Agenda Document Pack - Audit, Performance and Risk Committee - 30/06/2022
Moray Council · 30 June 2022
Back to Audit, Performance and Risk Committee — 30 June 2022 and its agenda
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Audit, Performance and Risk Committee Thursday, 30 June 2022 Remote Locations via Video Conference NOTICE IS HEREBY GIVEN that a Meeting of the Audit, Performance and Risk Committee, Remote Locations via Video Conference, on Thursday, 30 June 2022 at 09:00 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Unaudited Annual Accounts Report Report by Interim Chief Financial Officer 3 - 60 Page 1
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MORAY INTEGRATION JOINT BOARD SEDERUNT Mr Sandy Riddell (Chair) Mr Derick Murray (Voting Member) Councillor John Divers (Voting Member) Councillor Scott Lawrence (Voting Member) Mr Sean Coady (Member) Mr Steven Lindsay (Member) Ms Jane Mackie (Member) Simon Bokor-Ingram (Member) Jeanette Netherwood (Member) Mr Neil Strachan (Member) Clerk Name: Tracey Sutherland Clerk Telephone: 07971 879268 Clerk Email: committee.services@moray.gov.uk Page 2
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REPORT TO: SPECIAL MEETING OF THE MORAY INTEGRATION JOINT BOARD AUDIT, PERFORMANCE AND RISK COMMITTEE ON 30 JUNE 2022 SUBJECT: UNAUDITED ANNUAL ACCOUNTS BY: INTERIM 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 2022. 2. RECOMMENDATION 2.1. It is recommended that the Audit, Performance and Risk Committee: i) consider and note the unaudited Annual Accounts prior to their submission to the external auditor, noting that all figures remain subject to audit; ii) note the Annual Governance Statement contained within the unaudited Annual Accounts; and iii) note the accounting policies applied in the production of the unaudited Annual Accounts, pages 41 to 42 of the accounts. 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 2022 to its external auditors by 30 June 2022 and the audited annual accounts are required to be approved by the MIJB and published by the 30 September each year. Regulation 5 of the Local Authority (Capital Finance and Accounting) (Scotland) (Coronavirus) Amendment Regulations 2021 extended the dates, and these have been extended again for 2021/22 by further amendment regulations. This timescale and relates mainly Item 3. Page 3
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to the timing of the audit. Audited accounts, under the Act are required to be published by 15 December 2022. 3.3 A copy of the unaudited accounts is attached at APPENDIX 1 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 In relation Regulation 5 of the Local Authority (Capital Finance and Accounting) (Scotland) (Coronavirus) Amendment Regulations 2021, Scottish Government has advised that the Act has been extended again for 2021/22. Subsequently, this allows for the ability to delay the publication of Annual Accounts until December 2022. Audit Scotland have assessed the resources they have available to conduct the audit and have made a decision to exercise the powers to extend the timescales as set out in the legislation. The Chief Financial Officer has had regular contact with the external auditor to ensure reporting and inspections periods are appropriate and have adapted timelines accordingly, whilst ensuring the accounts preparation is completed in a timely manner. 4.2 The Annual Accounts have been prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2021/22 (the Code) which is underpinned by the International Financial Reporting Standards (IFRS). 4.3 Audit Scotland, under Regulation 5 of the Local Authority (Capital Finance and Accounting) (Scotland) (Coronavirus) Amendment Regulations 2021 is required to complete their audit by 30 November 2022. The audited accounts and the External Auditor’s report will be submitted to the MIJB at its meeting of 26 November 2022 prior to publication. 4.4 The Comprehensive Income and Expenditure Statement shows a surplus of £10.679m on the provision of services for the year. As at 31 March 2021, the Balance Sheet showed total Reserves of £6.155m. This increase is primarily due to late allocation from the Scottish Government as advance payment to support the continued remobilisation of services in relation to Covid-19 and additional winter funding investments. Note 7 within the unaudited accounts breaks down the General Fund Reserve between what is General Reserve and available for utilisation and supporting the budget and what is earmarked for specific purposes. 4.5 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 2021/22. Annual Governance Statement – is a means of reporting publicly on the MIJB’s governance arrangements, and seeks to provide assurance that its Page 4
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business is conducted in accordance with law, regulations and proper practices and that public money is safeguarded and properly accounted for. Financial Statements – provides detail of the main financial transactions through the Comprehensive Income & 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. 4.6 As at 31 March 2022 there were significant variances between budget and actual on several services. These are evident in the Comprehensive Income and Expenditure Statement and are detailed in a separate report being presented to this Board entitled ‘Revenue Budget Outturn for 2021/22’. A summary on the major variances is included within the Management Commentary as part of the Unaudited Annual Accounts. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Commissioning Plan 2019 – 2029 ‘Partners in Care’ 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 2021/22 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 2022. 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, Audit Scotland, which will provide assurance that the Accounts for 2021/22 give a true and fair view of the financial position and expenditure and income of the MIJB for the year ended 31 March 2022. (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report. Page 5
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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 as there has been no change to policy. (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 underspend on the provision of services of £10.679m for MIJB for the year ending 31 March 2022. At the beginning of the year the MIJB, held in its reserves £6.155m. The closing balance on the general fund reserve as at 31 March 2022 is £17.021m, consisting of £1.257m in a general reserve and £15.764m that has been earmarked for specific purposes as detailed in the unaudited annual accounts 2021/22. Author of Report: Deborah O’Shea, Interim Chief Financial Officer Background Papers: with author Ref: Page 6
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Moray Integration Joint Board Annual Accounts 2021/22 Appendix 1 UNAUDITED ANNUAL ACCOUNTS FOR THE YEAR ENDED 31 MARCH 2022 MORAY INTEGRATION JOINT BOARD Item 3. Page 7
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Moray Integration Joint Board Annual Accounts 2021/22 If you need information from the Moray Council in a different language or format, such as Braille, audio tape or large print, please contact: ياروم سلجم لبق نم تامولعم لىإ ةجاح ي ف متنك اذإ نوكتو ةغلب وأ ويدوأ ةناوطسأ ،يا ربلا لثم فلتخم لكش لىعوأ ةفلتخم نوكت نأ مط ب لاصّتلإا ءاجّرلاف ةظيلغ فورح لامعتساب ةعوب Jei pageidaujate tarnybos Moray tarybos teikiamą informaciją gauti kitokiu formatu, pvz., Brailio raštu, garso įrašu ar stambiu šriftu, kreipkitės: Jeśli potrzebują Państwo informacji od Rady Okręgu Moray w innym formacie, takim jak alfabet Braille'a, kasety audio lub druk dużą czcionką, prosimy o kontakt: Se necessitar de receber informações por parte do Concelho de Moray num formato diferente, como Braille, cassete áudio ou letras grandes, contacte: Ja Jums vajadzīga informācija no Marejas domes (Moray Council) citā valodā vai formātā, piemēram, Braila rakstā, audio lentā vai lielā drukā, sazinieties ar: ای نابز رگید یسک ےس لسنوک ےروم وک پآرگاتروص راکرد تامولعم ںیم لاثم ںوہ ˝ ،فورح ےڑب ای پیٹ ویڈآ ،ےلیربںیئامرف ہطبار رک امرف ینابرہم وت: Chief Financial Officer to the Moray Integration Joint Board, High Street, Elgin, IV30 1BX 01343 563125 accountancy.support@moray.gov.uk Page 8
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Moray Integration Joint Board Annual Accounts 2021/22 Table of Contents MORAY INTEGRATION JOINT BOARD MEMBERS ............................................................ 1 MANAGEMENT COMMENTARY .......................................................................................... 1 STATEMENT OF RESPONSIBILITIES ............................................................................... 23 REMUNERATION REPORT ............................................................................................... 25 ANNUAL GOVERNANCE STATEMENT ............................................................................. 29 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT ..................................... 39 MOVEMENT IN RESERVES STATEMENT ........................................................................ 40 BALANCE SHEET .............................................................................................................. 41 NOTES TO THE FINANCIAL STATEMENTS ..................................................................... 42 Note 1 Significant Accounting Policies ............................................................................. 42 Note 2 Critical Judgements and Estimation Uncertainty .................................................. 43 Note 3 Events after the Reporting Period ........................................................................ 44 Note 4 Expenditure and Income Analysis by Nature ........................................................ 44 Note 5 Taxation and Non-Specific Grant Income ............................................................. 45 Note 6 Debtors ................................................................................................................ 45 Note 7 Usable Reserve: General Fund ............................................................................ 46 Note 8 Agency Income and Expenditure .......................................................................... 47 Note 9 Related Party Transactions .................................................................................. 48 Note 10 VAT .................................................................................................................... 50 Note 11 Accounting Standards That Have Been Issued but Have Yet To Be Adopted .... 50 Page 9
