Public reports pack
Argyll and Bute Council · 26 March 2025
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 26 March 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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19 March 2025 NOTICE OF MEETING A meeting of the ARGYLL AND BUTE HSCP INTEGRATION JOINT BOARD (IJB) will be held ON A HYBRID BASIS IN THE COUNCIL CHAMBER, KILMORY, LOCHGILPHEAD AND BY MICROSOFT TEAMS on WEDNESDAY, 26 MARCH 2025 at 1:00 PM, which you are requested to attend. BUSINESS 1. APOLOGIES FOR ABSENCE 2. DECLARATIONS OF INTEREST (IF ANY) 3. MINUTES (Pages 3 - 8) Argyll and Bute Integration Joint Board held on 29 January 2025 4. MINUTES OF COMMITTEES (a) Argyll and Bute HSCP Clinical and Care Governance Committee held on 6 February 2025 (Pages 9 - 12) (b) Argyll and Bute HSCP Audit and Risk Committee held on 18 February 2025 (Pages 13 - 16) (c) Argyll and Bute HSCP Finance and Policy Committee held on 25 February 2025 (Pages 17 - 20) (d) Argyll and Bute HSCP Strategic Planning Group held on 13 March 2025 (Pages 21 - 24) (e) Argyll and Bute HSCP Finance and Policy Committee held on 18 March 2025 (Pages 25 - 28) 5. CHIEF OFFICER'S REPORT (Pages 29 - 38) Report by Chief Officer 6. TRANSITION OF THE CHAIR AND VICE CHAIR OF THE INTEGRATION JOINT BOARD (Pages 39 - 42) Report by Interim Head of Strategic Planning, Performance and Technology 7. REVIEW OF THE INTEGRATION SCHEME 2025 (Pages 43 - 46) Report by IJB Standards Officer 8. STANDARD REVIEW OF THE COMMITTEE TERMS OF REFERENCE (Pages 47 - 70) Report by Interim Head of Strategic Planning, Performance and Technology Public Document Pack
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9. FINANCE Reports by Head of Finance (a) Audited Annual Accounts 2023/24 & External Audit Report (Pages 71 - 118) (b) Management Accounts - 11 Months to 28 February 2025 (Pages 119 - 134) (c) Argyll and Bute HSCP Budget 2025/26 (Appendix 2(a) to follow) (Pages 135 - 168) 10. Q3 WORKFORCE REPORT 2024/25 (Pages 169 - 192) Report by Deputy Director of People 11. ARGYLL AND BUTE HSCP PERFORMANCE REPORT FQ3 2024/25 (OCTOBER TO DECEMBER) (Pages 193 - 210) Report by Interim Head of Strategic Planning, Performance and Technology 12. UPDATE - RENEWAL OF THE JOINT STRATEGIC PLAN (Pages 211 - 216) Report by Interim Head of Strategic Planning, Performance and Technology 13. DATE OF NEXT MEETING Wednesday 28 May 2025 Argyll and Bute HSCP Integration Joint Board (IJB) Contact: Hazel MacInnes, Senior Committee Officer Tel:01546 604269
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MINUTES of MEETING of ARGYLL AND BUTE HSCP INTEGRATION JOINT BOARD (IJB) held ON A HYBRID BASIS IN THE COUNCIL CHAMBER, KILMORY, LOCHGILPHEAD AND BY MICROSOFT TEAMS on WEDNESDAY, 29 JANUARY 2025 Members: Councillor Dougie McFadzean, Argyll and Bute Council (Chair) Councillor Kieron Green, Argyll and Bute Council Councillor Ross Moreland, Argyll and Bute Council Emily Austin, NHS Highland Non-Executive Board Member Karen Leach, NHS Highland Non-Executive Board Member Janice Preston, NHS Highland Non-Executive Board Member Evan Beswick, Chief Officer, Argyll and Bute HSCP Fiona Broderick, Staffside Lead, Argyll and Bute HSCP (Health) Linda Currie, Associate Director AHP, NHS Highland David Gibson, Chief Social Worker/Head of Children and Families and Justice, Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Rebecca Helliwell, Depute Medical Director, Argyll and Bute HSCP Elizabeth Higgins, Associate Nurse Director, NHS Highland Julie Hodges, Independent Sector Representative Kenny Mathieson, Public Representative Alison McGrory, Associate Director of Public Health, Argyll and Bute HSCP Kevin McIntosh, Staffside Lead, Argyll and Bute HSCP (Council) Angus MacTaggart, GP Representative, Argyll and Bute HSCP Kirstie Reid, Carers Representative, NHS Highland Takki Sulaiman, Chief Executive, Argyll and Bute Third Sector Interface Fiona Thomson, Lead Pharmacist, NHS Highland Tracey White, Carers Representative, NHS Highland Attending: Tim Allison, Director of Public Health and Policy Caroline Cherry, Head of Adult Services, Argyll and Bute HSCP Charlotte Craig, Interim Head of Service - Strategy Planning, Performance and Technology, Argyll and Bute HSCP Nikki Gillespie, Interim Head of Service – Mental Health, Disability and Dementia Services, Argyll and Bute HSCP Kristin Gillies, Senior Service Planning Manager, NHS Highland Hazel MacInnes, Senior Committee Officer, Argyll and Bute Council Angela Tillery, Principal Accountant, Argyll and Bute Council Donald Watt, Interim Head of Service – Acute and Community Care, Argyll and Bute HSCP 1. APOLOGIES FOR ABSENCE Apologies for absence were received from Graham Bell, Councillor Gary Mulvaney and Duncan Scott. 2. DECLARATIONS OF INTEREST There were none intimated. Page 3 Agenda Item 3
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3. MINUTES The Minutes of the meeting of the Argyll and Bute Integration Joint Board held on 27 November 2024 were approved as a correct record. 4. MINUTES OF COMMITTEES (a) Argyll and Bute HSCP Clinical and Care Governance Committee held on 28 November 2024 The Minutes of the meeting of the Clinical and Care Governance Committee held on 28 November 2024 were noted. (b) Argyll and Bute HSCP Strategic Planning Group held on 12 December 2024 The Minutes of the meeting of the Strategic Planning Group held on 12 December 2024 were noted. (c) Argyll and Bute HSCP Audit and Risk Committee held on 17 December 2024 The Minutes of the meeting of the Audit and Risk Committee held on 17 December 2024 were noted. The Chair of the Committee, Councillor Kieron Green, advised that the Special meeting that had been due to take place in January to review the Audited Accounts had been rescheduled. (d) Argyll and Bute HSCP Finance and Policy Committee held on 21 January 2025 The Minutes of the meeting of the Finance and Policy Committee held on 21 January 2025 were noted. The Chair ruled and the Board agreed to re-order the Business and to take Agenda item 11 – Director of Public Health Annual Report 2024 – Health Inequalities – at this point in proceedings to allow Dr Tim Allison to make his presentation and leave the meeting. 5. NHS HIGHLAND DIRECTOR OF PUBLIC HEALTH ANNUAL REPORT 2024 - HEALTH INEQUALITIES The Director of Public Health and Policy presented his Director of Public Health Annual Report 2024 – Health Inequalities, to the Integration Joint Board. Decision The Integration Joint Board noted the Director of Public Health Annual Report 2024 – Health Inequalities. (Reference: Report by Director of Public Health and Policy dated 28 January 2025 and Director of Public Health Annual Report 2024 – Health Inequalities, submitted) The Chair thanked Dr Allison for his report and for his attendance at the Board. Page 4
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6. CHIEF OFFICER REPORT Prior to the presentation of his report, the Chief Officer expressed his thanks to all HSCP staff, partners across agencies during the recent Storm Eowyn; he recognised the professional, coordinated and caring approach by all staff. He extended his hanks to the Senior Leadership Team for their input. The Chief Officer congratulated the following staff on their recent appointment to new roles – Nikki Gillespie, Interim Head of Service – Mental Health, Disability and Dementia Services; Donald Watt, Interim Head of Service – Acute and Community Care and Charlotte Craig, Interim Head of Service - Strategy Planning, Performance and Technology. He also thanked Julie Lusk, Head of Service –Adult Services, who was retiring from her role. The Board gave consideration to a report from the Chief Officer providing an update on activity across the Health and Social Care Partnership since the last report to the Board in November 2024. Decision The Integration Joint Board noted the report from the Chief Officer. (Reference: Report by Chief Officer dated 29 January 2025, submitted) 7. MEMBERSHIP OF THE INTEGRATION JOINT BOARD The Board gave consideration to a report advising of the nomination of a non-executive director as an appointee to the Integration Joint Board by NHS Highland following the completion of Susan Ringwood’s term as a non-executive director on the NHS Highland Board. Decision The Integration Joint Board – 1. noted the proposal of Janice Preston, NHS Highland non-executive director to the Integration Joint Board; and 2. agreed to appoint Janice Preston to the Audit and Risk Committee vacancy. (Reference: Report by Business Improvement Manager dated 29 January 2025, submitted) The Chair formally welcomed Janice Preston to her first meeting of the Board. 8. BUDGET MONITORING - 8 MONTHS TO 30 NOVEMBER 2024 The Board gave consideration to a report providing a summary of the financial position of the HSCP as at the end on month 8 and a forecast for the year ahead. Decision The Integration Joint Board – Page 5
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1. noted that the HSCP had overspent its budget by £1.6m; 2. noted that an overspend of £2.6m was forecast; 3. noted actions were required to reduce spend and additional funding was required from Argyll & Bute Council who held pension saving resource on behalf of the IJB; and 4. noted savings of £4.8m had been delivered, 73% of target. (Reference: Report by Head of Finance dated 29 January 2025, submitted) The Chair advised that in terms of Section 50(A)(4) of the Local Government (Scotland) Act 1973, Appendix 1 contained at item 8(b) of the Agenda relating to the following item of Business contained exempt information as defined in Paragraph 6 of Part 1 of Schedule 7A to the Local Government (Scotland) Act 1973. He advised that should the Board wish to discuss the content of Appendix 1, it would require the press and public to be excluded for that item of business. The Integration Joint Board confirmed that they did not want to discuss the content of Appendix 1. 9. BUDGET UPDATE 2025/26 The Board gave consideration to a report providing an estimate of the budget gap for 2025/26 and a summary of the progress made in developing savings plans. Decision The Integration Joint Board – 1. noted that budget planning for 2025/26 was on-going; 2. noted the HSCP was not currently operating on a financially sustainable basis; 3. noted the budget gap before savings and use of non-recurring resources was £15m; 4. endorsed the savings proposals to date and approved that work continue on developing these further; and 5. noted that the HSCP may not be able to propose a balanced budget in March and the implications were being discussed with partners. (Reference: Report by Head of Finance dated 29 January 2025, submitted) 10. STRATEGIC RISK REGISTER UPDATE The Board gave consideration to a report recommending changes to the Strategic Risk Register to reflect perceived increasing risk. Decision The Integration Joint Board – 1. noted that the Strategic Risk Register had been reviewed by the Leadership Team and the Audit & Risk Committee; Page 6
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2. approved the Strategic Risk Register; and 3. noted the Strategic Risk Register had been considered against the Strategic Objectives. (Reference: Report by Head of Finance dated 29 January 2025, submitted) 11. 2025/26 SOCIAL WORK FEES AND CHARGES The Board gave consideration to a report providing detail of the proposed Social Work Fees and Charges uplifts for 2025/26. Decision The Integration Joint Board – 1. endorsed the appended 2025/26 Social Work Fees and Charges proposals to be submitted to Argyll and Bute Council for ratification at its 2025/26 budget meeting; and 2. noted the increase in the means tested community-based service charges from £125 per week to £145 per week. (Reference: Report by Principal Accountant dated 29 January 2025, submitted) 12. ARGYLL AND BUTE HSCP PERFORMANCE REPORT FQ2 2024/25 The Board gave consideration to a report detailing the HSCP performance for quarter 2 2024/25. Decision The Integration Joint Board – 1. acknowledged performance for FQ2 2024/25 (July - September); 2. acknowledged the performance update on the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators contained at Appendix 1 to the submitted report; and 3. noted Delayed Discharge Sitrep as of 30 September 2024 contained at Appendix 2 to the submitted report. (Reference: Report by Head of Strategic Planning, Performance and Technology dated 29 January 2025, submitted) 13. INTEGRATION JOINT BOARD - REVIEW OF THE STANDING ORDERS The Board gave consideration to a report advising of an update to the Standing Orders as part of the routine review. The update reflected the updated representation of unpaid carers from one to two. Decision Page 7
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The Integration Joint Board approved the revised Standing Orders. (Reference: Report by Business Improvement Manager dated 29 January 2025, submitted) 14. CATEGORY 1 RESPONDER ASSURANCE UPDATE The Board gave consideration to a report providing assurance on the delivery of the IJB’s duty in relation to Category 1 Response. Decision The Integration Joint Board – 1. noted progress against the recommendations made in the previous year’s report; 2. noted assurance in the delivery of the duty; and 3. noted that Strategic/Operational Risk Registers inform capacity to respond. (Reference: Report by Business Improvement Manager dated 29 January 2025, submitted) 15. Q1 AND Q2 WHISTLEBLOWING REPORT 2024/25 The Quarter 1 and Quarter 2 Whistleblowing reports for 2024/25 were before the Board for noting. Decision The Integration Joint Board noted the content of the Quarter 1 and Quarter 2 Whistleblowing reports for 2024/25. (Reference: Reports by Director of People and Culture dated 24 September 2024 and 26 November 2024, submitted) 16. DIRECTION LOG UPDATE The Direction Log was before the Board for noting. Decision The Integration Joint Board noted the content of the Direction Log. (Reference: Direction Log as at 29 January 2025, submitted) 17. DATE OF NEXT MEETING The date of the next meeting was noted as 26 March 2025 and it was agreed that meetings would now go forward on a hybrid basis where possible. Page 8
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MINUTES of MEETING of ARGYLL AND BUTE HSCP CLINICAL AND CARE GOVERNANCE COMMITTEE held in the BY MICROSOFT TEAMS on THURSDAY, 6 FEBRUARY 2025 Present: Councillor Dougie McFadzean (Chair) Karen Leach Rebecca Helliwell Elizabeth Higgins David Gibson David Gibson Alison McGrory Councillor Ross Moreland Attending: Fiona Duff, Interim Head of Primary Services, Argyll and Bute HSCP Caroline Cherry, Head of Adult Services – Health and Community Care, Argyll and Bute HSCP Linda Currie, Associate Director of AHP, NHS Highland Fiona Thomson, Associate Director of Pharmacy, NHS Highland Charlotte Craig, Interim Head of Service Strategic Planning, Performance and Technology, Argyll and Bute HSCP Anke Rowe, Clinical and Care Governance Manager, Argyll and Bute HSCP Katie McKenzie, Committee Services Officer, Argyll and Bute Council 1. WELCOME AND APOLOGIES The Chair welcomed everyone to the meeting. Apologies for absence were intimated on behalf of Graham Bell, Fiona Broderick and Kevin McIntosh. 2. MINUTES (a) Minute of the previous meeting of the Clinical and Care Governance Committee, held on 28 November 2024 The Minute of the previous meeting of the Clinical and Care Governance Committee, held on 28 November 2024 was approved as a correct record. (b) Minute of the Clinical and Care Governance Group, held on 12 December 2024 The Minute of the Clinical and Care Governance Group, held on 12 December 2024 was noted. Page 9 Agenda Item 4a
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3. ACTION LOG Having given consideration to the Action Log, the Committee agreed – Action 1 - It was noted that a paper was being taken to SLT and in order to provide a more fulsome update, this item would remain on the action log and an update would be provided at the next meeting of the Committee. Action 2 – The Interim Head of Service Strategic Planning, Performance and Technology provided a brief update on the overlap of inspections spreadsheets and it was agreed that an update on progress would be provided at the next meeting of the Committee. Action 3 – The Chief Officer provided a brief update on Sexual Health Provision and it was agreed that an update would be provided at the next meeting of the Committee. Action 4 – The Deputy Medical Director provided a brief update on HIS Oban Police Custody and it was agreed that an update would be provided at the next meeting of the Committee. Action 5 – The Interim Head of Primary Care provided a brief update on the number of 2c practices within Argyll and Bute. Noting the ongoing work required in this regard, it was agreed that an update should be provided to the next meeting of the Committee. (Reference: Action Log dated 6 February 2025, submitted) 4. HEALTH AND SOCIAL CARE PARTNERSHIP - PERFORMANCE REPORT - FQ2 2024/25 (JUL - SEPT) The Committee gave consideration to a report which detailed the performance for FQ2 2024/25 (July - September) highlighting key performance trends cross the 84 Key Performance Indicators. The report also included performance updates from Heads of Service and Service Leads across the twelve service areas; the latest performance against the National Health and Wellbeing Outcome Indicators and the latest national update on Delayed Discharges. Decision The Clinical and Care Governance Committee – 1. acknowledged performance for FQ2 2024/25 (July- September); 2. acknowledged supporting performance commentary from Heads of Service and Service Leads; 3. acknowledged performance update on the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators as outlined in Appendix 1 of the report; and 4. noted Delayed Discharge Sitrep as of 30 September 2024 as outlined in Appendix 2 of the report. Page 10
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(Reference: Report by Head of Strategic Planning, Performance and Technology dated 6 February 2025, submitted) 5. DASHBOARD REPORT The Committee gave consideration to the dashboard report, which provided information on stage 2 complaints over the last 13 months; adverse events over the last 13 months; the number of inpatient falls over the last 13 months; the number of tissue viability incidents over the last 13 months; the number of violence and aggression incidents over the last 13 months and the number of medication errors over the last 13 months. Decision The Clinical and Care Governance Committee considered and noted the information contained within the dashboard report. (Reference: Report by Clinical and Care Governance Manager dated 6 February 2025, submitted) 6. HOSPITAL DIALYSIS REVIEW The Committee gave consideration to a report detailing the demand and local capacity to provide hospital haemodialysis in Argyll and Bute. A strategic service review commenced in January 2025 which will assess the configuration of hospital haemodialysis services within Argyll & Bute, and include the overall number and location of units required within the partnership area. Decision The Clinical and Care Governance Committee noted the background and timelines for the review of hospital dialysis services. (Reference: Report by Senior Service Planning Manager dated 6 February 2025, submitted) 7. REVIEW OF THE COMMITTEE TERMS OF REFERENCE The Committee gave consideration to a report reviewing the Terms of Reference to ensure that they are still fit for purpose and meet the oversight requirement of the Integration Joint Board. Decision The Clinical and Care Governance Committee approved the revised Terms of Reference and recommended them to the Integration Joint Board. (Reference: Report by Interim Head of Service Strategic Planning, Performance and Technology dated 6 February 2025, submitted) Page 11
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8. ANY OTHER BUSINESS The Deputy Medical Director updated the Committee on challenges being experienced with Bristow Helicopter Company regarding the use of the Coastguard helicopter for life and limb emergencies. This followed risk assessments carried out that would prevent the Coastguard helicopter landing at some of the current locations used. It was noted that this could present a significant clinical risk and it was agreed that an update would be brought to the next meeting of the Committee. The Associate Director of Nursing advised the Committee that a Safe Delivery of Care Inspection had been carried out in Oban, Lorn and the Isles Hospital. It was agreed that the Inspection Report would be circulated to the Committee when it was published, and that an update would be brought to the next meeting. The Chief Social Work Officer briefed the Committee on the challenges being faced by Children and Families and Social work due to a severe shortage of staff. It was noted that discussions were ongoing between the HSCP and Argyll and Bute Council, and also with the Chief Social Work Adviser of Scotland to establish an action plan. It was agreed that an update would be brought to the next meeting of the Committee. 9. DATE OF NEXT MEETING The Clinical and Care Governance Committee noted that their next meeting was scheduled to take place at 2:00 pm on Thursday, 1 May 2025. Page 12
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MINUTES of MEETING of ARGYLL AND BUTE HSCP AUDIT AND RISK COMMITTEE held BY MICROSOFT TEAMS on TUESDAY, 18 FEBRUARY 2025 Present: Councillor Kieron Green (Chair) Emily Austin Councillor Ross Moreland Janice Preston Attending: Evan Beswick, Chief Officer, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Moira Weatherston, Internal Audit Contractor, Argyll and Bute Council Mhairi Weldon, Senior Audit Assistant, Argyll and Bute Council Mark Outterside, Forvis Mazars Ishana Singh, Forvis Mazars Katie McKenzie, Committee Officer, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE The Chair welcomed everyone to the meeting. There were no apologies for absence intimated. 2. DECLARATIONS OF INTEREST (IF ANY) There were no declarations of interest. 3. MINUTES The Minute of the meeting of the Argyll and Bute HSCP Audit and Risk Committee held on 17 December 2024 was approved as a correct record. 4. AUDITED ANNUAL ACCOUNTS 2023/24 The Committee gave consideration to the Argyll and Bute Health and Social Care Partnership audited annual accounts. These have been subject to independent audit by Mazars, who have issued an unqualified audit report. Decision The Audit and Risk Committee - 1. noted that Mazars have completed their audit of the Annual Accounts and issued a draft unqualified Independent Auditors Report; Page 13 Agenda Item 4b
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2. considered the Annual Audit Report prepared by Mazars and management responses to their recommendations; 3. noted that the IJB was reporting an underspend of £2.9m carried forward in general reserves; 4. approved the draft letter of representation and the Audited Accounts in advance of formal approval by the IJB on 26 March 2025; and 5. noted that the accounts were prepared on a going concern basis. (Reference: Report by Head of Finance dated 18 February 2025, submitted) 5. HSCP 2024/25 INTERNAL AUDIT ANNUAL REPORT The Committee gave consideration to a report detailing the final 2024/25 Argyll and Bute HSCP Internal Audit Annual Report and providing a formal opinion for 2024/25 based on completed work. Decision The Audit and Risk Committee endorsed the 2024/25 HSCP Internal Audit Annual Report. (Reference: Report by Chief Internal Auditor dated 18 February 2025, submitted) 6. INTERNAL AUDIT UPDATE The Committee gave consideration to a report detailing the work carried out by Argyll and Bute Council’s Internal Audit Team on audits which are of operational relevance to the Committee. All audits have been completed as contained in the 2024/25 Internal Audit Plan. In addition, an update was provided on the actions from audit reports already presented to the Committee which were still open as at 30 December 2024. Decision The Audit and Risk Committee noted the progress on completion of the internal audit recommendations. (Reference: Report by Chief Internal Auditor dated 18 February 2025, submitted) 7. HEALTH AND SOCIAL CARE PARTNERSHIP (HSCP) INTERNAL AUDIT PLAN 2025/26 The Committee gave consideration to a report presenting the 2025/26 HSCP Internal Audit Plan and providing an indicative audit plan for 2026/27. Decision The Audit and Risk Committee – Page 14
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1. noted the Internal Audit Strategic Planning process covering 2024-27; and 2. endorsed the 2025/26 HSCP Internal Audit Plan. (Reference: Report by Chief Internal Auditor dated 18 February 2025, submitted) 8. AUDIT SCOTLAND PUBLICATIONS The Committee gave consideration to a report detailing a number of external audit reports which have been published by Audit Scotland in recent weeks including 2023/24 financial year audit reports for many public bodies along with their Annual Local Authority Financial Bulletin and strategy for Auditing climate change. They have also published the External Audit Report relating to Argyll & Bute Council prepared by Mazars. Decision The Audit and Risk Committee – 1. noted the Audit Scotland Local Government Financial Bulletin and Auditing Climate Change Strategy; and 2. noted the External Audit Report relating to Argyll & Bute Council (Reference: Report by Head of Finance dated 18 February 2025, submitted) 9. DATE OF NEXT MEETING The Audit and Risk Committee noted that their next meeting was scheduled to take place on Tuesday, 17 June 2025. Page 15
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MINUTES of MEETING of ARGYLL AND BUTE HSCP FINANCE AND POLICY COMMITTEE held in the BY MICROSOFT TEAMS on TUESDAY, 25 FEBRUARY 2025 Present: Councillor Dougie McFadzean (Chair) Karen Leach Kenny Mathieson Graham Bell Fiona Thomson Councillor Gary Mulvaney Attending: Fiona Broderick, Staffside Lead, Argyll and Bute HSCP (Health) Caroline Cherry, Head of Adult Services - Health and Community Care, Argyll and Bute HSCP Charlotte Craig, Interim Head of Service Strategic Planning, Performance and Technology, Argyll and Bute HSCP John Dreghorn, Service Improvement Officer, Argyll and Bute HSCP Fiona Duff, Interim Head of Primary Care, Argyll and Bute HSCP Nicola Gillespie, Interim Head of Adult Services (Mental Health, Disabilities, ASP & Dementia Services), Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Councillor Kieron Green, Argyll and Bute Council Rebecca Helliwell, Depute Medical Director, Argyll and Bute HSCP Julie Hodges, Independent Sector Representative Gillian McCready, Service Improvement Officer, Argyll and Bute HSCP Elaine McMillan, Operations Manager – Care at Home, Argyll and Bute HSCP Janice Preston, NHS Highland Non-Executive Board Member Takki Sulaiman, Chief Executive, Argyll and Bute Third Sector Interface Angela Tillery, Principal Accountant, Argyll and Bute Council Katie McKenzie, Committee Services Officer, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE Apologies for absence were received from Tracey White. 2. DECLARATIONS OF INTEREST There were no declarations of interest. 3. MINUTES The Minutes of the Meeting of the Finance and Policy Committee held on 21 January 2025 were approved as a correct record subject to the addition of Councillor Gary Mulvaney’s apologies under Item 1. Page 17 Agenda Item 4c
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4. BUDGET UPDATE 2025/26 The Committee gave consideration to a report detailing an estimate of the budget gap for 2025/26 and a summary of progress made in developing savings plans. Decision The Finance and Policy Committee – 1. noted that budget planning for 2025/26 was on-going; 2. noted the HSCP was not operating on a financially sustainable basis; 3. noted the budget gap before savings and use of non-recurring resources was £15.6m; 4. noted that there was currently a budget gap of £9.1m after taking into account savings proposals and non-recurring resourcing; 5. endorsed the savings proposals to date; and 6. noted that the HSCP expects to be reliant upon additional funding from both partners in 2025/26 and the implications were being discussed with both partners. (Reference: Report by Head of Finance dated 25 February 2025, submitted) 5. BUDGET MONITORING - 10 MONTHS TO 31 JANUARY 2025 The Committee gave consideration to a report providing a summary of the financial position as at the end of month 10 and a forecast for the year. Decision The Finance and Policy Committee – 1. noted that the HSCP had overspent its budget by £2.5m; 2. noted an overspend of £3.2m was forecast; 3. noted Argyll & Bute Council had confirmed the HSCP could access £3.05m in pension saving resource they hold on behalf of the IJB; 4. noted that reserves would be utilised to cover the remaining deficit and new projects funded from this source were on hold; and 5. noted savings of £5.1m had been delivered, 77% of target. (Reference: Report by Head of Finance dated 25 February 2025, submitted) 6. CARE AT HOME EFFICIENCY Page 18
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The Committee gave consideration to a report outlining processes to improve demand management and reduce spend on Care at Home. Decision The Finance and Policy Committee – 1. noted the continued overspend on care at home (older adults); 2. noted and discussed the operational changes with care at home; and 3. discussed future ways to propose policy changes to care at home and engagement to accompany any changes (Reference: Report by Head of Service - Health and Community Care, Operations Manager - Care at Home and Service Improvement Officer dated 25 February 2025, submitted) 7. CARR GOMM CONTRACTS REVIEW - UPDATE REPORT (OPERATIONAL DECISION) The Committee gave consideration to a report advising that the contract for the Responder Service is due for renewal at the end of March 2025. This is a 24 hour a day response service to falls, urgent calls, welfare calls, support re continence and personal care. It sits alongside a range of other contracts for services which support older adults to live in their own homes and to support them upon leaving hospital. The report detailed negotiations with Carr Gomm regarding the contract. Decision The Finance and Policy Committee – 1. noted progress in negotiations with Carr Gomm regarding the reduction in contract value; 2. noted the proposal from Carr Gomm and the project groups agreement in principle with Carr Gomm to proceed on this basis; 3. noted the saving of £725k that would be generated through implementation; 4. noted the establishment of the Contract Spec and Risk Management & Communications sub-groups; and 5. noted that SLT approved the changes as outlined in the report and the formal notification to Carr Gomm that the HSCP would proceed with the proposed reduction in service (Reference: Report by Service Improvement Officer dated 25 February 2025, submitted) 8. COMMITTEE TERMS OF REFERENCE REVIEW Page 19
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The Committee gave consideration to a report reviewing the Committee Terms of Reference to ensure that they are still fit for purpose and meet the oversight requirement of the Integration Joint Board. Decision The Finance and Policy Committee reviewed the Terms of Reference and approved them for recommendation to the Integration Joint Board. (Reference: Report by Interim Head of Service Strategic Planning, Performance and Technology dated 25 February 2025, submitted) 9. DATE OF NEXT MEETING The Finance and Policy Committee noted the date of the next meeting as Tuesday 18 March 2025 and agreed that an invitation would be extended to all members of the Integration Joint Board. Page 20
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MINUTES of MEETING of ARGYLL AND BUTE HSCP STRATEGIC PLANNING GROUP held BY MICROSOFT TEAMS on THURSDAY, 13 MARCH 2025 Present: Councillor Ross Moreland, Argyll and Bute Council (Chair) Graham Bell, NHS Highland Non-Executive Board Member and Member of IJB Evan Beswick, Chief Officer, Argyll and Bute HSCP Samantha Campbell, Health Improvement Principal, Argyll and Bute HSCP Caroline Cherry, Head of Adult Services – Health and Community Care, Argyll and Bute HSCP Charlotte Craig, Interim Head of Planning, Performance and Technology, Argyll and Bute HSCP (co-Chair) Nicola Gillespie, Interim Head of Adult Care – Mental Health, Disability and Dementia Services, Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Liz Higgins, Associate Nurse Director, NHS Highland Julie Hodges, Scottish Care Inspectorate Margaret Jacobsen, Chair of Dochas Centre Councillor Dougie McFadzean, Chair of IJB, Argyll and Bute Council Alison McGrory, Associate Director of Public Health, Argyll and Bute HSCP Kirsty MacKenzie, Carers Act Support Karl McLeish, Unscheduled Care Programme Lead, Argyll and Bute HSCP Sandra McLeod, Director of Customer Experience, ACHA Duncan Martin, Public Representative Kirstie Reid, Carers Representative, NHS Highland Anke Roexe, Senior Service Planning Manager, Argyll and Bute HSCP Alison Ryan, Service Planning Manager, Argyll and Bute HSCP Douglas Watt, Interim Head of Adult Care - Acute and Community Care, Argyll and Bute HSCP 1. WELCOME, INTRODUCTIONS AND APOLOGIES FOR ABSENCE The Chair welcomed those present. Apologies for absence were received from: Fiona Broderick, Staffside Lead for Argyll and Bute HSCP (Health) Linda Currie, Associate Director AHP, NHS Highland Janice Preston, Non Executive Member, NHS Highland Douglas Whyte, Housing Strategic Manager, Argyll and Bute Council, Takki Sulaiman, Chief Executive, Argyll and Bute TSI Page 21 Agenda Item 4d
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2. MINUTES AND MATTERS ARISING The Minutes of the meeting of the Argyll and Bute HSCP Strategic Planning Group held on 12 December 2024 were approved as a correct record. 3. STRATEGIC PLANNING GROUP WORK PLAN AND SUB COMMITTEES The Argyll and Bute HSCP Strategic Planning Group is a statutory group of the Integration Joint Board and its key role was to strategically plan on behalf of Partners and Strategic Services. The Interim Head of Planning, Performance and Technology and co-Chair of this Group, led a discussion on the purpose and role of the Strategic Planning Group and sought and received comments and suggestions from Members on how they saw this Group operating, what its work plan should be, and how it should be presented back up to the IJB, which she agreed to consider further. 4. COMMITTEE TERMS OF REFERENCE REVIEW The Committee Terms of Reference are subject to regular review to ensure that they are still fit for purpose and meet the oversight requirement of the Integration Joint Board. The Group was invited to review the current terms of reference and approve for recommendation to the Integration Joint Board. Decision The Strategic Planning Group: 1. Considered the terms of reference; and 2. Approved for recommendation to the Integrated Joint Board. (Reference: Report by Interim Head of Strategic Planning, Performance and Technology and Committee Terms of Reference dated May 2022, submitted) 5. LOCALITY PLANNING FOR HEALTH AND SOCIAL CARE IN ARGYLL & BUTE A paper outlining a number of areas for how the HSCP will continue to ensure the views of local areas are reflected in strategic and locality planning for health and social care delivery was considered. Decision The Strategic Planning Group: 1. Noted the ongoing intention of the HSCP to develop locality plans; 2. Noted the intention to engage with local communities in refined and innovate ways; and Page 22
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3. Agreed that the HSCP should facilitate a Citizens’ Panel for Argyll and Bute. (Reference: Report by Associate Director of Public Health, submitted) 6. OLDER ADULTS STRATEGY The purpose of this strategy is to consider how the particular needs and outcomes of older adults are met both within and beyond the role of individual services, acknowledging both the demographic challenges and the particular needs of older adults. Following engagement with staff, Executive Leadership of Argyll and Bute Council and the Older Adult Reference Group, the finalised Strategy for Older Adults from 2025-2030 was before the Strategic Planning Group for consideration. Decision The Strategic Planning Group: 1. Approved the finalised Strategy (subject to format); and 2. Noted the action plan with year one priority plans was in development. (Reference: Report by Head of Service, Health and Community Care, and Older Adults Strategy 2025-2030, submitted) 7. SCOTTISH GOVERNMENT WORKFORCE PLANNING GUIDANCE UPDATE NHS Boards and Health and Social Care Partnerships across Scotland had been awaiting guidance from Scottish Government on the requirements for the development of a 3 year strategic workforce plan. Given the current pressures across the health and social care system, the Scottish Government have instead asked that Boards submit an interim workforce planning document which covers the financial year 2025-26. This is to be submitted by 17 March 2025. A report advising on the proposed approach for the Interim Workforce Plan return was considered. Decision The Strategic Planning Group noted the update to workforce planning guidance. (Reference: Report by Head of People Planning & Development, submitted) 8. DATE OF NEXT MEETING - 12 JUNE 2025 The date of the next meeting was noted as Thursday 12 June 2025. Page 23
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MINUTES of MEETING of ARGYLL AND BUTE HSCP FINANCE AND POLICY COMMITTEE held BY MICROSOFT TEAMS on TUESDAY, 18 MARCH 2025 Present: Councillor Dougie McFadzean (Chair) Graham Bell Kenny Mathieson Tracey White Karen Leach Councillor Gary Mulvaney Attending: Evan Beswick, Chief Officer, Argyll and Bute HSCP Fiona Broderick, Staffside Lead, Argyll and Bute HSCP (Health) Caroline Cherry, Head of Adult Services - Health and Community Care, Argyll and Bute HSCP Charlotte Craig, Interim Head of Service Strategic Planning, Performance and Technology, Argyll and Bute HSCP Nicola Gillespie, Interim Head of Adult Services (Mental Health, Disabilities, ASP & Dementia Services), Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Councillor Kieron Green, Argyll and Bute Council Elizabeth Higgins, Associate Nurse Director, NHS Highland Julie Hodges, Independent Sector Representative Alison McGrory, Associate Director of Public Health, Argyll and Bute HSCP Kevin McIntosh, Assistant Operations Manager, Roads & Infrastructure Services, Argyll and Bute Council Councillor Ross Moreland, Argyll and Bute Council Kirstie Reid, Carers Representative, NHS Highland Takki Sulaiman, Chief Executive, Argyll and Bute Third Sector Interface Angela Tillery, Principal Accountant, Argyll and Bute Council Donald Watt, Interim Head of Adult Services (Acute and Community Care), Argyll and Bute HSCP Katie McKenzie, Committee Services Officer, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE An apology for absence was received from Fiona Thomson. 2. DECLARATIONS OF INTEREST Kenny Mathieson noted a connection in relation to item 6 of the agenda (Financial Savings Options – Social Work / Social Care (Confidential)) as a family member of his was a resident of Struan Lodge. As there was no substantive decision being taken, he advised he would remain in the meeting during the consideration of this item of Business. Page 25 Agenda Item 4e
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3. MINUTES The Minutes of the Meeting of the Finance and Policy Committee held on 25 February 2025 were approved as a correct record. 4. BUDGET MONITORING - 11 MONTHS TO 28 FEBRUARY 2025 The Committee gave consideration to a report providing a summary of the financial position as at the end of month 11 and a forecast for the year. Decision The Finance and Policy Committee – 1. noted that the HSCP had overspent its budget by £2.2m; 2. noted an overspend of £2.3m was forecast; 3. noted that Argyll & Bute Council had confirmed the HSCP could access £3.05m in pension saving resource they hold on behalf of the IJB; 4. noted that reserves would be utilised to cover the remaining deficit and that new projects funded from this source were on hold; and 5. noted savings of £5.1m had been delivered, 77% of target. (Reference: Report by Head of Finance dated 18 March 2025, submitted) Councillor Mulvaney left the meeting during consideration of the following item of business. 5. HSCP BUDGET 2025/26 The Committee gave consideration to a report providing an update on the development of the budget for 2025/26. Decision The Finance and Policy Committee – 1. endorsed the proposed HSCP budget for 2025/26 to the Argyll and Bute Integration Joint Board; 2. noted that the HSCP was continuing to face severe financial challenge and further savings required to be identified as part of a financial recovery plan; 3. noted the budget gap before savings and use of non-recurring resources was £12.9m; 4. noted that the IJB would be asked to approve an initial expenditure budget totalling £363.6m, a savings plan totalling £5.4m and the use of £3m in non- recurring resourcing; Page 26
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5. noted that the HSCP had not been able to identify 3% in NHS savings and therefore expects to be reliant upon additional resource from NHS Highland. This requirement is £4.5m as an opening position; 6. noted that the HSCP had continued to work with both partners throughout the development of a budget for approval; and 7. requested that the Management Team urgently develop plans to move the HSCP into a more financially sustainable operating model. (Reference: Report by Head of Finance dated 18 March, submitted) 6. FINANCIAL SAVINGS OPTIONS - SOCIAL WORK / SOCIAL CARE (CONFIDENTIAL) The Committee gave consideration to a report outlining potential actions that could be expected to reduce spend at a pace and magnitude to address the gap. A step reduction in service volume is likely to be the only way a sufficient step reduction in spend can be delivered in the relatively short term. Decision The Finance and Policy Committee – 1. noted that the HSCP had prepared a paper outlining potential savings options as requested by the Committee; and 2. noted the contents of the report and provided guidance to the leadership team on the next steps. (Reference: Report by Head of Finance dated 18 March, submitted) 7. TRANSFORMATION BOARD - UPDATE The Committee gave consideration to a report providing an update on the review of the Strategic Planning process of which transformation will play a key role in restructuring the board to support a more agile approach to delivery and increase IJB oversight to support improved change practice. Decision The Finance and Policy Committee considered and approved the proposed structure and practice. (Reference: Report by Interim Head of Strategic Planning, Performance and Technology dated 18 March, submitted) 8. DATE OF NEXT MEETING The Finance and Policy Committee noted the date of the next meeting as Tuesday 24 June 2025. Page 27
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1 Integration Joint Board Agenda item: Date of Meeting: 26 March 2025 Title of Report: Chief Officer Report Presented by: Evan Beswick, Chief Officer The Integration Joint Board is asked to: • Note the following report from the Chief Officer Introduction Welcome to my Chief Officer Report for March 2025 and I would like to start by highlighting some of the great work taking place in the Oban area which I experienced for myself on a recent visit to the locality. I was delighted to spend time with the team at Eadar Glinn care home in Oban on 27th February and witness first-hand the kind, thoughtful care that residents receive there. I came away with a real sense of the ambition that colleagues had that the residents could live fulfilling, dignified lives in that setting, where their choices and rights were valued. Staff working in the home for many years had lost none of their enthusiasm for their work, which was an inspiration. That same day, in Lorn & Islands Hospital, I heard about the fantastic, complex work ongoing to redesign the laboratory services, bringing them up to the highest standards and ensuring professional collaboration across NHS Highland. I was impressed with the team working across professions, and the commitment to quality and improvement. Taken together, these visits reminded me of the breadth and complexity across our integrated services. My visits put me particularly in mind of the work we have to do managing and balancing our capacity across hospital and social care settings, and brought home to me the importance of us looking ahead, not just at the here and now. It also brought home to me the importance of the strategic work being driven by our Older Adults Strategy, our Rural General Hospitals group and our Community Standards work in meeting the future challenges across our integrated system. In my report I have also highlighted the recent flooding we experienced in the theatres at Lorn & Islands Hospital and the difficult decision that we had to take to cancel all planned operations until repairs could be carried out. I would like to thank our staff and contractors for managing to resolve this issue so quickly. I would also Page 29 Agenda Item 5
