Agenda Document Pack - Audit, Performance and Risk Committee - 19/06/2025
Moray Council · 19 June 2025
Back to Audit, Performance and Risk Committee — 19 June 2025 and its agenda
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Audit, Performance and Risk Committee Thursday, 19 June 2025 Council Chambers NOTICE IS HEREBY GIVEN that a Meeting of the Audit, Performance and Risk Committee, Council Chambers, Council Office, High Street, Elgin, IV30 1BX on Thursday, 19 June 2025 at 09:30 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Minute of meeting of 27 March 2025 5 - 8 4. Action Log of 27 March 2025 9 - 10 5. Quarter 4 (January - March 2025) Performance Report - Adult Services 11 - 42 6. Quarter 4 (January to March 2025) Performance Report for Children and Families and Justice Social Work 43 - 78 7. Internal Audit Section - Update Report 79 - 110 8. Internal Audit Annual Report - 2024-25 111 - 120 9. Unaudited Annual Accounts 121 - 198 10. Annual Performance Report 2024-25 199 - 284 11. Development Sessions in November 2024 for Children Families and Justice Social Work 285 - 308 Page 1
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Item(s) which the Committee may wish to consider with the Press and Public excluded 12. CONFIDENTIAL Internal Audit Section Update Report - NHS Grampian Internal Audit Review • 1. Information relating to staffing matters; 13. CONFIDENTIAL Update on Improvement Plan for Adult Social Care Commissioning • 1. Information relating to staffing matters; 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 Sandy Riddell (Chair) Councillor Scott Lawrence (Voting Member) Mr Derick Murray (Voting Member) Councillor Ben Williams (Voting Member) Mr Sean Coady (Member) Ms Sonya Duncan (Member) Ms Deborah O'Shea (Member) Ms Judith Proctor (Member) Ms Deirdre McIntyre (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 AUDIT, PERFORMANCE AND RISK COMMITTEE Thursday, 27 March 2025 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Sean Coady, Ms Sonya Duncan, Councillor Scott Lawrence, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Councillor Ben Williams APOLOGIES Ms Deirdre McIntyre IN ATTENDANCE Interim Chief Social Work Officer/Head of Service; Chief Internal Auditor; Self- Directed Support and Unpaid Carers Team Manager; Angela Pieri, Engagement Lead, and Andrew Wallace, Senior Audit Manager, both Grant Thornton; Service Manager - Provider Services and Caroline O'Connor, Committee Services Officer. 1. Chair The meeting was chaired by Mr Sandy Riddell. 2. Declaration of Member's Interests The Committee noted there were no declarations of member's interests. 3. Minute of meeting of 30 January 2025 The minute of the meeting of 30 January 2025 was submitted and approved. 4. Action Log of Meeting of 30 January 2025 The Action Log of the meeting of 30 January 2025 was discussed and updated accordingly. 5. Quarter 3 (October - December 2024) Performance Report - Adult Services Item 3. Page 5
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The meeting had before it a report by the Corporate Programme Manager updating the Committee on adult services performance as at Quarter 3 2025 (October - December 2024). In response to Councillor Lawrence's concerns relating to the regression in mental health indicators, the Chair confirmed the Moray Integration Joint Board had been advised at their meeting that morning that a report is to be presented to the meeting of the Board in May providing clarity on planned developments and how they will be implemented. The Chief Officer further advised that the deterioration in that particular indicator related to the commencement of treatment under psychological therapies within 18 weeks of referral which is a challenge across Grampian and largely related to availability of workforce. Councillor Lawrence asked, with reference to paragraph 5.12, whether there was evidence of the effectiveness of the initiatives to address staff absence. In response, the Chair agreed it would be useful to include reference in future reports specifically relating to take-up and their impacts. Following consideration the Committee unanimously agreed to:- (i) note the performance of local indicators for Quarter 3 (October to December 2024) as presented in the Performance Report at Appendix 1; (ii) note the analysis of the highlighted local indicators and actions being undertaken to address performance that is outside of acceptable target ranges as detailed in Appendix 1; and (iii) note the initiatives ad progress in reducing unmet need as outlined in paras 5.3, 5.4 and in Appendix 2. 6. Quarter 3 Performance Report for Children and Families and Justice Social Work The meeting had before it a report by the Interim Chief Social Work Officer informing the Committee on Children and Families and Justice Social Work performance as at Quarter 3 (October to December 2024). The Chair noted the figure of 13.6% of individuals supported by Justice Social Work were females in Appendix 1 along with previous research relating to re-offending which demonstrated access to health services was a block to them being successfully rehabilitated. He suggested it may be useful to check with Justice Service Social Work whether there are such issues to ensure individuals are supported and solve the cycle of reoffending. In response, the Interim Chief Social Work Officer agreed future reports would quantify the data if possible or include reference to the research. During the course of discussion Councillor Lawrence, noting The Promise was initiated five years ago when Children's Services was under the remit of the Council and now sits under the auspices of the Moray Integration Joint Board, asked if there was something the Board could do to demonstrate its continued commitment to The Promise. In response the Chief Officer agreed to discuss the most suitable approach with the Chair and Depute Chair of the Board. Following consideration the Committee unanimously agreed to:- Page 6
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(i) note the performance of local indicators for Quarter 3 as presented in the Performance Report at Appendix 1; and (ii) note the analysis of the local indicators as detailed in Appendix 1. 7. Update on the Delivery of the Unpaid Carers Strategy The meeting had before it a report by the Service Manager Provider Services informing Committee of the progress made towards achieving the objectives outlined in the Unpaid Carers Strategy. Following consideration the Committee unanimously agreed to:- (i) acknowledge the progress made in meeting the objectives of the Strategy; (ii) recognise the challenges faced regarding capacity in delivering key objectives to date outlined in paragraph 4.3; and (iii) instruct the Lead Officer for Unpaid Carers to provide quarterly updates to this Committee to monitor ongoing progress in implementing the Strategy. 8. Internal Audit Section - Update Report The meeting had before it a report by the Chief Internal Auditor providing Committee with an update on the work of the Internal Audit Section. In response to a question from the Chair asking what the process is for escalation of outstanding actions, the Chief Internal Auditor advised where implementation dates for particular recommendations require to be changed, Internal Audit agree a revised date with the service which is then communicated to the Head of Service and Chief Officer. In terms of transparency the revised date is then reported back to this Committee. As a further update from an operational perspective, the Chief Officer confirmed she had asked for an overview of all outstanding audit actions for regular consideration by senior management team to ensure there was oversight of implementation dates. Following consider the Committee unanimously agreed to note the contents of the report. 9. External Audit Plan for the Year Ending 2024-25 and Update on Recommendations from 2023-24 The meeting had before it a report by the Chief Financial Officer informing the Committee of the External Auditor's Annual Plan for 2024/25 and updating on the recommendations following last years' audit. Following consideration the Committee unanimously agreed to note the contents of the External Auditor's Annual Plan for 2024/25 attached as Appendix 1 and update on audit recommendations from 2023/24 attached as Appendix 3. 10. Internal Audit Plan Year Ending 31 March 2026 The meeting had before it a report by the Chief Internal Auditor providing the Committee with information on the proposed internal audit coverage for the 2025/26 financial year. Page 7
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Following consideration the Committee unanimously agreed the proposed audit coverage. 11. Moray Integrated Community Equipment Store Audit The meeting had before it a report by the Service Manager, Provider Services updating the Committee on the last audit completed by the Internal Audit Section for the Moray Integrated Community Equipment Store. Following consideration the Committee unanimously agreed to:- (i) note the outcome of the Internal Audit for the Moray Integrated Community Equipment Store; and (ii) note the work being undertaken to take forward the Audit Recommendations. 12. Internal Audit Section - Completed Projects - NHS Grampian Reviews [Para 6.2.5] The meeting had before it a report by the Chief Internal Auditor providing Committee with an update on the internal audit work completed on NHS Grampian systems and practices. Following consideration the Committee unanimously agreed to note the audit update. Page 8
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MEETING OF MORAY INTEGRATION JOINT BOARD AUDIT, PERFORMANCE AND RISK COMMITTEE THURSDAY 27 MARCH 2025 ACTION LOG Item No. Title of Report Action Required Due Date Action By Update for 19 June 2025 1. Q1 Performance Report Information to be provided about the support that is on offer to staff to help improve their wellbeing. 27 June 2024 Sean Coady/ Natalie Jeffrey Due to new template from Scottish Government, new HSCM H&S Delivery Plan and Workforce Delivery Plan now scheduled for later 2025. 2. Q2 Performance Report Chief Officer to issue email update with information relating to the rise in targets detailed in Emergency Admissions graphs in Appendix 1. TBC Chief Officer In Progress 3. Q3 (Oct-Dec 2024) Performance Report – Adult Services Paragraph 5.12 – include evidence in future reports of the effectiveness of the initiatives to address staff absence specifically relating to take-up and their impacts. 19 June 2025 Corporate Programme Manager Item 4. Page 9
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Item No. Title of Report Action Required Due Date Action By Update for 19 June 2025 4. Q3 Performance Report for Children and Families and Justice Social Work Chief Officer agreed to discuss with the Chair and Depute Chair of the Board the most suitable approach for Board to recommit to The Promise following transfer of Children’s Services from Council to MIJB. TBC Chief Officer Page 10
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REPORT TO: MORAY INTEGRATION JOINT BOARD AUDIT, PERFORMANCE AND RISK COMMITTEE ON 19 JUNE 2025 SUBJECT: QUARTER 4 (JANUARY - MARCH 2025) PERFORMANCE REPORT – ADULT SERVICES BY: CORPORATE PROGRAMME MANAGER 1. REASON FOR REPORT 1.1 To update the Committee on performance as at Quarter 4 2025 (January - March). 2. RECOMMENDATION 2.1 It is recommended that the Committee consider and note: i) the performance of local indicators for Quarter 4 (January to March 2025) as presented in the Performance Report at Appendix 1; ii) the analysis of indicators that have been highlighted and actions being undertaken to address performance that is outside of acceptable target ranges as detailed in Appendix 1; iii) the revised format of this report, which will continue to evolve in future reporting periods. It is noted that different service areas may be highlighted within each report, or as requested by the Board; and iv) the inclusion of supplementary service information in Appendix 2, which provides additional context and evidence to support the mitigations outlined in relation to the national outcomes. 3. BACKGROUND 3.1 The purpose of this report is to ensure the Moray Integration Joint Board (MIJB) fulfils its ongoing responsibility to ensure effective monitoring and reporting on the delivery of services and on the programme of work as set out in its Strategic Plan. 3.2 Appendix 1 identifies local indicators for the MIJB and the functions delegated by NHS Grampian and Moray Council, enabling broader scrutiny and assurance by the Board. Item 5. Page 11
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4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Local Indicators are assessed on their performance via a common performance monitoring Red, Amber, and Green (RAG) traffic light rating system. Some of these local indicators sit with acute, although can and do impact our whole system. RAG scoring based on the following criteria: GREEN If Moray is performing better than target. AMBER If Moray is performing worse than target but within agreed tolerance. RED If Moray is performing worse than target by more than agreed tolerance. 4.2 The detailed performance report for quarter 4 is attached in Appendix 1. Summary of Previously Agreed Indicators 4.3 Performance within Health and Social Care Moray (HSCM) as demonstrated by the agreed indicators up to the end of quarter 4 of the financial year 2024/25 are showing as not improving. Four indicators are presenting as green; one is amber and six are red. 4.4 Figure 1 provides a summary and the historical trends. A summary of performance for each of the 6 reporting categories is provided below. EMERGENCY DEPARTMENT - AMBER 4.5 There was an increase in the rate per 1,000 this quarter to 22.0. This is a slight increase the numbers presenting in the last 2 quarters but still below March 2024 and the data has been trending down since then despite the small increase in the most recent month. DELAYED DISCHARGES – RED 4.6 The number of delays at the quarter 4 snapshot is up again to 40, which is up from 33 in quarter 3 but down on the 43 recorded this time last year. 4.7 Bed days lost due to delayed discharges increased to 1,149 this quarter, up from quarter 3 but down from 1,501 in March 2024. EMERGENCY ADMISSIONS – GREEN 4.8 The rate of emergency occupied bed days for over 65s has reduced in the last three months to 2,412 this quarter and is still down on the high of 2,749 in quarter 4 2022/23. The emergency admission rate per 1000 population for over 65s has decreased this quarter to 177.8 which is well below target and the high in quarter 2 2023/24 of 189.9. Similarly, the number of people over 65 admitted to hospital in an emergency also had hit a high of 133.2 in quarter 2 2023/24 and despite an increase this quarter is below target at 125.7 in quarter 4 2024/25. HOSPITAL RE-ADMISSIONS - GREEN 4.9 The 7-day re-admissions have increased to just over target at 3.9%, and the 28-day re-admissions have decreased further to well below target at 7.4%. Page 12
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MENTAL HEALTH – RED 4.10 After an improvement in performance from 40% in January 2024 there has been little variation in performance through the rest of 2024 and into 2025 with 65% of patients now being referred within 18 weeks at the end of quarter 4 2024/25. STAFF MANAGEMENT – RED 4.11 Sickness absence for NHS employed staff has reduced to its lowest rate at 4.9% (end of Feb) at the end of quarter 4 2024/25. Council employed staff sickness has remained high at 8.2% albeit slightly lower compared to the same period last year. Page 13
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Figure 1 – Performance Summary Note: In order to match other national and local data sources indicators are showing the last month in the reporting quarter. Targets have been updated from Q1 2425 using average of activity for previous calendar year. *From May 2022, the census figures for April 2021 onwards include delays due to infection control measures in place at hospital (delay reason codes 26X and 46X) Page 14
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5. Areas Requiring Improvement Delayed Discharges - Red Situation 5.1 In March 2025, delayed discharges rose to 40 — significantly higher than the previous quarter but slightly below the Q4 2023/24 figure of 43. The average through the quarter was 37 but the figure remains above the Scottish Government target of 26 for Moray. Bed days occupied by delayed discharges increased to 1,149 (from 981), in line with the rise in delays. The primary cause of delayed discharges remain the delays in availability of care and support in the community, particularly in rural areas. 5.2 Community hospitals operated at 97.6% occupancy (Jan–Mar), with an average stay of 71.7 days. Although length of stay has improved, patient acuity remains high, increasing the risk of readmission, particularly among frail, elderly individuals. 5.3 Unmet need remains high at the end of Q4 with 31 people in hospital and 154 people in the community awaiting care amounting to 1,307 hours. The demand for care continues to exceed available resources. These figures overall reflect ongoing whole-system pressures. Mitigation and Impact • Daily multi-disciplinary meetings support real-time collaborative decision- making and system flow. • Surge beds were operational for 177 days (Nov–Mar), easing pressure on acute and community services. • Enhanced scrutiny: All discharges over 90 days are discussed and logged on Datix system with action plans in place. • The Strategic Care at Home workstream is focused on maximising care delivery within budget. • Innovation and digital solutions: the Digital Health Institute (Growth Deal) is researching technology-enabled care solutions to support independent living. • Discharge Without Delay programme, in collaboration with NHS Grampian and Health Intelligence Scotland is progressing with system wide actions to reduce delays for people medically fit for discharge: Phase One completed, including national self-assessment tool and action planning. • CQS payment changes have enabled provision of sustainable additional care hours. • Proportionate care and telecare options are being expanded. • Resource Allocation meetings are being redesigned for efficiency. • Improved care home flow has reduced waits for long-term placements. • Absence management is in place to stabilise workforce capacity. Page 15
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5.4 While challenges persist, targeted interventions and strategic programmes are in place to improve flow, reduce delays, and support people to live well at home. Mental Health – Red Situation 5.5 The demand for adult mental health and primary care psychological therapies continues to exceed capacity. Increasing decline in population mental health means that demand continues to outstrip resource with ongoing uncertainty in relation to primary care funding for psychological therapies delivery. Delayed discharges have improved, but complex cases remain difficult to place. Medical staffing remains a key risk and remains on the Sector Risk Register. Mitigation • Closer monitoring of waiting times is underway. • Group development and job planning aim to increase throughput and maximise capacity. • Ward model changes in Ward 4 (e.g., single consultant model) are improving patient flow. • Migration to a new reporting system (TRAK) will provide improved data reporting. Staff Management – Red Situation 5.6 NHS staff sickness absence has dropped to 4.9%, the lowest since April 2023 and approaching the 4% target. However, Moray Council staff sickness has increased to 8.2%, remaining significantly above target. 5.7 Over the past year, NHS Grampian (NHSG) staff within HSCM have consistently had higher absence rates than NHSG overall, peaking at 7.36% in July 2024. Common causes of absence remain mental health and musculoskeletal issues, with seasonal spikes in respiratory and gastrointestinal illnesses during winter months. Mitigation • Vaccination campaigns for flu and COVID-19 aim to reduce severity and duration of illness. • Workstation assessments (DSE) are promoted for desk-based staff, with ergonomic equipment provided as needed. • Wellbeing Initiatives are promoted throughout the organisation and its partners. NHS Grampian actively encourage the We Care website for staff access to health and wellbeing resources. These are often downloaded resources and are shared across HSCM. • Occupational Health Service to provide support for both physical and mental health issues. • Safe Staffing Tools are used daily to monitor and manage workload and reduce stress related absences in clinical areas. 5.8 There are a number of services that contribute to addressing some of the challenges faced across the system in relation to waiting lists for services or accessing support in the community and Appendix 2 contains a snapshot of Page 16
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impact achieved in relation to Community Appointment Days, Primary Care activity in hours and out of hours, Volunteers recruitment and Unpaid carers. 6. PERFORMANCE FRAMEWORK DEVELOPMENT 6.1 Following the approval of the Strategic Delivery Plan by the Moray Integration Joint Board (MIJB) on 29 May 2025 (para 8 of the draft minute refers), the review of the performance management framework is now underway, with the appointment of the Senior Performance Officer providing capacity to take this forward. 6.2 A refreshed set of performance indicators and reporting arrangements is being developed to: • Ensure robust monitoring and governance • Maintain a clear line of sight between activity and outcomes • Support delivery of the strategic priorities set out in the new plan 6.3 A strengthened performance framework will enable better decision-making, accountability, and continuous improvement across the partnership. 7. 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” Performance management reporting is a legislative requirement under section 42 of the Public Bodies (Joint Working) (Scotland) Act 2014. In addition to publishing an Annual Performance Report, the Moray Integration Scheme requires that the MIJB will “monitor the performance of the delivery of integrated services using the Strategic Plan on an ongoing basis” (para 5.2.2 of the Moray Integration Scheme refers). (b) Policy and Legal There are no new policy or legal implications arising directly from this report. The report is consistent with existing statutory duties and governance arrangements. (c) Financial implications There are no direct financial implications associated with this report. However, performance insights may inform future resource planning and prioritisation aligned with strategic objectives. (d) Risk Implications and Mitigation While there are no immediate risks arising from this report, the long-term impacts of COVID-19 on the health and social care system remain uncertain. The performance framework will continue to be reviewed and adapted to ensure responsiveness to emerging risks and system pressures. There is also a risk that the MIJB may not deliver on the outcomes set out in the Strategic Plan. Where such risks are identified, they will Page 17
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be escalated and presented to the Board for appropriate oversight and action. (e) Staffing Implications While there are no direct staffing implications arising from this report, it is important to acknowledge the ongoing challenges with recruitment and staff absence across health and social care services. These workforce pressures continue to impact the MIJB’s ability to deliver services in line with strategic objectives Recruitment difficulties, particularly in rural and specialist roles, combined with high levels of sickness absence in some areas, pose a significant operational risk. These issues are being monitored closely, are considered within workforce planning, and service redesign efforts. (f) Property There are no property implications directly associated with this report. (g) Equalities/Socio Economic Impact An Equality Impact Assessment (EIA) is not required for this report, as it does not introduce or amend any policy or service that would directly affect individuals with protected characteristics. However, performance data may be used to inform future service improvements that promote equity and inclusion. (h) Climate Change and Biodiversity Impacts There are no direct climate or biodiversity implications arising from this report. However, it is recognised that extreme weather events and rising energy costs may increasingly impact service delivery, particularly in rural areas. These factors will be considered in future strategic planning. (i) Directions No new directions are required as a result of this report. (j) Consultations Senior Management Team, Operational Management Team Health and Social Care, Caroline O’Connor, Committee Services Officer, Moray Council and their comments are incorporated in the report. 8. CONCLUSION 8.1 This report provides the MIJB with an overview of the performance of specified Local indicators, outlines actions being undertaken to improve performance in Section 4, and further expanded in Appendix 1. 8.2 In addition, Appendix 2 includes supplementary service performance data that offers further insight into operational activity and system pressures, supporting a more comprehensive understanding of current performance across the partnership. This performance report supports the MIJB’s ongoing commitment to transparency, continuous improvement, and delivery of the strategic outcomes set out in the Moray Strategic Plan. Authors of Report: Jeanette Netherwood, Corporate Programme Manager Page 18
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Sonya Duncan, Corporate Manager Background Papers: Available on request Page 19
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Appendix 1 PERFORMANCE REPORT SUPPORTING CHARTS QUARTER 4 2024/25 (1 JANUARY 2025 – 31 MARCH 2025) Page 20
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Table of Contents Health and Social Care Moray - 1 - 2022-23 Quarter 1 Performance Report 1. TABLE OF CONTENTS 1. Table of Contents ............................................................................................................................. 1 1. Performance Summary .................................................................................................................... 2 Barometer Overview ........................................................................................................................... 2 2. Delayed Discharge - RED .................................................................................................................. 3 DD-01: Number of delayed discharges (including code 9, Census snapshot, at end of quarter) ....... 3 DD-02: Number of Bed Days Occupied by Delayed Discharges per quarter (inc code 9) per 1000 18+ population .................................................................................................................................... 3 3. Emergency Admissions - GREEN ...................................................................................................... 5 EA-01: Rate of emergency occupied bed days for over 65s per 1000 population .............................. 5 EA-02: Emergency Admissions rate per 1000 population for over 65s .............................................. 6 EA-03: Number of people over 65 years admitted as an emergency in the previous 12 months per 1000 population .................................................................................................................................. 7 4. Emergency Department – AMBER .................................................................................................. 8 AE-01: ED Attendance rates per 1,000 population (All Ages) ............................................................. 8 5. Hospital Re-admissions - AMBER .................................................................................................... 9 HR-01: Percentage of Emergency Re-admissions to hospital within 7 days - Moray Patients ........... 9 HR-02: Percentage of Emergency Re-admissions to hospital within 28 days - Moray Patients ....... 10 6. Mental Health – RED ..................................................................................................................... 11 MH-01: Percentage of patients commencing Psychological Therapy Treatment within 18 weeks of referral ............................................................................................................................................... 11 7. Staff Management - RED ............................................................................................................... 12 SM-01: NHS Sickness Absence % of Hours Lost ................................................................................ 12 SM-02: Council Sickness Absence (% of Calendar Days Lost) ............................................................ 12 Appendix 1: Key and Data Definitions .................................................................................................. 14 RAG Scoring Criteria .......................................................................................................................... 14 Peer Group Definition ....................................................................................................................... 14 Appendix 2: Strategic Priorities............................................................................................................. 15 Appendix 3: National Health and Wellbeing Outcomes ....................................................................... 17 Page 21
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Performance Summary Health and Social Care Moray - 2 - 2022-23 Quarter 1 Performance Report 1. PERFORMANCE SUMMARY BAROMETER OVERVIEW Moray currently has 11 local indicators. Of these 4 are Green, one is Amber and 6 are Red. Figure 1 - Performance Summary Note: In order to match other national and local data sources indicators are showing the last month in the reporting quarter. Targets have been updated from Q1 2024/25 using average of activity for previous calendar year. MH and SM are LDP Standard Indicators and targets are set nationally so remain unchanged. Q4 2324 Q1 2425 Q2 2425 Q3 2425 Q4 2425 New Target Previous Target Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar (from Q1 2425) (from Q1 2324 or earlier) AE Accident and Emergency AE-01 A&E Attendance rate per 1000 population (All Ages) 22.6 21.5 22.6 19.7 22.0 21.9 21.7 A DD Delayed Discharges DD-01 Number of delayed discharges (including code 9) at census point 43 33 40 33 40 26 10 R DD-02 Number of bed days occupied by delayed discharges (including code 9) at census point 1501 922 1115 981 1149 850 304 R EA Emergency Admissions EA-01 Rate of emergency occupied bed days for over 65s per 1000 population 2509 2606 2603 2604 2412 2681 2320 G‚ EA-02 Emergency admission rate per 1000 population for over 65s 179.9 178.7 177.7 183.6 177.8 187 177 G‚ EA-03 Number of people over 65 years admitted as an emergency in the previous 12 months per 1000 population 125.8 124.2 123.8 127.5 125.7 131 121 G‚ HR Hospital Readmissions HR-01 % Emergency readmissions to hospital within 7 days of discharge 4.4% 3.6% 4.6% 3.1% 3.9% 3.7% 3.9% R HR-02 % Emergency readmissions to hospital within 28 days of discharge 8.3% 6.9% 8.9% 6.9% 7.4% 7.9% 8.4% G‚ MH Mental Health MH-01 % of patients commencing Psychological Therapy Treatment within 18 weeks of referral 57% 70% 60% 44% 65% no change 90% R SM Staff Management SM-01 NHS Sickness Absence (% of hours lost) 5.7% 7.0% 6.4% 7.0% 4.9% no change 4% R SM-02 Council Sickness Absence (% of days lost) 9.7% 7.5% 7.3% 7.3% 8.2% no change 4% R Health and Social Care Moray Performance Report Code Barometer (Indicator) RAG Page 22
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Delayed Discharge - RED Health and Social Care Moray - 3 - 2022-23 Quarter 1 Performance Report 2. DELAYED DISCHARGE - RED Trend Analysis The number of delays at the quarter 4 snapshot is up again to 40, which is up from 33 in quarter 3 but down on the 43 recorded this time last year. Bed days lost due to delayed discharges increased to 1,149 this quarter, up from quarter 3 but down from 1,501 in March 2024. WDD-01: NUMBER OF DELAYED DISCHARGES (INCLUDING CODE 9, CENSUS SNAPSHOT, AT END OF QUARTER) Purpose Reliably achieving timely discharge from hospital is an important indicator of quality and is a marker for person centred, effective, integrated, and harm free care. Strategic Priority 2: HOME FIRST Linked Indicator(s) DD-02 National Health & Wellbeing Outcomes 2, 3, 5, 7 Figure 2 – Delayed Discharges Indicator Trend – Increasing Source Public Health Scotland DD-02: NUMBER OF BED DAYS OCCUPIED BY DELAYED DISCHARGES PER QUARTER (INC CODE 9) PER 1000 18+ POPULATION Page 23
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Delayed Discharge - RED Health and Social Care Moray - 4 - 2022-23 Quarter 1 Performance Report Purpose This monitors the number of people delayed in hospital once medically fit for discharge. Longer stays in hospital are associated with increased risk of infection, low mood, and reduced motivation. Strategic Priority 2: HOME FIRST Linked Indicator(s) DD-01 National Health & Wellbeing Outcomes 2, 3, 5, 7 Figure 3 – Delayed Discharge Bed-days Indicator Trend – Increasing Source Public Health Scotland Page 24
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Emergency Admissions - GREEN Health and Social Care Moray - 5 - 2022-23 Quarter 1 Performance Report 3. EMERGENCY ADMISSIONS - GREEN Trend Analysis The rate of emergency occupied bed days for over 65s has reduced in the last three months to 2,412 this quarter and is still down on the high of 2,749 in quarter 4 2022/23. The emergency admission rate per 1000 population for over 65s has decreased this quarter to 177.8 which is well below target and the high in quarter 2 2023/24 of 189.9. Similarly, the number of people over 65 admitted to hospital in an emergency also had hit a high of 133.2 in quarter 2 2023/24 and despite an increase this quarter is below target at 125.7 in quarter 4 2024/25. EA-01: RATE OF EMERGENCY OCCUPIED BED DAYS FOR OVER 65S PER 1000 POPULATION Purpose EA-01, EA-02, and EA-03 are all interconnected and provide a narrative when viewed together of whether emergency admissions and bed days are within tolerance and indicate where potential risks could arise. Strategic Priority 1: BUILDING RESILIENCE Linked Indicator(s) EA-02, EA-03 National Health & Wellbeing Outcomes 1, 2, 3, 5 Figure 4 – Emergency Occupied Bed-days (Over 65s) Indicator Trend – Reducing Source Health Intelligence Page 25
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Emergency Admissions - GREEN Health and Social Care Moray - 6 - 2022-23 Quarter 1 Performance Report EA-02: EMERGENCY ADMISSIONS RATE PER 1000 POPULATION FOR OVER 65S Purpose EA-01, EA-02, and EA-03 are all interconnected and provide a story when viewed together of whether emergency admissions and bed days are within tolerance and indicate where potential risks could arise. Strategic Priority 1: BUILDING RESILIENCE Linked Indicator(s) EA-01, EA-03 National Health & Wellbeing Outcomes 1, 2, 3, 5 Figure 5 – Emergency Admissions (Over 65s) Indicator Trend – Steady Source Health Intelligence Page 26
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Emergency Admissions - GREEN Health and Social Care Moray - 7 - 2022-23 Quarter 1 Performance Report EA-03: NUMBER OF PEOPLE OVER 65 YEARS ADMITTED AS AN EMERGENCY IN THE PREVIOUS 12 MONTHS PER 1000 POPULATION Purpose EA-01, EA-02, and EA-03 are all interconnected and provide a story when viewed together of whether emergency admissions and bed days are within tolerance and indicate where potential risks could arise. Strategic Priority 1: BUILDING RESILIENCE Linked Indicator(s) EA-01, EA-02 National Health & Wellbeing Outcomes 1, 2, 3, 5 Figure 6 – Number of Over 65 People Emergency Admissions Indicator Trend – Increasing Source Health Intelligence Page 27
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Emergency Department – AMBER Health and Social Care Moray - 8 - 2022-23 Quarter 1 Performance Report 4. EMERGENCY DEPARTMENT – AMBER Trend Analysis There was an increase in the rate per 1,000 this quarter to 22.0. This is a slight increase the numbers presenting in the last 2 quarters but still below March 2024 and the data has been trending down since then despite the small increase in the most recent month. AE-01: ED ATTENDANCE RATES PER 1,000 POPULATION (ALL AGES) Purpose A greater system-wide understanding of how people access emergency care, and why certain choices are made, will allow local health systems to develop intelligence about avoidable attendances at emergency departments and target their responses. Strategic Priority 3: PARTNERS IN CARE Linked Indicator(s) HR-01, HR-02 National Health & Wellbeing Outcomes 1, 2, 3, 5 Figure 7 – ED Attendance Rate Indicator Trend – Decreasing Source Health Intelligence Page 28
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Hospital Re-admissions - AMBER Health and Social Care Moray - 9 - 2022-23 Quarter 1 Performance Report 5. HOSPITAL RE-ADMISSIONS - AMBER Trend Analysis The 7-day re-admissions have increased to just over target to 3.9%, and the 28-day re-admissions have decreased further to well below target at 7.4%. HR-01: PERCENTAGE OF EMERGENCY RE-ADMISSIONS TO HOSPITAL WITHIN 7 DAYS - MORAY PATIENTS Purpose Re-admissions are often undesirable for patients and have also been shown to be associated with the quality of care provided to patients at several stages along the clinical pathway, including during initial hospital stays, transitional care services and post-discharge support. Strategic Priority 1: BUILDING RESILIENCE Linked Indicator(s) HR-02, AE-01 National Health & Wellbeing Outcome 1, 2, 3, 5 Figure 8 – 7-dayEmergency Readmissions Indicator Trend – Stable Source Health Intelligence Page 29
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Hospital Re-admissions - AMBER Health and Social Care Moray - 10 - 2022-23 Quarter 1 Performance Report HR-02: PERCENTAGE OF EMERGENCY RE-ADMISSIONS TO HOSPITAL WITHIN 28 DAYS - MORAY PATIENTS Purpose Re-admissions are often undesirable for patients and have also been shown to be associated with the quality of care provided to patients at several stages along the clinical pathway, including during initial hospital stays, transitional care services and post-discharge support. (This measure lags by a month due to the time required for a potential 28 day discharge to occur) Strategic Priority 1: BUILDING RESILIENCE Linked Indicator(s) HR-01, AE-01 National Health & Wellbeing Outcome 1, 2, 3, 5 Figure 9 – 28-day Emergency Readmissions Indicator Trend – Decreasing Source Health Intelligence Page 30
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Mental Health – RED Health and Social Care Moray - 11 - 2022-23 Quarter 1 Performance Report 6. MENTAL HEALTH – RED Trend Analysis After an improvement in performance from achieving a low 40% in January 2024 there has been little variation in performance through the rest of 2024 and into 2025 with 65% of patients now being referred within 18 weeks at the end of quarter 4 2024/25. MH-01: PERCENTAGE OF PATIENTS COMMENCING PSYCHOLOGICAL THERAPY TREATMENT WITHIN 18 WEEKS OF REFERRAL Purpose Timely access to healthcare is a key measure of quality and that applies equally in respect of access to mental health services. Strategic Priority 3: PARTNERS IN CARE Linked Indicator(s) National Health & Wellbeing Outcome 1, 2, 3, 5 Figure 10 – Psychological Therapy Treatment within 18 Weeks Indicator Trend – Steadily decreasing Source Health Intelligence Page 31
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Staff Management - RED Health and Social Care Moray - 12 - 2022-23 Quarter 1 Performance Report 7. STAFF MANAGEMENT - RED Trend Analysis Sickness absence for NHS employed staff has reduced to 4.9% (end of Feb) at the end of quarter 4 2024/25. Council employed staff sickness has remained high at 8.16% which is still low when compared last year. SM-01: NHS SICKNESS ABSENCE % OF HOURS LOST Purpose Attendance at work of all employees is essential in the interests of the effective and efficient operation of services. Strategic Priority 1: BUILDING RESILIENCE Linked Indicator(s) SM-02 National Health & Wellbeing Outcome 8 Figure 11 – NHS Sickness Absence Indicator Trend – Steadily increasing Source Health Intelligence SM-02: COUNCIL SICKNESS ABSENCE (% OF CALENDAR DAYS LOST) Purpose Attendance at work of all employees is essential in the interests of the effective and efficient operation of services. Strategic Priority 1: BUILDING RESILIENCE Linked Indicator(s) SM-01 National Health & Wellbeing Outcome 1, 2, 3, 5 Page 32
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Staff Management - RED Health and Social Care Moray - 13 - 2022-23 Quarter 1 Performance Report Figure 12 – Moray Council Sickness Absence Indicator Trend – Decreasing but high Source Council HR Page 33
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Staff Management - RED Health and Social Care Moray - 14 - 2022-23 Quarter 1 Performance Report APPENDIX 1: KEY AND DATA DEFINITIONS RAG SCORING CRITERIA GREEN If Moray is performing better than target. AMBER If Moray is performing worse than target but within specified tolerance. RED If Moray is performing worse than target but outside of specified tolerance. PEER GROUP DEFINITION Moray is defined as being in Peer Group 2 in the Local Government Benchmarking Framework Family Group 1 Family Group 2 Family Group 3 Family Group 4 East Renfrewshire East Dunbartonshire Aberdeenshire Edinburgh, City of Perth & Kinross Aberdeen City Shetland Islands Orkney Islands Moray Stirling East Lothian Angus Scottish Borders Highland Argyll & Bute Midlothian Falkirk Dumfries & Galloway Fife South Ayrshire West Lothian South Lanarkshire Renfrewshire Clackmannanshire Eilean Siar Dundee City East Ayrshire North Ayrshire North Lanarkshire Inverclyde West Dunbartonshire Glasgow City Page 34
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Staff Management - RED Health and Social Care Moray - 15 - 2022-23 Quarter 1 Performance Report APPENDIX 2: STRATEGIC PRIORITIES Page 35
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Staff Management - RED Health and Social Care Moray - 16 - 2022-23 Quarter 1 Performance Report •EA-01: RATE OF EMERGENCY OCCUPIED BED DAYS FOR OVER 65S PER 1000 POPULATION •EA-02: EMERGENCY ADMISSIONS RATE PER 1000 POPULATION FOR OVER 65S •EA-03: NUMBER OF PEOPLE OVER 65 YEARS ADMITTED AS AN EMERGENCY IN THE PREVIOUS 12 MONTHS PER 1000 POPULATION •HR-01: PERCENTAGE OF EMERGENCY RE-ADMISSIONS TO HOSPITAL WITHIN 28 DAYS - MORAY PATIENTS •HR-02: PERCENTAGE OF EMERGENCY RE-ADMISSIONS TO HOSPITAL WITHIN 7 DAYS - MORAY PATIENTS •SM-01: NHS SICKNESS ABSENCE % OF HOURS LOST •SM-02: COUNCIL SICKNESS ABSENCE (% OF CALENDAR DAYS LOST) BUILDING RESILIENCE •DD-01: NUMBER OF DELAYED DISCHARGES (INCLUDING CODE 9, CENSUS SNAPSHOT, AT END OF QUARTER) •DD-02: NUMBER OF BED DAYS OCCUPIED BY DELAYED DISCHARGES PER QUARTER (INC CODE 9) PER 1000 18+ POPULATION •UN-01: NUMBER OF LONG-TERM HOME CARE HOURS UNMET AT WEEKLY SNAPSHOT •UN-02: NUMBER OF PEOPLE WITH LONG-TERM CARE HOURS UNMET AT WEEKLY SNAPSHOT HOME FIRST •OA-01: NUMBER OF REVIEWS OUTSTANDING AT END OF QUARTER SNAPSHOT •MH-01: PERCENTAGE OF PATIENTS COMMENCING PSYCHOLOGICAL THERAPY TREATMENT WITHIN 18 WEEKS OF REFERRAL •AE-01: A&E ATTENDANCE RATES PER 1000 POPULATION (ALL AGES) PARTNERS IN CARE Page 36
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Staff Management - RED Health and Social Care Moray - 17 - 2022-23 Quarter 1 Performance Report APPENDIX 3: NATIONAL HEALTH AND WELLBEING OUTCOMES 1 - PEOPLE ARE ABLE TO LOOK AFTER AND IMPROVE THEIR OWN HEALTH AND WELLBEING AND LIVE IN GOOD HEALTH FOR LONGER. 2 - PEOPLE, INCLUDING THOSE WITH DISABILITIES OR 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. 3 - PEOPLE WHO USE HEALTH AND SOCIAL CARE SERVICES HAVE POSITIVE EXPERIENCES OF THOSE SERVICES, AND HAVE THEIR DIGNITY RESPECTED. 4 - 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 AND SOCIAL CARE SERVICES CONTRIBUTE TO REDUCING HEALTH INEQUALITIES. 6 - 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 WELLBEING. 7 - PEOPLE USING HEALTH AND SOCIAL CARE SERVICES ARE SAFE FROM HARM. 8 - 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 - RESOURCES ARE USED EFFECTIVELY AND EFFICIENTLY IN THE PROVISION OF HEALTH AND SOCIAL CARE SERVICES. Page 37
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APPENDIX 2 Supplementary Service Data Supporting Performance Mitigations Allied Health Professionals (AHP) Performance Community Appointment Days (CAD) Waiting lists for AHP services were at unprecedented levels post Covid-19 due to demand and backlog. Waiting List Pre CAD Post CAD Physiotherapy 262 138 Podiatry 267 172 The Putting People First Framework supports NHSG’s Plan for the Future, aiming to create a sustainable healthcare system over the next 10 years. The Framework details the need to test and deliver innovative Community Led Health approaches, with CADs being a recommendation. The aim of the CAD is to enhance both patient and staff experience, by moving away from treatment led care, aligning with and promoting a holistic and Realistic Medicine approach; giving those invited to attend the opportunity to discuss what matters to them most. Mitigation Results from the first CAD: Podiatry CAD • 48 patients attended Outcomes: • 48 completed patient passports • 8 discharged on the day • 9 follow up appointments booked • 31 placed on patient-initiated review (PIR) • Total discharges: 39 • After 6 months 6 patients contacted service following PIR MSK Physiotherapy CAD • 91 appointments made, 79 attended Outcomes: • 87 completed patient passports • 14 discharged on the day • 34 follow-up appointments booked • 31 placed on patient-initiated review • Total discharges: 45, significantly reducing the waiting list (Patient passports are a record of information that is important to the person, not necessarily clinical information) Page 38
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CADs are proving effective in reducing waiting lists and improving patient satisfaction. They align with national policy and local strategic goals for sustainable, community-based care. CADs will continue to be rolled out across services, supporting: • Locality-based care • Reduced waiting times • Enhanced patient experience • Alignment with the Moray Health and Social Care Partnership’s strategic priorities Feedback Received: “Today was so much more than getting my foot looked at. Whoever did this pilot deserves a medal- the whole experience has been brilliant for me… I am buzzing – thank you everyone” “I got lots of information which has helped with my confidence, motivation and mental health” Primary Care Situation December was the busiest month for Primary Care in Grampian. In-hours activity in Moray is among the highest in Scotland, with 836 direct encounters per 1,000 population, compared to the national average of 512. Area Total encounters per 1000 Direct encounters per 1000 Aberdeen City 1806 480 Aberdeenshire 2029 569 Moray 2025 836 Grampian 1967 579 Scotland 1357 512 Out-of-hours (OOH) consultations dropped by 9% year-on-year and 4% compared to the 2024 average. A&E attendances fell by 3% year-on-year and are 0.4% below the 2024 average. These reductions contrast with rising national trends, suggesting that high in-hours activity is effectively alleviating pressure on urgent and emergency services. Moray’s strong in-hours performance is helping reduce demand on OOH and A&E services, demonstrating the value of accessible, timely primary care. However, while primary care continues to demonstrate resilience and high levels of activity, it is important to acknowledge that not all aspects are without concern. Challenges around GP recruitment, retention, and increasing workload pressures remain significant and may impact service sustainability in the near future. Mitigation Page 39
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• Primary Care Improvement Plans and workstreams to support Primary Care In Hours activity are ongoing. • The GP Vision Programme is proposing plans to shape future sustainability. • A pan-Grampian application has been submitted for a Hospital at Home pathway (PATH – Preventing Admissions and Transitioning Home), which will: • Expand existing teams • Support early discharge and admission avoidance • Align with strategic priorities of HSCM, MIJB, and NHS Grampian, and the Grampian GP Vision programme. Primary Care Out of Hours (GMED) Update In 2024, GMED managed 107,608 cases, representing a 4% reduction in demand compared to 2023 (112,148 cases). This activity included: • 58,634 advice calls • 34,656 centre consultations • 11,128 home visits • 3,190 mental health advice calls Despite the recent decline, overall GMED activity has increased by 35.6% since 2020, reflecting sustained pressure on primary care services. The busiest locations in Moray remain Elgin, Forres, and Buckie. Moray, with a population of approximately 95,700, accounted for 24,329 contacts in 2024, 22.6% of all GMED activity. This highlights the significant reliance on out-of- hours services within the locality. Impact on Secondary Care GMED continues to play a critical role in managing demand and acting as a gatekeeper to secondary care. In 2024, 6,049 patients were admitted to hospital via GMED — a 19.5% decrease from 2023 (7,510 admissions) and a 31.4% reduction compared to pre-COVID levels in 2019 (8,822 admissions). GMED’s ability to manage increasing demand while reducing hospital admissions demonstrates its effectiveness in supporting system flow, reducing pressure on acute services, and aligning with the strategic aim of delivering the right care in the right place at the right time. Volunteers Situation Between January and March 2025, 231 volunteers contributed 4,105 hours of support across hospitals, The Oaks Palliative Centre, and community settings. Volunteers are a valued part of our workforce, contributing meaningfully to patient and community wellbeing. Despite national trends showing a decline in formal Page 40
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volunteering (18% participation in the 2023 Scottish Household Survey), Moray has maintained exceptional retention rates: • 84.89% (2022–2023) • 90.68% (2023–2024) • This far exceeds national averages and reflects strong engagement and satisfaction. Departures were for positive reasons such as employment or retirement. Volunteer milestones (2024–2025): • 9 volunteers reached 3 years of service • 4 reached 5 years • 7 reached 10 years • 10 volunteers progressed into healthcare careers High retention and progression into healthcare careers demonstrate the strategic value of volunteering in workforce development, community resilience, and citizen engagement. Volunteering in 2023 - Findings from the Scottish Household Survey Mitigation • All volunteers undergo robust induction, PVG checks, and sign confidentiality agreements. • Risk assessments are in place for all environments. • Oversight is maintained at both local and pan-Grampian levels. • Staff-side and union partners are engaged to ensure appropriate use and support of volunteers. • Ongoing recruitment campaigns are in place to sustain the programme. • Strategic alignment: Volunteering supports the Moray Health and Social Care Partnership’s goals of enhancing community-based care, building local capacity, and improving outcomes for citizens through meaningful engagement. Unpaid Carers Situation Unpaid carers are recognised as a vital part of the health and social care system. Support for carers is delivered in partnership with Quarriers, who provide Adult Carer Support Plans (ACSPs) and Young Carer Statements (YCSs). Below is the data for Quarriers Unpaid carer assessments. Quarriers Adult carer support plan Young carer statements Apr-Jun 24 38 21 Jul-Sep 24 21 13 Oct-Dec 24 33 15 Jan-Mar 25 41 11 Totals 133 60 Page 41
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In Q4, 41 ACSPs were completed, with an additional 4 awaiting authorisation, the highest quarterly total in year. This reflects improved capacity and responsiveness in identifying and supporting unpaid carers. Timely identification and support of unpaid carers is essential to sustaining caring roles and preventing carer breakdown, which directly supports the strategic aim of enabling people to live well at home and in their communities. Mitigation A variation to the contract with Quarriers was implemented on 1st January 2025, however, due to recruitment challenges, the transition will only start to realise the benefits in the next quarter. Responsibility for completing ACSPs and YCSs will transfer from Quarriers to a newly appointed Social Worker (Unpaid Carers). This change will: • Allow Quarriers to focus on direct support for carers of all ages • Improve efficiency and consistency in assessment delivery • Strengthen alignment with statutory duties under the Carers (Scotland) Act 2016 Strategic alignment: This transition supports the Partnership’s commitment to early intervention, prevention, and person-centred care. Page 42
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REPORT TO: MORAY INTEGRATION JOINT BOARD AUDIT, PERFORMANCE AND RISK COMMITTEE ON 19 JUNE 2025 SUBJECT: QUARTER 4 (JANUARY TO MARCH 2025) PERFORMANCE REPORT FOR CHILDREN AND FAMILIES AND JUSTICE SOCIAL WORK BY: INTERIM CHIEF SOCIAL WORK OFFICER/HEAD OF SERVICE 1. REASON FOR REPORT 1.1 To inform the Committee on Children and Families and Justice Social Work performance as at Quarter 4 (January to March 2025). 2. RECOMMENDATIONS 2.1 It is recommended Committee scrutinises and notes: i) the performance of local indicators for Quarter 4 as presented in the Performance Report at Appendix 1; and ii) the analysis of the local indicators as detailed in Appendix 1. 3. BACKGROUND 3.1 The purpose of this report is to inform Moray Integration Joint Board (MIJB) of the quarterly performance data which provides the analysis of the delivery of Children, Families and Justice Social Work services. 3.2 Appendix 1 identifies local indicators for the MIJB and the functions delegated by NHS Grampian and Moray Council for Children, Families and Justice Social Work services to allow wider scrutiny by the Board. 4. SUMMARY 4.1 Work is underway to develop and agree the refresh of Moray’s key performance indicators to enable recording of local data and measures set against the national performance indicators. 4.2 Appendix 1 provides a summary and the historical trends: • Child Protection activity • Looked after Children • Justice and Youth Justice Item 6. Page 43
