Agenda Document Pack - Moray Integration Joint Board - 25/06/2026
Moray Council · 25 June 2026
Back to Moray Integration Joint Board — 25 June 2026 and its agenda
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Moray Integration Joint Board Thursday, 25 June 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, 25 June 2026 at 13:30 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Minute of meeting of 26 March 2026 5 - 10 4. Action Log of 26 March 2026 11 - 14 5. Minutes - for noting 5a. Minute of meeting Clinical and Care Governance Committee of 26 February 2026 15 - 18 6. Revenue Budget Outturn for 2025-26 19 - 46 7. Unaudited Annual Accounts 47 - 130 8. External Audit Plan for the Year Ending 2025-26 and Update on Recommendations from 2024-25 131 - 196 Page 1
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9. Moray Adult Mental Health Strategic Group Performance Report 197 - 220 10. Annual Update on the Delivery of the Unpaid Carers Strategy 2023-28 221 - 244 11. Moray Alcohol and Drug Partnership - Strategic Delivery Plan 2026-29 245 - 322 12. Hosted Services Service Level Agreements 323 - 436 13. Moray Annual Performance Report 2025-26 437 - 514 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 John Divers (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) Ms Karen Greaves (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, 26 March 2026 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Councillor Peter Bloomfield, Professor Duff Bruce, Mrs Sheila Brumby, Ms Miriam Connor, 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 Alex Stephen, Mrs Christine Stevens, Councillor Ben Williams APOLOGIES Mr Sean Coady, Ms Sonya Duncan, Ms Karen Greaves BEM, Mr Michael Ritchie, Mr Dennis Robertson, Ms Elizabeth Robinson, Ms Laura Skaife-Knight IN ATTENDANCE Lead Pharmacist and Caroline O'Connor, Committee Services Officer ALSO IN ATTENDANCE Councillor Sandy Keith 1. Chair The meeting was chaired by Councillor Bridget Mustard, as Depute Chair of the Board. 2. Pre-Election Period The Chair reminded the Board the meeting was taking place during the pre-election period and that there are restrictions on the Council over publishing material which could show support for a particular party. As Board meetings are webcast, they fall within these restrictions. Item 3. Page 5
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The Chair stated the advice from the Monitoring Officer was that, whilst the Board can continue to deal with "business as usual" items, should debate become overtly political then the Chair may require to intervene. 3. 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. 4. Minute of meeting of 29 January 2026 The minute of the meeting of 29 January 2026 was submitted and approved. 5. Action Log of 29 January 2026 The Action Log of the meeting of 29 January 2026 was discussed and updated accordingly. 6. Minute of meeting Clinical and Care Governance Committee of 28 August 2025 The Board noted the minute of the meeting of the Clinical and Care Governance Committee of 28 August 2025. 7. Minute of meeting Audit Performance and Risk Committee of 29 October 2025 The Board noted the minute of the meeting of the Audit, Performance and Risk Committee of 29 October 2025. 8. Moray Integration Joint Board Draft Strategic Risk Register The meeting had before it a report by the Chief Officer presenting the Strategic Risk Register to the Board for approval, following scrutiny by the Audit, Performance and Risk Committee at their meeting held on 26 February 2026. Following consideration the Board unanimously agreed:- i) to approve the Board Strategic Risk Register included at Appendix 1, noting the current risk ratings, controls, assurances and areas of ongoing exposure; ii) to note that future reports will reflect scrutiny and feedback provided by the Audit, Performance and Risk Committee on 26 February 2026; and iii) 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. 9. Revenue Budget and Recovery Plan 2026/27 Page 6
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The meeting had before it a report by the Chief Financial Officer outlining the budget allocations to the Moray Integration Joint Board and asking the Board to consider the revenue budget for 2026/27, the estimated funding gap and the charges. In introducing the report, the Chair asked that any questions on the covering report be considered following which each of the individual Integrated Impact Assessments (IIAs) in Appendix 2A would be considered in order to ensure the Board fully scrutinised and understood the impacts of each of the savings. Mr Murray, acknowledging the budget was balanced as a result of the funding from partners and the delivery of savings as set out in Appendix 2 was critical to achieve that balanced budget, expressed concern whether the savings identified were deliverable, stating that of the proposed savings, 4 were rated Red and 14 were rated Amber and savings planned in previous years had not been delivery resulting in a significant overspend. In response, the Chief Officer provided assurance that resources would be allocated to support and monitor the delivery of savings for those highlighted as being difficult to deliver along with grip and control measures previously described to monitor operational and financial performance and identify emerging pressures at an early stage. Mr Riddell noted the need for transformation which he acknowledged takes time, expressed concern that it would not deliver savings at the required pace and queried whether action on longstanding operational issues such as sickness absence management would provide opportunities for efficiency. In response, the Chief Officer acknowledged the challenges in delivery transformation however advised positive progress was being made in terms of staff absence along with work being undertaken with other IJBs on a once for Grampian approach, to be the subject of a report to a future meeting of the Board for any decisions required within the Board's remit. Councillor Bloomfield and Mr Riddell sought assurance that the grip and control measures would ensure early visibility and planning to mitigate impact on services. The Chief Financial Officer confirmed measures were in place to ensure more rigorous consideration of the budget in liaison with budget managers along with ongoing other possible savings and identified efficiencies to help impact on any growth which would be reported to the Board on a regular basis. In order to strengthen assurance around the Board's financial position, Mr Stephen suggested it may be helpful to set out clearly the financial context including reserves, current position and trajectory into a financial recovery strategy which would be reported through Audit, Performance and Risk (APR) Committee to evidence grip and control and recovery and increasing the frequency of APR meetings to allow for timely review of any such strategy. In response, the Chief Officer agreed such an approach would be beneficial and agreed to prepare updates for APR and consider increased frequency of meetings. The Board considered and discussed each of the undernoted Integrated Impact Assessments (IIAs) and agreed the requested changes be made:- Ref Title Requested Change(s) 51. Change to procurement process for palliative care equipment Page 7
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52. Cease Housing Support Payments for Very Sheltered Housing Services 53. Review of Adult out of Area and Ordinary Residence Packages Section 10 "Justification" - wording to be reconsidered to meet with person-centred principles rather than just financial assistance 54. Review of contributions and charging policies for health and social care services Section 9 "Mitigating Actions" - add information on actions taken/referrals made in terms of benefits following completion of financial assessments. Add information on consultation to be undertaken on any proposal for changing charges. 55. Nutritional Prescribing Section 6 "Protected Groups - add more detail of impact on carers Section 9 "Mitigating Actions" - add information on support to be given in terms of income maximisation relating to potential financial impact Should be subject to Stage 2 IIA. 56. Supplies and Procurement 57. GMED Skills Mix Review 58. Review of Clinical Leadership provision 59. HSCM Minor Surgery More detailed report to be prepared for the Board providing clarity on funding, full impacts (ie pregnancy if removing support for vasectomies), numbers involved, increased waiting lists etc 60. Review of Commissioned contracts - Childrens services 61. Re-design of childcare social work teams 62. Accommodation Review - Social Work Office Community Hub 63. Review of OOA Care and Return to Local Community Section 9 "Mitigation Actions" - suggest strengthening 64. Cessation of all interim management arrangements Following the suggestion from Mr Stephen to strengthen assurance on the Board's financial position which the Chief Officer agreed to action, the Chair moved adding an additional recommendation (viii) "increased reporting and scrutiny arrangements through the Audit, Performance and Risk Committee." Following lengthy consideration and there being no one otherwise minded, the Board unanimously agreed:- Page 8
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i) to note the funding allocations proposed by NHS Grampian and Moray Council, detailed at 5.8; ii) to note the anticipated budget pressures detailed in 5.12; iii) to approve the 2026/27 proposed savings plan at 5.27 and detailed in Appendix 2; iv) to formally approve the Revenue Budget for 2026/27 as detailed in Appendix 1, following consideration on risks highlighted in 5.36; v) to direct the Chief Officer to formally write to partners to request the additional in year funding, totalling £9m; vi) to approve Directions for issue as set out at Appendix 5 to NHS Grampian and Moray Council; vii) to note no amendments to the reserves policy, as detailed in Appendix 6; and viii) increased reporting and scrutiny arrangements through the Audit, Performance and Risk Committee. 10. Medium Term Financial Framework 2026/27 - 2030/31 The meeting had before it a report by the Chief Financial Officer asking the Board to approve the updated Medium Term Financial Framework 2026/27 to 2030/31. Following consideration the Board unanimously agreed:- i) to approve the updated Medium Term Financial Framework (MTFF) as set out in the report and at Appendix 1; and ii) that a review of the Framework be carried out on an annual basis. 11. Membership of Board and Committees The meeting had before it a report by the Corporate Manager informing the Board of changes to membership of the Moray Integration Joint Board; Audit, Performance and Risk Committee and Clinical and Care Governance Committee. The meeting, in noting that this would be the last meeting of the Board prior to Councillor Ben Williams, Chair of Audit, Performance and Risk Committee stepping down, joined the Chair in paying tribute to Councillor Williams for his contributions and wished him well for the future and thanked Councillor Scott Lawrence for taking on the role of Chair of Audit, Performance and Review Committee. Following consideration the Board unanimously agreed:- i) Councillor Ben Williams will stand down as member of the Moray Integration Joint Board, effective 27 March 2026 Page 9
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ii) Councillor John Divers will join the Moray Integration Joint Board, effective 27 March 2026; iii) the appointment of a new Chair to the Audit, Performance and Risk Committee, effective 27 March 2026; and iv) the updated membership of the Board and its Committees, attached at Appendix 1. Page 10
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MEETING OF MORAY INTEGRATION JOINT BOARD Thursday 26 March 2026 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 25 JUNE 2026 1. 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 delivered at MIJB Development Session in April. Report to MIJB in June. Action to be closed. 2. 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. Item 4. Page 11
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 25 JUNE 2026 3. Childrens Services Pressures Report 27/11/25 i) Clear outline of accountability and responsibilities of the Board to be circulated. March 2026 JL Report being drafted for approval by Moray Council then to come to the Board. Governance for the Whole Family Wellbeing Fund Briefing Paper circulated to IJB Members on 7 April 2026. Action now closed 4. MIJB Draft Strategic Risk Register 26/03/26 When reviewed at Development Session, consideration to be given to:- i) suggested amended wording in Risk 2 from “directly impact” to indirect impact; ii) adding more information about the impact of the demographic change on services; and iii) adding more detail about the financial risk to the IJB. TBC JP/SD Development session proposed Nov 2026 5. Revenue Budget and Recovery Plan 2026/27 26/03/26 Integrated Impact Assessments contained in Appendix 2A related to savings approved by the Board are to be updated and resubmitted for consideration by the Board as and when changes are made TBC DO Ongoing 6. Medium Term Financial Framework 2026/27-2030/31 26/03/26 i) Future reports to be considered at June Board meetings to allow March Board to focus on budget report. ii) Ensure budget is included as part of the Carers Strategy June 2027 DO Due June 2027 Page 12
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 25 JUNE 2026 7. Membership of Board and Committees 26/03/26 Change wording in Appendix 1 from “User of Services Stakeholder” to “People receiving services Stakeholder” ASAP IW Completed. Action Closed. Page 13
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MINUTE OF MEETING OF THE CLINICAL AND CARE GOVERNANCE COMMITTEE Thursday, 26 February 2026 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Councillor Peter Bloomfield, Mrs Sheila Brumby, Mr Sean Coady, Ms Miriam Connor, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Jim Lyon, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Mrs Christine Stevens APOLOGIES Professor Duff Bruce, Ms Helen Chisholm, Ms Aimee McIntosh, Ms Elizabeth Robinson, Mr Alex Stephen IN ATTENDANCE Allied Health Professional Lead, Moray; Corporate Manager; Corporate Business Support Manager; Interim Service Manager, Mental Health and Drug and Alcohol Services; Interim Primary Care Development Manager; Aberdeenshire Clinical Lead GP and Caroline O'Connor, Committee Services Officer SUBSTITUTES Mr Sandy Riddell (for Mr Alex Stephen) 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 28 August 2025 The minute of the meeting of 28 August 2025 was submitted and approved. Item 5a. Page 15
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4. Action Log - 28 August 2025 The Action Log of the meeting of 28 August 2025 was discussed and updated accordingly. With reference to Item 2 on the Action Log where Councillor Bloomfield highlighted a typographical error in the due date column as it do not match with the date in the action required column, the Clerk confirmed the due date should read 25 September 2025 and, once amended, the action would be marked as closed. 5. Complaints Report for Quarters 1, 2 and 3, 2025/2026 The meeting had before it a report by the Chief Nurse - Moray informing the Committee of complaints and feedback reported and closed during Quarters 1, 2 and 3 (1 April 2025 - 31 December 2025). Following consideration the Committee unanimously agreed to note the totals, lessons learned, response times and action taken for complaints completed within the first three quarters of 2025/26. 6. Drug Related Deaths in Moray The meeting had before it a report by the Interim Service Manager, Mental Health and Drug and Alcohol services updating the Committee about drug related deaths in Moray. Following consideration the Committee unanimously agreed to note:- i) the drug related death figures for Moray; ii) ongoing work of the services in relation to the Multi Agency Risk System (MARS) process; iii) the National Benchmarking report on the implementation of the Medication Assisted Treatment (MAT) Standards: Scotland 2023/24; iv) the work being done on the Moray residential rehabilitation pathway; and v) the development of a strategic group and lived experience panel to align the Moray strategy and the National Mission. 7. 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 Committee of progress and exceptions reported to the Clinical and Care Governance Group since the last report to Committee in August 2025. Following consideration the Committee unanimously agreed to note the contents of the report. 8. Items for Escalation to MIJB Page 16
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The Committee noted that there were no items for escalation to the Moray Integration Joint Board. 9. Primary Care Update [Para 6.2.3] The meeting had before it a report by the Primary Care Development Manager informing Committee of issues identified within Moray Primary Care relating to the hand back of a General Medical Services Contract following a prolonged period of concern. In response to a question from Mr Riddell asking for the timescales of implementation of the action plan, the Primary Care Development Manager confirmed implementation of the action plan would be completed within 3 months. In order to provide assurance to Committee of completion of the action plan, the Chair moved adding an additional recommendation (iii) "to report back to this Committee on implementation of the Action Plan." Following consideration and there being no one otherwise minded, the Committee unanimously agreed to:- i) note that a Level 1 investigation was undertaken; ii) note the work undertaken to address and resolve the issues identified; and iii) report back to this Committee on implementation of the Action Plan. Page 17
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 25 JUNE 2026 SUBJECT: REVENUE BUDGET OUTTURN FOR 2025/2026 BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To inform the Moray Integration Joint Board (MIJB) of the unaudited financial outturn for 2025/26 for the core budgets and the impact this outturn will have on the 2026/27 budget. 2. RECOMMENDATIONS 2.1 It is recommended that the Board: i) consider and note the unaudited revenue outturn position for the financial year 2025/26; ii) consider and note the impact of the 2025/26 outturn on the 2026/27 revenue budget; and iii) approve for issue, the Directions shown in Appendix 4 to NHS Grampian and Moray Council. 3. BACKGROUND 3.1 The overall position for the MIJB is that core services were overspent by £7,196,896 as at 31 March 2026. The MIJB’s unaudited financial position for the financial year ending 31 March 2026 is shown at Appendix 1. This is summarised in the table below. Annual Budget £ Actual Expenditure £ Variance to date £ MIJB Core Service 194,859,174 200,210,969 (5,351,795) MIJB Strategic Funds & other resources 4,159,344 6,004,448 (1,845,104) Set Aside Budget 20,092,000 20,092,000 0 Total MIJB Expenditure 219,110,518 226,307,417 (7,196,899) Item 6. Page 19
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A list of services that are included in each budget heading are shown in Appendix 2 for information. 4. KEY MESSAGES 4.1 The MIJB forecast year end out turn as at December was £8.23m, after which a Financial Recovery Plan was put in place to deliver additional cost reductions and savings to ensure that MIJB remains within the parameters of the partners provisions, which were set aside in their budgets against the risk of MIJB overspending. The actual out turn position was £7.2m. The out turn reported financial position for the financial year shows: • MIJB is overspent by £7.2m for the financial year; • The outturn for the year was within the provisions in the partners accounts following a range of actions that took place during the last quarter to mitigate the risk and delivered further cost reductions; • Estimated savings delivered to date total £5.4m against planned full year savings of £9.5m, with £3m being carried forward into 2026/27; • New cost pressures, not reflected in the budget, totalling £1.04m have been identified during the financial year, through high-cost packages group (Q1 -Q3 pressures totalled £0.477, Q4 pressures totalled £0.374m with one off costs totalling £0.192m); • Levels of growth and demand have continued during 2025/26, which seems to be a trend being seen in many IJB’s across Scotland. For permanent care, there was an overall increase in resident numbers from 533 to 555 (4.13%) Within this there has been a reduction in residential placements and an increase in nursing placements 396 to 432 (9.1%). Increasing new packages of care for Care at Home service along with a number of large families coming into the Children & Families service during the year. All the spend is showing in the services budget lines. 2025/26 Revenue Position 4.2 MIJB is reporting a £7.2m unaudited overspend for the 2025/26 financial year. The forecast position reported in January 2026, for the year end was an overspend of £8.23m, which has improved slightly at the year end. Table 1: Movement in 2025/26 Forecast Outturn 2025/26 Outturn At Q1 (June) At Q2 (Sept) At Q3 (Dec) At Q4 (Mar) Core services (£5.54m) (£6.96m) (£5.28m) (£5.35m) Strategic funds £0.85m (£1.82m) (£2.95m) (£1.85m) MIJB Total Outturn (£4.69m) (£8.78m) (£8.23m) (£7.20m) 4.3 The outturn position is £1.1m lower than the forecast position reported in January 2026. The improved position in the final quarter of the financial year resulted in the MIJB reporting an overspend against their revenue resource limit, with deficit support funding provided by both partners. The movement in forecast throughout the year is due to the following: Page 20
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£m Q1 Forecast position 4.7 Care services provided in house 1.1 Children services 1 Prescribing tariff reduction 0.8 High-cost care packages 0.3 Shortfall in funding (pay award & eNIC) 0.7 Other 0.2 Q2 Forecast outturn 8.8 Additional pay award funding from SG (0.5) Q3 Forecast outturn 8.3 Strategic funds non pay funding allocation (1.2) Movement in core services expenditure 0.1 Q4 Outturn 7.2 Further details on the outturn financial position can be found in Appendix 1 and significant variance details in para 5 below. Savings programme 4.4 The 2025/26 savings delivery has been reviewed based on March outturn resulting in £0.9m deterioration from the forecast savings delivery at December. Progress against the total savings programme for the 2025/26 financial year is summarised in the table below. Table 2: Savings and budget reductions Full year plan December forecast Year to date savings SAVINGS £9.5M £6.3M £5.4M Further details on the savings can be found in Appendix 4 and details are found in para 7 below. 5. KEY MATTERS/SIGNIFICANT VARIANCES FOR 2025/26 Community Nursing 5.1 This budget is overspent by £425,978 at the year end. This is predominantly due to staffing, with overspends in District nurses £431,715 (including Acute nursing at Varis, Forres and Buckie), £102,136 overspend in Health visitors, which is being reduced by an underspend in Maryhill of £107,873. 5.2 The overspend is largely due to staffing as detailed above. District nurses had a budget realignment in 2025/26 of £313,982 and savings of £121,095, this was not achieved due to recruitment being successful for vacant posts that have been vacant for a significant time during which time bank staff have had to be used as well as the regrading of nurses from a band 6 to a band 7. Health visitors were expected to come in on budget after realignment and savings however the school nurses were regraded in the last quarter of the year resulting in an overspend in the budget. Page 21
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5.3 The outturn for the community nursing budget is £227,723 worse than forecasted. Due to overspends in staffing increasing in the past quarter as detailed above. Learning Disabilities 5.4 The Learning Disability (LD) service is overspent by £316,736 at the year-end. The overspend is essentially due to the purchase of care for people with complex needs which resulted in an overspend of £428,087, client and staff transport of £25,640 and property cost overspend of £23,588. This is offset by underspend of £100,173 for clinical, nursing and other services relating to consultant and management psychiatry staffing vacancies, more income received than expected of £34,358 and other small underspends of £1,239. 5.5 This budget has been under pressure for a number of years due to demographic pressures, transitions from Children’s services and people living longer and getting frailer whilst staying at home. The biggest overspends was for services provided to individuals in their own homes to support their daily living needs which enables people to stay living at home or in a homely setting for as long as possible and day care which provides activities during the day in the community. Work continues to progress savings plans across the LD service; however, this is being offset by ongoing demand pressures. In particular, more individuals with complex needs moving through transitions from children to adult services and also people moving into the area who require high-cost packages of care, which is impacting on the overall financial position. 5.6 The outturn for the LD service is £525,559 better than forecasted. Forecasting is difficult to do on this volatile budget as client needs can change and therefore costs can fluctuate and will be reviewed for 2026/27. Mental Health 5.7 This budget is overspent by £654,343 at the year end. This is due to overspends in clinical, nursing and other services as a result of ongoing use of agency locums of £302,457; purchase of care £195,385 relating to purchase of care in care homes and care at home; £144,810 relating to unachieved savings and £11,691 other minor overspends. 5.8 This budget is currently under pressure due to the recruitment issue for consultants and an increase in demand for services, including out of area packages as there is a lack of resource locally especially around autism and neurodiversity. Work is currently ongoing reviewing out of area packages to repatriate them to Moray. 5.9 The outturn for the Mental Health service is £165,097 worse than forecasted. This is due to the demand in services, with 3 new clients in permanent care in the last quarter and an agreed pressure for the suicide prevention contract. Older People and Physical Sensory Disability (Assessment & Care) 5.10 This budget is overspent by £1,933,488 at the end of the year. This primarily relates to overspends for home care in the area teams £575,752, permanent care £1,328,598 due to the increase in the number of clients receiving nursing care rather than residential care, short breaks £242,362 and self-directed support of Page 22
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£260,758. Bad debt provision for unpaid fees was £117,582 overspent, which is particularly high this year and other minor overspends of £18,000. This is being reduced by income received during the year above budget by £609,564. The variances within this overall budget heading reflect the shift in the balance of care to enable people to remain in their homes for longer, when people are living longer with more complex care needs. 5.11 Due to the increase in need and complexity along with increasing levels of growth and demand are having an impact on this budget. There are increases in permanent care which is seeing the move to nursing placements rather than residential placements. The demographics are showing we have an increasing elderly population who are living longer and requiring more complex care . 5.12 The outturn for this budget is £258,494 more overspent than the previous forecast due to increase in demand of services. Admin & Management 5.13 This budget is overspent by £1,029,617 at the year end. This is due to interim staffing arrangements and the vacancy target for the Council side not being met by £933,334. There was a non-recurring increase in target for 2025/26 of £750,000 that was not achievable. 5.14 The outturn for this budget is £613,260 more overspend than the previous forecast due to the unachieved vacancy target £692,539 being reduced by an improved position in staffing costs on the NHS side of £78,254 and Council £1,025. Children, Families & Justice Services 5.15 This budget is overspent by £793,663 at the year end. This is due to overspends in residential continuing care placements £418,127, external fostering placements £495,610, out of area residential placements £297,272, home to school taxis £28,201, no recourse to public funds costs £15,600 and self-directed support payments of £68,245. This overspend is being reduced by an underspend on mental health & wellbeing £156,041, trauma informed training £30,517, refund on Intensive Family Support contract £31,492, Criminal Justice £64,759, an overachievement of £246,097 against the vacancy target and minor underspends of £486. 5.16 These overspends are related to the number of children requiring to be accommodated through the Children’s Hearing system, family breakdown, and the need to keep children safe from familial harm while living at home. The costs of care have been rising significantly, availability of the correct care provision is a national challenge, and the market is under scrutiny with consultation for possible legislation on excessive profiteering. A long and immediate term strategy has been approved by the IJB to address: the need to reduce the flow-into care, develop small group family living models in Moray with support from Housing Services, strengthen early support, prevention and diversion, and have a more local provision in the Northeast across the three Grampian local authority areas, which can more effectively contribute to the flow-out of care. Page 23
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5.17 The outturn for this budget is £166,337 less overspend than the previous forecast predominantly due to increase in staffing vacancies. 6. STRATEGIC FUNDS 6.1 Strategic Funds relate to additional Scottish Government funding for Integrated Joint Boards. For the MIJB, they include: • Additional funding received via NHS Grampian and Moray Council (this may not be fully utilised in the year resulting in a contribution to overall MIJB financial position at year-end, which then needs to be earmarked as a commitment for the future year); and • Provisions for earmarked reserves has been made to fund unutilised allocation for Primary Care Improvement Funds, Action 15 additional investment funding, identified budget pressures, new burdens, and savings that were expected at the start of the year. 6.2 At the end of the financial year there was slippage on Strategic Funds of £1,845,104 which, when set against the overspend in core services, has resulted in an overall overspend of £7,196,899. 6.3 During the 2025/26 financial year, Scottish Government continued to commit on the national investment in health and social care. Allocations made during the year, which remain unspent are considered as earmarked funding and to be used for these specific purposes in future years. This has contributed to the MIJB reserves. 6.4 After consideration of funding received, earmarked reserves and application of slippage on Strategic Funds, the final MIJB financial position resulted in an overspend of £7,196,899. As set out in the Integration Scheme, NHS Grampian and Moray Council, as the funding partners make additional funding available to support the MIJB break even. The reserves are detailed below in paragraph 9. 7. CHANGES TO STAFFING ARRANGEMENTS 7.1 At the meeting of the Board on 29 May 2025, the Financial Regulations were approved (para 13 of the minute refers). All changes to staffing arrangements with financial implications and effects on establishment are to be advised to the Board. 7.2 The staffing arrangements are noted in Appendix 3 as dealt with under delegated powers for the period 1 January to 31 March 2026. 8. IMPACT ON 2026/27 BUDGET AND RISK 8.1 The actual out-turn for the 2025/26 Core Services budget year is an overspend of £5,351,795. However, the variances against the budget have been reviewed and classified as one-off or likely to be recurring. Impact in 2026/27 will be monitored continuously and reported regularly to the MIJB. The overall position is summarised below: Page 24
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Area Para Ref Recurring Non-Recurring £ £ OVERSPEND Staff 7.2 (2,207,628) (526,388) Purchasing of Care 7.3 (6,358,719) (1,277,354) Income 7.4 (143,161) 0 Supplies & Services 7.5 (113,199) 0 Property costs 7.6 (96,312) 0 Transport 7.7 0 (793,663) Aids & Adaptations 7.8 (194,666) 0 Other 7.9 (290,976) 0 Sub-total (9,404,661) (2,597,405) UNDERSPEND Staff 7.2 781,953 2,096,308 Purchasing of Care 7.3 2,396,313 0 Income 7.4 0 584,658 Supplies & Services 7.5 0 0 Property costs 7.6 0 102,236 Transport 7.7 0 164,378 Aids & Adaptations 7.8 0 171,491 Other 7.9 0 352,934 Sub-total 3,178,266 3,472,005 TOTAL (6,226,395) 874,600 Net Overspend (5,351,795) 8.2 Staff turnover can incur both under and overspends. Underspends can be attributed to the process of recruitment, which adds a natural delay, with posts being filled by new staff at lower points on the pay scale and in some circumstances the nature of the positions have been challenging to recruit to. The Council has recognised this turnover and had set as part of the budget process a vacancy factor saving, which has been met for numerous years. NHS Grampian has put in a vacancy factor saving since 2024/25. Overspends can be due to the use of bank staff/locum to provide required cover for vacancies/sickness and from the historic incremental drift and efficiency targets imposed. 8.3 The purchasing of care overspend relates to the purchase of home care by the area teams. The demographics show that Moray has an ageing population and the spend on external domiciliary care is increasing in relation to both increasing hours of commissioned care, the number of packages of care and complexity. For residential care we are also seeing a shift in the number of nursing care placements and reduction in residential care placements. This also reflects the shift in the balance of care to enable people to remain in their own homes for longer. 8.4 The under recovery of income budgets is apparent across a number of service headings. It is exceedingly difficult to predict the level of income accurately as client income is subject to the contributions policy which is based on a client’s Page 25
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financial assessment. Income recovery on all care at home services continues to reduce. The income will continue to reduce due to the legislation in relation to the Carers Act and free personal care for under 65’s. During 2025/26 additional income was received from permanent care placements, Community alarm, blue badges and income recoveries from the review of Direct Payments/ SDS contingency funds for clients. 8.5 The Supplies and services is showing a recurring overspend. Overspend includes software maintenance, purchase of meals for internal day services, washroom services for internal day services, equipment maintenance and system licences which is expected to be recurring. 8.6 The property costs are nearly break even, the recurring overspend in property costs primarily relates to the rising cost of energy and cleaning costs. The non- recurring underspend relates to rental costs that are not expected to continue. 8.7 Transport costs include both staff and clients which in total is a recurring overspend of £629,285 which primarily relates to internal day services transport and external day services transport for clients. The non-recurring underspend is due to variances in area teams, which is not expected to continue. 8.8 Aids and Adaptations overspend relates to Occupational therapy aids, servicing and stair lifts. There is also a non-recurring underspend in the improvement grants, due to the timing of works. 8.9 Other category relates to minor variances across the services but also includes recurring overspends relating to admin costs and primary care services The non- recurring underspend relates to primary care services and prescribing budget. 8.11 The financial results for 2025/26 show that underlying financial pressures on both the NHS and Council budgets remain, with the MIJB assuming responsibility for the budgets of the delegated functions and are expected to prioritise services within the budgets directed to it by Moray Council and NHS Grampian. 8.12 The 2026/27 revenue budget position as reported to the Board on 26 March 2026 (para 8 of the minute refers) presented a balanced budget position, through the use of partner contributions, and a challenging savings plan, which addressed the recurring overspend. The recurring overspend included when the budget was set was £4,393,522, however due to a classification recalculation at the year end the recurring overspend out turned at £6,226,395, which is £1,832,873 more than expected and budgeted. The out turn has a £2,096,308 non-recurring underspend in staffing, however, due to ongoing challenges with recruitment means that although classed as non-recurring there is still an element of this underspend that will be achieved in 2026/27. The Senior Management Team have met to discuss this difficult position and mitigating actions have been put in place to offset this gap. 8.13 This additional cost cannot be met from reserves going into 2026/27. There are ear marked reserves of £3,010,434 and no general reserve. With no general reserves the additional cost and any emerging budget pressure will have to be Page 26
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funded from additional savings or from recommissioning other activities. The Senior Management Team are actively addressing the situation to implement alternative measures to limit the financial pressure. Updates on the recovery and transformation process and further savings will be provided to the Board for approval during 2026/27 through the financial reporting processes. 9. SAVINGS 9.1 Through in-year reporting of the savings plan progress it was evident that the saving of £9,469,000 for 2025/26 would be partly achieved, forecast at Q3 was that £6,336,000 would potentially be achieved, the out turn was that £4,343,000 was saved at the end of the financial year, with expected reduction in overspends totalling £1,031,000. The MIJB has committed to continue to identify further efficiencies that will be reported throughout the year, recognising the significant pressure on the budget and the required transformation and disinvestment to allow the programmes of transformation to develop. Detailed information is included in Appendix 4. Efficiencies Para Ref Full Year Target Recurring Savings achieved at 31 Mar 2026 Non- Recurring Savings achieved at 31 Mar 2026 Reduction overspend in budget at 31 Mar 2026 £’000 £’000 £’000 £’000 Building Resilience 9.2 2,626 242 631 508 Home first 9.3 1,445 277 0 213 Partners in Care 9.4 1,821 939 0 310 Already implemented 9.5 3,577 2,204 50 0 Total Projected Efficiencies 9,469 3,662 681 1,031 9.2 Building resilience projects under this heading achieved savings totalling £1,381,000, with unachieved savings totalling £1,504,000 which will be carried forward into 2026/27, the projects under this heading are the right things to do and the scope of the projects will be reviewed/redefined. One project under this heading was non-recurring relating to the Self Directed Support (SDS) recovery, which achieved in excess of the target and will be continued in 2026/27 as a saving. 9.3 Home First projects under this heading achieved savings totalling £490,000, with unachieved savings totalling £279,000 which will be carried forward into 2026/27, the project relating to proportionate care will be classified as an efficiency going forward as any reduction in packages will help towards dealing with the unmet need. 9.4 Partners in Care projects under this heading achieved savings totalling £1,249,000, with unachieved savings totalling £804,000 which will be carried forward into 2026/27. Page 27
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9.5 Already implemented/enablers projects under this heading achieved savings totalling £2,254,000, with unachieved savings totalling £1,335,000 which will be carried forward into 2026/27. Two projects are classed as non-recurring for no non-essential travel and training totalling £50,000 will be continued into 2026/27. Within the 3.42% budget cuts was a non-recurring project relating to increased vacancy target of £750,000 however due to required use of agency staff and interim posts this was not achieved. 10. UPDATED BUDGET POSITION 10.1 During the financial year, budget adjustments arise relating in the main to the allocation of non-recurring funding that is received via NHS Grampian. In order to establish clarity of these budget allocations a summary reconciliation has been provided below. 10.2 The MIJB, for the 2025/26 has concluded the financial year in an overspend position. The additional funding contributions during the year are also show in the table below: £’s Approved Funding 30.3.25 187,737,377 Set aside funding 15,638,000 Balance of IJB reserves c/fwd to 25/26 1,187,022 Amendment to NHS Grampian core 1,245,457 Adjustments in Q1 4,302,519 Revised funding at start of Quarter 2 210,110,375 Adjustments in Qtr2 2,400,363 Revised funding at start of Qtr 3 212,510,738 Adjustments in Qtr 3 1,548,788 Revised funding at start of Qtr 4 214,059,526 Budget adjustments M10-M12 Unscheduled care funding 1,566,144 Pay Award 590,607 Open University 25,000 GP Walk in service 164,800 Hosted recharge (401,817) GVIP 573,797 Primary Care OOH (86,437) FLU allocation 124,810 Southfield Elgin 88,861 Ncare allocation 132,110 Thrombectomy Funding (111,636) HMP HEPC 102,002 Improvement Grant (41,867) Prescribing global sum adj (75,660) Other (20,788) Carefirst funding 64,972 Regrade 649,528 Page 28
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Ear Marked reserves c/fwd (2,747,434) Set Aside adjustment 4,454,000 Revised 2025/26 Financial Year Funding 219,110,518 10.3 In accordance with the updated budget position, revised Directions have been included at Appendix 5 for approval by the Board to be issued to NHS Grampian and Moray Council. 11. RESERVES 11.1 The MIJB Reserves Policy, was most recently approved on 25 January 2024 (para 16 of the minute refers). The policy was reviewed in January 2026 but there were no amendments made, so the policy remains valid and will be reviewed again no later than March 2027. The closing financial position on Reserves for 2025/26 is £3,010,434. This reserve is wholly for earmarked reserves; there is no usable general reserve to carry forward. The earmarked reserve will be called upon during the year in line with their specific purpose. The earmarked reserves detail is provided in the table below: Reserve Detail Type £000’s GP Premises Earmarked 21 National Drugs MAT Earmarked 250 OOH Winter Pressure funding Earmarked 172 Moray Cervical screening Earmarked 36 Moray hospital at home Earmarked 4 Moray Psychological Earmarked 275 MHO Funding Earmarked 138 Adult protection funding for CA Earmarked 72 Adult disability payment Earmarked National Trauma training services Earmarked 53 Moray School Nurse Earmarked 32 Moray Winter Fund HCSW & MDT Earmarked 182 LD Annual Health Checks Earmarked 69 Community Planning partnership Earmarked 2 Moray District Nurses Earmarked 111 Moray Alcohol Drug Partnership Earmarked 48 GP Walk in service Earmarked 165 Moray Unscheduled Care Funding Earmarked 1,380 TOTAL 3,010 12. SUMMARY OF IMPLICATIONS Page 29
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(a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan 2022 – 2032, ‘Partners in Care’ This report is consistent with the objectives of the Strategic Plan and includes budget information for services included in the MIJB Revenue Budget 2025/26. (b) Policy and Legal It is the responsibility of the organisation receiving the direction to work with the Chief Officer and Chief Financial Officer to deliver services within the resources identified. The Moray Integration Scheme (para 12.7 of the 2023 Integration Scheme) makes provision for dealing with in year variations to budget and forecast overspend by reference to agreed corrective action and recovery plans. It also makes provision for dealing with year-end actual overspend where such action and plans have been unsuccessful in balancing the relevant budget by reference to use of MIJB reserves and additional payments from NHS Grampian and Moray Council. (c) Financial implications The unaudited financial outturn for 2025/26 for the MIJB core budgets is £5,351,795 overspend. The financial details are set out in sections 3-9 of this report and in Appendix 1. The movements in the 2025/26 budget as detailed in paragraph 7 have been incorporated in the figures reported. The estimated recurring overspend of £6,226,395 as detailed in paragraph 8 was partly taken into account when setting the 2026/27 budget. The worsening position of £1,832,873 will be mitigated in part offset by some non-recurring staffing underspends continuing into 2026/27 and with the balance considered by a hold on vacancies for 3 months. (d) Risk Implications and Mitigations The most significant risk arising from this report is the control and management of expenditure to provide the Health and Social Care services required for the Moray Area, within budget. Due to the ongoing financial challenges, the financial circumstances of the partners and Scottish Government, the amount of reserves have reduced. There is significant pressure on the budget for 2026/27 along with increasing demands on the services and cost of living pressures. Considerations are being given to alternative measures that can be established to support the recurring overspends and to achieve the savings target set for 2026/27. There is a big risk for 2026/27 onwards to achieve a financial balance. There is a need for constant scrutiny around this rapidly changing situation and reporting to the Board will inform throughout 2026/27. With the impact of the out turn on 2026/27 there is a risk the mitigation will adversely affect overtime and agency use but will Page 30
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be robustly monitored and the impact of this measure will reduce any flexibility the IJB has to manage any new pressures or risks throughout the year. Both partners are aware of the situation. (e) Staffing Implications There are no direct implications in this report. (f) Property There are no direct implications in this report. (g) Equalities/Socio Economic Impact An Equality Impact Assessment is not required because there are no changes to policy resulting from this report. (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 10 above and in Appendix 5. (j) Consultations The Chief Officer, the Senior Management Team, Corporate Manager, Service Managers, Chief Finance Officer (Moray Council) and the Finance Officers from Health and Social Care Moray have been consulted and their comments have been incorporated in this report as appropriate. 13. CONCLUSION 13.1 This report identifies Moray IJB’s unaudited final out-turn position on the 2025/26 Budget of an overspend of £7,196,899 at 31 March 2026 and identifies major areas of variance between budget and actual for 2025/26. 13.2 The impact of the provisional outturn on the 2025/26 budget, of a recurring overspend of £6,226,395 is detailed in paragraph 8. 13.3 NHS Grampian and Moray Council have both carried forward ear marked reserves into 2026/27 which total £3,010,434. Author of Report: D O’Shea Chief Finance Officer Background Papers: Papers held by respective Accountancy teams. Ref: Page 31
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APPENDIX 1MORAY INTEGRATION JOINT BOARD JOINT FINANCE REPORT APRIL 2025 -MARCH 2026 Para Annual Budget (Net) Actual Ref Net Budget To Date To Date Variance £'s £'s £'s £'s 2025-26 2025-26 2025-26 2025-26 Community Hospitals 8,032,985 8,032,985 7,932,394 100,591 Community Nursing 5.1 6,243,791 6,243,791 6,669,769 (425,978) Learning Disabilities 5.4 20,913,472 20,913,472 21,230,208 (316,736) Mental Health 5.7 12,226,922 12,226,922 12,881,265 (654,343) Addictions 1,870,683 1,870,683 1,816,941 53,742 Adult Protection & Health Improvement 277,829 277,829 279,194 (1,365) Care Services provided in-house 25,190,042 25,190,042 25,494,628 (304,585) Older People & PSD Services 5.10 28,089,925 28,089,925 30,023,413 (1,933,488) Intermediate Care & OT 1,844,500 1,844,500 2,039,167 (194,667) Care Services provided by External Contractors 2,084,422 2,084,422 2,071,858 12,564 Other Community Services 10,116,981 10,116,981 10,310,329 (193,348) Admin & Management 5.13 2,056,178 2,056,178 3,085,795 (1,029,617) Other Operational Services 1,413,491 1,413,491 1,350,996 62,495 Primary Care Prescribing 21,441,366 21,441,366 21,312,276 129,090 Primary Care Services 22,829,732 22,829,732 22,953,431 (123,699) Hosted Services 6,130,694 6,130,694 5,986,619 144,075 Out of Area 1,780,000 1,780,000 1,834,354 (54,354) Improvement Grants 1,060,200 1,060,200 888,709 171,491 Childrens & Justice Services 5.15 21,255,961 21,255,961 22,049,624 (793,663) Total Moray IJB Core 194,859,174 194,859,174 200,210,969 (5,351,795) Other non-recurring Strategic Funds in the ledger 6,564,895 6,564,895 6,587,072 (22,177) Total Moray IJB Including Other Strategic funds in the ledger 201,424,069 201,424,069 206,798,041 (5,373,972) Other resources not included in ledger under core and strategic: 6 (2,405,550) (2,405,551) (582,625) (1,822,927) Total Moray IJB (incl. other strategic funds) and other costs not in ledger 199,018,519 199,018,518 206,215,417 (7,196,899) Set Aside Budget 20,092,000 - Overall Total Moray IJB 219,110,519 199,018,518 206,215,417 (7,196,899) Funded By: NHS Grampian 127,970,889 Moray Council funding 91,139,630 Total funding 219,110,519 Page 32
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APPENDIX 2 Description of MIJB Core Services 1. Community Hospitals includes community hospitals, community administration, vaccination centre and community Medical services in Moray. 2. Community Nursing related to Community Nursing services throughout Moray, including District Nurses and Health Visitors. 3. Learning Disabilities budget comprises of:- • Transitions, • Staff – social work and admin infrastructure, • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care, • Medical, Nursing, Allied Health Professionals and other staff. 4. Mental Health budget comprises of:- • Staff social work and admin infrastructure, • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care, • In patient accommodation in Buckie & Elgin. • Medical, Nursing, Allied Health Professionals and other staff. 5. Addictions budget comprises of:- • Staff – social work and admin infrastructure, • Medical and nursing staff • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care, • Moray Alcohol & Drugs Partnership. 6. Adult Protection and Health Improvement 7. Care Services provided in-house Services budget comprises of:- • Employment Support services, • Care at Home service/ re-ablement, • Integrated Day services (including Moray Resource Centre), • Supported Housing/Respite and • Occupational Therapy Equipment Store. 8. Older People & Physical Sensory Disability (PSD) budget comprises of:- • Staff – social work infrastructure (including access team and area teams), • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care and • Residential & Nursing Care home (permanent care), 9. Intermediate Care & Occupational Therapy budget includes:- • Staff – OT infrastructure • Occupational therapy equipment • Telecare/ Community Alarm equipment, • Blue Badge scheme Page 33
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APPENDIX 2 10. Other Community Services budget comprises of:- • Community services for each locality (Allied Health Professionals (AHP’s), Dental services, Public Health, Pharmacy and other specialist nursing roles). 11. Admin & Management budget comprises of :- • Admin & Management staff infrastructure, • Commissioning and Performance team, • Carefirst team, • Older People development, • Community Care finance, • Self Directed support & Carers • Target for staffing efficiencies from vacancies 12. Other Operational Services - range of operational services including – • Community Response Team • Child Protection • Winter Pressures • Clinical Governance • International Normalised Ratio (INR) blood clotting test Training • Moray Alcohol and Drug Partnership (ADP) 13. Primary Care Prescribing includes cost of drugs prescribed in Moray. 14. Primary Care Services relate to General Practitioner GP services in Moray. 15. Hosted Services, comprises of a range of Grampian wide services. These services are hosted and managed by a specific IJB on a Grampian wide basis and costs are re-allocated to IJB budgets. These services include:- Moray IJB Hosted & Managed services: • GMED out of Hours service. • Primary Care Contracts Team Aberdeen City/Aberdeenshire IJB Hosted & Managed services: • Intermediate care of elderly & rehab. • Marie Curie Nursing Service – out of hours nursing service for end of life patients • Continence Service – provides advice on continence issues and runs continence clinics • Sexual Health service • Diabetes Development Funding – overseen by the diabetes Network. Also covers the retinal screening service • Chronic Oedema Service – provides specialist support to oedema patients • Heart Failure Service – provided specialist nursing support to patients suffering from heart failure. • Police Forensic Examiner Service • HMP Grampian – provision of healthcare to HMP Grampian. Page 34
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APPENDIX 2 16. Out of Area Placements for a range of needs and conditions in accommodation out with Grampian. These are managed centrally within NHS Grampian and charged to IJB’s. 17. Improvement Grants managed by Council Housing Service, budget comprises of:- • Disabled adaptations • Private Sector Improvement grants • Grass cutting scheme 18. Children Services & Criminal Justice budget includes the following areas: a) Children Services area teams budget includes:- • Staff – social work (including access team, area teams, disability team, SCIM and Child Protection Unit) • Self directed support • Fostering home to school transport • Support to families b) Quality Assurance team budget includes:- • Staff – social work • Locality management groups funding c) Reviewing Team d) Commissioned Services budget includes:- • Commissioning team • Contracts for all services e) Corporate Parenting budget includes:- • Staff – social work (including fostering, adoption and throughcare/aftercare) • Continuing care payments, income maintenance, supported lodgings and throughcare/aftercare grants • Fostering/kinship fees and allowances. Placements with external fostering agencies. • Adoption allowances • Adoption fees to other local authorities f) Children Services Residential Unit - Cala g) Justice Services budget includes:- • Staff – social work • Youth Pod • Out of Hours team • Community Justice Reform • Criminal Justice Services h) Children Services Strategy and Support budget comprises of:- • Central management staffing • Trauma Informed Practice • Community Mental Health and Wellbeing Supports and Services Page 35
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APPENDIX 2 • Target for staffing efficiencies from vacancies i) Additional grant funding • Unaccompanied asylum seeking children • Corra Foundation Other definitions: Tier 1- Help to help you (information and advice), universal services to the whole community and an emphasis on prevention. Tier 2- Help when you need it (immediate help in a crisis, re-ablement) and regaining independence. Tier 3- Ongoing support for those in need through the delivery of 1 or more self- directed support options. Page 36
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APPENDIX 3 HEALTH & SOCIAL CARE MORAY DELEGATED AUTHORITY REPORTS - PERIOD January to March 2026 Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding 230660 Band 4, 14.8hrs Qualified Dental Nurse Permanent 04/02/26 234893 Band 7, 23hrs Highly Specialised Podiatrist in MSK Permanent 27/01/2026 235184 Band 6, 20hrs Specialist Band 6 Occupational Therapist Permanent 22/01/2026 235875 Band 6, 37hrs Band 6 - SM120824 - Specialist Physiotherapist - In-Patient Services Permanent 27/01/2026 236147 Band 6, 37hrs Band 6 Specialist Physiotherapist (Rotational) Permanent 27/01/2026 236356 Band 3, 74hrs Band 3 Generic Therapy Support Worker - Discharge 2 Assess Team Permanent 22/01/2026 236363 Band 6, 37hrs Band 6 Specialist Physiotherapist - Discharge 2 Assess Permanent 22/01/2026 237009 Band 3, 9hrs CE126240 CTAC Treatment Room Healthcare Support Worker Permanent 11/02/2026 Page 37
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APPENDIX 3 Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding 237033 Band 5, 33hrs Band 5 Nurse Permanent 22/01/2026 237582 B3, 38hrs B3 HCSW Permanent 22/01/2026 237810 Band 5, 37hrs NR235097 - Physiotherapist Permanent 27/01/2026 238088 Band 6, 21.6hrs Specialist Pharmacy Technician - Prescribing Efficiencies (B6) Permanent 27/01/2026 Funding - possibly from prescribing budget. Spend to save - agree RMG 26/01/26 238627 Band 6, 15hrs Multiple Sclerosis Specialist Nurse (Moray) permanent 04/02/2026 Agreed at RMG but will be £12k budget pressure 239267 Band 4, 37hrs Personal and Social Care Template Permanent 11/02/2026 Health Improvement Fund 238093 Band 6 18.5hrs Primary Care Practice Pharmacist (Band 6) Permanent 11/02/2026 240195 Band 3, 15hrs Dental Practice Receptionist/Administrator Permanent 20/02/2026 241651 Band 5, 37hrs NR235097 - Physiotherapist permanent 05/03/2026 241854 Band 6, 37hrs NR236147 - Specialist Physiotherapist (Rotational) permanent 05/03/2026 244839 Band 5, 36hrs NR241651 - Physiotherapist permanent 05/03/2026 RWW BF Page 38
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APPENDIX 3 Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding Project Officer A post of Project Officer is required to support delivery of the Financial Delivery plan projects for Health and Social Care Moray. Grade 9 36.25 hours Permanent As appointed Funding available from existing position Advanced Practitioner, Community Learning Disability Team – Temporary Increase The CLDT currently has 1 full time Advanced Practitioner and 1 29hr Advanced Practiitoner. The full time Advanced Practitioner, commenced Maternity Leave on 7th July 2025. She is expected to return to work in April 2026. This proposal is to increase the hours of 29hr Advanced Practitioner, to full time in order to provide much needed support to the team. Grade 10 7.25 hours Temporary September 25 to March 26 Funding from underspend Community Care Finance – Grade 3 0.35 fte (11.5 hours) (Remove from structure for Budget Saving) Reduction of 0.32fte (11.5 hours) of a 0.7fte (25.5 hours) Grade 3 Clerical Assistant post (that is currently vacant) from the structure as a budget saving for Community Care Finance for a recurring saving of £10,618 from April 2025. Grade 3 11.50 hours Permanent ASAP This is a saving Page 39
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APPENDIX 3 Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding Converting the existing post of auditor from 24.75 hours to 29 hours per week for the period until 15 June 2026 to coincide with the current period of secondment This proposal concerns the existing role of Auditor 24.75 hours and the request to increase the hours of this post on a temporary basis to 29 hours per week (0.8 fte) for the remainder of the current appointment. Grade 9 4.25 hours Temporary September 25 to June 26 Funding from vacant post Page 40
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APPENDIX 4 MIJB Budget 2025/26 MIJB proposed savings APPENDIX 4 Ref Service Brief Description Full year effect £000s Saving expected for 2025/26 Saving achieved in 2025/26 Planned Implementation Date Risk Level Update BR 1 Internal Care at Home review Review of Internal care at home including redesign 122.00 122.00 - Apr 25 Red Redesign to take forward to 2026/27. Stopping Medication collection implement by March 2026. BR 4 &5 Removal of locum / implement CESR Cease locum use - gradual & implement 2 CESR fellows 1,044.00 261.00 142.00 Jan-26 Amber CESRs have left, locum required to support but seeking to recruite to permanent position which will achieve saving going forward BR 6,7,8 GMED redesign Relocation from Health Village, redesign of clinical & admin staffing model, Ad astra Ehealth system 110.00 110.00 - Apr 25 Red Will be delivered in 2026/27 BR 9 Pool car vs expenses review Review into all teams transport and expenses to evalaute best options 20.00 20.00 20.00 Apr-25 Green BR 10,12 Cessation of leases and relocation Southfield, Strathisla dental practice 63.00 63.00 100.00 Apr-25 Green Strathisla cessation reliant upon NHS G carried forward into 2026/27 BR 14 Review of Care spot purchasing & review care packages 1,000.00 1,000.00 250.00 Jan-26 Red Reviews commenced in Jan 2025 and this is the continuation of that work already started So far the level of savings are no where near the saving expected and as such the £1m unlikely to be realistic - will continue into 2026/27 BR 15 Review of Care Purchasing 700.00 700.00 238.00 Oct-26 Red Saving to be delivered over 2025/26 and 2026/27 with reviews broadened to now include Mental Health Page 41
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APPENDIX 4 BR 42 *new SDS recovery Review packages to increase recovery 350.00 350.00 631.00 Apr-25 Green Recovery in excess of target HF 16 Short Breaks provision Review into planned and emergency short breaks - change in model 413.00 413.00 213.00 Apr-25 Amber Saving slipped and will be over 2 financial years 25/26 and 26/27 HF 17 Proportionate care Redesign model 555.00 555.00 - Apr-25 Red Carried forward into 2026/27 and classed as an efficiency HF 18 Night Time Responder (LD) Redesign LD nighttime model of care delivery 277.00 277.00 77.00 Apr-25 Red Project support required and saving will now be achieved over 2 financial years, 2025/26 & 2026/27 HF 20 Community hospital redesign Redesign of inpatient services supporting Home First 200.00 200.00 200.00 Apr-25 Green Project to be rescoped, will not be achieved in 2025/26 however reductions in overspend have been achieved PIC 23 Commissioning and contracts review Review of all contracts and redesign of provisions 350.00 350.00 284.00 Apr-25 Green Additional saving identified to commence 2026/27 PIC 21,24 Day Services review MRC catering & infrastructure 220.00 220.00 220.00 Apr-25 Green Change management plan to be progressed saving will be made over 2 financial 2025/26 & 2026/27 PIC 25 Complex & challenging behaviour unit Review Review into Woodview and change management 657.00 159.00 159.00 Apr-25 Green Project carried forward into 2026/27 PIC 26 Care home bed usage - LD review care home bed utilitsation 182.00 121.00 121.00 Apr-25 Green Progressing slower than expected, need fair access policy updated. Will be carried forward into 2026/27 PIC 27 LD review & review Internal review and redesign, review care home bed utilitsation 554.00 370.00 - Apr-25 Red Need to carry forward to 26/27 - in part linked to commissioning saving above PIC 28 Review of step down building based facilities Review into model of care 118.00 69.00 71.00 Apr-25 Green Due to current flow issues the rest of the beds will not be closed in 2025/26. Will be carried forward into 2026/27 PIC 30 Prescribing efficiencies -GP Medication cessation,switches within GP services and work with Care Homes 669.00 100.00 249.00 Apr-25 Green Spend to save initiative, achieved more than target PIC 43*new Prescribing efficiencies -Care home 69.00 69.00 Apr-25 Green Spend to save initiative, achieved target PIC 31 Digital Support efficiencies - NO TEMPLATE REQUIRED As part of DHI (Moray Growth Deal and Analogue To Digital Proposal) 100.00 100.00 - Apr-25 Red Strategy to be developed, will be carried forward into 2026/27 Page 42
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APPENDIX 4 PIC 33 Transport contract Review of how we contract for transport for childrens and adult services 292.00 146.00 26.00 Oct-25 Red Contracts being reviewed but will not be in place until 2026/27 AI 44 *new Reduction in overtime reduce the amount spent on overtime during the year 200.00 200.00 - Apr-25 Red Due to recruitment issues continuing will not be achieved in full 2025/26, will be carried forward into 2026/27 PIC 46 *new Review of palliative care services Review of provision of palliative care in Moray to improve outcomes 117.00 117.00 50.00 Apr-25 Amber Alternative plan to be worked up, will not be fully achieved in 2025/26 AI 38 No non-essential travel (I year) Non essential travel ban (out of area) 30.00 30.00 30.00 Apr-25 Green AI 38 No non-essential training (I year) Non essential training ban (conference attendance etc) 20.00 20.00 20.00 Apr-25 Green AI 41 *new Vacancy target NHS & increase on Council in line with pay award increase Already implemented 1,135.00 1,135.00 762.00 Apr-25 Amber Use of agency staff & interim positions have impacted on the savings being made in 2025/26 AI 47* new Healthcare system reduced payment Refund due for system 20.00 20.00 20.00 Apr-25 Green Implemented - refund received AI 48* new 3.42% budget cut on other services not included above 3.42% reduction in expenditure across a variety of budget headings 2,172.00 2,172.00 1,422.00 Mar-25 Amber Implemented in part, non recurring additional vacancy target was not achieved TOTAL 11,690.00 9,469.00 5,374.00 KEY BR Building Resilience HF Home First PIC Partners in Care AI Already implemented Page 43
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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 20260625GHB17 20260625MC17 2. Date Direction issued by the Moray Integration Joint Board 25.06.2026 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 Yes budget report for 25/26 to MIJB on 26.03.2026 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 - £103.01 million, of which £0.5 million is ring fenced for Housing Revenue Account aids and adaptations and £3.4m for Children Services joint out of area budget. NHS Grampian associated budget - £96.01 million, of which £6.1 million relates to Moray’s share for services Page 44
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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 update and reflect the budget position for 2025/26 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 45
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 25 JUNE 2026 SUBJECT: UNAUDITED ANNUAL ACCOUNTS BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To inform the Board of the Unaudited Annual Accounts of the Moray Integration Joint Board (MIJB) for the year ended 31 March 2026. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider and approve the unaudited Annual Accounts to be submitted to the external auditor, noting that all figures remain subject to audit, in Appendix 1; ii) approve the updated Local Code of Corporate Governance which supports the Annual Governance Statement, in Appendix 2; iii) note the accounting policies applied in the production of the unaudited Annual Accounts, pages 48 to 49 of the accounts; iv) note the Annual Governance Statement contained within the unaudited Annual Accounts and in Appendix 3; and v) approve the Best Value Statements as detailed in Appendix 4 3. BACKGROUND 3.1 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 requires that an integration joint board is subject to the audit and accounts regulations and legislation of a body under Section 106 of the Local Government (Scotland) Act 1973. 3.2 The Local Authority Accounts (Scotland) Regulations 2014 (2014 Regulations), places a statutory obligation on the MIJB to submit draft Annual Accounts for the year ended 31 March 2026 to its external auditors by 30 June 2026 and the audited Item 7. Page 47
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annual accounts are required to be approved by the MIJB and published by 30 October each year. 3.3 A copy of the unaudited accounts is attached at Appendix 1. 3.4 The MIJB has a statutory duty to conduct a review at least once in each financial year of the effectiveness of its system and to include a statement reporting the review within its Statement of Accounts. The MIJB does this through its Annual Governance Statement which is published as part of its Annual Accounts. 3.5 The MIJB has established arrangements and continues to develop its governance framework which includes the system of internal control. This system is intended to manage risk and support the achievement of the MIJB’s policies, aims and objectives. Reliance is placed on NHS Grampian and Moray Council systems of internal control that support compliance with both organisations’ policies and promotes achievement of each organisation’s aims and objectives; to the extent that these are complementary to those of the MIJB. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Annual Accounts have been prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26 (the Code) which is underpinned by the International Financial Reporting Standards (IFRS). 4.2 Grant Thornton, under the Local Authority Accounts (Scotland) Regulations 2014 is required to complete their audit by 30 September 2026, Grant Thornton is working to this deadline and audited accounts are due to be submitted to IJB in September 2026. The audited accounts and the External Auditor’s report statutory deadline for publication is 30 October 2026. 4.3 The Comprehensive Income and Expenditure Statement shows a surplus of £1.56m on the provision of services for the year. As at 31 March 2026, the Balance Sheet showed total Reserves of £3.1m. This increase is primarily due to funding relating to the Unscheduled care improvement plan and GP walk-in centre funding. Note 7 within the unaudited accounts breaks down the Reserves between what is General Reserve and available for utilisation and supporting the budget and what is earmarked for specific purposes. 4.4 The unaudited accounts are given at Appendix 1 and consist of the following: Management Commentary – provides the context through narrative that supports the financial statements. It describes the strategic intent of the MIJB, together with its performance through the year, highlighting areas of risk. It also provides some forward thinking on the forthcoming year and planned developments. Remuneration Report – details the pay and pension benefits accrued by the MIJB senior officers during 2025/26. Annual Governance Statement – is a means of reporting publicly on the MIJB’s governance arrangements, and seeks to provide assurance that its business is Page 48
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conducted in accordance with law, regulations and proper practices and that public money is safeguarded and properly accounted for. Financial Statements – provides detail of the main financial transactions through the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, and Balance Sheet. Notes to the Accounts – explains the use of accounting policies and provides supporting information to the main financial statements. 4.5 As at 31 March 2026 there were significant variances between budget and actual on several services. These are evident in the summary on the major variances included within the Management Commentary on pages 18 to 20. More details are included in the separate report, Revenue Budget Outturn for 2025/26, on this Boards agenda. 4.6 In April 2016 an updated Chartered Institute of Public Finance and Accountancy (CIPFA) / Society of Local Authority Chief Executives (SOLACE) ‘Delivering Good Governance in Local Government: Framework’ was published. The framework, whilst written in a local authority context, is applicable to integration authorities particularly as legislation recognises an IJB as a local government body under part VII of the Local Government (Scotland) Act 1973. 4.7 The Framework defines the principles that should underpin the governance arrangements and provides a structured approach. On 24 June 2021, the MIJB approved an updated Local Code of Corporate Governance based on the Framework and adopting the principles by which to evaluate performance (para 8 of the minute refers). The principles as set out in the CIPFA/SOLACE Framework are: a. Behaving with integrity, demonstrating strong commitment to ethical values and respecting the rule of law, b. Ensuring openness and comprehensive stakeholder engagement, c. Defining outcomes in terms of sustainable economic, social and environmental benefits, d. Determining the interventions necessary to optimise the achievement of intended outcomes, e. Developing the entity’s capacity, including the capability of its leadership and the individuals within it, f. Managing risk and performance through robust internal control and strong public financial management; and g. Implementing good practices in transparency, reporting and audit to deliver effective accountability 4.8 The term ‘Local Code’ refers to the governance structure in place and is a statement of the policies and procedures by which functions are directed and controlled and how engagement with service users, the local community and other stakeholders is carried out. The collective policies and procedures of the MIJB constitute a Local Code of Corporate Governance. Page 49
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4.9 The MIJB can achieve good governance by demonstrating that its governance structures comply with the principles as set out in the Framework. Regular review is carried out to assess the MIJB’s performance against the principles, identify areas for development and inform the Annual Governance Statement. Appendix 2 displays the sources utilised in assessing MIJB’s compliance against each governance principle. With regard to the partnership model of operation, reliance is also placed on the systems and procedures of Moray Council and NHS Grampian and so for completeness, assurance sources are listed for these organisations. 4.10 Whilst the MIJB has received limited assurance from the Internal Auditor, again for 2025/26 significant progress is being made to rectify this. Procedures are in place to ensure all audit recommendations and dates are not only achievable but are on the agendas for internal meetings, with oversight by the Senior Management Team. The replacement of the social care information system is in progress, however, is not expected to be fully implemented until April 2027. The governance statement from NHS Grampian attached at Appendix 3 gives assurance there are no significant control weaknesses. 4.11 One of the recommendations from the External Auditors report for 2024/25 was that the MIJB should undertake a formal review of the Best Value assurance framework and complete an assessment of the arrangements to secure best value. The outcome of the assessment was to be reported to the Audit, Performance and Risk Committee. The assessment is attached at Appendix 4. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Moray Partners in Care 2022-2032” The unaudited Annual Accounts have been completed and are available for audit inspection within the specified timescale. (b) Policy and Legal The Public Bodies (Joint Working) (Scotland) Act 2014 requires that the MIJB is subject to the audit and accounts provisions of a body under Section 106 of the Local Government (Scotland) Act 1973. The MIJB’s accounts are prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25 which is underpinned by IFRS. (c) Financial implications The unaudited Annual Accounts provide all required information about the MIJB in relation to its financial position at 31 March 2026. The overriding principle in relation to annual accounts preparation is to provide a true and fair view. (d) Risk Implications and Mitigation There are no risk issues arising directly from this report. The unaudited Annual Accounts will be subjected to audit by external auditors, Grant Thornton, which will provide assurance that the Accounts for 2025/26 give Page 50
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a true and fair view of the financial position and expenditure and income of the MIJB for the year ended 31 March 2026. Effective governance is essential in providing the framework for the MIJB to conduct its business. The annual review of governance arrangements aims to ensure that internal controls, risk management and associated governance arrangements are being constantly developed with the aim of providing reasonable assurance on the framework as a whole. Regular review and application of a Local Code of Corporate Governance supports this process (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact None arising directly from this report as there has been no change to policy as a result of this report. (h) Climate Change and Biodiversity Impacts There are no direct climate change and biodiversity implications. (i) Directions None arising directly from this report. (j) Consultations In preparation of the unaudited Annual Accounts, consultations have taken place between finance staff of both Moray Council and NHS Grampian. The Chief Officer and other key senior officers have been consulted for comment where appropriate 6. CONCLUSION 6.1 The Annual Accounts, subject to audit, show a surplus on the provision of services of £1.56m for MIJB for the year ending 31 March 2026. At the beginning of the year the MIJB, held in its reserves £1.45m. The closing balance on the reserves as at 31 March 2026 is £3.01m, consisting wholly of reserves earmarked for specific purposes as detailed in the unaudited annual accounts 2025/26. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: with author Ref: Page 51
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 UNAUDITED ANNUAL ACCOUNTS FOR THE YEAR ENDED 31 MARCH 2026 Moray Integration Joint Board Page 52
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 If you need information from the Moray Council in a different language or format, such as Braille, audio tape or large print, please contact: ياروم سلجم لبق نم تامولعم لىإ ةجاح ي ف متنك اذإ نوكتو ةغلب وأ ويدوأ ةناوطسأ ،يا ربلا لثم فلتخم لكش لىعوأ ةفلتخم نوكت نأ مط ب لاصّتلإا ءاجّرلاف ةظيلغ فورح لامعتساب ةعوب Jei pageidaujate tarnybos Moray tarybos teikiamą informaciją gauti kitokiu formatu, pvz., Brailio raštu, garso įrašu ar stambiu šriftu, kreipkitės: Jeśli potrzebują Państwo informacji od Rady Okręgu Moray w innym formacie, takim jak alfabet Braille'a, kasety audio lub druk dużą czcionką, prosimy o kontakt: Se necessitar de receber informações por parte do Concelho de Moray num formato diferente, como Braille, cassete áudio ou letras grandes, contacte: Ja Jums vajadzīga informācija no Marejas domes (Moray Council) citā valodā vai formātā, piemēram, Braila rakstā, audio lentā vai lielā drukā, sazinieties ar: ای نابز رگید یسک ےس لسنوک ےروم وک پآرگاتروص راکرد تامولعم ںیم لاثم ںوہ ˝ ،فورح ےڑب ای پیٹ ویڈآ ،ےلیربںیئامرف ہطبار رک امرف ینابرہم وت: Chief Finance Officer to the Moray Integration Joint Board, High Street, Elgin, IV30 1BX accountancy.support@moray.gov.uk Page 53
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 Table of Contents MORAY INTEGRATION JOINT BOARD MEMBERS 2025/26 .............................................. 1 MANAGEMENT COMMENTARY .......................................................................................... 2 STATEMENT OF RESPONSIBILITIES ............................................................................... 28 REMUNERATION REPORT ............................................................................................... 30 ANNUAL GOVERNANCE STATEMENT ............................................................................. 34 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT ..................................... 45 MOVEMENT IN RESERVES STATEMENT ........................................................................ 46 BALANCE SHEET .............................................................................................................. 47 NOTES TO THE FINANCIAL STATEMENTS ..................................................................... 48 Note 1 Significant Accounting Policies ............................................................................. 48 Note 2 Critical Judgements and Estimation Uncertainty .................................................. 49 Note 3 Events after the Reporting Period ........................................................................ 50 Note 4 Expenditure and Income Analysis by Nature ........................................................ 50 Note 5 Taxation and Non-Specific Grant Income ............................................................. 51 Note 6 Debtors ................................................................................................................ 51 Note 7 Usable Reserve: General Fund ............................................................................ 52 Note 8 Agency Income and Expenditure .......................................................................... 53 Note 9 Related Party Transactions .................................................................................. 54 Note 10 VAT .................................................................................................................... 56 Note 11 Accounting Standards That Have Been Issued but Have Yet To Be Adopted .... 56 Page 54
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 1 MORAY INTEGRATION JOINT BOARD MEMBERS 2025/26 Voting Members Dennis Robertson (Chair) Grampian Health Board (Vice Chair 01/04/2025 to 30/09/2025. Chair from 01/10/2025) Cllr. Elaine Kirby (Chair) Moray Council (21/11/2024 to 31/07/2025) Cllr. Bridget Mustard (Vice-Chair) Moray Council (Chair 1/08/2025 to 30/09/2025. Vice Chair from 01/10/2025) Sandy Riddell Grampian Health Board Derick Murray Grampian Health Board Alex Stephen Grampian Health Board Cllr. Peter Bloomfield Moray Council Cllr. Scott Lawrence Moray Council Cllr Ben Williams Moray Council (Left 27/03/2026) Cllr John Divers Moray Council (Joined 27/03/2026) Non-Voting Members Judith Proctor Chief Officer Jim Lyon Interim Chief Social Work Officer Jane Ewen Lead Nurse Professor Duff Bruce Non-Primary Medical Service Lead Dr Robert Lockhart GP Lead Sheila Brumby People Receiving Services Representative. Ivan Augustus Carer Representative (left 27/11/2025) Kevin Todd Moray Council Staff Representative (left 19/05/2025) Elizabeth Robinson Public Health Representative Deirdre McIntyre Grampian Health Board Staff Partnership (left 19/06/2025) Michael Ritchie Grampian Health Board Staff Partnership (Joined 16/07/2025) Page 55
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 2 MORAY INTEGRATION JOINT BOARD MEMBERS 2025/26 Continued Miriam Connor Unpaid Carer Representative (Joined 28/11/2025) Christine Stevens Unpaid Carer Representative (Joined 28/11/2025) Aimee McIntosh Third Sector Representative (joined 01/10/2025) Co-opted Members Sean Coady Head of Service and Deputy Chief Officer Deborah O’Shea Chief Finance Officer Adam Coldwells Interim Chief Executive Grampian Health Board (Left 01/10/2025) Laura Skaife-Knight Chief Executive Grampian Health Board (Joined 01/10/2025) Karen Greaves Chief Executive, Moray Council Sonya Duncan Interim Corporate Manager MANAGEMENT COMMENTARY The Role and Remit of the Moray Integration Joint Board The Public Bodies (Joint Working) (Scotland) Act 2014 required that Moray Council and Grampian Health Board prepared an Integration Scheme for the area of the local authority detailing the governance arrangements for the integration of health and social care services. This legislation resulted in the establishment of the Moray Integration Joint Board (MIJB) that became operational from 1 April 2016. Moray Council and Grampian Health Board, as the parties to the Integration Scheme, each nominate voting members to the MIJB, currently, four elected members from Moray Council and four Grampian Health Board members. Under the Public Bodies (Joint Working) (Scotland) Act 2014, a range of health and social care functions have been delegated from Moray Council and Grampian Health Board to the MIJB who has assumed responsibility for the planning and operational oversight of delivery of integrated services. MIJB also has a role to play in the strategic planning of unscheduled acute hospital-based services provided by Grampian Health Board as part of the ‘set aside’ arrangements. . Page 56
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 3 MANAGEMENT COMMENTARY (continued) Hosted services also form part of the MIJB budget. There are a number of services which are hosted by one of the three IJB’s within Grampian Health Board area on behalf of all the IJBs. Responsibilities include the planning and operational oversight of delivery of services managed by one IJB on a day-to-day basis. MIJB has responsibility for hosting services relating to Primary Care Contracts and the Grampian Medical Emergency Department (GMED) Primary Care Out of Hours service. Key Purpose and Strategy Following review and consultation, the refreshed Strategic Plan (2022-2032) is a continuation of the 2019 Strategic Plan. The current plan emphasises the strength of integration and in addition to our two main Partners – Moray Council and Grampian Health Board - the MIJB recognises the importance of the Third and Independent Sectors and Unpaid Carers, in facilitating the successful operation of the partnership of Moray Health & Social Care Partnership (Moray HSCP). As with all health and social care systems Moray is facing increasing demand for services at the same time as resources – both funding and workforce availability - are under pressure. These challenges will intensify in the coming years as our population ages and more people with increasing complex needs require support to meet their health and care needs. The MIJB sets the direction and strategic intent through the development and implementation of the Strategic Plan and seeks assurance on the management and delivery of services through Board level performance reporting which ensures an appropriate level of scrutiny and challenge. The Strategic Plan identifies priority areas to support strategic direction and vision. WE ARE PARTNERS IN CARE OUR VISION: “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.” OUR VALUES: Dignity and respect; person-led; care and compassion; safe, effective and responsive OUTCOMES: Lives are healthier – People live more independently – Experiences of services are positive – Quality of life is maintained/improved – Health inequalities are reduced – Carers are supported – People are safe – The workforce continually improves – Resources are used effectively and efficiently Page 57
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 4 MANAGEMENT COMMENTARY (continued) STRATEGIC PLAN KEY THEMES MANAGEMENT COMMENTARY (continued) The Plan purposefully places an emphasis on prevention and early intervention activities and seeks to prioritise these activities as a long-term goal, actively pursuing good health and wellbeing for the population, with increased investment in this area of work. It highlights the Home First approach and the rationale for this is to assist people in understanding that “hospital is not always the best place for people”, a statement frequently used and in particular if you are frail and elderly can be counter intuitive to a successful recovery. Initiatives to transform services in response to high levels of demand continue. The Moray Strategic Plan was refreshed in 2022 and along with the associated delivery plan, which was updated in May 2025, highlights key priorities for transformation. Population Moray is a largely rural area covering a land mass of 2,238 sq. km. It has a long coastline on the Moray Firth with harbours, fishing villages and world-class beaches. From the 2022 census, the area’s population is 93,4001, which is an increase of 0.1% since 2011. The population growth in Moray is slowing, and it is projected that the population in Moray will start to decline by 2030. This trend is forecast to continue. The main centre of population is Elgin, which is home to more than one quarter of the people living in Moray. Other towns of population between 4,000 and 10,000 are Forres, Buckie, Lossiemouth and Keith. The table below sets out projected population growth based on the 2022 baseline, which has not changed from the 2018 publication. Across Scotland there is a projected reduction in those in the 0-15 age group, limited change in the working age population, but significant growth in adults of pensionable age. By comparison it is projected that Moray will have a greater decrease in children, a marked decrease in those of a working age, but a significantly higher change in those of a pensionable age2. 1 Scotland's Census 2022 - Rounded population estimates - data | Scotland's Census 2 Population Projections for Scottish Areas 2018-based - National Records of Scotland (NRS) BUILDING RESILIENCE – Taking greater responsibility for our health and wellbeing HOME FIRST – Being supported at home or in a homely setting as far as possible PARTNERS IN CARE – Supporting citizens to make choices and take control of their care and support Page 58
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 5 MANAGEMENT COMMENTARY (continued) Performance Reporting Performance is reported quarterly to the Audit, Performance and Risk Committee of the MIJB. In addition to the quarterly reporting, there is a requirement under the Public Sector (Joint Working) (Scotland) Act 2014 for the MIJB to produce and publish an Annual Performance Report setting out an assessment of performance in planning and carrying out the delegated functions for which they are responsible. The Annual Performance Report is due to be published by 31 July this year and will be published on the Moray HSCP website, once approved by the MIJB. There is continued focus on one of the major aims of integration and a key measurable target for MIJB, to reduce the number of Moray residents that are ready to be sent home from hospital but have been delayed in this process. This is referred to as a ‘delayed discharge’. Delayed discharge can occur due to many reasons but quite often involves the onward provision of social care which can be complex in nature and/or finite in its availability. . .MSG indicator 4 – Number of Delayed Discharge Bed Days3 Year Q1 Q2 Q3 Q4 2021/22 592 784 1,142 1,294 2022/23 1,207 1,197 1,063 751 2023/24 732 845 1,162 1,501 2024/25 922 1,115 981 1,149 2025/26 1,015 1,217 1,141 1,004 3 https://publichealthscotland.scot/publications/delayed-discharges-in-nhsscotland-annual/delayed- discharges-in-nhsscotland-annual-annual-summary-of-occupied-bed-days-and-census-figures-data- to-march-2025/ About this release - Delayed discharges in NHS Scotland monthly - Figures for April 2026 - Delayed d… -22.2% -9.0% 30.8% -10.5% -0.2% 23.2% -30.0% -20.0% -10.0% 0.0% 10.0% 20.0% 30.0% 40.0% Children (0-15) Working Age Pensionable age and overProjected change (%) Age Group Projected percentage change in population (2018- 2043) by age Moray Scotland Page 59
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 6 Table 1 MANAGEMENT COMMENTARY (continued) Figure 1 With an ageing population the number of people delayed at any one time could increase again unless viable, sustainable alternative community provision is developed. Presentations to hospital from an older population have more acuity and complexity, exacerbating the issue of delays. The Scottish Government have set targets for delayed discharges per 100,000 and for Moray the target is 26. This is a continuing challenge, but focussed efforts to review and streamline processes and improve flow across the system are being undertaken through the “Home Assessment Pathway” project, utilising Scottish Government additional funding to reduce unscheduled care. . Delayed Discharges National Indicator 19 - Number of days people spend in hospital when they are ready to be discharged (per 1,000 population). Figure 2 below shows Moray’s performance over a five-year period showing the number of delayed discharge bed days, which fluctuates through the year, however during the last two quarters of 2025/26 there has been a sustained reduction, resulting in the lowest number of days at Q4 in the five-year period. The ongoing scrutiny of delays to find solutions, progress of projects to improve efficient use of care and support resources and embedding of the Self Direct Support (SDS) framework will be contributing to this reduction. 0 500 1,000 1,500 2,000 Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar 2021/22 2022/23 2023/24 2024/25 2025/26 MSG Indicator 4 - Number of delayed discharge bed days Page 60
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 7 MANAGEMENT COMMENTARY (continued) Figure 2 Within Children and Families and Justice Social Work, there is a continued focus on the provision of early family support, aiming to keep children in their families, when that is safe to do so. Amongst the supports and actions working towards this outcome is the provision of commissioned services deigned to deliver early and preventative support. The three commissioned prevention and early intervention services—Aberlour Youth Point, Families Together, and Functional Family Therapy—provided support to numerous families in the 2025/2026 financial year, as noted in the graph below. The supports provided included one to one and group sessions, family centred money advice service, practical assistance, family group decision making and functional family therapy focusing on improving communication and relationships. The impact of these supports is evidenced via regular contract monitoring mechanisms. Page 61
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 8 MANAGEMENT COMMENTARY (continued) . Another area of focus is to reduce the number of children in care and specifically in out-of-area care. This financial year showed a continuation of the longer-term direction of travel towards safely reducing reliance on care with the number of children looked after away from or at home reducing from 167 in October 2025 to 164 at the end of March 2026. However, this improvement is somewhat offset by a significant pressure point: a higher proportion of newly accommodated children required out-of-area care, increasing both operational complexity and financial pressure. Whilst the overall number of children entering out-of-area care can be considered low against the total number of looked after children, by the end of the financial year, this kind of care accounted for 63% of commissioned services spend, up from 53% at the start of the financial year. The Service continues to work towards the reduction of the overall number of children entering care, inclusive of the following actions planned for the next financial year: - Exploration of intensive family support service, - Services commissioned to provide early and preventative support, - The development of the Early Pathway and the refresh of GIRFEC in Moray. 112 115 131 126 100 105 110 115 120 125 130 135 Q1 Q2 Q3 Q4 Number of children 2025/2026 financial year Number of children and families supported by the 3 preventative commissioned services 3 2 8 4 0 1 2 3 4 5 6 7 8 9 Q1 Q2 Q3 Q4 Number of children 2025/2026 financial year Total new entries to out-of-area care Page 62
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 9 MANAGEMENT COMMENTARY (continued) Moray Integration Joint Board (MIJB) The MIJB has scrutinised and directed the delivery of services in line with the Integration Scheme and Strategic Plan while recognising that the cost base must change as the level of available budget in real terms is reducing. Both funding partners (Moray Council and NHS Grampian) have significant savings to achieve, and against this backdrop the MIJB directed a series of workshops during the year to support officers in their work. The focus has continued to be on achieving the highest quality and safety possible within a diminished budget, while being most efficient, and achieving the best possible outcomes for our residents. The Strategic Plan aspires to increasing spend on preventative work, “upstream” to tackle issues earlier, preventing crises where possible and reducing demand. However, a key challenge going forward will be to continue that focus at a time when budgets are under so much pressure and people are presenting with increasingly complex needs. Performance The MIJB, its committees and the Health and Social Care Partnership Senior Management Team receive regular assurance reports and updates on how the Strategic Plan commitments are being progressed through work streams and individual service plans, as well as detailed financial and performance updates. The strategic risk register was reviewed by the MIJB and Senior Management Team (SMT). It was approved in March 2026 and will form part of a robust risk monitoring framework in order to identify, assess and prioritise risks related to the delivery of services, particularly any which are likely to affect the delivery of the Strategic Plan. The inherent risks being faced by the MIJB, together with a current assessment on the level of the risks and mitigating actions being taken to reduce the impact of the risks, is reported biannually to the Audit Performance and Risk Committee for oversight and assurance. Management teams and the Care and Clinical Governance Group review and respond to any reports produced by Audit Scotland, Healthcare Improvement Scotland, the Care Inspectorate, and the Mental Welfare Commission for Scotland. Quarterly performance reports are produced for Moray HSCP management to review performance and to determine actions required to address areas for concern or to highlight areas showing improvement. This information is further scrutinised by the Senior Management team and then reported to the MIJB’s Audit, Performance and Risk Committee. There are many initiatives and ongoing projects being undertaken by Moray HSCP that are seeking to reduce the delays in hospitals and to meet unmet needs. For example, ensuring the provision of care at home is maximised within available budget is a key aspect of the Strategic Care at Home workstream. Funding has also been Page 63
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 10 MANAGEMENT COMMENTARY (continued) provided to NHS Grampian to support improvement in Unscheduled care across Grampian. Moray HSCP secured £1.38m to develop a Home Assessment Pathway (HAP) which focusses on prevention of admission to acute hospital and supported, timely discharge to assess. The programme was fully launched in May 2026 and as well as reporting through the HSCP and IJB structures, reports into the pan Grampian Unscheduled Care Delivery Board. Research into the type of equipment, benefits and impacts is being undertaken by the Digital Health Institute as part of the Growth Deal which will inform our Technology Enabled Care and Digital strategy which will provide other options for supporting people to live independently in their own homes. In addition to the Home Assessment Pathway work, the HSCP is also engaged with the collaborative initiative Discharge Without Delays which is also a Grampian wide initiative. This programme aims to reduce delays experienced by people who are medically fit to return home and is being facilitated by Health Intelligence Scotland. Whole system outcomes have been determined which will be incorporated into the revised performance report to this committee for 2025/26. This will also inform and contribute to the development of the Home Assessment Pathway work. The integration of Children & Families and Justice services into Moray HSCP under the direction of the MIJB is not yet reflected in the Board’s Strategic Plan. Work is ongoing to ensure appropriate governance of performance reporting so that it can be included in future MIJB Annual Performance Reports and the refresh of the Strategic Plan which will take place across 2026/27 will include these delegated services. Strategy and Plans The MIJB is required to review its Strategic Plan every three years as per the legislation and this is now planned to take place over 2026/27. The Strategic Plan 2022-2032 places an emphasis on prevention and early intervention with the aim of building resilience for individuals and communities. The Plan identified key aims of the MIJB and directed Moray HSCP to work closely with communities and key partners to reform the system of health and social care in Moray. It was also recognised that progress has been made against the three strategic themes and the review of the Plan focused on what already has been achieved the long-term strategic objectives make room for adapting to challenges and developments in health and social care over the coming years. The current Strategic Plan sets out the 3 key themes and the objectives; • Building Resilience – supporting people to take greater responsibility for their health and wellbeing. • Home First – supporting people at home or in a homely setting as far as possible. • Partners in Care – supporting citizens to make choices and take control of their care and support. Page 64
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 11 MANAGEMENT COMMENTARY (continued) Staff Wellbeing Moray HSCP, in partnership with Third Sector organisation Moray Wellbeing Hub, launched a new initiative designed to reduce barriers to accessing mental health support for the health and social care workforce. Funded through NHS Grampian Charity, the digital tools project offered one-to-one personal support sessions to help individuals manage and improve their wellbeing, as well as team awareness talks to build skills in peer support and colleague signposting. Through improving digital skills and fostering peer-led approaches, the initiative aimed to promote inclusion and resilience, challenge the stigma associated with accessing help, and create a more connected and supportive working environment. Promoting Health and Wellbeing Moray HSCP's commitment to promoting healthy and independent ageing was recognised on an international stage in July 2025, when Alice Illingworth, Realistic Medicine Wellbeing Co-ordinator with the Health Improvement Team, was invited to present at the End Pyjama (PJ) Paralysis global online summit. The two-day conference brought together health and care professionals from across the world who are working to reduce immobility, muscle deconditioning, and dependency in care settings, whilst protecting cognitive function, social interaction, and dignity. Alice presented on the Ageing Well work being undertaken in Moray as part of the partnership’s wider focus on preventing deconditioning – the decline in physical function experienced during periods of inactivity, which is of particular concern for less mobile older people and those experiencing extended hospital stays. Central to the presentation was the Moray Ageing Well Tool, an innovative digital self- check resource developed as part of the Making Every Opportunity Count (MeOC) programme. The tool supports older people to take control of their own health and wellbeing by encouraging individual reflection on personal needs and priorities, completing a health assessment, and connecting with relevant local services and support networks. The tool is currently in use across a range of settings, including GP practices, hospitals, social care, and the wider community. Building on the success of the initial Community Appointment Day (CAD) model piloted for musculoskeletal (MSK) Physiotherapy and Podiatry patients in Moray, the partnership and NHS Grampian continued to develop this innovative approach to service delivery during 2025/26. In October, we partnered with the Digital Health & Care Innovation Centre's (DHI) Rural Centre for Excellence to deliver an Occupational Therapy (OT) Community Appointment Day in Elgin. The event provided attendees, including those awaiting an OT assessment, with the opportunity to explore AskSARA, an online self-management tool offering personalised advice on equipment and home adaptations. Participants Page 65
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 12 MANAGEMENT COMMENTARY (continued) received hands-on support from Moray HSCP's Occupational Therapy Team to navigate the tool and review practical recommendations for remaining safe and independent at home. In July 2025, the Moray Be Active Life Long (BALL) wellbeing groups which are supported by Moray HSCP, marked a significant milestone. A celebration of their 20th anniversary brought together nearly 300 community members at a special event in Hopeman. The event recognised two decades of friendship, physical activity, and support for healthy ageing across Moray. BALL groups were developed following extensive community engagement with older people, who identified a need for greater opportunities to stay physically active and socially connected later in life. From an initial group of ten participants in 2005, the programme – which is unique to Moray – has grown into a network of 18 user-led groups welcoming more than 1,000 attendees each week. Our collaborative approach to prescribing improvement was showcased at the annual Scottish Practice Pharmacy and Prescribing Advisers (SP3A) conference in Glasgow, where Fiona Duncan, Primary Care Advanced Pharmacist, and Mandy Nascimento, Specialist Pharmacy Technician, presented on a significant joint initiative. Working in partnership, Pharmacy, Dietetics, and Health Visiting teams undertook a review of baby milk prescribing, with the aim of improving practice and reducing spend through consistent adherence to established clinical guidelines. Through targeted training, improved data sharing, and a refreshed rollout of guidance, the initiative has improved education for parents and carers on the appropriate use of baby milks and the milk ladder, supporting better clinical outcomes and more consistent practice across primary care, as well as achieving financial benefits. In June 2025, Moray HSCP launched a pilot project in partnership with Elgin Health Centre, aimed at proactively identifying unpaid carers and connecting them with appropriate support. It is estimated that approximately 16,200 adults and children in Moray provide some form of unpaid care; however, only around 13% are currently in contact with the Quarriers Carer Support Service, which is commissioned by the partnership to support adult and young carers across the area. A significant barrier to accessing support is identification – both by professionals and by carers themselves, many of whom do not recognise the care they provide as placing them in the role of a carer. Page 66
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 13 MANAGEMENT COMMENTARY (continued) The Unpaid Carers Team, working alongside Elgin Health Centre, is addressing this through staff training in carer identification and signposting to services, including Quarriers and Moray HSCP teams. The project establishes a clear carer pathway within GP practice settings, promotes annual health checks, and supports contingency planning to ensure carers receive timely information and support. The model is now being extended to other GP practices and education settings across Moray. In partnership with a range of statutory, community, and Third Sector organisations, Moray HSCP has continued to develop a Whole Systems Approach to improving healthy weight across Moray. Recognised as a key priority within Scotland’s Population Health Framework and the Board’s Strategic Plan, this collaborative model looks beyond individual choice to address the wider environmental, social, and economic factors that shape health outcomes. During the year, three interactive workshops brought together partners from across health, local authority, environmental health, children’s services, transport, education, community, and Third Sector organisations. These workshops produced a shared understanding of the causes and drivers of unhealthy weight in Moray, mapped existing provision, identified gaps and priorities for action, and generated a draft vision statement and systems map. A local action plan will be launched in 2026/27. Service Delivery/Business as Usual Moray HSCP has continued to invest in improving digital services and infrastructure for the benefit of citizens and staff. The partnership website has been migrated to a new platform, delivering improvements in accessibility, security, and user experience. The new multi-agency website, Getting It Right for Every Child (GIRFEC) in Moray (www.girfecinmoray.co.uk), was also launched as a central information resource for families, young people, and practitioners. Developed in partnership with NHS Grampian, Moray Council, and Third Sector organisations, the site includes dedicated sections on GIRFEC, the Child’s Plan, children’s rights, and a range of support services, as well as a local events calendar. Content was co-produced with local families and young people, with engaging graphics designed by a former pupil of Speyside High School during a digital media placement with Children's Services. Moray HSCP has achieved significant milestones in the national programme to transition community alarm and telecare services from analogue to digital technology, ahead of the UK-wide switchover deadline in January 2027. Page 67
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 14 MANAGEMENT COMMENTARY (continued) With approximately 1,500 community alarm and telecare devices in use by Moray residents, the Analogue to Digital Telecare (A2DT) programme represents one of our most significant transformation workstreams. Moray HSCP has been awarded both the Gold Level One and Gold Level Two Digital Telecare Implementation Awards from Digital Telecare for Scottish Local Government. The Gold Level Two award, which recognises partnerships that have delivered a live digital service to at least half of their users with a minimum of six weeks of safe, reliable operation, reflects the substantial progress achieved. At the time of the award, 56% of Moray's telecare devices were digital-ready Moray Community Justice Partnership hosted the local launch of Upside, a Scotland- wide service funded by the Scottish Government to support individuals as they leave prison and return to community life. Delivered in Moray by Turning Point Scotland, as part of a national partnership of eight leading charities, Upside provides support with housing, health, finances, substance use, and the rebuilding of family connections, with a focus on developing trusting relationships and connecting individuals with local services. The launch event also highlighted the work of Moray HSCP’s Voluntary Throughcare Service, which provides up to twelve months of support for individuals released from prison who are not subject to licence conditions. The service assists with accommodation, benefits, mental health support, addiction recovery, employment, and rebuilding family relationships, with the aim of empowering individuals to make positive and lasting change. In November 2025, Moray Council and MIJB hosted a civic reception to honour local foster carers, recognising their dedication, compassion, and the life-changing impact of their commitment to children and young people in Moray. Page 68