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Moray Integration Joint Board Annual Accounts 2021/22 1 MORAY INTEGRATION JOINT BOARD MEMBERS Voting Members Cllr. Shona Morrison (Chair) Moray Council Dennis Robertson (Vice-Chair) The Grampian Health Board Sandy Riddell The Grampian Health Board Derick Murray The Grampian Health Board Professor Siladitya Bhattacharya The Grampian Health Board Cllr. Theresa Coull Moray Council Cllr. Frank Brown Moray Council Cllr. John Divers Moray Council Non-Voting Members Simon Bokor-Ingram Interim Chief Officer Tracey Abdy Chief Financial Officer Jane Mackie Chief Social Work Officer Jane Ewen Lead Nurse Dr Malcolm Metcalfe Deputy Medical Director Dr Lewis Walker Registered Medical Practitioner Heidi Tweedie tsiMoray Val Thatcher Public Partnership Forum Representative Ivan Augustus Carer Representative Steven Lindsay Grampian Health Board Staff Partnership Karen Donaldson UNISON, Moray Council Co-opted Members Sean Coady Head of Service and IJB Hosted Services Dr Paul Southworth Consultant in Public Health Professor Caroline Hiscox The Grampian Health Board Roddy Burns Moray Council Page 10
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Moray Integration Joint Board Annual Accounts 2021/22 2 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 the 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, three elected members from Moray Council and three Grampian Health Board members (one executive and two non-executives). 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 3 IJB’s within the 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) Out of Hours service. Key Purpose and Strategy Following review and consultation, our second Strategic Planning (2019-29) – Partners in Care was launched in December 2019. The current plan emphasises the strength of integration and in addition to our two main Partners – Moray Council and the Grampian Health Board, the MIJB recognises the importance of the Third and Independent Sectors 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. Page 11
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Moray Integration Joint Board Annual Accounts 2021/22 3 MANAGEMENT COMMENTARY (continued) STRATEGIC PLAN KEY THEMES The Plan purposefully places an emphasis on prevention activities and seeks to prioritise these activities as a long term goal, actively pursuing good health and wellbeing for the population, this will mean increased investment in this area of work. It highlights the HOMEFIRST 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. The response to Covid-19 has escalated elements of the HOMEFIRST approach. Through 21/22 the pandemic has driven a level of transformational change. This pace will need to continue in the next year and beyond as we face significant levels of demand. Our Strategic Plan will be refreshed in 22/23 and will be accompanied by a delivery plan to reflect the recovery phase that will be needed to deal with day to day demand and a backlog that has accumulated. 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 – Making choices and taking control over decisions 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-centred; care and compassion; safe, effective and responsive OUTCOMES: Lives are healthier – People live more independently – Experiences of services are positive – Quality of life is improved – Health inequalities are reduced – Carers are supported – People are safe – The workforce continually improves – Resources are used effectively and efficiently Page 12
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Moray Integration Joint Board Annual Accounts 2021/22 4 MANAGEMENT COMMENTARY (continued) 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. The area’s projected population for 2022 is 95,780. 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 5,000 and 10,000 are Forres, Buckie, Lossiemouth and Keith. Moray’s population has grown significantly in recent years from 87,160 in 1997. The population growth in Moray is slowing and it is projected that against the 2018 baseline1 Moray will be one of the 14 councils in Scotland who will have had a population decline by 2030. This trend is forecast to continue. The table below sets out projected population growth based on the 2018 baseline. Across Scotland there is a projected reduction in children, 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 age. 1 https://www.nrscotland.gov.uk/files//statistics/nrs-visual/sub-nat-pop-proj-18/pop-proj-principal-2018- infographic.pdf Page 13
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Moray Integration Joint Board Annual Accounts 2021/22 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 30 November this year and will be published on the Health & Social Care Moray website. The Coronavirus Act (Scotland) has made provision to delay the publication of this document as prior to Covid it was published by 31 July. 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 several reasons but quite often involves the onward provision of social care which can be complex in nature. The table below notes performance over a four year period showing the number of delayed discharge bed days occupied varying significantly and with minimal seasonal pattern up to March 2022. There was a significant reduction in delayed discharges in April to June 2020 onwards as the focus of the COVID-19 response in Moray was assessing and finding suitable support for those in hospital (specifically those ready for discharge) to allow for the anticipated influx of COVID-19 patients. After a sharp increase in quarter 2 of 2020-21 an immense amount of work was undertaken across the Moray system to improve the position, however the challenges in identifying capacity in the community to provide care for those who need it has proved extremely challenging. The impact of covid on existing staffing levels combined with the increasing needs identified in the community and the increase in elderly and frail people attending hospital and then requiring some form of assistance has resulted in increased delayed discharges and increased unmet need in the community. Despite these efforts the number per 1000 population of bed days occupied by Delayed Discharges was at its highest level for five years in March 2022. Improvements throughout the year include twice weekly (moving to daily when required) operational meetings to scrutinise the Delayed Discharge workflow, looking specifically at issues and implementing solutions. A new contract commenced in November 2021 for Care at Home service provision. A new model has been established where there is a primary provider who will work in close partnership with HSCM provider services. It is intended that this will increase stability in the market for care at home, enhance partnership working and facilitate our continued development of the outcome approach to commissioning. Page 14
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Moray Integration Joint Board Annual Accounts 2021/22 6 MANAGEMENT COMMENTARY (continued) Th The Number of Bed Days Occupied by Delayed Discharges 18+ per 1,000 population Jun 21 Sept 21 Dec 21 Mar 22 592 784 1,142 1,294 Jun 20 Sept 20 Dec 20 Mar 21 242 803 672 496 Jun 19 Sept 19 Dec 19 Mar 20 768 751 971 1,208 Jun 18 Sept 18 Dec 18 Mar 19 1,008 1,276 1,070 926 Jun 17 Sept 17 Dec 17 Mar 18 1,161 749 823 1,089 e Nu of Bed Days Occupied by Delayed Discharges (inc code 9) 18+ per 1,000 po In relation to Emergency occupied bed days, there continues to be a focus on ensuring people are getting home quickly and can maintain their independence. This had resulted in a long- term downward trend in the rate of emergency occupied bed days for over 65’s per 1,000 population from June 2017 to March 2021. However, the reduction of 18% in this rate from Mar 20 to Mar 21 was not maintained and levels are back up to that of March 2021. Rate of Emergency Occupied Bed Days for over 65’s per 1000 Population Jun 21 Sept 21 Dec 21 Mar 22 1,859 1,934 2,045 2,140 Jun 20 Sept 20 Dec 20 Mar 21 2,087 2,040 1,840 1,780 Jun 19 Sept 19 Dec 19 Mar 20 2,117 2,097 2,112 2,173 Jun 18 Sept 18 Dec 18 Mar 19 2,380 2,375 2,344 2,274 Jun 17 Sept 17 Dec 17 Mar 18 2,558 2,531 2,495 2,444 Covid 19 challenges and successes Throughout 2021/22, the IJB continued to deliver services in line with the Integration Scheme and Strategic Plan, however the planning and delivery of services remained impacted by the COVID pandemic. Some services remained temporarily paused whilst others rapidly adapted their delivery method and the majority of the non-frontline workforce continued to work from home. Page 15
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Moray Integration Joint Board Annual Accounts 2021/22 7 MANAGEMENT COMMENTARY (continued) For much of the year Moray remained in a pandemic response phase, flexing and stepping up quickly to respond to spikes in COVID infection rates. It was clear it would not be possible in all cases to restore services to pre-pandemic levels as long as enhanced public health measures remained in place. It was further evident that what could be delivered from within existing resources (workforce, infrastructure, and finance) was diminished. Even at this level, the requirement to operate core services alongside the additional measures in place to support the pandemic response meant there was an immediate and ongoing resource impact The health and social care system was challenged by some significant periods of demand. A pan-Grampian approach was taken in how surge and flow through the system was managed to ensure people in the community and in hospital received the care they required. Those working in health and social care in Moray across all sectors, including independent providers and the third sector stepped up to the challenge on a daily basis but have felt the negative effects of the pandemic on our communities more keenly than others. They have continued to respond with compassion, empathy and dedication in protecting and promoting people’s opportunities to have the best possible lives. By November, Grampian had experienced three waves of raised levels of COVID-19 infection and was currently in a fourth cycle of elevated disease which left the entire health and care system struggling to meet the normal level of performance despite the incredible efforts of a reduced and exhausted workforce. The social care sector in Moray faced continued periods of extreme pressure that had an impact on the wider community and the effectiveness and efficiency of health services. Service managers implemented business continuity arrangements to ensure available staff resources were focussed on maintaining business critical functions, particularly in care at home, to try to ensure that all essential care was covered. Page 16