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4.3 Statistics for Child Protection activity are provided against the academic calendar which runs from August to July annually. This is because this data is gathered and analysed by the Children’s Services Partnership and reported to the Child Protection Committee (CPC) through the Child Protection Minimum Data Set. Appendix 1 begins with Child Protection Q2 from page 1 to 11, Financial Q4 data is from page 12 to 31. Any trends or anomalies in this data are considered through the CPC Data Sub-group and reported accordingly. 4.4 Statistics for Looked After Children, Justice and Youth Justice are reported over the financial year which runs from April to March which is the reporting calendar for this data. A summary of performance for each of the reporting categories is provided below. Child Protection activity 4.5 At the end of this Child Protection (CP) Quarter 2, 60 children were registered on the North East Child Protection Register (NECPR). There is no reliable way of comparing data with other areas before this information is officially published nationally. The data for Moray can be considered and interrogated against the trends over previous years until national data is published. Looked After Children 4.6 At the end of Financial (Fin) Quarter 4, the number of looked after children is 171. This includes 6 New Scots (formally Unaccompanied Asylum-Seeking Children (UASC)) and 5 children who are cared for on a part time basis (Short Breaks). 4.7 92.7% (51/55) of children in foster care are cared for by Moray Council foster carers. The Carer Recruitment Campaign continues to focus on recruitment of foster carers and supported lodgings carers. Resultantly, there has been increased capacity to have children and young people cared for by Moray Council foster carers. Thus, reducing the need to purchase external agency care. The Carer Recruitment Campaign is continuing where it is anticipated that the use of in-house carers will increase. 4.8 The target for children living with kinship carers is adjusted annually to the average of comparator authorities which was 28% for 2022/23 (this is a more than target based on the assumption Kinship care is preferable, where it is safe and appropriate, to non-family care). Currently 22.9% of looked after children in Moray are in approved Kinship care with family members. Moray is currently 5.1% below this average. Resultantly, work is being undertaken to strengthen practice, ensuring children, at the point of allocation, have a holistic extended family map produced, regularly updated, providing clear information on Kinship care options in the event short breaks or alternative care may be necessary in the future. 4.9 19.8% (34/171) of Looked After Children are cared for in residential care. The target for this indicator (this is a less than target based on the assumption foster care and kinship care will be the preferred option when it is safe and appropriate, where possible) is adjusted annually to the average of comparator authorities (17.5% for 2022/23). This figure includes five young people who are cared for on a part-time (short breaks) basis. For illustrative purposes on performance, excluding those who have short breaks (children and young people who are in the care of their families) the figure is 16.9% (29/171) which is 0.6% lower than the average of comparator authorities. Page 44
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However, in common with most of the comparator local authorities, Moray is higher than the Scotland national average percentage of 10%. 4.10 86% of brothers and sisters remain together in care. The Maintaining Relationships Project is developing an approach and policy to ensure brothers and sisters can remain together as far as possible and where this is their assessed needs. Due to resource limitations, this is much more difficult to achieve when there is need to accommodate large family groups. 4.11 For New Scots, Moray has not adopted the residential homes model used by other local authorities. Moray’s model comprises of a combination of local authority housing and supported lodgings care and support. As such, the uncertainty regarding the future numbers of New Scots should not have an impact on residential care capacity for Moray. 4.12 Statistically it is difficult to ascertain how other authorities record their numbers as the level of detail is not readily available. While nationally significant, the numbers of looked after children are comparatively small which means percentage baselines do not always provide meaningful comparison. An example of this is that in Moray, all New Scots and Short-term breaks are included within Looked After numbers. Not all comparator authorities do this, so an exercise is being undertaken to consider what is being recorded by them. Justice and Youth Justice 4.13 At the end of Financial (Fin) Quarter 4, there were 539 people supported by Justice and Youth Justice Services of whom 46 are “care experienced” young people (CEYP), Youth Justice 15 and Justice 31. 4.14 Overall, the number of CEYP in Justice and Youth Justice Social Work has been on a reducing trend from 13% at the end of March 2021 to 8.5% at the end of Fin Quarter 4. There has been a slight increase of 0.12% from Fin Quarter 3 and work continues to identify and support care experienced young people in these services, to offer early support where possible and reduce the risk of re-offending. 4.15 Most individuals supported by Youth Justice and Justice Social Work are male (86.5% Justice Social Work, 83.7% Youth Justice). Gender responsive support is offered to females taking account of research and data indicating women in the justice system are more likely to have experienced trauma and more likely to be a sole carer of a child or family member. 4.16 The Justice Social Work Service submitted 100% of reports to Court by their due date. This includes requests from Moray’s local Court and nationally. 5. KEY MATTERS RELEVANT TO RECOMMENDATION 5.1 Detailed charts and performance indicator data is attached in Appendix 1. 6. 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” Page 45
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This report notes that a review of key performance indicators is currently being developed in respect of the wider service functions that will align with key priority areas across the Children’s Services partnership. (b) Policy and Legal None arising as a direct result of this report. (c) Financial implications None arising as a direct result of this report. (d) Risk Implications and Mitigation None arising as a direct result of this report. (e) Staffing Implications There are no proposed changes to the staffing or reporting relationships. (f) Property None arising as a direct result of this report. (g) Equalities/Socio Economic Impact None arising as a direct result of this report. (h) Climate Change and Biodiversity Impacts None arising as a direct result of this report. (i) Directions None arising as a direct result of this report. (j) Consultations Children, Families and Justice Social Work Senior Management Team. 7. CONCLUSION 7.1 This report provides Committee with an overview of the performance of specified local and National indicators. Author of Report: Jim Lyon, Interim Chief Social Work Officer/Head of Service Background Papers: Appendix 1 Page 46
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APPENDIX 1 1 | P a g e CHILDREN & FAMILIES AND JUSTICE SOCIAL WORK - QUARTER 4 (JAN-MAR 2025) PERFORMANCE REPORT PLEASE NOTE THIS REPORT IS SPLIT INTO TWO SECTIONS. THE FOLLOWING SECTION USES THE ACADEMIC CALENDAR (1 AUG – 31 JULY). THE INFORMATION PRESENTED REPRESENTS CHILD PROTECTION (CP) QUARTER 2 WHICH IS LATEST AVAILABLE DATA (NOV 2024 - JAN 2025). At the end of the CP Quarter 2, 643 contacts, enquiries and referrals were made to the Access Team for 573 children (as per graph 1). Graph 1: CP Quarter 2 - Referrals received by Access Team The potential referral routes are Social Work, SCRA, Police, Courts, Education, Health, 3rd Sector, community, family and young person. When a referral has been received it can be categorised as: IRD – immediate child protection concerns. Enquiry – information gathering to determine next steps (if any). Assessment of need – team will conduct a child in need assessment. Number of contacts, enquiries and referrals can be more than the number of children, as they can come from a range of sources about the same child. Future reporting shall identify accepted referrals which is the key process for consideration of the need for follow up actions. Pie chart 1: Sources of referral 201 183 259 172 160 241 0 50 100 150 200 250 300 Nov-24 Dec-24 Jan-25 Referrals Referrals: No. in last month Referrals: No of children Page 47
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APPENDIX 1 2 | P a g e In CP Quarter 2, 31.6% of referrals were from the Police (204), followed by Education 23.4% (151), Family and Community 17.5% (113), Health and Social Work 17.2% (111), and 9.9% coming from other professionals (64) (as per pie chart 1). Where the number of referrals is higher than the number of children, this can be attributed to the fact there can be multiple sources of referrals about a child (e.g. Health, Education and Police). This potentially reflects consistent thresholds across the partnership. There has been a 30% increase in referrals from education since CP Quarter 1. The Service Manager is discussing this with Quality Improvement Manager in Education, to agree actions for clarity on the threshold of need, support to families at the right time from the right service and to understand the increase in more detail. Graph 2: IRDs and number of children subject to an IRD Graph 2 shows the quarterly trend in IRDs (between 1 Aug 2023 and 31 Jan 2025). In CP Quarter 2, 66 children were involved in 40 IRDs. Of the 66 children, five had been subject to two or more IRDs throughout this quarter (7.59%). For each quarter, the number of children is greater than the number of IRDs as each IRD can consider multiple children within a family. 204 151 113 111 64 Sources of Referral Police Education Family & Community Health and Social Work Other Agency 66 65 63 47 47 40 125 105 89 84 64 66 0 20 40 60 80 100 120 140 Q1 Q2 Q3 Q4 Q1 Q2 No. of IRDs and Children involved No. of IRDs held in Quarter No. of Children involved Page 48
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APPENDIX 1 3 | P a g e An interagency referral discussion (IRD) is a co‑ordinated inter-agency protective process until the point a child protection planning meeting (CPPM) is held, or until a decision is made that such a meeting is not required or alternative action is required. Pie chart 2: Main reasons for IRD As per chart above, throughout CP Quarter 2, physical assault remains a consistent reason for an IRD being held (27, 40.9%), followed by child sexual exploitation (12, 18.1%), sexual assault (11, 16.6%), domestic abuse (8, 12.1%), mental health (4, 6.%), neglect (2, 3%), child criminal exploitation (1, 1.5%) and other (1, 1.5%). Pie chart 3: Child protection concerns 27 12 11 8 4 2 1 1 Reasons for IRD Physical Assault Child Sexual Expl Sexual Assault Domestic Abuse Mental Health Neglect Child Criminal Expl Other reason Page 49
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APPENDIX 1 4 | P a g e During CP Quarter 2, Parental Drug Use, Domestic Abuse, Neglect, and Child affected by parent or carer mental ill health, are the main child protection concerns. *Note there may be more than one concern documented for each child. Following the IRDs, six Initial Child Protection Planning Meetings were convened, and 28 Joint Investigative Interviews were requested. Graph 3: Joint Investigative Interviewing Graph 3 shows the trend across the years 2023/25 for joint investigative interviews and Scottish Child Investigative Interviews. Graph 4 – JII & SCIM 24 23 23 16 11 7 5 4 3 2 CP Concerns as at 31 Jan 25 Parental Drug Misuse Domestic Abuse Neglect Child Affected by Parent/Carer Mental Ill- HealthEmotional Abuse Other Concern(s) Services Finding It Hard to Engage Parental Alcohol Misuse 16 26 9 12 12 9 7 7 13 10 4 7 9 7 11 5 12 13 22 8 11 9 6 7 7 13 9 4 7 9 7 11 5 12 3 4 1 1 3 0 0 0 0 1 0 0 0 0 0 0 0 0 5 10 15 20 0 5 10 15 20 25 30 JIIs using Scottish Child Interview Model (SCIM) JII: No. of children subject to a JII as decision of IRD JII: No. of JII by SCIM as decision of IRD JII: No. of JII by 5 day process as decision of IRD JII: No. of children who declined/or did not complete JII JIIs: No. of SCIM JIIs undertaken Page 50
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APPENDIX 1 5 | P a g e Graph 4 shows the activity of Joint Investigative Interviewing across CP Quarter 2, during which 28 children were recommended for Joint Investigative Interview (JII); 18 SCIM JIIs were completed and ten children either declined or a different form of interview was carried out. Graph 5: Initial Child Protection Planning Meetings Graph 5 shows the trend across the last three reporting years (2021 - 2025) for the number of Initial and Pre-birth Child Protection Planning Meetings, and the number of children. The number of children subject to CPPMs is higher than the number of meetings held, due to some meetings considering sibling groups. 7 9 7 11 5 12 7 9 7 11 5 12 3 1 2 4 3 3 4 8 5 7 2 9 0 2 4 6 8 10 12 14 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 JIIs using SCIM JII: No. of children subject to a JII as decision of IRD JII: No. of JII by SCIM as decision of IRD JII: No. of JII by 5 day process as decision of IRD JII: No. of children who declined/or did not complete JII 0 5 10 15 20 25 30 35 40 45 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Aug- Oct Nov- Jan Feb- Apr May- Jul Aug- Oct Nov- Jan Feb- Apr May- Jul Aug- Oct Nov- Jan Feb- Apr May- Jul Aug- Oct Nov- Jan Feb- Apr May- Jul 2021/22 2022/23 2023/24 2024/25 No. of children and ICPPMs and Pre-Birth CPPMs Number of children subject to Initial and Pre-Birth CPPMs Number of Initial and Pre-Birth CPPMs Page 51
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APPENDIX 1 6 | P a g e At the end of CP Quarter 2, six Initial and Pre-birth Child Protection Planning Meetings were held for ten children, all of whom were placed on the register. Graph 6: Conversions from IRD to ICCPM Graph 6 above shows the trend from 2021 through to 2025 and specifically CP Quarter 2, where the conversion rate from ICPPM to Child Protection Registration was 100%. A small percentage of children discussed in IRDs progress to ICPPM as the focus must be supporting parents and carers to create safety for their children. This requires periodic review to ensure IRDs are operating effectively as they are resource intensive. There must be clear understanding of the reasons IRDs are being held, for example, large numbers of IRDs resulting in very small numbers of investigations present potential risks in responding to children in greatest need of protection. 8 18 16 25 8 10 22 18 25 39 19 14 34 15 100 77 94 91 75 73 45 78 78 83 94 75 100 100 0 20 40 60 80 100 120 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Aug- Oct Nov-JanFeb-AprMay-Jul Aug- Oct Nov-JanFeb-AprMay-Jul Aug- Oct Nov-JanFeb-AprMay-Jul Aug- Oct Nov-Jan 2021/22 2022/23 2023/24 2024/2 Conversion Rate % IRD to Initial and Pre-Birth CPPMs % Initial and Pre-Birth CPPMs to Registration 644 referrals 40 IRDs 6 ICPPMs The conversion rate from referral to IRD is 6.2% The conversion rate from IRD to ICPPM is 15% Page 52
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APPENDIX 1 7 | P a g e During CP Quarter 2, there were 19 Review Child Protection Planning Meetings (RCPPM) held for 38 children, where their circumstances were reviewed with their families, lead professionals and independent advocates, to assess if the identified risks had been sufficiently reduced to consider removing the child’s name from the register. As above, referrals from education colleagues have increased, prompting discussions to better understand this trend. Collaboration with partner agencies is essential to ensure timely and appropriate support is available. Early support aims to prevent unnecessary escalation to the threshold for social work involvement and ensure referrals are directed to the most suitable sources of support. Graph 7: Child Protection Registration Trends The trend is depicted across Graph 7 from 2021 - 2025 and shows in CP Quarter 2, that 19 children were de-registered and ten new children were registered. This meant at the end of CP Quarter 2, the number of children who were on the Child Protection Register (CPR) had decreased by nine (from 69 to 60). We have recently amended the process for decision making at Child Protection Planning Meetings to enable the chairperson to exercise their independent status regarding the final decision whether the child meets the criteria for registration or deregistration. Regarding Graph 14, the aim is to support families make changes to safely parent their children within a more focused time frame i.e. 12 months. If risks have not been significantly 5 10 15 21 6 8 9 14 25 34 16 9 22 10 31 35 44 50 42 37 27 32 50 79 70 66 69 60 9 6 6 15 14 13 20 9 9 5 25 13 19 19 0 10 20 30 40 50 60 70 80 90 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Aug- Oct Nov- Jan Feb- Apr May- Jul Aug- Oct Nov- Jan Feb- Apr May- Jul Aug- Oct Nov- Jan Feb- Apr May- Jul Aug- Oct Nov- Jan 2021/22 2022/23 2023/24 2024/2 CP Registration Trends Number of Registrations Number on Register Number of De-Registrations Page 53
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APPENDIX 1 8 | P a g e reduced, then alternative safeguarding measures should be considered. If risk has been sufficiently reduced, and the child is experiencing safe and good enough care, then de- registration should be considered, with the reasons understood and agreed by partners. Graph 8: Child Protection Registration Comparator Authority Trends (up to 31 July 2023) Graph 9: Number of Child Protection Registrations Comparator Authority Trends (1 August 2022 to 31 July 2023) Chart 10: Number of Child Protection Deregistration Comparator Authority Trends (1 Page 54
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APPENDIX 1 9 | P a g e August 2022 to 31 July 2023) Pie chart 4: Registration reasons The reasons for new registrations often differ from the reasons for having an IRD. This is because, throughout the information-sharing process and child in need assessment stages, a more comprehensive understanding of the family's needs and a clearer perspective on risk and safety emerges. Regarding IRDs held for sexual abuse concerns, where the abuse is not within the family and the family provides effective support and is deemed capable of safeguarding the young person, registration is not required. Graph 11: Registration Categories Graph 11 above shows the trend in registration categories across the reporting period (from August 2023 to January 2025). 2 1 1 3 5 8 CP Q2 - Reasons for New Registrations Services find it hard to engage Child Affected by Parent/Carer Mental Ill-Health Domestic Abuse Parental Alcohol Use Parental Drug Use Emotional Abuse Criminal Exploitation Neglect Other Concern 3 1 6 8 6 8 5 2 1 7 11 4 4 2 1 3 5 3 3 3 1 3 16 1 2 8 3 3 1 5 5 4 1 5 1 2 8 9 13 8 2 4 2 3 4 0 5 10 15 20 Q1 23-24 Q2 23-24 Q3 23-24 Q4 23-24 Q1 24-25 Q2 24-25 Registration Categories Services find it hard to engage Child Affected by Parent/Carer Mental Ill-Health Child experiencing mental health problems Domestic Abuse Parental Alcohol Use Parental Drug Use Physical Abuse Page 55
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APPENDIX 1 10 | P a g e Graph 12: Family Groups As shown in Graph 12, at the end of CP Quarter 2, there were 15 family groups consisting of one child, six family groups with two children and 12 family groups of three or more children on the register. Graph 13: Previous Registrations At the end of the CP Quarter 2, there were 22 children on the register who had one previous registration and 15 with two or more previous registrations (as indicated in Graph 13). Graph 14: Time on Moray CPR I'm awaiting some more info to add to this section 12 6 14 10 6 15 9 5 14 0 2 4 6 8 10 12 14 16 CPR Family Group: 3 or more children CPR Family Group: 2 children CPR Family Group: Single child Family Groups on Moray CPR Nov-24 Dec-24 Jan-25 15 24 22 25 27 22 8 10 7 8 14 15 0 5 10 15 20 25 30 Q1 Q2 Q3 Q4 Q1 Q2 Previous Registrations on Moray CPR No. of children with 1 previous registration No. of children with more than 2 previous registration Page 56
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APPENDIX 1 11 | P a g e Graph 15: Age of children on the register Graph 15 shows the trend for 2023/25 against CP Quarter 2 data. The consistently higher prevalence in the last year, of children aged 5-10 years highlights the need for earlier support and diversion services, ensuring this is provided at the earliest stages of a child’s 6 3 14 11 26 6 3 8 21 26 1 8 9 23 29 0 5 10 15 20 25 30 35 > 2 years 18 mths < 2 years 1 year < 18 mths 6 mths < 1 year <6 months Time on Moray CPR Nov-24 Dec-24 Jan-25 1 1 1 1 1 1 1 4 4 3 1 12 15 18 25 29 37 36 26 22 22 21 22 20 21 17 18 19 19 16 20 20 22 25 26 24 26 26 26 24 24 25 25 25 26 23 23 9 10 11 13 15 15 15 18 18 18 19 19 19 16 20 20 17 15 1 1 1 1 1 1 1 1 1 2 3 2 2 2 0 5 10 15 20 25 30 35 40 Age Bands on Moray CPR Unborn 0-4 5 - 10 11 - 15 16+ Page 57
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APPENDIX 1 12 | P a g e development. The number of young people aged 16 years old has remained static throughout the Quarter. Page 58
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APPENDIX 1 13 | P a g e THE FOLLOWING SECTIONS REPORT AGAINST THE FINANCIAL QUARTER (JAN - MAR 2025) Graph 16: Number of children looked after away from home and at home Graph 16 identifies that at the end of Financial (Fin) Quarter 4, there were 171 children who were looked after by Moray which is an overall reduction from 180 to 171 following an initial increase. There is an increase in the number of newly accommodated children in 2024/25, which is being analysed through the ‘Critical Mass’ work which will support a better understanding of this data and identify mitigating actions. Since August 2023 the overall number of looked after children indicates a downward trajectory. Pie chart 5: Care setting categories At the end of Fin Quarter 4, 48% of children were in family settings at home or in kinship care with 52% in other settings such as foster care or residential homes. This has remained a stable figure highlighting many looked after children have been able to remain within their network of family and friends. Alongside this, 86% of brothers and sisters remain together in care which is above the national average of 79%. Brothers and sisters who are not together are because of family circumstances or assessed needs. The work of the Maintaining 176 178 185 187 183 180 182 172 172 177 179 175 173 175 177 176 175 180 178 171 160 165 170 175 180 185 190 No. of Looked After Children 55 11 5 17 43 32 1 6 1 Children in Care Settings Foster Care Residential in Moray Short Breaks /Shared Community Care Out of Area Kinship At Home Pros Adopters New Scots Secure Page 59
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APPENDIX 1 14 | P a g e Relationships Project is at an advanced stage, a key element of which is to sustain and increase the percentage of brothers and sisters remaining together in care in line with the Children’s Service Plan. Foster care (55) and kinship care (43) are the highest categories followed by children looked after at home (32). The children’s houses (11) Cala, Rowan Lea and Land Street, continue to operate at full capacity (14) where three young people are over 18, subject to Continuing Care, and not recorded as looked after children. The number of young people in the Out of Area category (residential and foster care) including Secure Care is 18. This external care is high cost where an updating report was presented to the Moray Council’s Education, Children’s & Leisure Services Committee in May 2025 (Fin Quarter 1 for 2025/26). A significant majority of young people are in family-based care (137, 80%) rather than residential care (34, 20%). The Carer Recruitment Campaign has seen new foster carers and supported lodgings caregivers approved to support young people remaining in Moray in family-based care settings. There remains the commitment to support young people in family-based care settings. This includes supporting families to identify and promote kinship care options via Family Group Decision Making processes. At the end of Fin Quarter 4, 16.9% of our looked after children were cared for on a full-time basis in residential care. If short breaks are included the figure of young people in residential care increases to 19.8%. The indicator (to be kept within or lower) is adjusted annually to the average of comparator authorities (17.5%, 2022/23). As such, Moray is 0.6% below the average indicator when considering full-time care on its own and 2.3% above if short breaks are included. This highlights that the priority for Moray is to support young people in family-based care, where possible, to provide a positive model of family life. The average of comparator authorities' data is based on 2022/23. More up to date comparator data is awaited although the timescales for this has not yet been clarified. One young person was remanded in secure care from November 2023 at the direction of the Court. This aligns with the recent changes in Justice legislation for children under 18 where they are remanded into the care of local authorities rather than Young Offenders Institutions. Moray hosts a group of six young people who are New Scots (formerly Unaccompanied Asylum-Seeking Children) via the National Transfer Scheme. These children and young people are allocated to the Throughcare and Aftercare Team by the Home Office and are counted as looked after children to ensure they receive full support. Initially, these young people are in Supported Lodgings or Supported Accommodation care settings. The team continues to successfully support them to move into their own independent housing once they have been granted asylum. The number of new arrivals of New Scots in Fin Quarter 4 was zero which was the same figure for Fin Quarter 3. COSLA and the Home Office cannot yet determine the reason for this reduction and whether it is a short- or long-term trend. The resource allocation system in Moray means there are the resources to support New Scots including any future increases in numbers. Page 60
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APPENDIX 1 15 | P a g e Graph 17: Moray foster care households At end of Fin Quarter 4 there were 55 children living in foster care, with 51 (92.7%) children living with Moray Council foster carers and 4 (7.2%) living with independent foster carers. This identifies that, despite the challenges in recruiting carers both locally and nationally, Moray has ensured that most children are living with in-house foster carers. Of our 36 fostering households, 83.3% are actively caring for a child. Not all fostering households have children living in their care. At the end of Fin Quarter 4 this comprises 6 (16.6%) in total. This is a small number due to family circumstances or matching considerations of their registration approval where foster carers are inactive for a short period of time. The Fostering Team is working to broaden the approvals capacity of Moray foster carers, with additional support and advice, to enable care for a wider group of children and maximise capacity. Graph 18: Children who live in foster care 35 36 37 37 36 35 36 36 27 27 25 25 28 31 31 30 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 0 5 10 15 20 25 30 35 40 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2023/24 2024/25 Moray Foster Carers No. of Moray Council Fostering Households No. of Moray Council Foster Carers with 'Active' placements % of Foster Households who are 'active' 44 43 45 47 45 48 46 45 47 46 51 51 50 48 47 47 47 52 53 51 11 11 7 7 7 7 7 6 6 6 6 6 6 6 6 6 5 5 5 4 0 10 20 30 40 50 60 70 Children in Foster Care Local Authority Foster Care Foster with other orgs paid for by Local Authority Page 61
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APPENDIX 1 16 | P a g e Graph 18 identifies that at the end of Fin Quarter 4, there were 51 children cared for by Moray foster carers, which is an increase from Fin Quarter 1 in 2024 which was 45. However, this includes some quarterly fluctuations where the pattern is relatively stable. The number of approved Moray foster carer households for children has remained stable. Although the carer recruitment campaign is resulting in new fostering households, this is balanced by other foster households ceasing or changing the type of fostering they provide. The challenge in recruiting and retaining foster carers is both a local and national issue. The recruitment campaign is significant in recruiting foster carers accompanied by work to achieve greater retention rates, focused on supporting foster carers with improved supervision, training and finances. Foster carers are graded by the level of skills learned and developed, ranging from Level 1 to Level 4 being the highest, which is under review to simplify the model and have a higher starting financial rate which should support recruitment. Young Carers work is reported to other Integration Joint Board Committees which is being reviewed with a view to inclusion in this report. Graph 19: Kinship care settings Kinship care is split into two groups: pre-approved kinship homes awaiting presentation at the Kinship Panel for approval and kinship households already approved at Panel. Moray is seeking to increase the numbers of kinship households. This is to ensure more children and young people can remain within their own communities and network of family and friends. It is envisaged that the numbers of kinship households will increase via the use of, for example, Family Group Decision Making processes. The Kinship Care Policy is under review including streamlining the assessment and decision- making processes and reviewing financial support which should support an increase in the number of kinship carers. 30 32 29 31 32 30 29 30 31 29 29 29 29 28 30 28 25 26 26 25 30 29 26 26 32 34 32 31 30 32 33 32 32 31 33 31 32 32 32 31 10 14 14 16 11 7 9 10 12 9 7 8 8 8 9 9 5 5 5 5 0 10 20 30 40 50 60 70 80 Kinship Care Settings Kinship: No. of Children in Pre-Approved Placements Kinship: No. of Children in Approved Placements Kinship: No. of households providing Kinship Placements Page 62
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APPENDIX 1 17 | P a g e Graph 20: Residential care Residential care is divided into those in residential care in Moray and those out with Moray. Children cared for in Moray live in the authority's own children’s houses, Cala and Action for Children’s two houses in Buckie and Elgin. The figure for this category is 11. As above, the children’s houses operate at capacity (14) including three young people in Continuing Care. Out of Area care tends to be specialist residential houses or residential schools. There has been a consistent focus on providing this care in Moray where possible, so children remain close to their families and support network. The figure for this category is 17. Work is underway to reduce the number of young people in Out of Area care which is expensive and does not geographically support young people in maintaining relationship in Moray including health, education, family and friends. Residential care settings can be the correct care setting for some children and young people, often due to previous unsuccessful multiple family care arrangements. However, in most cases, a family-based setting is preferrable as it better prepares young people for adulthood as they have a positive model of family life. For those young people in residential care, there is significant preparation via independent living skills to support them in the transition to adulthood. Graph 21: Through Care, After Care and Continuing Care data 13 14 14 14 13 12 13 12 12 13 13 12 11 10 12 12 11 10 12 11 11 11 11 11 11 11 11 10 10 11 11 9 9 11 12 12 12 14 14 17 0 5 10 15 20 25 30 Residential Care Settings Residential Care in Moray Residential Schools or Out of Area Placements 45 43 40 19 20 19 8 9 11 0 10 20 30 40 50 Jan-25 Feb-25 Mar-25 Through Care, After Care and Continuing Care TCAC: Open as Through Care TCAC: Open as Aftercare TCAC: Open as Continuing Care Page 63
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APPENDIX 1 18 | P a g e As illustrated in Graph 21, as at 31 March 2025, there were 70 young people receiving care from the Through Care After Care (TCAC) Team including eleven receiving Continuing care support. It is anticipated that the numbers of young people subject to Continuing Care will increase as this approach becomes more embedded in Moray. The team is divided into three sections: • Through Care: Young people receiving support to plan and prepare for independence. • After Care: Young people who have left care but are receiving continuing support. • Continuing Care: Young people who choose to remain where they live beyond their 18th birthday until they are 21 although it can be in place from 16. These young people cease to be formally looked after by Moray Council but are legally entitled to continue living where they are. This provides stability in a familiar and nurturing setting. There is a focus on continuing care to ensure young people in different care settings are given the opportunity to remain where they are living potentially until the age of 21. This is a key responsibility for the organisation and partners as corporate parents. The team is responsible for supporting New Scots (formerly Unaccompanied Asylum Seeking Children) via the National Transfer Scheme. This is an increasing workload for the team, which is dependent, in part, on the numbers of young people arriving in Kent, making future forecasting a significant challenge. The team offers considerable support to young people after they leave care (After Care) up to the age of 26. There is a commitment to offer the same support birth families provide for young people who are transitioning into adulthood. This is a key element of Moray Council’s and Health and Social Care Moray’s responsibilities as Corporate Parents. Other reporting areas being considered are positive destinations: work, education, training, and accommodation, and outcomes for New Scots. Justice and Youth Justice. Graph 22: Care experienced young people supported by Justice Services 435 424 421 424 403 415 422 450 440 449 443 466 472 478 477 492 490 497 496 44 42 42 44 42 43 39 37 35 31 34 34 36 40 40 44 46 48 43 0 1 2 3 4 5 6 7 8 9 10 0 100 200 300 400 500 600 Care Experienced People in the Justice System Open to Justice Team Open to Youth Justice % CEYP open to both MYJ and JS Page 64
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APPENDIX 1 19 | P a g e Nationally, care experienced young people (CEYP) are overrepresented in the Scottish Justice Systems. At the end of Fin Quarter 4, 8.5% (46 of 539) were CEYP (up to age 26) in the Justice System (Youth Justice 15, Justice Social Work 31) as depicted in graph 22. This figure has consistently remained below 12% throughout 2023/24. Work continues to identify CEYP and offer early assistance and support where possible. The aim is to address identified needs and risks to reduce re-offending rates and maximise support, including existing relationships, to reduce the length of time they are supported by justice services. Research informs that early entry or prolonged exposure to the criminal justice system can draw children into the system rather than rehabilitate and divert from the system. Children who are remanded or sentenced to custodial sentences in a secure care facility are included within the numbers above. Graph 23: Ages of children in Youth Justice The average age of a children receiving Youth Justice services is 15 years old which has remained consistent throughout this year. Most work is with children aged 11 to 15 years including supporting them to maintain or re-engage with education and meeting their identified needs. Whilst the team works with all schools throughout Moray, it has strong links with Moray Social, Emotion and Behavioural Needs Service (SEBN) where support is offered for social, emotional and behavioural needs. There is a small number of young people aged over 18 years in the Youth Justice Service, which continues where the team has the most meaningful relationship with them. Planned transitions and joint working between Youth Justice and Justice Social Work minimises the impact on the young person. 33 29 31 30 24 22 22 27 21 22 21 21 21 21 21 25 28 26 27 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 14 15 14 15 15 14 15 14 13 16 13 15 10 7 7 8 9 15 18 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 1 1 1 3 4 2 2 1 0 1 0 3 3 3 3 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 49 44 46 46 41 38 39 45 38 40 36 37 32 30 35 36 40 44 50 43 0 10 20 30 40 50 60 Age Bands - Youth Justice YJ: Age Band: 5-10 YJ: Age Band: 11-15 YJ: Age Band: 16-17 YJ: Age Band: 18+ YJ: No. open to Youth Justice Page 65
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APPENDIX 1 20 | P a g e Pie chart 6: Gender of individuals in Youth Justice Pie chart 7: Gender of individuals in Justice Services At the end of Fin Quarter 4, most individuals supported by Youth Justice were males accounting for 83.7% of children and young people supported by the service. In Justice Social Work 13.4% of individuals supported by the service were females, which has remained relatively static over the past year. It is recognised women in the justice process are more likely to have experienced trauma and are also more likely to be a sole carer for a child or family member. In line with The Promise, Justice Social Work is committed to keeping women in their local communities where it is safe to do so and provide robust alternatives to custodial sentences. Currently the team offers a gender responsive service which includes a weekly women’s group and a woman only unpaid work group. Support is offered in partnership with other services to promote opportunities for individuals to engage with community resources which will be available beyond their time within the justice service. Work continues to capture the views of individuals to evaluate the impact of this service and shape its development. Evaluation from the Area Public Health Co-ordinator, following delivery of wellbeing sessions, highlighted positive feedback from attendees. 36 7 Gender: Youth Justice YJ Gender: Male YJ Gender: Female 431 67 Gender: Justice Service Justice: Male Justice: Female Page 66
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APPENDIX 1 21 | P a g e Graph 24: Justice social work reports (JSWR) Justice Social Work reports (JSWR) remain a priority to reduce any delays in sentencing and for Fin Quarter 4 the target of 100% on time has been met. Whilst reports are prepared at the request of any Court for an individual living in Moray, most reports are submitted to Elgin Sheriff Court. There has been in an increase in report requests received over Fin Quarter 4 due to an increase in Court business during this time. Completion of Court reports on time results in appropriate sentencing for individuals which addresses their current assessed risks and needs, and reduces time spent on remand where a community sentence is imposed. It also importantly supports a timely outcome for victims of offences. Pie chart 8: Justice Report Types In addition to a standard JSWR report the Court may request additional assessments such as a Drug Treatment and Testing Order (DTTO) assessment and a Restriction of Liberty Order (ROLO) assessment as shown in pie chart 8. The imposition of a ROLO or DTTO can be a direct alternative to custody so effective assessments for these Orders can offer a robust community-based disposal. 104 104 106 103 130 107 107 138 96 96 90 94 121 95 95 121 100 100 100 100 100 100 100 100 0 20 40 60 80 100 120 0 20 40 60 80 100 120 140 160 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2023-24 2024-25 Justice - SW Reports submitted on time No. Social Enquiry Reports submitted on Time No. of People % of Reports on time [VALUE], [PERCENTAG E] 58, 42% 76, 55% [VALUE], [PERCENTAG E] Types of Report JSWR DTTO Assessment JSWR ROLO Assessment JSWR Standard JSWR Unpaid Work/DTTO/ROLO Assessment Page 67
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APPENDIX 1 22 | P a g e There has been an increase in the request for ROLO assessments during Fin Quarter 4. A ROLO is where an electronic tag is used to restrict an individual's movements, either to remain in a certain place within time frames or restrict from certain areas. This can be imposed as part of an Order supervised by a Social Worker or as a standalone disposal. Graph 25: Structured deferred sentences (SDS) An SDS is a flexible provision with structured social work support for an individual after conviction but prior to sentencing. Successful completion of an SDS reduces the need for a statutory Court Order, in turn reducing the overall length of time an individual is supported by the service. The number of in SDS disposals in Fin Quarter 4 has risen slightly but remain lower than in the previous year likely due to increases in other early intervention measures. Graph 26: Bail supervision Bail supervision is an alternative to remand and the priority for this in Moray is women, young people, those with caring or parental responsibilities and those with issues relating to mental health or addictions. Assessments are undertaken for all people where bail is being opposed by the Procurator Fiscal and are provided on the same day. There is a small reduction in the number of assessments requested in Fin Quarter 4 and a slight decrease in 9 11 9 20 16 18 21 17 21 8 10 11 9 9 9 20 15 17 20 17 21 6 10 11 0 5 10 15 20 25 30 35 40 45 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2022-23 2023-24 2024-25 Structured Deferred Sentences No. of Structured Deferred Sentences imposed No. of Individuals with SDS imposed 1 2 4 4 17 33 34 38 59 62 50 47 1 0 3 4 5 2 7 15 14 13 17 12 1 0 3 4 5 2 7 15 14 12 17 2 0 10 20 30 40 50 60 70 80 90 100 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2022-23 2022-23 2022-23 2022-23 2023-24 2023-24 2023-24 2023-24 2024-25 2024-25 2024-25 2024-25 Bail Supervision No. of requests from Court for Bail Supervision No. of Bail Supervision cases commenced No. of individuals commenced with Bail Supervision Page 68
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APPENDIX 1 23 | P a g e bail supervision orders imposed. There continues to be a significant number of assessments which do not result in bail being opposed and work is being undertaken nationally to understand trends, but data is not yet available to compare. The prison population in Scotland remains high, and bail supervision is one area of work which is hoped will assist in reducing these numbers whilst offering more positive outcomes for individuals within their local communities. Graph 27: CPO with supervision requirement Fin Quarter 4 has again seen a slight reduction in the imposition of Community Payback Orders (CPO). Most individuals made subject to a CPO are seen on the day of sentencing, for those where this has not been possible, an appointment with their allocated social worker is made within seven days of an Order being imposed. There is a reduction in the target met during this Quarter which is related to individuals not attending appointments for a variety of reasons, staff sickness and public holidays. Additional training is scheduled to ensure new and existing staff are entering this data correctly, for accuracy. Diversion from Prosecution Diversion from Prosecution (DfP) allows someone accused of offences to be dealt with outside of the formal justice system. Successful completion of a diversion from prosecution means an individual will not have a conviction for the alleged offence which may impact their current or future employment or education alongside other significant areas of their life. The Justice Social Work team undertakes all assessments of suitability; however, the Youth Justice team aids and supports young people aged 16 and 17. The referral rate varies which is a result of the process of cases being marked by the Procurator Fiscal. There can occasionally be delays in the commencement of these cases where additional agreement is required from the Procurator Fiscal, e.g. an extended period for completion. In comparison to Fin Quarter 4 last year there is a small increase in assessments completed for males and a small decrease in assessments completed for females. Outcomes Star data indicates most individuals feel an improvement in their wellbeing at the end of a DfP. Information contained within exit questionnaires include: 0 20 40 60 80 100 120 0 10 20 30 40 50 60 70 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2023-24 2023-24 2023-24 2023-24 2024-25 2024-25 2024-25 2024-25 CPOs with Supervision No. of new CPOs with Sup Req No. seen by Supervisor within 7 days % Target Met Page 69
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APPENDIX 1 24 | P a g e Work is being undertaken to improve the recording and examination of this data and feedback. Finalised updated guidance for DfP is awaited from the Scottish Government, however there are plans from Community Justice Scotland to provide training to all staff which it is anticipated will improve local and national practice. Graph 28: Diversion from prosecution: Female Graph 29: Diversion from prosecution: Male 6 5 8 5 2 1 3 4 1 0 0 4 0 1 2 1 0 0 2 1 1 2 3 8 2 2 5 2 3 3 1 1 0 0 4 4 0 1 5 0 1 2 3 8 2 2 5 2 1 2 1 0 0 0 2 4 0 0 5 0 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 Diversion from Prosecution: Female DFP Gender: Female DFP Commencing Gender: Female DFP Completed Gender: Female 6 12 9 3 7 6 7 12 12 4 5 8 1 5 6 3 2 1 7 4 5 3 4 9 2 7 3 4 7 5 2 4 8 11 4 6 2 8 3 5 0 2 4 6 8 10 12 14 Diverson from Prosecution: Male DFP Gender: Male DFP Commencing Gender: Male DFP Completed Gender: Male Page 70
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APPENDIX 1 25 | P a g e Policy, development, trauma-informed and commissioning. Procedure for the Supported Lodgings Project Supported lodging care is intended to provide young people with a gradual step between independent living and leaving their home environment, often arranged by the local authority (including fostering, residential setting, kinship, or continuing care). It offers a warm, welcoming and supportive environment which provides a young person opportunities to develop their independent living skills and a stepping stone towards independence. This Procedure has been developed to support the work of social workers with responsibilities around Supported Lodgings Service, which is a registered service subject to inspection by the Care Inspectorate. It outlines tasks and practice expectations for social workers, aiming to facilitate consistent service provision and seamless experience for young people and carers. The procedure is planned to be launched in June 2025. Trauma-Informed Practice In Moray, as part of the work towards the Scottish Government’s vision of trauma-informed and response workforce within public bodies, the Trauma Informed Development Officer has been leading on the assessment of services in terms of the principles of trauma-informed practice (Safety, Trust, Choice, Collaboration, and Empowerment), identification of areas of change and supporting future developments. A three-pronged approach is applied. The first prong, focusing on awareness-raising, consists of an Introduction Brief highlighting the Scottish Government’s vision at strategic and operational levels within the Service. The second prong, called a Walk Through Lens of teams and services, consists of an interactive session conducted to identify what is working well and what may need to be addressed to become trauma informed. The third prong consists of the development of action plan owned by the teams providing the service, which begun to be generated at the end of Fin Quarter 4. The Development Officer is supporting a total of 47 teams at present, and this number is anticipated to grow as teams from various parts of Health and Social Care Moray start their trauma informed journey. The currently supported teams are placed across Social Work, Justice Services, Drug and Alcohol Services, Health, Education, Housing and 3rd Sector partners. The line charts below indicate the progress of the work in this area as of the end of Fin Quarter 4. Page 71
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APPENDIX 1 26 | P a g e Graph 30: Number of delivered sessions Alongside the delivery of these sessions, the Development Officer is leading on the review of available training on trauma-informed practice for staff across Moray Council and Health and Social Care Moray. Agreement has been provided by NHS Education for Scotland for training to be embedded within the Moray online CLIVE learning management system. Once Legal Services have reviewed the licence agreement, the programmes will be available for embedding within CLIVE and promotional information will be released across the partnership. Children’s Social Work Development Plan A Children’s Social Work Development Plan was created following two development days in November 2025, where five key social work practice themes identified from a review of complaints were explored. The Plan, inclusive of arrangements for monitoring and evaluation, has been launched with warm reception. The tasks of the Plan fall into the following areas: - The voice of children and young people: toolkit and guidance for practitioners - Engagement with people who receive services: leaflets - Engagement with staff: consultation, newsletter, refresh of induction processes - Training: chronologies, assessment, analysis, permanence, child protection, trauma- informed practice, contextual safeguarding. - Newly Qualified Social Workers & Social Workers in Training: support for those in training and the trainers - Streamlining paperwork: core assessment, referral forms, and so on. - Policies and procedures: develop and update policies and procedures - Quality Assurance: self-evaluation within the service and with partners. The Plan will be reviewed, updated and shared widely on a quarterly basis. 7 18 28 32 36 37 41 1 2 4 6 11 12 13 0 0 0 0 0 0 2 0 5 10 15 20 25 30 35 40 45 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 Number of delivered sessions Introduction Brief Walk Through Lens Action Plan Page 72
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APPENDIX 1 27 | P a g e Newly Qualified Social Workers Conference A group of five local authorities formed the North Partnership to support newly qualified social workers in their final year or at the beginning of their career by facilitating an in- person conference focusing on the theme: ‘How to Survive in Social Work’. The conference, planned for 24 April 2025 and starring Dr Neil Thompson (author, educator and adviser in social work practice) consists of five workshops: Trauma Informed Practice UNCRC and Rights Based Practice Support and Supervision Professional Identity Professional Curiosity. There are plans in place to gather participant feedback following the event; this will be covered in the Fin Quarter 1 (Apr - Jun 2025) report. Children and Families and Justice Social Work Commissioning The Commissioning team within Children and Families and Justice Social Work leads on seven key areas of service contracts. The pie chart below indicates the percentage of each area from the total spend for Fin Quarter 4. Pie chart 9: Areas of service contracts spend The individual contracted service areas will be discussed next in turns. Page 73
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APPENDIX 1 28 | P a g e Family support services The family support services area, accounting for 12% of the spend, consists of: 1. the independent advocacy service 2. three services for prevention and early intervention in order to avoid family breakdown and possible out of area care arrangements: 2.1. Families Together 2.2. Functional Family Therapy 2.3. Aberlour Youth Point Moray. 1. Independent advocacy Moray’s Children’s Right Service, delivered by Quarriers, is available to all young people and their parents, carers and siblings. In this quarter, 194 young people and 152 parents, carers and siblings benefitted from the service. This is an increase compared to previous quarters, as shown on the figure below. This quarter saw 56 new referrals into this service, 24 for children and young people and 32 for parents, carers and siblings. Graph 31: Independent advocacy caseloads Pie chart 10: Categories of advocacy support provided In this quarter, the advocacy service was provided to young people who are looked after (83), are in need of protection (30) and need multiagency support (81). The figure on the left depicts this. The support provided includes the attending of meetings with the young people and adults. In Page 74
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APPENDIX 1 29 | P a g e “Young Person Worker has worked their magic” Parent, 27/02/25 this quarter, Quarriers staff have attended 285 in-person professional meetings: - 148 for children & young people - 137 for parents, carers & siblings. Quarriers are currently operating with a small waiting or pending service list; as at 31 March 2025 there were four referrals on it. Referrals on the waiting list are triaged with a view to prioritise service provision for looked after children and children requiring protection. The issue of capacity is hoped to be fully mitigated in the next quarter, due to the successful recruitment of staff increasing capacity. 2. Prevention and early intervention services The three prevention and early intervention services (Aberlour Youth Point, Families Together and Functional Family Therapy) supported a total of 133 children and young people and their families in this quarter. This is an increase compared to the previous quarter, as illustrated on the figure below. Graph 32: Early intervention services Despite the increase, these services have capacity for new referrals; this has been communicated across the Social Work teams. 2.1. Aberlour Youth Point Moray Aberlour Youth Point Moray supports children and young people who struggle to remain positively engaged within their home, school or community and who require a targeted support service. It also provides support to the parents or carers of the children and young people with whom they work. 15 54 39 18 72 43 0 10 20 30 40 50 60 70 80 Functional Family Therapy Families Together Aberlour Youth Point Q4 Q3 Page 75
