held by IJBs is now lower than the budget gap forecast for the year ahead. 3 The majority of IJBs reported operational overspends in-year, continuing the trend from previous years. While unplanned use of reserves decreased in 2024/25, as expected given the significant reduction in reserve levels in recent years, this was offset by a large increase in additional contributions from Page 198
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Key messages 5 partners. The partners, NHS boards and councils, also face significant financial challenges and will find it increasingly difficult to allocate further funding to IJBs during the year. 4 The funding gap in 2025/26 remains significant at £449 million, a slight decrease from £457 million in 2024/25. IJBs must work closely with partners to ensure budgets and savings plans are realistic and to identify solutions that will ensure services remain financially sustainable over the medium to long term. 5 Although the majority of planned savings were achieved in 2024/25, it is unclear what proportion of these savings are recurring. There continues to be a lack of transparency and detail in public reporting on savings performance. Page 199
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6RecommendationsRecommendations Recommendations Over the next year, IJBs and their partner council and NHS boards need to work more collaboratively to: • set realistic budgets before the start of the financial year that minimise the need for additional in-year contributions • consult and communicate with service users, carers and the wider public on plans for changes to services and ensure appropriate impact assessments are undertaken • set out in strategic plans how services will be made financially sustainable and how future demand can be managed through investment in prevention in the medium and long term, including consideration, for example, what services are delivered, how and to whom those services are delivered, and charges for services. Over the next year, IJBs should: • improve the clarity and comprehensiveness of their public reporting on savings performance, including comparisons to targets agreed during budget-setting, and whether savings made were recurring or non-recurring. Page 200
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7Introduction Introduction About health and social care integration 1. The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) requires councils and territorial NHS boards to work together in partnerships, known as Integration Authorities (IAs). As part of the Act, new bodies were created – Integration Joint Boards (IJBs). An IJB is a separate legal entity, responsible for the strategic planning and commissioning of a wide range of health and social care services across a partnership area. NHS board and council partner organisations are responsible for the delivery of services as directed by the IJB. 2. Of the 31 IAs in Scotland, 30 are IJBs. Stirling and Clackmannanshire councils have formed a single partnership with NHS Forth Valley. Highland currently follows a Lead Agency model where a Joint Monitoring Committee takes a similar strategic oversight role of adult community health and social care. Each IA is supported by an operational delivery partnership – the Health and Social Care Partnership (HSCP) – that manages the delivery of the services. The HSCP staff remain employees of the NHS or the council, depending on their role. More detail about integration can be found in our short guide – What is integration? Financial bulletin 2024/25 3. On behalf of the Accounts Commission, Audit Scotland has undertaken an analysis of the IJB annual accounts for 2024/25 and the annual audit reports produced by external auditors. The data and analysis are published on the Audit Scotland website as an interactive online tool – The IJB finance bulletin 2024/25. This interactive tool is supported by this bulletin. Data tool 4. In March 2025, we published a data tool that sets out financial data in an interactive way so that members of the public and in particular IJB members and other stakeholders could view the data and compare financial performance across the 30 IJBs in one location. This has been updated with data from the 2024/25 annual accounts. Page 201
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Introduction 8 5. We anticipate this will be a useful resource again for IJBs, their stakeholders and members of the public. It includes data on the funding and income and reserves position, outturn budget position, savings performance and financial outlook. The tool also includes local and national contextual data from the 2022 census that illustrates the increasing population pressures nationally and the significant variation across Scotland. Bulletin 6. This bulletin accompanies the interactive online data tool and provides a summary of the national level messages along with identified recommendations for improvement. 7. Our findings are based on the 2024/25 annual accounts for 30 IJBs (27 audited and three unaudited), 2024/25 annual audit reports, as well as IJB budget documentation for 2025/26. In addition, to assist understanding of the issues behind the data, a roundtable discussion was held with a group of IJB chief officers and chief finance officers in January 2026. 8. In the bulletin and data tool we convert some figures to real terms. This adjusts financial information from past and future years to prices for the year under review (2024/25). This is to take account of inflation so that trend information is comparable. To adjust for inflation, we use gross domestic product (GDP) deflators, which are published quarterly by HM Treasury. GDP deflators are the standard approach adopted by both the UK Government and Scottish Government when analysing public expenditure. Page 202
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9Context Context Demographic shifts are driving an increase in the demand and complexity of health and care needs 9. The pressures on Scotland’s community health and social care services are escalating. There are increased public expectations of services and as we live longer and the proportion of the population over 65 continues to rise, the demand for the care and support that this positive outcome brings also increases. Positive progress with improving the life expectancy in people of all ages with complex needs also brings associated additional costs. The increasing financial pressures the sector is experiencing are further aggravated by inflationary cost pressures. 10. Our roundtable discussions with IJB chief officers and chief finance officers raised several key challenges for the sector including some of the main drivers of cost pressures. These include prescribing costs, individually complex care packages, impacts of increased life expectancies and reduction in the working week for NHS and council staff. 11. Scotland’s wide-ranging population density from remote rural setting to urban populations in our towns and cities, presents different logistical challenges for providing community health and social care services to communities. This brings different associated cost pressures. Our interactive data tool provides information on the contextual profile of each IJB alongside the 2024/25 and 2023/24 financial data. 12. The 2022 Census sets out how the underlying factors impacting on the demand for social care and healthcare services have changed since 2011, Exhibit 1 (page 10). Page 203
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Context 10 Exhibit 1. 2022 Census data with comparison to 2011 Census The 2022 Census sets out how the underlying factors impacting on the demand for social care and healthcare services have changed since 2011. Source: Scotland’s Census 2022 2022 Census data Movement since 2011 Population 5.4 million 2.7% increase Proportion of population aged over 65 20% Increasing from 17% Population density (residents per km2) 70 Varying from 9 (Eilean Siar) to 3,555 (Glasgow) Percentage of people who reported having bad or very bad health 7% 27% increase Percentage of people with a long- term illness, disease or condition 21% Increasing from 19% Percentage of population that provide unpaid care 12% 28% increase Page 204