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Moray Integration Joint Board Annual Accounts 2021/22 8 MANAGEMENT COMMENTARY (continued) One of our key challenges was effective communication and engagement with all of our stakeholders (public, staff and partner organisations). Weekly updates were produced and widely circulated. The reach of our social media platforms has expanded and the website continued to be utilised to promote information about the work of the IJB. Much of the focus of the last 12 months has been to consolidate learning and positive developments arising out of the pandemic. This included collaboration across the sector to mitigate negative impacts on the lives of individuals, families, communities and colleagues who worked tirelessly to support people, their unpaid carers and each other. Vaccination Programme Take-up of the COVID-19 vaccine was high among all cohorts in Moray. In April 2021, Phase 2 of the COVID- 19 vaccination programme for the over 18s progressed. The offer of vaccinations progressed by age, starting with those aged 40-49. In August, 16 and 17 year olds were invited to come forward for vaccination and in September the offer was extended to children and young people aged 12- 15. In February 2022 it was confirmed children aged five to 11 would be offered a COVID vaccine on the recommendation of the Joint Committee on Vaccination and Immunisation (JCVI). Thanks to the efforts of vaccinators and frontline staff, the Scottish Government met its target of offering every eligible adult over 18 an appointment by 30 December. Nearly 77% of eligible adults in Scotland had received a booster or third dose by that date. The Covid vaccination programme was primarily delivered at the Fiona Alcock Vaccination Centre in Elgin through appointments and walk-in opportunities, with pop-up outreach clinics held in workplaces and community venues as well as the Mobile Information Bus, to increase vaccine uptake among the vaccine hesitant in all cohorts Page 17
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Moray Integration Joint Board Annual Accounts 2021/22 9 MANAGEMENT COMMENTARY (continued) Longer Term Impact of Covid-19 and Wellbeing There was real concern that after such a sustained period of intense physically and emotionally draining work, staff’s own resilience had been badly hit, with the recognition that they would need support and opportunities to decompress, reflect and recharge in order to find the reserves required to continue to respond to ongoing and future challenges. The We Care staff health and wellbeing programme was established to deliver, co-ordinate and enhance staff wellbeing across NHS Grampian and the Health and Social Care Partnerships. The website acted as a hub where people could access information, help and advice related to their own and or their team’s physical and mental wellbeing. Recovery and Re-mobilisation Resource was directed into supporting people to look after themselves by encouraging good infection control, testing and vaccination, and to protecting the most vulnerable, including vulnerable care home residents. Waiting times for care and support grew longer due to sustained service pressures. Additional work was directed towards increasing capacity and planning ahead for winter. Operation Iris was enacted at a Grampian wide level for an initial six month period to manage the health and care system through winter, with the NHS continuing to operate on an emergency footing. The interdependencies between services formed part of the assessment on how we remobilised, as no part of the system operates in isolation. While demand on the health and care system continued to be immense, we remained focused on planning for the longer term to ensure that services remained responsive to the community. Work on developing some areas of strategic and locality planning slowed as operational issues continued to be prioritised, but we also saw the acceleration of transformational redesign around the Home First programme alongside the opportunities presented by an expanded portfolio of health and care that now encompasses Dr Gray’s Hospital. Changes to Business as Usual Activities/ Transformation Care home and care at home assurance groups continued to meet to provide oversight and support to internal and external social care providers within the context of Covid in Moray. The group monitored information with an overview of cases staffing, safety, PPE, testing and any other pertinent issues. This is a multi-agency group that has supported and guided care homes and care at home in a positive way through the ongoing challenges Page 18
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Moray Integration Joint Board Annual Accounts 2021/22 10 MANAGEMENT COMMENTARY (continued) Care home and care at home assurance groups continued to meet to provide oversight and support to internal and external social care providers within the context of Covid in Moray. The group monitored information with an overview of cases staffing, safety, PPE, testing and any other pertinent issues. This is a multi-agency group that has supported and guided care homes and care at home in a positive way through the ongoing challenges. A new model of care at home has been implemented since October 2021. Health & Social Care Moray commissioned a single care at home external partner to jointly deliver an outcome based care at home service across Moray. Since its establishment, Health & Social Care Moray has liaised and worked closely with both NHS Grampian and Moray Council, along with other resilience partners, to ensure that the duties of Category 1 responders are adhered to. Following an amendment to legislation, IJBs are now included within the within the Civil Contingencies Act 2004 as Category 1 responders Longer Term Changes to Strategies and Plans Strategic planning has been delayed due to operation matters in response to the pandemic taking priority. The Strategic Planning and Commissioning Group (SPCG) was re- established in September 2021 and began to oversee the development of key programmes of work across the interfaces between primary, secondary and social care, developing the locality planning approach and coordination of the many enabling elements upon which planning and delivery of services is reliant. Locality planning resumed with intelligence gathering to inform locality profiles. Locality managers agreed terms of reference for the locality steering groups which will involve stakeholders developing approaches to community engagement to identify local health and wellbeing priorities for improvement. Locality engagement work commenced in the Lossiemouth area to consider future health and wellbeing provision and the impact on patients of the continued closure of the GP branch surgery buildings in Hopeman and Burghead Page 19
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Moray Integration Joint Board Annual Accounts 2021/22 11 MANAGEMENT COMMENTARY (continued) The strategic plan Moray Partners in Care was published in 2019 and it is recognised that the health and social care landscape has changed considerably since then. A refresh of the plan is essential to set the approach for the next 10 years. The revised plan – to be published in 2022 - will set out clearly our aims and objectives to the public and our workforce, building on what has already been achieved Other Impacts on services In November 2021, Moray was hit by Storm Arwen at one of the coldest periods of the year. All partners deployed an emergency response to power outages, road closures, water supply issues and the risk of flooding. Health & Social Care Moray and the local authority took action to ensure vulnerable residents were safe in their homes and access to hot food or had alternative accommodation. Throughout the stormy weather and despite access issues, staff worked diligently to ensure critical services were maintained. The Future Moray continued to progress the Home First approach to supporting people to avoid unnecessary hospital admission and to return home, wherever possible, without delay. This work has developed into Hospital without Walls, an ambitious model involving all aspects of Home First alongside unscheduled care, primary/secondary care and acute services. Hospital without Walls will offer hospital-level care to patients who are acutely unwell in their own home. It will establish a suite of responsive, co-ordinated, multi-disciplinary care supporting older people with frailty and multi-morbidity. Initial effort has been concentrated on developing a Home First Frailty Team who will be primarily focused at the ‘front door’ of Dr Gray’s Hospital but will also offer support within the community. The multi-disciplinary team will provide rapid geriatric assessments and allow a quick turnaround of those presenting at the front door. This will combine elements of the Discharge to Assess service which is now embedded into the system and provides an intermediate support approach for hospital in-patients who are medically stable and do not require acute hospital care but may still require rehabilitation. They are discharged home with short-term support to be fully assessed for longer-term needs in their own home. The IJB responded to the Scottish Government’s consultation on a National Care Service for Scotland following the recommendation of the Independent Review of adult social care. The National Care Service would operate as a new body to oversee social care, similar to how the National Health Service oversees health, enabling social care to have a more equal footing with health care. Page 20