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2 like to apologise to those patients who had their operations cancelled and our staff locally have been working hard to arrange new appointment dates for those individuals who were affected. As I have mentioned in previous reports we have been experiencing significant recruitment challenges in certain specialties and localities and although we are not alone in this we continue to have our own specific challenges because of the remote and rural nature of the HSCP. A recent example of this is in Campbeltown Hospital where, despite the best efforts of the team locally and an ongoing recruitment campaign, we have 10 registered nurse vacancies. To ensure we could continue to provide a safe, quality and sustainable service for our patients, both within the ward and the A&E Department, the HSCP’s Senior Leadership Team approved on 19 February 2025 a recommendation to temporarily reduce the number of beds at the hospital from 12 (plus 2 contingency) to 6 beds. Staff, the local community and local stakeholders have all been made aware of this decision. The proposed bed reduction was implemented in a safe planned way and took effect in the middle of March. This reduction will be a temporary measure and will be reviewed on a 4 weekly basis. Funding for the recruitment of registered nurses remains available and we will be continuing our recruitment campaign. If we are successful in recruiting additional staff then, following a period of training and local orientation and induction, we hope to be able to reinstate the beds in an incremental basis over a period of time. Our statutory Social Work services for children and families is also under considerable pressure with the level of need continuing to increase across a number of areas. We are facing significant recruitment challenges as there is a national shortage of qualified social workers. Our staff are prioritising elements of the service such as our statutory Social Work duties and we have ‘grow your own’ schemes in operation to hopefully recruit staff locally and we are attempting to institute the protected year for Newly Qualified Social Workers which helps them with the transition from education to professional social work in a supported working environment. The above two examples demonstrate that safety must always be at the forefront of the care that we deliver. People have an expectation that they will receive a good standard of care, delivered with professionalism, compassion and safety, and my team and I have a clear commitment to maintaining and improving this. However, while our services must always be safe, that does not mean we will always be able to provide care in the way and at the volume we have done previously. To that point, we are also continuing to face significant financial pressures and the IJB is required to approve a budget for the 2025/26 financial year. It has been more challenging than ever before to develop and present a budget which is agreed with partners and seeks to balance the requirement to operate within resources that are reducing in real terms with increasing demands for health and care services. While we are pleased to report that we have a viable budget for the coming year it is clear that substantial new savings need to be identified and implemented within the course of the year. The challenge is extreme and is one that the whole of the health Page 30
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3 and care sector is trying to manage at present. Further details of the budget position are included within the finance papers. Moving on to more of the details of my report I am delighted to inform the IJB that the Public Health team have been successful in obtaining funding to expand the research into the outcomes that can be achieved through the use of Community Link Workers (CLWs) within our remote and island communities. CLWs are non- clinical practitioners who work with people to identify social issues that might be affecting their health and wellbeing, and connect people to sources of support or resources within their community. I was also delighted to see that our Empty Homes Officer, Isla Binnie, was shortlisted for a national award that recognised the outstanding work that she is doing across Argyll and Bute. Although she was pipped to the post on the day the judging panel recognised and commended her work. One of the key priorities, both locally and nationally, is to address conditions early and to intervene to prevent diseases from progressing, preventing manageable conditions from becoming serious ones. I was therefore really pleased to see the excellent work that is taking place through the physical activity element of the Living Well Programme. Through strength and balance classes and education sessions the team are delivering this programme across our five main localities with the aim of empowering participants, all with long term conditions, to live well and manage their conditions independently. This support for self-management will be key to our approach to the future. As per usual I have also included in the National Updates section information on some of the recent announcements from the Scottish Government and there are also web links where you can find out more details of these announcements. I would like to finish my report by expressing my thanks to two members of staff who are leaving the organisation. My best wishes go to Ronnie Crawford, Residential and Aftercare Manager (Children’s Social Work), who retires on 13 April 2025 after nearly 40 years of public service. Ronnie has worked in Children and Families for all of these years and is well respected by her colleagues and by the families she has worked with and supported over the years. We all wish you well Ronnie in your retirement. This IJB will be the last meeting for Caroline Cherry, our Head of Adult Services (Health and Community Care), who has been offered and accepted the post of Principal Social Work Officer in Fife. This marks the end of a long and eventful journey within Argyll and Bute. Caroline joined as Head of Service in November 2019, and was able to visit all sites before the global pandemic hit, meaning she was able to provide essential leadership throughout that challenging period. In my short time as Chief Officer I have been grateful for Caroline’s wealth of expertise, her fair and robust scrutiny, and her clear values and passion for the care and dignity of older adults. I would like to thank Caroline for her work and impact within Argyll and Bute and wish her well in this next stage of her career. Thank you once again for taking the time to read my report and please feel free to contact me if you have any comments or suggestions for inclusion in future reports. Page 31
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4 HSCP Updates Community Link Working Funding The Public Health team are delighted to announce that they have been successful in obtaining funding from the National Centre for Remote and Rural Health and Care to expand the research into the outcomes that can be achieved through the use of Community Link Working within very remote and island settings across Argyll and Bute. Patients living within smaller GP practice catchment areas are in the most remote areas of our local authority, including on our small islands. The team recognised that there are research gaps around community link working in remote rural and island communities, which this project seeks to address. The funding will be used to understand how Community Link Working can be tailored to meet the needs of island communities and generate evidence on reducing health inequalities and improving access to services in rural areas. The research will engage with island residents and healthcare providers to explore the specific health and social needs of the community and how/whether CLWs can address these effectively. This exciting project will contribute to the evidence base for remote, rural, and island health and care research and evaluation, and increase the professional development of staff involved in the work. Further details on the engagement will be released soon, and general information about link working can be found here. Community Link Workers (CLWs) are non-clinical practitioners who work with people to identify social issues that might be affecting their health and wellbeing, and connect people to sources of support or resources within their community. CLWs are often based in or aligned to one or more GP practices, and work as part of a multidisciplinary team working together to support people holistically and improve outcomes for patients. Community Link Working recognises that social issues such as debt, relationships, employment, and loneliness, among others, can impact people's health and wellbeing. Empty Homes Officer Shortlisted for Award I would like to congratulate Isla Binnie, the HSCP's Empty Homes Officer, for recently being shortlisted for a national award to recognise her Outstanding Contribution to Empty Homes Work in Argyll and Bute. The winner was announced at the Scottish Empty Homes Conference on 25 February and although Isla was pipped to the post on the day, the work she has been doing was recognised and commended by the judging panel. I am so pleased by the recognition that the judging panel gave to Isla for the work she is doing across Argyll and Bute to help encourage long term property owners to bring their property back into occupation for HSCP staff to rent. My thanks go to her and everyone she is working with on this really important project for the HSCP. Page 32
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5 Service Updates Campbeltown Hospital Update Despite the best efforts of the team locally and an ongoing recruitment campaign we are continuing to face significant challenges with recruitment to registered nurse posts within Campbeltown Hospital. There are currently 10 registered nurse vacancies and the use of agency staff is therefore ongoing to help meet this challenge in staffing. In order to ensure that we can continue to provide a safe, quality and sustainable service for our patients, both within the ward and the A&E Department, a proposal was presented to the HSCP’s Senior Leadership Team meeting on 19 February 2025 recommending that the number of beds at the hospital be temporarily reduced from 12 (plus 2 contingency) to 6 beds. This proposal, which was supported by the HSCP’s medical and nursing professional leadership, was discussed fully by SLT and the recommendation to reduce the number of beds was approved. Staff locally have been fully aware of the challenging staffing situation at the hospital and were further informed of the decision by SLT. This reduction will greatly support our staff in their roles and will allow us to continue to provide safe care for our patients. The proposed bed reduction was implemented in a safe planned way and took effect in the middle of March. This bed reduction will be a temporary measure and will be reviewed on a 4 weekly basis. Funding for the recruitment of registered nurses remains available and we will be continuing our recruitment campaign. If we are successful in recruiting additional staff then, following a period of training and local orientation and induction, we hope to be able to reinstate the beds in an incremental basis over a period of time. Flooding at Lorn & Islands Hospital Early in February we experienced significant water ingress in the theatres at Lorn & Islands Hospital and as the safety of any surgery was our priority the difficult decision was taken to cancel all planned operations until repairs could be carried out and patients who had their operations cancelled were informed. Contingency plans were implemented to ensure that we could continue to provide emergency surgery. Work took place to resolve this issue and the theatres were fully operational once again by 17 February. We would like to thank our staff and contractors for managing to resolve this issue so quickly and our apologies once again go to those patients who had their operations cancelled. Our staff have been arranging new appointment dates for those individuals affected. Living Well Programme One of the key priorities, both locally and nationally, is to address conditions early and to intervene to prevent diseases from progressing, preventing manageable conditions from becoming serious ones. Here in Argyll and Bute the two year Page 33
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6 funded physical activity element of the Living Well Programme is already beginning to deliver on this. Through strength and balance classes and education sessions including behaviour change conversations, the team delivering this programme aim to empower participants, all with long term conditions, to live well and manage their conditions independently. Referrals can be made by any health professional and since taking referrals in the New Year, 84 participants have been referred and of those 70 are now actively engaging with the programme across five localities. Results in the five main localities are already evident from some of the feedback with comments from participants saying that: “This service has empowered me to vastly improve my mobility, wellbeing and had a positive impact regarding my own future and enable me to continue living independently” and “I have found that I feel much more in control of my body and freer in my movements. I would definitely recommend this class to anyone who has been offered the chance.” The next phase with this innovative programme is to not only continue to deliver a high class service but ensure the long term sustainable future for the programme beyond the two years HSCP funding. National Updates Financial Support for Student Carers During National Student Money Week (3-7 March 2025), unpaid carers in education are being encouraged to check if they are entitled to financial help from Social Security Scotland. It is estimated that there are around 35,000 unpaid carers attending college or university in Scotland. The type of help they provide includes emotional, mental or physical support for a family member, friend or neighbour. But many don’t recognise themselves as a carer, which could mean they are missing out on extra money. Further information is available here. Impact of New RSV Vaccine Health Secretary Neil Gray has welcomed a report showing the new RSV (Respiratory Syncytial Virus) vaccine has led to a significant decrease in hospitalisations among older people. Public Health Scotland research, published in The Lancet Infectious Diseases Journal, demonstrates that vaccination resulted in a 62% reduction in RSV-related hospitalisations among the eligible 75-79 age group. The Scottish Government invested £4.2 million via health boards in the vaccine supply. The programme began last August following expert scientific advice from the Joint Committee on Vaccination and Immunisation. Further information is available here. Attracting and Retaining Nurses and Midwives A taskforce has published 44 recommended actions on how to improve working conditions for Scotland’s nurses and midwives. The Nursing and Midwifery Page 34
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7 Taskforce was established by the Scottish Government in 2023 to build on efforts to make Scotland the best place for nurses and midwives to work. Chaired by Health Secretary Neil Gray, it brings together key stakeholders, including the Royal Colleges of Nursing and Midwifery, to engage with nursing and midwifery staff, understand the challenges they face and recommend ways to improve the profession. Further information is available here. Protecting, Strengthening and Renewing the NHS People across Scotland will have better access to NHS treatment through increased capacity, expanded primary care services, enhanced use of digital innovations and a range of other measures, First Minister John Swinney announced on 27 January. Speaking to representatives from across the health and social care sector, the First Minister set out action to drive down waiting times and reduce pressure on frontline services. Further information is available here. Social Care Reform A dedicated advisory board, support for unpaid carers and enshrining care home residents' rights to see loved ones are at the heart of revised plans for the National Care Service. Social Care Minister Maree Todd outlined the next steps for reform to Parliament after plans to progress the National Care Service Bill were paused for further consideration in November 2024. A new non-statutory advisory board – comprising of people with lived experience of accessing care, social care workers, care providers, trade unions, the NHS and local government – will be established to provide guidance and drive improvement within the sector. It is expected to meet for the first time in the spring. Further information is available here. News Islay Aquanatal and Baby Massage Classes Islay Maternity Services, with the support and funding from Bump to Birth Charity, have launched aquanatal classes. The funding helped facilitate midwife Suzie Hannah's completion of aquanatal instructor training and now she brings her expertise and enthusiasm to local expectant mothers, offering a safe and encouraging environment to engage in beneficial aquanatal exercises. Aquanatal classes provide valuable support for expectant mothers, combining physical activity with relaxation techniques that are specifically designed to meet their unique needs. These classes provide a low-impact exercise option that is gentle on the joints, which is particularly important during pregnancy. The buoyancy of the water supports the body, reducing the strain on muscles and ligaments while allowing for a full range of motion. This can help improve flexibility, strength, and endurance, all of which are valuable in preparing for childbirth. Page 35
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8 In addition to the physical benefits, the classes offer a wonderful opportunity for social interaction. As women come together, they share experiences, offer support, and build friendships, creating a nurturing community of mums-to-be. This feeling of companionship can be incredibly uplifting, providing vital emotional support and reassurance during the journey of pregnancy. Staffing Updates Interim Head of Strategic Planning, Performance and Technology I am delighted to confirm that, following an open process, Charlotte Craig has been appointed to the interim position for Head of Strategic Planning, Performance and Technology. Charlotte commenced in post on 27 January and will be supporting some of our pressing priorities around the integrated Joint Strategic Plan, digital first approach and pathways into NHS Greater Glasgow and Clyde. Interim Senior Manager for Health and Community Care I would also like to congratulate Karl McLeish who, following an open process, has been appointed to the interim position as Senior Manager of Health and Community Care. Karl will be covering for Donald Watt who is currently interim Head of Service covering Acute and Community Care across Oban, Mid-Argyll and Kintyre. Karl will cover the East of Argyll and Bute and will have a specific focus on strategic developments in the community. He will also remain covering unscheduled care. Ronnie Crawford Retiral I would like to wish Ronnie Crawford, Residential and Aftercare Manager (Children’s Social Work), my best wishes when she retires on 13 April 2025. Ronnie has had an amazing length of service, having worked in public service for nearly 40 years, starting with Strathclyde Regional Council and transferring over to Argyll and Bute Council when Strathclyde Region disaggregated. Ronnie has worked in Children and Families for all of these years and is well respected by her colleagues and by the families she has worked with and supported over the years. We all wish you well Ronnie in your retirement. Farewell to Caroline Cherry Caroline Cherry, Head of Adult Services (Health and Community Care), has been offered and accepted the post of Principal Social Work Officer in Fife and will be leaving her current role at the end of May. This marks the end of a long and eventful journey within Argyll and Bute. Caroline joined as Head of Service in November 2019, and was able to visit all sites before the global pandemic hit, meaning she was able to provide essential leadership through that challenging period. Her experience in the social care sector meant she Page 36
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9 was able to lead the transition towards greater support and collaboration within the care home sector – the benefits of which we live with today. Caroline’s legacy, aside from the team she has built, will include the Older Adults strategy, and the recent in-depth work on care at home which, as if we need reminding, leaves us all plenty to do for the future, but provides clear direction and an unmistakable impact on the future shape of care across Argyll and Bute. In my short time as Chief Officer I have been grateful for Caroline’s wealth of expertise, her fair and robust scrutiny, and her clear values and passion for the care and dignity of older adults. I would like to thank Caroline for her work and impact within Argyll and Bute and wish her well in this next stage of her career. Page 37
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1 Classification: OFFICIAL Integration Joint Board Date of Meeting: 26 March 2025 Title of Report: Transition of the Chair and Vice-Chair of the Integration Joint Board Presented by: Charlotte Craig, Interim Head of Service Strategic Planning, Performance and Technology The Integration Joint Board is asked to: ▪ Note the transition to a new Chair and Vice Chair of the Integration Joint Board in accordance with the Integration Scheme and the Public Bodies (Joint Working)(Integration Joint Boards)(Scotland) Order 2014. 1. EXECUTIVE SUMMARY 1.2 The tenure of the current IJB Chair is due to cease on the 31 March 2025. It was proposed that the NHS’s nominated IJB Chair, Graham Bell and Council’s nominated Vice Chair, Councillor Dougie McFadzean take up their new role roles at the end of March. 1.3 If each constituent body was in agreement with this then there no conflict in the Scheme of Integration or IJB’s Standing Orders that would prevent this from occurring. 2. RECOMMENDATIONS The Integration Joint Board note the transition of the Chair and Vice Chair in line with the two year rotation period between partners noting Councillor Hampsey held the position as IJB Chair for the first period of the tenure replaced as Policy lead by Councillor Dougie McFadzean. 3. DETAIL OF REPORT Article 4 of the Order provides for the Chair to be appointed by the NHS Board or the Council from among the voting members by the NHS Board and the Council. The Vice Chair is appointed by the constituent authority who did not appoint the Chair. The NHS Board and the Council have a responsibility for the appointment of the Chair and Vice Chair on an alternating basis. The NHS Board or the Council may change the person appointed by them as Chair or Vice Chair during an appointing period. Page 39 Agenda Item 6
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2 Classification: OFFICIAL 4. RELEVANT DATA AND INDICATORS No relevant data or indicators. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The Chair and Vice Chair provide key governance roles in supporting the delivery of the strategic priorities. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact - none 6.2 Staff Governance - none 6.3 Clinical and Care Governance – none 7. PROFESSIONAL ADVISORY No professional advisory required for this report. 8. EQUALITY & DIVERSITY IMPLICATIONS There are no implications of equality and diversity from the consideration of this report. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE There are no implications of GDPR from the consideration of this report. 9. RISK ASSESSMENT There are no risk implications from the consideration of this report if the IJB is in agreement with the transition. 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT There has been no consultation on the contents of this report. 11. CONCLUSIONS The Integration Joint Board are asked to note that the current IJB Chair Dougie McFadzean will complete his tenure on 31 March 2025. The current Vice Chair and NHS Nominated Chair Graham Bell will take up the office of chair for the two year period from 1 April 2025 to 31 March 2027. Council nominee Dougie McFadzean will take up the position of Vice Chair on 1 April 2025 to 31 March 2027. 12. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board Page 40
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3 Classification: OFFICIAL 13. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) N/A REPORT AUTHOR AND CONTACT Author Name Charlotte Craig Email charlotte.craig@argyll-bute.gov.uk Page 41
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1 Classification: OFFICIAL INTEGRATION JOINT BOARD Date of Meeting: 26th March 2025 Title of Report: Review of the Integration Scheme 2025 Presented by: Douglas Hendry, IJB Standards Officer The Integration Joint Board is asked to: • Note the requirement for a review of the current Integration Scheme to be carried out by 23rd March 2026. • Note the proposed steps in respect of carrying out the review, including the formation of a working group. • Note that further updates in respect of the review will be prepared for future meetings of Argyll and Bute Council, IJB and NHS Highland Board. 1. EXECUTIVE SUMMARY 1.1 The purpose of this report is to advise IJB members of the requirement to review the Health and Social Care Integration Scheme (the Scheme) and the proposed steps to achieve this. 1.2 In line with the provisions of section 44 of the Public Bodies (Joint Working) (Scotland) Act 2014 a review of the Integration Scheme between Argyll and Bute Council and NHS Highland requires to be completed and ready for submission to Scottish Ministers no later than 23rd March 2026, or a decision taken by the partner bodies that no changes are necessary to the current scheme by that date. 2. RECOMMENDATIONS 2.1 Note the requirement for a review of the current Integration Scheme to be carried out by 23rd March 2026. 2.2 Note the proposed steps in respect of carrying out the review, including the formation of a working group. 2.3 Note that further updates in respect of the review will be prepared for future meetings of Argyll and Bute Council, IJB and NHS Highland Board. 3. DETAIL OF REPORT 3.1 The legal requirement to complete a review of an Integration Scheme is set out in Section 44 of the Public Bodies (Joint Working) (Scotland) Act Page 43 Agenda Item 7
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2 Classification: OFFICIAL 2014 (the Act). The Scheme must be reviewed each subsequent period of 5 years beginning with the day on which the Scheme was approved, in this case 23rd March 2021. 3.2 On this basis a review of the Scheme is required by law to be completed by 23rd March 2026. The statutory responsibility to review the Scheme sits with the Board of NHS Highland and Argyll and Bute Council. 3.3 Drawing on the approach adopted for the previous review of the Scheme, which was undertaken in 2019/20, a Working Group has been established to determine and agree any revisions required to the Scheme. The Working Group includes Senior Officer representation from across the Council, Argyll and Bute HSCP, and NHS Highland. An initial meeting was held on 11 March 2025 and the Group have begun the process of identifying potential areas for change. 3.4 Once the Working Group have completed their review of the Scheme over the coming months, a further report will be prepared for the Council, IJB and NHS Highland Board to seek agreement on any proposed changes put forward. If both partner bodies are agreeable to any proposed amendments, there is then a requirement to undertake a formal consultation exercise in accordance with Section 46(4) of the Public Bodies (Joint Working) (Scotland) Act 2014. The Council and the Health Board must jointly consult with groups and individuals, to include prescribed stakeholders, and any others deemed appropriate. 3.5 In the event that a formal consultation exercise is required, the Working Group will develop, as part of their remit, a draft consultation and engagement strategy, for consideration and approval by the partner bodies at future meetings of the Council and NHS Highland Board. This will include details of the proposed consultation period/timetable, key consultees and methods of consultation/engagement. 4. RELEVANT DATA AND INDICATORS 4.1 The legal requirement to undertake a quinquennial review of the Integration Scheme is set out in section 44(5) of the Public Bodies (Joint Working) (Scotland) Act 2014. 5. CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 The Scheme and Standing Orders provide the key governance documents for the IJB that support the delivery of the work of the Health and Social Care Partnership. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact - none arising from this report 6.2 Staff Governance – none arising from this report 6.3 Clinical and Care Governance – none arising from this report Page 44
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3 Classification: OFFICIAL 7. PROFESSIONAL ADVISORY 7.1 Senior Officers from Argyll and Bute Council, HSCP and NHS Highland will meet regularly over the coming months as part of the Working Group tasked with reviewing the Scheme. 8. EQUALITY & DIVERSITY IMPLICATIONS 8.1 None arising from this report 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE 9.1 Activity is undertaken in line with GDPR regulations. 10. RISK ASSESSMENT 10.1 If the review of the Integration is not completed within the designated timescales, there is the risk of non-compliance with statutory measures under the Public Bodies (Joint Working) (Scotland) Act 2014. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT 11.1 If both partner bodies are agreeable to any proposed amendments, there is then a requirement to undertake a formal consultation exercise in accordance with Section 46(4) of the Public Bodies (Joint Working) (Scotland) Act 2014. The Council and the Health Board must jointly consult with groups and individuals, to include prescribed stakeholders, and any others deemed appropriate. 12. CONCLUSIONS 12.1 In line with the provisions of section 44 of the Public Bodies (Joint Working) (Scotland) Act 2014 a review of the current Integration requires to be completed and ready for submission to Scottish Ministers no later than 23rd March 2026. This report advises IJB members of the proposed steps to fulfil this requirement, including the creation of a Working Group. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) N/A Page 45
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4 Classification: OFFICIAL REPORT AUTHOR AND CONTACT Name: Laura Blackwood - Directorate Support Officer Email: laura.blackwood@argyll-bute.gov.uk Page 46
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1 Classification: OFFICIAL Integration Joint Board Date of Meeting: 26 March 2025 Title of Report: Standard review of the Committee Terms of Reference Presented by: Charlotte Craig, Interim Head of Strategic Planning, Performance and Technology The Committee is asked to: ▪ Review and approve the updated Committee Terms of Reference as recommended by the Committee’s and Strategic Planning Group 1. EXECUTIVE SUMMARY Good governance requires that the IJB review both its committee terms of reference and standing orders at regular intervals. The board is asked to consider the recommended changes from the Committee’s and Strategic Planning Group and approve ensuring that they are fit for purpose. Committee roles and responsibilities are developed from the Scheme of Integration and the committee has evolved to ensure that it provide appropriate consideration to risk on behalf of the IJB. While the Integration Scheme is under review this will not complete until 2026 following Scottish Government approval. All Committee’s and the Strategic Planning Group have reviewed the terms of reference and have recommended the updated document to the IJB for approval. 2. RECOMMENDATIONS a) The board review the updated terms of reference and approve until the update of the integration scheme or if any other occurrence stimulates and update. 3. DETAIL OF REPORT The document has been reviewed by Audit and Risk, Clinical and Care Governance and Finance and Policy Committees. It has also been reviewed by the Strategic Planning Group. Audit and Risk have confirmed the current terms of reference as continuing to be fit for purpose as have Finance and policy and have recommended no changes. Clinical and Care Governance have taken cognisance of the updated Clinical and Care Governance Framework and provided specific focus on public protection and a route for direct assurance on the process Page 47 Agenda Item 8
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2 Classification: OFFICIAL from the COGPP chair to the Committee Chair and Vice Chair and provide this to the group. • Strategic Planning discussed the use of IJB members to support development oversight where appropriate and this is encompassed in the current statement “communicate to the IJB that there's been appropriate discussion and engagement (in line with statutory responsibilities)”. As such there is no other recommended change to the terms of reference at this stage with exception of a resolution of community representation being noted in the correct parts of the document. • Locality Planning Groups, the board should note that until a formal framework for the engagement structure is presented to the IJB this will remain in situ until update. Current locality planning groups have been updated as to proposals as presented at the Strategic Planning Group on 13 March 2025 which have been supported to date. Ongoing engagement on how to deliver Locality Planning is ongoing with oversight from the Strategic Planning Group on 13 March 2025. This engagement recognises the potential to bring innovation and bravery into planning and working locally. The IJB will have the opportunity to shape these emerging plans later in the year. 4. RELEVANT DATA AND INDICATORS Decisions are recorded in the public meeting of the Integration Joint Board. Committees/Strategic Planning Group are enabled to make recommendation but not decision making as held in private. 5. CONTRIBUTION TO STRATEGIC PRIORITIES Supports the best use of resources and good governance of the IJB. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – Finance and Policy Committee offers oversight and scrutiny on behalf of the IJB in this area. 6.2 Staff Governance – this is reported to the IJB by employing bodies as set out in the Integration Scheme. 6.3 Clinical and Care Governance – performance of the committee has a direct impact on the oversight of clinical and care governance. 7. PROFESSIONAL ADVISORY Committees and the Strategic Planning Group have considered the terms of reference and made recommendation on the application of updates. 8. EQUALITY & DIVERSITY IMPLICATIONS Good governance ensures the IJB is undertaking its duty in respect of Equality Outcomes and meeting public sector equality duties. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Applicable when related to the business of the board. 9. RISK ASSESSMENT The board should be assured that the framework is in place to support them to consider the business of the IJB for assurance. Page 48
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3 Classification: OFFICIAL 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT All committee’s and the Strategic Planning Group were consulted in respect of the review to provide advisory to the Integration Joint Board in the continuance of carrying out their role as directed by the board. Three Locality Planning Groups to date have been involved in the review of activity to date. 11. CONCLUSIONS The board is asked to consider the recommendations and approve in respect of fitness for purpose in delivering the business of the Integration Joint Board noting further locality planning and ongoing community dialogue development. 12. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 13. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) N/A REPORT AUTHOR AND CONTACT Author Name Charlotte Craig Email charlotte.craig@argyll-bute.gov.uk Page 49
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1 Classification: OFFICIAL Argyll & Bute Integration Joint Board Committee Terms of Reference Page 51
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2 Classification: OFFICIAL Document control Title IJB Committee Terms of Reference Author Charlotte Craig Creation date May 2020 Date of version May 2022 Version history Version Comments V2.0 Approved at May IJB V2.1 Updated CSWO role and reflect staff changes V2.2 Update to the general provisions reflect the committee/group requirement to report annually to the IJB Updated Terms of Reference for the Strategic Planning Group V2.3 Update to job titles of professional advisory, members and addition of a cover page. V2.4 Update to Clinical and Care Governance Committee responsibilities for performance, remove current committee membership to separate document, update job titles. V2.5 Proposed update to Clinical and Care Governance Committee regarding line of oversight for public protection Proposed update supporting appointment of IJB members for oversight. Page 52
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3 Classification: OFFICIAL IJB Membership The role and constitution of IJB is established through legislation. The voting membership is: a. NHS Highland : 4 members of the NHS Highland Health Board b. Council: 4 Elected members of the Council nominated by the Council The term of office of the Chair and the Vice Chair will be a period of two years. NHS Highland and the Council will appoint one of their four representatives to act as Chair/Vice Chair on a two year rotating basis. The Chief Officer and Chief Financial Officer shall attend Committee meetings in their capacity of advisers and not as members of the Committees. The decision making structure whereby the committees of the IJB have Terms of Reference agreed by the IJB include the Clinical and Care Governance Committee, Audit and Risk Committee and Finance and Policy Committee. The act makes provision for a Strategic Planning Group for the development and delivery of the Strategic Plan. Argyll & Bute IJB have approved a Locality Planning Group model to engage on local planning. 1.1. Clinical and Care Governance Committee Membership The Committee will consist of not less than 6 members, being IJB representatives, officers, stakeholders and professional advisers. The IJB shall appoint IJB representatives to the Committee, appropriate officer representation will be co-ordinated by the Chief Officer. Role Membership Chair IJB Member (Council or NHS) Member Vice Chair IJB Member (Council or NHS) Member IJB Member Member IJB Member Member Chief Officer Member Deputy Medical Director Member Associate Director Public Health Member Head of Primary Care Member Associate Director of Nursing Member Head of Children & Families & Justice/CSWO Member Associate Director AHP Member Associate Director Pharmacy Member Head(s) of Adult Services Member Page 53
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4 Classification: OFFICIAL Head(s) of Adult Services Member Clinical Governance Manager Attendee (required) Staffside Representative Member Locality Staff attend as required Attendee Carer/public representatives Member 1.2. Audit and Risk Committee Membership Audit and Risk Committee consists of six members of the IJB (minimum two voting members - one from NHS Highland and one from the Council) The Chair and Vice-Chair of the IJB Audit and Risk Committee will be appointed by the IJB for a two-year term. Neither may be Chair or Vice-Chair of the IJB. Other persons may participate in meetings by invitation of the Chair. Role Membership Chair IJB Member Member Vice Chair IJB Member Member IJB Member Member IJB Member Member IJB Member Member IJB Member (professional advisory) Member Chief Officer Attendee (required) Chief Finance Officer Attendee (required) External Auditor Attendee (required) Internal Auditor Attendee (required) Officers attend as required Attendee 1.3. Finance and Policy Committee Membership The Committee will consist of not less than 8 members, being IJB representatives, officers, stakeholders and professional advisers. The IJB shall appoint IJB representatives to the Committee, appropriate officer representation will be co-ordinated by the Chief Officer. Role Membership Chair, Integrated Joint Board Member Vice - Chair, Integrated Joint Board Member IJB Member Member IJB Member Member IJB Member Member IJB Member Member Professional Advisory Group Representative Member Page 54
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5 Classification: OFFICIAL Chief Officer Attendee (required) Chief Finance Officer Attendee (required) Staffside Attendee (required) Officers attend as directed Attendee 1.4. Strategic Planning Group Membership The Strategic Planning Group is established according to Section 32 of the Public Bodies (Joint Working) (Scotland) Act 2014 and will report to the full IJB Board as required. Role Membership Chair Member Co-Chair (IJB Member) Member IJB Member ( carers) Member IJB Member Member IJB Member Member Chief Officer Member Chief Financial Officer Member Deputy Medical Director Member Associate Director Public Health Member Head of Primary Care Member Associate Director of Nursing Member Head of Children & Families & Justice/CSWO Member Associate Director of AHP Member Associate Director Pharmacy Member Head(s) of Adult Services Member Staffside Representative Member Senior Service Planning Manager Member Housing (Council and other) Member Third Sector (TSI CEO + 1) Member Carers Act Implementation Officer Member Independent Sector Member Community Representation Attendee Officers attend as required Attendee Page 55
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6 Classification: OFFICIAL Locality Planning Groups Membership Locality Planning Groups (x4) Role Current Membership Chair • Area Manager • Member Co-Chair • Other than HSCP staff • Member Community Members (2) • Various based on Locality • Member Carers (2) • To be recruited • Member Third Sector • Various based on Locality • Member Independent Sector • Various based on Locality • Member Primary Care • Various based on Locality • Member Housing • Various based on Locality • Member Education • Various based on Locality • Member Community Council (2) • To be recruited • Additional Members Argyll & Bute (not statutory) Elected members • Various based on Locality • Additional Members Argyll & Bute (not statutory) 2. GENERAL PROVISIONS REGULATING MEMBERSHIP Members of the IJB subscribe to and comply with the Standing Orders and Code of Conduct and the appointed Standards Officer is responsible for advising and guiding members of the Board on issues of conduct and propriety. A register of interests is in place for all Board members and senior officers. The IJB operates within an established procedural framework. The roles and responsibilities of Board members and officers are defined within the Integration Scheme, Standing Orders and Financial Regulations; these are subject to regular review. The Committees will report directly to IJB regularly and annually on a formal basis and will provide clear, robust, accurate and timely information on the quality of service performance. Page 56
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7 Classification: OFFICIAL 2.1. Appointments The IJB will make all appointments to the Committees including the appointment of the Chair and Vice-Chair of the Committees. 2.2. Chair and Vice-Chair 2.2.1. The Chair and Vice-Chair of the Committees will be members of the IJB appointed from those members appointed to the Committees; 2.2.2. The appointment of Chair and Vice-Chair will be for a two year term. 2.3. Quorum 2.3.1. Three members of the Audit & Risk Committee and the Finance & Policy Committee, one from each partner body and one other, shall constitute a quorum, with at least one of the members being Chair or Vice-Chair. 2.3.2. The Clinical & Governance Committee and Strategic Planning Group will require one third of their membership with at least one member from each partner body. 2.3.3. Ordinary Committee members (i.e. other than the Chair/Vice- Chair) may nominate deputies to attend meetings to ensure meetings are quorate, this will only be permitted with prior agreement by the Chair. 2.3.4. No business shall be transacted unless this minimum number of members is present. For the purposes of determining whether a meeting is quorate, members attending by video or audio link will be determined to be in attendance. 2.4. Frequency of Meetings 2.4.1. The Committees will meet on a frequency to be determined by IJB, on dates to be specified in an annual programme of meetings, with meetings normally held at least quarterly in each financial year at a place and time as determined by each Committee. 2.4.2. The Chair of each Committee may at any time convene additional meetings or increase frequency of meetings to consider business, which may require urgent consideration. 2.5. In Attendance 2.5.1 Agendas will follow standard template which will cover all Page 57
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8 Classification: OFFICIAL elements of the Committee’s framework. 2.6. Sub-groups 2.6.1. The Committees may at their discretion set up working groups for specific tasks. Membership of working groups will be open to anyone whom the Committees consider will be able to assist in the task assigned. The working groups will report their findings and any recommendations to each Committee. CLINICAL AND CARE GOVERNANCE COMMITTEE TERMS OF REFERENCE 1. REMIT The Committee’s framework will encompass the following responsibilities as detailed in paragraph 5.8 of the Integration Scheme. Each of the four elements, listed below, will be 1.1. underpinned by mechanisms to measure quality, clinical and service effectiveness and sustainability. They will be compliant with statutory, legal and policy obligations strongly underpinned by human rights values and social justice. Service delivery will be evidence-based, underpinned by robust mechanisms to integrate professional education, research and development. 1.2. Measure the quality of integrated service delivery by measuring delivery of personal outcomes and seeking feedback from service users and/or carers; 1.3. Professional regulation and workforce development; 1.4. Information governance 1.5. Safety of integrated service delivery and personal outcomes and quality of registered services The Committee will ensure that quality monitoring and governance arrangements are in place for safe and effective health and social care service delivery in Argyll and Bute. This will include the following:- 1.6 Compliance with professional codes, legislation, standards, guidance. Systems and processes to ensure a workforce with the appropriate knowledge and skills to meet the needs of the local Page 58