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 15 MANAGEMENT COMMENTARY (continued) The event brought together foster carers, elected members, board members, and officers to celebrate the remarkable contribution foster carers make to the lives of children and to communities across the area. The occasion also served to raise awareness of fostering and encourage those in Moray who may be able to offer a safe, stable, and nurturing home to a child or young person to come forward. Over the past year, Moray HSCP has made progress in strengthening and stabilising mental health services, although recognising the need for greater urgency in delivering meaningful improvements for people who have experienced long-standing gaps in support. Gaps have placed sustained pressure on GP practices, where clinicians have been supporting adults and children with complex mental health needs without consistent access to specialist services. It is acknowledged that individuals and families have waited too long for services that fully meet their needs. A number of key developments have helped improve service resilience. These include the appointment of a new Clinical Director for Moray Mental Health Services (Adult and Older Adult), the stabilisation of Consultant Psychiatry cover across Moray, the introduction of a dedicated email advice service enabling GPs to access psychiatric expertise, enhanced out-of-hours on-call arrangements through support from Royal Cornhill Hospital in Aberdeen, and an increased Community Mental Health Team presence within primary care settings. In addition, three Scottish Action for Mental Health (SAMH)-delivered services – the Distress Brief Intervention Service, Intensive Recovery and Community Support Service, and Suicide Prevention Service – are now fully staffed and operational across Moray. Mental Health and Wellbeing Practitioners based in GP practices also continue to strengthen early intervention, providing 255 appointments during August 2025 and supporting improved triage and faster responses for patients. Performance has improved in some areas of the Psychological Service, with 100% of Secondary Care referrals meeting national waiting time targets in September 2025. However, significant challenges remain within the Primary Care Psychological Service, where only 15% of referrals met the national standard and this will be prioritised for improvement. Page 69
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 16 MANAGEMENT COMMENTARY (continued) Longer Term Changes to Strategies and Plans A new initiative to strengthen and protect the ongoing relationships at the heart of care for young people leaving the care system has been launched in Moray. Care-experienced young people and practitioners co-designed the Maintaining Relationships Project to ensure that vital connections – with social workers, teachers, residential staff, and others – can be maintained safely and respectfully even after formal care arrangements have ended. The project responds directly to the experiences of young people who have described feeling “forgotten” or “abandoned” following transitions out of care. Members of the Moray Champions Board called on Moray HSCP to develop guidance enabling staff to maintain these important relationships in a way that places young people’s wishes at the centre. Launched ahead of Care Leavers Month, the project reflects Moray’s commitment to the national Promise – ensuring all of Scotland’s children and young people grow up loved, safe, and respected. The project is already attracting national interest and has the potential to provide a model for other areas across Scotland. Positive progress continues to be made in the delivery of the Children’s Services Plan 2023–2026. The annual report highlighted the difference being made by community planning partners – including Moray HSCP, Moray Council, NHS Grampian, and Third Sector organisations – working together and with local communities to safeguard, support, and promote child and family wellbeing. The next Children’s Services Plan is under development. Good progress has also been achieved in delivering the Moray Unpaid Carers Strategy, with a range of developments helping to strengthen support and improve the experiences of unpaid carers across Moray. The Strategy, which runs until 2028, is built around three strategic priorities – recognising, valuing, and supporting carers – and is underpinned by a delivery plan supported by annual Carer Act funding. Moray Alcohol and Drug Partnership (ADP) has continued to make significant progress in reducing drug and alcohol-related harms and improving outcomes for individuals and communities across Moray. Notable progress has been achieved during the year in implementing the national Medication Assisted Treatment (MAT) standards, which form a key part of Scotland's response to the ongoing drug-related deaths crisis. The standards provide a framework for ensuring that treatment is safe, person-centred, and effective. Page 70
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 17 MANAGEMENT COMMENTARY (continued) Improved referral pathways, delivered through a third sector direct access service, have reduced waiting times and enabled faster access to support, whilst frontline staff have continued to benefit from training in rights awareness, trauma-informed practice, and crisis response. In August 2025, a Recovery Together community event was held in Lossiemouth, marking International Overdose Awareness Day. The event provided an opportunity to remember those lost to substance use, support those still affected, and celebrate the strength and resilience found in recovery. The Rose Remembrance Walk and programme of activities reinforced the community's commitment to tackling stigma and promoting open conversation around recovery. Financial Review and Performance Financial performance forms part of the regular reporting cycle to the MIJB. Throughout the year the Board, through the reports it receives, is asked to consider the financial position at a given point and any management action deemed as necessary to ensure delivery of services within the designated financial framework. From the first quarter in the financial year, the Board was presented with financial information that included a forecast position to the end of the year. In November 2025 the Board received a financial report which forecast an expected overspend to the end of the financial year of £8.78m. This forecast remained fairly consistent throughout the remainder of the year and in January 2026, MIJB were forecasting an overspend to the end of the year of £8.23m, the MIJB actually out turned at £7.20m overspent. Both partners in line with the Integration Scheme, put in additional funding to cover this overspend. There was the use of ear marked reserves totalling £0.14m during the year, with new ear marked reserves totalling £1.70m leaving a balance of £3.01m in ear marked reserves to be carried forward into 2026/27. In March 2025, the MIJB agreed a savings plan of £9.47m, with a mixture of recurring savings and recurring reductions in spend. At the end of the financial year, this had been achieved in part, with recurring savings of £3.66m, £0.68m non-recurring savings and £1.03m reduction in overspend. Given the uncertainties associated with funding and the emerging overspend position at the early stage of the financial year, it was necessary to update the Board regularly on the emerging financial position. This was done formally through MIJB meetings and informally through development sessions. Page 71
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 18 MANAGEMENT COMMENTARY (continued) Service Area Budget £000’s Actual £000’s Variance (Over)/ under spend £000’s Note Community Hospitals & Services 8,033 7,932 101 Community Nursing104,360 6,244 6,670 (426) 1 Learning Disabilities 20,913 21,230 (317) 2 Mental Health 12,227 12,881 (654) 3 Addictions 1,871 1,817 54 Adult Protection & Health Improvement 278 279 (1) Care Services Provided In-House 25,190 25,495 (305) Older People Services & Physical & Sensory Disability 28,090 30,023 (1,933) 4 Intermediate Care & OT 1,845 2,039 (194) Care Services Provided by External Contractors 2,084 2,072 12 Other Community Services 10,117 10,310 (193) Administration & Management 2,056 3,086 (1,030) 5 Other Operational Services 1,413 1,351 62 Primary Care Prescribing 21,441 21,312 129 Primary Care Services 22,830 22,954 (124) Hosted Services 6,131 5,987 144 Out of Area Placements 1,780 1,834 (54) Improvement Grants 1,060 889 171 Children’s & Justice Services 21,256 22,050 (794) 6 Total Core Services 194,859 200,211 (5,352) Strategic Funds & Other Resources 14,367 6,005 8,362 7 TOTALS (before set aside) 209,226 206,216 3,010 Set Aside 20,092 20,092 - TOTAL 229,318 226,308 3,010 The table above summarises the financial performance of the MIJB by comparing budget against actual performance for the year. Page 72
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 19 MANAGEMENT COMMENTARY (continued) Significant variances against the budget were notably: Note 1 Community Nursing - This budget is overspent by £425,978 at the year end. This is predominantly due to staffing, with overspends in District nurses £431,715 (including Acute nursing at Varis, Forres and Buckie), £102,136 overspend in Health visitors, which is being reduced by an underspend in Maryhill of £107,873. The overspend is largely due to staffing as detailed above. District nurses had a budget realignment in 2025/26 of £313,982 and savings of £121,095, this was not achieved due to recruitment being successful for vacant posts that have been vacant for a significant time during which time bank staff have had to be used as well as the regrading of nurses from a band 6 to a band 7. Health visitors were expected to come in on budget after realignment and savings however the school nurses were regraded in the last quarter of the year resulting in an overspend in the budget. Note 2 Learning Disabilities (LD) – The Learning Disability (LD) service is overspent by £316,736 at the year-end. The overspend is essentially due to the purchase of care for people with complex needs which resulted in an overspend of £428,087, client and staff transport of £25,640 and property cost overspend of £23,588. This is offset by underspend of £100,173 for clinical, nursing and other services relating to consultant and management psychiatry staffing vacancies, more income received than expected of £34,358 and other small underspends of £1,239. This budget has been under pressure for a number of years due to demographic pressures, transitions from Children’s services and people living longer and getting frailer whilst staying at home. The biggest overspends was for services provided to individuals in their own homes to support their daily living needs which enables people to stay living at home or in a homely setting for as long as possible and day care which provides activities during the day in the community. Work continues to progress savings plans across the LD service; however, this is being offset by ongoing demand pressures. In particular, more individuals with complex needs moving through transitions from children to adult services and also people moving into the area who require high-cost packages of care, which is impacting on the overall financial position. Note 3 Mental Health – This budget is overspent by £654,343 at the year end. This is due to overspends in clinical, nursing and other services as a result of ongoing use of agency locums of £302,457; purchase of care £195,385 relating to purchase of care in care homes and care at home; £144,810 relating to unachieved savings and £11,691 other minor overspends. This budget is currently under pressure due to the recruitment issue for consultants and an increase in demand for services, including out of area packages as there is a lack of resource locally especially around autism and neurodiversity. Work is currently ongoing reviewing out of area packages to repatriate them to Moray. Note 4 Older People Services and Physical & Sensory Disability - This budget is overspent by £1,933,488 at the end of the year. This primarily relates to overspends for home care in the area teams £575,752, permanent care £1,328,598 due to the increase in the number of clients receiving nursing care rather than residential care, short breaks £242,362 and self-directed support of £260,758. Bad debt provision for unpaid fees was £117,582 overspent, which is particularly high this year and other Page 73
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 20 MANAGEMENT COMMENTARY (continued) minor overspends of £18,000. This is being reduced by income received during the year above budget by £609,564. The variances within this overall budget heading reflect the shift in the balance of care to enable people to remain in their homes for longer, when people are living longer with more complex care needs. Due to the increase in need and complexity along with increasing levels of growth and demand are having an impact on this budget. There are increases in permanent care which is seeing the move to nursing placements rather than residential placements. The demographics are showing we have an increasing elderly population who are living longer and requiring more complex care. Note 5 Admin and Management - This budget is overspent by £1,029,617 at the year end. This is due to interim staffing arrangements and the vacancy target for the Council side not being met by £933,334. There was a non-recurring increase in target for 2025/26 of £750,000 that was not achievable. Note 6 Children, Families and Justice Services – This budget is overspent by £793,663 at the year end. This is due to overspends in residential continuing care placements £418,127, external fostering placements £495,610, out of area residential placements £297,272, home to school taxis £28,201, no recourse to public funds costs £15,600 and self-directed support payments of £68,245. This overspend is being reduced by an underspend on mental health & wellbeing £156,041, trauma informed training £30,517, refund on Intensive Family Support contract £31,492, Criminal Justice £64,759, an overachievement of £246,097 against the vacancy target and minor underspends of £486. These overspends are related to the number of children requiring to be accommodated through the Children’s Hearing system, family breakdown, and the need to keep children safe from familial harm while living at home. The costs of care have been rising significantly, availability of the correct care provision is a national challenge, and the market is under scrutiny with consultation for possible legislation on excessive profiteering. A long and immediate term strategy has been approved by the IJB to address: the need to reduce the flow-into care, develop small group family living models in Moray with support from Housing Services, strengthen early support, prevention and diversion, and have a more local provision in the Northeast across the three Grampian local authority areas, which can more effectively contribute to the flow-out of care. Note 7 Strategic Funds and Other Resources – This budget is underspent by £8.362m as it relates to savings achieved during the year, any unallocated funding and reserves balances. MIJB’s financial performance is presented in the comprehensive income and expenditure statement (CIES), which can be seen on page 45. At 31 March 2026 there were ear marked reserves of £3.01m available to the MIJB, compared to £1.45m at 31 March 2025. These remaining reserves of £3.01m are for various purposes as described below: Page 74
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 21 MANAGEMENT COMMENTARY (continued) Earmarked Reserves Amount £000’s GP Premises 21 National Drugs MAT 250 OOH Winter Pressure funding 172 Moray Cervical screening 36 Moray hospital at home 4 Moray Psychological 275 MHO Funding 138 Adult protection funding for CA 72 National Trauma Training services 53 Moray School Nurse 32 Moray Winter Fund HCSW & MDT 182 LD Annual Health Checks 69 Community Planning partnership 2 Moray District Nurses 111 Moray Alcohol & Drug Partnership 48 GP Walk-in Service 165 Moray Unscheduled Care Improvement Plan 1,380 Total Earmarked 3,010 General Reserves 0 TOTAL Earmarked & General 3,010 Page 75
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 22 MANAGEMENT COMMENTARY (continued) GP Premises – balance of funding for improvement grants including the making of premises improvement grants to GP contractors. The continued digitalisation of paper GP records. Modifications for the purposes of improving ventilation and increase to the space available in NHS owned or leased premises for primary care multi- disciplinary teams. National Drugs Medication Assisted Treatment (MAT) for embedding and implementation of the standards will he be overseen by the MAT implementation support team (MIST). Out of Hours Winter Pressure funding – balance of funding to sustain GO out of hours and to support resilience to explore operational solutions. Moray Cervical Screening – balance of funding for smear test catch up campaign. Moray Hospital at home – development of Hospital at Home provides Acute hospital level care delivered by healthcare professionals, in a home context for a condition that would otherwise require acute hospital inpatient care. Moray Psychological – funding streams for mental health, psychological wellbeing, facilities, post diagnostic support and psychological therapies. Mental Health Officer (MHO) funding – funding to support additional mental health officer capacity. Adult protection funding for care at home– balance of funding to build capacity in care at home community-based services. National Trauma Training services – training for dealing with people affected by trauma and adversity. Moray School nurse – funding to support NHS Grampian to retain school nurse posts. Moray Winter Fund Health Care Social Workers (HCSW) – additional funding for further HCSW in both the IJB and Emergency department. Moray Winter fund Multi-Disciplinary Team – additional funding for service pressures includes Discharge to Assess, Home First Frailty team and volunteer development. Learning Disability Annual Health Checks – to implement the annual health checks. Community Planning Partnership – funding towards community planning partnership. Moray District Nurses – allocation to support recruitment and training of District Nurses. Moray Alcohol & Drug Partnership -funding to support local alcohol and drug issues. Page 76
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 23 MANAGEMENT COMMENTARY (continued) GP Walk-in Service – Scottish Government funding to expand walk-in GP services. Moray Unscheduled Care Improvement Plan – funding to enhance the delivery of unscheduled care services. All reserves are expected to be utilised for their intended purpose during 2026/27. Set Aside – Excluded from the financial performance table above on page 18 but included within the Comprehensive Income & Expenditure Account is £20.092m for Set Aside services. Set Aside is an amount representing resource consumption for large hospital services that are managed on a day-to-day basis by the NHS Grampian. MIJB has a responsibility for the strategic planning of these services in partnership with the Acute Sector and Mental Health Service. Set Aside services include: • Accident and emergency services at Aberdeen Royal Infirmary and Dr Gray’s inpatient and outpatient departments; • Inpatient hospital services relating to general medicine, geriatric medicine, rehabilitation medicine, respiratory medicine, learning disabilities, old age psychiatry and general psychiatry; and • Palliative care services provided at Roxburgh House Aberdeen and The Oaks Elgin. The budget allocated to Moray is designed to represent the consumption of these services by the Moray population. The MIJB integration scheme outlines that the method of establishing the set aside budget will take account of hospital activity data and cost information. Hospital activity data will reflect actual occupied bed day and admissions information, together with any planned changes in activity and case mix. This information was originally provided by Information Services Division, although this information hasn’t been updated since 2019/20. In the absence of updated information from Information Services Division, uplifts based on the baseline uplift was applied to the set aside budget calculation on an annual basis throughout the period up to 2024/25. During 2025/26 it was accepted that this did not provide an accurate reflection of the consumption by Moray residents within the Unplanned Care pathways and work was undertaken to update the set aside calculation. The updated set aside budget has been calculated using hospital activity data and cost information. The hospital activity data is taken from the SMR01 dataset for general/acute inpatient and day case and reflects inpatient stays and day case and outpatient activity. Costs are taken from the 2023/24 NHS Grampian cost book and uplifted by the baseline uplift amounts for 2024/25 and 2025/26 to reflect pay award Page 77
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 24 MANAGEMENT COMMENTARY (continued) and inflationary uplifts since 23/24. The set aside budget is the total of IJB activity multiplied by unit cost. The figures for 2021/22 to 2024/25 have been derived by uplifting 2019/20 figures by baseline funding uplift in 2021/22 (3.36%) ,2022/23 (6.70%), 2023/24 (5.35%) and 2024/25 (6.64%): 2025/26 2024/25 2023/24 2022/23 2021/22 Budget 20.092m 15.639m 14.665m 13.92m 13.04m Risks, Uncertainties and Future Developments The MIJB Chief Officer has a responsibility to maintain a risk strategy and risk reporting framework. Risks inherent within the MIJB are monitored, managed and reported at Audit, Performance and Risk Committee. In addition, a risk action log is monitored and managed by the Senior Management Team. The key strategic risks of the MIJB classed as ‘High’ and ‘Very High’ are presented below, the risk number relates to the MIJB internal risk numbering: Page 78
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 25 MANAGEMENT COMMENTARY (continued) VERY HIGH 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. Managing the risk – current controls in place – 1. Medium Term Financial Framework (MTFF) approved by MIJB on 26 March 2026. 2. Additional resource to support the Budget Savings Delivery has been extended until 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. 9. Financial pressures have been escalated to the Chief Executives of Moray Council and NHS Grampian, discussions continue as per the tri-partite arrangements. Assurances: • Quarterly Budget monitoring reporting to APR and MIJB. • Financial Reporting through MIJB, NHS Grampian and Moray Council. • The Project Management Office will support the Financial Recovery Savings presented 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. Page 79
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 26 MANAGEMENT COMMENTARY (continued) • 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 February 2026. • Risk 2 presented to MIJB in January 2026 with Q3 report. Development Aims for 2026/27 Unscheduled Care Improvement Building on the work done on the National Collaborative to support Discharge without Delay and the wider Grampian performance challenges around Unscheduled Care, the IJB will maintain its focus on ensuring the services delegated to it deliver agreed targets. This will be done under the current actions in the delivery plan, and these will be refreshed as part of the development of the new Strategic Plan. Included in this work is the Home Assessment Pathway programme which will be reviewed across the year in relation to its contribution to achieving and sustaining agreed outcomes. Implementation of Organisational Structures Since its inception the MIJB has sought to ensure the most effective and efficient structures are in place to support the delivery of its strategic aims and overall strategic plan. Over the course of 2025/26 a review of the HSCM organisational structure was undertaken. This was a collaborative piece work and engaged and involved staff. A consultation took place and, following this, the focus will be on implementing the new structure and realising the opportunities and benefits set out in the initial proposals. Developing further our Children, Families and Justice priorities and strategy Children, Families and Justice Services were delegated formally to the MIJB in 2023/24 under the integration scheme and there is now reporting of these services within the Clinical and Care Governance structures in place. Moray Council and Councillors retain statutory responsibilities for outcomes for Children and also remain Corporate Parents in respect of those Children and Young People who are cared for or accommodated out with their families. MIJB is committed to ensuring it plans and commissions services that are appropriate to meet the growing demand and which focus as far as practicable on early intervention and prevention and which reduce the need for a crisis response and costly out of area placements. The IJB agreed a strategic direction in November 2025 and this, under the direction of the new, permanent Head of Service and Chief Social Work Officer (starting August 2026) will be a focus for delivery over the course of the year. Page 80
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 27 MANAGEMENT COMMENTARY (continued) Strategic Plan Review The MIJB approved its Strategic Delivery Plan at its meeting in May 2025, and this now provided a refresh of delivery under the current 10-year Strategy. However, recognising the need to ensure all services delegated to it are reflected in the Strategic Plan, and that it needs to reflect the financial reality set out in the Medium-Term Financial Framework, we plan to undertake a review of the Strategic Plan by the end of the financial year. In addition, we will seek to: • Continue to develop how we care for our staff well-being, with staff our most valuable asset, through the development of our Workforce Plan; • Set out clear ambitions under a Digital and TECH programme; • Provide leadership and participation as key partners in the pan Grampian North East Strategic Transformation Group (NESTG); • Focus our budget setting efforts in the context of the Medium-Term Financial Strategy and longer-term sustainability. ………………………… ……………………… ……………………… Dennis Robertson Judith Proctor Deborah O’Shea Chair of Moray IJB Chief Officer Chief Financial Officer Page 81
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 28 STATEMENT OF RESPONSIBILITIES Responsibilities of the MIJB • To make arrangements for the proper administration of its financial affairs and to secure that one of its officers has the responsibility for the administration of those affairs. In Moray Integration Joint Board, that officer is the Chief Financial Officer; • To manage its affairs to achieve best value in the use of its resources and safeguard its assets; • Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014) and so far as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003); and • To approve the Annual Accounts. Signed on behalf of the Moray Integration Joint Board Dennis Robertson Chair of Moray IJB Page 82
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 29 STATEMENT OF RESPONSIBILITIES (continued) Responsibilities of the Chief Financial Officer The Chief Financial Officer is responsible for the preparation of the Moray Integration Joint Board’s statement of accounts in accordance with proper practices as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (the Code) 2025/26. In preparing the Annual Accounts the Chief Financial Officer has: • Selected suitable accounting policies and applied them consistently; • Made judgements and estimates that were reasonable and prudent; • Complied with legislation; and • Complied with the local authority code (in so far as it is compatible with legislation). The Chief Financial Officer has also: • Kept proper accounting records that were up to date; and • Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that the financial statements give a true and fair view of the financial position of the Moray Integration Joint Board as at 31 March 2026 and the transactions for the year then ended. Deborah O’Shea FCCA Chief Financial Officer Page 83
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 30 REMUNERATION REPORT Introduction This Remuneration Report is provided in accordance with the Local Authority Accounts (Scotland) Regulations 2014 (SSI2014/200) as part of the MIJB annual accounts. This report discloses information relating to the remuneration and pension benefits of specified MIJB members. All information disclosed in the tables is subject to external audit. Other sections within the Remuneration Report will be reviewed for consistency with the financial statements. Moray Integration Joint Board The voting members of MIJB are appointed through nomination by Moray Council and Grampian Health Board. There is provision within the Order to identify a suitably experienced proxy or deputy member for both the voting and non-voting membership to ensure that business is not disrupted by lack of attendance by any individual. MIJB Chair and Vice-Chair Nomination of the MIJB Chair and Vice-Chair post holders alternates every 18 months between a Councillor and a Health Board non-executive member. The MIJB does not provide any additional remuneration to the Chair, Vice-Chair or any other board members relating to their role on the MIJB. The MIJB does not reimburse the relevant partner organisations for any voting member costs borne by the partner. The MIJB does not have responsibilities in either the current or in future years for funding any pension entitlements of voting MIJB members. Therefore, no pension rights disclosures are provided for the Chair or Vice-Chair. Taxable Expenses 2024/25 Name Position Held Nomination By Taxable Expenses 2025/26 £ £ - Dennis Robertson Vice-Chair 01/04/25 – 30/09/25; Chair 01/10/25 to date Grampian Health Board - - Cllr Tracy Colyer Chair 01/04/24 – 26/09/24 Moray Council - - Cllr Elaine Kirby Chair 1/04/25 – 31/07/25 Moray Council - - Cllr Bridget Mustard Chair 1/08/25 – 30/09/25 Vice Chair 1/10/25 to date Moray Council - Page 84
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 31 REMUNERATION REPORT (continued) Officers of the MIJB The MIJB does not directly employ any staff in its own right; however specific post- holding officers are non-voting members of the Board. Chief Officer Under section 10 of the Public Bodies (Joint Working) (Scotland) Act 2014 a Chief Officer for the integration joint board has to be appointed and the employing partner has to formally second the officer to the Board. The employment contract for the Chief Officer will adhere to the legislative and regulatory framework of the employing partner organisation. The remuneration terms of the Chief Officer‘s employment are approved by the Board. Other Officers No other staff are appointed by the MIJB under a similar legal regime. Other non- voting board members who meet the criteria for disclosure are included in the disclosures below. Total 2024/25 Senior Employees Salary, Fees & Allowances Total 2025/26 £ £ £ 20,268 Simon Bokor-Ingram Chief Officer (1/04/24- 31/05/24) - - 95,673 Judith Proctor (from 25/07/24) 140,031 140,031 90,729 Deborah O’Shea Chief Financial Officer 95,135 95,135 In respect of officers’ pension benefits, the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis there is no pensions liability reflected on the MIJB balance sheet for the Chief Officer or any other officers. The MIJB however has a responsibility for funding the employer contributions for the current year in respect of the officer time spent on fulfilling the responsibilities of their role on the MIJB. The following table shows the MIJB’s funding during the year to support the officers’ pension benefits. The table also shows the total value of accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions. Page 85
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 32 REMUNERATION REPORT (continued) NOTE: no bonuses, expenses allowances, compensation for loss of office or any taxable benefits were made in 2025/26. In Year Pension Contributions Accrued Pension Benefits Year to 31/03/25 Year to 31/03/26 As at 31/03/2026 Difference from 31/03/2025 £ £ £ 000’s £ 000’s Simon Bokor- Ingram, Chief Officer (*) 4,378 0 Pension - - Lump Sum - - Judith Proctor, Chief Officer 21,526 31,507 Pension 43 5 Lump Sum 111 8 Deborah O’Shea Chief Financial Officer 20,339 21,309 Pension 4 2 Lump Sum 31 - (*) Simon Bokor-Ingram figures included in the table above, relate to the full year 2024/25 including employment after Chief Officer, as figures are unable to be apportioned. Page 86
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 33 REMUNERATION REPORT (continued) Disclosure by Pay bands As required by the regulations, the following table shows the number of persons whose remuneration for the year was £50,000 or above, in bands of £5,000. Number of Employees in Band 2024/25 Remuneration Band Number of Employees in Band 2025/25 1 £85,000 - £89,999 - - £90,000 - £94,999 1 1 £130,000 - £134,999 - - £135,000 - £139,999 1 Exit Packages There were no exit packages agreed by the MIJB during 2025/26 financial year, or in the preceding year. ……………………….. ……………………… Dennis Robertson Judith Proctor Chair of Moray IJB Chief Officer Page 87
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 34 ANNUAL GOVERNANCE STATEMENT The Annual Governance Statement describes the Moray Integration Joint Board’s (MIJB) governance arrangements and reports on the effectiveness of the MIJB’s system of internal control. Scope of Responsibility The MIJB is responsible for ensuring that its business is conducted in accordance with the law and appropriate standards, and that public money is safeguarded and used efficiently and effectively in pursuit of best value. In discharging its responsibilities, the MIJB has established arrangements for its governance which includes the system of internal control. This system is intended to manage risk and support the achievement of the MIJB’s policies, aims and objectives. The system provides reasonable but not absolute assurance of effectiveness. The MIJB places reliance of the systems of internal control of NHS Grampian systems and Moray Council, which supports organisational compliance of policies and procedures in addition to those of the MIJB. Assurances are required on the effectiveness of the governance arrangements of all three organisations, meaning a significant failure in one of the three Partners may require to be disclosed in the annual accounts of all three Partners. The Governance Framework The CIPFA/SOLACE framework for ‘Delivering Good Governance in Local Government’ last updated in 2016 remains current and provides a structured approach in defining seven principles that underpin effective governance arrangements. Whilst the framework is written specifically for Local Government, the principles apply equally to integration authorities, and while the MIJB continues to evolve as an entity in its own right. It continues to draw on the governance assurances of NHS Grampian and Moray Council as its principal funding partners. Given the scope of responsibility within the MIJB and the complexities surrounding the assurance arrangements, a Local Code of Corporate Governance was developed and the MIJB assesses the effectiveness of its governance arrangements against the principles set out in the document. The Code outlines the seven governance principles from the CIPFA/SOLACE guidance (as referenced below) and provides the sources of assurance for assessing compliance relative to the MIJB, Moray Council and NHS Grampian. These assurances include referencing the governance arrangements of NHS Grampian and Moray Council which are summarised annually and published in their respective Annual Governance Statements which form part of the annual accounts of each organisation. The respective governance statements can be found on the individual organisations’ websites: Moray Council: Annual Accounts - Moray Council and NHS Grampian: https://www.nhsgrampian.org/about-us/annual- accounts/. Page 88
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 35 ANNUAL GOVERNANCE STATEMENT (continued) Key Governance Arrangements All scheduled meetings of the Audit Performance and Risk Committee and the Clinical Care Governance Committee were held as timetabled during 2025/26. Moray HSCP established an emergency response group in March 2020, which has since transitioned into a Daily Response meeting. Representation from partner organisations continues through Moray HSCP staff, maintaining effective links and information flow to support a co-ordinated response across Grampian and within Moray. Governance standards and collaborative working continue to operate across the wider system, including NHS Grampian Directorates and pan Grampian partnership arrangements. The Grampian Operation Performance Escalation System (GOPES) supports senior leaders to have oversight of system pressures and coordinate responses. This has strengthened the use of defined performance thresholds escalation levels and decision making. Evaluation of the Effectiveness of Governance Governance Principle 1 – Behaving with integrity, demonstrating strong commitment to ethical values and respecting the rule of law Assessment of Effectiveness • The activities of the MIJB are governed by a Board comprising both voting and non-voting members, drawn from a diverse range of backgrounds to support inclusive and informed decision making. The Board meets bi-monthly and is supported by regular development sessions, providing dedicated time for in depth exploration of key strategic and operational issues. • Governance is further strengthened through the work of two committees: the Audit, Performance and Risk Committee, and the Clinical and Care Governance Committee, each operating with clearly defined remits to provide assurance and support effective scrutiny. • The MIJB operates in accordance with Standing Orders, which set out the rules governing the proceedings of the Board and its Committees. These are supported by the Scheme of Administration, which defines the structure and remit of the Board’s committees, ensuring clarity, consistency and transparency in governance arrangements. • To uphold high standards of ethical conduct, the MIJB has appointed a Standards Officer. This role supports compliance with the Ethical Standards in Public Life etc. (Scotland) Act 2000, which requires members of devolved public bodies to adhere to Codes of Conduct approved by Scottish Ministers. • The Standards Officer also ensures alignment with guidance issued by the Standards Commission for Scotland, reinforcing the Board’s commitment to integrity, accountability, ethical governance and supporting members to maintain high standards of conduct in decision making. Page 89
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 36 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 2 – Ensuring openness and comprehensive stakeholder engagement Assessment of Effectiveness • The MIJB’s Standing Orders provide for public and press access to meetings and reports, supporting transparency and accountability. Hybrid meeting arrangements continued throughout 2025/26 in response to positive feedback and to enhance accessibility for members and the public. • A dedicated Moray HSCP website supports access to Board information, including key strategies and supporting documentation and is subject to ongoing review and improvement. Agendas, reports and minutes for all committees are publicly available via the Moray Council website. • The voting and non-voting membership arrangements of the MIJB are in line with the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. The Board comprises eight voting members, with equal representation from Moray Council and NHS Grampian Board, alongside a range of non-voting members including professional advisors and stakeholder representatives. These arrangements ensure input from key stakeholder groups, including staff, third sector partners, people who use services and unpaid carers, supporting inclusive engagement and a broad range of perspectives in decision making. • The Community Empowerment (Scotland) Act 2015 places a statutory duty on MIJB and its Community Planning Partners to engage with communities on the planning and delivery of services and securing local outcomes. The MIJB’s approved Communications and Engagement Strategy supports active and meaningful engagement with all stakeholders and communities, ensuring that their views inform planning, delivery and continuous improvement of services. Governance Principle 3 – Defining outcomes in terms of sustainable economic, social and environmental benefits Assessment of Effectiveness • The MIJB Strategic Plan 2022-2032 building on the foundations of the 2019 plan, sets out long-term strategic objectives designed to be flexible and responsive to emerging challenges across health and social care. • To support delivery of a 3-year Delivery Plan was approved by MIJB in May 2025, underpinned by a medium-term financial framework. Together these provide a structured approach to translating strategic priorities into deliverable actions, aligned to available resources and focused on sustainable service delivery. • The strategic plan is supported by a comprehensive suite of documents, including a performance framework, workforce plan, and a communications, engagement and participation plan. The strategic plan and supporting documents will be prioritised for a refresh during 2026/27. • Collectively, these arrangements provide a clear and structured approach to defining, monitoring and delivering outcomes, with a clear focus on medium term priorities and measurable improvement. The outcomes are aligned to the Page 90
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 37 ANNUAL GOVERNANCE STATEMENT (continued) delivery of integrated health and social care services and are intended to improve population health, wellbeing and service sustainability within Moray. • In support of environmental sustainability, a Climate Change Duties report is prepared and submitted annually on behalf of the MIJB, demonstrating compliance with statutory environmental responsibilities and supporting continued progress against natural climate change objectives. Governance Principle 4 – Determining the interventions necessary to optimise the achievement of intended outcomes Assessment of Effectiveness • The MIJB’s decision making processes are designed to ensure that Board members receive clear, objective and comprehensive analysis of available options. Proposals set out how intended outcomes will be delivered, supported by proportionate assessment of risks, opportunities and implications. This supports informed and transparent decision making and enables the Board to determine appropriate interventions aligned to strategic priorities. • Board papers reflect the broad range of strategic and operational pressures under consideration. These include regular updates on current developments, alongside agenda items addressing opportunities and challenges, particularly those associated with transformation. • The MIJB recognises the importance of strong financial governance and has adopted the CIPFA Financial Management Code as a guiding framework for effective financial management. A Medium-Term Financial Strategy, approved in March 2026, supports this approach and is subject to regular review to ensure alignment with the Strategic Plan, Delivery Plan and the integration of delegated children’s services. These arrangements have operated effectively during the year, supporting the Board to determine and implement appropriate interventions and respond to emerging challenges. Governance Principle 5 – Developing the entity’s capacity, including the capability of its leadership and the individuals within it Assessment of Effectiveness • The Senior Management Team (SMT) and Officers and have established a programme of development sessions with Board members, with a focus on the challenging financial position and opportunities for service transformation. These sessions provide a structured forum to explore strategic challenges, consider options and support collective understanding of priorities. • Officers present a range of proposals through this process aimed at delivering the MIJB’s strategic objectives whilst contributing to the achievement of required financial efficiencies. • The MIJB continues to prioritise leadership development and collaborative working through regular development sessions involving Board members and h Officers. These sessions enable shared learning, strategic dialogue, and constructive challenge, supporting continuous development of leadership capability across the organisation. Page 91
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 38 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 6 – Managing risk and performance through robust internal control and strong public financial management Assessment of Effectiveness • As part of a robust risk monitoring framework the Strategic Risk Register was co-developed with Board members during a dedicated development session in October 2024 and formally approved by the Board in May 2025. This updated register is reviewed monthly by the Senior Management Team and updated and presented at least biannually to Audit, Performance and Risk Committee, and annually to MIJB. The Committee agreed that emerging or escalating risks would be reported in line with business need. A further Board development session to review and refresh the register is planned for November 2026. • The operational Performance Management Framework has been reviewed and is nearing completion. A key improvement has been the focus to shift towards more integrated reporting across all delegated services, rather than individual service level reports, to provide a more cohesive view of system performance. Reporting is presented three times per year to the Audit, Performance and Risk Committee. • The system of internal control system remains aligned with those of MIJB’s Partner organisations, reflecting their operational responsibility for service delivery under direction of the MIJB. The Audit, Performance and Risk Committee continues to receive assurance through regular reporting on the effectiveness of internal control arrangements. • During 2025/26, targeted improvement work has been undertaken in partnership with Internal Audit and the Operational Management team to strengthen arrangements for audit planning, coordination and delivery. This has included improving oversight of the full audit plan, clarifying ownership of actions, and strengthening processes to support the timely and consistent implementation of audit recommendations. This work has provided greater visibility of progress, supported more effective management control, and is beginning to address a number of legacy actions, some of which require review to ensure continued relevance within the current operating context. • The MIJB Chief Internal Auditor undertakes an annual review of the adequacy and effectiveness of internal controls, with the opinion incorporated within this statement. • The MIJB benefits from the oversight of an independent S95 Officer, who is a member of the Board. This Officer provides expert advice on all financial matters and ensure timely preparation and reporting of budget estimates, monitoring reports and annual accounts. • Governance arrangements continue to reflect recognised good practice frameworks, including the Code of Practice on Managing the Risk of Fraud and Corruption, Public Sector Internal Audit Standards (incorporating the principles of the Role of the Head of Internal Audit) and Audit Committees: Practical Guidance for Local Authorities and Police. These frameworks support the MIJB’s commitment to strong financial stewardship and effective internal control. Page 92
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 39 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 7 – Implementing good practices in transparency, reporting and audit to deliver effective accountability Assessment of Effectiveness • MIJB business is conducted through an approved cycle of Board and Committee meetings. To promote openness and accessibility, recordings of Board meetings are made available to the public. In addition, agendas, reports and minutes are published and accessible for the public to scrutinise. There is a standardised reporting format in place to ensure consistency, clarity and transparency how information is presented and decision-making processes. • The MIJB demonstrates its commitment to accountability through publication of its Annual Accounts and Annual Performance Report, both of which are subject to formal Board approval. These reports provide a clear account of financial stewardship, performance and progress against strategic priorities. • The Chief Internal Auditor reports independently to the Audit, Performance and Risk committee and has direct access to the Chief Officer, Chief Financial Officer and Chair of the Audit, Performance and Risk committee on any matter of concern. Throughout 2025/26, regular reporting has supported effective scrutiny of internal control arrangements, risk management and the delivery of the internal audit plan, strengthening overall assurance to the Board. Review of Adequacy and Effectiveness The MIJB has a responsibility for conducting, at least annually, a review of the effectiveness of the governance arrangements, including the system of internal control. The review is informed by the work of the Senior Management Team (which has responsibility for the development and maintenance of the internal control framework environment), the work of the Internal Auditors and the Chief Internal Auditor’s annual report and the reports from the External Auditor and other review agencies and inspectorates. Internal Audit Opinion Moray Council’s Internal Audit Section delivers the internal audit service for the Moray Integration Joint Board (MIJB). The Council’s Service Manager Internal Audit and Risk (Chief Audit Executive (CAE)) has recently been re-appointed as the Chief Internal Auditor to the MIJB until 31 March 2028. The Internal Audit Section has adopted the Global Internal Audit Standards (GIAS), which requires the Chief Internal Auditor to deliver an annual internal audit opinion and report. This report has been used to inform this governance statement. The Chief Internal Auditor’s evaluation of the adequacy and effectiveness of governance, risk management and the internal control framework is informed by the findings of audits undertaken on services operating under the direction of the MIJB. Additional assurance is obtained from the Internal Audit Service Provider for NHS Grampian regarding governance processes within that organisation. This includes the provision of relevant internal audit reports to the Chief Internal Auditor. In addition, reports issued by other external review agencies are considered as part of the overall assurance assessment. Page 93
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 40 ANNUAL GOVERNANCE STATEMENT (continued) Internal Audit operates independently within the organisation, with no management- imposed limitations on the scope of work undertaken. In accordance with GIAS, the Chief Internal Auditor prepares a risk-based Audit Plan for the MIJB. The Annual Audit Plan for 2025/26 included the following reviews: • Complex and Challenging Behaviour Services– A review of systems and procedures within Complex and Challenging Behaviour Services. • Social Care (Short Breaks)– A review of the governance, administrative and financial arrangements supporting the delivery of Social Care (Short Breaks), with particular regard to eligibility determination, record‑keeping and financial control processes. • Non-Payroll Expenditure–A review of non-payroll expenditure to test compliance with Financial Regulations, procurement requirements and payment-processing procedures. The audit of the Complex and Challenging Behaviour Service highlighted sustained levels of overtime worked by some officers, which, while demonstrating strong commitment, raises concerns about long-term service sustainability. Management has established a short-life working group to address these staffing pressures. The audit review of Social Care (Short Breaks) identified a need to consider the development of a charging policy for accommodated respite short breaks. This reflects findings from another audit review, which also suggested exploring charging arrangements for non-residential care services. The review of payments made through the Council’s Financial Management System identified instances where financial controls were not operating effectively, resulting in transaction processing errors and the need to recover expenditure from a service provider. While the majority of transactions tested were compliant and appropriately authorised, these findings, together with those from the Complex and Challenging Behaviour Service, highlight the need for improved compliance with Financial Regulations to ensure effective financial management, safeguard resources, and maintain robust governance. Follow-up reviews undertaken by the Internal Audit Section identified that several previously agreed recommendations remain outstanding, with revised implementation timescales required. Timely implementation of audit recommendations is critical to strengthening internal controls; delays increase the risk that control weaknesses persist. However, the MIJB has made notable progress in strengthening governance arrangements. Improvements include regular reporting on the implementation of audit recommendations to Senior Management and the Practice Governance Board, as well as more structured engagement with the Internal Audit Section. This includes attendance by the Chief Internal Auditor at Senior Management Team meetings to support the decision-making framework and the timely resolution of audit findings. Page 94
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 41 ANNUAL GOVERNANCE STATEMENT (continued) It was also noted that a replacement for the existing social work and social care case management system has been approved, with implementation planned by March 2027. As this system is the core database for highly sensitive social work information and supports the administrative and financial management of social care packages, its replacement represents a significant step towards strengthening information governance, improving operational resilience and enhancing overall service assurance. While progress has been made in strengthening governance and internal control arrangements within the MIJB, the outcomes of the audit work undertaken identified significant findings. In addition, several recommendations from previous reviews remain outstanding. After careful consideration of these factors, the Chief Internal Auditor has provided limited assurance that the MIJB had adequate systems of governance and internal control in place for the year ended 31 March 2026. Prior Year Governance Issues The Annual Governance Statement for 2024/25 highlighted a number of areas for development in looking to secure continuous improvement. An assessment of progress is provided below: Area for Improvement Identified in 2024/2 Action Undertaken / Progress Made in 2025/26 Developing further our approaches to frailty and Discharge without Delay. Realigning our organisational structure to ensure effective delivery of strategy and transformation. Progress has been made across the year in relation to improving the Partnership’s Delayed Discharge (DD) performance. Central to this has been the development of the Home Assessment Pathway (HAP) and its Discharge to Assess and Discharge without Delay Principles. The IJB retains a target of 26 DDs and, through the Grampian wide Unscheduled Care Programme, a target of no more than 5 delays in Dr Gray’s. Whilst overall DDs have reduced over the course of the year and we have, at times achieved the target, this has not yet been sustained. Work is ongoing to deliver that sustained improvement. Significant progress has been made in developing the organisational restructure. This has been a highly collaborative process with our teams. The structure will be implemented over 2026/27. Page 95
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 42 Area for Improvement Identified in 2024/2 Action Undertaken / Progress Made in 2025/26 Integration of Children’s Social Work and Justice Services governance and oversight within the IJB. Further strengthen performance oversight of the Board’s key strategies and priorities. Continue to improve on the progress for compliance with audit recommendations. Governance arrangements in these services have been set out and reporting is in place. In addition, a review of governance of the joint (IJB and Moray Council) Whole Family Wellbeing Fund (WFWF) took place and was agreed by partners, giving greater clarity on the oversight, decision making and reporting of this fund. An agreed performance structure is in place for the MIJB and has operated over the year. In addition, Moray HSCP has set out a revised structure for governance of the delivery plan and key strategic change, as well as in relation to Budget Savings Delivery. Progress has been made in strengthening arrangements. A dashboard of all audits and actions has been developed that enables a new Corporate IA Group to track progress and report / escalate issues. IA reports to the Moray HSCP every month and this enables positive dialogue with the Chief Internal Auditor. Page 96
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 43 Further Developments Following consideration of the review of adequacy and effectiveness, the following action plan has been established to ensure continual improvement of the MIJB’s governance arrangements and progress against the implementation of these issues will be assessed as part of the next annual review. Areas of focus for 2026/27 1. Review of the IJB’s Strategic Plan. 2. Implement new arrangements for lived experience members’ voting rights and support them in this transition. 3. Continue to implement strengthened arrangements for implementing Internal Audit actions. 4. Continued focus on budget savings delivery and medium-term financial challenge. Key Governance challenges going forward will involve: • Providing capacity to meet statutory obligations and ambitions to transform services, whilst managing expectations, increasing complexity and rising demand for services and the wider societal economic challenges now presented that also potentially drive demand. • As a Board, difficult decisions will be required in balancing how we meet the needs of our community whilst operating within the available resource envelope, this will be supported by our approach to risk as set out in our risk appetite statement. • Continuing to address our work force challenges in respect of recruitment and retention and where persistent vacancies will necessitate the need for redesign of roles and/or services. • Continuing to work closely with NHS Grampian, Moray Council and Moray Community Planning Partnership to build on existing relationships and establishing collaborative leadership, and to maximise the opportunities from an expanded health and social care remit within a pan Grampian approach and contribute to the emerging work of the North East Strategic Transformation Group (NESTG). • Continuing to implement the recommendations of internal and external audit, including learning from national reviews. • There have been no significant events up to the authorised for issue date. ANNUAL GOVERNANCE STATEMENT (continued) Page 97
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 44 ANNUAL GOVERNANCE STATEMENT (continued) Statement In our respective roles as Chair and Chief Officer of the MIJB, we are committed to ensuring good governance and recognise the contribution it makes to securing delivery of service outcomes in an effective and efficient manner. This annual governance statement summarises the MIJB’s current governance arrangements and affirms our commitment to ensuring they are regularly reviewed, developed and fit for purpose. Whilst recognising that improvements are required, as detailed earlier in the statement, it is our opinion that a reasonable level of assurance can be placed upon the adequacy and effectiveness of the MIJB’s governance arrangements. The ongoing challenge will be to meet all operational demands and pressures as we continue to operate within the legacy of the Covid 19 pandemic and global financial pressures, both of which have impacted at a socioeconomic level on our region and the community. Pressure on financial settlements is increasing for all partners, and we will continue to engage with them, the Scottish Government and the wider community to agree plans and outcomes that are both sustainable and achievable within this context. Taking that forward will be challenging as we aim to fulfil the nine Health and Wellbeing national health and well-being outcomes, and the strategic priorities identified and detailed in our Strategic Plan. Good governance remains an essential focus in delivering services in a way that both meets the needs of communities and discharges statutory best value responsibilities. These were arrangements in place for 2025/26 and up to the date of authorised for issue. ………………………… ……………………… Dennis Robertson Judith Proctor Chair of Moray IJB Chief Officer Page 98
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 45 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT This statement shows the cost of providing services for the year ended 31 March 2026 according to generally accepted accounting practices. 2024/25 2025/26 Net Expenditure Net Expenditure £ 000 £ 000 8,329 Community Hospitals 7,932 6,166 Community Nursing 6,670 19,975 Learning Disabilities 21,230 12,055 Mental Health 12,881 1,763 Addictions 1,817 273 Adult Protection & Health Improvement 279 22,754 Care Services Provided In-House 25,495 27,034 Older People & Physical & Sensory Disability Services 30,023 1,972 Intermediate Care and Occupational Therapy 2,039 1,817 Care Services Provided by External Providers 2,072 10,280 Other Community Services 10,310 3,152 Administration & Management 3,086 1,535 Other Operational services 1,351 21,937 Primary Care Prescribing 21,312 21,331 Primary Care Services 22,954 5,665 Hosted Services 5,987 1,971 Out of Area Placements 1,834 1,021 Improvement Grants 889 19,626 Children & Justice Services 22,050 6,020 Strategic Funds & Other Resources 6,005 15,639 Set Aside 20,092 210,315 Cost of Services 226,308 (209,779) Taxation and Non-Specific Grant Income (note 5) (227,868) 536 Deficit/(Surplus) on provision of Services (1,560) 536 Total Comprehensive Income and Expenditure (1,560) There are no statutory or presentational adjustments which reflect the MIJB’s application of the funding received from partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts. Page 99
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 46 MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the MIJB’s reserves. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices. Additional detail included within note 7 on page 52. Movement of Reserves During 2025/26 General Fund Balance £000 Opening Balance at 1 April 2025 (1,450) Total Comprehensive Income and Expenditure (1,560) (Increase) in 2025/26 (1,560) Closing Balance at 31 March 2026 (3,010) Movement of Reserves During 2024/25 General Fund Balance £000 Opening Balance at 1 April 2024 (1,986) Total Comprehensive Income and Expenditure 536 Decrease in 2024/25 536 Closing Balance at 31 March 2025 (1,450) Page 100
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 47 BALANCE SHEET The Balance Sheet shows the value of the MIJB’s assets and liabilities as at the balance sheet date. The net assets of the MIJB (assets less liabilities) are matched by the reserves held by the MIJB. 31 March 2025 £000 Notes 31 March 2026 £000 1,450 Short Term Debtors 6 3,010 Current Assets - Short Term Creditors - Current Liabilities - Provisions - Long Term Liabilities 1,450 Net Assets 3,010 1,450 Usable Reserve General Fund 7 3,010 1,450 Total Reserves 3,010 The unaudited annual accounts were issued on 25 June 2026. The Annual Accounts present a true and fair view of the financial position of the MIJB as at 31 March 2026 and its income and expenditure for the year then ended. Deborah O’Shea FCCA Chief Financial Officer Page 101
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 48 NOTES TO THE FINANCIAL STATEMENTS Note 1 Significant Accounting Policies General Principles The Financial Statements summarise the MIJB’s transactions for the 2025/26 financial year and its position at the year-end of 31 March 2026. The MIJB was established under the requirements of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. The Financial Statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26, supported by International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. The accounts are prepared on a going concern basis, which assumes that the MIJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: • Expenditure is recognised when goods or services are received, and their benefits are used by the MIJB. • Income is recognised when the MIJB has a right to the income, for instance by meeting any terms and conditions required to earn the income, and receipt of the income is probable. • Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet. • Where debts may not be received, the balance of debtors is written down. Funding The MIJB is primarily funded through funding contributions from the statutory funding partners, Moray Council and Grampian Health Board. Expenditure is incurred as the MIJB commissions’ specified health and social care services from the funding partners for the benefit of service recipients in Moray area. Cash and Cash Equivalents The MIJB does not operate a bank account or hold cash. Transactions are settled on behalf of the MIJB by the funding partners. Consequently, the MIJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. The funding balance due to or from each funding partner as at 31 March is represented as a debtor or creditor on the MIJB’s Balance Sheet. Page 102
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 49 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 1 Significant Accounting Policies (continued) Employee Benefits The MIJB does not directly employ staff. Staff are formally employed by the funding partners who retain the liability for pension benefits payable in the future. The MIJB therefore does not present a Pensions Liability on its Balance Sheet. The MIJB has a legal responsibility to appoint a Chief Officer. More details on the arrangements are provided in the Remuneration Report. The charges from the employing partner are treated as employee costs. Where material the Chief Officer’s absence entitlement as at 31 March is accrued, for example in relation to annual leave earned but not yet taken. Charges from funding partners for other staff are treated as administration costs. Reserves The MIJB’s reserves are classified as either Usable or Unusable Reserves. The MIJB’s only Usable Reserve is the General Fund. The balance of the General Fund as at 31 March shows the extent of resources which the MIJB can use in later years to support service provision. Indemnity Insurance The MIJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding Board members. Grampian Health Board and Moray Council have responsibility for claims in respect of the services that they are statutorily responsible for and that they provide. Unlike NHS Boards, the MIJB does not have any ‘shared risk’ exposure from participation in the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). The MIJB participation in the CNORIS scheme is therefore analogous to normal insurance arrangements. Note 2 Critical Judgements and Estimation Uncertainty In applying the accounting policies, the MIJB has had to make certain judgements about complex transactions or those involving uncertainty about future events. There are no material critical judgements or estimation uncertainty. Page 103
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 50 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 3 Events after the Reporting Period The unaudited accounts were issued by Deborah O’Shea, Chief Financial Officer on 25 June 2026. Events taking place after this date are not reflected in the financial statements or notes. Note 4 Expenditure and Income Analysis by Nature 2024/25 2025/26 £000 £000 98,217 Services commissioned from Moray Council 106,355 112,061 Services commissioned from Grampian Health Board 119,918 37 Auditor Fee: External Audit Work 35 210,315 Total Expenditure 226,308 (209,779) Partners Funding Contributions and Non- Specific Grant Income (227,868) 536 Deficit on the Provision of Services (1,560) Page 104
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 51 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 5 Taxation and Non-Specific Grant Income 2024/25 2025/26 £000 £000 88,441 Funding Contribution from Moray Council 94,522 121,338 Funding Contribution from Grampian Health Board 133,346 209,779 Taxation and Non-specific Grant Income 227,868 The funding contribution from Grampian Health Board shown above includes £20.092m in respect of ‘set aside’ resources relating to acute hospital and other resources. These are provided by Grampian Health Board who retains responsibility for managing the costs of providing the services. The MIJB however has responsibility for the consumption of, and level of demand placed on, these resources. Note 6 Debtors 31 March 2025 31 March 2026 £000 £000 1,187 Grampian Health Board 2,747 263 Moray Council 263 1,450 Debtors 3,010 Amounts owed by the funding partners are stated on a net basis. Creditor balances relating to expenditure obligations incurred by the funding partners but not yet settled in cash terms are offset against the funds they are holding on behalf of the MIJB. Page 105
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 52 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 7 Usable Reserve: General Fund The MIJB holds a balance on the General Fund for two main purposes: • To earmark, or build up, funds which are to be used for specific purposes in the future, such as known or predicted future expenditure needs. This supports strategic financial management. • To provide a contingency fund to cushion the impact of unexpected events or emergencies. This is regarded as a key part of the MIJB’s risk management framework. The table below shows the movements on the General Fund balance: Earmarked Reserves General Reserves PCIP & Action 15 Other Earmarked Total £000 £000 £000 £000 Balance at 1 April 2024 - 33 1,953 1,986 Transfers (out) 2024/25 - (33) (503) (536) Balance at 31 March 2025 - - 1,450 1,450 Transfer in/(out) 2025/26 - - 1,560 1,560 Balance at 31 March 2026 - - 3,010 3,010 Primary Care Improvement Fund (PCIP) - The purpose of this fund is to ring fence funding received from the Scottish Government as part of its Primary Care Transformation Plan; this includes Action 15 funding as part of this plan. This reserve is now depleted. Other earmarked reserves are noted in detail on pages 21 to 23. Page 106
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 53 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 8 Agency Income and Expenditure On behalf of all IJB’s within Grampian Health Board, the MIJB acts as the lead manager for Grampian Medical Emergency Department (GMED) and Primary Care Contracts. It commissions services on behalf of the other IJBs and reclaims the costs involved. The payments that are made on behalf of the other IJBs, and the consequential reimbursement, are not included in the Comprehensive Income and Expenditure Statement (CIES) since the MIJB is not acting as principal in these transactions. The amount of expenditure and income relating to the agency arrangement is shown below: 2024/25 2025/26 £000 £000 10,680 Expenditure on Agency Services 11,266 (10,680) Reimbursement for Agency Services (11,266) - Net Agency Expenditure excluded from the CIES - Page 107
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 54 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions The MIJB has related party relationships with Grampian Health Board and Moray Council. In particular the nature of the partnership means that the MIJB may influence, and be influenced by, its partners. The following transactions and balances included in the MIJB’s accounts are presented to provide additional information on the relationships. Transactions with Grampian Health Board 2024/25 2025/26 £000 £000 (121,338) Funding Contributions received from the NHS Board (133,346) 111,864 Expenditure on Services Provided by the NHS Board 119,691 197 Key Management Personnel: Non-Voting Board Members 227 (9,227) Net Transactions with Grampian Health Board (13,428) Key Management Personnel: The Chief Officer and Chief Financial Officer are non- voting Board members and are both employed by Grampian Health Board and recharged to the MIJB. Details of the remuneration of both officers are provided in the Remuneration Report. The Chief Officer is a joint appointment made by Moray Council and Grampian Health Board and is jointly accountable to the Chief Executives of both organisations, as such this post is jointly funded. The Chief Financial Officer, whilst a Board appointment, does not share this arrangement of funding. Balances with Grampian Health Board 31 March 2025 31 March 2026 £000 £000 1,187 Debtor balances: Amounts due from Grampian Health Board 2,747 1,187 Net Balance due from Grampian Health Board 2,747 Page 108
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 55 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions (continued) Transactions with Moray Council 2024/25 2025/26 £000 £000 (88,441) Funding Contributions received from the Council (94,522) 98,179 Expenditure on Services Provided by the Council 106,294 75 Key Management Personnel: Non-Voting Board Members 96 9,813 Net Transactions with Moray Council 11,868 Balances with Moray Council 31 March 2025 31 March 2026 £000 £000 263 Debtor balances: Amounts due from Moray Council 263 263 Net Balance due from Moray Council 263 Page 109
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 56 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 10 VAT The MIJB is not registered for VAT and as such VAT is settled or recovered by the partners. The VAT treatment of expenditure in the MIJB accounts depends on which of the partners is providing the services as each of these partners are treated differently for VAT purposes. VAT payable is included as an expense only to the extent that it is not recoverable from His Majesty’s Revenue and Customs. VAT receivable is excluded from income. Note 11 Accounting Standards That Have Been Issued but Have Yet To Be Adopted The Code requires the MIJB to identify any accounting standards that have been issued but have yet to be adopted and could have material impact on the accounts. This applies to the adoption of the following new or amended standards within the 2026/27 Code: • Amendments to FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (Amendments to Heritage assets) issued in March 2024; • Amendments to the Classification and Measurement of Financial Instruments (Amendments to IFRS 9 and IFRS 7) issued in May 2024; • Annual improvements to IFRS accounting standards – Volume 11 issued in July 2024; and • Contracts Referencing Nature-dependent Electricity (Amendments to IFRS 9 and IFRS 7) issued in December 2024. The Code requires implementation from 1 April 2026 and there is, therefore, no impact on the 2025/26 financial statements. The above amendments are not anticipated to have a material impact on the information provided in the financial statements. Page 110
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2025/26 57 Page 111
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LOCAL CODE OF CORPORATE GOVERNANCE APPENDIX 2 GOVERNANCE PRINCIPLES Principle A Behaving with integrity, demonstrating strong commitment to ethical values and respecting the rule of law SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Code of Conduct (Jan 2025 – standards for member and ethical conduct) Codes of Conduct Codes of Conduct Financial Regulations (May 2025) Financial Regulations & Authorisation policy Standing Financial Instructions Standards Officer Appointment (2026 – oversight of ethical standards and complaints) Scheme of Administration Schedule of Reserved Decisions Standing Orders (May 2022) Standing Orders Operational Scheme of Delegation Register of Interests (annually) Human Resources Policies Standing Orders Scheme of Administration (June 2018) Scheme of Delegation Human Resources Policies ( and Once for Scotland policies around Employee Conduct) Integration Scheme (Mar 2023) Register of Interests Staff Governance Committee Updated IJB Report Format (Sept 2022 – includes governance, risk and implications sections) Integrity Group Register of Interests Information Commissioners Officer Registration Employee Induction Process Feedback Service Duty of Candour Arrangements Computer Use Policy Staff Surveys Whistleblowing Standards Duty of Candour Arrangements Employee Induction Process Members handbook (2020 under review, expected 2026) Monitoring Officer Annual Report SLT Compliance Sub Group Care for People Plan (May 2026) Staff Engagement Programme Duty of Candour Arrangements Page 112
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LOCAL CODE OF CORPORATE GOVERNANCE E-Learning module on GDPR Policy for the Prevention, Detection and Investigation of Suspected Fraud, Theft or Corruption Whistleblowing policy Whistleblowing Policy GOVERNANCE PRINCIPLES Principle B Ensuring openness and comprehensive stakeholder engagement SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Strategic Plan (2022-2032) Community Consultation & Engagement Annual Delivery Plan (includes Financial Plan) Performance Management Framework (under review) Complaints Procedures & Responses Performance Management Framework Annual Performance Report (produced annual for public accountability) Use of Social Media Freedom of Information Compliance Communications & Engagement Strategy (updated framework in development, expected 2026) Freedom of Information Compliance Feedback Service Community Consultation Locality Planning Population Health Committee Third Sector Involvement in planning and service design Community Asset Transfers Grampian Clinical Strategy IJB Membership – Broad Range of Stakeholders Participatory Budgeting Plans NHS Grampian Area Partnership Forum Use of Social Media (public communication and engagement channel Equality, Diversity and Human Rights Policy Freedom of Information Compliance and reporting Stakeholder Engagement Framework Workforce Forum Complaints Handling Policy (including Learning – SPSO aligned) Page 113
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LOCAL CODE OF CORPORATE GOVERNANCE Staff Surveys (feedback and organisational learning) Governance Framework (transparency, reporting and accountability arrangements) Community Risk Register (2021) IJB & Committee meetings held in public Unpaid Carers Strategy Moray Mental Health and Wellbeing Strategy 2016- 2026 Locality Planning GOVERNANCE PRINCIPLES Principle C Defining outcomes in terms of sustainable economic, social and environmental benefits SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Strategic Plan (2022-2032 – defines outcomes and priorities) Moray 2027 – a Plan for the Future Annual Delivery Plan (includes Financial Plan) Annual Performance Report (measures delivery against outcomes) Corporate Plan – currently being updated Governance Framework Performance Management Framework (under review) Community Planning Board Performance Management Framework Annual Climate Change Duties and Responsibilities (statutory reporting and compliance) Local Outcome Improvement Plans – Updated with Partner Agencies Population Health Committee Page 114
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LOCAL CODE OF CORPORATE GOVERNANCE Equalities Outcomes (April 2025 – supports equiable service delivery) Governance Framework Grampian Clinical Strategy Best Value Report & Action Plan (continuous improvement and value for money) Performance Management Framework Equality & Diversity: Outcomes Best Value Report & Action Plan Improvement and Transformation Plans GOVERNANCE PRINCIPLES Principle D Determining the interventions necessary to optimise the achievement of intended outcomes SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Risk Management Processes (identification, escalation and mitigation of risks) Risk Management Processes Risk Management Processes Audit Planning (Internal & External) Audit Planning (Internal & External) Audit Planning (Internal & External) Performance Management Framework Performance Management Framework Performance Management Framework Budget Monitoring Processes Budget Monitoring Processes Budget Monitoring Processes Page 115
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LOCAL CODE OF CORPORATE GOVERNANCE Financial Planning (aligned to strategic and financial sustainability) Financial Planning – in line with Cipfa’s FM Code Principles Financial Planning MIJB Committee Structure (decision making and oversight arrangements) Moray Council Committee Structure Health & Safety Committee Governance Framework Asset Management Group Annual Accountability Review Health and Safety Arrangements Guide to Scrutiny at Moray Council Asset Management Group Business Continuity Planning Workforce and ICT Strategies Ministerial Strategic Group – Self Assessment May 2019 Ministerial Strategic Group – Self Assessment – May 2021 Grampian Clinical Strategy Clinical Governance Committee Page 116
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LOCAL CODE OF CORPORATE GOVERNANCE GOVERNANCE PRINCIPLES Principle E Developing the entity’s capacity, including the capability of its leadership and the individuals within it. SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Workforce Planning and Organisational Development Workforce Planning Employee Induction Processes Workforce Forum Elected Member Induction / Development Board Member Induction MIJB Voting Member Briefings (support for informed decision making) Employee Development Team Staff Partnership Representation MIJB Development Sessions (ongoing governance and leadership development) Moray Management Methods Leadership Schemes Board Member Induction (roles, responsibilitie and governance requirements) Employee Induction Processes Staff Governance Committee System Leadership Programme Employee Review and Development Programme ‘’ We Care’’ programme Strategic Transformation Plan 2023-25 Staff Leadership Forum NHSG 3 Year Delivery Plan 2023-26 Best Value Action Plan developed Page 117
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LOCAL CODE OF CORPORATE GOVERNANCE GOVERNANCE PRINCIPLES Principle F Managing risk and performance through robust internal control and strong public financial management. SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Financial Regulations (May 2025) Financial Regulations (update 29.6.23) Standing Financial Instructions Risk Management Strategy and Reporting (including escalation and oversight) Risk Management Policy & Strategy Budget Monitoring & Financial Planning Governance Framework (roles, responsibilities and assurance routes) Following the Public Pound – ALEO Funding Risk Management Framework & Reporting Budget Monitoring & Financial Planning (including in year reporting to MIJB) Performance Management Framework Audit Planning (Internal & External) Production of Annual Accounts Scheme of Delegation Policy for the Prevention, Detection and Investigation of Suspected Fraud, Theft or Corruption Audit Planning (Internal & External) Section 95 Officer Appointment Schedule of Reserved Decisions Business Continuity & Incident Response Plans Fraud, Theft, Bribery & Corruption Policy Operational Scheme of Delegation Performance Management Framework Participation in National Fraud Initiative Annual Report and Accounts (including annual governance statement) Clinical & Care Governance Committee (oversight of quality and safety risks) Information Assurance Group Performance, Assurance, Infrastructure and Finance Committee Moray Performance Review (Chief Executive) Budget Monitoring & Financial Planning Clinical Risk Management Group Internal and External Audit Plans Audit Planning (Internal & External) Business Continuity & Incident Response Planning Integration Scheme (Mar 2023 defines delegated functions and partner responsibilities) Procurement Regulations & Training Page 118
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LOCAL CODE OF CORPORATE GOVERNANCE Audit, Performance and Risk Committee Business Continuity Plans – to be revisited post pandemic Risk Policy (Sept 2020 – under review, update scheduled 2026) Clinical Risk Management Group (operational risk identification and escalation) Financial Recovery Plan Reserves Policy 2024 Internal Auditor Reappointment (2026) Operational Management Team (oversight of audit actions, risk and internal controls) GOVERNANCE PRINCIPLES Principle G Implementing good practices in transparency, reporting and audit to deliver effective accountability. SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Committee Reporting Framework (including escalation to MIJB and committees) Committee Reporting Framework Board sub-Committee Reporting Framework Financial Reporting – Budget Monitoring (regular reporting to MIJB) Financial Reporting – Budget Monitoring Financial Reporting – Budget Monitoring Production & Approval of Annual Budget Production & Approval of Annual Budget Production of Annual Report and Accounts Production of Annual Accounts (including Annual Governance Statement) Production of Annual Accounts Audit Planning (Internal & External) Page 119
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LOCAL CODE OF CORPORATE GOVERNANCE Audit Planning and reporting (Internal & External) Audit Planning (Internal & External) Assurance Framework Consultation and Stakeholder feedback mechanisms Statutory Returns Public Sector Reform Act disclosure Governance Framework (including assurance and reporting arrangements) Consultation Annual Complaints Report Externally commissioned review of Commissioned services Chief Social Work Officer Annual Report Annual Duty of Candour Report Locality Plans Scottish Public Services Ombudsman – Complaints Reporting and Responses Annual Climate Change Reporting Annual Complaints Report (including learning and service improvement actions) Annual Duty of Candour Report (statutory reporting and learning) Audit, Performance and Risk Committee (oversight of audit, risk and governance reporting) Page 120
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APPENDIX 3 1 NHS Grampian Board Secretariat Summerfield House 2 Eday Road Aberdeen AB15 6RE Deborah O’Shea Chief Finance Officer Moray Health and Social Care Partnership Date 4 June 2026 Our Ref GB/JA Enquiries to Julie Anderson Email jule.anderson24@nhs.scot Dear Debs, Governance Statement 2025/26 The Chief Executive is required to prepare a Governance Statement which forms part of the Accountability Report in the Integrated Joint Board’s annual report and accounts as part of the Health and Social Care partnerships. The Governance Statement requires each Chief Executive, in their capacity as Accountable Officer, to report that they have maintained sound and effective systems of internal control, performance and risk management across all of the Board’s activities. In preparing the Governance statement, the Chief Executive is required to seek assurance from a range of sources to evidence the organisation’s performance, risk management and internal control framework, including responses to actual and emerging risks. NHS Grampian is due to report its annual accounts by 26th June 2026 and a draft governance statement has been appended to aid in the preparation of the Integrated Joint Board’s draft accounts for the year ended 31st March 2026. Should you require any clarification on the above or need guidance on matters that need to be considered or reported in the formal statement please do not hesitate to contact myself at julie.anderson24@nhs.scot. Yours sincerely Julie Anderson Assistant Director of Finance Page 121
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2 Draft NHS Grampian Governance Statement 2025/2026 NHS Grampian is required to operate within the aspects of the Scottish Public Finance Manual (SPFM) which are set out within the guidance issued to Chief Executives and more generally to all Board members by the Scottish Government Health and Social Care Directorates as being applicable to NHS Boards. The SPFM is issued by Scottish Ministers to provide guidance to the Scottish Government and other relevant bodies on the proper handling and `reporting of public funds. The SPFM sets out the relevant statutory, parliamentary and administrative requirements, emphasises the need for efficiency, effectiveness and economy, and promotes good practice and high standards of propriety. As Accountable Officer, the Chief Executive is responsible for maintaining an adequate and effective system of internal control that identifies, prioritises and manages the principal risks facing the organisation, promotes achievement of the organisation’s aims and objectives and supports compliance with the organisation’s policies and safeguarding public funds. The Board continually monitors and reviews the effectiveness of the system of internal control with a specific focus on the delivery of safe and effective patient care, achievement of national and local targets and demonstrating best value and the efficient use of resources. Key elements of the system of internal control include: • A Board which meets regularly to discharge its governance responsibilities, set the strategic direction for the organisation and approve decisions in line with the Scheme of Delegation. The Board comprises the Executive Directors and Non- Executive members. The Board activity is open to public scrutiny with papers and minutes of meetings publicly available on the Board website; • Scheme of Delegation, Standing Orders and Standing Financial Instructions approved by the Board are subject to regular review to assess whether they are relevant and fully reflective of both best practice and mandatory requirements; • Mature and organisation wide risk management arrangements built on localised risk registers and processes which ensure, as appropriate, escalation of significant instances of non-compliance with applicable laws and regulations that exceed our risk appetite; • Dedicated full-time members of staff for key statutory compliance functions including Information Governance, Health and Safety, fire and asbestos, tasked with ensuring they are up to date with all relevant legislation and are responsible for co-ordinating management action in these areas; • A focus on best value and commitment to ensuring that resources are used efficiently, effectively and economically taking into consideration equal opportunities and sustainable development requirements; • Each key governance committee is supported by a designated lead Executive Director who has the delegated management accountability for statutory and regulatory matters; Page 122
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3 • Regular review of financial performance, risk management arrangements and non-financial performance against key service measures and standards by the Performance, Assurance, Finance and Infrastructure Committee & the Board; • Enhanced arrangement for financial management and control associated with financial recovery, including a Financial Recovery Board chaired by a non executive Board member and finance reports to every PAFIC and public Board meeting • Regular review of service quality against recognised professional clinical standards by the Clinical Governance Committee; • Regular review of workforce arrangements and implementation of the NHS Scotland Staff Governance standard by the Staff Governance Committee; • An active joint management and staff partnership forum (Grampian Area Partnership Forum) with staff side representation embedded in all key management teams and a dedicated full-time Employee Director who is a member of the Board; • Regular review of priorities for infrastructure investment and progress against the agreed Asset Management Plan by an Asset Management Group chaired by a Director and including management representatives from all operational sectors and representation from the clinical advisory structure; • Clear allocation of responsibilities to ensure we review and develop our organisational arrangements and services in line with national standards and guidance including consultation with all stakeholders on service change proposals to inform decision making; • Promotion of effective cross-sector governance arrangements through participation by the IJB Board members and the Chief Executives of each of the partner organisations in the regular meetings between the Chief Executives of all Public Sector organisations in Grampian and performance review meetings with each IJB Chief Officer to further develop and drive improvement through integrated service delivery; • A patient feedback service to record and investigate complaints and policies to protect employees who raise concerns in relation to suspected wrongdoing such as clinical malpractice, fraud and health and safety breaches; and • Separate governance arrangements for the NHS Grampian Charity including a Chair of the Trustees elected from within the body of the Trustees, an annual general meeting of all Trustees to agree all policy matters and an NHS Grampian Charity sub-committee with delegated authority to manage the day to day operational matters of the charity. Based on the evidence considered during the review of the effectiveness of the internal control environment NHS Grampian has confirmed that there are no known outstanding significant control weaknesses or other failures to achieve the standards set out in the guidance on governance, risk management and control. Page 123
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APPENDIX 4 Moray Health & Social Care Partnership Best Value Statement March 2026 Page 125
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APPENDIX 4 Best Value – Accountability and Governance Overview Purpose and framework This Best Value assurance narrative is aligned to the Scottish Government’s revised statutory Best Value guidance (2020). It is intended to support internal and external audit by setting out how Moray Health and Social Care Partnership (Moray HSCP)) and the Moray Integration Joint Board (MIJB) secure and evidence Best Value through existing governance, performance and assurance arrangements, rather than through bespoke measures or parallel reporting systems. Accountability and governance overview Accountability for securing Best Value within Moray Health and Social Care Partnership rests with the Moray Integration Joint Board (MIJB) as the accountable body. The MIJB is supported by the Chief Officer and Chief Finance Officer, with governance arrangements set out within the Integration Scheme, Standing Orders and Scheme of Administration. Scrutiny and assurance are provided through the MIJB committee structure, in particular the Audit, Performance and Risk Committee and the Clinical and Care Governance Committee. Assurance is achieved from established systems including quarterly performance and financial reporting, monitoring of Directions issued to Moray Council and NHS Grampian, internal and external audit activity, and publication of the Annual Performance Report. Risk management and assurance The MIJB manages risk as an integral part of its governance and Best Value arrangements. Strategic risks are identified, assessed and recorded within the MIJB Strategic Risk Register, which is aligned to the Strategic Plan and Risk Appetite approved by the Board. Ultimate accountability for strategic risk rests with the MIJB, with scrutiny and assurance provided through the Audit, Performance and Risk Committee. The Strategic Risk Register is reviewed by the Board on a regular basis, supported by interim reporting where material changes or emerging risks require escalation. Page 126
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APPENDIX 4 Assurance on the effectiveness of risk management is provided through a combination of Board and committee reporting, internal and external audit activity, and disclosure within the Annual Governance Statement. Development sessions and early financial risk consideration In addition to formal Board and committee reporting, Moray HSCP works closely with the MIJB through structured development sessions, particularly in relation to financial planning and emerging financial challenges. These sessions provide an opportunity for early discussion of significant budget pressures, savings proposals, and financial risks before formal papers are presented for decision. This approach supports informed and transparent decision-making by enabling Members to explore the strategic context, implications and risk profile of proposals in advance, including financial, reputational, operational and political considerations. It also allows the Board to determine its appetite for accepting or mitigating risk at an early stage, helping to ensure that subsequent formal reports are well-focused, proportionate and aligned with the Board’s expectations. By using development sessions in this way, the MIJB strengthens its governance and Best Value arrangements, supporting robust scrutiny while maintaining pace and clarity in decision-making during periods of financial constraint. Best Value assurance – key questions How do you receive assurance that the services supporting delivery of the strategic plan are securing Best Value? Assurance is provided through established governance and assurance arrangements, including quarterly performance and financial reporting to the MIJB and its committees, internal and external audit activity, and publication of the Annual Performance Report. In line with statutory guidance, IJB Directions issued to Moray Council and NHS Grampian are legally binding and provide a key mechanism for ensuring delivery of the Strategic Plan. A governance procedure is in place to monitor implementation and performance of Directions, with updates provided through Moray HSCP Senior Leadership Team and reported to the MIJB committee structure. Page 127
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APPENDIX 4 Do you consider there to be sufficient buy-in to the IJB’s longer-term vision from partner officers and members? The Strategic Plan was developed collaboratively with NHS Grampian, Moray Council and stakeholders. Partner boards have formally approved the Plan, and officers participate in joint planning and delivery groups to ensure alignment with wider system objectives. The IJB benefits from established joint working arrangements and strong links with Community Planning Partners. How is value for money demonstrated in decisions made by the IJB? All papers presented to the MIJB include consideration of financial implications. Business cases and proposals are supported by proportionate impact assessments covering resource implications, risks, timelines and anticipated outcomes. The governance procedure for Directions requires delegated leads to bring forward delivery proposals, enabling the MIJB to assess value for money as part of its decision-making. Do you consider there to be a culture of continuous improvement? The MIJB is committed to a culture of continuous improvement and redesign. Learning from performance reporting, audit activity and service review informs priorities within the Annual Strategic Delivery Plan, supporting sustainability and value for money in the current operating climate. Internal audit are key partners of Moray HSCP and are regular attenders at the Senior team meetings. Have service reviews been undertaken and is there evidence of improvement or reduced pressures through joint working? The Strategic Plan and Strategic Delivery Plan set out a programme of service review and redesign in response to increasing demand, financial and workforce pressures. Where redesign is undertaken, impact measures are identified to monitor sustainability, performance and outcomes. Have improvement actions been prioritised in terms of greatest impact? Improvement actions are prioritised through the Strategic Delivery Plan and agreed priorities, supported by proactive horizon scanning and programme planning. Page 128
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APPENDIX 4 What steps are taken to ensure quality of care is not compromised by cost-saving measures? All service change proposals are subject to appropriate assessment prior to approval, including equality and financial impact assessments, alongside stakeholder engagement where required. Proposals progress through established governance routes to ensure quality and safety are maintained. Is performance information reported at sufficient detail to assess value for money? Performance reporting to the MIJB is aligned to the Strategic Delivery Plan. The performance framework for Directions continues to be refined to strengthen assessment of impact and value for money. How does the IJB ensure management of resources is effective and sustainable? The MIJB receives regular reports on financial performance, strategic risks, workforce capacity and delivery of Directions. This provides ongoing assurance that resources are managed effectively Links to Evidential documents: Strategic Plan Integration Scheme Standing Orders Financial Regulations Quarterly Budget monitoring Reports Directions Policy Annual Performance Report; Equalities Report 2025-2029 Equality Impact Assessments MIJB Strategic Risk Register Page 129
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 25 JUNE 2026 SUBJECT: EXTERNAL AUDIT PLAN FOR THE YEAR ENDING 2025/26 AND UPDATE ON RECOMMENDATIONS FROM 2024/25 BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To inform the Board of the Auditor’s Annual Plan for 2025/26 and update on the recommendations following last years audit. 2. RECOMMENDATION 2.1 It is recommended that the Board considers and notes the contents of the External Auditor’s Annual Plan for 2025/26 and update on audit recommendations from 2024/25. 3. BACKGROUND 3.1 In September 2022, Grant Thornton was confirmed as the external auditor of the Moray Integration Joint Board (MIJB). The appointment was for financial years 2022/23 to 2026/27 inclusive. 3.2 Grant Thornton were appointed by the Accounts Commission to deliver the public audit for Moray, they will provide independent assurance to the people of Scotland that public money is spent appropriately and provides value. Audit work is carried out in accordance with International Standards on Auditing, the Code of Audit Practice https://www.audit-scotland.gov.uk/publications/code-of-audit- practice-2021 and any other relevant guidance. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 An Annual Audit Plan for 2025/26 has been received from Grant Thornton and is attached at Appendix 1 to this report. The Plan sets out the scope of the audit work and the auditors approach to the audit. The Plan details the initial risks identified by Grant Thornton and planned work to be undertaken for the audit of Item 8. Page 131
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the financial statements for the year ending 2025/26. Grant Thornton also aim to add value to the MIJB through its work. 4.2 The Audit Plan identifies the main risks for the MIJB which will be the focus of audit testing and are outlined in page 7 of the Plan. In order to assist with the assessment of risk, an Informing the Audit Risk Assessment was completed by senior managers and is attached at Appendix 2. 4.3 On page 27 of the Audit Plan, Grant Thornton has shown the External Audit fee for 2025/26 as being £35,480 (£36,500 for 2024/25, which also included an additional fee of £2,500). 4.4 The annual accounts timetable, including key deadlines are shown on page 23 of the audit plan and requires the MIJB to submit the Unaudited Annual Accounts along with supporting working papers to Grant Thornton by 30 June 2026 following consideration by those charged with governance at the meeting of the MIJB on 25 June 2026. The MIJB will be asked to approve the audited annual accounts and to consider the Annual Audit Report at its meeting on 24 September 2026. 4.5 As part of the audit on 2024/25 accounts, Grant Thornton produced the Annual Audit Report to the meeting of the MIJB on 30 October 2025 (para 3 of the minute refers), within which there were a number of recommendations following the work on the Wider Scope audit. Attached at Appendix 3 is the latest update on the recommendations, all of which have been actioned. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and MIJB Strategic Commissioning Plan ‘Partners in Care’ 2022 – 2032 The work undertaken by External Audit seeks to provide assurance to the MIJB on the financial governance and resource management. It will express a view on the key risks to be managed in order to secure operational efficiency in line with the Strategic Plan 2022 - 32. (b) Policy and Legal The external audit is conducted in terms of statutory powers afforded to the appointed External Auditor and in accordance with Grant Thorntons Code of Practice. (c) Financial implications The annual audit fee set for 2025/26 by Grant Thornton and paid by the MIJB is £35,480. (d) Risk Implications and Mitigation The risks associated with the Audit Plan have been identified and categorised within the Plan on page 10. (e) Staffing Implications Page 132
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Preparation of the MIJB’s financial statements will require input and coordination from the MIJB Chief Financial Officer and the finance teams of both Moray Council and NHS Grampian which forms part of the scheduled work. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact None arising directly from this report as there has been no change to policy. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions None arising directly from this report. (j) Consultations The content of the Plan has been discussed with the Chief Officer, Chief Internal Auditor and Senior Managers prior to production and their comments have been incorporated where appropriate. 6. CONCLUSION 6.1 The Annual Audit Plan informs the MIJB, its Committees and officers of the work to be undertaken by External Audit (Grant Thornton) in the year ahead. 6.2 The Audit recommendations from 2024/25 audit have been considered and progress has been made on them all. Author of Report: Deborah O’Shea Background Papers: with author Ref: Page 133
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Moray Integration Joint Board External Audit Plan - Draft Financial year ending 31 March 2026 Prepared for those Charged with Governance, the Controller of Audit and the Accounts Commission 24 March 2026 APPENDIX 1 Page 134
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Contents Section Page 1. Introduction and Headlines 03 2. Identified risks 06 3. Other matters 10 4. Materiality 13 5. IT audit strategy 16 6. Wider scope and Best Value arrangements 18 7. Logistics 22 8. Audit Fees 25 9. Independence matters 28 10. Communication of audit matters with those charged with governance 30 11. Appendices 33 Moray Integration Joint Board External Audit Plan 2025/26 2 Page 135
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Introduction and Headlines01 Moray Integration Joint Board External Audit Plan 2025/26 3 Page 136
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Introduction and headlines (1) Purpose This document provides an overview of the planned scope and timing of the external audit of Moray Integration Joint Board (the IJB) for those charged with governance. We are appointed by The Accounts Commission as the external auditors of the IJB for the five-year period 2022/23 to 2026/27. Respective responsibilities The Code of Audit Practice (the Code) summarises where the responsibilities of auditors begin and end and what is expected from the audited body. Our respective responsibilities, and that of the IJB are summarised in the Appendix of this Audit Plan. We draw your attention to this and the Code. Scope of our Audit The scope of our audit is set in accordance with the Code and International Standards on Auditing (ISAs) (UK). We are responsible for forming and expressing an opinion on the IJB’s financial statements, which have been prepared by management with the oversight of those charged with governance (the Audit, Performance and Risk Committee). Our audit of the financial statements does not relieve management, the IJB Audit, Performance and Risk Committee or the Board of your responsibilities. It is your responsibility to ensure that proper arrangements are in place for the conduct of your business, and that public money is safeguarded and properly accounted for. As part of our wider scope work, we will consider how you are fulfilling these responsibilities. Our audit approach is based on a thorough understanding of the IJB and is risk based. Significant risks Those risks requiring special audit consideration and procedures to address the likelihood of a material financial statement error have been identified as: • Management override of controls (ISA (UK) 240); We will communicate significant findings on these areas as well as any other significant matters arising from the audit to you in our Annual Audit (ISA 260) Report. Materiality We have calculated our planning materiality to be £5.258 million (PY: £5.070 million) for the IJB, which equates to 2.5% (PY: 2.5%) of your prior year gross expenditure as per the audited 2024/25 financial statements. Performance materiality has been determined as £3.943 million (PY: £3.802 million) and is based on 75% (PY: 75%) of planning materiality. We are obliged to report uncorrected omissions or misstatements other than those which are ‘clearly trivial’ to those charged with governance. Clearly trivial has been calculated at 5% of materiality being £0.263 million (PY: £0.254 million). A lower materiality threshold will of £25,000 will be used on salary and pension (CETV) tables for senior management and board members. We will revisit our materiality throughout our audit including updating to reflect the draft unaudited financial statements for 2025/26. Moray Integration Joint Board External Audit Plan 2025/26 4 Page 137
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Introduction and headlines (2) Audit Fees Audit fees were shared by Audit Scotland with the IJB in January 2026. The baseline audit fee set is £35,480. Audit fees are paid to Audit Scotland who in turn pay Grant Thornton UK LLP. The baseline audit fee has been agreed with the audited body. We reserve the right to review our fee during the audit should significant delays be encountered and/or new technical matters arise. Adding Value Through the Audit Our overall approach to adding value through the audit is clear and upfront communication, founded on our public sector credentials. We use our LEAP audit methodology and data analytics to ensure delivery of a quality audit. We have also invited members of your financial reporting team to our annual Local Government Chief Accountants workshop, which is led by our internal financial reporting technical team. Other Matters We summarise other audit matters for the Audit, Performance and Risk Committee’s awareness. This includes: • Consideration of going concern in accordance with Practice Note 10. • In accordance with the Code and planning guidance we also required to complete and submit a number of information returns and other deliverables to Audit Scotland during the year. Moray Integration Joint Board External Audit Plan 2025/26 5 Wider Scope and Best Value Audit In accordance with the Code, our planning considers the Wider Scope and Best Value areas of audit. We have identified the following wider scope significant risk and will conclude on this during the audit: • Financial sustainability – The IJB faces significant financial challenges over the medium and longer-term. The latest revenue monitoring report confirms the IJB are projecting a significant deficit of £8.233 million for 2025/26 which will require the partner authorities to provide additional funding contributions at year end. These additional funding contributions are factored into both partners in-year budgets. The IJB prepare a Medium-Term Financial Strategy which estimates a £38 million funding deficit to 2030/31 and there is a risk that the transformation and savings plans are not sufficient to address the identified funding gap over the medium term. As part of our integrated wider-scope work, we also use a risk-based approach to assess and report on whether the IJB has made proper arrangements for securing Best Value. Page 138