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11Financial performance Financial performance The financial position of IJBs continues to deteriorate, with increasing cost pressures meaning difficult decisions must be made IJB funding has increased in real terms since 2023/24 13. IJBs receive their funding as annually agreed contributions from their council and NHS board partners. Funding is largely provided to cover in-year expenditure on general services but can also be ring-fenced for specific services and national initiatives to be funded in future years. The funding split between NHS and council partners remains around 70 per cent from NHS boards and 30 per cent from councils. 14. There has been a 2.3 per cent real terms increase in funding between 2023/24 and 2024/25 as shown in Exhibit 2. Exhibit 2. IJB funding and income 2021/22 – 2024/25 Funding increased by 2.3 per cent in real terms in the past year. Source: IJB annual accounts £ million Partner contributions Covid-19 funding £594 £1,051 0 3,000 6,000 9,000 12,000 15,000 2024/252023/242022/232021/22 £12,642 £12,617 £12,903£10,948 Page 205
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Financial performance 12 15. The real-terms increase in funding helps cover inflationary cost pressures and increases in the living wage, however it does not necessarily result in additional funding for baseline services as the costs incurred by IJBs are increasing at a faster rate than funding. Most IJBs reported operational overspends in-year, requiring a notable increase in additional contributions from partner bodies as well as the unplanned use of reserves 16. Total net cost of services across all IJBs totalled £12.486 billion, an increase of five per cent on 2023/24. 17. Twenty-two IJBs reported a deficit on the cost of providing services with the majority (14) reporting a deficit of up to three per cent of their net cost of services. Eight IJBs reported a deficit of over three per cent, with the largest deficit being 5.1 per cent (Exhibit 3, page 13). There was a reduction in unplanned use of reserves, reflecting the falling reserve levels across the sector, however this was offset by a significant increase in additional partner contributions 18. Of the 22 IJBs reporting an operating deficit, ten IJBs made an unplanned drawdown from reserves to fund these deficits compared with 16 in the prior year. This reduction in unplanned drawdowns from reserves is in line with expectations as reserve levels fall across the sector (paragraphs 29–32). 19. Nineteen IJBs received additional contributions from partner bodies to cover the year-end overspend, a 73 per cent increase on 2023/24. The level of additional contributions from partners rose by 79 per cent, from £91 million in 2023/24 to £163 million in 2024/25. 20. Given the financial challenges faced by NHS boards and councils this continued level of additional contribution is unsustainable. The Local government financial bulletin 2024/25 and the Auditor General for Scotland’s NHS in Scotland 2025 report, both note the financial sustainability risks in these bodies. 21. A number of IJBs will have received additional partner contributions during the year that will not be captured by this analysis. These additional in-year contributions can arise for a variety of reasons, including specific one-off cost pressures not anticipated during budget-setting. Greater collaboration with partner NHS boards and councils in budget-setting could help ensure realistic budgets are set, minimising the need for additional contributions. Baseline services are the essential, minimum level of care and support to make sure everyone’s basic needs are met. These usually include things like: • access to a GP • help with daily living (such as washing, dressing, or eating) for those who need it • support to keep people safe and well in their homes • essential safeguarding and protection for vulnerable people. Page 206
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Financial performance 13 Exhibit 3. Operational surplus/deficit as a proportion of the 2024/25 net cost of service The majority of IJBs reported a deficit on the cost of providing services in 2024/25 requiring additional contributions from partner bodies and the unplanned use of reserves. Source: IJB audited and unaudited annual accounts -10% -8% -6% -4% -2% 0% 2% 4% North Lanarkshire South Lanarkshire Eilean Siar East Renfrewshire Angus South Ayrshire Glasgow Inverclyde West Dunbartonshire Argyll and Bute East Dunbartonshire North Ayrshire Renfrewshire Edinburgh East Lothian East Ayrshire Scottish Borders Dundee Moray West Lothian Clackmannanshire and Stirling Perth and Kinross Shetland Falkirk Midlothian Fife Aberdeen Dumfries and Galloway Orkney Aberdeenshire 2023/24 2024/25 Page 207
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Financial performance 14 Staff vacancies continue to affect the level of spend, but cost pressures continue to rise 22. Eight IJBs reported a surplus on the cost of delivering services in 2024/25, up from five in 2023/24. The surplus in all IJBs was mainly due to ongoing recruitment challenges and staff vacancies across the sector. It is likely that these recruitment issues are contributing to the picture of general decline in performance and satisfaction across the health and social care sector as we reported in our Community Health and Social Care: Performance 2025 report. 23. There are several significant cost pressures impacting on the level of deficits being faced by IJBs. Most notable among these are: • inflationary pressures • rising wage costs • prescribing costs • changing demographics and complexity of care, especially the cost of individual adult social care packages and care for people with learning disabilities. 24. We have produced several reports in recent years highlighting the challenges facing the health and social care sector. Most of the savings planned by IJBs were achieved; however, there is a lack of transparency around whether savings made were recurring in nature 25. There was a 71 per cent increase in the total savings target set by IJBs between 2023/24 and 2024/25, increasing from £214 million to £364 million. Overall, IJBs achieved 78 per cent (£276 million) of their planned savings in 2024/25, which is in line with the prior year performance. 26. Of the 28 IJBs where we could identify overall savings performance for the year, only four IJBs met or exceeded their savings target, with two achieving less than half of their target. 27. We could identify publicly reported information for only 15 of the 28 IJBs (54 per cent) regarding the split of savings between recurring and non-recurring. Based on the information available, 79 per cent of the achieved savings were recurring in nature. Examples of recurring savings include deletion of long-term vacant posts, efficiency savings and reduction in services. 28. The majority of IJBs have noted savings or operational underspends from unfilled vacancies due to issues with recruitment, which is in some cases offset by the additional costs of hiring agency staff. Savings of this nature are non-recurring and will need to be carried forward to be Some of the many reports where we have set out the range of pressures and challenges for the health and social care sector include: • IJB Finance and performance 2024 and IJBs’ Finance bulletin 2023/24 • NHS in Scotland 2024 and NHS in Scotland 2025 • Adult mental health, 2023 • General practice: Progress since the 2018 General Medical Services, 2025 • Improving care experience – delivering The Promise, 2025 • Community health and social care: Performance, 2025 • Delayed discharges, 2026 • Local Government Finance bulletin 2024/25. Page 208