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Moray Integration Joint Board Annual Accounts 2021/22 12 MANAGEMENT COMMENTARY (continued) It proposes that Local Integration Authorities would have more powers and would be directly funded by national government, rather than receiving their funding from local authorities and Health Boards as they do at the moment. Officers continued to work on developing the business case for the delegation of Moray Children’s Social Work and Criminal Justice to the IJB. Moray Council and NHS Grampian have now agreed the delegation, the next step to update the Integration Scheme and get approval from the Scottish Government. 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 mid-point in the financial year, the Board was presented with financial information that included a forecast position to the end of the year. In November 2021 the Board received a financial report which forecast an expected overspend to the end of the financial year of £2.3m. This forecast reduced throughout the remainder of the year and in December 2021, MIJB were forecasting a small underspend to the end of the year of £0.2m. In March 2021, the MIJB agreed a savings plan of £0.407m. At the end of the financial year, only £0.11m had not been achieved. Scottish Government additional funding was made available that covered the underachievement on the savings target and £0.11m was received as part of Covid funding. Given the uncertainties associated with Covid-19, 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. To support the response to Covid-19, the Scottish Government developed a process to assess the impact of Covid on Integration Authorities’ budgets. They did this through the development of local mobilisation plans for each health board area, which in turn captured each Integration Authority. The objective was to demonstrate the impact on IJB budgets and provide appropriate financial support. The local mobilisation plans were updated regularly throughout the year and funding allocations were made by the Scottish Government on the basis of these updates. At the end of the financial year, the cost of the mobilisation plan for Moray was £5.2m, this included £0.11m for the underachievement of the approved savings plan. The largest element of spend was £3.18m which was used to support sustainability payments to external providers of care. Any unspent funds are held in an earmarked reserve and drawn down as appropriate for the continued support to the pandemic response and recovery. Additional detail on the areas of spend supported through Covid-19 funding is highlighted in the table below: Page 21
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Moray Integration Joint Board Annual Accounts 2021/22 13 MANAGEMENT COMMENTARY (continued) Description Spend to 31 March 2022 £000’s Additional Staffing Costs 160 Provider Sustainability Payments 3,176 Remobilisation 1,178 Cleaning, materials & PPE 90 Elgin Community Hub 556 Prescribing 154 Other (244) Additional Capacity in Community 17 Underachievement of Savings 110 Total 5,197 Service Area Budget £000’s Actual £000’s Variance (Over)/ under spend Note Community Hospitals 5,494 5,477 17 Community Health104,360 5,490 4,932 558 4 Learning Disabilities 8,264 9,691 (1,427) 2 Mental Health 9,267 9,542 (275) Addictions 1,282 1,259 23 Adult Protection & Health Improvement 151 158 (7) Care Services Provided In-House 17,215 16,238 977 3 Older People Services & Physical & Sensory Disability 19,014 20,536 (1,522) 1 Intermediate Care & OT 1,524 1,828 (304) 5 Care Services Provided by External Contractors 8,540 8,271 269 Other Community Services 8,576 8,460 116 Administration & Management 2,400 2,404 (4) Other Operational Services 1,176 1,192 (16) Primary Care Prescribing 17,416 18,310 (894) Primary Care Services 18,278 18,307 (29) Hosted Services 4,619 4,632 (13) Out of Area Placements 669 832 (163) Improvement Grants 940 758 182 Total Core Services 130,315 132,827 (2,512) Strategic Funds & Other Resources 27,470 7,937 19,533 TOTALS (before set aside) 157,785 140,764 17,021 Page 22
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Moray Integration Joint Board Annual Accounts 2021/22 14 MANAGEMENT COMMENTARY (continued) The table above summarises the financial performance of the MIJB by comparing budget against actual performance for the year. MIJB’s financial performance is presented in the comprehensive income and expenditure statement (CIES), which can be seen on page 39. At 31 March 2022 there were usable reserves of £17.02m available to the MIJB, compared to £6.34m at 31 March 2021. These remaining reserves of £17.02m are for various purposes as described below: Earmarked Reserves Amount £000’s Action 15 72 Primary Care Improvement Plan 2,259 Covid-19 9,016 GP Premises 232 Moray care home infection control 223 Community Living Change Fund 319 National Drugs MAT 103 National Drugs Mission Moray 207 OOH Winter Pressure funding 202 Moray Cervical screening 110 Moray hospital at home 199 Moray interface discharge 205 Moray School nurse 46 Moray Psychological 492 MHO Funding 51 Care at Home Investment funding 656 Interim Care Funding 695 Moray Workforce well being 54 Moray Winter Fund HCSW 256 Moray Winter Fund MDT 367 Total Earmarked 15,764 General Reserves 1,257 TOTAL Earmarked & General 17,021 Page 23
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Moray Integration Joint Board Annual Accounts 2021/22 15 Action 15 – as part of the Mental Health Strategy 2017-2027, Scottish Government Ministers made a commitment to provide funding to support employment of 800 additional mental health workers to improve access. Primary Care Improvement Plan – Scottish Government investment to support the GP contract that was agreed in 2018. Covers 6 priority areas identified by Government. Covid 19 - additional funding provided by Scottish Government to address the impacts of the pandemic. 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. Community Living Change Fund – funding to be used over a three year period (2021-2024) to support reducing delayed discharge of those with complex needs, repatriate people inappropriately placed outside Scotland and to redesign the way service are provided for people with complex needs. Care Home Infection Control – to support Care Homes through the pandemic. 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 Interface Care & Discharge without Delay (DWD)- interface care programme is part of the urgent and unschedules care programme. DWD programme is to prevent delay and reduce length of stay. Moray School Nurse – balance of school nursing programme for additional school nurses. 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. Care at Home investment funding – balance of funding to build capacity in care at home community based services. Interim Care funding – balance of non-recurring funding basis to enable patients currently in hospital to move into care homes and other community settings. Page 24
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Moray Integration Joint Board Annual Accounts 2021/22 16 MANAGEMENT COMMENTARY (continued) Moray Workforce Wellbeing – funding to the health and wellbeing of those working in health and social care. 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. All reserves are expected to be utilised for their intended purpose during 2022/23. Significant variances against the budget were notably: Note 1 Older People Services and Physical & Sensory Disability - This budget was overspent by £1.5m at the end of the year. The final position includes an overspend for domiciliary care in the area teams, which incorporates the Hanover complexes for very sheltered housing in Forres and Elgin and for permanent care due to more clients receiving nursing care than residential care. The ageing population requiring more complex care and local demographics also contributes to this overspend. Note 2 Learning Disabilities – The Learning Disability (LD) service was overspent by £1.4m at the end of 2021-22. This consists of a £1.5m overspend, primarily relating to day services and the purchase of care for people with complex needs. Adults with learning disabilities are some of the most vulnerable people in our community and need a high level of support to live full and active lives. The overspend was offset in part by an underspend of £0.1m, relating primarily to staffing in speech and language and psychology services. The transformational change programme in learning disabilities helps to ensure that every opportunity for progressing people’s potential for independence is taken, and every support plan involves intense scrutiny which in turn ensures expenditure is appropriate to meeting individual outcomes. Note 3 Care Services Provided In-House – This budget was underspent by £1.0M at the end of the year. The most significant variances relate to the Care at Home services for all client groups and the Supported Living services which are underspent predominantly due to vacancies and issues with recruitment and retention. Overspends in internal day services £0.1m mainly due to transport costs and less income received than expected. Note 4 Community Health – This budget was underspent overall by £0.6m at the end of 2021-22 and is primarily due to vacancies, unplanned leave and retirements. Recruitment and retention is an issue, which is not just apparent in Moray and a plan is currently in place to deal with this going forward. Note 5 Intermediate Care & Occupational Therapy (OT) – This budget was overspent by £0.3m. This relates primarily to OT equipment where costs have increased due to manufacturing and supply to Moray and more complex equipment requests . Page 25