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9 Classification: OFFICIAL population. To actively liaise directly with formal structures such as Chief Officers Group for Public Protection for assurance within the framework responsibilities. 1.7 Effective internal systems that provide and publish clear, robust, accurate and timely information on the quality of service performance. 1.8 Systems to support the structured, systematic monitoring, assessment and management of risk’s-ordinated risk management, complaints, feedback and adverse events/incident system, ensuring that this focuses on learning, assurance and improvement. 1.9 Improvement and learning in areas of challenge or risk that are identified through local governance mechanisms and external scrutiny. 1.10 Mechanisms that encourage effective and open engagement with staff on the design, delivery, monitoring and improvement of the quality of care and services. 1.11 Planned and strategic approaches to learning, improvement, innovation and development, supporting an effective organisational learning culture. 1.12 To provide assurance to the Integrated Joint Board that systems, processes and procedures are in place and are delivering effective clinical and care governance throughout Argyll and Bute. This will include the following: 1.13 To develop and monitor clinical and care assurance systems to regulate the quality and safety of health and care services 1.14 To monitor implementation of Care Inspectorate and NHS Healthcare Improvement Scotland clinical standards and other external review body standards and guidelines – such as Mental Welfare Commission, SPSO etc. 1.15 To oversee self-evaluation and preparation for joint inspections and to oversee local implementation of recommendations following review Page 59
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10 Classification: OFFICIAL 1.16 To oversee the review all incidents to identify trends, to take appropriate action and disseminate lessons learnt across Argyll and Bute (and NHS Highland where appropriate) 1.17 To oversee the review of all feedback, including complaints and compliments, to ensure proper management, identify trends and disseminate lessons learnt across Argyll and Bute (and NHS Highland where appropriate) 1.18 To review Significant Adverse Event Review findings and ensure completion of resulting action plans Overseeing the development, agreement and review of clinical and care procedures, guidelines and protocols for delegated functions of the HSCP. 1.19 The NHSH Board governance structures should be utilised to ratify clinical policies, guidelines and protocols (e.g. the Area Drugs and Therapeutics Committee for policies relating to medicines, similarly the Council structures should be utilised for care procedures, guidelines and protocols where necessary to meet legal requirements). 1.20 To oversee the Clinical and Care Governance Risk Register and to ensure that risk management procedures are followed across Argyll and Bute to oversee the development of local risk registers and action plans. 1.21 To identify risks requiring attention and report to the IJB as required to ensure that professional standards are adhered to and that systems for governing regulatory requirements for professionals are in place as laid out in the professional Assurance Framework. 1.22 To oversee implementation of framework for professional supervision of clinical and care professionals working in Argyll and Bute to oversee the Clinical and Care Governance Risk Register and to ensure that risk management procedures are followed across Argyll and Bute 1.23 To oversee the development of local risk registers and action plans. 1.24 To identify risks requiring attention and report to the IJB as required to ensure that professional standards are adhered to and that systems for governing regulatory requirements for professionals are in place as laid out in the professional Assurance Framework. Page 60
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11 Classification: OFFICIAL 1.25 To oversee implementation of framework for professional supervision of clinical and care professionals working in Argyll and But Page 61
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12 Classification: OFFICIAL AUDIT AND RISK COMMITTEE TERMS OF REFERENCE REMIT 1.1. To agree the internal audit strategic plan, oversee and review action taken on internal audit recommendations. 1.2. To consider the External Auditor’s Annual Audit Plan, Annual Letter, relevant reports, and the report to those charged with governance and other specific External Audit reports. 1.3. To comment on the scope and depth of External Audit work and to ensure it gives value for money. 1.4. To commission work from Internal, External Audit and third parties where appropriate. 1.5. To consider the performance of Internal and External Audit. 1.6. To facilitate training to support the role of Audit and Risk Committee Members. 1.7. To promote a culture of compliance within the IJB to ensure the highest standards of probity and public accountability. 1.8. To support best practice in the financial administration of the IJB. 1.9. To review the IJB’s financial performance as contained in the Annual Performance Report, and to report annually to the IJB on the internal control environment. 1.10. There should be a least one meeting a year, or part thereof, where the Audit Committee meets the Internal and External Auditors separately from management. 1.11. The Committee will prepare an annual work plan setting out meeting dates for the financial year and anticipated internal audit, external audit, management reports and scrutiny topics expected to be covered at each meeting. 1.12. The Committee shall prepare an annual report to the IJB covering its activities and key findings each year. This report will be considered at the IJB meeting that agrees the External Auditor's annual audit letter. 1.13. To consider performance and inspection reports from internal audit, external audit and other relevant scrutiny bodies. 2 Regulatory Framework and Risk Management 2.1 To monitor and seek assurance with regard to risk management systems through the review of the effectiveness of risk control measures and corporate governance in the IJB. 2.2. To consider the IJB’s compliance with its own and other published standards and controls. 2.3. To monitor the IJB's compliance with the Public Interest Disclosure Act and the Bribery Act in the discharge of its functions. 3 Financial Accounts and Governance 3.1 To examine the activities and accounts of the IJB and exercise a governance role over management efforts to ensure that: (a) The expenditure approved by the IJB has been incurred for the purposes intended; (b) Services are being provided efficiently and effectively; Page 62
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13 Classification: OFFICIAL (c) Value for money is being obtained, all in accordance with Best Value requirements; and (d) The IJB has appropriate information and advice available to them to make decisions. 3.2. To review the annual statement of accounts. Specifically to consider whether appropriate accounting policies have been followed and whether there are concerns arising from the financial statements or from the audit that need to be brought to the attention of the IJB; 3.3. To oversee the production of the IJB’s Governance and Internal Control Statement; and support the approach to Best Value. 3.4 To consider the External Auditor’s report to those charged with governance on issues arising from the audit of the accounts. 4 Performance Monitoring 4.1 To assess the effectiveness of the IJB’s Performance Management Regime; 4.2 To commission specific reviews to be carried out where necessary; 4.3 To review Best Value arrangements and outcomes, with consideration of both external and internal Best Value reports, strategy/plans and outcomes from Best Value reviews; and 4.4 To review the impact of national performance reports from external bodies and consider their impact. 5 Scrutiny In respect of its scrutiny function: 5.1 The committee defines scrutiny as the process of ‘close and critical inquiry’ and ‘methodical examination’ holding others to account through monitoring examination and questioning of decisions actions and performance for the purposes of improvement. 5.2 The committee shall undertake scrutiny reviews at the request of IJB; 5.3 The committee shall receive and undertake requests for scrutiny reviews submitted by any member of the IJB; 5.4 The committee shall itself determine how and when to exercise this function; 5.5 In exercising this function, the committee may call for any inquiry that it considers necessary and may call any individual or for any document or documents it considers relevant to any such investigation; Page 63
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14 Classification: OFFICIAL FINANCE AND POLICY COMMITTEE TERMS OF REFERENCE REMIT 1. Financial Resources 1.1. To develop policy strategic objectives and priorities for recommendation to the IJB unless such matters are otherwise delegated. 1.2. To oversee the management of financial resources on a bi-monthly or as otherwise arranged by the IJB within general provisions before reporting to the Integration Joint Board. 1.3. To advise the Integration Joint Board on the Revenue Budget and requirements in Capital Planning from the partner bodies. 1.4. To review adjustments to Management budgets in so far as not delegated to officers within the terms of the financial regulations of the partner bodies and make recommendation to the Integration Joint Board for approval. 1.5. To consider and advise the Integration Joint Board on the monthly financial monitoring reports 1.6. To consider and advise the IJB on the medium term financial strategy 1.7. To advise the IJB on any financial recovery plan required as a result of an overspend. 2. Corporate Asset Management To liaise with the Council and NHS Highland to ensure that the IJB’s future corporate asset management requirements as determined by the Strategic Plan form part of the asset management plans for those parties. 3. Continuous Improvement a) To determine and implement the IJB’s policies in relation to the achievement of Best Value. b) To consider Best Value Reviews from Services as appropriate. Without prejudice to the duties and responsibilities and delegated authority of other Committees, to review the performance and effectiveness of all the Integration Joint Board’s work and the standards and level of service provided, to review the need to retain existing services, and to co-ordinate where necessary all the matters referred to in this sub-paragraph in respect of the Committees and Services of the Integration Joint Board. 4. Transformation a) To review financial and policy impacts of Transformational proposals b) Oversight of the Service Transformation Board and formal reporting from workstreams Page 64
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15 Classification: OFFICIAL Strategic Planning Group Terms of Reference 1 STATUTORY REQUIREMENT Section 32 of The Public Bodies (Joint Working) (Scotland) Act 2014 make provision for Integration Authorities to establish a Strategic Planning Group (SPG) for the development and delivery of the Strategic Plan. The Strategic Planning Group also acts as the point of contact with Locality Planning Groups(LPG’s) and subsequently reports LPG activity to the Integration Joint Board(IJB). 2 ROLE 2.1 The role of the Strategic Planning Group is to: • Receive direction and feedback from the IJB in respect of development of the strategic plan and delivery of the objectives therein over the period of the plan. • Prepare proposals for the Strategic Plan in regard to the integration delivery principles as described in section 31of the Act: The integration delivery principles are: (a) that the main purpose of services which are provided in pursuance of integration functions is to improve the wellbeing of service-users; (b) that, in so far as consistent with the main purpose, those services should be provided in a way which, so far as possible (i) is integrated from the point of view of service-users; (ii) takes account of the particular needs of different service-users; (iii) takes account of the particular needs of service-users in different parts of the area in which the service is being provided: (iv) takes account of the particular characteristics and circumstances of different service-users: (v) respects the rights of service-users: (vi) takes account of the dignity of service-users: (vii) takes account of the participation by service-users in the community in which service-users live: (viii) protects and improves the safety of service-users: (ix) improves the quality of the service: (x)is planned and led locally in a way which is engaged with the community (including in particular service-users, those who look Page 65
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16 Classification: OFFICIAL after service-users and those who are involved in the provision of health or social care): (xi) best anticipates needs and prevents them arising, and (xii) makes the best use of the available facilities, people and other resources. • set out the arrangements for the carrying out of the integration functions for the area of the IJB over the period of the plan; • setting out how those arrangements are intended to achieve, or contribute to achieving, the national health and wellbeing outcomes, and including such other material as the integration authority thinks fit. 3. REMIT 3.1 The remit of the Strategic Planning Group is directed by the Integrated Joint Board to development and review of the Health & Social Care Partnership Strategic Plan ensuring the alignment of service strategies. The SPG requires to: • review detailed business cases and change plans on behalf of the IJB • communicate to the IJB that there's been appropriate discussion and engagement (in line with statutory responsibilities) • provide a forum for discussion of emerging themes and initiatives that arise following the completion of your strategic plan • collaborate on the production of future strategic plans • oversee the delivery of the strategic plan on behalf of the IJB • Seek the views of the Strategic Planning Group on the proposals; • Provide the draft plans for consultation; • Take note of and act upon national policy, guidance, objectives and feedback from the Scottish Government; • Be responsible for in depth scrutiny on behalf of the IJB and monitoring of progress and performance against the strategic priorities and National Health and Wellbeing Outcomes (NHWBO); • Review the strategic plan annually and monitor progress via production of the Annual Performance Report; • Ensure there is a process in place to produce a new strategic plan on a 3 yearly cycle, taking cognisance of any updated Scottish Government guidance; • Provide a view on significant service developments which could impact on the delivery of the strategic plan; • Is responsible for ensuring Locality Planning Groups produce locality plans which meet local needs and align to the Strategic Plan. 3.2 Strategic Commissioning Planning Role Page 66
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17 Classification: OFFICIAL • A strategic commissioning plan must set out the arrangements for carrying out the integration functions in the Local Authority area over the period of the Strategic Plan. The area must be divided into a minimum of two localities for this purpose, and the arrangements for each locality must be set out separately. • A strategic commissioning plan must also set out the way in which the arrangements for carrying out the functions are intended to achieve or contribute towards achieving the national health and wellbeing outcomes. • The strategic commissioning plan should ensure correlation with other local policy directions as outlines in, for instance, Single Outcome Agreements, NHS Local Delivery Plans, Housing Strategies, NHS Clinical Strategies, community plans and other local corporate plans. 3.3 Locality Planning Groups • The Strategic Planning Group has a governance role with respect to the Locality Planning Groups and their alignment with the Strategic Plan objectives and the planning “architecture”. • The Strategic Planning Group will assess Locality Action Plans against the progress of the Strategic Plan. 4 Accountability • Act as a Reference Group to the Integration Joint Board (IJB) and is accountable to the IJB. 5 Membership The Act further stipulates the membership of the SPG as extracted below, the role and current membership of the Strategic Planning Group is contained in appendix 1. • Users of health care • Carers of users of health care • Commercial providers of health care • Non-commercial providers of health care • Health Professionals • Social Care Professionals • Users of social care • Carers of users of social care • Commercial providers of social care • Non-commercial providers of social care • Non-commercial providers of social housing • Third sector bodies carrying out activities related to health or social care Page 67
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18 Classification: OFFICIAL Appendix 1 FOR INFORMATION Locality Planning Group Terms of Reference ROLE OF MEMBERS • Contribute to relevant local, regional and national consultation responses or events, sharing local experience • Link local engagement mechanisms with wider stakeholders within their locality to be assured that the community voice can influence locality and strategic planning, • Share experiences and learning with other locality planning groups in order to shape locality plans and improve joined up working across the wider HSCP. • Participate in required learning opportunities to maximise individual member contributions • Develop mechanisms to better understand local need including inequalities, making use of all relevant and available quantitative and qualitative data in relation to their local priorities. Each member will preside for a 2 year period. If neither chair or vice chair are present the full group will appoint a temporary replacement FREQUENCY A minimum of 4 times per year. QUORUM Fifty percent of all members should be in attendance. AGENDA & PAPERS The agenda and papers for meetings will be issued one week prior to each meeting. ADMINISTRATION Recording of meeting activity will be in action note format, disseminated to attendees for agreement and ratification within 2 weeks following the meeting date. LOCATION Whenever possible meetings will be held in venues which support video or telephone conferencing. Page 68
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19 Classification: OFFICIAL TRANSPORT COSTS Volunteer members will have transport costs reimbursed. Please see the NHS Highland volunteer policy for more information. Page 69
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1 Integration Joint Board Date of Meeting: 26 March 2025 Title of Report: Audited Annual Accounts 2023/24 & External Audit Report Presented by: James Gow, Head of Finance The Integration Joint Board is asked to: • Note that Mazars have completed their audit of the Annual Accounts and for 2023-24 and issued a draft unqualified Independent Auditor’s Report. • Consider the Annual Audit Report prepared by Mazars and management responses to their recommendations. • Note that the IJB is reporting an underspend of £2.9m carried forward in general reserves. • Approve the Letter of Representation and the Audited Accounts for signature and publication. • Note that the accounts are prepared on a going concern basis. 1. EXECUTIVE SUMMARY 1.1 The Integration Joint Board is required to produce a set of audited annual accounts. These have been subject to independent audit by Mazars, who have issued an unqualified audit report. The Accounts, Audit Report and Letter of Representation have been considered and endorsed by the Audit & Risk Committee at its meeting on 18 February 2025. 1.2 The Audited Annual Report and Accounts are provided as an appendix along with External Audit Report and Letter of Representation and audit opinion. The figures in the accounts are unchanged from the unaudited accounts published in June 2024. As is normally the case, a number of relatively minor disclosure changes and corrections have been made to the accounts during the audit process, these are highlighted in the audit report. Following approval by the IJB, the accounts require to be signed by the Chair, Chief Officer and Chief Financial Officer. The audit report, letter of representation and the audit opinion, which requires to be signed by Mazars are also provided. The Audit Report will be published by Audit Scotland in due course. The risk in respect of financial sustainability is again highlighted by Mazars in their report. The audit and completion process has taken longer than initially planned. 1.3 In relation to financial performance, the accounts are reporting that the HSCP underspent against the allocations made available to it, by £2.9m. It is carrying its underspend forward within its general reserves to fund investment in service transformation and the budget gap in 2024/25. Page 71 Agenda Item 9a
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2 2. Recommendations 2.1 The Integration Joint Board is Recommended to: • Note that Mazars have completed their audit of the Annual Accounts and for 2023-24 and issued a draft unqualified Independent Auditor’s Report. • Consider the Annual Audit Report prepared by Mazars and management responses to their recommendations. • Note that the IJB is reporting an underspend of £2.9m carried forward in general reserves. • Approve the letter of representation and the Audited Accounts for signature and publication. • Note that the accounts are prepared on a going concern basis. 3. DETAIL OF REPORT 3.1 The Integration Joint Board was established under the requirements of the Public Bodies (Joint Working) (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 Authorities Accounting supported by International Financial Reporting Standards (IFRS) unless legislation or statutory guidance requires different treatment. 3.2 The Annual Accounts are subject to independent audit by Mazars and some minor changes have been made in respect of disclosures and the narrative. There have been no substantive changes to the unaudited accounts published in June, no objections raised by the public and no uncorrected errors highlighted by the auditor. The Audited Annual Accounts are provided as Appendix 1. The most significant change during the audit process has been to reduce the level detail on spend disclosed in the final version of the accounts. 3.3 Mazars conclude that the Integration Joint Board’s accounts present a true and fair view of the financial performance of the IJB during the year. The Independent Auditors Report provides further information on the audit process and basis of the opinion. It is acknowledged that the IJB is highly dependent upon both partners in respect of financial accounting processes and systems. 3.4 Mazars have prepared an Annual Audit Report for consideration by the IJB. This indicates the auditors are content with financial accounting and reporting and concludes that governance and arrangements for securing value for money were likewise appropriate. The audit report does make a recommendation in respect of medium term planning and the financial sustainability challenge currently faced by the HSCP and other public bodies. Mazars have also recommended that the IJB completes the development of the new strategic plan and requested that some improvements are made to the working papers provided alongside the accounts at the start of the audit. The recommendations and management responses are included in the Mazars report. 3.5 A summary of spend and resources over the past 3 years is provided below: Page 72
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3 2021/22 2022/23 2023/24 £'000 £'000 £'000 Employee Costs 101,153 111,382 125,466 Premises 10,009 11,260 11,236 Supplies and Services 15,183 15,253 20,029 Transport 3,201 3,918 4,153 Third Party Payments 148,745 155,004 163,926 Income -19,104 -18,458 -21,019 Primary Care Services 52,930 53,137 55,287 Other 248 285 317 Total Spend 312,365 331,781 359,395 Total Funding 326,975 327,575 362,284 Increase / (Decrease) in reserves 14,610 -4,206* 2,889 *deficit due to recovery of covid reserves Spend increased by £27.6m or 8.3% against the prior year with direct staff costs accounting for 35% of net expenditure. This is largely due to inflationary pressure and spend of reserves held at the end of the prior year. 3.6 Whilst there was an underspend against the resources allocated to the IJB of £2.9m, a better outturn than anticipated, the Scottish Government allocated £4.7m at the year end for value and sustainability work. This allocation resulted in total reserves increasing by £2.9m rather than reducing by £1.8m. The following table summarises the movement in reserves: Earmarked Reserves £000 Opening Reserves at 1 April 2023 16,991 Reserves spent during 2023/24 (3,139) Reserves returned to NHS Highland (2,297) Excess Social Work Spend – funded from reserves (788) NHS Underspend (added to general reserve) 2,798 Specific funding received and carried forward 6,314 Closing Balance at 31 March 2024 19,879 The general reserve is available to the IJB to hold, invest or spend at its discretion. The year end general reserve balance was £8.4m and this has been earmarked for: • Service Transformation & Budget Gap £7.8m • Prevention Programme £0.6m Investment in transformation and infrastructure projects are considered by the Transformation Board and the Infrastructure Transformation Board. Page 73
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4 3.7 The balance sheet debtor is equivalent to the reserves held by NHS Highland and Argyll and Bute Council. These have been earmarked for specific purposes and an analysis is included in Note 6 of the accounts. 3.8 The accounts present a favourable view of financial performance, provide an overview of the governance framework and summary of performance and risk. The HSCP has now operated within budget for four consecutive years and had reserves available to it at year end. However, the HSCP has a deficit budget which is reliant on the use of these reserves, this is not sustainable. In respect of the Going Concern judgement, the favourable outcome enables the IJB to fund its budget gap from reserves and non-recurring savings. 3.9 The Integration Joint Board is also asked to approve the draft letter of management representation (this is provided along with the External Audit Report). It provides a number of assurances from the Chief Finance Officer to the auditor and requires to be considered by the IJB prior to issue. 4. RELEVANT DATA AND INDICATORS 4.1 Information contained within the accounts is derived from the financial systems of NHS Highland and Argyll and Bute Council. The audit of the IJB accounts is supported by the audits of both partners. 5 CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 The annual accounts are a key statutory reporting and accountability requirement. They communicate both financial and key service delivery performance information in an accessible public document. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – The IJB is required to consider and approve the Audited Annual Accounts. The accounts present a favourable summary of financial performance during the year and the position at the year end. The Annual Audit Report provides important independent assurance to the IJB in respect of financial management and governance. 6.2 Staff Governance – None 6.3 Clinical Governance – None 7. PROFESSIONAL ADVISORY 7.1 Professional leads have had the opportunity to consider the contents of this report and the draft accounts. 8. EQUALITY & DIVERSITY IMPLICATIONS 8.1 None 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE 9.1 None Page 74
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5 10. RISK ASSESSMENT 10.1 There are no changes to the risk register arising from the contents of this report. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT 11.1 The unaudited annual accounts were made publicly available in June 2024. The accounts will be made publicly available by the HSCP and the Annual Audit Report will be published by Audit Scotland. No objections to the un-audited accounts were received by the auditor. 12. CONCLUSIONS 12.1 The audited accounts for 2023-24 require to be approved by the IJB prior to publication. This report summarises the accounts. These were audited by Mazars and an unqualified independent auditors report has been received. There were a small number of minor changes made as part of the audit process but no amendments to the figures. The accounts report that the IJB operated within budget during the year and that its governance arrangements were appropriate. The audit report provides the IJB with independent assurance in respect of financial management and governance. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required √ Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) SLT Unaudited Annual Report and Accounts 05/06/24 none Audit & Risk Committee Unaudited Annual Report and Accounts 18/06/24 endorsed Audit & Risk Committee Audited Annual Report and Accounts and External Audit Report 18/02/25 endorsed REPORT AUTHOR AND CONTACT James Gow, Head of Finance and Transformation, james.gow@argyll- bute.gov.uk APPENDIX 1: Annual Accounts for the year ended 31 March 2024 APPENDIX 2: External Audit Report and Audit Opinion APPENDIX 3: Letter of Representation Page 75
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Classification: OFFICIAL ARGYLL AND BUTE INTEGRATION JOINT BOARD Commonly known as Argyll and Bute Health & Social Care Partnership AUDITED ANNUAL ACCOUNTS FOR THE YEAR ENDED 31 MARCH 2024 Page 77
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ARGYLL AND BUTE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS CONTENTS Page 1 Classification: OFFICIAL Page Management Commentary 2 Statement of Responsibilities 10 Annual Governance Statement 12 Remuneration Report 19 Financial Statements: - Comprehensive Income and Expenditure Statement - Movement in Reserves Statement - Balance Sheet 22 Notes to the Financial Statements: 1. Material Accounting Policies 2. Events After the Reporting Period 3. Taxation and Non-Specific Grant Income 4. Debtors 5. Related Party Transactions 6. Usable Reserve: General Fund 7. Critical Judgements and Uncertainty 25 Independent Auditors Report 32 Page 78
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Management Commentary Page 2 Classification: OFFICIAL 1. INTRODUCTION This document provides the Financial Statements of Argyll and Bute Integration Joint Board (IJB) for the year ended 31 March 2024 and report on performance. The main purpose of the document is to demonstrate the stewardship of public funds entrusted to the HSCP for the delivery of its Strategic Plan. The requirements governing the format and content of the annual accounts are contained in The Code of Practice on Local Authority Accounting. These Accounts have been prepared in accordance with the Code. The Management Commentary provides an overview of the IJB’s financial position and operational performance for the year. This section also provides a summary of the challenges and risks which may impact in the future. The IJB is delighted to report a further improvement in its financial position. It has operated within the resources available to it and has maintained its general reserves. This has been achieved in extremely challenging circumstances and is as a result of the hard work of staff in delivering savings, carefully managing budgets and further improving financial governance. This provides the IJB with an opportunity to continue to progress its service transformation and investment plans and provides increased flexibility for managing financial risk. 2. THE INTEGRATION JOINT BOARD (IJB) The Argyll and Bute Health and Social Care Partnership (HSCP) is responsible for the planning and delivery of all community and acute health and social care services for adults and children. This includes services we deliver directly and a range of services which are purchased from external providers including NHS Greater Glasgow and Clyde. The Partnership is a distinct legal entity with a board of governors, the IJB which has responsibility and accountability for the planning, resourcing and oversight of the delivery of integrated services as described in its Strategic Plan. The IJB was delegated resources and responsibility for Health and Care service delivery from 1 April 2016. Membership of the IJB includes eight voting members with four Elected Members nominated by Argyll and Bute Council and four Board Members of NHS Highland. In addition there are non-voting appointees representing other sectors and stakeholder groups, such as the Third Sector, Independent Sector, Patients and Service Users, Carers, individuals with lived experience and staff. Argyll and Bute is home to 86,000 people, covers an area of 690,946 hectares and is the second largest local authority by area in Scotland. It has 23 inhabited islands, with 17% of the population living on islands. Argyll and Bute provides a number of unique opportunities for those who live and work here, however we also face a number of challenges. The geography associated with dispersed communities in remote and rural areas and islands presents a challenge in delivering services within the resources available. Of the population, 69% live in “remote” or “very remote” areas and 45% live in areas in the 20% “most deprived for geographic access to services”. Argyll and Bute has a higher proportion of older people than Scotland as a Page 79
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Management Commentary Page 3 Classification: OFFICIAL whole, with 12% aged 75+ compared to 8% in Scotland. This presents a demographic challenge in the context of a reducing and ageing population. It is having an impact on our funding and ability to recruit staff to deliver services. 3. HEALTH AND SOCIAL CARE PARTNERSHIP STRATEGIC PLAN The HSCP vision and priorities for health and social care are outlined in its Joint Strategic Plan 2022-2025. The vision and strategic objectives for the partnership have remained consistent and relevant for our communities, staff, partners and stakeholders: The Strategic Plan was produced following extensive consultation with our communities. The illustration below summarises these priorities, the full plan can be accessed at: https://www.nhshighland.scot.nhs.uk/OURAREAS/ARGYLLANDBUTE/Pages/JointStrategicPlan2022-25.aspx “People in Argyll and Bute will live longer, healthier, independent lives.” Page 80
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Management Commentary Page 4 Classification: OFFICIAL 4. PERFORMANCE MANAGEMENT AND REPORTING The Integrated Performance Management Framework and Dashboard has been developed in recent years and ensures that performance and improvement activity is reported in an accessible way which provides a holistic overview of performance against a range of internal performance indicators as well as the National Health & Wellbeing Outcomes. The interactive dashboard is accessible to all users, the performance measures themselves continue to be refined and improved in order to increase their relevance and reliability which in turn enables the process of performance improvement. The monitoring and reporting process ensures the HSCP is able to report performance against strategic priorities and provide nationally reported data on performance under the following headings; 1. Choice, Control and Innovation 2. Early Intervention & Enablement 3. Living Well & Active Citizenship 4. Community Coproduction The Annual Performance Report provides a more detailed overview. Performance across the Health and Social Care sector has been severely affected by the impact of the covid 19 pandemic. While the direct impact of covid was limited during 2023/24, the process of dealing with the diagnosis and treatment backlog and returning services to their previous levels continues to be challenging. This is a national issue and has unfortunately resulted in reduced activity levels, increased waiting lists and greater unmet care need. The Annual Performance Reports are published and available on the web site. As a consequence of our reliance on NHS Greater Glasgow and Clyde (NHS GG&C) for specialist hospital services, our remobilisation planning has been completed in tandem with them to agree the scale and pace of resumption of normal service. The following table identifies the length of wait associated with each of the specialities which are provided in Argyll and Bute as at 8 May 2024: Total on Waiting List Length of Wait (weeks) Prior Year Prior Year Main Specialty Over 26 12 to 26 Under 12 % > 12 Weeks Total on Waiting list % > 12 Weeks Consultant Outpatients 2133 483 465 1185 44.4 1727 31.9 Mental Health 1043 472 221 350 66.4 685 58.4 AHP 709 144 156 409 42.3 943 39.1 Nurse Led Clinics 332 118 50 164 50.6 359 51.3 Other 925 325 224 376 59.3 1540 57.5 Outpatient Waiting List Total 5142 1542 1116 2484 51.7 5254 45.5 There remains a backlog of treatment and diagnostic activity that the HSCP continues to address, this is a national priority particularly for those who are experiencing very long waits. It is acknowledged that for some treatment and diagnostics the waiting times figures have deteriorated during the year and action plans are in place to try to address this with staff recruitment being the most common constraint. The Annual Performance Report provides a more comprehensive overview of performance and benchmarks. Page 81
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Management Commentary Page 5 Classification: OFFICIAL 5. FINANCIAL PERFORMANCE 2023-24 The IJB is reporting an underspend against its budget and the resources available to it and therefore an increase in the reserves it holds. The IJB is therefore in an improving financial position and will carry forward funding in reserve to enable it to progress key transformation projects and investments and help fund its anticipated budget shortfall in 2024/25. A number of factors contributed to this improved position including effective delivery of savings, improved financial management and governance and additional funding allocations from the Scottish Government. Some of the general reserve had to be used to support spend on social care services which exceeded the funding provided by Argyll & Bute Council. This was primarily driven by higher demand for Older People services including care at home and residential care placements. The Covid-19 pandemic had a reduced impact in 2023/24. There were no new covid related costs and no specific funding received, other than for the vaccination programme. The consequences that Covid 19 and lockdowns had upon health and care needs within the community remains a challenge. The final outturn for 2023/24 was an underspend of £2.9m against the resources available of £362m. The underspend has been retained within the general reserve. It is intended that it will be used to enable service transformation, invested in key projects and will help mitigate the financial challenge in future years as inflation and increasing demand for services continue to put pressure on service budgets. The following table summarises financial performance against budget analysed between Health and Social Work services: Service Spend £000 Funding £000 Funds Transfer £000 (Surplus) / Deficit £000 Social Work Services 93,677 77,605 14,455 1,617 Health Services 265,718 284,679 (14,455) (4,506) GRAND TOTAL 359,395 362,284 - (2,889) Savings Delivery The budget for 2023/24 included a savings target of £8.9m. During the year £7.4m or 83% of the target was delivered. A clear demonstration of the efforts the HSCP continually takes to improve its efficiency and deliver best value. The savings programme is managed rigorously and is critical to longer term financial sustainability. Financial Statements Comprehensive Income and Expenditure Statement This statement shows the cost of providing services for the year according to accepted accounting practices. There are no statutory or presentational adjustments which affect the Page 82
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Management Commentary Page 6 Classification: OFFICIAL application of the funding received from partners, therefore the movement in the General Fund balance is solely due to the transactions summarised in the Comprehensive Income and Expenditure statement. Reconciliation of Comprehensive Income and Expenditure Statement to Financial Outturn: The table below reconciles the surplus on the provision of services of £2.9m as noted in the Comprehensive Income and Expenditure Statement to the financial outturn: £000 £000 Surplus on Provision of Services 2,889 Less Statutory Adjustments that don’t feature in financial outturn 0 Movement in General Fund Balance 2,889 Earmarked Reserves released to services (3,927) Reserves returned to NHS Highland (2,297) New Earmarked Reserves 6,315 Underspend transferred to General Reserves 2,798 Total Movement 2,889 Movement in Reserves Statement This statement shows the movement on the IJB’s Reserves. It has one reserve, its General Fund, a resource backed reserve which can be used to fund future expenditure. The balance on the General Fund increased from £17m to £19.9m. These resources have been earmarked for specific purposes. The increase is due to: • The favourable variance against budget within NHS services; and • The receipt of sustainability and value funding totalling £4.7m from Scottish Government. The IJB spent £3.9m of its reserves during the year and allocated this resource to a number of projects detailed in note 6. Included in this total is the £0.8m it allocated to fund excess social care costs during the year. The IJB Reserves Policy is that a prudent level of General Fund reserve is 2% of the revenue budget, this equates to around £7.5m. As at 31 March 2024 the IJB general reserves were consistent with this policy at £7.8m. The reserves are earmarked to enable key projects to progress and to fund the 2024/25 budget gap. Note 6 provides detail on the nature of these reserves and the purposes for which they are earmarked. The IJB is prioritising the re- mobilisation of services, service transformation and investment in infrastructure. Balance Sheet The Balance Sheet shows the value of the IJB’s assets and liabilities as at 31 March 2024. It does not hold fixed assets, these sit with the partner bodies. There are explanatory notes which accompany the Balance Sheet. The net worth of the IJB as at 31 March 2024 is £19.9m, this is supported by the General Fund. The balance consists of Short Term Debtors relating to Page 83
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Management Commentary Page 7 Classification: OFFICIAL earmarked reserves balances for delegated services and recognises the amounts owed to the Integration Joint Board by NHS Highland and Argyll and Bute Council. There are no provisions recognised on the Balance Sheet. NHS Highland made a year-end provision for annual leave of £0.7m (£1.1m in the prior year) for HSCP staff. It also made a provision of £35k for potential regrading costs. Argyll & Bute Council made a provision for £13k for payroll related costs, in the prior year a provision was made for £50k relating to the settlement of employment related matters, this provision was utilised during 2023/24. All provisions are reflected in the outturn position. There are historic provision balances and contingent liabilities relating to services provided prior to 1 April 2016, these will be recognised as required in the partner Annual Accounts. There would be further consideration of funding requirements for the IJB where the historic funding of these provisions are insufficient and may affect future IJB funding arrangements. 6. FINANCIAL OUTLOOK, RISKS AND PLANS FOR THE FUTURE Budget 2024-25 The budget for 2024/25 was approved by the IJB in March 2024. While the resources allocated to the HSCP are budgeted to increase, the impact of inflation and increasing service demand meant the HSCP was unable to balance its budget without relying on its reserves. To ensure that the IJB continues to improve efficiency and deliver value for money, a savings programme totalling £6.6m has been established. The IJB will also rely on reserves and a non-recurring pension cost saving to fund its activity in 2024/25 and protect services to the most vulnerable during particularly challenging times. Service transformation and the delivery of the value for Money Strategy are key to ensuring services are delivered in sustainable way. While the budgeted position is extremely challenging, the HSCP has operated within budget for the past four years, it has repaid £5m in debt and now holds reserves available to invest in transformation and infrastructure. Operating on a financially sustainable basis is a strategic priority and the IJB has expressed a relatively low appetite for financial risk. Medium to Longer Term Outlook Looking to 2025/26 and beyond, it is anticipated the Scottish public sector will continue to face a difficult financial outlook, this is outlined in the Spending Review and in recent reports issued by the Institute for Fiscal Studies. The impact of inflation and reducing real terms value of public funding are likely to present a challenge when coupled with increasing demand for services, workforce shortages and an ageing demographic. It is anticipated that the Scottish Government will publish a new three year spending review during 2024 and this will inform planning assumptions for the future and enable the HSCP to update its medium term financial planning. It is expected that Health and Social Care will remain a priority as services continue to recover from the impact of covid and to cope with increasing demand and waiting times. Financial pressures will require to be managed through continuing value for money and efficiency Page 84