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APPENDIX 1 30 | P a g e “Many thanks for the wealth of information”-Parent Carer, March 2025 The results from the Fin Quarter 3 survey completed by the young people and their families who access the service were mainly positive. 2.2. Families Together This service delivers a restorative family service in a variety of ways, including a range of one to one and group sessions, family focussed money advice service, practical support (e.g., food parcels and school bank referrals) and the Family Group Decision Making approach. The service has reported the provision of the following supports in Fin Quarter 4: • financial gains: 13 families were supported with welfare rights and 12 families were supported by the distribution of nine fuel bank vouchers, one supermarket voucher, two food bank referrals and purchased two SIM cards. • Debt managed: families supported with energy advice. The Family Group Decision Making (FGDM) process brings together a child or young person’s extended family and friends, providing a blame-free and future- focussed space to discuss the strengths and the difficulties the family faces. The main aim of this approach is to repair relationships and improve the child or young person’s support network. Children First are currently working with 8 families through FGDM with positive feedback, as exemplified by the quote to the right. 2.3. Functional Family Therapy Functional Family Therapy is a short term, strengths and family-based therapy programme designed to help families improve communication and relationships with a view to keep them together. Currently, 11 families are supported by this service. The quotation on the left demonstrates the changes one family faced in the service. Support for Unpaid Carers This service, delivered by Quarriers, accounting for 4% of the total spend in Fin Quarter 4 and is inclusive of the “Our therapist has been amazing at identifying our son’s triggers and patterns of behaviour and giving the family support and strategies to try to de-escalate and manage behaviours” – Parent 17/02/25 “Was good to talk to someone, thank you” – Young Person, 10/02/25 Page 76
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APPENDIX 1 31 | P a g e “I am always seeing my son with a smile on his face and hearing his contented noises, he holds my hand which tells me he is happy in Scotia”- Parent, 31/01/25 “You are all a great bunch of staff, and I do like living here. I know you look after me really well and you do love me”- Young Person in Residential Home provision of our statutory requirements under The Carers (Scotland) Act 2016. Currently, 1188 adult and 198 young carers (the highest this has ever been) benefit from this service with positive feedback, as exemplified by the quote to the right. As noted in the Fin Quarter 3 report, this contract has changed in terms of the responsibility of the completion of the Adult Carer Support Plan and Young Carer Statement. This moved from Quarriers to Health and Social Care Moray. Support and transition work will follow to ensure that there is no gap in the service delivery during the period of change. Out of area care via Scotland Excel of local frameworks Accounting 51% of the total spend, out of area care is provided to 23 young people; this is an increase of two young people since Fin Quarter 3. Out of area care is provided to: - 19 children in residential care under Scotland Excel Frameworks and Local Authority Framework (49% of spend) - 4 children in foster care under Scotland Excel Frameworks (2% of spend). Local Residential Care Accounting for 15% of the spend, residential care is provided to eight young people by Action for Children across two homes in Moray. The number of children benefiting from this service has not changed since the previous reporting period. The quote on the right is provided by one of the young people living and settled in one of the two homes. Children with a Disability – Residential services The Scotia residential service, accounting for 13% of the spend, is delivered by Aberlour Childcare Trust in Alba Place, Elgin. Currently, a small number of young people benefit from this service. Monitoring arrangements indicate that these children are fully supported, maintaining relationships with family and friends, and enjoy a wide range of inclusive community activities. The quote from a parent on the right exemplifies the positive impact of the service. Children with a disability- support Commissioned services supporting children and young people with disabilities account for 4% of the total spend and consist of a short break and group activities services. Page 77
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APPENDIX 1 32 | P a g e “I am enjoying having time to myself I am making use of the time by spending quality time with friends” Parent, 10/01/25 Short Breaks Services This contract commenced 1 September 2024 and provides day care and overnight short breaks for 12 young people. They deliver 15-day care and (on average) 21 overnight sessions per month. This allows a break for the family, the benefits of which is deemed positive, as demonstrated by the quote on the right. Group Activities This is new service co-commissioned with children, young people and their families, which was launched towards the end of the reporting period. There have been nine referrals into the service with the group sessions starting during the school Easter holidays. More information will be reported in the Fin Quarter 1 (Apr - Jun 2025) report. Contextual safeguarding In Moray, like other areas in Scotland, an increasing number of young people appear to be at risk of or posing harm in the community. Contextual safeguarding is a novel approach to understanding and responding to children's experiences of significant harm beyond their family and home; it offers a way to understand these risks, engage with children and young people and help to keep them safe. As this is a new area of work, initial efforts are focussed on awareness raising. The Contextual Safeguarding Working Group, under the banner of the multiagency Child Protection Implementation Group, has organised a series of sessions for professionals and practitioners. These sessions aim to enhance partnership staff’s comprehension of key roles in safeguarding children and young people where risks are evident outside their family homes. Pre- and post-session surveys are planned to measure the impact of the awareness- raising effort, which can be fed back to the MIJB within upcoming performance reports. In addition to this, a pilot framework aiming to enable partner agencies to understand and respond to contextual risks around groups of children who may or may not be supported by services on an individual basis. The pilot framework consisted of three meetings focusing on the sharing of relevant information with a view to identify common contextual factors (e.g., spaces, adults, etc) that influence behaviour or pose risk, and to build or mitigate these within individual support plans. The common contextual factors are also shared with senior members of staff to inform service delivery within the communities. The feedback from this pilot has been positive from attendees and we hope to embed the approach in the future. Page 78
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REPORT TO: MORAY INTEGRATION JOINT BOARD AUDIT, PERFORMANCE AND RISK COMMITTEE ON 19 JUNE 2025 SUBJECT: INTERNAL AUDIT SECTION - UPDATE REPORT BY: CHIEF INTERNAL AUDITOR 1. REASON FOR REPORT 1.1 This report provides Committee with an update on the work of the Internal Audit Section. 2. RECOMMENDATION 2.1 Committee is asked to consider the contents of the report, seek clarification on any points noted and otherwise note this audit update. 3. BACKGROUND 3.1 Public Sector Internal Audit Standards (PSIAS) require the Chief Internal Auditor to prepare and present reports to committee on internal audit’s activity relative to the audit plan and on any other relevant matters. 4. KEY MATTERS RELEVANT TO RECOMMENDATION Ways of Working Protocol- NHS Grampian & Integration Joint Board Internal Audit 4.1 As the Chief Internal Auditor, I provide assurance on the internal controls of systems and practices required by the MIJB to deliver services, whether through Council or NHS systems. As previously detailed, an agreement has been reached with the management of NHS Grampian and their Internal Audit Provider to receive and report reviews of NHS systems and practices relevant to this Committee. This will complement the reports already provided on Moray Council owned systems, given my role as the Council’s Auditor. 4.2 I am pleased to report that this collaborative arrangement has been further strengthened by the agreement of a 'Ways of Working Protocol' between the internal audit services of NHS Grampian and the Moray, Aberdeenshire, and Aberdeen City Integration Joint Boards (see Appendix 1). This agreement Item 7. Page 79
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aims to enhance governance and improve the control environment across all organisations by supporting more comprehensive and overarching reviews. Follow Up Reviews 4.3 Internal audit reports are regularly presented to members, detailing not only findings but also management's responses to the recommendations with agreed dates of implementation. Internal Audit will also undertake follow up reviews to evidence the effective implementation of these recommendations. Please see detailed the following completed follow up review: 4.4 Self Directed Support – Option 1 The Social Care (Self-Directed Support) (Scotland) Act 2013 came into effect in April 2014, introducing the term 'Self-Directed Support' (SDS) to describe how individuals can exercise choice and control over the support or services that enable them to live independently and achieve agreed outcomes. This follow-up review examined the implementation of recommendations from an audit of Self-Directed Support (SDS) Option 1. SDS Option 1 involves providing a direct payment to a supported person for the provision of support. The audit assessed the effectiveness of procedures for monitoring funds issued to individuals, including randomly selecting a sample of care packages to verify compliance with operating procedures. It also ensured that expenditures aligned with agreed budgets and support plans, and confirmed that surplus funds were recovered where appropriate. 4.5 The follow-up review found that significant progress has been made in implementing the audit recommendations. However, while workload and staffing concerns are acknowledged, several recommendations remain only partially implemented. This is the third follow-up review conducted by the Internal Audit Section for this audit. The Service has indicated that all recommendations should be fully implemented during 2025/26. It is proposed that no further follow-up review be undertaken; however, an audit of Self- Directed Support for direct payments will be included in a future Internal Audit Plan. The Follow-Up Report reviewing the implementation of the agreed recommendations is provided in Appendix 2. Self-Directed Support (SDS) – Option 2/3 4.6 This follow-up audit checked the implementation of recommendations related to the systems and procedures for administering SDS Options 2 and 3. SDS Option 2—Managed Budget, allows individuals, following a care assessment, to choose their own support while Health & Social Care Moray arranges its provision and payment. SDS Option 3—Managed Support, is where Health & Social Care Moray selects, commissions, and pays for appropriate support on behalf of the individual. The audit reviewed processes for assisting individuals in determining their preferred care delivery options, managing contractual relationships with care providers, overseeing financial management and monitoring individual care packages. The Follow-Up Report, provided in Appendix 3, highlights several recommendations that have not yet been implemented. The Service has set revised implementation dates for the outstanding recommendations and will review progress at monthly SDS Steering Group meetings, with updates also reported for monitoring at monthly Practice Governance Board meetings. Page 80
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Moray Integrated Community Equipment Store 4.7 An audit was previously undertaken on the Moray Integrated Community Equipment Store, which provides aids and equipment to assist individuals with daily tasks such as cooking, dressing, and bathing. Stock items vary in value, ranging from a few pounds to over £1,000 for certain hoists and specialised seating. A key feature of the Store is its handling of returned equipment that is no longer required. Where possible, returned items are decontaminated and made available for reuse. The audit identified significant areas requiring improvement in the Store’s current operating arrangements. A recent follow-up review found progress in implementing the recommendations; however, several remain outstanding and require revised implementation dates. The Follow-Up Report, which evaluates the implementation of the agreed recommendations, is provided in 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” Internal audit work supports good governance and assists in securing appropriate systems of internal control. (b) Policy and Legal The internal audit service is provided in terms of paragraph 7:1 of the Local Authority Accounts (Scotland) Regulations 2014, and there is a requirement to provide a service in accordance with published Public Sector Internal Audit Standards. (c) Financial Implications No implications directly arising from this report. (d) Risk Implications Audit reports highlight risk implications and contain recommendations for management to address as a means of mitigating. (e) Staffing Implications No implications directly arising from this report (f) Property No implications. (g) Equalities/ Socio Economic Impacts No implications. (h) Climate Change and Biodiversity Impacts None directly arising from this report. (i) Directions None arising directly from this report. (j) Consultations There have been no direct consultations during the preparation of this report. Page 81
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6. CONCLUSION 6.1 This report provides Committee with an update on internal audit work progressed in the latest review period. Author of Report: Dafydd Lewis, Chief Internal Auditor Background Papers: Internal Audit Files Ref: mijb/ap&rc/ Page 82
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Aberdeenshire Health & Socia! Care Partnership Aberdeen City Health & Social Care Partnership A., • ''" ' • • ..,, Ways of Working Protocol NHS Grampian and Integration Joint Boards Internal Audit NHS � Grampian The following sets out the protocol to be followed with regards to assurance activities across NHS Grampian and the Moray, Aberdeenshire and Aberdeen City fntegration Joint Boards. This work will be led by the respective Chief Internal Auditors (CIAs) and focus on the following: • The Internal Audit function of the Partner bodies will be included as formal consultees in the annual audit plans. It is acknowledged that each Partner body may have different consultation, committee reporting, and timescale requirements. However, where practical, ttie CIAs should share their draft audit plans to allow for consultation before the plans are finalised. • Where possible, and with the approval of the respective Audit Committees, an area for joint working/assurance should be considered annually. This will be subject to the availability of resources from each Partner body. ·A joint thematic report, bringing together the findings from each of the Partner bodies' reviews, should be considered. However, reporting arrangements will depend on the needs and requirements of each Partner body's Audit Committee. • There will be regular collaboration between the CIAs of the respective bodies. This will include a formal quarterly check in, in addition to ad hoc catch ups as required. • The CIAs will draw to the attention of their counterparts any significant findings from audit work they d�em as relevant throughout the year. • In line with their respective timelines, annual audit opinions will be shared by the CIAs with the Internal Audit function of the respective bodies for information. • NHS Grampian Internal Audit Reports shall be shared with the CIA of the IJBs in line with the agreement, as set out in the hold harmless letters. Hold harmless letters will be reviewed annually and updated as required. APPENDIX 1 Page 83
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APPENDIX 2 Moray Council Internal Audit Section BODY: Health & Social Care Moray SUBJECT: Self-Directed Support Financial Review REPORT REF: 22'013 Follow Up Audit Review Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation Key Control: Clear and current policy documents and operational guidelines have been developed for the financial administration of SDS packages. 5.01 The SDS Direct Payment guidance and financial monitoring procedures should be reviewed and updated on a regular basis. Low Yes 30/04/2022 Implemented. Implementation completed as detailed in the follow-up report presented to the Council’s Audit & Scrutiny Committee on 10/05/2023 (para 7 of minute refers) and MIJB’s Audit, Performance & Risk Committee on 29/06/2023 (para 5 of minute refers). Key Control: Financial reviews are being carried out to monitor the usage of SDS funding in accordance with operational guidelines. Page 84
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Moray Council Internal Audit Section 2 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation 5.02 Annual financial reviews should be undertaken in line with the direct payment financial monitoring procedures. High Yes 31/01/2022 (Revised Implementation Date 31/08/2023; Further Revised Implementation Date 30/09/2024) Part Implemented. Significant progress has been evidenced as made in undertaking annual financial reviews with the appointment of a temporary Finance Assistant post in September 2023. As an indication of the improvement in scale, 331 reviews were carried out in the 2024 calendar year compared to 107 undertaken in 2023. The additional resource has allowed all unmanaged accounts to be subjected to an annual review and although a backlog of managed account annual reviews is still in existence, this is being worked through using a logical system of risk-based prioritisation and all overdue reviews have been allocated to officers within the SDS Team for future undertaking. Accurate records are being kept of completed activities and due reviews and Page 85
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Moray Council Internal Audit Section 3 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation management are employing effective monitoring to direct limited resources to best use. It is considered that the service is applying focus to the financial review requirements and are on a clear path to address the recommendation fully by 31/03/2026 within current staff resources. 5.03 Consideration should be given to the routine production of reports from the Care First System which can be used to detail financial reviews falling due and allow management to prioritise workloads accordingly. The requirement of manual spreadsheets should be minimised wherever possible to ensure information reference Medium Yes 31/12/2021 Implemented. Implementation completed as detailed in the follow-up report presented to the Council’s Audit & Scrutiny Committee on 10/05/2023 (para 7 of minute refers) and MIJB’s Audit, Performance & Risk Committee on 29/06/2023 (para 5 of minute refers). Page 86
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Moray Council Internal Audit Section 4 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation points come direct from the Care First system. 5.04 A risk based approach should be initiated by management to prioritise outstanding financial reviews and work through the backlog in an order which makes best use of limited resources. High Yes 31/12/2021 (Revised Implementation Date 31/08/2023) Implemented. Implementation completed as detailed in the follow-up report presented to MIJB’s Audit, Performance & Risk Committee on 26/10/2023 (para 7 of minute refers) and the Council’s Audit & Scrutiny Committee on 22/11/2023 (para 5 of minute refers). 5.05 A reminder should be issued to people receiving services, and approved payroll providers where applicable, to inform the Authority when funds in excess of the contingency amount are held. This may assist in the High Yes 30/04/2022 Implemented. Implementation completed as detailed in the follow-up report presented to the Council’s Audit & Scrutiny Committee on 10/05/2023 (para 7 of minute refers) and MIJB’s Audit, Performance & Risk Committee on 29/06/2023 (para 5 of minute refers). Page 87
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Moray Council Internal Audit Section 5 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation prioritisation of early financial reviews and highlight issues for further investigation. 5.06 A review should be undertaken of all people receiving a service in regard to the current balances held within their SDS bank account. Action should then be taken to recover excess funds. High Yes 30/04/2022 (Revised Implementation Date 31/08/2023; Further Revised Implementation Date 30/09/2024) Implemented. Annual reviews for unmanaged accounts has allowed appropriate surpluses to be recovered on an ongoing basis. In relation to managed accounts where some annual reviews remain overdue as detailed at recommendation 5.02, bank balances are being obtained monthly and surpluses reclaimed where appropriate even though a comprehensive review has not yet been undertaken. Surpluses reclaimed in the 24/25 financial year to date, 10 months from April to December, amount to the significant sum of £932,337, illustrating the Page 88
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Moray Council Internal Audit Section 6 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation progress made by the SDS Team. 5.07 In compliance with established procedures, one-off direct payments should be subject to a financial monitoring review 3 months (or in limited circumstances at another interval) after the funding has been distributed to confirm its appropriate usage. Medium Yes 30/04/2022 (Revised Implementation Date 31/08/2023; Further Revised Implementation Date 31/03/2024) Part Implemented. Significant progress has been evidenced as made in undertaking reviews falling due, as detailed at recommendation 5.02. Although a small number of one-off payment reviews remain overdue, the backlog is being worked through using a logical system of risk-based prioritisation and all overdue reviews have been allocated to officers within the SDS Team for future undertaking. It is considered that the service is applying focus to the financial review requirements and are on a clear path to address the recommendation fully by 31/03/2026 within current staff resources. Page 89
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Moray Council Internal Audit Section 7 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation 5.08 The Service should comply with the monitoring requirements detailed within an agreement between the Council and the Service User for the purchase and adaptation of a mini van. Medium Yes 31/12/2021 (Revised Implementation Date 31/03/2023; Further Revised Implementation Date 31/12/2023) Implemented. Inspection visits have been undertaken and current MOT, road tax and insurance has been confirmed as held. The regulatory requirements will continue to be monitored by ongoing reviews for the period of the legal agreement. 5.09 Closing financial reviews of SDS care packages should be undertaken in accordance with agreed procedures. Evidence should be retained of any expenditure outwith the agreed support plan and of the full discussions held and decisions made by Social Workers regarding retrospective Medium Yes 31/12/2021 (Revised Implementation Date 31/08/2023; Further Revised Implementation Date 30/09/2024) Part Implemented. Significant progress has been evidenced as made in undertaking reviews falling due, as detailed at recommendation 5.02 and in common with recommendation 5.07. Although a number of closing reviews remain overdue, the backlog is being worked through and all overdue reviews have been allocated to officers within the SDS Team for future undertaking. It is considered that the service is applying focus Page 90
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Moray Council Internal Audit Section 8 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation authorisation. to the financial review requirements and are on a clear path to address the recommendation fully by 31/03/2026 within current staff resources. Key Control: SDS Funding is only used to support the service user's support plan outcomes and compliance is monitored to ensure public funds are spend appropriately. 5.10 Care and Support Plans should be reviewed annually to ensure the agreed care is being provided and continues to meet the needs of the person receiving the service. High Yes 01/05/2022 (Revised Implementation Date 31/08/2023; Further Revised Implementation Date 30/09/2024) Outstanding. The issue of annual reviews of care and support plans not being able to be resourced has also been raised in the audit of SDS Option 2/3 and the recent Out of Area Placements audit. The Heads of Service have stated a review schedule is to be established and reviews considered as part of efficiencies strategies. An implementation date of 31/12/2025 has now been set and progress will be reported in the Out of Area Page 91
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Moray Council Internal Audit Section 9 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation Placements follow-up review in due course. 5.11 All Social Workers should be reminded of the requirement to inform the SDS Team of any amendment to a Support Plan that will have a financial change to a the care package of a person receiving a service. High Yes 01/12/2022 Implemented. Implementation completed as detailed in the follow-up report presented to the Council’s Audit & Scrutiny Committee on 10/05/2023 (para 7 of minute refers) and MIJB’s Audit, Performance & Risk Committee on 29/06/2023 (para 5 of minute refers). Key Control: SDS service has effective arrangements in place to monitor support packages and report on performance. 5.12 Consideration should be given to the development of appropriate performance monitoring measures to be reported to service management on a regular basis. Given the current backlog of reviews and consequences of Low Yes 30/09/2022 (Revised Implementation Date 31/03/2023) Implemented. Implementation completed as detailed in the follow-up report presented to MIJB’s Audit, Performance & Risk Committee on 26/10/2023 (para 7 of minute refers) and the Council’s Audit & Scrutiny Committee on 22/11/2023 (para 5 of minute refers). Page 92
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Moray Council Internal Audit Section 10 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation direct payment accounts not being scrutinised on a timely schedule, it may be beneficial for performance information to be made available for management to identify any resourcing issues arising and assess risks involved. Page 93
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APPENDIX 3 Moray Council Internal Audit Section BODY: Health & Social Care Moray SUBJECT: Self Directed Support (Options 2 & 3) REPORT REF: 23'025 Follow Up Audit Review Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation Key Control: Effective controls operate in the management and recording arrangements for the delivery of SDS Options 2 and 3 care packages. 5.1 In accordance with SDS Regulations, evidence should be maintained to document the discussions held by social workers regarding the various care delivery options discussed with the individual using care services. High Yes 30/09/2023 Part Implemented- The Service has developed Social Work Assessment Guidance and documentation that includes a requirement for supporting and recording the conversations that need to occur with individuals and families when determining care delivery options. The new documentation aims to ensure the recording of clear and transparent discussions regarding the decision-making on SDS Page 94
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Moray Council Internal Audit Section 2 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation options. A quality assurance review was undertaken by the Service in January 2025 to evaluate compliance with the Guidance. The review found the majority of assessments sampled to have the supported person’s views on SDS options discussions recorded, but instances were identified of no or limited information being recorded on the supported person’s views. An action plan is to be developed on improvements required, and further reviews are to be carried out by the Service to monitor the recording of discussions and their quality. Outcome reporting will be overseen by monthly meetings of the Practice Governance Board, with the next meeting on 27/05/25. Internal Audit Section does not intend to undertake another formal review to evidence the implementation of this recommendation, but an overview of progress undertaken by the Page 95
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Moray Council Internal Audit Section 3 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation Service will be done when undertaking a follow-up review of other recommendations within this audit. 5.2 Documented procedures should be developed to support social workers and individuals using care services in the selecting of SDS care delivery options. High Yes 31/03/2024 (Revised Implementation Date 30/09/2025) Part Implemented- Comprehensive Social Work Assessment Guidance to support officers has been developed by the Service and put into operational use. An objective of the Guidance is to support a clear and transparent decision-making process and promote consistency whilst aligning with national and local policy requirements and best practices. However, additional work is required on updating the information available to individuals through guides and internet content to SDS standards and further developing the Resource Allocation System. A revised date of 30/09/2025 for full Page 96
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Moray Council Internal Audit Section 4 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation implementation has been agreed. 5.3 An annual reference document detailing a breakdown of the rates paid to care providers should be provided to all relevant officers to assist in budgetary planning and the accurate preparation of an individual's support package. High Yes 30/06/2023 (Revised Implementation Date 01/04/2025) Outstanding. An annual reference document is maintained and made available to all relevant officers to assist in the costing of support packages. However, the document has not been revised to include a breakdown of costs for block funding arrangements. Work is currently ongoing, together with the budget savings plan, to identify the appropriate costing breakdown required for block funded services. A revised implementation date of 01/04/2025 was agreed during this follow up review. Verification regarding the implementation of the recommendation will be done when undertaking the next follow up review for this Page 97
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Moray Council Internal Audit Section 5 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation audit. 5.4 All officers should be reminded to update the CareFirst System to ensure the database is up-to-date and accurate for each individual using care services. High Yes 30/09/2023 Implemented. The required content of the CareFirst System is set out in the new Social Work Assessment Guidance referred to in 5.1. Training programmes are being overseen by the SDS Consultant Practitioner, and quality assurance and review activities undertaken by the Service to evaluate the effectiveness of the new guidance in achieving the required case recording standards. This will continue to be monitored by further Service reviews and outcome reporting will be overseen by monthly meetings of the Practice Governance Board, with the next meeting on 27/05/25. 5.5 A tripartite agreement between Medium Yes 30/09/2024 (Revised Part Implemented- A random sample of Option 2 packages commencing in 2024/25 Page 98
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Moray Council Internal Audit Section 6 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation the individual using the care service, Council and care provider should be agreed for all SDS Option 2 care packages. Implementation Date 31/07/2025) was selected, and they all had a valid tripartite agreement in place. However, further to discussions with officers, a review of service provider payments is to be undertaken to identify any gaps in historical packages to ensure all Option 2 individuals receiving a social care service have a tripartite in place. A revised date for full implementation of the recommendation by 31/07/2025 has been agreed with the Service. 5.6 A contractual agreement detailing service delivery and costs should be agreed with the 3 providers of day care services noted within the findings. High Yes 31/03/2024 (Revised Implementation Date 31/08/2025) Outstanding. Contractual agreements with the 3 providers are not yet in place. However, work has been ongoing in line with the budget savings plan which will inform the service requirements and costs. This exercise is intended to be completed by 31/03/2025 and will allow contractual arrangements to be Page 99
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Moray Council Internal Audit Section 7 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation created for these services via a framework agreement. A revised implementation date of 31/08/2025 has been agreed with the Adult Social Care Commissioning Service. 5.7 Annual support plan reviews of individuals in receipt of SDS Option 2 and 3 care packages should be undertaken in accordance with agreed procedures. High Yes 30/09/2024 (Revised Implementation Date 31/12/2025) Outstanding. The recommendation of the requirement to undertake annual reviews of care and support plans was also detailed within the audit of SDS Option 1 and the recent Out of Area Placements review. The Heads of Service have stated that a review schedule is to be established, and the need to undertake annual reviews of care and support plans for individuals receiving social care services is to be considered as part of efficiency strategies. A revised implementation date of 31/12/2025 has now been agreed. 5.8 Consideration should be given for Medium Yes 30/09/2023 Implemented. A Standard Operating Page 100
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Moray Council Internal Audit Section 8 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation management to undertake regular reviews of the accuracy and recording of the checks completed to ensure the accuracy of payments made to care providers. Procedure (SOP) has been developed to comprehensively detail all checks required for invoice processing. A management review of a sample of invoices is being carried out on a monthly basis, to confirm verification checks have been fully undertaken in line with the SOP. The performance of the management review has been evidenced as recorded on the invoice monitoring spreadsheet maintained by Community Care Finance. 5.9 The Council's charging policy should be reviewed in regard to day care and a decision made as to whether a charge should be levied for the service in the future. High Yes 30/09/2023 (Revised Implementation Date 30/09/2025) Outstanding. The Charging and Contributions Policy has not yet been reviewed due to staffing resourcing issues. However, the Charging and Contributions Policy is planned for review as part of the ongoing savings work within the Service. A working group is reviewing the issue, Page 101
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Moray Council Internal Audit Section 9 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation considering its alignment with the COSLA Non-Residential Charging Policy. The outcome of the review and potential charging for day care services is planned to be presented to the MIJB for decision. A revised implementation date of 30/09/2025 has been agreed with the Service. It is appreciated the decision will thereafter be required to be considered by Moray Council under their statutory duties for the setting of charges, ahead of the 2026/27 budget setting process. 5.10 A review of arrangements regarding the authorisation of individual care packages should be undertaken. Thereafter, authorisation requirements should be documented and Medium Yes 31/08/2023 (Revised Implementation Date 30/06/2025) Outstanding. Full review and documentation of care package authorisation requirements have not been resourced to date. Significant temporary measures have been implemented as a result of work on the budget savings plan, including the creation of a High Cost Page 102
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Moray Council Internal Audit Section 10 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation communicated to all appropriate officers. Package Panel for appropriate authorisation, however expansion of the review and documentation is required. This is to be taken forward with urgency by the Service, with a full review of authorisation levels and documentation aligning to the development of the Resource Allocation process and with consideration given to the Financial Regulations. A revised implementation date of 30/06/2025 has been agreed with the Service. Page 103
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APPENDIX 4 Moray Council Internal Audit Section DEPARTMENT: Health & Social Care Moray SUBJECT: Moray Integrated Community Equipment Stores REPORT REF: 24'013 Follow Up Audit Review Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation Key Control: Effective systems and procedures operating to ensure accurate records are maintained to account for all occupational therapy equipment held within Stores and issued to people who access the service. 5.1 A full stock check should be undertaken to ensure records correspond to the actual number of items held within Stores. Items of equipment should be kept High Yes 31/03/2024 Implemented– The review confirmed that Stores officers completed a full stock check after implementing new stock management arrangements. The stock take was verified by an officer from the Internal Audit Section with only minor variances noted between system recorded figures and the actual stock held. Variances were investigated and explanations obtained. Page 104
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Moray Council Internal Audit Section 2 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation wherever possible in Asset Number order within the Stores Building. Asset Numbers should be clearly recorded where possible on shelving. Medium Yes 31/03/2024 Implemented- Asset numbers are now clearly recorded on shelving used for storing equipment. Shelf locations across the Store have also been added to the Stores Software Application (ELMS). 5.2 The software application used for purchasing equipment should be regularly updated with the stock issued to ensure an accurate unit price is maintained. Further exploration should be undertaken of ELMS with the purpose of enabling the direct purchase of equipment. Medium Medium Yes Yes 31/03/2024 (Revised Implementation Date 30/06/2025) 31/10/2024 (Revised Implementation Date 30/06/2025) Outstanding– The review found that the software application used for purchasing occupational therapy equipment, which is separate from ELMS, was not regularly updated with the stock issued. This impacts the accuracy of individual stock valuations. Outstanding- The Service is making enquiries with the software provider for ELMS to check whether it could provide stock valuations in accordance with accounting requirements. However, alternative solutions may be required. The outcome of these Page 105
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Moray Council Internal Audit Section 3 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation investigations will be reported to the Operational Management Team so that a preferred solution can be decided. A revised implementation date of 30/06/2025 has been agreed with the Service. 5.3 A review should be undertaken of the current policy of revaluing re- used items of equipment at 50% of the original unit price. Medium Yes 31/01/2024 (Revised Implementation Date 30/06/2025) Outstanding- The decision to revalue re- used equipment at 50% of the original purchase price is still under review. The Service has indicated they intend to provide a report to members of the MIJB at the conclusion of this exercise. A revised implementation date of 30/06/2025 has been agreed with the Service. 5.4 People who access the service should be advised that any equipment received should be included within their personal property content insurance. Medium Yes 31/01/2024 (Revised Implementation Date 30/06/2025) Outstanding– This recommendation is still under review by the Service. A report on this issue is intended to be provided to MIJB members. A revised implementation date of 30/06/2025 has been agreed with the Service. Page 106
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Moray Council Internal Audit Section 4 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation 5.5 Maximum and minimum stock levels should be implemented in ELMS to assist officers in ensuring the effective management of stock levels. Medium Yes 31/03/2024 Implemented- The review has confirmed that maximum and minimum stock level functions are now used within ELMS. The Service also intends to review these stock level parameters regularly. 5.6 A record should be maintained of the stock checks undertaken, and any adjustments to stock figures for equipment recorded within ELMS should require the authorisation of the supervisor. Medium Yes 31/01/2024 Implemented– Records of weekly stock checks are now maintained. It was also confirmed that adjustments to stock levels within ELMS can now only be authorised by supervisory officers. 5.7 In regard to the stock of returned specialised chairs noted during the audit review, a decision should be undertaken regarding their future use. Medium Yes 31/03/2024 Implemented- The Service has decided to retain the chairs. A meeting between officers from the Equipment Stores of Aberdeen City, Aberdeenshire and Moray agreed to explore options regarding the use of these chairs and other equipment within the Grampian area. In addition, the Service has advised that the chairs could be adapted to meet the specific Page 107
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Moray Council Internal Audit Section 5 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation needs of individuals, potentially providing an alternative to procuring new items. 5.8 Further development should be undertaken of ELMS to enable greater use of the software application in the management of stock items. Medium Yes 31/03/2024 Implemented– It was found that the Service is making greater use of the reporting functions within ELMS. In addition, data from ELMS is exported to another software application to allow for greater analysis of information. 5.9 Officers should be instructed to utilise the facility within ELMS to mark stock as out for delivery. Low Yes 30/06/2024 Implemented- Procedures are now in place requiring drivers delivering equipment from Stores to mark equipment as out for delivery within ELMS. 5.10 A review of off contract expenditure should be carried out and where necessary contracts developed. Low Yes 31/03/2024 (Revised Implementation Date 30/06/2025) Part Implemented- A contract review for procurement of occupational therapy equipment is being undertaken. This includes developing contacts that include a specialised type of chairs currently procured off contract. A revised implementation date of 30/06/2025 has been agreed with the Service. 5.11 A formal procedure should be Medium Yes 29/02/2024 Implemented- A record of all NHS officers Page 108
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Moray Council Internal Audit Section 6 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation established for maintaining a list of NHS officers requiring access to ELMS. with authorised access is maintained, including confirmation of up-to-date data protection training. The audit also confirmed regular reviews are undertaken that check for officers on-going access requirements to ELMS. 5.12 Current operating practices should be recorded within a Service Operating Manual. Medium Yes 31/03/2024 Implemented - Operating Procedures are now in place to provide officers with a point of reference guidance in the administration of the Moray Integrated Community Equipment Store. 5.13 A review of service procedures should be undertaken to ensure the Store is informed of a change in circumstances in an individual’s condition where an item of equipment may no longer be required. Arrangements should then be undertaken for collection at the earliest opportunity. Medium Yes 29/02/2024 Implemented- The Moray Integrated Community Equipment Service is informed of equipment issued to an individual but is no longer required. Testing has confirmed that when informed, arrangements are made for the collection of this equipment. Page 109
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Moray Council Internal Audit Section 7 Risk Ratings for Recommendations High Key controls absent, not being operated as designed or could be improved. Urgent attention required. Medium Less critically important controls absent, not being operated as designed or could be improved. Low Lower level controls absent, not being operated as designed or could be improved. No. Audit Recommendation Priority Accepted (Yes/ No) Date of Completion Status / Explanation If no agreement can be made for the equipment to be returned to the Store, consideration should be given to invoicing the individual for the item. Medium Yes 31/01/2024 (Revised Implementation Date 30/06/2025) Outstanding – A review of whether there should be invoicing for equipment not returned is currently on-going within the Service. It is intended to report to members of the MIJB on this issue. A revised implementation date of 30/06/2025 has been agreed with the Service. 5.14 Improvements identified to the Service during the audit review regarding the physical security of the Moray Integrated Community Equipment Store building should be implemented as a matter of urgency. High Yes 31/03/2024 Implemented - A new alarm system has been fitted at the Moray Integrated Community Equipment Store and is now in operation. Page 110
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REPORT TO: MORAY INTEGRATION JOINT BOARD AUDIT, PERFORMANCE AND RISK COMMITTEE ON 19 JUNE 2025 SUBJECT: INTERNAL AUDIT ANNUAL REPORT – 2024/25 BY: CHIEF INTERNAL AUDITOR 1. REASON FOR REPORT 1.1 This report provides Committee with details of internal audit work undertaken relative to the Moray Integration Joint Board (MIJB) for the financial year ended 31 March 2025, and the assurances available on which to base the internal audit opinion on the adequacy of the MIJB’s systems of internal control. 2. RECOMMENDATION 2.1 The Committee is asked to consider the contents of the annual report given as Appendix 1 to this report and seek clarification on any matters relating thereto. 3. BACKGROUND 3.1 The purpose of this report is to present the Committee with the Internal Audit Annual Report for the year to 31 March 2025 which includes the Chief Internal Auditor’s independent assurance opinion on the adequacy of the MIJB’s systems of internal control. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Public Sector Internal Audit Standards (PSIAS) require that the Chief Audit Executive (CAE), the MIJB’s Chief Internal Auditor, to provide an annual internal audit opinion and report on the adequacy and effectiveness of the MIJB’s systems of governance, risk management and internal controls to support the preparation of the Annual Governance Statement. This is in support of the overall governance arrangements of the MIJB. 4.2 The report covers the year to 31 March 2025 and is provided in Appendix 1. Item 8. Page 111
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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” Internal audit work supports good governance and assists in securing appropriate systems of internal control. (b) Policy and Legal The Internal Audit Service is provided in terms of paragraph 7:1 of the Local Authority Accounts (Scotland) Regulations 2014, and there is a requirement to provide a service in accordance with published Public Sector Internal Audit Standards. (c) Financial Implications No implications directly arising from this report. (d) Risk Implications and Mitigation No direct implications. (e) Staffing Implications No implications directly arising from this report (f) Property No implications. (g) Equalities/ Socio Economic Impacts No implications. (h) Climate Change and Biodiversity Impacts None directly arising from this report. (i) Directions None arising directly from this report. (j) Consultations There have been no direct consultations during the preparation of this report. 6. CONCLUSION 6.1 This report provides a summary overview of the nature and extent of audit work carried out during the year, and informs the annual internal audit opinion on the internal control environment operating within the MIJB. Author of Report: Dafydd Lewis, Chief Internal Auditor Background Papers: Internal Audit Files Ref: mijb/ap&rc/19062025 Page 112
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APPENDIX 1 INTERNAL AUDIT ANNUAL REPORT and OPINION 1 APRIL 2024 to 31 MARCH 2025 Page 113
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CONTENTS PAGE SECTION-1 INTRODUCTION 3 SECTION 2 BASIS OF OPINION 4 SECTION 3 SUMMARY AND LIMITATIONS OF WORK THAT SUPPORTS OPINION 4 - 7 SECTION 4 OPINION 7-8 Page 114
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SECTION 1 – INTRODUCTION Purpose of this report The Public Sector Internal Audit Standards (PSIAS) require the Chief Internal Auditor to provide a written statement to inform the Annual Governance Statement. This report constitutes the required statement. In compliance with the PSIAS, this report presents an opinion on the overall adequacy and effectiveness of the Moray Integration Joint Board’s (MIJB) risk management, control, and governance processes, based on the work performed by the Internal Audit Section. In addition, my evaluation includes an assessment of reports issued by other review agencies. The scope of internal audit work, the responsibilities of Internal Audit and the assurance provided on the adequacy and effectiveness of the MIJB’s internal control system are explained further in Section 4 of this report. Responsibilities of Management and Internal Audit It is management’s responsibility to maintain systems of risk management, internal control and governance. Internal audit is an element of the internal control framework established by management to examine, evaluate and report on accounting and other controls over operations. Internal audit assists management in effectively discharging its responsibilities and functions by examining and evaluating controls. Internal audit cannot be held responsible for internal control failures. The role of internal audit includes assessing the adequacy of risk management, internal controls, and governance arrangements put in place by management, as well as performing testing on a sample of transactions to ensure those controls were operating effectively during the period under review. The Audit and Risk Manager of Moray Council is the appointed Chief Internal Auditor of the MIJB. Moray Council’s Internal Audit Section allocates a portion of its available audit days to review the systems and practices of the MIJB. In addition, during 2024/25, an agreement was obtained from the management of NHS Grampian and their Internal Audit Provider to share their audit reports, which will also support the annual internal audit opinion on the MIJB’s internal control environment. The Public Sector Internal Audit Standards (PSIAS) require officers of the Internal Audit Section to communicate promptly any facts or matters that may affect their independence. This report confirms that all staff members involved in the 2024/25 internal audit reviews were independent of operational processes and that their objectivity was not compromised. Page 115
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SECTION 2 –BASIS OF OPINION My evaluation on the adequacy and effectiveness of the MIJB framework of governance, risk management and internal control is based on the following: • The audit work undertaken by the Moray Council Internal Audit Section during the year to 31 March 2025. • The audit work undertaken by the Internal Audit Provider of NHS Grampian for the year ended 31 March 2025. • Any issues highlighted in the governance statement by the Chief Officer of the MIJB for the year ended 31 March 2025. • Reports issued by the MIJB’s External Auditor and other external review agencies. • My knowledge of the MIJB’s governance, risk management and performance monitoring arrangements. Assurance is also based on the wider audit work conducted by the Chief Internal Auditor in his capacity as the Audit and Risk Manager of the Moray Council. SECTION 3- SUMMARY AND LIMITATIONS OF WORK THAT SUPPORTS THE OPINION Progress on the 2024/25 Internal Audit Plan The Internal Audit Section operates independently within the organisation, and I can confirm that management has imposed no limitations on the scope of audit work. The Internal Audit Annual Audit Plan presented to the Audit, Performance and Risk Committee describes in some detail the framework around which audit work is developed. In addition, the selection of audit topics was made with regard to corporate planning documents, budget data, and information drawn from the corporate risk register. Input from senior management regarding possible areas for audit was also taken into account. The internal audit work has been conducted in accordance with an established methodology that promotes quality and conformance with the Public Sector Internal Audit Standards and the agreed Internal Audit Annual Audit Plan. A summary of the audit projects completed from the MIJB Audit Plan is summarised as follows: • An audit was undertaken of the administrative arrangements for fostering and kinship care payments. The audit scope reviewed policies and procedures for the management of fostering and kinship payment of fees and allowances are administered in accordance with these policies and procedures and are operating within budgetary control. • It is pleasing to report that within the scope of the audit; the management of fostering and kinship payments was well managed. However, some administrative control improvements were noted concerning the recording of information and the introduction of additional verification checks to confirm eligibility for ongoing kinship allowance payments. Page 116