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Identified risks02 Moray Integration Joint Board External Audit Plan 2025/26 6 Page 139
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Significant risks identified (1) Significant risks are defined by ISAs (UK) as risks that, in the judgement of the auditor, require special audit consideration. In identifying risks, audit teams consider the nature of the risk, the potential magnitude of misstatement, and its likelihood. Significant risks are those risks that have a higher risk of material misstatement. Moray Integration Joint Board External Audit Plan 2025/26 7 “In determining significant risks, the auditor may first identify those assessed risks of material misstatement that have been assessed higher on the spectrum of inherent risk to form the basis for considering which risks may be close to the upper end. Being close to the upper end of the spectrum of inherent risk will differ from entity to entity and will not necessarily be the same for an entity period on period. It may depend on the nature and circumstances of the entity for which the risk is being assessed. The determination of which of the assessed risks of material misstatement are close to the upper end of the spectrum of inherent risk, and are therefore significant risks, is a matter of professional judgment, unless the risk is of a type specified to be treated as a significant risk in accordance with the requirements of another ISA (UK).” (ISA (UK) 315). In making the review of unusual significant transactions “the auditor shall treat identified significant related party transactions outside the entity’s normal course of business as giving rise to significant risks.” (ISA (UK) 550). Management should expect engagement teams to challenge management in areas that are complex, significant, or highly judgmental, which may be the case for accounting estimates, related parties and similar areas. Management should also expect to provide engagement teams with sufficient evidence to support their judgments and the approach they have adopted for key accounting policies referenced to accounting standards or changes thereto. Where estimates are used in the preparation of the financial statements, management should expect teams to challenge management’s assumptions and request evidence to support those assumptions. Page 140
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Significant risks identified (4) Significant risk Description Key aspects of our proposed response to the risk Management override of controls Under ISA (UK) 240 there is a non-rebuttable presumed risk that the risk of management override of controls is present in all entities. Our risk focuses on the areas of the financial statements where there is potential for management to use their judgement to influence the financial statements alongside the potential to override the entity’s internal controls, related to individual transactions. We have therefore identified management override of controls, in particular journals, management estimates and of transactions outside the course of business as a significant risk of material misstatement. We will: • Confirm our understanding over the agreement of balances and transactions to the year end submissions from Moray Council and NHS Grampian. • Document our understanding of and evaluate the design effectiveness of management’s key controls over journals at the partner authorities; • Gain an understanding of the critical judgements applied by management in the preparation of the financial statements and consider their reasonableness; • Evaluate the rationale for any changes in accounting policies, estimates or significant unusual transactions. Moray Integration Joint Board External Audit Plan 2025/26 8 Page 141
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Significant risks identified (2) Moray Integration Joint Board External Audit Plan 2025/26 9 Significant risk Description Key aspects of our proposed response to the risk Fraud in revenue recognition Under ISA (UK) 240 there is a rebuttable presumed risk that revenue may be misstated due to the improper recognition of revenue. This presumption can be rebutted if the auditor concludes that there is no risk of material misstatement due to fraud relating to revenue recognition. (rebutted) Having considered the risk factors set out in ISA 240 and the nature of the revenue streams at the IJB, we have determined that the risk of fraud arising from revenue recognition can be rebutted, because: • there is little incentive to manipulate revenue recognition; and • opportunities to manipulate revenue recognition are very limited. Therefore, we do not consider this to be a significant risk for the IJB. Fraud in expenditure recognition As set out in practice note 10 (Revised 2020) ‘The Audit of Public sector Financial Statements’, issued by the Public Audit Forum, which applies to all public sector entities, we consider there to be an inherent risk of fraud in expenditure recognition. The IJB delegates services to Moray Council and NHS Grampian. A budget is agreed by all parties in advance of the financial year. It is up to the Council and the NHS Board to spend the delegated budget, as agreed with the IJB. (rebutted) Having considered the risk factors set out in PN 10 and the nature of the expenditure streams at the IJB, we have determined that the risk of fraud arising from revenue recognition can be rebutted, because: • opportunities to manipulate expenditure recognition are very limited. Therefore, we do not consider this to be a significant risk for IJB Page 142
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Other matters03 Moray Integration Joint Board External Audit Plan 2025/26 10 Page 143
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Other matters (1) Other work In addition to our expected responsibilities under the Code of Practice, we have a number of other audit responsibilities, as follows: • We audit parts of your Remuneration Report, as required under the Code, and check whether these sections have been properly prepared (opinion). These procedures are performed to a lower materiality. • We read the sections of your Statement of Accounts which are not subject to audit and check that they are consistent with the financial statements on which we give an opinion (opinion). • We carry out work to satisfy ourselves that disclosures made in your Annual Governance Statement are in line with requirements set out in Delivering Good Governance in Local Government: Framework (Revised 2025) (opinion). • We consider our other duties under the Code and planning guidance (2025/26), as and when required, including: • Supporting Audit Scotland’s reporting to the Accounts Commission. • Contributing to Audit Scotland Performance Reports and providing regular updates to Audit Scotland to share awareness of current issues. • Contributing to the National Fraud Initiative (NFI) report. • Notifying the Controller of the Audit when circumstances indicate a statutory report may be required. • Completing mandated information requests and returns and notifying Audit Scotland of any cases of money laundering or fraud. • Review of Technical guidance prior to issue by Audit Scotland. Moray Integration Joint Board External Audit Plan 2025/26 11 Other material balances and transactions Under International Standards on Auditing, "irrespective of the assessed risks of material misstatement, the auditor shall design and perform substantive procedures for each material class of transactions, account balance and disclosure". All other material balances and transaction streams will therefore be audited. However, the procedures will not be as extensive as the procedures adopted for the risks identified in this report. Internal control environment During our initial audit planning we will develop our understanding of your control environment (design and implementation) as it relates to the preparation of your financial statements. In particular we will: • Consider key business processes and related controls. • Assess the design of key controls over all significant risks we have identified. This will include key controls over: • Journal entries and other key entity level controls. Our focus is on design and implementation of controls only. We do not intend to assess or place any reliance on the operating effectiveness of your controls during our audit. Page 144
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Other matters (2) Going concern assessment As auditors, we are required to obtain sufficient appropriate audit evidence regarding, and conclude on: • whether a material uncertainty related to going concern exists; and • the appropriateness of management’s use of the going concern basis of accounting in the preparation of the financial statements. The Public Audit Forum has been designated by the Financial Reporting Council as a “SORP-making body” for the purposes of maintaining and updating Practice Note 10: Audit of financial statements and regularity of public sector bodies in the United Kingdom (PN 10). It is intended that auditors of public sector bodies read PN 10 in conjunction with (ISAs) (UK). PN 10 was updated in 2020 to take account of revisions to ISAs (UK), including ISA (UK) 570 (Revised September 2019) on going concern. PN 10 allows auditors to apply a ‘continued provision of service approach’ when auditing going concern in the public sector, where appropriate. Audit Scotland’s also issued further guidance in a Going Concern publication in December 2020). Within our wider scope work we will conclude on the IJB arrangements to ensure financial sustainability. Internal Audit We read and understand the work of Internal Audit during the year, and how this work feeds into management’s governance processes and inclusion within the Annual Governance Statement. We do not rely directly upon the work of Internal Audit, and our approach is fully substantive. Moray Integration Joint Board External Audit Plan 2025/26 12 Financial reporting developments During our audit we will actively discuss emerging financial reporting developments with you. Progress against prior year audit recommendation As part of our final account's procedures, we will follow up on the implementation of prior year audit recommendations and report on progress against the recommendations in full within our Annual Audit Report. Page 145
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Materiality04 13Moray Integration Joint Board External Audit Plan 2025/26 Page 146
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Our approach to materiality (1) The concept of materiality is fundamental to the preparation of the financial statements and the audit process and not only applies to the monetary misstatements but also to disclosure requirements and adherence to acceptable accounting practice and applicable law. Moray Integration Joint Board External Audit Plan 2025/26 14 Matter Description Planned audit procedures 1 Determination We have determined planning materiality (financial statement materiality) at the planning stage of the audit based on professional judgement in the context of our knowledge of the IJB, including consideration of factors such as shareholder expectations, industry developments, financial stability and reporting requirements for the financial statements. We have determined financial statement materiality based on a proportion of the gross expenditure of the IJB for the financial year. We determine planning materiality to: – establish what level of misstatement could reasonably be expected to influence the economic decisions of users taken on the basis of the financial statements; – assist in establishing the scope of our audit engagement and audit tests; – determine sample sizes; and – assist in evaluating the effect of known and likely misstatements in the financial statements. 2 Other factors An item does not necessarily have to be large to be considered to have a material effect on the financial statements. An item may be considered to be material by nature when it relates to: – instances where greater precision is required (e.g. senior management remuneration, pension CETV tables and audit fees). 3 Reassessment of materiality Our assessment of materiality is kept under review throughout the audit process. We reconsider planning materiality on receipt of the draft statement of accounts and if, during the course of our audit engagement, we become aware of facts and circumstances that would have caused us to make a different determination of planning materiality. Misstatements, including omissions, are considered to be material if they, individually or in the aggregate, could reasonably be expected to influence the economic decisions of users taken on the basis of the financial statements; Judgments about materiality are made in light of surrounding circumstances, and are affected by the size or nature of a misstatement, or a combination of both; and Judgments about matters that are material to users of the financial statements are based on a consideration of the common financial information needs of users as a group. The possible effect of misstatements on specific individual users, whose needs may vary widely, is not considered. (ISA (UK) 320) Page 147
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Our approach to materiality (2) Moray Integration Joint Board External Audit Plan 2025/26 15 Materiality area 2025/26 planning materiality Qualitative factors considered Headline materiality for the financial statements £5.258 million Our materiality has been set at 2.5% of prior year gross expenditure of the IJB as per the 2024/25 financial statements (2024/25: 2.5%). In setting this threshold, the following factors have been considered: • There were no significant findings in the 2024/25 audit report. • No significant deficiencies have been identified with the IJB’s control environment. • The level of public interest in the IJB for Scotland by the public and the Scottish Government. Performance materiality for the financial statements £3.943 million Performance materiality has been set at 75% of financial statements materiality (2024/25: 75%). Performance materiality is used for the purposes of assessing the risks of material misstatement and determining the nature, timing, and extent of further audit procedures. This is the amount we set at less than materiality for the financial statements as a whole, to reduce to an appropriately low level the probability that the aggregate of uncorrected and undetected misstatements exceeds materiality for the financial statements as a whole. Reporting threshold £0.263 million This balance is set at 5% of materiality (2024/25: 5%). All misstatements above this threshold will be reported. Materiality for the senior management remuneration disclosure £25,000 PM: £18,750 Due to the public interest in senior officer remuneration disclosures, we apply specific audit procedures to this work and set a lower materiality level for this area. We design our procedures to detect errors in specific accounts at a lower level of precision which we have determined to be applicable for senior officer remuneration disclosures. We evaluate errors in this disclosure for both quantitative and qualitative factors against this lower level of materiality. We will apply heightened auditor focus in the completeness and clarity of disclosures in this area and will request amendments to be made if any errors exceed the threshold we have set or would alter the bandings reported for any individual. As a lower materiality is determined, we are required to determine a performance materiality (PM) for the Remuneration Report. Lower performance materiality has been set at 75% of Remuneration Report materiality. Page 148
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|© 2026 Grant Thornton UK LLP Commercial in Confidence IT audit strategy05 Moray Integration Joint Board External Audit Plan 2025/26 16 Page 149
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|© 2026 Grant Thornton UK LLP Commercial in Confidence IT audit strategy In accordance with ISA (UK) 315, we are required to obtain an understanding of the IT environment related to all key business processes, identify all risks from the use of IT related to those business process controls judged relevant to our audit and assess the relevant IT general controls (ITGCs) in place to mitigate them. Our audit will include completing an assessment of the design and implementation of ITGCs related to security management; technology acquisition, development and maintenance; and technology infrastructure. IT application Audit area Planned level IT audit assessment Oracle EBS Financial reporting – Moray Council • ITGC assessment (design and implementation effectiveness only) eFinancials Financial Reporting – NHS Grampian • ITGC assessment (design and implementation effectiveness only) The following IT applications are in scope for IT controls assessment based on the planned financial statement audit approach, we will perform the indicated level of assessment: Moray Integration Joint Board External Audit Plan 2025/26 17 Page 150
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Wider Scope and Best Value arrangements 06 Moray Integration Joint Board External Audit Plan 2025/26 18 Page 151
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Wider scope and best value arrangements (1) Our responsibilities under the Code of Audit Practice extend beyond the audit of the financial statements. The Code of Audit Practice sets out four areas that constitute the wider scope of public audit in Scotland. These are summarised below: We consider each of these areas through our audit planning process and have set out below the identified areas of risk for our wider scope work. From our initial planning work, we have identified one significant risk in relation to Financial Sustainability. We will continue to review your arrangements before we issue our Annual Audit Report. A conclusion on the effectiveness and appropriateness of arrangements the IJB has in place for each of the wider scope areas will be reported in the Annual Audit Report. 19Moray Integration Joint Board External Audit Plan 2025/26 Financial management Has the body got sound budgetary process, financial capacity and the control environment and internal controls are operating effectively. Financial Sustainability How the body looks forward to the medium and longer term to consider whether the body is planning effectively to deliver its services or the way in which they should be delivered. Vision, Leadership and Governance How effective are the body’s scrutiny and governance arrangements, leadership and decision making, and transparent reporting of financial and performance information. Use of Resources to Improve Outcomes How the body makes best use of their resources to meet stated outcomes and improvement objectives, through effective planning and working with strategic partners and communities. Page 152
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Wider scope and best value arrangements (2) 20Moray Integration Joint Board External Audit Plan 2025/26 Risk assessment of the IJB’s wider scope arrangements The risk assessment process has identified one significant risk. The risk is reflected below, and we have confirmed the planned audit procedures to be carried out in response to the risk. Area 2025/26 risk assessment 2025/26 risk -based procedures planned Financial Management Financial Sustainability Significant Risk - Financial sustainability The IJB faces significant financial challenges over the medium and longer-term due to the uncertainty over future Scottish Government funding allocations, workforce pressures and the rising cost of inflation. The 2025/26 budget was approved by the Board in March 2025 and projected an overall deficit for the financial year of £1.000 million, the deficit funded using earmarked reserves. The latest revenue monitoring report provides an update on the projected outturn at 31 December 2025 and highlights a deteriorating financial position for 2025/26, with the IJB projecting a significant deficit of £8.233 million for the full year. This is a result of increasing costs to the IJB due to rising demand for services, alongside the non-delivery of approximately £3.133 million of identified savings plans. This deficit will require the partner authorities to provide significant additional funding contributions at year end for the IJB to break-even. These additional funding contributions are factored into both partners in-year budgets. The IJB prepare a Medium-Term Financial Strategy (2026/27 – 2030/31) (MTFS) which will be presented to the Board in March 2026. The MTFS shows the IJB is facing significant and increasing overspends against future forecast budgets and the funding deficit over the period is projected to be £38 million. As a result of this significant funding deficit, the IJB will need to identify new approaches to manage the funding gap over the longer term. However, there is a risk that the transformation and savings plans agreed by the Board to address future financial pressures are not sufficient to address the identified funding gap over the medium term. We will: • Review progress against the 2025/26 savings plans and budget • Review how the IJB identifies significant financial pressures and builds them into its plans. • Review how the IJB plans to bridge its funding gap and identify achievable savings and future transformation. • Follow up the recommendations raised in the 2024/25 Annual Audit Report Page 153
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Wider scope and best value arrangements (3) 21Moray Integration Joint Board External Audit Plan 2025/26 Best Value Under the Code of Audit Practice, the duty on auditors to consider the arrangements an audited body has in place to secure Best Value applies to audited bodies that fall within section 106 of the Local Government (Scotland) Act 1973. Consideration of the arrangements the IJB has in place to secure Best Value will be carried out alongside the wider scope audit, and a conclusion on the arrangements the IJB has in place will be reported in the Annual Audit Report. Page 154
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Logistics07 Moray Integration Joint Board External Audit Plan 2025/26 22 Page 155
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Logistics Moray Integration Joint Board External Audit Plan 2025/26 23 The audit timeline Planning: March 2026 Key Dates Finals / Wider Scope: August - September 2026 Completion: September 2026 Key elements • Planning meeting with management to set audit scope • Agree timetable and deliverables with management and the Audit, Performance and Risk Committee • Issue the Audit Plan to management and the Audit, Performance and Risk Committee • Document design effectiveness of systems and processes Key elements • Audit team to complete fieldwork and detailed testing • Review of key judgements and estimates • Feedback on draft financial statements Key elements • Draft Audit Findings issued to management • Audit Findings meeting with management • Draft Auditor’s Annual Report issued to Audit, Performance and Risk Committee • Audit Findings presentation to Audit, Performance and Risk Committee • Annual Audit Report • Finalise and sign financial statements and audit report Year End: 31 March 2026 Audit, Performance and Risk Committee 24 September 2026 Audit phases: Audit, Performance and Risk Committee 25 June 2026 Audit Plan submitted to Audit Scotland: By 31 March 2026 Page 156
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Our team and communications Moray Integration Joint Board External Audit Plan 2025/26 24 Grant Thornton core team Service delivery Audit reporting Audit progress Technical support Formal communications Annual client service review The Audit Plan The Auditor’s Annual Report Audit planning meetings Audit clearance meetings Communication of issues log Technical updates Informal communications Open channel for discussion Communication of audit issues as they arise Notification of up-coming issues As part of our overall service delivery, we may utilise colleagues who are based overseas, primarily in India and the Philippines. Those colleagues work on a fully integrated basis with our team members based in the UK and receive the same training and professional development programmes as our UK based team. They work as part of the engagement team, reporting directly to the Audit Senior and Manager and will interact with you in the same was as our UK based team albeit on a remote basis. Our overseas team members use a remote working platform which is based in the UK. The remote working platform (or Virtual Desktop Interface) does not allow the user to move files from the remote platform to their local desktop meaning all audit related data is retained within the UK. Angela Pieri Engagement Leader Andrew Wallace Senior Audit Manager Christie Hastings (Planning) Alexander Chapman (Fieldwork) Audit Senior • Key contact for senior management and the Audit, Performance and Risk Committee • Overall quality assurance • Audit planning • Resource management • Performance management reporting • On-site audit team management • Day-to-day point of contact • Audit fieldwork Page 157
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Audit Fees08 Moray Integration Joint Board External Audit Plan 2025/26 25 Page 158
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Audit Fees (1) Relevant Professional Standards Across all sectors and firms, the Financial Reporting Council (FRC) has set out its expectation of improved financial reporting from organisations and the need for auditors to demonstrate increased scepticism and challenge and to undertake additional and more robust testing. As a firm, we are absolutely committed to meeting the expectations of the FRC on audit quality and public sector financial reporting. This includes, for Audit Scotland contracts, meeting the expectations of the Audit Scotland Quality Team and the Scottish quality framework. We are required to consider all relevant professional standards, including paragraphs 4.1 and 4.2 of the FRC’s Ethical Standard (revised 2024) which stipulate that the Engagement Lead (Key Audit Parter) must set a fee sufficient to enable the resourcing of the audit with partners and staff with appropriate time and skill to deliver an audit to the required professional and Ethical standards. Audit fees were shared by Audit Scotland with the IJB in January 2026. Audit fees are paid to Audit Scotland who in turn pay us. We reserve the right to review our fee during the audit should significant delays be encountered and/or new technical matters arise. Audit Scotland set the baseline audit fee. We can increase the fee, from the baseline, for the inclusion of additional risks, new technical matters or where specific client matters are identified, such as prior year misstatements and disclosure amendments re-occurring during the audit. Moray Integration Joint Board External Audit Plan 2025/26 26 The baseline fee of £35,480 has been set by Audit Scotland. In accordance with Audit Scotland guidance, we are able to discuss a variation to the audit fee where additional work is required. Further detail on the audit fee is available on the following page. Page 159
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Audit Fees (2) Audit fees for 2025/26 Additional Fees (Non-Audit Services) Fee Assumption In setting the fee for 2025/26 we have assumed that you will: • prepare a good quality set of accounts, supported by comprehensive and well-presented working papers which are ready at the start of the audit • provide appropriate analysis, support and evidence for all critical and significant judgements and estimates made in preparing the financial statements • provide early notice of proposed complex or unusual transactions which could have a material impact on the financial statements • Provide ongoing access to officers and management experts throughout the audit and timely responses to audit queries. Moray Integration Joint Board External Audit Plan 2025/26 27 Service Fees (£) External Auditor Remuneration £37,830 Pooled Costs £1,300 Contribution to Performance Audit and Best Value £7,050 Sectoral cap adjustment -£10,700 2025/26 Fee £35,480 Service Fees (£) At planning stage we confirm there are no planned non-audit services Nil Page 160
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Independence matters09 Moray Integration Joint Board External Audit Plan 2025/26 28 Page 161
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Independence considerations Ethical Standards and ISA (UK) 260 require us to give you timely disclosure of all significant matters that may bear upon the integrity, objectivity and independence of the firm or covered persons (including its partners, senior managers, managers). In this context, there are no matters that we are required to report. As part of our assessment of our independence at planning we note the following matters: We confirm that there are no significant facts or matters that impact on our independence at planning as auditors that we are required or wish to draw to your attention and consider that an objective reasonable and informed third party would take the same view. The firm and each covered person have complied with the Financial Reporting Council’s Ethical Standard and confirm that we are independent and are able to express an objective opinion on the financial statements. No non-audit services provided by Grant Thornton UK LLP have been identified. Any changes and full details of all fees charged for audit related and non-audit related services by Grant Thornton UK LLP and by Grant Thornton International Limited network member Firms will be included in our Annual Audit Report at the conclusion of the audit. Matter Conclusions Relationships with Grant Thornton We are not aware of any relationships between Grant Thornton and the IJB that may reasonably be thought to bear on our integrity, independence and objectivity. Relationships and Investments held by individuals We have not identified any potential issues in respect of personal relationships with the IJB or investments in the IJB held by individuals. Employment of Grant Thornton staff We are not aware of any former Grant Thornton partners or staff being employed, or holding discussions in respect of employment, by the IJB as a director or in a senior management role covering financial, accounting or control related areas. Business relationships We have not identified any business relationships between Grant Thornton and the IJB . Contingent fees in relation to non-audit services No contingent fee arrangements are in place for non-audit services provided. Gifts and hospitality We have not identified any gifts or hospitality provided to, or received from, a member of the IJB’s board, senior management or staff (that would exceed the threshold set in the Ethical Standard). Moray Integration Joint Board External Audit Plan 2025/26 29 Page 162
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Communication of audit matters with those charged with governance 10 Moray Integration Joint Board External Audit Plan 2025/26 30 Page 163
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Communication of audit matters with those charged with governance (1) Moray Integration Joint Board External Audit Plan 2025/26 31 Our communication plan Audit Plan Annual Audit Report Respective responsibilities of auditor and management/those charged with governance Overview of the planned scope and timing of the audit, form, timing and expected general content of communications including significant risks and Key Audit Matters Planned use of internal audit Confirmation of independence and objectivity A statement that we have complied with relevant ethical requirements regarding independence. Relationships and other matters which might be thought to bear on independence. Details of non-audit work performed by Grant Thornton UK LLP and network firms, together with fees charged. Details of safeguards applied to threats to independence Significant matters in relation to going concern Views about the qualitative aspects of the IJB’s accounting and financial reporting practices including accounting policies, accounting estimates and financial statement disclosures ISA (UK) 260, as well as other ISAs (UK), prescribe matters which we are required to communicate with those charged with governance, and which we set out in the table here. This document, the Audit Plan, outlines our audit strategy and plan to deliver the audit, while the Annual Audit Report will be issued prior to approval of the financial statements and will present key issues, findings and other matters arising from the audit, together with an explanation as to how these have been resolved. We will communicate any adverse or unexpected findings affecting the audit on a timely basis, either informally or via an audit progress memorandum. Page 164
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Communication of audit matters with those charged with governance (2) Our communication plan Audit Plan Annual Audit Report Significant findings from the audit Significant matters and issue arising during the audit and written representations that have been sought Significant difficulties encountered during the audit Significant deficiencies in internal control identified during the audit Significant matters arising in connection with related parties Identification or suspicion of fraud involving management and/or which results in material misstatement of the financial statements Non-compliance with laws and regulations Unadjusted misstatements and material disclosure omissions Moray Integration Joint Board External Audit Plan 2025/26 32 Respective responsibilities As auditor we are responsible for performing the audit in accordance with ISAs (UK), which is directed towards forming and expressing an opinion on the financial statements that have been prepared by management with the oversight of those charged with governance. The audit of the financial statements does not relieve management or those charged with governance of their responsibilities. Page 165
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Appendices12 Moray Integration Joint Board External Audit Plan 2025/26 33 Page 166
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|© 2026 Grant Thornton UK LLP Commercial in Confidence New or revised IFRS New or revised accounting standards that are in effect for reporting periods beginning on or after 1 January 2026. Amendment to IFRS 9 and IFRS 7 - Contracts Referencing Nature-dependent Electricity The International Accounting Standards Board (IASB) issued amendments to IFRS 9 and IFRS 7 to improve the reporting of nature-dependent electricity contracts, such as power purchase agreements (PPAs). These contracts, which secure electricity from sources like wind and solar power, can vary due to uncontrollable factors like weather. The amendments clarify the 'own-use' requirements, permit hedge accounting for these contracts, and introduce new disclosure requirements to help investors understand their impact on a company's financial performance and cash flows. The amendments are effective from 1 January 2026. Amendments to IFRS 9 and IFRS 7 – Classification and measurement of financial instruments These amendments clarify the requirements for the timing of recognition and derecognition of some financial assets and liabilities, adds guidance on the solely payment of principal and interest (SPPI) criteria, and includes updated disclosures for certain instruments (e.g. instruments with features linked to environmental social and governance (ESG) targets). The amendments are effective from 1 January 2026. IFRS 18 Presentation and Disclosure in the Financial Statements IFRS 18 will replace IAS 1 Presentation of Financial Statements. All entities reporting under IFRS Accounting Standards will be impacted. The new standard will impact the structure and presentation of the statement of profit or loss as well as introduce specific disclosure requirements. Some of the key changes are: • Introducing new defined categories for the presentation of income and expenses in the income statement • Introducing specified totals and subtotals, for example the mandatory inclusion of ‘Operating profit or loss’ subtotal. • Disclosure of management defined performance measures • Enhanced principles on aggregation and disaggregation which apply to the primary financial statements and notes. IFRS 18 will be effective in the UK from 1 January 2027. IFRS 19 Subsidiaries without Public Accountability: Disclosures IFRS 19 provides reduced disclosure requirements for eligible subsidiaries. A subsidiary is eligible if it does not have public accountability and has an ultimate or intermediate parent that produces consolidated financial statements available for public use that comply with IFRS Accounting Standards. IFRS 19 is a voluntary standard for eligible subsidiaries and is effective in the UK from 1 January 2027. 34Moray Integration Joint Board External Audit Plan 2025/26 Page 167
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|© 2026 Grant Thornton UK LLP Commercial in Confidence 35Moray Integration Joint Board External Audit Plan 2025/26 35 Responsibilities Moray Integration Joint Board Your responsibilities include: • Maintaining adequate accounting records and working papers • Preparing accounts for audit, comprising financial statements, which give a true and fair view, and related reports • Establishing and maintaining a sound system of internal control • Establishing sound arrangements for proper conduct of affairs, including the regularity of transactions • Maintaining standards of conduct for the prevention and detection of fraud and other irregularities • Maintaining strong corporate governance arrangements and a financial position that is soundly based • Establishing and maintaining an effective internal audit function. External Audit Our responsibilities include: • Compliance with the FRC Ethical Standard • Compliance with the Code and UK Auditing Standards (ISA’s UK) in the conduct and reporting of our financial statements audit • Compliance with the Code and guidance issued by Audit Scotland in the conduct and reporting of our wider scope work • Providing assurance on specified returns and other outputs (where required), as specified in guidance issued by Audit Scotland • Liaison with and notifying Audit Scotland when circumstances indicate a statutory report may be required. • Contributing to relevant performance studies (as set out in Audit Scotland’s Planning Guidance for 2025/26). The Code sets out auditor responsibilities and responsibilities of the audited body. Key responsibilities are summarised below. Please refer to the Code for further detail. Page 168
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© 2026 Grant Thornton UK LLP. All rights reserved. ‘Grant Thornton’ refers to the brand under which the Grant Thornton member firms provide assurance, tax and advisory services to their clients and/or refers to one or more member firms, as the context requires. Grant Thornton UK LLP is a member firm of Grant Thornton International Ltd (GTIL). GTIL and the member firms are not a worldwide partnership. GTIL and each member firm is a separate legal entity. Services are delivered by the member firms. GTIL does not provide services to clients. GTIL and its member firms are not agents of, and do not obligate, one another and are not liable for one another’s acts or omissions." Moray Integration Joint Board External Audit Plan 2025/26 36 Page 169
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MANAGEMENT RESPONSE TO INQUIRIES Moray Integration Joint Board 2025/26 APPENDIX 2 Page 170
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Table of Contents Section Page Purpose 3 General Enquiries of Management 4 Fraud 7 Fraud Risk Assessment 8 Laws and Regulations 13 Impact of Laws and Regulations 14 Related Parties 16 Going Concern 18 Accounting Estimates 20 Accounting Estimates - General Enquiries of Management 21 Appendix A – Accounting Estimates 24 2 Page 171
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Purpose This report includes a series of questions on each of these areas and the response we have received from Moray Integration Joint Board’s management. The Audit Committee should consider whether these responses are consistent with its understanding and whether there are any further comments it wishes to make. 3 Page 172
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General Enquiries of Management Question Management response 1. What do you regard as the key events or issues that will have a significant impact on the financial statements for 2025/26? Underlying deficit/ unachieved savings. Increasing costs through inflation impacting this and full costs of increases not being met through allocation from Scottish Government. Increasing demand (volume) and increasing complexity of care 2. Have you considered the appropriateness of the accounting policies adopted by Moray Integration Joint Board’s? Have there been any events or transactions that may cause you to change or adopt new accounting policies? If so, what are they? Accounting Policies are reviewed each year as the Accounts are prepared and changes incorporated where deemed necessary. No changes to accounting policies are anticipated for the 2025/26 accounts 3. Is there any use of financial instruments, including derivatives? If so, please explain No 4. Are you aware of any significant transaction outside the normal course of business? If so, what are they? Not aware 4 Page 173
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General Enquiries of Management Question Management response 5. Are you aware of any changes in circumstances that would lead to impairment of non-current assets? If so, what are they? N/a 6. Are you aware of any guarantee contracts? If so, please provide further details N/a 7. Are you aware of the existence of loss contingencies and/or un-asserted claims that may affect the financial statements? If so, please provide further details N/a 8. Other than in house solicitors, can you provide details of those solicitors utilised by Moray Integration Joint Board’s during the year. Please indicate where they are working on open litigation or contingencies from prior years? In house solicitors have been using external providers Brodies for some areas of work. 5 Page 174
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General Enquiries of Management Question Management response 9. Have any of the Moray Integration Joint Board’s service providers reported any items of fraud, non- compliance with laws and regulations or uncorrected misstatements which would affect the financial statements? If so, please provide further details Not aware of any 10. Can you provide details of other advisors consulted during the year and the issue on which they were consulted? N/A 11. Have you considered and identified assets for which expected credit loss provisions may be required under IFRS 9, such as debtors (including loans) and investments? If so, please provide further details N/A 6 Page 175
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Fraud Matters in relation to fraud ISA (UK) 240 covers auditors responsibilities relating to fraud in an audit of financial statements. The primary responsibility to prevent and detect fraud rests with both the Audit Committee and management. Management, with the oversight of the Audit Committee, needs to ensure a strong emphasis on fraud prevention and deterrence and encourage a culture of honest and ethical behaviour. As part of its oversight, the Audit Committee should consider the potential for override of controls and inappropriate influence over the financial reporting process. As Moray Integration Joint Board’s external auditor, we are responsible for obtaining reasonable assurance that the financial statements are free from material misstatement due to fraud or error. We are required to maintain professional scepticism throughout the audit, considering the potential for management override of controls. As part of our audit risk assessment procedures we are required to consider risks of fraud. This includes considering the arrangements management has put in place with regard to fraud risks including: • assessment that the financial statements could be materially misstated due to fraud, • process for identifying and responding to risks of fraud, including any identified specific risks, • communication with the Audit Committee regarding its processes for identifying and responding to risks of fraud, and • communication to employees regarding business practices and ethical behaviour. We need to understand how the Audit Committee oversees the above processes. We are also required to make inquiries of both management and the Audit Committee as to their knowledge of any actual, suspected or alleged fraud. These areas have been set out in the fraud risk assessment questions below together with responses from Moray Integration Joint Board’s management. 7 Page 176
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Fraud risk assessment Question Management response 1. Has Moray Integration Joint Board’s assessed the risk of material misstatement in the financial statements due to fraud? How has the process of identifying and responding to the risk of fraud been undertaken and what are the results of this process? How do the Moray Integration Joint Board’s risk management processes link to financial reporting? The MIJB has established risk management, governance and operating procedures to mitigate the risk of material misstatement in the financial statements. Agreed arrangements within the NHS for the investigation of fraud. In regard to the MIJB, Financial Regulations detail that all staff irregularities should be reported to the Chief Internal Auditor. This is supported by the Council’s Policy to Combat Fraud, Theft, Bribery and Corruption and the Whistleblowing Policy. In addition, an annual review of its counter-fraud framework is undertaken to help minimise the risk and impact of fraud. Although management is responsible for designing and operating effective controls, the review provides additional assurance by identifying improvements to strengthen fraud prevention and detection. It covers governance, fraud risk assessments, staff awareness etc. The review follows the CIPFA Code of Practice and includes targeted testing in higher-risk areas informed by public-sector fraud cases and regulatory guidance All irregularities and system reviews will be reported to the Audit, Performance and Risk Committee. The strategic risk register detailing the MIJB’s principal risks are regularly reviewed by SMT, with an annual report provided to MIJB Board. Services are also required to maintain risk registers detailing identifiable risks and mitigating actions/controls. In addition, the Chief Internal Auditor (MIJB) also prepares a risk-based audit plan that considers the IJB’s strategic objectives, associated risks and senior management's view. 2. What have you determined to be the classes of accounts, transactions and disclosures most at risk to fraud? Risk registers are also maintained by the parent organisations. Internal Audit will also review and test transactions to ensure compliance with Council Regulations and Procedures. IDEA, a computer-assisted software system, is used to analyse data and select samples for transaction testing under the direction of MIJB. 3. Are you aware of any instances of actual, suspected or alleged fraud, errors or other irregularities either within Moray Integration Joint Board as a whole, or within specific departments since 1 April 2025? If so, please provide details No irregularity known below the £5000 reporting threshold 8 Page 177
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Fraud risk assessment Question Management response 4. As a management team, how do you communicate risk issues (including fraud) to those charged with governance? Both the NHS and the Council have their own regulations regarding fraud. The NHS Counter Fraud Authority (NHSCFA) is a health authority charged with identifying, investigating and preventing fraud and other economic crimes within the NHS and the wider health group. The Council’s Financial Regulations require that all irregularities be reported to the Service Manager Internal Audit and Risk (CAE). The Service Manager Internal Audit and Risk (CAE) is also responsible for supporting the Council’s risk management arrangements which includes regularly reviewing the principal risks facing the Council. Principal risks facing the MIJB are reviewed regularly by SMT and the strategic risk register is then accordingly updated. The Chief Internal Auditor has an agreement to report NHS Grampian internal audit reviews to the MIJB Audit, Performance and Risk Committee. An agreed protocol is also being developed to govern fraud investigations, recognising that officers employed by both NHS Grampian and the Council have access to each organisation’s systems. This protocol is intended to ensure consistent, controlled and secure handling of any investigation where cross-organisational access or activity is involved 5. Have you identified any specific fraud risks? If so, please provide details Do you have any concerns there are areas that are at risk of fraud? Are there particular locations within Moray Integration Joint Board where fraud is more likely to occur? As part of the risk-based approach to developing the Annual Audit Plan, the Chief Internal Auditor considers fraud risks when determining which reviews should be undertaken. Where a specific fraud-related risk requires further scrutiny, it will either be included as a stand-alone project within the Audit Plan or incorporated into the annual counter-fraud review. However, the scope of this work applies only to services funded by the Council. 6. What processes do Moray Integration Joint Board have in place to identify and respond to risks of fraud? The NHS Counter Fraud Authority (NHSCFA) is responsible for identifying, investigating and preventing fraud within the NHS. The Council Financial Regulations detail that irregularities should be reported to the Audit and Risk Manager. This is supported by the Policy to Combat Fraud, Theft, Bribery and Corruption and the Whistleblowing Policy. In addition, the Council participates in the National Fraud Initiative data matching exercise and also publicises a point of contact to report fraud or irregularities involving the misuse of council resource 9 Page 178
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Fraud risk assessment Question Management response 7. How do you assess the overall control environment for Moray Integration Joint Board, including: • the existence of internal controls, including segregation of duties; and • the process for reviewing the effectiveness the system of internal control? If internal controls are not in place or not effective where are the risk areas and what mitigating actions have been taken? What other controls are in place to help prevent, deter or detect fraud? Are there any areas where there is a potential for override of controls or inappropriate influence over the financial reporting process (for example because of undue pressure to achieve financial targets)? If so, please provide details The responsibility for developing and maintaining sound control environment rests with management. However, internal audit prepares a risk based audit plan which considers the MIJB’s strategic objectives and associated risks. While the prevention of fraud and error rests with management through the design and operation of suitable systems of control, reviews undertaken by Internal Audit will make recommendations to improve the control environment. In addition, an annual review of the Council’s counter-fraud framework is undertaken, and this extends to services that fall under the direction of the MIJB. 8. Are there any areas where there is potential for misreporting? If so, please provide details None noted 10 Page 179
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Fraud risk assessment Question Management response 9. How does Moray Integration Joint Board communicate and encourage ethical behaviours and business processes of it’s staff and contractors? How do you encourage staff to report their concerns about fraud? What concerns are staff expected to report about fraud? Have any significant issues been reported? If so, please provide details Established arrangements exist to communicate and encourage ethical behaviours and business processes of its staff and contractors. Managers have an ongoing responsibility for implementing effective systems of control which secure the legitimacy of expenditure, the safeguarding of assets and income, the reliability of management information, the accuracy of record keeping and compliance with statutory guidance. They are also responsible for communicating this policy to their staff and ensuring established systems are followed. As detailed, the NHS Counter Fraud Authority (NHSCFA) is responsible for identifying, investigating and preventing fraud and other economic crimes within the NHS and the wider health group. The Council has a Policy to Combat Fraud, Theft, Bribery and Corruption. This policy is built around a counter fraud culture supported by practices to deter and detect fraudulent and corrupt activities. It takes account of the Council’s statutory obligations, including, and in particular, the provisions of the Bribery Act 2010. Council Financial Regulations detail that all irregularities should be reported to the Audit and Risk Manager. In addition, a Confidential ‘whistle blowing’ policy and procedure is in place, enabling employees to raise any concerns about any aspect of the Council’s work without fear of victimisation, subsequent discrimination or disadvantage, and in the knowledge that such concerns will be properly investigated 10. From a fraud and corruption perspective, what are considered to be high-risk posts? How are the risks relating to these posts identified, assessed and managed? There is an expectation that all staff and elected board members will act within the law and with honesty and integrity at all times. In particular, all staff and elected board members are expected to refrain from engaging in fraudulent or corrupt activity of any kind and shall refrain from offering, making or accepting bribes, whether financial or otherwise. Governance standards promote values and behaviours for the MIJB that demonstrate how it will uphold good practice and high standards of conduct. These include codes of conduct for both elected board members and employees and reflect the principles of public life identified by the Nolan Committee, including selflessness, honesty and integrity. This also takes in the Duty (Public Service) and Respect principles added by the Scottish Government 11. Are you aware of any related party relationships or transactions that could give rise to instances of fraud? If so, please provide details How do you mitigate the risks associated with fraud related to related party relationships and transactions? None noted 11 Page 180
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Fraud risk assessment Question Management response 12. What arrangements are in place to report fraud issues and risks to the Audit Committee? How does the Audit Committee exercise oversight over management's processes for identifying and responding to risks of fraud and breaches of internal control? What has been the outcome of these arrangements so far this year? The Global Internal Audit Standards (GIAS) applicable to Local Government in Scotland requires Internal Audit to report functionally to the Audit, Performance and Risk Committee on various issues relative to the work of the Internal Audit Service, including special investigations. The Audit, Performance and Risk Committee has a remit which includes ensuring that the highest standards of probity and public accountability are demonstrated. This involves oversight of internal control processes as a contribution to good governance and generally supporting an anti-fraud, theft, corruption, and bribery culture. This Committee considers reports produced by Internal and External Audit on the IJB’s systems; reports which include recommendations to strengthen internal controls and in turn reduce the risk of fraud and related behaviours going undetected. Further to the agreement reached with NHS Grampian, any internal audit reviews that are relevant to the MIJB are reported by the Chief Internal Auditor to the Audit, Performance and Risk Committee. This ensures that the Committee is kept informed of audit matters that may impact services directed by the MIJB and supports effective oversight across both partner organisations. 13. Are you aware of any whistle blowing potential or complaints by potential whistle blowers? If so, what has been your response? None noted 14. Have any reports been made under the Bribery Act? If so, please provide details None noted 12 Page 181
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Law and regulations Matters in relation to laws and regulations ISA (UK) 250 requires us to consider the impact of laws and regulations in an audit of the financial statements. Management, with the oversight of the Audit Committee, is responsible for ensuring that Moray Integration Joint Board’s operations are conducted in accordance with laws and regulations, including those that determine amounts in the financial statements. As auditor, we are responsible for obtaining reasonable assurance that the financial statements are free from material misstatement due to fraud or error, taking into account the appropriate legal and regulatory framework. As part of our risk assessment procedures we are required to make inquiries of management and the Audit Committee as to whether the body is in compliance with laws and regulations. Where we become aware of non-compliance or suspected non-compliance we need to gain an understanding of the non-compliance and the possible effect on the financial statements. Risk assessment questions have been set out below together with responses from management. 13 Page 182
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Impact of laws and regulations Question Management response 1. How does management gain assurance that all relevant laws and regulations have been complied with? What arrangements does Moray Integration Joint Board have in place to prevent and detect non-compliance with laws and regulations? Are you aware of any changes to the Moray Integration Joint Board’s regulatory environment that may have a significant impact on the Moray Integration Joint Board’s financial statements? Generally speaking each service area are familiar with the statutory regime in which they operate and will keep up to speed with developments through their professional associations such as CIPFA or SOLAR. Changes to legislation, consultations and guidance are notified to the IJB by the Scottish Government and are distributed to the relevant departmental area. The legal section has teams which specialise in different areas of Council activity and will be involved (at the request of client departments) in the implementation of more complex changes (such as formation of the IJB) and in any areas where legislation is unclear. Legal compliance will often be subject to external regulation (for example data protection). The IJB’s Integration Scheme (detailing the powers given to officers to implement services under specified legislation) is reviewed annually in line with revised legislative powers, in consultation with client departments 2. How is the Audit Committee provided with assurance that all relevant laws and regulations have been complied with? Overview of committee reports undertaken by Legal Services 3. Have there been any instances of non-compliance or suspected non-compliance with laws and regulation since 1 April 2025 with an on-going impact on the 2025/26 financial statements? If so, please provide details Not aware of any 4. Are there any actual or potential litigation or claims that would affect the financial statements? If so, please provide details None known 14 Page 183
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Impact of laws and regulations Question Management response 5. What arrangements does Moray Integration Joint Board have in place to identify, evaluate and account for litigation or claims? The legal section within Moray Council has teams which specialise in different areas of activity and will be involved (at the request of client departments) in the implementation of more complex changes (such as formation of the MIJB) and in any areas where legislation is unclear. Where necessary external advice will be sought 6. Have there been any reports from other regulatory bodies, such as HM Revenues and Customs, which indicate non-compliance? If so, please provide details None known 15 Page 184
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Related Parties Matters in relation to Related Parties Moray Integration Joint Board are required to disclose transactions with bodies/individuals that would be classed as related parties. These may include: ■ bodies that directly, or indirectly through one or more intermediaries, control, or are controlled by Moray Integration Joint Board ■ associates; ■ joint ventures; ■ a body that has an interest in the authority that gives it significant influence over the Moray Integration Joint Board; ■ key management personnel, and close members of the family of key management personnel, and ■ post-employment benefit plans (pension fund) for the benefit of employees of the Moray Integration Joint Board, or of any body that is a related party of the Moray Integration Joint Board. A disclosure is required if a transaction (or series of transactions) is material on either side, i.e. if a transaction is immaterial from the [type of body]’s perspective but material from a related party viewpoint then the Moray Integration Joint Board must disclose it. ISA (UK) 550 requires us to review your procedures for identifying related party transactions and obtain an understanding of the controls that you have established to identify such transactions. We will also carry out testing to ensure the related party transaction disclosures you make in the financial statements are complete and accurate. 16 Page 185
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Related Parties Question Management response 1. Have there been any changes in the related parties including those disclosed in Moray Integration Joint Board’s 2025/26 financial statements? If so please summarise: • the nature of the relationship between these related parties and Moray Integration Joint Board whether Moray Integration Joint Board has entered into or plans to enter into any transactions with these related parties • the type and purpose of these transactions No changes 2. What controls does Moray Integration Joint Board have in place to identify, account for and disclose related party transactions and relationships? Senior Officers and Elected Board Members make annual returns and members interests are regularly updated on the website, any significant factors that arise as part of this process would be factored into the Related Parties Note in the Annual Accounts 3. What controls are in place to authorise and approve significant transactions and arrangements with related parties? Normal procedures following the parties authorisation policies would apply – transactions over agreed limits are checked by Chief Financial Officer or Director of finance 4. What controls are in place to authorise and approve significant transactions outside of the normal course of business? For significant transactions that are new and outside the normal course of business IJB Board approval is required 17 Page 186
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Going Concern Matters in relation to Going Concern The audit approach for going concern is based on the requirements of ISA (UK) 570, as interpreted by Practice Note 10: Audit of financial statements and regularity of public sector bodies in the United Kingdom (Revised 2020). It also takes into account the National Audit Office's Supplementary Guidance Note (SGN) 01: Going Concern – Auditors’ responsibilities for local public bodies. Practice Note 10 confirms that in many (but not all) public sector bodies, the use of the going concern basis of accounting is not a matter of significant focus of the auditor’s time and resources because the applicable financial reporting frameworks envisage that the going concern basis for accounting will apply where the body’s services will continue to be delivered by the public sector. In such cases, a material uncertainty related to going concern is unlikely to exist. For this reason, a straightforward and standardised approach to compliance with ISA (UK) 570 will often be appropriate for public sector bodies. This will be a proportionate approach to going concern based on the body’s circumstances and the applicable financial reporting framework. In line with Practice Note 10, the auditor’s assessment of going concern should take account of the statutory nature of the body and the fact that the financial reporting framework for local government bodies presume going concern in the event of anticipated continuation of provision of the services provided by the body. Therefore, the public sector auditor applies a ‘continued provision of service approach’, unless there is clear evidence to the contrary. This would also apply even where those services are planned to transfer to another body, as in such circumstances, the underlying services will continue. For many public sector bodies, the financial sustainability of the body and the services it provides are more likely to be of significant public interest than the application of the going concern basis of accounting. Financial sustainability is a key component of value for money work and it is through such work that it will be considered. Page 187
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Going Concern Question Management response 1. What processes and controls does management have in place to identify events and / or conditions which may indicate that the statutory services being provided by Moray Integration Joint Board will no longer continue? Regular reporting on the IJB’s Finances would highlight any conditions which may mean the MIJB is no longer able to deliver statutory duties. Regular performance reports would also highlight this 2. Are management aware of any factors which may mean for Moray Integration Joint Board that either statutory services will no longer be provided or that funding for statutory services will be discontinued? If so, what are they? Not aware of any 3. With regard to the statutory services currently provided by Moray Integration Joint Board does Moray Integration Joint Board expect to continue to deliver them for the foreseeable future, or will they be delivered by related public authorities if there are any plans for Moray Integration Joint Board to cease to exist? The MIJB would expect to continue to deliver statutory services 4. Are management satisfied that the financial reporting framework permits Moray Integration Joint Board to prepare its financial statements on a going concern basis? Are management satisfied that preparing financial statements on a going concern basis will provide a faithful representation of the items in the financial statements? The annual accounts are prepared on a going concern basis and this will provide a faithful representation of the items included in the financial statements Page 188
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Accounting estimates Matters in relation to accounting estimates ISA (UK) 540 (Revised December 2018) requires auditors to understand and assess a body’s internal controls over accounting estimates, including: • The nature and extent of oversight and governance over management’s financial reporting process relevant to accounting estimates; • How management identifies the need for and applies specialised skills or knowledge related to accounting estimates; • How the body’s risk management process identifies and addresses risks relating to accounting estimates; • The body’s information system as it relates to accounting estimates; • The body’s control activities in relation to accounting estimates; and • How management reviews the outcomes of previous accounting estimates. As part of this process auditors also need to obtain an understanding of the role of those charged with governance, which is particularly important where the estimates have high estimation uncertainty, or require significant judgement. Specifically do Audit Committee members: • Understand the characteristics of the methods and models used to make the accounting estimates and the risks related to them; • Oversee management’s process for making accounting estimates, including the use of models, and the monitoring activities undertaken by management; and • Evaluate how management made the accounting estimates? We would ask the Audit Committee to satisfy itself that the arrangements for accounting estimates are adequate. 20 Page 189
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Accounting Estimates - General Enquiries of Management Question Management response 1. What are the classes of transactions, events and conditions, that are significant to the financial statements that give rise to the need for, or changes in, accounting estimate and related disclosures? None directly but the value of the pension liability from partner organisations would have implications 2. How does the Moray Integration Joint Board’s risk management process identify and address risks relating to accounting estimates? Managed by the partner organisations 3. How does management identify the methods, assumptions or source data, and the need for changes in them, in relation to key accounting estimates? The results of prior year audits are looked at to see whether there was any material concerns raised or amendments made 4. How do management review the outcomes of previous accounting estimates? The results of prior year audits are looked at to see whether there was any material concerns raised or amendments made 5. Were any changes made to the estimation processes in 2025/26 and, if so, what was the reason for these? No changes Page 190
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Accounting Estimates - General Enquiries of Management Question Management response 6. How does management identify the need for and apply specialised skills or knowledge related to accounting estimates? Each area is looked at in isolation and the relevant skills/knowledge/capacity considered 7. How does the Moray Integration Joint Board determine what control activities are needed for significant accounting estimates, including the controls at any service providers or management experts? Ensuring that relevant information is provided on time and accurately to ensure that the information received can be relied upon 8. How does management monitor the operation of control activities related to accounting estimates, including the key controls at any service providers or management experts? Regular updates provided by preparers of the Accounts on any issues that arise 9. What is the nature and extent of oversight and governance over management’s financial reporting process relevant to accounting estimates, including: - Management’s process for making significant accounting estimates - The methods and models used - The resultant accounting estimates included in the financial statements. The unaudited accounts are reported to Committee and then again upon completion of the audit. External Audit reporting also helps to inform on estimates Page 191
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Accounting Estimates - General Enquiries of Management Question Management response 10. Are management aware of any transactions, events, conditions (or changes in these) that may give rise to recognition or disclosure of significant accounting estimates that require significant judgement (other than those in Appendix A)? If so, what are they? Not aware of any 11. Why are management satisfied that their arrangements for the accounting estimates, as detailed in Appendix A, are reasonable? No major changes required to annual accounts in previous years 12. How is the Audit Committee provided with assurance that the arrangements for accounting estimates are adequate ? Annual accounts are reported 23 Page 192
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Appendix A Accounting Estimates Estimate Method / model used to make the estimate Controls used to identify estimates Whether management have used an expert Underlying assumptions: - Assessment of degree of uncertainty - Consideration of alternative estimates Has there been a change in accounting method in year? Valuation of defined benefit net pension fund liabilities Based on information from actuaries Information provided to actuaries based on year end position reducing the need for use of estimates. Yes Disclosure in accounts regarding the changes that could happen and the impact it would have on the figures included in the accounts No Accruals Based on actual entries in the ledger, or on information received from departments No In most cases based on actual ledger entries so no estimation . Where estimates are provided we know it will be based on professional judgement and we would query if it was materially different from estimates provided No Accrued income Based on actual entries in the ledger, or on information received from departments No In most cases based on actual ledger entries so no estimation . Where estimates are provided we know it will be based on professional judgement and we would query if it was materially different from estimates provided No 24 Page 193
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Best Value Consolidated List of Improvement Actions APPENDIX 3 1 2024/25 Recommendations • Recommendations identified on the wider scope risks and planned audit work. Background Recommendations Action Owner Progress Update March 2025 Completion Date (black – due date Green completed date) 1.Financial Management – Reporting of savings The budget and financial reports presented to the Board and Audit, Risk and Performance Committee do not detail whether savings are expected to be recurring in nature. Adding this context into both documents would provide a clear indication as to whether savings are expected to be one off savings or whether the benefit will continue in future years. The IJB prepare a year-end outturn which includes the final high-level savings position. However, this report does not include the appendix presented as part of the in-year monitoring reports detailing the final delivery position. It would be good practice to provide this same level of detail as part of the year-end outturn report which allows a comparison across the full financial year. The IJB should indicate whether savings are expected to be recurring or non-recurring in nature. The IJB should prepare a report showing a breakdown of savings delivered on a project basis as part of the year-end outturn report CFO Recurring and non recurring savings have been reported throughout 2025/26. The outturn report includes savings details 30 June 2026 25 June 2026 2.Assessment over the arrangements to secure Best Value We have noted that the IJB have no mechanism for formally reviewing and reporting on the arrangements to secure best value. The IJB should undertake a formal review of the Best Value assurance framework and complete an assessment of the arrangements to secure best value. The outcome of the assessment should be reported to the Audit, Performance and Risk Committee CFO Self assessment reported to Audit, Performance & Risk 25 June 2026. 31 March 2026 25 June 2026 Page 194
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Best Value Consolidated List of Improvement Actions APPENDIX 3 2 Prior Year Recommendations • Recommendations made as part of the wider scope work for the 2023/24 audit. Background Recommendations Progress update 2024/25 Progress Update at March 2026 Completion Date (black – due date Green completed date) 1. Financial Sustainability – Reserves The IJB intend to utilise £1.346 million of earmarked reserves to bridge the budget deficit in 2024/25. There is a risk that continued reliance on reserves to bridge funding gaps will create financial sustainability issues for the IJB. The IJB will need to continue to monitor the percentage level of adequate reserves as funding gaps continue to grow and the IJB looks to transformation in future years to ensure reserves do not dip to an unsustainable level. The 2025/26 budget has been agreed, with the IJB intending to use £1.000 million of earmarked reserves balances. The IJB have a limited amount of reserves balances (£1.450 million as at end of 2024/25) and continued use of reserves balances to manage the funding gap is not sustainable. The IJB should aim to bridge funding gaps through transformation and identifying alternative ways to deliver services 2026/27 budget has been agreed without the use of any reserves to balance the budget. There is no general reserve but there is ear marked reserves totalling £3m 31 March 2026 implemented 2. Senior Management Team Following the retirement of the previous Chief Officer, the current Chief Officer has been appointed on an interim basis. Furthermore, the Chief Social Worker at the Council is also appointed on an interim basis. The IJB and Council need to secure permanent positions for the both posts to provide certainty over the future direction of the IJB. The IJB have recruited a permanent Chief Officer who has been in role since November 2024 and had previously been appointed on an interim basis. To date, no permanent appointment has been made to the CSWO role meaning this recommendation is in progress. Recruitment has been successful for the appointment of a permanent Chief Social Work Officer, the candidate will be commencing with Moray HSCP in August 2026; 31 March 2026 implemented 3. Internal Audit Limited Assurance Opinion This is the third year in succession that Internal Audit have provided a limited assurance opinion. Fundamentally, this indicates there are weaknesses in the framework of governance, risk management and control. The IJB should have definitive plans in place to avoid further limited assurance opinions This is the fourth year in succession that Internal Audit have provided a limited assurance opinion. Fundamentally, this indicates there are weaknesses in the framework of governance, risk management and control. The IJB still require to put definitive plans in place to avoid further limited assurance opinions. Significant progress has been made, however there are still concerns with the recommendations being implemented following audits and progress on CareFirst (system is currently being replaced with a go live date of 31 March 2027), that the Internal Audit Manager is still considering giving a limited assurance. Will be in place for 2026/27 4. Performance Report - Management should review the format of the Performance Report and content to ensure it is succinct, focuses on the IJB;s performance and outcomes, and supports the user of the financial statements to understand the IJB’s purpose and achievements in year There has been no updates to the format of the Performance Report in 2024/25. The performance was reviewed during 2025/26 following the approval of the Strategic delivery plan approved by the IJB Committee on 27 March 2025. Format was updated from the Q3 report implemented Page 195
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Best Value Consolidated List of Improvement Actions APPENDIX 3 3 Background Recommendations Progress update 2024/25 Progress Update at March 2026 Completion Date (black – due date Green completed date) 5. Financial Sustainability – Transformation A depth of pace will need to be undertaken on the transformation programme to ensure the IJB can bridge the significant funding gap in a short space of time, to ensure that not only efficiencies can be delivered but that financial sustainability can be achieved. To ensure financial sustainability for the medium to longer term, the IJB will need to ensure that it is able to deliver increased productivity and efficiency initiatives to reduce costs and deliver financial benefits. The IJB will need to upscale the pace and delivery of transformation to achieve and mitigate the risk of becoming financially unsustainable A significant transformation/ savings plan is in place for 2024/25 onwards Savings plan in place for 2025/26 covered 2 financial years and the savings plan in place for 2026/2 will again be over more than 1 financial year. Transformation plans are also part of the savings plan for future years In conjunction with the medium term financial framework 6. Vision, Leadership and Governance – Internal Audit Moray IJB should ensure audit recommendation dates are realistic when set and are monitored for implementation. Where dates are moved or not met, a thorough understanding and follow up of these should be sought and explanations provided. A mechanism should be implemented to follow up on officers should missing recommendation deadlines become regular. Internal audit consult senior managers as part of the audit process. All dates set by internal audit are in agreement with the service with realistic achievable dates See details at point 3 above, same requirement Page 196
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 25 JUNE 2026 SUBJECT: MORAY ADULT MENTAL HEALTH STRATEGIC GROUP PERFORMANCE REPORT BY: DEPUTY HEAD OF SERVICE AND CONSULTANT IN PUBLIC HEALTH 1. REASON FOR REPORT 1.1 To provide the Board with assurance on progress towards delivery of the Moray Mental Health and Wellbeing Strategy 2016 - 2026. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) note the progress towards achievement of the Moray Mental Health and Wellbeing Strategy 2016 – 2026; ii) acknowledge the performance of Moray Mental Health services in relation to seven key performance measures; and iii) endorse the development of a new Moray Mental Health Strategy 2026/27. 3. BACKGROUND 3.1 This report provides an update on the Moray Adult Mental Health Strategic Group Progress Report submitted to the Moray Integration Joint Board (MIJB) on 29 May 2025 (para 10 of minute refers). 3.2 Scotland continues to face a growing mental health crisis. Moray and wider NHS Grampian are reporting unprecedented requests for support from mental wellbeing services and increased referrals for mental illness. This is demonstrated through rising demand for services, increased complexity and acuity of cases, and persistent inequalities in access and support. While there is a focus on developing and expanding services, significant workforce challenges, and funding shortfalls continue to challenge progress. Many of these challenges are amplified in Moray Item 9. Page 197
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due to the rural nature of many of our communities, difficulties in the recruitment and retention of staff, and access to specialist tertiary services. 3.3 The Moray Adult Mental Health Strategic Group continue to meet 6 times per year to facilitate progress of the Service Delivery Plan. All key stakeholders continue to engage positively to ensure a whole system approach is taken, with a focus from early intervention and prevention through to secondary and tertiary care. 3.4 The Moray Adult Mental Health and Wellbeing Strategic Group aim to ensure that the collective voice of lived and living experience influences the future design of services and that there is a capacity to respond to the challenges facing individuals and families affected by mental health in Moray. The group work closely with Moray Wellbeing Hub, Making Recovery Real Partnership and tsiMoray to achieve this. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Moray Mental Health and Wellbeing Delivery Plan 2024 – 2026 is included in Appendix 1. The Delivery Plan is laid out in 6 sections • Early intervention, prevention and self-management • Mental Health Quality Standard 1: Access • Mental Health Quality Standard 2: Assessment, Care Planning, Treatment & Support • Mental Health Quality Standard 3: Moving between and out of services • Mental Health Quality Standard 4: Workforce • Mental Health Quality Standard 5: Governance & accountability 4.2 Moray Health and Social Care Partnership continue to work closely with the Mental Welfare Commission, Health Improvement Scotland, and other national organisations to improve practice through specific case reviews, shared reflection, and visits/inspections of service provision. Updates are reported periodically to Moray Adult Mental Health Strategic Group to ensure the learning informs discussions and future service design. 4.3 The Moray Mental Health Strategy ‘Good Mental Health for All 2016 – 2026’ requires to be updated. This will be a priority for the Moray Mental Health and Wellbeing Strategic Group over the next 12 months. The new document and associated strategic planning framework will incorporate child and adult mental health and will link actions to key performance indicators from the outset. The national Mental Health and Wellbeing Strategy was last updated in 2023 and remains current with an emphasis on ‘shifting care toward prevention, early intervention, and community-based support. The overarching goal is to achieve full parity between mental and physical health, and to ensure that anyone seeking assistance only has to ask once to get fast, effective help.’ 4.4 Significant progress has been made over the last 12 months in delivering mental health and well being services within Moray. On the whole performance remains on par or better than the Grampian and national average. Workforce challenges which were preventing consistency within the senior management team and in the delivery of clinical services have to a large degree been addressed through Page 198
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permanent recruitment of senior management staffing and through recruitment to critical vacancies within psychiatry, psychology, and nursing. Moray Mental Health Performance Indicators 4.5 Seven performance indicators have been identified to provide performance oversight of mental health services in Moray and wider Grampian. The indicators form part of the suite of national quality indicators for mental health in Scotland. 4.6 In five of the seven indicators Moray Mental Health Services preform above the Grampian and national average, in one of the seven indicators Moray performs in line with the Grampian average, and in one indicator Moray performs below the national average. a) Average Length of Stay within a Mental Health Ward (2025) The average length of stay within Ward 4 is 34 days; this number has decreased year upon year for the past three years. The average length of stay in Muirton Ward is 72 days and again has dropped year upon year. The length of stay in Ward 4 is 19% lower than the national average (63 days), and in Muirton ward is 56% lower than national average (143 days) respectively. Ward 2023 2024 2025 National Avg Acute 49 49 42 National Avg Dementia 169 147 163 Ward 4 42 36 34 Muirton 105 126 72 b) The percentage of readmissions to a Mental Health Ward within 28 days of Discharge (2025) The percentage of readmissions within 28 days to Ward 4 is 3.7% and for Muirton is 6.7% compared to the Grampian average of 10.55% and national average of 6.3%. Ward 2024 2025 National 7.2% 6.3% Grampian 9.4% 10.5% Ward 4 5.2% 3.7% Muirton 0% 6.7% c) The percentage of people followed up within 7 days of discharge from a Mental Health Ward (2025) The percentage of people followed up within 7 days of discharge for Ward 4 is 93% for Muirton is 87%. The Grampian average is 74% and the national average is 54%. Ward type 2023 2024 2025 2026 (to Page 199
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current) National Avg Acute 55.7% 62% 54% Not available Grampian 60% 66% 74% 76% Ward 4 68% 69% 93% 100% Muirton 100% 87% 87% 100% d) Adult Community Mental Health Referrals to First Appointment The Moray percentage of Adult mental health referrals to first appointment within 8 weeks is 58%. The Grampian average is 57%. Area Within 1 week 1 to 8 Weeks >8 Weeks Total number of referrals Moray 13% 45% 42% 781 Grampian Avg. 10% 47% 42% 3321 e) Older Adult (65+) Community Mental Health Referrals to First Appointment The Moray percentage of Older Adult mental health referrals to first appointment within 8 weeks is 90%. The Grampian average is 69%. Area Within 1 week 2 to 8 Weeks >8 Weeks Total number of referrals Moray 10% 80% 10% 525 Grampian Avg. 10% 59% 31% 2611 f) The percentage of people who commence psychological therapy based treatment within 18 weeks of referral (2025) The national target is 90%, with a national average of 82.1% in last quarter (2025/26). The Moray percentage over past year was 58% The Grampian average was 36%. The Moray performance against this indicator has remained low for a sustained period of time. The performance indicator combines both Adult Psychological Therapies and Primary Care Psychological Therapies. When the two indicators are separated, the performance of Moray Adult Psychological Therapies has improved over the past 3 years with the percentage of people waiting for Adult Psychological Therapies who are seen within 18 weeks in Moray being 90% in 2025. The Grampian average was 64.5%. Page 200
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Table – Adult Psychological Therapies data sample on 04/06/26 indicated Area 0 – 18 weeks 19 – 36 weeks 37 - 52 weeks Over 52 weeks Total number of people waiting Moray 97.9% 2.1% 0% 0% 94 City 45.8% 31.3% 22.9% 0% 83 Shire 66.4% 27.9% 5.7% 0% 122 However, the percentage of people waiting for Primary Care Psychological Therapies who are seen within 18 weeks in Moray was 34% in 2025. The Grampian average was 68%. Table – Primary Care Psychological Therapies data sample on 04/06/26 indicated Area 0 – 18 weeks 19 – 36 weeks 37 - 52 weeks Over 52 weeks Total number of people waiting Moray 54% 45% 1% 0% 177 City 70% 24% 5% 1% 1011 Shire 87.9% 11.1% 1% 0% 789 The learning taken from improving the performance of Adult Psychological therapies is now being utilised to improve Primary Care Psychological Therapies performance with improvements expected within the current calendar year. g) Number of days people spend in hospital when they are ready to be discharged (2024/25) The number of days spent in hospital within mental health specialties, when patients are ready to be discharged, was 24.2 per 1,000 population for Grampian in 2024/25, compared to 28.2 for Scotland. The total number of days for Moray patients during this period was 1548, a rate of 20 per 1,000 population. Moray continues to have low levels of delayed discharges within mental health specialities with figures indicating a further improving trend into 2025/26. 4.7 There remain significant challenges in delivering the Moray Mental Health and Wellbeing Strategy 2016 – 2026 due to: • Pressures of sustaining services within the current financial climate • Ongoing recruitment and retention of staff in public, private and third sector settings • Sustaining staff health and wellbeing • Capacity to lead the changes required whilst sustaining management and delivery of clinical services • Availability and accessibility of good quality and timely data • Supporting increased and meaningful inclusion of lived and living experience in service design and delivery • Enhancing ADHD and Autism pathways • Strengthening the strategic approach to dementia Page 201
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• Sustaining Mental Health Officer staffing • Processing of applications for Guardianship 4.8 The public expectation of mental health services has never been greater. Moray Health and Social Care Partnership’s ability to meet this expectation against the difficulties outlined in paragraph 4.6 is incredibly challenging. The solution involves continuing to build on a whole system approach to mental health in Moray ensuring that community assets are supported to contribute towards prevention services, and information and sign posting is available to ensure self- management where appropriate. The aim is to develop pathways that ensure primary care services can support those people whose mental health is having a significant impact on their life, and where secondary care services can provide support for those individuals with a mental illness. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The approach set out in this report is consistent with the MIJB Strategic Plan. (b) Policy and Legal There are no implications for policy or legal. (c) Financial implications None at present; however, delivery of the plan may require some reprioritisation or shifting of resource. (d) Risk Implications and Mitigation Risks are recorded on the Moray Health and Social Care Partnership Risk Register, actions plans are in place and are routinely monitored. (e) Staffing Implications ¬None arising directly from this report. (f) Property There are no implications on property provision. (g) Equalities/Socio Economic Impact None arising directly from this report. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions None arising from this report. (j) Consultations The following people were consulted during the writing of this report: Partnership Development Lead, tsiMoray Page 202
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Sean Coady, Head of Service, Moray Health and Social Care Partnership Service Manager, Moray Mental Health and Drug and Alcohol Services Service Manager, SAMH ADP Coordinator, Moray Alcohol and Drug Partnership Public Protection Lead Officer, Moray Public Protection Team Lead Nurse, Mental Health and Substance Misuse Service, Moray GP Clinical Lead for Moray Clinical Director Mental Health Innovation Lead, DHI Improvement Officer Mental Wellbeing, Children’s Services Partnership Social Work Team Manager, Mental Health Consultant Practitioner Adults with Incapacity and Mental Health Lead Champion and Director, Moray Wellbeing Hub Consultant Clinical Psychologist, CAMHS Senior Commissioning Officer Service Manager, Policy Development and Commissioning 6. CONCLUSION 6.1 The Board are asked to note the updated Mental Health Service Delivery Plan 2024 – 26 and note the performance of Moray Mental Health Services against seven key performance measures. Author of Report: Iain Macdonald: Deputy Head of Service, MHSCP Background Papers: Appendix 1: Moray Mental Health and Wellbeing Service Delivery Plan Ref: Page 203
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APPENDIX 1 1 Appendix 1: Moray Mental Health Strategy Delivery Plan This delivery plan reflects the Moray Good Mental Health for All Strategy (2016-2026)i, and relevant national strategies and guidance documents, including ‘Scotland's Mental Health and Wellbeing Strategy 2023’ii which aims to: • Promote positive mental health and wellbeing for the whole population, improving understanding and tackling stigma, inequality and discrimination • Prevent mental health issues occurring or escalating and tackle underlying causes, adversities and inequalities wherever possible • Provide mental health and wellbeing support and care, ensuring people and communities can access the right information, skills, services and opportunities in the right place at the right time to meet their needs. The Delivery Plan is presented under the following headings: • Early intervention, prevention and self management • Mental Health Quality Standard 1: Access • Mental Health Quality Standard 2: Assessment, Care Planning, Treatment & Support • Mental Health Quality Standard 3: Moving between and out of services • Mental Health Quality Standard 4: Workforce • Mental Health Quality Standard 5: Governance & accountability This plan purely focusses on adult services at present; the medium term ambition is to merge the strategic planning processes for child and adult mental health services so that we see children as being clearly embedded within families and communities, enable seamless transitions from child to adult services (at whatever age and stage they occur) and can take a holistic approach to prevention of poor mental health. Throughout implementation of the plan we aim to embed the principles of prevention of poor mental health, and the Scottish Recovery Network which are to: Page 204
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APPENDIX 1 2 • Take a whole person approach • Champion and value lived experience by integrating it into all parts of the system • Embed peer support approaches and roles in mental health services and supports • Offer more community-based supports and choices so everyone can be supported when and where they need it • Work with others to create a more equal society where good mental health and wellbeing can flourishiii Section 1: Early intervention, prevention and self management: Underlying this section is the necessity of a move towards a preventative, population health model which promotes and sustains good mental health and wellbeing. Strategic Outcomes: • Communities, families and individuals are better equipped to support and protect people’s mental health and wellbeing and provide opportunities to connect with others. • More effective cross-policy action is in place to address the wide ranging factors that impact people’s mental health and wellbeing Outcome Actions Lead Timescale Progress Underlying determinants of good mental health are tackled, including financial inclusion, nurturing early years, healthy environments, active citizenship and participation and wellbeing of diverse communities. Work with Community Planning Partners to ensure cross policy actions that more effectively address the wide ranging social, economic and environmental factors that impact people’s mental health and wellbeing, including poverty, stigma, discrimination and injustice. Consultant in Public Health Mar 25 On track. This work is ongoing and taking place via the Community Planning Partnership, Community Planning Officers Group, GIRFEC Leadership Group, and the Fairer Moray Forum. It is a long term process. Positive attitudes to mental Work with CPP and other anchor organisations to adopt a ‘mental health in Health Improvement March 26 Public Health Scotland programme on the Mentally Page 205
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APPENDIX 1 3 health and to people with mental illness are promoted; we have raised awareness of mental health issues, reduced stigma and discrimination and promoted inclusion, including better access to mainstream services. all policies approach.’ Continue to tackle mental health stigma and ensure people can talk about their mental health and wellbeing, linking with See Me as appropriate. • Clear outcomes eg have worked with a minimum of 2 workplaces in each locality in Moray to implement mentally healthy Workplace policies. • The voice of lived experience has contributed to promotion of positive mental health within workplaces. Team Lead Making Recovery Real Partnership Flourishing Workplace framework now being offered across Moray. Wellbeing festival held May25, guided by the Five Ways to Wellbeing frame- work—Connect, Be Active, Take Notice, Keep Learning, and Give. The Festival aimed to raise awareness of local support services, encourage positive behaviour change, and foster community resili- ence. 70% participants re- ported positive outcomes Lived Experience: The Mental Wellbeing Strategic Group receives regular reports from Voice of Lived Experience and uses this feedback to adapt and develop services. We have promoted mental health, wellbeing and resilience through work; and addressed employability issues, including for those affected by mental ill health. Ensure that Employability Action Plan includes positive approaches to mental health & wellbeing. Employability Partnership Health Improvement Team Lead Oct 25 Health Improvement Team Lead is now the representative from the Moray Mental Health Strategic Group on the Employability partnership. People are supported to remain in work or return to employment through Moray Pathways’ training, support, Page 206
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APPENDIX 1 4 and coordinated employability services. Using Making Every Opportunity Count (MeOC) approach to link employability with health and wellbeing support to ensure people get the right help at the right time. We have developed social connections, tackled isolation, built resilience, strengthened use of community assets, including social prescribing, strengthening self care and peer support Roll out of social prescribing across Moray, building on existing Link Worker/ community connector roles Work with partners including Moray Wellbeing Hub to support the development of community hubs and building of community connections Health Improvement Team Lead CLD Lead May 26 Development of Community Connector roles is underway. We have promoted holistic health for people with long term conditions, promoting recovery approaches and social inclusion Review and Recommission: 1. Intensive Support Service – a high level support and recovery outreach service 2. Distress Brief Intervention Service – direct access self referral or via Health and Wellbeing Practitioners – for short term practical support for people not requiring secondary care MHSM Making Recovery Real Partnership MADP Coordinator Jan 25 Both services have recently been recommissioned under new arrangements for 4 years with potential for 2 further 12 month extensions 1. Intensive Recovery Service – SAMH 2. Distress Brief Intervention – SAMH Contract monitoring is now in place, with quarterly reporting to the Mental Health Strategic Group. We have improved Continue to commission Distress Brief MHSM, Making Dec 24 Distress Brief Intervention Page 207
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APPENDIX 1 5 responses to people in distress – both from services and the wider community, including action to prevent suicide and better support people who self harm. People experiencing crisis are kept safe and their situations do not further escalate Interventions – time limited and supported problem solving contact with people in distress for up to 14 days. Recovery Real Partnership and Moray Suicide Prevention Group Service has been commissioned as above. Trauma is recognised, responded to appropriately and prevented where possible. Ensure that all staff, operational and senior management, are trained in trauma- informed practice in line with Quality Standards. MHSM/Trauma Informed Practice Development Officer Sept 25 NHS Turas trauma informed practice training modules are being shared with the Moray Council Clive platform. 47 Council/HSCM teams were supported by Trauma Informed Practice Development Officer. Current processes and procedures are being reviewed to highlight good practice and areas which require further training. Page 208
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APPENDIX 1 6 Mental Health Quality Standard 1: Access: People in Moray have equitable and non discriminatory access to effective and relevant support for their mental health, within appropriate timescales. Outcome Actions Lead Timescale Progress People can access the person- centered support they require. Regardless of where contact is first made, patients will be supported to get the right help from the right source. We will have maximised the potential for digital innovation, tackling digital exclusion and literacy where it exists. Patients are able to easily access & understand information about who services are for, what is provided and how they can be referred to these. Staff feel more knowledgeable about other services in local area and how to link patients in to them. Develop an integrated mental health and wellbeing pathway, from community and self help, support for distress and crisis through to complex, severe and enduring and including a focus on recovery. This will include dynamic direct access as- sessment, easily accessible information about supports available and an effective method of information sharing between different services. MHSM Sep 25 Integrated Pathway is now in place Discover Pathways Moray | Mental Health Support Moray Community Connections digital platform is now fully functional. About the Project Police Flow Navigation Centre is now in place; this includes Police having direct access to Mental Health Practitioners for advice for patients in distress in the community. Page 209
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APPENDIX 1 7 Mental Health Quality Standard 2: Assessment, Care Planning, Treatment & Support: People with mental health conditions, including those with co-existing health conditions, experience improved quality and length of life, free from stigma and discrimination Mental health policies, support, care and treatment are better informed and shaped by people with lived experience of mental health issues and staff practitioners, with a focus on high quality provision that is recovery oriented. Outcome Actions Lead Timescale Progress Help and support will be centred around the person, respectful of their choices and based on evidence about what is most likely to help them. It will be focused on supporting them into independence and recovery. Comprehensive support and support that promote and support people’s mental health and wellbeing are available in a timely way that meets and respects individual needs. Identify and implement three projects to embed principles of realistic medicine and care in mental health service practice. For example: 1. Directory of services 2. Building a personalised approach to care 3. Implement shared decision making MHSM Sept 25 • Moray Community Connections digital platform includes mental health and wellbeing • GIRFE principles embedded in health and social care planning • Making Recovery Real Pathways website updated and refreshed • Increased focus on the interface between secondary care and primary care. Patients have a choice of how they access care and support; digitally or face to face. Expand offer of Near Me appointments MHSM Sept 25 In place but recognise the need to be flexible in adapting to needs and expectations. Strengthened support, care and treatment pathways for neurodiverse adults who require a diagnosis and support. Utilising adult National Neurodevelopmental Service Specification once it is available, strengthen, clarify and develop support MHSM Mar 26 There are now 575 people on the ADHD waiting list in Moray. National data indicates that 10 to 15% of these people will receive a Page 210
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APPENDIX 1 8 and care pathways for people requiring neurodevelopmental support, working in partnership with health, social care, third sector and other delivery partners. Identify appropriate and accessible supports for potentially neurodiverse adults who are awaiting assessment, aren’t functionally affected, or have lower-level needs. This may involve peer support. diagnosis; it is important that these people are not left waiting unnecessarily, or built false hope or expectation. Secondary care mental health services are working with colleagues in primary care and with Autism Scotland to review the current waiting list and to strengthen the screening and referral process. Current ADHD and Autism pathways have been clarified. The current staffing resource cannot meet the demands of the service. We will continue to utilise signposting and early intervention and support through the Moray Wellbeing Hub, Social Prescribing, Mental Health and Wellbeing practitioners, and Community Connections Moray platform. Public information and awareness campaign planned. Parity of services for older adults Understand the gaps in older adult services and develop plan to address these. MHSM Sept 25 This work is taking place as part of the Grampian wide review of Older People’s mental health services/pathways which is due to report in June 2026. Focus on recovery Continue to work with Scottish Recovery MRRP Sept 25 Projects in place, led by Moray Page 211
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APPENDIX 1 9 Network to develop and support the establishment of peer support networks in the settings where these will have most impact. Wellbeing Hub, including partners such as SAMH, SACRO, GREC and Arrows; note risk as funding ends March 2026. Ward 4/availability of an appropriate acute facility Respond to review of bed base being undertaken at Grampian wide level Establish a Moray group to ensure that local needs are considered, taken into account and fed back into overall Grampian review. MHSM Mar 25 Phase 1 of the Bed Base Review completed. Phase 2 is progressing with a focus on 7 key priorities. Regular reporting to the Grampian Mental Health and Learning Disability Board. Community Treatment & Support Model Explore and develop community-based models of psychiatric care and Psychiatric Assessment Suite MHSM Sept 25 This will be incorporated into the aim of the Mental Health Bed Base Review Priority 6. Community Treatment & Support Model Explore and develop community-based models of psychiatric care and Psychiatric Assessment Suite. Strengthen stepped care approach - develop business case for posts (potentially Band 7 Mental Health Practitioner) to work across Moray GP practices to provide thorough assessment of presentation/ problem, risk and identification of suitable options for care. Conduct self-assessment of specialist services and primary care, based on The National Confidential Inquiry into Suicide and Safety in Mental Health - Safer Services Toolkit. MHSM MHSM MHSM /Public Protecti on Lead Officer Sept 25 Dec 25 Workshops were facilitated with key stakeholders. Funding is not currently available to support Mental Health Practitioner posts, although the newly formed Grampian-wide Primary Care Board has indicated intent to progress this type of service, should funding become available. New action agreed - this will inform a number of improvement activities outlined within this plan. Page 212