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Moray Integration Joint Board Annual Accounts 2021/22 17 MANAGEMENT COMMENTARY (continued) Set Aside – Excluded from the financial performance table above on page 14 but included within the Comprehensive Income & Expenditure Account is £13.04m 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. As a result of prioritising resources to support the Covid pandemic Public Health Scotland have not produced activity data for Set Aside services for the 2019/20 or 2020/21 financial years. The figures for 2021/22 have been derived by uplifting 2019/20 figures by baseline funding uplift in 2020/21 (3.00%) and 2021/22 (3.36%): 2021/22 2020/21 2019/20 2018/19 Budget 13.04m 12.62m 12.252m 11.765m Number of Bed Days and A&E Attendances -------- ------- ------- 47,047 Page 26
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Moray Integration Joint Board Annual Accounts 2021/22 18 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 each meeting of the 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: VERY HIGH Risk 2 - There is a risk of MIJB financial failure in that the demand for services outstrips available financial resources. Financial pressures being experienced both by the funding Partners and Community Planning Partners will directly impact on decision making and prioritisation of MIJB. Mitigating Actions - Risk remains of the challenge that the MIJB can deliver transformation and efficiencies at the pace required. Financial information is reported regularly to both the MIJB, Senior Management Team and System Leadership Group. The Chief Officer and Chief Financial Officer (CFO) continue to engage in finance discussions with key personnel of both NHS Grampian and Moray Council. These conversations have continued throughout the Covid-19 pandemic. The Chief Officer and CFO will continue to engage with the partner organisations in respect of the financial position throughout the year. Cross partnership performance meetings are in place with partner CEOs, Finance Directors and the Chair/Vice Chair of the MIJB. The CFO and Senior Management Team have worked together to address further savings which will be presented to the Board for approval as part of the budget setting procedures for 2022/23. This should be a focus of continuous review to ensure any investment is made taking cognisance of existing budget pressures. Page 27
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Moray Integration Joint Board Annual Accounts 2021/22 19 MANAGEMENT COMMENTARY (continued) HIGH Risk 1 - The Integration Joint Board (IJB) does not function as set out within the Integration Scheme, Strategic Plan and Scheme of Administration and fails to deliver its objectives or expected outcomes. Inability to recruit and retain qualified and experience staff to provide and maintain sustainable, safe care. Mitigating Actions - Induction sessions are held for new IJB members and IJB members briefings are held regularly. Conduct and Standards training was held for IJB members in December 2020 with update provided by Legal Services as appropriate. Senior Management Team (SMT) regular meetings and directing managers and teams to focus on priorities. Regular development sessions are held with IJB and System Leadership Group (SLG) Strategic Plan and locality management structure is in place The work that has been progressed through the Covid19 response has escalated developments in some areas as a matter of priority. This has been achieved through collaborative working with partner organisations and the third sector Risk 3 - Inability to recruit and retain qualified and experience staff to provide and maintain sustainable, safe care. Mitigating Actions - System re-design and transformation. Organisational Development Plan and Workforce plan were updated and approved by MIJB in November 2019 and they are being progressed by the Workforce Forum. Workforce planning has recommenced alongside plans for NShG and Moray Council and an initial draft will be submitted to Senior Management Team 8 June 2022. Staff Wellbeing is a key focus and there are many initiatives being made available to all staff including training, support, information and access to activities. Locality Managers are developing the Multi-disciplinary teams in their areas and some project officer support has been provided to develop the locality planning model across Moray. Lead Managers are involved in regional and national initiatives to ensure all learning is adopted to improve this position. They are also linked to University Planning for intakes and programmes for future workforce development Page 28
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Moray Integration Joint Board Annual Accounts 2021/22 20 MANAGEMENT COMMENTARY (continued) HIGH (continued) Risk 5 - Inability to cope with unforeseen external emergencies or incidents as a result of inadequate emergency and resilience planning. Mitigating Actions – Information from the updated Business Impact Assessments /Business Continuity Plans has informed elements of the Winter Preparedness Plan (Surge plan). A Friday huddle is in place which gathers the status of services across the whole system to provide information and contact details to the Senior Manager on Call (SMOC) over the weekend. NHS Grampian have introduced system wide daily huddles to manage the flow and allocation of resources which require attendance from Dr Grays and HSCM. NHS Grampian have amended their approach to Pandemic preparation so HSCM Pandemic plan requires redrafting and testing. Practitioner group established for Moray with representation from HSCM, Dr Grays, Moray Council and NHS Grampian to discuss matters arising from the Local Resilience Forum and within our respective organisations. In addition it will provide a forum for discussion of the linkages between organisational response plans to ensure there are no gaps or over reliance on particular local resources. HSCM represented at Grampian Local Resilience Partnership meetings and working groups and at NHSG Civil Contingencies group to ensure that plans are aligned and networks are established and maintained for use to support a response. Risk 7 - Inability to achieve progress in relation to national Health and Wellbeing Outcomes. Performance of services falls below acceptable level. Mitigating Actions – Service managers monitor performance regularly within their teams and escalate any issues to the System Leadership Group (SLG) for further discussion to provide wider support, developing shared ownership and a greater understanding across the whole system. Key operational performance data is being circulated daily to all managers in the Daily dashboard to ensure any potential issues are identified quickly so action can be taken. This dashboard is being reviewed and will be further developed with the intention of further dashboards to provide a whole system overview. This has been discussed at SLG and agreed. Performance information is presented to the Performance sub group of Practice Governance Group to inform Social Care managers of the trends in service demands so that resources can be allocated appropriately. Page 29
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Moray Integration Joint Board Annual Accounts 2021/22 21 MANAGEMENT COMMENTARY (continued) HIGH (continued) Risk 8 - Inability to progress with delivery of Strategic Objectives and Transformation projects. Mitigating Actions - Integrated Infrastructure Group previously established, with ICT representation from NHS Grampian and Moray Council, to consider and provide solutions to data sharing issues and ICT infrastructure matters. Linkages to Infrastructure Board and information sharing groups had been established albeit these meetings are not taking place regularly at the moment. Data sharing groups for Grampian and Health and Social Care Moray were established and meetings were held regularly but have not taken place regularly during Covid. These meetings have oversight of any issues arising from Data protection and GDPR matters from either Council or NHS systems. During covid the issues have been dealt with as they arose Risk 9 - Requirements for support services are not prioritised by NHS Grampian and Moray Council. Mitigating Actions – Membership of the Board was reviewed and revised to ensure representation of all existing infrastructure processes and funding opportunities. Process for ensuring infrastructure change/investment requests developed. Infrastructure Manager in post and linking into other Infrastructure groups within NHS Grampian and Moray Council to ensure level of ‘gatekeeping’. Dr Gray’s site development plan is being produced collaboratively with input from NHS Grampian and HSCM management. Work is progressing on identification of needs for some services with regard to accommodation which will be communicated with partners to find the most effective solution Development Aims for 2022/23 HOME FIRST The planning and delivery to meet the threat of Covid-19 has led to some rapid change and has created a new starting point. Home First continues to be the key strategic theme/over- arching project to embed change going forwards, to ensure that in a new environment we can continue to meet health and care needs safely, and can react to further waves of Covid-19; winter pressures; and future unknown events. Developing from last year’s Operation Home First, Moray has continued to mature it’s Home First work streams whilst also ensuring they are targeted and coordinated. In an effort to explore the entire patient pathway Hospital without Walls was devised. This programme will ensure there is a suite of responsive, seamless, coordinated, multi-disciplinary care supporting older people with frailty and multi-morbidity. Hospital without Walls pulls together the individual work streams under Home First whilst also considering unscheduled care, primary and secondary care services. Page 30