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• A review was undertaken of the MIJB’s governance arrangements to prevent fraud and corruption. The Chartered Institute of Public Finance and Accountancy Code of Practice on Managing the Risk of Fraud and Corruption was used as the template for developing an audit programme of testing to be undertaken. This review was done as part of a joint audit exercise with the internal audit providers of NHS Grampian and Aberdeenshire, and Aberdeen City Integration Joint Boards. As the Integration Joint Boards deliver services through officers and systems of the Council and NHS Grampian, this approach has allowed for a more overarching and complete review to be undertaken. • Findings noted that further improvements are needed in developing agreed procedures between the internal audit services and the NHS Counter Fraud Authority, as officers of both NHS Grampian and the Council use systems of both organisations to deliver services. Recommendations also included a need to develop more effective reporting of irregularities and administrative arrangements. • An audit was undertaken of the systems and procedures supporting the delivery of services to individuals receiving adult care services who are classified as out of area (OOA). The review involved randomly selecting a sample of OOA placements to examine the arrangements for care delivery, determine the ordinary residence status, and assess the contract management agreements with care service providers. The audit identified significant concerns regarding the progress made in determining the ordinary residence status of individuals receiving adult care services, the contractual arrangements with care providers, and the recording and budgetary management of OOA placements. • A review was undertaken of residential care. The scope of the audit was to examine the processes for making accurate payments at agreed contract rates to third-party providers for the delivery of permanent residential care. Testing included verifying that all residents entering a residential care home following a care needs assessment had been financially assessed in accordance with the Charging for Residential Accommodation Guidance (CRAG) issued by the Scottish Government. A check was also made to verify the accuracy of the calculation of assessed contributions toward care costs, as well as the administrative arrangements for processing and paying third- party care providers. The audit found that the systems for administering financial assessments of residential care home residents and verifying and processing payments to third-party care home providers are significantly paper based. This has proved challenging, and consideration should be given to the digitalisation of this process. Further administrative improvements were also identified, including the need for improved information management arrangements and more efficient completion of financial assessments for individuals entering residential care homes. • The Internal Audit Section reports follow-up reviews to evidence the implementation of recommendations to the Audit, Performance and Risk Committee. It is appreciated the demands on services, however the follow- up audits undertaken of Self Directed Support and the Moray Integrated Community Stores found a number of recommendations where revised timescales for the implementation of recommendations were required. The Page 117
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need to revisit audit reviews to evidence the implementation of recommendations has resulted in an additional workload commitment for the Internal Audit Section. Implementation of recommendations is a key determinant in assessing the adequacy and effectiveness of the internal control system. If recommendations are not implemented in a timely manner, then weaknesses in control and governance frameworks will remain. While the demands on officers’ time are acknowledged, delays in responding to audit queries and recommendations can be challenging and does impact the timely reporting of audit reviews to the Committee. • A previous audit review of Social Care Information Governance identified the need to explore the development of a unified case recording system. It is encouraging to note that the Service is actively seeking a replacement for the current social work and social care case management system. However, it is essential that this is progressed in a timely manner, given that it involves the management and recording of highly sensitive information. • On a more positive note, as the Chief Internal Auditor of the MIJB, my role requires assurances of internal controls of systems and practices needed to deliver services, irrespective of whether they use Council or NHS systems. In the past members of the Audit, Performance and Risk Committee have been provided with audit reports of reviews undertaken regarding operating practices that use Moray Council owned systems due to my role as the Council’s Auditor. However, over the last year, an agreement has been reached with the senior management of NHS Grampian and their Internal Audit Provider to allow me to receive copies of NHS Grampian's internal audit reports of interest to the MIJB. Moving forward, this will enable members to have a more overarching opinion of MIJB governance and internal control arrangements irrespective of whether Council or NHS Grampian systems are used in the delivery of services. Governance - from a review of the Annual Governance Statement prepared for inclusion within the MIJB accounts, it was found to have been prepared in line with good practice guidance issued by CIPFA / SOLACE. The statement included an assessment of the effectiveness of governance arrangements within the MIJB regarding the seven principles of good governance identified within the guidance. It also referenced the governance processes of the principal partner bodies (NHS Grampian and Moray Council) as sources of additional assurance. A review of the Moray Council’s Chief Social Work Officer's annual report noted several governance arrangements to ensure effective service delivery. The quality of social work services is assured by the Practice Governance Board. However, the report details the financial challenges faced by Health and Social Care Partnership in Moray with “increasing overspend” against budgets and a need “to identify where savings can be made and where efficiencies can be created by doing things differently”. In addition, the report also details difficulties in recruiting social workers and social care staff, resulting in additional workloads for officers. As the Chief Internal Auditor, I note significant challenges faced by the Service. An audit review of Adult Social Care Commissioning Service undertaken by KPMG Governance, Risk & Compliance Services and reported to the Audit, Performance and Risk Committee (item 11) on 30 March 2023. The need for this review was highlighted due to concerns raised by senior Health & Social Care Moray management regarding administrative arrangements within the Adult Social Care Commissioning Service. Regular reporting has been undertaken to the Audit, Performance and Risk Committee on the progress of implementing the Page 118
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recommendations of improvements detailed within the audit report. It is pleasing to note that a recent report to the Audit, Performance and Risk Committee indicated that the implementation of recommendations is nearly complete. An internal audit review to verify the implementation of the recommendations from the review of the Adult Social Care Commissioning Service is included in the 2025/26 Annual Audit Plan. Risk Management - procedures are well developed with a risk management policy and strategy in place, a risk appetite statement has been prepared, and a risk register has been reviewed and updated regularly. The Risk Register summarises the principal risks facing the organisation under nine themes; these themes focus on critical risk areas, including finance, environment and operational continuity, together with transformation risks associated with change and infrastructure given the reliance of the MIJB on support from both the Council and the NHS. Statement on Conformance with the Public Sector Internal Audit Standards The Local Authority Accounts (Scotland) Regulations 2014 require public bodies to operate a professional and objective internal auditing service in accordance with recognised standards and practices in relation to internal auditing, the Public Sector Internal Audit Standards (PSIAS). A requirement of PSIAS is that an External Quality Assessment (EQA) is undertaken every 5 years. All Scottish local authorities are required to have an External Quality Assessment (EQA) every 5 years. As part of the Council’s membership of the Scottish Local Authorities Chief Internal Auditors’ Group, it was agreed that this EQA requirement would be met by each local authority's internal audit service undertaking a review of another council and will thereafter receive a review in return. An EQA of the Council’s Internal Audit Section was completed by the Chief Internal Auditor of Perth and Kinross Council, and the findings were reported to the Audit, Performance and Risk Committee on 26 September 2024. The overall conclusion of the external assessment is that the Internal Audit Section fully conforms to the PSIAS. This represents the highest level of performance standards in the delivery of an internal audit service and should provide assurance regarding the effectiveness of the current internal audit arrangements. The Public Sector Internal Audit Standards also require the Chief Internal Auditor to consider whether or not the audit staffing resources are sufficient to meet the audit needs of the organisation and where it is believed that the level of resources may adversely impact the provision of the annual internal audit opinion and draw this to the attention of the Committee. Unfortunately, I must again raise my concerns about whether the current staffing levels in the Internal Audit Section are sufficient to meet future auditing requirements. An attempt was made to appoint a part-time auditor; however, this was unsuccessful. The position is now being re- advertised. Members of the Audit, Performance and Risk Committee will be kept informed of any developments regarding staffing and their impact on the delivery of the internal audit service. SECTION 4 – OPINION Any system of control can only ever provide reasonable and not absolute assurances that control weaknesses or irregularities do not exist or that there is no risk of error, fraud, or breaches of laws or regulations. Furthermore, it is the responsibility of management to establish an appropriate internal control system and monitor its effectiveness. The Chief Internal Auditor is responsible for providing an annual assessment of the robustness of the internal control system. (Assurance was obtained in the interim form at the time of drafting this report from the Internal Audit Provider of NHS Grampian). Page 119
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As the appointed Chief Internal Auditor, I am required to provide an opinion on the systems of governance and internal control of the Moray Integration Joint Board. This assessment has been particularly challenging for 2024/25. The Service has made progress by introducing improved governance arrangements, notably through regular reporting on the implementation of audit recommendations at Senior Management and Practice Governance Board meetings. However, significant findings have emerged from the audits undertaken, and follow-up reviews have identified recommendations that remain outstanding and require revised implementation dates. Furthermore, advancing the development of a single case recording system within the Service continues to be a matter of significant importance. After careful consideration, it is my opinion that I can only provide limited assurance that the Moray Integration Joint Board has adequate systems of governance and internal control. Dafydd Lewis Chief Internal Auditor 13 May 2025 Page 120
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REPORT TO: MORAY INTEGRATION JOINT BOARD AUDIT, PERFORMANCE AND RISK COMMITTEE ON 19 JUNE 2025 SUBJECT: UNAUDITED ANNUAL ACCOUNTS BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To inform the Committee of the Unaudited Annual Accounts of the Moray Integration Joint Board (MIJB) for the year ended 31 March 2025. 2. RECOMMENDATION 2.1 It is recommended that the Committee: i) consider and scrutinise the unaudited Annual Accounts and recommend approval to the MIJB to be submitted to the external auditor, noting that all figures remain subject to audit, in Appendix 1; ii) note the Annual Governance Statement contained within the unaudited Annual Accounts and in Appendix 3; iii) note the accounting policies applied in the production of the unaudited Annual Accounts, pages 47 to 48 of the accounts; and iv) approve the updated Local Code of Corporate Governance which supports the Annual Governance Statement, in Appendix 2. 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 2025 to its external auditors by 30 June 2025 and the audited annual accounts are required to be approved by the MIJB and published by 30 October each year. Item 9. Page 121
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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 2024/25 (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 2025, as reported previously, Grant Thornton is unable to meet this deadline. The audited accounts and the External Auditor’s report will be submitted to the MIJB at a special meeting on 30 October 2025 prior to publication. 4.3 The Comprehensive Income and Expenditure Statement shows a deficit of £0.536m on the provision of services for the year. As at 31 March 2025, the Balance Sheet showed total Reserves of £1.45m. This increase is primarily due to transfer of reserves from Moray Council to MIJB relating to Asylum seekers grant,during the year. 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 2024/25. Annual Governance Statement – is a means of reporting publicly on the MIJB’s governance arrangements, and seeks to provide assurance that its business is conducted in accordance with law, regulations and proper practices and that public money is safeguarded and properly accounted for. Page 122
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Financial Statements – provides detail of the main financial transactions through the Comprehensive Income & 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 2025 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 16 to 17. More details are included in the separate report, Revenue Budget Outturn for 2024/25, on this Boards agenda. 4.6 In April 2016 an updated CIPFA/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. 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 Page 123
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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 Internal Auditor, again for 2024/25 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, although will take 18 months to 2 years to fully implement. The governance statement from NHS Grampian is attached at Appendix 3, gives assurance there are no significant control weaknesses. 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 2025. 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 2024/25 give a true and fair view of the financial position and expenditure and income of the MIJB for the year ended 31 March 2025. 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. Page 124
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(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 an overspend on the provision of services of £0.536m for MIJB for the year ending 31 March 2025. At the beginning of the year the MIJB, held in its reserves £1.986m. The closing balance on the reserves as at 31 March 2025 is £1.45m, consisting wholly of reserves earmarked for specific purposes as detailed in the unaudited annual accounts 2024/25. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: with author Ref: Page 125
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APPENDIX 1 UNAUDITED ANNUAL ACCOUNTS FOR THE YEAR ENDED 31 MARCH 2025 Moray Integration Joint Board Page 127
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Moray Integration Joint Board Annual Accounts 2024/25 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 لᘘق نم تامولعم ᣠإ ةجاح ᢝᡧᣚ متنك اذإ نوكتو ةغلᗷ وأ ويدوأ ةناوطسأ ،يا ᢔᣂلا لثم فلتخم لᜓش ᣢعوأ ةفلتخم نوكت نأ مط ب لاصّتﻹا ءاجّرلاف ةظᘭلغ فورح لامعتساᗷ 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: اي نابز رگيد یسک ےس لسنوک ےروم وک پآرگاتروص راکرد تامولعم ںيم ﻼثم ںوہ ˝ ،فورح ےڑب اي پيٹ ويڈآ ،ےليربںيئامرف 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 128
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Moray Integration Joint Board Annual Accounts 2024/25 Table of Contents MORAY INTEGRATION JOINT BOARD MEMBERS 2024/25 .............................................. 1 MANAGEMENT COMMENTARY .......................................................................................... 2 STATEMENT OF RESPONSIBILITIES ............................................................................... 27 REMUNERATION REPORT ............................................................................................... 29 ANNUAL GOVERNANCE STATEMENT ............................................................................. 33 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT ..................................... 44 MOVEMENT IN RESERVES STATEMENT ........................................................................ 45 BALANCE SHEET .............................................................................................................. 46 NOTES TO THE FINANCIAL STATEMENTS ..................................................................... 47 Note 1 Significant Accounting Policies ............................................................................. 47 Note 2 Critical Judgements and Estimation Uncertainty .................................................. 48 Note 3 Events after the Reporting Period ........................................................................ 49 Note 4 Expenditure and Income Analysis by Nature ........................................................ 49 Note 5 Taxation and Non-Specific Grant Income ............................................................. 50 Note 6 Debtors ................................................................................................................ 50 Note 7 Usable Reserve: General Fund ............................................................................ 51 Note 8 Agency Income and Expenditure .......................................................................... 52 Note 9 Related Party Transactions .................................................................................. 53 Note 10 VAT .................................................................................................................... 55 Note 11 Accounting Standards That Have Been Issued but Have Yet To Be Adopted .... 55 Page 129
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Moray Integration Joint Board Annual Accounts 2024/25 1 MORAY INTEGRATION JOINT BOARD MEMBERS 2024/25 Voting Members Dennis Robertson (Vice Chair) Grampian Health Board Tracy Colyer (Chair) Moray Council (Resigned 26/09/2024) Elaine Kirby (Chair) Moray Council (Joined 21/11/2024) Sandy Riddell Grampian Health Board Derick Murray Grampian Health Board Alex Stephen Grampian Health Board (Joined 1/7/2024) Cllr. Peter Bloomfield Moray Council Cllr. Scott Lawrence Moray Council Cllr Ben Williams Moray Council Non-Voting Members Simon Bokor-Ingram Chief Officer (left 31/5/2024) Judith Proctor Chief Officer (Joined 15/7/2024) Jim Lyon Interim Chief Social Work Officer (Joined 3/6/2024) Jane Ewen Lead Nurse Professor Duff Bruce Non Primary Medical Service Lead Dr Robert Lockhart GP Lead Dr Malcolm Simmons GP Lead (left 31/3/2025) Janette Topp Third Sector Stakeholder (19/4/2024 – 11/2/2025) Sheila Brumby Service User Representative (Joined 19/4/2024) Ivan Augustus Carer Representative Kevin Todd Moray Council Staff Representative Elizabeth Robinson Public Health Representative Deirdre McIntyre Grampian Health Board Staff Partnership Page 130
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Moray Integration Joint Board Annual Accounts 2024/25 2 MORAY INTEGRATION JOINT BOARD MEMBERS 2023/24 Continued 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 John Mundell Interim Chief Executive, Moray Council (3/6/2024 – 14/3/2025) Karen Greaves Chief Executive, Moray Council (Joined 17/3/2025) 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. 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. Page 131
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Moray Integration Joint Board Annual Accounts 2024/25 3 MANAGEMENT COMMENTARY (continued) 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 Health & Social Care Moray. 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. STRATEGIC PLAN KEY THEMES 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 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 132
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Moray Integration Joint Board Annual Accounts 2024/25 4 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) -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 133
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Moray Integration Joint Board Annual Accounts 2024/25 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 Health & Social Care Moray website, once approved by the MIJB. One of the major aims of integration and a key measurable target for MIJB is 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. Figures 1 and 2, below, notes Moray’s performance over a six-year period showing the number of delayed discharge bed days occupied varying significantly and with minimal seasonal pattern up to March 2025. Delayed discharges reduced during the COVID pandemic and the lock down periods, as people stayed in their own homes as per advice at the time and there was more availability of family members to support care needs. Notably, delayed discharges began to rise in Moray and across the country in March 2022 and work commenced across the three partnerships in Grampian to address the issue. Results in this activity can be seen from March 2023 onwards. However, winter 2023 saw delayed discharges increasing, in Moray and across the country and continues at an increased level. Figure 1 Page 134
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Moray Integration Joint Board Annual Accounts 2024/25 6 MANAGEMENT COMMENTARY (continued) Figure 2 There continues to be a focus on ensuring people are getting home quickly and can maintain their independence. In figures 3 and 4, below, the rate of emergency occupied bed days for over 65 years of age per 1000 population has increased since 2021/22 with a slow decrease since March 2023. 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 now set targets for delayed discharges per 100,000 and for Moray the target is 26. This presents a challenge, but efforts continue to review and streamline processes and improve flow across the system. The importance of integration across the system is key to making progress, and over the year teams have enhanced communication and decision making as a Moray system. There has been further redesign of pathways and dedicated resource assigned to supporting critical decision making in social care. This has all supported the steady progress that is evident from the national comparisons of Moray’s performance 0 200 400 600 800 1000 1200 1400 1600 Jun Sep Dec Mar Number of bed days occupied by delayed discharges 18+ at census date 2020/21 2021/22 2022/23 2023/24 2024/25 Page 135
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Moray Integration Joint Board Annual Accounts 2024/25 7 MANAGEMENT COMMENTARY (continued) Figure 3 Figure 4 1500 1700 1900 2100 2300 2500 2700 2900 Jun Sep Dec Mar Rate of Emergency Occupied Bed Days for over 65s per 1000 population 2020/21 2021/22 2022/23 2023/24 2024/25 Page 136
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Moray Integration Joint Board Annual Accounts 2024/25 8 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 has to 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 forwards 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 Moray Integration Joint Board and Senior Management Team. It was approved in May 2025 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 to 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 Health and Social Care Moray (HSCM) 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 HSCM 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. Page 137
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Moray Integration Joint Board Annual Accounts 2024/25 9 MANAGEMENT COMMENTARY (continued) 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. The collaborative initiative Discharge Without Delays being undertaken by partners across NHS Grampian, is aiming to reduce delays currently 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 The integration of Children & families and Justice services into Health & Social Care Moray under the direction of the MIJB is not yet reflected in the Board’s Strategic Plan. Work in ongoing to ensure appropriate governance of performance reporting so that it can be included in future MIJB Annual Performance Reports. Strategy and Plans The MIJB is required to review its Strategic Plan every three years as per the legislation. 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 HSCM 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 following vision and priorities for health and social care services in Moray. Health and Social Care Moray’s 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 138
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Moray Integration Joint Board Annual Accounts 2024/25 10 MANAGEMENT COMMENTARY (continued) Staff Wellbeing Health & Social Care Moray’s Health Improvement Team has achieved the Paths for All Walk at Work Award for its innovative efforts to promote physical activity in the workplace and encourage colleagues to boost their health and wellbeing through daily walking. Morgan McKay, Health Walk Coordinator, led the team in developing initiatives to get colleagues moving more. She carried out a travel survey to identify how staff travel to and from work and used the data to develop a plan to increase workplace activity. The team mapped convenient walking routes from two key work locations in Elgin – the Moray Council Annexe and Dr Gray's Hospital – offering both 30-minute and 15- minute options. To encourage staff to keep walking no matter the weather, Morgan arranged for umbrellas to be available for borrowing and designated areas for drying wet outdoor gear. Staff engagement was further boosted through participation in the Paths for All step count challenge, a twice-yearly walking initiative that connects Scottish workplaces in friendly competition. The Walk Moray project supports a network of trained volunteers to deliver a variety of weekly low-level, accessible and friendly health walks in communities across Moray which are a great way to increase your activity levels. Promoting Health and Wellbeing Health & Social Care Moray (HSCM) teamed up with community partners to highlight the importance of eating well and staying hydrated during Nutrition and Hydration Week. The national campaign aims to highlight how proper food and drink intake plays a vital role in overall health, particularly for people in care settings such as hospitals and care homes. Malnutrition and dehydration are often overlooked but can have serious consequences, leading to hospital admissions, longer hospital stays, delayed recovery, and a decline in overall wellbeing. HSCM is tackling this issue head-on with an exciting lineup of activities designed to educate, engage, and inspire action by colleagues and the wider public. Throughout the week, HSCM’s Health Improvement Team has been helping local partners host a variety of activities including information stands; launch of new food and drink initiatives; daily themed food days; poster displays; themed drinks trollies; and tea parties Page 139
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Moray Integration Joint Board Annual Accounts 2024/25 11 MANAGEMENT COMMENTARY (continued) Service Delivery/Business as Usual HSCM continues to invest in the delivery of high-quality services through commissioning activity across mental health, advocacy, and primary care. Following a competitive procurement process, Scottish mental health charity SAMH (Scottish Action for Mental Health) has been awarded contracts to deliver adult mental health community support services in Moray until 2029. SAMH will provide two key services: an intensive recovery service for individuals with higher-level mental health needs, and a new community support service, which includes delivery of the Distress Brief Intervention (DBI) programme. The intensive recovery service will continue to support people receiving care from hospital or community mental health teams, offering enhanced, community-based outreach to promote recovery and independent living. The new community support service will provide short-term, practical assistance to help individuals access appropriate support and tackle factors affecting their mental wellbeing. DBI will offer a rapid response to individuals in emotional distress, particularly those presenting to emergency or crisis services As part of ongoing efforts to support people to have their voices heard, HSCM has commissioned VoiceAbility as its new independent advocacy service provider. Launched in October 2024, this free and confidential service is available to adults accessing social care services in Moray, including those with mental health conditions, learning disabilities, autism, dementia, physical and sensory disabilities, as well as unpaid carers. VoiceAbility's trained advocates support individuals to understand their rights, express their views, and take an active role in decisions affecting their health and wellbeing. A new contract has also been awarded to secure the future of GP services in Aberlour Medical Practice, with Speyside Medical Group appointed as the new provider from April 2025. The experienced partnership of eight GPs currently operates Grantown-on-Spey and Glenlivet Medical Practices and will bring its expertise to serve the 3,000 patients in Aberlour. The practice had been under interim management by HSCM and NHS Grampian since February 2024, following the withdrawal of the previous sole GP contractor. Page 140
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Moray Integration Joint Board Annual Accounts 2024/25 12 MANAGEMENT COMMENTARY (continued) The aim of a Community Appointment Day (CAD) is to create the right conditions to allow clinicians to support people with their condition and beyond, lean into the local community services, embed personalised care and focus on prevention. With the intention of addressing increasing waiting lists by trialling a new model of care, NHS Grampian delivered their first CAD in Moray for MSK Physiotherapy and Podiatry patients. This was a new way of working, moving away from treatment led health and delivering services differently by strengthening local partnerships, particularly with communities, to enhance both patient and practitioner experience. There were 210 patients on the waiting list who were all invited, with 162 opted to attend and 120 attending on the day. Patients were linked their own online Personal Health Passport, which was completed by them as they moved around the zones. Patients received a one-to-one consultation with the appropriate clinician and were encouraged to have meaningful conversations about what matters most to them. The CAD followed Realistic medicine principles, focusing on personalised and values-based care. The voice of lived experience was heard throughout the planning process by involving the local Versus Arthritis Chronic Pain Group who offered valuable feedback and guidance. 19 community groups and partner services were in attendance to provide information about the support available within the local community. Bringing health and community organisations together under one roof, allowed people’s health and wellbeing to be viewed in full totality Preliminary Feedback was largely positive, indicating that patients felt the day had been ‘enlightening’, benefited greatly from having services available in one place and found out about what is available in communities Page 141
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Moray Integration Joint Board Annual Accounts 2024/25 13 MANAGEMENT COMMENTARY (continued) Longer Term Changes to Strategies and Plans Moray Community Justice Partnership The Moray Community Justice Partnership has formally launched its new improvement plan, which will bring together local agencies and communities to strengthen efforts to make Moray a safer place to live and work. The five-year plan focuses on rehabilitation and public safety. It builds on existing work to reduce reoffending and minimise the number of victims by offering individuals who have offended support to make positive life changes. The local priorities for improving justice outcomes were identified through engagement with community justice stakeholders and residents, and a strategic assessment of Moray's strengths and needs By 2029, the Moray Community Justice Partnership aims to: Strengthen engagement with communities to reduce stigma, increase understanding and support for community justice, and embed lived experience within its work; Improve access to support for individuals leaving prison to aid reintegration; Expand access to employability skills and employment opportunities for those with convictions; Enhance support for individuals in police custody; Develop more community-based restorative justice options. Significant progress in reducing drug and alcohol-related harms and improving lives across communities has been achieved through the work of the Moray Alcohol and Drug Partnership (ADP). Moray ADP has made notable progress in implementing the national Medication Assisted Treatment (MAT) standards, which are a key part of Scotland’s response to the ongoing drug related deaths crisis. The standards provide a framework ensuring treatment is safe, person-centred and effective. Improved referral pathways, delivered through a third sector direct access service, have reduced waiting times for people and enabled faster access to support. Feedback from lived experience groups has shaped pathways into and through Page 142
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Moray Integration Joint Board Annual Accounts 2024/25 14 MANAGEMENT COMMENTARY (continued) services to better reflect the realities of people’s lives, leading to improved outcomes, while frontline staff have benefitted from continued training on rights awareness, trauma informed practice and crisis response. Strategic Delivery Plan A revised Strategic Delivery Plan for 2025 to 2028 was approved in draft by MIJB in March 2025 and final version in May 2025. This plan incorporates the developments required to enhance our ability to meet predicted future demands for services, whilst undertaking reviews of existing models of care to ensure that the services provided are sustainable and fit for purpose. There are also projects to implement more efficient ways of working, to aid in meeting the financial challenge that is impacting on all public sector organisations. A robust governance framework will be essential to ensure that projects can be delivered within available resources and have a clear focus on outcomes Joint Inspection Moray's multi-agency Public Protection Partnership has evidenced substantial improvement in supporting and protecting adults at risk of harm The positive impact achieved by local authority, health and police colleagues in their work to keep people safe, has been acknowledged with publication in October 2024 of the Joint Inspection of Adult Support and Protection in Moray. The progress review by the Care Inspectorate and its scrutiny partners was a follow-up to a joint inspection carried out in 2022. On their return, inspectors found significant progress had been achieved across all seven priority areas identified for improvement. Mental Health Strategic Delivery Plan The Moray Mental Health and Wellbeing Delivery Plan 2024-2026 was approved by the MIJB in September 2024 and was updated in May 2025, which underpins the work required to progress the Moray Mental Health and Wellbeing Strategy 2016- 2026. Scotland is currently facing a growing mental health crisis, with challenges including rising demand for services, increased complexity 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 hinder progress. Many of these challenges are amplified in Moray due to the rural nature of many of our communities, difficulties in the recruitment and retention of staff, and access to specialist tertiary services Page 143
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Moray Integration Joint Board Annual Accounts 2024/25 15 MANAGEMENT COMMENTARY (continued) The Moray Adult Mental Health and Wellbeing Strategic group aim to ensure that the collective voice of lived and living experience influences the way that we design services and responses to address 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; for example, the involvement of lived experience in service development, commissioning, implementation and evaluation of the recently commissioned SAMH projects The alignment of Children’s Services and Adults Services mental health strategic planning and delivery is essential. Within Moray there is currently a Children’s Mental Health and Wellbeing Partnership and there is the Moray Mental Health and Wellbeing Strategic Group. There is a degree of cross representation between both groups to ensure shared planning however, there remains the medium term vision for there to be a single strategic group for children and adult mental health services in Moray 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 2024 the Board received a financial report which forecast an expected overspend to the end of the financial year of £5.58m. This forecast remained consistent throughout the remainder of the year and in January 2025, MIJB were forecasting an overspend to the end of the year of £5.51m, the MIJB actually out turned at £4.26m overspent. Both partners in line with the Integration Scheme, put in additional funding to cover this overspend, so with the use of ear marked reserves totalling £0.536m, this leaves a balance of £1.45m in ear marked reserves to be carried forward into 2025/26. In May 2024, the MIJB agreed a savings plan of £8.297m, 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 £2.302m and £2,331m 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 144
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Moray Integration Joint Board Annual Accounts 2024/25 16 MANAGEMENT COMMENTARY (continued) Service Area Budget £000’s Actual £000’s Variance (Over)/ under spend £000’s Note Community Hospitals & Services 7,700 8,328 (628) Community Nursing104,360 5,979 6,166 (187) Learning Disabilities 17,702 19,975 (2,273) 1 Mental Health 12,140 12,055 85 Addictions 1,907 1,763 144 Adult Protection & Health Improvement 249 273 (24) Care Services Provided In-House 24,743 22,754 1,989 2 Older People Services & Physical & Sensory Disability 24,775 27,034 (2,259) 3 Intermediate Care & OT 1,771 1,972 (201) Care Services Provided by External Contractors 1,835 1,816 19 Other Community Services 10,383 10,280 103 Administration & Management 3,333 3,152 181 Other Operational Services 1,377 1,535 (158) Primary Care Prescribing 18,748 21,937 (3,189) 4 Primary Care Services 21,427 21,331 96 Hosted Services 5,713 5,665 48 Out of Area Placements 720 1,971 (1,251) 5 Improvement Grants 1,207 1,021 186 Children’s & Justice Services 19,523 19,625 (102) Total Core Services 181,235 188,656 (7,421) Strategic Funds & Other Resources 14,891 6,020 8,871 TOTALS (before set aside) 196,126 194,676 1,450 Set Aside 15,639 15,639 - TOTAL 211,765 210,315 1,450 The table above summarises the financial performance of the MIJB by comparing budget against actual performance for the year. Page 145
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Moray Integration Joint Board Annual Accounts 2024/25 17 MANAGEMENT COMMENTARY (continued) Significant variances against the budget were notably: Note 1 Learning Disabilities (LD) – The LD service is overspent by £2,272,694 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 £2,806,801 and client transport of £13,781. This is offset by more income received than expected of £524,800 (income due from another authority and Change Fund funds from NHS) and other small underspends of £18,619 which primarily relate to property costs. There was a minor underspend of £4,469 in other Learning Disabilities clinical services. 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. Note 2 Care Services Provided In-House – This budget is underspent by £1,988,757 at the end of the year. This relates to underspend in staffing across all the services in this budget totalling £2,291,755 and other minor underspends of £8,275 which is being reduced by overspends relating to transport costs £97,970; insurance costs £29,047, utility costs £62,430 and less income than expected £121,826. Unfilled vacancies have been the main reason for the underspend throughout the year, and the issue of recruitment has been an ongoing problem Note 3 Older People Services and Physical & Sensory Disability - This budget is overspent by £2,259,056 at the end of the year. This primarily relates to overspends for home care in the area teams £539,818, permanent care £1,766,157 due to the increase in the number of clients receiving nursing care rather than residential care and respite care £105,776 this is being reduced by an underspend for day care £152,695. 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. The ageing population requiring more complex care and local demographics also contributes to this overspend as well as the correlation between the recruitment and retention of the internal home care service provision. Note 4 Primary Care Prescribing - The primary care prescribing budget is reporting an over spend of £3,189,386 for the twelve months to 31 March 2025. The overall average price has remained relatively consistent and includes cost reduction savings identified by Pharmacy implemented countered by the impact of short supply causing an increase in costs. This is spread across a range of products and is ongoing. This overall volume increase at 3.5% is less than previously anticipated. Note 5 Out of Area Placements – This budget is overspent by £1,250,899 at the year end. This is due to the continuing number of high cost individual specialised NHS placements. Page 146
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Moray Integration Joint Board Annual Accounts 2024/25 18 MANAGEMENT COMMENTARY (continued) MIJB’s financial performance is presented in the comprehensive income and expenditure statement (CIES), which can be seen on page 44. At 31 March 2025 there were ear marked reserves of £1.451m available to the MIJB, compared to £1.986m at 31 March 2024. These remaining reserves of £1.451m are for various purposes as described below: Earmarked Reserves Amount £000’s GP Premises 39 National Drugs MAT 250 OOH Winter Pressure funding 172 Moray Cervical screening 35 Moray hospital at home 5 Moray Psychological 315 MHO Funding 138 Adult protection funding for CA 18 Adult Disability payment 45 National Trauma Training services 62 Moray School Nurse 32 Moray Winter Fund HCSW & MDT 182 LD Annual Health Checks 69 Community Planning partnership 2 Moray District Nurses 56 OOH Dev Fellowship scheme 30 Total Earmarked 1,450 General Reserves 0 TOTAL Earmarked & General 1,450 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. Page 147
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Moray Integration Joint Board Annual Accounts 2024/25 19 MANAGEMENT COMMENTARY (continued) National Drugs Medication Assisted Treatment (MAT) for embedding and implementation of the standards will he be overseen by the MAT implementation support team (MIST). National Drugs Mission Moray – balance of funding for range of activities including: drug deaths, taskforce funding, priorities of national mission, residential rehabilitation, whole family approach, outreach, bear fatal overdose pathways and lived and living experience. 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. Adult Disability payment – funding to assist with the implementation of the adult disability payments. 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. Page 148
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Moray Integration Joint Board Annual Accounts 2024/25 20 MANAGEMENT COMMENTARY (continued) Out of Hours (OOH) Development Fellowship Scheme – scheme to keep GPs within clinical practice, increase GP’s confidence and competence in OOHs work All reserves are expected to be utilised for their intended purpose during 2025/26. Set Aside – Excluded from the financial performance table above on page 16 but included within the Comprehensive Income & Expenditure Account is £15.639m 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. 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 figures for 2024/25 have been derived by uplifting 2019/20 figures by baseline funding uplift in 2020/21 (3.00%), 2021/22 (3.36%) ,2022/23 (6.70%), and 2023/24 (5.35%) and 2024/25 (6.64%): 2024/25 2023/24 2022/23 2021/22 2020/21 Budget 15.639m 14.665m 13.92m 13.04m 12.62m Page 149
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Moray Integration Joint Board Annual Accounts 2024/25 21 MANAGEMENT COMMENTARY (continued) 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: 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 27 March 2025. 2. Additional resource to support services a Programme Management Office agreed until September 2025. 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. Review of MIJB Strategic Delivery Plan ensuring all projects are aligned with savings plans. 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 2025/26. Financial Development Sessions with MIJB members. Internal Audit quarterly reporting to APR. External Audits presented to MIJB/ Committees as appropriate. Six weekly Tri-partite partnership performance meetings with partner CEOs, Finance Directors and regular meetings with the Chair/Vice Chair of MIJB. Page 150
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Moray Integration Joint Board Annual Accounts 2024/25 22 MANAGEMENT COMMENTARY (continued) HIGH Risk 3 - There is a risk that the MIJB’s workforce strategy is not delivered impacting the quality of paid and unpaid Health & Social Care. Managing the risk – Current controls in place 1. Management structure currently under review. 2. Moray Council are aware of the housing issues and are conducting an assessment of needs, including people working in the Health and Care sector. 3. Staff wellbeing is a key focus and there are many initiatives across both parent organisations offering information, support and access to activities. 4. Collaborative approaches with educational institutions e.g. intakes and programmes for future workforce development. 5. Professional Development and retention programmes; Incentives have been secured to attract additional NHS dentists and dental practices to Moray. The Scottish Dental Access Initiative includes Moray, with grants of £50,000 and above available to allow dental practices to be established or extended– provided there is a seven-year commitment to providing NHS treatment. A recruitment and retention bonus is also being offered to eligible new dentists in Moray 6. GP sustainability Group and Primary Care Vison for the Future Groups now progressing across Grampian. 7. iMatter reports are used to develop actions plans for teams. Assurances: Operational oversight by Moray Workforce Forum. The HSCM Response Group continues to focus on leadership around emerging issues and resolving them, including staffing. Risk 5 - There is a risk that the MIJB does not comply with the necessary legislative and regulatory requirements in which it operates. Managing the risk – Current controls in place: 1. NHS Grampian Resilience Standards Action Plan approved (3 year). New standards are being drafted by Scottish Government, and these are expected in 2025 and will replace the current standards. 2. Continuous emergency preparedness awareness with partners under GLRP – including exercises and debriefs. 3. Learning from Inspection Reports, Adverse Events, Complaints – action plans and performance measures monitored by OMT with oversight by SMT. 4. HSCM Civil Contingencies group review specific risks and action plans to mitigate, developing plans and testing arrangements in partnership with NHSG and Council. 5. Annual review of internal resilience and emergency processes with Senior Managers on Call. Page 151
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Moray Integration Joint Board Annual Accounts 2024/25 23 MANAGEMENT COMMENTARY (continued) HIGH (continued) Assurances: Quarterly reporting to Clinical and Care Governance and Audit, Performance and Risk Committees. Annual Performance Report – published September 2024. Chief Social Work Officers Report. Internal and External Audits. Senior Management Meetings fortnightly. Joint meeting of MIJB Chief Officer with two Partner Body Chief Executives. Annual report on MIJB activity developed and reported to Moray Council and NHSG Risk 6 - There is a risk that the MIJB’s strategic aspirations are not transformative and as a result, we are unable to deliver outcomes for people in a sustainable way. Managing the risk – Current controls in place: 1. Clinical and Care Governance (CCG) Committee. Clinical Risk Management and Practice Governance group has oversight of their respective professional standards and links into Clinical and Care Governance Group, which escalates to CCG Committee as necessary. 2. High and Very High operational health service risks are reviewed by HSCM Clinical Risk Management (CRM) Group and also NHS Grampian CRM Group. 3. Annual Performance Reports. 4. Internal and External Audit. 5. Internal/External Inspection reports are scrutinised by appropriate operational groups and by exception to SLT for subsequent reporting to CCG or APR Committee as appropriate. 6. Care Home Collaborative Support Group meets to oversee and manage risks in care homes. 7. Children and Adult Protection services report to their respective committees. Governance Structure and Process (Senior Leadership Team meetings, Operational Team Meetings, Daily Huddles). Assurances: Audit, Performance and Risk and Clinical and Care Governance Sub-Committees oversight and scrutiny. The Clinical and Care Governance Framework was refreshed and presented to CCG Committee in November 2023 Page 152
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Moray Integration Joint Board Annual Accounts 2024/25 24 MANAGEMENT COMMENTARY (continued) HIGH (continued) Risk 7 - There is a risk that the MIJB is unable to exert influence on services delegated but hosted within another organisation. Managing the risk – Current controls in place: 1. Chief Officer regularly meets with Chief Officers of Aberdeen City Health and Social Care Partnership and Aberdeenshire Health and Social Care Partnership. 2. Significant changes to service delivery are discussed across all three HSCP’s. 3. Agreement that proposals regard significant service changes are presented to all three MIJB’s for approval. 4. Internal Audit of MIJB Hosted Services. Assurances: These largely come from the systems, process and procedures put in place by NHS Grampian, which are still being operated, along with any new processes which are put in place by the lead MIJB. North East System Wide Transformation Group (Officers only) led by the 4 pan- Grampian chief executives. The aim of the group is to develop real top-level leadership to drive forward the change agenda, especially relating to the delegated hospital-based services. Both the CEO group and the Chairs & Vice Chairs group meet quarterly. The meetings are evenly staggered between groups, giving some six weeks between them, allowing progressive work / iterative work to be timely between the forums. The Portfolio approach and wider system approach demonstrates closer joint working across the three Health and Social Care Partnerships and the Acute Sector. Development Aims for 2025/26 Discharge without Delay & Frailty at the Front Door Health and Social Care Moray is taking part, supported by the MIJB, in the National Collaborative to support Discharge without Delay. This approach supports us in undertaking mapping and self-assessment work and understanding where the application of best practice and learning from other areas can help us improve locally and get people home from an acute setting as quickly and safely as possible. By taking part in this collaborative, we aim to reduce further the number of people delayed in our system and to ensure we apply optimum practice across acute and community setting to do so. Page 153
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Moray Integration Joint Board Annual Accounts 2024/25 25 MANAGEMENT COMMENTARY (continued) Realignment 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 will take place that will support these aims and ensure that both HSCM and the MIJB have the right resources in place, and the right operational structure to enact our plans, deliver the best outcomes for people and operate sustainably within the current challenging financial conditions. Our organisational structure supports how we deliver our ambitions in our communities and directly with people and is a key enabler in driving progress against our priorities. Strengthening Integration and Oversight of Children, Families and Justice within our system 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 robust reporting across the system that ensures all partners can fulfil their statutory obligations while focussing on improving outcomes for our young people. A review of current reporting arrangements will take place to reduce any duplication in reporting whilst strengthening oversight of performance and delivery. Strengthening Performance Oversight The MIJB approved its Strategic Delivery Plan at its meeting in May 2025, and this now provides a clear line of sight from Strategic Plan to the impact of the programmes, services and initiatives in place to deliver it. Over the course of this year, we aim to further strengthen this line of sight, aligned to the Board’s Risk Appetite Statement, to ensure that our programmes of work are effective in achieving their objectives and represent value for money. Page 154
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Moray Integration Joint Board Annual Accounts 2024/25 26 MANAGEMENT COMMENTARY (continued) In addition, we will seek to: Maintain our focus on early intervention and prevention, reducing demand and supporting the resilience of people and communities. We’ll undertake learning from the successful Community Appointment Day which took place in Elgin as a possible model to support this; Continue to develop how we care for our staff well-being, with staff our most valuable asset; Provide leadership and participation as key partners in the NHS Grampian led Strategic Change Programme and ensure we explore effective joint working; Focus our budget setting efforts in the context of the Medium Term Financial Strategy and longer term sustainability. ………………………… ……………………… ……………………… Elaine Kirby Judith Proctor Deborah O’Shea Chair of Moray IJB Chief Officer Chief Financial Officer Page 155