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APPENDIX 1 10 Increased availability of timely, effective support, care and treatment that promotes and supports people’s mental health and wellbeing, meeting individual needs. Strengthen stepped care approach - develop business case for posts (potentially Band 7 Mental Health Practitioner) to work across Moray GP practices to provide thorough assessment of presentation/ problem, risk and identification of suitable options for care. Conduct self-assessment of specialist services and primary care, based on The National Confidential Inquiry into Suicide and Safety in Mental Health- Safer Services Toolkit. MHSM Sept 25 Being developed as part of the Grampian Older People’s and Dementia Pathway, due to report in June 2026. Page 213
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APPENDIX 1 11 Mental Health Quality Standard 3: Moving between and out of services Outcome Actions Lead Timescale Progress Ability to escalate or de-escalate treatment or support is as easy as possible; patient does not need to repeat their story and is supported in a seamless way. Remove barriers to accessing the right care, right place, right time and develop discharge and shared care arrangements with primary care, individuals and families. Implement dynamic case management, with the aim being to improve capacity but provide ease of access back into service if required. MHSM Sept 25 In place. Flexible and supportive structures are in place to support effective discharge – negotiated pathways to ensure patient’s needs are met, making patient movement up and down the pathway less complex. Introduce co-produced written care plans for transitions between services or discharge from services, which detail how to re-engage. Any risks should be clearly identified and documented, and the flexibility of transfer time and handover of care should be considered. Introduce case-based discussion regarding thresholds between primary and secondary care. Dynamic caseload management Community mental health staff to increase the level of working within community settings in order to strengthen relationships across the service. Understand what is required to strengthen effective MDTs within MHSM Sept 25 A Community Mental Health Nurse training plan and Community Mental Health Team Service Operating Procedure (SOP) has been finalised. An audit is currently being undertaken to evaluate the effectiveness of current pathways, and case flow between primary and secondary care. The audit will provide baseline information that can be used as a performance indicator for future audits of referral paths. Page 214
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APPENDIX 1 12 localities and implement action to ensure maximum effectiveness. Develop an effective process for ensuring that when people with long term complex needs return to Moray, they have appropriate supports in place; this may include the use of core and cluster supported housing opportunities for people with severe and enduring mental health conditions. MHSM Mar 26 A housing group is looking at future needs for people within the local area and supporting the return of ‘out of area’ placements. Page 215
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APPENDIX 1 13 Mental Health Quality Standard 4: Workforce: The mental health and wellbeing workforce is diverse, skilled, supported and sustainable, trauma & inequality informed Outcome Actions Lead Timescale Progress Workforce feels valued and respected and is more likely to want to work in Moray and remain here. Develop workforce plan for mental health services in Moray, linking to Grampian wide development and clearly aligning Moray services as part of wider Grampian mental health service offer MHSM Sept 25 The intention is to carry out a workforce survey later in the year, 2026, alongside the update to the MH Strategy. In parallel to this we will also routinely gather workforce data – retirement, sickness rates etc Undertake a needs analysis of current service in line with ‘Report of the Short Life Working Group into Primary Mental Healthcareiv’, considering the potential utilisation of Multidisciplinary Teams/extended roles. MHSM Dec 25 Complete Embedding mental health professionals, support workers and others with appropriate skills into Primary Care multidisciplinary teams within clusters or localities. Robust, resilient and effective Mental Health Officer (MHO) service is in place Redesign of MHO provision within current financial constraints to provide sufficient capacity while allowing other MHOs with substantive posts opportunities to have sufficient MHO work to maintain their skills. Social Work AWI and MH Lead June 25 A 0.8FTE Mental Health Officer post has been created, on a permanent basis, via Unscheduled Care funding; however it continues to be challenging to have adequate resource to carry out duties required. Temporary funding has enabled success in reducing waiting list for private guardianship applications, but Page 216
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APPENDIX 1 14 access to legal support continues to lcontribute to significant delays. Review capacity of Out of Hours Social Work function in relation to mental health and develop to address any needs. Social Work AWI and MH Lead June 25 Complete All out of hours staff are MHO qualified. Reduction in use of temporary and costly staffing Implement CESR model for psychiatry. Understand the workforce required to reduce or remove the need for locums and other temporary staffing solutions. Work with cross Grampian system to build stronger relationships and sustainability so that Grampian system can provide support and cover when necessary. MHSM Mar 25 CESR model posts were recruited however, the post holders subsequently left their posts within six months. Following this two out of three vacant/locum consultant psychiatrist posts are now filled. Two specialty doctor posts now also filled. Workforce is informed, trained and confident in supporting self-care and recommending digital MH resources Develop and implement training and CPD plan for Mental Health service staff, recognising new developments in digital supports but also the challenges that some people face in accessing and using digital facilities. MHSM June 25 Digital Skills Survey complete and implementation underway. Page 217
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APPENDIX 1 15 Mental Health Quality Standard 5: Governance & accountability Outcome Actions Lead Timescale Progress Clear and effective governance in place Review of adult and older adult mental health governance, strategic and delivery elements, including provision of reassurance to IJB, and strengthening the role of Making Recovery Real partnership and the voice of lived experience. Align governance between the strategic groups which oversee: • Children and Young People’s Mental Health, • Moray Alcohol and Drug Partnership, • Suicide Prevention Strategic Group and • Adult Mental Health Deputy Head of Service Dec 24 Clear Governance arrangements now in place within Moray and these link with wider Grampian Mental Health arrangements. Decision makers, service users and practitioners are better able to access the evidence, and data to provide assurance and adapt services to meet local needs. Work with, and learn from colleagues, including data analysts and Alcohol and Drug Development Team, to maximise use of data, evidence and evaluation in targeting and improving our work. Create performance dashboard and actively participate in Scottish Benchmarking Network MHSM Mar 25 Performance Framework in place Understand financial structures of mental health provision in Moray and identify & align short- and long-term funding opportunities. Mental Health Strategic Group Mar 25 Financial structures for Mental health clarified. Funding gaps escalated as appropriate at Moray, Grampian and National level. Undertake self-assessment against Core Mental MHSM Sept 25 Complete. Page 218
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APPENDIX 1 16 Health Quality Standardsv , ensuring the collective voice of lived experience and staff i Good Mental Health for All in Moray ii Mental health and wellbeing strategy - gov.scot (www.gov.scot) iii Scottish_Recovery_Network_Strategic_Plan_202124.pdf iv REPORT OF THE SHORT LIFE WORKING GROUP FOR MENTAL HEALTH IN PRIMARY CARE (www.gov.scot) Page 219
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APPENDIX 1 17 v https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2023/09/core-mental-health-standards/documents/core-mental-health- quality-standards/core-mental-health-quality-standards/govscot%3Adocument/core-mental-health-quality-standards.pdf Page 220
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 25 JUNE 2026 SUBJECT: ANNUAL UPDATE ON THE DELIVERY OF THE UNPAID CARERS STRATEGY 2023-2028 BY: SERVICE MANAGER, PROVIDER SERVICES 1. REASON FOR REPORT 1.1 This report provides the Board with an annual update on the progress of delivery of the Moray Unpaid Carers Strategy 2023–2028. 1.2 It informs the Board of progress in relation to delivery of the revised implementation plan, learning from engagement and surveys, and governance arrangements in place to monitor progress. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) notes the progress made during 2025–26 in delivering the objectives of the Unpaid Carers Strategy; ii) notes how engagement activity, surveys and evaluations have informed the revised implementation plan and commissioned service outcomes; and iii) instructs the Lead Officer for Unpaid Carers to provide 6-monthly updates to the Audit, Performance & Risk Committee, with annual reports to Moray Integration Joint Board (MIJB). 3. BACKGROUND 3.1 Unpaid carers are integral to the delivery of health and social care in Moray, providing essential support to individuals who would otherwise be unable to manage independently. 3.2 It is estimated that approximately 16,200 people in Moray undertake an unpaid caring role for a partner, family member, friend or neighbour. Item 10. Page 221
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3.3 The Moray Unpaid Carers Strategy 2023–2028 sets out the partnership’s commitment to valuing, recognising and supporting unpaid carers of all ages, in line with the Carers (Scotland) Act 2016. The strategy is delivered through a revised implementation plan, approved by the Carers Strategy Oversight Group, and supports delivery of national and local strategic priorities. 4. KEY MATTERS RELEVANT TO RECOMMENDATION Implementation of the Strategy 4.1 Work is continuing to implement the agreed actions within the Unpaid Carers Strategy 2023–2028 in line with the revised implementation plan (Appendix 1). 4.2 Surveys for adult unpaid carers, young unpaid carers and wider partners across health, social care and education have now been completed. The results have been analysed, key themes extracted and cross-referenced against the implementation plan. Updates have been made where required to ensure that the lived experience of unpaid carers is reflected throughout strategic actions. (Ref: 2.1.2, 2.1.3, 2.1.4). 4.3 Learning from the surveys has been used to strengthen outcomes within the new specification for the commissioned carer support service, which is currently out to tender. This ensures future service delivery is closely aligned to identified needs and priorities. (Ref: 2.1.3, 2.2.3) GP Practice Projects 4.4 The Unpaid Carer GP Project, piloted and developed in collaboration with Maryhill, Elgin Health Centre, has demonstrated improved identification, recording and increased referral of unpaid carers to support services. Learning from the pilot and its evaluation has informed a clear pathway for wider roll-out. Positive engagement has now taken place with two further GP practices to explore implementation of the initiative, providing a strong foundation for expanding carer-aware practice across primary care settings, with one of the practices confirming they would like to roll out the initiative. A baseline relating to the current number of unpaid carers registered with the practice has been identified as part of the initial phase. (Ref: 1.1.11, 1.1.12, 1.1.13, 1.1.14,) 4.5 To support this wider implementation, a dedicated GP Practice Unpaid Carer Toolkit has been developed, offering practical guidance, templates and resources to embed consistent carer-identification processes. Ongoing support will also be provided by the Unpaid Carer Team to ensure practices are confident and equipped to adopt the approach effectively. (Ref: 1.1.13, 1.1.14) Awareness Raising, Engagement and Workforce Development 4.6 Adult and young carer surveys have been carried out through Moray Engage to gather feedback on their experiences of being an unpaid carer in Moray, including what is going well and what positive changes would benefit them. The surveys also sought views on the carer support service to inform future development. Page 222
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(Ref: 2.1.3) 4.7 A survey was distributed to professionals across Moray Health and Social Care Partnership (MHSCP), seeking feedback on the referral process to the carer support service, the effectiveness of communication between services, and their general awareness of unpaid carers, their needs, and how to access further support. (Ref: 1.1.1, 1.1.2) Children and Young People 4.8 The targeted Young Carer Survey identified key priorities: • Improved support within education • Opportunities for breaks, social connection and peer support • Recognition of caring roles without stigma These findings are informing service development, commissioning and delivery. (Ref: 2.1.2, 2.1.3) 4.9 Engagement with social work teams has commenced and early feedback has demonstrated strengthened awareness and consistency in identifying and supporting young carers. (Ref: 1.1.7, 1.1.9) 4.10 Ten schools across Moray have worked alongside the Young Carers Strategy Officer to identify Young Carer Champions and to deliver targeted training staff and pupils to increase awareness of young carers and available support networks. This has led to improved identification, increased staff confidence and more supportive learning environments. This reflects a shift towards a child-centred, strength-based approach supported by stronger partnership working. (Ref: 1.1.18, 1.1.19) Assessment and Support Planning 4.11 In preparation for the transition of Adult Carer Support Plans (ACSP) and Young Carer Statements (YCS) from the carer support service to MHSCP in July 2025, new pathways of support were developed and implemented, informed by learning and feedback from previous versions. (Ref: 1.4.1, 1.4.2, 1.4.3, 1.4.4) 4.12 The ACSP has been redesigned to reflect a more conversational, strengths-based approach to assessing support needs and identifying any unmet needs of unpaid carers. This revised model has been trialled and refined following feedback and consultation with colleagues across MHSCP. (Ref: 3.2.1, 3.2.2, 3.2.3).= 4.13 The Young Carer Statement has been redesigned, with separate Primary and Secondary versions to better reflect age and stage. The revised approach: • Is holistic, strengths-based and child-centred • Focuses on wellbeing, relationships and aspirations • Supports young people to express their views in their own words Page 223
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• An “All About Me” section is being trialled in schools, enabling earlier engagement through trusted relationships. (Ref: 3.3.1, 3.3.2) Improvements to information sharing via SharePoint now ensure timely, secure and consent-based communication with schools. These developments support earlier identification and more responsive support. (Ref: 1.4.4) Quarriers Carer Support Service 4.14 Feedback has identified a need for greater access to community-based activities and local summer programmes. In response, the service will provide practical support and, where appropriate, financial assistance to reduce barriers to participation. In addition, some young carers have expressed a preference for activities that can be undertaken with their existing friendship groups; this will be reflected in the development of peer-led and group-based opportunities for young carers (Ref: 3.4.2, 3.5.3, 3.5.4, 3.8.1, 3.8.2) 4.15 Additional measures have included introducing flexibility in scheduling meetings to accommodate caring responsibilities, regular review of arrangements to ensure they remain appropriate, and maintaining the young person’s control over how their information is shared. This personalised approach has resulted in improved engagement, with the young person reporting increased confidence and a stronger sense that their views are shaping the support they receive. (Ref: 3.3.1, 3.3.2, 3.3.4) 4.16 The service is currently working in partnership with young carers to co-produce the forthcoming summer activity programme. Ongoing consultation and feedback mechanisms have enabled young carers to influence the design of the programme, including the types of activities offered, the pace of delivery, and how sessions are structured. (Ref: 2.1.2, 2,1,3, 2,1,4) 4.17 The service alongside our colleagues from the Arrows drug and alcohol service at the MacMoray Festival, providing information to event participants about unpaid carers and raising awareness of the support available to them. Discussions with Moray Alcohol and Drug Partnership (MADP) have taken place to highlight the gap in recognition for unpaid carers of those impacted by drug and alcohol use. A representative from the carers team attends quarterly MADP meetings. (Ref: 1.1.5, 1.6.1, 1.6.2) 4.18 Quarriers has continued to expand their outreach and awareness activities for unpaid carers through a range of community events and engagement opportunities. This included attending Lossiemouth High School parents’ evening to support evening engagement, adding a Get on a Bike session for adult carers, and hosting an information stall at Forres Health Centre. Looking ahead, they have secured a stall at the Forres Highland Games and arranged a meeting with Moray Chamber of Commerce to explore further awareness raising opportunities. Connections have also been made with local communities through events such as Craigellachie Primary School’s Community Picnic and Sports Day, and a variety Page 224
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of Saturday engagements including the Project Neuro Coffee Morning and coffee mornings at Forres Town Hall for Forres in Bloom and the Forres Cycling Club, helping to demonstrate our presence across weekend and community-based activities. (Ref: 1.1.1, 1.1,2, 1.7.2, 1.7.4, 3.1.2, 3.1.3, 2.4.1) 4.19 The national Carers Week runs from 8th – 14th June with a range of events and activities are taking place across Moray to support the theme “Building Carer Friendly Communities.” Throughout the week, the Carer Support Service will be actively engaging with the community through awareness raising activities, such as a pop-up stand at local supermarkets and outreach with the veteran community at the Erskine Veterans Activity Centre. A variety of wellbeing and engagement sessions are also planned, such as Aromatherapy Bingo and a Pilates session, alongside activities specifically for young carers, with further details shared via social media and e news updates. (Ref: 1.7.1, 1.7.4, 3.1.2, 3.1.3, 3.1.4, 3.4.1, 3.4.2, 3.5.1, 3.5.3) 4.20 Quarriers, in partnership with the Unpaid Carers Team, will hold an engagement session on 11th June during Carers Week, marking the launch of a series of regular engagement events across Moray. (Ref: 2.1.3, 2.1.1, 3.1.6, 3.1.7) Unpaid Carer Commissioned Service Contract 4.21 Following key changes to the unpaid carer service contract; specifically, the transition of completing ACSPs and YCSs in-house within MHSCP, it was agreed that a revised contract specification should be developed and the service put out to tender. This commissioning process is now underway, with the intention that providers will begin the 3-year contract from January 2027. (Ref: 4.1.1, 2.2.3) 4.22 The refreshed contract places a stronger emphasis on awareness raising, early identification and direct support for unpaid carers, ensuring the service is aligned with emerging needs and the wider strategic direction for carer support in Moray. To reflect the distinct requirements of different carer groups, the tender is being issued in two lots: one for adult unpaid carers and one for young carers. (Ref: 1.1, 1.4) 4.23 The service specification has been developed with the voice of unpaid carers at the forefront of what the service needs to look like. Feedback from the survey earlier this year have been the foundation of the new specification. (Ref: 2.1.1) Governance and Monitoring 4.24 The revised implementation plan to 2028 has been drafted, approved by the Carers Strategy Oversight Group and updated in line with engagement feedback. The plan has been shared with Quarriers, the commissioned carer support service, to ensure it remains a live working document aligned to operational delivery. (Ref: 2.1.4) 5. SUMMARY OF IMPLICATIONS Page 225
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(a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-2032” Supporting carers aligns with the ambitions outlined in the Moray IJB Strategic Plan, Corporate Plan, and LOIP. It will contribute to Outcome 6 of the National Health and Wellbeing Outcomes by improving health, wellbeing, and outcomes for both carers and the people they care for. Involving unpaid carers, the person they care for, and workers from health and social care services work together as partners they increase the chances of better outcomes for all involved, this aligns with Realistic Medicine, putting people at the centre of decision about care and support, alongside the key priorities highlighted through the work of EPiC. (b) Policy and Legal The local carer strategy meets the legal requirements set out in the Carers (Scotland) Act 2016, ensuring that carers have access to: • Information and advice services • Hospital discharge involvement • Adult Carer Support Plans or Young Carer Statements • Support for eligible needs (c) Financial implications Funding through the annual Carers Act allocation supports the delivery of the strategy. Actions outlined in the Strategy and Action Plan, including the commissioning of local information and advice services, must be managed within the existing resources and additional funding streams where possible. (d) Risk Implications and Mitigation Demand for support is likely to increase as more carers are identified. A local eligibility criteria is in place to ensure appropriate support is provided. (e) Staffing Implications The delivery of the strategy relies on a collaborative workforce, including unpaid carers, the public, third-party organisations, and the wider community. (f) Property No direct implications from this report. (g) Equalities/Socio Economic Impact Carers are more likely to experience inequality of outcome and poor health. The strategy aims to enhance opportunities for all carers, ensuring equitable access to support. (h) Climate Change and Biodiversity Impacts None arising directly from this report. Page 226
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(i) Directions None arising from this paper (j) Consultations Consultations have taken place with the Carer Representative(s) on the Board, Young Carers Strategy Officer, Assistant SDS & Carers Officer, Service Manager Provider Services, Carers Strategy Oversight Group, Quarriers Carer Support Service, Operational Management Team (OMT). 6. CONCLUSION Good progress has been made in delivering the Moray Unpaid Carers Strategy 2023–2028, particularly in relation to awareness raising, engagement, improved identification of carers, and the redesign of assessment and support planning processes. Key developments, including the GP Practice Project and strengthened use of carer feedback, provide a solid foundation for continued improvement. Continued oversight and regular reporting will support delivery of the revised implementation plan and maintain accountability for progress. Author of Report: Michelle Fleming, Self-Directed Support & Unpaid Carers Team Manager (SDS & Carers Lead Officer) Appendix 1: Carers Strategy Implementation Plan Background Papers: Ref: Page 227
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APPENDIX 1 1 MHSCP SDS Carer Plan 2023-28 Report Type: Actions Report Generated on: 26 May 2026 Action Status Cancelled Overdue; Neglected Unassigned; Check Progress Not Started; In Progress; Assigned Completed 1.1 UC Awareness Raising Design and implement awareness-raising targeting - NHS, Adult and Children’s Social Care, education, and wider Moray Council departments. This aims to embed understanding of unpaid carers' roles, challenges, and support needs. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 1.1.1 Launch targeted communication and engagement activities with Social Work Teams and Home Care Teams in Adult Services to introduce key carer-related issues, available support mechanisms, and statutory duties under the Carers (Scotland) Act 2016. 31-Dec- 2026 Update 30/1/26 - Professionals Newsletter first edition circulated Nov 25 with the second edition circulated end January 2026. Professionals newsletter includes policy updates, carer voice, practice spotlight articles and a training/learning hub of information. Newsletter invites professionals to get in touch with the unpaid carers team to arrange awareness raising/attendance at team meetings. 35% HSCM SDS UC2326 1.1.2 Maintain momentum and deepen understanding of carer issues and statutory duties through ongoing engagement and awareness raising across Adult Services. 31-Mar- 2028 April/May 26- Initial contact made with the SMART Team (Short Term Assessment and Reablement Team) and the Health Improvement Team Moray, including engagement at the Health Point within Dr Gray's Hospital, to strengthen connections and promote support for unpaid carers. 25% Page 228
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APPENDIX 1 2 HSCM SDS UC2326 1.1.3 Introduce Social Work Teams and Home Care Teams in Adult Services to the referral pathways for the commissioned unpaid carer support service, ensuring clarity and accessibility. 31-Dec- 2026 July 2025 - New referral pathway approved by Strategy Oversight Group and was approved at the Practice Governance Board on 26 August 2025 50% HSCM SDS UC2326 1.1.4 Ensure sustained understanding and consistent use of the referral process across Adult Services through ongoing communication. 31-Mar- 2028 0% HSCM SDS UC2326 1.1.5 Introduce MIDAS and MADP members to key carer-related issues, the referral process for the commissioned unpaid carer support service, available supports, and statutory responsibilities under the Carers (Scotland) Act 2016. 31-Jan- 2027 Quarriers Update 20/05/26 - Arrows We worked alongside our colleagues from the Arrows drug and alcohol service at the McMoray Festival, providing information to event participants about unpaid carers and raising awareness of the support available to them. Discussion with Moray ADP took place April 26 to highlight the gap in recognition for unpaid carers of those impacted by drug and alcohol use. A representative from the carers team attends quarterly ADP meetings. 10% HSCM SDS UC2326 1.1.6 Maintain ongoing engagement with MIDAS and MADP members to embed carer awareness and ensure consistent application of referral processes and statutory responsibilities. 31-Mar- 2028 0% HSCM SDS UC2326 1.1.7 Introduce Social Work Teams in Children’s Services to key carer-related issues, available support services, and statutory responsibilities under the Carers (Scotland) Act 2016. 31-Dec- 2026 20/05/26 - Awareness raising session have taken place with East, West and Access C&F social work teams 25% HSCM SDS UC2326 1.1.8 Maintain ongoing engagement and awareness raising on carer-related knowledge across Children’s Services to ensure consistent support and legislative compliance. 31-Mar- 2028 20/05/26 - Awareness raising session have taken place with East, West and Access C&F social work teams 25% HSCM SDS UC2326 1.1.9 Introduce Social Work Teams in Children & Families Services to the referral process for the commissioned unpaid carer support service, ensuring clarity and accessibility. 31-Dec- 2026 20/05/26 - Awareness raising session have taken place with East, West and Access C&F social work teams including referral process information 50% HSCM SDS UC2326 1.1.10 Maintain ongoing awareness and consistent use of the referral process across Children & Families Services through continued engagement and awareness raising. 31-Mar- 2028 20/05/26 - Awareness raising session have taken place with East, West and Access C&F social work teams including referal process information 50% Page 229
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APPENDIX 1 3 HSCM SDS UC2326 1.1.11 Work with Elgin Health Centre to run a pilot campaign raising staff awareness of adult unpaid carers, focusing on identifying hidden carers, improving carer recording in clinical systems, and strengthening signposting to commissioned support. 31-Oct- 2025 Pilot project agreed with Maryhill Group (Elgin Health Centre). Project brief developed, proposed carer pathway, TURAS training, SSSC badges, participation at whole practice team meetings. Separate action plan in place. January 2025 update - training/awareness training in progress at Maryhill - awaiting feedback. August Update - soft launch during carers week - HSCM news article with photos. Reports from GP practice indicate an increase in recording on unpaid carers on their systems. Final meeting held with Practice to ensure unpaid carer pathway is in use and complete an evaluation of the pilot. Update 30/1/26 - evaluation of the pilot completed and presented to Strategy Oversight Group Meeting. Proposal to roll out to other practices agreed. 100% HSCM SDS UC2326 1.1.12 Undertake a review of the GP project implementation at Elgin Health Centre, capturing critical insights, challenges encountered, and notable achievements to guide the phased expansion across GP practices in Moray. 30-Nov- 2025 Update 30/1/26 - evaluation of the pilot completed and presented to Strategy Oversight Group Meeting. Report highlights key learning and insights which have formed a proposal and method to roll out to other practices. This was agreed at Strategy Oversight Meeting on 16/12/25 100% HSCM SDS UC2326 1.1.13 Following evaluation stated in 1.1.12, develop a structured project plan to guide a roll-out of the campaign to all GP practices in Moray. 31-Mar- 2026 Update 30/1/26 - evaluation of the pilot completed and presented to Strategy Oversight Group Meeting. Report highlights key learning and insights which have formed a proposal and method to roll out to other practices. This was agreed at Strategy Oversight Meeting on 16/12/25 100% HSCM SDS UC2326 1.1.14 Implement the project plan to guide a roll-out of awareness raising, identification and recording of unpaid carers within GP practices in Moray 31-Mar- 2028 20/5/26 - Moving forward with Fochabers medical centre with baseline date obtained, and early discussions with another GP cluster. 15% HSCM SDS UC2326 1.1.15 Create a project plan to raise awareness of young carers in Moray GP practices, highlighting their roles and wellbeing impacts, improving identification and recording in clinical systems, and establishing clear signposting to commissioned support. 31-Mar- 2027 0% HSCM SDS UC2326 Implement the project plan to raise awareness of young carers in Moray GP 31-Mar- 2028 0% Page 230
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APPENDIX 1 4 1.1.16 practices, highlighting their roles and wellbeing impacts, improving identification and recording in clinical systems, and establishing clear signposting to commissioned support. HSCM SDS UC2326 1.1.17 Provide information/awareness to colleges/universities highlighting unpaid carer issues, the referral process to the commissioned unpaid carer support service, access to Young Carer Statements or Adult Carer Support Plans and supports available. Commissioned Carers Service 31-Mar- 2027 20/5/26 - SYCSA session, provided information regards transitions to college / uni, lists to be provided for main contacts. Contact to be made with Skills Development Scotland 35% HSCM SDS UC2326 1.1.18 Promote and raise awareness of Carer Champions in schools across Moray Commissioned Carers Service & (Quality Improvement Officer (SC)) 31-Mar- 2028 April/May 26 Monthly catch ups arranged with the Young Carer Strategy Officer, who is advising which schools have Young Carer Champions or Young Carer Groups and distributing service leaflets during school visits. Joint school visits offered where helpful 75% HSCM SDS UC2326 1.1.19 Establish Carer Champions in schools across Moray Commissioned Carers Service & (Quality Improvement Officer (SC)) 31-Mar- 2028 April/May26 - Greenwards Primary School contacted regarding attendance at a Young Carer Group session. The school is trialling the Young Carer Statement and has set up its first Young Carer Group with support from Young Carers strategy officer. 25% 1.2 Carers Rights "From Recognition to Rights" leadership training with unpaid carers Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 1.2.1 Promote unpaid carer empowerment by encouraging participation in the Coalition of Carers in Scotland leadership programme, helping carers build knowledge of their rights under the Carers (Scotland) Act 2016 and confidence to advocate locally. Commissioned Carers Service 31-Mar- 2028 First training sessions with 5 unpaid carers completed. Graduation event held during Carers Week 2025 (12th June) with attendees from both MIJB and HSCM Moray. Second training session with 7 parent carers held with a graduation event attended 20/11/25. Update Jan 26 - the commissioned carer service report plans to negotiate a 'train the trainer' type approach for 2026 and beyond, to enable longer term delivery. 25% 1.3 Carer Positive Award - Promote and facilitate the adoption of the Carer Positive award within Health and Social Care Moray (HSCM) and Moray Council, recognising and enhancing workplace practices that support employees that are unpaid carers. Page 231
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APPENDIX 1 5 Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 1.3.1 Identify a lead to progress Carer Positive within Moray Council 31-Oct- 2025 Current policy needs to be changed to reflect the Carers Leave Act, liaison with HR 100% HSCM SDS UC2326 1.3.2 Develop a structured project plan to guide the progression to the achievement of the Carer Positive Award, Level 2. Achieve Level 2 Carer Positive in Moray Council 31-Dec- 2026 0% HSCM SDS UC2326 1.3.3 Achieve Level 2 Carer Positive in Moray Council 31-Mar- 2028 0% HSCM SDS UC2326 1.3.4 Agree a programme of Carer Positive take-up in all hospitals in Moray 31-Mar- 2024 Level 1 (engaged) achieved by NHS Grampian 100% HSCM SDS UC2326 1.3.5 Achieve Level 1 Carer Positive in all hospitals in Moray (will need to be broken down to specific hospitals/years once commitment secured) 31-Mar- 2026 Level 1 (engaged) achieved by NHS Grampian 100% 1.4 Review and streamline referral, registration and access processes for the commissioned carer support service by offering telephone, online, face to face and paper options to ensure all unpaid carers can easily access support. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 1.4.1 Adults - Review the referral and registration process for the commissioned unpaid carer service following the transition of the completion of Adult Carer Support plans from the unpaid carer commissioned service to HSCM in July 2025. 30-Sep- 2025 20/5/26 - Referral and first conversation pathway reviewed and updated, ensuring unpaid carers receive information at the relevant times specific to their individual needs. 100% HSCM SDS UC2326 1.4.2 Adults - Review and implement the adult unpaid carer support pathway, including referral to the commissioned service, access to support, and completion of Adult Carer Support Plans by HSCM following the transition of ACSP duties in July 2025. 30-Sep- 2025 20/5/26 - Referral and first conversation pathway reviewed and updated, ensuring unpaid carers receive information at the relevant times specific to their individual needs. 100% HSCM SDS UC2326 1.4.3 Young - Review the referral and registration process for the commissioned unpaid carer service following the transition of the 31-Jan- 2026 Work completed with regards GDPR compliance following the award of the new carers contract in January 2024. Completed GDPR updated 100% Page 232
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APPENDIX 1 6 completion of Young Carer Statements from the unpaid carer commissioned service to HSCM in July 2025 . documentation. August 2025 - following the transition of YCS to HSCM a new referral has been developed and implemented, agreed by Strategy Oversight Group and final sign on at PGB 26th August 2025. HSCM SDS UC2326 1.4.4 Young - Review and implement the young carer support pathway, including referral to the commissioned service, access to support, and completion of Young Carer Statements by HSCM following the transition of YCS duties in July 2025. 31-Oct- 2026 20/5/26 - YCS to be shared with schools via Sharepoint, this is now in place 70% 1.5 Provide tailored support for unpaid carers during key transitions related to age, changing caring roles or personal circumstances, ensuring continuity of support, wellbeing, and access to appropriate resources throughout periods of change Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 1.5.1 Enable early identification and support for young carers transitioning from Secondary School to higher/further education Commissioned Carers Service 31-Mar- 2027 20/5/26 - SYCSA session, provided information regards transitions to college / uni, lists to be provided for main contacts. Contact to be made with Skills Development Scotland 15% HSCM SDS UC2326 1.5.2 Enable early identification and support for young carers making choices about employment – link to initiatives able to provide targeted support Commissioned Carers Service 31-Mar- 2027 20/5/26 - SYCSA session, provided information regards transitions to college / uni, lists to be provided for main contacts. Contact to be made with Skills Development Scotland 15% HSCM SDS UC2326 1.5.3 Enable early identification and support for carers of someone moving, or considering moving, into residential or nursing care Commissioned Carers Service & Assistant SDS & Unpaid Carers Officer 31-Mar- 2027 0% HSCM SDS UC2326 1.5.4 Enable early identification and tailored assistance for unpaid carers in employment, enabling informed decisions about balancing work and caring, including access to flexible working, job retention support and guidance for those staying in work. Commissioned Carers Service & Assistant SDS & Unpaid Carers Officer 31-Mar- 2028 20/5/26 - Privacy notice reviewed for adult and young shared with the commissioned carer service to include in welcome packs 25% HSCM SDS UC2326 1.5.5 Review and enable early identification and support for carers wishing to return to work. Commissioned Carers Service & Assistant SDS & Unpaid Carers Officer 30-Sep- 2027 Feb 26 - update from commissioned carer service - Service information available at Moray Pathways networking 25% Page 233
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APPENDIX 1 7 HSCM SDS UC2326 1.5.6 Develop and deliver targeted support to identify parent carers whose children with disabilities are nearing adulthood or independent living, ensuring they receive timely information, planning resources and emotional support to navigate key transitions Commissioned Carers Service & Assistant SDS & Unpaid Carers Officer 30-Sep- 2027 Feb 26 update from commissioned carer service - no activity 30% HSCM SDS UC2326 1.5.7 Review systems and develop approaches to enable early identification and support for former carers after a death or sudden end to caring, ensuring emotional, practical and informational support during transitions to reduce isolation and promote wellbeing Commissioned Carers Service 30-Sep- 2027 0% HSCM SDS UC2326 1.5.8 Develop, promote & facilitate peer support groups for carers whose caring role has ended or significantly reduced for different reasons. Commissioned Carers Service 31-Mar- 2028 0% 1.6 Problematic Drug/Alcohol Use - Improve identification and support for carers of family members who have problematic alcohol and/or drug use, recognising the sensitivities around identifying as a carer and the impact of cared for non-engagement. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 1.6.1 Research and develop targeted awareness campaigns to help people affected by problematic drug or alcohol use access support, using language that resonates and exploring avoiding traditional ‘carer’ labels early on to reduce resistance to self identifying Commissioned Carers Service 30-Apr- 2027 20/5/26 Quarriers Update - Arrows – We worked alongside our colleagues from the Arrows drug and alcohol service at the McMoray Festival, providing information to event participants about unpaid carers and raising awareness of the support available to them.Discussion with Moray ADP took place April 26 to highlight the gap in recognition for unpaid carers of those impacted by drug and alcohol use. A representative from the carers team attends quarterly ADP meetings. 15% HSCM SDS UC2326 1.6.2 Research and develop ways to embed unpaid carer support into Drug and Alcohol Services. Commissioned Carers Service 30-Apr- 2027 Feb 26 update from commissioned carer service - Carer Support programme 2026-27 will be promoted via Arrows and directly to those carers known to the Carers Service. 5% HSCM SDS UC2326 1.6.3 Create consultation forums for unpaid carers of people with problematic substance use, ensuring authentic engagement and using strategies to actively recruit carers who may not normally participate Commissioned Carers Service & Assistant SDS & Unpaid Carers Officer 31-Jan- 2028 0% Page 234
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APPENDIX 1 8 HSCM SDS UC2326 1.6.4 Design support pathways that allow people to self identify as unpaid carers even if they reject the label and integrate these approaches into community services such as support groups, treatment services and outreach programmes. 30-Apr- 2027 0% HSCM SDS UC2326 1.6.5 Develop and deliver awareness raising for professionals, including drug and alcohol services, GPs, social workers and housing officers, to identify hidden caring roles, using tools to start conversations and signpost individuals without judgment or stigma Commissioned Carers Service 30-Apr- 2027 0% HSCM SDS UC2326 1.6.6 Establish mechanisms to enable early identification and support for children and young people of those with problematic alcohol and/or drug use who may be taking on a caring role that isn’t recognised or acknowledged within the family. Commissioned Carers Service & Young Carer Strategy Officer 31-Oct- 2027 Feb 26 update from commissioned carer service - YC team planning for YC support 2026-27 includes plans for targeting information via Arrows to relevant families HSCM Update 05/03/26 - Meeting in place with C&F access teams, awareness raising training to take place 5% 1.7 Moray Wide Carer Aware Campaign - Develop and implement a targeted campaign across Moray to identify and acknowledge unpaid carers, fostering a sense of value and recognition within the community. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 1.7.1 Develop unique branding to use across all campaign materials 31-Aug- 2025 20/5/26 - Branding finalised, work underway to ascertain costs for the badges, cards, window stickers and posters 100% HSCM SDS UC2326 1.7.2 Establish a local business engagement to secure offers, providing promotional materials and public recognition to participating businesses in exchange for accessible discounts or incentives for unpaid carers presenting a recognised badge or card. 31-Dec- 2026 Connections made with Business Gateway. Flyers and Comms in preparation to circulate to businesses 20% HSCM SDS UC2326 1.7.3 Embed the unpaid carer awareness campaign in hospitals by displaying materials, promoting carer identification, rights and recognition through TURAS training, and identifying unpaid carer champions to lead cultural change and strengthen engagement 30-Apr- 2027 20/5/26 - Turas training been shared with health settings via unpaid carer team newsletters. 15% HSCM SDS UC2326 Develop a structured project plan to guide the design, development, and implementation 30-Apr- 2027 April/May 26 - Engagement at the Health Point within Dr Gray's Hospital and contact made with 25% Page 235
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APPENDIX 1 9 1.7.4 of an unpaid carer awareness campaign, ensuring timely delivery, stakeholder collaboration, and alignment with strategic outcomes. Wave Radio, the hospital radio service, to support future unpaid carer awareness raising across the hospital community. HSCM SDS UC2326 1.7.5 Research and evaluate the benefits to expanding the campaign to include young carers whilst considering current national offers such as the young carers card. 31-Mar- 2028 April/May 26 - Wider awareness raising activity underway including engagement with RAF Lossiemouth, community organisations and local events. Planned activity includes meeting SSAFA Community Support and Personnel Support on 11 May 26, stalls at the Learning and Wellbeing Event on 4 June and Friends and Family Day on 25 July, contact with The Link, Keith Community Radio, Keith Loft Youth Project, Moray Markets, Pride Moray, Elgin Sports Community Trust, Forres Health Centre, Forres Highland Games, Moray Chamber of Commerce, Craigellachie Primary School community events, Project Neuro Coffee Morning, Forres Town Hall coffee mornings, and Carers Week activities from 8-14 June including supermarket pop-up stands and outreach with the veteran community at the Erskine Veterans Activity Centre. 25% 2.1 Strengthen opportunities for carers of all ages in Moray to share their voices by developing diverse engagement forums that enable meaningful involvement, regular feedback on strategic outcomes and lived experience input to shape service improvement. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 2.1.1 Establish a Carers Voice Group to enable ad carers to engage in regular discussion & shared decision making on Carers Strategy implementation, supporting the identification of unmet needs and ensuring lived experience informs policy & service development Commissioned Carers Service 31-Jan- 2026 Feb 26 update from commissioned carer service - Carers Together (previously Carer Voice) input to Children's Services Plan consultation 100% HSCM SDS UC2326 2.1.2 Support and promote the Young Carer Reference Group to ensure sustained engagement, enabling young carers to participate in regular dialogue and collaborative decision making, contribute to the Carers Strategy, and help identify and prioritise unmet needs Commissioned Carers Service 30-Apr- 2027 April/May 26 - Monthly catch ups with the Young Carer Strategy Officer are supporting links to schools with Young Carer Champions and Young Carer Groups. Greenwards Primary School is trialling the Young Carer Statement and has set up its first Young Carer Group with support from Young Carers Strategy Officer. Young Carers Workers attended first Young Carers group at Greenwards Primary, new young carers identified 75% Page 236
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APPENDIX 1 10 within the school HSCM SDS UC2326 2.1.3 Create targeted feedback opportunities for unpaid carers—including parent, young adult, older carers and those supporting people with long term or residential care needs—and include additional groups identified by carers to help prioritise unmet needs 28-Feb- 2026 20/5/26 - adult, young and practitioner surveys completed. Results reported and alignment with strategy implementation plan actions. To be followed up yearly. Engagement events in place, with the first one scheduled for the 11/6/26 100% HSCM SDS UC2326 2.1.4 Enable two way communication between Carer Voice and Young Carer Reference Group activities & strategic platforms - IJB and Carers Strategic Oversight Group, ensuring carer perspectives inform decisions and strategic progress is shared transparently 31-Mar- 2028 20/5/26 - regular communication with the MIJB representatives, next meeting to take place on the 3/6/26. Continuation of the Young Carer Champion meetings to take place termly 85% HSCM SDS UC2326 2.1.5 Develop inclusive engagement mechanisms that enable adult and young unpaid carers to connect with the Unpaid Carer Representative on the IJB, ensuring their diverse views and lived experience are actively represented and valued in decision making 31-Dec- 2026 20/5/26 - regular communication with the MIJB representatives, next meeting to take place on the 3/6/26.Continuation of the Young Carer Champion meetings to take place termly 60% 2.2 Carer Skills Development & Training Opportunities Ensure unpaid carers can access skills development, training, and condition-specific awareness opportunities that enhance their ability to understand and effectively support the person they care for Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 2.2.1 Collate and analyse data from ACSPs and YCSs to identify trends and needs, informing access to condition specific awareness sessions that strengthen carers’ understanding, confidence and ability to provide effective support 31-Dec- 2026 Update 30/1/26 - This is ongoing and more data will be available to analyse as more ACSP and YCS are completed and entered onto CareFirst. 10% HSCM SDS UC2326 2.2.2 Engage a broad spectrum of condition- specific providers to deliver tailored awareness-raising opportunities for unpaid carers of all ages Commissioned Carers Service 30-Jun- 2027 April/May 26 - Meeting arranged in May 2026 with SAMH to identify training needs in relation to mental health support. 10% HSCM SDS UC2326 2.2.3 Evaluate the availability and accessibility of condition-specific training and awareness opportunities for unpaid carers, using findings to inform future service development, commissioning priorities, and targeted capacity building Commissioned Carers Service 30-Sep- 2027 Dec 25 Update provided by commissioned carer service - Annual survey of adult carers circulated, deadline for responses 5 Jan, after which all feedback will be collated and 2026 delivery plan prepared. 0% Page 237
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APPENDIX 1 11 3.1 Deliver an accessible, inclusive, and responsive information and advice service for carers of all ages, ensuring they can easily access clear, relevant, and timely guidance to make informed decisions and confidently navigate their caring role. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.1.1 Establish the parameters and arrangements for the Adult and Young Carers Contract from April 2023 and subsequent contract tendering process which is responsive to local need/risks and statutory requirements. 31-Mar- 2024 The current commissioned service has a letter of commitment running until September 2023 to enable a robust service specification can be developed, out to tender and contract awarded towards the end of 2023 100% HSCM SDS UC2326 3.1.2 Ensure relevant, timely and accessible information is available to adult carers, in a variety of formats, and is widely promoted. Commissioned Carers Service 31-Dec- 2026 20/5/26 - Referral and first conversation pathway reviewed and updated, ensuring unpaid carers receive information at the relevant times specific to their individual needs. 45% HSCM SDS UC2326 3.1.3 Ensure relevant, timely and accessible information is available to young carers, in a variety of formats, and is widely promoted Commissioned Carers Service 31-Dec- 2026 Feb 26 update from commissioned carer service - YC newsletter preparation and mailing 30% HSCM SDS UC2326 3.1.4 Continuously improve social media and online communications that are flexible and responsive, to ensure adult carers have easy access to the most up-to-date information. Commissioned Carers Service 31-Mar- 2028 Feb 26 update from commissioned carer service - no activity 25% HSCM SDS UC2326 3.1.5 Continuously improve and maintain social media and online communications that are flexible and responsive, to ensure young carers have easy access to the most up-to- date information. Commissioned Carers Service 31-Mar- 2028 0% HSCM SDS UC2326 3.1.6 Launch face to face information and advice sessions for adult carers across accessible locations in Moray, responding to direct enquiries and shaped by unmet needs identified through Adult Carer Support Plans (ACSPs). Commissioned Carers Service 31-Dec- 2026 Feb 26 update from commissioned carer service - Duty Worker daily; art therapy, chi me and movement workshops 25% HSCM SDS UC2326 3.1.7 Maintain face to face information and advice sessions for adult carers across accessible locations in Moray, responding to direct enquiries and shaped by unmet needs identified through Adult Carer Support Plans (ACSPs). Commissioned Carers Service 31-Mar- 2028 Feb 26 update from commissioned carer service - 2026 programme details in newsletter for circulation March 10% HSCM SDS UC2326 Launch face to face information and advice sessions for young carers across accessible Commissioned Carers Service 31-Dec- 2026 Feb 26 update from commissioned carer service - YC newsletter circulated, with details of 20% Page 238
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APPENDIX 1 12 3.1.8 locations in Moray, responding to direct enquiries and shaped by unmet needs identified through Young Carer Statements (YCS). activities available. HSCM SDS UC2326 3.1.9 Maintain face to face information and advice sessions for young carers across accessible locations in Moray, responding to direct enquiries and shaped by unmet needs identified through Young Carer Statements (YCS). Commissioned Carers Service 31-Mar- 2028 Feb 26 update from commissioned carer service - YC Resilience Workshop programme delivered; YC resilience 1:1 supports in place 25% HSCM SDS UC2326 3.1.10 Deliver targeted transitional support for young adult carers during key life changes— such as further education, employment, independent living, or shifts in their caring role—to ensure continuity of support, informed decisions, and improved wellbeing. Commissioned Carers Service 31-Mar- 2028 Feb 26 update from commissioned carers service - YAC focus for Young Carers Action Day event 11 Mar 20% HSCM SDS UC2326 3.1.11 Deliver targeted support to parent carers of children with disabilities, addressing the specific challenges they face and ensuring access to tailored support, education, guidance, and practical resources. Commissioned Carers Service 31-Mar- 2028 20/5/26 - YCSO met with Parents of ASN group, aware of her role and YC support available 30% 3.2 Review and enhance the Adult Carer Support Plan templates and processes to better enable the identification of carer needs, ensuring timely access to appropriate services and supports that reflect personal outcomes Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.2.1 Redesign the ACSP template to support strength based, outcome focused conversations, clarify available support options including self managed approaches and commissioned services and ensure alignment with Self Directed Support (SDS) standards. 30-Jun- 2025 100% HSCM SDS UC2326 3.2.2 Pilot and consult on the redesigned ACSP engaging unpaid carers in trial use and feedback, seeking input from social work, CareFirst, Data Protection, performance teams and external partners to ensure it meets diverse needs and aligns with best practice. 31-Aug- 2025 100% Page 239
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APPENDIX 1 13 HSCM SDS UC2326 3.2.3 Implement the final version of the redesigned Adult Carer Support Plan (ACSP) and associated processes, ensuring integration into the CareFirst system to support consistent use, performance monitoring and access across relevant teams and services 30-Sep- 2025 Revised ACSP presented to PGB on 26/8/25 and approved. Social Care Systems have received the document for input into CareFirst. Waiting response to ascertain if this can go onto CareFirst as advised no new documents are being added. ACSP is now on CareFirst 100% HSCM SDS UC2326 3.2.4 Evaluate the performance and impact of the new ACSP to ensure it delivers meaningful value to adult carers and remains fit for purpose. 30-Sep- 2026 20/5/26 - Test of change ongoing with day ops team, reviewing internal processes and documentation to ensure efficiencies and timely processes in line with legislation 35% 3.3 Review and enhance the Young Carer Statement templates and processes to better enable the identification of carer needs, ensuring timely access to appropriate services and supports that reflect personal outcomes Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.3.1 Redesign the Young Carer Statement template to support strength based, outcome focused conversations, clarify support options—including self managed approaches and commissioned services—and ensure alignment with Self Directed Support (SDS) standards. 31-Dec- 2025 Scoping exercise has commenced to look at examples from other HSCP's. Update: 30/1/26 - YCS (2 versions - primary and secondary age) in draft. GDPR checks completed. Ready for piloting with young carers through social worker for unpaid carers Feb 26 100% HSCM SDS UC2326 3.3.2 Pilot and consult on the redesigned Young Carer Statement by engaging unpaid carers in trial use and feedback, and seeking input from social work, CareFirst, Data Protection, performance teams and external partners to ensure it meets diverse needs. 31-Dec- 2026 Additional 20/5/26 update - Part 1 of the Young Carer Statement has been shared with the commissioned service. Greenwards Primary School is currently trialling the Young Carer Statement and joint school visits have been arranged to support this. 50% HSCM SDS UC2326 3.3.3 Implement the final version of the redesigned Young Carer Statement and associated processes, ensuring integration into the CareFirst system to support consistent use, performance monitoring and access across relevant teams and services 31-Mar- 2027 20/5/26 - redesigned YCS in use and shared via sharepoint, discussions in place for uploading to carefirst before migration to mosaic. 50% HSCM SDS UC2326 3.3.4 Evaluate the performance and impact of the new YCS to ensure it delivers meaningful value to young carers and remains fit for purposes 31-Oct- 2027 0% 3.4 Early Intervention/Prevention Enhance access to self-managed support for unpaid carers through early intervention and preventative approaches, Page 240
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APPENDIX 1 14 empowering them to sustain their caring role for as long as they choose and are able. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.4.1 Provide tailored skills development and information opportunities for adult unpaid carers responding to self-managed outcomes identified through Adult Carer Support Plans (ACSPs) to build confidence, independence, and caring resilience. Commissioned Carers Service 31-Mar- 2028 Feb 26 update from commissioned carer service - Wellbeing programme activities, including art therapy workshop, Chi Me, aromatherapy and Movement & Mobility. Get on a Bik info sessions at Blether & Brew. New workshop programme, led by author, exploring skills in self-help book. 30% HSCM SDS UC2326 3.4.2 Provide tailored skills development and information opportunities for young unpaid carers responding to self-managed outcomes identified through Young Carer Statements (YCSs) to build confidence, independence, and caring resilience. Commissioned Carers Service 31-Mar- 2028 Feb 26 update from commissioned carer service - YC Resilience Workshop programme delivered; YC resilience 1:1 supports in place 30% 3.5 Peer Support for UC Empower UC through peer support helping to manage physical, emotional and practical challenges, offering shared lived experience, wellbeing support, community based respite, and tools that build resilience and sustainability. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.5.1 Launch peer-led support opportunities that foster connection, shared experience, and emotional wellbeing among adult unpaid carers. Commissioned Carers Service 31-Oct- 2026 Feb 26 update from commissioned carer service - Blether & A Brew sessions at Keith, Forres, Elgin & Lossiemouth 25% HSCM SDS UC2326 3.5.2 Maintain peer-led support opportunities that foster connection, shared experience, and emotional wellbeing among adult unpaid carers. Commissioned Carers Service 31-Mar- 2028 Dec 25 - update provided by commissioned carer service - Peer support model review Jan-Mar 26, to inform delivery from April 26. 10% HSCM SDS UC2326 3.5.3 Launch peer-led support opportunities that foster connection, shared experience, and emotional wellbeing among young unpaid carers. Commissioned Carers Service 31-Oct- 2026 Feb 26 update from commissioned carers service - Outfit Moray activities supporting self-esteem and confidence; bowling; teambuilding craft activity; Wild Things activity. 20% HSCM SDS UC2326 3.5.4 Maintain peer-led support opportunities that foster connection, shared experience, and emotional wellbeing among young unpaid carers. Commissioned Carers Service 31-Mar- 2028 Feb 26 update from commissioned carer support service - YC Easter programme in place and promoted to YC via newsletter and targeted communications as appropriate 5% HSCM SDS UC2326 Develop a communications plan to raise awareness of peer support opportunities and Commissioned Carers Service 31-Oct- 2026 Feb 26 update from commissioned carer service - E-news circulation; Facebook posts; newsletter 50% Page 241
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APPENDIX 1 15 3.5.5 encourage ongoing engagement. preparation HSCM SDS UC2326 3.5.6 Collect feedback and outcome data to assess the value of adult carer peer support in improving carer wellbeing, resilience, and social connectedness. Commissioned Carers Service 31-Mar- 2027 Feb 26 update from commissioned carer service - Ongoing evaluation of support activities 5% HSCM SDS UC2326 3.5.7 Collect feedback and outcome data to assess the value of young carer peer support in improving carer wellbeing, resilience, and social connectedness. Commissioned Carers Service 31-Mar- 2027 Feb 26 update from commissioned carer service - 2026 YC activity programme, first 6 months in development 10% HSCM SDS UC2326 3.5.8 Embed Young Carer Groups within schools to provide peer connection, emotional support, and access to tailored information and resources. Commissioned Carers Service 31-Mar- 2028 April/May 26 - Monthly catch ups arranged with the Young Carer Strategy Officer to identify schools with Carer Champions or Young Carer Groups and distribute leaflets during school visits. Joint school visits offered where helpful. Greenwards Primary School contacted regarding attendance at a Young Carer Group session; the school is trialling the Young Carer Statement and has established its first Young Carer Group with support from Young Carers Strategy Officer. 30% 3.6 Equip carers with the knowledge, tools and support to prepare for emergencies and unexpected changes, co producing contingency plans that reflect individual needs and ensure continuity of care and peace of mind during crises or transitions. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.6.1 Enable adult unpaid carers to plan for emergencies by providing access to practical resources, guidance, and contingency planning tools—ensuring carers feel supported and equipped to respond to unforeseen situations with confidence Commissioned Carers Service 31-Mar- 2028 Feb 26 update from commissioned carer service - Emergency Planning toolkit supplied to all carers newly referred. 25% HSCM SDS UC2326 3.6.2 Enable young unpaid carers to plan for emergencies by providing access to practical resources, guidance, and contingency planning tools—ensuring carers feel supported and equipped to respond to unforeseen situations with confidence Commissioned Carers Service 31-Mar- 2028 Feb 26 update from commissioned carer service - 1:1 conversations with YC include emergency planning support. YC preference for 1:1 approach. 30% HSCM SDS UC2326 3.6.3 Research a secure, accessible system for storing and retrieving unpaid carers’ emergency plans, ensuring continuity of care and timely access for key professionals such 30-Apr- 2027 20/5/26 - conversations with GP practices advised information can be put onto KIS - toolkits in development 15% Page 242
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APPENDIX 1 16 as GPs, Out of Hours Social Work and Blue Light services. 3.7 Develop inclusive, needs-led policies that ensure adult carers, parent carers, and young carers have equitable access to meaningful short breaks and respite opportunities aligned with their personal outcomes. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.7.1 Review and update the current Short Breaks Service Statement to ensure alignment with the Carers Strategy, National guidance and Care Reform (Scotland) Bill, enhancing clarity, accessibility, and relevance for unpaid carers and professionals 30-Sep- 2026 20/5/26 - consultation closes on the 22nd May 2026 30% 3.8 Carer breaks are targeted, meaningful, and outcome-driven—supporting carers in ways that reflect their personal goals and statutory entitlements. Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.8.1 Establish relationships with local activity and break providers to increase the opportunities for carers to benefit from a range of local breaks. Commissioned Carers Service 31-Oct- 2026 Feb 26 update - Wellbeing programme promotes benefits of regular breaks, and variety of options available, to encourage carer participation. 25% HSCM SDS UC2326 3.8.2 Enable Moray’s participation in the Respitality Scotland programme to increase Moray carers’ opportunities to access breaks in Moray and beyond Commissioned Carers Service 30-Nov- 2026 Feb 26 update from commissioned carer service - Respitality donor certificates prepared for awarding. Arrangements in place to complete. 50% HSCM SDS UC2326 3.8.3 Forge a formal collaboration with Carefree to broaden the availability of hotel-based respite breaks for unpaid carers by embedding their offer within existing local carer support provision Commissioned Carers Service 31-Aug- 2026 Feb 26 update from commissioned carer service - Carefree information shared with carers. 25% 3.9 Review and develop Carer SDS provision inline with SDS Legislation and SDS Framework of Standards Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.9.1 Ascertain a dedicated and transparent SDS budget specifically for allocation to adult unpaid carer support, ensuring it reflects 31-Dec- 2026 Scoping exercise has been undertaken to ascertain how other HSCP's deliver unpaid carer SDS budgets. Current work of the Unpaid Carers 20% Page 243
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APPENDIX 1 17 actual demand, aligns with personal outcomes, and enables effective planning and delivery of SDS options Social Worker is being monitored and evaluated to ascertain the value of any budgets allocated on an annual basis to give local data. HSCM SDS UC2326 3.9.2 Ascertain a dedicated and transparent SDS budget specifically for allocation to young unpaid carer support, ensuring it reflects actual demand, aligns with personal outcomes, and enables effective planning and delivery of SDS options 31-Dec- 2026 20/5/26 - separation of the cared for and unpaid carers budget in alignment with the service agreements on care first. Development of an internal self evaluation against the SDS framework for standards (15%) 15% 3.10 School participation in national programmes to improve schools’ awareness of, and support for, young carers in education Code Action Title Agency Due Date Latest Status Update Status Progress Status Icon Assigned To HSCM SDS UC2326 3.10.1 Include young carer awareness in induction and professional development programmes for school staff 31-Mar- 2028 20/05/26 - awareness raising sessions for both pupils and staff have been delivered in schools, Turas training and education Scotland training shared 15% HSCM SDS UC2326 3.10.2 Conduct annual surveys of school staff to measure awareness of young carers and the impact of their caring role on their lives and education 31-Mar- 2028 20/5/26 - survey issued to all school staff, to take place annually 25% Page 244
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 25 JUNE 2026 SUBJECT: MORAY ALCOHOL AND DRUG PARTNERSHIP – STRATEGIC DELIVERY PLAN 2026–2029 BY: JUSTIN JANSEN, MADP COORDINATOR 1. REASON FOR REPORT 1.1 To present the Moray Alcohol and Drug Partnership (MADP) Strategic Delivery Plan 2026–2029 to the Board for approval. 1.2 The Strategic Delivery Plan sets out the local strategic direction and priorities for alcohol and drug services, partnership delivery, governance, and improvement activity across Moray for the period 2026–2029. 1.3 The plan aligns with the Scottish Government Alcohol & Drugs Strategic Plan 2026–2035, the Partnership Delivery Framework for Alcohol and Drug Partnerships, the National Service Specification for Alcohol and Drug Services, and the Charter of Rights for People Affected by Substance Use. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) notes the continued commitment of the Moray Alcohol and Drug Partnership to delivering a rights-based, trauma-informed, recovery- focused, and partnership-led approach to preventing harm, reducing inequalities, promoting recovery, and improving outcomes for individuals, families, and communities affected by alcohol and drugs; ii) notes that the Strategic Delivery Plan has been informed through national and local consultation activity, lived and living experience engagement, partnership review, governance discussions, and wider stakeholder feedback throughout development of the plan; Item 11. Page 245
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iii) approves the Moray Alcohol and Drug Partnership Strategic Delivery Plan 2026–2029 (Appendix 1); and iv) notes that progress against the Strategic Delivery Plan and associated action plans will be monitored through MADP governance arrangements, with ongoing assurance and progress reporting provided to the Board and Annual Performance Report (APR) processes thereafter. 3. BACKGROUND 3.1 Alcohol and drug harms continue to have a significant impact on individuals, families, communities, and wider public services across Moray. Local challenges include health inequalities, trauma, stigma, poverty, rural isolation, increasing complexity of substance use, workforce pressures, and barriers to accessing support. 3.2 The Moray Alcohol and Drug Partnership (MADP) Strategic Delivery Plan 2026– 2029, attached at Appendix 1, has been developed to provide a clear whole- system approach to prevention, harm reduction, treatment and care, recovery support, governance, and continuous improvement across the local alcohol and drug system. 3.3 The Strategic Delivery Plan aligns with the Scottish Government Alcohol & Drugs Strategic Plan 2026–2035, the Partnership Delivery Framework for Alcohol and Drug Partnerships, the National Service Specification for Alcohol and Drug Services, the Charter of Rights for People Affected by Substance Use, and wider national priorities relating to public health improvement, mental health, children and families, reducing inequalities, and community wellbeing. 3.4 Development of the Strategic Delivery Plan has included local partnership engagement, lived and living experience consultation, review of national policy developments, and consideration of emerging local priorities and improvement activity. The plan has been informed through national and local consultation processes, experiential learning approaches, partnership engagement, governance discussions, and wider stakeholder feedback. 3.5 The Strategic Delivery Plan also reflects a shift towards a more responsive and continuously reviewed delivery approach, rather than a fixed implementation model. This recognises the evolving nature of alcohol and drug harms, changing patterns of substance use, emerging drug trends, and the need for local systems and partnerships to remain flexible and responsive to emerging risks, experiential learning, local intelligence, and national developments. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Strategic Delivery Plan is structured around four interconnected strategic priorities: • Prevention and Early Intervention • Harm Reduction • Treatment and Care Page 246
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• Wider Circle of Support These priorities reflect both national direction and local need, while supporting a whole- system approach to prevention, recovery, reducing inequalities, and improving wellbeing across Moray. 4.2 The Strategic Delivery Plan is underpinned by the Charter of Rights for People Affected by Substance Use and the Moray Charter Implementation Toolkit, supporting rights-based, trauma-informed, recovery-focused, and person-centred approaches across planning, governance, workforce development, service delivery, and continuous improvement activity. 4.3 People with lived and living experience have played a central role in shaping the Strategic Delivery Plan through consultation activity, experiential learning approaches, Collective Voice activity, governance involvement, wider stakeholder engagement, and partnership review discussions throughout development of the plan. 4.4 The Strategic Delivery Plan reflects ongoing local improvement activity including development of residential rehabilitation pathways, Medical Assisted Treatment (MAT) Standards implementation, rights-based recovery approaches, whole family support, harm reduction and overdose prevention activity, assertive outreach and near-fatal overdose pathways, workforce development and trauma- informed practice, community recovery development, experiential learning activity, and local early warning and escalation arrangements in response to emerging harms and changing patterns of substance use. Local improvement activity has already supported significant developments across the partnership, including strengthened residential rehabilitation pathways and a substantial increase in residential rehabilitation referrals and access to treatment and support, with referrals increasing by over 600% following pathway redesign, strengthened partnership working, and improved local access arrangements. 4.5 The Strategic Delivery Plan supports a more flexible and responsive approach to delivery and improvement, recognising the evolving nature of alcohol and drug harms, changing substance use patterns, emerging trends, and the importance of ensuring local systems remain responsive to local need, experiential learning, partnership intelligence, and national developments. 4.6 Progress against the Strategic Delivery Plan and associated action plans will continue to be monitored through governance reporting, experiential learning, performance monitoring, partnership review arrangements, and ongoing engagement with lived and living experience groups, communities, and wider stakeholders. 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 Strategic Delivery Plan supports the priorities of the Moray Integration Joint Board Strategic Plan 2022–2032 through its focus on prevention, early Page 247
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intervention, reducing inequalities, improving health and wellbeing, supporting people to live well within their communities, and strengthening partnership working. The plan also contributes to Local Outcomes Improvement Plan priorities relating to community wellbeing, reducing inequalities, prevention, and improving outcomes for individuals, families, and communities affected by alcohol and drug use (b) Policy and Legal The Strategic Delivery Plan aligns with national alcohol and drug policy, the Charter of Rights for People Affected by Substance Use, MAT Standards, the Partnership Delivery Framework for Alcohol and Drug Partnerships, the National Service Specification for Alcohol and Drug Services, and wider national public health and human rights-based approaches. (c) Financial implications Delivery of the Strategic Delivery Plan will be supported through existing Scottish Government Alcohol and Drug Partnership funding allocations and associated local partnership resources. Associated action plans and improvement activity will continue to be monitored through MADP governance arrangements. (d) Risk Implications and Mitigation The Strategic Delivery Plan supports ongoing monitoring and response to emerging harms, inequalities, risks, workforce pressures, and changing patterns of alcohol and drug use through governance oversight, partnership intelligence, experiential learning, and local early warning and escalation arrangements. (e) Staffing Implications Delivery of the Strategic Delivery Plan will continue to require collaborative partnership working across statutory services, third sector organisations, advocacy services, recovery communities, and wider partners. Workforce development and trauma-informed practice remain important priorities across the partnership. (f) Property There are no direct property implications arising from this report. (g) Equalities/Socio Economic Impact The Strategic Delivery Plan supports rights-based and trauma-informed approaches focused on reducing inequalities, improving accessibility, reducing stigma, and strengthening inclusion for individuals, families, and communities affected by alcohol and drugs. (h) Climate Change and Biodiversity Impacts No direct climate change or biodiversity impacts arise from approval of this Strategic Delivery Plan. Where future service developments or commissioning activity have potential climate implications, these will be considered through the appropriate governance and decision-making processes. Page 248
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(i) Directions No new Directions are required as a result of this report. Delivery of services and functions within the Strategic Delivery Plan will continue through existing delegated arrangements and governance structures. (j) Consultations Consultation and engagement activity has included lived and living experience groups, local and national consultation activity, partnership engagement, governance discussions, Health and Social Care Moray, third sector partners, advocacy services, recovery communities, community planning partners, and wider local stakeholders. 6. CONCLUSION 6.1 The Moray Alcohol and Drug Partnership Strategic Delivery Plan 2026–2029 provides a clear and locally responsive framework for prevention, harm reduction, treatment, recovery, governance, and continuous improvement across Moray. The plan builds upon the significant foundation and improvement work progressed locally throughout the National Mission period and reflects both national direction and the realities, strengths, challenges, and opportunities experienced within local communities. 6.2 The Strategic Delivery Plan has been shaped through local and national consultation activity, partnership engagement, governance discussion, experiential learning, and lived and living experience involvement throughout development. It reflects a shared commitment across partners to reducing harm, improving wellbeing, strengthening recovery, reducing inequalities, and supporting compassionate, rights-based, and person-centred systems of care and support. 6.3 The plan also reflects the significant operational work already taking place across the partnership, including strengthened residential rehabilitation pathways, MAT Standards implementation, assertive outreach approaches, overdose prevention activity, workforce development, community recovery development, and local early warning and escalation arrangements in response to emerging harms and changing patterns of substance use. 6.4 The Moray Integration Joint Board is therefore asked to approve the Moray Alcohol and Drug Partnership Strategic Delivery Plan 2026–2029 attached at Appendix 1. Author of Report: Justin Jansen ADP co-ordinator Background Papers: 1. Scottish Government and COSLA – Preventing Harm, Promoting Recovery: Scotland’s Alcohol & Drugs Strategic Plan 2026–2035 Preventing Harm, Promoting Recovery: Scotland's Alcohol & Drugs Strategic Plan 2026 – 2035 - gov.scot 2. Scottish Government and COSLA – Alcohol and Drugs Partnership Delivery Framework 2026 Page 249
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What is an Alcohol and Drugs Partnership (ADP) - Alcohol and drugs: partnership delivery framework - 2026 - gov.scot 3. Scottish Government – National Service Specification for Alcohol and Drug Services Alcohol and drugs services: national specification - gov.scot 4. National Collaborative – Charter of Rights for People Affected by Substance Use Charter of Rights for People Affected by Substance Use - Lived experience 5. Moray Alcohol and Drug Partnership Strategic Delivery Plan 2026–2029 (Appendix 1) Page 250
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Page 0 of 71 AUTHOR: JUSTIN JANSEN LAST UPDATED 21/01/2025 MORAY ALCOHOL AND DRUG PARTNERSHIP STRATEGIC DELIVERY PLAN 2026- 2029 APPENDIX 1 Page 251
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Page 1 of 71 Contents 1. Executive Summary ........................................................................................................ 3 2. Call to Action ................................................................................................................... 5 3. Vision and Mission .......................................................................................................... 6 4. Strategic Context and Local Need ................................................................................. 8 4.1 Local Context ............................................................................................................. 8 4.2 Emerging Trends and Challenges ............................................................................ 9 4.3 Children, Families and Communities ..................................................................... 10 5. Human Rights, Lived Experience and Reducing Stigma ............................................ 12 6 Strategic Priorities ......................................................................................................... 12 6.1 Prevention and Early Intervention .......................................................................... 13 6.2 Harm Reduction ....................................................................................................... 14 6.3 Treatment and Care ................................................................................................. 15 6.4 Wider Circle of Support ........................................................................................... 16 7. Partnership Working, Governance, Accountability and Assurance .......................... 17 7.1 Partnership Working and Shared Responsibility .................................................. 17 7.2 Role of the Moray Alcohol and Drug Partnership ................................................. 18 7.3 Governance and Accountability Arrangements .................................................... 19 7.4 Lived and Living Experience within Governance and Improvement ................... 20 7.5 Risk, Escalation and Continuous Improvement ........................................................ 21 7.6 Transparency, Engagement and Public Learning ..................................................... 22 8. Outcomes, Performance and Continuous Improvement ............................................ 23 8.1 Outcomes and Intended Impact.............................................................................. 23 8.2 Performance, Monitoring and Improvement .......................................................... 25 8.3 Experiential Learning and Outcomes ..................................................................... 26 8.4 Reviewing and Refreshing the Strategic Delivery Plan ........................................ 27 9. Delivery, Implementation and Action Planning ........................................................... 28 9.1 Delivering the Strategic Delivery Plan.................................................................... 28 9.2 Action Plans and Improvement Activity ................................................................. 29 9.3 Accountability, Monitoring and Learning .............................................................. 30 9.4 Leadership, Participation and Advocacy ............................................................... 32 9.5 Implementation Priorities and Delivery Approach ................................................ 32 10. Financial Framework .............................................................................. 33 11. Conclusion .................................................................................................................. 38 Glossary ............................................................................................................................ 39 References ........................................................................................................................ 40 Key National Publications ............................................................................................. 40 Page 252
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Page 2 of 71 Appendix 1 - Moray ADP Delivery Plan Actions 2026-29 ................................................ 43 Appendix 2 - MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT ................ 57 Page 253
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Page 3 of 71 1. Executive Summary The Moray Alcohol and Drug Partnership (MADP) Strategic Delivery Plan 2026–2029 sets out a whole-system approach to preventing harm, promoting recovery, and improving the health and wellbeing of people, families, and communities affected by alcohol and drugs. The plan reflects a commitment to delivering compassionate, trauma-informed, rights-based, and person-centred systems of care shaped by partnership working, lived and living experience, continuous improvement, and evidence-informed practice. This Strategic Delivery Plan aligns with Scotland’s Alcohol & Drugs Strategic Plan 2026–2035, the Partnership Delivery Framework for Alcohol and Drug Partnerships, the National Service Specification for Alcohol and Drug Services, and the Charter of Rights for People Affected by Substance Use. It also reflects wider national priorities relating to population health improvement, mental health, public service reform, children and families, community wellbeing, and reducing inequalities. Local communities continue to face significant challenges associated with alcohol and drug use, including health inequalities, stigma, trauma, poverty, rural isolation, and increasing complexity of substance use patterns. Alcohol-related harms remain a significant issue alongside emerging trends relating to cocaine, ketamine, benzodiazepines, and poly-substance use. These challenges can have a profound impact on individuals, families, communities, and wider public services. As a largely rural area, local communities can also experience additional barriers to accessing support, including geographic isolation, limited public transport, workforce pressures, digital exclusion, and reduced access to specialist services. This plan recognises the importance of designing flexible, community-based, and accessible systems of support that reflect the realities of rural communities. The Strategic Delivery Plan is underpinned by a public health and human rights- based approach. Central to this is the Charter of Rights for People Affected by Substance Use and the Moray Charter Implementation Toolkit, which support the embedding of dignity, participation, accountability, non-discrimination, empowerment, and legality across local systems and services. The plan also incorporates the AAAQ Framework (Availability, Accessibility, Acceptability, and Quality) and FAIR methodology (Facts, Analysis, Identify, Review) to support continuous improvement, accountability, and rights-based service delivery. A key strength of the local approach is the involvement of people with lived and living experience in shaping priorities, improving services, informing workforce development, and strengthening governance and accountability across the partnership. Their experiences and insight continue to influence local improvement activity, service design, recovery approaches, and rights-based practice across the system. Page 254
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Page 4 of 71 The plan is structured around four interconnected priorities focused on prevention and early intervention, harm reduction, treatment and care, and the wider circle of support required to sustain recovery, wellbeing, inclusion, and community connection. Prevention and Early Intervention Preventing harms before they occur through early intervention, education, community engagement, whole family approaches, and reducing the wider inequalities and adverse experiences that increase vulnerability to alcohol and drug harms. Harm Reduction Reducing immediate risks and saving lives through evidence-based harm reduction approaches, including naloxone distribution, assertive outreach, near-fatal overdose pathways, Needle Exchange provision, public awareness activity, and strengthened local surveillance and early warning arrangements. Treatment and Care Improving access to high-quality, person-centred treatment and care that reflects the needs of people affected by alcohol and drugs, including those experiencing trauma, mental health challenges, poly-substance use, and complex needs. This includes strengthening pathways into, through, and out of residential rehabilitation alongside improving pathways across community, primary care, acute, and specialist services. Wider Circle of Support Recognising that recovery is supported not only through treatment services, but also through housing, employability, education, advocacy, peer support, recovery communities, family support, social connection, and inclusive communities. Moray is committed to strengthening recovery capital and ensuring people can access support that improves wellbeing, resilience, and long-term recovery outcomes. Partnership delivery remains central to the success of this Strategic Delivery Plan. MADP will continue working collaboratively with Health and Social Care Moray, the Moray Integration Joint Board, community planning partners, public protection, housing, justice, education, Police Scotland, third sector organisations, advocacy services, recovery communities, and local communities to support coordinated and sustainable improvement across the local alcohol and drug system. Governance arrangements within this plan support accountability, transparency, shared responsibility, and continuous improvement. Progress will be monitored through governance reporting, experiential feedback, performance data, local intelligence, and delivery planning processes to ensure services remain responsive, equitable, and effective. Page 255
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Page 5 of 71 This Strategic Delivery Plan reflects a continued commitment to reducing alcohol and drug-related harms, saving lives, promoting recovery, and supporting healthier, safer, and more inclusive communities. Through collaborative leadership, meaningful participation, rights-based practice, and partnership working, local services and communities will continue working together to improve outcomes and strengthen wellbeing for individuals, families, and communities affected by alcohol and drugs. 2. Call to Action Local communities continue to face significant challenges relating to alcohol and drug harms, including increasing complexity of substance use, health inequalities, stigma, trauma, poverty, social isolation, and barriers to accessing support within rural communities. These challenges affect not only individuals, but also families, communities, and wider public services. This Strategic Delivery Plan represents a shared commitment to strengthening a whole-system response to alcohol and drugs through prevention, harm reduction, treatment and care, and wider recovery support. Delivering meaningful and sustainable improvement will require strong partnership working, shared accountability, and continued collaboration across services, communities, and sectors. The Moray Alcohol and Drug Partnership recognises that no single organisation can address these challenges alone. Progress depends upon coordinated action across health and social care, housing, education, public protection, justice, community planning, third sector organisations, advocacy services, recovery communities, and local communities themselves. Equally important is the continued involvement of people with lived and living experience, whose insight and expertise remain central to shaping local priorities, improving services, strengthening accountability, and helping services and communities better understand the realities of alcohol and drug harm. This plan supports a continued shift towards prevention, early intervention, and community-based support, while ensuring that people experiencing alcohol and drug harms can access timely, compassionate, trauma-informed, and rights-based care when needed. It also recognises the importance of strengthening recovery capital through improved access to housing, family support, employability, education, advocacy, social connection, and inclusive recovery communities. Central to this approach is the Charter of Rights for People Affected by Substance Use and a commitment to embedding dignity, participation, accountability, and equitable access across local services and partnerships. The principles of the AAAQ Framework and FAIR methodology will continue to support improvement, transparency, participation, and rights-based service delivery. Page 256
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Page 6 of 71 This Strategic Delivery Plan also reflects a commitment to learning, adaptation, and continuous improvement. As patterns of alcohol and drug use continue to evolve, local services and partnerships must remain responsive to emerging trends, changing needs, and new evidence. Through collaborative leadership, meaningful engagement, and shared responsibility, partners will continue working together to reduce harms, save lives, promote recovery, and improve wellbeing for individuals, families, and communities. Behind every statistic, referral, and pathway are real people, families, and communities whose lives are affected by alcohol and drug harm in different ways. This strategy recognises the importance of responding with compassion, dignity, understanding, and hope, while continuing to build systems and communities where people feel listened to, supported, included, and able to access the help they need without fear of judgement or stigma. This is a collective call to action to create healthier, safer, and more compassionate communities where people affected by alcohol and drugs are supported with dignity, respect, hope, and opportunity. 3. Vision and Mission Vision To create a Moray where individuals, families, and communities affected by alcohol and drugs are supported to live healthier, safer, and more fulfilling lives through compassionate, trauma-informed, rights-based, and person-centred support. This vision is rooted in dignity, inclusion, equity, and hope. We are committed to reducing harms, preventing avoidable deaths, promoting recovery and wellbeing, and ensuring that no person is left behind due to stigma, inequality, poverty, trauma, or barriers to accessing support. By working collaboratively across communities, services, and partnerships, and by valuing the voices of lived and living experience, Moray aims to create a system where people feel listened to, respected, empowered, and supported to achieve the outcomes that matter most to them. Mission The Moray Alcohol and Drug Partnership (MADP) is committed to delivering a whole- system, public health, and human rights-based approach to preventing harm, promoting recovery, and improving wellbeing for people affected by alcohol and drugs. Our mission is to: Page 257
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Page 7 of 71 Embed Lived and Living Experience Ensure people with lived and living experience are meaningfully involved in the design, delivery, governance, monitoring, and improvement of services and systems across Moray. Their voices, experiences, and expertise will help shape local priorities, influence decision-making, strengthen accountability, and drive continuous improvement across the partnership. Embed Human Rights and Reduce Stigma Embed the Charter of Rights for People Affected by Substance Use across all services and partnerships, ensuring dignity, participation, accountability, non- discrimination, empowerment, and equitable access to support. MADP is committed to tackling stigma and promoting compassionate, inclusive, and recovery-focused communities. Prevent Harm and Promote Early Intervention Reduce the impact of alcohol and drug harms through prevention, education, early intervention, and community-based approaches that address the wider factors affecting health and wellbeing. Save Lives Through Harm Reduction Deliver evidence-based harm reduction initiatives that reduce immediate risks, prevent avoidable deaths, and improve health outcomes for individuals, families, and communities. Improve Access to Treatment and Care Ensure people can access timely, high-quality, trauma-informed, and person-centred treatment and care that reflects individual needs, promotes choice, and supports recovery. Strengthen Recovery and Wider Support Promote recovery and resilience by strengthening recovery capital through housing, employability, advocacy, education, peer support, family support, social connection, and inclusive recovery communities. Deliver Through Partnership and Continuous Improvement Work collaboratively across local communities, public services, third sector organisations, and national partners to deliver sustainable improvement, transparent governance, and responsive services that continue to evolve alongside local need, lived experience feedback, and emerging evidence. Page 258
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Page 8 of 71 Through this Strategic Delivery Plan, MADP will continue working alongside communities and partners to create a healthier, safer, and more compassionate communities where recovery, wellbeing, dignity, and hope are achievable for all. 4. Strategic Context and Local Need 4.1 Local Context Moray is a predominantly rural area with a diverse range of communities, each experiencing different levels of access, deprivation, and health inequality. While many people experience positive health and wellbeing outcomes, alcohol and drug harms continue to have a significant impact on individuals, families, communities, and local services. People affected by alcohol and drugs can experience a range of interconnected challenges including poverty, trauma, mental health difficulties, homelessness, stigma, social isolation, family breakdown, and reduced access to employment, education, and community support. These challenges are often compounded by wider inequalities and adverse life experiences, increasing vulnerability and reducing opportunities for recovery and wellbeing. As a rural area, additional barriers relating to geography, transport, workforce capacity, and access to specialist support continue to affect local communities. Long travel distances, limited public transport, digital exclusion, and concerns around privacy and stigma within smaller communities can make it more difficult for individuals and families to seek help or remain engaged with support. Alcohol-related harms continue to represent a significant public health challenge, contributing to physical health conditions, mental health challenges, family harms, hospital admissions, social isolation, and wider inequalities. Alongside this, local services continue to respond to evolving patterns of drug use, including increasing complexity associated with cocaine, ketamine, benzodiazepines, and poly-substance use. The Moray Alcohol and Drug Partnership recognises that alcohol and drug harms do not exist in isolation. They are closely linked to wider social determinants of health including housing, poverty, trauma, employability, education, community safety, and social connection. This Strategic Delivery Plan therefore adopts a whole-system and public health approach that recognises the importance of prevention, early intervention, partnership working, recovery-oriented systems of care, and community-based support. The Strategic Delivery Plan aligns with Scotland’s Alcohol & Drugs Strategic Plan 2026–2035 and reflects the national ambition to prevent harm, promote recovery, and save lives through a human rights-based and partnership-led approach. It also aligns with the Partnership Delivery Framework for Alcohol and Drug Partnerships, Page 259
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Page 9 of 71 the National Service Specification for Alcohol and Drug Services, and wider national priorities relating to population health improvement, public service reform, mental health, children and families, and reducing inequalities. 4.2 Emerging Trends and Challenges Patterns of alcohol and drug use continue to evolve, requiring services and partnerships to remain responsive, flexible, evidence-informed, and shaped by lived and living experience. Alcohol remains one of the most significant contributors to harm locally, impacting physical and mental health, relationships, family wellbeing, community safety, and wider public services. Hazardous and harmful drinking patterns can often become normalised, making prevention, early intervention, and stigma reduction particularly important. Alongside alcohol-related harms, increasing complexity of substance use presents ongoing challenges for services and communities. This includes increasing use of cocaine, ketamine, benzodiazepines, and poly-substance use, often alongside trauma, mental health challenges, physical health conditions, homelessness, poverty, or social exclusion. These patterns can increase the risk of harm, overdose, disengagement from services, and poorer health outcomes. Stigma continues to be a significant barrier for many individuals and families seeking support. Fear of judgement, discrimination, previous experiences of services, and stigma within communities can prevent people from accessing support, exercising their rights, or engaging in recovery. Reducing stigma and promoting compassionate, rights-based approaches therefore remains a key priority across services and partnerships. Recruitment and retention of skilled professionals within rural areas continues to present challenges across the system, impacting capacity, accessibility, and sustainability of support. Continued investment in workforce development, trauma- informed practice, supervision, wellbeing, and partnership working will remain essential to delivering high-quality and sustainable services. There is also an increasing need to respond effectively to emerging harms and trends through partnership intelligence, surveillance, and early warning approaches. Developments including strengthened intelligence sharing, assertive outreach approaches, near-fatal overdose responses, and local early warning and escalation arrangements support a more coordinated and responsive approach to reducing harms and protecting communities. Through collaborative working, experiential learning, local intelligence, and continuous improvement, services and partners will continue working together to strengthen responsiveness, reduce harm, and improve outcomes for individuals, families, and communities affected by alcohol and drugs. Page 260
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Page 10 of 71 4.3 Children, Families and Communities Alcohol and drug harms can have a significant impact on children, young people, families, and wider communities. Experiences such as trauma, adverse childhood experiences, family breakdown, bereavement, poverty, stigma, social exclusion, and parental substance use can have long-term effects on health, wellbeing, relationships, educational attainment, and life opportunities. The Moray Alcohol and Drug Partnership recognises the importance of prevention, early intervention, and whole family approaches that support both individuals and those around them. Families, carers, children, and affected others often play a vital role in supporting recovery and wellbeing, while also requiring support in their own right. Parental substance use remains an important area of focus. Children and young people affected by alcohol and drug use within the family may experience increased vulnerability, trauma, emotional distress, disrupted relationships, and wider inequalities. Moray is committed to strengthening partnership approaches that improve identification, support, early intervention, and collaborative working across children’s services, education, health, social care, and community-based support. This Strategic Delivery Plan promotes collaborative approaches across children’s services, education, health, social care, justice, housing, public protection, and community organisations to improve outcomes for children, young people, and families affected by alcohol and drugs. This includes strengthening prevention activity, improving access to family support, reducing stigma, supporting transitions, and ensuring that children and young people are able to access timely, compassionate, and age-appropriate support. Recovery is strengthened through connected and supportive communities where people feel included, valued, and able to access support without fear of judgement or stigma. Recovery communities, peer support, advocacy services, volunteering, community engagement, and social connection all play an important role in reducing isolation, building resilience, and supporting long-term recovery and wellbeing. Through partnership working, early intervention, family-inclusive approaches, and community support, local services and partners will continue working together to improve outcomes for children, families, and communities affected by alcohol and drugs. Page 261
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Page 11 of 71 4.4 Opportunities and Strengths While significant challenges remain, there are also strong foundations and opportunities to support meaningful and sustainable improvement across the local alcohol and drug system. A key strength is the development of a strong rights-based and trauma-informed approach through implementation of the Charter of Rights for People Affected by Substance Use and the Moray Charter Implementation Toolkit. The toolkit supports the embedding of participation, accountability, empowerment, dignity, and equitable access across services, governance arrangements, workforce development, and improvement activity. The use of the AAAQ Framework (Availability, Accessibility, Acceptability, and Quality) and FAIR methodology further supports transparency, participation, continuous improvement, and rights-based service delivery across the partnership. Another significant strength is the involvement of people with lived and living experience in shaping local priorities, service development, governance arrangements, workforce learning, and improvement activity. Through co-design, experiential feedback, Collective Voice approaches, experiential interviews, recovery communities, and partnership engagement activity, lived and living experience continues to strengthen understanding of local need, identify barriers and inequalities, and support meaningful and visible improvement across services and systems. Residential rehabilitation pathways have also been strengthened through adoption of the Scotland Excel Framework and redesign of local referral pathways. This has supported improved access to residential rehabilitation, strengthened partnership working, and enhanced pathways into, through, and out of treatment and recovery support. Partnership arrangements surrounding residential rehabilitation continue to strengthen continuity of care, collaborative planning, and recovery-focused support. Strong partnership working across statutory services, third sector organisations, advocacy services, recovery communities, and local communities continues to strengthen the ability to respond to local need in a coordinated and person-centred way. This includes developments relating to assertive outreach, independent advocacy, family support, prevention activity, harm reduction, and community-based recovery support. Partnership arrangements have also been strengthened to support emerging harms, learning, and continuous improvement. This includes local early warning and escalation processes, strengthened intelligence sharing, experiential learning approaches, and ongoing partnership review of local trends, risks, and outcomes. These strengths provide a strong foundation for continued improvement and support the ambition to deliver compassionate, inclusive, evidence-informed, and rights- Page 262
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Page 12 of 71 based systems of care that improve wellbeing, reduce harms, promote recovery, and save lives for individuals, families, and communities affected by alcohol and drugs. 5. Human Rights, Lived Experience and Reducing Stigma This Strategic Delivery Plan is underpinned by a human rights-based approach that promotes dignity, participation, accountability, non-discrimination, empowerment, and equitable access to support for people affected by alcohol and drugs. Central to this approach is the Charter of Rights for People Affected by Substance Use and the Moray Charter Implementation Toolkit, which support rights-based practice, participation, accountability, and continuous improvement across local services, governance arrangements, workforce development, and partnership activity. People with lived and living experience continue to play a vital role in shaping local priorities, informing improvement activity, strengthening accountability, and improving understanding of how services and systems are experienced across communities. Their insight and expertise remain central to co-design, experiential learning, governance, workforce learning, and recovery-focused improvement activity across the partnership. Independent advocacy also plays an important role in supporting individuals to understand and exercise their rights, express their views, navigate systems, and access appropriate support when needed. Reducing stigma remains a key priority across services, systems, and communities. Stigma and discrimination can create significant barriers to accessing support, exercising rights, participating in communities, and engaging in recovery. Promoting compassionate, trauma-informed, and non-stigmatising approaches across services and communities therefore remains essential to improving outcomes and strengthening inclusion. Through rights-based practice, meaningful participation, advocacy, partnership working, and continuous improvement, local services and partners will continue working together to strengthen inclusion, improve experiences and outcomes, and support compassionate and recovery-oriented communities. 6 Strategic Priorities The Strategic Delivery Plan 2026–2029 is structured around four interconnected strategic priorities that reflect both national direction and the specific needs, strengths, challenges, and opportunities identified locally. Page 263