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Management Commentary Page 8 Classification: OFFICIAL improvement, the implementation of new ways of working and careful forward planning. Investment in service transformation and development in the short term will have a focus on meeting anticipated financial challenges. The reserves held by the HSCP enables it to undertake this work in a considered way during 2024/25. The HSCP expects that it will be required to deliver cash releasing efficiency savings of 3% or around £10m per year to offset the impact of increasing demand and inflationary pressures. Financial Risks and Challenges The IJB has a robust approach to Risk Management and responsibility for oversight of financial risks and mitigations sit with its Finance & Policy Committee. Financial risks are considered and reported on a regular basis, four key financial risks which have an assessed value of £500k or more have been identified: Identified Risk Estimated Value £000 Summary of Mitigations Sustainability of service providers – providers reduce or close critical provision resulting in additional costs as the HSCP is required to identify alternative ways of providing statutory services. £750k (£0.5m-£1.5m range) On-going dialogue, monitoring and review. Engagement with partners. New Care @ Home contract. Non-Pay Inflation – macroeconomic conditions, increasing inflation, fair pay policy and supply chain disruption will result in non-pay inflation which exceeds budgeted allowance. £500k (£0.5m-£1.5m range) Allowance made for inflation in the budget, performance monitoring, continuous review of contract rates and pricing. Delivery of savings. Pay – settlements will exceed public pay policy and will not be fully funded by the Scottish Government. £500k (£0.5m-£1.5m range) Engagement in sector networks and close monitoring of progress with pay negotiations. Careful modelling and on-going vacancy management in place until uncertainty is reduced. Savings – failure to deliver the savings programme in full during the year contributes to a budget overspend and failure to achieve financial objectives. £500k (£0.5m-£1.5m range) Project management process and funds held in reserve. There are a number of additional risks which have a financial impact. The macroeconomic environment remains of concern, whilst the implications for the HSCP of higher inflation can be modelled and are understood, the impact upon some of the most vulnerable in the communities served by the HSCP is of additional concern. Increased poverty and impacts on health and well-being can be expected, this in turn may further increase service pressures along with the adverse impact covid lockdowns appear to have had. The HSCP has identified the following as the key risks it faces at present: • Sustainability of Commissioned Service Providers; • Workforce Recruitment and Retention; • Infrastructure condition and suitability due to reduced capital funding; • Long term financial sustainability; and • Socio-economic situation and cost of living crisis. Page 85
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Management Commentary Page 9 Classification: OFFICIAL Covid-19 pandemic The direct impact of the pandemic was much reduced as services largely returned to normal. The main challenge now is dealing with the adverse impacts the lockdowns have had on waiting times and upon the care and support needs of some of the most vulnerable in society and children in particular. There were no material allocations of funding for Covid-19 received. 7. CONCLUSION The Integration Joint Board’s final outturn position for 2023/24 was an underspend of £2.9m. This excess resource has been carried forward and earmarked to fund the budget gap in 2024/25, and enable investment in critical infrastructure and service transformation projects. The operating environment going forward remains challenging as there is a backlog of people awaiting diagnosis and treatment and increased demand for a range of services. The longer term financial environment is also likely to be difficult as the impact of inflation and restricted funding settlements will make it challenging to operate on a financially sustainable basis. The on-going identification and delivery of efficiency savings are increasingly important in this context. Making best use of the resources available to transform and improve services will help ensure that the HSCP is as prepared as it can be to meet both financial and service challenges. 8. ACKNOWLEDGEMENTS We would take this opportunity to acknowledge the effort in producing the Annual Accounts and to record our thanks to members of the Integration Joint Board and staff for their continued hard work and support. Councillor Dougie McFadzean Evan Beswick James Gow Chair Chief Officer Head of Finance and Transformation 26 March 2025 26 March 2025 26 March 2025 Page 86
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Statement of Responsibilities Page 10 Classification: OFFICIAL THE INTEGRATION JOINT BOARD’S RESPONSIBILITIES: The Integration Joint Board is required: - to ensure the Annual Accounts are prepared in accordance with the legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government Act 2003); - to make arrangements for the proper administration of its financial affairs and to secure that the proper officer of the board had responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this organisation, that officer is the Head of Finance and Transformation; - to manage its affairs to secure economic, efficient and effective use of its resources and safeguard its assets; and - to approve the Annual Accounts for signature. I confirm that these Annual Accounts were approved for signature by the Argyll and Bute Integration Joint Board at its meeting on 26 March 2025. Signed on behalf of the Integration Joint Board: Councillor Dougie McFadzean Chair 26 March 2025 Page 87
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Statement of Responsibilities Page 11 Classification: OFFICIAL THE CHIEF FINANCIAL OFFICER’S RESPONSIBILITIES: The Chief Financial Officer (Head of Finance and Transformation) is responsible for the preparation of the 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 Accounting Code). In preparing the annual accounts the Chief Financial Officer is responsible for: - selecting suitable accounting policies and applying them consistently; - making judgements and estimates on a reasonable basis; - complying with legislation; - complying with the Local Authority Code of Practice (in so far as it is compatible with legislation). The Chief Financial Officer is also required to: - keep proper accounting records which are up to date; and - take reasonable steps to ensure the propriety and regularity of the finances of the Integration Joint Board. I certify that the financial statements give a true and fair view of the financial position of the Argyll and Bute Integration Joint Board as at 31 March 2024, and its income and expenditure for the year then ended. James Gow Head of Finance and Transformation 26 March 2025 Page 88
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Annual Governance Statement Page 12 Classification: OFFICIAL INTRODUCTION The Annual Governance Statement explains Argyll and Bute Integration Joint Board’s (IJB) governance arrangements and reports on the effectiveness of its system of internal control. SCOPE OF RESPONSIBILITY The IJB is responsible for ensuring that its business is conducted in accordance with the law and appropriate standards, that public money is safeguarded, properly accounted for and used economically, efficiently and effectively. In discharging these responsibilities, the IJB has put in place arrangements for governance of its affairs which includes a system of internal control. This is based on an ongoing process designed to identify, prioritise and manage risk. The system aims to manage risks effectively and proportionately to delivery the IJB’s aims and objectives. The IJB places reliance on the NHS Highland and Argyll and Bute Council systems of internal control. These support compliance with both organisations’ policies and promote achievement of each organisation’s aims and objectives, as well as those of the IJB. The system can only provide reasonable and not absolute assurance of effectiveness. GOVERNANCE FRAMEWORK The IJB has been established as an independent legal entity from both Argyll and Bute Council and NHS Highland, with a separate governance framework. The IJB comprises eight voting members with four Elected Members nominated by Argyll and Bute Council and four Board members of NHS Highland. In addition there are a number of non-voting appointees representing other sectors and stakeholder groups, such as the Third Sector, Independent Sector, Patients and Service Users, Carers and Staff. The arrangements for the operation, remit and governance of the IJB are set out in the Integration Scheme which has been prepared and approved by Argyll and Bute Council and NHS Highland. The IJB, via a process of delegation from the Health Board and Local Authority has responsibility for the planning, resourcing and operational delivery of all integrated health and social care services within Argyll and Bute. The scheme of integration was revised, as required by legislation, and was approved by Scottish Government on 23 March 2021. It is published on the Council and NHS Highland websites. The funding available to the IJB is dependent on the funding made available to Argyll and Bute Council and NHS Highland and the corporate priorities of both. The IJB is therefore reliant on both partners for the resources to deliver health and social care services. The main features of the governance framework in place during 2023-24 were: • The Integration Scheme outlines the scope and functions of services that are delegated, the clinical and care governance, strategic planning, financial and operational management arrangements. Page 89
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Annual Governance Statement Page 13 Classification: OFFICIAL • The IJB operates within an established procedural framework. The roles and responsibilities of Board members and officers are defined within Standing Orders, the Integration Scheme, Financial Regulations and Standing Financial Instructions; all subject to regular review. • The strategic vision, mission and values of the IJB are set out in the Strategic Plan and are aligned to deliver on the National Outcomes for Adults, Older People and Children. • Effective partnership working with the Council and NHS Highland ensures delivery of the Strategic Objectives, through information sharing and clear lines of responsibility. • Members of the IJB subscribe to, and comply with, the Standing Orders and Code of Conduct. The Standards Officer is responsible for advising and guiding members of the Board on issues of conduct and propriety. A register of interests is held for Board members and senior officers. • Appropriate training, development and induction is provided for all new IJB members. Performance Development and Review schemes are in place for all staff through each partner agency, the aim of which is to focus on their individual performance and development and contribution to meeting service objectives. • Four Locality Planning Groups have been established and meet quarterly, they aim to provide an effective mechanism for local leadership of service planning and a way for localities to influence how resources are allocated in their area and allow them to contribute to the development and delivery of the Strategic Plan. • Effective scrutiny and decision making is supported by the formal submission of reports, findings and recommendations by Audit Scotland, Inspectorates and the Internal Audit service. • The decision making structure whereby the committees of the IJB have agreed Terms of Reference. These include the Clinical and Care Governance Committee, Audit and Risk Committee, Finance & Policy Committee, Strategic Planning Group and Locality Planning Groups. Terms of reference and the annual reporting framework are formally approved by the IJB and are reviewed regularly. • The outputs from committees is publicly available and reported through minutes being considered by the IJB. All committees self-assess their performance and provide an annual report to the IJB. • The Integrated Performance Management Framework focusses on embedding a performance management culture throughout the organisation with regular reporting to the IJB. The IJB prepares an Annual Performance Report, this is submitted to Scottish Government and is publicly available. • Reliance on the procedures, processes, policies and operational systems of Argyll and Bute Council and NHS Highland where these are operationally delegated. The IJB key governance documents are subject to periodic review. • The legislative framework requires the Chief Officer to be a single point of overall strategic and operational advice to the IJB and to be a member of the Senior Management Teams of Argyll and Bute Council and NHS Highland. • Robust Risk Management processes are in place and the IJB have set their risk appetite. All IJB and committee meetings took place by remote conferencing, this continues to be an efficient way of conducting business. Members of press and public were enabled to attend IJB meetings, and the recording of each meeting was subsequently published alongside the minutes. In March 2020, the IJB agreed a delegation of powers to the Chief Officer in an emergency to Page 90
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Annual Governance Statement Page 14 Classification: OFFICIAL instruct executive action on any matter for the duration of the Covid-19 emergency in consultation with the Chair or Vice Chair with such matters being subsequently reported to the Board. This delegation was not utilised but remained in place during 2023/24. THE SYSTEM OF INTERNAL FINANCIAL CONTROL The governance arrangements described operate on the basis of a system of internal controls. This is based on a framework of regular management and financial information, financial regulations, administrative procedures, management supervision and a system of delegation and accountability. Development and maintenance of the system is undertaken by managers within the IJB. During 2023-24 this included the following: - Financial Regulations and guidance relating to financial processes and procedures, these were updated in May 2024. - Formalised budget setting process, a three year budget outlook and identification of new savings projects. - Regular review of detailed financial performance reports. - Formal project management discipline. - Regular Finance and Policy Committee meetings to provide scrutiny of the financial position and progress with savings and service transformation. - An effective and independent Internal Audit function. - Integrated financial reporting and financial risk management. The system of internal financial control can provide reasonable and not absolute assurance and is designed to manage risk to a reasonable level. Responsibility for maintaining and operating an effective system of internal financial control rests with the Head of Finance and Transformation. The IJB’s financial management arrangements conform to the governance requirements of the CIPFA statement: ‘The Role of the Chief Financial Officer in Local Government (2016)’. In relation to managing the risk of fraud and corruption the IJB relies upon the financial regulations, processes and procedures put in place by both partners. Its Audit & Risk committee review arrangements for managing fraud risk, including through the work of its internal and external auditors. These arrangements are considered to provide adequate assurance on the management of fraud risk and are considered to be compliant with CIPFA’s Code of Practice on Managing the Risk of Fraud and Corruption. UPDATE ON GOVERNANCE IMPROVEMENT ACTIONS A number of areas for development in respect of governance have been progressed and this has resulted in a marked improvement in the way in which the IJB operates and is governed. The action plan is now fully implemented, highlights included the development of the Workforce plan, the roll out of the Integrated Performance Management System, the development of the engagement strategy and training and development for IJB members. Page 91
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Annual Governance Statement Page 15 Classification: OFFICIAL DATA PROTECTION The HSCP is committed to the highest standards of Data Protection and has put in place arrangements to ensure compliance with the General Data Protection Regulations in partnership with NHS Highland and Argyll & Bute Council. There were no significant or notifiable data breaches during 2023/24. INTERNAL AUDIT The IJB is required to put in place adequate and proportionate internal audit arrangements to provide independent assurance on risk management, corporate governance and the system of internal control. Following a competitive tendering process, Argyll and Bute Council Internal Audit Service were contracted as internal auditors for the IJB from 1 April 2021. This contract was extended for a further period of three years from 1 April 2024. The IJB complies with “The Role of the Head of Internal Audit in Public Organisations” (CIPFA) and operates in accordance with “Public Sector Internal Audit Standards” (CIPFA). The Chief Internal Auditor reports directly to the IJB Audit and Risk Committee with the right of access to the Head of Finance and Transformation, Chief Officer and Chair of the IJB Audit and Risk Committee on any matter. The annual programme of internal audit work is based on a strategic risk assessment, and is approved by the IJB Audit and Risk Committee. The role of the Audit and Risk Committee is to provide the IJB with independent assurance on the adequacy of the risk management framework, the internal control environment and the integrity of the financial reporting and annual governance processes. Membership of the Audit and Risk Committee includes six members of the IJB. Professional advisors, the internal auditor and external auditor support the committee and attend where appropriate. The Audit Plan was agreed in April 2023 and internal audit activity during the year included reviews of: • Risk Management; • Financial Management; • Adult Support & Protection; and • Management of Client Funds. In addition, the Committee considered a wide range of reports including several published by Audit Scotland. It also reviews performance in implementing audit recommendations. The Committee annual report confirms that 24 of the 29 recommendations outstanding or made during the year were implemented by management. All of the remaining 5 relate to the audits completed during 2023/24 and are in the process of being implemented. This reflects improved performance in implementing recommendations made by the auditor. The Chief Internal Auditor provides the Audit Committee with an annual report on audit activity for the Integration Joint Board. The annual report includes an independent opinion on the adequacy and effectiveness of the systems of governance and internal control. For financial year 2023/24 the overall conclusion of the Internal Auditor is to provide a reasonable level of assurance Page 92
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Annual Governance Statement Page 16 Classification: OFFICIAL on the adequacy of internal controls and governance arrangements within the IJB. This is an improved assessment compared to previous years and provides further independent assurance that the improvements being made in systems of governance and management are having a positive impact. BEST VALUE The IJB has a statutory duty to provide best value as a designated body under section 106 of the Local Government (Scotland) Act 1973. The Annual Performance Report sets out how the IJB fulfilled its obligations for best value in that year. The Annual Performance Report is publicly available. A short summary against the 8 best value themes is given below: Vision and Leadership The IJB and Senior Leadership team set clear direction and strategy as expressed in the Strategic Plan and Commissioning Strategy. There are strong mechanisms for contributions from the Locality Planning Groups and the Strategic Planning Group into these documents. The IJB has also approved its budget and Savings Plan for the 2024/25 financial year. Governance and Accountability The IJB has an open and transparent governance system in place. It seeks to continually develop and improve in response to emerging good practice and independent audit review. Support for the system of governance is provided by Argyll and Bute Council, this ensures that it is properly administered. Comprehensive and clear Board minutes and papers continue to be published and meetings are open to the public. Effective use of resources The Finance & Policy Committee meet regularly to scrutinise performance against budget, the delivery of savings and Transformation Programme. Improving financial management and governance has been a priority for a number of years, steps taken have contributed to the much improved financial performance of the HSCP. It continues to seek to identify ways of improving efficiency and has been able to generate funds to enable investment in longer term service transformation. Partnership and Collaborative Working Effective partnership working is a core element of the way in which the IJB has been established. The IJB works closely with NHS Highland and Argyll and Bute Council. The Chief Officer is a member of both Strategic Management Teams. In addition the HSCP works closely with third sector partners and its commissioned service providers by holding regular meetings with strategic partners and stakeholders. This has continued throughout 2023/24 and illustrates the ethos of partnership working. Further examples of effective partnership working during include the purchase of the Kintyre Care Centre, the outcomes from the Coll Collaborative Group, the Page 93
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Annual Governance Statement Page 17 Classification: OFFICIAL establishment of the Prevention Transformation Programme, participation in several place based programmes and the re-establishment of the locality planning groups. Community Responsiveness The Locality Planning Groups ensure that local concerns are addressed and feed into the Strategic Plan. In addition the Engagement Strategy ensures that consultation and engagement is carried out before policy changes are agreed. Most recently this has been demonstrated in the high levels of engagement in the development of the Carer’s Strategy, the Coll Collaborative work and the Strategic Plan. A commitment to co-production is an underlying theme and work is now underway to develop new models of service delivery with community based partners. Fairness and Equality A commitment to fairness and equality is at the core of the IJBs purpose, strategy and vision. The HSCP provides a wide range of essential and critical services to the most vulnerable in society. Equality Impact Assessments on new projects plans and strategies include an assessment of socio-economic impacts and islands impacts. Sustainability & Carbon Reduction Carbon reduction is an important objective for all public bodies. There are a number of strands to the IJB approach including: • The development of opportunities for remote provision of services and remote working to reduce travel for staff and service users. There has been extensive use of Near Me for remote consultations where appropriate, and continued utilisation of Microsoft Teams; • Piloting the use of drones for transporting items such as laboratory samples from islands and remote areas; • The installation of electric vehicle charging infrastructure and investment in the electrification of the fleet; • Investing in management capacity to develop a strategic approach to the HSCP estate to develop capital schemes to reduce carbon emissions; • The commissioning of consultancy services to identify opportunities for carbon reduction across the estate; • Identification of property fabric related backlog maintenance and improvement issues; and • The rationalisation of the estate through improved co-location arrangements. Performance, Outcomes & Improvement The HSCP reports performance in a holistic way and it has implemented its Integrated Performance Management Framework. It continues to work to increase activity to pre-pandemic levels and address the backlog of treatment and diagnosis. Addressing the backlog and long waits are a priority for NHS services across Scotland. A further priority remains the management of delayed discharges from the acute sector, both within Argyll & Bute and from Greater Glasgow Page 94
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Annual Governance Statement Page 18 Classification: OFFICIAL & Clyde. The HSCP continues to perform well by this measure, however the number of delays has increased and become increasingly difficult to manage due to a number of factors, including staffing in community based services. REVIEW OF EFFECTIVENESS The IJB has responsibility for conducting, at least annually, a review of the effectiveness of the governance arrangements including the system of internal financial control. This is informed by: - The work of officers within the IJB - The work of Internal Audit - The work of External Audit - External review and inspection reports - The compliance with statutory guidance issued for the integration of services - Recommendations from the Audit Committee. CONCLUSION AND OPINION ON ASSURANCE Appropriate governance arrangements are in place and have operated effectively throughout 2023/24. Continuous improvement and development is ongoing to ensure that the Partnership is able to deliver on its strategic objectives and operate on a financially sustainable basis in the longer term. The annual report and accounts outline an improved financial position and improving governance arrangements. The Annual Governance Statement outlines a number of key evidence sources which support the view that reasonable assurance can be placed upon the adequacy and effectiveness of the IJB’s systems of governance. Councillor Dougie McFadzean Evan Beswick Chair Chief Officer 26 March 2025 26 March 2025 Page 95
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Remuneration Report Page 19 Classification: OFFICIAL 1. INTRODUCTION The Local Authority Accounts (Scotland) Amendment Regulations 2014 (SSI No.2014/200) require local authorities and IJBs to prepare a Remuneration Report within the annual accounts. The information disclosed in the Remuneration Report is subject to external audit and the text is reviewed by external audit to ensure its consistency with the Financial Statements. 2. INTEGRATION JOINT BOARD The IJB comprises eight voting members appointed in equal numbers by the Health Board and Council. The partners appoint a Chair and Vice Chair in accordance with the Integration Scheme and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. Article 4 of the Order provides for the Chair to be appointed by NHS Highland or Argyll and Bute Council from among the voting members nominated by NHS Highland and the Council. The Vice Chair is appointed by the constituent authority who did not appoint the Chair. The NHS Board and the Council have responsibility for these appointments on an alternating basis and the NHS Board and the Council may change the person appointed by them as Chair or Vice Chair during an appointing period. Argyll and Bute Council appointed Councillor Amanda Hampsey as Chair from 19 May 2022 to 4 April 2024 and Cllr Dougie McFadzean from 25th April 2024. NHS Highland appointed Mr Graham Bell as Vice Chair from 1 April 2023. Mr Bell assumed leadership of the IJB in his role as Vice Chair between 4 April 2024 and 25th April 2024 in line with the Standing Orders. In addition there are professional advisors and stakeholder members who are non-voting members of the Integration Joint Board. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role. The IJB does not reimburse the relevant partner organisations for any voting board members costs. Travel and subsistence costs for all Board Members are re- imbursed in line with the policies of the Council and Health Board. The IJB does not have responsibilities, either in the current or future years, for funding any pension entitlements of voting IJB members. Therefore no pension rights or disclosures are provided for the Chair or Vice Chair. 3. OFFICERS OF THE IJB The IJB does not employ staff in its own right, however specific post-holding officers are non- voting members of the Board. Under Section 10 of the Public Bodies (Joint Working) (Scotland) Act 2014 a Chief Officer for the IJB has to be appointed and the employing partner has to formally second the officer to the IJB. The Chief Officer is regarded as an employee of the IJB although the contract of employment is with NHS Highland. No other staff are appointed by the IJB under a similar legal regime. Other non-voting board members who meet the criteria for disclosure are included below. The following table sets out the remuneration disclosures for 2023-24 for senior officers: Page 96
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Remuneration Report Page 20 Classification: OFFICIAL Total 2022-23 £ Senior Officer Salary (Inc Fees and Allowances) £ Taxable Expenses £ Total 2023-24 £ 105,197 Chief Officer – Fiona Davies 111,984 0 111,984 85,175 Head of Finance and Transformation – James Gow 89,456 822 90,278 17,038 Depute Chief Officer – George Morrison (until 31/5/22) - - - 207,410 Total 201,440 822 202,262 4. PENSION BENEFITS In respect of officers’ pension benefits the statutory responsibility for any future contributions rests with the employing partner organisation. Therefore there is no pension liability reflected on the IJB balance sheet for its officers. The IJB has a responsibility for funding the employer cash contributions each year. The Chief Officer is a member of the NHS Pension Scheme, costs for the pension scheme contributions and accrued pension entitlements are shown in the table below: 2022-23 2023-24 In-year Pension Contributions £ Accrued Pension Benefits £ In-year Pension Contributions £ Accrued Pension Benefits £ 21,390 Pension 35,000 Lump Sum 78,000 Chief Officer – Fiona Davies 22,840 Pension 32,000 Lump Sum 84,000 16,280 Pension 3,000 Lump Sum 0 Head of Finance and Transformation – James Gow 17,265 Pension 5,000 Lump Sum 0 3,156 Pension 46,000 Lump Sum 137,000 Depute Chief Officer – George Morrison (until 31/5/22) - - Page 97
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Remuneration Report Page 21 Classification: OFFICIAL 5. DISCLOSURE BY PAY BANDS Pay band information is not separately provided as all staff pay information is disclosed above. 6. EXIT PACKAGES There were no exit packages for senior officers agreed during 2023/24 or during 2022/23. Cllr Dougie McFadzean Evan Beswick Chair Chief Officer 26 March 2025 26 March 2025 Page 98
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 22 Classification: OFFICIAL COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT The statement below shows the cost of providing services for the year according to accepted accounting practices. 2022-23 2023-24 Net Expenditure £000 Gross Expenditure £000 Gross Income £000 Net Expenditure £000 245,665 Services Provided by NHS Highland 274,513 (8,795) 265,718 86,116 Services Provided by Argyll & Bute Council 105,996 (12,319) 93,677 331,781 Cost of Services 380,509 (21,114) 359,395 (327,575) Taxation and Non-Specific Grant Income (note 3) (362,284) 4,206 (Surplus) or Deficit on Provision of Services (2,889) 4,206 Total Comprehensive (Income) and Expenditure (2,889) The movement in the General Fund balance is solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently an Expenditure and Funding Analysis is not provided in these accounts. Page 99
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 23 Classification: OFFICIAL MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the IJB 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. Movements in Reserves During 2023-24: General Fund Balance £000 Total Reserves £000 Opening Balance at 31 March 2023 (16,990) (16,990) (Surplus) / Deficit on Provision of Services (2,889) (2,889) (Increase) / Decrease in Year 2023-24 (2,889) (2,889) Closing Balance at 31 March 2024 (19,879) (19,879) Movements in Reserves During 2022-23: General Fund Balance £000 Total Reserves £000 Opening Balance at 31 March 2022 (21,196) (21,196) (Surplus) / Deficit on Provision of Services 4,206 4,206 (Increase) / Decrease in Year 2022-23 4,206 4,206 Closing Balance at 31 March 2023 (16,990) (16,990) Page 100
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 24 Classification: OFFICIAL BALANCE SHEET The Balance Sheet shows the value of the IJB’s assets and liabilities as at the balance sheet date. The net assets of the IJB are matched by the reserves held by the IJB. 31 March 2023 Note 31 March 2024 £’000 £’000 16,991 Current Assets: Short Term Debtors 4 19,879 16,991 Net Assets 19,879 16,991 Usable Reserve: General Fund 6 19,879 16,991 Total Reserves 19,879 The unaudited accounts were authorised for issue on 18 June 2024. The audited accounts were approved by the IJB at its meeting on 26 March 2025. James Gow Head of Finance and Transformation 26 March 2025 Page 101
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 25 Classification: OFFICIAL 1. MATERIAL ACCOUNTING POLICIES 1.1 General Principles The Financial Statements summarise the transactions of the Integration Joint Board for the 2023/24 financial year and its position as at 31 March 2024. The Integration Joint Board was established under the requirements of the Public Bodies (Joint Working) (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 Authorities Accounting in the United Kingdom 2023-24, 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 the Integration Joint Board will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. 1.2 Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when cash payments are made or received. In particular: - Expenditure is recognised when goods or services are received and their benefits are used by the IJB. - Income is recognised when the IJB has a right to the income, for instance by meeting any terms and conditions required to earn 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. For the IJB annual accounts a debtor and/or creditor will be recorded where the partner contributions differ from the actual net expenditure in year, this allows any surplus or deficit on the provision of services to be transferred to the reserves held by the IJB. Where any in-year overspend exceeds reserves available the partners will make additional in-year payments, in this instance a creditor will not be recognised as future funding would be adjusted to reflect any future repayment. 1.3 Offsetting of Debtors and Creditors The IJB does not hold cash and cash equivalents. Instead the funding partners utilise, as directed by the Integration Joint Board, the amount of funding due to the Integration Joint Board to pay for services. The Integration Joint Board and the funding partners have confirmed that there is a ‘right of offset’, and that there is an intention to allow settlement of balances to be undertaken on a net Page 102
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 26 Classification: OFFICIAL basis. On this basis the Integration Joint Board’s financial statements present the balances due to and from the funding partners on a net basis rather than as separate creditors and debtors. 1.4 Funding The Integration Joint Board is primarily funded through funding contributions from the statutory funding partners, Argyll and Bute Council and NHS Highland. Expenditure is incurred as the Integration Joint Board commissions specified health and social care services from the funding partners for the benefit of service recipients in Argyll and Bute. 1.5 Cash and Cash Equivalents The Integration Joint Board does not operate a bank account or hold cash. Transactions are settled on behalf of the Integration Joint Board by the funding partners. Consequently the Integration Joint Board does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. The funding balance due to or from each partner at 31 March is represented as a debtor or creditor on the Integration Joint Board’s Balance Sheet. 1.6 Employee Benefits The Integration Joint Board 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 Integration Joint Board therefore does not present a Pensions Liability on its Balance Sheet. The Integration Joint Board has a legal responsibility to appoint a Chief Officer. 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 at 31 March is accrued, for example in relation to annual leave earned but not taken. 1.7 Provisions Provisions are liabilities of uncertain timing or amount. A provision is recognised as a liability on the balance sheet when there is an obligation as at 31 March due to a past event; settlement of the obligation is probable; and a reliable estimate of the amount can be made. Recognition of a provision will result in expenditure being charged to the Comprehensive Income and Expenditure Statement and will normally be a charge to the General Fund. Where NHS Highland or Argyll and Bute Council recognise provisions in relation to services included in the Integration Scheme these are disclosed in the IJB’s Annual Accounts. 1.8 Reserves The Integration Joint Board has a Reserves Policy in place which details the nature and use of reserves. The Integration Joint Board’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 Integration Joint Board can use in future years. Page 103
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 27 Classification: OFFICIAL 1.9 Indemnity Insurance The Integration Joint Board has indemnity insurance for costs relating primarily to potential claim liabilities regarding Board member and officer responsibilities. NHS Highland and Argyll and Bute Council have responsibility for claims in respect of the services that they are statutorily responsible for and that they provide. Unlike NHS Boards, the Integration Joint Board does not have any ‘shared risk’ exposure from participation in the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). The Integration Joint Board’s participation in the CNORIS scheme is therefore analogous to normal insurance arrangements. Known claims are assessed as to the value and probability of settlement. Where it is material the overall expected value of known claims taking probability of settlement into consideration, is provided for in the Integration Joint Board’s Balance Sheet. The likelihood of receipt of an insurance settlement to cover any claims is separately assessed and, where material, presented as either a debtor or disclosed as a contingent asset. 1.10 VAT Status The IJB is a non-taxable person and does not charge or recover VAT on its functions. 2. EVENTS AFTER THE REPORTING PERIOD The audited Annual Accounts were authorised for issue on 26 March 2025. Events taking place after this date are not reflected in the financial statements or notes. Events after the Balance Sheet date are those events, both favourable and unfavourable, that occur between the end of the reporting period and the date when the Annual Accounts are authorised for issue. Two types of events can be identified: • Those that provide evidence of conditions that existed at the end of the reporting period, the Annual Accounts are adjusted to reflect such events. • Those that are indicative of conditions that arose after the reporting period – The Annual Accounts are not adjusted to reflect such events, but where a category of events would have a material impact disclosure is made in the notes of the nature of the events and their estimated financial effect. There are no events to report after the reporting period end. Page 104
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 28 Classification: OFFICIAL 3. TAXATION AND NON-SPECIFIC GRANT INCOME The following taxation and non-specific grant income was recognised in the Comprehensive Income and Expenditure Statement: 31 March 2023 31 March 2024 £’000 £’000 74,391 Funding Contribution from Argyll and Bute Council 77,605 253,184 Funding Contribution from NHS Highland 284,679 327,575 Taxation and Non-specific Grant Income 362,284 The funding contributions from the partners shown above excludes any funding which is ring- fenced for the provision of specific services. Such funding is presented as income in the Cost of Services in the Comprehensive Income and Expenditure Statement. 4. DEBTORS 31 March 2023 31 March 2024 £’000 £’000 11,985 NHS Highland 16,490 5,006 Argyll and Bute Council 3,389 16,991 Total Debtors 19,879 Amounts owed by the partners are stated on a net basis. Debtor and Creditor balances recognised by the funding partners but not yet settled in cash terms are offset against the funds they are holding on behalf of the IJB. 5. RELATED PARTY TRANSACTIONS The Integration Joint Board has related party relationships with NHS Highland and Argyll and Bute Council. In particular, the nature of the partnership means that the IJB may influence, and be influenced by, its partners. The following transactions and balances included in the Integration Joint Board’s accounts provide additional information on the relationships. Transactions with NHS Highland: 2022-23 £000 Restated* 2023-24 £000 (253,184) Funding Contributions received from NHS Highland (284,679) 245,665 Expenditure on Services Provided by NHS Highland 265,718 (7,519) Net Transactions with NHS Highland (18,961) *The table above has been restated due to a clerical error in the prior year accounts. The correction is summarised below: Page 105
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 29 Classification: OFFICIAL 2022-23 Per Accounts £000 2022-23 Restated £000 Funding Contributions received from NHS Highland (245,665) (253,184) Expenditure on Services Provided by NHS Highland 253,184 245,665 Net Transactions with NHS Highland 7,519 (7,519) The restatement has no impact on any other balances within the prior year accounts. There are key management personnel employed by NHS Highland, these costs are included in the expenditure on services provided. The non-voting Board members employed by NHS Highland include the Lead Nurse, Clinical Director for Argyll and Bute, Public Health Specialist, Lead Allied Health Professional, Lead Pharmacist, Staff Representative and representatives from primary care and medical services. Details of remuneration, where required, is provided in the Remuneration Report. Transactions with Argyll and Bute Council 2022-23 £000 2023-24 £000 (74,391) Funding Contributions received from Argyll and Bute Council (77,605) 86,116 Expenditure on Services Provided by Argyll and Bute Council 93,677 11,725 Net Transactions with Argyll and Bute Council 16,072 There are key management personnel employed by Argyll and Bute Council, these costs are included in the expenditure on services provided. The non-voting Board members employed by Argyll and Bute Council include the Chief Financial Officer (Head of Finance and Transformation), Chief Social Work Officer and a Staff Representative. Details of remuneration, where required, is provided in the Remuneration Report. Support services, such as human resources, financial services, information technology and accommodation are not included in the delegations from Argyll and Bute Council. These are provided free of charge as ‘services in kind’ and not included in the expenditure of the IJB. 6. USABLE RESERVE: GENERAL FUND The IJB holds a balance on the General Fund which will normally comprise of three elements: 1. Funds that are earmarked or set aside for specific purposes. In Scotland, under Local Government rules, earmarked reserves are accounted for separately but remain legally part of the General Fund. The identification of earmarked reserves may include: Page 106
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 30 Classification: OFFICIAL • future use of funds for a specific purpose, as agreed by the Integration Joint Board; or • reserves for unspent revenue grants or contributions which were allocated for a defined purpose. 2. Funds which are not earmarked for specific purposes, but are set aside to deal with unexpected events; and 3. Funds held in excess of the target level of reserves and identified earmarked sums. Such reserves can be spent or earmarked at the discretion of the Integration Joint Board. The following table details the movements on the General Fund: 2022-23 2023-24 Balance at 31 March 2023 Transfers Out Transfers In Balance at 31 March 2024 £000 £000 £000 £000 610 Primary Care Transformation Fund 610 0 0 118 Technology Enabled Care 87 0 31 431 Alcohol & Drugs Partnership 369 433 495 82 Best start maternity services 0 28 110 178 Supporting improvements to GP premises 0 0 178 14 Scotgem accommodation funding 0 7 21 34 Mental Health after COVID/Long COVID 8 15 41 240 Community Living Change Fund 152 0 88 140 Primary Care OOH Funding 0 95 235 70 Insulin Pumps 70 0 0 61 ASC Nurse Director Support IPC 48 0 13 37 Trauma Network 0 0 37 167 PFG School Nursing 0 0 167 127 District Nurse Posts 0 0 127 138 E-health Strategy Funding 18 160 280 20 Perinatal MH Funding 0 0 20 64 Mental Health Officer Training 35 0 29 67 Type 2 Diabetes Framework 22 0 45 90 Trauma Training Programme 54 50 86 77 Staff Wellbeing Funding 38 0 39 145 Oban Accommodation Funding 0 0 145 250 Primary Care Education Fund 0 0 250 87 Vehicle Fleet Decarbonisation 0 0 87 Page 107
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ARGYLL AND BUTE INTEGRATION JOINT BOARD Financial Statements Page 31 Classification: OFFICIAL 636 Additional Band 2-4 Staffing 0 82 718 213 Nursing Support for Care Homes Funding 0 0 213 90 Remobilisation of Dental Services 0 0 90 285 Mental Health Facilities Funding 0 0 285 205 Diabetic Technologies Funding 168 0 37 190 Waiting Times Funding 190 160 160 133 Interface Care Programme 0 0 133 55 Medical Assisted Treatment Standards 0 0 55 56 Psychological Therapies 0 0 56 23 Inequalities Project Funding 23 0 0 102 Dementia Post Diagnostic Support 37 66 131 84 Dental Equipment 0 0 84 59 Eating Disorders Funding 59 0 0 29 Ventilation Improvement 0 0 29 39 Mental Health Recovery Services 0 0 39 279 Whole Family Wellbeing Fund 0 159 438 418 Care at Home Funding 418 0 0 84 Multi Disciplinary Teams Funding 40 0 44 229 Interim Care Funding 118 0 111 109 Primary Care Projects 21 9 97 645 Children’s Mental Health Services (CAHMS) 0 0 645 11 Children’s Oral and Dental Health 0 0 11 38 Health Checks – Learning Disability 0 38 76 104 Social Work Workforce 65 0 39 250 Hospital at Home Project 91 256 415 279 Public Dental Service 0 0 279 Digital Therapies 0 58 58 0 Sustainability & Value 0 4,697 4,697 8,499 General Reserves – Earmarked for Service Transformation & Budget Gap 3,482 2,798 7,815 600 General Reserves – Earmarked for Prevention Programme 0 0 600 16,991 General Fund 6,223 9,111 19,879 7. CRITICAL JUDGEMENTS AND ESTIMATION UNCERTAINTY In preparing the 2023/24 Annual Accounts, the IJB has had to make certain judgements about complex transactions or those involving uncertainty about future events. There are no critical judgements or material estimation uncertainties included within the Annual Accounts. Page 108