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Moray Integration Joint Board Annual Accounts 2021/22 22 MANAGEMENT COMMENTARY (continued) As a result of the Covid 19 activity and diversion, the Strategic Plan 2019-29, the Medium Term Financial Strategy and other supporting plans are due to revisited in 22/23. As the organisation continues to remobilise following the impacts of response, new, transformational ways of working are being adopted and are informing our approach to delivery of the strategic objectives outlined in the plan. In addition we will seek to: • Continue to develop systems leadership with a Portfolio approach; • Further embed Home First and develop Hospital without walls; • Ensure successful embedding of Discharge to Assess and how it interfaces with other services in support of reducing Delayed Discharges; • Continually develop by progressing the MIJB Improvement Action Plan measured against the Ministerial Strategic Objectives; • Ensure compliance with the Governance Framework as approved by the MIJB in January 2021; • Progress the Primary Care Improvement Plan; and • Embed recommendations from the Independent Review of Adult Social Care, and continue to embed Self Directed Support into mainstream activities. • Progress Housing development for people with a Learning Disability. ………………………… ……………………… ……………………… Cllr. Tracy Colyer Simon Bokor-Ingram Deborah O’Shea Chair of Moray IJB Chief Officer Interim Chief Financial Officer 30 June 2022 Page 31
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Moray Integration Joint Board Annual Accounts 2021/22 23 STATEMENT OF RESPONSIBILITIES Responsibilities of the MIJB • To make arrangements for the proper administration of its financial affairs and to secure that it has an officer responsible 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 the Local Authority (Capital Financing and Accounting) (Scotland) (Coronavirus) Amendment Regulations 2021, 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. Cllr. Tracy Colyer Chair of Moray IJB 30 June 2022 Page 32
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Moray Integration Joint Board Annual Accounts 2021/22 24 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 Annual Accounts in accordance with proper practices as required by legislation and 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 which 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 2022 and the transactions for the year then ended Deborah O’Shea FCCA Interim Chief Financial Officer 30 June 2022 Page 33
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Moray Integration Joint Board Annual Accounts 2021/22 25 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 the 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 2020/21 Name Position Held Nomination By Taxable Expenses 2021/22 £ £ - Dennis Robertson Vice-Chair 29/04/21 to date Chair 24/09/20 to 29/04/21 Grampian Health Board - - Cllr Shona Morrison Chair 29/04/21 to date Vice-Chair 01/10/19 to 29/04/2021 Moray Council - Page 34
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Moray Integration Joint Board Annual Accounts 2021/22 26 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 2020/21 Senior Employees Salary, Fees & Allowances Total 2021/22 £ £ £ 96,115 Simon Bokor-Ingram Chief Officer 109,826 109,826 87,271 Tracey Abdy Chief Financial Officer 93,904 93,904 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. NOTE: no bonuses, expenses allowances, compensation for loss of office or any taxable benefits were made in 2021/22 Page 35
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Moray Integration Joint Board Annual Accounts 2021/22 27 REMUNERATION REPORT (continued) In Year Pension Contributions Accrued Pension Benefits Year to 31/03/21 Year to 31/03/22 As at 31/03/2022 Difference from 31/03/2021 £ £ £ 000’s £ 000’s Simon Bokor- Ingram, Chief Officer 13,142 (from 20/4/20) 12,954 Pension 43 5 Lump Sum 87 7 Tracey Abdy Chief Financial Officer 18,075 18,561 Pension 20 2 Lump Sum 18 - 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 2020/21 Remuneration Band Number of Employees in Band 2021/22 1 £85,000 - £89,999 - - £90,000 - £94,999 1 1 £95,000 - £99,999 - - £105,000 - £109,999 1 Page 36
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Moray Integration Joint Board Annual Accounts 2021/22 28 REMUNERATION REPORT (continued) Exit Packages There were no exit packages agreed by the MIJB during 2021/22 financial year, or in the preceding year. ……………………….. ……………………… Cllr. Tracy Colyer Simon Bokor-Ingram Chair of Moray IJB Chief Officer 30 June 2022 Page 37
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Moray Integration Joint Board Annual Accounts 2021/22 29 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/ Key Governance Arrangements Covid-19 has had a significant impact on the MIJB and its approach to dealing with the pandemic has involved the use of amended governance arrangements granted under delegated powers. Page 38
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Moray Integration Joint Board Annual Accounts 2021/22 30 ANNUAL GOVERNANCE STATEMENT (continued) All of the scheduled Audit Performance and Risk Committee meetings were held as timetabled during 2021/22. An interim arrangement was agreed for the operation of the Clinical and Care Governance Committee whereby the Chair of the Committee received monthly updates on the key issues arising during the pandemic response. This related principally to the provision of care, care home oversight and child and adult protection matters. In addition the Chief Officer committed to providing weekly updates on the emerging situation to IJB Members, elected Members and staff. Health and Social Care Moray (HSCM) established an emergency response group that has been operational since the end of March 2020, with the frequency of meetings being adapted throughout the year dependent on the stage of response. Representation on the emergency 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. The collaborative working across the whole system increased with the Omicron wave of Covid as the impact on staffing levels and demand for services put extreme pressure on all aspects of service delivery. Up to three times daily meetings were held 7 days a week to ensure a co- ordinated response. In addition 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 directed by a Board comprising voting and non-voting members. The Board meets every two months and draws its membership from a broad range of sources. Formal Board meetings are augmented by regular development sessions that focus in detail on specific areas. The Board is also supported by an Audit, Performance and Risk Committee, and a Clinical and Care Governance Committee, each with a specific remit to support effective governance arrangements. The Scheme of Integration was reviewed during 2021 to increase by one voting member from each partner organisation to facilitate increased membership at the Committees • The MIJB operates in line with Standing Orders that govern proceedings of the Board and its Committees, and which incorporates the Board’s Scheme of Administration that deals with the Board’s committee structure and working groups. • The MIJB has appointed a Standards Officer to support compliance with an ethical standards framework in line with the Ethical Standards in Public Life etc. (Scotland) Act 2000 whereby members of devolved public bodies such as the MIJB are required to comply with Codes of Conduct, approved by Scottish Ministers, together with guidance issued by the Standards Commission. . Page 39
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Moray Integration Joint Board Annual Accounts 2021/22 31 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 2 – Ensuring openness and comprehensive stakeholder engagement Assessment of Effectiveness • Provision is made within MIJB’s Standing Orders for public and press access to meetings and reports. During the 2021/22 year there was a continued need to broadcast live Board meetings with attendance being virtual for all. A specific web- site has been developed for Health and Social Care Moray and is continuously monitored for improvement. Agendas, reports and minutes for all committees can be accessed via the website in addition to all the linked 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. 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 four 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 has in place a Strategic Plan 2019-29 which is supported by various documents including a medium term financial framework. Following the impact of the pandemic a review is planned for both documents. • The plan is underpinned by a performance framework, workforce plan, organisational development strategy, and a communications, engagement and participation plan. Initial work has commenced for an updated workforce plan due for completion by July 2022 • The suite of documents are designed to identify outcomes and forward-thinking on direction over the medium term. Outcomes are closely linked to the delivery of health and social care and the planned improvements for the population of Moray. • A climate change duties report is collated and submitted annually on behalf of the MIJB. Page 40
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Moray Integration Joint Board Annual Accounts 2021/22 32 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 4 – Determining the interventions necessary to optimise the achievement of intended outcomes Assessment of Effectiveness • The MIJB’s decision making process ensures that the members of the Board receive objective and robust analysis of a variety of options indicating how the intended outcomes will be achieved, providing information on the associated risks and opportunities. • Board papers reflect the broad range of matters under consideration including regular update reports by the Chief Officer on topical matters and agenda items covering opportunities and challenges arising from reconfiguration of services. • The Financial Management Code promoted by CIPFA is recognised as a means of assisting in ensuring good financial administration. A medium term financial strategy was approved by the MIJB in March 2022 and will be reviewed in the new financial year, once the strategic plan has been reviewed. Governance Principle 5 – Developing the entity’s capacity, including the capability of its leadership and the individuals within it Assessment of Effectiveness • The Senior and Operational Management teams were due to continue to take part in a Systems Leadership Programme led by The Kings Fund to support the leadership teams however this has been further paused for the Covid 19 response. During the Covid 19 response there has been increased opportunity to work collaboratively across organisations through use of new technology. • The MIJB has met with Officers regularly for development sessions to increase the opportunity for shared learning and constructive challenge. Page 41