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Page 13 of 71 While aligned to Scotland’s Alcohol & Drugs Strategic Plan 2026–2035, this plan is intentionally shaped by local need, partnership learning, community insight, and the realities of rural communities. Challenges relating to access, inequality, stigma, workforce capacity, transport, housing, social isolation, and increasing complexity of alcohol and drug use continue to affect individuals, families, communities, and services in different ways. The plan therefore focuses on delivering flexible, responsive, and community-based approaches that reflect local circumstances and priorities. Community participation and experiential learning remain central to delivery and improvement activity. The experiences and perspectives of people affected by alcohol and drugs continue to inform local priorities, identify barriers, strengthen accountability, and support service and system improvement across the partnership. Central to the Strategic Delivery Plan is the continued implementation of the Charter of Rights for People Affected by Substance Use and the Moray Charter Implementation Toolkit. These approaches support the embedding of dignity, accountability, participation, accessibility, and equitable access across planning, governance, workforce development, service delivery, and improvement activity. The Strategic Delivery Plan is also informed by: • Human rights-based approaches. • Trauma-informed practice. • The AAAQ Framework (Availability, Accessibility, Acceptability, and Quality). • FAIR methodology (Facts, Analysis, Identify, Review). • Partnership collaboration and shared accountability. • Continuous improvement and experiential learning. • Recovery-oriented systems of care. The four strategic priorities are: 6.1 Prevention and Early Intervention Preventing alcohol and drug harms before they occur remains a key priority within this Strategic Delivery Plan. Early intervention, prevention, education, and community-based support are essential to improving long-term health and wellbeing outcomes, reducing inequalities, and strengthening resilience within individuals, families, and communities. Prevention activity will continue to focus not only on substance use itself, but also on the wider factors that can increase vulnerability to harm, including trauma, poverty, mental health challenges, adverse childhood experiences, social isolation, inequality, and stigma. Page 264
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Page 14 of 71 Supporting children, young people, and families affected by alcohol and drugs remains particularly important. Strengthening early identification, family-inclusive practice, partnership working, and access to timely support can help reduce longer- term harms and improve outcomes across the life course. Prevention and early intervention approaches will continue to include: • Whole family support and family-inclusive practice. • Prevention and awareness activity within schools, communities, and wider settings. • Early identification and timely access to support. • Alcohol Brief Interventions and community-based prevention activity. • Support for children and young people affected by parental substance use. • Partnership approaches to reducing stigma and inequalities. • Community wellbeing and resilience activity. • Improved awareness of local support and treatment pathways. Partnership working across education, health, social care, housing, justice, community organisations, and recovery communities remains essential to delivering effective prevention and early intervention approaches that are accessible, compassionate, and responsive to local need. Through early intervention, prevention, education, and community support, services and partners will continue working together to reduce harms, strengthen wellbeing, and improve outcomes for individuals, families, and communities affected by alcohol and drugs. 6.2 Harm Reduction Reducing alcohol and drug-related harm and preventing avoidable deaths remains a central priority across local services and partnerships. Harm reduction approaches play an essential role in improving health outcomes, increasing engagement, supporting recovery, and protecting individuals, families, and communities from immediate and longer-term harm. Services and partners will continue to strengthen evidence-informed approaches that reduce risk, improve safety, and promote timely access to support and treatment. This includes recognising the increasing complexity of substance use patterns and the importance of responding flexibly to emerging harms, trends, and local intelligence. Harm reduction activity will continue to include: • Naloxone distribution and overdose prevention activity. Page 265
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Page 15 of 71 • Needle Exchange provision and safer injecting advice. • Assertive outreach and engagement approaches. • Near-fatal overdose pathways and follow-up support. • Public awareness and harm reduction messaging. • Partnership intelligence sharing and early warning arrangements. • Trauma-informed engagement approaches. • Improved pathways into treatment, care, and recovery support. Strengthening partnership approaches to monitoring emerging trends and risks also remains important. Developments relating to local early warning and escalation arrangements, experiential learning, surveillance activity, RADAR intelligence, and partnership information sharing support a more coordinated and responsive approach to reducing harm and protecting communities. Reducing stigma and improving accessibility remain important parts of effective harm reduction practice. Individuals affected by alcohol and drugs should be able to access support without fear of judgement, discrimination, or barriers that prevent engagement with services and recovery support. Through collaborative working, early intervention, outreach, harm reduction activity, and continuous learning, services and partners will continue working together to reduce harms, save lives, and improve health and wellbeing outcomes for individuals, families, and communities. 6.3 Treatment and Care Improving access to high-quality, person-centred treatment, care, and recovery support remains a key priority within this Strategic Delivery Plan. Services and partners will continue working together to ensure individuals can access timely, compassionate, and effective support that reflects their needs, circumstances, strengths, and recovery goals. People affected by alcohol and drugs may experience a range of interconnected challenges including trauma, mental health difficulties, physical health conditions, homelessness, poverty, family breakdown, social isolation, and involvement with justice services. Strengthening coordinated and flexible pathways across services therefore remains essential to improving experiences, engagement, continuity of care, and long-term outcomes. Treatment and recovery pathways will continue to focus on: • Improving access to high-quality treatment and support across Moray. • Strengthening pathways across community, primary care, acute, and specialist services. • Embedding rights-based and trauma-informed approaches across services. Page 266
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Page 16 of 71 • Continuing implementation and improvement of Medication Assisted Treatment (MAT) Standards. • Strengthening pathways into, through, and out of residential rehabilitation. • Supporting integrated approaches for people experiencing complex and poly- substance use. • Improving access to independent advocacy and holistic support. • Reducing barriers to engagement and improving continuity of care. • Using lived and living experience to inform service design, pathway development, and continuous improvement. • Strengthening partnership approaches to mental health, physical health, and wider wellbeing support. Residential rehabilitation pathways have been strengthened through redesign of local referral arrangements, improved partnership coordination, and development of clearer pathways into treatment and recovery support. Continued focus will remain on ensuring access is timely, equitable, and responsive to individual need, while strengthening preparation, aftercare, and long-term recovery support within communities. Recovery is recognised as a personal and ongoing process that looks different for everyone. Effective recovery support extends beyond clinical treatment and includes stable housing, family support, social connection, community participation, education, employability, wellbeing, and opportunities to build confidence and independence. Through partnership collaboration, integrated pathways, recovery-focused practice, and community-based support, services and partners will continue working together to improve access, strengthen recovery, and support better outcomes for individuals, families, and communities affected by alcohol and drugs. 6.4 Wider Circle of Support Recovery is supported not only through treatment services, but also through housing, employability, education, advocacy, peer support, recovery communities, family support, social connection, and inclusive communities. This Strategic Delivery Plan recognises the importance of strengthening the wider circle of support surrounding individuals and families affected by alcohol and drugs. Many people experience interconnected challenges including poverty, trauma, mental health difficulties, homelessness, stigma, social isolation, and barriers to accessing support and opportunities within communities. Addressing these wider factors remains essential to supporting long-term recovery, improving wellbeing, and reducing inequalities. People with lived and living experience are central to strengthening recovery communities, peer support approaches, community engagement, and inclusive recovery pathways across Moray. Their experiences, leadership, and participation continue to shape local recovery approaches, community development activity, experiential learning, and partnership improvement across the system. Page 267
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Page 17 of 71 Services and partners will continue working collaboratively to strengthen recovery capital and improve access to wider support including: • Strengthening recovery communities and peer support opportunities. • Improving access to advocacy, housing, welfare, and wider wellbeing support. • Supporting family members, carers, and affected others. • Promoting inclusive and recovery-focused communities. • Strengthening partnership approaches to employability, education, volunteering, and social inclusion. • Reducing stigma and improving community understanding of alcohol and drug harms. • Supporting participation, community engagement, and opportunities for connection and belonging. • Promoting long-term recovery, resilience, and wellbeing. • Supporting lived and living experience leadership, participation, and recovery community development. Recovery communities, peer support, and community-based approaches continue to play an important role in reducing isolation, strengthening resilience, promoting hope, and helping people remain connected within their communities. Strengthening partnership working across housing, justice, health, social care, education, community planning, advocacy services, third sector organisations, and recovery communities remains essential to ensuring individuals and families can access the broader support needed to sustain recovery and improve wellbeing. Through inclusive, recovery-focused, and community-based approaches, services and partners will continue working together to strengthen resilience, improve wellbeing, and support healthier and more connected communities. 7. Partnership Working, Governance, Accountability and Assurance 7.1 Partnership Working and Shared Responsibility Strong partnership working remains essential to delivering effective, coordinated, and sustainable responses to alcohol and drug harms. No single service or organisation can meet the wide range of needs experienced by individuals, families, and communities affected by alcohol and drugs. Delivering meaningful improvement therefore depends upon collaboration, shared accountability, and collective leadership across services, sectors, and communities. The Moray Alcohol and Drug Partnership brings together partners from health and social care, public protection, housing, justice, education, community planning, third sector organisations, advocacy services, recovery communities, and wider community networks to support a coordinated whole-system approach to prevention, harm reduction, treatment, recovery, and wellbeing. Partnership working supports improved communication, shared learning, integrated pathways, earlier intervention, and more responsive support for individuals and Page 268
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Page 18 of 71 families. Collaborative approaches also strengthen the ability to respond to emerging trends, local challenges, workforce pressures, inequalities, and changing community need. Partnership arrangements will continue to focus on: • Strengthening collaborative leadership and shared accountability. • Improving coordination across services and pathways. • Supporting integrated and person-centred approaches. • Strengthening prevention, harm reduction, treatment, and recovery activity. • Improving communication, engagement, and shared learning. • Supporting workforce development and reflective practice. • Strengthening community participation and local engagement. • Promoting continuous improvement and responsive service delivery. Community organisations, advocacy services, peer support approaches, and recovery communities continue to make an important contribution to the local system through relationship-based support, community connection, early engagement, and recovery-focused activity. Through partnership collaboration, shared responsibility, and continued learning, services and partners will continue working together to improve experiences, strengthen outcomes, reduce harms, and support healthier and more inclusive communities. People with lived and living experience are central to partnership working and system improvement across Moray. Their insight, expertise, and experiences help strengthen understanding of local need, identify barriers and inequalities, influence decision-making, improve service design, and support meaningful and sustainable change across services, systems, and communities. Through partnership working, shared accountability, lived and living experience leadership, and collaborative improvement approaches, Moray aims to strengthen local systems, improve outcomes, and support healthier and more inclusive communities. 7.2 Role of the Moray Alcohol and Drug Partnership The Moray Alcohol and Drug Partnership (MADP) provides strategic leadership, partnership coordination, oversight, and assurance in relation to alcohol and drug planning, improvement, and delivery across Moray. Working alongside local communities, partner organisations, and people with lived and living experience, MADP supports a whole-system and partnership-led approach to preventing harm, promoting recovery, reducing inequalities, and improving outcomes for individuals, families, and communities affected by alcohol and drugs. MADP is responsible for: • Developing, overseeing, and monitoring delivery of the Strategic Delivery Plan. Page 269
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Page 19 of 71 • Supporting partnership collaboration, shared responsibility, and collective leadership across the local system. • Providing strategic oversight, assurance, and governance in relation to alcohol and drug priorities within Moray. • Monitoring local performance, outcomes, risks, and improvement activity. • Supporting rights-based, trauma-informed, and recovery-oriented systems of care. • Embedding lived and living experience within governance, planning, service development, and continuous improvement activity. • Supporting alignment with national policy, standards, and strategic priorities while responding to local need and emerging challenges. • Promoting transparency, accountability, learning, and continuous improvement across services and partnerships. • Supporting coordinated local responses to emerging harms, inequalities, risks, and public protection concerns. MADP operates within the wider governance arrangements of Health and Social Care Moray and the Moray Integration Joint Board (IJB), while working collaboratively alongside Community Planning Partnership structures, public protection arrangements, third sector organisations, advocacy services, recovery communities, and wider local partnerships. The work of MADP is informed by local intelligence, partnership data, experiential learning, and the voices of people with lived and living experience. This supports a locally responsive, evidence-informed, and partnership-led approach to governance, planning, improvement, and accountability across Moray. 7.3 Governance and Accountability Arrangements Strong governance and accountability arrangements are essential to supporting effective delivery, oversight, transparency, and continuous improvement across the local alcohol and drug system. The Moray Alcohol and Drug Partnership operates within wider Health and Social Care Moray and Integration Joint Board governance arrangements and works alongside community planning partners, public protection structures, Community Justice partners, and wider strategic partnerships to support coordinated approaches to improving outcomes. Governance arrangements support: • Strategic leadership and oversight. • Monitoring of priorities, performance, and improvement activity. • Shared accountability across services and partnerships. • Oversight of risk, emerging harms, and escalation processes. • Collaborative planning and decision-making. • Continuous learning and responsive improvement activity. • Alignment with national priorities, standards, and guidance. Page 270
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Page 20 of 71 Regular reporting and review processes help ensure that local priorities, risks, challenges, emerging trends, and improvement activity remain visible across governance structures and continue to inform strategic and operational decision- making. Performance monitoring arrangements incorporate a range of information sources including service data, experiential learning, local intelligence, governance reporting, partnership review processes, and national reporting requirements. These approaches support transparency, accountability, learning, and ongoing improvement across services and systems. Through effective governance, collaborative leadership, and shared accountability, services and partners will continue working together to strengthen oversight, responsiveness, partnership delivery, and improvement across the local alcohol and drug system. 7.4 Lived and Living Experience within Governance and Improvement People with lived and living experience should be active partners in shaping governance, influencing decision-making, improving services, strengthening accountability, and supporting continuous improvement across the local alcohol and drug system. Lived and living experience is embedded across partnership planning, co-design, governance structures, service development, workforce development, experiential learning, and improvement activity throughout Moray. The voices, experiences, and expertise of people affected by alcohol and drugs help strengthen understanding of local need, identify barriers and inequalities, improve accessibility, influence service delivery, and support meaningful and sustainable change across services and communities. MADP is committed to ensuring that participation is meaningful, inclusive, trauma- informed, and supported. This includes recognising the importance of reducing barriers to participation, valuing lived and living experience expertise, ensuring feedback leads to visible action and improvement, and creating safe and accessible opportunities for involvement across services and partnerships. Experiential and co-design approaches continue to be strengthened through community engagement activity, experiential interviews, recovery communities, Collective Voice approaches, partnership events, experiential learning activity, and ongoing feedback and dialogue approaches that support transparency, accountability, learning, and visible improvement across the local system. The Charter of Rights for People Affected by Substance Use, alongside the Moray Charter Implementation Toolkit, supports the embedding of participation, accountability, dignity, empowerment, and rights-based approaches across local governance and improvement activity. The use of the AAAQ Framework and FAIR Page 271
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Page 21 of 71 methodology further supports experiential learning, continuous improvement, transparency, equitable access, and accountability across the local system. People with lived and living experience also make an important contribution to reducing stigma, strengthening recovery communities, improving services, supporting workforce learning, and influencing positive culture change across communities and systems. Through partnership working, rights-based practice, meaningful participation, and lived and living experience leadership, Moray aims to strengthen trust, improve outcomes, and ensure that local alcohol and drug services and systems are shaped by the people and communities they exist to support. 7.5 Risk, Escalation and Continuous Improvement Identifying and responding proactively to emerging harms, risks, inequalities, and changing patterns of alcohol and drug use remains an important part of local partnership delivery. Effective governance, shared intelligence, experiential learning, and collaborative working all support responsive, coordinated, and accountable approaches to reducing harm and protecting communities. Partnership arrangements support ongoing monitoring, intelligence sharing, experiential learning, and coordinated responses to emerging alcohol and drug- related concerns. This includes strengthened intelligence sharing, assertive outreach approaches, near-fatal overdose responses, experiential learning activity, and development of local early warning and escalation arrangements to support timely and coordinated responses to emerging risks and trends. Local approaches to risk monitoring and escalation have been strengthened through development of early warning and escalation processes, partnership review arrangements, and improved intelligence sharing across services and partners. These arrangements are informed by local intelligence, Public Health Scotland reporting, RADAR alerts and updates, experiential feedback, and wider partnership data. This supports earlier identification of emerging concerns, improved coordination across services, and more responsive approaches to reducing harm and protecting communities. MADP works alongside wider partnership structures including Health and Social Care Moray, Public Health Scotland, NHS Grampian public health colleagues, public protection partnerships, Community Planning Partnership arrangements, and Chief Officers Group structures to support shared oversight, risk management, collaborative decision-making, and coordinated responses to emerging issues and wider public health concerns. Responses to risk and emerging harm should be informed not only by data, surveillance, and intelligence, but also by the experiences of individuals, families, communities, and people affected by alcohol and drugs. Experiential feedback and Page 272
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Page 22 of 71 community insight continue to play an important role in identifying barriers, emerging concerns, service pressures, inequalities, and opportunities for improvement. Continuous improvement activity across Moray is informed by: • Performance and outcome data. • Public Health Scotland reporting and RADAR intelligence. • Experiential feedback and lived and living experience. • Partnership intelligence and local learning. • Service review and quality improvement activity. • National guidance, standards, and evidence-informed practice. • Community engagement and partnership collaboration. MADP is committed to promoting a culture of learning, reflection, accountability, transparency, and continuous improvement across all areas of planning, governance, and service delivery. This includes strengthening the ability of local systems and partnerships to identify risks early, respond collaboratively, reduce inequalities, and adapt to changing local need, emerging evidence, and evolving patterns of alcohol and drug use. Through collaborative leadership, experiential learning, public health intelligence, and shared accountability, services and partners will continue working together to strengthen prevention, reduce harms, improve responsiveness, and support safer and healthier communities. 7.6 Transparency, Engagement and Public Learning MADP is committed to promoting openness, transparency, accountability, and shared learning across all areas of alcohol and drug planning, delivery, governance, and improvement. Transparent reporting and meaningful engagement are essential to building trust, strengthening partnerships, improving services, and ensuring local approaches remain responsive to the needs and experiences of individuals, families, and communities. People with lived and living experience, communities, partners, and wider stakeholders should be able to understand local priorities, contribute to improvement activity, and see how feedback, learning, and experiential insight influence change and development across services and partnerships. Public reporting and learning approaches are informed by: • Performance and outcome data. • Experiential feedback and community insight. Page 273
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Page 23 of 71 • Partnership intelligence and local learning. • Public Health Scotland reporting and national intelligence. • Community engagement and co-design activity. • Service review and improvement processes. Approaches that support transparency, participation, and engagement continue to be strengthened through experiential learning activity, community engagement, ongoing feedback and dialogue approaches, partnership events, recovery community engagement, public reporting, and opportunities for collaboration and participation across services and communities. The Moray Charter Implementation Toolkit continues to support transparency, accountability, participation, and improvement across governance and service delivery arrangements. Experiential feedback, community engagement, and lived and living experience involvement also play an important role in identifying barriers, inequalities, service pressures, and opportunities for improvement across the local system. MADP remains committed to promoting a culture of openness, reflection, learning, and accountability across all areas of planning and delivery. This includes listening to communities, responding to local need, and ensuring improvement activity remains visible, collaborative, and evidence-informed. Through transparent governance, public learning, experiential feedback, and partnership collaboration, services and partners will continue working together to strengthen trust, improve outcomes, reduce stigma, and support compassionate and recovery-focused systems of care and support. 8. Outcomes, Performance and Continuous Improvement 8.1 Outcomes and Intended Impact Through this Strategic Delivery Plan, the partnership aims to improve health, wellbeing, recovery outcomes, and quality of life for individuals, families, and communities affected by alcohol and drugs. The intended outcomes within this plan are informed by local need, experiential learning, partnership intelligence, and a shared commitment to reducing harm, reducing inequalities, promoting recovery, and strengthening communities. Meaningful improvement extends beyond service activity and performance measures alone. Improving outcomes requires approaches that recognise the impact of trauma, stigma, inequality, poverty, social exclusion, housing instability, mental health, physical health, family wellbeing, and wider social determinants that affect individuals and communities. Page 274
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Page 24 of 71 Experiential learning and community insight continue to play an important role in understanding what positive outcomes look like for individuals, families, and communities, while also helping identify barriers, inequalities, gaps in support, and opportunities for improvement across services and systems. The Charter of Rights for People Affected by Substance Use and the Moray Charter Implementation Toolkit continue to support rights-based approaches to improvement, accountability, accessibility, participation, and equitable access across local services, pathways, governance arrangements, and community support. The intended outcomes of this Strategic Delivery Plan include: • Reduced alcohol and drug-related harms. • Improved health, wellbeing, and quality of life for individuals and families. • Reduced stigma, discrimination, and barriers to accessing support. • Improved access to compassionate, person-centred, and recovery-focused support. • Stronger prevention and early intervention approaches. • Improved recovery outcomes and increased community connection. • Strengthened support for children, young people, families, and affected others. • Reduced inequalities and improved access to support within rural communities. • Stronger recovery communities, peer support, advocacy, and community participation. • Increased involvement of people with lived and living experience in governance, service design, and improvement activity. • Improved partnership working, accountability, transparency, and continuous improvement. Recovery and wellbeing are recognised as personal and non-linear, influenced by a wide range of social, economic, health, and community factors. This Strategic Delivery Plan therefore promotes flexible, person-centred, and recovery-focused approaches that recognise individual strengths, experiences, aspirations, and goals. Through collaborative leadership, partnership working, experiential learning, and continuous improvement, services and partners will continue working together to improve outcomes, reduce harm, strengthen wellbeing, and support healthier and more inclusive communities. Page 275
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Page 25 of 71 8.2 Performance, Monitoring, and Improvement MADP is committed to ensuring that robust performance, monitoring, governance, and improvement arrangements support accountability, transparency, learning, and continuous improvement across the local alcohol and drug system. Effective monitoring and review processes are essential to understanding local need, identifying emerging risks and inequalities, measuring progress against strategic priorities, and ensuring that services and support remain responsive, evidence- informed, and aligned to the needs of individuals, families, and communities across Moray. Performance and improvement activity will be informed through a range of local and national information sources, including: • Local performance and outcome data. • DAISy reporting and national benchmarking information. • Public Health Scotland reporting and RADAR intelligence. • Partnership intelligence and local learning. • Service review and quality improvement activity. • National guidance, standards, and evidence-informed practice. • Experiential learning and lived and living experience feedback. The Moray Charter Implementation Toolkit, alongside the use of the AAAQ Framework and FAIR methodology, supports a structured and rights-based approach to improvement, participation, accountability, and transparent learning across the local alcohol and drug system. These approaches support local services and partnerships to identify barriers, understand inequalities, strengthen accessibility, and evidence improvement across services, pathways, governance arrangements, and community support. Performance monitoring across the lifetime of this Strategic Delivery Plan will support: • Ongoing review of local priorities and outcomes. • Identification of emerging trends, risks, and pressures. • Improvement planning and partnership learning. • Accountability and governance reporting. • Continuous improvement across services and systems. • Strengthened understanding of lived and living experience and community impact. MADP will continue to support collaborative approaches to review, improvement, and learning across the partnership, ensuring that monitoring arrangements reflect both measurable outcomes and the experiences of people accessing support across the local system. Through performance monitoring, partnership review, rights-based improvement approaches, and experiential learning, local services and partners will continue Page 276
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Page 26 of 71 working to strengthen accountability, improve outcomes, and support continuous improvement across alcohol and drug services and systems within Moray. 8.3 Experiential Learning and Outcomes Experiential learning plays a central role in shaping improvement, accountability, and outcomes across the local alcohol and drug system. Alongside performance data and partnership intelligence, understanding the experiences of individuals, families, communities, and people with lived and living experience is essential to identifying barriers, strengthening accessibility, improving services, and supporting meaningful and sustainable change. Across the local system, experiential learning supports a deeper understanding of how services, pathways, communities, and wider systems are experienced in practice. This includes understanding where people feel supported, where gaps or barriers exist, and where local approaches can be strengthened to improve wellbeing, recovery outcomes, inclusion, dignity, and access to support. People with lived and living experience are central to this work. Their insight, expertise, and leadership continue to influence local priorities, governance arrangements, service development, workforce learning, recovery community development, and wider improvement activity across the partnership. Experiential approaches are intended not only to gather feedback, but to strengthen participation, shared learning, accountability, and visible improvement across the local system. The Moray Lived and Living Experience (LLE) Panel plays an important role in supporting experiential learning, participation, co-design, and improvement activity across the partnership. The panel provides a structured and meaningful opportunity for people with lived and living experience to influence local priorities, identify barriers and inequalities, contribute to service and system improvement, and strengthen accountability across governance and partnership arrangements. Collective Voice approaches also support a broader understanding of the experiences of people affected by alcohol and drugs across Moray. This helps ensure that learning is not limited to one setting or pathway, but reflects the views, priorities, and experiences of people across communities, services, families, and recovery networks. Workforce development is also strengthened through lived and living experience. Moray recognises the value of people with lived and living experience in shaping and delivering training, improving staff understanding, challenging stigma, and supporting more compassionate, trauma-informed, and rights-based practice. This includes creating opportunities for people with lived and living experience to build confidence, skills, and capacity to contribute safely and meaningfully to training, engagement, governance, and service improvement activity. Experiential learning activity includes: • The Moray Lived and Living Experience (LLE) Panel. • Collective Voice approaches. Page 277
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Page 27 of 71 • Living and lived experience groups and recovery community engagement. • Experiential interviews and feedback approaches. • Community engagement and co-design activity. • “You Said, We Did” learning and feedback loops. • Partnership events and collaborative learning activity. • Workforce learning informed or delivered by people with lived and living experience. • Training, development, and capacity-building opportunities for people with lived and living experience. • Ongoing engagement with individuals, families, carers, and affected others. The Moray Charter Implementation Toolkit, alongside the use of the AAAQ Framework and FAIR methodology, supports a structured and rights-based approach to experiential learning and improvement. These approaches help local services and partnerships understand how people experience support and systems locally, identify barriers and inequalities, strengthen participation and accountability, and support meaningful and visible improvement across governance arrangements, pathways, and community support. Experiential learning also plays an important role in strengthening understanding of local need, rural inequalities, stigma, recovery experiences, accessibility, and the wider factors that impact people’s health, wellbeing, and recovery journeys. This helps ensure that improvement activity remains grounded in the realities of local communities and responsive to the experiences of people affected by alcohol and drugs. MADP will continue to strengthen approaches that support meaningful participation, collaborative learning, and visible improvement across the local alcohol and drug system. Through rights-based practice, experiential learning, Collective Voice approaches, workforce development, partnership collaboration, and lived and living experience leadership, local services and partners will continue working to improve outcomes, strengthen accountability, and support compassionate, inclusive, and recovery-oriented systems and communities across Moray. 8.4 Reviewing and Refreshing the Strategic Delivery Plan This Strategic Delivery Plan is intended to remain responsive to local need, emerging trends, partnership learning, lived and living experience, and changes across the wider alcohol and drug policy landscape. Recognising the evolving nature of alcohol and drug harms, recovery, and community need, ongoing review and continuous improvement will remain central to the delivery of this plan. MADP will continue to review progress against local priorities, outcomes, governance arrangements, and improvement activity throughout the lifetime of the Strategic Delivery Plan. This will include regular partnership review, governance reporting, performance monitoring, experiential learning, and engagement with individuals, families, communities, and people with lived and living experience. Particular focus will be given to ensuring that the Strategic Delivery Plan remains aligned to: Page 278
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Page 28 of 71 • Local need and emerging community priorities. • Rights-based and trauma-informed approaches. • Lived and living experience feedback and learning. • Public Health Scotland reporting, RADAR intelligence, and local partnership intelligence. • Emerging harms, risks, inequalities, and trends. • National policy, standards, and evidence-informed practice. • Partnership learning, service review, and continuous improvement activity. The Moray Charter Implementation Toolkit and associated Charter of Rights improvement actions will be reviewed on a quarterly basis to support accountability, monitor progress, identify barriers and gaps, and strengthen rights-based improvement activity across the local alcohol and drug system. This will help ensure that participation, accessibility, dignity, accountability, and continuous improvement remain embedded throughout planning, governance, and service delivery arrangements. Experiential learning and ongoing engagement with the Moray Lived and Living Experience (LLE) Panel, Collective Voice approaches, recovery communities, and wider community engagement activity will continue to inform the ongoing development and refinement of local priorities and improvement activity. MADP recognises the importance of ensuring that the Strategic Delivery Plan remains a live and responsive document that reflects the realities, experiences, and priorities of individuals, families, communities, and partners across Moray. Through ongoing review, collaborative learning, partnership accountability, and rights-based improvement approaches, the partnership will continue working to strengthen outcomes, improve experiences, and support compassionate, inclusive, and recovery-oriented systems and communities across Moray. 9. Delivery, Implementation and Action Planning 9.1 Delivering the Strategic Delivery Plan The Charter of Rights for People Affected by Substance Use underpins this Strategic Delivery Plan and provides the foundation for how local alcohol and drug services and systems will be delivered, monitored, reviewed, and improved across Moray. Delivery of the plan will continue to be guided by rights-based recovery, lived and living experience, participation, accountability, dignity, non-discrimination, equitable access to support, and trauma-informed practice. Delivering meaningful and sustainable improvement will require collective leadership, shared responsibility, and continued partnership working across the local alcohol and drug system. Improving outcomes for individuals, families, and communities affected by alcohol and drugs depends upon coordinated action across services, communities, governance structures, recovery communities, and wider partnerships throughout Moray. Page 279
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Page 29 of 71 MADP will provide strategic leadership, oversight, coordination, and assurance in relation to delivery of the Strategic Delivery Plan, while recognising that effective delivery depends upon a whole-system and partnership-led approach shaped by local need, lived and living experience, partnership learning, and ongoing engagement with communities and stakeholders. Local services and partners will continue working collaboratively to strengthen prevention, harm reduction, treatment and care, recovery support, workforce development, community engagement, and wider improvement activity across the local system. This includes strengthening approaches that improve accessibility, reduce inequalities, promote recovery, reduce stigma, and support compassionate, inclusive, and trauma-informed systems and communities. People with lived and living experience will remain central to delivery and implementation activity throughout the lifetime of this Strategic Delivery Plan. Participation, co-design, experiential learning, Collective Voice approaches, and collaborative improvement activity will continue to inform local priorities, governance arrangements, workforce development, service improvement, and community engagement across the partnership. The Moray Charter Implementation Toolkit, alongside the use of the AAAQ Framework and FAIR methodology, will continue to support a structured and rights- based approach to delivery, improvement, accountability, and participation across the local alcohol and drug system. These approaches will help strengthen understanding of local experiences, identify barriers and inequalities, support continuous improvement, and ensure that the principles of the Charter remain embedded throughout delivery of the Strategic Delivery Plan. 9.2 Action Plans and Improvement Activity This Strategic Delivery Plan provides the overarching strategic direction and framework for alcohol and drug partnership delivery across Moray. Supporting action plans, implementation plans, improvement frameworks, and partnership workstreams will provide the operational structure for delivering, monitoring, reviewing, and improving activity across the lifetime of the plan. The Charter of Rights for People Affected by Substance Use and the Moray Charter Implementation Toolkit will continue to underpin local delivery, improvement activity, governance arrangements, and partnership approaches across the local alcohol and drug system. These approaches support the practical implementation of rights-based recovery across services, pathways, workforce development, governance, and community support. The use of the AAAQ Framework (Availability, Accessibility, Acceptability, and Quality) and FAIR methodology (Facts, Analysis, Identify, Review) will continue to support a structured and rights-based approach to implementation, participation, accountability, experiential learning, continuous improvement, and understanding how services and systems are experienced locally. Page 280
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Page 30 of 71 Action plans and associated improvement activity will remain responsive and flexible to reflect: • Local need and community priorities. • Lived and living experience. • Public Health Scotland reporting and RADAR intelligence. • Partnership learning and local intelligence. • Emerging harms, risks, inequalities, and changing trends. • National guidance, standards, and evidence-informed practice. • Governance review, evaluation, and continuous improvement activity. Associated action plans and improvement workstreams may include: • Charter of Rights implementation and improvement actions. • Medication Assisted Treatment (MAT) Standards implementation and improvement activity. • Rights-based and trauma-informed practice development. • Workforce development, learning, and training activity. • Residential rehabilitation pathway improvement activity. • Prevention, harm reduction, treatment, and recovery-focused workstreams. • Experiential learning and lived and living experience improvement activity. • Community engagement, Collective Voice, advocacy, and recovery community development activity. • Local improvement actions responding to emerging harms, inequalities, and partnership priorities. Quarterly review of Charter implementation activity and associated rights-based improvement actions will support accountability, participation, monitoring of progress, identification of barriers and inequalities, and visible improvement across services, pathways, governance arrangements, and community support. Action plans and improvement frameworks will continue to be informed through performance monitoring, experiential learning, community engagement, partnership review, and governance reporting arrangements. This will help ensure that local delivery remains transparent, evidence-informed, accountable, and responsive to the experiences and needs of individuals, families, and communities across Moray. Through collaborative leadership, partnership working, rights-based practice, continuous improvement approaches, and lived and living experience leadership, local services and partners will continue working together to strengthen delivery, improve outcomes, and support compassionate, inclusive, and recovery-oriented systems and communities across Moray. 9.3 Accountability, Monitoring and Learning MADP is committed to ensuring transparent governance, accountability, monitoring, and continuous learning across delivery of this Strategic Delivery Plan. Effective monitoring and review arrangements are essential to understanding local need, Page 281
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Page 31 of 71 measuring progress, identifying emerging risks and inequalities, and ensuring that services and support remain responsive, evidence-informed, rights-based, and shaped by lived and living experience. Monitoring and learning approaches across the partnership will be informed through a combination of quantitative data, qualitative feedback, experiential learning, partnership intelligence, and local and national reporting arrangements. This includes understanding not only measurable outcomes and service activity, but also how individuals, families, and communities experience services, pathways, systems, and support across Moray. Monitoring, evaluation, and improvement activity will continue to be informed through: • DAISy reporting and national benchmarking information. • Public Health Scotland reporting and RADAR intelligence. • Local performance and outcome data. • Partnership intelligence and governance reporting. • Experiential learning and lived and living experience feedback. • Community engagement and co-design activity. • National guidance, standards, and evidence-informed practice. • Service review, evaluation, and continuous improvement activity. The Moray Charter Implementation Toolkit, alongside the use of the AAAQ Framework and FAIR methodology, will continue to support a structured and rights- based approach to monitoring, evaluation, participation, accountability, and continuous improvement across the local alcohol and drug system. These approaches support local services and partnerships to understand how systems and services are experienced locally, identify barriers and inequalities, strengthen accessibility and participation, and evidence meaningful improvement across governance arrangements, pathways, and community support. The Moray Lived and Living Experience (LLE) Panel, Collective Voice approaches, experiential interviews, recovery community engagement, and wider community participation activity will continue to play an important role in informing learning, accountability, and improvement across the partnership. Experiential learning and feedback will continue to support local understanding of recovery experiences, accessibility, stigma, inequalities, and barriers to support across communities. Regular review and reporting arrangements will support: • Oversight of strategic priorities, outcomes, and improvement activity. • Identification of emerging harms, risks, inequalities, and pressures. • Partnership accountability and governance assurance. • Continuous improvement and partnership learning. • Monitoring of Charter implementation and rights-based approaches. • Transparent reporting and public accountability. MADP will continue to provide regular reporting through local governance arrangements, including reporting to the Moray Integration Joint Board (IJB) and Page 282
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Page 32 of 71 wider partnership structures where appropriate. Reporting and review activity will help ensure that delivery of the Strategic Delivery Plan remains transparent, accountable, responsive to local need, and aligned to both local priorities and national expectations. Through partnership collaboration, rights-based practice, experiential learning, governance oversight, and continuous improvement approaches, local services and partners will continue working together to strengthen accountability, improve outcomes, and support compassionate, inclusive, and recovery-oriented systems and communities across Moray. 9.4 Leadership, Participation and Advocacy Strong leadership and meaningful participation are essential to delivering effective, compassionate, and inclusive alcohol and drug services across Moray. Leadership across the partnership will continue to focus on collaboration, accountability, reducing stigma, and strengthening systems and communities that support recovery and wellbeing. Leadership across the partnership will continue to promote collaborative working, reflective practice, workforce development, and compassionate approaches that strengthen inclusion, accessibility, recovery, and community wellbeing across Moray. Independent advocacy remains an important part of the local system, supporting individuals to understand their rights, express their views, participate in decisions affecting their care and recovery, and access appropriate support when needed. Advocacy approaches also help strengthen participation, improve communication between individuals and services, and support more person-centred and inclusive systems of care. Leadership across the partnership will continue to focus on: • Supporting meaningful participation and co-design. • Strengthening recovery communities and peer support approaches. • Promoting compassionate and stigma-free cultures. • Supporting workforce learning and reflective practice. • Improving accessibility, inclusion, and equitable access to support. • Strengthening partnership collaboration and shared accountability. Through collaborative leadership, advocacy, participation, and partnership working, local services and partners will continue working together to strengthen outcomes, improve experiences, and support healthier, safer, and more recovery-focused communities across Moray. 9.5 Implementation Priorities and Delivery Approach Implementation of this Strategic Delivery Plan will be supported through a range of associated action plans, improvement workstreams, partnership arrangements, and operational delivery plans across the lifetime of the strategy. These approaches are Page 283
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Page 33 of 71 intended to remain responsive, flexible, and informed by local need, partnership learning, emerging trends, and lived and living experience. Rather than adopting a fixed or static implementation model, delivery priorities will continue to evolve in response to: • Local intelligence and identified community need. • Emerging harms, risks, and changing substance use trends. • Experiential learning and feedback. • Performance monitoring and evaluation activity. • Public Health Scotland reporting and RADAR intelligence. • National policy developments, standards, and evidence-informed practice. • Ongoing governance review and partnership learning. Implementation activity across Moray will continue to focus on strengthening: • Prevention and early intervention approaches. • Harm reduction activity and overdose prevention. • Treatment, care, and recovery pathways. • Whole family approaches and support for children and young people. • Residential rehabilitation pathways and community-based recovery support. • Workforce development and trauma-informed practice. • Rights-based improvement and Charter implementation activity. • Recovery communities, peer support, and community engagement. • Partnership collaboration and system-wide improvement activity. Detailed operational delivery plans and associated improvement frameworks will sit alongside this Strategic Delivery Plan as live and evolving documents. These may include action trackers, Charter implementation plans, MAT Standards improvement activity, service development plans, workforce development activity, and local partnership workstreams. Regular review of implementation priorities and associated action plans will support accountability, transparency, continuous improvement, and responsive delivery across the local alcohol and drug system. This approach will help ensure that partnership activity remains aligned to local priorities, evidence-informed practice, and the experiences and needs of individuals, families, and communities across Moray. Through ongoing partnership collaboration, governance oversight, and continuous improvement approaches, local services and partners will continue working together to strengthen delivery, improve outcomes, and support healthier, safer, and more recovery-oriented communities across Moray. 10. Financial Framework Effective delivery of the Moray ADP Strategic Delivery Plan relies on secure, transparent, and strategically aligned investment. In 2026–27, the Scottish Government confirmed a total funding allocation of £1,528,285 to Moray Alcohol and Drug Partnership (MADP) to support local delivery aligned with national priorities, Page 284
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Page 34 of 71 including the National Mission to Reduce Drug Deaths, implementation of MAT Standards, the Charter of Rights, and whole-family approaches. This funding supports a range of essential services and strategic developments, including: • £1,015,019 core ADP budget (inclusive of Agenda for Change uplifts) to sustain key service delivery, including the MADP Support Team and commissioned services such as Quarriers Arrows and MIDAS. • £189,652 to support National Mission outcomes, including outreach and non- fatal overdose prevention. • £86,206 for residential rehabilitation, enabling access to quality-assured placements through the Scotland Excel Framework and enhancing pre- and post-rehabilitation supports. • £154,319 for the continued implementation of the Medication Assisted Treatment (MAT) Standards, reinforcing equity, access, and person-centred care. • £60,344 to strengthen whole-family approaches and embed inclusive, trauma- informed support for families affected by substance use. • £20,000 to develop and embed meaningful involvement of people with lived and living experience in service design, delivery, and governance. • £14,124 Stabilisation Fund to support short-term residential stabilisation and crisis care. In addition to continuation and committed funding, a proposed allocation of £40,000 has been identified to further enhance support around residential rehabilitation pathways, ensuring they remain trauma-informed, rights-based, and responsive to local need. A further £267,878 in carried-forward funding from previous allocations is committed to support key strategic priorities. This includes investment in bereavement support, implementation of the Charter of Rights, services for children and young people, and enhanced prevention and harm reduction activity. These investments will be progressed in partnership with stakeholders and in alignment with national priorities. Oversight of budget planning and spend is the shared responsibility of the ADP Strategic Group, the ADP Partnership Group, and the Budget Management Team, ensuring funding decisions are transparent, inclusive, and aligned to strategic priorities. This collaborative governance approach also embeds the voice of lived and living experience in financial decision-making. All funding allocations and strategic investments will be reviewed and assessed annually, with updated priorities and spending plans developed for each new financial year. This ensures the MADP remains responsive to emerging needs, learning, and evidence while maintaining a strong focus on prevention, recovery, and reducing harm across Moray. Page 285
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Page 35 of 71 This investment represents a vital enabler in delivering compassionate, high-quality, and person-centred responses to alcohol and drug-related harm in Moray. It supports the ADP’s collective commitment to building inclusive, trauma-informed, and recovery-focused communities where every person is supported to thrive. Page 286
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Page 36 of 71 Scottish Government Funding Allocation Notice: Supporting the Delivery of Alcohol and Drug Services 2026-27 Funding Stream 2025/26 Detail Core MADP Budget (inc AfC uplift) £1,015,019 •£513,266 NHS Board Baseline contribution: Scottish Government’s direct funding to support ADP projects in 2024-25. Recurring. •£87,793 NHS Agenda for Change (pay award) uplift based on returns submitted by Health Boards for 2023-24. New for 25/25 •£293,099 Additional Programme for Government Uplift to support improvement and innovation in D&A services Recurring since 2018-19 •£50,134 PfG Agenda for Change Uplift allowing greater security and flexibility to local areas. Additional National Mission uplift £189,652 For programmes of work which deliver the outcomes set out in the National Mission Outcomes Framework, includes outreach and nonfatal overdose Residential Rehab £ 86,206 To support residential treatment and services associated with preparation or aftercare. Whole family Approach framework £ 60,344 To implement and strengthen holistic whole family approaches and family inclusive practice, in accordance with the Whole Family Approach Framework. Lived and Living Experience £ 8,621 To support ADPs to develop meaningful, accessible and inclusive ways for people to be involved in decision-making MAT Standards £ 154,319 Funding agreed with local services in each IA area for the implementation of the MAT Standards Stabilisation Fund £ 14,124 To develop or bolster existing arrangements for residential stabilisation and crisis care support TOTAL CONFIRMED FUNDS AVAILABLE £1,528,285 PLANNED SPEND £1,526,555 £1,486,555 continuation and committed spend £40,000 proposals to MADP for change of spend 2025/26 Contingency £1,730 £267,878 carry committed to MAT Standard implementation and MADP priorities, spend plan to be agreed with Scottish Government on following thematic areas: Bereavement Support, Charter of Rights Implementation, Support for Children & Young People and Prevention/Harm Reduction Approaches. Page 287
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Page 37 of 71 SERVICE Core MADP Budget (inc AfC uplift) Additional National Mission uplift Residential Rehab Whole family Approach framework Lived and Living Experience MAT Standards Stabilisation Fund TOTALS PROVIDER MADP Support team £101,000 £101,000 Moray Council Workforce development £6,526 £3,474 £10,000 Moray Council Prevention material £1,000 £1,000 Moray Council Arrows Direct Access Service £563,500 £50,000 £50,000 £663,500 Quarriers Moray Integrated Drug and Alcohol Service £186,940 £99,652 £6,000 £137,508 £10,650 £435,887 NHS Grampian Residential Rehabilitation £80,206 £80,206 Spot Purchase - Excel Framework Advocacy Service £35,000 £35,000 TBC Young Persons Service YPZone £10,000 £10,000 Aberlour Lived & Living Experience panel £8,621 £11,379 £20,000 Moray Wellbeing Hub Pharmacist Substance Misuse £69,600 £69,600 NHS Grampian Independent MADP Chair £15,000 £15,000 Moray Council PROPOSED FOR 2026/27 Residential Rehab Support £40,000 £40,000 Quarriers TOTALS £1,019,065 £189,652 £86,206 £60,000 £8,621 £148,887 £14,124 £1,526,555 2024/25 FUNDING £1,015,019 £189,652 £86,206 £60,344 £8,621 £154,319 £14,124 £1,528,285 Page 288
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Page 38 of 71 11. Conclusion This Strategic Delivery Plan sets out Moray’s shared commitment to reducing alcohol and drug-related harms, improving wellbeing, strengthening recovery, and supporting healthier and more inclusive communities across Moray over the period 2026–2029. The challenges associated with alcohol and drug use are complex and continue to affect individuals, families, communities, and services across Moray in many different ways. This strategy recognises the importance of responding to these challenges through compassionate, rights-based, trauma-informed, and recovery- focused approaches that are shaped by local need, partnership learning, and the experiences of people affected by alcohol and drugs. At the centre of this Strategic Delivery Plan is a commitment to ensuring that people are treated with dignity, respect, compassion, and understanding. The partnership recognises the importance of listening to and learning from people with lived and living experience, families, carers, recovery communities, staff, and local communities to strengthen services, reduce stigma, improve accessibility, and support meaningful and lasting change. This Strategic Delivery Plan reflects the collective commitment of partners across Moray to work collaboratively to strengthen prevention, reduce harm, improve access to support and treatment, promote recovery, and improve outcomes for individuals, families, and communities. It also reflects a shared recognition that recovery is possible and that compassionate, inclusive, and person-centred support can make a significant difference in people’s lives. Over the lifetime of this strategy, MADP and partners will continue to build upon existing strengths, respond to emerging challenges, and work together to strengthen local systems, communities, and pathways of support. Through partnership working, continuous improvement, community engagement, and shared accountability, Moray will continue striving to create services and communities where people feel safe, supported, included, and empowered to achieve positive outcomes and recovery. The partnership recognises that meaningful change takes time, collaboration, trust, and sustained commitment. This Strategic Delivery Plan represents not only a framework for delivery and improvement, but a shared commitment to supporting people, families, and communities across Moray with compassion, dignity, hope, and respect. Page 289
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Page 39 of 71 Glossary AAAQ Framework: A rights-based tool assessing service delivery in terms of Availability, Accessibility, Acceptability, and Quality. It ensures equitable, rights-based care for individuals affected by substance use. ABI (Alcohol Brief Intervention): A short, evidence-based conversation designed to motivate individuals to reduce harmful alcohol consumption. ADP (Alcohol and Drug Partnership): Local partnerships tasked with implementing strategies to address alcohol and substance use, ensuring alignment with national frameworks. Arrows: A direct-access service provided by Quarriers, offering harm reduction, treatment pathways, and recovery support for individuals affected by substance use in Moray. Charter of Rights for People Affected by Substance Use: A national framework ensuring dignity, respect, and access to high-quality, trauma-informed care for individuals and families impacted by substance use. DAISy Outcome Monitoring System: Scotland's national system for tracking treatment engagement, individual recovery outcomes, and service performance. Direct Access Services: Services that do not require a formal referral, enabling immediate support for individuals affected by substance use. FAIR Model: A framework for evaluating services through Facts, Analysis, Identification, and Review, ensuring continuous service improvement. Integrated Joint Board (IJB): The governance structure responsible for the planning and delivery of integrated health and social care services in Moray. Lived Experience: The firsthand insights of individuals and families affected by alcohol and substance use, used to inform service design, delivery, and evaluation. MAT Standards (Medication-Assisted Treatment Standards): National standards ensuring equitable access to same-day, person-centred treatment for substance use. MIDAS (Moray Integrated Drug and Alcohol Service): A specialist service providing assessment, treatment, and recovery support for individuals with substance use needs, including MAT provision. Moray Charter Implementation Toolkit: A locally developed resource that operationalises the principles of the Charter of Rights, embedding rights-based and trauma-informed care into service delivery. Page 290
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Page 40 of 71 Prevention and Early Intervention: Strategies aimed at reducing the risk of substance use through education, community engagement, and outreach efforts. Quarriers: A key partner organisation providing services such as Arrows (substance use support) and Quarriers Carers (family and carer support). Recovery Capital: The personal, social, and community resources individuals draw on to achieve and sustain recovery from substance use. Residential Rehab Pathway: A structured process for accessing residential rehabilitation services, facilitated through the Scotland Excel Framework. Rights, Respect, Recovery: Scotland’s national strategy for supporting individuals and families affected by alcohol and substance use. Stigma: Negative attitudes and behaviours toward individuals affected by substance use, often acting as a barrier to seeking care and support. Trauma-Informed Care: An approach to service delivery that recognises the impact of trauma on individuals and prioritises safety, trust, and empowerment. UN Sustainable Development Goals (SDGs): Global goals to promote health and well-being, including Goal 3, which aligns with efforts to reduce alcohol and substance use harms. References Key National Publications 1. Scottish Government and COSLA (2026) Preventing Harm, Promoting Recovery: Scotland’s Alcohol & Drugs Strategic Plan 2026–2035. Edinburgh: Scottish Government. Available at: https://www.gov.scot/publications/preventing-harm-promoting-recovery- scotlands-alcohol-drugs-strategic-plan-2026-2035/ (Accessed: 19 May 2026). 2. Scottish Government and COSLA (2026) Alcohol and Drugs: Partnership Delivery Framework – 2026. Edinburgh: Scottish Government. Available at: https://www.gov.scot/publications/partnership-delivery-framework-alcohol- drugs-2026/ (Accessed: 19 May 2026). 3. Scottish Government (2018) Alcohol Framework 2018: Preventing Harm – Next Steps on Changing Our Relationship with Alcohol. Edinburgh: Scottish Government. Available at: https://www.gov.scot/publications/alcohol-framework-2018-preventing-harm- Page 291
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Page 41 of 71 next-steps-changing-relationship-alcohol/ (Accessed: 19 May 2026). 4. Scottish Government (2021) The National Charter of Rights for People Affected by Drug Use. Edinburgh: Scottish Government. Available at: https://www.gov.scot/publications/national-charter-rights-people-affected- drug-use/ (Accessed: 19 May 2026). 5. National Collaborative (2022) Charter of Rights for People Affected by Substance Use. Available at: https://nationalcollaborative.scot/charter-of-rights (Accessed: 19 May 2026). 6. United Nations Office on Drugs and Crime (UNODC) (2021) International Standards for the Treatment of Drug Use Disorders. Vienna: UNODC. Available at: https://www.unodc.org/res/drug_treatment_standards/ (Accessed: 19 May 2026). 7. World Health Organization (2010) Global Strategy to Reduce the Harmful Use of Alcohol. Geneva: World Health Organization. Available at: https://www.who.int/publications/i/item/global-strategy-to-reduce-the-harmful- use-of-alcohol (Accessed: 19 May 2026). 8. Public Health Scotland (2026) DAISy Outcome Monitoring System Guidance and Reporting Information. Available at: https://publichealthscotland.scot/ (Accessed: 19 May 2026). 9. Scottish Government (2021) Medication Assisted Treatment (MAT) Standards: Access, Choice, Support. Edinburgh: Scottish Government. Available at: https://www.gov.scot/publications/medication-assisted-treatment-mat- standards-scotland-access-choice-support/ (Accessed: 19 May 2026). 10. Moray Alcohol and Drug Partnership (MADP) (2026) Moray Charter Implementation Toolkit. Internal document included within the appendices of this Strategic Delivery Plan. 11. Healthcare Improvement Scotland (2019) Quality Principles: Standard Expectations of Care and Support in Drug and Alcohol Services. Edinburgh: Healthcare Improvement Scotland. Available at: https://www.healthcareimprovementscotland.org/our_work/substance_misuse/ quality_principles.aspx (Accessed: 19 May 2026). Page 292
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Page 42 of 71 United Nations (2019) Sustainable Development Goals (SDGs): Goal 3 – Ensure Healthy Lives and Promote Well-Being for All at All Ages. Available at: https://sdgs.un.org/goals/goal3 (Accessed: 19 May 2026). Page 293
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Page 43 of 71 Appendix 1 - Moray ADP Delivery Plan Actions 2026-29 Report Type: Actions Report Generated on: Action Status Cancelled Overdue; Neglected Unassigned; Check Progress Not Started; In Progress; Assigned Completed 1. NATIONAL PRIORITY 1: Fewer People Develop Problem Drug and Alcohol Use Code Objective Action and Agency Work currently in place Status Progress Status Icon and risk Additional Actions ADP LOIP Cat1.1 Develop and implement strategic approach to education, prevention and early intervention on alcohol and drugs across Moray. Map current activity: Assess effectiveness, reach and targeting of existing provision Develop and implement three- year plan, including evaluation framework. (Public awareness campaigns would then fit under this heading) (Explore evidence based approaches from elsewhere: planet youth / Icelandic model – NHS Highland) School Talks, Fieldwork at pharmacies & businesses, Naloxone, Service availability awareness & Training, Supporting SAS technicians. ADP Socials & Training with latest trends for community & RADAR updates. Page 294
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Page 44 of 71 Promote Dry January on ADP socials & Alcohol Focus fact sheets. Arrows promoting of Try Dry app etc for clients coming into service. ADP LOIP Cat1.2 Easy access to treatment and support – functional website with pathways for treatment and support, named services and their referral processes New ADP Website with detailed pathways into services. Arrows new website, After hours service. Referral pathway on websites to Arrows. ADP LOIP Cat1.3 Community Outreach – support groups in different locations in Moray, recovery cafes, drop ins Arrows fieldworkers & MIDAS duty & outreach workers. Operation Protector partner collaboration visits. Arrows support groups in communities & online. (Groups detailed on website) MARS outreach. Needle exchange & IEP outreach services. Recovery Café being re- developed to recovery focused hub. ADP LOIP Cat 1.4 ABIs are delivered and recorded in all recommended core and wider settings across Moray by March 2026 Delivery and recording of Alcohol Brief Intervention in alcohol/drug services will be actively encouraged and regularly achieved Map current delivery. Understand barriers to training, implementation and recording. Gain commitment from ADP partners for implementation of ABIs as an evidence-based intervention. Roll out programme of training and effective data capture methods. Health Improvement NHS G Susan Thom providing ABI training to staff. MIDAS & Arrows can all provide advice and apart of client care for assessments, reviews, drop in’s etc. Start logging and reporting ABI conversations / who in Moray is trained and delivering? ABI training in place with ST out with Alcohol & Drug services. Arrows & Justice also report quarterly. Not yet confirmed if ABI included in alcohol standards ADP LOIP CAT 1.5 Publicise a public calendar of events in Moray for peer support, webinars and training opportunities to help make recovery communities and collaborative working visible Moray ADP training calendar on website & shared with partners. Updates to ADP socials on events, Arrows socials with groups. ADP LOIP CAT 1.6 Support Children and young people affected by their own or someone else’s drug or alcohol use Abelour YP Corra funded project for YP own substance use. Arrows Corra funded Promising Futures family support. Children’s 1st & Quarriers Rights based service, Action for Children, Children’s residential services. Page 295
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Page 45 of 71 ADP LOIP CAT1.7 Community level assessment and reporting of alcohol related harms • Reduction in the number of off sale and on sale outlets licensed to sell alcohol. • Reduction in the number of off sale and on sale outlets supplying alcohol • Reduction in the visibility & advertising of alcohol for sale in the community Reduction of alcohol consumption in the region Work with Licensing Board and Forum to understand availability of alcohol across Moray and support responsible Licensing Policy. Re-engage with Licensing Policy Officers, Licensing Forum and Licensing Board. Understand commitment to responsible Licensing policy. Support awareness raising, education and training for Licensing Forum and Board members to increase understanding of legislative powers to reduce alcohol harm, Licensing Policy and Statement of Overprovision in Moray. ADP LOIP CAT1.8 Community engagement – Conduct public awareness campaigns to reduce stigma and increase awareness about the risks of harmful use of substances MADP, Arrows and MIDAS Recovery together events, Charter of rights engagement, social media campaigns. 2. NATIONAL PRIORITY 2: Risk Is Reduced For People Who Take Harmful Drugs Code Action Title Action and Agency Work currently in place Status Progress Status Icon Additional Actions ADP LOIP Cat2.1 All people are offered evidence-based harm reduction – Expansion to look at delivery of WAND, wound care, assessment of injecting risk, naloxone, DBS testing WAND program sits within MAT standards 3 and 4 Drop in & Outreach at Arrows for all – IEP provisions, DBS, Oral Hygiene, Sexual Health, Food Parcels, Triage & Assessment also offers, vaccinations also offered. Collaboration with MIDAS – Duty Bags & Wound Care Sop, NEO compliance. Arrows - Accuvein Machine. Partial agreement with Primary Care with Shared Care model. ADP LOIP Cat2.2 Delivery of harm reduction in all areas of Moray and on outreach efforts - Identify high risk areas in Moray and target outreach efforts to supply harm reduction and safer consumption practices information. As above & also MIDAS/ Arrows daily huddle for clients at high risk. NHS G Susan Thom DBS testing throughout Moray via operation protector & also postal. Using Daisy date on current substance use trends to inform services. ADP LOIP Cat2.3 Overdoses are prevented from becoming Fatal – Support all frontline services, families Proactive MIDAS & Arrows Daily huddle, MARS meetings, Arrows & MIDAS duty bags with IEP & Naloxone provisions. Cascade Naloxone training Page 296
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Page 46 of 71 and community with access to Naloxone, training and information. for all in Moray – pharmacies, family members, social work, businesses, Community justice, custody suite, etc. Custody suite also supplying naloxone on release. ADP LOIP Cat2.4 Community engagement – Conduct public awareness campaigns to reduce stigma and increase awareness about the risks of harmful drug and alcohol use. ADP social media plan in collaboration with partners, RADAR alerts. Awareness days in Café for overdose awareness and also recovery walk. ADP LOIP Cat2.5 Treatment and support - Increase access to treatment and support including MAT standards and a trauma informed workforce Currently meeting MAT standards & provisional green scoring. All MIDAS & Arrows trauma informed/ trained. ADP providing training via SDF for trauma informing staff. Fieldworkers for Arrows & MIDAS to access treatment & support within their community. Planned for additional Arrows fieldworker for youth focused support. ADP LOIP Cat2.6 Support community justice in diversion programs that support people into treatment, groups and aftercare programs Currently under development & more discussion required between CJ & ADP. CJ diversion needs more discussion. DTTO being completed by CJ staff. CJP looking to develop joint training relating to diversion from prosecution as part of new Community Justice Outcome Improvement Plan (CJOIP). Exploratory work beginning to understand the difference between number of assessments undertaken and cases commenced, in order to set improvement actions. Reviewing process for deciding who is placed on DTTO and improvements needed. Also looking at process around CPO drug or alcohol requirement – ensuring this is clear. ADP LOIP Cat2.7 Assess the Impact of groups and interventions through lived experience feedback, data and processes Group attendance & participation recorded at Arrows to allow for groups planning. Experiential feedback program & Lived Experience group feeds back to quality improvement plans. Service spec which required feedback reviews to service users for service improvements. All future designing of groups & services completed in collaboration with LE. CJP to review feedback processes for bail supervision and across partner organisations Page 297
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Page 47 of 71 Test for change with Moray Wellbeing Hub to seek lived experience feedback on CJOIP. This will link to work of the LLE. ADP LOIP Cat2.8 Review and implement best practice in alcohol and drug prevention and support for pre-natal, maternal and infant care To be developed. ADP LOIP Cat2.9 Develop and work with lived experience to support groups, mutual aid and peer led training and supports and in turn creating recovery capital in Moray LE & volunteer development included in all ADP planning & service planning. Re-development of BOW café into recovery café/ hub. 3. NATIONAL PRIORITY 3: People At Most Risk Have Access To Treatment and Recovery Code Action Title Action and Agency Work currently in place Status Progress Status Icon Additional Actions ADP LOIP Cat3.1 Review and ensure that non-fatal overdose pathways are established and effective. Formal pathway with SAS & daily huddle. Collaboration with A+E but pathway still under development. Completed as apart of MAT standards. ADP LOIP Cat3.2 Work with frontline services and SAS to ensure that high risk concerns and NFO’s are referred into substance use services at the point of crisis. Formal pathway with SAS & daily huddle. Collaboration with A+E but pathway still under development. Completed as apart of MAT standards. ADP LOIP Cat3.3 Efficient pathways between community justice and services are in place. Ensure people in police custody, prison or involved in community justice can access the alcohol/drug support they need however they first present Work ongoing with Prisons & custody suite. Pilot project within Aberdeen city with expansion to rest of Grampian for clear referral pathway into services. Work with Moray Wellbeing Hub on leaflets for clients to receive upon liberation to support their care. (Custody & Courts will hold stocks) Training & knowledge on local services provided for Custody Suites and basic pathway in place. ADP LOIP Cat3.4 Evaluate models of assertive outreach in Moray: how it works and what models we wish for the future to maximise retention and minimise premature disengagement. Fieldworkers, assertive outreach, LE worker in Arrows to maintain client engagement prior to worker allocation. Reviewed within ADP meetings & within Arrows. Operation protector work with Page 298
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Page 48 of 71 partner agencies. Hospital ward & A+E collaboration. ADP LOIP Cat3.5 People at high risk are proactively identified and offered support into services As above & also MIDAS & Arrows Daily huddle, SAS alerts, Assertive outreach & fieldworkers, MARS. ADP LOIP Cat3.6 MAT standards and awareness campaigns are public facing allowing people at risk to have information, advice about how and where to access support. JJ providing MAT presentation to services. Updates to ADP regularly on progress. ADP LOIP Cat3.7 Promote digital and telehealth options to improve access for people especially in outlying or rural areas of Moray Arrows developing out of hours call service. Clients offered telephone appointments & outreach appointments within their community. Access to recovery groups available via video/ call in at Arrows. NHS link in with Language Line for in person appointments. ADP LOIP Cat3.8 Shared and integrated care; Collaborate and support substance use treatment with primary care and mental health services to build up a position where there is joint responsibility between these services in meeting the needs of individuals with co- occurring conditions (alcohol/drugs and mental health), by working together to reach share solutions, so that there is no wrong door in accessing help and support in Moray. Arrows & MIDAS all MH trained, Consultant Psychiatrist also available. Assessment paperwork updated to include MH support to discuss at allocations meeting. Work ongoing with MAT 9 into 2025 with pathway being created. MH service undergoing large review. No MIDAS psychologist in post currently. Arrows links & referral pathways with MH services in Moray – SAMH, Mikeys Line etc. ADP LOIP Cat3.9 Engagement and partnership working: Avoid discharging someone recovering from an overdose from hospital unless continuity of support in the community has first been confirmed. Work ongoing with hospitals & FR S Bar. Feedback from liaison MH support to MIDAS if overdose in A+E. More formal notice would be better but daily huddle clashes with NHS hospital huddles. Awareness needed for hospitals on MIDAS duty system. Page 299
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Page 49 of 71 4. NATIONAL PRIORITY 4: People Receive High Quality Treatment and Recovery Services Code Action Title Action and Agency Work currently in place Status Progress Status Icon Additional Actions ADP LOIP Cat4.1 Have a monthly collaboration, partnership and good practice treatment meeting between managers of substance use services and the ADP coordinator. Frequent meetings in place due to MAT. Planning for monthly meetings with MIDAS, Arrows & KK. ADP LOIP Cat4.2 MAT Standards Implementation, working through the implementation and working group to guide and action changes needed in the provision of MAT Standards Fortnightly MAT implementation group, fortnightly working group, national MATSIN groups, STIR meetings with PHS. ADP LOIP Cat4.3 Effective use of resources (performance funding and reporting) to improve speed of care and quality of care – using sub group, lived experience and ADP to prioritise need. ADP strategic group set up & lived experience group to review and support changes. Planning to discuss budget with ADP members and provide more transparent information. Use of data to inform service changes and improvements (MIST, Quarterly Data, LLE Feedback, Data analyst for NHS & ADP) 6 monthly review now in place for all clients with new Arrows contract. Bail supervision & DTTO review in place for Criminal Justice. ADP LOIP Cat4.4 Work with commissioning to support tendering of 3rd sector service contract and accountability to contract Fortnightly contract meetings in place with commissioning and Arrows. 6 monthly client reviews of service & reports into commissioning quarterly. In person site visits & care inspectorate monitoring. ADP LOIP Cat4.5 Review and update Moray treatment pathway to ensure it effectively prepares people who want to access employability services to gain meaningful education, volunteering and employment opportunities so that people we support can access the care and support best suited to their needs. Collaborative relationships in place with local services/ agencies. (DWP, Social Work, Housing, Wellbeing Hub, Advocacy etc) Volunteer service in place for Arrows and currently under review. Information in staff orientation and client orientation packs on what is available and how to access support & case management software option to ensure staff go through all options. Work ongoing with Criminal Justice on employability and supporting unpaid work. Training underway on disclosure and how CJ staff can support clients into work. Employability team have arranged training for staff on disclosures/spent convictions etc as no Page 300
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Page 50 of 71 service exists in Moray for this. Working in partnership with justice social work to arrange more relevant placements or focus where is skills shortages etc Seeking to understand gaps in data and understanding. ADP LOIP Cat4.6 Assess current capacity for services to provide outreach in all of Moray and identify risks, gaps and opportunities to deploy a wider skill mix and joint working opportunities MIDAS & Arrows duty workers in place for joint care visits. Case management weekly meetings between services as well as daily discussions. Police Scotland collaboration & field working – Operation Protector visits, School visits with services. SAS technician training with lived experience component. Planning with Aberlour YP and new Arrows field worker for young persons substance use. Community asset working for all staff to meet clients in home community. Client support groups within Forres & Buckie and planning for future rural groups. MIDAS use of GP practices & Pharmacies to meet clients & also home visits. Currently over capacity for structured support and with more outreach & community work it could lead to longer waits to access structured support. ADP LOIP Cat4.7 Ensure that people have access to low threshold prescribing in Moray (without any expectation that individuals should first abstain from illicit drugs) Support in place for clients. Would be helpful if GP’s could take on some long term low risk clients so alleviate pressures on MIDAS. ADP LOIP Cat4.8 Ensure people can access psychologically informed low intensity psychosocial intervention from any alcohol/drug service and gain access to specialist addictions psychology where required Staff trained & further training plans in place. MAT 6 + 10 in place with supervision & coaching. No Psychologist currently & out to advert for second time. (Noted on risk register & COG) ADP LOIP Cat4.9 People have access to high standard evidence based, compassionate and quality assured treatment options and services are delivered in line with: - the 'Medication Assisted Treatment Standards', - 'Quality Principles: Standard Expectations of Care and Support in Drug and Alcohol Services' - 'Staying Alive in Scotland' - involvement of people with lived experience - new proposed national outcome measures As above All staff trauma informed & trained – working to get enhanced level. Lived experience in place supporting Arrows. Experiential feedback from clients to support service improvements. National groups & MAT. Contract feedback & specifications and 6 monthly review. Reflective practice with Psychologist needs reviewed due to not having psychologist in post. Staff Supervision in place. Page 301
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Page 51 of 71 ADP LOIP Cat4.10 People have the option to start MAT on the day of presentation: Have documented pathways that offer people a range of referral options for MAT including self-referral and drop-in services. Pathways should ensure the offer of person centred care that has been developed with the person in partnership with the multiagency team, and their family member or nominated person where applicable MAT pathways all in place and documented and submitted to MIST. Person centred signed off treatment plans in place with clients. ADP LOIP Cat4.11 Anticipate and contribute to the development of the Alcohol Treatment Standards Fieldwork & assertive outreach incorporating other substances & alcohol. Detox clients open to Arrows & MIDAS and outreach / duty support in place for community alcohol detox. ADP LOIP Cat4.12 Delivery and recording of Alcohol Brief Intervention in alcohol/drug services will be actively encouraged and regularly achieved ABI training in place with ST outwith Alcohol & Drug services. Arrows & Justice also report quarterly. Not yet confirmed if ABI included in alcohol standards. ADP LOIP Cat4.13 Develop a mechanism for people using services to feedback on the quality of the treatment they received. E.g. satisfaction surveys As Above, Experiential feedback, Contract 6 monthly satisfaction survey with commissioning. ADP LOIP Cat4.14 Ensuring people have access to risk and harm reduction information through briefings, websites, social media and campaigns Arrows use of Media & new Arrows website coming, client orientation packs & education initiatives, Overdose awareness campaigns, Naloxone & harm reduction in custody suites and Grampian Naloxone approach. Harm reduction also supplied during outreach & fieldworking appointments. Doorstep delivery for IEP & naloxone. DBS testing with NHS Grampian. ADP LOIP Cat4.15 Establish a Moray pathway for residential treatment which covers pathway, screening, aftercare and support needed for someone accessing residential treatment pathways based on the published good practice guide for pathways into residential treatment Scotland. Pathway in place but still being developed operationally. HIS audit on pathway in Moray and National framework meetings. Capacity issues with supporting clients into residential treatment. Meetings with treatment centres to establish pathways. ADP LOIP Cat4.16 All services to examine their care environment to ensure it is psychologically safe, trauma informed and prevents re- Risk assessments, trauma informed training of staff, seeing more people in their home environment, removal of barriers by more Page 302
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Page 52 of 71 traumatisation and stigmatisation of people using our services community work. Buildings still need work on becoming trauma informed. Looking for locations or building space. Work underway on a Grampian charter of rights and await the publishing of the national charter. ADP LOIP Cat4.16 Conduct a skills audit to inform training and coaching needs of service workers and volunteers regards trauma awareness and skills in motivational interviewing techniques Complete, implemented and training is underway. 5. NATIONAL PRIORITY 5: Quality of Life Is Improved For People who Experience Multiple Disadvantages Code Action Title Action and Agency Work currently in place Status Progress Status Icon Additional Actions ADP LOIP Cat5.1 Alcohol and drug services will collaborate with mental health services to ensure the provision of effective integrated support for people experiencing mental health and alcohol/ drug problems and the availability of mental healthcare at the point of medication assisted treatment delivery as per expectations: This is MAT Standard 9 Mental health support is available at the point of MAT, Midas is MH trained, Psychiatry available. Access to other services provided, OT, CBT, MDT and referral pathways into these services. Work to be done of the next year nationally on MAT 9. Looking for Arrows to access the MH duty worker system in progress. Volunteer Counselling in place at Arrows. ADP LOIP Cat5.2 Digital inclusion: Facilitate provision of phones or other devices and network connection for people affected by alcohol and drugs who are digitally excluded, at risk of isolation and who feel ready in their recovery to progress towards education, training or employment support Online sessions, support groups, sim cards available for people being supported. Access to technology through partnership working with the HUB. Online chat on Arrows new website in development. ADP LOIP Cat5.3 Ensure people can readily access mental healthcare and support for problematic alcohol/drug use no matter which service they first approach Pathways into other services for MH support is challenging and needs development. SU services offer support. Barriers in place. Gaps in provision. ADP LOIP Cat5.4 Ensure people can readily obtain acute hospital care and community treatment for problematic alcohol/drug use no matter where they first present Community treatment is in place, hospital admissions but difficulties in stabilisation as we do not have this in place in Moray. Duty system with Arrows and Midas in place but education is needed. Gap in stabilisation. Work needed on Page 303
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Page 53 of 71 referrals from hospital, A&E and wards into the duty team. No facilities for medically assisted alcohol detox. ADP LOIP Cat5.5 Ensure people's physical health needs are met in addition to any alcohol/drug related needs from both primary care (e.g. GPs, community link workers) and specialised alcohol/drug services no matter which they first approach for help In place with the GPs, some of our patients struggle to engage with their appointments, worker in place at Midas that supports people with their appointments. Wound care pathway in place, referral pathway with GPs in place. ADP LOIP Cat5.6 Ensure people can get help from alcohol/drug services and community support groups such as community forums and peer support no matter which they first approach for help Peer support network lived experience panel, supportive groups, lived experience development worker and we are branching out into all of Moray. Community hub, Keith Youth workers collaboration. ADP LOIP Cat5.7 Develop agreed accommodation pathways that ensures a housing need assessment is conducted well before discharge from hospital or prison or when someone presents for treatment Standard on the direct access service pathway. Community Justice working group in place with housing as a partner. Home from hospital team (social work) Housing First in Moray. Referral from housing into treatment are minimal. ADP LOIP Cat5.8 Develop agreed pathway with Housing, Welfare and Advocacy to ensure people have access to these services and support people into these services – MAT 8 Advocacy pathway in place, Welfare pathway in place, people are supported to access welfare, Gap with SU services and housing. ADP LOIP Cat5.9 Campaign for equitable access to the national concessionary bus pass scheme and improvements in rural public transport options to support people with their recovery Bus passes can be supported for all people if attending appointments, Arrows refund peoples bus costs. Arrows utilise DWP to access bus passes. Individual case by case basis. Inconsistent bus schedules, connect services and dial a bus are available but more info on this is needed for people being supported. ADP LOIP Cat5.10 Support community integration within our services by ensuring people have access to job training, housing assistance and social support to help reduce social isolation Volunteer pathways to allow for employment opportunities in place with Arrows, training opportunities through the ADP as well as SDF ADP LOIP Cat5.11 Support hub and outreach efforts in disadvantaged communities through prevention and education – prevention efforts can help individuals avoid substance use in the first place Buckie hub, Forres outreach, operation protector, school talks in schools in Moray, online conversation café, Education and drug awareness training to services. Naloxone training. Efforts are being to expand this to other areas. Page 304
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Page 54 of 71 ADP LOIP Cat5.12 Establish counselling and peer support groups to provide emotional and psychological support Collaboration with the Moray wellbeing hub drop in, development of Arrows Hub for collaboration and being a community asset. ADP LOIP Cat5.13 Ensure a crisis response team is available to address emergencies and NFO situations promptly Duty work team is in place and embedded in practice between Arrows and Midas who support and identify people at high risk and offer support. ADP LOIP Cat5.14 Alcohol and drug services will promote and encourage people’s participation in 12 step fellowships, SMART recovery, other peer support groups and Community Forum social networks Arrows weekly schedule, promotion on online platforms of daily support groups on offer, Midas motivate engagement with support groups, part of treatment planning and care plans. Cooking groups for people we support. Lived experience will steer future development of support groups. 6. NATIONAL PRIORITY 6: Children, Families and Communities Affected by Substance Use are Supported Code Action Title Agency and Action Work currently in place Status Progress Status Icon Additional Actions ADP LOIP Cat6.1 As part of 'The Promise' (Moray’s commitment to provide holistic family support), alcohol and drug services will strengthen their 'whole family approach' to care by guiding family members how they can best get involved in a loved one's care and advising people we support how this approach might be of benefit to them Arrows C+F Team gone due to new contract. Funding issues. Currently undergoing discussions with Corra funding to provide intensive whole family support which provides 2.5 workers. At point of assessment, people are offered opportunity to get family members involved who will then get contact from C+F team. Continuing family support groups. People also have option of nominated family member for services to contact with any concerns. Family members can also access support even if person is not engaging. Aberlour – Corra funded youth substance use service – 4 workers. ADP LOIP Cat6.2 Children and families are supported to find their own recovery. Ensure people affected by alcohol or drugs can easily access support for their children and help with parenting no matter which service they first approach. Arrows provides SMART family group, parenting group, cooking group online resources for structured support in AA/NA 12 step model style run by lived experience. Aberlour – Corra funded youth substance use service – 4 workers. Page 305
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Page 55 of 71 ADP LOIP Cat6.3 Ensure children and young people affected by alcohol or drugs can easily access support from their school. Arrows lived experience school talks in majority of high schools. Aberlour – Corra funded youth substance use service – 4 workers. Training of youth workers by Arrows – Keith ASG workers trained so far. ADP LOIP Cat6.4 Work with commissioning to support the family 3rd sector service contract and accountability to contract ADP LOIP Cat6.5 Assess how easy it is for families, children and young people to access support and find out from them whether that support protects them from harm and support their needs. Family experiential interview process, collective voice report from Moray wellbeing hub. Potential to review interview process to include children. (This could include support from Aberlour) Barriers & wait times struggle for families and referral process for each service. Youth justice service & group. Community safety aware of youth & youth bus in Elgin. ADP LOIP Cat6.6 All alcohol and drug services will deliver whole-family and family inclusive practice in line with published guidance unless there are very specific documented safety reasons that prevent it Arrows direct access support – detailed above. Whole family support & inclusive practice. Pathway into C+F social work being discussed and training provided to social social workers with Angela Ryan to support referrals. ADP LOIP Cat6.7 Promote the availability of confidential and non-judgemental family support for those affected by alcohol/drugs across Moray Family inclusive residential treatment Communication plans to promote corra funded project. More promotion on ADP socials on support for families and inclusive of bereavement support. ADP LOIP Cat6.8 Develop and promote guidance and support for young carers affected by alcohol or drug use in the family. ADP LOIP Cat6.9 Enable community forums as a key voice of lived experience to actively participate in local decision making, commissioning, implementation and performance management in an informed and equitably accessible way. Lived experience panel which includes family members. Ongoing family member experiential interviews until 2026 which will influence development plans. Ongoing work between Crim Just & Wellbeing hub for use of lived experience panel. ADP LOIP Cat6.10 Strengthen police relationships with the recovery community to build trust and willingness to seek help in coping with drug dealers, cuckooing, threats of violence and other community concerns. Operation Protector project with Police Scotland, MAT 3 provision, Recovery football with Police Scotland, Cuckooing list, Collaborative school talks. Community justice roadshow planned for 2025. Page 306
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Page 56 of 71 ADP LOIP Cat6.11 Community Forums to be supported by the lived experience development worker to enable people in recovery to feel a sense of connection, belonging and community to help sustain their ongoing recovery. Lived experience development worker – community groups with Moray wellbeing hub DWP groups, School holiday clubs, Arrows family groups – cooking & café style drop in. SAMH, Mikeys Line & Police Scotland event. Potential plans for more conversation style cafes with partners. ADP LOIP Cat6.12 Substance use services, will work to grow the network of peer-led local recovery communities in Moray. Funding for Arrows & Wellbeing hub for peer network events. Some support events already underway and arrows contract is very specific on including pathways for peer led support and pathways. 80% of current arrows staff have lived experience. ADP LOIP Cat6.13 People will be encouraged to step forward as Peer Supporters and will be able to access any support they require to flourish. ADP LOIP Cat6.14 Develop and promote guidance and support for children and young people affected by parental alcohol or drug use, including those witnessing a fatal or non-fatal overdose ADP LOIP Cat6.15 Establish alcohol/drug family support groups across Moray ADP LOIP Cat6.16 Provide support for family mediation for families affected by alcohol/drugs ADP LOIP Cat6.17 Support schools with the delivery of substance use education talks, information and knowledge of referral pathways Page 307
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 57 of 71 Appendix 2 - MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT 1. Right to Life – Duty bearers should take positive measures to increase the life expectancy of people who use substances, including adequate steps to provide a range of scientific, evidence-based and trauma informed support services on substance use prevention, overdose prevention and response, rehabilitation, harm reduction, HIV, viral hepatitis, and other infections and injuries sometimes associated with substance use. Moray Charter of Rights Identified Priorities Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? Not defined by substance use What is currently available to reduce stigma across services in Moray? Have approaches to reduce stigma been widely made available? Have services accepted approaches and taken bespoke action? Has there been any impact or evaluation on approaches to reduce stigma? Action: Raise awareness around the impact of stigmatising people impacted by substance use across service provides and key stakeholders. People are not automatically prescribed medication* What non-medical practices are currently being offered as an alternative or a support to traditional clinical approaches? What provision is currently available across Moray to offer alternative non-medical support e.g. Social Prescribing? Are organisations and services offering non-medical support to a wide variety of people? Are these non- medical approaches evaluated and quality assured? Action: Raise awareness with both clinicians and people with lived experience the importance to offer and accept alternative approaches of support instead of automatically prescribing a traditional prescription. People are treated within appropriate timescales What are the current timescales to be treated across Moray? How accessible is it to be treated within appropriate timescales? Is there equity across Moray to access support within appropriate timescales? Is the treatment offered within the appropriate timescale to a sufficient standard? Action: Investigate timescales for treatment and record any current waiting lists for provision. People have access to mental health services What mental health provision is available for the people of Moray? Are the mental health services and support easily available? Is there variation in the available support across Moray? Are the services and provision of a sufficient standard? Action: Review current mental health provision across Moray to identify any gaps in provision and challenges to access for people with lived experience. Professionals applying a person-centred care approach sees the person not the substance use dependency Is person-centred care available across Moray? Is it widely practiced among professionals? Is person-centred care offered to every person? Does the person- centred care meet the expectations of the individual? Action: Carry out an assessment on current workforce across services to understand if and how person-centred care is delivered. Rehab and recovery services widely available and easily accessible* Where are rehab and recovery services in Moray? Are they accessible? Are they acceptable? Are they of a sufficient standard for the people of Moray? Action: Review the current model for recovery hubs and produce a feasibility study for future design. Trauma Informed Trained Professionals What is the availability of fully trauma-informed trained workforce across Moray? How accessible is it for someone to access a trauma informed trained professional? Can they cater for a variety of needs? What standard of training and experience do they have? Action: Arrange trauma-informed training for professionals working with lived experience individuals. Thematic Analysis Identified from MAT Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? AS IS Analysis Page 308
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 58 of 71 TO BE Analysis Moray Action UN Panel Principles Output and Impact Participation Are views heard and understood? Accountability Who is accountable? Non- discrimination and equality What steps are being made to counter stigmatisation? Empowerment and capacity- building What steps are being made to ensure people know and understand their rights? Legality What steps are being made to ensure access to the same full range of rights as everyone else? Raise awareness around the impact of stigmatising people impacted by substance use across service provides and key stakeholders. Output: Impact: • People with lived experience will no longer be defined by substance use and seen as the whole person. Raise awareness with both clinicians and people with lived experience the importance to offer and accept alternative approaches of support instead of automatically prescribing a traditional prescription. Investigate timescales for treatment and record any current waiting lists for provision. Output: Impact: Review current mental health provision across Moray to identify any gaps in provision and challenges to access for people with lived experience. Carry out an assessment on current workforce across services to understand if and how person- centred care is delivered. Review the current model for recovery hubs and produce a feasibility study for future design Output: • Completed Feasibility Study on Recovery Hubs with recommendations Arrange trauma-informed training for professionals working with lived experience individuals Output: • Professionals working with people with lived experience fully trained in trauma training. Impact: MAT Thematic Analysis Action Participation Accountability Non- discrimination and equality Empowerment and capacity- building Legality Output and Impact Identified Priorities for ADP Service Delivery Plan 2025/26 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Page 309
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 59 of 71 2. Right to the highest attainable standard of physical and mental health (Article 12, ICESCR to be incorporated by the Human Rights Bill) • Duty bearers will be required to take deliberate, concrete, and targeted steps to ensure that substance use support services are available in sufficient quantity, geographically and financially accessible, acceptable to and known about by all people they serve and of sufficient quality including evidence base and independent oversight. • Duty bearers shall eliminate discrimination, formal and substantive, in the provision of health and social care and should not discriminate against people affected by substance use • Duty bearers should address the social and economic determinants that support or hinder positive health outcomes including stigma and discrimination of various kinds against people who use substances. Moray Charter of Rights Identified Priorities Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? Access to holistic and complementary therapies, life skills and peer support Access to Out of Hours Pharmacy Access to Out of Hours Doctors Aftercare made available Grace periods from services e.g. not discharged or stopped from access People are not automatically prescribed medication* Regular access to CMHN/CPN (especially during detox periods) Rehab and recovery services widely available and easily accessible* Action: Review the current model for recovery hubs and produce a feasibility study for future design Safe and welcoming, public facing environments Structured recovery schedule for months ahead Transport Access Youth worker support for young people Thematic Analysis Identified from MAT Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? AS IS Analysis Page 310