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Page 32 Classification: OFFICIAL Independent auditor’s report to the members of Argyll and Bute Integration Joint Board and the Accounts Commission Report on the audit of the financial statements Opinion on the financial statements We certify that we have audited the financial statements in the annual accounts of Argyll and Bute Integration Joint Board (“the IJB”) for the year ended 31 March 2024 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet, and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted, and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2023/24 (the 2023/24 Code). In our opinion the accompanying financial statements: • give a true and fair view of the state of affairs of the Argyll and Bute Integration Joint Board as at 31 March 2024 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted, and adapted by the 2023/24 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion We conducted our audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. Our responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of our report. We were appointed by the Accounts Commission on 18 May 2022. Our period of appointment is five years, covering 2022/23 to 2026/27. We are independent of the IJB in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the IJB. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Conclusions relating to going concern basis of accounting. We have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the IJB's ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. Page 109
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Page 33 Classification: OFFICIAL These conclusions are not intended to, nor do they, provide assurance on the IJB's current or future financial sustainability. However, we report on the IJB's arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement We report in our Annual Audit Report the most significant assessed risks of material misstatement that we identified and our judgements thereon. Responsibilities of the Head of Finance and Transformation and the Audit and Risk Committee for the financial statements As explained more fully in the Statement of Responsibilities, the Head of Finance and Transformation is responsible for the preparation of financial statements, that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Head of Finance and Transformation determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Head of Finance and Transformation is responsible for assessing each year the IJB’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the IJB operations. The Audit and Risk Committee is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using our understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the IJB; • inquiring of the Head of Finance and Transformation as to other laws or regulations that may be expected to have a fundamental effect on the operations of the IJB; • inquiring of the Head of Finance and Transformation concerning the IJB‘s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among our audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. Page 110
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Page 34 Classification: OFFICIAL The extent to which our procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the IJB‘s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report We have audited the parts of the Remuneration Report described as audited. In our opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Head of Finance and Transformation is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Statement of Responsibilities, Annual Governance Statement, and the unaudited part of the Remuneration Report. Our responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements, or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. Our opinion on the financial statements does not cover the other information and we do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In our opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has Page 111
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Page 35 Classification: OFFICIAL been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which we are required to report by exception. We are required by the Accounts Commission to report to you if, in our opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • we have not received all the information and explanations we require for our audit. We have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to our responsibilities for the annual accounts, our conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in our Annual Audit Report. Use of our report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, we do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. Mark Outterside, Audit Director For and on behalf of Forvis Mazars LLP Forvis Mazars The Corner Bank Chambers 26 Mosley Street Newcastle upon Tyne NE1 1DF 26 March 2025 Page 112
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Headquarters: Assynt House, Beechwood Park, INVERNESS IV2 3BW Chair: Sarah Compton-Bishop Chief Executive: Fiona Davies Classification: OFFICIAL Mark Outterside Forvis Mazars The Corner Bank Chambers 26 Mosley Street Newcastle upon Tyne NE1 1DF 26 March 2025 Kilmory Lochgilphead Argyll PA31 8RT Date: Our Ref: Enquiries to: Email: PA: 26 March 2025 JG/GW James Gow james.gow@argyll-bute.gov.uk gary.whyte@argyll-bute.gov.uk Dear Mark, Argyll and Bute Integration Joint Board - Audit for the Year Ended 31 March 2024 This representation letter is provided in connection with your audit of the financial statements of Argyll and Bute Integration Joint Board for the year ended 31 March 2024 for the purpose of expressing an opinion as to whether the financial statements give a true and fair view in accordance with the Part VII of the Local Government (Scotland) Act 1973 and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2023/24 (the 2023/24 Code). I confirm that the following representations are made on the basis of enquiries of management and staff with relevant knowledge and experience (and, where appropriate, inspection of supporting documentation) sufficient to satisfy myself that I can properly make each of the following representations to you. My responsibility for the financial statements and accounting information I believe that I have fulfilled my responsibilities for the true and fair presentation and preparation of the financial statements in accordance with the Part VII of the Local Government (Scotland) Act 1973 and UK adopted international accounting standards, as interpreted, and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2023/24 (the 2023/24 Code). My responsibility to provide and disclose relevant information I have provided you with: • access to all information of which I am aware that is relevant to the preparation of the financial statements such as records, documentation and other material; • additional information that you have requested from us for the purpose of the audit; and • unrestricted access to individuals within the IJB you determined it was necessary to contact in order to obtain audit evidence. Page 113
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Headquarters: Assynt House, Beechwood Park, INVERNESS IV2 3BW Chair: Sarah Compton-Bishop Chief Executive: Fiona Davies Classification: OFFICIAL I confirm as Head of Finance and Transformation that I have taken all the necessary steps to make me aware of any relevant audit information and to establish that you, as auditors, are aware of this information. As far as I am aware there is no relevant audit information of which you, as auditors, are unaware. Accounting records I confirm that all transactions undertaken by the IJB have been properly recorded in the accounting records and are reflected in the financial statements. All other records and related information, including minutes of all management and Board meetings, have been made available to you. Accounting policies I confirm that I have reviewed the accounting policies applied during the year in accordance with International Accounting Standard 8 and consider these policies to faithfully represent the effects of transactions, other events, or conditions on the IJB’s financial position, financial performance, and cash flows. Accounting estimates, including those measured at fair value I confirm that the methods, significant assumptions, and the data used by the IJB in making the accounting estimates, including those measured at fair value are appropriate to achieve recognition, measurement or disclosure that is in accordance with the applicable financial reporting framework. Contingencies There are no material contingent losses including pending or potential litigation that should be accrued where: • information presently available indicates that it is probable that an asset has been impaired, or a liability had been incurred at the balance sheet date; and • the amount of the loss can be reasonably estimated. There are no material contingent losses that should be disclosed where, although either or both the conditions specified above are not met, there is a reasonable possibility that a loss, or a loss greater than that accrued, may have been incurred at the balance sheet date. There are no contingent gains which should be disclosed. All material matters, including unasserted claims, that may result in litigation against the IJB have been brought to your attention. All known actual or possible litigation and claims whose effects should be considered when preparing the financial statements have been disclosed to you and accounted for and disclosed in accordance with the Part VII of the Local Government (Scotland) Act 1973 and UK adopted international accounting standards, as interpreted, and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2023/24 (the 2023/24 Code). Page 114
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Headquarters: Assynt House, Beechwood Park, INVERNESS IV2 3BW Chair: Sarah Compton-Bishop Chief Executive: Fiona Davies Classification: OFFICIAL Laws and regulations I confirm that I have disclosed to you all those events of which I are aware which involve known or suspected non-compliance with laws and regulations, together with the actual or contingent consequences which may arise therefrom. We have complied with all aspects of contractual agreements that would have a material effect on the accounts in the event of non-compliance. Fraud and error I acknowledge my responsibility as Head of Finance and Transformation for the design, implementation, and maintenance of internal control to prevent and detect fraud and error. I have disclosed to you: • all the results of my assessment of the risk that the financial statements may be materially misstated as a result of fraud; • all knowledge of fraud or suspected fraud affecting the IJB involving: ▪ management and those charged with governance; ▪ employees who have significant roles in internal control; and ▪ others where fraud could have a material effect on the financial statements. I have disclosed to you all information in relation to any allegations of fraud, or suspected fraud, affecting the IJB's financial statements communicated by employees, former employees, analysts, regulators, or others. Related party transactions I confirm that all related party relationships, transactions, and balances, have been appropriately accounted for and disclosed in accordance with the Part VII of the Local Government (Scotland) Act 1973 and UK adopted international accounting standards, as interpreted, and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2023/24 (the 2023/24 Code). I have disclosed to you the identity of the IJB’s related parties and all related party relationships and transactions of which I are aware. Future commitments I am not aware of any plans, intentions or commitments that may materially affect the carrying value or classification of assets and liabilities or give rise to additional liabilities. Ultimate parent company I confirm that the ultimate parent company for Argyll and Bute Integration Joint Board is the Scottish Government. Other Matters I confirm in relation to the following matters that: Page 115
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Headquarters: Assynt House, Beechwood Park, INVERNESS IV2 3BW Chair: Sarah Compton-Bishop Chief Executive: Fiona Davies Classification: OFFICIAL • COVID-19 – I have assessed the continued impact of the COVID-19 Virus pandemic on the IJB and the financial statements, including the impact of mitigation measures and uncertainties, and am satisfied that the financial statements and supporting notes fairly reflect that assessment. • Ukraine – I confirm that I have carried out an assessment of the potential impact of the continued conflict in Ukraine on the IJB and there is no significant impact on the IJB’s operations from restrictions or sanctions in place. • I confirm that I have assessed the impact on the IJB of the on-going Global Banking challenges, in particular whether there is any impact on the IJB’s ability to continue as a going concern, and on the post balance sheet events disclosures. Going concern To the best of my knowledge there is nothing to indicate that the IJB will not continue as a going concern in the foreseeable future. The period to which I have paid particular attention in assessing the appropriateness of the going concern basis is not less than twelve months from the date of approval of the accounts. Performance related allocations I confirm that I am not aware of any reason why the IJB’s funding allocation limits would be changed. Subsequent events I confirm all events subsequent to the date of the financial statements and for which the Part VII of the Local Government (Scotland) Act 1973 and UK adopted international accounting standards, as interpreted, and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2023/24 (the 2023/24 Code), require adjustment or disclosure have been adjusted or disclosed. Should further material events occur after the date of this letter which may necessitate revision of the figures included in the financial statements or inclusion of a note thereto, I will advise you accordingly. Annual Governance Statement I am satisfied that the Annual Governance Statement(AGS) fairly reflects the IJB's risk assurance and governance framework, and I confirm that I am not aware of any significant risks that are not disclosed within the Governance Statement. Annual Report The disclosures within the Annual Report and the Remuneration and Staff Report fairly reflect my understanding of the IJB’s financial and operating performance over the period covered by the financial statements. Unadjusted misstatements I confirm that there are no uncorrected misstatements. Page 116
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Headquarters: Assynt House, Beechwood Park, INVERNESS IV2 3BW Chair: Sarah Compton-Bishop Chief Executive: Fiona Davies Classification: OFFICIAL Yours sincerely, James Gow Head of Finance and Transformation Page 117
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1 Classification: OFFICIAL Integration Joint Board Date of Meeting: 26 March 2025 Title of Report: Budget Monitoring – 11 months to 28 February 2025 Presented by: James Gow, Head of Finance The IJB is recommended to: • Note that the HSCP has overspent its budget by £2.2m. • Note an overspend of £2.3m is forecast. • Note Argyll & Bute Council have confirmed the HSCP can access £3.05m in pension saving resource they hold on behalf of the IJB. • Note reserves will be utilised to cover the remaining deficit and new projects funded from this source are on hold. • Note savings of £5.1m have been delivered, 77% of target. 1. EXECUTIVE SUMMARY 1.1 This report provides a summary of the financial position as at the end of month 11 and forecast to the year end. The Social Work forecast remains of concern as costs (predominantly social care) are well in excess of the approved budget. Actions are required to manage this through reducing spend, increased use of reserves and by accessing non-recurring pension fund savings. Specific cost pressures relate to on-going high levels of agency and locum spend, increasing high-cost placements within Children’s and Families service and high demand and agency staff costs within Older Adult Services. The NHS position is now forecast in line with budget but there are still some risks. This report has been considered by the Finance & Policy Committee on 18th March. 1.2 The forecast is an overspend against budget estimated at £2.2m. Overall the position has improved, largely due to some additional resourcing, vacancy savings and slippage on project spend within the NHS budget. The approach to managing the continuing financial challenge into next year is: • Increase scrutiny of spend and vacancy management. • Progress the savings programme. • Develop additional controls to reduce spend within social care, particularly in respect of care at home. • Utilise additional resourcing from the pension fund savings and allocate remaining reserves. The Health, Social Work and Social Care sector continues to be in a very difficult and unsustainable financial position, this has been highlighted by Audit Page 119 Agenda Item 9b
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2 Classification: OFFICIAL Scotland in various reports. It is also case that many IJBs are in deficit, and many are now taking action to reduce access to care or increase charges to help fund shortfalls. The situation has changed rapidly from one where reserves were increasing and underspending to reduced real terms funding, increasing demand and overspending. This has not been planned nationally (real terms increases were promised in the Spending Review) and has created significant challenge throughout the sector. Resource levels are not sufficient to fund current service demands and delivery models. 2. Recommendations • Note that the HSCP has overspent its budget by £2.2m. • Note an overspend of £2.3m is forecast. • Note Argyll & Bute Council have confirmed the HSCP can access £3.05m in pension saving resource they hold on behalf of the IJB. • Note reserves will be utilised to cover the remaining deficit and any projects not fully committed have been paused. • Note savings of £5.1m have been delivered, 77% of target. 3. DETAIL OF REPORT 3.1 11 Months to 28 February 2025 The table below provides the year to date figures, Social Work/Care services report on a cash basis whereas Health report on an accruals basis. Appendix 1 provides further analysis: Service Actual £000 Budget £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 82,368 80,317 (2,051) (2.6%) HEALTH SERVICES TOTAL 251,780 251,590 (189) (0.1%) GRAND TOTAL 334,148 331,907 (2,240) (0.7%) 3.1.1 For social care budgets the concerns remain: • Number of external placements for children. • Demand for older adult care, increasing costs of care packages and management of delayed discharges, increasing demand for care home placements. • Spend on agency staff remains too high, the planned reduction is not being achieved. Agency staff numbers have been reduced slightly but too late in the year to have a significant impact on the financial position. Absence cover is problematic as services are often paying staff plus an enhanced rate for agency cover which generally amounts to 150% of the cost of the underlying staffing gap,1 FTE of resource can cost the equivalent of 2.5 FTE in these circumstances. 3.1.2 The NHS budget is still slightly overspent, the position has improved as slippage and reserves have been allocated. Overspending has continued at Page 120
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3 Classification: OFFICIAL Lorn and Islands Hospital, with locum medical costs remaining high. Increasing cost per case activity in Glasgow is also contributing to the overspend position. Spend on agency staffing has reduced, agency staff are generally only employed to cover for essential posts which are either vacant or there is an absence. The planned reduction has been achieved / exceeded for nursing and AHP groups, this has been supported by national initiatives to cut back spend. 3.2 3.2.1 Forecast Outturn The forecast outturn has improved as the position with NHS services is now in line with budget. This improvement is due to the allocation of earmarked reserves and recognition of slippage with some projects along with some funding allocations being confirmed. The Social Work forecast continues to present a significant challenge and a large overspend is expected. In addition to the implications in the current year, the budget is reliant upon reserves which are reducing and largely committed. Forecast spend is summarised below with further detail in appendix 2. Members will recall that the budget already relies upon the use of reserves and an allocation from the non-recurring pension fund saving, the overspend is in addition. Service Annual Budget £000 Forecast Outturn £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 92,235 94,681 (2,446) (2.7%) HEALTH SERVICES TOTAL 281,142 281,017 125 (0.0%) GRAND TOTAL 373,377 375,698 (2,321) (0.6)% 3.2.2 Within Social Work, Children’s and Families and Older Adult budgets are overspending, a £2.4m adverse variance is forecast. The overspend in Children’s Services relates to the increased number of children in out of area placements (£0.7m) and the regrading of staff (£0.3m) These are now being offset by underspending elsewhere within Children, Families and Justice. Spend on older adults remains above budget. The budgets summarised below were increased from £35.6m to £38.6m (8%) to allow for increasing demand and inflation. Social Care agency spend is at £3.9m for 10 months with around 50 members of staff currently employed on this basis. This has increased on £3.2m spend for all of last year and £0.8m in 2021/22. The cost of accommodation is adding to the problem. Alternative arrangements on Islay and Tiree will be available in the coming weeks to reduce this. Agency within nursing homes is reducing with recruitment but care at home agency is meeting service demand with limited scope for immediate improvement. Adult Services Budget Forecast Spend Variance External Residential Placements – demand led @ national contract rate £11.4m £12.4m (£1.0m) Care @ Home Service £19.6m £20.9m (£1.3m) Internal Care Home Placements £7.6m £ 7.9m (£0.3m) Total £38.6m £41.2m (£2.6m) Page 121
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4 Classification: OFFICIAL External residential placements includes provision within Argyll and Bute and in other local authority areas. These are generally at the nationally negotiated care home rates. While the figures fluctuate from week to week, there are typically around 170 older people in out of area placements of the 490 or so that are in privately owned care homes. This is due to both lack of local capacity and the choice of the individual / family concerned. The new Care at Home contract has been implemented in and is reducing costs per hour of care in areas where there are providers available. The national focus on reducing delayed discharges from acute services continues and is adding to pressure to ensure people are placed in residential care or provided with care at home packages as quickly as possible. Services continue to be provided beyond sustainable staffing levels and available budget, to meet increasing demand. Recovery actions reported to the February meeting of the Finance & Policy Committee are now being implemented. This is now including action to stop any further increase in the number of hours of homecare commissioned in each area and action to reduce the number of agency staff employed. The Social Work budget assumed £1.3m of the pension fund saving (£3.05m is held by the Council) would be allocated to revenue costs in 2024/25. Social Work £m Budgeted Reliance on Pension Fund Savings 1.3 Forecast revenue budget variance 2.4 Total budget gap 3.7 The HSCP have formally written to Council to request the full £3.05m available from the pension fund saving, this request has been approved. The remaining £0.7m (plus any further deterioration) will require to be funded from reserves. General reserves carried forward for social work totalled £2.6m, these are largely committed to projects (such as key worker housing, the shared service approach to catering and the care homes and housing project), and the completion of the Tigh a Rudha refurbishment and remodelling. Other projects not legally committed have been paused as Social Work General Reserves will be largely exhausted by the year end. 3.2.3 NHS services are forecasting breakeven now as funding has been confirmed for 2c practices and slippage on projects has been recognised in the position: - Agency staff – agency, locum and bank staff costs continue to be the single largest cost pressure. The gross spend on agency, locum and bank staffing across all services is £11.3m. LIH is the highest spending service area, reporting a gross cost of £4.8m. Whist recruitment within LIH nursing services has reduced the monthly agency costs being incurred, there are still long term vacancies for consultant physicians covered by agency staff. £3.2m spend relates to medical staffing vacancy cover. There is no indication that the challenges in recruiting consultant physicians will improve in the near future. - 2c practices – There is a pressure of £556k due to agency staffing. Page 122
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5 Classification: OFFICIAL - High cost out of area private sector referrals – Cost pressure £732k. 1 patient remains a delayed discharge at an unbudgeted cost of £3,500 per week. - Unachieved savings are further adding to cost pressures. Excess costs continue to be partly offset by vacancies and slippage on projects. While the forecast has improved, the Health budget is dependent upon the use of reserves (£4.3m). The intention is to deliver a balanced NHS position at the year-end however there are still some risks: - Delays in receiving data on cost per case charges from NHS GG&C. - Ongoing issues with PSD prescribing reporting. - Lack of clarity on the full cost of the implementation of Agenda for Change Non Pay Reform and funding. - Year end SLA increases due to activity adjustments. - Further unfunded private sector high cost admissions, including a significantly high cost complex care package. The national context within the NSH is that Boards are still collectively projecting an overspend in the current year and for 2025/26 budget planning. 3.2.4 Processes to reduce spend continue but the impact on Social Care budgets has so far been limited: • Continuing vacancy management. • Increased controls and reporting of agency and locum spend. • New approval process for agency staffing. The Social Work overspending has been reported within the Council, and further mitigations are being implemented, these overlap with actions associated with the work on the budget as the impact on the current year will is limited at this stage: • The remainder of the pension fund saving held by the Council has been formally allocated to the HSCP to fund the overspend. • A moratorium is in place on any new agency social care staff and all renewals are short term and subject to an exit strategy (in reality this may mean a cut in service where in house staff cannot be recruited or a rise in unmet need). A reduction of 5 agency staff has been achieved in February and March. • Plans to use interim beds to assist with delayed discharges as been halted. • Recovery of direct payment balances where these are not being fully spent (non-recurring) is underway. • The operation of the care at home service is underway as reported in February. • The project to expand capacity at Thomson Court has been paused (£500k of HSCP resource had been allocated to this). These measures may result in some reduction in service and increase in unmet need or further waiting times for care packages. The HSCP will not be able to Page 123
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6 Classification: OFFICIAL recover its Social Work / Social Care financial position by year end. The care at home efficiency work, reduction in care at home contract costs (reported separately) and the projects outlined in the budget paper are the main additional pieces of work that are underway to improve the situation next year. This is consistent with the national position in the sector with many IJBs taking action to address deficits. Concerns about financial sustainability was highlighted again this year by Audit Scotland (for both IJBs and the NHS) but there has not been a government response which addresses the issue. The impact of NI increases in April is a heightened risk for 3rd sector and commissioned service providers. At present there is no identified solution or funding. 3.3 Savings Delivery 3.3.1 3.3.2 3.3.3 3.4 3.4.1 The service improvement team, finance teams and management continue to progress, monitor and report on savings projects. As at Month 11 the total savings declared increased slightly to £5.1m (77%) of the £6.6m target, although £0.4m is on a non-recurring basis: 2024/25 Savings Year to 28 February 2025 Target Achievement Balance % £' 000 £' 000 £' 000 Fully Achieved 4,421 4,421 0 Partially Complete 2,192 302 1,890 Non Recurring - 370 (370) Total 6,613 5,093 1,520 77% Appendix 3a lists the fully delivered savings and 3b summarises the remaining savings, risk rated: Savings regarded as low risk £52k Savings unlikely to be achieved in full in 2024/25 £1,100k Savings unlikely to be deliverable in 2024/25 £738k Efforts to deliver as much of the balance as possible will continue into 2025/26 and the balances will be carried forward as approved savings. There are a number of projects where change processes are required and are taking time. The new medical staffing model in Cowal is now being implemented and it is hoped that the savings relating to FME contracts can progress soon. The amber and red rated projects represent a financial risk already incorporated in the forecast. Reserves Earmarked reserves of £19.9m were carried into 2024/25 including £4.7m for sustainability and value, this has been passed back to NHS Highland and replaced with a recurring allocation. To date £11.6m has been committed, including £4.3m to fund the NHS revenue budget gap and the £4.7m described above. The reserves position is summarised in Appendix 4. Remaining Page 124
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7 Classification: OFFICIAL 3.4.2 4 4.1 5 5.1 6 6.1 6.2 6.3 reserves are reduced to £8.2m, many of these are earmarked for specific purposes. It is likely that at least £0.7m of general reserves will be required to cover the overspend in Social Care which has required project work to be put on hold. The Scottish government have indicated that there is some scope for reallocating reserves to fund cost pressures. Much of the remaining reserves balance has been allocated: • £600k for the Prevention / Wellbeing project. • Estimated £529k for remodelling the Campbeltown Hospital to better locate new radiography equipment (now underway); • £366k for NHS houses on Coll (net of £100k from the Strategic Housing Fund); and • £940k for the Tigh a Rudha renovation and remodelling (Reserves are match for Council capital, Strategic Housing Fund and Island Programme Funding). Strategic development work has been paused due to capital funding constraints, the Care Homes and Housing project is continuing. The use of reserves to fund revenue spend is not sustainable. RELEVANT DATA AND INDICATORS Information is derived from the financial systems of both partners. CONTRIBUTION TO STRATEGIC PRIORITIES The Integration Joint Board has a responsibility to balance its budget and ensure spend and investment is aligned to the Strategic Plan. GOVERNANCE IMPLICATIONS Financial Impact – the forecast outturn position is a projected overspend. The Council are holding a pension fund saving which will be accessed. The HSCP expects to be reliant upon reserves to fund its overspend and expects general reserves to be largely exhausted by the end of the year. Staff Governance – None directly from this report but there is a strong link between HR management and delivering a balanced financial position. Clinical Governance – None directly, however if cost savings are required there are likely to be implications for care. 7. 7.1 8. PROFESSIONAL ADVISORY Professional Leads have been consulted with on the implications of the budget and savings programme. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 None directly. Page 125
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8 Classification: OFFICIAL 9. 9.1 10. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None. RISK ASSESSMENT 10.1 There are a number of financial risks: • Continuing impact of high service demand. • Inability to reduce supplementary staffing. • Pressure on support services relating to HR, administrative and finance processes. • Cancellation of projects and use of remaining reserves to fund overspending; and • Delivery of the remaining savings programme. The HSCP is not in a sustainable financial position as spend and service demand exceed resourcing. Financial recovery and development of the savings programme for 2025/26 remain priorities. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 None directly from this report, engagement on activities relating to savings and transformation forms part of the project plans where appropriate. The HSCP is transparent in respect of its finances and this report is publicly available. 12. CONCLUSIONS 12.1 12.2 This report provides a summary of the financial position as at the end of month 11. The Social Work forecast remains of serious concern and a large overspend is forecast due to on-going demand for services and reliance upon agency staffing. Funding the structural deficit with non-recurring resourcing is an urgent problem for future planning. The HSCP will utilise the non-recurring savings relating to pension costs from Argyll and Bute Council to part fund the overspend. This will restrict flexibility in future years and further adds to the longer-term gap between spend patterns and resources. This also reduces funding for development and transformation as the balance shifts further towards managing immediate pressures rather than longer term change. A further action is to put a hold on projects which were to be funded from reserves where spend is not committed. Argyll and Bute Council are aware of the situation. Page 126
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9 Classification: OFFICIAL 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required √ Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) Finance & Policy Committee Budget Monitoring 11 Months to 28 February 2025 18/03/2025 TBC Senior Leadership Team Budget Monitoring 11 Months to 28 February 2025 19/03/2025 TBC APPENDICES: Appendix 1 – Year to Date Position Appendix 2 – Forecast Outturn for 2024-25 Appendix 3a and 3b – Savings Programme Appendix 4 – Reserves AUTHOR NAME: James Gow, Head of Finance EMAIL: james.gow@argyll-bute.gov.uk Page 127
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Classification: OFFICIAL# ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP APPENDIX 1 REVENUE BUDGET MONITORING SUMMARY - YEAR TO DATE POSITION AS AT 28 FEBRUARY 2025 Reporting Criteria: +/- £50k or +/- 10% For information: The Council don't do monthly based accrual accounting, whereas Health do. On the Council side, there may be a mismatch between year to date actual and budgets, due to timing differences as to when invoices are paid. Health do monthly based accrual accounting, therefore, you should see a correlation in the year to date position and the year end outturn position. Service Actual £000 Budget £000 Variance £000 % Variance Explanation COUNCIL SERVICES: Chief Officer 983 292 (691) (236.6%) Adverse variance due to the under recovery of vacancy savings, partially offset by spend on agency staff and charges from housing services and a termination payment due to a senior officer leaving their substantive post. Service Development 381 395 14 3.5% Outwith reporting criteria. Looked After Children 6,718 6,090 (628) (10.3%) Overspend due to high numbers in children's residential placements. Child Protection 2,805 3,169 364 11.5% Forecast is based on known demands for the service and deferred income received from previous years. Children with a Disability 790 969 179 18.5% Saving due to two third sectors grants ending. Criminal Justice 164 256 92 35.9% Favourable variance is due to additional grant funding. Children and Families Central Management Costs 3,103 3,093 (10) (0.3%) Outwith reporting criteria. Older People - Homecare 18,578 17,257 (1,321) (7.7%) Overspend due to demand driven increase in payments to third party providers and the use of agency staff. Older People - Internal Residential 6,811 6,400 (411) (6.4%) Overspend due to the use of agency staff to cover sickness, holidays and vacancies. Older People - External Residential 9,546 9,425 (121) (1.3%) Variance is due to timing difference with third party payments. Older People - Other 7,765 7,979 214 2.7% The YTD variance is due to timing differences relating to re-charges to NHS and payments to third parties. Physical Disability 3,292 3,355 63 1.9% Forecast based on current assessed care packages. Learning Disability 17,152 17,302 150 0.9% Forecast is based on demands for this service. Mental Health 3,644 3,639 (5) (0.1%) Outwith reporting criteria. Adult Services Central Management Costs 636 696 60 8.6% The YTD variance is due to timing differences with charges to Health Boards and third party payments. COUNCIL SERVICES TOTAL 82,368 80,317 (2,051) (2.6%) HEALTH SERVICES: Explanation Health & Community Care Services 43,428 44,099 670 1.5% Saving due to vacancies across a number of services Acute & Complex Care Services 40,249 38,861 (1,387) (3.6%) Overspend due to agency locum usage to cover medical & nursing vacancies in LIH & Mental Health, high cost out of area private sector mental health placements Children & Families Services 10,354 10,252 (102) (1.0%) Overspend due to high cost of out of area inpatient placements Commissioned Services - NHS GG&C 75,807 74,744 (1,064) (1.4%) Higher cost per case activity within GGC relating to drug treatment prescribing & new treatments Commissioned Services - Other 4,472 4,231 (241) (5.7%) High cost other Scottish Board services charge for emergency care on a cost per case basis Primary Care Services inc Dental 28,728 28,712 (16) (0.1%) Outwith reporting criteria. Other Primary Care Services 9,847 9,847 0 0.0% Outwith reporting criteria. Prescribing 22,926 22,537 (389) (1.7%) Overspend due to price increases due to drug shortages Public Health 2,260 2,356 96 4.1% Saving due to vacancies Lead Nurse 1,709 1,828 119 6.5% Saving is due to vacancies/ secondments Management Service 1,212 1,499 286 19.1% Saving is due a technical accounting adjustment relating to clinical negligence provisions Planning & Performance 2,264 2,287 23 1.0% Outwith reporting criteria. Budget Reserves 0 1,650 1,650 100.0% Favourable variance due to slippage on reserves due to delays in implementation, generally due to recruitment Budget Reserves - Committed Pay & SLA 0 0 0 0.0% Outwith reporting criteria. Income (2,043) (1,799) 244 (13.5%) Seasonal increase in activity, longer stay Mental Health patient discharge Estates 10,567 10,488 (79) (0.8%) Inflationary pressures and increased demand for maintenance due to limited availability of capital funding, unachieved savings HEALTH SERVICES TOTAL 251,780 251,590 (189) (0.1%) GRAND TOTAL 334,148 331,907 (2,240) (0.7%) Page 129
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Classification: OFFICIAL# ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP APPENDIX 2 REVENUE BUDGET MONITORING FORECAST OUTTURN - AS AT 28 FEBRUARY 2025 Reporting Criteria: +/- £50k or +/- 10% Service Annual Budget £000 Outturn £000 Variance £000 % Variance Explanation COUNCIL SERVICES: Chief Officer (338) 42 (380) 112.4% The forecast overspend reflects an under recovery in vacancy savings due to either posts being filled or cost centres not open for savings due to agency costs being incurred. There is also an increased expectation of CRA spend based on Property Services Commitments along with unbudgeted spend on agency staff. Service Development 452 447 5 1.1% Outwith reporting criteria. Looked After Children 6,706 7,367 (661) (9.9%) The overspend reflects current known demand for the service with 16 active external residential placements with an average cost of a placement being c£120k per annum. The forecast overspend also reflects the increase in staffing costs in children's residential units as a result of a re-grading process. The overspend is partially offset by under spends in Foster and Adoption based on demand for these service areas. Child Protection 3,631 3,234 397 10.9% The forecast underspend is as a result of demand for contact and welfare services and deferred income in the area teams budget lines. Children with a Disability 1,051 863 188 17.9% The forecast underspend reflects a reduction in third sector grants payable to external organisations, one of which may re-start before then end of the financial year. Criminal Justice 230 132 98 42.6% The forecast underspend reflects additional grant funding received along with vacant posts. Children and Families Central Management Costs 3,762 3,773 (11) (0.3%) Outwith reporting criteria. Older People - Homecare 19,589 20,896 (1,307) (6.7%) The forecast overspend reflects the latest assessed needs packages for the homecare service with an increasing reliance on agency staff to cover the service. The forecast overspend on agency staff is currently £3.1m however this is partially offset by underspends in staffing budgets and third party payments. Older People - Internal Residential 7,533 7,896 (363) (4.8%) Overspend reflects increased use of agency staff at Kintyre Care Centre and Gortonvogie partially offset by a reduction in direct staff costs and payments due to Health Boards. Older People - External Residential 11,422 12,351 (929) (8.1%) The forecast overspend reflects the latest demand for service based care packages. Older People - Other 9,412 9,161 251 2.7% The forecast underspend is due to an expected increase in income from telecare services. Physical Disability 3,763 3,700 63 1.7% The forecast underspend is due to a combination of re-assessed packages and attritions. Learning Disability 19,951 19,792 159 0.8% Underspend reflects current demand for service and known commitments. Mental Health 4,252 4,259 (7) (0.2%) Outwith reporting criteria. Adult Services Central Management Costs 819 768 51 6.2% The forecast underspend is based on a reduced need for the training budget held here and some small underspends on supplies and services budgets. COUNCIL SERVICES TOTAL 92,235 94,681 (2,446) (2.7%) HEALTH SERVICES: Explanation Health & Community Care Services 48,128 47,439 690 1.4% Saving is due to vacancies across a number of services Acute & Complex Care Services 42,320 43,935 (1,615) (3.8%) Overspending due to agency locum usage to cover medical & nursing vacancies in LIH & Mental Health, high cost out of area private sector mental health placements Children & Families Services 11,173 11,233 (60) (0.5%) Overspend die to arrears costs of regrading of school nurses Commissioned Services - NHS GG&C 81,539 82,667 (1,128) (1.4%) Forecast overspend on cost per case activity within GGC relating to homecare drug prescribing & high cost procedures Commissioned Services - Other 4,548 4,859 (311) (6.8%) High cost of other Scottish Board services charge for emergency care on a cost per case basis Primary Care Services inc Dental 30,365 30,642 (277) (0.9%) Agency locum costs associated with running 2c GP Practices in A&B Other Primary Care Services 10,741 10,741 0 0.0% Outwith reporting criteria. Prescribing 24,805 25,210 (405) (1.6%) Overspend due to anticipated additional costs of prescribing, PSD reporting on the detail of costs runs two months in arrears Public Health 2,714 2,649 65 2.4% Saving due to vacancies Lead Nurse 1,988 1,876 112 5.6% Forecast saving is due to vacancies/secondments Management Service 1,756 1,424 332 18.9% The forecast variance is due a technical accounting adjustment relating to clinical negligence provisions & vacancies Planning & Performance 2,488 2,460 28 1.1% Outwith reporting criteria. Budget Reserves 2,600 0 2,600 100.0% Slippage on reserves due to delays in implementation, generally due to recruitment Budget Reserves - Committed 6,461 6,461 0 0.0% Reserves committed for Pay Reforms and SLA uplifts Income (1,944) (2,198) 254 (13.1%) Forecast activity income for patients from outwith A&B, long stay Mental Health patient discharged Estates & Depreciation 11,459 11,619 (160) (1.4%) Overspend due to inflationary pressures and increased demand for maintenance due to limited availability of capital funding, unachieved savings HEALTH SERVICES TOTAL 281,142 281,017 125 0.0% GRAND TOTAL 373,377 375,698 (2,321) (0.6%) Page 130
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Classification: OFFICIAL# Appendix 3a - 2024/25 Fully Complete Savings Target Ref. Savings Description £' 000 Social Work 2425-04 Increased income - fees and charges inflation 100 2425-05 Allocate uncommitted budget to savings 550 2425-06 Review of miscellaneous unspent budgets 115 2425-09 Revise LD budget to reflect current demand 270 2425-10 Revised budgets across looked after children’s services to reflect demand 200 2425-11 Travel Budgets reduction to reflect spend patterns 50 2425-12 Transformation Budget - Allocate Uncommitted budget to savings 130 2425-13 Review all centrally managed budgets 200 2425-14 Removal of redundant post from budget 54 2425-15 Removal of redundant post from budget : Older Adults – Lorn Campbell Court & Catering post 50 Health AB2223-8 1% reduction in hospital budgets 107 AB1920-35 Bed reduction savings : Dunoon 150 Declared in 2022 as non-recurring AB2021-23 Catering & Domestic Underspends 30 AB2324-28 Prescribing 110 AB2324-30 Reduction in training SLA with UWS 5 AB2324-30 Marie Curie Contract underspend 10 AB2425-01 Review of Primary Care Drugs - Drugs of limited value etc, switches etc 150 AB2425-02 Review of Secondary Care Drugs - changes to pricing & patent expiry 300 AB2425-03 Review of Unallocated Budget Reserves 450 AB2425-04 Additional Patient Treatment Income 50 AB2425-05 Review of out of area care packages 200 AB2425-06 Small value uncommitted budgets 20 AB2425-07 Review of Energy Budgets 50 AB2425-08A Service Redesigns LIH -Medical Staff 250 AB2425-08B Service Redesigns LIH - Nursing staff 60 AB2425-10 Additional reserves funding to savings 760 Total Fully Complete 4,421 Page 131