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Moray Integration Joint Board Annual Accounts 2021/22 33 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 is reviewed and updated regularly and presented to every Audit, Performance and Risk Committee. A related action log was created for monitoring purposes and is owned and monitored by the Senior Management Team. • A Performance Management Framework has been developed. Performance reporting falls within the scope of the Audit, Performance and Risk Committee and reporting is quarterly. • The internal control system links closely with those of the Partners, given their operational remit for delivery of services 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 has an independent S95 Officer who is a member of the MIJB, providing advice on all financial matters and ensure timely production and reporting of budget estimates, budget 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, etc. 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. During the year, recordings of Board meetings were made available to the public. Agendas, reports and minutes are available for the public to inspect. There is a standard reporting format in place to ensure consistency of approach and consideration by Members to provide transparency in decision making. • The MIJB publishes both Annual Accounts and an Annual Performance Report following Board approval. • The Chief Internal Auditor reports directly to the Audit, Performance and Risk committee with the right of access to the Chief Officer, Chief Financial Officer and Chair of the Audit, Performance and Risk committee on any matter. The Chief Internal Auditor has continued to report to Committee during 2021/22. Page 42
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Moray Integration Joint Board Annual Accounts 2021/22 34 ANNUAL GOVERNANCE STATEMENT (continued) 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 The Internal Audit Service for the MIJB is delivered by Moray Council’s Internal Audit Section, and the Council’s Audit and Risk Manager holds the Chief Internal Auditor appointment to the MIJB until the 31st of March 2024. The Council’s Internal Audit Section has adopted the Public Sector Internal Audit Standards (PSIAS) that 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. In addition, reports issued by other external review agencies are considered in the opinion provided by the Chief Internal Auditor. In accordance with PSIAS, the Chief Internal Auditor prepares a risk based Audit Plan for the MIJB, which has regard to the internal audit arrangements of both the Moray Council and NHS Grampian functions. The impact of the pandemic continued to affect the Internal Audit Section in that officers have been working from home with a need to change established working practices and make greater use of audio, video, and screen sharing software applications. In addition, the Section has also had several staff vacancies during the year. Despite these constraints, the Audit Plan for 2021/22 was completed. The audits reported to the MIJB Audit, Performance and Risk Committee included a review of the financial monitoring arrangements within the Self Directed Support Team for direct payments made to service users. The audit found several areas where improvements were required to current operating systems and procedures, including a need to review all the care packages of the service user to recover any excess funds. An audit report was also received into the management arrangements of income held for individuals under Corporate Appointeeship Arrangements. The review found that the service was administered well, but findings were noted, including a need to review cash handling procedures and further management overview of the corporate bank account reconciliation process. Page 43
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Moray Integration Joint Board Annual Accounts 2021/22 35 ANNUAL GOVERNANCE STATEMENT (continued) However, the Chief Internal Auditor has raised concerns regarding a report to the Audit, Performance and Risk Committee on the 31st of March that detailed the outcome of a review of the Health and Social Care Moray Commissioning Service into how social care contracts are currently being managed. This was a “peer” review led by the Strategic Procurement Manager (Social Care) of Aberdeen City and Aberdeenshire Councils. The report has highlighted a number of significant concerns about how social care contracts are managed. The Audit, Performance and Risk Committee have agreed for an external organisation to undertake a review of the Commissioning Service. The Chief Internal Auditor, after consideration to the results of the work carried out by Internal Audit, taken together with other sources of assurance, with specific reference to the peer review into how the Commissioning Service manages social care contracts; only limited assurance can be provided that the Moray Integration Joint Board has adequate systems of governance and internal control, for the year ended 31 March 2022. Page 44
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Moray Integration Joint Board Annual Accounts 2021/22 36 ANNUAL GOVERNANCE STATEMENT (continued) Prior Year Governance Issues The Annual Governance Statement for 2020/21 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 2020/21 Action Undertaken / Progress Made in 2021/22 It is recognised that the impact the pandemic has had on services drives the need to review the Strategic Plan 2019-29 during 2021/22. The review will require engagement of key stakeholders and MIJB approval following the governance framework. The Medium Term Financial Framework will be reviewed to reflect the emerging and anticipated financial challenge arising from Covid 19 and Scottish Government policy changes Focus will be placed on the Governance Framework approved by the Board in January 2021 to ensure this key document is embedded into operational and strategic delivery As part of the financial challenge it is necessary to ensure continuous dialogue and identification of further savings opportunities. This was a commitment made as part of the revenue budget setting for 2021/22, recognising current and future impact and the drive for transformation through Home First. Increase focus on the development of commissioning capabilities to deliver best value with a tender exercise for outcome based care at home services. The Strategic plan is being refreshed and will be presented to the IJB in November 2022. The Moray Portfolio is also working with NHS Grampian on their plan for the future, and will be undertaking a joint planning process in 2022 to define the future for Dr Grays Hospital. The Medium Term Financial Framework 22/23 to 26/27 was presented to the IJB in March 2022. It will be reviewed once the Strategic plan has been refreshed. The Governance Framework continues to be embedded. Portfolio arrangements will mean a refresh is required. Transformational redesign has continued at pace. Levels of demand, including backlogs post Covid, has resulted in it being more challenging to identify cash savings. Outcome based commissioning model in place, with evaluation in 2022/23. Further development of Self Directed Support and progressive changes to practice using the Three Conversation Model Page 45
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Moray Integration Joint Board Annual Accounts 2021/22 37 ANNUAL GOVERNANCE STATEMENT (continued) 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 2022/23 1. Extending the Hospital Without Walls model to move care closer to home, with a shift to earlier intervention that reduces the demands on acute hospital care. 2. Developing the Portfolio approach for the Moray Portfolio, and the interlink with the other Portfolios in Grampian, along with developing the governance framework for this whole system approach 3. Refresh the Strategic Plan during 2022, building on the learning of the last 2 years of the pandemic, and the transformational change that has begun 4. Using the 22/23 to 26/27 Medium Term Financial Framework to match the ambitions of the Strategic Plan so that services are sustainable 5. Work with the Digital Health and Care Innovation Centre as part of the Moray Growth Deal to test new ways of working that benefit the Moray population and bring improvements to the delivery of health and social care 6. Continue to extend the reach of Self Directed Support with an ambition for Moray to be an exemplar in this arena of supporting our residents in innovative ways that promote independence and choice 7. With the potential delegation of Children’s Social Work and Criminal Justice to the Moray IJB, better align service delivery in the Portfolio to the benefit of our residents, where care is seamless and access is clear Key Governance challenges going forward will involve: • Providing capacity to meet statutory obligations whilst managing expectation and rising demand for services, with a backlog of demand from the pandemic, and wider societal economic challenges which will also drive demand; • As a Board, difficult decisions will require to be made in ensuring we operate within available funding whilst meeting the needs of our residents; • Continue to address our work force challenges in respect of recruitment and retention; Page 46
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Moray Integration Joint Board Annual Accounts 2021/22 38 ANNUAL GOVERNANCE STATEMENT (continued) • Continuing to work closely with NHS Grampian and Moray Council to build on existing relationships and establishing collaborative leadership, and to maximise the opportunities from an expanded health and social care remit with the Portfolio approach, including Dr Grays hospital, and the potential delegation to the IJB of Children’s Social Work and Criminal Justice Services; • The challenges being faced from the pandemic are expected to be a continued focus for additional scrutiny for an extended period of time, and how well we manage the recovery of service delivery. 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 immediate challenge will be to continue to meet all operational demands as we continue to recover from the Covid-19 Pandemic and through re-mobilisation whilst not compromising the safety of employees and people that use our services; beyond that, pressure on financial settlements is set to continue during the incoming period, and we will continue to engage with our Partners and the wider community to agree plans and outcome targets that are both sustainable and achievable. Taking those forward will be challenging as we aim to fulfil the nine Health and Wellbeing national 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. ………………………… ……………………… Cllr. Tracy Colyer Simon Bokor-Ingram Chair of Moray IJB Chief Officer 30 June 2022 Page 47