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 60 of 71 TO BE Analysis MAT Thematic Analysis Action Participation Accountability Non- discrimination and equality Empowerment and capacity- building Legality Output and Impact Identified Priorities for ADP Service Delivery Plan 2025/26 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Moray Charter of Rights Action UN Panel Principles Output and Impact Participation Are views heard and understood? Accountability Who is accountable? Non- discrimination and equality What steps are being made to counter stigmatisation? Empowerment and capacity- building What steps are being made to ensure people know and understand their rights? Legality What steps are being made to ensure access to the same full range of rights as everyone else? Review the current model for recovery hubs and produce a feasibility study for future design People involved with decision making and fully engaged with feasibility study Provide equity of care across geographical areas Output: • Completed Feasibility Study on Recovery Hubs with recommendations. • Achieve MAT Standard 1 – Access Impact: • People requiring recovery support have access to support within their local community Page 311
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 61 of 71 3. Right to an adequate standard of living (Article 11, ICESCR to be incorporated by the Human Rights Bill) This includes the rights to adequate food, clothing and housing and the continuous improvement of living conditions • Duty bearers will be required to establish a basic minimum threshold for the enjoyment of these rights and take steps to use their maximum available resources to achieve progressively the full realisation of these rights over time. Moray Charter of Rights Identified Priorities Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? Consider access to services/support in the home setting* Continuity of care High quality of support, quality assured People don’t have to re-tell their story to multiple service providers to gain support Action: Review how communication between service providers can be improved People to have safe and secure housing needs met Practical help with filling in forms and accessing services Public facing Removal of barriers to access services* Single point of contact To be listened to and understood Transparent services Thematic Analysis Identified from MAT Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? AS IS Analysis Page 312
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 62 of 71 MAT Thematic Analysis Action Participation Accountability Non- discrimination and equality Empowerment and capacity- building Legality Output and Impact Identified Priorities for ADP Service Delivery Plan 2025/26 Qtr 1 Qtr 2 Qtr 3 Qtr 4 Moray Charter of Rights Action UN Panel Principles Output and Impact Participation Are views heard and understood? Accountability Who is accountable? Non- discrimination and equality What steps are being made to counter stigmatisation? Empowerment and capacity- building What steps are being made to ensure people know and understand their rights? Legality What steps are being made to ensure access to the same full range of rights as everyone else? Review how communication between service providers can be improved Output: • Communication is easily shared in line with appropriate Information Governance policy Impact: TO BE Analysis Page 313
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 63 of 71 Thematic Analysis Identified from MAT Experiential Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? 4. Right to private and family life (Article 8, European Convention on Human Rights 1953, incorporated by the Human Rights Act 1998) • Duty bearers must ensure all treatments, health and social care and other support are provided in a way that respects the privacy and inherent dignity of the person affected by substance use and, • Duty bearers should adopt legislative, administrative, and other measures to prevent arbitrary and unlawful interference with the family life and home of people who use substances. • Duty bearers should adopt legislative and other measures to prevent the disclosure of individuals’ personal health data, including substance test results and substance dependence treatment histories, without their free and informed consent. • Duty bearers should take steps to enable families to participate in decisions made about their loved ones who are affected by substance use. • Duty bearers must ensure that the best interests of the child are a primary consideration in decisions regarding their care, including in the context of parental drug dependence. • Duty bearers should ensure that a parent’s substance use should not be the sole justification for removing a child from parental care or preventing reunification or contact. MORAY Charter of Rights Identified Priorities Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? Access to suitably trained, educated and appropriately paid advocacy support Available childcare support to attend appointments Available support for friends and families supporting people with lived experience Peer advocacy for people using services Sharing of agreed and appropriate patient/client information across partners AS IS Analysis Page 314
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 64 of 71 ADP Thematic Analysis Action Participation Accountability Non- discrimination and equality Empowerment and capacity- building Legality Output and Impact Identified Priorities for ADP Service Delivery Plan 2025/26 Qtr 1 Qtr 2 Qtr 3 Qtr 4 MORAY Charter of Rights Action UN Panel Principles Output and Impact Participation Are views heard and understood? Accountability Who is accountable? Non- discrimination and equality What steps are being made to counter stigmatisation? Empowerment and capacity- building What steps are being made to ensure people know and understand their rights? Legality What steps are being made to ensure access to the same full range of rights as everyone else? TO BE Analysis Page 315
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 65 of 71 5. Right to a healthy environment (to be incorporated by the Human Rights Bill) This right recognises that a healthy environment is necessary for the enjoyment of all human rights, including the right to the highest attainable standard of physical and mental health. • Duty bearers will be required to establish a basic minimum threshold for the enjoyment of this right and take steps to use their maximum available resources to achieve progressively the full realisation of this right over time. Moray Charter of Rights Identified Priorities Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? Clear and consistent communication Consider access to services/support in the home setting* Correct language applied Free from discrimination from all settings Safe spaces, welcoming, private and trauma-informed Signs in licenced establishments Thematic Analysis Identified from MAT Experiential Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? AS IS Analysis Page 316
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 66 of 71 Moray Charter of Rights Action UN Panel Principles Output and Impact Participation Are views heard and understood? Accountability Who is accountable? Non- discrimination and equality What steps are being made to counter stigmatisation? Empowerment and capacity- building What steps are being made to ensure people know and understand their rights? Legality What steps are being made to ensure access to the same full range of rights as everyone else? ADP Thematic Analysis Action Participation Accountability Non- discrimination and equality Empowerment and capacity- building Legality Output and Impact Identified Priorities for ADP Service Delivery Plan 2025/26 Qtr 1 Qtr 2 Qtr 3 Qtr 4 TO BE Analysis Page 317
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 67 of 71 6. Freedom from torture and other cruel, inhuman, or degrading treatment or punishment (Article 3, European Convention on Human Rights 1953, incorporated by the Human Rights Act 1998) • Duty bearers should ensure access to essential medicines, including for substance dependence, pain treatment, and palliative care and, • Duty bearers should ensure that access to health care for people who use or are dependent on substances and are in places of detention is equivalent to that available in the community. Moray Charter of Rights Identified Priorities (to also include Thematic Analysis identified from ADP local level) Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? Access to treatment and support Recognition of the vulnerability from asking support Removal of barriers to access services* Thematic Analysis Identified from MAT experiential Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? Moray Charter of Rights Action UN Panel Principles Output and Impact Participation Are views heard and understood? Accountability Who is accountable? Non- discrimination and equality What steps are being made to counter stigmatisation? Empowerment and capacity- building What steps are being made to ensure people know and understand their rights? Legality What steps are being made to ensure access to the same full range of rights as everyone else? AS IS Analysis TO BE Analysis Page 318
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 68 of 71 ADP Thematic Analysis Action Participation Accountability Non- discrimination and equality Empowerment and capacity- building Legality Output and Impact Identified Priorities for ADP Service Delivery Plan 2025/26 Qtr 1 Qtr 2 Qtr 3 Qtr 4 7. Freedom from arbitrary arrest or detention (Article 5, European Convention on Human Rights 1953, incorporated by the Human Rights Act 1998) • Duty bearers must ensure that people are not detained solely based on substance use or substance dependence. • Duty bearers should prioritise diversion from prosecution for persons arrested for substance offences or substance-related offences of a minor nature and, • Duty bearers should prioritise non-custodial measures at the sentencing and post-sentencing stages for persons charged with or convicted of substance offences or substance-related offences of a minor nature. Moray Charter of Rights Identified Priorities Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? Clarity that those who use substances have the same rights as everyone else Non-judgemental approaches Not to be defined by substance use Right to review status of limitation/convictions Right to self-representation or advocate at meetings To be listened to and understood AS IS Analysis Page 319
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 69 of 71 Thematic Analysis Identified from MAT experiential Triple AAAQ Framework Action Availability What is currently available? Accessibility Is it easily accessible? Acceptability Does it cater for different needs? Quality Does it meet a sufficient standard? Moray Charter of Rights Action UN Panel Principles Output and Impact Participation Are views heard and understood? Accountability Who is accountable? Non- discrimination and equality What steps are being made to counter stigmatisation? Empowerment and capacity- building What steps are being made to ensure people know and understand their rights? Legality What steps are being made to ensure access to the same full range of rights as everyone else? ADP Thematic Analysis Action Participation Accountability Non- discrimination and equality Empowerment and capacity- building Legality Output and Impact Identified Priorities for Local ADP Service Delivery Plan 2025/26 Qtr 1 Qtr 2 Qtr 3 Qtr 4 TO BE Analysis Page 320
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 70 of 71 Identified Aspirations for Moray Short-Term Medium-Term Long-Term Outcome 1-3 years 3-5 years 5-12 years Recovery hubs accessible to all areas with a space for visiting service providers and organisations √ Increased success in recovery and rehabilitation Number of alcohol and drug related deaths to reduce Service providers trained and trauma-informed √ Substance use no longer to be stigmatised by service providers Increase of safe trauma-informed spaces Research into different treatment methods with cost benefit analysis √ More support for friends and family members of lived experience Aligning Actions with Moray Aspirations Moray Charter of Rights Actions including Thematic Analysis National Charter Reference Aspirations for next 1-3years Overall Outcome for Moray Recovery hubs accessible to all areas with a space for visiting service providers and organisations Service providers trained and trauma- informed Clear paths to support people affected by someone’s substance use Peer led recovery group meeting at least once a week Research into different treatment methods with cost benefit analysis Arrange trauma-informed training for professionals working with lived experience individuals 1 √ • Increased success in recovery and rehabilitation • Substance use to become less stigmatised • Number of alcohol and drug related deaths to reduce • Increase of safe trauma-informed spaces • More support for friends and family members of lived experience Carry out a skills audit on current workforce 1 √ Review the current model for recovery hubs and produce a feasibility study for future design 1 and 3 Page 321
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Vs0.4 – Moray Template to Report on National Charter MORAY CHARTER OF RIGHTS IMPLEMENTATION TOOL KIT Page 71 of 71 Moray Charter of Rights Actions including Thematic Analysis National Charter Reference Aspirations for next 3-5years Overall Outcome for Moray Establish working rehab hubs with evidence of success Easier access to services in rural locations Increased professional workforce to support people with lived experience Sustainable support groups for friends and family members Action Plan to streamline and better utilise the available facilities Arrange trauma-informed training for professionals working with lived experience individuals 1 √ • Massive fall in alcohol and drug related deaths and related harms • Recovery is possible and more visible • A celebration of people getting healthy again Carry out a skills audit on current workforce 1 √ Review the current model for recovery hubs and produce a feasibility study for future design 1 and 3 √ Moray Charter of Rights Actions including Thematic Analysis from ADP level National Charter Reference Aspirations for next 5-12years Overall Outcome for Moray Health is first not the substance dependency A lived experience, trauma- informed workforce delivering person- centred care Restructuring NHS and PoliceScotland’s delivery model/ infrastructure A responsible approach to alcohol licensing and availability Identification of substance users as a protected category in terms of discrimination law Third sector organisations on par with statutory around provision and wages Availability of outreach work Arrange trauma- informed training for professionals working with lived experience individuals 1 √ √ • Reduction in suicide and family bereavement • Significantly reduced stigma and self-stigma Carry out a skills audit on current workforce 1 √ √ Review the current model for recovery hubs and produce a feasibility study for future design 1 and 3 Page 322
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 25 JUNE 2026 SUBJECT: HOSTED SERVICES SERVICE LEVEL AGREEMENTS BY: INTERIM STRATEGIC LEAD 1. REASON FOR REPORT 1.1 To seek approval of the implementation of Service Level Agreements and accompanying governance and reporting arrangements for the 12 Hosted Services in Grampian 2. RECOMMENDATION 2.1 It is recommended that the Board: i) approves the implementation of the Service Level Agreements contained in Appendices 1 to 13, noting the developments highlighted in paragraph 4.6; ii) approves the approach to agreeing transformation activity detailed in paragraph 4.8; and iii) instructs the Chief Officer to submit baseline data reports to the Board meeting on 28 January 2027. 3. BACKGROUND 3.1 The three Integrated Joint Boards (IJBs) in the Grampian area are collectively responsible for the strategic planning of the 12 services known as Hosted Services. These are services delivered on a Grampian wide basis. The operational delivery of these services has been delegated to one of the IJBs as per the list below and until now IJBs have only received reports on these on an ad hoc/as required basis. Service Current Host Sexual Health Services Aberdeen City Specialist Older Adults Rehabilitation Services Aberdeen City Inpatient and Specialist Mental Health Services Aberdeen City Item 12. Page 323
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Service Current Host Marie Curie Nursing Aberdeenshire Heart Failure Service Aberdeenshire Continence Service Aberdeenshire Diabetes MCN (including Retinal Screening) Aberdeenshire Chronic Oedema Service Aberdeenshire Health Services in HMP Grampian Aberdeenshire Police custody Suite/Forensic Examiners Aberdeenshire GMEDs Moray Primary Care Contracts Team Moray 3.2 This report proposes plans to improve the visibility and accountability of Hosted Services for all three IJBs in Grampian enabling them to have more regular and structured assurance of financial, operational and transformational performance at an appropriate level and assurance that these services continue to contribute to their strategic intentions. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 At the point of health and social care integration in Grampian, most of the three IJBs focus was on making arrangements for the continued safe delivery of the delegated services under the relevant Integration Schemes. In June 2019, a report was submitted to each of the three Grampian IJBs which detailed proposals to attempt to bring more focus on hosted services however the recommendations in the report were not fully implemented. 4.2 In September 2021, the North East Strategic Partnership Group (NESPG) considered a report detailing a proposed review of the services that are hosted, the current arrangements for hosting and options for future performance monitoring. The report advised that there were a number of criteria for determining whether services should be hosted or not. These were: - Geography – if a service is only delivered in one location, it made sense for it to be hosted by the IJB that covers that location. For example, health services provided in Her Majesty’s Prison Peterhead are hosted by Aberdeenshire IJB. Efficiency – if there is a certain formula or standard for providing a service it made sense to set up the management arrangements for this once and prevent potential duplication and additional cost by replicating these across three IJB areas. Speciality – where there is specialist provision with low activity or perhaps where there is difficulty recruiting specialist staff, it made sense not to have three IJBs competing for staff or employing staff who are providing services to a small number of patients. 4.3 The proposed review was not progressed. The NESPG report proposed a Service Level Agreement (SLA) as an appropriate performance management tool for Hosted Services, although the information contained in each SLA would vary depending on the size and complexity of the service. An SLA is a formal contract between parties which details the service provided, the budget available and the performance measures which demonstrate whether the service is being delivered in line with budget and strategic intent. Although it was agreed that SLAs would Page 324
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be a useful performance management tool for Hosted Services, no further work was undertaken to develop these. 4.4 In March 2024, an Assurance Review of IJB Hosted Services was undertaken by Internal Audit as part of the Internal Audit Plan for Aberdeen City IJB. A Net Risk Rating of Moderate and Assurance Assessment of Reasonable was returned, with eight mitigating actions recommended. The recommendations were agreed and an action plan developed by officers in Aberdeen City Health and Social Care Partnership but it was noted that governance and performance management of Hosted Services should be consistent across Grampian. Appendix A contains the original Internal Audit Report and Appendix B contains the recommendations and progress made against these. 4.5 The report to IJB today relates to the last of the recommendations from the Internal Audit report, i.e. the development and implementation of SLAs along with reporting arrangements. This report is being presented to all three IJBs – Moray IJB on 25 June 2026, Aberdeen City IJB on 30 June 2026, and Aberdeenshire IJB on 1 July 2026. 4.6 SLAs have been developed for all 12 Hosted Services and these can be found at Appendices 1 to 13. (The Diabetes Service has two SLAs as there is a separate one for Retinal Screening). It should be noted that the budget for Mental Health and Learning Disabilities Inpatient and Specialist Services remains with NHS Grampian. In addition, there are a number of developments to highlight; a. Discussions are ongoing to transfer the inpatient frailty service back under the management of NHS Grampian. It is anticipated this will happen at some point over the summer of 2026 but there is no firm date yet. The SLA for SOARS reflects this. b. In relation to the Prison Healthcare SLA, the development of sub-SLAs for Primary Care Services is in progress but not in place yet. These will be appended to the main SLA when available. The sub-SLA for the provision of General medical Services has been completed and is attached. c. In developing the SLAs, it was identified that the Chronic Oedema Service has historically provided a service to people residing in Orkney and Shetland as was expected by NHS Grampian. It has been established that the Service Level agreement between NHS Grampian and Orkney and Shetlands Health Boards does not extend to the provision of services in the community. The Service intends to pause provision and to commence discussion with Orkney and Shetland Islands HSCPs. 4.7 These SLAs include the performance metrics (including budget performance) which will be reported to evidence delivery of the SLA. The performance metrics include quantitative and qualitative data considered relevant and proportionate to the size and type of service. It is acknowledged that further work may be required to strengthen the performance data and this will be undertaken in collaboration with the relevant Service Leads. 4.8 The SLAs also have a ‘Transformation’ section which covers known current and planned transformation activity and a commitment to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be Page 325
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data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership/Management Teams. Major transformation (using the Healthcare improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major service changes September 2025) requires approval by all three IJBs supported by appropriate impact assessments, where this is considered necessary. For all transformation, the outcomes/benefits need to be agreed in advance and the impact measured and reported. 4.9 The Internal Audit Report suggested that governance arrangements should be risk based and proportionate. The Hosted Services vary in size and complexity. Initially the intention had been to report annually to the IJBs on performance against all Hosted Services SLAs. Recognising that these SLAs are new it is proposed that baseline performance data for the financial year 2025/26 will be shared with all three IJBs at their meetings in November 2026/January 2027, with a view to informing decisions on reporting arrangements going forward. 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” As defined within the Moray Integration Scheme values and meeting the strategic aims contained within the MIJB Strategic Plan; Moray Partners in Care 2022-32. Hosted services support delivery of key services across Grampian for our Strategic Plan. (b) Policy and Legal There are no direct legal implications arising from the recommendations of this report. (c) Financial implications There are no direct financial implications arising from the recommendations of this report. The Hosted Services will all continue to be delivered using current budgets. Any changes to financial arrangements may be proposed by IJBs when the annual reports against the SLAs are considered. (d) Risk Implications and Mitigation Under integration arrangements Moray IJB hosts services on behalf of Aberdeen City and Aberdeenshire, who also host services on behalf of Moray. There is a risk the hosted services do not deliver the expected outcomes, fail to deliver transformation of services or face service failure, which would lead to a potential failure to meet health outcomes for Moray, reputational damage and resources not being maximised. By approving the implementation of the proposed governance arrangements for Hosted Services, IJBs will be better placed to make decisions in relation to strategic planning of these. Page 326
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(e) Staffing Implications There are no direct Workforce implications arising from the recommendations of this report. The Hosted Services will all continue to be delivered using existing staffing. Any changes to workforce arrangements may be proposed as part of the agreed approach to Transformation. (f) Property None directly associated with this report. (g) Equalities/Socio Economic Impact There are no direct implications for equalities arising from the recommendations set out in the report. There are no changes proposed to service delivery proposed. The report proposes new governance arrangements to provide the IJB with assurance in relation to its responsibility for strategic planning for Hosted Services. (h) Climate Change and Biodiversity Impacts None directly associated with this report. (i) Directions None directly associated with this report. (j) Consultations Chief Officer; Senior Management Team and Caroline O’Connor, Committee Services Officer, Moray Council, have been consulted for their areas of responsibility and comments have been incorporated into this report and Appendices. 6. CONCLUSION 6.1 This report sets out a consistent approach for the implementation of Service Level Agreements, including governance oversight and development of reporting arrangements, to provide assurance and scrutiny by Aberdeen City, Aberdeenshire and Moray Integration Joint Boards. Author of Report: Jeanette Netherwood, Interim Strategic Lead, MHSCP Background Papers: Ref: Page 327
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Internal Audit Assurance Review IJB Hosted Services Status: Final Report No: AC2415 Date: 4 March 2024 Assurance Year: 2023/24 Risk Level: Corporate Net Risk Rating Description Assurance Assessment Moderate There is a generally sound system of governance, risk management and control in place. Some issues, non-compliance or scope for improvement were identified, which may put at risk the achievement of objectives in the area audited. Reasonable Report Tracking Planned Date Actual Date Scope issued 11-Dec-23 11-Dec-23 Scope agreed 12-Jan-24 09-Jan-24 Fieldwork commenced 12-Jan-24 09-Jan-24 Fieldwork completed 09-Feb-24 21-Jan-24 Draft report issued 23-Feb-24 29-Jan-24 Process owner response 08-Mar-24 23-Feb-24 Director response 22-Mar-24 04-Mar-24 Final report issued 05-Apr-24 04-Mar-24 RAP Committee 02-Apr-24 Distribution Document type Assurance Report Director Sandra MacLeod, Chief Officer (ACHSCP) Process Owner Alison MacLeod, Strategy and Transformation Lead (ACHSCP) Stakeholder *Final only Fraser Bell, Chief Operating Officer (ACHSCP) Paul Mitchell, Chief Finance Officer (ACHSCP) Vikki Cuthbert, Interim Chief Officer – Governance (ACC)* External Audit* Lead auditor Phil Smith, Auditor APPENDIX A Page 328
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2 of 16 Internal Audit Contents 2 Executive Summary ........................................................................................... 5 3 Issues / Risks, Recommendations, and Management Response .................. 8 4 Appendix 1 – Assurance Terms and Rating Scales ...................................... 13 5 Appendix 2 – Assurance review scoping document .................................... 14 Page 329
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3 of 16 Internal Audit Introduction 1.1 Area subject to review The Public Bodies (Joint Working) (Scotland) Act 2014 mandated that Health Boards and Councils must delegate certain adult health and social care services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services where it was agreed locally within the Grampian region that these should be delivered by a single IJB on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality, and efficiency of the service. There are 12 Hosted Services across Grampian ranging in size and complexity, three of which make up 87% of the £85m budget (2023/24). Three services are hosted by the Aberdeen City IJB and account for 76% of the Hosted Services budget. The remaining nine are hosted by either the Aberdeenshire or the Moray IJB. Service Host Budget (£m) Inpatient & Specialist MHLD Services Aberdeen City 40 Specialist Older Adult Assessment & Rehab Services (SOARS) Aberdeen City 23 GMED Moray 11 HMP Grampian Aberdeenshire 3 Sexual Health Services Aberdeen City 2 Police Custody / Forensic Examiners Aberdeenshire 2 Retinal Screening / Diabetes MCN Aberdeenshire 1 Marie Curie Nursing Aberdeenshire 0.8 Continence Service Aberdeenshire 0.7 Primary Care Contracts Moray 0.6 Heart Failure Service Aberdeenshire 0.3 Chronic Oedema Service Aberdeenshire 0.3 TOTAL 85 A service may be hosted on grounds of geography, efficiency and/or speciality. While the hosting service is responsible for operational delivery, the strategic direction of the service remains with each IJB. 1.2 Rationale for the review The objective of this audit is to obtain assurance that the IJB has adequate arrangements in place to monitor the performance of services hosted on its behalf. The area has not been subject to review previously by Internal Audit but has been included in the 2023/24 Internal Audit plan following a recognition that governance and performance monitoring and reporting over hosted services, particularly in the smaller hosted services, could be further improved. Service delivery and additional demands faced by all three IJBs have diverted management intentions expressed in 2021 to improve visibility and accountability. It is hoped the audit can refocus the commitment across the IJBs to this, since to date it has not yet been possible to agree the detail and metrics required by partners across the region. There is a risk that without clear agreements for hosted services, this could impact on value for money and service quality. Where there is no standard against which key performance measures can be considered, and / or where appropriate key performance measures have not been established, the host IJB’s assurance and that of the recipient IJB will be limited. Performance monitoring mechanisms and reporting must be proportional and allow IJB’s to interact and transform hosted services through effective management, efficient processes, and cost savings at an operational level. The IJB’s each need assurance that service users are appropriately provided for, and that payment made for services delivers Best Value and is in line with established agreements. Robust, risk-appropriate agreements, monitoring, and reporting will mitigate financial, operational, and reputational risk for all of the IJB’s, and will allow each IJB to assess if their own strategic intentions are being met. Page 330
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4 of 16 Internal Audit 1.3 How to use this report This report has several sections and is designed for different stakeholders. The executive summary (section 2) is designed for senior staff and is cross referenced to the more detailed narrative in later sections (3 onwards) of the report should the reader require it. Section 3 contains the detailed narrative for risks and issues we identified in our work. Page 331
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5 of 16 Internal Audit 2 Executive Summary 2.1 Overall opinion The full chart of net risk and assurance assessment definitions can be found in Appendix 1 – Assurance Scope and Terms. We have assessed the net risk (risk arising after controls and risk mitigation actions have been applied) as: Net Risk Rating Description Assurance Assessment Moderate There is a generally sound system of governance, risk management and control in place. Some issues, non-compliance or scope for improvement were identified, which may put at risk the achievement of objectives in the area audited. Reasonable The organisational risk level at which this risk assessment applies is: Risk Level Definition Corporate This issue / risk level impacts the IJB as a whole. Mitigating actions should be taken at the Senior Leadership level. 2.2 Assurance assessment The level of net risk is assessed as MODERATE, with the control framework deemed to be providing REASONABLE assurance over the arrangements in place to monitor the performance of services hosted on its behalf. Whilst the report identifies a Major risk in respect of under-developed governance arrangements, the relative low level of expenditure in this area compared with the overall budget reduces its significance. However, this still concerns HSCP operations and finances. The risk areas identified impact negatively on the overall level of assurance and raise the requirement for action to strengthen the control framework. The IJB’s Integration Scheme sets out that the IJB should consider and agree hosting arrangements. With the exception of the transfer of one service to hosting in 2020, there has been no opportunity for the IJB to consider and agree the arrangements. The rationale needs to be reviewed and considered, and a pan-Grampian review of hosted services would be beneficial to demonstrate that hosting arrangements are the most effective method of service delivery to contribute to the integration and transformation of health and social care services. There have been no opportunities for Aberdeen City IJB to consider strategy and policy in respect of services hosted by the other integration authorities. Whilst the aims of each IJB have similarities, without strategic coordination at the regional level there is a risk hosted services could diverge from Aberdeen City’s objectives and impact other commitments (e.g. the scale and pace of transformation), and this may not be identified and mitigated sufficiently in advance. Similar risks have been identified in respect of performance management, and financial planning and monitoring. These require further review to establish consistent and proportionate planning and reporting arrangements to provide assurance over delivery, transformation, and cost management. This will require formal agreement with host IJB’s. The nature and detail of agreement necessary may vary depending on the materiality and risk level of the service delivered, however it is important to capture key elements of each arrangement, since control over planning and delivery of each service hosted on behalf of the IJB is limited and therefore risk is increased. Governance arrangements must be proportionate, but also provide the IJB with assurance that financial, strategic, operational, reputational, and other risks are adequately mitigated so that hosted services perform well and provide value for money. A clear Grampian-wide framework for discussing and managing the performance of hosted services is required to ensure the IJB can be confident that services hosted on its behalf help deliver its intended strategic priorities. Overarching principles and improved systematic processes are needed to monitor hosted services’ delivery and costs, to ensure service quality is appropriate, and transformation opportunities are identified. Page 332
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6 of 16 Internal Audit It is acknowledged that the Aberdeen City HSCP cannot address these matters alone. Collaboration with Aberdeenshire and Moray HSCP’s and NHS Grampian will be required to obtain and provide consistent, proportionate, and relevant assurance. As the host IJB for the greatest proportion of hosted service budgets Aberdeen City is in an optimal position to lead on this approach. 2.3 Severe or major issues / risks Issues and risks identified are categorised according to their impact on the Board. The following are summaries of higher rated issues / risks that have been identified as part of this review: Ref Severe or Major Issues / Risks Risk Agreed Risk Rating Page No. 1.3 Governance Arrangements – There are currently no formalised arrangements for cross-IJB reporting on the delivery of hosted services. Whilst Aberdeen City has sought to gather performance information for annual reporting, and is able to comprehensively report on the services it hosts on behalf of others, there are no clear and agreed governance and reporting arrangements across the board. It is recognised data may not be available in every hosted service. There is a risk that in the absence of suitable agreements and reporting lines the HSCP will not be aware if there are issues affecting operational delivery of services hosted on its behalf, and will not have sufficient opportunities to provide input to addressing such issues, resulting in impacts on delivery of its own strategic objectives. The HSCP’s Strategic Risk Register recognises this risk, and sets out mitigating actions including ongoing development of SLA’s. Until governance arrangements to be applied for hosted services are agreed, there will be less clarity over the expectations, responsibilities, and standards which should be adhered to in each arrangement. This can cause difficulties e.g. the Service noted ACHSCP made an operational change to an element of the SOARS service which it hosts on behalf of the other IJBs, and due to the absence of defined delegations or an agreed change management procedure objections were received, since not all IJBs had approved the change prior to the changes in service delivery. The nature and detail of agreement necessary may vary depending on the significance of the service delivered, however it is important to capture key elements of each arrangement, since control over planning and delivery of each service hosted on behalf of the IJB is limited and therefore risk is increased. Yes Major 9 Page 333
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7 of 16 Internal Audit Ref Severe or Major Issues / Risks Risk Agreed Risk Rating Page No. Any approach must be proportionate to the risk. Rationalising the number and distribution of hosted services may help in this respect, however there is currently an absence of assurance, and any review should not delay progress with determining a means of addressing this risk. In respect of lower-risk services, if a series of shared principles can be agreed supporting governance, delegations, and transparency, a level of mutual assurance could be provided between each IJB. Such principles could equally apply to higher-risk areas, but these may require further or more specific sources of assurance or risk mitigation to be determined. Governance arrangements must provide the IJB with assurance that financial, strategic, operational, reputational, and other risks are adequately mitigated so that hosted services perform well and provide value for money. 2.4 Management response The absence of clear and agreed governance arrangements was recognised in 2021 and plans were made to address this however lack of capacity due to the ongoing response to the COVID-19 pandemic meant these were not fully progressed. We welcome the renewed focus that this report provides and are committed to delivering improved governance arrangements in respect of hosted services. We will devise a schedule that facilitates this around other priorities. Page 334
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8 of 16 Internal Audit 3 Issues / Risks, Recommendations, and Management Response 3.1 Issues / Risks, recommendations, and management response Ref Description Risk Rating Moderate 1.1 Rationale for Hosting Services – The original rationale for hosting a service was that disaggregation would present significant risk to deliverability, quality, and efficiency. A service may be hosted on grounds of geography, efficiency and/or speciality. However, a pan-Grampian review of the appropriateness and distribution of hosting the 12 services has not been undertaken, certainly since integration in 2016. In the absence of review at this level there is a risk that justifications for maintaining the status quo in terms of service delivery models and locations may no longer hold true. The Aberdeen City Integration Scheme references the following (emphasis added): “Some delegated services may be hosted by the IJB on behalf of other integration authorities, or some delegated services may be hosted by another integration authority on behalf of the IJB. The IJB will consider and agree the hosting arrangements.” Except for Inpatient & Specialist MHLD Services where a transfer to a hosted arrangement was approved in 2020, there have been no reports provided to the IJB to allow it to consider and agree the hosting arrangements since integration in 2016. There is a risk that post-integration and revised strategic planning, hosted arrangements may no longer be aligned with the area’s needs, or represent Best Value and best practice across the region. The IJB will need periodic assurance that the arrangements are appropriate, or opportunities to agree proposals for their development. IA Recommended Mitigating Actions Aberdeen City HSCP should review the rationale for services it hosts to ensure hosting remains the most relevant and appropriate approach. The appetite, scope, and timeline for a pan-Grampian review of overall hosting arrangements and rationale should be discussed with regional partners. The three Grampian IJBs should be provided with the opportunity to review and agree hosting arrangements, and any proposals for their variation. Management Actions to Address Issues/Risks 1. Aberdeen City HSCP will review the rationale for services it hosts to ensure hosting remains the most relevant and appropriate approach. 2. Aberdeen City HSCP has gained approval from the three Grampian HSCP Chief Officers that there is an appetite for a pan Grampian review of overall hosting arrangements and rationale and will liaise with regional partners to develop a scope and timeline for this, including presentation of proposals to each IJB. Risk Agreed Person(s) Due Date Yes Lead for Strategy and Transformation, Aberdeen City HSCP 1. December 2024 2. December 2024 Page 335
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9 of 16 Internal Audit Ref Description Risk Rating Moderate 1.2 Strategic Direction and Alignment – The Aberdeen City Integration Scheme also states (emphasis added): “The IJB makes decisions on matters of strategy, policy and the annual budget as well as having oversight of, and obtaining assurance on, the performance of delegated services, including services that it hosts but not including the health services listed in Annex 4 or services which are hosted by another integration authority.” This matches a clause contained in Moray’s Integration Scheme. Aberdeenshire IJB sets out that it does not have ‘operational oversight’ of services hosted by another authority, whilst not explicitly excluding decision making on strategy, policy, and budget in this regard. This approach aligns with discussion at the North East Strategic Partnership Group (NESPG) in 2021 which identified that each individual IJB retains strategic responsibility, with the hosting IJB having operational responsibility only. There have been no reports to the Aberdeen City IJB to allow it to consider strategy and policy in respect of services hosted by the other integration authorities. Whilst the aims of each IJB have similarities, without strategic coordination at the regional level there is a risk hosted services could diverge from Aberdeen City’s objectives and impact other commitments (e.g. the scale and pace of transformation), and this may not be identified and mitigated sufficiently in advance. IA Recommended Mitigating Actions Aberdeen City HSCP should work with regional partners to obtain and provide assurance over the strategic alignment of services hosted on its behalf and on behalf of others. The IJB should be provided with opportunities to review and input to hosted services’ shared strategic objectives. Management Actions to Address Issues/Risks Aberdeen City HSCP will work with Aberdeenshire and Moray HSCPs to ensure the services it hosts on their behalf align with their Strategic Plans and, at the same time, seek to understand the current strategy for each of the services hosted by them on behalf of Aberdeen City IJB to confirm alignment to the Aberdeen City Strategic Plan. Risk Agreed Person(s) Due Date Yes Lead for Strategy and Transformation, Aberdeen City HSCP December 2024 Ref Description Risk Rating Major 1.3 Governance Arrangements – There are currently no formalised arrangements for cross- IJB reporting on the delivery of hosted services. Whilst Aberdeen City has sought to gather performance information for annual reporting, and is able to comprehensively report on the services it hosts on behalf of others, this is not the case across the board. In the absence of clear and agreed governance and reporting arrangements it may be difficult to obtain this level of detail from the other HSCP’s. In 2021 NESPG set out options including Service Level Agreements (SLA’s), Commissioned Services, and Shared Plans. It was intended that SLA’s would be developed for the smaller, less complex, lower risk services, and other options given consideration for more complex areas. Templates were prepared in 2022 but have not yet been adopted or populated. Engagement on this topic has reportedly proven difficult due to the shared challenges faced Page 336
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10 of 16 Internal Audit Ref Description Risk Rating Major by HSCP partners across the region in respect of increased service demand, workforce stability, and financial constraints. There is a risk that in the absence of suitable agreements and reporting lines the HSCP will not be aware if there are issues affecting operational delivery of services hosted on its behalf, and will not have sufficient opportunities to provide input to addressing such issues, resulting in impacts on delivery of its own strategic objectives. The HSCP’s Strategic Risk Register recognises this risk, and sets out mitigating actions including ongoing development of SLA’s. Until the governance arrangements to be applied for hosted services are agreed, there will be less clarity over the expectations, responsibilities, and standards which should be adhered to in each arrangement. This can cause difficulties e.g. the Service noted ACHSCP made an operational change to an element of the SOARS service that it hosts on behalf of the other IJBs, and due to the absence of defined delegations or an agreed change management procedure objections were received, since not all IJBs had approved the change prior to the changes in service delivery. The nature and detail of agreement necessary may vary depending on the significance of the service delivered, however it is important to capture key elements of each arrangement, since control over planning and delivery of each service hosted on behalf of the IJB is limited and therefore risk is increased. Any approach must be proportionate to the risk. 36 separately negotiated agreements (across three IJB’s and 12 services) may be disproportionate. Rationalising the number and distribution of hosted services (as recommended at 1.1 above) may help in this respect, however there is currently an absence of assurance, and any review should not delay progress with determining a means of addressing this risk. In respect of lower-risk services, if a series of shared principles can be agreed supporting governance, delegations, and transparency, a level of mutual assurance could be provided between each IJB. Such principles could equally apply to higher-risk areas, but these may require further or more specific sources of assurance or risk mitigation to be determined. Governance arrangements must provide the IJB with assurance that financial, strategic, operational, reputational, and other risks are adequately mitigated so that hosted services perform well and provide value for money. IA Recommended Mitigating Actions Aberdeen City HSCP should work with regional partners to develop and implement proportionate risk-based governance arrangements setting out key expectations and controls over hosted services. Management Actions to Address Issues/Risks 1. Aberdeen City HSCP will work with Aberdeenshire and Moray HSCPs to develop and agree proportionate, risk based governance arrangements. 2. Aberdeen City HSCP will work with Aberdeenshire and Moray HSCPs to implement the agreed governance arrangements. Risk Agreed Person(s) Due Date Yes Lead for Strategy and Transformation, Aberdeen City HSCP 1. December 2024 2. September 2025 Page 337
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11 of 16 Internal Audit Ref Description Risk Rating Moderate 1.4 Financial Planning and Reporting – Integration Authorities are funded by both the NHS and local government to provide health and social care services. The funding distribution and allocation depends on the specific needs and priorities of each IJB area, and should be aligned to the strategic objectives of each Health and Social Care Partnership. In the case of hosted services, while each IJB contributes to the service costs, the hosting IJB retains budgetary control. Of the 12 hosted services in the region, three are hosted by Aberdeen City, and account for 76% of the total hosted services budget (£65m out of £85m). Although hosting the more significant services gives Aberdeen City greater visibility over spend, demand led expenditure continues to present risks in these areas. Visibility and the ability to influence budgetary control (e.g. managing the risk and impact of expenditure variations) in the areas hosted by other IJB’s (the remaining 24% / £20m) is limited. For 2023/24 Aberdeen City HSCP budgeted £28.4m towards delivery of hosted services across Grampian: less than 8% of the Partnership’s total budget (£377.7m). Budget allocations for hosted services were initially determined at the point of integration in 2016. Annual budget setting for these services is reported as largely iterative rather than being informed by the sharing of data, risks, and assumptions from NHS Grampian (which remains largely responsible for operational delivery) and between the HSCP’s. There has been no subsequent review of the cost and allocation bases within and between services and IJB’s. There is a risk these may no longer be reflective of requirements and utilisation. Quarterly financial reporting is received by the HSCP from NHS Grampian but there is limited commentary and assurance over financial risks and mitigating actions in respect of individual hosted services. For example: from current financial reporting the IJB’s Chief Finance Officer cannot determine whether mitigating action can or is being taken in respect of £250,000 overspends forecast in both HMP Peterhead and Marie Curie services. Explanation for the challenges faced by hosted services is only reported in performance reports following the financial year-end in April. Opportunities for the IJB to apply scrutiny and to direct action are therefore limited. IA Recommended Mitigating Actions Aberdeen City HSCP should seek additional assurance over budgeting and expenditure on hosted services (both hosting and hosted on its behalf), and report on this periodically to the IJB. Management Actions to Address Issues/Risks Agreed. Risk Agreed Person(s) Due Date Yes Chief Finance Officer, Aberdeen City HSCP September 2024 Ref Description Risk Rating Moderate 1.5 Performance and Transformation – Hosted services performance reporting is presented annually to the IJB each April. The format differs between IJB’s making an overview of performance difficult to establish. It is recognised this may be due in part to a variation in the breadth and depth of data available for each service and on the nature of service delivery. Information on performance, financial challenges, and risk management is clearer in some reports than others and there is a risk that without standardisation certain aspects which Page 338
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12 of 16 Internal Audit Ref Description Risk Rating Moderate should be reported may not be. IJBs should be able to discern whether hosting arrangements are efficient and effective and are delivering best value and intended outcomes. Information regarding service changes, financial and workforce challenges, performance measures, service demand, adverse incidents and transformation may not have been considered, reducing the IJBs’ assurance over services hosted on its behalf. Quarterly performance reporting to the Aberdeen City HSCP Strategic Planning Group was planned, and this is referenced as a mitigating action in the Strategic Risk Register. Reporting has been postponed pending establishment of SLA’s and determination of performance metrics. Without these measures, the IJB lacks certainty that the services hosted on its behalf will provide high-quality, cost-effective solutions that achieve desired outcomes and offer the best value under the current governance frameworks. Assurance is derived from the procedures established by NHS Grampian before delegating services to the IJBs. The Aberdeen City HSCP risk register indicates it has conducted an in- depth review of the processes in the three hosted services it manages, however it has not examined the procedures in other hosted services to confirm their effectiveness in risk mitigation. Due to the lack of a Grampian-wide framework under which the three IJB’s deliver hosted services, there is limited assurance that significant matters and observations are shared between the IJBs and NHS Grampian for hosted services. There is no systematic process to capture and disseminate information where lessons have been learned from the delivery of hosted services across Grampian. Without a mandated focus for IJBs to regularly review and discuss the performance of hosted services, there is a risk of declining service efficiency and effectiveness, unmet expectations and missed opportunities for further integration, savings / investment, and transformation in health and social care within these areas. IA Recommended Mitigating Actions Aberdeen City HSCP should work with regional partners to obtain and provide a consistent level of assurance over performance and transformation of services hosted on its behalf and on behalf of others, and report on this periodically to the IJB. Management Actions to Address Issues/Risks This action is linked to the one above in relation to overall governance arrangements. 1. As part of the development of the governance arrangements, Aberdeen City HSCP, in conjunction with relevant colleagues in Aberdeenshire and Moray HSCPs, will develop relevant performance metrics and agree reporting routes and frequency. It is envisaged that the governance arrangements will include routes for agreement of transformation activity and any performance reporting will capture the progress on delivery and impact of this. 2. Once agreed, Aberdeen City HSCP, in conjunction with relevant colleagues in Aberdeenshire and Moray HSCPs, will implement the governance arrangements. Risk Agreed Person(s) Due Date Yes Alison MacLeod Lead for Strategy and Transformation, Aberdeen City HSCP 1. March 2025 2. September 2025 Page 339
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13 of 16 Internal Audit 4 Appendix 1 – Assurance Terms and Rating Scales 4.1 Overall report level and net risk rating definitions The following levels and ratings will be used to assess the risk in this report: Risk level Definition Corporate This issue / risk level impacts the IJB as a whole. Mitigating actions should be taken at the Senior Leadership level. Function This issue / risk level has implications at the functional level and the potential to impact across a range of services. They could be mitigated through the redeployment of resources or a change of policy within a given function. Cluster This issue / risk level impacts a particular Service or Cluster. Mitigating actions should be implemented by the responsible Chief Officer. Programme and Project This issue / risk level impacts the programme or project that has been reviewed. Mitigating actions should be taken at the level of the programme or project concerned. Net Risk Rating Description Assurance Assessment Minor A sound system of governance, risk management and control exists, with internal controls operating effectively and being consistently applied to support the achievement of objectives in the area audited. Substantial Moderate There is a generally sound system of governance, risk management and control in place. Some issues, non-compliance or scope for improvement were identified, which may put at risk the achievement of objectives in the area audited. Reasonable Major Significant gaps, weaknesses or non-compliance were identified. Improvement is required to the system of governance, risk management and control to effectively manage risks to the achievement of objectives in the area audited. Limited Severe Immediate action is required to address fundamental gaps, weaknesses or non- compliance identified. The system of governance, risk management and control is inadequate to effectively manage risks to the achievement of objectives in the area audited. Minimal Individual Issue / Risk Rating Definitions Minor Although the element of internal control is satisfactory there is scope for improvement. Addressing this issue is considered desirable and should result in enhanced control or better value for money. Action should be taken within a 12 month period. Moderate An element of control is missing or only partial in nature. The existence of the weakness identified has an impact on the audited area’s adequacy and effectiveness. Action should be taken within a six month period. Major The absence of, or failure to comply with, an appropriate internal control, which could result in, for example, a material financial loss. Action should be taken within three months. Severe This is an issue / risk that could significantly affect the achievement of one or many of the IJB’s objectives or could impact the effectiveness or efficiency of the IJB’s activities or processes. Action is considered imperative to ensure that the IJB is not exposed to severe risks and should be taken immediately. Page 340
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14 of 16 Internal Audit 5 Appendix 2 – Assurance review scoping document 5.1 Area subject to review The Public Bodies (Joint Working) (Scotland) Act 2014 mandated that Health Boards and Councils must delegate certain adult health and social care services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services where it was agreed locally within the Grampian region that these should be delivered by a single IJB on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality, and efficiency of the service. There are 12 Hosted Services across Grampian ranging in size and complexity, three of which make up 87% of the £85m budget (2023/24). Three services are hosted by the Aberdeen City IJB and account for 76% of the Hosted Services budget. The remaining nine are hosted by either the Aberdeenshire or the Moray IJB. Service Host Budget (£m) Inpatient & Specialist MHLD Services Aberdeen City 40 Specialist Older Adult Assessment & Rehab Services (SOARS) Aberdeen City 23 GMED Moray 11 HMP Grampian Aberdeenshire 3 Sexual Health Services Aberdeen City 2 Police Custody / Forensic Examiners Aberdeenshire 2 Retinal Screening / Diabetes MCN Aberdeenshire 1 Marie Curie Nursing Aberdeenshire 0.8 Continence Service Aberdeenshire 0.7 Primary Care Contracts Moray 0.6 Heart Failure Service Aberdeenshire 0.3 Chronic Oedema Service Aberdeenshire 0.3 TOTAL 85 A service may be hosted on grounds of geography, efficiency and/or speciality. While the hosting service is responsible for operational delivery, the strategic considerations and implications remain with each IJB. 5.2 Rationale for review The objective of this audit is to obtain assurance that the IJB has adequate arrangements in place to monitor the performance of services hosted on its behalf. The area has not been subject to review previously by Internal Audit but has been included in the 2023/24 Internal Audit plan following a recognition that governance and performance monitoring and reporting over hosted services is limited, particularly in the smaller hosted services. Service delivery and additional demands faced by all three IJBs have diverted management intentions expressed in 2021 to address this recognised governance gap and improve visibility and accountability. It is hoped the audit can refocus the commitment across the IJBs to this in 2024, since to date it has not yet been possible to agree the detail and metrics required by partners across the region. There is a risk that without clear agreements for hosted services, this could impact on value for money and service quality. Where there is no standard against which key performance measures can be considered, and / or where appropriate key performance measures have not been established, the host IJB’s assurance and that of the recipient IJB will be limited. Performance monitoring mechanisms and reporting must be proportional and allow IJB’s to interact and transform hosted services through effective management, efficient processes, and cost savings at an operational level. The IJB’s each need assurance that service users are appropriately provided for, and that payment made for services rendered delivers Best Value and is in line with established agreements. Robust, risk-appropriate agreements, monitoring, and reporting will mitigate financial, operational, and reputational risk for all of the IJB’s, and will allow each IJB to assess if their own strategic intentions are being met. 5.3 Scope and risk level of review Page 341
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15 of 16 Internal Audit This review will offer the following judgements: • An overall net risk rating at the Corporate level. • Individual net risk ratings for findings. . 5.3.1 Detailed scope areas As a risk-based review this scope is not limited by the specific areas of activity listed below. Where related and other issues / risks are identified in the undertaking of this review these will be reported, as considered appropriate by IA, within the resulting report. The specific areas to be covered by this review are: • Written Agreements, Policies & Processes • Strategic and Financial Planning • Systems and Record Keeping • Data Sharing • Key Performance Measures, Monitoring, and Reporting • Lessons Learned and Improvement Management 5.4 Methodology This review will be undertaken through interviews with key staff involved in the process(es) under review and analysis and review of supporting data, documentation, and paperwork. To support our work, we will review relevant legislation, codes of practice, policies, procedures, guidance. Due to hybrid working across the Council, this review will be undertaken primarily remotely. 5.5 IA outputs The IA outputs from this review will be: • A risk-based report with the results of the review, to be shared with the following: o Council Key Contacts (see 1.7 below) o Audit Committee (final only) o External Audit (final only) 5.6 IA staff The IA staff assigned to this review are: • Phil Smith, Auditor (Audit Lead) • Colin Harvey, Audit Team Manager • Jamie Dale, Chief Internal Auditor 5.7 Partnership key contacts The key contacts for this review across the Partnership are: • Sandra MacLeod, Chief Officer • Fraser Bell, Chief Operating Officer • Paul Mitchell, Chief Finance Officer • Alison MacLeod, Strategy & Transformation Lead (process owner) 5.8 Delivery plan and milestones The key delivery plan and milestones are: Page 342
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16 of 16 Internal Audit Milestone Planned date Scope issued 11/12/2023 Scope agreed 12/01/2024 Fieldwork commences 12/01/2024 Fieldwork completed 09/02/2024 Draft report issued 23/02/2024 Process owner response 08/03/2024 Director response 22/03/2024 Final report issued 05/04/2024 Page 343
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APPENDIX B Internal Audit – Hosted Services AC2415 – Progress Update June 2026 Ref Agreed Actions Due Responsible Comment 1.1 Aberdeen City HSCP will review the rationale for services it hosts to ensure hosting remains the most relevant and appropriate approach. Dec 24 Alison MacLeod ACHSCP Business Case/Options Appraisal template has been modified for the purposes of reviewing the rationale for hosted services. Meetings and Workshops have taken place with MHLD, Sexual Health and SOARS and templates have been completed. At the time of completion it was agreed that all hosting arrangements would remain as they were. A decision was subsequently made to return the inpatient frailty element of SOARS to NHS Grampian management as of June 2026. 1.1 Aberdeen City HSCP has gained approval from the three Grampian HSCP Chief Officers that there is an appetite for a pan Grampian review of overall hosting arrangements and rationale and will liaise with regional partners to develop a scope and timeline for this, including presentation of proposals to each IJB. Dec 24 Alison MacLeod Scope and timeline was originally agreed by the December 2024 deadline which confirmed proposals would be taken to IJBs in March 2025. Due to staff changes and other pressing priority work agreement was made with Internal Audit that the timeline for presenting proposals to IJBs would be extended to June 2026. 1.2 Aberdeen City HSCP will work with Aberdeenshire and Moray HSCPs to ensure the services it hosts on their behalf align with their Strategic Plans and, at the same time, seek to understand the current strategy for each of the services hosted by them on behalf of Aberdeen City IJB to confirm alignment to the Aberdeen City Strategic Plan. Dec 24 Alison MacLeod The strategic alignment check was built into the review of rationale process (see above) and was completed at the same time. 1.3 Aberdeen City HSCP will work with Aberdeenshire and Moray HSCPs to develop and agree proportionate, risk based governance arrangements. Dec 24 Alison MacLeod A Service Level Agreement (SLA) approach and template were agreed although the content of these will vary dependant on the size and complexity of the service. Reporting arrangements have also been developed and again these will be Page 344
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APPENDIX B Ref Agreed Actions Due Responsible Comment proportionate to the service. 1.3 Aberdeen City HSCP will work with Aberdeenshire and Moray HSCPs to implement the agreed governance arrangements. Sep 25 Alison MacLeod An extension to the implementation deadline was agreed in line with the extension to the timeline which will follow relevant approvals from the three IJBs. 1.4 Aberdeen City HSCP should seek additional assurance over budgeting and expenditure on hosted services (both hosting and hosted on its behalf), and report on this periodically to the IJB. Sep 24 Chief finance Officer (CFO) The three CFOs have set up a process to ensure there is monthly reporting on the financial performance of all Hosted Services to three CFOs and that this is incorporated into their reports to IJBs. 1.5 As part of the development of the governance arrangements, Aberdeen City HSCP, in conjunction with relevant colleagues in Aberdeenshire and Moray HSCPs, will develop relevant performance metrics and agree reporting routes and frequency. It is envisaged that the governance arrangements will include routes for agreement of transformation activity and any performance reporting will capture the progress on delivery and impact of this. Mar 25 Alison MacLeod Performance metrics, reporting routes and frequency, and a process for agreeing transformation activity have all been incorporated into the development and implementation of the SLAs. 1.5 Once agreed, Aberdeen City HSCP, in conjunction with relevant colleagues in Aberdeenshire and Moray HSCPs, will implement the governance arrangements. Sep 25 Alison MacLeod An extension to the implementation deadline was agreed in line with the extension to the timeline which will follow relevant approvals from the three IJBs. Page 345
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF OUT OF HOURS PRIMARY CARE SERVICE (GMED) 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Out of Hours Primary Care Service (GMED) by Moray Integration Joint Board, on behalf of all three IJBs in the Grampian NHS Board area (NHSG). This document identifies the services required and the expected level of services to be provided This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the GMED hosted service that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. • Duration, scope and renewal of this SLA contract. • Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Commencement Date” means the date of the start of the Service, or as otherwise specified. “Services” means the services to be supplied as specified in the Specification. APPENDIX 1 Page 346
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“Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. “Term” means the period from the commencement of the Service Level Agreement to the date of expiry. “Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services GMED is the Grampian-wide out of hours primary care service that cares for patients who have urgent but non-life threatening health needs that cannot wait until their GP practice is open. GMED is not an emergency service, a minor injury service or a walk-in service. The type of services that are provided include a: - face-to-face appointment - home visit - telephone advice call GMED operates from 18:00 until 08:00 each weekday, all weekend and national and local public holidays including over the festive period. GMED employs nearly 300 staff consisting of bank GPs with a core of substantive Advanced Nurse Practitioners (ANPs), Advanced Paramedic Practitioners (APPs) and healthcare support staff (Drivers, Dispatch and Administrators). GMED also provides comprehensive training to ANP and APP trainees as well as supporting General Practitioner specialty training, the Career Start programme and medical and clinical student placements. The service operates from bases in Aberdeen, Inverurie, Huntly, Peterhead, Fraserburgh, Elgin, Stonehaven and Banchory. It offers centre appointments and home visits in all above listed locations. To support home visits, the service manages a fleet of 12 vehicles. To access urgent care services, patients need to call 111 (NHS 24) who will triage the patient and refer to the most appropriate service, including GMED. Community pharmacies, Scottish Ambulance Service (SAS), community nursing, social work and some other services can refer patients directly to the dispatch hub via the professional-to- professional telephone line. Page 347
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2.2 Organisational Management and Governance The host IJB, Moray, will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Performance information is reviewed by the manager and areas out with targets and thresholds highlighted to the appropriate HSCM groups for clinical governance, health and safety, workforce etc and escalated to Senior Management Team Performance Oversight. Reports will be presented to all 3 IJBs on an annual basis as to progress against the agreed performance framework as described in section 4.0. 3.0 Finance There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards There is no formal Scottish Government or NHS Scotland-issued KPI specification for OOH services that defines targets or standards. The National Review of Primary Care Out of Hours Services (2015) discusses the need for quality measures but has not publish a KPI set. 4.2 Local Quality and Performance Measures There is no formal arrangement for monitoring progress towards outcomes agreed with the IJBs. The service, as part of regular reporting to IJBs, provides the following key performance indicators: - Workforce levels – rota fill rates, sickness levels and turnover rates providing assurance on the sustainability of the service. - Financial position – outlining the efficiency and cost‑effectiveness of the service. - Number of patient contacts – offering insight into demand levels and capacity management. - Number of complaints – indicating the quality of the service and areas requiring improvement. Page 348
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- Number of adverse events – informing on service quality, safety, and emerging trends. - Number of referrals to external agencies (i.e. admissions) – informing on service quality and safety and commitment to supporting local and board strategic objectives. Together with NHSG Health Intelligence, GMED has developed a dashboard on Tableau Illuminate that allows drilling patient contact information down that provides data on conditions seen, demand patterns across the region, hotspots or patient demographic. This allowed for GMED data to be included in NHS Grampian unscheduled care reporting. Reporting to the Host is undertaken through the appropriate governance committees and according to the Host Board’s established reporting schedule. 5.0 Transformation Activity The Host has operational responsibility to deliver the Hosted Service on behalf of the other three IJBs however the three IJBs have an interest in the strategic direction of the service including any planned transformational activity. This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Page 349
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Document details & change history Version Date Description Authorisation V1.0 3/6/26 Final for approval Martyna Chlost Document approvals Name Date Role Signature Martyna Cholst 3/6/26 Service Manager, GMED Page 350
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF SPECIALIST OLDER ADULT REHABILITATION SERVICES 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Specialist Older Adult and Rehabilitation Services (SOARS) hosted by Aberdeen City on behalf of all three IJBs in the Grampian NHS Board area. The service used to comprise of three distinct areas – Specialist Rehabilitation Inpatient Wards, Frailty, and the Prosthetics, Orthotics and Wheelchair Service and Horizons. In the last few years the Long Covid service has been introduced and with confirmation that Scottish Government funding is recurring work is underway to expand this service to include other conditions. It is anticipated that as of summer 2026 the inpatient Frailty service will be managed by NHS Grampian meaning that going forward there will only be two distinct areas to the hosted element. Due to the diverse nature of each of these services they are reported separately under each section of this SLA. This document identifies the services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs which will also identify any areas of proposed revision to the detail contained within the SLA. The Specialist Older Adult Rehabilitation Inpatient Services are based at Woodend Hospital in Aberdeen City it therefore made sense that Aberdeen City IJB hosted this service as it is wholly delivered within their geographical area. As it is a community based service linking closely to other community care services it is logical that it continues to be hosted. The Prosthetic, Orthotic and Wheelchair Service is based at Woodend Hospital. Again, in terms of geography it makes sense for it to be hosted by Aberdeen City IJB. These are very specialist services requiring a bespoke facility and the pool of staff to recruit from is limited. It is therefore more efficient to have one service for the Grampian area. APPENDIX 2 Page 351
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1.2 Purpose The purpose of this SLA is to set out: • Requirements for the Rehabilitation Hosted Services that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. • Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. “Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services Specialist Rehabilitation Inpatient Wards This service consists of four in-patient units based in Woodend Hospital providing specialist care and rehabilitation to individuals who are recently recovering from a life altering condition or injury. The speciality is staffed by a multidisciplinary team which includes Occupational Therapists (OTs), Physiotherapists, Nursing and Medical staff, Speech and Language Therapists (SaLT), Dieticians and Administrators. The majority of admissions come from Aberdeen Royal Infirmary (ARI) but occasionally patients may be admitted from other care facilities or the community. The four units are: - 1. Neuro Rehabilitation Unit (NRU) which consists of 12 beds with capacity for one surge bed and provides services Grampian wide 2. Stroke Rehabilitation unit (SRU) which consists of 28 beds with capacity for eight surge beds and provides services predominantly to Aberdeen City and Aberdeenshire patients although some Moray patients also use the service 3. Ortho Rehabilitation Unit (ORU) which consists of 18 beds with capacity for two surge beds and provides services to Aberdeen City and Aberdeenshire patients 4. Links Unit which consists of six beds for vascular amputee rehabilitation services Grampian wide Page 352
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Table below shows the Whole Time Equivalent (WTE) for each unit across the various staffing groups. Staffing for Links is for whole ward but only 6 beds are hosted. NRU ORU SRU Links Registered Nurses 9.81 (7.56) 11.49 (10.44) 17.95 (18.78) 11.62 (9.65) Nursing Health Care Support Worker (HCSW) 13.16 (15.12) 16.21 (14.11) 21.38 (21.77) 16.3 (15.44) Admin & Housekeepers 1.39 (1.65) 1.62 (1.55) 4.5 (4.21) 1.77 (1.82) Physiotherapists 2 4.35 across ORU and links 6 See ORU no’s Physio HCSW 1 2.4 across ORU and links 1.1 See ORU no’s Occupational Therapist 1.6 3.4 across ORU and Links 5 See ORU no’s Occupational Therapy HCSW 1 1 across ORU and Links 1 See ORU no’s Speech and Language Therapists 2 2.5 Speech and Language HCSW 0.8 In addition to above, the following staff support delivery of the specialist rehabilitation service: - 2.8 WTE Dietetic staff 2.8 WTE Night Nursing Team 9.8 WTE Advanced Nurse Practitioners (ANPs) 9 WTE permanent medical staff (medical staff also deliver outpatient clinics) In addition there can be up to five trainee, NES funded, medical staff depending on trainee numbers. . Some posts detailed with inpatient and outpatient are funded through Major Trauma. The service aims to deliver the six principles of good Rehabilitation: - • Easy to access for every individual • Provided at the right time • Realistic and meaningful to the individual • Integrated • Innovative and Ambitious • Delivered by flexible and skilled workforce. Page 353
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Prosthetic and Orthotic Service The Orthotic service provides lifelong orthotic care to adult and paediatric residents of Grampian. Orthotics are devices worn in shoes or on the body to support, align, or improve the function of the feet and lower limbs, helping relieve pain and prevent further injury. The service aligns to AHPs and Specialist Rehabilitation Services and works across numerous pathways, including Major Trauma, Paediatrics, Complex Neurological Conditions, Rheumatology, Endocrinology, Vascular etc. It offers outpatient appointments at Woodend Hospital and at Dr Gray’s Hospital in Moray. Inpatient cover is provided to Woodend Hospital, Aberdeen Royal Infirmary, Royal Cornhill Hospital, Roxburgh House and Dr Gray’s offering assessment, fitting and review appointments in addition to providing a second opinion to other health boards and attending MDT meetings and clinics. The service is also responsible for maintenance of all devices supplied. There are currently approximately 24,000 patients registered with the service. The Prosthetic Service for NHS Grampian is based at Woodend Hospital Aberdeen and provides a service to residents of Grampian, Orkney and Shetland. The service provides lifelong care to amputees and those with congenital limb loss across a number of pathways including major trauma, the sarcoma network for the north east of Scotland, vascular and endocrinology. The Prosthetic service provides inpatient and outpatient appointment consisting of assessments, limb fitting, review appointments and second opinions as required and often as part of a multi-disciplinary team as part of the wider amputee rehabilitation remit. The service also provides ongoing maintenance and repair of prostheses. The service also support the Scottish Specialist Prosthetic Service (SSPS) which is based in Edinburgh and directly funded by the Scottish Government. In terms of staff there are: - 4 WTE Orthotists and 1 WTE footwear practitioner within the orthotics service. 2.8WTE Prosthetists within the prosthetics service. Working across both services are: Prosthetics and Orthotics lead – 1WTE Technical staff – 5 WTE HCSW – 1 WTE Clerical officers – 3.8 WTE The service is based at Woodend Hospital in a custom facility for the Prosthetic and Orthotic service. This includes custom clinical areas and a custom manufacturing workshop facility. The service is involved in undergraduate teaching for Prosthetic and Orthotics students as well as undergraduate and postgraduate training for Allied health Professionals (AHPs) and medical staff. Operational and Professional governance is provided by the Lead for Prosthetics and Orthotics. Page 354
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Wheelchair Service The NHS Grampian Wheelchair Service provides wheelchairs and seating, in association with wheelchairs, to the populations of Grampian, Shetland and Orkney. It provides a range of manual and powered wheelchairs to meet the varied mobility and postural needs of those referred into the service enhancing the quality of life of both the patients and their carers. The NHS Grampian Wheelchair Service receives an average of 250 referrals each month. Around half of these can be directly issued a manual wheelchair if their requirements are purely mobility in nature and have no specific requirements such as oversized, unusual dimensions, postural needs etc. The remaining require to undergo specialist assessment by a qualified clinician (OT, Physio, Engineer) to establish specific needs and prescribe the associated specialist equipment. In addition to the assessment and provision of wheelchairs, the service also provides a maintenance and repair service to all NHS wheelchairs on issue. This is provided both on site and by mobile technicians that travel to patient’s homes to carry out these repairs. Finally the service also provides a refurbishment programme which allows the re-issue of wheelchairs, both manual and power, that are fit to be refurbished to the required medical standards. In terms of staffing there are: Clinical staff – 6.18 WTE (mix of Physio, OT, Clinical Scientist and CSW) Technical staff – 8.6 WTE (Wheelchair technicians, Storemen and Workshop Supervisor) Admin staff – 3.2 WTE There is also 1 clinical scientist trainee funded by NES The service is based at Woodend Hospital, Aberdeen. This is used for clinical appointments, administration, workshop activities, repairs, storage of stock wheelchairs and spare parts, and the arranging of deliveries. The service also provides a mobile delivery and repair service to people’s homes via four vans. Island clinics are held twice yearly and are located in suitable facilities in each of the Island Health Boards. Both island health boards have limited space and resource for storage of stock and carrying out repairs. Horizons The Centre provides an assessment and therapeutic rehabilitation service for individuals (aged 16 and above) across Grampian with complex needs, whose disability requires a multi-disciplinary approach. Support is given to people with many different conditions, in particular those of a neurological nature, such as head injury, multiple sclerosis, Parkinson's Disease and stroke. Several other services, which are part of the Specialist rehabilitation service, also operate from the Horizons building these include; amputee rehabilitation, Neuro/home link, major trauma vocational rehabilitation and specialist rehabilitation nurses, psychology, Page 355
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In terms of staffing there are: Occupational therapists (OTs): 1.5 WTE Physiotherapists: 1.5 WTE Dietetics: 0.26 WTE HCSW: 1 WTE The neuro home link team is multi-disciplinary consisting of OTs, Physiotherapists, HCSWs, Speech and Language therapists, dieticians and Neuropsychologists. Amputee rehabilitation is provided by physio and occupational therapists. There are 1.6 WTE administrative staff who support the services within the Horizons building. 2.2 Organisational Management and Governance Aberdeen City IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to all 3 IJBs on an annual basis as to progress against the agreed performance framework as described in section 4.0. The Specialist Rehabilitation services are overseen by the Chief Nurse of Aberdeen City Health and Social Care Partnership. Horizons is overseen by the Allied Health Professional (AHP) Lead. Both are members of the Senior Leadership Team reporting directly to the Chief Officer and onwards to the Integration joint Board (IJB) and its committees. There are regular linkages and communication with Acute colleagues to ensure effective management and service provision, cognisant of different challenges across areas / organisations. There is an escalation route via the Clinical and Care Governance Group and Risk Register. Assurance meetings take place in the form of Morbidity and Mortalities, Quality Improvement and Quality and Assurance meetings. 3.0 Finance Specialist Rehabilitation Inpatient Services The total budget for Specialist Rehabilitation Services is £16,449,848 and the contribution of each of the three IJB is shown below: - Total City Aberdeenshire Moray Specialist Rehab £12,546,329 £7,756,675 £4,110,100 £679,554 Prosthetics, Orthotics and Wheelchair Services The total budget for the Prosthetics, Orthotics and Wheelchair Services along with the contribution of each of the three IJB is shown below: - Page 356
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Total City Aberdeenshire Moray Prosthetics £627,634 £283,691 £294,360 £49,583 Orthotics £1,164,500 £539,163 £534,505 £90,831 Wheelchair £2,111,385 £861,445 £960,680 £289,260 There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process, and is informed by the SLA reporting arrangements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards The services are monitored against the following national standards: - Specialist Rehabilitation Inpatient Services The British Society of Physical & Rehabilitation Medicine | Home Ageing and frailty standards – Healthcare Improvement Scotland Infection Prevention and Control Standards Healthcare Improvement Scotland Quality Assurance Framework. Specialism specific standards e.g. National clinical guideline for stroke Prosthetics and Orthotics The National 4 Week musculoskeletal (MSK) Heat Target refers to the goal of ensuring that 90% of new patients referred for MS) services receive their first contact within 4 weeks. This target is part of a broader initiative to improve the efficiency and effectiveness of MSK services across Scotland. The framework aims to reduce variations in service provision and ensure that patients receive timely and appropriate care. Wheelchairs The Scottish Government have commissioned and supported nationally agreed Eligibility Criteria and also the development of a Quality Improvement Framework against which Health Boards can evaluate service delivery. Data on service performance against national standards can be viewed at Rehabilitation Technology Information Service (ReTIS) (scot.nhs.uk). Horizons Healthcare Improvement Scotland Quality Assurance Framework Page 357
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Condition specific standards ie; National clinical guideline for stroke 4.2 Local Quality and Performance Measures Specialist Rehabilitation Inpatient Services The key aims and outcomes for the service are to deliver holistic, person centred rehabilitation that is enabling and allows individuals to get back to being as independent as possible following a life changing event. And the measures used to monitor and understand performance are: - Overall occupancy levels of wards inc waiting lists Admissions and readmissions (by IJB area) Length of Stay (by IJB area) Delayed Discharges (numbers and reason by IJB area) Adverse events and clinical quality indicators eg; falls, pressure ulcers Feedback and adverse event level 2 reviews Complaints and compliments Patient/relative feedback via care assurance Prosthetics and Orthotics The key aims and outcomes for the services are: - • Provide high quality, timely, cost effective prosthetic and orthotic care for children and adults. • To restore mobility and function in order for individuals, promoting independence. • Reduce strain and worsening of musculoskeletal/neurological conditions by relieving pain and preventing falls and pressure ulcer prevention. • Provide ongoing support; in most cases for the lifetime of the user. • To ensure all equipment provision aligns with Medical Devices Regulations and the service adheres to the MHRA quality standards. The measures used to monitor and understand performance are: - Referrals (broken down by IJB area) Waiting List (broken down by IJB area) Adverse events and clinical quality indicators Complaints and compliments Patient/relative feedback Wheelchair Service The key aims and outcomes for the service are: - • To provide a comprehensive wheelchair service to people who have long-term mobility impairments, including the consideration of function, posture, pressure relief and comfort. • To support people’s mobility and independent living to help enhance their and their carers’ quality of life. Page 358
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• To not only give initial provision of the equipment, but ongoing support; in most cases for the lifetime of the user. • To work in collaboration with other health and social work based rehabilitation services to ensure that wheelchair mobility and postural needs are managed effectively as part of an integrated care management approach. • To deliver the best quality of service to patients throughout NHSG, O & S in accordance with the National Healthcare Quality standards for Wheelchair & Seating services. • To ensure all equipment provision aligns with Medical Devices Regulations and the service adheres to the MHRA quality standards. The measures used to monitor and understand performance are: - Wheelchair provision within NHS Scotland is covered by five different wheelchair services. Each are clinically governed by the national Clinical Healthcare Quality Standards (CHQS) for Wheelchair and Seating Services https://www.retis.scot.nhs.uk/pdf/wss-qif.pdf. These standards aligned care within wheelchair services to the overall NHS Quality Strategy in Scotland and provided a quality improvement framework against which individual health boards can evaluate and develop their performance. Overall the above aimed to ensure a fair and equitable service Scotland wide. Horizons The key aims of the service is to: Deliver specialist person centred assessment and rehabilitation to enable service users to become as independent as possible for neurological specific conditions. The measures used to monitor and understand performance are: Referrals Waiting lists Appointment type Adverse events and clinical quality indicators Complaints and compliments Patient/relative feedback 5.0 Transformation Activity The Host has operational responsibility to deliver the Hosted Service on behalf of the other three IJBs however the three IJBs have an interest in the strategic direction of the service including any planned transformational activity. This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Page 359
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Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Long Covid pathway was established with funding from the Scottish Government and began accepting referrals in October 2023 for individuals residing in Aberdeen City, Aberdeenshire and Moray. The funding had initially been non-recurring but this changed in September 2025 when the Scottish Government confirmed that NHS Grampian had been successful in securing additional funding to continue and expand the existing service. This funding is to be used to continue to support individuals living with Long Covid and to expand the service to include Myalgic Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS) and similar long-term conditions. Since confirmation of this funding, work has been progressing to review, evaluate and expand the current pathway ensuring that any expansion is designed to best meet the needs of people living with ME, CFS and similar conditions across Grampian. Regular progress reports are submitted to the Scottish Government. Document details & change history Version Date Description Authorisation V1.0 03/06/26 Draft for IJB Vicky Smith Document approvals Name Date Role Signature Julie Warender 05/06/26 Chief Nurse, ACHSCP Page 360
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF SPECIALIST MENTAL HEALTH AND LEARNING DISABILITY SERVICES 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Specialist Mental Health and Learning Disability Services (MHLDS) by Aberdeen City IJB on behalf of all three IJBs in the Grampian NHS Board area. The largest site from which services are provided is Royal Cornhill Hospital (RCH) which is located in Aberdeen City, hence the rationale for Aberdeen City to host. It should be noted that although Aberdeen City IJB has the host responsibility for service delivery NHS Grampian retains responsibility for the budget. This document identifies the services provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA therefore the service should be considered as partially hosted. 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the Specialist Mental Health and Learning Disability Services. • Roles and responsibilities of the host Integration Joint Board. • Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. APPENDIX 3 Page 361
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“Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services Specialist Mental Health and Learning Disability Services (MHLDS), hosted by Aberdeen City IJB on behalf of NHS Grampian, deliver a comprehensive range of inpatient and tertiary mental health services across Grampian, with additional provision to Orkney and Shetland through established network arrangements. Services are designed to support individuals with complex mental health conditions and learning disabilities, providing assessment, treatment, rehabilitation and specialist interventions across inpatient, community and outpatient settings. Inpatient Services Inpatient services are primarily delivered from Royal Cornhill Hospital, with additional provision historically across sites including Great Western Lodge, and acute admission, specialist care and rehabilitation pathways. Core inpatient services include: • General Adult Mental Health (18–65 years): acute admission wards delivering assessment, stabilisation and therapeutic interventions. There is SLA provision to the Ministry of Defence within these wards • Older Adult Mental Health (65+ years): functional acute admission and dementia inpatient care • Intensive Psychiatric Care Unit (IPCU): enhanced supervision and treatment for patients with high clinical risk • Learning Disability Inpatient Services: assessment, treatment and close supervision for individuals with co-morbid acute mental illness, complex learning disability and behavioural needs • Specialist Inpatient Units: including acquired brain injury/neuropsychiatry, rehabilitation services and the regional eating disorders unit • Forensic Mental Health (Low Secure): acute and rehabilitation pathways, including transition to community-based forensic rehabilitation provision • Adult Mental Health Rehabilitation These services operate within a structured pathway model supporting patient progression from acute care through to rehabilitation and community reintegration. Tertiary and Specialist Services In addition to inpatient provision, MHLDS delivers a range of specialist tertiary services on a pan-Grampian basis, including: Page 362
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• Unscheduled Mental Health Care • Child and Adolescent Mental Health Services • Eating Disorders Service (inpatient, day programme and outpatient) • Gender Identity Service • Perinatal and Infant Mental Health Services • Psychological therapies and adult psychotherapy services • Liaison psychiatry (adult and older adult) across acute hospital settings • Neuropsychiatry / Acquired Brain Injury services • Electroconvulsive Therapy (ECT) and specialist clinical services delivered through the Professor Reid Centre • Community adult mental health rehabilitation and forensic mental health outreach services supporting transition from inpatient to community care These services provide specialist assessment, treatment and support to individuals with complex or high risk presentations and form part of regional and national care networks. Pathways and System Integration Services are delivered through integrated pathways that support: • Unscheduled and urgent acute healthcare and treatment • Inpatient assessment, healthcare and treatment • Rehabilitation and recovery • Community reintegration Delivery is supported by multidisciplinary teams and aligned with Integration Joint Board arrangements to ensure coordinated, person-centred care across the system Figure 1 NHS Grampian Inpatient Mental Health services May 2026 – These services are fully delegated by NHS Grampian to Moray, or Aberdeenshire IJBs Location Ward No. of Beds Type of service Seafield Hospital Buckie Muirton 8 Dementia assessment Fraserburgh Hospital Brucklay 12 Dementia assessment Bennachie View Care Home, Inverurie Ashcroft 10 Dementia assessment Dr Gray’s Hospital, Elgin Ward 4 18 Acute Mental Health Assessment Figure 1a NHS Grampian Inpatient Mental Health services May 2026 Location Ward No. of Beds Type of service RCH, Aberdeen Dunnottar 18 Adult Mental Health Admission Ward RCH, Aberdeen Fraser 18 Adult Mental Health Admission Ward RCH, Aberdeen Huntly 18 Adult Mental Health Admission Ward Page 363
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Location Ward No. of Beds Type of service RCH, Aberdeen Fyvie 18 Adult Mental Health Admission Ward RCH, Aberdeen Skene 16 Older Adult - Dementia RCH, Aberdeen Brodie 10 Acquired Brain Injury Unit/Neuropsychiatry RCH, Aberdeen Corgarff 16 Adult Mental Health Rehabilitation RCH, Aberdeen Strathbeg 8 Learning Disability – close supervision unit (Forensic) RCH, Aberdeen Loirston 5 Learning Disability - admission RCH, Aberdeen Eden 10 North of Scotland Eating Disorders Unit RCH, Aberdeen IPCU, Blair Unit 8 Intensive Psychiatric Care Unit RCH, Aberdeen Forensic Acute, Blair Unit 8 Low Secure Forensic Acute RCH, Aberdeen Forensic Rehabilitati on, Blair Unit 16 Low Secure Forensic Rehabilitation RCH, Aberdeen Muick 20 Older Adult Ward RCH Aberdeen Davan 20 Older Adult Ward Great Western Lodge GWL 8 Rehabilitation Forensic Pathway The bed numbers outlined above reflect the established and funded bed base. While additional surge capacity may be implemented in response to periods of increased demand and system pressure, this is not part of the commissioned or funded capacity and should be utilised on a time-limited and risk-managed basis. The infrastructure is managed within NHS Grampian and like other parts of the estate there is a requirement for backlog maintenance to ensure the physical integrity and safety of the buildings are maintained. Where a matter requires substantial repair or significant investment in backlog or cyclical maintenance then this is risk assessed and prioritised against all other critical areas based on available funding and agreed through the NHSG’s Property and Asset Management Group. Risks relating to estate condition, environmental safety or suitability of inpatient and specialist MHLDS facilities will be recorded, escalated and monitored through NHS Grampian risk management processes, including DATIX and relevant service risk registers, where appropriate. 2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to all three IJBs on an annual basis as to progress against the agreed performance framework as described in section 4.0. Page 364
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The delivery of the vision is supported by a series of quality, safety, and assurance governance groups. The Governance Structure is presented in Appendix A. This highlights the meetings held locally and how they report into the wider system assurance structure. 2.3 Health & Safety Governance Health & Safety responsibilities for Specialist Mental Health and Learning Disability Services (Inpatients at RCH and Tertiary MHLDS) remain aligned to NHS Grampian’s statutory duties as the employer and service provider. The Host Integration Joint Board will ensure that appropriate local arrangements are in place for the identification, assessment, management and escalation of Health & Safety risks within hosted services. Assurance on key Health & Safety matters, including incidents, risk mitigation and compliance with relevant policy and statutory requirements, will be provided through existing clinical governance, Clinical Fora, Health & Safety and Staff Partnership assurance structures, with escalation to NHS Grampian and the Integration Joint Boards as required. 3.0 Finance NHS Grampian retains responsibility for the Specialist Mental Health and Learning Disability Services budget. There are therefore no individual contributions from each of the IJBs and budget reporting is undertaken via the NHS Grampian arrangements. Page 365
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4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards This Service Level Agreement is underpinned by a suite of national strategic, quality, safety and performance frameworks which set the expectations for safe, effective and person- centred care. These include the Mental Health and Wellbeing Strategy and Core Mental Health Standards, alongside specific national service specifications, standards and strategies for Child and Adolescent Mental Health Services (CAMHS), Dementia Standards, Scottish Electroconvulsive Assurance Network (SEAN) Standards, Forensic Mental Health, Psychological Therapies, Perinatal and Infant Mental Health, Eating Disorder Services, Neurodevelopmental (NDD) standards, and Gender Identity Services. Collectively, these frameworks define the required clinical standards, access targets, quality indicators and outcome measures against which services will be delivered, monitored and continuously improved. All parties to this agreement are expected to align service delivery with these national requirements to ensure consistency, equity and high-quality care across the system In addition, services will engage fully with the Mental Welfare Commission for Scotland through its programme of visits and reviews, recognising its role in safeguarding the rights and welfare of individuals. All services are expected to actively respond to, and demonstrate progress against, the Commission’s recommendations as part of ongoing quality assurance and service improvement. Healthcare Improvement Scotland Adverse Event Review process is monitored for assurance within organisational governance. Key measures include: - • Compliance with 18-week Referral to Treatment (RTT) waiting times for both Child and Adolescent Mental Health Services (CAMHS) and Psychological Therapies; • Delivery of improvement actions in line with Mental Health and Learning Disability (MHLD) Collaborative Response and Assurance Group (CRAG) requirements for delayed discharges; • Achievement of safe discharge standards, including 7-day follow-up post discharge. • The service also monitors 28-day readmission rates as an indicator of care quality and continuity. • In addition, the Electroconvulsive Therapy (ECT) Service is required to meet the standards set by the Scottish ECT Audit Network (SEAN), ensuring safe, effective, and high-quality delivery of ECT. 4.2 Local Quality and Performance Measures Local Performance measures include: - • Overall average occupancy levels in inpatient settings • Length of Stay in inpatient settings • 7-Day Follow-Up (where follow-up primarily related to tertiary MHLD Services) • G-OPES Level – a measure of Hospital Operational Performance Escalation • Outpatient Referrals (CAMHS and Tertiary MHLDS Psychological Therapies) • Referral Acceptance Rate (CAMHS and Tertiary MHLDS Psychological Therapies) • Waiting List Size (CAMHS and Tertiary MHLDS Psychological Therapies) Page 366
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• % compliance with 18-week referral to treatment target (CAMHS and Tertiary MHLDS Psychological Therapies) • Delayed Discharges (by reason) NB: Tertiary MHLD services are not measured by IJB area. In addition to clinical quality and performance indicators, services will operate in line with NHS Grampian incident reporting and review arrangements, including DATIX. Trends and themes relating to patient, staff and environmental safety — including violence, aggression and restraint; and falls for example — will be monitored through established governance structures to support shared learning, risk reduction and continuous improvement. 5.0 Transformation Activity The Host has operational responsibility to deliver the Hosted Service on behalf of the other three IJBs however the three IJBs have an interest in the strategic direction of the service including any planned transformational activity. This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Whole system MHLDS transformation change would be discussed within Cross System Strategic Delivery Team (CSSDT), and if appropriate to scope and remit, commissioned there. If higher level commissioning required, CSSDT would take to the MHLDS Board for evaluation and decision making. The Grampian Executive Team, North East Transformation Group, or Grampian MHLD Board may identify pieces of strategic work to commission, that could involve Specialist MHLDS (Inpatients at RCH and Tertiary MHLDS). Any agreed transformation or service change activity, including bed base reviews, ward closures or service reconfiguration, will be supported by appropriate risk assessment and quality impact considerations. This will include consideration of Health & Safety, workforce and environmental risks, with assurance provided through established governance and approval processes. Page 367
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Document details & change history Version Date Description Authorisation V1.0 05.06.26 Final Judith McLenan Document approvals Name Date Role Signature Judith McLenan 05.06.26 Lead for MHLDS Appendix A Current Governance Structure Page 368
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF SEXUAL HEALTH SERVICES 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Sexual Health Services (SHS) by Aberdeen City IJB on behalf of all three IJBs in the Grampian NHS Board area. This document identifies the services to be provided. This is a rolling SLA. A bi-annual report on delivery against this SLA will be prepared and submitted to all three Risk, Audit and Performance Committees, which will also identify any areas of proposed revision to the detail contained within the SLA. Rationale for Hosting: - Geography – main service based in Aberdeen City. Efficiency – as a relatively small service, it is easier to manage in one location without duplication in three IJB areas. Speciality – speciality service, maintaining one service avoids competition for same restricted pool of expertise. Hosting NHSG Sexual Health Service within an IJB is in line with other health board areas as a community facing and delivered service, which helps protect the prevention focus of the service. 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the NHSG Sexual Health Service hosted service that will be provided to all three IJBs including specific quality standards or "service levels". • Roles and responsibilities of the host IJB. • Supporting processes including performance monitoring arrangements. APPENDIX 4 Page 369
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1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under SLA the key personnel, performance monitoring framework and quality standards. “Host” means the IJB that manages services on behalf of the other IJBs in the NHS Board area. “Hosted Services” means those services that have been agreed by the IJB will be managed and delivered on a pan Grampian basis by a single IJB. 2.0 Specification 2.1 Description of Services Service Aims and Objectives: AIMS: - Improve the sexual health and wellbeing of people in Grampian. - Provide high quality services that are accessible in primary care, pharmacies and other partner settings in addition to NHSG Sexual Health Services. - Help people look after their own health with a focus on prevention of poor sexual health, early intervention, supported self-management; targeted to those in greatest need. OBJECTIVES: • Prioritise resources to population groups and demographic areas that are in greatest need of sexual health improvement. • Works with partners and key stakeholders in the HSCPs, Sexual Health and Blood Borne Virus (SHBBV) Managed Care Network (MCN), Community Planning Partnerships (CPPs), Integrated Children Services, Locality Planning groups and other non-health agencies including, third sector and voluntary agencies. • Make use of all our integrated data to performance manage the care we provide. • Support continuous service improvement with staff and public engagement; develop and maintain service and workforce plans. • Provide sustainable services with consideration to budget constraints, which meet the needs and improve the sexual health and wellbeing of our diverse population. Description of Services NHSG Sexual Health Services (SHS) provides holistic and comprehensive sexual and reproductive health care. The service is underpinned strategically by: • Sexual Health and Blood Borne Virus Action Plan 2023-2026* • Ending HIV Transmission in Scotland by 2030 • Women’s Health Plan: Phase Two 2026-2029 • Grampian Plan for the Future • ACHSCP Strategic Plan 2025 – 2029 and route map for delivery Page 370