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Moray Integration Joint Board Annual Accounts 2024/25 27 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 Elaine Kirby Chair of Moray IJB Page 156
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Moray Integration Joint Board Annual Accounts 2024/25 28 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). 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 2025 and the transactions for the year then ended. Deborah O’Shea FCCA Chief Financial Officer Page 157
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Moray Integration Joint Board Annual Accounts 2024/25 29 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 2023/24 Name Position Held Nomination By Taxable Expenses 2024/25 £ £ - Dennis Robertson Vice-Chair 01/04/24 – 26/09/24; 01/04/2025 to date Chair 27/09/24 to 31/03/25 Grampian Health Board - - Cllr Tracy Colyer Chair 01/04/24 – 26/09/24 Moray Council - - Cllr Elaine Kirby Vice-Chair 21/11/24 – 31/03/25 Chair 1/04/25 to date Moray Council - Page 158
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Moray Integration Joint Board Annual Accounts 2024/25 30 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 2023/24 Senior Employees Salary, Fees & Allowances Total 2024/25 £ £ £ 122,460 Simon Bokor-Ingram Chief Officer (1/04/24- 31/05/24) 20,268 20,268 - Judith Proctor (from 25/07/24) 95,673 95,673 83,476 Deborah O’Shea Interim Chief Financial Officer 90,729 90,729 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 159
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Moray Integration Joint Board Annual Accounts 2024/25 31 REMUNERATION REPORT (continued) NOTE: no bonuses, expenses allowances, compensation for loss of office or any taxable benefits were made in 2024/25 In Year Pension Contributions Accrued Pension Benefits Year to 31/03/24 Year to 31/03/25 As at 31/03/2025 Difference from 31/03/2024 £ £ £ 000’s £ 000’s Simon Bokor- Ingram, Chief Officer (*) 24,346 4,378 Pension 40 (6) Lump Sum 101 (22) Judith Proctor, Chief Officer - 21,526 Pension 36 9 Lump Sum 99 21 Deborah O’Shea Chief Financial Officer 7,179 20,339 Pension 9 (19) Lump Sum 31 - (*) Simon Bokor-Ingram figures included in the table above, relate to the full year and employment after Chief Officer, as figures are unable to be apportioned. Page 160
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Moray Integration Joint Board Annual Accounts 2024/25 32 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 2023/24 Remuneration Band Number of Employees in Band 2024/25 1 £80,000 - £84,999 - - £85,000 - £89,999 1 1 £120,000 - £124,999 - £130,000 - £134,999 1 Exit Packages There were no exit packages agreed by the MIJB during 2024/25 financial year, or in the preceding year. ……………………….. ……………………… Elaine Kirby Judith Proctor Chair of Moray IJB Chief Officer Page 161
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Moray Integration Joint Board Annual Accounts 2024/25 33 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 162
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Moray Integration Joint Board Annual Accounts 2024/25 34 ANNUAL GOVERNANCE STATEMENT (continued) Key Governance Arrangements All of the scheduled Audit Performance and Risk and Clinical Care Governance Committee meetings were held as timetabled during 2024/25. Health and Social Care Moray (HSCM) established an emergency response group that has been operational since the end of March 2020, this has now transformed into a Daily Response meeting. Representation on the response groups of the Partner organisations is provided by HSCM staff, ensuring the necessary links and flow of information to ensure a co-ordinated response on a pan Grampian basis and locally within Moray. There continues to be governance standards and collaborative working across the whole system, both across the NHS Portfolios and Grampian wide system. The use of a Grampian Operation Performance Escalation System (GOPES) was established to enable senior leaders to have oversight of where pressures were located in the system and to direct responses accordingly. This development has also strengthened the identification of key metric thresholds to inform the levels for escalation. 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 ensure broad representation. The Board meets bi-monthly and is supported by regular development sessions that allow 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 a Clinical and Care Governance Committee, each with clearly defined remits to support effective governance and assurance. The MIJB operates in accordance with Standing Orders, which set out the rules governing the proceedings of the Board and its Committees. These include the Scheme of Administration which defines the structure and remit of the Board’s committees, ensuring clarity and consistency 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 comply with 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, and ethical governance. Page 163
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Moray Integration Joint Board Annual Accounts 2024/25 35 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 2 – Ensuring openness and comprehensive stakeholder engagement Assessment of Effectiveness MIJB’s Standing Orders provide for public and press access to meetings and reports, supporting transparency and accountability. In response to positive feedback and to enhance accessibility, hybrid meetings continued throughout 2024/25. A dedicated website was developed for Health and Social Care Moray and is continuously monitored for improvement, and about to transition to a new platform to further improve the accessibility and quality of information. Agendas, reports and minutes for all committees can be accessed via Moray Council website, alongside links to all relevant strategies of the MIJB. Both 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. There are eight voting members, four are elected members appointed by Moray Council and four are non-executive members of NHS Grampian Board. The non-voting membership comprises six professional members and five stakeholder members representing: staff, third sector bodies carrying out activities in relation to health and social care, service users and unpaid carers, and six additional non-voting members which include the Chief Executives of Moray Council and NHS Grampian in an Ex-officio capacity. The broad membership of the MIJB ensures valued input and engagement from a wide range of stakeholders. 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 has an approved Communications and Engagement Strategy which recognises and promotes the active and meaningful engagement with all stakeholders. 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 that are flexible and responsive to emerging challenges and developments in health. To support the delivery of these objectives a 3 year delivery plan was approved by MIJB in May 2025, underpinned by a medium-term financial framework. The strategic plan is supported by a comprehensive suite of documents, including a performance framework, workforce plan, and a communications, engagement and participation plan. These documents are currently under review, with a focus on enabling service transformation within existing financial constraints. These documents collectively provide a structured approach to defining and achieving outcomes, with a clear focus on medium term priorities. The outcomes are directly aligned with the delivery of health and social care services and are aimed at driving measurable improvements for the population of Moray. Page 164
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Moray Integration Joint Board Annual Accounts 2024/25 36 ANNUAL GOVERNANCE STATEMENT (continued) In support of environmental sustainability, a climate change duties report is compiled and submitted annually on behalf of the MIJB, demonstrating the Board’s commitment to meeting its statutory environmental responsibilities 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. Each proposal outlines how intended outcomes will be achieved, supported by detailed assessments of associated risks and opportunities. Board papers reflect the broad range of strategic and operational matters under consideration. These include regular updates from the Chief Officer on current developments, as well as agenda items covering both opportunities and challenges, particularly those arising from reconfiguration and transformation of services. The MIJB recognises the importance of sound financial governance and has adopted the Financial Management Code promoted by CIPFA as a guiding framework for effective financial administration. A Medium-Term Financial Strategy, approved in March 2025, supports this approach and will be reviewed regularly to ensure alignment with the Strategic Plan, Delivery Plan and the integration of delegated children’s services. 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 developed a programme of Development sessions with Board members with a focus on the challenging financial position and exploring opportunities for service transformation. Officers present a range of proposals aimed at delivering the MIJB’s strategic objectives whilst also contributing to the necessary financial savings for the upcoming year. The MIJB continues to prioritise leadership development and collaborative working through the regular development sessions with Officers. These sessions provide valuable opportunities for shared learning, strategic dialogue, and constructive challenge, helping to strengthen leadership capabilities and organisational resilience. Page 165
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Moray Integration Joint Board Annual Accounts 2024/25 37 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 was formally approved by the Board in May 2025. This updated register will be reviewed monthly by the Senior Management Team and updated and presented biannually to Audit, Performance and Risk Committee, and annually to MIJB. A related action log was created for monitoring purposes and is owned and monitored by the Senior Management Team. The committee agreed in October that the register would be presented biannually with the caveat that any emerging or increasing risks would be presented as required. The Performance Management Framework has currently under review. Performance reporting falls within the scope of the Audit, Performance and Risk Committee and reporting is quarterly. This now includes reporting by the delegated Children’s & Families Services. The internal control system is closely 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 through its consideration of reports monitors the effectiveness of internal control procedures. The MIJB Chief Internal Auditor undertakes an annual review of the adequacy of internal controls and the opinion is included 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 have been developed and maintained to comply with the core functions of various good framework guidelines including 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), 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 166
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Moray Integration Joint Board Annual Accounts 2024/25 38 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 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 inspect. There is a standardised reporting format in place to ensure consistency, clarify and transparency in decision making processes. The MIJB demonstrates its commitment to accountability through publication of both its Annual Accounts and Annual Performance Report. Following formal approval by the Board. The Chief Internal Auditor reports independently to the Audit, Performance and Risk committee with direct access to the Chief Officer, Chief Financial Officer and Chair of the Audit, Performance and Risk committee on any matter of concern. Throughout 2024/25, the Chief Internal Auditor has continued to provide regular reports to the Committee, supporting effective oversight of internal accounts and assurance processes. 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), and the Council’s Audit and Risk Manager holds the Chief Internal Auditor appointment to the MIJB until the 31st of March 2026. The Council’s Internal Audit Section has adopted the Public Sector Internal Audit Standards (PSIAS), which requires the Chief Internal Auditor to deliver an annual internal audit opinion and report, which has also been used to inform this governance statement. The Chief Internal Auditor’s evaluation of the adequacy and effectiveness of the MIJB framework of governance, risk management and internal control includes consideration of the findings from the audit work undertaken by the Chief Internal Auditor in his role as the Audit and Risk Manager for the Moray Council. Assurance is also sought from the Internal Audit Service Provider for NHS Grampian of the governance processes adopted by that organisation. This includes the Chief Internal Auditor now being provided with internal audit reports by the Internal Audit Service Provider for NHS Grampian of interest to the MIJB. In addition, reports issued by other Page 167
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Moray Integration Joint Board Annual Accounts 2024/25 39 ANNUAL GOVERNANCE STATEMENT (continued) external review agencies are considered in the opinion provided by the Chief Internal Auditor. Internal Audit operates independently within the organisation, with no management- imposed limitations on the scope of audit work performed. In accordance with PSIAS, the Chief Internal Auditor prepares a risk-based Audit Plan for the MIJB, considering the internal audit arrangements of both Moray Council and NHS Grampian functions. The Annual Audit Plan for 2024/25 agreed to the following audits to be undertaken: Out of Area Placements- A review of the systems and procedures of people receiving adult social care services who are out of the Moray area. Residential Care- A review to assess the adequacy of procedures and administrative arrangements for third-party suppliers that provide care home services. The audit also included testing to verify the accuracy of financial assessments and the charging of residential care for both respite and permanent care residents. Fostering and Kinship- An audit to review fostering and kinship payments of fees and allowances, ensuring they comply with agreed policies and procedures. The audit review of out of area placements identified significant concerns regarding the progress in determining the ordinary residence status of individuals receiving adult social care services, contractual arrangements with care providers, and budgetary control arrangements. A review of residential care highlighted the need for improved administrative processes and the potential for further digitalisation. The fostering and kinship payments audit was found to be well managed within the scope of the review, though some administrative control improvements were noted. In addition to the projects outlined in the Audit Plan, governance arrangements were reviewed to prevent fraud and corruption. The audit found that further improvements are needed to enhance the effectiveness of counter fraud measures. Internal Audit has also undertaken follow-up reviews to evidence the implementation of recommendations from previously issued audit reports. The follow-up audits undertaken of Self-Directed Support and the Moray Integrated Community Store found several recommendations where revised timescales for implementing recommendations were required. A previous review of social care information governance noted a need for a single case recording system. The Service is seeking a replacement for the current arrangements for recording social care information, but there is a need for this to be progressed in a timely manner. Implementation of recommendations is a key element in determining the adequacy and effectiveness of governance and internal control systems. If recommendations are not implemented in a timely manner, then weaknesses in control and governance frameworks will remain. Page 168
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Moray Integration Joint Board Annual Accounts 2024/25 40 ANNUAL GOVERNANCE STATEMENT (continued) The Chief Internal Auditor, after considering the results of the work carried out by Internal Audit, together with other sources of assurance, has provided limited assurance that the Moray Integration Joint Board had adequate systems of governance and internal control for the year ended 31 March 2025. Prior Year Governance Issues The Annual Governance Statement for 2023/24 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 2023/24 Action Undertaken / Progress Made in 2024/25 GP visioning programme to deliver resilience and sustainability. Financial Sustainability with best value and outcomes. Assurance and reporting for Children’s Social Work and Justice Services. Progress within the agreed priority workstreams has been made across the year and there have been regular updates to the IJB on the programme. A Visioning refresh event was held in March 2025 and further work to strengthen the programme deliverables will be taken forward from that into the next financial year. The Chief Officer has put in place a Budget Savings Oversight Group (BSOG) which supports oversight of the delivery of the savings programme on a monthly basis. A Programme Management Office (PMO) has been established to support this work and our senior responsible officers for each savings programme. In addition, regular tri- partite meetings between the Chief Officer, Chief Finance Officer and the Director and Head of Finance in NHS Grampian and Moray Council take place to ensure shared visibility on financial matters for all partners. Assurance and reporting for CF&J continues to take place in both the IJB and its committees and within Moray Council Structures. Resource has now been secured to support a review of this across 2025/26 to ensure robust and proportionate reporting that is cognisant of the statutory roles of partner organisations. Page 169
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Moray Integration Joint Board Annual Accounts 2024/25 41 Area for Improvement Identified in 2023/24 Action Undertaken / Progress Made in 2024/25 Improvement in compliance with audit recommendations. Improvements continue to be made in this area with a process now in place to review audit actions in both the Operational Management Team (OMT) and within the Chief Officer’s Senior Management Team (SMT). This provides visibility on the delivery of actions within agreed timescales and on those actions that remain open and overdue so that a focus can be put upon those and ensure their closure. Improvement on progress has been evidenced; however, this area of improvement requires further development and will be included for developments in 2025/26. 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 2025/26 1. Developing further our approaches to frailty and Discharge without Delay. 2. Realigning our organisational structure to ensure effective delivery of strategy and transformation. 3. Integration of Children’s Social Work and Justice Services governance and oversight within the IJB. 4. Further strengthen performance oversight of the Board’s key strategies and priorities. 5 Continue to improve on the progress for compliance with audit recommendations. ANNUAL GOVERNANCE STATEMENT (continued) Page 170
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Moray Integration Joint Board Annual Accounts 2024/25 42 ANNUAL GOVERNANCE STATEMENT (continued) 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 the revised Portfolio approach, including Dr Grays hospital, and how the IJB contributes to the wider community planning agenda in Moray and the North East. Continuing to implement the recommendations of internal and external audit, including learning from national reviews. Continuing work with teams to provide assurance to MIJB as we develop the governance structures for Children’s Social Work and Criminal Justice Services that support decision making on how best to tackle poverty and inequalities. There have been no significant events up to the authorised for issue date. Page 171
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Moray Integration Joint Board Annual Accounts 2024/25 43 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 2024/25 and up to the date of authorised for issue. ………………………… ……………………… Elaine Kirby Judith Proctor Chair of Moray IJB Chief Officer Page 172
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Moray Integration Joint Board Annual Accounts 2024/25 44 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT This statement shows the cost of providing services for the year ended 31 March 2025 according to generally accepted accounting practices. 2023/24 2024/25 Net Expenditure Net Expenditure £ 000 £ 000 7,942 Community Hospitals 8,328 5,702 Community Nursing 6,166 18,366 Learning Disabilities 19,975 11,506 Mental Health 12,055 1,726 Addictions 1,763 213 Adult Protection & Health Improvement 273 23,044 Care Services Provided In-House 22,754 25,191 Older People & Physical & Sensory Disability Services 27,034 1,881 Intermediate Care and Occupational Therapy 1,972 1,808 Care Services Provided by External Providers 1,817 10,012 Other Community Services 10,280 2,828 Administration & Management 3,152 1,299 Other Operational services 1,535 21,339 Primary Care Prescribing 21,937 19,939 Primary Care Services 21,331 5,936 Hosted Services 5,665 1,777 Out of Area Placements 1,971 949 Improvement Grants 1,021 19,762 Children & Justice Services 19,625 6,898 Strategic Funds & Other Resources 6,020 14,665 Set Aside 15,639 202,783 Cost of Services 210,315 (200,086) Taxation and Non-Specific Grant Income (note 5) (209,779) 2,697 Deficit on provision of Services 536 2,697 Total Comprehensive Income and Expenditure 536 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. Children & Justice Services were integrated into the MIJB from 2023/24, with the first year being the shadow year meaning all financial responsibilities remained with the Council but from 2024/24 the MIJB has full control over the finances. Page 173
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Moray Integration Joint Board Annual Accounts 2024/25 45 MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the Moray Integration Joint Boards (MIJB) 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 51. Movement of Reserves During 2023/24 General Fund Balance £000 Opening Balance at 1 April 2024 (1,986) Total Comprehensive Income and Expenditure 536 (Increase) in 2024/25 536 Closing Balance at 31 March 2025 (1,450) Movement of Reserves During 2023/24 General Fund Balance £000 Opening Balance at 1 April 2023 (4,683) Total Comprehensive Income and Expenditure 2,697 Decrease in 2023/24 2,697 Closing Balance at 31 March 2024 (1,986) Page 174
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Moray Integration Joint Board Annual Accounts 2024/25 46 BALANCE SHEET The Balance Sheet shows the value of the Moray Integration Joint Board’s (MIJB) 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 2024 £000 Notes 31 March 2025 £000 1,986 Short Term Debtors 6 1,450 Current Assets - Short Term Creditors - Current Liabilities - Provisions - Long Term Liabilities 1,986 Net Assets 1,450 1,986 Usable Reserve General Fund 7 1,450 1,986 Total Reserves 1,450 The unaudited annual accounts were issued on 19 June 2025. The Annual Accounts present a true and fair view of the financial position of the MIJB as at 31 March 2025 and its income and expenditure for the year then ended. Deborah O’Shea FCCA Chief Financial Officer Page 175
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Moray Integration Joint Board Annual Accounts 2024/25 47 NOTES TO THE FINANCIAL STATEMENTS Note 1 Significant Accounting Policies General Principles The Financial Statements summarise the Moray Integration Joint Board’s (MIJB) transactions for the 2024/25 financial year and its position at the year-end of 31 March 2025. 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 2024/25, 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 176
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Moray Integration Joint Board Annual Accounts 2024/25 48 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 177
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Moray Integration Joint Board Annual Accounts 2024/25 49 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 19 June 2025. Events taking place after this date are not reflected in the financial statements or notes. Note 4 Expenditure and Income Analysis by Nature 2023/24 2024/25 £000 £000 95,500 Services commissioned from Moray Council 98,216 107,247 Services commissioned from Grampian Health Board 112,061 36 Auditor Fee: External Audit Work 38 202,783 Total Expenditure 210,315 (200,086) Partners Funding Contributions and Non- Specific Grant Income (209,779) 2,697 Deficit on the Provision of Services 536 Page 178
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Moray Integration Joint Board Annual Accounts 2024/25 50 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 5 Taxation and Non-Specific Grant Income 2023/24 2024/25 £000 £000 84,615 Funding Contribution from Moray Council 88,442 115,471 Funding Contribution from Grampian Health Board 121,337 200,086 Taxation and Non-specific Grant Income 209,779 The funding contribution from Grampian Health Board shown above includes £15.639m 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 2024 31 March 2025 £000 £000 1,723 Grampian Health Board 1,187 263 Moray Council 263 1,986 Debtors 1,450 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 179
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Moray Integration Joint Board Annual Accounts 2024/25 51 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 2023 - 937 3,746 4,683 Transfers (out) 2023/24 - (904) (1,793) (2,697) Balance at 31 March 2024 - 33 1,953 1,986 Transfer (out) 2024/25 - (33) (503) (536) Balance at 31 March 2025 - - 1,450 1,450 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. Other earmarked reserves are noted in detail on pages 18 to 20. Page 180
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Moray Integration Joint Board Annual Accounts 2024/25 52 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: 2023/24 2024/25 £000 £000 10,615 Expenditure on Agency Services 10,680 (10,615) Reimbursement for Agency Services (10,680) - Net Agency Expenditure excluded from the CIES - Page 181
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Moray Integration Joint Board Annual Accounts 2024/25 53 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 2023/24 2024/25 £000 £000 (115,471) Funding Contributions received from the NHS Board (121,338) 107,064 Expenditure on Services Provided by the NHS Board 111,864 183 Key Management Personnel: Non-Voting Board Members 197 (8,224) Net Transactions with Grampian Health Board (9,227) 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 2024 31 March 2025 £000 £000 1,723 Debtor balances: Amounts due from Grampian Health Board 1,187 1,723 Net Balance due from Grampian Health Board 1,187 Page 182
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Moray Integration Joint Board Annual Accounts 2024/25 54 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions (continued) Transactions with Moray Council 2023/24 2024/25 £000 £000 (84,615) Funding Contributions received from the Council (88,441) 95,455 Expenditure on Services Provided by the Council 98,178 81 Key Management Personnel: Non-Voting Board Members 75 10,921 Net Transactions with Moray Council 9,812 Balances with Moray Council 31 March 2024 31 March 2025 £000 £000 263 Debtor balances: Amounts due from Moray Council 263 263 Net Balance due from Moray Council 263 Page 183
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Moray Integration Joint Board Annual Accounts 2024/25 55 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 2024/25 Code: IAS 21 The Effects of Changes in Foreign Exchange Rate (Lack of Exchangeability) issued in August 2023; IFRS 17 Insurance Contracts issued in May 2017; and Changes to the measurement of non-investment assets within the 2025 to 2026 Code include adaptations and interpretations of IAS16 Property, Plant and Equipment, and IAS 38 Intangible Assets. The Code requires implementation from 1 April 2025 and there is, therefore, no impact on the 2024/25 financial statements. The above amendments are not anticipated to have a material impact on the information provided in the financial statements. Page 184
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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) Codes of Conduct Codes of Conduct Financial Regulations (May 2025) Financial Regulations & Authorisation policy Standing Financial Instructions Standards Officer Appointment (April 2024) 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) 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) Monitoring Officer Annual Report SLT Compliance Sub Group Care for People Plan (under review 2025) Staff Engagement Programme Duty of Candour Arrangements E-Learning module on GDPR Policy for the Prevention, Detection and Investigation of Suspected Fraud, Theft or Corruption Whistleblowing policy Whistleblowing Policy Page 187
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LOCAL CODE OF CORPORATE GOVERNANCE 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 (annually) Use of Social Media Freedom of Information Compliance Communications & Engagement Strategy (under review) Freedom of Information Compliance Feedback Service Community Consultation Locality Planning Population Health Committee Third Sector Involvement Community Asset Transfers Grampian Clinical Strategy IJB Membership – Broad Range of Stakeholders Participatory Budgeting Plans NHS Grampian Area Partnership Forum Use of Social Media Equality, Diversity and Human Rights Policy Freedom of Information Compliance Stakeholder Engagement Framework Workforce Forum Complaints Handling Policy Staff Surveys Governance Framework Community Risk Register (2021) IJB & Committee meetings held in public Unpaid Carers Strategy Moray Mental Health and Wellbeing Strategy 2016- 2026 Locality Planning Page 188
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LOCAL CODE OF CORPORATE GOVERNANCE 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) Moray 2027 – a Plan for the Future Annual Delivery Plan (includes Financial Plan) Annual Performance Report (annually) Corporate Plan – currently being updated Governance Framework Performance Management Framework (under review) Community Planning Board Performance Management Framework Climate Change Duties and Responsibilities (annually) Local Outcome Improvement Plans – Updated with Partner Agencies Population Health Committee Climate Change Duties and Responsibilities (annually) Governance Framework Grampian Clinical Strategy Equalities Outcomes (April 2025) Performance Management Framework Equality & Diversity: Outcomes Best Value Report & Action Plan Improvement and Transformation Plans Page 189
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LOCAL CODE OF CORPORATE GOVERNANCE 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 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 Financial Planning Financial Planning – in line with Cipfa’s FM Code Principles Financial Planning MIJB Committee Structure 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 190
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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 Employee Development Team Staff Partnership Representation MIJB Development Sessions Moray Management Methods Leadership Schemes Board Member Induction 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 191
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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 Risk Reporting Risk Management Policy & Strategy Budget Monitoring & Financial Planning Governance Framework Following the Public Pound – ALEO Funding Risk Management Framework & Reporting Budget Monitoring & Financial Planning 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 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) Procurement Regulations & Training Audit, Performance and Risk Committee Business Continuity Plans – to be revisited post pandemic Risk Policy (Sept 2020) Clinical Risk Management Group Page 192
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LOCAL CODE OF CORPORATE GOVERNANCE Financial Recovery Plan Reserves Policy 2024 Internal Auditor Reappointment 2024 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 Committee Reporting Framework Board sub-Committee Reporting Framework Financial Reporting – Budget Monitoring 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 Production of Annual Accounts Audit Planning (Internal & External) Audit Planning (Internal & External) Audit Planning (Internal & External) Assurance Framework Consultation Statutory Returns Public Sector Reform Act disclosure Governance Framework 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 Climate Change Reporting Annual Complaints Report Annual Duty of Candour Report Page 193
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APPENDIX 3 1 NHS Grampian Board Secretariat Summerfield House 2 Eday Road Aberdeen AB15 6RE Ms Deborah O’Shea Chief Finance Officer Moray Health and Social Care Partnership Date 12 June 2025 Our Ref GB/JA Enquiries to Julie Anderson Email jule.anderson24@nhs.scot Dear Ms O’Shea, Governance Statement 2024/25 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 27th June 2025 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 2025. 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 195
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2 Draft NHS Grampian Governance Statement 2024/2025 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 minutes of meetings publicly available; 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 196
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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; 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 Board Executive 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 197
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REPORT TO: MORAY INTEGRATION JOINT BOARD AUDIT, PERFORMANCE AND RISK COMMITTEE ON 19 JUNE 2025 SUBJECT: ANNUAL PERFORMANCE REPORT 2024/25 BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To present the Committee with the draft Annual Performance Report 2024/25. 2. RECOMMENDATION 2.1 It is recommended the Committee: i) consider and note the draft Annual Performance Report 2024/25 at Appendix 1; ii) note the national indicator 11-19 information will be updated and approved by Chair and Vice Chair of the Board prior to publication; and iii) recommend to the Moray Integration Joint Board for approval and publication of the Annual Performance Report 2024/25 by 31 July 2025. 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 Item 10. Page 199
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Indicators have 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 represents the challenges services face as we seek to meet increasing needs whilst reducing spend to keep within the approved budget. This highlights the pressures on our services, the exceptional work of our staff and the ways in which we worked collaboratively with our partners to continue to provide care and support to the people of Moray. 4.3 The items for focus were identified by staff and managers following a call for submissions. There is a vast amount of work being undertaken across Health and Social Care Moray so it is not possible to capture it all but it is hoped that the areas included provide examples of the breadth of work being undertaken. There is a continued effort to strengthen the links between the Strategic Plan, service delivery plans and related performance monitoring reports, to facilitate production of future APRs. 4.4 The revised Strategic Delivery Plan incorporates projects from the Financial Delivery Plan as well as requirements to build capacity to meet future needs through review and redesign of pathways. Future reporting to this committee will reflect performance against identified outcomes. 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 includes reporting on the national Core Suite of Integration Indicators provided by Public Health Scotland, using these to support reporting on how well we are progressing the nine National Page 200
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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 our 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 the 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. Author of Report: Jeanette Netherwood, Corporate Programme Manager, HSCM Background Papers: Ref: Page 201
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Annual Performance Report 2024/25 APPENDIX 1 APPENDIX 1 Moray Integration Joint Board Annual Performance Report 2024/25 DRAFT Page 202
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Annual Performance Report 2024/25 2 Moray Integration Joint Board Contents 1. Foreword ............................................................................................................. 3 2. Introduction ......................................................................................................... 4 3. Our board and partnership .................................................................................. 5 4. Our Strategic Plan vision and priorities ............................................................... 7 5. Our continuing challenges ................................................................................. 12 6. Measuring our performance .............................................................................. 15 7. Our performance in 2024/25 ............................................................................. 17 8. Our progress and achievements in 2024/25 ..................................................... 22 9. Working with communities across our localities ................................................ 49 10. Financial performance and best value ............................................................... 52 11. Looking forward – priorities for 2024/25 ............................................................ 58 Appendix A: Moray area profile ................................................................................ 60 Appendix B: Core suite of national indicators ........................................................... 61 Appendix C: Local indicators .................................................................................... 71 Appendix D: IJB decisions and directions ................................................................ 73 Appendix E: Changes to Membership of Moray Integration Joint Board during 2024/25 .................................................................................................................... 75 Appendix F: Inspections of services ......................................................................... 76 Page 203
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Annual Performance Report 2024/25 3 Moray Integration Joint Board 1. Foreword On behalf of the Moray Integration Joint Board, we are pleased to present our Annual Performance Report for the financial year 2024/25. This year has been one of continued determination, transformation, and collaboration. As we navigated the complexities of a changing financial landscape and increasing demand for services, our commitment to delivering person-centred, high-quality care has remained steadfast. Throughout 2024/25, we have taken significant steps toward long-term sustainability by developing and beginning to implement our financial savings plan. These efforts have required careful prioritisation and a willingness to make difficult decisions, always guided by the principle of protecting and supporting the most vulnerable members of our communities. The report that follows offers an honest and comprehensive reflection of our performance against key national indicators, alongside real-world examples that highlight how we are adapting our services to meet the evolving needs of the people of Moray. Our focus has remained on improving outcomes, promoting independence, and ensuring that people can access the right support at the right time. None of this would be possible without the dedication of our health and social care workforce. Their professionalism, compassion, and adaptability have once again proven to be the foundation of our progress. We are equally grateful to our partners across the third and independent sectors, whose collaborative spirit and innovative approaches continue to strengthen our shared response to complex challenges. We extend our heartfelt thanks to our unpaid carers and volunteers. Their vital contributions underpin the resilience of our communities, and we recognise the invaluable role they play in supporting health and wellbeing across Moray. As ever, we remain mindful that there is more work to do. The coming year will bring further change and challenge, and we must continue to improve where we fall short, listen to and learn from feedback, and work closely with individuals, families, communities, and partners to co-design better, more sustainable services. This report reflects not just the achievements of the past year, but also the values that guide us — integrity, collaboration, and a deep sense of responsibility to the people we serve. We invite you to read this report and learn more about our journey. Together, we will continue to strive toward our vision of a Moray where everyone can start well, live well, and age well. Councillor Elaine Kirby, Chair, Moray Integration Joint Board Dennis Roberston, Vice-chair, Moray Integration Joint Board Page 204
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Annual Performance Report 2024/25 4 Moray Integration Joint Board 2. Introduction All Integration Joint Boards (IJBs) in Scotland are required to publish annual performance reports to inform the public of progress in delivering their strategic intent and against the National Outcome Indicators. This is the ninth annual report of the Moray Integration Joint Board (MIJB) which is a Statutory Public Body under the Public Bodies (Joint Working)(Scotland) Act 2014. The MIJB has a broad range of health and social care services delegated to it by NHS Grampian and Moray Council and has responsibility to undertake the strategic planning and commissioning of those services for the benefit of the population of Moray. Operationally, these services are then delivered by Health and Social Care Moray (HSCM) which is the partnership entity which brings together and delivers care across the region. This report is the MIJB’s assessment of performance in carrying out its delegated functions. This has been scrutinised against national performance (Appendix B) and Ministerial Strategic Group indicators identified by the Scottish Government to measure progress in delivering the National Health and Wellbeing Outcomes and local key performance indicators (Appendix C). It also describes the progress of services managed and delivered by Health & Social Care Moray in delivering on the vision and commitments set out in the MIJB’s Strategic Plan, Partners in Care 2022-32, which was approved in November 2022 and the delivery plan which was approved in October 2023. Also included in this report is an assessment of the board’s financial performance. Page 205
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Annual Performance Report 2024/25 5 Moray Integration Joint Board 3. Our board and partnership Our board The Public Bodies (Joint Working) (Scotland) Act 2014 established a legal framework for the integration of health and social care services in Scotland. The purpose of integrating health and social care is to improve the experience of people who use these services, and to make it easier for them to get the care and support they need. This should be at the right time and in the right setting at any point in their care journey, with a focus on community-based and preventative care. Since it was established in April 2016, the Moray Integration Joint Board (MIJB) has been responsible for a range of functions delegated to it by Moray Council and NHS Grampian. These are set out in the Scheme of Integration. There are eight voting members on the MIJB – four appointed by Moray Council and four appointed by NHS Grampian. They are supported by non-voting members made up of leading officers from the council and NHS, and representatives of the third sector, people who receive services and unpaid carers. The MIJB’s role is to set the strategic direction for community health and social care services and to deliver the priorities set out in its Strategic Plan through the local partnership of Health & Social Care Moray (HSCM). The board receives payments from Moray Council and NHS Grampian to enable delivery of local priorities for health and social care. It gives directions to the local authority and health board as to how they must carry out their business to secure delivery of the strategic plan. Our partnership Services are commissioned and delivered through the partnership of HSCM which brings together staff employed by the local authority and by the NHS. The partnership is led by the Chief Officer supported by a Senior Management Team and Operational Management Team. The Chief Officer reports to the Chief Officers of Moray Council and NHS Grampian. In addition to directly providing services, the partnership also contracts for health and social care services from a range of partner organisations in the Third and Independent sectors. Within primary care services, a range of independent contractors including GPs, dentists, optometrists, and pharmacists, are also contracted by the Health Board under national frameworks. Services delegated to the MIJB and which are managed on its behalf by HSCM include: Page 206
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Annual Performance Report 2024/25 6 Moray Integration Joint Board • Social work and social care (older people’s services, mental health services, learning disability services, physical and sensory disability services) • Primary care services including GPs and community nursing • Allied health professions including occupational therapy and physiotherapy • Community hospitals • Health improvement • Community dental, ophthalmic and pharmaceutical services • Aspects of acute services (hospitals) relating to unscheduled care • Support for unpaid carers. Children and families health services hosted within the MIJB’s Scheme of Integration include: • Health visiting • School nursing • Allied health professions. Grampian-wide services hosted by Moray on behalf of all three health and social care partnerships are: • Primary care contractors • The GMED out of hours primary care service. In 2022, Moray Council, NHS Grampian Board and the MIJB agreed to progress with delegation of Children & Families and Justice Services to the MIJB. The Moray Integration Scheme was revised to reflect these changes and was approved by Scottish Ministers on 16 March 2023. Page 207
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Annual Performance Report 2024/25 7 Moray Integration Joint Board 4. Our Strategic Plan vision and priorities A key statutory duty of the Moray Integration Joint Board (MIJB) is to develop a Strategic Plan which must be reviewed every three years. A refreshed strategic plan was approved by the Board in November 2022. The integration of Children & Families and Justice Services into Health & Social Care Moray 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. The strategic plan sets the vision and local priorities that will help improve the health and wellbeing of the people of Moray. It outlines how services will be delivered to meet the National Outcomes for Health and Wellbeing, and achieve the core aims of integration. 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.” The plan has three strategic priorities to be delivered on. Building Resilience – supporting people to take greater responsibility for their health and wellbeing by: • focusing on prevention and tackling inequality; • nurturing and being an integral part of communities that care for each other. Home First – supporting people at home or in a homely setting as far as possible by: • working to give citizens of Moray the right care in the right place at the right time; • building communities where people are safe. Partners in Care – supporting people to make choices and take control of their care and support by: • working in partnership with all; • listening to what citizens are telling us and being transparent in our decision making and communications; • ensuring we make a positive impact beyond the services being delivered. The strategic intentions continue to focus on the triple aim of the national Health and Social Care Delivery Plan which is summarised as: • Better Care: improving the quality of care by targeting investment at improvement and delivering the best, most effective support; Page 208
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Annual Performance Report 2024/25 8 Moray Integration Joint Board • Better Health: improving health and wellbeing through support for healthier lives through early years, reducing health inequalities and focusing on prevention and self-management: • Better Value: increasing value and sustainability of care by making best use of available resources, ensuring efficient and consistent delivery, investing in effectiveness, and focusing on prevention and early intervention. The Strategic Delivery Plan was updated in May 2025 and sets out the actions that will be taken forward to deliver on the strategic priorities. Transformation and improvement priorities A revised Strategic Delivery Plan for 2025 to 2028 was approved by MIJB in May 2025. This plan incorporates the developments required to enhance our ability to meet predicted future demands for services, whilst undertaking reviews of existing models of care to ensure that the services provided are sustainable and fit for purpose. There are also projects to implement more efficient ways of working, to aid in meeting the financial challenge that is impacting on all public sector organisations. A robust governance framework will be essential to ensure that projects can be delivered within available resources and have a clear focus on outcomes. The work being progressed through the Rural Centre of Excellence led by the Digital Health Institute (DHI) on research and development projects, and local delivery of national programmes such as the Primary Care Improvement Plan (PCIP) and Discharge without Delay (DwD) are key focuses and are incorporated into the delivery plan. DwD will encompass workstreams relating to frailty, delayed discharges, and Getting it Right for Everyone (GIRFE) that are already underway. Rural Centre of Excellence Moray is leading the way in the development and testing digital solutions that could transform how health and social care services are delivered and received nationally and globally. The Rural Centre of Excellence (RCE) is a £5 million UK Government project, based in Moray and led by the Digital Health & Care Innovation Centre as part of the Moray Growth Deal. It brings together partners including Health and Social Care Moray and local citizens to find better ways to support people’s health, wellbeing and independence — especially in a rural setting like Moray — by creating digital tools and services that are easy to use and accessible to everyone, regardless of income, location or digital skills. The RCE is focused on solutions to everyday challenges identified by health and social care staff, people who receive services and families. Early developments include: Page 209
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Annual Performance Report 2024/25 9 Moray Integration Joint Board • Community Connections Moray: an easy to use online service directory to help people find local support and information. • Personal Data Store (PDS): a secure way for people to store and share their health story with services, if they choose, so they only need to tell it once. In 2024/25, five ‘Living Lab’ projects have progressed. These are practical, real-world trials where local people, staff, digital specialists and researchers work together to design and test new ideas that improve care and free up resources. • Supported Self-Management & Long-Term Conditions Management: Focused on healthy weight and diabetes, these projects have come together to create the ‘Heart of Moray’ wellness community—a new approach to healthy living supported by digital tools. • Community Occupational Therapy Lab: Developing online tools to help people find the right equipment and support more quickly, including a self- assessment tool, and options for more efficient digital referrals and assessments. • Care in Place: Testing how the Community Connections and personal data store tools can make life easier for unpaid carers, starting in Forres and Lossiemouth. • Smart Housing, Smart Communities Lab: Exploring how home sensors and digital tech can help people stay safe and well at home, and alert carers or services early if something seems wrong. Testing starts in Buckie in summer 2025. • Mental Wellbeing: Now underway, this project focused on making it easier to find mental health and wellbeing information and support through Community Connections. Primary Care Improvement Plan Implementation of the Moray Primary Care Improvement Plan, in response to the 2018 General Practitioner (GP) Contract and accompanying Memorandum of Understanding (MOU), is continuing. A key aspect of the Plan is to provide support to GPs by expanding the Multi-Disciplinary Team. Key areas of progress through 2024/25 were: • Pharmacotherapy – established; every Moray GP Practice has some access to all 3 levels; Level 1 (core), Level 2 (additional advanced) and Level 3 (additional specialist). • Vaccination transformation programme – established; all eligible vaccinations have moved from GP practices to HSCM. GP practices continue to assess patients’ eligibility for certain vaccinations. Travel vaccinations and all travel health advise has now transferred to HSCM. • Community Treatment and Care, Primary Care Occupational Therapy (Urgent Care and intervention for prevention), Mental Health & Wellbeing Practitioners Page 210