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Financial performance 15 found again in future years. It is essential that IJBs identify and achieve recurring savings as part of their budgeting and financial planning processes. Reporting around the nature of these savings and progress against these targets should be transparent. Total reserve levels continue to fall across IJBs. Almost half of IJBs no longer hold any contingency reserves 29. Total reserve levels across all IJBs have fallen by 12 per cent between 2023/24 and 2024/25 as shown in Exhibit 4. Contingency reserves have fallen by 13 per cent in the same timeframe and now represent only 0.7 per cent of the total net cost of services from IJBs. Contingency reserves are reserves that have not been earmarked for specific purposes and are used to mitigate the impact on ongoing financial pressures. The five IJBs with the highest total reserve balance hold 54 per cent of the total IJB reserves and 71 per cent of the contingency reserves, highlighting the generally low level of reserves across the sector. Exhibit 4. Total reserves level by year from 2021/22 to 2024/25 Total reserves held by IJBs have fallen by 12 per cent since 2023/24. Source: IJB audited and unaudited annual accounts £ million Ring-fenced/ Earmarked reserves Contingency reserves 0 300 600 900 1,200 1,500 2024/252023/242022/232021/22 Covid reserves 30. Two IJBs have utilised all of their reserves and a further 11 have utilised all of their contingency reserves, meaning 13 out of 30 IJBs (43 per cent) do not have reserves to drawdown to meet unforeseen financial challenges. Page 209
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Financial performance 16 31. Of the 17 IJBs that currently hold contingency reserves, only two of these maintain this reserve at the level of two per cent of their net cost of services, which is a common threshold used in IJB reserve policies. The average funding gap for 2025/26 is 3.6 per cent of net cost of services (paragraph 36) meaning even for IJBs who still maintain a level of contingency reserve, this would not be sufficient to meet the current level of financial challenge they are facing. 32. IJB reserve levels as a proportion of the net cost of services of each IJB are shown in Exhibit 5 (page 17). Page 210
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Financial performance 17 Exhibit 5. 2024/25 IJB year-end reserves as a proportion of net cost of services Almost half of IJBs have no contingency reserves and only two have contingency reserves above two percent of net cost of services. Source: IJB audited and unaudited annual accounts 0% 2% 4% 6% 8% 10% 12% Aberdeen Aberdeenshire Fife Midlothian Shetland West Lothian East Lothian Moray Dumfries and Galloway East Renfrewshire North Ayrshire Edinburgh Perth and Kinross East Ayrshire Glasgow Dundee South Ayrshire Scottish Borders Clackmannanshire and Stirling Falkirk Orkney South Lanarkshire Argyll and Bute Renfrewshire Angus North Lanarkshire West Dunbartonshire East Dunbartonshire Inverclyde Eilean Siar Ring-fenced/Earmarked reserves Contingency reserves Page 211
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Financial performance 18 Financial sustainability risks were raised in the majority of IJBs by appointed auditors 33. The majority of auditors raised financial sustainability risks in their reporting on the annual audit of IJBs. The risks identified included falling reserve levels, significant budget gaps and underdeveloped plans for the achievement of recurring savings. Based on a review of 27 annual audit reports, there were no modified opinions raised in any of the audits of IJBs in 2024/25 (Exhibit 6). Exhibit 6. 2024/25 analysis of IJB annual audits The majority of auditors raised financial sustainability risks in their reporting on the annual audit of IJBs. 2024/25 audit Financial management risks identified1 29% Financial sustainability risks identified1 86% Medium-term financial plan in place2 97% IJBs reporting turnover in senior officer roles (CO/CFO)2 60% IJBs who agreed a budget prior to the start of the financial year2 83% Notes: 1. Based on 28 IJBs, where Annual Audit Plans were available 2. Based on all IJBs Turnover figures include IJBs with interim chief officers (CO)/chief finance officers (CFO) in place. Source: Annual Audit Reports, Annual Audit Plans, IJB budget papers, medium-term financial plans Instability of leadership continues to be a challenge for IJBs 34. Over half of IJBs experienced a change in senior leadership at either the chief finance officer or chief officer level in 2024/25. This continues a pattern that has been evident for several years. 35. The leadership and strategic vision of senior officers is crucial in the strategic planning and decision-making required to drive much-needed transformation. Instability in leadership teams has the potential to disrupt strategic planning and the leadership capacity to bring about the fundamental change required to address the growing scale of challenges facing IJBs. This also has the potential to impact on relationships between IJBs and their partner bodies. Effective partnerships rely on strong and trusting relationships which can take time to develop and can be undermined by frequent turnover in key individuals. Throughout the report we refer to timescales in the short term as 1–2 years, medium term as 3–5 years and long term as over five years. Page 212
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Financial performance 19 The 2025/26 budget gap presents significant cause for concern, particularly given low levels of reserves 36. Budget setting in 2025/26 highlighted a gap of £449 million, a slight decrease from the prior year (£457 million) (Exhibit 7, page 20). The average budget gap for IJBs is 3.6 per cent of the 2024/25 net cost of services. IJB chief officers and chief finance officers in our roundtable discussion, acknowledged there remains scope for service redesign but IJBs are facing limited options for balancing budgets without reducing the services available and the eligibility of those who can access these services. Participants also recognised a need for improved data across the sector to give a stronger evidence base for planning and decision-making. 37. Twenty-one IJBs agreed a balanced budget before the start of the 2025/26 financial year. A further four agreed a budget that relied upon delivery of unidentified savings, which made up ten per cent of the budget gap. Five IJBs did not agree a budget before the start of the financial year. Delays in the agreement of savings plans and partner funding were the most common reasons for balanced budgets not being agreed at the start of the financial year. It is essential that IJBs and their partners work closely to ensure that savings plans are agreed and realistic. 38. We have not undertaken analysis of the draft 2026/27 Scottish Budget for this bulletin. In February 2026 the Accounts Commission published a supplement to the Local government financial bulletin that considers the impact on local government including social care services. Page 213
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Financial performance 20 Exhibit 7. IJB funding gaps for 2025/26 as a proportion of net cost of services The average budget gap for IJBs in 2025/26 is 3.6 per cent of the 2024/25 net cost of services. Source: IJB budget papers for 2025/26 0% 2% 4% 6% 8% 10% 12% Shetland Perth and Kinross Inverclyde North Ayrshire East Lothian North Lanarkshire South Ayrshire Renfrewshire Glasgow South Lanarkshire Angus West Lothian Argyll and Bute East Renfrewshire Edinburgh West Dunbartonshire Midlothian East Dunbartonshire Orkney Falkirk East Ayrshire Dundee Eilean Siar Fife Moray Aberdeen Scottish Borders Clackmannanshire and Stirling Aberdeenshire Dumfries and Galloway 25/26 gap as a proportion of NCOS 24/25 gap as a proportion of NCOS Page 214