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Classification: OFFICIAL# Appendix 3b - LIVE SAVINGS PROGRAMME Target Declared Remaining RISK NOTES Ref. Savings Description £' 000 £' 000 £' 000 Social Work 1819-33 Catering, Cleaning and other Ancillary Services 71 71 Project delivered limited savings and £25k declared on a non-recurring basis 2324-04 Contract & Demand Officer Post 49 49 Post currently filled due to manage contract reviews and renewals - alternative to be identified 2324-07 Care @ Home Contract 400 400 Service overspending and no savings anticipated in current year 2324-14 Reduce external placement budget by one (C&F) 160 160 No expectation this will be achieved as placements increasing 2425-01 Revert to National Minimum Pay Rate - uplift for some contracts is from £11.02 rather than £10.90 110 79 31 Some further progress expected depending on remaining contract uplifts 2425-03 Structured and monitored review of high cost care packages 150 150 Work at planning stage 2425-07 Review of expensive care packages 150 132 18 Underway 2425-08 Sleepovers Review 80 46 34 Underway Health AB1920-4 Review of Service Contracts (Bute Dialysis) 19 19 AB2021-16 Dunoon Medical Services 120 120 Stable staffing at CCH required to enable saving to be delivered, declared on non-recurring basis AB2021-64 FME (Dunoon) 50 50 Stable staffing at CCH required to enable saving to be delivered. AB2223-9 Forensic Service Contracts 20 20 Stable staffing at CCH required to enable saving to be delivered. AB2021-19 Hotel Services redesign to reflect reduction in inpatient numbers 99 30 69 Project underway and some savings delivered, more is anticipated AB2021-4a/b Admin & Clerical 127 7 120 Reductions in the working week to be considered in context of this saving AB2021-20 Centralised booking of medical records - reduction in admin costs 97 97 AB2122-33 centralise lab ordering £20k and theatre stock ordering £5 40 40 AB2122-66 Savings from building rationalisation following increase in home working 71 8 63 Was dependent upon changes in Dunoon, intended to deliver through a number of smaller savings, Whitegates saving dselivered £8k. AB2223-5 Estates Staffing Structure 129 129 HR continue to support but no progress to date AB2324-26 Childrens & Families Staffing and service re-modelling 250 250 Declared on non-recurring basis 2,192 302 1,890 230 178 52 1,224 124 1,100 738 0 738 Page 132
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Classification: OFFICIAL# Appendix 4 - Reserves Opening Reserves £ Spend during 2024/25 £ Additional Reserves 2024/25 £ Closing Reserves Balance £ Primary Care Projects 4,372 4,372 Technology Enabled Care (Near Me) 30,902 13,100 17,802 Technology Enabled Care 615 615 0 ADP Funding 494,873 250,000 244,873 Best Start - Maternity Services (Board re-provision) 110,773 13,000 97,773 Supporting Improvements to GP Premises 178,441 178,441 Scotgem Funding 21,420 21,420 Childrens Mental Health Services (CAHMS) 645,170 645,170 Community Living Change Fund 88,145 88,145 0 Primary Care OOH Funding 326,763 106,100 220,663 ASC Nurse Director Support IPC 12,666 12,666 0 Trauma Network Tranche 1 / Tranche 2 36,825 36,825 PFG School Nursing Tranche 2 166,783 166,783 District Nurse Posts 127,015 37,500 89,515 E-health Strategy Funding 279,498 4,181 275,317 Perinatal MH Funding 19,887 6,000 13,887 Mental Health Officer Training / Recovery 28,787 28,787 0 Type 2 Diabetes Framework 45,379 45,379 Trauma Training Programme 85,717 34,658 51,059 Wellbeing Funding 39,528 39,528 0 Oban Accommodation 145,000 145,000 Primary Care Education Fund 250,000 250,000 Fleet Decarbonisation 86,520 86,520 0 Additional Band 2-4 Staffing 717,913 250,000 467,913 Nursing Support for Care Homes 151,386 3,334 148,052 Remobilisation of Dental Services 89,604 89,604 0 Mental Health Facilities 285,284 120,000 165,284 Diabetic Technologies 36,934 36,934 0 Waiting Times Funding & Cancer Waiting Times Funding 159,500 159,500 0 Interface Care Programme 133,032 133,032 0 Medical Assisted Treatment Standards 55,052 55,052 Psychological Therapies 55,923 55,923 Dementia Post Diagnostic Support 131,248 38,100 93,148 Medical Equipment - Dental 84,285 84,285 0 Eating Disorders 238 238 Ventilation Improvement 29,200 29,200 0 Mental Health Recovery Services 38,931 38,931 Whole Family Wellbeing Fund 437,894 437,894 Multi Disciplinary Teams 44,000 44,000 Interim Care 111,087 111,087 0 General Reserves - Service Transformation & Estates 2,597,782 264,000 2,333,782 Social Work Workforce 38,990 38,990 Nurse Director Support for Care Homes 62,386 62,386 Digital Therapies 58,773 19,226 39,547 GDS element of the Public Dental Service 278,500 36,911 241,589 Hospital at Home Project 415,067 415,067 0 Learning Disability Health Checks 75,244 75,244 Mental Health after Covid Hospitalisation / Long Covid 41,153 41,153 Recovery Children's Oral Hlth & Dent(Childsmile) 10,827 10,827 Sustainability & Value 4,697,000 4,697,000 0 Prevention Programme 600,000 156,000 444,000 General Reserves - Revenue Funding 4,266,000 4,266,000 0 General Reserves - Estates & Transformation Projects 950,537 0 950,537 Total 19,878,849 11,630,080 0 8,248,769 Held by NHS 16,489,832 11,102,788 0 5,387,044 Held by Argyll & Bute Council 3,389,017 527,292 0 2,861,725 Total 19,878,849 11,630,080 0 8,248,769 Page 133
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1 Classification: OFFICIAL Integration Joint Board Date of Meeting: 26 March 2025 Title of Report: HSCP Budget 2025/26 Presented by: James Gow, Head of Finance The IJB is recommended to: • Note the budget gap before savings and use of non-recurring resources is £12.8m. • Approve the HSCP expenditure budget for 2025/26 totalling £398.1m incorporating a savings plan totalling £5.6m and allocation of £3m in non- recurring resourcing. • Note the HSCP continues to face severe financial challenge and further savings are required as part of a financial recovery plan. • Note the HSCP has not been able to identify 3% in NHS savings and therefore expects to be required to implement further savings or it will require additional resource from NHS Highland. The gap is £4.2m as an opening position. • Note the HSCP has worked with both partners throughout the development of the budget. • Request the management team urgently develop plans to move the HSCP into a more sustainable operating model. 1. EXECUTIVE SUMMARY 1.1 1.2 This report seeks approval for the HSCP operational budget for 2025/26. It has been considered and endorsed by the Finance & Policy Committee at its meeting on the 18th March 2025. The IJB is required to approve an expenditure budget prior to the commencement of the financial year which is in balance. This has not been possible in respect of the NHS element of the budget. The budget assumes that further savings can be identified and delivered in-year and / or additional resources will be made available as the year progresses. The report also highlights the scale of the 2026/27 challenge facing the IJB as non-recurring funding will be unavailable. More broadly, public finances remain under severe pressure and the Health and Social Care sector is not operating in a sustainable way. All IJBs are in a similar position and are having to identify ways of delivering services more efficiently. The savings proposals outlined in this report are not sufficient on their own to deliver 3% savings on NHS budgets and therefore the HSCP will be reliant upon additional savings being identified and upon NHS Highland for additional resourcing. This may present governance and reputational risk as brokerage will no longer be available from the Scottish Government although Page 135 Agenda Item 9c
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2 Classification: OFFICIAL there is not an expectation that all NHS Boards and IJBs will be able to operate within the resources allocated to them. 1.3 1.4 1.5 The budget gap, before the application of non-recurring funding and savings is £12.8m. The savings plan totals £5.6m and the use of non-recurring resourcing provides a further £3m. This leaves a budget gap of £4.2m within the NHS Budget. There are savings of £500k still to be identified assumed in the Council budget position. Actions to address this will be required throughout the year and the HSCP can expect further direction from partners as it presents a financial risk to them. Cost and demand pressures are significant and take account of Social Care demand and overspending. Further savings will impact on access, availability or quality of service provision. The HSCP has sought to develop proposals which minimise adverse impacts on the most vulnerable but it will have to find ways of operating more efficiently to ensure it is making best use of the considerable resources it does have available. IJBs are facing an extremely challenging environment with un-funded cost pressures and unfunded increases and demand. The National Insurance increase could add significantly to the budget gap outlined in this paper if it is not funded or absorbed by commissioned service providers. This could result in further closure of key services by 3rd and private sector providers. The IJB is required to set a budget which does not exceed the resources being made available to it by partners, this is within the terms of the integration scheme. NHS Highland are aware that the expenditure budget is in excess of the resources allocated by them at the start of the year. NHS Highland are also in a position whereby they also have a forecast deficit and an unidentified savings target, after assuming the HSCP will address its gap. 2. Recommendations • Note the budget gap before savings and use of non-recurring resources is £12.8m. • Approve the HSCP expenditure budget for 2025/26 totalling £398.1m incorporating a savings plan totalling £5.6m and allocation of £3m in non-recurring resourcing. • Note the HSCP continues to face severe financial challenge and further savings are required as part of a financial recovery plan. • Note the HSCP has not been able to identify 3% in NHS savings and therefore expects to be required to implement further savings or it will require additional resource from NHS Highland. The gap is £4.2m as an opening position. • Note the HSCP has worked with both partners throughout the development of the budget. • Request the management team urgently develop plans to move the HSCP into a more sustainable operating model. 3. DETAIL OF REPORT 3.1 Budget Context The HSCP is not operating on a sustainable basis, this situation is common with many IJBs reliant upon reserves (where available) to achieve financial Page 136
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3 Classification: OFFICIAL 3.2 balance. In addition to the challenge for next year, the HSCP is overspending in the current year, an indicator of the on-going high levels of demand for care and dependency upon agency staffing to deliver it. Summary figures indicate that every IJB has a budget gap before savings, this totals £562m (on a £10bn budget) with the average gap just over 5%. The Argyll and Bute figure was slightly better than average. Most IJBs are therefore reducing services and increasing charging to try to manage the situation. The approach is local rather than national, contrary to the principles of whole system planning and those outlined in the National Care Service plans. The Scottish Budget has been approved by parliament. However, there is still material uncertainty regarding funding for the Employer National Insurance increase for commissioned service providers. The budget allocated some additional funding for the NHS and for Local Authorities. There is no new money for Social Care demand pressures and nothing for the NI increase for contractors. This approach fails to recognise increasing numbers of older adults requiring health and social care. Some of the key points are: • The Public Pay Policy is 9% over 3 years. • Argyll & Bute Council are providing funding for the NI increase relating to directly employed staff. No funding has been confirmed for commissioned service providers in the health and social care sector. NHS directly employed staff will be funded at 60% only creating a £1.5m cost pressure. • The minimum pay rate for health and social care is to increase from £12 to £12.60 per hour (5%) and funding is allocated to cover this. • There is a general 3% uplift for non-pay cost pressures within the NHS budget. • Health Boards in deficit are expected to work towards breaking even over a number of years and no brokerage is available from 2025/26. • NHS Boards are expected to set out how 3% savings can be made each year to move towards financial balance. • Funding for Agenda for Change uplifts and the reduced working week is expected to be made available to cover costs. There are no new medium term planning figures available, this report focusses on a single year budget for 2025/26. The HSCP, like many others, is not operating in a financially sustainable way. Action to improve efficiency and make better use of available resources is required urgently. Service Demand An increasing concern relates to demographic change. Health and social care spend correlates to population age, the number of older adults is increasing and projected to do so for many years. A second strategic challenge is the continuing inability to recruit permanent staff (HSCP and commissioned services), not unrelated to the demographic issue. Long term population modelling is complex and subject to variation with the actual future population. Analytical work is continuing to better understand this at a locality level and the implications for future service demand and models of care in our communities. The table below summarises population projections: Page 137
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4 Classification: OFFICIAL Age Group 2023 2028 2033 2038 2043 2048 65 to 74 12,779 13,565 14,469 13,773 11,382 10,028 75 to 84 8,332 9,098 9,222 9,833 10,444 9,855 85+ 2,814 3,089 3,711 3,899 4,024 4,323 We can expect demand to increase incrementally each year well into the 2040’s. The 75+ age group is expected to increase by 16% over the next 10 years (1.6% per year) with the 85+ group increasing by more. The Scottish Government are making no financial allowance for this. While funding models allocate resources to areas based on demographics, the total budget is not being uplifted. Recent funding uplifts do not take account of cost inflation fully, never-mind increasing service demand. This approach is likely to result in continuing annual overspending if budgets are not increased in proportion to a well understood pressure. Alternatively, budget setting will require a significant element of service reduction year on year. 3.3 Social Work / Social Care Budget – 2025/26 The funding allocations are now finalised and the Social Work Budget is summarised below. Argyll & Bute Council allocated a further £500k to the HSCP as part of its budget setting process which has enabled the HSCP to propose a balanced budget on the assumption that further savings are identified and implemented in-year. The Scottish Government have made no new funding available for Social Care, however, Local Authorities were allocated additional resource and some of this has been passed on to the HSCP on a recurring basis, including £500k for service transformation. A fundamental risk, not resolved at time of writing, is the increase in employer National Insurance from 1 April 2025. The threshold change has a disproportionate adverse impact on the sector due to the number of part time employees. The HSCP estimate of the cost for Social Care is £1.3-1.4m with no funding confirmed as at 19th March. This is proportionate to the national estimate at £84m. Strong representations have been made directly to the Cabinet Secretary by the independent sector and IJBs. These highlighted risk of service closures in the context of an already extremely challenging and unsustainable service environment. A Scottish Government response is expected at the end of March. This is not included in the budget and savings outlined below: Social Work Budget 2025/26 £’000 £’000 Underlying budget deficit 1,300 Cost & Demand Pressures Pay Inflation – core staffing 1,143 Pay increments 203 Employer NI Increase – core staffing 864 Increase to base employee costs – regrading and transfers in 666 Anticipated inflation on contracts, supplies and services 649 Page 138
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5 Classification: OFFICIAL Children & Families Cost pressures 200 Older Adult Residential – fund current level of overspend 1,200 Care @ Home – fund current level of overspend 800 Allowance for 1% demand growth Older Adults – Demographic Change 450 Real Living Wage and Free Personal care – all services 2,823 Cost & Demand Pressures 8,998 Additional Resourcing: Employers NI Funding (60% SG and 40% Council) 864 Contribution to 24/25 pay settlement (1%) 339 Contribution to 25/26 pay settlement (1%) 370 Additional Funding from A&B Council 500 Inflation on NHS Resource Transfer 433 Real Living Wage and Free Personal Care uplift – all services 2,781 Total Additional Resourcing (5,287) Budget gap before savings 2025/26 5,011 Proposed savings and non-recurring resourcing are: Quantified Service Savings £’000 Risk Review of Care @ Home Contract Operational 712 Low Avoided inflation on above Operational 30 Low Increase in fees and charges – inflation increase Increase in fees already approved 200 Low Increased Telecare Charges Increase in fees already approved 40 Low Saving on ‘Just Checking’ Operational – not in use at present 15 Low Flat Cash Settlements on some contracts Operational – negotiated with service providers 100 Medium Care Package Reviews LD/PD/MH EQIA 1 200 Medium/ high Care @ Home Efficiencies Operational – EQIA in respect of individual elements to be provided as required 250 Medium/ high Additional Savings to be identified and delivered TBC 500 high Savings 2,047 Allocation of non-recurring pension saving 2,500 Low Allocation of reserves 464 Medium Total Savings / Non Recurring Funds 5,011 Page 139
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6 Classification: OFFICIAL 3.4 Additionally there is an NI cost pressure for contracted services £1.4m. If not resourced it is expected that there would be a sharing of the cost between service providers and the HSCP. Further savings would be required to compensate for any HSCP element. There is no contingency within the budget. The Council Budget earmarks £500k for transformational change and spend to save projects, this resource is held separately to this budget. Plans are to be developed and will be informed by the Transformation Board and the approach to the budget gap in 2026/27. Areas under consideration include: • Care @ Home Service – scheduling, digital & systems development and analysis of resourcing models and assessment processes. • Agency staffing and accommodation. • Care Homes Strategic Assessment. • High-cost care package reviews and direct payments. • Kintyre and Mid Argyll service sustainability. The use of £3m in non-recurring resourcing is not sustainable and must be addressed, this resource is not available from 1 April 2026. Social Work Budget £’000 £’000 Resourcing Base Budget Allocation Council* 77,204 Funds Flow from NHS 14,432 Additional Funding 5,287 Non-Recurring Resourcing 2,964 Total Resourcing 2025/26 99,887 Expenditure Base Expenditure Budget 92,936 Cost & Demand Pressures 8,998 Savings ( 2,047) Expenditure Budget 99,887 *Resourcing and expenditure budget reduced by £1,407 for transfer of hostels to education. NHS Budget 2025/26 The expectation from Scottish Government is that NHS Boards should improve their financial position (where in deficit) each year aiming to achieving balance in the medium term. Efficiency savings of 3% are to be delivered annually. The implication is that the HSCP savings target is £7.9m. Savings at this level would require an assumption (un-realistic) that this 3% could be applied to SLA costs (to contribute £2.6m to the target). This is important as SLA increases are a substantial element of the budget and cost pressure. The allocation of sustainability funding to the HSCP is based upon it being able to operate within budget if it could deliver 3% cost savings, this has not been possible. Current operating frameworks within the NHS are being maintained, these constrain change. Significant service change (required to deliver savings at this level) must comply with Planning with People guidance. Additionally, there are Page 140
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7 Classification: OFFICIAL currently no mechanisms which enable a reduction in permanent staffing other than through natural turnover. The budget position for NHS services is provided below, the IJB is requested to approve the expenditure budget on the basis that there is a budget gap of £4.2m that requires to be resolved through additional savings or resourcing. NHS Highland are aware of this, however the expenditure budget outlined below is a realistic one and is required to fund the operation of current services. NHS Budget 2025/26 £’000 £’000 Opening Underlying Deficit 5,209 Unachieved Savings 1,127 Opening Underlying Deficit 6,336 Funding Uplift (3%) 7,709 Formula Funding (NRAC) improvement 3,659 Funding for AfC award – non pay elements 2,460 New Medicines Fund 4,766 National Insurance Funding 1,800 Sustainability Funding – recurring (NRAC Share of £70m) 1,335 Sustainability Funding – Non recurring share of £250m set to 3% saving (£2.1m below NRAC) 2,638 Total Additional Resourcing 24,367 Inflation & Cost Pressures Pay Inflation 3% 2,958 National Insurance Costs (inc SLAs) 3,000 SLA Inflation 4,073 Non-Pay elements Agenda for Change 2,460 Prescribing & Drugs Inflation 8% 2,352 New Medicines 4,766 LIH Medical Staffing 1,000 Out of Area & Complex Care Packages - MH 1,200 Resource Transfer Uplift 433 National Services Increased Top Slice 1,041 Regional Heart & Lung SLA uplift 500 2C GP Practices – additional costs 300 Glasgow - service increases 200 Labs re-modelling (revenue funded) 110 Fleet replacement and inflation 300 Inflation on PFI charges 134 Estates Inflation & Cost pressures 456 Depreciation & FRS16 100 Radiology Reporting Contract – increased volume 150 Renal Transport Contract 250 Child Health Screening 100 Total Cost Pressures 25,883 2025/26 Deficit / Budget Gap (3% saving target) 7,852 As there is non-recurring sustainability funding built into the table above, the recurring budget gap is potentially £10.5m, it may be the case that this funding becomes recurring as part of the budgeting process for 2026/27. The following Page 141
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8 Classification: OFFICIAL NHS savings proposals form part of the budget, governance is in place for monitoring these, however the identification of new savings will be an iterative process throughout the year and delivery of savings will require on-going support from NHSH: Risk Rating for Saving Saving Proposal £'000 £'000 £'000 Team Responsible Depreciation - end of life assets 70 Estates Energy price reduction & Estates Procurement 100 Estates Primary Care prescribing 250 Prescribing Performance Analyst 0.5wte Band 5 22 Planning Contract Cost Reduction - Addictions 21 Public Health Health intelligence support worker 0.5 wte – EQIA 2 20 Public Health Living Well Grants – EQIA 3 12 Public Health Living Well Network Funding – EQIA 4 25 Public Health Effective prevention outcomes framework 12 Public Health Drug purchasing efficiencies / cost reduction 400 Prescribing Dental Services budget adjustment 100 Dental Secondary Care Prescribing 100 Finance / SLAs Misc budget adjustments 76 Finance Establishment reviews 65 Adult Services Review of minor allocations budgets 45 Adult Services Telecom Lines 35 Planning Additional patient treatment income 30 Acute Minor changes to staff bandings 25 Adult Services Reserves review – removal of reserves no longer required 400 Finance In-year slippage on cost pressures (non recurring) 200 Finance Flow Navigation Centre 277 NHSH Supplementary Staffing Reduction 200 Adult Services Re-instate savings not delivered 561 526 40 Total 838 1,536 1,238 3,612 Summary of incremental changes to the NHS budget: £’000 £’000 Opening Underlying Deficit 6,336 Additional Resourcing (24,367) Cost Pressures 25,883 Gap Before Savings 7,852 Proposed Savings (3,612) Remaining Gap / Additional Funding Requirement (4,240) There are other opportunities to deliver cash releasing savings in 2025/26 still to be fully developed and agreed: • Time to Care Project (TBC) Page 142
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9 Classification: OFFICIAL • Distress Brief Intervention Contract (£150k) • Maternity Service Review (TBC) • Efficiency from SLA contracts (3% is £2.6m) • Rural General Hospital Review / LIH staffing model (£1m cost pressure) Savings relating to these will require to be approved after the year commences and will contribute to reducing the residual budget gap. An important risk is the new SLA model being developed by Greater Glasgow and Clyde Health Board. While we have no firm information on the impact, GG&C are looking to pass on cost increases to other Boards to the extent that they have not been funded. It is acknowledged that the model has not been updated to reflect activity patterns for some years and activity may not align with the contract value. The above indicates the HSCP does not expect to be able to fund its planned and committed expenditure within the resources being initially made available by NHS Highland as it has not been able to identify 3% savings. This position is common across the NHS. NHS Highland are aware that this is a risk to their financial position, also significantly in deficit, but they are assuming the IJB gap will be addressed. The IJB are requested to approve the expenditure budget on the basis that there is a budget gap of £4.2m. A savings target on the SLA and an NRAC share of the sustainability funding are options that could contribute to managing down the gap. The HSCP has a track record of operating relatively close to the formula funding allocated to it. Taking further action at this stage would disadvantage services within Argyll & Bute further. There is however a risk that the IJB position will be reported to Scottish Government as it may contribute to NHSH overspending. The Scottish Government have indicated that Brokerage is not going to be made available. The consequences may be that spend above funding will result in a reported overspend in accounts and the potential for External Auditors to make adverse Section 22 reports (per the Public Finance & Accountability (Scotland) Act). This risk applies to the IJB as well as NHS Highland. Further direction from NHS Highland on future steps to move towards a sustainable financial position can be expected. The IJB is asked to approve the NHS opening expenditure budget at £298.2m which is £4.2m greater than the opening funding offer. NHS Budget £’000 £’000 Resourcing Opening Offer 308,376 Resource Transfer to A&B Council (14,432) NHS Service Resourcing 293,944 Expenditure Opening Expenditure Budget 275,913 Cost & Demand Pressures 25,883 Savings ( 3,612) Expenditure Budget 298,184 Remaining Gap 4,240 Page 143
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10 Classification: OFFICIAL 3.5 3.6 3.6.1 The structural gap for future years increases further as the budget relies upon non-recurring funds. The HSCP is required to continue efforts to narrow its budget gap for 2025/26 and intends to progress the projects summarised in the following sections. HSCP Summary Budget 2025/26 NHS £m Social Care £m IJB Total £m Opening Underlying Gap 6.3 1.3 7.6 Additional Resourcing (24.4) (5.3) (29.7) Pay, Cost & Demand Pressures 25.9 9.0 34.9 2025/26 Budget Gap 7.8 5.0 12.8 Mitigations Non-recurring Resources - (3.0) (3.0) Savings Plan (3.6) (2.0) (5.6) Remaining Gap / Additional Funding Requirement 4.2 - 4.2 Expenditure Budget 298.2 99.9 398.1 Urgent action is required to address the funding gap. There are unidentified savings included in the Social Work Budget to enable the HSCP to set a balanced budget and an additional gap in 2026/27 as non-recurring funding is not available. The expenditure budget for the NHS is £4.2m greater than resources available and action will be required to address this either through identification of additional savings or additional resourcing. Both partners are aware of the situation and dialogue is on-going to enable them to assess the risk associated with the HSCP financial position. • The NI issue for Health and Social Care providers is an additional risk for 2025/26. The HSCP has no identified resources to assist. • There is a remining budget gap for NHS services totalling £4.2m. • Reliance on non-recurring funding is a risk for 2026/27. Savings 2025/26 The IJB are asked to note the savings plan, the projects are listed above and total £5.6m. The delivery of the savings is a risk to the HSCP budget. The majority are operational in nature, the projects where EQIAs are required are highlighted in the tables and included as appendices. Further approvals (and EQIAs) will be sought as new proposals are progressed and detailed approaches to the unidentified savings target and budget gaps are developed. Summaries of key pieces of work underway are provided below: Care @ Home Contracts - £742k The saving outlined in the plan has been mutually agreed with the contractor. It was possible to achieve this level of saving through the Page 144
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11 Classification: OFFICIAL 3.7 elimination of duplication of service and therefore it is not expected that there will be significant adverse impacts. However, it is possible that, at certain times, there will be some reduction in the level of service available. Extensive partnership working has taken place with the contractor to deliver a mutually agreeable outcome that has the minimum possible impact on service and risk. There will continue to be a 24 hour response available during 2025/26 in the mainland area and Bute. Transformation and Service Reviews The Transformation Programme is in place, available resource is being allocated to priorities which will address the financial and staff resource challenge. Investment in change is challenging as resources that could have been invested are now being used to fund revenue cost pressures. However, the Council have required that £500k is set aside for future investment in transformation. There is also a shortage of capital resource. The Transformation Board and a series of other short life working groups are responsible for governance oversight. 3.7.1 3.7.2 Children’s & Families – Maternity Services Review The review of maternity services has been delayed but is nearing completion. The process is piloting a model for reviewing all services within Children, Families and Justice. It includes staff engagement from the outset and will take into account: • Configuration of services within Argyll & Bute. • Demographics, birth rates and complexity of need; and • Best practice and national service developments. The service budget under review is £2.7m with a further £3m included within the SLA with Greater Glasgow and Clyde for births which take place within their maternity units. The outcome will be reported through existing governance structures and a saving added to the plan if appropriate. Adult Services – Care @ Home Efficiencies The care at home service is a priority for transformation as it is not operating on a sustainable basis. There are a variety of models operating in local areas. Some are largely or wholly covered by the new contract while in others the service is delivered by HSCP employed staff and / or agency staff. Challenges include: • High demand and unmet need. • Increasing cost of agency staff. • Lack of housing options for workers (Islands & Oban). • Pressure to minimise hospital delays. The service impacts on a wide range of other services including those offered by community nurses, AHP teams and demand for residential care. The total budget sits at £20m. Specific consideration is being given to: Page 145
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12 Classification: OFFICIAL 3.7.3 3.7.4 3.7.5 • Linkages between telecare, mobile teams and responder contracts. • How to achieve a reduction in the use of agency staff and operate with sustainable staffing models. • Access and equity for Self-Directed Support payments. • Reviewing of assessment processes and governance of care packages. • A requirement for improved scheduling and digital systems. • A value for money review of the different models currently operating and re-consideration of the best strategic approach. Any specific policy changes to assessment methods or working practices will be supported by appropriate EQIAs. Longer-term planning for the financial and staffing implications of the increasing number of older adults is not adequately resolved. In order to reduce cost, it will be necessary to improve efficiency and ensure that resources are spent in the best way possible. A principled and values-based approach is being taken which will seek to deliver on the priorities (outlined in the strategic plan) in a fair, safe and equitable way. There is a short term opportunity to derive savings from reductions in agency staff costs through changes to accommodation provision and recruitment. Strategic development process is underway in respect of care homes, this piece of work is complex and will take further time to complete, it is not expected that financial savings will be derived from this budget in 2025/26 other than through inflation increases on charges. Adult Services – Time to Care The Time to Care project is nearing completion, it is externally facilitated by Meridian and funded by NHS Highland. It is intended to model how staff time is used within community teams with the objective of increasing the time staff have available to spend with patients and clients. It is intended that the project will report in April in a way that will enable some savings to be attributed to it. These are not likely to be immediate cash releasing savings and will not align with the initial savings plan for the project, it may help identify opportunities to reduce supplementary staffing in some teams. Acute & Complex Care – Rural General Hospital A review of the services offered within LIH is in its early stages. The HSCP will work with NHS Highland to look for opportunities to better co-ordinate activity in Oban and Fort William. There may be some options to reduce duplication across the sites and create more joined up and sustainable staffing structures. An approach to making better use of theatre capacity will feature with potential for income generation or reduction in SLA activity. Mid Argyll & Kintyre Service Model This project is intended to review all services delivered across the area to: • Address persistent staffing shortages. Page 146
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13 Classification: OFFICIAL 3.7.6 3.8 • Review demographic data and care needs. • Review the impact of recent investment in Kintyre (purchase of KCC and transition to an internal care at home service). • Identify unnecessary duplication. It is expected this work will identify savings, some of these could be available during 2025/26 but most are likely to relate to longer-term change to sustain services. No specific changes are incorporated in the savings plan. Care Package Reviews A decision has been made to invest in the review of care packages. The programme is being scoped and will include: • Care @ Home packages • LD/PD and Mental Health packages • Direct payments (Self Directed Support) The process will improve governance over care package decision making and the process will set targets for the number of packages to be reviewed starting with the most expensive ones. Care packages at present have a total cost of around £33m with 55 packages costing over £100k or £8.5m. These in total commit one third of the Social Care budget for the lifetime of clients, if spend is to be brought back into line with available resources, action on existing packages is important. Next Steps Following approval of the budget, directions will be issued to both partners. It is anticipated the HSCP will be asked to develop further saving and financial recovery plans urgently to reduce financial risk to both partners. Expenditure control processes will remain in place: • Chief Officer approval of all locum and agency contracts and extensions. • Moratorium on new social care agency contracts. • Continued scrutiny of vacant posts. • Changes to PECOS approval processes. • Implement Care at Home efficiency plan. The situation will remain challenging. It is likely that the HSCP will be required to continue to take short term decisions based on its financial position. On- going communication and consultation are critical as is engagement with partners. Professional support with the HR aspects of change is a gap within the management structure and a risk. Some mechanisms that organisations normally apply to reducing costs are not available as a result of policy commitments and approaches to HR management. Engagement with staff, the IJB and Finance and Policy Committee will continue. The financial challenge is now considered as a continual one rather than an annual process with the Finance & Policy Committee leading governance oversight. Page 147
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14 Classification: OFFICIAL 4 4.1 5 5.1 6 6.1 6.2 6.3 RELEVANT DATA AND INDICATORS Information is derived from publicly available public planning documents, professional networks and financial systems of both partners. CONTRIBUTION TO STRATEGIC PRIORITIES The Integration Joint Board has a responsibility to balance its budget and ensure spend and investment is aligned to the Strategic Priorities. GOVERNANCE IMPLICATIONS Financial Impact – the budget gap is significant and the HSCP expects to be reliant on additional funding from NHS Highland and potentially Argyll & Bute Council if it cannot identify and deliver sufficient budget savings during the year. The HSCP will continue to work with both partners on its savings proposals. There is a risk that this could result in adverse audit reports and reputational damage. Staff Governance – None directly from this report but there is a strong link between HR management and delivering a balanced financial position. Staff have been asked for ideas to contribute to savings and these have been reported to the IJB previously. Clinical Governance – There are clinical governance implications associated with the reductions in service required to reduce spend, these will be risk assessed and mitigated as far as possible. 7. 7.1 8. PROFESSIONAL ADVISORY The budget planning process for 2025/26 ensures that Professional Leads continue to be fully engaged. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 Service changes will require impact assessments to be completed, the reductions in service being planned at present will have impacts on service users, these are typically individuals and groups that are covered by equality legislation. 9. 9.1 10. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None. RISK ASSESSMENT 10.1 Financial sustainability is a Very High risk on the strategic risk register. Specific risks relating to this report include: • The HSCP is not able to identify savings opportunities to a great enough extent to enable it to operate within a very challenging budget. This could result in interventions from partners. Page 148
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15 Classification: OFFICIAL • There are additional cost pressures in year with pay increases and the SLA with Glasgow being specific risks. • Social Care funding for the Employer NI increase is not forthcoming putting the sector at risk or further inflating HSCP cost pressures. • The IJB may not support the proposals that are still to be developed to deliver the required savings. • Adverse impact upon workforce and lack of HR support to effect change. • The HSCP is not able to deliver the approved savings and operate on a financially sustainable basis in 2025/26 and beyond. This could have significance consequences for the IJB including potential adverse audit reports to the Scottish Parliament. The HSCP is not in a sustainable financial position as spend and service demand exceed resourcing, this is included in the Strategic Risk Register. Reliance upon non-recurring resourcing means that the challenge for 2026/27 and beyond is significant in addition to any further cost pressures that arise during 2025/26. There is no extant spending review covering 2026/27. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 None directly from this report, engagement on activities relating to savings and transformation forms part of the project plans where appropriate. The HSCP is transparent in respect of its finances and generally makes all reports publicly available. A public consultation on the budget was conducted in February 2024 using an interactive tool. The outcome was reported to the IJB. Whilst there were some specific issues raised, the overall tone of the responses indicated disappointment at the need to make reductions. To the extent that savings are necessary, the consensus indicated they should be evenly spread across services. A desire for management costs to be reduced was communicated by the public. The HSCP has not re-run the exercise due to the opportunity cost and real cost of extending the license for the software (£4k). It will however continue to communicate and engage with all partners in respect of the financial challenge it faces. 12. CONCLUSIONS 12.1 12.2 This report seeks approval from the IJB for an expenditure budget which is reliant upon the identification and delivery of additional savings and may also require additional financial support from NHS Highland. This situation has arisen as the HSCP has been allocated funding which assumed a 3% or £7.9m saving. Savings of this magnitude have not been identified. As a consequence, the financial sustainability of the HSCP must be considered to be a short term high grade risk. On-going work is required and is expected to improve the position and contribute towards savings targets and an improved financial situation. The gross budget gap before savings is £12.8m. The IJB is requested to approve: • the expenditure budget totalling £398.1m • the savings plan totalling £5.6m Page 149
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16 Classification: OFFICIAL 12.3 12.4 The HSCP is in an extremely challenging financial situation in 2025/26 as it still must identify and deliver further savings as well as address its structural budget shortfall in 2026/27. It expects demand for service will also continue to increase and inflationary pressure will likewise continue. The SLA with Greater Glasgow and Clyde and the resolution of the National Insurance increase for commissioned service providers are key risks to the financial plan. Dialogue with both partners in respect of the situation is continuing and the sector is seeking to ensure government are aware of the scale of the challenge. The constraints on the pace of service change and capacity to deliver it are further challenges. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required Argyll & Bute Council √ NHS Highland Health Board √ Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) SLT Budget Update 18/09/24 Amendments made IJB Budget Update 25/9/24 Noted Finance & Policy Committee Budget Update 28/9/24 As above SLT Budget Update 20/11/24 Noted Finance & Policy Committee Budget Update 22/11/24 Noted Finance & Policy Committee Budget Update 21/1/25 Noted SLT Budget Update 22/1/25 Noted IJB Budget Update 29/1/25 Noted Finance & Policy Budget Update 25/2/25 Noted Finance & Policy Draft Budget 2025/26 18/3/25 Draft proposals endorsed subject to final allocations AUTHOR NAME: James Gow, Head of Finance EMAIL: james.gow@argyll-bute.gov.uk Appendix 1 – Directions (2) Appendix 2 – EQIAs (4) Page 150
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Classification: OFFICIAL Argyll and Bute Integration Joint Board (the IJB) Written Directions to Argyll and Bute Council This Direction is written under sections 26 and 27 of the Public Bodies (Joint Working) Scotland Act 2014. This direction will be for the period from 1 April 2025 to 31 March 2026. 1. Functions and Services to be delivered by Argyll and Bute Council Argyll and Bute Council will carry out the functions specified in Annex 1 and Annex 2 of the Integration Scheme dated March 2021. Argyll and Bute Council will deliver the services to which those functions relate. 2. Delivery of Functions and Services Argyll and Bute Council will carry out the functions and deliver the services in a way which complies with all legal and regulatory requirements and having regard to: a) The Integration Delivery Principles b) The National Health & Wellbeing Outcomes c) The Integration Scheme; and d) The Argyll and Bute HSCP Strategic Plan 3. Finance The opening payment that will be made to Argyll and Bute Council for the period 1 April 2025 to 31 March 2026 will be £99,887,000. This is in respect of the following: Argyll and Bute Council Requisition £82,058,000 Funding transfer from NHS Highland, initial estimate £14,865,000 Contribution from SPF Saving £2,500,000 Contribution from Reserves £464,000 A cash payment will be made by NHS Highland to Argyll and Bute Council to the value of the funding transfer. The budget allocation outlined above may be subject to change. The most up to date financial position will be reported to the IJB and the Council as agreed in the Integration Scheme. The Council and the IJB will observe the roles and responsibilities as set out in the Integration Scheme for the management and the development of the budget. A further Direction may be issued following the financial year-end to set out the final payments. Page 151