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* The Sexual Health and Blood Borne Virus Action Plan is being updated at a national level. The aim is to deliver services in line with national and local clinical guidelines, in addition to agreed and published Health Improvement Scotland Standards for Sexual Health. Strategically and part financially, NHSG SHS is supported by the Directorate of Public Health Sexual Health and Blood borne virus (SHBBV) managed care network (MCN). The main hub of the Sexual Health Service is located in the Aberdeen Community Health and Care Village Health Village, which allows the integration of sexual and reproductive health services with genitourinary medicine/HIV services (GUM). There are also peripheral services delivered in Dr Gray’s Hospital in Elgin, and in Fraserburgh and Peterhead community hospitals. The service also delivers care in His Majesty’s Prison (HMP) Grampian. Since 2017, the Sexual Health Service has hosted the ‘Exchange Clinic’ in the evening for Gay, Bi-Sexual Men who have Sex with Men (GBMSM), which is delivered with support from with third sector partner, Alcohol and Drugs Action (ADA). A wide range of clinical preventative, diagnostic, treatment, care and support services are delivered by NHSG SHS including but not limited to: • Prevention methods for Sexually Transmitted Infections (STIs) and Human Immunodeficiency Virus (HIV), Hepatitis B and Hepatitis C [BBVs], including emergency assessment for HIV post-exposure prophylaxis and pre- exposure prophylaxis (PEP/PrEP), the latter for over 600 patients; testing and urgent treatment for STIs and BBVs; vaccination for Hepatitis A/B, Human Papilloma Virus (HPV), Gonorrhoea and Mpox. • HIV care for over 300 patients under care in Sexual Health and additional nursing, psychology and pharmacy support for additional 200 patients under the care of the Infection Unit. • Priority access clinics for urgent sexual health care with daily phone triage for approximately 2000 patients per month. • Emergency, routine and complex contraception including Long-Acting Reversible Contraception (LARC). • Young person’s/<18s early evening clinics; and multi-disciplinary meetings for vulnerable young people and adults with onwards referral for child/adult protection issues. • Community gynaecology service, which receives 1800 primary care referrals per year and has a joint referral pathway with hospital gynaecology. • Abortion care for residents across Grampian, NHS Shetland and ad hoc care for NHS Orkney with over 1800 procedures in 2024. In addition to late abortion care assessment who are referred to British Pregnancy Advisory Service (BPAS) under a local SLA. • Psychosexual medicine care. • Care post sexual assault. The Forensic Suite for the provision of forensic assessment in cases of sexual assault is contained within Aberdeen Health Village led by the forensic team in NHS Grampian. The service works closely with this team, seeing patients for follow on care and support as well as contributing to care pathways and staff training. • Leading service on routine enquiry, support and onwards referral in line with statutory responsibilities for those who are experiencing domestic Page 371
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abuse/trafficking/exploitation or who have experienced Female Genital Mutilation (FGM). *BPAS are the preferred supplier for late abortion across Scotland; conversations continue at national level on late-stage abortion. Partnership Working: NHSG SHS has close links with the SHBBV MCN with funding allocated to parts of the service including sessions for clinical care and leadership. The latter role involves addressing the higher-level outcomes of the Sexual Health and BBV Action Plan from a Grampian wide perspective with both clinical, non-clinical and third sector colleagues and involves working on data surveillance, needs assessments and benchmarking. The MCN Sexual Health clinical lead is accountable to the Strategic Lead for the SHBBV MCN (currently, Chris Littlejohn, Deputy Director of Public Health) and this is separate from the service/operational clinical lead who reports through the ACHSCP medical director. Partnership and integrated working also exist clinically with Public Health feeding into Problem Assessment Groups (PAGs) and Incident Management Teams (IMTs) in response to infection levels, along with Gynaecology, Infectious Disease colleagues (for HIV care), Hepatology Services (for Hepatitis/Co-infected for Hepatitis/HIV)); Women and Children’s services (including the Women’s Board), Substance Misuse Services, Community Pharmacy, Dr Gray’s Hospital, Local Authorities, HSCPs, (Moray and Aberdeenshire); Laboratories, Health Psychology, Forensic Services, Mental Health Services, Police Scotland and the Emergency Department. We have representation on the Women’s Health Board, ACHSCP Health and Safety Operation Group, ACHSCP Clinical Care Risk Management Group (CCRM), ACHSCP Clinical and Care Governance Group (CCG), ACHSCP Infection Prevention Control Group (IPC) and NHSG Public Health Committee. Training and Education: In addition to clinical responsibilities the service is an accredited training centre, for the College of Sexual and Reproductive Health providing specialist sexual health training for healthcare professionals including provision of practical training, training courses and internal staff development opportunities. The service is also actively involved in undergraduate training with students from Robert Gordon’s and Aberdeen University’s attending on a near daily basis, and postgraduate training and FY2, GP and specialty trainees part of the team. As a teaching service, there is a large investment of staff time hosting and training various junior medical and nursing staff. Part of the reason for this is to attract some of these trainees back to the service, qualified. There are also great opportunities for staff within the service to study and to then be able to develop their career within the service 'growing our own'. Participation in national groups/organisations: The service has representation on national groups and organisations where they contribute to policy or guidance development, advocacy, act as clinical experts or represent the interests of the NHSG. This includes following representation and roles: • Public Health Scotland Scottish Health Protection Network o Clinical Leads for Sexual and Reproductive Health Page 372
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o Clinical Leads for HIV including chair role o Lead Nurses Group o Strategic Leads • Scottish Government SHBBV oversight Group • Scottish Government HIV Transmission Elimination Group • Scottish Government/Women's Health Plan o Post Natal Contraception Group • Scottish Abortion Care Providers • Scottish Government CMO specialty advisor in Genitourinary medicine • The College of Sexual and Reproductive Health o Includes Scottish chair role • Sexual Assault Response Coordination Services (SARCS) Network • British Association for Sexual Health and HIV (BASHH) o Sexual Violence Group • NaSH User Management Group (NaSH is the patient management system used by Sexual Health departments in Scotland) • NaSH SHBBV Development Group 2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to all three IJBs on an annual basis as to progress against the agreed performance framework as described in section 4.0. Image 1: Service Governance Structure Line Management Accountability Nationally, governance for the implementation of the Sexual Health and Blood Borne Viruses Action Plan sits within the Scottish Health Protection Network (SPHN) which reports to the Scottish Government (Image 2). NHSG Strategic Lead ACHSCP Clinical Lead ACHSCP Chief Officer ACHSCP Chief Nurse Nurse Manager SHBBV MCN Clinical Lead Clinical Lead Service Manager Public Health Manager Deputy Service Manager Administrative Staff Medical Staff Nursing Staff Page 373
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Image 2: National Governance Structure Reporting on the implementation locally is complete through Public Health structures where the Strategic Lead is accountable to the Population Health Committee. Operationally, the service reports progress and escalation of risks via ACHSCP Clinical Governance Group and Committee. 3.0 Finance The budget for the service is the total of the three IJB contributions. There is a joint agreement between the Chief Finance Officers of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel, which all three CFOs have access to so that there is, visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process, and is informed by the Annual Reports relating to the Service Level Agreements. In addition to IJB funding the service also receives £236,654 per year from Public Health not including any monies for additional input e.g. Public Awareness Materials etc. This is reviewed on an annual basis and dependant on Scottish Government funding. The Sexual Health Service core budget with the split per IJB is: - Page 374
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4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards National quality and performance standards: NHS Boards are expected to be able to describe and demonstrate that they are implementing the national action plans and strategies as well as the HIS standards. 4.2 Local Quality and Performance Measures Agreed key performance indicators Urgent care • Individuals eligible for emergency contraception and postexposure prophylaxis following sexual exposure (PEPSE) to human immunodeficiency virus (HIV) are assessed urgently and as per national guidance. • Individuals with acute symptoms are offered an assessment for the need for sexually- transmitted infection testing within two working days of self-referral. Abortion • 100% of individuals are offered an abortion care assessment (telephone consultation) within 1 week of contact with services. • 100% individuals are offered a date for an abortion procedure within 1 week of abortion care assessment. HIV prevention and care • Individuals can access HIV pre-exposure prophylaxis (PrEP) within 28 days of contact with services. There should be rapid access pathways for those in highest clinical need. • Individuals who have a new diagnosis of HIV should be assessed by appropriately trained staff within 2 weeks of receiving an HIV positive test result with those having symptoms and/or signs potentially attributable to HIV (including those of primary infection) having assessment within 24 hours. • 95% of people living with HIV known their status. • 95% of those diagnosed are on antiretroviral therapy (ART). • 95% of those on ART achieve viral suppression. Contraception and Long-Acting Reversible Contraception • Individuals can access their choice of contraception including long-acting reversible contraception (LARC) within 28 days with rapid access pathways for those in highest clinical need. Community gynaecology and psychosexual problems • Individuals should be assessed within 18 weeks of self or primary care referral. Inclusion Groups* (including young people) • Individuals in inclusion groups are seen within one week (5 working days) of contacting the service. Page 375
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* e.g. people involved in Sex Work; Young People, Homeless, Persons with disabilities, Immigrants, Migrants, Refugees and other Displaced People, at risk adults and people affected by Substance Use (note these categories are not mutually exclusive or exhaustive). 5.0 Transformation Activity The Host has operational responsibility to deliver the Hosted Service on behalf of the other three IJBs however the three IJBs have an interest in the strategic direction of the service including any planned transformational activity. This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Service review and future planning: The service requires to produce a new service and complimentary workforce plan. This will be based on: • Self-completed audit against HIS Service Standards • Lived and Living Experience • Current service performance data (Improvement Plans) • A review of population needs including reviewing local/national data • Evidence of best practice including adherence of published and clinical guidelines • National strategic policy (see above) • Stakeholder engagement (Primary Care, Pharmacy, Infection Unit, Public Health, HSCPs, Scottish Prison Service, Third Sector, National Groups etc) Research and innovation: All staff are encouraged to participate in research and innovation. Previous and ongoing work includes: • Digital and remote care access o Online booking expansion o Postal self-sampling for STI/BBV o Patient online completed histories for abortion care o Coppr prescribing o Email clinical image pathway o Moray and Shetland abortion care pathway o Scottish Government funded HIV PrEP primary care pilot • Multi-agency working o Scottish Government funded BBV Opt-Out pilot in Emergency Department o POPPi study: Post-natal progesterone only pill (POP) opt-out study o Asylum care BBV testing Page 376
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• Research o Chief Scientific Office (CSO) Human Papilloma Virus (HPV) Equity Study offering HPV vaccine and testing to women in priority groups – in collaboration with HMP Grampian. o Desogestrel for bleeding on the implant (DEBI) study assessing impact on POP on implant bleeding. o UK Health Security Agency (UKHSA) Positive Voices HIV stigma survey Document details & change history Version Date Description Authorisation V1.0 26.03.26 Initial Draft Lisa Allerton Daniela Brawley Document approvals Name Date Role Signature Dianna Reed Sandy Reid 04/06/26 04/06/26 Clinical Lead Service Lead Page 377
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF PRIMARY CARE CONTRACTS ( PCCT) 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Primary Care Contracts (PCCT) by Moray Integration Joint Board, on behalf of all three IJBs in the Grampian NHS Board area (NHSG). This document identifies the services required and the expected level of services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the PCCT hosted service that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. • Duration, scope and renewal of this SLA contract. • Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Commencement Date” means the date of the start of the Service, or as otherwise specified. “Services” means the services to be supplied as specified in the Specification. APPENDIX 5 Page 378
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“Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. “Term” means the period from the commencement of the Service Level Agreement to the date of expiry. “Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services PCCT provides the shared administrative function for contractor services for NHS Grampian in such a way that it supports and enables a) the planning and delivery of integrated services within IJBs and b) governance processes, whilst adhering to legislation and national and local guidance. It provides the IJBs and, as appropriate, the Professional Leads with timely, accurate and relevant information on contract performance, to develop knowledge and expertise in all aspects of the legislative and regulatory framework that underpins the contractual process and to ensure the efficient operation of contract administration and governance processes including maintenance and distribution of all contract documentation. There is a contractual relationship between each of the contractor groups (Dental, GMS, Optometry and Pharmacy) and NHS Grampian. PCCT deals with applications from GPs, Community Opticians and Dentists to be included on the appropriate NHS Grampian Performer’s List i.e. the ability to carry out clinical services in NHS Grampian. It also processes new entrant applications via the Pharmacy Practices Committee (PPC) There are a significant number of specific contracts for GMS which are detailed in that they specify volume, cost and quality. There are specifications for some of the locally delivered Pharmacy services, and as part of a NHS Scotland initiative, nationally agreed specifications have recently been finalised for some pharmacy services. The relationship for Dental and Optometry services is one of a “licence to practice” with payment for “items of service”. Primary Medical Services - 67 General Practices Community Pharmacy – 127 Community Pharmacies Optometry Contractors – 96 Optometrists Dental Contractors – 185 General Dental Practitioners Primary Care Contracts Department staff - 8.75WTE Page 379
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2.75 x Band 3 Administrators 4 x Band 4 Senior Administrators 1 x Band 6 Service Support Manager 1x Band 8b Service Manager 2.2 Organisational Management and Governance The host IJB, Moray, will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Performance information is reviewed by the manager and areas out with targets and thresholds highlighted to the appropriate HSCM groups for clinical governance, health and safety, workforce etc and escalated to Senior Management Team Performance Oversight. Reports will be presented to all 3 IJBs on an annual basis as to progress against the agreed performance framework as described in section 4.0. 3.0 Finance There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards There are no formal Scottish Government or NHS Scotland-issued KPI specifications for PCCT services that defines targets or standards. However, PCCT is expected to work within the appropriate regulatory frameworks 4.2 Local Quality and Performance Measures There is no formal arrangement for monitoring progress towards outcomes agreed with the IJBs. The service, as part of regular reporting to IJBs, provides the following key operational performance indicators: - Workforce levels – rota fill rates, sickness levels and turnover rates providing assurance on the sustainability of the service. Page 380
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- Financial position – outlining the efficiency and cost‑effectiveness of the service. - Number of patient contacts – offering insight into demand levels and capacity management. - Number of complaints – indicating the quality of the service and areas requiring improvement. - Number of adverse events – informing on service quality, safety, and emerging trends. - Number of referrals to external agencies (i.e. admissions) – informing on service quality and safety and commitment to supporting local and board strategic objectives. Reporting to the Host is undertaken through the appropriate governance group and committees and according to the Host Board’s established reporting schedule. 5.0 Transformation Activity The Host has operational responsibility to deliver the Hosted Service on behalf of the other three IJBs however the three IJBs have an interest in the strategic direction of the service including any planned transformational activity. This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Document details & change history Version Date Description Authorisation 1.0 4/6/26 Final draft for approval Peter McLean Document approvals Name Date Role Signature Peter McLean 4/6/26 Service Manager, Primary Care Contracts Page 381
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF MARIE CURIE MANAGED CARE 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Marie Curie Managed Care by Aberdeenshire IJB on behalf of all three IJBs in the Grampian NHS Board area. This document identifies the services required and the expected level of services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. The Service is hosted for reasons of efficiency and speciality. Since the change in contract in 2023, Aberdeenshire hosts Marie Curie for managed care. 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the Marie Curie Managed Care hosted service that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. • Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. APPENDIX 6 Page 382
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“Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services The Marie-Curie Managed Care Service provides a service co-ordinated locally by a Senior Nurse to provide planned palliative nursing care to patients in their usual place of residence, who are in the end of life stage of their illness, whose needs can be met through short episodes of care, delivered through an agreed combination of days and/or evenings and/or nights as appropriate to support the needs of patients and carers. The Service is provided through an agreed combination of Registered Nurses and Healthcare Assistants with appropriate training and current experience in end-of-life palliative care, to deliver care and support for referred patients with a terminal illness, which will comprise management of pain and other symptoms and provision of emotional and practical support as set out in the care plan provided by the referrer. The current contract with Marie Curie is to deliver 1154 hours of care per month with a combination split of 20% - Registered Nurse, 80% Health Care Assistants. This is a rolling month-to-month contract with a 3-month notice period. Services will be delivered in the patient’s home (or other agreed location). Provider’s Staff contract outlines work area is within a specified radius of home. Operational Hours: Care is flexible and is based on patient need. Standard shifts are 9 hours. Night visits are delivered between the hours of 22:00 and 07:00. Day and Evening visits are of variable length and flexible between the hours of 07:00 to 23:00, subject to a minimum of 3 hours. Referrals: The Commissioner will ensure that requests for Services will be made by District Nurses and any other agreed referrers to the Marie Curie’s Referral Centre. During office hours (Monday to Friday 09:00 to 17:00) the call will then be transferred to the Senior Nurse at the local office to discuss and agree an appropriate package of care. Out with these times the Referral Centre will take the referral for care after registering the patient. The Referrer should advise the Senior Nurse at the local office of their referral to The Referral Centre the next working day. For referrals made out with office hours, Marie Curie's Referral Centre will confirm whether they are able to fulfil the request as soon as practically possible. Page 383
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2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to the Risk, Audit & Performance Committees of all 3 IJBs on an annual basis as to progress against the agreed performance framework as described in section 4.0. Governance of Marie Curie staff sits within Marie Curie’s governance structure. 3.0 Finance The table below relates to the 2025/26 financial year. No significant year-on-year variance is anticipated, although some fluctuation may occur. There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel, which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards All quality and performance measures are detailed in section 4.2 below. 4.2 Local Quality and Performance Measures Marie Curie provides monthly data on key service measures to the Chief Nurses and Finance Officers of each IJB. This includes: • Hours delivered • Patients Cost Centre Level 9 Code Cost Centre Level 9 Name Annual Budget N33280 CITY MARIE CURIE NURSING 376,767 N44382 ABERDEENSHIRE IRS M CURIE 155,568 N00702 MORAY MARIE CURIE NURSING 91,309 623,644 Page 384
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• Care contacts • Caseload metrics • Patient demographics • Performance against commissioned targets 5.0 Transformation Activity This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Document details & change history Version Date Description Authorisation V1.0 04/06/2026 Final Draft for approval Alison McGruther Document approvals Name Date Role Signature Alison McGruther 04/06/2026 Chief Nurse, Aberdeenshire HSCP Page 385
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF COMMUNITY DIABETES SPECIALIST NURSING 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Community Diabetes Specialist Nursing by Aberdeenshire IJB on behalf of all three IJBs in the Grampian NHS Board area. This document identifies the services required and the expected level of services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. The Community Diabetes Specialist Nursing Service is hosted for reasons of efficiency and speciality. The hosting arrangement is intended to provide equity of service and improve access to patients across all NHS Grampian communities. Offering appointments locally improves attendance, extends the reach of the service into rural areas and supports equity. Basing Community Diabetes Specialist Nurses within each area maximises staff efficiency, supports effective use of resources, allowing resources to be distributed as needed, and enables greater partnership working with Primary Care. The Community Diabetes Specialist Nursing service came to be hosted to address inconsistencies in education and governance within the service. The appointment of a Nurse Manager has supported the growth of the service and provided a more effective service for those living with diabetes. The Nurse Manager reports to the Chief Nurse for Aberdeenshire Health and Social Care Partnership leading to the Service being hosted by Aberdeenshire. Being part of the Health and Social Care Partnership allows the service to operate across the whole of Grampian, which in turn has allowed for the development of education packages for people living with diabetes and for health care professionals who care for patients in the communities. APPENDIX 7 Page 386
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1.2 Purpose The purpose of this SLA is to set out: • Requirements for the Community Diabetes Specialist Nursing hosted service that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. • Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. “Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services The Diabetes Specialist Nurses (DSN) will provide support pan-Grampian to people living with diabetes aged 16 - 21 years in the Young Person’s service, and from age 21+ years in the Adult Service. The service supports both direct patient care and wider workforce development to ensure high‑quality, consistent diabetes management. Education and training include structured and ad hoc teaching for primary care, annual and topic‑specific updates, practical skills sessions, and support for quality assurance of diabetes care. The team provides comprehensive support to practice‑based diabetes services through both our helpline and outreach activities. In addition to direct patient support, we deliver a wide range of teaching and training to enhance knowledge and clinical practice across primary care. 2.1.1 Scope of Provision Page 387
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• Clinical advice: A DSN helpline offering real‑time support to primary and secondary care teams. • Review patients from diagnosis using many different medias, e.g. face to face, group sessions, virtual clinics, telephone appointments, emails and text message. • Practice outreach: Direct input to practice teams, including system reviews, complex case discussions, and MDT learning. • Support Primary Care Practice nurses, GP, Pharmacist and district nurses with advice and education regarding their patients. • Clinical leadership: Expert guidance to promote consistent, evidence‑based diabetes management across Grampian. • Provide an education programme available to all health and social care professionals, including student nurses, in NHS Grampian. • Work in line with local, Scottish and National Guidance for Diabetes. • Support and work towards service improvement and participate in QI projects 2.1.2 Staffing Resources The funded and actual staffing establishment for the service is as follows: • WTE Band 8a Nurse Manager • 2.8 WTE Band 7 Senior DSN • 8.1 WTE Band 6 DSN DSN Bases • David Anderson Building, Aberdeen • Kincardine Hospital, Stonehaven • Saltoun Medical Practice, Fraserburgh • Maryhill House, Elgin Location for service delivery • David Anderson Building, Aberdeen • Kincardine Hospital, Stonehaven • Saltoun Medical Practice, Fraserburgh • Huntly Hospital • Peterhead • Inverurie • Health Village • Dr Grays Hospital 2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to the Risk, Audit & Performance Committees of all 3 IJBs on an annual basis as to progress against the agreed performance framework as described in section 4.0. Page 388
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The organisational management and governance arrangements for the Service are set out below: Adverse events are reported through the Clinical Care Risk Management Group (CCRMG). 3.0 Finance These budget lines are combined with the budget for Diabetic Eye Screening Service The table below relates to the 2025/26 financial year. No significant year-on-year variance is anticipated, although some fluctuation may occur. Cost Centre Level 9 Code Cost Centre Level 9 Name Annual Budget N33283 CITY DIABETES MCN 559,051 N44385 ABERDEENSHIRE IR DIAB/RET SCR 705,531 N00705 MORAY DIAB MCN INC RETINAL SCREE 256,320 1,520,902 Page 389
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There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel, which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards The Community Diabetes Specialist Nursing Service will be monitored against relevant national standards and quality indicators, including but not limited to: • Scottish Diabetes Survey outcomes, including the monitoring of annual checks, treatment targets, and access to structured education. • NICE Diabetes Guidance and associated safety and care quality standards. • SIGN Guidelines for Diabetes, ensuring consistency with evidence-based care pathways. • SCI-Diabetes Dashboard indicators, including clinical process measures, care bundle compliance, and data completeness. Performance monitoring will include: • Tracking progress against national diabetes improvement indicators. • Monitoring safety markers such as insulin-related incidents, DKA admissions, and hypo related emergency attendances. • Reporting progress through an agreed dashboard to all three IJBs. • Reporting frequency: Annual performance report, with interim six-monthly review information as required for internal governance. 4.2 Local Quality and Performance Measures • Provision of Clinical supervision • Activity Measures - Number of new referrals to the DSN service. - Helpline activity (calls, emails, professional queries). - Number of outreach visits or practice-based clinical support activities. - Attendance at MDT meetings. - Number of education sessions delivered (Teams and in person). - Mandatory training compliance. - Appraisal completion rates. - Participation in QI projects and service improvement activity Page 390
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5.0 Transformation Activity This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Document details & change history Version Date Description Authorisation V1.0 04/06/2026 Final draft for approval Alison McGruther Document approvals Name Date Role Signature Alison McGruther 04/06/2026 Chief Nurse, Aberdeenshire HSCP Page 391
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF DIABETIC EYE SCREENING 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Diabetic Eye Screening by Aberdeenshire IJB on behalf of all three IJBs in the Grampian NHS Board area. This document identifies the services required and the expected level of services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. Historically, Retinal screening was delivered at Kincardine Community Hospital. In 2010, Moray, Aberdeenshire and Aberdeen City agreed to establish a Grampian service based and hosted within Aberdeenshire. The Service is hosted for reasons of efficiency and speciality. The hosted arrangement for the Diabetic Eye Screening Service is intended to ensure retinal screening appointments are provided to all eligible diabetic patients across NHS Grampian. Offering screening locally ensures it is more accessible, convenient and maximises uptake, attendance and patient ocular health. The service operates in line with the national Diabetic Eye Screening programme and protocols surrounding patient eligibility, recall, results and referral. A full time Nurse manager post covers both Diabetic Nursing and Diabetic Eye Screening; strong clinical leadership and supervision wrap around the programme with oversight from Public Health 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the Diabetic Eye Screening hosted service that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. APPENDIX 8 Page 392
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• Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. “Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services The Diabetic Eye Screening Hosted Service provides retinal screening appointments to all eligible people with diabetes across NHS Grampian, covering Aberdeen City, Aberdeenshire and Moray. The current eligible population is approximately 43,000 patients. 2.1.1 Scope of Service Provision The service operates in accordance with the national Diabetic Eye Screening (DES) programme, including national protocols for patient eligibility, recall intervals, results reporting and referral pathways. On average, the service receives approximately 275 new patient referrals per month. The service delivers clinical retinal screening and assessment, including: • Fundus photography • Slit lamp examination • Optical Coherence Tomography (OCT) scanning 2.1.2 Service Delivery Model and Locations The service is delivered across 35 screening locations, all within NHS premises, including: • GP practices • Local health centres • Rural hospitals • Screening activity is provided through: • A fixed (static) screening site at the David Anderson Building, Aberdeen Royal Infirmary (ARI) Page 393
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• Three mobile screening units to improve accessibility and bring screening closer to patients • Use of slit lamp and OCT equipment within rural hospitals where available Wider Regional / Specialist Provision The service operates on a whole-NHS Grampian basis, ensuring consistent access to diabetic eye screening across urban, rural and remote communities. Regional coverage is supported through a combination of the fixed site in Aberdeen and outreach delivery via mobile units and rural hospital facilities. 2.1.3 Staffing & Resources The funded and actual staffing establishment for the service is as follows: • Consultant: 0.2 WTE funded / 0.2 WTE actual • Band 7: 1.6 WTE funded / 1.74 WTE actual • Band 6: 1.8 WTE funded / 0.8 WTE actual • Band 5: 1.6 WTE funded / 0.8 WTE actual • Band 4: 1.6 WTE funded / 3.22 WTE actual • Clerical (Bands 2 and 4): 2.6 WTE funded / 2.2 WTE actual Premises used for service delivery include: • A fixed screening site at the David Anderson Building, ARI, Aberdeen • Hosted NHS sites across Grampian, including GP practices, healthcare centres and local hospitals • Looking for a permanent base in Moray Key equipment includes: • Three mobile screening vans • Five fundus cameras • One OCT scanner • One slit lamp, with additional access to slit lamp and OCT equipment in some rural hospitals • Laptops provided through the national screening programme, maintained and updated at the national level A Medical Physics agreement (January 2025) is in place to ensure replacement of unsupported equipment when required. Use of hire cars is restarting to support service delivery. 2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to the Risk, Audit & Performance Committees of all 3 IJBs on a bi-annual basis as to progress against the agreed performance framework as described in section 4.0. The organisational management and governance structure for the Service is set out below: Page 394
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DES is a nationally-led programme with all governance, protocols and standards being devised at a national level. Datix are reported through the Clinical Care Risk Management Group (CCRMG). Annual reports are submitted via Public Health to the NHS Clinical Governance Committee. 3.0 Finance The table below relates to the 2025/26 financial year. Any variation in spend will be presented to each IJB. These budget lines are combined with the budget for the Diabetes Specialist Nursing Service. Cost Centre Level 9 Code Cost Centre Level 9 Name Annual Budget N33283 CITY DIABETES MCN 559,051 N44385 ABERDEENSHIRE IR DIAB/RET SCR 705,531 N00705 MORAY DIAB MCN INC RETINAL SCREE 256,320 1,520,902 Page 395
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There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel, which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards Quarterly key performance indicator (KPI) data is generated centrally by the Programme Lead, with nationally agreed standards across all Scottish boards. National EQA programme for all image-grading staff and a screening diploma requirement for screening staff. KPI 0: Total Population & Eligible Population figures KPI 3: Annual Successful Screening Rate (target 80%) KPI 5: Biennial Successful Screening Rate (target 80%) KPI 9: The percentage of encounters where the patient results were printed within 20 working days (target 95%) KPI 23: Appointment booked within 90 calendar days for newly diagnosed patients (target 100%) The Director of Public Health is responsible for screening programmes. All reports are shared with the Programme Manager, Screening Oversight and Assurance. Quarterly review meetings are held. 4.2 Local Quality and Performance Measures • Local IQA programme to measure local performance • Local training programme upon starting the service and periodically to ensure all staff meet screening expectations and standards. • Periodic patient feedback projects • Bi-annual patient surveys • Twice-yearly education days for staff • Part of the grading is to pass a specific number of patients to continue grading as part of the National EQA programme 5.0 Transformation Activity This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is Page 396
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collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Document details & change history Version Date Description Authorisation V1.0 04/06/2026 Final draft for approval Alison McGruther Document approvals Name Date Role Signature Alison McGruther 04/06/2026 Chief Nurse, Aberdeenshire HSCP Page 397
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF CUSTODY NURSING, FORENSIC MEDICAL EXAMINERS (FME) & SEXUAL ASSAULT RESPONSE COORDINATION SERVICE (SARCS) 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Custody Nursing, Forensic Medical Examiners (FME) & Sexual Assault Response Coordination Service (SARCS) by Aberdeenshire Health & Social Care Partnership on behalf of all three IJBs in the Grampian NHS Board area. This document identifies the services required and the expected level of services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. The Custody Nursing, FME & SARCS service is hosted by Aberdeenshire HSCP for reasons of efficiency and speciality. This is a historical agreement which remains operationally effective, supported by strong geographical knowledge and established partnerships within Aberdeenshire. The service operates as a specialist, standalone function with primary links to Police Scotland. All FME doctors are city-based, enabling effective cross-boundary delivery. 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the Custody Nursing, FME & SARCS hosted service that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. APPENDIX 9 Page 398
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• Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. “Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services The Custody Health Service delivers health care via nursing and Forensic Medical Examiners (FME) within 3 custody suites across Grampian, located in Aberdeen (Kittybrewster), Elgin and Fraserburgh. It is a Grampian-wide service. Duties include: • Specialist trained Chaperoning for forensic cases both for victim and perpetrator • Forensic Medical Examinations for both victim and perpetrator • Forensic procedures in obtaining bloods for drug and alcohol testing • Fitness to detain, for court, to release, for interview, for transfer and detentions • Developing care plans for their episode of care. The Custody Health Service team also provides: • Complex acute mental health assessments • Management of minor injuries and acutely unwell patients • Substance use service in the form of the provision of opioid replacement therapy • Harm reduction • Wound care • Advocacy • Mental health support in line with MAT standards • Onward referrals • Medication management • Life support in emergency situations. All services are provided on request from police Scotland. Page 399
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Aberdeen (Kittybrewster) On-site 24-hour nursing and FME cover based within the custody suite of 62 cells. Staffing: • 1.2 WTE Custody Nurse Team leader-band 7 • 6.2 WTE Custody Nurse Practitioners band 6 (this is the same nursing team that deliver the SARC service) Patients are referred by Police Scotland when health or forensic need identified. Elgin Off-site 24-hour cover is provided for 10 cells. The team is based in the Emergency Department, Dr Gray’s Hospital. Staffing: • 3 WTE Band 6 Custody practitioners A senior charge nurse from ED manages the team. Nurses are on site 80-100% of the time. Fraserburgh Off-site 24-hour cover is provided for 9 cells. Staffing: • 3.3 WTE Nursing Cover is provided from minor injury unit at Fraserburgh hospital by minor injury nurses with additional specialist training. Forensic Medical Examiners A range of services is provided on demand from the police or nursing team. This includes: • Forensic examinations of victims or perpetrators, child protection cases, and deceased individuals • Preparation of court reports and attending court FME coordinated the SARC self and police referrals, liaising with the national hub and Police Scotland. It is a requirement of the service to have a single FME on call available 24/7. The Sexual Assault Response Coordination Service (SARCS) is statutory service for self-referral and Police Scotland sexual assault victims for forensic examinations. The Service is provided by FMEs and nursing staff from Kittbrewster. Appointments for assessment following any reported concern of sexual assault or rape must be given within the standard timeframe of 7-14 days. Self-referral service for sexual assault forensic examinations are received via the national hub. The service must contact the individual within 3 hours of receiving the referral, with examination completed within the timeframe above. Scottish Government has directed NHS Grampian to employ a nurse coordinator to work within the SARCS service to coordinate all referrals and provide all through care following Page 400
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a forensic examination. 0.4 WTE of the Band 7 SARCS Nurse Co-ordinator/Custody team lead staffing is allocated to this duty. All SARCS cases (aged 16+ years) are seen at the MacKenzie suite at Aberdeen Health Village, Frederick Street, Aberdeen. All forensic examinations for those aged under 16 years are conducted at Royal Aberdeen Children’s Hospital by RACH staff. 2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to the Risk, Audit & Performance Committees of all 3 IJBs on a bi-annual basis as to progress against the agreed performance framework as described in section 4.0. The organisation management and governance arrangements for the Service are set out below: Page 401
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3.0 Finance The table below relates to the 2025/26 financial year. No significant year-on-year variance is anticipated, although some fluctuation may occur. There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel, which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards Custody • Healthcare Improvement Scotland (HIS) - Inspection Standard - Framework to Inspect healthcare provision within police custody centres – final version SARCS • Healthcare Improvement Scotland (HIS) - Healthcare and forensic medical services for people who have experienced rape, sexual assault or child sexual abuse: adults, young people and children, Draft Standards November 2024 • SARCS Quality Framework, reported on a quarterly basis via NSS – NSD SARCS quality framework route • Adult FME CELLMA extract shared quarterly via Public Health Scotland Forensic Medical Services route • SARCS qualitative returns reported on a quarterly basis via NSS – NSD SARCS quality framework route 4.2 Local Quality and Performance Measures Cost Centre Level 9 Code Cost Centre Level 9 Name Annual Budget N33286 CITY POLICE FORENSIC EXAMINERS 902,783 N44388 ABERDEENSHIRE IR POLICE FORENSIC 1,080,102 N00708 MORAY POLICE FORENSIC EXAMINER 392,520 2,375,405 Page 402
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All quality and performance measures for the service are described in section 4.1 above. 5.0 Transformation Activity This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Document details & change history Version Date Description Authorisation V1.0 04/06/2026 Final Draft for approval Alison McGruther Document approvals Name Date Role Signature Alison McGruther 04/06/2026 Chief Nurse, Aberdeenshire HSCP Page 403
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF COMMUNITY HEART FAILURE SERVICE 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of the Community Heart Failure Service by Aberdeenshire IJB on behalf of all three IJBs in the Grampian NHS Board area. This document identifies the services required and the expected level of services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. The Community Heart Failure Service is hosted for reasons of efficiency and speciality. The arrangement is intended to ensure equity of service provision across all NHS Grampian communities and provide a specialist service for patients with a confirmed diagnosis of Heart Failure due to Left Ventricular Systolic Dysfunction (LVSD) with an Ejection Fraction < 40% within the clinical scope of NHSG guidelines. The specialist nurses provide ongoing management of heart failure patients in the community, aiming to improve their quality of life and reduce hospital admissions. The creation of one Grampian service hosted by Aberdeenshire IJB ensures equity of care, improves financial efficiency, and provides consistent clinical leadership and supervision. 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the Community Heart Failure Service hosted service that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. • Supporting processes including performance monitoring arrangements. APPENDIX 10 Page 404
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1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. “Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services The Community Heart Failure Service is a Grampian-wide, nurse-led service providing assessment, treatment optimisation and ongoing management for adults with a confirmed diagnosis of Heart Failure due to Left Ventricular Systolic Dysfunction (LVSD) with an Ejection Fraction < 40% within the clinical scope of NHSG guidelines. The service supports patients across Aberdeenshire, Aberdeen City and Moray, operating within a community and primary care setting, and working in close liaison with secondary and tertiary cardiology services. 2.1.1. Service Scope The service delivers: • Community heart failure nursing care • Optimisation and monitoring of evidence-based heart failure therapies within NHSG treatment guidelines • Patient, carer and professional education • Nurse-led outpatient and community clinics across Grampian • Central advice line for patients and health professionals 2.1.2. Resources and Staffing Staffing: • 1.0 WTE Team Leader (Band 7) • 5.02 WTE Community Heart Failure Nurses (Band 6) • 0.60 WTE Administrative Support (Band 3) Page 405
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Staff are based across Moray, Banff and Buchan, and Aberdeen City/Aberdeenshire, with flexibility to manage caseloads based on clinical complexity and geography. The service operates a hub and spoke model with core clinic bases at: • Oldmachar Medical Practice (Aberdeen City) • Maryhill House, Elgin (Moray) • Saltoun Surgery, Fraserburgh (Banff and Buchan) In addition, nurse-led clinics are delivered at ad hoc locations across Grampian in response to clinical need, supporting equitable access for urban, rural and remote populations. 2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to the Risk, Audit & Performance Committees of all 3 IJBs on a bi-annual basis as to progress against the agreed performance framework as described in section 4.0. The organisational management and governance of the Service is set out below: Adverse events will be reported to the Clinical Care Risk Management Group (CCRMG). Page 406
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3.0 Finance The table below relates to the 2025/26 financial year. No significant year-on-year variance is anticipated, although some fluctuation may occur. There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel, which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards • Referral time to review in line with NHS Scotland waiting time guidance – Monthly • CNS workforce tool – Yearly 4.2 Local Quality and Performance Measures • Review of patient caseloads numbers – Monthly • Hospital admission avoidance – Monthly • Service patient advice line activity – Monthly • Clinical activity Boxi reports – Yearly alongside CNS workforce tool 5.0 Transformation Activity This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Cost Centre Level 9 Code Cost Centre Level 9 Name Annual Budget N33281 CITY HEART FAILURE SERVICE 149,962 N44383 ABERDEENSHIRE IR HEART FAIL 172,530 N00703 MORAY HEART FAILURE SERVICE 73,088 395,580 Page 407
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Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Document details & change history Version Date Description Authorisation V1.0 04/06/2026 Final draft for approval Alison McGruther Document approvals Name Date Role Signature Alison McGruther 04/06/2026 Chief Nurse, Aberdeenshire HSCP Page 408
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF BLADDER & BOWEL SPECIALIST SERVICE 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Bladder and Bowel Specialist Service by Aberdeenshire IJB on behalf of all three IJBs in the Grampian NHS Board area. This document identifies the services required and the expected level of services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. The hosted arrangement for the Bladder and Bowel Specialist Service is intended to ensure equity of service provision across all NHS Grampian communities and to support accessible clinic appointments for all patients. A significant proportion of service users are supported via the frailty pathway and may experience difficulty attending clinic-based appointments. Delivering the service on a hosted, pan-Grampian basis enables flexible models of care that help reduce additional pressures on community nursing teams while maintaining timely access to specialist support. Historically, the service—previously known as the continence service—was delivered separately by Moray, Aberdeenshire and Aberdeen City. The decision to establish a single service hosted within Aberdeenshire was made before the formation of the Integration Joint Board for reasons of efficiency and speciality. The approach ensures there is a standard model of service delivery, equity of care, financial efficiency, and consistent clinical leadership, supervision, and shared administrative support across Grampian. 1.2 Purpose The purpose of this SLA is to set out: APPENDIX 11 Page 409
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• Requirements for the Bladder and Bowel Specialist Service hosted service that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. • Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. “Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services The NHSG Bladder and Bowel Specialist Service is delivered pan-Grampian and provides a treatment-based, nurse-led model aimed at improving or resolving incontinence, with containment options available where clinically appropriate. 2.1.1 Scope of Service Provision The national best practice guidelines for continence management describe a treatment service model with the following structure: • Delivery of structured continence pathways: - Children provided for approximately six months with structured, supported toilet training program before containment is considered - Adults supported via a 12-week treatment plan prior to containment provision. Implementation of best practice would require all continence assessments to be delivered by bladder and bowel nurse specialists. Nationally this role has historically been shared between specialist and community nursing. Funding for the Bladder and Bowel Specialist Service in Grampian is currently based on the provision of an advisory service rather than a treatment service and resource is not currently sufficient to fully deliver the best practice model in Grampian. Page 410
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The Service currently provides: Clinical workload • Home-based and clinic-based case work across Grampian. • Daily specialist cover of patient and professionals' clinical advice line • Daily continence support to district nurses, community nurses, general practice, social work, education, care homes and other stakeholders covering an adult caseload of around 6500 patients. • Daily continence support to health visitors and school nurses, covering approximately 550 children. • 12-weekly clinical reviews for care-home residents receiving prescribed continence aids. • Processing an average of 2000 patient prescriptions per month and subsequent home delivery. Clinical and Multi-Disciplinary Contributions • Representation at the Uro-Gynaecology Multidisciplinary Team monthly meeting. • Daily clinical support and induction training for third-party providers and IJB community care services. • Delivery of a structured training programme, including: - Five core continence modules - Three paediatric continence modules Provided to NHSG, care home, and social care staff on a six-month rotation. • Provision of Health Care Support Worker induction training across three NHSG sites. • Delivery of the NHSG Ucath clinical skills components across multiple locations. • Clinical support to 14 community hospitals, 5 Cornhill wards, neuro-rehabilitation, and MS services for complex continence cases. • Contribution to acute wards (ARI and DGH) to ensure CAUTI compliance and continence best-practice discharge planning as requested. • NHSG represented nationally by the Service Manager at clinical lead groups and National Procurement, playing a stakeholder role in NHS Scotland contract CAP’s for containment devices and catheters and national service improvement planning including national formulary and service standardisation across all NHS Scotland. Clinic Delivery Locations and Frequency • DGH Outpatients, Elgin – weekly and twice monthly sessions • Health Village, Aberdeen – weekly • Kincardine Hospital, Stonehaven – monthly • Peterhead Community Hospital – monthly • The Hub, Inverurie – bi-weekly sessions plus ad hoc capacity • Post-Prostatectomy telephone clinic – weekly • Home visits as required Staffing Resources A. Nursing Establishment • 1 WTE Service Manager (Band 8a) • 2.6 WTE Specialist Nurses (Band 6) Page 411
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• 0.5 WTE Staff Nurse (Band 5) • 0.9 WTE Healthcare Support Workers (Band 3) B. Administrative Support • 0.6 WTE Secretary/Clinic Coordinator (Band 3) • 1.6 WTE Home Delivery Service Administrative Support (Band 2) C. Nursing Office Bases • Maryhill House, Elgin – supporting MHSCP • Staff Home Inverurie / hospital base – supporting AHSCP and ACHSCP 2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to the respective IJB Risk, Audit & Performance Committees on a bi-annual basis as to progress against the agreed performance framework as described in section 4.0. The governance arrangement for the service are set out below: 3.0 Finance The table below relates to the 2025/26 financial year. No significant year-on-year variance is anticipated, although some fluctuation may occur. Page 412
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There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel, which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJBs contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework The key aims and outcomes of the Service are to: 1. Provide comprehensive assessment and treatment plans All patients receive a full bladder and/or bowel assessment and a treatment plan with follow-up, with the aim of improving or curing symptoms rather than relying solely on containment products. 2. Promote independence and participation Support patients to remain as active and independent as possible, enabling participation in education, employment and wider society. 3. Support care at home and reduce wider system pressures Treat and manage bladder and bowel symptoms in a community setting, ideally within patients’ own homes, to reduce risks such as falls, skin damage, infection, and social isolation, thereby reducing demand on social care, GP services, ambulance services and acute hospital attendance. 4. Support children’s wellbeing and educational participation Enable children to achieve their potential through improved continence management that supports ongoing engagement in education To track performance against these aims and outcomes, the following measures will be used: • Number of active patients, reported by Integration Joint Board area and whether supported at home or in clinic. • Number of care-home resident reviews completed. • Clinical outcome measures, including UCAN referrals, monitored in terms of the duration patients remain on a continence product. Cost Centre Level 9 Code Cost Centre Level 9 Name Annual Budget N32290 CITY CONTINENCE SERVICE 327,952 N44384 ABERDEENSHIRE IR CONTINENCE 659,119 N00704 MORAY CONTINENCE SERVICE 387,840 1,374,912 Page 413
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4.1 National Quality and Performance Standards • Referral time to review in line with NHS Scotland waiting time guidance – Monthly • CNS workforce tool – Yearly 4.2 Local Quality and Performance Measures • Review of active patient caseload numbers – Quarterly • Service patient advice line activity – Monthly • Clinical activity Boxi reports – Yearly alongside CNS workforce tool • Prescribing monitoring, care provision element – Quarterly • Prescribing monitoring, financial spend element – Quarterly 5.0 Transformation Activity This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation activity the outcomes/benefits will be agreed in advance and the impact measured and reported. Page 414
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Document details & change history Version Date Description Authorisation V1.0 04/06/2026 Final Draft for approval Alison McGruther Document approvals Name Date Role Signature Alison McGruther 04/06/2026 Chief Nurse, Aberdeenshire HSCP Page 415
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF HMP GRAMPIAN HEALTH 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Health Services in HMP & YOI Grampian by Aberdeenshire IJB on behalf of all three IJBs in the Grampian NHS Board area. The Service is hosted for reasons of geography, being delivered from one location in Peterhead. This document identifies the services required and the expected level of services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the HMP & YOI Grampian Health hosted service that will be provided to all three Integration Joint Boards including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. • Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. “Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. APPENDIX 12 Page 416
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“Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services Delivery of holistic healthcare for the population of HMP Grampian. This includes the delivery of Primary Care (General Practice Services, Optometry, Dental, Podiatry and Nursing), Mental Health (Primary and Secondary Care level), Substance Use in Prisons, Allied Health Professions (in house and in reach from community). 2.1.1 Scope of Service Provision The Health Centre for HMP Grampian is located in the Prison setting and serves the prison population at every point of their sentence length. The establishment currently accommodates up to 560 people/persons in custody. At this time, we currently have 520 people. All of these people are entitled for a full suite of Health Care services equivalent to what is available and accessible within the community setting. The model for delivery includes both health centre and residential inhouse services. In addition, bespoke community in-reach clinics take place where required to meet the health needs of the Prison population. Specific processes and protocols are in place regarding admission, transition and liberation to ensure all assessments are in place to provide continuity of care or commence early intervention and address unmet treatment needs. 2.1.2 Staffing Resource Total establishment 38.97 WTE which consists of: • 30.37 WTE Nursing • 1.2 WTE Dental • 1.82 WTE Admin officer services • 2.71 WTE Admin patient services • 0.46 WTE Speech & Language Therapy • 0.54 WTE Occupational Therapy • Primary Care Medical Service (see Appendix 1) • Pharmacy Staff within HMP as required 2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to the Risk, Audit & Page 417
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Performance Committees of all 3 IJBs on a bi-annual basis as to progress against the agreed performance framework as described in section 4.0. The organisational management and governance of the Service is set out below: In addition, • Regulatory bodies for each profession ensuring good standards of practice are in place and are monitored. • Professional Leads structure for each MDT role, providing professional practice oversight. • National oversight structures which require regular reporting and inspection. 3.0 Finance The table below relates to the 2025/26 financial year. No significant year-on-year variance is anticipated, although some fluctuation may occur. Page 418
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There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel, which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards • MAT Standards - % compliance with MAT Standards 1–10; DAISY submission compliance - Quality of substance use treatment • Quality Assurance (HIS) - % HIS actions completed; % audit cycle completed - Assurance against national standards 4.2 Local Quality and Performance Measures • Access & WaitingTimes - % triaged within 24 hrs, • Long term conditions • Immunisations • Sexual health • MH/AHP wait compliance - Timeliness of access to core services 5.0 Transformation Activity This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation Page 419
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activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Document details & change history Version Date Description Authorisation V1 04/06/2026 Final draft for approval Alex Pirrie Document approvals Name Date Role Signature Alex Pirrie 04/06/2026 Partnership Manager (North), Aberdeenshire HSCP Page 420
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SERVICE LEVEL AGREEMENT (SLA) FOR THE PROVISION OF CHRONIC OEDEMA SERVICE 1.0 Overview 1.1 Introduction The Public Bodies (Joint Working) (Scotland) Act 2014 provided that Health Boards and Councils must delegate certain services to the Integration Joint Boards (IJBs) for planning and delivery. This included a group of delegated services for which it was agreed locally within Grampian that these should be delivered on a ‘hosted’ basis, where disaggregation would present significant risk to deliverability, quality and efficiency of the service. This is a Service Level Agreement (SLA) for the provision of Chronic Oedema Service by Aberdeenshire IJB on behalf of all three IJBs in the Grampian NHS Board area. This document identifies the services required and the expected level of services to be provided. This is a rolling SLA. An annual report on delivery against this SLA will be prepared and submitted to all three IJBs and NHS Grampian which will also identify any areas of proposed revision to the detail contained within the SLA. The Service is hosted for reasons of efficiency and speciality. It is a very small service and hosting allows for consistent delivery across Grampian, ensuring robust clinical governance and professional support for team members. 1.2 Purpose The purpose of this SLA is to set out: • Requirements for the Chronic Oedema hosted service that will be provided to all three Integration Joint Boards, including specific quality standards or "service levels". • Roles and responsibilities of the host Integration Joint Board. • Supporting processes including performance monitoring arrangements. 1.3 Definitions and Interpretations In this Service Level Agreement: “Services” means the services to be supplied as specified in the Specification. APPENDIX 13 Page 431
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“Specification” means the description of the Services to be supplied under the Service Level Agreement including the key personnel, performance monitoring framework and quality standards. “Host” means the Integration Joint Board that manages services on behalf of the other Integration Joint Boards in the NHS Board area “Hosted Services” means those services which have been agreed by the Integration Joint Boards will be managed and delivered on a pan-Grampian basis by a single Integration Joint Board. 2.0 Specification 2.1 Description of Services The Chronic Oedema Service delivers specialised assessment and long-term management for patients with oedema lasting over three months, aiming to prevent deterioration and associated complications. The service provides patient education, advice, and compression garments to support self-management and maintain quality of life. It also offers training for healthcare professionals and clinical advice to wider multidisciplinary teams. Care is delivered across multiple settings, including outpatient clinics, hospitals, and patients’ homes, supported by a main base in Aberdeen Health Village and satellite clinics in Stonehaven, Aboyne, Inverurie, Maud, Huntly and Elgin. Referrals are accepted via Consultants, GPs, primary care colleagues and Specialist Care Nurses, with a significant proportion of cases relating to cancer, alongside vascular and other medical causes of chronic oedema. Staffing The Service was historically provided by Allied Health Professionals but at this time includes both AHP and nursing staff. A recent organisational change process has resulted in improvements to the staffing model with the aim of providing equity of care across Aberdeen, Aberdeenshire and Moray. The establishment consists of: • 1 WTE 8a Chronic Oedema Specialist • 0.8 WTE Band 7 Chronic Oedema Practitioner • 0.54 WTE Band 4 Admin support • 0.31 WTE Band 4 Healthcare Support Worker As the current team lead is an AHP, the service is supported by the lead AHP, Aberdeenshire HSCP. This arrangement is considered effective for the needs of staff and service. 2.2 Organisational Management and Governance The host IJB will have responsibility for performance management of the host services for which it has operational oversight and shall use performance information to monitor the delivery of this service on an ongoing basis. Reports will be presented to the Risk, Audit & Page 432
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Assurance Committees of all 3 IJBs on a bi-annual basis as to progress against the agreed performance framework as described in section 4.0. The organisation management and governance structure for the Service is set out below: NHS Grampian Chronic Oedema Service is Hosted in Aberdeenshire IJB. The service sits under the line management of Aberdeenshire SMT and at this time is managed by the lead AHP in Aberdeenshire HSCP. The clinical supervision of the service lead is carried out in a peer supervision format with others post holders in services similar to this across NHS Scotland. The nursing member of the team at this time is registered with the NMC and goes through the revalidation process required of that professional body. Clinical supervision is carried out with this staff member by the service lead. Clinical assurance will be provided through the Clinical and Adult Social Work Governance Group (CASWGG) and issues escalated to the Clinical and Adult Social Work Governance Committee (CASWGC) where appropriate. Professional Practice audit is undertaken national to ensure practice is equitable to across Scotland. Random caseload audits are carried out as part of ongoing supervision arrangements. Page 433
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3.0 Finance The table below relates to the 2025/26 financial year. No significant year-on-year variance is anticipated, although some fluctuation may occur. Cost Centre Level 9 Code Cost Centre Level 9 Name Annual Budget N33284 CITY CHRONIC OEDEMA SERVICE 119,603 N44386 ABERDEENSHIRE IR CHRONIC OEDEMA 130,011 N00706 MORAY CHRONIC OEDEMA SERVICE 48,996 298,610 There is a joint agreement between the Chief Finance Officers (CFOs) of the three IJBs to share budget and expenditure information for all of the Hosted Services at each financial reporting period end. The practical route for this is through a central Microsoft Teams Channel, which all three CFOs have access to so that there is visibility and transparency of the financial position of each Hosted Service. This facilitates discussion and challenge and prompts early action to rectify any adverse trend in financial performance and/or agreement as to how any over or underspends will be managed. The financial performance of Hosted Services budgets is included in each IJB’s routine financial reporting process. Each IJB contribution is agreed annually as part of the IJB’s and NHS Grampian’s budget setting process and is informed by the Annual Reports relating to the Service Level Agreements. 4.0 Performance Monitoring Framework 4.1 National Quality and Performance Standards • British Lymphology Society and International Lymphoedema Framework provide national and international standards for intervention. • Appropriate SIGN guidelines should be recognised within practice. • Interaction with SLPN enhances national consistency from Scottish practitioners. • Bodies including COT, CSP and NMC review professional practice through audit and publish code of conduct. • Individual limb volume measurements are used as standard within clinic. 4.2 Local Quality and Performance Measures Data is now available on TRAK for the Chronic Oedema Service, which includes: • number of referrals • waiting time. Page 434
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Over the past 2 years, waiting time has reduced from 16 weeks to within the national standards. Levels of referral numbers have increased, especially from Surgical Head and Neck Service. Factors affecting outcome are monitored and held on a service database. Referrals by postcode are monitored annually to inform need for the localised service provision through the satellite clinics. As a specialist service, assessment and treatment planning is undertaken with a view to patients being managed in the community in the long term; therefore clinical caseload is managed by discharge with open review. A review of the service budget is undertaken on a quarterly basis and spend has remained within budget over the past year. The service will continue to ensure that the care provided is supported by evidence-based medicine. 5.0 Transformation Activity This SLA covers known current and planned transformation activity. The SLA commits all three IJBs to an approach for agreeing any future transformation activity. The approach is collaborative with any proposed service changes agreed by all parties. Transformation activity will be data led with clear outcomes agreed. There will be varying degrees of transformation. Minor transformation can be agreed by representatives of all three health and social care partnerships either at an operational level or a more strategic level by Senior Leadership or Management Teams. Major transformation (using the Healthcare Improvement Scotland (HIS) definition of major service change as described in the Planning with People Guidance as updated May 2024 and supplemented by HIS Guidance on identifying major health service changes September 2025) requires approval by all three IJBs. For all transformation the outcomes/benefits will be agreed in advance and the impact measured and reported. Document details & change history Version Date Description Authorisation V1.0 04/06/2026 Final draft for approval Catriona Cameron Document approvals Page 435
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Name Date Role Signature Catriona Cameron 04/06/2026 Lead Allied Health Professional, Aberdeenshire HSCP Page 436
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 25 JUNE 2026 SUBJECT: ANNUAL PERFORMANCE REPORT 2025/26 BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To present the Board with the draft Annual Performance Report 2025/26. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider and note the draft Annual Performance Report 2025/26 at Appendix 1; ii) note that the information for national indicators will be added once published in early July, and that these additions will be approved by the Chair and Vice Chair of the Board prior to publication; and iii) approves the draft Annual Performance Report 2025/26 for publication by 31 July 2026, subject to the inclusion of the outstanding indicators. 3. BACKGROUND 3.1 The Public Bodies (Joint Working) (Scotland) Act 2014 specifies that a performance report must be produced by an Integration Authority (IA) to ensure that performance is open and accountable and sets out an assessment of performance in planning and carrying out the integration functions for which they are responsible. This is to be produced for the benefit of Partnerships and their communities. 3.2 The required content of the Annual Performance Report (APR) is set out in the Public Bodies (Joint Working) (Content of Performance Report) (Scotland) Regulations 2014. 3.3 APRs should demonstrate how the partnership has performed against the National Health and Wellbeing Outcomes, within the context of the Strategic Plan and Financial Statement. To support this, a set of Core Integration Indicators have Item 13. Page 437
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been developed by the Scottish Government and the Board is expected to report upon performance using these and other locally specified indicators. 3.4 The Act obliges the IA to prepare a Performance Report for the previous reporting year and for this to be published by the end of July each year. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The APR provides an opportunity to present the story of the partnership’s overall performance over the 12 month period, including progress against the nine National Health and Wellbeing Outcomes and the commitments contained within the 2022-32 Strategic Plan. 4.2 The report sets out the challenges services face as they seek to meet increasing needs whilst reducing spend to keep within the approved budget. This highlights the pressures on services, the exceptional work of staff and the ways in which services worked collaboratively with partners to continue to provide care and support to the people of Moray. 4.3 The report has a slightly amended structure to previous years, focussing on the 3 Strategic Themes, the objectives of the Strategic Plan and Strategic Delivery plan with clear links to the National outcomes. This change is part of the continued efforts to demonstrate and strengthen the links between the Strategic Plan, service delivery plans, and related performance monitoring reports. 4.4 The draft APR, attached at Appendix 1, will be updated to include national indicators and Ministerial Strategic Group indicators when they are published in early July. It is proposed that this Committee consider this report and recommend that the Moray Integration Joint Board (MIJB), approve the draft Annual Performance Report for publication by 31 July 2026, subject to the inclusion of these outstanding indicators. It is further proposed that the Chair and Vice Chair of MIJB approve these additions prior to publication. 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” As defined within the Moray Integration Scheme values and meeting the strategic aims contained within the MIJB Strategic Plan; Moray Partners in Care 2022-32. Annual performance reports will be of interest to Grampian Health Board and Moray Council in monitoring the success of the integrated arrangements that they have put in place and in considering whether or not there is a need to review the Integration Scheme. (b) Policy and Legal IJBs have a legal obligation to produce an annual performance report in line with The Public Bodies (Joint Working) (Content of Performance Reports) (Scotland) Regulations 2014 and the Scottish Government Guidance: Health and Social Care Integration Partnerships: reporting guidance. This Page 438
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includes reporting on the national Core Suite of Integration Indicators provided by Public Health Scotland, using these to support reporting on how well the Partnership are progressing the nine National Health and Wellbeing Outcomes which apply to integrated health and social care. The Moray APR complies with all the requirements with the exception of a breakdown of spend per locality. Systems to facilitate a robust report on this have not yet been implemented. (c) Financial implications None directly associated with this report. (d) Risk Implications and Mitigation IJBs have a legal obligation to produce an annual performance report which meets the requirements set by Scottish Government. Should an APR not be provided there would be a failure to meet legislation and it would be difficult for the Moray IJB to confirm it undertakes its duties related to accountability and good governance. (e) Staffing Implications None directly associated with this report. (f) Property None directly associated with this report. (g) Equalities/Socio Economic Impact An Equality Impact Assessment is not required as there are no changes to policy arising from this report and therefore there will be no differential impact on people with protected characteristics. However, individual strategies will comply with the need for an Equalities Impact Assessment and is considered as part of service planning process. (h) Climate Change and Biodiversity Impacts None directly associated with this report. (i) Directions None directly associated with this report. (j) Consultations Chief Officer; Heads of Services; Chief Financial Officer, Service Managers and Caroline O’Connor, Committee Services Officer, Moray Council, have been consulted for their areas of responsibility and comments have been incorporated into this report and appendix. 6. CONCLUSION 6.1 Health and Social Care Moray’s Annual Performance Report is an opportunity to reflect on the varied activities and improvements that have been achieved over the year and consider how well the Partnership is delivering the Strategic Plan. Page 439
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Author of Report: Jeanette Netherwood, Corporate Programme Manager, MHSCP Background Papers: Ref: Page 440
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Annual Performance Report 2025/26 1 Moray Integration Joint Board APPENDIX 1 Page 441
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Annual Performance Report 2025/26 2 Moray Integration Joint Board Contents 1. Foreword from MIJB Chair and Vice-Chair ................................................. 2 2. Chief Officer’s Introduction ...................................................................... 5 3. Background .............................................................................................. 7 4. Board and Partnership Overview ............................................................... 8 5. Our Strategic Plan – Vision and Priorities ................................................ 10 6. Understanding Need in Moray ................................................................. 12 7. The Year in Context ................................................................................. 14 8. Performance Management and Reporting ............................................... 15 9. Strategic Theme 1 - Building Resilience ................................................... 17 10. Strategic Theme 2 : Home First ............................................................... 29 11. Strategic Theme 3: Partners in Care ........................................................ 38 12. Strategic Theme 4: Strategic Leadership, Planning and Performance ...... 44 13. Financial review and performance .......................................................... 52 APPENDICES ..................................................................................................... 61 14. Appendix A: Moray area profile ............................................................... 62 15. Appendix B: National Health & Wellbeing Outcomes .............................. 63 16. Appendix C: Core suite of national indicators ......................................... 64 17. Appendix D: Ministerial Group Indicators ................................................ 68 18. Appendix E: Inspections of services ........................................................ 69 19. Appendix F: Moray Integration Joint Board - Changes to Membership of Moray Integration Joint Board, decisions and directions .................................... 71 1. Foreword from MIJB Chair and Vice-Chair Page 442
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Annual Performance Report 2025/26 3 Moray Integration Joint Board On behalf of Moray Integration Joint Board (IJB), we are pleased to present our Annual Performance Report for 2025/26. This report reflects a year of significant challenge, continued change and meaningful progress for both the Board and Moray Health & Social Care Partnership (HSCP) – formerly Health & Social Care Moray. Across Scotland, health and social care services continue to face deepening challenges, with rising demand, increasing complexity of need, mounting service delivery costs, workforce pressures and significant financial constraints. It is welcome that more people are living longer; however, many are living with multiple long-term conditions and increasingly complex needs, requiring greater support to remain independent, connected and well within their own communities. At the same time, public services continue to operate within an extremely challenging financial environment, with difficult decisions required to reduce overspends and balance budgets. Despite these continued pressures, colleagues across Moray HSCP have continued to show remarkable commitment, compassion and resilience. Every day, staff across services go above and beyond to support people, families and communities across Moray. Their professionalism, adaptability and determination to provide high-quality care and support in challenging circumstances deserves sincere recognition and thanks. We also extend our heartfelt thanks to unpaid carers and volunteers across Moray. Their vital contributions underpin the resilience of our communities, and we recognise the invaluable role they play in supporting the health, wellbeing and independence of so many people. We would also like to recognise the valuable contribution of Moray IJB members, whose leadership, scrutiny and commitment have helped guide and support the strategic direction of health and social care services throughout the year. Against this backdrop, our focus has remained clear: improving health and wellbeing outcomes for people in Moray, supporting independence, positive experiences and quality of life, and working with communities and partners to deliver sustainable, high- quality services for the future. This report highlights the progress made during 2025/26 as Moray continues to shift the balance of care towards prevention, early intervention and community-based support to help people live well and independently at home for longer. During the year, we continued to see positive impact from collaborative and community-focused approaches, including: [to be added from submissions]. Page 443
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Annual Performance Report 2025/26 4 Moray Integration Joint Board While there is much to be proud of, we also recognise there are areas where improvement is still needed. Demand for services continues to grow, recruitment and workforce challenges remain significant, and difficult decisions continue to be required about how services are planned and delivered within available resources. Being open and transparent about these challenges is important. Delivering sustainable health and social care services for the future will require continued transformation, strong partnership working and meaningful engagement with staff, people with lived experience, unpaid carers, communities and partner organisations. This collective effort will be essential to improving experiences and outcomes for people, while helping to manage increasing demand and the rising cost and complexity of care. Although challenges remain, this report demonstrates the strength of partnership working across Moray and the dedication of the people who deliver, support and shape our services every day. Together, we continue to build on progress and work towards better outcomes for the people and communities of Moray. Dennis Robertson Chair Moray Integration Joint Board Councillor Bridget Mustard Vice-Chair Moray Integration Joint Board Page 444
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Annual Performance Report 2025/26 5 Moray Integration Joint Board 2. Chief Officer’s Introduction As I present this year’s Annual Performance Report for Moray’s Integration Joint Board, I do so with a strong sense of pride and gratitude. Throughout the year, our focus remained on improving health and wellbeing outcomes for the people of Moray, supporting independence, reducing inequalities, strengthening communities and redesigning services to ensure they remain sustainable for the future. As demand for services continues to grow and people's needs become increasingly complex, we are continuing to shift the balance of care towards prevention, early intervention and community-based support. This means helping people stay well for longer, supporting independence wherever possible and ensuring care is provided in the most appropriate setting, close to home and connected to local communities. This report highlights not only the challenges faced during the year, but also the progress made through partnership working, service redesign and the continued commitment of our workforce, communities and partners. Importantly, this year’s report is structured around the priorities set out within our Strategic Delivery Plan. This allows us to better demonstrate both the activity delivered during the year and also the difference this work is making for people and communities across Moray. Many of the examples throughout this report show how services are continuing to evolve — building on people’s strengths, improving personalised care, strengthening community support and working more collaboratively across organisational and professional boundaries. Throughout the year, our focus remained on improving health and wellbeing outcomes for people, supporting independence, reducing inequalities, strengthening communities and redesigning services to ensure they remain sustainable for the future. A key priority has been the continued shift towards strengths-based approaches, earlier intervention and prevention wherever possible. Across Moray, services have worked together to empower people with greater knowledge, choice and control over decisions about their own health and support, helping to reduce avoidable crisis, improve wellbeing and support people to live safely and independently within their own homes and communities for longer. At the same time, it’s important this report reflects the scale of challenge facing health and social care services both locally and nationally. The continuing financial climate has created significant pressure across the public sector, with rising demand for services, increasing complexity of care and escalating operating costs continuing to impact service delivery. Throughout this period, our Page 445
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Annual Performance Report 2025/26 6 Moray Integration Joint Board priority has remained protecting frontline services as far as possible, while ensuring resources are used effectively and sustainably. Good progress has been made during the year to strengthen financial oversight, control spending, secure best value and deliver identified medium and longer-term savings. Alongside this, we have continued to develop new approaches to service delivery, partnership working and community-based support. While progress has been made, we recognise there is still much more to do. Some people continue to experience delays, barriers and pressures within services, and we remain committed to listening to feedback, learning from experience and continuing to improve the quality and accessibility of support across Moray. I would like to thank all staff, partners, unpaid carers, volunteers, communities and people with lived experience who continue to contribute to improving health and social care services across Moray. Their dedication, expertise and commitment remain central to the progress outlined throughout this report. Judith Proctor Chief Officer Moray Integration Joint Board Page 446
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Annual Performance Report 2025/26 7 Moray Integration Joint Board 3. Background It is now 10 years since Moray IJB was established as a statutory public body by the Scottish Government under the Public Bodies (Joint Working) (Scotland) Act 2014. Under this legislation, all Integration Joint Boards (IJBs) are required to prepare and publish an annual performance report. The purpose of the report is to provide a clear and transparent account of how well the Integration Authority has carried out its responsibilities in planning and delivering integrated health and social care services. It is designed to support accountability to local communities, people who access services, unpaid carers and partners, and to support ongoing reflection on performance, learning and continuous improvement. Annual performance reports also play an important role in demonstrating progress towards the National Health and Wellbeing Outcomes, and in showing how effectively resources are being used to deliver care and support. They provide assurance at both local and national level, helping the public, partner organisations and the Scottish Government understand the impact of integration and the extent to which services are meeting people’s needs. Moray IJB is responsible for planning and commissioning a wide range of health and social care services for the people of Moray. These services are delegated to the Board by NHS Grampian and Moray Council. Day-to-day provision of services is carried out through Moray Health & Social Care Partnership (HSCP), which brings together staff employed by the local authority and NHS to manage and deliver joined-up services across communities for children and adults. This report sets out how well the Moray IJB has carried out its responsibilities over the past year. It highlights progress made in delivering the vision and commitments set out in the Strategic Plan, Partners in Care 2022–32, approved in November 2022, along with the supporting Delivery Plan approved in October 2023. It includes a profile of Moray (Appendix A), an assessment of performance against the Moray Strategic Plan and a range of national and local indicators, including the core suite of integration indicators (Appendix C), and Ministerial Strategic Group measures linked to the National Health and Wellbeing Outcomes (Appendix B. In doing so, the report reflects on what is working well, where challenges remain, and the actions being taken to improve outcomes for people and communities. Finally, the report includes an overview of the Board’s financial performance during the reporting period, providing transparency on how resources have been used to support the delivery of integrated services and whether best value has been achieved Page 447
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Annual Performance Report 2025/26 8 Moray Integration Joint Board 4. Board and Partnership Overview Health and social care services in Scotland are delivered through Integration Joint Boards (IJBs), established under the Public Bodies (Joint Working) (Scotland) Act 2014. The purpose of integration is simple: to make care and support more joined-up and easier for people to access. It is designed to help people get the right support, at the right time, in the right place – with a strong emphasis on prevention, early support, and care delivered as close to home as possible. Moray Integration Joint Board Moray Integration Joint Board (IJB) was established in April 2016. It is responsible for planning and overseeing a wide range of health and social care services for people living in Moray. These responsibilities are formally delegated to the Board by Moray Council and NHS Grampian through a legal agreement known as the Scheme of Integration. Moray IJB brings together elected members, NHS representatives, professional officers, and representatives from the third sector, along with people with lived experience of services and unpaid carers. In total, there are eight voting members – four appointed by Moray Council and four by NHS Grampian – supported by a wider group of non-voting members who contribute to decision-making and assurance. The Board’s role is to set the strategic direction for community health and social care in Moray and to agree priorities through its Strategic Plan. It does not deliver services directly. Instead, it directs how resources should be used to achieve agreed outcomes and holds the local system to account for delivery. Moray IJB receives funding contributions from Moray Council and NHS Grampian. These resources are used to plan and commission services that respond to local needs. The Board employs two direct staff members: the Chief Officer and the Chief Finance Officer. All other staff within the partnership remain legally employed by the partner NHS Board or Local Authority. Moray Health & Social Care Partnership Operationally services are delivered through Moray Health & Social Care Partnership (HSCP) – formerly Health & Social Care Moray – a partnership between NHS Grampian and Moray Council that brings together staff from Moray Council and NHS Grampian. Moray HSCP is operationally led by the Chief Officer, supported by senior and operational management teams. The Chief Officer is accountable to both partner organisations (as well as strategically to the IJB) and works closely with them to ensure services are delivered in line with the Board’s strategic priorities and the partner organisations’ financial settlements. Page 448
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Annual Performance Report 2025/26 9 Moray Integration Joint Board Services are delivered not only by Moray HSCP staff, but also through a network of commissioned partner organisations across the third and independent sectors. In primary care, this includes independent contractors such as GPs, dentists, optometrists, and pharmacists who provide services under national arrangements. Services The services planned and overseen through Moray IJB include: • Social work and social care services for adults, including older people, mental health services, learning disability services, and support for people with physical and sensory disabilities • Social work and social care services for children and families • Children and families health services including health visiting, school nursing, and allied health professions. • Justice services • Primary care services, including general practice and community nursing • Allied health professions such as physiotherapy and occupational therapy • Community hospitals • Health improvement services • Community dental, ophthalmic, and pharmaceutical services • Certain unscheduled care services linked to acute hospitals • Support for unpaid carers Moray also hosts some services on behalf of the wider Grampian area, including primary care contractor services and the GMED out-of-hours service. Page 449
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Annual Performance Report 2025/26 10 Moray Integration Joint Board 5. Our Strategic Plan – Vision and Priorities Moray Integration Joint Board (IJB) is legally required to develop and implement a Strategic Plan. This must align with the Scottish Government’s National Health and Wellbeing Outcomes (Appendix B) and detail how integrated health and social care services will be funded and delivered for the Moray partnership area. The Strategic Plan sets out the shared vision and local priorities that guide how services are planned and delivered to improve the health and wellbeing of people in Moray. It describes how local services contribute to the national outcomes and support the core aims of integration. The IJB must formally review and, if necessary, revise its Strategic Plan at least every three years. The current Strategic Plan is overdue for review, and work is underway to strengthen planning capacity and support the development of a refreshed plan for 2026-2029 to reflect recent developments and future priorities. Our Moray vision “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.” Our three strategic priorities The Strategic Plan is built around three priorities: Building Resilience Supporting people to take greater control of their health and wellbeing by: • focusing on prevention and reducing inequalities. • strengthening and supporting communities that care for one another. Home First Supporting people to remain at home or in a homely setting wherever possible by: • ensuring people receive the right care, in the right place, at the right time. • helping build safe and supportive communities. Partners in Care Supporting people to be active partners in their care and support by: • working in partnership with individuals, families, and communities. • listening to what people tell us and being open and transparent in how decisions are made. • aiming to make a positive difference beyond the services we directly deliver. Page 450
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Annual Performance Report 2025/26 11 Moray Integration Joint Board The strategic intentions continue to align with the triple aim set out in Scotland’s national Health and Social Care Delivery Plan: • Better Care: improving the quality of care by targeting investment where it can have the greatest impact and delivering effective, person-centred services. • Better Health: improving health and wellbeing by supporting healthier lives from the earliest years, reducing health inequalities and placing greater emphasis on prevention, early intervention, and self-management. • Better Value: improving the sustainability and value of services by making the best use of available resources, delivering care as efficiently and consistently as possible, investing in approaches that are proven to work, and focusing on prevention and early support. The Strategic Delivery Plan, updated in May 2025, sets out the key actions and areas of work that will support delivery of Moray’s strategic priorities. The integration of Children & Families and Justice Services into Moray Health & Social Care Partnership under the direction of Moray IJB will be incorporated into the next Strategic Plan. Page 451
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Annual Performance Report 2025/26 12 Moray Integration Joint Board 6. Understanding Need in Moray Moray faces increasing and changing demand driven by an ageing population, rising long-term conditions and persistent inequalities, requiring a continued shift towards prevention, community-based care and partnership approaches to improve outcomes and ensure sustainable services. Understanding the needs of local people and communities is essential to planning sustainable health and social care services. The Moray Joint Strategic Needs Assessment 2024 (JSNA) brings together evidence about the health, wellbeing and wider circumstances of people living in Moray. It helps inform priorities, service planning and future commissioning decisions across health and social care. The JSNA highlights a number of significant challenges and emerging pressures that continue to shape demand for services across Moray. Health inequalities and poverty While Moray is often seen as a relatively affluent area, poverty and inequality exist across many communities. Health outcomes continue to be strongly linked to deprivation, housing, employment, income and access to transport. People living in more disadvantaged circumstances are more likely to experience poorer health outcomes, lower life expectancy, and higher levels of alcohol and drug- related harm, mental ill health, and preventable illness. This highlights the importance of targeting support towards those most at risk and continuing to focus on prevention, early intervention and reducing inequalities. An ageing population and increasing complexity of need Moray’s population is ageing, with significant projected growth in the number of people aged over 80 in the coming years. As people live longer, more are living with multiple long-term conditions, frailty, dementia and increasing care and support needs. This is increasing demand for community-based services, care at home, reablement, housing adaptations and anticipatory care. Supporting people to remain independent and well at home for as long as possible continues to be a key strategic priority. Long-term conditions and mental wellbeing Page 452
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Annual Performance Report 2025/26 13 Moray Integration Joint Board Demand for health and social care services continues to grow as increasing numbers of people live with long-term conditions and multi-morbidity. Common causes of ill health and premature death in Moray include cardiovascular disease, cancer, neurological conditions and musculoskeletal conditions. At the same time, demand for mental health support continues to increase, including rising levels of anxiety, depression and dementia. These trends reinforce the need for more joined-up, person-centred approaches that support prevention, self-management and earlier intervention. Rurality, housing and wider pressures Moray’s geography and rural communities can create additional challenges in accessing services and support. Transport, fuel poverty, housing suitability and the wider cost of living continue to affect people’s health and wellbeing. Many households include someone living with a long-term illness or disability, increasing the need for accessible housing, adaptations and community support. Addressing these wider factors requires close partnership working across health, social care, housing, communities and the wider public sector. Service demand and sustainability Health and social care services continue to face growing demand alongside workforce and financial pressures. Increasing levels of need, combined with challenges in recruitment and retention, rising complexity of care, and pressure across urgent and unscheduled care services, mean that current models of care are becoming increasingly difficult to sustain. The JSNA highlights the importance of continuing to redesign services around prevention, community-based care, early support and partnership working to improve outcomes and ensure long-term sustainability. Looking ahead Taken together, these challenges point towards a continued strategic shift in Moray towards: • prevention and early intervention. • more care delivered at home or in local communities. • integrated and person-centred support. • reducing inequalities and tackling the wider causes of poor health. • transforming services to ensure they remain sustainable for the future. The Moray Area Profile can be found at Appendix A. Page 453
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Annual Performance Report 2025/26 14 Moray Integration Joint Board 7. The Year in Context A changing landscape for health and social care Health and social care services across Scotland continue to face significant challenge. People are living longer and increasingly require support for multiple long-term conditions, frailty and complex care needs. Demand for services continues to rise, while workforce pressures, inflation and financial constraints continue to impact the delivery of care and support. Nationally, Integration Joint Boards (IJBs) continue to face growing financial sustainability challenges. Audit Scotland highlighted that increasing demand and cost pressures are continuing to outstrip funding growth across the sector. At the same time, expectations of services continue to grow, and partnerships are required to redesign services to ensure they remain sustainable, person-centred and focused on prevention. For Moray, these pressures are further shaped by: • our rural geography and dispersed population • increasing demand for care and support • workforce recruitment and retention challenges • increasing complexity of care needs • health inequalities experienced by some communities • pressures across primary care, community services and hospital flow. Our response Throughout 2025/26, Moray HSCP continued to focus on: • prevention and early intervention • supporting independence and community-based care • redesigning services to improve sustainability • strengthening partnership and locality working • improving access to support • reducing delayed discharge and avoidable hospital admission • tackling inequalities and improving wellbeing. Page 454
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Annual Performance Report 2025/26 15 Moray Integration Joint Board 8. Performance Management and Reporting This report brings together a wide range of information and evidence to show how health and social care services in Moray performed between 1 April 2025 and 31 March 2026. It highlights the progress made towards delivering the Moray Integration Joint Board’s Strategic Plan and provides an overview of performance against national and local measures during 2025/26. Local context Monitoring performance helps us understand what is working well, where improvement is needed, and whether we are delivering on the priorities set out in Moray Integration Joint Board’s (IJB) Strategic Plan. Moray Health & Social Care Partnership has arrangements in place to regularly review performance across services using a range of local and national measures. This helps ensure services remain focused on improving outcomes for children and adults. Performance information is reviewed throughout the year by operational managers and senior leaders to identify progress, emerging pressures and any need for further action. Quarterly performance reports are considered by the Senior Management Team and formally scrutinised by Moray IJB’s Audit, Performance and Risk Committee. National context All health and social care partnerships in Scotland are measured against a national framework designed by the Scottish Government to assess progress in improving health and social care services. The National Health and Wellbeing Outcomes provide the overall framework for planning and delivering integrated health and social care services. These outcomes focus on improving people’s experiences of care and support, helping people to live healthier and more independent lives, and ensuring services are safe, effective and sustainable. Performance is also measured using a set of Core National Indicators (Appendix ?), which allow comparisons to be made across Integration Joint Boards and against the Scottish average. The indicators cover a range of areas including people’s experiences of care, health outcomes, hospital activity, community support, and support for unpaid carers. Each indicator helps measure progress towards one or more of the National Health and Wellbeing Outcomes. Throughout 2025/26, Moray HSCP continued to respond to growing demand, increasing complexity of need and ongoing workforce and financial pressures. While these Page 455
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Annual Performance Report 2025/26 16 Moray Integration Joint Board challenges are being felt across Scotland, our focus remains on supporting people to live well, independently and safely within their own communities for as long as possible. This report highlights how we are continuing to shift our approach from responding to crisis towards prevention, early intervention and community-based support. By investing in services that help people stay well, strengthening support for unpaid carers, expanding opportunities for self-management and redesigning services around people's needs, we are working to improve outcomes while ensuring services remain sustainable for the future. Across all of our strategic priorities, a common theme emerges helping people receive the right support, in the right place, at the right time. Whether through supporting children and families, enabling people to return home sooner from hospital, improving access to community support, or embracing innovation and partnership working, we are building a health and social care system that promotes independence, reduces inequalities and delivers care closer to home. Page 456
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Annual Performance Report 2025/26 17 Moray Integration Joint Board 9. Strategic Theme 1 - Building Resilience Strategic Objective 1: We focus on prevention and tackling inequality National Wellbeing Outcome Description Outcome 1: Health and Wellbeing People are able to look after and improve their own health and wellbeing and live in good health for longer. Outcome 2: Living in the community People, including those with disabilities, long- term conditions, or who are frail, are able to live as far as reasonably practicable, independently at home, or in a homely setting, in their community. Outcome 5: Health inequalities Health and social care services contribute to reducing health inequalities. Why this matters Improving health is about far more than treating illness. Many of the factors that influence health and wellbeing – such as poverty, housing, education, employment, and social connection – develop long before someone requires health or social care services. Preventing ill health, identifying problems earlier and reducing inequalities are therefore central to Moray Integration Joint Board’s strategic vision. Investing in prevention not only improves people’s quality of life but also helps ensure health and social care services remain sustainable for the future. During 2025/26, work under this strategic objective focused on improving access to preventative healthcare, strengthening community support, tackling the wider causes of poor health, and encouraging healthier lifestyles across all ages. Early Intervention and Prevention Learning Disabilities Annual Health Check Programme People with learning disabilities often experience poorer health outcomes and face barriers to accessing routine healthcare. Annual health checks help identify health issues earlier, enabling timely intervention and reducing inequalities in access to care. The programme continues to make a measurable difference across Moray. Since implementation began, 292 people have been offered an annual health check, with 226 completed. Flexible delivery arrangements, including home visits, have helped reach individuals who may otherwise struggle to engage with traditional healthcare settings. Page 457