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Financial performance 21 Exhibit 8. 2025/26 IJB funding gap planned actions The use of non-recurring reserves makes up five per cent of plans to bridge the funding gap. A further 10 per cent is made up of unidentified savings. Source: IJB budget papers for 2025/26 Agreed savings 68% Remaining gap 10% Deficit funding by partner bodies 9% Other 8% Use of reserves 5% 68% 8% 9% 10% 5% Reliance on non-recurring savings and sources of income is unsustainable 39. When IJBs set the 2025/26 budgets, they planned to bridge five per cent of the budget gap by deploying reserves (Exhibit 8). 40. The agreed savings contain both recurring and non-recurring savings, however we were only able to determine this information for 11 out of 30 IJBs based on a review of their budget papers at the time the budget was set. This further highlights the need for greater transparency around the nature of planned savings. Reliance on non-recurring savings to produce a balanced budget and fund recurring budget pressures is unsustainable. Service redesign is essential to ensuring the sustainability of health and social care services; however, this alone may not be sufficient. 41. The majority of auditors noted the need for IJBs to consider how services can be delivered differently to ensure they remain sustainable in the future. Given the scale of the financial challenges facing the sector, it is unlikely that service redesign projects will be sufficient to bridge the financial gaps facing IJBs in the medium-term. 42. IJBs will need to make difficult decisions to secure their financial sustainability, including the possibility of service reductions, changes to eligibility criteria, charging for some services or stopping non-essential services. It is essential that IJBs and partner bodies work closely together to address underlying financial and service pressures. This should involve appropriate consultation with service users and the wider public. IJBs must be transparent about the potential implications for service performance and outcomes that service changes may bring.Page 215
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Integration Joint Boards Financial bulletin 2024/25 Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 www.audit.scot ISBN 978 1 918486 01 8 Page 216
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APPENDIX 5 MORAY INTEGRATION JOINT BOARD DIRECTION Issued under Sections 26-28 of the Public Bodies (Joint Working) (Scotland) Act 2014 1. Title of Direction and Reference Number 20260326MC16 20260326GHB16 2. Date Direction issued by the Moray Integration Joint Board 26.03.2026 3. Effective date of the Direction 01.04.2026 4. Direction to: NHS Grampian and Moray Council 5. Does the Direction supersede/update a previous Direction? If yes, include the reference number(s) of previous Direction No, new budget for 2026/27 6. Functions covered by Direction All functions listed in Annex 1, Part 1 of the Moray Health and Social Care Integration Scheme and all functions listed in Annex 2, Part 1 of the Moray Health and Social Care Integration Scheme. 7. Direction Narrative Directed to deliver for the Board, the services noted below in pursuance of the functions noted below and within the associated budget noted below 8. Budget Allocation by MIJB to deliver on the Direction Moray Council associated budget - £104.2 million, of which £0.5 million is ring fenced for Housing Revenue Account aids and adaptations and £3.4 for Children Services & Criminal Justice OOA ring fenced shared budget. NHS Grampian associated budget - £90.4 million, of which £5.8 million relates to Moray’s share for services Page 217
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to be hosted and £21.4 million relates to primary care prescribing. An additional £20.1 million is set aside for large hospital services . All details contained in APPENDIX 1 to the report 9. Desired Outcomes The direction is intended to reflect the budget position for 2026/27 10. Performance monitoring arrangements and review Directions will be reviewed by the Audit Performance & Risk Committee on a six monthly basis for assurance. Any concerns should be escalated at the first available opportunity to the MIJB. An annual report of all current Directions will be presented to the MIJB Page 218
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 26 MARCH 2026 SUBJECT: MEDIUM TERM FINANCIAL FRAMEWORK 2026/27 – 2030/31 BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 The Board is asked to approve the updated Medium Term Financial Framework (MTFF) 2026/27 to 2030/31. 2. RECOMMENDATION 2.1 It is recommended that the Board i) consider and approve the updated Medium Term Financial Framework (MTFF) as set out below and at Appendix 1; and ii) agree that a review of the Framework be carried out on an annual basis. 3. BACKGROUND 3.1 The current MTFF covers the period 2025/26 to 2029/30 and was presented to the Board on 27 March 2025 (para 9 of the minute refers). 3.2 Scottish Government stipulated that the funding allocation to Integration Authorities should be additional and not substitutional to each Council’s 2025/26 recurring budgets for social care services and therefore, Local Authority social care budgets for allocation to Integration Authorities should be £150.7 million greater than 2024/25 recurring budgets. 3.3 In October 2018, the Scottish Government published it’s medium term financial framework for health and social care Scottish Government Medium Term Health and Social Care Financial Framework. This framework outlined the future shape of demand and expenditure for health and social care services and included cost and demand projections from work undertaken by the Institute of Fiscal Studies which outlines that UK expenditure on healthcare would require to increase by an average of 3.3% per annum over the next 15 years to maintain NHS levels at 2018 levels. The report also set out that spending on social care services would require Item 8. Page 219
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to increase by 3.9% per annum to meet the needs of an increasingly elderly population and an increasing number of younger adults living with disabilities. The Scottish Government has since updated its medium term financial framework in May 2022, Scotland’s Fiscal Outlook: The Scottish Government’s Medium-Term Financial Strategy, then again in May 2023, Scotland's Fiscal Outlook: The Scottish Government's Medium-Term Financial Strategy 3.4 The latest publication by the Scottish Government was the Medium-Term Financial Strategy 2025 (MTFS) published in June 2025, which sets out a challenging fiscal environment for the public sector, with resource funding projected to grow by only 1% per annum in real terms. The MTFS forecasts a widening resource fiscal gap, from £963 million in 2026/27 to £2.6 billion by 2029/30. These projections reflect ongoing economic volatility, sustained inflation pressures and increasing demand for public services, particularly in health and social care. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The current MTFF covers the period 2025/26 – 2029/30 and is due for review. Since this time, the national funding settlement and partner allocations have been confirmed, allowing the financial assumptions within the MTFF to be updated and finalised. The 2026/27 MTFF has therefore been developed against a backdrop of sustained inflationary pressures, confirmed pay awards and continued growth in demand-led health and social care services. The cost of delivering safe, high quality care continues to increase and it is important that these pressures are reflected transparently within the framework. They represent unavoidable costs associated with meeting statutory duties, sustaining essential services and ensuring people are supported safely and appropriately. 4.2 The Joint Strategic Needs Assessment (JSNA) was updated and presented to the IJB on 26 September 2024 (para 14 of the minute refers). The main goal of the JSNA is to accurately assess the care needs of local in order to improve the physical and mental wellbeing of individuals and communities. This information will be used to inform the reviews of the Strategic Plan. The latest Strategic plan was approved by the Board on 24 November 2022 (para 14 of the minute refers) and the Strategic Delivery Plan was presented to the Board on 29 May 2025 (para 8 of the minute refers). 4.3 The review of the Board’s MTFF takes account of information currently available, however it is recognised that assumptions and applied methodology will be subject of ongoing review and refinement as additional information becomes available. The financial outlook for 2026/27 remains highly complex and challenging. Rising demand, demographic pressures, and higher expectations of public services continue to drive costs across the system. These pressures are consistent with the wider financial context facing local government and NHS services and must be recognised transparently within the MTFF to ensure responsible medium-term planning and effective alignment with partner budgets. These updates also align with the national picture set out in Audit Scotland’s February 2026 bulletin, which highlights that IJBs across Scotland are facing a critical financial position, with costs and demand rising faster than available Page 220