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Annual Performance Report 2024/25 10 Moray Integration Joint Board and First Contact Physiotherapy Services are all available at each Moray GP practice. In addition to the Moray Primary Care Improvement Plan, the Grampian GP Strategic Vision programme 2024-2030 brings together the three HSC partnerships and NHS Grampian to address challenges around transforming general practice into the sustainable service, which enables people in their communities to stay well through the prevention and treatment of ill health. The Vision programme focuses on a 10-point plan including a focus on modern premises, integrated IT systems, data driven decisions and a robust education and workforce development plan. A Progress review recently undertaken shows that the 5 prioritized objectives are progressing well (Data; Digital; Multi-Disciplinary Team; Models of contract; Premises). Consideration is now being given to the remaining objectives. An action plan outlining changes to the delivery of the objectives, the steps and resources needed to move forward is being progressed Discharge Without Delay (DWD) NHS Grampian and the three Health and Social Care Partnerships (Aberdeen City, Aberdeenshire and Moray) are participating in the Scottish Government programme that aims to reduce hospital length of stay and improve the overall patient journey by facilitating timely and efficient discharge from hospital, through early and effective planning for discharge and promotion of a “Home First” ethos. The 4 workstreams of this national programme are: • Planned date of discharge/integrated discharge hub – from point of admission to hospital a realistic date and plan for discharge should be set by the multi- disciplinary team to provide a focus • Frailty at the front door – involves early comprehensive geriatric assessment for identified frail older people as early as possible to ensure informed discharge planning. • Discharge to assess (D2A)/Homefirst – provision of responsive community- based home care support that enables patients to return home without unnecessary delays. • Community hospital/step down rehabilitation units – to care for frail individuals who require rehabilitation and extended assessments as part of their discharge process, ensuring no delays. The benefits will be reduced length of stay in hospital, improved patient experience, improved hospital capacity and provision of appropriate care in a person’s preferred setting. The National DwD programme has completed phase one, which included the completion of a National self-assessment tool, the creation of actions and the identification of leads to represent Moray locally, regionally and nationally. The Moray leads are now attending local, national and regional meetings and will develop action plans for planned work which will be fed back to all groups. Page 211
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Annual Performance Report 2024/25 11 Moray Integration Joint Board This is a collaborative approach in Moray and local leads for each of the workstreams will work together with teams from DGH and HSC Morayto achieve the goals set and it will build on the work already undertaken for the Frailty Pathway. Moray’s DWD self-assessment has been submitted and has been added into a single submission to Scottish Government from NHSG and will inform next steps. Frailty Pathway The 'Focus on Frailty' collaborative, facilitated by Health Improvement Scotland took place between May 2023 and Nov 2024. Moray was one of six Health and Social Care Partnerships who participated within the national collaborative. A combination of national events and webinars took place which led to Moray designing a local frailty plan covering community and primary care through to acute services. A Moray Frailty Strategic Group was put in place to oversee the delivery, monitoring and evaluation of the local plan. The Moray group worked closely with Grampian colleagues and developed a Grampian Frailty Board to align planning across the three health and social care partnerships. Much of the national collaborative work has now been subsumed into the national Discharge Without Delay work. The Moray and Grampian Frailty groups continue to meet periodically to continue to develop on the good work that took place during the national collaborative. Areas of progress during 2024/25 include: • MEOC and Rockwood combined document used in a variety of community settings such as vaccination clinics, health centres and community hubs. Several other teams have now implemented this across Scotland. Promoting a positive approach to aging well. • Identification of severe frail patients in two primary care settings; Culbin Medical Practice and Maryhill Medical Practice. • Primary Care Occupational Therapy – EQ5D & Falls/Frailty programme 69% improvement. Integration of Tai Chi into treatment programmes for patients who are starting to become frail. • Polypharmacy reviews by clinical pharmacist led to reduction in prescribed medications, resulting in reduced risks of falls, • A dedicated frailty ward is now in place at Dr Gray’s Hospital; Ward 7. • Education and awareness sessions in Dr Gray’s Hospital ward areas and Emergency Department led by front line staff. • Physiotherapist now full time permanent in the Emergency Department – increased assessment of frailty, turn around and admission avoidance. • Increased use of data from Health Intelligence to display at department level. • Application of “Super 6” to these patients. • Document created and shared with the public regarding services available to them in Moray – very well received and positive feedback gained. This Page 212
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Annual Performance Report 2024/25 12 Moray Integration Joint Board is now also available in the Emergency Department and shared with patients identified as frail regardless of where they sit on the frailty scale. • The licensing of an NHS Grampian version of the ‘The Broons’ frailty comic strip first developed by NHS Highland. • The introduction of a Frailty Icon has progressed but has not been completed as yet. • Bench marking of the Frailty Standard which were published in November 2024 A quality improvement approach has been taken to this work, with successful tests of change then being scaled up. Early evidence indicates a reduction in people being admitted to hospital, a reduction in the length of time people are in hospital and a reduction in readmissions. Getting It Right for Everyone (GIRFE) Health & Social Care Moray became a partner within the national Getting it Right for Everyone (GIRFE) programme in October 2023. GIRFE is a multi-agency approach for health and social care services from young adulthood to end of life care. It builds on the previous Scottish Government policy Getting it Right for Every Child (GIRFEC). 10 partnerships were involved in work to co-design and test the principles which will support the national approach to GIRFE and the development of a toolkit to support staff to roll out and embed the approach. This work concluded in early 2025 and has been recently published. A Moray GIRFE Strategic Group has been formed and will continue to oversee the embedding of GIRFE within Moray. Key achievements in 2024/25 include: • Agreement that all newly commissioned services will require to demonstrate how they will adhere to the GIRFE principles • Ensuring GIRFE principles are embed in all new and updated polices and strategic plans • Promotion of GIRFE to health and social care practitioners and members of the public • Benchmarking of locality practice and performance against the GIRFE principles • Alignment of GIRFE plans across Grampian 5. Our continuing challenges Like all our community planning partners, we are ambitious for Moray. Already a great place to live, work, grow and enjoy life in wonderful surroundings, we recognise the importance of continued collaborative working with public sector bodies, third and independent sector organisations, other key groups and agencies, to tackle inequalities across Moray and improve the lives of residents and the services they receive. Page 213
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Annual Performance Report 2024/25 13 Moray Integration Joint Board Our progress in improving health and wellbeing outcomes continues to be challenged in many areas. Year on year, we have reported on the same issues of an ageing population, inequalities in health, workforce shortages, growing pressures on primary care and acute hospitals, and increasing reliance on unpaid carers. The cost of living crisis continues to impact on the health and wellbeing of children, families and more vulnerable people. We are challenged to balance providing statutory services to meet people’s assessed needs, offer choice and control in how their support needs are met and to keep them safe in times of crisis, with also supporting them to manage their own health and wellbeing and increase their independence to reduce their reliance on formal support services. One of our greatest challenges remains our funding position. The MIJB is delegated funding by both NHS Grampian and Moray Council to deliver the services for which it has responsibility. There are increasing pressures on the budgets of both partners, with NHS Grampian under increased level of financial scrutiny. The increasing costs of delivery of health and care (e.g. wage growth, national increases, costs of medicines etc) mean that budgets continue to be under significant pressure. The Financial Delivery Plan was implemented in 2024/25 where actions to achieve savings and reductions in overspends were identified to ensure that the Board can operate within its financial resources. Added to this, we continue to see growing demand for services as the population grows and as more people live with and experience ill health, frailty or other health and social care needs. The 2024/25 Annual Accounts, subject to audit, show an overspend on the provision of services of £4.26m for the year ending 31 March 2025. Our financial performance is detailed in section 10 of this report. It is recognised by the MIJB that there will be difficult decisions on how to allocate resources to meet the need to streamline pathways or transform the way supports and services are provided to make them sustainable and fit to meet future challenges. Our key challenges identified in our Joint Strategic Needs Assessment include: Population projections. Moray is projected to have an increasingly ageing population structure. Between 2023 and 2038 it is projected that the number of 5-17 year-olds in Moray will decline by 19% (-11% for Scotland). Conversely, those aged 85 and over will increase by 63% in Moray and 47% in Scotland. Across all the over 65 age groups, the percentage growth in both males and females is expected to be higher in Moray than Scotland. There is the potential for increased demand for health and social care services with a limited workforce. Inequalities Page 214
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Annual Performance Report 2024/25 14 Moray Integration Joint Board Although life expectancy is comparatively higher than the Scottish average, clear inequalities are present: females in the most deprived areas of Moray have a 3% lower life expectancy than Moray as a whole; males in the most deprived areas have a 5% lower life expectancy than Moray as a whole. Demand Some services have struggled to manage increase in demand due to a multitude of factors such as the impact of the pandemic on health and wellbeing, staff fatigue, and workforce challenges. Workforce We have an aging workforce with a sizable proportion of staff potentially nearing retirement as well as ongoing issues around recruitment and retention. Mental health Data from General Practices in Moray shows depression is the second most prevalent long-term condition recorded (4,005 patients) after hypertension. The prevalence of depression risen between 2017/18 and 2022/23. The rate per 1,000 population in Moray has increased from 42.5 to 53.7. The prevalence of dementia within the Moray population has increased from 4.9 per 1,000 population in 2017/18 to 5.6 in 2022/23. Behavioural risk factors The three leading groups of causes of ill-health and early death in Moray are cancers, cardiovascular diseases and neurological disorders. These groups of causes account for 50% of the total burden of health loss. The largest differences in burden - compared to Scotland - occur due to substance use disorders, digestive diseases and cancers. A large proportion of cancer and cardiovascular disease is preventable. Overweight, obesity and poor diet impact on health and wellbeing in a major way, affecting 67% of people in Scotland. Obesity is now the leading cause of death in Scotland and is linked to 23% of all deaths. Smoking is the single biggest avoidable risk factor for cancer and remains a leading cause of preventable disease and premature death. Alcohol is also recognised as a contributory factor in many other diseases including cancer, stroke and heart disease. Armed Forces veterans Veterans and service personnel have higher rates of certain health conditions, giving rise to greater need for services than in the general population. These conditions include mental health problems (e.g. PTSD, suicide, substance misuse); severe and enduring physical health conditions (e.g. multiple, complex injuries; ongoing support Page 215
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Annual Performance Report 2024/25 15 Moray Integration Joint Board through the national trauma network); impaired mobility and musculoskeletal disorders; chronic pain. The Moray area profile is included at Appendix A. 6. Measuring our performance Performance management arrangements established within the partnership facilitate overview and scrutiny of performance in relation to delivery of our Strategic Plan and against a range of local and national key performance indicators. Quarterly performance reports are produced for HSCM 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 on a quarterly basis. 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. We have used this framework as the basis for our performance report. National Health and Wellbeing Outcomes 1 Icon Health & wellbeing People are able to look after and improve their own health and wellbeing and live in good health for longer. 2 Icon 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 Icon Positive experiences People who use health and social care services have positive experiences of those services, and have their dignity respected. 4 Icon 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 Icon Health inequalities Page 216
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Annual Performance Report 2024/25 16 Moray Integration Joint Board Health and social care services contribute to reducing health inequalities. 6 Icon 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 Icon Safe from harm People using health and social care services are safe from harm. 8 Icon 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 Icon Use of resources Resources are used effectively and efficiently in the provision of health and social care. Our 2024/25 performance report looks at each of the Health & Wellbeing Outcomes alongside national indicators. National Indicators (to be updated in July when figures are published) The Core National Indicators (Appendix B) 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 are taken from the Health and Care Experience (HACE) Survey which is carried out nationally every two years. They were provided in 2023/24 therefore they are not due to be updated until 2025/26, so will remain the same as reported last year. Page 217
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Annual Performance Report 2024/25 17 Moray Integration Joint Board 7. Our performance in 2024/25 Moray Core Suite of National Integration Indicators (to be updated in July when stats are published) Health & Social Care Moray 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. In the 2023/24 report we highlighted areas where there were reductions in performance such as the percentage of adults supported at home who agree that they are supported to live as independently as possible (NI-2) reduced by 7% and the percentage of adults supported at home who agree they had a say in how their help, care or support was provided (NI-3) which reduced by 10%. Although the difference between years cannot be directly compared due to the changes in wording of the survey, and we were in line with Scotland, it was concerning that these indicators seemed to have declined. In addition, the fact that unpaid carers did not feel adequately supported is very concerning. These indicators are only collated every two years so there is no update this year, however there is a focussed effort to improve choice and control for people in how their support is provided through increasing knowledge of and use of conversations based on the principles of self-direct support (SDS), increasing knowledge of and access to opportunities in the communities and through progression of the plan for development of supports for the unpaid carers, described in the following pages. The detail of each of the indicators is included in Appendix B. Page 218
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Annual Performance Report 2024/25 18 Moray Integration Joint Board Summary of our performance at a glance - National Indicators (HACE ones (1-9) will remain the same as the survey is only conducted every second year) GREEN Our performance has improved compared to last year. AMBER Our performance is similar to last year. RED Our performance has got worse compared to last year. Please note that National Indicators 1-9 are based on the HACE survey which is undertaken every two years. 2024/25 figures remain the same as reported in 2023/24 Annual Performance Report. Results for 2, 3, 4, 5,7 and 9 are not comparable to previous years due to changes in survey wording. Outcome indicators National Indicator Scotland Our result Our progress 1 Percentage of adults able to look after their health very well or quite well 91% 92% 2 Percentage of adults supported at home who agree that they are supported to live as independently as possible 72% 72% 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% 4 Percentage of adults supported at home who agree that their health and care services seemed to be well co-ordinated 61% 66% 5 Percentage of adults receiving any care or support who rate it as excellent or good 70% 69% 6 Percentage of people with positive experience of the care provided by their GP practice 68% 69% 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% 8 Percentage of carers who feel supported to continue in their caring role 31% 28% 9 Percentage of adults supported at home who agree they felt safe 73% 70% Page 219
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Annual Performance Report 2024/25 19 Moray Integration Joint Board National Indicator(will be updated in July) Scotland Our result Our progress Data indicators 11 Premature mortality rate (rate for 2023 not yet available) 442 (for 2022) 330 (for 2022) 12 Emergency admission rate 11707 8338 13 Emergency bed day rate 112883 87123 14 Readmission to hospital within 28 days 104 77 15 Proportion of last 6 months of life spent at home or in a community setting 89% 91% 16 Falls rate 23 17.7 17 Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections 77 81.1% 18 Percentage of adults with intensive care needs receiving care at home 65% 61% 19 Number of days people spend in hospital when they are ready to be discharged 902 980 20 Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency Not yet available Not yet available Moray Local Indicators Performance in on target or within agreed tolerance in five of the 11 indicators. The following is an assessment of performance in the areas not meeting target. The rate for attendance at the Emergency Department (ED) (Accident and Emergency) is only slightly over target in March 2025. The number of people waiting to be discharged from hospital at census date (DD-01) fluctuated through the year but ended with a high figure of 40. The number of bed days occupied (DD-02) fluctuated through the year but was 1149 at Quarter 4 which was a reduction in comparison to the same period in the previous year. The contracted partner struggled throughout this year to accept new people for care packages, but through working collaboratively with partner changes to funding arrangements have been implemented recently resulting in recruitment of more staff leading to an increase in hours available for new people requiring care, which will contribute to reducing delays in discharges. Page 220
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Annual Performance Report 2024/25 20 Moray Integration Joint Board Readmissions to hospital at 7 days of discharge has fluctuated through the year and is just over target. It is anticipated that the continuation of the focussed work around frailty at both the national and Moray levels will provide a reduction in presentation to Hospital, within the frailty age groups. The percentage of patients starting psychological therapy within 18 weeks is not achieving target. Some people remain in treatment for extended periods due to the complexity of their illness and there are increased people requiring mental health support that means that demand continues to outstrip resource with ongoing uncertainty in relation to primary care funding for psychological therapies delivery. Group sessions are held, where appropriate, and further development should ensure a greater throughput of people and ongoing job planning with professional leads ensures that capacity is maximised across services. Moray is continuing to progress well with the implementation of the Medication Assisted Treatment Standards (MATS) and early feedback indicates Moray continues to meet the benchmarks set. NHS employed staff sickness absences have reduced significantly to 4.9%, the lowest figure since April 2023. Council employed staff sickness has increased to 8.2%. The NHS figures is getting closer to the target of 4% but Council figures remain well above target. Staff absences continue to be at a high level with mental health and muscular-skeletal injuries being the most common reasons. Mitigations to be added Page 221
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Annual Performance Report 2024/25 21 Moray Integration Joint Board The detail of each of the Local Indicators is included in Appendix C. Summary of our performance at a glance – Local Indicators GREEN Moray is performing better than target. AMBER Moray is performing worse than target but within agreed tolerance. RED Moray is performing worse than target by more than agreed tolerance. Indicator 2024/25 (Q4) Target Progress against target A&E attendance rate per 1000 population all ages 22.0 21.9 Number of Delayed Discharges (including code 9) at census point 40 26 Number of bed days occupied by delayed discharges (incl. code 9) at census point 1149 850 Rate of emergency occupied bed days for over 65s per 1000 population 2681 2320 Emergency admission rate per 1000 population for over 65’s 187 177 Number of people over 65 years admitted as an emergency in the previous 12 months per 1000 population 131 121 % Emergency readmissions to hospital within 7 days of discharge 3.7% 3.9% % Emergency readmissions to hospital within 28 days of discharge 7.9% 8.4% % of patients commencing Psychological Therapy Treatment within 18 weeks of referral 65% 90% NHS Sickness Absence (%of hours lost) 4.9% 4% Council Sickness Absence (% of calendar days lost) 8.2% 4% Page 222
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Annual Performance Report 2024/25 22 Moray Integration Joint Board 8. Our progress and achievements in 2024/25 Outcome 1: Health & wellbeing People are able to look after and improve their own health and wellbeing and live in good health for longer. National Indicators used to measure this outcome Indicator Title 2022 2023/24 2024/25 NI - 1 Percentage of adults able to look after their health very well or quite well 92.2% NI - 11 Premature mortality rate per 100,000 persons 330 NI - 12 Emergency admission rate (per 100,000 population) 8,338 Comment to be added –and updated when figures received Community Appointment Day The aim of a Community Appointment Day (CAD) is to create the right environment to enable clinicians to support people with their condition on the day and beyond, learn about available local community services, embed personalised care and focus on prevention. With the intention of addressing increasing waiting lists by trialling a new model of care, NHS Grampian delivered their first CAD in Moray for MSK Physiotherapy and Podiatry patients. This was a new way of working, moving away from treatment led health and delivering services differently by strengthening local partnerships, particularly with communities, to enhance both patient and practitioner experience. There were 210 patients on the waiting list who were all invited, 162 opted to attend and 120 actually attended on the day. Patients were linked their own online Personal Health Passport, which they completed as they moved around the zones. Patients received a one-to-one consultation with the appropriate clinician and were encouraged to have meaningful conversations about what matters most to them. The CAD followed Realistic medicine principles, focusing on personalised and values-based care. The voice of lived experience was heard throughout the planning process by involving the local Versus Arthritis Chronic Pain Group who offered valuable feedback and guidance. 19 community groups and partner services were in attendance to provide information about the support available within the local community. Bringing health and community organisations together under one roof, allowed people’s health and wellbeing to be viewed in full totality Preliminary Feedback was largely positive, indicating that patients felt the day had been ‘enlightening’, benefited greatly from having services available in one place and found out about what is available in communities. Page 223
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Annual Performance Report 2024/25 23 Moray Integration Joint Board High level analysis showed that patients particularly valued the focused time given to them, being listened to what matters to them, having access to a one-stop-shop, patient centred care and feeling informed. Included in the patient evaluation was the Collaborate tool; 78% reported that every effort was made to help them understand their health issue, 74% reported that every effort was made to include what mattered to them in choosing what they do next, 79% reported that every effort was made to listen to things that mattered to them most about their health issues. Overall, patients rated the experience 4.5 out of 5. 60% of patients were either recommended a Patient Initiated Reviews within 6 months or fully discharged from the service. Additionally, waiting lists dropped by 124 over a four-month period following CAD implementation, indicating a tangible impact on service demand. Follow up interviews are ongoing in partnership with Health Intelligence colleagues, and a final evaluation report is expected June 25. The MSK CAD recently featured as a good practice example in the Scottish Government’s Realistic Medicine Casebook Heart of Moray The majority of people in Moray are living with excess weight and a problem of this scale needs a whole system approach which focuses on: • Children, to give them the best start in life - they eat well and have a healthy weight • The food environment so it supports healthier choices • Ensure people have access to effective weight management services that meets their needs • Leaders across all sectors promote healthy weight and diet • Diet-related health inequalities are reduced During 2024/25 the Dietetic team worked collaboratively with NHS Grampian, Moray Leisure Centre and the Rural Centre of Excellence/ Digital Health and Care Innovation Centre (DHI) to develop a whole system approach to addressing obesity. HSCM received some Scottish Government funding to enable better detection, early intervention and management of overweight and obesity. The Heart of Moray launched in February 2025 and will build on pan Grampian weight management work which has significantly increased weight management provision in Moray through a range a interventions which span from Community Connections/Heart of Moray (Heart of Moray – Improving health and wellbeing together), Counterweight Core and exercise at Moray Leisure Centre, digital weight management services with Second Nature and a new NHS Grampian Specialist Weight Management Service. Public health teams will also be involved to deliver the whole systems approach to obesity across all localities in Moray. Page 224
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Annual Performance Report 2024/25 24 Moray Integration Joint Board Heart of Moray – Improving health and wellbeing together The Heart of Moray makes it easier to improve our health and wellbeing. It’s now at Moray Leisure Centre, a community place with friendly staff, social spaces and ways to be more active, learn about food and lifestyle and be supported for healthy weight management. heartof.co.uk Making Every Opportunity Count (MeOC) Using the making every opportunity count (MeOC) approach to have light touch early intervention and prevention conversations with people on lifestyle and life circumstances is a key focus to help people manage their own health and wellbeing. This year saw the launch of updated booklet and accompanying digital resource (webpage) for contact information for a variety of support services. Over 185 people have been trained and 812 conversations were recorded during 2024/25, with people accessing the supports they identified that met their needs. Ageing Well - Supporting older people to maintain their independence The Realistic Medicine Wellbeing Coordinators adapted existing resources to create a tool with a focus on older people’s health concerns. It support individuals to check in on their health and be more aware of available support services. The MeOC self-check tool links with the Realistic Medicine approach, which supports people using healthcare services to feel empowered to discuss their treatment, test or procedure fully with healthcare professionals. The aim of this discussion is to ensure people are aware that suggested treatment might come with side effects – or even negative outcomes - and also to reduce harm, waste and unwarranted variation. Community Justice Groups The Community justice social work team support the Ladies’ group RISE (Recovery Inclusion Support & Energy) and the Men’s group: SWITCH (Skills Wellbeing Inclusion Thrive Connection Hope) to meet weekly to progress a health & wellbeing programme that compliments the ongoing support provided by the social work team. The programme offers a holistic approach to health and wellbeing, introducing new experiences and instilling confidence, motivation and encouraging access to services. Those who attend these groups are currently under a supervision order and attendance at the groups is voluntary and participation is growing with a steady attendance throughout the year for RISE (with 36-40 attendees), and SWITCH has seen an increase from 15 to 41 attendees. Overall, 18 health and wellbeing sessions have been facilitated through a collaboration of participants, social work team and public health co-ordinator with a range of local third sector partners to help build the programme. Feedback from participants has been very positive and a particular highlight was a fencing session. Page 225
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Annual Performance Report 2024/25 25 Moray Integration Joint Board "we all had lots of fun fencing today and making music and photography a great variety where everyone was able to get involved, total escapism". This session was very much enjoyed by all, the coach leading was enthusiastic and motivated all participants to give this a try and others who were unable to physically take part were encouraged to be part of this. Other general feedback; “good guys, very engaging, easy to talk to” “Really useful session, friendly trainer and a relaxed atmosphere let people feel ok to give it a go” "Very interesting & helpful. Enjoyed it though it felt a bit scary to start with" Leading healthy, active lives The Community Wellbeing and Development Team exists to prevent, reduce, and significantly delay the need for long-term and residential care by enabling people to maintain their independence and lead healthy, active lives. The team supports a range of community health and wellbeing groups across Moray: o 18 x B.A.L.L. Groups (Be Active Life Long Learning) These active ageing groups are designed for older people and aim to support mobility, reduce the risk of falls, and combat isolation and loneliness through regular physical activity and social engagement. o 4 x S.E.T. Groups (Seated Exercise and Tea A natural progression for some B.A.L.L. participants, S.E.T. groups offer adapted seated exercises in a welcoming setting, encouraging continued movement and community integration. o Health and Wellbeing Groups Specialist groups that support and improve physical, emotional, and mental wellbeing. Delivered in partnership with health professionals, these groups offer a follow-on option after rehabilitation sessions, helping individuals build confidence, self-manage their health, and form new community connections. The team currently supports over 1,300 older people each week through these activities, enabling them to stay active and connected in their communities. Throughout the year, the team also works with external partners such as Wild Things Environmental Education in Action to deliver inclusive “green space” activities that promote mental health and wellbeing in nature. In 2024, a key focus was engaging with the wider community to identify local service gaps. One such gap was found in Portknockie, where—after multiple engagement events—a new community-led social group, “Knockin-on Abit,” was established. Run by the community, for the community, the group is helping reduce isolation and bring people together in a rural location. Through the team's Information and Activities Booklet, people are supported to access relevant local resources that promote wellbeing and independence. Over the Page 226
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Annual Performance Report 2024/25 26 Moray Integration Joint Board past year, the Community Wellbeing and Development Team supported more than 2,500 older people to stay connected and active in their communities. <Photos and permissions to be obtained > Social prescribing Whilst social prescribing continues to be delivered in Forres and Lossiemouth locality the good progress in 2023/24 was impacted in 2024/25 by the Community Connector services experiencing reducing staffing capacity which impacted the number of referrals accepted and the data returned. The Listening Service also ceased in April 2024 but restarted in Forres in March 2025. The impact of the staff reduction meant that there was a decrease of referrals of 210 (73% from previous year) from Forres and a decrease of 334 (57%) from Moray Coast. The majority of referrals were for smoking and weigh management, followed by benefits advice, carer’s information, physical activity, mental health, Clan and local support services. The aim is to scale up and implement social prescribing across other GP practices in Moray and to explore digital possibilities to facilitate earlier intervention and prevention, whilst acknowledging limited resources. Page 227
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Annual Performance Report 2024/25 27 Moray Integration Joint Board 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. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 2 Percentage of adults supported at home who agree that they are supported to live as independently as possible 71.9% NI - 3 Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided 59.5% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 68.7% NI - 12 Emergency admission rate (per 100,000 population) 8,338 NI - 15 Proportion of last 6 months of life spent at home or in a community setting 91.1% Commentary on national PI Care at Home Service Care at Home is one of the key services which enables people to live independently in their own home for longer. As at March 2025, the planned weekly hours of care being delivered by the internal Moray Council service and CQS our external partner, were 4,672. Number of planned weekly hours (March 2024) Number of planned weekly hours (March 2025) Change in hours % Internal Care at Home 3,692 4008 +316 +8.56% Partner provider 660 664 +4 -0.61% TOTAL 4,352 4,672 -244 +7.35% A weekly care at home hub meeting is in place to manage performance and ongoing challenges faced for each locality, to keep track of care provision. Understanding risks faced by those using services and providers assists with development of strategies for improvement across the service. Performance information from these meetings is submitted weekly to the Collaborative Care Home Support Team Meeting which oversees provision of care at home and care homes by internal and external services. A Strategic review of the approach for Care at Home service was undertaken and the MIJB decided in March 2025 to develop a flexible framework approach intended to grow availability of care provision. Page 228
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Annual Performance Report 2024/25 28 Moray Integration Joint Board Self-Directed Support The Self-Directed Support (SDS) team within HSCM continue to demonstrate a strong and continued commitment to the principles of Self-Directed Support, ensuring that people in Moray are empowered to live the lives they choose through collaboration, innovation, and person-centred approaches. A key milestone has been the establishment of the SDS Standards Steering Group, created to support the consistent embedding of the National SDS Framework of Standards across local practice relating to children and young people, adults and unpaid carers. This group brings together key stakeholders to ensure that the principles of SDS are reflected in every aspect of support planning and delivery as we progress. There has been a notable increase in the uptake of SDS Option 1 (Direct Payments) enabling families to have more flexibility in managing their own support. This has been achieved through effective recruitment of Personal Assistants (PA’s) supported by the SDS team, expanding the local workforce and providing individuals with greater flexibility and control when choosing who supports them for personal care, social support and support for unpaid carers to get a break from their caring role. Currently there are approximately 450 PA’s in Moray (increased from 415 last year), supporting 284 people (compared to 301 individuals last year). There was a vacancy for a Social Worker for Unpaid Carers for most of the year which had an impact on the number of people that could be supported to receive SDS as a Carer. The SDS Enablers ensure the SDS approaches are being used to support individuals in achieving their personal outcomes through low-cost or no-cost interventions wherever possible. This strength and asset, community based, resource-conscious approach has helped individuals access support that is both meaningful and sustainable. Ongoing efforts to develop a local framework of supports are progressing well. This framework aims to ensure that everyone eligible for SDS has access to a wide range of flexible, locally available options, strengthening true choice and control in line with SDS legislation. The Framework of Support will give transparency relating to cost and service availability across Moray for those individuals who require support funded through the four options of SDS. Communities and volunteer teams In 2024–25, 107 Health and Social Care Moray volunteers, coordinated by the Communities and Volunteering Team, gave over 9,000 hours of their time to support people across Moray. The service is open to adults aged 18 and over, with the majority of referrals relating to older people at risk of isolation and loneliness, delayed discharge, or loss of independence. As demand continues to exceed capacity, the team has been reshaping volunteer roles to deliver more responsive, place-based support that promotes early intervention, prevention, and self-management. This includes two key pilot Page 229
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Annual Performance Report 2024/25 29 Moray Integration Joint Board projects: the Welcome Home Service, offering short-term support following hospital discharge, and Community Responder Teams, who provide practical help for people with no local support. These responders play a key role in supporting the Home First approach—helping to prevent unnecessary hospital admissions and enabling faster, safer discharges. To better manage referrals and increase reach, the team is developing localised cohorts of Volunteer Responders, moving away from one-to- one matching. This shift enables faster, more responsive and flexible support where it’s needed most. To help manage waiting times for the befriending service, the Moray Caller Volunteer Service was expanded to offer regular phone contact for individuals awaiting a befriender, where appropriate. This interim support ensures that those referred continue to receive meaningful connection while awaiting face-to-face visits. Meanwhile, Befriending Volunteers continue to provide in-person visits, with a strengthened focus on helping individuals move from crisis to confidence, reconnect socially, and participate more fully in their communities. <Photos and permissions can be obtained if needed> “Moving with Dignity” – Proportionate Care Using a person-centred approach, respecting an individual’s abilities and preferences, whilst minimising the need for multiple people to be involved in moving and lifting is being adopted across services in HSCM. Currently there are a number of people with mobility issues, who currently require support from two people to safely move them, and discharges from hospital can be delayed whilst awaiting availability of carers to support them at home. A first cohort of staff have been trained in using specialist equipment, aids and techniques and meet regularly to practice their skills and problem solve for individual circumstances. There is a plan to cascade training out to the wider assessment teams and community hospitals in early 2025/26. Whilst a handful of cases are underway at present it is anticipated that adoption of these principles will assist with discharges from hospital, as part of the discharge process an assessment will be undertaken and individuals will have access to hoists and other necessary equipment, which will also reduce the requirement for two carers, releasing capacity for others. The Project team are focussing on rolling out training to local care teams to meet the need of specific clients and more broadly across all care teams including other partner care agencies. Page 230
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Annual Performance Report 2024/25 30 Moray Integration Joint Board Outcome 3: Positive experiences People who use health and social care services have positive experiences of those services, and have their dignity respected. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 4 Percentage of adults supported at home who agree that their health and social care services seemed to be well co-ordinated 65.7% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 68.7% NI - 6 Percentage of people with positive experience of care at their GP practice 68.6% NI - 17 Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections (to be updated) 81.1% Inspections Many of our services are assessed by the Care Inspectorate to ensure that services provided meet the required standards and peoples outcomes are being met. Appendix F provides details of all the inspections during 2024/25. Learning from complaints and feedback We place huge importance on using the comments and feedback we receive to continuously improve the quality and safety of services. As well as the feedback received directly by services and gathered via surveys conducted as part of monitoring the quality of services and service redesign, another source of information and learning is obtained from complaints received. A total of 138 complaints were received by Health and Social Care Moray in 2024/25. We record all complaints received onto either the DATIX system for health related services or LAGAN for social work and social care related services. It should be noted the figures reported for 2023/24 onwards include Children & Families and Justice Social Work Services, as these services were delegated to the Moray Integration Joint Board on 16 March 2023. This accounts for the increase in complaints recorded on Lagan from 2023/24 onwards. The number of complaints recorded in DATIX include the Out of Hours Primary Care Service (known as GMED) for the whole of Grampian, not just Moray. This is because the Moray Integration Joint Board host this service for the whole Grampian. The GMED service cares for patients who have urgent care needs and cannot wait until their GP Practice is open. GMED operates 18:00 until 08:00 each weekday, all weekends and each public holiday including the festive period. The services has on average 90,000 contacts annually (1/6 of the Grampian population). Page 231
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Annual Performance Report 2024/25 31 Moray Integration Joint Board In 2024/25, 23% (27) complaints were upheld fully, with the remainder being partially or not upheld. Aspects of services leading to complaints were around processes not being clear or not being followed appropriately by staff, communication issues relating to messages or guidance not being sufficiently clear for people and the right people not having been informed at the right time. HSCM governance structures allow ongoing review of complaints and incidents to identify areas for improvement and learning opportunities, to drive positive change. It is positive to note that complaints regarding provision of care are small in number and that very positive feedback is regularly received from people receiving support from services When a complaint is straightforward and does not require investigation, we aim to respond within 5 working days (often called frontline or early resolution complaints) but when an investigation is required, we aim to respond to complaints within the target of 20 working days. Performance during 2024/25 did not always achieve these targets. An average of 25 working days for frontline complaints and 51 working days 0 20 40 60 80 100 120 140 160 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 2024/25 Complaints Received by Year Datix Lagan Combined Year Number recorded in DATIX Number recorded in LAGAN Total complaints 2019/20 62 25 87 2020/21 33 32 65 2021/22 68 24 92 2022/23 78 30 108 2023/24 67 80 147 2024/25 71 67 138 Page 232
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Annual Performance Report 2024/25 32 Moray Integration Joint Board for investigative complaints for social work and social care services were recorded. For health related services there was an average of 3 working days for early resolution complaints and 45 working days for investigative complaints. This is an area for improvement and processes internally have been reviewed to ensure they are as streamlined as possible. Outcome 4: Quality of life Health and social care services are centred on helping to maintain or improve the quality of life of service users. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 6 Percentage of people with positive experience of care at their GP practice 68.6% NI - 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 69.3% NI - 12 Emergency admission rate (per 100,000 population) 8,338 Narrative to be added – when figures received Day opportunities The Day Opportunities Team continues to play a vital role in enhancing quality of life for individuals and their carers. By facilitating access to social activities and meaningful engagement, the team has supported both individuals and unpaid carers in achieving greater wellbeing. These opportunities have also provided much-needed respite for carers, contributing to their ongoing sustainability and resilience. The work of the Day Opportunities SDS Enablers has received regular and positive feedback from families and individuals who have benefited from their support. This feedback reflects a high level of satisfaction and underlines the impact of enabling roles in promoting choice, independence, and tailored outcomes. Such feedback includes “so happy with the supports put in place, feel like my wishes were listened to” highlighting the value individuals place on being fully engaged in the creation of their support. Further feedback includes “in the short time I have known you I can’t believe how much you have done for us which has really benefitted my mental health and wellbeing. B loves the Bosie, the choir and hopefully she will get to the darts club and craft group shortly. All supported by you” and "I'd be lost without the support, it's fine to get out of these 4 walls. It’s nice to get a chance to go to places in Elgin, as I don't have a chance otherwise". Housing developments Our strategic vision for LD housing in Moray is clearly articulated in the strategic plan. We are committed to sustainable accommodation through continued Page 233
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Annual Performance Report 2024/25 33 Moray Integration Joint Board collaboration with partners to develop long-term supported housing for individuals with learning disabilities. Additionally, we aim to provide tenancy support to help individuals and families establish and maintain tenancies in appropriate settings, thereby reducing the risk of inappropriate placements or care breakdowns. We are also working to integrate LD housing needs into the broader housing policy, specifically the Local Housing Strategy (SHIP). Over the previous year, the Partnership, led by the LD service, has been collaborating with Moray Council Housing Dept, Grampian Housing Association, and Springfield. Together, we have been planning and building flats and bungalows specifically for people with Learning Disabilities. Excitingly, the bungalows are due for occupation in July 2025. Outcome 5: Health inequalities Health and social care services contribute to reducing health inequalities. National Indicators used to measure this outcome Indicator Title 2022 2023/24 2024/25 NI - 11 Premature mortality rate per 100,000 persons 330 NI - 12 Emergency admission rate (per 100,000 population) 8338 Narrative for indicator to be provided once update in The Joint Strategic Needs Assessment, which helps us understand the current and future health and wellbeing needs of the local population and identify future priorities, was completed and approved in September 2024. Throughout 2024/25, HSCM continued to prioritise actions to address health inequalities and improve equity of access to care for all population groups, in alignment with the Public Sector Equality Duty and our Strategic Plan. Our Healthpoint service expanded its outreach activity, delivering 2,363 individual contacts across Moray through community-based campaigns and pop-up events. Key campaigns included Nutrition and Hydration Week, which engaged older adults in supported housing and care settings, and Ageing Well presentations delivered to 10 community groups with 237 attendees. These initiatives not only promoted physical wellbeing but also tackled social isolation which is a key determinant of poor health. Smoking cessation services reached increasing numbers of individuals. • 104 smoking quit attempts were recorded in 2024/25, with 24 successful 12- week quits. Page 234
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Annual Performance Report 2024/25 34 Moray Integration Joint Board The Walk Moray programme continued to improve physical activity and reduce isolation. In 2024/25, 19 health walks, including evening and dementia-friendly walks, attracted 122 new walkers and maintained an average of 100 participants per week thanks to the support of 101 volunteer walk leaders. Feedback highlighted improvements in confidence, mobility, and social connectedness. A multiagency assessment tool that identifies neglect and promotes early intervention to improve outcomes for families has been implemented. The Health Visiting and Family Nurse Partnership (FNP) teams are referring families to the council’s income maximisation team to ensure they are accessing the financial support they are entitled to. Through current Scottish Government funding, a local plan is in place to increase the qualified school nursing staffing establishment. The school nursing role focuses on prevention, early intervention, and support for the most vulnerable children over five years old. The School Nurse Pathway in Moray includes specific measures to identify and support young carers. Nurses respond to referrals, contribute to the child's chronology, and carry out wellbeing assessments using the GIRFEC National Practice Model. They coordinate health-related aspects of the child’s plan, alert relevant professionals, and link families to appropriate children’s and adult services. Making Every Opportunity Count (MeOC) is a health promotion approach that encourages colleagues to leverage everyday interactions to support individuals in making positive changes to their physical and mental health. In 2024/25, 185 new starts with the Care at Home Service received MeOC training as part of their induction. We extended our support to unpaid carers through development of Adult Carer Support Plans and embedded young carers into the School Nurse Pathway. Funding mechanisms such as the Health Improvement Fund and Third Sector Winter Support Fund provided nearly £25,000 in 2024/25 to community-led projects focused on healthy eating, financial inclusion, and local wellbeing initiatives. Service users with lived experience played a central role in shaping mental health service improvement. The Making Recovery Real partnership and collaboration with Moray Wellbeing Hub led to peer integration in mental health wards and influenced contract awards. Through participation in the National Frailty Collaborative, HSCM co-developed a Frailty Action Plan to promote early identification and prevention, and support people to age well in their communities. Over the past year, we have made significant strides in the delivery and development of the Learning Disability Annual Health Checks programme across Moray. Following the resounding success of an initial small-scale trial in Aberlour, of one nurse a day a week over six weeks, a proposal was taken forward to fund a community-based model by recruiting a nurse within the Learning Disability Team. This nurse is now Page 235