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Moray Integration Joint Board Annual Accounts 2021/22 39 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT This statement shows the cost of providing services for the year ended 31 March 2022 according to generally accepted accounting practices. 2020/21 2021/22 Net Expenditure Net Expenditure Restated £ 000 £ 000 5,587 Community Hospitals 5,477 4,853 Community Nursing 4,932 8,546 Learning Disabilities 9,691 8,649 Mental Health 9,542 1,143 Addictions 1,259 152 Adult Protection & Health Improvement 158 15,183 Care Services Provided In-House 16,238 19,835 Older People & Physical & Sensory Disability Services 20,536 1,497 Intermediate Care and Occupational Therapy 1,828 8,067 Care Services Provided by External Providers 8,271 7,725 Other Community Services 8,460 3,033 Administration & Management 2,404 871 Other Operational services 1,192 17,451 Primary Care Prescribing 18,310 17,541 Primary Care Services 18,307 4,526 Hosted Services 4,632 808 Out of Area Placements 832 613 Improvement Grants 758 6,702 Strategic Funds & Other Resources 7,937 12,620 Set Aside 13,044 145,402 Cost of Services 153,808 151,557 Taxation and Non-Specific Grant Income (note 5) 164,487 (6,155) (Surplus) or Deficit on provision of Services (10,679) (6,155) Total Comprehensive Income and Expenditure (10,679) The 2020/21 figures have been restated to take into account the administration and Management area being split into administration and management and other operational services. There are no statutory or presentational adjustments which reflect the MIJB’s application of the funding received from partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts. Page 48
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Moray Integration Joint Board Annual Accounts 2021/22 40 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 46. Movement of Reserves During 2021/22 General Fund Balance £000 Opening Balance at 1 April 2021 (6,342) Total Comprehensive Income and Expenditure (10,679) (Increase) or Decrease in 2021/22 (10,679) Closing Balance at 31 March 2022 (17,021) Movement of Reserves During 2020/21 General Fund Balance £000 Opening Balance at 1 April 2020 (187) Total Comprehensive Income and Expenditure (6,155) (Increase) or Decrease in 2020/21 (6,155) Closing Balance at 31 March 2021 (6,342) Page 49
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Moray Integration Joint Board Annual Accounts 2021/22 41 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 2021 £000 Notes 31 March 2022 £000 6,342 Short Term Debtors 6 17,021 Current Assets - Short Term Creditors - Current Liabilities - Provisions - Long Term Liabilities 6,342 Net Assets 17,021 6,342 Usable Reserve General Fund 7 17,021 6,342 Total Reserves 17,021 The unaudited annual accounts were issued on 30 June 2022. . Deborah O’Shea FCCA Interim Chief Financial Officer 30 June 2022 Page 50
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Moray Integration Joint Board Annual Accounts 2021/22 42 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 2021/22 financial year and its position at the year-end of 31 March 2022. 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 2021/22, 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 the 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 51
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Moray Integration Joint Board Annual Accounts 2021/22 43 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. The 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. During the overall Covid-19 response, a number of additional costs have been incurred beyond business as usual. The MIJB has followed national guidance regarding these and a range of additional costs are included in the MIJB’s accounts reflecting the MIJB acting as principal in the transactions including:- • social care sustainability costs; • all increase direct care Covid-19 costs; Page 52
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Moray Integration Joint Board Annual Accounts 2021/22 44 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 2 Critical Judgements and Estimation Uncertainty (continued) A further range of Covid-19 related costs and associated funding have not been recognised in the MIJB’s accounts in accordance with national accounting guidance. In these cases Moray Council is acting as principal and MIJB as the agent. This includes:- • £0.53m related to PPE and testing kits provided by NHS National Services Scotland to Moray for social care services. Note 3 Events after the Reporting Period The unaudited accounts were issued by Deborah O’Shea, Interim Chief Financial Officer on 30 June 2022. Events taking place after this date are not reflected in the financial statements or notes. Where events taking place before this date provided information about conditions existing at 31 March 2022, the figures in the financial statements and notes have been adjusted in all material respects to reflect the impact of this information. Note 4 Expenditure and Income Analysis by Nature 2020/21 2020/21 £000 £000 60,984 Services commissioned from Moray Council 65,020 84,391 Services commissioned from The Grampian Health Board 88,760 27 Auditor Fee: External Audit Work 28 145,402 Total Expenditure 153,808 (151,557) Partners Funding Contributions and Non- Specific Grant Income (164,487) (6,155) (Surplus) or Deficit on the Provision of Services (10,679) Page 53
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Moray Integration Joint Board Annual Accounts 2021/22 45 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 5 Taxation and Non-Specific Grant Income 2020/21 2020/21 £000 £000 45,060 Funding Contribution from Moray Council 50,549 106,497 Funding Contribution from The Grampian Health Board 113,938 151,557 Taxation and Non-specific Grant Income 164,487 The funding contribution from The Grampian Health Board shown above includes £13.044m in respect of ‘set aside’ resources relating to acute hospital and other resources. These are provided by The 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 2021 31 March 2022 £000 £000 6,160 The Grampian Health Board 15,739 182 Moray Council 1,282 6,342 Debtors 17,021 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 54
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Moray Integration Joint Board Annual Accounts 2021/22 46 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 Covid-19 Other Earmarked Total £000 £000 £000 £000 £000 Balance at 1 April 2020 - 187 - - 187 Transfers (out)/in 2020/21 1,598 1,480 2,725 352 6,155 Balance at 31 March 2021 1,598 1,667 2,725 352 6,342 Transfer out 2020/21 (360) - - - (360) Transfers in 2020/21 - 664 6,291 4,065 11,020 Balance at 31 March 2021 1,257 2,331 9,016 4,417 17,021 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. Covid – 19 – are funds received by Scottish Government during 2021/22 being held in an earmarked reserve to support the MIJB through the pandemic and remobilisation. Page 55
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Moray Integration Joint Board Annual Accounts 2021/22 47 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 8 Agency Income and Expenditure On behalf of all IJB’s within The 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: 2020/21 2021/22 £000 £000 10,032 Expenditure on Agency Services 9,136 (10,032) Reimbursement for Agency Services (9,136) - Net Agency Expenditure excluded from the CIES - Page 56
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Moray Integration Joint Board Annual Accounts 2021/22 48 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions The MIJB has related party relationships with The 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 the Grampian Health Board 2020/21 2021/22 £000 £000 (106,497) Funding Contributions received from the NHS Board (113,938) 84,208 Expenditure on Services Provided by the NHS Board 88,558 183 Key Management Personnel: Non-Voting Board Members 202 (22,106) Net Transactions with The Grampian Health Board (25,178) Key Management Personnel: The Chief Officer and Chief Financial Officer, are non-voting Board members and are both employed by The 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 The 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 the Grampian Health Board 31 March 2021 31 March 2021 £000 £000 6,160 Debtor balances: Amounts due from The Grampian Health Board 15,739 6,160 Net Balance due from The Grampian Health Board 15,739 Page 57
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Moray Integration Joint Board Annual Accounts 2021/22 49 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions (continued) Transactions with Moray Council 2020/21 2020/21 £000 £000 (45,060) Funding Contributions received from the Council (50,731) 60,945 Expenditure on Services Provided by the Council 64,971 66 Key Management Personnel: Non-Voting Board Members 78 15,951 Net Transactions with Moray Council 14,318 Balances with Moray Council 31 March 2021 31 March 2022 £000 £000 182 Debtor balances: Amounts due from Moray Council 1,282 - Creditor balances: Amounts due to Moray Council - 182 Net Balance due from Moray Council 1,282 Page 58
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Moray Integration Joint Board Annual Accounts 2021/22 50 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 10 VAT The MIJB is not registered for VAT and as such the 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 Her 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. There are no accounting standards issued but not yet adopted that impact on the 2021/22 financial statements. Page 59
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