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resources and partners increasingly constrained in their ability to provide additional in-year support. The refreshed MTFF therefore reflects realistic assumptions and transparent recognition of system-wide financial risk. This reflects a realistic assessment of the Partnership’s financial position rather than an assumption of longer-term financial sustainability. Given the current uncertainty, it is therefore considered necessary to review the medium term financial framework on an annual basis. The updated MTFF is included at Appendix 1. 4.4 Summary of the key information contained within the report relating to financial information, Table 3 in Appendix 1 details the budget pressures estimated to be required for the next 5 financial years, with assumptions detailed in the paragraphs after the table. 4.5 Tables 4 and 5 in Appendix 1, show the funding forecast for the next 5 years, this is based on flat cash settlement from the Council and a 2% increase on base funding each year for NHS Grampian. Table 5 shows the summary position and the level of savings required for the MIJB to achieve. Summary Position 2025/26 2026/27 2027/28 2028/29 2029/30 £000’s £000’s £000’s £000’s £000’s Estimated Budget Requirement 228,048 240,001 243,344 247,257 251,615 Total Funding 228,049 230,656 233,453 237,446 242,642 Use of ear marked reserves - - - - - Budget Surplus/(Deficit) - (9,344) (9,891) (9,811) (8,973) 4.6 The predicted rise in costs over the term of this framework is £38.017 million, which will require significant transformation to achieve financial balance. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan 2022 – 2032, ‘Partners in Care’ The approval of a balanced budget for the MIJB is key to the delivery of health and social care services in Moray in accordance with the Strategic Plan. (b) Policy and Legal In accordance with the Public Bodies (Joint Working) (Scotland) Act 2014, MIJB is subject to the audit and accounts regulations and legislation of a body under Section 106 of the Local Government (Scotland) Act 1973 and is classified as a local government body for accounts purposes by the Office for National Statistics. (c) Financial implications Page 221
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Financial implications are contained throughout the report. (d) Risk Implications and Mitigation The revenue budget for 2025/26 onwards is subject to the following risks: • GP Prescribing – represents around 13% of the MIJB core budget. It is well documented that the Prescribing budget can be extremely volatile in nature with volume and price increases potentially leading to substantial adverse variances. • Growth and demand in the system, together with service users with complex care needs are attracting additional financial challenge. These issues require to be managed within the overall resource of the MIJB. • The need to transform at pace and drive forward opportunities arising through changes to working practice experienced through the pandemic. The risk being the ability to capture and embed in a timely manner. • The implications of the cost of living crisis and current levels of inflation, which are still forecast to rise may mean the provision for inflation may not cover all the calls upon it. Price inflation may impact on areas where no provision has been made for inflationary increases and this will add pressure to budgets. Budget managers will need to control their expenditure to absorb such pressure if possible and may have to reduce service levels or identify further savings. (e) Staffing Implications There are no direct implications in this report. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact None arising directly from this report as there is no change to policy. Any subsequent changes to policy arising from proposals made within this paper will be considered appropriately. (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 None arising directly from this report. (j) Consultations Consultations have taken place with the Senior Management Team, the finance teams of both Moray Council and NHS Grampian, Caroline O’Connor, Committee Services Officer and the Corporate Manager. Page 222
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6. CONCLUSION 6.1 The Medium Term Financial Framework for 2026/27 to 2030/31 is presented at Appendix 1. 6.2 There will be close monitoring and review of the Medium Term Financial Framework on an annual basis. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: with author Ref: Page 223
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APPENDIX 1 MEDIUM TERM FINANCIAL FRAMEWORK 2026/27 – 2030/31 MORAY INTEGRATION JOINT BOARD Page 225
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Table of Contents Introduction ...................................................................................... 2 Context ............................................................................................ 3 Purpose ............................................................................................ 4 Influencing Factors ........................................................................... 5 Demographics .......................................................................................................... 5 Costs ....................................................................................................................... 7 Funding .................................................................................................................... 8 Risk and Sensitivity Analysis ..................................................................................... 10 Legislative & Policy Changes..................................................................................... 11 Demand .................................................................................................................. 12 Risk ........................................................................................................................ 12 Page 226
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Draft Medium Term Financial Framework 2026/27 - 2030/31 2 Introduction The Moray Integration Joint Board (MIJB) has been operating since April 2016 following the introduction of new legislation - the Public Bodies (Joint Working) (Scotland) Act 2014. The legislation was developed with the aim of reshaping the health and care system in Scotland to ensure sustainability of quality services through a time of change where demand continues to grow, the population is ageing and the budgets are reducing. It changed the way in which health and social care services were planned and delivered by introducing a single integrated system through the creation of Integration Authorities. The MIJB is funded through allocations made by NHS Grampian and Moray Council. MIJB has set out its approach for transforming the health and care system over the long term in its Strategic Plan 2022-32 and has defined its priorities for the next ten years through its Strategic Delivery Plan. The Strategic Plan is underpinned by three Strategic Outcomes. This Medium Term Financial Framework (MTFF) is designed to assist the MIJB from a planning perspective based on the totality of its financial resource across health and social care in meeting the needs of the people of Moray. It will support the delivery of the Strategic Plan within the context of the significant financial challenge being faced and the continuing pressure being driven by growing demand and complexity, higher costs and increasing expectations. BUILDING RESILIENCE – Taking greater responsibility for our health and wellbeing HOMEFIRST – Being supported at home or in a homely setting as far as possible PARTNERS IN CARE – Making choices and taking control over decisions Page 227