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Annual Performance Report 2024/25 35 Moray Integration Joint Board rolling out the Health Check to everyone with a diagnosed Learning Disability, ensuring that all are offered a check. Looking forward The 2025-2029 Equality Outcomes have now been set by the Board. 1. Provide accessible services that support people to remain safe in their own homes through person-centred care and digital transformation. 2. Unpaid carers will be given choice, opportunities, and support to care for their loved ones, ensuring their well-being enabling them to balance their caring responsibilities with their personal lives. 3. Support people with learning disabilities and their families in maintaining their health and wellbeing and establishing tenancies in new supported accommodation. 4. Continue to embed LD Annual Health Checks with a focus on early detection of health issues, improved health outcomes, enhanced access to healthcare, personalised health action plans, and reducing health inequalities for individuals aged 16+ with learning disabilities. 5. Support children and young people affected by their own or someone else’s drug or alcohol use. Ensure they can easily access support from their school and other services, and that families are supported to find their own recovery. 6. Support hub and outreach efforts in disadvantaged communities through tackling poverty, income levels, poor housing, and disadvantage to help individuals avoid substance use. Expand efforts to other areas, including school talks, online conversation café, education and drug awareness, and naloxone training. 7. A full redesign of adult day services will enable individuals to access day support that is person-centred and meets their agreed outcomes and aspirations. Where appropriate, day services will be provided within people’s own communities. 8. Prioritise the health and well-being of all staff by providing opportunities for personal well-being, development, and learning in a supportive and inclusive work environment. Page 236
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Annual Performance Report 2024/25 36 Moray Integration Joint Board 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. National Indicators used to measure this outcome Indicator Title 2023/24 2024/25 NI - 8 Percentage of carers who feel supported to continue in their caring role 28.2% NI - 18 Percentage of adults with intensive care needs receiving care at home 60.6% Narrative to be added re indicators The work that is described below is intended to improve these results, however given the increasing older people population in Moray, the level of need is likely to increase significantly, with no additional funding available to increase capacity for support, being able to provide support everywhere it is needed, will be an increasing challenge. Unpaid carers Unpaid carers can be any age, from young people to older people, with Carers UK predicting 3 in 5 of us will be a carer at some point in our lives. There are an estimated 16,200 unpaid carers in Moray. Not all unpaid carers in Moray require formal support from statutory services to assist them to meet the demand of the role, or to receive formal support for the person they care for, however, carers legislative rights are enshrined by the Carers (Scotland) Act 2016. During the 2024–2025 period, there has been steady, positive progress in the development and implementation of Moray’s Unpaid Carers Strategy. The focus has remained on enhancing awareness and recognition of unpaid carers across Moray. A key initiative is the ongoing promotion of the Moray Carer Aware campaign. This campaign aims to improve the identification and recognition of unpaid carers and includes the development of a proposed badge and ID card. Public engagement is planned to gather feedback and ensure the initiative aligns with carers' needs and preferences. A pilot project with Elgin Health Centre has introduced a carer awareness training programme. This bespoke training was aimed at increasing staff knowledge and ability to identify unpaid carers and has led to a rise in the number of carers recorded in the GP system. This programme is part of a broader unpaid carer pathway designed to enhance identification, recording, and referrals to appropriate support services. As of March 2025, there were:- Page 237
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Annual Performance Report 2024/25 37 Moray Integration Joint Board • 1188 adult carers registered with the service, of which there were 58 new adult carers referred to the service between Jan -March 25. 19 carers are receiving intensive support during this period. • 198 young carers registered with the service, of which there were 45 new young carers referred to the service between Jan-March 25. 1 young carer is receiving intensive support during this period. The Unpaid Carers Team also participated in the most recent Moray Integrated Joint Board (MIJB) development session. In collaboration with Quarriers, the commissioned carer support service, and with contributions from two young carers and an adult carer, the session provided valuable insights from lived experience and further supported awareness raising efforts. Access to day opportunities for cared-for individuals continues to be a vital form of support for unpaid carers, offering them essential breaks from their caring role. These opportunities help unpaid carers manage their mental health by giving them time to focus on their own well-being, reducing feelings of stress and isolation. The Day Opportunities team supports both the unpaid carer and the cared-for person in engaging with the community and creating space for meaningful breaks. This dual approach positively impacts the mental health and well-being of both parties. A testimonial from an unpaid carer supported by the Day Opportunities SDS Enablers in January 2025 stated: "Everything’s fine since Day ops got involved. I can go to Elgin or Tesco. I can get a haircut without worrying. The care side of support is good, but when the social side of it started, I felt a bit free. I know my wife is safe when I am not here.” The Day Opportunities team continues to offer weekly support through a person- centred, strengths-based approach aimed at delivering positive outcomes. Quarriers, as the commissioned carer support provider, plays a central role in promoting the mental health and well-being of unpaid carers through a wide range of tailored support services. These include: • Free professional counselling services to help unpaid carers manage stress, anxiety, and emotional strain related to their caring roles. • Sound therapy and art therapy sessions, which offer creative and holistic approaches to relaxation and mental health support. • Time to Live Short Break Awards, which allow unpaid carers to take restorative breaks tailored to their personal needs. • Respite break options, such as vouchers for activities like afternoon tea or play sessions, offering informal and enjoyable respite. • Hand massage workshops, which teach practical relaxation techniques to help carers manage day-to-day stress. • Monthly carer drop-in sessions, which provide a welcoming space for carers to connect, share experiences, and receive advice and support. Together, these services and initiatives represent positive steps toward improving the recognition, support, and well-being of unpaid carers across Moray. Page 238
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Annual Performance Report 2024/25 38 Moray Integration Joint Board Outcome 7: People are safe People who use health and social care services are safe from harm. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 9 Percentage of adults supported at home who agree they felt safe 70% NI - 11 Premature mortality rate per 100,000 persons 330 NI - 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 77 NI - 16 Falls rate per 1,000 population aged 65+ 17.7 Add narrative once data updated Falls Pathway To continue the focus and significance of addressing falls risks, a review of falls pathway was undertaken in collaboration with Scottish Ambulance Service. A test of change is planned to ensure multifactorial falls screening takes place at the earliest opportunity. Falls awareness and prevention groups have been held and run by the Primary Care Occupational Therapy service in sheltered housing and at The Oaks. Adult Support and Protection In 2024 a progress review by the Adult Support and Protection Joint Inspection Team was undertaken in Moray. The progress review was a follow up from our 2022 Joint Inspection where a number of improvement areas were highlighted as part of the report. Moray made significant progress in all the identified areas for improvement within the progress review. Inspectors also told us that in some areas of work, for example in the use of chronologies, we had made some of the best progress that they had seen across the country. The significant level of improvements made are testament to the hard work, dedication and expertise of frontline staff, managers and leaders across Moray Council, Police Scotland, NHS Grampian and our Voluntary Sector Partners who make up the Adult Protection Partnership in Moray and who form the governing body of Moray’s Adult Protection Committee (APC). Page 239
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Annual Performance Report 2024/25 39 Moray Integration Joint Board The Review found that Moray had made significant progress in all seven areas recommended in the 2022 joint inspection. The full report from the Care Inspectorate was published on 29th October 2024 and can be found here. Key findings included: • Consistent application and delivery of key processes. Practitioners were noted to be confident and highly professional and followed the multi- agency adult support and protection procedures meticulously • Investigations were carried out for all adults at risk who required them. Almost all Investigations were rated good or better (85%). • Adults at risk of harm had in place a Chronology. 80% of Chronologies were rated good or better, which is a significant improvement from 39% in 2022. • The Quality of Risk Assessments and Protection Plans had improvement significantly • Case Conferences were found to be carried out effectively. The right people from partner agencies prioritised attendance. Almost all Case Conferences were rated good or better for quality. • Initial Referral Discussions (IRDs) were found to be of an exemplar for the sector • The Adult Protection Committee (APC) and Chief Officers Group (COG) exercised sound and effective multi-agency governance over the delivery of improvements to adult support and protection • The partnership had a cohesive programme of multi-agency audits and quality assurance activities. These included involvement from front line practitioners. The below table evidences the significant progress Moray has made in relation to key processes comparing the findings of the 2022 Joint Inspection to the Progress Review 2024. Process 2022 Inspection 2024 Progress Review Chronology presence 27% 100% Chronology quality – good or better 39% 80% Risk Assessment presence 56% 68% Risk assessment quality – good or better 75% 100% Protection plan presence 68% 90% Protection plan quality – good or better 64% 80% Page 240
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Annual Performance Report 2024/25 40 Moray Integration Joint Board Investigation presence 48% 100% Investigation quality – good or better 52% 85% Case Conference quality – good or better 83% 91% The direction of the APC over the next two years will be based on the below main areas for development alongside activities within our Multi-Agency Improvement Plan. As a partnership, we recognise that we still have a distance to travel. However, we are proud of the journey thus far and the progress made over the last two years and know that adults at risk of harm are safer as a result of the work we undertake. The table below highlights areas of work we will focus on in the coming two years. Area for Development Where We Want To Be How Will We Get There? Involving the Adult in a Trauma Informed Way Have in place a trauma informed workforce for ASP in Moray Grampian wide programme of work for Trauma Informed ASP activity currently in progress. Chronologies All practitioners carry out good quality chronologies and discuss information within meetings alongside the Adult Suite of multi-agency training and guidance devised and carried out. Strategic Resourcing ASP in Moray to be fully resourced On going discussion at COG and APC to highlight risk. Quality Assurance Activity Have in place a clear suite of multi-agency and single agency audit activities that support in monitoring evaluating and improving ASP in Moray Audit and Quality Assurance yearly timetable devised and followed – with full participation of all partners Monitoring of commissioned services A particular strength of the Adult Social Care Commissioning team continues to be the proactive and reactive monitoring of contracts. The team have developed the monitoring process in the last financial year by including a second formal contract meeting for each provider as well as a monthly informal meetings. This ensures that relationships with providers remain strong, and they are well supported. The Page 241
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Annual Performance Report 2024/25 41 Moray Integration Joint Board commissioning team also lead a Learning Disability Provider Forum that meets 4 times a year with specific themes and guest speakers. In 2024/25 the themes were recruitment, care inspections, advocacy and staffing structures, including the Support Worker role. In 2024/25, the Commissioning Team were required to respond effectively to undertake enhanced monitoring for 5 external services and one internal service. These were required as a result of concerns raised by social work teams, from an annual site visit or a poor Inspection from the Care Inspectorate. Each of these enhanced monitoring programmes ensured a return to the required standards and resulted in delivery of services to meet outcomes for people, improved Care inspections or improved processes for the provider. Urgent health care out of hours 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. 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. In 2024, GMED dealt with 107,608 cases which was a 4% decrease in demand compared to the previous year (112,148). There were: • 58,634 advice calls, • 34,656 centre consultations, • 11,128 home visits and • 3,190 mental health advice calls However, if we compare the activity levels from 2020 (pre-Covid) there has been in increase in activity of 35.6% or 79,358 cases which is significant. GMED Activity Heat Map The heat map shows the demand in all locations across NHS Grampian in 2024. Elgin, Forres and Buckie are the busiest locations in Moray. . In 2024 the service had 24,329 contacts in Moray which represents 22.6% of all GMED activity, compared to 2020 (pre-COVID), when there were 19,488 contacts (24.6%) of all GMED activity. This demonstrates that even though the number of overall contacts has increased in Moray, as a percentage of GMED activity it has slightly reduced. Page 242
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Annual Performance Report 2024/25 42 Moray Integration Joint Board GMED is a successful gatekeeper for secondary care services. In 2024, we have admitted 6049 patients to the hospital, this shows a decrease of 19.5% compared to the previous year (7510) and by 31.4% pre-Covid (8822). 8822 7510 6049 0 2000 4000 6000 8000 10000 Hospital Admissions 2024 2023 2019 Page 243
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Annual Performance Report 2024/25 43 Moray Integration Joint Board 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. National Indicators used to measure this outcome There are no National Indicators to measure our progress towards this outcome. Our performance is in part measured using staff surveys. Feedback from Inspections The feedback from Care Inspectorate highlights how engaged staff are in the support and care they provide, as evidenced in section 8 of this report, examples:- ASP inspection - “Robust measures were in place to identify concerns early and promptly implement remedial action. Operational managers worked diligently and effectively to bring about necessary improvements to adult support and protection”. START – “People enjoyed support which was dignified and respectful. Staff felt supported by their supervisors and colleagues”. Moray Supported Lodgings project – “Young people benefit from leading and directing their own support within a multi-agency approach to care planning” Community Support Services – “People were supported by staff who were kind and caring” Staff survey The iMatter is an annual staff survey sent to all employees across health and social care in Grampian. During 2024/25 there was 56% response rate showing an employee engagement index of 77, and overall score of 7.1 which were similar to the previous year. Responses with the lowest scores were: “I feel the board members who are responsibility for my organisation are sufficiently visible”, “I have confidence and trust in Board members who are responsible for my organisation”, “I have sufficient support to do my job well” and “I am confident performance is managed well within my organisation”. There has been more information shared via newsletters and briefings during 2024/25 so it is hoped that this will have an impact on future scores. Feedback for the current year survey is expected in June 2025 which will inform priorities for our Workforce Plan. Workforce Forum Page 244
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Annual Performance Report 2024/25 44 Moray Integration Joint Board The Workforce Forum provides an opportunity for open dialogue between workforce, partnership and health and safety representatives, and enables colleagues to discuss and raise issues and best practice. Attendance at these meetings has increased significantly which is positive as more teams are now represented and engaged. During 2024/25 several discussions have been around difficult to fill vacancies and how these are managed. Personal & Social Care was the only job family to fall below the 90% stability target, with a stability rate of 83.3%. Alongside Admin services this is an area where we would anticipate there to be greater turnover as people develop experience and skills and then seek higher grade jobs. More stringent vacancy controls have been implemented across NSHG and this has led to fewer new starts during January 2024 to January 2025 which therefore increases figures of stability as there are less workforce with less than one year service. Workforce Stability across NHS employed teams Between February 2024 and January 2025, Moray H&SCP experienced a turnover rate of 9.18%, higher than the NHSG turnover rate of 7.46% for the same period. A turnover rate of around 10% is typically expected, suggesting that lower figures indicate a stable workforce. Absence actions and Wellbeing Initiatives Absence is monitored by all teams across the partnership and is governed by the application of the attendance policies of NHS Grampian and Moray Council. Across Health and Social Care Moray, sickness absence occurs across all staff groups, however there are elevated rates in nursing and social work, and provider services in particular. This is in part due to workload, exposure to infection and travel impact on an ageing work population. The most common long term sickness are related to Mental Health or Muscular-skeletal injuries and we have a number of wellbeing initiatives to help combat and recognise stress and general physical wellbeing. Page 245
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Annual Performance Report 2024/25 45 Moray Integration Joint Board • Wellbeing features as a regular standing item at our Workforce and Health and Safety groups where two way flow of information is encouraged with peer to peer support and appropriate escalation where necessary. Moray Council has mental health first aiders which have proved a very useful resource. • Peer to peer support has been established and some teams have a wellbeing weekly get- together, known as ‘Wellbeing Friday’. Other teams such as our AHP services operate a 30 minute ‘wellbeing window’ weekly where they will actively take a break and do something physical such as walking or stretching or yoga. • Collaboration with Moray Council and NESTRAN Health & Transport Action Plan for Grampian in promoting ‘active travel’ campaigns. • Promotion of the ‘At your best with Rest’ campaign to encourage staff to take their allocated breaks to increase efficiency and reduce fatigue and burn out. Some services have dedicated break areas and set times which allow the whole team to take a break together. Other teams have established a virtual tea break which has been very successful. We are very well supported by our Wellbeing colleagues in Grampian and the ‘We Care’ resources. • Promotion of flexible and hybrid working where appropriate. • Through ‘We Care’ we have a Covid Reflection listening service available as well as Recovery in Mental Health, Relaxation workshops and stress awareness training available to all. • We have an active Menopausal awareness programme, which offers training and tea and talk sessions. Page 246
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Annual Performance Report 2024/25 46 Moray Integration Joint Board Outcome 9: Use of resources Resources are used effectively and efficiently in the provision of health and social care. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 4 Percentage of adults supported at home who agree that their health and social care services seemed to be well co- ordinated 65.7% NI - 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 77 NI - 15 Proportion of last 6 months of life spent at home or in a community setting 91.1% NI - 16 Falls rate per 1,000 population aged 65+ 17.7 NI - 19 Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) 980 Commentary to be provided once data updated. Indicators 14-19 to be updated in July. Vaccination uptake The World Health Organisation (WHO) describes vaccines as one of the two public health interventions that have the greatest impact on the world’s health, the other being clean water. It is also considered as one of the most impactful and cost- effective public health interventions available to communities and populations across the world. Vaccination can prevent or reduce the severity of disease, minimise disability and save lives, often in many of the most disadvantaged people in society. It offers excellent value for money by reducing current and future public expenditure on health and social care provision. Uptake of seasonal flu and covid-19 vaccinations in Winter 2024/25 was similar in Grampian to elsewhere in Scotland and highest in the oldest age groups, and the Spring 2025 programme continues to perform well. Uptake shows a socioeconomic gradient with highest uptake amongst least deprived. COVID 19 Cohort % uptake 2023 % uptake 2024 Age 65 to 74 77.0% 65% Aged 75+ 83.9% 75% All social care workers 14.5% 6% At risk age 5 to 11 7.3% 7% At risk age 6 months to 4 years 13.6% 13% At risk age 12 to 64 35.8% 25.2% Page 247
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Annual Performance Report 2024/25 47 Moray Integration Joint Board Frontline health care workers 30.2% 19% Older people care home residents 87% 83% Weakened immune system 59% 38% TOTAL 60% 50% Influenza Cohort % uptake 2023 % uptake 2024 Age 50 to 64 43.1% Not offered Age 65 to 74 77.1% 70% Aged 75+ 84% 80% All health care workers 24.7% 25% All social care workers 13.1% 8% At risk age 18 to 64 44.2% 34% Older people care home residents 91% 85% Weakened immune system 63.9% 46% TOTAL 58.3% 55.6% The uptake of vaccinations amongst frontline health and social care staff continues to be lower than the partnership would like it to be, despite significant work by the Moray Immunisation Team to increase uptake. Several extra clinic dates were put on to increase numbers, with very little interest. There has been a marked decrease among most of the other cohorts too. It has been found that the lower uptake rates this year, compared to previous years, seem to be due to vaccine fatigue within the population. Improved access to medications for patients Moray Pharmacotherapy team undertook a cost efficiency project during 2024/25 that achieved £660k savings through working collaboratively with GP practices. A Specialist Pharmacy Technician (SPT) was appointed ‘Savings Champions’ in each practice cluster to motivate and guide and met with all GP practices teams/prescribers/clinicians to discuss project and effective methods re cost efficiency. A variety of methods were implemented including use of system tools to ensure most efficient prescribing, generic medications prescribed rather than branded, ensuring regular medication reviews of repeat prescriptions to ensure still relevant and regular care home polypharmacy reviews to look at stock levels held in care homes. Significant savings occurred in relation to inhaler switches, skin dermatology prescribing reviews, Diabetes blood monitoring testing aspects, dosage forms and changes in pack size and dosage reviews. Many of the changes benefited individuals through a reduction in the amount of prescriptions or the frequency of dose. Page 248
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Annual Performance Report 2024/25 48 Moray Integration Joint Board Due to the success of the project a further project is being taken forward in 2025 with GP practices but another project is underway with local Care Homes and it is anticipated savings will be in the region of £450k. Commissioning of services In the last year the commissioning team have been focusing on various workstreams that are linked with exploring and widening the provider market in Moray. Care at Home are progressing well with a test of change to give advance payment that provides greater stability for the provider enabling recruitment to meet their commitments. The result is a strengthening of the relationship and increased confidence and assurance that the hours can be provided, by staff working to the required standards. Quality of service provision has increased, with the most recent Care Inspectorate inspection reporting good and very good grades across all areas. This approach will be further progressed in 2025/2026. In June 24, the Learning Disability Service secured 13 flats and 4 bungalows in partnership with Springfield and Grampian Housing Association. The service provider was procured through a competitive tendering process with family members scoring the presentation element. This is the first time that family members have had autonomy like this in a tendering process and the feedback from them and from the presenting providers was that it was an experience that was valuable. The families also influenced the appointment of the successful provider, Community Integrated Care and this has ensured that all parties have a good understanding of expectations. The Service is due to open in August 25. The Commissioning Team worked closely with external providers to progress the Financial Delivery Plan project and efficiencies within contracts. This was undertaken by a joint review of service provision, management structures and capacity. By working in partnership with each provider and alongside Social Work colleagues, the saving achieved through contracts was £184,269 for 24/25. This will continue throughout 25/26 where significant savings are predicted to be realised. The Commissioning Team have awarded 21 contracts and undertaken nine letters of extension. The team are currently working on 19 contracts which are at various stages of the commissioning cycle. Within this, the voice of the citizens of Moray and learning from the Western Village tender will be embedded into practice so that the Health and Social Care Moray Adult Commissioning Team continue to promote and guide colleagues through Ethical Commissioning practices. Page 249
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Annual Performance Report 2024/25 49 Moray Integration Joint Board 9. Working with communities across our localities For service planning and delivery purposes, the four localities in Moray are: Forres and Lossiemouth; Elgin; Buckie, Cullen and Fochabers; Keith and Speyside Locality managers are leading on the development and delivery of locality plans to respond to local needs and reflect the priorities of communities. First drafts were published in 2022 and updated plans for 2023-2026 were approved by the MIJB in March 2023. Elgin Locality Multidisciplinary Team developments This is a continuing piece of developmental work for the Elgin locality. Following feedback form “How Good is our MDT” survey there is further work to ensure all professionals are represented at local MDT’s. Recently the Local Authority Occupational Therapy service has been attending the MDT’s with an understanding of how they can best support the MDT’s moving forward. Social Prescribing The Elgin locality if starting to focus on social prescribing and working firstly with the Maryhill Practice to trail this. It will then be extended to Linkwood practice once we have a model and services that suit the Elgin population to support social prescribing. The aim of the model is to support health and social acre professional to connect individuals to non-clinical support and community activities. The aim to support their health and wellbeing. The Health Improvement Team are supporting the development of this alongside the Locality manager. The next phase of the development will be to meet with the Practice and ascertain which are the top key areas of focus for the practice population that would benefit for the social prescribing model. Community Appointment Day (CAD)- Chronic Obstructive Pulmonary Disease (COPD) 16th April 2025 Preparations were carried out for this event following on the success of the CAD held for MSK in September 2024 with the purpose of inviting people with COPD registered with the Maryhill and Linkwood GP practices. Keith and Speyside Locality The Fleming Health Hub now has over 30 services that are able to provided appointments, classes and drop ins and that can be used by anyone across Moray who finds it easier and closer to home to access, in the Keith and Speyside Locality we have been forging working relations with other HSCM teams operating in and around the Locality and with third sector and local groups to look at what we can do in collaboration to support the health and wellbeing needs of our communities. Page 250
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Annual Performance Report 2024/25 50 Moray Integration Joint Board This has included intergenerational work where services on offer ranging from birth through to our older population . We have been around our secondary schools hosting 'Lets talk Health, Wellbeing and your Community' events and have had various educational events for staff and drop ins for the local population including Realistic Medicine and MEOC training and Dental Care guidance and demonstrations. We have a room specifically set up at the Fleming Health Hub for Moving With Dignity (proportionate care) training for our own staff and where appropriate other organisations and Care Homes, which will reduce the number of care staff required for visits to certain people. We are now also able to host annual health checks for people with Learning Difficulties and our OT teams have been able to introduce several new sessions around falls prevention. We have also been utilising space at our hospital sites in Dufftown and Keith to introduce specialist third sector services as appropriate, to encourage and make easier, access to these services. <Photos – Fleming Hospital Health Hub signage> We are also in discussions with our GP Practices and other professionals around what services they would like to see introduced to meet local identified need and we will be taking this forward in the coming year. Our online Professionals directory continues to support MDT working across the Locality and we are utilising this to share updates and information across our teams. This does not replace the many other MDT meetings that take place regularly across our GP practices and Community Hospitals but does support staff in ensuring the right people are involved and around any specific discussions at the right time and as required in support of a person, which should be at the heart of all MDT working. With Keith and Speyside being in places very rural, we have been working hard to ensure that we can raise awareness of services and support available that people can access in support of their own and their families health and wellbeing. Information areas in GP practices have been updated, HSCM teams have access to an online Health and Wellbeing directory and some teams have identified a Wellbeing Champion who is now taking the lead on ensuring their teams are able to look after their own wellbeing, this is supported by our Locality Health Improvement Coordinator. Poverty and the rising cost of living is something that impact us all and to support this we have also ensured that all GP practices are able to order and hand out free period products and condoms to patients and staff and that this is promoted. All of the above will support us encouraging and equipping people to start taking responsibility for their health and wellbeing and awareness of alternatives to medication where appropriate or in addition to medication as part of a more holistic approach. This aligns with Social Prescribing and something we will be championing more in the coming years. Page 251
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Annual Performance Report 2024/25 51 Moray Integration Joint Board Forres and Lossiemouth Locality The Forres and Lossiemouth Locality Steering Group continued to meet on a bi- monthly basis during 2024/25 to review performance data and progress in relation to their Locality Action Plan. The group continues to have public, health and social care and third sector representation. The group also has active involvement from Children Service Locality Planning and the Moray Council Community Support Team to avoid duplication and ensure alignment of various plans. Of particular note over the past year was the ongoing engagement activity that took place; this included pop up engagement clinics in health and care centres, engagement activity in local schools, and events in community settings. Events were facilitated by Health and Social Care, Children's Services, Moray Council Community Support Unit and GP staff. Work has continued to take place to strengthen MDT working and development of virtual wards to ensure the most vulnerable receive support when and where they require. Forres and Lossiemouth have supported the work of the Digital Health Design and Innovation Centre (DHI) and in particular the development of Living Lab 3 - the Personal Data Store and Community Connections Moray platform. In terms of overarching performance against the 17 indicators within the Moray Locality Dashboard, Forres and Lossiemouth Locality have performed better than the Moray Average in all but one of the indicators, and better than the National Average in all but two. Of particular note is the low rates of delayed discharges, low rates of emergency hospital admissions, and low rates of mental health unscheduled bed days. Page 252
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Annual Performance Report 2024/25 52 Moray Integration Joint Board 10. Financial performance and best value 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 2024 the Board received a financial report which forecast an expected overspend to the end of the financial year of £5.58m. This forecast remained consistent throughout the remainder of the year and in January 2025, MIJB were forecasting an overspend to the end of the year of £5.51m, the MIJB actually out turned at £4.26m overspent. Both partners in line with the Integration Scheme, put in additional funding to cover this overspend, so with the use of ear marked reserves totalling £0.535m, and a transfer into ear marked reserves for the Asylum seekers grant of £0.701m, this leaves a balance of £2.152m in ear marked reserves to be carried forward into 2025/26. In May 2024, the MIJB agreed a savings plan of £8.297m, 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 £2.302m and £2,331m 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 253
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Annual Performance Report 2024/25 53 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) Service Area Budget £000’s Actual £000’s Variance (Over)/ under spend £000’s Note Community Hospitals & Services 7,700 8,328 (628) Community Nursing104,360 5,979 6,166 (187) Learning Disabilities 17,702 19,975 (2,273) 1 Mental Health 12,140 12,055 85 Addictions 1,907 1,763 144 Adult Protection & Health Improvement 249 273 (24) Care Services Provided In-House 24,743 22,754 1,989 2 Older People Services & Physical & Sensory Disability 24,775 27,034 (2,259) 3 Intermediate Care & OT 1,771 1,972 (201) Care Services Provided by External Contractors 1,835 1,816 19 Other Community Services 10,383 10,280 103 Administration & Management 3,333 3,152 181 Other Operational Services 1,377 1,535 (158) Primary Care Prescribing 18,748 21,937 (3,189) 4 Primary Care Services 21,427 21,331 96 Hosted Services 5,713 5,665 48 Out of Area Placements 720 1,971 (1,251) 5 Improvement Grants 1,207 1,021 186 Children’s & Justice Services 19,523 19,625 (102) Total Core Services 181,235 188,656 (7,421) Strategic Funds & Other Resources 14,891 5,318 9,573 TOTALS (before set aside) 196,126 193,974 2,152 Set Aside 15,639 15,639 - TOTAL 211,765 209,613 2,152 The table above summarises the financial performance of the MIJB by comparing budget against actual performance for the year. Page 254
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Annual Performance Report 2024/25 54 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) Significant variances against the budget were notably: Note 1 Learning Disabilities – The Learning Disability (LD) service is overspent by £2,272,694 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 £2,806,801 and client transport of £13,781. This is offset by more income received than expected of £524,800 (income due from another authority and Change Fund funds from NHS) and other small underspends of £18,619 which primarily relate to property costs. There was a minor underspend of £4,469 in other Learning Disabilities clinical services. 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. Note 2 Care Services Provided In-House – This budget is underspent by £1,988,757 at the end of the year. This relates to underspend in staffing across all the services in this budget totalling £2,291,755 and other minor underspends of £8,275 which is being reduced by overspends relating to transport costs £97,970; insurance costs £29,047, utility costs £62,430 and less income than expected £121,826. Unfilled vacancies have been the main reason for the underspend throughout the year and the issue of recruitment has been an ongoing problem Note 3 Older People Services and Physical & Sensory Disability - This budget is overspent by £2,259,056 at the end of the year. This primarily relates to overspends for home care in the area teams £539,818, permanent care £1,766,157 due to the increase in the number of clients receiving nursing care rather than residential care and respite care £105,776 this is being reduced by an underspend for day care £152,695. 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 The ageing population requiring more complex care and local demographics also contributes to this overspend as well as the correlation between the recruitment and retention of the internal home care service provision. Note 4 Primary Care Prescribing - The primary care prescribing budget is reporting an over spend of £3,189,386 for the twelve months to 31 March 2025. The overall average price has remained relatively consistent and includes cost reduction savings identified by Pharmacy implemented countered by the impact of short supply causing an increase in costs. This is spread across a range of products and is ongoing. This overall volume increase at 3.5% is less than previously anticipated. Note 5 Out of Area Placements – This budget is overspent by £1,250,899 at the year end. This is due to the continuing number of high cost individual specialised placements. Page 255
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Annual Performance Report 2024/25 55 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) MIJB’s financial performance is presented in the comprehensive income and expenditure statement (CIES), which can be seen on page 42. At 31 March 2025 there were ear marked reserves of £2.152m available to the MIJB, compared to £1.986m at 31 March 2024. These remaining reserves of £2.152m are for various purposes as described below: Earmarked Reserves Amount £000’s GP Premises 39 National Drugs MAT 250 OOH Winter Pressure funding 172 Moray Cervical screening 35 Moray hospital at home 5 Moray Psychological 315 MHO Funding 138 Adult protection funding for CA 18 Adult Disability payment 45 National Trauma Training services 62 Moray School Nurse 32 Moray Winter Fund HCSW & MDT 182 LD Annual Health Checks 69 Community Planning partnership 2 Moray District Nurses 56 OOH Dev Fellowship scheme 30 Asylum Seekers grant 701 Total Earmarked 2,152 General Reserves 0 TOTAL Earmarked & General 2,152 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. Page 256
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Annual Performance Report 2024/25 56 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) National Drugs Medication Assisted Treatment (MAT) for embedding and implementation of the standards will he be overseen by the MAT implementation support team (MIST). National Drugs Mission Moray – balance of funding for range of activities including: drug deaths, taskforce funding, priorities of national mission, residential rehabilitation, whole family approach, outreach, bear fatal overdose pathways and lived and living experience. 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. Adult Disability payment – funding to assist with the implementation of the adult disability payments. 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. Page 257
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Annual Performance Report 2024/25 57 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) Out of Hours (OOH) Development Fellowship Scheme – scheme to keep GP’s within clinical practice, increase GP’s confidence and competence in OOHs work Asylum Seekers Grant – funding received from the Home Office to support young people who have travelled to the UK alone. All reserves are expected to be utilised for their intended purpose during 2025/26. Set Aside – Excluded from the financial performance table above on page 15 but included within the Comprehensive Income & Expenditure Account is £15.639m 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. 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 figures for 2024/25 have been derived by uplifting 2019/20 figures by baseline funding uplift in 2020/21 (3.00%), 2021/22 (3.36%) ,2022/23 (6.70%), and 2023/24 (5.35%) and 2024/25 (6.64%): 2024/25 2023/24 2022/23 2021/22 2020/21 Budget 15.639m 14.665m 13.92m 13.04m 12.62m Page 258
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Annual Performance Report 2024/25 58 Moray Integration Joint Board 11. Looking forward – priorities for 2024/25 Health and Social Care Moray is in a period of change. With the appointment of Judith Proctor as Chief Officer the senior management team have led a review of the Strategic Delivery plan and set clear objectives with a focus on delivering improvements to services for people, whilst ensuring efficient and effective use of resources, ever mindful of the severe financial constraints that are affecting all Health and Social Care Partnerships, Local Authorities and NHS services. Key priorities will be:- Realignment of Organisational Structures - A review of the HSCM organisational structure will take place to ensure that the right resources are in place and the governance structure to support implementation of plans is clear to ensure we drive progress to achieve our priorities. This will also include strengthening the integration and oversight of Children, Families and Justice services within our system to ensure that all partners fulfil their statutory obligations, whilst a review of current reporting arrangements will reduce any duplication in reporting whilst strengthening oversight of performance and delivery. Strengthening Performance Oversight - With the approval of the revised Strategic Delivery Plan in May 2025 work is underway to review the performance framework and improve line of sight from the plan through to programmes and services who will deliver it so that we can clearly evidence the intended and actual impacts on outcomes for people. Discharge without Delay (DWD) – there have been clear objectives set out at a National level for this programme of work and resources have been allocated to take this forward for Moray in collaboration with NHS Grampian and Scottish Government. Digital solutions – Evaluation and implementation of digital tools, new systems and solutions will help in the provision of efficient and effective services. Research being led by DHI and the living labs will inform options for expanding the use of Technology enabled care information and tools available for people to be able to live at home and feel safe and supported and the Smart Housing that will help people to live independently whilst ensuring they are save. The developments of the Community Connections tool, and the Personal Data Store will be integrated into business as usual pathways so people have ownership of their information but can share it with those directly involved in their support to prevent having to repeat it. Implementation of a new Social Work and Social Care Information Management system will enable services to utilise a modern system that is fit for the future and which will be able to link to other emerging technologies, ensuring we can provide responsive and well co-ordinated supports to people. Expanding the principles of Self-Directed Support into all aspects of service provision and development of flexible frameworks to provide people with more choice and control over who provides support for them is underway. Page 259
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Annual Performance Report 2024/25 59 Moray Integration Joint Board The redesign of the Care at Home service will be implemented in the coming year with the aim of expanding capacity to meet the growing need, whilst continuing to further develop pathways to increase provision of care at home. The Grampian wide pathway redesign of Mental Health Services is in progress and HSCM will be heavily involved to establish a sustainable service for Moray that ensures access to services needed. A new website is under construction that is aimed to aid Communication and Engagement to provide more information about services and how to access them and a new system will be implemented that will facilitate engagement and two way communication with various groups. Through the implementation of a communication strategy, we will provide regular updates for staff on the financial delivery plan and strategic delivery plan progress, and key aspects of the organisation. We aim to deliver more direct, honest and open messaging with people to manage expectations and to ask for help and support from individuals and communities on identifying ways we can support them better. Page 260
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Annual Performance Report 2024/25 60 Moray Integration Joint Board 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 261
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Annual Performance Report 2024/25 61 Moray Integration Joint Board Appendix B: Core suite of national indicators Source information from Public Health Scotland Survey fieldwork was carried out between October and December in the financial year presented and respondents were asked about their experiences over the previous 12 months. Please note results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years due to changes in survey wording. Also results for 2019/20 and 2021/22 for indicators 2, 3, 4, 5, 7 and 9 are comparable to each other, but not directly comparable to figures in previous years due to changes in survey wording and methodology. Calendar year 2023 is used here as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance issued by Public Health Scotland which was communicated to all Health and Social Care Partnerships. Using more complete calendar year data for 2023 should improve the consistency of reporting between Health and Social Care Partnerships. update Page 262
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Annual Performance Report 2024/25 62 Moray Integration Joint Board National Indicator 1 2023/24 Percentage of adults able to look after their health very well or quite well 92.2% Note – Health and Care Experience Survey is a sample survey of people aged 17 and over registered with a GP practice in Scotland. A change in survey wording between 2019/20 to 2023/24 has resulted in a small sampling error so care needs to be taken when comparing results. .Indicator Title 2023/24 NI - 2 Percentage of adults supported at home who agree that they are supported to live as independently as possible 71.9% Moray’s results for 2023/24, whilst very slightly reduced from the previous year, remain above the Scottish rate. Whilst there has been a reduction in this indicator over the period, the change in wording of the survey means we cannot compare previous years. It is however in line with the Scottish rate. This may reflect how people in the community feel, where there are continued levels of unmet need, following assessment. This remains a key focus to address and it is hoped that the work being undertaken in areas such as social prescribing, community health and wellbeing teams support and investigations into utilising developing digital technology to support people in their own homes may help release some capacity so that available care can be directed to those who these other solutions will not be suitable for. Page 263
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Annual Performance Report 2024/25 63 Moray Integration Joint Board Indicator Title 2023/24 NI - 3 Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided 59.5% Indicator Title 2023/24 NI - 4 Percentage of adults supported at home who agree that their health and social care services seemed to be well co-ordinated 65.7% This is another indicator in which HSCM are in line with national trends. It is disappointing that despite efforts to ensure that people are involved in how their support is provided, that people do not feel that they are. In relation to the care provided at home by our internal service the results from the recent care inspectorate report were excellent and the feedback from other inspections would indicate that the majority of people in receipt of services are happy and feel supported. Progress in this indicator is above the national rate. A direct comparison is not possible with previous years due to the change in wording of the survey. Page 264
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Annual Performance Report 2024/25 64 Moray Integration Joint Board Indicator Title 2023/24 NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 68.7% Indicator Title 2023/24 NI - 6 Percentage of people with positive experience of care at their GP practice 68.6% This indicator is now nearer the Scottish rate than it was previously. With the positive feedback from survey’s undertaken locally for various inspections it was anticipated that there would be an improvement in this indicator. It may be that the positive results will be shown in next year, but in any case, feedback is actively sought and acted on to enable improvements to be made. There has been a significant increase in the percentage of people with a positive experience of care at their GP practice and Moray is now in line with the Scottish rate. Whilst the figures are below where we would want to be it reflects the ongoing challenges of providing care and support in the community, for an increasingly older population who have more complex health issues. Page 265
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Annual Performance Report 2024/25 65 Moray Integration Joint Board Indicator Title 2023/24 NI - 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 69.3% Indicator Title 2023/24 NI - 8 Percentage of carers who feel supported to continue in their caring role 28.2% Due to the change in wording of the survey we cannot draw a direct comparison to previous years, however it is encouraging that we are in line with the Scottish rate and whilst the percentage has dropped, it was not as big a drop as the Scottish rate. Given the impact of the financial constraints on all health and care services, NHS and Local Authorities budgets it is likely that this indicator will not improve in the short term, and may in fact decrease, because the equivalent services and support are not available to the same amount of people as before. Efforts are being directed to encourage early intervention and prevention to assist people to take more ownership of their health and wellbeing. This result is below where HSCM would want it to be. Unpaid carers are an essential element of the provision of support and care in the community and it is a strategic priority for HSCM to support them. A new carers strategy was implemented during 2023/24 and work will continue to address the areas identified to try to have a positive impact on how carers feel. Page 266
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Annual Performance Report 2024/25 66 Moray Integration Joint Board Indicator Title 2023/24 NI - 9 Percentage of adults supported at home who agree they felt safe 70.0% Indicator Title 2023 NI - 11 Premature mortality rate per 100,000 persons Again, this is an indicator that we can’t compare with previous years however there is less of a gap between the Scottish rate and Moray’s position, which is positive. There is some way to go to get to the pre- Covid position but it is hoped that there will be a positive impact of the work that is being undertaken to conduct reviews to ensure people receive the support they need whilst drawing on the connections and relationships that people already have in their communities which is hoped will assist in establishing an increase in their feeling of safety. Page 267
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Annual Performance Report 2024/25 67 Moray Integration Joint Board Indicator Title 2024/25 NI - 12 Emergency admission rate (per 100,000 population) Indicator Title 2024/25 NI - 13 Emergency bed day rate (per 100,000 population) Page 268
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Annual Performance Report 2024/25 68 Moray Integration Joint Board Indicator Title 2024/25 NI - 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) Indicator Title 2024/25 NI - 15 Proportion of last 6 months of life spent at home or in a community setting Page 269
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Annual Performance Report 2024/25 69 Moray Integration Joint Board Indicator Title 2024/25 NI - 16 Falls rate per 1,000 population aged 65+ Indicator Title 2024/25 NI - 17 Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections Page 270