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Classification: OFFICIAL Argyll and Bute Integration Joint Board (the IJB) Written Directions to NHS Highland This Direction is written under sections 26 and 27 of the Public Bodies (Joint Working) Scotland Act 2014. This direction will be for the period from 1 April 2025 to 31 March 2026. 4. Functions and Services to be delivered by NHS Highland NHS Highland will carry out the functions specified in Annex 1 and Annex 2 of the Integration Scheme dated March 2021. NHS Highland will deliver the services to which those functions relate. 5. Delivery of Functions and Services NHS Highland will carry out the functions and deliver the services in a way which complies with all legal and regulatory requirements and having regard to: e) The Integration Delivery Principles f) The National Health & Wellbeing Outcomes g) The Integration Scheme; and h) The Argyll and Bute HSCP Joint Strategic Plan 6. Finance The opening payment that will be made to NHS Highland for the period 1 April 2025 to 31 March 2026 will be £298,184,000 inclusive of the funds transfer to Argyll & Bute Council. The IJB has an un-identified savings target of £4,240,000 at the start of the financial year. The Health Board receives a wide variety of in-year allocations, therefore the budget allocation outlined above may be subject to change. The most up to date financial position will be reported to the IJB and the Council as agreed in the Integration Scheme. NHS Highland and the IJB will observe the roles and responsibilities as set out in the Integration Scheme for the management and the development of the budget. A further Direction will be issued following the financial year-end to set out the final payments. Page 153
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Equality Impact Assessment Section 1: About the proposal Title of Proposal Discontinuation of Band 4 Public Health Intelligence Assistant position. Intended outcome of proposal The Public Health Intelligence Assistant post sits within the Argyll and Bute Public Health team. Tasks of this position included: • Develop and maintain a knowledge of health information sources, including their publication schedules, uses and limitations, and of national and local policies governing information sharing to ensure compliance. • Prepare reference and look-up files to support data analysis and help to maintain documentation relevant to the knowledge management of the team. • Support the timely collation, validation and submission of public health information required for performance monitoring. • Provides data support to the Public Health Team of the Directorate of Public Health and Health Policy. • Engage and participate in staff governance, ensuring that continuous learning and development, appraisal mechanisms and reviews are undertaken appropriately. • Develop intelligence, analyse information and communicate findings clearly and concisely, in written or verbal form and using charts, tabular or graphical output as appropriate. The post became vacant in Spring 2023 and the tasks were taken over by other members of the Public Health team. This proposal will cut the position of Public Health Intelligence Assistant as part of the saving strategy for the HSCP Argyll and Bute. Description of proposal The Public Health Intelligence (PHI) Team is part of the Argyll and Bute Public Health team. The task of PHI is to provide reliable analysis, interpretation and presentation of disparate sources of data and evidence for the Public Health Directorate, NHS Highland, and its partner agencies. Since the PHI assistant position became vacant in spring 2023 the Argyll and Bute team consists of a Public Health Intelligence Specialist. The post was advertised twice but could not be filled. A major problem in the recruitment process was that the post does not fulfil the requirements needed to sponsor the visa of a non-UK worker. Other options to fill this vacancy were discussed but had to be dismissed: 1. Turning the position into an apprenticeship in cooperation with a university. This option had to be dismissed, as the team does not have the capacity to appropriately mentor and support an apprentice. 2. Combining the post with a band 4 part-time position of another team to create a full-time position. No appropriate position in another team could be identified. In the absence of a PHI assistant their tasks had been taken over by other members of the Public Health team. Importantly, the Highland PHI team provides frequent and ongoing support for Argyll and Bute PHI work, without which the existing volume of work request could not be serviced. Considering the difficulties experienced in filling this position and the solution in form Page 155
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of the redistribution of tasks, the PHI assistant position will be cut to support the effort of NHS Highland to stay in budget. HSCP Strategic Priorities to which the proposal contributes • Budget requirements Lead officer details Name of lead officer Saskia Schmitz Job title Public Health Intelligence Specialist Department Public Health Appropriate officer details Name of appropriate officer Alison McGrory Job title Associate Director - Public Health Department Public Health Sign-off of EIA Date of sign-off Who will deliver the proposal? The work will be led by the Public Health Team. Section 2: Evidence used in the course of carrying out EIA Consultation / engagement Due to the difficulties described above, the post could not be filled for over a year and was a fortuitous saving to meet budget requirements. No consultation or engagement was conducted out with the public health team. The PHI Highland team was informed of the position cut. Data The Public Health Intelligence Assistant position has been vacant since spring 2023. Tasks previously held by this position were redistributed, which means that no specific area of work can be identified that will go undone without this position. Other information Gaps in evidence Section 3: Impact of proposal Impact on service users: Negative No impact Positive Don’t know Protected characteristics: Age X Disability X Ethnicity X Sex x Gender reassignment x Marriage and Civil Partnership x Pregnancy and Maternity x Religion x Sexual Orientation X Fairer Scotland Duty: Mainland rural population X Island populations X Low income X Low wealth X Page 156
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Negative No impact Positive Don’t know Material deprivation X Area deprivation X Socio-economic background X Communities of place X Communities of interest X If you have identified any negative impacts on service users, give more detail here: If any ‘don’t knows’ have been identified, when will impacts on these groups be clear? How has ‘due regard’ been given to any negative impacts that have been identified? Impact on service deliverers (including employees, volunteers etc.): Negative No impact Positive Don’t know Protected characteristics: Age X Disability X Ethnicity X Sex X Gender reassignment X Marriage and Civil Partnership X Pregnancy and Maternity X Religion X Sexual Orientation X Fairer Scotland Duty: Mainland rural population X Island populations X Low income X Low wealth X Material deprivation X Area deprivation X Socio-economic background X Communities of place X Communities of interest X If you have identified any negative impacts on service deliverers, give more detail here: If any ‘don’t knows’ have been identified, when will impacts on these groups be clear? How has ‘due regard’ been given to any negative impacts that have been identified? Section 4: Interdependencies Is this proposal likely to have any knock-on effects for any other activities carried out by or on behalf of the HSCP? Yes Page 157
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Details of knock-on effects identified This proposal will influence the work of the PHI team. Cutting the position will lead to a permanent decrease of capacity within the Argyll and Bute PHI team that will reduce the amount of projects the team can support in the future. To mitigate the effects of this proposal the team will reevaluate short-, medium- and long-term priorities, explore options for automation and further strengthen cooperative work with the Highland public health intelligence team and other analyst teams within the HSCP Argyll and Bute and NHS Highland. The ongoing support from the Highland PHI team is essential to meet the volume of work requests for PHI in Argyll and Bute. Section 5: Monitoring and review Monitoring and review This change will be reviewed in case of a change of budget or a change of the current established support structures, that would lead to a further decrease of the PHI capacities available. Page 158
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Equality Impact Assessment Section 1: About the proposal Title of Proposal Removal of £12,000 budget for Living Well grants Intended outcome of proposal Launched in September 2019, the Argyll and Bute Living Well strategy makes a commitment to support people living in Argyll and Bute with long-term conditions and those at risk of developing them. The strategy focuses on supporting people to manage their own health and supporting communities to build groups and networks which can link people together. More information about the strategy can be accessed here - Living Well Strategy — Living Well. Over the past 5 years, a small amount of in-year funding for third sector groups has been available in the form of Living Well grants. The Living Well grants were an opportunity for Third Sector or constituted community groups to fund projects that aligned to the key priorities of the Living Well strategy. This funding was aligned to the five-year, 2019-2024 strategy. The current iteration of this strategy is coming to an end; therefore this proposal will remove this small grant budget. Description of proposal The Living Well small grants budget funded non-recurring community projects from 2019-2025. The grants did not fund recurring projects. The grant projects funded under this workstream have either completed, or due to complete in 2025. The work of the Living Well Strategy evolved in 2022 into the Living Well Programme Board. This refresh has enabled a refocus on activity at two levels: 1. Community rehabilitation and wellbeing - Community Rehabilitation and Wellbeing Service to be provided by HSCP staff located within locality Physiotherapy departments and supported by Lead AHP. LiveArgyll facilities and staff to be accessed by these HSCP staff to deliver rehabilitation, strength & balance and education classes. 2. Community assets for Living Well priorities - person centred social support to connect people to community-based activities. This action includes developing and sustaining community-based support, for example using community development and co- production approaches. A community wellbeing development manager oversees the Community Assets steering group. This refresh has drawn in external & multi-partner funding to achieve actions identified by the programme board. In particular, the Community Assets for Living Well Priorities group has developed an action plan to focus on supporting community-based activities. A sub-group is also working to refresh the Living Well strategy from 2025. Due to the above changes, this proposal will remove the £12,000 budget for Living Well grants. HSCP Strategic Priorities to which the proposal contributes • Living Well and active citizenship Page 159
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Lead officer details Name of lead officer Samantha Campbell Job title Health Improvement Principal Department Public Health Appropriate officer details Name of appropriate officer Jenny Dryden Job title Health Improvement Lead Department Public Health Sign-off of EIA Date of sign-off Who will deliver the proposal? The current £12,000 budget sits with Public Health. The multi-partner Community Assets group will take forward community asset work under their workplan. Section 2: Evidence used in the course of carrying out EIA Consultation / engagement The grant process aligned to the Living Well Strategy 2019-2024. The requirement for this small grant fund has naturally come to an end, due to the evolution of the Living Well work, and the non-recurring nature of the funded projects and budget. Therefore, no specific engagement has been taken surrounding this proposal. Consultation and engagement will take place during the refresh of the strategy from 2025 onwards. Data: The budget available for grant funding has reduced year-on-year however has funded approximately five non-recurring projects per year. In 2024-2025, a maximum of £4000 per project could be applied for. The 2024-2025 projects are completing in 2025, and the previous year grants are all completed. Other information Gaps in evidence Section 3: Impact of proposal Impact on service users: Negative No impact Positive Don’t know Protected characteristics: Age X Disability X Ethnicity X Sex x Gender reassignment x Marriage and Civil Partnership x Pregnancy and Maternity x Religion x Sexual Orientation X Fairer Scotland Duty: Mainland rural population X Island populations X Low income X Page 160
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Negative No impact Positive Don’t know Low wealth X Material deprivation X Area deprivation X Socio-economic background X Communities of place X Communities of interest X If you have identified any negative impacts on service users, give more detail here: If any ‘don’t knows’ have been identified, when will impacts on these groups be clear? How has ‘due regard’ been given to any negative impacts that have been identified? For this project, service users are defined as the recipients of each grant funded project, i.e. the people the grant funding supported. No impact has been selected due to the following: • The projects were non-recurring and have all completed/due to complete in 2025 • Future need is picked up via ongoing work of the Living Well Programme board, which focuses on older adults and those with long-term conditions, thus mitigating any potential negative impact of this loss of grant funding in these population groups. • The grant funding was minimal, with a maximum of £4000 per project in 2024/25. Impact on service deliverers (including employees, volunteers etc.): Negative No impact Positive Don’t know Protected characteristics: Age X Disability X Ethnicity X Sex X Gender reassignment X Marriage and Civil Partnership X Pregnancy and Maternity X Religion X Sexual Orientation X Fairer Scotland Duty: Mainland rural population X Island populations X Low income X Low wealth X Material deprivation X Area deprivation X Socio-economic background X Communities of place X Communities of interest X If you have identified any negative impacts on service deliverers, give more detail here: If any ‘don’t knows’ have been identified, when will impacts on these groups be clear? Page 161
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How has ‘due regard’ been given to any negative impacts that have been identified? For this project, service deliverers are defined as the community groups/3rd sector organisations receiving the grant funding. Again, there are no negative impacts identified for specific population groups of 3rd sector organisations, due to the reasons listed above. However it should be noted that reduction in available funding for 3rd sector organisations across Argyll and Bute as a whole could have an impact on reducing the work these organisations can do, and contribute to instability of the 3rd sector. In year allocations or underspends from elsewhere in the budget may continue to be used to support grant-based health and wellbeing work. This will be on an ad hoc and non-recurring basis. Section 4: Interdependencies Is this proposal likely to have any knock-on effects for any other activities carried out by or on behalf of the HSCP? No Details of knock-on effects identified Section 5: Monitoring and review Monitoring and review In 2025, Public Health staff will work within a multi-partner subgroup to refresh the Living Well Strategy. During this work, if any impacts of this proposal are identified, this document will be updated accordingly. Page 162
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Equality Impact Assessment Section 1: About the proposal Title of Proposal Adapting existing model of building healthy communities within Argyll and Bute: disinvesting from the Living Well Network approach, to invest in a Living Well Community Assets approach. Intended outcome of proposal The existing Living Well Networks (LWNs) are for people with an interest in building healthy communities. They provide an opportunity for partners to come together to find out what issues matter to local communities; to plan activities and events together; and to network with individuals, services and organisations with an interest in improving health. Argyll and Bute HSCP Public Health team has provided funding for the network coordination time for a number of years. The Living Well Networks also identified a priority area from the Living Well strategy to focus on in their meetings each year. In 2022, the Living Well Strategy group merged with the Prevention Programme Board and undertook a refresh to become the Living Well Programme Board. This refresh has enabled a refocus on activity at two levels: 1. Community rehabilitation and wellbeing - Community Rehabilitation and Wellbeing Service to be provided by HSCP staff located within locality Physiotherapy departments and supported by Lead AHP. LiveArgyll facilities and staff to be accessed by these HSCP staff to deliver rehabilitation, strength & balance and education classes. 2. Community assets for Living Well priorities - person centred social support to connect people to community-based activities. This action includes developing and sustaining community-based support, for example using community development and co- production approaches. This proposal will cease the Living Well Network model and HSCP investment in the Living Well Network coordination time will come to an end. The HSCP will implement a new approach to building healthy communities within Argyll and Bute through focusing on Community Assets for Living Well priorities. This model will focus on community development, coproduction, reduce duplication, and support the development of community assets from the ground up. Description of proposal This proposal will see the cessation of the Living Well Networks in their current form. The aim of building healthy communities will be achieved through the ‘Community Assets for Living Well priorities’ group. This move will step away from an information sharing and networking approach. Although the value of these things are recognised, due to efficiencies, the HSCP is required to disinvest in some projects, in order to invest in transformational change that should hopefully achieve wider community benefit. The Community Assets for Living Well workstream currently has the following intentions: • Identifying existing assets and resources within local communities to support Living Well intentions. • Recognising the power of local people in making their communities good places to live. Page 163
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• Supporting community action on shared priorities for Living Well. • This proposal addresses the limitations of the current Living Well Network model which primarily focuses on information sharing and moves toward an action-based coproduction model. Community Assets for Living Well will take a local place-based approach for Community Asset development. HSCP Strategic Priorities to which the proposal contributes • Community Coproduction • Prevention, early intervention and enablement • Living Well and active citizenship Lead officer details Name of lead officer Samantha Campbell Job title Health Improvement Principal Department Public Health Appropriate officer details Name of appropriate officer Jenny Dryden Job title Health Improvement Lead Department Public Health Sign-off of EIA Date of sign-off Who will deliver the proposal? The work will be led by the Community Assets for Living Well priorities’ group, a multi-partner sub-group of the Living Well Programme Board. Section 2: Evidence used in the course of carrying out EIA Consultation / engagement Over the past five years, two reviews have taken place to review the Living Well Network aims and objectives. In 2019, a review was undertaken using the methods below: 1. Semi-structured interviews with Coordinators of locality HWNs 2. A survey sent out to all members of HWNs, collecting their opinions 3. A consultation day with the HWN Coordinators and the Health Improvement team 4. A survey sent out to senior managers and stakeholders This review identified some of the following strengths and weaknesses of the current model: Strengths • opportunity for networking to help create partnerships and collaborative working • an effective platform for information sharing • gateway to creating strong links with the Third Sector and public Weaknesses • lack of strategic direction • little region-wide coordination and poor inter-locality awareness, with good knowledge of the networks amongst members but a lack of knowledge/awareness from general public/staff In terms of the efficacy of the HWN at improving local health and wellbeing, opinions were split, with 33% of respondents feeling that their HWN was “very” or “extremely” effective, compared to 11% who felt it was “not so effective” or “not at all effective”, and 45% who felt it was “somewhat effective”. Respondents also felt that the network key objectives were networking, connecting people to support in their area, and promoting local services. Suggestions for future directions of the networks also emerged from this engagement, recognising that that the model may duplicate work of other partners, e.g. Argyll and Bute Council Community Planning Structures and Argyll and Bute Third Sector Interface. Page 164
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Suggestions for future directions including scoping sustainable models of funding and scoping community hub options for each local area. However, for a number of reasons, these directions had limited success. Engagement and consultation subsequently took place in 2022, where an options appraisal on the networks considered whether alternative models of community capacity building and coproduction could meet the strategic needs of Argyll and Bute HSCP. The identified option was: • Restructure the Living Well networks to have a clearer, more strategic focus on co- producing health and wellbeing initiatives. The 2019 review suggested coproduction be embedded organisationally, and that stronger links could be made to the strategic plan and commissioning strategy. This was operationalised on a pilot basis through Locality Planning Groups, with networks being more closely aligned to these groups. Feedback was gathered from partners throughout this pilot. After a year it was recognised that limited success could be made with this approach. In addition, the Locality Planning Group model temporarily paused. The engagement and consultation described above was used to inform the proposal, and also informs the Equalities Impact Assessment. Further engagement on the Equalities Impact Assessment of the new proposal took place with members of the wider Public Health team. Data: The key outcomes of the current Living Well Network model are described below, with further detail on their link to the new proposal. Outcomes and objectives of Living Well Network Proposal Planning for Health and Wellbeing Planning for health and wellbeing will be undertaken via the new Community Assets approach. Coordination of Local Network. The local networks are used to disseminate information, expert advice for health improvement, and as an opportunity for local updates. Service users and service deliverers, including those with protected characteristics can access this information in a number of alternative ways including: Argyll and Bute Council Community Planning Bulletin, Area Community Planning Groups, HSCP Locality Planning Groups, HSCP social media, Argyll and Bute Third Sector Interface networks and news bulletins (Adults Health and Wellbeing; All Our Children; and Social Enterprise). Health, wellbeing and support service information can also be accessed on https://abcd.scot/ Argyll and Bute’s Community Directory. A new proposal led by the Community Assets Group will enhance and leverage this resource as a centralised platform to create a 'One Front Door' approach to accessing Health and Wellbeing information and support services in Argyll and Bute. Represent Health & Wellbeing Network at other meetings. No longer applicable. Data on service providers (current Living Well Network Coordinator organisations): The current Living Well Network Coordinator organisations are: two third sector organisations, and two independent contractors. Three operate from mainland Argyll and Bute, and one from island Argyll and Bute. Page 165
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Other information This proposal will retain £30,000 funding to achieve this aim – the direction and investment of which will be agreed in partnership with the Community Assets for Living Well group. Gaps in evidence This is an evolving model and evidence will be gathered on an ongoing basis to identify best practice and potential improvements. Section 3: Impact of proposal Impact on service users: Negative No impact Positive Don’t know Protected characteristics: Age X Disability X Ethnicity X Sex x Gender reassignment x Marriage and Civil Partnership x Pregnancy and Maternity x Religion x Sexual Orientation X Fairer Scotland Duty: Mainland rural population X Island populations X Low income X Low wealth X Material deprivation X Area deprivation X Socio-economic background X Communities of place X Communities of interest X If you have identified any negative impacts on service users, give more detail here: If any ‘don’t knows’ have been identified, when will impacts on these groups be clear? Third sector organisations and other community groups involved in the networking are identified as the ‘service users’. For some of these groups, we have identified some aspects as unknown. Removing a networking opportunity may have an impact on these third sector organisations. However there are other networking opportunities across Argyll and Bute, impacts will be monitored and mitigations will be put in place wherever possible How has ‘due regard’ been given to any negative impacts that have been identified? Care will be taken in the proposal to ensure that community asset action plans developed maintain a place-based approach, and that rural and island populations are included within this community asset approach. The range of other opportunities for networking will also be shared widely. Impact on service deliverers (including employees, volunteers etc.): Negative No impact Positive Don’t know Protected characteristics: Age X Page 166
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Negative No impact Positive Don’t know Disability X Ethnicity X Sex X Gender reassignment X Marriage and Civil Partnership X Pregnancy and Maternity X Religion X Sexual Orientation X Fairer Scotland Duty: Mainland rural population X Island populations X Low income X Low wealth X Material deprivation X Area deprivation X Socio-economic background X Communities of place X Communities of interest X If you have identified any negative impacts on service deliverers, give more detail here: If any ‘don’t knows’ have been identified, when will impacts on these groups be clear? Two potential impacts on service deliverers have been identified and will be explained in more detail. The current service deliverers (known as Living Well Network Coordinators) are two third sector organisations and two independent contractors. Three operate from mainland Argyll and Bute, and one from island Argyll and Bute. This proposal will end the contractual relationship with all four service deliverers. These organisations/individuals may wish to undertake work under the new model, however this is unknown at present and will be dependent upon their direction and the action plan developed by the Community Assets group. This will therefore impact on the income of the individuals/organisations. How has ‘due regard’ been given to any negative impacts that have been identified? Section 4: Interdependencies Is this proposal likely to have any knock-on effects for any other activities carried out by or on behalf of the HSCP? Yes Details of knock-on effects identified The Community Assets Group is a subgroup of the Living Well Programme Board, which is a multi-partner board (including HSCP). This proposal will have a positive impact on Community Asset work. Some HSCP staff use the current network mailing lists for engagement requests and information sharing. HSCP staff will be informed of the end of the current networks and directed to the following sources of information distribution: • Argyll and Bute Council Community Planning Bulletin • Area Community Planning Groups Page 167
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• HSCP Locality Planning Groups • HSCP social media • Argyll and Bute Third Sector Interface networks and news bulletins (Adults Health and Wellbeing; All Our Children; and Social Enterprise). Current distribution lists will also be shared with the HSCP Communications and Engagement team. Data protection compliance for this has been undertaken through the existing contract and privacy policies. Section 5: Monitoring and review Monitoring and review In 2025, Public Health staff will review and consider their role in the Community Assets work, to ensure that they are able to identify EQIA impacts and update this document accordingly. This will take place quarterly in the first instance. Page 168
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Integration Joint Board Agenda item: Date of Meeting: March 2024 Title of Report: Q3 Workforce Report (2024/25) Presented by: Gaye Boyd, Deputy Director of People The Integrated Joint Board is asked to: • Note the content of the report. 1. EXECUTIVE SUMMARY This workforce report details the workforce data of the HSCP as at 31st December 2024 and provides the current demographic position, highlighting trends and advising of changes and progress made, as well as actions taken to address areas of concern. 2. RECOMMENDATIONS To note and discuss the workforce data contained within the report. 3. DETAIL OF REPORT The attached information is provided in relevant sections with observations and actions advised and provides data on the following: • Headcount and WTE • Workforce Profile • Time to Fill (recruitment) • Vacancies • Sickness Absence • Employee Relations • Redeployment • Mandatory Training • Appraisals Page 169 Agenda Item 10
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4. RELEVANT DATA AND INDICATORS - 51.6% of the NHS workforce and 49% of Council workforce within HSCP are over 50 - Time to fill for vacancies in the HSCP has reduced significantly for Council and NHS. Council posts take an average of 69 days to fill while the NHS Argyll & Bute average is 113.6 days.(national KPI is 116 days) - There has been a significant decrease in the numbers of Council vacancies advertised from 103 last reported to 61 during FQ3. In comparison NHS vacancies was 190. - Sickness absence in NHS has decreased to 5.73%, within the Council the days lost per FTE per month has shown a slight decrease, reducing from 2.79 in November to just 1.74 in December 2024. - During FQ3, there were 4 new Council Disciplinaries commenced, 2 carried forward and 3 concluded. There was 1 ongoing Grievance, and 2 concluded. NHS Employee Relations cases at end of December 24: 4 new Bullying & Harassment cases with 12 remaining active; 1 new Conduct case with 4 remaining active and 3 new Grievances and 8 remaining active. - Statutory and Mandatory Training completion rate for NHS staff is 68.2% overall for eLearning modules. The compliance rates continue to improve however is short of the target of 95%. Unfortunately, due to continued issues with a new Council system, there are no training statistics available for this FQ3. - The NHS appraisal completion rate has decreased since the last report to 25.7%. Argyll & Bute Council no longer has in place a formal PDP/appraisal approach. Instead managers are encouraged to carry out a Quality Conversation with their staff. An Annual survey is planned for Spring 2025to measure the success and impact of the quality conversation. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The information within this report contributes to the strategic priorities by informing decision making at all levels aligned to the delivery plan objectives, supporting best value and evidencing performance and progress. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact A reduction in sickness absence will reduce costs and can evidence a direct saving. 6.2 Staff Governance The workforce report is part of the suite of staff governance reports which evidence contribution to the Staff Governance Standard; Well Informed, Appropriately Trained and Developed, Involved in Decisions, Treated Fairly and Consistently and Continuously 7. PROFESSIONAL ADVISORY None 2 Page 170
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8. EQUALITY & DIVERSITY IMPLICATIONS E&D data is contained within the report. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE No personal or sensitive information is contained within the report 10. RISK ASSESSMENT Workforce associated risks are contained within the risk register 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT No public or user involvement to report within this current report 12. CONCLUSIONS It is recommended that the Integration Joint Board: • Note the content of this quarterly workforce report. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required X Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT NIL REPORT AUTHOR AND CONTACT Officers that contributed information to the report are: Jo McDill, HR&OD Officer, Argyll and Bute Council hr-hscp@argyll-bute.gov.uk Iain MacDiarmid, Workforce Planning Manager, NHS Highland, nhsh.workforceplanning@nhs.scot 3 Page 171
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WORKFORCE REPORT Argyll & Bute December 2024 Page 173
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CONTENT •Introduction •Headcount and WTE •Workforce Profile •Vacancies •Sickness Absence •Employee Relations •Redeployment •Mandatory Training •Appraisals 20XX 2 Page 174
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INTRODUCTION The Workforce Report considers the workforce position as of 31st December 2024, providing high level information for A&B HSCP. Some sections may represent an alternative timeline and will be highlighted. The report aims to shows the current position, trends and highlights where there have been changes and progress from previous periods as well as actions that are being taken to address some of the areas of concern. The Workforce Systems Teams proactively assesses data quality based on agreed data quality principles that are part of the data quality framework and addresses data quality issues at source to ensure that our workforce data is of high quality, reliable, and valuable to NHS Highland, and its stakeholders. Work continues on developing integrated (NHS and Council) data sets where possible. NHS Workforce dashboards are available at Operational levels as well as Job Families and continue to be developed. Council Health of the Organisation (HOO) reports are distributed to each service lead on a quarterly basis and Absence summaries are distributed monthly. 20XX 3 Page 175
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NHS HEADCOUNT AND WTE Key points: • 0.49% increase of workforce in the last 12months • December 2024 in post figure of 1,639 (headcount) of Substantive Staff an increase of 10 (0.31%) in the last 3 months • 97% of our contracts are permanent and this has been a consistent position since December 2022 4 Council Headcount Page 176
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WORKFORCE PROFILE - NHS SAMPLE FOOTER TEXT 5 Key points (NHS): • 834 employees (51% of the workforce) are over 50, 309 (18.9%) over 60 years, 70 (4.3%) over 65 • 37 (2.3%) employees are under 25 • 1391 (84.9%) employees are female • 841 (51.3%) employees are part time • 59 (3%) contracts are fixed term • Monthly Turnover (0.50%) is 0.31% lower than November’s figure and is lower than the Board figure of 0.65%. Retirement continues to be the main reason (35.5%) for leaving. Page 177
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COUNCIL WORKFORCE PROFILE SAMPLE FOOTER TEXT 6 Key points: • 49% of the workforce remain over 50 with 4% over 65 • 83% of our workforce is female. • 44% of our workforce are part time • 5% of our workforce are temporary (38) • Voluntary Turnover rate has reduced from 5% to 4% • No temporary employees leaving prior to end of contract • Modern apprenticeship retention remains higher than the council wide figure at 82% vs 72% Page 178
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TIME TO FILL Time to fill presents a count of days between post added to the recruitment system and the start date of the candidate. The fill period is therefore reliant on timely and accurate data input. The council posts take an average of 69 days to fill while the NHS Argyll & Bute average is 113.6 days in December There has been a significant decrease in the numbers of vacancies advertised from 103 during FQ2 to 61 during FQ3. At the end of December 2024, there were only 7 positions that remained unfilled. Both recruitment systems have the capability of reporting at each stage of the recruitment process and Recruitment Metrics is being finalised for future reporting. This will assist in identifying the source of delays. 7 Council NHS Status Posts at 31/12/2024 Conditional 74 Generic/Cohort 1 Interview 10 Live Advert 24 Redeployment 1 Shortlisting 17 Shortlisting Complete 22 Unconditional 41 Total 190 Average time to Fill (days) 113.6 Page 179
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HSCP CURRENT VACANCIES 8 NHS Vacancies (Jobtrain) 31/12/2024 Council Vacancies This slide provides a detailed breakdown of the vacant posts at the end of December. Information relating to re- advertising and posts vacant for a long period of time is being further developed and will be provided when available. Division Number of Vacancies A&B Children Families & Justice 24 Allied Health Professions 2 Medical and Dental 1 Nursing and Midwifery 20 Other Therapeutic 1 A&B MH LD & Addiction Services 33 Administrative Services 3 Allied Health Professions 6 Nursing and Midwifery 23 Other Therapeutic 1 A&B Older Adults & Hospital Services 101 Administrative Services 8 Allied Health Professions 19 Healthcare Sciences 1 Medical and Dental 7 Nursing and Midwifery 46 Support Services 20 A&B Primary Care 14 Administrative Services 5 Dental Support 3 Medical and Dental 1 Nursing and Midwifery 3 Other Therapeutic 2 Argyll & Bute Central 18 Administrative Services 8 Allied Health Professions 4 Personal and Social Care 2 Support Services 4 Total 190 This table has a total of 71 posts during FQ3 – which includes all internal/Ring Fenced as well as Casual posts, hence the difference of 10 from the previous slide. Page 180
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NHS SICKNESS ABSENCE 9 The graph presents absence rates across Argyll & Bute Divisions. The table presents the average absence rates of the HSCP in comparison with NHS Highland as a whole and the NHS Scotland national average per month. A&B HSCP has, in the main, a consistently lower absence rate than the board wide and National averages. * We await NHS Scotland average rates for December 2024. 4.00 4.50 5.00 5.50 6.00 6.50 7.00 7.50 8.00 Dec- 23 Jan-24 Feb- 24 Mar- 24 Apr- 24 May- 24 Jun-24 Jul-24 Aug- 24 Sep- 24 Oct-24 Nov- 24 Dec- 24 A&B HSCP 5.53 6.66 5.54 5.27 5.21 5.29 6.01 5.14 4.99 5.75 5.72 6.30 5.73 NHS Highland 6.50 7.39 6.51 6.16 5.94 5.92 6.00 5.99 5.58 5.79 6.07 5.97 6.41 NHS Scotland Average 6.52 6.99 6.17 6.07 6.19 6.39 6.22 6.67 6.04 6.01 6.53 6.16 % Absence Rate A&B HSCP NHS Highland NHS Scotland Average Page 181
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NHS SICKNESS ABSENCE REASONS 10 Top 20 Absence reasons presented for December 2024. Absences with an unknown cause/not specified remaining high (26%). Managers continue to be asked to ensure that an appropriate reason is recorded and continuously updated. System solutions and prompts are also being investigated. Manger attendance is required on Once for Scotland courses Reports are now distributed to SLTs, via the People Partners to demonstrate attendance at the Once for Scotland courses, both online and eLearning. For committee purposes absence reason is reported at HSCP level. Heads of Services receive their own divisional information. The top 3 reasons for absence are: 1. cold, cough, flu 2. gastro-intestinal 3. Anxiety/ stress /depression /other Covid-related illness decreased 4.5% of absences for A&B HSCP in December 2024. Top 20 Absence Reasons % for December 2024 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% % of Total Absences Page 182
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COUNCIL SICKNESS ABSENCE SAMPLE FOOTER TEXT 11 The costs for sickness absences for FQ3 are shown below. Overall the HSCP has spent above the Council average during this quarter with 6.4% compared to 4.4% On a positive note the days lost per FTE per month has shown a slight decrease, reducing from 2.79 in November to just 1.74 in December 2024. Days lost per FTE per Month Oct-24 Nov-24 Dec-24 HEAD OF ADULTS - ACUTE & COMPLEX CARE 2.90 3.04 2.30 HEAD OF ADULTS - HEALTH & COMMUNITY CARE 2.68 3.05 1.79 HEAD OF CHILDREN & FAM AND CRIMINAL JUS 2.08 2.51 1.51 HEAD OF STRATEGIC PLANNING & PERFORMANCE 1.25 1.46 1.12 HSCP TOTAL 2.45 2.79 1.74 Page 183
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COUNCIL SICKNESS REASONS & RTWD 12 Absence Reasons ‘Mental Health’ reasons has taken over from ‘Infections’ as the top reason in the short-tem category for FQ3. And ‘Mental Health’ reasons continues to remain the top reason in the long-term absence categories. Return to Work Discussion (RTWD) There has been a slight improvement in the completion of the RTWD during FQ3 from 35% in September, to 45% completion in December 2024. The RTW Discussions remain an extremely important part of the absence management process, and there is a commitment for them to take place within 3 days of an employee’s return to work after a period of absence. Page 184
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From 1st April 2024 cases include early resolution where known. In December 2024, 2 cases closed. The outcomes included 1 partially upheld and 1 upheld. Reviewing the annual position between the 1st December 2023 and 31st December 2024, 60 cases were opened and 51 cases closed 0 1 2 3 4 5 6 7 8 9 10 Dec- 23 Jan- 24 Feb- 24 Mar- 24 Apr- 24 May- 24 Jun- 24 Jul-24 Aug- 24 Sep- 24 Oct- 24 Nov- 24 Dec- 24 A&B 1 1 2 0 0 2 1 0 0 0 0 3 0 Acute 0 0 2 0 1 2 0 1 1 0 2 2 2 Corporate 1 0 3 1 0 0 1 2 0 2 0 1 0 NH HSCP 4 1 2 3 5 3 0 1 2 2 1 1 1 Overall Total 6 2 9 4 6 7 2 4 3 4 3 7 3 Grievance December 23 - December 24 (new cases open per month) 0 5 10 15 20 25 30 35 Dec-23Jan-24Feb-24 Mar- 24 Apr-24 May- 24 Jun-24 Jul-24 Aug- 24 Sep- 24 Oct-24 Nov- 24 Dec-24 A&B 5 6 7 7 6 8 8 7 6 6 5 8 8 Acute 5 5 6 4 5 7 7 8 8 8 7 9 10 Corporate 2 1 3 3 1 1 2 4 4 5 4 4 4 NH HSCP 8 9 9 12 15 14 12 10 8 8 6 7 7 Overall Total 20 21 25 26 27 30 29 29 26 27 22 28 29 Grievance December 23 - December 24 (active cases at end of month) Page 185
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From 1st April 2024 cases include early resolution where known. In December 2024, 2 cases closed. The outcomes included 2 resolved at early resolution. Reviewing the annual position between the 1st December 2023 and 31st December 2024, 31 cases were opened and 31 cases closed 0 1 2 3 4 5 6 Dec-23Jan-24Feb-24 Mar- 24 Apr-24 May- 24 Jun-24 Jul-24 Aug- 24 Sep- 24 Oct-24 Nov- 24 Dec-24 A&B 1 0 0 0 1 0 0 0 4 0 0 0 1 Acute 0 0 0 2 2 0 1 0 0 1 1 1 0 Corporate 0 0 0 0 0 0 0 0 0 0 0 1 1 NH HSCP 2 0 1 1 1 1 0 2 1 4 0 1 0 Overall Total 3 0 1 3 4 1 1 2 5 5 1 3 2 Conduct December 23 - December 24 (new cases open per month) 0 5 10 15 20 25 Dec- 23 Jan-24 Feb- 24 Mar- 24 Apr- 24 May- 24 Jun-24 Jul-24 Aug- 24 Sep- 24 Oct-24 Nov- 24 Dec- 24 A&B 1 1 1 1 2 2 2 2 6 5 3 3 4 Acute 8 6 5 4 5 4 3 3 3 3 2 3 3 Corporate 2 2 2 3 3 2 2 2 1 1 1 2 3 NH HSCP 12 12 13 13 13 14 11 12 10 14 13 12 11 Overall Total 23 21 21 21 23 22 18 19 20 23 19 20 21 Conduct December 23 - December 24 (active cases at end of month) Page 186
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0 1 2 3 4 5 6 7 8 9 10 Dec-23Jan-24Feb-24 Mar- 24 Apr-24 May- 24 Jun-24 Jul-24 Aug- 24 Sep- 24 Oct-24 Nov- 24 Dec-24 A&B 3 3 0 0 0 0 1 1 0 1 4 0 0 Acute 0 0 0 0 0 2 3 0 1 1 2 0 3 Corporate 0 1 0 1 1 0 0 1 0 2 0 6 0 NH HSCP 1 2 1 3 3 7 0 4 0 1 2 0 1 NHSH Total 4 6 1 4 4 9 4 6 1 5 8 6 4 Bullying and Harassment December 23 - December 24 (new cases open per month) 0 5 10 15 20 25 30 35 40 45 50 Dec- 23 Jan- 24 Feb- 24 Mar- 24 Apr- 24 May- 24 Jun-24 Jul-24 Aug- 24 Sep- 24 Oct- 24 Nov- 24 Dec- 24 A&B 15 18 17 17 17 17 15 13 13 13 15 15 12 Acute 5 5 5 4 3 4 7 4 4 5 5 4 7 Corporate 1 2 2 3 4 3 3 3 3 4 2 8 8 NH HSCP 8 9 10 13 15 21 19 18 16 14 15 11 11 NHSH Total 29 34 34 37 39 45 44 38 36 36 37 38 38 Bullying and Harassment December 23 - December 24 (active cases at end of month) From 1st April 2024 cases include early resolution where known. In December 2024, 4 cases closed. The outcomes included 2 resolved at early resolution and 2 learning outcomes. Reviewing the annual position between the 1st December 2023 and 31st December 2024, 62 cases were opened and 50 cases closed Page 187
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EMPLOYEE RELATIONS - COUNCIL 16 Grievance cases continue to remain relatively low; although there has been a significant increase in Disciplinary Cases. During FQ3 , there were 4 new Disciplinaries commenced, 2 carried forward and 3 concluded. There was 1 ongoing Grievance, and 2 concluded. Page 188