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Draft Medium Term Financial Framework 2026/27 - 2030/31 3 Context There are 31 Integration Authorities established between 14 health boards and 32 councils across Scotland. 30 of the Integration Authorities are separate legal entities and operate through a body corporate (Integration Joint Boards) and one area operates a Lead Agency model. Scottish Government has been clear in that health and social care integration remains a key priority. From the outset of integration, the aim has been to shift the balance of care from large hospital settings into community based care. In May 2024, the Institute for Financial Studies1 reported in 2019 that UK spending on healthcare would need to increase in real terms by an average of 3.3% per year over the next 15 years in order to maintain NHS provision at current levels. However, latest plans imply average growth of 2.7% per year between 2019/20 and 2024/25. The Office for Budget Responsibility (OBR) estimates that health spending will have to rise further to meet demographic and cost pressures There are numerous measures being used to monitor the local and national progress of Integration. The Scottish Government’s Ministerial Strategic Group for Health and Community Care have identified six priority areas against which progress is being measured: • Acute Unplanned Bed Days • Emergency Admissions • A&E Attendances • Delayed Discharge Bed Days • End of Life Spent at Home or in the Community • Balance of Care percentage of population in a Community or Institutional Setting 1The past and future of UK health spending | Institute for Fiscal Studies Page 228
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Draft Medium Term Financial Framework 2026/27 - 2030/31 4 Purpose MIJB is focused on improving the health and wellbeing of the people in Moray. It seeks to reduce health inequalities and drive transformational change through innovative approaches. Medium term financial planning is an essential part of the strategic planning process that supports the MIJB to develop plans which consider the financial climate and broader economic impacts. A robust medium term financial framework will provide transparency and support informed decision making. Inherent within the MTFF is a significant degree of uncertainty. Scottish Government funding settlements to our funding partners, Moray Council and NHS Grampian are currently on a one year only basis, this has a direct impact on the funding to the MIJB. The MTFF sets out anticipated cost pressures and future funding projections based on planning assumptions and advice from our funding partners. This is an evolving model and it will be essential to refine and update at regular intervals. This review of the framework follows the updated Strategic Plan and the full delegation of Children’s Services from 1 April 2024. Given the level of uncertainty and potential for variability, it is essential that the MIJB plans for a range of potential outcomes, ensuring sufficient flexibility to manage in a sustainable manner over the course of this plan. The MTFF Framework seeks to support the understanding surrounding the broader climate within which the MIJB will operate in over the medium term. There are wide- ranging factors which encompass the complexity that impacts on the financial pressures of the MIJB. The main objectives of the MTFF are: • To look to the longer term to help plan sustainable services, estimating the level of resources required to operate these services and deliver on the MIJB’s strategic ambition. • To estimate the level of increasing demand on services and provide a single document to communicate the financial context to all stakeholders and support partnership working. • The MTFF includes a five-year budget forecast that will be reviewed annually to ensure our strategic priorities remain the focus in a challenging financial climate. Page 229
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Draft Medium Term Financial Framework 2026/27 - 2030/31 5 Influencing Factors Demographics Moray’s population has grown significantly in the past 20 years from 87,000 in 2001 to 93,400 in 2022; an increase of 7.4%. However, recent projections show that Moray’s population growth is slowing, with the area forecast to experience a slight decline by 2032 based on the 2022 subnational population projections2. Moray is expected to see negative overall population change over this period. The age structure of the population is also set to shift significantly. Scotland’s 2022-based projections indicate continued population ageing, with projections showing an increase in the number of people of pensionable age by 2032. At the same time, the number of children is expected to fall in most council areas, meaning Moray is likely to experience a decrease in its 0–15 population. Given that the most substantial growth is anticipated in older age groups, demand for health, social care and wider public services is expected to rise, creating a challenging environment as we work to transform services and meet both national and local priorities. 2 Subnational Population Projections: 2022-based - National Records of Scotland (NRS) DEMOGRAPHICS COSTS FUNDING POLICY DEMAND RISKS Page 230
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Draft Medium Term Financial Framework 2026/27 - 2030/31 6 Table 1: Table 2: This MTFF has been updated following the backdrop of sustained inflationary pressures, confirmed pay awards and continued growth in demand-led health and social care services. The MTFF will be revised again once the Strategic Plan has been updated; which will allow our local systems to develop plans within the overall, agreed financial position and alongside service and workforce considerations. 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 Children Working age Pension age 2022-based projected population by sex and age group, principal projection, Moray, 2026-2036 2026 2036 -13% -6% 15% -15% -10% -5% 0% 5% 10% 15% 20% Children Working age Pension age Percentage change in projected population by age group, 2026-2036 Page 231