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Annual Performance Report 2025/26 18 Moray Integration Joint Board The programme has identified a wide range of previously unmet health needs, allowing earlier referral and coordinated support from appropriate services. Importantly, the programme has now moved from implementation into business as usual, embedding preventative care into routine practice. Impact • 292 people offered an Annual Health Check • 226 health checks completed • Earlier identification of unmet health needs and improved access to preventative care • Flexible delivery helping improve access for harder-to-reach individuals • Programme now established as an ongoing service Strengthening community support through social prescribing Social prescribing helps connect people with community groups, activities and practical support that can improve wellbeing and reduce social isolation while reducing reliance on formal services. During 2025/26, progress was made in establishing the infrastructure required to support a sustainable social prescribing model across Moray. While direct delivery is still at an early stage, important foundations have been put in place to support future implementation and evaluation. The Grampian Social Prescribing Toolkit, developed collaboratively with partners, provides a consistent approach to implementation across the region. Work during the year has laid the foundations for a pilot at Maryhill GP Practice in Elgin, which will help refine the model before wider rollout. Impact • Foundations established for a sustainable social prescribing model • Digital systems developed to support future delivery and evaluation • Regional toolkit completed to support consistent implementation • Pilot model developed for testing during 2026/27 Tackling poverty and reducing inequalities Poverty remains one of the strongest predictors of poor health outcomes. Addressing health inequalities therefore requires coordinated action across health, social care and wider community partners. Page 458
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Annual Performance Report 2025/26 19 Moray Integration Joint Board Moray HSCP continued to contribute to the development of a Moray-wide Poverty Strategy and Action Plan during 2025/26. This work will be strengthened further through the establishment of a new Anti-Poverty Strategic Group from 2026/27. Alongside strategic development, work has also focused on helping frontline staff recognise and respond to the impact of poverty through the Making Every Opportunity Count (MEOC) approach. Refreshed awareness sessions incorporating Realistic Medicine principles have equipped staff with practical skills and confidence to have supportive conversations with people about the wider factors affecting their health and wellbeing. While the longer-term impact of this work will take time to emerge, it has strengthened awareness of the relationship between poverty and health and increased confidence among staff to have supportive conversations about the wider circumstances affecting people's wellbeing. Impact • Continued development of a Moray-wide Poverty Strategy • New Anti-Poverty Strategic Group established for 2026/27 • 19 awareness sessions delivered • 155 staff from Moray HSCP, Dr Gray’s Hospital and the third sector participated Supporting healthier lifestyles: Whole Systems Approach to Improving Healthy Weight Obesity and poor diet are influenced by a complex combination of social, environmental and economic factors. Addressing these challenges requires coordinated action across organisations rather than focusing solely on individual behaviour change. During the year, Moray HSCP led on the development of a Whole Systems Approach to Healthy Weight, bringing together partners from health, education, local government, the third sector and wider community planning partnership. The stakeholder network expanded from approximately 35 organisations to more than 75, creating stronger shared ownership of healthy weight outcomes across Moray. Workshops and engagement activity increased understanding of how local policies and environments influence health and encouraged collaborative action across multiple sectors. Rather than relying on individual projects, this work is helping partners consider healthy weight as part of wider prevention, community planning and population health improvement activity. Impact Page 459
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Annual Performance Report 2025/26 20 Moray Integration Joint Board • Partnership network expanded from approximately 35 to over 75 organisations • Shared understanding of healthy weight strengthened across sectors • Foundations established for long-term system-wide action Nutrition and Hydration Week Good nutrition and hydration are fundamental to maintaining health, independence and quality of life, particularly for older adults and vulnerable groups. Local activity in support of National Nutrition and Hydration Week in March 2026, brought together 16 organisations across health, care and community settings to promote simple, practical interventions that support healthier everyday choices. Activities for patients, residents, supported people and practitioners included hydration stations, healthy snack initiatives, interactive challenges and accessible information. Feedback demonstrated increased awareness, healthier choices and improved confidence among staff and participants. Many organisations introduced changes designed to continue beyond the campaign itself, creating longer-term benefits. Impact • 16 organisations participated across Moray • Increased awareness of healthy nutrition and hydration • Practical improvements embedded within participating settings • Campaign messages extended through social media and community engagement Supporting healthier choices for children and families The Snacktember project encouraged healthier snacking among children while helping families overcome barriers to accessing fruit and vegetables. Working with three early years settings, one primary school and a youth club, the month-long initiative reached 130 families across Moray. Incentivised through fruit and vegetable-specific vouchers redeemable at a local supplier, alongside child-focused rewards, Snack-tember combined positive reinforcement, peer influence and school-based support Voucher uptake increased significantly during the programme, rising from 61% in the first week to almost 90% in the second week as awareness and engagement grew. Evaluation showed that 82% of parents reported the vouchers influenced their purchasing decisions, around 68% observed increased interest in healthier snacks from their children, and 82% intended to continue providing healthier snacks after the campaign. Page 460
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Annual Performance Report 2025/26 21 Moray Integration Joint Board The project also highlighted that affordability and availability continue to be barriers for some families, reinforcing the importance of longer-term system-wide approaches alongside targeted interventions. Impact • 130 families engaged • Voucher uptake increased to almost 90% • 82% of parents reported healthier purchasing choices • Evidence generated to inform future healthy weight initiatives Looking ahead The work undertaken during 2025/26 demonstrates a continued shift towards prevention, early intervention and reducing inequalities. While many of these initiatives are laying the foundations for longer-term change, they are already improving access to support, strengthening partnerships and helping people make healthier choices. The next phase of delivery will focus on embedding these approaches into routine practice, expanding successful models and ensuring that prevention remains at the heart of health and social care. Objective 2: We nurture and are part of communities that care for each other National Wellbeing Outcome Description Outcome 1: Health and Wellbeing People are able to look after and improve their own health and wellbeing and live in good health for longer. Outcome 4: Quality of life Health and social care services are centred on helping to maintain or improve the quality of life of people. Outcome 6: Carers are supported People who provide unpaid care are supported to look after their own health and wellbeing, including reducing any negative impact of their caring role on their own health and well-being. Why this matters Strong communities play a vital role in improving health and wellbeing. Families, unpaid carers, neighbours, volunteers and community organisations provide invaluable support that helps people stay independent, connected and resilient. Page 461
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Annual Performance Report 2025/26 22 Moray Integration Joint Board Building these community assets not only improves quality of life but also helps prevent crises and reduces demand on statutory services. During 2025/26, Moray HSCP continued to strengthen community partnerships, improve support for unpaid carers and develop more integrated services that help people access the right support at the right time. Supporting unpaid carers Unpaid carers make a significant contribution to the health and wellbeing of people across Moray. Recognising, identifying and supporting carers is essential to ensuring they can continue in their caring role, if they choose to do so, while maintaining their own health and wellbeing. During the year, implementation of the Moray Unpaid Carers Strategy 2023–2028 continued, with a strong emphasis on ensuring that services reflect the experiences of carers themselves. Surveys involving adult carers, young carers and partner organisations provided valuable insight into priorities and challenges. The findings have been used to strengthen the implementation plan and inform the specification for the future commissioned carers support service for adult and young carers. The feedback also reinforced the continuing pressures experienced by unpaid carers, highlighting the importance of maintaining accessible support and information services. Awareness of carers' needs has also increased across health, education and social care through regular communications, targeted training and the continued development of the partnership’s Carer Aware initiative. Schools have worked with the Young Carers Strategy Officer to identify Young Carer Champions, improving recognition of young carers and helping them access appropriate support. Impact • Lived experience directly informed future service design • New commissioned carers support service strengthened through consultation • 10 schools identified Young Carer Champions • Greater awareness of young carers across education and social work • Carer Aware initiative progressed towards implementation Strengthening community support and reducing isolation Communities themselves are often the best source of prevention and wellbeing. Local groups provide opportunities for people to remain active, build friendships and maintain independence. Page 462
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Annual Performance Report 2025/26 23 Moray Integration Joint Board The Be Active Life Long (BALL) programme, initiated and supported by Moray, continues to demonstrate the value of community-led prevention. It celebrated its 20th anniversary during 2025/26, reflecting two decades of community-led prevention. Eighteen groups across Moray now support around 1,000 members, delivering opportunities for physical activity, cognitive stimulation and social connection. During the year, participants collectively accessed more than 84,000 hours of activity, helping reduce loneliness and improve wellbeing. It also contributed more than £37,800 to the local economy through the use of local activity providers and the hire of community settings for sessions. Partnership working has continued to expand opportunities for residents through initiatives such as chair-based exercise programmes delivered with Dance North and accessible outdoor activities developed alongside Wild Things, supporting both physical and mental wellbeing. The Community and Volunteering Team also responded to 350 enquiries, connecting people to information, support and local activities. Impact • 18 BALL groups supporting approximately 1,000 members • Over 84,000 hours of activity delivered annually • 168 chair-based exercise Seated Exercise and Tea (SET) classes resulting in more than 3,300 attendances • More than 100 people participated in accessible outdoor wellbeing activities Improving access to primary care and mental health support Sustainable communities require accessible health services that provide early support and reduce the need for more intensive intervention. Implementation of the Moray Primary Care Improvement Plan continued during 2025/26, expanding multidisciplinary support available through GP practices. Services including Community Treatment and Care, First Contact Physiotherapy, Occupational Therapy and Mental Health and Wellbeing Practitioners are now available across every Moray GP practice, providing patients with faster access to the most appropriate professional. Mental health services have also expanded through new commissioned services delivered by Scottish Association for Mental Health (SAMH). Demand has continued to grow, with the Intensive Recovery and Community Support Service supporting 128 people during Quarter 3, compared with 85 people during Quarter 1, demonstrating increasing utilisation. Page 463
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Annual Performance Report 2025/26 24 Moray Integration Joint Board While demand for support continues to increase, these developments are helping ensure more people can access appropriate support earlier and closer to home. Mental Health and Wellbeing Practitioners embedded within GP practices offered 2,344 appointments during the previous financial year, helping people receive timely support and reducing pressure on general practice. Work has also continued to improve access to psychological therapies by strengthening pathways between primary and secondary care, ensuring people receive support from the most appropriate service without unnecessary delays or repeat referrals. Alongside service delivery, the Third Sector partner Moray Wellbeing Hub supports opportunities to ensure that people with lived experience help shape future mental health services and priorities. Impact • Multidisciplinary primary care services available across all Moray GP practices • New SAMH services fully operational and supporting increasing numbers of people • 2,344 Mental Health and Wellbeing Practitioner appointments delivered • Improved pathways reducing unnecessary delays between services • Lived experience informing future mental health planning Supporting children, young people and families Building resilient communities begins with giving children and families the best possible start in life. Community events such as the Summer Pop Up in the Park and Holiday Hub Hangout created welcoming spaces where families could access support, connect with local organisations and influence future services. Around 200 people attended the events, supported by more than 20 partner organisations and delivered through a partnership between the Moray Health Improvement Team, Moray Council Youth Work Team, Community Wardens and Lossiemouth Community Hub. Young people reported increased confidence and awareness of local opportunities, while feedback identified priorities for future community development. Work under the Children's Services Plan 2023-2026 continued to improve outcomes across several priority areas. Financial inclusion initiatives supported families experiencing poverty, with audits showing 94% of families were asked about their financial circumstances through health visiting and midwifery services. The Money Advice Team supported 199 families, securing over £201,000 in financial gains while helping reduce debt by more than £95,000. Page 464
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Annual Performance Report 2025/26 25 Moray Integration Joint Board Support for children with additional support needs also expanded, with Scottish Government investment improving communication support for 150 non-verbal children and increasing opportunities for participation in sport and leadership activities. Mental wellbeing remained a key priority. The newly commissioned SAMH service for children and young people received 40 referrals shortly after launch, while the Moray Parent Project provided extensive one-to-one and group support, helping parents build confidence to support both their own wellbeing and that of their children. Despite these positive developments, the impact of poverty and inequalities continues to affect outcomes for some children and families, reinforcing the need for sustained partnership working. Impact • Around 200 people engaged through community family events • Over 20 organisations working together to support local families • 199 families received money advice, securing more than £201,000 in financial gains • 150 non-verbal children benefited from enhanced communication support • New children and young people's mental wellbeing service successfully launched • Continued expansion of early intervention and family support services Supporting children and families with disability and neurodiversity Children and young people with additional support needs and neurodiverse conditions often require coordinated support across education, health and community services to help them achieve their full potential. During 2025/26, investment and partnership working have increased both the range of support available and opportunities for children and families to participate fully in their communities. A Scottish Government investment of £485,000 has strengthened communication support services, with 150 non-verbal children benefiting from enhanced provision. Support for parents has also expanded, helping families build confidence in supporting their children, with 83% of participants reporting increased confidence after accessing services. The focus on inclusion has extended beyond education into community life. Participation in sport among children and young people with additional support needs increased from 39% to 47%, while 66 young people became Young Sports Leaders, creating new opportunities for leadership, confidence and social connection. Demand for neurodevelopmental assessments continues to rise and currently exceeds available capacity. Work continues at a regional level to develop a Grampian-wide Page 465
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Annual Performance Report 2025/26 26 Moray Integration Joint Board pathway that will provide a more consistent and sustainable approach for children and families. Impact • £485,000 invested to strengthen support and communication provision • 150 non-verbal children benefited from enhanced communication support • 83% of parents accessing support reported increased confidence • Participation in sport increased from 39% to 47% • 66 young people with additional support needs became Young Sports Leaders Keeping children safe Protecting children is a shared responsibility that depends on strong partnership working, continual learning and listening to the voices of children and families. During the year, two multi-agency learning reviews were completed, providing opportunities to strengthen practice and improve local procedures. Additional staff have been trained to lead future reviews, helping to embed a culture of continuous learning across services. A new Child Protection Voice Toolkit has been developed to ensure children's experiences and perspectives are better reflected in protection processes, with training now underway. Online safety work also expanded through collaboration with Police Scotland, including education around harmful online ideologies and emerging risks for young people. Quality assurance activity continues to demonstrate positive practice, with solution- focused approaches increasingly evident within child protection planning meetings. Advocacy services for children and parents involved in child protection processes have also seen increased uptake, helping families understand their rights and participate in decisions affecting them. Impact • Two multi-agency learning reviews completed • Additional staff trained to lead future reviews • New Child Protection Voice Toolkit introduced • Increased access to advocacy for children and parents • Strengthened partnership approaches to safeguarding and online safety Improving emotional and mental wellbeing Good mental health in childhood lays the foundation for lifelong wellbeing. During 2025/26, Moray continued to strengthen early intervention and improve access to support for children, young people and their families. Page 466
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Annual Performance Report 2025/26 27 Moray Integration Joint Board The Moray Parent Project supported 76 new parents during the latter part of the year, delivering 259 individual sessions and 28 group sessions to help parents build confidence and support their own and their children's emotional wellbeing. Support for children experiencing emotional school avoidance has also expanded by embedding a successful pilot within an existing service, creating a sustainable early intervention model without additional cost. Alongside direct support, more than 160 professionals attended the "Children's Mental Health is Everyone's Business" event at Moray UHI in Elgin, increasing awareness of available services and strengthening partnership working across education, health and social care. Grampian Children and Adolescent Mental Health Service (CAMHS) continued to meet the national 18-week standard for more than 90% of referrals, although waiting times for non-urgent presentations remain around six months, highlighting continuing pressures on specialist services. Impact • 76 new parents supported through the Moray Parent Project • 259 one-to-one sessions and 28 group sessions delivered • New SAMH service launched with 40 referrals shortly after opening • Early intervention for emotional school avoidance embedded into mainstream delivery • 160 professionals strengthened their knowledge of children's mental health support Strengthening family support Helping families early can prevent difficulties from escalating and improve outcomes for children. During 2025/26, Moray HSCP continued to expand universal and targeted family support, recognising that confident and supported parents create stronger outcomes for children. The PEEP early years programme continued to grow through a partnership approach, with 962 parents registered and more than 1,000 attendances at sessions across Moray. The programme supports positive parent-child relationships and early child development while helping families build local support networks. The Moray Parent Project has evolved beyond its original focus on mental wellbeing and is now supporting wider family resilience and parenting confidence. Work also continued to strengthen children's rights through the ongoing development of the Getting it Right for Every Child (GIRFEC) website and expanded reach of the Children's Rights Service. Page 467
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Annual Performance Report 2025/26 28 Moray Integration Joint Board Support for young people affected by alcohol and drugs has been strengthened through the extension of the YP Zone (Aberlour Youth Point) service, secured through a combination of local and national funding. A new Drug and Alcohol Group has also been established to improve coordination across services. Closer collaboration between children's health services and Early Learning and Childcare settings is improving transitions into nursery, enabling providers to better plan support for children with additional needs before they start. Impact • 962 parents registered with the PEEP programme • More than 1,000 attendances at family support sessions • Parent support expanded beyond mental wellbeing to wider family resilience • YP Zone service extended through additional funding • Improved partnership working supporting smoother transitions into early learning Looking ahead Communities are strongest when people are connected, supported and able to help one another. During 2025/26, Moray HSCP continued to strengthen the networks, partnerships and community resources that enable this to happen. The next phase of work will build on these foundations by expanding support for unpaid carers, embedding integrated models of primary and mental health care, strengthening community-led prevention and ensuring that children and families can access the right support as early as possible. Page 468
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Annual Performance Report 2025/26 29 Moray Integration Joint Board 10. Strategic Theme 2 : Home First Objective 3: We work together to give you the right care in the right place at the right time National Wellbeing Outcome Description Outcomes 4: Quality of life Health and social care services are centred on helping to maintain or improve the quality of life of people. Why this matters Most people want to remain independent and receive care and support at home or within their own community wherever possible. Achieving this requires health and social care services to work seamlessly together, ensuring people receive the right support at the right time while avoiding unnecessary hospital admissions or delays. During 2025/26, Moray HSCP continued to strengthen community-based services, improve urgent care pathways and empower people to have greater choice and control over how their support is delivered. Supporting people to remain safely at home: Home Assessment Pathway Helping people return home safely after time in hospital or avoid unnecessary admission to hospital requires coordinated support from a range of professionals. Medication can often be a significant barrier to independence, particularly for older people living with multiple long-term conditions. A dedicated pharmacist joined the Home Assessment Pathway in January 2026 to undertake comprehensive medication reviews for people supported through the enhanced Discharge to Assess (D2A) service. Although the role is relatively new, it is already demonstrating significant benefits by reducing unnecessary medication, lowering the risk of falls and simplifying treatment regimes. The reviews have also identified medicines that were no longer required but continued to be prescribed, reducing waste while improving patient safety. In several cases, medications associated with confusion, falls and declining function in older adults were safely discontinued without adverse effects. Importantly, reducing medication burden has also enabled some people to require fewer daily care at home visits, supporting greater independence at home. Impact • 46 people received specialist medication reviews Page 469
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Annual Performance Report 2025/26 30 Moray Integration Joint Board • Daily tablet burden reduced by 56 doses • 25 falls-risk increasing medicines removed • Significantly lowered the combined side-effect risks from certain medications • 6 regular care visits no longer required • Ongoing prescribing savings of approximately £220 per month • Improved patient safety and reduced unnecessary medicines Supporting greater choice and control Self-Directed Support (SDS) enables people and families to have greater choice and control over how their care and support is arranged. During 2025/26, work continued to strengthen understanding of the available options while improving the flexibility and sustainability of local support arrangements. A new SDS Operational Group now brings together practitioners, independent advisers, advocacy services and Third Sector partners to promote consistent practice and shared learning across Moray. Practical improvements have also been introduced for people choosing to employ their own Personal Assistants, including dedicated recruitment support, monthly drop-in sessions and the establishment of an emergency pool of Personal Assistants to provide cover when needed. Information has been refreshed through updated webpages and guidance materials, making it easier for individuals and families to understand their options and make informed decisions. Alongside this, the Day Opportunities Team has continued to support people and unpaid carers to access meaningful activities within their communities using a strengths-based approach that builds on individual skills, interests and existing connections. Positive feedback has been received from individuals and families regarding the impact of this support. One individual described the support as being "a life raft in a raging sea", highlighting the value of timely and person-centred intervention. Impact • Multi-agency Self-Directed Support Operational Group established • Improved independent advice and advocacy across all four SDS options • Enhanced recruitment support for Personal Assistant employers • Emergency Personal Assistant pool established • Updated information resources improving access and understanding Page 470
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Annual Performance Report 2025/26 31 Moray Integration Joint Board • Positive feedback demonstrating significant benefit for individuals and families Providing urgent care closer to home: Out of Hours primary care (GMED) When GP practices are closed, timely access to urgent care is essential. GMED provides urgent assessment and treatment while helping ensure patients receive care in the most appropriate setting, reducing unnecessary attendance at Emergency Departments. Throughout 2025/26, GMED continued to provide urgent out-of-hours primary care across Grampian, helping people access the right care at the right time while reducing unnecessary demand on hospital services. Key developments have included enhancements to weekend skill mix, continued contribution to unscheduled care system improvements, and national recognition for teaching excellence. Together, these demonstrate GMED’s ongoing role in delivering high quality urgent care, supporting workforce development, and ensuring patients receive the right care, in the right place, at the right time. During the year, GMED managed 107,825 patient contacts across Grampian, including advice calls, consultations, home visits and mental health support. Within Moray alone, the service managed 16,043 contacts (14.8% of total activity), demonstrating its important role within the local urgent care system. Elgin, Forres and Buckie remain the busiest locations. Access to specialist mental health expertise during weekends has been enhanced through the introduction of a Mental Health Nurse within the Out of Hours service. This has improved multidisciplinary working and ensured people experiencing mental health difficulties are assessed by the clinician best placed to meet their needs. Earlier specialist assessment supports better decision-making and more appropriate onward referral while making better use of clinical resources. Beyond activity levels, GMED's greatest contribution is its ability to direct patients to the right service first time. Through effective clinical assessment and triage, many patients receive appropriate treatment within primary care, avoiding unnecessary hospital attendance and protecting capacity for those with the greatest need. Impact • 107,825 contacts managed across Grampian; 16,043 contacts from Moray residents • Thousands of patients supported through advice, consultations and home visits • Reduced unnecessary pressure on Emergency Departments • Improved patient access to appropriate care closer to home Page 471
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Annual Performance Report 2025/26 32 Moray Integration Joint Board • Specialist mental health nursing introduced to weekend service • Earlier access to appropriate assessment Improving the wider urgent care system GMED has also played an important role in supporting the wider redesign of unscheduled care through its involvement in the Flow Navigation Centre. Providing dedicated clinical support has strengthened coordination across services, enabling faster decision-making, reducing duplication and helping patients access the most appropriate care pathway. Positive feedback from clinicians and partner organisations has resulted in the arrangement being extended while longer-term service models are developed. Impact • Improved coordination across urgent care services • Better clinical decision-making and patient navigation • Reduced duplication between services • Enhanced resilience across the unscheduled care system Investing in the workforce of the future Providing the right care at the right time depends on developing a skilled and sustainable workforce. During 2025/26, GMED's partnership with the University of Aberdeen was recognised through a Principal's Teaching Excellence Award Certificate of Commendation, acknowledging the quality of out-of-hours placements provided for Year 4 medical students. The service has also supported pharmacists undertaking Independent Prescribing training through supervised shadowing opportunities, helping develop advanced clinical assessment and real-time prescribing skills while strengthening the future urgent care workforce. Impact • Recognition for teaching excellence • Strengthened partnership with the University of Aberdeen • Expanded learning opportunities for future independent prescribers Supporting young people's health and emotional wellbeing School nurses continue to play a vital role in supporting the health and wellbeing of children and young people, providing targeted support and ensuring referrals reach the most appropriate services. Page 472
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Annual Performance Report 2025/26 33 Moray Integration Joint Board Feedback from young people consistently highlights the value of having a trusted professional who listens and provides practical strategies to manage challenges such as anxiety and emotional wellbeing. Comments included: "It's really helped me." "Someone different to talk to and help you." "Helped me with strategies and ways to manage my anxiety." Parents also reported positive experiences, with one describing the service as having "helped greatly" by providing practical advice and reassurance. The service continues to use feedback to drive continuous improvement and ensure support remains responsive to the needs of children, young people and families. Impact • Positive feedback received from primary and secondary pupils • Young people reported improved confidence and coping strategies • Families valued practical advice and support • Continuous feedback informing service improvement Looking ahead The work undertaken during 2025/26 demonstrates continued progress towards delivering care closer to home, improving coordination between services and giving people greater choice and control over their care. As demand for services continues to grow and people’s needs become more complex, these integrated and person-centred approaches will remain essential to ensuring people receive the right care, in the right place, at the right time, while supporting the long-term sustainability of health and social care services in Moray. Objective 4: We help build communities where people are safe National Wellbeing Outcome Description Outcome 7: People are safe People who use health and social care services are safe from harm. Why it matters Creating safe communities is about more than responding when things go wrong. It means working together to prevent harm, identify risks early and ensure people can access the support they need when they need it. Throughout 2025/26, partners across Page 473
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Annual Performance Report 2025/26 34 Moray Integration Joint Board Moray continued to strengthen approaches to suicide prevention, alcohol and drug support, public protection and community justice, helping people stay safe and improving outcomes for some of the most vulnerable members of our communities. Suicide prevention and early intervention Suicide prevention remains a key public health priority. During the year, a wide range of awareness, training and capacity-building activities were delivered across schools, workplaces, community organisations and armed forces settings, helping to increase understanding of suicide risk and build confidence in supporting people who may be struggling. Learning from suicide deaths continues to inform local improvement activity. Moray partners have worked closely with regional colleagues to review emerging trends and strengthen local responses. Work is now underway to establish a multi-agency suicide review process in Moray, helping services better understand the circumstances surrounding deaths and identify opportunities for earlier intervention. Additional staff have been trained to deliver Applied Suicide Intervention Skills Training (ASIST), increasing local capacity to support people experiencing suicidal thoughts. Work also continued on the development of a local suicide cluster response protocol and the introduction of new systems to improve data collection and learning. Although suicide rates are influenced by many factors and changes may take time to emerge, these activities are helping build community capacity to recognise risk and support early intervention. Impact • Increased suicide prevention awareness across schools, workplaces and communities • Expanded local capacity to deliver suicide intervention training • New approaches being developed to strengthen learning from suicide deaths • Improved partnership arrangements to identify risks and respond earlier Reducing alcohol and drug-related harm Supporting people affected by alcohol and drug use remains a key priority. Throughout 2025/26, partners continued to focus on reducing harm, improving access to treatment and supporting long-term recovery. Timely access to treatment remained consistently above national standards, supported by strong partnership working and continued implementation of Medication Assisted Treatment (MAT) Standards. Outreach activity, welfare checks and assertive engagement helped people remain connected to services and reduced the number of unplanned discharges from treatment programmes. Page 474
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Annual Performance Report 2025/26 35 Moray Integration Joint Board Moray also strengthened its ability to identify and respond to emerging risks through the establishment of a local Early Warning Group, bringing partners together to monitor trends in drug use, overdoses and wider harm indicators. Access to residential rehabilitation continued to improve, supported by dedicated link worker arrangements that help individuals prepare for treatment and maintain recovery following discharge. Impact • Treatment access consistently exceeded national targets • Fewer people disengaged from treatment and support services • Improved access to residential rehabilitation and recovery support • New partnership arrangements established to monitor emerging risks and trends Protecting children and young people Partnership work across Moray continues to focus on preventing harm, supporting families and ensuring children and young people are safe, heard and supported. Preventative education programmes on healthy relationships, online safety and harmful online influences reached hundreds of young people, parents and professionals during the year. Training developed locally by Moray partners on harmful online ideologies attracted significant interest beyond Moray and has since been shared regionally, nationally and internationally. Progress has also been made in strengthening child protection practice through new multi-agency guidance, enhanced training, improved approaches to capturing the voice of the child and continued implementation of evidence-based family support programmes. Investment through Scotland’s Bairns’ Hoose programme has enabled further development of trauma-informed support for children who have experienced harm. Improvements to local facilities and specialist staffing are helping create more child- centred environments and experiences. There are encouraging signs that this work is making a difference. During the year, more children were able to leave the Child Protection Register because risks within their home circumstances had reduced and family situations had improved. Impact • Hundreds of children, families and professionals engaged in prevention and safety programmes • Increased support for children affected by trauma and abuse • More children able to leave child protection processes due to improved family circumstances Page 475
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Annual Performance Report 2025/26 36 Moray Integration Joint Board • Moray recognised nationally for innovative work on online safety and harmful ideologies Protecting adults at risk of harm Adult Support and Protection activity increased during the year, reflecting both growing complexity of need and continued vigilance in identifying and responding to concerns. Partnership working between social work, health services, Police Scotland and advocacy services continues to ensure adults at risk are supported and protected. Advocacy remains an important part of the process, helping individuals have their views represented in decisions affecting their lives. Adults supported through protection plans reported positive outcomes, including improved safety, better living conditions, increased confidence and reduced anxiety. Work also continued to strengthen quality assurance arrangements, with new case conference standards introduced across Grampian to improve consistency and support better outcomes. Impact • Increased identification and investigation of adults at risk of harm • Strong advocacy support ensuring people's voices are heard • More adults reporting improved safety and wellbeing • Enhanced quality assurance and partnership working arrangements Supporting rehabilitation and reducing reoffending Community justice partners continue to work together to support rehabilitation, reduce reoffending and help people successfully reintegrate into their communities. Community Payback Order completion rates remained strong, demonstrating continued engagement with community-based justice interventions. New approaches have focused on improving employability, developing practical skills and strengthening trauma-informed practice across services. Partnership working with prisons, housing providers, health services and recovery organisations has also been strengthened to improve support before and after release from custody. This includes enhanced liberation planning, better referral pathways and greater involvement of people with lived experience in shaping services. Impact • Strong completion rates for community justice interventions • Improved pathways between prison, health and community services • Increased focus on employability, recovery and rehabilitation • Greater involvement of people with lived experience in service development Page 476
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Annual Performance Report 2025/26 37 Moray Integration Joint Board Tackling violence against women and girls Preventing violence against women and girls remains a key priority for partners across Moray. Throughout the year, activity focused on raising awareness, strengthening professional skills and improving support for women, children and families affected by abuse. Public awareness campaigns, conferences and training events engaged hundreds of practitioners and community members, helping build understanding of the causes and consequences of violence against women and girls. The partnership continued to strengthen trauma-informed responses, improve referral pathways and support implementation of evidence-based approaches such as the Safe and Together model, which aims to improve outcomes for children while increasing accountability for perpetrators. Work also progressed to support implementation of the Caledonian Programme, helping address abusive behaviour and improve safety for women and children, contributing to earlier identification of abuse and more coordinated support for women, children and families affected by violence. Impact • Hundreds of people engaged through awareness raising and training activities • Continued development of trauma-informed support services • Increased local capacity to support children and families affected by domestic abuse • Strengthened partnership approaches to prevention and perpetrator accountability Page 477
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Annual Performance Report 2025/26 38 Moray Integration Joint Board 11. Strategic Theme 3: Partners in Care Strategic Objective 5: We are an ambitious and effective partnership National Wellbeing Outcome Description Outcome 8: Workforce People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. Outcome 9: Use of resources Resources are used effectively and efficiently in the provision of health and social care. Why this matters The health and social care system is facing growing demand from an ageing population, increasing numbers of people living with long-term conditions and significant workforce pressures. Meeting these challenges requires more than additional resources—it requires partners to work differently, redesign services and embrace innovation. During 2025/26, Health and Social Care Moray continued to strengthen partnership working across organisations, communities and the wider public sector to develop more sustainable models of care that improve outcomes for local people. Redesigning services for the future Rising demand, workforce pressures and changing population needs mean health, and social care services must continue to adapt to remain sustainable. Across Scotland there is a growing focus on helping people remain independent for longer, reducing unnecessary hospital stays and ensuring care is provided closer to home wherever possible. During the year, Moray continued work to redesign a number of services to better meet future demand. This includes work linked to national Discharge Without Delay and Home Assessment Pathway programmes, helping shape future models of care for people living with frailty and informing the future role of community hospitals. A review and redesign of Adult Day Care Services also progressed, bringing Artiquins together with Cedarwood within shared accommodation. This enables better use of high-quality facilities while supporting the continued delivery of services that meet people's needs. A wider review of day services is now underway to explore future options through engagement and consultation. Impact • Service redesign supporting more sustainable models of care • Better use of existing community facilities • Learning from national programmes informing future service development • Wider review of day services progressing to support long-term sustainability Page 478
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Annual Performance Report 2025/26 39 Moray Integration Joint Board Expanding choice and independence through Care at Home Demand for care at home continues to increase as more people wish to remain living independently within their own communities. During 2025/26, a new commissioning framework was introduced to strengthen delivery of care at home under Self-directed Support (SDS) options 2 and 3 , helping ensure people have greater choice and control over how their care is arranged. Implementation has taken longer than originally anticipated, reflecting the complexity of changing commissioning arrangements. The focus is now on embedding the new approach and demonstrating improved outcomes, quality and flexibility for people who require support. Work during 2026/27 will focus on embedding the framework and demonstrating benefits for people receiving support. Impact • New commissioning frameworks introduced • Greater emphasis on personal choice and independence • Foundations established for improved quality and sustainability Housing as part of health and wellbeing Having the right home is fundamental to living independently and maintaining good health. Suitable housing can reduce reliance on hospital care, support recovery and improve quality of life. The new Moray Local Housing Strategy recognises the growing need for supported accommodation for older people and people living with learning disability or mental health conditions, embedding these priorities into long-term planning across partner organisations. Although Moray does not currently have dedicated supported living accommodation for people under 65 with mental health needs, health, housing and third sector partners continue to work together to develop individual solutions while exploring future accommodation options. For people with learning disabilities, investment in local accommodation has enabled more individuals to remain in Moray, closer to their families and communities. The completion of Western Village in Elgin has supported people to return from out-of-area placements, reducing reliance on external provision while providing more person- centred support. This has also contributed to reduced Dynamic Support Register pressures, with earlier reporting noting a 60% reduction in the red category largely through successful transitions from out-of-area placements and hospital settings Work is now progressing to develop additional accommodation for people with complex needs through the Woodview programme. Impact • Local Housing Strategy strengthens links between housing and health Page 479
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Annual Performance Report 2025/26 40 Moray Integration Joint Board • More people with learning disabilities supported to live locally • Reduced reliance on out-of-area placements • Further supported accommodation development planned through Woodview Embedding a person-centred approach Improving services means ensuring people don’t have to navigate complex systems or repeat their story to multiple professionals. Throughout the year, Moray HSCP continued to embed the Getting It Right for Everyone (GIRFE) approach across health and social care. GIRFE promotes joined-up, person- centred support by encouraging professionals to work together around what matters most to the individual. Progress included identifying local champions, strengthening staff resources and incorporating GIRFE principles into newly commissioned services, refreshed policies and the Moray Community Connections digital platform. Embedding GIRFE helps reduce duplication, improves coordination between services and ensures conversations focus on what matters most to individuals. Moray's work has also been recognised nationally, being the first Health and Social Care Partnership invited to report its progress to the National GIRFE Collaborative. Impact • GIRFE principles embedded across new service specifications and policies • Local champion network established • Enhanced toolkit developed for staff • National recognition for Moray's leadership in implementing GIRFE Supporting people with long-term conditions As more people live longer with conditions such as diabetes, preventing illness and supporting self-management are becoming increasingly important. Supporting people to manage long-term conditions earlier can improve quality of life and reduce the need for more intensive intervention later. Dietetic services continued to work alongside the Moray Leisure Centre Heart of Moray programme to support healthier lifestyles, weight management and early intervention for people at risk of or living with diabetes. Partnership working across primary care and community services is strengthening access to support, while digital solutions are being explored to reach more people and encourage long-term behaviour change. Further expansion of these services is planned during 2026/27. Impact • Greater integration between dietetic and community services • Improved focus on prevention and early intervention Page 480
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Annual Performance Report 2025/26 41 Moray Integration Joint Board • Digital approaches being developed to increase access and participation Using technology to help people live independently Technology has an increasingly important role in helping people remain safe and independent at home while supporting more responsive care. During 2025/26, Moray successfully completed the transition from analogue to digital community alarms, ensuring continued reliability as national telecommunications systems change. This achievement was recognised with a Gold One Digital Telecare Implementation Award from Digital Telecare for Scottish Local Government. The partnership also continued to explore innovative approaches through the Smart Housing, Smart Communities initiative, testing how digital monitoring and predictive technologies could enhance telecare and support independent living. While recruitment to the pilot has been slower than anticipated, the project has been extended to allow further learning that will inform future service development. Impact • Successful transition to digital community alarms • Gold national award recognising implementation • Continued investment in innovative technology to support independent living Building a digital future for health and care Through the Moray Growth Deal's Rural Centre of Excellence for Digital Health and Care, partners are developing new ways of supporting people to manage their own health and wellbeing. The programme includes a series of "Living Labs" bringing together practitioners, supported people and unpaid carers to explore areas for research and development such as supported self-management, long-term conditions, care at home and mental wellbeing. The partnership also continues to develop Moray Community Connections, an online platform that helps people identify local services, community support and referral pathways, making it easier to access help at the right time. These developing initiatives are helping shape future approaches that could enable more people to manage their own health and wellbeing and access support closer to home. Impact • Digital innovation supporting prevention and self-management • Moray Community Connections improving access to local services • Learning from national digital programmes helping shape future care Page 481
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Annual Performance Report 2025/26 42 Moray Integration Joint Board Improving care through safer prescribing Older people living in care homes often take multiple prescriptions that have accumulated over many years. While many medications remain essential, others may no longer provide benefit and can increase the risk of falls, confusion, or unnecessary side effects. During the year, a dedicated pharmacist-led programme reviewed medication for residents across care homes, working closely with GP practices, care home staff, and pharmacy teams to ensure treatment remained appropriate and person-centered. The reviews resulted in 300 medicines being stopped or reduced, including 57 medicines associated with an increased risk of falls. Overall, daily medication administrations were reduced by 187 doses, simplifying treatment for residents and reducing the burden on care staff. The work also highlighted opportunities to improve quality of care. In one instance, medication intended only for short-term use had continued unnecessarily, while another resident was routinely being woken to receive sleeping medication. Addressing issues such as these has improved both patient experience and medication safety. Care homes also reported practical benefits, with one home reducing medication rounds by up to 2.5 hours each day, allowing staff to spend more time providing direct care. Impact • 300 medicines stopped or reduced • 57 falls-risk increasing medicines removed • 187 fewer daily medication administrations • Reduced medication burden for frail older people • One care home reduced medication rounds by up to 2.5 hours • Annual prescribing savings of £11,298 • All participating care homes requested the programme continue Using resources wisely through partnership working Making best use of limited resources allows more investment to be directed towards frontline care and support. During 2025/26, Moray’s pharmacy teams worked closely with GP practices and NHS Grampian’s Medicines Unit to review prescribing and identify clinically appropriate efficiencies. Originally established as a temporary spend-to-save initiative, the Specialist Pharmacy Technician role has delivered such significant benefits that it has now been made a permanent part of the service. Working collaboratively across Moray, the programme achieved £378,931 in efficiencies during 2025/26, substantially exceeding the original target of £200,000. This was achieved through evidence-based prescribing reviews, improved adherence to Page 482
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Annual Performance Report 2025/26 43 Moray Integration Joint Board regional formularies and ensuring patients received equally effective but more sustainable treatments where clinically appropriate. The work has also reduced unnecessary appointments and administrative workload, allowing clinical time to be focused where it is most needed. Several of the approaches developed in Moray have since been adopted across NHS Grampian, demonstrating the wider value of local innovation. Impact • £378,931 prescribing efficiencies delivered during 2025/26 • 189% of the original savings target achieved • Specialist Pharmacy Technician role made permanent following successful evaluation • Strong partnership working between pharmacy teams, GP practices, and NHS Grampian • Local innovations informing prescribing improvements across the wider health system Looking ahead Meeting future demand will require continued collaboration, innovation, and a willingness to redesign traditional models of care. During 2025/26, Health and Social Care Moray strengthened the foundations for this transformation by developing more integrated services, investing in digital solutions, and working with partners to ensure people can access the right support, in the right place, at the right time. An ambitious and effective partnership is one that continuously looks for better ways of delivering care and support. During 2025/26, collaborative working has demonstrated that improving quality and improving value can go hand in hand. By reducing unnecessary medication, supporting safer prescribing, and making better use of resources, the partnership has improved outcomes for patients while helping ensure the long-term sustainability of health and social care services across Moray. Page 483
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Annual Performance Report 2025/26 44 Moray Integration Joint Board 12. Strategic Theme 4: Strategic Leadership, Planning and Performance Objective 6: We make a positive impact beyond the services we deliver National Wellbeing Outcome Description Outcome 8: Engaged workforce People who work in health and social care services are supported to continuously improve the information, support, care and treatment they provide, and feel engaged with the work they do. Outcome 9: Use of resources Resources are used effectively and efficiently in the provision of health and social care. Why this matters Strong leadership, effective partnerships and good governance create the foundations for better care, better health and better value for the people of Moray. While much of this report focuses on frontline services, delivering sustainable health and social care also depends on effective leadership, a skilled workforce, strong partnerships and responsible stewardship of public resources. As demand continues to grow and financial pressures increase, we must continually improve how services are planned, delivered and supported. During 2025/26 we continued to invest in our workforce, embrace innovation, strengthen governance, make better use of technology and engage more effectively with our communities. Together, these activities help ensure services remain resilient, accountable and sustainable for the future. Supporting and developing our workforce Our staff are our greatest asset. Their knowledge, skills and commitment underpin every service we provide, yet like many health and social care organisations across Scotland, we face significant workforce challenges. Like health and social care organisations across Scotland, Moray continues to face significant workforce challenges. Analysis shows an increasing number of experienced staff approaching retirement, creating risks around succession planning and the retention of valuable knowledge and skills. Levels of staff absence for both NHS staff and Council staff were 6.6% and 8.5% at the end of quarter 4, above the national target of 4%. Short term absences relate to colds/flu and gastro/intestinal issues, with long term absence causes for both Council and NHS staff being anxiety, stress and other mental health illnesses or for Page 484
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Annual Performance Report 2025/26 45 Moray Integration Joint Board operations/post operation care. Absences can result in pressures for remaining workforce where it is not possible to suspend or reduce service delivery. At the same time, high levels of sickness absence and recruitment difficulties in some services, particularly mental health and community hospitals, place additional pressure on existing teams and increase reliance on bank, agency and overtime staffing. There is a need to use bank and agency staffing to supplement our workforce, particularly in mental health and community hospitals. Levels of overtime in our complex and challenging services and care at home services are high and are required due to the number of vacancies that exist. Workforce planning is underway as a partnership, with both employing partners and a new national workforce subgroup. Aspects under review are potential retirements and succession planning, absence monitoring, agency and bank use, overtime reliance, difficult to fill vacancies as well as rural displacement and use of Artificial Intelligence. Designing a sustainable workforce that will meet future challenges and opportunities is key for delivery of our strategic aims. Organisation change has commenced with the aims of addressing gaps in operational management, professional supervision and optimising the integration of adult, children, families and justice services and ensuring the right mix of multi-disciplinary teams at a locality level to better meet the needs of local communities and address persistent health inequalities in communities with higher levels of need. The first phase was completed with the senior management structure being approved by MIJB in November 2025, and further phases are to be completed by end of 2026. Recognising that a healthy workforce is essential to delivering high-quality care, significant investment has been made in staff wellbeing. A central Staff Health & Wellbeing resource was developed as a single point of access for support and information, receiving more than 1,500 views during the year. Local wellbeing information areas have also been established across teams, making support more visible and accessible. A network of 18 Staff Health & Wellbeing Champions has been created to promote wellbeing initiatives, encourage peer support and help colleagues access available services. Early feedback suggests the network has increased confidence in having wellbeing conversations and strengthened local ownership of health and wellbeing initiatives. National Wellbeing Week at Dr Gray's Hospital brought together NHS services and third sector partners to provide practical advice, health checks and wellbeing activities for Page 485
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Annual Performance Report 2025/26 46 Moray Integration Joint Board staff. The event strengthened awareness of available support while reinforcing the importance of staff wellbeing across the organisation. Impact • Workforce planning continues to address future retirement risks • Succession planning is being strengthened across services • More than 1,500 wellbeing resource views • 18 Wellbeing Champions established • Increased awareness and accessibility of staff support • Continued focus on creating a healthy and resilient workforce Learning from safety incidents Creating a culture where staff feel confident to report incidents is fundamental to improving safety. During 2025/26, reporting of adverse events increased across Health and Social Care Moray. While some incidents reflected challenging working environments—particularly violence and aggression experienced by frontline staff—the increase in reporting is also considered to reflect improvements in reporting systems and a stronger culture of openness. Information gathered through incident reporting is used to identify trends, implement improvements and reduce future risks to both staff and people using services. Encouragingly, reports involving sharps injuries reduced during the year, although the number of incidents meeting Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) criteria increased from two to four, highlighting the importance of continued vigilance and preventative action. Impact • Improved reporting arrangements strengthening organisational learning • Better understanding of risks across services • Reduction in sharps-related incidents • Continued focus on preventing workplace violence and aggression Volunteers strengthening community support Volunteers make a vital contribution to health and social care across Moray, enhancing services, reducing isolation and strengthening community resilience. A new Re-engage Volunteer role has also been introduced, recognising that many people wish to volunteer around work, family or other commitments. The role provides Page 486
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Annual Performance Report 2025/26 47 Moray Integration Joint Board flexible opportunities while enabling volunteers to gain skills, confidence and social connections. Looking ahead, volunteers will play an important role in supporting older people returning home from hospital who may have little or no support, helping them settle safely back into their communities. Within NHS services, new opportunities have also been introduced, including Visitor Volunteers, Pharmacy Support Volunteers and a patient clothes bank at Dr Gray's Hospital, improving patient Within NHS services, new opportunities have also been introduced, including Visitor Volunteers, Pharmacy Support Volunteers and a patient clothes bank at Dr Gray's Hospital, improving patient experience while allowing clinical staff to focus on delivering care. Impact • More than 250 volunteers supporting services • New flexible volunteering opportunities created • Increased community capacity and social connection • Additional support for patients and frontline staff Strengthening governance and accountability Strong governance helps ensure public resources are used effectively, risks are managed appropriately and learning leads to service improvement. During 2025/26 governance arrangements for delivery of savings programmes were strengthened through the introduction of a dedicated Budget Savings Oversight Group. The group provides additional scrutiny and support to ensure planned savings are delivered while maintaining service quality and patient/supported person safety. Learning from inspections, audits, significant adverse events and service reviews continues to be embedded across the organisation. Senior managers maintain oversight of recommendations and improvement actions to ensure lessons are translated into meaningful service improvements. Creating a culture where staff feel confident to report incidents remains an important part of improving safety. Reporting of adverse events increased during the year, reflecting both the challenges faced by frontline services and improvements in reporting systems and organisational learning. Information gathered through incident reporting is used to identify trends, reduce risks and improve safety for staff and people using services. Encouragingly, reports involving sharps injuries reduced during the year. Page 487
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Annual Performance Report 2025/26 48 Moray Integration Joint Board Impact • Stronger governance arrangements established • Improved oversight of savings programmes • Learning from audits, inspections and incidents embedded across services • Improved reporting arrangements supporting organisational learning • Continued focus on accountability, quality and safety Looking ahead Building a sustainable health and social care system requires investment in people as well as services. Over the coming year, work will continue to strengthen workforce planning, improve staff wellbeing and develop innovative approaches that enable Health and Social Care Moray to meet future demand while continuing to deliver high- quality care. Objective 7: We are transparent and we listen to you National Wellbeing Outcome Description Outcome 3: Positive experiences People who use health and social care services have positive experiences of those services and have their dignity respected. Outcome 9: Use of resources Resources are used effectively and efficiently in the provision of health and social care. Why this matters Being transparent means more than publishing information. It means communicating openly, involving people in decisions that affect them and learning from feedback to improve services. By listening to our communities and acting on what they tell us, we can build trust and deliver services that better meet local needs. Making information easier to access During summer 2025, the Moray HSCP website was rebuilt and moved onto a new digital platform. While much of the content remained the same, the redevelopment significantly improved how people access information. The new website offers a modern, accessible design that works more effectively across mobile devices, alongside improved navigation and search functionality. Behind the scenes, enhanced security, managed hosting and automatic backups have created a more resilient platform that can support future digital developments. Page 488
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Annual Performance Report 2025/26 49 Moray Integration Joint Board The project reduced hosting costs by more than 75% and was delivered entirely using in-house expertise.. Impact • Modern, accessible website • Improved user experience • More secure and resilient digital infrastructure • Over 75% reduction in hosting costs Keeping communities informed Throughout the year, the partnership continued to use proactive communications to keep local people informed about services, public health campaigns, recruitment opportunities and developments across health and social care. A total of 41 proactive news releases were issued during 2025/26, compared with 29 the previous year, helping raise awareness of the work of Moray IJB and Moray HSCP, and celebrate the work of staff, volunteers and community partners. Social media also continued to play an important role in connecting with communities. Facebook remains the partnership's primary channel with almost 8,000 followers, and saw strong levels of engagement during the year: These channels provide accessible and timely information while helping promote healthier lifestyles, recruitment campaigns and opportunities for community involvement. The continued development of Moray Community Connections is also helping people find local support, community groups and services more easily, making it simpler to access information and assistance when needed. Impact • Increased proactive communications throughout the year • More than 2.18 million social media views and 18,307 social media • Engagement increased by 12% • Greater awareness of local services and initiatives Giving people a stronger voice Listening to local people is essential to designing services that meet the needs of our communities. In August 2025, Moray Council launched Moray Engage, a new online platform that provides a single place for residents to participate in consultations, community projects and discussions about local services. Page 489
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Annual Performance Report 2025/26 50 Moray Integration Joint Board As a Community Planning Partnership member, Moray HSCP has its own dedicated space on the platform to gather views on health and social care priorities. During the platform's first year the platform received more than 35,500 visits and over 8,000 responses across all projects. Five Moray HSCP projects were published during 2025/26: • Carer Aware Campaign design poll • Improving Healthy Weight in Moray • Moray Adult Unpaid Carer Survey • Moray Young Carer Survey • Moray Short Breaks (Respite) Service Review Together these projects generated over 1,400 visits and 326 responses, achieving a strong engagement rate of 39%. Impact • Greater opportunities for community participation • Five engagement projects delivered • Strong engagement across projects Learning from complaints and feedback Feedback, whether positive or negative, helps us understand people's experiences of care and support. By listening to concerns and acting on what we learn, we can improve services and strengthen public confidence. During 2025/26, Moray HSCP received 169 complaints, compared with 138 in the previous year. After excluding withdrawn, duplicate or out-of-remit cases, complaint levels remain broadly consistent with previous years when considered alongside expanded service responsibilities. The most common themes related to communication, particularly within services experiencing high demand such as GMED, adult mental health and access teams. Of the complaints investigated during the year, 12% (18 complaints) were fully upheld, with the remainder partially upheld or not upheld. Complaints provide valuable learning that is shared across teams and used to improve how services operate, ensuring complaints contribute to continuous service improvement in line with the expectations of the Scottish Public Services Ombudsman. Where complaints can be resolved quickly, we aim to respond within five working days. More complex complaints requiring investigation have a target response time of 20 working days. Average response times were: Page 490
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Annual Performance Report 2025/26 51 Moray Integration Joint Board Complaint type Average response Social work and social care – early resolution 11 working days Social work and social care – investigation 37 working days Health services – early resolution 5 working days Health services – investigation 60 working days Improving response times remains a priority and progress continues to be monitored by the Senior Management Team. Impact • Learning from 169 complaints used to improve services • Communication identified as a key improvement priority • Ongoing work to improve response times and strengthen accountability Looking ahead Strong leadership, effective partnerships and meaningful engagement will remain essential as health and social care continues to evolve. During the coming year, we will continue to invest in our workforce, embrace innovation, strengthen governance and work alongside local communities to design services that are sustainable, person- centred and responsive to the needs of the people of Moray. Page 491
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Annual Performance Report 2025/26 52 Moray Integration Joint Board 13. Financial review and performance Financial performance forms part of the regular reporting cycle to the Moray IJB. Throughout the year the Board, through the reports it receives, is asked to consider the financial position at a given point and any management action deemed as necessary to ensure delivery of services within the designated financial framework. From the first quarter in the financial year, the Board was presented with financial information that included a forecast position to the end of the year. In November 2025, the Board received a financial report which forecast an expected overspend to the end of the financial year of £8.78m. This forecast remained fairly consistent throughout the remainder of the year and in January 2026, MIJB were forecasting an overspend to the end of the year of £8.23m, the Moray IJB actually out turned at £7.20m overspent. Both partners, in line with the Integration Scheme, put in additional funding to cover this overspend. There was the use of ear marked reserves totalling £0.14m during the year, with new ear marked reserves totalling £1.70m leaving a balance of £3.01m in ear marked reserves to be carried forward into 2026/27. In March 2025, the Moray IJB agreed a savings plan of £9.47m, with a mixture of recurring savings and recurring reductions in spend. At the end of the financial year, this had been achieved in part, with recurring savings of £3.66m, £0.68m non-recurring savings and £1.03m reduction in overspend. Given the uncertainties associated with funding and the emerging overspend position at the early stage of the financial year, it was necessary to update regularly on the emerging financial position. This was done formally through Moray IJB meetings and informally through development sessions. The table below summarises financial performance by comparing budget against actual performance for the year. Page 492
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Annual Performance Report 2025/26 53 Moray Integration Joint Board Service Area Budget £000’s Actual £000’s Variance (Over)/ under spend £000’s Note Community Hospitals & Services 8,033 7,932 101 Community Nursing 6,244 6,670 (426) 1 Learning Disabilities 20,913 21,230 (317) 2 Mental Health 12,227 12,881 (654) 3 Addictions 1,871 1,817 54 Adult Protection & Health Improvement 278 279 (1) Care Services Provided In-House 25,190 25,495 (305) Older People Services & Physical & Sensory Disability 28,090 30,023 (1,933) 4 Intermediate Care & OT 1,845 2,039 (194) Care Services Provided by External Contractors 2,084 2,072 12 Other Community Services 10,117 10,310 (193) Administration & Management 2,056 3,086 (1,030) 5 Other Operational Services 1,413 1,351 62 Primary Care Prescribing 21,441 21,312 129 Primary Care Services 22,830 22,954 (124) Hosted Services 6,131 5,987 144 Out of Area Placements 1,780 1,834 (54) Improvement Grants 1,060 889 171 Children’s & Justice Services 21,256 22,050 (794) 6 Total Core Services 194,859 200,211 (5,352) Strategic Funds & Other Resources 11,619 3,257 8,362 7 TOTALS (before set aside) 206,478 203,468 3,010 Set Aside 20,092 20,092 - TOTAL 226,570 223,560 3,010 Page 493
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Annual Performance Report 2025/26 54 Moray Integration Joint Board Significant variances against the budget were notably: Note 1: Community Nursing - This budget is overspent by £425,978 at the year end. This is predominantly due to staffing, with overspends in District nurses £431,715 (including Acute nursing at Varis, Forres and Buckie), £102,136 overspend in Health visitors, which is being reduced by an underspend in Maryhill of £107,873. The overspend is largely due to staffing as detailed above. District nurses had a budget realignment in 2025/26 of £313,982 and savings of £121,095, this was not achieved due to recruitment being successful for vacant posts that have been vacant for a significant time during which time bank staff have had to be used as well as the regrading of nurses from a band 6 to a band 7. Health visitors were expected to come in on budget after realignment and savings however the school nurses were regraded in the last quarter of the year resulting in an overspend in the budget. Note 2: Learning Disabilities (LD) – The Learning Disability (LD) service is overspent by £316,736 at the year-end. The overspend is essentially due to the purchase of care for people with complex needs which resulted in an overspend of £428,087, client and staff transport of £25,640 and property cost overspend of £23,588. This is offset by underspend of £100,173 for clinical, nursing and other services relating to consultant and management psychiatry staffing vacancies, more income received than expected of £34,358 and other small underspends of £1,239. This budget has been under pressure for a number of years due to demographic pressures, transitions from Children’s services and people living longer and getting frailer whilst staying at home. The biggest overspends was for services provided to individuals in their own homes to support their daily living needs which enables people to stay living at home or in a homely setting for as long as possible and day care which provides activities during the day in the community. Work continues to progress savings plans across the LD service; however, this is being offset by ongoing demand pressures. In particular, more individuals with complex needs moving through transitions from children to adult services and also people moving into the area who require high-cost packages of care, which is impacting on the overall financial position. Note 3: Mental Health – This budget is overspent by £654,343 at the year end. This is due to overspends in clinical, nursing and other services as a result of ongoing use of agency locums of £302,457; purchase of care £195,385 relating to purchase of care in care homes and care at home; £144,810 relating to unachieved savings and £11,691 other minor overspends. This budget is currently under pressure due to the recruitment issue for consultants and an increase in demand for services, including out of area packages as there is a lack of resource locally especially around autism and neurodiversity. Work is currently ongoing reviewing out of area packages to repatriate them to Moray. Page 494
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Annual Performance Report 2025/26 55 Moray Integration Joint Board Note 4: Older People Services and Physical & Sensory Disability - This budget is overspent by £1,933,488 at the end of the year. This primarily relates to overspends for home care in the area teams £575,752, permanent care £1,328,598 due to the increase in the number of clients receiving nursing care rather than residential care, short breaks £242,362 and self-directed support of £260,758. Bad debt provision for unpaid fees was £117,582 overspent, which is particularly high this year and other minor overspends of £18,000. This is being reduced by income received during the year above budget by £609,564. The variances within this overall budget heading reflect the shift in the balance of care to enable people to remain in their homes for longer, when people are living longer with more complex care needs. Due to the increase in need and complexity along with increasing levels of growth and demand are having an impact on this budget. There are increases in permanent care which is seeing the move to nursing placements rather than residential placements. The demographics are showing we have an increasing elderly population who are living longer and requiring more complex care. Note 5: Admin and Management - This budget is overspent by £1,029,617 at the year end. This is due to interim staffing arrangements and the vacancy target for the Council side not being met by £933,334. There was a non-recurring increase in target for 2025/26 of £750,000 that was not achievable. Note 6: Children, Families and Justice Services – This budget is overspent by £793,663 at the year end. This is due to overspends in residential continuing care placements £418,127, external fostering placements £495,610, out of area residential placements £297,272, home to school taxis £28,201, no recourse to public funds costs £15,600 and self-directed support payments of £68,245. This overspend is being reduced by an underspend on mental health & wellbeing £156,041, trauma informed training £30,517, refund on Intensive Family Support contract £31,492, Criminal Justice £64,759, an overachievement of £246,097 against the vacancy target and minor underspends of £486. These overspends are related to the number of children requiring to be accommodated through the Children’s Hearing system, family breakdown, and the need to keep children safe from familial harm while living at home. The costs of care have been rising significantly, availability of the correct care provision is a national challenge, and the market is under scrutiny with consultation for possible legislation on excessive profiteering. A long and immediate term strategy has been approved by the IJB to address: the need to reduce the flow-into care, develop small group family living models in Moray with support from Housing Services, strengthen early support, prevention and diversion, and have a more local provision in the Northeast across the three Grampian local authority areas, which can more effectively contribute to the flow- out of care. Page 495
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Annual Performance Report 2025/26 56 Moray Integration Joint Board Note 7: Strategic Funds and Other Resources – This budget is underspent by £8.362m as it relates to savings achieved during the year, any unallocated funding and reserves balances. MIJB’s financial performance is presented in the comprehensive income and expenditure statement (CIES), which can be seen on page 44. At 31 March 2026 there were ear marked reserves of £3.01m available to the MIJB, compared to £1.45m at 31 March 2025. These remaining reserves of £3.01m are for various purposes as described below: Page 496
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Annual Performance Report 2025/26 57 Moray Integration Joint Board Earmarked Reserves Amount £000’s GP Premises 21 National Drugs MAT 250 OOH Winter Pressure funding 172 Moray Cervical screening 36 Moray hospital at home 4 Moray Psychological 275 MHO Funding 138 Adult protection funding for CA 72 National Trauma Training services 53 Moray School Nurse 32 Moray Winter Fund HCSW & MDT 182 LD Annual Health Checks 69 Community Planning partnership 2 Moray District Nurses 111 Moray Alcohol & Drug Partnership 48 GP Walk-in Service 165 Moray Unscheduled Care Improvement Plan 1,380 Total Earmarked 3,010 General Reserves 0 TOTAL Earmarked & General 3,010 Page 497
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Annual Performance Report 2025/26 58 Moray Integration Joint Board GP Premises – balance of funding for improvement grants including the making of premises improvement grants to GP contractors. The continued digitalisation of paper GP records. Modifications for the purposes of improving ventilation and increase to the space available in NHS owned or leased premises for primary care multi-disciplinary teams. MAT Standards - National Drugs Medication Assisted Treatment (MAT) for embedding and implementation of the standards will he be overseen by the MAT implementation support team (MIST). Out of Hours Winter Pressure funding – balance of funding to sustain GO out of hours and to support resilience to explore operational solutions. Moray Cervical Screening – balance of funding for smear test catch up campaign. Moray Hospital at Home – development of Hospital at Home provides Acute hospital level care delivered by healthcare professionals, in a home context for a condition that would otherwise require acute hospital inpatient care. Moray Psychological – funding streams for mental health, psychological wellbeing, facilities, post diagnostic support and psychological therapies. Mental Health Officer (MHO) funding – funding to support additional mental health officer capacity. Adult protection funding for care at home – balance of funding to build capacity in care at home community-based services. National Trauma Training services – training for dealing with people affected by trauma and adversity. Moray School Nursing – funding to support NHS Grampian to retain school nurse posts. Moray Winter Fund Health Care Social Workers (HCSW) – additional funding for further HCSW in both the IJB and Emergency department. Moray Winter fund Multi-Disciplinary Team – additional funding for service pressures includes Discharge to Assess, Home First Frailty team and volunteer development. Learning Disability Annual Health Checks – to implement the annual health checks. Community Planning Partnership – funding towards community planning partnership. Moray District Nursing – allocation to support recruitment and training of District Nurses Moray Alcohol & Drug Partnership - funding to support local alcohol and drug issues . Page 498
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Annual Performance Report 2025/26 59 Moray Integration Joint Board GP Walk-in Service – Scottish Government funding to expand walk-in GP services Moray Unscheduled Care Improvement Plan – funding to enhance the delivery of unscheduled care services. All reserves are expected to be utilised for their intended purpose during 2026/27. Set Aside – Excluded from the financial performance table but included within the Comprehensive Income & Expenditure Account is £20.092m for Set Aside services. Set Aside is an amount representing resource consumption for large hospital services that are managed on a day-to-day basis by the NHS Grampian. MIJB has a responsibility for the strategic planning of these services in partnership with the Acute Sector and Mental Health Service. Set Aside services include: • Accident and emergency services at Aberdeen Royal Infirmary and Dr Gray’s inpatient and outpatient departments; • Inpatient hospital services relating to general medicine, geriatric medicine, rehabilitation medicine, respiratory medicine, learning disabilities, old age psychiatry and general psychiatry; and • Palliative care services provided at Roxburgh House Aberdeen and The Oaks Elgin. The budget allocated to Moray is designed to represent the consumption of these services by the Moray population. The MIJB integration scheme outlines that the method of establishing the set aside budget will take account of hospital activity data and cost information. Hospital activity data will reflect actual occupied bed day and admissions information, together with any planned changes in activity and case mix. This information was originally provided by Information Services Division, although this information hasn’t been updated since 2019/20. In the absence of updated information from Information Services Division, uplifts based on the baseline uplift was applied to the set aside budget calculation on an annual basis throughout the period up to 2024/25. During 2025/26 it was accepted that this did not provide an accurate reflection of the consumption by Moray residents within the Unplanned Care pathways and work was undertaken to update the set aside calculation. The updated set aside budget has been calculated using hospital activity data and cost information. The hospital activity data is taken from the SMR01 dataset for general/acute inpatient and day case and reflects inpatient stays and day case and Page 499
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Annual Performance Report 2025/26 60 Moray Integration Joint Board outpatient activity. Costs are taken from the 2023/24 NHS Grampian cost book and uplifted by the baseline uplift amounts for 2024/25 and 2025/26 to reflect pay award and inflationary uplifts since 23/24. The set aside budget is the total of IJB activity multiplied by unit cost The figures for 2021/22 to 2024/25 have been derived by uplifting 2019/20 figures by baseline funding uplift in 2021/22 (3.36%) ,2022/23 (6.70%), 2023/24 (5.35%) and 2024/25 (6.64%): 2025/26 2024/25 2023/24 2022/23 2021/22 Budget 20.092m 15.639m 14.665m 13.92m 13.04m Page 500
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Annual Performance Report 2025/26 61 Moray Integration Joint Board APPENDICES A. Moray Area Profile B. National Health & Wellbeing Outcomes C. Core Suite of National Indicators D. Ministerial Group Indicators E. Inspections of Services F. Moray Integration Joint Board – changes to membership, decisions and directions Page 501
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Annual Performance Report 2025/26 62 Moray Integration Joint Board 14. Appendix A: Moray area profile • Moray spans 864 square miles in North East Scotland • Comprising mainly coastal and rural communities • Rounded Population 93,400 (Scotland’s Census 2022 – Rounded population estimates, 2023), 1.72% of Scotland’s total population. • Population predicted to fall by 2.6% in next 10 years according to publicly available data last updated in 2022. Moray age profile 0-14 year olds 15 -64 year olds People aged 65 and over Moray 14,500 57,500 21,400 Scotland 21,400 3,153,300 1,091,100 Community • In 2023 it was estimated that there were 43,891 households in Moray. • 62.2% of adults living in Moray rate their neighbourhood as a good place to live (Scotland 59.1%) • The crime rate in Moray is 41 per 1,000 population (Scotland 55) • The rate of non-accidental fires in Moray is 13 per 10,000 population (Scotland 28) • In Moray, 45 drug crimes are recorded per 10,000 population (Scotland 97) Economic status • 12.5% of Moray households are estimated to be workless (Scotland 17.8%) • 20.1% of children aged under 16 within Moray are living with low income families (UK 20.1%) • In May 2023, 11.6% of all Moray households were on Universal Credit - 5,103 households (Scotland 18.7%) • 63.6% of homes were in Council Tax Bands A-C, 7.34% were in Council Tax Bands F-H, compared to 60.0% and 14.2% respectively in Scotland. Deprivation • Moray is the second least deprived mainland local authority in Scotland • (SIMD 20) • 2.7% of Moray population live within the highest of the Scottish Index of Multiple Deprivation (SIMD) quintiles (most deprived) • 13.3% live in the least deprived quintile. Page 502
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Annual Performance Report 2025/26 63 Moray Integration Joint Board 15. Appendix B: National Health & Wellbeing Outcomes National context The Scottish Government measures the performance of all health and social care partnerships against a set of high-level statements of what we should be aiming to achieve through integration and ultimately through the pursuit of quality improvement across health and social care. The National Health and Wellbeing Outcomes provide a strategic framework for the planning and delivery of health and social care services, and they focus on the experiences and quality of services for people receiving these services, carers and their families. National Health and Wellbeing Outcomes (NH&W) 1 Health & wellbeing People are able to look after and improve their own health and wellbeing and live in good health for longer. 2 Living in the community People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 3 Positive experiences People who use health and social care services have positive experiences of those services, and have their dignity respected. 4 Quality of life Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. 5 Health inequalities Health and social care services contribute to reducing health inequalities. 6 Support for carers People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and well- being. 7 Safe from harm People using health and social care services are safe from harm. 8 Workforce People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. 9 Use of resources Resources are used effectively and efficiently in the provision of health and social care. Page 503
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Annual Performance Report 2025/26 64 Moray Integration Joint Board 16. Appendix C: Core suite of national indicators Source information from Public Health Scotland National Indicators (to be updated in July when figures are published) The Core Suite of National Indicators have been developed from national data sources to enable comparisons between Integration Authority areas and with Scotland. Each indicator acts as a measure of progress against at least one outcome. There are 23 indicators in total with four (10, 21,22 and 23) still to be defined. Indicators 1-9 which are based on the Health and Care Experience (HACE) survey will not be updated as part of the May release as the information is not yet available. Results from the 2026 HACE survey will be available in the 7 July publication. Moray Core Suite of National Integration Indicators (to be updated in July when stats are published) Moray HSCP was in the top 50% for eight of the 19 reported indicators for this reporting period. This was a decrease from the previous reporting period where 11 were in the top 50%. Areas of particular strength were in relation to lower premature mortality rate, emergency admissions, emergency bed days, readmissions within 28 days and falls. There has been a significant reduction in the premature mortality rate (NI-11) and emergency admission rate (NI-12) (per 100,000 population) in comparison to the Scottish rate, with reductions of 25% and 29% respectively. Overall, we performed the same or better than Scotland for 12 of the 19 national indicators, with seven performing worse than Scotland. This is the same as the previous reporting period. Page 504
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Annual Performance Report 2025/26 65 Moray Integration Joint Board Summary of our performance at a glance - National Indicators GREEN Our performance has improved compared to last year. AMBER Our performance is similar to last year. RED Our performance has declined compared to last year. The results of the 2026 HACE survey will be published by the Scottish Government on 26 May 2026 and will be included in the PHS Core suite publication on 7 July 2026. Any further questions and comments on the HACE survey should be sent to patientexperience@gov.scot. .Outcome indicators Results for 2, 3, 4, 5,7 and 9 are not comparable to previous years due to changes in survey wording National Indicator (will be updated in July) Scotland Our result (2024/25) NH&W Outcomes 1 Percentage of adults able to look after their health very well or quite well 91% 92% 1 2 Percentage of adults supported at home who agree that they are supported to live as independently as possible 72% 72% 2 3 Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided. 60% 59% 2, 9 4 Percentage of adults supported at home who agree that their health and care services seemed to be well co-ordinated 61% 66% 3 5 Percentage of adults receiving any care or support who rate it as excellent or good 70% 69% 2, 3 6 Percentage of people with positive experience of the care provided by their GP practice 68% 69% 3, 4 7 Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life. 70% 69% 4 8 Percentage of carers who feel supported to continue in their caring role 31% 28% 6 9 Percentage of adults supported at home who agree they felt safe 73% 70% 7 Page 505
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Annual Performance Report 2025/26 66 Moray Integration Joint Board National Indicator Scotland Our result NH&W Outcomes Data indicators 11 Premature mortality rate 463 403 1, 5, 7 12 Emergency admission rate 11,462* 7,379* 1, 2, 4, 5 13 Emergency bed day rate 106,455* 72,740* 1, 2, 4, 5 14 Readmission to hospital within 28 days 104* 72* 7, 9 15 Proportion of last 6 months of life spent at home or in a community setting 89%* 93%* 7, 9 16 Falls rate 22.9* 11.2* 7, 9 17 Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections 73.8% 81.9% 3 18 Percentage of adults with intensive care needs receiving care at home 65% 60% 6 19 Number of days people spend in hospital when they are ready to be discharged 952 865 9 20 Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency** Not available Not available * The primary source of data for these indicators are Scottish Morbidity Records (SMRs) which are nationally collected discharge-based hospital records. In accordance with the recommendations made by Public Health Scotland (PHS) and communicated to all Health and Social Care Partnerships, the most recent reporting period available with complete and robust data is calendar year 2025. Reporting on 2025 calendar year rather than 2025/26 financial year may not fully reflect local activity, however, this is still recommended due to data quality and completeness levels at the time of reporting. **PHS has not provided information for indicator 20 beyond 2019/20 because detailed Patient Level Information Costing System (PLICS) cost information is not available. PHS previously published information to calendar year 2020 using costs from 2019/20 as a proxy but, given the impact of the COVID-19 pandemic on activity and expenditure, PHS no longer consider this appropriate. Page 506
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Annual Performance Report 2025/26 67 Moray Integration Joint Board HOLDING PAGE - Detailed analysis of each National Indicator will be presented in this section prior to publication Page 507
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Annual Performance Report 2025/26 68 Moray Integration Joint Board 17. Appendix D: Ministerial Group Indicators Page 508
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Annual Performance Report 2025/26 APPENDIX D 18. Appendix E: Inspections of services The annual performance report requires the IJB to report on inspections by external bodies. Inspections, Assurance and Service Quality Moray Health & Social Care Partnership monitors the quality and performance of both directly delivered services and externally commissioned services. This includes reviewing Care Inspectorate gradings, inspection findings, improvement requirements, complaints, and provider quality assurance information to ensure services remain safe, effective and person-centred. Overall, inspection findings during 2025/26 provide assurance that the majority of services are delivering good quality care, with most services graded Good (4) or Very Good (5) on the six-point scale. Indicator Result Services inspected 24 Services graded Good or above 92% Services with improvement requirements 3 Services supported through improvement planning 5 Inspection findings across services highlighted a number of common strengths, including committed staff teams, positive relationships with people using services, and a strong focus on person-centred care. Where improvement areas were identified, these generally reflected recurring themes across services, including medication management, care planning and recording, workforce capacity, and the need for robust and consistent quality assurance processes. Internal services In 2025/26, the Care Inspectorate inspected six internal services: • Community Support Service • Moray Supported Lodgings • Barlink • CALA • Woodview • START Inspection feedback across internal services was consistently positive, highlighting strong staff commitment, person-centred approaches, and positive outcomes for Page 509
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Moray Integration Joint Board - Annual Performance Report 2025/26 70 people using services. Performance across services was generally stable, with limited variation in grading. Where areas for improvement were identified, these related mainly to consistency of practice, including aspects of care planning, documentation and quality assurance processes. Action plans were developed and monitored through established quality assurance and improvement arrangements. Commissioned services In 2025/26, the Care Inspectorate inspected 18 externally commissioned services. Inspection findings identified a range of strengths across commissioned services, including caring staff, positive relationships with people using services, and a continued commitment to supporting people safely within their communities. While most commissioned services performed well, inspection findings indicated a greater degree of variation in performance compared to internal services. Where improvement requirements were identified, these reflected similar system-wide themes, particularly in relation to medication management, quality assurance and workforce capacity. Providers were supported through improvement planning and ongoing contract monitoring arrangements to address identified areas. Targeted assurance and improvement activity During 2025/26, the partnership undertook a significant assurance and improvement process in response to concerns identified within one service. This involved multi- agency review and oversight arrangements, engagement with families, the provider and regulatory partners, and ongoing monitoring to support improvement and ensure the safety and wellbeing of residents. Page 510
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Moray Integration Joint Board - Annual Performance Report 2025/26 71 19. Appendix F: Moray Integration Joint Board - Changes to Membership of Moray Integration Joint Board, decisions and directions Changes to Integration Joint Board Membership and Governance During 2025/26, the Moray Integration Joint Board (IJB) experienced a number of changes to its membership and leadership arrangements. A planned transition in Board leadership took place during the year. Dennis Robertson served as Vice Chair from 1 April to 30 September 2025 before assuming the role of Chair from 1 October 2025. Councillor Bridget Mustard joined the Board on 1 August 2025 and served as Chair from 1 August to 30 September 2025, before taking up the position of Vice Chair from 1 October 2025. There was one change to the voting membership representing Moray Council, with Councillor John Divers joining the Board on 27 March 2026 following the departure of Councillor Ben Williams. Within the non-voting membership, changes reflected both organisational appointments and representative succession. Following the appointment of Judith Proctor as Interim Chief Officer in July 2024, the Board continued to benefit from her leadership throughout 2025/26. Jim Lyon remained in post as Interim Chief Social Work Officer. The Board welcomed Aimee McIntosh as Third Sector Representative from 1 October 2025. Changes also took place within the Unpaid Carer Representative membership, with Ivan Augustus standing down in November 2025 after almost ten years of service. Miriam Connor and Christine Stevens were subsequently appointed as Unpaid Carer Representatives. There were also changes to staff partnership representation during the year. Kevin Todd, Moray Council Staff Representative, stood down in May 2025. Deirdre McIntyre concluded her role as Grampian Health Board Staff Partnership Representative in June 2025 and was succeeded by Michael Ritchie in July 2025. The Board's co-opted membership was strengthened through the appointment of Karen Greaves as Moray Council representative in March 2025 and Laura Skaife-Knight as NHS Grampian representative from October 2025. Existing co-opted members continued to provide professional and operational expertise to support the Board's governance and decision-making. The Board also maintained a pool of substitute members to support continuity of governance, with Councillor Sonya Warren joining as a substitute member in February 2025. Page 511
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Moray Integration Joint Board - Annual Performance Report 2025/26 72 Decision and directions Agendas and reports for all MIJB meetings during 2024/5 are set out in the papers which are published on the Moray Council website. Board meetings are open to the public and webcast, meaning they can be watched remotely as they happen or the recording viewed at a later time. Decisions taken by the Board in2025/26 included: May 2025 • Approved the final draft of the Strategic Delivery Plan (2025-2028). • Approved the new format of the Moray Integration Joint Board Risk Register. • Endorsed the updated Moray Mental Health and Wellbeing Strategy Delivery Plan 2024-2026. • Endorsed the Moray Mental Health and Wellbeing Strategic Performance Framework. • Approved the final MIJB Equality Mainstreaming Progress Report 2021- 2024. • Approved the MIJB Equality Outcomes for the period 2025-2029. • Approved mainstreaming of the Equality Duty. • Approved changes to the Moray Integration Joint Board Financial Regulations. June 2025 • Approved the unaudited Annual Accounts to be submitted to the external auditor, noting all figures remain subject to audit. Noted the Annual Governance Statement and accounting policies applied in the production of the unaudited Annual Accounts. • Approved the updated Local Code of Corporate Governance which supports the Annual Governance Statement. • Approved the proposed reduction in the number of formal meetings from 18-15 per year. • Approved the publication of the Annual Performance Report 2024/25 by 31 July 2025. • Approved a two-year extension to the current Moray Carers Strategy 2023-26, extending its term to March 2028. September 2025 • Approved the updated Moray Integration Joint Board Strategic Risk Register, including the adequacy of the identified mitigating controls. • Approved the Children Services Plan 2024-25 Annual Report. • Approved the publication of the Health and Social Care Moray Annual Complaints report 2024/25. October 2025 • Approved the Audited Annual Accounts for the financial year2024/25 and the letter of Representation. November 2025 • Agreed to increase the non-voting stakeholder members from five to six, to enable the inclusion of the two Unpaid Carer Stakeholder representatives on the MIJB membership from 28 November 2025. • Approved the draft Public Sector Climate Change submission to Sustainable Scotland Network for the reporting year 2024/25. • Endorsed the proposed revised management structure for the Senior Management Team of Health and Social Care Moray. Page 512
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Moray Integration Joint Board - Annual Performance Report 2025/26 73 January 2026 • Agreed the reappointment of the Board’s Chief Internal Auditor for a further two year period. • Formally nominate for approval by the Standards Commission, the reappointment of the Board’s Standards Officer and Depute Standards Officer, for a further period of two years until 1 April 2028. March 2026 • Approved the Board’s Strategic Risk Register, noting the current risk ratings, controls, assurances and areas of ongoing exposure. • Approved the 2026/27 proposed savings plan. • Approved the Revenue Budget for 2026/27, following consideration on risks. • Approved the updated Medium Term Financial Framework. Page 513
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Moray Integration Joint Board - Annual Performance Report 2025/26 74 Find out more about Moray Integration Joint Board and Moray Health & Social Care Partnership on our website: https://hscmoray.co.uk/index.html Follow us on social media Facebook @ hscmoray Instagram @hscmoray For further information contact: Moray Health & Social Care Partnership Moray Council Offices High Street Elgin Moray IV30 1BX Page 514