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Annual Performance Report 2024/25 70 Moray Integration Joint Board Indicator Title 2024/25 NI - 18 Percentage of adults with intensive care needs receiving care at home Indicator Title 2024/25 NI - 19 Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) Page 271
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Annual Performance Report 2024/25 71 Moray Integration Joint Board Appendix C: Local indicators Indicator 2020/21 (Q4) 2021/22 (Q4) 2022/23 (Q4) 2023/24 (Q4) 2024/25 (Q4) Target A&E attendance rate per 1000 population all ages 17.8 20.2 20.6 22.6 22.0 21.9 Throughout 2024/25 the figure has hovered around the target of 21.9 and whilst there was a slight increase in numbers presenting the last two quarters of the year it was still below the high in March 2024. Emergency Departments are under considerable pressure and whilst considerable efforts have been made to inform people about alternative sources of emergency care such as pharmacies, dentists, opticians and NHS24 further detailed work will be undertaken to try to understanding why and how people access emergency care, to help us develop intelligence about avoidable attendances, and how we can intercept them through alternative early prevention and intervention work. Number of Delayed Discharges (including code 9) at census point 17 46 26 43 40 26 Delayed discharges continue to fluctuate despite significant efforts from across many teams and services to reduce the delays and the potential negative impacts for people. There has been sustained focus of daily multi-disciplinary meetings with colleagues in Dr Grays and ARI to support collaborative decision making and improve system flow. All delayed discharges over 90 days are subject to enhanced scrutiny and actions to facilitate discharge prioritised. Challenges with provision of care at home in rural locations and increased complexity of needs of frail, elderly patients requiring discharges whilst maintaining choice and control for individuals need to be addressed. It is hoped that initiatives such as “Moving with Dignity”(proportionate care) will help discharges through the use of equipment and tools to assist those with mobility issues and reduce the need for double up care (two carers). The nationally led programme Discharge Without Delay is being taken forward across Grampian in collaboration with NSH Grampian and Health Intelligence Scotland to progress system wide actions to reduce delays and the clear performance targets identified will provide oversight of the progress being made over the next year. Number of bed days occupied by delayed discharges (incl. code 9) at census point 496 1294 751 1501 1149 850 The number of bed days has decreased from the high in March 2024 but is still sitting well above target and showing an increasing trend. The initiatives and focus on delayed discharges should reduce this number over the next year. Rate of emergency occupied bed days 1773 2140 2749 2509 2412 2681 Page 272
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Annual Performance Report 2024/25 72 Moray Integration Joint Board for over 65s per 1000 population The figures are showing a reducing trend and have been below target throughout the year. Emergency admission rate per 1000 population for over 65’s 174.8 183.0 185.8 179.7 177.8 187 This year the rates have been significantly lower than the previous year, with the exception of the period October to December, where there was peak in previous year’s which indicates it may be a seasonal variation. Number of people over 65 years admitted as an emergency in the previous 12 months per 1000 population 119.3 125.2 129.2 125.8 125.7 131 This rate is well below the target albeit there is slight increasing trend. % Emergency readmissions to hospital within 7 days of discharge 5.0% 3.4% 3.6% 4.4% 3.9% 3.7% This indicator has fluctuated during the year with a high in September, and although it has just gone over target it is below the March 2023/24 figure and overall is stable % Emergency readmissions to hospital within 28 days of discharge 9.8% 8.0% 7.5% 8.3% 7.4% 7.9% This rate has been showing a slight decreasing trend and with the exception of a high in September 2024 has been below target. The increase in September figures has been reflected over several years so may be a seasonal variation. % of patients commencing Psychological Therapy Treatment within 18 weeks of referral 100% 33% 73% 57% 65% 90% This indicator has reflected the challenge the service is experiencing with significantly increased demand and despite initiatives to undertake group work (where appropriate) to increase throughput and maximise capacity it has not been possible to generate the capacity required to meet the standard and achieve the target. NHS Sickness Absence (%of hours lost) 3.1% 4.7% 5.9% 5.7% 4.9% 4% Council Sickness Absence (% of calendar days lost) - 8.9% 9.7% 9.7% 8.2% 4% Page 273
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Annual Performance Report 2024/25 73 Moray Integration Joint Board Application of the appropriate absence monitoring procedures are monitored closely and support provided to individuals as required to ensure that absences are minimised. There are various wellbeing initiatives and supports available to staff and managers, such as vaccination campaigns for flu and Covid-19 to reduce severity and duration of illness, work station assessments where ergonomic equipment is needed and access to Occupational Health Service to provide support for both physical and mental health issues. Appendix D: IJB decisions and directions Agendas and reports for all MIJB meetings during 2023/24 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. Governance considerations and decisions made by the MIJB have included: May 2024 • Agreed to note the expected financial position at the end of the current financial year and the implications for 2024/25 and noted the recovery action plan and the intent to progress the savings highlighted. • Agreed to note the updated Financial Strategic Risk Register which provides an overview of the strategic financial risks, along with a summary of actions which are in place to mitigate those risks. • Formally approved the revenue budget for 2024/25, following consideration of the risks highlighted in the report. June 2024 • 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 MIJB Directions Policy. September 2024 • Approved the Audited Annual Accounts for the financial year 2023/24. • Approved the Moray Mental Health and Wellbeing Delivery Plan 2024- 2026 and approved the proposed governance structure in Moray. • Approved the Adult Joint Strategic Needs Assessment 2024 for Moray. • Approved the publication of the Health and Social Care Moray Annual Performance Report 2023/24. • Approved the publication of the Health and Social Care Moray Annual Complaints report 2023/24. Page 274
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Annual Performance Report 2024/25 74 Moray Integration Joint Board November 2024 • Approved the draft Public Sector Climate Change submission to Sustainable Scotland Network for the reporting year 2023/24. January 2025 • Endorsed the establishment of the Grampian Strategic Change Board. • Endorsed the collaborative approach proposed to develop a Route Map for Strategic Change. • Agreed that the IJB Chief Officers should actively participate in the development and implementation of the Route Map for Strategic Change and work collaborative with other partners to ensure the success of this crucial transformation program. • Approved the charges for services for the 2025/26 financial year for recommendation to Moray Council for approval and inclusion into their budget setting processes. • Approved the Children’s Services Plan 2023/24 annual report. • Approved the outline business case for the replacement of the Social Work and Social Care case management system. • Endorsed the collaborative whole system approach being taken in Moray and by partners across Grampian with regards to the Getting in Right for Everyone (GIRFE) programme. • Agreed to adopt the Standards Commission’s Model Code of Conduct for Members of Devolved Bodies as the Code of Conduct for the Moray IJB. March 2025 • Approved the 2025/26 proposed savings plan. • Formally approved the Revenue Budget for 2025/26. • Approved the updated Medium Term Financial Framework. • Approved the draft Moray IJB Equality Mainstreaming Progress Report 2021- 2024 for publication by April 2025. • Approved the strategic objectives of the Strategic Care at Home Group. Page 275
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Annual Performance Report 2024/25 75 Moray Integration Joint Board Appendix E: Changes to Membership of Moray Integration Joint Board during 2024/25 Changes to membership of MIJB during the year: Councillor Tracy Colyer became MIJB Chair on 1 April 2024. She resigned from the Board in September 2024. Denis Robertson, Vice-chair, took over the role of Chair until the end of 2024/25. Councillor Elaine Kirby takes on the role of Chair of the Board from 1 April 2025 until 30 September 2025, following which the role of Chair will revert back to a Health Board Member in line with the Integration Scheme. Following an open recruitment process, Sheila Brumby was appointed as Service User Stakeholder and Janette Topp as Third Sector Stakeholder in May 2024. Ms Topp resigned from the Board on 11 February 2025. NHS Grampian nominated Alex Stephen, Director of Finance, to MIJB, as of 1 July 2024. June Brown, Executive Nurse Director, is Mr Stephen’s nominated substitute. Dr Malcolm Simmons, GP Lead, stood down from the Board on 31 March 2025. This vacancy will not be recruited to. Dr Robert Lockhart, GP Lead, will continue as member of the MIJB and Clinical and Care Governance Committee. Judith Proctor was appointed Chief Officer of the MIJB and HSCM in November 2024, having served as Interim Chief Officer for the previous five months. She succeeded Simon Bokor-Ingram who stepped down from the position at the end of May 2024 due to health reasons. Jim Lyon was appointed Interim Chief Social Work Officer and Head of Service in June 2024. He succeeded Tracey Stephen who stepped down from the MIJB on her relocation to take up a role with a local authority in England. Agendas and reports for all MIJB meetings during 2024/25 are set out in the document packs which are published on the Moray Council website. Hybrid board meetings combine in-person attendance with remote participation, via video conferencing. They are open to the public to attend and are also webcast, meaning they can be watched remotely as they happen or the recording viewed at a later time. Page 276
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Annual Performance Report 2024/25 76 Moray Integration Joint Board Appendix F: Inspections of services The annual performance report requires the IJB to report on inspections by external bodies. Joint Inspection Adult Support and Protection Moray's multi-agency Public Protection Partnership has evidenced substantial improvement in supporting and protecting adults at risk of harm. The positive impact achieved by local authority, health and police colleagues in their work to keep people safe, has been acknowledged with publication in October 2024 of the Joint Inspection of Adult Support and Protection in Moray. The progress review by the Care Inspectorate and its scrutiny partners was a follow- up to a joint inspection carried out in 2022. On their return in August, inspectors found significant progress had been achieved across all seven priority areas identified for improvement. Key accomplishments identified in the progress report include: • Consistent application and delivery of key processes: Frontline staff were confident and highly professional. The partnership overall followed its comprehensive multi-agency adult support and protection procedures rigorously. • Improved investigations: Full adult support and protection investigations were now carried out for all adults at risk of harm who required them. The quality of these investigations had significantly improved, with almost all rated as good or better. This was described by inspectors as “another impressive improvement.” • Enhanced management of risk: The quality of chronologies (recording the order of events), risk assessments, and protection plans had greatly improved. Presence of risk assessments required further improvement, so that all adults at risk of harm had one. • Effective case conferences: Case conferences were now clearly defined and held for all adults at risk of harm who required them. There were competent and well-executed, with almost all rated good or better for quality. The partnership was actively working to support people to participate in their own case conferences. • Strategic leadership: The partnership had rigorously implemented its improvement plan following the 2022 inspection and taken forward a range of notable improvement focused activities. • Strengthen governance: Robust measures were in place to identify concerns early and promptly implement remedial action. Operational managers worked diligently and effectively to bring about necessary improvements to adult support and protection. • Multi-agency self-evaluation: The partnership had achieved significant progress and its cohesive programme of multi-agency audits and quality Page 277
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Annual Performance Report 2024/25 77 Moray Integration Joint Board assurance activities was successful. Frontline staff were involved in informing the improvement work. Care Inspectorate The following services managed by the HSCM were inspected in 2024/25. Short Term Assessment and Reablement Team (START) - Support Service Key messages: • People enjoyed support which was dignified and respectful. • Staff felt supported by their supervisors and colleagues. • Staff recruitment was managed well by the service. • People's reablement benefitted from good links between the service and other health and social care colleagues. • Improvements were required to ensure people benefitted from safe medication procedures. • Care plans required more detail and more regular review. Evaluation of service How well do we support people's wellbeing? 4 - Good How good is our leadership? 4 - Good How good is our staff team? 5 – Very good How well is our care and support planned? 3 - Adequate Moray Supported Lodgings Project – Adult Placement Services Key messages: • The management team evidenced insight to service gaps and provided a service improvement plan, which is in the early stages of implementation. • The impact of a six-month vacancy of the only supervising social worker post has had a negative impacted on predictable support for caregivers and taking forward service improvement plans. • Supported lodging caregivers provide young people with a safe and stable home base. • Young people are supported to reconnect with family and establish a positive network of support that aligns with their ethnicity, culture, traditions, and beliefs. • Educational attainment is a high priority with young people, who are enrolled in 'English as an additional language' lessons, and secondary and further education provisions. • Young people benefit from leading and directing their own support within a multi-agency approach to care planning. Evaluation of service Page 278
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Annual Performance Report 2024/25 78 Moray Integration Joint Board How well do we support people's wellbeing? 3 - Adequate How good is our leadership? 3 - Adequate How good is our staff team? 2 - Weak How well is our care and support planned? 4 - Good Community Support Service - Housing Support Service Key messages: • People were supported by staff who were kind and caring. • People were supported to access health care, meaning their care and support benefitted their health. • Improvements were required to ensure people benefitted from safe medication procedures. • Quality assurance checks and audits, that should improve people's care, required further development. • People did not know who was supporting them and were not confident that they received the correct amount of support. • People's care, and care plans, had not been reviewed regularly. Evaluation of service How well do we support people's wellbeing? 3 - Adequate How good is our leadership? 3 - Adequate How good is our staff team? 3 - Adequate How well is our care and support planned? 3 - Adequate Mental Welfare Commission for Scotland Muirton Ward, Seafield Hospital, Buckie An announced visits was carried out on 11 July 2024 to Muirton Ward at Seafield Hospital, Buckie, which is an older adult assessment unit for people with dementia. Key positive findings: • Compassionate Care: Individuals and most relatives described staff as caring, approachable, and experienced. The ward atmosphere was calm and settled. • Environment: The ward offered spacious and dementia-friendly areas, with good use of garden and communal spaces. Privacy was respected, and signage aided navigation. • Care records: Files were well organised, and care plans addressed both physical and mental health needs. Covert medication and legal documents were appropriately documented. • Physical health monitoring: There was consistent attention to physical health alongside mental health needs. Page 279
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Annual Performance Report 2024/25 79 Moray Integration Joint Board • Rights awareness: Advocacy services were engaged, and information on rights was visible and included in carers’ information packs. The Commission made five recommendations: • Ensure a formal process is in place to regularly review risk assessments and risk management plans. • Provide dedicated psychology support to inform care and assist with recovery, particularly in managing complex or distressed behaviours. • Review and improve the system for obtaining updates from community services (e.g. social work) to support timely discharge planning. • Ensure all psychotropic medications are legally authorised and that a regular audit process is implemented to maintain compliance. • Appoint a dedicated activity therapist to support a structured and meaningful activity programme tailored to individual and group needs. Ward 4, Dr Gray's Hospital, Elgin An announced visit was carried out on 16 October 2024 to Ward 4, Dr Gray’s Hospital, Elgin, which is an18-bedded adult acute psychiatric admission ward for adults. Key positive findings: • Staff dedication: Most individuals spoke positively about the caring and helpful nature of staff. • Patient involvement: People felt involved in decisions about their treatment and had regular access to their consultant psychiatrist. • Improved discharges: There has been some progress in discharging long-stay patients, although challenges remain due to delays in arranging community support. • Electronic records: The introduction of the TRAKCare healthcare information system has improved record-keeping, with more consistent and detailed updates. • Multidisciplinary team (MDT) records: MDT meeting documentation has significantly improved, providing clear, detailed summaries of care and treatment decisions. The Commission made 10 recommendations, including: • Better risk assessment and care planning. • Improving the quality of care plans • Ensuring access to psychology and pharmacy support. • Developing a seven-day activity programme. • Addressing outstanding environmental safety issues. • Improving legal compliance and promoting patient rights. HSCM submitted an improvement action plan to address the recommendations. Page 280
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Annual Performance Report 2024/25 80 Moray Integration Joint Board Care Inspectorate – inspections of externally commissioned services Care and support is commissioned from independent and third sector providers and these services are subject to contract monitoring by the Commissioning service to ensure that services are safe, effective and that they meet people’s needs. Performance is monitored through formal contract meetings, review of compliments, complaints and feedback from staff, carers and people who use services. Visits to providers involve observing care and support and looking at records and documents. The team also work closely with the Care Inspectorate. The following services commissioned by the partnership were inspected by the Care Inspectorate in 2024/25. Name of service Service provider How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is our care and support planned? Wakefield Nursing Home, Cullen Parklands Group 4 4 4 4 4 Abbeyside Care Home, Elgin Abbeyside Care Group 4 Not assessed 4 Not assessed Not assessed Spynie Care Home, Elgin Intobeige 3 4 3 4 4 Moray Services (Housing Support) Cornerstone 4 3 3 Not assessed 3 The Grove Care Home, Elgin Abbeyside Care Group 4 5 5 Not assessed Not assessed Meadowlark Care Home, Forres Renaissance Care 4 5 5 4 5 Ark Moray support service, Forres Ark Housing Association 3 4 3 Not assessed Not assessed Care at Home Care Quality Services Limited - Moray 3 3 3 Not assessed Not assessed Cathay Nursing Home, Forres Wallace Management Services Limited 4 4 4 4 4 Wakefield House Care Home Parklands Group 4 4 4 4 4 Page 281
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Annual Performance Report 2024/25 81 Moray Integration Joint Board Name of service Service provider How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is our care and support planned? Greyfriars Close, Elgin Turning Point Scotland 4 4 4 NA 4 Moray Services Cornerstone 4 3 3 NA 3 SAMH Housing support service SAMH 5 6 NA 5 5 Parkholme, Lossiemouth Cornerstone 3 3 3 3 3 RLO, Elgin Real Life Options 5 5 NA 5 5 Chandlers Rise, Elgin Hanover Housing Support Service - Care (North) 4 4 NA 4 4 Cornerstone Buckie Cornerstone 5 5 NA 5 5 The six-point scale 6 Excellent Outstanding or sector leading 5 Very good Major strengths 4 Good Important strengths, with some areas for improvement 3 Adequate Strengths just outweigh weaknesses 2 Weak Important weaknesses - priority action required 1 Unsatisfactory Major weaknesses - urgent remedial action required Page 282
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Annual Performance Report 2024/25 82 Moray Integration Joint Board Find out more about the Moray Integration Joint Board and Health & Social Care Moray on our website: https://hscmoray.co.uk/index.html Follow us on social media Facebook @ hscmoray Instagram @hscmoray For further information contact: Health & Social Care Moray Moray Council Offices High Street Elgin Moray IV30 1BX Gram.hscmcorporate@nhs.scot Page 283
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REPORT TO: MORAY INTEGRATION JOINT BOARD AUDIT, PERFORMANCE AND RISK COMMITTEE ON 19 JUNE 2025 SUBJECT: DEVELOPMENT SESSIONS IN NOVEMBER 2024 FOR CHILDREN, FAMILIES AND JUSTICE SOCIAL WORK BY: INTERIM CHIEF SOCIAL WORK OFFICER/HEAD OF SERVICE 1. REASON FOR REPORT 1.1 To inform Committee of the Development Sessions undertaken by Children and Families and Justice Social Work in November 2024 and the resulting actions to address learning from social work practice. 2. RECOMMENDATION 2.1 It is recommended Committee scrutinises and notes: i) the activity and outcomes related to the Development Sessions in 2024; ii) the content of the Improvement Action Plan at Appendix 3; and iii) agree an update on progress of the Action Plan will be provided to a future Committee meeting. 3. BACKGROUND 3.1 Professional learning and development must be at the heart of continual improvement of public services including, self-evaluation, reflective practice, findings from complaints, positive feedback, practice review methods, and most importantly, external evaluation - inspections. 3.2 In recent years there have been complaints which resulted in claims for financial compensation by complainants, learning reviews, a children’s services inspection, and other review activities which highlighted areas for improvement and strengths from which to build upon. 3.3 In 2024 Moray Council Social Work Services was the focus of negative media attention due to an upheld complaint in court resulting in financial Item 11. Page 285
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compensation. This was related to professional practice and processes which resulted in failure to uphold standards and ensure effective remedy. 3.4 In response, the Interim Chief Social Work Officer (CSWO), asked for a desk- top review of this case and four other significant complaints spanning over a 4- year period. Based on the initial themes identified, this included similar complaints received over the two years leading to the decision for practice review. 3.5 To address the identified underlying practice issues, workforce learning and development sessions were arranged to reflect on practice and identify service improvements from the findings of the above processes and from “leadership supported” reflective practice in Children, Families and Justice Services. 3.6 Two Development Sessions were devised, led by the Interim CSWO and supported by the Policy, Development & Commissioning Team, which took place on 14 and 27 November 2024. These sessions were attended by 111 members of staff. The focus was mainly on the key themes identified from historic and current complaints findings including: Communication Timely actions and practice Process and procedure The voice of children, young people and families Power imbalance and practice governance 3.7 A conversation café approach was used which enabled staff to freely discuss each of the themes with colleagues and reflect on their practice. The tone of the sessions was positive and encouraged staff to think about ‘what we do well’ and ‘what we can do better', in line with the continual improvement culture being promoted in the service. 3.8 Staff generated a wide range of ideas they believe will contribute to improvement across the service. These were refined and organised into an Action Plan (Appendix 3) which is in line with the Children’s Services Joint Inspection Improvement Plan 2024 and the Children’s Service Plan 2023-2026. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Initial feedback from the Development Sessions was provided to staff (Appendix 1) which was followed up by a Learning from Practice Report (Appendix 2) detailing the approach, reflective process, and aims. 4.2 The Learning from Practice Report records the responses from staff at the Development Sessions, emerging themes, and improvement actions. It was highlighted by the Interim Head of Service that future actions would contribute to the overall plans for continual improvement and self-evaluation and fit with the Children’s Services Joint Inspection Improvement Plan 2024 and the Children’s Service Plan 2023-2026. 4.3 The above noted Learning from Practice Action Plan (Appendix 3) was developed following the Development Sessions by the Policy, Development & Commissioning Team on behalf of the Interim Head of Service. The progress of Page 286
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the plan is reviewed by Service Managers ensuring the workforce is fully involved and is updated accordingly by the Consultant Practitioners. 4.4 The Action Plan has a RAG rating: Green = Completed, Amber = In Progress and Red = Not Started Yet. Most red areas are not outstanding tasks but future actions up to 2026 which shows positive identification of future work requirements and plans. Currently there are 26 actions in green including several policies, procedures and training initiatives with seven red actions out of date, of which four are procedures, one is kinship, and two are forms being created. 4.5 Additionally, the Children, Families and Justice Social Work leadership and workforce has identified the following priorities: Permanence planning Manageable caseloads Recruitment and retention Social work practice Quality Assurance Framework 4.6 The outcome of the Development Sessions and the Learning from Practice Action Plan is part of a wider continual improvement ethos. It is contributing to the current self-evaluation and continual improvement model launched across children’s services on 24 September 2024 and the drive for the development of Health and Social Care Moray as a “learning and development” organisation. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” This report notes the continuous improvement and self-evaluation activity required within the above-named plans and the Children’s Services Plan. The Action Plan links to the LOIP Outcome 2 – Building a Better Future for our Children and Young People in Moray by delivering actions which contribute to ensuring children and young people’s voices are heard and children live in safe and supportive families. (b) Policy and Legal None arising as a direct result of this report. The Action Plan is inclusive of actions for the Children, Families and Justice Social Work Policy Team. (c) Financial implications None arising as a direct result of this report. (d) Risk Implications and Mitigation None arising as a direct result of this report. The Action Plan requires regular monitoring and review to ensure actions are progressing in a timely manner to mitigate future complaints and financial compensation. (e) Staffing Implications There are no proposed changes to the staffing or reporting relationships. Page 287
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(f) Property None arising as a direct result of this report. (g) Equalities/Socio Economic Impact None arising as a direct result of this report. (h) Climate Change and Biodiversity Impacts None arising as a direct result of this report. (i) Directions None arising as a direct result of this report. (j) Consultations Children, Families and Justice Social Work Senior Management Team and workforce during the Development Sessions in November 2024 and in follow up correspondence and workplace meetings as documented. 6. CONCLUSION 6.1 This report provides Committee with an overview of the activity and outcomes related to the Development Sessions held in 2024 and the content of the resulting Action Plan. 6.2 Committee is requested to note this report and agree to receive an update on the progress of the Action Plan at a future Committee Meeting. Author of Report: Jim Lyon, Chief Social Work Officer / Head of Service Background Papers: Appendix 1 - Development Session Brief Summary Appendix 2 - Development Day Report Appendix 3 - Learning from Practice Action Plan Ref: Page 288
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Communication ‘Needs to be consistent, clear and collaborative’ ‘Ensure expectations are realistic, that we do what we can to meet these – we must communicate if we can’t meet expectations’ Timely Actions and Practice ‘Paperwork to be streamlined’ ‘There are challenges with high workloads and being able to have protected time when there is a shortage of staff’ Power Imbalance and Governance ‘We need to build trust, work in partnership, be transparent about concerns while giving families choice and empowering them to make positive changes’ ‘We need strong leadership and support when working with families who are more challenging’ Voice of Children, Young People and Families ‘This is a continuing process, not one-off or in response to a meeting or report’ ‘We would like a toolbox to help us hear children and young people’s voices’ Process and Procedure ‘We want to have clear processes and procedures which are updated and accessible’ ‘We like the use of flowcharts and checklists as methods to support how things are meant to happen’ Children and Families & Justice Services Development Session Learning from Practice – 14 & 27 November 2024 Following a review of feedback from people receiving our service, five key themes of practice were identified: • Communication • Timely actions and practice • Process and procedure (not being followed / not being in place / out of date) • The voice of children, young people and families • Power imbalance and governance In November 2024, 111 people attended two Learning from Practice sessions to explore the themes and share views on how we can deliver improved services. Overall, staff want to feel confident and skilled in their role through good induction, training, supervision, clear policies and procedures and streamlined paperwork. You told us: Your feedback on the sessions was: • The sessions were ‘meaningful and snappy’ • Great to hear the Head of Service views and vision • The sessions felt positive and boosted morale • Networking opportunities were welcomed • Want to see things moving on – change to be seen and evident We are working to collate all the feedback you gave us. Your feedback will inform our Social Work Development Plan. APPENDIX 1 Page 289
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 1 Learning from Practice Report Children, Families & Justice Services Development Session Learning from Practice – 14 & 27 November 2024 Page 290
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 2 Learning from Practice – 14 & 27 November 2024 In 2024 Moray Council Social Work services was the focus of negative media attention due to complaints. The Head of Service asked for a review of specific historical complaints and complaints received over the last two years. The desk-top review consisted of reading case files, CareFirst, electronic files and discussions with some of the social work staff involved. Five key practice themes were identified: • Communication (with children, young people and families, and communication with other professionals) • Timely Actions and Practice • Process and Procedure (not being followed, not being in place or out of date) • The voice of Children, Young People and Families • Power Imbalance and Governance The findings indicated that the themes were relevant to all the teams across children and families and justice services. Resultantly, the Head of Service led two Learning from Practice development sessions held on 14 and 27 November 2024. The sessions were well attended by 111 staff with good representation from all teams. The Head of Service provided the context for the sessions by detailing the five themes and emphasising the need for establishing a learning and development culture within the service. A conversation café approach ensured staff were able to discuss the learning from the themes and hear the views of colleagues from different teams. Identified managers, with an interest in learning and development, led and facilitated discussions and practice reflection leading to the start of a development plan. The tone of the day was positive and encouraged staff to think about what we do well and what we can do better. The Head of Service closed the sessions highlighting the importance of effective working together, support and challenge, continual improvement and the need for everyone to lay strong foundations for our learning and development culture. This was not a one-off overall event but the start of a wider programme of self-evaluation and improvement in which everyone will be involved. Feedback included: The sessions were ‘meaningful and snappy’ It was good to hear the Head of Service’s views and vision The sessions felt positive and boosted morale Networking opportunities were welcomed Staff want to see things moving on – change to be seen and evident Page 291
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 3 To ensure momentum the Head of Service shared a summary of the sessions with staff in December 2024. ‘Thank you for taking part in the above sessions in November and for your honest and valuable contribution to our plans for continual improvement and self-evaluation. The sessions generated lots of ideas and reflection across the range of themes identified. I have enclosed a one-page summary of the sessions while we put together a more detailed report and actions which shall come out in the new year. It was great meeting you and seeing how committed you are to establishing a learning and development culture within the service. You are dedicated, committed and diligent and we cannot provide services without you. I look forward to continuing our work next year and to further engagement with you.’ From the two sessions we received over 75 flipcharts with lots of positive ideas and thoughts. It took some time to manage the volume of information received and to make it more manageable, we organised it into areas of practice on which we need work on (Appendices 1 & 2). Page 292
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 4 1. Themes Below is a summary of the main themes detailing the findings from the file reading and what staff reflected on. Theme 1: Communication (with children, young people and families, and communication with other professionals) The file reading told us: Communication with families can be inconsistent, limited and delayed. There are inconsistencies in checking families understand the outcomes from their meetings, and they are not always kept up to date on changes. Expectations of families and other professionals are not always managed. Over promising and under delivering can lead to expectations not being met. Changes of plans are not always communicated effectively. Within professional networks, information can get lost, be misinterpreted and not always followed up. Staff reflected that: Communication with families should be regular, open and transparent, families should be updated on changes, plans and our involvement Communication within the workforce (colleagues, managers, service managers, senior leadership) needs to be consistent, clear and collaborative Expectations from families, colleagues and partners should be managed better. We must communicate effectively where, for any reason, changes have occurred, there has been slippage in delivering agreed tasks or outcomes Information sharing between agencies and professionals needs to improve Roles and responsibilities of different teams within social work and across the children’s services partnership could be better understood To reduce misunderstanding, we must reflect on our messaging and check with the recipient that the message has been properly understood Theme 2: Timely Actions and Practice The file reading told us: Paperwork and tasks are not always completed within timescales, leading to information not being shared with families or professionals when it should. The quality of assessments, chronologies and recording needs to improve. We need to be consistent in recording the rationale for decision making, and the process leading to decisions. Staff reflected that: Improved technology would aid efficiency and effectiveness The suite of paperwork should be reviewed and streamlined Information should be shared with families in plain language, in time for them to prepare for whatever process will follow Page 293
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 5 Processes and procedures should continue to be updated Realistic expectations should be set for people who receive our services and the children’s services partnership Partnership training on GIRFEC, chronologies, assessment and child planning would be beneficial Staff shortages create high workloads meaning there is a lack of time to produce the quality of work required Theme 3: Processes and Procedures (not being followed, not being in place or out of date) The file reading told us: Processes and procedures are not always followed or understood. Some procedures are out of date or need to be created. Staff reflected that: There has been an improvement in processes and procedures since the introduction of the policy team They would welcome flow charts and check lists to improve understanding and access simplified professional processes Opportunities to be involved in developing processes and procedures would be welcomed It would be helpful to find more efficient ways of being kept up to date with new processes and procedures e.g. agenda items in team meetings, briefings, future development sessions, one person responsible for updating others Theme 4: The Voice of Children, Young People and Families The file reading told us: Practice is varied in evidencing the voice of the child depending on their age and stage of development. Children and families do not always believe their views have been considered when we have made decisions with which they do not agree. Staff reflected that: Children should be asked who they want to help them express their views The Advocacy service is not the only, or always the best way to gather views Gathering views should be a continual process, not just a one-off activity Being honest and establishing trust is the key to effective relationships A tool kit to help gather views would be beneficial Children, young people and families, need to be helped to understand why it is not always possible to act on their wishes, while ensuring their voice is heard Page 294
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 6 Theme 5: Power Imbalance and Governance The file reading told us: Families have told us they feel we hold power over them (often referred to as the badge of office), and they feel ‘done to.’ Staff can find it difficult to balance parental rights and responsibilities and the rights of the child. A power imbalance can also exist when a parent or carer is in a position of high authority or has a strong or hostile manner. Staff can be challenged and intimidated in these circumstances and might find it difficult to respond in a balanced way. Staff reflected that: It is important to build trust, work in partnership with families and be transparent about concerns Families must be given choice and be empowered to make positive change They need strong leadership and support when working with families that are more challenging Regular reflective, high support and high challenge supervision is important Training and support would enable them to be skilled and confident to professionally challenge families and other agencies when required 2. Actions Staff also expressed their interest in: • Training which covers specialist areas of practice and core social work skills • Having leaflets explaining the social work role and procedural meetings • Being involved in development of new processes, paperwork, & creation of new tools • Development sessions or briefings to be kept up to date with changes • An action plan being based on feedback given at the development days Some areas of work identified in this report are already in progress, including: Streamlining Paperwork: A short life working group is in place to review the social work suite of paperwork. Training: A review and creation of a training plan for Social Workers in Training, Newly Qualified Social Workers and the wider staff group. This is in response to the new registration requirements of the Scottish Social Services Council and the mandatory learning activities for Newly Qualified Social Workers. The current induction of all new staff is also under review. There is a plan in place to deliver child protection training for all social work staff. More than 70% of staff are trained in Safe and Together. Solution orientated training was well attended by around 80% of social work staff. Page 295
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 7 Child and Young Person’s Voice: Staff requested tools to support them in collating the views of the child. A similar request was made from the Child Protection Committee which requested a toolbox for practitioners. A short life working group is working to progress this task. Processes and Procedures: Old policies and procedures are being updated. New procedures are being written in response to changing needs and recommendations from other service plans. Benchmark work is being carried out on a range of policies and procedures including a Procedure for Conducting Team Around the Child Meetings, a Significant Occurrence Procedure, and Managing Referrals Involving Staff amongst others. 3. Conclusions: Staff agreed with the themes identified by the desktop review and made suggestions for improvement. They are positive that taking a learning and development approach with an action plan, will support continuous learning and development. They reflected the importance of feeling confident and skilled in their role through good induction, training and supervision. It is important for them to learn and grow together with members of other teams, so they can benefit from each other’s knowledge and skills. They expressed the importance of having clear processes and procedures to ensure consistency in practice. This is important for people receiving our services, so they can expect the same response and professional standards in a consistent manner regardless of the team providing the service. It also helps to ensure a clear governance structure. Staff noted there are too many different report formats and they would like the paperwork to be streamlined, with different reports complementing each other. They are keen to be involved in a test of change of the new paperwork. From the feedback, a development plan has been produced (Appendices 1 & 2). Priority ideas were identified (green) and staff noted how we should progress these areas (blue). The actions which follow from the development plan, will include actions from the Children’s Services Joint Inspection Improvement Plan 2024 and the Children’s Service Plan 2023- 2026. The development and action plan will contribute to the overall plans for continual improvement and self-evaluation which will reflect further learning needs. Progress will be measured through the audit and evaluation programme. This can help ensure a continual learning and development culture can start to be embedded. Author: Page 296
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 8 Jim Lyon Chief Social Work Officer/Head of Service Page 297
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 9 Development Plan 2025 induction Development Staff Ideas (Priority Areas) Streamlined paperwork Engaging the child’s voice Processes and Procedures (P&P) Improve communication with people receiving our service and other professionals Updating old P&P Staff included in development Staff kept aware of changes and how to access P&P Multi-agency reflective case discussions Leaflets for families explaining roles and procedures Development of tool kit Current & Relevant Guidance Review of minutes and referral forms New core assessment New P&P developed in response to Deleting unnecessary documents Improve working across Children, Justice & Adult Services Stop silo working Page 298
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APPENDIX 2 Continual Improvement and Development Learning from Practice Report – January 2025 10 Training in practice areas Joint training Support for NQSW and SWIT Quality Assurance Clear pathway of support Guidance for supervisors Review and update of current induction programme Quality assurance, audits of current practice and training Support to embed current training and models i.e. Safe and Together Partnership training Joint Training with different teams in, Children Justice & Adult Services Specialist areas i.e. CSE, MH, Substance use Exemplars of good practice (assessments, chronologies etc) Legal matters i.e. Court Skills, CPO’s Core Training programme identified Core social work skills GIRFEC training Child Protection Development Staff Ideas (Priority Areas) Mock Children’s Hearings Page 299
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APPENDIX 3 Children and Families & Justice Services Learning from Practice Action Plan 2025-2026 The table below provides a description of the tasks required to complete the action plan. Task Descriptor Benchmarking and Scope Gathering information by researching other Local Authorities and exploring within Moray, including partner agencies, what information exists Workforce Collaboration and Contribution Engaging with staff, team managers, service managers and partners by seeking their views, involvement in short life working groups, and trialling new developments Create Creating the item, can be before or after collaboration Launch Raise awareness through briefings, discussion at Policy, Development & Commissioning (PDC) meetings, development sessions Training Deliver training as required Evaluate/Quality Assurance Evaluate feedback, quality assure work undertaken Page 300
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APPENDIX 3 Action Plan Development area Why are we doing this? What will we achieve Benchmark & Scope Workforce Collaboration & Contribution Create Launch Training Evaluate/ QA The voice of children and young people We want to be sure that children and young people can influence their plans and that their voices are heard A toolkit for practitioners Feb 25 June 25 June 25 June 25 Nov 25 Guidance for practitioners Feb 25 June 25 June 25 June 25 Nov 25 Development area Why are we doing this? What will we achieve Benchmark & Scope Workforce Collaboration & Contribution Create Launch Training Evaluate/ QA Engagement with people who receive services To provide written information for children, young people and their families about the social work role, meetings they might attend and processes which might affect them Child-friendly leaflets March 25 April 25 April 25 May 25 May 26 Leaflets that explain social work role, meetings and processes March 25 April 25 April 25 May25 May 26 Re-launch of existing leaflets March 25 Colour Key: Green – Completed Amber – In Progress Red – Not started yet Page 301
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APPENDIX 3 Development area Why are we doing this? What will we achieve Benchmark & Scope Workforce Collaboration & Contribution Create Launch Training Evaluate/ QA Engagement with staff For staff to be involved and kept aware of policy, procedure and training developments Information flow through PDC meetings Monthly Newsletters Every 4 months starting April 25 April 26 To improve the induction experience for all new staff Redesign induction programme April 25 June 25 June 25 Aug 25 Jan 26 Development area Why are we doing this? What will we achieve Benchmark & Scope Workforce Collaboration & Contribution Create Launch Training Evaluate/ QA Training To provide opportunities for staff to attend training and learn with other professionals Promote partnership training and information sharing Monthly at PDC meetings For staff to develop their skills and knowledge to improve their practice Child Protection Training Feb 25 April 25 April 25 Start module 1 May 25 Dec 26 Permanence Training April 25 June 25 July 25 Sept 25 March 26 Embedding of Safe and Together March 25 Forums April 25 onwards Nov 25 Embedding of Graded Care Profile 2 March 25 Re-launch May 25 April 25, then Nov 25 Page 302
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APPENDIX 3 every 2 months Development Training Chronologies April 25 May 25 May 25 May 25 Dec 25 Assessments April 25 May 25 May 25 May 25 Dec 25 Analysis April 25 May 25 May 25 May 25 Dec 25 Action Plans April 25 May 25 May 25 May 25 Dec 25 Specialist Training Mental Health April 25 May 25 June 25 Sept 25 Jan 26 Substance Use April 25 May 25 June 25 Oct 25 March 26 Sexual Harmful Behaviour March 25 April 25 Trauma Informed Practice Sep 24 Oct 24 Sep 24 June 25 June 25 Oct 25 Contextual Safeguarding Training Risk, Vulnerability & Exploitation Sept 24 Feb 25 Oct 24 April 25 Nov 25 Child Sexual Exploitation Sept 24 Feb 25 Oct 24 April 25 Nov 25 Gangs & County Lines Sept 24 Feb 25 Oct 24 April 25 Nov 25 Development area Why are we doing this? What will we achieve Benchmark & Scope Workforce Collaboration & Contribution Create Launch Training Evaluate/ QA Page 303
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APPENDIX 3 Newly Qualified Social Workers (NQSW) & Social Workers in Training (SWIT) To ensure all social work staff meet their learning requirements to enable them to be confident and competent practitioners A programme for NQSW & SWIT to meet their learning requirements Jan 25 April 25 March - April 25 June 25 Dec 25 Guidance for those who support NQSW and SWIT Jan 25 April 25 March - April 25 June 25 Dec 25 Development area Why are we doing this? What will we achieve Benchmark & Scope Workforce Collaboration & Contribution Create Launch Training Evaluate/ QA Supervision For staff to have regular and reflective supervision Update of paperwork and procedure Feb 25 Update May 25 May 26 Supervisors are trained and using the 4x4x4 model Re- advertise June 25 Dec 25 Supervisees understand the 4x4x4 model Re- advertise June 25 Dec 25 Development area Why are we doing this? What will we achieve Benchmark & Scope Workforce Collaboration & Contribution Create Launch Training Evaluate/ QA Streamlining paperwork To improve the quality of assessments and reports by using one agreed template based on the National Practice Model A core assessment and report template Jan 25 Started Jan 25 March 25 May25 Dec 25 To reduce the A singular form for April 25 April 25 May 25 June 25 Dec 25 Page 304
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APPENDIX 3 workload of staff referrals For consistency and ease of use A singular minute template April 25 April 25 May 25 June 25 Dec 25 To provide clarity on assessments and improve the quality of assessments we undertake A clear range of assessments additional to the core assessment and report template Started March 25 June 25 Dec 25 Development area Why are we doing this? What will we achieve Benchmark & Scope Workforce Collaboration & Contribution Create Launch Training Evaluate/ QA Policies & Procedures To support staff to undertake their role Update out of date policies and procedures Transitions April 24 Aug 24 June 24 May 25 June 25 Jun 27 Continuing Care April 24 Aug 24 June 24 May 25 June 25 Jun 27 LAC Manual Started May 23 Learning from practice for reviewing officers Review Nov 2025 Nov 27 Escalation procedure Review Dec 25 Dec 27 Smoking Policy for LAC - Foster and LA residential care settings Nov 24 Jan 25 Nov 24 April 25 Jul 27 Alcohol Policy for LAC - Foster and LA residential care settings Jan 25 Feb 25 March 25 May 25 May 27 Drug Use Policy for LAC - Foster and LA residential care settings Jan 25 Feb 25 March 25 May25 May 27 Page 305
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APPENDIX 3 Case recording Jan 24 Dec 24 May 25 May 27 Create new policies and procedures as required Supported lodgings Nov 24 Jan 25 March 25 Aug 25 Aug 27 Kinship Feb 25 April 25 June 25 July 25 June 28 Inter-agency Team around the Child Feb 25 Started April 25 Significant occurrence Jan 25 March 25 April 25 April 27 Referrals involving staff Feb 25 March 25 May 25 Aug 27 Flow charts and checklists To be included with updates and new policies and procedures Policies and procedures to have a trauma informed lens All updates, new policies, and procedures to be reviewed by Trauma Informed Lead Promote use of multi- agency reflective case discussions to support better outcomes for children May 25 Re-launch June 25 Dec 25 Development area Why are we doing this? What will we achieve Benchmark & Scope Workforce Collaboration & Contribution Create Launch Training Evaluate/ QA Quality Assurance & Audit Activity To ensure consistency and promotion of good A calendar of quality assurance activity across the year Feb 25 April 25 May 25 June 25 Dec 25 Page 306
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APPENDIX 3 practice Page 307
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