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Draft Medium Term Financial Framework 2026/27 - 2030/31 7 During 2024/25, the Joint Strategic Needs Assessment (JSNA) was produced to inform and support the production of the Strategic Plan for 2024 and beyond. The JSNA was developed through a short-life working group comprising of representatives from Health and Social Care Moray, The Moray Council, the Moray Health and Wellbeing Forum, NHS Information Services Division Scotland, and NHS Grampian. The SNA focused on the collation and analysis of data from a range of sources to inform the identification of priorities, and subsequent decision-making regarding service provision. It also contributes to longer term planning undertaken by the Moray Community Planning Partnership and the updating of the Moray Local Outcomes Improvement Plan (LOIP). There are seven relevant areas for Moray. The JSNA highlighted seven areas to be considered: • Population demographics – these are the basis of the JSNA and includes population projections, which is an increasingly ageing population in Moray along with a reducing birth rate. Deprivation in Scotland, where Moray is showing a low level of deprivation but child poverty is rising faster than Scotland as a whole. • Social, clinical and behaviour risk factors – there are a number of risk factors which are known to influence health, societal, behavioural and clinical. These risk factors are strongly influenced by the environments we live in and the commodities that we are able to access. Clinical risk factors may be associated with an increased risk of certain diseases or death. • Population health – the diseases, illnesses and risk factors faced by the population of Moray, with a purpose to not only understand future services but what can be done to prevent, treat or support in different ways. • Secondary care services – increasing hospital admissions, including emergency admissions, preventable admissions, unintentional injuries and falls and delayed discharges in Moray. • Social care – long stay residents supported in care homes is increasing and above the Scottish average as well as demand for care at home support. Most common client type for care at homes services in Moray are elderly and frail individuals. • Finance and workforce – Staff headcount has increased within Health & Social Care Moray, however, the workforce is becoming older, with increases in retirement and part time working. Increasing funding gap for Health & Social care since 2024/25 onwards. • Different ways of working – looking at partnerships with people and other transformations to meet the outcomes of people. Page 232
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Draft Medium Term Financial Framework 2026/27 - 2030/31 8 In response to the JSNA, the MIJB Strategic Plan was developed and set the direction and approach to prevention in addressing what is required in order to build resilience in individuals and communities to be able to maximise their health and wellbeing potential whilst ensuring services are available and fit for purpose when required. Costs There is a predicted rise in costs over the term of this framework of over £18 million. The key elements are in relation to pay and price inflation and the increasing number of complex care packages and the pressures on the prescribing budget. Table 3 Budget Pressures 2026/27 2027/28 2028/29 2029/30 2030/31 £000’s £000’s £000’s £000’s £000’s Pay 3,265 3,346 3,430 3,515 3,741 Non pay inflation 815 889 908 928 810 SG investment ie RLW, FPNC 4,400 4,598 4,806 5,023 5,249 High Cost Packages 1,860 1,500 1,500 1,500 1,500 Transitioning Children 1,293 800 800 800 800 Prescribing 1,708 1,000 1,000 1,000 1,000 Other 369 Recurring Deficit 4,394 9,000 6,000 3,000 1,000 Demographic 950 979 1,008 1,038 1,069 Total Budget Pressures 19,054 22,112 19,452 16,804 15,169 Assumptions embedded within Budget Pressures: Pay – 3%, in each year for Council and 2% in each year for NHS staffing. Funding will be provided for the health staff increase with the assumption that this will continue to be the case. Non pay inflation –2% in each of the following years for non pay external purchasing. Scottish Government investments – this relates to the Real Living wage (RLW) increase for adult and Children’s social care, National Care Home Contract (NCHC) and the Free Personal and Nursing Care, for 2026/27 includes increases of 5.16% and 5.51% for NCHC and 4.81% to 6.03% on RLW, but is assumed it will reduce to 4% in each of the following years Funding is received towards the majority of this pressure. High Cost Individuals – there are significant packages expected in 2026/27 for Learning Disability, Children and Young People and Mental Health service, but beyond then we will need to consider different care models in order to ensure we can manage the related Page 233
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Draft Medium Term Financial Framework 2026/27 - 2030/31 9 budget pressure. Transitioning Children – work has been on going to deal with the expected increase for clients coming into the service. There is expected to be a constant increase over the next few financial years, for which the service is monitoring and reviewing to ensure the budget pressures can be managed. Prescribing – pressure continues on this budget for the foreseeable future, due to increase in both demand and prices. Demographic pressure – pressure continues on this budget for the foreseeable future, due to increases in complexity and demand. Funding The two main sources of funding for the MIJB are provided by NHS Grampian and Moray Council. In recent years, additional investment for health and social care has been provided by the Scottish Government and this is passported through either the local authority or the health board. Any future funding will be impacted by the respective financial planning processes of both organisations and the funding settlements they receive. The MTFF makes assumptions regarding future funding contributions from both Partners based on information which is currently available. Outlined below is the potential funding that will be provided over the term of this plan. Table 4 Funding Forecast 2026/27 2027/28 2028/29 2029/30 2030/31 £000’s £000’s £000’s £000’s £000’s NHS Grampian Recurring 102,089 104,516 106,244 108,006 109,803 NHS Grampian Uplift (2%) 2,427 1,728 1,762 1,797 1,833 Moray Council Recurring 90,298 94,441 98,320 102,354 106,550 Additional SG investment 3,957 3,879 4,034 4,196 4,364 Set Aside 20,092 20,092 20,092 20,092 20,092 Deficit funding from partners 9,000 6,000 3,000 1,000 Total Funding Estimated 228,049 230,656 233,453 237,446 242,642 Table 5 Summary Position 2025/26 2026/27 2027/28 2028/29 2029/30 £000’s £000’s £000’s £000’s £000’s Estimated Budget Requirement 228,048 240,001 243,344 247,257 251,615 Total Funding 228,049 230,656 233,453 237,446 242,642 Use of ear marked reserves - - - - - Budget Surplus/(Deficit) - (9,344) (9,891) (9,811) (8,973) Page 234
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Draft Medium Term Financial Framework 2026/27 - 2030/31 10 The summary position tabled above highlights that the MIJB will be required to continue to closely observe the financial constraints within which it is operating. Future funding assumes a level of savings will be achieved each year, together with transformational redesign that we know we need to make in order to provide affordable sustainable services within the resources available. It assumes that the existing financial pressure will be addressed through savings alongside the need to transform the way we provide services across our whole system in an innovative way. With this in mind and assuming this can be achieved over the short-term, there still remains a deficit that will require to be addressed, again reinforcing the need to review this framework on a regular basis, updating it with the most current information available and creating a focus on the period ahead. Risk and Sensitivity Analysis The MTFF is a financial model based on the best available planning assumptions at the time and accordingly, has related risks associated with it. The main risks associated with this framework are: • Impact of MIJB decisions on Partner bodies and Vice-versa • Failure to identify a future budget pressure • Under estimation of the cost pressures • Under estimation of demand pressures • Public expectation of delivered services • Over /under estimated impact of local and national factors • Failure to accurately forecast income sources It is important that the MIJB is aware of these risks in determining its appetite to risk as it considers its Strategic Plan. The MIJB recognises strategic risks through its Risk Register. This is used to ensure that significant risks are identified and mitigating actions are effective in reducing these risks to an acceptable level. Sensitivity Analysis is used to test the major assumptions being made and what the implications would be, should those assumptions change. The Financial Projections outlined in this framework are based on what is determined to be a medium case scenario for future funding. In addition to the funding element, there are risks aligned to other assumptions made in the framework around future budget pressures for the MIJB. It is important that the MIJB regularly reviews this framework. Page 235