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MANDATORY TRAINING - NHS In December 2024, the Mandatory Training completion rate is 68.2% overall for eLearning modules, an increase since September 2024 when 67% was reported. Over the course of the year there has been focused attention on statutory mandatory training resulting in incremental improvement across all statutory mandatory training course. The launch of a new Violence & Aggression course in July 2024 for all job families caused a dip in the figures but completion numbers are now improving. There remains low levels of compliance in Staying Safe Online eLearning, but it is improving. There is now an established Statutory Mandatory monitoring and training implementation programme, with focused attention on improvement through Chief officers and HOS. 17 30% 40% 50% 60% 70% 80% 90% 100% Trajectory (% Completed) Equality and Diversity Fire Safety Hand Hygiene Information Governance Moving and Handling Module A Public Protection Staying Safe Online Violence and Aggression Why Infection Prevention Matters Target Page 189
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MANDATORY TRAINING - COUNCIL Unfortunately, due to continued issues with the Council IT systems, there are no training statistics available for this FQ3. The Council are continuing to work on the new process on the training management system LEON, to make it easier for employees to stay on top of their mandatory training. LEON continues to notify employees when their training is due and sends reminders to the employee and line manager. The reporting for this is still being refined, but it is expected to improve the overall compliance rates in the next few quarters. 18 Page 190
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APPRAISALS The table shows the appraisal completion percentage, recorded on the Turas Appraisal system for NHS employees as of 31/12/2024. The chart represents the overall appraisal completion percentage over the last 12 months recorded on the Turas Appraisal system for NHS employees. Improvement of appraisal rates and quality is a Board priority, and this will be an area of focus for the year ahead. Training for reviewees is available on the Turas Learn system The Council continues to encourage managers to carry out a Quality Conversation with their staff and no longer carries out the Formal PDP/appraisal approach. As such, the Council now conducts an Annual survey to measure the success and impact of the quality conversation. The next survey is due to be issued in the Spring of 2025. The results of this survey will be presented in due course. 19 22.00% 23.00% 24.00% 25.00% 26.00% 27.00% 28.00% 29.00% Jan-24 Feb-24 Mar-24 Apr-24 May-24 Jun-24 Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Appraisal % Completed Page 191
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1 Classification: OFFICIAL Integration Joint Board Date of Meeting: 26 March 2025 Title of Report: Health & Social Care Partnership - Performance Report – FQ3 2024/25 (October – December) Presented by: Charlotte Craig – Interim Head of Strategic Planning, Performance & Technology The Board is asked to: • Acknowledge performance for FQ3 2024/25 (October - December) • Acknowledge performance update on the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators (Appendix 1) • Note Delayed Discharge Sitrep as of 06 January 2025 (Appendix 2) EXECUTIVE SUMMARY This report details performance for the Financial Quarter (FQ) 3 2024/25 (October - December), the performance outputs are taken from the Integrated Performance Management Framework (IPMF) Reporting Dashboard with the focus on twelve key service areas. Overall performance for FQ3 notes 42 of 84 measures reporting as on target (50%). The report details performance against each of the service areas and the 84 supporting Key Performance Indicators. National Health & Wellbeing Indicators performance is included alongside latest performance from the National Delayed Discharge Sitrep. The use of the new performance Dashboard within SharePoint is designed to offer a more focused approach to the access and analysis of data, offering scope for self-service. In consideration of the report the board is reminded of the role of the Clinical and Care Governance Committee in providing more in depth scrutiny of performance. To ensure timely consideration for the IJB a high level report has been presented to the IJB ahead of this with update to follow in the next minute. 2. RECOMENDATIONS The Integration Joint Board are asked to acknowledge current FQ3 24/25 performance. 3. DETAIL OF REPORT The report details the HSCP (Health and Social Care Partnership) performance for FQ 3 2024/25 (October - December) highlighting key performance trends across the 84 KPIs (Key Performance Indicators). The latest performance against the National Health and Wellbeing Outcomes Indicators is reported (Appendix 1). Also included is the latest national update on Delayed Discharges Page 193 Agenda Item 11
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2 Classification: OFFICIAL (Appendix 2). 4. RELEVANT DATA & INDICATORS 4.1 FQ3 2024/25 (October - December) Performance Summary Overall performance for FQ3 notes that 84 KPI’s are scoring against target, with 42 (50%) reporting as on-track. This is a decrease of 8% from FQ2 position, where 49 KPI were on track (58%). The KPI’s report performance against the target and include the target, actual and variance and is a mix of both quantitative and qualitative indicators. The use of the green, amber and red graphics within the Dashboard is used to give an overview of the HSCP’s total performance for each of the twelve services and 84 KPI’s. The use of only green and red for the KPI’s is used to focus delivery with regards to sustaining performance on or above target. 4.2 Analysis of Key Performance This analysis identifies performance across the 12 service reporting categories within the Integrated Performance Management Framework (IPMF). 4.2.1 Children & Families Performance across 7 KPIs, Children & Families and Justice notes 4 (57%) on track, with 4 (43%) off track, against the targets set for Q3 24/25. This is consistent with 57% noted as on track in FQ2. Performance on or above target: • The percentage of Child Protection Register (CPR) cases that have an allocated Social Worker remains on target at 100% for FQ3, with no change noted from FQ2 position. Page 194
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3 Classification: OFFICIAL • The number of teams that have delivered 75% or more of the Universal Health Visiting Pathway (UHVP) reports 87% for FQ3, up from 78% FQ2. • FQ3 Number of Public Sector staff who have received at least basic training in how to identify and respond to women and children affected by Violence Against Women & Girls reports cumulative 250 against cumulative target of 90. • Percentage of Criminal Justice social work reports submitted 2 days before court reports is noted at 91% in FQ3, against 90% target and an increase from 82% reported in FQ2 Performance below target & areas for improvement: • The percentage of Child Protection Planning Meetings (CPPM's) held within 28 days of the initial referral reports 33% in FQ3 against 90% target and increase from 17% noted in FQ2. • Mental Health Services (CAMHS) children and young people seen within 18 weeks of referral reports 39% FQ3 against 85% target and a decrease from 73% reported in FQ2. • The number of statutory individual Health Assessments commenced within four weeks of coming into care in FQ3 reports 75% down from 100% for FQ2 4.2.2 Telecare and Digital Performance across 13 Key Performance Indicators (KPIs) for Strategic Planning, Performance & Technology Services shows 4 KPIs (31%) on track, with 9 KPIs (69%) reported as off track against the targets set for FQ3 24/25. Performance on track reports a decrease of 7% from the reported FQ2 24/25 position (38%) It should be acknowledged that nationally waiting time breaches are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients on waiting lists across varied health specialties. Performance on or above target: • The implementation of Just Checking activity monitoring equipment was successfully completed in 8 homes, down slightly from 9 in FQ2 but remains above the target (7) for FQ3. • Digital blood pressure monitoring in Primary Care continues to be rolled out, with 79 unique patients using the service by FQ3 against a target of 42, consistent with FQ2 levels. • Currently, 45% of telecare clients have enhanced packages, which are on target and an increase from 42% noted in FQ2. Further work is needed to accurately track this metric. • The e-health department resolved 100% of IT support requests during Q3, up from 99% in FQ2. Performance below target & areas for improvement: • FQ3 reported 169 new clients to Telecare, a 23% decrease compared to the previous quarter (219) and below the target of 200. • Progress in the digitalisation of telecare equipment has increased by 11% to 65% for FQ3, however this is below the 70% target set for the end of the period. • Consultations delivered via Near Me have continued to decline, from 999 in FQ2 to 888 in FQ3, against the quarterly target of 1025, showing no growth. • The number of telecare clients overdue for their annual review has decreased to 51%, below the 50% target. Work is continuing to improve data quality around this measure. Page 195
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4 Classification: OFFICIAL • There were zero Silvercloud referrals reported in FQ3, a fall from 57 in FQ2 against the quarterly target of 60. • 96% of FOI requests were completed within the statutory timescale, against 100% and down from 100% noted in FQ2. • Waiting times for cancer appointments at 31 and 62 days reported 15 cases, an increase from 12 in FQ2 against a target of zero. • New outpatient waiting times breaches over 12 weeks were noted at 49%, compared to the 46% target, no change from FQ2. • Outpatient long waiting times (over 52 weeks) were noted at 4.8%, an increase from 3.3% in FQ2 and above the target of 2.8%. 4.2.3 Primary Care Performance across 10 Key Performance Indicators (KPIs) for Primary Care shows 6 KPIs (60%) on track, with 4 KPIs (40%) reported as off track against the targets set for FQ3 24/25. This is a reported decrease of 10% from 70% on track in FQ2 24/25. Performance on or above target: • 81% of children who received Fluoride Varnish treatment did not require further dental treatment, consistent with FQ2 levels. • 54% of eligible residents have so far received their Winter Covid 19 booster. This is 7% higher than the national average and up from 4% noted at FQ2 end. • Across the HSCP GP practices operated the duration of FQ3 without resorting to contingency measures. Decease from 55 instances noted in FQ2. • GP practices remained at level zero during FQ3 resulting in no reduction in services provided. • 4.5% of consultations by GPs and other HSCW within the primary care setting were done digitally, meeting the target set (4.5%) • Primary Care Out-of-Hours Services covered 50% of all recorded out of hour consultations during FQ3, an increase from 46% in FQ 2 and exceeding their 45% target. Performance below target & areas for improvement: • 2 GP practices were returned to HSCP Control during FQ3, above a zero target and an increase from FQ2 (0). • 93% of children at 12 months of age received their 6 in 1 vaccination missing the 95% national target, down from 96% reported at FQ2. (data for this indicator is 1 quarter behind due to availability of statistics) • The Oral Health Improvement Team only managed to deliver 94% of their planned activity, down from 95% in FQ2 and against a target of 100%. • HSCP Dental services utilised 61% of clinic appointments, missing their 90% target. This is an improved position from 48% noted in FQ2. 4.2.4 Public Health Performance across 5 Key Performance Indicators (KPIs) for Public Health shows 4 KPIs (80%) on track against the targets set for FQ3 24/25. Performance on track reports a decrease of 20% from the reported FQ2 24/25 position (100%). Performance on or above target: Page 196
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5 Classification: OFFICIAL • Increase the monthly number of quit dates set, supported by NHS smoking cessation advisors or jointly through shared care with pharmacy, by people in the most deprived 40% areas in Argyll. Performance this quarter has significantly exceeded the target, with 28 quit dates achieved against a target of 10. Whilst significantly above target it shows a 3% decrease compared to FQ2. • Increase the number of engagement activities delivered in communities and supported through Living Well Networks. Performance continues to be above target, with an actual of 29 against a target of 20. This represents a 12% increase compared to FQ2. • Increase the number of referrals to community link workers supported by “We Are with You”. Performance this quarter achieved approximately 44% above the target, with an actual performance of 145 against a target of 101. The actual number of referrals is above target but 32% less than FQ2. • Number of instances working with Scottish Government or National Agencies on National Strategy and Policy Development. This is a new measure for 24/25 with a target initially set as 1. FQ3 noted 13 instances of working with Scottish Government or National Agencies on National Strategy and Policy development. Performance below target & areas for improvement: • Increase the number of people in Argyll and Bute attending training in the following areas, Money Counts, Behaviour Change, Mental Health and Suicide Prevention. The rolling target from 23/24 continues into 24/25, with the expectation of 17 additional clients each quarter. In FQ3 we fell 4% short of our target with 114 attendances, against a target of 119. 4.2.5 Finance Performance across 6 KPIs for Financial services notes 1 (17%) on track, with 5 (83%) off track against the targets set for Q3 24/25. This is a reported decrease of 66% from FQ2, where 5 (83%) of KPIs were on track. Performance on or above target: • Older People External Residential actual spend reports 95%, this is 5% below projected target in FQ3, with variance of 23% from the FQ2 position. Performance below target & areas for improvement: • Costs for Hospital Delayed Discharges in FQ3 report £453,500 (43%) over the target of £317,000 and an increase from £306,500 in FQ2. • GP prescribing expenditure notes actual spend being £126,000 (0.6%) over the projected spending target in FQ3. This is an improved position from FQ2, where performance was noted as 2% over the target. • Agency and Locum staffing expenditure reports a reduction of 1%, failing to meet the target reduction of 10%. However, this is an improvement on the FQ2 position, where a 6% increase was recorded. • Older People Internal Residential actual spend notes being over projected target by 8% for FQ3. This has increased from FQ2 position where 83% actual was noted. • FQ3 Older People Homecare actual spend reports being 4% above the projected target. This is an increase from the FQ2 position, where actual was below projected 92% Page 197
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6 Classification: OFFICIAL 4.2.6 Carers Performance across 4 Key Performance Indicators (KPIs) for Carers shows 3 KPIs (75%) on track, with 1 KPI (25%) reported as off track against the targets set for FQ3 24/25. Performance on track is consistent with the reported FQ2 24/25 position. Performance on or above target: • The number of Unpaid Carers Supported across A&B’s Carers Centres continues to be over the target of 3000 per quarter, with a slight increase to 3483 (4%) noted from previous FQ2. • The ACSP reviews, which now include welfare contacts, are well above target of 700 per quarter with 1739 achieved in FQ3 compared to 1396 in FQ2. • Young Carer Statements completed in FQ3 notes 53, is up from 35 recorded in FQ2 and remains above the target of 4 Performance below target & areas for improvement: • The number of Adult Carer Support Plans completed saw a significant increase this quarter (+11%), rising from 114 to 127 - just below the target of 133. 4.2.7 Allied Health Professionals Performance across 7 Key Performance Indicators (KPIs) for Allied Health Professionals shows 4 KPIs (57%) on track, with 3 KPIs (43%) reported as off track against the targets set for FQ3 24/25. Performance on track reports a decrease of 14% from the reported FQ2 24/25 position (71%). It should be acknowledged that nationally waiting time breaches are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients on waiting lists across varied health specialties. Performance on or above target: • MSK Outpatient Referral waits breaching >4 weeks are slightly up in FQ3 to 1029 (+6%) and meeting target of 1120. • Outpatients waiting over 12 weeks for AHP services continue their trend downwards in FQ3 – with a reported total of 467 against the target of 500. • Community Patient Discharges saw a slight decline in FQ3, dropping from 2,034 to 2,027, while still exceeding the target of 1,632. • The percentage of New versus Return Outpatient Physio AHP Referrals remains above the 30% target, with 31% noted in FQ3. Performance below target & areas for improvement: • AHP Priority 1&2 referrals breaching > 4 weeks in FQ2 reported 55 against a target of 48. • Priority 3 and 4 Community Patient Referrals breaching over 12 weeks have increased quarter on quarter, with FQ3 reporting 770 against a target of 400, up 35% from 558 noted in FQ2. Page 198
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7 Classification: OFFICIAL • AHP Outpatient Completed Waits decreased by 10% in FQ3, with 929 reported, just missing the target of 945. However, this remains part of an overall upward trend over the past year. 4.2.8 Delayed Discharges Performance across 6 Key Performance Indicators (KPIs) for Delayed Discharges shows 2 KPI (33%) on track, with 4 KPIs (67%) reported as off track against the targets set for FQ3 24/25. Performance on track reports a decrease of 50% from the reported FQ2 24/25 position (83%) For FY 2024/25 Delayed Discharges KPIs, we use a count at the end of quarter census point instead of full month data, as this aligns better with national reporting. It should be acknowledged nationally Delayed Discharges are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients showing as a Delayed Discharge. Performance on or above target: • Reduce the Number of people delayed in hospital with AWI code at Monthly Census Point. Performance was above target having achieved actual of 4 against a maximum target of 6. In this quarter, the number of people delayed with AWI code recorded remained at 3 in October and November and increased to 4 in December. • At the end of Q3, the number of people delayed in hospital awaiting assessment (Codes 11A and 11B) was 5, which is 14% of census clients, against a target of 10. The target was based on the average for the previous four quarters of 23/24, which ranged from 9 to 11. This is a noted reduction of 29% from FQ2 position which reported 7. Performance below target & areas for improvement: • The overall number of people delayed in hospital at Monthly Census Point as at the end of Q3 was 35, against the target of 31. This reflects an increase of 13% compared to FQ2 position (31). The target was set based on the average over the last four quarters of 23/24, where client numbers ranged between 29 and 34. • At the end of Q3 census point, the overall length of stay in a hospital (Delayed Discharge Bed Days) at Monthly Census Point was 907 against the target of 634. This represents an increase of 48% with 613 recorded in FQ2. The target was set based on the average bed days over the past four quarters of 23/24, which ranged from 598 to 695. • The number of people delayed awaiting a Care Home Placement was 10, compared to a target of 4, 150% over the target. The actual number of people waiting has increased by 900% (1 to 10) from FQ2 to FQ3. The target was set based on the average from the previous four quarters of 23/24, which ranged from 0-5. • At the end of FQ3, the number of people delayed in hospital awaiting care at home availability was 15, representing 43% of census clients, compared to a target of 12. The target was based on the average of the last four quarters of 23/24, which ranged from 8 to 14. This has decreased by 25% compared to FQ2 position (20). 4.2.9 Adult Social Care Page 199
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8 Classification: OFFICIAL Performance across 4 Key Performance Indicators (KPIs) for Adult Social Care shows 3 KPIs (75%) on track, with 1 KPI (25%) reported as off track against the targets set for FQ3 24/25. Performance on track reports an increase of 25% from the reported FQ2 24/25 position (50%). Performance on or above target: • Reduce the number of Unplanned Admissions to A&B hospitals directly from a care home has remained steady at 16 in both FQ2 and FQ3, which is below the target of 36. • Increasing the occupancy rates across A&B Care Homes has remained steady at 96% across FQ1, FQ2 and FQ3 and 2024/25. This KPI is now measured against available places (previously all empty beds). • The FQ3 performance was looking to reduce the value of assessed unmet need for care at home. FQ3 actual was £14,718.26, which is £1,960.78 (12%) below the target. Target is set at previous quarter’s value. Performance below target & areas for improvement: • Increasing the % of Older People who had their homecare monitoring review completed within 6 months was noted at 40% for FQ3, against a target of 49%, which is 18% below target. Compared to FQ2, where the actual was 37%, this represents a 3% increase (40%). 4.2.10 Community Hospitals Performance across 5 Key Performance Indicators (KPIs) for Community Hospitals shows 4 KPIs (80%) on track, with 1 KPI (20%) reported as off track against the targets set for FQ3 24/25. Performance on track has remained consistent, with an 80% track record across both FQ2 and FQ3. Performance on or above target: • The average length of stay for inpatients in A&B Community Hospitals was reduced to 7.4 days across the quarter, against the target of 7.8 days. This represents a 4% improvement compared to FQ2, where the average length of stay was 7.7 days. • A&E attendances meeting the 4 hrs wait target reached 95.1%, exceeding the 95% target by 0.1%. This is a slight reduction of 2% from FQ2, where performance was noted as 97.1%. • Maintain A&B Community Hospitals Bed occupancy rates below 80% target. Bed occupancy rates remained well below target at 70.6% for FQ3, marking a slight increase of 1.3% from 69.3% in FQ2. • Reduce the number of falls being reported in a Community Hospital setting in A&B. In FQ2, we reported 38 falls, well below the target of 54. This showed an increase of 1 fall from FQ2 (3%). Performance below target & areas for improvement: Page 200
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9 Classification: OFFICIAL • Reduce the rate of unplanned admissions to Community Hospitals for 65+ population. This KPI reported 490 admissions, 8% above the target of 452 for FQ3. This represents approximately 1% increase compared to FQ2. 4.2.11 Adults with Long Term Conditions / Adult Support & Protection / Alcohol Drugs Partnership Performance across 8 Key Performance Indicators (KPIs) for Adults with Long Term Conditions Services shows 3 KPIs (38%) on track, with 5 KPIs (62%) reported as off track against the targets set for FQ3 24/25. There is no change from FQ2 24/25. It should be acknowledged that nationally waiting time breaches for New Mental Health Outpatients (12 weeks) and Psychological Therapy (18 Weeks) are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients on waiting lists across varied health specialties Performance on or above target: • 10 Adults are on the dynamic support register with a category red or amber status, in line with Q3 target of 10, and down from 12 reported in FQ2. • FQ3 noted 30 Adults waiting for a psychological therapy service against the target of 175 or fewer, and a reduction from 40 in the previous quarter. • 90.8% of individuals referred to Alcohol and Drug treatment services were seen within the target waiting period, above the 90% target and an increase from 89.6% at FQ2. Performance below target & areas for improvement: • 12% of Adults with a Learning Disability were reported as overdue their annual review, up from 7% in FQ2 and above the 3% target. • 502 Adults were waiting for a Mental Health outpatient service, missing the target of 390 or less. And in increase of 13% from FQ2 position (446). • FQ3 noted 30% of Adult Support and Protection 'duty to inquire' procedures were completed within the 5 working day target, below 70% target and no change from FQ2. • Only 30% of Adult Support and Protection inquiries requiring investigative powers were completed within the 15 working day target (70%), down from 55% reported in FQ2. • 79% of Case Conferences began within 20 days of referral or within 12 weeks of the initial conference for review, an improvement on previous FQ2 (53%), but below the 100% target. 4.2.12 Rural General Hospitals (Lorn & Island Hospital) Performance across 9 Key Performance Indicators (KPIs) for Rural General Hospitals (LIH) shows 4 KPIs (44%) on track, with 5 KPIs (56%) reported as off track against the targets set for FQ3 24/25. Performance on track reports an 11% increase from the reported FQ2 position. Performance on or above target: Page 201
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10 Classification: OFFICIAL • Reduce the rate of unplanned admissions to LIH 65+ population. FQ3 performance noted the actual number of unplanned admissions was 322, down 16% from 383 in FQ2, meeting the target set of 345. • Reduce the number of LIH A&E Attendances that result in an unplanned admission. The FQ3 performance for reducing unplanned admission from A&E attendances was on target with both actual and target 19.2%. This is a decrease of approx. 1% from FQ2, where the rate was 19.8% and off target. • Reduce the number of falls being reported in a hospital setting in LIH. FQ3 performance noted the actual number of falls was 26 against a target of 26. This reflects a 21% reduction in falls from FQ2, where 33 Falls were reported. • Reduce the number of instances of tissue viability in Lorn & Islands Hospital. The target was to reduce the number of tissue viability instances to no more than 4. FQ3 performance on actual instances was 2, a reduction of 4 (67%) reported in FQ2. Performance below target & areas for improvement: • Reduce the total number of unplanned bed days in LIH. The actual number of unplanned bed days reported was 3327, 4 above the target of 3323, based on the 23/24 average. This represents a 12% increase from FQ2 of 2969. • Reduce the Average Length of Stay for inpatients in LIH. FQ3 Performance noted we achieved an actual rate of 5.3, against the target of 4.8. This is up 26% from 4.2 noted in FQ2. • Maintain LIH Bed Occupancy Rates below 90% target. FQ3 performance noted an actual rate of 92.4%, approx. 7% increase from 85.8% noted at FQ2. • Reduce the number of medication errors in LIH. The quarterly indicative target was set at no more than 6 per reporting period, 6 based on 2023/24 average. In FQ3 we noted an actual of 12, an increase of 3 (33%) from FQ2. 4.2.13 National Health & Wellbeing Outcome Indicators & Ministerial Steering Group Integration Indicators The National Health and Wellbeing Outcomes provide a strategic framework for the planning and delivery of health and social care services. This suite of outcomes serves to focus on improving the experiences and quality of services for people using those services, carers, and their families. These indicators form the basis of the annual reporting requirement for Health and Social Care Partnerships across Scotland. The national indicators will be updated and reported within A&B HSCP’s Integrated Performance Management Framework to provide the national performance position alongside the local service Key Performance Indicators suite. Page 202
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11 Classification: OFFICIAL The latest data in relation to 26 HWBOI and MSG Indicators reports 50% on track, with 13 on track and 13 off track. An overview of A&B HSCP’s latest performance against the 26 measures is reported in Appendix 1. It should be noted that reporting periods vary across the suite of national indicator measures, with some measures reported quarterly affected by national reporting data lag. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The monitoring and reporting against Key Performance Indicators using the Integrated Performance Management Framework and Dashboard ensures the HSCP can deliver against key strategic priorities. This in-turn is aligned with the Strategic Plan and key objectives. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact Financial performance is evidenced within the IPMF Dashboard ensuring best value as well as evidencing the impact and performance against organisational budget savings. 6.2 Staff Governance Key performance indicators within the IPMF ensure that staff governance requirements continue to be progressed and developed include health and safety, wellbeing and new service redesign and working practices. 6.3 Care and Clinical Governance Clinical Governance and patient safety remain at the core of prioritised service delivery against the new IPMF Dashboard and National Health & Wellbeing Outcomes Indicators. The new governance structure supporting the IPMF ensures that the Clinical & Care Governance Committee remain central to performance improvement. The development of the IPMF is focussed on moving away from previous traditional styles of reporting to a fully collaborative approach with Head of Service and Service Lead commentary. 7. PROFESSIONAL ADVISORY Data used within the performance dashboard is fully accessible in SharePoint with data trends and forecasting are identified to give wider strategic context. This provides the HSCP professional advisors with self –service performance information to inform their role in maintaining professional standards and outcomes. 8. EQUALITY & DIVERSITY IMPLICATIONS The Integrated Performance Management Framework captures relevant indicators used to inform the HSCP E&D work. Page 203
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12 Classification: OFFICIAL 8.1 PROTECTED CHARACTERISTICS Performance detailed within this report acknowledges the rights of the Child (UNCRC), Islands. Fairer Scotland, Socio-economic Duty, Equalities - protected characteristics. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Data use and sharing within this report and IPMF performance dashboard is covered within the Argyll and Bute Council & NHS Highland Data Sharing Agreement 10. RISK ASSESSMENT Risks and mitigations associated with performance data sources and reporting are managed and identified within the monthly Performance & Improvement Team- Work Plan. 10.1 STRATEGIC, OPERATIONAL OR CLIMATE RISK Performance reports are used by operational management to identify service delivery risk and to inform mitigation action accordingly. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Performance reporting is available for the public via Argyll and Bute Council and NHS Highland websites. The IPMF dashboard utilises SharePoint to support manager and staff access across the HSCP. 12. CONCLUSION The Integration Joint Board is asked to consider and acknowledge FQ2 2024/25 (July - September) performance as detailed in the IPMF Dashboard. The Board should also note that the 2025-26 review of KPI’s has commenced. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) Page 204
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13 Classification: OFFICIAL REPORT AUTHOR AND CONTACT Author Name: Douglas Hunter- Senior Manager Performance & Improvement Email: douglas.hunter@argyll-bute.gov.uk Page 205
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14 Classification: OFFICIAL Appendix 1 – HWBOI & MSG Integration Indicators. Core Suite of Integration Indicators Data notes 67% (6 of 9) HWBOI Outcomes measures reporting as above the national Scotland Rate. It is worth noting that performance will be influenced and vary in line with the total number of respondents participating in this voluntary survey. As such, caution should be noted with regards to previous comparison and trends Page 206
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15 Classification: OFFICIAL HWBOI - Performance Data notes 55.5% (5 of 9) HWBOI Performance measures reporting as above the national Scotland Rate. *Indicators 12, 13, 14, 15, 16, 18 Calendar year 2023 is used here as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. This is in line with guidance issued by Public Health Scotland which was communicated to all Health and Social Care Partnerships. Using more complete calendar year data for 2023 should improve the consistency of reporting between Health and Social Care Partnerships. Page 207
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16 Classification: OFFICIAL Ministerial Steering Group Integration Indicators Data notes 25% (2of 8) MSG Indicators reporting as above the national Scotland rate. MSG Indicators data notes that all MSG measures have increased in the last reporting year. Activity around Emergency Admissions, Unplanned Bed Days, A&E attendances and Delayed Discharge Bed Days all noted performance exceeding pre –Covid levels. This highlights the necessity to consider approaches to alleviate systems pressures around Urgent and Unscheduled Care and expedite hospital flow. Page 208
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17 Classification: OFFICIAL Appendix 2 - Delayed Discharge Sitrep – 6th January 2025 Page 209
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1 Classification: OFFICIAL Integration Joint Board Date of Meeting: 26 March 2025 Title of Report: Update – Renewal of the Joint Strategic Plan Presented by: Charlotte Craig, Interim Head of Strategic Planning, Performance and Technology The Board is asked to: ▪ Note the updated timeline for the renewal of the Joint Strategic Plan 1. EXECUTIVE SUMMARY As noted in the previous update In November 2024 to the Integration Joint Board, The Public Bodies (Joint Working) (Scotland) Act 2014 places a duty on Integration Joint Boards to develop a Joint Strategic Plan for integrated functions and budgets that they control, reviewing the plan at least every three years. The JSP is a high level strategy which sets out the vision, strategic objectives and priorities. The JSP is linked with the Joint Strategic Commissioning Strategy (JSCP) which sets out priorities for commissioning and market messages for providers. The development of the JSP and JSCP is overseen by the Strategic Planning Group (SPG). The new JSP will include the JSCP; there will be one combined document for the upcoming planning cycle. The Joint Strategic Needs Assessment which informs the plan is complete. In November the IJB was presented with draft priorities with a view to that addressing the health and social care requirement of the population of Argyll & Bute for the next five years, extending the planning period. Extensive work has been undertaken by teams so far however leadership has reflected on the changing policy environment potentially increased risk and financial pressures. Regular reporting of the annual priorities (year 3) is due to take place to the IJB in May 2025. It is proposed that at this point we review and extend the plan with a focus on outstanding priorities until the new plan is in place. This approach would aim to provide the Integration Joint Board with a greater level of assurance that the final plan has considered the transformational requirement and taken cognisance of both operational and strategic risk. We are also cognisant of our requirement to look outward in respect of our wider partnership including stakeholder communities, be explicit in our commissioning intentions and how we develop this to address our strategic risks and support sustainable service provision. Page 211 Agenda Item 12
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2 Classification: OFFICIAL 2. RECOMMENDATIONS The Integration Joint Board is asked to note the delayed timeline of the renewed Joint Strategic Plan and note the contingent action in place to progress this including an updated project plan to the Strategic Planning Group. 3. DETAIL OF REPORT Significant work has already been undertaken by teams with accompanying oversight through the IJB governance (see draft priorities in appendix 1). Given the increasing contraction of the public sector, shifting national policy and ongoing identified strategic risk, some reflection and review has been undertaken. To allow this review of the strategic direction the IJB is asked to support a short extension to the current plan based on the review of the year three priorities in May 2025. We would seek to extend pertinent activity based on the review within the current strategic framework delivering the first draft of the renewed strategy in September 2025 for consultation approval. Following consultation we will return to the IJB with finalised plan by March 2026. Senior Leadership Team would seek to draw together multiple strategic areas to respond to the increasing challenge e.g. workforce, islands, place and review this in the wider policy environment. We will look outward identifying what we need from wider partners to underpin our strategic approach to meeting the forecast need with a focus on developing services as they are to modern rural services delivered by rural practitioners with a focus on sustainability and flexibility. We will communicate an integrated vision working with partners to support community wealth and resilience in our changing environment. We will identify what services are not currently sustainable in their current model and look at other delivery options. We will deliver services differently that meet need, sustainably with opportunities for those who live and work in Argyll & Bute with a focus on developing the key skills that we need to support a culture of prevention and create a resilient, health aware population. We will sustain access to specialist services. We will ensure that you get the right service at the right time ensuring that we have a focus on the most vulnerable in our community with the aim of meeting care and therapeutic needs. We will develop supporting operational planning to deliver our strategy ensuring that we monitor performance and support continuous improvement. Safe quality care will be our driver however we will design our services to be delivered within available resource ensuring we make best use of partnership shared resource. We will participate as a key local partner providing a key building block of health and care services to support people to live and work well in Argyll & Bute. It is important that the new strategic plan and its priorities are realistic, align with staffing and financial resources and enable honest and transparent engagement with the communities we serve. This will take some additional time to create the JSP and ensure that it is written in accessible language. Page 212
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3 Classification: OFFICIAL 4. RELEVANT DATA AND INDICATORS • Joint Strategic Needs Assessment. • Data and indicators from the Integrated Performance Framework • Financial Data: Analysis of budgets and actual expenditure; procurement information. • Service data. • User experience and provider feedback. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The plan sets out the Strategic Priorities of the Integration Joint Board which will inform the operational delivery of the delegated services. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – Financial planning remains challenging within an annual budgetary allocation. With a focus on sustainable service as a draft priority the Strategy will require to plan for a period beyond its lifetime. 6.2 Staff Governance – Workforce remains a strategic risk and a risk to the delivery of the plan. The Joint Workforce Strategy should align with long term joint planning so requires to look outwards to place and partners. 6.3 Clinical and Care Governance – Safe delivery of care is essential. We will work with communities and partners to support modernisation of care consistent with wider policies of reform, sustain access to services and develop innovative rural roles and practice. 7. PROFESSIONAL ADVISORY The senior leadership has met specifically to jointly address the required strategic direction using the identified data and noting the strategic and operational risk to sustainable delivery. 8. EQUALITY & DIVERSITY IMPLICATIONS The Strategic Plan will be subject to rigorous review to ensure it meets the highest standards. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE No current impact on GDPR however wider partnership may impact data sharing agreements. 9. RISK ASSESSMENT There is substantial risk to the sustainability of the delivery of health and social care services in the strategic and operational risk environment without addressing changing demographics, their needs and workforce. Embedding rural flexibility in our planning approach will be key to delivering sustainable services in rural and island communities and preserving access to services. Page 213
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4 Classification: OFFICIAL 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT The Integration Joint Board is developing its approach to collaborating with communities undertaking an asset based approach which is key to sustaining population and resilient communities. We will embed this approach in our engagement and consultation ensuring this is in line with national guidance. 11. CONCLUSIONS The Integration Joint Board is asked to note the extended timeline to September 2025 on the basis of ensuring the longevity of the Joint Strategic Plan and supporting the plan as an active document over a proposed 5 year period. 12. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 13. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) N/A REPORT AUTHOR AND CONTACT Author Name Charlotte Craig Email charlotte.craig@argyll-bute.gov.uk Page 214
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5 Classification: OFFICIAL Appendix 1 Draft strategic priorities and drivers Living Well, Prevention, Early Intervention and Enablement: We will prioritise activity, interventions and services that: • Reduce the need for people having to access statutory/formal services in the first place. • Support people before their needs become more pronounced and require more complex intervention. • Support people to stay in their homes for longer or return home following treatment and continue to look after themselves as much as possible. Addressing inequalities and protecting the most vulnerable: We may not be able to continue to provide the range of activities, interventions and services that we currently do. When we must change how we provide certain services, we will assess the impact on the most vulnerable people and work with our partners to mitigate any potential negative effect. We may also have to choose between providing services directed at the general population and more targeted services in accordance with where there is the greatest need. Most health and social care services are aimed at all social groups despite differences in need but are often disproportionately used by people whose needs are lower. People and communities with the greatest health and social care needs often experience poorer access to support. Healthy and Engaged Workforce: Our workforce is our greatest asset and resource. If we are not able to attract and retain the right people, none of our priorities will be achievable. Ensuring service sustainability: This priority covers both financial sustainability and responding to the climate emergency. Some of our services in their current form are not sustainable overall for a number of reasons such as: workforce issues, increasing demand, and cost pressures. Individual services will need to develop more efficient delivery models ensuring they make best use of our resources. Quality and Safety: The HSCP needs to ensure that our services continue to operate safely and provide high quality interventions. We will review our quality systems and ensure we have robust quality improvement and clinical governance structures in place. A focus on quality will also entail that we assess our services in terms of impact and effectiveness. The practice of realistic health and social care means that we need to direct resources away from interventions and services for which there is not good evidence that they are effective. Drivers Values: We commit to our organisational values: Compassion, Integrity, Excellence, Leadership and Continuous Learning. Collaboration: Partnership working is central to improving our services. Key partners we will work with to plan and deliver our services include: • People with lived experience and local communities (individuals and community organisations and groups) • Voluntary/third sector organisations and service providers Page 215
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6 Classification: OFFICIAL • Independent sector service providers • colleagues from the Council (education, transport, economic development and housing) We also know there is more work to be done internally in terms of applying a system-wide approach and integrating social work, social care and health services workflows. Intelligence and Innovation: Many, if not all, of our services have evolved organically and over time, often without an evidence base. How we deliver our services has not always kept pace with patient need and other developments such technological change. In addition, there is not the workforce to continue some of the service models that we have currently in place. We will need to develop and implement new ways of working and collaborating across professional and locality boundaries. We will make decisions based on evidence and data. We will also use new systems and technology where appropriate to improve how we deliver services. Transformation Board: Our Transformation Board will oversee our large service change projects. It will set the priority projects for each year and ensure the HSCP understands the progress that is being made. Individual Service Plans and Commissioning Priorities: All services will have operational plans which will outline how each area plans to address the overall strategic priorities of the HSCP. Page 216