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Draft Medium Term Financial Framework 2026/27 - 2030/31 Page 11 Legislative & Policy Changes Integration Authorities are operating within a complex and changing environment where national issues are likely to have an impact on the services provided and how we deliver them locally. This environment has changed significantly since reported in March 2025 with the ongoing effect of public health and the economic impact. Some of the recent legislative changes impacting on integration authorities are: • Care Reform (Scotland) Act 2025 – this legislation was passed on 10 June 2025 and received Royal Assent on 22 July 2025, this Act is the successor to the original National Care Service (Scotland) Bill. It moved away from massive structural reform, meaning local authorities retain their statutory responsibilities, but introduced several key operations mandates for Integration Authorities. These include legal framework for information sharing and digital records; legal duty on integration authorities to provide support for unpaid carers who cannot take sufficient breaks from their role; Anne’s Law, which enshrines the right of adult care home residents to see loved ones, even during public health emergencies; and integration authorities must now follow new ethical commissioning guidance issued by Scottish Ministers. • Extension of IJB Voting Rights – in late 2025, the Scottish Government introduced the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment Order 2025. This legislation extends formal voting rights on IJBs to representatives of service users, unpaid carers and third-sector bodies. The changes are scheduled to come into force on 1 September 2026. • Scottish Living Wage – there is a continued commitment from Scottish Government to support the payment of the Scottish Living Wage to improve people’s lives and help build a fairer society. Scottish Government has continued to provide funding to support this commitment. For the 2026/27 financial year, the uplift is set to increase to a minimum of £13.45 per hour. • Delayed Discharge – a Scottish Government priority to reduce the number of people who are delayed from being discharged from hospital. Work is ongoing on a whole system approach to reduce this. • New National Oversight – National Care Service (NCS) Advisory Board was established in May 2025, to provide independent oversight to ensure service consistency across different Integration Authorities. Creation of a new statutory body, National Social Work Agency (NSWA) to oversee and advocate for the social work profession across Scotland, impacting how IJBs manage their social work workforce. Page 236
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Draft Medium Term Financial Framework 2026/27 - 2030/31 Page 12 Demand The recovery from the impact of the Covid-19 pandemic continues to create increased pressure and demand on our health and social care system. The full extent of this impact remains unknown but we are acutely aware of the current impact on the citizens of Moray in respect of the level of unmet need we are experiencing in both assessment and delivery of care. We understand that in order to address increasing demand it will require the whole health and social care system to work together to redesign to create truly transformational services. The landscape is constantly changing as we progress through the recovery stage. We must ensure we have robust plans in order to maintain delivery of our strategic aims whilst being mindful of the flexibility that will be required as we continue to understand the broader impacts that we face as we recover and remobilise following the pandemic. Risk We are experiencing challenging economic conditions. The effects of the global economy in turn are impacting on the Moray population through taxation, inflation and level of earnings. The broader impact is on the funding being made available to support public spending. Scotland’s funding is largely dependent on funding being received from the UK Government. The most recent ‘State of the Economy’ report3 from Scotland’s Chief Economic Advisor was published in February 2026 and highlighted the following: • Scotland’s GDP is forecast to grow by 1.3% in 2026, this is a slight strengthening compared to 2025 (1.1%) and is expected to be supported by falling inflation and loosening of monetary policy; • Scotland’s labour market has shown signs of “loosening” or cooling, with the unemployment rate forecasting to rise to 5.25% across the UK in 2026, with Scotland seeing similar trends as payrolled employee numbers declined throughout late 2025; • Consumer price inflation (CPI) was 3.4% in December 2025 and is projected to fall toward the 2% target by April 2026. 3 https://www.gov.scot/publications/scottish-economic-bulletin-february-2026/pages/8/ Page 237
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Draft Medium Term Financial Framework 2026/27 - 2030/31 Page 13 The MIJB is facing new risks which may impact on its budget over the next few years: • Significant financial pressures – the funding challenges are not only affecting the IJB’s but also both of the partners are under significant pressure too; • Health Debt – we are acutely aware of what is being described as the health debt, resulting from services which were paused during the pandemic and in some instances have not fully resumed. • Care Reform – this will have an impact on services and how they are delivered in the coming years, the full extent of which is still uncertain. It is important that the MIJB understands its appetite to risk to enable effective management and mitigation of the inherent risks. Page 238
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 26 MARCH 2026 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 Board considers and notes: i) Councillor Ben Williams will stand down as member of the MIJB, effective 27 March 2026; ii) Councillor John Divers will join the MIJB, effective 27 March 2026; iii) the appointment of a new Chair to the APR Committee, effective 27 March 2026; and iv) 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 and Social Care Integration Scheme (“Integration Scheme”) outlines certain Item 9. Page 239
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agreed provisions re membership (and includes the specific provisions taken from the Act and the Order). 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Councillor Ben Williams will stand down as member of the MIJB and associated Committees, effective 27 March 2026. Thursday 26 March 2026 will be their last meeting as a voting member of MIJB and Chair of APR Committee. 4.2 Councillor Scott Lawrence will take over Chair of APR Committee, effective 27 March 2026. 4.3 Councillor John Divers will join the MIJB, as voting member and member of APR Committee, effective 27 March 2026. 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. (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 Page 240
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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 agree 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 241
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APPENDIX 1 Moray Integration Joint Board – as at 27 March 2026 Moray Integration Joint Board 4 Council voting members Bridget Mustard (Vice-Chair) John Divers 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 Miriam Connor Christine Stevens 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 Scott Lawrence (Chair) John Divers 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 Miriam Connor Christine Stevens Service User Stakeholder Sheila Brumby Third Sector Stakeholder Aimee McIntosh Moray Council Staff Representative Vacant Chief Officer Professional Judith Proctor Page 243
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APPENDIX 1 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 244